NOTES OF THE MONTH.

PUBLIC APPRECIATION OF INFECTIOUS

return.

HOSPITALS.

IN our issue of April last (see vol. v., new series, p. 498) we recorded an instance of the growing appreciation of the usefulness of infectious hospitals, especially with regard to the admission and treatment of children. Another gratifying proof of this is afforded by Mr. Charles Harper who, in a recent report on the health of the rural district of Bath, observes that he has no difficulty in persuading parents to send their children to the hospital. In fact, it appears to be in such good repute that the small children think it a great hardship to be sent home, and often cry to Mr. Harper speaks in high terms of praise of the kindness shown by the hospital authorities, and adds that this, together with the extension of knowledge as to the nature of infection, will tend to make the public more anxious to obtain the advantages of isolation. Even now the patients are not all drawn from the poorer classes, but to a certain extent from those who are able to make some contributions towards the expenses of their maintenance and treatment. In addition to verifying, in a remarkable degree, the information collected by Dr. Thorne when investigating the subject, Mr. Harper's experience proves that even during the past two years a very considerable improvement has taken place in the attitude of the general public towards statutory hospitals.

INSTRUCTIONS FOR THE REARING OF INFANTS.

WITH the object of combatting the ignorance displayed by parents in the rearing of their offspring, Dr. Cameron has suggested to the Town Council of Huddersfield that they should adopt the plan already carried out in several cities at home and abroad of presenting to every person registering a birth a small handbill containing brief directions for the management of infants. He proposes that the first handbill shall contain only information about the feeding and clothing of infants, the ventilation of their rooms, &c., with brief directions for the prevention of infectious disease. On the approval of this, a separate pamphlet on the treatment of measles and whoopingcough should be prepared and distributed from house to house. Dr. Cameron believes that these broadsheets would be of essential service to numbers of intelligent but inexperienced mothers, and he strongly recommends the suggestion to his authority. The plan, which is deserving of every commendation, has been tried with excellent results in several parts of the country, and there is no reason why its adoption in Huddersfield should not be equally successful.

OFFICIAL VIEWS AS TO CHOLERA. WITH a view to further indicating the true lines of preventive action which should be followed in the event of cholera reaching these shores, Dr. Buchanan, the medical officer of the Local Government Board, has prepared a preliminary report on the subject, which is accompanied with extracts from reports made by himself and other medical inspectors in the years 1865-66 and 1873. In Dr. Buchanan's language, the reprints are intended to serve a double purpose. The extracts from the reports of Mr. |

Simon exhibit, at greater length than in a memorandum, the doctrines concerning cholera in Europe which have been continuously held by the principal medical advisers of the English Government. Dr. Buchanan believes that they are commanding more and always more adherents among sanitary authorities on the Continent, though hitherto they have not obtained sufficient recognition in practical effort. The extracts from the reports of medical inspectors on the other hand are primarily intended for the assistance of those who may have to deal with local conditions provocative of cholera or with any outbreak of the disease in England. Both series of extracts will at the present moment be of service as indicating the true lines of preventive action against the disease which is now threatening Europe.

For public use in this country the all-important principle of cholera prevention is, that cholera derives all its epidemic destructiveness from filth, and specially from excremental uncleanliness,' and 'the local conditions of safety are, above all, these two: (1) that by appropriate structural works all the excremental produce of the population shall be so promptly and so thoroughly removed, that the inhabited place in its air and soil shall be absolutely without fæcal impurities; and (2) that the water supply of the population shall be derived from such sources and conveyed in such channels that its contamination by excrement is impossible.'

These are the words of Mr. Simon, written nearly twenty years ago and embodying the experience of nearly twenty previous years. They were written when local sanitary authorities in England had seldom begun their work; when port sanitary authorities had made no provision for dealing with imported disease; and when special orders in face of cholera were requisite in order to give such powers as those authorities have now long possessed as standing defences against all infectious diseases. It is certain that in proportion as the sanitary authorities of England have done their regular work, and exercised their ordinary powers for the protection of the public health, the country has now even less to fear from cholera than in former invasions of Europe by the disease. The extracts from reports of medical inspectors relate to certain local appearances of cholera in England during the years 1865-66. The specimen reports relate to occurrences of cholera at TheydonBois, in Southampton, on Irish mail steamers, at a village near Bristol, and among migrating foreigners passing through English ports. Thus they show cholera making its appearance under a variety of circumstances, and they afford some instructive instances, first of the customary, though sometimes obscure, relationship of cholera with foul water or air; secondly of the way in which the disease has been restricted to the locality of its first appearance and has rapidly become extinguished there.

