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been several cases of typhoid fever, I looked into a house fwhere one of the inhabitants had recently recovered from tthis disease. This house was exceptionally clean; everything jwas tidy, bright, and well kept; the yard also was well swept, but here was an ashpit and privy combined and ialso an open untrapped drain which discharged sewer air 1within seven feet of the bottom of the bed where the person who had suffered from typhoid fever was in 1

the habit of sleeping. Then, immediately behind thewall of the yard there is a large dairy and piggeryfrom whence bad odours were wafted into the house. Itwas no easy matter to gain access to this dairy nor could Iwonder at the care with which the doors were locked con-sidering the state of things which was revealed when once Igot inside. At the time of my visit there were no less thanthirty-two cows kept in this yard. Right against the wallwhich separated the small backyard of the house wherethere had been a case of typhoid fever, a gigantic manure-heap rose to a height of about seven feet. Of course, thepart that rested against the wall was the highest. In lengththe dungheap must have measured some thirty feetand fifteen feet in width, and it extended to the wall of theyards of other houses besides the one mentioned. Againstthese yard walls there was also a shed where nine pigs andsome cows were kept together. One cow standing aside in acorner was ill and had bandages round its leg. In asmall separate shed, in another part of the yard, Iheard a cow moaning piteously. Looking through an

opening between the boards that formed the side of thisshed I saw a copious suppuration coming from the cow’seye. In the other sheds the cows were so closely packedthat they could not lie down without touching eachother. No spot in these sheds or in the yard was freefrom the actual presence of manure or the splashings ofmanure. It would be impossible for any person to keephimself clean in such a place and no attendant in thisyard could be in a fit condition to milk cows or to touchmilk cans. Milk ought not to be allowed to remain

anywhere near such overcrowded and badly kept cattle-sheds, yet this is where the cows are milked and the milk-cans washed. For this latter purpose there is in about thecentre of the yard a stone trough poised over liquid manureand within two or three feet of a grid which leads down tothe sewer. The ground worn away all round this grid has beenso hollowed out as to form a sort of moat always full of liquidmanure. This entrance to the drain is untrapped and it doesnot drain the yard propeily because it is higher than a part of the surrounding ground. On the other hand, it dischargessewer air upon the water trough. In consequence of thestagnation of manure there was a very pungent smell ofammonia. The yard has neither cement nor concrete. Thereis nothing to prevent the manure sinkirg into and foulingthe subsoil. No wonder that there were several cases oftyphoid fever in the street that runs behind this yard.The condition of the ashpits and privies combined is in

some of the houses most revolting. It sometimes happensthat they are quite unapproachable and it is scarcelysurprising that the inhabitants prefer to soil their back yardsthan to venture into their privies. It often also happens thatthe open and unprotected privy is immediately outside andunder a bedroom window. The drains which carry away therain-water from the back yards are sometimes untrapped andthus simply ventilate the sewer into this confined space andthis within a few feet of the windows. Many of the housesare in a dilapidated condition, and I noticed that some weretied up with iron stays to prevent them from falling intothe streets.

In the North Queen-street district I came across yetanother dairy which was combined with a bakery.. Passingthrough the baker’s shop and entering the yard behindthe first object that attracted my attention was a bigwooden cask or tub full of water. This water came directfrom the main and should therefore be clean, but the caskwas so placed that it must also receive rain-water from atemporary zinc roof placed over a cowshed. Further, thiswater, being uncovered, could absorb the effluvia given off bythe surrounding manure and by the drain which an inefficientbell-trap failed to intercept. , A part of the yard was onlyrendered accessible by planks of wood, such was its sloppycondition. The bakery faced a cowshed. A cat from thestables was playing among the flour. At the end of thiscompartment was the oven. Behind the oven, but placedright against the wall of the oven, stands the water-closet.This closet is so badly jointed that the water comes out

from under the pan each time that it is flushed and saturatesthe subsoil under, and the wall of, the baking oven. This

juxtaposition of a leaking closet and of bread-baking is, tosay the least of it, not appetising ; but within a few feet ofthe oven there are cows and the mess cows make, and aboveboth the bakery and the cows there are some bedrooms. Insuch cramped premises as these it is impossible to preventthe efliuvia from the cowsheds entering the bakehouse, tosay nothing of the water from the leaking closet which isheated and evaporated by the baking oven.A private house in this neighbourhood rented at 4s. a week

was pointed out to me because its inmates had suffered agood deal of sickness, scarlet fever, measles, &c. Here, inthe back yard, measuring about 10 ft. by 5 ft., I foundthat the privy was only separated from the scullery by awall four and a half inches thick and that it stood nineinches higher than the scullery floor. By the privy andforming part of it was an open asbpit full of disgustingfilth. The rain keeps this filth in a constant state ofmoisture, so that the excremental matter percolates throughthe rotting wall of the scullery, and yet against thiswall there are shelves where cooking utensils are

placed. On the mornicg of my visit some potatoes, readypeeled for cooking, were piled up against that part of thewall which was permeated with the moisture from the privy.When it rains the amount of water coming through the wallfrom the privy and into the scullery is much greater, and thescullery is only separated from the living-room by a doorwhich generally remains open.

