FIFTEENTH ANNUAL REPORT OF THE LOCAL GOVERNMENT BOARD 1885-86. SUPPLEMENT CONTAINING REPORTS AND PAPERS ON CHOLERA SUBMITTED BY THE BOARD'S MEDICAL OFFICER. to &otf) $|oUjserf at |3arltanmtt 6y Commantr of $cv iHajcrftg LONDON: PEIKTED BY EYRE AND SPOTTISWOODE. To be purchased, either directly or through any Bookseller, from any of the following Agents, viz. : Messrs. Hansard and Son, 13, Great Queen Street, W.C., and 32, Abingdon Street, Westminster ; Messrs. Eyre and Spottiswoode, East Harding Street, Fleet Street, and Sale Office, House of Lords ; Messrs. Adam and Charles Black, of Edinburgh ; Messrs. Alexander Thorn & Co., Limited, or Messrs. Hodges, Figgis, & Co., of Dublin. 1886. [0.— 4873.] Price 2s. LIBRARY OF THE PRUDENTIAL INS. CO. OF AMERICA NEWARK, N. J. STATISTICIAN'S DEPARTMENT Section .MEDIC A Subject.. Date%ecd.- Acknoivledged _ Indexed PUBLIC HEALTH. REPORT AND PAPERS ON CHOLERA. SUBMITTED BY THE MEDICAL OFFICER ov THE LOCAL GOVERNMENT BOARD 1886. CONTENTS. MEDICAL OFFICER'S REPORT Asiatic Cholera in Europe : International Conference --.-_. English Ports and other Districts: Their Security against Cholera - Recent Researches into the Pathology of Cholera APPENDIX. No. 1. — Summary Account by Dr. Thorne Thorne of the Prevalence of Cholera in Europe during 1884 and 1885 - 1 No. 2. — Report by Dr. Thorne Thorne on the Proceedings of the International Sanitary Conference held at Rome, 1885 - 25 No. 3. — Conclusions of the International Sanitary Conference of Constantinople, 1866 ; of the International Sanitary Conference of Vienna, 1874; and of the Technical Commission of the International Sanitary Conference of Rome, 1885 .>, No. 4.—Board's General Cholera Order of July 12th, 1883 102 No. 5. — Specimen of Board's Orders relating to Ragimportation - 106 No. 6. — Precautions against the Infection of Cholera No. 7. General Report by Dr. Ballard upon the Results of the Sanitary Survey made in anticipation of Cholera, 1885-86 - 110 No. 8. — Report by Dr. Blaxall on the Sanitary Survey of Port and principal Riparian Sanitary Districts, 1885-86 - 129 No. 8 (a). — Summary Table of Port and Riparian Districts inspected during 1885, with certain specified particulars of Shipping Trade and Sanitary Administration • 150 6 Page No. — Abstracts of Inspectors' Reports on the Sanitary Survey : (a.) On Port and Riparian Sanitary Districts - (b.) On various Metropolitan, Urban, and 158 Rural Districts 201 No 10. — Paper on the Relation of Bacteria to Asiatic Cholera, being a communication by Dr. E. Klein, F.R.S., to the Royal Society (February 5, 1885) ; reprinted from the Proceedings of the Royal Society, Vol. xxxiii. With a Supplement by Dr. Klein, April 1886 - 354 REPORT. TO THE RIGHT HONOURABLE THE PRESIDENT OF Medical THE LOCAL GOVERNMENT BOARD. Report. SIR, I have the honour to submit to you in the present Report an account of the observations of your Medical Department upon the subject of Asiatic Cholera during the year ended March 31st, 1886. They have had concern, first, with the epidemic on cholera ir prevalence of the disease in Europe, and with questions O f 1884r( '" measures for preventing its extension that in 1885 came under the consideration of the International Sanitary Conference at Rome; secondly, with the sanitary administration of ports and other districts of England inspected by the Department on account of their being regarded as the places where the appearance of cholera was most to be apprehended ; and, thirdly, with recent researches that have been made by French and German Sanitary Commissioners, as well as by inquirers acting for our own Government, into the pathology of cholera, as regards its intimate nature and its methods of communication. Cholera in Europe: International Conference. The cholera which in June 1884 began its epidemic invasion of Europe by outbreaks in the Mediterranean ports of France, attacking Italy a few weeks later, extended during that year, as I have previously reported, somewhat widely ; but by the end of December, the disease (at all events as an epidemic) had come to an end in both of these countries. Invasion ot Europe. At the beginning of 1885 all that was known to remain of cholera in Europe was a scattered prevalence of the disease in Spain. In that country, after a period of quiescence during the winter months, cholera re-appeared in certain Mediterranean provinces ; it speedily attained extensive dimensions, and maintained itself during the latter half of the year over a large portion of the peninsula. At the time when the epidemic may be said to have ceased, in the early months of the present year, cholera had invaded at least forty of the provinces into which Spain is divided, and it had caused 120,000 deaths. During 1885. in Spain, Franco- In the autumn of 1885, France and Italy again suffered from epidemic cholera. In France, it was most fatal to Toulon and Marseilles, but at the end of the year had begun to prevail in that north-west angle of France known as the department of Finistere. During last winter some hundreds of deaths were ascribe-.! to cholera in Brest and other pnces of the 8 nd Italy Cases m England. Rome Sanitary Conference. Attitude of England : department, and in this district, within easy reach of our own shores, is not certainly extinct at the date of this report. Medical Officers] Report. In like manner Italy, after her lengthened experience of cholera in 1884 and after the apparent cessation of the disease by the end of that year, began again to suffer from cholera in August 1885. Palermo was soon the seat of a serious epidemic, and during the next few months a number of Italian provinces were invaded. Probably, more or less cholera has continued through the past winter, for at the present date deaths from the disease are occurring at Brindisi, and a further extension of it in provinces on the Adriatic is threatened. On one or two occasions during the year cases believed to have been choleraic in nature were Avitnessed in England in the persons of sailors from the Mediterranean, but the disease did not spread to any person. Briefly stated, such has been the European experience of cholera, so far as we have learned of it, during the year ended March 31st, 1886. In the first of the papers appended to this report (A pp. No. 1) Dr. Thorn e narrates the course and prevalence of the disease, among such communities as have afforded the needful information, since its earliest declared invasion of Europe ; but his history does not profess to be complete. He can say little about cholera beyond Europe ; and necessarily has little to record concerning the method of transit of the disease. He gives, however, some instructive and significant illustrations of the relation between filth and our present cholera epidemic. He further shows that each country which has been invaded received the disease by its littoral provinces;* and he tells how countries which profess to take strict quarantine precautions have suffered some very severely and others (it Avould seem) not at all, the latter resembling in this respect our own country, which imposes no quarantine whatever against cholera upon any of the multitude of vessels which reach its shores from infected countries. In the spring of 1885, in view of the experience of Egypt in 1883 and of Mediterranean countries in 1884, Italy invited a number of Governments in various parts of the world to a conference on International Public Health. The Italian Government represented its dissatisfaction with the outcome of former conferences on the same subject, and desired to settle the basis of an international agreement, as to the measures for preventing the spread of epidemics from one country to another, such as might be acceptable to all Governments taking part in the conference. England consented to take part in this conference. It was opened at Rome on May 20th : — Our own country was represented by Her Majesty's Ambassador to Italy, with Sir Guyer Hunter and with Dr. Thorne of this department. The views of England concerning cholera in Europe, obtained from her own experience and strengthened by what she can learn * The first appearance of cholera in Italy in 1884 seems to have been nearly simultaneous at Genoa and among refugees from France quarantined near the mountain frontier. 9 of other countries, are that for European communities which have secured their soil, water, and air against befoulment, there is little or no danger of cholera, no matter though the disease be actually brought into their midst ; whereas communities which have not obtained this result have to encounter an unknown and serious leasure of risk from cholera, when it chances to be introduced nong them. English medicine holds that cholera in Europe has at tnes a power of spreading from the sick, to the healthy, exerting this power in the presence of filthy local circumstances and most effectively where sources of drinking water have got contaminated by discharges from cholera patients. England puts her trust in measures that shall secure purity of earth, of water, and of air ; and regards this purity as sufficient to prevent the spread of cholera in a European community. And as the measure that shall protect herself and other countries from such danger as attaches to intercourse with already infected places and communities, England relies and exhorts other countries to rely upon this same purity of local surroundings as the means for rendering that intercourse inoperative for harm. Medical Officer's Report. her views on cholera extension Accordingly, England imposes no restriction upon intercourse between one and another community — town and town, or nation and nation. She is content with providing for the care of persons actually sick, and with obtaining the destruction of whatever may be harmful in the discharges from cholera cases : and for the rest, she is satisfied that each community, at all events under European conditions, can, if it pleases, render cholera harmless for itself; doing so by the adoption of practices which are profitable against other diseases as well as against cholera. She would dispense, in land and sea traffic alike, with those detentions known as quarantines, having found them in practice to result rather in hazardous concealments and evasions than in any effectual exclusion of cholera. and on quaraiv tine. Therefore, upon receiving the invitation of the Italian Government, England was not particularly anxious to share in the deliberations of the new conference. But it was eventually decided that England should be represented there, for the conference promised a useful occasion for explaining the practice of England as regards cholera, and her experience on various questions of public hygiene. One of the first proceedings of the Rome Sanitary Conference was to delegate to a " Technical Commission " composed of its medical members and others, the consideration of the measures proper to be taken against the propagation of cholera by sea, especially between Asia and Europe ; and herein a variety of questions concerning the Mecca pilgrimage and the sanitary administration of the Suez Canal came under review. Some related questions of precautions in river and land traffic, and of means of disinfection also arose for consideration. Dr. Thorne tells us that this Commission commenced its business by excluding " all questions involving scientific and theoretical considerations " and especially such as related to the etiology of the disease." Proceedings of Conference. x Medical Officer's Repokt. Reception of English proposals, Results Prospective Debating under what I cannot but deem the most serious disadvantage of no declared accord upon principles of sanitary action against cholera, the Commission nevertheless succeeded in affirming a number of propositions for submission to the full Conference. These commanded but a varying acquiescence from the representatives of England; and as respects the more immediate proposals of the English delegates the Technical Commission declined to accede to the view that the Suez Canal might properly for sanitary purposes be regarded as an arm of the sea, and be traversable by English vessels without detention ; nor would the Commission affirm the English judgment as to the uselessness of detaining (or attempting to detain) in isolation at ports of arrival, healthy persons who had travelled from countries infected with cholera. Indeed the majority of members would seem to have held the opinion that such detention of healthy persons was indispensable ; they were disposed, however, to think the name " quarantine " might profitably be disused. The report of this Technical Commission was laid before the Rome Sanitary Conference ; but only to have its consideration postponed, until communication had been had with the several Governments : and it would seem that at the date in November appointed for reassembling of the Conference, the opinions of Governments had been found too diverse to allow of any hope of agreement upon the questions that had been in debate by the Technical Commission. For the Conference did not meet again. The English Government may expect that some useful result will have been gained by this Conference, though its labours have thus far been inconclusive.* For in preparation for the reassembling of the Conference the Italian Foreign Office issued a memorandum dealing more particularly with the matter which they regarded as of principal urgency arising out of the Home Conference ; and it was here pointed out that an international understanding on the sanitary regime of the Red Sea and the Suez Canal had become imperative : that the existing professions of control over isolation and disinfection were utterly vain for any sanitary purpose : and the memorandum went on to point out the reforms of practice in the Red Sea and the Canal which the Italian Government regarded as essential, and contended that the adoption of these reforms would allow of such free use being made of the Canal as a highway as England had contended for at the Conference; permitting the abolition of existing restrictions upon the movements of vessels, not only in the case of English shipping, but in the case of the vessels of all nations. Dr. Thome's account of the Proceedings of the Rome Conference, with a tabular comparison of the conclusions arrived at by its Technical Commission, with those of the Conferences of Constantinople (1866) and Vienna (1874), form the second and third of the appended papers. ( App. 2 and 3.) * Of this conference Dr. Thome can say that "on no occasion has the value of the adoption of sanitary measures, as the principal safeguard agsiinst cholera, been more prominently recognized," than by 11 Medical Officer's Report. fNGLisn Ports and other Districts. Their Security against Cholera. |[n my Report for 1884 I recorded the precautionary measures ich had been taken under the direction of your Board against introduction and spread of cholera in England ; that they had isisted (a) in maintaining the Board's Orders of 1883, imposing tain duties upon Masters of Ships, Customs Officers, and litary Authorities respectively, in regard of cholera-infected sels : (&) in prohibiting, during the time of cholera infection of tain countries, the importation of rags from those countries : I (c) in instructing local authorities and their officers as to conditions requisite for local security against cholera. All se precautionary measures have been maintained throughout the r which has now expired. In appendix to this Report I have ced copies of papers relating to these several subject matters >p. 4, 5, and 6). Cholera survey |[n 1884, a rapid medical survey of the chief English ports was, ier the Board's instructions, undertaken with a view of ascerling their state of preparedness to resist the introduction or cad of cholera. A fresh sanitary survey of the English coast i been made in 1885 on a larger scale, and in a more systematic nner ; and has been extended beyond ports and riparian districts a number of other sanitary areas of England and Wales. It i engaged your Medical Department through the year, and is progress at the present time.* Of 1885 Inquiry by the Board's inspectors into each of the 1662 sanitary areas of England has not been contemplated in the survey. Its design was to comprise those which were to be regarded as incurring chief risk of cholera being introduced into them or spreading within them. These were, first the ports and other littoral districts of the country that had chief opportunity of intercourse with infected countries, and therefore of acquiring for their own common unwholesome conditions such specifically injurious quality as that intercourse can bestow : secondly, the districts which cholera had in fact visited most severely during the epidemic of 1 866 ; and lastly — since unpreparedness against cholera is more or le3s surely indicated by unpreparedness against other diseases which appear and spread under circumstances of soil, water, or air pollution — a number of districts were selected as more especially requiring inspection for the reason that enteric fever or epidemic diarrhoea was known habitually to prevail in them. its limits, I.n each district that was visited by inspectors of the survey, estigation was made of the general sanitary circumstances of district with reference to cleanliness, sewerage and drainage, and its nature, I With the assistance of some inspectors temporarily attached to the Department, the most part, the actual ¦work of the " cholera survey " has been assigned to ibers of the permanent staff, whose ordinary duties have been performed by the ectors temporarily engaged. 12 Medical Officer's Report. excrement and refuse disposal, water supply, and condition of dwellings ; also as to the general sanitary administration of the district and the performance of duty by sanitary officers ; and, further, inquiry was made as to the provision of means of isolation and disinfection, both as concerns current English infections and in anticipation of the possible advent of cholera. Moreover, in the ports and coast districts of the kingdom, note was taken of various anomalies of their sanitary constitution with a view to amendment of them hereafter ;* and the arrangements made by the several sanitary authorities, for giving effect to the Cholera Order of this Board (July 12th, 1883), were examined. The inspectors were charged to take counsel, in every instance, with the sanitary authority and its executive officers about matters that were capable of amendment, to place their experience derived from other districts at the disposal of every sanitary administration, and when needful to leave with the authority a written memorandum of the advice which they had given in conference. This system of inspection and advising was uniformly pursued ; and I have reason to believe that it was generally appreciated by local sanitary bodies ; that where sense of responsibility for sanitary duty had been wanting, the inspections conduced in valuable measure towards its development ; and that where local authorities were desirous of performing their sanitary duties towards their own districts and the kingdom generally, they have been greatly aided by the inspectors' visits and have been correspondingly grateful to the Board for the advantage thereby afforded to them. nits of survey Eeports by two of the senior medical inspectors of the Board, Dr. Ballard and Dr. Blaxall, on the general results of the survey and on the coast survey particularly, will be found among the appended papers (Nos. 7 and 8). The reports themselves state in a comprehensive manner the general results of the inspections, and are well worth study not only as they have concern with the prevention of cholera in England, but also for the sake of the evidence they afford respecting the general working of the health administration of the country. The Appendix further contains (App. Nos. 8 (a.) and 9), in abstract, an account of the principal facts reported by each inspector, concerning the sanitary arrangements of the several districts visited. * In the following cases the efficient administration of one or another district, for the purpose of cholera prevention, was interfered with, sometimes seriously, through want of adaptation of the areas of riparian districts to the requirements of the Board's Order of 1883. The remedy that seems most commonly applicable is the formation of several districts into an amalgamated port sanitary district : — (1.) Chester and Holt/well. (2.) Dover and Deal. (3.) Exeter and Exmouth. (4.) Harwich and Ipswich. (5.) Preston and Lytham. (6.) Runcorn and Liverpool. Here Port Sanitary Districts are in question. Then, as regards Riparian Districts : (1.) Bangor and Beaumaris, (2.) Barnstaple, Bideford, and Northam, (3.) Carmarthen Urban and Carmarthen Rural Districts, (4.) Several Riparian Districts on Chichester Creek, (5.) Littlehampton, (6.) Sandwich, and (7.) Salcombe ; with the districts adjacent to each, appear to be in want of some better organization. Already, since the survey began, the Riparian Districts of Goole, Harrington, Littlehampton, Padstow, Fowey, and Blyth have come under the Board's consideration with a view to the rectification of complicated or anomalous arrangements. 13 Medical Officer's Report. lOf course this survey was designed rather to discover faults an to observe excellences; and accordingly a great many defects the local health arrangements of the kingdom are recorded, le sanitary arrangements of port and riparian districts, upon lich our security against the spread of cholera must very greatly pend, have been found in places excellent, in other places iously defective. Probably your Board will learn from the ;al of the inspectors' reports that the duty of caring for the blic health is becoming increasingly apprehended by English immunities, and you may be satisfied that the recent survey will ye conduced to a more general fulfilment of sanitary duty by i representatives of those communities. Recent Researches into the Pathology of Cholera. Irhe interest of England in Asiatic cholera during the year 35 has not been restricted to observation of the progress of demies on the Continent of Europe, nor to watchfulness for the nediate security of her own shores. The appointment in 1883 the French and German Governments of Scientific Commisns for the investigation of cholera in Egypt had given hope of etter understanding of the intimate nature of the disease ; and subsequent labours of the German Commissioners in India 'c been of the greatest interest to students of cholera in this intry. They have afforded occasion for review of our current ions as to cholera pathology, and for corresponding expectation t we might have attained to such knowledge of the disease svould aid our endeavours for its control. Cholera pathology Ilhe observations of Dr. Koch* and his fellow-workers in India 1883 and 1884 went to class cholera with certain diseases of active nature that have been shown to be essentially related to life of so-called microphytes present in the diseased body, these diseases, splenic fever, tuberculosis, and swine fever are most notable examples; and in them the relation to the ompanying microphyte is such that, after the microphyte has m grown through many successive generations (that is, during ; disease operations of the animal, or also, as in the three tances mentioned, outside the animal body' in organic soluis), it is able on its introduction into a healthy animal body engender the related disease in that animal. In such diseases these the microphyte is found in the very blood and tissues of animal, and this closest imaginable intimacy with the foreign anism has appeared to be necessary to the production of the disease. Dr. Koch's researches. Admittedly no microphytic organism was discovered by Koch (nor has any such been discovered by anyone else) in the blood or * See Dr. Robert Koch, in a report to a distinguished Medical Conference at Berlin, July 2Gth, 1884 ; Berl. Klin. Wochenschr. 1884, No. 31. 14 Medical Officer's REPORT. t Koch's arches. "Comma bacilli." tissues of cholera patients. But, as we know little about the manner in which such microphytes operate to injure the body in which they are found, it could not be altogether taken for granted that their absence from the blood and tissues was a refutation of their existence as a potential cause of disease. For all we knew to the contrary, was the reasoning of Koch, organisms concerned in the production of cholera would rather be discoverable in the seat of principal disturbance, namely, within the alimentary canal ; and he laid himself out to seek in that situation for a microphyte that might be peculiar to cholera: content to postpone a demonstration of the means by which such microphyte, if it existed, produced its associated disease. The position thus taken up by the German observer was a bold one ; and it presented undeniable fascinations. To discover the actual material of cholera in such a situation that it must be voided during the customary operations of the diseased body, to the danger of water and of soil that received contamination by it, would be in triumphant accord with the views prevailing among European etiologists respecting the spread of cholera among communities. In the event, Dr. Koch announced his discovery in the stools of typical cases of cholera, and in the diseased intestine, of a peculiar curved bacillus, " comma-bacillus," which he regarded as characteristic of the disease, and as having essential causative relations with it.* Moreover, during Dr. Koch's study of cholera in India, he found in the tank water of a cholera neighbourhood, numerous bacilli identical with those which he had come to consider as essentially concerned in the production of the disease.t Assuredly therefore, if Dr. Koch's observations should bear the test of critical examination, we had come to be on the verge of a better knowledge of the nature of cholera ; a knowledge that must needs be of avail to our endeavours for preventing the disease. * The organisms which Koch termed " comma-bacilli " were not found by him (in his earlier observations) in any disease except cholera. The fresher the stool, the more abundant did he find the bacilli in it. The more rapid the progress of a fatal case, the more crowded with comma-bacilli did he find the lining membrane of the intestine to be after death. He could cultivate them outside the body on appropriate media of various kinds. He found them to be killed by drying, and their growth and multiplication to be hindered by a number of agents of the kind commonly regarded as disinfectant. Koch is ready with an explanation of how these comma-bacilli, though absent from the blood and tissues, may operate to produce the disease which we know as cholera. They may be believed to do this by means of a chemical material or ferment which they produce during their stay in the intestine, and which being absorbed into the general system shall have the power of producing the specific disease. In this way the intensity of the resulting disease would be proportioned to the quantity of comma-bacilli that are at work, within the cavity of the intestine, for the production of the chemical ferment. t It is true that Dr. Koch did not succeed in causing cholera by the introduction of the tank comma-bacilli into the bodies of animals ; but provisionally he was able to account to himself for this failure, while maintaining his opinion that the tank bacilli were evidences of cholera. Later on, indeed (as will appear in a subsequent page), Dr. Koch and others did produce some injurious effects upon animals by inoculation of them with comma-bacilli ; but it must be doubtful whether these effects had any relation to cholera, and whether they were not rather of a septiccemic nature 15 Dr. Koch's views as to the nature of cholera and the means of its dissemination necessarily had chief concern for India. In the interests of that country the further study of the questions that had arisen became necessary, and this was entrusted by the Secretary of State for India to Dr. Klein, who possessed exceptional qualificains (in large degree through the experience he had gained ring his researches for this Board into the nature of infective )cesses) to conduct the required examination of the notable (alts announced by Dr. Koch. Dr. Gibbes was associated by 3 India Office in the inquiry, and Mr. Lingard rendered valuable istance to it. I Dr. Klein and his coadjutors working on the subject in India d no difficulty in ascertaining that the organisms described by )ch are almost invariably present in cholera* ; but, nevertheless, 3y were unable to assent to the opinion that the bacilli in estion had a claim to be considered essential to the diseaset ; lI on the whole, Dr. Klein is disposed to regard these and ier organisms identified by him in the intestinal contents of olera as being merely incidental to the putrefaction of those I With regard to the discovery of comma-bacilli in the water of ank in a cholera neighbourhood, the fact is made light of by •s. Klein and Gibbes. " There is in India," they say, " not a tank, not a pool, not a well, in village or town, to which, on the one hand, choleraic evacuations have not access, and from which on the other, the natives do not use the water for drinking purposes, and nevertheless, except in years of epidemics, isolated cases only are heard of around these tanks and wells. One might," so they say, " reasonably a«k, if the cholera evacuations contained the virus, why does not one case of cholera at once produce a wholesale outbreak?" A body of distinguished medical experts, invited by the Secretary i That is, in the rice water stools of cholera and in the intestines when examined er the ordinary circumstances of post-mortem examinations. Indeed, they estabed Avith equal uniformity the presence of another sort of bacillus (straight, smaller, not mobile) along with comma-bacilli in the mucus flakes of the cholera intestine, tally with Dr. Koch they were unable to discover any form of bacterial life in the >d or tissues of the cholera patient. Nor had they any difficulty in growing " comma-bacilli " (which should, more properly, Dr. Klein says, be spoken of ibrios) upon artificial media outside the body. I To set aside the circumstance that organisms resembling the comma-bacilli of ;h were soon detected in various situations having no relation to cholera {e.g., Dr. Lewis, in the fluids of the mouth of healthy persons), the pathological con¦ration which had most weight with our English observers in refusing their assent to views of Dr. Koch is as follows : — While it is true, they say, that under the mary conditions of post-mortem examination comma-bacilli are almost invariably ad, both in the mucus flakes of the small intestine and penefrating the mucous nbrane itself, it results from their own observations that if the post-mortem mination be made at a very short interval after death, these organisms are but y sparingly present even in the mucus flakes ; and in typical cases may be gether absent from any part of the intestinal mucous membrane — not a trace of n being discoverable even in the loosened superficial layer. The theory of Dr. ;h that these intestinal bacilli are able to cause cholera through their production of a chemical ferment capable of absorption into the general system, must therefore, the English observers contend, be abandoned. MEIHCAL Officer's Repokt. Further study by English observers their judgment on Dr. Koch's results. 16 Medicai Officer' Report. Present position of question. Recent observa tions by Dr. Klein, of State for India to consider the report of Drs. Klein and Gibbes; have expressed their judgment that the evidence hitherto adduced does not warrant the contention that any of the bacterial organisms known to be associated with cholera bear a causative relation to the disease. And indeed it would seem clear that Dr. Koch arrived too hastily at 'his affirmative conclusions. We are then, to-day, in the same position as before of ignorance as to what may be the relation of cholera to bacterial life. It is for this very reason, however, that I would venture to give a caution to students of last year's cholera researches; namely, not to allow their dissatisfaction with Koch's claim on behalf of his intestinal " bacilli " to dishearten them in their search after organisms that yet may exist undiscovered in the bodies of cholera patients. There is no warrant for asserting of cholera blood and tissues, any more than of small -pox blood and tissues, that because we have not yet, with our present methods, succeeded in demonstrating the foreign elements which are concerned in the disease, therefore such elements, even bacterial in their nature, do not exist. In the same way, I should wish to give a caution against a presumption which appears to have gained ground among Koch's opponents, that their objection to his inferences respecting the relation of cholera to comma-bacilli present in tank-water, justifies any defection from the doctrine formulated by Snow in 1849, and now based on abundant experience, that cholera epidemics in Europe may be produced by means of water polluted with cholera evacuations. Those who hold the doctrine that cholera can be so produced, do not need to be told that cholera excrements can contaminate hands of attendants and sources of drinking water without doing harm. But admitting always that this is possible, the fact affords no ground for saying that there are not states of evacuations and conditions of contamination, — conditions of places, of times and seasons, — in which pollution of water by cholera excrements may be the acting cause of cholera outbreaks among communities. Of our better known enteric fever of Europe no one would assert that it habitually spreads to nurses who have to soil their hands with its excrements, or that drinking water befouled by those excrements, needs must, under all circumstances, cause enteric fever among consumers of the water. But of enteric fever, no one I suppose would deny that water polluted by its excrements does, under circumstances that are not completely definable, become the cause of causes of enteric fever outbreaks among populations. An excellent resume, from the pen of Dr. Klein, of his researches in India, with criticism of Dr. Koch's conclusions respecting the relation of bacteria to Asiatic cholera, has recently appeared in the Proceedings of the Royal Society (February 1885), and with Dr. Klein's permission it is reproduced in the Appendix (No. 10) to the present report. It is supplemented by some more recent notes by Dr. Klein, bringing our knowledge of this relation down to the present date, April 1886. Herein he has occasion to comment on some later observations by Dr, Koch, in which that 17 pathologist is fain to admit the presence of " comma-bacilli " in a variety of situations independent of cholera, yet claims for those which are found in cholera some distinctive characters of their own ; and in which he records the fatal results of experiments on animals with sub-cultures of those bacilli which he regards as special to cholera. Dr. Klein disputes the assertion that Koch's bacilli have these specific characters ; and commenting on Dr. Koch's experiments, Dr. Klein certainly shows ground for believing that the experimental processes rather than the material itself were shargeable with the production of the resulting disease and death. Medicvi Officer' Rkport. I have the honour to be, Sir, Your obedient servant, April 1886, GEORGE BUCHANAN. E 20510. b APPENDIX. APPENDIX No. 1. Summary Account of the Prevalence of Cholera in Europe app. No. i. during 1884 and 1885; by Dr. Thorne Tiiorne. On the Preva- lence of Cholent In accordance with instructions, I have prepared the following in Europe durhiK mmary account of the prevalence of cholera in Europe since June by Dr^Thorno 884. The materials at my disposal have been almost exclusively tfnorne. atistical, consisting for the most part of statistics communicated i rough the press, and based partly on official, partly on non-official cords. But I have had opportunity, by means of documents comunicated to the Board by the Foreign Office and the Colonial Office, ' testing some, at any rate, of this information ; and whenever I have 'ound it necessary I have used those documents for the purposes of rrection or amplification. As yet, however, with the exception of a report prepared in the Ministry of the Interior at Rome, of another in the Prefecture de Police in Paris, and of a third by the Sanitary Officer of Gibraltar, no official accounts of the epidemic have been issued the Governments of the countries concerned.* Under these circumstances, I am unable to claim for this report the accuracy which should properly have characterised it ; but it may be regarded as affording some general indication of the extent and severity of the cholera prevalence in Europe since the onset of the disease at Toulon in the summer of 1884 ; and as such it may be of some use, pending the issue, by the several Governments concerned, of authoritative histories of the progress of the disease. I The statistics given deal with the epidemic up to the close of the last lancial year (31st March 1880), but whilst the report has been passing rough the press certain additional information, extending up to the d of May and bearing upon the continuance of the epidemic in Southern Europe, has been inserted. PREVALENCE OF CHOLERA DURING 1884. I. — In France. The first rumour of the existence of cholera in Europe came from Toulon and Toulon on June 23rd, 1884, when it was announced that 14 deaths had Marseilles Marseillesalready taken place, the first two fatal attacks having occurred on June 20th, and three more on the following day. It was also announced in the French Chamber on June 26th that, according to a report by Drs. Brouardel and Proust, who had been instructed to investigate the circumstances of the outbreak, the epidemic had commenced some 12 days before that date. By the 23rd a panic prevailed, and in the " Soir." of that day it was stated that 8,000 of the inhabitants had already left the town. No official reports have as yet appeared satisfactorily accounting for the origin of the outbreak. At first it was surmised that cholera had * See page 17 as to an official report subsequently received on the epidemic of 1885 in Spain. E 2051 C. A. I been imported from Cochin-China by means of the " Sarthe," a French Apr. No. 1. OntlioPreva- transport, recently arrived in the port of Toulon. But this view was lenec of Cholera provisionally set aside by a report from Drs. Brouardel and Proust to lmuuFlMßi? 11 * the effect that though two cases of the disease had occurred on board that by Dr. Thome vesse l at Saigon on' April Ist and 2nd, the patients had been sent ashore ¦Dr. Thome wne. there, that the vessel had subsequently been subjected to certain pro- cesses of disinfection ; and that during the 45 days passage to Toulon no fresh case had occurred on board. Suspicion next attached to other French transports from Tonkin, on which certain cholera occurrences had taken place whilst in Chinese waters, but no definite information has as yet been made public on the subject, and hence the actual source of the initial cases still remains obscure. By the 27th of June 40 fatal attacks had occurred in Toulon, and two deaths were reported from Marseilles. And the question as to the precise nature of the disease was set at rest by the announcement that the medical observers concerned very generally admitted that it was not an affection of a sporadic type, but Asiatic cholera Avith which they had to deal. By the end of June, 65 attacks had taken place at Toulon, and 17 at Marseilles. [The question of the occurrence of cases of cholera at Marseilles in 1883 is referred to in the Report of the Medical Officer for that year. See page ix., footnote.] During the month of July the daily number of deaths in Toulon varied from 5 to 49, the smallest number taking place on the last day of the month, by which time a substantial decrease in the intensity of the epidemic had set in. The total cholera deaths during the month amounted to 650; 715 fatal attacks in all having taken place since the commencement of the epidemic. During the same month, and in the presence of an exceptional period of heat, cholera had been steadily spreading in Marseilles, the daily record of deaths rising to some 70 and 80 during the second week of the month, and falling again to about 20 towards the end of the month, when as many as 1,244 fatal attacks had been registered. But, in the meantime, the epidemic had spread beyond Ei> idem of the the limits of the two cities first affected, and fatal attacks were recorded lisease, during the third week of July as having occurred inland at Aries and Aix in the department of the Bouches-du-Ehone, and also at some twelve other places in the departments of Var, Basses Alpes, Gard, &c, and also in a more south-easterly direction in the department of Aude. Of these secondary prevalences the largest outbreak was at Aries, whore between July 20th and 31st, no less than 79 fatal attacks were registered. During the month of August the epidemic continued to decrease in Toulon and Marseilles, the deaths varying between 8 and 1 per day in the former, and between 24 and 4 in the latter city, and the totals for the month being for Toulon 80, and for Marseilles 390. But during this month a wide diffusion of the epidemic had taken place, the disease having become fatally prevalent in some 80 additional towns and districts other than those affected during July. Many of the places affected suffered only from one, two, and three fatal attacks, but in all some 550 deaths over and above those recorded from Toulon and Marseilles had taken place by the end of the month, at localities both inland and in departments bordering on the Mediterranean coast. Of these deaths, 62 took place at Perpignan, 39 at Carcasonne, 12 in the port town of Cette, and 31 in the neighbouring town of Gigean, all in the three departments intermediate between the Bouches-du-lihone and the Spanish frontier. During Saptember the disease exhibited a rapid diminution both in Toulon and Marseilles, where the monthly record of deaths reached 29 2 3 II 106 respectively. And although fatal attacks were recorded from App. No, l. ne 30 freshly invaded localities, including the more inland departments OnthePreva. Drome and Cantal, yet r,o further diffusion of any magnitude took place. l ell £ c ot Cholera i p.i .i i i i jt> i i ¦.. i • v» • m Europe during also, of the other places already affected it was only m Perpisrnan, I884andl885: lere 70 additional deaths took place, that the disease maintained itself 'ih f^n eihjlll e ihj111 an epidemic form. I The months of October and November saw the end of epidemic cholera the localities hitherto referred to, in so far as any public record is ncerned. At Toulon a final group of some eight deaths was reported the middle of November, whereas at Marseilles the record of cholera aths ceased before the end of October. In all. there had been, accord- X to the returns which were published in the public press, somewhat er 880 fatal attacks in Toulon, and not very far from 2,000 in According to a report on the epidemic of cholera at Marseilles in 1884, Marseilles. by Mons. Guerard, engineer, the total cholera deaths from the commencement of the epidemic on June 27th to the 31st of October were 1,781, the disease having been fatally prevalent in all the 21 arrondissements. The population of the city is given as 360,099, and the cholera deaths during the period named amounted to a rate of 4#944 # 94 per 1,000 per annum; but it is explained that the number of the inhabitants was, at the date in question, abnormally lessened by the usual departures which take place every summer, and by the large exodus of people which the outbreak itself led to. In his description of the sanitary circumstances with which the epidemic was associated, M. G-uerard points out that the most neglected portions of the town in point of cleanliness were those which were most fatally affected, and he especially refers to the old quarters to the north of Port-Vieux and behind the Rue Cannebiere. Referring to the state of Marseilles forty years ago when, in the absence of sewei's, the Port-Vieux became a receptacle for all the liquid impurities of the town ; when local wells were in general use for the water supply; and when closets were but little known, all filth finding its way into the gutters ; the report adds that, with the exception of an abundant water-service, the same description holds good now for the old quarters. I But whilst cholera was steadily diminishing in the south of Trance, Sport ne manifestations of the disease had taken place in the north of lhat Lintry. From the information available it would appear that the first this northern series of outbreaks took place at Yport, a small fishing lage on the coast of Normandy. From an interesting report on the occurrence by Dr. Gibert, of Havre,* it would appear that the department of the Seine Inferieure had been entirely free from cholera until the disease was imported by the arrival there, on September 28th, of two of the crew of the " Louise-Marie," from the port of Cette. This vessel having arrived at Cette from Newfoundland nine of the crew shortly contracted cholera, two of the attacks terminating fatally. After this, several of the crew traversed France by rail, one dying of cholera on the journey. The personal effects of the remainder were at the same time submitted to some process of disinfection by a Sister of Mercy. One of the men, who left for Yport, had suffered from a choleraic attack at Cette, and on the day following his arrival (September 29th) his clothes were, with the aid of his sister-in-law, wrung out in water and hung up in front of certain dwelling-houses. On the 4th of October this sisterin-law was suffering from diarrhoea, and on her return that day from *Le cholera h, Yport, par M. le Doctr. Gibert ; Kevue Scientifique dv's Decembrc 1884. A 2 4 IVpp. No. i. having completed the washing of these clothes at the public " fontaine," theTreva- sne was seized with symptoms typical of the Asiatic disease, and died. :e of Cholera Cholera subsequently extended in the filthy narrow streets and bye-paths, ! an°liBB5 r ; ing in which low dwellings., excavated in the sloping surface and having the Dr. Thome natural soil for a flooring, supplied the place of houses. In all, there were 42 attacks and 18 deaths at Yport, the last case taking place about the middle of November. So also, on the Ist of November, the prevalence of cholera was Nantes. announced from Nantes, and it was stated that 24 fatal attacks had taken place up to that date. No detailed information is available as to the origin of this outbreak, which lingered on until about the 20th November, when 31 further deaths, making a total of 55, had been registered there. Another statement ("Times," 21st November), however, gave the total deaths from October 16th to November 12th as amounting to 93. But by far the most important extension of cholera was that which Paris and suburbs. affected the suburbs and subsequently the city of Paris. According to a report addressed by the Prefecture de Police to the Ministers of the Interior and of Commerce on the cholera epidemic of 1884 in Paris and in the Department of the Seine, the outbreak in Paris and in the suburbs is divided into two periods, namely, one extending from June 24th to October 24th, during which the epidemic character of the disease is stated to have been but imperfectly marked, and a second, beginning November 4th, which formed the commencement of the epidemic properly so called. During the earlier of these two periods the disease first affected the outskirts of the city, 14 communes being more or less involved, nearly all within the arrondissement of Saint-Denis. The extent of this outbreak was as follows : July, 6 cases and 5 deaths ; August, 17 cases and 8 deaths; September, 15 cases and 12 deaths; October, 25 cases and 18 deaths. In all, 63 cases and 43 deaths. The commune most affected was that of Aubervilliers, where one fatal attack occurred in August, six in September, and nine in October. During this same first period 103 attacks and 40 deaths are stated to have taken place in Paris, and 101 of these attacks are shown in a table to have been distributed in point of time as follows : June, 1 case ; July, 46 enses and 19 deaths ; August, 39 cases and 10 deaths ; September, 8 cases and 5 deaths ; October, 7 cases and 6 deaths. During the second of the periods referred to the cholera which, it is stated, had apparently disappeared from the northern suburbs of Paris at the end of October, only recurred to a comparatively trivial extent as an extension of the Paris epidemic. In the arrondissement of Saint- Denis 36 fatal attacks took place during the month of November, and 10 occurred in the arrondissement of Sceaux during the same period. But in the meantime the epidemic " properly so called " commenced in Paris by the occurrence of two fatal attacks on November 4th. The course of this prevalence is shown in the subjoined table. Deaths from Cholera in Paris from November 4th to November 30th, 1884. Date. Number of Deaths. November 4th - 2 „ sth 3 „ 6th - - - - 18 „ 7th - - - - 12 „ Bth - - 29 „ 9th . - - - 65 „ 10th ..... no Date. Number of Deaths. Vpp. No l l)n the Prevalence of Cholera in Europe durin: ISB4 and 1885 ( by Dr. Thorne Thome November 11th 94 „ 12th ... 81 „ 13th 85 „ 14th .... 65 „ 15th .... 67 „ 16th .... 40 „ 17th ... 38 „ 18th .... 48 „ 19th .... 30 „ 20th .... 34 „ 2lst 29 „ 22nd - 14 „ 23rd .... 20 „ 24th 11 „ 25th .... 9 „ 26th .... 7 „ 27th .... 4 „ 28th .... 10 „ 29th .... 5 „ 30th .... 8 Total Deaths - 938 During the month of December 19 more cholera deaths were registered in Paris, 15 taking place between the Ist and the 10th of the month, and the remaining four occurring on four separate days, the last death taking place on the 31st. Two deaths returned as "choleriform diarrhoea" also occurred during the month. So also, in December 37 deaths from either " cholera or choleriform dirrrhoea " took place in the suburbs of the city. |£ach of the twenty arrondissements into which Paris is divided sufh! more or less ; and of the eighty quartiers forming the city only escaped, but twenty-three of them only had from one to three fatal icks. During the month of November 26 cases and 8 deaths ocred in the prisons of Paris, the cases being distributed as follows :—: — i the Depot de la Prefecture de Police, 17 in the Prison de la Sante, 4in that of Sainte-Pelagie. Including the death? entered as due to leriform diarrhoea, the total fatal attacks which occurred in Paris and suburbs during the epidemic numbered 1,125.* KThe same report contains the following statement as to the previous cholera emics in Paris : " Releve dcs deces pendant les precedentes epidemics choleriques a Paris. BLe releve ci-apres dcs deces choleriques constates a Paris en 1832, en 1849, en 1-54, en 1865-66, et en 1873, facilitera la comparaison entre l'epidemie actuelle s precedentes. Cholerique de 1832 I ("Mars (a partir dv 26) - - 90 "| l rc PeriodeJ Avril - 12,733 I deces. Invasion. ] Mai - - - - 812 f 13,5C1 [.Juin (due 1" au 15) - - - 266J (Tin de Juin - - - - 602"] * Periode, I Juillet - - - - 2,573 I . , ni rudescence. | Aout - - - 969 f *' OUI LSeptembre - - - 357 J 2 HI V 4,501 969 Total 1.8,402 5 6 Arr. >'o. 1. Iho Prcvae of Choleni urope during and 1.885 ; me. Amongst the further occurrences of cholera in the North of France 18 deaths were announced as having taken place at Compiegne up to Xovember 20th. EriDKMii; bi; 1849. "Mars ... 130 Avril - C 94 Mai - - 2,426 I" Dont 3,537 pour Fn ville ; J uai ... 5,709 ¦< les dix premiers . deces. I jours - - [ 10,9.50 b Juillet - - - 419 Aoiit - - - 810 Septembre - - 670 Octobre 32 J Pendant la meine periode on a compte : — Dans les hopitaux et hospices civils .... 6,90.j Dans les liopitaux militaires - - - - - ],240 Et aux Invalides ¦ ...... gg Le chiffre total dcs deces est de . - 19,184 Spidemie de 1853-1854. 1853 Novembre (a partir dv 7) - ... 151") Deeembre - - - - - -518 1854 Janvier -------30 Fevrier ------.3 Mars -------92 Avril ------- 429 Mai - - " - - - - 320 I deces., Juin - •• - - - . - 938 7,626 Juillet - - - - - . -1121 Aout -----.. 2^396 Septembro ------ 343 Octobre - - - - - - 500 b Novembre - - - - . -129 Deeembre - - - - . -151 Epidemic de 1865-1866. Dews l re Periode. — Dv 24 aout 1865 au 11 Janvier 1866 - - 5 75Y Dont ,5,724 a domicile, et 2,027 dans les hopitaux. Le maximum journalier s'est produit le 14 octobre, avec 225 deces. 173 jours separent la premiere de la seconde periode. 2e2 e Periode.— Du 3 juillet 1886 au 29 novembre 1866 - . 5 257 Dont 3,458 a domicile, et 1,799 dans les hopitaux. Le maximum journalier se produit le 7 aout, avec 142 deces. Total dcs deces 1865-66 - 11008 Ei'idemie Cholerique de 1873. Deces. Dv 4 Septembre au 30 novembre - _ _ . - s"4 Savoir : Septembre - -„, octobre ---..:;: ™i Novembre -__ ._._ ' [Ilestbon de faire rdmarquer' quo la population de Paris s'elevait, d'anres les divers recensements, en : ' ' c eb 1831 a ' 785,862 habitants. 1846 a 1,053,897 „ Ulli^n :; <»*—*-¦.**»*). 1872 h 1,851,792 habS?] 16 d^ Ombrement de 1881 ' le c^e de la population est de 2,239,928 7 In all, the cholera deaths in France during the epidemic of 1884, as App. No. 1. lorded in the various sources to which I have had access, amounted On the Preva-30me 5,000. jence of Cholera o i. ii t-i i • i it m Europe during: LSut the Jb rencn epidemic was not altogether limited to territory on isstuudisss; continent of Europe. As late as the 3rd of September Her Britannic Km? 110 ™ 5 jesty's Acting Consul General for Algeria made a public statement to , effect that since the outbreak of cholera in the South of Europe not a iSSSe! 17 2jle case had occurred in North Africa, and he explained the quaran- _ v , :#l 3 measures in force with a view of maintaining that immunity; but, lough quarantine, in various degrees of severity, had been imposed arrivals from Mediterranean ports since 28th June, the occurrence of picious cases, four of them fatal, was announced on September 19th, m Oran, near the western extremity of tha coast of Algeria. And, ording to intelligence received from Bona, at the western extremity of the Algerian coastline, six of the passengers by a steamer arriving from France had, by September 29th, died of cholera after being landed. At the beginning of November news was published to the effect that cholera was " still " widely prevalent at Oran, as also at Bona, Algiers itself being stated to have "thus far" escaped. The maintained prevalence of fatal cholera at Oran was from time to time noted in the public press, 30 deaths being recorded for the week ended November 14th, and 14 more deaths being stated to have occurred by the 20th. After this there was a public announcement that .54 cholera deaths had taken place in Algeria during the week ended November 22nd, and with this all public announcements as to the Algerian epidemic ceased. II. — In Italy. When cholera broke out in the South of France, the Italian Govern- ment, having regard to the large number of Italian operatives employed in the localities infected, took special precautions to prevent the extension of the disease into Italy. A transport was sent to Toulon to bring away such persons as might desire to return to their own country, and arrangements were made for their detention in quarantine before being allowed to land at any Italian port. Considerable efforts were also made to quarantine all persons entering Italy by land, with the result that many thousand travellers were detained ill lazarettos at Ventimiglia, San Dalmazzo, Bardonnechia, Saluzzo, Pinerolo, &c. ; and as an additional precaution even mail-bags passing from other countries — such as England — through France on their way to Italy, were required to be enclosed in specially prepared bags coated with a solution of tar. As a result of such vigilance a few cases of cholera were Commencement ... ° i . i i o! tne epidemic. detected and isolated, as tor example, in the lazarettos at Genoa and Saluzzo. Nevertheless, by the 22nd of July information was obtained that the disease was alleged to have broken out in Spezia, and that it had been conveyed there by means of arrivals from Toulon. But according to information received about that date from Her Majesty's Ambassador at Rome, Spezia was still free from cholera, although a fatal case had occurred at Rio Maggiore, some 8 kilometres distant, to which place an Italian workman from Toulon had returned, after having performed the required quarantine. Two other non-fatal attacks had occurred amongst his fellow workmen. There were also at the same date cases of cholera at the lazaretto of Varignano. Three deaths had also occurred amongst the soldiers forming the sanitary cordon round the village of Pancalieri, at the foot of Monte Viso, where some Italian workmen from Toulon had been taken ill. s In the meantime, however, according to an official report* issued from the Ministry of the Interior at Eome, cholera had appeared in the following provinces : Cuneo on June 28th, Livorno July 14th, Porto Maurizio July 17th, Genoa July 19th, and Turin July 20th. App. No. 1. Klic Preva-3 of Cholera uropedurim and 1885 ; •r. Thome :ne. From the 24th of July onwards records of cholera deaths were regularly issued, and by the end of the first week in August those records appeared daily. The first of these regular records announced that 10 cholera deaths had occurred at Ventimiglia by July 24th ; 13 were recorded between July 31st and August 11th at Pancalieri, and up to August 15th 70 fatal attacks in all had occurred in the country, the cases being mainly scattered about north-eastern Italy. From this date a somewhat rapid diffusion of the disease took place, and this especially in the provinces of Turin, Massa, Parma, Bergamo, and Cuneo, and also at Spezia, where 24 deaths Avere first recorded on the 22nd of August and 41 on the 23rd, and at Busca. Cholera had, according to information from Her Majesty's Embassy at Rome and from some other sources, also appeared in two provinces to the south of Rome, namely, Campobasso on the Adriatic, and Cosenza which divides the Tyrrhene Sea from the Gulf of Tarauto. A regiment of infantry had been sent to the former province to isolate infected spots-. The disease shortly afterwards manifested itself at Naples, two deaths having occurred there on August 27th and five more following beforethe end of the month. In all, some 680 fatal attacks had taken place from the commencement of the epidemic to the end of August, and of these 138 had occurred at Spezia, 116 in the province of Cuneo, 88 at Busca, 62 in the province of Bergamo, and 51 in that of Campobasso. Diffusion of the epidemic. Xaplcs. A strenuous effort had been made to confine the disease to Spezia by means both of a military cordon on shore and of a maritime cordon in the bay, supported by gunboats, but it was largely evaded, the panicstricken population fleeing through the surrounding hills. Indeed during the two days which followed the official announcement of the epidemic in Spezia, no less than 6,000 of the inhabitants fled from the place. The month of September exhibited a great increase in the severity of the epidemic, and also a further diffusion of the disease. There was a considerable increase in the number of deaths in the province of Genoa, where the city itself was separately returned as infected on September 24th, and where 117 deaths occurred between that date and the end of the month ; the disease was maintained in the province of Parma ; at Spezia, where the fatal attacks had now reached 520 in number, the deaths had for some time varied from 20 to 38 a day ; considerable extensions of the disease had taken place in the province of Bergamo, where a total of 318 deaths had occurred by the end of the month ; a further heavy mortality had taken place in the province of Cuneo, Massa Carrara, and Parma ; several additional provinces had become infected, notably the province of Caserta, where 64 fatal attacks occurred between September 9th and 30th ; and four deaths were reported from the city of Rome and two from Venice. In the city of Genoa the occurrence of cholera was, according to local coi'respondence, largely associated with the use of polluted water, supplied by the aqueduct of the Nicolay Society, the source of which is near Busalla where cholera had been very prevalent, and in which, it ia stated^ the clothes of cholera patients had been washed. Under any circumstances the municipality ordered the Nicolay Society to discontinue the supply of this water. Cholera failed to spread to any extent in Rome, and in this connexion, it may be noted that, in addition to numerous other sanitary precautions * Jl colera in Italia, negli anni 1884 c 1885. Relazione del Deputato Giovanni Battista Morana, Segretario Generate del Ministero dell' Interne Roma, 1885. 9 App. N0..l lcuce of Cholera in Europe during-1884 and 1885 ; I opted by the municipality, no less than 144 fresh drinking fountains re opened to replace the wells that had been bricked up, and a comttee was formed to examine the conditions of the different aqueducts, which the excellent water-supply is delivered into the city, in order ensure their being free from risk of contamination. On the Preva by Dr. Thorne Thome. I The disease had by September also extended to the Adriatic provinces Rovigo and Ferrara ; and outbreaks had occurred in some of the •re southern portions of the peninsula, as at Chieti, Salerno, Beneato, and Caserta ; a single death was also reported from the province Palermo* in the island of Sicily. But it was in the city and province of Naples that the disease manifested itself with the greatest severity. Up to September 3rd only nine cholera deaths were stated to have occurred in the city of Naples since August 27th ; but on September 4th no less than 67 deaths were reported to have taken place there, and within little more than a week the daily number of fatal attacks was between 400 and 500. After the end of the second week in the month some diminution took place, the daily number of deaths falling gradually, first to some 160 during the course of the third week. By the end of the month a daily fatality, varying between 50 and 60, had been reached, but over 5,700 cholera deaths had by that time taken place in the city. During the same month some 520 deaths had occurred elsewhere in the province of Naples. The total cholera mortality for the kingdom during the month of September was over 7,800, making in all a fatality exceeding 8,500 since the commencement of the epidemic. With the month of October the extent of the epidemic became a good deal circumscribed. In the city and province of Naples there was, apart from some increase during the second week of the month, a general decline in the mortality, until at last by the end of the month the epidemic had ceased in the city and was practically over in the province. The total fatality for the city of Naples, recorded by the public press, since the commencement of the epidemic, had been over G,500, and close upon 800 deaths had occurred in the remainder of the province. Naples, From an interesting account of the cholera prevalence in Naples which was prepared by Her Majesty's Consul and communicated by the Foreign Office to the Board, it would appear that cholera was imported into Italy by means of Italian workmen and others who, escaping from Marseilles, crossed the Franco-Italian boundary. The means for quarantining the immigrants in and about Yentimiglia were so inadequate that a large number were first taken by sea to Spezia, where a floating quarantine hospital had been established, and thence, after a prescribed detention, they were shipped to different ports of the continent. In this way 65 Sicilian workmen arrived in Naples on August 3rd ? and took up their quarters in the Porto district, one of the districts of the city the sanitary circumstances of which were most defective. These workmen were subsequently removed to a floating lazaretto, but it is explained that this removal came too late, and that two days afterwards the first case of cholera occurred in the city. On August 6th and 18th other similar detachments arrived, the people being sent to their respective homes in the provinces. One man arriving on the 18th put up in the Mercato district ; he sickened with cholera the same night, and died within 48 hours. Another was attacked on the 21st r and on the 23rd one of fifteen men arriving from the lazaretto at Spezia, * As to this, see, however footnote, to the table on p. 12. 10 \rp. No. l. being seized with symptoms of cholera on landing, was removed to .~" hospital. This was the first case officially published. Further cases fence of c r iioi a eya and deaths occurred off and on until on September Ist the disease uro P? fi d fi Ti lls broke out with considerable violence, 60 cases and 20 deaths being notified. The districts of the city which were most affected were the ¦r. Thornc ne.' Mercato and Porto, and the two adjoining ones of Pendino and Vicaria. By September 10th 966 cases and 474 deaths were officially recognised ; but the consular report adds that some 550 deaths in persons whose bodies were found lying about in different parts of the city, and whom it was impossible to identify, were in accordance with the register of burials kept at the cemetery, buried there, in addition to those registered in the official records. By November 9th, when the official bulletin was suspended, the cases had amounted to 12,345 and, including the 550 fatal attacks above referred to, the deaths had reached 7,086. The four districts of the city which have been named and which are notoriously the most unhealthy and filthy, were much more severely affected than the remainder of the city. This is shown in the accompanying table, which is included in the consular report, and which shows the incidence of cases and deaths in the various districts of the city from August 23rd to November 9th :—: — Cases and Deaths in each District of the City of Naples. Population — s c-g 5 « S 3 -a ss = -«-=« — l« Ih a 1 fl< 4 i . >-=5 J-~ a |a gg _§ l.s| m Is -9 Name of District. .2~ i^E °« s3 w ; *| o^S 5 S^ | Iff, »*• till *] || I igi |i ipii n I'll ii i= in i!i San Ferdinando - 36,985 — 36,985 365 141 h Chiaja - - 36,611 12,710 49,827 328 166 Ban Guiseppe - 19,333 — 19,333 388 187 ! Montecalvario - 41,733 — 44,733 49(5 167 i Avvocata - - 39,428 9,586 49,014 438 134 Stella - - 40,693 — 40,693 476 174 L. fln » rds from the Medical Officer's Annual Report for that year, . xxviii. and xxix. : — " On three occasions there was threat of cholera importation into England. Her Majesty's troopship ' Crocodile,' after leaving Bombay on April 3rd, had eight cases of sickness believed to be cholera before reaching Gibraltar, all but one among * This is confirmed in the Report by Consul Wooldridge for 1885, where he says, as regards Barcelona : — " There was an outbreak of cholera in both 1884 and 1885." — See Reports of Her Majesty's Consuls, Part 111. Commercial, No. 6, 1886. 14 I. pp. No. l. « persons who had come from one and the same locality in India. Two he~p7eva, " convalescent cases from this ship were taken into the Garrison bof Cholera « Hospital at Portsoa. Then, in July the steamship ' Carthagena ' "muss""; 1 "" « arrived in Cardiff Roads from Marseilles, having had two men ill •r. Thome « o f < c i 10 leraic diarrhoea' during her passage; and afterwards in ¦IIC. T ? ? . rj.T._ i A X. .";„:„'! lr,v.rWl +-nrn man " August an Italian mail steamer [the 'Abysinia'] landed two men " ill of cholera at the Flatholm Hospital of the Cardiff Fort Sanitary " Authority, and one of them died. In no instance was there any 41 subsequent case of cholera on shore." PREVALENCE OF CHOLERA DURING 1885. I. — In Spain. Towards the end of the second week of April 1885 rumours reached this country to the effect that a dangerous epidemic of some sort had existed for a month or more at Xativa in the province of Valencia and that a medical commission had been sent by the Spanish Government to inquire into it. So also, about this date the existence of a few suspicious cases within a limited area in the south-west portion of the same province was officially notified. Portugal and Francs forthwith declared Spain to be infected and quarantine measures were imposed. But it was not until the beginning of June that cholera was publicly announced to be prevailing in Spain. Two cases resembling cholera were reported to have occurred in the province of Castellon on June sth ; on the 6th four eases and two deaths were recorded in the province of Valencia ; on the Bth eight cases and four deaths of a disease stated to resemble cholera occurred in the city of Madrid ; and 32 and 28 attacks respectively were reported from the province and city of Murcia on the 9th. Thus, the three coast provinces neighbouring to that of Alicante which suffered from the epidemic in 1881 had become seats of the disease, and the suspicion that the capital was also affected turned out to be presently well founded. ¦mencement elBBs epidemic. .During the month of June the disease spread in each of the provinces and cities referred to, the spread being on a wide scale in all except the city of Madrid. In the province ot Castellon ihe daily number of attacks and deaths had risen to over 100 and to about 50 respectively by the 17th of June, and by the end of the month the recorded attacks amounted to 1,656 and the deaths to 835 ; in the province of Valencia the cases and deaths rose steadily until a total of 6,446 attacks and 2,655 deaths had been reported by the end of the month ; in the province of Murcia 1,152 deaths occurred during the same period ; and in the city of Madrid 48 deaths were recorded. So also, in the meantime, the area of diffusion had considerably widened, the following cities and provinces being attacked in turn: — the cities of Cienpozuelos, Cartagena, Saragossa, Aranjuez, Cuenca, and Toledo, and the provinces of Huesca, Saragossa, Cuenca, Alicante, Toledo, and Teruel. Indeed by the end of June a total of 13,493 attacks and 5,101 deaths from cholera had been reported; the disease having, further, extended into the heart and to the northern portion of the kingdom. Extensive: diffusion o the disease During the month of July the epidemic increased both in severity and in the area of its diffusion. The disease was maintained in all the provinces and cities already attacked, the provinces of Castellon, Valencia, Murcia, Saragossa, Alicante, and Teruel, and the cities of Valencia. Saragossa, Cuenca, and Aranjuez being the principal sufferers. Thus, the record of deaths for the month was : — Provinces of Castellon 1,639, Valencia G,244, Murcia 1,902, Saragossa 2,593, Alicante 2,109 r Teruel 817, and cities of Valencia 2,006, Saragossa 623, Cuenca 273, and 15 Aranjuez 691. The disease also extended to the provinces of Tarragona, Albacete, Jean. Badajos, Segovia, Granada, Cordova, Malaga, Cadiz, Zamora, and Soria. In short, the epidemic was prevalent in nearly every portion of the kingdom except the extreme north-east and north-west, Id by the 31st of the month a total of 54,626 attacks and of 23,001 aths had been recorded for July. These, together with those occurring June, amounted to a total of 68,119 cases and 28,102 deaths. App. No. 1. On the Prevaleuce of Cholera in Europe during 1884 ana 1885; by Dr. Thorne Thorne. I Excepting only the cities of Cienpozuelos and Aranjuez, where the «ease ceased before the end of July, and those of Murcia and Toledo, iere an abatement soon after followed, the cholera was maintained ring August in nearly all the localities previously infected : and not ly so, but in some of the provinces and cities first invaded during 3 month of July the disease extended with very great severity. I The August record of cholera deaths included the following amongst 3 provinces: — Castellon 1,865, Valencia 1,853, Madrid 799, Murcia >76, Saragossa. 6,085, Cuen^a 2,0.33, Alicante 1,770, Toledo 1,954, ¦ruel 3,485, Tarragona 821, Albacete 1,503, Jaen 836, Granada $36, Cordova 796, Valladolid 995 ; and the following amongst the ies: — Madrid 684, Cartagena 275, Saragossa 1,003, Granada 3,026, rida 452, Almeria 619, and Teruel 371. The disease had also underlie a further extension, the provinces newly affected being those of ?rona, Navarre, Logrono, Burgos, and Palencia to the north ; Almeria to the extreme south ; Salamanca oa the west ; and Yalladolid and Guadalajara towards the centre of the kingdom. Those most severely affected were the provinces of Navarre with 2,455 deaths and Almeria with 1,031 deaths. There had also been 143 deaths at Adra on the south coast of the province of Almeria since August 18th; and at Motril on the same coast, where cholera is stated to have broken out about the I rd week of July the total cases and deaths at the end of August were S6 and 384 respectively. Ten fatal attacks also occurred during the nth in Gibraltar, and 12 within the Spanish lines. The Gibraltar break will be again referred to. The total record for the month for am included 14T,07l cases and 48,878 deaths. Gibraltar and neighbourhoo The month of September exhibited a decided decrease in the intensity of the epidemic, but the extent and suddenness of the decrease cannot have been anything like as great as would appear from the published statistics. Thus, in about a dozen of the provinces and cities in which considerable mortalities had occurred daily up to the 31st of August — and these localities included some of those which had been most severely affected — the record of further cases and deaths suddenly ceased with the end of that month. And similarly, other provinces followed suit in discontinuing record of cholera mortality within a few days of the commencement of September. The records for this latter month are therefore evidently most imperfect. With this qualification it remains to be noted that : — in the province and city of Madrid 247 and I J2 fresh deaths were recorded in September, before the official records for both districts closed. So also, in the province of Saragossa 491 fresh deaths took place between September Ist and 12th; and in the province and city of Granada 734 and 95 more deaths were recorded, the return of statistics closing on the 14th of the month. The following mortalities were also recorded : — Provinces of Almeria 421, Navarre 403, Valladolid 323, Ciudad Real 106, Barcelona 411 ; and cities of Valladolid 76, Barcelona 487, Almeria 354, Cadiz 281, Santander 1 25, and Adra 67. Some further deaths occurred in Gibraltar, and the disease was maintained at Linea within the Spanish lines. The total numbers of cases and deaths recorded in Spain during September were 17,884 and 6,157 respectively, but the record is very imperfect, and this especially as to the 16 non-fatal attacks concerning which no official returns were in certain instances made, although the return of deaths continued to be maintained. App. No. 1. lof Cholera All regular records of cholera deaths ceased with the month of September, and those which followed were but few in number and at somewhat long intervals. Thus, on the 9th October it was announced that 28 more deaths had occurred in the province of Albacete, and at different dates between the lat and the 24th of the month 77 additional deaths were reported as having taken place in the province of Malaga ; and again, 159 further deaths were returned from the city of Barcelona.* The disease also caused 10 additional deaths at Santander, 4 in the district of Linares, 4in Gibraltar, and 38 at Linea. In all, a further mortality of 316 cholera deaths was returned for the month of October, but no approximate estimate even of cases was made known. At the end of October some 20 to 30 cases were also reported in districts around the town of Bilbao, in the extreme north of the kingdom, on the left margin of the river of the same name ; and, the disease increasing there in November, an effort, which was frustrated by the attitude of the population, was made to place a military cordon round the infected localities. In the early stage of this outbreak the deaths were stated to number from three to six daily. After the middle of November no further news was received as to this prevalence. The last information for 1885 was from Marbella on the coast line of the province of Malaga, and about midway between that place and Gibraltar. Between December 13th and 25th 43 cholera deaths are stated to have occurred there. With this record cholera, in its epidemic form, seemingly came to an end in the peninsula. The total record of deaths as gathered from the public press and certain official documents since the commencement of the epidemic amounted to 83,453 ; the number of cases, {so far as these were reported, being 227,074. According to a summary account of the 1885 epidemic in Spain which appeared in a supplement to a report of the " Berlin Imperial Health Bureau" of March 16th, 1886, the epidemic was most widely diffused in the province of Saragossa where, in about four months, 9* 1 per cent, of the population became attacked by cholera, with a mean mortality of 33 per cent, of the cases of illness. It apparently was most virulent in the province of Jaen (in the north-east of Andalusia) Avhere, according to reports, more than one half (52 per cent.) of those attacked succumbed ; next came the mortality in the province of Valencia 47 ' 7 per cent., and Santander 46 per cent. On an average, it is stated that there died in Spain 8 persons out of every 22 attacked by cholera, or, more precisely, of every 100 reported cases of cholera 37 died. Summary for Spain The account referred to continues as follows : — "Among the large Spanish towns attacked, Aranjuez was by far the most severely stricken. Within only one month 19*8 per cent, of the nominal population suffered, and 10-1 per cent, died of cholera, rates which in fact, may be doubled if regard be had to the actually remaining population, for, according to trustworthy reports, at the beginning of the epidemic so many inhabitants left the town, that the authorities estimated the remaining population at only 4,500 (given population 8,155). " A similarly high percentage of mortality from cholera (over 50 per cent.) as in Aranjuez prevailed, according to official statements, in Villareal, Barcelona, and Madrid, and comparison of the numbers of * According to the official report by Consul Wooldridge, the total cholera mortality for the town of Barcelona in 1885 was 1,318. 17 cases of sickness and of deaths arouses the suspicion that, especially in App. Jfo. l. the large towns, eg., in Valencia, the actual number of sufferers has On the Prevalippn pve>n lirirpr lence of Cholera Oeen even largei. in Europe during "This conjecture is confirmed in the case of Madrid by a supple- iss* and 1885; mentary report of the Alcalde Presidente, Seiior Booch (Meraoria do Thorne. ° me las Medidas adoptadas para contener la invasion del Colera en 1885), in which the following numbers for the city are given: — 111. Died. Recovered. Male. Female. Male. Female. Male. Female. Reiidsa ts - - 655 933 399 582 256 351 Visitor 48 12 ;32 7 16 5 Sj»picio us cases - 210 349 14(5 200 64 149 Total - - 913 1,294 577 789 336 505 I" So that on the whole there sickened in Madrid 2,207, of whom 1,366 sd, or a mortality of 61 # 89 per cent. The perceptibly higher particition in sickness of the female sex is noteworthy. The so-called spicious cases, yielding as they do a mortality of 61 "73 per cent., may hesitatingly be set down as true cholera cases. I' 1 A.s regards the date of the commencement of the epidemic in idrid, the same publication gives support to the assumption that prior the earliest official lists in the ' Madrid Gazette,' cholera had already )ved fatal in the city. For within 19 weeks from May 20th to ptember 30th there died in 1885, 1,822 more persons than in the ¦responding period of 1884, and comparison of the numbers yields her the remarkable result that during the prevalence of the cholera ler diseases also exerted a higher mortality than on the year before, one must conclude that the number of cholera deaths was in reality fher than the lists and municipal publication referred to indicate. " I The distribution of cases of illness and of mortality in the several vinces from which reports were sent in, and in 12 large towns, are en at page 151 of the ' Veroffentlichungen ' of the Imperial Health reau, from which it would appear that the total numbers reported [•p • Cases of Illness Deaths. 264,166 08,051 Percentage of population 2 '2 0*8.3 I Whilst this report is passing through the press, an official document, aed by theDireccion General de Bimeficoneia y Sanidad, and containing tatistical account of the Spanish epidemic, of 1885, has corny to hand. om this document I extract the Table over leaf, which shows that, regards both intensity and area of diffusion, the epidemic was of even ;ater severity than was apparent from the sources of information to lich I had previously had access. I The outbreak which occurred in Gibraltar and in the immediate ighbourhood is dealt with at length in the annual report on the Public jalth of Gibraltar for 1885, by Surgeon-Major F. P. Staples, officer health. The outbreak (a) in Gib- raltar; ISo far as Gibraltar itself is concerned, the first case occurred on igust 6th, and the last case officially recorded was on the 1 3th of tober. These dates correspond very closely with those of the comsneement and disappearance of the disease from the town of Linea, t no direct connexion between the two outbreaks is stated to have E 20510. B 18 Arp.No. 1. General Summary for the Provinces. i h"8-2 Dates of the Epidemic Mortality. S'S 1-lJ . Total of : =r^r Proportion W gall % cb : per cent, of Provinces invaded. =g .£ "-'" -' =£ r{|'§ — 3 8 •§ a L,i •S| s ,£ I 1 3 3 . II IJ&fl „• I I 1 S| |§ I S-3 £ood o I 3 ! S -S'S P-| 5 * £ I O PS O J H g~ Ph 5O 558 12 „ - 8 Oct. - 89 1.58 58.74 Barcelona - 68 51.211 6,802 2,915 5 „ - 30 „ - 118 1 0.54 46.26 Bureos - - 35 03,52!) 2,310 786 7 .. - 5 Nov. - 122 1.24 34.03 Cdoeres - - 2 2,178 147 57 11 „ - 11 Sept. - 68 : 2.02 38.77 Cadiz* - - 7 180,681 2,232 984 12 „ - 31 Dec. - 173 0.75 44.09 Castellon - - 80 214,(580 16,768 0,430 5 June - 80 Sept. |- 118 3 38.42 CiudadEeal - 15 92,879 3,727 1,668 3 July - 6 Oct. - !»ti | 1.80 44.75 Cordoba - - 13 138,309 3,787 1.318 18 „ - 21 „ - 96 0.95 34.80 Cucncu - - 123 137,049 10,003 3,459 20 June - 30 „ - 133 2.51 34.58 Gcionn - - 38 73,049 2,194 052 21 July - 22 „ - 94 ! 0.89 29.72 Granada - - 132 304,568 24,736 10,285 1 „ - 9 Nov. - 132 12.82 41.58 Guadalajara - 33 28,496 2,944 777 6 „ - OOct. - 93 2.73 26.39 Guipiizcoa - 18 59,004 304 158 8 August 3 Dec. - 123 0.27 51.97 Huelva - - 11 48,826 402 231 81 „ - 31 „ - 123 0.50 50 Huesca - - 49 63,387 5,702 1,237 3 June - 24 Oct. - 144 1.96 21.40 J.,en - - 35 207,024 5,039 2,599 7 July - 29 ? - 115 1.26 51.58 Leon - - 8 7,981 111 48 7 Sept. - 23 „ - 47 0.60 43.24 Lerida - - 54 83,330 3,441 1,209 2 July - 21 ? - 112 j 1.45 35.13 Losrono - - 33 53.944 5,040 1,220 23 ? - 30 .. - 100 j 2.20 24.18 LuWO - - 4 31,144 10 10 11 „ - 26 Sept. - 1 0.05 100 Madrid - - 44 477.712 8,581 3.559 1 June - 27 Oct. - 140 0.75 11.40 Malaaa* - - 28 141.722 5,037 1,702 20 „ - 4 Nov. - 132 1.20 33.79 MuTOia - - 36 420,229 17,749 7,370 6 ? - 8 Oct. -126 1.70 11.56 Navarra - - 81 161,62(8 12,895 3,161 25 July - 0 Nov. -160 1.96 24.51 Orense - - 2 9,741 94 39 2 Sept. - 14 Oct. - 43 0.40 41.49 Oviedo* - - 6 72,352 04 38 21 August 2 Dec. - 104 0.05 59.88 Palencia - - 38 42,578 3,587 818 14 July - 19 Oct. - 98 1.92 22.80 Pontevedra - l 4,181 16 9 10 August 81 August 22 0.22 50.25 Salamanca* - 40 40,162 1-288 470 13 July - 31 Dec. - 172 1.19 30.90 Santander - 25 97,538 921 458 5 August 20 Nov. - 114 0.47 49.73 BeKOvia - - 68 50,917 2,403 803 28 Jane - 29 Oct. - 124 1.68 33.42 Sevilla - - 8 167,201 247 101 20 July - 17 Dec. - 145 0.06 10.89 Soria - - 57 86,661 3,079 1,019 1 „ - 22 Oct. - 114 2.73 33.09 Tarragona - 61 190,448 8,740 2,530 24 June - 13 ? - 110 1.29 29.02 Terue'l - - 101 171,312 21.909 6,960 27 „ - 25 „ - 121 4. (Hi 31.77 Toledo - - 73 170,857 10,303 3,972 20 „ - 30 „ - 133 2.32 38.53 Valencia - - 219 030,321 45,515 21,012 5 Peb. - 8 „ - 240 3.43 47.48 Valladolid - 101 157,01!) 7,678 2,603 12 July -1 13 ? - 94 1.66 34.35 Vizcaya - - 16 38,626 o;>s 274 1 Oct. -I 80 Nov. - 61 0.81 48.15 Zamora - - 30 49,418 3,587 764 21 July - Hi „ - 119 1.55 21.30 ZaragOZß - - 222 348,301 54,943 12,788 10 June - ] 4,. - 142 3.67 23.29 Totals - 2,247 0,575,641 888,685 119,020 5 Feb. - 31 Dec. - 330 1.82 35.32 Population re- 7,007 10,396,889 maining exempt. * The epidemic absolutely terminated in the province of Cadiz on March 20th; in that of Malaga on January 19th ; in that of Oviedo on January 30th ; and in that of Salamanca on January 17th. No subsequent case has been reported in the whole peninsula up to date. Madrid, 4th May 1886. El Jefe del Negociado, Julio Jimk.vez, Lopez, El Jefe dc la Seccion, El Director General, Manuel de la Paliza. Juliax de Zugasti. On the Prevalence of Cholera in Europe during 1884 and 1885 : by Dr. Thorne Thorne. been discovered. In Gibraltar a second case followed on the Bth, a third and fourth on the 10th and 1 lth respectively, and by the end of the month 15 cases and 10 deaths had taken place. Twelve more cases and nine deaths occurred at intervals between the Ist and the 24th of September, 19 Id a further occurrence of seven cases and four deaths between October Api Apij_No-1-hand 15th brought the outbreak to a close. In all, 34 cases and OnthePrevadeaths occurred in Gibraltar. &ropedu?B« In referring to the circumstances Avith which the disease was associated, 1884 and i 88 5; rgeon-Major Staples points to the fact that its main incidence was, as Thome. lOrne ring the cholera epidemic of 1865, upon the poor quarters of the town ; 12 centres of the disease being the same in both outbreaks, except in far as districts which have been rebuilt since the former epidemic ;aped during the past year. Summarising the conditions with which 3 disease was mainly associated, Dr. Staples refers especially to purity of air from overcrowding and faulty sanitary circumstances, purity of drinking water, and unwholesome food supplies. I According to a document submitted to the Board by the Colonial Office, (b) in Linea 3 first occurrence of cholera at Linea, just within the Spanish lines was lorded on August 14th, when four cases had already occurred and when } first death took place. Two more deaths took place on August 17th, :1 one on each of the three following days. Between the 20th and ; 26th no fresh cases or deaths were reported, but before the end of s month 18 more attacks and seven additional deaths had taken ice ; the total attacks and deaths for the month being 32 and 12 ipectively. E?he month of September exhibited a considerable increase in the iase. On one day only was there a break in the record of cases and ths, and the numbers of cases and deaths in a single day ihed as high as 36 and 11 respectively. In all there were in itember 295 cases and 44 deaths. After the first week of the month of October the daily number of attacks began to diminish ; the last deaths being registered on the 15th and the last cases on the 17th ; there having been 95 cases and 38 deaths during the month up to the latter date. In all, there were during this cholera prevalence in the town of Linea 443 cases and 194 I Comparison between these two adjoining places shows that, with a Gibraltar and illation of some 24,000 persons, the cholera deaths in Gibraltar Linea - Hinted to 23; whereas in the Spanish town of Linea, with only about :' as large a population, no less than 194 fatal attacks occurred, ing to the impracticability of preventing communication between ea and Gibraltar (and this because, amongst other reasons, of the ?ssity of carrying supplies from the former into the latter place, and ;he fact that some 4,000 persons daily enter Gibraltar from Spain in nexion with such supplies), no measures of land quarantine or other iictions on the movements of the populations were attempted. Continued Cholera Prevalence in Spain in 1886. It is, however, evident that the prevalence of cholera in Spain did not c with the close of ] 885. During the first two weeks of January S information Avas received as to 11 deaths at Algeciras and eight in province of Malaga. And, between January 27th and February 7th, leaths occurred at Tarifa ; the disease being still maintained there to some extent as late as March 3rd of this year, when the last information recorded the fact that four more deaths had come under notice. II. — In France. After the close of the epidemic of 1884 in France, neAVs as to cholera gy^ arseiUeg occurrences in that country practically ceased until, on the 2nd of August 1885, 12 fatal attacks were reported to have recently occurred at b 2 20 Api\No. i. Marseilles. By that date, however, the disease had already acquired OnthePreva- a firm hold on the city, for with the exception of two days only on inEurop^durlng which no intelligence was received as to the course of the epidemic, the daily mortality quickly rose, the largest number of deaths recorded 1884 and 1885 ; by Dr. Thome Thome. being 75 and 69 respectively on the 20th and 21st of the month. In all, 969 fatal attacks took place in Marseilles during August. But by the end of that month a diminution in the severity of the outbreak had already set in, and this being maintained, the last batch of 70 additional deaths* recorded for September was reported on the 14th of the month. After this no further cases were made known. The total cholera deaths for Marseilles in 1885 reached 1,039.* On the Bth of August one fatal attack was reported from Toulon. ¦(&) in Toulon. This was followed by another on the 18th, and after this date the disease extended rapidly until, by the end of the month, 206 deaths had taken place in that town. After the first few days of September the fatal attacks materially diminished in number, but there were only a few days during the month on which one or more deaths did not take place ; the total cholera fatality for the month amounting to 94. Fourteen more fatal cases followed during the course of the month of October, when the record of deaths ceased. In all, 314 fatal attacks occurred in Toulon. Continued Cholera Prevalence into 1886. Official records of the disease came to an end with the information above given. But from other sources information has been received which, though perhaps not in every detail accurate, goes to show that cholera still prevailed in certain parts of France during the remainder of 1885 and into the beginning of 1886. Thus, 71 deaths from a disease resembling cholera were reported as having occurred in the department of Finistere between October 7th and 31st. Three cholera deaths were reported from the Pyrenees Orientales on November 14th— 15th, and early in November the disease also appeared in the neighbourhood of Quimper. The disease was apparently introduced into Concarneau to the south-cast of Quimper from Toulon by the arrival of seamen on furlough from war-ships or transports recently returned from Tonquin,and it spread to several places such as Andierne, Guiloinec, Douarnenez, Kerhorre; and later on the disease was reported to be fatally prevalent in Brest and in the lie de Sein to the south of Brest. Indeed, between the beginning of November 1885 and the 31st of January 1886, 512 deaths are stated to have occurred in connexion with these outbreaks. How far they were all due to cholera may be open to question, but on the other hand there can be but little doubt that many of them may be regarded in the light of a continuation through the winter months of the epidemic which had made its way into the north-west of France during the previous autumn. Still later communications which have been received go to show that some similar disease (described as cholera but exhibiting an insignificant mortality in proportion to recorded attacks) continued to cause deaths at Douarnenez up to the middle of March 1 886, and that during the first * The subjoined paragraph appears in the " Report by Consul Perceval on the " Trade and Commerce of Marseilles for the year 1885." See Report from Her Majesty's Consuls, Part 111., Commercial No. fi, 1886. [C. — 4G57.] " I am of opinion " that Marseilles has herself to blame very much for the frequency of these epidemics " by neglecting sanitary precautions. When the disease is here in our midst great im" provements are promised ; when it is over nothing is done. The drainage system << iv (itrnnmnc . tl,» moil, rlvnmc n mr,tv,'im (l™,^,,™ !„*„ i 1... J..1. ._! 5? J " is atrocious ; the main drains emptying themselves into the docks where the vessels " lie, and no person who has not had the misfortune to experience it can form an " adequate idea of the effluvia arising from these drains on a warm summer's night." 21 two weeks of Api'il six deaths from such cause had occurred in the App. No. i. fishing village of Treboul, about two miles from Douarnenez. At the Qn the Prevabeginning of May the department of Finis tere was reported as apparently lence of Cholera C¦ ° n °. » .. l r tL J in Europe during free trom infection. 1884 andisss ; Dr. Thome Thome. 111. — In Italy. I After the cessation of the epidemic prevalence of cholera in Italy in iB4, no records of the disease, beyond an announcement that 12 cases d two deaths had occurred at Gaeta early in January 1885, and nt the town and suburbs had, in consequence, been isolated by a ilitary cordon, were received in this country until September 3rd, when olera was announced to have broken out at Trivio ; seven cases and o deaths having occurred there since August 27th. But according to the icial report subsequently issued by the Italian Minister of the Interior, olera was reported to have shown itself during the month of August the following provinces : — Naples, August Ist (one non-fatal case ly) ; Massa, August 3rd ; Genoa, August 4th ; Cremona, August 10th ne non-fatal case only); Porto Maurizio and Venice, August 11th ; rma, August 14th ; Piacenza, August loth (one fatal case only) ; exandria and Modena, August 17th ; and Caserta, August 2lst. On September 6th a single case was reported to have occurred in Outbreak in Sicily. Palermo, the capital of Sicily, and seven cholera deaths were reported from there by the Bth of the month. Thirteen more cases and four deaths were announced as having occurred in the city by the 14th, and then a rapid and sudden increase in the epidemic took place ; the occurrence of no less than 258 cases and 185 deaths being announced on the 19tli. Up to the end of the month the disease prevailed on a large scale, 2,509 cases and 1,426 deaths in all having then been recorded. With the month of October some diminution set in, but with the exception of four separate days, between the Ist and the 24th, for which no returns were forthcoming, and of another break towards the close of the month, a daily fatality, varying from 75 to 7, was maintained. By the end of October, 1,781 additional cases and BGI more deaths had been recorded. The total cases and deaths in this city then amounted to 4,290 and 2,287. From this date no further reports as to cholera in the city of Palermo reached this country. During the second week of September an isolated case of cholera was announced from the province of Palermo beyond the boundary of the city, and although no further news was received as to the continuance of this outbreak until the middle of October, yet from that date until the 28th of the month the disease exhibited itself on a somewhat wider scale, causing 212 cases and 131 deaths. These statistics did not, however, include the town of Monreale immediately to the south-west of the city of Palermo. In Monreale isolated cases and four deaths occurred at intervals between September 17th and 27th, and by the end of the month 48 cases and 15 deaths had been announced. The disease increased during the first week of October, and by the middle of the month an additional 140 cases and 56 deaths had taken place. Although no further intelligence was received after the end of October as to the prevalence of cholera in the city and province of Palermo, it is evident that the disease had not then ceased. So also, the number of cases and deaths which actually occurred were much in excess of the statistics which reached this country at the time. Indeed, in Signor Morana's official document, the province of Palermo is credited with 5,335 cases and 2,959 deaths, and even at the close of 1885, when the report was issued, the epidemic was not regarded as at an end. 22 App. No. i. Beyond a few isolated occurrences of the disease, the following On the~Prev, - outbreaks also were reported from the Island of Sicily : — At Bagheria lence of Cholera between September 17th and October 13th, 33 cases and 14 deaths; at issf an°d 1885?'" Villabcte between October Bth and 22nd, 20 cases and 9 deaths ; at by Dr. Thome Ficarazzi between October Bth and 13th, 20 cases and 3 deaths; at -I home. t» i „ i _ i-_.l __ /~v_j._i mi. i i aj.t- no i r> i^..i.!.« ,i Belmonte between October 11th and 14th, 22 cases and 9 deaths; and in the Isola delle Femine off the north coast of Palermo, between October Uth and 14th, 18 cases and 12 deaths. Cholera on the In addition to the 1 1 Italian provinces first attacked in August, and to mainland. Palermo, where the first cases took place in September, cases occurred in 13 other provinces during the latter month. By far the majority of these outbreaks were trivial, the total mortality varying between one and nine. But in the province of Reggio Emilia, which was invaded on September 11th, the cases and deaths reported were 47 and 2G respectively; in the province of Kovigo they were 81 and 56 ; and in that of Ferrara they amounted to 112 and 48. The intelligence as to cholera in Italy, which was made public during the months of August, September, and October 1885, took note only of a small proportion of the cases and deaths which actually occurred. But according to the official report issued by the Ministry of the Interior, cholera caused 6,397 attacks and 3,459 deaths ; the several provinces being attacked during the periods specified in the accompanying table : — *S5 ¦§ ¦3 Date of First Date of Last Provinces. -g s g„• Case in each Case in each S g £ ,; & 5 Province. Province. A H H Alessandria- 3 21 9 17 August- 17 Oct. Bologna - - 1 1 — 1 1 Sept. -.11 Sept. Caltanissetta - -I I — 7 „ - 7 ? Caserta 1 9 7I 21 August- 1 „ Cremona - - - 1 1 — 10 „ - 10 August. Cuneo - - 3 4 j 3 15 Sept. - 21 Sept. Ferrara - - - 5 112 ; 48 i 24 „ - 25 Oct. Genova - - - 15 66 43 4 August- 14 Nov. Girgenti - - - 3 3 2 17 Sept. - 24 Sept. Livorno - - 1 l 1 17 „ - 17 ? Mantova - - 1 1 / — 2 Oct. 2 Oct. Massa - - - : 7 G5 I 38 ! 3 August 14 „ Messina - - 2 2 —i 21 Sept. - 21 Sept. Milano - - 1 l 1 29 „ - 29 „ Modena - - 3 34 18 |17 August- 14 Nov. Napoli - - 1 i _ i fi . i August. Novara - 1 2 2 1 Sept. - 1 Sept. I'adova - - - 5 111 3 ' 6 Oct. - 3 Nov. Palermo - - - 14 5,535 2,959 ! 6 Sept. - Parma - - - 27 313 202 14 August 31 Oct. Pavia " - - 2 5 3 21 Sept. - 11 „ Piacenza - - 1 l i 15 August 15 August. Porto Maurizio - - 4 10 7I 11 „ 11 Sept. lleggio Emilia - -10 47 26 11 Sept. - Rovigo - - - 22 81 56 !15 „ - Trapani - - 4 35 9| 28 „ - 5 Nov Venezia - - - 13 34 21 11 August - Total - - 152 6,397 3,459 After the end of October 1885 no further intelligence was forthcoming ApivNo. i. (to cholera in Italy until December 23rd. Information then received OnthePrevas to the effect that during the latter month five fatal attacks had JfXr^dKj urred in the city of Venice, besides 15 cases and 10 deaths in the lhs^andisso; ivince of the same name. It is also noteworthy that Signor Morana, Thome. his report at the close of 1885, assigned no date for the close of the Idemic in the provinces of Palermo, Eeggio Emilia, Eovigo, and nice. From this it would appear that fresh cases were heard of up the date of the issue of that document. Continued Prevalence into 1886. (n the first three months of 1886 no information was received from y as to any cholera prevalence, but during the month of April it ime evident that the disease still existed in that country. The first news came from Brindisi where, between April sth and 15th, 72 cases and 1 5 deaths had taken place, and about the same date two deaths were announced as having occurred at Monopoli somewhat further to the north on the same coast Hue. The disease at Brindisi was, at first, officially regarded to be of a merely sporadic character, but 'the later history of the outbreak gives no support to this view. By the end of April cholera had spread to other places within the province of Brindisi, the first deaths outside the city taking place on May Ist. Intelligence as to fatal cholera in the city was suspended after May 15th, by which date 31 deaths had already taken place there. In the province of Brindisi intelligence as to cases and deaths was of a somewhat intermittent character up to May 19th, when 78 cases and 25 deaths had taken place. Since then no further news has been received. But on May 7th it became evident that cholera was also prevailing in the coast town of Bari to the north of Monopoli, the outbreak" 1 having, by the end of May, already led to 177 cases and to 70 deaths. . But the cholera prevalence during 1886 has not been limited to the southern extremity of the kingdom of Italy. On the Ist of May four cases and two deaths were reported as having occurred at Venice, and with the exception of four days, as to which no returns were received, the disease was steadily maintained up to the end of the month, the daily record of deaths having ranged from 2 to 21, and by far the largest mortality having occurred during the last week of the month. At the close of May, 276 cases and 151 deaths had occurred in Venice, and the epidemic was still maintained there. There had also been an extension of the disease to Vicenza. IV. England. England, and indeed the whole of the United Kingdom again remained free from epidemic cholera during 1885. But in several instances vessels arriving from foreign ports were dealt with under the Cholera Order, 1883. Thus, in the port of Liverpool, the << Mayo from Carthagena had a suspicious case of diarrhoea on board, but after medical inspection she was released. The " Cartagena" sailed from Marseilles on August Bth for Oran, but owing to the prevalence of diarrhoea on board she had to put back two of the crew dying, and two being placed in hospital at Marseilles On August 26th she left Marseilles, this time for Carthagena, and thence on September 11th she sailed for Liverpool. During the voyage diarrhoea again prevailed amongst the crew and on arrival at 24 App^No. i. Liverpool two men were placed in the port sanitary hospital, the vessel Onthepreva- being then released from all restrictions. in Europe during Again, a sailor, belonging to the barque " Ribbleton," reached Bristol lss^and 1885 ; on August 4th, after having travelled from Marseilles, and died under by Dr. Thome Thome. the following circumstances : — The " Ribbleton," having 13 persons on board, had remained at Marseilles from July 20th to August 6th discharging cargo and taking in ballast. Five days after entering the port one of her creAV who had, two days previously gone ashore without permission was seized with cholera. He died on the following day. The sailor above referred to as reaching Bristol on August 4th was paid off at Marseilles, and travelled thence overland direct to Bristol. On the day following his arrival he was taken ill with symptoms of cholera, and he died on August 7th ; the port medical officer, who has had considerable experience of the disease, declaring the attack to have been true Asiatic cholera. All necessary precautionary measures were adopted, and no further case of the disease arose. The " Ribbleton " herself subsequently reached Bristol on September 21st, another of her crew having sickened with " diarrhoea " on August 6th, the day the vessel left Marseilles, and being on the sick list up to September 3rd. The vessel having been disinfected, and her ballast having been discharged overboard and conveyed into the Channel, she was admitted into dock. A suspicious death also took place on board the S.S. " Crindau " in the port of Cardiff. The vessel arrived at Cardiff from Barcelona on September 2nd. The exact nature of the disease is somewhat doubtful ; it occurred in the case of a man who came on board after the arrival of the ship in port ; but the medical officer of health regarded it as a case of sporadic cholera. Precautions were taken as to disinfection and the burial of the body, the captain and the remainder of the crew having previously been allowed to land. 25 No. 2. Report on the Proceedings of the International Sanitary Con- " '- — ' ference held at Rome, 1885 ; by Dr. Thorne Tiiorne. ccedings of'the International I have the honour to report, that having been nominated to the Conference held oreign Office for that purpose by the Board, I attended the Inter- jL jffijfaMuJ ational Sanitary Conference of Rome in the capacity of British Thome. elevate. Great Britain was represented by three delegates, namely, ir John Savile Lumley, G.C.8., Her Majesty's Ambassador at the ourt of Rome, who acted as diplomatic and senior delegate ; Surgeon- General Sir William Guyer Hunter, and myself. Two other delegates, urgeon-General Sir Joseph Fayrer and Surgeon-Major Dr. Timothy went out from this country as representing British India, n all, the Conference consisted of 63 delegates, 31 being medical elegates and the remaining 32 being either the diplomatic representaves of their respective countries at the Court of Rome or specially ppointed delegates holding other official positions. All the European tates were represented ; a separate medical delegate for Egypt being lcluded amongst the Turkish representatives.* Of the European tates, Belgium, Greece, and Roumania were only represented by iplomatic delegates. Brazil, British India, and Mexico were repreented by both diplomatic and medical delegates, the United States of America by a medical delegate only, and the Argentine Republic, hili, China, Guatemala, Japan, Peru, and Uruguay by other than medical delegates. Following the precedents of the Constantinople nd Vienna° Conferences, it was decided that each autonomous Administration should dispose of one vote. I The expediency of convoking a Conference in Rome appears to have een first entertained by the Italian Government in 18S3 as the result f the epidemic of cholera Avhich prevailed in Egypt during the course f that year ; and in view of the experience acquired during the cholera pidemic of 1884 in Southern Europe, as to the value of the restricve measures by which it had been sought to stay the spread of the isease, it was later on felt that the occasion for the assembling of a inference was especially opportune. It was at first desired that the onference should take a much wider scope than that which was ltimately decided on, and which is set forth in the letter and memoindum addressed on April 21st, 1885, by Signor Mancini, Minister for Foreign Affairs at Rome, to the Italian representatives abroad. A copy f this letter and memorandum are annexed to this Report. The Italian Government were impressed by the circumstance that the deliberations f the two previous Conferences of Constantinople in 1866 and of Vienna in 1874 had failed to result in any international agreement as o the measures best adapted to prevent the spread of epidemic disease •om one country to another, and this especially in regard of quarantine estrictions, concerning which the " most complete anarchy continued to exist. It was hoped that the Conference, when it had discussed the subject from a technical and scientific point of view, might be able to settle the basis of an international agreement as to measures of prevention such as would be acceptable to all the Governments. Audit was also suggested that rules might be drawn up for the immediate application [* Dr Abbate Pacha, the delegate from Egypt, arrived in Rome too late to take rt in the discussions on the Conclusions which are dealt with in this Report. 26 Kpp.No. 2. of an International System of Sanitary Intelligence, such as had ' — ' ' been sn^ested by the Sanitary Conference which met at Washington he Pro- • iQQi ings of the m 1001. International BomTisS! 