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EGYPT.(FROM OUR OWN CORRESPONDENT.)

Rcnewal of Plague.IN addition to the rinderpest, which has been absorbing

all the energies of the Sanitary Department for the last ninemonths, human plague has now reappeared in Upper Egyptafter so long an interval that it seems probable that it musthave been reintroduced from abroad. The pilgrims nowreturning from Mecca are officially said to be free from

plague and cholera and as yet no cause for this new outbreakhas been found. History has again repeated itself, for itseems certain that the disease was kept concealed for sometime before it was discovered by the sanitary officers. Bare-faced concealment of infectious disease still continues in allthe villages attacked, and cases are eventually found inhouses which had been carefully searched a day or twobefore. Plague was found this time on March 5th in somesmall hamlets on the edge of the desert opposite the town ofGirgheh and it is believed that four deaths which occurredprior to that date must have been due to plague. Altogetherabout 200 people have already been attacked and of thesesome 180 have died, the first known case being that of a manwho died in his village five days after returning from Assioutwhere he had been called as a witness in the law courts.The high mortality is due to the fact that the disease istaking the pneumonic form, eight persons out of a family of11 having died in one house and four deaths occurred inanother household of five people. Cases of plague have alsooccurred in the little town of Tahta where for some daysthere has been a marked mortality among the rats. Addi-tional reports have been received from some villages inKeneh province on both sides of the Nile ; from one ofthese a man accompanied by his wife and three sisterswent across the Nile to attend a relative’s funeral. Threedays later the man, his wife, two of these sisters, and twoother sisters had all died from plague. Since then other caeshave occurred in the same village but all have been confinedto the family or neighbours of the original case. Major C.Garner, R.A.M.C., and a large staff have taken all the neces-sary precautions to try to prevent the spread of the diseasebut at this time of the year it is quite certain that it willspread in spite of all efforts. It is difficult to keep patiencewith the natives who obstruct legitimate and tactfully con-sidered sanitary precautions, especially when dealing withvillagers who suffered severely from plague only a year ago.Major Garner, for instance, suspected the existence of plagueat the village of Naknak but on inspection could find nocases there. Yet on the following day the wife of thesheikh of the village died and on the next day the nieceof the sheikh and two other people were found plague-stricken in the village. There can be no doubt that thesecases were purposely hidden during the house-to-house in-spection and nothing short of severe punishment will

prevent similar occurrences in other places. It will take

many a long year to change the habits of the Egyptianrustics who do not in the least believe in the necessity ofcleanliness and disinfection, who imagine that all illnessescome from an evil spirit, and that the Government officialsare all their hereditary enemies. If the many problemsof endemic disease are ever to be attacked seriously inEgypt the staff of English inspectors must be considerablyincreased. At present all the time of the staff is taken upin combating epidemics and, unfortunately, for some yearsto come the supply of native medical men will not equal thedemand. A further case of plague has now been reportedfrom Suez in a man who had just returned from Port Said.

Kasr-el-Ainy Hospital.This hospital and the medical school in connexion with it

are progressing satisfactorily every year. Electric lighting isnow being provided for the wards and the administrativeofficers and a new laundry has been built which will be workedby electric power. The in-patients have increased in numberto 1000 more than in previous years and the out-patientsnumber 66,000 annually, of whom 35,000 are new cases.

The entry of students last October was 36, being more thanat any time since the old days when youths were brought byforce to the Government schools. A micro-photograph roomhas been opened and also an additional room for the physio-logical laboratory. Mr. G. L. Crimp has been temporarilyengaged for pathological work during the absence of Dr.

W. St. Clair Symmers at the serum institute for cattle

plague, and Dr. G. Elliot Smith has also been given anEnglish assistant for anthropological work.

Obituary Notioe.Captain H. E. Haymes, R.A.M.C., of the Soudan Civil

Administration, died in the Soudan on March 15th. Hisdeath is not only deeply regretted by his many friendsbut it is a very serious loss to the Government. After adistinguished career at St. Thomas’s Hospital he tookresident appointments at the Royal Berkshire Hospital,Reading, and the Eastern Counties Asylum, Colchester,and soon after entering the Royal Army Medical Corps heapplied for service in the Egyptian army. He first cameto the front while in surgical charge of the woundeddervishes after the capture of the Khalifa at the endof 1899 and for his services on that occasion he wasadmitted to the Order of St. John of Jerusalem.In November, 1900, he accompanied Lieutenant-ColonelSparkes, C.M.G., on a tour, which eventually lasted 18months, in the Bahr el Gazzal province, and they travelledtogether all through the Niam-niam country, where Haymes’sskill in surgical operations spread far and wide and didmuch to pacify the wild tribes to whom England’s power wasunknown. His medical and sanitary work were alikeexcellent and he had in addition the rare gift of adminis-trative ability which marked him out very strongly forfuture employment as head of a province. He was a

