1111

and in finding a place comparatively in the suburbs to whichthe poor population was drifting every hour. They must not Alforget that the medical school was an important part of thehospital and if they would keep pace with the advance inmedicine and surgery it was imperative to obtain moreroom and greater extension of equipment than the presentbuilding could furnish. The existing deficiency was actingprejudicially against the medical school, for students wouldnot come where the requirements of modern science werenot to be had. 191

Mr. C. AWDRY, in the absence of the Bishop of Exeter, Beseconded the motion. As treasurer he had carefully con- pcsidered what was their duty at this juncture in view of the thlarge amount of money the scheme involved and he had

Sureluctantly come to the conclusion that it was necessary to suremove the hospital to a site where it would more fully meet inthe generous and charitable designs of its founders. b3

Mr. S. J. WILDE, one of the oldest subscribers, said he Simust vote against the proposal. He had known the district of

for a great many years and while it was quite true that thecharacter of the neighbourhood around the hospital had

0

changed there were many people living there still. Charing 0

Cross Hospital was not in a poor neighbourhood, yet it wasbeing extended at a very large cost, which showed the

st

necessity of its continuing where it was. He was afraidthat removal would be a step towards severing the hospital d

from the College. If, however, removal was necessary thiswas a very inopportune time for it because so many other ucentral hospitals were begging at present and the sum Owanted for the new King’s College Hospital was a very large P

one. si

Lieutenant- Colonel CLIFFORD PROBYN moved as an amend-ment- t

That the further consideration of the motion to remove the hospital "be postponed for a period of two years. a

He believed that by that time many of the poor who hadbeen disturbed by the Strand improvements would be re- established in the district and they would then know better owhat to do.

Mr. WILDE seconded the amendment. f

Mr. H. S. COLLINS, who had given .&1000 to the hospital sentirely because of local sentiment, pointed out that if removal took place such contributions would cease. Heregarded the expenditure on Charing Cross Hospital as a

t

great waste of money and thought that on charitablegrounds there should have been some communication

1

between that hospital and King’s College to see whether thetwo could not be brought together. The Rev. Dr. HEADLAM, Principal of King’s College, stated

that it was quite true nine or ten members of the committeeof management had resigned, but he understood that theiropposition arose not from objection to the removal but onaccount of the difficulties that would have to be faced inconnexion with the scheme. They all felt there would bedifficulties, but if they were convinced that removal wasright and would be beneficial they ought to face thesedifficulties, put their needs before the public, and do theirbest to carry out the proposal. The enlargement of CharingCross Hospital was a reason for the removal of King’sCollege, because there was room for one but not for two,and their medical students had to go further and furtherafield for the training that was necessary to them. Hehoped that in moving to South London they might be ableto meet a great need and be able to build a hospitalwhich was up to the standard of modern requirements.

Mr. M. M. McHARDY urged that the site to be looked forshould be adequate and suitable for a building to provide600 beds.On a show of hands the amendment, which secured only

six supporters, was rejected. The motion was then carried,only five hands being held up against it.Mr. SMITH, in answer to questions stated that there would

be plenty of money available to secure at least a suitable sitewhich in his view should be "on the centre of the fringe ofSouth London."On the motion respectively of Dr. D. FERRIER, seconded

by Mr. W. WATSON CHEYNE, and of Colonel FELLOWS,seconded by Mr. WILDE, the joint committee appointed bythe council of King’s College and the committee of manage-ment of the hospital was authorised to acquire a suitable andadequate site, and to apply to Parliament for an Act tocontain any powers necessary to carry out the removal ofthe hospital and power to sell, mortgage, lease, or otherwisedispose of the present site.

ANNUAL REPORT (1901 - 02) OF THEMEDICAL OFFICER OF THE LOCAL

GOVERNMENT BOARD.1

111.

BEFORE concluding our notice of the inspections made in1901-02 by the medical staff of the Local GovernmentBoard (the details of which fill about 230 pages of Mr. W. H.Power’s report), we think it right to comment very briefly onthe question of sanitary administration generally, as

suggested to us by a perusal of the reports of the several

inspectors. Our library contains a goodly number of reports-by successive medical officers of the Board, from Sir John,Simon onwards, every volume of which furnishes particularsof local investigations made by experts of acknowledgedcompetence concerning some of the more glaring instancesof sanitary delinquency brought to light during the year.

