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THE CHELSEA HOSPITAL FOR WOMEN.
160
THE LONDON COUNTY COUNCIL.
and Mr. Joseph Griffiths ; Professor of Comparative Anatomy and Physiology, Mr. Charles Stewart ; Lecturer on Anatomy and Physiology (Arris and Gale), Mr. W. G. Spencer ; and Erasmus Wilson Lecturer, Mr. J. H. Targett. The Regulations of the Council, section 24, relating to the meetings of Members as prepared by the President and VicePresidents in pursuance of the resolution of the Council on the 14th ult., were approved and adopted. The consideration of the proceedings at the half-yearly meetings of Fellows on the 5th inst., was postponed. As announced in our last issue, Mr. J. Whitaker Hulke was re-elected President, and Mr. Reginald Harrison, and Mr. Alfred Willett were elected Vice-Presidents for the ensuing year. Mr. J. H. Targett was reappointed Pathological Curator.
THE LONDON COUNTY COUNCIL. CONFERENCE BETWEEN THE PUBLIC HEALTH COMMITTEE OF THE COUNCIL AND REPRESENTATIVES OF VARIOUS COUNTY COUNCILS AND SANITARY AUTHORITIES.
upon the keepers of common lodging-houses or shelters to refuse fresh admissions, and another suggestion was to the effect that the local authority should be empowered to cause In the case ot the Drury-lane such buildings to be shut. lodging-house the council refused to admit fresh cases, but they did not actually close it or send away cases actually in the building at the time of the outbreak. This plan was effective in stopping the epidemic, and the cost entailed upon the ratepayers by the County Council’s action was probably recouped over and over again by the saving of life in preventing the spread of the disease among the population of London. In the case of private houses, however, it was proposed that the owners should be recouped in some way, and this, it may be remarked, was in accordance with a resolution recently passed by the Incorporated Society of the Medical Officers of Health empowering sanitary authorities to compensate in case of expenses incurred under the Public Health Acts. This power is also given to authorities under the Public Health Act. If the Council’s plan were adopted, the local authority would supply some sort of certificate on which it would be stated that on a certain day a particular house was in a sanitary condition. Dr. Niven did not think much advantage would be obtained from this suggestion, if lodging-houses other than common lodging-houses were not included in the suggestion. The whole powers implied in the suggestion seemed to be already embodied in the by laws of the Public Health Act. The suggestion, " that the local authority should have power to order the keeper of a common lodginghouse, in which there has been infectious disease, to refuse fresh admissions for such time as may be required by the authority," was ultimately adopted by the conference. At the afternoon sitting the question of the detention of vagrants exposed to infection by local authorities was discussed, and the conference adopted a resolution in favour of the proceeding. The questions of vagrancy tickets and of the vaccination of tramps were also discussed, but no resolutions
ON Thursday last, at the County Hall, Spring Gardens, there was opened a most important meeting, over which Sir John Hutton, Chairman of the London County Council, presided, and one which may result in considerable modification in our risks from a notorious method of spread of infection. The London County Council has summoned to a conference with its public health committee representatives of those county councls whose interest in sanitary affairs has impelled them to appoint a medical officer of health for their counties, and has asked them to consider what means, if any, can be adopted to prevent the spread of infectious diseases by vagrants. The subject is one of imminent interest, and has were passed. for some time been receiving the earnest attention of medical officers of health. The medical officer of health for Newcastle has recently presented a report to the council of that city detailing many points bearing upon the matter, and THE CHELSEA HOSPITAL FOR WOMEN. in reports to the London County Council last year on the prevalence of small-pox their medical officer pointed WE have received from the Secretary of the Chelsea to the spread of the disease by vagrants. for Women a copy of the report rendered by the Hospital The following points have been set down for discussion, and though the lines thus suggested will inevitably be committee of inquiry appointed by the house-committee left in more than one direction, they show the practical to investigate the statements made by Dr. Louis Parkes nature of the questions which the assembled sanitarians pro- relative to the sanitary condition and mortality statistics of These statements were contained in an pose to answer : 1. The compulsory notification by a vagrant the hospital. when leaving a casual ward or common lodging-house of his official by Dr. Parkes, their medical presented report destination. 2. His compulsory detention when exposed to and public analyst, to the Chelsea officer of health a dangerous infectious disease. 3. His compulsory vaccination. 4. The disinfection of his clothes. 