MEDICAL ADMINISTRA TION AS Dr. Bruce Low has continued to serve on the Committee which was appointed by the Advisory Board for the Army Medical Services "to direct a course of investigation into the practical prophylactic and therapeutic value of current methods of immunisation against enteric fever." Several reports of the work undertaken by experts under direction of the Committee have been published and investigation is still proceeding. Information being deemed desirable as to current practice of State Vaccine Establishments in Germany in the matters of preparation and distribution of glycerinated calf lymph, the scale upon which these establishments have been set up, the magnitude of their several operations, as well as the quality of the vaccination resulting from use of the lymph issued by them, Dr. Bruce Low was instructed to visit Germany with a view to reporting generally on the lymph institutes of that country. This duty Dr. Low carried out in May and June, 1905, and copy of report made by him on his observations appears as Appendix A., No. 3, to this volume. GENERAL ADMINISTRATIVE BUSINESS OF THE MEDICAL DEPARTMENT. The multiplicity and complexity of technical and administrative questions which arise in connexion with the purity and wholesomeness of the food supply of the country have led the Board to establish a separate subdivision of their Medical Department, for duty in relation to these matters. In general terms the duties which are required of this subdivision are to advise the Board as to the administration of the Sale of Food and Drugs Acts and other Acts relating to food questions; to deal with matters relating to the purity and adulteration of food which are brought to the Board's notice by public analysts, medical officers of health, and others; to obtain information upon special questions relating to the purity and adulteration of food and the use of deleterious substances therein; and to make suitable inquiries and investigations for the purpose. In 1905-6, as said above, the steps taken to initiate this subdepartment were, as a result of correspondence with the Treasury, limited to the detachment of one of the Medical Inspectors, Dr. Buchanan, to act provisionally as "Inspector of Foods." On completion of arrangements for office accommodation in July, Dr. Buchanan took up this special duty, and until the end of the year under review he undertook, to the extent possible in the circumstances, a variety of work in the directions I have mentioned. One of the most interesting of the inquiries thus made by Dr. Buchanan resulted from administrative difficulties arising in London with regard to the meat of pigs affected by tuberculosis. Investigation of this subject entailed consideration of a variety of intricate questions, such as the prevalence of tuberculosis in MEDICAL pigs; the appearance and detection of tuberculosis of one or another degree in the pig at the time of slaughter and in the REPORT. dressed carcass; the practice of public authorities at home and abroad in regard to the condemnation of the meat of tuberculous pigs; and the nature and scope of inspection of "dead meat" which is undertaken at the City Corporation markets at Smithfield and in metropolitan boroughs. These and kindred questions were dealt with by Dr. Buchanan in a comprehensive report on "Administration in London with regard to the meat of pigs affected by tuberculosis." This report, from considerations of space, is not reproduced in this volume. It was separately published in February, 1906. A memorandum by Dr. Buchanan on the subject generally appears as Appendix A., No. 4. MINISTRATIVE As hitherto your Medical Department has sought to extend OTHER ADits usefulness by obtaining and disseminating knowledge. Infor- CONSIDERAmation and experience in matters relating to public health have TIONS. been exchanged with other Departments of Government, and with representatives. of a number of authorities and public bodies at home and abroad. Conferences have been held at Office with local authorities and their officers with reference to prevalences of disease, hospital construction, local byelaws, appointment of officials and the like. Advice and assistance have been directly rendered to local authorities by visits of Medical Inspectors. Formal inquiries have been held by these officers into such matters as combination of districts for hospital or other administrative purpose, loans for hospital sites and buildings, proposals as to local byelaws, and schemes for water supply and sewage disposal. A summary of the total work of the Medical Inspectors is given in Appendix A., No. 5, and in Appendix A., No. 6, will be found abstracts of the several detailed inquiries undertaken by the Inspectors on account of outbreaks of infectious disease or of defective sanitary administration, and references to published reports which have been issued on these matters. Smallpox, it will be observed, made in 