675PUBLIO HEALTH.

H. W. Savory, Captain A. W. Clarke, Professor W. J. R.

Simpson, C.M.G, Dr. S. Squire Sprigge, Dr. Frederick t

Taylor, Mr. C. Louis Taylor, Dr. C. C. Ohoyce (Dean of the r

School), and Mr. P. J. Michelli, C.M G. (secretary of the s

Seamen’s Hospital). I

In proposing the toast of the evening, the CHAIRMAN .I.pointed out that the School of Clinical Medicine was founded (in 1906 for the purpose of affording for post-graduate tstudents an opportunity of bringing themselves into touch twith the most recent developments in medicine and surgery.It was felt that at the Dreadnought Hospital there existed i

a large amount of clinical material which was lost to I

education, and the sanction of the committee of the Seamen’s iHospital Society having been obtained the school received c

the sympathy and help of the leading physicians andsurgeons of the medical profession. During the first

year’s work 68 students attended, and since that timethe activities of the school had steadily been extended. ISince 1906, 560 students had been enrolled, composed of allclasses of medical men coming from Great Britain and Ireland,Canada, United States of America, Peru, Nicaragua, Chili,Brazil, Argentine, Spain, Greece, Holland, Germany, France,India, China, Straits Settlements, Australia, New Zealand,and South Africa. The school had been well attended byofficers of the medical services either before or after theirentry into those services. From the very first the naval

surgeons seconded for study had availed themselves of theadvantages of the new school, and within the last 18 months,owing to the action of the Durnford Commission, acting inconjunction with the Director-General of the Medical

Department of the Navy, Sir James Porter, systematiccourses of instruction had been attended by from 20 to30 officers annually. It was hoped that in the futurea still closer connexion would be established between theClinical School and the Royal Naval College at Greenwich.The Dreadnought Hospital and Clinical School afforded oneof the most complete courses of operative surgery in thekingdom, and negotiations were also in progress whereby thepost-graduate student would be afforded instruction in

practical medicine. After complimenting the board of

management of the Seamen’s Hospital on its excellent work,His Serene Highness pointed out that hosDitals were charit-able institutions snpported by a generous public. Everyonewho realised what the nation owed to men of the mercantilemarine should contribute to the maintenance of such excel-lent and necessary institutions as those of the Seamen’s

Hospital Society, and although the present occasion was notone in which he had been desired to make an appeal formoney he would hint to those who were generously disposedthat additions to the financial resources of the society wouldbe more than welcomed.

Sir MALCOLM MORRIS, with whose name the toast had beencoupled, in his reply said that the appointment of His SereneHighness (who had made the dinner a success by his presencein the chair that evening) to the office of a Sea Lord hadgiven the most profound gratification to every Englishman.Comparing the progress which had been made in navalmatters and in medicine, he pointed out an almost exactcoincidence. The change from the old wooden ship to themodern Dreadnought, the torpedo boat, and the submarinewas as great a revolution as that which had taken place inmedicine owing to the action of one man, a man whom theyhad laid to rest within the last few days, Lord Lister. Wetrusted in the navy for our protection, and what the navy did forour shores and our homes Lord Lister had done for our bodies.Sir Malcolm Morris also referred to the introduction and useof the Roentgen rays and the enormous advance in medicinedue to this agent owing to the work of, among others, SirMackenzie Davidson, and drew an interesting comparisonbetween the deep-sea sounding experiments of Lord Kelvinand modern methods of exploring the cavities of the humanbody. Referring to the need for post-graduate studies, hesaid that the greatest insurance that could be given to thenation was the insurance of a highly skilled and highlyeducated doctor, and they were greatly indebted to the headof the Navy Department for allowing the naval surgeonsto use the clinical school for instruction.

