THE PUBLIC HEALTH. LONDON. The principal feature in the Sanitary Legislation of the quarter has been the introduction of a new Vaccination Bill. The necessity of further legislation on the subject of vaccination has been felt by the alarming fatality of the present epidemic of smallpox, which has been very fatal in London, and has extensively prevailed in the provinces. This epidemic is still continuing, and existing legislation has been found quite unable to ensure the vaccination of the community. So prevalent has been the smallpox, that some persons have asked the question as to whether the cowpox is so perfect a preventive of smallpox as we have been led to consider it. With regard to this question, it may be asserted with the utmost confidence that where the disease of cowpox has been properly communicated to an individual, in such cases there is no more tendency for such an individual to take smallpox than if he had had smallpox itself. There is in a very small number of cases a tendency amongst persons who have had smallpox to take it again. It is, however, very questionable as to whether this number is at any time sufficient to keep up the smallpox in a community. We have also abundant evidence to show that in communities where the practice of vaccination is carefully carried out, there smallpox is only an exceptional visitor. When the practice of vaccination was first introduced by Jenner in this country, the demonstration of its being able to prevent smallpox was so complete that it was never contemplated that there would be any persons who would neglect for themselves or their families so important a means of preventing a foul and fatal disease. Every adult in the country had more or less personal experience of the fatal nature of smallpox, of the loathsome character of its symptoms, and the deformities it inflicted on those who had had it. But gradually these recollections passed away, and there sprang up in the community persons belonging to the party of medical impostors who maintained that cowpox did more harm than smallpox, and thus an indifference to vaccination has been engendered. It was then sought by legislation to remedy the consequences of this indifference, and powers were given to the Boards of Guardians to superintend the vaccination of their districts. Up to the present time this legislation has failed to secure the object desired, and a new Bill is now passing through the House of Commons for the purpose of improving the old Acts. Without going into the details of either the old or new Bills, we would observe that in all there is the same fatal oversight which must render impotent all attempts at vacci nation legislation. In England and Wales we have no compulsory registration of Births, and consequently there are no existing means of ascertaining whether every child born is vaccinated. In some districts in London it is believed that 25 per cent. of the children born are not registered. Yet in spite of this, the legislation assumes in its Vaccination Bills that every child born can be easily discovered for the purposes of vaccination. The necessity of compulsory registration in England and Wales has been pressed upon our Home Secretaries, on Poor Law Secretaries, on Presidents and Vice-Presidents of Privy Council for years, and not the slightest effort has been made in Parliament to secure a return of births, upon which alone can be founded any accurate statistics of the relations of birth to death in the kingdom. Another reason of the failure of our Vaccination Acts has been the small sum given to public vaccinators for performing the operation of vaccination. The former Acts named 18., and the present Bill offers 1s. 6d. Now our legislature ought to know that this is no payment for professional service, and that an operation requiring skill and attention will never be properly performed for such a payment. The operation thus paid for is entrusted by medical men to their apprentices and assistants, no satisfactory evidence of the operation being properly performed is ever given, and thousands annually undergo a sham operation, and are let loose on society to take and propagate the smallpox. It is a wellknown fact that in parishes where higher fees have been given to the public vaccinator than the minimum allowed by the Act, that there smallpox has not been known. Give the medical man an interest in looking after the cases of unvaccinated children and he will do so, and there will be no need for an elaborate system of certificates or inspectors. The fact is, if enough is paid to make it the interest of a respectable medical man to see after unvaccinated children, and also to ascertain that the vaccination has been properly performed, there hardly needs any further legislation. In a paper on Vaccination, recently published by Mr. Rumsey, of Cheltenham, whose opinions on State Medicine are always entitled to respect, he states his conviction that no compulsory Vaccination Act will ever succeed in this country. He advocates indirect compulsion by refusing admission into schools, factories, and all kinds of service, unless proof should be given of successful vaccination. He also advocates the removal of the superintendence of vaccination from the hands of the Poor Law authorities, and the placing it in the department of the Medical Officers of Health who are appointed by the vestries. Amongst the sanitary subjects demanding the attention of the legislation, is that of sea-scurvy. There is no doubt an increased tendency to the development of this disease on board our mercantile marine. The prevention of sea-scurvy is as simple as that of smallpox, but neither masters nor men will voluntarily adopt it on board our ships. We have a law compelling ships to take out lemonjuice, that it may be served to men on voyages beyond a certain duration. But if the sailors will not inform there is no one to prosecute. There ought to be a much more vigilant superintendence of ships going long voyages. At any rate the law might compel captains to take out lemon-juice, and when ships arrive with scurvy on board, an investigation as to its cause should immediately take place. The duty of superintendence should be placed in the hands of the Medical Officer of Health, when there is one in the port from which the vessels sail, or a special Medical Officer of Health should be appointed for this duty. Up to the present time no alarming outbreak of cholera in large populations has been reported this year, either in this country or on the continent of Europe. We may hope, therefore, that for the fourth time in the present century this plague has retired. It would be well if we could hope that the lessons taught by the last outbreak would be sufficiently impressive to render any further outbreak impossible. We have learned some new facts in the last outbreak we have had old impressions confirmed, and some old prejudices removed. There is no doubt now that the cholera is brought here from the East, and that it travels by means