11 The Conference was opened on the 20th of May by Signor Mancini, r. Thome' after -which Signor Cadorna, President of the Council of State, was Thorne. elected to the presidency. At this meeting a " Projet de Question prealable," which had been prepared by the Italian Government as a programme for the proceedings of the Conference, and which was mainly based on the conclusions arrived at by the Vienna Conference, was submitted by the President. At the second meeting on May 22nd, a resolution was passed adopting this programme in principle. But at the same sitting it was proposed by the French Ambassador that a Technical Commission consisting of the medical delegates should be formed in order to prepare a series of resolutions to be submitted to the Plenary Conference, and it having been decided that any diplomatic delegate was at liberty to attend the sittings of the Technical Commission, and, in the case of there being no technical delegate, to take part in the proceedings and to vote on that Commission, the proposition was unanimously assented to. The work of the Commission was materially assisted by the appointment of Sub-Committees on all the more important subjects dealt with ; the Sub-Committee in each case submitting to the Technical Commission a code of resolutions at which they had arrived, and which formed the basis for the discussions of the Commission. Members of both the British and the Indian delegations served on several of these Sub-Committees. The Technical Commission commenced its labours on May 23rd, 1885, under the Presidency of Dr. J. Moleschott, Senator of the Kingdom of Italy and Professor in the University of Home, and after holding 15 sittings, it reported its proceedings to the Plenary Conference at the third meeting of that body on the 12th of June. At this latter meeting the Conference decided, on the motion of the German Ambassador, to propose to the Italian Government that an adjournment should take place in order to enable the several diplomatic delegates to confer with their respective Governments as to the attitude each should take with regard to the Conclusions at which the Technical Commission had arrived, and this proposal having been assented to, it was decided at a fourth meeting held on June 13th, that the Conference should re-assemble on November 16th, 1885. When that date arrived it was, however, considered that, having regard to the divergence of opinions which had been manifested during the discussions of the Technical Commission, there would be advantage in further postponing the re-assembling of the Conference, and under these circumstances the following Report has to do only with the proceedings and the provisional Conclusions of the Technical Commission.* I have annexed these Conclusions to this Report, as also a Table in which the Conclusions of the Constantinople and Vienna Conferences, and those arrived at by the Technical Commission of the Rome Conference, are so arranged as to facilitate comparison between the results of the three Conferences. At an early sitting of the Technical Commission it was decided that the measures necessary for the prevention of cholera should, in the first * The summary of the Conclusions arrived at by the Technical Commission, which is appended to this Report, has been arranged by the compilers of the Proces-Verbaux in a different order to that in which they were discussed, and hence in the references that will here be made to them the numbers do not run consecutively. 27 instance, engage the attention of the delegates, and that all questions involving scientific and theoretical considerations, and especially such as related to the etiology of the disease, should be excluded from iscussion. At first, the " Programme Questionnaire " of the Italian xovernment was taken as the basis for the discussions of the Commission, ut some difficulties being experienced in following this course, it was ecided to proceed on the lines of a programme which was submitted ry M. Brouardel (France), and which, after certain modifications had >een introduced, dealt with the subject under the following headings : Mesures a prendre contre la Propagation dv Cholera par voie de er : — I°. Mesures d'assainissement an point de Depart; 2°. Mesures assainissement pendant la Traversee ; 3°. Dispositions speciales pour a Mer Rouge ; 4°. Mesures d'assainissement a l'Arrivee ; s°. Dispositions >eciales a la Mediteranee ; o°. Prophylaxie sanitaire de la Mer Before this decision had been arrived at a resolution had, owever, been come to on the question of Land Quarantine. A pp. No. 2. On the Pro- ceedings of the Interim tional Conference held at Rome, 1S85 ; by Dr. Thorno Thorne. I. — Land Quarantine. I The Technical Commission were all but unanimous in their conmnation of measures of land quarantine. By far the majority of the legates, including myself, held that cholera was largely transmissible by man agency, and that consequently sanitary cordons, if applied with the strictness of a scientific experiment, ought to be effective in preventing the spread of the disease ; but it was admitted that the recent experiences of Egypt and of Southern Europe, in 1883 and 1884, had once more demonstrated the futility of their application, and, as a result, a proposition by Dr. Rochard (France), to the effect that '« Les quarantaines de terre et les cordons sanitaires sont inutiles " (Conclusion No. 6) was adopted with the single dissentient voice of Turkey. II. — Maritime Quarantine The preliminary discussions on the subject of maritime quarantine disclosed great diversity of opinion on the part of the several delegates. One objected to any " arbitrary time quarantine ;" another to any quarantine whatever in European ports when the disease was already prevalent on the Continent ; a third wished materially to reduce the length of quarantine detentions ; whilst others apparently believed in the efficacy of quarantine as heretofore imposed, and even called for more stringent restrictions. During the course of the debate on the subject, information was asked for as to the system adopted in this country in substitution for quarantine, and I undertook to explain to the Commission the details and working of the system of v Medical Inspection," which has long been carried out in Great Britain, and which had received the formal approval of the Vienna Conference. I explained that under the Order of the Local Government Board, cholera-infected vessels — and infected vessels only — arriving in the ports of England and Wales were dealt with as follows : — The sick of cholera were immediately isolated, and those actually suspected of developing cholera could be detained, under observation, for 48 hours ; meanwhile all healthy persons were allowed to land, subject to notification of their destination beingcommunicated by the Port Sanitary Authority to the Medical Officers of Health of the localities to which they were bound, in order that these officers might exercise the needed surveillance over them on their arrival within their districts. I gave some details as to the sanitary organisation necessary to give effect to this system, and I explained how far the English local sanitary authorities had prepared them- 28 I pp. No. 2. selves in advance by duly appointing the requisite officers, and by prohe~Pro viding themselves with hospital accommodation for the isolation of tags of the infectious diseases. International attomeasssf* When the adjourned discussion was resumed, the lines of M. Brouby Dr. Thome ardel's programme were followed, the first point relating to the sanitary Thorne. measures to be adopted at ports of departure. A. — Mesures cV Assainisscment au Point de Depart. On this subject a series of 18 resolutions (Nos. 16-33) were formulated, some of them being arranged in the Proces-Verbaux under a separate heading, viz. :—": — " Prophylaxie Sanitaire Maritime. Mesures sanitaires generales." The majority of these latter dealt with matters which, in principle, are already carried out in the ports of this country ; they therefore received the support of the British delegation, and were unanimously adopted. They related, I°, to the importance of maintaining in all ports conditions favourable to a high standard of health, and a sanitary authority from whom information as to the state of health could be obtained ; 2 C , to the provision of facilities for isolating cholera patients, and for disinfection by steam under pressure in such vessels as carried passengers ; and 3°, to the need for medical examination and cleansing of vessels before the commencement of lading, to the medical examination of passengers, and to the exclusion from vessels of sick persons and infected articles. Another Conclusion relating to the desirability of requiring all passenger vessels to carry a medical officer was adopted with two dissentients only. But a Conclusion (No. 22) to the effect that " The consul of the country to which a vessel is destined shall " have the right to take part in the sanitary inspections of vessels " which are made by the agents of the land authority . . . ." it was opposed by the British delegation, and was only carried by eight votes to six, there being eight abstentions. As regards another resolution, which proposed that all the clothing, &c, of every person sailing from a port where cholera was prevalent should be disinfected before departure, I pointed out that such a measure would be impracticable, as, for example, in the large ports of the United Kingdom ; and a similar objection having been taken by the Indian delegation, the proposal was in the end rejected; a modification, limiting such action to the clothing, &C, of persons actually suffering from cholera, being agreed to. At a later stage a distinction was drawn between vessels carrying a medical officer on board and those not so provided ; the former were termed " Grands Navires," the latter " Petits Navires," and as regards the precautions necessary in the case of Petits Navires at ports of departure, a few additional restrictions (Conclusions 29-33) were proposed, and were adopted with all but complete unanimity. B. — Mesures tV Assainissement pendant la Traverse'e. The health precautions to be taken during the sea voyage next came on for discussion. With regard to (a.) Suspected Ships,* three resolutions, Nos. 34-36, relating to the frequent cleansing and disinfection of soiled linen and of the closets, and to the maintenance of cleanliness and ventilation during the passage, were unanimously assented to. As to (b.) Infected Ships,* two resolutions (Nos. 37 and 38), relating to the * These terms were not denned by the Technical Commission. During its thirteenth sitting the Russian delegate (Dr. Eck) presented a document containing an elaborate explanation of the terms ; but it was felt that since the acceptance of the definitions proposed might involve re-consideration, by some of the delegates, of Conclusions in which those terms had been embodied, the proposition had better be withdrawn. 29 |;asures of isolation, cleansing, and disinfection to be adopted on board app. No 2 the occurrence of cholera, were unanimously assented to, but the British — legates, not desiring to impose restrictions which they believed would rcodirf^fof'the impracticable of execution in the case of large vessels, such as troop- international 1 . « j n ? , 1 1 ,• /-»-r«^-> 1 > , Conference held ips, abstained trom Acting on a subsequent resolution (No. 39), which at Rome,iBBs; ;nt to prohibit for the remainder of the voyage the use by any healthy byDr-Thonw rsons of the compartments (les locaux) in which attacks of cholera d taken place. Two special resolutions (Nos. 40 and 41), applicable I" Petits Navires," and relating to the same subject, were also opted. One of these dealt with the need of supplying to masters of eh vessels a code of instructions v as to the action to be taken in the ¦cumstances referred to. C. — Dispositions Speciales pour la Mer Rouge. At this stage the report of a Sub-Committee on the special measures to be adopted in the Red Sea was brought up, and the first paragraph, which laid it down that all steamships coming from cholera-infected ports beyond the Straits of Babel-Mandeb should be subjected to medical inspection in the Red Sea (Conclusion No. 42), led to a lengthened discussion. With the exception of the delegates for Spain and Brazil, who objected to the proposal on the ground that inspection was an insufficient precaution, the Commission were evidently unanimous in assenting to the principle of medical inspection. But viewing the report of the Sub-Committee as a whole, I pointed out to the Commission that the medical inspection proposed could only be regarded as a preliminary step to the imposition of quarantine, and this whenever the medical officer of the port, who was to be " independent " (Conclusion No. 43), chose to regard any case on board as suspect. Under these circumstances the British delegation felt it their duty to oppose the proposal. (The word " independent " as applied to this officer was intended to suggest that the appointment should be made by an International Commission.) During the course of the debate it Avas pointed out by the British and Indian delegations that no instance could be cited in which cholera had been communicated to Europe by means of a British vessel from India, and that, therefore, so far as British vessels were concerned, the proposal could not be shown to be necessary. Both delegations Avere ready to give their assent to any system of inspection which had for its object the acquiring of information as to the sanitary state of the vessel, and I pointed out that such information might be communicated by the representatives of the various countries to their respective Governments ; who could, in turn, either refuse to admit the vessels concerned into their ports, or subject them to such meaaures of detention as they thought fit ; but that England, having eiected to carry out the system of medical inspection as formulated at Vienna, Avould decline to be a party to the imposition of any system of quarantine. lAt this stage Sir Guyer Hunter made a definite proposal with regard English vessels sailing direct to British ports. The proposal Avas to 1 following effect : " Les navires anglais, marchands, troupiers, postaux et autres, gui ne communiquent ni avec l'Egypte ni avec aucun port de PEurope devront pouvoir traverser toujours le Canal de Suez sans inspection,* comme bras de mer," but the proposal only received 1 support of Great Britain and India, there being two abstentions, mely, . Japan and Russia. * It will be seen from what has already been stated that the objection to inspection which is involved in this proposal, had reference solely to such inspection as was aimed at in the Conclusions of the Technical Commission, and which is referrod to in the footnote on page 40. 30 1. Suspected Vessels. Afp. No. 2 In the end, a series of Conclusions was adopted (Conclusions Nos. 42- On the Pro- ¦esoftius 46^ under the heading of " Suspected Vessels," relating to the pro¦ence Lid posed inspection and to its results. One Conclusion (No. 44) laid it n Thnv^ ; down that if the medical officer of such a ship certified that sanitary Dr. Thorn Thome. precautions and measures of disinfection had been observed, and that there had been no case or suspicion of cholera on board during the sea passage, and if the port medical officer was satisfied that there was no suspicion of cholera on board, free pratique should at once be granted. Others were to the effect that suspected vessels not disembarking passengers in the Red Sea or in Egypt, need only be subjected to one medical inspection near Suez, but that if the contrary were the case there should be a first inspection near the Straits of Babel-Mandeb, and a second at the first port touched at. 2. Infected Vessels. As regards " Infected Vessels," that is to say, vessels on which there was or had been during the voyage any case of cholera, several Conclusions (Nos. 47-50) were come to requiring that all the passengers should be landed and isolated in groups, each numbering as few as was found possible, that the sick should be further separately isolated under medical supervision, that the ship and all articles of clothing, &c, should be disinfected, and that the passengers and crew should be subjected to detention under " observation " for five days, it being understood that the five days would be repeated as regards each group every time a fresh case suspected to be cholera occurred. The British delegation, having opposed the inspection which was intended to precede the imposition of quarantine detention, abstained from voting on all the Conclusions (Nos. 43-46, and Nos. 48, 50, and 51) relating to the appointment of the officer who was to carry out these several regulations as to suspected and infected vessels, and as to the method in which they Avere to be performed, excepting only the one (No. 47) which actually prescribed the landing of nil the passengers, healthy as well as sick, if any, and the one (No. 49) which defined the period of detention. These they opposed. The latter Conclusion (No. 49) may be regarded as the crucial one of the Technical Commission, and it is noteworthy that it was only adopted by a majority of four (13 ayes, 9 noes), the minority being made up of the delegates for Great Britain and India, who objected in principle to quarantine detentions ; of the delegate for the United States of America, who opposed the application of any arbitrary time quarantine ; and of the delegates for Brazil, Spain, Mexico, Iloumania, Servia, and Turkey, who regarded the restriction as inadequate. Five of the latter States formed the minority in an amendment, which was rejected, to the effect that the detention should be of 10 days' duration. During the course of this discussion a point relating to the attitude of the British and Indian delegations was raised. It amounted to a protest by the French and German delegations to the application of the word " quarantaine " to this measure of detention under " observation."* As to this I would observe: — 1. That speaking for the * M. liocharcl (France), in addressing the Commission, at its eighth sitting, said: — ' s M. Thome Thorne assimile la visite mcdicale a un commencement de quaran" .tame. On etait convenu de ne pas prononcer cc mot. Si les delegues franoais " avaient vouhi en parler, ils l'auraient fait (Tune facon ouverte." And Dr. Koch (Germany), at the same sitting, said: "Je proteste contre la denomination de " quarantaine donuee a une observation de cinq jours." See " Proces-Verbaux," pp. ,172 and 183. 31 delegation from France, M. Brouardel, who was the reporter for the Apr. No. 2. Ib-Committee on "Dispositions speciales pour la Mer Rouge," had Onthe "i7 0 . jviously stated at the third sitting of the Technical Commission that oeetaywof the i French delegation had come to the Conference with conciliatory conference' Lid we, on the basis of limiting, as far as possible, the duration of g^ft^ irantine, " prete a limiter les quarantaines autant que possible ;" Thome. I 2. That the word " quarantaine " has hitherto always been I plied to such detentions. As to this I would refer to one of the inclusions arrived at by the Constantinople Conference, and which is this effect : " Relativement ala quarantaine d'observation et hla quarantaine de rigueur, la Conference est d'avis que la difference entre ces deux regimes consiste en cc que la quarantaine d'observation est un temps d'epreuve, de simple surveillance, tandis que la quarantaine de rigueur consiste dans le debarquemcnt au lazaret avec disinfection, et comprend toutes les mesures applicables a une provenance cholerique." So also, at the Vienna Conference, tentions for the purposes of " observation " were included under the ading " Systeme dcs Quarantaines," as opposed to the " Systeme de nspection Medicale," and the process is referred to as " la quarantaine )bservation." In short, the system of " observation " advocated by c Technical Commission corresponds not only with that of quarantine, t is in fact the " quarantaine de rigueur " of the Constantinople inference. The preponderance of opinion in favour of quarantine detentions, both as regards the Red Sea and, as will be seen later on, as regards all Ports of Arrival, which was exhibited by the Technical Commission was, I believe, much larger than that which was anticipated prior to the assembling of the Conference ; and I have been unable altogether to dissociate^this result from the, change of name above referred to. As already indicated (see footnote, p. 30) the word quarantine had not only become distasteful to certain members of the Commission, but, so far as could be judged, some of the delegates regarded the Conclusions arrived at on this subject as aimed at superseding the quarantine system. Indeed, the President of the Technical Commission, in addressing the Italian Minister of Foreign Affairs on the conclusion of the labours of the Commission, wrote in the opening sentence of his communication* :—": — " La Conference "... se distingue dcs conferences precedentes en cc qu'elle a rejette, " sans reserve, les quarantaines. Non settlement la Commission Tech" nique, dans son travail preparatoire, a declare iuutiles les quarantaines " de terre, et les cordons sanitaires, mais, en outre, elle a propose de " transformer les quarantaines maritimes en inspections et observations." I have already explained that the change referred to was, in my opinion, one of nomenclature only. And inasmuch as the detention approved by the Commission is in all essentials a rigorous quarantine, I shall continue throughout this report to designate it accordingly. At the close of the discussion as to the restrictions referred to, the Russian delegate who had personal experience of the state of the quarantine stations in the Red Sea, proposed a resolution which amongst other things, expressed the opinion that the restrictions should not be applied until arrangements had been made to carry them out. The motion was declared to be out of order, on the ground that it dealt with a question of administration, but it may here be observed that although the necessity for providing the requisite organisation for * "L'CEuvre de la Conference Sanitaire de Rome, parM. Jac. Molesehott." See reprint in "La Kevue Soientiflque," 12th September 1885. [The italics are mine. -R.T.T.] 32 enforcing quarantine restrictions in the Red Sea was laid down at Constantinople in 1866, and again at Vienna in 1874, the Egyptian delegate, at the last sitting of the Plenary Conference, submitted a " Memoire," in which he pointed out that, in so far as measures of isolation and disinfection in that sea were concerned, they were applied in a manner which was altogether insufficient and untrustworthy (" tou a fait insuflirfante et illusoire "), and this because the means for their proper application did not exist. He went on to express the view that, under these circumstances, the passage of the Suez Canal in quarantine appeared to be the only possible and practical solution of the question.* ATT. No. 2. On the Pro- ceedings of the International D. — Mcsures iV Assainissemcnt a VArrivee A Sub-Committee having been appointed to prepare a code of regulations as to the measures which it was necessary to adopt at ports of arrival, the resulting report indicated a want of unanimity amongst the members ; and the Technical Commission having rejected a proposal of the majority of the Committee to impose more stringent quarantine detentions at ports of arrival than those which had been regarded as sufficing in the case of the Red Sea, new members were added to the Sub-Committee, and later on a fresh report was presented. The first two Conclusions of the enlarged Sub-Committee (Nos. 68 and 69) dealt with the inspection of Suspected Vessels on arrival, and to the granting of free pratique to the passengers in vessels in which no case or suspicion of cholera had existed during the voyage, and where proper sanitary measures had been in force. These were adopted by large majorities. But with regard to a third Conclusion (No. 70), which required vessels similarly free from all suspicion of infection to be subjected to a detention of 24 hours, together with certain processes of disinfection, and this simply because the voyage had been of less than 10 days' duration, I urged that the medical inspection for the purposes of dealing with any actually sick should suffice, and that the detention, under such circumstances, of healthy persons was not only vexatious but useless. The resolution was, however, adopted, there being 11 votes for, 6 against, and 4 abstentions. With reference to Infected Vessels, it was unanimously decided that any cases of cholera found on board should at once be landed and isolated, and that measures of disinfection should be adopted (Conclusions Nos. 71 and 72). But on the further proposal that all the passengers and crew should also be isolated (Conclusion No. 73) during a period of five days (Conclusion No. 74), considerable want of unanimity was exhibited, and the latter Conclusion was only adopted by 11 ayes, against 8 noes, there being 2 abstentions. As in the case of the Red * A recent example of the impracticability of carrying out the measures which are professedly in operation in the Red Sea occurred in the autumn of 1885. Two French transports, the " Chateau Yqueni" and the " Nive," from Tonquin, were ordered into quarantine at Tor under the Cholera Regulations. The " Chateau Yquem" reached that place on October 29th, the passengers and ( J0 men of the crew were landed, about a dozen being accommodated in a hut, and the remainder under canvas. The " Nive " arrived there on November 3rd, and on her arrival the Director of Encampment pointed out that if all were compelled to land under the existing climatic conditions and in view of the character of the accommodation available, the result would be to aggravate the then prevailing sickness, and to lead to an increased mortality. In the end, some of the more healthy amongst the passengers were sent ashore, but those who were really ill (the cases are then described as dysentery, fever, &c.) were left on board ; the adoption of sanitary measures being in the main relied on. 33 I a quarantine, the minority was made up of the delegates of Great itain and India, who objected altogether to the detention of the llthy, and of those of States (Brazil, Spain, Mexico, Roumania, Servia, il Turkej') who wished for more severe restrictions, and who also in s case unsuccessfully endeavoured to carry a resolution imposing a days' quarantine. The requirement embodied in Conclusion No. 74 s to some extent modified by a subsequent Conclusion (No. 75), iording to which a detention under " observation" for 2i hours was suffice in the case of a vessel the medical officer of which should tify that no case of cholera had existed on board within 10 days. Consions (Nos. 76 and 77) were next adopted for dealing with the iseugers landed, and for securing measures of disinfection, &c.j neither ; British nor the Indian delegation taking any part in the vote. Apr. No. -I. On the Pro- ceedings of the International Conference held at Home, 1885 ; by Dr. Thorne Thorne. JS. — Dispositions Spe'cialcs d la Medileranc'e. Ifhe Sub-Committee which had reported on the measures to be*taken the several ports of arrival, also submitted a series of resolutions i cial to ports in the Mediterranean, those in the Black Sea and the i of Marmora being also included. These resolutions had to do ;h : 1. Suspected Ships ; and 2. Infected Ships. 1. Suspected Ships. The first Conclusion submitted (No. 79) required the landing in isolated and specially constructed buildings of all the passengers and crews of suspected vessels, and it at once became evident that there was great diversity of opinion amongst the delegates of those States which, bordering on the Mediterranean, would have to apply the regulation to their own ports. The adoption of this Conclusion was opposed by the British delegation, but it was ultimately adopted by 10 votes to 4 in a meeting represented by 21 States. When, however, length of detention came to be dealt with, a series of amendments, having for their respective objects either to increase or to lessen its severity, were proposed, and when ultimately it was decided that the detention should last either three or six full days, according as the vessel carried a medical officer or not, the Conclusion dealing with this point (No. 80) was only adopted by 6 ayes to 5 noes, there being no less than 10 abstentions. The majority included two Mediterranean Powers. A further Conclusion (No. 81), to the effect that the length of the voyage should be deducted from the period of detention, was also carried by a majority of one vote only. The British delegation took no part in these votes, on the ground that they had already opposed the landing and detention of persons from vessels which were not even regarded as 2. Infected Ships. ti regards Infected Ships it was decided (Conclusion No. 82) that were to be subjected in Mediterranean ports to the same general lations as applied to infected vessels at ports of arrival. IDhese regulations, it will be remembered, involved a detention under at ion of five days' duration ; whereas the Conclusion (No. 80) as to pected vessels in the Mediterranean, which was opposed by the tish delegation, admitted, in certain cases, of a similar detention of days' duration. In other words, a suspected vessel might come to be ained longer than one actually infected, in so far as Mediterranean ts are concerned. E 20510. C 34 F. — Prophylaxie Sanitairc de la Mer Caspienne, App. No. 2. I the Pro- As to the Caspian, it Avas held that the application to that sea of the lings of the measures proposed with regard to other seas, would suffice. See Conr national , * ° ferenoeheld elusion No. 83. at Romt!, 1885 ; by Dr. Thome Fe. In connexion with the prevention of cholera the Technical Commission also discussed the following questions : 1. The Mecca Pilgrimage; 2. River Measures of Sanitation ; 3. Land Measures of Sanitation ; and 4. Disinfection. 111. — The Mecca Pilgrimagi The Conclusions arrived at with reference to this subject were in the main the result of the labours of a Sub-Committee on which Dr. Timothy Lewis sat, and the majority of them met with the unanimous support of the Technical Commission. The first Conclusion (No. 52) laid it down as desirable that every pilgrim should be required to possess the necessary means for his support before being allowed to start. This practice is already adopted in the Dutch colonies, and at the request of the Turkish delegate the Conclusion was so worded as to declare that such a requirement is in conformity with the Musulman religious precepts. The next six Conclusions (Nos. 53-58) dealt with measures of sanitary precaution in connexion with the embarkation of pilgrims, on the lines already adopted by Her Majesty's Indian Government ; indeed one of the Conclusions (No. 58) definitely recommends, for general observance in States from whence pilgrims commence their voyage, the measures adopted by that Government in connexion with the transport of pilgrims to and from the Red Sea. The next Conclusion (No. 59) did not meet with similar unanimity. It dealt with the disembarkation of all passengers and the crew at the sanitary station in the Red Sea, with a view to the cleansing and disinfection of the vessel, &c, and to the medical inspection on shore of all on board. Subject to certain conditions, it was ultimately decided that, in the absence of any suspicion of cholera, the vessel and all on board could proceed to the Hedjaz after 24 hours' detention; but in the case of the vessel not being provided with a medical officer, or in the event of any suspicion of cholera having occurred amongst either crew or passengers, a detention on shore of five days was decided on, the detention to be renewed as regards any groups in which any suspicion of cholera might arise during the period of seclusion. This Conclusion was opposed by certain delegates who desired to lengthen the quaran tine detention, but it was ultimately carried by 16 to 5, and it received the support of the British and Indian delegations. The next Conclusion (No. 60) dealt with the arrival of the vessel at a port in the Hedjaz, and it required, amongst other things, the return of the vessel to the sanitary station in case of any cholera having appeared on board since the date of medical inspection at that station. Two other Conclusions (Nos. 61 and 62) relating to the movement of pilgrims inland were adopted. The first laid it down as necessary that the medical officers attached to the pilgrims or to the vessels should accompany the worshippers throughout their pilgrimage, and take all necessary precautions to secure their welfare and prevent the spread of disease ; and the second urged that sanitary measures should be largely applied to the resting places of the pilgrims, and above all to the holy cities of the Hedjaz. No opposition was offered to either of these Conclusions, but the Turkish delegate abstained from voting on the second one. As regards the next two Conclusions (Nos. 63, 64), dealing with the passage 35 I the pilgrim vessels to Mediterranean ports, the British delegation, ether with the Indian, acting on the same principles as dictated their ion when dealing with quarantine restrictions in the Red Sea, abstained li voting ; and they observed the same attitude as regards Concluis Nos. 65 and 67, which related to certain restrictions to be josed on " petits navires," and to the promulgation of an Internauxl Penal Code dealing with contraventions of the regulations mulated as to the Red Sea. One other Conclusion (No. 66) reng to this subject made reference to two places in the Red Sea as ng suitable for the establishment of the requisite sanitary stations ; nely, the Island of Camarau to the south, and the neighbourhood of >un Ouna and the coast of Attaka to the north. App. No, 2. On the Pro- ceedings of the International Conference held at Rome, 1885 ; by Dr. Thorne Thornc. There is at first sight an apparent inconsistency in the attitude which, with the assent of my colleague, Sir Guyer Hunter, and with the support of the Indian delegation, I took in being party to a vote which gave sanction to a five days' quarantine detention of all pilgrims, healthy as well as sick, under the conditions specified in Conclusion No. 59, when compared with the refusal to assent to a similar regulation in the case of the ordinary traffic from the Red Sea into and through the Mediterranean. The attitude taken was, however, I venture to submit, entirely consistent. The opposition taken by myself and my colleague to Conclusion No. 49 was based on the demand which was made on behalf of Great Britain that she should deal as she saw fit with such vessels as sailed to her own ports without touching elsewhere during the voyage, and I took occasion to point out during the debates on this subject that Great Britain, in demanding the free passage of the Suez Canal as an arm of the sea, made no demand which was exceptional to herself, but maintained that each country should be allowed to deal as it chose (i.e., by medical inspection or by the imposition of quarantine restrictions) and where it chose with regard to vessels bound for its own ports, and both Sir Joseph Fayrer and Sir Guyer Hunter took the opportunity, during the discussion on the Mecca Pilgrimage restrictions, to point to this principle as guiding us in our votes. But in dealing with the disembarkation of pilgrims, we had to remember that Turkey desired quarantine restrictions at its ports in the Red Sea, and just as we maintained our right to be free from such restrictions as regards vessels sailing to our own ports, so we felt it due to Turkey not to oppose her wishes as regards those bound for her ports. But directly it was attempted to impose similar restrictions to pilgrim vessels Avhich were bound to Mediterranean ports of no specific nationality, we felt that we could not take any part in imposing on the Mediterranean Powers restrictions to which we had made objections on the ground that they were vexatious and useless in so far as British ports are concerned. IV. — River Measures of Sanitation An unsuccessful attempt having been made to declare sanitary cordons as applicable to the shores of great rivers, two Conclusions relating to rivers (Nos. 14 and 15) were assented to without opposition. The first laid it down that river ports to which sea-going vessels had access ought to be subject to the same regulations as sea ports ; and the second urged the adoption of rigorous sanitary measures, and the prevention of overcrowding in the case of river shipping, and advocated the appointment of a medical officer, and the provision of means of isolation at each principal point of call (point de relache). The Conditions in question aim at the appointment at the river ports C 2 36 of all countries of medical officers of health, such as already exist in nil sanitary districts, whether port, riparian, or other, throughout England and Wales, and at securing the construction of hospitals for the immediate isolation of the infectious sick, such as have been provided to S3 large an extent by the local authorities in this country ; and us such they received the support of the British delegation. .Vpr. No. 2 On the Pro V. — Sanitary Measures on Land. The Technical Commission having at an early sitting expressed the conviction that land measures of quarantine were useless (Conclusion No. 6), a Sub-Committee, of which I was a member, was appointed to prepare a series of resolutions for submission to the Commission as to the precautions which might usefully be taken to prevent the spread of cholera on land, and when these came on for discussion, I took the opportunity of explaining at some length what had been the attitude of England in this respect since the date of the last Conference at Vienna in 1 874. Recalling the measures taken on our coast line in connexion with the system of medical inspection, and referring to these as constituting our first line of defence, I pointed out the great importance which was attached throughout the country to the improvement of the sanitary circumstances under which the people lived, and especially to the provision of wholesome water-supply, of efficient means of sewerage and house drainage, of healthy dwellings, and of small local hospitals for the isolation of first attacks of all cases of dangerous infectious diseases, including cholera. I then referred to the action taken by the Local Government Board, through the agency of its staff of Inspectors and otherwise, in urging the importance of these matters on the Local Sanitary Authorities, and having explained that in this country the cost of all such measures was borne exclusively by the local authorities, I furnished some statistics as to loans which such authorities had, with the sanction of the Board, incurred for sanitary purposes since the date of the Vienna Conference. [When I was in Rome the materials at my disposal, as to loans raised by sanitary authorities, were limited to those with which the Local Government Board have had concern. But quite apart from these, large sums are raised year by year under private Acts, and without the sanction of the Board ; and since my return I have had opportunity of ascertaining that, including loans raised both under private and public Acts for purposes mainly of a sanitary character, the average amount for the period 1875-76* to 1883-84 exceeded 6| millions sterling per annum. It is true that in certain years the loans so raised have included considerable sums for objects such as gasworks; but on the other hand, no account has been taken of loans raised under the Artizans and Labourers Dwellings Acts, and the cost of many public works of water-supply has been defrayed by private companies, whose operations are not included in the above estimate. And not only so, but examination of the current expenses of sanitary authorities shows that during an ordinarily typical year, the cost of measures essentially sanitary in their influence exceeds 2\ millions ; this amount leaving altogether out of consideration the payment of principal and interest on loans, and, in almost all cases, also of the salaries of sanitary officers. And, further, the above-named figures relate solely to the provinces and take no account of the large loans and current sanitary expenses of the metropolis. Lastly, I would note that I took occasion to explain to the * This is the first period for which the necessary statistics are available. 37 Technical Commission that expenditures such as I have referred to are, app. No. 2.. with only very trivial exceptions, voluntarily incurred in the interests of On the Pro health.] ceedings of the T ., J , .x 1. x 1 ? . ?. 1 , , International I then went on to show, in connexion with this expenditure, that the Conference held erage annual mortality for England and Wales was now only 19 as by^ThornV posed to 22 per thousand in the decennial period 1861-70, and this not- Thorne. withstanding increase in population of some 5 millions ; and taking the continued fever mortality of this country as that which, in point of causation, most nearly resembled cholera, I pointed out that whereas in the five years 1865-69, this mortality was at the rate of 934 per million living, it had steadily fallen to 428 per million during the period 1880-82, and that it was now only 307 per million. Referring to the allegation which has at times been made to the effect that the views of Great Britain on the quarantine question were largely influenced by commercial and financial considerations, I maintained that there was no country where a higher value was set on human life, and that if England had really believed in the efficacy of quarantine measures, the financial burden which it involved would have been borne in the interests of the community as readily as had been the expenditure above referred to in connexion with the alternative system of coping with disease, whether imported or otherwise, by an efficient sanitary administration. Finally, I maintained that many of the most important sanitary measures adopted in England had been brought about in anticipation of the possible importation of cholera ; that no such saving of life as had been effected would have been secured if the English people had been led to put their trust in quarantine restrictions ; and that the substitution of the system of quarantine which the Technical Commission desired to urge upon the Conference, in replacement of the system which has been elaborated in this country, could only have a disastrous effect. I The Conclusions arrived at in connexion with the precautionary ?asures to be observed on land (Nos. 6 to 13) affirmed principles •eady held in view in this country as to the prime importance of antecent sanitary measures, the need for an organized system of sanitary ministration in every district, the notification of disease, the immediate )lation of the sick, and the disinfection of infected articles. It was so laid down as desirable that the health authorities of Ihe different uutries should be in direct communication with each other as to all international measures of urgency ; and certain special regulations were agreed to as to the precautions to be taken on the great lines of land traffic, and as to international trains. Some of the latter appeared to the British delegation as superfluous, but recognizing the right of each country to adopt such internal measures of precaution as it saw fit, we gave a general support to the conclusions in question. VI. — Disinfection. Another Sub-Committee dealt with the question of disinfection, and the conclusions submitted to the Commission were assented to with almost complete unanimity. The Conclusions in question (No. 5, i.-ix.) were dealt with en bloc ; they do not pretend to deal withjlie subject of disinfection in an exhaustive manner, but rather to indicate the measures of disinfection and cleansing, as also the methods of their application, which may be regarded as available, in the case of articles or persons that have actually been soiled or come in contact with cholera patients, under the circumstances of a sea voyage. A further Conclusion (No. 84), relating to the general application to 38 of cholera, was adopted by 17 votes. There were, however, three abstentions, and these included the British delegation, not because any contrary view was entertained, but because we regarded the instructions under which we acted as limited to the consideration of cholera only. App. No. 2. On the Pro- eeedinjrs of the International Conference held at Rome, 1S8B ; by Dr. Thorne Thome. General Review. "Review of the labours of the Technical Commission goes to show that in some respects the Conclusions arrived at indicate progress since the Conferences of Constantinople and Vienna, in regard to the measures which may be properly applied towards the prevention of cholera. Thus :— I. On no occasion has the value of the adoption of sanitary measures as the principal safeguard against cholera been more prominently recognised than was the case at Home. This point is set out in one form or other, in nearly every group of Conclusions arrived at by the Commission, and it was formally adopted in Conclusion No. 4 as a governing principle. 11. In the matter of disinfection it was for the first time distinctly laid down that it is not necessary to consider articles as infected merely because they come from a country where cholera prevails ; that only persons or articles that have actually been soiled by choleraic discharges, and articles that have been worn by persons suffering from cholera, ought to be subjected to such process ; and that in the case of individuals, disinfection by means of baths ought alone to be resorted to; fumigations being thus incidentally condemned as useless. The Conclusions relating to this subject, and especially Nos. 11 and 12, may in this respect be contrasted with those embodied under the Conclusions formulated in §§4 and 5, " Systeme de l'lnspection Medicale " at Vienna. See pages 81 and 85. lit. The restrictions which the majority of the Technical Commission deemed it requisite to apply to the sea traffic from the East into the Mediterranean by means of the Red Sea and the Suez Canal, are in certain respects less stringent than those which were adopted at Vienna. These restrictions may be summarized as follows : Vienna 1874. Method alternative to Medical Inspection. (a.) Vessels from suspected Ports. Five days' quarantine. (b.) Vessels from Infected Ports.^ Seven days' (or in certain exceptional cases ten days') quarantine. Towards the several periods of 5, 7, and 10 days the duration of the voyage is to reckon, subject, however, to a detention of 24 hours even when no suspicious case of cholera has arisen on board. (c.) Infected Vessels. If any case or suspected case has arisen during the voyage, seven days' quarantine. Rome 1885. No ALTERNATIVE METHOD ADOPTED. (a.) Suspected Vessels. Medical inspection near Suez. If the officer making it is satisfied that there is an absence of all suspicion, free pratique to be immediately granted. (b.) Infected Vessels. Five days' quarantine. As to vessels which are not regarded as suspect or infected, the App. No. 2. difference is, however, more apparent than real, for the inspection on the Pro- I quired by the Rome Conclusion, in order to enable the port medical of the • ,•'.„ . ii,. • i International icer to grant free pratique, would or necessity occupy some hours, conference held d this especially in the case of night arrivals, when the passengers fty^^xij^?,^ would be in bed, and it is only in so far as the number of hours occu- Thome. led in the inspection might fall short of the 24 hours' detention escribed by the Vienna Conclusion that there would be any gain, ideed, in the absence of the staff necessary to make the proper spections, the existing authorities at present accept, in the case of eh ships as troop and mail steamers carrying a European medical officer, and having undergone a sea voyage of not less than 10 days, Ie declaration of that officer and of the captain, and even the detenin of 24 hours, is thus, in practice, avoided. As regards infected ssels the minimum period of quarantine detention is reduced from seven to five days.* The reduction in stringency amounts, therefore, I°, in the case of nonsuspected vessels, at the most to a few hours ; and 2°, in the case of infected vessels, to 48 hours. This gain is, of course, very trivial ; and in view of the recent experience we have had of the failure of the existing regulations to protect Europe from invasion by cholera, it is difficult to understand how any different result could be expected, were the slight modifications suggested by the Technical Commission carried into effect. Their main, if not only, value lies in the fact that by once more diminishing the duration of quarantine detentions, they may con- stitute a further step toward 3 their entire abandonment. But in dealing with the action to be taken at ports of arrival, and Ipecially at ports in the Mediterranean, the action of the Conference d a distinctly retrograde tendency. The Vienna Conference, whilst ing down regulations as to quarantine detentions for those countries lich preferred to retain the quarantine system, recommended the stem of Medical Inspection for adoption in European ports, this system solving the isolation and detention only of such persons as are found arrival to be suffering from or suspect of cholera j the healthy being mitred to free pratique after certain processes of disinfection have en carried out. But in the Conclusions of the Technical Commission the Rome Conference, medical inspection finds no place, except so far as this term may stand for a formality preliminary : 1, to a tentionof24 hours in cases where the sea voyage from suspected ports s lasted less than 10 days, and this not only in cases where cholera, Dugh not then present, has prevailed on board within the previous 1 days, but also when no suspicion whatever exists of cholera either ing or having occurred on board; and 2°, to the imposition of a arantine detention varying in duration from three to six days on sick d healthy alike. It has already been explained that although the itial period of detention might, in the case of Suspected Vessels, tend to six days, it was limited as regards Infected Vessels to five days. The attitude of the British delegation was, as already explained, adverse to all these quarantine restrictions, and in opposing them I was strongly influenced by the knowledge of the great benefits and saving of life which in this country had followed on the system of sanitary administration which had replaced restrictions on the movements of healthy persons, and by the renewed experience of 1884, as to the kThe restrictions as to " Petits Navires " arc more stringent, in so far as two cal inspections, instead of one, are required. 40 impossibility of preventing the development of cholera in Europe by means of the quarantine restrictions in force both in the Red Sea and in Mediterranean ports. I was also impressed with the fact that, whereas the authorities and inhabitants of sanitary districts have, in this country, indicated their belief in a system of sanitary administration on which they rely for the prevention of cholera and other preventible diseases by voluntarily incurring a large expenditure in their efforts to mature it, there was, as regards many countries which professed to trust in the value of quarantine measures an absence of any evidence to show that the authorities so far believed in their efficacy as to have prepared themselves beforehand with the necessary means for the efficient enforcement of those restrictions. .Apr. No. 2. On tins Pro- ceedings of the International Conference held at Rome, ISSS ; liy Dr. Thome Thome. It will be observed that no proposition was submitted by the British delegation with a view of securing the recognition by the Technical Commission of the system of medical inspection as an alternative to that of the quarantine detentions which had been decided on. The point was carefully considered, but it was felt that since the Conclusions arrived at by the Commission were provisional only, the matter could best be dealt with on there-assembling of the Plenary Conference. The adjournments which took place when that event occurred have, hitherto, prevented any action being taken in that direction. One important outcome of the Rome Conference still calls for notice. Just before the date at which it was intended that the Conference should re-assemble, a " Memoire sur la Conference Sanitaire Internationale de Rome " was issued by the Italian Foreign Office, and it was shortly afterwards supplied to the delegates. Dealing, in the first instance, with the Conclusions of the Technical Commission and referring to the " Regime Sanitaire " of the Red Sea and the Suez Canal, the Memoire premises that an understanding between the several Governments on this subject is imperatively called for. It next refers to the existing Egyptian control, and it explains that since the sanitary stations at the Wells of Moses and at El Tor are absolutely deficient in the arrangements on shore which would be necessary for the carrying out of the processes of isolation and disinfection, no attempts are, as a matter of fact, made to carry these processes into effect. Proceeding to review the action which the Technical Commission proposed to substitute for the existing one, it next points out certain reforms which are necessary in the sanitary regulations of the passage of the Suez Canal, and which would have the effect of expediting that passage and of preventing communication with the shores; and then, in an important chapter entitled " Solution de la Question Sanitaire," it proceeds to state that such reforms in the Canal Service as have been indicated in the Memoire would render possible the acceptance, as also the extension to other nations, of the proposal of the British delegation, which was rejected by the Technical Commission, to the effect that British ships, whether merchant vessels, troopships, postal steamers, or others, which neither communicate with Egypt or any foreign port of Europe, should at all times be permitted to pass through the Suez Canal without inspection, as through an arm of the sea. The Memoire then goes on to indicate the desirability of accepting the British proposal, subject, however, to inspection in the Red Sea.* * As to this 1 would point out that the opposition of the British delegation to inspection was clearly defined by me during the sittings of the Technical Commission as being limited solely to such " inspection " as was. in effect, a process preliminary to the imposition of quarantine. 41 (The views expressed in this Meaioire must be regarded as of consider- Apg.No. *• le importance, and this the more so, because they indicate a very OntheTronsiderable advance beyond those which are embodied in the Conclu- internal •° ft '? c ms of the Technical Commission relating to the subject in question. Conferenceheid at Rome, 1885 ; Dr. Thornc Thornp. Papers referred to in the above Report. rculatre adressee par son excellence le mlnistre dcs Affaires Etrangeres de Sa Majeste le Eoi d'ltalie aux Ambassadeurs et Ministres de Sa Majeste. Monsieur, Rome, 21 avril 1885. Par mon telegramme d'hier, je vous a! prie d'inviter Eciellement le gouvernement aupres duquel vous etes accredite a sndre part a, la Conference sanitaire internationale, gui, sur l'initiae dv gouvernement royal, doit so reunir a Rome le 15 dv mois )chain. La pensee gui nous a suggere cette initiative est bien simple. ILa Conference de Constantinople de 1866 avait discute plus partilierement le cote technique dv probleme concernant la sante publique ternationale, selon les resultats dcs etudes accomplies jusqu'alors, rtout en vue dcs conditions de propagation et de transinissibilite dv olera. I La Conference de Yienne de 1874, prenant comrac point de depart i conclusions techniques de la Conference de Constantinople, s'etait orcee de faire un pas plus loin ; elle s'etait propose, en effet, de isiderer et de decider quelles mesures devaient etre regardees, au point vue administratif, comme opportunes et repondant aux desiderata de science, tels que ceux-ci avaient etc eclaircis et .irretes par la inference precedente. lApres la Conference de Vienne on a essaye plusieurs fois et de ferentes manieres de transformer les deliberations que cette Con•ence avait adoptees a titre purement consultatif, en vrais accords ernationaux, destines a fournir a chaque gouvernement la regie nstante et uniforme pour les mesures a adopter en prevision de toute snace d'epidemie. Ces tentatives ont cependant echoue completement jusqu'ici. IL'anarchie la plus complete a continue a. regner en matiere de irantaines ; a chaque apparition d'epidemie, il a fallu echanger tuelleinent, entre les differents gouvernements, dcs explications barrassuntes et dcs reclamations au sujet dcs mesures de precaution jptees par les uns envers les autres sans entente prealable, et ?c dcs consequences desastreuses pour le commerce, livre par suite de diversite dcs regimes sanitaires au hasard de contrals incertains le desordres artificiels. Le gouvernement italien a voulu remedier a cet etat de choses en proposant une Conference sanitaire, au sein de laquelle dcs fonctionnaires competents et dcs hommes ayant la pratique de ces questions, pourront, eu profitant, dans la mesure qu'ils jugeront opportune, dcs etudes precedentes, envisager le probleme sous ses multiples aspects sans aucune idee preconcue et avec entiere liberte d'appreciation, pour aboutir a une serie de conclusions aptes a former l'objet d'a(.'cords internutionaux, dcs que chaque gouvernement aura pu les examiner et 42 La Conference cle Home a necessairement un double objectif d'etudes. Arr. No. 2 Soil premier soin devra etre de rechercher par quels moyens on pourrait prevenir ou etouffer le fle*au dans les pays d'ongine ou aux On the Pro- ceeilings of the international Conference held at Rome, 1885 ; by Dr. Thome Thornc. premieres etapes de sa marche. Ensuite dans la prevision dv cas ou, malgre les mesures preventives le cholera ou une autre maladie contagieuse viendrait a se developper, la Conference devrait etudier et proposer une serie de moyens efficaces pour en empecher la diffusion dans les autres pays en etablissant sur dcs bases rationnelles, dcs regies acceptees dun cominun consentement, et dictees par dcs principea uniformes, soit quant a la duree et a la forme dcs quarantaines, soit pour tout autre emploi de moyens de preservation et de defense. t # Avant qu'on cut adhere a notre invitation, une negociation speciale avait etc entamee entre differentes puissances et l'Egypte relativement a la composition et aux attributions dv conseil sanitaire international d'Alexandrie. Ces negotiations, surtout pour cc gui concerne les raesurea dont Papplication pourrait devenir urgente, ne sauraient etre ni retardees, ni entravees par suite dv programme beaucoup plus etendu dont la Conference internationale est saisie. II reste done entendu que cette negociation poursuivra son cours et que son objet restera etranger aux matieres soumises a la Conference. Celle-ci pourra, toutefois, comprendre les accords gui viendraient a resulter de la negotiation dont il s'agit, dans l'ensemble dcs mesures a proposer pour la preservation internationale de la sante publique. Yeuillez porter sans retard, cc gui precede, a la connaissance dv gouvernement de et lvi presenter le memoire cifoint. Vous aurez soin en meme temps de le prevenir que les vues dv gouvernement italien au sujet dv programme de la Conference ne sauraient prejuger la liberte entiere et absolve dcs gouvernements gui y prendront part, et par consequent dv gouvernement italien lui-meme, de dormer a leurs delegues les instructions qu'ils estimeraient les plus convenables. Reserve expresse est egalement faite aux "¦ouvei'iiements respectifs d'examiner et apprecier en son temps les conclusions de la Conference, pour en faire l'objet dun accord forinel. Agree/., etc. (Signe) Mancini. MEMOIRE. I. — Le Gouvernement italien a etc amene, dcs 1883, a prendre I'initiative dune Conference sanitaire internationale a la suite de l'epidemie cholerique gui a alors desole l'Egypte. Les maux et la crise economique ilont le cholera a etc, l'annee passee, la cause n'ont fait que fe confirmer dans son initiative. Les Conferences sanitaires precedentes, de Paris en 1851-52 et en 1859, de Constantinople en 18G6, de Vienne en 1874, et de Washington en 1881, avaient etc egalement convoquees apres dcs invasions epidemiques. Au moment d'inviter les Etats interesses a prendre part a la Conference de Kome, le Gouvernement dv Rom e pouvait avoir autre motif d'hesitation, sauf la pensee que l'on put mettre en doute l'utilite de semblables Conferences. Aussi a-t-il eu soin de rechercher avec la plus grande attention de quels resultats pratiques, aussi bien que scientifiques, on est redevable aiax Conferences precedentes ; cet examen a pu le convaincre que les Gouvernements auxquels en revient I'initiative, ainsi que ceux gui y ont participe, n'ont pas fait ceuvre sterile. II est bien vrai qu'une seulo Conference, la premiere, a etc suivie Apr. No. 2. dune convention Internationale. Cette convention, signee le 3 fevrier On the Pro- R52 a Paris par les plenipotentiaires de cinq Etats, n'a etc ensuite intenmtionai 16 ifiee que par les Gouvernements de France, de Sardaigne et de ("nferonc^held Kscane; en 186G, lors de l'c'pidemie cholerique et a la suite dcs SLIK^jSL 1 lamations dcs populations, elle tut denoncee par l'ltalie, de sorte Thome. Ba partir dv 3 avril 1867, elle n'etait plus en vigueur. II est t'galent vrai que les quatre Conferences successives ont vte lenues sans qu'aucune convention sanitaire ne s'ensuivit. II y a lieu toutefois de croire que, si l'empressement de la part dcs gouvernements a accepter l'invitation pour ces Conferences ne s'est pas maintenu alors qu'il s'agissait de contracter diplomatiquement l'engagement d'en appliquer les resolutions, cela 11c doit pas etre attribue a la nature de cette Itiere, qu'on a pu presumer ne pas etre apte a former l'objet de )ulations internationales, mais plut&t a la circonstance que les Gouvernements, le moment critique passe, distraits par dcs preoccupations bien plus pressantes, ont cesse d'etre portes a restreindre, a cet ¦ird, leur liberte d'action en vue de sc prcmunir contre dcs dangers ignes et incertains. Notre epoque est caracterisee par lc tres-grand nombre de stipulations que les Etats confluent entre eux pour rt'gler une foule de lirs rapports, non seulement commercial! x par les traites de commerce de navigation, mais aussi de toute autre espece, dcs accords existant sormais pour presque chaque groupe assez important d'interets n'aux et materiels dcs peuples. Toutes sortes de conventions reglent communications postales, t^legraphiques et par chemins de fer, braseant a peu pres l'univers entier, ninsi que les Unions monetaires metriques, pour la protection de la propriete litteraire et industrielle pour toute forme d'assistance recipvoque. II y a done lieu de tonner que le soin de la sante publiiuie, matiere dont l'imporice est extreme, car elle vise a la sauvegarde de la vie humaine, n'ait pas forme l'objet jusqu'ici dune entente Internationale. Cependant, si Ton nest pas encore arrive, comme resultat, a dcs stipulations diplomatiques, on est autorise a esperer c^ue cc but pourra maintenant etre atteint, les Conferences precedentes ayant considerable- nient aplani la voie aux accords future. Un aperfu historique de l'ceuvre de ces Conferences suffira a la demontrer. tl. — La Conf(srence de Paris, en 1859, devait reviser, en les simplit, les dispositions adoptees en 1852, et presenter un projet de vention susceptible d'etre plus facilement acceptc'. Si elle ne put indre son but, e'est que les graves evenements politiques de cette cc et de l'annee suivante empecberent I' adoption dv nouveau projet de convention redige par ses soins. La Conference de Constantinople, provoquee par l'invasion dv cholera 11865, apres avoir entrepris et acheve, au point de vue scientifique, ude generale dv probleme, devait en outre proposer, et proposa en t, dcs mesures pratiques en vue d'empecher le retour de I'epidemie. fut grace aux resolutions qu'elle avait adoptees, au sujet dcs pretions a prendre pour preserver l'Egypte de l'invasion dv cholera la voie de l'Hedjaz, qu'un service sanitaire et quarantenaire put ; organise dune maniere plus satisfaisante dans la Mer Rouge. Les >ositions prises par cette Conference, en cc gui concerne les lazarets tines aux pelerins, purent egalement etre mises en pratique quelque temps apres. La Conference de "Vienne, en 1874, ayant soiimis a un nouvel examen les questions scientifiques, soigneusement etudiees par la Conference 44 precedente, s'occupa aussi de plusieurs mesures speciales et immediates ¦ — ' de preservation. Pour cc gui a trait aux quarantaines maritimes, elle ceedingsTof "the approuva les mesures recommendees par la Conference de Constantiintemationni nople, et notanunent i'institution de quarantaines dans la Mer Rouge et SS 3 Rome, c iBss! d (^ ans la er Caspienne, en ajoutant qu'elles devaient etre etablies et by Dr. Thornc organisees dune facon complete et satisfaisante, selon les principes les pins rigoureux de l'hygiene. Par contre, et pour le cas ou le cholera penetrerait en Europe, elle suggera l'adoption dun systeme d'inspections medicales, en meme temps qu'elle indiquait les bases dun reglement quarantenaire pour les Etats gui prefereraient maintenir les quarantaines ; elle deconseilla les quarantaines terrestres et fluviales et pro- posa la creation dune Commission internationale permanente pour les epidemics. L'oeuvre de la Conference de Vienne fut done dune grande utilite et doit etre justement appreciee. Elle donna lieu a dcs discussions tres importantes, lesquelles, consignees dans les proces-verbaux, offrent une source abondante de serieuse et profonde doctrine, et fournissent en meme temps la reponse aux problemes les plus ardus de la science sanitaire et dcs opidemies, ainsi qu'une nombreuse serie de conseils pratiques et d'application administrative. C'estun travail gui ne pouvait, certes, etre fait que par >.;ne assemblee composee d'hommes speeiaux et hautement competents en fait de politique, d'administration et de medecine. La Conference de Washington cut enfin plus particulierement le but de preparer un systeme international d'informationa periodiques sur l'etat sanitaire dcs ports et dcs localites placees sous la jurisdiction dcs puissances representees dans cette reunion, ainsi que dcs navires partant de ces rnemea ports. Le Gouvernement dv Koi pense que ces donnees hiatoriques, toutes sommaires qu'elles sont, suffisent pour temoigner dcs bienfaits que de pareilles reunions ont pu rendre. Bien qu'elles n'aient abouti, ni a la stipulation d'accords diplomatiques, ni a la realisation d'effets immediats, elles ont toutefois etabli les arrets de la science, de I' experience et de la pratique administrative, en cc gui concerne les questions sanitaires. Les Gouvernements et les me'decins ont pu et pourront y puiser d'utiles enseignements et une regie precieuse alors qu'ila seront appeles a assumer la responsabilite inseparable de l'adoption ou de la reforme de toute mesnre sanitaire. 111. — Quant au programme dcs travaux de la Conference desormais convoquee pour le 15 mai, il convient de rappeler le precedent de la Conference de Constantinople, dont le programme fut trace par un comite, choisi parmi ses membres et charge par elle de cc soin. Tout en se reservant d'enoncer son opinion sur cc point dcs que la Conference se trouvera reunie, le Gouvernement dv Roi croit devoir dcs a present dormer l'indication sommaire de sa maniere de voir a l'egard dv programme. Le mandat de la Conference, l'objet de ses etudes, sera necessairement double : son travail aura une partie technico-scientifique et une autre partie diplomatico- administrative. Quant a la partie technique et scientifique, la Conference pourrait reprendre en examen les conclusions dcs Conferences sanitaires precedentes, et notamment de celle de Vienne, pour voir cc qu'il y a lieu d'er, conserve!- ou d'en modifier, cc qu'il convient d'en retrancher ou d'y ajouter. Cette revision offrirait deju, a elle seule, ala Conference un vaste champ d'activite, si Ton veut tenir compte dcs progres realises dans les sciences medicales et sanitaires et de l'exue- 45 rience successivement acquise par les administrations ties differents Ait. No. 2 Etals On (hcPro- » Passant ensuite a examiner, dans le domaine diplomatique efc feedings of the • . . .•n i .« t / . PV - r l • , International nv.nistratir, Ja question dcs moyens preventus a adopter, cv egard conference held ssi aux interets dv commerce et a la liberte de la navigation, la oy'iVr^fhorae Conference aurait a arreter les bases dun accord international accep- Thome. Ible par tous les gouvernement3. Cet accord devrait avoir pour but, it d'otouffer, si possible, la maladie a ses debuts, 011 d'en enrayer la arclie dcs ses premieres manifestations, soit encore de prevoir le cas 1, ac developpant malgre toutes les precautions prises, le cholera ou ule autrc maladie contagieuse comporterait I' adoption de mesures eciales, aptes aen empecher la diffusion. On etablirait ainsi, sur !S bases rationnelles et d'apres dcs principes uniformes, les regies a ivr'e par rapport, soit a la duree et au systeme dcs quarantaines, soit a l'emploi d'autre moyens de preservation et de defense. La Conference pourrait enfin formuler les regies pratiques et positives liur I'application immediate dv systeme international d' informations nitaires, suggere par la Conference de Washington, et auquel se ttache la question de l'etablissement, dans line localite opportune, une Agence officielle, oules nouvelles sanitaires de source sure seraient ncentrees, et d'ou elles seraient transmises aux Gouvernements faisant utie d'uue Union sanitaire Internationale et contribuant aux frais gui 1 resulieraient. L' Union serait, elle-meme, constitute avec dcs attri- butions et d'apres dcs principes fixes par la Conference. Tellea sont les vnes dv Gouvernement italien au sujet dcs lignes generates dv programme a adopter. Ces vues ne sauraient, cependant, prejuger la liberte entiere et absolve dcs Gouvernements gui interviendront a la Conference, et par consequent dv Gouvernement italien ui-meme, de dormer a leurs delegues les instructions qu'ils estimeraient les plus convenables, ainsi que d'apprecier, en son temps, les proposi- tns et les conclusions de la Conference. Rome, 20 Avril 1885. RELEVB DES CONCLUSIONS ADOPTEES PAR LA COMMISSION TECHNIQUE DE LA CONFERENCE SANITAIRE INTERNATIONALE DE ROME (1885). I. iNFORSrATION SANITAIRE. 1. II est necessaire que, dans chaque pays, il existe un bureau central d'informations et d' avert issements sanitaires ; tous ces bureaux echangeront, entre eux, dcs correspondances et dcs communications regulieres. Adoptee par 18 oui, contre 1 non (Suisse) et 1 abstention (Pays-Bas). 2. La Commission techique exprime le voeu que la Conference intertionale affirme la necessite de publier un bulletin de statistique interionale pour chaque ville importante, bulletin ayant une base et une nule uniformes et faisant connaitre, chaque semaine, le total dcs es et le nombre de morts causees par chacune dcs maladies epidemes et en partieulier par le cholera et la fievre jaune. fdoptee a l'unanimite, sauf les delegues de la Russie et de la Turquie, se sont abstenus. 3. En cc gui concerne le cholera et la fievre jaune, les premiers cas gui eclateront dans les differentes localites et specialement dans les ports maritimes, devront etre notifies directement, par voie telegraphique, aux differents Gouvernements. Adoptee a l'unanimite. 46 App. No. 2. 11. On the Pro- Prophylaxie Sanitaire dv Cholera, feedings of the International Conference held Regie gdndrale dc Prophylaxie. 4. L'assainissement et l'isolement reel et conuplet, dans la mesure indiquee par la science, de tout cc gui peut apporter le cholera, sont les raeilleurs moyens d'en empecher l'importation et la propagation. Adoptee en principe. Disinfection. 5. La Sous Commission recommande conime moyens de disinfection contre les epidemics de cholera, outre la destruction : 1° la vapeur a 100° ; 2° l'acide phenique, le chlorure tie chaux ; 3° l'aeration. On preparera chaque fois dcs solutions aqueuses d'acide phenique et de chlorure de chaux : Fnibles de 2 °/o/ o d'acide phenique, de 1 °/o/ o de chlorure de chaux, Fortes de 5 °/o/ o d'acide phenique, de 4 °/o/ o de chlorure de chaux. [[/application de ces moyens serait comme suit : I. Pour la disinfection dcs personnes, lavages et bains avec l'une dcs solutions faibles : 11. Pour la disinfection dcs linges, dcs habits, dcs couvertures et d'autres effets dv meme genre : (a) La destruction ; (b) La vapeur qu'on fait passer a travers ces objets pendant une heure ; (c) L' ebullition pendant 30 minutes ; (d) L'immersion j)our 24 heures dans l'une dcs solutions faibles ; (c) L'aeration (la sereine) pendant trois ou quatre semaines, mais seulement pour les cas ou aucun dcs autres moyens nest applicable. Les objets en cuir, comme malles, bottes, etc., seront ou detruits ou laves a plusieurs reprises avec l'une dcs solutions faibles. 111. Les vomissements et les dejections seront meles avec l'une dcs solutions fortes. Les pieces de linge, d'habits, de couvertures et de literie, recemment souillees, gui ne peuvent etre immcdiatement soumises a la vapeur, seront de suite plongees dans les memes solutions fortes et y resteront 4 heures. IV. Les cadavres ne doivent pas etre lav£s. On les enveloppera soigneu^ement de draps trempes dune dcs deux solutions fortes, et on les mettra immediatement dans le cercueil. V. La disinfection dcs marchandises et dcs colis de poste est superfine. (La vapeur sous pression serait le seul moyen, si on voulait desinfecter les chiffons en gros.) VI. Pour la disinfection dcs navires pendant la traversee, on desinfectera le pont et la classe, ou l'accident cholerique ou suspect a eu lieu ; on lavera les parois de la cabine, ou dv local, au moms deux fois, avec l'une dcs solutions faibles, puis on les soumettra a l'aeration. Dans le cas ou dcs objets de grande valeur n'auraient pas etc en contact immediat avec l'accident cholerique ou suspect et une desinfection rigoureuse amenerait une perte de cc rnobilier, gui ne serait pas justifiee, le medecin dv bord arretera les niesures gui devront suffire a sauvegarder l'interet sanitaire. L'eau dcs cales sera pompee et remplacee par l'eau de iner au moms deux fois a chaaue desinfection. 47 Les water-closets seront bien laves avec les solutions fortes, au moms App. No. 2. deux fois, par jour. On the Pro- VII. Si l'eau potable est suspecte, on doit la faire bouillir avant de ceodinss of tho s'en servir et, si on ne Putilise qu'apres 24 heures, l'ebullition doit etre ConTroncTheki rt'petee. n 1 t I*. • • by Dr. Tliorno lous les aliments suspects seront ou detruits, ou au moms cuits de Thome. nouveau. VIII. Pour les h6pitaux a, terre, toutes les parois dcs salles seront lavees avec l'une dcs solutions faibles, puis aerees, puis nettoyees, enfin repeintes, en separant, autant que possible, dcs autres la salle sujette a la disinfection. Les latrines seront desinfectees, au moms deux fois par jour, en y versant dcs solutions fortes en quantite au moms egale a celle dcs dejections recueillies depuis la derniere disinfection. IX. Les habits dv personnel resteront toujours a l'hdpital et seront regulierement desinfectes. Pour ses lavages, le personnel so servira dcs solutions faibles. Adoptee a l'unanimite, sauf le delegue de la Turquie, gui a vote contre. (a) Propiiylaxie Sanitaire Terrkstre. G. Les quarantaines de terre et les cordons sanitaires sont inutiles. Adoptee par 20 oui, contre 1 non (Turquie). K. Pour prevenir le developpement dv cholera et sa propagation par les munications terrestres, il faut : 11°. Assainir partout et en tout temps, isoler les premiers cas et desinter. Les moyens d'isolement et de disinfection doivent etre prepares vance, sur l'avis de l'autorite sanitaire ; 12°. Denoncer immediatement chaque cas declare ou suspect de cholera, [vi de droit, selon les regies dv pays, et faire constater par dcs decins competents la nature de la maladie ou les causes de la mort au yen de l'autopsie ; I>°. Qu'il y ait dans chaque pays un service medical hygienique orga''. Dcs fonctionnaires devront etre etablis dans les districts et les icipales villes en nombre suffisant pour qu'aucun point habite ne reste dehors de cette surveillance hygienique ; B°. Que les autorites d'hygiene publique dcs difPerents pays puissent so tre en communication directe, sans intermediaire, chaque fois qu'elles uiront besom, pour se renseigner ou pour s' entendre, sur dcs mesures ¦gence a, prendre. Adoptee a l'unanimite. En temps de cholera : 8. Une attention toute particuliere est due aux grands chemins, sur lesquels peuvent voyager dcs malades choleriques et aux points d'arrivee principaux, afin de pouvoir appliquer, en temps utile, l'assainissement, isoler le malade et operer la desinfection. Adoptee a l'unanimite. 9. Sur les grandes routes terrestres, que parcourent dcs masses d'ouvriers ou d'emigrants, seront places, autant que possible, aux stations principales, dcs medecins pour preter leurs soins aux malades. Adoptee a l'unanimite. 10. Les trains directs parcourant plusieurs pays devront etre changes au passage dun pays contamine dans un pays indemne. Us devront etre ¦mipagnes dun medecin gui prendra les mesures necessaires dans le ou un voyageur tomberait malade pendant le trajet. Une proprete rigoureuse sera observee sur les trains et aux stations dcs 48 Api>. No. t. chemins de fer. Chaque station devra avoir au moms une chambre On the Pr- separee dcs autres, pour recevoir provisoirement le inalade. coeclinßsofthe Adoptee par 10 oui (Autriche, Hongrie, Bresil, Danemork, Espagne, Conference hold Italie > Mexique, Portugal, Serbie, Suisse), contre 6 non (Allemagne, France, Pavs-Bas, Koumanie, Suede, Norvege) et 5 abstentions (Etats- at Rome, 1885 ; by Dr. Thome Thorno. Unis de l'Amerique dv Nord, Grande-Bretagne, Inde, Russie, Turquie). 11. La disinfection dcs personnes ne doit se faire qu'au moyen de lavages disinfectants, et seulcment dans les cas, ou elles seraient souillees de dejections clioleriqnes. Adoptee a l'unanimite, moms une abstention (Espagne). 12. Toute provenance dun pays, ou existe le cholera, n'etant pas necessairement infectee, on ne desinfectera que cc gui est souille, ou peut avoir etc a I'usage dcs eholeriques, et particulierement les linges, les habits et les chiffons. Adoptee ;"i l'unanimite, moms «ne abstention (Turquie). 13. Les regies d'hygiene generale, surtout en cc gui concerne les agglomerations d'individus, rapprovisionnement dcs marches, les vivres, I'eau potable, le transport dcs malades, I'enterrement dcs cadavres, etc., etc., applicables en tout temps, devront etre encore plus rigoureusement suivies en temps de cholera. Adoptee a l'unanimite. (is) Propiivlaxie Sanitaire Fluviale. 14. Les ports dcs fleuves, ou abordent dcs navires traversant la mer, doivcnt etre sou mis au meme regime que les ports de mer. Adoptee a Funaniinite. 15. Les bateaux <|vi desservent les grands fleuves devront etre soumis a une hygiene rigoureuse. L'encombrement dcs passagers sera strictement interdit. Un medecin sera attache a chaque point de relache important et, dans cha(]iie station, une chambre convenablement isolee devra etre preparee. Adoptee a l'unanimite, moms une abstention (Turquie). (c) Prophylaxie Sanitaire Maritime. Mesures Sanitaires Generales. Ports. 16. II est de Pinteret de chaque nation d'assurer la salubrite de ses ports de mer. Elle evitera souvent ainsi l'invasion de son sol par les maladies exotiques, et surtout elle ne transportera que rarement sur ses vaisseaux les maladies endemiques. Adoptee a l'unanimite. 17. Dans chaque port il serait necessaire qu'il y cut toujours une autorite sanitaire ayant mission de fournir aux consuls dcs informations officielles sur l'etat sanitaire de cc port. Adoptee a runanimite. 18. II sera accorde aux consuls la faculte de puiser aux bureaux d'hygiene leurs renseignements sur l'etat sanitaire dcs ports et dcs villes. Adoptee par 10 oui (Autriche, Hongrie, Etats-Unis de l'Amerique dv Nord, France, Italic, Mexique, Pays-Bas, Portugal, Russie, Suisse), contre 2 non (Roumanie, Turquie) et 8 abstentions (Allemagne, Bresil, Danemark, Grande-Bretagne, Inde, Japon, Suede, Norvege). 19. Chaque navire, destine au transport dcs voyageurs, gui part dun port suspect devra etre convenablement construit et posseder dcs locaux gui permettent l'isolement dcs choleriques. Adoptee a l'unanimite. 49 20. Les paquebots provenant dcs pays oil regne le cholera, seront App. No. 2 ¦tenus d'avoir une etuve de disinfection par la vapeur. On the Pro- On the Pro- i Adoptee a l'unanitnite. ceedingsof the 21. Les batiments a vapeur, destines au transport dcs voyageurs coifferenc^hcid jvenant de pays ou regne le cholera, seront tenus d'avoir a bord un ?* > m mmil mi 18 r 86 0 i ¦decin, nonime par le gouvernement, auquel appartient le bateau, ou Thome. :n par l'autorite sanitaire, revocable seuletnent par cc gouvernement cette autorite, et completement independent dcs compagnies de navi- gation et dcs armateurs dcs bateaux. Adoptee par 19 oui, contre 2 abstentions (Suede, Ncrvege). Mesures Sanitaires Specialks § 1. Mesures d'Assaixissement au Point de Depart. Grands Paquebots. 12. Le consul dv pays de destination aura le droit d'assister aux lections sanitaires dv navire gui seront faites par les agents de torite I erritoriale, conformement aux regies gui seront etablies par conventions ou dcs traites. lidoptee par 8 oui (Autriche, Ilongrie, Danemark, fitats-Unis de merique dv Nord, Italic, Pays-Bas, Portugal, kSuede), 8 abstenis (Allemagne, Bresil, Espagne, France, Mexique, Norvege, llussie, isse), 6 non (Grande-Bretagne, Inde, Japon, lloumanie, Serbie, r([uie). I! 3. Le chargement dv navire ne commencera que lorsque son netage aura etc opere, soit par les rnoyens ordinaires, soit par un proe special de desinfection, si cela aura etc juge necessaire. II sera to, a cet effet, par le capitaine et lo niedecin dv bord. Le resultat la visite sera relate sur le registre dv bord. Adoptee a I 1I 1 unanimity. 24. Le medecin examinera les passagers gui se presenteront pour embarquer, provenant dun port ou regne le cholera. II refusera ceux gui lvi paraitront suspects de cholera. Adoptee a Punanimite, moms une abstention (Turquie). 85. Pour ceux gui lvi sembleront dans de bonnes conditions, il veillera qu'ils n'lntroduisent pas a bord dcs linges, dcs liardes ou dcs objets iterie, souilles ou suspects. Adoptee a l'unanimite. 26. Les vetements et les objets de literie ayant servi aux individus niorts dv cholera ne devront jamais etre acceptes. Adoptee a, l'unaniraite. 117. Lorsque le cholera se montre a bord dv navire pendant le sejour s un port containing les malades chez lesquels les premiers syraples de cette affection auront etc constates, seront immediatement ges sur l'hdpital, et tous lenrs effets, ainsi que les objets de literie, leur auront servi, seront detruits ou desinfectes. En outre, droit dans lequel le cholerique se trouvait, sera imnx'jdiatement nfecte. Adoptee a l'unanimite. 28. Les sacs renfermant les vetements d'individus ayant succombe a l'etranger seront desinfectes avant le depart. Adoptee a l'unanimite. Pciits Navires 29. Au point de vue sanitaire, il faut distinguer deux sortes de navires : ceux gui ont un medecia et ceux gui n'en ont pas. On doit E 20,'i10. 1) 50 App^No. 2. considerer ces derniers comme petits navires, quels que soient leur n the Pro- tonnage et le chiffre do leur equipage, qu'ils soient a voile ou a ceedings of the vaneur International vapeui . Conference held Adoptee a l'unanimite, moms l'Espagne gui a vote non. at Rome, 1885; Qf , \ v l ,1™ „„?,•*„ — :„„„ !„ ;:„„,•*„;„„ A~U c'o,l™- 30. A bord dcs petits navires, le capitaine doit s'adresser au consul by Dr. Thome Thome. dv pays de destination dv navire, pour qu'il fasse vLsiter son navire par Un medecin avant le chargement et pour que cc dernier examine les passagers. Cette visite est independante de l'inspection, gui releve de l'autorite sanitaire dv port. Adoptee par 20 oui, coutre 1 non (Bresil) et 1 abstention (Turquie). 31. Le resultat de cette visite, ainsi que I'indication dcs mesures de propretc et de disinfection, seront consignes sur le registre dv bord. Adoptee a l'unanimite moms unc abstention (Turquie). 32. Le lest ne doit jamais etre constitue par de la terre ou dcs materiaux poreux. Adoptee a l'unanimite. 33. Le capitaine veillera a cc qu'on n'introduise ni linge, ni hardes ni objets de literie souilles ou suspects. Adoptee a l'unanimite. § 2. Mesures d'Assainissement pendant la Traversee. Grands Paquebots. Navires Suspects. 34. Le linge de corps dcs passagers et de l'equipage, sali ou souille, sera lave le jour meme, apres avoir etc plonge dans Feau bouillante ou dans une solution desinfectante. Adoptee a l'unanimite. 35. Les lieux d'aisance seront laves et desinfectes, au moms deux fois par jour. Adoptee a l'unanimite. 3(3. Une j^roprete rigourcuse, une ventilation active seront maintenues, pendant toute la traversee, a bord dcs navires suspects. Adoptee li l'unanimite. Navires Infectes. 37. Dcs que le medecin constatera les premiers signes dv cliolera il avisera immediatement le capitaine et prendra, de concert avec lvi» les mesures necessaires pour isoler les malades dv reste dv personnel. Adoptee a l'unanimite. 38. Les locaux ayant etc occupes par dcs choleriques seront immediatement desinfectes. Adoptee a l'unanimite. 39. Autant que possible, les locaux ainsi desinfectes resteront largement ouverts et isoles, et ne recevront aucun autre passager en sante pendant toute la traversee. Adoptee par 19 oui, contre 1 non (Espagne) et 2 abstentions (Grande Bretagne et Inde). Petits Navires. 40. Pendant la traversee, le capitaine devra prendre toutes les mesures necessaires pour la disinfection dv linge dcs passagers et de P equipage, pour l'isolement dcs malades, en cas d'infection cliolerique et pour la disinfection dcs locaux. 11 consigne le tout sur le registre dv bord. A.doi}tee li l'unanimite 51 K4l. Pour le mettre a meme de remplir ces fonctions, il lvi sera remis App. No. 2. depart, par le consul de sa nation, une instruction sanitaire, claire on the~Proconcise, gui sera ulterieurement redigee. Cette instruction sera j^ dillg ! i° f *^ c iduite en difterentes langues, ofFerte aux divers Gouvernements et Coifferenco^eid distribute. ?* ?? m ,S, 1885 ; Dr. Thome Adoptee 11 l'unanimite, moms une abstention (Bresil). Thome. DISPOSITIONS SPKCIALES POUR LA MER EOUGE Grands Paquebots. Navircs Suspects. 142. Tous les batiments a vapeur provenant dcs ports infectes de olera au dela dv detroit de Bab-el- Man deb subiront, dans la Mer >uge, une inspection medicale. I Adoptee par 16 oui, contre 4 non (Bresil, Espagne, Grande-Bretagnede) et 2 abstentions (Etats-Unis de l'Amerique dv Nord, Japon). 43. Cette visite sera faite par un niedecin dv port, independent. Adoptee par 17 oui, contre 1 non (Espagne), et 4 abstentions (Etats- Unis de l'Amerique dv Nord, Grande-Bretagne, Inde, Japon). 44. Si le niedecin dv navire certifie que les mesures d'assainissemont ont etc prises au point de depart, que les mesures d'assainissement et de disinfection ont etc observees pendant la traversee, qu'il ny a eu, pendant le voyage, ni mort, ni malade, ni suspect de cholera, enfin si l'examen medical fait par le medecin dv port lvi permet de constater qu'il n'existe personne atteint ou suspect de cette maladie, la libre pratique immediate sera accordee. B Adoptee par 17 oui, contre 1 non (Espagne) et 4 abstentions (Etatsis de l'Amerique dv Nord, Grande-Bretagne, Inde, Japon). Kl5. Les batiments gui ne laisseront pas de voyageurs dans les ports de Mer Rouge, ni en particulier et Egypte, subiront une seule inspection dicale pres de Suez. Adoptee par 16 oui, contre 2 non (Espagne, Turquie) et 4 abstentions (Etats-Unis de PArnerique dv Nord, Grande-Bretagne, Inde, Japon). K[6. Les batiments gui auront dcs passagers a destination de l'Egypte de tout autre port de la Mer Rouge, subiront une premiere inspecl pres dv detroit de Bab-el-Mandeb, et une secoude au premier port K Adoptee par 17 oui, contre 1 non (Espagne) et 4 abstentions (Etatsis de l'Amerique dv Nord, Grande-Bretagne, Inde, Japon). Navires Infectes 17. Si le navire est infecte, c'est-a-dire s'il y a, ou s'il y a eu a bord ou plusieurs choleri(mes, les passagers seront debarques et isoles, ares par groupes chacun aussi peu nombreux que possible. I Adoptee par 18 oui, contre 2 non (Grande-Bretagne, Inde) et 2 tentions (Bresil, Japon). 88. Le navire, les vetements et les effets d'usage dcs gens tie I'oqui o et dcs passagers seront desinfectes. Adoptee par 19 oui et 3 abstentions (Grande-Bretagne, Inde Mexique). 49. Les passagers et les gens de l'equipage seront soumis a une observation de cinq jours. ILdoptee par 13 oui (Allemagne, Autriehe, Hongrie, Danemark, ncej Jtalie, Japon, Pays-Bas, Portugal, Russie, Suede, Norvege, sse), contre 9 non (Bresil, Espagne, Etats-Unis de l'Amerique dv •d, Grande-Bretagne, Inde, Mexique, Roumanie, Serbie, Turquie). d 2 52 50. Les malades seront isoles, remis aux soins et places sous la responsabilite dcs medecins. App. No. 2. On the pro- Adoptee par 18 oui, contre 1 non (Bresil) et 2 abstentions (Grande- Bretagne, Inde). Petits Navires. 51. Les petits navires venant de I' Ocean indien et entrant dans la Mer Eouge, s'ils debarquent dcs passagers dans la Mer Rouge, devront etre traites corarae les grands navires, gui sont dans le raerae cas ; lorsqu'ils ne font que pareourir cette mer pour passer de I' Ocean indien dans la Mediterranee, ils subiront une double visite, l'une a l'entree de la Mer Eouge, I'autre a Suez. S'ils sont indemnes, ils continueront leur chemin ; s'ils ont eu de dcs choleriques, ils seront traites comme les grands navires infectes. Adoptee par 17 oui, contre 1 non (Espagne) et 4 abstentions (Bresil, Grande- Bretagne, Inde, Turquie). Pklerinage a la. Mecque. 52. II est desirable que chaque pelerin possede les ressources necessaires pour, etre a l'abri dcs privations pendant son pelerinage a la Meeque, cc gui d'ailleurs est conforme aux prescriptions religieuses musulmanes et adopte par le gouvcrnement dcs Indes neerlandaises. Cettc mesure previendra la misere, une dcs causes les plus importantes de l'extension dv cholera parmi les pelerins. Adoptee a 1' unanimity. 53. Chaque navire a pelerins et chaqne caravane seront accompagnes par un nombre suffisant de medecins, designes par le gouvernement dv pays oil se forme le convoi. Adoptee a l'unanimite. 51. Un navire sera considere comme navire a pelerins, s'il a a bord plus de trente pelerins. Adoptee a l'unanimite. 55. Dans les ports oil existe le cholera, avant I'embarquement dcs pelerins, le navire sera nettoye et desinfecte, visite par son medeein et, en outre, par l'autorite sanitaire dv port. Le modecin dv navire examinera chaque personne ; il n'admettra que celles gui ne sont ni malades, ni suspectes de cholera. II veillera a cc que Ton n'introduise pas a bord dcs linges, dcs hardes, dcs objets de literie ou autres elTets dv memo genre souilles ou suspect. Tous les effets provenant d'endroits contamines ou suspects de cholera seront desinfectes avant l'embarque-. ment. Les vetements et objet.s de literie ayant servi aux malades choleriques ne seront jamais ad mis a bord. Si le cholera se manifeste a bord, les malades seront de suite diriges sur l'hopital et l'endroit qu'ils occupaient dans le navire sera immediatement desinfecte. Adoptee a l'unanimite. 56. L'autorite sanitaire dv port d'embarquement et le medeein dv bord veilleront ace qu'il ny ait pas d'encoinbrement. Un navire a, vapeur doit avoir dans les entreponts au moiiis 9 pieds de surface et 54 pieds cubes d'espace, pour chaque passager. A bord dcs voiliers chaque passager doit avoir 12 pieds de surface et 72 pieds cubes d'espace. Adoptee a l'unanimite, 57. Pendant la traversee, le medecin dv bord veillera a cc qu'une proprete rigoureuse et une ventilation active soient maintenues, a cc que tout linge sali ou souille soit lave le meme jour et disinfecte, et 53 ace que les lieux d'aisance soiont laves et desinfectes au moms deux App - No. 2, lis par jour. On the Pro- Adoptee a l'unanimite. ceedingsof the .„ i, , , , . i,/ i^M -, international 00. Jin general, toutes les mesures adoptees par le Gouvernement de Conference held fnde britannique relativeinent a l'embarquement et au transport dcs by Di\Thonfe lerins dcs Indes dans la Mer Rouge, sont recommendees a I' adoption Thome, tous les pays d'ou partent dcs pelerins. Adoptee a l'unanimite. 159. Tout navire a pelerins, arrive dans la Mer Rouge, fera escale a station sanitaire, ou il subira une inspection medicale rigoureuse. i visite dcs passagers et de l'equipage sera faite a terre. Le navire les effets dcs passagers et de l'equipage seront desinfectes, puis capitaine prendra les mesures necessaires pour assurer le nettoyage mplet dv navire, le lavage dcs efFets dcs passagers et do l'equipage. ISi le medeein dv bord certifie que toutes les mesures d'assainissement de disinfection out etc prises avant le depart, que les mesures d'assaiisement et de disinfection ont etc observers pendant la traversee, 'il ny a eu pendant le voyage ni mort, ni malade, ni suspect de lolera, enfin si l'examen medical, fait deux fois pendant 24 heures, par medecin de la station sanitaire, permet de constater qu'il n'existe raonne atteint ou suspect de cholera, le navire pourra reembarquer et se rendre au port de sa destination definitive au liedjaz. Si le navire est sans medecin, ou s'il y a eu dcs accidents de cholera, ou dcs cas suspects a bord pendant la traversee, ou si ces nieines acci- iits surviennent a I'arrivee dv navire a la station sanitaire, il sera le pendant cinq jours et desinfecte ainsi que tou3 les effets dcs ssagers et de l'equipage. Les passagers et les gens de l'equipage ont isoles a terre pendant cinq jours. Les malades et les suspects ont isoles par groupes separes. Les valides seront repartis en tupes dont chacun ne pourra s'embarquer qu'apres cinq jours sans :un accident, comptes depuie la separation dv dernier malade, s'il y en v eu. Le navire sera autorise a se rendre au port de sa destination definitive au Hedjaz, quant il aura embarque tons les grouped de passagers, sauf lea personnes gui ont etc isolees pour cause tie contamination et gui n'ont pas encore subi le temps d' observation reglementaire. Adoptee par 1G oui, contre 5 non (Bresil, Espagne, Mexi<^ue, Serbie, Turquie). 60. A son arrivee au Hedjaz, le navire subira de nouveau une inspection medicale rigoureuse. Un delai de 24 heures sera accorde au medecin dv port, s'il le juge necessaire, pour formuler le resullat de ses constatations sanitaires. Si le medecin de bord certifie qu'il ny a eu aucun accident cholerique ou suspect depuia que le navire a quitte la station sanitaire, et si I'inepection i'aite par le medeciu dv port, permet de con stater qu'il ny a eu ni mort, ni cas de cholera, le navire aura de suite libre pratique. Si, au contraire, il y a eu dcs cas choleriques ou suspects, le uavire devra imme"diatement retourner a la station sanitaire pour y subir de nouveau toutes les mesures d'observation, d'isolement et de desinfection decrites dans Particle precedent. Adoptee a l'unanimite, 61. Les medecins presents, ceux gui auront etc delegues ou envoyes en mission, ainsi que ceux gui seront arrives avec les navires, ou avec les caravanes, suivront les pelerins pendant toute la duree dv pelerinage. Us seront charges d'assurer le service sanitaire, de facon a prevenir le i\' plrtni pnicnt di rliol M-a narmi Ips nMprins et «i I'eDidemie echltait ils 54 devront soigner les malades et avertir, le plus rapidement possible, les Gouvernemcnts interesses. App. No. 2. On the Pro- I national me, 1885 ; Adoptee a l'unanimite. 62. II est de necessite absolve que les mesures d'assainissement soient large'ment applique"es aux lieux ou sejournent les pelerins, et surtout aux villes saintes dv lleiljaz. Adoptee a l'unanimite, nioins une abstention (Turquie). 63. Si pendant toute la duree dv pelerinage, il ny a pas eu d'accident cholerique, les navires a pelerins subiront a leur retour une inspection medicale rigoureuse au port d'embarquement dv Hedjaz. Les uavires » destination^ l'Egypte et ceux gui doivent passer par le canal maritime dans la Mediterranee, subiront une seconde inspection, les premiers dans ports egvptiens, et les autres (ceux a destination de la Medilerranee) pros de Suez. Cette deuxieme inspection decidera si ces navires peuvent etre eonsideres coimne nets, ou s'ils doivent etre soumis a l'observation et a, la desinfection. Adoptee a l'unanimite, moms deux abstentions (Grande-Bretagne et l'lnde). 64. Si pendant le pelerinage, il y a eu dcs accidents choleriques, les navires a destination dcs ports de I'Egypte et de la Mediterranee seront envoyes a la station sanitaire, ou ils subiront une observation de cinq jours a compter de risolcment dcs malades et la desinfection complete dcs etFets et dcs navires, dans les conditions indiquees pour l'arrivee dcs navires infectes ou suspects ; puis ils subiront une seconde inspection medicale dans les ports d'arrivee en Egypte ou pres de Suez. Adoptee par 14 oui, contre 5 mm (Bresil, Espagne, Mexique, Serbie, Turquie) et 2 abstentions (Grande-Bretagne, Inde). 65. Les petits navires venant de FOcean Indien, et entrant dans la Mer Rouge, s'ils sont charges de pelerins, subiront le regime special dcs navires A pelerins. Adoptee par 17 oui, contre 1 uon (Espagne) et 4 abstentions (Bresil, Grande-Bretagne, Inde, Turquie). 66- La Commission technique u'a pas autorite pour fixer les lieux ou seront etablies les stations sanitaires et ceux ou se feront les inspections medicales, mais les renseigneinents qu'elle possede lvi permettent de croire que, sous le rapport sanitaire, File de Camaran pour les navires a pelerins venant dv sud, Aioun Ouna et la cote d'Attaka pour ceux gui reviennent dv pelerinage de la Mecque et gui se dirigeut vers les ports de l'Egypte ou de la Mediterranee, presentent dcs conditions convenables. Adoptee a l'unanimite Code Penal Sanitaire pouk la Mer Rouge 67. La Commission technique exprime le voeu que In Conference sanitaire intern ationale pose les bases dun code penal international applicable aux contraventions sanitaires commises dans la Mer Rouge. Adoptee a l'unanimite sauf deux al)stentions (Grande-Bretagne, Inde). §3. Mesures d'Assainisseuent 1 t/Ahiuvee. Navires Suspects. 68. La libre pratique ne sera accordee qu'apres une inspection sanitaire faite de jour et par un medecin dv port d'arrivee, inspection gui devra etablir I'etat sanitaire exact dcs passagers et de l'equipage et 55 constater que les mesures d'assainissement et de desinfection ont etc App.No. 2. rigoureusement executees, au point de depart et pendant la traversee. Onthe~Pro- t Adoptee par 17 oui, 2 non (Bresil, Espagne) 2 abstentions (Dane- i^j",^;^ 6 irk, Portugal). Conference hel Conference held 169. Les passagers recevront libre pratique, s'il ny a, on s'il ny a eu, ff i^liionfo 5 bord ni mort, ni malade, ni .suspect de cholera. Thome. Adoptee par 15 oui, 3 non (Bresil, Espagne, Mexique), 3 abstentions •anemark, Grande-Bretagne, Inde). 170. Dans le cas ou la traversee a dure moms de dix jours, il y aura c observation de 24 heures et une desinfection a bord dv linge sale et i effets a usage. 10 Adoptee par 11 oui, 6 non (Bresil, Espagne, Etats-Unis de l'Amerique s Nord, Grande-Bretagne, Inde, Mexique), 1 abstentions (Autriche, anemark, Serbie, Turquie). Navire s Infectes, Malades. 71. Les malades seront immediatement debarques dans un local isole. I Adoptee a l'unanimite, moms le delegue de la Turquie, gui s'est stenu. 72. La desinfection aura lieu, comme il est (lit dans les articles qu reglementent la desinfectio Adoptee a l'unanimite. Passagers ct Equipage. 73. Les passagers et I' equipage seront isoles. I Adoptee par 17 oui, contre 2 non (Grande-Bretagne, Inde), et 2 stentions (Etats-Unis de i'Araerique dv Nord, Russie). 74. Cet isolement- durera cinq jours. I Adoptee par 11 oui, contre 8 non (Bresil, Espagne, Grande-Bretagne, :le, Mexicpie, Roumanie, Serbie, Turquie), et 2 abstentions (Danemark, ats-Unis de l'Amerique dv Nord). 175. Dans le ens on, d'apres le certiticat dv medeciu dv bord, il ny rait pas eu a bord ties cas de cholera depuis dix jours, I' observation urra etre reduite a 24 heures. Adoptee par 10 oui (Allemagne, Autriche, Hongrie, France, Italic. Pays-Bas, Russie, Suede, Norvege, Suisse), contre 7 non (Bresil, Espagne, Mexique, Portugal, Roumanie, Serbie, Turquie), et 4 abstentions (Danemark, Etats-Unis de l'Amerique dv Nord, Grande-Bretagne, inde). 7G. Les passagers seront divises par groupes, chacun aussi peu nombreux que possible, de facon a, cc que, si dcs accidents se montraient dans un groupe, la duree de I' isolement ne flit pas augmentee pour tous. Adoptee par 18 oui, contre 3 abstentions (Etats-Unis de l'Amerique dv Nord, Grande-Bretagne, Inde). 77. L'autorite sanitaire prendra les mesures qu'elle jugera necessaires pour la desinfection, et prescrira les moyens prophylactiques dont les princqjes ont etc adojites par la Conference. Adoptee par 18 oui, contre 3 abstentions (Danemark, Grande-Bretagne, Inde). Navires. 78. Le navire sera desinfecte suivant les regies donnees dans les articles consacres ala desinfection. Toutes les operations de desinfection dv navire seront faites en presence et sous la responsabilite dv chef de l'autorite sanitaire dv port d'arrivee. Adoptee a l'unanimite. 56 Arr. Xo. 2. Dispositions Speciales a la Mediteruanee On the Pro- Navires Suspects. ceedings of the International Conference held 79. Les passagers et I' equipage seront debarques dans un local isole, bv^r?Thonio ; construit dans cc but avec toutes les conditions necessaires pour realiser Dr. Thome Tiiome. la disinfection et l'isolement. Adoptee par 10 oui (Bresil, Danemark, Espagne, France, Italic, Mexique, Portugal, Houmanie, Serbie, Turquie), contre 4 non (Autriche, Hongrie, Grande-Bretngne, Inde), et 7 abstentions (Allemagne, Etats- Unis de l'Amerique dv Nord, Pays-Bas, Russie, Suede, Norvege, Suede). 80. Get isolement variera de trois a six jours pleins, suivant les conditions dv navire, qu'il s'agisse dun grand paquebot on dun petit navire, qu'il y ait, ou non, un medecin a bord. Adoptee par 6 oui (France, Italic, Norvege, Pays-Bas, Portugal, Suisse), contre 5 non (Bresil, Espagne, Mexique, Serbie, Turquie), et 10 abstentions (Allemagne, Autriche, Hongrie, Danemark, Etats-Unis de l'Amerique dv Nord, Grande -Bretagne, Inde, Portugal, Russie, Suede). 81. On deduira de la duree d'isoleraent celle de la traversec. Adoptee par 7 oui (France, Italic, Pays-Bas, Portugal, Suede y Norvege, Suisse), contre 6 non (Bresil, Espagne, Mexique, Roumanie,. Serbie, Turquie), et 8 abstentions (Allemagne, Autricbe, Hongrie, Danemark, Etats-Unis de l'Amerique dv Nord, Grande-Bretagne, Jnde, Portugal, Russie, Suisse). Navires Infectfo, 82. Les navires infectes seront soumis, dans les ports de la Mediterranee, aux regies generales applicables aux navires infectas dans les ports d'ari'ivee. Adoptee par 12 oui, contre 2 non (Espagne, Mexique) et 7 abstentions (Bresil, Danemark, Etats-Unis de rAmerique dv Nord, Grande- Bretagne, Inde, Russie, Turquie). Peophylaxie Sanitairb de la mer Caspienne. 83. Les mesures sufflsantes pour la Mer Caspienne se trouvent dans. les mesures etablies par les autres mere. Adoptee a I'unannnite. 111. Propiiylaxie Sanitaibe de la Fievbe Jaune. 84. Les mesures recommandees contre le cholera sont, en general, applicables a la fievre jaune et aux autres maladies, gui regnent epidemiquement sous Finfluence dcs mauvaises conditions sanitaires et gui sont transmises par l'intermediaire de I'homme. Les moyens les plus efficaces pour empecher la propagation dcs maladies de cette classe sont : _ L'assainissement dcs villes et dcs vaisseaux partant dcs ports infectes, l'isolement dcs malades et la disinfection dcs effets et dcs locaux infectesou suspects. Adoptee par 17 oui, contre o abstentions (Gramle-Bretagne, Indc r Turquie). CHOLERA. o.usions of the international sanitary conference f Constantinople, 1806 ; of the International anitary Conference of Vienna, 1874 ; and of tke echnical Commission of the International Sanitary onference of rome, 1885. 58 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1860. Conference of Vienna, 1874. International Sanitary Conference of Home, 1885. I. I. Origine et Genese nu Cholera; endemicite Origine et Genese dv Cholera ; exdeiitcitk et epidkmigite de cette maladie dans et epidemicite de cette maladie dans I,'lnde. i/Inde. Conclusions. Le cholera asiatique, celui gui a diverges reprises Le cholera asiatique, susceptible de s'etendre a parcouru le monde, a son origine dans I'lnde (epidemique), se developpe spontanement dans ou il a pris naissauee et ou il existe en permanence I'lnde, et e'est toujours dv dehors qu'il arrive, a l'etat endemique. quand il eclate dans d'autres pays. Adoptee a "unanimite. Proces-\erbal, No. 14, j Adopte a l'unanimite. Proces-verbaux, pages page 4. 26-379. La Conference considere comme demontre que II ne revet pas le caractere endemique dans le cholera asiatique, envahissant, ne s'est jamais d'aatres pays que I'lnde. developpe spontanement etnat n'a jamais etc observe Adopte a l'tinanimite. Proces-verbaux, pages a, l'etat d'endemie (qu'il faut bien distinguer dcs 2 6-379. foyers secondaires plus ou moms tenaces) dans aueun dcs pays gui viennent d'etre enumeres (Europe, &c), et qu'ily est toujours venu du^dehors. Quant aux pays voisin de I'lnde, tout en admettant comme probable que le cholera ny existe pas a l'etat endemique, la Conference ne se croit pas autorisee h conclure formellement a cet egard. Adoptee par 19 voix contre 2. Prcces- verbal, No. 16, page 11. La Conference sans rejeter la possibility que le cholera ne vienne ;\ s'acclimater dans nos pays, regarde le fait i comme problematique. Adoptee a, l'unanimite. Proces-verbal, No. 16, page 11. Le cholera asiatique ne parait pas avoir dans le llejaz de foyer originel, mais il semble y avoir etc jusqu'ici toujours importe dv deliors. Adoptee par 19 voix, contre 0. MM. Dickson, Goodeve, et Monlau se sont abstenus. Proces-verbal, No. 17, page 9 ¦ _____ __ 59 Fonclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Home, 1885. 1 1 Relativement a l'endemicite dv cholera dans l'lnde, la Conference ne peut que repondre qu'il y a dans l'lnde certaines localite*, comprises principalement dans la vallee dv Gange, ou le cholera est endemique, sans qu'il soit possible de les preciser toutes, ni d'affirmer qu'elles aient le privilege exclusif de dormer naissance a la maladie. Adoptee a l'unanimite. Proces-verbal, No. 17, page 9. Eelativement aux causes de l'endemie eholerique, la Conference repond que nous ne connaissons pas les conditions speciales sous l'influence desquelles le cholera nait dans l'inde et y regne dans certaines localites a l'etat endemique. Adoptee a l'unanimite. Proces-verbal, No. 17, page 9. Relativement aux circonstances gui concourent an developpement et a la propagation dcs epidemics de cholera dans l'lnde, la Conference conclut que les pelerinages sont, dans l'lnde, la plus puissante de toutes les causes gui coucourent au developpement et a la propagation dcs epidemics de cholera. Adoptee a, l'unaniniite. Proces-verbal, No. 17, page 10. transmissibilite et prol'agation dv cholera, h. 1° Preuves de la Transmissibilite tirees Questions de transmissibilite. DE LA MARCHE DES EI'IDEMIES DE CIIOLEHA considerees en general. 1 transmissibilite pah l'homke. Conclusion. Tousless les faits enonees ne demontrent ils pas La Conference accepte la transmissibilite dv jusqu'a la derniere evidence que le cholera est cholera par l'homme dun milieu infecte ; elle ne propage par l'homme et avec une vitesse d'autant considere l'homme comme pouvant etre la cause plus grande que ses propres migrations se sout specifique, qu'en dehors de I'influence de la localite activees et sont devenues plus rapides? La infectee ; en outre, elle le regarde comme le propa- Uonference n'hesite pas a repondre affirmative- gateur dv cholera, lorsqu'il vient dun endroit ou ment le germe de la maladie existe dejsL Adoptee a l'unanimite moms 1 abstention. Adoj)te ;i Tunanimite. Proces-verbaux, pp. 28, ! Proces-verbal, No. 18. page 7. 379. 60 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Home, 1885. 2° PrEUVBS TIEEES I)E FAITS IjTABLISSANT LA PROPAGATION DU CHOLERA PAR IMPORTATION. 3" PREUVEB TIROES DE LA PROGRESSION DES l£pi DEMIES DE CHOLERA DANS LES LOCALITEB atteintes. 