The Recent Work of the Local Government Board.

THE RECENT WORK OF THE LOCAL GOVERNMENT BOARD.

111

and local administration; and (e) local taxation and valuation ; and of these sections it is the second which will have the greatest interest for readers of THE LANCET. It is, how-

important to note that certain of the matters dealt with in this section will be more fully treated of in the forthcoming annual report of the medical officer of the Local

ever,

THE LANCET.

Government Board which

we

shall notice in due

propose to do now is to bring before activity of this great department by briefly we

LONDON : SATURDAY, JANUARY 8, 1910.

All

course.

our

readers the

mentioning

some

of its recent work.

Since the

1871, when the Local GovernmentBoard was constituted, there has been sanctioned by the department the borrowing of money by urban and-

The Recent Work of the Local Government Board.

year

amounting to the enormous total of 184,262,578, large proportion of which has been devoted many-must disappointment want of enthusiasm with which their painstaking efforts: to matters connected with the public health-a fact which are received by the public; in fact, the cynic has saidindicates the heavy responsibilities which devolve upon the that the surest route to an unknown grave is to, Board in sanctioning these loans and in auditing the accounts. In the matter of the combe a writer of Blue-books, an opinion which, althought to which they in part relate. not wholly true, has a substantial basis. Blue-books,, pulsory purchase of land not otherwise obtainable there were recordsissued during 1908 19 Orders, a number which should be very more especially those which take the form of known as annual reports, are not, as a rule, attrac- materially increased under the provisions of the Housing and tive reading ; they do not appeal to the imagination, Town Planning Aet which has just received the Royal Assent. and it is but rarely that any expression of opinion iss The voluntary employment of adoptive Acts is a subject that ventured upon from one cover to the other. They aree in a measure indicates the progress in sanitary conception written nearly always in a dry, unattractive style with made by local authorities in the country, and we are told and with but no illustrations s that up to Dec. 31st, 1908, no less than 703 urban and digressions rarely any to relieve the monotony of their story or to lighten the e 318 rural authorities had adopted that very useful measure burden of their statistical tables ; and, lastly, they of f the Infectious Disease (Prevention) Act, 1890, while necessity appear when some of the facts which they y steady progress has been made as regards the adoption of. THE authors of Blue-books-for each sometimes feel

a

little

has,

we

rural authorities

believe,

at the

a

-

,

Ll Part III. of the Public Health Acts Amendment Act, 1890. contain, and which would otherwise have been full of interest, have passed into history, or at any rate Records are furnished in the report of the work carried out have become more or less common knowledge. Yet t under the Alkalies Acts, the Burial Act, and the Canal Boats Blue-books form our most important literature ; only y Act, as well as under the Housing of the Working Classes Act, lr while there is a very useful summary of the operations of the through them do we possess a continuous record of our national business year by year and a knowledge of the ie Metropolitan Asylums Board for the year 1908. During that 11 ve year 31,447 cases of fever " and diphtheria were notified, highly complex machinery under which the administrative world works. We have heard the Civil Service spoken 22,071 of which were scarlet fever. Of these scarlet fever notifications 90 ’ 9 per cent. were admitted into hospital, the of as a great conspiracy of silence, a description Mi of it which in these days of réclame is an eloqueni nt corresponding percentages of diphtheria and enteric fever testimony to its merits. Governments come and gc cases being 814 and 504. The fatality rate of the scarlet with all their disturbing influences, but the Civil Service. Ie, fever was 2’ 6 per cent., of the diphtheria 97per cent., and anc adapting itself to the exigencies of the situation, ld of the enteric fever 16’ 3 per cent. The laboratory work of serving each side with equal loyalty, holds on its way ; and the Metropolitan Asylums Board is gradually undergoing exof its personnel little is ever heard until perchance and tension, and in addition to 23,500 doses of antitoxin supplied

occasional unknown

to the fever

and

and clinical work

name ist appears in the honours lis the worker passes to his well-earned retirement It. Of all the Government departments the one which is in ii.

hospitals was

in 1908

a

large

carried out.

amount of As

bearing

diagnostic upon this

class of work reference may be made to an important closest touch with the daily lives of the people is the Loca appointment made last week by Mr. BURNS in connexion Government Board, and the mere perusal of the index of an - nywith the pathological work of the Local Government Board. of its annual reports will suffice to show this. Hithert rto One of the pathologists of the Royal Commission on

these reports have been published in one volume which c late years has become a somewhat unwieldy tome, butit ubappears that in future certain of the parts are to be put

lished

Tuberculosis, Dr. ARTHUR EASTWOOD, has been appointed an

additional medical

inspector,

of this appointment will be

and the immediate

to

apply

to

object public health by the Royal

e: work the very important results obtained separately, an arrangement which will save exit will 1 as enable those wish to who Commission referred to, and by this means to ensure public But it is inform themselves of, say, Poor-law only to purchase sep pa- the freedom of foods from tuberculosis. the into intended to extend in also the are intereste’ that of which pathoinvestigation they report rately part and of methods the of arrangediseases, Part II. of the report for 1908, which is now before us, dea diagnosis logical made for the necessary ments have already been with (a) county council administration ; (b) public heal

pense to the

THE

112

FUNCTIONS OF THE PARATHYROIDS.

