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which a considerable increased expenditure has been cast upon the
Metropolitan local authorities. The chief increased expenditure
will be the removal of snow, as the provisions for the removal of
Just and ashes from houses, although the penalties are stringent,
yet there will be, except in very bad weather, little extra cost
incurred bv neglect to carry out the provisions. There are sections
against manufacturers, slaughterhouse keepers, and others allowing
the drainage from their works or from manure running over an
open space or footpath, and also increased powers to inspectors of
nuisances as regards the removal of "manure, dung, soil, filth or
other matter which ought to be removed." These powers give
increased facility for the removal, but in so doing considerable
extra cost may be involved. Bye-laws may be made by the
London County Council as regards various matters, which, with
the general alterations in the Act, including the pressing obligation
of a regular and systematic examination of all the houses in the
district, will render the appointment of additional inspectors of
nuisances absolutely necessary. For instance, the increased supervision
required to carry out the Act as regards workshops and
smoke nuisances would take up the entire time of one inspector.
The provisions now in force for compelling the supply of water to
houses and to the water-closets therein, have been much extended,
and will doubtless meet numerous cases where great difficulty is
now experienced. The extent of the benefits conferred will,
however, depend to a great extent on the bye-laws to be made.
Many of the additions and alterations will be referred to later,
suffice it now to say that considerable alterations and improvements
have been made in the legal procedure necessary to obtain
the abatement of nuisances, but no summonses can be taken out
except on order from the sanitary authority.
Diphtheria outbreak at Clapton.—The causation of diphtheria
seems as little known now as years ago. During the whole time
I have been Medical Officer of Health for Hackney, I have devoted
especial attention to the subject and arrived at certain conclusions.
One is that it spreads from person to person, and perhaps through