501

The former post, to which Dr. J. Douglas Stanley wasappointed, carries an honorarium of .E100 per annum andentails a large amount of work, for it will be necessary thatthe consulting physician should examine a large number ofpatients, not only when the hospital is opened but whenevera vacancy occurs, in order that the cases most likely tobenefit may be selected. Dr. Stanley is physician bothto the Queen’s and the Children’s Hospitals and no onewho knows his keenness and energy will doubt that he willcarry out the new work thrown upon him with conscientiousability and with an eye to securing the best results from thesanatorium treatment. Dr. Paul Mathews, who has held thepost of resident medical officer in the Newcastle-upon-TyneSanatorium, was appointed medical superintendent at

Salterley Grange.Infectaaics Ihsease in the Yaq’dley Rural District.

There is evidently need for increased hospital accommoda-tion for infectious diseases in the Yardley district, for asomewhat sudden rise in the number of scarlet fever caseshas made it necessary to admit only special cases to the bedsat the disposal of the authorities, so that many cases havehad to be refused admission and provided with home treat-ment. Fortunately this state of affairs has not so far proveda serious menace to the public health, for apparently onlytwo fresh cases have occurred in houses from which patientscould not be removed. The district council cannot count,however, on a continuance or repetition of such good luck,and it would be wise to accept the warning that the

hospital accommodation it has provided is not sufficient’ for the very possible needs of the district.

26 Cost of King’s NO’l’ton Lunatics.The enormous strain which the maintenance of the insane

throws upon any public community was illustrated at arecent meeting of the King’s Norton board of guardians,when Mr. Garret, the chairman of the finance committee,drew attention to the fact that within a period of two or threeyears the cost, so far as King’s Norton was concerned, hadrisen from 10,000 to .E12,000 per year, exceeding thetotal cost of maintaining the inmates of the workhouse, theold people in the infirmary, and the children in the cottagehomes. If the people generally could be got to realise thestrain which is thrown upon them by insanity it is possiblethat useful laws aimed at its reduction might be obtained.The present system of trying to obtain as many so-calledcures as possible simply serves to increase the calamity, andit appears strange that there is no outcry against it.

The Annual Report of the Medical Officer of Health ofTF(t’C7’A<MKM.

Dr. H. Malet’s report on the health of Wolverhampton dis-closes a comparatively satisfactory condition of affairs inthat town during 1907, the total death-rate for the year being14 5 per 1000, or 3 2 per 1000 less than during the previousyear. This is no doubt due partly to absence of infantilediarrhoea and partly to a lowered birth-rate, but some part ofthe diminution must be ascribed to gradually improving con-ditions, and it is probable that the appointment of a ladyinspector of midwives who is to supervise the midwives andgive advice to mothers will help to reduce the high infantilemortality-rate which is so largely due to the ignoranceregarding the proper treatment of babies which exists

amongst the working classes.The Walsall and -District Hospital.

The financial position of the Walsall District Hospital isa subject of serious concern to the committee, and at arecent meeting of the general committee the chairman, Mr.F. J. Cotterell, stated that although it had been suggestedthat the hospital had not been as economically managed aspossible he was unable, after going carefully through allthe details, to hold out any hope that it would be possible todiminish the expenditure to any degree except by the closureof a certain number of beds. It was estimated that theexpenditure for the present year would be E1100 in excessof the income and the adverse balance would thus be raisedto .E2000. In these circumstances the committee felt that,much as they regretted the step, some of the beds mustbe closed. In the meantime, however, efforts to increasethe income were being continued and appeals were beingmade to secure support from surrounding districts whichderive benefit from the hospital.August llth.

NEWCASTLE-UPON-TYNE.

(FROM OUR OWN CORRESPONDENT.)

Statistics of the Royal TTactoria Infirmary, 1907.THE year 1907 was an eventful one in the history of this

institution in view of the fact that the magnificent newbuildings on the Moor Edge were completed and opened byH. M. the King in July. The old infirmary buildings on theForth banks alongside the Central Railway station wereformally surrendered to the corporation of Newcastle-upon-Tyne in August. The new infirmary is much more extensiveand affords much greater accommodation for the receptionand treatment of patients than the original institution. Thenumber of beds for patients has increased from 293 onJan. lst, 1907, to 411 on Dec. 31st, 1907. The number of

patients admitted during the year was 6445, an increase of1546 over 1906. The average daily number in the wards was335 4 against 251’ 8 in the previous year, while the highestnumber in the wards on any one day was 407, against 291 in1906. The average length of stay was slightly greater-viz., 18 - 9 days in 1907 and 18 - 7 in 1906. The numberof out-patients was 35,445, an increase of 3001 over

the number for 1906, while the casuals receiving treat-ment numbered 18,274, as against 17,808 in 1906.The total attendances in the out-patient department(indoor and outdoor) showed a decrease of 3669-93,244 in 1907 and 96,913 in 1906. The total ordinaryincome in 1907 was .622,869, an increase of .66342 over