4° Preuves tirees de l'efficacite de cbrtaines mesxjres preventives. Texte relatif a ces preuves adopte par 21 voix contre 0 et 5 abstentions. Proces-verbal, No. 18, page 8. Conclusion generale dv Ciiapitre. La Conference conelut que la transmissibilite dv cholera asiatique est une verite incontestable, prouvee par dcs faits gui n'admettent aucune autre interpretation. Adoptee a l'unanimite. Proces-verbal, No. 18, l)l )a 0 e 8 - n m , , JS 7 Transmissibilitk tar l atmosphere seule. Sur la possibility de la propagation dv cholera Aucun fait n nest' est venu pronver jusqu'ici que le I par l'atmosphere la Conference repond qu'aucun cholera pmsse se propager au loin par l'atmosphere fait nest venu prouver jusqu'ici que le cholera seule, dans quelque condition qu'elle soit ; en outre, puisse se propager au loin par l'atmosphere seule, c ' est » ne 101 - sans exception, que jamais une dans quelque condition qu'elle soit ; et qu'en outre epidenne de cholera ne s est propagee d un point e'est une loi, sans exception, que jamais une * un autre (lans uu tom I)SI )S l)lusl )lus court VlOV 10 cclvi epidemic de cholera ne s'est propagee dun point necessaire a l'homme pour s'y transporter. a un autre dans un temps plus court que celui L ' air ambiant est le vehicule principal de l'agent necessaire a l'homme pour s'y transporter. generateur dv cholera ; mais la transmission de la Adoptee h l'unanimite. Proces-verbal, No. 18, maladie par l'atmosphere reste, dans l'immense pp a g e g_ majorite dcs cas, limitee a, une distance tres rapprochee dv foyer demission. Quant aux faits cites de transport par l'atmosphere a un ou plusieurs milles de distance, ils ne sont pas suf&samment c.oncluants. Adoptee a 'uuanimite. Proces-verbaux, pp. 43, 381 61 I ; Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Viennu, 1874. International Sanitary Conference of Home, 1885. Comment s'oi'ere l'imi>ortation dv cholera et quels sont les agents de la trans- MISSION ? L'homme atteint de cholera est, par lui-meme, le principal agent propagateur de cette maladie, et un seul cholerique peut douner lieu au developpement dune epidemic Adoptee a l'unanimite. Proces-verbal, Mo. 18, page 8 La Conference a etc amenee a conclure que certains faits tendent a prouver qu'un seul individu (a, plus forte raison plusieurs) venant dun lieu j contamine, et souffrant de diarrhee, peut suffire a j dormer lieu au developpement dune epidemic cholerique, ou, en d'autres ternies, que la diarrhee dite premonitoire peut transmettie le cholera. Adoptee a l'unanimite, moms 1 contre. Procesverbal, No. 18, page 9. DuR^E DE L'INCUBATION. DdREE DE L'INCUBATION. Conclusion. Dans presque tousless les cas, la periode d'incubation, c'est-a-dire le temps Dans presque tousless les cas oil la periode d'ineubu- Coll le entre le moment oil un individu a pu contractor Pintoxication tion, 'cest-tt-dire le temps ecoule entre le moment cho^rique et le debut de la diarrhee premonitoire ou dv cholera confirme, ! i ou uu individu a pu contractor l'intoxication ne d«l d «l» asse l sas quelques jours. Tousless les faits cites dune incubation plus I cholerique et le debut de la diarrh.ie premonitoire Ion fi ue s^ rapportent a dcs cas gui ne sont pas concluants, ou bien parceque I ou dv cholera confirme, ne depasse ]>as quelques a (i i aiT^ 1^ c premonitoire a etc comprise dans la periode d'incubation, ou bien jours. Tousless les faits cites dune incubation plus P aree< l ne ' a contamination a pu avoir lieu apres le depart dv lieu infecte. longue se rapportent a dcs cas gui ne sont pas L'observation niontre que la duree de la diarrhee cholerique, dite prej concluants, ou bien parceque la diarrhee premoni- monitoire, — qu'il nefaut pas confondre avectoutes les diarrhees gui existent | toire a etc comprise dans la periode d'incubation, j en tem P s . de cholera,— ne depasse pas quelques jours. | ou bien parceque la contamination a pu avoir lieu ' Les faits cites comme exceptionnels ne prouvent pas que les cas de j apres le depart dv lieu iufecte. i diarrhee gui se prolongent au dela appartiennent au cholera et soient Adoptee a la majorite de 20 voix, contre 1, et 4 susceptibles de transmettre la maladie, quand l'individu atteint a etc abstentions. Proces-verbal, No. 18, pa^e 10.' i s 01 * 8 8 * 18 ** * toute cause de contamination. ¦Resultat dv vote: 13 oai, 1 non, 4 abstentions. Proces-verbaux, pa<*es 43, 45, 382. ° — ? I 62 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. „ , , -ill' -a. TiiANSMISSIBILITE PAX LES ANIMAUX. Snr la question de savoir si le cholera peut-etre importe et transmis par dcs animaux vivants, la On ne connalt aucun fait probant de la trans - Conference a repondu: II ny a aucun fait coimu missibilite dv cholera par les animaux a l'homme, gui etablisse que Ie cholera ait etc importe par dcs mais i] est tres-rationnel d'en admettre la animaux vivants ; mais il est rationnel cependant possibilite. de les considerer, dans certains cas, comme etant Eesultat dv vote : 10 oui, 2 non, 6 abstentions, dcs objets dits susceptibles. Proces-verbaux, pages 36, 380. La premiere partie de la conclusion a etc adoptee il l'unanimite ; la seconde par 16 voix, contre 8, et 3 abstentions. Proces-verbal, No. 18, pages 14 et 15. bur la question de savoir si le cholera peut etre importe et transmis par dcs linges, dcs hardes, etc., la Conference a repondu que le cholera peut etre transmis par les effets a usage provenant dun lieu infecte et specialement par ceux gui ont servi aux choleriques ; et que meme il resulte de certains faits que la maladie peut etre iinportee au loin par ces memes effets renfermes a l'abri dv contact de lair libre. Adoptee par 21 voix, contre 2, et 2 abstentions. Proces- verbal, No. 19, page 9. 5° DE LA TRANSMISSIBILITIS PAR LES MARCHANDISES. Eelativement aux marehandises, la Conference, Tout en constatant, a l'unanimite, l'absence de tout en constatant a l'unanimite, Tabsence de la transmission dv cholera par les marehandises, la preuves a Tappui de la transmission dv cholera par j Conference a admis la possibilite dv fait dans es marehandises, a admis (a la majorite de 16 voix certaines conditions, ontre 5 et 3 abstentions) la possibilite dv fait Eesultat dv vote : 13 oui, 5 abstentions. Procesans certaines conditions. verbaux, pages 36, 380. Eesumant cc gui vient dit dans les articles >recedents, la Conference, jusqu'a plus ample nforme, croit qu'il sera;sage de considerer comme uspecte, a moms de conditions particulieres et deerminees, toute pioveuauce dun foyer cholerique. Adoptee par 14 voix, 10 abstentions. Procesverbal, No. 19, pages 12 et 13. 63 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Home, 1885. Transmissibilite par les cadavres CHOLIJRIQUKS. En cc gui concerne les eadavres de choleriques, Bien qu'il ne soit pas prouve par dcs faits la Conference a repondu : Bien qu'il ne soit pas concluants que les cadavres de choleriques puissent prouve par dcs faits concluants que les cadavres de transmettre Ie cholera, il est prudent de les choleriques puissent transmettre le cholera, il est considerer comme dangereux. prudent de les considerer comme dangereux. Adoptee a l'unanimite. Proces-verbaux, pages Adoptee par 22 voix, contre 0, et 1 abstention. 42-381. Proces-verbal, No. 20, page 5. De l'influence dcs moyens be communications. La Conference est d'avis que les communications maritimes sont, par leur nature, les plus dangereuses : que cc sont elles gui propagent le plus surement au loin le cholera, et qu'ensuite vienncnt celles par chemins de fer gui, dans un temj)s tres court, peuvent porter la maladie a grande distance. Adoptee ;\ l'unanimite. Proces-verbal, No. 20, page 5. Quant a. l'influence dcs deserts, la Conference, s'en tenant aux faits etablis par l'experience, conclut que les grands deserts sont one barriere tres efficace contre la propagation dv cholera, et elle reconnait qu'il est sans exemple que cette maladie ait etc importee en Egypte ou en Syrie, a travers le desert, par les caravanes parties de la Mecque. Adoptee par 22 voix, contre 0. 3 abstentions. Proces-verbal, No. 20, page 13. De l'inflttence dcs agglomerations. La Conference repond dune maniere generale que toute agglomeration d'hommes — parmi laquelle s'introduit le cholera — est une condition favorable a l'extension rapide de la maladie, ct — si cette agglomeration se trouve dans de mauvaises conditions hygieniques — a la violence de I'epidemie parmi elle ; Qu'en pareil cas la rapidite de l'extension est proportionnee a la concentration de la masse agglomeree, taudis que la violence de I'epidemie est — toutes choses egales d'ailleurs — d'autant plus prononcee que les individus composant 1' agglomeration ont moms subi deja l'influence cholerique, ou en sont restes vierges ; e'est-a-dire, en d'autre termes, que les individus gui ont deja subi l'influence dun foyer cholerique jouisseut dune sorte d'immuuite relative et temporaire gui contre-balance les facheux effets de ['agglomeration ; Qu'enfin dans une masse agglomeree, plus l'extension est rapide plus aussi la cessation de I'epidemie est prompte, a moms que de nouveaux arrivages sains ne viennent fournir un nouvel aliment a. la maladie et ainsi l'entretenir. Adoptee par 20 voix contre 0. 2 abstentions. Proces-verbal, No. 20, page 15. 64 Conclusions of the International Sanitary Conclusions of the International Sanitarj Conclusions of the Technical Commission of the Conference of Constantinople, 186(!. Conference of Vienna, 1874. International Sanitary Conference of Home, 1885. En cc gui coneerne les navires, la Conference conclut que l'intensite dcs epidemics de cholera a hord dcs navires encombres d'hommes est, eu general, proportionnee a l'encombrenient et est d'autant plus violente, toutes choses egales d'ailleuvs, que ces hommes ne sortent pas dun foyer cholerique ou ils ont sejourne ; que sur les navires encombres la marche dcs cpidemies de cholera est d'ordinaire rapide ; enfin la Conference ajoute que le danger d'impovtation par les navires et celui de donuer lieu a, une epidemic grave ne sont pas entitlement subordonnes si ¦ I'intensite, ni nieme a l'existence dcs accidents eholcriques constates a bord pendant la traversse. Adoptee par 19 voix contre 0, et une abstention. Proces- verbal No. 20, page 18. Relativement aux lazarets la Conference eonelut, que I'agglomeration d'individus provenant dun lieu ou regne le I cholera, dans un lazaret, n'a pas pour effet de produire parmi ies quarantenaires une grande extension de la maladie, mais qu'une telle agglomeration n'en est pas moms tres daugereuse pour le voisinage, en cc qu'elle est propre a y favoriser la propagation dv cholera. Adoptee par 15 voix contre 0, et 1 abstention. Proccs-verhal, No. 20, page 20. Par rapport aux grandee agglomerations d'hommes, la Conference couelut que les grandes agglomerations i d'hommes (armees, foires, pelerinages) sont un dcs plus stirs moyeus de propagation dv cholera ; qu'elles constituent de grands foyers cpidemiques gui, soit qu'ils marchent a la maniere dune armee, soit qu'ils se disseminent comme les foires et les pMerinages, importent la maladie dans les pays qu'ils traversent; que ces agglomerations, apres avoir subi, dune maniere ordinairement rapide, l'influence dv cholera, y deviennent beaucoup moms sensibles et que celle-ci y disparait meine tres-promptement, a moms que de nouveaux-arrives ne viennent entretenir la maladie. Adoptee a l'unaniniitO (22 voix). Proces-verbal, No. 21, page 6. Eelativenient a l'influence de la dissemination la Conference conclut que la dissemination dune masse agglomeree, operee en temps opportun, peut rendre moms violente une epidemic de cholera gui vient d'y apparaitre et meme en arreter l'extension ; mais que cette dissemination ferait naitre au contraire un gracd danger de propagation, si elle etait accomplie au sein de localites encore indemncs. Adoptee a l'unanimite (22 voix). Proces-verbal, No. 21, page !). Quant au role dv pelerinage de La Mecque, la Conference eonelut que le role dv pelerinage de La Mecque, comme agent propagateur dv cholera par rapport aux contrees voisines de l'Europe (les seules a l'egard desquelles nous ayons dcs renseignements positifs), a etc l'importation de cette maladie en Egypte, deux fois, a 34 ans d'intervalle, pendant la saison chaude. Adoptee a l'unanimite (22 voix). Proces-verbal, No. 21, page 9. 65 Conclusions of the International Sanitary Conclusion? of the International Sanitary I Conclusions of the Technical Commission of th Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Home, 1885. DE l/INFLUENCE DES CONDITIONS HYGI^NIQTJES. En conclusion, la Conference reconnait que les conditions hygieniques et autres gui en general predisposent une population a contracter le cholera et par suite favorisent l'intensite dcs epidemics, sont : la misere avec toutes ses consequences, raccuniulation dcs individus, l'etat maladif de ceux-ci, la saison chaude, le defaut d'aerage, les exhaiaisons dun sol poreux impregne de matieres organiques, surtout si ces matieres proviennent de dejections choleriques. En outre, la Conference opine que, comme il paralt demontre par l'experience que les dejections dcs choleriques renferment le principe generateur dv cholera, il est legitime d'admettre que les egouts, les lieux d'aisance et les eaux contanrinees dune ville peuvent devenir dcs agents de propagation de la maladie. La Conference ajoute qu'il semble resulter de certains faits que le sol dune localite, une fois impregne de detritus choleriques, a pu conserver pendant uu temps assez long la propriete de degager le principe de la maladie et d'entretenir ainsi une epidemic, ou meaie de la regenerer alors qu'elle etait eteinte. Adoptee a I'unariimite (19 voix). Proces-verbal, No. 21, page 14. De L'lMMONTrfj I'AK RAPPOET AU CHOLERA. En conclusion, I'immnnitc dont jouissent certaines localites, e'est-a-dire la resistance, permanente ou temporaire. generale ou partielle, opposee par ces localites au developpement dv cholera dans leur circons(.-rii)tion, est un fait gui n'excliit pas la transnaissibilite, mais gui indique que certaines conditions locales, non encore toutes determinees, sont un obstacle au developpement de la maladie. De meme l'immnnite plus ou moms complete et plus ou nioins durable dont jouissent le plus grand nombre dcs personnes placees au milieu dun foyer cholerique, imniunite gui atteste la resistance individuelle au principe toxique, est une circonstance dont il faut tenir le plus grand compte. Au point de vuc dv developpement epidemique, elle est le correctif dc la transmissibilite, et sous le rapport de la prophylaxie, elle met sur la voie dcs moyens propres a restreindre les ravages de la maladie. Adoptee a la majorite de 21 voix contre 1, et 3 abstentions. Proces-verbal, No. 22, page 15. Deductions kelatives aux attkibuts dv principe g^n^rateur dv Cholera. En resume, selon la Conference, dans l'etat actuel de la science, on ne peut emettre que dcs hypotheses sur la nature dv principe generatear dv cholera ; nous savons seulement qu'il est originaire de certaines contrees de l'lnde et qu'il s'y maintient en permanence ; que cc principe se regenere clans l'homme, et l'accompagne dans ses peregrinations ; cju'il pent ainsi etre propage au loin, de pays en pays, par dcs regenerations successives, sans jamais alors se reproduire spontanement en dehors de L'homme. Adoptee a I'nnanimite (2o voix), moms 1 abstention. Proces-verbal, No. 22, page 15. E 20510 E 66 Conclusions of the International Sanitary Conclusions of the International Sanitary | Conclusions of the Technical Commission of the Conference of Constantinople, 18CG. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885 Action cc lair sub la Tkansmissibilite. Kelativement aux vehicules dv principe genera- II resulte de l'etude dcs faits qu'si lair libre le teur dv cholera, la Conference conclut que lair principe generateur dv cholera perd ra]>idement ambiant est le vehicule principal de I'agent genera- son activite morbifique, telle est la regie ; mais, teuv dv cholera ; mais la transmission de la maladie dans certaines conditions particulieres dv confinepar l'atmosphere reste, dans rimmense majorite meut, cette activite pent se conserve! 1 pendant un dcs cas, lirnitee a one distance tres-rapprochee dv temps indeterinine. foyer demission. Quant aux faits cites de trans- Le cholera pent etre transmis par les effets a port par l'atmosphere a un ou plusieurs milles de usage provenant dun lieu infecte et specialement distance, ils ne sont pas suffisamment concluants. par ceux gui out servi aux choleriques ; et memo Adoptee a la majorite de 24 voix coutre 0 et 1 il resulte de certains faits que la maladie pent etre abstention. M. Goodeve a fait one reserve quant emportee an loin par ces memes effets renfermes a a la distance. Proces-verbal No. 22, page 10. l'abri dv contact de lair libre. Les grands deserts sont une barriere tres-emcace contre la propagation dv cholera, et il est sans exemple que eette maladie ait etc' emportee en Egypte ou en Syrie, a travers le desert, par les caravanes parties de La Mecque. Adoptee a l'unanimite. rroces-verbaux, pp. 43, 381. tltansmissip.ilite par les aliments et les Boissons. Selon la Conference, l'eau et certains ingesta (a.) Aliments: peuvent aussi servir de vehicules a l'introduction La Conterence ne possedant pas de preuves | dans l'organisme dv jirincipe generateur dv cholera, concluants pour la transmission dv cholera par les Cela pose, il s'en suit pour ainsi dire m'cessaire- aliments, ne se croit pas autorisee a prendre une ment que les voies par les()uelles l'ngent toxique decision a cet egard. penetre dans l'economie sont principalement les Resultatduvote: lloui, 7 non. Proces-vevbaux, voies respiratoires et tres probablement aussi les pages 3-'?. 380. voies digestives. Quant a la penetration par la (b.) Boissons: peau, rien ne tend a I'etablir. " Le cholera pcut etre propage par les boissons, j Adopte a l'unanimite (2G voix). Proces- verbal particuliereinent par l'eau." No. 22, page 17. Adoptee a l'unanimite. Page 380. 67 c 2 Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Eome, 1885. Quant aux principaux receptacles dv principe cholerique, la Conference conclut que la matiere dcs dejections choleriques etant incontestableinent le principal receptacle de l'agent morbifique, il s'eu suit que tout cc gui est contamine par ces dejections devient aussi un receptacle d'oii le principe generateur dv cholera peut se degager, sous l'influence dcs conditions favorables ; il s'ensuit encore que la genese dv germe cholerique a lieu tres probablement dans les voies digestives, a rexelusion, peut-etre, de tout autre appareil de l'organisme. Adoptee a l'unanimite (26 voix). Proces-verbal, No. 22, page 17. Par rapport a la duree de l'activite morbitique dv principe hors de l'organisme, la Conference repond qu'il resulte de I'etude dcs faits qua lair libre le principe generateur dv cholera perd rapidenient son activite morbifique et que telle est la regie ; mais que, dans certaines conditions particulieres de confinement, cette activite peut se conserver pendant un temps indetermine. Adoptee a. I'unaniniite (25 voix). Proces-verbal, No. 22, page 17. Par rapport a la duree de la diarrhee choleri([ue, la Conference declare que l'observation montre que la duree de la diarrhee cholerique, dite premonitoire, — qu'il ne faut pas confondre avec toutes les diarrhees (jui existent en temps de cholera, — ne depasse pas quelqucs jours. Les faits cites comme exeeptionnels ne prouvent pas que les cas de diarrhee gui se prolongent au deli appartiennent au cholera et soient susceptibles de transmettre la maladie, quand l'individu atteint a etc soustrait a toute cause de contamination. Adoptee par 15 voix contre 4, et 3 abstentions. MM. de Lallemand et Maccas out fait one reserve sur la 2 me partie de la conclusion. KaPL>ORT 81 X LA MA.&CHE El LE MODE BE PKOPAGATION DU CHOLERA EX 1860. Conclusions adoptees par la Conference. Dcs faits observes en 1865, il resulte: 1° que la propagation dv cholera s'effectue par le mouvement dcs hommes. quels que soient d'ailleurs les moyens de locomotion dont ils se senrent ; 2° que la propagation en est d'autant plus ; j h craindre que les moyens de locomotion sont plus rai>ides et plus multiplies ; 3° que, toutes choses egales d'ailleurs, ! 1 une grande masse infectee ou un seul individu malade peuvent propager le cholera a de grandes distances. 68 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1860. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. Tkoisiemi: Groupf. de Questions. I. Mesures Hygieniques. Conclusions. Dans l'opinion de la Conference, nous ne con- Xo. 4. L'assainissement et l'isolement reel et naissons pas dcs moyens directs pour eteindre les complet dans la mesure indiquee par la science, foyers endemiques dv cholera, mais on peut de tout cc gui pent apporier le cholera, sont les esperer d'y parvenir par an ensemble de mesures ! ¦ meilleurs moyens d'en empecher l'importation et panni lesquelles le role le plus important reviendra | : la propagation, aux mesures hygieniques. Adoptee en principe. Proces-verbaux, page 168. Adoptee h runanimitc. Proces-vcrbal, No. 24, I Quant a lliygiene navale, la Conference est d'avis que Ton devrait : 1° Ouvrir dcs concours, et decerner dcs prix aux auteurs dcs decouvertes ou perfectionne- ; ments dont le resultat inuncdiat serait un progres quelconque dans l'assainissement dcs navires, dans I'amelioration dcs conditions hygieniques dcs equipages, ou dans lc bien-etrc dcs passagers. ! k2° Publier un manuel d'hygienc navale a i'usage de la marine marchande de chaque pays, 'execution dcs prescriptions les plus importantes de cc manuel serait obligatoire pour les capitaines ou patrons. 3° Encourager par dcs primes et dcs recompenses ceux dcs armateurs, capitaines ou patrons ' de navire gui se seraient distingues dans le bon entretien de leurs Mtiments et de leurs i equipages. Adoptee a l'unanimite et 4 abstentions. Proems-verbal, Xo. 29, page 4. Pendant le cholera surtout il faut eviter, suivant la Conference, les inconvenients et les dangers geeg ec Conclusions, Nos. 23, 24 and 25 page 88. provenant dune mauvaise place de moutllage, de l'eau potable et dcs provisions mal choisies, ' de l'encombrement, de l'etat sanitaire dcs homines embarques, de Fetat dcs effets a usage, de la qualite dcs marchandises, dv manque de separation dcs malades, dv defaut de ventilation dv [vire et de l'aeration dcs effets ti usage et surtout dv manque de proprete dcs lieux d'aisance. Adoptee a l'unanimite. Proces-verbal, Xo. 29, page 4. 69 Conclusions cf the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1874. La Conference est d'avis que l'assaiuissenient dcs ports, avec defense d'y l'aire aboutir les ! See Conclusions, Nos. 16, 17, and 18, page 86. egouts de la \ille, leur dragage periodique et leur bonne police sanitaire interieure, sont dcs mesures hygieniques de la plus haute importance pour le preservation dcs maladies transmissibles en general et da cholera en particulier. L'assainissernent dcs quartiers, attenant aux ports de mer, et leur police sanitaire la plus severe sont aussi dcs mesures de preservation tres importantes. Adoptee a l'unanimite. Proces- verbal, No. 25, page 8. Dans Popinion de la Conference, l'assainissement dcs villes est un moyen preventif de premier See Conclusion, No. 4, page CB. ordre pour s'opposer a la reception dv cholera, et en mitiger les ravages. Cet assainissement doit etre base principalement sur un ensemble de mesures gui tendent a maintenir la purete de Fair, a approvisionner les villes dune eau same et abondante et k empecher l'infection dv sol pai dcs matieres organiques. * La disinfection sur place, et l'enlevement immediat dcs matieres excrementielles, est une mesure hygienique dune importance capitale, surtout en temps de cholera. Adoptee a l'unanimite. Proces- verbal, No. 25, page 11. Suivaut la Conference, une sage organisation de I'assistance publique, les visites preventives See Conclusion, No. 7, page 81. generates, on, a leur defaut, les visites medicales clans les maisons envahies, — les secours immediat saux attaques, — la publication dcs Instructions populaires, — l'encouragement gui naitde la confiance dans la promptitude et l'etendue dcs secours, et de la publication de l'etat veritable de l'epidemie, ainsi que l'installation d'hopitaux speciaux et de maisons de refuge teinporaire pour abriter les families dcs nmlades pauvres, sont dcs mesures hygieniques et administratives tres efficaces pour entraver la propagation dv cholera, et pour en diminuer les ravages, dans les I localites envahies. Adoptee a l'linanimite. Troces- verbal, No. 20, page 20. Suivaut la Conference, l'interruption temporaire dcs communications avec les lieux infectes, I pourvu qu'cAle puisse 6tre absolve, est le preservatif le plus sur contre la transmission dv cholera. Le depkeement oji'.iortun et la dissemination methodique dcs agglomerations mobiles (caravanes, cor]>s de troupes, etc.) sont dcs mesures higieniqnes tres effieaces pour prevenir le cholera d'eclater parmi elles, ainsi que pour eu arreter Vexiension on en adoucir la violence. L'emigration opportune et la dissemination blen reglee peuvent dormer lieu an meme resultats favorables dans les agglomerations fixes (localites, etablissements publics). AdoiJtee a l'uuanimite. Proces-verbal, No. 27, pap'e 4. I . . Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. QUESTIONS DE LA DISINFECTION. DISINFECTION. uc est d'avis (|iie la disinfection I" Connait-on dcs moyens ou dcs precedes tie No. 5. La Sous-Commission recommande comme J appliquee an cholera, d'apres unemethode rationelle desinfection, grace auxquels le principe generateur | moyens de disinfection contre les epidemics de jetj et avec perseverance, s'offre conmie un puissant on contagieux dv cholera peut siirement etre detruit \ cholera, outre la destruction : — auxiliare : | on perdre de son intensity ? r , La vapeur j. ]0t)O . 1° Pour diminuer la receptivite dune localitc Resultat dv vote : 12 nou, 7 abstentions. Pro- 2n 2 n L'acide phenique le chlorure de chaux ; menace par 1c cholera ; ces-verbaux, pages 66, 382. _„ t, ? , . , , , , ? . ? 3° L'aeration. 2° Pour detruire le germe de la maladie importe ? «. i t -t i dans une locality et 2 . Coi ? liait -° n dcs m °Y™* on f1 ? s P^cedes de On prfj^, chaqne fois dcs solutions aqueuses ' __ ¦ disinfection, grace auxqiiels le pnncipe geiu-rateur j d'acide phenim.e et de chlorure de chaux: — 3° Jrour hiniter dans certames circonstances ou contagienx dv cholera peut avec quelque chance t ~u a 9 °i a* 'A h' ' favorahles, l'extension dc l'epidemie. de succes etre detruit ou perdre de son intensite ? tamies ac - /o/ o a acme pnemque, , . . , x . dc 1 de chlorure de chaux, Adoptee a 1 unaninute. Proces-verbal, No. 2*", Resultat : 13 oui, ;*> non. Proces-verhaux, pnjjes „ i m <->< -n -J -v' • page 10. G7 383. f f ° lteS u CITOI-KRA DE IInX»E PAB LA VOIE ? - ,_ maritime. Mksures a prendre kn dehors be l Europe. 1° Convenance don etablisscmcnt sanitaire a Sec Conclusions, Xos. 42 and 46, page 91. l'entree de la Mer Rouge. En vue do prevenir de nouvelles invasions dv No. 83. Les mesures Miffisantes pour la Mer Adniise a, l'unanimite, moms 1 CM. Goodeve) chol t'i"' en Europe, la Conference approuve les Caspienne Be trouvent dans les mesures etablies Proces-verDal, No. 31, patre 14. mesures recommandees par la Conference de pour les autres mere. Constantinople, notaimuent les quarantaines dans A , ? „ . . , _, la Mor T?oinrp o t dans la M,.r Pacnipiino Adoptee a 1 uuamimtc. Proces-verbaux, page 2° Quel serait le caractere de cet etablissement ? d Mci Koage et a s a AUr a *P Ionn( - 303. b La Conference croit que le caractere inter- Ces . q»^f ntaines .fevront etre instituees et ! national est line condition sine qua, non de l'eta- or p n s d » ne maniere complete et satisfaisante, j blissement dont il s'agit. Resterait aux gouverne- sclon les maximes d h^ lone le l >lus rigoureuses. ments interesses a s'entendre sur la forme et la I I'roces-verbaux, pp. 282, 385. mesure h dormer a. I'intervention de chacun. On j con^oit tres bien, par exemple, que la Porte ou le i gouvernement egyptien pourrait avoir la direction, mais sons le controle et avec l'assistance ds l'Europe. Adoptee par 15 voix contre 3 (MM. Goodeve, Dickson, et Bykow), et 2 abstentions. Procesverbal, No. 32, page 10. 3° Dans quels cas, comment et par gui seraient | j appliquees les mesures ? La Conference conclut que les mesures seraient j appliquees en vertu dun reglement international gui specifierait les cas, et par une autorite soumi.se au controle dcs gouvcrneinents interesses. Adoptee par 17 voix, contre 2. Proees-verbal, J No. 32, page 13. 74 75 Conference of Constantinople, 1866. Conference of A r ienna, 1874. ¦ International Sanitary Conference of Rome, 1885. Pelekikage a la Mecqtte. Qdestion dv PEUBKINAGE r>E la Mecque. No. 52. II est desirable que chaque pelerin possede les ressources necessaires pour etre a _ I. Organisation dv service sanitaire sur le r . lbl .; deg pr i vat i ons pendant son pelerinage a la littoral de la Mer Rouge. Mecque, cc gui d'ailleurs est conforme aux pre,-. -? . . , , r, o, -. • scriptions religieuses musulmanes et adopte par Dans 1' opinion de la Conference, le service ,* & , ,, T , A ¦ „ n \* n ? ¦v l , v .. ? i -.t t> le ffonvernement dcs Indes neerlandaises. Cette samtan-e a organiser sur le littoral de a Mer Rouge | previendra la misere, une dcs causes les comprendrait, outre le projet dun lazaret inter- i.nportantes de dv cholera parmi national avec arraisonnenient obligatoire an detroit f ..T l , t-, , , ¦? , . les pelerins. de Bab-el-Mandel). Adoptee a l'unanimite. Proces-verbaux, page 1° Dcs pastes de medecins sanitaires, savoir : 228. trois sur le littoral Africain, a Koseir, a Souakin, Xo. 53. Chaque navire a pelerins et chaque a Massowah, et deux, pour le moment, sur la cote caravane seront accompagnes par un nombre arabique, dont le jninei]>al serait a Djeddah et suffisant de medecins, designes par ie gouverne- Fautre a Yanibo ; ment dv pays ou. se forme le convoi. 2» Deux lazarets, dont l'un. a El- Wesch, serait Adoptee a l'unanimite. Proces-verbaux, page affeete exelusivement aux pelerins, et l'autre a. "j 225. Tor, serait destine a la quarantaine dcs arrivages Xo. 54. Un navire sera considere comrac navire ordinaires atteints de cholera ; ! a pelerins, s'il a a bord plus de trente pelerins. 3° Une direction, siegeant a Suez, assistee dune Adoptee a l'unanimite. Proces-verbaux, page Connnission Internationale gui deciderait de toutes 228. les questions concernant le service sanitaire de la Xo. 55. Dans les ports ou existe le cholera, avant Mer Rouge. l'embarquement dcs pelerins, le navire sera nettoye T , .v. v ..,,., et desinfecte, visite i>ar son medecin et, en outre, Les deux premieres concluaons ont * adoptees l'autorite sanitaire dv port. Le medecin dv par 14 voix dont 2, celles de MM. Goodeve et £ avire examinera chaque personne ; il n'admettra Dickson avec reserve an sujet de Tor. A a cdles j IR . ni \ n . dlades ni suspcC tes de seance suivante plusieurs membres absents ont chok , ra nVeiUera a cc que l'on n'introduise pas adhere a ces deux conclusions. h bord deg d(?s objetg de j iterje La 3~ conclusion a etc adoptee par 18 voix ou autres t>ffets dv niC ' mc g enre sollill es ?» contre 4, celles de MM. Goodeve, Dickson, Keun suspects. Tons les effets provenant d endroits et Bykow. MM. Millingen, Malcum et Salih contamines ou suspects de cholera seront desmeffendi se sont abstenus. Proces-verbaux, No. 32, fectes avant 'embarquement. Les vetements et page 15, et No 33, page 4. ob JLJ L ' ts de Uterie a >' ant . "em anx matad« choleriqucs ne seront jamais adnns a, bord. 76 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, ISfiC. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. 2" Conditions pour !e depart et precautions rela- ' Si le cholera se maaifeste a bord, les malades tives a I'embarquement dcs pelerins. seront de suite diriges sur l'hopital, et I'endroit Adoptees a I'unanhnite, avec quelques reserves qu'Os occupaient dans le navire sera immediatepar MM. Goodeve et Dickson. Proees-verbal, ment desinfecte. No 33 Daffes 5 et 6 Adoptee a I'unanimite. Proces-verbaux, page ' ' 228 3° Mesures d'hysriene a niettre en pratique dans * les lieux ou s'accomplit le pelerinage! No " "• L'autonte sanitaire dv port d embarque- Adoptee a I'unanimite. Proces- 7erbal, No. 33, m m f nt et le redeem dv bord veilleront a cc qu'il nyn y »r» r ait pas d encombrement. Un navire a vapeur P ° ' doit avoir dans les entreponts au moms 9 pieds de 4° V aurait-il quelque mesure a prendre dans surface et 54 pieds cubes d'espace, pour chaque le Hedjaz contre Pimportation dv cholera par mer passager. A bord dcs voiliers chaque passager ou par terre ? doit avoir 12 pieds de surface et 72 pieds cubes La Conference ne compte aucunement sur les d'espace. mesures de quarantaine gui seraient prises dans le Adoptee a, I'unanimite. Proces - verbaux, Hedjaz contra l'importation dv cholera parmi les page 229. pelerins. o 57. p pedantn dant la traversee, le medecin dv bord Adoptee a 1 unannmte. Proees-verbal, No. S3, veillera a cc qu'une proprete rigoureuse et une page 6. ventilation active soient maintenues, a cc que tout 5° Mesures a prendre contre les provenances dv linge sali ou souille soit lave le meme jour et Hedjaz, si le cholera s'y manifestait pendant le desinfecte, et a cc que les lieux d'aisance soient pelerinage. laves et disinfectes au moms deux fois par jour. La Conference est d'avis que, dans le cas ou le Adoptee a l'unauimite. Proces - verbaux, cholera se mauifesterait dans le Hedjaz a l'epoque page 229. dv pelerinage, il y aurait lieu d'interrompre tern- No. 58. En general, toutes les mesures adoptees porairement, e'est-a-dire pendant la duree de p ar l e Gouvernement de l'lnde britannique relativel'epidemie, tout communication maritime entre les men t a I'embarquement et au transport dcs pelerins ports arabiques et le littoral egyptien. des Indes dans la Mer Rouge, sont recommandees L'applicatiou convenable de cette mesure sup- a l'adoption de tousless les pays d'ou partent dcs pose l'existence dun service sanitaire organise sur pelerins. le littoral de la Mer Rouge, comme il a etc expose Adoptee h I'unanimite. Proces - verbaux, precedemment, et de plus la presence dune force page 229. militaire suffisante, tant pour maintenir le bon j No. 59. Tout navire a pelerins, arrive dans la Mer ordre parmi le? pelerins, que pour la police rnari- : i Rouge, fera escale a la station sanitaire, ou. il subira time. A cc dernier point de vue, il serait a desirer | une inspection medicale rigoureuse. La visite dcs que les gouvernements interesses s'entendissent a passagers et de l'equipage sera faite a terre. Le l'effet d'assurer l'execution dcs mesures prescrites. navire et les effets dcs passagers et de l'equipage 77 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 18GG, Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. Cela etant, la Conference pense qu'il pourrait j seront desinfectes, puis le capitaine prendra les etre procede a l'execution de la maniere suiyante, i mesures necessaires pour assurer le nettoyage sauf les modifications gui, sans alterer le principe complet dv navire, le lavage dcs effets dcs passafondamental de la inesure, seraieut jugees, par la gers et de l'equipage. Commission Internationale siegeant a Sue::, propres Si le medecin dv bord certifie que toutes les h en faciliter ['application ; ; mesures d'assainissement et de disinfection ont etc 1° En cas de manifestation dv cholera parmi les : j PPisesy ises avant le depart, que les mesures d'assaipelerins, les medecins eanitaires dv Hedjaz signa- j | ni ssement et de disinfection out etc observers leraient le fait aux autorites locales, aiusi qu'aux i ! P endant }a traversee, qu'il ny a eu pendant le navires de guerre stationees a Djeddah et a Yambo. ! I voyage n^ mort, ni malade, ni suspect de cholera, De plus, tout en mentionnant le fait sur la patente ! ! enf ! n S1 1 exam en medical, fait deux fois pendant de sante, ils en expedieraient l'avis en Egypte et 24 neures » par le medecin de la station sanitaire, a El-Wesch. permet de constater qu'il n'existe personne atteint o ?,,.,,,. ou suspect de cholera, le navire pourra reembar-2° bur la declaration dcs medecins susmen- | quer e t se rendre :iu port de sa destination definitive tionnes, les autorites mformeraient les pelenns que au Hediaz. ceiix d'entr'eux gui voudraient s'embarquer pour ! Si le navire est sans medecin, on s'il y a eu dcs 1 Egypte auraient, avant d'y aborder, a faire accidents de cholera, ou dcs cas suspects a bord quarantine a El-Wesch et les previendra.ent en pendant la traversee, ou si ces memes accidents meme temps qu ils sont libres de s.uvre la voie de surviennent a l'arrivee dv navire a la station sanirc" " taire, il sera isole pendant cinq jours et desinfecte 3° Les embarquements se feraient sous la sur- ams^ lue1 ue tousless les effets dcs passagers et de l'equiveillance de l'autorite sanitaire, dans les conditions '¦ ! PP a S e - passagers et les gens de l'equipage determinees par elle, et dans les ports qu'elle aurait I i seront isoles a terre pendant cinq jours. Les designes. i malades et les suspects seront isoles par groupes .„ -r , . separes. Les valides seront repartis en groupes 4« Les navires de guerre concourraient a assurer I dont eha cun ne pourra s'embarquer qu'apres cinq 1 execution dcs mesures prescrites, Us feraient la j jours sans aucu n accident, comptes depuis la sepapoliee de mer, et exereerait une surveillance aussi , rat i on dv dernier malade, s'il y en a eu exacte que possible a 1 effet d empecher tout depart Le navire sera autorise a se rendre au port de clanclestin. sa destination definitive au Hedjaz, quand il aura 5° Sur i'avis recu de la presence dsi cholera i [ embarque tons les groupes^ de passagers, sauf les parmi les pelenns, les autorites sanitaires egypti- ! j personnes gui ont etc isolees pour cause de conennes interdiraient l'entree de tons les "ports i i tammation et gui n'ont pas encore subi le temps ! d'figypte a toutes provenances de la cote arabique, ! d'observaticm reglementaire. jetj et elles renverraient les navires deliquants, apres j Adoptee par 16 oui, contre 5 non (Bresil, ; les avoir ravitailles an besom, sur nn point dc la ! Espagne, Mexique, Serbie, Turquie). Proces• verbanx, page 232. 78 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 18GC. ~ Conference of Vienna, 1874. International Sanitary Conference of Koine, 1885. cote arabique, soit a El-Wesch, soit ailleurs, oil il No. GO. A son arrivee an Hedjaz,le navire subira purgeraient quarantaine, confonnement aux regies de uouveau une inspection medicale rigoureuse. adoptees. Une delai de 24 heures sera accorde au medecin | dv port, s'il le juge necessaire, pour formuler le 6° Les pelerins transported a El-Wesch y seraient resultat de ses constatations sanitaires. Si le medecin tenus en quarantaine et ils ne seraient autorises a de bord certifie qu'il ny a eu aucun accident chorepartir pour l'Egypte que quinze jours pleins lerique, ou suspect depuis quo le navire a quitte apres la disparition dv cholera parnii eux et apres la statiou sanitaire, et si l'inspection faite par le disinfection de leurs hardes et bagages. En medecin dv port permet de constater qu'il ny a eu quittant El-Wesch, les navires gui les transporte- ni niort, ni cas de cholera le uavire aura de suite raient seraient — pour ceuxqui se rendent a Suez — lilire pratique. Si, au contraire, il y a eu dcs cas dans Pobligation de toucher a Tor ou ils seraient choleriques ou suspects, le navire derra immediatesoumis a une observation de 24 heures et a une nient retourner a, la station sanitaire pour y subir visite medicale dans le but de constater leur etat de nouveau toutes les mesures d'observation, sanitaire. La patente nette et l'aulorisation de d'isolemeut et de disinfection decrites dans l'article continueur leur route ne leur seraient delivrees que precedent. tout autant que l'etat sanitaire dv bord aurait etc Adoptee a l'unanimite. Proces - verbaux, reconnu exempt de danger. page 233. 7° Quant a la caravane pour l'Egypte, elle No. 61. Les medecins presents, ceux gui auront s'arreterait selon l'usage dans l'endroit ordinaire etc delegues ou envoyes en mission, ainsi que ceux de sa station, pros d'El-Wesch ; elle y subirait une gui seront arrives avec les navires, ou avec les visite medicale ct elle ne recevrait l'autorisation de caravanes, suivront les pelerins pendant toute la continuer sa route qu'apres avoir etc exempte de duree dv pelerinage. Ils seront charges d'assurer cholera depuis quinze jours. le service sanitaire, de fagon a prevenir le de- Jveloppement dv cholera parmi les pelerins et, si 8o Relativement auv pelerins a destination de l'epidemie eclatait, ils devront soigner les malades l'lnde ou d'autres pays an dela de la Mer Rouge, et avertir* le plus rapidement possible, les Gouils seraient autorises a s'embarquer pour retourner verneinents interesses. chez eux, mais en se soumettant aux regies pie- Adoptee a l'unanimite. Proces-verbaux, page scntes par l'autorite sanitaire dv port d'embarque- 232. ment. No. 62. 11 est de necessite absolve que les mesures C° Les communications maritimes nitre le | d'assainissement soient largement appliquees aux Hedjaz et l'figypte ne pourraient etre retablics ¦ I lieux ou sejournent les pe'lerins, et surtout aux que quinze jours au moms apres la cessation de villes saintes dv Hedjaz. tout indice de cholera dans le Hedjaz, declaree i Adoptee a l'unanimite, mois une abstention officiellement par l'autorite sanitaire de Djeddah. (Turquie). Proces-verbaux, page 233. 79 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. Mais alors, et nieme en tout temps, les navires ?,,.»,. •, , j, •¦, i ¦? ¦ charges de pelerins a destination de Suez, seraient N »- 63 - Sl Pedant toute la duree dv pelerinage, il ny a pas eu d accident cholenque, les toujours dans l'obligation de toucher a Tor, et navires a pelerins subiront a leur retour unc inspection medicale ngoureuse au port d embarqued'y stationner 24 heures, pour y subir une visite meilt dv Hed J az - Jf" navires * destination de l'Egypte et ceux gui doivent passer par le canal medicate comme il a etc dit plus bant L'autorite maritime dans la Mediterranee, subiront une seconde inspection, les premiers dans les ports sanitaire de Suez poorrait renvoyer a Tor tout egyptiens, et les autres (ceux a destination de la Mediterranee) pres de Suez. Cette deuxienie navire gui n'aurait pas rempli cette formalite. inspection deciders* si ces navires peuvent etre consideres comme nets, on s ils doivent etre sounns a l'observation et a la desinfection. 10° Un reglement dcs penalites encourues, pour Adoptee h l'unanimite, moms deux abstentions (Grande-Bretagne et l'lnde). Procestoutes les infractions aiix mesures prescrites, verbaux, page 234. devrait etre formulc par la Commission inter- No 64- gj ? pen( | an t l c pelerinage, il y a eu dcs accidents choleriques, les navires a destination rationale. Le reglement anglais (Native Passenger j & es p orts u cholera dk l'lnde en Europe par la voie i>e terre. Mesures a prendre en Perse: organisation cl'un systeme sanitaire; precautions concernant les pelerinages, le transport dcs cadavres, etc. Mesures conseillees dans le rapport adoptees a I'unanimite. Mirza-Malkom Khan et M. Sawas votent sous reserve. Proces-verbal, No. 34, page 14. Mesures a vrendre sur la frontiers turco-persane. Mesures conseillees dans le rapport adoptees par 15 voix contre 0, et 6 abstentions. Proces-verbal, No. 35, page 7. Mesures contre l'importation r>u cholera tar la Boukharie et les steppes de la Tartarie. Texte dv rapport adopte, avec quelques rectifications, a, I'unanimite. Proces-verbal, No. 35, page 8. Mesures a prendre sur la frontiers russo-persane. Texte dv rapport adopte a I'unanimite. Proces-verbal, No. 35, page 8. Resume dv rapport adopte par la Conference a I'unanimite, moms 1 abstention. Proces-verbal, No. 35, page 8. 111. Mesures Quarantenaires. afplicables aux provenances cholerlques. Considerations generales sur la question dcs Mesures restrictives. Conclusions. Kelativement aux mesures restrictives employees jusqu'ici contre le cholera, la Conference est d'avis que les enseignements a tirer de l'experience de cette premiere epoque dcs quarantaines n'ont pas une valeur concluante. Adoptee par 18 voix contre 2, et 3 abstentions. Proces-verbal, No. 37, page 12. La Conference conclut cependant, d'apres les faits cites dans la rapport, qu'il est incontestable que dcs quarantaines etablies sur dcs bases rationales et cmformes aux progres de la science peuvent servir de barriere efficace contre l'envahissement dv cholera. Adoptee a I'unanimite. Proces-verbal, No. 37, page 13. Les bases dv systeme de prophylaxie devraient consister, suivant la Conference : 1° a combattre les germes de la maladie dans ses foyers primitifs, avant qu'ils ne se disseminent et ne se propagent au dehors ; 2° a etablir dcs quarantaines en accord avec les principes aujourd'hui admis sur la transmissibilite dv cholera et son mode de propagation. Adoptee a runanimite. M. Goodeve vote sous reserve. Proces-verbal, No. 38, page 12. 81 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1860. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. Cordons sanitaires, isolement, interruption Quarantaines de terre. Prophylaxis sanitaire terrestre. et restrictions dcs oommunications. Considerant que les quarantines de terre sont **o. 6. Les quarantaines de terre et les cordons Pnvrr,.cmv C inexecutables et inutiles, yulesu les nombreux moyens samtaires sont inutiles. Conclusions. de communication gui augmented de jour en jour ; Adoptee par 20 om contre 1 non (Turquie). La Conference est d'avis que les cordons sani- cons id e rant en outre qu'elles portent dcs atteintes l roces-verbaux, page yd. taires, employes^ au milieu de populations nor- g rav es aux interets commerciaux, la Conference No. 7. Pour prevenir le developpement dv breuses et serrees, sont dun effet incertain et re jj e tte les quarantaines de terre. cholera et sa propagation par les communications souvent sont dangereux ; que par contre, employes Resultat dv vote : 13 oui, 4 con, 2 abstentions, terrestres il faut : — dans dcs localites ou dcs contrees dont la popula- Proces-verbaux, pages 82, 384. 1° Assainir partout et en tout temps, l'isoler les est clair-semee, comme dans certain pays asiatiques, premiers cas et debinfecter. Les moyens d'isoleles cordons sont appeles a, rendre de graads services men t e t de desinfection doivent etre prepares contre la propagation de la maladie. d'avance, sur l'avis de Pautorite sanitaire. Adoptee a, Funanimite, moms M. Goodeve gui 2° Denoncer immediatement chaque cas declare s'est abstenu. Proces-verbal, No. 38, page 17. ou snspect de cholera a que de droit, selon les regies dv pays,et faire constater par dcs medecins T n f , . 1O ?. , . . . competents. la nature de la maladie ou les causes de la mort au moyen de Fautopsie. La Conference opine: 1" que Fisolement partout P ' djms eun m6dical h isni ue organi^. Dcs fonctionnaires ou A pent etre applique au premiers cas gui mar- ; | kg ; nci , e8 villes eu nombre suffisant pour qu ' aucun quent le debut dune epidemic est une mesure de surveillance hygienique. prudence quaucun pays ne deijrait neghger de P d'hygiene publique dcs different! pays puissent se mettre en communica. iSSA'fi^ dSffpS tion d^ecte, sans intermedfale, ch^uAois qu'elles en auront besom, pour se renseigner ou pour cable et plus utile que la population dv pays est s sur dcs mesure* d urgence a prendre plus clair-semee et que la sequestration a lieu plus Ado P tce a l ™**™& Pioces-verbaux, page 291. pres dv debut d'uue epidemic ; 3° que Fisolement y jn te)lt e)11 p S d e cholera • dcs foyers initiaux est la mesure capitale de pro- No. 8. Une attention toute particuliere est due aux grands cheniins, sur lesquels peuvent phylaxie contre les envahissements dv cholera. i voyag er dcs malades choleriques et aux points d'arrivee principaux, afin de pouvoir appliquer, Adoptee a 1 unammite. Proces-verbal, No. 39, I en tenips utilGj i' aS sainissement, isoler le malades et operer la desinfection. page 5. Adoptee a l'unanimite. Proces-verbaux, p. 292. La Conference est d'avis que Interruption est le N Sur kg deg routes terrestres que parcou rent dcs masses d'ouvriers ou Emigrants, meUleur moyen d isoler les foyers choleriques, que V^ possible, aux stations principals, dcs medecins pour preter leur soins par consequent, v y a lieu de 1 employer toutes les \ A if' t'ois que les circonstances se pretent a uue execu- au^ ,*' \"i» • ..' t. v. . onn .• ¦ ,i ,-ii Adoptee a 1 unammite. Proces-verbaux, page 299. tion ngoureuse ; mais que cette mesure, applicable r seulement a dcs points circonscrits, devient im- Xo. 10. Les trains directs parcourant plusieurs pays devront etre changes au passage dun practicable et inefficace lorsque F epidemie s'est pnys contamine dans un pays indemne. Us devront etre accompagnes dun medecin gui prendra propagee sur un grand espace. les mesures necessaires dans le cas ou un voyageur tomberait malade pendant le trajet. E 20510, F 82 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. Adoptee a la maiorite de 19 voix contre 2, celles ZZ ? '. . ; , . _ . de MM. Goodeve et Dickson. MM. -le C< c de _, Unc proprete rigonreuse sera observee sur les trains et aux stations dcs chemms de fer. Lallemand, Fauvel, Miihlig ont vote pour sous Chat ll!('l l ! ( ' sta lo , v devra avoir au moms une chambre separee dcs autres, pour recevoir provisoire%, v v i at on t nieiit le inalade. reserves, Proces-verbal, JNo. 39, page /. at*' * -.n ?,,., TT • -n - -i i. -^ ¦*¦.--..• ° Adoptee part 10 om (Autriche, Hongrie, Bresil, Danemark, Espagne, Italic, Mexique, La Conference est d'opinion qu'il y a lieu: 1" de Portugal, Serbie, Suisse), contre C non (Allemagne, France, Pays-Has, Roumanie, Suede, restreindre Immigration dans la circonscriptiou de Nonrege) et 5 abstentions QEtats Unis de l'Amerique dv Jford, Grande-Bretagne, Inde, Russie, la ville infectee; 2° de fixer par un reglement le Tunjuie). n ombre dcs personnes que chaque navire pourrait Proces-rerbaux, page 297. embarquer, proportionnellement a. sa capacite ; ¦m-iitj' 1-*-^ 1 -*-^ i -i ¦ c ¦ . -? -? • <- 3" de soumettre les personnes et leurs effets a dcs Xo.\\. La desinfection dcs personnes ne doit se faire qn'au moyen de lavages desinfectants, precautions preambles, telles qu'une visite medicale, et foment dans les cas, on elles seraient souillee de dejections choleriques. la purification dcs hardes et effete, etc. Ado P tec a ] ™amm^ moms une abstention (Espagne). Adoptee a I'unanimite, moms une voix, celle de No. 12. Toute provenance dun pays, ou existe le cholera, n'etant pas necessairement infectee, M. Millingcn gui s'abstient. Proces-verbal, No. 39, ou ne desinfectera (jue cc (jiii est souille ou pent avoir etc a l'usage dcs choleriques, et page 9. particulieivment les linges, les habits et les chiffons. Adoptee a I'unanimite, moms une abstention (Turquie). Proces-verbaux, p. 300. No. 13. Les regies d'hygiene generate, surtout en cc gui concerne les agglomerations d'individus, l'approvisionnenient dcs marches, les vivres, l'eau potable, le transport dcs malades, l'enterreinent dcs cadavres, etc., etc., applicables en tout temps, devront etre encore plus rigooreusement suivies en temps de cholera. Adoptee a I'unanimite. Proces-verbaux, page 301. Question dcs lazarets. Conclusions. En cc gui concerne les etablissements quarantenaires, la Conference propose : — 1° Que les lazarets soient etablis, autant que possible, dans dcs iles depourvues de population, et a defaut d'iles, dans dcs localites isolees et eloignees de plusieurs milles dcs villes, villages et autres lieux hahites. Que lair de ces localites soit salubre, le terrain de consistance rocheuse, Teau aboudante, le mouillage facile, sur et spacieux. 2° Que les edifices coinposant l'ensemble dcs lazarets soient construits d'ajni's les principes de I'article VII. dv present rapport, et de maniere a, assurer la separation rigoureuse ties differentes categories de quarantenaires, suivant la nature de la provenance et la date de , , , , . 83 F 2 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. l'arrivee. Que l'isolement de l'hopital dcs choleriques, dcs logements dcs quarantenaires, dcs buanderies, dcs magasins et hangars, dcs habitations dv personnel dv service, etc., soit complet. . Que la distance entre tons ces edifices, impossible a preciser d'avance, soit en rapport avec les indications consignees dans le paragraphs 13 dv rapport. 3° Que les cabinets d'aisance soient organises d'apres le systeme dcs fosses mobiles chargees de disinfectants. Que les egouts et les fosses communes soient proscrits. Que les matieres dcs dejections soient versees dans dcs fosses creusees dans le sol et recouvertes de chaux vive, de terre argileuse ou de poussier de charbon vegetal. 4° Que chaque lazaret ait deux debarcaderes, dont l'un de contumace, l'autre de libre pratique, un office de sante, dcs logements pour I'administration, uu corps de garde, un depot de literie et d'ameublement, un depot de vivres, une hotellerie. Adoptee a l'unanimite. M. Moulau a vote la 3 me conclusion sous reserve. Proces-verbal, No. 41, page 10. 5° Que les parloirs dcs lazarets soient supprimes pour les visiteurs, et les visites aux quarantenaires interdites, sauf dans dcs cas exceptionuels et avec l'autorisation speciale de l'autorite sanitaire ; qu'il soit toutefois permis aux personnes gui le demanderaient d'entrer au lazaret et d'y rester en se soumettant, dans cc cas, au regime dcs quarantenaires avec lesquels ils seraient en communication. La premiere partie de cette conclusion est adoptee par 10 voix contre 9, celles de MM. Dickson, Vernoni, Bosi, Keun, Sawas, Miihlig, Stenersen, Hiibsch, Bartolettd. La seconde partie est adoptee a, l'unanimite, moius 1 contre et 1 abstention. Proces-verbal, No. 41, page 12 et 13. 6° Que la direction dcs etablissements quarantenaires soit confiee a, dcs medecins, et qu'eu outre chaque lazaret soit pourvu de trois medecins, au moms, dont l'un attache a l'hopital, l'autre au service dcs quarantenaires, le troisieme charge dv service dv port et de I'exterieur dv lazaret. 7° Que le nombre dcs lazarets pour la quarantaine de rigueur soit limite proportionnellement au mouvement maritime et a l'etendue dv littoral de chaque Etat ; mais qu'il y ait cependant dcs postes secondaires pour les provenances soumises a la quarantaine d'observatiou. 8° Que, dans dcs cas d'urgence, on etablisse dcs lazarets temporaires, dcs campements, ou dcs lazarets flottants, selon les circonstances particulieres a, chaque localite. Adoptee a l'unanimite. Proces-verbal, No. 41, page 13. 9° Tout en admettant, dans certains cas, l'opportunite de lazarets internationaux administres sous le controle de conseils inixtes, la Conference est d'avis qu'en general l'institntion de ces etablissements nest pas recommandable. Adoptee par 9 voix contre 8, et 1 abstention. Proces-verbal, No. 41, page 14. I 84 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. Mesures a pbexdre dans les ports de l'Europe. Lorsque le cholera a fait invasion en Europe, la Conference recommande lc systeme d'inspection medicale, mais pour les Etats gui preferect I maintenir les quarantaines, elle ctablit les bases dun reglement quarantenaire. A. Systeme de l'inspection mkdicale. II y aura, dans chaque port ouvert au commerce, See Conclusion, No. 17, page BC. une antorite sanitaire composee de medecins et — d'admimstrateurs, aides par un personnel de I service. Le nombre dcs membres de ces differentes categories variera dans chaque port, selon l'importance 1 dv mouvement maritime, mais ll devra etre suffisant pour pouvoir accomplir dans toutes les circonstances et avec i rapidite, les mesures exigees pour les navires, les equipages et les passagers. Le chef de cc service sera toujours tenu au courant par dcs communications officielles, de l'etat sanitaire de tousless les ports infectes de cholera. Les navires provenant dun port net, n'ayant (d'apres la declaration sous serment dv capitaine) touche dans leur voyage aucun port intermediate suspect, ni communique directement avec aucun navire suspect, et sur lesquels durant le voyage on n'aura constate aucun cas suspect ou confirme de cholera, auront la libre pratique. Les navires provenant dun port suspect ou infecte, et ceux provenant de ports non suspects, mais gui ont eu dans le voyage dcs relations intermediates compromettantes, ou sur lesquels il y a eu durant la traversee dcs cas suspects de maladie ou de mort de cholera, seront sounds dcs leur arrivee a une visite medicale rigoreuse, pour constater l'etat sanitaire dv bord. S'il resulte de la visite medicale qu'il n'existe parmi les hommes de l'equipage et les passagers aucun cas j suspect de maladie ou de mort de cholera, le navire, avec tout cc qu'il renferme, sera admis a la libre pratique. Mais si dcs cas de cholera ou de nature suspecte se sont manifestos ii bord durant la traversee, le navire, les vetements et les effets a. usage dcs gens de l'equipage et dcs passagers seront soumis d'abord a, une desintectiou , rigoureuse, bien que l'equipage et les passagers aiem etc trouVes indemnes dv cholera dans le port. : . [ 85 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Home, 1885. S'il y a a Parrivee dcs cas suspects de maladie ou de mort de cholera, les malades seront immediatement transported dans un lazaret, ou dans un local isole, pouvant en tenir lieu et pret a, les recevoir ; les cadavres seront jetes a la mer avec les precautions d'usage, ou ensevelis apres avoir etc convenablement desinfectes ; les passagers et l'equipage seront soumis a une desinfection rigoureuse et le navire lui-meme sera desinfecte, apres , qu'on en aura eloigne les passagers et la partie dv personnel de l'equipage gui nest pas necessaire a la desinfection et a la surveillance. Les v^tements et les effets a, usage dcs malades et meme dcs passagers sains seront assujettis, dans un local special et sous le contr6le rigoureux de l'autorite sanitaire, a, une radicale desinfection. Apres cette desinfection, les effets seront rendus aux passagers et aux personnes de l'equipage gui seront admis I a libre pratique. - §6. Les marchandises debarquees seront admises a libre pratique, a, l'exception dcs chiffons et autres objets susceptibles, que l'on devra soumettre a une radicale desinfection. Proces-verbaux, pages 282, 283. 1 I regime quarantenaire et disinfection. Conclusions. Relativement a la quarantaine d'observation et a. la quarantaine de rigueur, la Conference est d'avis que la difference entre ces deux regimes consiste en cc que la quarantaine d'observation est un temps d'epreuve, de simple surveillance, tandis que la quarantaine de rigueur consiste dans .c debarquement au lazaret avec desinfection, et comprend toutes les mesures applicables a, une provenance cholerique. Adoptee par 21 vdix, contre 0 (MM. Maccas et Pelikan ont vote pour, avec reserve), 3 abstentions. Proces-verbal, No. 42, page 17. La Conference est d'avis : 1" que la quarantaine de rigueur applicable aux personnes venant dun lieu contaminee soit fixee, en regie generale, a. dix jours pleins, et que cette quarantaine commence, pour les personnes, au moment de leur entree au lazaret. Que si pendant le cours de la quarantaine il se produisait parmi elles dcs cas de cholera ou de diarrhee cholerique, les personnes saines, apres la separation dcs malades, devraient recommencer la quarantaine de dix jours pleins. 2° Qu'il y a lieu de considerer comme suspectes les personnes affectees de diarrhee, de les isoler dcs personnes bien portantes, ainsi que dcs malades de cholera, et de ne leur accorder la pratique, au bout de la quarantaine reglementaire, qua. la suite de l'observation medicale constatant la nature non-cholerique de la diarrhee. Adoptee par 17 voix, contre 0. (4 adhesions conditioners, 2 voudraient que la quarantaine fut portee a, 15 jours, 2 a, 17 jours.) Proces-verbal, No. 42, page 26. 86 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. La Conference est d'avis ; I<> d'appliquer aux B. — Systeme dcs Quarantainks. Proi-hylaxik sanitaire maritime. navires supposes containing la quarantaine de Pkovenances de ports infectss. Mesures sanitaires generales. rigueur, fixee a 10 jours pleins a dater de l'arnvee; „ 2° d'admettre une difference entre les navires .lo. lo provenances de ports infectes sont sou- l orts. a bord desqoels se serait manifesto le cholera ou misesaune observation variant de la 7 jours pleins No. 16. II est de l'interet de chaque nation d'asla diarrhee cholerique, et les navires gui n'auraient selon ' es cas - Dans les ports dcs Etats orientaux surer la salubrite de ses ports de mer. Elle evitera pas eu d'accideuts choleriques pendant la traversee : de HSurope, et ailleurs dans certains cas exception- souvent ainsi I'invasion de son sol par les maladies dans le premier cas seraient applicables toutes les ne^ s seulement, la duree de l'observation peut etre exotiques, et surtout elle ne transportera que raremesures de rigueur,d'isolement et de disinfection ; portee a 10 jours. meut sur ses vaisseaux les maladies endemiques. dans le second cas, les navires pouraient etre Navires 2° Si Fautorite sanitaire a la preuve Adoptee a runaminite. Proces-verbaux, page exemptes dv dechargement dcs marehandises non suspects, suffisante qu'aucun cas de cholera ou de 114 114-sujettes a purification, et ne seraient soumis qua nature suspecte n'a eu lieu a bord () - 17. Dans chaque port il serait necessairc dcs mesures generates d'hygiene sans disinfection durant la traversee, la duree de Pobser- de soumettre a dcs precautions vation est de 3 a 7 jours a dater de mission de lournir aux consuls dcs informations exceptionclles les navires encombres et a bord l'inspection medicale. officielles sur l'etat sanitaire de cc port, desquels il se serait nianifeste une epidemic grave Si, dans ces conditions, la traversee a i Adoptee a I'imaminite. Proces-verbaux, page de cholera, precautions gui consisteraient a un dure au nioins 7 jours, l'observation est U5. isolement plus complet, a la desinfection par les reduite a 24 heures pour les constata- No. 18. II sera accorde aux consuls la faculte de agents les plus actifs et meine a, la prolongation tions et les disinfections gui pourraient puiser aux bureaux d'hygiene leurs renseignements et au redoublement, selon les cas, de la duree de etre jugees necessaires. sur l'etat sanitaire dcs ports. la quarantaine ; 4" de reduire a 5 jours la quaran- Dans les cas de cette categoric, la Adoptee par 10 oui (Autriche-Hongrie, Etatstame applicable aux navires dont la traversee quarantaine d'observation pent etre Unis de l'Amerique dv Nord, France, Italic, .aurait dure de 15 a 30 jours sans aucun accident purgee a bord, taut qu'aucun cas de Mexique, Pays-Bas, Portugal, Russie, Suisse), cholerique, et a 24 heures lorsque la duree de la cholera ou d'accidents suspects ne s'est contre 2 non (Roumanie, Turquie),et 8 absentions traverse^ depasserait 30 jours; dans les deux cas, manifesto- et. si les conditions hygie- (Allemagne, Bresil, Danemark, Grande-Bretagne, desinfection dcs marehandises susceptibles, dcs niques dv navire le permettent. Inde, Japon, Suede Norvege) mtlt tatfr Pai ' tleS BUSpeCteS ' Uiais SimS d6chM S*- Dans ces cas d&hargement dv navire nest No . 19 . Chaque navire> dostin6 au trans ort dcs i,™ 2,,, . .t,. t , . . ..¦ point obUgatoire. voyageurs, gui part dun port suspect devra etre Adoptee a 1 unaminite, nioins une voix, celle de v . „ t-, , , ? ? vi S -x * ~ ¦> j i M Goodeve oui s'abstknt M Pelikin fait «es Navlres 3 En cas de cholera ou d'accidents convenablement construit et posseder dcs loeaux No 43 page 7 a l )res ' arrivee > Ia duree de l'observation Adoptee a L'unanumte. Proces - verbaux, "'. ' pour les personnes non inalades est : page 140. Kelativement aux navires gui ont a bord un de 7 jours pleins, a dater de leur isole- No. 20. Les paquebots provenant dcs pays, ou medecin commissionne et gui sont soumis pendant ment dans un lazaret on dans un eu- regne le cholera, seront tenus d'avoir une etuve la traversee a dcs mesures d'hygiene et de desiufec- droit pouvant eu tenir lieu. de desinfection par la vapeur. tion, la Conference s'est prouoncee de la maniere Los malades sont debarques et Adoptee a l'unanimite. Proces - verbaux, suivante: — recoivent les soins convenables dans un page 206. 87 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. Les navires en patente brute de cholera gui Navires local isole et separe dcs persounes en Xo. 21. Les batiments a vapeur, destines au auront rempli les conditions specifiees dans le ! infectes. observation. | transport dcs voyageurs provenant de pays ou cours de cet article, pourront compter les jours de Le navire et tons les objets susceptibles rcgne le cholera, seront tenus d'avoir a bord un la traverse* comme jours de quarantaine jusqu'a, sont sduniis a mie disinfection rigoureuse, medeciu nomine par le Gouvernement, auqael i concurrence de 9 jours. Us feront au port d'arrivee apres laquelle les personnes restees a j appartient le bateau, ou bien par l'autorite sanitaire. une quarantaine d'observation calculee de maniere bord dv navire sont assujetties a une revocable settlement par cc gouvernement ou cette k accomplir la quarantaine reglementaire de observation de 7 jpurs. autorite, et completement independant dcs com-10 jours pleius.« l'roces-verbaux, pages 284-386. pagnies de navigation et dcs armateurs de bateaux. Comme cepeudant la traversee dcs navires n'a Adoptee par 19 oui, contre 2 abstentions (Suede, pas toujours la memo duree et que celle-ci peut 1 jiovenaxcks de pouts suspects. : Xorvege). Proces-verbaux, page 124. varier de 1 a 9 jours et plus, la Conference a etabli 4° Les provenances dcs ports suspects, c'est-a- j l'echelle suivante comme regie a observer dans dire voisins dun port oil regne le cholera et ayant " l'application de la mesure proposee : dcs relations libres avec cc port, peuvent etre Apres 24 heures de traversee 9 jours de quaran- soumises a une observation, gui n'excedera pas tame d'observation. o jours, si aucun accident suspect ne s'est produit „ 2 jours „ 8 ? ? a bord. " 3 » " ' " » Dispositions diverses. „ 4 „ „ 6 „ „ r. k 5° Les navires charges d'emi grants, de pelenns, 6 4 et ; en geuoral, tons les navires juges particuliere-7 3 ment dangereux pour la sante publique, peuvent, g 2 dans les conditions mentionnees precedemment, 9 )? 24 heures , tre I'objet de precautions speciales que deter„ . . x , , . ? minera l'autorite sanitaire dv port d'arrivee. Pour les navxres dont la t traverse aurait depasse 6. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. Xo. 75. Dans la cas ou, d'apres le eertificat dv niedecin dv bord, il ny aurait pas eu a bord dcs cas de cholera depuis dix joins, l'observation pourra etre reduite a 24 heure Adoptee par 10 oui (Allemague, Autriche, Hongrie, Fiance, Italic, Pays-Baa, Russie, Saede, Norvege, .Suisse), contre 7 non (Bresil, Espagne, Mexique, Portugal, Roamanie, Serbie, Turqnie), et 4 abstentions (Danemark, Etats-Unis tie l'Amerique dv Nord, Grande-Bretagne, Inde). Proces-verbaux, page 242. Xo. 76. Les passagers seront di vises par groupes chacnn aussi pen nombreux que possible, de faeon a cc que, si dcs accidents se montraient dans un groupe, la duree de Fisolement ne tut pas augmentee pour tous. Adoptee par 18 oui, contre 3 abstentions (Etats-Unis de I'Amerique dv Xord, Grande- Bretagne, Inde). Proces-verbaux, page 243. No. 77. L'autorite sanitaire prendra les mesures qu'elle jugera necessaire pour la disinfection, et prescrira les moyens prophylactiques dont les principes ont etc adoptes par la Conference. Adoptee par 18 oui, contre 3 abstentions (Danemark, Grande-Bretagne, Inde). Procesverbaux, page 243. Navires. Xo. 78. Le navire sera desinfecte suivant les regies donnees dans les articles consacres a la desinfection. Toutes les operations de disinfection dv navire seront faites en presence et sous la responsabilite dv chef de l'autorite sanitaire dv port d'arrivee. Adoptee a l'unanimite. Proces-verbaux, page 251. Dispositions splsciales a la Mediterrax^e. Navikes suspects. Xo. 79. Les passagers et l'equipage seront debarqnes dans un local isole, construit dans cc but avec toutes les conditions necessaires pour realiser la desinfectiou et l'isolement. Adoptee par 10 oui (Bresil, Danemark, Espagne, Prance, Italic, Mexique, Portugal, Roumanie, Serbie, Turquie), contre 4 non (Autriche, Hongrie, Grande-Bretagne, Inde), ct 7 abstentions (AUemagne, Etats-Unis de I'Amerique dv Nord, Pays-Bas, Russie, Suede, Norvege, Suisse). Proces-verbaux, page 255. Xo. 80. Cet isolement variera de trois a. six jours pleins, suivant les conditions dv navire, qu'il s'agisse d'nn grand paquebot ou dun petit navire ; qu'il y ait, ou non, un niedecin a bord. Adoptee par 6 oui (France, Italic, Norvege, Pays-Bas, Portugal, Suisse), eontre 5 non (Bresil, Espagne, Mexique, Serbie, Turquie), et 10 abstentions (Allemagne,* Autricbe, Hongrie, Danemark, Etats-Unis de I'Amerique dv Nord, Grande-Bretagne, Inde, Roumanie, Russie, Suede). Proces-verbaux, page 257. 95 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. ___ | No. 81. On deduira de la duree de l'isolement, celle de la traversee. Adoptee par 7 oui (France, Italic, Pays-Bas, Portugal, Suede, Norvege, Suisse), contre 6 non (Bresil, Espagne, Mexique, Roomanie, Serbie, Turquie), et 8 abstentions (Allemagne, Autriche, Hongrie, Daneinark, Etats-Unis de l'Amerique dv Nord, Grande-Bretagne, Inde, Portugal, Kussie, Suisse). Proces-verbaux, page 258. Navires ixfectes. No. 82. Les navires infectes seront soumis, dans les ports de la Mediterranee, aux regies generales applicables aux navires iufectes dans les ports d'arrivee. __ Adoptee par 12 oui, contre 2 non (Espagne, Mexique), et 7 abstentions (Bresil, Danemark, Etats-Unis de l'Amerique dv Nord, Grande-Bretagne, hide, llussie, Turquie). Proces-verbaux, page 259. QuARAXTAIXES FLUVIALES. PItOPIIYLAXIK SANITAIRE FLUVIALE. Toutes les raisons produites, pour demontrer No. 14. Les ports dcs fleuves oil abordent dcs que les quarantaines par terre sont impraticables navires traversant la iner, doivent etre soumis au et inutiles pour empecher la propagation dv meme regime que les ports de mer. cholera, sont egalement valables pour les quaran- Adoptee a l'unanimite. Proces - verbaux, tames dans le cours dcs fleuves. page 299. Toutefois les mesures recommandees dans le No< 15 Les bateaux gui desservent les grands systeme de 1 inspection medicale adopte par la fleuves d( . vront etre soumis h une hygiene Conference peuvent y etre appliquees aux navires ri g Om . ecue.S c. L'encombrement dcs passagers sera ayaut le cholera a bord. strictemeut interdit. Quant aux ports de rembouchure, ils rentrent Un medecin sera attache a chaque point de dans la categoric dcs ports maritimes, et par con- relache important et, dans chaque station, une sequent les menies mesures y sont applicables. chanibre convenablenient isolee devra etre pre- Eesultat dv vote : ii m f^ ?„ . . , Yq ou j Adojitee a lunammitc, moms uue abstention 3 abstentions (Serbie, Turquie. Egypte). (Turquie). Proces-verbaux, page 298. Proces-verbaux, pages 298, 388. 96 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. Question de la disinfection. Conclusions. Suivant I'opinion de la Conference, la desin- La disinfection soit dcs effets a usage, soit dcs See "Disinfection," pages 70 and 71. fection consiste dans l'emploi de differents moyens navires, sera operee par les procedes qne les propres a assainir les lieux et lesobjets contamines autorites coinpetentes de chaque pays jugeront les par le germe cholerique. Ces moyens sont lair, inieux appropries aux circonstances. l'eau, le feu dans certains cas, ainsi que les sub- La Conference adopte : stances chimiques reeonimandees par la science et 21 oui. signalees dans le Kapport dcs mesures hygieniques. 1 abstention (Espagne). Proces - verbaux, La desinfeetion s'applique : 1" aux navires pro- pages 285, 388. venant de lieux infectes et a bord desquels se serait manifested soit une epidemic grave de cholera, soit dcs cas isoles de cette maladie ou seulement dcs cas de diarrhee cholerique. 2° Elle s'applique aux hardes et effets a usage See also " Questions de la Desinfeetion," page 70. des choleriques ainsi que dea personnes gui subissent le regime de la quarantaine de rigueur tant au lazaret qua. bord dcs navires. 3° Elle s'applique en outre aux marchandises | supposees contaminees telles que les drilles, les ¦ chiffons, les peaux, les cuirs, les plumes et autres debris animaux, ainsi que les lames et autres substances non emballees provenant dun lieu infecte ou dun navire sujet lui-meme a la desinfeetion. Les lettres et depeches seront enfermees I dans une boite et desinfectees par le degagement de chlore sans etre percees. Quant aux marchandises en general, sortant dcs fabriques et bien emballees, elles sont reputees non contaminees et consequemment non sujettes a la desinfeetion. 4° Enfin la desinfeetion s'applique aux animaux vivants, par I'aeration ou l'immersion dans l'eau, lorsque les autorites sanitaires le jugeront convenable. Adoptee a Tunanimite moms M. Goodeve gui s'abstient ; 4 votent sous diverses reserves. Proces verbal, No. 43, page 12 et 13. 97 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 18G6. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. La patexte de sante et l'arraisonkement. Conclusions : Dans l'opinioh de la Conference, il y a lieu de supprimer la qualification de patente suspecte et de maintenir celle de patonte nette et de patente brute, l'une temoignant de l'absence dv | cholera, l'autre attestant sa presence ainsi que le degre de sa manifestation. Adoptee a Funanimite. Proces-verbal, No. 43, page 13. La Conference exprime le vceu que le mot sporadique soit supprime sur les patentes oil Ton se bornerait, suivant le cas, a, nientionner l'existence dv cholera asiatique, ou dv cholera nostras. Adoptee a Fnnanimite. Proces-verbal, No. 43, page 14. La Conference est d'avis que la patente de sante doit faire mention dv cholera asiatique depuis le premier cas de ea manifestation jusqu'au dernier accident gui marque la fin de l'epidemie ; que les autorites sanitaires ne devront accordcr la libre pratique aux provenances dun lieu ou a regne nne epidemic que 15 jours apres la date de sa complete disparition. Adoptee a runanimite. Proces-verbal, No. 43, page 14. La Conference opine qu'il est d'absolue necessite, eomme garantie de la sante publique, qu'un navire n'ait qu'une patente delivree par l'autorite sanitaire dv point dv depart; qu'il est egalement necessaire que cette patente ne soit pas changee jusqu'a l'arrivee dv navire a destination definitive, et qu'en consequence les autorites sanitaires doivent se borner a viser ! la patente primitive sans la remplacer par une nouvelle patente jusqu'au voyage de retour. La Conference emet le vceu que les gouvernements gui attachent une importance particuliere au maintien de la patente coDsulaire veuillent bien consentir, dans l'interet de la sante publique, I a la remplacer par un visa sur la patente delivree par l'autorite sanitaire. Adoptee a l'unanimite, moms une abstention. Proces-verbal, No. 43, page 14. a 98 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Home, 1885. C. Dispositions communes aux deux systemes. (Inspection m^dicale. — Quarantaines.) La Conference est d'avis que I'arraisonnement Le capitaine, le medecin, et les officiers dv bord est mi acte de la plus haute importance en temps sont tenus de declarer a. l'autorite sanitaire tout cc de cholera. Les reticences, les fausses declara- qu'ils peuvent savoir d'apparition suspecte de tions, rendent illusoires le systeme restrictif le maladie parmi l'equipage et les passagers. mieux combine et compromettent la sante publique. Elles doivent etre severement punies par les En cas de fausse declaration, on de reticence lois de chaque pays. calculee, ils sont passibles dcs peines edictees par les lois sanitaires. II serait a desirer qu'une A cc propos la Conference emet le vobu que le entente internationak' s'etablit a cc sujet. Procesgouvernement ottoman promulgne dans le plus verbaux, pages 285, 387. bref delai.un code penal contre les infractions aux reglements sanitaires. La Conference exprime le vccu qu'une loi penale, See " Code Penale Sanitaire pour la Mer applicable aux contraventions sanitaires, soit Rouge," page 79. Adoptee a l'unanimite, one abstention. Proces- edictee dans l'Empire Ottoman, verbal, No. 43, page 14. Resultatdu vote: 15 oui, 4 non, .'5 abstentions. Proces- verbaux, pages 286, 388. ])K I.'INrORMATION SANITAIRE. Troisieme Partie. j^ 0 i j] egt nggessaire que dans chaque pays il existe an bureau central d'informations et d'avertisse- Projet be creation iVifne Commission Inter- ments charge de reunir tons les renseignments NATIONALS PERMANENT]: DES EpiDEMIES. Sailitaires. !• Tons ces bureaux echangeront entre eux dcs ,-r, ,T, T ? ' correspondances et dcs communications regulieres. (Bi;t. Utilite.) ' & ? . . , v ?. „ . . c . Adoptee par 18 oui, contre 1 non (Suisse) et II sera institue a Vienne .me Commission Sani- x ahs f entio^ (Poys Bas ). taire Internationale perinanente ayant jiour objet l'etude dcs maladies epidemiques. Proces-verbaux, page 304. 99 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 1866. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885, 11. No. 2. La Commission technique exprime le voeu que la Conference Internationale affirme la necessite (Attributions.) ,je pp U l»lier uu bulletin de statistique internationale Les attributions de cette Commission seront P our chaque ville importante, bulletin ayant une purement scientifiques ; elle pourra etre consulted base et une formnle umforme et iaisant connaitrc dans les questions scientifiques. chaque semaine le total dcs deces par chacune dcs La Commission aura pour tache principale l'etude maladies epidennques et en particular pour le dv cholera, au point de vue de l'etiologie et de la cholera et la fievre 3aune, prophylaxie. Adoptee a l'unanimite saufles deligues de Russie Keanmoins elle pourra coiupyendre dans ses et de Turquie, gui se sont abstenus. etudes les autres maladies epidemiques. A cet effet. elle tracera un programme com- Proces-verbaux, page 306. prenant les recherches devant etre entreprises dune . maniere uniforme par tons les Etats contractants, No - ?• En cc . l l * s premiers cas gui eclateront dans les diffeautres maladies epidemiques.* rentes et specialement dans les ports man- Eile fera connaitre le resultat de ses travaux. *™es- deyront etre notifies directement par voie Enfin elle pourra proposer la convocation de telegraphique aux differents Gouvernements. Conferences sanitaires inteniationales, et elle sera Adoptee a l'unanimite. chargee d'elaborer le programme de ccs Conferences. Proces-verbaux, page 304. ? Voir quelques excniples k l'annexe. 111. (Composition. Fonctionnement.) La Commission sera composee de medecins delegues par les Gouvernements participants. II y alira au siege de la Commission un bureau a residence lixe, charge de centraliser les travaux et de dormer suite aux deliberations de la Commission generale. La nomination et la composition de cc bureau sont laissees aux soins de la Commission generale. Les gouvernements dcs Etats participants clonneront a leurs autorites sanitaires et a leurs conseils d'hygiene publique les instructions necessaires, pour fournir a la Commission internationale tousless les renseignements relatifs aux questions (jui rentrent dans le cercle de ses etudes. i Dans les pays ou dcs conseils saniiaires interiiationaux sont etablis, ceux-ci fourniront tousless les renseignements ! qu'ils possedent, et prescriront les recherches necessaires. 100 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 18GC. Conference of Vienna, 1874. International Sanitary Conference of Rome, 1885. IV. (VOIES ET MOYENS.) Les frais necessites pour le fonctionnement de la Commission internationale seront repartis cntre les divers Etats interesses, et seront regies par voie diplomatique. V. (POSTES ET MISSIOXS.) Dans les pays oil il ny a pas de service sanitaire organise, les etudes seront faites, avec l'assentiment dv gouvernement local, par dcs missions temporaires, ou par dcs medecins en residence fixe. Ces missions et ce.s postes sanitaires fixes, institues par voie internationale, seront crees d'apres les indications de la Commission internationale, recevront d'elle leurs instructions, et lvi rendront compte de leurs travaux. (Ahticxe additioxxel.) II serait a desirer qu'un Conseil de sante international, analogue it ceux gui fonctionnent avec tant d'avantage '¦ a Constantinople et a Alcxandric, fut institue en Perse. Un tel conseil contribuerait beaucoup par l'autorite de ses avis, donnes en connaissance de cause, a ameliorer les conditions sanitaires de cc pays, et serait en meme temps un puissant moyen de protection contre I'invasion dcs epidemics en Europe. Proces-verbaux, pages 330, 331. Annexe a l'Article 11. dv projet de creation dune Commission Internationale DES EPIDEMIES. Comme premieres recherches, la Commission pourrait s'occuper dcs questions suivantes : 1° L'etude I'eguliere et suivie de la quantite de pluie et de la quantite d'eau d'evaporations pendant l'annee dans les stations suivantes. Bender-Bouschir, Tauris, Astrakan, Ispahan, Suez, Bakou, Teheran, Alexandrie, Tiflis. 2° L'etude scientifiques dcs conditions telluriques de ces differentes villes. 3° L'examen plus exact, et entrepris avec plus d'esprit d'analyse, qu'il ne la cte jusqu'ici, de l'apparition et de la propagation dv cholera sur les vaisseaux. 101 Conclusions of the International Sanitary Conclusions of the International Sanitary Conclusions of the Technical Commission of the Conference of Constantinople, 186 G. Conference of Vienna* 1874. International Sanitary Conference of Eome, 1885. Les recherches porteront provisoirement sur quelques lignes tres-frequentees : Calcutta-Maurice, Alexandrie-Malte, Alexandrie-Marseille, Southampton-Amerique dv Nord, Hatnbourg-New York, Singapore-Aden-Djeddah, Calcutta- Aden-Djeddah, Bombay -Aden-Djeddah, Naples-Venise. 4° Faire constater les premiers cas de chaque epideinie de cholera gui eclate dans les differentes localites et specialement dans les ports maritimes de l'Europe, et reunir tousless les elements dune Btatistique complete ' relative h la marche dv cholera en Europe. 5° Determiner par dcs faits scientifiques la duree precise de l'incnbation dv cholera. Adoptee a I'unaminite. Proces-verbaux, pp. 390, 391. QUATJUEMS PAKTIE. PkOPHYLAXIE SANITAIKE DE LA FIEVRE JAUNE. La Conference a entendu plusieurs communica- No. 84. Les mesures recommandees contre le tions sur la fievre jaune, mais elle a decide a cholera sont,en general, applicables a la^fievre jaune I'unaminite que cette question devait etre renvoyee et aux autres maladies, gui regnent epidemiquement a la Commission internationale permanente dcs sous l'influence dcs mauvaises conditions sanitaires epidemics, dont elle a propose la creation. et ( ( l v ' sont transmises par Pintermediaire de l'homme. Les moyens les plus efficaces pour empecher la propagation dcs maladies de cette classe, sont : L'assainissement dcs villes et dcs vaisseaux ' partant dcs ports infectes, Pisolement dcs malades et la disinfection dcs effets et dcs locaux infectes ou susj>ects. Adoptee par 17 oui, contre 3 abstentions (Grande-Bretagne, Inde, Turquie). Procesverbaux, page 303. 102 No. 4. A PP. No. 4, Io all Port Sanitary Authorities, except the Port Sanitary Authority for the Port of London; to all Urban and Eural Sanitary Authorities whose districts include or abut on any part of a customs port, which part is not within the jurisdiction of any Port Sanitary Authority; to all Officers of Customs; to all Medical Officers of Health of the Sanitary Authorities aforesaid ; BrsU Cholera to all Masters of Ships ; and to all others whom it may concern. Whereas We, the Local Government Board, by an Order bearing date the 17th day of July, 1873, made certain rules and regulations with a view to the treatment of persons affected with cholera, and for preventing the spread of the disease ; And whereas cholera is now prevalent in certain parts of Egypt with which this country has communication, and it is expedient that, in place of the rules and regulations made by the said Order, other rules and re<>-ulations as herein-after contained should be made : Now therefore, We, the Local Government Board, do hereby rescind the said Order, except in so far as it may apply to any proceedings now ponding, and We do, by this Our Order, and in exercise of the power conferred on Us by Section 130 of the Public Health Act, 1875, and every other power enabling Us in this behalf, make the following rules and regulations, and declare that they shall be enforced and executed by the authorities herein-after named :—: — Definitions. Art. 1. — In this order — The term " ship " includes vessel or boat The term "Officer of Customs" includes any person acting under the authority of the Commissioners of Customs ; The term " master " includes the officer or person for the time being in charge or command of a ship ; The term " cholera " includes choleraic diarrhcea ; The term " sanitary authority " means every port sanitary authority except the Port Sanitary Authority for the Port of London, and every urban or rural sanitary authority whose district includes or abuts on any part of a customs port, which part is not within the jurisdiction of a port sanitary authority ; The term "Medical Officer of Health" includes any duly qualified medical practitioner appointed by a sanitary authority to act in the execution of this Order ; For the purposes of this Order, — (1.) So much of a customs port abutting on an urban or rural sanitary district as is nearer to such district than to any other, and is not included within the jurisdiction of any port sanitary authority, shall be deemed to be within such district ; (2.) Every ship shall be deemed infected with cholera, in which there is or has been during the voyage or during the stay of such ship in a port in the course of such voyage, any case of cholera. I. — Regulations as to Detention by Officers of Customs Art. 2. — If any Officer of Customs, on the arrival of any ship, ascertain from the master of such ship or otherwise, or have reason to suspect, that the ship is infected with cholera, he shall detain such ship, and 103 Iler the master forthwith to moor or anchor the same in such position such Officer of Customs shall direct ; and thereupon the master shall thvvith moor or anchor the ship accordingly. App. No. i, General Cholera Order. tit. 3. — Whilst such ship shall be so detained, no person shall leave same. lixt. 4. — The Officer of Customs detaining any ship as aforesaid shall hwith give notice thereof, and of the cause of such detention, to the itary authority of the place where the ship shall be so detained. I^rt. 5. — Such detention by the Officer of Customs shall cense as soon the ship shall have been duly visited and examined by the Medical Leer of Health ; or, if the ship shall, upon such examination, be found be infected with cholera, as soon us the same shall be moored or hored in pursuance of Art. 10 of this Order. I'rovided, that if the examination be not commenced within 12 hours r notice given as aforesaid, the ship shall, on the expiration of the 12 hours, be released from detention. II. — Regulations as to Sanitary Authorities. Ijt. 6. — Every port sanitary authority, except as aforesaid, and every )r sanitary authority within whose district persons are likely to be led from any ship coming foreign shall, as speedily as practicable, i the approval of the Chief Officer of Customs of the port, fix some :e within the jurisdiction or district of the sanitary authority where ship may be moored, or anchored, for the purpose of Art. 10 ; and [1 make provision for the reception of cholera patients and persons bring from illness removed under Arts. 13 and 14. lii't. 7. — The sanitary authority, on notice being given to them by an cer of Customs, under this Order, shall forthwith cause the ship in ird to which such notice shall have been given, to be visited and exnod by their Medical Officer of Health for the purpose of ascertaining sther she is infected with cholera. Art. 8. — The Medical Officer of Health, if he has reason to believe that any ship within the jurisdiction or district of the sanitary authority, whether examined by the Officer of Customs or not, is infected with cholera, shall, or if she have come from a place infected with cholera may, visit and examine such ship, for the purpose of ascertaining whether she is so infected ; and the master of such ship shall permit the same to be so visited and examined. IJt. 9. — If the Medical Officer of Health on making such examination foresaid (whether under Art. 7 or 8), shall be of opinion that the i is infected, he shall give a certificate in duplicate in the following i, or to the like effect, and shall deliver one copy to the master and in the other or transmit it to the sanitary authority. Certificate. day of 188 Sanitary Authority of I hereby certify that I have examined the ship of , now lying in the port of [or detained at ] and that I find that she is infected with cholera. Medical Officer of Health [or Medical Practitioner appointed by the Sanitary Authority. ¦ v t. io. — The master of every ship so certified to be infected with era shall thereupon moor or anchor her at the place fixed for that 104 A.PP. No. 4, keral Cholera er. purpose under Art. 6, nml she shall remain there until the requirements of this Order have been duly fulfilled. Art. 11. — No person shall leave any such ship until the examination herein-after mentioned shall have been made. Art. 12.— The Medical Officer of Health shall, as soon as possible after any such ship has been certified to be infected with cholera, examine all persons on board of the same, and all persons who shall not be certified by him, as hereafter mentioned, shall be permitted to land immediately on their giving their names and the places of their destination. Art. 13. — Every person certified by the Medical Officer of Health to be suffering from cholera, shall be dealt with under any regulations that may have been made by the sanitary authority under Section 125 of the Public Health Act, 1H75 ; or, where no such regulations shall have been made, shall be removed, if the condition of the patient admit of it, to some hospital or place previously appointed for that purpose by the said authority ; and no person so removed shall leave such hospital or place until the Medical Officer of Health shall have certified that such person is free from the said disease. If any person suffering from cholera cannot be removed, the ship shall remain subject, for the purposes of this Order, to the control of the Medical Officer of Health ; and the infected person shall not be removed from or leave the ship, except with the consent in writing of the Medical Officer of Health. Art. 14. — Any person certified by the Medical Officer of Health to be suffering from any illness which such Officer suspects may prove to be cholei-a, may either be detained on board the ship for any period not exceeding two day?, or be taken to some hospital or other place previously appointed by the sanitary authority, and detained there, fora like period, in order that it may be ascertained whether the illness is or is not cholera. Any such person who, while so detained, shall be certified by the Medical Officer of Health to be suffering from cholera, shall be dealt with as provided by Art. 13 of this Order. Art. 15. — The Medical Officer of Health shall in the case of every ship certified to be infected, give directions, and take such steps as may appear to him to be necessary, for preventing the spread of infection, and the master of thy said ship shall forthwith carry into execution such directions as shall be so given to him. Art. 16. — In the event of any death from cholera taking place on board of such ship while so detained, the master shall, as directed by the sanitary authority or the Medical Officer of Health, either cause the dead body to be taken out to sea, and committed to the deep, properly loaded to prevent its rising, or shall deliver it into the charge of the said authority for interment ; and the authority shall thereupon have the same interred. Art. 17. — The master shall cause any articles that may have been soiled with cholera discharges to be destroyed, and the clothing and bedding and other articles of personal use likely to retain infection which have been used by any person who may have suffered from cholera on board such ship, or who, having left such ship, shall have suffered from cholera during the stay of such ship in any port, to be disinfected or (if necessary) destroyed ; and if the master shall have neglected to do so before the ship arrives in port, he shall forthwith, or upon the direction of the sanitary authority or the Medical Officer of Health, cause the same to be disinfected or destroyed, as the case may require; and if the said master neglect to comply with such direction within a 105 reasonable time, the authority shall cause the same to be carried into execution. A PP. No. 4, General Cholera Order. Kirt. 18. — The master shall cause the ship to be disinfected and every cle therein, other than those last described, which may probably be cted with cholera, to be disinfected or destroyed, according to the ctions of the Medical Officer of Healh. Given under the seal of Office of the Local Government Board, this twelfth day of July, in the year one thousand eight hundred and eight-three. (1.5.) Charles W. Dilke, President. Hugh Owen, Secretary. I notice. — The Public Health Act, 1875, provides by section 130 that ¦ person wilfully neglecting, or refusing to obey or carry out, or trncting the execution of any regulation made under that section, 11 be liable to a penalty not exceeding Fifty pounds. Date of publication in the " London Gazette," 13th July 1883. 106 A pp. No, Specimen It Order. No. 5. Specimen of Board's Orders as to Bag-importation. To all Port Sanitary Authorities, to all Urban aiul Rural Sanitary Authorities, to all Officers of Customs, to all Officers of Health of the Sanitary Authorities aforesaid, to all masters of ships, and to all others whom it may concern. Whereas cholera is now prevalent in certain parts of Spain, and it is expedient that regulations should be made with reference to ships having on board bales of rags from that country : Now therefore, We, the Local Government Board, do, by this Ouv Order, and in exercise of the power conferred on Us by section 130 of the Public Health Act, 1875, and every other power'enabling Us in this behalf, make the following regulations, and declare that they shall be enforced and executed by the authority or authorities herein-after specified : — • Article 1. — In this Order— The term " sanitary authority" means port sanitary authority urban sanitary authority, or rural sanitary authority ; The term "ship" includes vessel or boat ; The term " Officer of Customs " includes any person acting under the authority of the Commissioners of Customs ; The term " master " includes the officer or person for the time being in charge or command of a ship. Article 2. — From and after the date of this Order, and until the first day of November, 1885, no rags from Spain shall be delivered overside, except for the purpose of export, nor landed in any port or place in England or Wales. Article 3. — If any rags shall be delivered overside or landed in contravention of this Order, they shall, unless forthwith exported, be destroyed by the person having control over the same, with such precautions as may be directed by the Medical Officer of Health of the sanitary authority within whose jurisdiction or district the same may be found. Article 4. — All masters of vessels, consignees, and other persons having control of any rags prohibited under this Order from being delivered overside, except for the purpose of export, or landed, are required to obey these regulations. Article o. — All Officers of Customs are empowered to prevent the delivery overside or landing of rags in contravention of this Order. Article 6. — It shall be the duty of the sanitary authority to take proceedings against masters of ships, consignees, or other persons having control over any rags, who shall wilfully neglect or refuse to obey or carry out, or shall obstruct the execution of any of these regulations. Given under the seal of office of the Local Government Board, this twenty-third day of June, in the year one thousand eight hundred and eighty-five (1.5.) Chables W. Dilke, President. Hugh Owen, Secretary. Notice. — The Public Health Act, 1875, provides by section 130 that any person wilfully neglecting, or refusing to obey or carry out, or obstructing the execution of any regulation made under that section shall be liable to a penalty not exceeding Fifty pounds. 107 No. 6. Precautions against the Infection of Cholera. A.PP. No. ( 1. The Order of the Local Government Board, of July 12, 1883, ow in force, gives certain special powers to the Sanitary Authorities ? the sea coast, enabling them to deal with any cases of cholera brought lto port, so as to prevent as far as possible the spread of the disease lto the country. But as cases of choleraic infection have widely ifferent degrees of severity, it is possible that some such cases, slightly teefed, will, notwithstanding the vigilance of local authorities, be anded without particular notice in English sea-board towns, whence icy may advance to other, and perhaps inland, places. Precautions against the Infection ol Cholera. 2. Former experience of cholera in England justifies a belief that the n-esence of imported eases of the disease at various spots in the country ill not be capable of causing much injury to the population, if the aces receiving the infection have had the advantage of proper nitary administration ; and, in order that all local populations may ake their self-defence as effective as they can, it will be well for them 0 have regard to the present state of knowledge concerning the mode 1 which epidemics of cholera (at least in this country) are produced. 3. Cholera in England shows itself so little contagious, in the sense which small-pox and scarlatina are commonly called contagious, that, ' reasonable care be taken where it is present, there is almost no risk lat the disease will spread to persons who nurse and otherwise closely ttend upon the sick. But cholera has a certain peculiar infeetiveness its own, which, where local conditions assist, can operate with rrible force, and at considerable distances from the sick. It is laracteristlc of cholera (and as much so of the slight cases Avhere arrhoea is the only symptom as of the disease in its more developed id alarming forms) that all matters which the patient discharges from is stomach and bowels are, or can become, infective. Probably, under 'dinary circumstances, the patient has no power of infecting other persons except, by means of these discharges ; nor any power of infectng even by them except in so far as particles of them are enabled to aint the food, water, or air, which people consume. Thus, when a case cholera is imported into any place, the disease is not likely to spread, llesa in proportion as it finds, locally open to it, certain facilities for treading by indirect infection. 4. In order rightly to appreciate what these facilities must be, the bllowing considerations have to be borne in mind :— -first, that any loleraic discharge, cast without previous thorough disinfection into ny cesspool or drain, or other depository or conduit of filth, has a acuity of infecting the excremental matters with which it there mingles, nd probably, more or less, the effluvia which those matters evolve; ecoiidly, that the infective power of choleraic discharges attaches to halever bedding, clothing, towels, and like things, have been imbued itb. them, and renders these things, if not thoroughly disinfected, as capable of spreading the disease in places to which they are sent (for washing or other puiposes) as, in like circumstances, the patient himself would be ; thirdly, that if, by leakage or soakage from cesspools or drains, or through reckless casting out of slops and wash water, any taint (however small) of the infective material gets access to wells or other sources of drinking water, it imparts to enormous volumes of Ethe power of propagating the disease. When due regard is had se possibilities of indirect infection, there will be no difficulty in standiu 0 " that even a single case of cholera perhaps of the slightest 108 Ait. No. 6 Precautions against the Infection of degree, and perhaps quite unsuspected in its neighbourhood, may, if local circumstances co-operate, exert a terribly infective power on considerable masses of population. 5. The dangers which have to be guarded against as favouring the spread of cholera-infection are, particularly, two. First, and above all, there is the danger of water-supplies which are in any (even the slightest) degree tainted by house refuse or other like kinds of filth ; as where there is outflow, leakage, or filtration, from sewers, house-drains, privies, cesspools, foul ditches, or the like, into springs, streams, wells, or reservoirs from which the supply of water is drawn, or into the soil in which the wells are situate; a danger which may exist on a small scale (but, perhaps, often repeated in the same district) at the pump or dip-well of a private house, or, on a large or even vast scale, in the source of public waterworks. And secondly, there is the danger of breathing air which is foul with effluvia from the same sorts of impurity. 6. Information as to the high degree in which those two dangers affect the public health in ordinary times, and as to the special importance which attaches to them at times when any diarrhceal infection is likely to be introduced, has now for so many years been before the public, that the improved systems of refuse-removal and water-supply by which those dangers are permanently obviated for large populations, and also the minor structural improvements by which separate households are secured against them, ought long ago to have come into universal use. So far, however, as this wiser course has not been adopted in any sanitary district, security must, as far as practicable, be sought, in measures of a temporary and palliative kind. (a.) Immediate and searching examination of sources of water supply should be made in all cases where the source is in any degree open to the suspicion of impurity ; and the water both from private and public sources should be examined. Where pollution is discovered, everything practicable should be done to prevent the pollution from continuing, or, if this object cannot be obtained, to prevent the water from being drunk. Cisterns should be cleaned, and any connnexions of waste-pipes with drains should be severed. (&.) Simultaneously, there should be immediate thorough removal of every sort of house refuse and other filth which has accumulated in neglected places; future accumulations of the same sort should be prevented : attention should be given to all defects of house-drains and sinks through which offensive smell are let into houses ; thorough washing and lime washing of uncleanly premises, especially of such as are densely occupied, should be practised again and again. 7. It may fairly be believed that, in considerable parts of the country, conditions favourable to the spread of cholera are now less abundant than at any former time ; and in this connexion, the gratifying fact deserves to be recorded that during recent years enteric fever, the disease which in its methods of extension bears the nearest resemblance to cholera, has continuously and notably declined in England. But it is certain that in many places such conditions are present as would, if cholera were introduced, assist in the spread of that disease. It is to be hoped that in all th.3se cases, the local sanitary authorities will at once do everything that can be done to put their districts into a wholesome state. Measures of cleanliness, taken beforehand, are of far more importance for the protection of a district against cholera than removal or disinfection of filth after the disense has actually made its appearance. 109 8. It is important for the public very distinctly to remember that Ins taken and costs incurred for the purposes to which this memoldum refers cannot in any event be regarded as wasted. The local editions which would enable cholera, if imported, to spread its ection in this country, are conditions which, day by day, in the sence of cholera, create and spread other diseases ; diseases, which, being never absent from the country, are in the long run, far more itructive than cholera ; and the sanitary improvements which would tify a sense of security against any apprehended importation of )lera, would, to their extent, though cholera should never re-appear England, give amply remunerative results in the prevention of those Ler diseases. A it. No. t Precautions ngainst the Infection of Cholera. George Buchanan, Local Government Board, Medical Officer of the Board. July 21, 1885. 110 1 No. 7. General Report upon the Results of the Sanitary Survey made in anticipation of Cholera, 1885-86; by Dr. Ballard. iPP. No. 7. On Sanitary '_ Survey made in anticipation of Cholera; by In 1884, introduction of cholera into the country being more immediately threatened, it was thought by the Board desirable that a special inquiry should be instituted with a view to ascertain our state of preparedness to resist the introduction of the disease or its spread. The last occasion on which epidemic cholera obtained a footing and spread among our communities was in 1866. Before that we had suffered from three epidemics, viz., in 1832, 1849, and 1854. As to these four epidemics, it may suffice here to say that each succeeding one, taking the kingdom as a Avhole, gathered fewer victims than the preceding, ft is not necessary to go far to discover the reason of this progressive immunity. To the outbreak of 1 832 no known means of defence could be opposed ; the disease was new to the experience of Europe; but, as panic subsided, the practical English mind set itself to discover the causes of the epidemic, and the conditions of its extension. Each succeeding epidemic brought fresh minds into contact with the problem, and collateral investigations were stimulated, the joint result of the whole being the gradual building up (on very ancient foundations indeed) of a progressive science, which we now call " sanitary science," and which is the guide of the Medical Department of the Board in its dealings with matters relating to public health. As regards cholera, the order of our scientific acquisitions was somewhat of this kind. The first thing that became apparent was its special connexion with lilthiuess of person and surroundings, bad housing, lowness and unwholesomeness of site, and misery. Its spread in localities where it had been introduced and in families was at first thought to indicate a contagion? element about it ; later on this interpretation became more definitely shaped to the doctrine now held, that under certain circumstances the evacuations of the sick ore an element of danger ; then followed, during the epidemic of 1854, the remarkable and shrewd observations of the late Dr. Snow, demonstrating incontrovertibly the connexion of cholera with a consumption of specifically polluted water, startling the profession by the novelty of his doctrine, and inaugurating a new epoch of etiological investigation. Each step of scientific advance has been a firm one, each has served to give clearer insight into the signification of earlier observations, and, which is mere to the purpose, each step of scientific advance has been associated with a parallel advance in preventive medical art. Dr. Ballard. Cholera epidemics of former years ; iioir teaching : resulting The wisdom of Parliament has led to such consecutive legislation as has given effect to these several advances of our knowledge. In due order the country has been provided with such statutes as the Nuisances Removal and Diseases Prevention Acts, the Metropolis Local Management Acts, and other local Acts applicable to certain large towns, the Sanitary Act of 1866, and lastly, the Public Health Acts of 1872, 1875, and subsequent years, together with other collateral statutes all bearing in the same direction. With all this, and in great part as a consequence of this legislation, the public mind has been instructed, some amount at least of sanitary knowledge has filtered down to the lower strata of society, and a popular interest is manifested at the present time even in the more delicate and abstruse investigations of professional inquirers. How different is all this from the condition of affairs when cholera made its first incursion into England in 1832 ; and, which is again much more csrislation : 111 to the purpose, how very different is the sanitary condition of England Arr. No. 7. Ew from what its condition was in 1832 ! Then every man did that ,->n s-miHry lich was right in his own eyes, not knowing any better guide than his Survey made in n ignorant beliefs and those of advisers who were at that time as ohoteraf^s'*' lorant in such matters as himself. Now, throughout the length and Dr - BaflkwE ?adth of England and Wales, organizations for the sanitary improve- ranitwy o A i , i i .ii. i t i t» ¦%• J . i X . . organization nt or the country have been established by Parliament, provided with and improveicial medical advisers who at least have some definite rules to guide ments< I em ; and, taking the kingdom as a whole, an amount of what we are customed to call sanitary work has beeD accomplished which, looking ck to 1832, has made it almost a new country from this point of view, d has removed from our midst to a very great extent the most serious those unwholesome conditions on which, as we now know, the spread epidemic cholera is dependent. Panic should now be impossible, except leed where neglect has preceded it, and we can look forward with s dread than perhaps the population of any other European country the introduction of epidemic cholera. We have faith in our system prevention, and have grounds of experience for our faith in it. And Recent action is because of their faith in it that this Board have thought it right reference 1 ?