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the precautions taken by them for the protection of the public, in addition to the favourable opinions we have already expressed respecting their establishment.-ED.]

HAY AND HARVEST WORK WITHOUT BEER. Farmers in considerable numbers have either given up, or are now giving up, the practice of giving their men beer in hay and harvest work. Conferences of farmers have recently been held in various parts of the country on this subject, and after full discussion it has been generally agreed that it was desirable to discontinue the practice of giving beer. At well-attended conferences of farmers in the Town Hall, Basingstoke, on June 11, and in the County Hall, Lewes, on June 17, the following resolution was unanimously passed:

'That in the opinion of this Conference it is desirable in the interests of both masters and men that the practice of supplying be er in the hay and harvest field be discontinued, and that all work be paid for entirely in cash.'

All experience goes to prove that this change will be of great advantage to the men. They will soon fall into the way of providing themselves with good wholesome drinks at a small cost. Perhaps you will kindly assist by allowing the following receipts, that have been found useful, to appear in an early issue of your paper.

Home-Made Drinks for the Harvest.

STOKOS is a most refreshing and strengthening drink. It is easily made, and costs only 3d. per gallon.

Put into a large pan lb. of fine fresh oatmeal, 6 oz. of white sugar, half a lemon cut into small pieces. Mix with a little warm water, then pour a gallon of boiling water into it; stir all together thoroughly and use when cold. The lemon may be omitted. raspberry vinegar, citric acid, or any other flavouring may be used instead. More oatmeal may be used if preferred.

COKOS is a good nourishing drink made as follows:-8 oz. of sugar, 6 ozs. of good fine oatmeal, 4 ozs. of cocoa at rod. per lb., mixed gradually and smoothly into a gallon of boiling water; take to the field in a stone jar. Cost 6d. per gallon.

A GOOD HARVEST DRINK. Boil oz. hops, oz. of ginger (bruised), in 1 gall. of water, for twenty-five minutes, add 1 lb. of brown sugar and boil ten minutes more, then strain and bottle while hot; it will be ready for drinking when cold. It should be kept in a cool place. Dried horehound may be used instead of hops. Cost 3d. per gallon. GINGER BEER.-Pour two gallons of boiling water over 1 lb. of lump sugar, 1 oz. of bruised ginger, two lemons sliced, let it stand till lukewarm, then add one tablespoonful of brewer's barm, or one small teacupful of baker's barm; let it stand twelve hours, then bottle it. It will be ready for use in twenty-four hours. Cost 4d. per gallon. Boiling water poured on a few slices of lemon, with a little sugar, makes a very refreshing drink. Butter-milk should be more used as a drink.

One ounce of coffee and half an ounce of sugar in two quarts of water is a very thirst-quenching drink. So is cold tea, but neither of these is so supporting as the oatmeal drink.

It is quite a mistake to suppose that beer or spirits give strength. They do give a spurt to a man, but that quickly goes off and spurts in hard heavy work, too often made, certainly lessen the working

powers.

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THE INTERNATIONAL HEALTH EXHIBITION. THE Minister of Commerce, M. Hérisson, has nominated the following as members of the jury of the International Health Exhibition, now held at London. M. Arnould, Professor of Hygiene at the Medical Faculty of Lille, M. Bérard, Secretary to the Comité Consultatif of Art and Manufacture; M. Brouardel, Gueneau de Mussy and Proust: M. Buisson, Director of Elementary Education; M. Dethomas and Dr. Liouville, deputies; M. Dutert, Inspector of Schools of Design; Dr. Gariel, Assistant Professor of Physics at the Paris Medical Faculty; M. Guillaume, Member of the Institut; M. Guy, President of the Syndical Chamber of Wholesale Distillers of Paris; M. Jacquemart, Inspector General of Technical Education and of the Art and Trade Schools; M. Jartauld, President of the Paris Syndical Chamber of Wine and Spirits; M. Jordan, Professor of Art and Manufacture at the Ecole Centrale; M. Lavezzari, Principal Architect of the Berck-on-Sea Hospital: Dr. Layel, Professor of Hygiene at the Bordeaux Medical Faculty: M. Leblanc, Member of the Academy of Medicine, formerly Chief Veterinary Surgeon of the Prefecture of the Seine: M. Lesoufaché, architect; M. de Montmahon, Inspector-General of Elementary Education; M. Emile Müller, Professor of Art and Manufacture at the Ecole Centrale; Dr. Napias, General Secretary to the Society of Public Medicine and Professional Hygiene; M. Nourrit, Printer and Publisher: M. Schrieber, President of the Syndical Chamber of India-rubber; M. G. Trelat, Professor at the Ecole Special d'Architecture; Dr. Vallin, Professor at the Military Medical School of the Val du Grace.

VENTILATION OPEN COMPETITION. Ar the Ventilation Open Competition just concluded at Birkenhead, Messrs. Robert Boyle & Son, of 64 Holborn Viaduct and Glasgow, have been awarded the Gold Medal, the highest and only prize offered for their system of ventilation, it being adjudged the best.

NOTICES OF MEETINGS.

SOCIAL SCIENCE CONGRESS.

