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affairs in that the number of members entered on the booksduring the year exhibits an increase over that of any previousyear. The dispensary appears to be doing good work uponlines that should benefit the poor without cheating themedical man. 0 si sic omnes! ! Of E3244 spent £80 wasplaced to the credit of the Reserve Fund, E406 was spent onDrugs and Instruments, £116 on Domestic and Establishment- charges, Z187 on Rents, and E224 on Official Salaries..E1536were paid to the Medical Officers (not including E293 asConfinement Fees) and E563 to the Dispensers. We havedisregarded shillings and sundry small items in this abstractfrom the receipt and expenditure account for the year. Therules for benefit members only recognise two classes ofbeneficiaries-a class whose average weekly income is under30s. and a class whose average weekly income is under 50s.-so that in a manner a wage-limit is imposed. All contribu-tions to the funds of the institution derived from weeklypayments are distributed annually among the medical officersafter the current expenses have been defrayed and thesecurrent charges form, in our opinion, but a moderate per-centage of the expenditure.

THE MANCHESTER AND SALFORD UNITED FRIENDLYSOCIETIES’ COUNCIL.

This body, which met recently in Manchester, wouldseem to possess among its component delegates gentlemenwho do not share the views of Dr. Baddeley as to theremuneration of the medical officers of medical aid societiesand we are certain that to work under these persons wouldbe a very different thing for a practitioner from workingwith Canon Erskine Clarke and his committee. BrotherJ. B. Hargreaves, a Rechabite, maintained, we learn fromthe Manchester Courier, that the medical officers were wellpaid and that "the friendly societies had greyly assistedthem to build up their practices," forgetting that the

resignations of medical officers as soon as they can getsomething better to do can hardly be adduced as proofsof the enjoyable nature of the appointment given up.Brother Matley said, in contradiction of Mr. Hargreaves’sassertion that the medical officers were well paid, that I hisdoctor remarked to him that the fees naid did not exactlypay him, but the money was sure." Brother Pedder sug-gested that the term medical service should be substitutedfor medical aid, as he considered that medical men were’paid for the services they rendered and "if they said not,let them advance their reasons." We refer Mr. Pedder toDr. Baddeley’s article as well as to many articles in our owncolumns. He need not remain in ignorance of the legitimateobjections of the medical profession to medical aid associa-tions one minute longer than he chooses.

Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL INSPECTORS OF THE LOCALGOVERNMENT BOARD.

Upon an Outbreak of Enteric Fever at Wadebridge, in theRural District of St. Columb Major; upon the Sanitary Condi.tion of the Place; and upon Administration by the St. ColumbM60or -Rural District Council, by Dr. G. S. BUCHANAN.1-Wadebridge is a small town on the River Camel, somesix miles above its mouth at Padstow on the north coast ofCornwall. In the autumn of 1897 this town, which withthe village of Egloshayle on the opposite side of the Camelhas a population of about 2000, suffered heavily from entericfever. No fewer than fifty cases and nine deaths occurredin Wadebridge and Egloshayle, while elsewhere severalcases, some of which were fatal, appear to have beendue to infection contracted in Wadebridge. The severityof the outbreak was still more manifest when the distribu-tion of the houses invaded by fever came to be studied.Dr. Buchanan found as a result of house-to-house inquirythat in a locality in Wadebridge which he terms the"Trevanson-street area," comprising a group of thirty-sevendwellings, fever had occurred in as many as twenty-two,whereas in the rest of Wadebridge and Egloshayle only eleven

1 London : Eyre and Spottiswoode, East Harding-street, B.C.; JohnMenzies and Co., Edinburgh and Glasgow ; Hodges, Figgis, and Co.,Dublin. 1898. Price 9d.

