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220 REPORTS OF MEDICAL OFFICERS OF HEALTH. Public Health and Poor Law. LOCAL GOVERNMENT DEPARTMENT, REPORTS OF MEDICAL OFFICERS OF HEALTH. Sanitary District of the County of Durham.-Dr. Eustace Hill’s report takes the form of a summary of the district reports, together with an introduction on the sanitary con- ditions and requirements of the county. Compulsory notifi- cation of infectious diseases is in force in twenty-nine dis- tricts, having a total population of 529,349, whilst the remaining thirteen, with a population of 207,170, have as yet not adopted the Notification Act, although some very densely populated areas are included amongst them. Dr. Hill tells us that the cost of notification amongst those districts which have adopted the Act was during 1892 at a rate of ;E1 2s. 7d. per 1000 of the population. These figures do not include measles, the notification of which has been found so expensive in two of the districts that it has been recently discontinued. In commenting upon this fact, Dr. Hill remarks that unless notification of this disease is made compulsory throughout the county and power is given to isolate the early cases little good is likely to result. School closure as a means of preventing the spread of measles has been attended with varying results in the county ; in some districts it seems to have served to stamp out the disease ; in others to temporarily arrest it ; while in yet others no good appears to have resulted. There appears to have been some misunderstanding on the pait of some of the medical officers of health as to their duty in sending copies of any special reports they may have made to the County Council, and Dr. Hill points out that by the Local Government Board’s order of March, 1891, their duties in this respect are the same, whether or not part of their salary be repaid by the County Council. Considerable improvement has apparently taken place in the character of the reports of the various districts, and Dr. Hill is inclined to attribute this-in part at least-to the fact that a large proportion of the reports are now printed. It certainly is desirable that this should be the case, and it seems hard to expect a medical officer of health to produce an elaborate report and to give him no opportunity of educating those under his care in sanitary matters. Where, however, as in the case under notice, the reports are summarised by the county medical officer of health, the public still have an opportunity of referring to any report they may be interested ’’, in. The death-rate of the county was, during 1892, 18 4 per 1000, the rate for the urban district being 18 ’4 and for the rural district 18’5. The infantile mortality in the urban districts was 152 and in the rural 156. As regards the zymotic death-rate, the urban districts yielded one of 2 ’55 and the rural one of 2 ’12. There are signs of some activity in the erection of fever hospitals in the county, but it is disappointing to learn that in most cases the structures are but temporary ones. Dr. Hill refers to the great initial expense of permanent buildings and advocates the formation of joint hospital boards as the best solution of the difficulty. In concluding his report Dr. Hill advises the county council to institute a course of popular lectures on public and domestic hygiene. Liverpool Urban Sanitary District.-Assuming the con- tinuance of the decrease which obtained in the population of Liverpool between 1881-91, it is estimated that the present population of the borough is 513,790. In spite, however, of the decrease, Liverpool easily maintains its position as the most thickly populated city in the kingdom, having 98’6 persons per acre, as against 57 ’1 for London. During the prevalence of cholera on the Continent last year every pre- caution was taken to deal with any cases of that disease which might be imported into the city. The emigrant lodging-houses, which are under common lodging-houses’ by-laws, were visited frequently both by day and night. Several Russian Jews developed symptoms clinically undis- tinguishable from cholera, and in one case cultivations of the comma bacillus were obtained. With regard, however, to the latter case, the period of incubation was so lengthy that there was some doubt as to its real nature. There were 73 cases of typhus fever in Liverpool during 1892 and 18 deaths from the disease. With the sanction of the President of the Board of Trade, the Liverpool Corporation has drawn up by-laws for the licensing of seamen’s lodging-houses under the Merchant Shipping (Fishing Boats) Act, 1833. Dr. Stopford Taylor. report contains a capital spot map of the borough, and numerous statistical tables which bear witness to the enormous. amount of sanitary work done in the district. Portsmouth Urban and Port Sanitary Distract.