1909

from week to week. No doubt is entertained in any quarterthat they are complete. That the first case discoveredwas the first case in reality is most probably the truth.It was certainly-the word is here used deliberately-notpreceded by any important number of minor or of ambulantcases; one or two such there may have been ; more theresurely cannot have been. And if early in the epidemic itshould be guessed that there may have been some oversightof declared or bubonic cases they diminished very quickly atall events; but the general feeling is that there never canhave been more than (say) half a dozen at the outside. Thisis the opinion of all in a position to judge-of the residentstaffs at the hospitals, for example, and of the staffs of thedepartment of public health. As regards the latter, nodoubts are entertained by it ; it has the confidence of theprofession which knows that its members will be rationallydealt with. A good many cases have been reported rather late,and even occasionally after death under medical care ; butno one who has been puzzled by early symptoms fears that hewill be rudely brought to book under the law, or thathe will be asked publicly to explain his delay in reporting.On the other hand, all have learned that anything like wilfulconcealment or gross delay in reporting (in the case of otherinfectious diseases dealt with under the same law) is dealtwith strictly. But the distant critic unacquainted with localconditions will be inclined to argue that wilful concealment of

cases has occurred. He will refer to the early cases-if,indeed, cases of plague they were-in Calcutta. But the truthis that no evidence which would enable a reader to form anopinion was adduced regarding them; a bare statement thatthe bacillus was observed comprised it. What, exactly, itwas that was seen was not described; and whatever thebacteriological competency of an observer may be that, in acase where the possibilities of mistake are many, is not

enough. From other quarters the evidence of precedentcases of ambulant plague-those, namely, in which there isrecognised glandular swelling-is that practitioners remem-bered meeting with such cases which " must havebeen " plague, only after plagne had become epidemic.Now, at first, attention was often drawn in Sydneyto instances of glandular swelling, but they were almostalways easily traced to one or other of the recognisedcauses and in reality were reported for protection ; hardlyever had the patient any symptom of general illness, but theswelling was chronic, or at least of long standing. In oneor two cases the cause of the swelling could not be madeout, but then the most careful consideration and bacterio-logical examinations failed to afford the slightest support toa diagnosis of plague. In short, with as thorough a know-ledge of plague as could be got from epidemiological andclinical study of accounts of the disease and its outbreaks,

’ acquired long before the disease actually appeared here,nothing at all has been observed to support the notion thatthose causes of incompleteness in the epidemiological accountswhich have existed or have been assumed in other cases haveoccurred here. The great importance of this matter inrelation to certain etiological views is a good reason for

writing upon it at some length.There is little of interest to note except the diminished

number of new cases for the week already shown above.The Millard house on having its floor taken up revealed a drysandy soil and nothing else. The newly admitted casesshow the same degree of virulence in the infection as at firston the average. Inoculation has recommenced; arrange-ments have been made for inoculating the inhabitants of theinfected area and those employed there in preference toothers, but comparatively little interest is shown by thepublic. On the first two days a few more and a few less tthan 100 respectively presented themselves.May 15th.

______________

1 Papers relating to the Outbreak of Bubonic Plague in India toMarch, 1897.

THE DURHAM MEDICAL GRADUATEB’ ASSOCIA-TION.—The annual meeting of this association, followed bya dinner, is held alternately in London and Newcastle-on-Tyne. This year the turn of Newcastle came, very oppor-tunely on the eve of the visit of the Prince of Wales. ManyDurham graduates practising in London were present. Theassociation is prosperous and betrays a warm affection forits alma M67*. The dinner was held at the Grand Hotel,Barras Bridge, and was ably presided over by Dr. W. C.Beatley.

THE UNIVERSAL EXHIBITION AT PARIS.

(FROM OUR SPECIAL COBRESPOBDE1T.)

Opening of the International Congress Season.- G’1’aplwlogy.- Agrwult1tre and Health. - (grocers and Health.-11-onzeib’s Work and Health.-The Housing (If the Poor.

