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and old rails, but it requires almost to be rebuilt, and the reportof the Commission recommends, in addition, that it should beprolonged some five metres. Its present length is 48 metresand its width 3’ 80 metres, except at the head, which is7’ 8 metres wide. It has no railway. This pier serves forthe landing of pilgrims going to the second or thirdcordons.The third landing stage (" De-Yr") is still further north.

Its length is 117 metres and its width 3’ 40 metres ; the headhas completely disappeared. It is of the same constructionas the other two and requires thorough repair and alsolengthening by some 10 or 20 metres, the water at its end

being very shallow. There is no railway along this jetty. Itis used for landing and re-embarking pilgrims for the thirdand fourth cordons.The fourth landing stage (I E1-Kat-el-Kurush") is situated

at the inner end of a bay, between the fifth and sixth cordons.It is 80 metres long and three metres wide, with a head fourmetres wide. It is built on eight arches and piles of dressedstone on a concrete base. It is in fair condition, but two ofthe arches are cracked and the pier is not nearly long enough.At low tide there are only 20 centimetres (about eight inches)of water at the head, and almost constantly the pilgrimslanding here have to jump into the water up to their waistsand wade ashore. They may be seen doing so in Fig. 4. Ithas been proposed to lengthen this pier by 60 metres, at anestimated cost of over .&T.2700, but the inspection com-mission, for reasons which will be explained later, recom-mends the reduction of the long diameter of the lazaret toabout one half of its present length, with consequentabandonment of the fifth and sixth existing cordons and alsoof this landing stage.Proposed new; landing stage.-At a spot between the

present third and fourth cordons there is a small island ashort distance from the shore and united to the latter by asandy spit or causeway, except at high tide, when the islandis completely cut off. The commission proposes to constructa new jetty, running over this causeway and out at the northend of the island. It will be almost in front of the secondof the three disinfecting blocks to be described hereafter.There will thus still be four landing stages for pilgrims and,as will be shown in a later chapter, they will be quite asusefully and almost as symmetrically placed as at present.When once the pilgrims are landed they are conducted,

with their baggage, to one of the three disinfecting blocks.These buildings and the measures applied there will bedescribed in the next article.

(To be continued.)

THE OUTBREAK OF PLAGUE IN JEDDAH.

(FROM THE BRITISH DELEGATE TO THE CONSTANTINOPLEBOARD OF HEALTH.)

THE outbreak of plague in Jeddah is beginning to subside.It will be recalled that the present epidemic, which is

probably a revival of that which prevailed there last summer,began about Jan. 8th. At the date of my last letter the total number of cases recorded down to Feb. 3rd hadbeen 23, and that of deaths 22. Since then the weeklyreturns have been as follows :- ’From Feb. 4th to 10th......... 10 cases, 10 deaths. i

The total number of cases since the reappearance of thedisease has therefore been 330 and that of deaths 317. Itis a remarkable fact that, with the single exception of afatal case of plague in a Javanese pilgrim, the outbreak

1 THE LANCET, Feb. 16th, p. 464.2 I should be glad of this opportunity to correct a slight printer’s

error which crept into my last letter. In column 2 of page 464 ofTHE LANCET, line 33, the word "Japanese" should be "Javanese."There are no doubt several Japanese Moslems; but during my stay in

in Jeddah has been strictly confined to the native inhabitantsof the town. A few other pilgrims did, however, developthe disease shortly after leaving Jeddah on their returnjourney home, and to these I shall refer again; but it is

certainly noteworthy that, with plague epidemic, and fairlyseverely epidemic, in the town of Jeddah, the largestpilgrimage on record passed through that town twice-

first, on the way to Mecca, and later after the completionof the Haj-and yet scarcely half a dozen of the pilgrimscontracted the infection. I am inclined to attribute thisrelative immunity to the facts that the pilgrims do not staylong in Jeddah-not more than a few days as a rule, thoughin some instances it may be for much longer ; that most ofthem lodge in houses specially built for the purpose, whichare surveyed, cleansed, and whitewashed and put in orderbefore the arrival of the pilgrims; and that those who aretoo poor to stop in houses camp out in the open air, wherethey are little exposed to the infection of plague eitherfrom contact with the inhabitants of the town or with rats.There seems to have been much difficulty in applying

measures for the suppression of the outbreak. The Arabinhabitants dread European interference more than thedisease ; the large majority of cases have only become knownto the authorities after death and it is certain that manythat recovered were never brought to the knowledge of thelatter. Scarcely any of the cases have been removed to

hospital. When a death from plague has become known thehouse where it occurred has been disinfected, but there musthave been numbers of infected houses to which neither dis-infection nor any other measure of prophylaxis was applied.Shortly after the revival of the disease in January it wasproved beyond a doubt that rats were dying from plague andwere in all probability the main channel by which the infec-tion was being spread. A small reward, of the value of onepenny, was offered for the bodies of dead rats, but there isno evidence at present that this measure led to any sub-stantial results. The medical staff of the town was

strengthened and an ample supply of plague prophylacticwas furnished to them, but the latest reports show thatit was almost impossible to induce the people to allowthemselves to be inoculated. In some instances the oppo-sition to the authorities took a more active form andviolence was used, In one case a native woman-possiblyinterpreting too literally the injunction to heap coals of fireon others’ heads-poured a torrent of hot ashes from awindow on to the head of a disinfector who attempted toenter the house.

