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however, are included with the civil population." The

general list of deaths comprises 18 from small-pox, 13 frommeasles, 85 from enteric fever, 36 from dysentery, 59from Mediterranean fever, 477 from tubercle, 459 from

cardiopathy, and 1217 from enteritis ; of the deaths

from enteritis 1030 occurred at ages under five yearsand 187 at ages over five years. Dr. S. Pisani, the

chief Government medical officer, draws a gloomy pictureof the infiltration of the subsoil with sewage in the

suburban areas and urges the carrying out of drainageworks. No fewer than 2097 persons, almost half the number

- deceased, were interred in churches, and hermetically-sealedinc coffins are sometimes used. The highest shade tem-perature was 96’3°F. in June, the lowest being 414° in

December. No rain fell during June, July, and August; thetotal for the remaining months was 29’18 inches. In the samereport Dr. Tem. Zammit gives an account of laboratory workrelative to the reaction of the serum of enteric fever and ofMediterranean (undulant) fever cases on the specific micro-organism of the respective diseases. Cases of Mediterraneanfever of one week’s duration gave the agglutinative reactionimmediately; long standing or early cases gave the reactionafter a few minutes.

___

A SECOND special meeting of the Chelsea Clinical Society-to consider the Preventive Treatment of Tuberculosis washeld at the Jenner Institute of Preventive Medicine on

Tuesday evening last. Interesting papers were read and- communications made by Dr. Theodore Williams, Dr. J. E.

Squire, Dr. R. Maguire, Dr. S. H. Habershon, Dr. RufenachtWalters and Sir C. Gage-Brown. We shall publish a reportof the meeting in an early issue.

THE annual mess of volunteer medical officers organisedby the Volunteer Medical Association will be held on Wed-nesday, May 10th, at Limmer’s Hotel, under the presidency- of Major-General Trotter, General Commanding the HomeDistrict. Further particulars can be obtained from the messsecretary, Surgeon-Lieutenant L. A. Bidwell, 59, Wimpole-street, Cavendish-square, W.

A COMPLAINT having been made to the Saxon Governmentby the husband of a woman who had died in the Dresden- Clinic for Women that a necropsy had been performed onthe body without his sanction the Minister of the Interiorhas ordered that in future no post-mortem examinations areto be made in hospitals without the express consent of therelatives.

____

THE thirty-first anniversary dinner in aid of the funds ofthe French Hospital and Dispensary is announced to take

place at the Hotel Cecil on May 6th, when the chair will be-taken by His Excellency the French Ambassador, supportedby the Lord Mayor and the Sheriffs of London.

THE Baillie Lectures will be delivered in the large theatreof the St. George’s Hospital Medical School on Thursdays,May llth, 18th, and 25th, at 5 P.M., by Dr. W. HowshipDickinson, Baillie Lecturer for the year and consultingphysician to the hospital. -

THE chairman and members of the council of the MedicalGraduates’ College and Polyclinic will give a con-

versazione at the College. 22, Chenies-street, Gower-street,W.C., on the evening of Monday, May 1st, from 9 till 12.

H.R.H. THE PRINCE OF WALES has nominated the follow-

ing as delegates on behalf of the National Associationfor the Prevention of Consumption and Other Formsof Tuberculosis to the Berlin Congress for the Prevention

of Tuberculosis :-Sir Hermann Weber, Mr. Malcolm Morris,Dr. Hillier, and Mr. C. Rube.

AK International Congress of Veterinary Surgeons willbe held at Baden-Baden on August 7th-12th inclusive.Particulars can be obtained from the general secretary, Dr.Casper, Baden-Baden.

-

SURGEON-GENERAL J. A. MARSTON, C.B., has been

selected to fill the appointment of Honorary Surgeon to theQueen, vacant by the death of Deputy Inspector-GeneralJ. Jee, V.C., C.B.

-

THE annual dinner of old students of King’s College.London, will be held at the Holborn Restaurant on Monday,June 26th. Dr. W. S. Playfair will take the chair.

THE Autumn Congress of the Sanitary Institute will beheld this year in Southampton by invitation of the mayorand corporation, commencing on August 29th.

