1089PUBLIC HEALTH SERVICES.

worms. Dr. Winkel, of Java, Dutch East Indies, gavea report of the salvarsan treatment of framboesia.By a few injections the disease is, as a rule, cured.Prof. Ziemann reported on a disease known in thetropics as gangosa, somewhat resembling framboesia.Dr. Hoppenhauer, of Tiibingen, praised the resultsobtained by the treatment of dysentry by yatren,which he described as the best remedy in acuteand chronic cases. Excellent results have beenreported from the Congo, from the British and theDutch East Indies, from Tapan, and from SouthAmerica by many authors, who all agree with theextremely good action of the compound. Dr. Werner,of Berlin, spoke on the five-days’ fever (febrisquintana), a disease which had been observed duringthe war in the Balkans. Among other papers readbefore the congress was one by Prof. Thiel, of Leyden,on anopheles ; one by Prof. Muhlens on his travelsthrough South America for the study of malaria;and one by Prof. Zschukke on the diseases in CentralAmerica. The meeting was attended by 200 medicalmen who had had experience in tropical diseases.

Public Health Services.REPORTS OF MEDICAL OFFICERS OF HEALTH.THE following health statistics for’Liverpool and

Leeds show a great similarity. Liverpool has a higherbirth-rate, while Leeds shows higher cancer and child-birth mortality. In Liverpool the childbirth death-rate is generally low, perhaps owing to the excellentlead that has been given for many.;.. years by theLadies’ Charity.

Liverpool.Dr. A. A. Mussen, the present medical officer of

health, and Dr. E. W. Hope, his predecessor, producea joint report. Only one case of small-pox occurredduring the year, and about 75 per cent. of the childpopulation are successfully vaccinated. The results ofan inquiry suggested that a considerable amount ofvaccination of unvaccinated children is also donewithin the school period. Six cases of anthrax werereported during the year. Two of the patients handledwool, three handled hides, and one looked after amachine for crushing bone. Up to 1924 nearly allthe cases of enteric fever in Liverpool have beencaused by B. typhosus, but in that year there were24 cases caused by B. paratyphosus, besides 36 causedby B. typhosus. Most of the paratyphoid cases

occurred in April and May and they had an unusualsex and age distribution. Females and persons under15 were chiefly affected, and as none of the usualfood sources of typhoid fever could be traced, it isdeduced that the agent responsible is widely usedbut not heavily infected, and is more indulged in bychildren than adults.There were 230 notifications of encephalitis lethar-

gica compared with 111 in the previous year. Thediagnosis was revised in 33 cases after admission tohospital in favour of tuberculous meningitis (eightcases), enteric fever (three cases), pneumonia (four

cases), or other conditions, but there remained189 cases with a case fatality of 10-6. The case

fatality in 1923 was 32-4, and it is suggested that thedecrease is partly due to mild cases being recognised.Up to the autumn of 1922 lethargic symptoms werepredominant, during 1923 cerebral irritation becamea more prominent symptom, and in 1924 there wasa tendency to revert to the lethargic type. Priorto 1923 the disease occurred in groups with no directassociation of cases, during 1923 it was widespreadin the city and neighbourhood, in 1924 the area

chiefly affected was a broad band of city and suburbs.Half of the’ 1924 cases were under the age of 20.Before this age sequelæ are commoner, whilst themortality increases with advancing age. The Liver-pool experience is exceptional in that the infectiousnature of the disease is clearly demonstrated. Inabout 18 per cent. of the 1924 cases, and in 9 per cent.of the 1923 cases, a possible connexion with a pre-ceding case was made out. The incubation periodis usually from a week to a fortnight. A diagram showsthat encephalitis and influenza are not as a rule

prevalent together ; but in 1924 epidemics of the twodiseases occurred simultaneously. Inquiries aboutthe condition of 94 survivors under 16 years of ageshowed that 37 had made a complete recovery orwere but slightly affected. Of the remaining 57,37 were attending elementary schools, 9 were absentfrom school, 3 had left school, 4 were in reformatoryschools for delinquency, 2 in special schools, and 2 inasylums. Among the 57 the most frequent condi-tion was alteration of the sleep rhythm, which wasusually associated with a want of self-control andin extreme cases with moral imbecility. The admissionof these children to asylums is not recommended,for recovery may still be possible ; and it is suggestedthat an attempt should first be made to educate themin special classes, and that, if this fails, a residentialinstitution may have to be considered. In view ofthe definite infectivity of the disease, school-childrenfrom infected houses are excluded from school fora period of three weeks.A chart shows the death-rate in Liverpool per