the income for 1906. The total ordinary expenditureamounted to .627,267, which exceeds the expenditure for1906 by .66806. The excess of ordinary expenditure overordinary income amounts for the year to .64397, whilein 1906 the excess of expenditure over income totalled<&bgr;3932. That is to say, that for every .6100 of income theinfirmary authorities spent in 1907 about 119 and in 1906about 123. The cost per in-patient, calculated upon thetotal ordinary expenditure less the cost of out-patient andcasuals, was .64 Os. 5-kd., the average stay being 18 9 days.The cost per occupied bed was L77 5s. 10d. In 1906,calculated upon a similar basis, the cost per in-patient was.63 18&. (average stay 18 ’ 7 days), and the cost per occupiedbed 975 17s. 7. It is to be noted that nearly one-half(.&bgr;I0,877) of the total ordinary income for 1907 (<&bgr;22,869)was made up of workmen’s subscriptions. This amount of.,10,877 IP exceeds the amount received from the same sourceduring 1906 by .63658.

Anntbal Report of the 1lTedieal Officer of Health ofNewaastlefo1’ 1907.

According to the annual report of the medical officer ofhealth (Dr. H. E. Armstrong) the population of the city inthe middle of 1907 was estimated to be 272,969. Therewere 1251 cases of infectious disease notified during the

year, including 614 cases of scarlet fever, 383 of diphtheria,and 66 of enteric fever. The death-rate from all causes was16 - 8 per 1000 of the population and the death-rate from theseven " chief zymotic diseases "1-4 per 1000 of the popula-tion. Scarlet fever was responsible for 22 deaths, giving amortality per cent. to cases notified of 3’ 6. Diphtheriacaused 52 deaths and the rate of mortality to cases was 13’6per cent., as against 18.1 in the previous year. There was anincrease of 19 cases over, the number in 1906. Entericfever caused 11 deaths ; the rate of mortality to casesnotified was 16’7 per cent. The number of deaths fromdiarrhoea was only 46 during the year, as compared with areturn of 257 for the year 1906. A large part of the reportconsists of a reprint of a previous report submitted by themedical officer of health to the sanitary committee on Tuber-culosis, its Casualties, Causes, and Control. After reviewingthe range and fatality of human tuberculosis Dr. Armstrongproceeds to consider the causes of the disease and the mediaby which the bacillus gains entrance into the bodies of pre-viously healthy human beings. These he enumerates in thefollowing order: (a) the milk and milk products of tuber-culous cows consumed as focd; (b) the milk of a tuberculoushuman mother; (a) the flesh of tuberculous animals consumedas food ; (d) dried expectorated matters and other infectiousdischarges of consumptive persons inhaled or swallowed asatmospheric dust, &:c. ; ; (e) heredity ; and (f) marriage

502

of the tuberculous, &c. Each of these causes is con-

sidered in detail and under the head of the pre-valence of tuberculosis among dairy cows Dr. Armstrongestimates that there are 560,000 tuberculous milch cows inEngland alone and nearly one and a quarter millions in theUnited Kingdom. ’’ The bare idea of the amount of possiblehuman tuberculosis from the milk of so immense a number ofdiseased cows is appalling." The question of extinction oftuberculosis is then sketched and in reply to the query, Isthe control of the disease so far as it relates to the two chiefarticles of diet, meat and milk, worth while trying ? Dr.Armstrong’s answer is : "To this the reply is undoubtedlyYes ! for although the cost of exterminating tuberculosis infood-yielding animals must of necessity be great, and islikely to be opposed by persons whose private interests maybe touched and by party politicians, yet the prospect of thebenefit in view to the State and suffering humanity and thehope of obtaining it are greater still."

Professor 1. OlivcT.Dr. Thomas Oliver, professor of physiology in the Uni-

versity of Durham, who was president of the section ofindustrial diseases at the recent annual meeting of theBritish Medical Association, is to be congratulated upon thehonorary degree of doctor of science recently conferred uponhim by the University of Sheffield as a mark of recognition ofthe value of his work in industrial hygiene.August,10th.

___ ___

WALES AND WESTERN COUNTIES NOTES.

(FROM OUR OWN CORRESPONDENT.)

Medical Inspection in the Rhondda Valleys.THE Rhondda urban district council has not yet decided

how the medical inspection of the school children in thedistrict shall be carried on, but a proposal has been made bya committee that an assistant medical officer of health shallbe appointed who shall reside at the isolation hospital anddevote part of his or her time to the medical inspection ofschool children. As the population of the district is consider-ably over 130,000 it is obvious that the whole of the medicalinspections cannot be done by one officer in addition to theduties attached to the hospital, where there are now 36 bedsand will very shortly be 52, a number all too few for the sizeand industrial character of the district. Three years agothe district council obtained special clauses in a private Billenabling the medical officer of health to enter the publicelementary schools in the district and to examine thescholars in attendance, excluding from school any he con-sidered likely to spread infection. A further provisionrequires the head teacher of a school to inform the medicalofficer of health of the name and address of any child in theschool who is suffering from an infectious disease and uponrequest the teacher must furnish a list of the scholars

attending the school, payment being made at the rate of 6d.for every 25 names.

