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THE REPORT OF THE LOCAL GOVERNMENTBOARD.

I.THE sixth annual Report of the Local Government Board

has recently appeared. This important document (which isheaded 1876-77, and is dated April 20th, 1877) relateschiefly to the proceedings of the Board in 1876 and a part of1875. It is divided into two parts, and is followed by abulky appendix of circulars, reports of inspectors, andreturns relating to the several parts. The first part dealswith the administration of the laws relating to the relief ofthe poor; the second with the administration of the laws

affecting local government and the public health. It doesnot appear why the publication of this Report should havebeen so much delayed, but so long as it was held back fromthe public there was hope that the report of the MedicalOfficer of the Board, of the continuation of which in a

separate form some doubts had been entertained after Mr.John Simon’s retirement, might also be only delayed. It isgratifying to be able to state, on the authority of Mr.Sclater-Booth at p. xov. of the present Report, that theMedical Officer’s Report will still appear in t separate form,and that the series of these peculiarly important documents,in professional estimation, will not be broken.The first part of the Local Government Board’s Report,

that which relates to Poor-law relief, contains less whichcalls for our attention in this descriptive notice than thesecond part, that which relates to public health. We maynote here of the first part that it shows a marked decreasein the expenditure for the relief of the poor during theperiod to which it refers, and a still more marked decrease-the decrease in this matter being continuous over a seriesof years-in pauperism. The decrease in expenditure isespecially marked with respect to out-door relief, thediminution of which the Local Government Board hasespecially had in view of late years in the advice it hasurged upon boards of guardians. In other words, the re-forms which the Board has pressed upon guardians in theadministration of out-door relief have had this marked result,and would appear to contemplate that ultimately no out-door relief from the rates would be granted. With respectto medical questions in this part of the Report, we may notethat only six of the unions and parishes in the metropolisnow retain their in door sick in mixed workhouses, the re-mainder providing accommodation for them-or being nowengaged in making provision for them-in separate build-ings. A brief account is given of the measures adopted bythe Local Government Board and the managers of theMetropolitan Asylum District with reference to the lateepidemic of small-pox, which may be consulted with

advantage by those interested in the subject. Thenumber of lunatics, including imbecile persons andidiots, chargeable to the poor-rates in 1876, was 55,575,an increase of 944 upon the number as charged inthe previous year. A curious question was raised inthe past year by the Irish Government, the latter

having asked the Home Government, as a precautionagainst the introduction of small-pox into Ireland, to dis-continue the practice of removing paupers from the port ofLiverpool there, so long as small- pox was prevalent in thatport. The question was submitted to the Local GovernmentBoard, and this Board very judiciously adopted the point ofview that the effect of this particular kind of intercoursewould be slight while the daily and hourly communica-tion between the two countries in other respects continuedwholly without restrictions. Moreover, the Board was

advised that it had no legal authority to stop such removals.The guardians of the several unions in the neighbourhoodof Liverpool were requested, however, to exercise the greatestpossible caution in the removal of paupers while small-poxcontinued within their boundaries, so that any liability totransmission of the disease by that means might be held asfar as practicable in check. "No case," the Board states," has been brought to our knowledge in which it is evenalleged that the infection of small-pox has been conveyedto Ireland by the removal to it of a pauper suffering fromthe disease."

From the second part of the Ecport, that relating topublic health, after reference to the provisions of the Rivers’Pollution Act, 1876, it would appear that, in addition tonumerous alterations of areas of sanitary districts whichthe Board has caused to be made for various purposes, it

, conferred certain urban powers upon fifty-two rural sanitary

. authorities, and approved, in additional cases, of the ap-.

pointment of seventy medical officers of health (fourteenrural and fifty-six urban) and fifty-one inspectors of.

nuisances (six rural and forty-five urban). The urbanpowers granted to rural sanitary authorities usually related

to the power of making bye-laws as to cleansing of-

i streets, removal of refuse, and the construction of new-! buildings. The total number of appointments now

existing which the Board has sanctioned since thepassing of the Public Health Act, 1872, is as follows:-

Medical Officers of Health By rural authorities 394, urbanauthorities 387, combined authorities 44, total 825. In-spectors of Nuisances By rural authorities 507, urban authori-ties 319, combined authorities 17, total 843. Medical officersof health and inspectors of nuisances have also beenappointed for forty-five of the forty-six port sanitaryauthorities constituted under the Board’s orders. On the31st December, 1876, there were forty-two district combina-tions for the appointment of medical officers of health,embracing 140 rural and 126 urban authorities, and seven-teen district combinations for the appointment of inspectorsof nuisances, embracing fifteen rural and thirty-seven urbanauthorities.The loans to sanitary authorities sanctioned by the Board

in 1876 amounted to .62,563,708. The total outstanding.-loans to local authorities on the 25th March, 1876, were a&

follows :-To urban sanitary authorities =638,546,284, to,rural sanitary authorities .6204,456, making a grand totalof 38,950,740.

