Index to Volume VI. Part 73. July 15,1875

would be confined to the flue, and would find its exit in the ordinary way. If we mistake not, this system has to a limited extent been carried out at Gloucester, under the direction of the city surveyor, but in London especially there would be many difficulties in construction and other points, which must for some time to come prevent its adoption from becoming general, how desirable soever it may be.

HOW TO PREVENT AND OPPOSE THE CHOLERA.

THE National Health Society have issued a circular letter to sanitary authorities, stating that in view of the spread of cholera in France, and of the possibility that the disease may be imported into this country, it appears to be very important that householders generally should understand the precautions which they must individually adopt if the progress of the disease-when it has once gained a footing here is to be checked. In these circumstances the society has prepared a memorandum, couched in plain and simple language, explaining How to Prevent and Oppose the Cholera.' The society suggests that this pamphlet might very usefully be distributed from house to house in each district by the officers of the sanitary staff. With the object of encouraging as far as possible the taking of precautions against the invasion of cholera the society are prepared to supply copies at the cost of printing-viz., 17. IS. per 1,000, and will on request give instructions for the filling in of certain blanks on the last page, with the names of the local medical officer of health and inspector of nuisances, without further charge, provided that no less than 5,000 copies are ordered. The memorandum contains a variety of useful instructions as to the precautions to be observed to keep the cholera away, and to prevent its spread if it should come. Its universal distribution throughout the country would therefore be a great advantage, and it is to be hoped that local authorities may see fit to incur the small expense which the purchase of a few thousand copies would entail. It should be added in this connection that the pamphlet, being a copyright publication, cannot be reprinted without the assent of the society.

VACCINATION v. VACILLATION.

THE Guardians of Dewsbury appear to be sincerely desirous of emulating the doughty deeds of the Keighley guardians of happy memory, and of spending a period of seclusion at York Castle in the sacred cause of anti-vaccination, to be welcomed back at its termination with banners and bands of music. It is perfectly idle for the guardians to pretend that they are anxious to carry out the vaccination laws under proper safeguards. Their whole action shows them to be possessed with the demon of incurable wrong-h g-headedness. They have trifled with the law and the Local Government Board long enough. With their specious pleas of lack of proper candidates, and of desire that the vaccinator shall give a guarantee against ill-effects arising from vaccination, they have frittered away something like twelve months of time, during which the district has remained unprotected from small-pox. It is to be hoped that the guardians will now recognise that, whether they like it or not, the law is more powerful than they, and that if they do not do as the law tells them, what Mr. Baron

Huddleston delicately styles 'very serious consequences' will follow for themselves.

POISONED BY CANNED TOMATOES.-DANGER OF USING A CHLORIDE OF ZINC FLUX. AN interesting case, in which a whole family were poisoned (fortunately not fatally) by eating canned tomatoes, is reported by Dr. J. G. Johnson, of Brooklyn. A lady, her son and nephew, and three daughters, partook of bread and butter and boiled tomatoes for lunch. About two hours after they were all taken ill with burning pain in the pit of the stomach, intense thirst, dryness of the throat, retching and tenesmus. On the symptoms increasing the mother administered a purge, and the boys, after some hours, were able to throw off the contents of their stomachs, and improved. The mother and daughters grew worse, and by the fourth day the eldest daughter had all the symptoms of severe gastro-enteritis, the abdomen being intensely tender, and she was beginning to sink into a state of coma. The mother and second daughter suffered in the same way, the latter having, in addition, a fiery red eruption from head to foot, accompanied with intolerable itching. The eldest daughter passed into a state of profound coma, from which she could not be aroused, and on the evening of the eighth day she was seized with epileptiform convulsions, which continued with considerable severity till the tenth day, when the bowels began to act, and the patient improved. By this time the other patients were also convalescent. That they were suffering from some irritant poison was evident from the fact that they all sat down to lunch in health, and that all who partook of the lunch were affected. That the poisoning was not caused by the bread and butter was proved by the lady's husband having eaten of it for breakfast and supper with impunity. Dr. Johnson concluded the symptoms were not those which might be expected from the ingestion of over-ripe or spoiled tomatoes, and that if there had been a ferment or poisonous mould present it would have been rendered innocuous, as the tomatoes had been well boiled just before being eaten. Could the vessel used in cooking have introduced a mineral poison? No; the vessel was made of fire-clay with a salt glaze, and had been in use by the family for over a month. The spoon used in stirring was also carefully examined—it was triple plated and unworn. The poison must have been a soluble one, and contained in the tomato juice, for the eldest daughter (who suffered most severely) had not eaten of the solid part, but soaked bread in the juice. Unfortunately the dishes had been washed, and none of the fruit or juice remained for analysis. The symptoms corresponded closely with those of verdigris poisoning, and Dr. Johnson was at first inclined to attribute them to this, as in canning establishments large copper kettles are used, and verdigris frequently forms in them when acid fruits are stewed and allowed to stand. However, on showing a can similar to that used for the tomatoes to a tinsmith a flood of light was thrown upon the case. This man pointed out to Dr. Johnson that the cap was not fastened to the head of the can by a resin amalgam, as the sides were, but that the amalgam was made of muriate of zinc-i.e. pieces of zinc were placed in muriatic acid and dissolved till the acid would no longer attack the zinc, and this liquid was painted into the groove at the head of the can.

