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Reports of medical officers of health
378
REPORTS
OF MEDICAL
conduct of members of the community at large, and it thus becomes an exceedingly difficult matter to compass the good rule and happiness of these poor sufferers. As to the necessity of providing for the compulsory notification of the disease if the Act is once and for all to wipe out leprosy from the Colony, mention has already been made."
REPORTS
OF MEDICAL OF HEALTH.
OFFICERS
PLUMSTEAD. DR. SIDNEY DAVIES, in his annual report for Plurnstead, makes the following remarks : -
Sewer Fenli[afors and Z)~htheria.--Diphtheria has always been regarded as one of the infectious diseases most affected by insanitary conditions, especially by dampness and foulness of soil, and by air infected by foul emanations, whether from surface filth or by sewer gas. It is true there is a tendency of late years to underrate the influence of insanitary conditions, and to attribute the prevalence of the disease almost wholly to infection, but personally, I am decidedly of opinion that, whether directly or indirectly, filthy emanations produce diphtheria. T h e houses in which the diphtheria cases occurred were not found to have any serious sanitary defects ; the streets which were mostly affected are not by any means the worst streets in Plumstead. For the most part the soilis decidedly dry, and there is no reason for supposing it to be filthy. T h e large majority of the houses had water-closets outside the house with efficient water supply, their sink drains were disconnected, and there was no possibility of sewer gas entering the houses directly. The only possible source of sewer gas is the manhole ventilators, rain pipes directly connected with the sewer, and other faulty means of sewer ventilation. During the last quarter of the year, when diphtheria prevailed largely in the metropolis, causing a higher death-rate than in any previous year, Plumstead was even worse in this respect than the rest of London, having about four times as much diphtheria proportionally as the whole of London. Woolwich, on the other hand, had only half as much as London. H o w is it that such a healthy place as I have shown Plumstead to be should have so much diphtheria ? Why should Woolwich,separated only by an artificial boundary from Plumstead, be so much more flee from diphtheria, although its death-rate is much higher, and its sanitary conditions cn the whole less favourable ? During last year Plumstead had in proportion to population over five times as many cases of diphtheria notified as Woolwich, and over four times as many if the last four years are taken. H o w is it that the mere fact of living within the boundaries of Plumstead sanitary administration seems to mean greater proclivity to diphtheria,
OFFICERS
OF HEALTH.
although in every other respect it means improved hygienic conditions. Several cases of diphtheria having occurred in small streets where there were manhole ventilators, which had been complained of as emitting bad smells, I inquired as to the existence of these open manholes in Woolwich, and found that there were none. I n Plumstead, on the contrary, they have been put in all over the parish during the last five or six years, I believe. T h e y act for the most part for outlets of sewer gas, as well as inlets of fresh air. I t is common to see children playing right over them, indeed the streets I have referred to may be considered as the natural playground for the adjoining houses. If balls or marbles disappear through the grids, the distressed owner puts his or her face over it in the search for the lost property. Here, at any rate, is ample means of inhaling sewer gas. With regard to the causes of the recent increase of diphtheria in large towns, I agree with Dr. Biddle, of Kingston, that lately " i t seems to be ,a disease attributable to misdirected sanitation rather than to the absence of sanitary arrangements. Cows and milk. and the kissing of eats had place in the world before diphtheria became so common, but open grating, imperfect gulleys and traps, and sewer ventilation generally are of comparatively recent origin." SALFORD. Dr. Paget's annual report for r892 preserves the same excellent printing, lucid tabular arrangement, and general distinction of form which among other qualities rendered the Salford report~ formany years while Dr. Tatham was its medical officer of health, and still render them models of what an annual report should be. The year on which Dr. Paget reports was chiefly remarkable for an epidemic of measles, which caused 306 deaths, or about one-fifth of the whole mortality in the borough during the year. A n d yet this disease is stilt commonly regarded as a mild complaint of children. The gradual substitution of water-closets for midden-privies, the methods of drain examination, the demolition of insanitary dwellings, and other important matters are discussed in the report. BEDFORDSHIRE.
