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mortality, our Commissioner summarised them in the tw(words "overworked and underfed." But there was also bacsanitation; this was described as follows :-
" The first defect that strikes one is the construction o:
the ashpits or cesspits, whichever you choose to call them,I made numerous inquiries, and 1 find that some of theseashpits are simply holes in the earth; others have certainlygut walls to them, but these are plain bricks and plainmortar-that is to say, thoroughly porous; consequently,all the liquid that goes into these ashpits filters through thewalls and contaminates the surrounding soil. I also madesome inquiries, and discovered that at Cradley, in one ortwo instances, and probably in many, the dejections comingfrom the typhoid patients were thrown into these ashpitswithout being previously disinfected. The consequence is,that the specific germ of typhoid fever is now travelling inthe subsoil of Cradley; we do not know to what distance orto what extent. Close to these ashpits, which are a con-stant source of contamination for the subsoil, are numerouswells. There is also a supply of drinking-water in theneighbourhood, provided by a company; but from myinquiries of the inhabitants I find that they constantly useand drink the water from these shallow wells that aboundin the whole district. Now that water is contaminated,off and on, by the filtrations from the ashpits, and isalso contaminated by the surface drainage of all thedomestic slops. At Cradley, for instance, I found thedomestic slops thrown out into the main street, and flowingdown the street and gradually sinking into the soil: I meanthe fish water, the vegetable water, the washing water, andso forth; the rest goes into the ash pits, where it is notseparated from the subsoil, because the walls are porous."After describing the overcrowding of the bedrooms, the
dampness and dilapidation of the houses and the work-shops, the witness went on to remark: "The holes in thewalls and in the roofs of these workshops admit draughtsand cold, and in one sense are perhaps beneficial, becausethey ensure very efficient ventilation, and when people arehard at work it is a good thing for them to have such anabundant supply of air ; but, when they bring into theseworkshops little children, babies, and sit them about inthese damp places, these children, who are not working,suffer terribly from the damp, the draughts, and the rainthat comes in."
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Subsequently Lord Dunraven asked : "Do you considerthat the condition of this district which you are speakingof is exceptionally bad?"—" I think it compares, for its
sanitary neglect, with some of the places in the South ofFrance and in Spain.""As regards England, I mean; is it worse than other
places in England ?"—" My reason for mentioning the Southof France and Spain is that those are the countries wherethe recent cholera epidemic broke out, where the conditionshave been somewhat similar-namely, the fact that dejec-tions from patients were in communication with subsoildrainage. It is true that, in this case, they are put intoashpits ; but, if these ashpits are not watertight, it reallyis more dangerous than if the soil were thrown out into thestreet. If thrown into the street, it would be oxidised tosome extent by the air; here it is kept together in a porousreceptacle, and can ferment and become more injuriousthan if it were thrown out in the open air, and into thegutters of the streets, as they do at Marseilles and Toulon."Asked by Lord Sandhurst whether in the country districts
abroad lie had seen any centres of labour like Cradley,the witness replied: "No, I have not seen anythingmore dilapidated, and more miserable and poverty-stricken,and damp and wretched. Besides, on the Continent thereis always a certain amount of refinement among the work-ing classes, and a certain amount of pleasure available tothem, so that life with them never looks so depressed.""And that is utterly wanting at Cradley Heath ?"-" Yes.Lord Baring then inquired, "Is there anything in the
climate that accounts for that ?"-" I mean that the conti-nental workman has more pleasures accessible to him, andthat his life is more refined.""Does not that arise out of the climate to a great extent?"
-" The climate contributes, but I should think it is due toa great extent to the natural character of the people andtheir general training."Towards the end of the examination the Earl of Limerick
put the following very important questions : " This is whatI wished to get from you: whether you thought that therewas any defect in the present law, whether you thought
the powers in the present law were insufficient, or whetheryou thought it was necessary to supplement the existingsanitary powers by further legislation?"-" should not like,for personal reasons, to make allusion to any one particulardistrict, but I may say that throughout England I havealways found this trouble-that the medical officer of healthwas not able to fully accomplish his duties because hisappointment depended upon the local authorities, and itoften happened that members of that local authority ortheir relatives were themselves the owners of the worstincriminated property."
" Then you think that the present sanitary powers in thisdistrict would be sufficient if they were properly enforced ?"-If the medical officer could act independently of localpressure."
" If he, in fact, were appointed in some manner whichsecured his freedom from local pressure, you think that thepowers already given would be sufficient?"—" I think so, sofar as those special defects are concerned. I think that thatis the difficulty—that the medical officers of health cannotdo what they might wish to do; and it could be shown thatseveral medical officers of health have lost their positionsthrough trying conscientiously to apply the existing law."Lord Dunraven: "How do you know that?"-" I know
personally of such a thing occurring. It is very easy for avestry to cause their medical officer of health so much un-pleasantness through bickering and resisting that he findshimself compelled to throw up his position."
