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THE PUBLIC-HOUSE AS A FACTOR INTHE SPREAD OF DISEASE.

(FROM A CORRESPONDENT.)

DURING the past two or three years there has been aconsiderable amount of discussion in the medical papers ofGreat Britain and of the United States in regard to the roleplayed by various social factors in the dissemination of

pulmonary tuberculosis. In most cases the factors which

favour the spread of pulmonary tuberculosis are those whichtend to aggravate the evils of many other infectious diseases,and this will be seen to hold good in the case of the public-house.The public-hcuse appeared to me to play so prominent a

part in the lives of a large number of the inhabitants of acertain poor part of London that I resolved to make a " pub"to I I pub " visitation that I might see how far the conditionsat the various " Blue Dragons," " Black Swans," and RoyalGeorges," whose flaring portals invite the passer-by at mostof the corners in the district, were likely to conduce to thespread of disease. There is certainly much disease in theneighbourhood and there is certainly much drinking, butthese notes do not attempt to deal with the connexionbetween the two. My tour of inspection was not taken fromtemperance motives and the temperance question enteredin none of its far-reaching aspects into my speculations.Putting entirely aside considerations as to whether the

person who drinks is more susceptible to pulmonary tuber-culosis than he who is a teetotaler, I went to look atcertain of the places where drink is dispensed to see whether,however wholesome and salutary the fluid supplied, the con-ditions of supply were not in themselves dangerous tohealth. I had been into a public-house in a poor localitybefore in my life, so that I may say at once that I expectedto find much that would be offensive to the modern medical

eye but I did not expect to find quite such a state of affairsas was revealed to me. The result of my little tour hasbeen to strengthen my preconceived ideas of the ordinarypublic-house as a menace to health both from a

medical and a sanitary standpoint. The community hasa right to demand that the elementary laws of

hygiene should in any place of general resort be con-formed to in such a way that health is not endangeredto any marked extent, but it is my conviction that in the

majority of instances undue laxity is observed in the attemptto safeguard the health of the frequenters of bars. The

question of sanitation is almost wholly disregarded in themanagement of the public-house. Saturday night is

naturally the time when the public-house may be observedunder the worst conditions. It is the time, however, whenthose in charge of public-houses should make their moststrenuous attempts to protect their customers. As far as Ihave been able to find out they do nothing of the sort.

The first "house of call" that I entered was crowded tosuffocation pitch with a throng of men and women packedtogether near the counters in compact masses. I wentinto what is called a "private bar." These " privatebars" form an especially objectionable feature of Londonpublic-houses of the lower class. The bars are merelynarrow boarded compartments opening on to a commoncounter and are presumably provided for the con-

venience of women or of those who do not wish to drinkin a public-house in the full sight of their fellow men. Itstands to reason that in so confined a space, even when thepublic-house is not full, it is impossible to avoid coming intoclose contact with other visitors. Those in front havingobtained their needs squash back to permit later incomers toreach the counter and the result is a thorough rubbing ofshoulders with all sorts and conditions of folk regardless oftheir sanitary condition. Of all the diseases or affectionswhich may be contracted with particular ease and frequencyin the public-house pulmonary tuberculosis takes the first

place, both on account of the gravity of the maladyand of the conditions prevailing which favour its propa-gation. THE LANCET on several occasions during recentyears has drawn attention to the probability that pulmonarytuberculosis is spread considerably by the agency of public-houses, and from my cursory observation-no more thancursory observation is needed-I am sure that it must be so.

In the lower class of taverns the floor is usually strewedwith sawdust which is expectorated upon freely. The floor

thus becomes impregnated with sputum ; the sawdust whendry is kicked about by the feet of visitors until the air ischarged with the floating particles. The ventilation is

usually vile, the heat very great (warmth, be it remembered,is one of the special inducements for poor folk to enter apublic-house), and sanitary organisation is absent. It

goes without saying that consumptives frequently resort tothese places, where all the conditions by which infection ismost easily conveyed are in full working order.The conditions of dirt, overcrowding, heat. and disorder

which I noticed in the first public-house that I entered wereall repeated in the others that I visited. There were thesame evil smells, the same stifling atmosphere, the samelarge intermixture of sick people with the usual clientèleof drinkers. And the usual clientèle appeared to thecasual eye to consist always of about a third whogenerally wanted refreshment, a third who habituallycraved for drink, and a third who were using a bar asa place of social resort and were doing business or

conversing with their friends. Some of these latter wereprobably habititis and equally probably drank too much ;others were accidental visitors, for it must not be forgottenthat if a poor man desires to give a mate social entertain-ment the bar offers him his only chance. He cannot invitea friend round to his club, and it would be well if temperanceadvocates (possibly members of well-appointed clubs) wouldsometimes remember this when they inveigh against theimmorality of the tempter who in the course of a casualchat says, " Have a drink." Owing to the similarity of theconditions that I observed in public-house after public-house the notes of each particular visit would makemonotonous and purposeless reading but I came to the con-clusion (as, I am sure, everyone would have done who hadreceived a medical training) that the public-house barplays a prominent part in the spread of pulmonarytuberculosis and that therefore the advocates of tem-

