636 death-rate from enteric fever among European soldiers in India it shows a very low one indeed from this fever in the native army and jail population of India. The fever statistics do not reflect, says the Sanitary Commissioner, the opinion so prominent of late that enteric fever is quite common among ad1lU natives of India. Lest it should be thought that enteric fever when it occurs among natives is not correctly diagnosed, but is returned under some other heading, the Sanitary Commissioner significantly adds that whether we take the case of native troops or prisoners their mortality from all fevers is considerably below that of European troops from enteric fever alone. Passing on to Section IX. of the report there is some interesting and instructive information to be found under the heading of " General Remarks." From a health point of view, as well as from a political and spectacular aspect, the Coronation Durbar at Delhi was, as we know, a remarkable success and the brief reference thereto at p. 102 is worth reading. We have already referred to the subject of malaria in connexion with the experiments which were commenced at Mian Mir in 1902, and which have been carried on up to the date of the publication of this report. An excellent résurné of the literature of trypanosomiasis to be found, beginning at p. 108 of this section, to which we may call attention, and at p. 112 there is an interesting account of the discovery by Major W. B. Leishman, R.A.M.C., of an important parasite, together with its history and the work that has been done in connexion therewith. INTERNATIONAL CONGRESS OF OTOLOGY. THE seventh International Congress of Otology was held at Bordeaux from August lst to 4th, the President being Dr. MOURE. At the opening meeting the PRESIDENT delivered an address upon the History of Otology in France, com- mencing with the work of Duverney in 1683. The Choice of a Sinzple and Practical Aconmetric FOr17b1l1a. A joint report upon this subject was presented by Dr. POLITZER (Vienna), Dr. DELSAUX, and Dr. GRADENIGO (Turin), who form a permanent committee meeting once a year for studying the points still undecided. Dr. QUIx (Utrecht), Dr. PANSE (Dresden), Dr. TRETROP (Antwerp), and Dr. BONNIER (Paris) read papers on the same question. The Diagnosis and Treatment of Suppuration of the Labyrinth. Dr. BRIEGER (Breslau) said that the radical mastoid opera- tion might lead to the spontaneous cure of a suppurating labyrinth, or, on the other hand, the suppuration, latent before, might become active after the operation and provoke fatal meningitis. He gave the indications, according to the present state of knowledge, for operation on the labyrinth and described the methods of procedure. Dr. vorr STEIN (Moscow) said that he distinguished cases according as the bony capsule, the perilymphatic space, the endolymphatic system, or the whole of the organ was affected. Dr. J. DuNDAS GRANT (London) spoke of the relations of labyrinthitis to meningitis and to cerebellar abscess. He also discussed the symptoms and compared them with those of cerebellar abscess, with which it was possible also that a labyrinthine suppuration might co-exist. Dr. POLITZER showed some preparations of morbid changes in the labyrinth in connexion with chronic suppurative otitis media.-Dr. PANSE, the PRESIDENT, and Dr. ESCAT (Toulouse) also made communications upon the subject. The Technique of the Opening and After-trecctnzent of Otogenous Cm’ebral Abscess. Dr. KNAPP (New York) showed an instrument designed by Dr. Whiting (New York) for examining the walls of the abscess cavity. In the after-treatment the most serious troubles were hernia cerebri (which was caused by a secondary abscess) and secondary abscesses inside the cranium. Dr. SCHMIRGELOW (Copenhagen) advised that the opera- tion should be planned so as to make it possible to explore both the cerebrum and the cerebellum. The anassthetic should be given with great caution owing to the risk of failure of respiration. Dr. BoTEY (Barcelona) said that the operation ought always to be commenced by an exploration of the mastoid and the tympanum, passing thence to. the intracranial cavity. He advised that in nearly all cases the brain should be punctured through the intact dura mater before incising the latter, in order to make certain of the existence of an abscess, for when the dura mater had been opened by a knife the brain and meninges were much more exposed to infection. He condemned irrigation of’ the abscess cavity and advised drainage by means of several small tubes. Dr. GRADENIGO described a special form of intra- cranial complication with the following association of symptoms-acnte otitis media, severe pain in the corre- sponding side of the head, especially in the temporo- parietal region, and later paralysis of the external rectus on the same aicle. Sir WILLIAM MACEWEN (Glasgow) said that he treated the aural and cerebral foci and excised the morbid track between them ; neglect of the latter precaution was a frequent cause of recurrences. He preferred chloroform as an anassthetic rather than ether because the latter induced oedema of the brain. If after having incised the dura mater no adhesions were found in the subarachnoid space he waited 24 hours before incising the brain. After as free an incision as possible he irrigated with the greatest gentleness and used either no drain or at the most sometimes a strand of gauze. Numerous other communications were made by various speakers, among whom Dr. BROECKAERT (Ghent) showed an ingenious syringe for injecting paraffin while cold; Dr. DENCH (New York) contributed a paper on the Radical Mastoid Operation; and Dr. GRADEMGo and Dr. PoLITZER urged the necessity of making the study of otology a com- pulsory subject. A small museum of pathological specimens, models, and instruments was arranged in one of the rooms at the School of Medicine where the Congress was held. Public Health and Poor Law. LOCAL GOVERNMENT BOARD. ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH. The Borough of Preston.-The history of the isolation of small-pox in this borough during 1903 affords an in- structive example of the risks which attend the use of " I temporary " hospitals. In 1888-89 a temporary build- ing was erected to cope with an epidemic of small-pox. It was afterwards taken down and stored away until 1893, when it was rebuilt upon its present site and again used in 1903. On Feb. 27th there occurred a gale which completely demolished the eastern wing which, by a happy circumstance, was unoccupied at the time. The remainder of the building was subsequently rendered more secure by props and other supports. There are other instances on record of disasters such as these, and we have heard of children suffering from diphtheria having to be taken from the hospital during a violent snowstorm and placed under a hedge until assistance could be secured. There can be no doubt that although these temporary structures have their advantages their ready destructibility by fire or storm renders them very unsuitable for the isolation of patients acutely ill or otherwise incapable of speedy removal. Two female health visitors were appointed at the beginning of 1903 and they have already done- good work in dealing with the excessive infantile mortality for which Preston bears an unenviable notoriety. Mr. H. 0. Pilkington, the medical officer of health, mentions the cases of mothers who have had 15, 12, 10, 9, 8, 6, and 5 children, and who have buried 8, 7, 5, 7, 7, 4, and 5 of their offspring under the age of 12 months. The reports of the female health visitors suggest that had the conditions of feeding and nursing of these children been better several of their lives might have been spared. The Borough of Eastbollrne.-The question of providing accommodation at the isolation hospital for cases of pulmo- nary tuberculosis was considered by the council of this borough during 1903, but after full consideration Dr. W. G. Willoughby, the medical officer of health, arrived at the conclusion that such a course would be undesirable. Dr. Willoughby thinks that it is not the proper function of a
Transcript
636
death-rate from enteric fever among European soldiers inIndia it shows a very low one indeed from this fever in thenative army and jail population of India. The fever statisticsdo not reflect, says the Sanitary Commissioner, the opinion soprominent of late that enteric fever is quite common amongad1lU natives of India. Lest it should be thought thatenteric fever when it occurs among natives is not correctlydiagnosed, but is returned under some other heading, theSanitary Commissioner significantly adds that whether wetake the case of native troops or prisoners their mortalityfrom all fevers is considerably below that of European troopsfrom enteric fever alone.
Passing on to Section IX. of the report there is someinteresting and instructive information to be found underthe heading of " General Remarks." From a health point ofview, as well as from a political and spectacular aspect, theCoronation Durbar at Delhi was, as we know, a remarkablesuccess and the brief reference thereto at p. 102 is worthreading. We have already referred to the subject ofmalaria in connexion with the experiments which were
commenced at Mian Mir in 1902, and which have been carriedon up to the date of the publication of this report. Anexcellent résurné of the literature of trypanosomiasis to befound, beginning at p. 108 of this section, to which we maycall attention, and at p. 112 there is an interesting accountof the discovery by Major W. B. Leishman, R.A.M.C., of animportant parasite, together with its history and the workthat has been done in connexion therewith.
INTERNATIONAL CONGRESS OF OTOLOGY.
THE seventh International Congress of Otology was heldat Bordeaux from August lst to 4th, the President beingDr. MOURE.At the opening meeting the PRESIDENT delivered an
address upon the History of Otology in France, com-mencing with the work of Duverney in 1683.The Choice of a Sinzple and Practical Aconmetric FOr17b1l1a.A joint report upon this subject was presented by Dr.
POLITZER (Vienna), Dr. DELSAUX, and Dr. GRADENIGO
(Turin), who form a permanent committee meeting once ayear for studying the points still undecided. Dr. QUIx(Utrecht), Dr. PANSE (Dresden), Dr. TRETROP (Antwerp),and Dr. BONNIER (Paris) read papers on the same question.
The Diagnosis and Treatment of Suppuration of theLabyrinth.
