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is that part of the curve dealing with women aged55—65. Wliy should this curve not have followed thegeneral course, which can be seen in fuller detail in thediagram on p. 48 of the Registrar-(xeneral’a report, andwhy should the general reduction in both sexes at agesover 55 have been so much less than that at earlier ages?No conclusive answer is given in the report to these

questions ; nor is this possible ; but the material

suggests a widening of the problem for consideration.Has there been in recent years an undue reactionagainst the food restriction during war-time whichwould suffice to account for the failure at higher agesto secure the reduced mortality shown in the young ?This would raise the question as to whether deathsfrom glycosuria in elderly people are rightly returnedas due to diabetes ; but whether wrongly attributed tohyperglycæmia or not, they must for many years tocome be classed with diabetes, the result of pancreaticdisease. The same problem has appeared in theUnited States, where also it has been suggested thatover-eating in elderly people is largely responsible forthe relatively unfavourable course of the diabeticcurve at ages over 55. The question is one of whichmore will be heard.

MEDICINE AND THE LAW.

Mosquitoes as ct Nuisance.IN what is stated to be the first case of its kind,

the sheriff court at Paisley has held that it is a,

nuisance within the Public Health (Scotland) Acts ifa land-owner allows stagnant water to remain uponhis land so that mosquitoes breed there in suchnumbers as to cause annoyance and injury to localresidents. The action was brought by the healthauthorities of the county of Renfrew, and the courtordered the respondents to clean out the overgrown

. and stagnant ditches which had become the breeding-place of the mosquitoes.

It is rash for writers in England to offer anyexposition of Scots law. but it may perhaps beassumed that the principles of nuisance are the sameon both sides of the border. In England we haveour own statutory nuisances defined under the PublicHealth Acts as from time to time extended. And,apart from statute, English common law treats as anuisance a state of affairs which interferes with thehealth of the public. From the brief report of thePaisley case in the Times, it does not appear that thepotential danger of mosquitoes as carriers of malariawas stressed ; it was apparently the mere ordinarybiting of the insects which annoyed the neighbours.If there were present the added menace to healthwhich would exist in malarial districts, the legalnuisance would be even more clearly established.In England at common law we have known twoclasses of nuisance. There are public nuisanceswhich are offences against the public where there isprejudice to the health of the public generally. Andthere are private nuisances—acts which are not,necessarily harmful in themselves but which result in prejudice to a particular complainant. Behaviour, .which is likely to spread disease, was held to be a public nuisance as long ago as 1815 in the case of iR. v. Vantandillo, where a mother had carried along a public highway her child which was suffering fromsmall-pox. In later years the collection of infectious i

patients in a hospital was deemed a private nuisance’ ‘in the case of Metropolitan Asylums Board r. Flill. (

Local authorities have. of course, for a long time been i

authorised to make by-laws to prevent nuisance from rubbish or from the keeping of animals if injurious to health. From this it is not a long step to stagnantditches which breed mosquitoes. In the recent s

Paisley case the land-owners pleaded that they had cdone nothing wrong and that they were not responsible tfor an act of nature to which they had not contributed, dThe plea did not serve, nor would it, have served in c

England, where the principle is embedded in the law i;that a man must so keep what is his that he does not r

larm his neighbour. 8

Public Health Services.REPORTS OF MEDICAL OFFICERS OF HEALTH.

THE following are some of the H)26 statistics forsix districts :—

Death-rates Death-ratesper 1000 of the per 1000

population. buths.

Name ofdistriet and

population.

Wiltshire .. 16.2 11.1 0.60 1.42 1.6 1 8 3.9 5.9 .,.(298,300)Willesden .. 15.5 9.5 0.93 1.37 1 .4 1 5 3 7 5 3

1 9

(173.854)Sunderland .. 23.4 13.8 1.46 1.18 3.4 1.2 20 1 101 ; I

(163,800)Grimsby .. 19.8 12.1 1.42 1.35 2 0 1.4 102 91 5 8

(87, 190)Stoke Newington 16.0 10.7 1.02 1.77 1 8 1 9 7 18 4.7

(53.080)Watford .. 15.2 9.5 1.30 1.28 1.5 1.1 1 3 12 -,-2(50,033)

