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Rabies
84
RABIES.
to give legal notice, such notice to be specially brought before the next meeting of the authorities, and, if confirmed, to have the same force as if it had been originally issued under the authority of the Board. Notice having been given and not obeyed within the time, the next step is application for a summons. The summons is generally granted returnable within seven days; this period in some instances may not be too long, but in most cases where it is capable of proof that repeated application has been made to the owner without effect, why should there be a longer time than forty-eight hours for appearance of defendant ? These remarks may be illustrated by an actual case taken from the writer's experience: (x) Information to local authority of drain and closet stopped up, and water cut off; (2) Letter sent to owner; (3) Five days afterwards meeting of local authority, notice served to abate forthwith ; no abatement in twenty-four hours ; (4) Second letter, threatening proceedings ; (5)Application for summons on ninth day from first intimation ; stipendiary declined to grant summons returnable in less than seven days, l~ecause he himself would only be sitting that day week ; (6) Appearance of defendant, magistrate's order, the order obeyed within two days after hearing. Total time from first intimation to actual remedy of urgent nuisance, eighteen days. This is an example of ordinary delay ; there may be circumstances in which disputed liability, plea of demurrer, or other pleas, paralyse effectual action for several weeks. There are many ways by which the problem how to obviate unnecessary delay may be solved ; but that it must be solved in one way or another is obvious. It is not sufficient that nuisances be abated, they must be abated promptly. BowEli v. SANDFORD.~THE RIGHT TO DIVERT
SUBTERRANEAN WATER.--This will be a leading case. Mr. Justice Denman's lucid judgment will be found fully reported in the Times of June 8th. The action was brought for an injunction to restrain the defendant from diverting, permitting a certain drift (i.e. an underground artificial conduit or tunnel for water)or pipes from remaining open near or under a certain spring, and from otherwise diverting or depriving the plaintiffs or any of them of the use of the water of the said spring. It was proved that the spring had been used by the inhabitants for 40 years previous to ~874, that although a great portion of the subterranean water was flowing in channels unascertained, in one portion it did flow in a defined channel, and moreover that the defendant had notice when he bought the property of the existence of the easement. The learned judge said that in this case Acton v. Blundell and Chasemore v. Richards did not apply, and the plaintiffs were entitled to the injunction.
RABIES. THERE are not wanting signs which indicate that we are again on the eve of an epidemic of rabies. There is only one method of prevention, that is to have a general order enforced throughout the length and breadth of the country restricting the freedom of the one animal which has ever been known to propagate it to any extent, that is the dog. Experience fully justifies the statement that if every dog, which is not actually led, be muzzled for even so short a period as two months, the result would be to extinguish the disease for the time, and it would not be heard of for several years to come. This question is as important in the interests of the canine as in the human race. If the canine race should be in some supernatural way suddenly endowed with speech and reason, they themselves would give a vote in favour of a brief period of isolation and duress rather than run the risk of so agonising and terrible a death. The main opposition has arisen from the selfish instincts of the sportsman and that large section of the community which ever opposes "regulation." While this is the chief measure to be relied upon, there can be also little doubt, that with the accumulated evidence as to the benefits of inoculation of persons actually bitten, evidence generally accepted by the scientific world as trustworthy, the time has come for the Government to establish stations in London, Scotland, and Ireland, at which persons who have been bitten by mad dogs could be treated by preventive inoculation. At present the patient apprehensive of rabies has to be hurried over to Paris at considerable expense and inconvenience, to undergo a treatment, in itself of the simplest kind, the technique of which is known in all its details, and which any professed bacteriologist could carry out.
