THE JESMOND OUTBREAK.

528 and the cicatricial degeneration of the observed in such rare cases of pemphigus do not constitute a distinct nosological entity, but are to be attributed to the process known under the name of xerosis parenchymatosa of the conjunctiva, which is itself the final result of a grave inflammatory process affecting the mucous membrane of the eye, such as trachoma and conjunctival diphtheritis. The influence of the dermatosis bullosa in determining the ophthalmic phenomenon in question would, according to Dr. Gosetti, be sufficiently defined as a local trophic disturbance (perturbazione trofica) due to general disease of a marasmatic kind (such as pemphigus undoubtedly is), and affecting the conjunctival tissue. This trophic disturbance, with the consequent inflammatory process and the eruption of the bleb-like vesicles on the mucous membrane of the palpebrfe., would result in the atrophising sclerosis and the irreparable blindness that follows it.

of the

if it takes place in the sewers. Wefail to how a district which has its sewers fouled by offensive and decomposed drainage, which is only periodically jerked into them from drains which are little better than cesspools, can be held up as free from danger. The sewers themselves, and apart from the drains which join them, may be free from suspicion, and to this extent one of the contending parties may be right; but blocked and ill-constructed house drains are, as a rule, a greater source of danger than mere faulty sewers, for they are in much more intimate communication with dwellings. And Mr. Armstrong is doubtless also perfectly correct. He held that, milk being the cause, the disease was not found to be associated with any structural defect; and he was probably largely influenced in his opinion by the fact that scarlatina is not a disease the cause of which can be satisfactorily traced to sewers and drains, even when these are admittedly faulty. The case seems to us to be one in which there is truth on both sides; but also one in which there is overTHE JESMOND OUTBREAK. whelming evidence that the surveyor’s report as to the MR. HENRY ARMSTRONG has recently presented to the number of "badly laid house drains"calls for definite action corporation of Newcastle-on-Tyne a report on an out- on the part of the sanitary authority, if a favourite residenbreak of scarlet fever, the cause of which was, after a care- tial quarter is to maintain the standard of health which it ful examination of all the circumstances, attributed by him appears to claim for itself. to the use of milk from a special dairy, the infection having MEDICAL CANVASSING. been received, after the milk left the cow, directly or must WE from the of children a whose children again enter our protest against the system of carman, indirectly, electors and governors for medical appointments were declared to have had neither scarlet fever nor sore canvassing throats, whereas in three cases redness of fauces, enlarge- bo hospitals and public institutions which is still in vogue ment of tonsils, &c., were discovered. The area of the in country towns, and also, we regret to say, in London. incidence of the disease is described in the report, and it is Some of our readers have tried it, and know what it means shown that up to a certain date and among the consumers beyond a waste of time and money, which can often be ill of the milk 116 cases of scarlatina or of other form of sore afforded. Then, again, the governors of a hospital are throat were certified, the attacks being spread over sixty- usually unable to judge as to the special fitness of a candithree households. Roughly speaking, Jesmond-road may date for the vacant post, the meaning of medical terms and be taken as the centre of the affected area, there having the distinction between those of a similar sound being been as many cases to the south of it as to the north ; and, unknown to them. Moreover, they do not understand the duties connected with the post which they propose to fill, as regards that area, it is reported that, under the circumstances which led to the disease, structural sanitary or the value of the appointments which, having been predefects were in no way the cause of it. Since the issue of viously held by the candidates, qualify for such a post. We the report some doubts have been expressed as to the venture to state that there are few hospitals the governors source of the infection, and it is stated that the Jesmond of which take sufficient trouble to visit even the out-patient district is one where there have been numerous complaints department and see the work done there, or follow a suras to sewer and drain ventilation, and that it is by no geon’s visit and see what it means for good. They attend occasional board meetings, some of them even with regumeans a locality the sanitary state of which is above suspicion. On the other hand, it is contended that, larity ; they may look into a ward and speak to the sister, though perfection cannot be claimed for the sewers of this a nurse, or a favourite patient; their name is on the district, they are in good and efficient working order. The list of governors of the place ; they subscribe to its funds ; subject has given rise to considerable local correspondence, they feel that they have done what is expected of them. A and the city engineer has prepared a report on the subject, vacancy occurs amongst the staff, and a friend writes: in which he admits that " nasty smells " and "foul smells " " support So-and-so, he is a nephew of mine"; a Royal peroccur and have been complained of, yet " sewer gas" has sonage writes, or one whose influence is great, and the vote not been detected. Thus, he writes: " Foul smells? Yes, goes accordingly; besides, it saves trouble. We would and in considerable variety and vigour. Sewer gas ? No." not say that there are not some who do consider the And he explains, so far as we can understand him, that patients as well as themselves; but, alas, they are few. foul smells from a sewer refer to recent sewage smells, and The right to elect gives them an increased sense of import. that sewer " gas" comes from stale and decomposed ance, and they do not appreciate their own relative sewage. As regards the latter, he proceeds to express his ignorance of the qualifications of the candidates. The belief that not one person in ten in Newcastle has ever medical men attached to the hospital are undoubtedly the smelt "real sewer gas." Unfortunately, he goes on to best judges, and it should be left to them to recommend admit " nasty drain smells." He then explains that it is a for the election, the committee still retaining the actual common practice to lay house drains with little or no fall, power to elect, canvassing being forbidden. This method and that from these and other is employed at most of the large London hospitals, and with gaping joints, &c., causes the drain pipes at times get half-filled before there is works admirably. The staff are as jealous of the sufficient force behind to drivethe accumulated stuff into honour of the hospital as the most enthusiastic of Thus he admits the very conditions which governors, and are much better judges in every way the sewers. tend so often to make public sewers not only foul but of the merits of their future colleague. It seems to dangerous ; indeed, there are few circumstances which us derogatory to the dignity of the profession that more effectually foul sewers than that very retention of members thereof should be compelled to visit and extol, sewage in drain pipes, which is admitted to cause sewer to gentlemen not in touch with the medical sciences, "gas," and, by reason of the resulting decomposition, to the numerous perfections possessed by the visitor-that is, if

conjunctiva

cornea

be

dangerous

see

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