1905-6 little demands on the time and energies of the Medical Department. Emergency visits of Inspectors in aid of local administration in connexion with smallpox, which in the two antecedent years had numbered 36 and 20, amounted to no more than five. Nevertheless, release of the Board's staff from much time-consuming duty in regard of this single disease proved of less advantage to general public health administration than was to be desired. Supervision of local vaccination administration occupied your Inspectors to an extent even greater than customary, and as a result some 25 per cent. more Unions were inspected in 1905-6 than in the preceding year. Meanwhile the other current work of the Department remained at least as abundant as before; so that little opportunity has been found for exercising that personal supervision by the Inspectors of the health administration of Rural Areas and of minor Urban Districts, need for which was illustrated in last year's MEDICAL ENTERIC FEVER AND PUBLIC WATER SUPPLY. Basingstoke. Lincoln. report. Among detailed inquiries of more than ordinary interest undertaken by Medical Inspectors in 1905-6 the following appear to deserve some particular notice. Epidemics of enteric fever at Basingstoke and Lincoln, accounts of which by Drs. Farrar and Reece will be found in Appendices A., Nos. 7 and 8, afford a useful lesson to local authorities taking over and developing public water sources originally established by private enterprise. Not many Basingstoke. The Corporation, in 1883, acquired waterworks set up many years before by a Company in the north-east quarter of the town. These works consisted, with pumping apparatus, of two shallow wells in the chalk, A. and B., situated near together and connected by means of an adit. Pumping for water supply of the town was from A. well alone. years after purchase of the works it was noted that during wet weather well A. was apt to receive discoloured or turbid water by way of the adit connecting it with B.; and accordingly, on continued representation of the Medical Officer of Health, the water of well B. was sought to be excluded from well A. by means of a brick wall three feet thick grouted in cement built across the connecting adit in question. To a certain extent these measures served their purpose of preventing occasional and obvious turbidity of the water delivered to the town from well A. But the Medical Officer of Health was by no means satisfied that all risk of dangerous pollution of the supply of the town had thus been averted, and in his annual reports to his authority he continued to give prominence to opinion that the town water remained untrustworthy and unfit for public use. In these circumstances the Town Council determined, in the end, to seek other and more satisfactory source of supply, and in 1904 obtained sanction from the Board to loan for a well and pumping station at West Ham, at some distance from the town. Unhappily, while these new waterworks were in process of construction, and before water therefrom could be made available in Basingstoke, the water in well A. of the existing waterworks became specifically polluted, in all probability in the way indicated by Dr. Farrar, and a widespread prevalence of enteric fever resulted. From September to November, 1905, there occurred in the town some 170 cases of the malady, an attack-rate equal to 15 per 1,000 of the estimated population, with 15 deaths. Lincoln.-The Corporation purchased in 1871 the works of a Company in whose hands the water supply of the city had rested since 1848. At the date of purchase these works comprised the Hartsholme Lake at Skillingthorpe, filter beds and pumping station at Boultham, and a service reservoir at Westgate. By the Act of 1871, which enabled the Company to sell their works to the Corporation of Lincoln, the latter body were given power, in view of the increasing demands of the town, to take water, in addition to that impounded at Hartsholme, from the Pike Drain and from the Catch-water Drain near to their OFFICER'S junction with the River Witham within the confines of the City. MEDICAL And as time went on and demand for water increased the REPORT. authority supplemented their supplies by impounding water in certain Ballast Pits at Boultham, while at the same time extending considerably their filtration areas. At no time seemingly since purchase of the waterworks has the water supply of Lincoln been deemed wholly satisfactory; and as long ago as 1885 the Medical Officer of Health, Dr. Harrison, while commenting in a special report on its inadequacy, raised serious question as to the uniform wholesomeness of the water delivered in the town. It was in reference to this report by Dr. Harrison that the Board expressed the view that the Town Council will incur grave responsibility if disease should hereafter spread in the City through preventable pollution of the water supply." In 1886, Dr. Airy, one of the