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Reports of medical officers of health
R E P O R T S OF M E D I C A L O F F I C E R S OF H E A L T H . At the trial Pollock B. held that the defendants were justified under the Act in what they had done. The Queen's Bench Division set aside the judgment, and ordered judgment to be entered for the plaintiff. The defendants appealed. Counsel for the defendants argued that the plaintiff was not entitled to notice of the resolution. H e knew perfectly well that his buildings were disapproved of by the Board; he had had continual communications with the Board about the houses, and the Board had given him notice ordering him to pull them down. The two cases relied upon by the plaintiff were distinguishable. Cooper v. The Wandsworth District Board of Works (8 t T. Rep., N.S., 278 ; I4 C. B., N.S., I8o), was decided under the Metropolitan Building Act, I855, the terms of which.are different to the Public Health Act, i875. Masters v. The Pontypool Local Government Board (9 Ch. Div., 677) is also distinguishable, as in that case the Board had previously approved of the plaintiff's buildings. Lord Esher, M.R. : The power which the Local Board assumed to exercise in this case, to enter upon the plaintiff's property and pull down a house he had built upon it, is one which affects the property in a most highly penal way. That being so, those to whom such a power has been given must take extra care to follow each necessary step in the strictest manner, and the Court will look to see this has been done. The cases cited of Cooper v. The Wandsworth District Board of Health and Masters v. The Pontypool Local Board are authorities to say that where a Local Board has the power, after and in consequence of the misconduct of a building owner, to enter upon his land and pull down his buildings and charge him with the expenses of doing so, it is a necessary implication, according to the fundamental principles of justice, to give him notice of what they are going to do, and an opportunity of suggesting that they should take a tess severe course. For want of notice that they were going to pull down the buildings "the defendants were acting contrary to law. The appeal must be dismissed, Lord Justices Fry and Lopes agreed. Appeal dismissed. T H E ~IoLT SYSTEM OF DISINFECTION.--ConsuI
Cridland states (Cons. Rep., No. 668), that in consequence of the adoption at Charleston of the Holt system (fully described in PUBLIC HEALTH, Vol. I., 368) for the disinfection of vessels arriving at the quarantine station of the port from infected places, and now in operation, vessels, which heretofore were detained for io, i5, 3 o, or 60 days before obtaining permission to come up to the port, are disinfected by t h e new process so thoroughly that all danger is removed in a few days--probably five days being the limit.
REPORTS
OF
MEDICAL HEALTH.
i5~
OFFICERS
OF
ISLE OF WIGHT.
Population, 1889, z8"396; birth-rate, 27"! ; death-rate, i6" 5. The annual report for x889 of the rural sanitary district of the Isle of Wight, by Dr. Joseph Groves, is a very complete, candid exposition. He is able to chronicle distinct advances in local administration--the Authority has adopted the Notification Act; routine proceedings are delegated to a committee; and the board have, therefore, more leisure to consider larger questions. In a portion of the district in which no water could be had, save from ditches or fouled streams, for ordinary domestic purposes, the well supply being deficient in quantity, the Authority has taken measures to provide the houses with rain water. There are still reforms needed. Dr. Groves urges strongly the adoption of proper bye-laws, saying : - I agree with your committee who considered my last annual report, that "bye-laws are absolutely necessary in the rural sanitary district for the health and prosperity of the Island." It is somewhat remarkable that in a large district like yours, made up not only of rural but of urban areas, in which speculative building operations have gone on without the slightest control, a district on the borders of which are" considerable towns which shoot a good deal of their filth into it, a district in which road gutters, ditches, and streams in too many instances are fouled by sewage, you have not thought it necessary to take legal proceedings for more than two years. Some of the offenders are not particularly amenable to the advice or opinion of your officers. Some of them clear up their nuisances when the final notice is served, and allow them to begin re-accumulating the next day. I f you refer to the Inspectors' books you will find that some half-dozen filth nuisances have, in the aggregate, occupied an enormous amount of time, and yet they are as likely to be on ~he books again next week as they have been at any moment during the past four or five years. There would appear to be a kind of timidity lest, if you proceed against offenders, you may not get a conviction. This certainly cannot apply in the case of offences against the bye-laws, to which you are committed, and they wilt enable you, therefore, to compel obedience where it is now withheld. Bye-laws will also prove useful as a means of education; many persons are anxious to do what is right, but they do not know what is right. The list of proposed bye-laws may come up again for further consideration. In past discussions it has seemed to me there was too great disposition to consider in what manner particular bye-la~cs would affect
I52
R E P O R T S OF M E D I C A L O F F I C E R S OF H E A L T H .
