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subtleties more or less technical until the Congress passed, notwithout a sense of relief, to the next topic, ’’ The FunctionalAdaptation of Limbs affected by Lesion (Arti Trauma-tizzati). This proved a most interesting theme, in the dis-cussion of which the successes of the mechanician workingin concert with the surgeon were conspicuously in evidence.Finally, at its closing sitting, on May 27th, the Congressdealt with the Statistics, in their Medical Aspects, referringto the Application of the Laws on the Casualties of Industryand Labour." For the interesting and animated exchange ofviews which this theme evoked reference must be made tothe official" Resoconto" shortly to be published, as well asfor the subsidiary communications submitted in supplementto the seven main topics dealt with on the agenda paper.Thus closed a highly successful Congress on one of the

most important subjects of the day, involving issues of thedeepest interest to Labour, Industry, Capital, and Science,whether social, medical, or surgical. An eloquent valedic-dictory discourse from Dr. Ottolenghi was followed by amotion on the part of Dr. Liniger proposing Dusseldorf as theseat of the next Congress. This was carried by acclamationand the delegates thereafter proceeded "from labour torefreshment " in the form of a sumptuous banquet in the I.Hôtel Excelsior.

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HEALTH OF THE CITY OF LONDON.

WE are indebted to Dr. William Collingridge for a copy ofhis recently published report as medical officer of health ofthe City of London. In this report, which is the ninth bythe present writer, the sanitarv condition of the Cityin recent years is compared with that obtaining in the middleof last century-very much, we doubt not, to the gratifica-tion of the City Corporation. In connexion with the vitalstatistics of the City, the first matter to claim attention isthe unique character of its population. Dr. Collingridgereports that some persons who desire to belittle the import-ance of the City frequently allude to it as of only one squaremile in area, with a decreasing and insignificant population.To this calumny the report supplies the sufficient refutationthat whilst the number of persons passing the night withinthe City is probably less than 20,000, the number con-gregated on that area during the daytime is estimated toexceed 385,000. Of the magnitude of the assemblage ofhuman beings that daily takes place in the City someidea may be gathered from a further statement in the reportthat the number of persons known to have entered and leftthe City on one day alone in May, 1891, was not less than1,186,000. Having regard to the foregoing facts, and especiallyto the consideration that the Corporation are responsible for thehygienic welfare of an unknown number of persons during theirdaily sojourn in the City, the medical officer of health veryproperly urges upon his sanitary authority the necessity ofascertaining, by actual enumeration, the number of personsresident in the City during the working hours of the

day. Dr. Collingridge tells us that the taking of the firstday census of London was decided upon by the CityCorporation in the year 1866, a special committee of whichreported, at the time, as follows :-The Imperial Census taken decennially under the authority of Parlia-

ment affords no indication whatever of the actual population of theCity, and every recurring census only leads further astray in thisrespect. That census is gathered, for the sake of convenience, while thepopulation is sleeping, and affords in almost every other district a fairindication of the actual number of the inhabitants ; but, owing to thepeculiar and exceptional nature of the City population and the circum-stances of those who there carry on their business, it so happens thatthe census taken by the Imperial Government omits from enumerationin the City the very class of persons whose trade, wealth, and enterprisemake the City what in fact it is-the greatest, most crowded, andwealthiest commercial empoiium to be found in the world. In view of the near approach of the next Imperial Censusyear, and having regard to the desirability that no time <

should be lost in making the necessary preliminary arrange- <

ments, the medical officer of health recommends that pro-vision should be made for the day enumeration above referred Ito at or near the date of the next Imperial Census taking- ii.e., in 1911. t

Very remarkable is the improvement that has taken place r

in the health and sanitary environment of the citizens of r

London within the last 60 years. In order to appreciate the r

growth of reform it will suffice to compare with the state of a

things now happily existing the deplorable conditions of life e

in the metropolis in the days of Sir John Simon, the first a

medical officer of health. Reporting in 1849, Sir John Simonstated that as far as could be ascertained there were

within the City some thousands of houses with cess-

pools attached to them, and that the supply of drinkingwater was only a fraction of what it should be. Thousandsof the people had no supply of water to the housesin which they dwelt. For possession of the first neces-

sity of social life such persons wholly depended on

their power of attending, pail in hand, beside the neareststand-cock, where, with their neighbours, they waitedtheir turn during the tedious dribbling of a single smallpipe." " Again, in referring to the conditions then prevail-ing in tenement houses he wrote: "It is no uncommon

thing, in a room 12 feet square or less, to find three or fourfamilies styed together (perhaps with infectious disease

among them) filling the same place day and night-men,women, and children in the promiscuous intimacy of cattle.Of these inmates it is nearly superfluous to observe that inall offices of nature they are gregarious and public ; thatevery instinct of personal or sexual decency is stifled ; thatevery nakedness of life is uncovered there. Who can wonderat what becomes, physically or morally, of infants begottenand born in these bestial crowds!" " A cursory perusal ofthe present report will suffice to show how vast is the