100,000 from diabetes for each quinquennium since1890. During 1890-94 the rate was 3-8, and duringthe next three quinquennia it was 5-3, 6-5, and 8.4.During 1910 to 1914 it was again 8.4 ; in the warquinquennium it fell to 7-4, and during 1920 -24 itrose to 8-6. During the first six quinquennia about120 males died, compared with 100 females, but inthe last quinquennium only 75 males died, as against100 females, and it seems conceivable that thisalteration is due to insulin having a more markedeffect in males. A satisfactory scheme is now inoperation for dealing with all classes of blind persons,and the city council has passed a resolution recom-mending all corporation committees to give specialconsideration to the workshops of the blind whenmaking contracts for articles such as brushes and mats.The Carnegie Welfare Institute is proving a mostvaluable addition to the maternity and child welfarescheme, and the present report contains photographsand a plan of this new building. Out of 20,599 births,13,270 were attended by practising midwives and1501 by the midwives of the staff of the Ladies’Charity; 398 still-born babieswere examined bythe citybacteriologist, of which 26 (6 per cent.) were reportedas probably syphilitic. There were 690 notifications ofophthalmia neonatorum during the year with three casesof damaged sight among the survivors. X ray examina-tion has been much used for the diagnosis of tuber-culosis, and the satisfactory results are shown by thefacts that whilst out of 1806 admissions to sanatoria,only nine patients were subsequently considered tobe non-tuberculous; cases diagnosed as negative seldomreturn to see the tuberculosis officer. The Seamen’sDispensary was opened in January, 1924. Though itis intended primarily to deal with venereal disease,seamen will be able to obtain advice there for otherailments, including tropical diseases, before beingreferred to other institutions. The number of newcases of venereal disease dealt with at the dispensary

1090 PUBLIC HEALTH SERVICES.

during 1924 was 428. A few years ago the Welshsheep farmers suffered serious loss from the con-

demnation cf their mutton at the Liverpool abattoirowing to the effects of liver fluke. The efforts ofthe Board of Agriculture to eradicate the diseasein North Wales by spraying the pastures and brookswith chemical substances intended to destroy the watersnail, which is the intermediate host of the liver fluke,have apparently been successful. The Welsh sheepnow show remarkable freedom, though the Irish andScotch sheep are severely infected. Of 3740 cows inthe city cowsheds in 1924, 26 were found with tuber-culosis of the udder. The bacteriological report onthe examination of milk samples taken from bulk doesnot indicate that tubercle of the udder is gettingless but rather that it is on the increase. Of samplesof country milk examined during the eight years1913—20, 6’4 per cent. were tuberculous, while forthe four years 1921-24 the figure was 10.1. During1924, 57 out of 549 " bulk " samples of country milkand 22 out of 232 " bulk " samples of city milk provedtuberculous (10-4 and 9-5 per cent. respectively).

Housing is still a serious problem in Liverpool,and the houses provided since the war have neither over-taken arrears nor met the needs of the growing popula-tion. An estimate is put forward that Liverpool isworse off now than it was at the end of 1914 by rathermore than 10,000 houses.

Leeds.Dr. J. Johnstone Jervis records the prevalence of

influenza of a peculiarly malignant form at the beginning of the year. The deaths registered numbered404, and the death-rate for the year (0-86) was thehighest since the influenza years of 1918-19. Duringthe epidemic the infant mortality-rate went up witha bound, and in the hird week of February reachedthe pheno:neilally high figure of 321. The generaldeath-rate rose to 38.4 in the first week of March andwas 35-9 and 26.1 in the two subsequent weeks.Normal figures were reached about April. A goodmany cases ended fatally within 48 hours of the firstsymptoms. Some cases were removed to hospital,but as a rule too late to be of any use, and Dr. Jervishas not much faith in hospital removal for influenzacomplicated with pneumonia. He refers to the inade-quate hospital accommodation provided for the cityfor non-infectious diseases. All the voluntary institu-tions have long lists of patients awaiting admission,whilst the Poor-law infirmaries are partially empty.The way out of the difficulty, says Dr. Jervis, isobviously to open the doors of the Poor-law infirmariesto the whole community. Atmospheric impurity inLeeds is getting less. The percentage of factorychimneys emitting dense smoke for more than threeminutes during an hour’s observation is also decreasing.Thus, the percentage from 1920-24 ha& been 12-4,8.6, 7-1, 3-3, and 1.7. During these five years over25,000 observations of one hour each have been made.Among 2063 cows in the city 13 cases of tuberculosiswere found, in 5 of which the udder was affected,whilst the remaining 8 had generalised tuberculosis.There has been little advance in cleanliness of methods.