The cip

was then placed on and held with a clamp, and the soldering iron passed round. Of course the solder held the acid in, and if there happened to be too much acid applied to the groove, then, as the tin expanded with the heat, it would be forced into the can. This appeared to Dr. Johnson to offer a reasonable solution to the problem he had set himself to master-the source and nature of the poison in canned tomatoes, the ingestion of which had so nearly proved fatal. That chloride of zinc was the poisonous agent in these cans is not absolutely proved, but so nearly that Dr. Johnson is more than justified in warning the profession and the public against this new danger, and cautioning purchasers to reject every article of canned food that does not show the line of resin around the edge of the solder of the cap, the same as is seen on the seams at the side of the can.'

LAMB AT THREEPENCE A POUND.

that cholera is not communicable from person to
person. That the disease cannot be ascribed to
'somebody else'; that is, that the sick do not manu-
facture a special poison' which causes the disease.
That cholera is a local disease-an epidemic affecting
localities, and there depending upon pollution of
earth, air, and water and buildings. That the isola-
tion of the sick cannot stop the disease, nor quaran-
tine, nor cordons, nor the like. These, indeed, may
tend fatally to aggravate the disease, directly and
indirectly, by turning away our attention from the
only measures which can stop it. That the only
preventive is to put the earth, air, and water and
buildings into a healthy state by scavenging, lime-
washing, and every kind of sanitary work, and, if
cholera does come, to move the people from the
places where the disease has broken out and then to
cleanse. Persons about cholera patients do not
'catch' the disease from the sick any more than
cases of poisoning 'infect' others. If a number of
persons have been poisoned, say by arsenic put by
mistake into food, it is because they have each swal-
lowed the arsenic. It is not because they have taken

A MAN named Clark, living at Turnham Green,
was lately prosecuted by the Fulham Board of
Works for exposing for sale in King Street West,it,' the 'mysterious influence,' of one another.
Hammersmith, the carcase of a lamb unfit for food
of man. Dr. Collier, the medical officer of health
for the district, stated that on the evening of the
21st. ult his attention was drawn to the defendant's
stall by a man calling out 'Lamb, 3d. a pound.' He
went up to the stall and noticed a carcase of lamb,
the flesh of which was spotted. He was of opinion
that the animal had died of fever, and the meat had
been brought before a magistrate and an order to
destroy it obtained. Mr. Kisch, who appeared for
the defendant, said the meat was Australian, and
was so late in the market, through delays in transit,
that the defendant had been able to purchase it at
an exceptionally cheap rate. It was passed by the
port sanitary authority and by the chief inspector
of the meat market. Mr. William Wild, Chief
inspector of the market, was called, and confirmed
Mr. Kisch's statement. The defendant was fined
10l. and 31. 5s. costs; the magistrate remarking
that if it had appeared to him that the defendant
knew the meat was bad he would have sent him to
prison.