the individual, rather than how far they would be efficient for the protection of the community. I would most respectfully venture to remind you that, as a sanitary authority, you exist for one object, and one object only, the prevention of disease and death. To this end you employ officers to carry out your instructions and the requiremen's of the law. You make bye-laws simply that the law may be more quickly and perfectly applied. The aim is the comfort and happiness of the people, and the conservation of their wealth, in a word, the general well.being of the community. The community pay for these advantages, and they are their right. It is your bounden duty, and the bounden duty of your officers, to use every known method to secure them the possession they have purchased ; and it should not be forgotten that bye-laws, if they are directed against anyone, are directed against those who selfishly deny to others the rights which, as citizens, are theirs. The report has so many interesting details of the sanitary condition of and history of various places in the Isle of Wight, that its attentive perusal by visitors would be of great utility, and it should be for this purpose on sale in the stationers' shops. RAMSGATE.
Population, 25,628; birth-rate, 23 8 ; death-rate, rS"~ ; zymotic rate, r 5. Dr. E. Walford has issued his annual report for the year ~889, in the course of which he asks the earnest consideration of the Sanitary Authority to the present arrangement for the "disposal of infectious cases, he says : In many ways the present arrangement for the disposal of infectious cases throughout the whole Isle of Thanet acts injuriously upon this district, as all the deaths that take place in the hospital, whatever locality the patients may have been sent from, are registered in Ramsgate, thereby unfairly increasing our zymotic death-rate and having an injurious effect on the health reputation of the town. For instance, last year six patients died of typhoid fever in the hospital, of whom no less than five were sent there from another town in the Isle of Thanet, and yet they all have to appear in our statistics. Three deaths from diphtheria and one from scarlet fever also have to appear in them, although the patients were all sent from other districts. Although the hospital is situated in our district, and Ramsgate thereby suffers the serious disadvantages I have pointed out, yet the sanitary authorities have no control over the management of the place, and Ramsgate is not even fairly represented on the joint committee, and its representatives can easily be outvoted on important questions. Such a question has lately arisen. The joint committee, by numerically out-voting
the Ramsgate representatives, have decided to send all the infected bedding, clothing, etc., from Margate, Br~adstairs, and all parts of the Isle of Thanet into our district and get them disinfected at the Northwood tIospital. In plain language they are not content with the privilege of being able to swell our zymotic death-rate to the great benefit of their own, but they are also intending to make us incur the additional risk of receiving infected material which they dare not keep in their own districts. There is no clause in the original agreement between the different sanitary authorities which allows them to act thus, and it is desirable that the council should consider at once whether steps cannot be taken to prevent this action, if necessary, by taking legal measures to restrain them. Small~ex derivedfrem Ostead.--Dr. E. Walford also gives the following interesting history of imported small-pox, and of the measures which were taken to prevent its spread. Students will note in reading this account additional evidence of the great infectiousness of the corpse of a person who has died of small-pox : I Small-pox was imported into the town on two, probably on three, separate occasions from Ostend, and caused a good deal of anxiety to the sanitary authorities in the early part of the spring. On February 2oth, a fishing vessel arrived from Ostend; the following day one of the crew was taken ill at his lodgings in the town, and on the 25th was found to have confluent small-pox. H e was immediately removed to the Northwood Hospital, the bedding, etc., was burnt, and the other inmates of the house were revaccinated. The man died, but, owing to the precautions taken, no one caught the infection from him. In the meantime the vessel had sailed again to the North Sea, but during the few days she was in the harbour the skipper had lodged at the house of his brother-inlaw. Within the next fortnight two cases of smallpox occurred in this house. On March i3th a fresh importation from Ostend took place. The skipper of a Ramsgate fishing vessel, which had lately put into Ostend, was taken ill there. He at once crossed over to Dover by the mail steamer and travelled by train to Ramsgate, arriving there late at night, with the rash developing on his face. He was reported to me at eleven p.m., and by cne a.m. the following morning had been removed to the hospital, and all infected c:othing, etc., removed to the disinfecting chamber, and the members of his family had been revaccinated. No one took the infection from him. On March 2oth, a man and his wife, living in a distant part of the town, were found to be suffering from small-pox. I could not trace the slightest connection between them and the cases which had already occurred. The man was engaged in work at the harbour, and it is more than probable that he had caught the infection there from some fisherman lately come from Ostend.
