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appointed Research Scholar of the British MedicalAssociation, has vacated the position of Demonstrator of

Physiology, and has been succeeded by Dr. J. S. Bolton.The Lectureships in Ophthalmology and Operative Surgeryhave been constituted Professorships, and Professor PriestleySmith and Professor Jordan Lloyd have been elected to fillthese chairs. Mr. C. Leedham-Green, surgeon to out-patientsat the Queen’s Hospital, has been appointed AssistantLecturer in Bacteriology.

University College. B’fistol.-Mr. C. A. Morton, F R.C S.,and Dr. J. Swain, M.S. Lond., have been appointed JointProfessors of Surgery, in the place of the late Mr. GreigSmith.

SOME LITERATURE CONCERNING THEPLAGUE.

WE have already alluded very briefly to some recentlypublished reports regarding the plague, and we may nownotice them somewhat more in detail, although it will bedifficult, if not impossible, to do so at any length, seeingthat the literature on the subject is somewhat voluminous.Taking them in chronological order we may start withthe report regarding the prevalence of bubonic plaguein the colony of Hong-Kong during the years 1895and 1896 by the Acting Colonial Surgeon, J. M.

Atkinson, M.B. Lond., D.P.H. Camb. This, it will be seen,deals only with the history of the disease in Hong-Kongduring those years and refers to the able report byDr. Lowson, Acting Superintendent, Government Civil Hos-pital, for the history of the epidemic in 1894. In view ofthe important practical questions that have engaged, or areengaging, the attention of many experts in Europe andIndia, the author has endeavoured to set forth such deduc-tions as seemed to him reasonably warranted from the dataat his command and to enumerate the more important factsto be noted in preventing or limiting the occurrence andspread of the disease.The report contains a brief history of the plague in China

and Hong-Kong during modern times, drawn from that byDr. Rennie on the disease at Canton in 1894 contained inthe Imperial Maritime Customs Medical Reports, and fromAllbutt’s System of Medicine, 1896, together with a sketchplan drawn to scale showing the several places referred to andillustrating the progress and route taken by the disease.Touching the prevalence of plague in Hong-Kong in 1895 itis shown that the total number of cases reported was forty-four ; that the disease commenced at the end of April andcontinued more or less during the remainder of the year;that the greatest number of cases occurred during the monthsof June and December, but that the disease did notassume such proportions as to constitute an epidemic; Iand that, with the exception of Heung-lane, in no portionof the colony did it obtain any serious hold. The procedureadopted on the receipt of information that the disease badre-appeared consisted of house-to-house visitation, theremoval and segregation of the sick, together with theisolation of the infected, the notification of infected localities,and the application, general and special, of sanitary regula-tions, disinfection, cleansing, the removal of overcrowding,and the strict and steady application of the powers conferredby public health ordinances to tenements, lodging-honses, &c.The condition of Hong-Kong as regards the overcrowding ofhouses on a given space, their vicious construction of cock-lofts, mEzzanine floors and back-yard obstructions, involvingovercrowding, absence of light, ventilation, cleanliness anddecency, was something terrible and called for wholesalechanges in every direction. Although much has probablybeen done of late years under the pressure and in-fluence of the alarm caused by the epidemic of plagueit is impossible to believe that there does not even

now remain a good deal to be carried out in the samedirection. Passing from the sanitary and prophylacticmeasures required in this and in all cases of epidemicdisease, we come to the medical aspect of plague. Thepathology, symptoms, and morbid anatomy having beendescribed in Dr. Lowson’s report of the plague in 1894 andin Dr. Wiim’s later report, the author confines himself to