5’. The regulation Vestry, on Feb. 6th of this year, and will be found enuand supervision of common shelters not subject to the laws merated in THE LANCET of Feb. 10th. As a result of Dr. Parkes’s report, a committee of inquiry, consisting of Lord relating to common lodging-houses. The first point to which the conference devoted its atten- Balfour of Burleigh, Lord Sandhurst, Sir Charles Wenttion was the consideration of the proposal that common worth Dilke, Dr. (now Sir) John Williams, Mr. H. G. Howse, shelters which are not subject to the law relating to common F.R.C.S., and Mr. J. H. Brass, was appointed by the hospital lodging-houses should be made subject to law. This was authorities, and the result of their action is now before us. The report deals with Dr. Parkes’s statements under two carried unanimously. The next business was a motion by Dr. Seaton, which was heads: (1) the general sanitary state of the hospital ; and seconded by Dr. Armstrong, that in times of prevalence of in- (2) the mortality statistics of the patients in the hospital fectious disease there should be a medical examination of all with special regard to the deaths among the inmates persons entering common lodging-houses and casual wards. upon whom surgical operations had been performed. Under The discussion excited a considerable amount of interest in the the first head the committee of inquiry find Dr. Louis conference. Various amendments were moved. One speaker Parkes to have been practically justified in his course. In proposed that the common lodging-houses should be exempt their opinion it was clearly his plain duty to call the from this examination on the ground that it was impracticable, attention of the hospital authorities to the matter, and in and another speaker wanted to know what authority could the event of their refusing prompt attention to make a undertake the task of examining, as in London, millions of formal appeal to the vestry. The committee do not, howcasuals. Various suggestions on this point were submitted. ever, understand why Dr. Parkes recommended that notice The difficulty was got over by Mr. Beachcroft’s proposal, which should be served under the Public Health (London) Act was carried without any dissentient voice, to make the upon the hospital authorities at a time when the hospital resolution read that "there should be power to the local was, and had been for three weeks, empty of patients. authorities to require medical examination of all persons Under the second head the committee of inquiry also arrive at findings whose net result is distinctly adverse entering common lodging-houses and casual wards." Dr. Armstrong moved that on admission each inmate to the hospital and its staff. They consider the should be allowed the luxury of a bath of clean water. He death-rate high under several operative heads. The mentioned a case where twelve persons had bathed in water occurrence of septicaemia they point out not to have in which two small-pox vagrants had performed their ablu- been general and prevalent in the practice of all the staff, tions. The conference decided that cleanliness being neces- a fact which has at any rate a favourable bearing upon sary also during the intervening period the luxury in question the sanitary state of the building. They find the adminisshould not be limited to times of epidemics. tration of the hospital generally to leave much to be desired. One of the suggestions set down for discussion proposed The committee of management in their opinion do not meet that powers should be given to the local authority to call sufficiently frequently, and the house-committee was very
REPORTS OF MEDICAL INSPECTORS.
161
by means of which the infection of diphtheria was conveyed, and he arrives at the conclusion that the disease was probably related, in so far as its origin was concerned, with those throat affections which had antecedently prevailed amongst the measles patients and amongst some of the scarlet fever patients or that it was newly brought into the town. Of the cases investigated 89 per cent. were amongst children of fourteen years or under and the disease was entirely confined to the working classes ; in short, it was practically limited to those who, by reason both of social status and of age, were attending the elementary public schools. Inquiry into school attendances as a means for diffusion of the infection showed, amongst other things, that, out of forty-four children who were the first to be attacked, in their respective families no less than forty-three were in attendance at one or other of the elementary schools. No special sanitary defects were discovered at these schools ; but it is now well known that, quite apart from these, schools have a tendency to intensify the infective quality of diphtheria which amply We have only accounts for the diffusion of the disease. touched on one part of the extremely interesting investigaLOCAL GOVERNMENT DEPARTMENT. tion made by Dr. Wheaton. The report deals with other points and takes in the question of diphtheria in the rural C also. It merits and will repay careful perusal. REPORTS OF INSPECTORS OF THE MEDICAL DEPARTMENT district
The medical record of the cases they consider to have been kept in a completely satisfactory manner. It is obvious that the result of this report must be some decisive action on the part of the hospital authorities. An unimpeachable practical committee of inquiry have found that the hospital in more than one important direction sadly wants setting in order, and as officers responsible to the public for the good management of an institution supported by the public, the authorities must take early steps to effect this end. A meeting of the board of management of the hospital, under the presidency of the Earl of Cadogan, K.G., was held on Wednesday last to consider the report; and a special general meeting of the governors is convened for an early date with the same view.