improvement that has been effected in all that concernsthe health and sanitary wellbeing of the citizens of Londonsince Sir John Simon penned his burning words.The enormous expense incurred in the formation of new

thoroughfares, in the widening of streets, in the demolitionof unhealthy areas, and in the provision of dwellings for theworking classes has been willingly met by the ratepayers. Inno other town at the present day is the work of public cleans-ing more thoroughly attended to, and nowhere is sanitaryaccommodation for visitors better provided for. Without -apure and plentiful water-supply no community can be heldto be living under satisfactory conditions of health or even ofcleanliness. Dr. Collingridge reports that the citizens haveno reason to complain of the quality of the water supplied tothe metropolis, but that they do complain bitterly of itscost. In consequence of what is considered unfair taxationin this regard, a considerable number of artesian wells havebeen already sunk in the City, and many more are now inprocess of construction. In every instance in which thewater from these wells has been examined the public analysthas testified to its excellent quality.The character of the food-supplies of the City received

special attention during the year under report. We are notsurprised to hear that the due supervision of the quality ofthe meat and other food which in enormous quantity passesthrough the City markets entails heavy responsibility on thesanitary staff, and this responsibility has been furtheraugmented by the issue of new regulations by the LocalGovernment Board.The milk-supply of the City has been kept under constant

supervision, and the milk arriving in London for delivery todealers in the City has been subjected to bacteriological andchemical investigation by the officers of the health depart-ment. Very full, if somewhat startling, particulars are givenin the report concerning the analysis of milk samples in eachof the last four years, the results of examination beingtabulated under the following heads: (1) fairly clean andpure ; (2) unclean ; and (3) tuberculous. Notwithstandingthe publicity given in recent years to the details of analysis3f milk by the public analyst, the present report showsthat even in the year 1907 not less than 37 per cent. of the

samples analysed were returned as ., unclean, whilst 8’ 3per cent. were returned as "tuberculous." The proportion}f tubercle-contaminated milk in the City supply appears tolave been practically constant in recent years, and it is

mportant to note that in every case in which milk has been:ondemned as tuberculous the bacteriological result has been:onfirmed on examination of the herd of cows producing it._’here is little reason to look further afield for the causes ofmman tuberculosis, unless the degree of contaminationn the milk-supply of London is enormously greater thanhat of the country generally. The value of bacteriologv as aleans for determining the presence or absence of disease inlilk is abundantly shown in the present report, and it isot a little surprising to learn that practically no precautionsre even yet taken by either farmers or wholesale dealers tonsure that the milk shall not be a vehicle for the convey-nce of tuberculosis.

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Dr. Collingridge is clearly of opinion that the control of r

milk-supplies is a matter for the supreme authority of the v

Board of Agriculture and Fisheries, whose business it shouldbe to see that the Dairies, Cowsheds, and Milk-shops Orders r4

are effectively carried out by those responsible for their fiadministration. While the best method of controlling the i!milk-supply is undoubtedly at its source-viz., the farm, v

there is no real difficulty in effecting this on the spot by thelocal authority, for upon bringing the facts to the notice of the n

local medical officers of health steps have promptly been ttaken in every case to improve the local sanitary condi- ftions of the farm concerned. This indicates that there is yno necessity for a central authority to waste time and o

money in inspecting country farms where their intrusion a

would be resented, all that is necessary being for eachurban authority to maintain strict supervision over the

purity of the milk supplied to the district, and wherethis is unsatisfactory to communicate at once with the localauthority and also with the Board of Agriculture andFisheries. Dr. Collingridge questions the wisdom of theLondon County Council in its present attempt to acquirepowers for examining milk at the metropolitan railway stationswith a view of preventing the distribution of dirty milk.Obviously it would be better to eliminate the risk of danger (at the farm than to seek to control it after delivery in 1London. He expresses his conviction that piecemeal legis-lation of this kind can never be effective, and that theonly satisfactory way of dealing with this question is

Ifor the Government to proceed at once with the long- , ipromised general measure dealing comprehensively withthe subject. In this connexion it is satisfactory to notethat last week Mr. John Burns introduced into the Houseof Commons his promised measure entitled The Milk andDairies Bill," which seems likely to be effective providedthat it eventually obtains a place in the Statute Book ; someof the provisions, however, will provoke opposition. Andhowever thorough may be the supervision of the milk farm,there are other factors prejudicially affecting the whole-someness of the milk during its transit to London. For

example, the churn in common use is sadly ill adapted forits purpose, as it affords a resting-place for filth which

readily obtains access to the milk through the ventilatingapertures in the lids. Moreover, the churns are oftenreturned to the farmers unscalded and even unlocked, sothat there is no guarantee that even ordinary cleanlinesshas been observed. Again, the practically universal systemof mixing at the metropolitan railway stations necessarilyleads to exposure of the milk to contamination by the dustconstantly present in the atmosphere of a great city. At thestations the milk is treated with a "rouser," which hasoften been allowed to stand on the dirty platforms ; and themixing is conducted by the operator, who plunges his nakedarm into the churn, transferring some of the milk to anothervessel. In these several ways the milk runs the risk ofserious pollution before delivery to the consumer, who,seldom adopts the precaution of boiling it before use asfood.Of the investigations undertaken during the year for the

detection of obscure disease, and of the administrativemeasures adopted for the protection of the public health,the report contains full and very instructive particulars.Among these the most far-reaching and important is the

investigation which was undertaken with the aid of Dr.Klein, and which establishes the value of bacteriology asa means of elucidating difficult sanitary problems. Dr.