One

This case affords a good illustration of the unsatisfactory way in which meat is inspected. All meat intended for food of man should be subjected to a careful examination to ascertain if it be sound and free from disease, and the examiner should possess the necessary skill and knowledge. inspection is sufficient provided it be thorough. As matters are, however, it would appear that meat may run the gauntlet of two inspections and yet be so bad as to be pronounced unsound directly it is seen by a medical officer of health. We are pleased to notice that the inspection of meat markets was one of the special subjects discussed at the Public Medicine Section of the Belfast meeting of the British Medical Association. Few topics are more deserving of attention.

MISS FLORENCE NIGHTINGALE ON THE

CHOLERA.

In a letter appearing in the New York Herald Miss Florence Nightingale gives the following practical advice concerning the cholera :-That our whole experience in India, where cholera is never wholly absent, tends to prove-nay, actually does prove

In looking sadly at Egypt-Egypt, where cholera did not begin anywhere along the route from India to Europe, but at Damietta, where no ship and no passenger ever stops, and where the dreadful insanitary condition of the place fully accounts for any outbreak of cholera-in sorrowfully looking at Egypt and at Europe now, one might almost say that it is this doctrine of a special poison emanating from the sick and which it is thought can be carried in a package that has (mentally) 'poisoned' us. People will soon believe that you can take cholera by taking a railway ticket. They speak as if the only reason against enforcing quarantine were, not that it is an impossibility and an absurdity to stop disease in this way, but that it is impossible to enforce quarantine. If only we could,' they say, 'all would be well.' Vigorously enforce sanitary measures, but with judgment-e.g. scavenge, scavenge, scavenge; wash, cleanse, and limewash; remove all putrid human refuse from privies and cesspits, and cesspools and dustbins; look to stables and cowsheds and pigsties; look to common lodging-houses and crowded places, dirty houses and yards. 'Set your house in order' in all ways sanitary and hygienic according to the conditions of the place, and all will be well.' The real danger to be feared is in blaming somebody else and not our own selves for such an epidemic visitation. As a matter of fact, if the disease attacks ourselves we ourselves are already liable to it. To trust for protection to stopping intercourse would be just as rational as to try to sweep back an incoming flood instead of getting out of its way.

MR. CHARLES WINGATE, of New York, points out in the Medico-Legal Journal, published in that city, that sanitary legislation in England dates from a very early period. For instance, Edward II. decreed that a butcher who sold measled pork should be fined for the first offence, pilloried for the second, imprisoned and fined for the third, and expelled the town for the fourth. Richard II. took measures against the pollution of rivers. Henry VII. prohibited cattle-slaying within walled towns with three exceptions. Elizabeth enacted that only one family might dwell in a cottage. The plague, in the time of Charles II., led to many health enactments. More than two centuries ago we read that Shakespeare's father was repeatedly fined by the authorities of Stratford-on-Avon for throwing garbage into the streets in front of his cottage.

THE PUBLIC HEALTH

DURING JULY 1884.

THE mean temperature during the month of July at the Royal Observatory, Greenwich, was 63°4; it exceeded by 18 the average July temperature in one hundred years, and was as much as 3°.6 above that recorded in the corresponding month of 1883. An excess of temperature prevailed on fifteen days of the month, while on the other sixteen days it was below the average. The warmest day of the month was the 4th, when the mean was 72°4, and showed an excess of no less than 1100; the coolest day was the 26th, when the mean was only 54°2, and 8°.5 below the average. Rain was measured at Greenwich on sixteen days during the month, to the aggregate amount of 18 inches, which was o'8 of an inch below the average July rainfall in sixty-one years. During the first seven months of this year the rainfall amounted to 10.7 inches, which was nearly three inches below the average rainfall in the same period of sixty-one years. The sun was above the horizon during 496-8 hours in July, but only 126.5❘ hours of bright sunshine were recorded at Greenwich; this amount was considerably below that registered in the corresponding period of any year since 1879. Southwesterly winds prevailed almost throughout the month.

In the twenty-eight large English towns dealt with by the Registrar-General in his Weekly Returns, which have an estimated population of nearly eight millions and three-quarters, 28,589 births and 19,121 deaths were registered during the five weeks ending the 2nd inst. The birth-rate, which had been 35.5 and 346 in the two preceding months, further declined to 340 during July, and almost corresponded with the rates recorded in the same month of the two preceding years, 1882-83. In these twenty-eight towns the lowest birthrates last month were 28.1 in Bradford, 28.2 in Brighton, and 29.2 in Huddersfield and in Halifax; in the other towns the rates ranged upwards to 408 in Nottingham, 421 in Cardiff, and 42:4 in Sunderland. The birth-rate last month in London was 329, while it averaged 351 in the twenty-seven provincial towns.

