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living room. As to water-supply, the most noticeabledefect lies in the direct communications between water-closets and waterpipes. Of 300 houses inspected, 180 hadbeen invaded by scarlet fever; 351 cases and 43 deathshaving taken place up to the end of December last. Butnotwithstanding the grave sanitary defects observed,Dr. Blaxall states that his inquiry went to show that thespread of the disease was essentially effected by personal inter-communication between infected and healthy, the schoolsplaying a prominent part in the dissemination. The schoolswere, indeed, at first closed, but on their reopening, threechildren attended who were actually ill with scarlet fever ;and in the end, 87 persons had to tell the tale of the firstattacks in their families being in the persons of childrenwho returned from school ill with the complaint. Manyreckless instances of exposure of infected persons were alsoheard of. It is likewise noticed that a number of persons datedtheir attack from attending on the occasion of laying thememorial stone on Nov. 5th, on the spot where the Princeof Orange landed, the event having brought together a largeconcourse of people. Unfortunately Dr. Blaxall’s reporttells the story of serious neglect in sanitary administration.No means of isolation were available, no efficient measuresof disinfection of bedding and clothing were resorted to, nopains were taken to prevent the exposure of infected persons,and no warning was given against the free intercommunica-tion that prevailed, beyond advising the closure of theschools at the beginning of November. Recommenda- I,tions are appended to Dr. Blaxall’s report, and theseaim at securing for Lower Brixham such sanitary circum-stances as shall tend to prevent the occurrence of preventableinfectious disease, and to stay its spread should it beaccidentally imported, as also to secure for the place animproved sanitary administration and a better performanceof the duties which properly devolve on the sanitary officialsappointed under the Public Health Act.

Diphtheria at Camberley and York To2arz, by Dr.PARSONS.—These districts, in the parish of Frimley, areacquiring an unenviable reputation as regards diphtheria;but it is difficult to assert with any degree of confidence towhat the recurrence of this disease in the locality is due.Since 1886, when Mr. Power reported on a milk epidemicthere, the district seems to have been tolerably free fromdiphtheria or other throat illness until the autumn of lastyear, and then, following on certain deaths from " croup

"

and "laryngismus stridulus," together with ill-definedthroat attacks, diphtheria made its appearance at the closeof September; and in the end there were, between this dateand Jan. 12th of this year, sixty attacks in twenty-sixfamilies, and nineteen deaths. The 1886 outbreak wasespecially marked upon the well-to-do classes, its incidencebeing apparently related to the amount of milk consumed;but this last epidemic attacked almost exclusively personsof the cottager class, servants, artisans, and labourers.The bulk of the sufferers were also children belonging tothe school-going classes. Dr. Parsons, having regard to thelocalisation, distribution, and other circumstances of theoutbreak, points out that in order to explain the firstreal dissemination of the disease, there should be foundsome condition or combination of circumstances cominginto operation about the beginning of November last,and acting in a scattered fashion over a somewhatwide area, though exhibiting a preference for certainlocalities, and confined in its operation to the poorer or lowermiddle class. But no such condition could be ascertainedas having thus operated. Certain conditions, such as milk-supply, could apparently be excluded with confidence;school-going seems unquestionably to have operated in