The Lord Mayor having recently announced his intention of desiring to ta~e some steps for the furtherance of M. Pasteur's system, M. Pasteur has written to his Lordship a letter stating that the number of persons bitten in England amply justifies the establishment of such an institution. In x886 eighty-eight, in i887 twenty-four, in i888 sixty-three, and during the five months of i889 thirty-five cases derived from this countr.y, have been treated at the Pasteur Institute, thkt is about an average of fifty in each year. An antirabic institution should not be supported by private generosity, but by the nation. If a new building has to be erected, and a staff of assistants, the scheme in its initial stage will be opposed. T h e proper way is to utilise existing buildings and institutions ; for example, there is for London the Brown Institution, or arrangements probably might be made at the Bacteriological Laboratory, King's College. Whether facilities for preventive inoculation be established at the expense of the State or at the
THE
METROPOLITAN
e x p e r s e of individuals, it is evident that M . Pasteur's m o s t cordial co-operation may be relied upon. THE
METROPOLITAN BOARD.
ASYLUMS
T H E report of the chairman, Sir E d w i n Galsworthy, of the work d o n e during the twelve months ending M a r c h 25, I889, has recently appeared. I t is a d o c u m e n t of m u c h interest, and should b e attentively perused. Speaking of measles, Sir E d w i n m a k e s the following remarks : During the autumn of I888, and the winter of the present year, the metropolis, in common with other parts of the country, was visited by an epidemic of measles of exceptional severity, the number of deaths from the disease in the metropolitan district alone during the months of November, December, and January, averaging no less than I33 weekly. These deaths are indicative of a mortality far in excess ot the recorded mortality flora small-pox of any similar period during the several epidemics of small-pox with which the Asylums Board have been called upon to cope during the past I7 years, and were hardly exceeded during the memorable epidemic of small-pox which visited the metropolis during I87O-I. In view of this excessive death-rate and of the admitted fact that measles is a dangerous infectious disease of a febrile character, and, therefore, one which it is reasonable to suppose might, to a considerable extent, be mitigated by the prompt and proper isolation of cases which cannot be isolated in their own homes, it is hardly a matter for surprise that representations should have been made to the Managers asking them to consider the desirability of admitting measles into their hospitals. The General Purposes Committee, in reporting to the Board upon the matter, expressed a doubt as to whether the Managers had any legal power, saving under section 15 of the Poor Law Act, I879, to admit cases of measles, and the Managers ultimately decided to send a reply in these terms to those bodies who had addressed them upon the subject. The question of the isolation of measles is nevertheless one which can hardly be indefinitely delayed, and will be dealt with probably by such central sanitary authority as may ultimately be charged with the supervision of the health requirements of the metropolis, the disease having, as reference to the Registrar's annual statistics will show, undoubtedly increased in extent and virulence during the past few years, and being one which, if improperly or neglectfully treated, leaves much constitutional mischief behind. Apart from these considerations, it would seem that inasmuch as the paramount duty of a sanitary authority is the prevention of death from preventible causes, it would seem to follow that whether deaths are occasioned by fever, small-pox, diphtheria, or measles, equal precautions should be adopted. If the mortality which characterised last autumn's epidemic of measles had affected the adult population instead of children, public opinion would rrobably have insisted upon provision being made for the proper isolation and treatment of patients afflicted with this disease. T h e legal position of the managers in regard to the admission into the hospitals of cases of infectious disorders still continues anomalous and unsatisfactory. I t was the intention of the President of the Local G o v e r n m e n t B o a r d to introduce a Bill into the H o u s e to put matters on a better footing, but circumstances have not been favourable t o a d m i t of this being done.
ASYLUMS THE
BOARD.
SANITARY
85 CONGRESS
OF
J889.
THE eleventh Congress of the Sanitary Institute will be held at Worcester, from September 24th to S e p t e m b e r 28th. T h e r e will be an exhibition, inincluding sanitary apparatus and appliances, in the Exhibition Buildings, Shrub Hill. T h e congress is divided into three sections, viz. : Section i : Sanitary Science and P r e v e n t i v e M e d i c i n e - - p r e s i d e n t , George Wilson, M.A., M.D., F . C . S . ; hon. see., J. F. J. Sykes, M.B., B.Sc. Section 2 : Engineering and Architecture M president, H e n r y J. Marten, M . I . C . E . ; hon. see., E. C. Robins, F.S.A., F . R . I . B . A . Section 3 : Chemistry, Meteorology, and G e o l o g y - - p r e s i d e n t , J o h n W. Tripe, M . D , M.R.C.S. ; hon. see., G. J. Symons, F.R.S. I n connection with the congress, a conference of medical officers of health will be held, as a n n o u n c e d at page 65 . It is important to note that medical officers of health attending the conference will have access to the meetings of the congress.
