LOCAL GOVERNMENT BOARD.

1106 and freedom from dirt. Such certificates are, it seems, If it is practicable to issued by a local medical society. devise a reasonable bacteriological standard for all times of the year there might be advantage in adopting this standard, but it appears to us that it should only be adopted under the very best expert advice and in no way associated with any company which has shareholders to consider. Probably the local sanitary authority might begin by adopting some standard of general cleanliness, any certificates issued being renewable annually. Plynipton St. Mary Rural District.-The council of this district possesses apparently the right to send one or more patients to the Didworthy sanatorium for consumption and the medical officer of health invited the Poor-law medical officers to send in the names of any patients who were thought suitable for the institution. It seems, however, that only one patient was discovered in a sufficiently early phase of the disease to be suitable for admission and he, after a short stay at the sanatorium, was discharged " relieved but not cured." Bor01lgh of Richmond.-Dr. J. H. Crocker, the medical officer of health of this borough, is also medical officer to the education committee, and in this latter capacity he reports that there has recently been amongst the school children a distinct improvement in the cleanliness of the bodies and clothing of the children. In addition to cases of infectious disease Dr. Crocker’s attention seems to have been called mainly to cases of suspected ringworm, of defective sight, and of vermin in the hair and on the body. Visits have been paid, in addition to the elementary schools, to the county school and to the girls’ high school. No actual treatment was undertaken by the medical officer of health but in cases where medical advice appeared desirable the patients were advised to procure it. Bor01lgh of WeY1no1lth and ff-relcombe Regis.-Mr. W. B. Barclay, the medical officer of health of this borough, LOCAL GOVERNMENT BOARD. has made an inspection of the cowsheds contained within its limits and has recorded his notes in the annual REPORTS OF MEDICAL OFFICERS OF HEALTH. report. They will, we hope, be read by all the councillors City of Bath.-The sanitary authority of this city has as also by others. Mr. Barclay does not, as is the case with subsidised beds at the Winsley Sanatorium for Consumption some medical officers of health, find all the cowsheds and during 1906 such beds were occupied by 15 patients. I I fairly satisfactory"but he shows by his notes that the The annual report of the sanatorium is, as regards the Bath majority of them are in an eminently undesirable state. As beds, a little difficult to interpret and to avoid misunderstand- he rightly observes, the cowman has a rooted objection to the ing the passage relative thereto is given verbatim. Of the use of water as also to cleansing the udders and teats of the 15 patients from Bath " five showed no signs of active cows before milking. He observed one cowman while in the disease on discharge and four were certainly fit for some act of milking the cows rub his hands at intervals on the work, whilst four showed marked improvement and were filthy sides of the animal," and in a manner so uncongaining ground on discharge, though there was no chance of sciously as to show that this was his habitual practice. return to work for some little while. Five cases showed no Speaking generally, Mr. Barclay says, " the condition of the improvement, though it is only fair to say that two of these rural cowsheds is most unsatisfactory." We should like to after leaving see all medical officers of health equally candid with regard cases were extremely advanced and died the sanatorium, while two others had serious complications to the cowsheds in their districts. We might then hope to see some reduction in our infantile mortality. on admission and were eventually advised to seek surgical Ashton in-Makerfield Urban -District. -Reference is make in aid." Apparently there had been great difficulty in securing the current annual report of Mr. Nathan Hannah, the medical we sanatorium for cases treatment, although gather early from an extract from the sanatorium report, which is officer of health of this district, to the damage done by furnished by Dr. W. H. Symons, the medical officer of subsidences caused by mining operations which by the wide health of Bath, that that city is now sending earlier cases cracks which are thereby caused in the walls of dwellings conduce to dampness and draughts as well as, occasionally, to than formerly. Woking Urban District.