THE following 'special questions' relating to Sanitary Science have been agreed upon between the local committees and the council of the Social Science Association for discussion in the Congress, to be held in Birmingham in September next.

HEALTH.-I. What is the best method of dealing with (a) town sewage; (b) the products of house and street scavenging; and (c) the products of combustion? 2. What are the best means, legislative or other, of securing those improvements in the dwellings of the poor which are essential to the welfare of the community. 3. How far may the average death-rate of a population be considered an efficient test of its sanitary condition; and by what means can the high deathrate of children be reduced.

VACCINATION OFFICERS' ASSOCIATION.
THE next meeting of members of this Association will be held on
Saturday, July 19, at 2.30 P.M., at the Charing Cross Hospital Medi-
cal School, 62 Chandos Street, Strand, W.C.

AGENDA. 1. To read minutes of last meeting. 2. Correspondence.
3. Election of members and honorary members. 4. To take into
consideration a letter received from Dr. Henry Stevens, Inspector of
the Local Government Board, asking for information from members
of this Association, as follows. To show how promptly on the
action of the Vaccination Officer the protection of vaccination can be
secured to those in infected houses. Any instances in which such
prompt action has illustrated its advantages.' 5. To consider the
pamphlet issued by 'The National Health Society' upon the benefits
of vaccination, and to move a resolution. 6. And such other business
as may arise.
C. O. ELKERTON,
Hon. Sec.

APPOINTMENTS

20 Clarendon Street, Pimlico,

London, S.W.

UNDER THE PUBLIC HEALTH ACT.

MEDICAL OFFICERS OF HEALTH.

BRAUND, James Montague, M.R.C.S.Eng., L.S.A.Lond., has been
re-appointed Medical Officer of Health for the North Division
of the Stratton Rural Sanitary District, at £25 for one year
CLEGG, Walter, M.R.C.S. Eng., L.S.A. Lond., has been re-appointed
Medical Officer of Health for the Boston Port Sanitary District,
for one year.

COGAN, Lee Fyson, L.R.C.P. Edin. and L.M., M.R.C.S.Eng., has
been re-appointed Medical Officer of Health for the Northampton
Urban Sanitary District, at £150 per annum, for three years.
FISHER, Thomas, M. R.C.S.Eng., L.S.A. Lond., has been re-appointed
Medical Officer of Health for the Garstang Rural Sanitary
District, at £50 for one year.

GAYLOR, Edward, L.R.C.P.Edin., and L.M., L.F.P.S.Glasg., has
been re-appointed Medical Officer of Health for the Alfreton
Urban Sanitary District, at £20 for one year, and for the Ripley
Urban Sanitary District at £20, for one year.

HOLLIS, Elphinstone, M.D., M.B., C.M., Univ. Edin., has been
appointed Medical Officer of Health for the Woodbridge Rural
Sanitary District, Suffolk, at 'L50 for one year, vice Marshall,
deceased.

JAMES, James Rowland, M.B. Univ. Edin., M.R.C.S.Eng., has been
re-appointed Medical Officer of Health for the Ystradyfodwg
Urban Sanitary District, Glamorganshire at £150 per annum,
for one year.

LIVETT, Henry William, L. R.C.P. Edin., M.R.C.S.Eng., L.S.A.
Lond., has been re-appointed Medical Officer of Health for the
Wells (Som.) Urban Sanitary District, at £30 per annum, for
three years.

MARSHALL, William Norris, M.R.C.S. Eng., L.S. A. Lond., has been
re-appointed Medical Officer of Health for the Newent Rural
Sanitary District, at £40 for the year ending April 30, 1885.
MOXON, James Burdett, M. R.C.S.Eng., L.S.A.Lond., has been
re-appointed Medical Officer of Health for the Glanford Brigg
Rural Sanitary District, at £120 per annum until June 30, 1886.
POLLARD, William' Robert, L. R.C.P.Edin., L. R.C.S.Irel., has been
re-appointed Medical Officer of Health for the Blackburn Rural
Sanitary District, at £50 for one year.

ROBINSON, William, M.D., M.R.C.S.Eng., L.S.A. Lond., has been
appointed Medical Officer of Health for the Gateshead Urban
Sanitary District, at £350 per annum, as Medical Officer of
Health, and £50 per annum for attending the hospital, from
year to year, vice Green, resigned.

SEATON, Edward, M.D. Univ. Lond., M.R.C P.Lond., has been
appointed Medical Officer of Health, Public Analyst, and
Examiner of Gas, for the Parish of St. Luke, Chelsea, at £450
per annum, vice Barclay, deceased

J.

SPURGIN, William Henry, M. R.C.S. Eng., L.S.A. Lond., has been appointed Medical Officer of Health for the Maryport Urban Sanitary District, Cumberland, at £35 for one year, vice Pearson, resigned. STATHERS, George Nicholson, L.R.C. P. Edin., M. R.C.S.Eng., has been appointed Medical Officer of Health for the No. 1 Division of the Wycombe Rural Sanitary District, at £40 for one year, rice Hayman, resigned.

STEELE, Henry Octavius, M R.C.S. Eng., L.S. A. Lond., has been re-appointed Medical Officer of Health for the Cleckheaton Urban Sanitary District, at £40 for one year.