1 THE LANCET, July 24th, 1897.

the facts elicited by the further experience of 1896, and thefollowing are some of the facts and deductions set forth inhis report. The main channel by which the bacillus gainsaccess to the body appears to be the digestive tract; infection-by the skin (inoculation) is relatively rare, and the immunityof those who attended plague patients or were engaged in the-inspection and disinfection of infected houses shows that theplague bacillus is not commonly received by the respiratory-tract through the medium of the air. The plague bacillus wasnot detected, it may be mentioned, in the course of manyexaminations of hospital ward air made for that purpose.Rats, mice, monkeys, pigs, and fowls have been proved tohave acquired plague after having been fed with fragmentsof organs of animals that have died from the disease. In.addition to the faeces, the bacillus leaves the body by theurine, as demonstrated by the result of culture experiments.The period of incubation seems to be generally from threeto five days, although one case is related by Dr. Wilm offifteen days. About 70 per cent. of the deaths of those-attacked by the disease took place during the first six days.In 95 per cent. of the cases albumin was found in the urine,varying in amount from one-tenth to one-half.The general conclusions to be drawn from the experience

of bubonic plague in Hong-Kong in 1895 and 1896 are statedin the report as follows :-A. That the occurrence of plagueis favoured by : (1) Long prevalence of drought or of’abnormally low rainfall ; (2) atmospheric temperature below82° F. ; (3) absence of sunshine ; and (4) general insanitaryconditions such as obstruction to the free access of light andair to domestic dwellings. B. That the steps to be taken toretard the progress of the disease are : (1) General cleanli-ness and the free admission of light and air to domesticdwellings; (2) the immediate isolation of the sick and thosewho have been in close contact with the disease ; and (3) thecareful and systematic disinfection of all premises in which,cases occur and of latrines.

(To be concluded.)

Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF INSPECTORS OF THE MEDICAL DEPARTMENT, OF THE LOCAL GOVERNMENT BOARD.

Enteric Fever at Hucknall Torkard, by Dr. Blwhanan.1-Hucknall Torkard, a small town in Nottinghamshire ofsome 15,000 inhabitants, has more than once suffered fromenteric fever, and last year no less than 141 cases were

reported there. In considering the causes of this outbreakDr. Buchanan arrived at the conclusion that there had beenno common infection by reason of occupation, food, or milk ;that in view of the two distinct systems of sewers these couldnot be held to be primarily responsible ; and that there wasno evidence that the public water-supply, which was generalto the whole town, had caused the epidemic or was exposedto any source of pollution. But there had been a heavyincidence of the disease on certain streets and localities,and in a number of houses the occurrence of multipleattacks was remarkable. Detailed investigation of suchlocalities brought out the fact that there were presentfrequent conditions of dirt, unpaved and badly-drainedyards, pollution of soil from waste water and soakageof middens, undue overcrowding, and conditions affect-

ing pail-closets which favour retention of infection. Theseare conditions which notoriously facilitate the -spread ofenteric fever, they are conditions which are known by thosewho have only the most superficial knowledge of publichealth to be those which sanitary administration should dealwith ; and yet in certain towns like this one they are allowedto persist to the danger of public health year after year.Nothing accounts for persistently recurring enteric fevermore than does the disgraceful practice still so common in

many parts of England of storing up excreta and refuse inclose proximity to dwellings in receptacles open to rainfall

1 Eyre and Spottiswoode, East Harding-street, E.C.; John Menzieand Co., Edinburgh and Glasgow; Hodges, Figgis, and Co., Dublin.Price 3d.

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and sun and sunk into the ground. If people had wantedto design something which by fouling the air ; by pollutingfood supplies in pantries, &3., opening on to back yards ;and by storing up infection in a polluted soil would ensureTecurring typhoid fever, midden-systems such as thosewhich exist in Hucknall Torkard and other places would- certainly have to be accredited with having achieved the endaimed at. It is to be hoped that after this renewed expe-rience the District Council will amend these dangerous con-ditions by carrying out the recommendations attached toDr. Buchanan’s report.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Blackpool Urban Dist’l’iat.-Dr. Jasper Anderson traced, hethinks, during the year 1896 an epidemic of enteric fever tothe consumption of mussels which were procured from a spotwhere the sea water had an opportunity of becoming fouledby sewage. It seems that there were 21 cases notified inOctober, ag against 8 in September and 8 in November;and in 10 out of the 21 cases notified in October a history of<eating mussels was obtained. It seems, however, that in-certain cases the period which elapsed between the con-sumption of the mussels and the development of the diseasewas rather long for enteric fever. A complication is intro-duced, too, by the seasonal increase of enteric fever occurringat a time when the mussels are regarded as in good conditionat Blackpool. However, we have little doubt that entericfever may be conveyed by sewage-polluted mussels, and wequite agree with Dr. Anderson as to the desirability ofpreventing their consumption. -