The annual death-rate in the twenty-eight towns, which in the two preceding months had been 2017 and 193, rose to 22.8 during July, principally owing to the greatly increased fatality of diarrhoeal diseases. This rate considerably exceeded those recorded in the corresponding months of 1882 and 1883, which were 19.1 and 20.7 per 1,000 respectively. The lowest rate of mortality last month in these towns was 14'5 in Bristol. The rates in the other towns, ranged in order from the lowest, were as follow:-Brighton, 14.6; Portsmouth, 158; Huddersfield, 175; Derby, 18'1; Plymouth, 18·2; Hull, 18:4; Birkenhead, 18.6; Birmingham, 191; Bradford, 19'3; Oldham, 2015; Blackburn, 208; Wolverhampton, 209; Salford, 214; Norwich, 214; Halifax, 216; Sunderland, 224; Bolton, 22'7; Cardiff, 23.1; London, 23.7; Newcastle-upon-Tyne, 239; Sheffield, 240; Leeds, 245; Manchester, 250; Nottingham, 25.6; Liverpool, 267; Preston, 26.8; and the highest rate during the month, 27.3 in Leicester. While the death-rate in London during July, as above stated, was as much as 23.7 per 1,000, it did not average more than 22'0 in the twentyseven provincial towns. The 19, 121 deaths from all causes in the twenty-eight towns during the five weeks of July included 4,986 which were referred to the principal zymotic diseases, of which 3,012 resulted from diarrhoeal diseases, 540 from measles, 529 from whooping-cough, 366 from scarlet fever, 214 from fever' (principally enteric), 132 from small-pox, and 123 from diphtheria. These 4,986 deaths were equal to 26 per cent. of the total deaths, and to an annual rate of 5'94 per 1,000. zymotic rate, owing to the prevalence of summer diarrhoea, considerably exceeded that recorded in recent months, and also was above the rate from the same diseases in the corresponding months of either of the two preceding years. The zymotic death-rate in London during July was

This

as much as 7'03 per 1,000 (of which 4.52 was due to diarrhoea), whereas it did not exceed 501 in the provincial towns, among which the diarrhoea rate was 2.95 per 1,000. The zymotic rates in the provincial towns ranged from I'I and 18 in Huddersfield and Bristol, to 7.5 in Liverpool, 78 in Nottingham, 90 in Preston, and 10'4 in Leicester. Diarrhoea was by far the most fatal zymotic disease in the twenty-eight towns during July. The rate of mortality from this disease in these towns, which had been but 0.37.in June, rose to 3.67 during July, and exceeded that recorded in the corresponding month of 1883, when it did not exceed 2.40 per 1,000. The diarrhoea deathrate last month did not exceed 0:49 in Huddersfield, 107 in Wolverhampton, and 1'09 in Halifax; while it ranged upwards in the other towns to 4'53 in Leeds, 6.00 in Nottingham, 7.34 in Preston, and 8.80 in Leicester. While the rate of mortality from diarrhoea was 4.52 in London, it did not average more than 2.95 in the twentyseven provincial towns. The death-rate from measles, which had been o'94 and 0.92 per 1,000 in the two preceding months, further declined during July to 0.64. In London the rate from this disease was o'60, and the highest rates among the provincial towns were 1.98 in Liverpool, and 2·08 in Blackburn. The rate of mortality from whooping-cough was 0.63 per 1,000, and showed a further decline from the rates in recent months, although it considerably exceeded the rate recorded in the corresponding period of last year. In London the rate from this disease was 0.73 per 1,000, and among the provincial towns the highest whooping-cough rates were 1'02 in Leicester, III in Liverpool, and 2.37 in Sunderland. The deathrate from scarlet fever, which in the eight preceding months had steadily declined from 0.84 to 0.35 per 1,000, rose again during July to O'44. In London the rate of mortality from scarlet fever was equal to 0.38 per 1,000. while in the twenty-seven provincial towns it averaged 0:48, and showed the highest proportional fatality in Wolverhampton, Sheffield, and Cardiff. The death-rate from 'fever (principally enteric or typhoid) showed a slight increase upon recent monthly rates, and was considerably higher in London than in the aggregate of the provincial towns. The rate of mortality from diphtheria corresponded with the rate in the preceding month; this disease showed some prevalence in London, but very few fatal cases were recorded in the provincial towns. During the five weeks of July 132 fatal cases of small-pox were registered in the twenty-eight towns, showing a marked decline from the number during June; of these, 102 were returned in London, 13 in Liverpool, 6 in Sheffield, 5 in Hull, 5 in Sunderland, and 1 in Cardiff. Judged by the returns of the Metropolitan Asylum Hospitals, the prevalence of small-pox in London showed a further considerable decline throughout July. The number of small-pox patients under treatment in these hospitals, which in the nine previous months had steadily increased from 41 to 1,290, declined to 892 at the end of July. The average weekly number of new patients admitted to these hospitals, which had risen from 18 to 275 in the six previous months, fell during July to 151.