Captain A. W. CLARKE proposed the toast of The MedicalServices " with considerable happiness, departing from theformal statement, with which he had been supplied by theauthorities, to detail his own experiences, as one who hadbeen all over the world, of the vast debt which scatteredcommunities owe to the ministrations of medicine. ,

Director-General Sir JAMES PORTER, who replied, saidthat it was now recognised that only the best that themedical profession could furnish was good enough for theservice which he represented, and referred to the con-

nexion between the Royal Naval Medical Service, the RoyalArmy Medical Corps, the Indian Medical Service, and theColonial Services, which was now being recognised so thatthose services were not going to live any longer in water-tight compartments.

Sir JOHN ROSE BRADFORD, who proposed "The Guests,"referred with gratitude to the great interest which theColonial Office and successive Colonial Secretaries had takenin the advancement of tropical medicine. With the toast he

coupled in humorous phrases the names of Sir ThomasBarlow (the President of the Royal College of Physicians ofLondon) and Mr. Rickman Godlee (the President of the

Royal College of Surgeons of England), who both madesuitable replies.The dinner was the largest ever held by the school.

Public Health.REPORTS OF MEDICAL OFFICERS OF HEALTH.

<7cMM o East S2assex.-Mr. A. G. R. Foulerton attributesan important share in the reduction of infant mortality inthis county to the influence of the large number of trainedmidwives introduced into the rural districts by the SussexNursing Association, and to the supervision of untrained mid-wives by the county authorities. In the class of mothersamong whose infants the highest mortality occurs it is oftenof little use to distribute leaflets, however well prepared,while women health visitors are prone to be looked on with sus-

picion and considered unpractical. The midwife, on the otherhand, nearly always has the mother’s full confidence, and heradvice usually determines the mother’s treatment of her infant.In January, 1911, the midwives under supervision numbered159, of whom 86 were trained. Out of 1931 maternity casesin which the midwives acted as such, and not as monthlynurses, it was necessary for them in 193 instances to send formedical aid on behalf of the mother or the infant. During1910 the rate of reported still-births was 1 for every 74 con-finements. The report reviews a variety of subjects arisingout of the annual reports from individual districts in thecounty for 1910, and, as is frequently the case with countyreports, makes a somewhat late appearance in consequence ofthe time required to get all the data completed. In thisinstance, however, the delay has enabled the county statisticsto be revised by the Census data of 1911, which showed thatthe aggregate of the several local estimates of populationwas some 10,000 in excess of the actual figure.

Co2cnty of Kent.-Dr. W. J. Howarth’s report gives afurther illustration of the great progress which has beenmade in many directions in organising the county sanitaryservice. It contains some important observations on thecondition of the encampments of hop-pickers which shouldbe seriously considered by those concerned. Where hutsare employed it is common to find no provision forsurface drainage and no rain-water spouting, with theresult of much dampness and discomfort to the occu-pants. The tents used are often unsatisfactory, particu-larly for the women and children, being badly pitchedand not watertight. The by-laws require cooking-housesto be thoroughly cleaned and kept clean, but unfortunatelydo not insist on cooking-houses being provided. The privyaccommodation is also generally inadequate, and inMaidstone rural district Dr. Tew refers to the liabilitywhich still exists for the pollution of water-supplies, andexpresses the fear that the lessons of the typhoid epidemic of1897 are being forgotten or ignored. It would seem that theencampments of hop-pickers are in many places of a consider-able size, and there is much to be said for the local authority

I detailing special men during the picking season to supervise! the scavenging arrangements and ensure the protection of

water-supplies. Frequent inspection of the foodstuffs broughtL in barrows to these encampments is also particularly necessary.) City of Yorrk.-Dr. Edmund M. Smith’s annual report forl this city is interesting reading as showing the care which isl given to all branches of public health administration. It is

reasonable to conclude that the notable decline in the

676 VITAL STATISTICS.

general death-rate and also in the mortality from tubercu-losis and diseases of infancy which has characterised Yorkduring the past decade is to be attributed to a materialextent to the increased efficiency of the municipalsanitary work. The efforts already made in variousdirections to combat tuberculosis are particularly striking,and the experience gained should be invaluable now