perance principles may claim to be on the right tackhere. Exactly how much of the prevalence of pul-monary tuberculosis is due to the public-house cannot, ofcourse, be ascertained, but the returns of the EnglishRegistrar-General for 1903 showed that public-house servantswere especial victims to the malady, a fact which can surelybe construed as a reflection upon the sanitary organisation oftheir environment. When a small class of the communityis found to be particularly prone to a very general diseasethe point always merits investigation because of the import-ance of discovering foci. It would be quite outside mypurposes in writing as well as quite unnecessary in thecolumns of THE LANCET to expatiate upon the prevalence ofpulmonary consumption. The report of the medical officerof health of the City of Westminster relating to the thirdquarter of the year 1905 shows that the death-rates per 1000of persons living in Westminster in the period mentionedwere for all causes 12- 0 and for phthisis 1.11. There is

nothing abnormal about these figures and they provenothing so far as any indictment against public-houses goes.But they show sufficiently the number of chances thatthere must be that a certain proportion of the clienteleof every public-house in a city will be persons suffer-

ing from a communicable disease. And the conditionsfavourable to intercommunication are all present, atmo-

spheric pollution in particular. Fliigge some time agomade investigations in regard to the identification ofsalivary bacteria and showed that when a large numberof individuals are gathered together indoors in a confinedarea the air is full of these bacteria. THE LANCET,in its issue of Sept. 17th, 1904, p. 841, commentingupon these conclusions, pointed out the importance ofthe bacteriological study of indoor air in’ relation tothe spread of infectious diseases. If the air of a crowded

public-house were to be examined bacteriologically the

quantity of salivary bacteria would certainly be very large.Next only, perhaps, to the public elementary school thereis no agency so capable of spreading disease as the public-house.

BIRMINGHAM.(FROM OUR OWN CORRESPONDENT.)

Birmingham Medical Mission.THE annual report of the above mission has lately been

presented. From it I gather that the total number of casesdealt with during the year was 4502, whilst 19,548

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attendances had been made. Since the mission was founded30 years ago over 500,000 poor people have been helped invarious ways. The financial statement disclosed receiptsamounting to £1671 13s. 8d. and payments to L1632 14s. 3d.,leaving a bank balance for the year ending June 30th last of.638 19s. 5d. The resignation by Dr. Thomas Savage of thepresidency of the mission was received.

South Staffordshire Small-pox Hospital.P On Dec. 4th the new small-pox hospital, which has beenerected for the use of a number of authorities inthe South Staffordshire area, will be opened for the

reception of patients. The hospital will be controlledby a board which, on the formation of a district,was appointed under an Order of the Local GovernmentBoard in 1903. The area embraced consists of the boroughsof Wolverhampton and Smethwick and the districts ofAmblecote, Bilston, Coseley, Darlaston, Heath Town,Rowley Regis, Sedgley, Short Heath, Tettenhall, Tipton,Wednesfield, and Kingswinford. The population of thesedistricts at the last census was 337,387, the rateable valuewas £970,877, and the area was 34,183 acres. The hospitalhas been erected on a site at Moxley. The site is boundedon two sides by the canal and is almost entirely isolatedfrom dwelling houses ; it includes an area of 56 acres. The

present buildings will provide accommodation for 40 patientsand for a sufficient staff of nurses and officials, including aresident medical man, to look after a larger number ofpatients should an epidemic arise. The hospital, apart fromthe administrative block, consists of three pavilions. No. 1and 3 pavilions will accommodate 16 patients each andNo. 2 pavilion, which is an observation block for doubtfulcases, will accommodate eight persons. Each of these

pavilions has two separate wards (male and female) witha nurses’ kitchen separating them. The three pavilions areconnected together, and also to the administrative block, bycovered ways for use in inclement weather. Accommoda-tion for infected and disinfected clothing, a disinfector,destructor, and mortuary are provided. The grounds in thebuilding area have been laid out in a simple manner withshrubs and trees and the remainder of the site is beingplanted with trees by the Midland Reafforest:ng Associa-tion. The cost of the work, including the purchase of land,will be about £18,000.

