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THE SEVENTEENTH INTERNATIONALCONGRESS OF MEDICINE (1913).

SECTION ON HISTORY OF MEDICINE.

THIS section will meet in the library of the Royal Collegeof Physicians of London, Pall Mall, S.W., under the presidencyof Dr. Norman Moore. Each session will be fully occupied withthe reading and discussion of independent papers, of whicha final complete list will shortly be published. In spite ofthe fact that this is the first International Congress ofMedicine at which a section has been specially devoted tothis subject, and in spite of the late date at which it wasdetermined to organise it, the profession has testified

abundantly to the interest established in the subject by thevery large number of contributions that have been promisedfrom all parts of the British empire, the continent, America,and elsewhere. During the session of the Congress therewill be exhibits of early medical books, manuscripts, andother objects of medical interest in the Royal College ofPhysicians.The section has also, in conjunction with Mr. H. S.

Wellcome, organised an important Historical MedicalMuseum, which was opened on June 24th and will remainopen for some three months.l This museum has beenaccommodated in extensive buildings to the east of

Welbeck-street, and will be entered from Wigmore-street.It is by far the most important collection of objects illus-trating the historical aspects of medicine that has ever beenbrought together in any country. A serious effort has beenmade to illustrate every branch of medical and pharma-ceutical science and to arrange the material so as to displaythe evolution of these sciences. A full catalogue is in courseof preparation.The authorities of the British Museum have also kindly

made arrangements for an exhibition of early medical booksand coins and medals of medical interest in the King’sLibrary of the British Museum from August 6th to 12th.

SUBSECTION ON ANESTHESIA, GENERAL AND LOCAL.The president of this section is Dr. Dudley Buxton, and

the meetings will be held in one of the rooms of the ImperialCollege.There are five discussions, of which the first is on Recent

Methods for Producing Analgesia and the second on RecentMethods for Producing General Ansesthesia, both of whichshould prove interesting, as a good deal of new work hasbeen done lately, especially in America.Another interesting topic is that on the Post-operative

Effects and Toxasmias Associated with Anaesthetics, to beintroduced by Dr. William Hunter. A large number offoreign visitors have notified their wish to take part in thesediscussions, and it is hoped that the British anaesthetistswho have not sent in their names up to the present timewill notify the honorary secretary, Dr. Herbert Scharlieb,C.M.G., 49, Wimpole-street, W., of their wish to speak.A number of papers have also been promised for the

afternoon sessions.The ladies’ committee of the subsection, in conjunction

with the ladies of the section of surgery and the subsectionof orthopaedics, has invited visitors to a garden party onAugust 8th. The president and council of the subsectionwill give a lunch on Sunday, August 10th, in the groundsof the Zoological Society by kind permission of the Fellowsof that society. Application for tickets should be sent tothe honorary secretary.

SECTION OF MEDICINE.

The dinner of the Section of Medicine will he held at theConnaught Rooms, Great Queen-street, Kingsway, W.C., onFriday, August 8th. at 7.15 P.M. precisely.

Tickets, price 25s. (including wine and cigars), may beobtained from Mr. George Bethell, 11, Chandos-street,Cavendish-square, W., up to August 5th, and after that dateat the Central Bureau, Albert Hall. Applications for ticketsmust be accompanied by cheque or money order, payable toMr. George Bethell. Members of Congress are requested toapply early for their tickets so that suitable seating arrange-ments may be made.

1 THE LANCET, July 5th, 1913, p. 34.

Public Health.ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH.

City of Westniinster. -The wide scope of the sanitary workcarried out in this portion of London, with its great varietyof population is, as usual, well illustrated by Dr. F. J.Allan’s last annual report. As with most reports which arenow being issued, much prominence is given to the actiontaken to deal with tuberculosis cases since notificationbecame general and the nature of the new arrangementswhich will be necessary in connexion with sanatoriumbenefit. In Westminster systematic inquiries have beenmade regarding notified cases and their families by a special"phthisis visitor," but it has been impossible to keep touchwith, or to obtain information about, a large class of con-sumptives who are I I casual " or homeless, while a numberof persons notified from private addresses are found to bein lodgings for a short time only. One source of homeless.persons in Westminster-the seats and corners of theThames Embankment-has been to a large extent removedby the Local Government Board scheme for issuing lodging-house tickets. At the end of October a central officewas opened by the Metropolitan Asylums Board atWaterloo Bridge, where tickets distributed by the police arepresented. Every man and woman who receives a ticket isassured of food and shelter, while opportunity is afforded,through charitable agencies cooperating in the work, of

helping any case that seems at all likely to respond to-remedial treatment. Under the auspices of the Health,