(To be continued.)

MANCHESTER.(FROM OUR OWN CORRESPONDENT.)

Manchester Royal Infirmary.THE annual meeting of the Manchester Royal Infirmary

was held on the 12th inst. The chairman of the board ofmanagement, Mr. E. S. Heywood, was able to report that" financially the infirmary was quite sound," and the con-valescent hospital and the Cheadle asylum, its two greatdependencies, were in a satisfactory condition. At the lattertwo new wings have been completed and further extensionswill shortly have to be made. He paid a touching tribute tothe memory of the late Professor Lund and spoke of theproposed scheme for the sale of a large portion of the landround the infirmary and the building of another hospital asrequiring the sanction of the corporation and likewiseof the trustees. This scheme, which has not been reallylaid before the medical staff, is disapproved by someof its members, and Dr. Harris moved an amendment tothe report so far as the proposed scheme is concerned. OnJan. llth, 1897, it was decided by the trustees to rebuild theinfirmary on the present site and this decision has not beenrescinded. Nothing, however, has been done in face of thedetermined opposition cf the corporation. If the suggestedscheme is adopted the infirmary, Dr. Harris said, wouldretain a portion of land too small to provide the wholeaccommodation required for patients but yet too largefor the requirements of an emergency, accident, and out-patient hospital. "If they decided to go elsewhere for themain portion of the hospital, they ought," he said, " as

trustees, to sell the whole of the site and with themoney so obtained build and endow the new hospital else-where." He also spoke of the pavilion and block systems forhospitals and was satisfied that the former was "an ideal ofpre-antiseptic days " and that a non-pavilion hospital couldgive all the requirements wanted and be perfectly sanitary.Mr. G. A. Wright seconded the amendment, which wassupported by Mr. Hardie, who has given much attentionto hospital construction. The long discussion that tookplace shows that there is much difference of opinion as towhat ought to be done and in the end Dr. Harris withdrewhis amendment as it was agreed to add a sentence to thereport to the effect that the scheme would be submittedto a special meeting of the trustees as soon as possible.Letters appeared in yesterday’s papers from Dr. Leech andDr. Judson Bury taking exception to the action of Dr.Harris in moving his amendment without consulting themedical board and also criticising his views. So the matterstands for the present. In mv opinion it would be better to

541

sell the whole ot tne site and build elsewnere on a plot largeenough for a pavilion hospital if that is thought best-and itcertainly gives more light, easier ventilation, and spreads the sick and injured over a larger area than the block plan-both in the interests of the city and of the infirmary. Thescheme of the "sixes," the name given to the joint com-mittee of the corporation and the infirmary board, is an

objectionable compromise that would spoil the finest site inthe city, leave the present infirmary cramped within itsnarrowest bounds, too large and yet too small-a shabbymonument of an incomplete and unsatisfactory scheme,wasteful of the money both of the corporation and the

infirmary, wasteful as to administration, and wasteful of thetime and energies both of students and of hospital staff.

The Position of a Medical Officer of Health.A case was decided at the Manchester Assizes on the

llth inst. by Mr. Justice Bruce which has some interest tomedical officers of health. An action was brought by abutcher against the corporation of Rochdale for damages onaccount of trespass by the medical officer of health for theborough and a meat inspector, who condemned some meatthe plaintiff had exposed as unfit for food and ordered it tobe destroyed, the case not being taken before the justices.There was the usual discrepancy of evidence, the plaintiffand various experts saying it was good against the opinionof the medical officer, the inspector, and a veterinary sur-geon. The medical officer stated that the case was not takenbefore the justices as he wished to do the plaintiff as littleinjury as possible and that the latter consented to itsremoval and destruction. Counsel for the corporationsubmitted that the medical officer was not a servant ofthe corporatior, the appointment being compulsory underthe Public Health Act, and that the corporation werenot liable therefore for what he did. The jury foundfor the plaintiff and gave him £50 damages, subject to thedecision of the point of law. The question raised sub-sequently came on for argument and the judge now gave hisdecision. He said that neither under the local Acts in forceat Rochdale nor under the Pablic Health Act, 1875, hadeither of the officers in question any authority to destroymeat without an order of the justices, and the questionarose as to whether the corporation was liable for theacts of the officers. In the resolution of the corpora-tion appointing the medical officer of health it was statedthat in any case which he might think desirable heshould himself inspect any animal or meat exposedfor sale which was deemed to be diseased or unsound.If he found such was the case he could give instruc-tions for the animal or the meat to be destroyed. The

power to appoint the medical officer was vested in the

corporation, who were authorised to fix and pay his salaryand who had conferred upon them power of removal. Sofar as he had ascertained there was no reservation of those

