575AN INTERNATIONAL INQUIRY INTO INSANITY IN PRISONS.

Other columns in the original table record the average daily(natural) flow of the river Thames, the total number of

bacteria per cubic centimetre in the raw Thames water, andthe turbidity of the water in the successive months. These

figures point to like conclusions. For instance, in August of.last year the average daily flow was 428-4 millions of

,gallons, and in December it was 4093 . 5 millions of gallons ;,the total number of bacteria per cubic centimetre found in

the raw water was 436 and 6710 in these two months re-

spectively, and the ratio of the turbidity was 0’95 forAugust to 16’83 for December, figures which need no com-ment. We have already recorded the important researchwork on the effects of storage of raw water upon the vitalityof the typhoid bacillus which has been carried out in theBoard’s laboratories during the year; the present reportshows that not only does storage effect a remarkable reduc-tion in the number of bacteria of all sorts, both excrementaland otherwise, but also a considerable reduction in the

degree of turbidity and of hardness and in the amount of’colour and oxidisable matter ; it is indeed remarkable that"as judged by the bacillus coli test the Lee water afterstorage, but before filtration, was often purer than the

filtered water from the Southwark and Vauxhall works.

With regard to the presence of bacillus coli in the

filtered waters from the different supply stations we read

that "The ’best month’ results were remarkably good "-in six cases 100 per cent. of first-class samples, i.e., samplescontaining no typical baccillus coli in 100 cubic centimetresof water were obtained-" " but, with the exception of the

East London (Lee) and Kempton Park, all the filtered waterdeteriorated to a striking and unsatisfactory extent in

January as a result of the mid-December floods." In thatmonth filtered water from the Lambeth and Southwark and

Vauxhall supplies gave only 10’ 9 and 10 ’ 5 per cent. of first-class samples respectively. On the other hand, the averagefor the latter supply has improved to 67’ 2 per cent. for the12 months under review from 47. 6 per cent. for the 12

months previously, an improvement almost certainly due tothe increased use of stored water in that system. In his

general conclusions Dr. Houston points to the necessity forincreased and more equal storage accommodation at the

Board’s different works, the unequal and in some cases toorapid filtration which occurs at them, the variable and some-times unsatisfactory quality of the water as delivered to theconsumers, and, most important of all, the remarkable per-centage improvement in the quality of the raw water effectedby storage and filtration. He is able, however, to drawattention to the satisfactory average quality of the metro-politan water-supply, and to add :Certain investigations carried out since last year tend to make one look

with rather less disfavour than previously on the present sources ofwater-supply. In the first place the extreme difficulty experienced inisolating/fæcal streptococci from one cubic centimetre of the raw watersis a point in their favour. Secondly, the fact that no typhoid bacilli havebeen found in the raw waters despite the use, for nearly a year, of themost recent and searching tests for this microbe, is a matter worthnoting. Negative evidence, however, in experiments’ of this kind, isapt to be unconvincing; still it can be said with confidence, that thenature of the negative evidence which has been accumulated, is of amuch less inconclusive character than any previously brought forward.These remarks, however, must not be read as implying that any relaxa-tion in the existing processes of purification of the river water by meansof storage and filtration is justifiable. - - .... _

The report of the Water Examiner for April is also to hand.It shows the Thames water to have been in good conditionon all but five days when it was more or less coloured andturbid. The number of filtered water samples giving first-class results with the bacillus coli tests was very satisfactory,being 94-0, 97-2, and 95-7 per cent. of samples taken fromthe Thames, Lee, and New River respectively. Further

striking evidence is to hand as to the effect of simple storageon Lee water. Whereas 94 per cent. of samples of the raw

1 THE LANCET, July 25th, 1908, p. 255.

water contained bacillus coli in one cubic centimetre (orless) of water only 34-9 per cent. of one cubic centimetresamples contained bacillus coli after simple storage withoutfiltration.

AN INTERNATIONAL INQUIRY INTO INSANITYIN PRISONS.