Society a scheme was inaugurated in January, 1912, to pro-vide for the periodic medical inspection of children in theSoho portion of the district. A special feature of this schemeis that while the occasion of visiting the families concernedor bringing the child to the inspecting centre is the noti-fication of a birth, the system aims at keeping the childrenunder observation and medical advice right up to the age oftheir entering school, when their medical records are trans-ferred to the school medical officers. In this way manyphysical defects-especially dental caries, adenoids, andrickets-are discovered at a much earlier stage than wouldotherwise be the case, with corresponding advantageto the child and saving to the education authority.Dr. Allan goes so far as to say, in fact, that the

problem of the defective school child in most instancesresolves itself into the problem of the under-school-agechild, and he considers it hardly likely to be solved by anyscheme short of a national one ensuring to all children

regular medical supervision from birth to school age. The

inspection centre is staffed by a medical officer and a trainednurse, assisted by members of the society. A second centreis now to be opened in Roehampton-street to serve thePimlico and St. John’s districts. Several new artesian wells.have been sunk in Westminster during the past year. If it is

proposed to continue driving these wells on any considerablescale the fall which has in the past occurred in the under-ground water levels of London should be remembered. Thethree artesian wells ,near the National Gallery, which nowcan only supply one of the Trafalgar-square fountains,formerly also served most of the public buildings in Whitehall,as well as Millbank Prison and the Houses of Parliament.Dr. Allan refers to the increasing tendency in Westminsterto form deep basements and sub-basements, and theutilisation of such places for workrooms and restaurants.Frequently these basements are below the level of the sewers,and they have to be drained by special ejector systems.Unless the pumping is automatic in its action nuisancearises from the sewage being lifted in bulk into the sewer, andcausing escape of effluvium from the ventilating grids in theroadway. The ventilation of these underground places is atbest difficult to contrive, and sometimes is very faulty ; inmore than one instance the inlet for fresh air was in con-

tiguity with the outlet ; in one case the outlet from theshaft from the lavatories was being placed immediately belowthe intake for the grill-room ; in others the source of the airwas a central well into which kitchens, lavatories, or otherrooms were sending a varied selection of smells. Dr. Allan

points out that the difficulties in securing proper ventilationand temperature in these places are increased by the firerequirements of the county council, and urges cooperation

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between the fire-preventing and sanitary authorities to avoid’ conflicting official directions being given. Referring to the de-vision of the High Court in the recent appeal case of Spiers andPond, Limited, v. Green, Dr. Allan states that it will removemany small milk vendors who keep general shops from thesupervision of the sanitary authorities, and suggests thatthis position should be reversed by amendment of the Milkand Dairies Bill.

Borozctgt of Deptford.-Dr. W. H. Whitehouse reports thatvery unsatisfactory conditions have been found from inspec-tion of houses let in lodgings in this metropolitan borough.For years only about 10 per cent. of sublet houses have beenregistered, while the by-laws regulating them need amendingand strengthening. It is still common for tenement housesto have only a single water-tap in the scullery on the groundfloor for the use of the various families, with the result thathabits of uncleanliness are produced and contamination ofthe water used for drinking and cooking becomes common.All waste water and slops have to be taken to the basementin the same way, while these upstairs lodgers have no properplaces in which to store food or any conveniences for washing.Many other indications can be found in the report ofthe unhealthy conditions which obtain in the poor-classproperties which are a conspicuous feature of this part ofLondon. Tuberculosis, among other diseases, is speciallylikely to be propagated under such conditions, and theirremedy must go hand in hand with the clinical work of thetuberculosis dispensary if the good results which the report. anticipates from a borough tuberculosis dispensary are to beobtained. Dr. Whitehouse has some strong observations tomake on the evils of alcohol in general and medicatedwines" in particular, but it is not clear that the opinionswhich he expresses on the latter point are the result of anyspecial investigation of the subject in Deptford. To preventcancer a large number of "hints " are given, which includethe avoidance of excessively hot food and drink, ices andiced drinks, the thorough mastication of all food, abstinencefrom alcohol, and ceasing to inhale cigarette smoke. Thefinal direction is to avoid injuries to the bones, joints, andbreasts." " I I Hints of this nature are sometimes useful, butare difficult to give without imperilling the sense of

proportion which is one of the chief assets of a medicalofficer of health.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN the 96 English and Welsh towns, with populationsexceeding 50,000 persons at the last Census, and whoseaggregate population at the middle of this year is estimatedat 17,852,766 persons, 8754 births and 3824 deaths were

registered during the week ended Saturday, July 5th.The annual rate of mortality in these towns, which had

steadily declined from 13’5 5 to 11’3 per 1000 in the fivepreceding weeks, further fell to 11’2 2 per 1000 in the weekunder notice. During the 13 weeks of last quarterthe mean annual death-rate in these towns averaged13’5, against 13’3 per 1000 in London during the same,period. Among the several towns the death-rates lastweek ranged from 2 - 3 in Ealing, 2’9 9 in Gillingham and in’Southend-on-Sea, 4-2 in Acton, 4’ 3 in Devonport, and4- 4 in Enfield, to 15 - 4 in West Hartlepool, 15 - 8 in Barnsley,

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16-2 in Dudley and in Stockport, 17-6 in Halifax, and 19-6 61 in West Bromwich.