R E P O R T S OF M E D I C A L O F F I C E R S OF H E A L T H . On March 291h and 3otb, cases were found in two more houses, and on April 161h and 2oth two persons who had been in contact with them also developed the disease. After this date no fresh cases occurred. Altogether seven houses in different parts of the borough were infected, and lO persons caught the disease, including a nurse at the hospital, a workman who helped to remove some infected bedding, and a man who made a coffin for a patient who had died. Four of the patients died. None of them had been re~acccinated. They w e r e (i) Male, aged 24 : only one vaccination mark in infancy. (2) Female, aged 63: vaccinated in infancy ; no marks visible. (3) Male, aged 23 : uncertain ; no marks visible ; he had a severe attack of hemorrhagic small-pox, and died in five days. (4) Male, aged 45: vaccinated in infancy ; two marks visible ; he died t e e months later from lung disease, caused by the attack of small-pox. Eighty-seven persons who had been in direct or indirect communication with the above cases, were revaccinated, and none of them contracted the disease. From enquiries made of the English Consul at Ostend it was ascertained that a severe epidemic was prevailing there at that time, many hundreds of cases having occurred. All fishing vessels arriving from that port were boarded, and in some instances the clothing and belongings of the crews were disinfected before they landed in Ramsgate Halbour. Mr. Councillor Emett, the chairman of the Sanitary Committee, took an active personal interest in these precautions. He not only gave orders that his own vessels were not to go to Ostend, but by his influence most of the Ramsgate smack-ogcners were persuaded to do likewise, and so the danger to which the borough was exposed for about three months was very greatly diminished. WOOLWICH. Population, 1886, 37,212 ; birth-rate, 37"3 ; deathrate, 2o"3 ; zymotic rate, i'3. Dr. W. R. Smith has issued the first annual report of the health of Woolwich, in the course of which he gives the following clear account of the position which it has hitherto occupied, being the only district, until 1889, in which the appointment of a health officer was optional, not compulsory. "Administralion.--Woolwich occupies a unique position in the method of its administration. From 18o 7 to I852 its affairs were managed under a Private Improvement Act. In 1852 a provisional order was obtained for the application of the Public Health Act of 1848 , and the Local Board of Health, which thereupon for sanitary purposes superseded the old Board of Commissioners, has retained its
i53
constitution of 2I members up to the present time, 18 of these are elected by the ratepayers, and three are nominated on behalf of the Government. In the Metropolis Management Act of 1855, Woolwich was scheduled as a Metropolitan parish, and, consequently, in many respects became sub ject to the jurisdiction of the Metropolitan Board of Works. By Section 238 , however, the new powers and duties conferred upon Metropolitan local authorities were not extended to the Woolwich Local Board of Health, except the one of electing a representative on the Metropolitan Board of Works ; and, on the other hand, because of its Metropolitan position, the Public Health Acts of 1872 and 1875, which consolidated public health law in England generally, have no application in this district except in a few unimportant particulars. By the Local Government Act of i888, the Metropolitan Board of Works was abolished, the London County Council succeeding to its duties, the Parliamentary borough of Woolwich being represented on that body by two members, who may not necessarily have any connection with the Local Board ; and thus, in many matters affecting the health interest of the district, the Local Board, although the Local Sanitary Authority, may have no voice nor exercise any control. Perhaps the chief anomaly resulting from the singular position occupied by Woolwich in respect of sanitary law was the absence of any obligation upon the Local Board to appoint a medical officer of health, although a permissive provision existed in the Public Health Act of i848 by which the Board could have appointed such an officer ; this provision, however, was not acted upon, and it was not until the passing of the Infectious Disease (Notification) Act, I889, the Board was obliged by Section ~2 to appoint such an officer, and on Tuesday, October 291h, i889, I had the honour of being elected your first medical officer of health." Dr. Smith, on appointment, set to work to organize the department. An additional inspector was p.rovided, and a systematic house to house inspectmn was made. As might be expected, a number of sanitary defects were discovered, some over-crowding, a considerable deficiency of water supply to closets, and ash receptacles. The closets, it appears, are mostly of the long hopper kind, a pattern which more particularly requires an abundant water supply to keep clean and in working order. House Refuse. M The removal of house refuse from the town is effected by contract, at a cost to North Woolwich of .~$38 lOS. per annum, and to South Woolwich by barges at a cost of one shilling per cubic yard, which amounted in the year i889 to A~,oso x6s., this latter sum being independent of the provision by the Board of twelve men and eight horses and carts specially for the purpose of collection, at an estimated cost of ;~r,268 I6s.
