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Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF INSPECTORS OF THE MEDICAL DEPARTMENT

OF THE LOCAL GOVERNMENT BOARD.

On certain locaUsed Oittbrea7is of Diphtheria at Crofton andOrpington by Dr. S. Monekton OOpt1nan. -The report in

question discusses a number of comparatively small and yetvery fatal occurrences of diphtheria in the Bromley ruralsanitary district, and much of their interest lies in the

obscurity attaching to the causation of the disease, and thisalthough all the circumstances of the majority of the cases

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seemed more than usually accessible. Typical amongst theattacks was one at an old mansion known as Crofton Court,where between February and May five cases occurred with threedeaths. There were certain chances of the importation of adefinite infection, although none could be absolutely proved.Bat, admitting such importation, the infection seems to haveclung with tenacity to the premises, notwithstanding theadoption of measures of prevention. From this point of viewCrofton Court is a place of interest, and it exhibited con-ditions which can hardly be said to be rare in old countryhouses to which diphtheria has clung in somewhat thesame fashion. The house itself had certain definite sanitarydefects, but many of these were remedied on the occurrenceof the first case. The site was, however, very damp, waterwas near the surface, and a cellar exhibited conditionsshowing that damp air had constant access to the interiorof the house. Dampness was also favoured by thicktrees, which overshadowed some of the windows andthus excluded sunlight. Then, again, there had prevailedin connexion with these defects a predisposition to sore-throat of an undefined sort amongst the members of thehousehold. And, lastly, there was the difficult question ofthe possible influence of the offensive carting about of"London manure" in close proximity to the house.Some will find in one or more of these conditions

ample to explain the cause itself of diphtheria ; others willregard them mainly as favouring the reception of an externalinfection due to importation and the retention of thatinfection when once introduced. The various points are dis-cussed at some length by Dr. Copeman, and we could havewished that this report had found a place amongst thosewhich are placed on sale. Incidentally Dr. Copeman foundit necessary to deal with the so-called "Bexley system,"which has been devised with a view of getting rid of, or atleast postponing, the question of drainage and sewerage. He

distinctly condemns it. Any system under which cesspoolsare to be emptied by pumping machinery and tank carts canonly be regarded as possessing the elements of efficiency pro-vided the cesspools are really watertight. In the case underdiscussion they are leaky cesspools, acd in a waterloggedfoil; they fail to secure the proper disposal of all the liquidrefuse, and they perpetuate the waterlogged state of the soilinstead of aiming at lowerirg the high level of subsoil water,which is a distinct drawback to the healthiness of the areahere under consideration. Under these circumstances Dr.

Copeman advised the Bromley rural authority no longer todelay the construction, in connexion with the Orpingtonsewer, of a sewerage system to serve the Crofton district.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Pitdsey Urban Sanitary District.-Dr. W. Lovell Hunter,in the introduction to his annual report for 1894, gives somfexcellent advice to the new district council as to their dutiesand responsibilities under the Public Health Acts, and WEtrust that this year’s report will show that the advice hasnot been thrown away. The new council have been given !good stvt, inasmuch as the general death-rate for 1894,which was 14’6 per 1000, was the lowest yet recorded. DrHunter reminds the council that the low death-rate cannotbe entirely attributed to local causes, but he considers thatthere are three sanitary measures which have in particularhad their effect-i.e., improved scavenging, prevention of leacpoisoning, and a better provision for checking the spreacof infectious disease. In the matter of compulsory notification Dr. Hunter, in urging his sanitary authority to adopt thiAct, points out that Leeds, the only large town in the WesRiding of Yorkshire not previously under the Act, embrace(its provisions last year, and that 83 per cent. of the tota

West Riding population are now under notification. Perhapsthe now 1’ndaey council will see their way shortly to addingtheir population of 13,900 to the total. Dr. Hunter did not,hear of a single case of lead poisoning during 1894, althoughit appears that the water supplied to the district still retains.the power of acting upon lead, as evidenced by analyses osamples drawn in the early morning from a lead pipe 18’)feet long. The monthly averages of lead ranged from 0-06 to.0-19 gr. per gallon, the lowest average being in August and th<-highest in April. The analyses show a very decided improve-ment on those for 1892, though not in all cases as comparedwith those for 1893; indeed, in some months the analyses for1894 show an increase on those for the preceding year.There are in Pudsey few mill chimneys in properties to it&area, but Dr. Hunter reports that frequent complaints as to?the smoke nuisance reach him ; he points out that a reason-able smoke limit adopted by the council and enforced wouldsoon improve the condition of the town.