THE MACCLESFIELD OUTBREAK OF SCARLET FEVER, SORE THROAT, AND DIPHTHERIA. DR. PARSONS' report o f this curious outbreak is now published. T h e outbreak occurred in the township of U p t o n , and e x t e n d e d into the borough of M~cclesfield. D u r i n g the whole of January there had b e e n only reported to the Macclesfield Sanitary Authority ~ 2 cases of scarlet fever, but during the week ending February 2nd there were no less than 32 cases reported, a n d during the next three weeks there were 7, 4, and 2 cases respectively reported. U p t o n is in the district of the R u r a l Sanitary Authority, a n d is a small place containing 4~ houses and 228 i n h a b i t a n t s ; it is practically a suburb of Macclesfield. T h e origin of the disease seems to have been in U p t o n . I n U p t o n no cases of scarlet fever are known to have existed before January 24th, but between J a n u a r y 24th and February Ist I o cases of scarlet fever occurred in seven different households. It was noticed that the cases of scarlet fever in U p t o n and Maeclesfield were accompanied often in the same household by a m o r e n u m e r o u s series of cases of sore throat, occurring chiefly in older persons, varying in severity, the m o r e serious having a diphtheritic tendency, and two developing into distinct diphtheria. T h e majority of the cases in U p t o n were supplied with milk from a particular dairy, that o f Mr. V. T h e percentage of households attacked supplied with Mr. V.'s milk was 77 ; those from other sources 17. I n Maeclesfield 28 out of 32 cases also used milk from Mr. V.'s dairy. " T h e case against the suspected milk is further strengthened when we c o m e to consider the * Macclesfield is one of the notification towns.
RABIES.
to give legal notice, such notice to be specially brought before the next meeting of the authorities, and, if confirmed, to have the same force as if it had been originally issued under the authority of the Board. Notice having been given and not obeyed within the time, the next step is application for a summons. The summons is generally granted returnable within seven days; this period in some instances may not be too long, but in most cases where it is capable of proof that repeated application has been made to the owner without effect, why should there be a longer time than forty-eight hours for appearance of defendant ? These remarks may be illustrated by an actual case taken from the writer's experience: (x) Information to local authority of drain and closet stopped up, and water cut off; (2) Letter sent to owner; (3) Five days afterwards meeting of local authority, notice served to abate forthwith ; no abatement in twenty-four hours ; (4) Second letter, threatening proceedings ; (5)Application for summons on ninth day from first intimation ; stipendiary declined to grant summons returnable in less than seven days, l~ecause he himself would only be sitting that day week ; (6) Appearance of defendant, magistrate's order, the order obeyed within two days after hearing. Total time from first intimation to actual remedy of urgent nuisance, eighteen days. This is an example of ordinary delay ; there may be circumstances in which disputed liability, plea of demurrer, or other pleas, paralyse effectual action for several weeks. There are many ways by which the problem how to obviate unnecessary delay may be solved ; but that it must be solved in one way or another is obvious. It is not sufficient that nuisances be abated, they must be abated promptly. BowEli v. SANDFORD.~THE RIGHT TO DIVERT
SUBTERRANEAN WATER.--This will be a leading case. Mr. Justice Denman's lucid judgment will be found fully reported in the Times of June 8th. The action was brought for an injunction to restrain the defendant from diverting, permitting a certain drift (i.e. an underground artificial conduit or tunnel for water)or pipes from remaining open near or under a certain spring, and from otherwise diverting or depriving the plaintiffs or any of them of the use of the water of the said spring. It was proved that the spring had been used by the inhabitants for 40 years previous to ~874, that although a great portion of the subterranean water was flowing in channels unascertained, in one portion it did flow in a defined channel, and moreover that the defendant had notice when he bought the property of the existence of the easement. The learned judge said that in this case Acton v. Blundell and Chasemore v. Richards did not apply, and the plaintiffs were entitled to the injunction.