154
R E P O R T S OF M E D I C A L OFFICERS OF H E A L T H .
The total cost for the collection and removal of house refuse is therefore very great, being no less during the year 1889 than .~2,358 2s. ; and Dr. Smith considers it a question for serious consideration whether or not a less expensive and more desirable method should be adopted, by which the town refuse should be burnt within their own area, and the product utilized for building sites. Sewerage.--The district on the south side of the river was sewered in I853--54. The local branch sewers are of socketed pipes, varying in diameter from ten inches to two feet. The mains are carried down the front streets, with branches extending into each back street, so that the passage of drains beneath the houses is as far as possible avoided. These sewers join the main southern outfall sewer in its passage to Crossness. The sewage of North Woolwich, together with that of a considerable district under the jurisdiction of the East H a m Local Board, is discharged by a common sewer straight into the Thames. This sewer is fide-locked at high water, and the sewer is consequently for the last 400 feet of its length enlarged to the dimensions of a tank so as to provide for the consequent retention of sewage. Houses Let in Lodgings.--Dr. Smith strongly recommends the authority to put in force bye-laws which were made so long ago as i869, but which have been a dead letter. These bye-laws Dr. Smith has amended to suit modern requirements.
Isolation of Infectious Cases in f-fospitaL--Here Dr. Smith meets with quite a novel difficulty. H e says there is one cause in operation at Woolwich which has a tendency to operate against the isolation of cases of an infectious nature. The Government authorities at the Arsenal, evidently with the desire of preventing the spread of such diseases amongst the men in their employ, require their employ6s, upon the occurrence of any infectious disease in their households, to abstain from going to work, and payment is made to any such person during his enforced absence, of a certain proportion of his wages. To supplement this Government allowance, an infectious sick club has been formed in each department of the Arsenal, and consequently it may, and, in fact, generally does happen, that under these circumstances a workman may actually be in receipt weekly of a larger sum of money than he would have been in receipt of if at work ; an inducement is thus provided for cases of an infectious character to be retained, which, under other circumstances, would probably have been iso]ated, and the inhabitants generally are exposed to a grave danger, not alone from the retention of such a cause of infection, but also from the additional fact that the other inmates of the infected premises are walking about the district, if only for the purchase of the necessary articles of food and clothing. Dr. Smith thinks that, in view of the fact that
proper provision is now made for the isolation of cases of infectious disease, the time has perhaps come for the Government to re-consider their action in these cases, by which at present the enforced idleness of their employ6s is encouraged in most cases for a period at least of six weeks. The Disinfeclion Process hitherto carried out has been most unsatisfactory. It has consisted in the pouring of sulphuric acid upon a plate containing some McDougali's powder, and allowing the gases thus generated to escape into the infected room for a period of some three or four hours. Only occasionally has the bedding and clothing been removed to the hot-air chamber of the Board for disinfection. From the whole report it" is evident that Woolwich has hitherto been in a low sta~e of sanitation, and that the administrative body has wasted much public money from want of skilled advice. It is perfectly true that a local authority may go on for years without an efficient health officer, and the district show no marked deviation from others in the death-rate, or even show any undue incidence of preventable disease. But during this time the authority is either not providing for the comfort of the ratepayers in keeping the district free from nuisarices, or neglecting to provide proper water supply or facilities for sewage disposal, or else it is spending money rashly. It is not creditable to the intelligence of the representatives of Woolwich that compulsion was needed before they elected a health officer. We are, however, glad to find that once they had to do it, they elected one so well qualified to guide them in the right direction. THE RATIONAL DRESS SOCmTY.--A new society has been formed, of which Miss Glynn is Hon. Secretary, and the leading idea of which would seem to be to dress sensibly, and especially to wear no stays. Lady Harburton, who spoke at the first meeting of the Society, thought that its objects were not sufficiently thorough to work any radical change for the better. In this remark there may be some truth ; at all events it might not be out of place to add to the Society's programme the prohibition of cosmetics; the lavish powder some middle-aged ladies bestow on their faces is neither cleanly nor becoming. It may be useful to call to mind past legislation on the subject. An Act was passed in 177o, which enacted, " T h a t all women of whatever age, rank, profession or degree, whether virgins, maids, or widows, that shall from and after such Act, impose upon, seduce and betray into matrimony any of his majesty's subjects by scents, paints, cosmetics, washes, artificial teeth, false hair, iron stays, hoops, high-heeled shoes, bolstered hips, shall incur the penalty of the law now in force against witchcraft and like misdemeanours, and that the marriage upon conviction shall stand null and void."