spreading the infection ; and communication with animals,such as a cat and p’geons, which similarly suffered fromfatal throat disease, seems to have caused diffusion of infec-tion, but whether it was conveyed from the lower animal tothe human being or the reverse is by no means clear. Damp,boggy situations, dampness from defective eave-spouting, andill-ventilated houses were also noticed in the places affected ;and in some instances there was history of exposure to sewereffluvia; for Camberley, having a system of sewers, has nopublic water-supply, a position which must always be un-satisfactory, and often attended with danger of distinct andunwholesome nuisance. There is also no isolation hospital,and hence no chance of staying such infections promptly.The Surrey County Council is, however, expected to inter-vene as to the administration by an urban authority of partof the district involved.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Northampton Urban District.—With a population nowexceeding 61,000, Northampton had during 1888 the lowestdeath-rate recorded for thirteen years-namely, one of 15’6per 1000; the former high rate of infantile mortality alsoshows indications of change for the better, and the zymoticrate was the lowest recorded for a long period. Only 2deaths from diphtheria were registered ; but there is thesuspicious record of 7 from " croup," which was not of thespasmodic type. The only means of isolation possessed bythe Northampton corporation consists of some "hideoushuts," which are not even weather-proof ; and Mr. Cogan,while declaring them to be a disgrace to the town, veryproperly urges that a hospital having some attractivenessabout it should be substituted for the present very deterrentaccommodation, which cannot fail to be a serious source ofhindrance to the sanitary authority in any future attemptsat securing isolation. There is now an abundant and awholesome water service available for the borough, andhence there is now no longer excuse for resorting to localwells in the town. In some instances there is record of theclosure of such wells, and they should soon be altogetherthings of the past. The town stands much in need ofmodern bye-laws as to the drainage of new buildings, theregulations in force being mainly of value as indicating howsuch work ought never to be done.Kettering Urban District.--The presence of enteric fever

in this district during 1888 is stated by Mr. W. Dryland tohave been a cause of much anxiety. Indeed, twice recentlythe disease has prevailed somewhat extensively; it caused15 deaths in 1886, and 10 last year. During the monthof March last intractable diarrhoea led to the breakirrgup of a girl’s school, and shortly afterwards enteric feverappeared amongst the scholars in four or five different partsof the country, simultaneous attacks occurring amongstsome of the inhabitants of the town in connexion with afalling off in the public water-supply and in the imperfectcondition of a local sewer and its connexions. After a fort-night’s continuous flushing this sewer was cleared of itssolid contents, and the fever in that locality virtuallyceased. But other cases occurred in the town in April,June, July, and August. One redeeming feature of theattack is that it gave occasion for a large amount of sani-tary work, including the relaying of certain sewers, and itis stated that steps have been taken to secure a furthersupply of water for the town, which, it is hoped, will soonhave a constant service. As far as can be judged of thepresent population, the general death-rate for the year isheld to be about 16 per 1000.Belper Rural District.—Notwithstanding the importation

of small-pox, this district was saved by Mr. Allen fromhmriedly erecting a hospital that would have been uselessfor permanent purposes, and the authority are again urgedto make proper provision whilst they are free from anyemergency. Although the general death-rate has diminished,that amongst infants is still held to be far too high. Asteady diminution is also reported as to nuisances, and thebye-laws in operation are expected to secure for new dwell-ings appropriate sanitary surroundings. The regulationsunder the Contagious Diseases (Animals) Act, which weresuggested by the Derbyshire Dairy Farmers’ Association,have been virtually adopted, and it is hoped that they willwork satisfactorily. In the meantime dairy and dairy-farmpremises are carefully inspected.

Halifcax Urban Dastrict.-The annual report for 1888 byMr. D. Ainley consists almost exclusively of statements ofstatistics and of causes of death, from which it appears thatthe general mortality was at the rate of 19’6 per 1000, arate distinctly below the average; the zymotic rate was1 per 1000. The borough hospital has been again mostuseful, and it is worthy of note that during the past twoyears not a single death from scarlet fever has occurredamongst those isolated there. The inspector of nuisancesappends a report dealing with a number of subjects, andindicating that in his department considerable activity ismaintained.

VITAL STATISTICS..

