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position, I am told, is quite different. There it is not, Iunderstand, a question of insufficient wages but of theabsolute determination of the negro to live outside the

wages system altogether. He seeks to cultivate a little plot-of land for himself, to live entirely on his land, and will notwork for anyone else, however high the wages may be.

-Certainly if the negro can live on the soil, if he can afford tokeep large towns, factories, mills, and workshops at a

distance, and is not attracted to them by the hope of pleasure,dissipation, and gain he may develop an agricultural race ofpeople whose physique will excel that of the town-livingwhite man.

MEDICAL NOTES FROM THE FAR EAST.

(FROM A SPECIAL CORRESPONDENT.)(Concluded from p. 258.)-

CTHE scenery around Matsuyama is as picturesque as could ]

be wished and the great Daimyo’s castle for which it is

noted standing out from the trees on the top of the topmosthill, with a magnificent view over 100 miles of land and sea, 1

has been taken over for the housing of the captive Russianofficers. At the time of my visit-namely, in August, 1904-there were about 2000 prisoners in Matsuyama, and of thesethere were then 270 in hospital, almost all suffering fromwounds; altogether 670 wounded had been admitted. It

speaks well for the Japanese medical men that only sevenof these have died (all from the effects of gunshot wounds)and that there has been no death from sickness. Surgeon-General Kikuzi, who was formerly an assistant to ProfessorBruns of Tiibingen, is in charge of the whole hospitaland himself performs all the operations. Two Russianmedical men assist in the work of the hospital, one of them,who holds the rank of colonel, taking charge of the medicalwards. The Japanese Government has built the hospitaland equipped it on generous lines, the complete medicaland nursing staff for the 270 patients under treatment

consisting of 11 Japanese medical men and the two Russiansalready mentioned, with 10 male and 66 female nurses, apartfrom the clerical and menial establishment. The hospital isat some distance from. and out of sight of, the main

prisoners’ quarters, being situated in rich open country atthe end of a village on the outskirts of Matsuyama. The

compound is inclosed by a simple wire fence of four strandsguarded at the entrance and no doubt elsewhere by a sentryin khaki, but there cannot be much danger of escape. NoRussian could be mistaken for a Japanese and in this land ofsecret information and detectives no European could passmore than a few days without the circumstances becomingknown to the authorities. ’LNo person of any nationalitycould well leave the island of Shikoku or, outside of Shikoku,leave Japan without supplying particulars of name, age,parentage, profession, home residence, business, and objectof journey to several police officers in turn. At Matsuyamathe captured Russians are in safe keeping without obviousimprisonment.Surgeon-General Kikuzi-" Médecin Inspecteur," as he has

had printed on the European side of his visiting card-is oneof three surgeons-general in Japan who, with three in

Manchuria, make up the list of general officers under BaronKoike, the Director-General in Tokio. The others who, withSurgeon-General Kikuzi, make up the three in Japan areSurgeon-General Hashimoto at the Red Cross Hospital inTokio and Surgeon-General Sato in Hiroshima.The hospital is built, like others, of unstained imbricated

wooden boards, has thatched roofs, and is designed on thepavilion principle, the pavilions being connected by a coveredcentral corridor. At one end of it sites are staked out andfoundations are being laid for four or six new pavilions,for, as my host remarked with a quiet smile, "we areexpecting more guests before long." The infectious wardwas away by itself beyond the site of the proposed newpavilions but it was empty. No case of sickness had died,there had been no case of epidemic disease, and there wasat the time no case of medical interest in the wards. Thelatrine system was on the same unreasonable principle as atSasebo and Hiroshima and need not be again condemned indetail. On the other hand, the Japanese military medicalservice has an excellent regulation by which the rank and

iile are given two lectures every month in companies by themedical officers on the principles of health, first aid, and theapplication of the first field dressing. A correspondingregulation might well be introduced into our army and inorder to insure the intelligent execution of sanitarymeasures it should be laid down as essential that everyofficer in the army, whether combatant or non-combatant,should have a good knowledge of the same subjectson broader lines. To this regulation the Japanese soldieris now showing absolute submission with the verybest results. Similarly in Japanese civil life there is a

regulation by which every child in the schools is assignedto the care of a particular medical man whose duty it is toexamine and to report on the child’s health and physiqueevery year and to give instruction on health matters once amonth. In Japan both the Government and the public aremaking a serious, and in their belief a successful, effort toimprove the national physique. In some of the Japaneseprefectures (corresponding in size to our counties) there isalready a well-organised prefectoral health department. At

