432 FRENCH HEALTH RESORTS.

their duty, the unnecessary number of books to be kept,the non-payment of substitutes in case of illness or absenceon public duty, the necessity for the appointment of hospitalwarders, and the objection to warders’ families living in theprison. We are glad to see that in paragraphs 58, 60, 61,62, 64, 65, and 72 the justice of these complaints has beenacknowledged and their recommendations adopted. Allthese points we indicated in our issue of November 17th,1883. We cannot leave this part of the report withoutdrawing attention to a portion of paragraph 59, in which theboard are convicted of a deliberate attempt to falsify areport. The circumstances are shortly as follows :-A medicalofficer was called on to attend a member of a warder’s familywho resided in the town. This duty he objected to perform,as not being laid down in his instructions or implied byusage. A correspondence with the board ensued, and intheir minute of August 23rd, 1880, they state, "That thePrisons Board require’ the medical officer to attend thefamilies of warders, provided they live within one half mileof the prison ; and the medical officer neglecting to do soacts thus at his peril, and it is the duty of the governor toreport such omission of duty." The discharge of thisduty by medical officers of prisons "was one of thereasons put forth by the late departmental committee en-titling medical officers of prisons to an increase of salary."Paragraph 59 states: "We do not find that the perform-ance of this duty was stipulated for when the salaries of themedical officers were last fixed, although it was so stated tothem by the General Prisons Board." It is inconceivablehow any board could make such a mis-statement, or, havingmade it, be allowed to retain their places.The report deals very particularly with the control and

inspection of the various convict establishments in Ireland,and in paragraph 119 with the intermediate prison at Lusk.We think they are wise in recommending its discontinuance;they find that it is both useless and expensive. It may bethat the distinctive character of Lusk-namely, the carefulselection of its inmates-has been carried out too minutely.There were only twenty-four convicts there at the timethe commissioners inspected it, and the cost of main-tenance and staff combined reached the exorbitant sum of986 per head. This is out of all proportion to any resultobtainable.We are glad to find that the report recommends the

personal inspection of all convict establishments by themembers of the board instead of the inspectors.The diminution of the number of prisons in Ireland is also

recommended, and we agree with the commissioners thatthe grouping together, as in England, of large numbers ofprisoners is conducive to greater economy and efficiency,both in maintenance and treatment. Under the presentsystem each prison has only a relatively small number ofprisoners; as a consequence a large proportion are employedas wardsmen, cooks, cleaners, &c., which interferes with thetask labour, trades, and education carried on. By consoli-dating the prison administration greater economy can bepractised, better educational and labour results obtained,and a healthier morale initiated.Space prevents our going into the report at greater length ; I

it is in many respects a valuable addition to our knowledgeof prison affairs in Ireland, and is the result of the pro- ltracted labour of an essentially able commission. They Irecommend changes in the board which we advocated lastyear, and which anyone cognisant with prison affairs inIreland was satisfied must eventually be decided on. 1

We congratulate our medical confrères especially, as to ]

them is largely due the beneficial changes in contemplation. (

Drs. Robert MacDornell and Sigerson devoted much andvaluable time to the question, and the interests of themedical officers were safe in their hands. The proceedingsof the commission were conducted with thoroughness and ttact, and we hope the result to the general administrationand the medical officers will be the establishment of fharmony and general co-operation the absence of which fthe report so much deplores, t t

tWESTMINSTER HOSPITAL. -The Committee of ’ °

Management of this hospital have decided upon a scheme to textend the accommodation for out-patients, the resident c

medical staff, and the nurses. The plan includes the erec- ition of a new medical school apart from the hospital build- Iing. The estimated cost of the improvements is 16,000, c

X9000 of which has already been subscribed.

FRENCH HEALTH RESORTS.(From our Paris C’0?’7’60M<6M<.)

ROYAT ; MONT DORE.THE waters of Royat, a pretty little town situated in a

valley about half a mile from Clermont-Ferrand, are chloro-alkaline, lithic, and ferro-arsenical, which, according to thedifferent sources they are taken from, are considered usefulin a variety of affections, such as those comprised under theterm arthritism (gout, rheumatism, eczema, &c.), and inchloro-anaemic and nervous ailments. They have also beenfound highly useful in uterine diseases, the successful treat.ment of which has obtained for Royat the title of the FrenchEms. Affections of the throat and lungs are also muchbenefited by these waters. They are gaseous, containing cer-tain proportions of free carbonic acid, and of varied tem-perature. They are employed internally and externally.Their action in the economy is similar to that of the purealkaline waters, without having any of the inconveniencesof the latter, owing to their containing a large proportion ofchloride salts and to the presence of iron and arsenic. The" Source C&eacute;sar" is the most popular, and is more freely drunkwith wine at the table than the water from the other springs.It is slightly stimulant and tonic, owing to the carbonic acidwith which it is saturated. Taken in health, it has theeffect of stimulating the mucous membrane of the stomach,develops the appetite, and considerably increases the urinarysecretion. Taken at meals and mixed with wine, it facili.tates digestion and relieves nausea when present. Its useis particularly recommended to persons of sedentary habits,and to those having much mental labour to perform; alsoto constitutions weakened by hard physical work, disease,&c. The bathing and hydrotherapic arrangements are mostcomplete, there being a large swimming bath containing run.ning water naturally tepid at 31&deg; to 32&deg; C., and suitable forpatients of all ages. Dr. Boucomont, one of the principal phy.sicians and inspector of the waters at Royat, showed me an.apparatus of his own invention, by which a patient who cannotstand the shock of a cold douche has only his feet douched,without wetting the upper parts of his body. He has foundthis very useful in nervous patients, particularly those ofthe female sex, and in all cases of congestion of any of theviscera, even of the brain, which may be benefited by deri.vation towards the lower extremities. It struck me thatsuch a mode of applying the douche would be useful in in.somnia, but Dr. Boucomont said he had not yet tried it in suchcases. But, besides invalids, tourists will find here sufficientopportunity to satisfy their scientific curiosity, whether it bein natural history, archceology, mineralogy, or numismatics.The same may be said, indeed, of the whole of Auvergne,which is laid out in charming landscapes, picturesque scenery,and a soil most varied in character. The range of volcanicmountains of this beautiful province, its druidical re-