Cridland states (Cons. Rep., No. 668), that in consequence of the adoption at Charleston of the Holt system (fully described in PUBLIC HEALTH, Vol. I., 368) for the disinfection of vessels arriving at the quarantine station of the port from infected places, and now in operation, vessels, which heretofore were detained for io, i5, 3 o, or 60 days before obtaining permission to come up to the port, are disinfected by t h e new process so thoroughly that all danger is removed in a few days--probably five days being the limit.
REPORTS
OF
MEDICAL HEALTH.
i5~
OFFICERS
OF
ISLE OF WIGHT.
Population, 1889, z8"396; birth-rate, 27"! ; death-rate, i6" 5. The annual report for x889 of the rural sanitary district of the Isle of Wight, by Dr. Joseph Groves, is a very complete, candid exposition. He is able to chronicle distinct advances in local administration--the Authority has adopted the Notification Act; routine proceedings are delegated to a committee; and the board have, therefore, more leisure to consider larger questions. In a portion of the district in which no water could be had, save from ditches or fouled streams, for ordinary domestic purposes, the well supply being deficient in quantity, the Authority has taken measures to provide the houses with rain water. There are still reforms needed. Dr. Groves urges strongly the adoption of proper bye-laws, saying : - I agree with your committee who considered my last annual report, that "bye-laws are absolutely necessary in the rural sanitary district for the health and prosperity of the Island." It is somewhat remarkable that in a large district like yours, made up not only of rural but of urban areas, in which speculative building operations have gone on without the slightest control, a district on the borders of which are" considerable towns which shoot a good deal of their filth into it, a district in which road gutters, ditches, and streams in too many instances are fouled by sewage, you have not thought it necessary to take legal proceedings for more than two years. Some of the offenders are not particularly amenable to the advice or opinion of your officers. Some of them clear up their nuisances when the final notice is served, and allow them to begin re-accumulating the next day. I f you refer to the Inspectors' books you will find that some half-dozen filth nuisances have, in the aggregate, occupied an enormous amount of time, and yet they are as likely to be on ~he books again next week as they have been at any moment during the past four or five years. There would appear to be a kind of timidity lest, if you proceed against offenders, you may not get a conviction. This certainly cannot apply in the case of offences against the bye-laws, to which you are committed, and they wilt enable you, therefore, to compel obedience where it is now withheld. Bye-laws will also prove useful as a means of education; many persons are anxious to do what is right, but they do not know what is right. The list of proposed bye-laws may come up again for further consideration. In past discussions it has seemed to me there was too great disposition to consider in what manner particular bye-la~cs would affect
I52
R E P O R T S OF M E D I C A L O F F I C E R S OF H E A L T H .
the individual, rather than how far they would be efficient for the protection of the community. I would most respectfully venture to remind you that, as a sanitary authority, you exist for one object, and one object only, the prevention of disease and death. To this end you employ officers to carry out your instructions and the requiremen's of the law. You make bye-laws simply that the law may be more quickly and perfectly applied. The aim is the comfort and happiness of the people, and the conservation of their wealth, in a word, the general well.being of the community. The community pay for these advantages, and they are their right. It is your bounden duty, and the bounden duty of your officers, to use every known method to secure them the possession they have purchased ; and it should not be forgotten that bye-laws, if they are directed against anyone, are directed against those who selfishly deny to others the rights which, as citizens, are theirs. The report has so many interesting details of the sanitary condition of and history of various places in the Isle of Wight, that its attentive perusal by visitors would be of great utility, and it should be for this purpose on sale in the stationers' shops. RAMSGATE.
