894 LOOKING BACK.-PUBLIC HEALTH.

scope of the work which it is proposed to do. They will, inparticular, require to be informed : (i.) what precautions theLocal Education Authoritywill take to secure that only thosechildren shall be treated in a School Clinic for whose treat-ment adequate provision cannot otherwise be made, whetherby the parents or by voluntary associations or institutions,such as hospitals, or through the agency of the Poor Law;(ii.) what precise diseases and defects will be treated ; (iii.)by whom and on what terms and conditions the treatmentwill be carried out and what will be its extent; (iv.) what isthe estimated cost of the clinic in respect of buildings andequipment, maintenance and administration, and treatment,and how it is proposed to meet this cost, out of the rates orotherwise. "

Looking Back.FROM

THE LANCET, SATURDAY, Sept. 18th, 1830.

SEDATIVE QUALITIES OF THE WEB OF THE BLACK

SPIDER.-The web of the black spider has received com-mendation from many respectable sources, as a sedativeagent, capable of calming with peculiar ease and certainty,morbid excitability of the cerebral and nervous systems. Onthe credit of those qualities it has been employed in thevarious forms of temulence (exhaustion from intoxication),and not without a share of reputed success, sufficient toentitle it to consideration in that state of constitutionalirritation. In the summer of 1827 we tried this article inmany cases, and in full doses. To test its qualities, it wasgiven, where the state of the patient admitted, uncombinedwith opiates. When thus used, its effects were generallypartial or doubtful, and its powers inadequate to the pro-duction of tranquillity or sleep. In one case only have Ifound this substance to exert great or decided sedativeattributes. This was the case of an intelligent young man,(in private practice,) who, after consuming, by his own

report, three quarts of brandy, in thirty-six hours, fell into astate of temulent excitation so excessive, that he was

incapable of keeping a recumbent, or even a sitting posture,for more than a moment, but paced his chamber with aceaseless step for two days and nights. He was not

delirious, on the contrary his conversation was rational,though hurried and vehement. But he was so farunder the influence of spectral hallucination, that if heclosed his eyes for a moment, day or night, he was

instantly visited by a host of phantoms of frightfulaspect; hence chiefly his aversion to lie down, or

make any voluntary effort to sleep. This patient took

opium, opium with camphor, and black drop at shortintervals, and in full doses, until the quantum of opiateapproached the utmost limit of probable safe administration,without even partial relief of constitutional irritation, or anyapparent proneness to sleep. The temulent excitement

kept unabated for twenty-four hours, the second night passedin constant vigilance, locomotion, and mental excitement ;and it seemed probable that excitation so intense, pro-tracted, and unremitting, must soon lapse into deliriumor convulsions. At this time, the morning of the third

day, (the second of my attendance,) he began the use

of the fresh web in pills of five grains every hour. Itseffect was prompt and unequivocal. He calmed, even

sensibly to himself, with every dose, and watched with desirefor the time of repeating the pills. The first effect of theweb was to abate his restless movements about the room, hebecame disposed to sit down, and kept his chair, with shortintervals of walking, for some hours. In the evening heconsented to go to bed, got up once or twice, but returned tobed without difficulty, took an opiate at night, the first foreighteen hours, and slept continuously for eight hours. Thecure was completed without difficulty, by repeating the webless frequently next day, with quiet, suitable nourishment,

I

and another opiate at night. The patient spoke emphatic-ally, both the first and second days, of the soothing influenceproduced by the pills. 1 He was not at the time informed oftheir composition.-.Dr. Wright, A1JW’l’. Jou1’n. ;1 An article on Spider Pills was published in THE LANCET of

June 25th, 1904, p. 1815.

Public Health.REPORTS OF MEDICAL OFFICERS OF HEALTH.

