915THE INFECTIOUS DISEASES PREVENTION BILL.

divergencies of political opinion that may temporarilyinterfere with the amity of nations. For science will endure when all these conflicts have been long forgotten, and the fruits of such international intercourse will be

reaped by future generations when wars and their causes I,have become mere matters of history. We believe, then, that the forthcoming Congress at Berlin will prove of greatadvantage to the cause of peace; that it will be a signalsuccess from a scientific standpoint we have no doubt ; whilst the fact that it will be presided over by a man whois so completely filled with the true spirit of science will go farto render it not the least memorable gathering of its kind.

4.

THOSE who are interested in questions concerning thepublic health cannot complain that members of Parliamenthave been backward in claiming consideration for the law swhich deal with this subject. The promise which theQueen’s Speech contained, that the Housing of the WorkingClasses Acts and the Metropolitan Public Health Actsshould be consolidated and amended has not as yet been

fulfilled, but there is no apparent reason why this workshould not be completed before the end of the session.In the meantime, however, Parliament has been engaged

in the consideration of Mr. LEES KNOWLES’s useful measure,the Infectious Diseases Prevention Bill. Mr. KNOWLES

has collected in one Bill a variety of provisions not embodiedin the general statistics, but obtained by different localauthorities who have felt the need for further powers than

those given them by the Public Health Act of 1875. Mr.

KNOwLES’s Bill makes these powers available in everyurban and rural sanitary district after their adoption by the ’’,local authority. London he deals with differently, and,following the precedent of the Infectious Disease Notifica-tion Act, he makes his own measure apply to the metropoliswithin two months after it has become law.

The most useful powers which it enables local authorities

to obtain are those for the limitations of injury due to thedistribution of an infected milk-supply. Every dairyman i,

supplying milk within a district may be required to furnishto the local authority a complete list of his customers

within the district on payment of a small sum, when themedical officer of health suspects that the outbreak or

spread of infectious disease is due to the milk-supply. This

is a provision to which, we understand, dairymen have taken exception, on the ground that the inquiry which amedical ofiicer of health makes when milk is under sus-

picion is itself injurious to the business of the dairyman. IAn objection such as this has, however, little weightat the present time, for the notification of infectious

diseases gives the medical officer of health the informationwhich he formerly sought by house-to-house inquiry. The

medical officer of health, having obtained the knowledgethat the milk is injurious, is able to inspect the farm andcattle, and his authority may prohibit the sale of the

milk within the district in which they are situated.If these powers are promptly acted upon, the frequencywith which milk epidemics attain considerable proportionsought to be limited. There is in the Bill as it now stands

a limitation which we do not doubt is the result of inten-

tion, but the wisdom of which appears to us to be a little ques-tionable. The local authority can only prohibit the sale of

! milk under this Act when the incriminated dairy is situatedbeyond the limits of the district; for the prohibition of milk

supplied from dairies within the district the provisions ofthe Contagious Diseases (Animals) Act are apparently tobe relied upon. If we are right in our surmise, we fear thelatter will befound to be inadequate; and we trust, therefore,this point will be carefully considered by the promoters ofthe Bill before it passes into law. An amendment whichhas been proposed by Mr. H. L. LAWSON will com-

mend itself to those who dwell in the metropolis. Mr.

LAWSON’S object is to exclude from the county of Londonany milk-supply which is found to be producing injurious

results in any one district, and his amendment therefore con-fers this power upon the County Council, who will further, inexceptional cases, be able themselves to inquire into out-breaks of disease spread by milk. We presume the Councilwould only undertake this latter duty when the area of thedistribution of the milk rendered it necessary that the

inquiry should be conducted with a body having juris.diction over the county.A further provision in the Bill gives to local authorities

the opportunity of obtaining for their medical officers ofhealth the same facilities for inquiry into diseases spreadby laundries as in that spread by milk. Infectious disease

is undoubtedly occasionally distributed in this manner, and:

the power, although less important than that relating to.

milk, is one which may exceptionally be found to be useful.Another clause gives the local authority itself power to

undertake the disinfection of infected houses and infected’

articles, and to remove the latter for this purpose; while,

another renders illegal the removal of infectious corpsesfrom hospitals to private houses when this cannot be done

’ with safety ; a third gives facilities for the compulsoryremoval to a mortuary of infectious corpses retained in rooms

’

occupied by other persons; and a fourth prohibits altogetherthe use of public conveyances other than hearses for the

’ removal of infectious corpses. These clauses contain useful

powers, but they will have to be exercised with consider-able care and judgment. Medical officers of health are

being increasingly trusted by the Legislature and by the!

public, and before all things they will need discretion inthe performance of these new duties which it is proposed toimpose upon them.