STPART, William, M. B., C. M. Univ. Aberd., has been re-appointed Medical Officer of Health for the South Division of the Stratton Rural Sanitary District, at £15 for one year. TURNER, George, L. R.C.P.Lond., M. R.C. S. Eng., S.S.Cert Cantab, has been re-appointed Medical Officer of Health for the BishopStortford, Buntingford. Hertford, and Ware Rural, and the Bi-hop-Stortford, Hertford, and Ware Urban Sanitary Districts combined, at £600 per annum, for five years. WARREN, Thomas, M.R.C.S. Eng., LS.A. Lond., has been reappointed Medical Officer of Health for the No. 2 Division of the Wycombe Rural Sanitary District, at £35 for one year.

SURVEYORS, CLERKS TO GUARDIANS, INSPECTORS OF NUISANCES, &c.

BASTIMAN, Mr. James, has been appointed Inspector of Nuisances for the Scarborough Urban Sanitary District, at £tos per annum, rice Finlay, resigned.

BERINGER, Mr. John Jacob, has been appointed Public Analyst for the Borough of Penryn, vice Parry.

BEST. Mr. Joseph, has been appointed Surveyor to the Shildon and East Thickley Local Board and Urban Sanitary Authority, co. Durham, at £40 per annum, and Inspector of Nuisances at £60 per annum, vice Laycock, appointed Surveyor to the Walker Local Board and Urban Sanitary Authority.

BALLAM, Mr. Frederick, has been appointed Inspector of Nuisances for the Wareham Urban Sanitary District, at £10 per annum, vice Hobbs, resigned.

PASWELL, Mr. Thomas, Branch Manager of the London and Provincial Banking Company, has been appointed Treasurer to the Tredegar Local Board and Urban Sanitary Authority, and to the Bedwellty Guardians and Rural Sanitary Authority, Monmouthshire, vice Green, resigned.

Bowry, Mr. John, has been appointed Surveyor and Inspector of Nuisances to the Corporation and Urban Sanitary Authority of Chepping Wycombe, Bucks, at £150 per annum, vice Wakelam, who declined the appointment.

BRADLEY, Mr. Herbert Edward, Manager of the Chipping Sodbury Branch of the National Provincial Bank of England, has been appointed Treasurer to the Chipping Sodbury Guardians and Rural Sanitary Authority, vice Foxwell, resigned. BROOM, George 1. C., C.É., has been appointed Surveyor_and Inspector of Nuisances to the Corporation and Urban Sanitary Authority of St. Helens, at £400 per annum, vice Hart, resigned. Bows, Mr. Thomas, has been appointed Inspector of Nuisances for the Leighton Buzzard Rural Sanitary District, at £83 per annum, vice Mr. W. Brown, deceased.

COLE, Mr. S. B., has been elected Chairman of the Bilston Improvement Commissioners and Urban Sanitary Authority for the ensuing year.

C.WLARD,

Mr. Christopher Lethbridge, Solicitor, has been appointed Clerk to the Launceston Local Board and Urban Sanitary Authority, at thirty guineas per annum, vice Mr. J. L. Cowlard, his father, resigned.

CRESSWELL, Mr. F., has been appointed Collector to the Awre Local Board and Urban Sanitary Authority, Gloucestershire, at £15

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annum.

FLATHER, Mr. Thomas, has been appointed Accountant to the Cor. poration and Urban Sanitary Authority of Bradford, Yorkshire, at £300 per annum.

GIRATHEAD, Mr. Francis Joseph, Solicitor, has been appointed Clerk to the Reeth Guardians and Rural Sanitary Authority, Yorkshire, at £40 per annum, as Clerk to the Guardians, and such salary as Clerk to the Rural Sanitary Authority, to the School Attendance Committee, and to the Assessment Committee, as may be fixed from time to time, and fees as Returning Officer and Superintendent Registrar of Births, &c., vice Tomlin, deceased. GREENHALGH, Mr. Christopher, on being relieved of his duties as Inspector of Nuisances, is to be continued as Surveyor to the Gainsborough Local Board and Urban Sanitary Authority, at £125 per annum, and £25 per annum for the Water Works. HARMAN, Mr. Thomas, has been appointed Collector to the West Hartlepool Improvement Commissioners and Urban Sanitary Authority, at £125 per annum, vice Downey, appointed Accountant.

HARRISON, Mr. John, has been elected a Member of the Dronfield Local Board and Urban Sanitary Authority, vice Rhodes, resigned.

HEWARD, Mr. Samuel, has been re-appointed Inspector of Nuisances for the Whit wick Urban Sanitary D strict at o per annum, for five years ending June 24, 1889.

HILL, Mr. F. A. Brooks, Bank Manager, has been appointed Treasurer to the Pewsey Guardians and Rural Sanitary Authority, vice Wood, resigned.

HOLDROYD, Mr. Alfred, has been re-appointed Inspector of Nuisances for the Cleckheaton Urban Sanitary District, at £35 for the year ending June 24 next.

HOOLEY, Mr. Cosmo C., has been appointed Surveyor to the Bartonupon-Irwell Rural Sanitary Authority, at £225 per annum, vice Price, resigned.

