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Washington Government Printing Office in 1900, but it hasnot been found practicable up to the present time to publishthe full report. This is of a very elaborate and voluminousnature, consisting as it does of 2600 type-written pages,accompanied by numerous maps, plans, and charts. It ismeanwhile deposited in the library of the office of theSurgeon-General of the United States army for reference.The declaration of war against Spain found the United

States Government in a state of medical unpreparedness.Surgeon General G. M. Sternberg in his brief introduction tothe abstract of the report in question tells us that the assem-bling of 250,000 volunteer troops in military camps in thespring of 1898 taxed all the bureaus of the War Departmentto the utmost, the medical corps of the regular army beinghardly sufficient for the small army of 25,000 men. To thiscorps of trained medical officers a large addition had perforceto be made and this enlarged medical department had soonto confront an enormous task, as may be judged by the factthat more than 20,000 cases of typhoid fever occurred amongthe troops encamped within the limits of the United States.A board of medical officers was convened by special ordersissued from the Adjutant-General’s office in August, 1898,and an abstract of its report has been published in orderthat the conclusions arrived at by the board may be avail-able for the use of the profession at the earliest practicabledate. The first 12 chapters of this abstract describe and dealwith the facts connected with the medical history of thisfever in the different divisions and camps and in the severalarmy corps, and the remaining three chapters treat ofcoincident malaria and typhoid fever and of the etiologyof the latter disease, with a summary of general statementsand conclusions. - The abstract, consisting of 239 pages, forms a very

condensed pricis of the report itself but is nevertheless full of interesting and important material. This does not readily lend itself to further analysis and we must content ourselves twith dealing with some of its more salient features only. While the commissioners express their confident conviction i

that water infection was one of the means by which typhoid fever was spread through a division at Chickamauga, forexample, they are, as will be seen, very far from adoptingthis as an exclusive channel. While not implying that thisfever ever originated de novo, they nevertheless hold thattyphoid fever is so widely distributed that in any largeassembly of men collected from different parts there will

always be some present who are already infected with it.

They regard it, in other words, as an axiom that typhoidfever will appear and spread whenever and wherever a largenumber of men are congregated and allow their own excre-tions to accumulate about them.

During the Spanish war of 1898 it was found that typhoidfever showed itself in every regiment constituting six army s

corps. More than 90 per cent. of the volunteer regiments developed this fever within eight weeks of going into camp ; tit was also developed in certain of the regular regiments o

within three to five weeks after going into camp ; and it pbecame epidemic in both small and larger encampments, e

whether located in the Northern or in the Southern States. a

The origin, progressive development, and persistent preva- t:lence of the disease in companies and corps seem to have tbeen carefully worked out. The commissioners’ investiga- btions confirm the doctrine of the specific, and do not support tthe pythogenic, origin of this fever. Typhoid fever is dis- seminated by the transference of the excretions of an tinfected individual to the alimentary canal of others and an a

infected man may scatter the infection before the disease is t]

recognised in him. It is easy to see why typhoid fever is a

more likely to become epidemic in camp than in civil life c

on account of the greater difficulty of disposing of the f(

excretions, alvine and urinary, in the former case espe- ti

ciallv, where, as in the war of 1898, camp pollution is c

stated to have been the greatest sanitary sin committed by the troops. Owing to the observations of Professor A. E. a

Wright and Major D. Semple, R.A.M.C., and to those of t(Dr. P. Horton-Smith and others we know how frequently and Rpersistently typhoid bacilli are present, sometimes in enormous a

quantities, in the urine of enteric fever patients and how the tldisease may consequently be spread through the urine of n

patients affected with typhoid bacilluria. slInstances of ignorance of camp hygiene and neglect of fI

sanitary precautions in the way of too long occupation and N

insafficiently frequent change of sites, improper or inade- rr

quate methods of sewage disposal and disinfection and of guarding against contamination of the water-supply or of ti

the provision of means for the sterilisation of water, andvarious other points, are cited and passed in review. Thepart played by flies as carriers of infection and by the

