1172

state in their report that all parts of the asylum continued to be maintained in excellent order, that the day rooms weresuitably furnished and had a pleasing appearance, that thepatients were quiet and orderly, that the new sewage workswere completed and appeared to be working efficiently, thatthe beds and bedding were in excellent order, that the dormi-tories were clean and well ventilated, and that the medicalcase-books were very well kept. The committee of manage-ment states in its report that the cost of the new sewageworks amounted to R2259, that papering and painting havebeen carried out at a cost of £614, that steady progress is

being made in the laying out of the grounds, that the stateand condition of the asylum have been satisfactory, and thatthe maintenance rate for patients has been reduced from12s. 6d. per week to 12s. as after April lst, 1904.Durham County Asylum (Annual Report for 1903).-The

daily average number of patients resident doring the yearwas 1496, comprising 776 males and 720 females. Theadmissions during the year amounted to 412-viz., 251 malesand 161 females. Of these 334 were first admissions. Dr.W. St. John Skeen, the medical superintendent, states in hisreport that the admissions were of the usual types of insanityand " as in previous years there was a large proportion of agedand feeble persons ; several of these feeble cases died withina short time after being admitted. 40 of the admissionswere over 60 years of age as compared with 23 the previousyear; 17 were over 70 years of age as compared with 11 in theprevious year." Of the causes of insanity in the admissionsheredity (60 cases) and alcoholism (57 cases) were the mostfrequent, after which followed ill health, bodily injury andaccident, domestic troubles, and old age in descendingorder of frequency. " 42 cases of general paralysis wertadmitted, an increase of 19 on the previous year .....showing that this form of insanity is much on the increase.’The number of patients discharged as recovered during thyear amounted to 164-viz., 82 males and 82 females, or 10’!per cent. of the average number resident. The death

during the year amounted to 178, or 11.9 per cent. a

calculated on the same basis. Of the deaths three were du<to cerebral haemorrhage, eight to renal disease, nine t

pulmonary and other forms of tuberculosis, ten to cardiadisease, 14 to congestion of the lungs, 25 to pneumonia, 39 tgeneral paralysis of the insane, and the rest to other causesThe general health of the asylum has been good, with thexception of a few cases of scarlet fever, all of whicrecovered. There have been no serious injuries or casualticamong the patients during the year. Two patients escapeduring the year. The Commissioners in Lunacy state in the’report that increased provision has been made for dealinwith outbreaks of fire and securing the exit of patienifrom the buildings, that the asylum is maintained in veigood order, that the day rooms were warm and comfortablethat the dormitories and bedding were well aired and clea!that the patients appeared to be personally tidy and wecared for, and that the medical case-books appeared to 1well kept. The committee of management states in its repothat the desirability of making provision for the separatreatment of tuberculous patients is engaging its attentiothat a temporary hospital for the isolation of patients (case of an outbreak of small-pox) has been erected at a coof &pound;247 10s., and that iron fire-escape staircases for t]double dormitories at Winterton have been provided at

cost of f.143. Other improvements effected during the yeinclude the installation of an efficient system of electifire-alarms throughout the institution. A proposal by tcommittee to extend the main buildings with the objectaffording accommodation for 90 additional patients wdeclined by the Commissioners in Lunacy who advised .alternative scheme to the effect of building an additiorward for not more than 60 patients at Sedgfield.

A MARTYR TO SCIENCE.-It is announced thMr. Clarence M. Dally, an electrical engineer, diedOct. 2nd at his home in East Orange, New Jersey, U.S.Mr. Dally is said to have been for seven years a sufferer fr(cancerous disease which was primarily due to exposurechemicals and the action of the x rays during continuous <

perimental study. Some time ago Mr. Dally was one of tchief assistants in the laboratory of Mr. Thomas A. Edis(with whom he was connected for about 16 years. He born in Woodbridge, New Jersey, 39 years ago and servfor five years in the United States navy as chief gunnerthe Enterprise. -

Public Health and Poor Law.LOCAL GOVERNMENT BOARD.

ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH.

The Borou.gh of Battersea.-The account given by Dr.G. F. McCleary in his current annual report of the

working of the Battersea Infants’ Milk Depot is ofconsiderable interest. An average number of between

300 and 400 were fed at the depot during 1903but many of these consumed the milk for a short

period only. By way of obtaining some testimony otherthan statistical as to the value of the depot, Dr.McCleary sent round a circular at the end of February ofthe present year to the medical practitioners of the districtand to the visiting physicians of certain children’s hospitalsto which Battersea children were being taken. In answer

. to this circular asking for expressions of opinion as to thevalue of this milk 41 definite replies were received, and it

