1072 PUBLIC HEALTH AND POOR LAW.-VITAL STATISTICS.

Public Health and Poor Law.LOCAL GOVERNMENT BOARD.

ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH.

Nottingham Urban -District. -Enteric fever was very pre-valent in Nottingham during 1900 and Dr. P. Boobbyer makesthe defects of the conservancy system responsible for it.The prevalence would appear to be confined to certain,districts. Special steel pails-as contrasted with wooden

pails commonly in use-are employed for the excreta of allpatients who are treated at their own homes, but, as Dr.Boobbyer observes, a case only comes under preventivemeasures when its nature is sufficiently apparent to enablethe medical attendant to notify, and by this time all thedamage may be done. It is thought that the woodenpails absorb the excreta and give out infected dust. Theinfluence of excrement disposal en, or rather its associationwith, the prevalence of enteric fever is well shown fromthe fact that with pail-closets one case occurred in every 92houses, with midden-privies one in every 20, and with water-closets one in every 407. Dr. Boobbyer has also observedthat there is a concentration of cases to the leeward of therefuse heaps, an association which has been observed forthe last three years.Portsmouth Urban Distrtct.-Dr. A. Mearns Fraser reports

that an effort is being made in Portsmouth to erect a sana-torium for tuberculous patients by means of voluntary sub-scriptions. He thinks that if this praiseworthy attempt failsin its object the town council, as the sanitary authority,should take up the matter and carry it out well. As heobserves, large sums are being expended annually upon theprevention of enteric fever, scarlet fever, and diphtheria,whereas practically nothing is being expended upon thedirect control of tuberculosis, and this notwithstanding thefact that the three diseases just mentioned exacted a death-toll in Portsmouth in 1900 only a little in excess of half thatcaused by the tubercle bacillus. There were no fewer than1083 cases of enteric fever notified in Portsmouth last year,but the fatality-rate (849 per cent.) was fortunately nothigh. Dr. Fraser is unable to account for the prevalence ofthe disease, but its main incidence seems to have been on thepoorer and less sanitary portions of the town.Bromsgrove Urban District.-Dr. H. Cameron Kidd has in

his estimate of the population of this district come very nearto the census figures, the former being 8500 and the latter8416. Dr. Kidd took the inhabited dwellings in the districtas the basis of his calculations and lie has every reason tobe gratified with the result. Bromsgrove is doing goodwork in the matter of the control of tuberculosis, and it is

encouraging to find so small a district as this emulating thepractices of our large towns in this particular. Unfortu-nately the neighbouring sanitary authorities are not equallyalert, and a proposal from Bromsgrove that there shouldbe combination for the purpose of appointing a veterinaryinspector did not receive adequate support. Dr. Kidd has,however, been able to induce his district council to adopt thescheme which is in operation at Ludlow under the advice ofDr. C. B. Cranstoun, the medical officer of health. Samplesof milk from each dairy in the town are, after due notice,examined for tubercle bacilli, and if such bacilli are foundthe dairyman is summoned for selling unsound milk," andordered to stop the supply until it is proved to be pure. Wepresume that this means until no tubercle bacilli are to bedetected therein. Moreover, the tuberculin test is applied toall cows supplying the dairy. This is very satisfactory, and Dr.Kidd. is to be congratulated on having brought the schemeinto operation.

St. Helens Urban .District.-Dr. F. Drew Harris furnishesin his current annual report an interesting detailed accountof the infant milk depôt at St. Helens which hasbeen carried on after the fashion of the original depot at

Fecamp in Normandy. The subject is of considerableinterest at the present moment owing to the discussionwhich has recently taken place in our columns upon themerits or demerits of boiled milk. A small six-roomed housewas procured in a convenient position in St. Helens, and theseveral rooms were appropriated to one or another purpose con-nected with the scheme. In one room are contained thesterilisers and the bottle-washing machine, and in another

the baskets containing the supplies of bottled milk for eachcustomer are stored. In another room the babies are weighedfrom time to time. The sterilised humanised milk for theinfants is prepared by means of the dilution of, and theaddition of cream and sugar to, good cow’s milk. The milk isthen placed in small stoppered bottles of some five ounces