RABIES. THERE are not wanting signs which indicate that we are again on the eve of an epidemic of rabies. There is only one method of prevention, that is to have a general order enforced throughout the length and breadth of the country restricting the freedom of the one animal which has ever been known to propagate it to any extent, that is the dog. Experience fully justifies the statement that if every dog, which is not actually led, be muzzled for even so short a period as two months, the result would be to extinguish the disease for the time, and it would not be heard of for several years to come. This question is as important in the interests of the canine as in the human race. If the canine race should be in some supernatural way suddenly endowed with speech and reason, they themselves would give a vote in favour of a brief period of isolation and duress rather than run the risk of so agonising and terrible a death. The main opposition has arisen from the selfish instincts of the sportsman and that large section of the community which ever opposes "regulation." While this is the chief measure to be relied upon, there can be also little doubt, that with the accumulated evidence as to the benefits of inoculation of persons actually bitten, evidence generally accepted by the scientific world as trustworthy, the time has come for the Government to establish stations in London, Scotland, and Ireland, at which persons who have been bitten by mad dogs could be treated by preventive inoculation. At present the patient apprehensive of rabies has to be hurried over to Paris at considerable expense and inconvenience, to undergo a treatment, in itself of the simplest kind, the technique of which is known in all its details, and which any professed bacteriologist could carry out.
The Lord Mayor having recently announced his intention of desiring to ta~e some steps for the furtherance of M. Pasteur's system, M. Pasteur has written to his Lordship a letter stating that the number of persons bitten in England amply justifies the establishment of such an institution. In x886 eighty-eight, in i887 twenty-four, in i888 sixty-three, and during the five months of i889 thirty-five cases derived from this countr.y, have been treated at the Pasteur Institute, thkt is about an average of fifty in each year. An antirabic institution should not be supported by private generosity, but by the nation. If a new building has to be erected, and a staff of assistants, the scheme in its initial stage will be opposed. T h e proper way is to utilise existing buildings and institutions ; for example, there is for London the Brown Institution, or arrangements probably might be made at the Bacteriological Laboratory, King's College. Whether facilities for preventive inoculation be established at the expense of the State or at the
THE
METROPOLITAN
e x p e r s e of individuals, it is evident that M . Pasteur's m o s t cordial co-operation may be relied upon. THE
METROPOLITAN BOARD.
ASYLUMS
T H E report of the chairman, Sir E d w i n Galsworthy, of the work d o n e during the twelve months ending M a r c h 25, I889, has recently appeared. I t is a d o c u m e n t of m u c h interest, and should b e attentively perused. Speaking of measles, Sir E d w i n m a k e s the following remarks : During the autumn of I888, and the winter of the present year, the metropolis, in common with other parts of the country, was visited by an epidemic of measles of exceptional severity, the number of deaths from the disease in the metropolitan district alone during the months of November, December, and January, averaging no less than I33 weekly. These deaths are indicative of a mortality far in excess ot the recorded mortality flora small-pox of any similar period during the several epidemics of small-pox with which the Asylums Board have been called upon to cope during the past I7 years, and were hardly exceeded during the memorable epidemic of small-pox which visited the metropolis during I87O-I. In view of this excessive death-rate and of the admitted fact that measles is a dangerous infectious disease of a febrile character, and, therefore, one which it is reasonable to suppose might, to a considerable extent, be mitigated by the prompt and proper isolation of cases which cannot be isolated in their own homes, it is hardly a matter for surprise that representations should have been made to the Managers asking them to consider the desirability of admitting measles into their hospitals. The General Purposes Committee, in reporting to the Board upon the matter, expressed a doubt as to whether the Managers had any legal power, saving under section 15 of the Poor Law Act, I879, to admit cases of measles, and the Managers ultimately decided to send a reply in these terms to those bodies who had addressed them upon the subject. The question of the isolation of measles is nevertheless one which can hardly be indefinitely delayed, and will be dealt with probably by such central sanitary authority as may ultimately be charged with the supervision of the health requirements of the metropolis, the disease having, as reference to the Registrar's annual statistics will show, undoubtedly increased in extent and virulence during the past few years, and being one which, if improperly or neglectfully treated, leaves much constitutional mischief behind. Apart from these considerations, it would seem that inasmuch as the paramount duty of a sanitary authority is the prevention of death from preventible causes, it would seem to follow that whether deaths are occasioned by fever, small-pox, diphtheria, or measles, equal precautions should be adopted. If the mortality which characterised last autumn's epidemic of measles had affected the adult population instead of children, public opinion would rrobably have insisted upon provision being made for the proper isolation and treatment of patients afflicted with this disease. T h e legal position of the managers in regard to the admission into the hospitals of cases of infectious disorders still continues anomalous and unsatisfactory. I t was the intention of the President of the Local G o v e r n m e n t B o a r d to introduce a Bill into the H o u s e to put matters on a better footing, but circumstances have not been favourable t o a d m i t of this being done.