© ascertain, with such precision as was practicable, the position of oholera. England and Wales as regards general and special preparedness against a possible invasion of cholera. It was clear that with the" medical staff at the disposal of the Department a comprehensive inquiry would not be practicable, nor, indeed, was it contemplated. The first thing to be done obviously was to Preliminary see that the port sanitary districts were in a due state of defence, and jjj^stigation : this was the work of 1884. The inquiry was conducted by Dr. Blaxall, with the temporary assistance of Dr. de Chaumont. The list of port sanitary districts visited on that occasion is given at p. 136 of the last Report of the Medical Officer of the Board. The inquiry was continued in 1885, and many of these ports were re-visited by the same inspectors, and by Dr. D. S. Davies, whose temporary services were then engaged. In 1884, the preparedness of the principal port sanitary authorities for action was the object of the inquiry, but, incidentally and complementarily, some inquiries were instituted into the preparedness of the corresponding urban sanitary districts. This part of the inquiry was, however, subsidiary to the principal object, and was limited in its scope. Later on, in the early months of 1885, the Board more extended had observed the need for more systematic inquiry in the port sanitary districts, and also had thought it expedient to extend the inquiry to sanitary districts not connected with ports : accordingly further temporary additions were made to the medical staff of the Department, and for the special work of the cholera survey, now thoroughly organised, Dr. Blaxall, Dr. Airy, Mr. Spear, Dr. Page, Dr. D. S. Davies, and myself were detailed. The direction of the survey generally was committed to me, Dr. Blaxall, however, being left as before in special charge of the port survey, for which he had peculiar qualifications, and to this survey was now added an inquiry as to the preparedness for action of the riparian authorities who had, under the Public Health Act of 1885, had functions and corresponding duties, conferred on them, in respect of shipping. A report of the proceedings of the Department as respects port and riparian authorities is being prepared by Dr. Blaxall. The present report has reference only to the pro- ceedings of the Department in respect of urban and rural sanitary authorities, whose districts (together with some waterside districts of the metropolis) have been brought under survey from the commencement of 1885 to about March 1886. 112 In the selection of districts for earliest survey, the considerations which have guided the Department have been the following :—: — Apr. No. 7. On Sanitary 1. The safe-guarding of our first or littoral line of defence. 2. Our experience of the behaviour of the epidemic of 1866 in its Dr. Ball'arrt. incidence on certain districts in England and Wales. 3. Our experience of the special incidence of enteric fever during late years upon various districts of the country — enteric fever being known to spread through agencies similar to those which cholera favours. In a less degree, our experience of the incidence of the ordinary annual epidemic diarrhoea of this Selection of districts. country has similarly been taken into account. In addition to these guiding considerations, the Department made use of the special information in its possession as to the varying energy of local authorities, and as to the competence and efficiency of their medical officers of health. There was no departure from these principles ; the only apparent departures having been on the rare occasions when the last of the above considerations was given exceptional weight. From the time that I took charge of the survey, the instructions given to the inspectors engaged upon it, and which I followed myself in the very few inspections which I made personally, were definite. All wrought upon precisely the same lines ; definite points of inquiry were specified, and a form of report under several headings was drawn up with a view to secure uniformity and to enable the Board to ascertain readily the condition of each district as to any one of the various points included in the inquiry. Naturally, in the course of the inspector's survey, he was brought into immediate personal and official relationship with the executive officers of each authority, and especially into free communication with the medical officers of health. The very high advantages of the last-mentioned fact I shall have occasion to refer to at a later period of this report. Finally, there was that which was held to bo the most important instruction of all — namely, that before finally quitting a district the inspector who had made its survey was to seek an interview with the sanitary authority, or, where this was not expedient or conveniently practicable, with its chairman and executive officers, and on that occasion to talk over with them the sanitary condition of the district, pointing out in general (and occasionally in special) tsrms the defects he had observed, and stating (again in general or occasionally in special terms) the remedies which in his opinion ought, to be applied ; to instruct them, where necessary, as to their special duties in the event of the appearance of cholera in the district; and lastly to leave with the authority a written memorandum embodying the advice which he had given in conference. Plan of inquiry uniform. Number of districts inspected . The total number of sanitary districts brought under survey and reported upon during the period to which this report has reference wftB 285, namely 188 urban sanitary districts, 87 rural sanitary districts, and S waterside districts within the metropolitan area. In appendix to this report (pp. 201-353) will be found arranged in a tabular form a precis of the most important points in relation to protection against cholera brought to light by the survey, points which have reference, I°, to general sanitary condition, and 2°, to sanitary administration. This tabular statement (in which the districts surveyed are arranged in counties) will enable me to curtail the general observations I may have to make, and will usefully serve as the text or basis of them. The circumstances of urban and rural sanitary districts differ in such a way that I have thought it well to keep separate the parts of the precis which refer to them and, to some extent, they are distinguished from each other in the remarks which now follow. 113 In the first place, however, the remark must be made that there is an artificiality about the distribution of sanitary districts into urban and rural which is actual, although not at first sight apparent. Taking each kind of district as thus designated en masse, it is the fact that urban districts consist mainly of populations gathered together into towns, and rural districts of populations scattered broadcast over a country district, or gathered into small village groupings. But actually, not only do urban districts differ very greatly among themselves in the size of their really town aggregations, but in some of them the populations are not gathered into anything that deserves the name of " town " at all, or at the most into small communities to which the term " village " would be properly applied. On the other hand, there are rural sanitary districts which contain important town populations, sometimes towns which are market towns of no inconsiderable size or aggregations of industrial populations for which only proper designation is the term "town." As illustrations of the former may be mentioned Chorley Urban District in Cheshire and South Caveand-Wallingfen in Yorkshire. As illustrations of the latter may be mentioned the rural districts of Tavistock in Devon, Stourbridge in Worcestershire, and VVoodbridge in Suffolk : — populous places, virtually with urban populations, these have come to be deprived of advantages which are granted by the Public Health Act to some village populations (constituted urban districts) which have far less need for them. Of the two errors, the latter is to my mind the more serious. It is better in any case to have more advantages than are absolutely needed than too few. App. No. 7. On Sanitary Survey made in anticipation of Cholera; by Dr. Ballard. Anomalies noted. The points to which special attention was directed during the survey are the following, viz. : — I°. The generally cleanly condition of the roadways, especially the back and narrower roadways and courts, and also of domestic premises atid immediate surroundings of houses. 2°. The drainage of the place, that is to say, the provision made for carrying liquid slops or sewage matters safely away from domestic premises and roadways and their proper disposal without creating nuisance, and the general efficiency of the whole system. 3°. The provisions in use for dealing with the excrement of the population, and the existence or nonexistence of excremental nuisances, the class of nuisances most closely associated with the spread of cholera. 4°. The efficiency with which non-liquid refuse matters, such as decomposable domestic refuse commonly mixed in receptacles with ashes and other non-decomposable refuse, is dealt with for removal so as to avoid dangerous nuisances. s°. The water supply, its sufficiency in quantity and its quality or liability to dangerous pollution, especially to excremental pollution. 6°. The general condition of the dwellings of the poor and labouring classes, especially as regards cleanliness or uncleanliness (often necessarily associated with structural defects or dilapidations), dryness or dampness, and provision for due ventilation. 7°. The prevalence of crowding of poor dwellings upon insufficient area, the result of which is to deprive the inhabitants of the amount of free air movement and of light which is essential to their well-being and health, and to intensify the malignant influence of excremental aud other filth nuisances about them ; and B°. The prevalence of unwholesome crowding of individuals in single houses, which I take it is the true meaning of the term " overcrowding." In addition, the inspector was required to report upon the efficiency of the sanitary administration and upon the quality of the work done by the Medical Officer of Health and by the Inspector of Conditions specially inquired about. E 20510. a 114 Nuisances, and as to the special provision made for dealing with spreading diseases and as to special preparation made for the advent of cholera. App. No. 7. On Sanitary Survey made hi anticipation of Cholera ; by Dr. Ballard. Nuisances, domestic and other. The general results of the inquiry may be summarised as follows :—: — 1. General Cleanliness. — There has been observed little to complain of in the cleanliness of the main streets of towns, whether large or small. These at all events are usually kept in decent repair and fairly scavenged. And in the larger towns inspected the same may be said generally about back streets and courts and domestic premises, the exceptions in these towns being chiefly the localities where a low class of labouring population, especially Irish population, exists. The habits of such people are often dirty, and they give much trouble to sanitary officers. Some metropolitan waterside populations of foreign immigrants are similarly complained of by Dr. de Chaumont. It is in the smaller towns, and especially in those within rural sanitary districts, that most complaint of uncleanliness has been made, and chiefly in those towns, whether within urban or rural districts, which contain the largest proportion of a labouring population, and whei'e sewering works had been neglected, or the removal of refuse matters had not been undertaken by the sanitary authority as part of their own proper functions. The keeping of pigs in the close yards of houses is often regarded with leniency by the sanitary authorities of small towns, and pig-nuisances are often not sought to be dealt with under appropriate byelaws in urban districts, nor under the provisions of the Public Health Act relating to nuisances in rural districts. Still, I. think, on a review of the whole survey, it may fairly be said that there has been observed less general uncleanliness in and about dwellings, especially the dwellings of the poor, than might have been observed 10 or 20 years ago. If it were to be asked where the uncleanliness of the surroundings of domestic premises is most remarkable, there can be but one reply, namely, that it is most remarkable in the agricultural villages in some rural districts, especially in those most distant from large centres of population and on soils which are naturally retentive of moisture or boggy. Natural difficulties of this kind are often not efficiently grappled with. Mining villages used to have a bad name, but the improvement of cleanliness in them of late years has been marvellous. This improvement is very striking in the county of Durham and in South Wales. These are colliery districts, and the reason of the improvement is to be found in this, that the colliery owners, Avho also usually own the villages where their workpeople reside, have of late years in many instances, on the opening of a new mine, been at the expense of erecting convenient dwellings laid out in well-arranged rows or streets, and have undertaken to provide them with all the appliances for decent living. Similar honourable mention may be made of the owners of other large industrial works, such as iron works, in different parts of the country. I mention the fact as a healthy sign of the times. Sewerage and drainage. 2. Drainage. — Nearly all the towns in the urban districts visited were found to be provided with sewers of some kind. But the quality of the sewers varied considerably. Of course it was to be expected that the older towns sewered many years ago, when the principles of efficient sewering were less understood than they are now, would be found provided for less satisfactorily than those sewered more recently. But in some towns the old sewering is (as described) so defective as to be almost more an injury to the place than an advantage, and a wholesome method of removing liquid sewage can only be attained, by complete reconstruction. In other towns, while an old and defective 115 system, long ago provided, has been retained in the older parts, more approved methods have been introduced into newer parts. Apart from such original faults of construction as undue flatness, the absence of due provision against regurgitation from tidal influx of water (when the discharge is into the sea or into a tidal river), &c, and apart from defects due to age and consequent dilapidation, the fault most commonly found with town sewers has been an absence of due provision for their ventilation and for requisite flushing. An inadequate notion of the importance of these provisions seems largely to prevail, and hence either no provision for them is made at all, or j>rovision to an extent far below the requirements of the case. Indeed, so far has this inadequacy proceeded sometimes, that ventilators originally provided have been permitted to be stopped up by inhabitants, or have been actually closed again by the sanitary authorities themselves, with a view to remedy offensive odours complained of as proceeding from them, and this occasionally against the expressed advice of the medical officer of health. The proceeding has been a most dangerous one, especially dangerous when cholera is threatened. The authorities have not perceived, or have been unwilling perhaps to understand, that offensive odours from a ventilator indicate a dangerous foulness of the air within the sewer, due to some cause which ought to be sought out and remedied, and that sewer air thus specially foul is specially dangerous also to the inhabitants of houses into which or into the immediate vicinity of which it is driven by the denial to it of a safer mode of discharge. The most common of the faults causing this foulness of the sewer air complained of as issuing from the ventilators has been observed to be the retention and deposit of sewage matters in the sewers from defects of construction or want of due flushing; the discharge into the sewers of overflows from privy or closet cesspools ; the want of due flushing, by means of proper apparatus, of closets communicating with house drains, which thus become permanent depositories of old excremental matters j and the construction in the sewers themselves, beneath the manholes, of eatchpits for excrement and more solid matters, with the object of keeping the intermediate portion of the sewage system clear with a minimum of trouble. Whenever these faults have been committed, the inspector making the survey has not failed to express these views to the authority. J3ut sometimes when complaints of ventilators have been made, the sanitary authority have made a compromise more dangerous still, more dangerous because delusive and productive of a false sense of security. They have introduced charcoal boxes into the ventilating openings. This is only another mode of stopping up the ventilators and arresting the ventilation. In small towns, and especially in those which are under the control of rural authorities, the sewering was often found very defective. Sometimes there were no sewers provided at all, or those that had been put in were only partially provided and piecemeal without any systematic method, having their outfalls into some convenient watercourse (perhaps within the town itself) or into some neighbouring ditches, in either case creating nuisance. Sometimes superficial highway drains, roughly constructed, and never intended to carry anything but surface water, were found to receive domestic sewage, the overflows of cesspools, of the discharges from waterclosets or cesspools sometimes multiple. Cesspools placed even beneath occupied dwellings were found to be the habitual recipients of all kinds of domestic liquid filth. And while this was commonly the case with small towns, the villages in rural districts were naturally found to be still worse off in the matter of sewers. Either there was found no attempt at sewering at all, or only a few pipes were introduced here and there for the drainage of some group of App. No. 7. On Sanitary Survey made in anticipation of Cholera j by Dr. Ballard. Sewerage and drainage. n 2 dwellings into some neighbouring ditch or watercourse. No doubt there were exceptions to all this, exceptions due to unusual activity of the sanitary authority or else to the action of some wealthy landowner who had sewered a town or village wholly or mainly on his own property at his own private expense : in this respect, again, a word of commendation must be given to the owners of many new colliery villages in Durham and South Wales. App. No. 7. On Sanitary Survey made in anticipation of Cholera; by Dr. Ballard. Sewerage and drainage. And here I must interpolate a remark of concurrence with the impression left on the minds of the inspectors who have made the survey in colliery villages, to the effect that under some exceptional circumstances the absence of deep sewers is not altogether to be deprecated : a good system of surface drainage by well-constructed surface channels has, where the channels have been carefully and daily cleansed under local supervision, appeared to answer well, and even to be preferable to the provision of sewers. In towns where the sewers are old and defective, or where there are no sewers at all, the house drainage has been found correspondingly defective and bad, sometimes very dangerously so. And similar defects have been found even in towns which are satisfactorily sewered. The money collected from the ratepayers as a body or borrowed for public works, to be repaid by instalments, has been expended in the public sewering ; but work that had to be done at private expense, and which should have been done concurrently with sewer construction or improvement, has not been enforced,. — under a mistaken but common notion of leniency. In many towns it was found that the efforts of the medical officers of health had proved effectual in cutting off internal sink communications with house drains, but in some instances this was only done in the case of new houses. In other towns no attempt to do it had been made at all. Again, in some well-sewered towns, cesspools were found still existent for the reception of domestic slops and the discharges from waterclosets, but in very many they had been systematically abolished when the sewers were constructed. The due ventilation of the soil pipes of waterclosets was found quite exceptional or provided for only in houses recently erected. In villages without due provision for drainage, especially in villages situated upon an impervious soil, such as clay, sewage nuisances about domestic premises were ordinary matters of observation. Still, on the whole, it may be said that, in the matter of drainage and removal and safe disposal of liquid filth, the country (so far as the results of present survey may be taken as a criterion) is in a far safer condition than it was at ihe period of the cholera epidemic of 1866. The towns, especially the larger towns, are much safer (of course with some sad exceptions), and even the smaller towns and villages have, on the whole, been somewhat improved. 3°. Excrement Conservancy and Disposal. — Since the period of the last cholera epidemic great efforts have been made by the Board to gather and diffuse information popularly upon this important subject, and on the whole with some success. The great obstacle to improvement has been local tradition. Perhaps there is no branch of sanitation in which local customs and traditions have had a more baleful influence in hindering improvements than this. There is none in which prejudice has been more obstructive. The revolutionising of a system of dealing with excrement is a work which can only be successfully undertaken by resolute men, working with clear ideas about what is wanted. Thus it has come to pass that much of the improvement effected has been of the nature of a compromise. In the north of England, where Excrement disposal. the old-fashioned type of midden privy, often large enough to hold a year's App. No. 7. accumulation, deep sunk in the earth, open and so arranged as to receive On Sanitary all the rain drippings from the privy roofs, the utmost that has commonly Survey made in anticipation of been obtained has been moderate reduction in size, covering of the ashpit, Cholera ; by sometimes raising of its floor, and occasionally removal to a somewhat Dr. Ballard. greater distance from the house than before, while an attempt has been Excrement disposal. improperly made to remedy the wetness and offensiveness of its contents by draining ifc into the house drains. Sometimes even where a water-carriage system has been introduced for closets within houses, the old midden privies have been left for out-door or servants' use. The abolition of " privy-pits " in districts where this system has prevailed has been perhaps still more difficult of accomplishment, especially where the soil is very porous or deeply fissured, as in some kinds of rocky or in chalk districts. The convenience of a pit which rarely, if ever, requires to be emptied, is fully appreciated. In respect of both these systems, the midden system and the privy-pit system, the nuisance is intensified where either of these contrivances is placed in confined situations, as in back yards closely built round, or in close courts, and where their systematic cleansing is not undertaken by the local sanitary authority. The very act of cleansing them is often a source of intolerable nuisance ; of course it is so where there is no access to the midden or privy-pit except through a dwelling-house ; but in some places a practice prevails which is a nuisance, not merely to the inhabitants of an individual house, but also to the entire neighbourhood, namely, the shooting down of the midden privy contents in the roadway, and leaving them there until it be found convenient to cart them away. It is in small towns and villages that this last kind of nuisance mostly occurs, but large towns are frequently found where the midden privy system prevails, and houses, sometimes many, sometimes few, c;in only get their privies emptied by transport of their filth through the house. The absence of any kind of privy accommodation at all is certiiinly becoming less frequently observed than it used to be. But still it is met with in parts of some large towns and in many rural villages. Mostly where this fault was observed, it has been in places where cottages are closely crowded together, back-to-back or one above another on a hill side, and without any yard space at all about them. Some Cornish coast fishing villages and small towns furnish notable examples of this. The men habitually discharge their bowels on the beach, but the excrement of tlie women and children is retained in vessels within the houses until a definite hour in the day, when it is all carried to some accustomed place on the shore, or to some shoot provided on the beach, as at St. Ives. Sanitary authorities are slow to deal with such a practice as this, but at Padstow «a system of collection has been organised, which to some extent obviates the resultant evils. I think it may be said that in the direction of wholesome dealing with excrement less has been accomplished, especially in small towns and in rural villages, of recent years than in any other direction of sanitary amendment. Indeed, in some rural districts the condition of things in this respect is still most deplorable. It 0 . Removal of solid Refuse; Vegetable or Animal Refuse, and Refuse removal. mestic Dust or Ashes. — Where the midden privy system prevails these d matters are habitually cast into the midden, and there await the c, when, together with the privy matter, it is convenient to cart them ly. In some of the towns visited bins of varying size are provided domestic premises for their reception, and in some towns, as Merthyr . Dowlais, large iron receptacles are provided in poor localities for 118 public use, and are systematically emptied by the authority. At Cambridge and some other towns the retention at all of such matter on domestic premises for any length of time is discouraged, and inhabitants -ire required to put them outside their doors in portable vessels of some kind ana they are collected daily, or on certain fixed days, in the several districts of the town by the town scavengers. This is altogether an admirable arrangement, indeed, it is the best conceivable, and in towns where adopted it has been found perfectly practicable, and to work well in keeping the towns clean, and domestic premises free from litter. Even in the Irish quarters of such a town as Cardiff where this arrangement is adopted, I have seen nothing of the nature of decomposable litter. But there are towns, and those not of inconsiderable •size, in which either there are no receptacles at all, or they have been permitted to fall into such a state of disrepair that decomposable refuse has to be heaped in any odd corner of back yards, passages, or courts : hence, by the absence of any proper systematic scavenging, such refuse has been permitted by the authorities to become a permanent, or recurring source of nuisance. Cardiff has been mentioned as an example of what can be done in a fairly large town. Swansea is a not very far distant town from it, and the same thing might be accomplished there, but I hail reason to complain in Swansea of much nuisance from such accumulations. In country villages where there is abundant garden space about houses, the nuisance of decomposable refuse accumulation is little observable, but in towns, even in small towns, it is often noticeable where the sanitary authority do not themselves undertake removal. But even in towns where the authority do undertake removal of refuse, back places or places not. immediately accessible are apt to be neglected, especially in poor localities where the inhabitants are unwilling or unable to fee the scavengers. But it is not to be inferred from the observation just made about rural villages that it is of no consequence whatever whether a rural authority see to the proper disposal of the littering filth, or do not see to it even in such isolated places as farmhouses "and premises. It may matter very greatly. A filthy farmyard littered with animal manure "and vegetable refuse, with possibly (nay, probably often ) human excrement in addition, may not only be a cause of serious and repeated disease, or even mortality, in the adjoiningdwelling, but may endanger persons, or even towns, at a distance. An example of this occurred during last year's survey at Swansea, where an alarming epidemic of enteric fever broke out in the town, and where the town water supply came from a reservoir gathering drainage water from some distant hills, part of which water was polluted by the drainage from some isolated farms where enteric fever had not only shortly before broken out, but where it had been recurrent year after year. The premises of the most important of these farms were disgustingly filthy and had long been so, yet had remained undealt with by the rural authority in whose district it lay. The water supply of the town of Tenby, which I visited almost immediately after Swansea, was found liable during part of the year to precisely similar endangerments. And it is not only a danger which relates to enteric fever. It is to be recollected that cholera contagion moves in parallel lines with this disease. A pp. No. 7. On Sanitary Survy made in anticipation of hnlcra ; by Dr. JialliUi Ilofuse removal. s°. Water Supply. — A very cursory glance at col. 6 of the appended tables will suffice to show that nearly all of the urban districts included in the survey, so far as it has gone, were found to be now independent of local sources of domestic water supply, and to be Water supplies provided with a supply from some extraneous source.* Few of the apf. No. 7. results of the survey are more gratifying than this, when it is o ~ — On Sanitary kept in mind that the urban districts particularly referred to are Survey made in anticipation of principally the districts along the coast, or in closest relation with the Cholera; by coast, and with our ports ; and when, in this connection it is remembered Dr. Ballard. that the most serious extensions of cholera have in former years been Water supplies. brought about through the agency of specifically polluted drinking water. It is specially gratifying to notice how generally external supplies have taken the place of house-wells in the colliery districts of South Wales ancl Durham. It is observable too that the supplies, where given, have usually been extended to all parts of an urban district, that the supplies are almost universally upon the " constant " system and abundant in quantity, and that concurrently with the giving of a public supply, measures have been taken to abolish such dangerous local supplies to domestic premises as shallow wells. Indeed in very many districts such sources as shallow Avells are now non-existent ; in other urban districts, where they have not been as yet totally abolished, a progressive abolition of them is in hand. Nor, as a rule, have the inspectors engaged upon the survey found much occasion to complain of the quality of the water, or of pollutions, or suspicion of pollution at its source, or in the course of its distribution, but there are some notable and very serious exceptions to the rule. The tale told by the inspectors about the rural districts is very different. The provision of a public supply to small tovms and villages within the jurisdiction of rural authorities is the exception and not the rule, and even where there has been found anything deserving the name of public supply, it has been provided usually by some local proprietor for his own tenants alone, and by no effort made by the rural authority in behalf of the populations under their sanitary care. As a rule these small towns and villages, neglected often in other respects {e.g., in their scavenging and drainage), are still left, as during former cholera years, to draw their domestic Avater supplies from shallow wells sunk in a soil sodden with soakings from privies and leaky drains, from some streams polluted either with the drainage of the place itself, or of parts higher up, and in some few places even from such filthy sources as ponds and ditches. Again lam bound to add that in many of the colliery villages in rural districts of Durham, where the mine workings are sunk through the magnesian limestone, the good water struck during the sinkings has been made available by the owners for the domestic use of their tenants, by conveying it by pipes into their villages. It will be perceived then, from what has preceded, that the Public Health (Water) Act, 1878, which it was hoped would greatly ameliorate the condition of the rural districts of the country in this respect, and which in many parts has ho ameliorated it, has frequently failed in its object. For any notice that has been taken of the Act in some of the rural districts visited during the survey the statute might just as well not have been passed. * Whenever the term " public supply " is used it signifies that water is laid on to the place and available to the inhabitants generally by stand pipes or public taps, or supplied to individual houses or convenient groups of houses, sometimes from works the property of the sanitary authority, at other times from the works of some public or private company, and now and then by the owners of the place (acting in their private capacity) from extraneous sources of their own. It has not been considered necessary to distinguish between these several modes of supply in the tabular precis, although specific information on the subject has been given in the several inspectors' full reports. 120 App. No. 7. In some few towns with a public supply it was observed to be the practice to flush the sewers from the water mains through a direct communication between the two. In every town where these things are done or permitted, the danger of the practice wa3 pointed out by the inspector. For the most part in watercloseted towns with a public water supply, the supply to the cistern closet is given through the medium of a special flushing tank ; but in some it was found that direct communication of the mains with the closet pans was permitted. These were the ordinary faults, where fault was discovered, in the method of distribution on the constant system. In the few instances of intermittent supply, the fault of using the same storage cistern for the closet and for the supply of drinking water was not unusual. In rural districts it was not uncommon to find that the water brought from springs at a distance was unprotected in its course or some part of its course. On Sanitary "Water supplies. Before concluding what I have to say about water supplies, it may be well to allude to a difficulty expei-ienced at Swansea, and which was pointed out to me by the town clerk there in connexion Avith the outbreak of entei'ic fever above referred to. The waterworks and reservoirs are the property of the Urban Sanitary Authority of Swansea, but the gathering ground of the reservoir which became specifically polluted is a wide range of moorland at a distance, which moorland is dotted over with farm homesteads and cottages, the whole being out of the sanitary jurisdiction of the Urban authority, and within the jurisdiction of a rural authority which has no particular interest in safe-guarding the town supply, and evidently, in this instance, took no trouble in the matter. The unwholesome condition of these farmsteads, and especially of that one which did the most mischief last year, was well known to the medical officer of Swansea, and to the urban authority, and had been so known for a long time before last year's outbreak. Nor was last year the first year in which danger had arisen of pollution of the Swansea water from these places. It was a constant danger, and an especial danger in time of heavy rain, of which all were well aware. Yet the urban authority have been throughout powerless to obviate it, except by the purchase of the whole tract of land and the farms upon it, or by abandoning a large part of their gathering grounds and so contracting the water supply of their rapidly growing urban district. Some effectual remedy against such a state of things ought to exist. 6°. Condition of the Dwellings of the Poor and Labouring Classes, Overcrowding upon Area, and Overcrowding in Dwellings. — The recently issued Report of the Royal Commission on the Housing of the Poor, of which a late President of the Board was the Chairman, relieves me of the necessity of making many remarks upon this element of the survey. For the most part the tabulated precis appended to this report may be left to speak for itself. It may suffice generally to say that with the exception of newly formed urban districts consisting mainly of newly erected dwellings built in accordance with good byelaws, few urban or rural districts are completely free from faults under these headings. All authorities show a disposition to deal tenderly with the private interests involved in interference with structural faults ; and looking at the difficulties which surround much of such interference, it is not easy to say that tenderness of dealing with them is not to some extent justifiable. But the maintenance of cleanliness and such small structural amendments as are conducive to cleanliness, as, for example, the remedying of defects of flooring and paving (which defy all the efforts of a housekeeper at keeping a dwelling clean), improvements of house ventilation, the remedying of dampness by due rain spouting Housing of population. 121 by paving and surface drainage about a house and the like, which are Arr. No. 7. covered by the powers given to sanitary authorities by the Public Health On Sanitary Act, there is no excuse for sanitary authorities neglecting. Yet such Survey made in simple matters are neglected, and greatly neglected too, not only iv rural anticipation of Cholera; by places, but in some poorer parts of considerable towns. Neither is there Dr. Ba'iiard. any justification for neglecting the unwholesome condition of the sur- Housing of population. roundings of such dwellings as it is neglected sometimes. A fortiori there is no excuse whatever to be made for such a sanitary authority as the Corporation of Tenby who permit and take rent for the continued occupation of premises which are their own property and are wholly unfit for human habitation. These things have all their bearing upon liability to extension of cholera, since it has long ago been known that it is in places thus generally neglected that cholera once introduced is apt to spread most freely. But there are two faults so common over the Welsh districts, one of construction and the other of occupation, that they deserve special mention. The first is one very common indeed in the hilly districts of South Wales, namely, the construction of houses in this way : a house, say, of three floors, is arranged thus — the two upper floors looking frontwise up the hill are entered from a roadway on this side, but the lower floor has no connexion whatever (except structurally) with this part of the dwelling, being entered from a roadway or pathway at the rear some 10 or 12 feet lower down the hill, and as it backs upon the earth beneath the upper roadway is altogether without due ventilation, and is necessarily very damp and dark. It is in fact little better than a bricked cave. An abundance of such dwellings may be seen in the older parts of Merthyr Tydfil, and I have seen such as far west as Tenby — dwellings the continued occupation of which has over and over again been protested against by the medical officer of health, now on the general ground of their unwholesomeness and now on the ground of their having actually conduced to the fatal issue of disease. Yet there they remain as samples of a traditional mode, and so in the eyes of the authority a justifiable mode, of constructing dwellings in hilly parts. They are dealt with as tenderly as any other private property. — The other fault is a sub-species as it were of '•' overcrowding." So far as I know, it is a Welsh speciality and is met with principally if not solely in newly opened mining districts where there is for the time insufficient house accommodation for the number of miners and labourers who suddenly flock into it. The miners working by shifts, it is found convenient to take into a cottage two sets of lodgers who occupy all the beds in the dwelling not at night only, but both by night and by day ; one set entering and lying down to sleep in the same room and in the same bed that had been vacated just previously by other lodgers. It is an arrangement the ludicrous side of which has been represented in the stage play of " Box and Cox," but the tragic side of which was dwelt on many years ago by the present Medical Officer of the Board when investigating an epidemic of typhus fever at Festiniog. lam not aware of any attempt having been at any time Ke by a sanitary authority to deal with this sort of occupation. The jers attending it are enhanced when the bunk or fixed bed found in many Welsh cottages, as in many cottages in the rural parts of Scotland, is the kind that is in use. 7°. Sanitary Administration. — One result of the survey has been to Local adminisbring prominently into notice some points in relation to the sanitary administration of local authorities established by the Public Health Act, 1872, which it may not be out of place to refer to here. One is the very varying degree of efficiency of their administration. This is the first thing that must strike a reader of the reports, and by the use of various 122 API>. Xo. 7. brief terms it has been endeavoured to represent the variety in the appended tabular precis. The same general fact may be gathered in a measure, as a matter of inference, from the several columns of the precis. Many sanitary authorities have been working and are still working earnestly for the improvement of the districts in their charge, not in one direction only but in all directions of importance. Others have since their constitution done no efficient work, or little of primary importance in the way of necessary improvement. Indeed, some of these latter authorities, it will be seen, evince no desire even to be properly instructed as to the sanitary requirements of their districts, asking for no reports from their medical officers of health, and paying little or no regard to them when presented. And, unfortunately (though this is only what was to be expected), it is the very districts Avhich are in the most unwholesome condition in which this sanitary apathy of the authorities is most observable. Among the urban districts thus neglected in many important matters the following (not including all such, however) may be specially mentioned (see footnote): Dart ford; Sandwich; Chiehester ;* Ilavant ; Alverstoke (Gosport) ; Norwich; Huntingdon ; Ramsay ; Godmanclicstcr ; Gainsborough ; :;: Exeter ;* Crediton ;• Bridgwater ; South Cave and Wallingfen : Pickering ; Whitby ; Hinderwellj Guisborovgh ; liedcar ; Stanhope, ; Durham; Gtitcshead ; Walker; Cowpen ; Bedling tonshire / Alnwick and Canongate ; Holy well ; Mold;* Pontypridd ; Bridgend ;* Pembroke;* Tenby ; llnverfordioest ;* and Cardigan. It will be observed that the majority of these urban places are either on the coast or close to it, and thus (if we are to judge by former experience) more liable than inland places to suffer from cholera should it unhappily invade this country, and also to suffer earlier than they. The list includes three cathedral cities, one of which is a university city also. Among the several rural districts brought under survey, the following may similarly be specially mentioned: JJartford ; Tonbridge ; Maidstone ; Westbourne ;* Ilavant ; Fareham ; Isle of Wight; Thrapston; Chesterton; Orsett ; 'Rochford ; Woodbridge ; Sherborne ; St. Thomas (Devon) ;* Crediton; St. Germans; Helston ; Heniswoith ; Thome; llowden; Malton ; Pickering ; Whitby; Castle Ward; Beliord ; Berwick; Carmarthen;'* Pembroke ;* Haver/ b/ dwest; and IlolywelL* There is yet a third class of authorities, the most numerous of all, especially in the rural districts, which is intermediate between these extremes, where laxity and tardiness is the rule of the administration, a laxity and tardiness which shows itself in a variety of ways (as exhibited in the several columns of the precis), not the least infrequent of which is a tenderness in dealing with private premises, and with recurring nuisances on and about them, and in the neglect of the conditions under which the poorer part of their population live, that part of the population least capable of self-help. On Sanitiiry ley made ir Jipation of era; by Ballard. ,1 adminison. That on the whole there should be more laxity of administration in rural than in urban districts is due, as I am inclined to believe, to a * The districts marked * Mere amongst those which appear to have suffered most heavily from cholera iv the epidemic of 1866, so far as can be judged from the Registrar-General's Report on the cholera epidemic of that year. The districts printed in italics are districts which had been on one or more former occasions inspected by the Board's Medical Inspectors, and the sanitary authorities of which had on each such occasion been officially advised as to the sanitary requirements of their districts. In some of these districts nothing whatever or only an insignificant amount of work has been done to carry into effect the Board's recommendations, in others one or two of the permanent works recommended were accomplished after the inspection, the sanitary authority subsequently falling again into neglectful ways. combination of causes, sometimes one sometimes another of which is predominant. Among these causes may be suggested — the large amount and the variety of administrative work now thrown by the Legislature upon boards of guardians ; the fact that the elected members of the sanitary authorities in agricultural districts are principally farmers, to whom repeated or prolonged attendances at board meetings is often very inconvenient ; the obstacles which among this class of persons arise out of old traditional convictions and habits of thought and practice and hinder the utilization by them of modern sanitary knowledge ; and the too frequent abstention of the more cultured class of ex-qfflcio members. In short, the broad result of the experience of the Medical Department, confirmed by the results of this survey, is that sanitary administration is often distasteful to existent rural authorities. And this distastef ulness and impatience with sanitary work shows itself in a variety of ways familiar to the Board's inspectors. One of these is a not uncommon practice of the retirement of members from board meetings as soon as the sanitary business commences ; and another is a practice of referring important matters to parochial committees as the surest way of shelving them, thus virtually (in a way which certainly the Legislature never contemplated) reinstating the evils of the vestry administration under the Sanitary Act of 1866, which sort of administration it was one of the objects of the Public Health Acts of 1872 and 1875 to put an end to. The sanitary administration in the Isle of Wight Rural District is a typical example of the practices I am referring to ; and, since the survey report of Mr. Spear states that, notwithstanding the recommendations of the Board on the occasion of my own inspection of the district in 1880, the objectionable practices described in my report on that inspection have not been abandoned, it may not be out of place to reprint what I then said upon App. No. 7. On Sanitary Survey made in anticipation of Cholera; by Dr. Hnllard. Local administration. I' The rural authority, which is the board of guardians (with a few exceptions) of the Isle of Wight Union, consists of 53 elected and 20 ex-officio members. Their meetings take place fortnightly. The guardians meet as the rural sanitary authority after all their business as guardians of the poor has been completed. They meet for poor law I business at 10.30 a.m., and this business usually occupies them, for about four hours. The average time subsequently occupied by sanitary business is, I am informed, on an average of 1\ hours, but sometimes Pit is a much longer time. The guardians who happen to come to the poor law sitting are those who subsequently transact the sanitary business. It is not customray for members who have not come to the " former to come for attendance at the latter. The ox-officio guardians, " with the exception of about four of them, who are pretty regular I attendants, very rarely come to the sanitary meetings. At these meetings the entries made by the medical officers of health in their journals are read, and also the reports made by the inspectors of nuisances in their report books ; and the statements thus read arc initialed by the chairman, or directions are given to the inspectors upon them. Now, no doubt it is in a certain sense convenient to the members and to the clerk that the sanitary busines should thus be appended to the poor law business of the board ; but it is only natural that interest should flag after four hours' continuous work, with its attendant fatigue, " and that a disposition should be felt on the part of all concerned to " shorten as far as possible the sittings as the sanitary authority. That 11 this feeling does operate to some extent is shown by the habitual depar" ture of a number of those who have attended the guardians' meeting, as " soon as the sanitary business conies on. I" This feeling indicates itself in another way, namely, by the apparent tendency of the authority to delegate its functions of inquiry in any important local matter to parochial committees, such committees consisting of members of the authority, together with other persons qualified 124 " so to act. Such a proceeding is perfectly legal, and in accordance with " the 202 nd section of the Public Health Act. But the exercise of this " power of delegation to a parochial committee is liable to be carried to " excess, and if not carefully guarded may lead to a virtual reinstating, 11 under shadow of the above section, of much the same sort of vestry " administration which was in force before the Public Health Act of 1872 " was passed: while the authority as a whole, losing their proper interest " in principles of action, may come to think they have done their work " when they have accepted as matter of course the conclusions of their " local committees. This is especially likely to be the case when the " questions referred to a parochial committee involve the expenditure of " money." ATT. No. 7. On Sanitary Survey made in anticipation of Cholera; by Dr. Bnllard. Local administration. The following two examples of the bad working of the system under the same authority are given :—: — "Some few years ago the deficiency of water in a place called Tinker'^ " Lane v/as brought prominently under the notice of the authority, and 11 the subject was referred to a parochial committee. The deficiency was " only too obvious, many of the poor cottagers there getting their water " from a polluted and muddy stream of water at the bottom of the lane, " the only available source of supply. Nothing in the way of efficient 11 action resulting from the appointment of the committee, Dr. Wm. " Hoffmeister, the medical officer of health, repeated his complaint, and " a letter was written by the Local Government Board to the authority " upon the subject. This letter was referred to the parochial committee. " Nothing came of all this until January 1878, when it was discovered " that a supply of water was available in the neighbourhood, and in May " 1878 a tender was accepted for the erection of a reservoir to store this " water, and to lay the necessary supply pipes. In August 1878 a vestry " meeting, called for the purpose, sent in a protest against the scheme, and three weeks later the parochial committee came to the following resolution : ' That in consequence of an Act of Parliament being passed, " ' entitled the "Public Health Water Act, 1878," making it compulsory " 'on the owners of property to supply their houses with water, which " ' will come into force on the 25th March 1879, it is not desirable ti> " ' proceed with any further steps to supply Tinker's Lane with water " ' until after that date.' In this resolution it would appear the rural " authority coincided, although they had been informed by circular " letter from the Local Government Board that the passing of the Act did. " not relieve rural authorities of the duties imposed on them by the " Public Health Act to provide their districts with a supply of water. " From that time to this nothing further has been done to remedy the " deficiency either under the Public Health Act or the Pnblic Health (Water) Act. "Another illustration of administrative miscarriage resulting from " delegation of an irnportfint question to a parochial committee is afforded " by the case of Carisbrooke (at the outskirts of Newport) the cesspool " nuisances of which place have been for many years notorious. The 11 subject was in the hands of a parochial committee for six years. The " steps consisted in the admission of the evil and recognition of the only " effectual remedy; consultation with an eminent engigeer, Mr. Bailey " Denton, who suggested two alternative proceedings, either of them " practicable ; a vestry meeting of the inhabitants which protested against " any costly scheme of drainage; the immediate abandonment of the project ; and, finally, the construction of additional cesspools, which. " the authority has not undertaken to empty, and has neglected ever " since."* Still there is this broad result which may be regarded with gratification, namely, that in many of the districts which suffered more or less * I have the less hesitation in reproducing these instances, from the fact that up to the present time, after a lapse of six years, the rural authority have taken no action in improving the conditions of these two places as stated in my Report. The condition 0 are precisely the s&me as they were when X made mv inspection* 125 Itvily from cholera in 18G6, improvement has been effected under provisions of the Public Health Acts, which, by the establishment definite sanitary authorities has stimulated local interest in such tters, and has afforded facilities for sanitary work which have ;n largely used, even though not always to the fullest possible ent. A great deal of very good work has been done, especially in urban districts constituted by the Act of 1872 ; it may not be much to say (considering the time which has elapsed, and the iculty of surmounting traditional prejudice, and of indoctrinating masses with modern scientific sanitary notions, and creating faith in m), as much as could fairly have been anticipated. This remark ecially applies to some of the colliery districts of South Wales, which jgether suffered more severely from cholera in 1866 than almost any er part of the kingdom. App. No. 7 On Sanitary Survey made in anticipation of Cholera; by Dr. Ballard, B°. Medical Officers of Health. — The generally satisfactory manner in which the institution by the Public Health Act of 1872 of medical officers of health in the several sanitary districts of the kingdom has worked, where the efforts of these officers have been seconded by those of the authorities which they serve, is one of the points brought out by the survey. Considering the large demand suddenly made for skilled advice by the Act of 1872, and the inadequacy of medical education in respect of sanitary matters at that time, this result is creditable to the profession, inasmuch as it shows that it could raise itself to the requirements of the day in an unaccustomed branch of study and practice. Many of these officers have exhibited much courage and boldness in pressing their good advice upon authorities little disposed to adopt it, and often in distinct disparagement of their own individual interests a3 private medical practitioners. The office is one which often demands the exercise of tact as well as the power of practically applying hygenic knowledge ; and perhaps the failure of some of the medical officers of health to exercise influence over their authorities has resulted as much from the lack of: the former as from the lack of the latter qualification. Medical officers of health are exposed too, in some instances, to discouragements which they find it difficult to fight against. One form which this discouragement takes is illustrated by what is reported as having taken place in the VVhitby Rural District of the North Riding of Yorkshire. And it certainly is not conducive to efficiency of administration that tha district medical officers of an union should be made as it were ex officio medical officers of health, and compensated ¦by a mere trifling addition to their poor law salaries. I am far from saying that such a combination of offices always works badly. The result of the survey, so far as it has gone, is not to this effect, and in some instances of extensive scattered population there is scarcely an alternative, but there are reasons for believing that the work would in many cases be better done under other arrangements. The most unsatisfactory working of the institution is in some of those exceptional districts where the medical officer of health is, under existing circumstances, not under the Board's Order, and consequently is not under obligation to forward a copy of his annual report to the Board. Some, however, of the medical officers of health thus situated are amongst the best and most active in the kingdom, and regularly make and forward to the Board annual reports. Others, however, either make no annual reports at all, or if they do make them, do not forward copies : in this case the sanitary state of the district is withdrawn from the cognizance of the Board unless on occasion of some special inquiry instituted by the Medical Department. Instances of this stale of things aud of the evil Health officers, 126 results of it are Exeter Urban, and Norwich Urban, two important cathedral cities, the bad sanitary administration and unwholesome conditions of which were unknown officially to the Board until the .survey Avas made. I may perhaps be permitted to suggest that the rectification of this inconvenient anomaly will be worthy of consideration when any general legislation in sanitary matters may next be contemplated. App. No. 7. On Sanitary Survey made in anticipation of Cholera ; by Dr. Ballard. Nuisance inspectors. 9°. Work of the Inspectors of Nuisances. — In such a general statement as this it is not easy to separate what it is desirable to say about the work of inspector of nuisances and the abatement and prevention of nuisances, from what it is desirable to say about the general sanitary administration of the districts by the sanitary authority. Where the former is inefficient the latter can scarcely fail to be so too, iuasmuch as under the Public Health Act the term " nuisance " embraces nearly every evil of primary importance as a cause of general unhealthiness of a population. But instances will be found in the tabular precis where the best efforts of an active and intelligent inspector of nuisances to do good work have been thwarted by the apathy of the sanitary authority. The best work has been done in those districts where the medical officer of health is trusted, and his advice respected, and where the inspectors of nuisances have been working systematically under the habitual direction of such an officer. Unfortunately, however, this has not always been the case, and the inspector of nuisances has been regarded especially in rural districts as a person who had no concern with anything not absolutely made the subject of complaints, or with any thing but what the members of the authority have thought fit themselves to regard as nuisances, irrespectively of the definition of the word " nuisances " given in the Public Health Act. It is probably due in part to such ignorance of the legal signification of the term, that the appointment of persons devoid of any previous training or of any special qualifications for the post, and indeed occasionally of quite unfit persons, has been in some instances made — such persons for instance as " a watchmaker" in Newhaven Urban District, "a grocer in the town" in Budleigh Salterton, " a dairyman and milkseller " in Sherborne Urban, "an auctioneer" in Crowle Urban and Pickering Rural, "a beershopkeeper " in Barnard Castle Urban, "an elderly man without experience" in Cowpen Urban, " the editor of a newspaper" in Cardigan Urban, •'and a publican" in Pontypridd Rural District. It is scarcely necessary to add that these appointments were not productive of satisfactory results. The greatest and most frequent inefficiency in the dealing with nuisances was observed in the rural districts, and this was especially the case with recurring nuisances, such nuisances as commonly require for their prevention some structural works, the provision of sewers or some public provision for removing excrement and refuse from villages, which provisions rural authorities are often slow to make. 10°. Hospital Provision, SfC — In comparatively few districts visited in the course of this survey has provision been made to carry into effect the sections of the Public Health Act Avhich enable sanitary authorities to provide isolation hospitals and other public appliances for dealing with diseases of an infectious character ; and in some, where hospital provision has been ostensibly made, it is of such an imperfect character as to be scarcely of any practical value. But there appears in some districts to be a disposition to make this provision. As might have been anticipated, the urban districts are better supplied in this respect than the rural, the sanitary authorities of which appear sometimes to consider that they have done all that is requisite for this purpose when they have made provision for paupers at the union workhouse. I may Hospital add, however, that in many instances where hospital provision has been App. No. 7. I -de, the hospital is at too great a distance to be safely available On sanitary the reception of cholera patients who cannot without risk to Survey made in 5 be conveyed far even in a hand-borne litter. A most curious ChoToniTby 0 ' 1 unique miscomprehension of the intention of the Legislature Dr< BallardL [1 misapplication of a section of the Public Health Act relating to spitals came to light during the survey of Gainsborough. The Jtion referred to is section 132, which empowers a local authority to act payment from a patient using the hospital. About eight years ago j Gainsborough urban authority obtained a loan of 1. 500/. for the ;ction of a hospital, Avhich was accordingly built, at a distance of aut a mile from town. But having built the hospital the authority anged to take in no case gratuitously, but in every case to make a irge for maintenance, the lowest charge for an adult being 21. per ek, a less amount, however, for children. There was also a disecting apparatus provided at the hospital. The result of this strange lduct of the sanitary authority has been that up to the time of . Airy's survey not one patient had been received into the hospital, .t the building itself is being permitted to fall into decay, and that the disinfecting apparatus is being consumed with rust. 111 0 . Special Preparation in anticipation of Cholera. — In but few Cholera prethe districts visited had any special preparation been made in antici- ( ' ilutions caution' pation of cholera. In some there was last year an unusual spirit of activity manifested in dealing with ordinary nuisances, and copies of the Board's memorandum on precautions against cholera had been distributed in the district. Where no hospitals have been provided, perhaps is is as much as might have been anticipated until the disease shall more immediately threatened ; but there is reason to hope, and indeed believe, that when that event happens, the medical officers of health 1, as a body, be prepared to advise their several authorities, and to 1 actively and judicious))' with cholera, should it break out. This, hout doubt, is the case in those coast urban districts which have n inspected, and in many of the riparian rural districts. 12°. Subsequent inquiries by the Board. — As respects the large Further action majority of the districts included in the survey, inquiry has been Eojird. subsequently made by the Board as to the result of the inspector's interview with the sanitary authority and as to the action taken by them to carry into effect the recommendations which he made for the improvement and safeguarding of their district. Col. 17 of the tabular precis is devoted to this subject. It may be left to speak for itself in respect of individual districts. Ail that need here be said generally on the matter is that it would appear that the survey is likely in many districts to be productive of good results, one evidence of which is the applications which have in a number of instances been made for the Board's sanction to the contracting of loans for important improvements the need of which has been pointed out by the inspector. In those instances in which nothing or little of precise importance for the safeguarding of a district has been undertaken on the inspector's recommendation, the blame of any future evil consequences will not rest on the Board, but upon the local sanitary authority who may have neglected to take advantage of an exceptional opportunity of enlightenment, and to perform essential duties clearly laid before them. I cannot properly bring these observations to a close without alluding to one incidental advantage which has accrued from the survey. I allude to the encouragement which the personal interview with the Board's inspectors has afforded to many medical officers of health, who 128 App. No. 7 On Sanitary Survey made in anticipation of Cholera; by Dr. Ballard under multiform difficulties, discouragements, and impediments have been anxious and have striven to perform their duties efficiently and for the benefit of the communities in their charge. The inspectors engaged upon the survey have all told me of the gratification at the inspector's visit experienced and expressed by these gentlemen and of their thankfulness for the advice given them personally as to the best methods of discharging their functions and of attaining the ends they have in view. Especially has this been the case with medical officers of health newly appointed, who. when they have not filled a similar post before, and have not been specially prepared for it, have been most grateful for the opportunity thus afforded them of acquiring a kind of knowledge which they could scarcely acquire in any other way or in any way so effectually. No. 8. Report on the Sanitary Survey of Port and Principal Kiparian Sanitary Districts, 1885-6 ; by Dr. Blaxaix. Apr. No. 8. On the Port and Riparian Sanitary Districts of England and Wales ; by Dr. Blaxall. In 1884, when the danger of the introduction of cholera into this country appeared imminent by reason of that disease prevailing extensively in France and other parts of the Continent in frequent maritime intercommunication with this country, the Local Government Board instituted inquiry at the principal seaports of England and Wales, with a view to ascertain how far the several authorities were prepared to give effect to the Cholera Regulations, and to act promptly upon the appearance of the disease. These inquiries were carried out by myself and Dr. de Chaumont, who was temporarily employed for the purpose. Cause of inquiry 1884. In 1885 the inquiries were renewed on a more extensive scale, embracing all the Port and Riparian Districts of England and Wales. Dr. de Chaumont and Dr. Davies, temporary inspectors, and Dr. Airy, Dr. Page, Mr. Spear, and myself, of the permanent medical staff, were employed on this duty as well as on the inspection of inland districts. 1885. Before proceeding to report on the results of these inquiries, it will be well to give some account of the constitution of the several port sanitary authorities, together with the duties devolving upon them, the mode of procedure commonly observed in respect of vessels arriving from foreign and colonial ports, and the line of action laid down by the Cholera Regulations, 1883. Preliminary. Constitution of Port and Riparian Sanitary Districts In 1872 the Local Government Board constituted certain of the Customs ports, or parts of such ports, into Port Sanitary Districts, appointing the pre-existing local sanitary authorities (urban or rural, as the case might be, and singly or in combination) Port Sanitary Authorities for the administration of business appertaining to health. Constitution of port sanitary districts. Some of the port sanitary districts were constituted permanently, others temporarily only, subject to reconstitution year by year. The administration in some instances is vested in a single local authority, upon whom devolves the cost of administration. In other instances the Port Sanitary Authority is formed by the amalgamation of the several urban or rural authorities whose districts abut on the river or harbour concerned, the cost of administration being defrayed by contribution from the said districts. In other instances, again, the riparian authorities contribute, but are not represented, the administration being centred in the chief local authority. The constitution of Port Sanitary Districts, and the administration thereof, had for their object the twofold purpose of— (1) forming in concert with the Customs authority the first line of defence against the introduction and spread of dangerous infectious disease, and (2) the preservation of the health of crews and passengers by securing that vessels should be kept in a wholesome condition. _ With a view to carry these purposes into effect each Port Sanitary Authority is required to appoint a medical officer of health and an inspector of nuisances ; the Board (wheii applied to) paying half the Duties of port sanitary authorities. salaries of these officers out of moneys voted by Parliament. It is the duty of the authority to make due hospital provision for cases of infectious disease, and with the aid of the above-mentioned officers, to carry into operation in respect of shipping in the port the several 1 E 20510. 130 clauses of the Public Health Act relating to nuisances, disease prevention, &c. APP. No. 8. On the Port and Riparian The Port Sanitary Districts thus constituted by no means embrace all the ports, harbours, creeks, rivers, and shores where shipping traffic is carried on, but here health questions have not been lost sight of, since under the Public Health Act, 1875 (sec. 110), the several Riparian authorities of England and Wales, being the Urban and Rural local sanitary authorities of the kingdom, are responsible for administering such clauses of the Act as relate to vessels. Until the passing of the Public Health '(Ships) Act, 1886, the powers of these authorities were limited to the dealing with nuisances ; now, however, their powers extend to the clauses relating to disease prevention, hospital provision, &c. The Board's Cholera Regulations, 1883, are incumbent alike upon port and riparian sanitary authorities. Sanitary District of England ami Waks | by Dr. With regard to the. usual Mode of Procedure in respect of Vessels arriving from Foreign or Colonial Ports. At each Customs port a station or stations have been appointed by the Commissioners of Customs for the boarding of vessels arriving from foreign or colonial ports ; and captains are required on arrival to take their vessels with despatch to these stations without touching at any intermediate place, and not to remove therefrom except with the knowledge of the Customs officer. The primary duty of the Customs officer is to guard the revenue ; but he is further required to exercise certain functions in respect of the health of ships. Besides such duties, hardly more than nominal, imposed on him by the Quarantine laws, he has more important duties in respect of indigenous infections and of cholera. He has to make inquiry as to the health of the port whence the vessel has come, and as to the health of the crew and passengers during the voyage home, and at the time of arrival. In the event of infectious sickness being reported to him he is, in compliance with instructions from the Commissioners of Customs (General Order, 20th April 1861), to acquaint the local authority (Port or Riparian as the case may be) of the circumstance. Upon this authority will then devolve the responsibility of taking steps to prevent the introduction and spread of the disease. For this purpose, the Medical Officer of Health is to board the vessel, and should he find the sickness to be of an infectious character, his duty is to take steps to secure the isolation of the sick, together with efficient disinfection of the vessel, bedding, clothes, etc., and to satisfy himself as to the health of the rest of the persons on board. The above mode of procedure has special reference to the infectious diseases that are usually present in this country, such as small-pox, measles, scarlatina, diphtheria, and " fever." But with regard to cholera, which is not epidemic here except when introduced from without, the Local Government Board in 1883, when this disease prevailed in Egypt, the more effectually to guard against the danger of its introduction, issued Cholera Regulations, imposing additional duties on the Customs Boarding Officer, and also on port or riparian authorities, and granting them increased and more defined powers. Bera Reaula Thus, should the boarding officer on the arrival of any ship ascertain from the master or otherwise, or have reason to suspect that the ship is infected with cholera, he is to detain such ship (Art. II.), and forthwith to give notice thereof, and of the cause of such detention, to the sanitary authority (Art. IV.). Port sanitary authorities are required to appoint, with the approval of the Customs, stations for mooring infected vessels (Art. VI.) ; to isolate cases of cholera ; to examine all persons on board, detaining suspicious 131 ases under observation (healthy persons being allowed to leave the ship, heir names and places of destination having first been noted) ; and to eeure the disinfection of the vessel, articles of clothing, &c, &c. Arts. VIII.-XVIII.). Further, Art. VIII. provides that "the Medical Officer of Health, if he have reason to believe that any ship, whether examined by the officer of customs or not, is infected with cholera, shall, or if she have come from a place infected with cholera, may visit and examine such ship for the purpose of ascertaining whether she is so infected, &c." Apr. Xo. 8. On the Port and Riparian SanitaryDistriots of England and Wales ; by Dr. Blaxall. Recent Medical Survey. IWe have now to consider the particulars and general teaching of the cent medical survey around the coast of England and Wales, as ithei-ed from the reports of the several medical inspectors employed on at duty, an abstract of whose reports will be found in the Appendix p. 158-200). Medical survey around the coast of England and Wales. tThe survey of the year 1885 included 13 permanent and 34 temporary rt sanitary districts ; and 38 riparian districts, making a total of 85 itricts inspected. lOf the 47 port sanitary districts, 29 are administered by a single thority, and eight by a joint board, while the remaining 10 districts ye their sanitary administration performed by a single authority, Dugh the district extends beyond the area of that authority's jurisdic?n. In these last cases, the outlying districts sometimes contribute ;vards the Port authority's expenses. I Evidence was forthcoming of much good work done, as will be preltly shown, in the way of sanitary administration with reference to ;asures adopted, both to prevent the spread of disease and to insure a lolesome condition of vessels. KOn the other hand many weak points were revealed, together with ich neglect of sanitary administration. The riparian authorities had, I a rule, omitted to carry out the duties imposed upon them, owing nerally, it would seem, to ignorance of the requirements of the Public salth Acts. iThe opportunity offered by these inquiries for personal intercommu;ation between the medical inspectors and local health authorities oved of essential service in enabling the authorities to apprehend the ture and importance of the duties devolving upon them as adminisitors of the Public Health Acts and Cholera Regulations, and to inform smselves on a variety of points which they had before neglected or d imperfectly understood. IThe several questions of port sanitary administration may well be nsidered under the following heads :—: — (1.) Position and boundaries of districts. (2.) Boarding stations and Customs inquiry 1(3.) Mooring stations. (4.) Appointment of port medical officers of health and inspectors of isances. K(5.) Prevention of introduction of infectious disease under («) the blic Health Act, (b.) the Cholera Regulations, (c.) Rag Orders, and ) Quarantine Acts. (6.) Sanitary Inspection of vessels (7.) Port Sanitary Administration. (1.) Position and Boundaries of Districts. IThe boundaries of a port sanitary district should be defined in such a inner as to admit of the provisions of the Public Health Act and Cholera Defining of Districts. l 2 132 app. No. 8. Regulations, together Avith the duties connected with the Customs On the Fort boarding, being carried out within the limits of such district, in order and Riparian to avo id disputes and uncertainty of action which are apt to ensue where SamtaryDistncts * . . . *" -• rpi • . ' n-nnn n -nnn f \ C t two or more authorities are concerned. The inconvenience of defects of England and Wales j by Dr. in these arrangements is seen in the case of Harwich and Ipswich, and Blaialf. recently also of Hull and Goole. In each case the respective two districts are situated on the same river and have the same boarding station situated in the district nearer of the two to the mouth of the river, giving rise to the question as to the responsible authority for carrying out administration, in the way of preventing the introduction of infectious disease. Other districts' similarly circumstanced are at the present time working harmoniously, but questions may arise at any moment to disturb this unanimity. Again, in certain localities the close juxtaposition and intermingling of riparian districts is such that vessels pass quickly to and from the jurisdiction of one authority to that of another, thereby affording opportunity for Masters of vessels to evade inquiry and inspection besides rendering efficient sanitary administration very difficult if not impracticable. Such difficulty was exemplified at Fowey (Liskeard and St. Austell riparian authorities), and again on the river Blyth. To obviate the evils here noted it would seem desirable that the several riparian authorities so circumstanced should be either constituted Port Sanitary Authorities under a joint board, or be made contributory, and the responsibility of administration centred in the principal authority. Where the extent and boundaries of a district are definitely settled there are certain advantages gained by granting it a permanent constitution ; such as increased facilities for obtaining borrowing powers and for making isolation hospital provision, while the annual work of reconstitution is avoided. The Tyne and Swansea port sanitary authorities afford examples of efficient sanitary administration of ports composed of several coast districts, the one on the joint board system (River Tyne Port Sanitary Authority), the other on the contributory system, administered by the principal authority (Swansea Town Council). (2.) Boarding Stations. Kng In considering this subject it must be borne in mind that the position S. Rt f +V.O Knarrlinrr ufnfinno i'c nrimarilv n fnotnma onrl Btiinninrr.trnrla of the boarding stations is primarily a Customs and .shipping-trade question ; such stations having been designed mainly for the protection of the revenue without causing undue hindrance to trade. At the same time the fact of the Customs inquiry being concerned also with the health of the crews and passengers of ships renders these stations important in a health point of view as a means of affording protection against the introduction of infectious disease. And in this connexion it is important they should be sufficiently removed from inhabited dwellings and from the vicinity of shipping so as to prevent risk of inter-communication being had with newly arrived vessels before the health inquiry shall have taken place. Here it may be noted that under the Quarantine Acts and Regulations the Commissioners of Her Majesty's Customs are authorised to appoint places at which vessels coming from America, the West Indies, or elsewhere at any time when yellow fever or plague is supposed to prevail in those parts, shall anchor, for the purpose of having the state of health of their respective crews ascertained. But with regard to cases of indigenous infectious disease (small-pox, measles, scarlatina, fever, &c), the question of introduction by vessels would appear hitherto to have been deemed of not sufficient importance to be regarded in determining the position of the boarding stations. With cholera, App - 8 - No App-No-8-however, threatening our shores, this was a point not to be overlooked On the Port by our survey : special attention was therefore directed to the subject sSiSSSrtricts »the course of the port inquiries. It was then found that these w E , ngll V ld snd5 nd ions were not infrequently situated either in the docks or along- BiaxaiL y r< side quays in the vicinity of shipping and dwellings. Moreover, vessels entering the docks were subject to become tide-locked, so that, in the event of cholera being present on board any vessel so detained, her immediate removal to the mooring station appointed for infected vessels would be impracticable. The Board brought the danger here indicated under notice of the Commissioners of Customs, and temporary arrangements were made at certain ports for the boarding by the Customs officer to take place at a distance from the docks. Further, as a weak point in our line of defence against the introdue- lof disease into this country, I find that Mr. Spear reports that, on south coast, vessels arriving from foreign ports (specially yachts and ing boats) may, and sometimes do communicate with the shore before ergoing inquiry at the hands of the Customs. This has since jived the attention of the Commissioners of Her Majesty's Customs, 3 issued a notice, dated 4th August 1885, requiring " all yachts on rrival at any port in the United Kingdom from any foreign country r the Channel Islands to bring to at the appointed boarding station •f such port, to be boarded by the proper officers of Customs, as irected by the sth section of the Act 46 and 47 Viet. cap. 55." tm informed that at Falinouth traders of various descriptions inept vessels for the purpose of selling their goods before they enter ¦ ports or have been communicated with by the Customs officer, o again, in my own experience at Preston, I found there was neither Istguard nor Customs officer stationed along the banks of the river ble ; as a consequence vessels may pass the town of Lytham and so :h Preston before being overhauled. True, the foreign trade of ston is very inconsiderable, amounting to some two or three vessels r per annum : still, the facilities here offei'ed for the introduction of infectious disease demand notice. (3.) Mooring Stations for Infected Vessels. In selecting a mooring station for infected vessels the chief points for Mooring sideration are safe anchorage combined with a position sufficiently ' stations ' ated, and at the same time convenient of access for the medical ;er of health, in order that he may be enabled to supervise the ying out of disinfection, &c. In many of the districts the mooring ions fulfil these requirements ; and this is specially so in respect torts situated on rivers. But it is otherwise where the ports are he coast, and where the shipping trade is carried on wholly in dock, at Hartlepool, Maryport, Workington, and Whitehaven ; for here anchorages are exposed, and ships have uot infrequently to run where for shelter. The Customs officers were found at our inspection to be invariably acquainted with the requirements of the Cholera Regulations as to the appointment of mooring stations by sanitary authorities, but at certain places that came under observation the sanitary authorities and the Customs had come to no arrangement on the subject ; while at other places again the authorities proposed sending infected vessels miles out of their districts, a proceeding for which they had no justification. ¦Ye found that personal communication with the authorities concerned duced to the immediate adoption of measures to remedy these 134 Kp. No. 8. several shortcomings. Where mooring stations were found wanting, e"iort the Customs officer and the authorities were brought together, and riparian stations appointed forthwith ; and, with regard to unsafe anchorages, it iryDjstrlctS I ;f' i 4.1, „,. xi_ nL AIaM i?,,,™^^^ ,11,1 nnt nrnnnw fn fiotnhiish ¦S ami ?' ? ' was explained that the Cholera Regulations did not propose to establish ji b y Dr ' hard-and-fast rules at the risk of involving danger [to infected ships; but that, in the event of threatening weather, it was at the discretion of the captain to decide whether to run to other anchorages or not, with the proviso that if he elected to run, he was to signal to the authority on shore his intention to do so and the proposed place of destination, in order that the authority of the port to which he was going might be advised as to the advent of the infected ship. Again, as to the proposal to send infected ships out of the district for isolation purposes, it was explained that the Cholera Regulations provide that the authority, on being made aware of the arrival within its district of an infected vessel, shall take immediate action to secure the removal of the infected person to hospital (if the sufferer be in a condition to admit of it), and shall then order the infected vessel to the mooring station and proceed to carry out disinfection. It was explained that this provision put it out of the power of the authority to send the vessel out of the district, which course would indeed be attended Avith risk of life to the sick as well as to the rest of the crew. Further, it was explained, that, if the Cholera Regulations were intelligently carried out, there would be no necessity for the infected ship to be removed to any great distance. (4.) Appointment of Port Medical Officers of Health and Inspectors of Nuisances. lintmentof In certain port sanitary districts (Newcastle, Sunderlaml, Bristol, rs ' Cardiff, Swansea, Newport (Mon.), &c), the urban medical officer of health is appointed also for the port district, either on a fixed salary to include payment for both urban and port duties, or receiving an increment of salary for the latter. Generally speaking, there is decided advantage in the responsibility being thus centred in one officer, seeing how closely interwoven are the town and shipping interests in regard to health questions. In other districts, London and Wcymouth for example, a medical officer of health is appointed specially for port purposes, on a fixed salary ; the officer of London devoting his whole time to the duty. In other port-districts the authorities instruct the urban medical officer of health, or some local practitioner to board vessels when requisite, paying him a fee for such duty. This mode of remuneration by fee is found to work very unsatisfactorily, failing to secure that systematic and efficient performance of the duties of the office which is required by the Public Health Act and Cholera Regulations, besides placing the medical officer of health in a delicate and unpleasant position : for, should he neglect to board a vessel, the public health might suffer, or, on the other hand, should ho board and no disease be found present he lays himself open to animadversion for the sake of his fee for boarding . In some instances the medical officer of health, urban or rural, as the case may be, is required to perform port duties Avithout any arrangement being made for special remuneration. In addition to the arrangements above noted, certain authorities have appointed medical officers of health for the special purpose of carrying out the Cholera Regulations, for example as at Swansea and Bristol. This diversity in respect of the appointment of port medical officers of health obtains also in respect of that of port inspectors of nuisances. Certain niitliovitipfl lnvp tlipy placing cholera cases from ship-board in a town hospital drained into ommon sewers. Imperfections in such sewers, even though ordinarily mrmless, might become serious if cholera discharges were received into le sewers and decomposed there. (b". Under the Cholera Regulations^) — The Regulations require port and riparian authorities to isolate cases of cholera from ship-board within their respective districts. I Certain of the authorities are ready prepared to carry this into effect. ivcrpool, for example, has provided a permanent cholera hospital; r yne ports a floating hospital ; Swansea a temporary iron building ; ardiff a tent on the Flatholm ; Newport (Mon.) a Avooden hospital ; c riparian district of Llanelly a Doeeker's tent to be put up at any oment. I The several riparian authorities on the river Tees being apprehensive the introduction cf cholera in 1884, agreed to provide a hospital itween them, and for this purpose purchased a vessel which they fitted ) for the reception of cases, and anchored in a suitable spot. [During ,c present year (1885), however, some misunderstanding having arisen, ie amalgamation was abandoned and the Board held a public inquiry ith the result that a joint port sanitary authority was constituted.] But our inquiries revealed the fact that a considerable proportion of the authorities had made no hospital provision whatever, gome of them stating that, should occasion arise, they would then get tents or huts ; others that they proposed to retain the cases on board the vessels by which they were trought. Care was taken to impress upon these authorities that the allimportant point was to be prepared beforehand with the means of dealing promptly with any vessel having cholera on board, and it was pointed out to them that any delay or want of decision in taking 'efficient action with such a vessel might be attended with serious consequences and would certainly lead to alarm and mistrust. Further it was pointed out that the authorities would not be justified in keeping an infected person on board the ship as if the ship were a hospital provided by themselves. In the course of the present inquiry, it appeared that the several health authorities of the Solent had no isolation hospitals suitable for the reception of cholera cases that might arrive in vessels. Accordingly, in pursuance of instructions from the Board, it was suggested to them that they should amalgamate for the purpose of making such provision. They took some preliminary action with this object and certain of the authorities concerned applied to the Admiralty for the loan of the " Edgar," a fine line-of-battle-ship well adapted foist hospital, and forming part of the quarantine establishment at the Motherbank. The Port Sanitary Authority of Portsmouth received a reply from the Admiralty to the effect that the Admiralty declined to lend the ship for the purpose, but were willing to sell her. The authorities were not disposed to make the purchase, and so the matter fell through. This is much to be regretted, for the " Edgar " would fulfil the purpose of an efficient hospital for the several port and riparian districts of the Solent, while it might continue to serve for the isolation of troops if any arrived home infected with cholera or other foreign infectious disease. A.PP. NO. 8. On the Port and Riparian Sanitary District of England and "Wales ; by Dr. Blaxall. (c.) Action under the Rag Order. — In 1883 when cholera prevailed in Egypt, and again in 1884 when the disease was present in France and Italy, the Local Government Board issued regulations prohibiting the importation of rags from the infected countries except under the following conditions as laid down in Art. 2, viz. : " Provided that nothing in this Rag Order. " Article shall be deemed to prohibit the delivery overside or landing of " any rags which may have been previously proved to the satisfaction of the sanitary authority into whose jurisdiction or district the same may " be brought, or any officer duly authorised by the sanitary authority " for that purpose, and certified accordingly by such authority or officer not to have come either directly or indirectly from any place where " cholera has occurred during the present year" : thereby giving to the sanitary authority certain discretionary power in the matter. This discretionary power, however, was found not to work well, for while certain sanitary authorities deemed it impossible to ascertain whence the rags were collected, and considered the fact of their coming from a cholera-infected country sufficient reason for preventing, by all means in their power, the rags being landed in their districts, other less scrupulous authorities placed little or no restriction on importation of such rags. This was notably the case with the port sanitary authority of Southampton, and on the circumstance being brought under notice of the Board I was instructed to inquire into the mutter. I found that rags from Havre had been landed at Southampton, although cholera was at the time prevailing at Yport, about 10 or 12 miles from Havre. Upon obtaining a return of the amount of rags brought from France and delivered at Southampton in the months of November and December 1883 and. 1884, it was found that the number of bales had increased from 384, imported during November and December 1883, to 2,128 during the corresponding months of 1884. So that Southampton it would appear was admitting rags that had been refused entrance at other of our ports. Profiting by this experience, the Board have, in their later orders prohibiting the importation of rags, omitted the provision which conferred a discretionary power upon sanitary authorities. Quarantine Acts (d.) Action under the Quarantine Acts. — This report would be incomplete without reference to the quarantinable diseases, yellow fever and plague, which are the two diseases specially excluded by the Customs Order 35/1861 from among those required to be reported by the Customs to the local sanitary authority, the responsibility of taking precautions against the introduction of those diseases continuing to devolve upon the Imperial Government under the quarantine Acts and Regulations. But inasmuch as the Government possesses neither quarantine establishments nor isolation hospitals for the purpose, it is obvious it is not in a position to deal efficiently with any case of such disease. Having regard to this, and in view of the rapid steam communication maintained between the United Kingdom and the countries subject to yellow fever, it seems to me a matter of serious importance that the line of action to be adopted in the event of a vessel arriving home with yellow fever on board should be defined without delay. It should include 143 isolation of the infected, together with supervision of cases of suspicion, app. No. 8. isolation, and disinfection of the ship, destruction or disinfection of onthePort infected bedding, articles of clothing, and the like. In my judgment and. Uiparian _ these several measures could best be carried out by the local health o^En^iamfand S authority in case of yellow fever as in the case of cholera. Biaxai'i by D *' Attention has recently been directed to this subject in consequence of the arrival at Liverpool from Jamaica of a vessel which was said to have lost three of her crew from yellow fever during the passage home. The Customs reported this circumstance to the quarantine medical officer. He went on board the vessel and concluded the men had died of yellow fever. But he considered the vessel *ad fulfilled the requirements of the Quarantine Regulations, and accordingly he admitted her to pratique and she entered the docks without any communication whatever to the Local Sanitary Authority or its officers. Now, had the same course been pursued in hot weather instead of in mid-winter there is much doubt whether it would have proved effectual to prevent the spread of the disease to shore. (6.) Sanitary Inspection of Vessels. Inspection of Under the Public Health Act vessels are considered in the light of vessels. dwellings, and port and riparian authorities are required to inspect them with a view of insuring their being kept in a wholesome condition, with reference specially to the closets, water-storage, bilges, ventilation of sleeping berths, and other conditions generally likely to exercise an influence upon health (sections 91 — 111). Among the port sanitary authorities that have done good work in securing obedience to this law may be mentioned — London, Tyne Ports, Sunderland, Liverpool, Hull, Swansea, and Cardiff. On the other hand, a notable number of authorities, some of them acting for districts with a considerable amount of shipping trade, were found to have done nothing in the way of inspection of vessels. Plymouth, Hartlepool, Harwich, Ipswich, Fleetwood, and Cowes, belong to this category. And the riparian authorities generally have taken no means to ensure the wholesome condition of their vessels. The value of these inspections may be inferred from the beneficial results that have attended them where they have been made, for, whereas at their commencement in various ports from 50 to 60 per cent, of the vessels examined were found faulty in one particular or another, now after the inspections have been carried on for some few years the number of vessels so reported are reduced to from 5 to 20 per cent. And perhaps one of the most satisfactory features in connexion with this improvement is the willingness which masters and shipowners manifest to carry out the x-ecommendations of the port sanitary authorities.* * I annex, in the form of headings for a report book, a noto of the principal points which the inspector of nuisances to a port or riparian sanitary authority has commonly to observe : — Name 5 3 ln?pttl. A o n r C & »•*»¦**• 3el. I I <*»" *£* * A jg '3 Owners. h ° M OB 02 . No. 8. On the Port and Riparian Sanitar.vDistrirts of England and Males; by Dr. Blaxall. " I The proposed hospital is to consist of an administrative block, and ree ward blocks, erected on a platform placed on floating iron inders ; and so far as I can judge it gives good promise of fulfilling j requirements of a port isolation hospital. The authority have likewise obtained powers under section 125 to require masters and owners to notify the presence of infectious disease on board their vessels, and as an additional precaution the inspector of nuisances makes an abstract from the " Shipping Gazette" of all vessels sailing from what are known to be cholera-infected ports, that he may be enabled to keep a vigilant look out for all such vessels arriving in In 1884 the number of vessels inspected amounted to 12,078 out of a total of 15,290 that entered the port. Mr. Armstrong reports as the result of the inspections that the sanitary conditions of vessels was as follows :— " Good, 9,425.'' "Passable, 2,152." "Defective, 501." " Total inspected, 12,078." Of the 501 defective 123 had structural defects. The requirements of the port sanitary authority to remedy the several defects were carried out in all but 48 vessels, which left the port before they could be revisited. In respect of these Mr. Armstrong remarks : " Note is taken of these vessels, which, when they return, will " be looked after; if bound to British ports advice is sent to the '• sanitary authorities." This is good work. 1[3.)I [3.) Liverpool. — Here also the port sanitary authority have done good rk, and are able to point to successful dealing in the last two years with jlera- infected ships through having a cholera hospital ready at commd. It remains available for the same purpose should occasion require ; t, though an important provision against that particular emergency, the spital is apparently of no use at other times owing to some arrangesnt entered into at the time of erection by which the use of the ilding is restricted to cholera cases. The consequence is — the ;hority possessing no other isolation hospital and the urban district jmporary one only for small-pox patients — that cases of other infectious eases (measles, scarlatina, fever, &c.) that may arrive in vessels have be sent either to the Workhouse Hospital, or to the Netherfield bscription Hospital, the authority contributing to the latter, and so [uiring a right to send cases there. |)r. Taylor, the urban medical officer of health, is appointed to carry the port duties, and Captain Brown, a master mariner, holds the ;e of port inspector of nuisances. ?he district embraces some nine miles of river with the docks on Birkenhead side, and a line of docks on the Liverpool side upwards ix miles in length. )uring the year 1884, 16,121 vessels entered the port, and of these Taylor reports that 4,092 were subjected to inspection, of which fiber 230 were found to exhibit sanitary defects. tfhe inspector of nuisances has no assistant and no steam launch to litate the carrying out of his duties ; thus, in these respects as well n that of isolation hospital provision (which is limited to cases of lera), Liverpool, one of the principal ports of England, compares avourably with London and the Tyne ports. E 20510. X 146 Apr. Xo (4.) Hull.— In a health point of view Hull acquires importance from I e Port being the port at which foreign emigrants chiefly arrive, and so is peculiarly exposed to risk of introduction of cholera or other infectious gland and disease that may be prevailing on the continent, j by Dr. xhe urban medical officer of health, Dr. Mason, is appointed for port ,11. n . nil • ii Pf* duties, and a seafaring man as inspector of nuisances. This latter officer, in view of the threatened danger of cholera invasion has, under direction of the sanitary authority, boarded steamers bringing transmigrants in the river, making special inquiry as to health, and removing infectious cases for the purpose of isolation. These are valuable precautions, but they cannot be regarded in the same light as medical inspections, which should undoubtediy be carried out when cholera is impending, if not at other times. During the year 1884 a total of 4,604 vessels entered this port. Of these 2,346 were subjected to inspection, with the result that 158 exhibited structural defects and 272 required cleaning by lime washing or painting. Particulars of the sanitary administration of this port would be incomplete without reference being made to the vexed question that has arisen between Hull and Groole as to the carrying out of the Cholera Regulations in respect of Goole shipping. The Board's Regulations provide that the Customs Officer shall detain a ship infected with cholera, and shall report the same to the authority of the place in which the detention is made ; and further that the said authority shall carry out the several precautionary measures prescribed. In the case of Goole ships, the detention by the Customs officer takes place within the waters of the Hull sanitary authority, who thus become charged with duty under the Board's Order in respect of Goole shipping. The port sanitary authority of Hull repudiate any responsibility for Goole affairs.* Goole, on the other hand, remains helpless in the matter, because vessels bound for that port (Goole) are boarded by the Customs within the jurisdiction of the Hull Sanitary Authority. Further, the Hull authority has refrained from appointing a mooring station from the mistaken notion that to do so would have the effect of rendering thorn more amenable in respect of any vessel bound for Goole that might be detained in their district. This matter is here referred to as showing how desirable it is that the Board should place these matters on a sound basis. (5-7.) Swansea, Cardiff', and Newport, have done good work, and have been peculiarly on the alert to prevent the introduction of cholera. (8.) Bristol. — Thi3 port sanitary authority affords a typical example of amendment. On my first visit here on port survey duty, the sanitary administration was limited to securing the isolation of cases of infectious disease brought under notice by the Customs. This supineness, however, evidently arose from the authority not duly recognising their responsible position ; for, on my directing their attention to the various duties incumbent upon them, and fully explaining their import, they at once proceeded to carry them out, with the result that I am able now to report the appointment of two inspectors of nuisances for the inspection of vessels, the one at Bristol, the other an old man-of-war's man, at * Holywell, a small rural district below Chester on the Dee, found itself in the same position towards Chester (under the Board's Cholera Order) that Hull was placed in towards Goole. In contrast to Hull, however, Holywell provided for the execution of the Board's Order, by erecting a little hospital at Mostyn into which, any sick could be taken from Deeside vessels, no matter to what port they were bound. 147 lonmouth ; also the erection of a port isolation hospital at Avon uth. App. No. 8. On the Port and Riparian Krhe authority have likewise obtained powers under section 125 to uire masters to notify the presence of infectious disease on board ir vessels. Sanitary Districts of England and Wales ; by Dr. Blaxall. E'he medical officer of health, Mr. Da vies (also health officer for the m district), besides drawing up a circular to apprise authorities of advent of persons from infected ships has prepared a code of instrucs for the guidance of inspectors when examining vessels. In contradistinction to the foregoing and certain other port sanitary horities that have with more or less efficiency carried out the duties r olving upon them, the following may be noted as examples of horities that had in great measure or altogether failed to recognise obligations imposed upon them. Defective port sanitary administration. II.) Plymouth. — In this category must be mentioned Plymouth, account of its position, size, and importance as a seaport, and the ent of its shipping trade, which in 1884 amounted to 739 vessels m foreign and colonial ports, and 3,022 coasters, making a total 3,761 vessels. I Che sanitary administration is vested in a joint board formed by resentatives of the several contributory urban authorities of Plynth, Stonehouse, and Devonport, and the rural authorities of Plympton Mary and St. Germans. The authority have established a hospital ship, the " Pique," an old wooden frigate, which they obtained by ioan from the Admiralty some few years ago and fitted up as a hospital ship, for the reception of port cases of infectious disease, for which purpose she is well adapted. The arrangement made in respect of the duties of a medical officer of health was both peculiar and unsatisfactory. Mr. Fox, a resident medical practitioner, was paid a fixed salary of 60/. per annum for taking charge of the hospital ship ; but the only provision made for ihe performance of the important duties specially pertaining to the office of port medical officer of health, was the payment to him of a fee for boarding any vessel reported to him by the inspector to have infectious sickness on board. So, again, the said inspector was the officer for the urban district, and was paid by the port sanitary authority 5/. per annum to board vessels reported by the Customs, and to remove the infected persons to hospital, under direction of the port medical officer of health; but no arrangement was made for the inspection of vessels. Hence the 3,761 vessels that entered this port in 1884 were practically unenred for as to their sanitary condition, and the 3,022 coasters went altogether unchallenged as to health. On the occasion of my last official inquiry at Plymouth I met the joint board in conference, when I again pointed out to them the duties for which they were responsible as the sanitary administrators of the port, explaining to them the several particulars in which they had failed to discharge them. I am glad to be able to report that, according to information received from the clerk, they have since appointed an inspector of nuisances for the port to carry out the inspection of vessels. 