. On turning over, at random, the pages of any one of these, volumes we meet with case after case of grave neglect of: statutory duty by sanitary authorities, almost alwaysculminating in more or less serious outbursts of preventable-disease. When it is realised that only in the rarest instances

. are these inquiries directed by the Board, unless either at theurgent request of some defaulting authority apprehensiveof financial loss from deserted lodging houses, or else on the

petition of actual sufferers from the neglect of their

statutory protectors, we are constrained to ask what is the-

sum-total of loss of life and health that is caused annually inthis country, and especially in our *’ health resorts," by thegreed, the ignorance, or the apathy of the authorities who

are the appointed custodians of the public health.We do not possess the means to answer this question but it

’- is certain that the Local Government Board-advised by its

’ own medical staff and kept informed on health matters byan army of medical officers of health stationed everywherefor this very purpose-must be cognisant of the local sanitaryshortcomings of which we are allowed to see an occasionalexample but the full extent of which the Board refuses tomake public. The Board unquestionably possesses the power

a to call to account the authorities responsible for the neglect! referred to and we are astonished that English public opinionn has not long ago protested against the continued applica-tion of mere palliatives for the removal of an acknowledged

national danger.d In numerous recent instances we have found it desirable-

,e on public grounds to direct attention in our columns to their accumulations of insanitary conditions against which medical:11’

officers of health have to contend in their efforts to conserve the

in health of the people-conditions of which Dr. H T. Bulstrodesupplies a striking and typical example in his present report

as on the sanitary state of Whitehaven. As an excuse for

se inaction in similar circumstances it is often contended bysanitary authorities that in order to deal effectually withevils of such magnitude nothing short of wholesale demolition

rg of entire insanitary areas would be of permanent avail and

10, 5 s

that the rehousing of the evicted people required by law0, would involve local financial ruin. We are, of course, familiar

with this specious reasoning and equally so with the appealad niisericordiant which often effectually accompanies it.

bal Considerations of this kind may probably have weighed witha the Local Government Board and may have induced it to

For deal leniently with authorities which unfortunately inherit.de statutory responsibility for defects not of their own causing.

and which are doing something at least for their removal.

11y But what excuse can be made on behalf of district councils

ed which are perpetuating the same evils in cottage property’

now actually in course of construction ? Why does the!lId central authority tolerate the covering of vast areas of landite with dwelling-houses which, built in defiance of sanitaryof knowledge, will in a few years present conditions hardly-.

better than those which render the slum property of ourled older towns unfit for human habitation ? To both these ques-

ws tions the answer is too obvious to require formal statement.

by The speculative builder of to-day avoids the territory of

,ge- our great municipalities where, at ary rate, some regard is-and paid to the durability of houses built within their jurisdic-to tion. He directs his attention generally to the confines ofof populous towns, to suburbs where sanitary matters are in the

1 Previous notices of this report were published in THE LANCET Sept. 19th (p. 839), and of Oct. 3rd (p. 972), 1903, respectively.

1112

hands of district councils composed mainly of petty trades-men who equally with himself are anxious for the rapidextension of house building. Being in appearance a manof aftluence the speculative builder readily obtains a seat onthe district council and, devoting much attention to localaffairs, he speedily rises to an influential position among hisfellow councillors. He then proceeds to acquire possessionof every available acre of land in the district and to erectthereon row after row of cottages which will stand longenough to enable him to dispose of them to his own satis-faction and to repeat the same process elsewhere, probablyin a distant part of the country.Within less than a score of miles from where we write, in

districts fringing the metropolis and beyond the reach ofLondon by-laws, thousands of cottages are now being erected,many of them are water-logged and others are on "made"

"

land-cottages which if built within the metropolitan areawould not pass muster for a day. But what is particularlydistracting from the Londoner’s point of view is this-thatthe sites now being covered with sparely built houses willalmost certainly be absorbed into the metropolitan area notmany years hence ; in which event the successors of our

present borough councillors will have to deal with what will then have become unhealthy areas after the manner in which icertain of the older areas of London are at this moment Ibeing dealt with. 1From the preventive standpoint that portion of Mr. c

Power’s report which deals with the Board’s administrative caction in relation to the London small-pox epidemic in u

the period to which his report relates is full of interest fand instruction. From the beginning of the epidemic to f,the end of March, 1902, the notification of cases of small-pox o

in London amounted to about 6000. But although this total is Ga large one it must not be inferred that London in its entirety iisuffered heavily from the disease. In the later months of a’

1901 St. Pancras, St. Marylebone, Holborn, and Bermondsey, va

and in the earlier months of 1902 Shoreditch, Bethnal Green, m

Stepney, Poplar, St. Pancras, Hackney, Southwark, Camber- oiwell, and Battersea suffered most severely from the epidemic. w

But even in these boroughs the disease did not involve more bithan limited sections of the population, whilst not a few va

boroughs were from first to last comparatively free from fo

small-pox. The Board in its capacity as the sanitary intelli- se

gence department of the State-always alive to the risk of prthe importation of small-pox from abroad and mindful of thescandalous neglect of vaccination in London to which we thhave already referred-took exceptional pains to bring about, th,

through its medical staff, better administration of the vac- hacination law by the guardians, forcibly reminding them of oftheir responsibilities in connexion with the epidemic. ins