THE season for international congresses has now fairlybegun. There were only three such congresses in the monthof May, but 23 are taking place during the course of thismonth. The congress which in the month of May attractedthe most general attention was that of graphology ; a

fact which is not surprising when we remember how

experts in handwriting quarrelled over the celebrated

Dreyfus bordereau. I am not aware, however, that any-thing was said about the graphology of medical prescriptionsthough this was certainly a subject on which a very interest-ing paper might have been written, beginning with someaccount of the mystic invocation to Jupiter which heads aprescription and concluding with some sarcastic allusions tothe art of illegibility. Among the congresses that havealready been held this month was that of the friendly andbenefit societies called Le Congres de la Mutuality. Whenthe medical profession is better organised it should contriveto have a voice at such gatherings so that the other side ofthe questions treated may be brought forward. As it was we.were treated to panegyrics on the advantages of thrift andon the benefit and growth of organisations the principal’object of which it is to provide for a rainy day. Of courseall this is excellent so far as it goes, but to accumulate vast.reserve funds at other people’s expense is not quite so esti-mable a performance. That the working classes and thesmall trading classes should be praised for such foresight.and economy as they have displayed is quite rightand proper, but at the same time it should be knownthat a part of these funds is not the result of economy andsaving but the direct profit obtained by sweating membersof the medical profession. It does not suffice to say thisoutside; it should be repeated within such congresses, so

that it might be heard and understood by those who areresponsible for the widespread grievances that afflict a largesection of the medical profession in most countries. Anotherimportant congress was that of the grocers. I have notmuch to say about this meeting beyond mentioning thefact that there was an imposing British delegation ofover 100 members. Considering how at scientific inter-national congresses, such as that of hygiene, GreatBritain is often very feebly represented, I must confessto a feeling of discouragement when I found thatthe grocers manage these things much better than themedical profession. But the grocers had also some thingsto say that affect public health. They were loud andbitter in their complaints against the truck system andagainst trusts which not only ruined legitimate tradebut which, by abolishing competition, placed the public atthe mercy of the monopolists. Such monopolists could moreeasily foist unwholesome articles on to the public, or sell.things at exorbitant prices. The delegates, though theyrepresented the master grocers, very generally agreed thatthe hours of labour for their shop assistants were too longand that they should be reduced. In this respect Englandwas mentioned as a model nation where there is not onlycomplete rest on Sundays but generally a half holiday in the?middle of the week. It would be worth while holding suchcongresses if for no other purpose than to spread this customto other nations among whom the exaggerated duration ofthe day’s work for shop assistants has a very detrimentaleffect on’public health.M. Casimir-Perier, formerly President of the French

Republic, presided over the Congress on AgriculturalEducation. He eloquently urged that every effort should bemade to render education in agriculture at once attractiveand easy, for it was most necessary to check the continualmigration of the rural populations to the great towns.Though most of the speakers supported this view from theeconomical standpoint its importance as a question ofnational health and national defence was also admitted. Itis from country districts that the best soldiers are recruited,

and this for the simple reason that rural populations are

healthier than town populations. In the name of the FrenchGovernment M. Jean Dupuy, Minister of Agriculture, wished

1910

the delegates welcome, so that the congress had a good setoff. Mr. Sutton represented the British Royal AgriculturaSociety, and there were influential delegations from th<United States and most of the European nations. Herethen, was another opportunity, while keeping well within thEprogramme of the congress, of propagating principles anc

projects of reform which would not only promote the in.terests of agriculture but also benefit the public health. The

principal resolution adopted by the congress was in favoulof teaching in universities and high schools those scienceswhich bear upon agriculture, such as chemistry, zoology,botany, geology, vegetable pathology, bacteriology, &c.Needless to point out, though the agriculturist would studybacteriology in view of preserving vegetable life and thelives of cattle, 8;,c., he would not faij to realise that in manyrespects the same principles apply’to the preservation ofhuman life. The brotherhood of the sciences is an un-deniable fact and a most beneficent fact, and hence sanitaryreformers are well within their scope of action when theywish every success to the scientific agriculturist. Besides,on agriculture depends our food-supply and therefore it wasbut natural that several medical men should attend this

congress. Dr. Cathelineau, for instance, read an interestingpaper on the bacteriology of milk, insisting also that butteroften contained the bacillus of tuberculosis and that there-fore milk should be always sterilised. As the dairy industrydepends on fermentation it should be conducted underconditions of the most perfect asepsis. There was also agood deal said about the cultivation of the vine and the

necessity of legislation to prevent the adulteration of wine.The sale of cheap pure wine best contributed to prevent theevils of alcoholism, therefore a resolution was carried infavour of abolishing all local taxation (octrois) on wine.When natural wines became scarce and dear they werereplaced by manufactured alcohols, with the result thatthere was invariably a great increase in drunkenness, crime,and insanity. The agriculturists in wine-growing countrieshad to be taught not only how to contend against thediseases that devastated the vineyards, but also how to

employ such precautions in the making, bottling, &c., ofwine that it would be able to travel and to keep withoutbeing strengthened by adding the more or less poisonousalcohols of commerce. Thus in many ways the Congress onAgricultural Education treated questions that might appro-priately find a place in a congress of hygiene.Then there has been an immense gathering of women-

women politicians, women of science, and women authors andartists ; but far more numerous than all these were the womenengaged in works of charity and philanthropy. It was the

