586

the wide amplitude of the curve, even with such smallfluctuations (amounting only to about 20 F.) as occurredin the cases.The Cambridge Scientific Instrument Company has also

supplied a thermometer for use in the axilla. The clock-work cylinder can be made to revolve more rapidly thanonce a day. Of course, the charts here given are reducedin size, the actual dimensions being 12t by 8t inches. Toogreat a correspondence between the records of the nurses of the instrument must not be expected.

RONALD Ross, C.B., F R C.S. Eng., F.R.S.,Professor of Tropical Medicine, University of Liverpool.

A TRIPLE-WICK CANDLE.

AT a patient’s house it is generally difficult, and oftenimpossible, to obtain a suitable light for making observations.This is especially the case when a light for the ophthal-moscope is needed. An ordinary electric lamp simply givesthe image of the incandescent wire on the retina unless thelamp glass is ground to a degree that dims the light. Acommon candle throws only its own small image on thefundus. Every efficient portable electric lamp is heavy anduncertain in its action, and the best lamp of all-a paraffinlamp with a broad wick-is not only cumbersome but soilswhatever is near it to a degree that is at last insupportable.A serviceable light I have often obtained by cutting awaywith a knife one side of two pieces of candle, so as to bringtheir wicks near enough together for the flames to blend.This suggested the idea of a three-candle wick. After agood many trials the most serviceable is found to be a waxcandle, oval in section, 1! inches wide, with the three wicksa quarter of an inch apart. The flames of these blend,forming a flat flame Hths of an inch wide, which is a

practically adequate illumination. Experiment shows thatthe light is steadier and better without any form ofchimney or lantern. The oval candle (as supplied) isinclosed in a tin tube of corresponding size and shape,with tubular caps to fit on each end to prevent the topsof the wicks being broken. The "wax" is hard andsoon sets after the flame has been blown out or extin-

guished by the cap. The metal casing prevents any "gutter-ing," and the candle when burned down can easily be pushedup from the lower end by the fingers. The dimensions otthe outer case are 5 inches long, l inches wide, and iths ofan inch thick, a sufficiently small size to prevent conscious-ness of its presence in the pocket. It is made by Hawksley,357, Oxford-street, London, W. If a condensed light isdesired it can be obtained by a lens on a rod hinged to ametal band to lip over the case.

W. R. GOWERS, M.D. Lond.

UTERINE " FLAG MOP."

THIS little instrument is designed to serve as a sub.

stitute for the instrument known as Playfair’s probe andI think will be found convenient for all the cases where

that instrument is useful, the great point which alwaysstruck me as against the latter being the difficulty of

removing the wool after use. In my little instrument itis, at any rate, quite easy to replace the lint, wool, or

gauze by a clean piece in a moment; in fact, it is theapplication of the principle of ordinary sponge-holder toan instrument which is intended to be used in cleaningout or making applications to the interior of cavities forwhich the ordinary sponge-holder is too bulky. The instru-ment has been made for me by Messrs. Reynolds and Bransonof Leeds in aluminium, and either strips of lint or piecesof bandage or ribbon gauze can be used with it very con-veniently, and these may be inserted either in the form of a

broad gtrip placed between the serrated portion, so that themetal grips the material like the midrib of a leaf, or by theedge, roo as to make a flag. Turning tin instrument roundin the hand the material is easily rolled around to make a

convenient mop, and is equally easily undone and replacedwhen soiled by use. If it is thought advisable to protect thetip of the instrument (which, however, is blunt), a narrowstrip of gauze or lint can be inserted between the serrationsnear the top, carried over the top, and then wound spirallyround as in bandaging a finger, and fastened off where

required by the moveable collar, which brings the serratedsurfaces together. The instrument is sufficiently rigid foruse, but can be bent in easy curves to suit the shape of theuterus or any other cavity ; and as there is a little projectionat two and a half inches from the point it can be usedas an ordinary uterine sound if desired.

E SOLLY, M.B. Lond., F.R.C.S. Eng.

SPECTACLE FRAMES FOR PTOSIS.

Messrs. W. F. Stanley and Co. of Railway- approach,London-bridge, have sent us a spectacle frame intended forthe relief of ptosis without operation. To the upper bordersof the lens frames are fitted small spring supports which

will obviously keep up the droop’ng eyelids. We doubt thecomfort of the apparatus, but to thjae persons who dreadanything in the way of an operation the spectacles will veryposbibly appeal. The illustration shows the spectacles in use.