West Hartlepool Urban Sanitary District -Dr. SamuelGourley reports that during 1894 the general death-rate ohis district was 14 6 per 1000 of the population, and thinfantile mortality 125 per 1000 registered births. There?were in the period under review eleven cases with five deaths.from small-pox ; not one of the fatal cases showed signs cfbeing vaccinated. Dr. Gourley condemned during the yea?’seventeen carcases on account of extensive tuberculosis.-and he considers that in cases such as these, where the,butcher has bought the beast in open market, compensationshould be allowed. The smoke nuisance could, Dr. Gourleyreports, be much reduced by careful stoking, and he thinks,that unless proceedings are taken in some cf the worstcases there is but little chance of improvement taking place.It is not clear why the sanitary authority are averse tc’

relieving the population of West Hartlepool from this excess.of smoke.

Short Heath Urban Sanitary District.-In this d:istrict,.which contains a population ot but 2667, there seems to beconsiderable difficulty in the matter of isolation accommoda-tion, and Mr. John Hartill, the medical officer of health;proposes that the district shall for the purpose of small-poxhospital accommodation be grouped with others under th&-Isolation Hospital Act, 1893, while for other infectiousdisease he advises that six beds be provided in Short Heath.There were 90 cases of small-pox in Short Heath during 1894,the death-rate among the unvaccinated being more than fotrtimes greater than among the vaccinated.

Poole Urban anrl Port Sanitary Districts --Dr. I-le:rbert.Lawton, through his annual report for 1894, impresses uponthe inhabitants of his district the fact that it is incombent.upon the householder or nearest relative to notify cases ufinfectious disease to him, and that their responsibilities in

: that direction are in no way relieved by the medical certifi -,

cate. During 1894 it appears that 36 out of 105 cases were: not notified by the householder. We are glad to see-

. that Dr. Lawton draws attention to this point. The methods

l of excrement disposal in Poole proper were, to judge by areport from one of the medical inspectors of the Local

I Government Board, anything but satisfactory ; indeed, theaccounts given of the proximity of privy cesspits tc,

t dwellings and the soaking of liquid filth up the wals,were such as to render changes imperative. We are glad,

; therefore, to be able to record that the sewage disposalscheme has been begun, and also that during 1894 twentyold plivy vaults were filled in. The sanitary condition of-the bakehouses and slaughterhouses in Poole is apparentlynot as it should be, but there is no reference in Dr. Lawton-’.,

, report as to dairies, cowsheds, and milkshops; no doubt, how--e ever, having regard to the importance of this matter boths to Bournemouth and Poole, they are well looked after. Noe case of infectious disease has, Dr. Lawton reports, beer..>s notified from any of the vessels frequenting the port, and the-a health of the seamen has, he states, been satisfactory. In., referring to the machinery for cholera prevention, we note,. that Dr. Lawton speaks of a "quarantine " station. It.t would, perhaps, be as well in speaking of cholera to avoid)t this word and to use the terms of the Cholera Order.r Chelmsford Rural Sanitary District.-The defunct Chelmsd ford rural sanitary authority now replaced by the rural !d district council may, as Dr. Thresh observes, look bacli" upon their work with satisfaction ; and we will add thate if the new council carry on the work of progress initiatedit by their predecessors their district will soon be one of the-d b2st-equipped rural areas in the county. Dr. Thresh’;a

reports are always cheerful reading because thoee portions

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of them having reference to sanitary improvements bear

