1681REPORT OF PLAGUE IN CALCUTTA.-NOTES FROM INDIA.-LIVERPOOL. I

An innovation of great importance consists in allowing andindeed persuading the people to return to their rooms imme-diately after disinfection. This practice is adopted on faithin the value of disinfection and with the object of reducinginconveniences for householders to a minimum. The otherstriking plan adopted in Calcutta has been the wholesaledisinfection of streets and large collections of houses. Thisis known as " extra disinfections." The idea appears to be to

anticipate a further outbreak by destroying any poison whichmay be lying latent. It is a great experiment, and the valueof disinfection for an Indian city, in the case of plague atany rate, must stand or fall by the results in the near future.The amount of perchloride of mercury which is being dailyused must be enormous. It must be understood that thiswholesale disinfection has not been done while the outbreakwas raging, but since.The report contains many interesting tables of mortality

and maps showing the localisation of the disease to certainparts of the city. I note an almost complete absence ofthe clinical aspects of plague. This is due to the absence offacilities for observation, practically no hospital being keptnp by the plague authorities. Neither is there any record ofbacteriological work-probably for the same reason. In

Major Deane’s report I note an undertone of doubt uponthe value of all bacteriological work with regard to plague.This is exceptional, but I trust that its influence will not beinjurious. The volume before me is purely a record of plagueadministration and consists very largely of the work donein the way of disinfection. It is, perhaps, too early togather the value of the scheme so recently adopted, butwhile a cleansing of the city must do good I do not feel sosanguine of the results as the main authors of this report.In fact, I find the chairman himself writing: "I I am muchafraid that all our efforts will not prevent the occurrence of amore serious epidemic than any yet experienced." There are

many other points in the report to which it is hardlynecessary to refer, as certain sections of all plague reports aremore or less like each other. The influence of rats in the

spread of plague is discursively dealt with at the end of thevolume. I do not gather that any new facts have beenobserved but a general doubt is expressed as to their powerof diffusing the disease. They are looked upon by the authorsmore as companions in trouble than as affecting the spread ofinfection to man. With the evidence obtained in other partsof the world I cannot subscribe to this view.Taking the report as a whole it must be admitted that

the subject matters taken up have been adequately treated.There are many points omitted, however, which might havebeen included.

NOTES FROM INDIA.

(FROM OUR SPECIAL CORRESPONDENT.)

Variations in the Incidenee of Disease inDifferent Parts of- ZM<0:.&mdash;<?CM)K Some Statements on P4que 8ym-ptoms.-Military Rank or the Title of .. -Doctor."-Further Increase of Plague in India.A ItEt1$r1 of the various operations performed in the

different provinces of India, and published by one of yourIndian contemporaries, brings out the curious frequency ofcertain diseases in some parts and the rarity of the samediseases in others. Cataract, for example, so common inthe North-West Provinces, and to a lesser degree in thePunjab, is comparatively rare in Madras. Stone, which isso frequent in the Punjab, is also rare in Madras. Hydroceleis a wide-spread disease in India and is said to be acommon complaint-much more so than in Earope-butthe returns show a peculiar infrequency in the Punjab.Obstetric operations are as frequently performed in Madrasas in the other provinces, but cases of ovariotomy are

exceptionally few. They are much more numerous in theNorth-West Provinces and the Punjab. Taking Indiagenerally I may add other differences to the incidence ofdisease as compared with the British Isles. Appendicitisseems to be extremely rare in India. On the other hand,haemorrhoids are particularly common. Boils and carbunclesare much more frequently met with than at home. Onewriter in the Indian Medical Gazette says that they may beepidemic in character, that they are contagious from oneperson to another, that they are locally contagious from onepart of the body to another, and that there is an infection

of the house as shown by successive inhabitants beingattacked. Acute rheumatism is very uncommon in Indiaand cancer is not so frequent as in Europe. A recent investi-gation into the large amount of cases of fever followingthe famine shows that typhoid fever and Malta fever dooccur amongst the natives of India. The occurrence of

typhoid fever has been recognised for some years by theyounger generation of practitioners, but is still acceptedwith hesitation by the older school.

Exception would probably be made by those in Indiawho have had most experience of plague to some ofthe statements made by recent writers at home. Itis stated, for example, that the most potent agent inthe spread of the disease is undoubtedly contact withinfected persons. This is not borne out in India, forthe low contagious properties are recognised everywhere.Cases in one family or household are nearly alwayssimultaneous or nearly so-not successive at intervals as ifcaught one from another. The percentage of cases among" contacts is extremely small-less than 4 per cent.-andthe occurrence of cases amongst friends and relatives visit-ing the sick in hospital is uncommon. Amongst nativeattendants it may almost be said to be rare. Then it is saidthat boils and carbuncles in plague are rare. While it istrue that these complications vary at different places and insuccessive outbreaks their occurrence was by no means un-common both in Bombay and Poona in the first two years ofthe epidemic. Again, it has been stated that suppurationtakes place in and around the glands at an early date. Thisis quite incorrect. Breaking down and sloughing occur, buttrue suppuration is certainly delayed for a week, generallylonger.A recent article by Dr. Balfour Stewart of Liverpool treats

among other matters upon the value of Lustig’s serum in thetreatment of plague. My previously expressed opinions andcriticisms upon which you have permitted a long discussionin your columns are fully confirmed. Dr. Stewart hadexceptional opportunities of judging while on duty inBombay. The classification of plague into eight types is, tosay the least, confusing. For all practical purposes thedivision into bubonic, septic, and pneumonic, is ample, andwill include every case, so that to add nervous, toxic (orfulminant), puerperal, and two mild types is unnecessary.A curious custom has gradually been adopted by the

officers of the Indian Medical Service holding civil appoint-ments and carrying on private practice in Calcutta in givingthemselves the title of "Doctor rather than that of theirmilitary rank. In most other places the surgeon has hisrank stated on his name board, but in Calcutta Dr. -without any other title is used. Possibly the gradual develop-ment of competition with purely civilian practitioners explainsthis custom.

There has been a considerable increase in the mortalityfrom plague throughout India during the past week. Thenumber of deaths given is 2943, an increase of 795 over

that of the previous seven days. The disease is worse inthe Bombay Presidency, 2663 deaths being recorded. Bengalreturns 242 deaths, of which 11 occurred in the Sarun district.Nov. 16th.

LIVERPOOL.(FROM OUR OWN CORRESPONDENT.)

The Health (If the County Palatine.THE annual report of the medical officer of health of the

county palatine (Mr. E. Sergeant) contains a regret that thegross death-rate (17 per 1000) does not compare favourablywith the previous year, although it is below the countyaverage for the ten years ending 1898. The increase in thedeath-rate is due to an increase in the number of cases ofinfluenza and affections of the respiratory organs. Thebirth-rate shows a slight diminution as compared with 1898.Increased attention has been paid to the carrying out ofsanitary work in the county, with the result that 37 866nuisances have been abated in the districts. House-to-houseinspection has been carried out systematically and 200 houseshave been condemned as unfit for human habitation. Underthe Sale of Food and Drugs Act, 1557 samples have beenanalysed, of which 195, or 12-52 per cent., were found to con-stitute offences against the Act. The report states that the _

Vaccination Act, 1898, has worked on the whole in a satis-factory manner, and there is no reason to fear a falling-off in