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Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Gateshead (population 65,550).-Dr. Charles Green re-

ports for j881 a death-rate of 20’4 per 1000 population.Zymotic diseases caused a death-rate somewhat less thanthe average of the country for the last five years, this beingheld by Dr. Green "for a large urban district as satisfac-tory." Diarrhae<t caused nearly 50 per cent. of all the

zymotic deaths. Dr. Green devoted some time in the in-

vestigation of this disease in connexion with the inquirybeing made on the subject by Dr. Ballard for the LocalGovernment Board. The following conditions, he observes,were found in the respective percentage of cases. Very foulashpits, 40 per cent. ; ashpits, 95 per cent. ; houses badlyventilated, 60 per cent. ; improper feeding, 25 per cent.; ar-tificial feeding, 60 per cent.; patients previously delicate,25 per cent. From these facts Dr. Green draws thefollowing conclusions :-1. That although improper feed-ing is to some exteut a cause of diarrhcea, it is not to thegreat extent supposed. 2. That insanitary surroundingsare the principal cause of the disease. 3. That heat is a icause of the disease; thus, of the 82 deaths during theyear there were 10 in Juty, 30 in August, and 10 in Sep-tember ; that is to say, about half the cases occurred inthe third quarter of the year-the only time there was anysummer. Dr. Green, as well as other medical officers ofhealth, insists upon the necessity of a compulsory notifica-tion of disease, if infectious diseases are to be effectuallydealt with ; he would have more power given for theremoval of cases to hospital. He would have, also, thepower vested in the sanitary authority to close schoolson account of iufectious disease. Four deaths from

typhus are reported, two being, unhappily, members ofthe hospital staff, one the matron and the other anurse. Three other nurses were also attacked with disease,but recovered, one after a long and serious illness. TheGateshead sanitary authority, strange to say, does notpossess any apparatus for disinfecting by heat. The systemof excrement disposal chiefly adopted in the borough is themidden-privy, with its intolerable nuisance, offensiveness, andfilthiness. Of its unwhulesomeness the evidence must besuperabundant, yet the sanitary authority persist in its use asif any efforts of theirs to amend the health of the populationcould be other than a sham while this hideous farce ofexcrement-disposal exists. Dr. Green has some observationson the proximity of the Fever Hospital to inhabited houses,and from his invatiga.ti.ms during the year has no reason tobelieve that the hospital has exercised any injury on neigh-bouring houses.

City and County of Hereford (Combined Rgral and UrbanSanitary A utl6orities). -Population 79,000. Dr. VavasourSandford in his report for 1881 is enabled to show a declen-sion of moftctlity throughout his combiued district, a slowand sure stdmping out of zymotic disease in progress, andgenerally a prospect of fatntling a promise that he made tothe City of Hereford seven years ago, that "before sixyears your city .ba)l rank as one of the most healthy in theUnited K’nndom." The death-rate of Hereford last year-namely, 15’4-was the lowest on record he tells us; thebirth-rate was 26’8. Dr. Vavasour Sandford claims, not

unnaturally, credit for the medical officer in bringing aboutso excellent an t-ffect upon the deat i-rate. As a rule wedeprecate too hasty conclusions from death-rates. A singlefatal epidemic will often reverse apparently well-foundedresults, but it would be unjust not to coucede Dr. VavasourSandford’s claim on the excellent fruits of his several years’labours.

Iest Hartlepool -Dr. Gourley reports fnr this urbandistrict for 1881 a deat,h-rate of 17 ’45 per 1000 population,and a birrh-rate of 42 3. Scarlatina was the infectiousdisease chieny prevalent during the year, and six deathswere attributed to enreric fever, the cases occurring in con-nexion with polluted walls. The supply of water delivered tothe town by the water company is stated to be good and ample,but wells are still extensively in use, and largely polluted.The wells in most pdrts of the town," says Dr. Gourley,

" are shallow, and in most cases sunk in ballast, and are all

in too close proximity to the drains and ashpits to be safesources of supply. There is the less need to have recourseto this supply, as the water company furnishes an ample andcontinuous supply of pure water ; the only complaint beingthe price charged." Scavenging is very imperfectly carriedout, and instances are found of badly cleansed, filthily kept,and sloppy ashpits. The sanitary authority pay a fee tomedical men for notifying cases of infectious disease comingunder their observation to the medical officer of health orinspector of nuisances, and although all medical men havenot fallen into the plan, the medical officer of health hasderived material assistance from those who have agreed tomeet the wishes of the sanitary authority in this respect.