- ,,-

Wiltshire.Dr. Claude E. Tangye reports that the towns of

Wiltshire have pure and usually adequate water-supplies, but that many of the villages are dependentupon wells which have become hopelessly polluted.and that some of the villages depend upon rain-wateronly. No new supplies were provided during 1926.but it is hoped that a scheme for Amesbury will becompleted in 1927. The recurring appearance of casesof enteric fever at Hindon, coupled with highlypolluted wells, has led the Tisbury R.D.C. to formulatea scheme for this parish. The town council of Swindonis promoting a scheme for the extension of their

pumping operations at Ogbourne, and at the Ministryinquiry in February, 1927, a protective clause forexisting wells within a radius of two miles fromOgbourne was agreed to. A new reservoir is to be

constructed by the TrowbridgeWater Company to meetthe water shortage in Melksham.

"

Apart from theimmediate danger to health involved from contami-nated water," says Dr. Tangye,

" the milk-producingindustry of Wiltshire is likely to suffer in the ftitur(- ifwater-supplies to farms remain polluted." The regula-tions of the new milk order are based on the assumptionthat a good water-supply is available, and in manyWiltshire farms these requirements cannot be metowing to the dirty and restricted water-supplies.During recent years there has been a great advancein the matter of rivers pollution, but Calne. Malmes-bury, and Trowbridge remain to be dealt with. Worksat Calne are in progress. At Trowbridge domesticsewage is efficiently treated but unpurified trade refuseis discharged into the Biss. Malmesbury is a source .of continuous pollution of the Avon.Administration of the Milk Act. which became law

in September. 1925, has been chiefly cclnfilled to dealingwith complaints from outside authorities as to tuber-culous nlilk. During 1926 15 such complaints werereceived from London County Council, 3 fromSalisbury City. and 1 from Woking U.D. As the- result20 cows were identified by the veterinary surgeons asgiving tuberculous milk and, with one exception.subsequently slaughtered. Dr. Tangye refers to thedifficulty caused by the month’s delay in waiting forthe result of the biological test and the further month’sdelay which usually elapses before suspected cowscan be proved to be the culprits. Another difficultyis with regard to mixed milk. One of the complaintsreceived referred to the milk of a depot supplied 1) N-80 farms situateu in three counties. These difficulties

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will, of course, be much reduced when an efficientsystem of veterinary inspection is in operation in alldistricts. During the autumn a new joint coödinatingsubcumrnittee was formed, including representativesfrom all the committees dealing with any aspect ofthe milk question.An outbreak of food poisoning affecting 40 persons

at Downton was thought to be due to cooked liaiii.Several of those affected were seriously ill, but therewere no fatal results. The haiii was ascertained to beof Danish origin, and a hitherto undescribed bacilluswas isolated at the Salisbury laboratory, which onsubmission to the Lister Institute was stated to beprobably of the dysentery type. The county council isthe authority for dealing with small-pox, and the newhospital at Ogbourne St. George for the north of thecounty is now complete. The 317 notifications ofdiphtheria with 17 deaths is the worst record since1920. Highworth R.D. with 50 cases, and the town ofDevizes with 49 cases, were the most heavily affecteddistricts. Encephalitis lethargica caused 7 deathsamong the 20 cases notified and poliomyelitis4 deaths among the 13 cases notified. The practiceof midwifery by unqualified persons has almostceased. It has been found impossible with the presenthealth visiting staff to extend the supervision ofinfa,nts up to the school age. The orthopaedic schemecentred on the Children’s Orthopaedic Hospital atBath is doing good work, but a greatly needed exten-sion is " a satisfactory method of teaching and super-vising remedial exercises for postural defects through-out the county."