ASYLUMS THE
BOARD.
SANITARY
85 CONGRESS
OF
J889.
THE eleventh Congress of the Sanitary Institute will be held at Worcester, from September 24th to S e p t e m b e r 28th. T h e r e will be an exhibition, inincluding sanitary apparatus and appliances, in the Exhibition Buildings, Shrub Hill. T h e congress is divided into three sections, viz. : Section i : Sanitary Science and P r e v e n t i v e M e d i c i n e - - p r e s i d e n t , George Wilson, M.A., M.D., F . C . S . ; hon. see., J. F. J. Sykes, M.B., B.Sc. Section 2 : Engineering and Architecture M president, H e n r y J. Marten, M . I . C . E . ; hon. see., E. C. Robins, F.S.A., F . R . I . B . A . Section 3 : Chemistry, Meteorology, and G e o l o g y - - p r e s i d e n t , J o h n W. Tripe, M . D , M.R.C.S. ; hon. see., G. J. Symons, F.R.S. I n connection with the congress, a conference of medical officers of health will be held, as a n n o u n c e d at page 65 . It is important to note that medical officers of health attending the conference will have access to the meetings of the congress.
THE MACCLESFIELD OUTBREAK OF SCARLET FEVER, SORE THROAT, AND DIPHTHERIA. DR. PARSONS' report o f this curious outbreak is now published. T h e outbreak occurred in the township of U p t o n , and e x t e n d e d into the borough of M~cclesfield. D u r i n g the whole of January there had b e e n only reported to the Macclesfield Sanitary Authority ~ 2 cases of scarlet fever, but during the week ending February 2nd there were no less than 32 cases reported, a n d during the next three weeks there were 7, 4, and 2 cases respectively reported. U p t o n is in the district of the R u r a l Sanitary Authority, a n d is a small place containing 4~ houses and 228 i n h a b i t a n t s ; it is practically a suburb of Macclesfield. T h e origin of the disease seems to have been in U p t o n . I n U p t o n no cases of scarlet fever are known to have existed before January 24th, but between J a n u a r y 24th and February Ist I o cases of scarlet fever occurred in seven different households. It was noticed that the cases of scarlet fever in U p t o n and Maeclesfield were accompanied often in the same household by a m o r e n u m e r o u s series of cases of sore throat, occurring chiefly in older persons, varying in severity, the m o r e serious having a diphtheritic tendency, and two developing into distinct diphtheria. T h e majority of the cases in U p t o n were supplied with milk from a particular dairy, that o f Mr. V. T h e percentage of households attacked supplied with Mr. V.'s milk was 77 ; those from other sources 17. I n Maeclesfield 28 out of 32 cases also used milk from Mr. V.'s dairy. " T h e case against the suspected milk is further strengthened when we c o m e to consider the * Macclesfield is one of the notification towns.