119NOTES FROM INDIA.-CHINA.

report contains particulars of 12 deaths that occurred eitherduring treatment or within 14 days of the completion oftreatment. The majority of these cases arrived late and allwere badly bitten. These are not classed as failures, as thetreatment had not time to develop its effect before deathensued from the bites. Of the six cases classed as failures,five were bitten on the bare skin, and the sixth was bittenthrough the thinnest clothing, and there were four verydeep wounds. In one of the cases of failure hydrophobiadeveloped seven months after treatment. In the course ofthe report Major G. Lamb, I.M.S., gives an account of theimproved method of preparing the anti-rabic vaccine, whichis much simpler than the method originated by Pasteur, inthat the strength of the doses can be more accurately fixed,and that there is very much less chance of disagreeableafter-effects to the patients, in fact, since the method hasbeen adopted at Kasauli no such after-effects have beenobserved.In the balance-sheet appended to the report are given the

details of the income and expenditure of the institute duringthe financial year ended March 31st, 1908. The total income,including the balance of the previous year, was Rs.57,295-4-9,and the expenditure amounted to Rs.36,627-11-9, leaving abalance of Rs.20,667-9-0. Most of the balance will beabsorbed in very necessary repairs and additions to the

buildings of the institute at Kasauli. The sum of Rs.15,000will be placed to the credit of a building and repair fundin accordance with a resolution passed at a meeting heldon Oct. 16th, 1908.

Ambulance Work in the Punjab.A central Punjab branch of the St. John Ambulance

Association has been formed, mainly through the enterpriseof Dr. 0. A. Owen of Lahore, the Lieutenant-Governor andthe Bishop of Lahore having consented to act as pre-sident and vice-president respectively, while an influentialcommittee has been got together. A" first-aid " class will beinstituted as soon as possible. The course of instruction willconsist of lectures with practical work given at intervals of aweek. The class will then be examined and certificatesawarded to successful candidates. Certificated candidates willbe formed into ambulance divisions, which will meet once amonth for instruction. These ambulance divisions will be avail-able for grave public disasters, such as earthquakes, fires,and railway accidents. It is also proposed to start classesat once for railway servants and the police, it being re-cognised that a knowledge of the principles of " first aid " isessential to both in the interests of the public, if not ofthemselves.

Strange Coincidence : Ne7v TVater7vorks and Increased Death-Rate.

The annual report of the Sanitary Commissioner of theGovernment of Bombay contains a tabular statistical state-ment showing the average annual death-rate in the principaltowns of the Bombay Presidency since the completion of theirdrainage and waterworks. These rates he contrasts with theaverage annual death-rate of the five-year period precedingthe introduction of the new water and drainage system andalso with the mortality-rate for the surrounding rural districtsin which these towns are situated. On comparison the figuresseem to indicate a rather peculiar state of affairs in the caseof Ahmedabad and Karachi, whereby the rate of mortalitysince the introduction of the new water and drainage systemsis much in excess of what the average was for the five yearsprior to their introduction and also of that in the surroundingrural districts. The Sanitary Commissioner offers no explana-tion of these remarkable statistics, which show a contraryresult to the great advantagea caused by the introduction ofpiped water supplies into other cantonments occupied byBritish troops.June 1st.

CHINA.(FROM OUR OWN CORRESPONDENT.)

Plague in the Island of Hainan.AMID the mass of research work and investigation on the

subject of plague there seems room for more detailed informa-tion at regular intervals on its geographical distribution,more particularly with reference to endemic foci in places

which may be out of the beaten track and yet in sufficientlyfrequent communication with other parts to be a chronic.source of infection. One typical example of such a place is.the island of Hainan, about 12 miles from the mainland ofthe south coast of China. It is almost a terra incognita tothe world. Nearly all its trade is carried on with Hong-Kong, to which it exports pigs, poultry, eggs, bullocks,vegetables, and other provisions in large quantities. At.

