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drawn as it usually is in England, and doubtless would have been in Paris under normal conditions." (P. 235.)
TYPHUS IN METZ, 1870.
Of Metz, Dr. Guillemin states that, contrary to the opinion commonly entertained, typhus did occur in the city during the blockade, concurrently with enteric fever. Upon this question the physicians practising there were almost unanimous, and some of them who had formerly been in the army had studied the disease during the Crimean War. What was observed in Metz was an example of a still-born epidemic (épidémie de typhus avortée). The disease never became general, never underwent the extension or assumed the gravity observed in the Crimea or in Algeria, for the sufficient reason that the causes giving rise to it had not been either so long in action or so intense. It prevailed most among the inhabitants of the suburbs who, at the commencement of hostilities, had fled into the city. This class of persons suffered, as a necessity of their position, from insufficiency of food and from overcrowding. Although the soldiery were not altogether exempt from typhus, it is incontestable that they suffered from the disease much less than the civil population; and it is to the slight incidence of the disease upon the troops that is owing the fact that not a few military medical men may not have observed it. Cases of petechial typhus were, however, recorded in several of the military ambulances by Drs. Herpin, Onzaneau, Rosman, Méry, and others, and at one time grave fears were entertained lest the malady should spread actively. Dr. Méry, writing on the subject observes: "I had charge of a young mobile, in the Rue des Trinitaires, who after being treated ten days in the Tabacs hospital, was brought home by his parents, and died of typhus as well characterised as the disease I saw in the Crimea. As to the sick in the city, I can assure you that I have seen among them numerous cases of typhus, some slight, some severe. I saw there the disease pursuing the same course that it followed on its apparition in the Crimea in 1854-55, and if the blockade had continued longer, we should have had a second edition of the Crimean disaster." Dr. Guillemin, himself, observed in
Metz several cases of slight typhus, but no case of petechial typhus. In his notes made at the time he wrote: "The typhus observed in Metz had not the characters of Oriental typhus. The fever and excitement at the beginning and the encephalic congestion were less considerable; the eruption was rare, little marked, but it was the eruption of typhus, not of typhoid. There was no intestinal complication, little or no diarrhoea, no tenderness in the right iliac region. The duration was short, rarely fifteen days in the cases observed by me. The convalescence was marked, quick, and sudden. Between morning and evening the sick would pass from a state of sickness to a state of convalescence. They asked for food, and they ate without danger."
The most clearly marked cases of exanthematic typhus, and the gravest cases, occurred, as already noted, among the poorest portion of the civil population. Some of these cases occurred also among the ambulances, especially in those ambulances in which the more serious forms of disease were treated. But, as a rule, the cases of typhus observed in both ambulances and hospitals were cases of "typhus abortif." These facts are readily explained. The poorer classes of the civil population, especially refugees, suffered much more from deficiency of food and from overcrowding than the wounded and sick soldiery. These latter were fairly nourished even to the end of the blockade. The diseases which prevailed in the army were neither very numerous nor very serious, and the number of cachectics were few. There was no great overcrowding either in the ambulances or hospitals. The feeding of the soldiers during the last fortnight or three weeks of the blockade had been insufficient and little varied, but then only. The predisposing causes of epidemics of typhus had not, in fact, exercised any action upon the army except for a very short time and with slight intensity. The state of things among the troops at Metz was in no respect comparable to that which existed among the army in the Crimea when typhus began to spread among it, or among the indigenous population of Algeria in 1868, when typhus broke out there. Add, finally, that the troops were not exposed to much fatigue.
MR. STANSFELD'S PUBLIC HEALTH LEGACY.