Staffordshire Se7verage Schemes.A Local Government Board inspector has lately held a

public inquiry with respect to an application by the Staffordrural district council for loans of £5000 and £4500 to enableit to carry out works of sewerage in the parishes of CastleChurch and Tillington. During recent years large quasi-urban districts on the boundary of the borough of Staffordhave sprung up and for some time the borough authoritieshave complained of the pollution of the boundary brooks bythe flowing therein of sewage from these residential dis-tricts. Eventually a statutory notice was served upon therural district council under the Rivers Pollution Act andafter much inquiry and discussion of various systems ofsewerage the rural district council eventually accepted aproposal made by the corporation that the districts shouldbe sewered on the same plan as the borough had adopted andthat the council should pay the corporation £150 a year forthe reception and treatment of the sewage. Application wasthen made to the Local Government Board for power toraise the necessary money. At the public inquiry theprincipal objection was that the scheme was too exten-sive. The inspector will report to the Local GovernmentBoard in due course.-The Fenton urban district councilhas been successful in obtaining an order staying the

operation of an injunction granted in January, 1903, untilJanuary, 1907. The action was brought to restrain the

pollution of the Trent by sewage and an injunction wasgranted by which the district coancil was compelled to

carry out the works necessary to obviate the nuisance.These works are now in process of construction. It wasstated that from 18 to 20 injunctions had been grantedagainst local bodies in the Potteries and over <&150,000 hadbeen spent in trying to get rid of the nuisance but the Trentwas still foul.

lVczter Undertakings.The South Staffordshire Waterworks Company is about

to enter upon important works at Burton-on-Trent. Owingto its elevation the district known as Winshill on the eastbank of the Trent has for many years suffered from an

indifferent water-supply. At the last meeting of the health

committee a communication was received from the companyinclosing an agreement whereby the latter promise toconstruct works at Winshill at an estimated expenditure ofZ6500 provided that the corporation contributed R1000.These terms were accepted by the committee. The remedywill take the form of a water tower.-In continuation of the

policy already laid down by the water committee of the

Birmingham city council a further area of 742 acres on thewatershed in the Elan Valley is being planted. The totalarea now under plantation is about 310 acres.

The Feeding of Underfed Children.The central relief committee of the Birmingham board of

guardians has decided to carry out itself the provisionsof the Relief (School Children) Order recently issued by theLocal Government Board with reference to the feeding ofunderfed children. The classes which will be dealt with bythe guardians are : (1) children of parents permanently im.poverished, (2) children of people who could provide butneglected to provide food for them, and (3) cases of tem-porary distress. Mr. George Hookham and the BirminghamSchools Cheap Dinner Society will undertake to feed thefatherless children and children who have been deserted forwhom no provision has been made in the Local GovernmentBoard Order.Nov. 28th.

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MANCHESTER.(FROM OUR OWN CORRESPONDENT.)

Recruiting in Manchester.OPINIONS as to the deterioration of race as affecting our

own people, especially in the large towns, vary considerably,some maintaining stoutly that it is a myth, while otherspoint to the ill-developed wastrels at our street corners inproof of their contention that we are a decadent race. Thistest, however, is only applicable to a section, though anumerous section, of the people and not to those whoseheredity and environment have been more favourable.Looking to the working class, that from which most of ourrecruits come, the result of recent returns shows that in thisdistrict there is no improvement on the deplorable state ofthings revealed a year or two ago. During the year endingSept. 30th, 1904, 5038 men offered themselves for enlistment,and of these only 1738 were finally approved. Of the rest,1962 were rejected by recruiters and 1522 were sent away asphysically unfit. 69 per cent. were rejected as below thephysical requirements, for" flat feet," or for defective teeth.The militia returns for the same year show 5150 applicationsfor enlistment with 1600 finally approved. The militiarecruits are enlisted between the ages of 17 and 35 yearsand the line between 18 and 25 years, giving the former awider field, while the examination is less strict. For the

present year there were 4554 applications for the line,of which only 732 were accepted. For the militiathe figures were 3813 applicants, of whom 599 onlypassed the physical and medical tests. No improvement hastaken place since 1899, when 11,000 men offered themselvesfor enlistment, 8000 of whom were rejected as physicallyunfit. Of the 3000 left a few over 1000 only could be putinto the army, the remainder being taken into the lowergrade of the militia. Only the other week on two daysabout 60 would-be recruits presented themselves at the Man-chester office, of whom only four were found fit to serve.These figures, which could no doubt be supplemented by othersfrom various industrial districts, show a deplorable state ofphysical inefficiency in the working-class population, whichno one can contemplate without grave misgivings. "Thestalwart breed of our peasants " is a thing of the past andthe rare exceptions to this state of physical degeneracy arenot to be found in the Manchester slums.

New Infirmary ect Nantwich.An important addition to the Nantwich workhouse hospital

was opened about a fortnight since. It consists of a nurses’home and wards for 74 women patients.

" Christmas is Coming."One of the signs of the advancing season is the annual

discussion on the question of beer or no beer for workhouseinmates at Christmas. The Oldham guardians have earlymade up their minds and decided, by 11 votes to 7,against supplying beer to those in their charge at Christmas.