-Influerze caused no less than 165 deaths during 1892, but the majority occurred during the first quarter of the year. Scarlet fever, though prevalent to a considerable extent, only yielded a case mortality of 1’8 per cent., and this is perhaps the more remarkable in that many cases had to ? refused admission to the fever hospital owing to want of beds. As regards enteric fever, Dr. B. H. Mumby states that it show itself to an undue extent in the borough ; whereas, owing to the good water-supply, it should be a rare disease in Ports- mouth. He attributes its prevalence to the imperfect drainage arrangements and the resulting pollution of the subsoil under houses. As an example of the value of notification Dr. Mumby gives a table to show that those diseases which are notifiabie have decreased since compulsory notification more rapidly than those which are at present not notified, and he expresses satisfaction at .the manner in which notification has worked in the district. Under the Housing of the Working Classes Act, 1890, the council are about to demolish an unhealtbv area in this district, and fifty-nine houses have, during the year, been certified as unfit for human habitation. During the inspection of workshops, for which a special inspector has been appointed, no less than 107 notices to abate over- crowding were issued, and of these 104 have been complied with. In his capacity of port medical officer of health Dr. Mumby reports that since the middle of August a careful, inspection of all ships and crews coming from possibly in- fected ports has been made outside the harbour. The port sanitary authority has provided a floating hospital for cases of cholera, and it has been arranged that it is to be moved near the quarantine ships at the Motherbank should it he- used for the purpose for which it is intended. Blackpool Urban Sanitary District.-The populaton of this district, estimated on the assumption of 4’84 persons to each house, was, for 1892, 26,740. The death-rate of the borough varied from 13 ’6 to 17 ’85 per 1000, and the zymotic death-rate from 0 ’44 to 1’88. The variations of the infantile mortality in the various wards were very marked, ranging from 111-9 to as much as 263 per 1000 births, whilst the quarterly rate for the whole district varied from 200 in the first quarter to 107 in the second. Dr. Jasper Anderson draws attention to the exceptionally high rate of deaths after confine- ments which occurs in Blackpool-i. e , 15 6 per 1000 registered births, as against 4 ’89 per 1000 for England and Wales (1890), An endeavour is being made in Blackpool to treat phthisis as an infectious disease. In every case after death from phthisis the sanitary authority makes an offer, which in many oass has been accepted, to disinfect the house. In addition to this an admirable memorandum as to the prevention of phthisis accompanies the offer of disinfection. Dr. Anderson is also endeavouring to obtain the notification of all cases of phthisis. There is no doubt that if Dr. Anderson’s circular were acted upon in all houses where phthisis exists muc ,, good would be effected. Possibly the medical practitioners might find copies useful to leave with the patients’ friends, VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN thirty-three of the largest English towns 6361 births and 4914 deaths were registered during the week ending Sate" day, July 15th. The annual rate of mortality in these towns. which had increased in the preceding seven weeks from 175 to 23’8 per 1000, further roselast week to 24-8. In Londcln the rate was 22-9 per 1000, whilst it averaged 262 in the thirty- two provincial towns. The lowest rates in’these towns were 12 3 in Huddersfield, 12-5 in Halifax, 13’4 in Bristol. 14 ’2 in Brighton and 16 2 in Plymouth ; the highest rates were 31-6 in Bolton, 34’7 in Wolverhampton, 34-9 in Liverpool and in Salford and 51 ’6 in Preston. The 4914 deaths in- eluded 1431, which were referred to the principal moL-’ diseases, against numbers increasing from 415 to 1197 in the preceding six weeks ; of these, 1024 resulted from d1ÌaJ’J1hae, 112 from measles, 95 from whooping-cough, 72 from diphtheria 65 from scarlet fever, 48 from "fever" (principally enttL7 and 15 from small-pox. The lowest death-rates from these r diseases were recorded in Huddersfield, Bristol, Halifax Newcastle-upon-Tyne and Gateshead, whilst they caused!!:; highest rates in West Ham, Salford, Blackburn, Leicesto