ALLEGED INJURY BY VACCINATION. THE anti-vaccinators make up in misdirected energy what they lack in numbers. Their latest attempt is an endeavour to make capital out of certain words used in the National Health Society's useful leaflet of Facts concerning Vaccination,' in order to make appear that the Local Government Board was stultifying itself by approving language which Dr. Cory's case traversed. Mr. George Russell, however, was able without difficulty to meet Mr. Hopwood's astute

inquiries on the subject. He pointed to the words of the pamphlet,' that with due care in the performance of the operation no risk of any injurious effects from it need be feared,' and that such mischief as the communication of a foul disease by vaccination 'could only happen through the most gross and culpable carelessness on the part of the vaccinator.' These statements were in no way inconsistent with the report of the medical experts respecting Dr. Cory's case. The committee reported expressly that 'the infants from whom Dr. Cory took lymph for his experiments on his own arm were in such a condition of obvious syphilitic disease as would certainly have precluded their use as vaccinifers by even an inconsiderate and reckless vaccinator. Indeed, they were selected by Dr. Cory for his self-vaccination because they were unquestionable syphilitic cases.' It is a rule of practice in the profession not to use in vaccination lymph taken from a child in whom there is any suspicion whatever of syphilitic taint, or indeed in whom there is any skin disease, although of a character known to be harmless, and the observance of this professional rule is strictly enjoined by the Local Government Board in its instructions to public vaccinators throughout the country. The Board saw no reason to alter their view with regard to the pamphlet in question, which had been revised by their medical officer, and had been recommended for house-to-house distribution.

A YOUTHFUL SANITARIAN.

DR. H. C. BARTLETT, F.C.S., in his address on 'Some of the Present Aspects of Practical Sanitation,' delivered at the anniversary meeting of the Sanitary Institute of Great Britain, on July 10, refers to the written examination of May Austin, aged 13, Standard VII., who sends in a paper from the Rea Street Board School, Birmingham, shown in the School Board exhibit at the International Health Exhibition. Dr. Bartlett goes on to declare that in answer to the question 'What special points would you think of in choosing a house?' the answer was Dryness, light, good air, good water, and good drainage.' In delineating these principal points,' the descriptions are so terse and full, so complete, and leave out so little of what is essential, that unless the whole examination and teaching is the cut-and-dried result of mere memoria technica, nothing could be more satisfactory. If May Austin can reply on paper equally well to half a dozen more questions coming equally within the scope of our own examinations, and pass a by no means more difficult vivâ voce, he feels bound to admit to himself that he, as an examiner of the Sanitary Institute, must pass that very clever little girl-certainly as a sanitary inspector, and perhaps as a local

surveyor.

TYPHOID FEVER IN WORCESTER.

IN his last report on the health of Worcester, Dr. Strange discusses the question how it is that, with the causes of typhoid fever so well ascertained, the disease still prevails in a town supposed to be drained and scavenged like Worcester. It is, he believes, that the draining and scavenging are imperfect. The sewers are defective, there being a frequent issue of sewer-gas from the gullies. It was to remedy this defect that eighty new ventilators were fixed a short time ago. But the chief fault