that the administrative conditions are altered by generalnotification of pulmonary tuberculosis and by the pro-spect of sanatorium provision being available on a largescale. There are three school nurses for the city whosework is combined with that of health visiting. In the latterduties the rule that no notes should be taken by the healthvisitor at the homes is at first sight arbitrary, but has muchto commend it. The results of inquiries made as to the

practice of different towns in dealing with tuberculous meatshow that while the recommendations of the Royal Com-mission of 1898 are usually taken as the standard they arefrequently departed from. In York the entire carcass is notcondemned when tuberculous lesions are present in both

body cavities but are "in the early stages," or even

when they are present in the muscular system or

in the lymphatic glands embedded in the muscles.Cases in which the latter conditions obtain do not oftencome under notice in meat inspection, but when they dothere is usually substantial ground for total condemnation.The employment of a veterinary meat inspector, who actswith the sanitary inspectors in systematic inspection of thenumerous private slaughter-houses, has had satisfactoryresults, while butchers, as a result of their system of insur-ance, show an increasing disposition to consult the sanitaryauthorities in all cases of doubt. In advising on thedestruction of rats Dr. Smith lays stress on the advantagesof using bacterial virus and on the harmlessness of the virusto man. The latter statement needs the qualification thatthe virus should not be allowed to contaminate food or placeswhere food is kept. A substantial beginning appears to havebeen made in applying the provisions of the Housing Actand regulations to insanitary property in York.

Metropolitan Borrough of Wandsroo’1’th.-A bulky volumehas lately been issued by the borough council which com-prises a mass of information relating its general administra-tion up to March 31st, 1911, and includes the reports of themedical officer of health and the public analyst for 1910.These show that the proportion of samples of foods takenunder the Sale of Food and Drugs Acts which proved to beadulterated or otherwise unsatisfactory was as high as 9 percent., a figure attributed mainly to greater discrimination inthe selection of the samples and to the improved methodsemployed in obtaining them. Among the adulterations

ireported the substitution for arrowroot of a flour containing90 per cent. of tapioca may be mentioned. As Dr. P. CaldwellSmith points out, a comparison of the price paid for thearrowroot, Is. 6d. a pound, with that usually paid for

tapioca, 3d. a pound, shows that a large profit may beobtained by this practice. The amount of boron preservativein some samples of prepared meats was exceptionally high,in one case (sausages) reaching 55 grains per pound. Pro-

ceedings were taken against certain of the vendors and convic-tions obtained. This was also the case with a sample of cocoacontaining 33 per cent. of extraneous shell, and with severalsamples where margarine was substituted for butter. The

penalties usually imposed in these cases seem, however, to bemuch too small. A fine of .f:1, or even .f:5, is not enough toact as a deterrent to the practice of gross and profitablefrauds such as are recorded in these reports. We would liketo see more drastic action, for example, in the case of skimmilk found to contain 44 per cent. of added water, or of thevendor who carries unadulterated milk in his large churn forthe benefit of inspectors and casual purchasers, while

habitually distributing adulterated milk in small cans to hisregular customers.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN the 94 largest English towns having an estimatedpopulation of 17.559.219 persons in the middle of this year,8793 births and 5194 deaths were registered during the weekending March 2nd. The annual rate of mortality in thesetowns, which had decreased from 21’ 6 to 16 8 per 1000 in the

three preceding weeks, further declined to 15 4 per 1000 inthe week under notice. During the first nine weeks of thecurrent quarter the mean annual death-rate in these largetowns averaged 17 0 per 1000, while in London duringthe same period the average death-rate did not exceed16 2 per 1000. The annual death-rates last week in theseveral towns ranged from 3 5 in Acton, 6’4 in Wallaseyand Darlingr,on, 7-5 in Ilford, and 8 0 in Lincoln, to 23-7 7in Ipswich, 23-8 in Huddersfield, 24 6 in Merthyr Tydfil,24 9 in Gloucester, and 26- 8 in Great Yarmouth.The 5194 deaths from all causes last week were 451 fewer