INAUGURATION OF THE LIVERPOOLSCHOOL OF TROPICAL DISEASES.

FOLLOWc closely upon the opening of the Thompson-Yates laboratories in University College, Liverpool, in

October last by Lord Lister, it becomes our pleasing duty torecord the inauguration on April 22nd of the new School ofTropical Diseases in Liverpool also by Lord Lister. Theidea of the institution of schools in this country for instruct-ing in tropical diseases medical men about to practise in thetropics advocated by Mr. Chamberlain some months agowas nowhere more eagerly taken up than in Liverpool. At

the annual dinner of the Royal Southern Hospital onNov. 12th, 1898, Mr. Alfred L. Jones, a prominent Liverpoolcitizen and West Africa merchant, made an offer off,350 a year to start a school in Liverpool for the

study of tropical diseases. The offer was made in the

presence of Professor Rubert Boyce of University College,Liverpool, and Dr. William Alexander of the Royal SouthernHospital. The president of the Royal Southern Hospitalaccepted the generous offer on condition that UniversityCollege, Liverpool, and the Royal Southern Hospital shouldbe united in the undertaking. This condition was cordiallyacquiesced in by Professor Glazebrook, the principal of theCollege. The great interest subsequently taken in theproject by Mr. Alfred L. Jones, aided by the indomitableenergy of Professor Boyce, resulted in subscriptions anddonations coming in from all quarters towards the expensesof the proposed school. To those two gentlemen, warmlysupported by the committee and medical staff of theRoyal Southern Hospital, is due the establishment of theLiverpool School of Tropical Diseases. The managementof the school is in the hands of a strong committee, of whichMr. Alfred L. Jones is the chairman and Mr. WilliamAdamson (president of the Royal Southern Hospital) thevice-chairman. The committee also consists of dulyappointed representatives of University College, Liverpool,the Royal Southern Hospital, the Liverpool Chamber ofCommerce, the Steamship Owners’ Association, and the Ship-owners’ Association. A sum of over E1700 has already beenpromised, partly in annual subscriptions and partly in

donations, in support of the school, which promisesto be of great value to all interested in tropicalcountries, either in trade or otherwise. A large floorin the Royal Southern Hospital has been set apartfor tropical cases. This floor includes a cheerfulward containing 12 beds, now fully occupied, also an

extensive laboratory for the examination of blood, urine,fasces, &c., and furnished with the apparatus applicable tomodern research. Dr. Rubert Boyce, the professor ofpathology in University College, Liverpool, will super-intend the pathological department of the school, with Dr.Annett as pathological demonstrator. The committee havebeen fortunate in securing the services of Major Ronald Ross,

1175

Indian Medical Service, as special lecturer on tropicaldiseases. Major Ross’s lectures will be illustrated by lanternslides and diagrams with reference to the cases inthe tropical diseases ward. Dr. Annett will devotehis whole time to the subject of pathology andwill teach both in the ward laboratory and in the

Thompson-Yates laboratory in University College. Fourcourses of lectures of two months each will be deliveredto qualified men each year. The number of malarial casestreated in Liverpool in 1898 amounted to 294. In the pre-vious year, as noted in THE LANCET of March 18th, therewere 242 cases of malaria, 14 of beri-beri, 30 of dysentery,and 39 of tropical ansemia. With the means of instructionin the varied forms of tropical diseases thus afforded thereought to be no need for Liverpool students to proceed toLondon to obtain that which is ready to hand at their owndoors. It may be safe to say that if the new school inLiverpool maintains the energy which has characterised itsinitiation the requisite recognition by the Colonial Office canonly be a matter of a very short space of time. At least theLondon School of Tropical Diseases cannot claim priorityof foundation.The proceedings of the inauguration commenced by

the opening of the new ward in the Royal SouthernHospital, to be called the " Samuel Henry ThompsonWard" " (after the father of the donor of the Thompson-Yates Laboratories). Amongst those present, in addi-tion to Lord Lister (who performed the openingceremony), were Sir Richard Thorne, K.C.B., SirCharles Cameron (Dublin), Sir Christopher Nixon, SirBosdin Leech, Sir James C. Browne, Dr. Church (the Pre-sident of the Royal College of Physicians of London),Dr. J. W. Moore (the President of the Royal College of

Physicians of Ireland), the Lord Mayor of Liverpool,Mr. Alfred L. Jones (the Chairman of the LiverpoolSchool of Tropical Diseases), Major Ross, Indian MedicalService, Professor Michael Foster, &c.

