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650 Public Health and Poor Law. LOCAL GOVERNMENT DEPARTMENT. REPORTS OF MEDICAL OFFICERS OF HEALTH. I -Dur7tant County -District.-Dr. Eustace Hill has recently .presented to the Durham county council an interesting I account of an outbreak of enteric fever which occurred in ’the autumn of 1895 in the urban district of Leadgate. The - outbreak lasted during September, October, and November, most of the cases being notified during September and the first half of October. As, however, Dr. Hill remarks, the dates of notification cannot be relied upon as indicating the dates upon which the patients were taken ill, since several of the cases were notified two or three weeks after the com- mencement of the illness. There were several interesting points in connexion with the disease. In the first place the .percentage incidence up to forty years of age was much more marked upon the males than upon the females, but .after this age the excess was on the females. This male excess may perhaps be accounted for partly by the habits and occupation of the working population, but we note that even under ten years of age the disparity still obtained. In its clinical aspects the disease presented some inte- resting features, such, for instance, as the absence of diarrhosa in numerous cases, and a large number of quite anomalous attacks bearing a strong resemblance to influenza, but often occurring in households where apparently were well- marked cases of enteric fever. The fatality rate of the epidemic was very small-a little over 5 per cent.-and the disease seemed to be possessed of a considerable degree of infectivity. Having regard to the rather anomalous character of the outbreak some remarks on the eruption, condition of the spleen, and the temperature would have been interesting. As to the cause of the outbreak, the Leadgate district is supplied with water by the Consett Water Company, and the same company supplies water from the same source to other districts in north-west Durham. There was thus at hand a controlling factor as regards water-supply, and by an - examination of the notification returns ot the other districts supplied by the Consett Water Company it was soon apparent that the pollution of the company’s water at its source would not explain the outbreak, and that any question of water pollution must necessarily be of a local nature. On examining into the recent history of the water company’s operations, Dr. Hill was able to elicit the fact that the main supplying Leadgate suddenly burst on Sept. lst at a point on the reservoir side of Leadgate and from eight to ten hours the water was cut off from the town. It also seems that at dates antecedent to this the water-supply of Leadgate was turned off. The question, therefore, suggests itself as to whether during one of these intervals the water-mains supplying Leadgate may not have become specifically fouled, and a thesis of this kind seems, on the whole, the best ’explanation of the outburst. The district is a mining one where settlements of the ground are common, and this fact renders fracture and displacement of sewers and water-mains a not improbable matter. Although water seems to have probably been the most potent factor in the outburst, suspi- cion rests upon a certain milk-supply as having been at least a subsidiary cause, and the conditions which Dr. Hill’s report reveals of the absence of proper control over the milk traffic of the district are certainly such as to call for speedy atten- tion. There is the further fact in connexion with the milk- supply that many of the cows were fed in fields through which sewage-polluted streams passed, but Dr. Hill was unable to ascertain that any of the cows suffered from illness. In addition to water and milk as factors in causation Dr. Hill was led to suspect emanations from sewers and infected privies as having had some share in spreading the disease, and the recommendations with which his report closes have in view the amelioration of all the conditions likely to have had a share in causation. Aston 1llczzor Urban lJi.strict.-Mr. Henry May, medical officer of health of this district, is always very prompt in issuing his annual report, and we have just received that relating to 1895. As an illustration of the value of isolation Mr. May observes that in his experience- when a first case of scarlet fever in a house is removed to hospital, it has rarely been followed by an extension of the disease to the other members of the same family, whereas non-removal has generally resulted in extension through the household. We should have been glad of some figures in support of this statement, as really reliable evidence on this point is well worth recording, and the subject is by no means a simple one. During 1895 there were 35 cases of small-pox notified in this district, and Mr. May has added these cases to those occurring during 1893-4, and furnished a table in regard to their vaccination &c. which we here reproduce; it will be seen that there were no deaths among vaccinated children under fifteen , years of age. u i 1 t In the matter of hospital accommodation the sanitary authority are to be congratulated upon their determination to provide a separate building for small-pox well removed from human habitations. Poole Urban District.-Dr. Herbert Lawton is endeavour- ing to enforce dual notification in his district, and he reports that during 1895 in only 12 instances did the householder or nearest relative fail to notify to the medical officer of health. The new scheme for the sewage of Poole seems to be advanc- ing in a satisfactory manner, and we are glad, too, to see that Dr. Lawton’s repeated recommendations in reference to a revision of the obsolete by-laws have at last been carried into effect. Dr. Bulstrode, of the Local Government Board, has, it appears, been stimulating the authority as to the condition of the dairies, cowsheds, and milkshops of the district. As far as we are able to judge from Dr. Lawton’s remarks regulations under the Dairies, Cowsheds, and Ililk- shops Order seem to have been drawn up by the sanitary authority, but to have been allowed hitherto to remain in practice a dead letter, and Dr. Lawton requests to be supplied with copies of the regulations in order that they may be properly distributed in the district. There are few matters of more importance to the public health, more especially to the infantile population, than a proper supervision of the milk traffic of a district ; and it is perfectly obvious that unless the milk vendors know what is the law relative to cleansing &c. they can hardly be expected to comply with its requirements. Huddersfield Urban District.-In his last quarterly report Dr. Robert Kaye states that the sanitary authority of Hudders- field have resolved to furnish the medical officer of health with a supply of diphtheric antitoxin for the convenience of any medical practitioner in the district who may care to make use of it. VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN thirty-three of the largest English towns 6468 births and 4159 deaths were registered during the week ending Feb. 29th. The annual rate of mortality in these towns, which had been 19-3 and 19-4 per 1000 in the two preceding weeks, further rose last week to 20-0. In London the rate was 20-3 per 1000, while it averaged 19 in the thirty-two provincial towns. The lowest rates in these towns were 10-2 in Derby, 12-2 in Cardiff, 13 7 in Burnley, 14 3 in Brighton, and 15 in Croydon ; the highest rates were 23’0 in Bolton, 23-7 in Manchester, 239 in Liverpool, 25-0 in Norwich, and 25-2 in Preston. The
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Page 1: VITAL STATISTICS.