" It is very easy to understand that such might be the case;but are we to understand that you know that that hasoccurred in this district?"-" No, I do not say in this districtat all. I know that it has occurred, and I was careful tosay that this was a general difficulty throughout England,and might account for the special difficulty in that specialdistrict."In answer to further questions, the opinion was expressed
that the authorities in the nail and chain district had notfully and satisfactorily carried out their powers for the pre-vention of disease.Such were some of the principal points elucidated by the
examination; and these were in many respects confirmedincidentally by the evidence of other witnesses, notably thevery able testimony of Mr. Hugh Ker, F.R.C.S. Ed.
ARMY ESTIMATES.
THE estimate of the sum required to defray the expenseof the pay &c. of the medical establishment and cost ofmedicines &c. for the year 1889-90 is stated at .6299,500,being a reduction of .65400 upon that of the preceding year.Of the saving, £4300 is under the head of pay, &c. of medical
staff, and arises from a reduction in the numbers employed,and £1000 is effected on the cost of medicines. The per-sonnel of the department, exclusive of the officers borne onthe Indian establishment, will consist of 1 director-general,7 surgeons-general, 15 deputy-surgeons-general, 481 brigadesurgeons, surgeons-major, and surgeons, 80 acting medicalofficers, who are taken from the retired list and receive £150a year in addition to their retired pay, and 1 apothecary.The total number of medical officers will therefore be 585,being 27 fewer than in the preceding year, and with thisdifference also, that 25 more acting medical officers will beemployed. There are also 35 quartermasters of the MedicalStaff Corps provided for, but these cannot of course beincluded in the number of medical officers. The total sumrequired for the pay of the medical officers is .6212,115. Inaddition to this, £5000 are taken for the pay of surgeons ofMilitia, and jE6000 for pay of civilian medical practitionersand medical officers of military prisons, and for medical bills.Provision is made for 11 surgeons on probation, so that wemay presume the limit of reduction in the numbers on theestablishment has been reached. The estimated number ofmedical officers on half-pay eligible for employment is only6, requiring a sum of .61663. The numbers on the retiredlist amount to 501, being an increase of 14 upon thepreceding year, and the amount of retired pay is esti-mated at .6195,000. We observe with satisfaction thatno reduction is proposed in the Medical Staff Corps, ihestrength of which-2400-is certainly not greater thanis required. There is a slight reduction—amounting to£120—in the sum taken for pay of nurses, extra duty
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pay of regimental hospital orderlies, and miscellaneouslabour ; as the details are not given, we can onlyinfer that no change of any importance in the system ofhospital nursing is contemplated. The Army MedicalSchool at Netley is charged with a sum of f:7509, but asthis includes £700 allowance to the examiners of candidatesfor the medical service and E200 allowance to armysurgeons in aid of expenses incurred in obtaining certificatesin operative surgery, neither of which are properly classedas expenses of the School, the amount required would bemore correctly stated at E6609. As having a very importantbearing on the health of the troops, we observe that underthe head of works, buildings, and repairs, £16,000 are to betaken to build new barracks in Dublin, f 10,000 for demoli-tions, re-appropriations, and sanitary improvements in theRoyal Barracks, Dublin, E400 to reconstruct drainage ofRichmond Barracks, and E3700 for purchase of land adjoin-ing Wellington Barracks, or upwards of £30,000 for theimprovement of the barracks in Dublin alone. At Dover£1652 are required for the alteration of the drains of theCitadel, at Worcester £400 to remodel drainage of barracks,and Windsor and Shoeburyness each are entered for E1500to improve the water-supply. On foreign stations the onlyimportant sanitary works appear to be a contribution of£300 towards the drainage of Cape Town, f450 to improvethe water-supply and drainage at Wynberg, E200 to lay onwater to the camp at Mount Troodos, Cyprus, and £14,230for hntrnent for increased garrison at Malta. The last ofthese has an important bearing on health in the way ofreducing the overcrowding in barracks, which has alwaysbeen considered one of the remediable causes of fever in thegarrison of the island.
NAVY ESTIMATES.
THE first portion of the Navy Estimates for 1889-90,with explanatory observations by the financial secretary,and explanation of differences, has been presented to Par-liament. Vote 3, for medical establishments and services,amounts to £121,900, being an increase of £2400 upon theamount taken for the preceding year. This is stated to be"principally due to provision for increased numbers. Thereis a reduction on wages at medical establishments." Fromthe subheads under this vote, it appears that none of theincrease is due to the salaries and allowances of the medicalofficers, but arises entirely under the heads of hospitaland infirmary provisions and stores, medicines, and instru-ments ; subsistence &c. of seamen at sick quarters &c., not in
charge of naval officers; contributions to lock hospitals; anda small sum for miscellaneous disbursements. The numbersof medical officers on the effective vote are 325 on full payand 41 on salary; on the non-effective vote, 15 on half-payand 244 on retired pay. When the separate statement isissued giving the details of the various subheads of the vote,we shall notice more fully the charges for the medicalservice.
Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.
