401

ANNUAL REPORT OF THE MEDICALOFFICER OF THE LOCAL GOVERN-

MENT BOARD.

II.1THE supervision of public vaccination throughout England

and Wales occupied a considerable portion of the attentionof the Local Government Board’s medical staff during theyear 1894. In view of the sad calamity which has recentlybefallen the people of Gloucester because of the stubbornrefusal of the Poor-law guardians to enforce the Vac-cination Acts, Dr. Thorne Thorne’s account of the growingtendency amongst some constituted authorities to shirk theirstatutory duties will surely receive more than passing atten-tion. The medical officer tells us that of the 890,695 childrenborn in England and Wales during 1892, 14. 9 per cent. werenot finally accounted for as regards vaccination, including13,278, or 1-7 per cent., whose vaccination had been postponedunder medical certificate. In the metropolis the amount ofdefault reached 18’4 per cent., and in the provinces 14’3per cent., both these rates being more than double thosewhich obtained six years previously, when the progressivefailure on the part of many Poor-law guardians properly toenforce the provisions of the Vaccination Acts, which hascharacterised recent years, may be regarded as havingdefinitely set in. Having regard to the very serious dangerto the public health, even in the metropolis itself, whichthese figures disclose-a danger which is certainly growingmore imminent as time goes on-it is impossible to contem-plate without sad forebodings the inexplicable delay of theRoyal Commission to publish their final report. What-ever the verdict of the Commissioners may be on the

subject of vaccination, it is certain that the patienceof our profession, as well as that of the public,has been most unfairly tried in waiting for it, and wedeliberately express the opinion that in the event of furtherdelay in the production of the report becoming necessary thereason for it should be clearly and promptly announced inParliament. But that which strikes us as of paramountimportance in present circumstances is the considerationthat the tardiness above referred to is being interpreted bymany of the opponents of vaccination as proof that the Com-missioners attach but slight importance to the alleged pro-tective power of vaccination against small-pox, and by thismeans they contrive to persuade disaffected guardians to bemore lax than ever in enforcing the law.In the year 1892 not less than 1983 infants born during

that year in England and Wales, out of a total of 665,640who were submitted to the operation, were certified as in-

susceptible to vaccination. Inasmuch as the records of this

operation at the Board’s own station in Lamb’s Conduit-streetshow that out of more than 88,000 persons vaccinated bytheir officers in the course of a long series of years not asingle instance of insusceptibility has been known, theoccurrence of 1983 cases of alleged insusceptibility in asingle year calls for serious investigation. For example, itwould be interesting to know how many of these instancesof failure to communicate protection against small-poxoccurred in union workhouses or other establishments whichare specially excluded from the supervision of the Board’smedical department. It would also be instructive to ascertainwhat proportion of the total failures occurred in the prac-tice of public vaccinators. It is more than probable thatinquiries of this nature have already been prosecuted onbehalf of the Royal Commission, in which case we may readmore on this important aspect of the subject in the forth-coming report.Pari passu with the growing practice in recent years of

isolating scarlet fever patients in hospitals, this disease has,in not a few instances, shown a tendency to reappear inhouseholds shortly after the return thereto of persons whohad resided for some time in hospital as scarlet fever patients,and the term "return cases" has come to be applied tosuch instances of secondary infection. The hospital belong-ing jointly to the Bromley and Beckenham district councilsseems to have come under the notice of the Board in thisconnexion during 1894, and the late Mr. T. W. Thompsonwas instructed to confer with the representatives of the

1 No. I. appeared in THE LANCET of July 25th, 1896.

combined hospital authorities on the subject. The cir-cumstances are clearly set out in Mr. Thompson’s report,which shows that a certain number of " return cases " appearto have been caused in the way above indicated as a resultof the operations of this hospital ; but in consequence chieflyof the smallness of the figures concerned Mr. Thompsondid not profess to have discovered any definite solutionof the matter under investigation. The report, however,which is included in Dr. Thorne Thorne’s appendix, isfull of interest to those who, as practical sanitarians,have to deal from time to time with return cases of scarletfever, for it will readily be understood that these unfortu-nate accidents interpose difficulties of no light kind in theway of those whose duty it is to secure the prompt isolationof first cases of infectious disease. Dr. Theodore Thomsoncontributes a valuable report, which is included in the sameappendix, on the subject of the prevalence and fatality ofmeasles. We have repeatedly published statistics in thesecolumns showing that the mortality from most of the diseasesof the so-called zymotic class has been slowly but steadilydecreasing in recent years ; the case of measles, however,forms an important exception. This disease kills annually,on the average, nearly thirteen thousand persons, mostly,if not exclusively, young children, and it unfortunately showsa tendency to increase. Even in the quinquennium 1890-94the death-rate from measles was higher than that from

any other zymotic disease except whooping-cough anddiarrhoea. The mortality from measles is always muchgreater in towns than in country places, the diseasebeing more frequently epidemic in towns where the

