Oldalképek
PDF
ePub

A DEFUNCT PROVERB.

THE proverb, 'A green yule makes a fat kirkyard,' which was formerly an article of belief, is no longer borne out by fact. When the laws of health and the doctrines of hygiene were little understood, ventilation and drainage little practised, and the prevention of small-pox by vaccination unknown, diseases of a. epidemic character frequently raged during an open winter, and disappeared when the frost came. Now a genial winter is not necessarily attended by exceptional 'ills to which flesh is heir'-warmth means comfort, and comfort promotes health. It is cold, we know, that kills; cold that chills the blood and stiffens the limbs; cold that feeds the ague and rheumatism; cold that gives birth to asthma, catarrh, and consumption. The frost and snow, to which the young and strong and wellto-do look forward as one of the joys of Christmas, to the weak, the invalid, and the aged are but too often messengers of death.

THE TREATMENT OF DIPHTHERIA. PROFESSOR KLEBS, of Prague, describes in the Med. Chir. Centralblatt (No. 22) a series of experiments performed on himself and other persons to test the efficacy of benzoate of soda in destroying the formation of microscopic fungi in the body. He has found that it procured relief in several cases of gastric catarrh and other diseases which are often noticed in persons who work a great deal among decomposed organic substances. In order, however, to be quite certain of the antiseptic or antimycetic power of this drug it was necessary to find out whether, when introduced into the body of a healthy animal, it would enable it to resist infection. Diphtheritic membranes were accordingly soaked for some time in Buchholtz's solution, then mixed with benzoate of soda, and inoculated upon the surface of several healthy animals, of which some had previously received a hypodermic injection of the above-mentioned substance. It was then shown that in those animals which had had the injection the diphtheritic membrane was destroyed in ten minutes, whilst it still could be seen in the eyes of the others two hours after the operation. Klebs has administered benzoate of soda in doses varying from five grammes to his patients, who never experienced the least inconvenience from it.-British Medical Journal.

DIPHTHERIA.

THE following figures relative to the deaths from diphtheria, gathered from the annual reports of the Registrar-General, have recently been published in the Pall Mall Gazette. It is only since 1855 (the year of the severe epidemic of diphtheria in France) that this disease has been placed under a separate heading in the tables of mortality. It appears that from 1855 until the end of 1876, 81,361 deaths from diphtheria were registered in England, or o'78 per cent. of the total number of deaths from all causes. Excluding from consideration the first three years of this period, in which some of the deaths appear to have been recorded under other headings, it seems that the greatest number of deaths occurred in the year 1859, when as many as 10,184 were registered, being 2'3 per cent. of the total number of deaths in that year. The lowest rate was in 1872, when only 2,152 deaths occurred, or o'43 per cent. of the whole number recorded. During the ten years 1861-70, 18,467 males and 20,987 females died from diphtheria, or a total of 39,454, of which no fewer than 22,150 or 56'1 per cent., were children under the age of five years, and 9,925 or 25'1 per cent., were between five and ten years old. Thus 81 per cent. of the deaths during that period occurred among children under ten years of age. Between the ages of ten and fifteen 3,082 deaths were registered, or 78 per cent., leaving just 11 per cent., including those of fifteen years and upwards. The disease seems to be most fatal to children between one and two years of age, as over 13 per cent. of the total number of deaths during 1861-70 occurred at that period. In the year 1876 the deaths from diphtheria were relatively more fatal to children than in the period 1861-70; the total number being 3,151, of which 90'1 per cent. were those of children under ten years of age, and 27 per cent. those between the ages of ten and fifteen years. In the list of 115 causes of death in England in 1876, diphtheria comes 29th in the order of fatality. The tables of mortality published by Dr. Farr in 1875 disclose the curious fact that more persons die of diphtheria in the healthy districts of England than in those where the general mortality is higher. For instance, in the healthy districts, out of 100,000 persons born 1,029 die of diphtheria; while in the less healthy districts, such as Liverpool, the deaths from diphtheria amount to only 441. On the other hand, the deaths from scarlet fever in the healthy districts number 2,140, while in Liverpool they are 3,830 out of every 100,000 born. Again, the population of the south-eastern counties is about two-thirds of that of London, and yet the deaths from diphtheria in those counties exceeded by 37 the deaths from that disease in the metropolis. The best medical authorities assert that the disease has existed from the earliest days of medical history; but it certainly did not occupy a very distinct place in nosology until a comparatively recent date. The severe epidemic at Tours in 1818 led to a thorough investigation of the disease by Bretonneau, who gave it the name of diphtheria. There can be no doubt, however, that there is still much to be learned as to the causes of this disease.

