MEDICAL OFFICER'S REPORT. Occasional Proceedings. was a very unusual concurrence of deaths by puerperal fever; Great Ormesby and Waltham Abbey, where there had been outbreaks of diphtheria; Wellington and Aston Clinton, where scarlatina had caused anxiety; Harting and Hadlow, where there had been typhoid fever; Southampton and Epping, where cases of Asiatic cholera had shown themselves, and, in connexion with. the inspection of Epping, Leytonstone, where a drainage-nuisance was much complained of; Swansea, where cases of yellow fever had occurred; Chichester, Leeds and Harwich, where question had arisen as to the sufficiency of action taken by the local authorities for the protection of the public health. In Woolwich, where fever had been epidemic, an inquiry which had been begun in 1864, and which therefore my last Report mentioned as in progress at the end of the year, was completed. And besides the above cases, where local inspections were made, my Lords, on other occasions of local complaint or alarm, had written communication with the authorities of these other places, viz. :- Newton in the Chesterton Union, Deptford, Paddington, St. Pancras, Farnham, Horfield in the Clifton Union, Debenham in the Bosmere and Claydon Union, Waltham Abbey, Bethnal Green, Colney Hatch, Camberwell, Shirley, Whitstable, Bury, Golborne in the Leigh Union, Wistanstow in the Church Stretton Union, Silver Hill in the Hastings Union, Birling, Aylesford, Brundall and Bradestone in the Blofield Union, Watlington in the Henley Union, Standon in the Ware Union, Maidenhead, Ramsey in the Huntingdon Union, Child's Hill in the Hendon Union, Otley, New Shoreham, Burtonon-Trent, Headcorn in the Hollingbourne Union, Tottenham, Twickenham, Maidstone, Basingstoke, Enfield, South Shields, Wing, Kensington, Clapton, Hounslow, Cleator. * Concerning the cases where inspections were made, excepting those of Bristol, Wellington, and Woolwich, I subjoin either the reports or extracts from the reports which I received from the inspecting officers. (See App. Nos. 4-8 and 14-16.) To the cases of Southampton, Epping, and Swansea, I shall refer in later sections of this report. To the case of Maidenhead I need not further advert than to say that the mortality which had occurred in that town was, in my opinion, sufficiently accounted for by the facts of obstetrical practice which the inspector (Mr. Radcliffe) sets forth in his report. Except as regards these cases, the main interest of the papers which I append consists in their bearing on the question which was discussed in my last year's report-the very important question of the working of the Nuisances Removal Acts in England. The report on Greenock is of course not relevant to that question, but is valuable here for the more general purpose of showing to what monstrous degrees of overcrowding and filth, and to what consequent sufferings by disease, a popula * At Bristol there was insufficient hospital-accommodation for the poor with typhus, and the chief object of the inspection was to see to means for increasing the accommodation. At Wellington no question of much practical interest was raised. Regarding Woolwich, further inquiry did not add anything important to the information given in my last annual report. MEDICAL OFFICER'S REPORT. tion (even when its industrial circumstances are prosperous) may be brought by the unregulated use of tenement-houses. The remaining cases may be regarded as supplementary illustrations of the argument of my last year's report on the inefficiency of Occasional our Nuisances Removal law:-Aston Clinton, with the pestiferous 'roceedings. crowding of its children in plaiting schools,Great Ormesby, with its structural nuisances,-Waltham Abbey, with its sewageditch continuing, in spite of remonstrances, under jurisdiction of a local board of health,-Hadlow, with its cesspools and stinking drains,-Harting (in the often complained of Midhurst Union) with its drinking-water almost ostentatiously polluted by excrement, and filth piled up as though it were treasure,-Harwich, with no useful memory of its former sufferings by cholera, but still cesspooled to the worst degree, and still with the worst of water-supplies, Chichester, an episcopal city, a municipal and parliamentary borough, where still the inhabitants drink from beside their cesspools, and endure once a fortnight the almost unique nuisance of a very large cattle market in their streets,— and Leeds, with such an administration of the Nuisances Removal Act as, in proportion to the importance of the town, may perhaps be deemed the worst which has come to the knowledge of this department. * In order to do full justice to these cases in their illustrative relation to the efficiency of the Nuisances Removal Acts, it is requisite to remember that the year 1865, with its incessant alarms and public and private manifestos as to the approach of epidemic disease, was eminently a year when it might have been expected that the authorities would not be sleeping at their posts. Yet, adverting also to the evidence which was given on these matters in my last annual report, I cannot doubt but that the few above-mentioned instances represent innumerable others, now existing far and wide throughout the country. As regards the correspondence which my Lords had during the year, on questions generally of the same nature as the above, I need only observe that the complaints which were addressed to their Lordships tallied