Southampton Urban District.-The recent extension ofthis borough has done much towards bringing its population’ap to 100,000, and it was estimated for 1836 at 98 002. Mr.Wellesley Harris, owing to the necessary uncertainty of theestimate under conditions of extensive and of considerableimmigration, urged the desirability of a census being taken,but the council was unwilling, it appears, to undertake thetask. The general death-rate of the district was for 189616-47 per 1000, as against a rate of 18 27 in 1895, the rate forthe town proper being 17-63. There were nine cases ofsmall-pox notified during the year, several of them beingimported by ships frequenting the port. One case was

apparently caused by a bag of dirty linen sent home fromthe Cape. The history of 1896 re small-pox teaches, Mr.Harris ob3erves, the wisdom of having provided the float-ing hospital in which the cases were well isolated. Informer years the introduction of a case of small-poxinto the old hospital appears to have been liable to causethe spread of the disease to the surrounding district.Scarlet fever became epidemic in Southampton during theyear, and the hospital accommodation was quite inadequateto deal with it, only 31 per cent. of the cases being isolated.Mr Harris thinks that had there been sufficient accommo-dation the epidemic would have been much curtailed, andhe furnishes instances in support of his contention. Every-thing seems to have been done to control the epidemic,and the public were educated up to their responsibilities bymeans of leaflets, &c. Under these circumstances we areglad to learn that the sanitary authority have acquired a suit-able hospital site, and have applied to the Local GovernmentBoard for sanction to borrow <S30,000 for the erection of ahospital. School closure was resorted to on two occasionsfor preventing the spread of measles, and in each case thisaction, Mr. Harris states, was attended with excellent results.Complaints in reference to the discharge of sewage on theforeshore have been made from time to time, and it has, itseems, been decided by the Council to accept the proposalof Mr. Harris to collect and treat the sewage and to dis-charge the purified effluent at one point on the ebbing tide.Mr. Harris advocates that samples of the effluent should be Itaken regularly and submitted to the borough analyst for I’examination.

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VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN thirty-three of the largest English towns 7195 birthsand 6212 deaths were registered during the week endingSaturday, August 14th. The annual rate of mortality inthese towns, which had increased in the six preceding weeksfrom 14 7 to 26’9 per 1000, further rose during the week to29-5. In London the rate was 26’2 per 1000, while it averaged317 in the thirty-two provincial towns. The lowest death-rates in these towns were 14-6 in Swansea, 15-8 in Halifax,

16-4 in Croydon and in Huddersfield, and 18-2 ’in Bristol;the highest rates were 39-6 in Salford, 40-9 in Liverpool, 42 6in Preston, and 43-0 in Birmingham. The 6212 deaths inthese towns included 2368 which were referred to the