Dr. Leonard Wilde, the " m e d i c a l adviser" to the Bedfordshire County Council, has presented an annual report which summarises the reports of the district medical offÉcers, preceded by a general report on the county. T h e following remarks may be quoted : - Noliflcalio~.--It is greatly to be regretted that compulsory notification has not been universally adopted throughout the country, as, until this is done, the unprotected districts are a danger to their neighbours, for it not infrequently happens that in these districts patients imperfectly recovered from infectious disease are unwittingty allowed to migrate into cther districts, and thus become unsuspected centres of infection.
LAW
REPORT.
Zso/ation Has_pitals.--It is a matter of importance that the County Council should be empowered to provide hospitals when the local authorities fail to do so, as is contemplated in the Infectious Hospitals Bill, which has been introduced into the House of Lords by Lord Thring, and which, in addition to the above powers, enables the County Council, on application by a local authority, or on the report of the medical officer or adviser of the council (after a local inquiry has been h e l d ) t o constitute hospital districts. -Dfsf~fection.--With few exceptions disinfection is very imperfectly carried out in the county. T o be of any use it should be done under the supervision of the sanitary authority, by a specially skilled official. T h e bedding, clothes, and other articles from infected households should be disinfected, free of expense,in a public steam disinfector. In the rural districts it might be found convenient to have the disinfecting stations in connection with the isolation hospital for the district. By this plan one apparatas would serve both hospital and district. VOLUNTARY DESTRUCTION OF U N S O U N D MEAT.
- - I n dealing with unsound meat I have, during the past year, adopted a method which up to the present appears to answer well. Whenever a carcass is found unsound, the owner is asked to sign a form requesting the destruction. I f he refuses to do so a prosecution follows. This plan which is, I believe, adopted in Edinburgh, Birkenhead, and some other places has the advantage of doing away with the necessity of bringing before the magistrates cases in which the owner of the meat has obviously no intention of selling the same. I am indebted to the Medical Officer of Health for Birkenhead for the following forms, which I now employ on these occasions : MEDICAL O F F I C E R O F H E A L T H ' S DEPARTMENT. TOWN HALL~ CARDIFF, ............. I 8 9 S I R , - - I h a v e to i n f o r m y o u t h a t I h a v e this . . . . . . . seized u n d e r section I I 6 of the P u b l i c H e a l t h Act~ I 8 7 5 ) at t h e A b a t t o i r . . . . . . . . . . . . the . . . . . . . . . . . . of a . . . . . . . . . . . . . . . . . . . . . b e l o n g i n g to y o n , a n d unless in the m e a n t i m e you consent to its destructionD w h i c h y o u m a y d o b y calling at this Office, or b y s e n d i n g y o u r c o n s e n t in w r i t i n g , I shall a p p l y to a M a g i s t r a t e for a n o r d e r at the Police C o u r t . . . . . . . . . . . . . . . . . . as s o o n after . . . . . . . . . . . . . . . as the a p p l i c a t i o n e a n be h e a r d .
I am, your obedient servant,
To .................... COUNTY BOROUGH OF CARDIFF. H E A L T H DEPARTMENT.
..................... t8 9
To
THE MEDICAL OFFICER OF HEALTH, SIR, . . . . . . . . . . . . . . . . . . . . . h e r e b y a u t h o r ] s e you to t a k e a n d c a r r y a w a y . . . . . . . . . . . . . . . b e l o n g i n g to . . . . . . . . . . . . . . n o w b e i n g at the . . . . . . . . . a n d request y o u to d e s t r o y t h e s a m e as b e i n g u n s o u n d , --Froln Dr.
H/'alford's A n n u a l
Report/or 2892 , Cardiff.
379 LAW
THE
HOUSING
OF
IMPORTANT
REPORT. THE
WORKING
CLASSES. M
CASE AT HERTFORD.