scantily attended.
not constitute the vehicle
Public H ealth and Poor Law.
OF THE LOCAL GOVERNMENT BOARD.
On -Diphtheria in the Hinckley Urban and Rural Districts, by Dr. S. W. WHEATON.1-Dr. Wheaton’s report deals in i much detail with all the circumstances of a prevalence of diphtheria which appeared at first sight at least to be complicated with antecedent measles and diphtheria, and whicht presented many points of etiological interest. The town of 1 Hinckley is first described. Apart from its water-supply, is good, nearly every sanitary circumstance was found to bei faulty. Imperfect sewers, a defective condition of sewerage( as a whole, deposits of sewer contents, foul effluvia from sewer ventilators, and in some old parts of the town bad house drainage were revealed as the result of inquiry ; a damp soil 1‘ rendered more damp by overflows from rain-tanks, damp house walls, a soil sodden with filth by reason of leakage from drains, and stagnant water on the ground surface were conditions which affected a large number of houses ; in short, the old part of the town and some of the newer parts presented health conditions of a most imperfect character. In February, 1893, there was a death from diphtheria; then there was a cessation, but between Sept. 14th and Nov. 30th the year’s death-roll from that disease was made up to twenty-eight, and it became evident that the attacks had numbered between two and three hundred. In 1892 there had been much measles, and the disease had been marked by a septic exudation on the fauces and throat which was regarded as of a diphtheritic nature. No paralytic symptoms had, however, ensued. Then followed 178 attacks of scarlet fever, but these were not especially identified with throat symptoms. There were, however, a few fatal cases in which malignant throat affections ensued, and in one case a death was registered as due to scarlet fever and diphtheria. The septic sore-throats during the measles outbreak in 1892 seemed to have been associated with local sanitary defects, but the epidemic of diphtheria in the autumn and closing months of 1893 was scattered almost indiscriminately over the whole town. Owing to the somewhat widely prevailing view as to the relation of sewer and drain emanations to diphtheria Dr. Wheaton, after eliminating a number of conditions, such as water, milksupply, &c., dealt somewhat in detail with this subject, and he made personal investigation into seventy-six of the diphtheria attacks. In three invaded houses only did he find any untrapped drain terminating in the dwelling; and he states that in the majority of cases where diphtheria had occurred the house drains were in good condition and efficiently trapped. So also the disease was not especially prevalent where the sewer defects were most marked, and there were special instances, such as the workhouse, where the drains communicated with one of the faulty sewers, where they were themselves defective, and where they were additionally fouled by being made to receive a deposit of privy contents, and where, nevertheless, no case of diphtheria occurred. Whatever, therefore, the influence of the notably faulty sewer and drain conditions in Hinckley, Dr. Wheaton concludes that they did
which
REPORTS OF MEDICAL OFFICERS OF HEALTH.