’signs of steady progress. For instance, in the report nowbefore us. that for 1894, we read under the head of improve-ments effected during the year of a new water-supply forWoodham Ferris, Retterdon, East Hanningford, and Runwell ;of the provision of an isolation hospital after the plans<of the Local Government Board, in which, by the way,the families of labourers will be admitted free of charge ;and of the adoption of new and important by-laws.Under the head of improvements contemplated we read ofschemes already far advanced for fresh water-supplies andthe provision of a disinfecting apparatus. It seems, too,that the sanitary authority has recently obtained by-lawsapplicable to all the more populous parishes with respect tothe offensive trades enumerated in the Public Health Act.We notice with regret that the Essex County Council is not*very energetic in public health matters. For instance, inreferring to some houses which are a danger to the public in- consequence of their dilapidated condition, Dr. ’Threshobserves : " Our clerk having ruled that it is the duty of the- county council to deal with such dangerous structures, nothingwill probably be done until someone is injured" ; and, again,in discussing the effluent of sewage farms : "If the countycouncil paid any attention to the condition of our rivers, doubt-less they would insist upon a higher standard being reached."In dealing with the prevalence of infectious disease Dr.Thresh refers to the manner in which the practice of medicalmen differs in regard to cases of an infectious character ; insome cases he (Dr. Thresh) finds every precaution taken, inothers but few. More especially is the absence of pre-cautions discoverable in slight cases of diphtheria. Dr.Thresh observes as to this that if a case is sufficientlysuspicious to warrant notification it is sufficiently serious tonecessitate the most complete isolation possible under the- circumstances.

Wimbledon Urban Sanitary District.-The general death-rate for this district for 1894 was, Mr. Evelyn Pocklingtontells us the lowest during the last eighteen years-i.e., 10.3 3per 1000. In a case where the mother of two children suffer-ing from scarlet fever neglected to duly notify the medical,officer of health the bench inflicted a fine of 10s. for each case.:ilIr. Pocklington reports that considerable discontent has beenevinced during the year owing to the unsatisfactory state of’the fever hospital, and he insists upon the importance of erect-ing a more suitable building. New by-laws in regard to pig-sticking have recently been adopted, and their enforcementhas resulted in considerable benefit. Mr. Pocklington thinks,’however, that in certain parts of his district the prohibitive- distance of pigsties from dwellings should be 150 ft. instead-of, as at present, 100 ft.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN thirty-three of the largest English towns 6693 birthsand 5635 deaths were registered during the week endingMarch 23rd. The annual rate of mortality in these towns,which had been 35’0 and 32’2 per 1000 in the two preceding"weeks, further declined last week to 27’7. In London the:rate was equal to 26’0 per 1000, while it averaged 29-0 inthe thirty-two provincial towns. The lowest rates in thesetowns were 18’9 in Birkenhead, 19’9 in Swansea, 20-6 iniHalifax, and 20 7 in West Ham and in Nottingham ; the

highest rates were 36’4 in Blackburn, 36.5 in Manchester,37’1 in Wolverbampton, 38’1 in Oldham, and 47 5 in Brighton.The 5635 deaths included 314 which were referred to theprincipal zymotic diseases, against 338 and 302 in the twopreceding weeks ; of these, 100 resulted from whooping-cough.’72 from measles, 50 from diphtheria, 39 from diarrhoea, 29from scarlet fever, 22 from "fever" (principally enteric),and 2 from small-pox. No death from any of these diseaseswas recorded last week in Huddersfield or in Halifax ;in the other towns they caused the lowest death-rates inBristol and Portsmouth ; and the highest rates in Wolver-hampton, Bolton, Manchester, Blackburn, and Newcastle-upon-Tyne. The greatest mortality from measles occurredin Brighton, Plymouth, Bolton, Manchester, and Sheffield ;from scarlet fever in Wolverhampton ; and from whooping-cough in Norwich, Leicester, Blackburn, and Newcastle-’upon-Tyne. The mortality from "fever " showed no markedexcess in any of the large towns. The 50 deaths fromdiphtheria included 24 in London, 5 in Leeds, 4 in Birming-iham, 3 in Manchester, and 3 in West Ham. One fatal

case of small-pox was registered in Derby and one in

Liverpool, but not one in London or in any other ofthe thirty-three large towns. There were 58 cases of

small-pox under treatment in the Metropolitan AsylumHospitals and in the Highgate Small-pox Hospital on