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 5667 birthsand 3547 deaths were registered during the week endingApril 2’Jth. The annual rate of mortality in these towns,

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which had been 20’3 and 19’9 per 1000 in the preceding Itwo weeks, further declined last week to 19’4. During thefirst three weeks of the current quarter the death-rate inthese towns averaged 19’9 per 1000, and was 2-7 belowthe mean rate in the corresponding periods of the ten

years 1879-88. The lowest rates in these towns lastweek were 12’0 in Brighton, 13’9 in Leicester, 14’2 inBirkenhead, and 16’6 in Norwich. The rates in the othertowns ranged upwards to 25’6 in Newcastle-upon-Tyne,28’0 in Blackburn, 28’6 in Manchester, and 37’6 in Preston.The deaths referred to the principal zymotic diseases inthese towns, which had been 464 and 436 in the precedingtwo weeks, were last week 440; they included 177 frommeasles, 133 from whooping-cough, 42 from diphtheria, 36from scarlet fever, 33 from diarrhoea, 19 from "fever" "

(principally enteric), and not one from small-pox. Thesezymotic diseases caused the lowest death-rates last weekin Leicester, Hull, and Derby; and the highest rates inPlymouth, Manchester, Bolton, and Preston. The greatestmortality from measles was recorded in Huddersfield,Preston, Blackburn, Bolton, and Manchester ; fromwhooping-cough in Oldham, Cardiff, Nottingham, Preston,and Plymouth ; and from scarlet fever in Sheffieldand Blackburn. The 42 deaths from diphtheria in thetwenty-eight towns included 22 in London, 6 in Salford,4 in Bolton, and 3 in Manchester. The mortality from"fever" showed no marked excess in any of the towns ; andmo death from small-pox was registered in any of thetwenty-eight great towns. No small-pox patient wasunder treatment at the end of the week either in theMetropolitan Asylum Hospitals or in the HighgateSmall-pox Hospital. The number of scarlet-fever patientsin the Metropolitan Asylum and London Fever Hospitalsat the end of last week was 570, against 580 and 572 inthe preceding two Saturdays; 50 cases were admittedto these hospitals during the week, against 47 and 56 in theprevious two weeks. The deaths referred to diseases of ’,the respiratory organs in London, which had been 364 and294 in the preceding two weeks, were. last week 299, and were 105 below the corrected weekly average. The causesof 64, or 1-8 per cent., of the deaths in the twenty-eighttowns last week were not certified either by a registeredmedical practitioner or by a coroner. All the causes ofdeath were duly certified in Sunderland, Oldham, Ports-mouth, Brighton, and in six other smaller towns. Thelargest proportions of uncertified deaths were registered inHuddersfield, Bradford, Leeds, and Newcastle-upon-Tyne.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 21’8 and 23’0 per 1000 in the preceding twoweeks, further rose to 23’7 in the week ending April 20th;this rate exceeded by 4’3 per 1000 the mean rate during thesame period in the twenty-eight large English towns. Therates in these Scotch towns ranged last week from 14’0and 15-8 in Greenock and Perth, to 29’4 in Glasgowand 29’9 in Paisley. The 607 deaths in the eight townsshowed a further increase of 19 upon the numbers in thepreceding two weeks, and included 50 which were referredto whooping-cough, 34 to measles, 8 to diarrhoea, 6 to

diphtheria, 5 to "fever" (principally enteric), 4 to scarletfever, and not one to small-pox; in all, 107 deaths resultedfrom these principal zymotic diseases, against 90 and 87m the preceding two weeks. These 107 deaths were equalto an annual rate of 4’2 per 1000, which exceeded byt’8 the mean rate from the same diseases in thetwenty-eight English towns. The fatal cases of whoop-Mg-cough, which had increased in the preceding four weeksfrom 31 to 44, further rose last week to 50, of which 39occurred in Glasgow, 5 in Dundee, and 4 in Edinburgh. The34 deaths from measles exceeded those in the previous weekby 7, and included 23 in Glasgow, 5 in Aberdeen, and 3 inGreenock. The 8 deaths attributed to diarrhoea, of which5 occurred in Glasgow, also exceeded the number in theprevious week. The 6 fatal cases of diphtheria, on theother hand, showed a further decline from the numbers inrecent weeks, and included 3 in Glasgow and 2 in Edin-burgh. Three of the 4 deaths from scarlet fever and 3 ofthe 5 from "fever" were returned in Glasgow. The deathsfrom the principal diseases of the respiratory organs, whichhad steadily declined in the preceding five weeks from 173to 122, rose again last week to 140, and exceeded thenumber in the corresponding week of last year by 14.

