831

the filter beds. When the Thames is in high flood, wateris not pumped from the island.Intakes/rom the T7tct2)i es. -There are three intakes from the

Thames : (1) the new intake, used for the first time lastsummer to fill the new reservoir ; (2) the middle intake;and (3) the old intake, situated near the filter bedmarked 7.At the new intake there are three bays. The water passes

through a screen which is formed of 34 in. bars, and throughthree sluices into an irregular octagonal reservoir. Whenvisited on Dec. 9th, work was in progress here. A newengine house was completed and one engine was erected,t1i1 , ØfB11r1 tunc iri ’YBrnøQQ nf hoinm erpni-.nrl Thn anorina

formed of 14-in. bars, and is then conducted through three36-in. pipes to the filter beds. A vertical filtering screen(Fig. 6), of which a drawing is given, was formerly in use atHampton. This system was found to be unsatisfactory,

chiefly from the fact that the work of cleaning it involvedmuch trouble, because it entailed moving and replacing thewhole of the ballast.

Filter &es.—There are nine filter beds at Hampton. Ofthese two are to the north and the others to the south-westof the Lower Sunbury-road and close to the Thames. Thetotal area occupied by the filter beds is nine acres. Theywere not all made at the same date and are not constructedin exactly the same way. Their general form will be seen

FIG. 7.

Southwark and Vauxhall Company. Hampton Filter Beds.

in working order is a triple-expansion high-speed engine,driving centrifugal pumps, the indicated horse power being160; the steam is generated by four water-tube high-pressureboilers. The new reservoir, which was first filled during thesummer of 1896, has a capacity of 90,000,000 gallons. It isfaced with bricks and concrete. When visited on Dec. 9thwater from this reservoir was being drawn for the supply ofthe filters. The Thames was in flood and turbid.From the second or middle intake the water is conveyed

through a 36-in. conduit, and passes through a verticaliron screen similar to that at the new intake. The water isthen admitted to the filter beds. At the old intake there aresix bays, and the water passes through a screen which is

by looking at the accompanying diagram (Fig. 7). Theearliest filters are those numbered 2, 3, 4 ; these were

made in the years 1868-9. The sides of these beds arenot vertical, but are arranged at a slope of 12 : 1. Thenewer filter beds have almost vertical sides. There is oneother point of difference. In the older beds the filteredwater channels have central upright ventilators, in the caseof the newer beds the ventilation is carried out by means ofshafts situated at the sides of the beds. All the filtershave central channels for the collection of the filteredwater, which passes into them through agricultural tiles. Thesand is cleansed by washing under high pressure.

(To be continued.)

ANNUAL REPORT FOR 1895 OF THEMEDICAL OFFICER OF HEALTH OFTHE ADMINISTRATIVE COUNTY

OF LONDON.

FIRST NOTICE.Ms. SHIRLEY MURPHY has recently issued his annual

report as medical officer of health to the London CountyCouncil. The present volume, which relates to the year1895, makes the fourth of the series that was commenced in1892 ; it extends to 134 folio pages, and is arranged on thesame general plan as were its three predecessors.Having regard to the high degree of importance attaching

to an authoritative treatise on the public health of themetropolis, we have devoted more than ordinary attention tothe volume before us. The work is thoroughly well done andwill fully sustain the high reputation of the author. Com-paring the present report with the first of the series we areimpressed with the amount and elaborateness of statisticaldetail with which its pages abound, not less than with theevidence it affords of steady improvement in the practicalsanitary work achieved by the local boards since the establish-ment of a coordinating central authority. Like that of its

predecessors, the subject matter of the present report isdivided into two sections-the first dealing with statisticsand the second with sanitary administration.The London Census which was taken last March showed

that the population of the administrative county has notbeen increasing since 1891 quite so rapidly as it had donebetween 1881 and 1890. Estimated on the assumption thatthe rate of increase has been constant since 1891 the popula-tion of the administrative county of London in the middleof 1895 is believed to have numbered 4,402,284, or 11,217less than it would have been had the rate of increase obtain-ing between 1881 and 1890 prevailed since the latter date.In thirteen of the London sanitary districts there has beena decrease of population since 1891, whilst an increase hastaken place in the remaining districts. In only twelve ofthe latter districts, however, was the increase greater thanthe excess of births over deaths in the five years 1891-95.The London death-rate in 1895 is given as 19 9 per 1000,