Congres des CEuvres et Institutions Feminines. I am notaware that there is a good equivalent in the Englishlanguage for the word " couvres." It means work, but workfor a particular purpose or mission, and all charitable organi-sations come under this denomination. Now there are somany works of this description that from the very first thecongress was hopelessly blocked by the reports brought bythe delegates who individually were all naturally anxious toprove how very worthy of sympathy was their own particularmission. Those reports brought by the foreign delegatestook up three-quarters of the sittings. Altogether therewere more than 200 of such reports. In many cases

only summaries could be read and it was rarelypossible to discuss the points raised. Therefore the con-

gress became terribly monotonous, yet these documentshave a literary and historical value, but they are bettersuited for publication in a volume than for a congress.There was, of course, a great deal said about the careof children and about institutions affecting the same.

A somewhat sharp discussion arose when Madame Dussaudurged that creches should not be converted into institu-tions offering a premium on idleness. Therefore beforeadmitting the children an inquiry should be made as

to the position of the parents, but Mesdames Bazaine,Kauffmann, and Louise Dehor retorted that a little child orinfant should not be made to suffer on account of theidleness or vice of its parents, and MademoiselleBonnevial protested that the object of day nurseries, &c.,was not to punish bad parents but to save unfoitunatechildren. The congress adopted various resolutions toincrease the financial and other help given to poor mothersand to render it illegal for any woman to work during thefirst month following upon her confinement. Of course, theold arguments against the Contagious Diseases Act were

brought forward again, but M. Trarieux and M. Derenger,

Senators, urged that such regulations were necessary forthe preservation of public health. Madame Pognon, profiting

, by this division in opinion, attacked virtuous women for theirwant of sympathy with their fallen sisters, who weregenerally driven to a deplorable life not through anyinherent vice of their own, but by the force of economicalcircumstances. It was not contempt but sympathy and atrue understanding of the situation which alone wouldremedy the evil. In respect to this want of understandingof the true position of women, Mademoiselle Selma Rizaattempted to show that Mahommedan women held a betterlegal position than Christian women. Mahomed was a greatadvocate of women’s rights and also a great sanitary reformer.Consequently married women controlled their own propertyindependently of their husbands, and if divorced retained thecare of their children. On the other hand, as there is and canbe no prostitution among Mahommedan women, ContagiousDiseases Acts when employed in Mahommedan countries onlyaffected the Christian populations. Unfortunately the instruc-tions given by Mahomed that young women should be care-fully educated had to a large extent been neglected, andconsequently many Mussulman women had fallen into a con-dition of apathy and ignorance and led lives that might beconsidered as a sort of slavery. This was their own faultand contrary to the text and spirit of their laws and religion.A delegate from Alsace, Madame de Schlumberger, in regardto the question of morality thought that a mother shouldabove all strive to remain the friend, companion, and con-fidante of her son during the critical period of adolescence.A mother should not fear from a mistaken feeling of modestyto speak of certain subjects, for it is on these very subjectsthat young men most need experienced advice. Thecongress adopted a resolution to this effect. In dealingwith economic questions, which of course materially affectpublic health, for with extreme poverty sanitation becomesalmost impossible, the congress adopted a motion in favourof what might be called a Woman’s Homestead Act.Already in France it is illegal to seize for debts the bed andthe implements of work, such, for instance, as a sewing-machine. These enactments should be enlarged so thathomes cannot be so readily broken up. Another resolutionadopted proposed to abolish all work for wages under the ageof 16. Such is the nature of a few out of the enormousnumber of questions brought before this congress. Theywill suffice to show how the subjects treated often affected,directly or indirectly, the causes that bear upon publichealth.The Congres des Habitations Bon Marche (artisans’

dwellings and the housing of the poor) has also met thismonth and was presided over by M. Jules Siegfried, Senatorand formerly Minister of Commerce. Mr. David Waterlowattended on behalf of his father, Sir Sydney Waterlow, whoas chairman of the Housing of the Working Classes Com-mittee in the British House of Commons was one of thehonorary presidents of the congress, together with Mr.