, transport of infective material by soldiers on their persons orin their clothing, bedding, and tentage, and its disseminationthrough the air in the form of dust as well as the persistenceof the disease in companies and corps when once introducedare likewise all considered and Passed in review. Nor is itoverlooked that susceptible material in the way of draftsand reinforcements composed of young and newly arrivedsoldiers is being supplied to the force in the field. It isstated emphatically by the commission that infected waterwas not an important factor in the spread of typhoid fever inthe national encampments of 1898 and at pages 182 and 183some of the reasons on which this opinion is based are given.Taking the case of Jacksonville and Knoxville, for example,it is alleged to be beyond question that the water therewas not infected. The supply at Jacksonville " came fromartesian wells more than 1000 feet deep and was distri-buted by means of pipes. In August and September of 1898there were in round numbers at Jacksonville 30,000 civiliansor inhabitants of the city and the same number of soldiersencamped near by. Both civilians and soldiers drank waterfrom the same source. There were only a few sporadic casesin the city at a time when each of the three division hos-pitals was receiving a score or more of patients with thisdisease each day. The same condition existed at Knoxville.Here the soldiers obtained their water-supply from the pipesthat furnished West Knoxville. We satisfied ourselves froman inspection of the health officer’s books that there were nocases of typhoid fever among the citizens at that time andstill there were hundreds of cases among the soldiers."

Allusion is made in the abstract to the results and medicalhistories of other campaigns in other countries, and thebacteriological information about the enteric bacillus andtyphoid fever is up to date, but we have exhausted our space.We have, however, said enough, we trust, to show that thereport of the American commission is an able, comprehensive,and important official document.

Public Health and Poor Law.LOCAL GOVERNMENT BOARD.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

West Riding County District.-The strides made by thescience of bacteriology have rendered it necessary in theinterests of the public health that medical practitionersthroughout the country should be afforded facilities for

obtaining a bacteriological examination, not only in casespresenting some diagnostic difficulty, but also in order toenable the physician to determine when infection is at an endand when the patient may safely mix with the public. Seeingthat this is a matter of public health concern it is right thatthe facilities in question should be provided by a publichealth authority, and the county council would seem to bethe authority which can most usefully perform this function.We are glad to see that the West Riding County Council hastaken this view and that it has recently provided a laboratoryand appointed a competent bacteriologist. Dr. J. R. Kaye,the county medical officer of health, tells us in his currentannual report that each medical officer of health in the

county has been provided with outfits for obtaining samplesfor bacteriological examination, and that any medical prac-titioner in the county can now obtain such outfits free of allcharge from the local medical officer of health. Specimenswhen taken are at once forwarded to the county laboratoryand the results are transmitted as expeditiously as possibleto the local medical officer of health and to the practitionerwho furnished the sample. The facilities thus affordedare being much appreciated by the medical profession inthe West Riding and from April 22nd to Dec. 31st, 1901,no less than 177 Widal’s tests were applied, 228 specimens ofsputa were examined for the tubercle bacillus, and 383 swabsfrom suspected cases of diphtheria were sent to the laboratory.Much useful work has been done with regard to the exa-mination of the urine of patients who had suffered fromenteric fever, and in one case the facts suggested that atrooper returned from South Africa had suffered while there

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from an unrecognised attack of this disease. In connexionwith the subject of tuberculosis it is instructive to learn thatthe sputum of five patients who had recently undergonethe open-air treatment was examined and in each instancetubercle bacilli, albeit in small numbers, were detected. Inthe matter of smoke abatement Dr. Kaye regrets that moreprogress is not made in the county and he states that butlittle encouragement is given by the district councillors tosanitary inspectors who make efforts in this direction. Thisis a very deplorable state of affairs.