IN the Revue de Psychiatrie for February, 1908, Dr. F.Pactet publishes the results of an international inquiry as tothe number of insane persons found in the prison populationof various countries and notes the steps taken to discover theinsane among the prisoners and to arrange for their disposaland treatment. The results which he established were : (a)That a definite percentage of prisoners are insane ; (b) thatsuch persons often remain in prison a considerable time beforetheir mental condition is recognised ; (c) that the ordinarymedical service of the prisons is insufficient, owing to theabsence of special training of the medical officers, for the

early diagnosis of mental disease; and (d) that a systemanalogous to that established in Belgium in 1891, wherebya periodical inspection of the prisoners by alienists is carried

out, is useful. The allegation has ,been frequently madethat a large proportion of the persons undergoing legaldetention in this country are really insane. It should

be noted, however, that Mr. R. Brayn, medical superin-tendent of the State Criminal Lunatic Asylum at Broad-moor, is not of opinion that the prisons of this countryinclose insane persons or that the diagnosis of insanity is

overlooked with any frequency by the magistrates. Mr. Braynis also satisfied that the medical service of the prisons is

competent to detect cases of insanity when they do occur.Other distinguished psychologists do not share this view ; forexample, Dr. A. R. Urquhart, physician superintendent ofthe James Murray Royal Asylum at Perth, is an advocate forthe adoption of the Belgian system, under which the prisonsare periodically inspected by alienists appointed for the

purpose, believing that the unsuspected insane are in fact tobe found in the prisons.

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THE HEALTH OF WARWICKSHIRE.

Dr. A. Bostock Hill’s able and interesting report on thehealth of the county of Warwickshire is well worth thecareful consideration of all who are interested in the healthof the people. The report in some respects is perhaps ratheroptimistic; nevertheless, it shows that much good has

resulted from past work and it suggests further hope forthe future. It is by births and deaths that vitality andhealth are estimated, and of births and deaths Dr. BostockHill has much to say. Discussing the birth-rate of his

district, he points out that it varies considerably, the highesturban rate being 37 - 2 in Bulkington, and the lowest 17.5in Stratford-on-Avon. The highest rural birth-rate, 36 ’8,was in Foleshill, and the lowest, 12’ 6, in Coventry, whilstin both Farnborough and Monk’s Kirby it was below 20.The average birth-rate for the county was 25 ’ 08, showing afall of 0 - 62 as contrasted with the previous year, and

being 1’ 22 less than the average for England andWales. The fall of the birth-rate is to be regretted,but against it must be set the gain which has been

made by the simultaneous reduction of the infantile

mortality; this is stated as 99 per 1000, which con-

trasts very favourably with the 124 per 1000 of the

previous year, and Dr. Bostock Hill points out thatwhen the falling birth-rate and the infantile mortalityrate are considered together there has been an actual gain tothe county of 144 lives. Perhaps the most satisfactory partof the report is that which deals with these facts, andthe part which raises hope for the future is the statementthat the mothers, and particularly the younger mothers,

576 .THE RELATION OF .THE PHARMACIST TO THE PHYSICIAN.i

welcome the health visitors ,and do their best to carry out I,the instructions given to them. The total death-rate for the- districts was 12’ 48 per 1000 as contrasted with 13’ 5 and--12 - 87 in the two previous years. In the urban districts

Erdington had the lowest >death-rate, 8 78 per 1000, and,&bgr;ulkington the highest, 20’7. The zymotic death-rate was0’ 84, the lowest yet recorded in the county, a distinct

improvement upon the 1’ 49 of the previous year, due very. largely to the diminution of diarrhoea.

THE RELATION OF THE PHARMACIST TO THE

PHYSICIAN.

IN the July 131ÛleÜn. vf the Amerwan PharmaceuticalAssociation Dr. C. S. N. Hallberg deals in an interestingmanner with the relation of the pharmacist to the physician.Dealing first .with the prescription he points out that many

I physicians have ceased to write prescriptions, partly owingIto the common practice among patients of handing their..prescriptions to their friends. A prescription is designedonly for a particular person for a particular period and

--should not be. regarded as a common recipe. Accordingto a declaration formulated by a joint committee of

physicians and pharmacists at Chicago a prescription is

;t.a.n ’utterance of the prescriber who alone should directand control its employment. It should, whenever prac-ticable, bear the name of the patient, the age, if a minor,and the date when written. It should be retained by’the pharmacist as a record for not less than five years,nor the protection of the prescriber, the pharmacist, and thepattient. It should not be dispensed more than once if the,prescriber signifies that it is not to be repeated ("N. rep."),

1 if it contains narcotic or habit-forming drugs, or if

.asked for by any other person than the ’original patient.f These requirements are exceedingly reasonable and have been. -approved by several medical societies. The recommendation’of medicines by the .pharmacist furnishes a fruitful source oftrouble between ’him and the physician. Theoretically thepharmacist should not recommend any medicines but shouldsuggest that’his patrons should seek the advice of a physician..The pharmacist has no right to ’diagnose, and herein lies a

