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decade the birth-rate was 33’ 46 and in the decade before thatit was 34’14. In 1903 it was 29-43, a still further diminutionbeing thus shown, for the average for the previous two yearswas 31’8. The fall in the birth-rate to some extent explainedthe decrease in the gross number of infant deaths, whichitem had formed a comparatively small portion of the

mortality bill for the past two years. In connexion with the

sanitary condition of the borough 1)r. Malet refers to somedefects and particularly directs attention to the necessityfor conversion of the pail system into a water-closet

svstem which should be done under the Provisional Orderbut which would be a heavy charge on the rates,as in most cases much of the cost would haveto be borne by the borough. There was, however, no

one thing that could be suggested in connexion with theimprovement of the public health which was of such im-portance as this change. There was another great needwhich, though it was perhaps second in importance to thatalready indicated, would in all probability have to come firstin order of time. This was an increased water-supply andthat problem must be faced at the earliest possible oppor-tunity. Not only would any great conversion of pail-closetsinto water-closets put too great a demand upon their

present water-supply but such conversion in the poorerdistricts would scarcely be possible unless the necessarywater could be supplied gratuitously. Not only so,but experience of the past three years, and especiallyof the last, showed unmistakeably what a lavish supplyof water for general cleansing and flushing purposescould do for the health of the town. The benefitof a free use of water was twofold: first, the generalcleansing effect-yard and court surfaces, roads, and drainswere all washed and thus decomposing matters were removedand air impurity lessened ; and, second, the preventionof dust. This was a matter of the greatest importance;dust, and especially the lighter dust, was mostly organicmatter and contained myriads of living germs, many ofthem germs of disease. The amount of filth that wasinhaled and swallowed in that form in dry weather wassimply inconceivable and anything that would diminish theevil made strongly for the public health. The milk-supplywas a matter which concerned the health of all large townsand especially, of course, the health of children. Unfortu-nately at present any efficient control was impossible, for

they had no jurisdiction outside their own boundaries, andmost of the milk-supply came from outside, some of it fromvery far outside.

Health of If-ar7vie7es7tire: Decrease in the Birth-rate.In his report on the health of the county of Warwick for

the year 1903 Professor A. Bostock Hill, the county medicalofficer of health, calls particular attention to the diminutionin the birth-rate. ’’The human element," he says, "is themain factor of power and no increase of wealth can com-pensate a nation for the loss of virile citizens, on whom theultimate safety of the country must depend." He viewswith serious apprehension the constant decline in the birth-rate throughout the country and calls public attention to thefact that if the production of healthy children is to bechecked, as it has been of late years, we must expect aprogressive moral and physical deterioration. As comparedwith 1902 the number of births during the year had de-creased by 79, which brought the birth-rate below the

average for England and Wales. Two rural districts showeda higher rate than is recorded in any of the urban districts.The lowest birth-rate was in Coventry but nowhere

perhaps had the decrease in the birth-rate been more

marked than in the borough of Aston, where it had fallenfrom 44 per 1000 in 1874 to 28 - 7 per 1000 in 1903. Mr. F. H.May, the medical officer of health of the borough of Aston,attributes this highly unsatisfactory state of affairs to the" lessened number of marriages and the effect of educationin fostering an inclination in many to restrict their families,a desire attributable in some to mere selfishness and inothers to the fear that in the keen competition of life theywill not be able to maintain and bring up a large family tothe standard they would wish."

Homefor Epileptics-Aston Board of Guardians.This board has recently considered the report of its

representatives at the conference between the threeBirmingham boards on the subject of the care of sane

epileptics and feeble-minded persons. The figures, so saidthe chairman, Mr. W. Brown, as furnished were not a verytrustworthy guide as to the cost of such an operation as

was under discussion. From estimates, however, which hadbeen got out by the clerk it worked out that Aston wouldhave to spend on the care of these classes of inmates some-

thing like Z600 or Z700 per annum more than they werenow doing. The conference was of opinion that it wasdesirable for the three boards to combine for the purposeof providing and maintaining a home for the reception of theclasses of cases mentioned above and that, in the firstinstance the accommodation provided should be for 200inmates: 110 by the Birmingham Hoard, 40 by the King’sNorton Board, and 50 by the Aston Board. A motion thatthe Aston Board should join with the others named abovewas eventually put to the meeting and unanimouslycarried.

I Sept. 8th, 1904.

LIVERPOOL.

(FROM OUR OWN CORRESPONDENT.)

Ifealtlt of Liverpool : Decrease of the Death-rate.AT the weekly meeting of the health committee of the

city council held on Sept. 1st it was reported that the death-rate was 29’ 4 per 1000, as against 37 - 7 per 1000 a fortnightago and 20’ 8 per 1000 for the corresponding period of lastyear. There had been 177 deaths of children under twelvemonths old. Deaths from diarrhoea numbered 180, as against259 in the previous week. There were 276 cases of scarletfever in the city hospitals. The health committee hasauthorised the medical officer of health to have circularsprinted for distribution by the Charity Organisation Societyin reference to the care of children.

