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Public Health.ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH

FOR 1910.

County of Middlesex.-In reporting on the administration ofthe Midwives Act Dr. C. W. F. Young states that during1910 as many as 283 midwives notified to the countycouncil that they intended to act as midwives, and that inaddition 466 other certified midwives reside in the county.Of the practising midwives only 91 are now enrolled byreason of having been in bonâ fide practice before the passingof the Act, the rest being qualified by examination. Dr.

Young considers that the county is well supplied with mid-wives, and that many of them do not attend a large number ofcases, though they are anxious to do so. Out of some 27,000births, it is estimated that 9482 were attended by registeredwomen as midwives and 1356 by nurses under medical men.Medical aid notifications were received in respect of 754births attended by midwives, a proportion of 2-3 per cent.,almost identical with that in 1909. Of 41 cases ofpuerperal fever notified in the county 15 occurred in thepractice of midwives. The report refers to the sanitaryregulation of tents, vans, and other moveable dwellings,which frequently give rise to difficulty, as while the localauthority can enforce its by-laws (for example, as to obtain-ing a sufficient supply of water) on the occupant, it cannotdo so on the owner of land habitually let as a camping-ground. The principal facts of sanitary administration inthe 33 sanitary districts (29 urban and 4 rural) of whichMiddlesex is now composed are set out in a very instructivemanner. Dr. Young’s next report should have the furtherinterest of presenting statistical data regarding the severaldistricts which are based on the recent Census enumeration.The population of the administrative county has increasedfrom 792.476 in 1901 to 1.126.694 in 1911.

Metropolitan Borough of Islington.-Islington, one of thelargest of the London boroughs, has shared in the diminu-tion of population which has taken place in the morecentral parts of the metropolis. It had 327,423 inhabi-tants this year, a decrease of 7568 on the previous Census.Although there is evidence that many dwellings are un-occupied, the density of population is high-117 per acre.There has also been a notable increase in pauperism, anaverage of 10,476 people per week being in receipt of reliefduring 1910. The changes in the character of the population,and the possibility that, owing to the system of relief in

Islington or to other causes, there is a considerable

immigration of persons of the poorest class, give specialimportance to the efforts of the medical officer of health todeal with unsatisfactory housing, food-supply, and likematters. Several dwellings were closed as unhealthy underthe Housing and Town Planning Act during the year, andthere is room for a vigorous policy in this respect. Mr. A. E.Harris presses for the appointment of health visitors, notonly for the prevention of infant mortality, but in order todeal with individual cases of phthisis notified under theLocal Government Board orders. In the absence of visitingthese orders merely throw on the health departmenta mass of comparatively useless clerical work. Thereport gives details of inspection of kitchens of restaurants,coffee and dining rooms, and similar places, a largenumber of which were found to be in an extremelyunsatisfactory condition as regards cleanliness, lighting, andventilation. It is an anomaly that while refuse is removedfrom the large hotels and restaurants, when desired, free ofextra charge, there is only a weekly clearance from smallcoffee-shops and eating-houses ; any extra removal is chargedfor, and the occupiers prefer to keep their bins crowded totheir utmost capacity. These small shops are in the poorestparts of the borough, and the accumulated refuse gives riseto various nuisances and breeds large numbers of flies. In

places where ice-creams are made the most unsatisfactorycondition which is now found on inspection is the want ofsuitable storage for the materials used, which at present arekept anywhere, and have sometimes been found in the bed-rooms of the makers. The inspectors have secured a markedimprovement in the cleanliness of milk measures, but Mr.Harris finds that the lids of milk-cans are sometimes in a

very uncleanly state. He considers also that the time has

come for requiring that foodstuffs, particularly thosewhich are eaten in a raw state, should no longer be sold inopen-fronted shops. Mr. Harris has continued the energeticadministration of the Sale of Food and Drugs Acts for whichIslington has for many years been conspicuous, but he againdraws attention to the way in which the clumsy and anti-quated provisions of these Acts make it impossible to dealwith flagrant cases of misdescription and adulteration, par-ticularly of foods and drinks sold in poor neighbourhoods;and his report contains some striking illustrations of the needfor official definitions of foods in this country, comparable tothose in force in British colonies and the United States.

County Borough of St. Helens.-Under the St. HelensCorporation Act, 1898, the town council can require anyprivy ashpit in the borough to be converted and adapted tothe water-closet system, whether it give rise to nuisance ornot, and any tub or pail-closet to be converted into a water-closet if it creates a nuisance. If the latter do not createnuisance the conversion can still be enforced by the muni-cipality if it is prepared to contribute half the cost. Not-

withstanding these provisions a great deal remains to be donein this town to improve methods of excrement and refusedisposal. There remain as many as 2820 privy middens,most of which are in the thickly inhabited portions of thetown, and 6882 pail closets, which are still almost as

numerous as’the water-closets in the borough. The retentionof privy-ashpits and the defects in the pail system no doubtcontribute to the maintenance of sporadic enteric fever. Thisdisease occurred in 71 houses in 1910 and is understood to bestill more prevalent during the present year. Dr. J. J. Buchan

