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INFLUENZA.
159 its occurrence in the College appears to he anterior t() 1a the past I two cases outside the College grounds. have seen septic throats going on to diphtheria occur over and over again among the boys when no trace cf the disease, could be found among the residents outside the College boundaries. My twenty-four years’ experience at SIR ANDREW CLARK will resume his instructions in College taught me that the boys conveyed infections illnessClinical Medicine at the London Hospital on Tuesday, to the residents around rather than the reverse. Dr. 19th inst., at 2 o’clock. Bristowe states that he cannot fix the date of the occurrenceof the first case at the College ; but if he will go into dates accurately he will find, I think, that the boys were infected before any case whatever occurred among the residents disWELLINGTON COLLEGE SORE-THROAT. connected with the College. The Notification Act is im BY J. G. BARFORD. operation in the district, and definite information available for Dr. Bristowe. If he will go carefully into the DURING the twenty-four years I acted as medical officer notes, and especially the temperature charts, of each caseadmitted into the sanatorium during the term, he will to Wellington College I had numerous opportunities of have no difficulty in fixing the date of the first case in watching the progress of epidemic diseases as they affect which the specitic virus displayed itself. Anyhow, by schoolboys and the particular form of sore- tliroat occurring this method I have in the past found no difficulty in fixing; from time to time at Wellington College, which has puzzled approximately the date of the first occurrence of septicthe best physicians and surgeons of the latter half of the sore-throat in the form it presents at Wellington College, which in the first instance does not present definite signs of nineteenth century, from London and elsewhere, whom it for the diphtheria is engrafted on to septic diphtheria, was my privilege to meet and cooperate with from the first throats as a secondary disease. A comparison of this approxiyear of the opening of the College in 1859 to the end of mate date with the date of the case first notified from 1883. But at no period of these twenty-four years does it the village would settle the point which Dr. Bristowe’s In his book he admits theappear that the boys have suffered in such numbers, nor, report leaves so obscure. elevation of temperature as a marked feature at the onset apparently from Dr. Bristowe’s report, more severely of this disease, and I find from the comparison of 100 than they have during the third term of the past uniform. year. The admission of 244 boys into the sanatorium, charts that the temperature at the onset is very Here there is reliable data for comparison, of which as stated in the report-that is, more than half of the school-is an occurrence, I believe, unprecedented he does not appear to have availed himaelf. The report in the history of the College. When it is remembered that leaves Wellington College uncertain as to the origin of a the boys did not reassemble till the latter half of September disease, and would teach that whenever the rainfall is in and were dispersed at the beginning of December, the actual excess of an average, the inmates of Wellington College period of residence amounted only to ten weeks, making an may have again to seek a home elsewhere. (To be continued.) average admission into the sanatorium of from twenty-tour to twenty-five a week. The governors of the College express their satisfaction that, in the opinion of Dr. Bristowe, " the recent outbreak of illness cannot be attributed to defective INFLUENZA. drainage or water-supply, but rather to the almost unprece-
THE death has been announced of M. de Quatrefages, the eminent ethnologist, aged eighty-two. He was author of "Crania Ethnica," and the standard work "Études des Races Humaines."