which becomes 21’2 on correction for age and sex constitu-tion of the population. Applying the same principle ofcorrection to the sanitary areas of London it is shown in auseful table that if the death-rate of London as a whole betaken as 1000 the rates of twenty-four of the sanitary dis-tricts exceeded that rate whilst the remainder were in defectof it. Comparing the London death-rate at all ages in the fiveyears 1891-5 with that of the previous decade, there was adecrease equal to 3 per cent. among males and 2 per cent.

832

among females. A table is given showing the iiuctu’1tions ofmortality in these two periods at the several periods of life. :

Examination of this table shows that the fall in the death-rate at all ages is mainly due to a decrease at ages underforty-five years, for the death-rate of both males and females 1above that age has for some reason increased. Pursuing the I

subject farther, Mr. Shirley Murphy shows by another table ]that within the last five years there has been a mean annualsaving of 1304 lives, and that this represents 85,519 years of I’’life capital annaally saved to the community. The Iactual gain is therefore greater than would appear frjm the Inumber of lives saved, and this is evident from the great ’saving of life at the earlier ages which is shown by the table I

Turning now to that portion of the report which cea.ls withthe prevalence of common infectious diseases it is at once

apparent that by the parsing of the Diseases Notification Actthe sanitary authorities of the metropolis have acquired imore effective powers for grappling with these diseases,especially in relation to the attendance of children at school. IStatistics are rapidly accumulating with respect, not to

mortality alone, but what is infinitely more important, tosickness also, from these diseases in London, and Mr, ShirleyMurphy is to be congratulated on the lucid manner in whichhe presents these statistics in his successive annual reports.The question of small-pox 1nJrtÛitJ/ in London during 1895has been already noticed in connexion with the Registrar-General’s annual summary ; Mr. Shirley Murphy, however,furnishes particulars of the incidence of attaeks by thisdisease in the course of the year. It appears that from the

beginning of 1895 to its close not a single week passed inwhich one or more cases of small-pox did not occur. Towardsthe end of June the attacks rapidly increased in number, andfrom that period until the middle of October feara were enter-tained lest this disease should become epidemic in London.The eastern parts of the metropolis were specially affected,the disease being communicated by tramps, and spreading toneighbouring places from Wbitechapel, which suffered moreseverely than other sanitary areas. In connexion with the

subject of small-pox prevalence in London the Medical Officerof Health again draws attention to the large increase in thenumber of children appearing in the vaccination returns as"not finally accounted for " in recent years. In 1893, thelatest year for which returns are available, the proportion soreturned was equal to 18’2 per cent. of the total births"The neglect of vaccination in London, in recent years,"says Mr. Shirley Murphy, " appears to be already manifestingitself by an increase in the proportion which deaths ofchildren from small-pox bear to deaths from this disease atall ages."The mortality from measles was rather below the decennial

average in London as a whole. The eastern districts suffered Imore severely than the others from this disease, but thehighest mortality occurred in St. Luke’s sanitary area, theadjoining areas of Holborn and Clerkenwell also sufferingseverely.

Scarlet fever was somewhat more prevalent in 1895 than ithad been in the previous year, although from the case fatalityit may be gathered that the type of disease was milderIn the present, as also in previous reports, a diagram hasbeen inserted showing the rela.tionship of school attendanceto scarlet fever prevalence. The diagram for 1895 shows amarked diminution of scarlet fever incidence in the month ofAugust, which corresponds with the summer holiday. Thecurve shows a fall in the week immediately following tne com-mencement of the holidays and a rise in the week immediatelysucceeding their termiuatim. In this respect the statisticsof 1895 appear t3 confirm those of recent previous years asregards the County of London, at anyra’e. In proportion topopulation the eastern districts of London suffered moreseverely than other districts in 1895 in respect both of thenumber of attacks and of the number of deaths. The out-break of scarlet fever in Islington in the course of the yearwas caused by an infected milk-supply, which gave rise toas many as 125 cases in that district alone.The incidence of diphtheria sickness in the County of

London during 1895 corresponded exactly with that of theprevious year, but was less than that of 1893. Judgedby the "case fatality," however, the type of the diseaseseems to have been milder in 1895 than in either of the twopreceding years. The question of how far this reduction incase fatality may be related to the more frequent use ofantitoxic serum in 1895 in the treatment of diphtheria isdiscussed by Mr. Shirley Murphy in the text, and interestingstatistics are given bearing upon this relationship.