-During the summer of 1906 occa- the risks of the spread of infection from one house to another. sional discolouration of the water drawn from the taps in Mr. Hannah has also noticed smoke coming from one house to this district was noticed, and although it appears clear that another through these crevices. To those who live in nonthis was due to deposits of iron it is not stated whether such mining districts the havoc wrought by mining subsidences is deposits were caused by the traces of iron which are altogether unknown and in the coal country there is not contained in the water drawn from the well itself or sufficient attention paid to the matter. Where the miners’ whether it was caused by corrosion of the water mains. cottages belong to the mine owners the miners hesitate to There is no doubt that waters which contain iron at the complain and where the local sanitary authority is largely source are only freed from this metal with the greatest difficomposed of mine owners and mine agents, the sanitary culty, but it is nevertheless possible by suitable treatment inspector, who has been known to be also a rent collector, is materially to diminish the amount which is likely to reach the liable to overlook these matters. Nevertheless, the nuisance Dr. R. W. C. Pierce, the medical officer of health, is a very real one. consumer. has during 1906 paid special attention to the condition of Co2cnty Borough of Blccekb-urn.-Inquiries have systematicthe dairies, cowsheds, and milkshops in the district, and the ally been made in this borough since 1897 as to the methods recent report of the Royal Commission on Tuberculosis has of feeding infants, and Dr. Alfred Greenwood reports that in enormously accentuated the importance of action in this that year 63 per cent. of the children were fed at the breast As Dr. Pierce observes, there is, no doubt, need for alone. According to these observations the proportion of sense. considerable modification of the Model Regulations under the: breast-fed children has steadily decreased until in 1905 only Dairies, Cowsheds, and Milkshops Order. They are, as ati 38 per cent. were exclusively breast-fed. It would be useful present worded, very difficult to apply and there is too muchL to know whether the same officer has made the observations scope for differences of opinion. Something more precise isi during the whole period. If this is true, there is, as the necessary. Dr. Pierce refers to a plan which has, he states, medical officer of health observes, a contrast between this of affairs and that which obtains in Japan, where it is been adopted in New York, where certificates are issued toI that 99 per cent. of the infants are breast-fed. As dairymen if their milk reaches a certain standard of quality

disease was present in a very large number and alcoholic in 25 cases. 34 persons (21 males and 13 females) were discharged recovered during the year, and the proportion (per cent.) of recoveries to admissions (excluding transfers) was 39’ 62 for males, 29’ 54 for females, and 35 ’ 05 for the two sexes. During the year 19 patients were granted leave of absence on trial, and in selected cases of the rate-paid class a weekly allowance was made during the period of probation. This allowance is granted in accordance with Section 55 of the Lunacy Act. Forty-seven patients (23 males and 24 females) died during the year; the proportion (per cent.) of deaths to the daily average number resident was 9’ 09 for males, 7’ 64 for females, and 8’ 29 for the two sexes. General paralysis of the insane was the cause of death in 11 cases. The weekly charge for rate-paid patients, which had been 12s. 3d. since July lst, 1901, was reduced to lls. 8d. on Jan. lst, 1906, but the visiting committee states that " owing to the many expenses which have to be met and the general increase in the cost of many articles of daily use and consumption which fall upon this account [maintenance account] we do not anticipate that the reduction will be permanent." The farm account showed a profit on the year’s working of .S.598. Dr. Steen records with satisfaction that the committee has sanctioned for non-statutory purposes the use of the title " City of London Mental Hospital"in the place of the old title, "City of London Asylum." He reports that this concession has already called forth many expressions of gratitude both from the patients and their friends. excess