Wellington,
dented rainfall." The chief importance of this sentence turns on the "almost," for it is a candid admission that there have been previous heavy rainfalls, but on these occasions the heavy rainfall has not been productive of the same illness or fatality among the boys. Three deaths in one year from diseases or their complications believed to be preventable, and which cannot be referred, according to Dr. Bristowe, to defective drainage or water-supply, are probably unpre. cedented in the history of our public schools. Is it possible that more or less rainfall can make this differc-nee ? I would ask, Can Dr. Bristowe be in earnest in leading the governors to entertain such an idea? Dr. Brietowe states in his book on "The Theory and Practice of Medicine" that "diphtheria is a disease of all countries and all seasons" (heavy rainfall or not), and that "there is reason to believe that the sanitary state of houses or localities, and the condition of health of those who are exposed to its poison, have much influence over its development." How can Dr. Bristowe reconcile the teaching in his book with the opinion he has expressed to the governors of Wellington College? I have read the article on Diphtheria in Dr. Bristowe’s book (1884 edition), and cannot find a syllable on the influence of rainfall in the production of diphtheria. It is evident that Dr. Bristowe has attached no importance to rainfall in the past; or, as a lecturer on medicine and the author of a book on the "Theory and Practice of Medicine," he would have made some reference to it before. I appears to me most unfortunate for the reputation of Wellington College that Dr. Bristowe can find nothing further than this to explain the outbreak. Does the poison or germ which sets up diphtheria, in
Dr. Bristowe’s judgment, come down from the clouds with the rain to Wellington College ? or is it that he would have us believe that the rainfall has some peculiar disturbing influence on the soil at Wellington College, creating it thereby into a cultivating medium for the poison which has recently presented itself in so virulent a form ? Dr. Bristowe seems to me to be on the horns of a dilemma, and has to admit one or the other cause. Any theory he may have of the possible introduction of the disease from the villagewithout is shaken by the fact that
SELDOM in the records of previous pandemics of influenza. has a third annual recurrence of this remarkable disorderexhibited such virulence as at the present time. Indeed, previous experience has mostly been to show that after the first outbreak the malady may recur in a more or less sporadic manner, and then disappear almost entirely. But. there is no question now that the recurrence of this winter, which commenced in this country in Cornwall and in Scotland. has equalled in severity the first outbreak of the winter of 1889-90, as well as in the extraordinary diffusion of the disease which has taken place during the past fortnight. So. widf spread has this extension been that it is difficult and bewildering to follow its course from day to day, so as to. give any coherent account of the progress of the pandemicwave.
There is no question that the influenza has once more For weeks a marked foothold in the metropolis. past, it is true, the Registrar-General’s returns have given a certain number of deaths directly attributed to the disease, but last week this number rose remarkably, reaching 95, as compared with 37in the preceding week, and 19 in the one before that. Medical practitioners are again overburdened with engagements, and nursing institutions In Kensington are being taxed far beyond their resources. an outbreak has occurred in the infirmary, just as last week at the Fulham Infirmary, and the disease is very prevalent. in the neighbourhood. In the southern and western suburbs it is also rapidly extending, especially in Hounslow, Isleworth, and Ealing. Cases have occurred in the Hampstead Workhouse, and in the Chelsea and Wellington Barracks. The General Post Oilice departments, which suffered so severely two years ago, are again crippled by the sickness. The general mortality of London for the past week was32-8 per 1000, which is about the average for the past three weeks, the deaths referred to diseases of the respiratory organs amounting to 1084, or 455 in excess of theaverage. In the home counties influenza is still very prevalent. It continues to spread in Berkshire and in Bucks; in Surrey it still persists in Chertsey and Walton; in Herts iti is very
gained
160 prevalent in Watford, and most severe in Kent and Essex. in New York, Boston, and Philadelphia; has prevailed, but 1n these latter counties the outbreak seems to be especially not with its former severity, in Chicago ; and is especially
Canterbury has suffered more than on the two previous occasions; and the agricultural as well as the urban communities in that district, and in and around Maidstone and Ashford, are also widely attacked. It prevails, further, in Chatham and Rochester, and still exists in Dover, Walmer, and other parts of the coast. In Essex it is generally prevalent, the villages on the coast suffering especially, but the epidemic has caused many deaths in Chelmsford, Colchester, Halstead, and other places. In the southern counties, Sussex and Hampshire, especially Porchester, Portsmouth, and Southampton, have suffered severely ; whilst in Dorset the outbreak has been attended with great fatality. In Norfolk the epidemic has appeared at Norwich, King’s Lynn, and many of the country districts; in Suffolk, at Lowestofand Bury St. E imunds, where the mortality has been very high. It is very prevalent in Cambs and Hunts, and in Northamptonshire, especially around Peterborough. At Leicester we are informed by Dr. Tomkins, the medical officer of health, that "for more than three weeks scattered cases of influenza have occurred, but only during the last week has it become at all prevalent, and at present the epidemic has not spread to anything like the extent of last year, nor is the type of so severe a character. Only one death has hitherto been reported." This mildness of type, which unfortunately has not been the case generally, is also noted in the outbreak at Birmingham and in South Lincolnvirulent.
rife at St. Louis, Kansas City, and Memphis In Canada the type of the outbreak, which is now subsiding, has been ’ mostly mild. ___________
MEDICAL DEFENCE
UNION, LIMITED.