Public Health Congress Report of the Liverpool Delegates.The report of the delegates from the Liveipool city council

who attended the annual congress of the Royal Instituteof Public Health at Folkestone in July has just beenissued. Mr. A. Shelmerdine read a paper on the Distribu-tion and Sale of Humanised and Sterilised Milk. He gavean account of the municipal milk depot in Liverpool andits administration and the details of preparing and dis-

tributing the milk. As regarded the results, he said that,without attempting to draw too close deductions, the factstood out that of the 4453 infants coming very pro-miscuously to the depots at varied ages and in conditionsof health below the average the mortality was 78 per 1000,as against 159 per 1000 for the whole city. But it must beremembered that in that 159 per 1000 for the whole city, and88 to 118 for the best districts, and 212 to 215 for the worstdistricts, were included also breast-fed infants. Clearly, ifbreast-fed infants were excluded and artificially-fed infantsonly taken into account the rate of mortality amongst themwould be enormously higher and would show even moreforcibly the advantages of the sterilised food, which ofcourse is an artificial food, over other methods of artificial

feeding. On the point of the general milk-supply the senseof the section was in favour of compulsory inspection organ-ised by a superior authority which could not be influencedby local interests. Infantile mortality was a subjectwhich received close attention. The delegates declaredthat broad facts stood out that artificially fed infants intimes of drought and heat suffered enormously, whilstbreast-fed infants, although by no means escaping altogether,yet did escape to a very great extent. It was manifest fromthe discussion that local conditions varied very considerably,that the incidence of mortality varied, and that the period atwhich an outbreak reached its maximum in one town differedwidely from that in another town. The housing problem,the need for isolation hospitals, and hospitals for consump-tives also engaged the consideration of the meeting, and inregard to the latter subject the deputation pointed to theremarkable decline in the amount of tuberculous disease inLiverpool in comparatively recent years as evidence of theinfluence exerted by general sanitation on this form ofillness.

The Liverpool School of Tropical Medieine and TropicalDisease Research in West -Africa: : Honour for

llTccjor Ronald Ross, C.B.The chairman of the Liverpool School of Tropical Medicine

(Sir Alfred Jones, K.C.M.G.) is sending Dr. Christy, who hasjust returned from the Congo sleeping sickness expedition ofthe school, to Anno Bon in order to continue further to

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rationsextend observations upon trypanosomiasis. Anno Bon is a irsmall and very little known island and affords a very pexcellent opportunity for conducting scientific investiga- ytions not only in problems of disease but also in anthro- r(

pology and natural history. Major Ronald Ross, C.B., L

F.R.S., late I.M.S., the professor of tropical medicine at inthe University of Liverpool and director of the Liverpool gSchool of Tropical Medicine, has been elected foreign o

corresponding member of the Paris Academy of Medicine. ’

Dr. A. S. Grünbaum’s Appointment at Leeds University.Dr. Albert S. Grunbaum, lecturer on experimental medicine

at the University of Liverpool and director of the Liverpool I

Cancer Research, is to be congratulated upon his recent dappointment as professor of pathology at the University of ,Leeds. A graduate in arts and medicine of the Universityof Cambridge, he has been trained in London, Bonn, Vienna, iand Berlin ; he has therefore had the advantages of a wideeducation. For several years past he has devoted himself 1to scientific research, more especially in connexion with .

experimental medicine. It has been in this pursuitthat he has gained for himself universal distinction inconnexion with the application of the serum reaction to (the diagnosis of typhoid fever. He has worked hard at ithe Thompson-Yates laboratories at the University of 1

Liverpool and for several years he acted as treasurer ofthe laboratories and has initiated a most efficient and economical system of laboratory finance. The chemical study of the actions of pathogenic organisms has especiallyoccupied him. Some of the work coming from the Liverpool laboratory to which his name has not been formally attachednevertheless owes its initiation and fulfilment to him. Dr.Grunbaum has the advantage of being a good linguist andwidely read in the literature of his subject. He wasGoulstonian lecturer for 1903 at the Royal College ofPhysicians of London and amongst other distinctions he heldthe Grocers’ Company Research scholarship and the ErnestHart Scholarship of the British Medical Association. Hetakes up his appointment at Leeds with the best wishes ofhis numerous Liverpool friends.

Waterloo District Conncil and Sterilised Humanised Milk:Infantile 31orta7ity.

The chairman of the health committee of the districtcouncil reported that he had had an interview with Dr.E. W. Hope (the medical officer of health of Liverpool) withreference to a supply of sterilised humanised milk fordistribution in the district. The health committee thereuponinstructed the inspector of nuisances to arrange for a supplyof the milk for the district forthwith and to notify themedical practitioners of the district accordingly. The

large infantile mortality in the district has been mostly dueto diarrhoea, as in Liverpool.Sept.6th.