SANITARY PUBLICATIONS RECEIVED.

The Exit Channel Method of rapidly Removing, Deodorising, and Clarifying Sewage as applicable to Glasgow,' by Horatio K. Bromhead, A.R.I.B., A. J.I.A. Glasgow: Bell and Bain. 1878.

APPOINTMENTS OF HEALTH OFFICERS, INSPECTORS OF NUISANCES, ETC.

BROOKING, Mr. E., has been appointed (pro tem.), Surveyor and Inspector of Nuisances to the Finchley Local Board and Urban Sanitary Authority.

FAWCETT, R., Esq., of the National Provincial Bank of England, has been appointed Treasurer to the Brotton Local Board and Urban Sanitary Authority, Yorkshire.

GREVETT, Mr. Robert, has been appointed Collector to the Worthing Local Board and Urban Sanitary Authority, at 35s. per cent. commission, vice Snewin, resigned through ill health.

HARRISON, Frederick, Esq., of the London and County,Bank, Barnet, has been appointed Treasurer to the Finchley Local Board and Urban Sanitary Authority.

HAWKINS, Mr. Richard, has been appointed Collector to the Finchley Local Board and Urban Sanitary Authority.

MOORE, Mr. N., has been appointed Collector to the Brotton Local
Board and Urban Sanitary Authority.

SAYER, Edward, Esq., has been elected Chairman of the Finchley
Local Board and Urban Sanitary Authority.
SMITH, Thomas George, Esq., of the National and Provincial Bank
of England, has been appointed Treasurer to the Bridgend
Local Board and Urban Sanitary Authority, Glamorganshire.
STEVENS, Mr. Henry, Solicitor, has been appointed Clerk to the
Finchley Local Board and Urban Sanitary Authority.

SUTTON, Field Flowers, M. D. Univ. Edin., M.R.C.S. Eng., L.S.A.
Lond., has been appointed Medical Officer of Health for the
Streatham &c. Division of the Wandsworth District, vice Noel,
deceased

SWORDER, Horace, L. R.C.P., Lond. M. R.C.S. Eng., L.S.A. Lond., has been appointed Medical Officer of Health for the Luton Urban Sanitary District, at 50l. for one year, vice Haward, resigned.

WEBBER, E., Esq., of the National Provincial Bank of England, has been appointed Treasurer to the Newport Guardians and Rural Sanitary Authority, Monmouthshire, vice Vernon.

VACANCIES.

CARDIFF, CORPORATION AND URBAN SANITARY AUTHORITY OF. Town Clerk and Clerk to: 700l, per ann., and 300l. per ann. for Clerks.

CHELTENHAM, CORPORATION AND URBAN SANITARY AUTHORITY OF. Surveyor: 300l. per ann., and certain allowances (without restriction from private practice).

DENBIGH URBAN SANITARY DISTRICT. Medical Officer of Health: 30%. per ann.

FINCHLEY URBAN SANITARY DISTRICT. Medical Officer of Health.
Application to Mr. Henry Stevens, Solicitor, Clerk to the
Authority, 22 Bedford Row, London.

MANCHESTER, CORPORATION AND URBAN SANITARY AUTHORITY
OF. Surveyor: 1,000l. per ann. Application, 20th instant, to
the Mayor.
MELTON MOWBRAY RURAL SANITARY DISTRICT. Medical Officer of
Health for the Waltham Sub-District: 157. 10s. per ann. (and
407. per ann. and fees, as Poor-law District Medical Officer).
Application, 15th instant, to Frederick J. Oldham, Clerk to the
Authority.

