260 LIVERPOOL.

included families and culminated in the true ethics ofhumanity, the modern sentiment of love uniting the wholehuman race. It was a generally accepted opinion thatfamily affection was a distinctively human characteristic butthis he considered to be no more than an exhibition ofhuman self-conceit. The lower animals showed obvious

examples of family affection and among them parrots,monkeys, and swallows stood on the highest pinnacle ofdomestic faithfulness.

Professor Forel then went on to say that in the human

species it was altogether at variance with ethical principlesthat the male sex should make use of its superior strengthto oppress the female sex. Only education could help in

developing the ethical feelings-that education which taughtmen to keep their lower instincts in check. Temperance inappeasing every need was not by any means the same thingas leading an ascetic life. The greatest difficulty of ethicallife was that the results of deeds inspired by ethical feelingswere not in harmony and in proportion with the intention.Therefore the art of real ethical education consisted in

making motives and deeds harmonise. Professor Foreldeclared egotism to be an anti-ethical feeling accordingto the actually accepted sense but he emphasised the factthat in their true sense egotism and altruism were not opposedto one another and that both were necessary. He said thatlaws were necessary evils ; they were, however, indis-pensable for keeping our passionate inclinations in check.These inclinations we inherited with our nature. The moreevolved and developed mankind became the less need therewas of laws.

Speaking of sexual ethics, Professor Forel alluded to theMalthusian system, which experience had proved to be

impracticable and, in fact, it could not be otherwise, forit did not take account of human nature and was simplya propaganda of abstinence. He rejected also the viewsadvocated by Tolstoy who began to proclaim the benefits ofcontinence at an age when, owing to his advanced years, hewas already beyond temptation. The artificial prevention ofconception was, however, an ethical duty in all cases inwhich the woman could not regain her strength afterher first labour and in which married couples were thesubject of bodily or mental deficiency. Professor Foreldid not recommend the prohibition of child-bearing butonly its regulation. Healthy, intelligent women ought,he said, to bring forth many children at proper intervals.He vehemently denounced the social injustice with whichillegitimate children were treated and he demanded for theman entire equality of rights. He also spoke very severely ofthe terrible negligence which allowed girls to enter the stateof matrimony without having previously been enlightened.He sharply criticised the existing system of prostitution andthe so-called mariages de convenance and said that onlystupidity could prevent the enlightenment of children insexual matters.

Coming to the hygiene of sexual life Professor Foreldemonstrated that ethics were here in complete agreementwith hygienic laws. Everything that the ethics of sexuallife claimed was at the same time hygienic. He referred tothe dangers of alcohol, which were well shown by the factthat most insane people and bodily and mentally deficientchildren were descended from intemperate parents. Suchchildren have usually been conceived after the consumptionof alcoholic beverages. The State organisation of prostitutiondid not deter young men from resorting to prostitutes andrather had the effect of inducing them to do so. Ittherefore ought to be discontinued and marriage oughtto be encouraged among young men. Men ought notto defer marriage until they had earned enough tolive luxuriously and to give parties and entertainments butthey ought to marry while they could love their wives withthe fervour of early manhood.

LIVERPOOL.(FROM OUR OWN CORRESPONDENT.)

The Report of the Medical Officer of Health for 190,5. ’

Dr. E. W. Hope’s report on the health of Liverpool duringthe year 1905 possesses many points of great interest.Dealing with the large amount of infantile mortality, hestates that the loss of infant life in the various districts ofthe city varied widely, the range during the year being from84 per 1000 in the district where it was the lowest up to 240per 1000 in the district where it was the highest. Even in

the lowest the death-rate of infants was more than four timesas high as the general death-rate of the community.Zymotic diseases accounted for 899 deaths, the greatmajority of them-viz., 681-being due to diarrhoea, the

exciting cause being, no doubt, the same as that in thecase of atrophy-viz., improper feeding. Following upon thiscomes whooping-cough with 60 death and measles with59 deaths. Under the heading of diseases of the digestivesystem no less than 267 deaths of infants are recorded ;677 deaths of infants were due to diseases of the respira-tory system and 496 deaths to diseases of the nervous

system. The natural guardian of the infant is the motherand it is only with extreme caution that the efforts ofthe municipality can be specially directed to the preserva-tion of infant life, but such efforts have been made in avariety of ways. Hospital provision is now available forinfants suffering from whooping-cough and measles wherethey can be received, together with the mother ifnecessary. With regard to feeding there is strongevidence that the efforts of the health committee inwidely circulating instructions as to the feeding ofinfants, in employing a large staff to give verbal instructionsand to supervise, in establishing sterilised milk depots atwhich milk specially prepared for infants can be obtained,and in improving the general sanitation of slums haveresulted in marked benefit. Dr. Hope alludes to the goodresults which have followed from the voluntary notificationof cases of pulmonary tuberculosis since February, 1901,when the system came into operation. A special formupon which the notification can be made has been circu-lated among medical men and in those cases in whichthe requirements of the health committee have been fulfilledthe usual notification fee has been paid. During the year1905, 1971 cases of pulmonary tuberculosis were reported,of which 110 were duplicates, leaving a total of 1861 casesreported. The deaths from the disease totalled 1245 ; in 614instances the rooms and bedding were disinfected and in 64cases the bedding, &c., were removed for special disinfectionin the apparatus for that purpose. Out of the 1861 casesreported 1257 were males. The birth-rate of Liverpool isstill the highest in the country, thus raising uniformly thecrude death-rate. The death-rate, 19’ 2 per 1000, was at apoint indicative of great health improvement-the lowestever recorded. Last year six importations of small-pox hadto be dealt with-isolation, revaccination, disinfection, anddomiciliary visitation for defined periods being among theexpedients for the protection of others. There were 325 casesof typhoid fever reported during the year, as against434 in the preceding year, and 681 in 1903. The deathsfrom the disease were 49, being 33 fewer than in the pre-ceding year. Those figures represent the lowest recordedsince the extension of the city boundaries in 1895.

