2
874 water company’s service, it is less prevalent than formerly. But Gravesend is still almost wholly dependent on cesspools, and these are, as formerly, excavations in the chalk, varying in depth from a few feet to sixty feet. In courts these cesspools are, as a rule, left open, and their emanations frequently mingle freely with the surrounding air; and, placed as they commonly are near to dwelling-houses, they constitute a most serious nuisance. The deeper cesspools are apparently never emptied. The distribution of water is also very defective. In some parts of the town many of the inhabitants are without water, or are dependent on supplies collected in pails or pans for a large portion of the day, and the result of this was noticeable in the want of cleanliness about courts and alleys. A description is given in the report of certain areas which call for urgent remedy under the ordinary statutes and the Artisans and Labourers’ Dwellings Acts. The Town Council may be credited with having made certain substantial improvements in connexion with the isolation of infectious diseases and the water- supply ; but in the other matters named the state of the town is serious. Mr. Murphy reminds the inhabitants that the Registrar-General when writing of the epidemic pre- valence of cholera in 1848-49 stated, with regard to the condition of Gravesend at that time as follows: " There are no available common sewers, and the sanitary state of the town must be inevitably bad; the whole of the surface and underground drainage falls into rudely constructed .cesspools." The report adds that, with but slight modifica- tion, these remarks are now equally applicable. REPORTS OF MEDICAL OFFICERS OF HEALTH. - SuK Urban District.-The borough of Hull had in 1884 a - death-rate of 21-1 and a birth-rate of 37’5 per 1000. The infantile mortality under one year was high, reaching as it did 172 per 1000 registered births. This was to a consider- -able extent accounted for by the fact that of 331 deaths from diarrhoea, 271 occurred in children aged one year or under, the outbreak being almost entirely limited to the third quarter of the year. In dealing with the causes of diarrhoea, Dr. Mason, premising that Hull stood next to Leicester and Salford as regards its high mortality from this cause, refers to the fact that milk, which is the staple article of infant diet, is so often ill-kept that a quantity of it which comes from tuberculous cows is probably more liable to ferment on this account, and that diarrhoea is the conse- ’quence. As preventive agents against diarrhoea, he advocates personal cleanliness, efficient ventilation of dwellings, the abatement of conditions of overcrowding, and the immediate removal of night-soil, accumulations of refuse, and all nuisances in the vicinity of dwellings. He further urges the establishment of creches in different parts of the town. In another part of his report he refers to the importation of very young calves from Holland-a traffic which, in his view, calls for stringent supervision. In some towns either the weight or the age of the animal whose carcase is for sale is taken into consideration as regards its suitability for human consumption, and thus calves may be passed if they either weigh 48 lb. or are three weeks old. Dr. Mason is of opinion that this does not suffice, and in Hull carcases are not passed unless there is, quite irrespective of weight, evidence of sufficiently mature age. The flesh of very young calves should not, in his opinion, be sold, it being unfit for human consumption, whilst the early slaughter involves a needless waste of bovine life. Bolton Urban District.-Tbe satisfactory state of health in this district, reported on for some few years past, was interfered with last year by reason of an unusual prevalence of diarrhoea and chest diseases ; the death-rate was 24’0 per 1000. Enteric fever of a severe type prevailed during the early part of the year. The diarrhoea deaths were 211 in number, and corresponded to an annual rate of 19 per 1000, and this exceptional mortality occurred in connexion with high temperature and limited rainfall in July and August. Under the Bolton Improvement Act 493 cases of infectious diseases were reported, and the system of notification, to- gether with the newly constructed hospital, enabled the authority to deal with a large number of cases with con- siderable efficiency. Gradually, the disinclination on the part of parents to allow their children to be removed for isolation purposes is disappearing. Four cases were - admitted into the hospital from the adjoining rural district at a cost of 1 guinea a week, but the average cost per patient in the hospital is estimated to be ;E2. The total cost of maintaining the hospital for the year was 621, or an average of .E10 per patient, and this Mr. Sargeant asks the Town Council to view in the light of an insurance fee paid by the public against the spread of infectious disease, which, quite irrespective of the misery and death it occasions, is enormously expensive to the families concerned, and by killing the bread-winners often adds materially to the amount of the poor-rates. VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN twenty-eight of the largest English towns 5895 births and 3075 deaths were registered during the week ending Oct. 31st. The annual death-rate in these towns, which had been equal to 17’6, 17’7, and 18’5 per 1000, declined again last week to 18’0. During the first four weeks of the current quarter the death-rate in these towns averaged 18’0 per 1000, which was 2’7 below the mean rate in the corresponding periods of the nine years 1876-84. The lowest rates in these towns last week were 9-7 in Norwich, 13-1 in Brad- ford, 14-0 in Birmingham, and 14’2 in Sunderland. The rates in the other towns ranged upwards to 23’4 in Liver- pool, 23 in Brighton, 23-9 in Huddersfield, and 24’0 in Plymouth. The deaths referred to the principal zymotic diseases in the twenty-eight towns, which had been 340 and 299 in the preceding two weeks, further fell last week to 273, and were fewer than in any previous week of this year; they included 65 from measles, 64 from whooping- cough, 54 from diarrhoea, 33 from scarlet fever, 32 from "fever" (principally enteric), 19 from diphtheria, and 6 from small-pox. No death from any of these zymotic diseases was recorded during the week in Norwich, Wolverbampton, Huddersfield, or Halifax; while they caused the highest death-rates in Salford, New- castle-upon-Tyne, Cardiff, and Preston. The greatest mortality from measles occurred in Oldham, Newcastle- upon-Tyne, and Manchester ; from whooping-cough in Birkenhead and Sunderland; from scarlet fever in Preston and Leicester; and from "fever" in Cardiff, Portsmouth, and Plymouth. The 19 deaths from diphtheria included 10 in London and 3 in Liverpool. Small-pox caused 10 deaths in London and its outer ring (including 5 recorded in the metropolitan asylum hospital-ship Atlas, moored in the Thames off Dartford), 1 in Nottingham and 1 in Preston. The number of small-pox patients in the metropolitan asylum hospitals situated in and around London, which had steadily declined in the preceding twenty-one weeks from 1389 to 99, had further fallen to 88 on Saturday last; the admissions, which had been 16 and 11 in the previous two weeks, were 14 last week. The deaths referred to diseases of the respiratory organs in London, which had increased in the preceding five weeks from 152 to 356, further rose last week to 358, but were 9 below the corrected average. The causes of 76. or 2-4 per cent., of the deaths in the twenty- eight towns last week were not certified either by a regis- tered medical practitioner or by a coroner. All the causes of death were duly certified in Bradford, Portsmouth, Bolton, and in four other smaller towns. The largest propor- tions of uncertified deaths were recorded in Salford, Sheffield, Leicester, Hull, and Sunderland. HEALTH OF SCOTCH TOWNS. The annual rate of mortality in the eight Scotch towns, which had been 19’1 and 17’9 per 1000 in the preceding two weeks, rose to 31’2 in the week ending the 31st Oct., and exceeded by 3’2 the mean rate during the same week in the twenty-eight English towns. The rates in the Scotch towns last week ranged from 11’6 in Perth and 143 in Aberdeen, to 25’5 in Paisley and 27’3 in Glasgow. The 518 deaths in the eight towns included 15 which were referred to diarrhoea, 13 to scarlet fever, 9 to whooping-cough, 9 to diphtheria, 7 to "fever" (typhus, enteric, or simple), 2 to measles, and not one to small-pox; in all, 55 deaths resulted from these principal zymotic diseases, against 59 and 43 in the preceding two weeks. These 55 deaths were equal to an annual rate of 2-3 per 1000, which was 0’7 above the mean rate from the same diseases in the twenty-eight English towns. The 15 deaths attributed to diarrhoeal diseases exceeded the number in the previous week by 3, but were 6 fewer than those returned in the correspond- ing week of last year; 7 occurred in Glasgow and 3 in Aberdeen. The fatal cases of scarlet fever, which had been
