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Public Health and Poor Law.LOCAL GOVERNMENT D E P A R T M E N T.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

King’s Norton Rural District.-This district had in 1885the low death-rate of 12’9 per 1000, the zymotic rate onlyreacheq 0’4, and the rate of deaths amongst infants underone year per 100 births was only 10’6. There was no deathfrom small-pox, and the vaccination returns show that of655 children due for vaccination only one remains outstand-ing. A few cases of diphtheria and of enteric fever occurred,and where these were associated with insanitary conditionsremedial action was taken. Many improvements have beeneffected since the last report in the drainage and water-supply, and further works are still in progress. The sanitaryhospital has well served its purpose of preventing thespread of disease, but it is only a temporary structure. The

night-soil removal is very properly not imposed on the in-habitants ; but being done by private contract, it is stillnot quite satisfactory. The disgusting practice of tippingthe refuse into the road and then shovelling it into cartsshould be put down with a strong hand, and the authorityhad better adopt the model bye-laws on the prevention ofnuisances which deal with this practice. But, on the whole,Mr. Hollinshead may be congratulated on the state of hisdistrict.

Swinton Urban District.-In this district scarlet feverbecame somewhat widely prevalent during the past year,and Mr. W. M. Jones points out how difficult it is to controlsuch a disease when the first cases are kept secret from thesanitary authority. The Local Board of Health, by offeringa fee for each case reported, afford an inducement to reportevery case; but yet this outbreak was allowed to get a firmhold on the affected locality without a single case beingreported. This failure of a voluntary system of notificationis by no means exceptional, and even the refusal of a singlepractitioner to comply with the wishes of the authority hasmore than once led to an entire break-down in the system.But in Swinton more is wanted than information as tospreading diseases-namely, some means for their isola-tion. When this is provided it will be time enough to callfor compulsion in the matter of notification. Drainageworks are still in progress, and the water-supply of thedistrict is excellent.

Todmorden Urbrcn District.-Mr. Charles Thorp recom-mends night scavenging. As to this we would suggestperusal of the model bye-law of the Local GovernmentBoard dealing with this subject, and of the comments on itin the annotated edition of the bye-laws. It is there pointedout that hitherto the construction of privies and receptaclesfor filth and refuse has very generally been such as to ensurerapid decomposition and consequent offensiveness of con-tents, and on this account it has been a frequent practiceto require such structures to be emptied at night. This is,however, precisely the time not only when the scavengersthemselves cannot see to do their work properly, but whenthey are least likely to be subjected to any proper super-vision. Hence needlessly offensive operations are likely to becarried out. It is also the only time when persons desirousof absenting themselves during the process of scavengingare practically unable to do so. So also the period of sleepis that during which the human system is least able toresist the influence likely to result from the inhalation ofnoxious effluvia. And further, the more the conditionsresulting from faulty structures are brought to light, themore likely are they to be remedied. For these and otherreasons, scavenging under cover of darkness should beavoided. The death-rate for the district in 1R85 was 17’3,and that from zymotic diseases 0’78, per 1000. The isolationhospital was useful in staying the spread of scarlet fever.

Towyn Urban District.-In a population of 3450, the death-rate for 1885 was 17.6 per 1000, which is not low for so smalla population. Dr. Grosholz reduces it to 16’8 by deducting thedeaths of prematurely born children; but obviously such areduction makes the statistics valueless for the purposes ofcomparison, unless the same reduction were made every-where else. No single case of sickness was heard of fromeither enteric fever or from diphtheria, but measles led tothe temporary closing of the elementary schools. A curious

epidemic of diarrhoea occurred in this district, beginning in

Towyn, then creeping up the Dysynni valley to Aber-ganolwyn, and finally expending itself in Aberdovey. Nosingle circumstance, such as water-supply &c., seems tohave been common to those affected, and these were in manyinstances adults. Such outbreaks call for very searchinginvestigation, but in this instance the actual cause was notmade out. Towyn stands in great need of a proper systemof sewerage and water-supply.Aston Urban District.-The death-rate for this district