Nagasaki, for instance, this department consists of 16medical officers of health who are paid from .E.70 toE200 a year by the prefectoral government without fixity oftenure and are sent to various districts as may be required.A good instance of scientific observation in medical

subjects being visibly turned to account is the Japaneserecord of frost-bite during the war with China in the winterof 1893-94. The temperature in Manchuria goes down to- 20°F.—i.e., over 500 of frost-and frost-bite duringthe winter months became seriously common among theJapanese troops. Surgeon-General Kikuzi, however, atthat time principal medical officer of one of the armies,observed that frost-bite seldom occurred even at thelowest temperatures so long as the men kept theirboots on and remained dry. In driving snow withuncovered hands and ears, or if these extremities werecovered only with absorbent woollen materials which becamesoaked with moisture, frost-bite was of more frequentoccurrence and in exposure after crossing a river, as in thebattle of the Yalu fought against the Chinese, it was mostcommon of all. The prophylaxis against frost-bite is

evidently therefore to instruct the troops to keep themselvesas dry as possible and use will be made of this knowledgein the campaign during the winter. Incidentally thisaffords an example of a subject in which the medical officermust be consulted by any general who understands the

importance of health to the efficiency of troops.At Matsuyama there was a collection of bullets and

splinters, the third that I had seen, and one that would wellrepay examination. The Sasebo collection was essentiallyone of shell fragments, the Hiroshima collection was one ofRussian bullets, and this at Matsuyama was one of specimensof the slender Japanese bullet. As a rule the jagged irregulardistortion produced by ricochet off rock or stone could be

distinguished from the slighter degrees of distortion due toconcomitant fracture of a hard bone, and in general animpression was formed that the more slender the bullet themore common is distortion in bulk but the less common is

fragmentation. The most remarkable specimen was the

complete base of a shrapnel shell, with its cells for the

shrapnel intact, measuring six centimetres in diameter and1’ 3 centimetres in thickness and weighing 235 grammes,which was extracted, so far as can be remembered, froma pelvic wound with the result that the patient com-pletely recovered. This collection is kept in a glass case inthe operation hut together with many interesting pathologicalspecimens preserved in alcohol, chiefly fragments of boneand excised aneurysms of various sorts ; the preservation inalcohol has caused a good deal of shrinking and bleachingwhich might have been avoided by the use of formalin andglycerine. The operation hut consists of three rooms-

namely, a well-lighted theatre about 18 feet square, withglass windows along three sides ; an instrument room con-taining instruments, dressings, museum, and sterilisers ; andan empty preparation room. Everything was simple.efficient, and cleanly. The only article especially callingfor remark was the aseptic dressing invented by Surgeon-General Kikuzi 1 which consists of the charcoal made byburning rice-straw, inclosed in linen bags of three con-

venient sizes. Straw charcoal is preferred because of itsfine division. Rice-straw is used because of the prevalenceof rice throughout Japan and China but any straw is equally

1 Bruns’s Beiträge zur Klinischen Chirurgie, Band xxiii.

392

useful, whether fresh or old, clean or dirty. The straw is

simply collected into any convenient iron vessel or in largequantities on the earth, or brick, or stone floor of a room,after which it is set on fire and left to burn itself out in alimited supply of air by covering the vessel in the one caseor closing the doors and windows in the other. Bags ofordinary linen, freed from fat and sterilised, are filled withthe charcoal under aseptic precautions and the asepticdressing is complete. Its advantages are that as straw isobtainable almost everywhere it is only necessary to carry thelinen bags, that it possesses some bactericidal properties, andthat as compared with gauze it is both more absorbent andvery much cheaper, costing only one-sixteenth of the priceof even the inexpensive gauze made in Japan. In theMino-Owari earthquake of 1891, when the supply of surgicaldressings was cut off for some days by the destruction of therailway, 1600 injured persons were treated with dressingsmade of rice-straw charcoal at a total cost of 3s. 6d.Among the 670 Russian wounded 22 have been operated on

for aneurysm, five of these being arterio-venous lesions andthe remainder false or spurious aneurysms of arteries. Sixfalse aneurysms were of the femoral artery. Brief notes ofsome of the cases were made. In one of them the bullet, aswas subsequently found, in passing from side to side throughboth thighs must have grazed the front of the rightfemoral artery in Scarpa’s triangle without injuring thevein. All that was seen at the time of admission was a