Bristol Water-supply.The water-supply of Bristol is not in the hands of the city

corporation but is controlled by a private company whoobtain supplies from springs on the sides of the Mendip Hillssome 16 miles from the city, and from wells and springsabout 12 miles distant. The supply is constant and good. Sandfiltration is resorted to before delivery into the mains and theanalytical results recorded in the annual report of themedical officer of health (Mr. D. S. Davies) show that thewater is quite above suspicion of pollution. Before filtra-tion there were found 240 colonies per cubic centimetre onnutrient gelatin at 22&deg; C., a number which was reduced to36 colonies by filtration. The amount of chlorine was low,1.6 parts per 100,000, but of albuminoid ammonia ratherhigh-namely, before filtration 0’03 per 100,000 and afterfiltration 0 - 008 per 100, 000.

Hospital Sunday Fund in Bristol.The total amount contributed to the Hospital Sunday Fund

at Bristol for 1908 was .61859, being Z104 more than in 1907.Of this sum Z1776 have been divided amongst the variousmedical charities of the city, the final distribution beingmade by the committee of the Fund at its meeting onJuly 31st.

The ffealt7t of Bristol.The death-rate in Bristol for 1907 was 13’ 3, compared

with 14 7 in 1906 and the ten years’ average of 16 -1. This.death-rate is the lowest on record for Bristol. The birth-rate was 24’ 2, which also is the lowest on record. The.infantile rate was 100 per 1000 births, which is the lowestinfantile rate ever recorded in the city.

New Cottage Hospital for Torrington (De2on).For many years the need of a hospital for Torrington has.

been felt and on August 5th, in the presence of a largegathering, Mrs. Scott Browne, in the unavoidable absence ofLady Gertrude Rolle, laid the memorial stone of a cottagehospital. The memorial stone has an inscription stating-that the institution is "in memory of William Glubb, who -

endowed it, of the Honourable Mark Rolle, who gave the site,and of William Vaughan, who originated the scheme." Thehospital will be completed in a few months at a cost of.&1190, the whole of which sum has been raised. The greaterportion of the maintenance is provided for by a bequest fromthe late Mr. Glubb which produces 230 per annum.

The Sanitary Condition of Monmouthshire.At the last meeting of the Monmouth county council

attention was drawn in a report of the medical officer ofhealth (Dr. D. T. Rocyn-Jones) to the two urban districts ofAbertillery and Rhymney. In each locality there appears to,be a great lack of suitable dwellings for the colliers who areemployed there. In Abertillery it is the general custom totake in lodgers whether there is a spare room or not, for insome instances the same beds are occupied by different per-sons both day and night. The district council is advised toprovide a public slaughter-house and in this connexion it is ofinterest to note that the same recommendation has been madeby the Abertillery medical officer of health (Dr. D. C. Muir)for at least ten years. Another suggestion made in the reportto the county council is the erection of a refuse destructor,and this again is but the echo of a strong recommendation ofDr. Muir in 1903, in which year, according to the review ofthe sanitary condition of the county issued by the sanitarycommittee of the county council, it was decided to erect adestructor in connexion with -an electrical installation. Themedical officer of health of Rhymney (Dr. T. H. Redwood)has for years reported unfavourably upon the back-to-backand back-to-earth houses in his district, and the attention ofthe county council is once more drawn to this objectionabletype of house, and it is to be hoped that that body will nowinsist upon their closure or conversion into dwellings with athrough ventilation.August 10th.

_________________

SCOTLAND.

(FROM OUR OWN CORRESPONDENTS.)

Clyde Pollution.IT is expected that in a very short time, when the various

sewage works now completed or in process of completionare in full working order, Glasgow will cease to be anoffender in the matter of river pollution. In connexionwith this matter a circular has been issued to ’local ship-owners and to the masters of all vessels visited by thesanitary inspectors to the effect that all water-closets forseamen and firemen on board ships of all nations must be

kept closed while the vessels are in harbour. The portauthorities have now provided latrines ashore for theseclasses, special provision having been made for the Lascarand Chinese crews. Now that the city of Glasgow has set itsown house in order communications have been addressed to thelocal authorities in the upper and lower reaches of the river forthe prevention of the pollution of the river there. The Lanark-shire county council has given satisfactory assurances thatit is dealing with the matter, but there are still one or twoneighbouring burghs which continue dumping their sewageinto the Clyde and show no indication of altering theirmethods. As soon, however, as the new sewage scheme forGlasgow is completed-and this will be very shortly-thecity will no doubt take proceedings for the enforcement ofthe provisions of the Rivers Pollution Acts, and in that waycompel the recalcitrant burghs to fall into line with themajority.