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All of the infants were artificially fed, and great care appears always to have been exercised in their dieting. The same conditions as to weather, &c., existed prior to the outbreak, and the uniformity in symptoms and sequence of cases left no room for doubt in the mind of the Medical Officer of the Institution that these infants were infected in some way by the child Lily Kelly, admitted on July 7th.

With this view I fully concur, since the facts corroborate what I have observed over and over again under ordinary domestic conditions, viz., that when acute autumnal diarrhoea attacks an infant, other infants, or young children, or even occasionally adults, who happen to be brought into contact with the sick one, do themselves very frequently develope symptoms similar in kind, though modified in degree. That effluvia from offensive fœcal excretions are capable of exerting a prejudicial influence upon those who inhale them is beyond question; it seems a point of common sense that infants suffering from acute autumnal diarrhœa should be so isolated that their evacuations shall not possibly become a source of infection to the other young children, or other members of the family.

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Mr. S. W. NORTH (York) said some two years ago about a hundred and sixty cases where children had died from diarrhoea, and he found that the cases where there were two sick in one house were very rare; he believed there was an epidemic and contagious form of diarrhoea, but the majority of cases of summer diarrhoea were not of an infectious character.

Dr. J. F. J. SYKES (London) said that in his district typhus was happily unknown; it was purely due to local congestion of a population with insanitary habits, and the remedy was so simple that it was nothing short of a disgrace that typhus should exist at all; and he sincerely trusted Dr. Hope would try to stir up the Liverpool people in this matter. As to diarrhoea, he believed there was a good deal directly due to injudicious feeding. He thought with Dr. North that infectious disease also did frequently exist as a cause, and it was their important duty to try and differentiate between the two; they should not attribute it all to germs in the water, although it was probably one of the many causes, for diarrhoea was only a symptom of various diseases.

Dr. F. M. CORNER (Poplar) said that according to his experience,

which was not great with regard to typhus, it had been due to the habits of the people; certain families would live like pigs, and everything would get into a shocking condition with animal reekage. Undoubtedly this disease arose through crowds herding together, and the filthy habits of this class of people. In gauging the mortality of diarrhoea they rarely found out whether the cases were hand-fed or from the natural milk; it was a great shortcoming in their returns, because many of these deaths should be attributed more to injudicious feeding than to diarrhoea attack.

Dr. J. F. TATHAM (Salford) thought Liverpool ought to be congratulated on the fact that it had an assistant Medical Officer of Health with a remarkably good temper. It was enough to make one's blood boil to read in his report that so recently as the years 1882-3, the cases of typhus were numbered by thousands. He did not think the medical men had acted as they should have done. The Corporation of Liverpool had spent thousands of pounds in rectifying unhealthy areas; the health committee of the city had not been supported as they ought to have been in their effort to provide for the compulsory notification of infectious diseases. The present state of things was a cruelty to the public and to the poor wretches who were exposed to the ravages of this frightful pestilence; it was also an iniquity to the other authorities living outside. It appeared to him that Liverpool acted as a fever manufactory for the whole of Lancashire. They in Salford had frequently cases of typhus imported from Liverpool, and they were undoubtedly prejudiced by the fact that Liverpool did not possess powers for the compulsory notification of infectious disease. The facts stated by Dr. Hope showed the necessity there was for the keenest vigilance on the part of Health Authorities and their officers; they had to run great risk, even of their lives, by their daily contact with typhus and other fevers; and if only for this reason, they ought to be clothed with those protective powers which most other great authorities in England possessed. He felt a little ashamed of his professional brethren in Liverpool, that they would not allow the authorities to obtain these powers. Dr. Hope's paper was a serious indictment against the state of things at present existing in Liverpool.