Ze!fes.&mdash;This borough, which was formerly under threeseparate sanitary authorities, has by its incorporation be.come happily united under one. Mr. J. G. Braden con.gratulates the corporation on this change in the sanitaryadministrative efficiency in the town. The area of the sani.tary district is stated at 1011 acres, and the population,according to the recent census, at 11,190. Mr. Braden

reports for 1881 a death-rate of 14’3 per 1000 population, anda birth-rate of 26 9. He says : " The health of the town isnow, and has been for some time past, in a very satisfactorystate. Our death-rate last year shows a marked decrease.Food is plentiful, good, and moderate in price ; the labourerfinds no great lack of employment at fair wages ; and, in anagricultural district such as this is, should the present yearprove good, not much cause of complaint need be felt."

Lichfield, Ritral (area 58,349 ; population, 1881, 22,381).-Dr. Moncktnn reports for this district in 1881 a death-rate of15’54 per 1000 population, and a birth-rate of 32’57.Twenty-five deaths were caused by the principal zymoticdiseases, chiefly from scarlet fever. Ten fatal cases ofepidemic membranous croup were also recorded. Dr.Monckton advances reasons for retaining that name andfor discarding the term diphtheria. The report is instruc-tive as showing how closely the cases of infectious diseasewere followed up v the medical officer of health, and how,in conjunction ,tith the medical men in attendance upon thecases, the aid of the sanitary authority was brought to bearin checking the diffusion of an infectious disease a<.d remedy.ing local sanitary defects. In this respect Dr. Monckton’smode of procedure deserves especial commendation.

Shrewsbury.&mdash;Dr. Thursfield reports for this boroughduring 1881 a death-rate of 17 per 1000 population, as com-pared with an average of 20’9 for the seven years 1874-80,and with an anticipated death-rate by the "Healthy DistrictLife Tables" of 16 per 1000. "I ventured in a previous report,"he says, " a belief that one might anticipate for Shrewsburya death-rate not much exceeding 17 per 1000 ; it is there-fore satisfactory to be able to state that the mean death-rateof the last two years 1880 and 1881 is 17 ’2, or a very nearapproach to the above." Writing of infantile mortality inhis report for 1877, Dr. Thursfield observes : "Allowing amargin for the influence of aggregation apart from localsurroundings, I see no reason why Shrewsbury might notaim at an average death-rate of young children of very littleover 10 per cent. of births ; and I believe that this resultmay be obtained by the provision of a plentiful supply of purewater, the structural reform of courts, &c." "It is thereforemost satisfactory," he adds, " to be able for the past year torecord a mortality under this heading of nearly exactly IDper cent., especially as, although much influenced by local sur-roundings, infantile mortality chiefly depends upon a varietyof circumstances, social, personal, and domestic." " Under theheading of zymotic disease Dr. Thursfield is able to record thebest return" that he has ever been called upon to give for theborough, comparing favourably not only with previous yearsbut al,,o with the returns for England and Wales. The follow-ing observations on infectious disease deserve quotation :-" With increasing success in the isolation of infectiousdisease (which as a rule attacks the individual once in a life-time only) it is specially necessary to be mindful of the factthat there is increased necessity for stricter precautionarymeasures, as there are a larger number of children liable totake disease if brought in contact with the infection, althoughowing to improved sanitary conditions and surroundings,children may be expected to (as indeed I believe they do asa rule) suffer less severely when attacked. This brings us incontact with another most practical and tangible danger tobe guarded against, as it is chiefly through mild unattendedand unrecognised cases that those diseases which spreadthrough personal contact with infection are disseminated by

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schools. Isolated outbreaks of infectious disease may alwaysbe looked for, at least for a time, either from direct impor-tation or from revival of old germs, but absence of epidemicsof such diseases as measles, scarlet fever, diphtheria,whooping-cough, &c., can only be looked for provided thedanger of their spread through school agency be sufficiently

appreciated and guarded against. There are other diseaseswhich, although less dangerous to life, children compelledby law to attend school should be equally guarded against,and on one occasion during the past year I was glad toobtain the closure of a school on account of the evident dis-semination of ophthalmia in the school."

