297THE DIET OF THE AUSTRALIAN.

communications was read. Professor Erisman, the Presidentof this section, deplored the divisions of opinion which existamong medical authorities upon the etiology and epidemio-logy of cholera. He looked forward to the time when allwill hold one and the same opinion upon these subjects.He praised the good work done by the Russian NationalHealth Society, which had issued and widely circulated aform for the collection of information upon many points con-nected with cholera. His final words were : "Collect thematerial and the conclusions will come of themselves." Inthe other papers read in this section the authors agreed in theopinion that the most frequent cause of the spread of cholerain the recent epidemic was the use of unboiled water takenfrom polluted or impure sources.In the section of Gynxcology a lively debate followed

Dr. Smolski’s paper upon the Treatment of Extra-uterineGestation. Dr. Phenomenof described the operation of Sym-physiotomy.

In the section of Hygiene questions relating to Disinfec-tion were discussed by Dr. Levashef and others. The neces-

sity for diffusing a general knowledge of the laws of hygieneand for insisting upon their importance being recognised wasthe text of more than one paper both in this and in othersections, and was the subject of some general resolutionswhich were passed by the final general meeting of the con-gress. In the section devoted to Zeinskaia Meditzina (orthe relation of the zemstvos or local government authoritiesto medicine) the position of the feldsoher, or trained medicalassistant, was very fully discussed.In the section of Nerve Diseases many papers of interest

were communicated. The President of the section, Dr.

Merjeevski, announced that a subscription had been set onfoot among Russian societies interested in psychiatry inorder to found some memorial to the late Professor Charcot,and that a telegram had been sent to Madame Charcot in-forming her of this proposal.

In the section of Surgery an important paper was read byProfessor Pavlof upon the new smokeless powder and the newbullets and their powerof penetration.The last general meeting of the congress was held on

Jan. 16th. The President, Professor Lukianof, then read hisaddress upon Intercellular Substances. The general con-clusions arrived at by the congress were read. The most

important of these were concerned with the subject of healthpreservation and the spread of knowledge of the rules ofhygiene. The President was able to state that a sum ofmoney had been put aside to be spent with this object, andfurther subscriptions were invited to form a capital sum, thework constituting a memorial to the devoted physicians whohad fallen victims in the typhoid fever and cholera epidemicsof 1891 and 1892.The next congress in memory of Pirogoff will be held in

Kief.

THE DIET OF THE AUSTRALIAN.

THE question whether Australia will become a wine-

drinking country, among many others of a more distinctlymedical character, was discussed in a lecture by Dr. MurrayGibbes at the opening meeting of the Goulburn ValleyMedical Association, Victoria.The lecturer pointed out that different nations had always,

from time immemorial, selected certain beverages as nationaldrinks, and that the fact that the fruit, leaf, or grain sup-plying the essential principle of the drink was not alwaysindigenous to the national soil was itself a proof that con-venience was not the only factor in dictating the choice.Many Continental nations drink, of course, 1.in ordinaire, orthe wine of their particular district, and for centuries-until,indeed, free trade and an increasing population prevented it-the Englishman’s beer was made from the Englishman’sbarley. On the other hand, the universal Western vogue ofdrinking decoctions made from the Eastern shrubs tea andcoffee shows that the popularity of a beverage has no

geographical limits. The Australians at the present timedrink virtually twice as much tea as any European nation,the figures being 4 70 lb. per head per annum in Englandand 8681b. in Australia ; and as they also come third onthe list with regard to beer it will be seen that considerablechange in the national customs will be required beforeAustralia becomes a nation of wine-drinkers. Dr. Murray

