581LOOKING BACK.-PUBLIC HEALTH.

being described simply as a wife or widow, with mention ofher husband’s occupation but without mention of her own.

In making preparations for the present supplement it wasdecided to make another attempt to investigate the questionof female occupational mortality. But although much labourhas been devoted to the subject, including the critical exa-mination of the particulars of more than half a millionfemale deaths, the attempt has again proved fruitless, mainlyfor the reasons above alluded to. It is hoped, however, thatthe instructions under which the registrars now work willproduce more trustworthy records of occupation, and that itwill be possible in 1910-12 to produce more accurate statisticsas to female occupational mortality than has been possibleon the present occasion.

Looking Back.FROM

THE LANCET, SATURDAY, August 21st, 1830.

Edaabzcrgh Medical and 816’l’gwal Journal.. (Concluded.)

The following notice is so extremely interesting that weshall fquote it at length; it exemplifies admirably thevaluable assistance which chemistry affords in the develop-ment of medico-legal investigations. Had the accidentoccurred before Orfila reduced toxicology to a science, it ismore than probable, that the unfortunate pastrycook wouldhave been condemned as a felon and sent to the guillotine.The statement of the case and the chemical evidence are

worthy of the deepest consideration, and afford to themedical world a practical lesson of the most valuable kind.ON THE POISONOUS EFFECTS OF CERTAIN SPOILED ARTICLES

OF FOOD.

IT is well known that certain articles of food have been

frequently observed on the Continent to acquire poisonousqualities of a peculiar kind, and in a way which chemists andphysicians have not hitherto been able to explain very satis-factorily. Among these articles the most frequent are apeculiar variety of sausage, and a particular kind of cheeseused in Germany ; but both in France and Germany, baconand ham have been also several times found to acquirepoisonous qualities analogous to those which characterisethe sausage-poison and cheese-poison. A very elaborate

inquiry into an accident supposed to have arisen from spoiledham has just been published by M. Ollivier in the ArchivesGénérales de Medecine. His investigations set completelyat rest the common notion that such cases arise from theaccidental impregnation of the meat with metallic poisons ;but he has not succeeded in discovering the real cause.

In the instance which gave rise to his investigation, themaster of a family purchased a ham-pie at a pastry-cook’sin Paris, and the whole family ate the meat of the pie thesame day, and the crust on the following day. Threehours after dinner the master of the house was seized with

general uneasiness, followed by cold sweats, shivering,violent pain in the stomach, and frequent vomiting ; thenwith burning thirst, extreme tenderness of the belly, so thatthe weight of the bed-clothes could scarcely be borne, pro-fuse purging, and colic of extreme violence. His daughter,twenty-seven years of age, and a child nine years old, weresimilarly attacked. A physician, who was called to theirassistance soon after they were taken ill, drew up a minntereport of the symptoms in each of his patients, and declaredthat they had a violent inflammation of the stomach, whichhe was inclined to ascribe to natural verdigris, or the carbon-ate of copper having been communicated by the pastry-cook’smoulds. In a few days all the three individuals recoveredtinder an antiphlogistic treatment. About the same periodseveral accidents of the like nature occurred among thecustomers of this pastry-cook and, in consequence, a

judicial investigation was ordered. The shop being properlyinspected, it was found that every operation was conductedwith due attention to cleanliness. MM. Ollivier and Barruelwere appointed to analyse the remains of the meat whichproduced the cases first mentioned, as well as the alvinedischarges of the child. The alvine discharges had a leek-green colour, and were not fetid, but of a seur smell.

Sulphuretted hydrogen did not induce any change in

colour, neither was any change of colour produced bythe same reagent after the fluid was filtered. The remainsof the pie had become mouldy. The meat and pastewere separately examined. The contact of sulphurettedhydrogen did not produce any change of colour ineither. When. they were incinerated in a crucible andthe residue treated with diluted nitric acid, the filtered

liquid on being neutralised with ammonia did not give anyprecipitate with ferrocyanate of potass, or with sulphurettedhydrogen, and did not become blue with ammonia, Another

portion of the remains of the pie was treated with alcoholand a few drops of acetic acid, and the alcoholic solutionswere evaporated to the volume of half a drachm. The residuewas agitated with four times its volume of distilled water,filtered and evaporated, and dissolved again in water. Thissolution was not affected by sulphuretted hydrogen or bynitric acid. These experiments furnish ample proof that thepie did not contain a trace of arsenic, copper, antimony, orlead. The only conclusion, therefore, which M. Ollivier con-ceived it possible to draw was, that the ham had, in someway or another, acquired the poisonous properties sometimesremarked in German sausages, cheese, and ham.-ArchivesGénérales de 1J;Iédeeine, F6vriei-, 1830.

Public Health.REPORTS OF MEDICAL OFFICERS OF HEALTH.