AT Hertford County Sessions on Saturday, before G. Faudel Phillips, Esq. (in the chair), Mr. R. T. Andrews, architect and surveyor, and Mr. Win. F. Andrews, timber merchant, were summoned under the provisions of the Housing of the Working Classes Act for being the owners of ten dwellinghouses near Well Green, Brickendon, such premises being, it was alleged, unfit for human habitation. Mr. Grubbe, barrister (instructed by Mr. T. I. Sworder), appeared on behalf of the Hertford Rural Sanitary Authority, and Mr. Hawks defended. In opening his case, Mr. Grubbe briefly outlined the evidence that will be found below, and applied for a closing order. H e thought the Bench would be of opinion that Messrs. Andrews had been treated by the Authority with the greatest forbearance. H e contended that Authority would have been guilty of a gross dereliction of duty had they not taken action. Dr. George Turner, medical officer of health for the combined district of East Herts., and for the Hertford R u r a l Sanitary Authority's district, stated that he made a report to the Sanitary Authority on the state of Mr. Andrews' cottages on March 4th. On April i4th he visited the cottages again with Mr. Scales. H e found Savage's cottage damp, with no proper provision for carrying off rain water, the walls were dirty, and he could see daylight through the roof. T h e walls and ceiling were lined with match-boarding, in which were crevices one could see through. H e then went to the cottage inhabited by J. Allure, his wife, and six children. T h e door here had shrunk, and witness could see daylight through the ceiling and roof. In Saville's cottage the brick floor was broken, the door shrunk, and rain came into the front room. On June tst he visited the cottage occupied by H. Meach, his wife, and seven children, and found it in a like state. I n George Wilsher's house be could see daylight through the roof and through the ceiling of the front room. Matthews' house wasin much the same state, and holes in the walls communicated with the next house. Saville's cottage was very damp, the fl-ont door shrunk, daylight could be seen through ceiling and roof, and witness could see through the walls into the next room. H e added that the houses were too thinly constructed. H e was not a builder, but did not think the boarding in any of the places was thick enough or properly put together, or that the wood was seasoned. Witness objected to brick floors in all cases, because they were practically always damp. They drew up the moisture from the ground, and absorbed it when they were washed. Mr. Urban A. Smith, county surveyor, said that on June 6th last he examined the ten cottages in
REPORTS
OF MEDICAL
conduct of members of the community at large, and it thus becomes an exceedingly difficult matter to compass the good rule and happiness of these poor sufferers. As to the necessity of providing for the compulsory notification of the disease if the Act is once and for all to wipe out leprosy from the Colony, mention has already been made."
REPORTS
OF MEDICAL OF HEALTH.
OFFICERS
PLUMSTEAD. DR. SIDNEY DAVIES, in his annual report for Plurnstead, makes the following remarks : -
Sewer Fenli[afors and Z)~htheria.--Diphtheria has always been regarded as one of the infectious diseases most affected by insanitary conditions, especially by dampness and foulness of soil, and by air infected by foul emanations, whether from surface filth or by sewer gas. It is true there is a tendency of late years to underrate the influence of insanitary conditions, and to attribute the prevalence of the disease almost wholly to infection, but personally, I am decidedly of opinion that, whether directly or indirectly, filthy emanations produce diphtheria. T h e houses in which the diphtheria cases occurred were not found to have any serious sanitary defects ; the streets which were mostly affected are not by any means the worst streets in Plumstead. For the most part the soilis decidedly dry, and there is no reason for supposing it to be filthy. T h e large majority of the houses had water-closets outside the house with efficient water supply, their sink drains were disconnected, and there was no possibility of sewer gas entering the houses directly. The only possible source of sewer gas is the manhole ventilators, rain pipes directly connected with the sewer, and other faulty means of sewer ventilation. During the last quarter of the year, when diphtheria prevailed largely in the metropolis, causing a higher death-rate than in any previous year, Plumstead was even worse in this respect than the rest of London, having about four times as much diphtheria proportionally as the whole of London. Woolwich, on the other hand, had only half as much as London. H o w is it that such a healthy place as I have shown Plumstead to be should have so much diphtheria ? Why should Woolwich,separated only by an artificial boundary from Plumstead, be so much more flee from diphtheria, although its death-rate is much higher, and its sanitary conditions cn the whole less favourable ? During last year Plumstead had in proportion to population over five times as many cases of diphtheria notified as Woolwich, and over four times as many if the last four years are taken. H o w is it that the mere fact of living within the boundaries of Plumstead sanitary administration seems to mean greater proclivity to diphtheria,
OFFICERS
OF HEALTH.