Circulars were addressed to the borough councils urging 19(upon them the necessity for energetic action with a view plaof limiting the spread of infection, such, e.g., as the decmedical examination of all notified cases and their nui

immediate isolation in hospital, the disinfection of houses theand bedding, and the vaccination of so-called "small-pox we:contacts." The Board further adopted the unusual course me,

of requesting that its medical department should be kept actsupplied with precise information of the measures which in Aeach case had been taken by the local officers to check the of 1

spread of infection. The London School Board was also Boa

approached and its attention was directed to the large propor- adntion of unvaccinated children in certain small-pox stricken rea(

parishes ; it was urged to encourage the prompt vaccination of of such children with the hope of preventing the spread of portinfection by contact in school. The School Board thereupon M. promptly resolved to afford facility under reasonable con-ditions to the vaccination officers of the metropolis to enterthe schools belonging to the Board in infected areas and toexamine the arms of children with a view of inducingparents to allow the vaccination of those who were unpro-tected. At a later date the Local Government Board com-municated further with the metropolitan borough councils tothe effect that cases of small-pox were frequently escaping TIdetection owing to their being mistaken for chicken-pox ; Courit was therefore suggested by the central authority that receI

chicken-pox should be included in the list of diseases was tthe notification of which is compulsory under the London 22 ’9Public Health Act. It will be remembered that this soliciaction of the Board led subsequently to the addition of publinotified cases of chicken-pox to the weekly returns of takercases of infectious disease in London published by the analyRegistrar- General. Referring to the splendid services factsrendered by the Metropolitan Asylums Board in combating were

’ades- small-pox Mr. Power writes thus : " Here it is not necessaryrapid to say more than that, under circumstances of exceptionalman dinioulty and pressure, the authority in question expandedat on and increased both its hospital accommodation and its landlocal and river ambulance service so as to keep pace always withg his the demands of the metropolis. Throughout the epidemic no!-sion disadvantage to London arose by delay of removal of small-erect pox patients from their homes or of their reception and treat.long ment in hospital. There can be no doubt at all that thesatis- efficiency of the Metropolitan Asylums Board, as hospital)ably and as ambulance authority, largely contributed to suchmeasure of success as was attained in dealing with Londone, in small pox." " Passing on to review, on the one hand, theh of exemplary conduct of the great majority of the municipal;ted, councils, and on the other, the reprehensible behaviourde" " of certain boards of guardians in neglecting theirarea statutory duties, Mr. Power deals leniently with thearly very few among the former which, reflecting, perhaps,that the antagonistic spirit of their guardian colleagues,will had incurred the special censure of the Board. Henot nevertheless pointedly alludes to, although he forbears toour name, a certain recalcitrant council which paid the penaltywill of disobedience by losing the services of no less than five ofiich its own officials through their being attacked by small-ient pox. Although, in the exercise of his discretion, Mr. Power

has deemed it inexpedient to praise municipal boroughMr. councils the preventive action of which against small-poxjive deserved high commendation, or, on the other hand, to holdin up to reprobation individual boards of guardians which in the

’est face of a terrible epidemic exceptionably failed in the per-to formance of a public duty, he feels called upon to mention

pox one vaccination authority-the board of guardians of St.1 is Giles and St. George, Bloomsbury-the action of which wasety in the highest degree commendable. Under this vaccinationof authority very thorough measures of vaccination and re-

9Y, vaccination were carried out from the first. It is the3n, municipal borough of Holborn which profited by the serviceser- of this public-spirited board of guardians. This boroughic. was early invaded by small-pox and there is no doubt that)re but for the cooperation against small-pox here happily pre-w vailing between independent authorities jointly responsible

for the repression of the disease, the rapidly growing andli- severe epidemic in Holborn would have attained much graverof proportions.

As regards preventive measures against importation intove this country of cholera and bubonic plague Mr. Power refers tot, the routine records of the prevalence of cholera abroad which

c- have, as in past years, been continuously kept by members?f of his staff, and to the exceptional action of the Board’sinspectors during the year in respect of plague. Early in

g 1901, on the occurrence of certain cases of locally suspectedw plague in districts within the outer ring of London, the Boarde deemed it proper to direct two of its inspectors to visit a

ir number of the districts referred to and generally to reminda the local authorities concerned of their responsibilities asx well as to advise them with regard to the precautionarye measures desirable to be taken beforehand in dealing witht actual or suspected cases of the disease.As regards the final section of this report, which treatsof the auxiliary ocientific investigations undertaken on theBoard’s behalf during the year, inasmuch as they do not- admit of summarising we have no alternative but to refer ourt readers for particulars to the report before us, fully one-thirdof which is occupied with the highly interesting and im-pportant details contributed by Dr. Klein, Dr. Martin, Dr.

M. H. Gordon, Dr. A. C. Houston, and Dr. J. S. Haldane.

MEDICINE AND THE LAW.

The Analysis of Perishable Articles of Food.THE first prosecutions instituted by the Norfolk Oounty

Council in respect of the addition of boric acid to milk camerecently to an unfortunate conclusion. In one case whichwas gone into fully the milk was proved by analysis to contain22 ’9 grains of boric acid per imperial pint. The defendant’ssolicitor, however, took the point that the certificate of thepublic analyst was silent as to whether any change hadtaken place in the milk that might interfere with theanalysis. The magistrates, after retiring to consider thefacts and the point of law thus raised, intimated that theywere satisfied as to the addition of boric acid and also that