powers, and the appointment was in that respect unlike thepower conferred by the Public Health Act in cases wherethe salary of the medical officer was paid partly out of moneyvoted by,Parliament and where the power to appoint andremove was subject to the control of the Local GovernmentBoard." He thought that in this case the medical officer,and of course the inspector, must be regarded as theservants of the corporation. He considered that themedical officer was acting within the scope of hisduties, and though he had neglected to take the propersteps-as to bringing the case before the justices-" theirregularity was in the course and manner of doing some-thing they were authorised to do." Judgment was givenfor the plaintiff. There seems to have been no doubtof the accuracy of the view held by Dr. Henry, who has hadeighteen years’ experience as medical officer of health forRochdale, as to the condition of the meat, but the moral maybe drawn that it is not well to give the vendor the option ofgoing before a justice or of having the meat destroyedwithout that proceedirg in order to shield him fromexposure.

Deat7i from Lead Poisoning.On the llth inst. Mr. Smelt, the city coroner, held an

inquest on the body of a man, aged forty-seven years, whohad worked as a glass-cutter for a firm in Ancoats. It seemsthat some time ago he showed symptoms of lead poisoningand was advised to take ceitain precautions. He was ill butwent to his work on the 5th inst., became worse and wasremoved to the Ancoats Hospital, but after receiving attentionthere was taken home and died on the 6’ih inst. His wotk

irictuded putting the finisbing polish on glass with puttypowder which contains lead. A certificate of death fromepilepsy bad been given by a medical man and the factoryinspector had only accidentally learned that he bad leadpoisoning, to which Dr. Reynolds stated his death was due.The coroner said that the certificate given to a certainextent was incorrect, as it eid not suggest that lead poisoninghad brought on the epilepsy or had anything to do with thedeath. " He hoped that medical men would be more carefulin such cases, so as to obviate the risk of deaths of thisnature being passed over without inquiry."

The late Professor Lund.In the appreciative sketch of the career of the late

Professor Lund which appeared in THE LANCET of Feb. 12thit is noted that his funeral was largely attended. It mayperhaps be allowable to say that there was evidenced aspecial desire to show respect to his memory on the part ofthe governing body of the infirmary where his chief surgicalwork was done and where his demonstraticns in the earlydays of antiseptic surgery did so much to forward itsprogress, by his colleagues on the staff of the infirmary, bythe Owens College and the various hospitals and societies ofManchester and Salford, and by many of the practitioners ofthe large district in which he was known and respected.

Feb. 15th.

SCOTLAND.

(FROM OUR OWN CORRESPONDENTS.)

Professor Sir W. T. Gairdner on the Prevention of Disease.THE Senate of the University of Glasgow, following the

precedent of former years, has again during the presentsession arranged a series of lectures open to the public, andit was as a contributor to this series that Professor SirWilliam Gairdner addressed a large audience on the 14th inst.on the Prevention of Disease. At the commencement of hislecture he reminded his audience that for ten years he hadbeen medical officer of health for the city and expressedhis belief that no one could adequately teach curative-medicine without a knowledge of preventive medicine.The prevention of disease was no doubt in one sense

included in the subject of public health, but it was

also in a special sense within the department of a professorof medicine, because the prevention of disease in the family,in the individual, and among groups of individual personswas as much a part of the duty of the practitioner as wasthe cure of disease when this actually existed. The closeassociation between prevention and cure was conspicuouslyillustrated by such a disease as scurvy, and this furtheremphasised the importance of the investigation of thecauses of diseases, a lesson which was also pressed homeby the great cholera epidemic of 1832. Sir WilliamGairdner spoke in high terms of the work of suchsanitary reformers as Sir Edwin Chadwick, Lord Shaftes-bury, Lord Playfair, and Dr. Southwood Smith, whoinitiated the great movement for improving the health oftowns. He considered, however, that the first applicationof the clear light of science to the history of epidemic orother diseases was the invention of the mode of expressingthe death-rate by the late Dr. Farr, which furnished anaccurate foundation upon which the relative freedom fromdisease of different places may be calculated on the basis ofthe incidence of the deaths in the different places. Dr. Farrfound that there were only three districts in England inwhich the death-rate was as low as 15 per 1000; that infourteen it was 16 per 1000 ; and that in forty-seven it was17 per 1000. He therefore found that to get a sufficientlybroad basis for his statement he must take 17 per 1000.As showing the improvement that had taken placeSir William Gairdner mentioned the fact that Dr. Tatham,the present head of the Statistical Department, hadfound that he could operate with a death-rate of 15 per1000, and that one-sixth of the population of Englandin 263 districts had a death-rate below 15 per 1000 inthe period 1881-90, and that fully a quarter of the popu-lation was below the standard of Dr. Farr. With regardto the reduction of the death-rate in Glasgow Sir WilliamGairdner referred his audience to Dr. Russell’s admirablebook on "The Evolution of the Function of the PublicHealth Administration," and remarked that whereas inhis own day the death-rate reached as a rule 30 per 1000