Gibbes considered that the character of the drink adoptedas national must always be largely dictated by the characterof the soil and food, which, in its turn, is dependentupon the climate of the country, and he quoted SirWilliam Roberts in support of the somewhat paradoxical-sounding theory, the enunciation of which formed therest of the paper. Sir William Roberts, according to-Dr. Murray Gibbes, has said that all beverages, alcoholicor non-alcoholic, conduce to one of two conditions-retardation of the digestive process or excitation of the.nervous system. It was the retardation of digestion that.Dr. Murray Gibbes considered at length in his lecture, showi]3g--that the harsher climes required the stronger foods, while thesestronger and more nitrogenous foods-inasmuch as timewas necessary for their proper assimilation-called for checks,upon a too-rapid and so incomplete digestion ; and chief’amongst these checks he placed the vegetable acids contained’in wine, and the sedative properties of tea and coffee. In,

proof of this point he cited the examples of the nationaldiets of England, Holland, Germany, and China, and he-proposed to account for the opium-habit of the last-namednation as the result of a physiological need for a gastric.sedative. Having then ingeniously, if not quite conclusively,demonstrated that a meat-eating nation must swallow a

proportional quantity of checks to too rapid a digestion, he.continued as follows : - I I In Australia meat forms the-

principal item of every meal, while beer and tea are thebeverages. The average quantity of beer drank is M-gallons per head per annum. South Australia heads thelist with 20 gallons, Victoria comes next with 19 36, andNew Zealand completes the tale with 9 5. Although we do,not consume so much beer as is consumed in England wemake up for it in quality ...... for whereas English paleale contains 40 grains of vegetable acids to the pintColonial ale contains 191 grains....... Colonials do notcare for English ale, finding that it does not contain suffi--cient vegetable acid food-retarders. The Colonials are the-greatest tea-drinkers in the world, and the amount consumed!is annually increasing. " This description of Australian diet.pourtrays a state of things which Dr. Murray Gibbes wouldsee altered. He considers it necessary that his brotherColonials should forthwith proceed to adapt their amount ofmeat-food to their immediate wants, and that they should;!drink the juice of their splendid vines instead of a pernicious,quantity of over-strong beer and thrice-boiled tea.

Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Worcester Couitty Sanitary -District.-Mr. Fosbroke, the-

county medical officer of health, in presenting his report for1892, first gives a general rESUnae of the sanitary condition of-his district, and afterwards a short synopsis of each sanitarydistrict in the county. There are still eleven sanitaryauthorities in the county who do not publish the reports of-’their medical officers of health. This is rather disappointing,as it was certainly to be hoped that the circulation of the,county medical officers’ reports would have stimulated and)interested local authorities at least so far as to do this scant,justice to their medical officers. The birth-rates in the urbandistricts of the county varied from 15 ’6 per 1000 in GreatMalvern to 43 ’3 in Oldbury, while those in the rural districtsranged from 14’1 in Worcester to 55 5 in Winchcombe. The-

general death-rate of the county was 18’1 per 1000 living .that for the urban districts being 19’8; that for the-rural 17 8. The zymotic death-rates were 14 in the urbanand 0’8 in the rural districts. In connexion with a lowcase mortality from measles in the borough of KidderminsterMr. Corbet, the medical officer of health, speaks very highlyof the value of notifying this disease, and Mr. Fosbroke has.recently persuaded the corporation of Evesham to schedule.measles as a notifiable disease. In discussing diphtheria.Mr. Fosbroke points to the desirability of notifying all cases.of " sore-throat " during an epidemic of that disease. Theinfantile mortality in the urban district of the county ranges.from 94 per 1000 births in Bewdley to 215 in Oldbury, where’there is much female employment in factories. Notification