Mr. ADAMSON (the president of the Royal Southern

Hospital) in requesting Lord Lister to declare the SamuelHenry Thompson Ward to be now set apart, in con-

nexion with the newly established Liverpool School, forthe treatment of special cases of tropical diseases, drewattention to the fact that this was no new move on

the part ’of the committee of the hospital, for since thefoundation of the hospital 57 years ago the wards hadnever been free from tropical maladies and it was an

interesting fact that during the last few years 460 cases hadbeen under treatment in these wards. In 1877 19 cases ofmalaria were brought to the hospital in one day. The

proximity of the hospital to the docks was the chief reasonfor the patients being carried thither. The ward which his

lordship had just opened was full. The occupants of thebeds, 12 in number, represented the following nationalities-viz., China, India, the United States, Norway, Sweden,Russia, Finland, England, and Ireland. The tropicaldiseases from which the patients were suffering had beencontracted in Java, India, Brazil, Savannah, South Carolina,Sierra Leone, Forcados, Old Calabar, Benin, and Cape CoastCastle. They also hoped to train nurses who would goabroad, provided not only with a certificate of competencyas fully qualified nurses, but who had under the medicalstaff of the hospital acquired a special knowledge oftropical diseases. It was also hoped to train negresses asnurses.

Lord LISTER, in declaring the ward open, felt sure

that Liverpool was doing in this matter what was ofthe greatest importance for the welfare of mankind. Itmight have been supposed by some people that the treat-ment of tropical diseases in Liverpool was a somewhatfictitious matter and that patients were got together for thepurpose of the school and for nothing else, but they nowlearnt that patients with tropical diseases had for a longtime past been treated in that hospital. At the same timeit was to the advantage of those patients that there shouldbe a distinct tropical diseases school. In direct propor-tion as any hospital or hospital ward had associated withit a school in which diseases were earnestly studied inall their bearings and under the critical eye of observerswas the welfare of the patients. People sometimes had thenotion that a hospital with a medical school attached wasnot so good for the patients as a hospital which had nomedical school. There could be no more ridiculous mistake.Lord Lister said that he could not avoid saying that the com-mittee of the Liverpool School of Tropical Diseases were to

be congratulated on having obtained the services of so dis-tinguished a man in that particular class of diseases asMajor Ross. That gentleman’s observations had been of thehighest importance and every week or two they saw evidenceand confirmation of the efficacy of his work, the recognitionof which came from Germany, France, and other countries.His lordship also congratulated the school on having Pro-fessor Boyce as the head of the pathological department.

THE INAUGURAL DINNER.The day’s proceedings were followed by the inaugural

banquet which was presided over by Mr. Alfred L. Jones(the chairman of the school), with Lord Lister on his

right as the guest of the evening and the Lord Mayorof Liverpool on his left. Amongst the other guests wereDr. Church (President of the Royal College of Physiciansof London), Professor Michael Foster (President-electof the British Association), Dr. J. W. Moore (Presidentof the Royal College of Physicians of Ireland), Sir RichardThorne, K.C.B. (Principal Medical Officer to the LocalGovernment Board), Sir William Broadbent, Bart., His

