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The presidential address
PUBLIG HEALTH: ournal ot the 3ncorporate $octet flB¢ ical ®ITlccr of /health. VoL. XVI.
No. 2.
of
Now~I~ER, 1903.
EDITORIAL. THE PRESIDENTIAL ADDRESS. THE great experience of the newty-elecSed President in all matters pertaining to rural sanitation enabled him to speak with authority upon a subject of the highest interest and importance to medical officers of health, especially to those holding office in rural districts. It is doubtful whether any, save those engaged in rural sanitation, realize the difficulties encountered in attempting to provide suitable water-supplies for villages, hamlets, and small groups of houses. Towns with large populations and corresponding ratable values can always, in this country, provide ample supplies of good water at a reasonable cost, and the only difficulties are those of an engineering character. Funds being available, the services of competent engineers can be secured and the difficulties overcome. In thinlypopulated districts the expense of providing a public supply is usually much greater per head of population, and the works to be undertaken are too small to be deemed worthy of consideration by any eminent engineer ; consequently, if the medical officer of health or the local surveyor cannot devise a scheme and prove its practicability, a public supply is not likely to be provided. In urban districts the medical officer of health has usually little to do with the water department, and frequently the head of this department objects to any interference by the medical officer. In rural districts, on the other hand, everything connected wi~n the water-supplies-the quantity, quality, distribution, etc.--is more or less under the supervision of the medical officer, and if localities are badly supplied, the local authorities look to him for advice as ~o how a suitable supply can be obtained. When new houses are erected he has to examine the proposed supply, and certify whether there
66
T h e Presidential Address
t~buo H,~ta
is a reasonable supply of wholesome water available within a reasonable distance. All this presupposes that the medical officer of health has no mean knowledge of chemistry, geology, and engineering, and it is quite certain that no such officer in a rural district can properly discharge his duties unless he has made a special study of these subjects. As Dr. Groves says, he should at least be acquainted with the leading facts of physical geology, and know how to utilize the information furnished by the various maps issued by the Geological Survey. Dr. Groves is somewhat optimistic in his views as to the expense at which rural water-supplies can be provided. He appears to have forgotten that nearly every such scheme must be carried out with borrowed money, and must therefore receive the sanction of the Local Government Board. By the time this sanction is acquired the scheme will no longer be a simple one, but as complicated with duplication of pumps, engines, mains, etc., as though it were a scheme for a large town, and of vital importance that the district should never for a single moment be deprived of water. Moreover, the expense will have so increased that probably the authority will abandon the scheme. The requirements of the Board are certainly preventing the carrying out of many small schemes which would provide supplies infinitely better than those which a~ present exist. Rural authorities should be encouraged rather than discouraged, and the Local Government Board could help greatly in this by showing that it is anxious to assist in reducing the cost of such schemes to the minimum, compatible with reasonable efficiency. Comprehensive schemes for supplying groups of parishes have been carried out within recent years in several counties, and it has been found possible in this way to provide water for an exceedingly scattered population at a fairly reasonable cost. Dr. Groves justly remarks that by obtaining such supplies " w e do far more than give the people wholesome water to drink--we increase enormously the use of water for domestic, dairy, and other purposes which affect the interests of the public health, and we effect an incalculable economy of labour and time, and save the money they represent." He might also have added that the market value of the land in the district is considerably increased, and a great inducement offered to the town dweller to move into the country. Apart from the provision of public supplies, Dr. Groves shows that very much could be done to improve present conditions were the springs and wells now utilized, more adequately protected, and his remarks on the methods of effecting improvements are well worth
~ovember,1~031
The
Presidential Address
67