with and corroborated the opinion which I have expressed as to the frequent inoperativeness of our present sanitary laws, and that my Lords were unable to suggest remedies to persons who addressed them on this subject. One case, however, deserves particular mention. From the respective vicars of Aylesford and Birling, two parishes in the Malling Union, my Lords in September last received complaints that the board of guardians refused to act in execution of the law, as authority for the removal of nuisances; the first complainant adding that a case of cholera (fatal after seven hours' illness) had just occurred in his parish; and the second, that, in a hamlet in his parish, always more or less marked by illness, where the *I am glad to state, as the sequel of the communications which my Lords have addressed to the town council of Leeds on the sanitary state of the town, that for some time past considerable exertions have been making there to amend the state of things described in Dr. Hunter's report. MEDICAL OFFICER'S REPORT. Occasional people had open cesspools about their houses, and were drinking polluted water, fever was spreading fast from house to house. In answer to a letter which my Lords hereupon immediately (Sept. 14) ordered to be addressed to the board of guardians, Proceedings. inquiring on the subject, the clerk on the 27th September wrote that the guardians had directed a special meeting to be called for that day fortnight to take their Lordships' letter into consideration; and on the 11th October he wrote-" that at a special meeting held this day to take into consideration the Nuisances Removal Acts, it was moved that it was inexpedient to adopt those Acts, whereupon an amendment was proposed that they be adopted, and negatived by a majority of six to five." On receipt of this answer, my Lords directed a second letter to be written (Oct. 12) requesting to be informed of the precise meaning of this resolution, inasmuch as the Acts were general and did not require to be specially adopted, and asking particularly whether the guardians declined to receive complaints and to take proceedings under the Acts. To this second letter the guardians, on the 18th October, replied, "that they considered the resolution passed at the meeting to be a sufficient expression of their meaning, which was, that they did not consider the 5th section of 23 and 24 Vict. c. 77. to be imperative, and they therefore declined to appoint a committee under that section." While this reply was still under their Lordships' consideration, one of the complainants wrote that, in some uncertainty whether their former applications to the board of guardians had been in all respects strictly in order, and in hope that the decision of the former meeting of the board might be reversed by another and larger meeting, they had decided to recommence their endeavours to move the board. Again, delay was interposed by a fortnight's adjournment of the board, and it was not till the 18th November that my Lords received the following information from the vicar of Birling: "The board of guardians has not thought fit to make any reply to the memorial from this parish or to my own letter (both dated 28th ultimo) but I am informed by the elected guardian of this parish the matter of the nuisances in Aylesford, Birling, and Snodland parishes was pressed at the adjourned meeting on the 15th instant, when the adoption of the Nuisances Acts was strongly advocated by E. L. Betts, Esq., and others, but as strongly opposed by the chairman, whose statements of the operation of the law at last secured a majority of one against the adoption of the Acts." A letter to the same effect was received from the other complainant; and on the 21st my Lords received from the rector of Snodland, a third parish in the union, complaints that nuisances existed also there to an alarming extent, that typhus and diphtheria abounded, and that by the decision of the Malling board the inhabitants were left without any local authority to whom to apply. My Lords now brought the correspondence under the consideration of Secretary Sir George Grey; who referred it to the Attorney and Solicitor General for MEDICAL OFFICER'S REPORT. their opinion, whether, under the circumstances represented, proceedings should be instituted against the guardians of the Malling union, with a view to compel them to take such measures as were necessary for the protection of the public health. On the 28th Occasional December the answer of the law-officers was reported, to the Proceedings. effect that, in their opinion, there was not legal ground for the institution of proceedings against the guardians. The case requires no comment from me, but I beg leave to add the remarks with which the law-officers concluded the expression of their opinion:-" It is evident that the legislature has hitherto thought it sufficient to rely mainly on the vigilance and discretion of the local authorities, without providing against any perverseness or voluntary neglect on their part; and the present case seems to show that in some districts, at all events, further security is required for the public good." III. FOREIGN EPIDEMICS OF THE YEAR, AND THE GENERAL In relation to the spread of pestilential disorders, the year 1865 was of extraordinary and most painful interest. That in this year, after more than a century's interval, the herds of England were revisited by the most malignant of bovine plagues-the, to