District.-The
Urban Sanitary infantile mortality Salford for 1893 was higher than for some years past, beingLl per 1000 registered births. The excess is in large part ) be accounted for by the high death-rate from infantile iarrhoea. The death-rate among illegitimate children was na :ss than 397 per 1000 births. Out of a total of 4895 deaths i the district 162 were uncertified either by a medical practiAs regards infectious disease, 49’4 per oner or a coroner. ent. of those cases notified were isolated-a percentage which shows a decided increase on years subsequent to 1887. ’here were two outbursts of typhoid fever in the district in tie months of September and November. In the case of oth these outbreaks several defects in drains were discovered, nd Mr. Paget is inclined to think that the drains acted as gents of dissemination by virtue of the fact that the prolonged drought precluded the efficient flushing of the drains. ,nd sewers. Mr. Paget trusts that with the introduction of he Thirlmere water greater flushing facilities will be obtained. n reference to smoke nuisances thirty-nine firms were re)orted, but, owing to the inferior coal which the prolonged :oal strike necessitated the consumption of, prosecutions were ’or the time being suspended. Mr. Paget’s report contains several spot maps, and also one showing the result of the ;anitary survey of Salford, and setting forth by aid of lifferent colours the mean quinquennial death-rate obtaining n each enumeration district : this map should have great ocal value. The waters of the Manchester Ship Canal were,
Salford
Mr. Paget tells us, peculiarly offensive during the summer months to those parts of the borough situated within half a nile of it, and he expresses a hope that the efforts of the joint board for the Rivers Mersey and Irwell will succeed in reducing the serious pollution of the waters feeding the Ship Canal. Mr. Paget goes on to observe : "The existence of an enormous water-way through the borough of Salford, navigable for ocean-going vessels, may be of material commercial benefit to the community; but the protection of this water-way from such pollutions as may give rise to emanations productive of a general lowering of health in its immediate neighbourhood is of no less importance to the welfare of the borough." Blackpool Urban Sanitary District.-Mr. Jasper Anderson remarks with regard to the infantile mortality in Blackpool during 1893 that the dry, hot summer of the year in question brought about a high mortality, the rate being 192-8 per 1000 births. The mortality was most marked during the third quarter of the year, and Mr. Anderson thinks that the excess is connected with the overcrowding and maternal neglect produced by the influx of visitors. The death-rate among illegitimate children was no less than 314’6 per 1000 births-in other words, as Mr. Anderson observes, an illegitimate child has but half the probability of reaching the age of twelve months as one born in wedlock. A table is also given in the report before us showing ages in months of the infants who died during the first year of life, and from this it appears that, out of a total of 123 deaths, no less than 29 died before attaining the age of one month. In regard to 1 Eyre and Spottiswoode, East Harding-street, E.C.; John Menzies and Co., Edinburgh and Glasgow; Hodges, Figgis and Co., Dublin. 6d. infectious disease, an important point has been gained by the
THE LONDON COUNTY COUNCIL.
and Mr. Joseph Griffiths ; Professor of Comparative Anatomy and Physiology, Mr. Charles Stewart ; Lecturer on Anatomy and Physiology (Arris and Gale), Mr. W. G. Spencer ; and Erasmus Wilson Lecturer, Mr. J. H. Targett. The Regulations of the Council, section 24, relating to the meetings of Members as prepared by the President and VicePresidents in pursuance of the resolution of the Council on the 14th ult., were approved and adopted. The consideration of the proceedings at the half-yearly meetings of Fellows on the 5th inst., was postponed. As announced in our last issue, Mr. J. Whitaker Hulke was re-elected President, and Mr. Reginald Harrison, and Mr. Alfred Willett were elected Vice-Presidents for the ensuing year. Mr. J. H. Targett was reappointed Pathological Curator.
THE LONDON COUNTY COUNCIL. CONFERENCE BETWEEN THE PUBLIC HEALTH COMMITTEE OF THE COUNCIL AND REPRESENTATIVES OF VARIOUS COUNTY COUNCILS AND SANITARY AUTHORITIES.