82.) Coivcs. — Until March last (1885), the sanitary administration of i port devolved on the urban authority of West Cowes. I "here was no inspection of vessels, and no isolation hospital provision either port or urban district. The urban medical officer of health instructed to board vessels when the Customs reported sickness, ment for the same to be by fee ; whilst the urban inspector of sances was to undertake any port duties that might be required of with the understanding that 101. of the salary he had hitherto k 2 148 »ipp. No. 8. received as urban inspector was to count as remuneration for this extra the Port PO rt (lut y- and Riparian The sanitary management of the Medina has recently been placed on of Engiand S and tS a different footing, the riparian districts of the river having been forme 1 Bes ; by Dr, call. into a port sanitary district under the jurisdiction of a joint board con- sisting of representatives of the several authorities. It is to be hoped that their administration will be marked by a better appreciation of the responsible duties devolving upon a port sanitary authority. (3.) Hartlepool, with its large foreign trade, amounting in 1884 to 1,332 vessels inwards, besides coasters, has no inspector of nuisances, and has made no arrangements for securing the inspection of vessels- ; moreover the terms upon which the medical officer of health is appointed are most unsatisfactory ; he receives a salary of 10/. per annum, and fees (according to a specified scale) for boarding vessels when required to do so by the Customs. The urban authorities of Old and West Hartlepool, having no isolation hospital of their own, have entered this year (1885) into amalgamation with the port sanitary authority for the purpose of acquiring land adjoining the site of the present Hartlepool Hospital, whereon to provide a suitable hospital for the three districts. Boston, Dartmouth, Exeter, Carnarvon, Fleetwood, &c, may be specified as amongst other authorities that had done little or nothing. They were alike without isolation hospital provision, or without any arrangement for the systematic inspection of vessels required by the Public Health Act, section 92. Riparian. Riparian Districts. — The shipping in many of these districts is considerable. For example, during the year 1884, 1,152 foreign and 1,043 coastwise vessels entered the port of Goole, and 1,151 foreign and 2,411 coastwise vessels the port of Grimsby, yet the riparian districts generally had, as already stated, shown themselves unmindful of the duties imposed upon them by the Public Health Act. Concluding Remarks. Having regard to what is herein set forth, the port surveys would seem to show that port and riparian authorities ought to bo more directly responsible for the prompt detection of the presence of infectiousdisease on board vessels. Action by the health authorities under the existing regime is seldom taken until the presence of disease has been made known to them, either by the Customs, or by the introduction of disease by means of infected persons landed from vessels, i.e., after the mischief has been done. Then, I would suggest, for the consideration of the Board, the expediency of inquiry into the health of all vessels on arrival being placed in the hands of the constituted health authority. It is possible that, under the present quarantine laws, such a proposal is not immediately admissible, but the advantages of it do not the less deserve the Board's consideration. Under the proposed system, inquiry by the Sanitary Authority would be made by an officer (not necessarily medical) appointed by the authority concerned, and would be conducted in person on board the vessel, instead of by hailing from a boat, tug, or landing-place. This would be a more likely mode of securing reliable information. The medical officer of health would be called in by the inspecting officer, if any sickness was observed ; and on the sickness being found infectious in nature, the infected persons would, as at present, be removed to hospital, and disinfection of the vessel be effected under the health officer's instructions. There would be no need, under any spurious pretence of quarantine, to forbid communication with the shore in the case of App.No h. cholera, nor yet in the case of yellow fever or plague. On th ~p~". On the Port Such inquiry by an officer appointed by the local sanitary authority and Riparian instead of by the Customs would not hinder trade. Usually the health §? Engtondtnd 18 and the Customs officers would go off to the ship together, inquiry by Wales; by Dr. the health officer taking precedence, however, over the inquiry made axa ' for purposes of revenue. There would no doubt be a larger expense if the proposed scheme were adopted ; and the question of who ought to defray this expense may be considered under a twofold ajpect, in relation to general or local interests. The prevention of the introduction of infectious disease by means of vessels arriving from foreign or colonial ports is a matter that affects this country at large, and so is of imperial importance : the danger Result of Port involved by coastwise vessels trading from one home port to another, is Inquiries. primarily of local import, infection being liable to be conveyed by such vessels much in. the same way as disease may be disseminated inland by means of infected persons travelling from one locality to another. Hence it would appear an equitable arrangement that the expense should be borne jointly by the Imperial Government and by the local authorities. The various authorities with whom we were brought in personal communication evinced considerable interest in the health question, and for the most part were desirous of acquiring information. Many of them who had previously been careless of their duties promising to carry them out in future. It is also satisfactory to observe the increasing care manifested by port medical officers of health in the adoption of measures for the prevention of the spread of disease, especially the growing custom of warning each other of tha advent of infected vessels. These are steps in the right direction, and cannot fail to prove of considerable public utility ; and we may look forward to the time when all port sanitary authorities will recognise the value of preventive measures and share in the desire to carry them out, and when shipowners, alive to the inconvenience and expense incurred through having infectious sickness ¦on board, will co-operate with health authorities in preventing the ship- ment of infected persons. The present inspection has certainly procured for the Board the confidence and gratitude of many port sanitary authorities who are desirous of efficiently performing their sanitary duties. Appended to this report will be found a list (pp. 150-157) of the port and principal riparian districts included in our inquiries. This I have prepared for the ready informationof the Board, giving under different headings the names of the districts, and certain particulars respecting them, such as the amount of shipping-trade, isolation hospital provision, i«m ' Authoutj - Of -which anef Total. from Colonial Ireland. Ports. PORT SANITARY DISTRICTS 171 Colchester :— Northern France, Baltic . . . . "\ /¦ U - SIA - £ 3,367 - 111-5 1 171 Colciiestek (Maldon Baltic .....) (^ Division) :—: — Maldon U.S.A. 172 Cowes :— Havre, Rouen, Germany, Scandinavia - • 4,141 2 219 U.S.A. (now Joint Hoard) . 172 Dartmouth:— Baltic, France, German}-. (See Salcombe.) • 1,088 1 40 173 Dover :— Franco, Belgium (passensrer traffic) - - 577 — 2,291 Deal U.S.A. 173 Exeter :— Baltic, France .... -793 1 78 U.S.A. 174 FAXMOT/TH and France (specially Brittany), Spain - - 1,038 130 ICI Joint Board. 175 Faversitam:— Baltic - - - ... 7,972 — 112 U.S.A. 175 Fleetwooj):— Spain, Portugal, Valparaiso, West Indies - - 1,196 408 143 U.S.A. 175 Gloucester :— Nantes, Baltic, America, Black Sea - - 4,295 118 325 U.S.A. 17(5 Gloucester (Chcpstoic None. (Very little coasting trade) . . x x — Division) :—: — Chepstow U.S.A. 177 Hull :— Denmark, Sweden, Northern France. Large 1,334 10 | 2,770 U.S.A. transmigrant traffic. 177 Ipswich:— Baltic - .... 2,904 ] 145 U.o.A. 17S Lancaster:- Baltic, Hamburgh, Spain. (See Morecambe) - 227 164 31 U.S.A. l"y Lnrs (King's Lynn Baltic, France, Spain ¦ • . . 671 5 240 Division) :—: — King's Lynn U.S.A. 180 LXSTN ( Wells Divi- Riga, St. Petersburg - . 105 — 10 sion) : — Wells U.S.A. 150 Ne^iiayen:— Brittany; daily with Dieppe, Honfleur - 221 2 1 1.C94 U.S.A. 181 New SnoREDAM :— Northern France, Baltic - - - 337 4 ! 2SC Steyning R.S.A. 151 Pexzance :— Baltic ••¦«•. *| A U.S.A. I 1- 1,731 18 47-i 181 Penzance (Hayle Di- Baltic • • - « . vision) : — J 1 Hayle U.S.A. 152 Poole :— France, Baltic 812 17 07 U.S.A. 182 Portsmouth :— Coruniui, Brest, Cherbourg, Baltic - . 1,743 1 848 U.S.A. 153 specified Particulars of Shipping Trade and Sanitary Administration — continued. Are Port Medical Port Inspector of inspected °SltK h ; aSISif Port Ho9 P ital Pro " p^f inquiry by his Action. his Action. Health Acts? TEMPORARILY CONSTlTUTED— continued. Special :— Special. Small ; floating. Yes. Dr. Airy, if sickness. Urban M.O.H. Urban I. of N. None. Yes. Do. Urban M.O.H. :— Urban I. of N. :— None. No. „ Blaxal!. unsatisfact ory. unsatisfactory. Urban M.O.H. :— Urban I. of N. :— None. No. „ Davies. if sickness. on request. Urban M.O.H. :— Urban I. of N.:— None. No. Do. if sickness. on request. Urban M.O.H. :— Special. None. Urban H. ten miles distant. No. Do. if sickness. Urban M.0.H. :- Special:- Small. No. Do. if sickness. unsatisfactory. Urban M.O.H. Special. None. Yes. „ de Chaumont. j Urban M.O.H. :— Urban I. of N. :— None. Since visit. „ Blaxall. if sickness. on request. Urban M.O.H. :— None for Gloucester. None. Inefficient Urban H. No. Do. if sickness. Special for Sharpness. Urban M.0.H. :- Urban I. of N.:— None. No. „ Blaxall. on request. on request. Urban M.O.H. Special. Urban H. ; near shipping. Yes. Do. Urban M.O.H. Urban I. of N. Urban H. No. „ Airy. Urban M.O.H. Urban I. of N. Urban H. ; suitable for cholera. Since visit. „ Blaxall. Urban M.O.H. :— Urban I. of N. :- Small. No. „ Airy, unsatisfactory. unsatisfactory. Urban M.O.H. Vacant. None. No. Do. Special. Urban I. of N. None. Urban H. ; small ; inefficient. Yes. Mr. Spear. Special. Rural I. of N. None. No. Do. Urban M.O.H. :— Urban I. of N. Urban H. Yes. Dr. Davies. if sickness. Urban M.O.H. :— None. None. No. Do. on request. Urban M.O.H. Urban I. of N. Yes. Yes. Do. Urban M.O.H. Special. Urban H. No. „ Blaxall. 154 Port and Eiparian Districts inspected during 1885 ; with certain Vessels Inwards during 1884. District and , ,_ . _ . ... Coasters. From p age> Principal Foreign Trade with Foreign Authority. Of which and" Total. from Colonial Ireland. Ports. PORT SANITARY DISTRICTS 183 Preston :— Norway (.annual average, 3) - • 178 96 3 Lytham U.S.A. 183 Rochester:— Riga, Stockholm, Archangel - - - 4,527 — 392 U.S.A. 181 Southampton:— Brazil, West Indies, France • - - 7,919 17 1,817 U.S.A. 184 Swansea :— Northern France, Spain, Scandinavia, Baltic - 5,760 779 1.851 185 Teignmouth:— Baltic - 768 5 19 U.S.A. 185 Wofkiwgton :— Spain W 62 727 31 U.S.A. RIPARIAN _ . _ — — — p - 186 Abeeyutwith :— Baltic, Holland, France .... 227 40 17 U.S.A. 180 Aldeboegh:— Little or no foreign trade 100 — 1 Plomesgate R.S.A. 187 AMLVCcn :— Spain (little) 100 — 4 Anglesey R.S.A. 187 I BatjCxOß and Beau- America. (See Holy head.) • 5,392 2,765 MAEIS: — U.S.A.s. 187 Babbow-in-Fueness :— Rotterdam, Antwerp, Baltic, Mediterranean - 1,835 786 97 I U.S.A. 188 Baenstaple, Bide- No information available ... - 1,878 18 11 ford, &c. :— The several S.A.s. 138 BEEWICK-ON-Tweed :— Baltic, Belgium, Spain 293 1 98 U.S.A. 189 BLTTn :— #0 information available .... 417 '( 309 The several S.A.s. 189 Beidpoet :— Baltic, France. (All trade included with Wey- x * x U.S.A. mouth.) 190 Beixham :— France ; fishing boats only. (All trade included x x * U.S.A. with Dartmouth.) 190 Carmarthen :— Baltic ------- 321 4 U.S.A. 190 Chichestee Ceeek :— France (fishing boats from Havre) 452 r 22 The several S.A.s. 191 Fowbt :— Northern France, Hamburgh, Belgium - . - 1,9(51 8 352 St. Austell > p c a „ Liskeard j K - s - A - b K-b-A-s-191 FisnorAED :— Baltic. (All trade included with Cardigan) x x x Haverford west R.S.A. 191 Goole :— Boulogne, Dunkirk, Rotterdam, Hamburg - - 1,043 2 1,152 5.8 X 155 specified Particulars of Shipping Trade and Sanitary Administration — continued. Are Port Medical Port Inspector of J2raoted °SS? 1; aSffia Port Hospital Provision. £der Inquiry by his Action. his Action. Health Acts ? TEMPORARILY CONSTlTUTED— continued. Urban M.O.H:- Urban I. of N.:- None. No. Dr. Blaxall. on request. on request. Urban M.O.H. Special. Joint Urban H., with Chatham. Yes. „ do Chaumont. j Special. Special. Urban H. ; not suited for ship-borne Yes. „ Blaxall. cholera. Urban M.O.H. :— Two, special :— Yes ; for cholera. Yes. Do. (also deputies.) Three assistants. Urban M.O.H. Urban I. of N. None. Yes. „ Davies. No arrangement. Vacant. None. Urban H. ; inefficient. Yes. „ Blaxall. DISTRICTS. Urban M.O.H. :— Urban I. of IV. :— None. No. Dr. Davies. on request. on request. No arrangement. No arrangement. None. No. „ Airy. Rural M.O.H. :— No information. Yes ; cottage ; for cholera. No. „ Davies. on request. No arrangement. No arrangement. None. No. Do. Urban M.O.H. :— No arrangement. Urban H. ; not suited for ship-borne No. „ Blaxall. if sickness. cholera. No arrangement. No arrangement. None. No. „ Davies. Urban M.O.H. :— No arrangement. Yes. No. „ Page, if sickness. No arrangement. No arrangement. None. No. Do. Urban M.O.H. :— Urban I. of N. :— Shed for cholera ; unsatisfactory. No. „ Davies. if sickness. on request. Urban M.O.H. :— Urban I. of N. :— None. No. Do. on request. on request. No arrangement. No arrangement. None. No. Do. No arrangement. No arrangement. None. No. Mr. Spear. St. Austell Rural I. of N. :— Joint ; floating ; since visit. No. Dr. Davies. R.M.O.H. :— on request, if sickness. Rural M.O.H. :— No arrangement. None. No. Do. on request. Urban M.O.H. .— No arrangement. Urban H, No. „ Blaxall. if sickness. 156 Port and Riparian Districts inspected during 1885 ; with certain , ¦ Vessels Inwards during 1884. District and , „ _ . ... Coasters - Prom I ii a(re . Principal Foreign Trade with Foreign Authority. Of which and Total. from Colonial Ireland. Ports. RIPARIAN ! — :—: — 192 Gkeit Grimsby:— Rotterdam, Antwerp, Baltic. Little transmigrant 2,411 — 1,151 I U.S.A. traffic. 192 Habbingtoit: — No foreign trade 215 Workington IT. ¦) (j « „ Whitehavcnß.j !s - A - s sins Holyheai):— Little or no foreign trade. (All trade included x x x U.S.A. with Bangor and Beaumaris.) iqt Llixelly :— Northern France and Spain - - - 1.242 138 214 U.S.A. 198 LiTTLEnAMPiON :— Northern France, Baltic ... - 422 1 55 U.S.A., and East Preston 194 Mabyport :— Baltic, Spain .... - 1,421 908 42 I 194 Middlesbrough, Rotterdam, Antwerp, St. Malo, Baltic, Mediter- 2,685 6 1,357 Stockton, &c. :— ranean. The several S.A.s. (P.S.D. since set up.) ,„, Miliom — Little or no foreign trade. (Customs roturns only 206 ? 1 J U.S.A. for September to December 1884.) 195 Mobecambe :— None. (Irish trade included with Lancaster) - 376 x iQfi Mostyn :— Spain. (Irish trade included with Chester) ¦ 1.824 x 109 Holywell, R.S.A. 196 Padstow :— No information available • ¦ • • 678 6 4 The several S.A.s. 196 Port Madoc :— Hamburgh, Bremen, Baltic. (Coasting trade in- x x 49 Ynyscynhaiarn U.S.A. eluded with Carnarvon.) 197 Runcohn :— No information available - ... 2,963 215 220 197 Salcombe :— None. (Coasting trade included with Dartmouth.) x x - Salcombe U. ) «. • „ Kingsbridge ß. S*-*-*' 197 SANDWicn :— Baltic (Little) .... f ? The several S.A.s. 197 ScARBOEouon :— Norway, Sweden - ... 317 2 34 198 Seaham:— No information available • 1.983 ? 103 I . S,.\ . 198 Sillotb::— Hamburgh, Spain, Baltic - - -648 191 16 199 Watchet Baltic. (All trade included with Bridgwater.) • x x x Williton R.S.A. 199 WHIXBYi— Baltic 908 — 18 199 WniTEHAVEN-.- Baltic, Spain 1,646 836 27 200 Woodbridge i— Baltic . ...» 120 6 200 Yarmouth (Nobfolk) Baltic .... - 983 3 2J3 157 specified Particulars of Shipping Trade and Sanitary Administration — continued. Are VessoJs Port Medical Port Inspector of inspected Officer of Health; Nuisances; Hospital Provision. under Inquiry by anil Limits of and Limits of Public liis Action. his Action. Health Acts? DlSTRlCTS— continued. Urban M.O.H. :— No arrangement. Urban H ; inefficient. No. Dr. Blaxall. on request. No arrangement. No arrangement. None. No. Do. Urban M.O.H. No arrangement. Available. No. „ Davies. Urban M.O.H. :— Urban I. of N. :— Doecker's tents for cholera. No. Do. if sickness. on request. No arrangement. No arrangement. None. No. Mr. Spear. No arrangement. No arrangement. Urban H ; defective. No. Dr. Blaxall. Urban M.O.H. :— No arrangement. Joint ; floating. No. Do. if sickness. No arrangement. No arrangement. None. No. Do. No arrangement. No arrangement. None. o. ? .rage. Rural M.O.H. :— Rural I. of N. :- Hut, for cholera. No. „ Davies. if sickness. on request. No arrangement. No arrangement. None. o. No arrangement. No arrangement. None. No. Do. No arrangement. No arrangement. Urban H. ; small. No. „ Airy. No arrangement. No arrangement. None. No. „ Davies. No arrangement. No arrangement. None. Urban M.0.H. :- Urban I. of N. :- Urban H. ' No. „ Blaxall. if sickness. on request. No arrangement. No arrangement. Shipowners maintain small H. No. „ Page. No arrangement. No arrangement. None. Rural M.0.H. :- Rural I. of N. :- None. No. „ Davies. on request. on request. Urban M.0.H.:- Urban I. of N. :- None No. „ Blaxall. on request. on request. No arrangement. No arrangement. Harbour Co f^>°™™' H>; very N °" D °' No arrangement. No arrangement. Rural H. : small. No. Mr. Spear. Urban M.0.H.:- Urban I. of N. :- Urban H. No. Dr. Airy. if sickness. on request. I 158 i No. 9 (a). Abstracts of Inspectors' Reports on the Sanitary Survey Port and Riparian Sanitary Districts. AFP. No. 9 («) Permanent Port Sanitary Districts. (A.) Port Sanitary Districts Permanently constituted. A. 1. Cardiff (Glamorgan) P. S. D. # Dr. Blaxall. This District includes with Cardiff U.S.D., the Riparian Dis- tricts of Peuarth Urban and Cardiff Rural. Port Sanitary Authority. — Cardiff Town Council. Cost of Administration. — Defrayed by the Port Sanitary Authority (the Riparian Districts of Penarth Urban and Cardiff Rural do not contribute). Port M. 0. Health.— Be. Paine, M. 0. 11. of the Urban District. Port I. of Nuisances. — Mr. Govin, I. of N. of the Urban District. Shipping Trade. — Chiefly with Spain, France, Mediterranean, Baltic, and China. During the year 1884, 4,054 vessels from foreign and colonial ports and 8,664 coasters entered Cardiff Port. Chief Facts reported.- — Inspection of vessels carried out under P. H. A., § 92, but owing to the I. of N. not having kept a Report Book, the precise number of vessels so inspected is not known. The Authority have no isolation hospital of their own, but are allowed the use of a small building which is an offshoot of the general hospital ship " Hamadryad," and is supported by voluntary contributions from shipowners. This small hospital building is not adapted for the isolation of two infectious diseases at the same time. — The appointed boarding station is at the Docks, but during the time that cholera prevailed in France and Spain, vessels were boarded in Penarth Roads. — The S.A.s arrangements for giving" effect to the remaining Cholera Regulations are satisfactory. The mooring station is in the vicinity of Flatholm Island, whereon the Authority have provided a hospital tent for the isolation of cholera cases brought in vessels. This tent was used on two occasions in 1.884, the patient on one occasion being the captain of the S.S. " Rishanglys." This vessel had watered at the infected Port of Marseilles when cholera was epidemic there, and during her passage home the disease appeared on board. On her arrival at Cardiff, Dr. Paine had a sample of the water analysed, when it was found to give evidence of sewage contamination. In 1884, the respective P. S. A.'s of Cardiff and Newport entered into an agreement whereby the P. S. A. of Newport were allowed the use of the tent on the Flatholm for the isolation of any cholera cases that might be brought into their port in vessels, but in the following year (1885) Cardiff refused to renew the agreement. — In December 1885, the use of the boarding steamer was with Dr. Paine's concurrence discontinued. * In these abstracts, it has been permitted to use the abbreviations, — M. 0. H. for Medical Officer of Health ; I. of N. for Inspector of Nuisances ; S. A. or D. for Sanitary Authority or District ; P., port ; IL, Urban ; R., Rural ; P. H. A., Public Health Act, 1875. App. No. [) (a) A. 2. HartlepoOL (Durham) P. S. D. Dr. Blaxall. Peminnent tThis Port Sanitary District includes the Urban Districts of r est Hartlepool, Hartlepool Borough, Middleton-in-Stranton, and hroston. Port Sunitai'v Districts. Port Sanitary Authority. — A joint Board formed of representatives of the above Urban Authorities. Cost of Administration. — Defrayed by the joint Board. Port M. 0. Health. — Mr. Biggart appointed on very unsatisfactory terms, viz., on a salary of 10/. per annum, and to receive fees for boarding any vessel reported to him to have sickness on joard, but in the event of the fees exceeding 10/. during the year the salary is to merge therein. Port I. of Nuisances. — 'None. Shipping Trade. — Baltic (timber trade considerable), French Ports, Black Sea, Mediterranean, and regular traffic twice a week with Hamburgh. During the year 1884, 1,332 vessels from foreign and colonial ports, and 2,017 coasters entered the port. Chief Facts reported. — Inspection of vessels under § 92, P. H. A. lot carried out. The Port Sanitary Authority possess an isolation lospital, but it is small and very imperfect. Recognising this 'act, the Authority some short time since entered into amalgamation with the Urban Authorities of West Hartlepool and Hartle>ool, and joint application haa been made for a loan to enable them o build a hospital for the three districts, upon land adjoining the <~ite of the present hospital. The boarding is appointed to take )lace outside the docks, but to a certain extent this depends upon ;he weather, for when this is boisterous vessels quickly seek shelter n the docks. The mooring station is situated inside the harbour, _>ut the outside anchorage is dangerous, necessitating at times vessels running elsewhere for safety. The Port M. O. Health has nade himself acquainted with the Cholera Regulations, and ho promises to carry them out. The present isolation hospital is well situated for the reception of cholera cases from ship-board. The iccommodation is limited, but there is sufficient ground space to idmit of extensions. A. 3. Harwich (Essex) P. S. D. Dr. Airy This district includes parts of the Riparian Districts of Tendring Rural, Samford Rural, and Woodbridge Rural, besides Harwich Urban Sanitary District. (Vessels bound for the port of Ipswich have to pass through the port of Harwich.) Port Sanitary Authority. — A joint board, composed principally of members of the Harwich Town Council, and the rest delegates from the several Riparian (Rural) Authorities above named. Ipswich is not represented on the Board. Cost of Administration. — The three Rural Riparian Districts contribute in the proportion of half their rateable value, Harwich contributing in proportion to its whole rateable value. Port 31. O. Health. — Mr. W. W. Hard wick c, with a salary of 15 guineas a year. Mr. Hardwicke is also M. O. H. for Harwich U.S.D. Port I. of Nuisances. — Mr. Ainsbury, with a salary of 10/. a year. Shipping Trade. — With Denmark. With Hamburgh, Rotterdam, and Antwerp (passenger traffic in connexion with the Great Eastern Railway). With the Baltic for timber. With America for grain. 160 A little trade with the Black Sea. During the year 1884, 811 vessels from foreign ports (almost all being Great Eastern passenger boats), and 1,169 coasters, entered the port. • App. Xo. 9 («) IVrmanent B Sanitary icts. Chief Facts reported. — No inspection of vessels under the P. H. A., § 92. The P. S. A. have a small floating hospital, consisting of a ward for three or four beds, erected on a disused barge, with a small cabin at each end for nurse and kitchen. Bedding and stores are kept on shore, for fear of thieves. Water would be taken on board from Harwich. The appointed anchorage for the hospital barge is off Shotley Point, between the fairways of the rivers Orwell and Stour, which meet in Harwich Harbour. The Customs boarding station is in the middle of the harbour. Vessels bound for Ipswich (as well as those for Harwich and Parkeston) are boarded in Harwich Harbour. The former are sent on, with a Harwich Customs Officer on board, who remains with the vessel until he is " cleared " by an Ipswich Customs Officer coming on board in Butterman's Bay (if the ship has to be lightered) or at Ipswich Dock. In case infectious disease of any kind be found on board an Ipswich vessel in Harwich harbour, the Harwich P. S. A. repudiate the responsibility of dealing with it. The Port M. O. H. is now acquainted with his duties under the Cholera Regulations, and is prepared to carry them out. An infected vessel would be anchored between Shotley House and Bloody Point. Cases of cholera found on board Harwich vessels would be taken on board the floating hospital. A. 4. Liverpool (Lancashire) P. S. D. Dr. Blaxall. This Port district includes riparian districts as follows: — Urban Sanitary Districts. — Liverpool, Birkenhead, Bootle-cum-Linacre, Southport, Birkdale, Bromborough, Garston, Little Crosby, Great Crosby, Higher Bebington, Lower Bebington, Toxteth Park, Tranmere, Wallasey, and Waterloo-with-Seaforth ; and Rural Sanitary Districts. — Ormskirk, Prescot, West Derby, and Wirral. Port Sanitary Authority. — Liverpool Town Council. Cost of Administration. — Defrayed by contribution; Liverpool paying 82*5 per cent, and seven* other Urban Authorities contributing sums varying from o's per cent, to 7'o per cent. Port M. O. Health.— Dr. Taylor, Health Officer of the Urban District. Port I. of Nuisances. — Captain Brown, a master mariner. Shipping Trade. — With all parts of the world. Emigration and passenger traffic with the United States and Canada considerable. During 1884, 4,852 vessels engaged in foreign and colonial trade entered the port of Liverpool, besides 11,269 coasters. Chief Facts reported. — River and dock district extensive. lnspection of vessels (P. H. A.,§ 92) fairly carried out, considering that the I. of N. has no assistant, and that there is no steam launch provided for his use. In 1884, the number of vessels inspected amounted to 4,092 ; of these 230 exhibited sanitary defects of one kind or another. The P. S. A. possess an iron hospital for the reception of cholera cases. The building occupies an open situation facing the water on the Birkenhead side of the river, near the mooring station and convenient for landing. The P. S. A. are precluded from * Birkenhead, Bebington Higher, Bebington Lower, Garston, Toxteth Park, Tranmere, and Wallasey. making use of it for other than cholera cases. The Urban Authority possess a temporary small-pox hospital to which port cases of small-pox are sent, while cases of other infectious disease are taken either to the workhouse or to the Netherh'eld Hospital. Arrangements have been made for cases of infectious sickness found on board vessels on the Birkenhead side of the river to be received into the Birkenhead Sanitary hospital, and for Dr. Vacher, the M. O. H. of Birkenhead, to undertake the carrying out of the disinfection, etc. of the infected vessels, &c. The P. S. A. have not obtained powers under § 125, P. H. A. to require owners and masters to notify the presence of infectious disease on board their vessels. Satisfactory arrangements have been made for giving effect to the Cholera Order. During 1 884, three vessels from Marseilles that arrived at Liverpool had suffered during the homeward voyage from cholera or choleraic diarrhoea. These vessels had watered at Marseilles where cholera at the time was prevailing ; the captain of one of them, attributing the outbreak in his ship to the drinking of this water, ordered it to be boiled prior to being issued ; the result of this precaution was that the diarrhoea ceased. There is a Quarantine M. 0., to whom the Customs Officer is required to report the presence of infectious disease before communicating with the P. S. A. ; but upon the Board representing to the Lords of the Privy Council that the delay hereby occasioned militated against prompt action in dealing with the cases, instructions were given for that usual course to be departed from in inspect of cholera cases, and immediate information to be given to the P. S. A. The Riparian District and Town of Euncorn, situated on the Mersey about 6 miles above the Port Sanitary District of Liverpool, carries on a considerable shipping trade. Vessels bound for Euncorn are boarded by the Customs within the Port Sanitary District of Liverpool, and in the event of infectious sickness being found present, information of the same is given to the Liverpool Port Sanitary Authority, who then undertake the measures necessary to prevent the spread of the disease. Apr. No. 9 (a). « Permanent Port Sanitary Districts. A. 5. London P. S. D. — Dk. de Chaumont. Ilhis port district extends, from Teddington Lock, down both es of the Thames to its estuary, viz., to an imaginary straight c drawn from Havengore Creek in Essex, to Winden Point the Isle of Sheppy. It includes above 40 Riparian Sanitary stricts, and, as well, the waters and Eiparian Districts of the jdway estuary comprised between the imaginary line above erred to and another imaginary line to the westward of it, drawn ectly from Coalmouth Creek to Stangate Creek, thence southward Swale Church, and again north-eastward to Elmley Chapel. Port Sanitary Authority. — The Corporation of London. Cost of Administration. — Defrayed solely by the Port S. A. Port Medical Officer of Health. — Dr. William Collingridge, salary 700 A per annum. Icting Assistant Health Officer^ Gravesend), and Medical Officer the Port Sanitary Hospital. — Mr. Philip Whitcombe, at a dy remuneration of 210/. ¦Port Inspectors of Nuisances. — Mr. W. H. Lewis at 175/. per num. ; and Mr. W. Giles at 60*., Mr. H. Spadaccini at 50*., and \ W. Baillie at 45*. per week respectively. E 20510. L 162 Arr. No. 0 (a) Permanent Port Sanitary Districts. Shipping Trade. — With all parts of the world. Transmigrant traffic (emigrants to America from continental ports) insignificant now as compared with former years, but still a very possible source of danger as regards cholera. Insailings during 1884: from foreign and colonial ports, 10,8G8 ; coastwise, 41,782. Chief Facts reported. — Hospital provision : Port Sanitary Hospital newly erected on Kent shore, three-quarters of a mile below Gravesend. Two and a half acres of land adjacent to hospital acquired by P. S. A. for temporary extension of the establishment if requisite. Ship " Rhin " (some time disused, but lying off Gravesend) also available for hospital purposes. Customs Boarding Stations: At Gravesend, just below town pier. At Sheerness (by Coastguard), Garrison Point. Mooring station below Gravesend near Port Hospital. Inspection of vessels, under P. H. A., § 92, carried out. P. S. A. have obtained, and exercise, powers under § 125. Canal Boats Acts duly enforced. Satisfactory arrangements have been made under the Cholera Order. Several medical men retained to act if necessary as inspecting officers. At Gravesend, Customs would forthwith report arrival of infected ship to Dr. Collingridge at Greenwich and to Mr. Whitcombe at Gravesend : the latter would at once go on board and proceed Tinder the Order. At Sheerness, Coastguard would order cholerasuspected ship (whether or not bound to places beyond jurisdiction of Port S. A. of London) to " let go," and would notify arrival to Dr. Arrol of Sheerness, who would visit the ship, which in the event of being found cholera-infected, would be sent round to the mooring station below Gravesend to be there dealt with. A. 6. Lowestoft (Suffolk) P. S. D.— Dr. Airy. This Port Sanitary District includes all the Avaters abutting upon the Urban Sanitary District of Lowestoft, together with a very small portion, on the north shore of the inner harbour, belonging to the Mutford and Lothingland R. S. D. (Lowestoft has considerable inland water communication). Port Sanitary Authority. — Lowestoft Improvement Commissioners. Cost of Administration. — Defrayed by the Port Sanitary Authority. Port M. 0. Health.— Dr. D. C. Smith, who is also M. O. H. for the Lowestoft Urban Sanitary District, and for the Mutford Rural S. D. Salary, for the Port S. D., 20/. Port I. of Nuisances. — Mr. J. Rayment (salary, 10/.). Also I. of N. for the Lowestoft U. S. D, and Mutford R. S. D. Shipping Trade. — Chiefly with the Baltic ; a little with the Mediterranean, the Black Sea, and Australia ; a few French fishing boats. During the year 1884, 125 vessels from foreign and colonial ports, and 49G coasters, entered the port. Chief Facts reported. — There is no systematic inspection of vessels under the P. H. A., § 92. The Urban Authority have an isolation hospital (The " Sanitorium ") inland about half-a-mile from the town, but accessible from the inner harbour without passing through the town ; a wooden structure, containing four wards, fitted for 30 beds ; kept in general readiness, with a nurse residing as care-taker. The Boarding Station is at the mouth of the new (outer) harbour. A mooring place for infected vessels has been fixed upon within the harbour. The arrangements with the Customs authorities are satisfactory. In case a vessel were reported app. No. 9 (a) to him by the Customs Officers as infected, the M. O. H. would p ei . ma ~ t (i prepared to carry out his duties under the Cholera, Regulations. Port Sanitary or the isolation of infectious cases from shipboard, the urban District* nitary hospital is fairly convenient ; but as its drainage enters o public sewer, it would be well not to receive ship-borne cholera cases there. A. 7. Milford (Pembroke) P. S. D.— Dr. D. S. Davies. (This District includes the Riparian Districts of Milford and embroke Urban, and Haverfordwest, Pembroke, and Narberth ural. I Port Sanitary Authority. — A joint Board of 13 members reprenting the Riparian Districts. iCost of Administration. — Is contributed by Riparian Authorities cording to rateable values of parishes abutting on the haven. The Port M. 0. H. and 1. of N. — Are appointed by the combined authority. The appointments are permanent since 1879. These officers hold similar positions in the Milford U. S. D. and the M. O. H., also in the Haverfordwest R. S. D. Shipping Trade. — Is chiefly coasting trade with Ireland. There is a regular and frequent S.S. service in connexion with the Great Western Railway running to Waterford and Cork. In 1884, 18 foreign ships arrived to discharge and 1,506 coasting vessels ; of these 836 represent the S.S. service. This is a much frequented port of call. Chief Facts reported. — As to systematic inspection, a boat is lired, and vessels from infected ports, or otherwise open to sus)icion, are inspected. The boat hire is not paid by the authoty. A special officer and a launch would be required to carry ut complete systematic inspection. The P. S. A. have a small solation hospital for six patients near Milford; but the authority nive determined to make use of Dale Fort for cholera purposes ; "his position is near to the Boarding Station, but is far removed 'rom Milford, and from medical aid. The arrangements for deention of vessels and notification of cholera will be carried out, id the M. O. H. is prepared to act. A. 8. Newcastle, River Tyne P. S. D. — Dr. Blaxall. This Port District comprises Riparian Urban Sanitary Districts as follows : — Felling, Gateshead, Hebburn, Howdon, Jarrow, Newcastle-on- Tyne, South Shields, Tynemouth, Walker, Wallsend, and Willington Quay. Port Sanitary Authority. — A joint Board composed of representatives of the several Riparian Authorities. Cost of Administration. — Defrayed by the joint Board. I Port M. O. Health. — H. Armstrong, Esquire, M. O. H. of Newstle-on-Tyne. Assistant Port M. O. 11., Dr. T. F. Armstrong. LPort I. of Nuisances. — Mr. Taylor, master mariner, and two sistants. I Shipping Trade. — With the Baltic, Rotterdam, Hamburgh, ranee, Spain, the Mediterranean Ports, America, Coast of Africa, c, and some transmigrant traffic. In the year 1884, 5,634 jssels from foreign and colonial ports, and 9,656 coasters entered ie port. l 2 164 App. No. 9 (a) Permanent Port Sanitary Districts. Chief Facts reported. — The sanitary administration of the port is very efficiently carried out. The P. S. A. have provided a steam launch to facilitate the carrying out of the port duties ; also two floating hospitals, one for cases of home infectious disease, and the other for the reception of cholera cases from ship-board, and they are now in process of constructing a third hospital on a platform floated by means of iron tubes, to replace the first of these hospitals, which is fast becoming rotten and unfit for use. The Assistant Port M. O. H. resides at Shields, convenient for boarding vessels as they enter the port. Transmigrants are carefully inspected. During the year 18S4, 12,078 vessels were inspected out of 13,489 that entered the harbour. Satisfactory arrangements have been made for giving effect to the Cholera Eegulations. A. 9. Newport (Monmouth) P. S. D. — Dr. Blaxall. This district includes Newport Urban, and Newport and Cardiff Rural. Port Sanitary Authority. — Newport Town Council. Cost of Administration. — Defrayed by the several authorities concerned, Newport Urban contributing 85 per cent., and Newport Rural and Cardiff Rural, 12 and 3 per cent, of the total. Port M. O. Health.— Dr. Davies, M. O. H. of the Urban District. /. of Nuisances. — Mr. Williams, I. of N. for the Urban District. Shipping Trade. — With Havre, Antwerp, Bilbao, Carthagena, and other Spanish ports; with Mediterranean, Baltic, America, &c. During 1884, 1,585 vessels from foreign and colonial ports, and 7,830 coasters entered this port. Chief Facts reported. — Inspection of vessels carried out. The Authority possess an isolation hospital situated in the town. It consists of three cottages, and affords fair accommodation for 12 patients. In the course of the year 1884 eight cases of infectious disease were admitted into this hospital from vessels ; two of the cases were detected by the Customs Officer, and six came under notice by the I. of N. in other ways. The boarding station is situated at the docks, but in view of the threatened danger of cholera introduction, the Authority went to some expense in chartering steamers to enable the examination of vessels to be made before allowing them to enter the river. Arrangements with the Customs are satisfactory. The M. O. of 11. has made himself thoroughly acquainted with his duties. In 1884 the P. S. A., recognising the unfi tness of their own isolation hospital for the reception of ship-borne cholera cases, entered into an arrangement with the Cardiff P. S. A. by which they obtained permission to use the Cardiff cholera tent at Flatholm Island should occasion arise. In the following year, however, Cardiff refused to renew this arrangement, whereupon, iv pursuance of instructions from the Local Government Board, I met in conference representatives of the Newport and Cardiff P. S. A.'s when I pointed out the advantages to the public to be derived from a continuance of the former arrangements. The Cardiff Authority insisted that in this case the Newport Authority should bear an equal share with them of the expenses incurred ; but to this proposition Newport objected, as being by far the smaller port of the two ; and the arrangement fell through. I learn that the P. S. A. of Newport have since provided a cholera hospital of their own. A. 10. Plymouth (Devon) P. S. D. — Dr. Blaxall. app. No. 9 (a) This includes (wholly or in part) Plymouth, Devonport, and Permanent East Stonehouse Urban Sanitary Districts ; and Plympton St. Mary, Krfcts"" 1 St. Germans, nnd Tavistock Rural Sanitary Districts. I Port Sanitary Authority. — A joint Board consisting of members f all the above Sanitary Authorities except Tavistock Rural. Cost of Administration. — Defrayed by contribution from all the Riparian Districts except Tavistock. Port M. O. Health. — Mr. Fox, who does not hold any other appointment under the P. H. Act. Arrangement in respect of his remuneration is very unsatisfactory, viz., a fixed salary for taking charge of the Port floating isolation hospital, and payment to him of a fee for visiting any ship reported to him as having infectious sickness on board. (Port I. of Nuisances. — Mr. Clegg, the Urban I. of N., has been quired to board any vessel reported to him by the Customs to ive sickness on board, and he has received a small salary for is special duty. But lam informed, since my conference with c Authority, that an I. of N. has been appointed specially for this I Shipping Trade. — With the Channel Islands, France, Corunna, d Mediterranean ports. In addition mail boats from Marseilles, est Indies, the Cape, and Australia call at Plymouth. During c year 1884, 739 vessels arrived in the port from foreign and lonial ports, and 3,022 coasters. I Chief Facts reported. — Inspection of vessels (P. H. A., § 92) not rried out. The Authority possess a floating isolation hospital, viz. c " Pique," a wooden frigate lent to them by the Admiralty. She is ?11 adapted to the purpose, but is anchored in an exposed situation. Ith regard to carrying out the Cholera Regulations : — The regular ipointed boarding station is in the Sound, but vessels arriving from c near French ports, or from the Channel Islands were, until the nger of this proceeding, as a likely means of introducing in- disease into the country, had been brought under notice of 3 Customs by the Local Government Board, allowed to go to 3 quays before being subjected to inquiry by the Customs, structions have since been issued for such vessels to be boarded the Sound during such time as cholera is known to be present on } French coast. ¦Arrangements are satisfactory in respect of mooring stations for fected vessels. The " Pique " affords efficient means for the •lation and treatment of cholei-a cases from shipboard. A. 11. Sunderland (Durham) P. S. D. — Dr. Blaxall. Irhis district includes Sunderland and Southwick Urban, and nderland Rural, Sanitary Districts. K°ort Sanitary Authority. — A joint Board, consisting of 20 repretatives of Sunderland Urban Authority, one of Southwick, and 3e of Sunderland R. S. A. Port M. 0. Health.— Dr. Harris, M. O. H. of the Urban District. Port I. Nuisances. — Captain Preston, a retired master mariner. I Shipping Trade. — With the Baltic and Dutch ports (considered also with Spain, the Mediterranean, Black Sea, &c. In 1 course of the year 1884, 1,513 vessels from foreign and colonial •ts and 5,389 coasters entered this port. 166 App. No. 9 (a.) Permanent Port Sanitary Districts. Chief Facts reported. — Inspection of vessels (§ 92, P. H. A.) lias been very satisfactorily carried out. In ] 876, 955 vessels were inspected ; of this number 60 per cent, were found in an unsanitary condition, whereas in 1884, 2,153 were inspected, and of these 17 per cent, only were unfavourably reported of. The P. S. A. have no isolation hospital of their own, but cases of infectious disease found on board vessels are removed to the urban sanitary hospital. This hospital, however, is not suitable for the reception of cholera eases from shipboard. Satisfactory arrangements made between the Customs and the P. S. A. for giving effect to the Cholera Order. The M. 0. H. is thoroughly acquainted with the duties required of him under the said Order. The P. S. A. have purchased a boat house conveniently situated for the reception of cholera cases from vessels, but it will require not a few improvements before it can be made use of for the purpose. A. 12. Wetmoutii (Dorset) P. S. D.— Dr. D. S. Da vies. This district comprises Portland, and Weymouth-and-Melcombe Regis, Urban, and Weymouth Rural Sanitary Districts. Port Sanitary Authority. — A joint Board composed of members of the above Sanitary Authorities. Cost of Administration. — Defrayed by contribution from the several districts. Port M. 0. JT.— Mr. R. P. Simpson, with a salary of 50/, per annum. Port 1. of N. — Mr. Wm, Butt, with a salary of 20/. per annum. [Neither of these officers hold posts under any other Sanitary Authority.] Shipping Trade. — Daily boat service with Cherbourg and frequent communication with the Channel Islands. Large French trade ; as many as 600 vessels entering the harbour during the year, also an occasional vessel from the Baltic and the Black Sea. Coasting trade chiefly in coals with the North of England ports. A great many ships call at the coal hulks at Portland Roads. Chief Facts reported. — The systematic inspection of vessels is carried out in accordance with § 92, P. H. A. and regulations under § 125 are also enforced The Customs Officer is prepared to act with the officers of the S. A. in carrying out the provisions of the Cholera Order. There is an excellent sanitary hospital belonging to the P. S. A. also available for urban use : there are 24 beds and an observation ward, also a permanent disinfecting chamber and an ambulance and stretcher for removal of patients. The managers of the steamboat service have adopted special regulations to prevent the introduction of disease. A. 13. Wisbech (Cambridge) P. S. D.— Dr. Airy. This Port Sanitary District includes with Wisbech Urban, the Ripariiin Districts of Sutton Bridge Urban, Walsoken Urban, and parts of Holbeach Rural and Wisbech Rural. Inland water communication by the river Nene and the Wisbech Canal. Port Sanitary Authority. — Wisbech Town Council. Cost of Administration. — Defrayed jointly by the Port Sanitary Authority and the S. As. of all the included Riparian Districts. Port M. 0. Health.— Mr. A. H. Haines, of Long Sutton Arp.NaiKa) (Lincolnshire), with a salary of 20/. a year. Permanent Permanent Port I. Nuisances.— Mr. W. W. Nicholls (Harbour Master), JftSJ*^ with a salary of hi. ss. a year. (These officers do not hold similar positions in any Urban or Rural Sanitary District.) J Shipping Trade. — Chiefly with the Baltic ports, for timber, also ith North America and the Gulf of Florida. One vessel from >unkerque during the year. In 1884, 140 vessels from foreign orts, and 141 coasters, entered the port. Chief Facts reported. — Inspection of vessels under the P. H. A., 92, is duly carried out. In 1884 about 20 vessels were inspected >y the M. O. H. The English vessels were found in fairly good rder, but the foreign vessels, especially Russian, were often found irty, ill-ventilated, and with insufficient berth space. The '. S. A. have a good newly-built hospital for infectious diseases, bout a mile below Sutton Bridge and eight miles below Visbech. It stands within 100 yards of the Wisbech river, 'rom which it is accessible by a sloping landing-stage. Water vould be brought to it from Wisbech. There is also an isolation lospital in the outskirts of Wisbech town, maintained jointly by ie Wisbech Urban and Rural and the Walsoken Urban Sanitary )istricts. The usual boarding station is in Wisbech " Eve " (off the mouth of the Wisbech river), but sometimes vessels are brought by the pilots up to Sutton Bridge before boarding. Arrangements with the Customs Authorities are quite satisfactory. The M. O. H. is well acquainted with his duties under the Cholera Regulations, and is prepared to carry them out. Any vessel found to be infected would be anchored in the " Eye " out of the direct line of traffic. Cholera patients would be isolated in the Port hospital below Sutton Bridge. (B.) Port Sanitary Districts temporarily constituted. B. 1. Boston (Lincolnshire) P. S. D. — Dr. Airy. This District comprises the estuary of the river Witham and the Temporary roadstead termed " Boston deep ; " and includes, with the Boston j$ a r trfc'ts! tary U. S. D., parts of three Riparian Rural Districts, viz., Boston, Spilsby, and Holbeach. (Boston has inland water communications with Lincoln.) Port Sanitary Authority. — Boston Town Council. Cost of Administration. — Defrayed by the Urban Sanitary Authority. Port M. O. Health. — This office is nominally held by Dr. Clegg, (M. O. H. for the Urban District), but there is no stated salary, nor payment by fees. Port I. Nuisances. — Nominally, W. Stephenson (I. of N. for the Urban District), without salary or fees. Shipping Trade. — With Russian and Baltic ports, South America, the Black Sea, and Alexandria. (No trade with France or Spain.) During the year 1884, 18 vessels from foreign ports, and 445 coasters entered the port of Boston. Chief Facts reported. — There has been no inspection of vessels under the P. H. A., § 92, and no cases of sickness are known to have arrived from sea. Possibly cases might have been found, it looked for. The M.O. H. now undertakes to inspect all. vessels 168 APP. No. 9 («) Temporary B Sanitary icts arriving from infected countries. The only existing means of isolation in the district is a hospital belonging jointly to the Boston Urban and Rural Sanitary Authorities, (the cost being divided between them, but the administration being left in the hands of the Rural S. I).). It is a converted farm house, one and a half miles from the town, accessible from the harbour without traversing the town. It has four rooms available for patients, and one or two rooms are always kept ready. The boarding station is at Clay Hole, at the head of the Boston Deep, off Fneston shore, which is four or five miles distant from Boston. There is no telegraphic communication. Some mode of signalling an infected arrival might be arranged with the coastguard. The general arrangements with the Customs Officers are satisfactory, and the M. O. H. is prepared to carry out the Cholera Regulations. The mooring station is at the " East Countryman's Berth," near Clay Hole. Cholera cases might be treated in the joint Urban and Rural hospital. B. 2. Bridgwater (Somerset) P. S. D. — Dr. Blaxali This district comprises the Bridgwater and Burnham Urban, and the Axbridge anil Bridgwater Rural Sanitary Districts. Port Sanitary Authority . — Bridgwater Town Council. Cost of Administration. — Defrayed by the Bridgwater Urban Sanitary Authority. (The Urban District of Burnham and the Rural Districts of Axbridge and Bridgwater do not contribute.) The question of meeting the cost of administration was raised at the conference, and attention was then directed to the requirements of the P. H. A., § 290. Port M. 0. Health.— My. Parsons, Health Officer of the Urban District. Port I. Nuisances. — Mr. Laffam, I, of N. for the Urban District. Shipping Trade. — Chiefly with the Baltic, America, Smyrna and Brittany. During 1884, 64 vessels from foreign and colonial ports, and 3,933 coasters entered the port. Chief Facts reported. — Inspection of vessels, under P. 11. A., § 92, very partially carried out. The P. S. A. do not possess any isolation hospital, but on one or two occasions port cases of infectious diseases have been isolated in the Urban Hospital, a small building situated near the docks. The Customs boarding station, as well as the mooring station for infected vessels, are situated off Burnham, 10 or 12 miles from Bridgwater, the Customs arranging to telegraph to the Port M. O. H. should his services be required. The P. S. A. have no means for isolating cases of cholera from ship-board. I suggested at the conference that the Authority should provide tents or huts ready to be erected, on immediate notice, on a sandy piece of land conveniently accessible for the mooring station, and sufficiently removed from the town of Burnham. B. 3. Bristol (Gloucester) P. S. D. — Dr. Blaxall. This district includes Bristol Urban, and Axbridge, Barton Regis, and Bedminster Rural Sanitary Districts. Port Sanitary Authority. — Bristol Town Council, who defray the cost of administration. 169 App. No. 9 (a) Port M. O. Health.— Mr. Davies, M. O. H. for the Urban District, with an assistant M. O. to carry out prompt boarding of vessels as required by the Cholera Regulations. Temporary Port Sanitary Districts. Port I. Nuisances. — One of the staff of Urban Inspectors is detailed for the duties in the docks at Bristol ; and an old man-ofwar's man appointed at Avonmouth. Shipping Trade. — With the Mediterranean, Black Sea, France, United States, Canada, &c. During 1884, 820 vessels from Foreign and Colonial ports, and 7,544 coasters. Chief Facts repo?'ted.^-When first visited the P. S. A. had not recognised the duties devolving upon them under the P. H. A. There was no Port I. of N., and as a consequence no inspection of vessels under P. 11. A., § 92. Action was limited to visiting vessels reported by the Customs Officer to have sickness on board, and isolating in the Urban Hospital any cases of infectious disease then found present. Their shortcomings were pointed out to the Authority, and matters have since been placed on a far more satisfactory footing, and proper arrangements have been made to carry out the Cholera Regulations. As stated above, a Port I. of N. is now appointed for duty in the docks, and an assistant inspector at Avonmouth. The M. 0. H. has drawn up a code of instructions for the guidance of the inspectors. Inspection of vessels (§ 92) is now carried out, and the particulars noted in a Report Book. The Authority have obtained powers, under P. H. A., § 125, to require captains of vessels to notify the presence of infectious disease. They have built a port infectious hospital at Avonmouth, but its construction is not satisfactory. The arrangement of the building will not admit of efficient isolation of two diseases at the same time ; while the interior of the wards are in direct communication with the drains by means of the bath pipes. Cardigan (Cardigan and Pembroke) P. S. D. — Dr. D. S. Davies. Riparian Districts included. — The Urban and Rural Sanitary Districts of Cardigan. Port Sanitary Authority. — The Cardigan Town Council. The R. S. A. does not contribute towards expenses. Port M. 0. Health and I. of N.— The M. O. H. and I. of N. hold similar positions in Cardigan Urban District. Shipping Trade. — The Foreign Trade is small, but there is considerable communication with Bristol and the South Wales ports, and some Iri&h trade. During the year 1884, 4 vessels arrived from Foreign Ports, and 863 coasters. Chief Facts reported. — Foreign vessels have been inspected to prevent introduction of disease, but no systematic inspection under § 92, P. 11. A. has been carried out. There is no isolation hospital provided by the P. S. A., or available for their use. Vessels are boarded within the bar, and the Customs Officer is prepared to give notice of disease on board ship, upon which M. O. H. will act in accordance with his powers. The Port District is of some extent, and boat hire to the boarding station has to be provided. B. 5. Carnarvon (Carnarvon) P. S. D. — Dr. D. S. Davies, Riparian Districts included. — This District includes, with the U. S. D., parts of the Carnarvon R. S. D. in the counties of Carnarvon and Anglesey. 170 App. No. 9 (a) Temporary Port Sanitary Districts. Port Sanitary Authority. — Carnarvon Town Council. Cost of Administration. — The Riparian R. S. A. contributes 8/. annually towards the expenses. Port M. 0. Health.— Mr. E. H. Williams ; is not M. O. H. for the Urban District. Port I. Nuisances. — The I. of N. holds a similar position in the Urban District. Shipping Trade. — The chief trade is in timber from America and from the Baltic; no Spanish or French trade. In 1884, 17 vessel, from Foreign countries entered the port. Chief Facts reported. — Foreign vessels from infected places, and all suspected craft have been visited and examined, but systematic inspection under § 92, P. 11. A, has not been carried out hitherto, as it was not understood to be required. The boarding station is in the Strait, and the detention and anchorage of infected vessels is provided for, but there is no hospital provision made by the P. S. A. or available for their use. Vessels discharging frequently lie at some distance from the shore, the S. A. will consequently need to provide means by which their inspecting officers shall be able to reach the vessels. B. 6. Chester (Cheshire) P. S. D.— Dr. Page. This Port Sanitary District includes the Riparian Districts of Chester (City) Urban and Hawarden Rural. Port Sanitary Authority. — Chester Town Council. Cost of Administration, — Defrayed by the P. S. A. (Hawarden 11. S. D. has not been called upon to contribute). Port M. 0. Health.— G. A. Kenyon, M.8., M. O. H. for the City of Chester, and associated Sanitary Districts is Port M. O. H. Dr. Kenyon receives 20/. a year and he is appointed annually. Port I. Nuisances. — Mr. 11. Wharton, I. of N. of the city. 10/. a year salary as Port I. of N. and reappointment annual. Shipping Trade. — Chiefly coasting from Barrow-in-Furness and the Duddon with iron ore. A vessel occasionally comes with flints from France (Dieppe and St. Valeric), but there has been no Spanish or Mediterranean trade of recent years. During 1884 nine vessels from foreign parts and 403 coasters entered the port of Chester. (Statistics furnished by Mr. L Hughes, Collector of Customs, Connah's Quay.) Chief Facts reported. — Inspection of vessels under § 92, P. 11. A. carried out and results entered by I. of N. in a properly appointed Report Book. The P. S. A. have no isolation hospital of their own, but the Town Council contribute 50/. a year towards the establishment charges of the fever wards of Chester City Infirmary, and have the right of admission for all cases of infectious disease, including cholera. There is, however, no efficient provision belonging either to the 11. S. A. or the city infirmary for purposes of disinfection of clothing, bedding and the like. The Customs boarding station for all vessels coming foreign and entering the Dee is at Mostyu in the Holyvvell R. S. D., 20 miles below Chester and for coasters, at their destination, those for Chester at Saltney Wharf. The mooring station for Chester in the event of infection breaking out on board ship after arrival at Saltney Wharf is the Cheese Stage on the opposite or north bank of the Dee. 171 App. No. 9 (a) The M. O. H. is acquainted with his duties under the Cholera Regulations, and is prepared to carry them out. Temporary Port Sanitary Districts. B 7. Colchester (Colchester Division) (Essex) P. S. D. — Dr. Airy. This district includes with the Colchester U. S. D., the Riparian Districts of Tendring Rural and Lexden & Winstree Rural. Port Sanitary Authority. — Colchester Town Council. Cost of Administration. — Defrayed by the Port Sanitary Authority, without contribution from the Riparian Districts, except in respect of hospital expenses. Port M. 0. Health. — Mr. W. S. Ling, of Brightlingsea, receiving a salaiy of 10/. a year and extra fees for visits of inspection. Port I. Nuisances. — Mr. J. Ames, with a salary of 20/. a year. Shipping Trade. — Chiefly with the Baltic, a little with the North of France. Yacht communication with Cherbourg, Boulogne, &c. No trade with Spain or the Mediterranean. During the year 1884, 101 vessels from foreign and 2,244 coasters entered this Port of Colchester. Chief Facts reported. — Inspection of vessels under the P. H. A., § 92, is carried out by the I. of N. The M. O. 11. only visits vessels reported to him as having sickness on board. In 1884 only one vessel was inspected by him. The P. S. A. have a floating hospital, a barge on which a 3-bedded ward is erected, with a small cabin for the nurse. It is moored in the river off Brightlingsea, and kept ready for use. Water would it is said be brought by boat from Colchester. The Urban Authority have a separate isolation hospital near the town. The boarding station is off Brightlingsea, not far above the floating hospital, 9 miles below Colchester. Satisfactory arrangements have been made with the Customs Authorities. An infected vessel would be anchored not far below the hospital barge, out of the fairway. The M. O. H. is prepared to carry out his duties under the Cholera Regulations. Cholera patients would be taken to the floating hospital. B 8. Colchester (Maldon Division) (Essex) P. S. D. — Dr. Airy. This Port Sanitary District includes with the Maldon U. S. D. part of the Maldon Rural District. Port Sanitary Authority. — Maldon Town Council Cost of Administration. — Defrayed by the Port Sanitary Authority. Port M. 0. Health.— Dr. E. P. Gutteridge of Maldon, with a salary of 10/. a year. Dr. Gutteridge is also M. 0. H. for the Urban District. Port I. Nuisances. — Mr. A. Mac Nab, with a salary of 25/. a year. Shipping Trade. — Chiefly with Baltic ports, for timber and grain, a little with Holland and Belgium; two or three vessels from Guernsey, with granite. During the year 1884, 10 vessels from foreign ports, and 1,123 coasters entered this port of Maldon. Chief Facts reported. — Inspection of shipping under the P. H. A., § 92, is well carried out by the I. of N., aided by the coastguard. The M. O. H. visits any vessels reported to him by the 1. of N. In 1884, 1,101 vessels were inspected by the I. of N. The Authority 172 have no isolation hospital. They rely on being able, in case of need, to procure and erect a hospital tent on some pasture land near the river, about a mile below the town. Water would need to be taken in cask from Maldon. The Customs boarding station is off Stansgate, about six miles below Maldon. Satisfactory arrangements have been made with the Customs Authorities. Infected vessels would be anchored just below the boarding station. The M. O. H. is prepared to carry out his duties under the Cholera Regulations. In default of any isolation hospital, the S. A. could only make some extempore arrangement for the reception of cholera cases. App. No. 9 (a) Temporary Port Sanitary Districts. B. 9. Cowes* (Isle of Wight) P. S. D.— Dr. Blaxall. This district comprises East Cowes, Newport, and West Cowes Urban, and part of the Isle of Wight Rural, Sanitary Districts. Port Sanitary Authority. — At date of inspection West Cowes Local Board. Port M. 0. Health.— Dr. Hoffmeister the M. O. H. of the West Cowes Urban District. No provision made to secure the systematic performance of the duties appertaining to the office, payment to be by fees for boarding vessels reported by the Customs to have sickness on board. Port I. Nuisances. — Mr. Sergeant, the Urban I. of N. No special remuneration for carrying out the port duties, but told to consider 10/. of his salary as Urban Inspector as payment for the same. Shipping Trade. — Principally with Havre, Rouen, and the German and Scandinavian ports. Many small vessels go up the River Medina for cement. During the year 1884, 219 vessels from foreign and colonial ports, including yachts, callers for coal, &c., and 4,141 coasters entered the port. These coasters include the daily packets from Portsmouth and Southampton. Chief Facts reported. — No inspection of vessels under P. H. A., § 92. No infectious hospital provisions for either Port or Urban Sanitary District. A mooring station appointed for infected vessels. M. O. H. acquainted with the requirements of the Cholera Regulations ; but in the existing want of means of isolation ready at command, this port authority is quite unprepared to deal with cholera cases should they arrive in any vessel. Authority advised to join with other Solent Authorities in making suitable hospital provision, but declined to do so. B. 10. Dartmouth (Devon) P. S. D.— Dr. D. S. Davies This district includes Dartmouth Urban and Totnes Rural Sanitary Districts. Port Sanitary Authority. — Town Council of Dartmouth. Shipping Trade. — Timber from the Baltic ; grain from the Black Sea ; steamers from India, via. Suez ; trade with the French and German ports; and some American and Canadian traffic. Forty vessels from foreign ports and 1,088 coasters entered port during 1884. Many vessels call at the coal hulks. From five to six hundred vessels thus frequent the port during the year. * This has recently heen constituted a permanent Port District ; the P. S. A. consisting of members of the several Sanitary Authorities, whose districts, or parts, of them, are included in the port. 173 Apr. No. t) («) Chief Facts reported.— The Port M. O. is Health Officer of the Urban District. The town surveyor acts as I. of N. for the U. S. D., and also the P. S. D. Systematic inspection of shipping is not carried out under §92 of P. H. A. Under the circumstances I advised the appointment of an inspector able to devote time to this duty. Hospital Accommodation. — There is no proper hospital accom* modation for infectious diseases occurring in the town or port. The M. O. H. previously undertook to provide this for port purposes in a house in the town. The Authority appears willing to provide the necessary accommodation, but cannot obtain a site. The proper course appears to be to obtain a floating hospital, and this I recommend strongly to the Authority. Execution of Cholera Order. — The boarding station and anchorage for infected vessels arc fixed, and the Customs and S. A. are prepared to co-operate in carrying out the provisions of the Order. Temporary Port Sanitary Districts. 13 11. Dover (Kent), comprising Dover, Walmer, and Deal, P. S. D. — Dr. D. S. Davies. Port Sanitary Administration. — Carried out by the Town Council of Deal in combination with the Local Board of Walmer. The Urban Officers at Deal and x Dover perform the duties under the Public Health Act and Cholera Order. Shipping Trade. — At Dover the chief trade is frequent and extensive passenger traffic with France and Belgium. In addition 40 to 60 Baltic timber ships visit the port in the year. There is also some Black Sea, Mediterranean, and Egyptian trade. There is no shipping trade at Deal ; boats only can land here ; but the Deal boatmen hold freqtient communication with vessels in the Downs. Chief Facts reported. — Systematic inspection of vessels has not been carried out here. At Dover the urban M. O. H. is prepared to carry out the provisions of the Cholera Order upon receiving notice, which is arranged for, from the Customs Officer. Should the M. O. H. be unavoidably absent, arrangements have been made to prevent delay in examining vessels. Hospital provision for port sanitary purposes is provided by arrangement with Dr. Astley, who has established a hospital for infectious diseases at Dover: any required extension would be met by erecting tents. [The superintendent of the passenger traffic has issued special directions to the captains of passenger steamboats to be on the watch for suspicious cases. Should any case of disease be received on board it would be isolated in a deck house, and on arrival the vessel would be dealt with under the Order.] A cottage has been provided at Deal for use as a hospital in case of need, and all necessary precautions would be taken. B. 12. Exeter (Devon) P. S. D.— Dr. D. S. Davies This district includes Exeter, Exmouth, and St. Thomas, Urban, and Newton Abbott, and St. Thomas, Rural, Sanitary Districts. The port extends from Exeter Bridge to the Cheekstone Eock, near Exmouth. But only vessels of less than 300 tons burden can proceed up river to Exeter ; larger vessels discharge in the bight off Exmouth into lighters. 174 App. No. 9 (a) Temporary Port Sanita Districts. Port Sanitary Authority. — The Port M. O. H. lives in Exeter. The Port I. of N. is harbour-muster atExmouth; he on discovering or receiving notice of infectious disease on board ship communicates with the M. O. 11. The M. O. H. is aware of the provisions of the Cholera Order, and is prepared to carry them out. Shipping Trade. — Chiefly with the Baltic, America, and French Ports. There is no Mediterranean or Black Sea trade. During the year 1884, 78 vessels from foreign ports, and 793 coasters entered the port. Chief Facts reported No hospital accommodation available for cholera ; accommodation for other infectious diseases at the Sanatorium of the U. S. D., 10 miles distant from Exmouth. Systematic inspection of vessels is not carried out ; but the Port I. of N. has hitherto carefully watched for disease on board of vessels. I pointed out the requirements of the P. 11 . A., § 92. The Port M. O. 11. is paid by fee, and is apparently not expected to take part in any sanitary action unless summoned to the assistance of the Port I. of N. I! 13. Falmoutii and Truro (Cornwall) P. S. D. — Dr. D. S. Davies. This district includes Falmouth Borough, Falmouth Local Board, Penryn, and Truro Urban ; and Falmouth, and Truro Rural, Sanitary Districts. Port Sanitary Authority. — Is a joint Board. Port M. 0. Health. — The Port M. O. 11. holds similar position in the Falmouth Urban Districts. The Port I. of N. is only paid for part time service, and has no special facilities afforded him for visiting the ships in this extensive harbour ; hence inspection under P. H. A., § 92 is not carried out. Trade of the Port. — Includes regular traders with Spain in oxen, traders with France and Brittany, some grain boats from the Black Sea, timber ships from the Baltic, and some Mediterranean trade. Falmouth is also a much frequented port of call, as many as 1,900 callers arriving during the year. Port Hospital Accommodation. — A small wooden building of two wards, each with 1,620 feet cubic air space, is provided in a good open situation a short distance from the town. Seven small-pox patients have recently been trealed in these wards. As infectious disease is often introduced into this port on board ship, provision of more ample hospital accommodation is needed ; hitherto the Port M. O. 11. has by prompt action succeeded in preventing infectious disease imported in ships from getting introduced into the town. Chief Facts reported. — The Customs boarding station is at any convenient spot in the harbour ; it appears that bumboats occasionally communicate with incoming vessels before they have been boarded by the Customs in spite of care taken to prevent them. The anchorage ground for infected vessels is in St. Just's Pool, and the Customs arrangements with the S. A. appear to be satisfactory. The M. 0. H. understands, and will carry out the provisions of the Order. The M.^O. H. is expected by the Port S. A. to attend all patients in the Port isolation hospital. B. 14. Faversham (Kent) P. S. D. — Dr. de Chaumont. App. No. 9 (a) This district includes the Kiparian Districts of Faversham Urban, Temporary and Faversham and Sheppey Rural. SS2M£ Port Sanitary Authority. — Faversham Improvement Com- missioners. Cost of Administration.- — Defrayed by contributions from the several Authorities concerned. Port M. 0. Health. — Mr. J. Irvine Boswell, who is also M. O. H. of the Urban District of Faversham. Port I. Nuisances — Mr. Monger, who does not hold a similar appointment in the Urban District. Shipping Trade. — Principally with the Baltic. 112 vessels from foreign ports, and 7,972 coasters entered the port during the year 1884. The trade is limited to small craft by the shallowness of the Avater of the port. Chief Facts reported. — Inspection of vessels is carried out. IS either the Urban nor Port S. A. possess an isolation hospital. Arrangements have been made with the Customs for carrying out the Cholera Regulations. B. 15. Fleetwood (Lancashire) P. S. D. — Dr. Blaxall. This district includes, with the Fleetwood Urban, the Fylde and Garstang Rural Sanitary Districts. Port Sanitary Authority. — Fleetwood Improvement Commissioners. Port M. 0. Health, and I. Nuisances. — Dr. Fassett, M. O. H., and Mr. Gantler I. of N. of the Urban District, are required to carry out the Port duties. Shipping Trade. — With San Francisco, Valparaiso, Canada, United States, Spain, Portugal, West Indies, &c. During 1884, 143 vessels from foreign and colonial ports, and 1,196 coasters entered this Port. Chief Facts reported. — Since the Port Medical Survey of 18S4 inspection of vessels under P. 11. A., § 92 has been carried out, also arrangements have been made between the Customs, and the P. S. A. for appointing a mooring station ; and the M. O. H. has made himself acquainted with the requirements of the Cholera Regulations. The Port Sanitary Authority have no means of isolation of infectious cases, nor have the Urban Sanitary Authority. B. 16. Gloucester, Gloucester Division P. S. D. — Dr. Blaxall. This district comprises Gloucester Urban, and Dursley, Gloucester, Thornbury, and W T heatenhurst Rural Sanitary Districts. The docks at Gloucester and at Sharpness, together with several miles of ship-canal are included in this P. S. D. Port Sanitary Authority. — Gloucester Town Council, who have hitherto defrayed the cost of administration, but who have recently applied to the Board to call upon the other Riparian Authorities to contribute. Port M. O. Health.— Dr. Wilton, the M. O. H. of the Urban District, is appointed to carry out the Port duties. Port I. Nuisances. — No officer appointed for the Gloucester section of the district, but the Dock-master is appointed I. of N o for Sharpness section. 176 App. No. 9 (a) Temporary Port Sanitary Districts. Shipping Trade. — Baltic, America, Black Sea, Australia. Small craft from Nantes and other French ports. In 1884, 325 vessels arrived from foreign, and 4,295 coasters. Chief Facts reported. — Inspection of vessels (P. H. A., § 92) has not been carried out, but the I. of N. at Sharpness is an intelligent man and promises to comply with the requirements of this section in future. Pilots are instructed to make special inquiry as to the health of vessels on arrival, and to signalise by means of flags whether they come from infected ports, and whether sickness be present on board. In the event of sickness being present the vessel is to be brought up in the Kingroad, to be there boarded by the Customs Officer of Bristol, who would report the circumstance to the P. S. A. of Bristol, who would then take the necessary action to prevent the introduction of disease into this country. But, should an infected vessel reach Sharpness Dock she would have to remain there awhile since the rapid ebb of the tide would not admit of her egress. In this case immediate information of the arrival of the vessel Avould be sent to the Port M. O. H. who is well acquainted with the requirements of the Cholera Regulations. The authority have no means of isolation. It was proposed to erect an isolation hospital on a particular site, but, having in pursuance of instructions examined the site and found it unsuitable I advised that the Port and Urban Authorities should amalgamate for the purpose of providing elsewhere a suitable permanent hospital ; and that mean- Avhile temporary provision for cholera cases should be made by the P. S. A. in the way of tents or huts. This latter recommendation has been acted upon. B 17. Gloucester — Chepstow Division (Monmouthshire) P. S. D. — Dr. Blaxall. This district comprises the Chepstow Urban and Rural Sanitaiy Districts. Port Sanitary Authority . — Chepstow U. S. A. Port M. 0. Health.— Mr. King M. O. H. for the Urban District. Port I. Nuisances. — Mr. Thorn I. of N. for the Urban District. These officers receive no special remuneration for Port Duties. Shipping Trade. — Little or no foreign trade ; one vessel only having arrived (from Baltic) during the last two years. The coasting trade is limited to a few colliers from Cardiff, grain barges from Bristol, and an occasional vessel from Plymouth. Chief Facts reported. — No inspection of vessels under P. H. A., § 92. The Authority do not possess means of isolation of infectious disease, beyond some temporary provision of a very unsatisfactory character recently made for the reception of small-pox cases, which disease was epidemic in the town at the time of this inquiry. No Customs Officer is stationed at Chepstow. I explained to the Authority the duties required of them under the P. H. A. and the Cholera Regulations ; and I further, pointed out to the M. O. H. that the fact of there being no Customs Officer at Chepstow rendered it the more incumbent upon him to be on the alert to board any vessel from foreign, that might arrive. 177 App. No. 9 (a) B. 18. Hull (Yorks) P. S. D.— Du. Blaxall. Temporary This comprises the Hull Urban Sanitary District alone. Pnvt Sanitary Districts. Port Sanitary Authority. — Hull Town Council. Port 31. O. Health.— Dr. Mason the Health Officer of Hull Urban District. Port I. Nuisances. — A Port I. of N. has been appointed, and also an Assistant I. of N. who is a manner. Shipping Trade. — With Denmark, Sweden, Germany, France, Alexandria, Odessa, India. Weekly traffic between Hull, Gottenburg, Hamburgh, and Antwerp, brings over a number of transmigrants*, from various parts of the Continent en route, via Hull anil Liverpool, for the United States, Canada, and other parts. 2,770 vessels from foreign and colonial ports, and 1,834 coasters entered this port in 1884. Chief Facts reported. — Inspection of vessels under 1\ 11. A., § 92 is undertaken; thus, out of a total of 4,601 vessels that entered this port in 1884, 2,346 were inspected. Steamers engaged in passenger (transmigrants) traffic are boarded by the Port I. of N., as they come up the river. P. S. A. do not possess an isolation hospital. Port cases of inFectious sickness are isolated in the Urban Sanitary Hospital, -which is situated by the "waterside, convenient for the purpose. The Customs Authority and the Port M. O. H. are fully acquainted with the Cholera Regulations ; but the altitude assumed by the P. S. A. in regard to the duties required of them under the said Regulations is both unsatisfactory and embarrassing. This Authority have refused to recognise their responsibility in regard to cholera cases that may be found in vessels bound for Goole, which vessels would, seeing that the Customs' boarding station for all vessels bound up the Humber is in Hull waters, be rightly reported by the Customs' officer to the Hull P. S. A. Moreover, this Authority have purposely avoided, appointing a mooring station. With a view, if possible, to reconcile differences of this sort, I met in conference the Hull Port Sanitary Committee and representatives of the Goole Authority, and suggested that the Hull P. S. A. should carry out the measures required by the Cholera Regulations for the prevention of the introduction and spread of disease in respect of vessels bound for Goole, as well as of those bound for Hull, and that Goole should bear its own share of the expenses so incurred. This proposition was fully discussed and agreed upon, but the Town Council refused to ratify the recommendation of their own Port Sanitary Committee. The Board hereupon instituted a public inquiry with a view of constituting these S. A's a joint P. S. A. B. 19. Ipswich (Suffolk) P. S. D.—Dn. Airy This Port Sanitary District includes with the Ipswich U. S. D, parts of the Riparian Districts of Satnford Rural and Woodbridge Rural, on opposite sides of the River Orwell. llt perVaps deserves mention that the co-operation of the shipping firm chiefly ged in the transmigrant traffic, and the railway station-muster at Hull, in dealing this class of people, has been promised to the Port Sanitary Authority ; the er undertaking to instruct their officers and stewards to keep the passengers r supervision during their passage from the continent to this country ; ihe latter lising to have the closets at the stations used by transmigrants to be kept under ial disinfection. E 20510. M 178 APP.No.!) (a) Port Sanitary Authority. — Ipswich Town Council. Cost of Administration. — Defrayed by the P. S. A. alone ; the included Riparian Districts do not contribute. Temporary Port Sanitary Districts. Port M. 0. Health.— Mr. G. S. Elliston is M. O. H. for the borough and port, with a combined salary of 200/. Port I. Nuisances. — Mr. G. Moss is I. of N. for the Borough and Port, with a combined salary of 144/. Shipping Trade— Chiefly with Baltic ports; a little with France, Spain, the Mediterranean, and the Black Sea. During the year 1884, 145 vessels from foreign ports, and 2,904 coasters, entered the port of Ipswich. Chief Facts reported. — There is some inspection, occasional but not systematic, of vessels under the P. H. A., § 92. The M. 0. H. seldom acts except in cases where the Customs Officers report sickness on board ship. [I represented to the Authority the danger attending the use of impure water brought by vessels from foreign ports. Masters of vessels are not willing to clean out their watertanks.] The Urban Sanitary Authority have a very good, newlybuilt hospital for infectious diseases, consisting of three pavilions of two wards each, connected by covered passages (open at the sides) with a central administrative block. This hospital is distant about H miles from the town, on high ground to the east. It has the town water laid on. Drainage dealt with by subsoil irrigation. Patients from on board ship might be conveyed to the hospital without passing through the town. Vessels bound for Ipswich are first boarded in Harwich harbour, at the mouth of the river, by the Harwich Customs Officer. Any case of cholera found on board should, according to the Board's Cholera Order, be in charge of the Harwich P. S. A., but the Harwich P. S.A. do not admit their responsibility in the cane of a vessel bound for Ipswich. If the vessel is allowed to proceed up the river, she takes a Harwich Customs Officer with her, who is cleared by an Ipswich Customs Officer coming on board, either at Butterman's Bay, six or seven miles below Ipswich, if the ship has to be lightered, or at the Ipswich Docks, if she can go right up. Satisfactory arrangements have been made with the Ipswich Customs Authorities. The appointed mooring place for infected vessels is at Levington Creek, about five miles below the town. The M. O. H. is acquainted with his duties under the Cholera Regulations, and prepared to carry them out. A wing of the Urban Sanitary Hospital is reserved for cholera cases, if needful. B. 20. Lancaster (Lancashire) P. S. D. — Dh. Blaxall This district includes Lancaster, and Poulton-Bare-and-Torrisholme Urban, and Lancaster Rural, Sanitary Districts. Port Sanitary Authority. — Lancaster Town Council, who at present defray the whole cost of administration, but inasmuch as the Glasson Dock (where the principal part of the shipping trade is carried on) is situated within the Rural Sanitary District, the Port Sanitary Authority have applied to the Local Government Board for the Rural Authority to be made contributory. Port M. 0. Health and I. Nuisances. — Mr. Harker, M. O. 11., and Mr. Smith, I. N. of the Urban District, are appointed respectively for the port duties, and are now paid by special salary, instead of by fee as was the case on my visit in 1884 to this port. 179 Shipping Trade. — With United States, Canada, Nova Scotia, Baltic, Hamburgh, and Spain. Thirty-one vessels from foreign and Colonial ports, and 227 coasters entered the harbour in 1884. A.rp. No.O (a) Temporary Vqrt Sanitary Districts. Chief Facts reported. — Since the above-named officers have been jaid by special salary, the duties of inspection (by P. 11. A., § 92) lave been carried out. The P. S. A. do not possess an isolation lospital ; but Port cases of infectious disease are isolated in the Jrban Sanitary Hospital, which is conveniently situated for the mrpose, being below the town and near the river. Cases of cholera n-ought in vessels could be isolated here ; but, as was pointed out, separate provision by means of tents or huts on the adjacent land would be a preferable course. Port M. O. H. is thoroughly acquainted with the Cholera Regulations, and due arrangements lave been made between the Customs and P. S. A. to give effect to he same. B 21. Lynn— King's Lynn Division (Norfolk) P. S. D.— Dr. Airy. This district includes, with the King's Lynn U. S. D., the Riparian District of Freebridge Lynn (Rural). (Inland water communication by the Rivers Ouse and Cam.) Port Sanitary Authority. — King's Lynn Town Council. Cost of Administration. — Defrayed by the Port Sanitary Authority. I Port M. O. Health.— Mr. S. W. W. Wilson, who is also M. O. H. or the Urban District, receives a fee of 10*. 6d. for each visit of nspection to a vessel reported to him by the Customs Officer or >y the I. of N. Port I. Nuisances. — Mr. J. Hall (I. of N. for the Urban District), without salary or fees. Shipping Trade. — Chiefly with Baltic ports, a little with France and Spain, the Mediterranean, Black Sea, and North and South America. During the year 1884, 246 vessels from foreign ports, and 671 coasters entered the port. Chief Facts reported. — There has been no systematic inspection of shipping under the P. H. A., § 92 ; but only of vessels reported by the Customs Officer as having sickness on board. Eight such vessels were visited by the M. O. H. in 1884. The authority have a small isolation hospital about half a mile outside the town, consisting of one room with three beds, and a kitchen which is also a nurse's room. It is kept ready for use. There io space for extension. A large marquee is kept in store. The boarding station is off the dock-entrance ; but vessels are met in the Roads by the Lynn pilots, who have orders not to bring into port any vessel with sickness on board, but to report such vessel to the Sanitary Authority. On information from the pilots, the M. O. H. communicates with the Customs Officers, who have orders from the Board of Trade in such case to send an officer with the M. O. 11. to board the vessel in the Roads. The M. O. H. is prepared to carry out his duties under the Cholera Regulations. The mooring place for an infected vessel is in the Roads, out of the direct line of traffic. The Authority had once a floating hospital, but it fell into disrepair, and has been abandoned. It would, however, be easy to renew this provision. At present the only means of isolation is the very insufficient accommodation described above. M 2 180 APi> No_o (a), -g 22. Lynn— Wells Division (Norfolk) P. S. D. (Part of the Customs Port of Lynn). — Dr. Airy. Temporary X Sanitary icts. This Port Sanitary District includes all the waters abutting upon the parish (Urban Sanitary District) of Wells-next- the-Sea. Port Sanitary Authority. — Wells Improvement Commissioners. Cost of Administration. — Def rayed by the Port Sanitary Authority. Port 31. O. Health. — F. Long, M.D., who has held office since August 1881. His salary is 51. a year. Port I. Nuisances. — The former officer has recently died, and the office was vacant at date of inspection. Salary 3/. a year. Shipping Trade. — Chiefly with Baltic ports, especially Riga and St. Petersburg; occasionally with Holland; rarely with France. During the year 1884, 10 vessels from foreign ports and 105 coasters entered the port. Chief Facts reported. — Inspection of vessels under § 92, P. H. A. is carried out in such cases as are thought to require it. Two vessels were inspected in 1884. On one of them Avas a case of diarrhoea, not choleraic, attributed to impure water. The Authority have no isolation hospital, but propose, in case of need, to obtain the use of a disused coast-guard house (with three beds) on the sand-hills east of the harbour 2 miles from the town ; or to moor a lighter in the lower part of the harbour (the " Run ") ; or to provide a tent hospital, to be erected on the sands on the east side of the harbour. Water would have to be specially conveyed to it from the town. The boarding station is at the Quay side. It is evidently important that vessels suspected of infection should be stopped before reaching the Quay. The Commissioners undertook to instruct the pilots and tug-master accordingly. The Port M. O. 11. is prepared to carry out his duties under the Board's Cholera Regulations, with regard to any infected vessel. The mooring station is in the lower part of the harbour (the " Run "). 3. 23. Newiiaven (Sussex) P. S. D.— Mr. Speak. This district includes so much of the port of Newhaven as abuts upon the Local Government District of Newhaven and the waters and places described in the Order of 16th May 1882. Port Sanitary Authority. — Newhaven Local Board. (7 t/ Cost of Administration. — Defrayed by P. S. A Port M. O. Health.— Dv. G. F. Fussell (M. O. H., East Sussex Combination); residence, Brighton. Salary 10/. S. A. propose to appoint a deputy M. O. 11. living on the spot. Port I. Nuisances. — Mr. Quaif'e, I. of N., Urban Sanitary District. Shipping Trade. — With Dieppe, Honfleur, St. Nazaire (Brittany), and the Baltic. From Dieppe two packets per diem regularly ; from Honfleur, one or two cargo boats per diem ; from St. Na*,aire y two steamboats weekly ; a very irregular trade with the Baltic. Considerable coasting trade also. Gross amount of shipping, 1883. — Passenger .ships, 1,095; cargo boats, 1,069; Foreign, (i.e., boats registered abroad), 50. Chief Facts reported. — Inspection of vessels carried out under § 92 of P. 11. Act, 1875. A place appointed for boarding of vessels, and a verbal understanding as to Ihe mooring of infected ships. A small hospital — at an old mill buildin«", offering very Blight accommodation, and very ill-provided — in the hands of Apr. No. y.(«) he Urban Sanitary Authority, it is thought might be made use Temporary of for cases of cholera brought by ship. It is situated three- }\9 r } Sanitary n ? „ iii i • i ¦• i Districts. quarters or a mile from the harbour, and is approached by a lifficult ascent. Hand stretchers would be available. The Authority have hitherto failed to find a more convenient site for a lospital building. The Cholera Regulations were fully discussed vith the Authority, the Sanitary Officers, the Chief Officers of Customs, and the Harbour-master ; the Regulations appear to be understood. B. 24. New Siioukiiam (Sussex) P. S. D.— Mr. Speah. This district includes the Riparian Districts of Steyning Rural (four parishes of) and New Shoreham Urban. (Port Sanitary Authority. — " The Guardians acting as a Rural anitary Authority." (The representatives of the Urban Authority :'e excluded). of Administration. — Defrayed by both Sanitary Authorities, ew Shoreham paying about one fifth of the whole. Port M. O. Health. — N. 11. Jarvis, salary 15/. per annum (a medical practitioner residing at Southwick). Port I. Nuisances. — T. F. Gates, 10/. per annum (I. of N. in the Steyning Rural Sanitary District.) Shipping Trade. — With the Baltic, Northern Ports of France, Channel Islands, Spain, British trade. In 1884 vessels from abroad, 286 ; coastwise, 337. I Chief Facts reported. — A place, somewhat difficult of access, ppointed by the Customs Authorities for the mooring of inscted ships. No hospital available for isolation. M. O. H. irepared to visit ships whenever requested ; no inspection of essels under § 92, P. H. Act. I Duties fully explained to Authority and Officers. M. O. H. mder takes to visit all ships from infected ports, or otherwise when teemst [¦eems desirable. I. of N. to inspect all vessels from time to ime. B. 25. Penzance, including Haylb (Cornwall). — Dk. D. S. Davies. Administration. — Penzance, by the Town Council ; Hayle, by the Hayle Local Board. i Shipping Trade. — (A. Penzance.) Timber from the Baltic, grain om New York ; some French, but no Spanish trade ; boats om the Mediterranean are mostly callers. There is some Channel sland trade, and considerable home coasting traffic ; about 3 foreign vessels arrive with cargoes in the year. I Shipping Trade. — (B. Hayle.) Some timber trade with Norway, rain ships from Kronstadt, and an occasional vessel from France r Spain. There is no Mediterranean trade. Inspection of Vessels under § 92, P. H. Act — At Penzance, ships are inspected systematically. At Hayle, there appears to be no Port I. of N., but the Harbour-master calls in the aid of the M. 0. IT. when he thinks it necessary. Arrangements made under the Cholera Order. — (A. Penzance.) The Customs' Officer is prepared to detain vessels and to give the notice required by the Order, and the M. O. 11. is acquainted with 182 and prepared to carry out the provisions of the Order. The anchorage ground is fixed in " Gwavas Lake." APP. No. y (a) Temporary (13. Hayle.) The anchorage ground is fixed at the " Dynamite Station." ' The arrangements as to execution of the Order are all understood. B Sanitary icts. Hospital Accommodation.— (A. Penzance.) There is a hospital available for Urban and Port purposes near the outskirts of the town, but this would not be used for cholera. A new hospital is contemplated, pending the completion of which temporary accommodation would be needed. (13. Hayle.) Hospital accommodation is as yet only under consideration, and it is proposed to unite with Phillack U.S.D. B. 2G. Poole (Dorsetshire) P. S. D.— Dr. D. S. Davies. This district includes Poole, Swanage, and Wareham Urban ; and Poole, Wareham, and Purbeck Rural, Sanitary Districts. Port Sanitary Authority. — The Town Council of Poole Port M. 0. Health.— My. 11. A. Lawton, who does not hold an} other appointment under P. 11. A. Port I. of Nuisances. — Mr. J. Elford, Surveyor for the Poole U. S. I). Shipping Trade. — Timber vessels from the Baltic, and some trade with France and the Channel Islands. No Mediterranean trade. There is considerable coasting trade with the Northern English and the South Wales Ports, Chief Facts reported. — The systematic inspection of vessels under § 92, P. 11. A. is satisfactorily carried out; care is taken to obtain information of any infectious disease arriving on board ship. The arrangements for carrying out the Cholera Order are made, and will be acted upon. There is hospital accommodation for infectious cases of permanent kind for seven patients, Avell situated and adapted for isolating cases of one disease ; a mortuary is needed for this hospital ; a boat with a canvas covering is provided for removal of patients from ship to hospital. B. 28. Portsmouth (Hants) P. S. D. — Dr.. Blaxall This district includes the Portsmouth, Alverstoke, and Fareham Urban, and the Fareham Rural, Sanitary Districts. Port Sanitary Authority. — Portsmouth Towr Council Port 31. O. lie alth.— Dr. Sykes, M. 0. H. of the Portsmouth Urban District. Port I. Nuisances. ~ The Harbour-master. Shipping Trade. — With Corunna, Brest, Cherbourg, Baltic, &c. During the year 1884, 348 vessels arrived in the port from foreign and colonial ports, and 1,743 coasters. Chief Facts reported. — No inspection of vessels under P. 11. A., § 92. Prompt detection on certain occasions of infectious disease on board coasters by the Port I. of N. Boarding station inside the harbour. Mooring station at Spithead for large ships only, no arrangement made in respect of small vessels. Port M. O. H. is acquainted with the requirements of the Cholera Regulalations. No isolation hospital provided for the Port District. Port cases of infectious sickness received into the Urban Sanitary hospital. Urban Sanitary hospital unfit, by reason of its situation, for the reception of cholera cases from shipboard. It was suggested to this P. S. A. authority that they should amalgamate with the other authorities of the Solent, and make application to the Apr. No. 9 (a) Admiralty for the loan of the "Edgar" (quarantine hulk at the Temporary motherbank) already fitted up for the purpose of an isolation Port Sanitary hospital. Application was accordingly made, but the Admiralty Dlstncts Dlstnctsdeclined to lend the hulk though they offered to sell her. The Port S. A. are not disposed to purchase, and so the matter fell through. Meanwhile the frequent arrival home of troopships direct from India somewhat exposes Portsmouth to the danger of introduction of cholera. But at Portsmouth there exists no sanitary hospital for the reception of cholera cases. B. 29. Preston (Lancashire) P. S. D. — Dn. Blaxali The so-called Port Sanitary District of Preston is confined to the water of the town of Lytham. Port Sanitary Authority. — Urban Sanitary Authority of Lytham. . Port M. O. Health. — The Urban M. O. 11. nominally carries out the health duties of the Port. Shipping Trade. — Small trade with Norway. In 1884, three vessels from Norway and 178 coasters. Lytham itself has no shipping-trade, but vessels pass up to the town of Preston, either through the Port Sanitary District of Preston or, avoiding this, up the south side of the river. New docks in process of construction at Preston are to be completed in three or four years, when a great increase in the shipping trade is expected. Chief Fads reported. — Vessels never stay within the limits of the Port Sanitary District, but pass up to Preston, where there is a quay appointed for the discharge of cargo. No boarding station, and no Customs Officer until Preston be reached. The M. O. 11. has made himself acquainted with the Cholera Regulations. The constitution of the P. S. A. and boundaries of the district require amendment. B. 30. Rochester (Kent) P. S. D. — Du. de Chaumont. This District includes the Riparian Districts of Rochester, Chatham, and Gillingham Urban. 1100, Mailing, Medway, Milton and North Aylesford Rural. Port Sanitary Authority. — Town Council of Rochester. Cost of Administration. — Defrayed by contribution from the several Riparian Authorities. Port M. 0. Health.— Dr. Knight, who is also Urban M. 0. 11. Port I. of Nuisances. — Two inspectors are employed for port purposes. Shipping Trade. — Chiefly with Riga, Stockholme, Archangel, occasional vessels from Spain and Black Sea. During the year 1884, 392 vessels from foreign and 4,827 coasters entered the port. Chief Facts reported. — Inspection of vessels under P. 11. A., §92 carried out. The authority do not possess an isolation hospital. Vessels from foreign or colonial ports bound for Rochester, are on arrival at the mouth of the Medway, boarded by the Customs within the jurisdiction of the P. S. A. of London, which authority undertakes the isolation and care of cases of cholera or other infectious disease discovered on board. 184 B. 31. Southampton (Hants) P. S. D. — Dr. Blaxall. Apr. No. 9 (a.) This district includes Southampton, and Shirley-with-Freemantle Urban, and New Forest and South Stonehain Rural, Sanitary Districts. Temporary Sanitary ricts. Port Sanitary Authority. — Town Council Southampton. Port M. 0. Health. — Dr. Mope, recently appointed. He is not the M. O. H. of the Urban District, Port I. of Nuisances. — Mr. Cox, appointed Port I. of N. Shipping Trade.—- Chiefly with Brazil, West Indies, Havre, Honfleur, Cherbourg, St. Malo, Channel Islands, etc. During 1884, 1,817 vessels from Foreign and Colonial ports, and 7,919 coasters entered this port. Chief Facts reported. — Inspection of vessels under P. H. A., § 92 carried out. The P. S. A. have no isolation hospital of their own, but make use of the Urban Sanitary Hospital when requiring to isolate cases. Satisfactory arrangements made between the Customs and the P. S. A. for giving effect to the Cholera Regulations. The boarding station for large ships is about 1^ miles down the river, but boats from Havre, St. Malo, etc. enter the docks before being boarded by the Customs. In the event of cholera spreading to any of the above-named ports, the Customs have authorised the boats arriving from thence to be boarded before they are allowed to enter the docks. The Urban Sanitary Hospital is not adapted for the reception of ship-borne cholera, and iv the absence of any suitable provision for the isolation of such cases, it was suggested to the P. S. A. that they should unite with other of the Port and Riparian Authorities of the Solent in making application to the Admiralty for the loan of H.M.S. " Edgar " (part of the quarantine establishment at the motherbank) lor the purpose. The suggestion, however, was not acted upon. This Authority under the discretionary power granted to the Local Authorities by the Rag Order of 1884, has freely permitted the importation of rags from infected countries ; even from Havre, when cholera was present at Yport, only a few miles distant. Indeed, so little restriction has this Authority placed upon the rag trade during the prevalence of cholera on the Continent, that the importation of rags into Southampton greatly increased at the very period during which at other home ports, where due precautions against the introduction of infectious disease by this means were being observed, the rag-trade almost entirely ceased. B. 32. Swansea (Glamorganshire) P. S. D. — Dk. Ballard. This Port Sanitary District includes the Urban Districts of Swansea, Aberafon, Neath, Forthcawl, Margam and Oystermouth, and the Rural Districts of Bridgend, Cowbridge, and Swansea. Port Sanitary Authority. — The Town Council of Swansea Cost of Administration. — The Urban Districts contribute in proportion to their several rateable values. The Rural Districts contribute in proportion to the rateable values of such of the contributory places within them as abut upon that part of the Customs Port which is within the jurisdiction of the Port Sanitary Authority. Port M. 0. Health.— Mr. Ebenezer Davies, M. O. H. of Swansea U. S. D., assisted by Dr. James Svmes, M. O. H. of 185 Briton Ferry TJ. S. D., Dr. D. Davies, M. 0. H. of Aberafon Apr. No. o (a) U. S. D., Dr. James of Porthcawl, Dr. Ryding, M. O. H. of Neath Tern )0 ~, U. 8. D. The Health Officers are paid by fee of 1/. I*. for each Port Sanitary visit made. Districts. Port I. of Nuisances. — Two Inspectors at Swansea specially appointed for port purposes, assisted by an acting I. of N. at Port Talbot, at Briton Ferry, and at Porthcawl. All paid by salary. Shipping Trade. — With Baltic and Scandinavian ports generally, with northern ports of France and Spain, with European Asiatic and African ports of the Mediterranean, and with North and South American ports. During 188-1, 7,651 vessels entered the port, viz: 1,851 foreign and 5,760 coasters. Chief Facts reported. — Hospital provision of huts and tents sufficient, and held in readiness. The ordinary boarding stations ;ire : — At Swansea, in basin just outside dock gates and at entrance to river. At Briton Ferry, outside entrance to dock. At Port Talbot, the extreme western part of float. At Porthcawl, between the buoys in the dock. For giving effect to Cholera Regulations, pilots are instructed to bring up at Mumbles Point in the outer roads all vessels with cholera on board or suspected of having cholera, as well as vessels from ports infected by cholera. The Port M. O. H. and I. of N. carry out their duties under the Cholera Order satisfactorily. B. 33. Teignmouth (Devonshire) P. S. D.— Dr. D. S. Davies. This district includes Teignmouth Urban, and Newton Abbot Rural, Sanitary Districts. Administration of the P. S. D. — By the Teignmouth Urban Sanitary Authority, the Port M. O. H. and I. of N. hold similar positions in the Urban District. Shipping Trade. — Timber from the Baltic, occasional rags from the Russian ports (none in 1884), a few French traders, and some trade with the Channel Islands and the Mediterranean. Also a large coasting trade in coal with South Wales and the Northern English ports. Chief Facts reported. — Inspection of vessels under § 92, P. H. A. systematically carried out, and attended by satisfactory results. Anchorage ground for infected vessels, and arrangements for notification under Cholera Order satisfactory. The Port M. O. H. is acquainted with the provisions of the Order and prepared to carry them out. Hospital Provision. — The building formerly intended for use as a cholera hospital has been devoted to other purposes, and no means of isolation for cholera are now available. The Urban Sanitary Hospital is quite unfit in position, construction, and accommodation for use as an isolation hospital. On an emergency cholera tents would need to be provided. B. 34. Workington (Cumberland) P. S. D. — Dr. Blaxall This district includes Workington Urban, and Cockermouth Rural, Sanitary Districts. Port Sanitary Authority. — Workington Local Board constituted P. S. A. March 1885 in place of the Cockermouth Rural Sanitary Authority. 186 Cost of Administration. — Defrayed by the Workington Local Board, and by the Cockermouth Rural Sanitary Authority which contributes in proportion to its rateable value. Apr. No. 9 (a) Temporary Port Sanitary Districts. Port M. O. Health. — The recently constituted P. S. A. had not, at the time of this inquiry, appointed a Health Officer for the Port. They v had advertised for one on a salary of 51. per annum, but had received no applications for the appointment as might be expected with promise of such small remuneration. Inspector of Nuisances. — This officer had resigned shortly before this inquiry. He was reported to have inspected some 600 vessels (P. H. A., § 92), and to have found them in a fairly sanitary condition. Shipping Trade. — Principally with Spain (iron ore). Depression in the iron market has caused a sensible decline in the shipping trade. The number of vessels arriving from foreign ports fell from 109 vessels in the year 1882 to 34 in 1884. The coastwisevessels that entered this port in 1881 numbered 1662. Chief Facts reported. — No Port isolation hospital. The hospital belonging to the Urban Authority very inefficient and not suitable for the reception of cholera cases from shipboard. The Customs boarding station is situated at the docks or at the mouth of the river. No satisfactory arrangements yet made as to mooring station. Anchorage off the harbour exposed. The Collector of Customs attended at the conference I had with the P. S. A., when it was arranged that small vessels should be moored inside and large vessels outside the harbour, and that in the event of threatening weather captains should be at liberty to run elsewhere for shelter, the Customs engaging to telegraph their destinations to the Sanitary Authorities concerned. A site was also selected whereon to make temporary hospital provision for cholera patients from shipboard. (C.) Riparian Districts. C. 1. Aberystwith (Cardiganshire). — Dr. D. S. Da vies. This Riparian District is under the jurisdiction of the Aberystwith Town Council acting as U. S. A. Districts Shipping Trade. — With the Baltic, America, Holland, France ; and a considerable coasting trade with Bristol, Liverpool, Newport (South Wales), and Llanelly. In 1884, 17 foreign and 227 coasting vessels arrived. Port M. O. 11. and I. of N.— The Urban Officers. Chief Facts reported. — Systematic inspection under P. 11. A., §92 has not been carried out. The S. A. have no sanitary hospital, but there is a building in their hands which could at small cost be converted into a temporary isolation hospital. The boarding station and anchorage for infected vessels are fixed, and arrangements made for notification to M. 0. 11., who is prepared to act. C. 2. Aldeburgh (Suffolk). — Dr. Airy. This Riparian District is under the jurisdiction of the Plomesgate R. S. A. (the Board of Guardians). It has only tAvo small landing places on its coast, Aldeburgh and Orford. Shipping Trade. — With the Baltic and France. During 1884, only one vessel from a foreign port, and 100 coasters, arrived. Chief Facts reported. — The R. S. A. have not had occasion to exercise any functions whatever in respect of the shipping coming under their jurisdiction. Inspection of vessels under the P. H. A., Afp. No. a (a) § 92, has not been curried out. The S. A. have no means of Riparian isolating infectious disease. No arrangements have been made I)istricts with the Customs Officers. The M. O. H. for the Eural District has no acquaintance with the details of his duties under the Board's Cholera Order. At an interview with the R. S. A. I urged the provision of meant- of isolation, and the adoption of all available precautions against cholera. The S. A. appointed a Committee to consider the question of isolation. [Since the date of my visit, the town of Aldeburgh has received a charter of incorporation, and has become an Urban Sanitary District, independent of the Plomesgate Rural Authority.] C. 3. Amlwcii (Anglesey). — Dr. D. S. Da vies The Port of Amlwch is under the jurisdiction of the Anglesey Rural S. A. Shipping Trade. — With Spain in copper ore, occasional French trade, coasting traffic in copper with Newcastle. In 1884, four foreign vessels arrived, and about 160 coasters. Chief Facts reported. — The systematic inspection of vessels is not carried out in accordance with § 92, P. H. A. Arrangements for carrying out the provisions of the Cholera Order have been made, and the Rural M. 0. H. is prepared to act. A cottage near Amlwch has been rented for hospital purposes by the R. S. A. It might be found difficult to provide nurses. C. 4. Bangor (Carnarvonshire) ; Beaumaris (Anglesey). — Dr. D. S. Davies. These two Urban Sanitary Districts are opposite one another on the Menai Strait, and are included in one Customs Port. Shipping Trade. — Almost entirely to Bangor. American vessels with timber ; a large outward slate trade, No French, Spanish, or Mediterranean trade. Administration is by the U. S. As. and their officers. The systematic inspection of vessels under § 92, P. 11. A. has not been carried out. Chief Facts reported. — The Customs Officer is stationed at 3angor, but the Customs boarding station ami the anchorage ground for infected vessels under the Cholera Order, are in the Jeaumaris District. The arrangements for notification and procedure under this Order appear to be understood. The Customs )fficer will notify to the Beaumaris Authority, Avho are the acting authority under the Order. Their M. 0. 11. lives in the north of Anglesey, so there is need of appointing a resident assistant medical man as M. O. 11. under the Order. There is no hospital accommolation at Beaumaris, but the Bangor S. A. have a hospital tent, vhich they would, it appears, be willing to lend. The condition of affairs here is unsatisfactory, and the constitution for port anitary purposes of a joint Board with equitable adjustment of expenses, would appear to be desirable. C. 5. Barrow-in-Furness (Lancashire). — Dr. Blaxall. The Riparian District of Barrow-in-Furness is under the jurisdiction of the Urban Sanitary Authority of Barrow-in-Furness. 