City of Bristol.-Dr. D. S. Davies, in his current annualreport, furnishes an instructive chart relative to the behaviourof infantile mortality in Bristol and Huddersfield respectively.There is, in a sense, a great similarity between the twocurves, each having recently reached a lower level than everbefore. Dr. Davies points out the fallacies which are liableto attend an inference that in Huddersfield the fall whichhas taken place is to be attributed to the special measureswhich have been taken against infantile mortality inHuddersfield. He does not think that the facts adduced

support the view that the Huddersfield fall is due either

entirely or in any large degree to the measures in question,an. opinion which seems to be borne out by the fact thatduring the three years in which, special measures have beentaken in Huddersfield there has been a reduction of 18 percent. in the infantile mortality, while in Bristol, where nosuch special measures have been taken, there has been areduction of 15 per cent.. Certainly, great caution should beexercised in drawing inferences from data which are not

sufficiently numerous to afford a proper basis for infer-ences. But there can, we think, be no doubt thatthe methods adopted at Huddersfield are on right lines,and even if, as is not improbable, they as yetshow no effect upon the death-rate curves, they mightshow some result were it possible to construct a curve

as to physical conditions. Dr. Davies, who, as is wellknown, has devoted special attention to the subject ofchronic carriers in enteric fever, gives a brief but interest-ing account of current knowledge as regards carrier casesas well as a synopsis of the outbreak of enteric fever at theBrentry Reformatory, Bristol, which was attributed by himto the specific contamination by a carrier case of milk whichhad been already sterilised. An account of this outbreakwas given in our columns at the time. It appears thatpossibly this same woman, who is held responsible for theBrentry outbreak, may have been also the cause of entericfever at another establishment in 1904 and of a commencingoutbreak in another in< 1905. At any rate, the carrier-casetheory was found to fit in with the facts as regards theBrentry outbreak in 1906-07. There is, however, need forgreat caution in working with this carrier-case theory, as it isa very tempting one to employ and one which may possiblyresult in shutting our eyes to other causes. A considerablenumber of people who have reached middle life have sufferedfrom a definite or suspected attack of enteric fever, and havingregard to the fact that in carrier cases there may be numerousand long intervals between the bacilli-bearing periodsthere is the danger of assuming that, even in the absence ofdemonstrated enteric fever bacilli, everyone who has hadenteric fever is a carrier case. We shall doubtless hear muchof carrier cases in the near future because. in epidemiology

582 PUBLIC HEALTH.-VITAL STATISTICS.

fashion is so strong. But we do trust that wherever the Icarrier case is called in the full circumstantial as well as i]

bacteriological evidence will be furnished, because there is pundoubtedly a great deal yet to be learnt both about the Ichronic carrier and the carrier whom the Germans term the d"acute" carrier-i.e., a person who has been in contact iwith a case of enteric fever and who without manifesting any r

symptoms of the disease may carry and excrete enteric 1fever bacilli. Dr. Davies’s account of the outbreaks referred T:

to is accompanied by some useful diagrams. J

Borough of Leivis7iam.-We have referred on several toccasions recently to measures taken, notably in France, 1for diminishing the loss of child life through instruction andhelp to pregnant mothers, and we are interested to see thatin Lewisham Miss Duncombe (one of the Grey Ladies) ihas established what is practically a school for mothers 1

during the antenatal period. Not only are advice and in- Istruction given but also in needy cases almost free meals. IDinners are also provided for nursing mothers, every induce-

I

ment being made to the mothers to breast-feed their offspring.Where breast-feeding is not possible and poverty preventsthe purchase of milk orders for a free supply are given. Mr.A. Wellesley Harris speaks highly of the value of this

movement, which is, we are glad to see, likely to becopied in other places. There are also in Lewisham threecreches which are performing admirable work in connexionwith this question of infantile mortality. Mr. Harris reportsthat he has encountered considerable difficulty in obtainingthe disinfection of schools after cases of infectious diseasehad occurred amongst the scholars attending such schools.The attitude of the education committee of the London

County Council would seem to be, if not actually obstructive,at least lacking in that spirit of cooperation and assistancewhich should characterise its dealings with the London

sanitary authorities if the ratepayers are to be properlyprotected and to obtain some return for the enormousexpenditure to which they are put in supportingthe numerous authorities concerned in the governmentof London. Apparently the education committee ofthe London County Council had, without informing theborough medical officers of health, instructed schoolkeepersnot to allow any disinfection of the school premises withoutsanction from the education office, a procedure which is

certainly not in the interests of the public health. Evenafter the difficulties of the position had been pointed out byMr. Harris consent seems to have been very grudgingly givento the effect that those medical officers who use formalin

spray may be allowed to disinfect before or after schoolhours without sanction from the officer. " This attempt toplace the borough medical officers of health in an altogethersubordinate position by practically dictating to them howthey shall do their work seems to us an undesirable

procedure and not one which is calculated to promote goodrelations between the London County Council as a whole andthe local authorities.