gives figures which show that it would be practicable to con-tinue conversion at a much greater rate than hitherto withoutmaterially adding to the local rates. In August, 1910, anoutbreak of poisoning attributed to canned meat was investi-gated. A large tin of a well-known brand of corned beef hadbeen opened by a grocer and sold by the slice on the same orthe next day to 11 customers, through whom the meat waseaten by 33 persons. All but one of these became ill withina very short time of eating the meat ; the shortest period ofincubation was two hours and the longest ten hours; themajority were affected in about four hours. The symptomsconsisted chiefly of vomiting and severe diarrhoea., continuedfrom six to 24 hours after the onset; the illness was accom-panied by a great amount of depression, which left thepersons affected ill for some days. Bacteriological examina-tion failed to show any evidence of the presence of bacilliof the Gaertner group or B. botulinus, and the generalhistory of the outbreak made it probable that it wasdue to bacterial toxin rather than to living bacteria. Dr.Bachan considers that much good has been done by thesystematic visiting by a trained nurse of practically all birthsnotified under the Notification of Births Act. In this waythe percentage of infants who are breast-fed has increased,and on the present method of reckoning amounted to 98 in1910. An inquiry into 2170 cases showed that only 6,6 percent. of the infants originally reckoned as breast-fed at birthwere weaned before they were six months old. In St.Helens the town council pay a small fee-6d. per birth-to medical practitioners and midwives notifying under theAct.

County Borough of Blackpool.-Dr. E. W. Rees-Jones’sreport contains several matters of interest. The birth-rate of

Blackpool, which was 27-74 in 1898, has now fallen to 16 - 7 ;the death-rate for 1910 was as low as 12 ° 47. The Census

population, 58,378, on April 1st .last is, of course, greatlybelow the normal population of this popular seaside resortduring a large part of the year. Blackpool is so dependenton visitors that there is special need for precautions

against the spread of infectious disease through lodging-houses, and Dr. Rees-Jones strongly urges, in regard tophthisis, that the sanitary authority should have compulsory

. powers to disinfect thoroughly all premises which have been: occupied by consumptive persons, and that it should be apenal offence to allow such premises to be occupied by others7without previous disinfection. Measles has been a notifiabledisease in Blackpool for over 20 years ; in 1910 the notifica-tions were 660, and the deaths 4 only. Dr. Rees-Jones considersit doubtful whether the administrative measures based on1 notification have had much effect in reducing the prevalenceof the disease, but believes that a marked effect has been

produced by them on the case mortality. The cost of thes infectious diseases hospital to the rates, including interest,

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sinking fund, renewal expenses, and cost of disinfectionaveraged £2 5s. per patient per week ; cost of maintenancein food averaged for the year 4s. lld. per head per week

Special attention is given by the sanitary authority to basement dwellings ; 89 families living in basement rooms havEonly one room for the whole of the family. In Blackpool th(administration of the Shop Hours Acts and Employment ojChildren Act is carried out in the department of the medicalofficer of health.

REPORTS OF SCHOOL MEDICAL OFFICERS.

Connty Borough of Stockport.-Mr. II. E. Corbin, in

presenting the report of the school medical officer (Dr. M.Gertrude Edis), is able to state that the amount of treatmentobtained as a result of inspection is very satisfactory. Ofthe 5102 children inspected out of a school population of17,906, 68.6 per cent. were found to have one or more

defects, and 15’ 6 per cent. parents attended. As in mostother places, great difficulty exists in dealing with ring-worm and verminous conditions, and less improvement isreported in these conditions than in other defects, theactual percentage of verminous heads found being increasedover last year’s figure. It is suggested that the cloakroomshelp in spreading the condition. In connexion with anasmia(379 cases) it is suggested that the badly ventilated class-rooms are a contributory factor. There were 32 mentallydefective children, and 215 " backward " cases, of whom 60per cent. were accounted for by some physical defect, and 40per cent. showed no obvious cause. 126 cases had deformities.Difficulty in the treatment of ringworm arose partly becauseof the refusal of the infirmary board to treat school cases,and led to the issue of a circular letter to all practitioners- in the town and to the passing of special administrativemeasures. The success of these measures is not stated. Adetailed report on the sanitary circumstances of schoolsreveals a number of grave defects ; in four schools privy-middens exist, many schools are dirty, cloakroom accom-modation is bad, and in some schools the heating arrange-ments are very poor, in one department so much so thatfrequent exercise has had to be added to overcoats worn inthe class-room to maintain the temperature. This last schoolwas a non-provided institution.