! must have been gratifying to Dr. McCleary to find that withone exception all were in favour of the supply, two of the

practitioners having by preference fed their own offsprington the milk. One of the answers referred to the depot asII "a perfect godsend to the working classes," while another? expressed the opinion that it was the only pro- gressive’ venture of the local borough council which has. benefited the public." More than one reply regarded the"

depot as having been the means of saving children’s lives6 and a reply from the medical officer of one of the dis-3 pensaries is : " I am of opinion that the milk has beens the means of saving the lives of a large number ofs hand-fed infants treated at our dispensary suffering frome wasting. rickets, and other disorders brought on by im-o proper feeding." In one or two instances the milk,c according to the replies, has disagreed with the children,o but the writer of one of these replies adds but I haves. generally to blame the parents rather than the milk." Dr.le McCleary regards this medical testimony as the most trust-h worthy evidence at present available-more so, that is tos say, than statistical evidence. It is, as Dr. McCleary states,d doubtful whether the value of these institutions can beir adequately expressed in figures and he is probably right ing withholding statistical data for the present. Certaints criticisms are directed against these depots and perhaps the’y one which in a sense receives most support is that ’whiche, takes municipal trading as its basis. Obviously, if muni-a, cipalities supplied bread-and-butter and clothes a difficulty’11 as regards private enterprise might be created. But in36 the present instance it is surely reasonable to urgert that this saving of infant life is, having regard to thete falling birth-rate, a far more important matter fromin, an economical standpoint than the financial dislocation’in which might accrue in certain directions from a-general,st adoption of milk depots. For ourselves we hope to see suchhe general adoption, as we have great faith in their educationalavalue. The question, however, has apparently arisen in Batter-

ar sea as to whether if the municipality professes to supply pureric milk it should not be thorough in the matter and keep its ownhe cows. Educationally a perfectly equipped cowhouse wouldof have great value but it is doubtful whether it is expedient

- as to urge its provision. The precautions as regards cleanlinessan provided for in the contract are, it appears to us, admirable,ml and if they are duly carried out there should not be much

to complain of.&mdash; The Borough of St. Helens.-It is interesting to compare

the evidence as to the Battersea milk dep6t with that con-at tained in the current annual report of Dr. F. Drew Harrison as to the St. Helens dep6t which has been in operation sinceA. 1899. The result of last year’s work is not altogether satis-om factory, as will be seen by the appended table.’ Theto medical officer of health is unable to understand the apathy

ex- of the public " in neglecting what, on the face of it, is a:.he most useful institution." He is inclined to infer that theon, distance of the depot from the outlying districts limits itsvas usefulness, notwithstanding the fact that a pure food canved be thus obtained at such a reasonable price. He suggestson that such dep&ocirc;ts should be established in certain parts of thetown.

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Table showing the Results since the Dep&ocirc;t mas Started.

Whether the children supplied with milk from this depotare the offspring of the more careful parents and hence moreprone on that ground alone to survive is the question whichat once arises in connexion with these figures, but in our viewthe difference is such that the rates cannot be thus entirelyaccounted for and we hope that Dr. Harris’s suggestion as tosub-dep6ts will be carried out. The figures as to cost are ofinterest.

1899-1900. 1900-01. 1901-02.(8 months.)P, s. d. P, s. d. &pound; s. d.

Cost of installation ... 235 2 5 ... 123 7 1 32 8 7

As to this total &pound;390 18s. ld. Dr. Harris states that althoughit has been paid out of revenue it may really be regarded as acapital charge since it will not occur in future years. Thecurrent cost is thus shown :&mdash;

1900-01. 1901-02. 1902-03. 1903-04.je s. d. 2 s. d. &pound; s. d. P- s. d.

Current expen- 471 3 2 ... 402 16 3 ... 440 4 6 ... 326 7 5diture ...... t 402 16 3 ... 440 4 6 ... 326 7 5

Income from sale 328 9 5 ... 245 16 3 ... 208 16 8 ... 139 13 8 Iof milk ", (,

Amount falling 142 13 7 ... 157 0 0 ... 231 7 10 ... 186 13 9on rates

The cost per life presumably saved is certainly not great.The City of Liverpool.-Milk depots have been in operation

in Liverpool since 1901, and as Dr. E. W. Hope embodies in hisannual report for 1903 a review of the work of such depots a,r6su,m6 maybe of interest in connexion with the Battersea andSt. Helens notices. It is, however, to be borne in mind, andit is a matter of some importance in relation to the problemgenerally, that to St. Helens belongs the credit, as Dr. Hopepoints out, of initiating these depots. The first Liverpooldepot was started in the centre of a populous district wheredeaths from diarrhoea were numerous, and shortly afterwardsanother depot, employed merely as a distributing centre, wasbrought into use. This place was presumably so much appre-ciated that another depot with another distributing centre inconnexion therewith has now been opened. It was also deter-

mined, it seems, to allow the sale from dairies of thehumanised milk prepared at the depots, this step being takenpartly on economical grounds and partly with a view tointerest the trade. We gather, however, that this arrange-ment is not altogether free from drawbacks, as the bottles areliable to be tampered with at the dairies. In point of fact,the only complaints which have been received as to the milkhave been in relation to bottles supplied vid the dairies.The milk is supplied by contract both by the cityand country cow-keepers but the provisions of the Liver-