mains, its Byzantine churches, its mediaeval castles, its pinewoods, its cascades, and its torrents, all contribute tl)captivate the attention of the tourist. Royat is evidently arising place, and deserves to be better known ; but it is im-possible for me, within the limits of a letter, to do more thanscant justice to a health resort that possesses so manyadvantages over similar places in this or any other country.Anyone interested in this watering-place cannot do betterthan read a description of it in a little work by Dr. Bouco-mont, entitled " Les Eaux Mindrales d’ Auvergne," which ofcourse contains information only from a medical point ofview. The season begins about the middle of June and endsabout the middle of September, the cure lasting about threeweeks. The treatment should be continued for some time onthe return home of the patients by drinking the bottled waters.Those from the C&eacute;sar and St. Victor springs should be pre-ferred for this purpose, as they are of a lower temperature, andare on that account, and from their containing a large propor.tion of free carbonic acid, better kept in a state of preserva.tion than the water of the other springs, of which there aretwo : " La Grande Source," or what used to be called the"Source Eug&eacute;nie," and the "St. Mart." They are par.ticularly adapted to gouty and rheumatic subjects in thechronic or asthenic forms, who, being unable to visit the spaitself, are obliged to drink such waters for an indefiniteperiod. They are also found particularly useful in thecutaneous manifestations connected with these diatheses.On leaving Royat, I proceeded to Mont Dore, which is

433REPORTS OF MEDICAL OFFICERS OF HEALTH.

situated about the middle of a valley surrounded by high imountains-the Capuchin, the Angle, and the Pic de Sancy,the last (the highest) being 6186 feet above the level of thesea. A vegetation of the deepest green covers the two sidesof the valley, and the shades are lovely. Two cascades, theDore and the Dogne, unite to form the Dordogne, whoselimpid waters overflow the meadows at the foot of the valley.Mont Dore, which is in the department of the Puy-de-D6me, is thirty miles to the west of Clermont, and isreached partly by railway and partly by an engineering roadin diligences and carriages, winding up and across a charmingcountry, which for beauty and grandeur may be comparedto Switzerland. Its altitude is about 1050 metres, or about3445 feet, above the level of the sea. Its climate is rathermild, the thermometer seldom rising above 86&deg; F. in the twohottest months of the year (July and August), and rarelyfalling below 40&deg; F. It is, after Bareges, the highest watering-place in France, and therefore favourable to debilitatedsubjects, and to those who cannot resist the heat of the plains.Notwithstanding what has been said and written to the con-trary, Ishould consideritquite unsuited for phthisical patientsin any stage of the disease, owing to the great fall of thetemperature in the evenings, which are damp; yet invalids areto be found there in large numbers. Mont Dore is certainlyone of the most ancient, if not the most important, thermalstations of France, having been known as such almost sincethe commencement of the Christian era; it was also muchfrequented by the Gauls and Romans, who had constructedthere a vast establishment, as shown by fragments ofcolumns and the ruins of a swimming bath, which may beseen at the present day. The waters of Mont Dore, whichare the least mineralised of all the waters of Auvergne,have been classed among the alkaline bicarbonates. Theycontain chloride of sodium and sulphate of soda, with meretraces of iron and alumina. They also contain a smallquantity of arsenic (about a milligramme to the litre), thepresence of which latter would seem to justify their employ-ment in pulmonary phthisis. The waters from the varioussprings, of which there are no less than seven, are hot,their temperature rising as high as 109&deg; F. They allcontain the same ingredients, varying only in quantityaccording to the different springs. Mont Dore is cele-brated for its various kinds of baths, and its rooms for sprayand inhalation. Herein the patients breathe the mineralwaters reduced to steam; but I question the propriety ofapplying this treatment to phthisical patients, not only onaccount of its weakening powers, but of the known tendencyof such treatment to produce congestion of the lungs, andthus determine spitting of blood. If Koch’s theory asto the propagation of pulmonary tuberculosis by bacilliemanating from the lungs of phthisical patients be correct,there is here offered a favourable field for their dissemina-tion through the atmosphere of these rooms (eight in num-ber), which are small, communicating with steam boilers,and in which there are ten or twelve patients at a timedivested of their ordinary clothes and dressed in a flannelcostume made for the purpose. Here they breathe the samevapour with which the room is filled, and here they remainfrom fifteen to forty-five minutes, or as long as they can con-veniently bear it. Moreover, the patients must run the riskof catching cold on leaving the "sudatorium," as it has beenappropriately termed, although every precaution is takenagainst their doing so. According to the physicians prac-tising at Mont Dore, the waters of this spa have been fomdmost useful in all affections of the respiratory organs,including asthma and pulmonary phthisis, also in chronicrheumatism, gout, and congestion of the liver. Nasal catarrhwith ozaeaa, of whatever origin, is successfully treatedby the use of these waters, administered internally,but more especially by local irrigation with them.The latter is effected by the use of an indiarubber tube,but the operation must be performed with caution, andunder the surveillance of a medical man, as headaches andeven syncope have been induced by the water penetratingthe frontal sinuses. Like all watering-places in France,Mont Dore is provided with the inevitable casino, whichis composed of a theatre, ball-room, reading-room, roomsfor billiards and other games, and for refreshments. It isnot much frequented by foreigners, and this may accountfor the hotel accommodation not being equal to that obtainedat the other stations, where the comfort of visitors, particu-larly English and American, is more studied. The seasonbegins about the middle of June, and ends about the sametime in September; but July and August are the months