out of some 480 dwellings had been invaded. The distribu.tion of these dwellings and the number of cases in each areillustrated in a map which accompanies the report. Dr.Buchanan attributes this heavy incidence of fever within"Trevanson-street area" to specific contamination of theground water which is drawn from the four wells situateclose to one another within this area. The principal reasonsfor this conclusion were three. Firstly, there was negativeevidence which tended to exclude any wholesale operationof agencies of infection other than water, and on theother hand there was positive evidence that the area ofsupply of these four wells coincided with the area severelyaffected. Secondly, in all but four instances each of thefifty persons attacked was ascertained either to have beenliving within the Trevanson-street area or to have drunkwater from one or other of the Trevanson-street group ofwells at the date or dates on which infection was presumablycontracted. Thirdly, within the Trevanson-street area

only fifteen houses escaped fever. Of these, the inhabitantsin three instances were old people who might be consideredunlikely to contract the disease ; the occupants of other twodwellings always boiled their water ; while in seven otherdwellings which escaped the occupiers had obtained alldrinking-water from wells outside Trevanson-street area alto-gether. The opportunities of contamination of water sup-plied by these four wells seem to have been numerous.

Dr. Buchanan shows that infection of this water shortlyantecedent to and during the first weeks of the outbreak maywell have been occasioned by direct soakage of sewage froma rubble drain which passes near each of the wells and whichduring this period was receiving infectious matters froma water-closet in a house where one of the earliestcases of fever occurred. And in any case, it wouldappear, the soil which is drained by these wells was so

bafouled that the enteric fever organism, once introduced,must needs have found abundant opportunities of multiply-ing therein.The history of the sanitary administration of Wade-

bridge by the local authority of the place, the St. ColumbMajor rural district council, is one of gross neglect.From the facts given in this report it seems open to doubtwhether this district council performs any sanitary dutieswhatever. In this district there is no notification ofinfectious diseases, there is no isolation hospital, there areno by-laws and no adoptive acts are in force. In the case

of Wadebridge, which there appears no reason to considerthe only part of the St. Columb district in which sanitarymatters are neglected, there is no public water supply, not-withstanding the known unwholesomeness of nearly everywell in the town; the sewers are mere rubble drainssoaking into the rock wherein the wells of the place are

sunk ; and there is no system of public scavenging.All these and other unwholesome conditions have beenallowed to persist despite the repeated advice of an ablemedical officer of health and despite numerous representa-tions made for years by the Local Government Boardand by the Cornwall County Council. A conspicuousinstance of indifference to the public health of thedistrict is afforded by the refusal of this council toentertain the question of giving Wadebridge a wholesomepublic water-service even when residents in the town hadbeen to the trouble and expense of drawing up a detailedscheme for such a supply and of obtaining expert opinionupon its purity and sufficiency. Fortunately for Wadebridgeit appears likely that this town, in combination with theadjacent village of Egloshayle, will shortly become a

separate urban district and its inhabitants will then have anopportunity of inaugurating the extensive series of sanitaryworks which the neglect of the present authority has madenecessary. That the new council should select the best menavailable to fill the offices of medical officer of health,surveyor, and inspector of nuisances " seems very essential.It would be surprising if Wadebridge ratepayers did notresent the loss of the money which in the past has beengiven to the St. Columb Major rural district council underthe name of "sanitary rate." Nevertheless, when they havethe sanitary administration of the town in their own handswe may hope that they will not be found to grudge theexpense of securing for their district that wholesomenesswhich at present it so conspicuously lacks.

REPORTS OF MEDICAL OFFICERS OF HEAL H.