MR. STANSFELD, in vacating the Presidency of the Local Government Board on the dissolution of the Liberal Ministry, has left a legacy of difficulties to his successor, to local authorities, and probably also, in time to come, to the Legislature, the magnitude of which even thus early it is not difficult to estimate. In the one question alone of appointment of Medical Officers of Health Mr. Stansfeld has contrived to stultify one of the most important aims of the Public Health Act 1872, and add to existing incongruities of sanitary districts, other incongruities more glaring than any which previously existed. It seems desirable at the present moment to set forth a plain recital of some of the results which have followed Mr. Stansfeld's public health policy. To this end we have analysed the accessible returns of appointments of Medical Officers of Health, and we give the results for the consideration of our readers. Let it be premised that the general inspectors of the Local Government Board, under the instructions of Mr. Stansfeld, advised differently as to the fittest arrangements for a Medical Officer of Health, at different times. In some sanitary districts it was advised that the Poor-law Medical Officers should be appointed Medical Officers of Health, each in his own district. In other districts it was advised that the Poor-law Medical Officers should not be appointed Medical Officers of Health, but that sanitary districts should combine so as to have a Medical Officer of Health in common, giving him a salary sufficiently large to secure his whole time. In still other districts it was advised that a combination of the two preceding forms of advice should be acted upon, but this third more advanced form of advice does not appear to have been adopted anywhere. These different kinds of advice were tendered without any reference to peculiarities of locality; they were offered simply as outcomes of official wisdom at different stages of development. Upon the advice thus proffered, Local Authorities set to work, particularly in rural sanitary districts, in conjunction as a rule with the Inspectors of the Local Government Board, to carry it into effect, and the results of this
combined Central and Local wisdom we have now before us in numerous instances. These will be best dealt with in four classes, to wit: (1) Selected districts, for the most part curiosities of appointment; (2) Districts with several Medical Officers of Health; (3) Districts in combination having one Medical Officer of Health; (4) Districts not in combination having one Medical Officer of Health.
1. Selected Sanitary Districts. Of these districts there is a luxury of choice. Adlington, urban, appoints a Medical Officer of Health for a population of 2,606, located on 1,046 acres, and gives him 77. a year. Alresford, rural, divides its districts into two parts, to each of which it appoints a Medical Officer of Health. The first part has an acreage of 17,000 and a population of 3,734; the second part, an acreage of 22,000 and a population of 5,530; and to each Medical Officer a like salary is given, namely, 107. Ashby-de-la-Zouch, urban, with an acreage of 4,505 and a population of 4,110, pays the Medical Officer of Health 10%. 10s. a year. Aston, Warwick, rural, having an acreage of 27,385 and a population of 17,544, pays the Medical Officer of Health a salary of 150l. Baldersby, urban, enjoys a Medical Officer of Health, for a population of 296 and an area of 1,744 acres, at a salary of 31. 3s. Bangor, urban, with a population of 7,733, with a clearer eye to economy, gives its Medical Officer of Health" fees for services rendered." Basford, rural, stands out an almost typical district, for with an acreage of 53,326 and a population of 81,561, it takes a Medical Officer of Health's whole time, and gives him 500l. a year. Chard, rural, also gives a probably fitting stipend (for whole time or not is uncertain) of 350%. for an acreage of 60,342 and a population of 28,852. Consett, urban, on the other hand, with an acreage of 10,824 and a population of 6,000, thinks that every useful purpose is met by giving a Medical Officer of Health "17. 1s. per day when he is required." Hartlepool, urban, holds that 107. a year is a sufficient salary for a health-officer's care of 13,000 people; and Hull, with an obvious fellow-feeling, gives its Medical Officer of Health 201. a year for the health-charge of 127,746, and such additional fees as he may pick up in inspecting ships under the Order of the Local Government Board as to cholera. Llandisfawr, rural, indulges in four Medical Officers of Health, for a population
of 16,000, and pays each "according to services." Louth, rural
The foregoing facts have been culled pretty much at random from our list. They may be taken in part as illustrating some of the vagaries of local authorities who have repudiated Central interference with their Medical Officers of Health; and in part as showing how some local authorities have turned certain Central advice to good account.
Combined Sanitary Districts.-The sanitary districts of which we have information, that have been formed by a combination of several sanitary districts, are forty-six in number. These combined districts are best arranged in order of salary-indeed, hardly any other systematic arrangement is possible, unless an alphabetical one-as no definite relationship is to be discovered between the salary and the amount of work to be done for it, whether in relation to area of district or to population, or to both area and population.
It may be held that, in those districts which have been formed with the assistance of Inspectors of the Local Government Board, the chief thing aimed at was to get such grouping as would give the sum set down as a reasonable salary with the least cost to the several districts, irrespective of the duties for which the sum was to be paid. This list is so interesting and instructive that we give it entire.