650

Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL OFFICERS OF HEALTH. I

-Dur7tant County -District.-Dr. Eustace Hill has recently.presented to the Durham county council an interesting Iaccount of an outbreak of enteric fever which occurred in’the autumn of 1895 in the urban district of Leadgate. The- outbreak lasted during September, October, and November,most of the cases being notified during September and thefirst half of October. As, however, Dr. Hill remarks, thedates of notification cannot be relied upon as indicating thedates upon which the patients were taken ill, since several ofthe cases were notified two or three weeks after the com-mencement of the illness. There were several interestingpoints in connexion with the disease. In the first place the.percentage incidence up to forty years of age was muchmore marked upon the males than upon the females, but.after this age the excess was on the females. This maleexcess may perhaps be accounted for partly by the habits andoccupation of the working population, but we note thateven under ten years of age the disparity still obtained.In its clinical aspects the disease presented some inte-

resting features, such, for instance, as the absence ofdiarrhosa in numerous cases, and a large number of quiteanomalous attacks bearing a strong resemblance to influenza,but often occurring in households where apparently were well-marked cases of enteric fever. The fatality rate of the

epidemic was very small-a little over 5 per cent.-and thedisease seemed to be possessed of a considerable degree ofinfectivity. Having regard to the rather anomalous characterof the outbreak some remarks on the eruption, condition ofthe spleen, and the temperature would have been interesting.As to the cause of the outbreak, the Leadgate district is

supplied with water by the Consett Water Company, and thesame company supplies water from the same source to otherdistricts in north-west Durham. There was thus at handa controlling factor as regards water-supply, and by an- examination of the notification returns ot the other districtssupplied by the Consett Water Company it was soon apparentthat the pollution of the company’s water at its source wouldnot explain the outbreak, and that any question of waterpollution must necessarily be of a local nature. On examininginto the recent history of the water company’s operations,Dr. Hill was able to elicit the fact that the main

supplying Leadgate suddenly burst on Sept. lst at a

point on the reservoir side of Leadgate and from eight to tenhours the water was cut off from the town. It also seemsthat at dates antecedent to this the water-supply of Leadgatewas turned off. The question, therefore, suggests itself asto whether during one of these intervals the water-mainssupplying Leadgate may not have become specifically fouled,and a thesis of this kind seems, on the whole, the best’explanation of the outburst. The district is a mining onewhere settlements of the ground are common, and this factrenders fracture and displacement of sewers and water-mainsa not improbable matter. Although water seems to have