The rate of infant mortality in the twenty-eight towns, measured by the proportion of deaths under one year of age to births registered, was equal to 246 per 1,000 during July, against 163 and 195 in the corresponding periods of the two preceding years, 1882-83. This increase was entirely due to the excessive fatality of summer diarrhoea, which caused very high rates of infant mortality in many of the towns. While the infant mortality did not exceed 131 per 1,000 in Brighton and Bristol, where but little diarrhoea existed, it was equal to 303 in Nottingham, 326 in Preston, and 453 in Leicester, where the highest deathrates from diarrhoea were recorded.

The death-rate from diseases of the respiratory organs, judged by the metropolitan returns, differed but slightly from the average during July. The weekly number of deaths referred to these diseases in London averaged

194, and the annual death-rate was equal to 2.52 per 1,000. In Liverpool the annual rate of mortality from these diseases was last month equal to 3.80 per 1,000.

The causes of 390 of the 19,121 deaths registered in the twenty-eight towns during the five weeks of July were not certified, either by medical practitioners or by coroners. These uncertified deaths were equal to 2'04 per cent. of the total deaths, which was below the average in recent months. In London the proportion of uncertified deaths did not exceed 107 per cent., while it averaged 2.92 in the twenty-seven provincial towns; and ranged from 0.00 and 0.76 in Portsmouth and Plymouth, to 500 in Hull, 5.81 in Oldham, and 7'41 in Birkenhead.

Among the population living in the outer ring of suburban districts around London, estimated at rather more than a million persons, the annual death-rate during July from all causes was equal to 18.9 per 1,000, against 14'6 and 16.7 in the corresponding periods of 1882 and 1883. During the five weeks ending the 2nd instant, 313 fatal cases of diarrhoea, 69 of whooping-cough, 29 of measles, 24 of small-pox, 22 of diphtheria, 19 of 'fever,' and 12 of scarlet fever were recorded in the outer ring. These 488 deaths were equal to an annual rate of 4.74 per 1,000, which considerably exceeded the rate recorded in the same month of the two previous years. The fatality of measles and scarlet fever showed a decline, but that of each of the other zymotic diseases showed an increase. The 24 deaths from small-pox registered in the outer ring included 15 in West Ham, 3 in Croydon, and 2 in Hornsey. Six fatal cases of diphtheria occurred in Tottenham sub-district, and 6 of measles in the subdistrict of Bromley.

THE use of tube or Abyssinian wells for obtaining water in rural districts has often been resorted to, and almost invariably with success. This plan, which possesses many obvious advantages over the ordinary open well, has been tried with excellent results at Watford. In referring to the subject in a recent report, Dr. Saunders suggests that the sanitary authority should obtain the necessary tackle and lend it to persons whose means are small. At this time of the year, when the usual supplies of water in many districts are getting scanty, the suggestion is well worthy of a trial.

M. HYADES has written a memoir on the hygiene of the Fuegians which he studied during his visit to Terra del Fuego. His memoir contains also considerable information on affections peculiar to the Fuegians. It might have been reasonably expected that the hygiene of the Fuegians would have been open to the celebrated description by the schoolboy of the habits and manners of the Romans !