County Borough of S7vrcnsecc.-Mr. Ebenezer Davies, themedical officer of health of Swansea, must be almost if notquite the father of the public health service, and in hiscurrent annual report he furnishes a "retrospect "of sanitarywork in Swansea which carries us back far into the lastcentury, to what is in effect, from the standpoint of time, thedawn of sanitation in this country. According to a reportmade in 1849 to the then General Board of Health by Mr,G. T. Clark, the superintending inspector, the deaths fromconsumption in the Swansea district, which included theGower Peninsula, amounted to 1 in 4’ 8 of the total deaths;from "typhus," which probably included enteric fever andcontinued fever, 1 in 11; from epidemics, including typhus,"1 in 3 5. The report referred to stated that nothing de-serving the name of a system of drainage can be said toexist," and the bulk of the population were dependent uponpumps and open watercourses for their water-supply. Butat that time there was this redeeming feature that "single-family occupancy of houses was the rule," and Mr. Davieswishes that the same observation could be made now.

Gradually a sort of public health conscience evolved andthe desirability of carrying out the provision of the PublicHealth Act, 1848, was recognised. In September, 1853, Mr.M. H. Michael, an active member of the council, was

appointed medical officer of health for 12 months at a salaryof <&150. Mr. Michael did some hard hitting and later thecholera arrived to emphasise his arguments. But the

expense of carrying out Mr. Michael’s recommendations wasvery great, violent opposition was encountered, and beforethe end of the year it was resolved that the appointmentshould not be renewed. Attempts to make another appoint-ment were made but unsuccessfully, and it was not until

1865, when the historical outbreak of yellow fever occurredat Swansea, that, after a report by Dr. (afterwards Sir

George) Buchanan, Mr. Davies was appointed medical officerof health in October, 1865, at .f:100 per annum. This

appointment was therefore made before the Sanitary Act of1866 rendered certain public health measures compulsory onsanitary authorities. It is of interest, having regard to theremarkable discoveries which have since been made, torecall the Swansea outbreak of yellow fever, since it is, webelieve, the only occasion in which this disease has actuallyspread in England. The Hecla, the barque which was instru-mental in introducing the disease, arrived off Swansea on

Sept. 8th, 1865, there having been cases of illness on boardthe precise nature of which was not disclosed. Between

Sept. 15th and Oct. 13th there were 22 cases, which werein all probability yellow fever, and seven others in which astrong suspicion of yellow fever attached to the illness.Of the 22 cases no fewer than 15 died. Of the22 cases, 21 occurred in persons living or workingin proximity to the infected ship or of that por-tion of the cargo which had been discharged, andthere was no sufficient evidence to attribute the cases to

personal infection. As Mr. Davies observes "persons laysick of yellow fever in various parts of the town and noextension occurred from any of their centres, at least 12 innumber." " In the light of our present knowledge it wouldappear, therefore, that both the ship and the cargo retainedliving and infected stegomyia fasciata and that theseinsects did not wander far from ship or cargo, a view whichreceives support from recent researches as to the habits ofstegomyia fasciata. In concluding his interesting retrospectin his fortieth annual report Mr. Davies compares the figuresfor the ten years 1866-75 with the ten years 1898-1907. In thisinterval the general death-rate was reduced from 23’6 6 to17’ 7, the zymotic death-rate from 4’ 49 to 2’ 06, the"fever" death-rate from 0-75 to 0 - 09, and the phthisisdeath-rate from 2 18 to 1’ 45 per 1000 in each instance.