probably been the most potent factor in the outburst, suspi-cion rests upon a certain milk-supply as having been at leasta subsidiary cause, and the conditions which Dr. Hill’s reportreveals of the absence of proper control over the milk trafficof the district are certainly such as to call for speedy atten-tion. There is the further fact in connexion with the milk-

supply that many of the cows were fed in fields throughwhich sewage-polluted streams passed, but Dr. Hill wasunable to ascertain that any of the cows suffered from illness.In addition to water and milk as factors in causation Dr. Hillwas led to suspect emanations from sewers and infectedprivies as having had some share in spreading the disease,and the recommendations with which his report closes havein view the amelioration of all the conditions likely tohave had a share in causation.

Aston 1llczzor Urban lJi.strict.-Mr. Henry May, medicalofficer of health of this district, is always very prompt inissuing his annual report, and we have just received thatrelating to 1895. As an illustration of the value of isolationMr. May observes that in his experience- when a first case ofscarlet fever in a house is removed to hospital, it has rarely

been followed by an extension of the disease to the othermembers of the same family, whereas non-removal has

generally resulted in extension through the household. Weshould have been glad of some figures in support of thisstatement, as really reliable evidence on this point is wellworth recording, and the subject is by no means a simple one.During 1895 there were 35 cases of small-pox notified in thisdistrict, and Mr. May has added these cases to those occurringduring 1893-4, and furnished a table in regard to theirvaccination &c. which we here reproduce; it will be seen thatthere were no deaths among vaccinated children under fifteen

,

years of age. -

u i 1 t

In the matter of hospital accommodation the sanitaryauthority are to be congratulated upon their determination toprovide a separate building for small-pox well removed fromhuman habitations.

Poole Urban District.-Dr. Herbert Lawton is endeavour-ing to enforce dual notification in his district, and he reportsthat during 1895 in only 12 instances did the householder ornearest relative fail to notify to the medical officer of health.The new scheme for the sewage of Poole seems to be advanc-ing in a satisfactory manner, and we are glad, too, to seethat Dr. Lawton’s repeated recommendations in reference toa revision of the obsolete by-laws have at last been carriedinto effect. Dr. Bulstrode, of the Local Government Board,has, it appears, been stimulating the authority as to thecondition of the dairies, cowsheds, and milkshops of thedistrict. As far as we are able to judge from Dr. Lawton’sremarks regulations under the Dairies, Cowsheds, and Ililk-shops Order seem to have been drawn up by the sanitaryauthority, but to have been allowed hitherto to remain inpractice a dead letter, and Dr. Lawton requests to be suppliedwith copies of the regulations in order that they may beproperly distributed in the district. There are few mattersof more importance to the public health, more especially tothe infantile population, than a proper supervision of themilk traffic of a district ; and it is perfectly obvious thatunless the milk vendors know what is the law relative tocleansing &c. they can hardly be expected to comply withits requirements.

Huddersfield Urban District.-In his last quarterly reportDr. Robert Kaye states that the sanitary authority of Hudders-field have resolved to furnish the medical officer of healthwith a supply of diphtheric antitoxin for the convenience ofany medical practitioner in the district who may care tomake use of it.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN thirty-three of the largest English towns 6468 birthsand 4159 deaths were registered during the week endingFeb. 29th. The annual rate of mortality in these towns,which had been 19-3 and 19-4 per 1000 in the two precedingweeks, further rose last week to 20-0. In London therate was 20-3 per 1000, while it averaged 19 in the

thirty-two provincial towns. The lowest rates in thesetowns were 10-2 in Derby, 12-2 in Cardiff, 13 7 in Burnley,14 3 in Brighton, and 15 in Croydon ; the highestrates were 23’0 in Bolton, 23-7 in Manchester, 239 in

Liverpool, 25-0 in Norwich, and 25-2 in Preston. The

Page 2: VITAL STATISTICS.

