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845 REPORTS OF MEDICAL INSPECTORS. person or persons paying the same. No directions whatever are given as to how the Roviil CtJl1eg of Surgeons are to apply these large funds, and the trustees of the will have no voice in the matter, as their duties will end with the paying over of the money. Public Health and Poor Law. LOCAL GOVERNMENT DEPARTMENT. REPORTS OF INSPECTORS OF THE MEDICAL DEPARTMENT OF THE LOCAL GOVERNMENT BOARD. Diphtheria and Fever in and about Dartford, by Mr. J. SPEAR.-The neighbourhood of Dartford is acquiring an unfavourable sanitary history. The rural sanitary district was inspected in 1879 by Dr. Thorne Thorne on account of a prevalence of diphtheria; the urban and rural districts were again inspected by Mr. Spear in 1882 on account of diph- theria in the rural and enteric fever in the urban areas, and now again the whole registration subdistrict of Dartford is reinspected by Mr. Spear in 1884. The enteric fever preva- lence in the urban district, previously reported on, was found to have ceased ; but on the other hand diphtheria had become more general and fatal in the whole subdistrict, and the urban district, which had previously escaped this dis- ease, was found to be implicated. So far as the sanitary circumstances of the urban district are concerned, the re- inspection resulted in ascertaining that a system of sewerage had been laid down, and that some commencement had been made in connecting houses with it, thus doing away with the ash-pits and privy-pits which had abounded there. So also there had been improvement in paving the stree’s and yards, and in enforcing the building bye-laws ; but on the other hand, the extension of the Kent Company’s water had been inadequate, and a large number of houses were still found to be dependent on supplies which are character- ised as not only defective, but as often dangerous. The state of the rural district remains, in several important respects, most unsatisfactory. Diphtheria is maintained. recurring at intervals ; and its reappearance is explained as affecting localities which have been previously in- vaded, and which still show many grave sanitary faults, such as lie within the power of a sanitary authority to remove. Such a statement, in an official report, throws a very serious responsibility on the authority, but the detailed descriptions which are given fully support the inference which is drawn. Botany Bay attracted attenticn in 1882 owing to the fatality from diphtheria and fever which it exhibited ; during 1883 there occurred amongst its 300 inhabitants 3 deaths from diphtheria, 2 from so-called croup, and three from scarlet fever. In close proximity to the houses the ground is beiog riddled with cesspools. The original ones remain, and as fast as they fill fresh ones are dug; but they are so dug that the contents may to the utmost possible extent soak away. The soil also contains drains, some of which have been choked for six months, and in the midst of such filthy contrivances are sunk the wells which supply the inhabitants, notwithstanding the fact that the Kent supply is available. The sanitary condition of other localities which have already been previously reported on has also undergone no improvement. In Mr. Spear’s last report he pointed out the generally defective character of the administration of the sanitary laws by the guardians, referring specially to their default in the abatement of ordinary nuisances. He also stated that the appointment of a single inspector of nuisances over an area of 35,000 acres and having a population of 20,000 was not calculated to ensure a proper performance of duty, especially as the officer in question was mainly engaged in other duties for the guardians. All remains just as it then did, and the only remedy seems to be for the inhabitants to make formal com- plaint to the Government under the Public Health Act. Diphtheria in the Chippenham Rural District, by Lr. BLAXALL.-In this report Dr. Blaxall in the first case gives an account of some cases of diphtheria which were ante- cedent to those with which this outbreak was concerned. The particulars of the cases given are instructive, as show- ing how diphtheria may unwittingly be spread, and as indi- eatiog also that the infection is capable of being transmitted hy persons who are not themselves affected. One other very important point transpires. Certain of the infected families occupied large farms supplying milk and cream to dairy companies, to whom the farmers have bound themselves under a heavy bond to report all cases of infectious disease occurring in or about their premises. But in these cases the actual character of the disease was not suspected, and hence no report could be made. The interests of the dairy cus- tomers could not therefore be protected, and the case affords another proof that in the boiling of all milk safety alone can be found. The epidemic more imme- diately considered took place at Lacock, where out of somewhat over 1100 people no less than 72 attacks and 8 deaths occurred, the outbreak dating from towards the end of November last. Thirty-eight of the cases were primary attacks in households, and of the>e 32 occurred in pupils of the Lacock school, who were in attendance there up to the dates of their respective attacks. Unwhole- some conditions do not appear to have been specially con- cerned with the causation and spread of the disease, acd the origin of the first case could not be precisely determined. But the affecdon once existing, personal communication between the sick and healthy was ample to account for the spread, and inquiry showed that after the school had been closed, its re-opening, on nearly every occasion, led to a flesh distribution of infection, some four or five children attending each time who were only just recovering from diphtheria. The village of Lacock needs numerous sanitary improve- ments as regards water-supply, means of closet accommoda- tion, sewerage and drainage, &c. But of all indications to which such an epidemic as this gives prominence, the most urgent is the need for a wider provision of small hospitals, which would enable sanitary authorities at once to isolate first cases of infectious disease, and to keep them under super- vision until they were really free from infection and fit to return to their homes and follow their usual avocations, whether these include school attendance or net. Such small hospitals in rural districts would save many lives, and would also prevent our system of compulsory education trom acting as an indirect means of spreadmg disease. REPORTS OF MEDICAL OFFICERS OF HEALTH. Hull (Urban).-The borough of Hull had, in 1883, a birth-rate of 36’0 and a death-rate of 22-5 prr 1000, on an estimated population of 176,296. The infant mortality was high. In the large towns of England the deaths under one year average 156 per 1000 births, but in Hull they reach 183. The great epidemic of scarlet fever from which Hull has suffered since 1881 has now practically subsided; the deaths from this cause during the year having fallen to 74. In dealing with the subject of infantile diarrhoea, Dr. Mason shows from the Hull records during the past fifteen years that the highest mortality occurs in the first or second week of August, the suddenness of the outburst being related to high temperature and low rainfall. In his opinion the origin and pathology of this disease point to a particular germ requiring a certain temperature for its development and pro- pagation, and expending its virulence upon the intestines and lungs. He has not iníreqmntly found amongst children that have died of diarrhoea, a pneumonia secondary to the diar- rbae>1, and his investigations are now being directed in tracing the relationship between the two diseases. The prevalence of cholera in Egypt led to some action towards procuring a hospital for the purposes of the port, but the proceedings have unfortunately fallen through, both as re- gards the purchase of an old Admiralty vessel and as to acquiring a site on shore. Taunton Urban District.-In so far as the death-rate is concerned Taunton has improved, although a rate of 21’5 per 1000 is by no means a small one for a borough of less than 17,000 people. The efforts to secure an improved water-supply have temporarily failed, owing to geological difficulties, but renewed efforts are being made in this direc- tion. Thesystemofsewerageremainsdefective, much more effi- cient means both of ventilation and of flushing being especially needed. Diphtheria, which has long hung about Taunton and its neighbourhood, was less last year, but the immediate isolation of first attacks and suspicious cases of sore-throat is still needed. Enteric fever was somewhat in excess in 1883, and it was largely dependent on the use of polluted well water, together with conditions favourable to the admission of sewer air into dwellings. The sanitary hospital received 72 patients, and the establishment is reported by Dr. Alford