consideration. There is no doubt that in the country one has to make the best of existing conditions. It is folly to close a well and cat off a source of supply if by so doing the people are driven to obtain water from even more dangerous sources. Even rain-water supplies may be rendered available for many domestic purposes if builders and others accepted the common-sense suggestions of the president, and constructed Proper receptacles, and took suffieient~ care to prevent fouled water entering the tanks. Only in exceptional eases can sufficient water be collected from a roof to supply all the requirements of the inmates of the house. It is a mistake, therefore, for Rural Sanitary Authorities to grant water certificates for new houses when no other provision has been made. However large the storage tanks, the supply fails during the summer months, the tenants, naturally, complain to the Authority, and the troubles of the medical officer of health begin. Incidentally, Dr. Groves also refers to a subject which is as interesting to the urban medical officer as the rural, and that is the danger of relying too much on the results of chemical and bacteriological analyses. Notwithstanding the frequency with which both have been found misleading, there is still a tendency to trust them rather than to make careful inspections of the source from which the water is obtained. Analyses are fluttered in the eyes of the public, and dazzle them; meanwhile sewage pours intermittently into the well, and sooner or later produces an outbreak of disease. Dr. Groves does not wish to minimize in the slightest degree the value of water analysis. It has its own important place, especially in determining whether the mineral constituents are objectionable, either on account of their quantity or quality, but no analysis, chemical or bacteriological, can tell whether any given source is "safe." The danger of trusting to small filter-beds without proper supervision is another point worthy of emphasis. With skilled management they may be trusted to insure the bacterial parity of a water, but improperly managed, the filtered water may be actually worse than the unfiltered. Neither can domestic filtration be trusted, and a suspicious water should always be boiled before being used for drinking purposes. The importance of a good and pure supply for dairy purposes is also insisted upon. The filthy condition of cows and cowsheds and dairies in many rural districts is chiefly due to the limited supply of water, and the danger arising from washing dairy-vessels in polluted rain-water cannot be too strongly urged. This danger is one which affects the town dwellers who consume milk from such country dairies, and it is to their interest, as well as to the interest 5--9,
68
T h e Presidential A d d r e s s
~p~c ae~at,~
of the rural population, that better supplies of water should be rendered available in agricultural districts. No doubt Dr. Groves' able address will direc~ attention to this subject, a subject which, as he justly observes, is " o f momentous concern to each one of us, for it affects very closely the interests of the public health, the guardians of which we are."
DR. B. A. WHITELEGGE, C.B., His Majesty's Chief Inspector of Factories, has been appointed President of the Epidemiological Society in the place of the late Dr. W. H. Corfield. THE RAINFALL DURING THE SUMMER MONTHS.- The exceptionally severe rainfall in the lower Thames Valley during the past summer gave rise to the impression that the condition was widespread. In Symons" Meteorological Magazine (September) it is shown that in North Wales, Lancashire, and the West of Ireland, the summer was actually drier than the average, and by far the greater par~ of the British Isles had t~ total rainfall for June, July and August less than 25 per cent. in excess of the average. The heavy falls were confined to the south-east part of England. Eastward from the borders of Cornwall and Wales to the North Sea the excess much exceeded 50 per cent., and within a roughly circular area, with a radius of about forty miles from London, the excess was greater than 100 per cent.--in other words, more than twice the normal amount. June was the wettest, and August the least wet, of the three mvnths as a rule. At Camden Square the average fall for the three summer months is 6"25 inches ; this year it was 15"87, two and a half times the average. FACTORS IN SPREADING TYPHOID FEVER.--During twenty-five years, reports to the State Board of Health showed that typhoid fever existed in Michigan inversely as the depth of water in wells. Recently there has apparently been a marked change in this relation. From March 1st to June 30th, 1903, the average depth of water in the observation well at Lansing has been over twice as much, and the typhoid fever over 80 per cent. more prevalent than the average for the ten years preceding. The unusual spread of typhoid fever in Michigan, notwithstanding the existence of conditions which hitherto favoured its decline, may be due to several facts, such as that one circuit judge has decided that typhoid fever is not a communicable disease, dangerous to the public health, and some boards of supervisors have refused to allow bills for expenses incurred by local health officials for the care of indigent typhoid fever patients, thus practically putting a stop to local work by health officials for the restriction of typhoid fever in those parts of the Sgate. In cities, especially in Menominee, typhoid fever is and has been a great factor in the mortality rate. Even the Detroit Board of Health takes no action to require reports from householders and physic'ians, or other measures'for the restriction of this dangerous communicable disease, such as placarding of premises and disinfection of discharges and of premises after death or recovery of patients.-Journ. A. M. A., July 25th, 1903.
