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collection should be in the hands of the vestry; 2, whetherthis is decided in the aflimative or the negative, your com.mittee should be authorised to prepare draft regulations forcollection for the consideration of the vestry ; 3, that if thecontract system is to be continued, your committee shouldreport on the modifications which are required in the presentform of contract ; 4, that whether the vestry decide upondoing their own work as dust collectors or not, the refuseshould be partly or wholly burnt, and, therefore, your com-mittee should be instructed to seek for a site for works, andthat the vestry,should offer a premium of x50 for the bestscheme of disposing of refuse by fire, accompanied with plansand other details." This report gives reason to fear that theVestry is still influenced more by considerations for thepecuniary interests of contractors than for the sanitaryinterests of the ratepayers and inhabitants generally. Letus hope, however, that recommendations 2 and 4 will meetwith the approval of the vestry.

SMALL-POX IN THE METROPOLIS.

We have received the following circular from the Metro-politan Asylums Board :—

Metropolitan Asylums Board, 37, Norfolk-street, Strand,London, Feb. 8th, 1881.

SIALL-PON.

DEAR SIR,-The managers at their meeting on Saturdaylast having had under consideration a report from the chair-men of the several hospital committees directing attention tothe rapid spread of small-pox in the metropolis-no less than330 acute cases of this disease having been received into thehospitals of the Board during the past fortnight-I was

directed to state for the information of your - thatshould the number of admissions continue at the presentrate, all the accommodation the managers have or canprovide (pending the decision of the House of Lords inthe Hampstead Hospital case) will be exhausted in aboutthree weeks, after which it will be necessary for the varioussanitary authorities and Boards of Guardians to supplementthe action of this Board by making provision for the accom-modation of any additional cases of small-pox that mayarise in their respective districts.

I am, dear Sir, yours faithfully,To -, Clerk to the ——. W. F. JEBB, Clerk.

THE VACCINATION ACT, 1867.A voluminous Parliamentary Return has been published

moved for by Mr. Barran, showing the number of prosecutions in respect to England and Wales since the 1st day o:January, 1875, to the 1st day of January, 1879, under thfVaccination Act, 167, distinguishing (1) those who undeisection 29 have neglected to procure the vaccination of a

child, and (2) those who under section 31 have disobeyed thorder of a justice for the vaccination of a child, and howoften prosecutions under this section were repeated for thesame child; stating also the amount of penalty inflicted onconviction, whether imprisoned in case of default, and if dis-charged under section 31, and the grounds for that discharge.No attempt is made to summarise the facts given in thereturn under its separate headings, but it is left for eachperson to form his own summaries and deductions. Therewould appear to be very little uniformity in the mode ofdealing with these cases by the magistrates in differeut dis-tricts.

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COMBINATION OF SANITARY DISTRICTS.

We gather from the North Wales Gqtardian that theLocal Government Board contemplates the combination ofthe rural sanitary districts of Curwea, Ruthin, St. Asaph,and Holywell with the urban sanitary districts of Abergele,Denbigh, Ruthin, and Llangollen, for the purpose of ap-pointing a single medical officer of health. This project wasunder the consideration of the Rural Sanitary Authorityof Ruthin at a recent meeting, Mr. Murray Browne, thegeneral inspector of the Local Government Board for NorthWales, being present ; but the project met with much oppo-sition, and in the end the subject was adjourned to the nextmeeting. The report of the proceedings in the local papersshows a very considerable amount of misapprehension on theposition and duties of a medical oflicerof health and the objectof the Local Government Board.

r SUNDAY MILK.’

At a recent meeting of the Greenwich District Board ofr Works it was moBed and carried that the inspectors of

nuisances should be instructed to take milk samples on’ Sundays. It would appear that the milk-dealer has beent accustomed to have his own way in this district on that day,1 and one of the members of the Board expressed the opinion

that it was as lawful to prevent children being served with

- milk-and-water on the Sunday as for any other good deedl to be done on that day. It is probable that milk-clealerst have been as quick to perceive their freedom from the

restraining influence of the sanitary authority on a Sundayelsewhere than in Greenwich, and we commend the exampleof the Greenwich District Board to sanitary authorities

’ generally. -

--

b At the recent meeting of the Yorkshire Association ofMedical Officers of Health, at ZYakefield, the President,Mr. S. W. North of York, asked the question, How long a apatient recovering from infectious disease - small-pox orscarlet fever-should be detained in hospital before being

.

allowed to go forth and mingle with healthy individuals?Mr. Butterfield, the medical officer of health for Bradford, inreplying to this question, observed that he did not think"the usual six weeks" as at all sufficient. He had knowncases last over eight weeks, and sometimes over three months.Obviously if periods of detention extending over even the

.. least of these larger periods-viz., two months-have to be

. entertained by local authorities, other considerations thanthose of preventing the dissemination of infection will

I

chiefly influence their action in the matter.Colonel Bolton, the water examiner for the metropolis, in

: his report on the condition of the water delivered by the, different metropolitan water companies in December last,. says that the water in the Thames was indiilerent in quality

from the 1st to the 4th of December, when it improved, andremained good until the 15tb, after which it became bad,and continued in that condition for the remainder of themonth. The water in the river Lea was also generally badduring the greater part of the month. PrOfeEWl’ Franklandstates that the water taken from the the differentcompanies, except the Grand Junction Company, was " eye-cientlynitered before delivery." The water distributed bythe East London Company (including Thames water) was"slightly turbid through inetficient filtration."A gentleman residing at Horsham has been summoned

before the local magistrates for having failed to provide aproper supply of water to a "lodge" h’3 licd built upon hisestate. He contended that a "lodge" ws,s somethingdifferent from a residence, and that there was water within areasonable distance. The magistrates, however, inflicted afine of 5s. with costs, but the defendant announced hisintention to appeal.

