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781 that such a charity would interfere with the trained nurse and the medical men established in the locality. The proposed nursing charity was successfully nipped in the bud. Instead of indiscriminate charity there is at Loughton a Maternity Club. The mothers subscribe some months in advance to this institution and when they are confined they are attended by one of the local fully-qualified practitioners and the club pays him a guinea fee. At first the subscriptions paid by the mothers did not suffice and the balance was made up by donations from charitable persons. Now, however, the Maternity Club has ceased to be a charity the members subscribe enough not only to pay the guinea fee to the medical attendant, but also to pay a nurse and to get various things specially needed at such a time. Thus there are no midwifery cases attended in Loughton for less than a guinea and one of the local practitioners assured me that during the last four years he had had no bad debts and he had not even been put to the unpleasantness of having to ask for his money. It is true that the inhabitants of Loughton are fairly prosperous. They work for the railway, for corn- merchants, and as gardeners for the local residents. The most improvident belong to the mixed gipsy class. They are not true gipsies, for when a number of gipsies were turned out of Epping Forest some of them married East-end women and thus a sort of half-breed race has grown up. They live by providing donkeys and various sorts of entertainments for the holiday folk who visit the forest. These are the only class of people at Loughton likely to give the local practi- tioners some trouble. There is a provident society at Lough- ton which is self-supporting and there are benefit societies and medical aid associations. These all pay 1d. a week I for adults, but for children they pay less. However, as the population is exceptionally healthy and there is very little sickness these sums represent more than they would in a large town and I did not hear any complaints. The nurses from Plaistow and other and nearer nursing institutions do not come to Loughton. Yet the poor have an efficient nurse to attend to them. This is one of the ’’ Queen’s nurses" and she costs the community about £100 a year. The money is raised by subscription and managed by a committee on which the interests of both Church and Chapel are duly represented. The nurse has a cottage to live in, must not accept any fee, and only attends to others than the poor in a case of emergency. If an accident happens to a well-to-do person and the help of a nurse is required immediately then the medical attendant may send for this nurse, but she must leave the case as soon as a paid nurse has been brought down from London. It is therefore only in cases of emer- gency that the Queen’s nurse can be employed, and on those occasions the person profiting by her services is supposed to contribute half a guinea towards her maintenance. Such a case, however, is of rare occurrence. The nurse’s time is devoted to attending the poor, but she must only visit patients to whom she is sent by one of the medical men of the town. Thus the matter is entirely in the hands of the local practitioners : the nurse is there to help them and not to compete against them. The inhabitants of Loughton seem to have realised that it is the business of medical men to attend to the sick and that the best way of helping those who are ill is to help medical men to do their work. Efficient nursing is a great help ; the gTievance at Plaistow, East Ham, and elsewhere is not against nurses who help, but against nurses, most of them insufficiently trained, who compete against fully-trained nurses and against the medical practitioners. The fact that such a grievance does not exist at Loughton, though it prevails extensively in the immediate neighbourhood, shows what the profession can do when its members are united, and it indicates also that there is a way out of the difficulty. NOTES FROM INDIA. (FROM OUR SPECIAL CORRESPONDENT.) A Third Outbreak of Plague in Bombay.-New Measures and their Probable Consequences. --Appointments of Divisional HealtA Officers.-Plague elsewhere. IT cannot be disguised that Bombay is seeing the com- mencement of a third outbreak of the plague epidemic. The deaths during the past week have risen from 101 to 162, the type of the disease appears to be extremely virulent, and the cases are occurring in all parts of the city. Considerable anxiety is being felt and expressed in trade circles with regard to the probability of severe plague regulations being- again enforced. The continuous expenditure on plague- measures is also telling seriously in many quarters, and has. virtually brought the finances of the Bombay Government. to insolvency. The new plague powers and organisations are- much the same as the old, but instead of the Plague. Committee the Municipal Commissioner becomes the- responsible chief plague authority. As he is interested in, the municipality, and especially in its finances, whatever- plague measures may be enforced will at least be subject to. proper financial control. The denial of the riots of last March being premeditated’ is only an official defence of departmental policy. No one- believes it. I have been given an intimation that if the- former obnoxious measures be reintroduced rioting will be- repeated. The plague regulations being so distasteful the. native leaders seek for means of counteracting them. The’ loss of a few lives is nothing to them and is admitted ago such. They recognise the results of the last riots and almost regret that they were not brought about before, and they have the foresight to see that the enforcement of sanitary measures which lead to disturbance will assuredly be- condemned and consequently withdrawn. A fight against. disease when the people are against you cannot be conducted’ at the point of the bayonet. This, I believe, is the native- opinion and indicates their future policy. If the new powers. placed in the hands of the Commissioner be carried out with’ the martial spirit and with the military assistance of the- late Plague Committee the rioting will be repeated. In view’ of the developing third outbreak it is to be hoped a more. sympathetic course will be adopted. In the reorganisation scheme for the Health Department of Bombay city 4 divisional health officers have been appointed. Dr. C. H. Cayley has been given No. 1 division, comprising. the south of the island and the eastern district of the city. Mr. J. Leask has No. 2 division, comprising the westerib and central districts of the city; Mr. W. Venis No. 3! divison, comprising the northern part of the city; Dr. S. C. Hormasjee (a Parsee) No. 4 division, comprising the whole- of the suburbs on the north. As Mr. J. Leask is not a medical man his appointment to such a post is a curious. anomaly. His powers for administrative work are un- doubted and he has acted as the assistant health officer for- some years. Personally nothing but praise can be said in his favour, but in principle the appointment is wrong. Some- other post might well have been given to him in order to. secure his services to the corporation. In other places plague seems more intense than it has ever- been in Bombay. Dharwar district shows a death-rate 0f 82 per cent., Thana district of 78 per cent., Satara district of about 80 per cent., and Belgaum of 77 per cent. Also & much larger proportion of the population has been attacked. The ridiculous rules made for the English nurses at Calcutta; and previously reported were withdrawn soon after they were made publicly known by the press. MANCHESTER. (FROM OUR OWN CORRESPONDENT.) Infectious Diseases at Health Resorts. IN his report on the health of Manchester for the second quarter of this year Dr. Niven draws attention to the- frequency with which children contract scarlet fever and other infectious fevers at " health resorts and to the little- solicitude shown by heads of families that the quarters. selected should present a clean bill of health. He points. out that at most of our health resorts there are powers for- the compulsory notification of infectious disease and that visitors may obtain reliable information from the local’ medical officers of health. It is to be feared, however, that the danger of infection cannot always be met in this way,. for there is no doubt that many children are taken to these" places after suffering from scarlet fever and before desquama-- tion is finished and after measles before they are free from. infection. It is clearly the duty of medical practitioners to. do all they can to prevent their patients being moved before- they cease to be dangerous to others. Poisoning Attributed to Potted Shrimps. Some 40 or more people at St. Anne’s-on-the-Sea have’