HOULDERSHAW, Mr. William, has been appointed Inspector of Nuisances for the Liversedge Urban Sanitary District, Yorkshire, at £26 per annum, vice Womersley, whose appointment has expired.

HUGHES, Mr. Thomas, has been appointed Public Analyst for the Borough of Newport, Mon., until Sept. 11.

JONES, Mr. E. W. T., has been re-appointed Public Analyst for the Borough of Walsall for one year.

KNIGHTS, Mr. James West, has been re-appointed Public Analyst for the County of Huntingdon.

MANN, Mr. Robert, has been elected a Member of the Handsworth Local Board and Urban Sanitary Authority, vice Bragge, dereased.

MCNEILL, John Patrick, M.D. Univ. Dub.. has been re-appointed Pub ic Analyst for the Borough of Tiverton.

NIXON, Mr. Thomas, has been re-appointed Inspector of Nuisances for the Stafford Rural Sanitary District, at 50 per annum, in addition to £15 and £35 per annum, as Inquiry and Attendance Officer to the School Attendance Committee. PLATT, Mr. Samuel, has been appointed Inspector of Nuisances for the Gainsborough Urban Sanitary District, at £30 per annum, vice Greenhalgh, relieved of his duties (but continued as Surveyor

PONTING, Mr. Frederick William, Banker, has been appointed Treasurer to the Preston Guardians and Rural Sanitary Authority, vice Dalby, resigned.

PRICE, Mr. John, C. E., Assoc. M. Inst. C.E., M.S.E., has been appointed Surveyor and Inspector of Nuisances to the Toxteth Park Local Board and Urban Sanitary Authority, at £350 per annum, vice Hall, deceased. RIDLINGTON, Mr. Walter, has been appointed Surveyor, Inspector of Nuisances, and Collector to the Holbeach Local Board and Urban Sanitary Authority, at 100 per annum, vice Douse, resigned, after nearly twenty-two years' service.

RILEY, Mr. Thomas, has been elected a Member of the Board of Fleetwood Commissioners and Urban Sanitary Authority, vice Warbrick, deceased.

ROBINSON, Mr. Thomas. has been elected a Member of the Nelson Local Board and Urban Sanitary Authority, vice Elliott, resigned.

SHAW, Mr. Joseph, has been appointed Surveyor to the Stainlandwith-Old Lindley Local Board and Urban Sanitary Authority at £15 per annum and re-appointed Inspector of Nuisances at £30 per annum for three years, from April 11 last, and Collector at £19 per annum (£65 altogether).

SMALLPIECE, Mr. Gilbert John. has been appointed Treasurer to the Guildford Guardians and Rural Sanitary Authority, vice Hay. don, re-igned.

STAINTHORPE, Mr. Thomas William, has been appointed Surveyor and Inspector of Nuisances to the newly-formed Eston Local Board and Urban Sanitary Authority, at £150 per annum, for three years, from July 1.

STEPHENSON, Mr. John, has been re-appointed Inspector of Nuisances for the Boston Port Sanitary District for one year. STUART, Mr. Charles Madock, has been appointed Public Analyst for the Borough of Newcastle-under-Lyme, vice Purdie, resigned. THORPE, Mr. G. A., has been appointed Deputy Accountant to the Corporation and Urban Sanitary Authority of Bradford, Yorkshire, at £200 per annum.

UNWIN, Mr. W. T., has been appointed Surveyor and Inspector of Nuisances to the March Local Board and Urban Sanitary Authority, at £80 per annum, vice Amos.

WAKELAM, Mr. Henry Titus, C.E., who was appointed Surveyor and Inspector of Nuisances to the Corporation and Urban Sanitary Authority of Chepping Wycombe, Bucks, has declined the appointment, and continues as Surveyor and Inspector of Nuis ances to the Corporation and Urban Sanitary Authority of Oswestry, at the increased salary of £150 per annum. WHITTAKER, Mr. John, has been appointed Surveyor, Inspector of Nuisances, and Collector to the Worsborough Local Board and Urban Sanitary Authority, Yorkshire, at £140 per annum, with house, gas, and water, vice Senior and Wilkinson, resigned. WILLIAMS, Mr. Frederick Edward, has been appointed Clerk to the Leigh Guardians and Rural Sanitary Authority, Lancashire, at £120 per annum as Clerk to the Guardians, 60 per annum as Clerk to the Rural Sanitary Authority, £30 per annum as Clerk to the Assessment Committee, Lao per annum as Clerk to the School Attendance Committee, and fees as Returning Officer and Superintendent Registrar of Births, &c., vice Heywood, resigned.

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MEDICAL OFFICER OF HEALTH for the Grange Urban Sanitary District, Lancashire.

CLERK to the Oundle Guardians and Rural Sanitary Authority. SURVEYOR to the Swinton and Pendlebury Local Board, Lancashire. SURVEYOR AND INSPECTOR OF NUISANCES to the Haverhill Local Board and Urban Sanitary Authority: 100 per annum, from year to year, with the prospect of additional salary as Manager of the Gas Works. Application, 21st inst., to Charles F. Freeman, Clerk, Haverhill, Suffolk. SANITARY INSPECTOR for the Parish of St. Pancras, £90 rising to 100 per annum. Application, 17th instant, to Thomas Eccleston Gibb, Vestry Clerk, Pancras Road.