Chesterfield Urban District.-This district, which possesses,according to a recent School Board census, a population

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of 24,493, yielded during 1897 an infantile mortality of noless than 220 per 1000 births, a result due in the main todiarrhoeal diseases. But this heavy death-toll has not beenwithout its redeeming features, as it seems that the spiritof philanthropy has been instrumental in providing a ladyadviser, as she may not inaptly be termed, whose duty it is tovisit all houses in which births have taken place and there togive advice on infant feeding and on domestic hygiene.Dr. Meredith Richards, in referring to this matter, observesthat while ignorance and foolishness are rampant there islittle evidence of wilful neglect. There were 59 cases, with 10deaths, of enteric fever during 1897, and although suspicionattached in one case to shellfish from Cleethorpes and inanother to mussels Dr. Richards regards the pollution ofthe soil by privy-middens and personal infection as themost probable causes of this prevalence of the disease inChesterfield. One case of enteric fever to which referenceis made illustrates well what obvious limitations theremust be to the information to be derived from notification.A patient presenting apparently some ill-defined symptomsdeveloped general peritonitis, and on a post-mortem examina-tion being made it was clear that the man in question hadbeen suffering from enteric fever for some three weekspreviously. He had been working up to within ten daysof his death and he only took to his bed on the day pre-ceding this event. Had this man not had perforationit is not improbable that the fact of his having sufferedfrom enteric fever would have escaped notice. Surelyin our etiological investigations we must leave a marginfor the undiscovered and we must not allow ourselves tobelieve that a spot map of the notified cases tells us all thestory. Another instance of the relative value of notificationas it is at present carried out is furnished in Dr. Richards’sreport. Through the agency of the school attendanceofficer the medical officer of health was made aware of 64absentees, and, on visiting these, 25 cases of scarlet feverwere discovered. Probably but few of these cases would havebeen notified through the ordinary channels. We may refer,too, to certain cases of diphtheria as teaching a somewhatsimilar lesson. Two cases of this disease occurred amongthe infants attending a certain class in one of the schools.Dr. Richards forthwith examined the throats of all thechildren in this class ; three children had slightly abnormalthroats, but none of them complained of indisposition. Asa result of bacteriological examination diphtheria bacilliwere found in one of the throats, and the child beingexcluded from the class no further cases occurred. It wouldhave been interesting could all the throats have beenexamined, as it is not unlikely that the bacillus would havebeen found in throats other than those presenting a slightlyabnormal appearance. It is true, however, as Dr. Richardsobserves, that bacteriological examination is of the greatestvalue in circumstances such as these where children havebeen exposed to the risks of specific infection.

Cardiff Urban District.-Dr. Edward Walford has recentlypresented to his sanitary authority a concise report on theuse of antiseptics in food, with reference more particularlyto boric acid. After briefly discussing the powers conferredby the Sale of Food and Drugs Act and the difficultiesencountered in its application, Dr. Walford points out that asmuch as from 15 to 30 grains of this drug may be consumedper diem by a bottle-fed baby if it is true, as is alleged, thata solution of 1 in 1000 of boric acid is required to keep milksweet for forty hours ; and this amount is, as he observes,much in excess of the maximum dose for infants. Dr. Walfordalso quotes Mr. C. E. Cassal, F.I.C., to the effect that aninfant taking a quart of milk per diem may absorb as muchas 28 grains of boric acid, and it is in connexion with infantsthat Dr. Walford sees the greatest risk from the use of anti-septics in food, the infant being as it were continuouslydosed with by no means minute quantities of the preparation,whatever it may be. In the compilation of the report undernotice much use has been made of ’’ THE LANCET SpecialCommission on the Use of Antiseptics in Food," whichappeared in our issue of Jan. 2nd, 1897; but the author hasalso addressed a circular letter to the medical officers ofhealth and the clerks of the thirty-three large towns, with aview to ascertaining what action other sanitary authoritieshave taken. Oat of ninety replies which Dr. Walford hasreceived only three state that proceedings have been taken.Two convictions were obtained at Birmingham in caseswhere there were respectively no less than 60 and 65 grains iof boric acid per gallon of milk, and the Monmouthshire and Glamorgansbire County Councils have also instituted pro-ceedings. As was shoiwn in our Special Commission there,