: As in me case or scarlet; rever, a magram 18 insenea, showing the distribution of diphtheria attacks in the several- weeks of the year. From this diagram it appears that there was a considerable diminution in diphtheria prevalence inI the holiday month of August corresponding exactly withB the diminution in the attacks by scarlet fever. As in some! previous years, the diminished prevalence among childrenl under three years of age occurs somewhat later than amongI children of school age, suggesting, in Mr. Shirley Murphy’s! opinon, that the decrease among infants resulted from! diminished opportunity of infection from older children.j The heaviest incidence of this disease was upon the eastern

districts of London generally, but the district of Greenwichi had the highest case-rote during the year. In proportionJ to population the incidence of sickness from enteric fever inj 1895 did not differ greatly from the average in the previoust four years. In this year, as in the previous decade, the, eastern group of districts had the highest death-rates from. enteric fever and the western districts the lowest. An) unusually heavy incidence of the disease was experienced) at Plumstead, where as ma,ry as 215 cases were reported,r giving an attack-rate of 3’7 per 1000.i The mortality from phthisis in the administrative county. of London was heavier in 1695 than in the preceding year.) The rates of mortality from this disease ranged from 1 55 in- the western group of sanita.ry areas to 2 05 in the eastein, group and -2 65 in the central. The lowest rates weres 0 87 in Lewisham, and the highest 3’28 in St. Saviour’s Southwark and 3 31 in St. Giles’s.

THE INTERNATIONAL SANITARYCONFERENCE.

FROM Venice, under date March 13iih, our SpecialCorrespondent writes :-The regulations of arrivals from ports on the Persian Gulf

engaged the attention of the Conference for several sittings,and the following measures were discussed and approved :-A ship arriving from one of these ports and certified as

infected must immediately disembark its patients, who willat once be isolated. The other passengers will also have toland and subject themselves to surveillance for a period notexceeding ten days. Soiled linen and articles in personaluse will be disinfected, as also the ship itself in that part orparts of it deemed necessary by the authorities.

Suspected ships-those, that is to say, which have haicases of the "pestis" on board, but have had no fresh casefor twelve days-will undergo a medical visit. The linen,the wearing apparel, and such like which the authoritiesmay pronounce contaminated will be disinfected. Thepassengers and the crew will be subjectcd to a ten days’surveillance. The bilge water will be emptied out, the holdand ballast disinfected, and good potable water supplied.Immunised ships will have free course, provided always

that they have completed ten whole days since their

departure from the last infected port, otherwise they willhave to remain under surveillance until the expiry of thisperiod. All the same, the authorities at the port of arrivalwill have it in their power to prescribe and enforce themeasures adopted for suspected ships. In applying thesemeasures in circumstances as they arise the autholities,however, will have to make allowance for the presence onboard of a medical man provided with disinfecting apparatus,since, as already stated, in such cases the measures takenwill be less vigorous.

Special measures will be authorised for adoption in regardto certain ships, especially those conveying piJglims, and,indeed, for all others found in bad hygienic condition.Ships declining to undergo the measures prescribed by theauthorities will have it in their power to put back to sea.Their passengers, however, will have the right to demanddisembarkation provided that they submit to the measuresprescribed by the authorities of the port at which they wantto land.The Conference next resolved upon the construction cf two

hygienic establishments in the Persian Gulf-one in thedistrict of Ormuz or in the Island of Ormuz, or in that of1-ishm ; and the other in the neighbourhood of Bassora, ata suitable point to be suh: equently agreed upon. Each ofthese establishments will be ully equipped with a medicalstaff, with sanitary officers and warders, with disit.fect:rg