Excellency F. M. Hodgson, C.M.G. (Governor of theGold Coast), Sir C. Nixon, Sir J. Crichton Browne,Sir C. Cameron, Sir Bosdin Leech, Sir Raylton Dixon,Sir J. S. Willox, M.P., Sir E. Russell, Mr. W. F.Lawrence, M.P., Mr. A. F. Warr, Mr. C. McArthur, M.P.,the President of the Manchester Chamber of Commerce,Professor Clifford Allbutt (Regius Professor of Physic,Cambridge University), Dr. Patrick Manson, Dr. WaldemarHaffkine, C.I.E., Mr. W. Adamson (vice-chairman ofthe Liverpool School of Tropical Diseases), PrincipalGlazebrook, Professor Boyce, Professor Paterson, Pro-fessor Carter, Dr. Alexander, Dr. Adam, Mr. J. W.Hughes, Mr. Charles W. Jones, Mr. Charles Booth, jun.,Mr. J. 0. Strafford, Colonel Goffey, Mr. J. Chadwick, andMr. A. H. Milne (honorary secretary), representing thecommittee of the school, the town clerk, the headconstable, Dr. E. W. Hope (the medical officer of healthof Liverpool), the general manager and secretary of the

Mersey Docks and Harbour Board, the secretary ofthe Chamber of Commerce, the Presidents of theCotton, Timber, General Brokers, West India and AfricanAssociations, the President of the Liverpool ConsularAssociation (the Consul-General for Brazil), the secre-

tary (the Consul for Uruguay) and the treasurer (theBelgian Consul) of the same, the Consul of the UnitedStates of America, the Consuls-General for Chili, Belgium,France, Mexico, and Italy, the Consuls of Costa Rica, Den-mark, Norway, Sweden, Switzerland, and Venezuela, Pro-fessor Sims Woodhead, Professor S. Martin, Mr. Pye-Smith,Dr. Leech, Dr. Rose Bradford, Major Ross, I.M.S. (Lectureron Tropical Diseases to the Liverpool School) ,Mr. R. Brockle-bank, Mr. Walter Holland, Mr. R. D. Holt, Mr. A. Garnett,Mr. E. K. Muspratt, Mr. W. J. Davey, Mr. W. B. Bowring,Colonel Nicholson, Major Herbert, Mr. John Rankin, Mr.Alfred Booth, Mr. W. Killick, Mr. L. S. Cohen, Mr. R. T.Clarke, Dr. H. 0. Forbes, Mr. Mitchell Banks, Dr. MacfieCampbell, Mr. R. Jones, Dr. Cameron, Mr. Puzey, Dr. Barr,Mr. Damer Harrisson, Mr. W. Bolton, Mr. G. R. Wilson,Mr. H. J. Ward, Mr. John Holt, Mr. G. R. Sandbach,Mr. J. Handaside Dick, Mr. J. B. Hutton, Mr. J.Walkden, Mr. G. H. Paterson, Mr. H. Cottrell, Mr. A. T.Crawford, Mr. E. H. Harrison, Mr. A. McNicol, CaptainVoules, Mr. E. H. Cookson, Mr. L. Cappel, Dr. Macalister,Mr. Newbolt, Dr. Berry, Dr. Barendt, Mr. Holland, Dr. H.Jones, Dr. Baker, Dr. Owen, Dr. Morris, Dr. Archdall, theEditor of the J01l’rnal of Commerce, the Editor of the

Shipping Telegrapt, Mr. R. P. Haddon, Dr. Hill, Dr. War-rington, Dr. Mott, Dr. Steeves, Mr. J. Houlding, Mr. F.Willis, Dr. Nisbet, Mr. A. Maxwell, Dr. Bernard, Mr. J.Tunnicliffe, Mr. C. Killick, Mr. G. Hamilton, Dr. R.

Hamilton, Dr. Davidson, Dr. Griinbaum, Professor Raleigh,Professor Sherrington, Professor Lodge, Professor Herdman,Dr. Caton, Dr. Glynn, Mr. J. Stewart, Mr. A. T. Squarey,Mr. W. D. Hughes, Mr. G. T. Addis, Mr. W. P. Hartley,Mr. J. Pickering, Dr. Roberts, Dr. Clarke, Mr. W.Dalton, Dr. Abram, Mr. Bickersteth, Dr. Permewan, Dr.Bushby, Dr. Marsden, Dr. Manby, Dr. Annett, Dr. Rider,Dr. Grossman, Dr. Thomas, Dr. Williams, Captain Graham,Mr. James, Mr. R. Williams, Mr. David Jones, Dr. Lee,Dr. Bradshaw, Dr. Richardson, Dr. Hayward, Mr. G. W.Neville, Dr. Moore, Mr. C. McIver, Mr. A. T. Crawford, andothers.