ELEVENTH ANNUAL REPORT (FOR 1902)OF THE MEDICAL OFFICER OF

HEALTH OF THE ADMINIS-TRATIVE COUNTY OF

LONDON.

iii.1

AMONG the official publications of medical officers ofhealth Mr. Shirley Murphy’s present report is quite excep-tional in this respect, that it contains particulars of the

behaviour of chicken-pox in a vast urban community side byside with those of a concurrent epidemic of small-pox.We have previously learnt that in the early days of the

recent epidemic the spread of small-pox in London wasaccelerated by the circumstance that in some cases there hadbeen failure to distinguish between chicke1-pox and small-pox. Accordingly the Council, acting on the advice of themedical officer of health, most prudently resolved to requirethe compulsory notification of chicken pox to the local sani-tary authoiities of the metropoiis under the provisions of thePublic Health Act. Although the primary object of thisexpedient was obviously the arrest of small-pox, it never-theless incidentally enabled Mr. Shirley Murphy to prepareunique statistics concerning not less than 25,000 cases ofvaricella, and these he has analysed with every needfuldetail, not only with regard to the age and sex inci-dence of the attacks but also with regard to theirdistribution in relation to locality and to time. Itis common knowledge that varicella is but rarely a fataldisease. At any rate, only a few deaths annually have beenattributed to this cause in the returns of Somerset Houseand probably most of theFe have really been cases of un-rf cognised small-pnx. Consinerat,joJ1s of space prevent our

1 Nos. I. and II. were published in THE LANCET of Feb. 6th (p. 385and 13th (p. 456), 1904, respectively.

587

following Mr. Shirley Murphy, as we should have liked to do,in his careful and lucid examination of the local incidence ofvaricella. We would, however, especially direct the atten-tion of the profession to this portion of his report, feelingassured that it will be found interesting and helpful to busypractitioners in their treatment of what is sometimes a veryperplexing complication of graver diseases.

Measles in 1902 appears to have been somewhat less fatalthan usual in London, accounting for the deaths of 51 per100,000 of the population at all age, as compared with 58,the average rate in the preceding ten years. In the metro-

polis it was more fatal in 1902 than in any of the greatEnglibh towns except Bristol, Bradford, Hull, Salford, andNewcastle. Measles mortality is important mainly inearly childhood, for more than nine-tenths of the deathsoccur at ages under five years. Above this age thedeaths from this disease in London are less than150 a year on the average. Ignorance among parentsconcerning the infectiousness of measles and their un-

willingness or inability to take the necessary precautionsare the chief causes of the almost universal prevalence ofthe disease ; and the fact of its high infectiveness for aboutthree days before the rash militates greatly against thesuccess of public efforts to limit its spread. Varyingtemporary success has attended the action of local medicalofficers of health in excluding possibly infective childrenfrom school. In spite of every precaution the disease inLondon recurs with increasing severity every two or threeyears, attacking the susceptible children who have accumu-lated in the intervals. "It is not probable," says Mr. ShirleyMurphy, that efforts made to limit the spread of measleswill do more than postpone the age of attack, but it may beexpected if this result can be attained that the mortality ofmeasles would be diminished." The County Council has,with the consent of the Local Government Board, appliedto measles those sections of the Public Health Actwhich prohibit the exposure of infected persons and

things and their transmission from place to place with-out reasonable precautions and also those sections whichprovide for the disinfection of houses and clothing and forthe disposal of bodies dead of dangerous infectious diseases.The county medical officer suggests the trial, at any rate, ofhospital accommodation as a means of checking the presentexcessive mortality of measles. Pulmonary diseases are wellknown to be the most frequent and fatal of the complica-tions occurring in measles-complications, moreover, againstwhich the poor have the least adequate means of contending.It is therefore worthy of consideration whether the hospitaltreatment of measles cases should not be tried, on a limitedscale, with a view of testing its value in reducing thefatality of the severer attacks of that disease.

Scarlet fever in London does not appear to have variedgreatly, either in prevalence or in fatality, during the lasttwo years. But if the last decade be compared with thefirst decade included in the table-namely, that terminatingwith 1868-the mortality to which it gave rise is seen tohave decreased enormously. Diagram IX. in the presentreport shows this clearly. Thus, the mortality in theten years 1859-68 is shown to have ranged from10 per cent. below to as much as 235 per cent.above the mean rate for the whole period, whilst inthe teu-year period just completed it has fallen from30 per cent. below to 85 per cent. below the mean.