188 Apr. No. 9 (a) Itipnriai Districts Shipping Trade. — With the Baltic, India, California, North America, Spain, the Mediterranean, Rotterdam, Antwerp. During the year 1884, 97 vessels from foreign and colonial ports and 1,835 coasters entered the port. Chief Facts reported. — The Urban Medical Officer of Health is required to carry out the health duties of the port in respect of any vessel reported to him to have infectious sickness on board. This officer has made himself acquainted with the requirements of the Cholera Regulations. The Urban Inspector of Nuisances has not received any special instructions with regard to vessels. No inspection of vessels under P. H. A., § 92, has been made. The Urban Authority possess a useful infectious hospital, but the situation of the building is inconvenient for the reception of cases of cholera from shipboard. The drainage goes into the town sewers. I advised the authority to provide suitable accommodation for this special purpose at Foulney Island, which is in the vicinity of the mooring station, and so, convenient for landing the cases. C. 6 Barxstaple and Bideford (Devonshire). — Dr. D. S. Davies As the boarding station off Appledore for vessels bound to Barnstaple (Barnstaple U. S. D.), Bideford (U. S. D.), Fremington (Barnstaple Rural S. D.), and all places within Barnstaple Bar is in the waters of the Northam U. S. D. ; the Northam U. S. Authority becomes responsible for carrying out the Cholera Order with respect to such vessels. As there is no constituted P. S. A. there are no contributing Authorities, so the expense would fall upon Northam. Shipping Trade. — During the year 11 foreign vessels and 1,878 coasting vessels came within the bar, bound to these various ports. M. O. Health and I. of Nuisances. — The M. 0. H. living at Bideford, and I. of N. living at Northam, would act as Riparian Officers. The Customs Officer at Appledore, within the Northam U. S. D., (where are the boarding station and anchorage ground) is prepared to communicate Avith the M. 0. H., who understands and will cany out the Order. There is no hospital accommodation although the Authority appear anxious to obtain one. In any emergency it is suggested to use an old barn on Northam Burrows. The road to this is bad, and the present building unsuitable, but it might serve for the commencement of an administrative block, or wards might be built out from it ; the space for extension is ample. C. 7. Berwick-upon-Tweed (Northumberland). — Dr. Page. This Riparian District is the Borough of Berwick-upon-Tweed, and is under the jurisdiction of its Sanitary Authority. Shipping Trade. — Chiefly with Baltic ports, but to a small extent with Spain, Belgium, and South America. During 1884, 98 vessels from foreign and 293 coasters entered the port. Chkf Facts reported. — No inspection of vessels under § 92, P. H. A. has been made. The M. O. H. is acquainted with his duties under the Cholera Regulations. The Customs boarding station is at the Carr Rock, a projecting point on the south, or Tweedinouth side of the estuary of the Tweed. As regards infected App. No. a (a) vessels, it was stated that infected persons would be removed to the Riparian*'"' Port isolation hospital, but that the infected vessel would be sent Districts. to the Firth of Forth or the Tyne for " purposes of detention and disinfection," I pointed out in my conference with representatives of the Sanitary Authority that it would be the duty of the Authority to see to the disinfection of vessels, and that it was clearly improper to allow a vessel to depart in a foul condition to other districts or ports. And I recommended that the Cholera Regulations should be stringently carried out. In regard to hospital provision, in addition to enteric fever wards at the infirmary, and the Borough Cottage Hospital for infectious diseases, there is a Port Hospital, erected in 1872. This building consists of two large wards, capable of accommodating eight patients, and is conveniently situated for access from the harbour or beach. There was no wash house or mortuary attached to it at the date of my visit. Provision of these and certain other improvements were included as recommendations in my advice to the Sanitary Authority on the requirements of their district. A portable hand ambulance litter, and a steam disinfecting chamber upon wheels are in readiness for the purposes of the Urban Sanitary District. C. 8. Blyth (Northumberland). — Dr. Page. The estuary of the River Blyth constitutes a port which is under the divided jurisdiction of the Urban Sanitary Authorities of South Blyth, Bedlingtonshire, and Cowpen ; and in consequence of the eminently unsatisfactory administration of Port affairs resulting from this arrangement, I reported to the Board in favour of the constitution of a P. S. A., with jurisdiction over the whole Creek. Shipping Trade. — Export of coal to the Mediterranean, Baltic, and Ports of the United Kingdom. Imports of timber, battens, and pit props from the Baltic. In 1884, about 150,000 tons of coal were exported, and the in- sailings were 309 vessels from foreign and 417 coasters. Chief Facts reported. — No inspection of shipping under the P. H. A., § 92 has been made, nor have steps been taken to give effect to the Cholera Regulations. The M. O. H. for the Urban District of South Blyth has hitherto dealt with all shipping entering the estuary in respect of cases of infectious sickness on board. He is acquainted with the requirements of the Cholera Regulations. No arrangements have been made with the Customs Authority, and the Collector of Customs informed me that there is no isolated mooring or anchorage for an infected vessel in South Blyth waters. Such vessel would have to bo moored in Bedlingtonshire waters on the north shore. The South Blyth Authority have a small Cottage Hospital conveniently accessible from the port ; but it is indiscriminately used for the reception of medical and surgical cases of illness occurring on board ship ; it is not adapted for the simultaneous treatment of two different infectious diseases; it is not effectually isolated, and there is no ambulance, disinfection, or mortuary provision in connexion with it. C. 9. Bkidpokt (Dorsetshire) R.— Dr. D. S. Daviks. Shipping Trade. — In flax with Russian (Baltic) ports, and small trade with France and Channel Islands. Coasting trade chiefly with Northern English ports and with South Wales. 190 y?r. No. y («) Riparian Districts. Chief Facts reported. — The U. S. A. and their officers administer the Riparian District. No systematic inspection of vessels under § 92, P. H. A. appears to be carried out. The anchorage outside the harbour is exposed, and in bad weather a vessel would have to run right in, or take shelter in Portland Roads. Harbour a mile from town. Arrangements for notification under Cholera Order made and order understood by M. O. H. A shed provided for cholera cases. C. 10. Bkixiiam (Devonshire) R.— Dr. D. S. Da vies. Shipping Trade. — There is very little foreign trade ; but many vessels, especially French fishing boats, run in for shelter during the year ; there is also a large home fishing trade. Administration of this Riparian District is by the Brixham U. S. A. and their officers. Chief Facts reported. — Anchorage for infected vessels in Torbay Roads, or under shelter of the Breakwater. Arrangements for notification under Cholera Order made, and provisions of Order apparently understood by M. 0. H. No hospital provision made, but .steps to this end promised by S. A. No systematic inspection of shipping under § 92 P. H. A. C. 11. Carmarthen (Carmarthenshire). — Dr. D. S. Davies. (Including Carmarthen Urban, and Carmarthen R. S. D.) Shipping Trade. — Trade with the Baltic and America. No Spanish or Mediterranean trade. Four foreign vessels all to Carmarthen arrived during 1884, and 321 coasters, including traders, within the bar. A few coasting vessels go to Laugharne. The boarding station for vessels bound to Carmarthen is at Ferryside, in the Rural District, 8 miles below Carmarthen, where a cholera vessel would be detained. The M. 0. H. lives here, but the I. of N. lives beyond Carmarthen, and there are no means at Ferryside for isolating cases of infectious sickness. Inspection tinder P. H. A., § 92. — This has not been carried out. It would have to be done at Carmarthen as all vessels not detained at Ferryside under the Order proceed, when the tide serves, up the river. C. 12. Chichester Creek (Sussex). — Mr. Spear. The eastern shore of Chichester harbour and Itchenor channel (including the coastguard station at W. Wittering, the watch vessel, boarding station, and station for infected ships, and the Customs station at Itchenor) are within this Riparian District, which is under the jurisdiction of the Westhampnett R. S. A. Shipping Trade. — Oyster boats from the French coast (principally from Havre), a very few boats from Jersey, and coasting traffic. 452 vessels or smacks passed the harbour mouth in 1 884. 22 smacks from the French coast entered the harbour during the three months April-June, 1885. These boats contain usually three men, and will come in from 12 to 24 hours from Havre. Chief Facts reported. — The coastguard at W. Wittering (entrance of the harbour), and the Customs officer at Itchenor, would anchor any infected vessel near their respective stations, and communicate with the Westhampnett R. S. A. The latter have not considered any further course. They have no hospital available ; they were not acquainted with the Cholera Regulations ; no inspection of vessels Arp. No. 9 (a) (Sec. 92 of P. H. Act) is made. Regulations explained, and .—. — appointment of coastguard (with the consent of the Admiralty) as District?. I. of N. for shipping purposes advised. C. 13. FowEr (Cornwall).— Dr. I). S. Davies. Fowey, partly in St. Austell partly in Liskeard Rural Sanitary District has some foreign trade in oranges and in timber, and a large number of callers. It is also engaged, as are Par, Charlestown, Penkewan and Gorran (in the St. Austell district) in the export of home products, chiefly China clay and mining produce. The Fowey river dividing the St. Austell and the Liskeard R. S. Districts, some difficulty has arisen in connexion with the working of the Cholera Order. It appears that the anchorage ground under Art. 2 would be in the Liskeard District, but that the vessel would be removed for purposes of Art. 10 into the St. Austell District. Probably the difficulty would be entirely met by the constitution of a joint board. No hospital provision lias been made (April, 1885). A local practitioner is empowered by the St. Austell 11. S. A. to act as M. O. H. for port purposes at Par, Fowey, and Mevagissey in the absence of the proper officer ; and this S. A. appeal's to be prepared to carry out the provisions of the Order. C. 14. Fisiiguard (Pembroke). — Dn. D. S. Davies. Fishguard is the only Port of any note on a considerable extent of coast line in the Haverfordwest Rural Sanitary District. It has some timber traffic with the Baltic, also general trade with the Channel Islands and English coast towns. There is no French or Spanish trade. Vessels often shelter in the roadstead, so that altogether 10 or 15 ships may be in the harbour at one time. Chief Facts reported. — The Customs Officer at Fishguard and the M. O. H. for this part of the Rural District are acquainted with and are prepared to carry out the Cholera Order. There is no permanent hospital provision, but a hospital tent at Haverfordwest belonging to the R. S. A. would, I am told, be available at short notice for any part of the District. No definite site for erection of this tent has been secured at or near Fishguard, and no definite arrangements have been made for duly equipping it when erected. C. 15. Goole (Yorks).— Dr. Blaxall. Goole is under the jurisdiction of the Goole Urban Sanitary Authority. Shipping Trade. — Considerable trade is carried on with Boulogne, Dunkirk, Rotterdam, Rouen, Calais, Antwerp, Ghent, lamburgh, Ostend. During the year 1884, 1,152 vessels from foreign and colonial ports, and 1,043 coasters entered this port, jroole is also a terminus of an extensive canal system. Chief Facts reported. — The Urban Authority of Goole have carried out their duty under the Canal Boats Acts, of registering canal boats but they have been unmindful of their obligations inder the Public Health Act to secure the inspection of sea-going vessels. Their failure in this respect was pointed out to them 192 Apr. No. y (a) Rpariiin Districts together with the peculiar facilities afforded by their shipping-trade, as by their canal traffic, for the introduction and spread of disease in their district. The Urban Authority possesses a Sanitary hospital which is used for the isolation of cases of indigenous infectious disease found on board vessels. With regard to arrangements for giving effect to the Cholera Regulations : — Vessels bound for Goole are boarded by the Customs Authority within the Port Sanitary District of Hull, and in the event therefore of cholera being found present on board any vessel, it becomes the duty of the Customs to report the circumstance to the Hull Port Sanitary Authority, upon whom would then devolve the responsibility of taking action necessary for preventing the introduction and spread of the disease. The Hull Authority, however, declined to admit their responsibility in regard. of vessels bound for Goole. Subsequently, at a conference I held with the Hull Port Sanitary Committee, representatives of the Goole Authority being present, it was arranged that the Hull Authority should take all needful action in respect of cholera cases found on beard Goole ships, Goole undertaking to pay the additional expenses thereby incurred by Hull. The agreement thus arrived at did not, however, get the sanction of the Hull Town Council, and in consequence this Board have since held a public inquiry with a view to constituting a joint Port Sanitary Authority for the Humber. C. 16. Ghimsby (Lincolnshire). — Dr. Blaxall. Grimsby is under the jurisdiction cf the Grimsby Urban Authority. Shipping Trade. — With the Baltic, Black Sea, America, Dieppe, Rotterdam, and Antwerp. Passenger traffic twice a week with the Continent, by which a small number of transmigrants are brought over to this country en route for America or elsewhere. In 1884, 1,151 vessels from Foreign and Colonial Ports and 2,411 coasters arrived in this port. Fishing trade considerable. Chief Facts reported. —No inspection of vessels under P. 11. A., § 92. The Urban Authority possess an iron infectious hospital of faulty construction ; the drainage from the building goes into the town sewers. It is not suitable for the isolation of cholera cases from vessels. The Medical Officer of Health of the Urban District has made himself acquainted with the Cholera Regulations. No arrangement had been made as to a mooring station, but after the subject had been discussed at the Conference, an agreement was entered into between the Collector of Customs and the Authority to appoint a suitable spot as a mooring station for infected vessels ; also a resolution was passed to appoint a Pore Inspector ol Nuisances. C. 17. Harhixgton Harbour (Cumberland). — Dr, Blaxall. The Urban District of Workington and the Rural District of Whitehaven abut upon Harrington Harbour, and vessels passquickly from one district to the other, and the Customs boarding may take place in either district ; but vessels for the most part bring to in the Whitehaven Riparian District where the process of loading and unloading cargo is carried out. Shipping Trade. — Little or no Foreign trade. During 1884, vessels from Foreign ports, nil. Coasters inwards, 215. 193 Chief Facts reported. — No arrangements made to give effect to the Cholera Regulations. At the Conference held in regard of this matter there were present representatives of the Workington (Port and Urban), and Whitehaven (Rural), Sanitary Authorities and representatives also of the Harrington Parochial Committee. 1 suggested that Harrington should be included in the Port Sanitary District of Workington, and that it should contribute towards defraying the cost of administration in proportion to its rateable value. As regards the Cholera Regulations, as a temporary arrangement in view of any emergency, the Workington Port Sanitary Authority agreed to carry out the Cholera Regulations should any vessel arrive at. Harrington with cholera on board, Riparian Districts. C. 18. I-lolyhead (Anglesey). — Dr. D. S. Davies. Administration by the liolyhead Urban Sanitary Authority. Shipping Trade. — Regular daily steam traflie with Dublin. Only one or two foreign ships inwards in the year, but vessels from all parts frequently put in the harbour for refuge. Chief Facts reported. — Systematic inspection of vessels not carried out. It would be diflicult to do this with all vessels frequenting the harbour for refuge, but vessels arriving to discharge or communicating with the shore might easily be inspected. The Officer of Customs is prepared to give immediate notice of any infectious disease to the Sanitary Authority, and to detain and notify cholera arrivals in accordance with the Order. An Assistant M. O. H. under the Order has been appointed to act in case the M. O. H. (who lives at Llanerchyniedd), cannot attend within the prescribed time. A convenient hospital on Salt Island is available for the use of the Sanitary Authority for cases of cholera or other infectious disease removed from ship-board. The infectious ward contains two ' beds ; there is room for extension in what is now a public recreation ground. The hospital is sewered by a separate drain to the sea. C. 19. Llanelly (Carmarthen). — Dr. D. S. Davies. This Riparian District is under the jurisdiction of the Llanelly Urban Sanitary Authority. Shipping Trade. — There is a large trade in pit props. Tn 1884, 218 foreign vessels arrived. There is trade with the North of France, the North of Spain, including Bilbao, with Norway, Sicily, and New Brunswick ; also considerable coasting trade. The M. O. Health and L Nuisances. — The officers of the Urban District act also for the port. Chief Facts reported. — Systematic inspection of vessels under § 92, P. H. Act has not hitherto been undertaken. The Urban Authority has provided one of Daecker's Patent Portable Hospitals ; it is to be set up upon a site near to the docks for the accommodation of any cholera cases requiring to be dealt with. Arrangements with the Customs for^ the execution of the Cholera Order have been made. C. 20. Littlehampton (Sussex). — Mr. Speak. The Littlehampton Urban (in which are nearly all the discharging wharves), and the East Preston Rural are the Sanitary Districts concerned. About 20 small vessels yearly, besides E 20510. N 194 App. No. 9 (a) Riparian Districts. barges, pass Littlehamptou, and proceed up the River Arun to Arundel in the Arundel Urban Sanitary District. Shipping Trade. — With Baltic and France (Northern Ports). About 55 * vessels yearly, but principally from March to October, enter from abroad ; 422 coastwise. Chief Fads reported.— A Fort S. A. was at one time in existence here, but has noAV " lapsed." The coastguard boards vessels entering the harbour, and takes charge of them until the Customs officer arrives ; the possibilities of seamen landing meanwhile, and of landsmen visiting the vessels seem insufficiently guarded against. A place has been appointed under Article 2 for the mooring of infected vessels ; but, as it is just beyond the Urban Authority's boundaries, and within the district of the Rural Authority (one comparatively little concerned), it is not altogether satisfactory. Neither of the Authorities have provided any hospital, nor has any inspection of shipping (§ 92, P. H. Act) taken place. Requirements of Cholera Order, and of P. H. Act, fully explained. Arrangements for giving them effect are to be made. [Littlehampton has now (June 1886) been reconstituted a Port Sanitary District. It is to be administered by a Joint Board, composed of members of the Littlehampton Urban, and the East Preston Rural, Sanitary Authorities.] C. 21. Maryport (Cumberland).— Dr. Blaxall. The Riparian District of Maryport is under the jurisdiction of the Maryport Urban Sanitary Authority. Shipping Trade. — With British North America, United States, Australia, Spain, Baltic. The foreign trade has fallen off considerably during the last four or five years, but the coasting trade is still important. During the year 1884, 42 vessels from foreign and colonial ports and 1,421 coasters entered the port. Chief Facts reported. — Inspection of vessels had not been carried out, nor had steps been taken to give effect to the Cholera Regulations. No arrangements had been made with the Customs authority. The Collector of Customs attended the conference I held with representatives of the Authority, and he pointed out the dangerous character of the anchorage off the town. Arrangements were made as a result of the conference for mooring infected vessels in a very large dock, which is little used, and which affords ample space for the purpose; also for erecting huts near-by for isolating persons suffering from cholera removed from the vessels. Subsequently the clerk informed the Board that an officer had been appointed to inspect vessels. 22. Middlesbrough and Stockton (Yorkshire and Durham). — c Dk, Blaxall. This district includes Eston, Kirkleatham, Middlesborough, Normanby, Stockton, and South Stockton, Urban ; and Guisborough, Hartlepool, and Stockton Rural Sanitary Districts. The several Riparian Authorities of the River Tees, of which Middlesborough and Stockton are the principal, carry out considerable shipping trade with Spain, Italy, Black Sea, Baltic, Rotterdam, Antwerp, and St. Malo; there is also a considerable coasting trade. During the year 1884, 1,171 vessels from Foreign and Colonial Ports, and 2,139 coasters entered the port of Middlesborough, and 18(5 Foreign, and 546 coasters entered Stockton port. 195 iIPP. Xo. 9 (a) Chief Facts reported. — The several Authorities had not carried out the duties devolving upon them in regard to the P. H. Act ; but in 1884, recognising how greatly the Foreign trade exposed their several districts to the risk of introduction of* cholera, the Authorities combined together and provided a floating hospital for the reception of cholera cases. Satisfactory arrangements were also made with the Customs Authority as to appointing a mooring station, and for giving effect to the Cholera Regulations generally. In 1885, the amalgamation of the several Authorities was abandoned, whereupon the Board held a public inquiry and in January 1886 and constituted a joint Port Sanitary Authority under the name of the River Tees Port S. A. Itjparian Districts. C. 23. Millom (Cumberland). — Dr. Blaxali Millom is under the jurisdiction of the Millom Urban Sanitary Authority. Shipping Trade. — Millom is a Customs Crock in the Whitehaven Customs Port. There was no separate return of the shipping trade from this District till September 1884, from which date to the end of the year one vessel from foreign, and 206 coasters entered the district. The Avaters of this Riparian District are shallow. Chief Facts reported. — The Urban M. O. H. and the I. of N. were present at a conference I had with the S. A. No infectious hospital provision, and no mooring station. The sliallowncss of theVwater presents some difficulty in the matter of selecting a suitable spot for the latter. The Cholera Regulations were fully discussed at the Conference, when the Customs Officer and the Authority agreed together to make arrangements adapted to give effect to the Cholera Regulations so far as circumstances would admit ; and it was arranged that in the event of any cases of cholera being brought into the district in vessels, the Urban M. 0. H. would take action in accordance with his duties under the Cholera Regulations. C. 24. Moeecambe (Lancashire).— Dk. Pagk. The Riparian District is under the jurisdiction of the Poulton- Bare-and-Torrisholme Urban Sanitary Authority. Shipping Trade. — The port is situated at Morecambe, the only place within the district having any seagoing trade. The trade is with Scotland and Cumberland in pig iron, and there is a weekly steamboat service with Ireland (Londonderry) for passengers and cattle. During the year 1885, no foreign vessel entered the port; coasters numbered 376. Chief Facts reported. — No inspection of vessels under § 92, P. H. A., has been carried out. The clerk and other officers of the Urban Sanitary Authority had, until the date of my visit, been under the misapprehension that the port of Morecambe was under the jurisdiction of the neighbouring Lancaster Port Sanitary Authority. The error apparently arose out of the circumstance that the Poulton-Bareand-Torrisholme Sanitary Authority had been included amongst the Authorities in the Order which constituted the Lancaster Port Authority. But upon making inquiry of the clerks of their respective districts, I am informed that no part of the district in question abuts upon the River Lune or upon any of the waters of the Port Sanitary District of Lancaster. There is no hospital provision within tUo district. The Sanitary Authority have, I am told, 196 AW. No. 9 (a) Riparian Districts, unsuccessfully endeavoured to combine with the adjoining Urban and Rural Sanitary Districts of Lancaster in making joint hospital provision for infectious diseases. There is no mortuary. The Customs boarding station is in Morecambe Harbour. In the event of an infected vessel arriving the master would be be ordered by the Officer of Customs to anchor at No. 3 Bell Buoy, 2 miles westward, who would then communicate with the M. O. H. of this Urban District I advised the M. O. H. to make himself acquainted with the Cholera Regulations, and at my interview with members of the Authority impressed upon them the necessity of systematic inspection of shipping. C. 25. Mostyn (Flintshire).— Du. D. S. Davtes. Mostyu Quay, Bagillt, and Connah's Quay are included in the Riparian District of Holywell, winch is administered by the Holywell R. S. A. Shipping Trade. — Copper pyrites are brought to Mostyn from Spanish ports. About 100 foreign vessels arrived to discharge during the 12 months, chiefly steamships, performing the journey in eight or nine days. There is also considerable coasting traffic with all the Deeside ports. In sailing coasters during 1884, 1,824. Chief Facts reported. — There is a separate M. O. 11. and I. of N. for the North and South Divisions of the Holywell R. S. I)., and these officers perform port duties. No systematic inspection of vessels is attempted ; but arrangements for notification of cholera and other infectious diseases by the Customs Officers have been made, and one or other of the M. O.s H. would deal with infected ships under the Order. A small wooden hospital has been erected during the year upon the quay at Mostyn for the reception of cholera cases. C. 26. Padstow (Cornwall).— Dr. D. S. Davtes. All vessels entering the Camel River, on the estuary of which Padstow is situated, are bound either to Padstow itself or to Wadebridge, some 4 or 5 miles higher up. The shores of the estuary include three Riparian Districts, namely, Padstow Urban, Bodmin Rural, and St. Columb Major Rural. The Boarding Station and Anchorage Ground under the Cholera Order for all vessels entering the haven are situated between Hawker's Cove and Harbour Cove, or in bad weather at " The Pool." The difficulties in the Avay of deciding in Avhich Riparian District a vessel would be under one and another set of circumstances, are so great that the constitution of a P. S. A. here is imperative for the effectual protection of the harbour. At present no systematic inspection of shipping is attempted ; complete uncertainty prevails as to carrying out the General Cholera Order, and there is no available isolation hospital provision in either of the three Riparian Districts. C. 27. Port Madoc (Carnarvonshire) .—Dr. D. S. Davies. Port Madoc is under the jurisdiction of the Ynyscynhaiarn Urban Sanitary Authority, Shipping Trade. — Chiefly in slates. Trade with Hamburgh, Bremen, Odense, Antwerp, and various Baltic, Danish, German, and French Ports. 49 foreign arrivals in 1 884. M. O. Health and I. of N.~Dv. Rees of Carnarvon. The I. of N. lives at Port Madoc. Apr. No. 9 (a) ¦Riparian Districts. Chief Facts reported. — Systematic inspection of vessels not carried out. No hospital accommodation for infectious cases. Arrangements made for boarding and detention of vessels under the Cholera Order, and for securing the services under the Order of an assistant M. 0. H. in the event of Dr. Rees not being able to act in' a particular instance within the prescribed period. C. 28. Runcorn (Cheshire). — Dr. Aiky. This Riparian District is under the jurisdiction of the Runcorn U. S. A. (Board of Improvement Commissioners). It has a certain amount of shipping trade, and extensive inland water communication by the Bridgewater and Weaver Canals. Chief Facts reported. — Inspection of vessels, other than canal boats, had not been carried out. No special arrangements had been made for giving effect to the Cholera Regulations. As regards a mooring place for infected vessels, there is no safe anchorage near Runcorn, and the Commissioners have not succeeded in their endeavour to arrange with Liverpool for permission to anchor within that port vessels found at Runcorn to be infected. The Urban Authority have an isolation hospital on a hill above the town, containing at present one ward with four beds. A second similar ward was in course of construction at the time of my visit. Water is supplied to this hospital from the Runcorn Waterworks. The hospital does not communicate with the town sewers. It would be quite suitable for the reception of cases of cholera, though it is difficult of access by a steep road. C. 29. Salcomde (Devon).— Dr. D. S. Davies. The trade here is almost entirely coasting. There is no foreign trade, but W. Indian vessels call for orders. Salcombe is the Boarding Station. The Authorities are prepared to take precautions in case of need. There is no hospital provision. C. 30. Sandavich (Kent).-- Dr. D. S. Davies Shipping Trade. — Chiefly coasting, communication with Sundered, Hartlepool, and Shields, South Wales, London, and Guernsey. Also one or two timber ships from the Baltic. Chief Facts reported— The Boarding Station is at some distance from the town, the portion of river intervening lies between the Riparian Rural Districts of Eastry on the one hand and Thanet on the other There is no hospital accommodation and no inspection of shipping carried out. A copy of the Cholera Order has been sent to this S. A. C. 31. Scarborough (Yorks).— Dr. Blaxall. This Riparian District is under the jurisdiction of the Scarborough USA 'Shipping Trade.— Scarborough carries on a small trade with Norway and Sweden, and is a place of call for French fishing boats. ' During the year 1884, the insailings were 84 vessels from foreign ports and 317 coasters. 198 App. No. 9 (a) Riparian Districts, Chief Facts reported. — The open harbour of Scarborough does not afford safe anchorage, while the artificial harbour is too small to afford space for the accommodation of an infected vessel. Both the Collector of Customs and the Urban M. O. H. are acquainted with the provisions of the Cholera Regulations, and are prepared to carry them out to the best of their ability. Should stress of weather render it necessary for an infected vessel to run for shelter they would immediately telegraph her place of destination to the Authority concerned. Efficient means for the isolation of cholera cases can be secured in the Sanatorium, a building which stands in the grounds of the Urban Sanitary Hospital. Inspection of vessels and P. 11. A., § 92 has not been carried out. C. 32. Seaham Harbour (Durham). — Dr. Page The Riparian District of Seaham Harbour is under the jurisdiction of Seaham Harbour U. S. A. Shipping Trade. — Export of coal; most of the vessels belong to the Marquis of Londonderry, owner of the port, and are employed in regular traffic between the Seaham Collieries and tho Thames. The in-sailings during 1884, were 109 ships from foreign and 1,983 coasters. Chief Facts reported, — No inspection of vessels under § 92, P. H. A., has been made, nor effect given to the Cholera Regulations. The Collector of Customs, is prepared, so far as the duties of the Officer of Customs under the Board's Order are concerned, to net thereon. He pointed, however, out to me that there is no safe mooring place here for vessels ; Seaham Harbour consisting of three small docks and an outer basin, the latter only large enough to enable a ship to be swung round for the purpose of entering the docks. Tho anchorage would be unsafe when it blew dead on shore. As regards the Cholera Regulations, the S. A. have resolved, so I am informed by the Chairman, who is also Lord Londonderry's agent, that no infected ship shall be allowed to enter, and that instructions have been issued to pilots to signal the condition of each ship to the harbour-master, who is, in the event of cholera being on board, to refuse arrival to such ship. An infected vessel ¦would in this case have to proceed to the Tyne, Wear, Tees, or Humber Ports. In my interview with representatives of the Authorities I stated that the Cholera Regulations should be duly observed. As regards hospital prevision, there is,, in addition to a small two-roomed cottage of make-shift character, belonging to the S. A., — a well-equipped Seamen's Hospital, towards the maintenance of which dues are levied upon all ships entering the port, and into which all cases of illness in ships' crews, whether of an infectious or non-infectious character, are admitted. C. 33. Silloth (Cumberland). — Dr. Blaxall. This Riparian District is under the jurisdiction of the Silloth U. S. A. Foreign trade is inconsiderable, and carried on chiefly with Hamburgh, South America, Spain, and the Baltic. During 1884, 16 vessels arrived from foreign ports, and 648 coasters. Chief^ Facts reported. — The Sanitary Authority had not fulfilled the duties incumbent upon them under the Public Health Act. The Authority were proposing to send infected vessels some 9 miles 199 or so out of the district ; but on its being pointed out at a conference I had with them that they had no authority to do this, the proposition was abandoned, and a suitable place appointed for a mooring station for infected vessels. The Authority ;it this conference were further advised to provide a hospital hut capable of being erected at short notice, on a spot remote from dwellings and conveniently situated for landing cases from infected vessels. This recommendation, I am informed, has since been acted upon. Aw. Xo. 9 (a) Riparian Districts. C. 34. Watciiet (Somersetshire). — Dn. 1). S. Davies. Minehead, Watchet, and Porlock are creeks in the Rural Sanitary District of Williton. Administration is carried out by Williton R. S. A. and the M. Os. H. and Is. of N. of the East and West Division of the R. S. D. Shipping Trade. — To Watchet, chiefly foreign trade with the Baltic, five or six vessels yearly. Coasting trade with Swansea in coals, total shipping inwards 297 in 1834. Chief Facts reported. — No systematic inspection under P. H. A., § 92. No infectious diseases hospital provided. The general arrangements for notification and. execution of the Cholera Order appear not unsatisfactory. C. 35. Wiiitby (Yorkshire). — Dr. Blaxall This Riparian District is under the jurisdiction of the Whilby U. S. A. Shipping Trade. — Principally with the Baltic. During the year 1884, 18 vessels from foreign and colonial ports, and 908 coasters arrived in this port. In addition there is the fishing trade, which is considerable. Chief Facts reported .—'The Urban M. O. H. and the I. of N. have not received any special instructions with regard to their duties under the P. H. A. in respect of vessels; but the M. 0. 11. las made himself acquainted with the Cholera Regulations and is >repared to carry them out, should occasion arise, so far as it may >c in his power to do so; but the Authority are unprovided with leans of isolation for cholera cases or other infectious diseases, n 1884, the Authority being apprehensive of the introduction of holcra by vessels, requested the Collector of Customs to apply to lie Commissioners for permission to board outside in Whitby roads. ?he Commissioners, however, refused to grant this application, on lie ground that the trade was exclusively with the Baltic, where lere was no cholera present. At a conference I had with the S. A. le importance of making suitable provision for the reception of holera cases was urged upon the Authority. C. 36. Whitkhaven (Cumberland).— Dr. Blaxall. This Riparian District is under the jurisdiction of the Whitehaven U. S. A. I Shipping Trade.— -With Baltic, North America, Spain, South merica. During the year 1884, 27 vessels from foreign and lonial ports, and 1,646 coasters entered the port. Chief Facts reported. — Inspection of vessels as required by the P. H. A., § 92 had not been carried out, nor had steps been taken to give effect to the Cholera Regulations. No arrangement had been 200 Apr. No. 9 (a) Riparian Districts. made with the Customs Authority as to the detention of vessels and as to appointment of a mooring station. The Collector of Customs attended the conference I held with representatives of the Authority, when these matters were settled ; but the Urban M. O. H. intimated that he would have nothing to do with cholera vessels. The Authority do not possess an isolation hospital, but are allowed to isolate cases in a very inperfect hospital which belongs to the Harbour Commissioners. In subsequent correspondence the clerk to the Authority informed the Board that an officer had been appointed to inspect vessels, and that the Cholera Regulations would be carried out. C. .'-57. Woodbkidge (Suffolk). — Mk. Spear. This Riparian District is under the jurisdiction of the Woodbrirlize R. S. A. Shipping Trade. — With the Baitic and with English ports. During the year 1884, some 120 small "coasters," and about six ships from the Baltic entered; besides a number of barges from Harwich, Ipswich, London, &c. Chief Facts reported. — A place has been appointed for the mooring of infected ships, but no other action has been taken under the Cholera Regulations, and no inspection of vessels (§ 92, P. 11. A.) has been made. The R. S. A» possess a small cottage hospital, but its situation would hardly permit of its use for the reception of a cholera patient arriving by ship ; the accommodation afforded by it is moreover of the slightest. The duties of the Authority with respect to vessels, &c., under the Cholera Regulations and under the P. 11. A. were pointed out. C. 38. Yarmouth (Norfolk), Riparian. — Dr. Airy. This Riparian District is under the jurisdiction of the Great Yarmouth U. S. A. (the Town Council). The trade of Yarmouth, the degree in which the port is frequented by passing vessels, and the extent of its inland water communication, give it special importance in respect of port sanitation. It is now proposed to constitute Yarmouth a P. S. D. Shipping Trade. — With Norway and the Baltic (for timber), a little with France and Spain, coasting trade with Sunderland and the Tyne (for coal). During the year 1884, 243 vessels from foreign ports and 1)88 coasters entered the haven, besides fishing boats. Chief Facts reported. — The Urban M. O. H., Mr. John Bately, is charged with the duty of inspecting and taking action under the P. 11. A. and Cholera Regulations with regard to any vessel reported to him as having infectious disease on board. Mr. Bately is well acquainted with the requirements of the Cholera Regulations, and is prepared to carry them out. There is no systematic inspection of vessels under P. 11. A., § 92. The U. S. A. have a useful isolation hospital, accessible from the beach without traversing the town. But it would probably be best to make some special provision for cholera cases. The Customs boarding station is just within the mouth of the Haven. The appointed mooring place; for infected vessels is at a point about half a mile up the Haven. 201 App No. 9 (6) No. 9 (l>). Abstract of Inspectors' Reports on the Sanitary Survey. Various Metropolitan, Urban, and Rural Districts. T A 1? U L A T E D. Pages Districts in Metropolis 202-9 Urban Sanitary Districts. In Cambridge - - - 230-33 „ Cheshire ... 254-57 „ Cornwall •• - - 242-45 „ Cumberland - - 282-85 „ Devon - 234-41 „ Dorset ... 24G-49 „ Durham - - - 266-77 „ Essex ... 226-29 „ Gloucester - 246-49 „ Hampshire - - - 218-25 „ Huntingdon - - - 226-33 „ Kent - - - 206-17 I Lancashire - - - 250-57 Lincoln ... 230-33 Monmouth - - - 282-85 Norfolk ... 226-29 Northumberland - - 274-81 Somerset - - - 246-49 Sussex - 214-21 York — East Biding - - 258-61 ? York — North Riding - 258-65 „ York — West Hiding - 254-57 „ North Wales - - 286-89 „ South Wales - 286-301 Pages Bubal Sanitary Districts. In Cambridge - - - 310-13 „ Cheshire - - - 326-29 „ Cornwall - - - 322-29 „ Devon - - - 318-21 „ Dorset - - - 314-17 „ Durham ... 334-41 „ Essex ... 314-17 „ Hampshire - - - 310-13 „ Huntingdon- - - 310-13 „ Kent - - - 302-9 „ Lincoln ... 326-29 „ Northampton - - 310-13 ? Northumberland - - 338-45 „ Somerset ... 326-29 „ Suffolk - - - 314-17 „ Sussex - - - 306-9 „ York— East Riding - - 330-33 „ York— North Riding - 330-33 „ York— West Riding - 330-33 „ North Wales - - 350-53 „ South Wales - 342-49 [ Where subsequent inquiries were directed by the Board as to action taken by Sanitary Authorities (see column 17 of these tables) , they were in many cases made, or replies were received, while this report has been preparing for press. In such cases the later facts have been inserted. — July 1886.] E 20510. (> 202 METROPOLITAN WATER-SIDE DISTRICTS. 1. 2. 3. 4. Urban Sanitary District. Tnsnpptnr and Cleanliness of Excrement Disposal and inspector anU Pmnlnnvn mill , ¦»¦. Date of Report. DomStto Sewering and Drainage. Removal. Population (1881). Premises. Industries, &c. I Wiiitbciiafel - Fair for a district Metropolitan system - - - W.c's generally Dr. de Cliaumont. difficult toman- Feb. 1885. age< St. Geokgk-in-the Metropolitan system - - - W.c's. The vestry is now en- I5 AaT forcing the provision of waterflushing arrangement for every Dr.de Cliaumont, closet. Pains taken to enforce Feb. 1885. cleanliness in poor neighbour- P. 47,157. hoods. Limbhousb - - Metropolitan system. In Lime- W.c's. Flushing arrangements | , house Fields very low-lying only where closets are within ; i.' i i U - 10 ' sewer: ventilators offensive. dwellings. I'eii. 1080. Sewer probably a sewer ol P. 58,548. deposit. POPLAB— Dr. de Cliaumont, Feb. 1885. P. 156,510. Nor/hern Part, Metropolitan system. Occasional W.c's, but often without flushing Bow and Brom- complaints of offensive odour arrangements in poorer houses, ley. from ventilators. Southern Part, Metropolitan system, but unsatis- Ditto Poplar and 1 sle factory: sewer sometimes surof Dogs, charged and many houses Hooded. ] ltOinaHJiiTHß - Metropolitan .system. Satis- — — Dr. de Cliaumont, factory. Feb. 1885. P. 36,024. Bbrmondsey - Metropolitan system. Offensive W.c's : about £of ithem without T . ?, Ol „ __ + smells from sewer gratings, and flushing arrangements. Malawi apparently considerable deposit mar. iBBo. in Bewerßi P. 86,652. Gbbbnwicu - - Metropolitan system. Accumu- W.c's T»r dfi rhaniTinnt lations occur in main sewer, jjr. ae unaumoni, ?„.»:„„ ni ,j lanni Feb. 1885. causing nuisance. P. Ml .233. I 203 METROPOLITAN WATER-SIDE DISTRICTS. 5. 6 7. __8. ______ 9-_ r.ml'/twfnf Crowding overcrowding of I Refuse Removal. Water Supply. Uvvelling S of Dwellings on Dwe lling 8 . of Poor. Aren. ! Pair - - - East London Waterworks. Many of worst I Sonic overcrowd- mostly on constant system. parts of district ing. have been ! cleared away under Artizans and Labourers : Dwellings Acts, but still some crowded and dirty neighbourhoods. Some of these have been eon- j demned, A colony of Polish Jews exceptionally slovenly and filthy in habits. Many dock labourers in district, but few seamen. Satisfactory - East London Waterwoiks: Decreasing popu- ! Occasional. mostly on constant system. lation. Several \ Where still intermittent, clearances effecbutts and cisterns in fair ted under A. and order. L. Dwellings | Acts, and more , in contemplation where there are crowded and unwholesome areas. i Pair - - ¦ East London Waterworks: Population uta- Occasional in tene- mostly on constant system. tionary or de- , ment houses. ¦ creasing, Some I parts very bad. 'dirty, and disreputable. Several j clearances under A. & L. Dwellings Acts, and several houses reported to S.A. and otherwise dealt with under X. R. Act. Limehouso Fields, where cholera broke out in I,S(i(>, now sewered. but still nasty. Seamen's lodging houses clean. ' Satisfactory. A East London Waterworks: Fair on the whole, but some bad. Not much, pail system of part on constant and part on crowded places, collection intro- j intermittent system. W.c's duced and j sometimes Hushed from working well. drinking-water cisterns. East London Waterworks. Some clearances effected under A. and Some. Very partially on constant L. Dwellings Acts. Dwellings of system. Some houses in labourers fair on the whole, but lower parts of district not some unsatisfactory as to eleanlisupplied. ness. I Southward and Kent Water Many clearances effected, and charac- Companies. ter of district changed of late years. Little now that would be likely to influence the spread of cholera. Pair - - - Southwark Company : inter- Many clearances, although not under Occasional, mittent system. Cisterns the A. and L. Dwellings Acts, being progressively substituted for butts. Unsatisfactory - Kent Water Company. Partly No clearance under A. and L. Dwellings Occasional, constant, and partly on inter- Acts. Dwellings fair, with exceptions, mittent system. W.c's supplied direct from drinkingwater cisterns. 204 METROPOLITAN WATER-SIDE D fSTßlCTS— continued. Urban Sanitary District. Inspector and Administration by Sanitary ! Work of Medical Offloor Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. I WHITECHAPEL - Satisfactory ... - Satisfactory and supported Satisfactory by S.A. Dr. de Chaumont, Feb. 188.-.. P. 71,314. I St. George-in- Satisfactory .... M.O.H. recently appointed Satisfactory - the-Eabt. ¦ Dr. de Chaumont, I Feb. 1885. P. 17,157. LiMEHOrsE - Satisfactory .... Satisfactory - - j Satisfactory I Dr. do Chauniont, Feb. 1885. P. 68,648. Poplar— >. Dr. de Chaumont, Feb. 1885. P. 166,510. Northern Part, How and Bromley. >• Satisfactory - Satisfactory - • j Satisfactory - Southern Part, Poplar and Isle of Dogs. L L... _..._... Dr. de Chaumont, Feb. 1885. P. 86,024. Bbemondsey - Active work and improve- Excellent systematic work. Dr.de Chaumont, ments Roiii* on. Mar. 1885. P. 86,652. Greenwich - — — Dr. de Chaumont, Feb. 18S5. j P. 131 ) 23;{. j METROPOLITAN WATE Ii-SIDE DlSTRlCTS— continued. 13. 14. 15. 16. 17. o,"o Result of Board's subsequent Inquiry I Abatement and | £g as to Action taken by S.A. on Prevention Hospital Provision. || S Recommendations of Inspector , of Nuisances. || Jg with Date of Information. fl as" 43 Metropolitan Asy- — — No subsequent inquiry to date. May 27th, ] lurns Board Hos- 1886. pit uls. Metropolitan Asy- None - — No subsequent inquiry to date. May 27th, I lurns Board Hos- 1886. pitals. Metropolitan Asy- — — No subsequent inquiry to date. May 27th, lums Board Hos- 1886. pitals. Metropolitan Asy- — Preparing No subsequent inquiry to date. May 27th, '. lums Board Hos- 1886. pitals. ! Metropolitan Asy- — — No subsequent inquiry to date. May 27th, I lums Board Hos- 1886. pitals. | Metropolitan Asy- None - Preparing No subsequent inquiryto date. May 27th. I lums Board Hos- 1886. pitals. I Metropolitan Asy- Yes - — No subsequent inquiry to date. May 27th, lums Board JTos- 1886. I pitals. i i 206 M ETI {( > I '( ) I , I TAN WATER-SIDE DlSTRlCTS— continued. ? 2. 3^_ 4. _ _ ( i Itrlian Sniiitnr.v / . cl(norallv unsewcred ¦ - - r- r .vy ess] ols in the chalk, I ' ' which are sour i : dangerous ' I V - hi nuisan c. Wx's coming into use, ¦ >s ¦ th flushing arrange.• • .... only surface draiuacc - - - Privypitsand sspools serving for •¦ . - where they .x:>t. i ' .;^ i :. , f l pi; ... .- \T»r»Js Onh surf ran . ., • - - Prirj \is and cessj -Is serving ..•¦.-... a. ii . s ¦¦¦ - " i -:¦" exist. \s ..... . -. ¦. v- .. v;-.:,- ( - Onl> s»i ... ..¦-... :,. . - Vv.. .- vI . sspools gening for 207 METROPOLITAN WATER- SIDE DlSTRlCTS— continued. 5. 6. 7. 8. 9. T~ ~ Salary Crowding Overcrowding of Refuse Removal. Water Supply. Dwellings of Dwellings on Dwellings. of Poor. Area. Satisfactory - Kent Water Company. Partly j Fair, but some streets in an unwhole- on constant, and partly on some condition, notably where tenintermittent system. 'W.o's anted by a colony of poor Italians, of ten supplied from drinking- No clearances under A. and L. water cisterns. Dwellings Acts, but clearances in Hughes Fields impending. Negligent - - Public supply gradually being Many dirty and A few courts - Some eases obextended. Still many shallow ill-ventilated. served, wells liable to pollution or | actually polluted. Satisfactory- - Public supply mostly. A few Satisfactory on the ¦ None. wells fowl or liable to pollu- whole, tion by cesspools. Fair - ¦ - Public supply intermittent. Many unwhole- In poorer parts - Homo. Wells said to be falling into some dwellings, disuse. They are necessarily polluted. Fair - - - Public supply constant. Wells Fair, with excop- | Some crowding in Sometimes, but in use, but closed by 8. A. tions. parts. dealt with when when pronounced unfit for discovered. Unsatisfactory - Public supply constant and Fair, but some Close courts and Little. good. Many wells which unsound which back -to - back ought to be closed. ought to bo houses, closed. "Unwholesome in parts in consequence of privies, Very unsatisfactory Public supply good and con- Bad, dirty, and Many courts and Little, stant. No wells in use. dilapidated.with some dwellings offensive privies. crowded to- Satisfactory - Public supply to about half the Veryfair •¦ Little crowding; - None, population. The rest supplied by polluted local wells. 208 METROPOLITAN WATER-SIDE DlSTRlCTS— continued. 1. 10. 1L 12. ! Urban Sanitary I District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. Dkpifokh - - Satisfactory .... Dr. de Chaumont, Fob. 1888. P. (included under Greenwich) 84,653. KENT — continued. Daetford, U. - Unsatisfactory and inefficient. I Good ; but his advice is dis- Inefficient. I. of N. makes I Mr I Snr'ir Advice of M.O.H. neglected. regarded. M.O.H. not few inspections, and keeps Ti'moiasfi' Some improvements, how- under Board's Order. no useful record of his work. June 1886. eveis Blnoe Mr _ Spcar . s in . J. 10,168. spection in 1884. (Agricultural market town, paper making.) Erith, U. - - Dr. de Chaumont, Feb. 1885. V. 9,812. IGravesend, U. - Dr. de Chaumont, Feb. 1885. P. 23,302. Chatham, IT. - — M.O.H. not under Board's Efficient. I. of N. is surveyor Dr. de Chaumont, Order. also : an assistant employed. March 1885. P. 26,421. (Industries connected mainly with Government Establishment.) Rochester, U. - M.O.H. not under Board's Said by M.O.H. to be satis- Dr. de Chaumont, Order. factory. March 1885. P. 21,307. (Dockyard employments, cement works, &c.) GILLIN&HAM, U. Very apathetic, to say the M.O.H. draws attention to Inefficient. I. of N. has oth^r Dr. de Chaumont, least defects, but cannot get duties. March 1885. them remedied. P. 20,745. (Industries connected with Government Establishment.) TonbridptE, IT. - Fairly good , - - Good • ... g00(ig 00( i . Mr. J. Spear, March 1885. P. 9,317. (Agricultural market town.) 209 METROPOLITAN WATER-SIDE DlSTRlCTS— continued. 13. 14. 15. 16. 17. E"3 Result of Board's subsequent Inquiry Abatement and | g^ as to Action taken by S.A. on Prevention Hospital Provision. || | Recommendations of Inspector; of Nuisances. -g a | g with Date of Information. A as*' Metropolitan Asy- Yes. — No subsequent inquiry to date. May 27th, lums Board Hos- 1886. pitals. KENT — continued. Not habitually efficient, None - - - None - None -i No subsequent inquiry to date. May 27th, I although some im- 1886. proveraents effected. None ... None - — No subsequent inquiry to date. May 27th. 1886. Very unsatisfactory — — ! Survey led to more detailed inspection of and three miles I i borough in June 1885. S.A. are taking away. action [Feb. 1886] as to water supply and excrement disposal, and are about to erect a new permanent infectious diseases hospital, with means of disinfection and a mortuary. No measures to be adopted in regard of a system cf sewering. Satisfactory - - Small hospital con- Ransome's None - May 1885. Some action as to polluted jointly with chamber wells and dilapidated property. Sewer- Rochester, at hospital. age question left in abeyance. Said to be efficient - Small hospital two Ransome's None - June 1885. S.A. are taking action as to miles off. Insuffi- chamber polluted wells and refuse disposal and cient accommoda- at hospital. removal (loan for works of water supply tj on> since applied for). Nothing done as to sewerage or dilapidated dwellings. Dilatory and inefficient None - • - None - None ¦ The question of scavenging is still matter \ of official correspondence. May 27th, 1886. •pai- Yes - — None - No subsequent inquiry to date (May 27th, 1886), but sanction to loan of 19,000?. for works of water supply applied for. 210 KENT — continued. 1. 2. 3. 4. - Urban Sanitary District. i .nnntni. onfl Cleanliness of Excrement Disposal and liX Krt. Xaf Sewering and Drains Population (1881). Premises. Imlustrios, &c. — SouTirnoßorcHT, U. Fair - - - Drainage defects observed at Mr. spears inspection in 1882 Mr. .1. Spear, satisfactorily remedied. March 1885. P. 3,870. (Health resort.) Maidstone U ¦ Fair - - - Main sewers fairly effective. Tri- W.c's without flushing arrange' butary sewers insumciently yen- merits. Bencc fouling of drains Mr. J. Spear, tilated and flushed, hence com- and tributary sewers and nui- March 1885, plaints of foul smells. sance. Some privy pits. V. 211,628. (Agricultural market town, paper-making, &c.) llfrnp; Bat TJ. - Sewered. Some defects causing W.c's mostly with flushing ar*',,'' . flooding remedied. Inefficient rangements. Sinks, Ac, cut oil Dr. V. .>. Davies, ventilation and flushing. in new property only. Jan. 1885. P. 2,810. Faversham, TJ. - Variable - Unsatisfactory drainage - - W.c's without flushing arrangements in poorer quarters. Dr. de Chaumont, Mar. 1885. P. 8,743. (Fishing, brick-making, &o.) Milton, 1". - - Fair - - - Fair, but district is low-lying, and W.c's with flushing cisterns, ' , ' . there is nuisance from outfall. Dr. de Chaumont, Sewers ventilated, but com- Mar. 1885. plaints of nuisance. I. b219. (Brick and cement making, canal traffic, &c.) Sittingboubne, U. Fair - - - System of surface drainage only - Half of the houses have w.c's _, , „. provided with water. The rest, Dr. de Chaumont, privy pitßi Water-pipes cut Mal- - 18S5 - off from drains. P. 7,856. (Brick and cement makinjr, papermaking.) Shbbbness, 11. - Unsatisfactory - Unsatisfactory. Only partially W.c's, mostly without flushing _ , „, sewered. cisterns, communicating with Dr. de Chaumont, bad sewer s. About 1,200 privies, Mar. 1885. often lilthv< P. 14,286. (Dockyard occupations.) Broadstaiks, U. - Townsewered. Tide flows a mile up W.c's hand-Hushed _ . „ . . sewers, producing back pressure Dr. v. ». iJavics. o f sewer a j r! nm \ consequent Jan. 1880. nuisance. Sewers ventilated I. 4,:i22. and flushed. Notwithstanding, ,„ ? , . most houses still drain into (Sea-side resort.) cesspools, often under houses, and liquid contents soak away into soil. Waste-pipes of about half the houses disconnected. Margate, U. - No sewering generally. Houses W.c's mostly _. 1A ? .. . drained into larjre cesspools in Dr. D. S. Davies, the clmlk> into which J llquld Jan. iN^a. matters soak away. Very par- I P. 16,030. bialtown drainage with insuffl- I .„ ? . . cient ventilation and flushing. (bea-siac resort.) Extension said to lie contempla- 211 X VI NT — coiitin ucd. 5. 6. 7. 8. 9. Sanitary Crowding ? .. . Refuse Removal. Water Supply. of rf DweUlngs 0Q " f of Poor. Area. - Works of water supply making — I None - - - fair progress. Fair - - - Mainly by wholesome public Cottages fairly Some crowded Some, supply, not always sufficient, clean, but often back -to -back and then supplemented by ill- ventilated. houses in courts, water from polluted Medway, One-tenth of population use wells liable to pollution. Fair - - - Public supply abundant and {rood. Some few shallow wells. Public supply intermittent, Unsatisfactory - Crowding in older None. but good quality. Some wells parts. In parts where enteric fever is frequent. Fair - - - Public supply (as Bitting* Fair - - - Old town with None, bourne) constant. Few narrow streets. wells. | i Satisfactory - - Public supply constant. Few Good ¦ ¦ - None - - - None. wells. Satisfactory - - Public supply not constant, Bad - - - Crowding in nar- Not much, and yet but few storage row alleys, and cisterns, and these not back-to-back, always separate from w.c. supply- Satisfactory - - Public supply supplemented, when deficient, from a suspicious well. Constant service. Satisfactory - - Public supply constant and almost universally used. X E N T — contiti ued, ! 10. _1L 12. Urban Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. cf Health. Nuisances. Population (1881). Industries, &c. Soutiiborougii.U. S.A. engaged in improving Mr T Sn .•iv drainage and water supply Ma'wiii 199 X ' since Mr - Spear's inspection loot). •.. -i uu*> P. 8,870. (Heal tli resort.) i Matdstone, IT. - Pair Good Unsatisfactory ... Sir. J. Spear. j March 1885. P. 20,023. (Agricultural market town, paper-making, &c.) Herne Bay, U. - Satisfactory - Satisfactory ¦ Dr. D. S. Davies, Jan. 1885. P. 2,816. Faversham, U. - Dr. de Chaumont, Mar. 1886. P. 8,748. (Fishing, brickmaking, &c.) Milton, 11.- ¦ Dr. de Chaumont,' Mar. 1885. P. 4,2 lit. (Brick and cement making, canal traffic, &c.) Sittingbotjbne/U. — — Dr. de Chaumont, Mar. 188 S. P. 7,850. (Brick and cement mnkiiig, papermaking.) Sheernkss, U. - Not active .... Dr. do Chaumont, Mar. 1885. P. 14,280. (Dockyard occupations.) Broadstairs, U. Model byelaws enforced • - Satisfactory .... Satisfactory - Dr. D. S. Davies, Jan. 1885. P. 4,322. (Sea-side resort.) Margate, U. - Satisfactory - - - Satisfactory. I. of N. is Sur- Dr. D. S. Davies, taSSSite" ' a Tan. 1885. inspector. P. 16,030. I (Sea-side resort.) j KENT — continued. 13. 14^ 15. 16. 17. c/o Result of Board's subsequent Inquiry Abatement and _g\ £g as to Action taken by S. A. on Prevention Hospital Provision. || j| Recommendations of Inspector; of Nuisances. || | § with Date of Information. — — No subsequent inquiry to date, but small loan for works of water supply .since applied for. May 27th, 1880. Fair .... Good hospital and Ransome's None • No subsequent inquiry to date. May ambulance. apparatus. 27th, 1886, None. — — No reply received to date [May 27th, 1886], to Board's inquiry of March 1885 as to S.A.s action in regard to hospital provision, sewer-flushing, &c. None ... Hot-air None - M.O.H. in 1885 report draws attention to chamber. extremely unsatisfactory conditions connected with sewage discharge, and speaks of room for improvement as regards water supply ; several surface wells closed. As Sittingbourne - As Sitting- None • No subsequent inquiry to date. May 27tta, bourne. 1886. Satisfactory - ¦ Good hospital, con- Nelson ! None ¦I No subsequent inquiry to date. May 27th, jointly with Mil- stove at 1880. ton TT. and R. hospital. Part of the engi- None - | None - June 1885. S.A. content to regard water neer's cottage. In- supply as safe from pollution, and consullieient. sider present hospital as adequate. — . Joint hospital with At hos- — No subsequent inquiry to date (May 27th, R.S.A. at North- pital.Ran- 1866), but M.0.H. , in 1885 report, says woods. Insuffi- some'a ap-! the cesspool system of drainage should eient. paratus. j be abolished, and trusts that it will, now sewerage of Broadstairs is completed. ; I Satisfactory - - The Northwoods Do. — |No subsequent inquiry to date (May 27th, Hospital (joint 1886), but loan of 6,500?. sanctioned in provision). In- April last for works of water supply, sufficient. 214 KENT — continued. 1. 2. 3. 4. Urban Sanitary \ District. Inspector and nl^Jvif l?S I Excrement Disposal and Date of Report, **$£££* Sewering and Drainage. Remov[ll Population (1881). Premises. Industries, &c. RAMSGATE, U. - Mostly sewered. Outfall said to W.e"i mostly tv» t» a t»-«j be source of nuisance. Sewers Dr. D.B. Davies, ventilated and Hushed. Waste ÜBni 1888 l pipes in course of being cut oIT. P. 22,688. Dover, U. - - Sewered throughout. Ventilation W.c's mostly with flushing eisl)r D S Davies and (lushing satisfactory. terns and satisfactory. Jan. 1885. P. 30,270. DEAL, TJ. - - - — Sewered. Flushing, but insuffl- W.c's, some without (lushing 1,,, n < n.ivi,.v cient ventilation. arrangements, and otherwise Jan. 1886? unsatisfactory. Privies also. P. 8,500. Sandwich, L. - — — n I, a Tjavifis Not sewered. Drainage into cess- Privy pits and cesspools; cleansing ! I'iii is's'- pools, some of large size, and neglected. Cesspools allow of j " scarcely, if ever, cleaned out. dangerous soakagc into soil and I P. 2,846. into wells. FOLKESTONE, U. - Sewered throughout. Ventilation W.c's of good type in new houses, i, I) <• i). lv i ( , s ' ll > (l Hushing unsatisfactory. and being improved in old ones. ' T-iii' iss * ow nouses drain into cesspools. ¦ lJ " Waste pipes cut oil in new P. 18,816. houses, not in old ones. HTTHE, U. - - Sewered satisfactorily. Sewers Mostly w.c's, some of good type, Dr D S Davies Hushed and ventilated. some of bad type. Jan. 1885. P. 4,178. Sandgate, U. - A military drain and a town W.c's. rw n 53. Dover, U. - - Satisfactory - Satisfactory Dr. D. S. Davics, Jan. 1885. P. 30,270. Deal, U. - - Satisfactory • Fair Dr, D. S. Davies, Jan. 1885. P. 8,500. Sandwich, U. - Town in a most dangerous n t> o ii • condition for advent of Dr. D. S Davies, pholpra Jan. 1885. cnoiera. P. 2,846. Folkestone, 11. - New byelaws satisfactorily Satisfactory. I. of N. is sur- Dr.D.S. Davies, workcU - voyoralso. Jan. 1885. P. 18,816. Hythe, U. - - —— Dr. D. S. Davies, Jan. 1885. P. 4,173. Sandgatic, U. - Active. I. of N. is surveyor Dr. D. S. Davies, also * Jan. 1885. P. 1,660. SUSSEX— continued. Lewes, U. - - Fair on the whole - - - Fair ... • Not satisfactory Mr. J. Spear, Nov. 1885. P. 11,19!). (Agricultural market town.) Newhaven, U. - Some improvement since es- Probably further personal New officer (a watchmaker). ¦m j c . tablishment of district in influence of M.O.H. with No previous training. Mi.j.hneai, 1881, but little permanent S.A. required. June 18S&. abatement of sewage P. 3,806. nuisances. (Shipping trade.) New Shoeeham, Lax administration. Recom- Very fair .... Unsatisfactory. I. of N. is U. mendations of Board on surveyor and collector also, in- t a™«. Dr. Thome's inspection in T,,wiss.f 1882 onl y ver y Partially diuy iBBo. carried out. P. 13,505. (Shipping trade, fishing.) 217 r KENT— continued. _ 13. 14. 15. 16. 17. g3 Result of Board's subsequent Inquiry Abatement and 5? So as to Action taken by S.A. on Prevention Hospital Provision. tgj Recommendations of Inspector s of Nuisances. "3 3 ¦§ § with Date of Information. 'ffl g^ g_s Satisfactory - - ' Tin, Northwoods (At hospital. N ? o S^^™u3^m^MSnS& ! sufflcipnt ! " M.0.H., in 1885 report, says new scheme 1 is "being actively carried out." — At villa hospitals Lyons' .Us- No subsequent inquiry to date. May 27th, under Dr. Astley's infector. 18st> 18st>control. __ »t _ _ February 1885. Attention of 8. A. called to ' several matters needing action. M.0.H., in 1885 report, speaks of better scavenging of district. _ _ November 1885. New scavenging contract ' " entered into, [n his 1885 report, M.O.H. \ speaks of foul privy pi is and cesspools Hi ill existing, though in some known cases pai 1 or cart li closets have been substitut eil . Water supply remains as hitherto. Satisfactory ¦ Satjsfactory hospi- A^J& 1- SEM^^ Ul prOT IM ""- lor in respect of loans for works of streel improvement, sewerage, disinfecting chamber) &o. None - - - None - — No subsequent inquiry to date. May 27th, 1880. \T ono — — No subsequent inquiry to date. May 87th, 1886. S USS EX— continued. togSSST* " YeB - ' " hospital None - I mrea - still in progress. Unsatisfactory - - Make shift, insuffl- None - None - October 1885. House-to-house inspection •i.-iit nmvisic n a.l made with a view to remedying defects an oMmUI build- of drainage, &c, bi-ought to light. ;,' (Nothing to dateasto schemeof sewer- ! - age. June 2Bth, 1886.) Inefficient - - - None - - - None - None - No subsequent inquiry to date. May 27tli, | lSSt>. I I ( E 20510. T 218 SUSSEX — continued. 1. 2. 3. 4. Urban Sanitary District. Inspector mid SSSSIS a ¦ ,n • Excrement Disposal and Date of Report. ""SSStto Seweiing and Drainage. Removal. Population (1881). Premises. Industries, &c. "~ ~ ' ' i WOBTHING, U. - Some improve- Sewered throughout. Ventilation W.c's: those without flushing I ? * tnent in road- insufficient. arrangements often foul. Many! VAv f ?£« Wil J' s ill recent | closets supplied direct from the i inov. ib»j. years. Domestic water mains. P. 10,{>7<>. premises often | (Sea-side resort. rauoh neglected. fishing.) i West Woktjiixg, j Fair ... Sewered. Private drainage ocea- W.e's. Domestic water-storage i 11. [Distriel mainly sionally defective. cistern often supplies w.c. also. Mr T annni- i of better-class lodging-houses.] .±.l UVi Itoui I P. 750. i (Sea-side resort.) | LiTTLKHAAirTOK, | Fair - - - ! Sewered, but one-eighth of houses , W.c's, mostly without flushing XJ. not connected. Sewers tide- arrangements, and very foul in ? T „ locked for Id hours out of 12. , consequence. tiik«" IF> Insufficiently ventilated, and July ios,j. sewer air driven back into house | P. 3,920. drains and escaping about „ . . dwellings. Private drainage uu- ! (Sea-side resort. satisfactory, harbour work, I fishing.) Abi'ndel, U. - Fair on the whole Very old barrel drains serve as Mostly deep privy pits and vaults, ¦, , r , T „ , sewers, but no nuisance as j gradually being converted into i iLl iL- gradients are steep. Not regu- w.c's. Privy iiits sometimes ]SS| ' larly ventilated. very foul. P. 2,748. (Agricultural market town.) ! rjxoß, V. ¦ - Fair - - - i Sewered nearly throughout. Yen- W.c's, mostly without flushing MV T tilation inadequate. Sewers arrangements, and hence foul- j r.'iiv in*- Hushed. House drainage un- ness of drains and nuisance from Jmi • satisfactory. Some pesspools sewer ventilators. P. 3,290. overflow into sewers. j (Sea-side resort, fishing, &c.) I CmcnESTKR, U. - ; Fair - - • Not sewered. Sewage polluted Open privy pita : or w.ob without Mv T Snciir stream passes through city. flushing arrangements diseharg- Cesspools universal, situated, ing into cesspools. June 1880. even imdor IIOUSeS; alld thejr . P. 8,114. ' liquid contents rise and fall . (Market town.) i wfth ground water. HAMPSHIRE. Havant, U. - - | Unsatisfactory - Sewers old and imperfect. Much \ Deep privy pits of rough construe- I ¦»! j cnpßrc npBr of sewage enters stream passing tion, ill-kept and offensive, often I i!i Tii- through town. Private drain- close to houses. htpt. i»Bu. age very defective ; leaky cess- P. 8,032. I pools even for new houses (Agriculture, in High Street, tanneries, &c.) j Portsmouth, L t . - j Sewering and house drainage ' Mostly w.e's discharging into j Dr Blaxall vel '- v 'a u 'ty. Faults, however, faulty, leaky, sewers. Some I Jan 188" ' recognised, and reconstruction w.c's without Hushing arrange' I of sewers under consideration of ments. Some cesspit privies. P. 127,989. S.A. 219 SUSSEX— continued. ___ &j_ & 7. __8. 9. Sanitary Crowding Overcrowding of ' | Refuse Removal. ; Water Supply. Wife 0 ' !of Dwellings on Dwellings. of Poor. Area. . . . _ _____ j Not altogether Public, supply constant, but Many dirty nnd Crowding in older Occasional, satisfactory. from comparatively slmllow ill-ventilated, parts of town. j wells nenr oentve of town. Possible danger of contamination in distribution. | | ' Satisfactory- - Public supply intermittent. Pair - - - None - - - None. ! Cistern arrangements not always satisfactory. A few ! wells liable to pollution. I J Unsatisfactory - Public supply to about one- I Pair • - - Little crowding - None, third of town only. Rest supplied from local wells often subject to pollution. i ! Satisfactory- - Public supply by stand-pipes. A few cottnges Little crowding - None, but many local well-supplies damp and ill- ; I of doubtful purity. ventilated. \ i ! Not altogether Public supply to about one-half ¦ Fair - - • j Little crowding ¦ None. satisfactory. the town. Local wells, liable j to pollution, used for the rest. i Not wholly satis- ' Public supply to less than one- Clean and tidy as : Some crowding in None, 'factory. j half the houses on constant a rule. ' centre of city. service principle and of good j quality. Shallow wells, other- : wise in use, necessarily liable ; to dangerous pollution from i the cesspools. (See Col. o.) HAMPSHIRE. Very unsatisfae- Public supply for parts of Unsatisfactory ; Not much crowd- i Rare. torv. district from Portsmouth i some hardly (it | ing. Waterworks Co. (see Ports- \ for human habimouth). Local wells and j tation, and sur- ; , springs, some obviously pol- rounded by lilt h luted, and all liable to pollu- I nuisances. Satisfactory. ! Public supply from Portsmouth \ Waterworks Co., deriving \ water from springs near j Havant. Apparent liability i L to pollution at source. Reme- j ) dial measures in contemplation since survey was made. 220 SUS SEX— continued. 1. 10. 1L i 12. Urban Sanitary District. , Inspector and , Administration by Sanitary Work of Medical Officer : Work of Inspector of Date of Report. Authority. of Health. Nuisances, Population (1881). Industries, &o. — _ ___ 1 -j " I Worthing, U. - Fair, with certain exceptions, | Good Fair „, T q „„ e.g., fnilure to remove risks at XI of contamination to public Nov. 1885. water sup p, y P. 10,970. (Sea-side resort, fishing.) West Wort fting, Fair Good Fair U. ] Mr. J. Spear, Nov. 1885. P. T6O. (Sea-side resort.) LiTTLKiiAitPTON, Fnir Good Good U. Mr. J. Spear. July 1885. P. 3,92(5. (Sea-side resort, harbour work, fishing.) Aeundel, U. - Fair on the whole - - - Good Fair Mr. J. Spear, Sept. 1885. P. 2,748. (Agricultural market town.) | ' Bognok, IT. - - Pair on the whole - - - M.O.H. old and feeble, but Routine duties insufficiently ? T „ helped by liis son. attended to. I. of N. is : Mr. J . spear, Surveyor also, and in pn- Jul.v 1885. V!lt( . practice. P. 3.29(i. 1 (Sea-side resort, I fishing, &C.) (Jhichester, Ij. - Lax administration. Little Not very successful hitherto. Inefficient - ,» T c improvement since Dr. M.O.H. only recently unt ?Hf« Airy's inspection in 187 K. der Board's Order. P. 8,114. ! (Market town.) i I __J HAMPSHIRE— vontinvccl. Havant, U. - Inefficient. New byelaws not Fair, but M.O.H. lias not j Fair, but 1. of N. powerless ». r R ... enforced. This district pressed his advice sutli- atrainst a lax S.A. h~* ioqk obviously in a dangerous ciently on the B.A. sepi. 1880. condition for advent of P. 3,03i'. cholera. (Agriculture, tanneries, &c.) i Portsmocth, U. Working under byelaws of ' — — Fair - - - Dr. Blaxall, ! old date - Jan. 1885. P. 127,989. I 221 SUSSEX— continued. 13. 14. 15. 16. 17. L hi \ i 5"o Result of Board's subsequent Inquiry I Abatement and | |g as to Action tn ken by S.A. on Prevention Hospital Provision, j || J Recommendations of Inspector; of Nuisances. |fi 191 9 with Date of Information. H OB ! Pair, with exceptions None - - - I None - None - March 1886. S.A. in jroneral terms promise action en Inspector's advice. Pail .... None - - - None - None ¦ July 1886. Advice of Inspector acted upon "as far as practicable."' No de- i tails given, Fair .... None - - - None - None - I July 1885. Attention promised to Mr. ! Spear's suggest ions. Fair .... Nohc - - - None - J None - No subsequent inquiry to date. May 27th. 1886. Fair ... - None - - - None - i None - | Recently appointed M.O.H.in lSBsreport (Feb. 1886) speaks of house-to-house inspection of district in progress, and I of action taken to remedy the sanitary defects brought tj light. Inefficient - - - An old "pest house," None - None - July 1885. S.A. iilivc to necessity of | wholly inadequate. action in the directions indicated by ! Inspector. Proper hospital to be pro- I vided. HAMPSHlRE— continued. i j | Inefficient - None - - - None - None - No subsequent general inquiry made, but ] sewerage is still matter of correspondence. May 27th, 1886. Yes. — — No subsequent inquiry to date. May 27th, 1886. 222 KAMPSmRV-continued. 1. 2. 3. Urban Sanitary District. Inspector and SSSwSSSTISd : ... Excrement Disposal and Date of Report. dESSho Sewering ami Draiuage. Removal. i Population (1881). | Premises. Industries, &c. I Alveestoke, U. - Courtsanddomeß- Not sewered, and what surface ' Privy pita land cesspools riddling I * T ' tic Bromines of drainage there is very defective, I soil, and huddled u|» amongst Mr. J. Spear, poorer uoinda- causing much nuisance, and houses. It is the rule not t( July 1885. tionlilthv. fouling of air and soil. empty these pits until excrep ?, r S i ment reaches privy floor. Ex-'"•>o >o • crement nuisances universal. (Harbour work, shipbuilding, &c) ! Farfham U • -Satisfactory • Mostly sewered. Inefficient yon- Mostly w.c's, flushed in older ' ' ' ' ! tilation. House drainage defec- ! property by pipes direct lrom Mr. J. Spear, liv( , MM j o |tL,n | tL , n tlio cause of com- ' water main. Sept. 1885. plaint, P. 7,1«u. (Agricultural market town.) East Coaves T" - Sewerniß and house drainage un- W.c's discharging into sewers, f satisfactory. Sewage nuisances. ; and mostly without Hushing i)r. Blnxall, ; No provision for flushing. arrangements. May 1885. P. 2,512. West Cowes U - I Sewering improved within recent j W.c's discharging into sewers, years, and house drainage mi- : and often without any flushing J)r. Blaxall, proved, but still much room for arrangements. May 1885. Improvement. Sower vontila- I p. 6,721, tion and flushing still bad. i St Helen's U. - Notsatisfactoryin i Populous parts sewered. Sowers Wator-closets common source of poorer quarters. ' and drains not satisfactory, i nuisance from want of Hushing, Mr. J. Spear, [ j Want ()1 due ventilation and; A tew cesspools. Oct. 1886. flushing. P. 4,210. (Sea-side resort, ; agriculture.) ' Newport U - - Some courts and ' Sewering extended since Dr. Bal- W.c's without Hushing arrange| T c , many private lard's inspection in 1880, but incuts, often filthy. In out-1 a t iS-"' yards neglected. not sufficiently. System still lying parts privy pits. Hepr. ls^ii. unventilatcd, and house drains p, 0,430. defective. Nuisance. complained ? ... , ol from escape of sower air into (Agricultural dwellings. market town.) BHANKLIN, U. - Not wholly satis- Almost completely sewered. In- ; W.c's without flushing arrange„ _ _ factory. sufficient ventilation and Hush- ; meats frequent source of nui- I. /?'o'- iU ' insr. House drainage often sauce, sept. 188.;. j defect i ve , I. 2,740. (Sea-side resort.) I SANDOWN, V. ' - ' Fair - - -I Sewered. Ventilation recently i W.e's or pan closets not duly A . r v practically abolished by order of Hushed. A few cessi»ools. oi i««S SIA - of sewer air; vet. i>,s.j. escaping at house connexions, i P. 8,120. Private drainage often defective. ! (Sea-side resort.) Veatnok, U. -i Fair on the whole Sewerage somowhat improved since I W.c's, but in cottage property Dr. Ballard's inspection in 1880, without flushing arrangements. h ''• °I* ar ' I but still needs improvement, j BoPt'looo- Ventilation improved. House p. 8,604. drainage stili imperfect. (Sea-side resort.) Rydf;, I.- - - ! Fair; with some Sewering complete and fairly I W.c's, some without flushing .. r s , exceptions in satisfactory. Ventilation mi- arrangements, v / iia- ' older courts. proved of late years, but more sept.lBBo. required. House drainage still P. 11,461. detective. (Sea-side resort.) ; 223 HAMPSHlRE— continued. 5. c. 7. ___ 8. 9. Sanitary Crowding Overcrowding of : Refuse Removal. \ Water Supply. Dwellings j of" Dwellings on Dwellings. of Poor. Area. i |_ I Efficient removal j Supply by a private company ' Town consists largely of crowded courts ! Not much. of domestic re- j intermittent. Poorer popu- j and alloys within the ramparts, which fuse. lationhavenostoragecistcrtis. latter themselves impede ventilation. i Many of the houses unlit for habita- : j tion owing to dampness and decay. With all this, and intermingled with i the crowded dwellings, lilthy foul privy pits and sloppiness and filth nuisances generally. Satisfactory- - | Mastl.y public supply, not Fair - - - Lit tie crowding • Rare, free from danger of possible pollution. Direct and dangerous communication bo- ! tween mains and sewers for flushing purposes. ; ' Public supply insufficient. Rain-water tanks in use. I i I i Satisfactory- - \ Public supply, although an;;- j Cottage property Narrow streets in merited, insufficient. Inter- | bad in parts, older part. mittent. Some wells liable although some to pollution still in use. improvements. j Neglected in | Public (Ryde) supply for about j Fair, with excep- < None - - - None. poorer quarters, half population. Rest sup-, lions, provision being , plied by underground rainmade only for i water tanks and shallow better class of | wells, houses. I : Unsatisfactory • [ Public supply from Caris- ! Many unsatisfac- j Several courts and Rare. lirooke. Sonic local wells, lory, although : back places. i liable to pollution. some improve- ! i i ments of late j years. I • i I i I | Unsatisfactory - : Public supply good, but in- j Fair - - - None - - - None. I adequate. Intermittent. , j About one-third of town supplied by local wells shallow and liable to pollution. Unsatisfactory in Public supply, with all the Fair - - - None - - - | None, poorer quarters. dangerous characters observed when district was inspected by Dr. Uallard in ' 1880. Some neglect • Public supply intermittent. | Fair - - - None - - - Rare. Protection given against | chance pollution since Dr.' i liallard's inspection. Still sonic neglect, Public supply improved in j Fair on the whole i A few courts - None, as noted at l)r. ! quantity. Intermittent : j I Ballard's inspec- storage cisterns sometimes i tion iv 1880. cxposetl to drain air. 224 HAM PS lI I R E — eon tinned. 1. 10. 11. 12. Urban Sanitary District. 1 Inspector anil Administration by Sanitary Work of Medical Officer Work of Inspector of f Date of Report. Authority. of Health. Nuisances. f l'opuliition (1881). Industries, &c. | Alveestoke, U. - Vci'v unsatisfactory. District M.O.H. an originally oner- Office vacitnl - M r g evidently in a very dun-; getic officer who has come ! iiJ!f- trerous condition foradvciif to acquiesce in an incom¦iui.yi.sN). of cholera. potent admiuistrtition of P. 21,581. : affairs. (Harbour work, | " shipbuilding, &c.) j Fareu-vm. V. - : B.A, seemingly auxious to Fair. M.O.H. not under Inefficient. I. of N. holds ? ? s carry out improvements, Board's Order. other offices which inter,;• ,',','' i but ' iK'tfliifcnl of advice of | fere greatly with his wort; Bept-isHo. | M-O .H. as I. of N. P. 7,183. (Agricultural market town.) East Cowbs, U. - Inefficieni - - M.O.H. has given sound — Dr. Blaxall, advlce *° 8>A ' May 1885. P.WU West Oowes, U. ! tnefflcient- - - - M.O.H. has been persistent Good ? ?. ? in his advice to S. A. .and m ico- "as got certain remedial Ma J lßB °- measures adopted. P. 6,721. St. Helen's, U. - ; Unsatisfactory. Admiuistra- Fair i Fair if, i <„,„.,, tive efficiency appears M 6ct:Sr fallin « off - P. 4,210. (Sea-side resort, agriculture.) Newpobt, U. - ! Lax and ill-directed. Bye- M.O.H. knows his district ; 1.0 l \. is surveyor also: lax Air FSi rir ! ilws ""^ rnlol ' ( ' ei '- I(3W wt '"- hui has failed to in dealing With nuisances ¦?',.'. ' improvements since Dr. Bal- | exert much influence with j and In administering byeoepi. 1880. , ard . H [ nS p CC tioii in 1880, | S.A. laws, but probably little P. 9,430. but points of prune iinpor- j | oncouraged by S.A. (Agricultural tance "' - ll - d ' cß ll'cß'dmarket town.) j Shaxklin, U. - Some general laxity of ad- Apparently on the whole I, of N. somewhat inactive - Mr. J. Spear. ministration. lair. Sept. 1885. P. 2,740. (Sea-side resort.) Sandown, U. - Lax administration. Closure | Fair Fair ..... •c r o of sewer ventilators ordered i (Vt'ijw ' '" opposition to advice of ; Oct. 1888. M.O.H. P. 3,12(1. (Sea-side resort.) Yextxok, U. - Administration improyed after Apparently on the whole Pair ¦vt,, , c,., .... Dr. Ballard's visit in 1880, : fair. 4",'<"ivv- I)Ut 110W tn ere are indica- | Kt.pi. isBO. tiong of re t rog j. esB i on , (Sea-side resort.) I Hyde, Y. ¦ - Lax, but some improvements Fair I Not wholly satisfactory - ¦.. , i s , . in town since Dr. Ballard's I a'Jti ' iQQK inspection in 1880. i 1 oCpi. 1000. Y. 11,401. (Sea-side resort.) 225 HAMPSHlRE— continued. 13^ 14^ 16. 17. h hi 5,"5 Result nf Board's subsequent Inquiry Abatement and | gg as to Action taken by S.A. on Prevention Hospital Provision. || | Recommendations of Inspector , of Nuisances. || g | with Date of Information. | 5 & S* __ Wholly inefficient. None - - - j None ¦ None - I September aud October 1888. Some action Filth and excrc- as to oleausing reported. No comprei ment nuisances i hensive sanitary improvements.— May | universal. 1886. Hospital provision in abeyance. Inefficient - - - None - - - None - None - ! November 1885. S.A. have clone something as to sewer ventilation, and have removed connexions between water mains and sewers; severance of direct communication between water service pipes and wuter-closei pans under consideration. I I None - - None - None - Mr. Spear re-inspected the district in September 1885, and found no evidence i of action since Dr. Blaxall's visit.— November 1886. S.A. have obtained a loan of :joo/. [or works of water supply, and are moving in the matter of sewer ventilation. No j hospital provided. None - - - I None - | None - | Mr. Spear re-inspected the district in August ISSS, and found that but little had heen done to remedy defects pointed out by Dr. Blaxall. In November 1885, S.A. say they are giving attention to some of Inspectors' recommendations. Nothing' said as to others, notably hospital provision. Unsatisfactory - - None - - - None - j None - | March 1880. 8.A., in a lengthy letter, make some show of action ; but reply frenorally very unsatisfactory. Inefficient - - - None ¦ - - None - None ¦ No subsequent inquiry to date. May 27th, Inefficient - - - None - - - None - None - May 1880. S.A.s reply very unsatisfactory as to hospital, sewering, sewer-ventilation, and refuse disposal and removal. (Xo hospital provided.) Inefficient - - - None - • - None - None - March 1880. S.A. report progress as to sewer ventilation, refuse removal, and improvement of private drains ; and promise revision of building, &c, byelaws. Satisfactory on the j None - - - None - None - No subsequent inquiry to date. May 27th, whole, due mainly 1886. to the action of a sanitary committee which has now ceased to meet. Not wholly satisfac- Yes - Stove at None - No subsequent inquiry to date. May 27th, tory hospital. 1886. 226 JCj O O 1-j -*.\-» 1. 2. 3. 4. Urban Sanitary District. Inspector and ffiSSraand i , Excrement Disposal and Date of Report. D«S!£tlo Sewering and Drainage. j Removal. Population (1S81). Premises. Indust rles, &c. ¦_ - — WEST Ham, U. • i Sonic parts dirty, Sewered, but at some incon- W.c's. Closet and driuki wato : . ? _, . ! parti v due to venience in parts on acconnt of supplies kept reparatil U°i iia" the ' degraded low level. System will, from i'oo. iss.>. character of increase of buildings, be P. 128,068. , population. probably soon over - taxed. .... , ? House drainage not fully satis(Urtuallv ; factory. A difficult district to part of the j j i wltn , tgA d j thcil . metropolis ; although : best with if ! not included in the j ' "eat Wltn it. i metropolitan district.) Soutjieno, U. - Fair - -Sewered. Insufficient ventilation W.c's not generally provided wit] M T f. nud flushing. House drainage flushing arrangements, but suci Z' iJfi- unsatisfactory. are external to dwellings. A jmov. 188.). few ))rivy |)jts , v prittlewell. P. 7/J79. (Sea-side resort.) Colchester, U. - Satisfactory, except Sewered almost throughout. Now mainly w.c's, but som ? ... in t be 'poorest Ventilators closed by S.A. privy pits still left. Kxert t ¦ r iiuV i parts. Sewers Hushed. mental nuisances not alway Jan. 188»i. kept under. P. 28,374. (Garrison town. Ordinary trade of ¦ market town.) I NORFOLK. i I " I Norwich, U. - i Poorer quarters Beweragc faulty, admitting large j W.c's with or without water flush .. ... unsatisfactory. volumes of spring water, to deal In poorer quarters privy pit Tim issi' v '" 1 wmt ' n pumping power is often old, large, neglected, an( jan. iew. Inadequate. Partial ventilation. very offensive: they are einptice P. 87,812. Sewage often discharged into j by contractors on requisition <-\f,,L,i.,*,i ..,,.»i- „ ; 1 1 - i the river instead of being' not in lixed rotation, but accord I ivniswni works, silk pumped to sewage farm. i ing to the number of complaints traffic &c 3 ' illlfl B PP UcßtionB "•eceived by 1 HUNTINGDONSHIRE. Huntingdon, V. > Courts and poor Town sewered. Ventilation quite W.c's insufficiently flushed. Ole Mr T Hnnnr dwellings often insufficient. House drains gene- | privy pits deep and neglected May 1885. neglected. rally dangerously imperfect. and a few privy middens. P. 4,828. (Country town, agricultural and trading population.) j ! Ramsey, U. - - Unsatisfactory, es- 1 Vublic and private drainage most i Large foul privy pits and middei Mr J Sdcti- peeially back- I unsatisfactory, liquid sewage privies of old bad type, ln- SrWissi' ' ways and private! not being effectually removed sufficient privy accommodation • r yards. from town, but stagnating in P. 4,617. large culverts and archways. (Agriculture.) 227 ESSEX. 5. 6. 7. 8. rondSof Crowding Overcrowding of I Refuse Removal. Water Supply. Dwellings of Dwellings on Dwellings. of Poor. Area. I . _ |_ ; . .__ . Unsatisfactory - Public supply, from K. London Much dirty and - — Occasional, but Waterworks, intermittent. unwholesome dealt with cottage property when dis(e.r/., Cherry covered. island, ana streets off North \Vool w i c h Road), but important improve m cuts made since last cholera cpideniic. Unsatisfactory - Public water supply con- Satisfactory on None - - Infrequent. stant and satisfactory. A the whole, lew local wells liable to pollution at Prittlcwell. Satisfactory on Public supply good from deep Satisfactory on A good deal of Occasional, but the whole. wells. A tributary supply the whole. crowding, in tho dealt with. from springs liable to sewage old (Roman) pollution. part of town especially. NORFOLK. (Unsatisfactory - Public supply constant, and Numberless courts and alleys thickly Nut infrequent, on the whole satisfactory. crowded with dwellings, often back- In lower and poorer parts of to-back, dirty, air stagnant, and city, shallow wells liable to both air and soil befouled by privy dangerous exeremental pol- | pits, the water being supplied by lution. shallow wells close to them. Many of these dwellings unlit for human i j habitation. lI U NTINGDONSHI HE. Unsatisfactory. No Public supply on constant j Unsatisfactory - Many courts in Occasional. public provision. system to about one-third centre of town, of town ; remainder from Town closely shallow wells almost neces- : mult, sarily dangerously polluted. I | | | Very uiuatisfac" ' Water from public pumps and | Unsatisfactory - Several small Occasional, tory. Large ac- other local sources insuffloient courts behind cumulations. No in quantity and liable to broad mam public provision. dangerous pollution. streets. 228 ESSEX — continued. 1. 10. 11. _____!2! 2 - — - Urban Sanitary District. Inspector and Administration by Sanitary ' Work of Medical Officer Work of Inspector of Date of Beport. Authority. of Health. Nuisances. Population (1881). Industries, &c. West Ham, U. • I S.A. made much improvement Efficient. M.O.H. not under Efficient - _. .. r ,, . . since old cholera times. The j Board's Order. l)r - ! r . ( '.'H"" 10 " 1 ' most serious fault is the low lM '"- 18S& - damp site of its houses, • !'. 128,953. to remedy which no mea.,. , „ sures are taken in the case plrtofX ofnewones. metropolis ; although not included in the | metropolitan : district.) fSorritENi), U. - i Pair and improving of late. Fair Satisfactory .... ? r „ faults at Prittlewell, obv J- iJJ. l -. ar ' served by Dr. Thorne at his Nov. ivio. inspection on account of I. 7,979. '-Fever" outbreak in 1880, | (Sea-side resort.) %££ l " bt ' stUl existenl Colchbstbk, U. -| On the whole efficient and Fair .... - Fair - Dr. Airy, progressive. Jan. 1886. l». 28,374. (Garrison town. < Ordinary trade of i market town.) NO FiFO LX— continued. I Norwich U. -Failure of costly sewering M.O.H. Rives little personal I. of N. active, and really does works in 1870* appears to attention to duties of his much of M.O.H. s proper r laafl" have discouraged B. A. City office. (Not under the | work. Jan. 1880. j n a (j an aerou« condition for Board's Order.) P. 87,842. advent of cholera. (Mustard works, I silk factories, river traffic, &c.) HUNTINGDONSHIRE— continued. Huntingdon, U. Very lax. Little attention M.O.H. an invalid. Has Inefficient - M T paid to details of sanitary now resigned. ti' isa- ar- work. District much in same may lass. , condition as at Dr. Parsons's P. 4,228. inspection in 1880, although (Country town, iv ™peoted in 188-*. agricultural and trading population,) Ramsey, U. - Ineffective. Town in pre- M.O.H. active, but his ad- Very unsatisfactory. I. of N. •« -r c cisely same unwholesome vice to S.A. somewhat in- is blind to most obvious ™ \v"itoii, drainage of very objectionable some, and are emptied once a March 1880. character. fortnight. Some 20 cesspits. P. 28,503. 231 HUNTINGDONSHIRE—co^ue*/. 5. 6. __ _7. 8. 0. (¦oSmof Crowding Overcrowding of Refuse Bemovnl. ; Wa. or Supply. Dwellings of Dwellings on towellings. ' I of Poor. Area. _ __ .. _ Very unsatisfae- ] Shallow wells sunk into same Unsatisfactory. None - - - j Occasional. tory. Large nc- > gravel bed us the privy pits Surroundings cumulations. No close to them. Most dis- I often dirty. public provision. I gusting and dangerous (see < col. 4). Very unsatisfac- ] Shallow wells sunk into gravel ! Generally clean, A few courts - < Some few iinvels. i tory. Large nc- ! close to leaky drains and foul but many dam]) j cumulations. No I privy pits, and necessarily and ill- ventilated. I public provision. ' dangerously and disgustingly polluted. CAMBRIDGE. ! I Very uusiitisfiic- : About two-thirds from Cam- Fair, but with nn- ' None - - • None, tory and slovenly. ' bridge Water Oo.'s mains, one- wholesome sursixth from a public well, one- roundings, I : sixth from shallow wells liable to dangerous pollution. Water j i supply being extended. ! Satisfactory - - Public supply constant and Fair - - • I Much crowding in i Occasional, good. Some dangerous shal- parts and backlcivv wells still in use. to-back houses. Artizans l>wel- I lin^s Act about to be applied. LINCOLNSHIRE. ____ . _ — j Unsatisfactory - Public water supply from Very unsatisfac- Dense crowding None observed. Trent, and most dangerously tory. in older parts, polluted with town sewage discharged into the river. Some wells. Scheme on foot for v new supply. Partly public supply, constant — and good. About So wells liable to dangerous pollution from imperfect sewers mid drains. 232 HUNTINGDONSHIRE — continued. 1. 10. _1L 12^ Urban Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. ! Authority. of Health. Nuisances. Population (1881). | Industries. &c. —. i | GoDMANCHKStfiB, Vei-ylax-and inefficient. Town I Further personal influence 1. of N. is a. young officer, who U. in same condition as when ¦ with B. A. required, has hardly yet taken up "T" T T „ inspected by Dr. Parsons j his work. U" ,i!- in 1880 and again in 1881. -May j.ooi>. P. 2,188. (Agriculture.) St. Neots, U. - [netlicient .... Fair Fair - .... Mr. J. Spear. May 1885. | P. 4,261. (Agriculture.) CAMBRlDGE— continued. Chesterton, IT. - S.A. have done some good j Satisfactory. District has Inefficient; I. of N. engaged ? . o work, but can do coin- ! been improved through too much in other duties. t ilT paratively little withoul i the action of M.O.H. June lose proper building byelaws I. 5,706. and until district is duly (Agriculture sewered. mainly.) Cambridge, U. - Slow progress ; but some use- Aery satisfactory - - - Satisfactory .... Dr Airy lv ' wo " tulle t ulle - I )ec. 1885. P. :>5,30:i. (Mostly occupations connected with University.) LINCOLNSHIRE— continued. Gainsborocchi. Miserably inefficient. Town M.O.H. zealous, and would Inactive .... [J, in a most dangerous con- be efficient with an active T . .. dit ion for advent of cholera. S.A. He is not under i ,S« Suffered heavily in 1866. Hoard's Order. I. 10,87:5. (Agricultural implement works, &c.) Great Grimsby, Inefficient ... .—. — U. Dr. Blaxall, March 1886. P. 28,503. 233 HUNTINGDONSHIRE— continued. I 13. 14. 15. \Q^ 17. I k it ~ §/3 Result of Board's subsequent Inquiry ; Abatement and J> gg as to Action taken by S.A.. on Prevention | Hospital Provision. |= _| Recommendations of Inspector ; of Nuisances. eg •§ g jj. lto o{ information. .2 ft So » No serious attempt | None - - - None - None - June 1885. Some notion to be taken re made drainage, excrement disposal, and scavenging. NothiEg said concerning water supply. No steps taken to date to provide hospital accommodation. May 27th, 18SIJ. Habitual neglect - Xone - - - None - None - No subsequent inquiry to date. May 27th, I CAMBRlDGE— continued. Ineflicient - - - None - - - None - None . No subsequent inquiry to date (May 27th, ( 1886) : M.0.H., in 1885 report, speaks of privy pit nuisances, of want of drainage scheme, of need of improvement of scavenging : and also of need for provision of cottage hospital. Satisfactory - - Yes- • - - Fraser's Nothing of No subsequent inquiry to date. May 27th, apparatus, much note. 1880. LINCOLNSHIRE— continued. No dealing with Yes, but a prohibi- Nelson's, None -No sulisfnui'iit .inquiry to «Jnt« (May 27th. 1 nuisances although tory tariff having at hospi- 1886), but oan of 1.433 J. *»««« reported. been imposed, it ; tal, but water Bupply sanctioned in September has never been ] never 1885. used. been used, and: now rust- Yes, but unsatisfac i None - None - May 1885. B.A. ftro carrying out Dr. ?¦ to ?y_ Blaxall s recommendations. [¦¦ i E 20510. Q 234 1 q V ' A \ t <£ ¦ *-* ' ' - ¦ I ~~ Urban Sanitary Cleanliness of Excrement Disposal and SatTofKrt. El^^H Wl Beweri »« ""* Drai " !lfr "- Be-val. i Population (1881). Premises. Industries. &C. ! sii,\i,,i-Tii r - : Poor Quarters neg- Sewering fair and fairly ventilated, ; W.c's. No flushing arrangement Simioi in, i . , .oor quarters neg but flushing defective. Private ' in cottage property. W.c's of tei Mr. J. Spear, ieiW)ll drainage generally defective, in improper situations. Cess- Aug. 1885. an d consequent nuisance. pools have been abolished. i (Sea-side resort,) St Titomas TJ - Unsatisfactory - Sewered. Tnadequate ventilation. W.c's with flushing arrangements, ST. ihomas, v. - | unsatisractorj |?.j,.1 1(. drainage exceedingly bui occasionally improperlj Mr. J. Spear, defective. Many dwellings) situated. Aug. 1885. polluted with drain' air. (Shop-keeping, &c.) Exmottth U -' New system of sewering satis- W.c'n; some not adequately ¦ ' " factory. Sewers ventilated and flushed. Cesspools abolished. Dr.D.S. Dayies, ; flushed. .March LBB5. I Budleigb Sai- Fair, except poor Sewered satisfactorily. Ventila- -Mainly w.c's without (lushing teuton U domestic pre- tion fair. Private drainage often arrangements, and apt there raises. very imperfect in construction, foro to he foul. Mr. J. Spear, anilunwholfismne. Aug. 1 885. P. 1,908. (Sea-side resort, fishing.) Exeteb II - Domestic premises Sewewold.somedecaycdandlcaky. W.c's; some without flushing ar¦ ' in lower quarter Unwholesome, ollensive dis- rangements, and closets often Mr. J. Spear, (|f . (lju . ,„,,,.], pusal ol'sewaw. Sowers jiracti- improperly located (in cellars Sept.lBBs. neKlected cally unven'tilated. Private &c). In older parts inadequati p ;i7(;(; - drainage exceedingly defective, privy accommodation. ._ . ; polluting many dwellings with (Centre o alargc Krninair. agricultural district.) Teiqnmodth I' - Newly sewered. Sewers venti- W.c's mostly with Jlnshinfr ' V , ,/• lated and Hushed. House arrangements. Dr.D. S. navies. drainage satisfactory. March LBB5. P. 7,120. (Sea-side resort.) Torquay, U. - Good - - Sewered satisfactorily. Ventila- W.c's satisfactory - - - - ¦rv tj a j) • tion and flushing satisfactory. March 1885. P. 24,767. Dartmouth, U. - ' Old system of sewers. Main W.c's with separate flushing -p. .„ ? . sewer more recent. General boxes. J i El6B'E 168 ' ! condition of sewers not satis- MarchlBBs. factory. Inadequate flushing P. 5,725. and ventilation. LOWEB BBIXHAM, U. — Sewered. Sewers (lushed but in- [Many houses without any privy . adequately ventilated. accommodation, there being no Dr. I), s. Danes, ' room about them. Hence, ex- March LBB5. crement stored iv the bedrooms p. s,3ij(|. &c., until collected by town scavengers. Salcombe, U. - i Many old square and somotulm- W.6'g, biit many houses without •p. ? c ,, . lar sewers. Ventilation and any privy accommodation, ex\i V ,!i'^ l( ' s ' flushing imperfect. House! crement being stored in room marcn ism... drainage inisaiisCaetorv. and cast away every mornitiK P. 1,822. into estuary. No space often for erection of privies. 235 DEVONSHIRE. 5. _c ! _ 7. 8. 9. Refuse Removal. Water Supply. °S|| f of Dwellings on ° of Poor. Area. Not wholly satis- Water works supply very par- Unsatisfactory - Several ill-kept Infrequent. factory. tiul and intermittent. Cot- courts and back Stages have no storage cisterns. places. Supply chiefly, however, from shallow wells, necessarily in constant danger of pollution. ry- - . Public supply on constant sys- I Some dirty with Many small courts infrequent, teni mostly; not sufficiently unwholesome behind main guarded from dangerous surroundings. thoroughfares. pollution. Not wholly satis- Public supply constant and factory. good. 1 Some shallow wells j still in use. but looked after. Wholly unsatis- Public supply partial. Two- j Fair, with excep- Few courts - - None. factory. thirds of population insulli- ; lions. oiently supplied by shallow I wells much in danger of \ pollution from drains. Efficient - - Public supply from sources not Many decayed In lower quarters Considerable. free from pollution. Constant and filthy. a network of j service, but storage cisterns j courts and alleys still generally used, the same with houses cistern serving for domestic lilthy and disupply and flushing closets. lapidated. Paving of courts, however, now proceeding. I Fairly satisfactory Public supply intermittent, but otherwise satisfactory. Satisfactory - - Publjc supply constant and satisfactory. Satisfactory- - Public supply intermittent; good. Few shallow wells, probably soon to be abolished. Satisfactory- - Public supply constant ; good. '. — j Unsatisfactory - Public supply. Constant only ; for paw of year. 236 DEVONSHIRE — continued. | - | Urban Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries. &c. Sip-mouth, 11. ¦ ! Inefficient - - M.O.H. appears anxious for , Inefficient .... improvements, but advice Mr. J. Spear, given to B.A. in respect of Aug. 1885. certain dangerous condip. 3|3 | [;,-,, t ions has been inadequate. (Sea-side resort.) . I St. Thomas, U. - Fair, but deficiency in the j Unsatisfactory - - - Unsatisfactory , r T ., matter of skilled advice. {'" iJ«- ' District far from safe on Aug. 1885. advenl of C holera. P. 0,161. (Shop-keeping, &c.) Exmouxh.U. - Satisfactory- - - - Satisfactory - Dr. I), s. Davies, ¦ March 1886. I. 6,2 15. Bttdleigh Sal- Pair on the whole, but much Fair Not satisfactory. I. of X. is a xertos, L T . important work yet to be grocer in the town. Mr. J. Spear, ( '"' l( '- Aug. 1885. P. 1,908. (Sea-side resort, '¦ fishing.) Exetbb, U. - - Inadequate for a city of such Judging from report of !I.of N. fairly competent, and ? T c,, „ „ importance. City far from M.0.H., unsatisfactory. lias one assistant. J.iil'i- safe on advent bf cholera. The three D.M.O.'s act r(|H - 1 " >)- Suffered heavily in 1800. as assistants, have a fair P. 87,665. knowledgeof their respective districts, report upon details, ,-, .. , and otherwise do useful work, but it is not their part to centre oi a large , j ,n, n . 0!|(1 , in(l comprehensive advice. M.0.11. is not 111 . 11 ; 11 under Boards Order. Teignmouth, U. I Satisfactory - - - •! Satisfactory - • Satisfactory - Dr. 1). S. Davits. ! .March LBB5. P. 7,120. (Sea-side resort.) TOKQUAY, U. -j Satisfactory - - - • Very good - - - Very pood i Dr. D. S. Davies, Maiyh 1883. 1\ 21,707. DaetmoutH, U. - j Fair Fairly active ... Fairly active - Dr. 1). S. Davies. March 1885. P, 5,725. Lower ßrixitaii, S.A. made improvements j M.O.H. not under Boards U. during last few years, i Order. Dr. D. S. Davies, Slowly progressing. March 1883. P. 8,866. Salcombe, U. - Satisfactory- - - - Dr. D. S. Davies, March 1885. P. 1,822. 237 DEVONSHIRE— continued. 13. 14. 15. 16. 17. •*" * £ I ' gi/o Result of Hoard's subsequent Inquiry Abatement and J> |g ;|s u> Acf . m taken by g#A _ Qn Prevention Hospital Provision. |j Recommendations of Inspector ; of Nuisances. |g with Date of Information. Inefficient - Small; wholly in- None - None - December 1885 — January 1886. Scheme adequate. I for formation of water company on foot. j Action in progress on other matters. i February 1886. Loan granted for works of sewerage. 1 Sonic progress being Exeter Hospital None - j None - November 1885. Koine sewer-ventilation made on the whole. used occasionally. accomplished: scheme of water supply improvement in process of completion : other points of Mr. Spear's advice are being attended to. Satisfactory - • None - - - None - j Prepared No subsequent inquiry to date. May 27th, Unsatisfactory - - None - - - None - None - M.0.H., in 1888 report, shows that water supply is now constant! and that S.A. have undertaken the duty of scavenging. Inefficient dealing j Yes, but unsatisfnc- Yes - - None - No information forthcoming to date in i with recurring nui- tory and slovenly reply to Board's repeated inquiries as to sauces. in management. action of S.A. on Mr. Spear's recommendations. June Kith, ISSO, Satisfactory - - Wholly inadequate- Yes- - — M.0.H., in 1888 report, shows that good work lias heen done as to water supply and sewerage. Nothing settled as to ] permanent hospital. Efficient - - - Satisfactory pro- Yes- - Prepared No subsequent inquiry to date. May 27th, I Satisfactory. — — June 1880. S.A. endeavouring to obtain ! site for hospital, and meanwhile have in I view the provision of flouting accommodation. None — — June 1880. S.A. reply, after repeated in- ! (|iiiiics, tlia) ;i committee has been j appointed to secure a house for hospital I purposes. No satisfactory information furnished as to steps to Vie taken in j regard of privy accommodation. None ... — — No subsequent inquiry to date. Julvisth, I 18S0. 238 DEVONSHlRE— continued, 1. 2. •*• i ~ I ! Urban Sanitary District. , , _ j Cleanliness of Excrement Disposal and Date of Report. Domestic Sewering and Drainage. Removal. Population (1881). Premises. Industries, &c. Pitmouth U -Domestic provi- Sewered. Defective flushing and W.c's, many without flushing arsion bad in ventilation. Sewage nuisances rangements, but excrementel Dr. Blaxall, places, but im- in certain places. Lower parts nuisances much loss than in June 1885. provement since of town subject to flooding by 1878. j' 7;i7i)i. Dr. Blaxall's in- sewage. (Chemical and other spection in 1878. ; works, shipbuilding, &c.) Past Storehouse Pair - - - Sewering very unsatisfactory. All ' W.c's, many withoul Hushing arthe ventilators closed by S.A., rangements, and m a lilthy with danger to the population. | condition. Dr. dlnxall, Jlouse drainage unsatisfactory. June 1885. P. 15,041. Dkvospoht l r . - ] Fair - - - Sewered, and old sewers being W.c's. Those in poorer quarters re-constructed. Old sewers not without Hushing arrangements. Dr. Blaxjß.ll, , ventilated, but now ones are June ' SSi - ventilated and flushed. i Shipbuilding.) CBEDITON IT. - ; Unsatisfactory - Sewered. Two of the main sewers W.c's a common nuisance from , are sewers of deposit. Unventi- iuadequate flushing. Often a ¦'??? lated. Private drainago very choked and overflowing from April LBSG. unsatisfactory. neglect where flushing arrangel> i^gij. ments have not been provided. (Market town.) '¦ Babnbtaple, U. -Satisfactory- - Sewered. No ventilation and in- Mostly w.o s | ns tj ¦ sulticient flushing. Improvet I iffi ments in these respects, and in juij Looo. house drainage] in contempla- P. 13,271. tion. i Agricultural market town.) Ilpbacombe, IT. - Very satisfactory Sewered and drained satisfac- I W.c's i satisfactory Dr. D. S. Dmvics, torily. Ventilation free. July 1886. P. (i,255. (Sea-side l'esort, lishiiiK.) 1 EiDKPOEi), U. - I Satisfactory - - Sewered. Ventilation and Hush- W.c's, but some without Hushing ,-,,. T > a Tla ,,: n . ing. House drainage less satis- arrangements. July 1885. factory. P. 6,512. ( .'Market town, shipbuilding.) j Nobtham U. - - Fair - - - Drainage fairly complete - - W.o's .satisfactory. A few privy Dr. D. S. Davies, : |)lls ' July 1885. P. 4,464. (Fishing, ship- j building; partly seaside resort.) 239 I ) X VONSHlKE— continued. _ _ rr o O 5. O. /• O- *?• cSffiEfof Crowdin 8 ! Overcrowding o! , I Rbf use Removal. Water Supply. Dwellings •of Dwellings on • Dwellings. of Poor, Area. Improved, but j Public supply inadequate, and Many dirty and ' Many crowded i Overcrowding, bul still defective, still exposed to pollution in some dilapl- i ami confined it is dealt with its open course to the town. ; dated. streets. by S.A. Unsatisfactory. Public supply intermittent, Fair - - - Many close courts, Much crowding, Nuisances from inadequate, and suspicious bul generally a but ouer-vvoxrdoffensive acou- in quality, storage tanks lair amount of ing doubtful, mulations. (many underground) having air space about overflow into drains. dwellings. Efflcioni - - Public supply on constant sys- Fair - - - Dwellings on the Much crowding, tern abundant and good. most crowded but owr-crowdareas have been > ing doubtful. demolished. Some j close courts still exist. Very bad, and Shallow wells, probably all ; Often unsatis- ' Yes - - - Infrequent, many pigstye nui- liable to sewage pollution. factory, with i sances permitted. Two public pumps. Alto- filthy surroundgether insufficient quantity ings, of water. I Satisfactory - - Public supply constant and Satisfactory - - Little crowding - Infrequent. satisfactory. Satisfactory- -'Public supply constant and Good - - Some crowding- Occasional in the good. near the quay. "season. 1 Satisfactory - Public supply constant. A few Good out lie whole Little crowding. None. wells still in use, but looked Much clearing after. effected. i Satisfactory- - Public pumps and wells, ap- : Fair - - - j Some overcrowd- Some at Appleparently wholesome. Some ing at Apple- dore. suspicious private wells. All dore. looked after. 240 ] )B VONSHI RE— continued. 1. _Jillt - *° " 1C '' °^ proper about to resign.) April 1885.' advice< I -P. 4,105. . j (Market town.) BaenstapijE, U. ¦ Satisfactory .... Energetic and efficient - Very good - Dr. D. S. Davies, July 188"). P. 13,271. (Agricultural market town.) li.feacombe, IT. - Fairly satisfactory - - - Active and efficient ¦ - Efficient Dr. 1). S. Davies, July 1885. P. 6,255. (Sea-side resort, fishing.) Hideford, U. - S.A. have done good work - 1 Satisfactory .... New olh'ccr .... Dr. D. S. Davies. July 1885. P. 6,51-2. (Market town, shipbuilding.) Northam, U. - : Satisfactory - - - ¦ Very satisfactory • - - j Good on the whole - Dr. D. S. Davies, ! July 1885. P. 4,454. (Fishing, shipbuilding; partly sea-side resort.) I 241 DEVONSHlRE— continued. 13. 14. 15. 16. 17. ""• e.'g Result of Board's subsequent Inquiry Abatement and g> fc 3 : ,s to Action taken by S.A. on Prevention Hospital Provision. |J Recommendations of Inspector ; of Nuisances. Jg |g with Date of Information. .2 ft |,-S fi OS Improvement since , Yes, but still very ' None - None - September 1885. Sewage nuisances folic 1878. unsatisfactory, abated by means of new works, save si j and faulty in its Sutton Pool, as to which the S.A. are in administration. correspondence with the Harbour Commissioners. New permanent hospital to ! be provided ; application made in 1886 I for sanction to borrow 0,600/. for site. Inefficient - - - None - - - None - None - No reply to date to Board's repealed inquiries as to action of S.A. on Dr.Blaxall's memorandum of advice. July Ist, 1886, Efficient ... None - - None - Made some No subsequent inquiry to date. May 27th, I prepara- 18S0. tions. Inefficient. No at- None ... None - i None - December 1885. Some action reported as tempt to deal with taken or proposed on certain of Mr. recurring nuisances. Spear's recommendations : nothing said as to scavenging or hospital provision, i Satisfactory - - None, but S.A. con- None - None - Application made by S.A. in 1886 for sanetemplate erecting tion to loans for hospital and works of hospital. sewerage and street improvement, Satisfactory - - Yes .... Chemical Prepared No subsequent inquiry to date. May27tli, disinfect- 1886. ing chamber. Small hospital in None - None - No subsequent inquiry to date. May 27th, I course of erection. ' 18Sti. ! (See Port Survey None - ! None - No subsequent inquiry to date. May 27th, abstract.) 