No. 2.
of
Now~I~ER, 1903.
EDITORIAL. THE PRESIDENTIAL ADDRESS. THE great experience of the newty-elecSed President in all matters pertaining to rural sanitation enabled him to speak with authority upon a subject of the highest interest and importance to medical officers of health, especially to those holding office in rural districts. It is doubtful whether any, save those engaged in rural sanitation, realize the difficulties encountered in attempting to provide suitable water-supplies for villages, hamlets, and small groups of houses. Towns with large populations and corresponding ratable values can always, in this country, provide ample supplies of good water at a reasonable cost, and the only difficulties are those of an engineering character. Funds being available, the services of competent engineers can be secured and the difficulties overcome. In thinlypopulated districts the expense of providing a public supply is usually much greater per head of population, and the works to be undertaken are too small to be deemed worthy of consideration by any eminent engineer ; consequently, if the medical officer of health or the local surveyor cannot devise a scheme and prove its practicability, a public supply is not likely to be provided. In urban districts the medical officer of health has usually little to do with the water department, and frequently the head of this department objects to any interference by the medical officer. In rural districts, on the other hand, everything connected wi~n the water-supplies-the quantity, quality, distribution, etc.--is more or less under the supervision of the medical officer, and if localities are badly supplied, the local authorities look to him for advice as ~o how a suitable supply can be obtained. When new houses are erected he has to examine the proposed supply, and certify whether there
66
T h e Presidential Address
t~buo H,~ta
is a reasonable supply of wholesome water available within a reasonable distance. All this presupposes that the medical officer of health has no mean knowledge of chemistry, geology, and engineering, and it is quite certain that no such officer in a rural district can properly discharge his duties unless he has made a special study of these subjects. As Dr. Groves says, he should at least be acquainted with the leading facts of physical geology, and know how to utilize the information furnished by the various maps issued by the Geological Survey. Dr. Groves is somewhat optimistic in his views as to the expense at which rural water-supplies can be provided. He appears to have forgotten that nearly every such scheme must be carried out with borrowed money, and must therefore receive the sanction of the Local Government Board. By the time this sanction is acquired the scheme will no longer be a simple one, but as complicated with duplication of pumps, engines, mains, etc., as though it were a scheme for a large town, and of vital importance that the district should never for a single moment be deprived of water. Moreover, the expense will have so increased that probably the authority will abandon the scheme. The requirements of the Board are certainly preventing the carrying out of many small schemes which would provide supplies infinitely better than those which a~ present exist. Rural authorities should be encouraged rather than discouraged, and the Local Government Board could help greatly in this by showing that it is anxious to assist in reducing the cost of such schemes to the minimum, compatible with reasonable efficiency. Comprehensive schemes for supplying groups of parishes have been carried out within recent years in several counties, and it has been found possible in this way to provide water for an exceedingly scattered population at a fairly reasonable cost. Dr. Groves justly remarks that by obtaining such supplies " w e do far more than give the people wholesome water to drink--we increase enormously the use of water for domestic, dairy, and other purposes which affect the interests of the public health, and we effect an incalculable economy of labour and time, and save the money they represent." He might also have added that the market value of the land in the district is considerably increased, and a great inducement offered to the town dweller to move into the country. Apart from the provision of public supplies, Dr. Groves shows that very much could be done to improve present conditions were the springs and wells now utilized, more adequately protected, and his remarks on the methods of effecting improvements are well worth
~ovember,1~031
The
Presidential Address
67