The causes of 75, or more than 12 per cent., of the deathsregistered during the week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 25’7 per 1000in each of the preceding two weeks, declined to 23’5in the week ending April 20th. During the first threeweeks of the current quarter the death-rate in the cityaveraged 25’0 per 1000, the mean rate during the sameperiod being only 17’9 in London and 17-8 in Edinburgh.The 159 deaths in Dublin showed a decline of 15 fromthe number returned in each of the previous two weeks;they included 3 which were referred to whooping-cough,2 to measles, 2 to "fever," 1 to diarrhoea, and not oneeither to small-pox, scarlet fever, or diphtheria. Thus thedeaths from these principal zymotic diseases, which hadbeen 7 and 21 in the previous two weeks, declined againlast week to 8; they were equal to an annual rate of 1’2per 1000, the rates from the same diseases being 2’0 inLondon and 1’6 in Edinburgh. The fatal cases both ofmeasles and of whooping-cough showed a considerabledecline from the numbers in the previous week. Thetwo deaths from " fever " were below the average, and cor-responded with the number in each of the previous twoweeks. The deaths both of infants and of elderly personsshowed a decline from the numbers in the precedingweek. Three inquest cases and 3 deaths from violencewere registered; and 51, or nearly a third, of the deathsoccurred in public institutions. The causes of 19, or

nearly 12 per cent., of the deaths in the city were notcertified.

Correspondence.

METROPOLITAN SEWAGE DISPOSAL.

"Audi alteram partem. ’

To the Editors of THE LANCET.SIRS,—I made no reply to Dr. Dupre’s letter in your

issue of March 9tb, as I thought that your leading articlewas quite a sufficient answer. Dr. Dupre, however, itseems, does not think so, but still maintains that theaction of the Metropolitan Board of Works did not runcounter to the recommendations of the Royal Commissionon Metropolitan Sewage Discharge. Let us see if this isthe case.The Royal Commission recommended that, after pre-

cipitation of the solids, the effluent sewage should be eitherutilised on land or discharged into the river " at least aslow as Hole Haven." Did the Metropolitan Board of Worksloyally set about carrying out these recommendations ? Onthe contrary, they set to work to find out how they couldevade them. Instead of taking the advice of the RoyalCommission, they consulted four " independent chemistsof the highest standing" (of whom Dr. Dupre was one),who advised that, if the effluent water were treated in aparticular way, it would be sufficiently purified to be dis-charged into the river at the present outfalls at all states ofthe tide-a plan which, as you pointed out, had been con-sidered and rejected by the Royal Commissioners. Fortifiedby this advice, the Board commenced the construction ofextra precipitating tanks, at, as I have said, "an enormousexpense," and this notwithstanding the fact that their ownspecial chemical adviser, Sir Henry Roscoe, whose authorityeven Dr. Dupre will admit, went out of his way to warnthem "that sooner or later the recommendations of LordBramwell’s Commission will have to be adopted, and thatthe sewage, whether previously clarified or not, must eitherbe filtered through land or discharged into the estuary ata point not higher than the Sea Reach"; significantlyadding that "the growth of the metropolis during the quarterof a century which has elapsed since the adoption of thepresent main drainage and outfall system has been so

enormous that arrangements which worked satisfactorilyup to some few years ago are now found to be inadequate,and will of course become more so as time goes on."

Dr. Dupre says that one of the four eminent chemistsconsulted was " the only chemist by profession on theRoyal Commission," and leaves it to be inferred that theonly chemical authority on that Commission gave his sanc-tion to the processes adopted by the Board. This is very