Dr. E. W. HOPE (Liverpool) said it was certainly a most extraordinary thing that they had in Liverpool such an enormous amount of this disease after it had been stamped out in almost every other town. They had in Liverpool, however, an immense poor labouring population, and notwithstanding the large staff of lodging-house inspectors and sub-let house inspectors, their mode of life was something beyond description; it was shocking to see the manner in which these wretched creatures liked to huddle together. If turned out of one district they migrated to another, and quickly made it as bad or worse than the one they left. He made it a practice not to go into these houses until the windows had been opened for some


minutes, and he gave the inspectors similar instructions. He believed the people of Liverpool would welcome some measure for compulsory notification, and he thought the medical profession would also, did they know of the amount of evidence collected during late years. might have been that the matter was prematurely brought forward, or that evidence was lacking to show the absolute necessity of it previously; but to his knowledge hundreds had suffered, and hundreds of persons had lost their lives owing to the want of some system of prompt notification. It seemed at one time to be looked upon almost as a point of honour to throw every difficulty in the way of the Medical Officer of Health in this respect; he hoped this feeling was rapidly disappearing. Immense structural alterations had taken place at Liverpool, and it was gratifying to find that the cases were dwindling down from thousands to hundreds, owing to the great sanitary operations carried out in the city.






IN availing myself of the privilege of addressing the members of the Congress in this active and stirring town, which is spreading itself out in every direction, I have thought it well to bring before them a subject of great interest, but which has not been hitherto much discussed, viz., the extension of our great cities and the erection of new ones; and to suggest such a course as would ensure that such requirements as are now considered to be necessary for their healthful occupation may be provided for at the outset.

In ancient times the creation of a new city almost implied the foundation of a new colony.

In mediæval times towns have risen round monasteries or churches of Bishops, as Mr. Freeman shews was the case at Wells, Lichfield, and Sherborne; or round a castle, as at Windsor and the Yorkshire Richmond.

But, within our own times, numerous towns, such as Fleetwood, Crewe and Southport, have suddenly sprung into being; whilst, from each of our large cities, extensive suburbs are being pushed out, forming, in fact, new towns.

Of the conditions to be noted in selecting a site for a new city, we have descriptions by writers of all ages, from Vitruvius in the first century to Dr. Parkes in his well-known work of our own time. But this is a subject too large for a short address, and it is of the extensions only that I wish now to speak. They have, almost invariably, been carried out by speculators without any general definite guiding plan, with little or no forethought

*Freeman's" Exeter." p.

for future extension, and with slight provision for supplying the inevitable future wants of the inhabitants. Thus, in course of time, spaces have to be cleared out for churches, schools, institutes, baths, and such like edifices as are now required for a large population, and clearances have to be made to allow for its free breathing. The extension of the cities take place in different directions and from different motives.

The well-to-do citizens leave their smoky town and confined houses to form new suburbs, where they may breathe freely in their open gardens.

The artizans cluster together at first for cheapness and for nearness to their work. Then comes overcrowding and then sanitary acts, and then suddenly the neighbouring fields are invaded, and acres of ground are covered with new small houses, put up as a speculation in the cheapest way, with just so much breathing space as the Local Bye-Laws (if there be any) will


Now if this be the time of activity in building new towns and extending old ones, it is also pre-eminently the time of activity and power in corporate bodies. From Town Councils to Vestries from Trade Guilds to Trade Unions-from companies formed for their own benefit and companies formed (all honour be to them) for the benefit of their fellow citizens-an active part is being taken in public work.

New and extensive powers are being acquired and exercised by Corporations for the sewage, the supply of water and of gas, for providing open spaces, regulating the width of streets, and even the height of rooms and size of windows. Bye-Laws are sufficient evidence of this.

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Now I simply wish to extend these powers. I wish that when it may appear evident to a Corporation that any district will require before long a large accession of houses for a population which is clearly increasing to an overflow, such Corporation shall have the powers (and I think that public opinion will require it to exercise them) to acquire control over the requisite land-to formulate a general plan, giving the width and direction of the streets-to provide spaces for such public buildings as are certain to be required in a well regulated community, and for such open spaces as are required for its healthy enjoyment.

My scheme is not a very grand one in any respect; I simply want to provide at first for those requirements which must eventually be provided for, and which can only be fulfilled at a great cost, and even then imperfectly, if not so provided at first.

Bolton Corporation Waterworks, 1881, and Bolton Corporation Act, 1872, 1877, & 1882-pp. 8, 26.

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