Population, 25,628; birth-rate, 23 8 ; death-rate, rS"~ ; zymotic rate, r 5. Dr. E. Walford has issued his annual report for the year ~889, in the course of which he asks the earnest consideration of the Sanitary Authority to the present arrangement for the "disposal of infectious cases, he says : In many ways the present arrangement for the disposal of infectious cases throughout the whole Isle of Thanet acts injuriously upon this district, as all the deaths that take place in the hospital, whatever locality the patients may have been sent from, are registered in Ramsgate, thereby unfairly increasing our zymotic death-rate and having an injurious effect on the health reputation of the town. For instance, last year six patients died of typhoid fever in the hospital, of whom no less than five were sent there from another town in the Isle of Thanet, and yet they all have to appear in our statistics. Three deaths from diphtheria and one from scarlet fever also have to appear in them, although the patients were all sent from other districts. Although the hospital is situated in our district, and Ramsgate thereby suffers the serious disadvantages I have pointed out, yet the sanitary authorities have no control over the management of the place, and Ramsgate is not even fairly represented on the joint committee, and its representatives can easily be outvoted on important questions. Such a question has lately arisen. The joint committee, by numerically out-voting
the Ramsgate representatives, have decided to send all the infected bedding, clothing, etc., from Margate, Br~adstairs, and all parts of the Isle of Thanet into our district and get them disinfected at the Northwood tIospital. In plain language they are not content with the privilege of being able to swell our zymotic death-rate to the great benefit of their own, but they are also intending to make us incur the additional risk of receiving infected material which they dare not keep in their own districts. There is no clause in the original agreement between the different sanitary authorities which allows them to act thus, and it is desirable that the council should consider at once whether steps cannot be taken to prevent this action, if necessary, by taking legal measures to restrain them. Small~ex derivedfrem Ostead.--Dr. E. Walford also gives the following interesting history of imported small-pox, and of the measures which were taken to prevent its spread. Students will note in reading this account additional evidence of the great infectiousness of the corpse of a person who has died of small-pox : I Small-pox was imported into the town on two, probably on three, separate occasions from Ostend, and caused a good deal of anxiety to the sanitary authorities in the early part of the spring. On February 2oth, a fishing vessel arrived from Ostend; the following day one of the crew was taken ill at his lodgings in the town, and on the 25th was found to have confluent small-pox. H e was immediately removed to the Northwood Hospital, the bedding, etc., was burnt, and the other inmates of the house were revaccinated. The man died, but, owing to the precautions taken, no one caught the infection from him. In the meantime the vessel had sailed again to the North Sea, but during the few days she was in the harbour the skipper had lodged at the house of his brother-inlaw. Within the next fortnight two cases of smallpox occurred in this house. On March i3th a fresh importation from Ostend took place. The skipper of a Ramsgate fishing vessel, which had lately put into Ostend, was taken ill there. He at once crossed over to Dover by the mail steamer and travelled by train to Ramsgate, arriving there late at night, with the rash developing on his face. He was reported to me at eleven p.m., and by cne a.m. the following morning had been removed to the hospital, and all infected c:othing, etc., removed to the disinfecting chamber, and the members of his family had been revaccinated. No one took the infection from him. On March 2oth, a man and his wife, living in a distant part of the town, were found to be suffering from small-pox. I could not trace the slightest connection between them and the cases which had already occurred. The man was engaged in work at the harbour, and it is more than probable that he had caught the infection there from some fisherman lately come from Ostend.