most favourable for following the course of treatment enjoinedat Mont Dore. The waters should not be used for morethan a fortnight on account of their exciting properties,and the local physicians should always be consulted in thematter. I may, however, observe that the waters are contra-indicated in persons of a languid circulation, and suchas have a tendency to haemorrhage.

Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Peterborough (Rural).-This district had in 1883 a death-rate of 17’3 and a birth-rate of 30’5 per 1000 living. Diph-theria was somewhat prevalent in the district, and, as sooften happens, it exhibited a certain obscure relationshipwith scarlet fever. Speaking generally of the class of in-fectious diseases due to filth causes, Dr. Paley observes thatthe district has been comparatively free from them, a resultwhich he attributes to the efficient removal of all sorts offilth accumulations from the vicinity of the dwellings ofrich and poor alike.Hendon (Urban). -Dr. Cameron gives a lengthened account

of the continued prevalence of diphtheria and scarlet fever,which were so marked during the first nine months of 1883,and to which we at the time adverted, especially in con-nexion with Mr. Power’s report on an earlier stage of theoutbreak. On the whole, the general health of the districtwas much better at the end of 1883 than at the end of theprevious year, and a hope is expressed in the report that theexperiences of 1883 will prove to be exceptional in thehistory of the district. Seldom have recurrences of diph-theria proved so persistent, and this notwithstanding effortsmade to prevent the diffusion of the disease by means ofintsrcommunication. Estimating the population at 11,370,the death-rate was, considering the circumstances, remark-ably low-namely, 15’7 per 1000. Hendon at last stands achance of being efficiently sewered; the scheme has beensubmitted to and approved by the Local Government Board,and the work is, we trust, now in progress.Rotherham (Urban).-This borough, with an estimated

population of 35,650, had in 1883 a death-rate of 20’5per 1000, this rate exhibiting a decrease not only on thatof the previous year, but also on the annual average forthe preceding ten years. Zymotic diseases were also lessprevalent than formerly; but this is certainly not due to thecompleteness of the provision for arresting the progress ofthose affections which can properly be called infectious, for

the borough is still unprovided with either an infectioushospital or a mortuary. Smoke is still a cause of muchtrouble to the town, it being deluged with carbon and de-

leterious gases, resulting from the wasteful methods of com-: bustion which are in vogue. Substantial additions haveL been made to the work of sewering the borough, and aL number of street improvements have been effected. But, efficient sanitary regulation in connexion with bye-laws andL the cattle market still calls for the attention of the authority., South Shields (Urban).-South Shields, with a popula-tion of some 62,000, may be congratulated on havingl achieved a substantial reduction in its annual mortality.l The rate per 1000 for 1883 stood at 20-9, but taking the, means of triennial periods, Dr. Munro claims to show clearly

the sanitary progress which has been effected. For the three, years 1872-74 the rate was 25’8 ; that for the years 1875-7 wasl 22 7 ; that for 1878-80 was 22’6 ; and during the past threeL years the mean has stood at 19 7. This, too, is accompanied; by a fall in the rate of infant mortality, the deaths under, one year now standing at 13 ’9 per 100 registered births, asl opposed to 14’9 in the fifty large towns. So also the rate9 for the so-called zymotic diseases was 2’27 per 1000, whereas

in the fifty towns it was 2 46. The most important incidentt in the sanitary history of the year was the opening of theL new borough infectious hospital, an establishment well- adapted tothe needsof the district, and subject to an excellenti system of administrative regulations. During the year fifty-a one patients came into the building, twenty-three of theses being cases of scarlet fever, twelve of small-pox, seven of