has for some five years ranged from 12 to slightly over14 per 1000, and stands now at the latter figure; but the in-fantile deaths are not so satisfactory, amounting as they doto 14 per year of every hundred children born. Scarlatinaalone prevailed as an epidemic; and in this connexion it isnoteworthy that the opening of an excellent hospital forinfectious diseases has been one of the prominent featuresof the year. The sanitary authority have also determinedto make an effort to secure early information as to casesneeding isolation, by organising a system of voluntary noti-fication at a fee of half-a-crown per case reported. Improve-ments in water-supply, sewer-ventilation, and methods ofhouse-drainage are being effected, and the additional actionneeded to place the district in a satisfactory state is indicatedby Dr. Bostock Hill in his report. Diagrams are also appendedshowing a new ventilating manhole, and details as to house-drainage ; these cannot but be extremely useful to buildersand to the public generally.

Llanelly Rural District.—In reference to a prevalenceof scarlet fever, Dr. Raglan Thomas reports that in theBerwick hamlet much time was lost, by lack of information,in isolating the first attacks, and that the school authoritiesdid not for some months comply with the request to closecertain schools. It cannot be too widely known thatunder the revised Education Code the authorities of allschools coming within the provisions of that code have noalternative but to close schools on the instruction of thesanitary authority of the district, and also that, though appealmay be made to the Education Department, yet this doesnot enable the school officials to keep the schools openpending the appeal. The tabulated account of prevalentdisease, its causes, extent, and the resulting sanitary actionembodied in this report show that active work is main-tained in this district, which in 1885 had a mortality at therate of 15’33 per 1000. During the year, and with a view toany cholera emergency, a hospital hut was provided.

Taunton Urban and Rural Districts.-Considerable im-provement in the water-supply of the urban district waseffected during the year; but the private fittings, andnotably the cisterns, call for further attention. Thus,Dr. Alford says that drinking-water is even drawn directlyfrom a pipe discharging into the pan of a dirty closet.Closet supplies should always be drawn from separatecisterns, and if the service be a constant one no othercisterns are needed. The need for efficient ventilation andflushing of the town sewers has several times been com-mented on, especially in connexion with diphtheria, and wefear that even now the construction of the sewers remainsfaulty: if so, lodgment of contents is certain, and no venti-lation and flushing should be regarded as superseding thenecessity for reconstruction of such portions as are foundto be faulty. The death-rate for Taunton reached 23’6 per1000 during the past year, and the zymotic rate was no lessthan 3’7 per 1000. Fourteen deaths took place from small-pox, the disease prevailing in some dwellings built back-to-back in dark courts and alleys, with garbage, manure, filthypremises, and closets around; a state of things which needsthe active interference of the sanitary authority. Measles andscarlet fever also prevailed. It is evident that there stillremains ample scope for the labours of the energetic officerof health, who has already done much for Taunton. In therural district the death-rate was also very high, reaching asit did over 18 per 1000; and the zymotic rate, too, was noless than 2’6 per 1000-small-pox, measles, and diphtheriabeing main contributors to it. In a number of places inthis district there are old and imperfect sewers and drains,accompanied with stagnant and decomposing surface-slops.The water-supply also remains far from satisfactory, shallowwells being the rule, and these are often in most dangerousproximity to privies and piggeries The past history ofthese two districts in relation to diphtheria should have ledbefore this to more intelligent action, with a view toremedial measures being adopted on a wide and compre-hensive scale. Many nuisances are well looked after, goodadvice is given, and the sanitary hospital works well. But

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more than this is needed for the due protection of life andhealth.