City of Nemeastle.-Dr. Henry E. Armstrong’s reportcontains a reference to nine cows which were found clinicallyaffected with tuberculosis, four of them suffering from tuber-culosis of the udder. Whilst these cows were in the cow-sheds they were being milked twice daily and they wereconsequently pouring tubercle bacilli into the milk pail."It would be interesting if Dr. Armstrong could watch the

895PUBLIC HEALTH.-VITAL STATISTICS.

history of persons who were known habitually to have con- (

sumed this tuberculous milk. There is only one dairy to (every 500 persons in Newcastle and consequently Dr. t

Armstrong infers that most of the milk supplying the 1

population comes from outside the city limits, where there is [practically no veterinary inspection of the cattle. It is- r

instructive with reference to this question of tuberculosis to flearn that the number of carcasses condemned for this (

disease was greater during the last nine months of 1907 (

than for any similar period previously, and that the local ’.butchers’ cattle insurance society paid to its members as I

compensation during 1907 the sum of 438. Dr. Armstrong Ithinks that a large part of compensation for tuberculous Icattle should be paid for out of the public purse. Much iboneless meat from America reaches Newcastle and also, of icourse, many other large towns. Such meat defies inspec- i

tion and it is not improbable, seeing that the glands and fat i

are removed, that some of it may be derived from tuberculouscarcasses. In Dr. Armstrong’s view only whole carcasses,together with their viscera, should be allowed to be importedand everything should be subjected to inspection on arrival.It may be mentioned that in Newcastle the fat of carcassescondemned for tuberculosis has now to be thoroughlysterilised and is used in the manufacture of soap.

County Borough of Salford.-Mr. C. H. Tattersall, whois medical officer of health of this town of 236,670 inhabi-tants, reports that in 1901 he took into consideration thecost of dealing with pulmonary tuberculosis by the isola-tion of advanced cases and the treatment of early cases ina sanatorium together with the usual procedure as regardsinspection and disinfection. The cost was estimated at

&pound; 20,000 per annum and the sanitary committee did not feeljustified in advising the council to incur such a large expendi-ture. The subject has again been considered by the com-mittee but on a less comprehensive scale. It has beenproposed inter alia to convert one of the empty large housesin the borough for the accommodation of eight patients and itis thought that this might be done for <B1000 per annum.This sum, together with the expense of bacteriological work,notification fees, medical inspection, salary and provision fordisinfection, would, it is estimated, bring the total annualexpenditure up to <B1550. Voluntary notification has alreadybeen introduced and blue and red cards are used for the

purpose; the blue card indicating that the sanitary authorityis not to interfere, the red cards that the visits of the

inspectors are desired, but in no case is this visiting to beallowed to interfere with the opportunity for the patient toearn a livelihood so long as proper precautions are carried out.From July 14th to the end of the year 356 notifications werereceived, 143 cases to be visited, 213 not to be visited.

Although the proposal to form a small hospital has not yetbeen acted upon the council has retained five beds at the

Crossley Sanatorium at a cost of .6260 per year. This is a

good move as it will educate the council as to the value ofthese institutions.

County Borough of Huddersfield.-Dr. S. G. Moore, in dis-cussing the behaviour of pulmonary tuberculosis in Hudders-field, gives a chart which, he thinks, demonstrates that thedecline in the death-rate from this disease which had taken 1place up to recent years has now ceased and he concludesthat if this arrest persists the only admissible inference isthat the general sanitation of the borough is unsatisfactory.We gather that there is a disposition to allow of the erec-tion of back-to-back houses in Huddersfield, a fact whichDr. Moore deplores, and he points out that such houses can-not have as much ventilation and light as through houses.The importance of securing plenty of direct sunlight andthrough ventilation as an aid to the destruction of thetubercle bacillus is obvious, as shown by numerous bacterio-logical experiments. Dr. Moore thinks that if every humancase of tuberculosis were so dealt with as to render theescape of living tubercle bacilli impracticable there would beno guarantee that the disease itself would be arrested, and’the same statement would, he says, hold true were all bovineand other domestic animal tuberculosis prevented. We have.in his view, no proof that the germs of tuberculosis do not’normally exist outside of living organisms and that thebacillus may not persist among vegetable surroundings.In his opinion the soundest line of attack is to render thehuman " soil" unsuitable for the growth of the bacillus.