Dr. BRIEGER (Breslau) said that the radical mastoid opera-tion might lead to the spontaneous cure of a suppuratinglabyrinth, or, on the other hand, the suppuration, latent
before, might become active after the operation and provokefatal meningitis. He gave the indications, according to thepresent state of knowledge, for operation on the labyrinthand described the methods of procedure.
Dr. vorr STEIN (Moscow) said that he distinguished casesaccording as the bony capsule, the perilymphatic space, theendolymphatic system, or the whole of the organ was
affected.Dr. J. DuNDAS GRANT (London) spoke of the relations of
labyrinthitis to meningitis and to cerebellar abscess. Healso discussed the symptoms and compared them with thoseof cerebellar abscess, with which it was possible also that alabyrinthine suppuration might co-exist.
Dr. POLITZER showed some preparations of morbid changesin the labyrinth in connexion with chronic suppurativeotitis media.-Dr. PANSE, the PRESIDENT, and Dr. ESCAT(Toulouse) also made communications upon the subject.
The Technique of the Opening and After-trecctnzent ofOtogenous Cm’ebral Abscess.
Dr. KNAPP (New York) showed an instrument designed byDr. Whiting (New York) for examining the walls of theabscess cavity. In the after-treatment the most serioustroubles were hernia cerebri (which was caused by a
secondary abscess) and secondary abscesses inside thecranium.
Dr. SCHMIRGELOW (Copenhagen) advised that the opera-tion should be planned so as to make it possible to exploreboth the cerebrum and the cerebellum. The anasstheticshould be given with great caution owing to the risk offailure of respiration.
Dr. BoTEY (Barcelona) said that the operation oughtalways to be commenced by an exploration of the mastoidand the tympanum, passing thence to. the intracranial
cavity. He advised that in nearly all cases the brain shouldbe punctured through the intact dura mater before incisingthe latter, in order to make certain of the existence of anabscess, for when the dura mater had been opened by aknife the brain and meninges were much more exposed toinfection. He condemned irrigation of’ the abscess cavityand advised drainage by means of several small tubes.
Dr. GRADENIGO described a special form of intra-cranial complication with the following association of
symptoms-acnte otitis media, severe pain in the corre-
sponding side of the head, especially in the temporo-parietal region, and later paralysis of the external rectuson the same aicle.
Sir WILLIAM MACEWEN (Glasgow) said that he treated theaural and cerebral foci and excised the morbid track between
them ; neglect of the latter precaution was a frequent causeof recurrences. He preferred chloroform as an anasstheticrather than ether because the latter induced oedema of thebrain. If after having incised the dura mater no adhesionswere found in the subarachnoid space he waited 24 hoursbefore incising the brain. After as free an incision aspossible he irrigated with the greatest gentleness and usedeither no drain or at the most sometimes a strand of gauze.Numerous other communications were made by various
speakers, among whom Dr. BROECKAERT (Ghent) showed aningenious syringe for injecting paraffin while cold; Dr.DENCH (New York) contributed a paper on the RadicalMastoid Operation; and Dr. GRADEMGo and Dr. PoLITZERurged the necessity of making the study of otology a com-pulsory subject.A small museum of pathological specimens, models, and
instruments was arranged in one of the rooms at the Schoolof Medicine where the Congress was held.
Public Health and Poor Law.LOCAL GOVERNMENT BOARD.
ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH.
The Borough of Preston.-The history of the isolationof small-pox in this borough during 1903 affords an in-structive example of the risks which attend the use of" I temporary " hospitals. In 1888-89 a temporary build-ing was erected to cope with an epidemic of small-pox.It was afterwards taken down and stored away until1893, when it was rebuilt upon its present site and againused in 1903. On Feb. 27th there occurred a galewhich completely demolished the eastern wing which, by ahappy circumstance, was unoccupied at the time. Theremainder of the building was subsequently rendered moresecure by props and other supports. There are otherinstances on record of disasters such as these, and we haveheard of children suffering from diphtheria having to betaken from the hospital during a violent snowstorm andplaced under a hedge until assistance could be secured.There can be no doubt that although these temporarystructures have their advantages their ready destructibilityby fire or storm renders them very unsuitable for theisolation of patients acutely ill or otherwise incapable ofspeedy removal. Two female health visitors were appointedat the beginning of 1903 and they have already done- goodwork in dealing with the excessive infantile mortality forwhich Preston bears an unenviable notoriety. Mr. H. 0.Pilkington, the medical officer of health, mentions the casesof mothers who have had 15, 12, 10, 9, 8, 6, and 5 children,and who have buried 8, 7, 5, 7, 7, 4, and 5 of their offspringunder the age of 12 months. The reports of the femalehealth visitors suggest that had the conditions of feedingand nursing of these children been better several of theirlives might have been spared.