THE Secretary of the Union sends us for publication the following report:A representative and well-attended meeting of the
members of the Medical Defence Union was held at the registered offices of the company on Jan. 7th, for the purpose of confirming a resolution altering some of the articles of association. Mr. Lawson Tait presided, and in moving the confirmatory resolution explained that the proposed alterations, unanimously decided upon by the members on Dec. 15bh last after much deliberation, had been improperly described as a reconstruction of the company. They were nothing of the sort, but simply an example of an every-day occurrence of a company finding ib desirable to alter some of its working rules, and doing so.-Dr. H. Woods opposed the resolution, and urged that the first meeting was technically illegal. In a short but censorious speech he reflected generally upon the President and Council, who, he said, sought to alter the shire. articles in such a way as would enable them, if they thought In Worcestershire cases are very numerous at Kidder- fit, to decline to defend anyone but themselves and their minster and its vicinity ; in Staffordshire, at Tipton (chiefly friends ; be referred particularly to the proposals as to among children) and Stafford and neighbourhood. Further election of the Council.-Dr. Saundby regretted that Dr. north we find that the outbreak-which a month back was Woods saw things in a false light and in a way that the so prevalent in Newcastle-is now spreading through Yorkvast majority of his professional brethren did not and could shire, especially around Richmond, Darlington, and Leeds ; not view them. The course Dr. Woods was adopting in and it has appeared in Lancashire at Bolton and Liverpool. the present instance was on a par with that which be had lln Cheshire there is much sickness; and in Mold, in Flint- taken in connexion with the affairs of the British Medical Association and in other matters. It was an shire, and other parts of North Wales. The epidemic is subsiding in the towns and villages of unfortunate attitude of mind which led him to impute South Wales-as at Cardiff, Aberdare, Carmarthen, mala fides to his colleagues on the simplest matter, and, Tredegar, and Abergavenny, but it still prevails in Mon- after making unfounded assumptions against his promouth. It has appeared in Bath, and still exists in an fessional brethren, to proceed to build up a casuistical super. aggravated form in Somerset, Wilts, and Devon. Thus itstructure thereon, -Mr. Lawson Tait, in reply, referring to the will be seen that the disease prevails over the greater part technical objection, pointed out that Dr. Woods had already - of the country. been informed that the Court of Appeal, in a similar case, From Scotland it has ,praetically disappeared. In Irelandhad ] decided the very-point that Dr. Woods had laised, and it prevails at Limerick, Fermoy, and Baltimore. Of the(decided it exactly opposite to his contention. The present Channel Islands, Guernsey has been the most seriously proceedings were quite in order. The members of the Union attacked. perfectly well understood Dr. Woods ; and that they were The accounts furnished from the Continent show that capable of managing their own affairs in their best interests influenza is still raging in many parts, and, indeed, in some was shown by the fact that, while two proxies only had been towns-e.g., Hamburg-it has reappeared after a month’s lodged in favour of Dr. Woods, more than 900 had been abeyance. In France it prevails in all parts, from the Pas lodged in favour of the proposed changes. de Calais in the North, where it is extremely severe, to The resolution was then put and passed, Dr. Woods alone Marseilles and the Riviera in the South, where its type dissenting. ’seems to be milder. In Paris it continues to spread ; at Montpellier it is largely on the increase. In Germany the epidemic has been present for several weeks at ’Berlin, where it is now on the decline, but where it has attacked the horses. At Munich it has only recently broken out, and is spreading rapidly. Of other cities where it has prevailed or is still occurring may be menLOCAL GOVERNMENT DEPARTMENT. tioned Kiel, Breslau, Dresden, Magdeburg, Brunswick, Stettin, and Cologne. In Denmark the outbreak has REPORTS OF MEDICAL OFFICERS OF HEALTH. ’’been especially severe ; at Copenhagen itself the number of cases has been enormous, and the attacks have been Nottingham Urban District.