JTuxu 29, 1895.] THE MEDICAL INSTITUTIONS OF LONDON. [TM1a. 1451 2 I myself strongly incline to the view that an infintesimal alleged specific fouling of their waters by that case lends amount of the poison of enteric fever in drinking water is itself to corroborate the strong probability that the outbreak eufficient to cause the disease in those consuming the water. was in fact thus brought about. Indeed we know, from eminent bacteriological research, We have seen already in milk outbreaks of typhoid how a that the bacillus of enteric fever is, when present in water, great many of those using the infected milk escape the dis- there only in proportion relatively small; and that the ease, not because they are not susceptible to the disease, but organism even when present in water in the bulk, may be on account of the fact that the infective germs of the fever entirely absent from the small quantity submitted for exa- are not uniformly distributed in the milk, hiouseholds thus in mination. And again, other microbes may be present so many instances receiving milk free from the dangerous in- numerously in typhoid-polluted water as to render obscure, gredients which are contained in that supplied to, it may be, and even to prevent recognition of, the scantily present the very next house to which the milk is taken. May it not bacilli of typhoid fever. This was prominently brought for- well be so with water in reference to the germs of typhoid? ward in the case of the Worthing outbreak of 1893. (See also Professor Koch has stated that when enteric fever is found AppendiX A.); and again finds place in the report of the to be occurring in largely increasing quantity over an area Royal Commission on Metropolitan Water Supply. On the supplied with the same water and unconnected case with case, question of the amount of polluting material necessary to it will be well to seek for evidence of water as the cause. induce typhoid as the result of consumption of water, Pro- In any case, pending the settlement of the vexed ques-ion fessor Odling seems to regard " a very considerable dose " as of the direct relation between rivers and typhoid as cause -essential; and others appear to hold the same view. But Dr. and effect, would it not be best to take the excellent advice Sims Woodhead admits that in respect of typhoid, knowledge offered by the late Sir George Buchanan ? I refer to his state- on this point is not definite. He even says that the entry ment that if populations are so situate that they must needs into a domestic cistern of one single specimen of the bacillus pollute the river on whose banks they reside, the river should of typhoid might, by reason of multiplication in the cistern, be frankly recognised as unclean. prove a danger to all the household consuming the water. " Thus," he says, " regarding rivers as sources of drinking Coming to an actual occurrence, additional to that water, one of two positions ought, I submit, to be consist- of Caterham, where the evacuations of a single typhoid ently aimed at-either that, being a necessary source of patient may be regarded as in all probability the start- domestic water supply, the river shall be absolutely pro- ing point, indeed, the vera causa of an alarming epidemic tected against pollution; or else that, being (in whatever of the same disease, I would here like to draw special degree) used as a sewer, it shall be classed as not fit to supply attention to the prevalence of the malady at Black- drinking water." burn in 1881. The outbreak embraced in all 260 attacks in For the rest as regards this particular instance of the Tees the period February to May of that year (No. 128),- and Dr. epidemic, I am content to know that the chief medical Airy, in his careful and elaborate report, sets forthwith great adviser of the State on public health matters, Dr. Thorne clearness the details of the occurrence. I shall have occasion Thorne, has (as previously stated) said, in presenting the at a later stage to refer at greater length to this instance of report which Dr. Barry made upon it, that " seldom, if ever, waterborne typhoid, but treating of it here from the point of has a case of the fouling of water intended for human con- view of great harm following small beginnings, I will leave sumption, so gross or so persistently maintained, come for the time the general question of water consumption and within the cognisance of the Medical Department, and fever as cause and effect. seldom, if ever, has the proof of the relation of the use of Dr. Airy records how, in his opinion, the dejecta from a the water so befouled to wholesale