LOCAL INTELLIGENCE.

The Stoke Damerel Rural Sanitary Authority and their officers have subscribed for a tablet in memory of their late chairman, Mr. F. C. Rickard, which has been placed in the Board room. It consists of a slab of coloured stone, on which is placed a white marble scroll, bearing the following inscription: This tablet is erected by the Commissioners of the Poor of Devonport and their officers in remembrance of the late Francis C. Rickard, Esq., who for twentysix years was a member of the Board, and for the last fourteen years faithfully carried out the duties of Chairman. April 1884.'

The Cambridge Improvement Commissioners and Urban Sanitary Authority have passed the following resolution by 17 votes to 10: That it is expedient to apply in the next session of Parliament for legislative sanction to alter the constitution of the Board of Commissioners, and to amend the provisions of the Local Acts and the Award Act with respect to the relations between the university and the town on the basis of the provisions of the Bill of 1874; and empowered the Parliamentary Committee to take the necessary steps for carrying it into effect.

The Denton Local Government District is to be merged in the Haughton District, on Sept. 29, by Provisional Order of the Local Government Board.

The Barking-Town Local Board and Urban Sanitary Authority have increased the salary of the Survevor from £80 to £150 per annum, and that of the Inspector of Nuisances from £40 to £70 per

annum.

The Maryport Urban Sanitary Authority, upon a vacancy for a Medical Officer of Health having arisen by the resignation of Dr. Pearson, have increased the salary from £25 to £50 per annum.

An

At Llandysilio, a statutory meeting of owners and ratepayers was held some time since, and a resolution passed, that it was expedient that it should be constituted a Local Government District. inquiry was then held in accordance with the Act of Parliament; but as certain works of drainage, &c., had not been carried out, the Inspector declined to report in favour of the resolution. They have now, however, been completed, and another inquiry held, at which the Inspector intimated that he would report in favour of the parish being constituted a Local Government District under the title of 'The Menai Bridge Local Government District,' with a Board of nine members, Mr. H. Bulkely Pryce to be the returning officer.

The parish of East Grinstead has been constituted a Local Government District by Provisional Order of the Local Government Board. There are to be twelve members, and, if there should be a contest, the voting-papers are to be collected on August 20.

The St. Anne' s-on-the-Sea Medical Officer of Health commences his report to the Local Board and Urban Sanitary Authority, dated July 1, with the following satisfactory sentence. During the past month not a single death has taken place in this district.'

The Stafford Rural Sanitary Authority, at their meeting on June 21, reconsidered the proposed reduction of the salary of Dr. George Reid, the Medical Officer of Health, from £75 to £50 per annum, in compliance with the request of the Local Government Board (see page 574); and, after a short discussion, a resolution that a reply be sent to the Local Government Board to the effect 'that the authority could not come to any other conclusion than that previously arrived at,' was proposed and carried by 11 votes to 3.

The Colchester Town Council and Urban Sanitary Authority, have voted Two hundred guineas to Mr. Charles Clegg, the Surveyor, in recognition of his extra services in connection with the erection of a water tower, &c., instead of increasing his salary £80 per annum, which he had asked for.

CREDITON IMPROVEMENT COMMISSIONERS AND URBAN SANITARY AUTHORITY.-At the annual election on the 1st instant, the following were elected commissioners for the ensuing three years, viz. -Messrs. James Templeton, John Squire, William Pope, G. H. Chaplin, W. H. Symes, William Dodridge, James Searle, *G. Bicknell, William Labbett, and A. A. Gale. ( Retiring commissioners re-elected).

VACCINATION OFFICERS' ASSOCIATION. THIS association was inaugurated on Feb. 16, 1884, and has already on its roll of members almost every vaccination officer of the metropolis and surrounding districts, and as honorary members a large number of public vaccinators, medical officers of health, and other distinguished persons interested in the promotion of vaccination. The association has received the cordial support of Henry Stevens, Esq., M.D., one of Her Majesty's Inspectors under the Local Government Board, who, under date lan. 31, 1884, wrote to the promoters of the association as follows:-'I may state that I fully sympathise with you in your desire to unite together for mutual support and co-operation, and I believe that much advantage might accrue to the community by securing a more complete administration of the Vaccination Acts through such combination.' The objects of the association are to secure as far as possible uniformity of action in working of the