although in every other respect it means improved hygienic conditions. Several cases of diphtheria having occurred in small streets where there were manhole ventilators, which had been complained of as emitting bad smells, I inquired as to the existence of these open manholes in Woolwich, and found that there were none. I n Plumstead, on the contrary, they have been put in all over the parish during the last five or six years, I believe. T h e y act for the most part for outlets of sewer gas, as well as inlets of fresh air. I t is common to see children playing right over them, indeed the streets I have referred to may be considered as the natural playground for the adjoining houses. If balls or marbles disappear through the grids, the distressed owner puts his or her face over it in the search for the lost property. Here, at any rate, is ample means of inhaling sewer gas. With regard to the causes of the recent increase of diphtheria in large towns, I agree with Dr. Biddle, of Kingston, that lately " i t seems to be ,a disease attributable to misdirected sanitation rather than to the absence of sanitary arrangements. Cows and milk. and the kissing of eats had place in the world before diphtheria became so common, but open grating, imperfect gulleys and traps, and sewer ventilation generally are of comparatively recent origin." SALFORD. Dr. Paget's annual report for r892 preserves the same excellent printing, lucid tabular arrangement, and general distinction of form which among other qualities rendered the Salford report~ formany years while Dr. Tatham was its medical officer of health, and still render them models of what an annual report should be. The year on which Dr. Paget reports was chiefly remarkable for an epidemic of measles, which caused 306 deaths, or about one-fifth of the whole mortality in the borough during the year. A n d yet this disease is stilt commonly regarded as a mild complaint of children. The gradual substitution of water-closets for midden-privies, the methods of drain examination, the demolition of insanitary dwellings, and other important matters are discussed in the report. BEDFORDSHIRE.
Dr. Leonard Wilde, the " m e d i c a l adviser" to the Bedfordshire County Council, has presented an annual report which summarises the reports of the district medical offÉcers, preceded by a general report on the county. T h e following remarks may be quoted : - Noliflcalio~.--It is greatly to be regretted that compulsory notification has not been universally adopted throughout the country, as, until this is done, the unprotected districts are a danger to their neighbours, for it not infrequently happens that in these districts patients imperfectly recovered from infectious disease are unwittingty allowed to migrate into cther districts, and thus become unsuspected centres of infection.
LAW
REPORT.
Zso/ation Has_pitals.--It is a matter of importance that the County Council should be empowered to provide hospitals when the local authorities fail to do so, as is contemplated in the Infectious Hospitals Bill, which has been introduced into the House of Lords by Lord Thring, and which, in addition to the above powers, enables the County Council, on application by a local authority, or on the report of the medical officer or adviser of the council (after a local inquiry has been h e l d ) t o constitute hospital districts. -Dfsf~fection.--With few exceptions disinfection is very imperfectly carried out in the county. T o be of any use it should be done under the supervision of the sanitary authority, by a specially skilled official. T h e bedding, clothes, and other articles from infected households should be disinfected, free of expense,in a public steam disinfector. In the rural districts it might be found convenient to have the disinfecting stations in connection with the isolation hospital for the district. By this plan one apparatas would serve both hospital and district. VOLUNTARY DESTRUCTION OF U N S O U N D MEAT.
