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any question that a radical change in the sanitary adminis-trations of Indian towns, both large and smaU, is one of themost urgent needs for reform. The native forms of muni-cipal government are so entirely influenced by the personalinterest of the members that anything like sanitaryprogress under the present régime is hardly to beexpected. The few sanitary commissioners are practicallyofficers without men and their powers are limited. In Madrasthere are district medical and sanitary officers but theyare not specially qualified in sanitary science. It has beensuggested that the medical men holding the public healthdiploma who have been recently sent out by the Secretaryof State should be offered appointments of this characterand should form the nucleus of such an organisation. Therewould be no difficulty in obtaining other officers fromEngland to satisfy the requirements for the furtherdevelopment of such a service. In addition, it shouldbe compulsory on all municipalities to appoint as healthofficers only those who hold a sanitary qualification.This certainly should be made to apply to all townsof 50,000 people. It might be objected that such an estab-lishment would be interfering with the province of the IndianMedical Service, but if there were shown any real dispositionto create such an administration this difficulty might easily be overcome. Either the public health officers might be placed in a special seJvice or they might be incorporated forspecial nork in the Indian Medical Service. What is of vitalimportance, should such an organisation be created, is that’the officers should possess a sanitary qualification. At the

present time the Indian Medical Service could provide but afew men adequately prepared to fill such offices, so thateither time must be allowed for a new generation of menqualified in public health work to be developed or

assistance of men from England who are not in theservice must be requisitioned for the special purpose. As amatter of general administration it would probably be betterto create a special service or, if under the control of theheads of the Indian Medical Department, with an entirelydistinct organisation. It is high time also that nativemedical men should have inducements offered to them totake up sanitary qualifications. The smattering of instruc-tion in hygiene which the universities and colleges at presentgive is totally inadequate. Regular examinations anddegrees in public health might readily be established.Another most urgent want is the provision of a thoroughlywell-equipped bacteriological laboratory properly officeredfor each presidency. India offers so many diseases in man-and animals which require further scientific investigationthat the opportunities at present lost are much to be deplored.The Government of Bombay have at last conceded that

the Plague Committee should be instructed to exempt fromsegregation or detention persons who can produce satis-factory evidence of having been inoculated within theprevious four months. They stipulate, however, that the

. inoculation shall have been performed by specially selectedofficers and that the premises, clothing, and effects of the’ inoculated persons shall be properly disinfected. Theseconditions are necessary to safeguard the possibilities of

conveying contagion, but of course involve considerabletrouble and hamper business movements very greatly. It is,however, a concession of considerable magnitude. It remainsto be seen whether the Plague Committee will give facilitiesfor inoculation beyond those offered by the municipality.If these inducements had been offered earlier it would haveled thousands to willingly offer themselves for inoculation.The delay has been disastrous, if not to the lives of the

people, to the trade of the city. If inoculation with Haff-kine’s prophylactic fluid can be permitted now to replace thenecessity for detention and quarantine it might equally wellhave been allowed four months ago.The past week has shown a marked decline in the

mortality from plague ; while there has been some improve-ment in the city for some two or three weeks past; thesuburbs continue to be seriously affected. Now, however,there are signs of abatement everywhere. Judging frompast experience the decline will regularly continue and weshall probably see an almost complete subsidence in thecoarse of six or eight weeks. The type of the disease is

also not so severe. The system of segregation has been stillfurther relaxed and the granting of passes to traders is morefreely given. House-to-house visitation has been practicallyabolished and very few 11 contacts " are now removed. In short,all the measures of the Plague Committee hitherto adoptedwith such stringency have been practically suspended and

yet there is not the slightest evidence of further spread ofthe disease. This clearly shows either that severe sanitarymeasures are not required for plague or that when once anepidemic shows signs of declining the various rules of inspec-tion, segregation, detention, and disinfection can be doneaway with. The disease seems to take its own particularcourse whatever may be done, although doubtless sanitarymeasures have an influence on the extent or the severity ofthe outbreak. Relapsing fever seems also to be dying out.April 2nd.

BIRMINGHAM.

(FROM OUR OWN CORRESPONDENT.)

" The Dangers of Medical -Life."WHAT was aptly described as above by the presiding

magistrate at Aston Police-court on April 15th is an illustra.tion of the difficulties which sometimes beset the medicalpractitioner in the discharge of his duties. Mr. Parry,a surgeon, was brought to the court on a warrant chargedwith committing a criminal assault on a Mrs. Mathews. Thesolicitor who had been instructed to prosecute said thatsince the case was put into his hands he had examinedthe witnesses for the prosecution and in his judg-ment the evidence did not support the charge. The state-ment of prosecutrix was not corroborated in importantpoints. Mr. Vincent Jones, to whom Mr. Parry acted as

assistant, was called and he stated that he found the prosecu-trix suffering from hysteria and that Mr. Parry had only donewhat was quite right in enforcing the administration of asoothing draught. The Bench decided that Mr. Parry wasentirely and completely exonerated, stating that such casesfrequently occurred and expressing their sympathy with anygentleman subjected to such a charge as this. A favourableending to an unfounded charge of so serious a nature hardlycompensates for the perils the medical man is exposed to indealing with a certain class of patients, but it affords anexample of the annoyance and risks which constitute one of"the dangers of medical life."