Willesden..Dr. George F. Buchan reports that year by year

four-fifths of the infant deaths in this urban districtare due to known causes against which active measuresare required. These may be grouped as: (1) con-genital malformations, prematurity, &c. ; (2) diar-rhoea, &c.; and (3) respiratory diseases, includingwhooping-cough and measles. Of the 143 infantdeaths in 1926 02 were caused by the first group,10 by the second, and 44 by the third. Last yearDr. W. D. Champneys reported on cancer andexpressed the opinion that the most important measurewould be a cancer clinic for free diagnosis. After thereport had been considered by the council the healthcommittee consulted with the local medical advisorycommittee, and the final outcome was a reference tothe health propaganda committee to deal with thequestion of cancer as a part of health propaganda.There were two cases of small-pox in ’Villesden during1926, one of them fatal. The original case. a man of43. contracted the disease in Paris. He became ill ina London hotel, but the disease was unrecognised.He moved with his wife to a nursing home in Willesden,where his wife became ill with severe hæmorrhagicsmall-pox and was removed to a small-pox hospital.where she died the same evening. The contacts werevaccinated and no further cases occurred in Willesden.Seven cases of typhoid fever were notified ; fourwere removed to the municipal hospital, where twowere rediagnosed and one died, this being the onlydeath from typhoid. There were 19 notifications ofthe infectious diseases of the nervous system withfour deaths. Dr. Buchan is much impressed with thevalue of the work done at the three schools for mothers,and a syllabus of the health talks is included in hisreport. He complains bitterly, however, of the

unsuitability and inadequacy of the premises provided.o progress has been made as regards an open-airschool, but a local orthopædic clinic is to be estab-lished. The medical staff are taking part in theBoard of Education anthropometric inquiry, andcompleted 198 schedules during 1926.

Greater use has been made of Section 111 of theHousing Act of 1925. "hut much tm:e is lost indealing with the disputatious owner." The delay iscaused by advertising for tenders, reporting to thecommittee, aud then to the council for acceptance.The owner, in the meantime, obtains information as to progress from the published council agenda and Icarries out some work. The agreement with the

contractor has then to be modified and a new

schedule of work and an amended estimate of costmade. The Meat Regulations of 1924 are beingobserved satisfactorily in Willesden. and one prosecu-tion under the regulations had a salutary effect. Atthe municipal hospital serum treatment of scarletfever has given satisfactory results. The percentage ofcases with complications has been reduced, and whenthe serum has been given early the disease has beencut short. There were 306 cases treated without asingle death. The Dick test has also been usedsuccessfully for the patients in a non-scarlet feverw ard. after the introduction uf a case of scarlet fever.By its means and a subsequent prophylactic dose ofscarlet fever antitoxin it is found that completecontrol over anv further occurrence of cases can bemaintained. During 1926 the Schick test followedby immunisation has been adopted for the nursingstaff in the diphtheria wards. Since its adoption therehas been no diphtheria among the nurses, amongstwhom previously the incidence of this disease was high.Appendix II is a valuable article on Rheumatism inChildhood by Dr. C. T. Maitland, containing a

description of the ’’ rheumatism supervisory centre "

of the Paddington Green Children’s Hospital. In

Appendix 1. Dr. Alice Gray reports on diphtheria in theStonebridge area and emphasises the futility of themethods in vogue for the prevention of diphtheriaprevious to the discovery of the value of theSchick test followed by active imnmnisation of thesusceptible.

Sunderland.Dr. Eustace Thorp (acting medical ofticer of health

for the county borough) says much has been done inthe provision of houses for those in regular work,but that little has as yet been planned for that largeclass, the casual worker, living at present underappalling conditions, who requires his accommodationin the vicinity of the river or his work. There is notmuch chance also for workers with large young familiesor for newly married pairs. He thinks the plan ofputting old houses into good repair and letting infiats is worth more than a passing thought. Some ofthese old houses have been well built and can standalteration and remodelling. The 584 new houseserected during the year included 338 municipal housesand 207 erected with State assistance. Greater effortsare being made by cowkeepers to keep their animalsclean. Out of 104 samples of milk examined fortubercle bacilli five gave a positive result. There isa limited number of tradesmen who do not adherestrictly to the rule of the Butchers’ Association that.when any abnormality exists or there is any doubt asto the fitness of meat for sale. the advice of the healthdepartment should be obtained at once. There are68 licensed slaughter-houses within the borough.Continued good results in preventing cross infectionare reported from the use of the bed isolation ward atthe infectious diseases hospital.