THE Sanitary Authorities of St. Pancras have resorted to a special organisation of their staff to make a house-tohouse call weekly, not only for the purpose of looking after the water-supply and drainage, but to see that the dustbins are clear of animal and vegetable refuse. number of men are employed in following the carts, sup plied with carbolic acid, and as soon as the bins are cleared commence their work of disinfecting. It is a most remarkable fact that four-fifths of the inhabitants exhibit annoyance at the weekly visits, and in the majority of cases will not allow the dustbins to be emptied until they are overflowing with refuse. This circumstance, however, only puts in a stronger light the urgent necessity, especially during hot weather, of removing all the multifarious decomposing matter of which the so-called dustbin is the receptacle in all neighbourhoods, rich as well as poor. The Vestry of St. Pancras have shown practical common sense in the step which they have taken, which should be imitated by every parish. Very forcible and stringent measures are required to prevent many of the inhabitants of this vast metropolis from becoming piggishly indifferent to dirt and bad smells.

NOTIFICATION

OF INFECTIOUS
DISEASE.

THE question of the compulsory notification of infectious
disease, and especially of the person by whom such notifi-
cation is to be made, appears to have now taken firm root
as one of the most pressing sanitary problems of the day.
It was hardly to be expected, perhaps, that there should
be absolute unanimity with regard to it on the part of the
medical profession; but one was scarcely prepared for the
complete opposition of opinion which has been revealed
by recent discussions at the International Health Exhibi-
tion and elsewhere. We publish to-day two admirable
papers on the subject by two acknowledged leaders of the
sanitary world. The one argues strongly in favour of notifi-
cation by the medical man; the other argues just as strongly
in opposition to it. The one treats as of no importance ob-
jections which seem to the other to be of paramount weight.
If we could print the opinions of these two authorities in
parallel columns, such of our readers as do not possess
an abnormal development of the critical faculty might well
stand aghast, and wonder how with views so divergent as
these, there could be any hope of the system of compul-
sory notification making progress at all. The answer is to
be found in the words of Goethe: More light': and it is
with the view of shedding more refulgence upon the
question that we inaugurated the system of returns to
which we refer more at length below. After all, a system
of whatever kind must be judged by its results; and the
outward and visible sign of those results is, in the case
before us, a diminution of the prevalence of fatality of
zymotic disease. We have before pointed to the futility of
merely collecting together for dry statistical purposes a
record of the zymotic sickness in this or that district. The
notification return, though useful of course for reference
and table-making, should be regarded primarily as a
danger signal, upon which the local authorities, if they are
wise, will lose no time in acting.

There are reasons for belief that before very long a general inquiry into notification and its results, actual and proposed, will be undertaken by the Government. Such an inquiry has been recommended by the Special Committee which was appointed this session to deal with the various Corporation Bills containing sanitary clauses, and it is apparently coming to be generally recognised that the present haphazard method of dealing with the matter can be endured no longer. Meanwhile, we think it useful and instructive to place upon record each month the numerical results of disease-notification, as obligingly furnished to us by the various medical officers of health. Later on it may be possible, from a study of the returns and of the Registrar General's figures about towns not included in the tables, to form some sort of statistical judgment as to the propriety of extending the system of compulsory notification throughout the country. At present the materials for such a judgment do not exist; and it is especially with the object of helping towards a calm and impartial consideration of the question that our returns of infectious sickness have been organised.

The following table contains uniform statistics for sickness and mortality in twenty-eight of the thirty-eight urban sanitary districts in England and Scotland in which the noti. fication of infectious disease is compulsory. We hasten to take this opportunity gratefully to acknowledge the very general response of the medical officers of health whose co-operation we invited in this matter. We are pleased to be able to state that the health officers of a very large majority of the thirty-eight towns in which notification is compulsory have most readily responded to our appeal, and we are glad to be enabled to publish our first monthly table so nearly complete. We have every reason to hope that the number of contributors will increase. We would specially thank the medical officers of health for the prompt dispatch of their cards. While we are fully aware of the difficulty which is often experienced in furnishing the required information immediately after the close of the

Towns.

Table Showing Sickness and Mortality in Large Towns of England and Scotland During the Month of July 1884.