NEWMARKET LOCAL BOARD AND URBAN SANITARY AUTHORITY.
Surveyor and Inspector of Nuisances:
WANTAGE IMPROVEMENT COMMISSIONERS AND URBAN SANITARY
AUTHORITY, Berkshire. Surveyor: 30l. per ann. Inspector of
Nuisances: 10l. per ann. Applications, 6th instant, to Edward
Ormond, Clerk.
WEYMOUTH AND MELCOMBE-REGIS URBAN SANITARY DISTRICT.
Inspector of Nuisances: 100l. per ann. Application, 11th instant,
to Frederick Charles Steggall, Town Clerk.

SANITARY PATENTS.

4507. Ventilating hats, etc. L. F. Marsh.

This consists in forming slits at the junction of the body and brim of the forehead part, and in fitting flat tubes within the hat or cap, with the lower mouths of the tubes projecting, or flush with the body so as to leave clear and free apertures under the silk or other band. The lower ends of the flat tubes are curved, and the upper parts are secured and lie close to the body up to about level with the top of the leather or canvas round, for the free passage of air into the interior of the hat or cap, from which the heated air may escape from the crown in the usual way.

[blocks in formation]

Original Papers.

THE WINTER CLIMATE OF SOME OF OUR HEALTH RESORTS.

BY JOHN W. TRIPE, M.D.,

Hon. Secretary of the Meteorological Society, Medical Officer of Health for Hackney, etc.

6

THE definition of the word 'climate' in its broadest sense is given by Dr. Scoresby Jackson as the sum of all those physical forces which by their operation upon the constitutions of organised beings prohibit their permanent migration from one region of the earth's surface to another.'* I need scarcely say that I do not use the word in this sense, and propose only to give the results of the meteorological observations taken at the localities treated of in such a manner as to enable any person to select for himself the particular place which he may deem most suitable for his ailments or most pleasant to his feelings. Of course in so limited a space as can be afforded in this journal, the influence of soil and other terrestrial agencies will not be considered, although some of the chief characteristics of each place will be noted.

As comparatively few persons can comprehend practically the precise meaning of the degrees of temperature for certain months, I propose in discussing the observations to use as a basis for comparison a table based upon records made at Camden Town, by G. J. Symons, Esq, hon. secretary of the Meteorological Society with myself. I would also observe that I have selected London as the basis of

comparison, because its climate is known to a larger number of persons than any other, and Camden Town as a better representative place than Greenwich, or any other station. I would also mention that I have been restricted to the discussion of the results obtained during a few years only, because corresponding observations have not been made for a long time at all the available stations; indeed, for Ramsgate and Hastings the returns could not be had for more than three winters. This, however, under the circumstances is no objection, for although the mean temperature and other meteorological elements of the climate of a locality cannot be calculated with anything like certainty even on a series of observations extending for twenty years, yet as they will be used only for comparison inter se, no great error can arise. It must also be remembered that as all the places to be treated of are situated on the seaside, their climate is much more regular in winter than at inland places, chiefly in consequence of the comparatively uniform temperature of the sea during the winter months.

In order to bring out this point somewhat strongly, I give a table of the mean air temperatures for November, December, January, February, and March at Penzance and Ventnor for different periods, by which it will be seen that, although the means for each month at Penzance differed somewhat, especially in January, yet the averages for the years 1863-73 and 1873-77 varied only o3° Fahr. As regards Ventnor the agreement was greater still, as the mean temperature for 1850-61 was 43.8°, for 1863–73 43'9, and 1873-7 43.8°, so that it varied only o1° in any of these periods. The manner in which Ventnor is

* Medical Climatology,' page 2.