large pulsating swelling filling the triangle and distendingthe skin of the limb. On the operating table a very extensiveextravasation of blood was found. The femoral arterybeing controlled in the groin the site of injury of itswalls was roughly determined and the vessel was doublylegatured above and below. The vein was similarlyiigatured above and below and the whole tumour with threeinches of the artery and vein was removed. The aneurysmhad extended right across in front of the femoral vein which,however, was uninjured. The patient had recovered withoutany untoward sign. There were several interesting cases

of injuries of the head, arranged to some extent in series.In one a bullet had entered through the mastoid bone imme-diately behind the right external auditory meatus, and passing] ight across the head had made its exit at an almost

corresponding position perhaps an inch further back, with-out causing any symptoms beyond those of local shock.’J here was not even any headache left and healing had beencomplete. Another man had been hit half an inch belowthe inferior edge of the right orbit. The bullet must have

passed directly backwards through the malar bone andantrurn of Highmore, through the spheno-maxillary fossaand sphenoid bone into the temporo-sphenoidal lobe, and<,ut through the petrous and mastoid portions of the temporalbone. The aperture of exit was just behind the base of themastoid on the same side. The patient had lost all hearingin the right ear but otherwise he had made a completerecovery. In a third case the wound of entrance was ani uch above the left external auditory meatus and that ofexit was two inches in front of the right parietal eminence.The injury was incurred on May lst, 1904, and resultedin a right-sided hemiplegia but this gradually cleared upand finally completely disappeared. In the South Africanwar these side-to-side lesions through the Rolandic area

were looked upon as almost invariably fatal. In the

present case it was probable that the left motor cortexhad alone been injured and that its function hadbeen re-established by the opening up of collateralconnexions and by the training of deeper cells totake on cortical functions. There were two or threecases of "fore-and-aft" wounds, one of which must

certainly have passed directly through the corona radiataof one side, causing hemiplegia at the time, but recovery wasat my visit almost complete. A similar case may be recalledof an officer of the 19th Hussars, seconded to Thorneycroft’sMounted Infantry and hit at Colenso on his first day withhis new regiment in a precisely similar way. He was atfirst completely paralysed’on both sides. Six weeks later hewas carried on board a hospital ship still almost powerlesson one side and finally he was able to walk ashore at theLondon Docks. Two casts of gunshot wound of the spinalcord were seen. One of these patients was in the low stateassociated with he]pl-ess paralysis on the downward grade.In the other case the bullet had entered beneath the eighthrib in the right flank and had passed apparently throughthe liver, the vertebral column, and at least the spinalmembranes to reach the surface through the muscles -of the

back on the left side of the eighth or ninth dorsal vertebra..This injury was received on May lst, 1904, and resultedin total paralysis but after three months the man wasable to walk down the ward and back again at marchingpace with hardly any dragging of the foot and certainlywith no limp. The most probable explanation of this andmany similar recoveries is that there had been compressionof the cord by a hasmatorrhachis or collection of bloodwithin or outside the spinal membranes and that absorptionof this blood allowed the cord to recover its functions.

There were two interesting cases in which a bullet had

passed through the brachial plexus, the wound being abovethe clavicle in one and below it in the other. In the formerthe man must have had his head almost resting on hisshoulder, for the same bullet first passed through the tracheafrom side to side and thence into the shoulder through theposterior triangle of the neck near its base and out behind.The wounds in the trachea were perfectly healed; thearm appeared to be completely paralysed but the pectoralmuscles were not wasted and their function seemed to beretained ; the sympathetic was of course uninjured. In thesecond case the wound of entrance was close outside the-coracoid process, while that of exit was below the angle ofthe scapula of the same side. The musculo-spiral andulnar nerves were completely severed but no other nerves

were injured. The general health of this patient hashitherto prevented operation but suture will certainly be-attempted as soon as possible. The first-mentioned patient,is, I think, to be let alone. To the many instances ofwonderful escape may be added one in which the wound ofentrance is marked by a small scar in the median line of theneck two inches immediately below the pomum Adami,while the wound of exit is equally small and equally wellhealed, one inch to the left of the seventh prominentcervical spine. Recovery has been complete.

In one of the wards there was a series of fractures of thefemur set in gypsum. As already observed at Sasebo.and Hiroshima, they were all well and securely fixed butthere was no valid reason why they should not have had thesuperior advantages of treatment by extension.

Last of all the cases that these letters will have the-privilege of reporting in connexion with this war is one thatmust be unique. When a bullet strikes a bone one of two-things may happen, as was proved over and over agdin in theSouth African war. Striking compact tissue it may break

it, or striking cancellous tissue it may perforate it, breakingit also or not breaking it, according to a variety of othercircumstances. Many instances occurred of bullets drillinga clean path through the cancellous epiphyses of the tibia,and femur. But here for the first time on record was an

indisputable case of drilling of compact diaphysial bone.