TVol’aester County District.-The efforts which have beenmade in this county for the erection of a county sanatoriumfor pulmonary tuberculosis seem in a fair way partially tobecome realised. The council as a whole has apparentlydeclined the offer of a site from Viscount Cobham and it hasalso declined to participate in a scheme proposed by Mr. J.Dangerfield who also offered the loan of a site for five years.The members of the council did not, it appears, see their wayto " accept further responsibilities which are outside thescope of the work entrusted to them." Apparently they donot regard such provision as within their powers under theIsolation Hospitals Acts. Eventually, however, six trusteeswere found for the property offered by Mr. Dangerfield, andit is likely that a start will shortly be made with the institu-tion. The county council will, to), it seems, contribute .S300towards the scheme.Durham County -Distriet.-Dr. T. Eustace Hill, in present-

ing his eleventh annual report on the health and sanitarycondition of Durham, furnishes the welcome intelligence thatthe birth-rate of the county evinced during 1901 an upwardtendency. The diminishing birth-rate manifested in thecountry as a whole is one of the most serious problems withwhich we are faced. Unfortunately, in the case of Durhamthe increased birth-rate was associated with an increaseddeath-rate, such death-rate being almost entirely caused byinfantile diarrhoea. In fact, infantile mortality seems to beexcessive over the whole county of Durham. During 1901the infantile mortality was no less than 177 per 1000 regis-tered births. In the six boroughs the rate was only 160, butin the other urban districts the enormous average of 191 wasreached, while in no less than eight urban districts theinfantile mortality exceeded 200 and even in the rural dis-tricts the rate was 176 per 1000 births. Many of the localmedical officers of health urge the appointment of lady healthvisitors with a view of instructing the people with respect tothe reduction of this infantile mortality. As Dr. Hill pointsout, not only have the deaths to be considered but also the

permanent injury which results to our child population fromunhealthy surroundings and improper feeding. Dr. Hill

reports that the action of the county council in arrangingwith the Durham University College of Medicine for the

gratuitous bacteriological examination in doubtful cases ofphthisis, diphtheria, and enteric fever is much appreciatedby the medical practitioners throughout the county. Therewas a marked rise in the incidence of enteric fever in the

county during 1901, more particularly during the autumnmonths. Numerous causes seemed to have operated in theproduction of the disease, and in some cases the illness isattributed to the erection of houses upon "made" groundcontaining animal or organic matter. One of the annual

reports, that of Mr. D. S. Park of Houghton-le-Spring, sug-gests that the excessive incidence of enteric fever on themale population, the majority of whom are miners, may beascribable to the conditions under which the coal-minerswork. The phthisis death-rate in the county declined from1-26 in 1900 to 1-11 in 1901, but the deaths from otherforms of tuberculosis showed an increase. The countysanatorium for consumptives at Horne Hall, Stanhope, has,Dr. Hill reports, done excellent work during 1901. Thesanatorium is supported largely by voluntary contributions,and the payment of £.75 per annum reserves the sole use ofone bed in the sanatorium. Dr. Hill expresses the hope thatother sanitary authorities in the county will follow the

example set by the Sunderland and Gateshead corporationsin making an annual contribution towards the expenses ofthe institution.

Glamorganshire County Council. - Glamorganshire isanother of those counties in which provision is made forbacteriological investigation, but in this case a small feeis charged to medical practitioners who wish to take

advantage of the facilities afforded ; presumably examina-tions for district medical officers of health are made free ofcharge. The bacteriological laboratory of the county was inthe first instance established by the county council, but itwas shortly after taken over by a joint committee consisting

of members of the health committee of the corporation of. Cardiff and of the sanitary committee of the county council,! together with representatives of the technical instruction! committees of the borough and council. The directors

of the laboratory are the medical officers of health ofCardiff and of the county council. It is noted that during