The Borough of Eastbollrne.-The question of providingaccommodation at the isolation hospital for cases of pulmo-nary tuberculosis was considered by the council of this
borough during 1903, but after full consideration Dr. W. G.Willoughby, the medical officer of health, arrived at theconclusion that such a course would be undesirable. Dr.Willoughby thinks that it is not the proper function of a
637
sanitary authority "to set up a second infirmary for the ’’
.chronic and practically hopeless cases that now find their 7
way into the union infirmary." Such cases should, he thinks, ’,be dealt with by the guardians. But apart from this there (does not seem to be a suitable building at the fever hospital ifor the purpose of treating consumptive patients, and Dr. aWilloughby thinks that even if there were a suitable buildingthe presence of consumptive patients might from a senti-mental standpoint injure the present popularity of the ’institution. The other objection which he raises seems to the ’’us to have even greater force-i.e., that the consumptive Jpatients would have a prejudice against the hospital from 1the fact that the acute exanthemata are treated there.
Plympton St. Mary Rural -Distq-ict.-Alr. S. Noy Scottspeaks appreciatively of the work of the Didworthy iSanatorium for Consumption which has recently been opened
’
near Brent for the consumptive poor of Devonshire. He 4does not, however, speak enthusiastically as to the results ofsanatoriums generally. As he observes, it is impossible tosegregate into these institutions even a small proportion of thelarge number of persons who are suffering from pulmonary 1tuberculosis and it seems, he thinks, " almost foolish to
expect that the isolation and treatment of a few of thesepeople for a few months will produce any marked effect uponthe prevalence of the disease or reduce the death-rate in anyway proportionate to the cost which such treatment in-volves." He sees, too, great difficulty in continuing to pro-vide the discharged patient with anything approaching theabundant food which has formed such an essential part ofthe sanatorium treatment.
The 3oroe<yla of To7,qva?f.-A very useful and encouragingmethod of inspecting the dairies, cowsheds, and milkshops inthis borough was introduced by the late Mr. P. Q. Karkeek,the former medical officer of health, and is continued by Dr.Thomas Dunlop, his successor. Twice yearly a systematicinspection is made, not only of the dairies and cowshedsin the borough, but also of all the dairy farms outsidethe borough limits which send their milk into the borough.As an outcome of these inspections a register is compiled’which is printed in the form of a bill and posted upthroughout the town, copies being forwarded to all the
- dairymen and farmers ,concerned. These bills, which may beregarded as a species of informal licence, are in force forsix months, when another inspection takes place. Thefarmers apparently welcome the inspections and endeavour tocarry out the suggestions made, and a very material improve-ment in the former .condition of affairs appears to have taken
,place. But Dr. Dunlop thinks that sufficient care is not
taken in the milking of the cows and he states that whensome of the milk is treated in a separator the sedimentbetrays signs of material of which the healthy udder isinnocent. Proper means for washing the hands of themilkers are rarely seen and the milkers do not wear
overalls. This is not satisfactorv and we should like tosee the facts stated on the bill. The cow’s udders and themilker’s hands should be washed before the operation, themilk should be strained immediately after milking, and itshould then be cooled. All the utensils should be sub-
sequently scalded or preferably steamed. The Torquaymethods are admirable so far as they go but we cannot helpthinking that the informal licences in vogue may provesomewhat a false security if, that is to say, the bills whichare posted are intended to imply freedom from the likelihoodof specific contamination. We hope that Dr. Dunlop will.continue to deal with this very important subject in hisfuture annual reports and that he will record annually thefurther progress which he has been able to make. TheTorquay example might be usefully followed in other places.
VITAL STATISTICS.
HEALTH OF ENGLISH TOWNS.