lies in the house drains and closets. Many of the house drains are badly laid, more especially in newly-erected cottages. The closets, sanitary or water, are constantly getting out of order, chiefly through the negligence of those who use them; and, if it were not that they are always placed out of doors in cottage property, the consequences would be much more serious than they now are. Moreover, waterclosets of an old-fashioned construction and imperfect action are still to be found in the better class of houses, and, consequently, typhoid is as frequent in | them as in the poorest cottages. The large oldfashioned privy cess-pits, some of which still remain, are also answerable for their share of typhoid. In regard to the purity of the water supply of his district, Dr. Strange observes that in so porous a soil as that of Worcester, percolation of foul matters may take place along great distances underground. The discharges from typhoid patients are often thrown into drains, or buried lightly in the soil, without efficient disinfection. These may, and doubtless do sometimes, gain entrance into the wells. And this is all the more probable because some years ago (1866), when well-water was largely used, hundreds of wells were found to be terribly polluted with sewage matter. Dr. Strange reminds his authority that a prevalence of typhoid reflects discredit upon the sanitary arrangements of the town, and he appends a list of practical suggestions, which, if carried out, would soon bring about the removal of this blot. The authority should bear in mind Mr. Simon's opinion, that 'present knowledge seems very positively to say, that the degree and extent in which enteric fever shall remain unexterminated from England will expose the degree and extent in which sanitary administration had failed in rudimentary duties.'

ISOLATION PROVISION FOR SCARLATINA. IN commenting on the prevalence and fatality of scarlet fever in Northampton during the past year, Mr. Lee Cogan again draws the serious attention of the Town Council to the fact that, in the absence of means for hospital isolation, efforts to cope with the disease, with the object of checking its propagation, were rendered, if not positively inert, at least, comparatively speaking, ineffective. As Mr. Cogan points out, infectious hospitals afford advantages beneficial both to the sufferers and also to the community at large. The circumstances under which these patients can be treated in well conducted institutions are manifestly in every respect immeasurably more favourable for them than when treated in their own homes. The public by the removal of infected persons is preserved from the dangers of infection. The experience of almost every town possessing an infectious hospital testifies to the benefit to the public health afforded by such institutions, and Mr. Cogan anticipates that before long every town of any size throughout the country will see the absolute necessity of providing itself with a sanatorium for the disposal of its infectious sick. It is, indeed, for cases of scarlatina that, as Dr. Thorne has emphasised in his report on the subject, isolation is most constantly and most urgently needed. The mortality it occasions exceeds that of any other communicable fever prevalent in the country; it is highly infectious, and there are no effectual means apart from its isolation by which its spread can be stayed. It is to be

hoped that the Town Council of Northampton, who are responsible for a population of nearly 55,000 persons, will no longer delay the erection of a suitable hospital, the more so now that the extension of cholera to this country is by no means an unlikely contingency.

THE DELANCEY FEVER HOSPITAL.

THE report recently presented on the work of the Delancey Fever Hospital during the first decade of its existence affords abundant evidence of the benefits

which accrue to a district provided with properly equipped isolation accommodation. This is evidenced in a striking way by the immunity which Cheltenham enjoys from small-pox. Although during the past ten years the disease has gained a footing in the town on twenty separate occasions, yet not a solitary case has remained in the district for over forty-eight hours, nor has the disease in any instance spread beyond the family it entered. These results have undoubtedly been brought about by the prompt and energetic measures which have in each case been adopted for the isolation of the sick, for the thorough disinfection of the premises, and the vaccination of the inmates. Notwithstanding that there was a considerable prevalence of scarlet fever in some of the lower parts of the town, 59 cases having been reported during 1883, but five persons only were sent to the hospital by the Town Council, and two by the Board of Guardians. As the committee of the hospital observe, these numbers tell their own tale of cases allowed to go through the disease at home, often in crowded localities, with the absolute certainty of widening the circle of infection, and so defeating the very objects for which the institution was founded. It is to be hoped that in future years the local authorities will avail themselves more extensively of the accommodation afforded by the hospital, and this will doubtless be accelerated by the material reduction which has recently been made in the scale of charges. Dr. W. R. Smith, who appears to have bestowed much care on the working of the hospital, notes that the average age of the 48 cases of scarlet fever was 15 years, and the average length of stay a little over forty-three days. All the patients were discharged cured. During the year the erection of a small-pox laundry and washhouse was completed, and the hospital was provided with a self-acting disinfecting apparatus.

WHAT IS A DWELLING-HOUSE?