Vaccination Acts, the exchange of experience and advice, and the mutual benefits of its members. The members of the association will consider and answer all matters of correspondence submitted for their consideration, and will, to the best of their ability and experience, assist all brother officers in any matters of interest arising in the course of their duties. The association will further endeavour to obtain such alterations in matters of detail as from time to time may in their opinion prove beneficial to the cause they represent. Every vaccination officer, public vaccinator, and medical officer of health is cognisant of the many difficulties and hindrances that are frequently met with in the proper enforcement of vaccination, which, when efficiently and properly enforced, has repeatedly proved to be of such incalculable benefit to the community, and the association feel that, by thorough combination and with the hearty support and assistance of the medical profession generally, and others interested in the promotion of efficient vaccination, the objects of the Vaccination Acts will be better served in the future, and the public health safe-guarded more thoroughly. The association do not confine themselves to London and districts only, therefore the support of all vaccination officers, public vaccinators, and medical officers of health throughout the country is earnestly desired, and the association appeal to all such gentlemen to become members and honorary members. The annual subscription for members (vaccination officers) is 5s., and for honorary members 10s. The association is under the management of the elected officers and committee, consisting of twelve, who are all subject to annual election at the general meeting in February, when an annual balance-sheet and report will be published. Applications for membership, honorary membership, rules, and all other information can be obtained of the honorary secretary, Charles O. Elkerton, 20 Clarendon Street, Pimlico, S.W.

MANAGEMENT.

Chairman.-Mr. Charles Shattock, St. Mary Abbotts, Kensington. Vice-Chairmen.-Mr. William M. S. Sherman, Whitechapel; Mr. William H. Ward, Bethnal Green.

Treasurer.-Mr. John H. Richards, St. Pancras.

Honorary Secretary.-Mr. Charles O. Elkerton, St. George, Hanover Square.

Committee.-Mr. Charles Atkins, vaccination officer, Lewisham; Mr. William Bence, vaccination officer, Edmonton; Mr. Charles O. Elkerton, vaccination officer, St. George's Union, Middlesex; Mr. Charles Hearson, vaccination officer, Lambeth; Mr. William Malins, vaccination officer, Islington; Mr. Thomas W. Maslen, vaccination officer, Greenwich; Mr. J. R. Moloney, vaccination officer, Stepney; Mr. John H. Richards, vaccination officer, St Pancras; Mr. Charles Shattock, vaccination officer, Kensington; Mr. William M. S. Sherman, vaccination officer, Whitechapel: Mr. Willian John Upton, vaccination officer, Mile End Old Town; Mr. William H. Ward, vaccination officer, Bethnal Green

Honorary Members.-Lieut.-General Batten, 14 Notting Hill Square, Kensington, W. Dr. Charles Thomas Blackman. 4 Highbury Grove. N.; Dr. W. Riddell Brunton, 43 Kirkdale, Sydenham, S.E.; Dr. Edwin Child. Kingston-on-Thames; Dr. C. C. Claremont, Millbrooke House, Hampstead Road, N.W.; Dr. Robert Cory, St. Thomas's Hospital; Dr. Richard Fegan, Westcombe Park, Blackheath, S.E. Dr. Charles Maynard Frost, 47 Ladbroke Square, Notting Hill, W.; Dr. William Hall, Tottenham, Middlesex; Dr. Henry F. E. Harrison, 33 Shepherd's Bush Green, W.; Dr. Joseph Loane, 1 Dock Street, Whitechapel, E.; Mr. Shirley F. Murphy, St. Pancras; Dr. Robert S. Nightingale, 658 Commercial Road, Limehouse, E.; Dr. John Reid, 12 Bridge Avenue, Hammersmith, W.; Dr. George A. Rogers, 164 High Street, Shadwell, E.; Dr. Thomas Scoresby-Jackson, St. Hilda,' Hoe Street, Walthamstow, Essex; Dr. James Smart, 256 Cambridge Road, E.; Dr. Meredith Townsend, 27 Upper Phillimore Place, Kensington, W.; Dr. Alfred G. Wells, Beaumont Terrace, West Kensington, W.

NOTES AND QUERIES.

Having for some time back been in the receipt of Queries appertaining strictly to sanitary work, and which it would be easy to answer, without having to refer our correspondent to competent professional advisers, we have opened a column in which to register such Queries and Replies thereto as can fairly be expected from us; and our subscribers and readers are invited to make such use of this column as will tend 10 benefit themselves and the community. Both Queries and Replies will, however, be subjected, if unnecessarily long, to a strict curtailment.

125. FLOWERS IN SICK ROOMS.

Are cut flowers unhealthy in a sick room? Are flowers growing in pots unhealthy in a bedroom either during the day or night? If so, why? A. Z. [Healthy plants and cut flowers are not unwholesome in bed and other inhabited rooms, and in those cases where mischief has arisen from their presence, it is invariably caused by fungi generated in the stale, unventilated earth of the pots. or in the putrid water in which cut flowers are kept. To secure immunity from any injurious effects the water of cut flowers must be frequently changed, and the potted plants be effectually drained, and have the earth freely stirred up from time to time. Interesting papers on the subject may be consulted by reference to the Lancet, Vol. ii., 1878, p. 68;; the Practitioner, Vol. ii., 1881. p. 387, and Vol. i., 1982, p. 238: and also to the British Medical Journal, Vol. i., 1884, p. 1137. -ED.]

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ORIGINAL PAPERS.

THE NOTIFICATION OF INFECTIOUS DISEASE: ITS IMPORTANCE AND ITS DIFFICULTIES.*

By ALFRED HILL, M.D.,

Medical Officer of Health for Birmingham. WHETHER Lord Bacon did or did not say that 'knowledge is power' matters little compared with the importance of the truth expressed in the dictum. Without a knowledge of the causes, symptoms, and treatment of a disease, we should possess very little power to alleviate or cure it; but without a know. ledge of its existence, none at all.