REPORTS OF MEDICAL OFFICERS OF HEALTH.
Coventry Urban District.-The annual report for 1888issued by Dr. M. Fenton gives a record of excellent andsustained work for the improvement and promotion of thehealth of the public in the urban district. Inspections arewell maintained, not only on the occurrence of disease, butfor the far more important object of preventing disease.Middensteads are steadily being abolished; indeed, onlylifty-four remain, and twelve of these are in process ofconversion. No less than 244 sinks have been severed fromdirect communication with the house drains since the lasthouse-to-house inspection, but t good deal still remains tobe done in this respect. The water-supply is good, and itsuse is steadily extending. But the quantity is insufficient,and measures are about to be taken to secure furtherpowers in this matter. The Hospital for Infectious Diseasesdoes excellent service, and it is becoming more in favourwith the public. Both measles and scarlatina prevailed
somewhat widely in 1888, and 162 cases of the latter diseasewere isolated in the hospital. There was no fatal diphtheria,but an occurrence of septic pharyngitis, which was appa-rently infectious and which caused three deaths, was pro-bably much the same thing under a new name. The generalmortality for the district, in a population which is statednow to exceed 50,000, was 15’9 per 1000.
Bilston Urban District.-The small-pox outbreak of 1887was, according to Dr. Hidley Bailey’s report, continued into1888 ; and up to May forty-two additional cases occurred, ofwhich twenty-two were removed to the temporary cottagehospital. Scarlatina was also somewhat prevalent, butthere is unfortunately no reference to any means of hospitalisolation for cases of this disease. On the whole, the zymoticrate was not heavy, reaching as it did only 0’82 per 1000living. The ordinary routine work of inspection was main-tained throughout the year, and it is worth recording thata continuous service of water was substituted for an inter-mittent supply, with its attendant dangers and drawbacks.
Liverpool Port Sanitary District.-The past year was abusy one in this port. No less than 22,290 vessels enteredthe port, and of these 4126 were inspected. Emigration alsoled to an increase of work; but it is reported that thearrangements are now so complete that the 240,566 personswho passed through Liverpool last year caused no specialanxiety, whilst the public safety was secured. Of theseemigrants thirty-seven were sent to hospital on arrival owingto sickness. Dr. Stopford Taylor refers also in his reportto the correspondence which has passed between Runcornand the Liverpool port authority, and which has endedsatisfactorily by Liverpool undertaking to carry out theprovisions of the cholera regulations for vessels bound forRuncorn, subject to a payment for expenses &c. incurred.
Hastings Urban District.-The death-rate of this urbandistrict during 1888, subject to such corrections as are
deemed necessary, is given as 13’1 per 1000 living; thepopulation being estimated at 55,119. The amount ofdeath from so-called zymotic diseases was at the rate of0’47 per 1000. Four fatal attacks of diphtheria occurredout of eleven reported cases, two of them being imported.The sanatorium served to isolate 69 cases of scarlatina, andmany useful pieces of sanitary work are recorded by Mr.Knox Shaw.
Sutton-Coldfield Urban District.-This district had during1888 a low death-rate—viz., 10-8 per 1000 ; and of childrendying under one year of age the proportion was onlyas 7’6 to every 100 births. In dealing with the deathsfrom infectious diseases, Dr. Bostock Hill records 5 fromdiphtheria out of 30 attacks which were heard of, theprevalence being a continuation of an outbreak during theprevious year. It is satisfactory to notice the absence ofany death from either enteric fever or diarrhœa. Greatstrides are stated to have been made in sanitary matters,and this especially in the matters of sewerage and water-supply. A good code of bye-laws is now in force, and regula-tions have been made as to milkshops, dairies, and cow-sheds ; the district also possesses a well-equipped hospitalfor infectious diseases, into which twenty-four patients werereceived last year. The influence of the elementary schoolsin spreading infection is considered in the report, and Dr.Hill lays down the conditions which should, in his opinion,regulate the attendance of children, with a view to themaintenance of freedom from preventable disease.
VITAL STATISTICS.
HEALTH OF ENGLISH TOWNS.
IN twenty-eight of the largest English towns 5926 birthsand 3818 deaths were registered during the week endingMarch 23rd. The annual rate of mortality in these towns,which had been 19-7, 21-0, and 21-3 per 1000 in the pre-ceding three weeks, declined again last week to 20-8.During the first twelve weeks of the current quarter thedeath-rate in these towns averaged 21’0 per 1000, and was2-7 below the mean rate in the corresponding periods ofthe ten years 1879-88. The lowest rates in these townslast week were 15.0 in Brighton, 16’1 in Halifax, 16-6 inLeicester, and 17-5 in Derby. The rates in the othertowns ranged upwards to 28.8 in Sunderland, 29-5 inPreston, 31’5 in Manchester, and 36’1 in Blackburn. Thedeaths referred to the principal zymotic diseases in thesetowns, which had been 431 and 434 in the preceding twoweeks, further rose last week to 469; they included 200 from