than the number in the previous week, and included 394which were referred to the principal epidemic diseases,against numbers declining from 435 to 353 in the three pre-ceding weeks. These 394 deaths from the principal epidemicdiseases included 142 which resulted from whooping-cough,109 from measles, 53 from diphtheria, 49 from infantilediarrhoeal diseases, 21 from scarlet fever, and 20 fromenteric fever, but not one from small-pox. The meanannual death-rate from these diseases last week was equalto 1 2 per 1000, against 1-1 and 1-0 in the two

preceding weeks. The deaths attributed to whooping-cough,which had decreased from 186 to 147 in the three precedingweeks, again declined to 142 last week, and caused thehighest annual death-rates of 2 2 in Tottenham, 2 3 inWest Bromwich, 2-8 in Walsall, and 38 in MerthyrTvdfil. The deaths referred to measles, which had been 98,69, and 88 in the three preceding weeks, rose to 109 lastweek ; the highest annual death-rates from this diseasewere 1’7 7 in Rhondda, 22 in Manchester, 2.5 5 in York, 2.7 7in Salford, and 2 8 in Warrington. The fatal cases of

diphtheria, which had declined from 71 to 44 in thefour preceding weeks, rose to 53 last week, and included 23in London and its 14 suburban districts, and 2 each inBirmingham, Grimsby, Manchester, Huddersfield, Rother-

ham, and Newcastle-on-Tyne. The deaths of infantsunder two years of age attributed to diarrhoeal diseases,which had been 49, 58, and 39 in the three precedingweeks, rose to 49 last week ; 23 deaths occurred inLondon and its suburban districts, and 3 each in Liverpool,Manchester, Salford, and Cardiff. The deaths referred toscarlet fever, which had been 22, 28, and 17 in the threepreceding weeks, rose to 21 last week, and included 3 inBirmingham, and 2 each in London, Manchester, Preston,Huddersfield, and Leeds. The 20 fatal cases of enteric feverwere 2 in excess of the average in the eight preceding weeksof the current quarter; 4 deaths were registered in

Manchester, and 2 each in London, Salford, and Cardiff.The number of scarlet fever patients under treatment in

the Metropolitan Asylums and in the London Fever Hospital,which had decreased from 1512 to 1427 during the three pre-ceding weeks, had further declined to 1392 on Saturday last;160 new cases of this disease were admitted to these institu-tions during the week, against 178, 154, and 181 in thethree previous weeks. These hospitals also containedon Saturday last 1136 cases of diphtheria, 462 of whooping-cough, 222 of measles, and 64 of enteric fever, but not oneof small-pox. The 1228 deaths from all causes recorded inLondon were 106 fewer than the number in the previousweek, and were equal to an annual death-rate of 14 2 per1000 The deaths referred to diseases of the respiratorysystem, which had decreased from 545 to 352 in the threepreceding weeks, further declined to 295 last week, andwere 23 below the number registered in the correspondingweek of last year.

Of the 5194 deaths in the 94 large towns, 172 resultedfrom different forms of violence, and 374 were the

subject of coroners’ inquests. The causes of 34, or 0-7 7per cent., of the deaths registered last week were notcertified either by a registered medical practitioner or by acoroner after inquest. All the causes of death were dulycertified in Sheffield, Leeds, Bristol, West Ham, Bradford,Hull, Nottingham, Portsmouth, and in 66 other smallertowns. The 34 uncertified causes of death last week in-cluded 6 in Birmingham, 4 in London, and 2 each inStoke-on-Trent, Dadley, St. Helens, Burnley, Blackburn, andSunderland.

____

HEALTH OF SCOTCH TOWNS.

In the 18 largest Scotch towns, having an estimated popu-lation of 2,182,400 persons in the middle of this year, 1175births and 784 deaths were registered during the week