Annotations.

EPIDEMIC INFLUENZA AND THE DEATH-RATE.

" Ne quid nimis.’

THE Registrar-General’s weekly returns for the first

quarter of this year showed a remarkable general in-crease in the rate of mortality in our largest towns, forwhich the meteorological conditions of the quarter do notappear to supply a satisfactory explanation. Speaking

generally, temperature is the mainly controlling influenceof the death-rate in the first or winter quarter of the year;but the mean temperature of the first three months of thisyear was unusually high, and considerably exceeded theaverage in each of those months. Notwithstanding themildness of the winter, the mean annual death-rate in thetwenty-eight large English towns dealt with in the Regis-trar-General’s weekly return was 24’7 per 1000, against22 0, 22’1, and 209 in the preceding three corresponding

916

quarters; indeed, the death-rate in these towns exceeded that which prevailed in the first quarter of any year since i

1882, when the rate was equally high. Since 1882, however, ithe English death-rate has shown a marked and persistent (

decline, especially in the largest towns, so that the rate (recorded last quarter (24’7) points more strongly to some exceptional influence than did the same rate in 1882. For 1

instance, the rate from the principal zymotic diseases in the afirst quarter of 1882 was 3’76 per 1000, whereas in the cor- (responding period of this year it did not exceed 2’04. i

Excluding, therefore, the rate from these diseases, the rate ]from all other causes was 22-7 last quarter, against 20’9 in the same three months of 1882. Whether or not it was the ]influenza epidemic that exercised the maleficent influence i

upon the death-rate of our largest towns last quarter, it isnot without interest to note the varying proportions of the increase in the recorded death-rate in the several towns. :

Compared with the recorded rate in the first quarter of 1889, which was exceptionally low, the mean rate in ]

the twenty-eight towns last quarter showed an increaseequal to 18 per cent. ; in London the increase was21 per cent. ; whereas the mean rate of increase in the

twenty-seven provincial towns did not exceed 16 per cent.In three of these towns the death-rate last quarter showedan actual decline from the rate in the first quarter of 1889;the decrease being 5 per cent. in Birkenhead, 9 per cent. inCardiff, and 12 per cent. in Blackburn. The decline in

Blackburn, it should be pointed out, was from 32’3 to 28-5,and was more than explained by a marked fall in the

zymotic death-rate. In each of the twenty-three other pro-vincial towns under notice the death-rate last quartershowed an increase. The increase was, however, less than10 per cent. in Oldham, Nottingham, Salford, Preston,Huddersfield, Norwich, Leicester, and Liverpool; it wasbetween 10 and 20 per cent. in Derby, Sunderland, New-castle-on-Tyne, Plymouth, and Manchester; and between20 and 30 per cent. in Birmingham, Halifax, Sheffield,Portsmouth, Bolton, Wolverhampton, and Leeds. The

highest proportional increases were 30 per cent. in

Brighton, 32 per cent. in Bradford, 33 per cent. in Bristol,and 37 per cent. in Hull. It will be impossible to ascertainwhether the above-noted ratios of increase bear any constantrelation to the varying intensity of the recent influenza

epidemic in the several towns until the causes of death inthe current year have been classified and carefully analysed.It is obvious, however, that if the general death-rate inEngland and Wales in the first quarter of this year showsan increase similar in proportion to that recorded in ourlargest towns, it must have been considerably higher thanin the corresponding period of any year since 1886, whenexceptionally wintry weather prevailed.

GERMAN CONGRESS OF MEDICINE.