18Pii. 242 CORNWALL. 1. _2. 3- 4. 1 Urban Sanitary District. T ?,..,,,,1 Cleanliness of Excrement Disposal and ffior Report. ""gSto 1 * Sewering and Drainage. Removal . Population (1881). Premises. Industries, &c. . | - . Padstow.U. - -Satisfactory -Sewered - ¦No privy accommodation to some ±ajjoj.u.., l. houses, and from I hem excre- Dr. D. 8. Davies, ment is collected by pails. A June ISS3. few w.c's without, water-flush p i hqq arrangements. (Seafaring occupations and shipbuilding.) | Vuwqttat IT - ! Sewering completed, having been W.c's, but many without flushing '"""*' extended after Dr. Ballard's in- arrangements. Dr. 1). S. Davies, spection in 1879. Flushing, but June 1885. inadequate ventilation. P. 1,000. (Sea-side resort.) Truro U - - 01(l 1 >iifß or stone sewers now ! W.c's mostly. Privy pits and ' ' being replaced by pipes. Plush- cesspools being progressively Dr. D. 8. Davies, ing, but insufficient ventilation. abolished. April 1885. Outfall of sewers unsatisfactory. P. 10,619. ¦outh, U., i Fair - - - Sewered. Ventilation inadequate. W.c's to most houses. Afewcess- Falmottth : Deposit tanks within town, a : pools and privy pits left, i ISI j' v, possible danger during a cholera season. House drainage not hit report.] qu}te satisfactory. Dr. D. S. Davies, March 1885. P. 12,131. (Port, and health resort.) Peneyn U. - - Pair - - - : Pipe drainage only lit for .slop I Mostly large open midden privies, 1 ' and surface water, but used for rarely emptied. Dr. D. S. Davies, a l, ou( 10( , w\Sl). Industries, &c. I _ . ! Padstow, U. -Satisfactory .... Very fair. M.O.H. advises Excellent Dr. D. S. Davics, well< June 1885. j (Seafaring occu; pation and shipbuilding.) i Xkwquay, U. - i Evidently someprogress made I Dr. 1) S Davies since Dr. Ballarcrs inspcc- P. 1,000. j (Sea-side resort.) ; Tei'ko, U. - - Making progress. Satisfactory - ¦ ; Dr. D. S. Davies, i April 1885. V. 10.U19. l'.w.Jiorrir, U., : Fair, but efficiency weakened ! Very good - - - • I. of N. is Surveyor also in , and Falmouth I by want of unanimity be- both districts. Capable man l'Aßisir, U. tween S.A.s of town and I [Joint report.] parish. ': Dr. 1). S. Davies, ! March 1885. P. 12,131. ! (Port, and health resort.) I i PBHETif, TJ. - | S. A. slow to see danger of ex- j M.O.H. a good and able I. ofN. acts under direction ! l)r D S Davies I crement nuisances, although officer. Advises S.A. of M.0.H., but timidly. '?, 'i,,' 188 . ' pressed upon them by ; soundly. Julj 1880. M.O.H. P. 3,10R ' s ' cesspools now in the town. P. 6,795. i i . . . SOMERSETS 1 11 RE. I BuiiirnvATEß, U. - I Unsatisfactory sewering. Sewers W.c's without any flushing ar,,, ?, ?. of stone; porous. Xo venti- rangements, discharging into k'i iS- lation, and imperfect flushing. the imperfect sewers. BxcreieD. iBB.j. House drainage not satisfactory. mental nuisances of exaggerated P. 12,007. character. Chard, U. - - Fair, with exeep- Sewering fairly efficient. House W.c's, without flushing arrange- M , T n tions. drainage unsatisfactory. nients. Not sufficient number May'lBBs. "•' s01 "° parts# A few ))rivy P. '2,411. '" 8 ' (Agricultural markei town, linen, lace, and collar manufacture. GLOUCESTERSHIRE. Gloucester, U. - Sewering unsatisfactory; im- Mainly w.o's without flushing 1)r Blaxall provement contemplated. arrangements. Jan. 1885. ' P. 36,521. Bristol, U. - - Sewered, but no ventilation. W.c's, and other forms of water T)r Hlnvnll House drainage ill course of carriage of excrement. Jan. 1885. improvement. P. 200,874. I 247 i DOR SETSIII R L . 5. __6. 7. 8 . 9. ? Sanitary Crowding Overcrowd in,-; of j Refuse Removal. Water Supply. Swellings of Dwellings on Dwellings. of Poor. Area. Satisfactory- - Publio supply on constant system. Satisfactory - - j Public supply ponstant and I pood. Unsatisfactory ¦ ] Public supply on constant sys- : Unsatisfactory - Some close oonrto Some. tern; but some drinkingwater cisterns used also for Bushing closets. Satisfactory - - Public supply constant and good to about half the houses, and in course of being slowly extended. Otherwise suspicious shallow wells. SOMERSETSHIRE. Satisfactory- -Public supply constant and Revoltingly filthy good. A few wells exposed places noted ill to pollution, but public sup- ¦ Dr. Blaxall s inply being extended. , spection in 1874, are in same condition still. Very unsatisfac- Public supply by some stand- : Many dirty damp, j Many close courts ! Occasional, tow, and much pipes, and to two-fifths of and ill-ventiresultant nui- houses. Constant. Liable | latcd. sance. to pollution of dangerous | GLOUCESTERSHIRE . Satisfactory- - Public supply; liable to pollution from direct communication of sewers with w.e's, Wells close to pervious sewers are also in use. Satisfactory- - Publio supply satisfactory 1 248 I i Urban Sanitary District. Inspector and Administration by Sanitary j Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. Poole. U. - - Appears energetic. Satisfactory- ... ¦ Dr. 1). S. Davies. Feb. ISBS. P. 12,810. Wbymctoth, U. ¦ Good I. of N. a good officer at one _ _, „ .... . time, but now getting old ' ftb^ 1U1(l lesS effldent ' P. 13,715. SiiERDOKXE, U. ¦ Fair Fair, although further oner- Fair, but on occasions I. of N. -, r , , getic action required. has objected to visit infected M«»ita' houses on account of bis M»y isno. occupation, namely, a dairy- P. 5,053. man and milk seller. (Market town, silk factory, glovemaking.) BRiuronT, U. - Dr. 1). S. Davies, Feb. 1885. P. 6,795. SOMERSETSHIRE—cowftVmerf. I Bridgkwater, U. i Inefficient. Town in a danger- — - ¦pi -?, ? ous condition for advent of 1)1. lilaxall, nlinlprn Feb. 1885. cnoiera. P. 12,007. Chard, U. - Fair on the whole, but many No systematic inspection, j I. of N. works up to a very Mr J Spear failures. influence of M.O.H. in I low standard. "\iay iss*i ' direction of sanitary iin- ! provements not great. P. 2,111. (Agricultural market town, linen, lace, and collar ; manufacture.) GLOUCESTERSHIRE— continued. CiLOrCESTER, IJ. - , Dr. Blaxall, Jan. 1885. P. 86,521. Bristol, U. - Efficient j Excellent - Efficient Dr. Blaxall, Jan. 188"). P. 200,781. 249 DORSETSHlRE— continued. 13. 14. 15. J6j_ _ 17. ~ g t g/5 Result of Board's subsequent [nquiry Abatement and g^ |£ as to Action taken by S.A. on Prevention Hospital Provision. |s | Recommendations of Inspector ; of Nuisances. -g | with Date of Information. — — ft'C 0 j» „___ _ _ _ Same hospital pro- None ¦ — No subsequent inquiry to date, May27th, rision as for port. '¦¦ 188fi. Satisfactory. — — No subsequent inquiry to date, May 27th, Satisfactory on the Unsatisfactory make- None - — No subsequent inquiry to date (May 27th. whole. ' siiiii for eholei'a. 1888), Iml loan of 0.01)0/. sanctioned in Nbhospital for in- April 1885 for works of water supply. _ ::: . ¦ __ : for possible cholera, | has been done in regard to the substi- j but unfitted for , tution of the public wain supply to | the piu'pose, houses supplied by wells. SOMERSETSHIBE— continued. [nefflcient - - - Small, inefficient - June 1885. Some steps taken in regard to hospital, l>ndly closet accommodation and defective pro- | situated. perty. January 1886. Loan <>l 1,288(. sanctioned tor works of water supply. April 1880. S.A.. alter protracted delay, mnke unsatisfactory general reply as to defective sewerinf? and the like. [nefflcient - - - None - - Nor- - None - No subsequent inquiry to date, July 15th, LBBO. GLO UCESTE RSHlRB— continued. Yes, but in many - - November 1885. Some alterations at ' respects of objec- preseni town hospital lo be carried out. \ tiouable character. *\ hnve not actwl on repeated advice of Board and their M.O.H. to provide more adequate and satisfactory means of isolation for the city. Systematic and em- Yes- - - - ¦- i Preparing No subsequent inquirj- to date. May 27th, cient. i 18S(l - | ._ 1 . __L I 250 LANCASHIRE. 1. 2. 3. 4. ___ ¦ ; Urban Sanitary j Inspector and SJSand Excrement Disposal and Dateofßeport. %3ic Sewering and Drainage. Removal _ Population (lssi). Premises. ¦ i Industries, &c. i ; |_ I _ __ |_ _____ LtthaMi U. - - Bye streets in very Sewering improved of lain years, W.c's and many very unwholesome ? ?. ? "dirty condition. but ventilation and fiushingin- cesspit privies of worst type. a i' u \- ' ' • efficient. House drainage mi•Ul- -- Ul 1885- I satisfactory. P. 4,122. (Fishing) I Fr.EETwooD, I. - Some bnok st roots 1 Sewered. Inefficient ventilation. Cesspit privies of worst type with t, ?, n and yords dirty. Sewage nuisance at Copse ditch, overflows into drains, w.o'sin \ iuw- Honse drainage defective in old new houses. Aug. 1885. property. P. 0,733. (Shipping I ratio, fishing.) I \ BIiACKPOOL.IT. - Pair, oxeopi al Sewered. Ventilation nml (lush- 'W.c's and midden priyiesi tlio n ? Queenstown, a iiij-r defective, llniise drainage latter being progressively im- DeclBBs poor quarter. . satisfactory, proved u way. I. 1 1,229. (Soa-sidc resort.) Lancaster, U. - Unsatisfactory - i Sewered. Ventilation very do- j Mostly w.c's, but in some pianos .. ?, n fective. <»hl house drains dv- large privy pits (misnamed I A r iss- fective. "earth closets") sources of Aug. 18b.). great nuisance, especially on I J . 20,(103. iicinj? emptied. (County town.) ; I i I I l'ori.To\, Babe, ; Very satisfactory- ' Sewering satisfactory, but ventila- \ W.c's and middeu privies ash Torhis- ! tors obHtrncted by charcoal holme, !'. trays. Duly Unshod. Dr. Pnge, Dec. ISSS. I P. 3,931. j i ¦ (Sea-side resort, fishing.) Liverpool, lT. - ! \? n \x . . . Sewered. Some dm sewers mn- ; Mainly w.c's. Trough closets I)!, ;{]. u .,n tain deposit. Spwert; vputilnted now' substitutocl lor cesspits VI by 1885 ' '""' " lls '''' 1 '- ! |md midden privies which used in bo source of inucli rmisance, P. 552,508. (Port, &c.) i Toxtetii Pabk, i Unsatisfactory in Sewored. Sowers venl lated. ! W.c's mostly, but unwholesome U. old pai'ts. Flushing uuHatiwfnctoi'y. cesspit privies met withi which Dr. Blaxall, I tyro a nuisance. May 1883. P. 10,308. West Derby, IT. . > Unsatisfactory in Populous plncos sowered. Yon- W.o's. some without flushing Dr Wax-ill older parts. , tilatinu imperfi'ct. Some nrrangements. Foul midden vr'nviaHß ' ventilators closed ill-advisedly. i privies of worst type and (.osspools used m rural parts neglected. P. 38,014. which are not sewered. I Waltou-on-the- Sewering fairly efficient, Iml I Mostly w.c's of good construction, Hill, IJ. offensive mnells from the grids but old cottages have deep privy Dr Blaxall indicate some faultinesH or | pits, creating grave nuisances. May 1885 ' defective ventilation. Flushed. P. 18,536. (Rapidly growing residential locality.) 251 LANCASHIRE. 5. 6. 7. 8. 9. ! I i Co S ndl&f i Crowdln « I Overcrowding of Refuse Removal. Water Supply. kings' lof Dwelling* on I)W{lllillg! , of Poor. Area. i i _ ! " ! " " ""'' ~ 1 > ! Unsatisfactory - Public supply constant mul Fnir - - - \one - - - Little or none, good. One pipe, however, Baid (o pass through a sewer. I j Unsatisfactory - Public supply constant mid Fair - - - None - - • i Little or none. said to be pood. I j ' : Satisfactory - - Public supply constant and j Pair generally. ; Pair, but some Excessive (hiring good; tmi in rural purls Improvements crowding in i visitors' season, wells and rain-water cisterns, j progressing. central part. Unsatisfactory - Public supply constant and Fair - - - 1 Some very confined Very little. good. courts. Unsatisfactory ¦• j Public supply constant and | Satisfactory - - None - - - None, wood. i ! I Satisfactory - - ! Public supply considered Many rookeries abolished, but still wholesome, Suit not tree from I frequent crowding in unwholesome suspicion. New scheme in ; tenemented dwellings in some, I liaiul. especially the Irish quarters. ' i Although many occupied cellars , closed, yet cellar occupation existent. : Unsatisfactory - Public supply from Liverpool i Dirty unwholesome dwellings in lanes ; Corporal ion Works as above. ! and courts, with some filthy privies ; 1 Drinking water occasionally j of the worst type. drawn from w.C. cisterns. Unsatisfactory ¦ Public supply from Liverpool In the. pari adjoining Liverpool the ! Corporation Works as above. houses sub-let. At "Old Swan" j Constant. Occasionally drink- many of the bouses are dirty, with i ing water drawn from w.e all kinds of filthy surroundings, cisterns. I Unsatisfactory - Public supply from Liverpool . Corporation works as above. Constant. Occasionally drinking water drawn from I w.c. cisterns, it 2 252 LANCASII I RE— continued. I . 10. 11. 12. i" ¦ ! Inspector and : Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Lttham, U. - Neglected M.O.H.'s advice as Satisfactory - - 1 Unsatisfactory,. m || ;is to remedying some in, ' x '_ ¦ sanitary conditions. Wig. ISSi). P. 4,122. (Fishing.) Fleetwoop, U. - Inefficient j M.O.H. has advised soundly Satisfactory - Dr. Blaxall, Aug. 1885. P (5,733. (Shipping trade, fishing.) I j Blackpool,!. 7. - I Active, efficient, and progres- I M.O.H. active, advising | Active andvery efficient under Tl , p OD , n sive. well, and doing excellent j M.O.H.'s direction, Dec. 1885. VVOrk ' P. 14,229. (Sea-side resort.) Lancaster, I. - Fair, but not sufficiently active | Satisfactory - - - - j Satisfactory - l)r Klivill '" s "PPressing privy and I K'S refuse nuisances. P. 20,663. (Count v town.) Poulton, Hare, Active and efficient - - -Satisfactory - Efficient. I. of N. is surveyor ato Torris- ¦ also. HOLME] U. Dr. Page, i Doc. 1885. P. 3,931. Liverpool, U. ¦ Efßciont. Great improve- Satisfactory systematic work Satisfactory systematic work ¦ Dr Blaxall ments effected and st ill pro- ' P. 552,6(18. (Port, &c.) Toxteth Pabk, ; S.A. have done much good \ M.O.H. very recently ap- ' '• ot N. recently appointed, '-'• work. pointed. but long enough to have Dr. Blaxall, learned to be more efficient. May 1883. P. L 0.868. West Dbbby, TJ. Much good work done, but Satisfactory. Moil not Satisfactory 1),. Blaxall ''¦ IV( ' nnwholeson on- under Board's Order. May 1885. d)t ions Int. I' 33,614. cton-on-the- S. A. regulate the sanitary M.O.H. too advanced in Inefficient for want of time to ILL > v - aiTMii-;viiients ul tit.- new years for the satisfactory carry out the duties. I. of N. )r. Blaxall dwellings now rapidly performance of the duties is clerk to the U.S.A. May is*;-,. spnn-n^ up, and n this of his office. Not under p y °° are doing a good work. Board's Order. (Rapidly growing residential locality.) 253 LANCASHlRE— continued. 13. 14. 15. 16. 17. i *"< £-f Elesult of Board's subsequeni Inquiry Abatomeni and J ; |g ?„, ,, A( ,, ion )llkcil by giA _ ?„ Prevention ! Hospital Provision. |= Recommendation* of Inspector; of Nuisances. with date of Information. : | £ gs,| y-~ y -~ _ _______ . Recurring nuisances None - - - None - None - November 1885. S..\. tire adopting tin from cesspits not remedial measures suggested by In efficiently dealt spector. Scheme for joint hospita with. promotedi Recurring nuisances None - - - None - None - November 1885. Some action as to sewage' from cesspits not nuisance, Bewer- ventilation, and imelficiently dealt provement of slaughter-houses: t< ¦ with, obtained for hospital for ship-borne ¦ infections and cholera. No information us to cesspit privies and refuse removal. Efficient - - Yes, but inadequate. | Scott 'sap- Preparing March 188tl. Endeavours will bo made by S. A. contemplating paratus. actively. "Sanitary Committee" to carry out new provision. certain of l>r. Page's recommendations! further information promised, but not received to date. May _7th, 188\ . »iry, nctivity. District in much tor also. Juno Laoa. ( i |( , s . mu , N; niit;irv condition I. 16,176. as when inspected by l>r. ! (Chemical works, AiiyinW* I canal navigation.) \ liiuin viifmi. ! S.,\. have done innch good M.O.H. :i zealous and Efficient „¦ work, hut in d.'iiliri'i 1 with earnest oHicerandudvises Ci t i'qo- ordinary unwholesome eon- soundly. Heisnoi under '"•' lWu ' ditions negligent of the good Board's Order. I. 84,000. advice of (lit- M.O.H. (Shipbuilding, ironworks, and : shipping trade.) YORKSHIRE.— West Riding — continued. j . | Goolb, U. - - B. A. carrying out improvements Efficient • - - Good ...«,.. n,. pi ,„ it under advice of M.O.H. March 1885. !'. 10,418. I (Shipping f rade mainly.) (i;i \\r,F. I". - ¦ i Lax administration • - - Unsatisfactory ... Inefficient. [. of N. is an Sir J Spear auctioneer. I. 8,853. (Agriculture, (lax, mills, breweries.) 257 LANCASHlRE— continued. 13. 14. 15. 16. 17. H,"5 Result of Board's subsequent Inquiry Abatement and | |g as to Artioil takoil by S 01] Prevention Hospital Provision. |s „£ Recommendations of Inspector ; of Nuisances. a | r = with Date of Information. I =»"" i Inefficient - - - Yes. — None ¦ September 1885— January 1886. B.A. I i taking action as to means of excrement disposal, and insanitary dwellings. M.O.U. reports ;."ond progress us to former. Loan of 7>ltto2. sanctioned in September | 1 886 for purposes of providing further hospital accommodation and a disinfecting apparatus. Inefficient - - - None. None - July 1886. Nothing done to (yet rid of objectionable midden privies; no hospital provided. Efficient - - - Yes - None - Preparing No subsequent inquiry to date. May 27th, 1886. CII ESH I R E~ continued. Efficient, qxeept as to None - - - None - None ¦| No subsequent inquiry to date. May27th, privy nuisances. ¦ \N\\. . Unsatisfactory. Old Yes; small, but being None - I None -! January 1886. 8. A .'s reply shows that uuisances recognised extended. , ¦ some good work lias been and is being by Dr. Virv. done on Dr. Airy s recommendations. iT«oDfiafnfttnvv - Yes - Yes- • M.O.H.gave June 1885. Points of advice under consi- Unsatisiaotorj ¦ ics very good deration. No information from B.A. as I advice us to precau- to action to dale. May 27th, 1888, tionai'y measures to lte adopted, but his recommendations have not been carried into effect. YORKSHIRE. — West Riding — continued. yesv es . - . None - None, ex* No subsequent inquiry to date. May 27th, cent hos- 1886. pital and arrangement for notification. -r, .. m Tw nrlp . - . ! None - None - June 188 G. Some drainage improvements Failure - - - »«™ b . carried out iluc | musauces abated. No details given. 258 YORKSHIR E.— East Riding— continued. 1 2. 3. 4^ [Jrbau Sanitary District. Inspector and rSI™ B ,^ • Excrement Disposal and Report. B°]Xmeltic B °]XmeItic Sewering and Drainage. Removal> L'opulation (1881). Premises. , Industries, kc. South Cate am> Slop nuisances No drainage I Privy-pits or ashpit privies, or n WaUiINGFEJT, U. abound. ditch. Dr. Airy. March 1885. ['. 2,065. (Agriculture mid brick -making.) Kingston • on • | Good - - - ( Sewered. Improvements since I Privies with small receptacles for Him U. Dr. Air.v's inspection in LBB2, excrement and refuse: older ? i, and sewers more offlciently yen- ' ones allowing soakage into soil. wwiTissH tilated. Much recent improve- I About 20,000 of these can only ment in house dramage. Waste < be emptied by carrying contents P. 151,240. pipescutoff. through houses. Apt to be a (An important port. nuisance in warm weather. A variety of j industries.) I | YORKSHIRE.-- North Riding. Scarborough, U. • Fair on the whole Sewered. Sewers ventilated and AV.e's. Also by privies with small n _ m , v ,ii Hushed with a hose. Waste receptacles, some. allowing July 1885. pipes cut off. soakage into soil. I. 30,504. (Health resort mainly; fishing.) > 131 altox. V. • - Fair - - - ; Sewering on the whole satis- W.c's. with flushing cisterns in Mr T Sbpht factory. Recent attention to larger houses, otherwise midden Deciss ventilation and flushing. House privies of old defective type, bui drainage satisfactory on the gradually being 1 replaced by P. 8,754. whole. I üb-closets on Rochdale system. } (Agricultural I i j market town.) ¦ I Pickering, U. - J Unsatisfactory. ; Sewered irregularly and unsatis- Privy-pits and midden privifls of 3lr J Spear Sloppy and | faotorily. Ventilation insnffl- old objectionable type. Some Dec'lBBs ' sewage - sodden cient. Discharges into roadside houses without privy accommosoil in certain ¦ ditches. House drainage most dation. Excrement nuisances P. 3,959. yards. detective. universal. (Agriculture | mainly.) Whitby, U. - - I Roadways clean. Sewering very defective and mi- VV.c's in ne\y part. In old part Dr Blaxall Foulness of ( systematic, Discharge into woodon privy receptacles, and July 1883 some domestic ' harbour product ivcof ftrcal nui- frequent excremenlal nuisances. •' * jiremises from Banco. Deficient ventilation and I. 14.08 H. lish refuse, &c. flushing. House drainage un(Fishings health I satisfactory, even in better parts resort.) oi town. HINDERWELI, U. • Cleanliness often Most unsatisfactory and offensive Large midden privies a lource of Mr T Srwnv neglected. drainage arrangements— or none nuisance, or no accommodation Tj'aelBBs Staithesinadis- at all— and hence general pre- of any sort. graceful state. valence of sewage nuisances. 1». 2, K!7. (Fishing, agriculture, mining.) 259 YORKSHIRE.— East Riding— continued. _ 5 ' _ 6- 7. S. 9. 17 T Sanitary Crowding; ? ? , Refuse Removal. I Water Supply. «&' of Dwellings on Ov ™ din S ot Dwellings c Dwellings, of Poor. Area. __ .__ I ... I j j , Public supply at South Cave Pair, except some None. good. Elsewhere water from wretched hovels ! polluted shallow wells, at Newport, ponds, canal, &c. Satisfactory. Public supply Rood and con- Very commonly lln old town an > Little Well Bailey & Fry s stant. No shallow wells. damp from abundance of looked after. Destructor | foundation. Some courts and yards used. very badly built witli houses and some on sites | crowded so as to ; of shot town I exclude direel refuse. Generally sunlight and any clean and well I free nir movelooked after now. I ment. Even in ; newly built parts arrangements for i tree aeration at rearof" terraces '', i very insuliiciont. j • Privies in very ' small back yards close to pantries ! I and back doors. YORKSJJ ERE.— North Riding. j | Satisfactory- -Public supply constant: and Fair ¦ - - A few close locali- Very little, if any. good. t ies. Satisfactory- - Public water supply liable to Fair - - - Many confined Considerable. occasional pollution. courts and back Most unsatisfac- | Public supply on constant ser- Generally unsatis- A few conflnod Occasional. tory. vice to about one third of factory and back yards. houses. The rest supplied surroundings by wells liable to dangerous also. Many pollution, or actually so pol- damp and illluted, ventilated. Fair - - - Public supply on constant Many unsatisfac- In old town much Much. system. tory. crowding, impeding circulation of air. Great negligence- Scanty water supply, mostly Very bad. espe- Much crowding. Yes. Gross infrom dangerously polluted ciiilly at Stai- At Staithes stances at wells or "beck." Sewage thes and Runs- and Runswick staithes and pollution at Staithes and wick. Many houses huddled Runswick. Port Mulgrave known and quite unlit for together,and,beadmitted, out not remedied. human habita- sides, often built tion. against damp earth banks. 260 i i YORKSHIRE.— East Rinmc — continued. 1. 10. 11 12- Urban Sanitary District. Inspector and Vdministration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Inilusl nrs. &r. ; j i —— — | South Cave and Inactive. (It is difficult to Inactive and inefficient - Inactive and inefficient \Vki.li \(;i- i-:n. I". understand why this Local Dr. Airy, Board exists.)- March 1885. !'. 2,0f15. (Agriculture and brick-making.) Kin^ston-ox- Generally efficient. Active Active, but sanitary work Effectiveness increased since Him.. l : . progress made since Dr. hindered by M.O.H. hold- 1882. Additions made to , ? A iry's inspection in 1882. ing conjointly "llicc of inspectorial staff. March 1886. police surgeon. I. 154,240, (Important port. A variety of industries.) YOUKSI LJ RE. — North Riding — continued. Scakbobough, U. Generally efflcieni ¦ ¦ • Efficient. M.O.H. not under Efficient - - - - - Dr.Blaxall, Board's Order. July 1885. P. 50,504, (Health resort mainly: fishing.) Mai.tos. V. - - Fair. Considerable improve- Fair on the whole - - Competent and energotic Mr. ,T. Spear, ments effected. hitherto. l)ec. 1885. I". 8,75 1. (Agricultural market town.) I'ickebino, U. - Inefficient. Due attention Fair .... Fair Mr T Sv.onr ll(lt P !lirt to I'ccomniendaiLiw I ions of M.( >.H. Dial rict in l/cc. i.ooo. dangerous condition for P. 3,969. advent of cholera. (Agriculture mainly.) WniTBY. U. - - Inefficient M.O.H. newly appointed; Doubtful efficiency. I. of N. .. „, .. promising. is Surveyor also. Ur. Blaxall. J July ISBS. P. 14,086. (Fishing ; health resort.) HINDBEWELL, U. Wholly inefficient. The vil- M.O.H. makes reports verb- j I, of N. holds a variety of „ r „ lages of this district in a ally for the most part, and other offices, and arrangert' isSr most dangerons condition does not sufficiently in- ments accordingly unsatmjjcc. iwo. c or iu i ven t of cholera. gist on his advice. factory. P. 2,467. (Fishing, agriculture, raining.) I I . _ 261 YORKSHIRE.— East RimsG—confinued. 13. 14. ___ 1^ !?i_ 17. ] VT" if a£ Result of Board's subsequent Enquiry Abatement and - J!:j ..».,• i i i ? * .a ao £ as to Action taken by B,A. on • Prevention Hospital Provision. || J Recommendations of Inspector « of Nuisances. || || with Date of Information. I ineUiciont - - - ! None - - - None - j None - ' July 1885. Stream supplying Broorafl© to be cleansed : privies, cesspools, &c, i be supervised : no oilier sanitary acti< mentioned; nothing done in regard i hospitul provision. Satisfactory - - ! Hospital now in Ransom c's i Prepared ! July 18815. Action taken or in conten oourse of erection, chamber. ' plutionon Inspector's advice. i i i YORKSHIRE.— North Riding— continued. Recurring privy nui- A pay hospital and GoddardA None - No subsequent inquiry to date. Muy27tl sances not sufli- an infectious di- Massey'g issu. ciently dealt with. seases hospital for chamber. Otherwise satis- other people not factory. h<"ld in readiness, and generally in- , sufficient for needs of district. Efficient - - - None - - - None - None -I No subsequent inquiry to date. MayU7tl 1880. ! Wholly unsatisfactory None - ¦ I None - None ¦ I June 1888. Generally unsatUfaetory re ply; inspection of district being uiadt mikl nuisances abated. No details givei i Fnefßcient - - - None - ¦ - *"'"' " None - August— November 1888. B.A. takin action on Uf. Blaxall's recommendations. Loan of 10,621?. for works of sewerage sanctioned by Board in December 1885. M.O.H. in 188S report says S.A. luid been unable to secure a site for a permaneni hospital. Wliollv iiicllicioiit Nona - " ' None - i None - i January IflBB, Contemplated action as to The most obvious ' water supply of parts of district. On niitynnpps nPKlected i iMarcli 17lli Hoard made iiK|iiiry as to nuisances negiecieu. _^ _ .„,(,„„ ?n 0i1,,.,- points, and on June 29th S.A. senl a general and unsatisfactory reply, but, on July loth, spoke of some directions given to secure discontinuance of pi«-keeping and more frequent removal of midden contents af Staitht's : otherwise lint little done. 262 I I YORKSHIRE. — North Riding — continued. 1. 3^ S. 4^_ i i Urban Sanitary District. Inspector and . nSi"™H Excrement Disposal and Date of Report. a domestic Sewering and Dialling*, aeraoval. Population (1881). I'reniiscs. Industries, &c | i ' | j GuiSTioKoroir, U. - Many back lanes Sewered. Sewers defective in -Mainly midden privies of b:id < , r T w nnpnved. places j insufficiently ventilated. ¦ type, and too close to houses, n kE- ; "' House drains often source of A few pail and water closets, vet. ins.). nuisance. J. 8,61(1. (Market town.) Bedcar, U. - - Unsatisfactory. ! Sewered, but unsatisfactory in . W.c's with flushing cisterns, in , r T Private yards . certain important respects. In- , better class of bouses. Else- V, , |)( - :n ' in lower parts I sufficient ventilation. House where foul dilapidated midden jjec. i.ssi). jili 11 1 \ . drainage often defective. privies occasionally in confined P. 2.458. positions. A few pail closets. (Health resort, fishing.) | i KiRKLEvrnAH. I.- Fair, but yards of I Sewered: catehpits at manholes | W.c's, mostly with flushing cis- Ar _ T ( private houses : and hence stenches from the , terns. A few pails. Otherwise n ibor 1 ' often dilapi- very few ventilating openings. ' midden privies of bad type and uec.lBBs. dated ami Private drainage imperfect, al- source of much nuisance. P. 3,B!iS. sloppy. though some recent improve- j (Health resort, " ieilU fishing, mining, agriculture.) Saltbukw, U. - Fair - - - | Old defective sewers being gra- W.c's Avith flushing arrangements, i .. T B dually re-laid. House drainage A few pail closets. Many midden j ,[' -rJi? 11 ' 1 oft en' imperfect, but sink pipes > privies of bad type. Dec - 1885 - disconnected. P. 1,646. (Sea-side resort.) Skeiton and Unsatisfactory - I Most of the villages have sowers j Midden privies of bad type and Bhotiok, U. discharging into neighbouring in bad positions. Pail closets T „ water-courses, creating nui- being introduced. Mr. d.hpear, i ganees . often choked branches, uoc. isso. Defective ventilation. Private V. 13,688. drainage bad and causing I (Iron and stone nuisances. mining.) LoFxrs. V. - - Unsatisfactory - Sewering fairly satisfactory. Pri- Midden privies of bad type. Some Mr T«i mv vate drainage improved, but still pail and earth closets introiV.,.iJu largely unsatisfactory. duced have lessened nuisances. P. 8,699. (Iron and stone mining, agriculture.) MiDDLESBEoroir, Good on the whole. Sewering good, and, except in | Mostly midden privies of good U. I older parts, efficiently venti- type. Improved ash closets. Dr p . |f?0 _ luted and Hushed. June 1885. P. 55,!»t. (Iron working and shipbuilding, chemical works, &c.) South Stockton, Good, with ex- Sewering satisfactory. Efficient Midden privies of good type. U. ceptions. ventilation and flushing. House j Dr Page drainage good. Waste pipes ! March 1885. cut o£f< P. 10,886. (Iron working, shipbuilding, potteries.) 263 YORKSHIRE. — North Riding — continued. 5. 6. 7. 8. 9. I I ' | Salary . Crowding Overcrowding of Refuse Removal. Water Supply. WKr "' »wellin P s on Dwelling* of Poor. Area. i_ _J I " " I I ~~ Unsatisfactory - : Public supply satisfactory on Fair with some : A few courts un- ! Rare. I the whole. Some polluted exceptions. satisfactory wells. Unsystematic'and Public water supply on con- Unsatisfactory. Some crowding Occasional, unsatisfactory. stant service, except in sum- Some unll) for and other condi- Midden privy mer, when constancy is must humnn habit a- tions impeding j contents thrown | needed. A well or two of tion. free circulation on roadways. questionable character. of air. 1 Scavenging Irre- Public supply constant. Ilmiy Fair, with excep- Somo crowded j None. . shallow wells often liable to tions. localities in dangerous pollution. Duns- (.'oat ham. . dale supplied partly from a stream. i ' Unsystematic and ; Public supply constant and Fair, with excep- . None - - - Rare, unsatisfactory. good. No wells. tions. ' I Careless - -I Public supply in part, but ' Often very un- Rare - - - Rare, fails sometimes. Many local * satisfactory, sources of supply of doubtful j Yards nnpaved, j nuritr. dilapidated, and foul. Satisfactory on Public supply mostly. Else- j Many damp and I Rare - - • None. the wliol!'. • where various local springs j unsatisfactory. I not free from pollution. | ! '¦ Satisfactory- - Public supply constant. Same i Exceptionally i None - - - None, as South Stockton (see | good. ( below). Satisfactory- • Public supply constant, but Fairly satisfactory Noi fully satis- Yes, but diminishsource (River Tees) sewage- \ factory. ing. polluted. Tliis fault about , | to be amended. 264 YORKSHIRE.— North Riding —continued. 1. 10. U. 12. Urban Sanitary District. [nspectorand ; Administration by Sanitary Work of Medical Offloer | Work of Inspector of Date of Report. : Authority. of Health. Nuisances. l J n]>iiJ:itioii (1881). ! Industries, &c. ] Guisbobough.U. Very imperfect adrainistra- | Very good - - - - Goods I. of N. is Surveyor also .. T „ lion. S.A. reluctant to deal Mr. d. spear, , wit]l some wel ] 8 llowu t0 Dec. 1885. dangerously polluted. Ad- P. 6,616. vice of M.O.H, insufficiently ,-,» , . i regarded. (Market town.) Redcvr IF. - - Inefficient. Noi much im- Inefficient. M.O.H. old and Lof N. holds a variety of ai orovemeni since Dr '< Feeble; he is not under the other offices. As efficient Mr. J. Spenr, Thome's insnect ion in 1875 ; Board's Order. ashecanbe under eircivm- Dec. 1885. ' stances. P. 2,458. : (Health resort, [ fishing.) Kihkleath.vm.U. Fiiir - ¦ - ¦ -Fair .... Fair; I. of N. is Surveyor also - Mr. J. Spear. Dec. 1885. P. 3,898. (Health resort, tishintr. mining, i agriculture.) baltbubn, U. - Very fair Good - - - Unsatisfactory - Mr, J. Spear. Dec. 1885. P. 1,646. (Sea-side resort.) i Skelton avt> Lax administration - - Very good - - - Pair - - - Beotton, U. Mr. J. Spear, I Dec. 1885. P. 18,588. (Iron and stone mining.) j Loftcs, U. - - I Fair - - Good - ... Fair - - - - Mr. J. Spear, i Dec. 1885. I. among other matters, as to action melUi alitea in regard of sewer-ventilation, excrement disposal, and paving of house yards. Fair ; gradual dealing None - - - None - None -No subsequent inquiry to date. May 27tli, ; with recurring 18StJ> nuisances. T fi a °mS fO t r e°mS NflM " ' " ' *"" " ]& ffinttffASoS Sy remZl offi of S.A on Mr Spear's recommendations, sances. Ma >' 27th - 188 °- Good .... Small, unsatisfactory No subsequent inquiry to date. May 27th, cottage hospital in 1880. readiness. Efficient - - - Yes good - - Ransome's Prepared No subsequent inquiry to date (May 27th, umutsni its, guuu s tove. 1880), but loan of 1,000?. sanctioned m September 1885 for works of sewerage, and application since made for sanction to loan of 12,000?. for works of water supply. Very efficient - - None. Can use None - Prepared Revision of existing defective byela^ys y Middlesbrough suggested by Board in June 1885. No hospital • but reply as to steps contemplated received rarely used. from S.A. to date. May 27th, 1886. E 20510. S 266 DUEHAM. 1. 2. 3. 4. Urban Sanitary District. Tn Waste Mostly midden privies of bad pipes, &c., cut off. type, even in newly-erected Dr. Page, properties. Nov. 1885. P. 10,097. (Market town, collieries, and coke ovens.) SniLDON and E4.ST Back streets and Sewered. Objectionable catch- Midden privies of bad type, caus- Thickley U. passages dirty pit manholes causing nuisance. ing nuisance close to dwellings. ' and neglected/ Sewers ventilated, but made Dr. Page, quately flushed. House drainage June 1885. mainly satisfactory. P. 8,704. (Coul mining and railway works.) Spenntmooe U. - Back streets and Sewering complete. Sewers venti- Midden privies unsatisfactory, domestic pre- lated and flushed. House drain- close to pantries and windows, Dr. Page, mises unsatis- age fair. Improved of late. offensive and spoiling food. May 1885. factory, but P. 5,917. being improved. (Ironworks, collieries.) Barnakd Castle, Domestic premises Sewered, and sewers ventilated Chiefly w.c's flushed by direct U in lower and and flushed. House drainage communication with water I „ „ older parts neg- satisfactory. mains in dangerous manner, nif r# i?sf ' lected and dirty. Badly constructed midden May 1885. privies, causing nuisance. P. 4,541. (Agricultural market town.) 267 DURHAM. Sanitary Crowding Overcrowding of Refuse Removal. Water Supply, Dwellings of Dwellings on Dwellings. of Poor. Area. Unsatisfactory Public supply constant and Generally good, In certain parts Not common, and slovenly. said to be of good quality but in many crowded back- Midden con- (but ?)., instances un- to-back houses, tents thrown wholesome from Privies in some into street be- constant often- cases have to fore carting sive emanations be emptied by away. from the privies carrying conin small yards tents through ¦ of houses, pre- houses, venting opening of back windows. Efficient - - Public supply constant and Fairly good. S.A. Numerous close, Little now. Def good. take vigorous ill - ventilated with, action in respect courts, but in of them. admirable condition as to freedom from nuisances. "Well supervised. Regular by S.A. - Public, supply from a deep well Courts with filthy exposed to possible danger of privies. pollution from the building of houses on new made land in the vicinity of the well. Few shallow wells, and those suspicious. More frequent Public supply same as Hartle- . scavenging of pool. Several dangerous wells middens than in use. S.A. in progress of formerly. closing them. Satisfactory- - Public supply constant and Good, with ex- Some back-to-back Some, said to be of good quality. ceptions. houses. Courts fairly open. Unsatisfactory - Public supply good and con- Good, with ex- None - - - None, stant. ceptions. Unsatisfactory Public supply constant and Much improve- None - - - None, still, although good. No wells now existent. ment since 1884. some improve- Entire streets ment since Dr. closed and Parsons's in- many houses spection in 1884. demolished. Inadequate and Public supply good, but not In lower parts Crowding in parts Much, especially unsatisfactory. sufficient storage. JSK. uStte SS^SS of'Mg o? habitation. dwellings. militia. s 2 268 i. io. L v. i*i Urban Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. | Population (1881). Industries, &c. Darlington U S.A. working to improve dis- M.O.H. advises as to sanitary Efficient trict, but there is much yet improvements, but has no Dr. Page, t do aptitude for reporting. March 1885. 4 P. 88,104. (Chiefly ironworks.) Stockton-ox- Excellent administration - Efficient .... Efficient • • - Tees, U. Dr. Page, March 1885. P. 41,015. (Ironworks, shipbuilding, potteries.) _ T . M.O.H. has advised im- I. of N. just deceased of enteric HARTLKroot, I . provements. fever.' Dr. Blaxall, Feb. issr,. P. 12,361. Good and efficient. M.O.H. West HABTLE- , not lm( i, T Board's Order. tool, V. Dr. Blaxall, Pel). 1885. P. 28,258. On the whole fair in respect M.O.H. advises S.A., but I. of N. is surveyor and col- BlSTror Auck- j o f gome important works, does not report his action. lector also ; an able officer. land, IT. but might be better. Dr. Page, Nov. 1885. P. 10,097. (Market town, collieries, and coke ovens.) Lax administration. Byelaws Excellent, if only S.A. would Very good Sitildon ant) East not enforced. S.A. tender as act on advice. Thickl-et, U. regards existing interests. Dr. Page, June 1885. P. 8,704. (Coal mining and railway works.) Spfnnymoor IT Highly efficient. Vigorous and Very efficient and M.O.H. Efficient and systematic - ' ' creditable administration successful in advice to S.A. Dr. Page, since Dr. Parsons's inspec- May 1885. tion in 1881. P. 5.917. (Ironworks, collieries.) Barhard Castle Lax administration. New Efficient .... Not efficient. [Present sur•jy^ J byelaws not enforced. veyor is a beershop keeper.] Dr. Page, May 1835. P. 4,5 U. (Agricultural market town.) 269 DURHAM — continued. 13. 14; 15. 16. 17. §, o Result of Board's subsequent Inquiry Abatement and J\ |g as to Action taken by S.A. on Prevention Hospital Provision. JJ * 3 Recommendations of Inspector ; Of Nuisances. || |j with Date of Information. Efficient - - - Good hospital and Yes, but of None - No subsequent inquiry to date. May 27t ambulance. doubtful 1886. efficiency. Very efficient - No hospital in dis- Nelson's None - March 1885. S.A. will not adopt Artiza trict, but arrange- stove. and Labourers Dwellings Act ; but oth ment with Mid- recommendations will be carried out. dlesbrough Fever Hospital, which is rarely used however. None ° None - Arrange- In April 1885, Board suggested to S.A. the ment for provision of a public slaughter-house, notification M. O. H. in 1885 report says public of infectious slaughter-houses are to be erected. diseases. None - - • None - Arrange- No subsequent inquiry to date, but loa ment for for works of sewerage recently appliec notification for. May 27th, 1886. of infectious diseases. Not satisfactory . Small hospital • None - None ¦ No subsequent inquiry to date. May 27t 1886. Recurring nuisances None ¦ - - None - None - July 1885. Dr. Page's recommendatio not satisfactorily (save as to hospital provision) adopte dealt with. March 1886. No hospital accommod tion provided for district. M.O.H. 1885 report speaks of some of recoi mendations being in abeyance. Satisfactory • - None - - - None - None - June 1885. General promise of action " far as practicable " on Dr. Page s advie Apparently nothing done as to hospita to date. May 27th, 1886. Unsatisfactory - - None - - - None - None - August 1885. Some little action as cleansing and detective privies. Oth matters to receive attention. May 188( Site purchased for permanent hospita M.O.H. in 1585 report says S.A. ha decided to construct a new stora reservoir. I 270 i i DURHAM — continued. L 2. 3^_ 4. Urban Sanitary District. T , , Cleanliness of Excrement Disposal and Daieof'Seport. Sewering and Drainage. Removal. Population (1881). Premises. Industries, &c. Stanhope U - Satisfactory - - Sewering defective, unventilated, Midden privies of worst type. A bXAHHOPB, v. satisiacrory inadequately flushed. few w.e's with flushing cis- Dr. Page, terns. April 1885. P. 1,840. (Limestone quarrying and lead mining.) Tow Law U - Satisfactory - Sewered; sewers ventilated and Midden privies a source of ' flushed; house drainage satis- nuisance. Dr. Page, factory. Outfalls defective, but April 1885. ivi v course of improvement. P. 5,005. (Collieries and iron smelting.) Durham U - - Domestic yards Sewered, but with defective venti- Midden privies an abundant ' ' and courts neg- I lation. House drains of bad source of nuisance. Little done Dr. Page, lected and filthy, construction, and very nnsatis- to remedy prevalent excremental Jan. 1888. * factory nuisances since Dr. Spears mp UM n spection in 1881. Many privies r - *¦*">**" • have to be emptied through (Market and dwelling-rooms. University city ; carpet works.) Wiltington U - Slop nuisances in Sewering defective in parts, Midden privies ill-constructed back yards from and inadequately ventilated. and source of nuisance. 5r5 r- -. a il e r' bad paving. Flushed. Some improvement JNov. issj. since Mr. Spear's inspection in P. 7,238. 1881. (Collieries and coking.) ]}r\ndon and Satisfactory. Villages of district sewered. Sink Midden privies of improved type Bysiiotti.es, U. Much improve- pipes cut off. since 1880. In colliery villages ment since Mr. they are placed as usual m Dr. Page, Snear's ins Dc- blocks between rows of houses. Dec. 1885. ti ' on in im » P. 10,853. (Collieries and coking.) Seauam Harbour, Common yards Sewered. Ventilation insufficient Midden privies of bad construc¦jj. uneven and and no flushing. House drain- tion. " ' Dr. Page, sloppy. age fair. June 1885. P. 8,182. (Shipping coal ; collieries, and glassbottle making.) Houghton-le- Fair - Sewering complete, efficient, yen- Midden privies capable of much Spring U. tilated, and flushed. House improvement. ' ' drainge satisfactory, and waste Dr. Page, pipes cu t off. March 1885. P. 6,0 U. (Collieries and agriculture.) Sunderland, U. - Good on the whole Sewered. Ventilation and flush- Midden privies, some objection, ing defective. In old houses able, some of improved type. Dr. ae Onanmont, drainage unsatisfactory. W.c's of unsatisfactory cha- March 1885, racter> In part of o i d Sunderaud Dr. iSlaxaii l an( j n0 prlV y accommodation (re-inspection), at aIL July 1885. P. 116,548. (Shipping trade, shipbuilding, iron works, &c.) 271 DURHAM — continued. 5. 6. 7. . 8. 9. Sanitary Crowding Overcrowding Refuse Removal. Water Supply. Dwellings 0 of Dwellings on Dwellings. of Poor. Area. Unsystematic and Public supply constant and Good, with excep- None - - - None. unsatisfactory. good. tions. Unsatisfactory - Public supply, constant and Satisfactory - None - None at prese good. time. More systematic Public supply now good and Large number of Very much crowd- Considerable, than in 1881. constant. filthy, neglected, ing in courts dilapidated and yards, where dwellings; un- free movement wholesomeness of air is imposaggravated by sible. filthy surroundings. Unsatisfactory Public supply constant and Generally good. None • Very little, where houses good. Many unwholesome Improvements are not owned wells now closed by S.A. since 1881. by colliery proprietors. Satisfactory - - Public supply constant and Satisfactory • - None - - - None at present good. Left to occupiers, Public supply constant and Satisfactory - - None • None. and very un- good, satisfactory. Fairly efficient - Public supply constant and Satisfactory - - None • None. good. Satisfactory on Public supply constant and Fair, except in Much in old Sun- Some, the whole. good. old Sunderland. derland. 272 I i i DURHAM — continued. 1. 10. 1L 12. Urban Sanitary District. tnspi ctor and Administration by Sanitary "Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. ; Stvniiope U • Inefficient .... Efficient, but salary only 31. Inefficient .... _ per annum ! Dr. Page, April 1885. P. 1,840. (Limestone quarrying and lead mining.) Tow Law, L t . - Fairly good, but old defective Very good ... - Satisfactory .... _ „ byelaws in use. Dr. Pave, April 1885. P. 3,003. (Collieries and iron smelting). Durham, TJ. - Inefficient. Little done to Very inefficient - - - I. of N. painstaking, but carry out Board's recom- working under great dist ,£!'•' mendations on occasion of advantages. Jan. 188(). ;n Ir Sp ear ' s inspection in P. 14,302. 1881 . District in dangerous ,-,,., . condition for advent of (Market and phnlpn University city; "noiera. carpet works.) Willixgton, U. S.A. have much improved dis- Efficient .... Active and intelligent T . ? rrict since it passed from ¦P r> the hands of the U.S.A. of >0v.1885. Durham. P. 7.238. (Collieries and coking.) Brandon and Generally efficient. Made im- Efficient; M.O.H. advises Active and efficient • Byshottles. U. portant reforms since Mr. soundly. T1 p > Spear's inspection in 1881. ])' 18^' ew ''y e ' aws enforced. P. 10,853. (Collieries and coking.) SeattamHarboub, Unsatisfactory, especially in Unsatisfactory. M.O.H. not I. of N. a new officer- U. respect of prevailing excre- nnder Board's Order. Dr. Page, mental nuisances. Poorly paid for work re- June 1885. quisite. P. 8,182. (Shipping coal; collieries, and glassbottle making.) Hougitton-le- Efficient administration - - M.O.H. advises well - - Efficient ; I. of N. is surveyor Spring, U. also. Dr. Page, March 1885. P. 6,041. (Collieries and agriculture.) Sunderland, v. S.A. done some good work - Efficient - • - Efficient Dr. de Chaumont, March 1885, and Dr. Blazall (re-inspection), July 1885. P. 110,548. Kping trade, ildinp, iron ¦k5,&, ; .) I I 273 DURHAM — continued. 13. 14. 15. 16. 17. H,"o Result of Board's subsequent Inquiry Abatement and jf |g as to Action taken by S.A. on Prevention Hospital Provision. |J __S Recommendations of Inspector ; of Nuisances. |j c -| | witn jj ate of information. S OB*" Unsatisfactory. Ob- None - - - None - None - June 1885. Some action as to sewervious nuisances flushing and ventilation, and as to neglected. cleansing in contemplation. Satisfactory, except as None - - ¦ None - None - M.O.H. in 1885 report speaks of steps regards midden taken to carry out some of Dr. Page s privies suggestions, but reports many defects and nuisances as existing still. Wholly unsatisfactory. Unsatisfactory pro- None - None - April 1880. S.A. " are using their utmost Excrcmcntal nui- vision, and that " endeavours to put and maintain the sauces still the pro- not kept in readi- " City in a perfectly sanitary condition, vailing chnracteris- ness. No details of action, tic of district. Not wholly satis- None - - - None - None - No subsequent inquiry to date. May 27th, factory. lsm - Efficient - - - None - - - None - None, ex- No reply to date to Board's inquiry of cept ar- April as to hospital accommodation, &c. ranging July 15th, 1880. for early information. Inefficient - - - Unsatisfactory None - None of July 1885. Some little action in con- Hospital provision mucheffl- nexion with sewers ; otherwise no meaof makeshift cha- ciency. sures of sanitary improvement in conracter; not held temptation. in readiness on emergency. Efficient - - - None. S.A. seeking None - None, ex- Promised copy of resolutions of S.A. on • Limuclu a s j te cept ar- consideration of Inspector's advice not ranging received to date. May 27th, 1880. for early information, and active dealing with nuisances. T-...V -Yes - - - - Hot-air Preparing December 1885. S.A. are acting on Inx ail chamber. specters recommendations. May 1886. New permanent hospital to be erected on land already purchased by loan. 274 DURHAM — continued. 1. 2. 3. 4. Urban Sanitary District. Inspector and Cleanliness of Excrement Disposal and Date of Report. UomS Sewering and Drainage. Removal. Population (1881). Promises. Industries, &c. Soctjt Shields, U. Sewered. Sewers insufficiently Improved midden privies. Some t> i ny, , ™+ ventilated, hut flushed. House w.c's, with flushing arrange- Mnr^S isas drainage defective in older ments. March 1885. parts> but looked aXter on P. 56,875. occasion. Jabeow, U. - - Satisfactory- - Mainly surface drainage - - Midden privies as in South Shields Dr. de Chaumont, March 1885. P. 25,469. Gatesiiead, U. - Many house yards Sewers defective and of unsatis- Midden privies. Some of them of T>r p«™ nlth y and ne S" factory construction. Flushing worst type close to doors and M isS lected. unsatisfactory. Some dangerous windows, and dangerous nuirao. iBBb. connexions between manholes sances. Some of improved type P. 65,803. and water-mains. House drain- in new dwellings. Some w.c s, (Engineering a » e faultv> many of them ""^ti^etory. works, ironworks, glass and chemical works, &c.) NORTHUMBERLAND. Newcastle, U. - Dr. de Chaumont, March 1885. P. 145,359. Benwell and Back streets un- Sewered. Sewers ventilated and Midden privies in old property Fenham, U. paved and dirty. flushed. House drainage satis- defective, and source of nuisance. Dr Pn,irr> Scotswood road factory. Sinks and waste pipes In newer property better conrw isk* (under turnpike cut off. structed. W.c's in Scotswood kjli. 1000. trust), bad sur- with flushing cisterns. P. 4,893. face drainage. (Elswick engineering and Ordnance Works, shipbuilding, &c.) Tynemouth, U. - Good, except in Sewered efficiently. Sewers venti- Midden privies ; often connected Dr Pace lower parts of lated and flushed. Stinks, how- with sewers; gradually being Sent 1885* Shields. ever, due to old privy midden replaced by pail closets. p . xoo<>. connexions. P. 44,118. (Shipping trade ; shipbuilding. Tynemouth a health resort.) Walker, U. - - Generally bad. Sewered, but sewers inadequately Midden privies of bad construe- I Dr Vnsce Some improve- ventilated. Flushing unsatis- tion often adjoining houses, ill- I Nov 1885* ment, however, factory. scavenged and dangerous nuisince Dr. Barry's sances. Byelaws made June P. 9,527. inspection in 1881 not strictly enforced. (Shipbuilding. Alkali 1883> works pulled down.) Cowpen, U. - - Very bad, both Sewering unsatisfactory. Sewers Midden privies of worst type, and I Dr. Page back streets and and drains unventilated, and prevailing excremental nui- I June 1885 house yards. sewer air at high water driven sances. x, in (-.„„ out in close vicinity of dwellings. (Shipbuilding, collieries, glass- I 275 DURHAM— co ntin tied. 5. 6. 7. 8. 8L iwh&7«i Crowding Overorowdingof Refuse Removal. Water Supply. DwßSgi of Dwellings on Dwellings. of Poor. Area. Satisfactory - - Public supply constant and New property Much crowding Some among the good. satisfactory. Old on area in older Irish populaproperty defec- parts of district. tion. tive in many parts, and some without privy accommodation. Public supply constant and Satisfactory on the No crowding - At times among good. whole. the Irish population. Pair, except at Public supply constant and In newer parts Perhaps some of Considerable. Wreckenton vil- good ; but in outlying parts satisfactory, but the worst specilage. by wells exposed to pollution . in older parts mens of crowding most wretched upon area in the and unwhole- kingdom are to some dwellings be seen here in exposed to con- the older part of stant influence the district, of excremental and filth emanations. NORTHUMBERLAND. Public supply constant but — — rather scanty. Satisfactory - - Public supply constant and Generally good - None - None. good. I Satisfactory - - Public supply constant. Some Generally satis- Very much Much overcrowdof doubtful purity and factory, but crowded in ing in some wlioh'someness from under- much tenanted lower parts of parts, ground mine workings. property unfit North Shields. for habitation in Clearance much lower parts of needed. N. Shields. I Very bad and Public supply constant and Recently - built Dangerous crowd- None, slovenly. good. houses good. ing, with nui- Many of the sances associated, older extremely bad, with dangerous excremental and slop nuisances about them. Very bad and Public supply chiefly constant : Generally fair, Great crowding, Yes ; but varying slovenly, creat- otherwise a well at Cowpen, but exceptions. with excrement with amount of ing dangerous and probably polluted pit Flooded eel- nuisances in trade. nuisances. water. lured houses some parts. drained since Dr. Barry's inspection in 1883. I I 276 DURHAM— continued. _____ L 10. 1L 12. Urban Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1S81). Industries, &c. South Shields, Efficient .... Satisfactory - • Dr. de Chauwont, March 1885. P. 56.575. Jarkow, U. - Efficient. Dr. de Chaumont, March 1885. P. 25,169. Gates head, U. - Inefficient. Very little done Efficient .... Efficient and energetic - -p. p to give effect to the Board's v i infn 1 recommendations on Dr. xeu. is&o. Barry's inspection in 1883. P. 05,803. The older part of the town lrl . . in a dangerous condition for (Engineering advent of cho lera. woiks, ironworks, glass and chemical works, be.) NORTHUMBERLAND— continued. "Newcastle, U. - Satisfactory .... Satisfactory .... Systematic and satisfactory -I Dr. de Chaumont, March 1885. P. 145,359. Benwell/ and Good administration - - Efficient ... - Efficient Fenham, U. Dr. Page, Oct. 1885. P. 4,893. (Elswiek engineering and Ordnance Works, shipbuilding, &c.) Tykemouth, U.- Generally good administra- Highly efficient - - • Active and efficient • -n t> tion, but S.A. indisposed to « r^ i£fr deal with the unhealthy hept. 1885. areag in N< ShieldSi P. 41,118. (Shipping trade ; shipbuilding. Tynemouth a health resort.) Walker, U. - Very inefficient, especially in M.O.H. advises S.A. soundly More efficient than at time of T»r Picp respect of excrement nui- Dr. Barry's inspection. ij' ' -fsK? sauces. District in a dani>o\. isso. gerous condition for advent P. 0,527. of cholera. (Shipbuilding. Alkali works pulled down.) Cowpex, U. - Inactive. S.A. neglect to M.O.H. advises S.A. soundly I. of N. newly appointed. An Dr. Page, carry out recommendations and boldly. elderly man without ex- June 1885. of M.O.H. The amount of perieiice. This action is in P. 10 003. work done in pursuance of opposition to the Board's ¦nhnllHinoi Board's reconimenda- recommendation as to I. of puuiKiuih tionson Dr. Barry s inspection in 1883 is insig- N. glass- niflcant. District in a dangerous condition le works.) for a d V ent of cholera. 277 DURHAM— continued. 13; 14. 15. 16. 17. p,-q Result of Board's subsequent Inquiry Abatement and | g| as to Action taken by S.A. on Prevention Hospital Provision. || *§ Eecommendations of Inspector i olNmsances. |B | g with Date of Information. .2 ft £.o Fair on the whole - Permanent hospital Lyon'sdis- None No subsequent inquiry to date. July 15th, I infector. special as 1889. Ye 3. — None, ex- No subsequent inquiry to date. May 27th, — ' cept hos- 1880. pital and system of disease notification. Cannot be efficient Yes, and in readi- None - None - February 1880. Some work being done under present system ness. on lines indicated by Inspector, but of excrement disposal. requisite comprehensive measures of sanitary reform not adopted. NORTHUMBERLAND— continued. Yes. — Special No subsequent inquiry to date (May 27th, I house-to- 1888), but loan of 20,000?. sanctioned for house in- hospital purposes, spection. Efficient - - - None - - - None - None - No subsequent inquiry to date (May 27th, 1886), but M.O.H. in 18S5 report says Dr. Page's recommendations continue to receive S.A.s serious consideration. Efficient - - - Highly unsatis- Yes - None - February and March 1886. S.A.s replies factory provision. give evidence of action taken or in con- Subject under teniplation on Dr. Page's several points consideration of of advice. Very efficient - None - - - None - None - January 1886. Inspector's reeommeuda-1 ' tions are being carried into effect. Inefficient - None - - - None - None - September 1885. S.A.s reply to Board's remonstrances and inquiries wholly unsatisfactory. No evidc: ceof requisite action. I 278 NORTHUMBERLAND— continued. L 2. 3. 4. Urban Sanitary District. Inspector and RoadwLv^and Excrement Disposal and Date of Report. R °f) d oSic 0 Sic Sewering and Drainage. Bemoval. Population (1881). Premises. Industries, &c. South Blyth, U. - Satisfactory - - Sewered. Sewers ventilated and Midden privies ; much improved I)r Page flushed. Satisfactory. of late. June 1885. P. 1,983. (Shipbuilding, ironworks, and collieries.) South Gosfoeth, Satisfactory - - Sewerod, and sewers ventilated Chiefly w.c's with flushing cis- U. and flushed. Disposal by irriga- terns. Some privies and open Dr Pasre on unsa tisfactory. middens. Oct. 1885. P. 4,126. (Colliery and residential.) Moepeth, U. - - Satisfactory- - Sewered. Sewers unventilated W.c's and midden privies in equal Dr Pa2i> and insufficiently flushed. proportion. Some w.c's in t,,'-,5q2 House waste-pipes cut off. direct communication with JunolBBs> water mains. P. 0,115. (Agricultural market town.) Bedlingtonsiiibe, Roadways fair, Defective sewering generally. Badly constructed and ill-placed U. except back Offensive disposal of sewage. midden privies, causing excre- I rii. p om streets and house mental nuisances. June lBBs yards, which are June 1885. commonly an- P. 14,510. paved and (Collieries.) a]o VW. Nettbiggiu, U. - Roadways not Sewered. Sewers ventilated and Midden privies drained into I ™? x> n , ra duly cleansed. flushed. House waste-pipes sewers, blocking up drains. Jmi«i«w Domestic pro- cut oil. June 1885. misQS clean> P. 1,388. (Fishing, lodginghouse keeping.) Alnwick and Roadways satis- Sewered. Inadequate ventilation W.c's. Direct communication I Canon gate, U. factory. Do- with water mains being pro- T)r Psiirp mestic premises gressively out off since Mr. Ort 188-' un paved, Spear's inspection in 1884. A v and sloppy. few midden privies. P. 6,698. (Agricultural market town.) Amble, U. Satisfactory - - Sewering adequate. Sewers yen- Midden privies, badly placed in Dr Pace t Hated and flushed. some localities, and a source of June 1885. nuisance. P. 2,016. (Agricultural.) Berwick-upon- Fair - - - Berwick proper well sewered, and In Berwick proper w.c's with Tweed, U. sewers ventilated. No sewering flushing cisterns. In Tweed- Dr de Chaumont of certain outskirts. mouth and Spital ash - pit March 1885. ' privies. Dr. Page, June 1885. (Re-inspection.) P. 13,998. (Iron working, agriculture, fishing.) 279 NORTHUMBERLAND— continued. 5. 6. 7. 8. 9. RonSn y of Cr ° w ding Overcrowding of Refuse Removal. Water Supply. Dwefe of Dwellings on Dwellings. of Poor. Area. Satisfactory - - Public supply constant and Satisfactory. Im- A few back-to- ' None - good. provements since back and con- I Dr. Barry's in- fined houses, spection in 1883. but improvements about them. Unsatisfactory - Public supply, constant and Generally satis- Very exceptional None - good. factory. Im- crowding, provements progressing. Unsatisfactory as Public supply inadequate. A Satisfactory - - None - None - respects clear- few wells, ing of midden privies. Inefficient and Public supply constant, and Satisfactory gene- In Bedlington In the colliery unsatisfactory. said to be good. rally, but some many close villages. exceptions. courts, air of which is polluted by excremental and slop nuisances. Unsatisfactory - Public supply constant and Satisfactory - - None ... None, good. A few private wells. Satisfactory - - Public supply inadequate, and Numerous close Much crowding , Much, much of it liable to dangerous dwellings unlit on area in j pollution. S.A. seeking better for habitation narrow courts . supply. and surrounded of back-to-back by nuisances. houses, free movement of air i being thus obstructed. Done by S.A. - Never failing wells and springs. Satisfactory - - None - - - Overcrowding of Water good. tenemented houses. Satisfactory - - Public supply constant and Fairly good - - Some crowding in , A good deal of I good. older parts of overcrowding. town. NORTHUMBERLAND—™/*^^. 1. 10. 1L 12^ I . l__ _ . | Urban Sanitnry i District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. __ _ South Blyxii, V. B.A. acting energetically and Very good - Efficient; I. of N. is surveyor T»r Pnifc usefully since Dr. Harry's in- also. f^'ai&V spection in 1883. Many juneisss. substantial improvements P. 1,982. effected. (Shipbuilding, ironworks, nnd collieries.) Soum Gosfortu, Administration active and Good - Efficient U. well directed. Dr. Page, Oct. 1888. P. 4,126. (Colliery nnd residential.) MoEPETn, IT. - Fairly efficient. S.A. well Efficient. M.O.H. advises Good and efficient - Dr Page officered. soundly. June 1885. P. 0,115. (Agricultural market town.) Beplinoton- Wanting inactivity. Beoom- Fairly pood. M.O.H. Energetic; I. of N. is surveyor shire, U. mendations of M.O.H. only advises in detail. also. T)r Pnofl carried out to small extent, TnViaiuM aua many of the most imjunt issj. portant improvements re- P. 14,510. commended on Dr. Parsons's (Collieries.) inspection in 1879 not carricu out. Newbiggix, U. - Fairly efficient. S.A. attend to Very efficient - - Active and efficient - Dr. Page, adviße of M-OH- June 1885. P. 1,388. (Fishing, lodginghouse keeping.) Alnwick and Very inefficient, and in several M.O.H. just resigned. He I. of N. is surveyor also; ca- Canongate, U. important respects complete was an energetic and pable officer, and has duly T>r Pnirp inaction, and this notwith- competent officer. reported to S.A. r»«i iom standing recommendations Uct. 18SB. of the u oarj j n igs.j, P. 0,093. (Agricultural market town.) Amble, U. - - Improvements have been Good. M.O.H. advises well Indifferent - - • t. t, carried out since Mr. June 1885 Power's inspection in 1883. P. 2,016. (Agricultural.) Beewick-upon- Fairly good, and improve- M.O.H. newly appointed Efficient Tweed, U. ments eifected. Dr. de Chaumont, March 1885. Dr. Page, June 1885. (Re-inspection.) P. 13,998. (Iron working, agriculture, fishing.) 281 NORTHUMBERLAND— continued. 13. 14. 15. 16. 17. 2,"0 Result of Board's subsequent Inquiry Abatement nnd H? o?^ , . .. , , . ~ . .3 • £> ° as to Action taken by S.A. on Prevention Hospital Provision. || -J Recommendations of Inspector ; of Nuisances. || || with Date of Information. i Efficient. Recurring Cottage Hospital j None - | None - No subsequent inquiry to date. May 27th, nuisances duly dealt improved since 188<>. with. Dr. Barry's inspection. Efficient, except as to i None - - None - | None - November 1885. S.A. will do their best midden cleansing. to carry out Dr. Page's suggestions. I Fair .... None - - None • I None - February 188(i. Action of S.A., taken or contemplated, on Dr. Page's advice satisfactory, savo as to hospital provision. Nuisances not habi- Yes - Yes; a hot- None - June 1880. Excrement and refuse removal tually or efficiently air oven. contracted for; sewers receiving attendealt with. tion ; arrangements made with South I Blyth U.S.A. as to (cottage) hospital j accommodation ; ambulance and means of disinfection provided ; byelaws under j consideration. Nothing done as to system of midden privies or to improve condition of back streets and yards. Efficient • None - - None - None - Late M.O.H. in 1885 speaks of action having been taken on Dr. Page's advice ; urges some system of scavenging under immediate control of S.A. Nuisances not dealt None, but site for None - None - October 1885. S.A. state that Or. Page's with. one selected. recommendations are receiving attention, and that some (not specified) have already been carried into effect. 1880. Sanction to loan for hospital purposes has been applied for. ¦ Fair under advice of None, but provision None - None - August 1885. Action promised as to hos- M.O.H. contemplated. pital provision and replacement of midden privies, but up to February 1880 nothing apparently accomplished. Efficient - - - Yes .... Portable None - September 1885 — June 1886. S.A. have steam dis- taken action on Inspectors' advice, infecting except as to sewerage system for Tweed- i chamber. mouth and Spital. 282 CUMBERLAND. L 2. 3. 4. Urban Sanitary District. , Cleanliness of Excrement Disposal and Dateof Report. Sewering and Drainage. Removnl . Population (1881). Premises. Industries, &c. 0 TT . pjr . . . Sewering general. Sewers venti- Mostly w.c'« with flushing Carlisle, v. *air lated and flushed. House arrangementi. Dr. Blaxall, drainage defective. Aug. 1885. P. 35,930. (Ironworks and factories.) ¦Mauyport IT - Fair - - - No sewering. Works now in pro- Pail and tul) closets and midden makhoki.l. . privies i regularly emptied. Dr. Blaxall, R Aug. 1885. (Ironworks, collieries, shipbuilding, and shipping trade.) WorkinCtTON U - Roadways good, Sewers, but certain of them badly W.c's with flushing box universal but yards and constructed. Ventilation defec- Dr. Page, court's filthy. tive, but sewers flushed. House April 1885. drainage good, and all waste- Dr. Blaxall, pipes cut off. Aug. 1885. (Re-inspection.) P. 13,308. (Collieries, iron working, &c.) w T vpv TT Sewered. Sewers ventilated and Mostly w.c's with flushing cisflushed. House waste water- terns. Cess-pit privies being Dr. Blaxall, pipes not out oft. abolished. Aug. ]ss,s. (Collieries, ironworks, &c.) MONMOUTHSHIRE. _ Citepstow U - Sewered. Sewers not ventilated W.c's, without means of flushing • I _ ' ' nor flushed. House drainage Dr. Blaxall, detective and imperfect. Feb. 1885. Vfwpout U - - Fair - - - Mostly sewered. Certain sewers Filthy, badly-constructed w.c's , . not ventilated without Hushing arrangements. Dr. Blaxall. July 1885. (Shipping trade. dockwork, factories. ) TredeCtAE U - Fair - - - Sewering incomplete and un- Privies directly over open drains , . systematic ; only ventilated which they thus ventilate very Dr. D. S. Davies, through privies and untrapped offensively and dangerously. Nov. 1885. street gullies. Some dangerously Many cesspits. Some pails. P. 18,771. leaky house drains. (Collieries, ironworks.) Rhymnet U - Fair - - - No complete or satisfactory system Privies directly over open drains. r~ " '. , of drainage. There are drains Some pails. Cesspits common Dr D. h. Davies, o f various character through and offen neglected as to empty- Nov. 1885. which mountain streams run. ing for many months. P. 8,663. O n ' y ventilated through open I ? ? privies and untrapped gullies. (Ironworking. ' *v n almost exclusively.) I - ' 283 CUMBERLAND. 5. 6. 7. 8. 9^ ¦ i Sanitary Crowding Overcrowding of Refuse Removal. Wator Snpply. Dwellings 0 of Dwellings on Dwellings. of Poor. Area. Unsatisfactory - Public supply from Eiver Eden Dirty - - - Many courts and Probably. of questionable purity. Con- j alleys with little stant. ftir space. Satisfactory- - Public supply from River Eden Fair, with excep- Many baok-to- Some, but less of questionable purity. Con- tions. back. Crowded. than formerly. stant. Satisfactory, with Public supply without inter- lOn the whole fair, ! Crowding in ' None now. exceptions. ventionol cistern. At times but some i courts in vaintermittent. Water needs wretched pro- j rioUB parts, i filtration. perty exists. 1 made more dan- Building bye- gerous by filthy klaws not en- | and neglected forced in im- state of surface. portant particulars. Satisfactory - - Public supply from Ennerdale Bad in some parts I Some confined j Some. lake; abundant, good, and courts. b constant. MONMOUTHSHIRE. _ _ • By contract twice Public supply by a company ; a week ; said to unsatisfactory, in respect be satisfactory. both of quantity and quality. A few wells. Unsatisfactory - Public supply plentiful and Many dirty and Many close courts Yes: a difficulty wholesome. ill-ventilated. for the mot Satisfactory. - Public supply mainly. Supply Mostly fair, but Crowding of nar- None apparently. at outskirts by springs and some very un- row streets in " pist ills." wholesome dwel- older parts. lings with back to earth. Satisfactory- - Public supply on constant Many damp houses. Open straggling None, system. " Pistills," springs, Some built into town, and wells in outlying parts the earth and are watched. hence damp and ill-ventilated. | 284 CUMBERLAND— continued. L 10. U. l *L I Sanitary | Jorand Administration by Sanitary Work of Medical Offlcor Work of Inspector of •Report. Authority. of Health. Nuisances, ion (1881). ;ries, &c. j Carlisle, U. - S.A. have done much good work, Efficient - - - ¦ Good_, „. ? but dwellings of the poor in- Dr. Blaxall, sufficiently attended to. Aug. 18S5. (Ironworks and M\rtport, I. - S.A. badly advised formerly, Efficient - Efficient - but well advised now. and : Dr. Hlaxan, j improving in sanitary ad- j Aug. 1885. ministration. P. 8,126. (Ironworks, collieries, shipbuilding, and shipping trade.) , Workikoion.U. Administration not efficient. Very good : active - - L °^.iB sunreyoralso^work Dr. Pap-, . \ f "> svs" ! b ™S t0 ° lar^ lOT (1 »« P er / April -2,,, 1885. [^Scdfy ignored? ' fornmrice of duties of both Aug. 1886. (Re-inspection.) P. 13,308. (Collieries, iron working, &c.) Whitbhaven, TJ. 8. A. have done some very good Efficient .. T.l II work, but failed to improve Au 1886 BOrne of the WC "' st P °° r ' I. 19,296. (Collieries, ironworks, &c.) MONMOUTHSHIRE— continued. Ciiepstom', U. - Inefficient .... Dr. Blaxall, Feb. 18S5. P. 3,591. Newpoet, U. ¦ Inefficient- • M.O.H. an intelligent officer Good Dr. Blaxall, July 1885. P. 35,313. (Shipping trade, clockwork, factories.) TuEDEaAE, U. - S,A. alive to health interests M.O.H. gives sound advice - Efficient ; I. of N. is surveyor Dr. 1). S. Davies. ot , to . wn > I)U * hesitating to also. S'ov 1885 adopt a needful scheme for iniiiroved drainage. P. 18,771. (Collieries, ironworks.) ; RnvMXEV, V. - S.A, largely composed of re- M.O.H. advises well and is Active and efficient ¦ I)r I) S Dftviea presentatives of the iron alive to the requirements NnviSSfi " company. Appear willing of district. NOV.IBBB. to hel]. the .M.0.1 1. P. 8,603. (Tron working almost exclusively.) 285 i i C UMBERL AN D-- -continued. 13. 14. 15. 16. 17- __ g,"3 Result of Board's subsequent Inquiry Abatement and j? . So as to Action taken by S.A. on Prevention Hospital Provision. J "gj _^ Recommendations of Inspector ; of Nuisances. "c B "1 § with Date of Information. 1 :2 s- sj i i a ,"* ! sanction to borrow 6,000/. for works o sewerage and 2002. for provision ( slaughter-houses. I Better than former* Yes g very n, None - lj»e & M.O.H.has tiiken to purohase site for publ advised. slaughter-house. Inefficient - - - Yes, but and rained Non,- that None - June 18* >^Ugjven -MjogaW, is uiiutm. to date (May anhj lgg6) Board's inquiry or Außiist 1888 as actual securing of efficient filtration aiu constancy of water supply. [Seeßiparian ab- None - None - J to proper hospital provision; they a content with present building. MONMOUTHSHIRE— continued. Unsatisfactory - - Mat ' cl) 1888 l StAl stlite tll!lt they hi l v^ -MavJahm lAanta. I carried out improvements recommended Uon of an ohl baric sk.nT^se to meet the | by l)r Blaxall in connexion with their requirements of an epidemic ofßmall-pox. present hospital. I, T >¦ r i m tjvwip . None - AuKuat 1886. B.A. still considering ques- Unsatisfactory - - None - ¦ - None «one tkrn of hospital provision: revision of byelaws to be undertaken. March 1886. Proposal submitted to Board in regard to hospital ; not considered satisfactory. „ Vn™ - l'l'i'nared Vi)ril lS8(i. Dr. Davies's advice receiving Satisfactory so far as None - ¦ - None ™2Sm consideration. June 1886. No practicable under regards hospital to be provided. Nothing said existing conditions. hospital. as to byelaws. . Nnnn . . . None - None - April 1886. S.A. are giving attention Fair XNOne Dr. Davies s reconmiendations. 286 NO.Lvi.xl WA..|j_hiis. Urban Sanitary District. Tnsnector and Cleanliness ol Excrement Disposal and iV , . I Roadways and Hawavinir unri Tliwiniura Date of Report. Domestic Sewering and Drainage. Removal. Population (1881). Premises. I Industries, &c. HoiiTWELL. U. - Fair ... Drainage incomplete and unsyste- Mainly large open privy middens ] , naatioi stone or brick barrel. of bad construction, and not I Dr. D. 8. Davies, Unftushed and unventilated. emptied sufficiently often. Some I June 18S5. privies over open square drains. P. 3,090. (Lead mining, copper, paper, and flannel works.) Mold TJ - - Roadways fairly Main sewers as described by Dr. Liirgo open midden privies. Not _._,„_ . kept. ' Blaxall in ]«7<>. Disposal of duly scavenged. Same faults Dr. 1). S. Dimes, sewage unsatisfactory. 'is in 1876. June 188."). P. 4,820. (A fading town; population decreasing. ) Flint U. ¦ - Improved since Completely sewered now : sewers Unsatisfactory middenstead ar•r. ' _ _ . Dr. Blaxall's ventilated and Hushed. rangoments still prevalent. Only Dr> T P- S -V a 1 vies> inspection in afeww.c's. J une iooi>. 187(! P. 5,01X5. (Chemical works, collieries, and paper mills.) Ynyscyniiaiarn, Pair - - - Completely sewered. Sewers W.o's in better houses. Midden U. ventilated and Hushed, but dis- privies in poorer houses; source T . t . „ „ . connexion of sink and waste- of recurring nuisances. Dr. D. b. Davies, nines ,K,.,,i(.(i, K ,.,,i ( . ( i Dec. 1885. plpes neeaea - P. 5,50 G. (Slate-quarrying and snipping trade.) Holyiiead, U. - Roadways fair, Some pipe drainage, neither venti- Objectionable. Midden privies as I t«» -n c n,,,;o U domestic pro- lated nor satisfactorily Hushed. at Dr. Ogle's inspection in 187S). iV i««K lllis es unsatis- Not cleansed by S.A. Some vet. isso. factory. w.c's hand-flushed. P. 8,080. (Railway work chiefly.) SOUTH WALES. Cardiff, U. - - Good - - Sewered. Sewers offensive in dry W.c's, but often no flushing ' Dr Blaxall weather from want of flushing. arrangement on account of den- July 1885. ciency of water. P. 86,3(U. Poxtypeidd, IT.1 T . - Good - - - Not sewered. Slop and surface Privies, and uncovered cesspits Dr D S Davies water run into river, which is soaking into soil from which May 1885. tluls the Bewer ot district. water is in some places drunk. P. 12,317. Mountain Ash, U. Good - - - Sewered, and sewerage being Mostly w.c's at a distance from Dr. D. S. Davies, extended as required. dwellings, without flushing cis- May 1885. terns, but not unsatisfactory on 287 NORTH WALES. 5. 6. 7. 8. 9. I i Sanitary Crowding Overcrowding of Refuse Removal. Water Supply. Dwelling of Dwellings on Dwellings. of Poor. Area. [ i Unsatisfactory - Wells, some, of suspicious ; Fair in sonic Some crowding None at present. character. parts. Houses amid unwholebeliind " Blue some surround- Bell " Inn utter- ings. ly shocking, dirty, and neg- Unsatisfactory - Sutriciont public supply lor As might be ex- Somo unwhole- None, whole town, but still some pected in a de- some neglected extremely dangerous wells in creasing town, courts, use, some of which are on some houses property belonging to a mem- much neglected, ber of the S.A. ' dirty, and unwholesome. Middens teads Public supply good, constant, Much improved j Crowding and in- None now. fairly looked and sufficient. No wells. since 1876, but sufficient airafter, still there is a space, with unlilthy Irish I wholesome surquar'ter. roundings in older parts, but on the whole, improvement. Refuse removal Public supply satisfactory - Require extension Only exceptional - None, left to occupiers. of drainage to Fair, but refuse Public supply apparently I A town almost : None - - - None now. matters not good. A few wells. wholly built for satisfactorily I accommodation disposed of. of labourers and j artizans. Con- ' dition of many i dwellings un- | satisfactory. I I . SOUTH WALES. Efficient - - Public supply continuous, but Fair on the whole. A few courts, not Much crowding, *' mC insufficient. Fresh powers Well looked very close. but t overobtained. after. crowding. Collected and Public constant supply insulfi- Fair on the whole, j Crowding and None to speak of. tipped on an cient in dry seasons. Filtered but little back | courts not preoffensive heap. ' and apparently wholesome. space. valent. ! Some wells liable to contamination. •— »¦» ¦ ¦ ! < rs% i srffl«fis fi =x,. ki °" sFI3 s Fl3 except in dry seasons. S.A. ! \ v \ P w '- y otcu " | are increasing supply. j (.i.hive obtained ; byelaws to regulate houses let i j in lodgings. 288 i ! i i i NORTH WALES— continued. _L 10. 11. 1^ Urban Sanitary District. 1 nspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1S81). [nclustries, &c. — - Holtweli U - B.A. not made much progress M.O.H. advises satis- Satisfactory . . | . ? ' , ' . since Dr. Blaxall's visit in faotonly. Dr. D. ». myies, lg - ( ._ g er ious defects persist | June 188 a. tvoxn one inspection to 1». 8,090. another. (Load mining) copper, paper, and flannel works.) Mold U - - S.A. not sufficiently active in M.O.H. an active and good Inactive. I. of N. afraid of ' '_. . respect of water supply and officer. giving offence. Dr. D. S. Davies, sea £ en ging. Juno iss.). P. 1,320. (A fading town ; population do creasing.) Flint, U. - - Good work done since Dr. M.O.H. newly appointed - Efficient ' ' _. . Blaxall's inspection in 1876. Dr. D.S. Davies, giA# appear inclined to .1 one ISSj. progress. P. 5,086. (Chemical works, collieries, and paper mills.) Ynyscynhaiarn, Fair administration, but S.A. Satisfactory- ... Efficient U. should undertake excre_ _ „ _ . nier.t and refuse removal. Dr. D.S. Dnvies, Dec. 1885. P. 5,500. (Slate-quarrying and snipping trade.) Holyhkad, 11. - Requires to bo more active - Satisfactory- ... Not quite satisfactory. I. ofN. n« t> c t>.,,m > c r> ¦„ Irish quarter. sewer is a brook, arched over but 1 ill i?ss ' not "inverted." Some houses Oct - 1885 - drain directly into it. P. 4,153. (Market town.) Maesteo, U. - - Many roadways No complete system. Drains d is- W.o's, without flushing arrange- I i). n t»t p ¦ neglected. charge into river, but con- merits, discharge into drains, n't 'ims structed so as to be capable of Some privy-pits, many soaking wet. isao. connexion with a main sewer. into soil. P. 8,310. (Collieries and iron working and tinplate manufactures.) NEATHi I. - - Roadways insuffl- Sewering complete. Sewers W.e's mostly Dr D S Davi > cientJy cleaused. flushed, but not ventilated. ' Oct 1885. P. 10,384. (Tin-plate manufactures, chemical works, collieries, and iron and copper working.) Mab&am, U. - - Many roadways Improvement of sewering in pro- Privy pits, some very bad and n „ „ T)n ¦_ require atten- gress, but not on a definite offensive, being gradually re'« t'iss* tion# system. placed by w.c's without flushing »epr. ihbo. arrangements. P. 5,708. (Collieries, copper work, brass founding.) Briton Perky, U. Fairly satisfac- Sewering completed, flushing W.c's with flushing cisterns ; satisr» t> c 1 1.,-,,, tory. efficient, but ventilation insutii- factory. Privy pits a nuisance I," iif^ cient - "*' Giant's Grave. P. (5.061. (Collieries, iron works, and tinplate works.) , 291 ¦SOUTH WALES — continued. 5. 6. 7^ 8. _9. (Stionof Crowding Overcrowding of i Refuse Removal. Water Supply. Dwellings of Dwellings on Dwellings. of Poor. Area. I Daily removal Mainly public Supply from Satisfactory. Clean No crowding. Not common, exwhere ash- ltho'nddsi Gas and Water and in good Plenty of yard cent in newer closets or pails Company. Some wells. order. space on tlie colliery neighare used. whole. bourhoods with rapid influx of population. S.A. about to adopt byelaws for houses let in lodgings. Generally satis- Ample and good public supply Many ill-ventila- Rarely - - - Only among the factory. on constant system. tedbaek-to-buek Irish. or back-to-earth cottages. About one-half dirty inside and in yards. i Generally fair - Public water supply. Some Many unsatisfac- None - - - Little, underground oisiernage. Tory from damp and dilapidation, but these are now being dealt with. ji' a j r . . Public supply, by stand-pipes. Fair, but some None - - - None. Short sometimes. damp from lack of spouting. Some cellar dwellings. I j,\,; r . . . Public supply on constant Fairly good - - Courts and houses None at present, .system. Satisfactory. too much crowded together in older parts of town. Ashbins in use, Public supply from dangerous- Unsatisfactory - None - - - None, systematically' I.V polluted source. New emptied by con- supply in progress, tractor. r..- . public supply from Neath Much improved of Few back-to-back None. Waterworks Company. Con- late. houses and slant, except in drought. A courts, few wells and " pistills " need watching. I 292 SOUTH WALES— continued. 1. 10. U. 12- Urban Sanitary j District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (18S1). Industries, &c. Ystuadyfodwg, Good and promising; doing Good ¦ ... Satisfactory U. their best to improve dis- Dr. D. S. Davies, tnct> May 1885. P. 55,032. (Coal-mining district.) MEBTHYB Ttd- Good on the whole, but not Good ... . Satisfactory - j/jl v, dealing actively enough ' with unwholesome dwell)r. Ballard, ii ngg am \ their surround- Sept. 1885. j,,g Si P. 48,861. (Collieries and iron working.) Bridgend U. - S-A. are hesitating about M.O.H. newly appointed Fairly efficient ' '. sewering, and rarely ask for Dr. D. S. Davies, Inspector's report book. Oct. 1885. ' ' P. 4,153. (Market town.) t Maestkg, U. - Fair on the whole. Not sufficiently systematic - Dr. D. S. Davies, Oct. 1885. P. 8,310. (Collieries and iron working and tinplate manufactures.) Nuattt V - Fairly good .... Fairly satisfactory. M.O.H. I. of N. is a surveyor in private ixaxin, v. • not under Board's Order. practice. Much occupied in Dr. D. S. Davies, other work. Enough work Oct. 1885. probably to occupy one p 2().j S j man's whole time. (Tin-plate manufactures, chemical works, collieries, and iron and copper working.) Margam, IT. - S.A. recently constituted; M.O.H. occupies similar I. of N. is surveyor also ; will ¦n. r> « T>..,,inu acting slowly. post at Aberafon. probably be efficient when ta*'i«Si he !Uld S - A - ooni ° t0 under- Sept - 1885 ' stand each other. P. 5,708. (Collieries, copper works, brass founding.) Briton Ferry, Fairly good .... Satisfactory - - - I. of N. is surveyor also, and U. cannot therefore make con- Dr D S Davies stant systematic inspections. Aug. 1885. P. 6,061. (Collieries, iron works, and tin- I plate works.) 293 SOUTH WALES— continued. 13. 14. 15. 16. 17 L It's Result of Board's subsequent Inquiry Abatement and | gg aa to Action taken by S.A. on Prevention Hospital Provision. 1 J Recommendations of Inspector ; of Nuisances. || || with Date of Information. Efficient on the whole None. S.A. contem- Yes, ; None at 'No subsequent inquiry to date (May 27th, plating an expert- "Fraser's \ present. • 1886), but M.O.H. in 1885 report says mental hospital' Patent." joint board (with Pontypridd U.S.A.) has for part of dis- been formed for purposes of a sewerage trict. system ; no evidence of action of joint board. Nothing said as to hospital provision. Satisfactory on the Two hospitals kepi Apparatus Prepared No subsequent inquiry to date. May 27th, whole. in constant readi- provided to act at 188(i. ness. at each once, hospital. Fairly efficient, so far None - - - None - Partially July 1886. Apparently nothing done or in as practicable. prepared. contemplation on Inspector's advice. Fair, but recurring None - - - None ¦ None - May 188(i. Isolated premises in Maesteg nuisances not cflec- taken as hospital for seven years, tually dealt with. Systems of water distribution and refuse removal receiving S.A.s attention. None of permanent Portable Hospital September 1885. I. of N. and his assisnature, but pro- apparatus, tents held tants instructed by S.A. to look well to vision is under in readi- condition of drainage! (public and priconsideration of ness. vate) and dwellings. S.A. Inefficient as yet, but None - - - None - None - No subsequent inquiry to date. May 27th. better results to be 1880. looked for in time. ' Generally satisfactory None - - - None - None ; but September 1885. Dr. Davics's suggestions will pro- to be discussed by S.A. with a view to bably be their adoption, made. 294 SOUTH WALES— continued. 1. 2. 3. 4. v ' i Urban Sanitary j District. I Inspector and Cleanliness of Excrement Disposal and Date of Report. Domestic" Severing and Drainage. Removal. Population (1881). ! Premises. Industries, Ac. | __ — AIiFKAFON D - Fair - - - Sewered completely. Sewers veil- W.c's mostly without flushing _ ' . tilated and flushed. arrangements, and hence many Dr. D. S. Davies, ! f nim d choked from neglect. Au;r. 1885. P. 4,859. (Collieries, tinplate works, iron and copper works. &c.) Swansea II - - Roadways fair, Sewering, commenced in 1864, not W.c's with flushing cisterns in but courts and i yet completed, but progressing. sewered parts ; elsewhere offen- Dr. Jmllard, l>a.elc yards Sewers flushed systematically. sive privy pits much neglected. Aug. 1885. neglected. P. 05,597. (Market town, maritime trading. and metal working.) Oyster uo u in U - Main roadways Unsewered. Drains discharge Some w.c's discharging into drains . fair ivi vl t side offensively along beach. only adapted for surface drain- Dr. D. 8. Davies, streets unsatis- age. Other houses have buckets Aug. 1685. factory. used as ash-closets. Nuisance. P. 3,487. (Fishing and maritime. Health resort.) LIANBILT, U. • Satisfactory- - All but "Forge" district sewered- W.c's, mostly with flushing cis' ' terns, are rapidly being subl)r. D. S. Davies.. stituted for cesspits and ashpit Aug. 1885. % privies. P. 19,700. (Copper, lead, and tin-plate working.) Carmarthen, V. - Satisfactory - - Sewering complete, with arrange- Satisfactory. All cesspools abo_ TA „_, . ments for ventilation and Hush- lished. W.C s hand-flushed. Dr « * 8 ;£ aVleS> i"?~ r - All houses connected. Ot't. loot). P. 10,51:>. (Agricultural market town, but some factories ; iron and tin works.) Pfmbroke U. - Many roadways No drainage arrangements what- Mostly privy pits or privies over . unmade at ever except unsatisfactory ones ashpits, soaking into soil and Dr. D. S. Davies, Pembroke Dock. in Admiralty quarter of Per- much neglected. Sept. 1880. Chamber slops broke Dock. P. 14,156. commonly cast into street. Tenby TJ - - Roadways fair, Partially sewered in a patchwork W.c's universal, mostly hand" ' ' domestic premi- style. No ventilation. Outfalls flushed. Some serious faults Dr. Ballard, ses a]so exce pt improved since 1870. pointed out by Mr. Radchfte in Sept. 1885. ln o i(}(, s t parts 1870 still unremedied, notwith- P 4 750. of town. standing mischief known to ' ' have accrued from them. (Health resort, agricultural market town.) 295 SOUTH WALES— continued. 5. 6. 7. 8. 9. : Sanitary Crowding Overcrowding o£ i Refuse Removal. Water Supply. Dwellings of Dwellings on Dwellings. of Poor. Areii. . _ , - , L Satisfactory - - | Public supply constant, abun- I Generally fair and Some houses, built, None. danti and good. A few wells. ' improved, but against hillside, some dwellings confined. complained of I I by Dr. Airy in i 1877 still unimproved. Some houses damp from lack of spouting. Unsatisfactory • I Publio supply by pipe and tap, ! Fairly good, | Many close and \ Occasionally, not constant, mid insuliicient ] except in some ; ill - ventilated i rants being nigh, in quantity. Reservoir pol- courts. courts in older ; Of houses let luted at time of visit, causing I parts of town. in lodgings. 279 severe outbreak of enteric i Elsewhere am- : are registered fever. pie space about and regulated. houses. Fair - - - Public supply by Oystermouth Fair - - - Not much crowd- None. Waterworks Company ; not ing of houses, much used. Wells numerous. Roof rain-water often used. Satisfactory - - i Public upply on constant Many houses un- A few courts - None, system. Satisfactory. satisfactory, but steady improvement going on. Systematic and Public supply satisfactory - Improving, but Some courts and None, satisfactory some dirty alleys and backquarters which, to-back houses, however, are as in most old watched. towns. No public arrange- Public water supply at Pern- Many unsatisfac- Parts of Pembroke Some oycrcrowdments made. broke improved, but Pern- tory. crowded, other- ing in Pembroke Dock still mainly wise mostly broke, dependent on polluted wells with abundant as at cholera outbreak in airspace. 18(50. Satisfactory- -' Public supply on constant Fair generally, but Crowding of dwel- Occasional oversvstem. Open to dangerous some grievous lings on area in crowding, pollution at source similarly exceptions, es- older parts where to Swansea. Inadequate in pecially in Cor- there are also quantity. poration pro- unwholesome perty. Places courts. complained of by Mr. Radcliffe in 1870, still unremedied. Very many cottages without due ventilation. 296 SOUTH WALES— continued. __ 1. 10. 11. 12. Urban Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. I I Abke\fox, I. - S.A. appear willing to act on I Satisfactory - - - -'I.of N. holds other offices; is ¦n -n a-n ¦ advice, but do not appear to : inclined to let matters drift. ''¦ ?• S - 1 lj l - VleS> take the initiative. Much \ Aug. isk.). work of drainage and water : P. 4,859. supply accomplished since i rColleries,ti». Dr. Alry's report, 1877. plate works, iron and copper works, &c.) Swvx^Ei, U. • ! Fairly good. S.A. attend to ' M.O.H. an able and :I. of N.s work much im' . . the advice of their M.O.H. thorough officer doing proved of late; work now UT. uaiiara, excellent work. done systematically under Au S- 1885. direction of M.O.H. P. 05,51)7. (Market town, maritime trading, ' and metal working.) Oystermouth, U. I Unsatisfactory- - - - Satisfactory ... Satisfactory ¦ Dr. D. S. Davies, Aug. 1885. P. 3,487. (Fishing and maritime. Health resort.) Llanelly, U. - Efficient and progressive - Very good .... Very good ; I. of N. works Dr. D. S. Davies, under direction of M.O.H. Aug. 1885. P. 19,7»!0. (Copper, lead, and tin-plate working.) Carmarthen, U. Efficient. S.A. have done ex- M.O.H. an able and Very good ; and I. of N. works Dr I) S Davies cellent work since 1873. thorough officer, doing under direction of M.O.H. Oct. 1885. Earnest administration. good work. P. 10,512. (Agricultural market town, but some factories ; iron and tin works.) Pembroke, TJ. - The Board's recommendations M.O.H. energetic, and boldly Unsatisfactory work, I.ofN. t)» t> c TVivios on r - Airy's inspection in doing his best to urge S.A. is surveyor also. Oar*' -lam 1879 almost wholly ignored. to action, stpi. iaao. District in a dangerous con- P. 11,15 G. dition for advent of cholera, from which it suffered severely in 18G6. Tenby, U. - - Careless and apathetic. Little M.O.H. does little or no I. of N. is surveyor also. Dr "BilHrd evidence of steady sanitary work. Makes no reports, Never reports and does no c'tusr," work of any kind. because, he says, his advice systematic work. (Sept. issj. is syst e ma tically ignored. P. 4,750. He is not under Board's (Health resort, Order - Agricultural market town.) SOUTH WALES—continued. 13. 14. 15. 16. 17; o. ki g, o Result of Board's subsequent Inquiry Abatement and | gg as to Action taken by S.A. on Prevention Hospital Provision. gj *§ Recommendations of Inspector, of Nuisances. |fi 111 1 with Date of Information. . _ _ Not satisfactory- - None ... None • — September 1885. Action taken in s:>nse of certain of recommendations left with Authority. No decision come to as regards hospital provision. L.-w — vision, but huts provision being pushed forward. Source of water and tents pro- anticipated. supply considered safe from pollution, vided. Nothing as to other recommendations. February 1886. S.A. in treaty (or :i site on which to erect permanent hospital. | Efficient, so far as j None - - - None - None - ,No subsequent inquiry to date (May 27th, lack of systematic | 1806), but sanction to a loan of 6,f!o(jZ, I drainage permits. for works of sewerage has been applied for. M.O.H. in 1885 report again draws attention to need for good water supply. Efficient ... A Doecker's hut for Disinfecting Preparing No subsequent inquiry to date. May 27th, eight beds, pro- chamber 1886. vided under provided. Cholera Order, would be used for I urban purposes. I Efficient; prompt Yes, but open to Disinfecting Preparing No subsequent inquiry to date. May 27th, dealing with re- improvement. oven. 18S6. curring nuisances. 1 Unsatisfactory - - None - - • None - None - June 1886. Removal of night soil and filth to be contracted for ; general | statement that action will be taken on other recommendations of Inspector. I I I Wholly inefficient. None ... None - Nono • ! October 1885. Some action being taken :ts Obvious nuisances to water supply, sewerage, and sewage not dealt with. outfall; small loans since sanctioned for those purposes. E 20510. U 298 - SOUTH WALES-continued. 1. 2. 3. 4. .... Urban Sanitary District. Inspector and P^S^ivt B^ Excrement Disposal and Date of Report. R °C,£tic Sewering and Drainage. RemovaL Population (1881). Premises. Industries, &c. Haverfordwest, Fair, but offensive Not systematically sewered. Many Partly w.e's and partly privies, U. smells in most drains (or sewers ?) only troughs which are situated over streams ' n n« n • parts of town. in the rock covered over. Of- or sewers which they ventilate. . ur. i). a.VKVies, fensive and bad. Some cesspits polluting the soil. Jsept. 1885. P. 6,898. 1 (Agricultural market town.) Cardigan, U. - Principal road- No systematic sewering. Square Privies of abominable construcn ti «ti • ways fair - oc - stone drains and a few pipes. tion, leaking into hedge side ur. v. a. jjjmes, fensive collections Drains unventilated and not ditches. Many houses without Jan. issu. of refuse in side flushed. any accommodation at all. A P. 3,609. streets. few hand-flushed w.c's. (Agricultural market town, some shipping trade.) Ybektstwitit, U. - Satisfactory - - Complete sewering, but sewers W.c's, with inefficient flushing . not ventilated. arrangements. No cesspools. A Dr. D. S. Davies, f ew pr i v ies. Jan. 1886. P. 7,133. m (Ironworks, slate enamelling, V some shipping trade.) 299 SOUTH WALES— continued. 5. 6. 7. 8- 9. Sanitary Crowding Overcrowd inir of I Refuse Removal. Water Supply. Dwellings of Dwellings on Dwellings. of Poor Area. Imperfect - - Public supply intermittent. All the defects apt Much overcrowd- Yes, in some parts Pump wells open to dangerous to be found m ing of dwellings which have a excreniental pollution from old towns. with privies very poor popu- I so il in dangerous lation. Not proximity. looked after. Very imperfect re- Public supply intermittent, but At the " Mwldan " Crowding and in- Apparently none, removal. Refuse apparently wholesome. houses built into sufficient air cast into cor- the hill side, and space about ners of streets hence damp and dwellings in or courts unventilated (a "Mwldan and prevalent Welsh other parts. custom). Satisfactory- - Public supply from Plynlimmon Pair ; improve- Some courts, &c, None app a rently. | ° al ¦ excellent and constant to ments progress- being improved, most parts. ii n X- — __—_———— 300 1. 10. 11. 12. Urban Sanitary District, Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. Haverfokdwest, S.A. have done little to carry out M.O.H. appears active, but Inefficient. I. of N. is super- U. improvements since Dr. Par- hos failed to rouse S.A. to intendent of police also. ¦n,. t> P. 12,493. [Whitstable and Seasalter only.] (Seafaring population.) Milton, R. - Dr. de Ohaumont, March 1885. P. 11,195. Sheppey, R. - - Fair - - - Merely surface drainage - - Mainly privies. Earth closets [Queenborough in the better-class houses, mainly.] Dr. de Chaumont, March 1885. P. 3,918. h (Agriculture, lure and cement works.) 5. 6. _7. 8. 9. Sanitary Crowding Overcrowding o Refuse Removal. Water Supply. Dwellings 0 of Dwellings on Dwellings. of Poor. Area. Unsatisfactory - Kent Waterworks Company : Many new houses Infrequent - - Occasional. supply being extended, but erected of late district still largely supplied years, and being from wells liable to pollu- still constructed tion. without regard to sanitary requirements. I Unsatisfactory - Wells, some of which have Unsatisfactory, but None - - • Somotimes. been closed on occurrence some improveof enteric fever. Improve- ment of late ment at Stoke. Pond water years, used at High Halstow. I Unsatisfactory - Mainly local wells, often found Fair on the whole. Very little - - Very little, polluted with sewage. Some old cottages scarcely fit for habitation. t Unsatisfactory - Shallow wells liable to pollu- Small, often damp Some in Hadlow - Some overcrow tion, and often found pollu- and dilapidated, ing. ted. with filthy surroundings. I Unsatisfactory - Local wells, all subject to Some small, dirty, None - - • None, pollution. Rain-water cis- and dilapidated, terns. Water generally and surroundscanty in amount. ings generally bad. Satisfactory - Public supply for last sor 6 Fair on the whole Some - - - Not much, years, but many wells in use, mostly brackish. Public supply given to Rain- Improvements ham and Lower Halstow. made at Murs- Borden lane supplied from ton. wells with suspicious surroundings. I Satisfactory . From two wells in the town ¦ Good^ Queers ™b*°™™ None. elsewhere.except borough. Elmley, where houses are mere hovels. 304 KENT— continued. 1. 10. 1L 12. 1? Ural Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of ; Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. | Dabtfoed, R. - Very inefficient. No improve- Four M.O.H.'s (D.M.O.'s). Two I.'s of N. One fairly e(B-w t Bn™i. nient of administration since Unsatisfactory, but cient, the other incompetent ninoiaa* Dr. Thome's inspection in M.O.H.'s do their best and indolent. I dune 18801 1879.and Mr. Spear's in 1882 under much discourage- P. 24,067. and 1884. No building bye- ment. (Agriculture laws in s P ite of repeated cement works, recommendations, paper works.) Hoo, E. - - ¦ Dr. de Chaumont, Feb. 1885. P. 3,405. (Agriculture, brick making.) MallinG, E. - Not very efficient, but appa- M.O.H. of a combined I. of N. is also Surveyor of Mr J Sne-ir rently some attention paid district. Good. Highways, and gives'to this ATfl'rnh 188=; ' t0 individual matters duty the larger share of jiditn moo. brought before them. attention, so that work of I. 22,745. [Improvements set on of N. sutlers. (Agriculture, foot since BUrvev wa S made.] cement works, paper mills, brick making.) Tojtbridge, R. - Inefficient .... Same as above ... Satisfactory .... Mr. J. Spear, March 1885. P. 15,360 (Agriculture.) JMaidstone, R. - Inefficient .... Same as above - - Good Mr. J. Spear, March 1885. P. 15,468. (Agriculture.) Blean, R. - • Dr. de Chaumont, March 1885. P. 12,493. [Whitstable and Seasalter only.] (Seafaring population.) Milton, R. - - Dr. de Chaumont, March 1885. P. 11,195. Sheppet, R. - — [Queenborough mainly.] Dr. de Chanmont, March 1885. manure and cement 305 KENT — continued. 13. 14. 1^ 16. 17. §¦3 Result of Board's subsequent Inquiry Abatemeutand jP £o as to Action taken by S. A. on Prevention Hospital Provision. || Recommendations of Inspootor ; of Nuisances. "2 % % ~ -with Date of Information. 5 w** Complete failure - None - - - None - None - No subsequent inquiry to date (May 27th, 188ti), Viut loan of 1,700?. sanctioned in October last for works of sewerage in Eynesford and Farningham. except a satisfactory. I fumigating box at workhouse. Inefficient - - - None • - - None • None - No subsequent inquiry to date (May 27th, inemcieni " UUD W&), but loan of 5.725 Z. sanctioned in September last for works of sewerage, &c, at West Mailing. Nothing done as to hospital provision. Tnofflr , ; . nf . None • - - None - None - No subsequent inquiry to dat-3( May 27th, Inefficient- - JNone r*o«e 1886), but loan of 1,138*. sanctioned in December last for works of sewerage and sewage disposal. inefficientdealingwith None - - - None - None - No roh^ne*^g^o date (Ma^mh, recurring nuisances. provision. ¦«•„„„ . . . None - None - May 1885. Some action as to sewerage and sewer ventilation reported as taken prior to inspection in March.—November 1885. Steps taken in regard to polluted wells at Whitstable. Nothing done respecting permanent hospital provision. — No subsequent inquiry to date. May 27th, m _ . None . . - None - None - No subsequent inquiry to date. May 27th, 306 KENT — continued. 1. 2. 3. 4. Rural Sanitary District. Inspector and Road Sand , n • Excrement Disposal and Date of Report, DoSicD 0 Sic Sewering and Dramage. Removal. Population (1881). Premises. Industries, &c. Thanet, r. . . Sewerage at Westgate - - - Privy pits and cesspools generally. Dr. D. S. Davies, Jan. 1885. P. 7,786. RomneyMarsii, R. Drainage unsatisfactory; com- Privy pits and cesspools _ _ „ .. . rnonly into cesspools, but occal)r. 1). h. irnyies, sionally some pipe drainage. Jan. 1030. P. 6,059. SUSSEX. West Fiele R. - Fair - - - No regular system of drainage to At Glynde pan-closets eommuni- Mr T Sneir nny of tne small villages. At eating with unventilated drains NnvlBB6 Glynde large cesspools with and cesspools : elsewhere deep tj . a overflows to ditches ; elsewhere offensive privy pits. * • ->' 369 - highway drains used, or sewage (Agriculture, finds its way by various chancement works.) nels to nearest ditch. Chailey, R. - - Fair with exeep- General prevalence of sewage Privy pits generally, very foul and Mr J Suear tions, e.g., those nuisances, due to absence of sources of much nuisance. lipc'iKH'i ' ofßingmer. sewers or defective construction ,. c e ° I™' 1 ™' of them where provided. r, 10,0/0. (Agriculture.) Newhiven R. - Fair - - - Rottingdean and Kemp Town Rottingdean and Kemp Town Mr T **ra»nr sewered, but insufficient venti- w.c's or pan closets without Nnvisß'f lation. No sewering of outlying water flush, and sources of nui- I ¦Doanw villages. Sewage nuisances. sance. Elsewhere privy pits P. 8,607. and cesspools. (Agriculture. | Rottingdean is a sea-side resort.) Steyning, R. - Some neglect - Steyning sewered, but system in Defective w.c's at Aldrington. Mr I Snear many respects imperfect. Al- Elsewhere privy pits or closets ! J ill v 1885 ' drington partially sewered. discharging into highway drains : * * Elsewhere no systematic drain- with considerable privy and I V. IO.JLj. a>r( j ; , ln( j prevalence of sewage cesspit nuisances. (Agriculture. nuisances. A sea-side resort.) East Preston, R. Some neglect at Want of due means of drainage in Privy pits and cesspools creating ¦viv t «„«„. Wick. the villages, and consequent nuisances. NovilSsT sewage nuisances. P. 8,025. (Agriculture, some brickmaking.) Westiiampnett, R. Fair on the whole Villages without proper sewers, Privy pits mostly foul, too close to , iVTr T Snp-ir highway drains being used : houses and wells, and sources of t i T&a- house drains defective. Sewage nuisance and danger. Jn] > 188d< nuisances. P. 15,(189. (Agriculture.) Westbourne, R. . Neglect - - No proper sewering, and conse- Privy pits of worst construction, c quent sewage nuisances, espe- and at Hermitage and Bosham Mr. J. Spear, cially at Hermitage. often close to dwellings. Great »ept. JBBo. nuisances. P. 7,420. (Agriculture, lishing.) 307 KENT— continued. 5. 6. 7. 8. 9. Sanitary Crowding Overcrowding of Refuse Removal. Water Supply. Dwellings of Dwellings on Dwellings. of Poor. Area. Satisfactory - Public supplies to some places, but elsewhere shallow wells liable to pollution. Fair • • Shallow wells, open springs, and ditches; very unsatisfactory. ! — SUSSEX. Unsatisfactory - Public supply by standpipes to Many damp and None - - - None, part of Glynde. Elsewhere somewhat diwells, often subject to pollu- lapidated, tion. Unsatisfactory - Mainly local wells, often ex- In every village in- Infrequent - - Infrequent. •* posed to sewage pollution. Btances of damp, Occasionally ponds, ditches, dilapidated, ana _; C _ neglected dwellings, some unfit for habitation. Unsatisfactory - Public supply to Rottingdean Fair on the whole None - - - Infrequent, and Kemp Town from Brighton mains. Elsewhere wells, occasionally polluted. Unsatisfactory - Public supply to about half the Fair on the whole Occasional - - Occasional. district. Elsewhere local sources, often liable to pollution. Unsatisfactory ¦ Local wells, often close to privies, Fair on the whole None - - - None. Unsatisfactory ( cesg ' pjtS) and Uable to pollution from them. Varvinsr efficiency Very partial public supply. Fair on the whole Occasional - - Infrequent. V ar.\ ing cmcienc j E f se where inadequate supply from local wells, liable to pollution and occasionally found grossly polluted. Reckless neglect - Wells and stream subject to Many small, di- Occasional - - None. Keckiess neglect pollutions from sewage 1^ and and from privies. with tilthy surroundings. 308 KENT— continued. 1. 10. i-l* Rural Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of : Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. Tuanet, n . Satisfactory. Dr. D. S. Diivies, Jan. 1885. P. 7,786. ROMNEVMAESn.R. Dr. D. S. Davies, Jan. ISBS. P. 6,059. SUSSEX — continued. West Firle, R. - Lax administration - - M.O.H. (not D.M.0.). Fair Fair - - - Mr. J. Spear, Nov. 1885. P. 2,369. (Agriculture, cement works.) Chailet, R. ¦ Lax administration - - M.O.H. (D.M.0.). Fair. Mr. J. Spear, Dec. 1885. P. 10,373. ( Agriculture.) Newhaven, R. ¦ Lax administration - - M.O.H. (notD.M.O.). M.O.H. Satisfactory .... Mr. J. Spear, ° f combined district ; satis- Nov. 1885. facto1 'y- P. 8,607. (Agriculture. Rottingdean is a seaside resort.) Stetniug, R. - Lax administration - - M.O.H. (notD.M.O.). M.O.H. New officer, without any w, t cMI,c M1 , of combined district ; satis- previous training. M j r ulyl8 PBs?' P 85?' feotory. P. 16,325. (Agriculture. A sea-side resort.) East Pbeston, R. Lax administration • - M.0.H. (n0tD.M.0.). M.O.H. Fair ¦««¦_ t Cnonr of combined district ; satis- factory. P. 8,025. (Agriculture, some brickmaking.) Westhampnett.R. Lax administration - - M.O.H. (D.M.0.). A low Inefficient Mi- t «n,«r standard of the necessities Tulviß^f of villa & e sanitation (Agriculture.) Westboukne, R. Quite ineffective. Important M.O.H. (not D.M.0.). M.O.H. Very inefficient m t sitwir matters referred to parochial of combined district ; satisivir. d . oi^r) committees and thus shelved. factory, oept. ISBS. Hermitage suffered very P. 7,420. heavily from cholera in 1866. fAo-i-nUniw That place and indeed the flh »T whole district is in a very n&ning.j dangerous condition should cholera be introduced. 309 KENT— continued. ia_ 14^ 15. 18. 17^ a. k 4 g.'S Result of Board's subsequent Inquiry Abatement and a vja . . I .Ej £O as to Action taken by S.A. on Prevention i Hospital Provision. o 3 5s t> i ii »t 1 »¦§ ,-,0 Recommendations of Inspector; of Nuisances. c 2 .a « ?, -p. . er , ¦S3 os with Date of Information. .3 a i o ft x'^ — — April 1885. S.A. promise attention to ' matter of water supply. f11.0.U. in i 1885 report says nothing has boon done I as to this at Minster, where a better ! supply is much needed. None - • . None - None - November 1885. Consideration of sujrtcested byelaws as to new streets and buildings deferred. SUSSEX— continued. Some failure - - None - - - None - None - February 1888. General statement that ! M.O.H. and I. of N. are " taking raea" sures to carry out the recommenda" tions of Mr. Spear." Failure ... None ... None - None - June 188!!. No evidence of any great activity, past or contemplated.' Nuisances receiving attention. Failure to deal with None - - - None - None - February 1880, Action taken as to ! recurring nuisance. Rottingdean sewers only. Considerable failure - None - - - None - None - No subsequent inquiry to date. May 27th, I 1886. I j Failure ... None ... None - None - No subsequent inquiry to date. May 27th, 188 G. .