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compulsory notification of infectious diseases. The duty of reporting is "dual," or imposed on the medical attendant as well as the householder, a system which at the present time is much favoured by sanitary authorities, and it has also the approval of the Local Government Board. Although on this point there is much diversity of opinion, experience shows that information of disease received from the medical practitioner is more prompt and reliable than when coming from the householder, so that whatever method of notification is adopted the responsibility will in the end rest with the medical man. The advantages of notification are now generally acknowledged : in the case of small-pox the disease can be kept in almost perfect check, scarlet fever may be restrained, and there is less danger of the disease being spread broadcast by children attending school in the "peeling stage." In typhoid fever and diphtheria early notification of the existence of diseases is of equal importance, and owing to the knowledge gained we are often enabled to rectify defective drainage, or take means to prevent the dangers which would arise from polluted water or contaminated milk, isolation of these diseases in the hospital being not always practicable. The total diseases notified since our compulsory clause came into force, amount to 7217, made up as follows: small-pox, 323; scarlet fever, 4106; diphtheria, 110; fever, 1151; puerpural fever, 35; and English cholera, 13. During the three years ending 1880, measles was on the list of diseases to be notified, and information was received concerning 1453 cases.

Without a hospital for the isolation of infectious diseases, the benefits derivable from notification would be limited, and on that account the provision of means for the seclusion of the infected sick ought invariably to precede notification. The extent of the hospital accommodation is influenced by notification, for when the latter is carried out efficiently, a small hospital is sufficient for the isolation of the infectious disease which may from time to time occur, but if on the other hand, these first cases owing to their existence being unknown are not secluded, an epidemic is probably the result, and the largest hospital may be inadequate to meet its demands. The Borough fever hospital was built in 1883, but it was not until January 1884 that we had occasion to send in any patients. The hospital has had a continuous use and secured a good reputation which is of much value, as it practically enables us to effect a removal without difficulty in any case we consider desirable. The following cases have been annually treated, 62 in 1884, 120 in 1885, 208 in 1886, and to the end of August this year, 177 cases have already been admitted. The proportion of patients

admitted to diseases notified show an increasing ratio, last year it was 51 per cent. as against 46 per cent. for 1885. The table below gives particulars of the total cases admitted.

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The death-rate of patients treated has been very favourable, and it is fair to assume that cleanliness, good air, careful feeding, and efficient nursing have beneficially influenced the course of many cases, especially those removed from the houses of the filthy and improvident. The patient is also benefitted by exchanging gloomy, and perhaps unsanitary surroundings, for attentive treatment in a spacious ward, pleasantly situated and provided with all the accessories to make the necessary detention as cheerful as possible. Scarlet fever patients are generally sent into the hospital after the rash and sore throat have decided the diagnosis, and the average duration of treatment in the hospital-and, in my opinion, continuance of "infectiousness"-was, in 1885 and 1886, forty-one days for each year.

The average stay of the typhoid patients treated in the hospital was also forty-one days, and of small-pox thirty days. The total cost of maintenance per patient for last year was only 14s. weekly during the average duration of treatment. By Sec. 132, Public Health Act, a local authority may recover cost of maintenance of patients in hospital, but this power has never been exercised in Bolton, and all residents in the borough, who are not paupers, have an equal right to be admitted. We believe that while good nursing and hospital treatment may prove an advantage to the patient and his friends, the community is equally benefitted in effecting the complete isolation in hospital of infection so that it may cease to be a source of public danger. Hence we avoid the delay and unpopularity which would undoubtedly arise if payment were insisted on in any of the cases admitted.

I may briefly explain that our hospital has already cost over £9000, it is built on the pavilion principle and provides accommodation for the treatment of thirty-two adults, with 2000 cubic feet of air space per patient, and for eight children in cots. The building consists of two one-storied pavilions, an administrative block, and a mortuary and laundry block. The two pavilions are exactly the same in construction, and are placed 60 feet apart with a due north and south aspect, an open verandah runs along the south front of each pavilion, and from the centre of each verandah, and opposite the pavilion entrance, an open covered passage, semi-circular in form, leads to the administrative block, which is a two-storied building. The various buildings are supplied with the usual accommodation required for the purposes of nursing, and great attention has been paid to ventilation by means of warmed air, and to the removal of vitiated air and the offensive products of gas combustion.

The sewage is treated on the premises by precipitation and filtration, and the excreta, contents of beds, and other objectionable matter, are burnt daily in a specially constructed furnace, called an Incinerator, which is found to be of the greatest value. The hospital stands in about three and a half acres of beautifully laid out grounds, and this year a site for a new pavilion has been prepared, and the administrative block enlarged so as to be in readiness for an extension which the increasing popularity of the hospital will soon render absolutely necessary. For disinfection at the hospital we rely chiefly on washing after thorough soaking in a solution of carbolic acid. A small hot air disinfector is in use for articles that cannot without damage be washed in boiling water.