County of Ayr.-Dr. C. R. Macdonald’s report takes us up tcJuly, 1911, and comprises reports for the Northern, Kilmar-nock, and Ayr and Carrick districts, and for the schoolsin the Burgh of Ayr. In the Northern district the numberof "entrants" and "leavers" examined was 3537, thenumber found defective being 2309 ; out of 280 special casespresented by the teachers, in 273 the attention of parentswas drawn to a remediable condition. It is not a littleremarkable that for all these children only 122 parentsattended, and it would be extremely interesting to have alight thrown on the social school conditions, if any, which

go to produce this effect. A large proportion of the defectsfound among the routine cases were in regard tocleanliness, and when these are subtracted only 997 casesremain, of which 360 were "bad" dental caries. 163 defec-tive vision, and 175 deafness. There were 36 cases oftuberculosis and 18 of valvular disease of the heart. It iscurious to note that only one case of enuresis is recorded.The figures quoted are fairly typical of many other districts,and it is a matter for consideration whether an economy inenergy might not be effected by a method of examina-tion other than that of mechanical routine. It is also amatter of interest to consider how long an investigationof some kind into the digestive system can be left out ofschool examinations. Possibly some light might be thrownby such an investigation on "malnutrition." The medicalofficer of the Northern district reports on the privy-midden, still existing in some schools, as "an absolute abomination."There is no excuse of any kind for the persistence of these insanitary antiquities. Dr. B. C. Stevens reports forthe Kilmarnock district that more parents attended than lastyear, 3654 routine cases were seen and 365 special cases, andwith these children 364 parents came to the inspection. Onein nine of these children suffered from malnutrition, as

compared with the tigure of 1 in 18 for the Northern district,and 1 in 23 for the district of Ayr and Carrick. As the threedistricts concerned are only divided for administrative

purposes, and the report does not note any special differencesbetween them, it is to be presumed that these wide

., divergences are due to differences of standard in estimatinge nutrition.. Hampshire County Council.-Dr. Robert A. Lyster’s report- deals with the three districts into which the county is dividede for school purposes, containing 42 urban and 308 rural

schools, with 13,?53-and 33,009 children in average attend-f ance respectively. During the year 1185 visits were made to1 schools, of which 458 were routine visits, and 48,895 examina-

tions of children made, children known to be defective beingexamined on several occasions. 7885 routine cases were

inspected and 41,010 special examinations made, this figureincluding re-examinations. The method adopted provides forthe registering not only of the usual observations, but also,among other matters, gives the number of rooms in the homes

, of children and number occupied, and the occupation of theparents. The cooperation of the teachers is greatly encouraged,and went as far in one school as the actual rehearsing of amedical inspection in order to secure smoothness of work-ing. It is interesting to note on these figures that Dr.Lyster classes 1’06 per cent. "entrants" (5 years) as

suffering from bad nutrition and 0-89 per cent. "leavers" "

(13 years) ; this is a diminution on the figures of the pre-vious year, whereas dirtiness has increased. In regard toclothing Dr. Lyster notes the prevalence of over-clothing,and the fact that this is often confined to the chest andabdomen, the legs being left bare. This is probably auniversal experience with certain sections of the population,and may well account for the prevalence of bronchitis andbroncho-pneumonia among children whose parents are of thepoorer class. Considerable attention is directed to the con-dition of clothing. as also of footgear, and a strong plea isput in for the "economical and hygienic" clogs. Thedifference between the North where clogs are habituallyworn and the South where they are not appears to be amatter of social custom only. Medical inspection will

prove a powerful weapon indeed if it can produce not onlyfashions which will tend to eradicate pediculi, but alsofashions in footwear. The figures for attendance of

parents at examination are not given, but it is stated thatfew attend, partly owing to the long distances to be travelled.Despite this over 54 per cent. obtain treatment for the defectspointed out at inspection, and apart from dental defects64. 4 per cent. are treated. A special investigation was madein the Farebam Poor-law area to discover why childrenneeding treatment had not obtained it. Inquiries were con-ducted concerning children living in 282 homes, and the factemerged that more than half these cases had a total income(excluding rent) of not more than 10s. to 20;-. a week. while10 per cent. of the cases were below 10s. a week. A tabula-tion of special work done in connexion with schools byteacher and others is given, and is interesting as affording ameasure of the amount of individual initiative and goodwillavailable for school purposes.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 77 of the largest English towns, having an estimatedpopulation of 16,157.797 persons in the middle of this year,7900 births and 4056 deaths were registered during theweek ending Nov. llth. The annual rate of mortality inthese towns, which had been 14’4, 13 3, and 13.5 in thethree preceding weeks, declined to 13 1 psr 1000 in theweek under notice. Dnring the first six weeks of thecurrent quarter the mean annual death-rate in these townsaveraged 14 1, or 0’1 per 1000 above that recorded inLondon during the same period. The death rates in the77 towns last week ranged from 5.0 in Walthamstow,5’1 1 in King’s Norton, 5-7 in Willesden, and 6.2 2in Reading, to 19.0 in Swansea, 20-0 in Stockton-or.-Tees, 20’7 in Sunderland, and 21.6 in Bootle. The4056 deaths from all causes in the 77 towns were 126fewer than the number returned in the previous week,and included 279 which were referred to the principalepidemic diseases, against numbers decreasing from 2900 to301 in the 11 preceding weeks. Of these 279 deaths, 113resulted from infantile diarrhoea, 55 from diphtheria, 37from measles, 26 from scarlet fever, 24 from enteric fever,and 24 from whooping-cough, but not one from small-pox.The mean annual death-rate from these epidemic diseases