There were only seven (mild) cases of small-poxnotified with no deaths, and Leeds also showed lessincrease in encephalitis lethargica than many othertowns. The cancer death-rate was the highest everrecorded. The health ccmmittee have set up a specialcommittee to inquire into the local incidence of thedisease. Considerable progress has been made in thereorganisation of the tuberculosis scheme. A whole-time clinical tuberculosis officer has been appointed,and a sanatorium school for children with signs ofearly disease of a non-infective type has been openedat the Hollies, Weetwood. The provision of sana-torium accommodation for women and children is a-matter of extreme urgency. Dr. Jervis is also ofopinion that no tuberculosis scheme can be consideredcomplete which does not find suitable remunerativeemployment under favourable conditions for the menand women who undergo sanatorium treatment.:993 new cases attended the 14 antenatal centres,

and there were 8558 births. About 20 per cent. ofthe total births took place in institutions or nursinghomes. The corporation have made arrangementsfor the provision of maternity beds at the threePoor-law union infirmaries. This scheme came intooperation on April 1st and was not much usedduring the year. It is, however, expected thatwhen the excellence of the accommodation becomesknown the facilities will be utilised to the full. A

special block at the city hospital has been openedfor cases of puerperal sepsis. Cases of septic abortionand abscess of the breast will also be admitted.The health committee have spent considerable sums

during the year in providing convalescent home treat-ment for mothers and babies. The housing problemis as .pressing as ever. Dr. Jervis points out thatabout two-thirds of all the deaths occur in back-to-back houses. He is unable, however, to give separatefigures for the ancient and modern back-to-back houses..The modern ones, he says, are little different from" through " houses in healthiness, and this statementappears to be borne out by the figures of deaths, seeingthat 77,790 of the 115,289 houses in Leeds, or verynearly two-thirds, are of the back-to-back type.

MENTAL HOSPITAL REPORTS.Dorset finds that its mental patients are steadily

increasing in number, especially the women, butDorset Mental Hospital has still some of its 950 bedsvacant. The recovery-rate for the year was 43 per cent.and the death-rate 7-44 per cent., a figure which, thesuperintendent complains, in common with so manyof his colleagues, might be lower if the infirmarieswere prepared to relieve the asylums of their unneces-sary burden of senile cases. There was an epidemicof scarlet fever, introduced by a nurse, and over 100persons were affected by a mild influenza epidemicin the spring. A visiting surgeon has recently beenappointed and his services will be much appreciated.The dental surgeon has seen 193 patients during theyear. Recent structural improvements include anautomatic telephone system, a steam disinfector, andthe installation of four special baths for continuoustreatment. The hospital now has 70 additional acresof farm land which will be extremely helpful to thepatients and organisation staff. Dorset county wasone of the first to develop the important out-patientaspect of the mental work. The clinic at the DorsetCounty Hospital continues to flourish. The numberof new cases is increasing and many patients dis-charged from the hospital report from time to timefor advice or treatment. This is clearly a most valuablefunction of the clinic. The commonest type of out-patient is the anxiety neurosis. Parole is granted to33 patients outside the hospital grounds and to 81 onthe estate, and there are open-door wards and a clubward. The laboratory has been busy with routineexaminations and three typhoid carriers have beendetected, with the result that there has only been onecase of typhoid in the hospital, whereas it used to beendemic. Investigation has been made into the urea-content of the blood in epilepsy.

Wilts County Mental Hospital has over 1000patients under care. The recovery-rate was 27-7per cent. and the death-rate 7’1 per cent. 44-4 percent. of those who recovered were admitted intheir first attack within three months of its onset.Almost all those discharged had a probationary periodon trial and several of these were helped with a moneygrant. The general health during the year was good,but there were 12 cases of dysentery and two oftyphoid fever, which has not yet been traced to itssource. A cinematograph apparatus has beeninstalled. The patients are encouraged to wear

their own clothes, though at present only a smallproportion are doing so. At present there is no

laboratory.Derby Borough Mental Hospital has had a recovery-

rate of 10-7 per cent. for men and 53-3 per cent. forwomen, among its 400 patients. The death-rate was