In order to prevent the spread of disease, and the possibility of one or two cases developing into a widespread and fatal epidemic, a knowledge of the existence of first cases is indispensable. The importance of this knowledge, I presume, will be almost universally admitted. There is only one way of obtaining such knowledge, and that is by means of notification, the imparting of it or making it known to the proper person or authority.

Leaving out the small section who deny the desirability of notification at all as too insignificant in number to demand attention, there are two classes of those who agree that notification is desirable, who stand in opposition to each other as to the question, on whom should the duty of notifying devolve? This question is one not so much exercising the mind of the general public as that of the members of the medical profession, but it is one upon which, on this account, it is very desirable there should be as nearly as possible unanimity of opinion and action among medical men, as it is with them and them alone that primarily the duty of notification of some kind must rest, and without whose co-operation any notification of a thoroughly efficient kind is impossible. There is a difficulty, however, in obtaining this unanimity, and while one section of the profession fully admits the importance and necessity of notification, and is willing to carry it out, another, and, I believe, a smaller and still diminishing one, strenuously resists all attempts to impose the duty upon them, maintaining that it should be imposed solely on the householder or guardian. At first sight there is a certain amount of reasonableness in this view of the case, but even this disappears when its advocates proceed to argue that where notification is in operation it has had the effect of doing harm rather than good. If this is their opinion, instead of declaring that they are in favour of early notification as an abstract proposition, they should, to be logical, declare themselves opposed to it, unless they are prepared to prove that notification by the householder is beneficial, while by medical men it is injurious.

I propose here to consider the alleged objections to compulsory notification by the medical attendant, as it is these which constitute the chief obstacles or difficulties with which notification has to contend. The first of these is the compulsory character of the duty, the compulsion pure and simple, no objection being made to the proposal to put compulsion

Paper read at the Conference organised at the International Health Exhibition by the Society of Medical Officers of Health, the Sanitary Institute of Great Britain, and the Parkes Museum of Hygiene, on June 13, 1884.

on the householder or guardian, though I fail to see that compulsion as such need be considered more objectionable by a professional than by a non-professional informant. It is, however, said to be derogatory to a medical man's dignity and selfrespect to be so compelled. But wherever a duty of great importance to the general welfare has to be performed, the only way to ensure its performance is to make it compulsory; to make the Act simply permissive would inevitably mean failure from noncompliance on the part of some, where it is essential that compliance should be made by all. It is rather late in the day for medical men to display such extreme sensitiveness on this point, and to treat it as though it were a new principle and practice. They are accustomed to notify under compulsion the deaths of persons whom they have attended; and although it is true that when this measure was originally proposed it met with similar opposition to that now exhibited to the notification of disease, it became law; and while it proves a great public advantage, it is found to be in no way detrimental to the interests of the medical man, or hurtful to his amour propre. Compulsion again is seen in the laws in respect of registration of medical men, and of their services as scientific witnesses, in respect of the sale of poisons, and more heavily still with regard to the provisions for the practice of vivisection. Under these circumstances, it seems difficult to understand why, when another service inseparably connected with professional duty, and inferior to none of the others in importance, is required in the interests of public health, there should be such a violent opposition to its imposition. It seems to me that the dignity of medical men, instead of being injured by the performance of the duty required, would be greatly magnified and enhanced. All law is associated with compulsion, which is as indispensable to control the action of non-medical men as of medical. This is seen in the registration of births, vaccination, education, regulation of hours of labour in mills, manufactories, and other places, service on juries, and numerous other matters, and it is only because it is impossible to accomplish the object in view by voluntary action that penalties become necessary. It has been urged by one opponent of compulsory notification that the voluntary principle is the true one, that it has been known to succeed, and he does not see why it should not be adopted everywhere. There is a simplicity about this view which renders any serious consideration of it unnecessary.

No one will deny, I presume, the value for various purposes of the certification by the medical man of cases after death, but it is of little use as regards the prevention of disease, because it comes too late ; notification seeks to remedy this defect by giving to the sanitary authority the earliest information possible of the case, by which not only may the best be done for it in the way of removing causes, and rendering assistance in various ways, so as probably to prevent a fatal termination, but also to prevent the spread of the disease to other members of the household and to neighbours. The causes of the disease are often not inquired into by the medical attendant, who is apt to regard his duties more as curative than preventive; it is seldom that he makes a searching examination of a house with the view of discovering sanitary defects, whereas the duty of a medical officer of health is not to meddle in any way with a patient, but to seek for any existing defect in the sanitary arrangements of the dwelling. Let us

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take a common case; a me.nber of a family may be suffering from diphtheria or typhoid fever, which the medical attendant may skilfully diagnose and treat, but he may content himself with some general inquiry as to the sanitary condition of the house and its surroundings without making a rigorous investigation; the cause of the illness may be probably a sink or cellar drain in direct communication with the sewer, or it may be a faulty water-closet, leaky soil pipe, a polluted well, or some similar defect. discoverable only by such an investigation as would be made by the medical officer of health. If this exciting cause of the illness be allowed to remain during the illness, there is little likelihood that the patient will recover, but if speedily removed the probabilities of recovery are inmensely enhanced, causâ sublatâ tollitur effectus. So that not only is the recovery of the patient rendered more likely, but the dangers of the spread of the disease are likewise diminished. This illustration will serve to indicate the value of early notification, and one of the directions in which it is calculated to be of advantage.