opportunities for direct infection from person to personin schools and elsewhere are unusually frequent. Althoughit is well known that uncomplicated measles is a compara-tively mild disease as it occurs generally amongst thechildren of well-to-do persons, the case is far otherwise

amongst the poor. The importance to sanitary authoritiesof being able to devise measures for the control of measlesamong the latter class on its first appearance in theirdistricts is apparent on consideration of the tender age atwhich measles is mostly fatal-namely, during the secondyear of life. " If," says Dr. Thorne Thorne. "measles, whichformerly was epidemic every other year, be so far discouragedby preventive measures as to acquire epidemicity only everyfourth year, it is clear that a larger number of susceptiblechildren will, when the epidemic arrives, have reached agesat which the disease is little fatal, and that in this waymany lives will be saved which formerly were sacrificed tomeasles." In discussing the measures likely to prove service-able in the face of an epidemic of measles Dr. ThorneThorne naturally turns to notification, and endeavours tolearn how far this expedient has been adopted by thesanitary authorities of the country and with what results.Here, it must be confessed, the returns are disappointing.The notification of this disease has not been required underthe Act by any considerable number of authorities, andit appears from the report to be questionable whether

any great amount of good has been obtained inthose cases where the disease has been scheduled.’’ Unfortunately, it is impossible," says Dr. Thorne Thorne,"to point to any one district as having systematicallyadopted all practicable measures of precaution for the

prevention of measles ; but the facts recorded go to indicatethat in so far as in particular districts the difficulties of theproblem have been realised ...... by so far have the resultsobtained been found encouraging to the sanitary authoritiesconcerned."The Cholera Survey, which had been commenced in 1892,

was continued throughout 1894, in which year thirty port orriparian sanitary districts and 162 inland sanitary districtswere inspected as to their general sanitary administration,with especial relation to the danger that might be incurredas the result of any chance cholera brought into their midst.Dr. Thorne Thorne reports with justifiable pride that "not asingle death from Asiatic cholera occurred in this country in1894," although 135 deaths had been caused by it in theprevious year. This exceptional experience of 1894 mustbe regarded with satisfaction by the Board and by thecountry. Dr. Thorne Thorne quotes three instancesfrom the past history of cholera in which thisdisease, after traversing Russia and Northern Germany,effected an entrance into English communities. Cholera wasintroduced into England in 1848, in which year 1105 deathswere attributed to it, followed by 53,293 in 1849. Thedisease was again introduced in 1853, when 4419 persons fel

402

’victims to it and 20,097 in the following year. In 1893 itwas introduced again and for the last time. In that year135 deaths were referred to cholera, but not one death was.attributed to it in 1894. Without endeavouring to appraisewith accuracy what this country owes to the expenditureincurred for sanitary purposes during the period when wewere exposed to the test of the late European choleraepidemic, Dr. Thorne Thorne concludes this part of his

report with the remark : "I I have no hesitation in assertingthat the exceptional expenditure incurred in this countryduring 1893-95, whether by the Central Government or bylocal authorities, was one which, even from the financialpoint of view, must be classed as reproductive."

INTERIM REPORT OF THE DEPART-MENTAL COMMITTEE ON DANGEROUS

TRADES.

AN interim report of this committee, appointed by Mr..Asquith and reappointed in January last by Sir MatthewWhite Ridley, has recently been issued. The committeeconsists of Mr. H. J. Tennant, M.P. (chairman), Mrs. H. J.Tennant (née Miss May Abraham), Mr. Thomas Oliver,M.D. Glasg., F.R.C.P. Lond., and Commander Hamilton

’Smith, one of Her Majesty’s inspectors of factories (sec-.retary).

The doings of this valuable committee have up to the

present been unavoidably incomplete, for certain additionshave been from time to time made to its agenda which insome cases necessitate going over the same ground twice.The present report deals with the following dangerous trades:(1) bronzing in lithographic works; (2) paper-staining,colouring, and enamelling; (3) the use of steam loco-motives in factories; (4) indiarubber works; (5) the useof inflammable or spirit paints ; (6) dry-cleaning; and- (7) the manufacture, filling, corking, &c., of mineral waters.In pursuance of its investigations the committee has visited134 works and examined 153 persons. The request ofCommander Hamilton Smith for fresh persons to volunteerevidence (published in THE LANCET of Jan. 18th, 1896) hasit appears been effective in gathering information.With regard to bronzing in the lithographic trade, a pro-