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

We see by this table that the mean monthly sea temperature at Falmouth varied only between 52.8° and 47.7° or 5'1°; at St. Mary, Scilly Islands, less still, as the oscillation was only 39°, at the lightship, 47°. At Scarborough, which is removed from the direct influence of the Gulf Stream, the mean temperature was lower, and the range greater, as the highest monthly mean, viz., that of November, was 480° and the lowest 405°, giving a range of 7.5°. At Castletown, in Ireland, the range of sea temperature was smaller than at any other British station, viz., between 49.2° and 466°. At Cannes, in the Mediterranean, the range was 5'4°, but the temperature for November was as high as 610°, whilst that for February was 546°, which was nearly one degree above the mean for November at the lightship. It is true that as these observations were made in different years they are not strictly comparable, yet they show that the warmth of the sea at Cannes is so much greater than at any other place above mentioned as to account in part for the high and equable temperature of this health resort.

It must, however, be remembered that invalids should not select a winter residence from meteoro

logical data only, as it will always be necessary to consider whether a sheltered or an open spot be required, whether the air should be bracing or somewhat mild and relaxing. Also, if exercise be necessary, whether or not it can be taken under those circumstances which are most suitable, because it is not enough in many cases to reside in a sheltered spot, but it is also requisite to have some equally

* Dymond's 'Meteorology of Cornwall.'
Whiteley on The Temperature of the Sea.'
Marcet's Climate of Cannes.'

sheltered place to walk or drive in. The nature of the soil also requires consideration, as a large rainfall would not be so great a hindrance to exercise on a chalky or gravelly as on a clayey soil. The drainage of the roads, ditches, and houses as well as the water-supply should also be taken into account. I have briefly alluded to these matters now, because they will not receive much attention hereafter, as the chief object of these papers is to assist invalids and others in selecting suitable localities for winter residence, and if necessary to change from one place to another whenever the tables show that the meteorological conditions of that selected are likely to become less suitable for them. There is also another point to which the attention of those seeking a change of climate in consequence of disease must be directed, namely, the necessity of adopting a regimen suited to the disease and their condition of body, as without it the curative influence of a different climate may be almost entirely lost.

Before deciding on the place of residence it is absolutely necessary to take the disease, if any, into consideration, as a climate which is suitable for consumption is as a rule unsuitable for chronic bronchitis or other diseases of the lungs. Thus, a low lying locality is generally deemed inadmissible for consumption, as this disease is found to be more rife in such places than in those at greater elevations. Indeed in the summer months the high level localities in Switzerland, i.e., more than 2,700 feet above sea level are most highly recommended, because phthisis occurs amongst the inhabitants of these places only at the rate of 51 per cent., whilst the low altitude places gave as high a percentage as 102 per cent. of the deaths from all causes. Nearly as great a difference has been observed as regards localities situated near to each other when the variation in elevation was only about 500 feet, which probably arises from the fact that 'blowy' places are better suited for consumption than localities where the air is still, warm, and depressing. This has been well shown by Dr. C. Theodore Williams* in his lately published work, as he found that only a comparatively small proportion of his and his father's patients were much improved by a winter residence in Cornwall and South Devon, whilst 60 per cent. were 'much improved' at Torquay, 65 per cent. at Bournemouth, 69 per cent at Ventnor, and 72 per cent. at Hastings. As will be shown when treating of Hastings and Ramsgate, there is but little difference between the winter climate of both places, so that as new promenades have been made in the latter town, one above and the other below the cliff, it will probably become a favourite winter residence for those requiring a breezy and stimulating atmosphere.

For those who are suffering from chronic bronchitis or laryngeal affections the climate of Penzance, St. Mary's, Scilly, or Torquay is suitable, and in most cases Ventnor also. The time of year during which each locality may be best used as a winter residence will be pointed out when discussing the meteorological observations taken at each town. The reason why the air of these places agrees with those who are thus afflicted is that it acts as a sedative on the inflamed or irritated mucous membrane, and gradually restores it to a comparatively healthy condition. The temperament of the patient will affect the choice, as, if of a nervous disposition, the former will probably be most suitable, but if

* 'Influence of Climate on Pulmonary Consumption.'

leuco-phlegmatic, Ventnor, Worthing, or Clifton. As regards those who suffer from asthma no particular | place can be recommended, for so much depends on the cause that the locality should only be selected under proper medical advice or after personal trial, as the sedative climate of Cornwall and South Devon suits some, while it aggravates the attacks in others. There is, however, one fair guide, viz., if Penzance or Torquay should disagree, Ventnor or Worthing will probably be found suitable.