298 VITAL STATISTICS.

of infectious disease is now general throughout the county,-except in the cases of the Stourbridge urban and Tewkes-bury rural districts. The sanitary authority of Stour-

bridge invited Mr. Fosbroke to supply them with some

"facts" pointing to the utility of the NotificationAct, and although a large number was brought for-ward and the usual reasons given the sanitary authorityhad not adopted the Act at the time the report underfnotice went to press. Mr. Fosbroke showed that, as regardsthe annual cost of notification, no sanitary authority- -with the exception of Kidderminster, where measles is

scheduled-paid more than £18. There seems to be inWorcestershire an excellent field for the operation of theIsolation Hospitals Act, 1893, as but few of the authoritiesare provided with permanent means for isolating patients ofall classes. Considerable improvement both as regards- drainage and water-supply seems to have taken place in the’county during the year, and numerous schemes are under,contemplation. As regards river pollution, Mr. Fosbrokewas, at the time of writing his report, engaged in investi-gating the pollution of the Severn, and we presume that anaccount of this will be included in the next annual report.The Factory and Workshops Act, 1891, does not appear tobe properly enforced in the county, and Mr. Fosbroke- expresses a hope that more consideration will be given tothis important Act during 1894.

Gloucester G’onnty Sanitary -District. -Althouch we place’this notice with the reports of medical officers of health, it isnecessary to point out that it is not the work of a

<county medical officer, or indeed of any medical officerat all. The County Council of Gloucestershire havemot yet appointed a county medical officer of healthand the report we are considering is entitled the "AnnualReport of the Medical Officers of Health (Reports) Com-mittee." It refers to the year 1892, and consists of lessthan half-a-dozen small pages of large print. Obviously thenumerous and valuable reports of the several medical officersof health in Gloucestershire cannot receive adequate treat-’ment in such a summary, and, in fact, it is to be regrettedthat the report was ever issued. We would, indeed, venture to,suggest that, before the issue of the 1893 report, the com-.mittee should obtain and study some of the able summaries ’i,"of the county medical officers of health which we have from- time to time had the pleasure of noticing in the columns,of THE LANCET. The report before us refers to a popu-lation of 884,552, but no attempt is made, beyond a calcu-ation of the death-rates and birth-rates for the county, tosummarise the vital statistics contained in the several

reports. The general death-rate of the county was 16’79per 1000, but no differentiation into urban and rural rateshas been made, and no figures with regard to infantile

mortality or zymotic diseases are given. The committee<are of opinion, as regards hospital accommodation, that with..proper ambulances there would be no great difficulty in

.conveying patients suffering from infectious disease a con-siderable distance by rail, and they advocate the provision ofhospitals near railway stations centrally situated. Theviews of the committee on the subject of water-supply and,drainage are thus set forth. " It is not necessary toenhance the advantage of good water and good drainage.We venture, however, to cite the district of Horfield as an,example The medical officer of health reports that the

water-supply is excellent, the drainage good, and the districthealthy ; 41 cases of scarlet fever and 8 of diphtheria’occurred, and no deaths from either disease; death-rate, 11’7."Here, then, we have in a lay report the interesting problem

- of the relations of water-supply and drainage to scarlet fever.and diphtheria settled for us, though it is impossible to deter-mine from the report whether it is meant that the absence ofany fatal case of diphtheria or scarlet fever was due to thegood drainage and water-supply or whether the numbers ofeach disease are regarded as small. Perhaps it might be pointedout to the committee that Horfield being a suburb of Bristol’would be likely to contain an excess of persons past the agesmost susceptible to scarlet fever and diphtheria, and that

>41 cases of scarlet fever and 8 of diphtheria are not

phenomenal numbers for a population less than 7000. Weregret that we cannot congratulate the committee upon their’:report, and we are inclined to ask whether it is necessary--or, at any rate, desirable-that the reports of the medicalofficers of health should be treated in this inefficient manner.