lhe Royal Infirmary and 8unimer Diarrhœa in Children.The committee of the Royal Infirmary has fallen in with the

wishes of the corporation to set apart a ward in the infirmaryfor the exclusive treatment of children suffering from summerdiarrhoea. A ward containing 20 beds has been fullyequipped for the purpose in the large recreation room, theexpenses of which will be borne by the municipality. Itwill be interesting to ascertain the causes of the diarrhoea ininfants now so prevalent in Liverpool, and every endeavourhas been made by the health authorities of the city to copewith the disease. The ward will be in use during the presentepidemic.

Liverpool Convalescent Institution.Liverpool Convalescent Institution.The Lord Mayor of Liverpool presided over the thirty-

second annual meeting of the subscribers in the GladstoneHall of the institution, at Woolton, on July 14th. Thereport of the council shows that 2732 patients were admittedduring the year 1905. The increase in the number of patientsis to a large extent the result of the system of nominationand recommendation forms, by which subscribers and donorsare entitled to recommend patients for admission, either onpayment of the nominal sum of 5s. per week, or withoutcharge, in proportion to the amount of their contribu-tion. By this cooperative system benefactors are broughtinto more intimate touch with the working and administrationof the institution and their interest is maintained. Bythe liberality of Miss Winslow and Messrs. Walker of Lither-land, two more free beds have been added, making, with thesums received from new subscribers, a net increase duringthe year of .E65 in annual subscriptions, the total amountunder this head being now ;E1122. The sums received from,

261WALES AND WESTERN COUNTIES NOTES.

or on behalf of, patients towards their own maintenanceamounted to £1606. The special donations received duringthe year were as follows: Hospital Sunday and SaturdayFund, £368 15s. Mr. Arthur Earle, £330, "In MemoriamElizabeth Earle" ; whilst other special donations amountedto B155 10s. The expenditure incurred in laying out thefields is now fully justified by the improvement in the

general appearance of the grounds and also in affordingincreased facilities to patients for open-air exercise. Thefourth closed shelter completed this year has proved anadditional attraction for patients.July 24th.

WALES AND WESTERN COUNTIES NOTES.(FROM OUR OWN CORRESPONDENTS.) II

Cardiff and Swansea Hospitals.THE complete report of the Cardiff Infirmary for the year

1905 shows that the economical management which hascharacterised this institution in former years has beenmaintained. The average weekly cost per patient was ’,£14s. 8d., or about 3d. per week less than in 1904. The ’’

average cost per occupied bed was .B64 5s. 4d., a sum whichcompares favourably with that expended in the SwanseaHospital during the year ending May 31st last-namely,71 19s. It is only fair to state that the cost per bed in8wansea in the previous year was only £63 12s., and thetotal income in the year just ended fell short of the totalexpenditure by only ;E183, whereas the Cardiff expenditureexceeded the income by .B2312. The more favourablefinancial position of the Swansea institution appears to bealmost entirely due to the larger proportionate amountcontributed by the workpeople of the district as comparedwith Cardiff. The total income in Swansea was E8265 andthe workpeople subscribed .B3519, or 42 per cent. In Cardiffthe total income was .Bll, 725 and the workpeople’s contribu-tion was .63584, or 30 per cent. of the whole. If the Cardiffworkpeople bad contributed in the same proportion as theircomrades in Swansea there would have been a balance on the

right side of nearly £100 on the year’s working of the Cardiffinstitution. Although a great deal has been done duringthe past few years in the way of remodelling the wards andthe administrative quarters of the Cardiff Infirmary nothinghas been done to improve the out-patient department withthe exception of the erection of casualty rooms. It is esti-mated that a sum of E7000 should be spent on this depart-ment if it is to fulfil the requirements of the present day.Early in the year an anonymous donor offered .BIOOO towardsthis amount, provided the remainder were forthcoming fromother sources before the end of the year. It is gratifying tofind that there are now only R2000 to be subscribed towardsthe sum named.