-Dr. Boobbyer’s report characterised by great suddenness of onset In Belgium it is comes late, but the cause is one that will be appreciated, It is practically a "very general, being severe at Brussels and Luxemburg, and and especially in his own districb. seriously interfering with trade at Mechlin and Ghent. It is second edition, in which he has utilised the returns of last still causing great mortality in the lunatic colony of Gheel. year’s census, and has thus dealt with the large statistical in Austro-Hungary it still exists in Vienna, and at Pesth discrepancies which those returns divulged. The Registrarit seems to be unusually virulent. In Italy, where it has General’s estimate of the population of Nottingham turned hitherto chiefly attacked the northern cities, it is spread- out, in fact, to be no less than 40,233 in excess of the actual ing in Florence, Venice, and Rome, and is getting much figures given by the census, and this accounts for a deathIt has reached Turkey and Greece, for rate of 1 ’5 per 1000 higher than that which the estimated worse in Naples. many cases have occurred at Constantinople and Athens. returns indicated ; the real corrected rate for 1890 being 19’2 At Malta the Mediterranean Squadron has suffered severely per 1000 living. The zymotic rate was low as compared from its effects. It has ceased to occur at Gibraltar, but with that for the large towns, being 1’8 per 1000, and prevails in many parts of Spain and Portugal, where, how- it is reported that the new hospital at Bagthorpe, erected by the corporation, is now completed. Daring 1890, the notified ever, it is on the decline. Across the Atlantic influenza is at present widely cases of disease included 984 of scarlet fever, 348 of enteric ,diffused over the United States, both in the north and fever, and 64 of diphtheria ; and it is a somewhat remarksouth. It spread rapidly at the opening of the New Year j able fact that, in the case of scarlet fever, the percentage
Public Health
and
Poor Law.
(
THE death has been announced of M. de Quatrefages, the eminent ethnologist, aged eighty-two. He was author of "Crania Ethnica," and the standard work "Études des Races Humaines."
Wellington,
dented rainfall." The chief importance of this sentence turns on the "almost," for it is a candid admission that there have been previous heavy rainfalls, but on these occasions the heavy rainfall has not been productive of the same illness or fatality among the boys. Three deaths in one year from diseases or their complications believed to be preventable, and which cannot be referred, according to Dr. Bristowe, to defective drainage or water-supply, are probably unpre. cedented in the history of our public schools. Is it possible that more or less rainfall can make this differc-nee ? I would ask, Can Dr. Bristowe be in earnest in leading the governors to entertain such an idea? Dr. Brietowe states in his book on "The Theory and Practice of Medicine" that "diphtheria is a disease of all countries and all seasons" (heavy rainfall or not), and that "there is reason to believe that the sanitary state of houses or localities, and the condition of health of those who are exposed to its poison, have much influence over its development." How can Dr. Bristowe reconcile the teaching in his book with the opinion he has expressed to the governors of Wellington College? I have read the article on Diphtheria in Dr. Bristowe’s book (1884 edition), and cannot find a syllable on the influence of rainfall in the production of diphtheria. It is evident that Dr. Bristowe has attached no importance to rainfall in the past; or, as a lecturer on medicine and the author of a book on the "Theory and Practice of Medicine," he would have made some reference to it before. I appears to me most unfortunate for the reputation of Wellington College that Dr. Bristowe can find nothing further than this to explain the outbreak. Does the poison or germ which sets up diphtheria, in
Dr. Bristowe’s judgment, come down from the clouds with the rain to Wellington College ? or is it that he would have us believe that the rainfall has some peculiar disturbing influence on the soil at Wellington College, creating it thereby into a cultivating medium for the poison which has recently presented itself in so virulent a form ? Dr. Bristowe seems to me to be on the horns of a dilemma, and has to admit one or the other cause. Any theory he may have of the possible introduction of the disease from the villagewithout is shaken by the fact that
SELDOM in the records of previous pandemics of influenza. has a third annual recurrence of this remarkable disorderexhibited such virulence as at the present time. Indeed, previous experience has mostly been to show that after the first outbreak the malady may recur in a more or less sporadic manner, and then disappear almost entirely. But. there is no question now that the recurrence of this winter, which commenced in this country in Cornwall and in Scotland. has equalled in severity the first outbreak of the winter of 1889-90, as well as in the extraordinary diffusion of the disease which has taken place during the past fortnight. So. widf spread has this extension been that it is difficult and bewildering to follow its course from day to day, so as to. give any coherent account of the progress of the pandemicwave.