651

4159 deaths included 580 which were referred to the

principal zymotic diseases, against 512 and 561 in thetwo preceding weeks ; of these, 222 resulted frommeasles, 156 from whooping-cough, 91 from diphtheria,41 from scarlet fever, 41 from diarrhoea, 29 from "fever" "

(principally enteric), and not one from small-pox. No deathfrom any of these diseases occurred in Wolverhampton orin Halifax; in the other towns they caused the lowestdeath-rates in Burnley, Swansea, Cardiff, and Preston,and the highest rates in Birkenhead, Manchester, Salford,and Norwich. The greatest mortality from measles ocurredin Leeds, London, Birkenhead, Sunderland, Leicester, andNorwich ; and from whooping-cough in Derby, West Ham,Manchester, Bradford, and Bolton. The mortality fromscarlet fever and from " fever" showed no marked excessin any of the large towns. The 91 deaths from diphtheriaincluded 48 in London, 10 in Birmingham, 6 in Liverpool,4 in Bradford, and 3 each in Portsmouth, Hull, and New-castle-upon-Tyne. No fatal case of small-pox was

registered in any of the thirty-three large towns.There were 51 cases of small-pox under treatmentin the Metropolitan Asylum Hospitals and in the

Highgate Small-pox Hospital on Saturday last, the 29thult, against 64, 60, and 58 at the end of the three

preceding weeks; 1 new case was admitted during theweek, against 6, 12, and 5 in the three preceding weeks.The number of scarlet fever patients in the MetropolitanAsylum Hospitals and in the London Fever Hospital at theend of the week was 2933, against 2883, 2944, and 2937on the three preceding Saturdays; 244 new cases were

admitted during the week, against 285, 303, and 234 in thethree preceding weeks. The deaths referred to diseases ofthe respiratory organs in London, which had declined from446 to 377 in the three preceding weeks, rose again to 404last week, but were 213 below the corrected average. Thecauses of 61, or 1’5 per cent., of the deaths in the thirty-three towns were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death were Iduly certified in Brighton, Portsmouth, Bolton, Oldham, andin eight other smaller towns ; the largest proportions ofuncertified deaths were registered in Birmingham, Leicester,Preston, and Huddersfield.

____

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had increased in the three preceding weeks, from18’8 to 19’5 per 1000, was again 19’5 during the week endingFeb. 29th, and was 0’5 per 1000 below the mean rate duringthe same period in the thirty-three large English towns.The rates in the several towns ranged from 14’0 in Leithand 15’0 in Paisley to 20’8 in Glasgow and 20’9 inDundee. The 570 deaths in these towns included 27 whichwere referred to whooping-cough, 17 to diarrhoea, 9 to

measles, 6 to diphtheria, 3 to scarlet fever, 2 to "fever,"and not one to small-pox. In all, 64 deaths resulted fromthese principal zymotic diseases, against 66 and 60 in thetwo preceding weeks. These 64 deaths were equal to anannual rate of 2-2 per 1000, which was 0’6 below the meanrate last week from the same diseases in the thirty-threelarge English towns. The fatal cases of whooping-cough,which had been 30 and 32 in the two preceding weeks, de-clined again to 27 last week, of which 17 occurred in Glasgow,and 3 in Aberdeen. The 17 deaths from diarrhoea exceededthe numbers recorded in recent weeks, and included 10 inGlasgow. The fatal cases of measles, which had been 5and 4 in the two preceding weeks, rose to 9 last week, ofwhich 6 occurred in Glasgow and 2 in Edinburgh. The- deaths referred to diphtheria, which had been 10, 5, and1 in the three preceding weeks, rose again to 6 last week,and included 3 in Edinburgh. The 3 fatal cases of scarletfever showed a decline of 3 from the number in the pre-ceding week, and included 2 in Glasgow, where the 2 deathsreferred to "fever" were also recorded. The deaths fromdiseases of the respiratory organs in these towns, whichhad been 105 and 120 in the two preceding weeks, declinedto 111 last week, and were little more than a fifth of theexceptionally high number recorded in the correspondingweek of last year. The causes of 37, or more than 6 percent., of the deaths in these eight towns last week were notcertified.

____

HEALTH OF DUBLIN.