- ? ; Complete failure - None - - - None - None - January and March 1880. But litile i action taken ; difficulties urged as to I sewerage, &c. Replies unsatisfactory., j 310 HAMPSHIRE. Rural Sanitary- District. Inspector and ¦Rnndwavs arid ¦ j t-> • Excrement Disposal and Date of Report. B B T oZsdc 0 Zsdc ! Sewering and Drainage. Population (1881). Premises. Industries, &c. ! Havant, R. - - Domestic premises Only one village (Emsworth) Mainly privy pits, often close to often neglected. sewered, but with many defects, dwellings or under wasnhouse Mr. J. bpear, an( j private drainage as bad as roof, generally foul and neg- Sept. 1885. it well can be. Elsewhere cess- lected. Some w.c.'s discharging P. 5,640. pools, often with overflow into into cesspools. ? '.',,' ditches, &c. Sewage nuisances. (Agriculture, Fakeham, R. - Side streets and Sewers of rude and deffictive con- Privy pits and cesspools often foul ' „ domestic pro- struction at Tichfleld and Cos- and close to houses. a ' iuan r ' mises often ne- ham villages. Elsewhere high- Aug. ISSS. glected. way drains or cesspools. Private I P. 9,637. drainage bad. (Mainly agriculture, j fishing.) Isle of "Wight, R. Fair - - - Sewers provided at Yarmouth, Mostly privy pits soaking into Brading, BemLridge, and Hay- earth or discharging into some i\ 7 i P 3 r> land, but so partially used as to adjacent watercourse. Oct. 1885. be of j itt ] c va i ue) or so neg- 1 P. 28,008. lected as to become themselves ? . ? sources of nuisance. Elsewhere (Agriculture, highway drains or cesspools nsmng, me.) used, or sewage runs into a stream or nearest ditch. Sewage nuisances prevalent. NORTHAMPTONSHIRE. Tiirafston, R. - Much neglect in Old leaky highway drains used Mainly deep, roughly constructed 1 larger villages. where available as sewers ; privy pits, occasionally close [ Mr. J . hpear, otherwise sewage discharged to dwellings or against house Oct. 1885. j nto near e s t ditch. This gene- walls. Very foul. P. 15,115. rally stagnant and foul. Private ? ... drains very defective and sources (Agriculture; of nuisance, some boot and cloth manufactures.) HUNTINGDONSHIRE. Huntingdon, R. - Domestic premises Highway drains used. No sewers Generally privy pits. A few pail I -_ often neglected. in several villages. Private drains closets introduced with advan- I tvt ' i «a^ ar> often so constructed as to be tagc. May 1885. source of danger. Sewage im- I P. 8,528. properly disposed of. (Agriculture.) CAMBRIDGESHIRE. Chesterton, R. - Domestic premises Drainage of villages, Ac, generally Privy pits often mere holes in the I .., T Q and back ways most defective. Sewage nuis- eartn, large, foul, and over- I m. is** 11 "' of ten filthy. ances almost universal. Grand- flowing so as to form filthy poois 1 may lsss. Chester, a suburb of Cambridge, and dangerous nuisances. P. 23,343. is no exception. (Agriculture.) 311 HAMPSHIRE. rr of»o f» 5. 6. 7. °» «*• Sanitary Crowding Overcrowding of I Effuse Removal. "Water Supply. Dwellings of DweUin « 8 on Dwellings. of Poof. Area. Very unsatisfac- Partly public supply from Unsatisfactory ; Little crowding - Infrequent. Tory, and causing Portsmouth Water Co. (See dampness, nnd complaints. Havant U.) Elsewhere disrepair cornshallow wells polluted or mon. liable to pollution. Unsatisfactory - Public supply (Portsmouth Unsatisfactory, None very remark- Infrequent. Water Co.) at Cosham. (See but some im- able. Havant U.) Elsewhere wells provement in often spoken of as pollutedand Porchester since water deficient in quantity. Dr. Stevpns's inspection in 1872. Great neglect - Public supplies to some parts On the whole fair, Rarely crowding - Infrequent, adjacent to towns having but exceptions, waterworks. Elsewhere shallow wells, streams, or ponds, and unsatisfactory both as to quantity and quality. Long distances have to be sometimes traversed for water. NORTHAMPTONSHIRE. Unsatisfactory - Various. Local springs insuffi- Generally unsatis- Some crowding in Occasional, ciently protected from pollu- factory. Damp, some of the viltions ; shallow wells often dirty, dilapi- lages. found polluted ; occasionally dated cottages sewage-polluted streams. All in all the larger the water supplies must be villages. regarded with suspicion. HUNTINGDONSHIRE. ! Unsatisfactory - Shallow wells, some of them Many dilapidated, Infrequent - - Occasional, polluted. Ponds fed by damp, and dirty, surface drainage, dirty and but probably sometimes with scanty improving of supply of water. recent years. CAMBRIDGESHIRE. Vprvbad - • Water supplies of many villages Very unsatisfac- Some confined Occasional. 3 scarce and contaminated. Tory ; many dwell- courts, and such Some few parts have a ings mere hovels places further public supply from Cam- unfit for habita- polluted with bridge Co. or artesian wells. tion. accumulationsof refuse. I I | ' ______^__ | 312 HAMPSHlRE— continued. I 10. 11. 12. Rural Sanitary District. Inspector and Administration by Sanitary "Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. of Nuisances. Population (1881). Industries, &c. Hwant It - Lax administration. S.A. have M.O.H. (not D.M.0.). Fair, Fair now ordered a house-to-house but advice not much fol- Mr. J. Spear, inspection. District in a dan- lowed, kept. lbSo. gerous condition for advent P 5,040. of cholera. (Agriculture. fishing.) Fareitam R Only some minor improve- M.O.H. (not D.M.0.). Pre- Fair ; " " ments effected. Larger pared to offer competent i\lr. .J. !>pear matters, e.g., of drainage and advice. Aug. 18:i5. water supply, neglected. I. 9,G37. District in a dangerous con,_, . ' . , dition for advent of cholera. (Mainly agfricul. ture, fishing.) Isle of Wight R Very lax and inefficient. M.O.H. (not D.M.0.). An No organised inspection - - ? T o M.O.H.'s report for 1888 had able officer; but his ad- A' o5 Par> not yet been considered, lin- vice is almost absolutely Oct. 1885. portant matters often left to disregarded. P. 28,008. parochial committees, and , , . ? then neglected. Mr. Spear's (Agriculture, report t])US ii n dioates no nsnmg, &c.) remarkable amendment sine.' Dr. Ballard's inspection in 1880. The Registration District of Isle of Wight suffered heavily from cholera NORTHAMPTONSHIRE— continued. Thrapston, R. - Wholly inefficient. Import- M.O.H. (not D.M.0.). Fair I. of N. is collector also. , a ant matters referred to paro- on the whole. Works fairly on the whole, «.\i£ ar ' ehial committees and then but other duties hinder Oct. 1885. indefinitely postponed. Bis- him, and district is large P. 15,115. trict generally in a danger- and important. ? ... ously unwholesome condi(Agnculture; tionf and has suffered much some boot and f late rs from ente ric H U NTINGDONSHIRE— continued. Huntingdon R. Administration not altogether Three M.O.H.'s (D.M.O.'s). Two I.'s of N. who are Reliev_, _ _ inefficient, but much work Fair. ing Officers also. Unsatis- M l\ ,?o c e r ar> of permanent character factory. May 1885. required. P. 8,528 (Agriculture.) CAMBRIDGESHIRE— continued. Che^ekton, R. - Wholly unsatisfactory. S.A. M.0.H.(n0tD.M.0.). Highly I. of N. very inadequately T „ habitually ignore the reports competent, and deplores paid, but does what he can. at iiE£ ar> of M.O.H. until some out- his inability to get any- Aiay i8»o. break of disease compels thing done for improve- P. 23,343. passing attention. Of late ment of district, but does ? . ? , some outbreak of enteric his best. ( Agriculture.; fever or diphtheria of annual occurrence. 313 HAMPSHlRE— continued. 13. 14. 15. 16. 17. c.o Result of Hoard's subsequent Inquiry Abatement and *' J-^5 . . .. . . . _ . .B ./ £° as to Action taken by S.A. on Prevention Hospital Provision. || _| Recommendations of Inspector j of Nuisances. || || with Date of Information. Failure to deal with None - - • None - None - May 1S8(5. Steps to be taken as to water recurring nuisances. supply for Hayling. S.A. p'winjt attention to some points of advice : nothing said respecting others. Failure 1o deal with None ... None - None - No subsequent inquiry to date (May 27th, recurring nuisances. 1886), but loans of 5,000/. sanctioned in September last for works of sewerage, &c. I Very general default • None ... None - None - May 1880. S.A.s reply wholly unsatisfactory. No evidence of requisite action on Mr. Spear's detailed advice to S.A. NORTHAMPTONSHIRE— continued. Complete failure - | None - - - None - None - June 1886. Inspection of Bri^stock ordered in connexion with water supply and excrement disposal. Nothing said as to other recommendations of Inspector, and no reply to renewed inquiry to date. July 12th, 1880. lI UNTINGDONSHIRE— continued. ! Failure to deal with None - - - None - None - October 1885. After repeated requests for recurring nuisance. information as to action of S.A. on Mr. Spear's advice, Board receive a reply far from satisfactory. CAMBRIDGESHIRE— continued. Failure - - - None. Addenbrook None - None - May 1886. After repeated inquiries as to Hospital occasion- action of S.A. on Mr. Spear's reconially used. mendations, 11 reply is received which is extremely unsatisfactory. 314 ! I ESSEX. 1 2. 3« # Rural Sanitary District. , Cleanliness of , i Excrement l)isi)os;il and Inspector, ana Roadways and SpwoHnir and Drainage n i Date of Report. Domestic! sewering anu .urtunu#e. Kemoval. Population (1881). Premises. Industries, &c. , Ohbett R - .Unsatisfactory - No proper drainage arrangements. Rough privy pits and cesspools Sewage nuisances general creating ruth-nuisances generally Mr. J. Spear, throughout the district, and June 1885. increasing with rapid growth P. lii.tso. of the population. (Agriculture, dock construction, ceinenl works, &c.) Rochpobd It - Parts of district A few villages partially sewered, A few w.c's in larger houses. Pan neglected but roughly and imperfectly. closets often very foul from lack Mr. J. Spear, Sewuge nuisances common. of flushing. Privy pits and Dec isss. vaults rough, large, and often 1> 1(i4 ., 7 dangerously near sources of Wiitcr supply. (Agriculture, fishing, brick making.) SUFFOLK. Woodbridge, R. ¦ Often neglected ¦ General want of sewers. Con- Mainly privy pits, deep, large, and , r ? sequent prevalence of sewage i foul, very often dangerously Mr. J. Spear, nuisances. Cesspools, highway ! near dwellings and sources oi Dee. 1885. drains, ditches, and streams! water supply (in two instances P 22 51G made use of. i» Woodbridge practically with_, '. ' in the dwellings). I Including Woodbridge Town. I (Agriculture ; shipping trade at Woodbridge. Felixstowe a sea-side DORSETSHIRE. Dorcbesteb It. - ¦ Partial drainage systems for slop Mostly privy pits. A few earth ', ' . water in some villages. closets. .Looked after by 1. Shesboene.R. -Neglected - - Where any sewers exist they and Mainly privy vaults and pits, often T „ the private drains are so defee- mere holes in the earth. w iaa c e K ar ' tivel y constructed as to conmay ishb. stitute a nuisance. I*. 7,642. (Agriculture.) Bimpport 11 - — No open cesspools, but privies ? ' ' . discharging into covered vaults. Dr. D. s. Davies, ]''cb. 18S5. IJ.1 J . 8,016. [ Hurt on Bradstoek 315 ESSEX. . 5 6. 7. 8. 9. Sanitary Crowding ,^ ,• r | Eefuseßemoval. Water Supply Con^nof of DwellingB on Ov,™ wdmgof of Poor. Area. Unsatisfactory - Public supply to some larger Very unsatisfac- None - - - Some overcrowdvillages, hut occasionally of tory on account ing noticed. suspicious quality. Else- ; of the lilthy whore scanty local supplies i surroundings. from wells liable to pollution, mid from ponds. ¦Unsatisfactory ¦ Water supplies generally insuM- Unsatisfactory - Some in Leigh and Occasional. cient in quantity and inacces- Rochford. sible, and much of bud or of doubtful quality. SUFFOLK. Unsatisfactory - A 1 Felixstqwe mostly from Many very mi- None - - Occasional. some private waterworks. satisfactory. At Woodbridge and elsewhere, local wells, streams, ponds, or ditches. Supplies all more or less liable to pollution. DORSETSHIRE. Pair - - - Mostly from shallow wells. i Very unsatlsfac- Water supply in many villages Generally unsatis- None - - - Occasional, tory, and conse- requires protection from sur- factory, some quently much face pollution. In others it is mere hovels, nuisance. habitually scarce and bad. i Surroundings of , houses neglected. ; » "Water from wells; yet Brid- port Urban water pipes pass ; through village. 316 E SSEX — contin ued. !. 1O 11. 12 : Rural Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, Sec. Oesftt R - - Ineffective. No serious at- M.O.H. ( D.M.0. ) Has Time of I, of N. all taken up uubtt, iv. mciie g. —¦; lvpresented (0 SA Wlth looking after recurring Mr. J. Spear, KrO winir sanitary needs of needs of the district, but 1 cesspool nuisances, i.e., m June 1885. the district. District very advice little regarded. mere scavenging work. P, 10,480. unsafe for advent of cholera. (Agriculture, dock construction, cement works, &c.) ROCHBOBD, E. - Unsatisfactory- - - ¦ M.O.H. (D.M.0. ). Fair - j Unsatisfactory. Hasavariety of other duties. Mr. .T. Spear, Dec. 18S5. P. 16,427. ( Agriculture, fishing, brick making.) SUFFOLK—coM tinned. .—- . - j Woodbripge, R. Inefficient - - - M.O.H. (D.M.0.). Too low Inefficient a standard ol the necessi- i Mr. J. Spear. ti( , s of vi n ilgo sanitation ; Dec. 1885. | adopted hitherto. P. 22,510. [Including Wboabridge Town.] (Agriculture ; snipping trade at woobridge. Pelixstowe sen-side resort). DORSETSHlRE— continued. Dokckester, R. - ! Pair - - - Two M.O.H. 's (D.M.O.'s). Active and intelligent - Dr. 1). S.Davies, j G °° d ' March 3885. P. 17,323. Shkeborne, R. -Inefficient M.O.H. (D.M.0.). Has Totally incompetent .., T o failed to organise in any Mi". J. Sspear, sense the work of his de- May 1880. partment. I. 7 s Ci-2. (Agriculture.) Bhidport, R. - - — - Dr. D. S. Davies, Feb. 1885. I. 8,016. [Burton Bradstock i>nly.] 317 ES SEX — continued. 13. 14. 15. 16. 17. §/c Result of Board's subsequent Inquiry Abatement and m> jT-s , , S s5 i£^- ) as to Action taken by S.A. on Prevention Hospital Provision. -g a b -n i *• r i 1 ' g-g — =2 Reeommandations of Inspector ; of Nuisances. "5 2 .9" .., ? . r r P i.-.s cs j» 5 with Date ol lurnrmation. Complete failure - None. A Dcaoker None - j None, ex- September-October 1885. S.A.'s replies as hospital purchased I cept for to action in connexion with water supply and put away. early in- extremely unsatisfactory : Loan of SOOt. formation. sanctioned in September 1885 for purchase of site for permanent hospital. L Failure to deal with An old farmhouse; None - j None - April 1886. Some action taken or in conrecurring nuisances. unsatisfactory. temptation as to drainage, sewer-ventilation, and scavenging ; but reply of S.A. generally unsatisfactory. S UFFOL X- ¦- continued. Failure - Small cottage; not None - None - April ISSfi. S.A. prepared to deal with in state of prepa- question of scavenging, otherwise no ration. promise of remedial measures. Inspector's advice combated. DORSETSHIRE— continued. — No subsequent inquiry to date. May 27th, 1886. Complete failure - None - - - Small Nel- None - August 1885. Apparently no action taken. son stove Inspector's statement controverted. at work- Further remonstrance by Board, house. ___ April 1885. S.A. content with existing water supply for Burton Biadstock. 318 DEVON. 1. 2. 3. 4. Rural Sanitary District. Inspector and Cleanliness of Excrement Disposal and fflofEeport. *$£%£* s" s "™ ri^ !wl Drama« e ' Removal. i Population (1881). Premises. Industries, &c. St. TiiOAr.vs, It. - Unsatisfactory • ; Nuisances from ill-constructed [n towns or largo villages, w.c's or T % sewers and drains, or from total ! panclosots often in such a con- I" i 'l°r ir ' absence of means of removing dition and bo placed as to be Aug. is* o. sewage, universal. dangerous. Otherwise privy pits, ' I. .'W.927. often foul and neglected. (Agriculture and fishing.) Totnks, E. - - Some villages and hamlets Mostly privy pits. Earth closets | _ ? c ? . drained with various dogrcesof ai Buckfastlcigh no( very sue- V i i«i- efficiency, others either not at cessfully managed. March 1885. ;ll] (11 , very i mper fectly. P. 10,720. KingsbkidijE, R. - Kingsbridgo in same condition of I Privy accommodation improved ti t» cTi • bad drainage as when visited by ! at outlying places. m , i iJIi V - ies ' Dr. Ballard in 18sl>. hut a drainmarcn isso. age 5( ,] u ., 110 sa i,i t0 ))0) )0 un der P. 16|934. consideration. Otherwise improvements effected in places. : T.wjstock. ft. - ; Satisfactory in Tavistock fairly sewered. In the : Mainly w.c's (satisfactory) ii ri,,,.i,,,i™ (?.„> ,>p i Tiivistock, but Ullages drainage is defective or Tavistock. Privy cesspits gradu ' V t , unsatisfactory wholly bad and dangerous. ally being superseded in som iavistocK.j in gomo larger villages by pail closets. Manj Mr. . l. Spear, villages. cottages, especially in Calstock, March 1885. without privy accommodation. P. 29,190. (Town occupations in Tiivistock. i In villages, copper and tin mining, quarrying, and agriculture.) i Ceeditox, R. - Very unsatisfae- Sewage nuisances almost uni- I'riv.v |)its mere holes in the Mr T Snnar lory. yersal. Sewers, where any exist, earth, and generally sources of «i i,,'.;'i i Lvii ' imperfect, partial, and of rough : nuisance. Al "' 11885 - construction. P. 18,764. j (Agriculture.) Baenstaple. R. - Fail 1 - - Some villages drained throughout, \ Usually privy pits, supervised I>,\ ii ii c Tkonioo others partially, some not at all. I. of I\'. Where possible, pails T,,uiis- iiro bein 8 introduced. P. 18,466. (Agriculture ; some little shipping trade.) Bieefoed, R. - Fair - - - Clovelly and Hartland drained. Pan and syphon closets in t\v t> c n.,,-;,,^ Many smaller villages un- Clovelly. Otherwise privy pits TnwVssK drained. general. Many houses in Wool•^ 1080- fardisworthy ' without privy P. 7,792. accommodation. (Agriculture, fishing. Oiovelly a sea-side resort.) 319 Drj V ON. _ 5 : 6- 7. 8. 9. Sanitary Crowding Refuse Eemoval. Water Supply. ' nwellin-* '' of Dwellings on j Overcrowding of Unsatisfactory -Water supplies mostly from Certain number of Much in Heavy- Occasional, in wells exposed to pollution, dwellings in tree, Topsham, larger villages, aud insufficient in quantity, j mosi of tho vil- i and Lympstone. j lages unfit for j habitation from dampness, bad j ventilation, and dilapidation. cion. Bill improvements have in places been effected. ' Suspicions wells stil! in use in Kingsbridge and elsewhere, but more watchfulness exorcised aboul them. Bcesandn j now supplied with water, good and abundant. Efficient in Tavis- Public supply in Tavistock j Many cottages in villages are unfit for habitation from damptock, inefficieni good and plentiful. In out- ! nes.s and dilapidation, and ai Calstock and G-unnislake elsewhere. i lying villages often inauffl- (large villages) such dwellings are in addition huddled eient in amount, und various' together and overcrowded. Surface paving about surface springs and rivulets ; dwellings greatly neglected, liable to pollution are used. i Unsatisfactory - i Water in most of villages bad Fair - - - None - - - None observed, and scarce. Satisfactory - ' Wells. Carefully looked after | Fair on the whole i None very re- > None, by M.O.H. and I. of N. markable. I Satisfactory - ' Wells generally. Some insuf- ! Fair - - - i None very re- None. flciently protected from pol- markable. lution. 320 DEVON— continued. 1. 10. 11. 12. Rural Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date Of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. ¦ St. Thomas, R. - i Very imperfect administra- M.O.H. (M.O. of work- I. of N. Old and without tion. S. A. have tried to : house). Is only engaged to training, and unequal to Mr. J . Spear, work without skilled advice [ do any work on occasion : duties. Aug. l.Saa. or gupervlsion of district, i of sonic serious outbreak P. 33.927. I This district suffered j of disease, and is then .... , j very heavily from cholera paid by fee. Nueharrange(Agricuit-ure ana in lg6Bi ;|1 ; (l js jn a very | nients of course are ennsnmg.j dangerous condition now I tirely inadequate. M.O.H. for the introduction of not under Hoard's Order. ; that disease. Totnes, R. - - i Fair administration. Im- Two I.'s of N., who work D- 1) S Davies ¦ provements made in various systematically. March 1885. ' I)larps> i Kingsbriucje, R. ; Sanitary administration ap- ' M.O.H. (not D.M.0.). Looks ' I. of X. now paid by salary, ii -n c n.,,,;^. i pears to have improved after his district fairly Fairly satisfactory. m i T««- I « inca Dr - Ballard's visit in well. P. 18,934. I Tavistock, R, - j Sanitary administration pro- M.O.H. (not D.M.0.). Very I Two I.'s of X., both energetic, ' n ,1,1 .i,,,, m r,f bably improving, but S.A.. good. It is due to his good olticcrs. '' VnH have a habit of referring im- energy and advice that J portant matters to parochial improvement in this dis, Mr. J. Spear, committees and then neg- trict can be noted. March 1885. lecting them. I*. 29,10(1. (Town occupations \ in Tavistock. In villages, popper and tin mining, quarrying, and agriculture.) i Creditor, R. - Inefficient. Public works of M.O.H. (D.M.0.). Further Inefficient - j tvt., t 0n,,,,,,o n ,,,,,, improvement not seriously personal influence re- AnHl is!« ' undertaken. quired. (Agriculture.) EAEXSTArLE, R. Sanitary improvements in M.O.H. (D.M.0.). Efficient Three I.'s of N. (Relieving ! Dr. D. S. Davies, progress. and active. Otlicers also). Efficient. July 1885. P. 18,450. (Agriculture; some little shipping trade.) Bidefokd, R. - Fair, but inactive as regards M.O.H. (D.M.0.). Satisfae- Fair Dr. D. S. Davies, village drainage. tory. ' July 1885. (Agriculture, fishing. Clovelly a sea-side resort.) 321 XJX-J V Vyi-i ( (JitT i/it Hi, (. 1 1 I k si I Abatements » || of Board's subsequent Inquiry ¦- m £° as to Action taken by B. A. on Prevention i Hospital Provision. I "5 sos o t> i r , 1 ] S-g ~.S Recommendations of inspector; of Nuisances. cS •- 2 ¦? t, . .. T f •S * j; g with Date of Information. S £*" t failure - Occasionally can ; None - None - November 1886. S.A. have done some- i use, Exeter llos- ' tHing in regard to water supply, drainpital. a^e, and excrement disposal, and con- ' template further worh as to sewerage at Heavitree and Topsham. Content with ; present M.0.11. arrangements. ' Fair on the whole - ! None - - - ! None - ; None - M.O.H.'s 1885 report gives evidence of i | some action as to water supply and j sewerage. Fair - None - - - None • None - M.O.H. in 1885 report states thai satisfactory progress is being made with drainage of Kmgsbridge. Dodbrook.and West Alvington ; and that pood work has been clone in the matter of water supply. Improving - - - None - - - ! None - None - j July 1886. No action to be taken in regard to hospital provision ; question of buildin;? byelaws under consideration. Failure • - - None - - - None - None - No subsequent inquiry to date. May 27th, 'Satisfactory - -'None - - - None - None - No subsequent inquiry to date. May 27th, 'Satisfactory - - None - - - None " None - No subsequent inquiry to date. May 27th, 188(1, 322 CORNWALL. 1, 2. 3. 4. Rural Sanitary District. Inspector and nSpTanr] , Excrement Disposal and Date of Report. Domestic Sewering and Drainags. Removal. Population (1881). Premises. Industries, &c. Stkattox, 11. - Fair - - - i Budo and Stratton both pipe- i Mostly ordinary privios; some drained, other villages fairly j w.c'st at Stratlon, Uude, mid J?'l 1885 satisfactory. Poughill. (District largely rural. Budea sea-side Camelfobd, R. - ¦ Pair - - -. Drainage for slops : pipes and sur- Privy pits generally. A few w.c's | , , , . face channels in larger villages. in larger villages. Dr. U.S. Davies, July ISSS. I. 7605. i (Agriculture ; some quarrying. Tintagel sea-sido St. Germans, R. - Drainage of Torpoint and Saltash ! Privies and w.c's where there are j very bud. Pipe drainage of recent sowers, as at Millbrook. Dr. D. 8. Davies, V( , r| -,. s cx tendod at Millbrook; April 1885. i elsewhere little or nono. (Agricultures maritime occupations, 1 Millbrook a sea-side Liskeaed, 11. - Towns or larger villages without W.c's in more populous places. ' . proper drainage or with defec- | Privies. In some places insuf- I Dr. I). S. Davies, , (i vo drainage : consequent sew- | flcient privy accommodation. April 1885. | ago nuisances. I. -21,251. Bodmin, E. - - .Much improvemeni of drainage j Various arrangements. Some w.c's . , needed. in towns. Souk; box privies with l [Only partial survey movable receptacles. Some ormade.j dinary cesspool privies, J)r. D. S. Davies, I May lsss. I. 14,187. IS. CoiiTJMB Major, ' Fair ... Newlyn drainage completed, i Many privy pits j large In St. Co- H^ Drainage incomplete and unsa- | lurab. Some pails :\ro intro_ ? ? „ . tisfactory at St. Cdumb ;md duced and work satisfactorily. Dr. D. 8. Davies, Wadebridge. June 1885. P. 12,994. (Agriculture ; China clay working.) • St. Austell, It. - Drainage at Mevflgissey unsatis- j No privy accommodation in parts . „ .. . factory. Much work done re- ] of Mevogissey and no room to ur. u.b. invvieß, centlyatFowey. Parandsome erect privies. W.c's in larger April lsss. other places unsatisfactory. places and privies in others. P. 28,604. TbtjEO, R. - - Fair - - - Some pipe drainage exists at a Mostly privies ; contents used in Tlr I) S T>ivies tow P^ ace8 > iill( l BOmeold stono gardens. In some places no a«Jiis!bk drains serve for slop drainage privies, and excrement scattered April 1885. at others. over ash-heaps. P. 25,363. 323 CORNWALL. 5. 6. 7 . 8 . 9. Sanitary Crowding Overcrowding of ; Refuse Removal. Water Supply. of Dwellings on Dwellings. of Tom 1 . Area. Pair for rural dis- Wells almost universally. Fair ... None - • ¦ Nono observed, trict, Water ratherscanty. Scheme for Bude and Stratton under consideration,butits adoption doubtful. Unsatisfactory ¦ Pumps, wells, and springs. Pair on the whole Nono - - - None observed. Sonic action taken to protect them. Unsatisfactory - Millbrook still unsatisfactory. ; — • Some of the wells,closed after certain outbreaks of fever, re-opened. "Water supply of Torpoini from wells inevil- i ably greatly polluted and very dangerous. Saltash well water is also liable to pollution. Unsatisfactory - Unsatisfactory as to quality In — various places. In others fairly satisfactory. Many water supplies require ¦ ¦ protection from pollution. Unsatisfactory - Wells universally ; their pro- Satisfactory on the Little worth None. tection is looked after by whole. speaking of. sanitary officers. Vnirlv "ood - - Good water supply by S.A. to Fair - - - Greal crowding ¦ Fairly good gtTAustell antf neighbouring on area at Mcvillaecs. Efforts to supply yagissey and other places being continued. rowey. | Unsatisfactory - Water supply given to many places, and care has been taken to protect- it; but further action is requisite. 324 CORNWALL — continued. ilu ml Sanitary District. I, Inspector and Administration by Sanitary Work ol Medical Offloer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. Strvttox, 11. ¦ Tardy administration - -Two M.O.H.'b (D.M.O.'s). Fair Dr. D.S. Davies, Filir - July 1888. P. 7130. (District largely rural. Buden seaside resort.) Camelfohp, R. - Tardy administration - - Two M.O.H.'s (D.M.O.'s) - Fair Dr. D. S. Davies, ' July 1885. I. 7,605. (Agriculture •. some quarrying. Boscastle and Tintagel sea-side ; resorts.) St. Germans R. I B. A. extremely tardy, and put- 1 M.O.H. (not D.M.0.). I. of N. intelligent and aotivo ' . ting off from year to year Earnest ; and gives (rood a •l'lHflK '""^ Important and urgent advice. April Ihhu. works of drainage and water P. 1G.73C. supply at Torpoint and Salt,. ... aon, in respect of which they (Agriculture-, h;lV0 ,„,,,„ !1(lvis( , (l by the maritime occupa- i Board ftnd itB i nsp ,, ( ., oi , s tions. Millbrook IVolll tin)o to time wi , hoU | a sea-side resort.) effecti Parts of the districl which have suffered on various recent occasions from enteric fever are in a very dangerous condition for | advent of cholera. Liskeaki), R. -Not very active administra- M.0.H.(D.M.0.).Has urged Fair, but district large ;I. of _ _, _ _ . tion. improvements from time N. is not overpaid. Dr. D.S. Davies, to time. April 1885. P. 24,261. BODMJN, R.- -Administration wanting in M.O.H. (not D.M.0.). He District very large, and I. of N. r ,. . .. , energy. has not exerted much does not devote his whole [Only partial survey influence with S.A., and time to duties. m;iae --l is underpaid. Dr. D. S. Davies, | May 1885. P. 14,187. ST if ( l 0I T? r:UB MA " Fairly active.but S.A.need some M.O.H. (not D.M.O.). Active Very good JE> pressure. S.A. have unusual and well deserving the Dr. D. S. Davies, confidence in their M.0.H., confidence of the S.A., June 1885. and act creditably on his which he possesses. i> v>oai advice in emergencies. Have • iJs»ow«. made improvements in New(Agriculture ; lyn East since Dr. Hallard's China day work- inspection in 1880. ing.) St. Austell, R. - S.A. have done of recent years M.O.H. (D.M.0.). Satislac- Active and satisfactory • t\_ -n o -n ¦ much good work, and on the, tory. Ur.lJ. h. JJavies, whole the administration is April 1880. satisfactory. P. 26,604. Truro, R. - - S.A. fairly active ... Two M.O.H.'s (one D.M.0.). Active; but should be paid to r» li o t> • Give good advice. give his whole time, the dis- Ap\tlSr S trict ' trict being large. P. 25,363. 325 C ORN W ALL— continued. 13. 14. 15. 16. 17. _________ ? a | $^o Result of Board's subsequent Inquiry Abatement and J> | o Mto A( . t , on f . lkcn ,)y, )y sA Qn Prevention Hospital Provision. || _J Recommendations of Inspector ; of Nuisances. jg || with Date of Information. X a KB j a oa w Fair - - - - ' None ... None - None - No subsequent inquiry to date. May 27th, 18*0. Moderate efficiency - None - - - None - None - ! July 188fi. Reply unsatisfactory as to water supply. Difference of opinion | exists on part ol officers of S.A. respecting the need of certain placet*. S.A. hold I that tin; supplies are adequate. Unsatisfactory - - None - ¦ - None - None - i Application made in autumn of 1885 for sanction to loans to amount of 8,0002. in respect of sewerage and water supply of Torpoint. Unsatisfactory. — June 1885. Steps to be taken in regard to water supply and sewerage of Polruan and Callington. March 1880 (M.O.H. 1885 report): Nothing done as to Polruan. Action taken as to Callington. Minor improvements in water supply and sewerage at other place.-:. , None ... None - None - i Detailed inspection made by Dr. Parsons since Dr. Davies's partial survey. No reply to date to Board's request of January for information as to action of S.A. in regard to several important matters. May 27th, 18SU. Fair ... - None - - • None - None - ' November 1885. S.A. prefer to await the ' appearance of infectious disease before taking steps to provide means of isola- ; tion. Further remonstrance from i Hoard. ! Fair .... None ... None - None - j Nothing done as to water supply of Meva- I ' gissey. No reply to date to Hoard's inquiry of June 1885 as to steps to lie taken in repaid to drainage of that place. | May 27th, ISBC. TTns-Hisfnetorv - - None - - • None - None - August 1885. Steps being taken to secure unsatisiacioij cottage hospitals for possible cholera at various points on coast. Portscatho water supply improved. 326 CORNWALL— continued. 1. 2. 3. 4. __ Rural Sanitary District. Inspector and Roadways and a • ,„ , Excrement Disposal and Date of lteport. i),,..ti,. Sewering and Drainage. uomestu • Removal. Population (1881). Premises. Industries, &c. Ij_ - ¦ ¦ Helbtoit, R. - - Unsatisfactory - : Porthlepen still very unsatisfac- Porthleven has worst type of mid. Tory, with sewage nuisances. den privies producing excre- Dr. U.S. levies, Village drainage generally bad. mental nuisances dangerous to July 1885. health. Elsewhere ordinary P. 20,240. privy pits. (Agriculture, I fishing, quarrying.) | Penzance, Ji. - ' The drainage of Newlyn unsatis- | Mostly privies ... .. .. ? .. . , factory, and should be taken in \ -iN :l: l - VIL ' s ' ! hand soon. Mnrazion recently A ' )r " 1885 - sewered : other villages unsa- I. tisfactory. SOMERSETSHIRE. WitLiTON, R.- - Pair - - - Minehead recently sewered, and In Minehead, w.c.'s. Elsewhere ? . „ .. . most of houses now connected. ordinary type of privies. Some '•"'• ' J ' 8 \r o a . vieSl Elsowhere partial slop drainage. earth closets. UCC loot). (Agriculture mainly. Minehead a sea-side I Chard, R. - - Often neglected - Certain of larger villages sewered, Roughly constructed privy pits M _ H v but imperfect ventilation and for the most part. M IR«K other defects ; house connexions • 1°" 1 °" a ' ;\n: insufflcieni and defective. P. ±V>l2. Elsewhere sewage and slop nui(Agriculture In sances sancestowns various textile manufactures.) LINCOLNSHIRE. Gainsborough, R. Fair ... Much attention has been given to Everywhere brick privy pits: ... .. the drainage ot the villages. sonic, however, too near to t ion! wells. They are emptied when JuiieiSSo. lt igoonvenlenl to use the ma- P. 19,070. nnre in gardens, &.c (Agriculture.) CHESHIRE. I I I Runcoen, R. - - Satisfactory, with j Drainage defective at Weston, i Privy system in vogue generally, j _ .. exceptions. causing nuisance. Improvements Little nuisanoe, except where inj loaJB ' ' n c '' sll '' ( 't progressing. suflloient space. I. IX,B<>7. (Agriculture; dock and canal works at Weston Point.) 327 CO RN W ALL— continued. 5. 6. 7. 8. 9. Sanitary Crowding i Overcrowding of Refuse Removal. Water Supply. Dwellings 0 of Dwellings on I Dwellings. of Poor. Area. Unsatisfactory; ; Water supplies ai Porthleven Many uusatisfac- Bad? -to - buck ¦, None observed. especially in j very unsatisfactory and liable j tory from dan- houses. &c, in growing town of to pollution; elsewhere wells gerous dilapida- Porthleven. Porthleven. of various quality. linns and filthy surroundings : rl)ut some improvement since Dr. Ballard's inspection in ISS2. Fair on the whole, Public supply ill Marazioc but exceptions. satisfactory; elsewhere •¦shoots" or wells looked after by the M.O.H. SOMERSETSHIRE. Fair .' . : Good public supply at Mine- Improvements have None apparent. hend. Watchel badly sup- i been carried out. plied by wells : a scheme for its better supply under I consideration. Elsewhere sources of supply various. Unsatisfactory - A company's supply, uol yet A number of Not much crowd- Occasional. generally used, recently ob- ! houses unlit for ing. tamed for Crewkerne. Else- habitation in all where the various sources of j parts of district. supply are often inadequate or open to suspicion of pollution. LINCOLNSHIRE. ! Refuse thrown Some river-side hamlets, e.g., Many old houses None - - - Occasional, into privy pit or Butterwiok, use water from damp. on manure heap. Trent. (Butterwiok had cholera in 18(18.) Elsewhere wells often polluted or liable to pollution from privies, &c. . CHESHIRE. Refuse removed ' Good public supply at Halton, Fairly good. At : None - - - None observed. with privy stuff, Weston, and Weston Point. Weston there :S lr si ' llin : aist B rrs: 8 " j Usewhere pumps and springs. damp basements. 328 CORNWALL— continued. 1. 10. 11. 12^ ! Rural Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Beport. Authority. of Health. Nuisances. Population (1881). Industries, &o. i Helstox, 11. - Inactive administration. Forth- M.O.H.(notD.M.<).). Active, Two I. 's of N. Doing better -n -n o-n • leven still in much the ! hut appears to have failed work than in 1882, but not Ur. I). IS. Jmvies, game disgracefully unwhole- to exert adequate influence duly supported by the S.A. J uly 1885. some condition as at Dr. Bal- on the S.A. P. 20,219. lard's inspection in 3882 as ? ,¦ . v ? respects the very necessary ( Agriculture, 1( j iu]p or tant amendments fishing, quarry- then Bll £ geB ted. Pbxzaxce, It. - Fairly good administration M.O.H. (not D.M.0.). Fair Fair .--.-- t> cj i-v ¦ and S.A. proceeding with a M^r' es> I Plans for further drainage April 18SB. . m(l water Bu pply, P. 25,610. SOMERSETSHIRE— continued. Willitox, R. - Fair ------ TwoM.O.H.'s (one D.M.0.). Satisfactory • • ? T . „ ? . Active and give sound Dr. D. S. Davies, a Av\p P Dec. 1885. ' ' ' P. 18,685. (Agriculture m ainly. Minehead a sea-side I resort.) Ciiabd, R. - - Some improvements effected, M.O.H. (D.M.0.). Pair, but Three I.'s of N. Fair - ? t j but progress slow. advice too general. May, 1885. ' P. 22,942. (Agriculture. In towns various textile manufactures.) LINCOLNSHIRE— continued. Gainsborough, It. Administration good - - M.O.H. newly appointed - Satisfactory - Dr. Airy, i June 1885. P. 1 .1,075. (Agriculture.) CHESHlRE— continued. Runcokn, R. -Administration above the M.O.H. (not D.M.0.). Well i Efficient. I. of N. aotingsatis- T . ? average of rural districts. trained and efficient l'actorilv under M.O.H. Dr. Airy, ° ollicer June 1885. omcer. P. 18,897. (Agriculture ; dock '< and canal works j at Weston Point.) 329 CORNWALL— continued. 13. 14. 15. 16. 17. i ,- <¦ T < i u_g Recommendations oi Inspector ; of Nuisances. h e .3 2 ?, -, .. . .. .5 3 o§ with Date of Information. Some improvement, None - • • None - None - April 1886. Action taken by S.A. as to but much still need- water supply and scavenging of Porthful, especially at leven. No information as to other Porthleven. matters to date. July 7th, 1880. None - - - None - None - No subsequent inquiry to date. May 27th, SOME RSETSHI HE— continued. Pair - - • None - - • None - None - July 1886. General statement that the attention of the sanitary officers lias been called to the various points of advice. S.A. have hopes of hospital being provided by private subscriptions. Recurring nuisances None - - - Only stov- None - No subsequent inquiry to date. May -27th, inadequately dealt I ing appa- ISBH. with. rat us at workhouse. LINCOLNSHIRE— continued. Not perfect efficiency, None; but S.A. None • None • No subsequent inquiry to date. May 27th, but better than in seeking to make 188 V ery rough and imperfect. But privy pits.spurces of much excre- ( Mr. J. Spear, ;n; n many places no attempt or j mental nuisance. Many dwel- Dee. 1885. pretence at drainage. Sewage lings without any privy accom- P. 14,277. nuisances general. modation. (Agriculture.) i'rrk-Tin\f E - Netrlected - ¦ Bough, sometiaiea dilapidated Midden privies of worst type and PICKEKIN&, K. -NCKdcn gu 6 {£| . ce Qhaamh vil]afr( , privy pits often in confined Mr. J. Sppar, streets; private drains similarly j situations or against house walls, Dee. 1885. of rough construction and often j and neglected. ]> ,;7ic) choked as they pass beneath dwellings. Sewage nuisances (Agriculture abundant, mainly.) WuTTTiv 1? - - Neelootedinmany Village drainage very defective Mainly midden privies of worst wh.ij.jjx, iv. ' ,mrts ' everywhere, and sewage nuisan- type, sources of excremental Mr. J. Spear, oes very prevalent. nuisances. Some houses have no Dec. ISBS. privy accommodation at all. P. 9,921. (Iron stone mining, fishing, agriculture.) riiiannprnifn R . Fair on the whole Considerable improvements in Improvements during recent years uuisiJOKuuuji, . sewering effected in villages in privy arrangements in certain Mr. J. Spear, during recent years. villages, but similar action re- Dec. 1885. quired ill others. P. 8,521. (Iron stone reining, agriculture.) 331 5. 6. 7. 8. 9. Sanitary Crowding Overcrowding of j Refuse Removal.' Water Supply. Dwellings of Dwellings on Dwellings. of Poor. Area. All refuse and Unsatisfactory. Either from Fair, with some i Some at Ryhill - Some overcrowdsometimes even wells mostly bud, or from signal excep- ing in some oi slops thrown springs inconveniently dis- lions. the colliery vilinto privy pits, tant. lages. Very unsatisfac- ! Very insufficient supply Rene« I Unsatisfactory; Some in Thorne Occasional. tiiry. Great neir- | r;illy. At Thorne and Stain- some, houses uu- and Epworth. lectasarnle. forth impure cannl water fit for habitation. drunk. In other places shallow wells often polluted. YORKSHIRE.— East Riding. j Refuse removed) Shallow wells, generally brack- Unsatisfactory - None, except at None apparent. with privy stuiY. j ish or polluted. Some rain- ; Howden. water tubs or underground ! cisterns. A scheme of water supply from railway cutting | in chalk wolds h;is been suggested. YORKSHIRE.— North Ridtng. i I Very unsatisfac- Hovingham supplied satisfac- Unsatisfactory. | None - - - Occasional, to'ry. torily. Elsewhere local wells Dampness com- , liable to dangerous pollution, lnon. Some j or from streams sometimes mere hovels, receiving sewage. ! Very unsatisfac- Some few villages have satis- Unsatisfactory. A little crowding Occasional, to'ry. factory supply. Others sup- Many damp from in some villages, plied 'from local wells liable structural deto pollution, or from running fects. Some streams occasionally polluted dirty and dilapiwith sewage. Great deficiency dated, of water in places. Very unsatisfac- Sometimes from springs (where Unsatisfactory. Much crowding at Considerable, torv. supply is often inadequately Many houses Robin Hood s protected from befoulment in unfit for habita- Bay and some its distribution). Sometimes ' tion. Many elsewhere, from shallow wells and run- damp, dilapining streams. dated, and surrounded by sewage nuisances. Varying in charac- Generally satisfactory, but Fair on the whole None remarkable Not observed, ter. some polluted streams and shallow wells in use in some villages. 332 YORKSHIRE.— West Riding — continued. 1. 10. _ n- l 2: J_ I Rural Sanitary Inspectoral Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. HEM^onr.r.R. Tardy and unwilling in the M.O.H. (noi DM.OJ Dili- I. olf k Works diligently matter of public improve- gent and painstaking. unuu .u.u.n. 4«wii i laai ments, except that some vil- Apill ISSO. j drainage ] 111S ) x . en ,„¦„. P. 11,1(IG. v uj ( . ( |. [neffleient. (Agriculture, stone quarrying, Mr. J. Spear, to certain obvious causes of detail. Jan. 1888. nuisance. But a little per- P. 12,828. manent work has been done ? ... since Dr. Parsona's inspection (Agriculture, jn 18g3 vhiefly the laving canal navigation, of som( . (;oo yar( js of sewers &c -t in tho villages. Villages obviously dangerously liable to spread of cholera, should it be introduced. YORKSHIRE. — East Riding — continued. llowdex, It. - S.A. taken little useful action. ! M.O.H. new to district - Not very efficient - ¦n,, a:.,,. Sewage scheme proposed for Tnn« imk Jlowdcn. Viliajres obviously jum jssj. dangerously liable to spread P. 12,182. o f cholera, should it be in(Agriculture, t induced. brickmaking, canal navigation.) YORKSHIRE. — Nortii Riding — continued. Malton, R. ¦ Unsatisfactory. Little cvi- M.O.H. (not D.M.0.). Fair, Fair - dence of sanitary improve- but further personal m¦nJ* i«a« ' ment. flucnoo required. P. 14,277. (Agriculture.) PICKEEING.B. - Very lax. Powers of S.A. M.O.H. (not D.M.0.). Fair, L °fN- fills similar office to w Ta ' delegated to a committee but reports and recom- Urban S.D. Js to private Mr. J. Spear, which rarely meets. mendations not much re- business as auctioneer, but Dec. 1885. wniou iwoiy raeuw. garded by S.A. gives considerable time to P. 0,711). his work ' (Agriculture mainly.) Wiiitby,R. - Very inefficient. Sanitary Three M.O.H.'t .(two of them^ I^SSS& , r T a officers absurdly underpaid. D.M.O.'i). Admit wretched ndu-ulo u.slj s nu l11 ; •f/"; 0^ M li J - ii S BPB B P 8^ ri Their salaries have recently condition o their districts, object oi I. of N. apparontlj Dec 1885. 1)( , ( , n 1 . ( . (1u( . ed i{i per oen f, but do little or no work is to keep things quiet. P 9 921. District in a dangerous con- because of their dissatis,T,T T . . . dition for advent of cholera. faction with scale ot pay(lron stone mining, ment. fishing, agriculture.) Guisboeough, R. Progt-ess slow, but some im- M.O.H. (not D.M.0.). Good Fair Mr. J. Spear, provements eftetited. Dec. 1885. P. 8,251. (Iron stone mining, agriculture.) YORKSHIRE. —West Riding —continued. 13. 14. 15. 16. 17. 3 g go Result of Hoard's subsequent Inquiry Abatement and |. WQ as to Action taken by S.A. on Prevention Hospital Provision. |_g jjjj Roeonnnend.ations of Inspector; of Nuisances. || |g with Date of Information. % a ».2 fl as Ordinary nuisances None - - - None - None - June-October 18S5. Very little evidence kept, down pretty of action. Building byelnws to lie well, bu( little done adopted. M.O.H. in 188!> report says to prevent recur- Dr. Airy's recommendations are rerenees. ceiving Authority's consideration. Almost complete None - - - None - None - March 188}!. Some action reported as to failure. sewer improvement and cleansing. Nothing said as to water supply and other matters. S.A. apparently not inclined to incur much expense in remedying existing sanitary defects. i I YORKSHIRE. —East Riding —continued. . Very languid dealing None • - - None - None - No subsequent inquiry to data (May 27th, With nuisances. 1888), but a new scheme of sewerage tor Howden is in progress. YORKSHIRE. —North Riding —continued. Failure to deal with None - - - None - None - April 188(1. Officers of S.A. are carrying recurring nuisances. out Mr. Spear's recommendations. Almost complete None - - - None - None - Board's inquiry (March 11th) as to action failure to deal with of S.A. unanswered to date. May 27th, recurring nuisances. 1880. No dealing whatever None - - - None - None - April 1888. In reply to Board's request with the most gross lor details of action taken on Mr. Spear's and obvious nuisan- advice, S.A. make an unsatisfactory Cl.s. general statement that their oflicers are instructed to tilke measures in regard thereto. Dealing with recurring None - - - None - None - No reply to date to Board's request of nuisances not habi- March last for information as to action tual. nf S-A- on Mr- suggestions. May 27th, 1886. 334 P DURHAM. 3. 4. Excrement Disposal and Sewering and Drainage. Removal . "JStsiTSi; = ; m^sy^nijssa?a£ of the most populous places. wise satisfactory. Sewers well ventilated but (lush- I in,:; inadequate. H-rnrKTON R - Good - - - Populous parts well sewered; Modern privies, limited capacity, STOCKTON, K. uooa older systems deficient in venti- and satisfactory. Dr. Page, l at i 011 an ,j flushing. March 1885. J I. 1(1,137. (Iron works, potteries, agriculture,} Seduki-ield, E. - Good, with excep- j Sewering systems curried out in | Midden privies. Want of privy tion of Trimdon the more populous villages, with accommodation at irmidon ?, i'TZ' Colliery and ventilation and flushing. Colliery. r cd. i^sD. Low gpenny- P. 17,103. moor. (Collieries, agriculture.) HutTLErooL, R. ¦ Satisfactory- - Drainage of villages fair with ex> Midden privies. Improvements D p ¦ ceptionof "40-acres." in these of late years. June ISBS. P. 2,167. (Agriculture.) Aucklaki), E. - Varying - - Faulty piecemeal sewering in the Midden privies of had type, n ,j villages; unsatisfactory. No ven- causing excremental nuisances. April issV. tilafaon or flushing. P. 58,854. (Iron works, collieries, and agriculture.) TEESDALE, E. • Good, with excep- System of sewering in some vil- Midden privies of bad type, and l)r Piire ilon °^ oc k- lages ; but without ventilation. sources of nuisance from near- May 188o! flel(il Elsewhere none or insufficient, ness to houses, and neglect. P- 18,283. (Agriculture, some collieries, lead smelting, and quarrying.) Weasdams, B. -Satisfactory on Defective rubble drains, which are Midden privies of bad type, and Dr Page v wno^ e< a source of nuisance at Fros- sources of nuisance from this April 1885. terley. Improvement contem- cause and from neglect. plated. Wolsingham sewered. P. 10,902. but nuisance at outfall. (Lead mining, quarrying. Steel works at Wolsingham.) 335 D U R tl AM? 5. 6._ 7. J^ 9- Sanitary Crowding Overcrowding of Refuse Removal. Water Supply. Dwellings of Dwellings on Dwellings. of l'oor. Area. 1 ; I ¦ ' Fair, with exoep- Public supplies at Cockerton Very good - - None - - - Infrequent, tions. and Middleton St. George. Public wells elsewhere, in good positions. Private wells numerous and dangerously near privies and middens. Satisfactory - Public supply to many villages. Good - - - None - - - None. Others supplied by wells sunk by S.A. Satisfactory. Varying in effl- Public supply lor many vil- Fair, with excep- I None - - - Occasional, ciency. lages. Others supplied from tions. wells liable to pollution. Worst supply :it Tiimdon Colliery village. Satisfactory-- - Public and private wells. Pri- Generally good. Nonu - - - None. ' vate wells at "40-acres" liable "40-acres" an to pollution. exception. Much improvement ot j late years owing j to vigorous action of the M.O.H. Unsatisfactory - Public supply constant to most Generally fair, ex- Crowding very! None. villages. Some villages in- cepl for damp i noticeable ai adequately supplied. from want ol j Crook. cave - spouting. Much dilapidated property at Crook. Unsatisfactory - Mostly local wells, some ex- Fair, with excep- Little crowding - None, posed to sewage pollution. tions. I Unsatisfactory - Inadequate and liable to pollu- Generally satis- None - - - None. tion at Frosterley. In some factoryparts from springs, and good. At \V olsingham shallow wells universally exposed to cxc jmental pollution, probable cause of fever outbreak in 1884. 336 DURHAM— continued. L_ 10. 11. 12. - 1 Rural Sanitary Distriot. Inspector and Administration by Sanitary Work of Medioal Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. 1 ! ' I Daki.ington, R. Very efficient - - - - ] M.O.H. (tiol a D.M.0.). Very satisfactory. 1. of Xis Very satisfactory. Surveyor also. Dr. Page, March 188. r ). P. 12,572. (Iron works at Middleton St. George : elsewhere agriculture.) Stockton, It. - Good permanent work done. M.O.U. (not a D.M.0.). Very satisfactory _ ? Act on advice of 31.0.11. Very good. Dr. Page, March 1885. P. 10,137. (Iron works, potteries, agriculture.) SEDfiEFiELD, R. - Good M.0.11. (a D.M.0.). Good, Good and energetic „ v i and gives competent ncl- J*r. 1 age, vipp Feb. 1885. vlCe< P. 17,103. (Collieries, agriculture.) llaetlei'ool, R. Satisfactory. Curry out sug> Good and efficient - - Good and efficient - _ _, gestions of M.O.H. Dr. Page, June 1885. P. 2,167. (Agriculture.) j Auckland, It. - Inactive Three M.O.H.'s (not Very good Dr. Page, D.M.O.'s). fair. April 1885. ; P. 58,854. (Iron works, collieries, and agriculture.) Teesdale, R. - Inactive, and insufficient at- Three M.O.H.'s (I) M O s) Efficient Dr. Page tention to reports of M.O.H. Two efficient, one (M.O.H. May 1885*. f° r Gainford) inefficient. P. 10,233. (Agriculture, some collieries, lead smelting, and quarrying.) Weardale, R. - Generally efficient. Action Four M.O.H.'s (U of them Vigorous and efficient. I.ofN. Dr l'a«e abou ! lo betaken for water | D.M.O.'s). Efficient or fair, is Surveyor also. Avn-il 1885 fuPPly »t Wolsingham and except at Wolsingham. P. 10,902. Prosterley. (Lead mining, quarrying. Steel works at Wolsingham.) 337 DURHAM — continued. 13. 14^ _15. 16. 17. p.'o Result of Board's subsequent Inquiry Abatement and | fcg B8 to Action taken by S.A. on Prevention Hospital Provision. || _| Reconimendations of Inspector | of Nuisances. || with Date of Information. 5 Si* I Efficient ... Use Darlington U. ! None - i None - No subsequent inquiry to date. May 27th, I Fever Hospital. 1886. (Cliairman of S.A. undertook to say that Inspector's advice would be acted on.) Efficient - - - None, but there is None - None - No subsequent inquiry to date. May 27th, I arrangement with issti ; but M.O.H. In 1885 report shows k Middlesbrough that sewor-vontilation is receiving iit- Pever Hospital, tention. which is not made use of. Fair, but a deficiency None - - - None - None - June 1883. S.A. are moving in the matters I of scavenging staff. of water supply, sewerage, and excrement disposal and removal at certain places. Nothing said as to hospital provision or byelaws. Efficient ... Use West Hartle- None - None - June 1885. S.A. will take steps to secure pool Fever Hos- the provision of privy accommodation, pitttl. Nothing done as to water supply of "ID-acres." Inefficient ¦ ¦ - None • • - None - None - December 1885. S.A. show that some work is being done as recommended by Dr. Page. Ordinary nuisances None - - - None • None . June 1885. S.A. speak of some steps to be abated. taken as to water supply and sewerage, but reply generally unsatisfactory. M.O.H. 's 1885 reports contain but little evidence of any sanitary improvements in the sense of Dr. Page's advice. Further letter of June 188(5 from S.A. in reply to renewed inquiry by Board, extremely unsatisfactory. Ordinary nuisances None - - - None - None - June 1885. Measures in progress as to abated. water supply, sewerage, and sewage disposal. Question of adoption of byelaws (Series 11., 111., IV., and VI.) reserved tor future consideration. 338 DUEHAM — continued. 1. 2. 3. 4L4 L Rural Sanitary i InsDectorand Cleanliness of Exorement Disposal and Uatrof Report. %% d 0 S 1 1 c nd Sewerin « »» d DrahlilCe - Removal. Population (1881). Premises. Industries, &c. Lanciie'Tei: R. - Varying in diffe- Sewering completed in many Midden privies of bad type, of ten ' re n t villages. villages, and in progress in ill placed and causing serious Dr. Page, others, but sewers generally nuisances, Nov. 1885. inadequately ventilated and un- P, 40,519. flushed. (Collieries and coking mostly.) iIrRnAMi lrRnAM t> . . j-'air - - - Of late years systems of sewering ! Midden privies of bad type gene' ' * provided in the most populous rally in use, and often too close Dr. Page, villages, but in all without I to dwellings. Jan. 1886. flushing arrangements, and in all j P 38 539. tout the most recently sewered I without adequate ventilation, i (Collieries, coking, House drainage defective in i &<¦.) certain colliery villages. Eashtgton It - Surface nuisances i Some of the colliery villages pipe- ; Very general absence or deficiency abound in vil- | sewered without ventilation. , of privy accommodation m all Dr. Page. loaea without I Others drained by surface j old villages. Whore existent at Feb. 1885. priw aceommo- I channels. all, old fashioned midden privies P. 38,884. dation. Refuse! in use. ,',.'. , and excrement j (Collieries.) heaped before j doors of houses. Hottohton •IE - Satisfactory- - No complete systems of sewering, Midden privies of ordinary type, Spktnc* R but previously existing highway j but in newer dwellings of re' ' drains, more or less efficient, j duced dimensions and covered. Dr. Page, utilised. Outfalls into water- i In some old villages, absence of i March 1885. courses which are thus ren- | privy accommodation. P. 28,104. dered grossly offensive. (Collieries.) CHESTER- LB - Unsatisfactory. Urban village of Chester-le-Street Midden privies of bad type ; often STREET R. Some populous sewered, and sewers ventilated, j sources of nuisance from close. ' places wholly Other villages more or less j ness to dwellings. Dr. Page, neglected and ' sewered, and others drained Jan. 188(i. unwholesome. partly by pipes and partly by P. 13,352. open channels. (Collieries, iron works, chemical works.) NORTHUMBERLAND. Tynk.moutie, R. - Unsatisfactory • Sewering of district progressing Uncovered, objectionable, midden T1 p satisfactorily. privies remain as at Dr. Barry's Sept. 1885. inspection in 1883. P. 31,405. {Collieries, shipbuilding, and agriculture.) Castle Ward, R. \ Unsatisfactory - Sewering generally defective or Midden privies of a type and in Dr Paire wanting. positions to be common sources Oct. 1885. o£ nuance. P. 15,591. (Collieries, brickmaking, steelworking, agriculture.) 339 I ) UUK AM.— coutin ued. 5. _6. 7. 8. 9. I ; i , Sanitary Crowding j Overcrowding of Refuse Removal. Water Supply. Dwellings of Dwellings on Dwellings. of Poor. Area. I Very unsatisfac- Public supply constant and Generally good, Little crowding - None, tory, cxcciit good to most of the villages. but damp from where muter- Some villages still dependent lack of spouting taken by colliery on wells. ! and drainage of owners.' subsoil. Many some from filthy surroundings. .Unsatisfactory ¦ Mostly public supply constant Better than for- Little crowding - None. and good. Some villages merly,but many j i without adequate or readily j damp from want ! accessible supplies. of cave-spouting, now depopu- Scavenging done Villages as a rule supplied by i Dwellings in older \No crowding - Some at Castle by colliery owners from magnesian , colliery villages -Mien, owners with I limestone tapped in sinking ' sometimes very j varying em- mine shafts, but the arrange- defective. Some ciency. Bad at ' merits for distribution vary ; new, well ar- Trimdon Foun- I from good to unsatisfactory. ranged dwel- Fair on the whole Public supply ; constant and Generally good - A few 'Nck-to- Rare. good to nearly every village. ba( X ll0 "? t ?J crowded and without back At Chester- lfl- Public supply to many villages! Fair, but with : Some crowding, Notinuoh at Street satisfac in progress or supply to some bad excep- ihi I > i tin... present time. i tory Elsewhere others. In some villages tions. Damp- mented houses, varying. I a supply from colliery work- ness from lack ' ings or from wells. of cave-spout- ; common evil throughout dis- j NORTHUMBERLAND. i Still unsatisfac- Considerable improvement Varying : but a None remarkable Infrequent. tory . since Dr. Barry's inspection. ge^raUbsenc^ but some improvements Unsatisfaotorv - The Tyneside villages have an Fair, except as re- None very remark- j None. unsawsractorj inadequate public supply gards dampness able. from Newcastle and Gates- from want of head Works ; other parts have cave-spout mg. an inadequate supply from Some unnt tor wells and springs. habitation. 340 1) UR HA M— con tinned. _L 10. 1L 12. Rural Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer i Work or Inspector of Date of Report, Authority. of Health. Nuisances. Population (1881). Industries, &c. i LaNCHESTEB, R. ; Fairly efficient, especially of Three M.O.H.'s (D.M.O.'s). j Efficient. I. of N. is surveyor ? -„ recent years. Satisfactory. j also, l/i*. xagc, Nov. 1885. P. 40,510. (Collieries and coking mostly.) j Durham, R. • Administration improved" M.O.H. (>w< D.M.0.). Highly Active and efficient. I. of N. , ? j since Mr. Spear's inspection efficient. is surveyor also. T iJ"u, 4 " '" 1881. Jan. 1880. P. 38,539. (Collieries, coking, &c.) Easingtox, R. - S.A. do little themselves in M.O.H. (not D.M.0.). Satis- Satisfactory .... y. p the way of sanitary admi- factory and earnest. ]' A iss r nistration, relying on I'olliery • laao. owners for the management P. 33,384. of their respective villages. in in -;, . \ Still some progress has been (LollitrKSj mi(d(l Bin?e Ml ,_ p ower > s iv.i v . spection in 1879, especially as respects water supply and new dwellings. Houghton -le - Fairly efficient. District much Two M.O.H.'s (not D.M.0.). I Satisfactory .... Sphixg, R. improved since Jlr. Power's Satisfactory. Dr. Page, inspection in 1874. March' 1885. i P. 28,104. (Collieries.) Chester -lk - A good deal of permanent Two M.O.H.'s (D.M.O.'s). j Systematic and satisfactory - Street, R. work done in recent years, One newly appointed, the j _. -„_ _ but sanitary administration other satisfactory and r iIS/' otherwise mifrht be more advising soundly, Jan. 1880. efficient. P. 43,352. (Collieries, iron works, chemical works.) NORTHUMBERLAND— continued. Tynemouth, R. - Active and efficient in many Two M.O.H.'s (one a D.M.0.). Energetic and efficient - ])r Pa«O essential matters. 1m- Very good, M.O.H.'s ad- Sent ISB5' provements in sewering, vise well, and have influ'!' ' ! ° ' water supply, and privy ao> ence with S.A. 1 . 31,40.). commodation progressing. (Collieries, shipbuilding, and agriculture.) Castle Ward, R. Very inefficient. Only the M.O.H. (not D.M.0.) (80/. I. of N. energetic and really Dr Page most trivial kind of work per annum.) Has made does the work that the Oc't 1885 carried out. P. H. Act no systematic inspection, M.O.H. ought to do, so far _ " „ . ' almost a dead letter. and has apparently given as he can. 1 • 15.59*- S.A. none of that detailed (Collieries, brick- advice which the circummakiiig, steel- stances of the district working, Rgricul* • urgently require, ture.) 341 DURHAM — continued. 13. 14. 15. 16. 17. S.'o Result of Board's subsequent Inquiry Abatement and J> |g as to Action taken by S.A. on Prevention Hospital Provision. || Jj Recommendations of Inspector ; of Nuisances. s 2 -g 2 with Date of Information. 2 2. $.2 P !»*- Not thoroughly satis- Now in course of None - i Only dis- May 1886. S.A. " are very busy with son factory. construction in tributionof tary works." No details given. conjunction with handbills. some other S.A.'s. Pair .... None - - - None - j Some pro- May 1886. Nothing done on Inspector I paration. advice. I Capable of much im- Small cottage hos- — — No subsequent inquiry to date. May27t provement. pital, which has 1880. proved useful. Efficient - - - None - - - None - None ¦ M.O.H. Park in 1888 report says man of Dr. Pages suggestions have bei acted on. Two hospitals, each of te beds, to be provided. Inefficient on account None - - - None - None - May 1886. Some action as to wate oi imperfect dealing supply and drainage. Questions of by with recurring nui- laws and hospital provision under coi I sances. sideration. S.A. not sufficiently alh to scope of present powers. NORTHUMBERLAND— continued. Efficient - - - None • • • None - None - No subsequent inquiry to date (May •27th, 188 but loans to amount of 4,090*. sanctioned since inspection for works of sewerage and water supply. Apparentl nothing done as to hospital provision. TnpfTiciptit - - - None - - - None - None - June 1880. Some action being taken an< menicienr «one Col|templation ou ])r> Page . a .^ y{w Hospital question deferred for a time. I 342 NORTHUMBERLAND— continued. 1. 2. 3. 4. Rural Sanitary Inspector and Cleanliness of Excrement Disposal and Date of Report. Domestic Sewering and Drainage. Removal. Population (1881). Premises. Industries. &c. i Mokpetii, R. - Very good - - Colliery villages satisfactorily j Midden privies looked after by n . t, drained and drainage looked \ colliery owners, and o>i the m: ¦"*£> after by owners. whole kept from being nuisance. (Collieries, agriculture.) At.xwick. R. - - Pair, with exeep- In most localities systems of Mostly midden privies j often in lv , p tions. sewering and house drainage, unwholesome positions in reft! ibsr * mt "° ventilation. Some im- spect of dwellings. Some im- UCI. isso. portant localities still undrained. proved systems (w.c's or pail P. 12,609. privies) in limited use. (Agriculture, collieries, fishing.) Belfokd, R. - - Satisfactqry.'except Villages generally unsewered and Midden privies often in too close : T1 p at Sea Houses. in much need of sewering. proximity to dwellings. Houses J V S without any privy accomtnoda- ; Sept. 1885. tion at gen Hoiises and else- j P. 5,737. where. (Agriculture, but fishing at Sea Houses and North Sundeiiand.) Berwick, R. - - Fair, with exoep- Villages all undrained and some ; Midden privies often in too close | ¦p. p tions. in consequence abounding in j proximity to dwellings, and j i,';, ,:: slop nntaancvH. sources of nuisance. Some! Sept. 1885. houses in every village without \ P. 7,050. any privy accommodation. (Agriculture ; at Holy Island fishing.) SOUTH WALES. POKTTPEIDD, R. - Fair - - - Partly sewered at Caerphilly. At Caerphilly some w.c's, and a 1) ¦I) S 1)' r" Elsewhere mason or stone slo]) satisfactory pail system. Else- I Mow'iofiK drains, and surface channelling. where cesspools, privy pits, and .ua.\ i»3&. unsatisfactory pail system. P. 10,978. (Coal mining, agriculture.) , Bridoend, R. - Roads in mining Many colliery towns and villages Pail system largely in use, but not ru 4- i -[ valleys very more or less completely drained. under management of S.A., and [Partial survey.] badly kept. ' hence in rows of cottages with- Dr. D. S. Davies, out sufficient space there are Feb. 1880. excrement nuisances. Neglected -p .10 t-or cesspools and privies leaking r - - s "" i0 - into ditches, &c. Pont-y-Cymer especially bad. Neath, R. Roadways much Drainage generally deficient, but Mostly privy pits without syste- T)r T» S l>ivies neglected in work in this direction now in matic supervision of S.A., and n»t i««- parts. hand. consequent excrement nuisuci, isj,o. anoegi gome Mjh oloBetSi P. 28,670. (Mining and metal works.) 343 NORTHUMBERLAND— continued. 5. 6. 7. 8. 9. Sanitary Crowding Overcrowding of Refuse Removal. Water Supply. Dwellings of Dwellings on Dwellings. of Poor. Area. Satisfactory - Water to villages from colliery Satisfactory. Some None - - - I None. workings to village stand excellent colliery pipes ; elsewhere pump-wells dwellings rein suspicious positions. eetitly erected. Fair - - • Some public supply by 8.A., but Generally good - None - - - i None, mostly villages supplied by owners. Some villages have a scanty supply of condensed steam from colliery engines. j Unsatisfactory ¦ j Inadequate, and mostly from Generally good; None remarkable 'At Sea House wells. but older cot- ' \ during herrin tages damp from fishery, lack of eavespouting. Satisfactory - - Public supply at Norham ; Dampness from None - - - ! None, except a elsewhere wells or other lack of cave- Holy Island. sources often at too great spouting, a predistance from dwellings. valent fault ; but otherwise dwellings generally good. SOUTH WALES. Satisfactory - - Public supply at Caerphilly. Miners' houses No remarkable Only in newt Elsewhere wells of variable satisfactory on crowding. mining district quality according to sur- the whole. before a sutf round'ings; some very ob- cieney of liousi viously liable? to pollution. are built. Unsatisfactory - Town and villages at head of Unwholesome in Garw Valley from Garw ninny parts. Water Company's reservoir. Elsewhere "pistills" and wells. Unsatisfactory - Public supply in parts. Else- The various parts of district differ Only in i newly where wells and other in character, some being practically worked district, supplies liable to dangerous urban, with too little air space where as yet pollution. about houses and with dwellings there are not requiring attention. sufficient number of houses. 344 NORTHUMBERLAND— continued. i. __ 10 - _ y- 12. Rural Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. I~I ~ ~ ' Mokpeth, R. ¦ Good administration. B.A. give M.O.H. (a D.M.0.). Does Office vacant - - , - - -r, ? effect to advice (if M.O.H. good work and advises ?r. Page, soundly [M.O.H. Morpeth June 1886. U. also]. P. 14,064. (Collieries, agriculture.) Alnwick, R. - Administration active and M.O.H. (not D.M.0.) Very Very good and energetic - Dr. Page, P oo(1 - « OO|] - Oct. 1886. P. 12,600. (Agriculture, collieries, fishing.) Belfoed, R. - No public works yet carried M.O.H. (not D.M.0.). Effi- Efficient ¦n i, , out. Little sanitary work cient. Stifle. rtoil(1 - P. r.,737. (Agriculture, but fishing at Sea Houses and North Sunderland.) Berwick, R. Inefficient .... M.O.H. (a D.M.0.). Advises I. of N. intelligent and active, i),. i).,, r , soundlv,but without much but not sufficiently sup- Septic, ported by S. A. P. 7,050. (Agriculture; at Holy Island fishing. SOUTH WA LE S— continued. Pontypritid, R. Appear inclined to adopt suff« Four M.O.H.'s (D.M.O.'s). Not very satisfactory. I. of N. !)>• B s Dnvinß gestious offered by JJoard's Badly paid, and work un- is a publican by trade, and MaylBBs. Inspector. satisfactory. is the Surveyor of the dis- I'. 10,978. (Coal mining, agriculture.) Eridgeku, E. - Unsatisfactory. Pont-y-Cymer The D.M.O's, are M.O.H.'s - rT . ? , -| cannot be dealt with effec[Partial survey.] tuillly by Uu , SA> at Bridg . Dr. D. S. Davies, end. Feb. 1886. I. 28,. r )35. Neath^R. - - S.A. doing some good work. Six M.O.H.'s (all D.M.O's.)- Two I.'s of N., one of whom is Dr D S Davies District appears to suffer also surveyor. Would do Oct'lSBs ' from the division of medical better under a single M.O.H sanitary control. P. 28,670. (Mining and metal works.) 345 NOKTHUMBE RL AND— conthm c d. 13. J. 4. 15. 16. VL^ __ g,"c Result of Board's subsequent Inquiry Abatement and |^ Jjg as to Action taken by S. A. on Prevention Hospital Provision || _g Recommendation of Inspector ; of Nuisances. 1 1 with Date of ii n f orm . lticm . s a I* Very efficient - - None ... None - None -j No subsequent inquiry to d:itc> (May 27th, 1886), but M.O.H. in 1885 report says I Dr. Page's advice has not been over- I looked. Efficient - - - None ... None - None -! No subsequent inquiry to date. July loth, I 1880. Inefficient - - None - - - None - None - December 1885 and February 1888. S.A.s I replies not satisfactory, but some sani- I tary activity reported. i Inefficient - - - None - - - None - None -; In December 1885 S.A. report progress I on certain of Dr. Page's reconnnenda- I tions, and in January 188(> forward copy I I of statement of Sanitary Committee as I to measures of improvement needed for I Holy Island. SOUTH WALES— continued. Inefficient ... None - - None - None - No satisfactory reply to date from S.A. to I Board's repeated inquiries. M.O.H. "s j 1885 reports show a sad state of affairs I as still existing in the R.S.D., but some I action as to scavenging and water | supply. Nothing done as to hospital provision. i Inefficient - - - l)r - Davies has made a complete inspection of the district (April) since his par- I tial survey of February 188(5. but no 1 inquiry has yet been addressed to S.A. I July Bth, 1880. Fairly satisfactory None - - - None - None - February 1880. The whole of " the recom" mendations " made by Dr. Davies I " have been carried out." Loans sane- I tioned in 1885 for 3,7(>0J. and 4f "nwMllinnx on ™ m Refuse Removal. Water Supply. Dwellings oi Dwelling on Dwellings. of Poor. Area. Unsatisfactory ¦ Public supply mostly, which is Varying, and mostly satisfactory. None. Unsatisraotorj tXi4lv satisfactory, but Some "under-dwe lings" on steep Pontardawe supplied from hill side very objectionable. several sources, some of which are unsafe. Fair - - - Public supply in some parts, Fair, but bad and crowded in some None * air "nd a general scheme is now parts. New building byelaws lately in progress. adopted. Unsatisfactory - Xo public supplies. Wells and Fair - - - None - - - Occasional. " pistills " (spouts) looked after by S.A. I Unsatisfactory - Wells, &c, looked after by Many bad dwell- Crowding only at un&atisiactory "jjggjfT' proteoted, and ings dosed as oc Kidwelly. closed on becoming suspicious. casion has arisen. Pig nuisances about cottages frequent. I I Unsatisfactory • Pumps," pistills," and, in places, SomeoMhe^er Occasional crowd- None, some public supply. Mostly cottages aamp, ing. satisfactory, and in some ill - ventilated eases protection against and without •Pnhitn «nnnlv nt Narberth i Many houses dila- No very remark- : Dealt with when ! P oS£rK&£ri!X b£ Piiatedandunflt able crowding. , discovered. have in many cases erected | for habitation. ! pumps and protected drink- i JsA, have been i with them. No scavenging Mainly from wells liable to ! Unsatisfaotory, None - - - ¦ None. arrangements dangerous pollutions. | both^ by^n .ason Tsr e ls\ B r,A i llso }) y reason Nevland - i of deficiency of drainage! and privy accommodation. 101 •»• f)iMl , i for human habi- places, e.g., bi. , tation. jU;i.\ hi h ami Fishguard. 348 SOUTH WALES— continued. 1. 10. 1L 12. Rural Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. Pontaf.dave, R. Fairly satisfactory, but S.A. Two M.O.H.'s (D.M.O.'s). Fair. I. of N. would probably _,_,„„. weakly submit to on (side Interest themselves in work better under direction \T ' isf!i VieSl dictation. their work. of a single M.O.H. jN OV. lous. P. 20,185. (Coal mining and tinplate works.) Swansea, R. - Take little interest insanitary Two M.O.H.'s Satisfactory One chief and two sub-inspec•r, t» o t» ¦ work. Very small attend- tors. Satisfactory. # hP' \?o ft 7 ' once ot R- s -A. at meetings, JNov. 1885. notwithstanding the im- P. 29,404. portance of district, and its ,_. , , , ? exposure to importation of (Tinplate and other Hiiooan metal works.) crease. Gowee, R. - - Variable, but have -takwi M.O.H. (D.M.0.). Efficient Efficient. I. of N. is also road t\ Tk cs t» ¦ action for the protection of surveyor. Dr. 1). ». Davits, W( ,ii s Nov. 1885. wtlls> P. 7,615. (Scattered population ; agricultural and fishing.) Llakexly, R. - Slow, but progressive. Lax M.0.H. (D.M.0.) Does very Unsystematic, but S.A. are _ _. ct, . in administering building good and careful work, dealing with this fault. Dr. D. S. Davies, byelaws. and has obtained full con- A»g- 1885. fldence of the S§A# P. 24,856. (Collieries, v tinplate works, agriculture.) CABMARTHEN, R. Inactive. I. of N.s report Pour M.O.H.'s (D.M.O.'s) - I. of N. about to be dismissed -p. ? oT , • , not dealt with for Itnree and two new ones appointed. Drt i? # B vP« VieBl months. Since Mr. Powers JMOV. ib»D. inspection in 1878, however, P. 24,051. some unwholesome cottages . . . ? , removed and some water (Agriculture.) supplies protected. Narbekth, R. Sanitary committee not in- Four M.O.H.'s (D.M.O.'s) - I. of N. is an architect and -n -n o -n«,,io= active. master builder. Satisfac'"-?" ill- t01 'y on tho whol<1 ' but his i>o\.i»sj. business hinders very effi- P. 19,451. cient work in so large a (Agricultural. district districtpartly colliery.) Pembeoki:, R. - Inefficient. Xo systematic M.O.H. is D.M.O. Reports I. of «t» •• dealing with common nui- to S.A. unwholesome con- but requires more assistance n't isiaK sauces. Little improvement ditions. and support, uct. isst). since Dr. Airy's inspection P. 11,441. in 1880. District, especially . . . ? i Nevland, in a dangerous (Agricultural. condition for advent of railway and clocks.) c no lera. Haveefoedwest, Apathetic S.A. Disregard re- Four M.O.H.'s (D.M.O.'s) - I. of N. is also school atten- R. ports of the M.O.H.'s. dance officer ; a capable -n,. T> *? Dnvipn man - but district too large Dr At/im ' tor his m^^ement. P. 23,581. (Chiefly agriculture.) 349 SOUTH WALES— continued. 13. 14. IS. 16. 17. §,"0 Result of Board's subsequent Inquiry Abatement and |_ M as to Action taken by S. A. on Prevention Hospita Provision. || _J Recommendations of Inspector ; of Nuisances. "S g | g with Date of Intorma tion. ft 02 ¦*"" Fair - ... None ... None - None - April 1886. Sanction applied for to loan of l, Population (1881). Premises. Industries, &c. Holywell, R. - This large rural district contains many parts which are urban in character, inhabitated by I ~ -n c. -n ¦ Sources of water supply various, and in many cases require attention. Some progress is, July 1885. P. 33,268. — 1 351 NORTH WALES. 5. 6. 7. 8. 9, Sanitary Crowding Overcrowding of Refuse Removal. Water supply. Dwellings of Dwellings on Dwellings. of Poor. Area. i n ~~r~ a poor population, and work is not brisk. Many unsatisfactory conditions of excrement and refuse removal. I however, being made. 1 i ' A A 2 352 NORTH WALES— continued. L 10. 1L 12. I Rural Sanitary District. Inspector and Administration by Sanitary Work of Medical Officer Work of Inspector of Date of Report. Authority. of Health. Nuisances. Population (1881). Industries, &c. _ - Holywell, R. - It is difficult to obtain sanitary improvements. Dr. D. S. Davies, . July 1885. P. 33,268. 353 NORTH WALES— continued. 18. 14. 15. 16. 17. &3 Result of Board's subsequent Inquiry Abatement and | |g as to Action taken by B.A. on Prevention Hospital Provision. |J _jS Hccommendations of Inspector ; of Nuisances. , | c ¦% | witl , Date ot information. Hospital now being No subsequent inquiry to date. May 27th, erected. 1880. ¦ 354 App. No. 10. Ec Relation iteria to c Cholera ; . Klein. No. 10. On the Kelation of Bacteria to Asiatic Cholera, being a communication by Dr. E. Klein, F.R.S., to the Royal Society (Feb. 5, 1885); reprinted from the Proceedings of the Royal Society, Vol. xxxiii. — With a Supplement by Dr. Klein j April 1886. I propose to bring before the Royal Society the results of an inquiry into the etiology of Asiatic cholera, undertaken, at the instance and expense of the Secretary of State for India, by myself, Dr. Gibbes, and Mr. Alfred Lingard, while in India. This investigation will be published in extenso by the India Office, but permission has been granted to us to bring to the notice of the Society some of the more important points of our inquiry, particularly those regarding the relation of bacteria to Asiatic cholera. I shall supplement them by giving the results of further observations which I have made since my return from India. As is now well known, Dr. Robert Koch, in an extensive inquiry into the etiology of cholera in Egypt, Calcutta, and in France, 1883-84, undertaken by him, Drs. Gaffky and Fisher, at the instance of the German Government, has arrived at certain conclusions, which, briefly stated, are these : 1. In all persons suffering from Asiatic cholera, there occur in the rice-wnter stools during the acute stage of the disease certain wellcharacterised bacteria, which, on account of their curved shape, Koch called " commabacilli." 2. These commabacilli are mobile rods, of small size, of about the same thickness as tubercle-bacilli, but only of half their length ; they are always more or less curved, sometimes as much as to form half a circle ; they vary in length according to the state of growth ; they occur either singly or in couples, in the latter case arranged like an S. 3. The commabacilli occur in great numbers in the mucus-flakes as well as in the fluid of the choleraic evacuations. They occur in the lower part of the ileum of persons dead in the acute stage, almost to the exclusion of other bacteria, and in such great numbers, that the lower part of the ileum may be considered to contain almost " a pure (l cultivation of commabacilli." 4. The mucous membrane of the ileum, particularly that of the lower part, around, and in the lymphatic glands located here — the solitary and Peyer's lymph-glands — exhibits in typical and rapidly fatal cases characteristic alterations : loosening and detachment of the epithelium of the surface, and of that lining the glands of Lieberkiihn ; swelling of the mucous membrane, and congestion of blood vessels, particularly at the peripheral portions of the lymph-glands. These alterations are due to the presence, growth, and multiplication of the commabacilli in these tissues, and the disease cholera is caused by the production on the part of these commabacilli, and by the absorption on the part of the system, of a special chemical ferment. This state of the presence of the commabacilli in the tissue is best pronounced in the lower part of ileum, higher up it is more limited, and gradually diminishes, and finally disappears in the upper part of the small intestine. 5. The blood and other tissues are free of any organisms. 355 6. The commabacilli grow well outside the body at the ordinary temperature of the room, but better still at higher temperatures up to 38° or 40° C. They divide transversely ; after division, the two offsprings may remain joined end to end in the shape of an S ; and, by further division, they may grow into a spiral-like or wavy form. They grow well in the mucus-flakes taken from the intestine, and placed on linen kept in a moist cell ; they grow well on potato, in broth, in Agar-Agar jelly, in solid nourishing gelatine mixture (gelatine, peptone, and beef extract). In this latter substance they exhibit a peculiar and definite mode of growth not seen by Koch on any oiher bacteria. The commabacilli require for their growth an alkaline medium ; they are killed by acid, by drying, and various antiseptic media. App. No. 10. On the Relation of Bacteria to Asiatic Cholera ; by Dr. Klein, 17. On account of their constant occurrence in the intestines of tients suffering from Asiatic cholera, on account of their absence in other diseases of the intestine, and on account of their peculiar mode growth in nourishing gelatine, Koch vindicates for these commaiilli not only an important diagnostic value, but also considers them the true cause of cholera. a t Since his return to Germany, Koch has convinced himself of the ctness of the observations of Nicati and Rietsch, who maintain cholera can be produced in dogs ami guinea-pigs by injecting tly into the small intestine of these animals the commabacilli taken either directly from the choleraic evacuations or from artificial cultivations. Our investigations enable us to say this :—: — 11. Koch's statement as to the almost constant occurrence of coraraa-3illi in the rice-water stools of cholera patients is correct; the commajilli vary greatly in numbers in different stools and in different cases, some being exceedingly scarce, in others numerous. 2. These commabacilli vary greatly in length, some" being twice and three times as long as others, some well curved, as much as to form half a circle, others showing only just a slight bend. The name commabacillus is inappropriate, as in reality they are vibrios. El. The commabacilli occur in the mucus-flakes of the rice-water >ls, as well as in those taken from the ileum of a person dead of lera. The sooner after death the examination is made, the fewer imabacilli are found in the mucus-flakes; in several typical rapidly fatal cases, the mucus -flakes taken from the ileum, and examined soon after death (from between 14 minutes and an hour or an hour and a half), contain the commabacilli only very sparingly indeed, and not to the exclusion of other bacteria. Our investigations do not bear out Kch's statement as to the lower part of the ileum being, in acute ical cases of cholera, almost " a pure cultivation of commabacilli." not one of the many post-mortem examinations of typical acute cases r e we found such a state. 4. The mucous membrane of the ileum of typical rapidly fatal cases, if examined soon after death, does not contain in any part any trace of a commabacillus or any other bacteria, not even in the superficial loosened epithelium. If the post-mortem examination is sufficiently delayed, commabacilli and other bacteria may be found penetrating into the spaces of the mucous membrane. The theory of Koch's as to the commabacilli present in the mucous membrane secreting a chemical poison inducing the disease cannot, therefore, be correct. 5. Neither the blood nor any other tissue contains commabacilli or any other micro-organisms of known character. 356 APP. No. 10, On the Relation of Bacteria to Asiatic Cholera ; by Dr. Klein. 6. The behaviour of the commabacilli in artificial media is not such as to justify their being considered as specific. They grow well in alkaline and neutral media, are not killed by weak acids, and their mode of growth in gelatine-mixture.*, however peculiar, is not more peculiar than that of other putrefactive bacteria ; they show marked differences when grown in different media, but not more so than the ordinary putrefactive bacteria when compared in their growth with one another. The manner in which the choleraic commabacilli grow in gelatine is identical with that shown by some forms of the commabacillus of the mouth of healthy persons (Lewis) ; in that same medium they show the same peculiar character of growth in gelatine as Koch's commabacilli. 7. Koch overlooked that "commabacilli" occur in other intestinal diseases, in the mouths of healthy persons, and, as shown recently, even in some common articles of food. 8. The experiments performed by Koch and others on animals do not in the least prove that the commabacilli are capable of producing cholera or any other disease. The results obtained by them are much easier explained in a manner opposed to that given by Koch and others. 9. There is direct evidence to show that the water contaminated with choleraic evacuations, and containing, of course, the commabacilli, when used for domestic purposes, including drinking, by a large number of persons did not produce cholera. 10. The mucus-flakes taken from the small intestine of a typical rapidly fatal case of cholera, contain numerous mucus-corpuscles filled with peculiar minute straight bacilli ; in this state they are found when the examination is made very soon after death ; soon, however, the mucus-corpuscles swell up and disintegrate, and then their bacilli become free. The small bacilli are never missed in the mucus-flakes. They are only one-third or one-fourth the length of the commabacilli, and only about half their thickness. They are non-mobile ; they grow well in Agar-Agar jelly, but show in their modes of growth no peculiarity by which they could be considered as specific. When grown on the free surface of the nourishing material they form spores. 11. These small bacilli are not present in the blood, in the mucous membrane of the intestine, or in any other tissue. 12. Experiments made with these small bacilli on animals produced no result. 13. Since my return to London, I have ascertained that the commabacilli of cholera show two distinct modes of division, one the known one of transverse division, and a second one of division in length. When growing in neutral Agar-Agar jelly at the ordinary temperature of the room, after some days the bacilli swell up, owing to the appearance in their protoplasm of one or more vacuoles ; as these vacuoles increase, so the commabacilli become gradually changed, first into plano-convex, then into oblong bi-convex, and ultimately into circular corpuscles. The longer the original commabacillus, the larger the final circle. These circular organisms are mobile, just as the commabacilli ; and, by disintegration of the protoplasm at two opposite points, two perfect more or less semicircular commabacilli are formed. Growing the commabacilli in Agar-Agar jelly kept at higher temperatures (30° to 40° 0.), they multiply by transverse division only; but, transferring these to neutral Agar-Agar jelly, and keeping this at the ordinary temperature of the room, they again gradually change into circular organisms, which, by division in the diameter of the circle, form two new commabacilli. Apr. No. 10. Supplement, by Dr. Klein"; April 1886. Since Koch first pointed out the occurrence of commabacilli in the () " tlie . R * la . tion , , * . „ - ot Bacteria, to discharges from, and in the contents of, the bowels of persons affected Asiatic Cholera wilh Asiatic cholera, and since he maintained (Berlin. Klin. Wochens. b .v Dr. Klein. No. 31, 1884) that neither he nor others with whom he consulted had ever seen any bacteria like them, however many fluids and substances contain- ( ;j{ li ' ing bacterial mixtures they examined ; a number of observations have been published to show that commabacilli do occur elsewhere than in " cholera asiatica." Tinkler and Prior were the first to point out that in stale stools of patients suffering from cholera nostras or sporadic (English) cholera, there occur commabacilli. I have in the above paper pointed out that also in ether intestinal disorders (dysentery, intestinal tuberculosis, diarrhoea), commabacilli occur. T. R. Lewis has drawn attention to the fact that in the normal fluid of the mouth commabacilli are to be met with which in morphological respects resemble those found in the bowels of cholera asiatica ; and Deneke found commabacilli in old cheese ; and T have pointed out that in the contents of the coecum of perfectly normal guinea-pigs there occur crowds of commabacilli, some differing from, others identical in morphological aspects with, those found in cholera asiatica. Koch and his supporters had therefore in view of these observations to modify their original view as to the sole occurrence of commabacilli in cholera asiatica. Their proposition was then put in this form : true commabacilli occur also in other conditions besides the Kstinal discharges or contents of the bowels of patients affected with Are some 1 "?" X * +Vi i * 111 1 * +1-,' la * i A' l'ff" peculiar to cholera asiatica, but the commabacilli in this last-named disease differ cholera? from all other commabacilli in their peculiar mode of growth in nutritive gelatine. As regards the commabacilli of Finkler and Prior, generally known I tinkler's commabacilli, there can be no question whatever that these er from Koch's commabacilli. They are in the first place larger, in the »nd place they grow conspicuously more rapidly in nutrient gelatine Species and on potato than Koch's. Two tubes. — each containing nutrient gel- la lta ' i — - _ _ o o atine (10 p. c. gelatine) of exactly the same composition, — one of them inoculated with Koch's, the other with Finkler's commabacillus, show in the course of two to three days, when growing at a temperature of 19-21° Centigrade, such well marked differences, that a distinction between the two is easily made. There can then be no doubt whatever that the two kinds "of commabacilli are two distinct species. Dr. Miller (Deutsche Med. Woch., No. 40, 1884) has pointed out that some of the commabacilli derived from the fluid of the mouth, or rather from a carious tooth, are in size and mode of growth identical with Finkler's commabacilli. Quite recently Kuisl (Aerztl. Intelligenzbl. 1885, Nos. 36 and 37) isolated from the contents of the ccecum of a person who had committed suicide, commabacilli which in all respects were identical with Finkler's commabacillus. From this it follows that Finkler's commabacillus is an organism which occurs in normal fluids of the animal body when they have become putrid. The commabacilli pointed out by T. R. Lewis in the normal fluid of the mouth are not the same as those described by Miller, for they certainly do not grow like them. In a large series of experiments which I have made, I have in two instances succeeded in cultivating Lewis' commabacilli, and I am quite clear that they are identical with Koch's both in morphological respects (i.e., as to shape, size, and aspect) and in their mode of growth in nutrient gelatine. Deneke's commabacillus, although identical with Koch's in morphological respects, shows f according to Deneke) in its mode of growth, slight 358 No. 10. differences from Koch's; but it seems to me that these differences arevery slight, so slight indeed that Deneke himself at first thought his commabacillus identical with Koch's. In his later publications he has, however, modified this view inasmuch as he states that his commabacillus grow a little faster than Koch's in nutrient gelatine. As to the experiments with these commabacilli on animals, see later on. Ec Relation c Cholera; The commabacilli which I have referred to as occurring in the normal contents of the coecum of guinea-pigs, are of very different varieties; some in size, in shape, in arrangement as S and as spirals are identical with Koch's ; others are much larger and are differently curved ; these latter are being described and figured by Mr. "Watson Cheyne (for the British Medical Journal). He says they occur in the contents of the ccecum of a guinea-pig dying in consequence of the injection into its intestine of choleraic commabacilli. As to these Mr. W. Cheyne maintains that "by careful cultivation he has convinced himself that they are identical with Koch's commabacilli." Mr. Watson Cheyne,, when making this statement, and in concluding that his guinea-pig had died of cholera, evidently was not aware that these organisms are found normally in the contents of the coecum of healthy guinea-pigs. Intestinal There can be no doubt about the almost constant occurrence of Koch's commabacilli in the intestinal contents of cholera patients, but as pointed out in the paper to which this is a supplement, their number is subject to very great variation ; in some cases the mucus-flakes of the contents of the ileum contain them numerously, in others very sparingly indeed. Now there can be no doubt that, so far as our knowledge goes, in no other intestinal disorder have Koch's commabacilli been yet discovered^ But at the same time it must be added that our knowledge of the bacteria occurring in the intestine in various intestinal disorders is far toolimited, nay, I may say, it is next to nought ; in point of fact, thorough and systematic observation, and by many different workers, has not yet been made of any other intestinal disorder besides asiatic cholera. Until this has been done we are entitled to regard exclusive occurrence of Koch's commabacilli in asiatic cholera as not yet established. conmiubacilli. But assuming that Koch's commabacilli are peculiar to the intestineof cholera, an important question arises, viz., whether these commabacilli which are present in cholera asiatica in the ileum only, — and more particularly in the mucus-flakes and fluid suspended in the cavity of the ileum, — occur there as the result of some antecedent condition specially favourable to the growth and multiplication of such bacilli ; or whether they are to be regarded as in any sense a cause of the disease. Koch, in his first paper, laid great stress on the occurrence of the commabacilli in acute typical cases within the tissue of the mucous membrane, particularly in and around the Peyer's glands. This observation has not however been verified, and any significance it may be supposed to have had may be set aside. All that remains to be discussed, therefore, is the question of the significance of the presence of Koch's commabacilli in the intestinal contents of cholera asiatica. As to this the following alternatives present themselves : either (a.) the commabacilli are, as maintained by Koch, the real cause of cholera, or (b.) their conspicuous presence in the contents of the intestine in cholera is but an incident of the peculiar state of the intestine. As regards the first alternative, neither the distribution of the organisms nor their very unequal occurrence in the dead matter contained in the intestinal cavity afford any presumption in its favour ; and against it we have the important consideration that no infectious disease is known in which the organism causing the disease is not present in the blood or in the affected tissues themselves. Such not being the case with the commabacilli in cholera, Significance oi Koch's bacilli in cholera. 359 App. No. 10, On the Relation of Bacteria to Asiatic Cholera - by Dr. Klein. as shown in the former paper, the other alternative, for our present argument, become 9 provisionally a far more reasonable assumption. Upon this assumption the commabacilli would be always present in the intestine of the healthy body ; but not finding here favourable conditions would remain extremely limited in numbers. Only when the alimentary canal undergoes those peculiar alterations cbaracteristic of cholera do the conditions for their multiplication become more favourable and then their number increases rapidly. Whether the commabacilli are normally present in the contents of the healthy human intestine, has not been proved or disproved ; in fact no systematic observations have been made on this subject. To prove the existence of Koch's commabacilli by cultivation (the only sure method if present in very small numbers), even in early eases of cholera, is not such an easy matter as is represented by some of the adherents of Koch. lam quite sure that there are cases of pronounced cholera where the demonstration of Koch's commabacilli by cultivation is extremely difficult, if not practically impossible, owing to their great scarcity and to the abundance of other bacteria. How much more difficult then would be their uniform demonstration in the healthy intestine if thay are normally present there only in very small numbers ? As bearing on sudden increase and consequent easy demonstration of commabacilli in the intestine of cholera, is the important influence (well known in bacteriological inquiries) that the nature and character of a nutritive medium exerts on the power of multiplication of certain species of bacteria. Thus, many and diverse microorganisms co-existing in a certain nutritive medium, and different species multiplying therein with different rapidity, various alterations in the nature of the medium will be effected by their life processes ; I some species perhaps adding matters to, while others perhaps subtract matters from, the medium, with the result that the nutritive qualities of the latter become so far modified that species which at first could not get sufficient nutriment from it to make any advance get in the end such abundance as to enable them to dominate all other dissimilar species that were associated with them. As illustrating the difficulty of discovering commabacilli in a living and normal intestine which nevertheless contains enough of them to set up, under artificially-made favourable conditions, myriad multiplication of these organisms, I cite a recent experiment of my own upon a monkey. A loop of the monkey's ileum near the ileoccecal valve was ligatured so as to completely isolate it from the rest of the gut. Of the mucous contents which the isolated loop contained, a few drops were withdrawn with a Pravaz syringe, and carefully examined for commabacilli, but none could be found. Then 5 C.C. of a saturated solution of magnesium sulphate were injected into that loop, the loop returned into the abdominal cavity, the wound stitched up, and one gramme of chloral hydrate injected under the skin of the groin of the monkey. The animal was killed 48 hours later, and the ligatured loop was found filled with fluid, containing numerous mucus-flakes, and in these flakes crowds of commabacilli were met with ; in fact in microscopic specimens prepared in the usual way, the number of commabacilli ascertained to be present after staining was greater than in similar specimens prepared from undoubtedly typical cases of cholera. This experiment proves conclusively that the condition artificially induced in the loop of the ileum had an important influence on the multiplication of the commabacilli, of which there must have been present some few examples previously, though too few to be demonstrable. 360 App. No, 10. A large number of experiments have been performed by Koch and On theßelntion other observers to prove that by injection of commabacilli into the intes- tines of animals other than man cholera can be produced. If this were of Bacteria to Asintic Cholera really the case, i.e., if by injection in this fashion of artificial cultivations Dr. Klein. of the choleraic commabacilli the disease " Asiatic cholera " could be produced in animals, then proof that the choleraic commabacilli are the vera causa of the disease would have been definitely furnished, and i the question practically set at rest. These experiments may be classed in two categories : — Exnerimen and their In the first, comprising experiments made on dogs, guinea-pigs, and fpsiehiiiir. rabbits, the abdominal cavity is opened, the duodenum is drawn out, and into its cavity commabacilli from an artificial cultivation are injected. The animals, at any rate some o£ them, die in one or two days, the bowels are found inflamed, in their interior are mucus-flakes and numerous commabacilli. These experiments, as is obvious from their nature, cannot possess a high value, since death of the experimental animals by septic infection is not excluded. That in the intestine of the animals which died the commabacilli that were injected should have greatly multiplied, cannot surprise us, since an inflamed intestine would be, so to speak, their natural breeding ground. Accordingly doubt must attach to all the experiments performed first by Nicati and llietsch, then by Koch, by Babes, by van Ermengem and others. A large number of these experiments were indeed repeated by myself and by my friend Mr. Gr. Dowdeswell, both on dogs and guinea-pigs, but under strictly antiseptic precautions, and under carbolic spray ; but in not one single instance did death occur, although several C.C. of fresh or old culture of Koch's comma- bacilli had been injected into the duodenum of each animal. The other category of experiments are those performed by Koch and by Finkler. Koch (Conferenz iiber Cholera, Berlin, 4 May 1885) states that if guinea-pigs are kept without food for 24 hours, and then 5 C.C. of a 5 p.c. solution of sodic carbonate are administered to them per os, the contents of their stomachs remain alkaline even three hours afterwards. Twenty minutes after the introduction of the solution of sodic carbonate each animal receives per os 10 C.C. of a culture of the choleraic commabacilli in broth, and immediately after, for each 200 grammes weight of the body, it receives into the peritoneal cavity 1 C.C of German tincture of opium. Most of the animals so treated die in Hto3 days, and after death both small and large intestines are found filled with, and distended by, a watery fluid in which occur great numbers of the commabacilli. Here then is a kind of choleraic appearance in animals receiving into their alimentary canal commabacilli. The introduction of the sadie carbonate preparatory to the introduction of the culture of commabacilli is necessary, according to Koch, in order to enable the commabacilli to reach the small intestine unscathed, the acid gastric juice having a fatal effect on them. But now we have to note a curious confession by Koch respecting these experiments, viz. : — that unless the animals receive the opium tincture into the peritoneal cavity, they remain perfectly well. In a series of animals which received first the sodic carbonate, then the commabacilli, but which were spared injection of tincture of opium into their peritoneal cavities, Koch found that all remained well ; and he ascertained, on examining microscopically and by culture the contents of the ileum of such animals 20 hours later, that there were present the same commabacilli as had been injected. This inability of commabacilli to provoke mischief in the absence of the peritoneal injection is regarded by Koch as due to the too rapid passage of the commabacilli through the small intestine, and to their not having, there- 361 App. No. 10. Ou the Relation of Bacteria to Asiatic Cholera; by Dr. Klein. i fore, sufficient time to multiply therein. But considering that Koch himself has shown that even after 20 hours they can be recovered from the small intestine in a living state, and considering too the extreme Ipidity with which commabacilli are capable of multiplying at the temrature of the body (a litre flask of broth inoculated with a trace of a oplet of a culture of commabacilli and kept at 35° C. becomes uniformly rbid with them in a night), this explanation of the failure of the mmabacilli to produce in the above guinea-pigs any bad effect is idently very unsatisfactory. [.Seemingly, in Koch's opinion, in order to allow the commabacilli on leir passage through the small intestine time to sufficiently multiply nd to produce their fatal effect, it is necessary to stop the movement of le small intestine, and thus he injects the tincture of opium into the >eritoneal cavity. The assumption on the part of Koch that the njection of tincture of opium into the peritoneal cavity relaxes le intestine and stops the peristaltic movement is a perfectly arbitrary ne ; the only experiments known as to the effect of the injection ; tincture of opium into the peritoneal cavity were made on dogs, nd here the effect was just the reverse from that assumed by Koch, viz., creased peristalsis.] Upon the whole there are ample grounds for suspecting that the method of opium administration adopted by Koch, and especially the quantity of the drug injected by him into the peritoneal cavity, had much to do with the fatal malady he induced in guinea-pigs. I myself repeated his experiments, modifying only the method of opium administration and the quantity of it introduced, with the result that in no instance did I produce a fatal effect oh the guinea-pigs operated upon. Thus, after dosing guinea-pigs with sodic carbonate, followed up by administration of choleraic commabacilli, I injected subcutaneously into each of them tincture of opium in sufficient quantity to keep the animal narcotized for several hours (or with similar object I injected into the peritoneal cavity watery solution of extract of opium instead of the German tincture) ; but, as I have said, without ill effect in any case. In all probability so long as the intestine of a guinea-pig remains normal, commabacilli will not multiply in it ; but should local damage be done or local irritation be set up in the gut or its neighbourhood, as by injection of tincture of opium in large quantity into the peritoneal cavity, or by iujection of saturated solution of sulphate of magnesia into an isolated loop of the ileum, abundant increase of the commabacilli, simultaneously introduced or normally present in the intestine, will quickly follow, with or without death of the animal from the injury done to it. In any case the conclusion that commabacilli per se can bring about the death of the animal experimented on, is not warranted; since Koch himself has shown that these organisms introduced in huge quantity* into guinea-pigs have no deleterious effect on those animals. If further illustration be wanted of the important influence of peritoneal injection of tincture of opium in producing death of animals dosed with quantities of commabacilli, it is forthcoming from some other and similar experiments of Koch and Finkler, made with totally different varieties of this micro-organism. Thus, Koch experimenting with Deneke's comma- * In order that the nature of these experiments of Koch may be duly appreciated, I append an estimate, based on these guinea-pig experiments, of the quantities that would be required in the case of man. Thus : after 24 hours fasting the human stomach would receive 1800 C.C. of nauseous fluids (solution of carbonate of soda and culture of comma-bacilli), followed \>y injection into the peritoneal cavity of 10 ounces of tincture of opium ! This is a method of " infection with cholera " very different from what occurs in the human subject under actual conditions of App. No. 10. bacillus of s( ale cheese, found Hi at administration of cultures of these On theßeiation micro-organisms to guinea-pigs, in sequence to a dosing with sodic car°f f Bacteria to bonate, and iust before injection of tincture of opium into the peritoneum, Asiatic Cholera whs followed by death of the animals so dealt with. And Finkler, who Dr. Klein. made a large number of similar experiments with the commabacillus which bears his name (Ergiinzungshefte zum Central bl. f. allg. Gesundheitspfl., I Band, Heft 5-6), records results which are identical in every respect with those obtained by Koch. it is true that Finkler concludes from his experiments that his commabacilli must be regarded as pathogenic for cholera nostras ; but since Finkler's commabacilli are present in fluids of the mouth (Miller) and in the contents of the intestine (Kuisl) it is clear that in all probability they have Experiments nothing whatever to do with cholera nostras. On the other hand fail to show causative since the results obtained under like methods of experimentation with Koch's and with Finkler's commabacilli, are identical in all respects, relation. both as regards the nature of the disease induced and the condition of the intestine found after death, the disease from which the guinea-pigs died after the introduction of Koch's commabacilli cannot well have been Asiatic cholera. And indeed we find that the symptoms under which Koch's animals died were not such as belong exclusively to cholera ; the presence of mucous fluid in their small and large intestine, the fall of their temperature two or three hours before death, the impairment also of their mobility a few hours before death, are symptoms commonly present in rodents dying of septic and septicaemic poisoning, and are by no means special to cholera. In many rodents dying from septic and septicsemic poisoning changes in the intestine and severe diarrhoea are very conspicuous symptoms. It is further necessary to remember in this connexion that certain, bacteria are known to have pathogenic properties on rodents, although these bacteria are derived from putrid secretions, — e.g., the micrococcus isolated by Pasteur and Steinberg from the fluid of the mouth, the bacillus isolated by Bienstock from normal human foecal matter, the micrococcus isolated by myself from pneumonic sputum, the bacterium isolated by Brieger from human foecal matter, the bacillus isolated by Escherich from the foecal matter of milk -fed infants, and the bacillus isolated by myself from the mesenteric glands of a child that died of infantile diarrhoea. In this connexion also it deserves mention that Yon Emmerich has described a species of bacterium (probably bacterium termo) which he found in the intestinal contents of patients dead of cholera asiatica; and more recently Buchner and Yon Emmerich found this bacterium also in the mucus of the bronchial tubes of patients dead of cholera asiatica. This bacterium Yon Emmerich and Buchner consider as the active cause of cholera ; it acts very poisonously when subcutaneously inoculated into guinea-pigs. But Brieger has shown that this is the same bacterium that was isolated by him from normal foecal matter. For myself I was first under the impression that this bacterium of Yon Emmerich, the so-called " Naples bacillus," is identical with the minute straight bacillus found by me in the mucus-flakes of the cholera intestine and described in the paper, but there can be no doubt that the two are totally different. Ptomaine theory. Finally, in reference to Koch's theory of a special chemical ferment, manufactured by commabacilli in the intestine of the cholera patient, acting as the direct cause of cholera sj-mptoms, certain experiments by Nicati and Rietsch, by van Ermengem and by Klebs require notice. They go to show that the commabacilli, when multiplying in culture media, produce a chemical substance akin to a ptomaine, which is 363 A PP. No. 10, On the Relation of Bacteria to Asiatic Cholera; by Dr. Klein. capable of producing infection and death when injected subcutaneously into certain animals. And further, these experiments of Nicati and Bietsch, and of van Ermengem (not to mention the Ferran inoculations), show that the result obtained by subcutaneous injection of the cultures depends on the quantity thus administered ; a fact compatible only with the assumption of a non-organized chemical poison. It is, however, erroneous to regard, as Klebs does, the production of a poisonous ptomaine as peculiar to cultures of commabacilli ; since Berdez, who carried on his investigations under my direction, has distinctly proved (British Medical Journal, 1885,) that in cultures of septic bacillus subtilis, a3 well as in cultures of Koch's and of Finkler's commabacilli, there is present a chemical poison, obtainable apart from the organism ; and that this chemical substance subcutaneously injected in large quantities has the same poisonous effect on animals as that attributed to •cultures of Koch's commabacilli. For Her Majesty's Stationery Office.