B valuable guiding principle which admits of general applica-tion. Dr. Hallberg suggests that the pharmacist should neverrecommend patent medicines or display them, but whether’ ’he should refuse to supply them on demand must be left to individual judgment. His refusal would be rendered more

easily possible if physicians’ through their societies wouldresolve to give preference to those pharmacists who do notkeep patent medicines at all. ’To meet the popular demandfor domestic medicines ’ it has been suggested that a

list of official articles should be selected by the jointmedical and pharmaceutical societies, such articles tobe supplied with suitable labels. Dr. Hallberg’s observationsare largely applicable to all countries where the Englishtongue is used. In many continental countries the pharmacist; its bound to observe a rigid code of ethics and in some of I

these countries care: is taken to regulate the number opharmacies, so that it- is possible for the rules to be carried’out and at the same’ time the pharmacist is able to conductthe business with profit.

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FOOD POISONING AT ST. ANNE’S-ON-THE-SEA.

WE have received from Mr. ’Edward Sergeant, the medicalomcer of health of the’ eounty palatine’ of Lancaster, a copyof his report on the outbreak of food poisoning whichoccurred early’ in July last in the urban’district of St.

Anne’s.on-the-Sea. Investigation showed that altogether’there were 76 cases of poisoning, aild without exception

the cause of illness was attributable to either potted beefor pork pies. 34 cases of illness due to the potted meatcame under observation- and 42 attacks were traceableto pork pies. Three deaths occurred, two of which wereattributed to potted meat and one to pork pie. The fatalcases exhibited the following symptoms. The food wasconsumed about 8 or 9 in the evening. The patientsoommenced to be ill with pain in the stomach, vomiting,and diarrhoea about 1 o’clock next morning. Death from

syncope took place six days after- the meat was eaten.There could be little doubt, that both the potted meatand the pork pie had established some kind of bacterialpoisoning-a conclusion, at all events, which was borne outby the bacteriological investigations made by Professor S.Delepine. The bacillus obtained from the pie when mixedwith the food of a guinea-pig caused the infection anddeath of that animal..Inoculation with cultures of thebacillus obtained from one fatal case and also from the

’potted meat produced infection and death in two or

three days. The blood of other patients gave the

characteristic reaction indicating that they had beeninfected by the same bacillus. The outbreak appears,therefore, to have been due to a bacitllus which had most ofthe characters of the bacillus enteritidis of Gaertner, whichis similar to the organisms which have been found in foodcausing analogous poisonous symptoms in previous outbreaks.’There was evidence also that the blood of some of thebakehouse employees had been similarly infected. The

insanitary surroundings in which the bakehouse was foundfurther suggests that the fons et origo rnali was the intestinalorganism. There can be little doubt that am efficientsanitary condition in places where food is prepared andcooked is of the utmost importance to the health of the

public, especially as ’it has been -shown that even in the

process of cooking some pathogenic organisms may surviveowing to the temperature not having completely penetratedthe mass.

___

WE regret to announce the death of Sir Charles GageBrown, E.C.M.G., M.D., which took place on Thursday,August 13th, at Wreningham Rectory, Norwich. Sir Charles

Gage Brown, who was for many years physician andmedical. adviser to the Colonial Office and to the Crown

.Agents for the Colonies, and who on occasions gavecounsel also to the Foreign Office and Audit O:ffi.oe, hadreached the age of 82 years.

Dr. Lucas-Championniere, consulting surgeon to the

Hotel-Dieu, Paris, and senior surgeon at the Beacon.Hospital, attended at the Royal College of Surgeons of

England on Tuesday last and signed the roll of HonoraryFellows in pursuance of his election by the Council..

Dr. W. H. Willcox, assistant physician to St. Mary’sHospital, has been appointed to the post of Senior SeientificAnalyst to the Home Office in succession to the late SirThomas Stevenson.

READING PATHOLOGICAL SOCIETY.-At a recentmeeting of this-society the following were elected officersfor the new-i.e., the seventy-eighth-session: President,Dr.1 Jamieson B. Hurry;’ honorary librarian, Dr. Francis HHawkins ; honorary curator, Dr. H. M. Clarke ; andhonorary secretaries, Mr. N. B. Clowes and Dr. W. B.Secretan. For many years it has been the custom of thesociety to inaugurate the session by an oration, which Willon’ this occasion be delivered by Dr. F. W. Andrewes,pathologist to St. Bartholomew’s Hospital, subject, "TheTreatment-of Infectious Conditions by Vaccines." After theoration the, annual dinner of the society will be held.