Board's Medical Inspectors, having inspected Lincoln in the course of the "Cholera Survey" of that year left with the Corporation a memorandum of recommendations, the first of which referred to "The unsafe character of part of the public water supply, and the need of inquiry concerning other sources of supply." In 1894, Dr. Wheaton, another of the Board's Medical Inspectors, met the Corporation in conference, and urged that body to "endeavour to obtain a supply of water from a source which is above suspicion for their district, in place of their present supply." But it was not until 1898 that the Corporation of Lincoln finally came to determination to improve the water supply of their City; a decision which took effect in. 1901, when a contract was entered into with Messrs. Chapman and Sons, of Salford, with the object of obtaining satisfactory water on the site of the existing works by means of a deep boring into the underlying strata there. The operations in question were, however, unhappily delayed by jamming, with loss of the boring tool, and by measures consequent on this accident. Meanwhile the epidemic of enteric fever which is referred by Dr. Reece to the public water supply seized on the City and its neighbourhood. In the course of some six to seven months there occurred in Lincoln above 1,000 cases of the malady, an attack rate of about 19 per 1,000, with some 120 deaths. SEWAGE In 1902 the Board, in view of a report by Major Norton, WATER one of the Board's Engineering Inspectors, on recent local SUPPLY AND inquiry by him respecting loan for certain extensions of the DISPOSAL. Fulbourn Asylum, directed the attention of the Town Council of Cambridge "to the danger that exists of possible pollution to the Asylum Wells and those of the Cambridge Waterworks Company by discharge of untreated sewage from the Asylum direct on to land having a chalk sub-soil and in close proximity to the water supplies above mentioned." As a consequence much correspondence took place in the succeeding twelve months 25783 b MEDICAL between the several authorities interested in the questions which had been thus raised, but without satisfactory result; the Visitors of the Asylum eventually making reply in October, 1903, to the Commissioners in Lunacy that " They do not admit the danger to which reference is made, but that they are prepared to meet the Directors of the Water Company in conference if the Directors think proper to propose one.' Thus matters stood until, early in 1905, there occurred a serious prevalence of enteric fever among inmates of the Asylum in question; whereupon the Board at the instance of the Commissioners in Lunacy directed investigation of the local circumstances attending this outbreak of fever, with special reference to the question of the arrangements for the disposal of sewage at the Asylum, and of possible danger therefrom to the Cambridge Water Supply. Dr. Copeman, the Medical Inspector to whom this investigation was entrusted, fully confirmed as a result of his inquiry the misgivings on the subject of Cambridge water supply which on the representations of Major Norton had been entertained by the Board. His report, which is reproduced in Appendix A., No. 9, showed that owing to special hydro-geological conditions of the particular area on which the Asylum sewage was being disposed of and from which a large portion of the Cambridge water supply was being drawn, colouring matter in solution allowed to permeate into the soil of the Asylum irrigation area was able to pass toward, if not into, the Fulbourn Well of the Cambridge Water Company and that it also passed into the Asylum well, which drew upon the same basin of underground water. Since," says Dr. Copeman in summing up the evidence as to pollution by the Asylum of the underground water in its neighbourhood, "it is not possible to deny the potentiality of danger from this cause, through the medium of the water supply, alike to the inhabitants of the town of Cambridge and to the inmates of the Fulbourn Asylum, it is undoubtedly incumbent on the Committee of Visitors to take measures, under expert advice and with the least possible delay, for providing a comprehensive and adequate system for the carriage and disposal of the Asylum sewage." 66 Dr. Copeman's report was in due course forwarded to all the parties concerned; but at the time of writing a completely satisfactory scheme of disposal of the Asylum sewage has not yet been arrived at. In their Third Report (1905) the Royal Commission on Sewage Disposal, in drawing attention to the fact that water supplies are liable to other and serious pollutions besides those which can be dealt with under the Rivers Pollution Prevention Act, go on to express the opinion that in this matter the supervision of some superior authority is desirable in the interests of public health. And the Commissioners recommend establishment of a Central Water Authority exercising general superin |