upon the keepers of common lodging-houses or shelters to refuse fresh admissions, and another suggestion was to the effect that the local authority should be empowered to cause In the case ot the Drury-lane such buildings to be shut. lodging-house the council refused to admit fresh cases, but they did not actually close it or send away cases actually in the building at the time of the outbreak. This plan was effective in stopping the epidemic, and the cost entailed upon the ratepayers by the County Council’s action was probably recouped over and over again by the saving of life in preventing the spread of the disease among the population of London. In the case of private houses, however, it was proposed that the owners should be recouped in some way, and this, it may be remarked, was in accordance with a resolution recently passed by the Incorporated Society of the Medical Officers of Health empowering sanitary authorities to compensate in case of expenses incurred under the Public Health Acts. This power is also given to authorities under the Public Health Act. If the Council’s plan were adopted, the local authority would supply some sort of certificate on which it would be stated that on a certain day a particular house was in a sanitary condition. Dr. Niven did not think much advantage would be obtained from this suggestion, if lodging-houses other than common lodging-houses were not included in the suggestion. The whole powers implied in the suggestion seemed to be already embodied in the by laws of the Public Health Act. The suggestion, " that the local authority should have power to order the keeper of a common lodginghouse, in which there has been infectious disease, to refuse fresh admissions for such time as may be required by the authority," was ultimately adopted by the conference. At the afternoon sitting the question of the detention of vagrants exposed to infection by local authorities was discussed, and the conference adopted a resolution in favour of the proceeding. The questions of vagrancy tickets and of the vaccination of tramps were also discussed, but no resolutions
ON Thursday last, at the County Hall, Spring Gardens, there was opened a most important meeting, over which Sir John Hutton, Chairman of the London County Council, presided, and one which may result in considerable modification in our risks from a notorious method of spread of infection. The London County Council has summoned to a conference with its public health committee representatives of those county councls whose interest in sanitary affairs has impelled them to appoint a medical officer of health for their counties, and has asked them to consider what means, if any, can be adopted to prevent the spread of infectious diseases by vagrants. The subject is one of imminent interest, and has were passed. for some time been receiving the earnest attention of medical officers of health. The medical officer of health for Newcastle has recently presented a report to the council of that city detailing many points bearing upon the matter, and THE CHELSEA HOSPITAL FOR WOMEN. in reports to the London County Council last year on the prevalence of small-pox their medical officer pointed WE have received from the Secretary of the Chelsea to the spread of the disease by vagrants. for Women a copy of the report rendered by the Hospital The following points have been set down for discussion, and though the lines thus suggested will inevitably be committee of inquiry appointed by the house-committee left in more than one direction, they show the practical to investigate the statements made by Dr. Louis Parkes nature of the questions which the assembled sanitarians pro- relative to the sanitary condition and mortality statistics of These statements were contained in an pose to answer : 1. The compulsory notification by a vagrant the hospital. when leaving a casual ward or common lodging-house of his official by Dr. Parkes, their medical presented report destination. 2. His compulsory detention when exposed to and public analyst, to the Chelsea officer of health a dangerous infectious disease. 3. His compulsory vaccination. 4. The disinfection of his clothes. 5’. The regulation Vestry, on Feb. 6th of this year, and will be found enuand supervision of common shelters not subject to the laws merated in THE LANCET of Feb. 10th. As a result of Dr. Parkes’s report, a committee of inquiry, consisting of Lord relating to common lodging-houses. The first point to which the conference devoted its atten- Balfour of Burleigh, Lord Sandhurst, Sir Charles Wenttion was the consideration of the proposal that common worth Dilke, Dr. (now Sir) John Williams, Mr. H. G. Howse, shelters which are not subject to the law relating to common F.R.C.S., and Mr. J. H. Brass, was appointed by the hospital lodging-houses should be made subject to law. This was authorities, and the result of their action is now before us. The report deals with Dr. Parkes’s statements under two carried unanimously. The next business was a motion by Dr. Seaton, which was heads: (1) the general sanitary state of the hospital ; and seconded by Dr. Armstrong, that in times of prevalence of in- (2) the mortality statistics of the patients in the hospital fectious disease there should be a medical examination of all with special regard to the deaths among the inmates persons entering common lodging-houses and casual wards. upon whom surgical operations had been performed. Under The discussion excited a considerable amount of interest in the the first head the committee of inquiry find Dr. Louis conference. Various amendments were moved. One speaker Parkes to have been practically justified in his course. In proposed that the common lodging-houses should be exempt their opinion it was clearly his plain duty to call the from this examination on the ground that it was impracticable, attention of the hospital authorities to the matter, and in and another speaker wanted to know what authority could the event of their refusing prompt attention to make a undertake the task of examining, as in London, millions of formal appeal to the vestry. The committee do not, howcasuals. Various suggestions on this point were submitted. ever, understand why Dr. Parkes recommended that notice The difficulty was got over by Mr. Beachcroft’s proposal, which should be served under the Public Health (London) Act was carried without any dissentient voice, to make the upon the hospital authorities at a time when the hospital resolution read that "there should be power to the local was, and had been for three weeks, empty of patients. authorities to require medical examination of all persons Under the second head the committee of inquiry also arrive at findings whose net result is distinctly adverse entering common lodging-houses and casual wards." Dr. Armstrong moved that on admission each inmate to the hospital and its staff. They consider the should be allowed the luxury of a bath of clean water. He death-rate high under several operative heads. The mentioned a case where twelve persons had bathed in water occurrence of septicaemia they point out not to have in which two small-pox vagrants had performed their ablu- been general and prevalent in the practice of all the staff, tions. The conference decided that cleanliness being neces- a fact which has at any rate a favourable bearing upon sary also during the intervening period the luxury in question the sanitary state of the building. They find the adminisshould not be limited to times of epidemics. tration of the hospital generally to leave much to be desired. One of the suggestions set down for discussion proposed The committee of management in their opinion do not meet that powers should be given to the local authority to call sufficiently frequently, and the house-committee was very
REPORTS OF MEDICAL INSPECTORS.