R E P O R T S OF M E D I C A L O F F I C E R S OF H E A L T H . On March 291h and 3otb, cases were found in two more houses, and on April 161h and 2oth two persons who had been in contact with them also developed the disease. After this date no fresh cases occurred. Altogether seven houses in different parts of the borough were infected, and lO persons caught the disease, including a nurse at the hospital, a workman who helped to remove some infected bedding, and a man who made a coffin for a patient who had died. Four of the patients died. None of them had been re~acccinated. They w e r e (i) Male, aged 24 : only one vaccination mark in infancy. (2) Female, aged 63: vaccinated in infancy ; no marks visible. (3) Male, aged 23 : uncertain ; no marks visible ; he had a severe attack of hemorrhagic small-pox, and died in five days. (4) Male, aged 45: vaccinated in infancy ; two marks visible ; he died t e e months later from lung disease, caused by the attack of small-pox. Eighty-seven persons who had been in direct or indirect communication with the above cases, were revaccinated, and none of them contracted the disease. From enquiries made of the English Consul at Ostend it was ascertained that a severe epidemic was prevailing there at that time, many hundreds of cases having occurred. All fishing vessels arriving from that port were boarded, and in some instances the clothing and belongings of the crews were disinfected before they landed in Ramsgate Halbour. Mr. Councillor Emett, the chairman of the Sanitary Committee, took an active personal interest in these precautions. He not only gave orders that his own vessels were not to go to Ostend, but by his influence most of the Ramsgate smack-ogcners were persuaded to do likewise, and so the danger to which the borough was exposed for about three months was very greatly diminished. WOOLWICH. Population, 1886, 37,212 ; birth-rate, 37"3 ; deathrate, 2o"3 ; zymotic rate, i'3. Dr. W. R. Smith has issued the first annual report of the health of Woolwich, in the course of which he gives the following clear account of the position which it has hitherto occupied, being the only district, until 1889, in which the appointment of a health officer was optional, not compulsory. "Administralion.--Woolwich occupies a unique position in the method of its administration. From 18o 7 to I852 its affairs were managed under a Private Improvement Act. In 1852 a provisional order was obtained for the application of the Public Health Act of 1848 , and the Local Board of Health, which thereupon for sanitary purposes superseded the old Board of Commissioners, has retained its
i53
constitution of 2I members up to the present time, 18 of these are elected by the ratepayers, and three are nominated on behalf of the Government. In the Metropolis Management Act of 1855, Woolwich was scheduled as a Metropolitan parish, and, consequently, in many respects became sub ject to the jurisdiction of the Metropolitan Board of Works. By Section 238 , however, the new powers and duties conferred upon Metropolitan local authorities were not extended to the Woolwich Local Board of Health, except the one of electing a representative on the Metropolitan Board of Works ; and, on the other hand, because of its Metropolitan position, the Public Health Acts of 1872 and 1875, which consolidated public health law in England generally, have no application in this district except in a few unimportant particulars. By the Local Government Act of i888, the Metropolitan Board of Works was abolished, the London County Council succeeding to its duties, the Parliamentary borough of Woolwich being represented on that body by two members, who may not necessarily have any connection with the Local Board ; and thus, in many matters affecting the health interest of the district, the Local Board, although the Local Sanitary Authority, may have no voice nor exercise any control. Perhaps the chief anomaly resulting from the singular position occupied by Woolwich in respect of sanitary law was the absence of any obligation upon the Local Board to appoint a medical officer of health, although a permissive provision existed in the Public Health Act of i848 by which the Board could have appointed such an officer ; this provision, however, was not acted upon, and it was not until the passing of the Infectious Disease (Notification) Act, I889, the Board was obliged by Section ~2 to appoint such an officer, and on Tuesday, October 291h, i889, I had the honour of being elected your first medical officer of health." Dr. Smith, on appointment, set to work to organize the department. An additional inspector was p.rovided, and a systematic house to house inspectmn was made. As might be expected, a number of sanitary defects were discovered, some over-crowding, a considerable deficiency of water supply to closets, and ash receptacles. The closets, it appears, are mostly of the long hopper kind, a pattern which more particularly requires an abundant water supply to keep clean and in working order. House Refuse. M The removal of house refuse from the town is effected by contract, at a cost to North Woolwich of .~$38 lOS. per annum, and to South Woolwich by barges at a cost of one shilling per cubic yard, which amounted in the year i889 to A~,oso x6s., this latter sum being independent of the provision by the Board of twelve men and eight horses and carts specially for the purpose of collection, at an estimated cost of ;~r,268 I6s.
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R E P O R T S OF M E D I C A L OFFICERS OF H E A L T H .