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Dublin.&mdash;The deaths within the municipal area duringthe four weeks ending January 28th, amounted to 765,being in the annual ratio of 39’75 per 1000. Zymotic diseasescaused 182 deaths, there being an increase in the admissionsinto hospitals of patients suffering from typhus, scarlatina,and measles. The death-rate for the month was very high,but shows an improvement as compared with the corre-sponding month of last year. The high mortality was prin-cipally due to the serious epidemic of measles, which caused141 deaths out of a total of 182 caused by all zymoticdiseases; and excluding this disease, the deaths from allother causes were below the average mortality of the firstfour weeks of the past ten years. Dr. Cameron points outthe difficulty of inducing the mothers of very youngchildren to allow the latter, when suffering from infectiousdisease, to go into hospital, and suggests that it would bedesirable to provide wards into which both mothers andtheir children could be admitted during epidemics.

The London Gazette of Feb. 28th declares the 90th sectionof the Public Health Act, 1875, which relates to houses letin lodgings, to be in force in respect of Benwell and Fenham,Northumberland, and of Croydon, Surrey.

It is stated that the epidemic of small-pox, which recentlymade its appearance at Armley gaol, Leeds, continues tospread, and that another prisoner died on Wednesday.The Port of Aden and other ports of the Gulf of Aden

have been declared by the Portuguese Government to be freefrom yellow fever.

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VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

In twenty-eight of the largest English towns, 6056 birthsand 4118 deaths were registered during the week ending the25th ult. The annual death-rate in these towns, which inthe two preceding weeks had been so high as 29’8 and26’4 per 1000, further declined last week to 25-4. Thelowest rates in these towns last week were 16’2 in Cardiff,and 17’5 in Birkenhead, Huddersfield, and Halifax; therates in the other towns ranged upwards to 30’9 in Black-burn, 31’0 in Preston, 36’2 in Bolton, and 40’5 in Brighton.The deaths referred to the principal zymutic diseases inthe twenty-eight towns were 639, showing a slight increaseupon the number in the previous week; 264 resulted fromwhooping-cough, 148 from measles, 101 from scarlet fever,58 from "fever" 33 from diarrhoea, 22 from diphtheria, and13 from small-pox. No death from any of these diseases wasrecorded last week in Derby; whereas they caused thehighest death-rates in Brighton, Bolton, and Blackburn.Whooping-cough showed the largest proportional fatalityin Brighton and Wolverhampton ; scarlet fever, in Hulland Nottingham ; measles, in Brighton, Blackburn, Norwich,and Bolton ; and fever in Blackburn and Oldham. The 22deaths from diphtheria in the twenty-eight towns included13 in London, and 3 in Portsmouth. Small-pox caused 9deaths in London and its suburban districts, and one each inNottingham, Liverpool, Bradford, Leeds, and Hull. Thenumber of small-pox cases in the metropolitan asylum hos-pitals had further declined to 436 on Saturday last ; the newcases of small-pox admitted to these hospitals, which haddeclined to 67 in the previous week, rose again to 89 lastweek. The deaths referred to the respiratory diseases inLondon, which had been 994 and 769 in the two pre-ceding weeks, further fell to 545 last week, but exceeded thecorrected weekly average by 56. The causes of 95, or 2’3 perper cent. of the deaths in the twenty-eight towns last weekwere not certified either by a registered medical practitioneror by a coroner. The proportion of uncertified deaths did

not exceed 1’4 per cent. in London, whereas it averaged3-1 in the twenty-seven provincial towns. All the causesof death were duly certified in Brighton, Portsmouth,Norwich, Plymouth, Bristol, Wolverhampton, Birkenhead,Halifax, and Cardiff; while the proportions of uncertifieddeaths were largest in Salford, Bolton, Sheffield, and Hull.