Change of air and scene are very useful for dyspeptics, especially if a locality be selected which admits of exercise being taken regularly, and the air be not too depressing. Of course the amount of exercise must depend on the form of dyspepsia and the strength of the patient, but as a rule Ventnor, Worthing, Hastings, Ramsgate, and similar places where there is not a large rainfall or too sedative an atmosphere, are preferable. As, however, the climate varies at these and other localities according to the amount of shelter afforded by the adjacent highland, the tables must be consulted as to the best season for each locality. Torquay often proves most suitable, especially for those who are of a sanguine temperament, but frequently the reverse for those who have a moist and cool skin, with a weak circulation. As regards those who take change of air merely for the purpose of avoiding the cold winds and snow so prevalent during winter in the northern parts of England, Ventnor, Worthing, Torquay, and many other localities in South Devon or Cornwall may be selected, the great objection, however, to the lastnamed places being the amount of rain, which often interferes with outdoor exercise or amusements.

There are two other points which may be briefly alluded to here; one is the amount of clothing to be worn, and the other of exercise to be taken. As regards the former, whatever part of the English coast be selected, the quantity of flannel underclothing should not be reduced, and especial regard should be had as to the temperature of the lower limbs, especially of the feet, as it often happens that in turning a corner whilst passing from one sheltered spot to another, a comparatively cold wind is encountered, and much of the beneficial effects of the change may become lost. The same remark applies to sudden showers which would make the feet damp if stout boots and warm woollen socks or stockings are not worn. Exercise to be beneficial should be regular and moderate, and never taken too soon after a meal, as few invalids have sufficient nervous energy for digestion of their food and exercise to go on at the same time. It should also be stopped short of fatigue, and if carried so far as to cause perspiration, great care must be used in avoiding a sudden chill. Invalids and children should never take exercise before breakfast, and exercise should be followed by perfect rest, all tendency to restlessness being as far as possible subdued.

THE Northam Local Board have received a letter from the Local Government Board on the subject of the Report of their inspector on the inquiry held by him as to the alleged default in providing sufficient sewers, the proposed the number of members; and stating that as the Board alteration of the area of the district, and the diminution of sewers, they (the Local Government Board) would defer were now providing part of the western district with any further action in that matter for the present, and that it was desirable the number of members should be reduced from 24 to 12.

JANUARY 10, 1879

A SUGGESTION TO USE A STAN

DARD SOLUTION

OF CARAMEL

THE

(BURNT SUGAR), INSTEAD OF THE SANITARY RECORD.

STANDARD AMMONIA AND NESS-
LER'S SOLUTION IN TESTING FOR
AMMONIA.

BY T. H. WALKER,
Medical Officer of Health, Longtown Sanitary Authority.

I HAVE found it more convenient in nesslerising to use a standard solution of caramel for comparison, instead of a second cylinder of nesslerised ammonia. The process takes less time to perform and one trial is only necessary, whereas with nessler two or three trials are often necessary to get the exact shade.

Different

It is well known that the tint produced by nessler is never for any length of time the same depth. Thus for two or three minutes it darkens, and then in a short time it begins to get lighter until it becomes perfectly colourless. samples of water differ greatly in the time required for these changes of colour (both when nessler is added to a sample of water and when added to the Now in testing, if we ammoniacal distillate). have to wait two or three minutes for the colour to become properly developed, and then have to repeat once or twice, ten minutes is easily lost, when probably the tint in the original water has become fainter, thus giving too low an estimate of the ammonia present.