capacity, the stoppers are closed and the bottles are placed inthe steriliser. By an ingenious device the steam is subjectedto slight pressure by means of which its temperature isincreased by about 2° C. When the thermometer registers102° C. the time is noted .and the bottles are kept at thattemperature for 45 minutes, the whole operation lasting, it

appears, from three to three and a half hours. We areassured that by this means the milk does not possess any-thing approaching a "boiled" taste and that such milk hasbeen kept in the closed bottles for more than a month.When the heating process is ended the fire is raked out andthe bottles are allowed to cool. They are then taken outand placed in baskets each of which holds nine bottles-i.e., six feeds for the day and three for the night. Thequantity of the milk is adjusted according to the age of thechild. Before use each bottle is placed in a little hot water,the stopper is removed, and a teat is fitted to the bottle direct.Every Wednesday the babies are brought to be inspectedand weighed and the records are entered in a book. Thenumber of children on the books has steadily increased andin August, 1900, over 140 were being fed. As yet it isdifficult, Dr. Harris tells us, to furnish reliable statistics as.

to the results of the method, but there is evidence pointingto the conclusion that the infantile death-rate has been verymarkedly reduced thereby ; indeed, the saving of life wouldappear to be about 86 per 1000. It seems, too, that duringthe hot weather of Angust many cases were brought tothe depot in the last stages of diarrhoea and obtained thegreatest benefit from the humanised milk. Dr. Harris alsosupplies his readers with the figures for Fecamp which showexcellent results from the system. A dep6t has also beenopened at Havre, and here, too, the results seem very pro-mising. In England, Liverpool, Dukinfield, and Ashtonhave already started deputs, and in Belfast one is in courseof construction.Bath Urban Distri.ct.-1’he Bath Town Council have

decided to supply diphtheria antitoxin gratuitously to allthose who cannot afford to purchase it, and this proviso will,we expect, be found in practice to have a wide application.Small tubes containing 800 Ehrlich-Behring immunity nnitsare also provided for persons who have been exposed toinfection. As Dr. W. H. Symons remarks, the preventionof one case of diphtheria which would be treated at theisolation hospital at the public expense would more thancover the cost of antitoxin for many years. The Bath TownCouncil haB e also a supply of plague serum and vaccine readyfor emergency. These are praiseworthy provisions, and weare led to reflect as to how many sanitary authorities inthis country are equally as ready as Bath in this sense. The

voluntary notification of phthisis is in force in Bath andDr. Symons has apparently been endeavouring to persuadethe Great Western Railway Company to take action to

prevent infection from spreading through the agency of

railway carriages.Bedford County District.-Dr. George Newman, in his

annual volume, which summarises the reports of the districtmedical ofiicers of health, devotes a small section to "Pro-

ceedings of the County Council Relating to Public Health."Such proceedings have not, we gather, unduly taxed thetime of the Bedfordshire county councillors. Their totalexertions in this sense seem to have taken the form of resolu-tions respecting the Bedford sewage farm, the distribu-tion of communications with respect to the provision ofdiphtheria antitoxin by district councils, and as to the pre-vention of phthisis. Action was also taken in reference tothe Biggleswade water-supply, and the medical officer ofhealth was instructed to report upon the isolation accom.modation of the county. These actions, however, althoughfew in number, are steps in the right direction..

VITAL STATISTICS.

. HEALTH OF ENGLISH TOWNS.IN 33 of the largest English towns 6556 births and 3498

deaths were registered during the week ending Oct. 12th.The annual rate of mortality in these towns, which haddeclined from 21’6 to 15-6 per 1000 in the seven preceding

1073VITAL STATISTICS.—THE SERVICES.