There is no question that the influenza has once more For weeks a marked foothold in the metropolis. past, it is true, the Registrar-General’s returns have given a certain number of deaths directly attributed to the disease, but last week this number rose remarkably, reaching 95, as compared with 37in the preceding week, and 19 in the one before that. Medical practitioners are again overburdened with engagements, and nursing institutions In Kensington are being taxed far beyond their resources. an outbreak has occurred in the infirmary, just as last week at the Fulham Infirmary, and the disease is very prevalent. in the neighbourhood. In the southern and western suburbs it is also rapidly extending, especially in Hounslow, Isleworth, and Ealing. Cases have occurred in the Hampstead Workhouse, and in the Chelsea and Wellington Barracks. The General Post Oilice departments, which suffered so severely two years ago, are again crippled by the sickness. The general mortality of London for the past week was32-8 per 1000, which is about the average for the past three weeks, the deaths referred to diseases of the respiratory organs amounting to 1084, or 455 in excess of theaverage. In the home counties influenza is still very prevalent. It continues to spread in Berkshire and in Bucks; in Surrey it still persists in Chertsey and Walton; in Herts iti is very
gained
160 prevalent in Watford, and most severe in Kent and Essex. in New York, Boston, and Philadelphia; has prevailed, but 1n these latter counties the outbreak seems to be especially not with its former severity, in Chicago ; and is especially
Canterbury has suffered more than on the two previous occasions; and the agricultural as well as the urban communities in that district, and in and around Maidstone and Ashford, are also widely attacked. It prevails, further, in Chatham and Rochester, and still exists in Dover, Walmer, and other parts of the coast. In Essex it is generally prevalent, the villages on the coast suffering especially, but the epidemic has caused many deaths in Chelmsford, Colchester, Halstead, and other places. In the southern counties, Sussex and Hampshire, especially Porchester, Portsmouth, and Southampton, have suffered severely ; whilst in Dorset the outbreak has been attended with great fatality. In Norfolk the epidemic has appeared at Norwich, King’s Lynn, and many of the country districts; in Suffolk, at Lowestofand Bury St. E imunds, where the mortality has been very high. It is very prevalent in Cambs and Hunts, and in Northamptonshire, especially around Peterborough. At Leicester we are informed by Dr. Tomkins, the medical officer of health, that "for more than three weeks scattered cases of influenza have occurred, but only during the last week has it become at all prevalent, and at present the epidemic has not spread to anything like the extent of last year, nor is the type of so severe a character. Only one death has hitherto been reported." This mildness of type, which unfortunately has not been the case generally, is also noted in the outbreak at Birmingham and in South Lincolnvirulent.
rife at St. Louis, Kansas City, and Memphis In Canada the type of the outbreak, which is now subsiding, has been ’ mostly mild. ___________
MEDICAL DEFENCE
UNION, LIMITED.
THE Secretary of the Union sends us for publication the following report:A representative and well-attended meeting of the
members of the Medical Defence Union was held at the registered offices of the company on Jan. 7th, for the purpose of confirming a resolution altering some of the articles of association. Mr. Lawson Tait presided, and in moving the confirmatory resolution explained that the proposed alterations, unanimously decided upon by the members on Dec. 15bh last after much deliberation, had been improperly described as a reconstruction of the company. They were nothing of the sort, but simply an example of an every-day occurrence of a company finding ib desirable to alter some of its working rules, and doing so.-Dr. H. Woods opposed the resolution, and urged that the first meeting was technically illegal. In a short but censorious speech he reflected generally upon the President and Council, who, he said, sought to alter the shire. articles in such a way as would enable them, if they thought In Worcestershire cases are very numerous at Kidder- fit, to decline to defend anyone but themselves and their minster and its vicinity ; in Staffordshire, at Tipton (chiefly friends ; be referred particularly to the proposals as to among children) and Stafford and neighbourhood. Further election of the Council.