County Borough of Sunderland.-Dr. H. Renney furnishesin his current annual report some figures relative to the after-history of the cases of pulmonary tuberculosis sent by the

;orporation to the Stanhope sanatorium. Since June, 1901,)3 persons have been discharged from the institution; of,hese 35 are dead, 15 well, 6 fairly well, and 7 cannot)e traced. Of those who died the average duration of (lifeafter discharge from the sanatorium was about two years.Chere will be considerable differences of opinion as to theseigures : 15 well out of 63 treated. But it is difficult toliscuss the figures as they are here presented. How many)f the 15 who are well have been recently discharged ?rhe fact is this method of presenting the after-results islot satisfactory. What the unprejudiced observer wishes tomow is how many of the cases discharged in any given yearare alive some four to five years afterwards and to demon- -strate this the figures must be kept in the German fashion-i.e., those for each year kept quite separate throughout the-successive years of observation. If Dr. Renney will adoptthis practice he will be making a useful contribution to ourknowledge as regards the after-results of sanatorium treat-ment.

G’o2c.nt Borough of Grimsby.-Dr. W. B. Simpson draws-attention to the increasing proportion of the total deaths--which takes place in public institutions. The statistics are

only available since 1896, when the proportion of deaths in.

public institutions to total deaths was 3’55 per cent., thepercentage in 1906 being 10-45 and in 1907 10-60. It

appears, however, that in 1896 the percentage of persons-dying in public institutions was an exceptionally low one, as -in 1897 it had increased to 6-32 per cent. Nevertheless,-the actual increase has been very marked. Dr. Simpsonattributes this increase to the growing popularity of.

public institutions rather than to poverty and in this--he is probably correct. As regards the spread of tuber-culosis by the milk of tuberculous cows, he furnishes a good-instance of the manner in which apparently healthy cowsmay be spreading the disease by their milk. On examiningthe carcass of a cow recently killed he found nearly everyinternal organ studded with miliary tuberculosis and yet theanimal had until a short time before death been supplyingmilk to Grimsby. There was no actual disease of the udder,.but, as is now known, the milk may nevertheless containtubercle bacilli, or if not the milk the excretions which -

may foul the udder. Dr. Simpson thinks that if onlysterilised milk was used for human consumption there would’be a very appreciable diminution of tuberculous disease inchildhood.

Metropolitcan Borough of Hccmpstead.-The vital statistics-of this borough are always of interest owing to the fact thatit is inhabited, for the most part, by a well-to-do class where.,the social conditions conduce to a low marriage-rate, birth-rate, infantile mortality-rate, and death-rate ; and to someextent the figures show how intimately health is bound up. .with good social conditions. Taking the rates in the ordermentioned above we find that the marriage-rate for 1907 was14’2 per 1000 as against a rate for the previous ten years of13 9 per 1000, the greatest number of marriages having taken.place in the third quarter of the year. The birth-rate for1907 (14’7 7 per 1000) shows a considerable decrease on therate for previous years, an interesting circumstance in view.of the increased marriage-rate. The birth-rate’ for Londonas a whole was 25 6. In Hampstead the greatest number ofbirths was in the second quarter of the year, a fact which’gives rise to interesting reflections. The death-rate was only9’0 per 1000-the lowest on record for Hampstead. With"reference to infantile mortality the remarkably low figures of73 per 1000 births was registered, as against a rate for thewhole of London of 116 and for the 76 great towns of 127"per 1000 births. This low infantile mortality Dr. G. F.McCleary attributes mainly to favourable weather condi--tions. But it has to be mentioned that important steps-aretaken by way of directly influencing this drain upon our

supply of babies, there having been appointed a lady in--

spector to visit the children whose births are notified underthe Notification of Births Act, and there being also a bodyof health visitors who carry on work in the same direction.The council has also obtained by-laws providing for the

paving of back yards.VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8336 births and 4433’deaths were registered during the week ending Sept. 12th.The annual rate of mortality in these towns, which had.