assistance and laboratories. The amount of work devolving upon the Local Government Board in dealing with the annual reports of medical officers of health may be gathered from the fact that in 1908 there were received in the department 1126 reports from urban districts and 678 from rural year we are glad to see that as many as 87 local authorities made regulations under the Dairies, Cowsheds, and Milkshops Order, 1885, there being at the end of 1908 only 159 local authorities without such regulations. It is reported, too, that 100 local authorities

districts, and during the

same

minority of the recent Royal Commission. But subjects-indoor and outdoor relief, the treatment

all these

of pauper

children, medical relief, the care of the insane, with the subject of unemployment and the with which motor-cars traverse our streets-are

which

controlled

are

and which

are

guided,

inspection supply. Water-supply

that he has a

to 2400 million

gallons. This additional storage should very greatly increase the security of the water-supply of the metropolis, since all recent work has shown the value of such storage in reducing the number of organisms present, in destroying the vitality of pathogenic organisms, and in increasing the life of the fitters, and thus London is by way of presenting to the world an unparalleled example of a population of many millions supplied in great part from a river polluted with sewage effluents over many miles of its course and yet, owing to its careful filtration, doing so without any clear signs of mischief as regards water-borne diseases. It seems to us that the experience of London in a matter such as this cannot be disregarded by the epidemiologist, and it has to be remembered that in former years, when the storage was much less and the filtration less carefully carried out, the same tale as regards absence of water-borne disease had to be told. The risks of filtration are, as the experiences of Hamburg and Altona have taught us, very considerable, but there is, nevertheless, something about enteric fever in London in the past which it remains for the epidemiologist of the future to unravel. The subject of the sale of foods and drugs is another difficult and important subject which is gone into in the report under notice in considerable detail, and attention is drawn to the eminently undesirable practice of inviting applicants for the post of public analyst to state the terms upon which they are prepared to accept the appointment. In the view of the

the Local Government Board, so far as the public is con-

Whatever mutations the political kaleidoscope BURNS, he must, it seems to us, feel

secretaries.

has in store for Mr.

and food-supply are fully and freely discussed in the report. As regards the important subof London’s ject water-supply, great progress has recently been made in facilities for the storage of river water prior to filtration, the storage capacity of the Thames valley being in a fair way to amount to 7500 million gallons, and in the Lea valley it already amounts

in

cerned, quietly and unostentatiously by the permanent secretary of the Board, and by his colleagues, the assistant

have at the end

of this year arranged for the periodical of milch cows. All this betokens a purer milk-

by

together rapidity subjects

presided during a highly important period over department of which he has every reason to be proud and

which has afforded him

an

admirable field for his abilities.

The Functions of the

Parathyroids.

SINCE the

discovery of the parathyroids in 1880 by the Swedish anatomist SANDSTROEM, their function has been more or less of an enigma, and various views have been put forward widely different in character. Recent experimental and pathological investigations have, however, established that when

they are diseased or injured the peculiar contetany, which has itself been for long the subject of speculation and hypothesis, frequently results. The whole subject is reviewed in an interesting and instructive manner by Professor ISAAC OTT and Dr. JOHN C. ScoTT in a

dition of

collection of

papers

entitled

"

Contributions

from

the

Physiological Laboratory of the Medico-Chirurgical College of Philadelphia, Part XVIII.," of which we have received a copy. They state that in man there are usually four parathyroids : two on each side, situated in front of the

vertebral column

just

behind the

posterior margins

the thyroid gland. They in colour, and or reddish-brown are reddish-yellow their size and shape correspond to those of a small grain of Indian corn. They are in close relation with the of

the

lateral

lobes

of

thyroid artery, from which they usually derive their blood-supply. It has been shown by W. N. BERKELEY of New York in 125 necropsies that they may be as numerous as five or six, but there may be only two or three, or even one. Developmentally they arise as thickenings of the epithelium on the dorsal aspect of the third and fourth visceral clefts. Small accessory parathyroid granules have been found by ERDHEIM in the thymus, and these thymic parathyroids have been found and removed in animals by Professor OTT and Dr. ScoTT. Histologically, the cells in the parathyroid are very different from those in the thyroid. They are described as of two and the chief cells with which we are in entire Local Government Board, being types-the form a colloid material which, unlike agreement, the offering of such appointments "on tender" oxyphile. They Removal is open to strong objection. We are also glad to see that that of the thyroid, does not contain iodine. the Board is encouraging the practice of informal sampling of the parathyroids in animals causes tetany, with partial of food for analysis as the best means of determining the paralysis, especially of the extensors, trembling in all quarters in which a formal attack should be made with the muscles followed by a series of convulsive attacks, the view of bringing habitual offenders to light. during which the temperature rises, the condition beginning We have not tried to touch upon the subject of county or upon that of local taxation and ’, valuation, nor have we said anything about that overwhelm-i ing subject the Poor-law, concerning which such portly I

council administration

volumes have

recently

been written

by

the

majority

inferior

in from 24 to 48 hours.

Chemical

analyses

in

cases

of

tetany in infants show changes in the calcium salts in various organs-e.g., QUEST found the amount of calcium in the brains of three infants

and his

results

have

dying

from

been confirmed

tetany to be small, and by MACOALLUM and