A GOOD deal of somewhat heated controversy arose in the House of Commons on May 27 with reference to a definition suggested by Sir Edward Watkin that 'a household qualification' and 'a dwelling-house qualification' should mean respectively a tenement containing not less than two habitable apartments. The honourable baronet, remarking that the dwellings conferring the franchise ought to be dwellings fit for Christian people, argued that the class in which fathers, mothers, and children of both sexes lived in the same room could not be regarded as capable citizens, and were unfitted, therefore, for the dignity of a vote. This view was disputed by Mr. Gladstone, who brought his Midlothian experience to bear upon the question, and Sir Charles Dilke, whose position as Chairman of the Royal Commission on the Homes of the Poor has convinced him that the majority of the one-roomed population of the country

are very capable citizens indeed.' To the argument of this point we shall not, of course, address ourselves; but there is one complaint made by quite a number of members in the course of the debate which has a wider significance, and that is the absence of any definition as to what constitutes a dwelling-house. The late Master of the Rolls, one of the acutest intellects the world has ever seen, in an appeal case with reference to the term 'dwellinghouse,' said 'What that means nobody can say.' And he went on to observe, I have tried, and tried in vain, to frame an exhaustive definition which is satisfactory to my own mind.' Where so eminent a lawyer has failed, it would, of course, be presumptuous of us to offer an opinion; but may we suggest that opportunity should be taken in some way or other to settle the question which has exercised so many minds in Parliament and elsewhere. The Franchise Bill appears to afford an excellent opportunity of doing this, and it is after all in connection with the voters' register that the wrangles about the meaning of the term chiefly arise.

DIRTY TENANTS.

THE Gateshead Sanitary Authority have instructed their inspector to take vigorous action against those people who habitually keep their houses in a filthy condition, to the danger of the public health. Mr. Jones, the inspector, has accordingly summoned several persons before the magistrates, as it is beyond doubt that much of the disease in the borough is caused entirely by the filthy habits of such people. On the 13th ult. Thomas Dickison, of 4 Chapel Street, Gateshead, was charged with having his house in an indescribably filthy condition. The defendant did not appear, but his wife said that they had six children in the house, and none

healthier.

were

The magistrates ordered the house to be thoroughly cleansed at once, and adjourned the case for a week. Their decision would depend upon how their orders were complied with. The Corporation of Newcastle, at their last meeting, acting under Sect. 90 of the Public Health Act of 1875, passed some by-laws for the better regulation of tenemented property, which will enable them to deal more effectually with dirty tenants and refractory landlords. The motion was strongly opposed, on the plea that the terms of by-laws were not publicly well known, and that they would probably be infringed unwittingly. Mr. Annan, as a matter of justice, gave notice that he would move at the next meeting that they be rescinded.

FOREIGN SANITARY EXHIBITS AT THE HEALTH EXHIBITION.

VISITORS to the Health Exhibition, if they will take the trouble to examine some of the examples shown by foreign exhibitors, will be able to make instructive comparisons between these and some of the exhibits of our own country. From a strictly sanitary point perhaps they will not be able to do so, as the foreign sections generally seem to have ignored the question of drainage on any scientific principle, and this perhaps is not to be wondered at, as any one having had much experience of foreign hotels and houses must have come to the conclusion that both science and principle are entirely wanting. In the Belgian Section they will see that the sanitary arrangements

of some of their large schools are more or less illustrated, but that, however, on lines which we should scarcely care to follow. A few efforts are also shown as regards housing the poor, although on a small scale, but one example on the building society principle goes carefully into the cost, and gives the results, which certainly seem to be very satisfactory, and might be in certain circumstances developed more fully in this country, where the want of organisation is a great hindrance to the movement. In the French Section, however, some attempts at sanitation may be noticed; an apparatus for disinfecting clothing and bedding by means of hot air and fumigation is illustrated, and several hygienic works and brochures are given; but these we are afraid are special cases, and the majority of Frenchmen have not yet awakened to the broad principles which are rapidly becoming so general here and in America. Some instances of housing the poor, also on a small scale, are shown, but the illustrations scarcely lead us to suppose that the sanitary requirements are met in the way that we are accustomed to.

SLAUGHTER-HOUSE REFORM.