The bullet had entered behind, and below, the calf of the legand had issued from the subcutaneous surface of the tibia

exactly nine centimetres (three and a half inches) above thetip of the internal malleolus. The skin wound had healedand the depression in the bone could still be felt, with an un-runled surface of bone in a ring all around it. A skiagramin a plane at right angles to the axis of this track would bea very remarkable record. There is, it is said, a specimen ina Paris museum showing a femur cleanly drilled by the newFrench bullet but it is believed that this lesion was inflictedin a post-mortem experiment.

It was to me an impressive experience after havingvisited so many Japanese hospitals and inspected the-wounds of so many Japanese soldiers and sailors tocome to Matsuyama and find myself in a hospital wardbefore a row of white men, on an average six inchestaller than their opponents, saluting and obeying the

Japanese surgeon-general. This feeling was even increased’on a visit to the officers’ pavilion where there were

servants, books, cards, and cigarettes, and the patients weregentlemen all, with whom it would have been a pleasure to-stay and to talk more than the few available minutes. Oneof the officers, a Baikal Cossack, spoke English fluently. Itseemed to be a curious inversion of conventional notions-when Russian officers were led into captivity in Japan.

In conclusion, an apology must be made for the incom-pleteness of the foregoing notes. Incomplete they mustnecessarily be, for once only in each case has there been an,

opportunity of visiting any particular hospital, and that onlythrough the medium of many officials, to whom a great debtof thanks is due. It may be hoped, however, that enoughhas been said to stimulate public interest in the official

reports of Lieutenant-Colonel W. G. Macpherson, R.A.M.C.,

393

British attache with the Japanese forces now in Manchuria.,and in the report of the Japanese naval and military medicalservices which is expected to appear after the conclusion ofthe war.

BIRMINGHAM.

(FROM OUR OWN CORRESPONDENT.)

University Intelligence.Dr. R. Saundby, professor of medicine in the University,

has promised to give a course of lectures upon Medical Ethicsto medical students and practitioners during the summersessions.-Dr. Edward Malins, professor oE midwifery, hasbeen appointed examiner in midwifery and diseases of womenin the Victoria University, Manchester.-Dr. A. StanleyBarnes, Dr. J. T. Hewetson, and Dr. Thomas Wilson havebeen re-appointed honorary curators of the pathologicalmuseum of the University.

" Humanised " Milk.The report of the deputation from the hea,lth committee of

the city council, which recently visited Liverpool for thepurpose of making inquiries into the method there adopted ofsupplying "humanised" milk, was considered at the last

meeting of the above committee. In view of the goodresults as shown in the marked diminution of the infantilemortality-rate claimed for it by the Liverpool authorities, itwas decided to introduce a similar system into Birminghamand a subcommittee was appointed to confer with the dairy-men in the district in order to ascertain whether they wouldundertake to supply such milk or whether they had anysuggestion to make in reference to the provision of suchmilk by the city authorities. The Daily Post dealt withthe matter in a leading article in which it deprecatedany further experimentation in the direction of municipaltrading and was of opinion that the supply of the milkmight very well be left to private enterprise. Consider-able correspondence followed in the public press. The

opponents of the scheme observed that "humanised" milkwas milk devoid of antiscorbutic qualities and that itsintroduction would tend still further to diminish theamount of breast feeding among the masses. The

rejoinders were that it is unsatisfactory to leave the"humanisation" " of the milk to the mothers who are oftenignorant and careless, that it is well-nigh impossible toobtain pure milk and to keep it pure, that the less troubleand expense associated with breast feeding will prevent anyfurther decrease in its practice, and that the introduction ofsuch a supply as that now meditated has been largelyresponsible for the decided fall in the infantile mortality-rate at Liverpool.

The Hospitals. ’

Mr. Wilfrid Allport, who for the last five years has actedas honorary assistant ophthalmic surgeon to the Queen’sHospital, has been elected honorary ophthalmic surgeon tothe same institution in the place of Mr. J. Priestley Smithwho has resigned.&mdash;The new buildings of the Birminghamand Midland Hospital for Women are rapidly nearing com-pletion. The new convalescent home in connexion withit was opened on Feb. 4th before a large and distin-

guished company by the Right Honourable the Countess

Beauchamp. The home, which is situated a short distancefrom the main buildings at Sparkhill, is a picturesque houseof two storeys with accommodation for 12 patients. At its

opening, Mr. J. S. Nettlefold, chairman of the committee ofmanagement, made a strong appeal for a further .610,000 inorder that the main building might be opened free fromdebt. It is estimated that the entire cost of the hospitalwill amount to f:40,000, of which sum more than &pound; 30,000have already been promised. The hospital will affordaccommodation for 1000 patients per annum.