pool Milk Clauses of 1900, which apparently followthose of the Manchester Milk Clauses of 1899, give thecorporation power to inspect and to control the countryplaces. At the depot a mixture of cow’s milk, water, cream,salt, and sugar, so as to approach as near as possible to thehuman milk, is prepared in amounts sufficient for one feed,and the bottle and its contents are then sterilised. Verbalinstructions as to the use of the milk are given and from threeto five visits are made to the homes to see that the milk isbeing properly used. There is, however, difficulty in

inducing the mothers to take their children to the depot tobe weighed. There has recently been a reduction in theinfantile mortality of Liverpool but this has doubtless, asDr. Hope states, been due to multiple causes. " It is not forone moment claimed that it is altogether brought about

’ by the sterilised milk." From early in 1901 to Dec. 31st,1903, 6295 infants were fed upon this milk either directlyfrom the dep6ts or through dairies, the average age atthe commencement of the course being three and a halfmonths. Only 367 were admitted to the privileges of the

institution after they were 12 months of age. We aretold that in the great majority of instances the infants thrive,increasing in weight and remaining perfectly healthy.The closest supervision was kept over 4453 cases which weresupplied directly from the depot. Of this number 350 died,but 49 of them had been fed for less than one week ; 18 hadtaken the milk irregularly, and 228 were ill-some of themhopelessly ill-when the milk was first supplied. The cause ofdeath in each case was made the subject of investigation andit was found that of all those who died only 55 were fairlyhealthy at the time when they were entered on the books.Out of these 55 only 11 died either from diarrhoea or con-vulsions and in several of them it is stated that the milkhad been discontinued prior to the beginning of the fatalillness. Dr. Hope, without, of course, laying much stress

upon them, considers the figures as a whole in this fashion." Out of the 4453 coming very promiscuously to the depots atvarious ages and in conditions of health below the average,the mortality was 78 per 1000, as against 159 per 1000 forthe whole city and 88 to 118 in the best districts and 212 to215 for the worst." But Dr. Hope points out that the death-rates other than those among the dep6t children embodyalso breast-fed infants and clearly if these were included theadvantage would apparently be still greater in favour of thedepots. It would be useful to know, if possible, the infantilemortality of the districts from which the infants are mainlydrawn and to have some general idea as to the class. The

average duration of the period during which the milk wastaken would also be of value. But, as Dr. Hope observes,there is in addition to the statistical evidence the testimonyof parents, medical men, and personal observation-all

pointing to the conclusion that infants’ lives have beensaved by the use of this milk on numerous occasions. We

give the following figures as regards cost for comparisonwith the St. Helens figures.

Expenditure and Income for the Years 1901 to 1903.1901. 1902. 1903.E s. d. Y- s. d. &pound; s. d.

Expenditure ... 1874 8 10 ... 4334 18 11 ... 4259 3 5Sale of Milk ... 518 0 2 ... 1534 13 7 ... 2230 11 1

2%c County Borovgh of -Derby.-Dr. William J. Howarth

reports that the death-rate from pulmonary tuberculosisin Derby in 1903 was the lowest rate on record, theactual number of deaths registered from this complaintbeing 104. Endeavours have been made to ascertain thesource of infection in the case of persons who have beennotified to be suffering from this disease but Dr. Howarthobserves that it is very difficult to obtain information which" would enable one to arrive at an opinion with any degreeof certainty." For instance, he was only able to discovereight houses in which a previous case of the disease hadexisted at a sufficiently recent date to justify the assumptionof direct infection, and in dealing with cases where there wasa marked family history of the disease the last death hadtaken place at a period so remote as to exclude the possi-bility of direct infection and in the majority of cases therehad been numerous changes of residence. As Dr. Howarthremarks, " infection in these cases could only be associatedwith the earlier cases on the assumption that infection maytake place and be followed by a long period of latency beforethe characteristic symptoms of the disease are manifested."Dr. Howarth, however, has apparently seen a few cases inwhich there was a suggestion that repeated visits of a healthyman to houses containing tuberculous persons may have beenresponsible for infection. There have been no cases, the

report tells us, of what is termed secondary house infection,although the address of every person dying from consumptionfor the lat seven years has been recorded. No case of con-

sumption has been reported from any one of these houses.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8691 births and 4439deaths were registered during the week ending Oct. 15th.The annual rate of mortality in these towns, which hadbeen 16’0, 15 ’6, and 15. 1 per 1000 in the three precedingweeks, increased again last week to 15’ 2 per 1000. InLondon the death-rate was 14.2 2 per 1000, while itaveraged 15.6 in the 75 other large towns. The lowestdeath-rates in these towns were 5’1 in Tottenham, 7-6 in