consideration. There is no doubt that in the country one has to make the best of existing conditions. It is folly to close a well and cat off a source of supply if by so doing the people are driven to obtain water from even more dangerous sources. Even rain-water supplies may be rendered available for many domestic purposes if builders and others accepted the common-sense suggestions of the president, and constructed Proper receptacles, and took suffieient~ care to prevent fouled water entering the tanks. Only in exceptional eases can sufficient water be collected from a roof to supply all the requirements of the inmates of the house. It is a mistake, therefore, for Rural Sanitary Authorities to grant water certificates for new houses when no other provision has been made. However large the storage tanks, the supply fails during the summer months, the tenants, naturally, complain to the Authority, and the troubles of the medical officer of health begin. Incidentally, Dr. Groves also refers to a subject which is as interesting to the urban medical officer as the rural, and that is the danger of relying too much on the results of chemical and bacteriological analyses. Notwithstanding the frequency with which both have been found misleading, there is still a tendency to trust them rather than to make careful inspections of the source from which the water is obtained. Analyses are fluttered in the eyes of the public, and dazzle them; meanwhile sewage pours intermittently into the well, and sooner or later produces an outbreak of disease. Dr. Groves does not wish to minimize in the slightest degree the value of water analysis. It has its own important place, especially in determining whether the mineral constituents are objectionable, either on account of their quantity or quality, but no analysis, chemical or bacteriological, can tell whether any given source is "safe." The danger of trusting to small filter-beds without proper supervision is another point worthy of emphasis. With skilled management they may be trusted to insure the bacterial parity of a water, but improperly managed, the filtered water may be actually worse than the unfiltered. Neither can domestic filtration be trusted, and a suspicious water should always be boiled before being used for drinking purposes. The importance of a good and pure supply for dairy purposes is also insisted upon. The filthy condition of cows and cowsheds and dairies in many rural districts is chiefly due to the limited supply of water, and the danger arising from washing dairy-vessels in polluted rain-water cannot be too strongly urged. This danger is one which affects the town dwellers who consume milk from such country dairies, and it is to their interest, as well as to the interest 5--9,
68
T h e Presidential A d d r e s s
~p~c ae~at,~
of the rural population, that better supplies of water should be rendered available in agricultural districts. No doubt Dr. Groves' able address will direc~ attention to this subject, a subject which, as he justly observes, is " o f momentous concern to each one of us, for it affects very closely the interests of the public health, the guardians of which we are."
DR. B. A. WHITELEGGE, C.B., His Majesty's Chief Inspector of Factories, has been appointed President of the Epidemiological Society in the place of the late Dr. W. H. Corfield. THE RAINFALL DURING THE SUMMER MONTHS.- The exceptionally severe rainfall in the lower Thames Valley during the past summer gave rise to the impression that the condition was widespread. In Symons" Meteorological Magazine (September) it is shown that in North Wales, Lancashire, and the West of Ireland, the summer was actually drier than the average, and by far the greater par~ of the British Isles had t~ total rainfall for June, July and August less than 25 per cent. in excess of the average. The heavy falls were confined to the south-east part of England. Eastward from the borders of Cornwall and Wales to the North Sea the excess much exceeded 50 per cent., and within a roughly circular area, with a radius of about forty miles from London, the excess was greater than 100 per cent.--in other words, more than twice the normal amount. June was the wettest, and August the least wet, of the three mvnths as a rule. At Camden Square the average fall for the three summer months is 6"25 inches ; this year it was 15"87, two and a half times the average. FACTORS IN SPREADING TYPHOID FEVER.--During twenty-five years, reports to the State Board of Health showed that typhoid fever existed in Michigan inversely as the depth of water in wells. Recently there has apparently been a marked change in this relation. From March 1st to June 30th, 1903, the average depth of water in the observation well at Lansing has been over twice as much, and the typhoid fever over 80 per cent. more prevalent than the average for the ten years preceding. The unusual spread of typhoid fever in Michigan, notwithstanding the existence of conditions which hitherto favoured its decline, may be due to several facts, such as that one circuit judge has decided that typhoid fever is not a communicable disease, dangerous to the public health, and some boards of supervisors have refused to allow bills for expenses incurred by local health officials for the care of indigent typhoid fever patients, thus practically putting a stop to local work by health officials for the restriction of typhoid fever in those parts of the Sgate. In cities, especially in Menominee, typhoid fever is and has been a great factor in the mortality rate. Even the Detroit Board of Health takes no action to require reports from householders and physic'ians, or other measures'for the restriction of this dangerous communicable disease, such as placarding of premises and disinfection of discharges and of premises after death or recovery of patients.-Journ. A. M. A., July 25th, 1903.