The Birmingharn Corporation arcd the Wye.The action of the Birmingham corporation in seeking to

reduce by seven million gallons daily the compensation waterwhich, by the Act of 1892. it should return to the Wye, wasdiscussed by the Severn Board of Conservators at its lastmeeting. The suggestion of the chairman was adopted thata deputation should be appointed to wait upon the Board ofAgriculture and Fisheries and to object to the proposedreduction on the ground that any further abstraction ofwater would be injurious to the fisheries of both the Wyeand the Severn. ;

The Health of the City.The report of the medical officer of health for the final

qnarter of 1904 has just been published. The birth-rate was

slightly lower than it was in 1903 ; the death-rate was thesame in the two years. The zymotic death-rate was low butthe mortality from respiratory diseases was high. Althoughthe cases of diphtheria reported were less numerous thanusual the death-rate was high; this was attributed to

parents not sending for medical help early enough andto insufficient use of antitoxin ; only 33 per cent. of thepatients apparently were treated with antitoxin suppliedby the municipality. It was pointed out that the casesof typhoid fever were few despite the fact that thesummer was long, warm, and dry; this was taken as

indicating that some of the conditions favourable to its

development have been removed. Deaths from diarrhoeawere relatively few and each was made the subject of aninquiry by one of the health visitors. The death-rate for theweek ending Jan. 21st was 19 per 1000, as compared with19’ 8 for the preceding week ; for the week ending Jan. 28thit was still further lowered to 16’ 5. The zymotic death-rateremained steadily about 1 per 1000. There has been aslight increase in the number of cases of scarlet fever anddiphtheria notified. The number of patients in the typhoidfever wards has been reduced to nine.

Severe Outbreak of Measles in Wednesbury.The epidemic of measles which has recently visited

Wednesbury has proved to be of a virulent type ; of the 94deaths from all causes during the last six weeks no lessthan 41 were attributable to this disease.

Feb. 7th. _________________

LIVERPOOL.

(FROM OUR OWN CORRESPONDENT.)

Annual Tleport for 19041 of the West Derby, Liverpool, andToxteth Park Joint Hospital for Phthisis at Hesrvall.

THE annual report consists of three reports by themedical officers of the three unions to the Heswall jointcommittee and also the report of Mr. H. P. Cleaver, theclerk. Each medical officer was only allowed to report onhis own cases. In the medical management of the hospitaleach medical officer sends in his own cases without referenceto his colleagues. All cases must have had tubercle bacillifound before admission. The medical officers are on duty inrotation, a month at a time ; during that time the medicalofficer on duty is responsible for all patients, examines anddischarges them, prescribes the treatment, and takes notes.He places in the hospital record his opinion of the case ondischarge. A medical officer who is not on duty may visitthe hospital to examine his own cases. The clerk’s reportshows the cases in detail with the hospital discharge and theinitials of the medical officer discharging ; also the resultsof sputum examination (all done at the Thompson-Yateslaboratory), any news of after-results which has reachedthe hospital, and the report of a special non-medicalvisitor who was sent round in December last to follow

up the cases. Dr. Nathan Raw’s report on the casesadmitted from West Derby states that 34 patients wereunder treatment during the year. In ten cases the diseasewas arrested, 12 were improved, two were not improved,whilst ten remained in the sanatorium. There was no deathin the sanatorium during the year. Some of the patientshave continued at their work since leaving the sanatorium andreport themselves to him at intervals, while others have leftthe neighbourhood and he has lost sight of them. Thesanatorium continues to do the good work for which it wasprovided. There has been during 1904 a decided improve-ment in the character of the admissions, most of them

being amenable to treatment, and it cannot be im-

pressed too strongly that the treatment, to give thebest results, must be commenced in the early stagesof the disease. The sanatorium performs a humane andeconomic work amongst the poor. It rescues some fromcertain death, it relieves the suffering and prolongs theworking life of others, whilst it isolates them all from theirordinary home surroundings, thus preventing the spread ofinfection to healthy members of the family. It also acts asan educational influence in teaching the patients the nature

! of the disease and the best methods of resisting its attack.Of the cases from the Toxteth union Dr. David Smart reports