The town disinfection is conducted at a disinfecting establishment at School Hill, which is also provided with a wash-house, mortuary, and furnace for the destruction of articles very filthy or not worth disinfecting. For over nine years the disinfection was conducted in two hot-air chambers, but the process was never considered reliable, for we found that the temperature in different parts of the chambers varied considerably, and after the application of a scorching heat, say 250°, to certain bulky articles, as beds, mattresses, &c., for four or five hours, the temperature registered in the interior of the article was seldom higher than 150° to 180° F. With the new process, which has been in operation about twelve months, namely, superheated steam under pressure, the process of disinfection is more expeditious, for the steam is evenly distributed in the chamber and rapidly permeates the most bulky articles, and it is interesting to know, from the researches of Klein and Koch,

"that the complete penetration of an object by steam heat for more than five minutes is sufficient for its thorough disinfection." Our steam apparatus is the one patented by Washington Lyon, and so far it has done its work admirably.

The next subject I desire to bring before you, namely, excrement removal, I approach with some trepidation, as it is surrounded with practical difficulties of no ordinary kind. The question was considered in Bolton so far back as 1874, and it was then decided to adopt the Manchester pail system, and this has been followed with some modifications to the present time. We have now in use 6,000 dry ash closets, 8,670 old ashpits, and 1,400 water-closets. Many of the large and offensive ashpits have been converted to the new system, and the effect has been to raise the tone of health of the improved district and lower the deaths from diarrhoea. Water-carriage under favourable circumstances seems to my mind the most complete, most decent, and best adapted for large populations, but many towns from deficiency of water-supply, or owing to the condition of the sewers or outfall, are not suitable for water-carriage. In such cases some form of pail system should be adopted which will allow the refuse to be frequently removed.

The old privy, or midden, which provides for the storageperhaps for months-of fæcal matter, together with all kinds of animal and vegetable refuse within a few feet of the very atmosphere we breathe, is abominable, and ought to be prohibited by law. According to Dr. Buchanan, in all towns where the refuse matters are not removed frequently there is a higher death-rate, especially among children, than where the refuse matters are speedily removed. I do not propose to consider the details of the various forms of pail closets; to my mind the principle involving prompt removal of refuse is good, and the special system adopted is of minor importance. The following classification includes most of the systems in use:

1. Pails without absorbents.

2. Pails with absorbents as ash, earth, &c.

3. Pails with appliances to drain off the liquid portion.

When pails are adopted, the mechanical appliances of the closet should be as simple as possible, and the local authority should be provided with vans, suitable air-tight lids for the pails, and use the greatest care to transport the excreta to the depôt without smell. The cost of collection is increased somewhat, but then the important bearing of such removal on health, as against storage of foul matters in ashpits, should influence largely the consideration of the question. In this town, it has been calculated that the annual cost of scavenging

per house on the new system is 5s. 3d., as compared with 3s. 7d. per house on the old system. The increased cost of scavenging is no doubt large, and one can understand how easy it is for our complicated form of ash-closet to get out of order, especially in the poorer districts of the town; but then, are we justified in reverting to a modified ashpit? or in simplifying the present pail-closet? To my judgment the latter plan seems to commend itself. The bulk of the refuse of the town is taken to an admirably arranged depôt, erected at a cost of £30,000, called Wellington Yard.

The excretal refuse is there ground up with fine ash and formed into a crude manure which is sought after by the farmers, and may be stored in large quantities without producing a smell. The other refuse consisting of cinders, vegetable and house refuse of all kinds, is consumed in what is called Fryer's Destructor, and reduced to about a third its bulk. The outburn from the furnace consisting of clinker is ground up with lime and forms mortar. The amount of refuse consumed daily in this way is about sixty tons, and the mortar produced shows a handsome profit to the department of nearly £1,000 a


The time at my disposal will not allow me to do more than refer to the other sanitary works of the town. The new sewage works at Hacken many of you visited yesterday, and had the advantage of a detailed description from the engineer. The arrangement of detritus tanks, settling and mud tanks with the turbine and pump driven by effluent water, seem beautifully adapted both theoretically and practically for efficiently dealing with the sewage of the town and district. The clarifying agent now in use is milk of lime with ground cinders which have passed through the fire of the Destructor, and this is mixed with the sewage at the old works at Burnden, but the apparatus is equally well adapted for the employment of any other precipitating or purifying agent as carbon, alumina, &c. The total cost of the works was a little over £30,000.

The waterworks will be visited on Saturday next and during your stay in Bolton you will have the opportunity of noticing that the water is soft, clear, and of good quality for drinking purposes. The total gathering ground is 3,166 acres and the storage capacity of our reservoir is about 1,000,000,000 gallons. The average daily consumption of water in the town and surrounding district is 5,600,000 gallons, representing a supply of nearly 22 gallons per head daily, for domestic purposes, and 6 gallons per head for trade purposes. The filtering tanks, four in number-three being in use at one time, have a superficial area of 10,000 square yards, and are capable of filtering

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