- - I n dealing with unsound meat I have, during the past year, adopted a method which up to the present appears to answer well. Whenever a carcass is found unsound, the owner is asked to sign a form requesting the destruction. I f he refuses to do so a prosecution follows. This plan which is, I believe, adopted in Edinburgh, Birkenhead, and some other places has the advantage of doing away with the necessity of bringing before the magistrates cases in which the owner of the meat has obviously no intention of selling the same. I am indebted to the Medical Officer of Health for Birkenhead for the following forms, which I now employ on these occasions : MEDICAL O F F I C E R O F H E A L T H ' S DEPARTMENT. TOWN HALL~ CARDIFF, ............. I 8 9 S I R , - - I h a v e to i n f o r m y o u t h a t I h a v e this . . . . . . . seized u n d e r section I I 6 of the P u b l i c H e a l t h Act~ I 8 7 5 ) at t h e A b a t t o i r . . . . . . . . . . . . the . . . . . . . . . . . . of a . . . . . . . . . . . . . . . . . . . . . b e l o n g i n g to y o n , a n d unless in the m e a n t i m e you consent to its destructionD w h i c h y o u m a y d o b y calling at this Office, or b y s e n d i n g y o u r c o n s e n t in w r i t i n g , I shall a p p l y to a M a g i s t r a t e for a n o r d e r at the Police C o u r t . . . . . . . . . . . . . . . . . . as s o o n after . . . . . . . . . . . . . . . as the a p p l i c a t i o n e a n be h e a r d .
I am, your obedient servant,
To .................... COUNTY BOROUGH OF CARDIFF. H E A L T H DEPARTMENT.
..................... t8 9
To
THE MEDICAL OFFICER OF HEALTH, SIR, . . . . . . . . . . . . . . . . . . . . . h e r e b y a u t h o r ] s e you to t a k e a n d c a r r y a w a y . . . . . . . . . . . . . . . b e l o n g i n g to . . . . . . . . . . . . . . n o w b e i n g at the . . . . . . . . . a n d request y o u to d e s t r o y t h e s a m e as b e i n g u n s o u n d , --Froln Dr.
H/'alford's A n n u a l
Report/or 2892 , Cardiff.
379 LAW
THE
HOUSING
OF
IMPORTANT
REPORT. THE
WORKING
CLASSES. M
CASE AT HERTFORD.
AT Hertford County Sessions on Saturday, before G. Faudel Phillips, Esq. (in the chair), Mr. R. T. Andrews, architect and surveyor, and Mr. Win. F. Andrews, timber merchant, were summoned under the provisions of the Housing of the Working Classes Act for being the owners of ten dwellinghouses near Well Green, Brickendon, such premises being, it was alleged, unfit for human habitation. Mr. Grubbe, barrister (instructed by Mr. T. I. Sworder), appeared on behalf of the Hertford Rural Sanitary Authority, and Mr. Hawks defended. In opening his case, Mr. Grubbe briefly outlined the evidence that will be found below, and applied for a closing order. H e thought the Bench would be of opinion that Messrs. Andrews had been treated by the Authority with the greatest forbearance. H e contended that Authority would have been guilty of a gross dereliction of duty had they not taken action. Dr. George Turner, medical officer of health for the combined district of East Herts., and for the Hertford R u r a l Sanitary Authority's district, stated that he made a report to the Sanitary Authority on the state of Mr. Andrews' cottages on March 4th. On April i4th he visited the cottages again with Mr. Scales. H e found Savage's cottage damp, with no proper provision for carrying off rain water, the walls were dirty, and he could see daylight through the roof. T h e walls and ceiling were lined with match-boarding, in which were crevices one could see through. H e then went to the cottage inhabited by J. Allure, his wife, and six children. T h e door here had shrunk, and witness could see daylight through the ceiling and roof. In Saville's cottage the brick floor was broken, the door shrunk, and rain came into the front room. On June tst he visited the cottage occupied by H. Meach, his wife, and seven children, and found it in a like state. I n George Wilsher's house be could see daylight through the roof and through the ceiling of the front room. Matthews' house wasin much the same state, and holes in the walls communicated with the next house. Saville's cottage was very damp, the fl-ont door shrunk, daylight could be seen through ceiling and roof, and witness could see through the walls into the next room. H e added that the houses were too thinly constructed. H e was not a builder, but did not think the boarding in any of the places was thick enough or properly put together, or that the wood was seasoned. Witness objected to brick floors in all cases, because they were practically always damp. They drew up the moisture from the ground, and absorbed it when they were washed. Mr. Urban A. Smith, county surveyor, said that on June 6th last he examined the ten cottages in