very good all-round sportsman and a splendid big gameshot. He also went with Major Hunter on a punitiveexpedition in the Rumbek district, where he was woundedin the hand by a spear. He was specially decorated byH.H. the Khedive for his valuable services and thenreturned to Cairo to repair his own health after many attacksof malaria. Soon disdaining the delights of polo and smarbsociety he volunteered to return to the Bahr el Gazzal wherehe was given both administrative and medical duties andwhile serving there he was again selected to accompany asmall military patrol. The patrol was fired at by someignorant villlagers and unfortunately Haymes was slightlywounded in the head. The climate is a very bad one forsurgical injuries ; his previous hardships had doubtlessweakened his constitution and pysemia including a septicabscess of the lung resulted, causing death in 13 days. Hewas universally beloved by his fellow officers and friendsand he won the hearts of all the natives by his exceptionalqualities of just, upright, brave, straightforward commonsense.

Cairo, April 3rd. _____ ___

NEW YORK.

(FROM OUR OWN CORRESPONDENT.)

A Bill to Remodel the Medical Department of the UnitedStates Army.

A BILL has been introduced recentlv into the Senate andHouse of Representatives of the United States framed withthe view of bringing about important changes in the ArmyMedical Service. According to the Surgeon-General of theUnited States Army the Medical Department at presentsuffers from three serious defects of organisation whichhandicap its efficiency in time of peace and render im-possible any efficient expansion in time of war. Theseare : a commissioned personnel entirely inadequate to

perform the medical service of the army even in timeof peace ; insufficient inducement in the way of payand promotion to attract the most desirable class of youngphysicians to enter the corps ; and no satisfactory meansof expansion to meet war conditions and special needsin time of peace. The only means of expansion hereto-fore existing, the employment of contract surgeons to

supplement the insufficient commissioned personnel, hasalways been wastetul and unsatisfactory and has nowbecome absolutely unpractical because of the recent decisionthat the contract surgeon not being an officer obedience tohis orders cannot be enforced even in the case of the enlistedmen of the hospital corps. The organisations necessary toremove these defects are briefly as follows. The medical

department to consist of medical corps and medical reservecorps. Medical corps.-1. Size : (a) sufficient to form an

adequate nucleus in time of war, and (b) sufficient to doall ordinary duty in time of peace. 2. Grades : (a) to offer

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sufficient emoluments to induce efficient men to enter the i

corps ; (b) to officer properly the war nucleus ; and (c) to i

officer properly and to administer in time of peace. Medicalreserve corps to be drawn from medical men in civil life.-1. Size : (a) to meet unusual demands in time of peace,epidemics, care of troops at small stations, examination ofrecruits at unimportant places, &c. ; (b) to increase medical Idepartment to proper size to meet demands in insurrectionsand small wars where increase in upper (administrative)grades is not necessary and where volunteer troops are notcalled out. 2. Grades : to have commissioned grade inorder to meet adequately requirements of military service.

The Sanitary Condition of the Isthm7ts of Panama.Dr. J. C. Perry of the United States Public Health

and Marine Hospital Service has been at Colon and theIsthmus of Panama by the command of President Roosevelt,making investigations into the sanitary condition of thecanal. Dr. Perry has submitted an exhaustive preliminaryreport to the Surgeon General to the Public Health and MarineHospital Service. The writer finds malarial fevers in allforms the chief bane of the locality, but yellow fever,tuberculosis, and rheumatism are more or less prevalent.He finds the sanitary conditions in Colon and Panama ex-tremely bad and along the railway road the state of affairsin this respect is even worse. The death-rate of Colon ishigh. Statistics compiled give an annual death-rate of47 per 1000, but taking into consideration that theseare probably incomplete he thinks that the mortalityis not less than 50 per 1000. He considers that thenatives are not so immune as is generally thoughtto be the case, although, of course, they have ac-

quired a considerable degree of immunity. The rainy seasonat Colon and in the immediate vicinity lasts from May toJanuary, the rainfall during that period averaging about 125inches, which is twice the precipitation at Panama. Alongthe line of railroad between the two citiesare 18 villages,with a population of about 15,000, almost exclusively negroesand Chinese. The sanitary condition of these places iswretched in the extreme. As to what extent the prevailingdiseases can be diminished or prevented by proper sanitaryequipment and regulations Dr. Perry says : 11 Having shownthat 75 per cent. of the diseases are malarial ; yellow feverexists and will increase upon introduction of new material ;that dysentery, tuberculosis, and rheumatism are common,I think that a conservative estimate would be that 80 percent. or even more of these diseases could be prevented." 75per cent of the population of Colon consists of Jamaican orother negroes and Dr. Perry is of the opinion that to make ita clean city will necessitate the destruction of all the shantieswhich they now inhabit and their replacement by dwellingsbuilt on good sanitary principles. The conditions are muchthe same in Panama, which, Dr. Perry says, can be made ahealthy tropical city by the introduction of a modern sewer-age system and a good water-supply.