cess necessitated by the great demand for illuminated showcards, birthday cards, and the like, much that is instructive,if painful, may be gathered from the report. It seems thatin this process while dabbing the metallic powder on to thesized surface of the card the operatives become coveredwith fine glittering dust. Their eyes, noses, mouths, andhair lodge quantities of it, and when it is considered that thissharp angular powder consists of copper and zinc with, onthe average, 0’12 per cent. of metallic arsenic the onlywonder is that the trade has not hitherto been reckonedan even more dangerous one. ’’ No specific disease," weare told, I is traceable to bronzing as an occupation. Thecommittee have, however, seen girls, women, and boysliterally covered with this dust, who admit that it gets downtheir neck and under their clothes, that it irritates the skin,that they suffer from headache, constipation, bad taste inthe mouth, loss of appetite, extreme drowsiness, lethargy,anaemia, skin eruption, respiratory catarrh, and generalmalaise." Mr. Archibald Newland, one of Her Majesty’sinspectors, states that he has found several cases of slightbut distinct copper-poisoning among operatives in this trade.One instance in particular he relates in which a Glasgow’’ hand suffering from eruptions from this cause was refusedpermission by the manager to wear a respirator on theground that he (the manager) considered the bronze dustquite innocuous.The recommendations of the committee seem admirable.

Overalls should be worn of such a colour as to show the dustand these should be washed once a week ; washable and

frequently changed respirators should be worn ; no foodshould be eaten in the workrooms; personal cleanliness shouldbe enforced ; half a pint of milk should be supplied to each operative twice daily, at 11 A.M. and 4.30 P.J’lI. Further, Iall " hands " should be examined by the certifying surgeon once a month.

The great danger of the paper-staining trade lies in thelack of proper ventilation, for the temperature of the work-rooms is necessarily high. This, added to the dust gene-rated in the processes of

" I flockid g and" mica dusting "-in which latter process large quantities of finely dividedsilicate of magnesium enter the air passages-rendersthis trade most unhealthy, especially to young persons.The recommendations of the committee are muchthe same in this case as in bronzing, with the addi.tional recommendation of artificial ventilation by means offans or otherwise. In the indiarubber trade, especially in thematter of making waterproof clothing, &c., the chief dangerlies in the inhalation of the vapour of naphtha, in whichmedium the indiarubber is dissolved, and in the noxiousfumes of carbon bisulphide, so largely used in the process of"vulcanising"; the inhalation of naphtha vapour, even whenlargely diluted, is alleged to produce dizziness and nausea,although, according to Dr. Arlidge, it does not give rise toany definite disease. The committee considers that it un.doubtedly tends to undermine the constitution. Carbonbisulphide, according to the evidence of Mr. Rogers, pro.duces " violent headaches, dizziness, and sick-vomiting, andin some persons peripheral neuritis is set up." The dangersof volatile or spirit paints, used on account of their quick-drying properties, and of the processes of dry cleaning(mettoyccge it see) chiefly arise from the volatile natureof the benzine compounds used as solvents. Not only isthere great danger of fire in both of these trades, but thevapours generated frequently cause dizziness and even in.sensibility. In the case of inflammable paint the committeerecommends that none shall be used the "flash point" ofwhich, by Abel’s apparatus, is lower than 100° F.In the aerated water trade accidents caused by the

bursting of bottles during or after the process of fillingare frequent. Gauntlets and the careful netting-in of themachines are the remedies suggested by the committee,The practice of licking labels has not been exhaustively dealtwith in this report, as the matter is to receive fuller attentionwhen the labeling of cotton reels comes under consideration.The appendix to the report contains some interesting

figures with regard to the diseases prevalent in the india-rubber trade, and a report by Dr. Dupre on various kinds ofrespirators. The unsatisfactory nature of his conclusions inthis matter opens a large field for the ingenuity of inventors,

" No form of respirator," says his report, " has yet beendesigned to combine lightness, coolness, and ease. On thecontrary, its presence makes him [the wearer] breathe faster,get hotter, and perspire more freely."

" WHAT IS HYPNOTISM? "

A MEETING of the Society for Psychical Research was heldat the Westminster Town Hall on July 10th, whose pro’ceedings are worthy of report. Professor William Crookes,F.R.S., the President of the society, was in in the chair.

Dr. J. Milne Bramwell read a paper entitled What isHypnotism? " He commenced by giving a short account ofthe mesmerists and the controversy between them and JamesBraid. According to the former, mesmerism was a physicalpower possessed not only by man but also by magnets andother inanimate objects ; according to the latter, the

phenomena were purely subjective and resulted from changesin the nervous system, not of the operator, but of the subject.At first Braid’s explanation of the phenomena was a purelyphysical one, and since his day various attempts have beenmade to explain hypnosis from the same standpoint.Dr. Bramwell gave an account of three of these: 1. The

Salpêtrière theory, which explained hypnotic phenomenaby the assumption of a morbid nervous condition. Thisposition has been rendered untenable, since very extendedstatistics have shown that 95 per cent. of mankind at largecan be hypnotised and that the most difficult to influence arethe hysterical and ill-balanced. Many of the errors of themesmerists in reference to metals and magnets have beenrevived by this school and apparently from the same cause-viz., failure to recognise the influence of mental impressionsduring physical experiments. 2. Heidenhain’s theory,which explains the phenomena by a cerebral inhibition,and entirely depends upon the assumption that hypnoticacts are performed unconsciously. The experimental