Windsor Urban -Disti-ict.-Dr. Casey reports that thedeath-rate for this district during 1885 was 18’6 per 1000 ona population of 12,493, a fatal epidemic of measles havinghelped to increase the mortality. It is, however, satisfactoryto note that a single death from enteric fever was the onlyone that had taken place from that cause during a period offive years. In connexion with the work of the year it isstated that samples from eight wells were submitted foranalysis and condemned, and that twenty-four houses were,at the instance of the authority, furnished with a supplyfrom the mains. It is astounding to think of the ignoranceof the owners of "private" wells which are sunk in the soilof this ancient borough, honeycombed as it has been in thepast with cesspools leaking on all sides; but it remains afact that people in Windsor still draw their water from thesame source as that into which their ancestors poured theirfilth. Only two houses were closed during the year, andthe report dealing with this question points to the evilsconnected with leasehold tenure, a lessee being naturallymost unwilling to go to any expense in improving a pro-perty in which he will in a few years lose all interest. Thisis true, but leases can hardly be abolished, and sanitaryauthorities are constituted in order to see that personshaving a financial interest-however limited-in propertyshall not so use, and profit by, that property as to prejudicethe public health. --

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 6052 birth and 3862 deaths were registered during the week endingApril 3rd. The annual death-rate in these towns, whichhad been equal to 29’3 and 26’4 per 1000 in the precedingtwo weeks, further declined last week to 22.2. During thEthirteen weeks ending last Saturday the death-rate inthese towns averaged 24’4 per 1000, and precisely corre-

sponded with the mean rate in the thirteen correspondingweeks of the ten years 1876-85. The lowest rates inthese towns last week were 12’4 in Wolverhampton, 15-6 inSunderland, 15’9 in Norwich, and 18-8 in Hull. The ratesin the other towns ranged upwards to 27’9 in Plymouth,28’7 in Brighton, 28-8 in Bolton, and 31-4 in Blackburn. Thedeaths referred to the principal zymotic diseases in thetwenty-eight towns, which had been 430,427, and 406 in theprevious three weeks, further declined last week to 359; theyincluded 157 from whooping-cough, 97 from measles, 36 fromdiarrhoea, 30 from "fever" (principally enteric), 19 fromscarlet fever, 19 from diphtheria, and only 1 from small-pox. No death from any of these zymotic diseases wasrecorded last week in Norwich, Wolverhampton, or Hudders-field ; whereas they caused the highest death-rates in Bolton,Birmingham, and Blackburn. The greatest mortalityfrom whooping-cough occurred in Newcastle-upon-Tyne,London, Portsmouth, and Birkenhead; from measles inPortsmouth, Oldham, Birmingham, Plymouth, and Black-burn ; and from "fever" in Preston. The 19 deaths fromdiphtheria in the twenty-eight towns included 8 in London,2 in Bristol, and 2 in Manchester. Small-pox caused 1death in Liverpool, and not one in London and its outerring, or in any of the twenty-six other large Englishtowns. The number of small-pox patients in the metro-politan asylum hospitals situated in and around London,which had been 7 and 8 on the preceding two Saturdays,had further increased to 11 at the end of last week; 4 caseswere admitted to these hospitals during the week, against2 and 5 in the preceding two weeks. The deaths referredto diseases of the respiratory organs in London, which hadbeen 917 and 710 in the preceding two weeks, furtherdeclined last week to 506, and were 30 below the correctedweekly average. The causes of 83, or 2-2 per cent., of thedeaths in the twenty-eight towns last week were notcertified either by a registered medical practitioner or by acoroner. All the causes of death were duly certified inPortsmouth, Brighton, Leicester, Plymouth, Derby, andliuddersfield. The largest proportions of uncertified deathswere registered in Oldham, Sheffield, and Preston.