________________

WALES AND WESTERN COUNTIES NOTES.

(FROM OUR OWN CORRESPONDENTS.)

New Isolation Hospital for Pontypridd.AN isolation hospital which has been erected by the

Pontypridd urban district council was formally openedon August 25th by Sir Alfred Thomas, M.P. The site,which consists of two acres, cost .E500 and is situatedin an elevated position about four miles from the town.The buildings include an administrative block, two one-

storey pavilions each with two wards, and one block fora mortuary, laundry, and disinfector. There is a totalaccommodation for 20 patients. The cost of the insti-tution is about £9000. The need for a steam disin-fector is emphasised in the last report of the medicalofficer of health (Mr. Howard Davies) when he statesthat during an epidemic of small-pox in 1903 compen-sation for infected clothing destroyed was paid to theamount of .Ell1, most of which sum would have been saved.had a steam disinfect or been in use. In 1902 there were 383cases of scarlet fever, with 13 deaths, in Pontypridd and in1903 there were 358 cases with nine deaths. The town hasa population of 33,000 persons.

Cardiff Infirmary.In the printed report of the Cardiff Infirmary which has

just been issued there is contained for the first time intabular form an account of the cases admitted for treatment

nto the wards of the infirmary and of the operationsperformed. The tables refer only to the latter half of theear 1903 but if the compilation is continued in future

eports, as it doubtless will be, a valuable record will result.)uring the period named there were admitted into thenfirmary 978 patients, of whom 127 were treated in the

gynecological ward and 183 in the eye ward. Of the 528operations undertaken 86 are placed under the heading, gynaecological" and 138 were operations upon the eye.

Inaportation of Frozen Meat to Cardiff.An increasing quantity of frozen meat is reaching Cardiff.

During the second quarter of this year six cargoes werelelivered, all from the River Plate, and included the equiva-ent of over 40,000 carcasses of mutton and nearly 4000 ofbeef. These imports are all inspected on arrival and thenspector of nuisances of the sanitary authority withinwhose area they are consigned is notified so that the meat:s kept as far as possible under supervision until the time ofsale.

Death of Dr. Edward Crossman.The announcement of the sudden death of Dr. ’Edward

Crossman on Sept. lst was received by the medical pro-fession in Bristol with feelings of sincere regret. He wasborn in the year 1832 and was a student at the London

Hospital in the "fifties," acting as house surgeon after

qualifying as M.R.C.S. Eng. and L.S.A. in 1855. Later heobtained the licence of the Royal College of Physicians ofLondon and graduated as M.D. Durh. More than 20 yearsago he was appointed medical officer of health to the BartonRegis rural sanitary authority and at the time of his deathheld the same position under the rural district council. Hetook a keen interest in his sanitary work and many importantsanitary improvements in the district were due to his initia-tive. Dr. Crossman was on the staff of the FrenchayGeneral Dispensary and of the Hambrook Village Hospital.He was a past president of the Bath and Bristol branch ofthe British Medical Association.

Trials of Small Motor-cars.The trials of small motor-cars which took place in

Herefordshire last week cannot fail to be of interest tomedical practitioners. There were 35 cars submitted totrial divided into four classes with a maximum price of£125, £150, £175, and £200 respectively. Two journeys of50 miles each were made daily by every car so thatin the six days 600 miles were completed. The resultof the trials has shown that there are on the market

trustworthy cars at a low price. Four cars made all the12 runs without stopping and in very many instanceswhere a stop had to be made it was for a trivial and

easily remediable cause. One of the cars in the £125 classdid very well and at the end of the week was in excellentcondition. In the third and fourth classes as many as15 cars have been recommended by the judges for non-stopawards. The main roads in Herefordshire are of an averagecondition and there are a few stiff hills, all of which withone exception were easily taken by all the cars. In spite ofthe large number of motor cars of all sizes which were in thecity of Hereford and the surrounding district during theweek it is gratifying to learn that only two slight accidentsoccurred.

Death of Dr. George Strong.Dr. George Strong, who died at Bath on August 29th, was

in his 93rd year. He was the son of the late Rev. Robert

Strong of Brampton Abbotts, Herefordshire, and was a

descendant of Sir Francis Drake. He took the degree of M.D.at the University of Edinburgh in 1835 and in the same yearwas admitted L.R.C.S. Edin. For many years he resided inhis native county near Ross. He had a very high reputationas an antiquarian and was the author of a work on ’’ TheHeraldry of Herefordshire." He was a deputy-lieutenantand the oldest justice of the peace in the county, havingbeen placed on the commission in the year 1844. His wifedied in 1892 and he is survived by two daughters.

*

Sewage of Axminster .At a meeting of the Axminster (Devon) rural district

council held on August 25th a communication was read from,

the Devon county council inclosing an order under the RiversPollution Act to prevent the sewage of Axminster fromflowing into the river Axe and stating that if no steps were

s taken in the matter within two months legal action would1 ensne.

t Sept.5th.