THE annual meeting of the "Congress fur innere Medicin" took place this year at Vienna, on April 15th and followingdays, and it has been resolved that the Congress shouldmeet every alternate year at Wiesbaden, the meetings takingplace in other years at Berlin, Leipsic, Munich, and Vienna inturn. The president on this occasion was Professor Nothnagel,who, in his opening address, spoke of the former leaders ofthe Vienna school-van Swieten, de Haen, Stoll, Peter

Frank, von Hildebrandt, and, "later, the energetic,thorough scientist Skoda, the medical artist Oppolzer, the gifted pathfinder Turck, until we come to him whose loss weall still deplore-the cultured, clear-thinking Bamberger."It must, he said, be a good soil which could produce such aseries of eminent clinical observers. Attractive as is the

subject of the development of medical knowledge and itsprogress, he was compelled to limit his remarks to thepresent position of medicine and its relations to science.

To notably prolong human life is and always will be an

impossibility, since the duration of the individual life is aninherited quality peculiar to each organism, which mustcease to act after a certain time. If we exclude the intro-duction of hygienic measures, and the protection from cer.tain diseases, medicine really did but little for the main-tenance of health for generations. But in these latter days,and save for a few exceptions gained by simple and faithfulobservation of nature, the advances in prophylaxis haveall occurred from a more exact application of pathologicalknowledge. As to treatment, that of old time was basedon imperfect knowledge and the observation of external

phenomena alone, without reference to the nature ofmorbid processes. In spite of the increasing knowledgeof anatomy, therapeutics at the commencement of this

century had not emerged from the old Hippocratic ways,and this is not surprising since no advance had been madein the knowledge of the nature of disease. Indeed, somemethods, now recognised as of value, were stumbled on bypersons without medical training, whilst many "systems" were advocated without having scientific basis. New pathshad to be opened up; medical study had to cease to bemerely descriptive and to follow the methods of scientificinquiry if it were to emerge from its stagnation in regard totherapeutics. When physiological and pathological anatomyarose, when chemistry and physics, experimentation andpathological histology, obtained firm footing, then treat-ment became scientific. It may be that in the pursuit ofclinical research the main object of our art has beensometimes lost sight of ; but there need be no fear thatclinical medicine will not adapt itself to new discoveriesor be divorced from pharmacology. For a thousand yearsmedicine sought to deal with external signs alone, un-trammelled by scientific knowledge; then it wished toconfine nature within "systems" which had been deduc-tively established. There was no advance by either path;men desired to treat without knowing, to influence andcontrol Nature without penetrating her secrets. But sincemedicine has entered on the path of induction it has beenable to record striking practical results. The way ofmedicine reaches the "possible

"

only through the "known."The Minister of Instruction, Dr. von Gautsch, greeted theCongress in the name of the Government, and BurgomasterDr. Prix welcomed it on behalf of the city of Vienna. Pro-fessor Billroth spoke for the Society of Physicians ; andafter the formal business of electing associates and con-stituting the bureaus, the subject of the Treatment of

Empyema was introduced by Professor Immermann of Basleand Dr. Schede, the debate being shared in by Drs.Fraentzel, Curschmann, Hofmokl, and Leyden. At the

banquet on the following evening the toasts included " TheHealth of his Majesty the Emperor Francis Joseph," pro.posed by the chairman, Professor Nothnagel; Professor

Leyden gave "Prosperity to Vienna"; Professor Cantanitoasted the Congress; and Professor Mosler the Vienna

Faculty of Medicine, in a speech full of memories of hisstudent days in Vienna and the leaders of medicine thenreigning in the University-Rokitansky, Skoda, Oppolzer,and Hebra. On the evening of the 17th inst. ProfessorNothnagel gave a reception to the members of the Congress.

THE SALE OF POISONS.

A VERY curious anomaly has been noted by Dr. Stevenson,in his official report as the Government visitor on thePharmaceutical Society’s examinations in London. After

referring to the number of rejections at the preliminaryexamination, which render it evident that many imperfectlyeducated candidates present themselves, he reports uponthe large number rejected at the minor examinations

through failing in chemistry, pharmacy, and dispensing.-