The death-rate in Dublin, which had declined in the e

five preceding weeks from 27’4 to 19-8 per 1000, rose againto 28-5 during the week ending Feb. 29th. During thepast nine weeks of the current quarter the death-rate inthe city has averaged 25-2 per 1000, the rate during thesame period being 19 4 in London and 17’4 in Edinburgh.The 178 deaths registered in Dublin during the week undernotice showed an increase of 45 upon the number in thepreceding week, and included 9 which were referred tothe principal zymotic diseases, against 10, 8, and 2 in thethree preceding weeks; of these, 5 resulted from " fever,"2 from scarlet fever, 1 from whooping-cough, 1 fromdiarrhoea, and not one either from small-pox, measles,or diphtheria. These 9 deaths were equal to an annualrate of 1’3 per 1000, the zymotic death-rate during thesame period being 3’4 in London and 1-9 in Edinburgh.The deaths referred to different forms of "fever," which hadbeen 2, 3, and 1 in the three preceding weeks, rose again to5 last week. The mortality from scarlet fever also exceededthat recorded in the preceding week. The 178 deaths inDublin last week included 21 of infants under one yearof age, and 36 of persons aged upwards of sixty years ;the deaths both of infants and of elderly persons showed adecline from the numbers recorded in recent weeks. Eightinquest cases and 8 deaths from violence were registered;and 67, or more than a third, of the deaths occurred in

public institutions. The causes of 8, or nearly 5 per cent.,of the deaths in the city last week were not certified.

THE SERVICES.

MOVEMENTS OF THE MEDICAL STAFF.THE following officers have embarked for India :-Surgeon-

Lieutenant-Colonel Swayne and Surgeon-Major Mitchell; andthe following have arrived from India :--Brigade-Surgeon-Lieutenant-Colonel H. T. Browne and Surgeon-Majors Buttand Watson. Surgeon-Majors Hughes, Bartlett and Porter,and Surgeon-Captains Cummins and Wilson, and Surgeon-Lieutenant Spencer have arrived from Ashanti. Surgeon-Major Barker has been appointed to Dover, and Surgeon-Captain Allport has embarked for Malta. Surgeon-CaptainDunn has been transferred from India to the EgyptianArmy. >

INDIA AND THE INDIAN MEDICAL SERVICES.The Queen has been pleased to approve of the following

admissions to Her Majesty’s Indian Medical Services :-To be Surgeon-Lieutenants (dated Jan. 29th, 1896). Bengal :Archer William Ross Cochrane, William Wesley Clemesha,James Alexander Black, Roger Parker Wilson, VictorEdward Hugh Lindesay, James Currie Robertson, NormanRobinson Jones Rainier, .Christopher Dering Dawes, andEdmund Ludlow Perry. Madras: Michael Biddulph Pin-chard, William James Niblock, Clarence Barrymore Harrison,Ernest Le Fevre Payne, Nicholas Purcell O’Gorman Lalor,Thomas Henry Symons, and Ernest Reinhold Rost.

Bombay: Chintaman Ramchandra Bakhle and KrishnajiVishnoo Kukday.

Surgeon-Lieutenant-Colonel Randolph Caldecott to be

Brigade-Surgeon-Lieutenant-Colonel, subject to Her Majesty’sapproval, vice Brigade-Surgeon-Lieutenant-Colonel S. O’B.Banks, promoted. Surgeon-Lieutenant-Colonel FrankHokins Pedroza, Madras Medical Establishment, retiresfrom the service. Surgeon-Lieutenant-Colonel A. Reid,M.B., Bengal Medical Establishment, to be Medical Store-keeper, Punjab Command, sub. pro tenz., vice Brigade-Surgeon-Lieutenant-Colonel C. W. Calthrop, appointedPrincipal Medical Officer, Malakand Brigade. Surgeon-Major L. A. Wadell, M.B., Deputy Sanitary Commissioner,Northern Circle, Bengal, is appointed Chemical Exp minerand Professor of Chemistry in the Medical College, Calcutta.

NAVAL MEDICAL SERVICE.

Jeremiah Sugrue, M.D., has been promoted to the rank ofStaff-Surgeon in Her Majesty’s Fleet.The following appointments are notified :-Fleet-Surgeon

R. W. Williams to the Irnperieuse. Staff Surgeons : G. D.Twigg to the ..L1Iersey; J. H. Thomas to the Daedalus;Henry Harries to the Grafton; ; and J. Sugrue, M.D., tothe j’?MX2;<M-. Surgeons : H. Huskisson, M.B., and M. P.Jones to the 1ic/ ; ; E. T. Tuck, H. G. T. Major,W. R. Trythall, and J. C. Rowan, M.B., to the FM/ "C. J. E. Cock to the Tlivid, to be lent to the Impregnable,


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