It is noteworthy that the Paddington Vestry have success.fully prosecuted the owners of certain barges for havingmoored their vessels for upwards of twelve when ladenwith offensive matters, within 500 yards of inhabiteddwellings. A fine of ten shillings, with cosb, was inflictedin each case. -

The " States" of Guernsey, it is reported, have repudiatedthe Burial Act by refusing to sanction iM registration. Theclergy, members of the "States," took an active part in

speaking, as well as voting, against the Act.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

Although the registered mortality last week showed a

decline from the recent excess, it again exhibited some of theeffects of the recent severe frost. In twenty of the largestEnglish towns, estimated to contain in the middle of thisyear a population exceeding seven and a half millions ofpersons, 5891 births and 4092 deaths were registered lastweek. The births exceeded by 705, and the deaths by noless than 835, the average weekly numhers during lastyear. The deaths, however, showed a decline of 430 fromthe high number returned in the previous week. The annualdeath-rate in these twenty towns, which in the first fourweeks of the year increased from 21’3 to 31’0, declinedagain last week to 28’0. During the five weeks of thecurrent quarter, ending on Saturday last, the death-rate in

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these towns averaged 26’5 per 1000, against 26’0, the averagerate in the corresponding periods of the five years 1876-80.The recent excess in the death-rate was remarkably smallconsidering the late inclemency of the weather.The deaths in the twenty towns referred to the principal

zymotic diseases, which had been 390 and 373 in the twopreceding weeks, further declined to 366 last week, and in-cluded 102 from whooping-cough, 70 from scarlet fever, 54from small-pox, 49 from measles, and 41 from fever (princi-pally enteric). The annual death-rate from the principalzymotic diseases averaged 2’5 per 1000 in the twenty towns,among which it ranged from 0’7 and 0’8 in Bristol andLeicester, to 3’6 and 3’9 in Norwich and Sunderland. Scarletfever showed the largest proportional fatality in Norwich,Sunderland, and Oldham ; while whooping-cough was mostfatal in Leeds and Liverpool. The 20 deaths from diphtheriain the twenty towns included 12 in London, 3 in Bradford,2 in Liverpool, and 2 in Birmingham. The death-rate from

_

fever (principally enteric) was highest in Nottingham andSunderland. Small-pox caused 58 more deaths in London

: and its suburbs, while no fatal case of this disease wasregistered in any of the nineteen large provincial towns.The number of small-pox patients under treatment in theMetropolitan Asylum Hospitals, which had steadily increasedfrom 77 to 520 in the fourteen preceding weeks, furtherrose to 617 on Saturday last; this is a larger number thanhas been under treatment in these hospitals since June,1878. The number of new cases of small-pox admitted tothese hospitals, which had been 142 and 114 in the twoprevious weeks, rose last week to 234. The HighgateSmall-pox Hospital contained 37 patients on Saturday last,against 27 and 30 at the end of the two preceding weeks;30 new cases were admitted during the week.

, The deaths referred to diseases of the respiratory organs in

London, which had been 371, 617, and 702 in the three pre-ceding weeks, declined last week, under the influence ofhigher temperature, to 606, but exceeded the correctedaverage number in the corresponding week of the last tenyears by 52; 441 were referred to bronchitis and 97 to pneu-monia. The annual death-rate from lung diseases (excludingphthisis) was equal to 8’5 per 1000 in London, while the ratefrom the same diseases was 11’1 in Salford and 14’3 inLiverpool.In the twenty towns last week the causes of 118, or

2’9 per cent., of the deaths were not certified, either by a re-gistered medical practitioner or by a coroner. The propor-tion of uncertified deaths did not exceed 1’8 per cent. inLondon, while it averaged 3’9 per cent. in the nineteenprovincial towns. No uncertified deaths were registered lastweek in Portsmouth or Norwich, while their proportionwas largest in Oldham and Sunderland.

HEALTH OF SCOTCH TOWNS.