Collingridge gives account of an outbreak of illness occurringin a large business establishment in the City in which alarge number of persons became seriously ill, apparently asa result of ingesting a quantity of " vermin destroyer " whichhad in some way got mixed with their food. In every casethe illness is described as having been very severe, althoughhappily not fatal, the patients having recovered by the endof a week from attack. What is particularly important froma public health point of view is the fact that examination ofthe excreta of the patients showed the presence of the samebacterium which is contained in the vermin destroyer andwhich is stated to be fatal to rats, mice, and other rodents,but to be harmless to domestic animals and to human beings tIn view of this investigation the truth of the latter clause ofthe statement would appear to be more than doubtful.Indeed, a representation has already been made to the

Government, as a result of which it ’is hoped that some

restriction will be placed on the indiscriminate sale ofvermin poisons of this nature.The usual tables of vital statistics are included in this

report, and Dr. Collingridge is able to report a death-ratefor 1908 of only 12 - 6 per 1000 of the population ; this rateis almost identical with the rate of the preceding year,whilst that of the entire County of London was 13’ 8.The useful standard tables issued by the Local Govern.

ment Board are appended, and especial prominence is givento the infantile mortality table, which shows the loss of lifefrom the principal causes at the several stages of the first

year of age. Measured in terms of total births the deathsof infants under the age of one year were only 65 per 1000,as against 113 per 1000 for the whole of London.

SANITATION IN INDIA.

VI. &mdash;JAILS (ooati-nzced).- SM?’7H<:.

THE report for the year 1907 on the Prison Administrationof Burma is furnished by Lieutenant-Colonel G. J. H. Bell,I.M.S. The number of jails in this province are six centraland 24 district jails. At the beginning of the year the totalnumber of prisoners of all classes in confinement was 14,129,an increase of 901 over the corresponding numbers for 1906.During the year, however, there was an actual decrease of1201 in the number of prisoners admitted, the numbers beingrespectively (for 1906 and 1907) 35,674 and 34,473.We are glad to note that a wise reform in the jail adminis.

tration has now been perfected-namely, the segregation ofjuvenile criminals from the rest of the jail population, whilstarrangements are also being made to provide separateaccommodation for juvenile first offenders and juvenilehabituals. The jail at Meiktila has been set apart for thispurpose. Certain structural alterations require to be madein this jail, the details of which are being worked out by thePublic Works Department ; the jail when altered will

provide separate accommodation for 100 juvenile firstoffenders and 50 juvenile habituals, thus supplying a long-felt want ; for these new arrangements should add verylargely to the reformatory and educational character ofsentences of imprisonment passed on juvenile offenders.With regard to the number of these prisoners in the yearunder review they fell from 171 in 1906 to 89 in 1907.

’ Another fact that should be noted is the general decrease of54 in the number of offences of assaults and mutiny. This,though not so large as in the preceding year, is still verysatisfactory. Rangoon, however, showed a very marked

, increase in this class of offence-viz., from 50 in 1906 to, 178 in 1907. The superintendent of the jails reports that, the assaults were not due to any combination amongst the. prisoners, but that each case was an attempt apparently to’ take revenge for a private grudge or was due to sudden

outbreaks of temper.

Coming now to the vital facts relative to the jails in Burma it is evident that wise forethought has been’ exercised in this direction. With regard to the water-supply’ samples were sent to the chemical examiner for analyse,’ and when the report thereon was unfavourable steps were taken to remedy the defects. In several jails the drinking’

water is boiled. Water drums fitted with taps and locks are’

being supplied, only two jails remaining without them. Other means of ensuring a good water-supply were thet

improvement of existing filtering arrangements. Thus atS

Thayetmyo a masonry cistern for cooling the filtered and: boiled water was provided and brought into use in August, and as one cistern was found to be inadequate the provision of another was approved of. At Myingyan the excessive1’ amount of total solids in the drinking water has been

suspected of being the cause of cases of muco-colitis. Over-f concentration by prolonged boiling probably had the

result of increasing this defect, and care is now taken that1 the water is boiled only for 10 minutes. At the Rangoon jails’i the chief source of the water-supply therein was pronouncedf by the chemical examiner to be unfit for drinking purposes

1 Nos. I., II., III., IV., and V. wore published in THE LANCET ofApril 10th (p. 1067) and 24th (p. 1199), and May 1st (p. 1269), 15th(p. 1412), and 22nd (p. 1480), respectively.