Saturday last, March 23rd, against 68, 56, and 57 at the endof the three preceding weeks ; 14 new cases were admittedduring the week, against 8 and 12 in the two precedingweeks. The number of scarlet fever patients in the Metro.politan Asylum Hospitals and in the London Fever Hospitalat the end of the week was 1587, against 1621, 1619, and 1615on the three preceding Saturdays; 184 new cases were

admitted during the week, against 143, 141, and 133 in thethree preceding weeks. The deaths referred to diseases ofthe respiratory organs in London, which had been 1448,1366. and 1031 in the three preceding weeks, further declinedto 740 last week, but were 254 above the corrected average.The causes of 74, or 1-3 per cent., of the deaths in thethirty-three towns were not certified either by a registeredmedical practitioner or by a coroner. All the causes of deathwere duly certified in West Ham, Bristol, Bradford, Leeds, ’Sunderland, and in eleven other smaller towns; the largestproportions of uncertified deaths were registered in Birming.ham, Leicester, Hull, and Newcastleupon-Tyne.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had declined in the three preceding weeks from 42’8to 35-1 per 1000, further fell to 31-2 during the week endingMarch 23rd, but exceeded by 3’5 per 1000 the meanrate during the same period in the thirty-three largeEnglish towns. The rates in the eight Scotch townsranged from 25’1 in Greenock and 27’2 in Aberdeen, to40 in Edinburgh and 42-0 in Leith. The 900 deaths inthese towns included 56 which were referred to measles,27 to whooping-cough, 17 to diarrhoea, 9 to diphtheria,5 to scarlet fever. 1 to "fever," and not one to small-pox. In all, 115 deaths resulted from these principalzymotic diseases, against 144 and 110 in the two precedingweeks. These 115 deaths were equal to an annual rate of4’0 per 1000, which was 2’5 above the mean rate lastweek from the same diseases in the thirty-three largeEnglish towns. The fatal cases of measles, which bad been72 and 48 in the two preceding weeks, rose again to 56 lastweek, of which 19 occurred in Edinburgh, 17 in Leith, 9in Glasgow, and 9 in Aberdeen. The deaths referredto whooping-congh, which had been 39 and 22 in the twopreceding weeks, increased to 27 last week, and included17 in Glasgow, 3 in Aberdeen, and 3 in Leith. The 9 fatalcases of diphtheria exceeded those recorded in any recentweek, and included 6 in Glasgow. The deaths from scarletfever, which had been 6 and 10 in the two preceding weeks,declined again to 5 last week, of which 3 occurred in Glas.gow and 2 in Edinburgh. The deaths referred to diseases ofthe respiratory organs in these towns, which had declinedfrom 544 to 385 in the three preceding weeks, further fellto 313 last week, but were nearly three times the numberrecorded in the corresponding week of last year. Thecauses of 48, or more than 5 per cent., of the deaths inthese eight towns last week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 48’8 and 42’4per 1000 in the two preceding weeks, rose again to 45.0during the week ending March 23rd. During the past twelveweeks of the current quarter the death-rate in the city hasaveraged 36’1 per 1000, against 264 in London and 31’1 inEdinburgh. The 302 deaths registered in Dublin during theweek under notice showed an increase of 18 upon thenumber in the previous week, and included 7 which werereferred to the principal zymotic diseases, against 14 and 9 inthe two preceding weeks; of these, 5 resulted from small-poxand 2 from " fever," but not one either from measles, scarletfever, diphtheria, whooping-cough, or diarrhoea. These7 deaths were equal to an annual rate of 1’0 per 1000,the zymotic death-rate during the same period being 1.4in London and 53 in Edinburgh. The fatal cases of small-pox.which had been 4,5, and in the three preceding weeks, were5last week. Since the commencement of the current year nofewer than 77 deaths from small-pox have been recorded inDublin. The 302 deaths registered in Dublin last week incladed39 of infants under one year of age and 102 of persons aged up’wards of sixty years ; the deaths both of infants and of eldely