I make a solution of caramel by dropping about ten drops of caramel into 100 c.c. of distilled water. I then dilute I c.c. of this 'strong' solution with 9 c.c. of distilled water; this makes the standard solution. To test this a standard colour is produced by adding say 20 c.c. of ammonia solution to 100 c.c. of water and nesslerising. The same number of cc. of standard solution of caramel (20) is added to a similar quantity of water; if the same depth of colour is produced the caramel is of a right strength; if too dark a little more water must be added; if too light a little more of the 'strong' caramel solution until the exact shade is produced.

It seems not to have occurred to the authorities of the Merthyr Workhouse that aged paupers are affected by extreme cold in much the same way as aged persons of all conditions of life. But a report presented at the last meeting of the guardians, stating that no less than seven of these poor old people had succumbed to the extreme severity of the weather during the previous week, seems to have awakened them to the fact that if they do not want to see the aged inmates dropping off like flies, they must adopt the very obvious expedient of keeping their poor old bodies warm. The medical officer gave his opinion decisively that the cause of these deaths was the inability of the master to raise the temperature of the infirmary wards above 40° Fahr. by means of the ordinary fires, whilst during the night the temperature of the rooms was much lower. The chairman of the board seems to be in wholesome fear of the Local Government Board, and said that if the matter was not taken in hand at once, it might mean We are glad to find an inquiry by that august body. that it was resolved, in view of the heavy mortality, to at once heat the wards by means of American

stoves.

FRIDAY, JANUARY 10, 1879.

The Editor will be glad to receive, with a view to publication, announcements of meetings, reports of proceedings, and abstracts or originals of papers read before the members of any sanitary or kindred association.

DIPHTHERIA IN NORTH LONDON.

THERE was much truth in the remarks made at the Stafford Congress last autumn by Sir Henry Cole, and by Dr. Tidy in his recently-published annual report (see SANITARY RECORD for January 3, page 6), as to the Local Government Board and their official reports. We have had before to complain of the inexcusable delay which takes place in the publication of documents which are of great public interest, but which cease to be of value when they are not given to the world for months—often many months after they are due. The Report for 1877 of the Local Government Board itself was not issued till November of last year, and the Supplementary Report of the Board's medical officer, which is even of more interest to us, and which was spoken of as 'forthcoming,' has not, so far as we are aware, yet come forth as promised. Not only, however, are the Board's own blue-books thus tardily produced, but the reports of their inspectors on matters of immediate importance are, for some inexplicable reason, bottled up at Whitehall till almost Thus the results of the inquiry comeveryone has forgotten the circumstances which gave rise to them. menced seven months ago by Mr. W. H. Power into the epidemic of diphtheria which last year caused so much consternation in North London, have only this week been officially published, although hints more or less vague as to the upshot of the inquiry have been allowed to appear in unprofessional journals such as the Times and the Standard. It must be confessed, however, that the value of Mr. Power's report amply atones for the delay in its production. It opens to us an entirely new field of ætiology, and coming as it does when the public interest in diphtheria has been rendered so keen and wide-spread by the lamented death of the Princess Alice, it is sure to receive ample discussion and criticism.

The exciting cause of nearly the whole of the 264 cases and 38 deaths from throat illness, which occasioned such wide-spread alarm in Kilburn and St. John's Wood in May and June of last year, is shown by Mr. Power in his report to have been, not sewer-gas, as was popularly supposed and energeti

cally upheld, but milk, and milk supplied by one particular dealer. This is by itself a most important discovery. Hitherto no conclusive evidence has been adduced of diphtheria being disseminated by the agency of milk, as in the case of scarlet or enteric fever, and all that previous research has justified us in affirming is, in the words of Mr. Power, that the disease has a power of spreading from person to person, and has also a faculty of development out of an antecedent prevalence of throat illness, the diphtheritic character of which may not, until a certain stage of the prevalence has been reached, be affirmed.

