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127 Public Health. REPORTS OF MEDICAL OFFICERS OF HEALTH. The Health of JolwnnesbMrg.1-A sketch made in 1885 shows the high veld before the discovery of gold mines, when the undulating plains were broken only by occasional farm- houses with a wagon and a few cattle in the neighbourhood of each. The following year certain farms on the Witwaters- rand were proclaimed as public goldfields, and the town of Johannesburg rapidly sprang into being. In 1896 there was already a population of 102,714, of whom half were white people, and to-day the population has reached 180,687, of whom rather more than half are whites, some 6000 are Asiatics, and the remainder are coloured South Africans. In some ways the town is an ideal residence for Europeans, for it is unique in possessing gold mines, coalfields, and a climate in which white men can work all the year round, at an elevation of nearly 6000 feet. In order to discover the importation of plague in the pneumonic form, pneumonia was for four years made a notifiable disease, but now it is found cheaper to inquire into each fatal case of the disease occurring among Asiatics, while free examination of the sputum of any suspicious patient is made. The death-rate from pneumonia for the three years brings out very clearly the high mortality which usually occurs in negroes and negroids, The deaths per 1000 among the whites and Asiatics varied from 0 - 8 to 1 - 9, being about the same average as in London, but the South African coloured population furnished from 6’ 6 to 9 - 6 deaths. An important contribu- tion to the study of pneumonia among natives was made by Dr. G. A. Turner, the medical officer of the Native Labour Association, who found that in 160 necropsies the lungs of 93 contained the ova of schistosomum hasmatobium, though only 69 of the natives had died from pulmonary disease. This is an observation of some importance, because in Egypt it has always been held that the lungs are only rarely the site of the egg of this worm. Though it has been known for nearly half a century that the bilharzia disease exists in South Africa we were hardly prepared for Dr. Turner’s figures. As the result of 971 necropsies on natives from all parts of South Africa he tound that at least 80 per cent. were infected. Dr. A. W. May, the Government bacterio- logist, is reported to have found another rarity, a cyst con- taining terminal-spined bilharzia eggs in the stomach of an imported Chinaman. The number of cases of enteric fever was during last year the lowest on record, and the cases will probably diminish still further when the municipality has completed the extension of the water- carriage system of sewage disposal, and the universal earth-closet becomes a thing of the past. In two of the small outbreaks of enteric fever the spread of the infection was traced to a carrier, in each case a native employed in a dairy. Both carriers were isolated, and one of them was treated with a vaccine prepared from the organism which was isolated from his urine. Of the natives employed by the municipality who contracted typhoid fever, 71 per cent. belonged to the scavenging service and were employed in handling night soil, &c. Of the deaths from tuberculosis, more than one- third occurred amongst miners employed underground, most of them being machine drillers and suffering from silicosis, while it is stated that many other miners returned to Cornwall to die from phthisis. Clerks and salesmen furnished the next largest number of deaths from tuberculosis, and some of these were ex-miners. A great danger is the steady increase of phthisis among natives, who succumb rapidly, for more than half the 1129 cases registered died in less than six months. Dr. Turner has pointed out that the bilharzia pulmonary lesions probably predispose the natives to tubercle. Cancer was the cause of 48 deaths among the natives, the liver and stomach being most commonly attacked. Syphilis is thought to have been introduced from Kimberley in 1881, and is now widely prevalent amongst the natives of the Transvaal and Bechuanaland. It is believed to be conveyed sometimes by the use of infected knives in 1 Report of the Medical Officer of Health on the Public Health and Sanitary Circumstances of Johannesburg during the Triennium, July 1st, 1906, to June 30th, 1909. By C. Porter, M.D., D.P.H., Johannesburg, February, 