Kiungchow, which is the seat of the government, there is apopulation of 50,000, and at Hoihow, the main seaport, thereare about 30,000. The rest of the population is dotted about.the island in small overcrowded villages. Some years agoaFrench government medical officer of the Tonkin medicalstaff was detailed to Hoihow for the purpose of giving thenatives and others free attendance and medicine, otherwisethe natives depend for help on a small number of medicalmissionaries belonging to the American Presbyterian Mission.As far as can be ascertained plague was introduced fromCanton to Hoihow in 1895 and worked havoc there, the mor-tality being 75 per cent. From there it spread to surround--ing villages and other parts of the island. Curiouslyenough, no case has been reported from Hoihow since thatyear, though it has become endemic in the Simkow district,only 30 miles distant, and has spread to Nodoa and neigh-bouring market towns, which carry on a large junk trade-with Simkow because of its superior harbour and nativeshipping facilities. Epidemic outbreaks are invariablypreceded by an easily noticed heavy rat mortality. InNodoa the people carry out basket-loads of dead rats anddump them in a pool of water or upon the soil. In Namfongmarket town, however, rats died both last year and thiswithout giving rise to the human epidemic. In Notiamarket, 15 miles from Nodoa, there are plague outbreaksevery winter, and on the first appearances of cases the peoplemove out into booths near the market. Nodoa and Notiaboth have shaded streets, poor drainage, and are filthy. Thenatives are notoriously dirty and poverty stricken. The ratslike the grass thatching over these streets and breed in it ingreat numbers. The severest epidemic in Nodoa was in1905 and it recurred last year and this year; last year it wasnot so severe as this year. Out of about 1000 inhabitants, from200 to 300 have died this year. In Notia the mortality is.never great and it continues from season to season withgreat regularity. The Chinese say that where the mortalityis very great plague is wiped out completely, and this-

theory of survival of the fittest (i.e., the most immune)is given colour to by the high mortality which attended.the first and only epidemic we know of in Hoihow.In the outlying villages, where the people have no greatbusiness interests at stake, as in the larger market towns,whenever there are signs of plague outbreak they all move-out into booths, as they generally have made the observationthat when they promptly clear out of their houses they avoidan epidemic. Dr. J. F. Kelly, to whom I am indebted for a.

good deal of my information, says that though the Christianfollowers of his Mission have had rats dying in their com-pound, they have all escaped by observing cleanliness andthe use of disinfectants. He has identified the bacilluspestis to make sure of the epidemic, and adds that the-intestinal form prevails extensively. Hainan would be aninteresting field for the further study of plague epidemiology,-as outbreaks rise and fall without any preventive measuresbeing taken by the authorities. It also suffers from periodicalvisitations of cholera. The climate is favourable to thehealth of the foreigner. The temperature ranges from 52°to 950 F. Tropical thunderstorms are of frequent occurrencethroughout the spring and early part of the summer, and the-accompanying rainfall at times is very heavy. According tothe Customs- meteorological tables the highest rainfall for-one day was 2 40 inches, which occurred in the month ofSeptember.

Plague in Shanghai and North China.

With regard to the outbreak last year in North China, atTongsban, in spite of predictions to the contrary, there have,so far, been no further reports of cases, although the hot.season has set in-the maximum shade temperature lastweek being 106° F. Attention to sanitary details, rat

catching, &c., combined with the long very cold winter, haveall no doubt militated against plague becoming endemic inthis region. In Shanghai, up to the present, the medicalofficer of health, Dr. A. Stanley, can reasonably claim to have

120 OBITUARY.

done a good piece of plague prevention work, as the following,figures will show:-

Plccy2ce Among -Rats: Comparative Monthly Figures.

* Not yet received.

There have been no cases of human plague either in theEuropean or Chinese population, and, as regards the latter,a noteworthy feature has been the absence of any markeddegree of opposition, cooperation being given to a greaterextent than would naturally be expected, a circumstanceprobably due to the use of tact and forbearance, and espe-cially to the use of the Chinese language by the foreign staff,who thus get into much closer touch with the native com-munity. The active rat destruction undertaken by Dr.

Stanley from the outset brings into prominence the economyof preventive plague administration, as compared with the- expensive measures entailed in suppressing an outbreak ofhuman plague, in addition to the annoyance to the com-munity and interference with trade.

Peking, June .9th. _________________

Obituary.NATHANIEL JOSEPH HOBART, M.D. GLASG.,

M.R.C.S. ENG.,’CONSULTING SURGEON TO THE NORTH INFIRMARY AND CITY OF CORK

HOSPITAL, ETC.

THE recent announcement of the death of Dr. Nathaniel

Joseph Hobart caused considerable regret in Cork, especiallyamongst his medical colleagues. Dr. Hobart became a

Member of the Royal College of Surgeons of England in theyear 1846. The following year he obtained his degree inmedicine at the Glasgow University, and at the time of hisdemise cannot have been very far from the patriarchal ageof 90 years. He was for many years one of the visitingsurgeons of the North Infirmary, Cork, and always kept fully-abreast with the progress of medical science. When anti-

septic surgery was introduced he at once recognised itsworth and strongly advocated its adoption. He was enthu-siastically interested in his hospital work and devoted thegreatest possible attention to the patients entrusted tohis care. When advancing years compelled him reluc-tantly to resign his hospital appointment the board ofgovernors, anxious still to retain some of his valuableservices and also with a view to expressing their highopinion of his great worth, unanimously appointed him con-sulting surgeon of the institution. He had also earned therank of consulting surgeon to the Hospitals for Incurables,for the Eye and Ear, and for Women and Children, in Cork,and his leadership in the profession was acknowledged byhis successive election to the presidencies of the Cork MedicalSociety, of the Irish Medical Association, and of the Corkbranch of the British Medical Association. He establishedfor himself a great reputation as a surgeon and enjoyed alarge private practice in the city and county of Cork. A