Geoffrey Drage, M.P. M. Siegfried in opening the congressexpressed his sense of shame at the fact that so large aproportion of the peasantry still ignored the most elementarycomforts and decencies of home-life. While in large townsthere were block buildings where the rate of mortalityattained the appalling figure of 80 deaths per 1000 perannum, yet the death-rate of the town as a whole mightbe even lower than 20 per 1000. To remedy this disgracefulloss of life sanitary reformers, architects, engineers, andfinanciers should come together and devise healthy dwellingswhere the rent charge should not exceed from 3 to 4 percent. of the capital invested. Actually the rents paid amountto from 5 to 60 per cent. on the capital cost of the buildings.But if we were to reduce the profits of capitalists from60 per cent. to 3 or 4 per cent. on moral grounds we mustalso make the tenants realise on moral grounds thit theyshould not squander in unnecessary things what they shouldreserve for the essentials of existence. M. Siegfried con-cluded by quoting Jules Simon, who said : 11 without homethere is no family ; without family there is no morality;without morality there are no men ; and without men therecan be no nation." M. George Picot, Permanent Secretary ofthe Academy of Moral and Political Sciences, read a lengthypaper on Artisans’ Dwellings. He is an economist of the oldschool and fears State intervention. Nevertheless, he dididmit that it might be useful and without peril to removesuch legal obstacles as exist preventing the investment ofcapital which is locked up. In every other respect he arguedn favour of existing conditions and it was difficult to see

1911

where reform was to find a footing. Capital refused to be" moralised" and preferred high dividends. But if an outsideinfluence should set a good example then investors mightbecome reconciled to smaller profits in the face of such com-petition. M. Cheysson suggested that conflicting interestsmight be reconciled by a system of profit-sharing betweenproprietors and their tenants. The latter would then be less

likely to injure the houses in which they dwelt. But this

suggestion met with only scant support. M. Weber thoughtthat the State was in any case quite justified in buildinghomes for the aged and infirm. Reports were read describ-ing what had been done in England-the Peabody buildings,the County Council common lodging-houses, &c. Lengthyarguments were held as to whether State or municipalintervention tended to paralyse private enterprise. M.Hector Denis, the well-known Belgian economist, was

strongly in favour of municipal tenements and lodging-houses and was supported by many members of the con-

gress, including several directors of private enterprises. ’,The congress adopted a motion effecting a compromise anddeclaring that as circumstances differed greatly in thevarious countries the question of State intervention shouldbe reserved for future congresses. But in any case the Statemust actively interfere to enforce all necessary sanitaryregulations, and the congress determined to elect a per-manent international committee to collect information.

Paris, June 24th.

NOTES FROM INDIA.

(FROM OUR SPECIAL CORRESPONDENT.)

The 6M’Mp07’C Plague Riots.-Improved Plague Mortality.-- BtT’7 Hono1t’l’S.-The Anti-rabic Institute.

THE Local Government resolution recently issued explainsthe origin and course of the Cawnpore plague riots. Thereseems to have been a general fear of plague in the city and anignorance of and uncertainty about the plague regulations.The compulsory removal to hospital and segregation of twocases seem to have inflamed the people and while they weregathering for a general meeting a false rumour was startedabout a boy being forcibly removed to the hospital to be burntalive. The mob made for the hospital, murdered the headconstable and five other men, and set fire to the huts of the hos-pital and segregation camp. A large assembly of the roughestelements afterwards took place on the parade-ground. As

many of the men were armed with big sticks and were pre-pared for a disturbance the magistrate thought it wise to havethem disarmed. Fottunately he arrived with the 5th BengalCavalry and had the ground cleared, but there was a greatdeal of stone-throwing. Thinking the disturbance was overthe cavalry returned to barracks. The mob, however, brokeout again and had it not been for the presence of theVolunteer Light Horse, who were compelled to fire on thecrowd, there is no knowing what massacres might have takenplace. The next day was more peaceful and conferencestook place about the plague regulations. The inquiryshowed that the people had not been sufficiently informedabout the plague regulations, that the police were utterlyuseless, being apathetic and ignorant and without anyinformation as to the state of feeling among the populace,and that the leading natives failed to lend any assistanceand apparently gave covert support to the agitators.