In eight of the largest Scotch towns, having an esti-mated population of rather more than a million and a quarter

. persons, the annual death-rate averaged 28’9 per 1000last week, against 24 -6, 31’1, and 34’7 in the three precedingweeks; this rate was 0’9 above the average rate in thetwenty large English towns. The rates in the eight Scotchtowns ranged from 18’4and 18’9 in Greenock and Edinburgh,to 33’9 and 35’1 in Glasgow and Perth. The deaths referredto the principal zymotic diseases in the eight towns, whichhad been 107 and 125 in the two previous weeks, declinedto 94 last week, and was equal to an annual rate of 3’7per 1000; ia the twenty large English towns the ratesfrom these diseases did not exceed 2’5. In the eight Scotchtowns the zymotic death-rate last week ranged from 1’9 inGreenock and Perth, to 4’8 and 5’2 in Glasgow and Leith.The fatal cases of scarlet fever in the eight towns, whichhad been 28 and 27 in the two preceding weeks,further declined to 14 last week, of which 9 occurred inGlasgow, 3 in Edinburgh, and 2 in Leith. The 34 deaths fromwhooping-cough were within 3 of the high number in theprevious week, and included 20 in Glasgow and 8 inDundee. The 10 deaths referred to "fever," however,showed a decline of 15 from the number in the previousweek; 5 were returned in Glasgow and 2 in Leith. Eightof the 9 deaths from measles, as well as 5 of the 10 fromdiphtheria, occurred in Glasgow. Diarrhœa fatality con.

tinues to exceed the average for the season. The deaths

referred to acute diseases of the lungs (bronchitis, pneli-monia, and pleurisy), in the eight Scotch towns, declinedlast week to 261, from 307 and 348 in the two previous

weeks. These 261 deaths from lung diseases were equal toan annual rate of 10’5 per 1000 of the population in theeight Scotch towns; the death-rate from the same diseasesin London did not exceed 7’6. The greatest fatality oflung diseases iri the Scotch towns occurred again last weekin Glasgow, Paisley, and Perth.

HEALTH OF DUBLIN.

The rate of mortality in Dublin showed but a slight declinefrom the exceedingly high rates in recent weeks. Theannual rate of mortality from all causes in the city, whichhad been equal to 35’1, 45’7, and 47’4, in the three precedingweeks, was 46’5 last week. During the first five weeks ofthe current quarter the death-rate in the city averaged 41’3per 1000, against 25’8 in London, and 24’0 in Edinburgh. The297 deaths in Dublin last week showed a decline of but 6from the number in the previous week, and included 31, orrather more than 10 per cent., which were referred to theprincipal zymotic diseases, against 37 and 34 in the twoprevious weeks. These 31 zymotic deaths in Dublin lastweek included 17 which were referred to fever (typhus,enteric or typhoid, and simple continued), 6 to

whooping-cough, 3 to scarlet fever, 3 to diphtheria, and oneeach to small-pox and diarrhœa. The annual death-ratefrom these zymotic diseases was equal to 4’9 per 1000 inDublin last week, while it did not exceed 2’9 in Londonand 2’2 in Edinburgh. The deaths referred to fever inDublin, which had been 17 and 15 in the two previousweeks, rose again to 17 last week; during the past fiveweeks the annual death-rate from fever has been equal to2’19 per 1000, and nearly nine times as high as the averagerate from the same cause in the twenty large Englishtowns in the same period. The 6 deaths from whooping-cough in Dublin last week corresponded with the numberin the previous week, while the fatal cases of scarlet fevershowed a further decline. The deaths of infants showed anincrease, while those of elderly persons were only four lessthan the exceptionally high number returned in the previousweek.

HEALTH MATTERS GENERALLY AT HOMEAND ABROAD.

THE "HOWARD" PRIZE ESSAY ON ORIENTAL PLAGUE.

The one fact of interest about this essay on " OrientalPlague" is that it has been adjudged by the Council of theStatistical Society the "Howard Medal for 1880 and a grantof 920. It is from this point of view alone the essaydeserves consideration. The terms of the competition re-quired that the disease should be treated of in its social,economical, political, and international relations. No diseaseduring the past ten years has occupied a larger degree ofpublic and, so to speak, international attention than Orientalplague ; yet of this there is not the slightest intimation inthe essay, and, in consequence, the various social, eco-

nomical, political, and international questions which have sorecently had to be considered in this country on the subject re-ceive no notice, and it does not appear that either the essayistor the Council knew of their existence. "Frequent reference,"it is said at the beginning of the essay, " has been made tomany works treating of the plague, these being specified atthe end of the essay." The works specified are twelve innumber, and do not include the great report of theFrench Academy of Medicine or one of the numerous

reports on plague since its appearance in Western Asiain 1853. Much of the essay is taken up by a so-

called "historical slietch," the value of which may besurmised from the fact that outbreaks of "dancingmania and "sweating sickness" are mingled promiscuouslywith outbreaks of Oriental plague. Howard’s work as toplague is mixed up inextricably with his work as to prisons.The chapter on the Conditions under which the Plaguearises " is written without any reference to the recent im-portant light which has been thrown on the subject. Theillustrations of the social effects of plague are derived fromthe older historians, although we have had the opportunityof studying them in our own days. Then, as to accuracy oflanguage. Plague, we are told, appeared in 1813in Malta andGozo, killing between 4000 and 5000 people. A few lines afterwe read that plague has not been seen in Malta for one hun-dred and thirty-seven years ! Again we read : "Plato reco-gnised the contagious power of ophthalmia, and so in the four-