After the loyal toasts had been duly honoured the

1176

CHAIRMAN proposed "The Study of Tropical Diseases" "

and said that he often wondered why Liverpool had notsooner taken up the study of tropical diseases scientifically.He felt that the present effort was worthy of all Englandand there was a feature connected with it which was most

pleasing. That was the assistance which they had receivedfrom other countries. Germany, Holland, and Belgium hadsent liberal contributions. The speaker paid a high tributeto the Royal Southern Hospital and to Professor Boyce fortheir public spirit.

Lord LISTER, who responded to the toast, said that hewas fully convinced of the great importance of making aspecial study of tropical diseases. The medical studentin the ordinary hospital had rare opportunities of

seeing these diseases and for a man who was aboutto practise in the tropics it was essential that heshould have opportunities of studying them here before

.embarking on his tropical career. In Liverpool they had asupply of tropical diseases second to none in the British;Isles. He had been over the laboratories in which these in-vestigations were to be conducted and they seemed to himto be eminently satisfactory. He had also seen the syllabus- of the course of instruction. Such being the case he

sympathised with them deeply in feeling that it was

somewhat of a hardship if men who had studiedin Liverpool under the best conceivable conditionsthat could exist in the British Isles had neverthe-less to go to London. He felt so strongly in the matterthat he took the opportunity of seeking an interviewwith Mr. Chamberlain on the subject. He found thatMr. Chamberlain cordially sympathised with them in their.efforts; and in the second place he learned from him that"the arrangement proposed was made for only one single.year and he commissioned him to say to them that whenthat year had expired he would reconsider the question. He<Lord Lister) hoped that the time would come when theywould be in cooperation with the London School of TropicalDiseases which had his heartiest sympathy.

Dr. J. W. MooRE (the President of the Royal Collegeof Physicians of Ireland) also responded to the toast and=said that it was a strange thing that in studying diseasesiamiliar to their own country they sometimes omitted to studythose prevailing in tropical or sub-tropical climates. One- disease particularly before his mind was typhus fever whichtad always been regarded as peculiar to sub-Arctic climates.and especially to Irish populations. As far as Ireland wasconcerned it was rapidly becoming the extinct dodo ofmedicine, but he was astonished to read in the last volumeof the " Twentieth Century Practice" " an elaborate article ontyphus fever written by a Mexican, based on his practical- experience of the disease in Mexico. He congratulatedLiverpool upon the establishment of the laboratories whichthey had had the privilege of inspecting and upon thatspecial ward in the Royal Southern Hospital. The Lord

Mayor proposed "The Liverpool School of Tropical Diseases"which was responded to by Dr. William Carter and Pro-fessor Boyce. Dr. Church (the President of the Royal Col-atege of Physicians of London) replied to the toast of TheMedical Profession" in a polished speech. Professor Foster

(President-elect of the British Association) also acknow-

ledged the toast in a speech brimful of humour. Thetoast of "Our Guests" was replied to by the Governor ofthe Gold Coast and Mr. W. F. Lawrence, M.P. The pro-ceedings of the day reflected much credit upon Liverpool;and marked a red-letter day in its annals.

PLAGUE IN BOMBAY.1

(Concluded from p. 1116.)IN accordance with the reports of former epidemics

and the experience of the Austrian Commissionerswe are led to assume as an unquestionable fact that-in both forms of the plague-the bubonic and the

pneumonic-the initial infection is a local one and

1 Uber die Beulenpest in Bombay im Jahre 1897. Gesammtberichtder von der Kaiserlichen Akademie der Wissenschaften in Wien, zumStudium der Beulenpest nach Indien entsendeten Commission.Theile I. und II. A. Mit 5 Lichtdrucken und 36 Curventafeln. InCommission bei Carl Gerold’s Sohn, Buchhandler der KaiserlichenAkademie der Wissenschaften. Wien. 1898. (On the Bubonic Plagueof Bombay in 1897. A Joint Report of the Commissioners sent to Indiaby the Imperial Academy of Sciences of Vienna to Study the BubonicPlague. Parts I. and II. A Vienna: Carl Gerold’s Son. 1898.)