Death under Chloroform.A death under chloroform happened at the Guest Hospital,

Dudley, on April 14th. The patient was a young woman, agedtwenty-four years, suffering from a deep-rooted abscess of theright breast. About five drachms of chloroform were adminis-tered by Mr. Tuxford, the house surgeon, in the presence ofDr. A. S. Underhill. The deceased struggled violently untilshe became insensible. Directly the operation was concludedthe breathing ceased. Dr. Higgs, who made the post-mortemexamination, stated that the brain was slightly congested,but that all the organs were healthy ; in his opinion deathwas due to paralysis of the muscles of respiration. A verdict.of "Death from misadventure" " was returned’by the jury atthe inquest held on April 18th.

’

April 19th.

LIVERPOOL.(FROM OUR OWN CORRESPONDENT.)

Changes at the Liverpool Hospitals.THE number of vacancies on the senior staff of the Liver-

pool hospitals has been exceptionally large during thelast three months. To begin with there occurred thevacancies at the Royal Infirmary, at the Royal SouthernHospital, and at the Ladies’ Charity and Lying.inHospital - all owing to resignations through lapse oftime. These posts have been filled up as recorded inTHE LANCET. The vacancy on the surgical staff ofthe Stanley Hospital caused by the appointment of Mr.G. P. Newbolt to the Royal Southern Hospital was filledup on the 12th inst. by the appointment of Mr. DouglasCrawford. who had been for three years assistant surgeon tothe hospital. At the present time there are vacancies onthe staffs of the Women’s Hospital and the Ladies’ Charityand Lying-in Hospital due to the appointment of Dr. T. B.Grimsdale to the Royal Infirmary, the regulations of the

Royal Infirmary not allowing of the retention of similarposts at other Liverpool hospitals by members of its staff.

1149

The Proposed Smallpox Hospital at Fazakerley.Mr. W. W. E. Fletcher, inspector of the Local Government

Board, held an inquiry at the Municipal Offices, Liverpool,on the 19th inst. in reference to the application by theLiverpool Corporation for powers to borrow R38.000 for thepurchase of a site for a small. pox hospital and convalescenthome at Fazakerley. The application was opposed by ownersof estates in the vicinity. The town clerk of Liverpool insupporting the application detailed at length the steps whichthe corporation had taken during the last fourteen years toprovide accommodation for infectious diseases, which hadproved most beneficial in restricting infection and in im-proving the general health of the city. Althoughthe Registrar-General’s return stated that the death-rate ofLiverpool was very high, yet the population upen whichthose returns were based was much under-estimated, as theactual population of the city was 50,000 in excess of theofficial Bgures. The official return put down the popula-tion at 643,000, whereas in point of fact it ought to havebeen 690, 000. The corporation found themselves bound toprovide for the actual number. Under existing circum-stances the corporation had to ask poor-law authoritiesto receive infectious cases in workhouse hospitals, wherethere was no doubt they were a source of danger.At present there were at the disposal of the corpora-tion 540 beds for the treatment of infectious diseases, but260 of these beds were in wooden buildings of a temporarycharacter. Another point emphasised by the town clerk wasthat there was no hospital for the treatment of small-pox atthe north end of the city, which was most densely populated.The corporation did not admit that there was danger to thegeneral public from institutions of this character providedthe regulations of the Local Government Board were

observed. The proposed site was large enough to enablethe hospitals committee to have the required 400 yardsof space between the small-pox and convalescenthospitals which they proposed to build and also toallow of ample space between these buildings andwhatever houses might be erected on land adjoining.There was some argument between the opposing parties in reference to the estate having a clay subsoil which, it wasstated, would render it unfit for hospital purposes, and alsowith regard to the fact that owing to the overflow of theFazakerley brook the property was liable to periodical flood-ing. Dr. Hope supported the application of the corporationand adversely commented upon the adoption of floatinghospitals on the Mersey. He also said that he had neverknown a case of infection traced to an ambulance carriagein progress through the streets. The great recommendationof the proposed site consisted in the fact of its nearness tothe densely populated parts of the city.

The West Derby Guardians on the Treatment of PanperImbeciles and Epileptics and the Midwives Bill.