The incidence of reported attacks is well hown in

Diagram XI. which gives the relative incidence of scarletfever cases in each month since 1891, the first year in whichnotmcanon in ijonaon was compulsory, lading tne n’scquinquennium after this year it is seen that the reportedcases were in the proportion of 5-9 per 1000 of the popula-tion at all ages, whilst in the more recent quinquennium theproportion fell to 3’ 8 per 1000. It is further to be noted asa probable factor of this decrease that since 1890 theadmissions for scarlet fever to the hospitals of the Metro-politan Asylums Board have steadily increased from 40 percent. to 78 per cent. of the totil cases known to haveoccurred in the metropolis. In 1902 scarlet fever mortalitywas lower in London than in any of the great English townsexcept Leeds. Nottingham, Hull, and Leicester, but it washigher than in any or the chief continental and foreigntowns except St. Petersburg, Berlin, Vienna, and NewYork.In regard to the preventive efforts of the County Council

respecting scarlet fever we notice with regret that althoughin 1902 that authority sought to obtain parliamentary

authority for prohibiting the distribution of infected milkin the metropolis, including the right to require from milkvendors lists of their customers and information as to thesource of their milk, nevertheless, these powers were

rejected by Parliament, so that a highly important measure,obviously necessary for the protection of the people ofLondon against infectious disease, is still wanting.During the last four years there has been in London a

steady decline in the fatality of diphtheria as comparedwith its average in the four years immediately preceding-a decrease represented by a fall in the average death-rateof more than one-third. It is further worthy of note thatduring the last 12 years there has been also a decline in thecase mortality of this disease, the mortality among thenotified attacks having fallen from 22 5 per cent. in 1891 to10 per cent. in 1902. In the year 1902 diphtheria was Jessfatal in London than in any of the great English townsexcept Manchester, Birmingham, Leeds, Nottingham,Leicester, and Newcastle-on-Tyne, whilst if the figures areto be trusted it was more fatal in London than in any ofthe chief foreign and continental towns except Paris,St. Petersburg, Vienna, and New York.Typhus as an endemic disease has now practically ceased

to trouble us in London, although it still continues to’’ breed true" in parts of Ireland and occasional cases ofthe disease are from time to time imported thence intocertain parts of this country. Not many years ago typhuswas, perhaps, next to small-pox, the most dreaded pesti-lence that infested the slums of our great commercial centresouu rrc ".1.1. aoaucauucu UL.1,"" U.&.Lll’V "I...&"’ iu vv.u.W.l.I.U’-t.",-,,",,, wa

as largely as enteric fever to the death toll of the metropolis.But now, happily, this is no longer true ; in the year 1902not a single death was attributed to typhus and the death-rate therefrom in the last ten years has averaged less than1 per 1,000,000 of the population. The virtual extermina-tion of typhus is doubtless peculiarly gratifying to the

county medical officer of health who in past years, both inthe fever hospital and in the slums, devoted so muchpersonal attention to the study and prevention of thatdisease.

Enteric fever has occurred in London during the last twoyears in the proportion of 70 per 100,000 of the population.If the period since 1869 be divided into two portions it willbe seen by Diagram XVII. that in the first half of thatperiod-viz., from 1869 to 1884-the death-rate from thatdisease was almost constantly above the mean for thewhole period, whilst since 1884 it has been as con-

stantly below it. A careful study of this chart will showthis clearly. What is peculiar in the history of entericfever in 1902 is the fact of its abnormal distributionwith respect to time. Thus Diagram XVIII. shows thatwhilst the duration of excessive enteric fever prevalenceextends normally from the thirty-fourth to the fifty-firstweek of the year, in 1902 that period began as early as thetwenty-fifth week, exceptional prevalence being noted in thetwenty-ninth and thirtieth weeks of that year. This increasewas not limited to any one locality but was widely dis-tributed throughout London. In discussing the causes

of enteric fever in London the subject most frequentlyreferred to by local medical officers of health is that of infec-tion from the consumption of shell-fish. Large quantities ofsuch food, especially cockles, came to London from theneighbourhood of Southend and many London inhabitantsvisited that resort during the summer months, some for asingle day and others for longer periods, many of them par-taking of shell fish during their stay. "There is no reason fordoubting," says Mr. Shirley Murphy, "that many cases ofenteric fever in London were caused in this way, and it ishighly probable that the consumption of shell-fish from otherplaces had a similar result."

In view of the foregoing experience it is satisfactory tonote that the County Council has memorialised the LocalGovernment Board, expressing the Council’s hope that, in theinterests of the public health, the Board will as soon as

possible take steps to amend the law so as to prohibit thelaying down of shell-fish in sewage-polluted creeks, &c., andto prohibit the sale of such shell. fish for human consump-tion ; it also asks that all unpolluted layings, fattening beds,and storage ponds at present in use may be protected frompollution by any person or any sanitary authority. As thissubject is now under consideration by the Royal Com-mission on Sewage Disposal we may hope that suitable legis-lative measures will be adopted by the Government for theprotection of an important source of food supply.