Grimsby.Dr. B. C. Stevens reports that the general hospital,

with accommodation for 60 patients, serves a widedistrict, including Cleethorpes and Immingham, andthat its sphere of usefulness is curtailed by want ofbeds. The general level of Grimsby is only one or twofeet above ordinary spring tide level and the sewerslaid before the erection of the pumping station in1892 are too flat to be self-cleansing. Three gangs ofmen with flushing tanks are continuously employedflushing them. There are no street level sewer ventila-tors and ventilation is achieved by means of shaftserected against, buildings and since 1910 by ventcolumns. For four-fifths of the town pumping of thesewnge has to be employed. the periods of pumpingand of discharging by gravitation being about equal,The remaining fifth of the town is drained by gravita-tion, the sewage being held up for about, half the timeby a penstock. Thanks to the additional pumpingcapacity there is now no flooding, even when a heavyrainfall coincides with spring tides. The town is nowpractically free of box privies. The hospital pavilion.

1368

with 24 beds for advanced cases of tuberculosis, wasopened in July, since which it has been fully occupied.The two notified cases of puerperal fever bothterminated fatally. Antiscarlet-fever serum was

used for septic cases and helped to reduce the

temperature, but in one case did not prevent theformation of two abscesses and otit,is media. Of the94 cases of diphtheria admitted to hospital fromGrimsby all recovered, and this good result is claimed to be due to the early use of antitoxin and prompt bacteriological reports from the municipal laboratory.The V.D. scheme has been improved by the substitutionof eight sessions in the week for live. New cases ofsyphilis show a reduction of 35 per cent. and all the pregnant syphilitic women attending the clinic havegiven birth to full-term healthy babies.

Stoke Newington.Prof. Henry Kenwood, in the last of his long series of

annual reports for this metropolitan borough, drawsattention to the large number of deaths of StokeNewington residents which occur in public institu- ’,tions outside the borough. During 1926 266 of the i568 deaths occurred in such institutions. During the Ifirst two years of the borough’s existence (1901-02) the Inumber of these deaths was only one-half of the 1926figure. Dr. Kenwood points out that nearly half theinfant mortality occurs during the first month andthat, while during the past 20 years the infantmortality-rate has fallen by 50 per cent., the neonatalrate has remained stationary. Dr. Kenwood hasendeavoured to arrange with the London hospitals fora notice to be sent to the borough maternity and childwelfare department when children requiring after-care are discharged from hospital. He has suppliednotification forms to the various hospitals with stampedand addressed envelopes, but so far has not receivedthe full information desired. He thinks the generaladoption in London of such a system would be of greatbenefit to the children and would also be a relief to thehospital almoners. During the year arrangementshave been made with the British Dental Hospital toequip and maintain a surgery on the council’spremises and to provide, direct, and supervise a

dentist at an inclusive charge of £120 yearly. Thisscheme will provide dental treatment in connexionwith the maternity and child welfare work-ascheme similar to that adopted in Battersea,Hampstead, Holborn, Shoreditch, and Stepney.

TVatford.Dr. William J. Cox states that the housing question

in the borough still remains one of great difticulty andthat there are about 1500 families waiting for municipalhouses, in spite of the fact that 953 municipal houseshave been erected since 1920 and that 172 are in hand.In addition 114 non-parlour houses have been erectedon the Wiggenhall Estate to rehouse the tenants ofhouses closed. In 1921 the late Dr. A. King, M.O.H.,scheduled six areas including 249 insanitary houses,of which 138 have been dealt with up to now. TheWatford Joint Isolation Hospital had an unusualexperience during 1926 in having to admit 20 blindinfants and most of the staff from Sunshine House,Chorley Wood. An epidemic affected practicallyeveryone in this institution and was subsequentlydecided to be German measles. All the cases weremild. Out of 173 samples of milk examined 7 werefound to contain tubercle bacilli and 20 blood or puscells. Watford is an important centre for the slaughterof animals, and the " Kosher " method is practised atone large slaughter-house. The consultations at theantenatal centre are well attended ; the number ofexpectant mothers for 1926 was 276, while the totalbirths were 775. The dental work is also increasing.The orthopaedic centre under Mr. S. L. Higgs dealtwith 62 Watford children sent from the infant welfarecentre suffering from various deformities. Thisinstitution is an out-centre for an orthopaedic hospitaland serves the neighbouring district. Dr. Uox, as

assistant school medical officer for 1-terts, is responsiblefor the medical inspection of half the Watford schools,

and states that there is very little difficulty inubtaifiing treatment iur tin’ ailments of the childrenAN-heii the need has been pointed out t" tlm parents.Reinspection by the dentist shows an increasing

percentage of children with sound dentures year by

year. ________________

INFECTIOUS DISEASE IN ENGLAND ANDWALES DURING THE WEEK ENDED

JUNE 11TH, 1927.