Of even more interest, however, than the causation of the epidemic by milk is the fact which Mr. Power found himself unable to explain away, that in no possible fashion could the milk have been humanly infected, either by pollution of the water used to cleanse the milk utensils (or perhaps added to the milk itself), or by the fouling of the utensils with soil, refuse, litter, etc., or by contamination of the air, from which milk might have absorbed infectious matter, or by the milking of the cows by persons suffering from any throat affections. Mr. Power has, therefore, been driven to surmise that actual 'cow conditions' capable of affecting the milk directly or indirectly may have brought about the result observed. In plain words, that is, the milk as it came from the cow contained in it properties which were capable of setting up diphtheritic symptoms in the person drinking it.

This suggestion is, it need hardly be said, of the greatest pathological importance. If it be true that a certain diseased condition of the cow can bring on diphtheria in the human subject in the same way that cow-pox induces vaccinia, many outbreaks the origin of which has hitherto remained obscure may probably be ascribed to this cause. The Pathological Society have, we observe, already taken the matter up, and there is thus great hope that Mr. Power's theory, for at present it is nothing more, will receive the most exhaustive investigation.

In the course of the inquiry, which appears to have been one of peculiar difficulty, every conceivable condition known to be capable of producing the result observed was in turn investigated by Mr. Power, with negative results in each case. It is true that he found at first much to connect the incidence of throat illness with the sewerage arrangements of the area in which the disease was especially virulent; but he is able to show that a cause much more potent was at work in the causation of the epidemic. He does not deny that the popular belief that the sewer defects of the district, and especially the sewer nuisances which were generally complained of after the heavy rainfall on the 10th of April last, has some primâ facie justification; but he shows that if those conditions have held any place in the causation of the epidemic, they have held but a secondary and subordinate place.

such

In proof of his assertion that milk caused the epidemic, Mr. Power adduces several most cogent and irrefutable arguments, and we must confess our unqualified admiration at the skilful manner in which he has fitted together the pieces of a seemingly inscrutable puzzle. Preliminary inquiries as to the number of cases showed that of 118 households invaded, no less than 78 got their first attacks during the four weeks ended May 25. In the third week in May, moreover, the newly-invaded households bounded to the very large number of 46, against 7 in the preceding week. The fall was almost as sudden, viz., to 15 and 8 in the two succeeding weeks, and thenceforth the outbreak as terminated abruptly. Obviously in this history of the prevalence of throat illness there was question of some factor strongly circumscribed in area and operation during a very limited time. Mr. Power was at first inclined to regard the relation of the illness to milk as improbable, although Dr. Morton, of Kilburn, had observed that a very large proportion of the cases occurring in his practice were served with milk by one or other of two tradesmen, both of whom, he ascertained, obtained their milk supply from the same wholesale dealer. Subsequent inquiry, however, showed beyond doubt that the milk of these retailers was most distinctly operative in causing diphtheria. Of 473 households supplied by them, 68 were invaded, whilst of the 2,227 other households in the area under consideration, only 30 were invaded-a difference of incidence in the proportion of II to I between the two sets of customers. In the special sewage area, moreover, where it was held that sewers had been concerned

in the outbreak, there was a difference of incidence of no less than 13 to 1 between the same sets of customers. So that in the facts of the milk-supply of this latter area a reason was found apart from any question of sewer circumstances, for the special

incidence of throat illness observed therein.

Further evidence tending to implicate milk was discovered in the ages of the persons attacked, 21 out of 233 cases investigated in this relation being in infants between the ages of one to three, and 124 in children between three and twelve, children being essentially the milk-drinkers in their families. It was found too, with regard to time, that the customers of these retailers bore almost the whole brunt of the outburst which first attracted attention to the district, and which was locally referred to sewer causation. Tables given by Mr. Power show that from almost complete immunity during the five weeks ended April 13, customers of the two retailers before mentioned commenced to suffer in rapidly increasing ratio, until in the middle of May they were invaded in one week at the rate of 70 per 1,000 households. After that date their rate of attack declined even more rapidly than it had arisen, and by the middle of June had become almost nil. The milk supplied by these retailers was derived from one of two

« ElőzőTovább »