weeks, rose again to 15 ’9 per 1000 last week. In London the a

death-rate was 15’0 per 1000, while it averaged 16’5 in o

the 32 large provincial towns. The lowest death-rates 1in these towns were 9’3 in Derby, 9’7 in Croydon, 11’6 v

in Swansea, 12’0 in Cardiff, 12’6 in Plymouth, and 12’7 in t

]3irkenhead; the highest rates were 19-6 in Hull, 20-8 c

in Manchester, 21’7 in Salford, and 22’5 in Newcastle. 1The 3498 deaths in these towns last week included 485 whichwere referred to the principal zymotic diseases, against 732,z634, and 525 in the three preceding weeks ; of these,217 resulted from diarrhoeal diseases, 93 from diphtheria, 755 from "fever" (principally enteric), 51 from scarletfever, 34 from measles, 32 from whooping-cough, and three ffrom small-pox. The lowest death-rates from these diseases

twere recorded in Derby, Birkenhead, Huddersfield, Halifax,and Bradford ; and the highest rates in West Ham, tSalford, Sheffield, and Hull. The greatest proportional

t

mortality from scarlet fever occurred in Swansea, Preston,and Halifax; from whooping-cough in Newcastle ; from"fever " in West Ham and Portsmouth ; and from diarrhceal tdiseases in West Ham, Wolverhampton, Salford, Hull,Sheffield, and Gateshead. The mortality from measlesshowed no marked excess in any of the large towns. The 193 deaths from diphtheria in these towns included54 in London, five in West Ham, five in Leicester,and four in Liverpool. Three fatal cases of small-poxwere registered in London, but not one in any of the32 large provincial towns ; the number of small-pox patientsunder treatment in the Metropolitan Asylums hospitals atthe end of the week was 175, against numbers winch hadincreased from 13 to 169 on the eight preceding Saturdays ;37 new cases were admitted during the week, against 37,44, and 51 in the three preceding weeks. The number ofscarlet fever cases in these hospitals and in the LondonFever Hospital, which had increased from 2994 to 3159 at theend of the five preceding weeks, had further risen to 3280-011 Saturday last ; 422 new cases were admitted during theweek, against 427, 460, and 426 in the three precedingweeks. The deaths referred to diseases of the respiratoryorgans in London, which had been 124, 137, and 132 in thethree preceding weeks, increased again last week to 186, butwere 55 below the corrected average. The causes of 39,or 1’1 per cent., of the deaths in the 33 towns were

not certified, either by a registered medical practitioneror by a coroner. All the causes of death were dulycertified in West Ham, Nottingham. Salford, Bradford,Hull, and in 16 other smaller towns; the largest pro-portions of uncertified deaths were registered in Liverpool,Manchester, Halifax. Sheffield, and Sunderland.

HEALTH OF SCOTCH TOWKS.

The annual rate of mortality in the eight Scotch towns,which had declined from 17’8 to 14’5 per 1000 in the’five preceding weeks, rose again to 16’1 during the weekending Oct. 12th, and showed an excess of 0’2 per 1000over the mean rate during the same period in the 33 largeEnglish towns. The rates in the eight Scotch towns rangedfrom 6’2 in Perth and 10’4 in Paisley to 17’7 in Dundee and23’6 in Greenock. The 513 deaths in these towns included32 which were referred to diarrhoea, seven to scarlet fever,six to measles, six to diphtheria, six to "fever," and fiveto whooping-cough. In all. 62 deaths resulted from theseprincipal zymotic diseases last week, against 73 and 82 inthe two preceding weeks. These 62 deaths were equal toan annual rate of 1-9 per 1000, which was 0’3 below themean rate last week from the same diseases in the33 large English towns. The fatal cases of diarrhoea, whichhad been 42 in each of the two preceding weeks, declinedlast week to 32, of which 18 occurred in Glasgow, four inEdinburgh, three in Dundee, three in Leith, and two inAberdeen. The deaths from scarlet fever, which hadbeen two, four, and seven in the three preceding weeks,were again seven last week, and included four in Greenockand two in Glasgow. The fatal cases of measles, whichhad been five, 12, and 14 in the three preceding weeks,declined again last week to six, of which five were registered-in Glasgow. The six deaths from diphtheria correspondedwith the number in the preceding week, and included threein Edinburgh and two in Glasgow. The fatal cases ofwhooping-cough, which had been seven in each of thetwo preceding weeks, declined last week to five, of whichthree occurred in Edinburgh. The deaths referred todifferent forms of "fever," which had been six, seven, andsix in the three preceding weeks, were again six last week