Notifications.—The following cases of infectionsdisease were notified during the week: - Small-pox.243 (last week 25i); scarlet fever. 1128: diphtheria.668; enteric fever. 80; pneumonia. 915: puerperalfever, 43; puerperal pyrexia, 90; cerebro spinalfever. 14 acute poliomyelitis, 6; encephaliti-lethargica, 32 dysentery, 4; ophthalmia neona-

torum. 113.

Cases of small-pox were notified from the countres of

Derby 2, Durham 125, Kent I (Gravesend). Lancet-tep laNorthumberland ] ,í, Nottitigiiiiii (Mansfield and ManstieldWoodhouse), Stafford 1. Warwick 1 (Coventr, ,. York--North Riding 1 (Eston), Yorks West Riding 3s, City of York .Glamorgan 7. Monmouth : 3. None was returned froml,ondon, Middlesex, or Surrey.

Deaths.—In the aggregate of great towns, includingLondon, there were no deaths from small-pox, 4 (2)from enteric fever, 43 (1) from measles, 6 (1) fromscarlet fever, 31 (I)) from whooping-cough, 1! (2)from diphtheria, 47 (10) from diarrhœa and entetiti-under two years, and 33 (J) front influenza. Thefigures in parentheses aie those for London it self.

The Services.ROYAL ARMY MEDICAL CORPS.

THE undermentioned Capts. to be Majs. : I Cran (Prov.),L. A. J. Graham, and .1. C. Denvir.

Capt. L. C. Goument retires, receiving a gratuity.R. S. de C. Bennett to be temp. Lt.

ARMY DENTAL CORPS.

Capt. J. V. M. Byrne to he Maj.

THERRITORIAL ARMY.

Col. Sir George T. Beatson vacates the appt. of Hon. Col.R.A.M.C. Units, 52nd (Lowland) Div., on completion oftenure.

Col. G. H. Edington (retd.) to be Hon. Col. R.A.M.C.

Units, 52 (Lowland) Div.Lt. 0. G. Misquith. late R.A.M.C.. T.A., to be Lt.W’. R. Ward, late Surg. Sub.-Lt.. R.N.V.R., to be Lt.

TERRITORIAL ARMY RESERVE OF OFFICERS.

Capt. R. M. Savege. from the Active Liat, tu be Capt.

ROYAL AIR FOUCE.

E. P. Carroll and G. W. McAleer are granted short servicecommissions in the rank of Flying Oilicer for three years onthe active list.

--

INDIAN MEDICAL SERVICES.

The King has approved of the retirement of Lt.-Cols.E. O. Thurston and T. (r. N. Stokes.

Capt. J. D. L. Yule to be Mai.Lt. J. E. Gray to be Capt. (Prov.).Lt.-Col. W. M. H. Spiller to be officiating A.D.M.S.,

C.P. District, vice Col. E. P. Sewell, on leave. Capt.C. S. V. Ramanan has been appointed Specialist inOphthalmology, Madras District (temporarily), vice Maj.E. F. BV. Grellier. Captain C. S. Allagappan has beenappointed Specialist in Surgery, Secunderabad. vice Capt.Cr. A. Whitfield. Maj. E. F. W. Grellier lias been appointedSpecialist in Ophthalmology, Lahore District, vice Maj.R. M. Dickson. Maj. G. D. R. Carr has been appointedSurgical Specialist, Lahore District, Lahore (temporarily).vice Vlaj. R. V. Vint. Maj. C. II. II. Harold to be AssistantDirector of Hygiene and Pathology. Headquarters. NorthernCommand, vice Maj. T. S. Blackwell. Maj. M. J. Williamsonto be officiating D.A.D.M.S. (Mobilisation). Peshawar