556

convey and to store the electric energy therein, were

authorised and protected by the statutory powers of thecorporation and it was only when the electric current wasallowed to leak and to do damage that a nuisance was set upwhich was not protected; that what happened in this case,where considerable damage was done to a warehouse,constituted a nuisance for which the corporation was re-sponsible and that there was sufficient evidence of negligenceon the part of the corporation or its servants to justify thejudge in the King’s Bench Division in leaving the question ofnegligence for the consideration of the jury. In this actionsubstantial damages were given to the plaintiffs. It is saidthat the committee is not likely to proceed further in thematter. After all, there is some comfort in the thought thatif the corporation, with the aid of its " electric supplysystem," blows up a house or warehouse, with or withoutinjury to those on the premises, the "system" may becalled a

" nuisance" and may be proceeded against withsome chance of success.

Isolation Hospital for Preston.On August 10th the foundation-stone of a new isolation

hospital at Preston was laid by Dr. Brown, chairman of thehealth committee. It is expected to cost f:20,000, and is tobe provided with two pavilions for scarlet fever patients, onefor diphtheria and one for typhoid fever. There are to be 56beds, or about one for every 2000 inhabitants.August 15th.

LIVERPOOL.

(FROM OUR OWN CORRESPONDENT.)

Observations of the Medical Officer of Health of Liverpoolupon the Report of Dr. R. J. Reece to the Local Govern-ment Board on Small-pox and Small-pox Hospitals

at Liverpool, 1902-03.THE port sanitary and hospitals committee of the Liverpool

corporation on March 30th, 1905, had under considerationthe report of Dr. R. J. Reece to the Local Government Boardon small-pox and small-pox hospitals at Liverpool, 1902-03,and passed the following resolution :-That the medical officer be requested to furnish the committee with

his observations upon the report.

In pursuance of that resolution Dr. E. W. Hope submittedsome observations, a summary of which is appended.Dr. Hope said that the investigations made by Dr. Reeceextended over nearly 12 months-namely, from March,1904, to February, 1905, and he devoted the closest personalattention to those aspects of the outbreak respectingwhich the Local Government Board desired informationand which may be presumed to be those dealt within the report. After mentioning the area of the city-viz., 23 square miles, with a population of 723,430-anacknowledgment is made of the cordial cooperation andassistance given locally in the course of the investigations.Dr. Hope arranged that every book and every record shouldbe placed at Dr. Reece’s disposal, also that every member ofthe staff whom he desired to interview should be available forthe purpose. After these preliminaries Dr. Reece’s report pro-ceeds to deal with three important matters connected with theoutbreak-viz., (1) the administrative arrangements avail-able for dealing with importations of small-pox into the cityand for preventing and limiting its spread ; (2) the admin-istration of the hospitals ; and (3) the influence exerted bythe hospitals themselves in the diffusion of small-pox bywhat has been called "aerial convection." Dr. Reecementions that Liverpool as a great seaport town has beenespecially prone to receive small-pox and regarding theaction of the health committee in combating the disease andin promoting vaccination and revaccination he speaks interms of praise. Want of practical experience of the

sanitary administration of cities, Dr. Hope says, has ledDr. Reece to make observations which convey a wrongimpression. His complaint on p. 4 of his report that nolist had been kept of I I contacts " placed under observationsuggests a laxity which did not occur. The addresses notonly of " contacts " but of all out-workers, with all the namesnecessary, were carefully kept and each officer engaged invisiting them had been duly recorded, together with hisvisit in his work books. Dr. Hope gives a facsimileof the record sheets in Appendix B of his observations.These sheets were at Dr. Reece’s disposal. On p. 7 of his

report Dr. Reece complains that the names of patients are

not recorded in a particular book, a book, it may beobserved, which was not intended for their record. Butthere were placed in his hands volumes in which the name,age, address, and date of every patient are recorded, one ofthem being a volume especially kept for that purpose andthe other being a book recording the admission of patientsto hospital. It is not apparent therefore why a complaintof this character is made. Dr. Reece complains on p. 10of his report that spot maps of disease were not made

systematically in the health department. It is not quiteclear in Dr. Hope’s mind what he means by this, whetheror not it is inferred that spot maps of disease are made inother places but not in Liverpool. His remark appears toDr. Hope to arise from a misapprehension of the objectsaimed at by medical officers of health in preparing spotmaps. They are only prepared when some useful

purpose would be served by their preparation and whensuch maps are necessary to explain or to simplifyreports which might otherwise be obscure. Dr. Reececriticises the methods in which the hospital registers andbooks were kept and suggests that they may be due to thewant of previous experience and the short stay of theresident medical officers at the hospitals. Dr. Reece says:"In this report the city hospitals receiving small-pox casesare alone dealt with, but it is manifest that the scheme ofsupervision of the whole of the city kospitals merits theattention of the hospitals committee of the corporation."This observation, suggesting negligence on the part of thehospitals committee, Dr. Hope says is too general toadmit of comment. Dr. Reece, he says, does not

appear to have visited these institutions or to havetaken steps to acquaint himself with the method oftheir supervision. Dr. Reece also observes on p. 6 ofhis report that the medical officer of health has no directadministrative control over the various city hospitals,to which Dr. Hope replies that no one with practicalknowledge of the sanitary administration of large citieslike Liverpool would suggest that the medical officer couldpossibly exercise direct administrative control over the cityhospitals. In smaller districts it can take place with

advantage but in the large cities it would be impracticable.Dr. Hope devotes a large part of his " observations" in

questioning Dr. Reece’s remarks on the alleged influence ofthe small-pox hospitals in disseminating the disease, other-wise known as the theory of aerial convection, and sa5sthat if Dr. Reece’s assertions are well founded the

hospital for small-pox erected upon a site carefully selectedfor the purpose and approved by the Local GovernmentBoard, after full and complete inquiries by the Board’s

experienced inspectors, must be closed as a public danger.Dr. Hope challenges Dr. Reece’s findings and questions thestatements and diagrams by which the .theory of aerialconvection was supported with reference to the small-poxhospitals of the city. One of Dr. Hope’s strongest argumentsagainst this theory lies in the fact that the invasion bysmall-pox of houses near to the Fazakerley hospital wasleast when the hospital had most patients. Dr. Hopealso emphasises the fact that no hospital had so manysurrounding cases of small-pox as one which itself neverreceived a small-pox patient. In reference to Dr. Reece’sremarks on p. 9 of his report, stating that "the generallyaccepted and, so far as I am aware, the only completelysatisfactory explanation of the peculiarities of small-poxincidence around hospitals receiving acute cases of thedisease is dissemination of infection by aerial convection,"Dr. Hope replies that " it must at once be pointed out thatthe statement that the theory is generally accepted is with-out justification. The theory is not generally accepted byexperts ; it is not generally accepted by medical officers ofhealth, and it has been rejected by the High Courts ofJustice both in Ireland and England when the theory hadbeen put forward to restrain the use of certain sites forsmall-pox hospitals." Dr. Hope concludes his "observations"by saying that "neither the Local Government Board northe port sanitary and hospitals committee could assent tothe continued use of the Fazakerley hospital if the allega-tions contained in Dr. Reece’s table are to be regardedseriously." " The committee will, of course, appreciatethat Dr. Reece’s report derives its importance from theofficial position which he holds, and although it does notappear that the Local Government Board have adopted thereport, or have given official acceptance to it, yet no doubtmust be allowed to remain as to the views of the Board andthe views of the committee in the matter."August 15th.