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regards the use of the long-tube bottle for artificial feeding r(respiratory organs, which had been 354 and 412 in the two previous weeks, declined again to 355 in the there has been, it seems, in Blackburn some improvement tl w under notice, but exceeded by 45 the corrected year by year. The average infantile mortality in Blackburn week since 1898 has ranged from 100 per 1000 births in the a average number in the corresponding week of the five lowest ward to 245 in the highest. Dr. Greenwood points years 1902-06. The 24 deaths referred to influenza somey w exceeded the corrected average. The causes of 42, or out that the fact of the registration of births being only what required before the child is six weeks old precludes the D0 .8 per cent., of the deaths registered during the week were n certified either by a registered medical practitioner or officer of the sanitary authority from taking any steps not during the first few weeks of life when the infantile bby a coroner. All the causes of death were duly certified i) Leeds, Bristol, West Ham, Bradford, Newcastle-on-Tyne, mortality is at the highest point and he advocates the adop- in a in 49 other of the 76 towns ; the proportion of untion of the system in vogue in Huddersfield by which notifica- and c tion of birth is required within two days. In addition to the certified deaths, however, again showed considerable excess i] Birmingham, South Shields, Sunderland, and Sheffield. usual precautions relative to the reduction of infantile mor- in tality a course of lectures is given to teachers in school hygiene and lessons are given to the older girls in the HEALTH OF SCOTCH TOWNS. feeding and care of infants at certain of the elementary The annual rate of mortality in eight of the principal is laid this course and Dr. schools, by great importance upon S Greenwood who is medical officer to the education com- Scotch towns, which had been equal to 20’3and 2 1 4 per 1000 in the two preceding weeks, rose again to 20’ mittee. An important voluntary movement, much on the 19’ i: the week ending April 13th, and exceeded by 3 -3 the mean in same lines as takes place in certain parts of Paris, is now r during the same week in the 76 large English towns. being organised in Blackburn by some local philanthropists. rate ’] rates in the eight Scotch towns ranged from 14 - 1 and A number of poor women, who have either been quiteThe 1 2 in Paisley and Aberdeen to 21’4 in Dundee and 23’ 6 recently confined or are within a month of that event, 15’ i Glasgow. The 700 deaths in the eight towns showed an in are to be supplied daily and gratuitously with a suitable i of 27 upon the number in the previous week, and ready cooked dinner from a restaurant which is to be opened increase i 124 which were referred to the principal epidemic shortly. In return for this the mother is to feed her baby included c at the breast and to allow the child to be weighed diseases, against 102, 107, and 114 in the three preceding There is much that is worth reading in Dr.weeks. These 124 deaths were equal to an annual rate of once weekly. :: 6 per 1000, which exceeded by 1’8 per 1000 the rate 3’ Greenwood’s report. f the principal epidemic diseases in the 76 English from towns ; they included 49 which were referred to "fever," 55 to whooping-cough, eight to measles, five to diphtheria, VITAL STATISTICS. five to diarrhoea, two to scarlet fever, and not one to The deaths referred to "fever," which had s small-pox. HEALTH OF ENGLISH TOWNS. tbeen 39 and 48 in the two preceding weeks, further r to 49 in the week under notice, and included IN 76 of the largest English towns 8979 births and 5196 rose 3 in Glasgow, eight in Edinburgh, four in Greenock, deaths-were registered during the week ending April 13th. 31 The annual rate of mortality, which had been equal to 17’ 7 aand three both in Leith and in Dundee; cerebro-spinal and 17 -9 per 1000 in the two preceding weeks, declined nmeningitis caused 30 deaths in Glasgow, eight in Edinburgh, t in Dundee, three in Leith, and one in Greenock, in to 16’9 in the week under notice. During the 13 weeks of two last quarter the death-rate in these towns averaged aaddition to a fatal case of typhus fever. The 55 deaths from v in the eight towns included 45 in Glasgow, 19’ 0 per 1000, the rate during the same period in Londonwhooping-cough f in Edinburgh, and three in Aberdeen. Of the eight fatal being 19’2. The lowest rates in the 76 towns last week five of measles