The objection to voluntary notification is that it is incomplete, and, as human nature is constituted, probably ever must be. but unless complete it is useless for the prevention of epidemics; it is only because of its incompleteness, and, therefore, uselessness under the voluntary system, that it is necessary to resort to compulsion. The value of complete notification was well seen in Birmingham during the early days of the present visitation of small-pox. This disease is one which from its rarity, and from the dread of it in the minds of the public, is more likely to be spontaneously notified than any other ordinary zymotic; the consequence was that for many months the disease could get no footing in the town, because under the influence of fear every case was notified to me directly on its nature being made out; over many months seventy-seven sporadic cases were reported, with the result that the disease was prevented spreading by means of isolation, disinfection, &c. ; but in time cases occurred which were not reported, and then the disease, liberated from control, rapidly became epidemic; as long as every case was reported the epidemic was prevented, but no longer. The voluntary system answered for a time, but soon broke down as it always will do, and as it always has done from time immemorial to the present. The experiment has been made so long that it is unnecessary to continue it; it has indeed lasted too long, and to continue it still is altogether unjustifiable. Of the three hundred practitioners in Birmingham only one hundred and eighteen have ever voluntarily notified.*

* In reference to this statement, Mr. Lawson Tait, F.R.C.S., wrote to a daily contemporary:-The experiment has been conducted by the Health Committee, of which I am chairman, and I am not aware that they have expressed any opinion whatever to the effect that it is a failure. Personally I regard it as a success, and the fact that nearly 2,400 cases were reported last year is sufficient evidence in support of my belief. In 1877, before the experiment began, we admitted only 43 cases of scarlet fever to the hospital, while last year we admitted 638, a number much larger than we had satisfactory accommodation for. The Town Council has just sanctioned an expenditure of 28,000 for a new hospital for scarlet fever, and last year they distinctly refused to apply for powers to secure compulsory notification in the Consolidation Act. We believe, therefore, that compulsion is wholly unnecessary. There are only 257 practitioners in the Medical Directory' returned as practising in Birmingham, and of these I believe there are only 140 practising in such a way as to be likely to be called upon to deal with infectious diseases within the municipal area. As Dr. Hill tells us 118 have notified voluntarily, we may take it that there are only some 22 whom we have yet to convert to our views.'

The voluntary system answers very well in the case of cholera, because so great is the alarm and even horror excited by the disease, that it is practically compulsory, in other words, that result is effected by fear which is denied by reason. But in the case of a disease of which there is no fear, such as scarlet fever, although it is a thousand times more destructive to life, the voluntary system breaks down altogether. Instead of the medical man reporting every case of preventable disease, he reports only such as he chooses; he will report for instance the case of a domestic servant whose presence in a large and respectable family is considered objectionable, and whose removal is therefore desired, and she is removed to the hospital accordingly, but the next case he may for special but insufficient reasons decline to notify, although the danger to the public may be as great in the one case as in the other.

There is generally no reticence in publishing to the whole world the illnesses of Royal or distinguished personages, and in much more detail than is required for the protection of the public health, while in notification of disease to the sanitary authority there is no publication at all, there is simply intimation accepted in confidence and acted upon with the sole view of benefiting the patient and the community. Notification to be of real value must not be optional but imperative, it must not be sub-ordinated to individual interests or caprice, because it is then too uncertain, too impartial, and frequently too late. As a fact I frequently receive from the medical man notification of cases of zymotic disease after being attended by him for several weeks, and sometimes after the death of the patient. This is under the voluntary system which obtains in Birmingham, although for such information a fee of five shillings is paid. To expect efficient, that is, complete notification by voluntary means, is to ignore all past experience, and to display a credulity which would discredit an intelligent child.

Another alleged objection to notification by the medical man is that it leads to the concealment of cases, and consequent spread of disease, but the proof of this has never been forthcoming, and the objection rests on mere assumption. Let us hear on the contrary what is said by some who have had experience of the actual working of the compulsory clauses, for a little practice is worth much hypothesis, however ingenious. Dr. Butterfield, when Medical Officer of Health of Bradford, wrote, 'As to the allegation that people would conceal infectious disease, and not send for medical advice for fear of having the case reported, I can safely say that such has not been the case in this town.' The Mayor of Macclesfield says, 'Our experience is that compulsory notice does not tend to concealment, but rather the reverse.' The Mayor of Oldham gives similar testimony, and the same with other towns; while in Dundee it was found that there was less concealment of disease after notification was made by the medical attendant, than there had been previously when the duty rested with the householder. It thus appears that there is no ground for the assumption of notification leading to concealment, and if there were, it would constitute an argument against notification, whether by the householder or the medical man, and is therefore an argument against notification altogether.

It is further asserted that compulsory powers promote antagonism between the medical practitioners

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