-Dr. Saundby regretted that Dr. north we find that the outbreak-which a month back was Woods saw things in a false light and in a way that the so prevalent in Newcastle-is now spreading through Yorkvast majority of his professional brethren did not and could shire, especially around Richmond, Darlington, and Leeds ; not view them. The course Dr. Woods was adopting in and it has appeared in Lancashire at Bolton and Liverpool. the present instance was on a par with that which be had lln Cheshire there is much sickness; and in Mold, in Flint- taken in connexion with the affairs of the British Medical Association and in other matters. It was an shire, and other parts of North Wales. The epidemic is subsiding in the towns and villages of unfortunate attitude of mind which led him to impute South Wales-as at Cardiff, Aberdare, Carmarthen, mala fides to his colleagues on the simplest matter, and, Tredegar, and Abergavenny, but it still prevails in Mon- after making unfounded assumptions against his promouth. It has appeared in Bath, and still exists in an fessional brethren, to proceed to build up a casuistical super. aggravated form in Somerset, Wilts, and Devon. Thus itstructure thereon, -Mr. Lawson Tait, in reply, referring to the will be seen that the disease prevails over the greater part technical objection, pointed out that Dr. Woods had already - of the country. been informed that the Court of Appeal, in a similar case, From Scotland it has ,praetically disappeared. In Irelandhad ] decided the very-point that Dr. Woods had laised, and it prevails at Limerick, Fermoy, and Baltimore. Of the(decided it exactly opposite to his contention. The present Channel Islands, Guernsey has been the most seriously proceedings were quite in order. The members of the Union attacked. perfectly well understood Dr. Woods ; and that they were The accounts furnished from the Continent show that capable of managing their own affairs in their best interests influenza is still raging in many parts, and, indeed, in some was shown by the fact that, while two proxies only had been towns-e.g., Hamburg-it has reappeared after a month’s lodged in favour of Dr. Woods, more than 900 had been abeyance. In France it prevails in all parts, from the Pas lodged in favour of the proposed changes. de Calais in the North, where it is extremely severe, to The resolution was then put and passed, Dr. Woods alone Marseilles and the Riviera in the South, where its type dissenting. ’seems to be milder. In Paris it continues to spread ; at Montpellier it is largely on the increase. In Germany the epidemic has been present for several weeks at ’Berlin, where it is now on the decline, but where it has attacked the horses. At Munich it has only recently broken out, and is spreading rapidly. Of other cities where it has prevailed or is still occurring may be menLOCAL GOVERNMENT DEPARTMENT. tioned Kiel, Breslau, Dresden, Magdeburg, Brunswick, Stettin, and Cologne. In Denmark the outbreak has REPORTS OF MEDICAL OFFICERS OF HEALTH. ’’been especially severe ; at Copenhagen itself the number of cases has been enormous, and the attacks have been Nottingham Urban District.-Dr. Boobbyer’s report characterised by great suddenness of onset In Belgium it is comes late, but the cause is one that will be appreciated, It is practically a "very general, being severe at Brussels and Luxemburg, and and especially in his own districb. seriously interfering with trade at Mechlin and Ghent. It is second edition, in which he has utilised the returns of last still causing great mortality in the lunatic colony of Gheel. year’s census, and has thus dealt with the large statistical in Austro-Hungary it still exists in Vienna, and at Pesth discrepancies which those returns divulged. The Registrarit seems to be unusually virulent. In Italy, where it has General’s estimate of the population of Nottingham turned hitherto chiefly attacked the northern cities, it is spread- out, in fact, to be no less than 40,233 in excess of the actual ing in Florence, Venice, and Rome, and is getting much figures given by the census, and this accounts for a deathIt has reached Turkey and Greece, for rate of 1 ’5 per 1000 higher than that which the estimated worse in Naples. many cases have occurred at Constantinople and Athens. returns indicated ; the real corrected rate for 1890 being 19’2 At Malta the Mediterranean Squadron has suffered severely per 1000 living. The zymotic rate was low as compared from its effects. It has ceased to occur at Gibraltar, but with that for the large towns, being 1’8 per 1000, and prevails in many parts of Spain and Portugal, where, how- it is reported that the new hospital at Bagthorpe, erected by the corporation, is now completed. Daring 1890, the notified ever, it is on the decline. Across the Atlantic influenza is at present widely cases of disease included 984 of scarlet fever, 348 of enteric ,diffused over the United States, both in the north and fever, and 64 of diphtheria ; and it is a somewhat remarksouth. It spread rapidly at the opening of the New Year j able fact that, in the case of scarlet fever, the percentage
Public Health
and
Poor Law.
(