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MEDICAL ASPECTS OF THE WAR.

ON the 28th September the Daily Telegraph published aletter from its correspondent at Buda-Pesth, in which itwas stated,’on the authority of an American physician, thatnothing could be more inhuman than the way in which thewounded Russians were treated in hospital. This statementhas called forth a letter from the military attacDé of theUnited States, at the head-quarters of the Russian armyon the Danube, denying the statement, and furnishing thefollowing interesting details respecting the hospitalarrangements of that army. He states that it pos-sesses 42 semi-permanent hospitals, each composed of 3&

huts, and having attached 24 baggage-waggons, 3

pharmacy -waggons, with a staff of 12 surgeons, 300

assistant-surgeons, 3 dispensers, and a greater or lessnumber of sisters of charity (volunteers). Each hospitalgives accommodation to 600 patients, or at need 1000. The

hospital-tents measure 35 feet in length, 25 feet in breadth,15 feet in height to the ridge, and 5 feet in height of wall.Each tent can receive 22 beds, allowing one foot of spacebetween each couple. The hospital of Gorny-Studien,which the correspondent of the Daily Telegraph haddescribed as well situated and perfectly organised, the mili-tary attache says differs in no respect from any of theothers. Fourteen of these hospitals are situated in Bulgaria,15 in Roumania, and 7 in Russia. Six are kept in reserve.The Bulgarian hospitals furnish accommodation for 8400patients, the Roumanian for 9000. In addition to the hos-pitals above-mentioned, each division has its special hos-pital of six huts, and each battalion its ambulance-waggon(on springs), making a total of 18 waggons for eachdivision. The medical staff of the divisional hospital con-sists of a principal medical officer, four assistants havingcharge of the administration of the hospital, four surgeons,and a certain number of assistant-surgeons and attendants.Each regiment, moreover, has attached to it three phy-sicians and one surgeon. A supplementary service of 350ambulance-waggons on springs is under the direction ofthe chief sanitary officer of the army, and is detached forservice where it seems most necessary. But the provision of

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u,mbulance-waggons has proved utterly inadequate in some " Mf. Yuuna ave us a good supply of c!o’h, which willof the severe engagements which have occurred, as, for be amply stiffloirit fur 0!U’ want6 at the hospital but ifexample, before Plevna, where, in one instance, 9500 anything were being sent from Euglaiid I would recommendwounded had to be provided for in two days. The regula- warm lambswool dra.wers and jprseys and warm stockings.tion waggon in such cases has had to be suplemented by They could easily be distributed to the many half-starved,the ordinary country waggon used by the commissariat. half-clad, and wholly sick who are now beginning to infestThis account refers solely to the military hospitals proper, this place; and I have no doubt Kars also. They are castand does not include the hospitals provided by the Red off by the Government as being useless, and numbers willCross Society. die of cold and hunger. 1000 pairs of drawers and stockingsOf the general state of health of the Russian army on the and 1000 jerseys could be given away with advantage.

D&Bbe very little information is permitted to be published, When Mr. Young was here I had no idea the poor fellowsand at the present moment little is accurately known. would be so utterly uncared for. Our plan for the present

E’rom the Turkish forces in Bulgaria and Roumelia the is to give the wounded a pair of drawers and jersey when,account become more and more gloomy as to the state of leaving the hospital.health. The Times correspondent, writing from Philip- " Dr. Buckby is seriously ill with typhoid fever at Rars,pi3poiis on the 21st ult., states that the condition of things and Dr. Casson far from well.inthmt district, medico-sanitarily; could not well be worse. " Drs. James Denniston and John Pinkerton, afterThere is an almost entire absence of organisation in the being detained at Constantinople on the ground of notTurkish medical and surgical arrangements. The neglect having their diplomas to prove they were qualified sur-ef the sick and wounded is revolting, and the state of the geons, were to start thence on the 19th of October forhospitals indescribable. "The mortality is shocking to re Erzeroum."late, gangrene, of course, being of extremely common The National Aid Society has published an interestingGoospcenoe." The only relief to the story is found in the series of letters from its agents and others, relating to theexertions of Dr. Stoker, Dr. Eccles, Dr. Baker, and others operations of the Society in the present war. The dates ofof the National Aid Society, and in the efforts of the Red the letters range from the 30th July to the 29th September.- Crescent Society. Several telegrams are also given of a later date. We trustThe condition of the soldiers in the field appears to be that the Society will from time to time continue the pub-