Aston Manor Urban Sanitary District.-Mr. Henry May,the medical officer of health for this district, is to be con-gratulated upon the fact that his report for 1893 is the first

for that year we have received, and also because he has re-cently completed twenty-one years of service to his sanitaryauthority. During this period the population of his district hasmore than doubled itself. Mr. May refers to the great over.crowding in the public elementary schools in Aston, andexpresses satisfaction at the action of the School Board intaking steps to provide additional accommodation. The timerequired to disinfect articles by means of the old hot airapparatus is so great that the work can only with great diffi.culty be performed at all ; and Mr. May strongly advisesthe provision of a more modern apparatus. During the lastthree months of 1893 there were 97 cases of small-poxnotified, and some difficulty was experienced in providingisolation accommodation for them. Among 15 cases occurringin unvaccinated persons during the year there were 5 deaths;and among 97 of those vaccinated there was but one.

The proportion of scarlet fever cases isolated in hospitalduring the year was only 38 per cent. of the number notified,and it seems that the small charge made for admission intothe hospital acts as a deterrent. The character of the diph.theria prevalent during the year remained, as in 1892, of amild type, there being but three deaths out of 47 cases. Oftyphoid fever there were no less than 127 cases, a numbermore than double that in 1892 ; and Mr. May, after makinginquiries as to the distribution of the disease, was inclinedto suspect the water-supply (which is the same as thatin some parts of Birmingham). It seems, however, thatin Birmingham the incidence of typhoid fever was lessin the districts so supplied than in others, and it was,therefore, inferred that the water was not to blame.We must, however, fully indorse Mr. May’s expression ofopinion as to the desirability of the bacteriological as wellas the chemical examination of all water used for drinkingpurposes. The mortality from diarrhoea in Aston Manorshowed a great increase in the last year, there being 181deaths, as against 95 in 1892 There was, too, a much heavierincidence of mortality from this disease on persons above fiveyears of age than in the previous year. It is somewhat sur-

prising that the Aston Manor sanitary authority should haveproposed to isolate small-pox and scarlet fever on the samesite, and the refusal of the Local Government Board tosanction a loan for such a purpose is surely what might havebeen anticipated. With the evidence before us of Fulham,Oldham, Leicester, and other places, of the disastrous effectsof attempting to isolate small-pox and scarlet fever on thesame site and at the same time, it is difficult to understandhow such a proposal can seriously be made. The generaldeath-rate of Aston Manor for 1892 was 16 7, or 0’9 higherthan the average for the decade 1881 to 1891. The infantilemortality was a high one-namely, 187 per 1000 births, asagainst 146 and 152 for 1891 and 1892, an excess largely, nodoubt, to be accounted for by the heavy diarrhoeal mortality.The zymotic death-rate was 3’6, compared with 2 6 for 1892.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN thirty-three of the largest English towns 6536 birthsand 4156 deaths were registered during the week endingJan. 27th. The annual rate of mortality in these towns,which had been 28-6 and 23.2 per 1000 in the precedingtwo weeks, further declined last week to 20 7. In Londonthe rate was 19’8 per 1000, while it averaged 214 in thethirty-two provincial towns. The lowest rates in thesetowns were 14-8 in Derby, 14’9 in Leicester, 16’0 in WestHam, 16 5 in Sunderland, and 16’8 in Portsmouth; the

highest rates were 24’8 in Preston, 25-6 in Birming.ham, 29 6 in Plymouth, 30’1 in Salford, and 31’1 inNorwich. The 4156 deaths included 480 which were re-

ferred to the principal zymotic diseases, against 548 and497 in the preceding two weeks; of these, 192 resultedfrom whooping-cough, 80 from diphtheria, 73 from measles,42 from "fever" (principally enteric), 42 from diar-rhoea, 35 from scarlet fever, and 16 from small-Dox,These diseases caused the lowest death-rates in Portsmouth,Leicester, Huddersfield, and Halifax, and the highest ratesin Newcastle-upon-Tyne, Plymouth, Birkenhead, Bristol, andBurnley. The greatest mortality from measles occurred inWolverhampton, Birkenhead, and Burnley; from scarletfever in Derby and Burnley ; from whooping-cough in

Newcastle-upon-Tyne, Swansea, Bristol, and Plymouth; and