The West Derby Board of Guardians are about to enterinto an agreement with the select vestry of the parish ofLiverpool and the Ormskirk Union for the classification andaccommodation of epileptic, imbecile, and weak-mindedchildren. The West Derby board are to provide accommoda-tion for 110 juvenile epileptics, the select vestry are to findaccommodation for 170 imbeciles, and the Ormskirkguardians are to provide for 60 weak-minded children. Thenew movement is in the direction of classification of thesediseases, which require special treatment. The West Derbyboard of guardians have also resolved by a majority of 18votes to 9 to petition Parliament in favour of the Bill for theCompulsory Registration of Midwives. Two prominentmedical members of the board opposed the resolution on theground that it was full of dangers which, in the interests ofthe poor, it was desirable should be avoided.

the Daitgers of False 2’eeth.An inquest was recently held by the city coroner touching

the death of a grocer’s assistant aged thirty years. Thedeceased wore false teeth attached to a vuloonite suction-plate and fastened to his natural teeth by wires. He wasin the habit of sleeping with the false teeth in his mouth.On the morning of March 19th the deceased unfortunatelyswallowed the false teeth during sleep. He was taken tothe Royal Southern Hospital when the teeth were felt tobe impacted at the junction of the pharynx with theoesophagus on the left side of the larynx. As it was foundimpossible to remove the teeth by manipulation they were

eventually withdrawn through an artificial aperture madein the neck. However, the unfortunate man succumbed a,

week later, septicaemia having supervened.April 19th.

SCOTLAND.

(FROM OUR OWN CORRESPONDENT.)

6ilasgorv Fever and Small-pox Hospitals.THE report of the City of Glasgow Fever and Small-pox.

Hospitals for the year ending May 31st, 1897, has just beenissued. The greater part of it is by Dr. Alexander Johnston,physician-superintendent of the fever hospitals, the fewpages devoted to the small-pox hospital being by Dr. R. S.Thomson. The general statistical summary of the patientsis as follows: remaining in hospitals June 1st, 1896, 607 ;admitted during 1896-97, 4861; cured, relieved, and died,4997 ; remaining in hospitals May 31st, 1897, 471. The totalnumber of deaths was 497, of which 91 occurred withinforty-eight hours of admission, and the general mortalitycalculated on completed cases was 10 2 per ceat. The dailyaverage number of patients was 627, of nurses and servants319, and of officers 14. The average residence of each

patient was between forty-one and forty-two days ; the total’ordinary expenditure was £ 34,224 ; the average daily costper patient was 2s. 11.9d. ; and the average cost of treat-ment per patient was £ 6 5s. 22d. The 4861 cases admittedwere classified as follows: scarlet fever, 1956 (with 89’deaths) ; diphtheria, 180 (with 38 deaths); enteric fever,545 (with 106 deaths) ; typhus fever, 13 (with 5 deaths) ;’small-pox, 2 (with 1 death) ; chicken-pox, 29 (with 1 death) ;measles, 1442 (with 164 deaths) ; whooping-cough, 348 (withb6 deaths) ; erysipelas, 53 (with 4 deaths) ; puerperal fever,26 (with 9 deaths) ; epidemic roseola, 13 (with no death) ;the admissions also included 108 nursing mothers and 143’cases of non-infectious disease, among which there were 41patients suffering from pneumonia. The average periods ofresidence for the various classes of disease were as follows :-scarlet fever, fifty-eight days ; enteric fever, fifty-five dayswhooping-cough, fifty-three days; typhus fever, twenty-eightdays; measles, twenty-nine days ; and small-pox, thirty-one days. The classification of the admissions accord-ing to age was: under ten years, 3382 or 69’5 percent.; between ten and twenty - five years, 1132, or

23’2 per cent.; and over twenty-five years, 347, or

71 per cent. The scarlet fever mortality was 4 5 percent., being the lowest in the history of these hospitals.Anti-streptococcic serum was tried in scarlet fever, but

nothing to show that it was of great value was observed.Laparotomy was performed in two cases of intestinal perfora-tion occurring in enteric fever, but without averting a fatairesult. The clinical classes were attended by 110 male and15 female students. A paper on

" The Administrative Treat-ment of Undefined Cases certified as Scarlet Fever," byDr. Frederick Dittmar and Dr. John Brownlee, assistantmedical officers at one of the fever hospitals, was publishedin THE LANCET of April 3rd, 1897.

A.pril18th. ________________

IRELAND.; (FROM OUR OWN CORRESPONDENTS.)

The Meath Hospital, Dublin.THE annual meeting of the Governors of the Meath

Hospital and County Dublin Infirmary was held on April18th, under the presidency of Sir Philip Smyly. Thesecretary, Mr. Francis Primrose, read the annual report,which showed that the hospital had been maintained aaregards all its departments in a most efficient conditionduring the past year and that the convalescent home at

Bray in connexion with the hospital had continued to confermuch benefit on the patients sent there during the lasttwelve months. Dr. J. W. Moore moved a vote of thanks to.the County Grand Jury and remarked that this would be thelast occasion on which they would have an opportunity of,thanking the Grand Jury, to whom they were greatly,indebted for their interest in the institution and fortheir substantial grants to its funds. He stated that he