kindly, genial manner endeared him to his patients. As a-consultant he was a great favourite with the younger practi-tioners, as he was always most courteous to them and everpunctilious in the observance of professional etiquette. Hehad a bright, cheery manner and was a delightfulraconteur. When" the Battle of the Clubs" at Cork wasstarted he was appointed chairman of the professional meet-ings and was a most regular attendant at them. If any little- differences of opinion occurred, the chairman’s suave mannertended to at once dispel them and to preserve the wonderfulcohesion which characterised the action of the Cork medicalmen in the face of grave difficulties. There can be no doubt,too, that his calm judgment and mature experience largelyaided in the accomplishment of the victory which was- eventually secured. Dr. Hobart’s funeral was private ; hadit been otherwise, his professional brethren would by their

attendance at his grave have expressed their high esteem andtheir great respect for his memory.

CAWAS LALCACA, M.D. BRUx., L.R.C.P. LOND.,L. M.S. BOMBAY.

THE indignant horror of the community at the cowardlyassassinations of the late Sir Curzon Wyllie and Dr. CawasLalcaca must be shared by all our readers, and while themedical profession has to lament in the murder of the Parsigentleman a professional brother, who was held in highestimation by his acquaintances, the tragedy is softened bythe melancholy reflection that he gave his life in a vainattempt to save that of another man for whom he appears tohave felt a profound devotion. The evidence as to the exactdetails of the double murder is a little confused, but from themurderer’s own statement to the police there seems no doubtthat he shot Dr. Lalcaca, who sprang forward to come to

grips with him as soon as he had fired at his first victim.Dr. Lalcaca was born at Allahabad and became a

student of the Grant Medical College in Bombay, wherehe held the Anderson scholarship in practical surgeryand obtained the Licentiateship of Medicine and Surgeryin 1884. In the same year he came to England andbecame a Licentiate of the Royal College of Physiciansof London, which he followed by taking the M.D.at Brussels in 1885, after taking out a course in practicalanatomy at University College, London. Returning to

Bombay he gained some surgical experience as a hospitalresident and then proceeded to Shanghai, where he has

practised for over 20 years with industry and success,obtaining his first introduction from his uncle, a prominentParsi merchant in the Chinese towns. At the time ofhis death he was enjoying a well-earned holiday inthis country. The details of his murder at the close ofthe Indian reception on July 1st were given such widepublicity in the daily press that there is no need for usto repeat them. He died as he was being removed toSt. George’s Hospital and an inquest was held on his body atthe Westminster coroner’s court on July 5th, when a verdictof "wilful murder" was returned against the student

Dhingra. The medical evidence was given by Mr. R. S.Trevor, pathologist at St. George’s Hospital, who stated thathe had found in the right breast an oval bullet wound halfan inch in its greatest diameter, the direction of entrance ofthe bullet being downwards. There was another bullet holein the top of the lower lobe of the right lung. That lobe ofthe lung was penetrated by the bullet. One bullet, unalteredin shape, was found embedded in the left side of the pelvis.He failed to find the second bullet. The cause of death was

hæmorrhage and shock from injuries produced by a bulletwound entering the body at the back. The bullet enteredthe back of the right shoulder when Dr. Lalcaca was

stooping forward.To his professional ability and personal charm several of

his friends have borne witness in the columns of the Times,and we quote from two letters published last week in thatjournal. Sir Henry Morris, who had met him in professionalconsultation, wrote : "In addition to his evident efficiencyas a medical man, Dr. Lalcaca had much in his favour tocommend him to others. Of fine physique and very hand-some features, he was a man of most charming manners andof very attractive address, and he seemed full of livingenergy and of physical and moral courage." And the Rev.T. J. Rhivertaft bore like testimony to his exceptionalqualities in these words : "I I have never met any man who,although a non-Christian, had so deep a sense of the duty offollowing the guidance of conscience and of helping others.He had the anima naturaliter Cristiana, and on a rather

trying railway journey this Parsi gentleman taught his com-panions many lessons by his sympathetic kindliness andself-forgetfulness in his efforts to make others comfortable.I for one was not surprised to learn that he perished tryingto save the life of another." Dr. Lalcaca was under 50 yearsof age and was unmarried.

DEATHS OF EMINENT FOREIGN MEDICAL MEN.-Thedeath of the following eminent foreign medical man isannounced :-Dr. Paul Langerhans of Berlin, whose nameis known as an active politician both in Parliament andin the municipal council. In the latter position he helped tocarry out many sanitary reforms. In early life he practisedas a medical man. He was 89 years of age.