A LITTLE tract with the above title reaches us from Coventry. Some particulars relating to the Public Abattoir movement having been supplied to the 'Coventry Society for the Prevention of Cruelty to Animals,' the committee thought it advisable to lay the information before the public, together with some extracts from the reports of various societies, in the hope that it might help forward the provision of improved accommodation for slaughtering in Coventry. We heartily wish the compilers of the pamphlet all success. Coventry, like so many other important towns, has no public slaughter-house, and the slaughtering is done in fifty-three private slaughter-houses, the condition of many of which is far from satisfactory from a sanitary point of view, many of them being 'small, situate in the midst of crowded localities, approachable up entries and passages, in close proximity to dwelling-houses, and in one or two cases are to the front of the street, where the public may witness the slaughtering.' We are pleased to see that organisations for the repression of cruelty to animals are taking this matter up. Those who desire the efficient inspection of all carcases intended for the food of man, and that killing shall be done under wholesome conditions, will find useful allies in those who are working for the prevention of cruelty. The general provision of public slaughter-houses, and requiring that all killing and dressing be done therein, is the only way to prevent cruelty, no less than the only way to stop the trade in diseased meat.

EMIGRATION

By the issue of the emigration return for the month of June we are enabled to summarise the returns for the first six months of this year. It appears that during this period there has been a very marked decline in emigration from the United Kingdom. During the first half of 1884 the total number of emigrants from the various ports where emigration officers are stationed was 165,594, of which 129,129 were of British origin (including 71,088 English, 12,040 Scotch, and 46,001 Irish), 35,116 foreigners, and 1,049 whose nationality was not distinguished. Compared with the corresponding period of the

preceding year 1883, the number of emigrants for each division of the United Kingdom, as well as the number of foreigners, showed a decrease, the largest proportional decline being in the Irish emigrants. In British emigration the decline amounted to 20 per cent. among the English, 27 among the Scotch, and no less than 38 among the Irish. The numbers of British emigrants, which during the first six months of the three years 1881-83, were 115,793, 148,730, and 178,955 respectively, declined, as before stated, during the first half of this year to 129,129, or as much as 28 per cent. Of these 129,129 emigrants of British origin, 82,276 sailed for the United States, 19,476 for British North America, 22,799 for Australia, and 4,578 for all other places. Compared with the corresponding period of 1883 the emigration to the United States declined 27 per cent.; to British North America, 30 per cent.; to Australia, 25 per cent.; and to all other places 25 per cent. With reference to the proportion of the population of the three divisions of the United Kingdom who emigrated during the first six months of the current year, it may be noted that of each million of their estimated populations 2,657 English, 3,138 Scotch, and 9,296 Irish, emigrated. These proportions showed a marked decline from those recorded in the corresponding period of 1883, when they were 3,340, 4,358, and 14,326 respectively.

SANITARY ARRANGEMENTS IN THE CITY. AT a recent meeting of the City Commissioners of Sewers it was moved, 'that in all instances where new houses were being erected the Commissioners of Sewers should place themselves in communication with the building or other owner, and treat with him or them for the construction of a proper ventilating shaft in the chimney-breasts or party or other walls for the purpose of ventilating the sewers, carrying the ventilating shafts well above all adjoining roofs. At first sight this may appear to be a rather startling suggestion, to bring the foul gases from the sewer through the house. At present the sewers under the public roads are ventilated by a number of iron gratings placed in the centre of the roads and communicating by means of brick shafts with the sewers, these gratings serving both as inlets of fresh air and outlets for the foul air. But

it must certainly strike anyone that the idea of discharging the gases at the level of the roadway is rather a primitive one, and not in keeping with the advanced views in other directions, and it would undoubtedly be a great improvement to disperse the foul air above the roofs of the houses. If every house in a road were provided with a 4-inch ventilating pipe attached to the branch drain leading from the sewer, the gratings in the roadway would then become inlets of fresh air, and the discharge of foul air being so thoroughly subdivided, and also effected above the houses, the arrangement would then become as safe as could be well imagined. The ordinary suggestion is that the ventilating pipes should be carried up outside the houses. The advantage of placing the pipes inside is that they would thus be kept warmer and the up-draught be stronger. It would be objected at once that in case of a single joint of this pipe becoming defective the house would be poisoned by gas from a great length of sewer, but in new houses this danger might be averted by placing the pipe in a carefully and specially arranged flue, so that any escape of gas