1416 THE EPIDEMIC OF TYPHOID FEVER AT BELFAST.-BIRMINGHAM.

a report on the subject dated Oct. 13th last says: "By farthe greater part of the metropolis is supplied with waterdrawn from the Rivers Thames and Lea, which drain areasincomparably more densely populated and more highly culti.vated than are the gathering grounds of the Belfast supply.In the valleys of the Thames and Lea above the intakes ofthe London supply typhoid fever is certainly at all timespresent among the population." Yet the typhoid fever mor-tality in London for the ten years from 1881 to 1890 onlyaveraged 1’9 per 10,000 of the population, and this ismuch below the average of ten out of fourteen largeEnglish towns which are reputed to have water-suppliesabove suspicion. Dr. Frankland then adds the followingargument: "If London, which is supplied with waterinitially far more exposed to contamination than is thatof Belfast, exhibits no excess of typhoid fever mortalitybut, on the contrary, a very low average death-rate from thisdisease it is difficult to see why the water of Belfast, which issubmitted to the same treatment of storage and filtration asis that supplied to London, should be credited with the com-munication of this disease, more especially as the Belfastwater is subjected to a far more prolonged storage than is thecase with any of the water supplied to London. It is

particularly noteworthy, in connexion with water-borne

epidemics of typhoid, that these have in almost all casesoccurred through contamination of water, which was sup-plied generally without storage and almost invariably with-out filtration." Dr. Frankland, in support of this contentionquotes the evidence he gave before the Royal Commission onthe London water-supply (1892) concerning the West Middle.sex Waterworks. He then showed that unfiltued Thames waterfrom Hampton contained 1437 bacteria in a cubic centimetre.After passing through one storage reservoir this same watfr icontained only 318 bacteria, and after a second storage 177bacteria per cubic centimetre. In a previous report en thewater-supply of Belfast, dated July 24th last, Dr. Franklandsays : 11 VVith storage capacity the Belfast supply appears tobe well provided, both the Woodburn and Stoneyford watersbeing subjected to a protracted period of quiescence in thelarge reservoirs bearing these names. A slight defect inthis storage system I have already referred to-viz, theadmixture of some unstored water with the stream belowthe Woodburn reservoirs. The benefits of storage are

also to some extent neutralised in this portion of the

supply by passing the water from these reservoirs

through an open stream clothed with vegetation insteadof exclusively through a closed culvert. The Belfast

water-supply is further provided with a most admirableseries of filter beds constructed on the most approvedprinciples and worked with great care and attention.’This latter includes the allowing of a considerable amount ofwater to run to waste whenever a filter bed has been cleaned,so that there may be time for the slime deposit to form itselfon the surface of the sand before the water is distributed fordiinking purposes. The result of these measures was thatin the worst sample 96 6 per cent. of the bacteria in the un-filtered water had been removed, and in the best sample98 8 per cent. had been removed. In spite of these goodresults it is at least theoretically possible that the watermight be contaminated, but Dr. Frankland concludes inhis last report that "it appears in the highest degree im-probable that the typhoid now prevalent in Belfast should bechargeable to the water as sent out to the consumer." Tothis he adds that as there are two water areas it is not

likely that both would be simultaneously contaminated ;and, if one only was contaminated, then the fever, instead ofbeing spread all over the town, would be limited to thedistrict provided by that supply.

In spite of these reassuring utterances, a strong impressionprevails that the water is the cause of the epidemic. It is

argued that Dr. Frankland was not fully informed as to allthe circumstances. Thus it is a mistake to say that thereare two separate water-supplies. The gathering grounds arequite separate, but the waters meet together and are mixedat the filter beds. Consequently Dr. Frankland has beencalled to Belfast for a third time and a list of sixteen farmhouses has been given to him where the drainage from thestables, manure heaps, houses, &c., discharges either intothe subsoil or the adjoining small water courses which areall situated on the Stoneyford gathering ground supply-ing Belfast with drinking water. At the commencement ofthe year there were four cases of typhoid fever in one ofthese farm houses, and it is urged that it was only afterthese four cases on the gathering ground that the fever