that it remains so. The primary infection (through theskin) is the cause of the bubonic disease and of thedevelopment of plague metastases. But if in everysuch case we must assume a primary local andthen a locally fixed source of continuous infectionwe must admit the existence of a primary bubo in everystage of the disease, even if the evidence thereof cannotbe made out with absolute certainty either clinically or

anatomically. Dr. Muller (p. 209) says that in his

experience post-mortem examination has shown considerableglandular swellings which have entirely escaped detectionduring life. We must conclude, therefore, that a primarybubo may exist for days before evidencing pain or swelling.It is even conceivable that the course of the symptoms mayremain entirely localised, although clinically we find thateven in mild cases a general infection of the system mayexist, proved by a subsequent appearance of a bubo,carbuncle, enlargement of the spleen, and subcutaneoushaemorrhage.2 The prognosis depends upon the capabilityof resistance of the organism, especially of the circulatoryand nervous centres, against the poison in the blood.

Clinically it is impossible to establish any difference inthe type of the plague. Being a disease of one nature(einheitlich), only the symptoms under which it manifestsitself may be differentiated, since they depend upon anaggregate of influences, such as the natural resistance of theorganism, the virulence and quantity of the poison to beovercome, and the manner in which it found its entranceinto the system. A correct differentiation can be based onlyupon the way in which the disease invaded the organism, andon this principle we distinguish the glandular-bubonic andthe pneumonic plague.The Commissioners during their stay at the height of the

epidemic in Bombay did not have sufficient opportunities tocome to a conclusion regarding the period of incubation;they adduce, therefore, the opinion of other observers, espe-cially that of Dr. Choksy (p. 214), chief medical officer ofthe Arthur-road Hospital, who lays it down at from three tosix days, in exceptional cases below, in others above, thattime, extending even to 12 days.Two doors are known at present as to the entrance of

plague poison into the human system-namely, the integn-ment, including the mucous membrane of the mouth, thenasal and the pharyngeal cavities, on the one hand,and the respiratory apparatus on the other. From theconsideration of these conditions follow the individual

prophylactic measures. The commonplace advice to avoidall contact with the person of the plague-stricken or

with his expectoration and other excreta will not be

accepted by those whose duty it is to be busy aboutthe sufferer or by those who are linked by blood-relation-ship. Generally speaking, we should avoid all draw-backs lowering the vitality of the organism and excesses ofall sorts, observe general hygienic principles, laying the chiefimportance upon a most scrupulous attention to the skin anddisinfecting those parts of the body which come in contactwith the patient or his excreta. The prophylactic measures,therefore, in the bubonic plague are those generally observedin all infectious diseases. Dr. Miiller adds: "I bathedthree times at least daily, chiefly on account of the heat ;any injuries to the skin I covered with sticking-plaster;the other measures as to clothing and diet which play animportant part in ancient treatises on the plague we tookno notice of."

Dr. Muller is unable to give data regarding age, employ-ment, &c., of the patients suffering from plague. This much,however, he states, that the most critical age of infectionmay be put down at between the ages of 20 and 30 years.He had five cases between 10 and 15 years, 13 between15 and 20 years, 12 between 30 and 40 years, three of50 years, and one of 60 years of age. The youngest patientwas an infant a few months old, extremely emaciated, thechild of a Hindoo opium-eater. She had the typical bubo,of the size of a hazel nut, in the right groin. The childrecovered. The official report for 1896-97 gives much infor-mation on this subject.Owing to hygienic precautions the medical staff of the

hospitals escaped with one exception, that of Dr. P. N.Davda (a Jain) ; none of the sweepers and wardboys died,although they had to poultice and dress the incised buboes.The same freedom was observed among the numerous

2 See h&aelig;morrhagic cases: p. 45 of "Dhondi Sadu," and p. 63 of

"Gopall Laximon," and others.