. 1901 there were examined in the laboratory 391 specimens of! suspected diphtheria, 122 of suspected enteric fever, 197. of suspected pulmonary tuberculosis, and among the other

details may be mentioned bacteriological examination of soiland of milk, the examination of rats for plague, and theexamination of milk and pus for pathogenic organisms.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8721 births and 4970deaths were registered during the week ending Nov. 15th.The annual rate of mortality in these towns, which hadbeen 16 - 9, 16 - 6, and 17’ 3 per 1000 in the three precedingweeks, further rose last week to 17’ 4 per 1000. In Londonthe rate of mortality was 17’ 7 per 1000, while it averaged 17 ° 3per 1000 in the 75 other large towns. The lowest death-ratesin these towns were 8’0 0 in Coventry, 8’3 in Northampton,8 - 5 in Bournemouth, 9’ 5 in East Ham, 10’ 0 in Aston Manor,10-6 in Leyton, 10’8 in Ipswich, and 11’1 in Wallasey ; ;the highest rates were 22’3 in Middlesbrough, 22’4 in St.Helens, 23-2 in Nottingham, 23-4 in Liverpool, 24-4 in

Burnley, 25-1 in Merthyr Tydfil, 25.6 in Cardiff, 26-5 inStockport, and 35-1 in Hanley. The 4970 deaths inthese towns last week included 509 which were referred tothe principal infectious diseases, against 604, 576, and 558in the three preceding weeks; of these 509 deaths, 166resulted from measles, 101 from diarrhoea, 76 fromdiphtheria, 59 from "fever" (principally enteric), 52from scarlet fever, 51 from whooping-cough, and four fromsmall-pox. No death from any of these diseaseswas registered last week in Leyton, Bournemouth,Reading, Northampton, Ipswich, Smethwick, Coventry,Derby, Wallasey, Rochdale, or Barrow-in-Furness ; whilethey caused the highest death-rates in Bristol, Hanley,Grimsby, Liverpool, Bury, Salford, Burnley, West Hartle-pool, South Shields, Newport (Mon.), and Cardiff. Thegreatest proportional mortality from measles occurred inHanley, Liverpool, Bootle, Salford, Leeds, Hull, WestHartlepool, South Shields, Newport (Mon.), Cardiff, andMerthyr Tydfil ; from scarlet fever in Oldham and Swansea ;from diphtheria in Bristol, St. Helens, Bury, Burnley,Middlesbrough, and West Hartlepool ; from whooping-cough in Stock port ; from "fever" in Grimsby, Black-burn, and York ; and from diarrhoea in Hornsey andHanley. One fatal case of small-pox was registeredin Liverpool, one in Bolton, one in Burnley, and one inMerthyr Tydfil, but not one in any other of the 76 largetowns. The number of small-pox patients under treatmentin the Metropolitan Asylums hospitals on Saturday, Nov. 15th,was 11, against 23, 19, and 14 on the three precedingSaturdays ; two new cases were admitted last week, againstone, six, and none in the three preceding weeks. Thenumber of scarlet fever cases in these hospitals and inthe London Fever Hospital, which had been 2904, 2869, and2900 at the end of the three preceding weeks, had furtherdeclined to 2839 at the end of last week ; 285 new caseswere admitted during the week, against 362, 349, and346 in the three preceding weeks. The deaths referredto diseases of the respiratory organs in London, whichhad been 291, 298, and 332 in the three precedingweeks, further rose last week to 347, but were 55below the corrected average number. The deaths

directly attributed to influenza in London numberednine last week, against six, 10, and 23 in the three pre-ceding weeks. The causes of 54, or 1’1 1 per cent., of thedeaths in the 76 large towns last week were not certifiedeither by a registered medical practitioner or by a coroner.All the causes of death were duly certified in) West Ham,Leicester, Nottingham, Manchester, Salford, Bradford,Leeds, and in 44 other smaller towns ; the largest propor-tions of uncertified deaths were registered in WestBromwich, Birmingham, Liverpool, Bury, Huddersfield,Sheffield, and Sunderland.

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HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principal