The 3824 deaths from all causes were 34 fewer than’the number in the previous week, and included 281which were referred to the principal epidemic diseases,against 307 and 306 in the two preceding weeks. Of these281 deaths, 107 resulted from infantile diarrhoeal diseases,75 from measles, 53 from whooping-cough, 24 from diph-theria, 13 from scarlet fever, and 9 from enteric fever,’but not one from small-pox. The mean annual death-ratefrom these diseases last week was equal to 0-8 per 1000,against 0-9 per 1000 in the three preceding weeks. Thedeaths of infants under two years of age attributed to diar-’rhoea and enteritis, which had been 100, 90, and 105in the three preceding weeks, further rose to 107 last week,and included 28 in London and its 14 suburban districts,15 in Liverpool, 7 each in Birmingham and Sheffield, and 5each in Stoke-on-Trent and Leeds. The deaths referred tomeasles, which had been 83, 87, and 81 in the three pre-. ceding weeks, fell to 75 last week; of this number 20

I occurred in London and its 14 suburban districts, 13 in Stoke.- on-Trent, 8 in Manchester, and 5 each in Walsall and in

1 Liverpool. The fatal cases of whooping-cough, which had: been 56, 77, and 68 in the three preceding weeks, fellto 53 last week ; 11 deaths were recorded in London andtits 14 suburban districts, 7 in Liverpool, and 5 in Man-: chester. The deaths attributed to diphtheria, which had

been been 32, 23, and 31 in the three precedingweeks, fell again to 24 last week, and included 6 in’ London, and 2 deaths each in Stoke-on-Trent, in Man-

chester, in Bradford, and in Sunderland. The deathsreferred to scarlet fever, which had been 22, 22, and 15. in the three preceding weeks, further fell to 13 last week,! of which 3 were registered in London and 3 in Birmingham.The fatal cases of enteric fever, which had been 15, 8, and. 6 in the three preceding weeks, rose to 9 last week, and, included 1 in each of nine towns.

The number of scarlet fever patients under treatment inthe Metropolitan Asylums and the London Fever Hospitals,

which had risen from 1418 to 1604 at the endof the three preceding weeks, further rose to 1697 onSaturday last; 314 new cases were admitted duringthe week, against 186, 273, and 286 in the threepreceding weeks. These hospitals also contained on

Saturday last 819 cases of diphtheria, 439 of measles,273 of whooping-cough, and 38 of enteric fever, butnone of small-pox. The 925 deaths from all causes inLondon were 34 more than the number in the previousweek, and were equal to an annual death-rate of 10’7 7per 1000. The deaths referred to diseases of the respiratorysystem, which had been 122, 127, and 126 in the threepreceding weeks, were 106 last week, and were 25 fewerthan the number recorded in the corresponding week oflast year.Of the 3824 deaths from all causes in the 96 towns, 180

resulted from various forms of violence and 312 were

the subject of coroners’ inquests. The causes of 17, or

0 ’4 per cent., of the total deaths were not certified either bya registered medical practitioner or by a coroner after

inquest. All the causes of death were duly certified inLondon and its 14 suburban districts, in Sheffield, Leeds,Bristol, Bradford, Newcastle-on-Tyne, Nottingham, andin 64 other smaller towns. The 17 uncertified causes ofdeath last week included 4 in Birmingham, and 2 each inWarrington, Blackburn, and Preston.

HEALTH OF SCOTCH TOWNS.

In the 16 largest Scotch towns, with an aggregate popula-tion estimated at 2,259,600 persons at the middle of this

year, 1251 births and 595 deaths were registered during theweek ended Saturday, July 5th. The annual rate ofmortality in these towns, which had been 14-3, 14-8, and14 9 in the three preceding weeks, fell again to 13’7 per1000 in the week under notice. During the 13 weeks oflast quarter the mean annual death-rate in these Scotch townsaveraged 16’ 3, against 13’ 5 per 1000 in the 96 large Englishtowns. Among the towns the death-rates last week rangedfrom 4’5 5 in Perth, 7-8 8 in Kirkcaldy, and 8’4 in Leith andCoatbridge, to 14-7 in Glasgow, 19-0 in Falkirk, 19-9 9 inAyr, and 22 8 in Greenock.The 595 deaths from all causes were 51 below the

number in the previous week, and included 89 which werereferred to the principal epidemic diseases, against 75and 72 in the two preceding weeks. Of these 89 deaths, 38resulted from measles, 21 from infantile diarrhceal diseases,20 from whooping-cough, 7 from scarlet fever, 2 from

diphtheria, and 1 from enteric fever, but not one fromsmall-pox. These 89 deaths from the principal epidemicdiseases corresponded to an annual death-rate of 2-1, against0 8 per 1000 in the 96 English towns. The deaths attri-buted to measles, which had been 29, 34, and 35 in the threepreceding weeks, were 38 last week, and included 27in Glasgow, 6 in Aberdeen, and 2 in Dundee. Thedeaths referred to whooping-cough, which had declinedfrom 40 to 15 in the five preceding weeks, rose again to20 last week; of this number 11 were registered in Glasgow,2 in Edinburgh, 2 in Aberdeen, and 2 in Hamilton. Thefatal cases of diarrhoea and enteritis (among infants under2 years of age), which had risen from 6 to 12 in the threepreceding weeks, further rose to 21 last week, and included9 in Glasgow, 3 in Greenock, and 2 each in Edinburgh,Dundee, and Aberdeen. The deaths from scarlet fever,