161
by means of which the infection of diphtheria was conveyed, and he arrives at the conclusion that the disease was probably related, in so far as its origin was concerned, with those throat affections which had antecedently prevailed amongst the measles patients and amongst some of the scarlet fever patients or that it was newly brought into the town. Of the cases investigated 89 per cent. were amongst children of fourteen years or under and the disease was entirely confined to the working classes ; in short, it was practically limited to those who, by reason both of social status and of age, were attending the elementary public schools. Inquiry into school attendances as a means for diffusion of the infection showed, amongst other things, that, out of forty-four children who were the first to be attacked, in their respective families no less than forty-three were in attendance at one or other of the elementary schools. No special sanitary defects were discovered at these schools ; but it is now well known that, quite apart from these, schools have a tendency to intensify the infective quality of diphtheria which amply We have only accounts for the diffusion of the disease. touched on one part of the extremely interesting investigaLOCAL GOVERNMENT DEPARTMENT. tion made by Dr. Wheaton. The report deals with other points and takes in the question of diphtheria in the rural C also. It merits and will repay careful perusal. REPORTS OF INSPECTORS OF THE MEDICAL DEPARTMENT district
The medical record of the cases they consider to have been kept in a completely satisfactory manner. It is obvious that the result of this report must be some decisive action on the part of the hospital authorities. An unimpeachable practical committee of inquiry have found that the hospital in more than one important direction sadly wants setting in order, and as officers responsible to the public for the good management of an institution supported by the public, the authorities must take early steps to effect this end. A meeting of the board of management of the hospital, under the presidency of the Earl of Cadogan, K.G., was held on Wednesday last to consider the report; and a special general meeting of the governors is convened for an early date with the same view.
scantily attended.
not constitute the vehicle
Public H ealth and Poor Law.
OF THE LOCAL GOVERNMENT BOARD.
On -Diphtheria in the Hinckley Urban and Rural Districts, by Dr. S. W. WHEATON.1-Dr. Wheaton’s report deals in i much detail with all the circumstances of a prevalence of diphtheria which appeared at first sight at least to be complicated with antecedent measles and diphtheria, and whicht presented many points of etiological interest. The town of 1 Hinckley is first described. Apart from its water-supply, is good, nearly every sanitary circumstance was found to bei faulty. Imperfect sewers, a defective condition of sewerage( as a whole, deposits of sewer contents, foul effluvia from sewer ventilators, and in some old parts of the town bad house drainage were revealed as the result of inquiry ; a damp soil 1‘ rendered more damp by overflows from rain-tanks, damp house walls, a soil sodden with filth by reason of leakage from drains, and stagnant water on the ground surface were conditions which affected a large number of houses ; in short, the old part of the town and some of the newer parts presented health conditions of a most imperfect character. In February, 1893, there was a death from diphtheria; then there was a cessation, but between Sept. 14th and Nov. 30th the year’s death-roll from that disease was made up to twenty-eight, and it became evident that the attacks had numbered between two and three hundred. In 1892 there had been much measles, and the disease had been marked by a septic exudation on the fauces and throat which was regarded as of a diphtheritic nature. No paralytic symptoms had, however, ensued. Then followed 178 attacks of scarlet fever, but these were not especially identified with throat symptoms. There were, however, a few fatal cases in which malignant throat affections ensued, and in one case a death was registered as due to scarlet fever and diphtheria. The septic sore-throats during the measles outbreak in 1892 seemed to have been associated with local sanitary defects, but the epidemic of diphtheria in the autumn and closing months of 1893 was scattered almost indiscriminately over the whole town. Owing to the somewhat widely prevailing view as to the relation