became so general in Belfast. Bat here we are face to facewith a difficulty. The cases at this farm, if I am rightlyinformed, occurred last January and the compulsory notifi.cation of infectious diseases only came into force last March.In the month of January 33 ca?es of typhoid fever werevoluntarily notified and in February 14 cases. Now in themonth of March when compulsory notification came intoforce 215 cases of typhoid fever were reported. The figuresfor the following months were as follows: April, 289; May,527 ; June, 262; July, 172 ; August, 304; September, 379;and October, 354. Thus from January to the end ofOctober we have a total of over 2000 cases notified astyphoid fever. There is every reason to believe thatsome errors in diagnosis have been committed. This isshown by the fact that a good number of the patients wereup and well and attending to their business two or threedays after they had been reported to the medical officer ofhealth as suffering from typhoid fever. What, however, isstill more significant is the fact that the number of deathsregistered as due to typhoid fever do not at all correspondwith the number of cases said to have occurred. There were12 deaths in January, 19 in February, 16 in March, 35 inApril, 40 in May. 35 in June, 9 in July, 30 in August, 27 inSeptember, and 33 in October. Since then 9 deaths werereported for the week ending Nov. 6th, and 5 deaths for theweek ending Nov. 13th. This gives us for the year andup to Nov. 13th 270 deaths from typhoid fever. But typhoidfever is endemic at Belfast, there having been 145 deaths fromthat disease in 1884, 184 in 1895, and 136 in 1896. Thus wemay say that typhoid fever is much more prevalent this yearthan usual; but the difference is not so startling asto justify the belief in the presence of some veryexceptional caufe. If the water had been unusually contami.nated we might have expected a greater number of deathsand a more uniform distribution of the disease. Thoughthere are cases in all directions still the great majorityare confined to two districts widely apart-namely, thehigh-level Shankhill and Crumlin district, and the low-level district on the other side of the water known as theBallymagarret and the Newtownwards.road district. Thenin the first, the Shankhill district, there are the barracks, theprison, and the union workhouse, with some thousands ofinhabitants drinking the same water and yet escaping fromthe fever.What, then, are the causes of the present prevalence of

typhoid fever at Belfast ? This is a complex question withwhich I cannot venture to deal till I have carried my in-vestigations farther afield. But I may at least say thismuch, that not only is the soil unfavourable, alluvial andmoist, but it is highly contaminated by some 20,000 cesspitsthat still exist in the town. Many of the houses cannot beapproached from behind so that the contents of the cesspitshave to be carried through the kitchens and the inhabitedparts of the houses. A vast section of the population is

singularly careless as to sanitary matters. Proper precautionsare rarely enforced and there is little or no skilled nursing.The climate also is very damp and the flax spinning in whicha large section of the population is occupied is unhealthywork. But all these are matters which I must discussmore fully when I have had the time to collect more

3vidence. For the present I must content myself with sayinghbat I have not yet come across sufficient proof to be able to)onclude that the present exceptional prevalence of typhoidfever in Belfast is due to a general contamination of the water-supply ; but that there is much to show that the condition ofjhe subsoil, the want of proper drainage, and the habits ofjhe people are all well calculated to facilitate the spread offiucb a disease as typhoid fever.

BIRMINGHAM.(FBOM OUR OWN CORRESPONDENT.)

- Dy<M?M6 Prosecution.AN important prosecution under the city by-laws as affecting

drainage was heard at the Police-court recently. A buildersubmitted plans for the erection of a number of houses whichwere disapproved by the corporation owing to certain defects.Again and yet again the plans were rejected. The houseswere put up without the proposed alterations, hence theaction by the corporation. It was stated that there wasone inlet and one outlet for each house instead of tw

1417BIRMINGHAM.-MANCHESTER.-SCOTLAND.

and only one trap for the six houses. In accordance withthe by-laws each house should have a separate connexionwith the main drain. For the defence it was alleged thatpreviously to the appointment of the present city surveyorthe corporation allowed blocks cf houses to be drained withone trap. An expert stated that in his judgment there wasao sanitary defect in the plan followed and that a differentinterpretation was placed upon the by-laws to that pre-viously existing. The Bench held that the by-laws had beenbroken and fined the defendant 20s. and costs, granting aease for appeal. Besides the question of legal interpretationof the by-laws the construction of the drainage from asanitary point of view is important. Authorities appear todiffer upon this arrangement, some considering that the

system of interception traps are an unnecessary evil. Anauthoritative solution of this difficulty would go far to dispelthe apprehension which exists as to the best plan of drainagefor dwelling. houses, more especially in the face of prevalententeric fever cases.

The Po:ice and Assaults.The repeated advice given by magistrates to the police as

to the use of the staff in self-defence is prudent and

judicious. They are recommended not to be aggressive, andwhen force is necessary to take care that they shall notstrike the heads of their assailants with truncheons. This ismo doubt wise as a sentiment of calm and reflective considera-tion from the bench. In the excitement of a street row underextreme provocation and often personal injury human natureis apt to assert itself and blow to be returned for blow. A

police officer was lately convicted of viciously assaulting’four men in a crowd and was sentenced to one month’smprisonment. The officer had been previously knockeddown twice and kicked, when he got up in a sort of dazedway and ran amok among the crowd of bystanders. Someefforts have been made to obtain an appeal on the groundthat an injury to the head such as the constable receivedfrequently causes irresponsibility of immediate action. Whilerecognising the danger of this plea in many instances itwould appear probable from subsequent evidence that thismight be reasonably allowed in this particular case, andi am glad to say that an appeal has ultimately beenadmitted, the necessary recognisances being entered into.Jastice demands that the circumstances should be fairly andfully investigated on behalf of the police as well as for theprotection of the public.