The total cost for the collection and removal of house refuse is therefore very great, being no less during the year 1889 than .~2,358 2s. ; and Dr. Smith considers it a question for serious consideration whether or not a less expensive and more desirable method should be adopted, by which the town refuse should be burnt within their own area, and the product utilized for building sites. Sewerage.--The district on the south side of the river was sewered in I853--54. The local branch sewers are of socketed pipes, varying in diameter from ten inches to two feet. The mains are carried down the front streets, with branches extending into each back street, so that the passage of drains beneath the houses is as far as possible avoided. These sewers join the main southern outfall sewer in its passage to Crossness. The sewage of North Woolwich, together with that of a considerable district under the jurisdiction of the East H a m Local Board, is discharged by a common sewer straight into the Thames. This sewer is fide-locked at high water, and the sewer is consequently for the last 400 feet of its length enlarged to the dimensions of a tank so as to provide for the consequent retention of sewage. Houses Let in Lodgings.--Dr. Smith strongly recommends the authority to put in force bye-laws which were made so long ago as i869, but which have been a dead letter. These bye-laws Dr. Smith has amended to suit modern requirements.
Isolation of Infectious Cases in f-fospitaL--Here Dr. Smith meets with quite a novel difficulty. H e says there is one cause in operation at Woolwich which has a tendency to operate against the isolation of cases of an infectious nature. The Government authorities at the Arsenal, evidently with the desire of preventing the spread of such diseases amongst the men in their employ, require their employ6s, upon the occurrence of any infectious disease in their households, to abstain from going to work, and payment is made to any such person during his enforced absence, of a certain proportion of his wages. To supplement this Government allowance, an infectious sick club has been formed in each department of the Arsenal, and consequently it may, and, in fact, generally does happen, that under these circumstances a workman may actually be in receipt weekly of a larger sum of money than he would have been in receipt of if at work ; an inducement is thus provided for cases of an infectious character to be retained, which, under other circumstances, would probably have been iso]ated, and the inhabitants generally are exposed to a grave danger, not alone from the retention of such a cause of infection, but also from the additional fact that the other inmates of the infected premises are walking about the district, if only for the purchase of the necessary articles of food and clothing. Dr. Smith thinks that, in view of the fact that
proper provision is now made for the isolation of cases of infectious disease, the time has perhaps come for the Government to re-consider their action in these cases, by which at present the enforced idleness of their employ6s is encouraged in most cases for a period at least of six weeks. The Disinfeclion Process hitherto carried out has been most unsatisfactory. It has consisted in the pouring of sulphuric acid upon a plate containing some McDougali's powder, and allowing the gases thus generated to escape into the infected room for a period of some three or four hours. Only occasionally has the bedding and clothing been removed to the hot-air chamber of the Board for disinfection. From the whole report it" is evident that Woolwich has hitherto been in a low sta~e of sanitation, and that the administrative body has wasted much public money from want of skilled advice. It is perfectly true that a local authority may go on for years without an efficient health officer, and the district show no marked deviation from others in the death-rate, or even show any undue incidence of preventable disease. But during this time the authority is either not providing for the comfort of the ratepayers in keeping the district free from nuisarices, or neglecting to provide proper water supply or facilities for sewage disposal, or else it is spending money rashly. It is not creditable to the intelligence of the representatives of Woolwich that compulsion was needed before they elected a health officer. We are, however, glad to find that once they had to do it, they elected one so well qualified to guide them in the right direction. THE RATIONAL DRESS SOCmTY.--A new society has been formed, of which Miss Glynn is Hon. Secretary, and the leading idea of which would seem to be to dress sensibly, and especially to wear no stays. Lady Harburton, who spoke at the first meeting of the Society, thought that its objects were not sufficiently thorough to work any radical change for the better. In this remark there may be some truth ; at all events it might not be out of place to add to the Society's programme the prohibition of cosmetics; the lavish powder some middle-aged ladies bestow on their faces is neither cleanly nor becoming. It may be useful to call to mind past legislation on the subject. An Act was passed in 177o, which enacted, " T h a t all women of whatever age, rank, profession or degree, whether virgins, maids, or widows, that shall from and after such Act, impose upon, seduce and betray into matrimony any of his majesty's subjects by scents, paints, cosmetics, washes, artificial teeth, false hair, iron stays, hoops, high-heeled shoes, bolstered hips, shall incur the penalty of the law now in force against witchcraft and like misdemeanours, and that the marriage upon conviction shall stand null and void."