1910. Pp. 68. the circumcision rite and by the practice in some districts of inoculating the parents with blood when a birth has taken place. White children have been infected through being kissed by syphilitic native nurses, and circulars have been distributed arranging for the free examination of native servants and the free issue of curative medicines by district surgeons. Only three cases of small-pox occurred during the three years, for vaccination of natives is compulsory. Anky- lostomiasis is notifiable, but only 15 cases were reported, though the disease is exceedingly prevalent among the natives recruited from the east coast and from the central tropical areas of South Africa. The comparative freedom from ankylostomiasis in miners is probably due to the fact that the Rand mine waters are acid and provide a natural process of disinfection against the larvse of the worm. 40 lepers, including 3 white women, were notified and were removed to the leper asylum in Pretoria. No case of bubonic plague occurred among men or rats, and 43,098 rats and mice were destroyed with the aid of traps, dogs, and ferrets. There are now 15 registered nursing homes in Johannesburg, all inspected and licensed by the Public Health Department. We cordially congratulate Dr. Porter and his staff upon the excellent work which they are doing, and we hope that the mayor and his municipal colleagues will heed the grave warnings and recommendations of this report. VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN 77 of the largest English towns 8350 births and 3588 deaths were registered during the week ending July 2and: *- The annual rate of mortality in these towns, which had been so low as 11’1 and 11-2 2 per 1000 in the two preceding weeks, further declined to 11’0 0 in the week under notice. During the 13 weeks of the past quarter the annual death-rate in these towns averaged only 12- 7 per 1000, and was 1- 6 below the mean rate in these towns in the four preceding corre- sponding quarters. In London during the same period the death-rate, calculated on the estimated population, did not exceed 12 - 2 per 1000. The lowest reported annual rates of mortality during last week in these 77 towns were 3’7 in East Ham, and 6’3 in Willesden and in Hornsey ; the rates in the rest of the 77 towns ranged upwards to 17.1 1 in Huddersfield, 18.1 1 in Oldham, 19 - 2 in Warrington, and 21-3 in Tynemouth. In London the reported death- rate last week was only 10-3 per 1000. The 3588 deaths registered last week in the 77 towns showed a decline of 45 from the number in the previous week, and included 336 which were referred to the principal epidemic diseases, against numbers declining from 425 to 353 in the five preceding weeks ; of these 336 deaths, 113 resulted from measles, 110 from whooping-cough, 55 from diarrhoea, 25 diphtheria, 20 from scarlet fever, and 13 from enteric fever, but not one from small-pox. The mean annual rate of mortality from these epidemic diseases in the 77 towns last week was equal to 1 - 0 per 1000, against 1,1 1 in each of the two preceding weeks. No death from any of these epi- demic diseases was registered last week in Croydon, East Ham, Walthamstow, Derby, or in 14 other smaller towns ; the annual death-rates therefrom ranged upwards, however, to 2’8 8 in Grimsby and in Warrington, 2 - 9 in Oldham, 3-0 in Stockport, and 3-3 3 in Barrow-in-Furness. The fatal cases of measles in the 77 towns, which had been 149, 106, and 94 in the three preceding weeks, rose again to 113 last week ;. the highest annual rates from this disease last week were 1-7 in Preston, 1-8 8 in Oldham, 2.0 0 in Merthyr Tydfil, and 3-3 3 in Barrow-in-Furness. The 110 deaths from whooping-cough showed a decline of 24 from the number in the previous week, but caused rates equal to 1.4 4 in Ipswich, 1’5 5 in Stockport and in Bootle, and 2- 1 in Warrington. The deaths attributed to diarrhoea, which had been 75 and 70 in the two previous weeks, further declined under the influence of lower temperature to 55 ; the deaths from this cause were proportionately most numerous in Grimsby. The 25 fatal cases of diphtheria showed an increase of 8 upon the low number in the previous week, and included 7 in London and its suburban districts, and 2 each in Liverpool and Manchester. The fatal cases of scarlet fever, which had been 22 and 25 in the two preceding weeks, declined to 20 last week, of which 4