principal zymotic diseases, against 1337 and 1994 in the twopreceding weeks ; of these, 2038 resulted from diarrhea134 from measles, 70 from whooping cough, 54 fromdiphtheria, 36 from scarlet fever, and 36 from "fever,"principally enteric. The lowest death-rates from thesediseases were recorded in Halifax, Bristol, Swansea, andHuddersfield ; and the highest rates in Salford, Leeds,Sheffield, Preston, and Birmingham. The greatest mortalityfrom measles occurred in Swansea, Birmingham, Birkethead,Salford, Blackburn, and Preston ; from scarlet fever inHuddersfield ; from whooping - cough in Plymouth, Wol-verhampton, and Blackburn ; from " fever " in Derby ; andfrom diarrhosa in Birmingham, Leicester, Nottingham,Liverpool, Leeds, and Sbeffield. The 54 deaths fromdiphtheria included 38 in London. 3 in Birmingham, and 3in Leicester. No fatal case of small-pox was registered duringthe week in any of the thirty-three large towns ; and therewere no small-pox patients under treatment in any of theMetropolitan Asylum Hospitals on the 14th inst. Thenumber of cases of scarlet fever in the Metropolitan AsylumHospitals and in the London Fever Hospital at the endof the week was 3341, against numbers increasing from2380 to 3239 on the fourteen preceding Saturdays ; 347 newcases were admitted during the week, against 396, 390, and376 in the three preceding weeks. The deaths referred todiseases of the respiratory organs in London, which hadbeen 146 and 156 in the two preceding weeks, declinedduring the week to 118, and were 63 below the correctedaverage. The causes of 68, or 1-1 per cent., of thedeaths in the thirty-three towns were not certifiedeither by a registered medical practitioner or by a coroner.All the causes of death were duly certified in Portsmouth,Cardiff, Manchester, Hull, and in nine other smaller towns;the largest proportions of nncertlfied deaths were registeredin Lsicester, LiverpJol, Shemeld and S-mderland.

In thirty-three of the targest English towns 6796births and 6058 deaths were registered during the week

ending Aug. 21st. The annual rate of mortality in thesetowns, which had increased in the seven preceding weeksfrom 14-7 to 29-5 per 1000, declined again last week to 28’7.In London the rate was 24’2 per 1000, while it averaged31’8 in the thirty-two provincial towns. The lowestdeath-rates in these towns were 12’0 in Halifax, 12’8 inHuddersneH, 17’2 in Swansea, and 18’9 in Bristol; the

highest rates were 42’9 in Birmingham, 45’2 in Hdl.45-3 in Preston, and 52-6 in Wolverhampton. The 6058deaths in these towns included 2319 which were referredto the principal zymotic diseases, against 1994 and 2368in the two preceding weeks ; of these, 1997 re-

sulted from diarrhaea, 138 from measles, 74 from

whooping-cough, 42 from diphtheria, 34 from scarlet fever,34 from "fever" (principally enteric), and not one from

small-pox. The lowest death-rates from these diseases wererecorded in Huddersfield, Halifax, Swansea, and Oldham;and the highest rates in Manchester, Birmingham, Wolver-bampton, Hull, and Preston. The greatest mortalityfrom measles occurred in Salford, Blackburn, Birming-ham, Manchester, and Preston ; from scarlet fever in

Wolverhampton; from whooping-cough in Gateshead; andfrom diarrhoea in Leeds, Manchester, Burnley. Salford,Leicester, Birmingham, Wolverhampton, and Hull. Themortality from "fever" showed no marked excess inany of the large towns. The 42 deaths from diphtheriaincluded 29 in London and 3 in Liverpool. No fatalcase of small-pox was registered last week in anyof the thirty - three large towns, and no small - poxpatients were under treatment in any of the MetropolitanAsylum Hospitals during the week ending Saturdaylast, the 21st inst. The number of scarlet feverpatients in the Metropolitan Asylum Hospitals and in theLondon Fever Hospital at the end of the week was 3400,against 3106, 3239, and 3341 on the three precedingSaturdays ; 340 new cases were admitted during the week,against 360. 376, and 347 in the three preceding weeks.The deaths referred to diseases of the respiratory organ’in London, which had been 156 and 118 in the two pre-ceding weeks, were 119 last week, and were 53 belowthe corrected average. The causes of 61, or 1-0 percent.. of the deaths in the thirty-three towns were notcertified either by a registered medical practitioner or by a