is a scarcity of evidence as to the precise effects upon;health of boric acid in food, but it is by no means unlikelythat this absence of evidence is due in no small degree to thefact that the subject has not in the past received adequateattention ; and it may be observed that according to the-Select Committee of the House of Commons, which reportedupon this subject in 1896, the sale of articles to which anti-septics have been added is prohibited in France, Germany,.Italy, Spain, Brazil, and the Argentine Republic. Whether’the example of these countries should or should not befollowed in its entirety, there would appear to be a nearlyunanimous opinion that when antiseptics are used the nature.and amount of such substances should be distinctly setforth by the vendor and there should be little difficulty incarrying this opinion into effect. It appears to us that theMedical Department of the Local Government Board might,usefully make this subject a matter for one of their scientificinvestigations.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN thirty-three of the largest English towns 6568 birthsand 4500 deaths were registered during the week endingFeb. 26th. The annual rate of mortality in these towns, whichhad been 20-7 and 20-4 per 1000 in the two preceding weeks,rose again last week to 20 9. In London the rate was 21.9

per 1000, while it averaged 20.3 in the thirty-two provincialtowns. The lowest rates in these towns were 12 6 in,

Croydon, 12.9 in Derby, 14 5 in Bradford, and 15-8 inOldham; the highest rates were 24’7 in Liverpool, 25-1 inGateshead, 26-0 in Bolton, and 302 in WolverhamptonThe 4500 deaths included 504 which were referred tothe principal zymotic diseases, against 497 and 464 inthe two preceding weeks ; of these, 217 resulted frommeasles, 112 from whooping-cough, 69 from diphtheria, 38from "fever" (principally enteric), 34 from scarlet fever,and 34 from diarrhoea,. No death from any of these diseaseswas recorded last week in Plymouth; in the other town&.

they caused the lowest death-rates in Portsmouth, Preston,Norwich, and Halifax, and the highest rates in Gateshead,Birkenhead, Bristol, and Leicester. The greatest mortalityfrom measles occurred in London, Wolverhampton, Brighton;,Birkenhead, Bristol, and Leicester; and from whooping-cough in Newcastle-upon-Tyne, Bolton and Gateshead.The mortality from scarlet fever and from "fever" " showedno marked excess in any of the large towns. The 69 deathsfrom diphtheria included 46 in London, 5 in Cardiff, and 3 inLiverpool. No fatal case of small-pox was registered duringlast week either in London or in any other of the thirty--three large towns; and no small-pox patients were undertreatment in any of the Metropolitan Asylum Hospitals. The.number of scarlet fever patients in these hospitals and inthe London Fever Hospital at the end of last week was2674, against 2964, 2871, and 2781 on the three precedingSaturdays ; 199 new cases were admitted during the week,against 209, 232, and 233 in the three preceding weeks.The deaths referred to diseases of the respiratory organsin London, which had been 468 and 438 in the two precedingweeks, further declined to 416 last week, and were 124.below the corrected average. The causes of 52, or 1°6 percent., of the deaths in the thirty - three towns were

not certified either by a registered medical practitioner orby a coroner. All the causes of death were duly certifiedin Portsmouth, Leicester, Bradford, Leeds, and in ten othersmaller towns ; the largest proportions of uncertified deathswere registered in Birmingham, Liverpool, Haddersfield, andNewcastle-upon-Tyne. -

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had increased in the four preceding weeks from 17 °4to 20’4 per 1000, further rose to 20 5 during the week end-ing Feb. 28th, but was slightly below the mean rate duringthe same period in the thirty-three large English towns.The rates in the eight Scotch towns ranged from 14 5 inGreenock and 17 4 in Dundee to 30 3 in Paisley and 37 4 inPerth. The 619 deaths in these towns included 20 whichwere referred to whooping-cough, 17 to diarrhoea, 16 tomeasles, 10 to scarlet fever, 6 to "fever," and 3 to diphtheria.In all, 72 deaths resulted from these principal zymoticdiseases, against 72 and 90 in the two preceding weeks.These 72 deaths were equal to an annual rate of