four were returned in Glasgow and three c cases were 6’ 3 in Handsworth, 8’ 1 in Hornsey, 8’5 5 in Leyton, i Edinburgh; and four of the five deaths referred to and 9’in Willesden ; the rates ranged upwards in the in other towns to 23-1in Salford and Huddersfield, 24’8 in ddiphtheria occurred in Glasgow. The deaths in the eight t referred to diseases of the respiratory organs, including South Shields, 27-1in Burnley, and 30-8in Birkenhead. towns which had declined from 155 to 109 in the four The 5196 deaths in the 76 towns showed a decline pneumonia, I of 296 from the number in the previous week,preceding weeks, rose again to 118 in the week under I and included 544 which were referred to the principal rnotice, but were 52 below the number in the corresponding epidemic diseases, against 559 and 568 in theoweek of last year. The causes of 17, or 2’4 per cent., of of these, 228 resulted from tthe deaths registered in the eight towns during the week two preceding weeks ; v not certified or not stated ; in the 76 English towns measles, 171 from whooping-cough, 50 from diarrhoea,were 37 from diphtheria, 30 from "fever" (principally enteric), tthe proportion of uncertified deaths did not exceed 0 -8 per 28 from scarlet fever, but not one from small-pox. ccent. No death from any of these epidemic diseases was regisHEALTH OF DUBLIN. tered last week in Leicester, Derby, Plymouth, Halifax, and in eight other smaller towns ; the annual rates from these The annual rate of mortality in Dublin, which had been diseases, however, ranged upwards to 4 - 1 in Newport tequal to 223, 24 -3, and 28 -3per 1000 in the three preceding -< declined again to 26’6in the week ending April 13th. (Mon.), 4’6 in Middlesbrougb, 7’5 in West Bromwich, and weeks, 11’0 in Birkenhead. The 228 fatal cases of measles were During 1 the 13 weeks of last quarter the death-rate in the fewer by 23 than the number in the previous week ; the (city averaged 27 ° 2 per 1000, the rates during the same not exceeding 192 in London and 196in Edinburgh. highest annual death-rates therefrom were 3’ 4 in Bolton,period 1 4’1in Newport (Mon.), 6’8 in West Bromwich, and 8’8 in The *: 199 deaths of Dublin residents registered during the Birkenhead. The deaths from whooping-cough, which hadvweek under notice showed a decline of 13 from the number been 175 and 170 in the two previous weeks, were 171 last in i the previous week, and included 19 which were referred 1 the principal epidemic diseases, against 12 and 15 in the week; the highest death-rates from this disease being to 2 -0 in Burnley, 2’3 in East Ham, and 2 -6 in Middles- two 1 preceding weeks; of these, seven resulted both from I and from whooping-cough, two from diphtheria, brough. The 37 fatal cases of diphtheria showed a measles further decline from the numbers in the two preceding two 1 from diarrhoea, one from "fever," and not one either weeks, but included eight in London, four in Manchesterifrom small-pox or from scarlet fever. These 19 deaths were and Salford, and three in Birmingham. "Fever" caused equal i to an annual rate of 2’5 per 1000, the rate during an annual rate of 1-4 in South Shields and 2’ 0 in Great 1the same week from the principal epidemic diseases 1 1-66 in London and 2 -7 in Edinburgh. The fatal Yarmouth, and scarlet fever a rate of 1’ 5 in Grimsby. Thebeing 50 deaths attributed to diarrhoea showed an increase upon cases i of measles in Dublin exceeded the number in any recent weekly numbers. No case of small-pox has been previous week of this year; and those of whooping-cough ] under treatment in the Metropolitan Asylums Hospitalswere within one of the high number in the previous week. since the end of June last. The number of scarlet feverThe 199 deaths from all causes included 42 of children under I patients in these hospitals and in the London Fever Hospital, one year of age and 58 of persons aged upwards of 60 years, which had been 2657 and 2666 in the two previous weeks, Ieach of these numbers showing t further increase upon had declined to 2637 at the end of the week under notice ;1those returned in recent weeks. Six inquest cases and three 296 new cases were admitted during the week, against 330 Ideaths from violence were registered; and 75, or 37-7 per The and 352 in the two preceding weeks. The deaths in Icent., of the deaths occurred in public institutions. I of nine, or 4’5 per cent., of the deaths in Dublin London referred to pneumonia and other diseases of the causes ____

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