Paper .’lToney as a Means of Oarrying Irnfectious Germs.Dr. Thomas Darlington, health commissioner of the city of

New York, has pointed out the dangers liable to result fromthe use of coins and of dirty paper money, based upon theinvestigations of Dr. William H. Park, head of the Bureauof Research in the Department. The report made by Dr.Park was to the effect that experiments upon coins demon-strated that the metals produced a deleterious effect uponbacteria, so that within 48 hours they were usually free fromdisease bacteria. He further reported that the investigationsso far have established the fact that bacteria are not killedby any substance in paper money but remain alive until timeand drying destroy them. No actual disease bacteria haveas yet been demonstrated. The report is only preliminary ;experiments are still going on and will be continued forsome time.April 2nd.

____________

AUSTRALIA.

(FROM OUR OWN CORRESPONDENT.)

The Bubonic Plague.BUBONIC plague has broken out again in Queensland.

Five cases have been reported from Brisbane. Three caseswere unofficially stated to have occurred at Cairns but onfurther investigation one proved not to be plague. Dr.B. B. Ham, the health commissioner, has had to object to

irresponsible statements being made to the press as tosuspicious cases of illness. The Board of Public Health inVictoria has forwarded a circular to all the municipalitiesin that State requesting that steps should be taken to

destroy all rats as a precaution against plague. Duringthe last quarter of 1903 29,000 rats were destroyed, butonly about six municipal bodies have concerned themselvesin the matter.

nphoid Fever in Victoria.

Typhoid fever has increased in prevalence in Victoria thisseason. The returns for the fortnight ending Feb. 27thshowed 225 cases, with ten deaths, as against 138 casesduring the corresponding period of 1903. The increase wasespecially marked in the Bendigo district. The Board ofHealth is inquiring into the condition of the cases in thesuburbs of Melbourne, especially as to their relations to.

milk-supply, and a report is being prepared. 75 cases of

typhoid fever are under treatment at the Melbourne Hospital.Prevention and Treatment of Tuberculosis.

The Victorian Society for the Prevention of Tuberculosishas prepared a leaflet dealing with the proper disinfection ofhouses after their occupation by consumptives. It recom.mends the burning of wearing apparel, pillows, and mat-tresses, the repapering of rooms and ceilings, and the washingof floors and furniture with disinfectants. The leaflet hasbeen forwarded to the press with a request for publicationand also to municipal councils. The latter have been asked toinstruct their health officers to insist on proper disinfectionand ventilation of houses. The committee of the AustinHospital has called for tenders for the erection of theKronheimer wing for consumptives but the residents inthe neighbourhood are still agitating against its erectionand the Premier declines to give a maintenance grant to theinstitution. A meeting was recently held in Melbourne ofthe subscribers to the Victorian Sanatorium for Consumptives,which has recently been incorporated under the Hospitalsand Charities Act, to adopt by-laws and to appoint staffsfor the management of the sanatorium. The objects of theinstitution were stated to be "the prevention and cure oftuberculosis (a) by treating persons who are labouring undersuch an incipient form of disease as to afford a reasonablehope of their obtaining benefit from a temporary residence ina suitable climate; (b) by treating persons who, beingconvalescent, require further medical treatment and changeof air to re-establish their health ; (e) by treating personswho may be in such other conditions as the institution in

any general meeting may consider it advisable to treat ; and(d) by such wider or other means as the institution maythink fit to adopt." Under By-law 17 power was given tothe committee of management two appoint and dismissmedical and other officers, whether honorary or otherwise."An amendment that the honorary medical officers might beelected by the subscribers was rejected. The following wereappointed honorary medical officers : Consulting physician:Mr. D. Turner. Medical examiners: Melbourne, Dr. S Bird,Dr. R. H. Strong, and Dr. Turner ; Echuca, Dr. R. BindonStoney; Eaglehawk. Dr. B. S. Cowen; Bendigo, Mr. C. BurkeGaffney ; Warrnambool, Dr. M’Knight.

Friendly Societies’ Institutes and the Medioal Profession.Reference has previously been made to differences existing

between the Balmain United Friendly Societies Dispensaryand the New South Wales branch of the British MedicalAssociation. The dispensary used to have four medicalofficers to whom the sum of Z1320 per annum was paid in thefollowing manner. Each medical officer was paid a monthlysalary at the rate of f.150 per annum and the remaining E.720were divided into 12 parts of .E60, allotted to the officersaccording to the number of prescriptions issued by each.The medical officers were allowed a guinea for confinementsand the right of private practice. The dispensary has 3500members, and the amounts paid to the surgeons averagedabout 7s. M. a member. The New South Wales branch ofthe British Medical Association thought that the paymentwas too little and at its instigation the four medical officersdemanded payment per capita at the rate of 16s. per memberper annum, practically the same rates as those receivedby the local lodge surgeons before the dispensary was

established. The dispensary board of managers declined toadopt the system and two of its four medical officersresigned. The British Medical Association Council thendeclared the dispensary "inimical to the interests of themedical profession " in the terms of No. 36 of its Articles of