Infantile Mortality in Cardiff, Swansea, and Rhondda.The statistical table relating to infantile mortality which

is now included in the annual reports of medical officers ofhealth enables a detailed comparison to be made of thenumber of deaths of young children in different localities.In 1905 the infantile mortality rate in Cardiff was 118 per1000 births, in Swansea 130 per 1000, and in the Rhondda199 per 1000. The Rhondda rate was about equal to thatwhich has been recorded during the previous ten years andwas higher than that in any of the 75 great towns ofEngland and Wales. It is of interest to find that the pro-portion of deaths at varying age periods was pra.ctically thesame in the three towns. In Cardiff 27 per cent. of thechildren died under a month old, in Swansea 28 per cent.,and in the Rhondda 26 per cent. Under six months oldthere died in Cardiff 68 per cent., in Swansea 71 per cent.,and in the Rhondda 68 per cent. When the causes ofdeath are compared there is, however, a much greaterdisparity. Premature birth was recorded as the cause ofdeath in 12 per cent. of the Cardiff children, in 10 per cent.of those in Swansea, and in only 7 per cent. of those in theRhondda. Tuberculous diseases were responsible for 6 percent. of the Cardiff deaths, 4 per cent. of those in Swansea,and 3 per cent. of those in the Rhondda. Diarrhoeal diseasescaused 14 per cent. of the Cardiff, 10 per cent. of theSwansea, and 20 per cent. of the Rhondda deaths. In con-nexion with this last group Dr. J. D. Jenkins states that nomeasures directed specially towards their prevention havebeen carried out in the Rhondda with the exception of thedistribution, through the medium of one of the registrars

of deaths, of cards containing a number of hints drawnup both in English and in Welsh for the guidance ofmothers in the feeding and general management of theirbabies. This distribution has been going on for four

years and it is now possible to compare the diarrhcealdeath-rate during those years with that which prevailedpreviously. As the cards were distributed in only a portionof the district and to the mothers of four-fifths (about3600) of the children born in the whole of the Rhondda itis also possible to compare the results during the same yearsin the card-distributed area with those in the districtwhere no cards were given. In 1905 the infantile diarrhoeadeath-rate was 33 per 1000 births in the " card district "

and 50 per 1000 in the rest of the sanitary area, comparedwith 74 and 58 respectively in 1901 when no cards were dis-tributed. The fall in the "card district" is thus verynoticeable. It should be stated that the division of thetwo districts is a purely arbitrary one. The inhabitants ofeach are of the same class of life, living in similarly builthouses the sanitary arrangements of which are almostidentical and with the wage-earner bringing home aboutthe same amount of money. These results as recorded byDr. Jenkins are a strong argument in favour of his plea forthe appointment of one or more women inspectors who byvisiting the homes of the people could point out the pitfallsto be avoided and the best measures to adopt in order toassist in the upbringing of healthy and well-grown children.

The Dolgelly Urban Conncil and Isolation.The question of providing an isolation hospital for the

urban and rural districts of Dolgelly, in North Wales, wasfurther discussed at meetings of the urban and rural councilsheld on July 20th and 21st. Since the previous meetings ofthese councils, mentioned in THE LANCET of June 23rd,p. 1791, there have been 16 fresh cases of scarlet fevernotified in the urban district and one death occurred in asmall cottage where there were four cases of the disease andwhere any kind of isolation was impracticable. Two deputa-tions, representing the district nursing association andDr. Williams’s Endowed School for Girls, attended beforethe urban council and urged it to proceed with the erectionof an isolation hospital, a free gift of land for which

purpose has been offered. A petition to the same

effect, signed by 300 residents, was also handed in.Reference was made to the pecuniary loss caused by theoutbreak of infectious disease in towns that laid themselvesout as visitors’ resorts like Dolgelly, and on behalf of theschool it was pointed out that they would be incurring agreat danger if it was rendered unsafe tor the boarders fromvarious parts of England and Wales to be together with theday pupils from the district. At a previous meeting of therural council it was decided to accept the offer of a free

: gift of land and to proceed with the erection of a hospitalat a cost not exceeding £500, provided that the urbancouncil contributed two-thirds of the cost, the rural councilto contribute one-third. The urban council after a discussion

lasting for two hours accepted those terms but only on the: casting vote of the chairman. The rural council met the

following morning and after further considering the matterdecided to take no further action until the views of thevarious parishes were obtained. It was stated that 90 per

cent. of the rural population were opposed to the move-’ ment as it would increase the burden of the rates.

, Monmouthshire Water-supply.The example set by the county council of Glamorgan in

its endeavour to secure for the inhabitants the countywatersheds is being followed by the Monmouthshire council.

. The county surveyor has presented a report dealing with thel available supplies in the county and at a conference held. on July 18th between representatives of the council and, of the local sanitary authorities a proposition was unani-. mously passed expressing the opinion that it was desirable

to conserve the present sources of water-supply and to. take steps to prevent outside companies and bodies fromi extracting water to which the inhabitants of the county: have a natural claim. The county council was asked to, promote a Bill in the next session of Parliament having

these ends in view. Monmouthshire has an area abouttwo-thirds that of Glamorgan and a population in the

- administrative county of only about one-third but a very) large extent of the Monmouthshire coalfields is still un-

worked, so that a great increase in the population is probableduring the next 20 years when the eastern and western

valleys of Monmouthshire will be as densely populated as