of sewer and drain emanations to diphtheria Dr. Wheaton, after eliminating a number of conditions, such as water, milksupply, &c., dealt somewhat in detail with this subject, and he made personal investigation into seventy-six of the diphtheria attacks. In three invaded houses only did he find any untrapped drain terminating in the dwelling; and he states that in the majority of cases where diphtheria had occurred the house drains were in good condition and efficiently trapped. So also the disease was not especially prevalent where the sewer defects were most marked, and there were special instances, such as the workhouse, where the drains communicated with one of the faulty sewers, where they were themselves defective, and where they were additionally fouled by being made to receive a deposit of privy contents, and where, nevertheless, no case of diphtheria occurred. Whatever, therefore, the influence of the notably faulty sewer and drain conditions in Hinckley, Dr. Wheaton concludes that they did
which
REPORTS OF MEDICAL OFFICERS OF HEALTH.
District.-The
Urban Sanitary infantile mortality Salford for 1893 was higher than for some years past, beingLl per 1000 registered births. The excess is in large part ) be accounted for by the high death-rate from infantile iarrhoea. The death-rate among illegitimate children was na :ss than 397 per 1000 births. Out of a total of 4895 deaths i the district 162 were uncertified either by a medical practiAs regards infectious disease, 49’4 per oner or a coroner. ent. of those cases notified were isolated-a percentage which shows a decided increase on years subsequent to 1887. ’here were two outbursts of typhoid fever in the district in tie months of September and November. In the case of oth these outbreaks several defects in drains were discovered, nd Mr. Paget is inclined to think that the drains acted as gents of dissemination by virtue of the fact that the prolonged drought precluded the efficient flushing of the drains. ,nd sewers. Mr. Paget trusts that with the introduction of he Thirlmere water greater flushing facilities will be obtained. n reference to smoke nuisances thirty-nine firms were re)orted, but, owing to the inferior coal which the prolonged :oal strike necessitated the consumption of, prosecutions were ’or the time being suspended. Mr. Paget’s report contains several spot maps, and also one showing the result of the ;anitary survey of Salford, and setting forth by aid of lifferent colours the mean quinquennial death-rate obtaining n each enumeration district : this map should have great ocal value. The waters of the Manchester Ship Canal were,
Salford
Mr. Paget tells us, peculiarly offensive during the summer months to those parts of the borough situated within half a nile of it, and he expresses a hope that the efforts of the joint board for the Rivers Mersey and Irwell will succeed in reducing the serious pollution of the waters feeding the Ship Canal. Mr. Paget goes on to observe : "The existence of an enormous water-way through the borough of Salford, navigable for ocean-going vessels, may be of material commercial benefit to the community; but the protection of this water-way from such pollutions as may give rise to emanations productive of a general lowering of health in its immediate neighbourhood is of no less importance to the welfare of the borough." Blackpool Urban Sanitary District.-Mr. Jasper Anderson remarks with regard to the infantile mortality in Blackpool during 1893 that the dry, hot summer of the year in question brought about a high mortality, the rate being 192-8 per 1000 births. The mortality was most marked during the third quarter of the year, and Mr. Anderson thinks that the excess is connected with the overcrowding and maternal neglect produced by the influx of visitors. The death-rate among illegitimate children was no less than 314’6 per 1000 births-in other words, as Mr. Anderson observes, an illegitimate child has but half the probability of reaching the age of twelve months as one born in wedlock. A table is also given in the report before us showing ages in months of the infants who died during the first year of life, and from this it appears that, out of a total of 123 deaths, no less than 29 died before attaining the age of one month. In regard to 1 Eyre and Spottiswoode, East Harding-street, E.C.; John Menzies and Co., Edinburgh and Glasgow; Hodges, Figgis and Co., Dublin. 6d. infectious disease, an important point has been gained by the