The Cataconabs of Christ Church.Under the recent Birmingham Churches Act the building

of Christ Church is to be removed and the site sold. Underthe church are catacombs containing 137 bodies, very few ofwhich have been claimed by their descendants. The cele-brated Baskerville is buried here. Failing sufficient interestwith the surviving relatives these bodies will be removed toWilton Cemetery for interment, that of Baskerville beingreserved for St. Pnilip’s Churchyard in the centre ofthe town of his labours.Nov. 23rd. S

MANCHESTER.

(FROM OUR OWN CORRESPONDENT.)

(lua’J’dians and Chemical Odours.PROBABLY in Oliver Twist’s time nothing would have been

’done to protect him from bad smells but it must be acknow-ledged that no smells then existed which could be comparedfor sickeniDg persistency with those now provided abundantlyby the ingenuity and liberality of some of our chemicalinanufacturers. So shockingly offensive are these smellsthat the Prestwich guardians have asked the Manchesterguardians to join them in a deputation to the sani-tary committee of the Manchester Corporation "to directattention to the nuisance which was caused by the smellsfrom certain chemical works." It is no wonder that thetwo boards should act together in this matter, as the’Prestwich and Crumpmll woikhouses are near neighbours.As regards nuisances chemical manufacturers seem to beespecially prominent. They are among the most diligent inthe production of black smoke, and so highly do they valuetheir proficiency in this art that they seek for greaterprivileges than are allowed to other manufacturers, while,they are uiarivalled in the skill with which they concert’bad smells act distribute them to the unfoxtunates vh)

dwell around. No doubt something has been done in variousplaces to put partial restraint on them, but there are well-known instances in Manchester where all such efforts havebeen evaded or defied. The practical applications of chemicalscience must be defective when the result is an almostunendurable nuisance, and it is time that the offendersshould be compelled to have more regard for the comfort andwell-being of others than they now exhibit, and they mightas a change apply their science to the prevention instead ofthe production of bad smells.

Manchesterr Childrren’s Hospital.On Nov. 13th many of those interested in the Manchester

Children’s Hospital assembled at St. Anne’s-on-the-Seato take part in the formal opening and presentation ofa convalescent home by Sir Wm. Agnew, president of thehospital. By his munificence in building and also in theequipment of this home a need long felt has been relieved.It is amply provided with ground for extension and standssome sixty or eighty yards from the coast line.There is accommodation for twenty-five boys and girlg-

‘

as well as for a matron, two nurses, and two servants." TheRev. S. A. Steinthal said that Sir William Agnew had thatmorning given .8600 towards the endowment and that 350or .E400 a year would be required for the maintenance ofthe home. This will no doubt be found, for the hospital hasmany friends.

The Coachman with Medical Instincts.

The medical profession is familiar with many varieties ofirregular competition, but it is comparatively rare that themedical man’s coachman turns practitioner. That such a thingdoes happen sometimes is shown by the evidence given atan inquest held by the Manchester city coroner on the 17thinst. as to the death of a child three days old. At the birtha nurse and the uncle of the child’s father-" who was con-sidered very clever at the game "-were present. It was givenin evidence, according to the newspaper report, that he wasacting as assistant to a medical man, and when Mr. Smelt,the coroner, told him he had a distinct recollection thathe was the late Mr. Pettinger’s coachman the man acknow-ledged that it was so. It is a little hard on Dr. Nichol, awell - known practitioner in the neighbourhood, that heshould be opposed by Mr. Nicholls-sometime coachman,now accoucheur - however clever he may be " at thegame," and it seems to be a case which deserves inquiryby the Manchester Medico-Ethical Association. The coronerobserved that "a person who knowingly engaged an un-

qualified man had to be content with the outcome," butthe profession generally should not be content when suchscandals are possible. The medical man does not seem tohave been present at the inquest.

SCOTLAND.(FROM OUR OWN CORRESPONDENTS.)

The Social and Sanitary Society of Edinburgh,THE annual meeting of this society was held in Edinburgh

on Monday. After the report for the past year had beenread and adopted Dr. Brock, the medical officer of healthof Midlothian, spoke at some length on the milk question.He emphasised the necessity ot a pure milk-supply andpointed out the liability to infection with tuberculosis andother infectious diseases through the milk-supply. Tuber-culosis was responsible for one-seventh the total deaths inthat country and dairy cows were tuberculous to the extent offrom 20 to 50 per cent., so that it was necessary to make everyeffort to eliminate this source of infection. The diseasemight be communicated by cream, butter, cheese, and butter-milk, as well as by milk. To ensure a non-tuberculous milk-supply it was necessary that the animals should be systemati-cally tested with tuberculin and that all the tuberculous cowsthus discovered should be weeded out of the herds. Toguard against infection with scarlet fever he thought variousprecautions necessary. The dairy buildings should beremoved from the neighbourhood of dwelling houses,the milk should go straight from producer to consumer,and the people employed about a dairy should beregularly inspected by a medical man. He advocatedthe formation of a dairy company with the view ofp oviding a pure milk-supply. He showed how much good