and included four in Glasgow. The deaths from diseasesof the respiratory organs in these towns, which had been101 and 77 in the two preceding weeks, further declined lastweek to 75, and showed a decline of 29 from the number inthe corresponding period of last year. The causes of 16,or more than 3 per cent., of the deaths in these eight townslast week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 23’4, 17’8, and19’9 per 1000 in the three preceding weeks, declined again to19’7 during the week ending Oct. 12th. During the pastfour weeks the death-rate has averaged 20’2 per 1000,the rates during the same period being 15’1 in Londonand 15’6 in Edinburgh. The 142 deaths belongingto Dublin registered during the week under noticewere only slightly below the number in the precedingweek, and included 21 which were referred to the prin-cipal zymotic diseases, against 30, 17, and 20 in thethree preceding weeks ; of these, 14 resulted from diar-rhoea, six from "fever," and one from whooping-cough,These 21 deaths were equal to an annual rate of 2 ’9 per 1000,the zymotic death-rates during the same period being 1’9 inLondon and 1-8 in Edinburgh. The fatal cases of diarrhoea,which had been 20, 11, and 9 in the three precedingweeks, rose again last week to 14. The deaths referred todifferent kinds of "fever," which had been three, three,and eight in the three preceding weeks, declined againto six last wee],:. The 142 deaths in Dublin last weekincluded 36 of children under one year of age and 29of persons aged upwards of 60 years ; the deaths of infantsshowed a slight increase, while those of elderly personswere considerably below the number in the preceding week.Six inquest cases and five deaths from violence were regis-tered ; and 39, or more than one-fourth, of the deathsoccurred in public institutions. The causes of 14, or nearly10 per cent., of the deaths in Dublin last week were notcertified.

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THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.The following appointments are announced :-Staff Surgeon

A. J. Pickthorn to the President for three months’ hospitalstudy. Surgeons: H. W. G. Green to the IJfajesti(]; E.Sutton to Plymouth Hospital ; R. B. Scribner to the Shear-,tr,tte2- ; and M. L. M. Validin to the ’Wildfire for theIntmotclite and Naval Barracks.

ROYAL ARMY MEDICAL CORPS.

Major Henry James McLaughlin to be Lieutenant-Colonel.Dated July 27th, 1901. Lieutenant Robert Longfield Daviesresigns his commission. Dated Oct. 12th, 1901. Civil SurgeonStafford Adye-Curran to be Lieutenant. Dated July 26th,1901. Major H. M. Sloggett is posted to the Station Hos-pital, Western Heights, Dover, for temporary duty. Sur-

geon-Major J. Mill, A. M. R. , has assumed temporary medicalcharge of troops, Station Hospital, &0., Leith Fort. Lien-tenant-Colonel H. Charlesworth is posted to Portsmouth forgeneral duty. Lieutenant C. Thompson has joined at Alder-shot and is posted to the Depot. Captain H. D. Mason isappointed Adjutant of the Manchester Companies of theVolunteer Medical Staff Corps. Major W. A. Morris has

joined at Aldershot, and is posted to the Cambridge Hospitalfor duty.

VOLUNTEER CORPS.

Artillery: 1st Cardigan (Western Division, Royal GarrisonArtillery) : Abraham Thomas to be Surgeon-Lieutenant.Ri fle : lst (Brecknockshire) Volunteer Battalion the SouthWales Borderers : John Griffiths to be Surgeon-Lieutenant.

VOLUNTEER MEDICAL STAFF CORPS.The Glasgow Companies :-Donald James MacKintosh to

be Surgeon-Lieutenant.SOUTH AFRICAN WAR NOTES.

The following have been discharged from hospital to

duty :-Major J. H. Brannigan, R.A.M.C., Colonel J. LaneNotter, R.A.M.C., Captain J. Grech, R.A.M.C., and Civil

Surgeon Philip William James.Lieutenant-Colonel J. G. MacNeece, R.A.M.C., Captain

G. S. McLoughlin, R.A.M.C., Lieutenant J. W. H.

Houghton, R.A.M.C., and Civil Surgeons R. H. Browne