Outside Jeddah the following known cases of plague-which undoubtedly contracted the infection in that town-have occurred. Three persons arriving in Mecca from Jeddahdeveloped the disease and two of them died. Two pilgrimson the return journey to India were landed at Aden withsigns of plague and one of them died. Two other cases in

pilgrims returning from Jeddah to the Yemen were landed atCamaran. Finally, among pilgrims returning northwards bythe Suez Canal, two cases of plague have been observed, bothat the Egyptian lazaret of El Tor. There have thus been,so far as is known, only nine instances in which the infectionhas been carried from Jeddah, and these have not given riseto any epidemic extension of plague elsewhere. Had Jeddahbeen as deeply infected with cholera as it has been withplague, it is easy to imagine how very different and how in-finitely more serious to the rest of the world the resultwould have been.Constantinople, April 24th.

BIRMINGHAM.(FROM OUR OWN CORRESPONDENT.)

Our Hospitals and their Incomes.IN previous communications I have drawn attention to the

comparative stagnation or actual diminution of the amountof subscriptions received by our hospitals, and on Friday lasta most able article dealing with this matter and giving definitestatistics appeared in the Birmingham Daily Post. The

subject is one which must be of interest to all cities wherethere are many hospitals, and I have no hesitation, therefore,

the Hedjaz last winter I did not come across, or indeed hear of, anypilgrims of that race. Javanese (a general term for pilgrims from theDutch East Indies) are, next to Indians, usually the most numerous ofall races in each year’s pilgrimage.

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in touching upon the matter again in the light of the ex-tended information so recently provided, more especially asthe conclusions which our leading daily paper draws from theinvestigations of its contributor are open to some doubt.Taking five of our principal hospitals, the General, theQueen’s, the Women’s, the Children’s, and the EyeHospital, it appears that 20 years ago (1886) thetotal income of the five was 34,069 and last year(1906) it amounted to 54,825. In 1886 the moietyderived from subscriptions was £12,963, and in 1906this moiety had increased to 17,416—that is, in the formeryear the subscriptions formed a little more than 35. 1 percent. of the total income and in the latter year the percentagehad fallen to about 30’ 7. In other words, there has beenduring the past 20 years a relative diminution of the sub-scriptions as contrasted with the total income. During thesame period the number of in-patients received into the fivehospitals has increased from 7134 to 10,297, and the numberof out-patients from 10,297 to 159,032. One of the inferencesdrawn from these facts by the writer of the leading articlein the Daily Post is that as the number of subscribers andthe amount of subscriptions are falling off some of the com-mittees should " concentrate their attention upon the acquire-ment of new subscribers," and he urges that nothing but apersonal canvass will produce the desired effect. It is

frequently stated that " the number of persons capableof giving a regular subscription to one or more institu-tions is far larger than is accounted for by a perusalof the subscription lists," but the evidence upon which thisstatement is made is not quite clear, and it by no meansfollows that because a given person has a certain amountof income or lives in a certain style he has any moneywhich he can devote to hospital support, for frequently hehas to spend the whole of the income he makes in maintain-ing those conditions of life which enable him to gain theincome. Moreover, in considering this question of therelative diminution of hospital support by persons who havegood average incomes, it must not be forgotten that thenumber of hospitals, dispensaries, and other charities is

continually increasing, and taking the case of Birminghamthe actual increase in the amount of subscriptions duringthe past 20 years as shown by the returns of the fivehospitals referred to does not give a complete ideaof the total increase of subscriptions during the wholeof that period, for numerous other charities on variousscales have been established or enlarged and theirnecessities have caused an expansion of the area

over which subscriptions are distributed. It may still lappear when statistics are available that taking allthe newer institutions into consideration the amount of