Comity BfJrO/6gh of Oldham.-Dr. J. B. Wilkinson, themedical officer of health, is, we are glad to see, taking stepsto deal vigorously with the smoke nuisance not only ofOldham itself but also of the surrounding towns, and thereis a prospect of the formation of a smoke board comprised ofrepresentatives for Oldham and other places near. Dr.Wilkinson supplies data which show, as he says, that thereare appliances on the market which can do away withblack smoke almost entirely, one of such appliances beingcheap, trustworthy, and inexpensive to work. So much so isthis the case that he regards it as " the duty of every millowner who considers in any way the welfare of the town andits inhabitants to take steps to prevent the emission of black

,

smoke from his mill in the future." We cordially endorsethis sentiment and we have hopes of the smoke board. Thefact that so many of the members of local authorities in

manufacturing districts are themselves smoke producersrenders it very difficult to get much done through local

influence, but if for smoke administrative purposes a non-smoke producing area could be combined with a smoke areauseful work might, we think, be carried out.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8895 births and 4682deaths were registered during the week ending August 15th.

’he annual rate of mortality in these towns, which hadIlcreased during the four preceding weeks from 11 1 to 13’2 2er 1000, further rose to 15’ 0 in the week under notice.)uring the first seven weeks of the current quarter theLeath-rate in these towns, notwithstanding this recentncrease, averaged only 12’4 per 1000, and in London theate during the same period did not exceed 11’ 5. Theowest annual death-rates in these 76 towns during the weekmder notice were 4’7 in West Hartlepool, 6-0 in King’sNorton, 6 - 6 in Leyton, and 7’ 6 in Norwich ; the rates in;he other towns ranged upwards, however, to 26-3 inVIerthyr Tydfil, 26.5 in Stockport, 27 - 2 in Middlesbrough,md 32 - 9 in Rhondda. In London the death-rate during theweek did not exceed 13 - 2. The 4682 deaths from all causes,n the 76 towns showed a further increase of 577 uponjhe low numbers returned in recent weeks, and in-sluded 1132 which were referred to the principal epidemicliseases, against numbers steadily increasing from 299 to726 in the six preceding weeks ; of these 1132 deaths, 927resulted from diarrhcea, 62 from measles, 61 from whoop-ing-cough, 34 from scarlet fever, 32 from diphtheria, and16 from "fever" (principally enteric), but not one fromsmall-pox. The deaths from these epidemic diseases lastweek were equal to an annual rate of 3 - 6 per 1000,against rates increasing from 1’1 1 to 2 - 3 in the four precedingweeks ; in London the death-rate from these epidemic diseasesdid not exceed 2’ 7 per 1000. No death from any of theseepidemic diseases was registered last week in Hastings,Brighton, Bournemouth, or in four other smaller towns;the annual death-rate from these diseases ranged upwards,however, to 8’4 in Bootle, 10’6 6 in Middlesbrough, 11.8 8 inAston Manor, and 18 - 0 in Rhondda. The deaths attributedto diarrhoea in the 76 towns, which had steadily increasedduring the nine preceding weeks from 63 to 506, furtherrose to 927 in the week under notice, and caused in thesetowns annual death-rates ranging upwards to 6’ 9 in Burnley,7 - 6 in Bootle, 10 1 in Middlesbrough, 11 - 8 in Aston Manor,and 15’ 7 in Rhondda. It is noticeable that the markedincrease in the death-rate during recent weeks has beenalmost entirely due to diarrhoea, mainly infantile. The 62fatal cases of measles showed a decline, while those ofwhooping-cough were somewhat more numerous; measleswas proportionally most fatal in West Ham, Stockport, andRochdale, and whooping-cough in Wolverhampton, Walsall,Southampton, and Stockton-on-Tees. The 34 deaths fromscarlet fever corresponded with the number in the previousweek, and showed the largest proportional excess in Swanseaand West Bromwich. Of the 32 deaths from diphtheria, 10occurred in London and its suburban districts, three in

Liverpool, three in Manchester, and two in Great Yarmouth,which were equal to an annual rate of 2 per 1000. The16 deaths referred to "fever" showed a decline of seven

from the number in the previous week. The number ofscarlet fever patients under treatment in the Metro-

politan Asylums and the London Fever Hospitals, whichhad increased in the four preceding weeks from 2573 to2761, had further risen to 2808 on August 15th ; the num-ber of new cases of this disease admitted to these hospitalsduring the week under notice further declined, however, to343, from 423, 363, and 358 in the three preceding weeks. Thedeaths in London referred to pneumonia and other diseasesof the respiratory organs, which had steadily increasedfrom 104 to 132 in the four preceding weeks, declined to128 in the week under notice, but exceeded the correctedaverage number in the corresponding week of the five

years 1903-07 by seven. The causes of 37, or 0,8 8 percent., of the deaths registered in the 76 towns last weekwere not certified either by a registered medical practitioneror by a coroner. All the causes of death were again lastweek duly certified in Leeds, Bristol, West Ham, Bradford,Newcastle-on-Tyne, and in 63 other smaller towns ; sixuncertified causes of death were, however, registered duringthe week in Liverpool, five in Sheffield, four in Sunderland,and three in Birmingham.

-

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been equal to 14’3, 13 . 5, and12 8 8 per 1000 in the three preceding weeks, rose again to13 - 4 in the week ending August 15th. During the firstseven weeks of the current quarter the annual death-rate inthese eight towns averaged 13 2 2 per 1000, and exceededby 0 - 8 the mean rate during the same period in the 76