HEALTH OF SCOTCH TOWNS. The annual rate of mortality in the eight Scotch towns,

which had been equal to 27’9 and 24’7 per 1000 in the pre-

ceding two weeks, further declined to 21’6 in the weekending April 3rd, and was 0’6 below the mean rate duringthe same week in the twenty-eight English towns. The

. rates in the Scotch towns last week ranged from 11.5 and, 14’1 in Perth and Leith, to 22-5 in Paisley and 25-5 in

Glasgow. The 534 deaths in the eight towns showed afurther decline of 75 from the numbers returned in thepreceeding two weeks, and included 14 which were referredto whooping-cough, 11 to diarrhoea, 5 to "fever" (typhus,enteric, or simple), 5 to diphtheria, 4 to scarlet fever, 4 tomeasles, and 3 to small-pox; in all, 46 deaths resulted fromthese principal zymotic diseases, against 46 and 62 in thepreceding two weeks. These 46 deaths were equal to anannual rate of 1’9 per 1000, which was 0’2 below the meanrate from the same diseases in the twenty-eight Englishtowns. The fatal cases of whooping-cough, which hadbeen 20, 14, and 29 in the previous three weeks, declinedagain last week to 14, of which 12 occurred in Glas-gow. The 11 deaths attributed to diarrhoea correspondedwith the number in the previous week, but were 6above the number in the corresponding week of last year.The 5 deaths from "fever exceeded the number in the pre-vious week by 1, and included 2 in Edinburgh and 2 inPaisley. The deaths from diphtheria, which had been but 1in each of the previous two weeks, rose last week to 5, ofwhich 2 occurred in Aberdeen. The 4 fatal cases of scarletfever were returned in Glasgow, and the 4 of measles inEdinburgh. The 3 deaths referred to small-pox included2 in Leith and 1 (certified as chicken-pox) in Aberdeen. Thedeaths referred to acute diseases of the respiratory organsin the eight towns, which had been 204 and 148 in the pre-ceding two weeks, further declined last week to 134, butwere 4 above the number returned in the correspondingweek of last year. The causes of 80, or 15 per cent., of thedeaths in the eight Scotch towns last week were not certified.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been equalto 40’5 and 34-6 per 1000 in the preceding two weeks,further declined to 34’4 in the week ending April 3rd.During the thirteen weeks ending last Saturday the death-rate in the city averaged no less than 33’5 per 1000;the mean rate during the same period did not exceed 24’8in London and 20’0 in Edinburgh. The 233 deaths inDublin last week were within one of the number returnedin the previous week, and included 15 which were referredto the principal zymotic diseases, against 19, 13, and 18in the previous three weeks; 6 resulted from whooping-cough, 5 from "fever" (typhus, enteric, or simple), 3 fromscarlet fever, 1 from diarrhoea, and not one either from small-pox, measles, or diphtheria. These 15 deaths were equal toan annual rate of 2’2 per 1000, the rates from the samediseases being 2’3 in London and 1’4 in Edinburgh. The fatalcases of whooping-cough, which had been 6 and 12 in thepreceding two weeks, declined again last week to 6. Thedeaths referred to " fever," on the other hand, rose againto 5, from 6 and 1 in the previous two weeks. The 3 fatalcases of scarlet fever showed an increase upon recentweekly numbers. Two inquest cases and 3 deaths fromviolence were registered; and 74, or nearly a third of thedeaths, were recorded in public institutions. The deathsof infants were more numerous than in the previous week,whereas those of elderly persons showed a marked declinefrom recent weekly numbers. The causes of 39, or nearly17 per cent., of the deaths registered during the week werenot certified.

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THE SERVICES.

WAR OFFICE. - Coldstream Guards : Surgeon RobertHippisley Cox, Medical Staff, to be Surgeon, vice J. Magill,M.D., promoted.ARMY MEDICAL STAFF.-Surgeon-Major Hubert Roth-

well Greene, from the Seconded List, to be Surgeon-Major.The undermentioned Surgeons-Major are granted retired pay,with the honorary rank of Brigade Surgeon: Hubert Roth-well Greene, John Fitzgerald Brodie, Vivian Wearne.ADMIRALTY.-In accordance with the provisions of Her

Majesty’s Order in Council of April 1st, 1881, Fleet SurgeonWilliam Middleton Power has been placed on the RetiredList of his rank.

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The undermentioned surgeons have been promoted to the