HEALTH OF SCOTCH TOWNS.

The annual death-rate in the eight Scotch towns, whichhad been equal to 24’7 and 23.7 in the two precedingweeks, further declined in the week ending the 25th ult.to 22’6, and was 2’8 below the average rate in the largeEnglish towns. The deaths referred to the principalzymotic diseases in these Scotch towns, which had been104 and 79 in the two previous weeks, rose to 85 last week;of these, 24 were attributed to diarrhoea, 16 to diphtheria,16 to whooping-cough, 11 to measles, 11 to "fever," andnot one to small-pox. The annual death-rate from thesezymotic diseases was 0’4 below the mean rate in thetwenty-eight English towns. The highest zymotic ratesin the Scotch towns occurred last week in Glasgowand Perth. The deaths referred to diarrhoea in tha eighttowns were equal to a rate very considerably exceeding thatwhich prevailed in the English towns. The 16 fatal casesof whooping-cough showed a considerable decline fromrecent weekly numbers. Of the 16 deaths from diphtheria,11 occurred in Glasgow, 3 in Edinburgh, and 2 in Greenock,while measles showed the largest proportional fatality inPerth. The 11 deaths from " fever " were equal to a death-rate considerably in excess of that recorded in the Englishtowns ; 5 occurred in Glasgow, 3 in Edinburgh, and 2 inAberdeen. The reported deaths from acute diseases of thelungs in the eight towns were 34 below the number in thecorresponding week of last year.

HEALTH OF DUBLIN.

The rate of mortality in Dublin, which had been equal to33’6 and 36’9 per 1000 in the two preceding weeks, declinedagain to 33’6 in the week ending 25th ult. During the firsteight weeks of the current quarter the death rate averaged35 3, against 26’9 in London and 19’8 in Edinburgh. The224 deaths in Dublin showed a decline of 22 from the numberin the previous week ; 39 were referred to measles, 3 to"fever," one each to scarlet fever, diphtheria, whooping-cough, and diarrhoea, and not one to small-pox. The annualdeath-rate from these principal zymotic diseases was equal to6’9 per 1000 in the city; the death-rate from the same diseaseswas 4’3 in London and 2’7 in Edinburgh. The fatal casesof measles, which had been 23 and 33 in the two previousweeks, further rose to 39 last week, and averaged 36 in thefirst eight weeks of this year. The 6 deaths from "fever"showed a decline from recent weekly numbers, and thedeaths from other zymotic diseases were also less numerous.The deaths both of infants and elderly persons also showeda decline.

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HEALTH OF BELGIAN TOWNS IN 1881.

As a supplement to his weekly return for Brussels, Dr.Janssens, die chief medical officer of that city, has justissued a summary of the mortality statistics for 1881 of allthe towns iu Belgium having a population exceeding 2000persons. In Brussels (including suburbs) the death-rateduring the year was equal to 23’9 per 1000, against 21’2 inLondon aud 28.6 in Paris. In addition to Brussels, thereappear to be three Belgian cities having a population ex-ceeding 100,000 persons ; in these the death-rate last yearwas equal to 20’8 in Li&egrave;ge, 23 4 in Anvers, and 25-7 in Gand.In sixty other Belgian town-< the population ranges from4S,431 in Bruges, to 2841 in Waremme. As might be ex-pected, in so lung a listof small towns, the death-rate rangedwidely, the two lowest being 14 8 and 16’0 In only four of thetowns did the rate exceed 28 per 1000 ; the h’ghest ratebeing 30’7 in Verviers, the population of whi.;h is given as41,256. The high death-rate in Verviers is shown to havebeen mainly due to a severe epidemic of small-pox, whichcaused 248 deaths during the year, equal to a death-rate of6 per 1000 of the population. Small-IJox appears from thisreturn to have been somewhat prevalent in Belgium duringlast year, as 712 fatal cases were recorded in its principaltowns, and 464 exclusive of Verviers. Dr. Janssen’s ex-cellent summary would be much improved by the addition