I am pleased to be able to record a great reductionin the plague mortality throughout India. There wereonly 975 deaths in the whole of India last week. TheBengal Presidency had 388 deaths and the Bombay Pre-sidency 519.The following medical practitioners have come in for

Birthday Honours :-Colonel Campbell, I.M.S., of Shillong ;Captain C. H. James, I.M.S., of Jullunder; Miss CharlotteAdams, L.R.C.P. Edin., of Jodhpur; Miss Susan Campbellof Ajmere; Mrs. H. Smith of Jullunder ; and MajorStevenson, I.M.S., of Allahabad, the two first-mentioned

getting the Kaisar-i-Hind gold medal and the others thesilver medal. I have not heard of any honours having yetbeen given to the plague medical officers who were appointedby the Secretary of State.An Anti-rabic Institute for India is at last an accom-

plished fact. After numerous delays Government have

stepped in and practically settled the difficulties. TheIndian Chiefs’ Victoria Jubilee Bacteriological Institute came

to nought and the scheme for a Pasteur Institute has hungfire for years. The Royal Army Medical Corps, having anofficer in Major D. Semple who had studied in Paris andLille, determined to utilise his experiences, and the annualexpense for sending soldiers to Paris was diverted for thenew institute. The central committee of the proposedPasteur Institute saw their opportunity and took over itscontrol. With a capital of Rs. 70,000 and a yearly grant ofRs. 19,500 the expenses of the new institute ought to be fairlywell met. The public may congratulate themselves thatat last means are provided whereby European and nativepatients alike can be offered the best available treatment forthe terrible disease of rabies.May 24th. -

The Fantine, the CAolera, and the Coming Monsoon.-TlteDecline in the Plague Epidemic.

THE famine shows no signs of abatement and the totalnumber of people under famine relief for the whole of Indiahas now reached 5,700,000. The Central Provinces chieflyare affected. In the Bombay Presidency cholera has beendecimating the labourers on the relief works. At Hadmatiathere is a camp of 25,000 people and the disease is of a mostvirulent type. The scare has almost emptied the camp.

Intimately associated in interest with the present famineare the prospects of the coming monsoon. Unfortunatelythe forecasts are not favourable. The weather at Mauritiusis reported as being more like that of April than of May,at the Seychelles the wind is unsteady, and the south-easttrade winds between the two islands are unusually light,with less rain and sea than usual. These reports seem toindicate considerable delay in the advance of the south-east trade winds towards the Equator, and the current seemsto be determined more than usual towards the Zanzibarcoast.The plague mortality continues to decline throughout

i India, only 746 deaths being reported for last week. FromBunder Abbas it is announced that plague has appeared atKishm and that 18 cases have occurred since April 30th.The Australian papers report plague as prevailing at Sydney,Fremantle, Adelaide, Melbourne, and Brisbane. Rats

teeming with plague have been found in Melbourne. Thereis also a death reported from Durban, the victim being anEast Indian.The trial of inoculation has been fairly extensive but in

Bombay city, notwithstanding that the number of peopleinoculated has reached nearly 200,000, little impressionseems to have been produced on the current outbreak. Theprophylactic has been used this year in Karachi, Sholapur,Surat, and Aden.May 31st.

MANCHESTER.

(FROM OUR OWN CORRESPONDENT.)

Tramps and their Ohild’l’en.AT a meeting of the Chorlton Board of Guardians, held

on June 22nd, the subject of the best mode of dealingwith tramps and their children came up for discussion.A communication from the Coventry Board of Guardianswas read, asking them to support the following resolu-tion : " That the Local Government Board be askedto give the guardians permission to detain trampsfor a period of seven days, and that while suchtramps are performing the legal task of work theirchildren should receive such elementary education as couldbe given by the proper officials." When one considersthe results that follow the more systematic methods ofthe elementary schools, the effect of a week’s tuition evenby the most earnest and skilful teacher would not be veryvisible on such waifs and strays and would be dissipatedby the time the next stopping-place was reached. Dr.J. M. Rhodes who has had much experience in, andthought much on, such subjects considered that thereshould be power to detain such children for at least sixmonths and that the guardians should have authorityto detain and educate them just as they had forchildren not under proper guardianship. This would nodoubt be good for the majority of the children, but somewould object to the interference with the parental relation-

ship and its duties. Among the habitual tramps, however, the