occurrence of enteric fever single case of typhoid at Shorrock's Row, Guide, shown in been more obvious and patent." the plan given at a later stage, gave rise to the epidemic. He [To be continuel.] puts out at some little length how the drainage of the privy, into which the dejecta were Cast, could have found its way into the reservoirs which supplied Blackburn. The case was one of undoubted typhoid, and the evacuations had carbolic acid cast over them by an unskilled labourer, neither the BRITISH MEDICAL ASSOCIATION.' health officer or nuisance inspector proceeding to the spot, despite the fact that the town water service was palpably SIXTY-THIRD ANNUAL MEETING THE endangered at the place of occurrence. The attack was cer- OF tified on February 22nd. A reference to the plan will show BRITISH MEDICAL ASSOCIATION the manner in which the public supply was threatened, and IN LONDON, 1895. when I have occasion to mention this outbreak on a later page, I shall have to point out the extreme liability of the cul- vert furnishing water to the borough to pollution from the THE MEDICAL INSTITUTIONS OF LONDON. row of houses in which this case was treated. I need not (Continued from page 138)1.) follow Dr. Airy through the successive paragraphs in which he seeks to prove that the Blackburn water was liable to THE RISE AND FALL OF THE PRIVATE MEDICAL contamination by these specif£c excreta; let it suffice when I SCHOOLS IN LONDON. state in his own words that " it appears that in the latter part of February every section of the water supply of Black- By D'ARcy PowEB, M.A., F.R.C.S.Eng., burn contained more or less of the water that had passed Demonstrator of Surgery at St. B%rtholomew's Hospital; and Surgeon to through the conduit under Shorrock's Row. Therefore, sup- the Victoria Hospital for Children. posing the conduit water at that time to be the vehicle of IV.-BRooKxSIs SCHOOL, OR THE BLENHEIM STREET OR enteric fever, we can see how a general outbreak of fever in GREAT MARLBOROUGH STREET SCHOOL. the early part of March in different parts of the town might BROOKES's SCHOOL was a private speculation of Joshua be accounted for." Now there were three reservoirs to which Brookes, the brother of the celebrated menagerie keeper in the drainings of the dejecta could have found their way- Exeter 'Change. He was born November 24th, 1761, and was namely, Guide, with acapacity of 90,000,000 gallons; Fishmoor a student of the Great Windmill Street School; and he after- Lodge, 310,000,000 gallons; and Audley, 12,000,000 gallons. wards studied under Portal in Paris. His school was situated Wme are told that the second had only 50,000,000 gallons in it in what is now known as Ramilies Street, at the foot of *h*u Dr. Airy was there, so that there could not have been Blenheim Steps in Oxford Street, and was the last building -poX than a total of 152,000,000 gallons at most when the in- on the left beyond the Mews as one goes down the steps quiry was held; but how much less is not told us. Here by the side of Buszard's shop, just before turning into tbhu is an outbreak undoubtedly due to waterborne infection, Great Marlborough Street. The school was established Xd4i; which detailed inquiry enables only one attack to be solely to teach anatomy, and the summer course wias loohe upon as the origin of the large epidermic among a vast especially well attended ; for Brookes had invented, a body' ot people drinking from three different storage reser- method of injecting his. subjects with nitre,, which fitted vois, whose relationship at a time coinciding with the them for dissection in the hot, weather, wheni tlere 1452 TEaJOzA] THE MEDICAL INSTITUTIONS OF LONDON. [JUNE 29, 189& Brookes's School (from a water-colour drawing made June, 1817, now in the possession of the Royal College of Surgeons of England). were no regular classes in the large medical schools attached V.-DERMOTT's SCEOOL: THE GIERRARD STREBET OB LiTrm to the hospitals. For this method he was made a Fellow of WINDMILL STREET SCHOOL OF MEDICINB. the Royal Society. Mr. South says that he literally spent This school originated directly out of Brookes's school, for the whole of his day in the dissecting room, and that he taught Dermott had been an assistant in the Blenheim Street School his students entirely from dissected parts. using neither for a year or two before Brookes died. This event happenec plates, diagrams, nor blackboard sketches. He worked with in 1833, a fortnight before the session opened, and as Dermott such assiduitythat hewasrecognised throughoutEurope as the was unable to obtain possession of the premises, he bought.