them, unfamiliar murrain of the Russian Steppes, would in itself be a sad distinction of the year. But the eventfulness of 1865 was even less in that field of suffering than in relation to human epidemics, and, in the latter respect, to persons who had to care for the public health, the last nine months of the year were a time of continuous anxiety. First, early in April, it was rumoured that a disease of the nature of Plague, coming from beyond the Ural Mountains, and causing depopulation in its course, had not only reached St. Petersburg, where it was said to be causing fearful ravages, but had spread beyond the Prussian frontier, and was prevailing, though in a less destructive form, at Dantzig and various other places in North Germany. Next, in June, came the importation of Asiatic Cholera into Egypt, and thereupon, radiating from Alexandria, for results which as yet have but begun, the renewed influence of this terrible infection in Europe. Thirdly, in September, there was the fact (hitherto, I believe, unparalleled in the epidemiological experience of this country) that an outbreak of Yellow Fever, fortunately not on a large scale, was occasioned to the population of Swansea by the arrival of an infected ship from Cuba. It was but to a very limited extent that these important occurrences involved proceedings which technically were under the Public Health Act, 1858; and, strictly speaking, proceedings under that Act are all that I am called upon to mention here. I may, however, so far exceed that limit as to include certain other proceedings which the same occurrences involved, and which were of general sanitary interest, - proceedings of the Lords of the III. Foreign Epidemics and Quarantine. MEDICAL OFFICER'S REPORT. Council, which were either taken under the Quarantine Act, or at least had regard to its administration. * III. Foreign 1. The first of the occurrences to which I have adverted, the Epidemies and rumour in April last that a "Siberian plague" was advancing Quarantine. towards this country, was one which, except for the proverbial 1. "Siberian faculty of rumour to distort as well as magnify what it represents, Plague." might have justified the greatest alarm. And it was of course one which tended to raise a question of quarantine. Under the circumstances, my Lords thought it expedient that the facts should be investigated from this department, and, at their desire, I took the requisite steps for that purpose. Dr. Whitley was sent to St. Petersburg, and Dr. Sanderson to the country of the lower Vistula. The results of these investigations are contained in papers which I subjoin-App. Nos. 9, 10, 11; viz., a report which I addressed to the Lord President on the 19th April, and reports subsequently made by the two inspectors. Briefly, I may here state that the rumour which gave rise to the inquiry had joined together and disfigured two mutually independent truths; one, that our wellknown typhus and relapsing fevers were epidemic in St. Petersburg; † the other, that cerebro-spinal meningitis-a peculiar nervous fever, hitherto scarcely known in England, was epidemic in parts of North Germany. It is only with respect to the latter disease that I need here. make any further statement. From communications which have been made to me since the time when the inspectors reported, and particularly from information for which I am indebted to Dr. F. J. Brown, of Rochester, and to Dr. Clapton, one of my colleagues at St. Thomas's Hospital, I have reason to believe that for some time past the disease has been present in small amount in this country. I subjoin (App. No. 12) the substance of the communications with which Dr. Brown and Dr. Clapton have favoured me. It is, in my opinion, unquestionable that some of the cases illustrate in sporadic form the same cerebro-spinal meningitis which in other countries has prevailed epidemically. And to this I may add two considerations. First, the morbid influence may perhaps to some extent show itself otherwise than in marked cases of idiopathic cerebro-spinal meningitis:-experience of Terrible inflictions have before now come to us by that line of transit, and cholera is not the only pestilence which has thus come. Apparently it was through Russia, and perhaps as a 'Siberian plague," that, five centuries ago, the Black Death came to England. That, according to the best authorities, the Black Death, under the name of Pali Plague, still lives, and from time to time spreads, in the western and northern parts of India, and, when last told of, was even high in the Himalaya; that, if its infection passed the hills, little story would come to us of how it filtered through the sands of nomad and other savage life; but that presently it might be on the confines of Russia, and then again suddenly of the gravest European interest ;-these are considerations which, in the minds of persons who know the facts of the case, would check all disposition to treat rumours of "Siberian Plague" with indifference. It may be worth noting, that among the very various information which reached me from Russia about the time when the above proceedings were in progress, I found, as oue element of confusion in the popular impression of the case, that a carbuncular disease of cattle, which was prevailing in parts of Russia, and which, according to a well-known property of such diseases, had in some cases led to nfection of human beings, was being spoken of as "Siberian Plague." |