subscriptions is still showing reduction as contrasted withthe number of patients treated and the total amount ofincome. If this should prove to be so the fact would not besurprising, for it must be remembered that the portion of thecommunity from which subscriptions are drawn finds that theexpense of living continually increases. We are in a period ofextravagance, not only in public but also in private life, andat present there is no sign of a movement which shall tend tothe reduction of those so-called " necessary " expenses whichabsorb money that otherwise might be devoted to charities.Further, the classes from whom hospital subscriptions areexpected are feeling more and more the burden oftaxation. Their incomes are taxed in unreasonableproportion for national purposes, they are taxed forthe education of other people’s children, and for the moreor less complete maintenance of many of them. In thesecircumstances it is scarcely surprising that voluntary sub-scriptions for charitable purposes do not greatly increase, forit may be taken as certain that the more people are forced todo the less they will do in a voluntary manner. Looked atfrom this point of view it does not appear probable that apersonal canvass will be very effectual in raising the amountof the subscriptions for any length of time, for it is notlikely that the causes which militate against increasewill diminish. In these circumstances, then, it becomesinteresting to inquire into the amount given to the hos-

pitals by the more popular Hospital Saturday Fund, whichmay be looked upon as the subscriptions of those whomake most use of the hospitals. This Fund, under theadmirable management of the committee, has consider-ably increased during the past 20 years, and it is there-fore the more surprising to find from the statistics pro-vided that the portion devoted to the five hospitals hasdiminished as contrasted with their total income. In 1886 j

the amount given from the Hospital Saturday Fund to thefive hospitals under consideration was .E4583, and in 1906 ithad increased to E6975, or, in other words, in the earlier

year it formed a little less than 13’ 5 per cent. of the totalincome and in 1906 a little more than 12’ 7 per cent. Thereis no doubt that the remainder of the Hospital Saturday Fundis well utilised, but in the circumstances it may be urgedfairly that more of it might with advantage be devoted to themaintenance of the hospitals.

The Health of Birmingham.For a considerable period we have rejoiced in a low death-

rate and some of the more sanguine of us were hopeful thatthe time had come when the low rate would be practicallypermanent. We are inclined to feel disappointed, therefore,to find from the medical officer’s report that whilst it isstill low, 19’ 9 per 1000, it is higher than it has been duringthe first quarter of the year since 1904, but there is consola-tion in the knowledge that it is still below the average forthe first quarter of the past ten years, which is 20’ 3 per1000. Part of the increase appears to have been due to thevery varying and inclement weather, for the number ofdeaths from pulmonary and pleuritic inflammations has beenlarge. Measles also has been more than usually fatal, andthe scarlet fever from which we have been suffering appearsto have become more virulent, for its death-rate has risen to4’ 7 per cent. Diphtheria and typhoid fever are also moreprevalent than is desirable. The birth-rate for the quarterwas only 29 per 1000.

The Noti fcecction of Consumption at Coventry.’ Coventry has decided to follow Birmingham’s lead and itssanitary committee has made arrangements for the voluntarynotification of pulmonary tuberculosis. It was also de-cided at a recent meeting of the Coventry city councilthat Birmingham should be approached as to the termson which Coventry might be allowed to utilise the proposedsanatorium which is to be established near Cheltenham,where it is suggested that 40 chalets should be erected assoon as possible.April 30th.

LIVERPOOL.(FROM OUR OWN CORRESPONDENT.)

Tlte Health of Liverpool.THE birth-rate in Liverpool for the week ended April 20th

was 35 per 1000. The death-rate was 20’1 1 per 1000, com-pared with a mortality of 23’ 5 per 1000 a year ago. The

zymotic cases in hospital were : small-pox, 4 ; scarlet fever,372 ; typhus fever, 7 ; typhoid fever, 42 ; diphtheria,37 ; and in isolation, 63. This time last year the epidemicof measles was accountable for the higher death-rate.

St. Helen’s Hospital: Workmen’s Contributions.The thirty-fourth annual report of the St. Helen’s Hospital

showed that, in spite of the large growth of expenditure con-sequent on the enlargement of the hospital, the income for theyear had grown correspondingly owing entirely to the highlysatisfactory increase in the penny-a-week contributions of theworking men, which amounted to .63198, against £2478 inthe previous year. During the year 829 patients had beentreated, against 707 in the previous year. The hospital hassustained a great loss by the death of Sir David Gamble,Bart., who was one of its warmest supporters.

Epidemic of Measles at St. Helen’s.The medical officer of health (Dr. J. J. Buchan) has sub-

mitted a lengthy report on the epidemic of measles amongschool children to the St. Helen’s health committee. Hestated that the history of measles during the last 30 yearsin St. Helen’s showed that the disease had been almostconstantly present, breaking out in epidemics of greateror less severity every two or three years. The epidemicsexhibited themselves in two forms, a major and a minorvariety. In the major epidemics the disease had appearedin the earlier part of the year and assumed a more virulenttype than in the minor ones, which contributed less to thedeath-rate. The disease was spread by personal contact withthe sufferer, particularly in the early stage of the illness, the in-fection then being apparently given off by the discharges fromthe throat, nose, and lungs. The actual cause of the disease hadnot so far been discovered. Measles appeared to be spread to a,