IN 76 of the largest English towns 8896 births and 6639deaths were registered during the week ending August 20th.The annual rate of mortality in these towns, which hadbeen 16-4, 19-8, and 22 1 per 1000 in the three precedingweeks, further rose last week to 22’ 7 per 1000. In Londonthe death-rate was 21’6 per 1000, while it averaged23’2 in the 75 other large towns. The lowest death-rates in these towns were 7’ 8 in King’s Norton, 9’ 6 inHandsworth (Staffs.), 10- 5 in West Hartlepool, 10- 7 in Black-burn, 11’ 8 in Hastings and in Devonport, 12-0 0 in Burton-on-Trent, and 12 1 in Bournemouth ; while the highest rates
vere 31-0 0 in Hanley, 31-4 in Tynemouth, 31-8 8 in St.lelens, 32 1 in Salford, 32 3 in Tottenham, 33-4 in York,!4 - 0 in Wigan, 34-6 6 in Bootle, and 39’ 1 in Liverpool. Thei639 deaths in these towns last week included 2842 which wereeferred to the principal infectious diseases, against 1255,059, and 2710 in the three preceding weeks ; of these!842 deaths, 2538 resulted from diarrhoea, 130 from measles,’9 from whooping-cough, 39 from diphtheria, 30 from’ fever " (principally enteric), and 26 from scarlet fever, butiot any from small-pox. The lowest death-rates last weekrom these principal infectious diseases were recorded in
castings, Bournemouth, Devonport, Burton-on-Trent, King’sNorton, Stockton-on-Tees, West Hartlepool, and Southshields ; and the highest rates in Tottenham, East Ham,xrimsby, Birkenhead, Liverpool, Bootle, York, Hull, andhondda. The greatest proportional mortality from measles)ccurred in Blackburn, Huddersfield, Halifax, Bradford,md Rhondda; and from diarrhoea in Tottenham, West3am, East Ham, Leyton, Reading, Grimsby, Liverpool,3ootle, Wigan, York, and Hull. The mortality fromeach of the other principal infectious diseases showedio marked excess in any of the large towns; and nofatal case of small-pox was recorded either in London)r in any of the 75 large provincial towns. Thelumber of small-pox patients under treatment in the Metro-politan Asylums hospitals, which had been 46, 32, and 21 atthe end of the three preceding weeks, had further declinedj0 18 at the end of last week ; two new cases were admittedluring the week, against seven, two, and none in the threepreceding weeks. The number of scarlet fever cases in;hese hospitals and in the London Fever Hospital on Saturdaylast, August 20th, was 1745, against 1784, 1758, and 1763m the three preceding Saturdays ; 198 new cases wereadmitted during the week, against 243, 166, and 189 in thethree preceding weeks. The deaths in London referred topneumonia and diseases of the respiratory system, whichhad been 118, 112, and 121 in the three preceding weeks,declined again last week to 106, and were 14 below thenumber in the corresponding period of last year. The causesof 39, or 0’6 6 per cent., of the deaths in the 76 townslast week were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death wereduly certified in West Ham, Bristol, Salford, Bradford,Leeds, Newcastle-on-Tyne, and in 49 other smaller towns;while the largest proportions of uncertified deaths were
registered in Liverpool, St. Helens, Manchester, Halifax,South Shields, Gateshead, and Tynemouth.
HEALTH OF SCOTCH TOWNS.
The annual rate of mortality in eight of the principal Scotchtowns, which had been 14 1, 14 - 6, and 15’ per 1000 in thethree preceding weeks, further rose to 17’ per 1000during the week ending August 20th, but was 5’ 6 per 1000below the mean rate during the same period in the 76 largeEnglish towns. The rates in the eight Scotch towns
ranged from 7-8 8 in Leith and 12-3 in Perth, to 20 - 2 inGreenock, and 21-1 1 in Paisley. The 567 deaths in thesetowns included 66 which were referred to diarrhoea, 16 towhooping-cough, seven to measles, four to scarlet fever,and one to diphtheria, but not any to small-pox or to"fever." In all, 94 deaths resulted from these principalinfectious diseases last week, against 58, 85, and 109 in thethree preceding weeks. These 94 deaths were equal to anannual rate of 2 - 8 per 1000, which was 6 - 9 per 1000below the mean rate last week from the same diseasesin the 76 large English towns. The fatal cases of diar-rhoea, which had been 24, 48, and 68 in the three
preceding weeks, declined again last week to 66, ofwhich 44 were registered in Glasgow, five in Aberdeen, fivein Leith, four in Edinburgh, four in Dundee, and three inPaisley. The deaths from whooping-cough, which hadbeen 26 in each of the two preceding weeks, decreased to16 last week, and included 11 in Glasgow and two inDundee. The fatal cases of measles, which had been seven,five, and six in the three preceding weeks, rose againlast week to seven, of which three occurred in Glasgow.The deaths from scarlet fever, which had been two, one, andtwo in the three preceding weeks, further rose to four lastweek, and included two in Edinburgh. The deaths referredto diseases of the respiratory organs in these towns, whichhad been 55, 47, and 39 in the three preceding weeks, roseagain last week to 47, but were slightly below the numberin the corresponding period of last year. The causes of