of human intercourse. The cholera epidemic of 1866 has shown more clearly than ever that this disease is dependent on a special poison, and that this poison is capable of being conveyed more particularly by the agency of water. The several outbreaks of the cholera in the towns of the continent showed that in all probability the water supply of these towns had become contaminated, whilst the outbreak of the cholera in London, confined almost entirely to one district, and that district having an impure supply of water, confirmed the suspicion which had been created by the history of the outbreaks of cholera in 1848 and 1854, that the drinking-water of the metropolis was the principal means by which the poison of the disease was propagated. An interesting meeting for the purpose of deliberating on some questions connected with cholera, took place at Weimar on the 28th and 29th of April last. This meeting consisted chiefly of German physicians, of whom the most distinguished were Professors Pettenkofer and Griesinger. Mr. John Simon attended from England. There were about sixty physicians present. The questions proposed for discussion were as follows: 1. The causes of the spread of cholera. 4. Points for further investigation. With regard to the first question, the conference was unanimously of opinion that cholera is spread by means of a poison. Of the nature of the poison, there was not sufficient evidence to arrive at any definite conclusion. Dr. Klob, of Vienna, and Dr. Thomé, of Cologne, both exhibited specimens of low organisms that they had discovered in the dejections of cholera patients. These forms were cellular, and produced by germination fungoid growths similar to those found in moulds. The Conference received with much caution these communications. It will be remembered that in this country in 1848, Drs. Britton and Swayne, of Bristol, discovered germs of a similar nature in cholera investigations. There was every reason to believe that the organisms then found were not peculiar to cholera, but that they were organic bodies of various kinds that had probably been taken into the intestines by food. Too much caution cannot be exercised in coming to conclusions with regard to the significance of these so-called cholera-spores. With regard to the propagation of cholera by drinking-water, Mr. Simon brought before the Conference the experience of London in the three last epidemics. The demonstration of water conveying the poison has not been apparently so complete anywhere as in London. Professor Pettenkofer laid his researches upon the influence of soil on the production of cholera before the Conference. He maintains that soil overflowing with sewage, and suddenly becoming exposed from the sinking of the ground-water, is a nidus for the spread of cholera-poison. This subject was one which the Conference agreed required further investigation before any fixed laws could be laid. On the second point, the utility of disinfection, the Conference was quite agreed. Where disinfectants had not succeeded, the causes were clearly pointed out, as in the movements of troops, thoroughly bad buildings, and overloaded drains and cesspools, or the use of impure drinking water. The disinfectants especially recommended by the Conference were carbolic acid and sulphate of iron. The latter disinfectant has not been much used in England, but it has one qualification that has led to its being recommended by Professor Pettenkofer, and that is its permanency and acid reaction. Other disinfectants, as chlorine, carbolic acid, and the permanganates, act well immediately, but lose their power in the course of a little time. The Conference recommend a mixture of carbolic acid and sulphate of iron for ordinary disinfection. For soiled linen it was recommended that it should be boiled, and then dipped in a solution of sulphate of zinc. This should be constantly used for waterclosets, drains, cesspools, and accumulations of vegetable and animal matter. The Conference recommended that attention should be given to the following points:-1. To lower organisms in reference to cholera. 2. To the influence of drinking-water. 3. The con dition of the soil and the influence of the height of ground-water. 4. Whether cholera be transmitted through goods. 5. The relation of cholera to other diseases coming after. 6. The spread of cholera on board ship. We may add to these notes on cholera that a Commission appointed to inquire into the supply of water for the East London Water-works have reported and confirmed the worst suspicions with regard to the impure nature of the supply of water to the people of the East of London in July last. Captain Tyler also, in a report made to the Board of Revenue, has confirmed all these statements of the impurity of the East London water-supply. Whilst refraining from giving an opinion as to whether this water contained the poison which killed the people in the East of London, he gives a fearful picture of the wretchedness of many districts that he visited. He clearly shows that during last summer large numbers of families had a deficient supply of water, and gives pictures of the dirt and misery of people for want of water that ought not to exist in a country where there is a legislation professing to care for the poor on the one hand, and a water company with plenty of water to supply on the other. It is painful to contemplate the unworthy reasons that are assigned by people in power for not exercising the slightest authority in removing from their poorer neighbours the cause of disease and death. In our last number we mentioned that a deputation of the Social Science Association was about to wait on the President of the Privy Council for the purpose of urging upon him the necessity of an amendment and consolidation of the laws relating to public health. The Duke of Marlborough and Lord Robert Grosvenor, the President and Vice-President of the Privy Council, with whom was Mr. John Simon, received the deputation on the 2nd of April. Their Lordships were addressed by Mr. Rendle, Dr. Lankester, Mr. Rumsey, Mr. James Beal, and Dr. A. P. Stewart. The point chiefly urged by the speakers, was the want of anything like unity in our sanitary legislations. Mr. Rumsey, so well known for his work on State Medicine, urged the necessity for the union and consolidation of central authority in sanitary matters, which is at present distributed between the Privy Council, the Home Office, the Poor Law Board, and the Registrar-General, producing uncertainty and confusion in local administration. He also pointed out the great anomalies which mark local administration in the provinces, the variety of boards existing under poor-law and local government and Public Health Acts; and the remarkable difference in the area and population of the districts under these several boards, the inhabitants of a district varying from less than a hundred to many thousands. He recommended an improved constitution of local boards with higher qualifications for |