hardly better than the sick in hospital. The sickness is be- lication of its agents’ letters in this form. The collectedcoming inordinate. Typhus and dysentery are widely pre- letters permit a juster conception to be formed of thevalent. The troops, indeed, seem in November to be in Society’s work.hardly better state than were the Turkish troops in the The following is from The Times of Nov. 7th. It appears()cimea. in the depth of the winter of 1854-55. Another in telegrams from "Our Special Correspondent" with thefact recalling Crimean days is the recent effort of the Medi- army of Bulgaria at Bogot :-- eaJiCocEncil at Constantinople to intercept, on petty grounds, "The Aide-de Camp of Haki P,isha, is wounded in thetwo English surgeons proceeding to Armenia to supply the thigh. Three Englishmen were brought in here with Hakiplaces of Drs Buckby and Casson, both shut up in Kars. Pasha from Telis. One of them, Colonel Coope, formerlyThe work of English surgeons serving with the Turkish army an officer in the 7th Fusiliers, is an officer in B1ker Pasha’sim 1854-56 was rendered almost nugatory by the difficulties Gendarmerie; but it appears that the organisation of thisthrown in their way by the heads of the Turkish Medical body is a mere paper reform to please Europe, and theseDepartment. officers find themselves in possession of a well-paid sinecure,A telegram from Constantinople, dated the 3rd November, at least for the present. Colonel Coope, becoming weary of

announces the capture, by the Russians, at Telis, of Dr. inaction, proposed to organise a Corps of Stretchermen, toDouglas, of St. Thomas’s Hospital, and Dr. Nicholls (or carry the wounded off the battle-field, and he proceeded toVatchell), of the London Hospital, left in charge of wounded Telis for that purpose; but Osman Pasha declared heT’lirlrs there. wanted no English doctors; that he was the saviour of

Lord Blantyre has favoured us with the following extracts Turkey, and would rescue her without foreign assistance.from letters received by him from Armenia :- Colonel Coope, therefore, found himself again without occu-

The English Consul to Lord Blantyre. pation, and joined the English Ambulance at Telis, to assistin dressing the wounded, donning the Red Crescent on his"Erzeroum, 10th Oct. (received 30th Oct. 1877). left arm, and in this anomalous position he was captured.

"I gent Dr. Casson (who is with the army near Kars) on The Russians cannot understand his holding the Sultan’sTuesday, 2nd, six cartloads of stores, consisting of ninety- commission as an officer of Gendarmerie, and at the samenine bed and pillow-cases ready for filling, and twenty- time wearing the Red Crescent; consequently, Coloneltwo cases of drugs, splints, clothing, medical comforts, Coope will probably be detained as a prisoner of war, andblankets, soup, lime-juice, &c. These were confided to me sent to Russia. The other Englishmen-Dr. Douglas, ofby the National Aid Society through their agent, Mr. J. S. St. Thomas’s and St. Mary’s Hospitals, and Dr. Vachell,Young, who came up here a fortnight since with a well- of the London Hospital-are treated with the greatestselected batch of stores. courtesy. They have capital quarters, and dine-and break-

"Our hospital is doing very well indeed ; it is very clean fast with the Grand Duke Nicholas, who shows themand sweet. The patients seem comfortable, and express marked attention.themselves happy and grateful. The staff now work well, "I visited the field hospitals here in their company thisand everything, I can assure you, goes very smoothly. Each afternoon. Dr. Douglas authorises me to state that he sawmatt having become versed in the duties he has to perform, the Russian dead horribly mutilated after their first repulsethe daily work is got through speedily, silently, and at Telis. Many were headless, all were stripped naked, andthroughly, and whether we have four or forty new patients he saw one body of a man who had received a comparativelysuddenly sent to us, their entry is marked by no hurry or slight wound from the Turkish fire, and had then been shotconfusion; they are told off to their beds, looked to, and five times in a circle through the breast by a revolver heldmade comfortable without delay. I have been repeatedly so close that the powder had burned the flesh. He is posi-told that the one desire of the patients in the other hospitals tive that the man was murdered, as his first wound was toois to be transferred to the ’ English Hospital."’ slight to cause death. Both these English doctors have

Mr. Featherstonhaugh, writing from Elzeroum, 4th Oct., travelled from Constantinople to Plevna, and have onlysays:— seen or heard of three Russian prisoners in the Turkish

11 It freezes every night, and the mornings are very cold, lines. The Turkish authorities, they state, declare they dobut the days are beautifully fine." not want English doctors, but English soldiers ; that theAnd on Hth Oct. :- wounded are of no use, as they cannot fight any more, and"Our hospital is rather empty just now, only about 100 are only a useless burden to the State. Both of these young

in; but any day may fill it again, as about 2000 were surgeons might have made their escape, but remained atwounded last week, and there was another battle on Tues- their posts by the wounded, and were captured with them.day, when the Russians were again driven back. It was They were under fire in Telis, and describe the effect of theexpected that the attack would be renewed to-day. It is new artitlery projectiles of the Guard as being terrific, thesaid that the Russians have been reinforced by another Turkish soldiers being blown to atoms in their trenches.division; if so I fear they will be too much for Muhktar. The garrison of Telis were all regulars."