would even be convenient if they were of one uniform size. Spot maps and the graphic method of representing statistics are to be commended. In the best spot maps, the ground-work of the map is shaded according to the density of the population; from those not thus shaded, a person who does not know the density of the population might draw the erroneous deduction that a portion thickly speckled with scarlet fever deaths had a serious meaning, although the greater incidence on that part was due merely to superior density of population. A sickness spot map is far superior to a mortality spot map, for it not unfrequently happens that in, for instance, typhoid fever, a large number of cases may occur which result in but few deaths. The very general adoption of the Infectious Disease Notification Act will now enable Medical Officers of Health to make spot maps of their districts for those particular maladies which cannot but be valuable. In Manchester it may be mentioned the Health Officer sends a spot map (disease chart) to each of the free public libraries and public reading rooms every week.

In the future, photography will also be largely used both as a convenient means of record and also as useful evidence in legal proceedings-the more especially since successive improvements in the instruments have rendered the operation itself simple and learned with facility. The following figure (Fig. 53), copied from one of Dr. W. J. Simpson's Reports of the Health of Calcutta, at once shows the great utility of a photograph. The picture clearly represents excessive pollution of earth and water and faulty excrement disposal.

The other class of reports are mostly made with a special object in view, that is to represent to the authority the desirability of doing something, or else they are special reports upon the action taken by himself or officers. If the Medical Officer of Health makes any recommendation, its best position is at the end of the report, and such recommendation should be in the clearest and most precise language. Once having recommended a course of action to a sanitary authority, and the course of action recommended having been ignored, the responsibility lies altogether on the authority, and is taken away from the Health Officer. It is therefore unwise on his part to show any irritation on the subject, or to caustically allude to it in subsequent reports. If the matter

waited for, and the identical thing recommended in a different for the public health of his district, a good opportunity may be

reported upon is of real importance and he considers it essential

FIG. 53. TANK IN A CALCUTTA BUSTEE WITH HUTS AND PRIVIES ON ITS EDGE.

way. Experience shows that a really necessary thing is ultimately carried, although the opposition at first be violent and demonstrative.

(438) Duties of a Port Medical Officer of Health.

Duties appertaining to an officer having charge of a port of some size will alone be considered, those pertaining to the smaller ports being only different in the amount of inspecting necessary to be performed. It must be borne in mind that by sect. 110 of the Public Health Act, all ships save those belonging to Her Majesty's Government, or to foreign governments are as regards nuisances to be treated as houses. The old quarantine Act of George IV. is still in force, but the chief regulations respecting the duties of sanitary officers are contained in the general orders of the Local Government Board of 1883.

The duties of a Port Health Officer may be divided into ordinary routine duties, and to special duties with regard to possible cholera invasion.

The ordinary routine duties in respect to the supervision of the inspectors, attendance at an office, &c., are not different to those of other Health Officers.

Naturally the most important work is in reference to the inspection of incoming vessels in which there is reason to suspect that sickness is on board. This knowledge is obtained in various ways; in a properly arranged Port Health Office, the daily and medical press is methodically perused for the purpose of learning of the existence of disease in foreign or home ports, and by the aid of the information thus acquired and from the Shipping Gazette, the vessels expected, and the approximate times of their arrival are obtained. Such ships are visited without delay, either by the Medical Officer of Health personally, or by his inspectors. Under the Quarantine Act also all diseases whatsoever on board vessels entering a port and not arriving coastwise are to be reported to the Customs, who detain the ship until she is released by the Health Officer of the port. The Customs therefore report these cases to the Health Office, and it is one of the most essential duties of a Port Medical Officer of Health to board such vessels, and to see the cases of illness, and to ascertain whether the illness is one of an

infectious nature or not. If the disease is infectious, then by section 125 of the Public Health Act, the patient may be removed from the vessel to a hospital. In large ports also the sanitary authority have made, under section 125 of the same Act, notification and disinfection compulsory on the masters. There is then this important and essential difference in the duties of land and port Medical Officers of Health. In the latter, it is no part of routine duty to visit cases of sickness for the purpose of diagnosing disease, but with the Port Medical Officer of Health, he may be daily obliged to investigate for himself the nature of the sickness, and cause the patient to be removed or not according to circumstances, and the vessel to be detained until properly disinfected.

The special duties in connection with apprehended cholera invasion are of two kinds, viz. (1) the obtaining full and early information respecting the disease, and (2) those involved in preventing the spread of infection.

The channels through which information is obtained are thus summarized by Dr. Armstrong:-1

1. Vigilant observation of records of cholera in foreign countries. 2. Arrangements with the Customs, for the earliest possible information of arrivals of infected or suspected vessels, or vessels from infected countries.

3. The publication of printed information in the port on the subject of "Cholera and its prevention."

4. Careful inquiry into the water supply of ships.

5. Inquiry into cases of ailment of a suspicious character on shipboard (diarrhoea, &c.).

6. The engagement of a sufficient staff.

7. The keeping of a " Homeward-bound Register."

8. The provision of special accommodation for cases of cholera. (See also ante in the chapter on cholera.)

(439) The Report of a Port Medical Officer of Health.

In the 16th Annual Report of the Local Government Board (Supplement) is given Mr. Armstrong's annual report to the River Tyne Port Sanitary Authority for the year ending December 31st, 1886, as an example. It would therefore be well, as this report has

1 Public Health, vol. i. p. 40.

received official sanction, to follow its arrangement as far as practicable. The following is a general outline of the report:

1. Infectious Disease in the Port.-Under this heading is given a short succinct history of the cases of infectious disease admitted into the isolation hospitals, the diseases reported on various vessels from foreign ports and similar matters.

2. Cholera Precautions. In this section details of the special precautions against the importation of cholera are given, and a table shows the number of vessels which arrived from infected ports during the year.

3. Hospital Accommodation.-Under this heading the nature of the existing hospital accommodation is given.

4. General Sanitary Work.-This is the most important part of the report. It gives the total number of vessels arriving in the port, the total number of vessels inspected, their nationality, and a summary of their sanitary condition.

The number of notices served to abate nuisances or structural or other defects are given as follows:

Notices were also served or orders to abate nuisances to remedy sanitary defects, either in the crew spaces, closets, peaks, holds, or bilges, as follows:

(440) The Duties of a Medical Officer of Health in a Combined

District.

These are somewhat different in detail. If the district is of any great extent it is practically impossible for the Health Officer to attend daily at any office, and personal interviews must take place