1104 and that too many of ’the older and more experienced men have been laid on the shelf. He thinks also that it is a -mistake to allow the didactic lecture to go by the board. April 1st. __________________ NOTES FROM INDIA. (FROM OUR OWN CORRESPONDENTS. ) Plag1le. THE plague returns for the week ending Feb. 26th show - 18,992 deaths for all India and Burma as compared with 18,922 for the week preceding. The Bombay Presidency reported 1043, Bengal Presidency 2367, the United Provinces 7936, the Punjab 3697, the Central Provinces 1583, Rajputana 1833, and Burma 357. For the week ending March 5th similar returns give 21,514 deaths for all India and Burma, of which Bombay Presidency reported 1008, Bengal Presidency 2554, the United Provinces 8260. the Punjab 6227, the Central Provinces 1300, Rajputana 1708, and Burma 300. A Disscussion on Plague at the Viceroy’s Representative Council. The new Councils discuss many subjects, and it was not likely that plague would escape notice, for there are some critics who hold the Government responsible for all the ills that afflict the people of India. When, however, it comes to assertions that official shortcomings in the matter of sanitary improvements are responsible for the pre- valence of plague, and that Europeans escape the disease because their welfare is more closely regarded than that of the people at large, it is time for plain speaking. In the Viceroy’s Legislative Council at a recent meeting the Director-General of the Indian Medical Service had to traverse statements of this kind, and his remarks should have some effect in influencing public opinion. Surgeon- General Lukis follows the highest scientific authorities in tracing the causation of plague to the rat and the rat flea, and shows that the question is one of domestic hygiene and not of general sanitation. The "domestication " of the rat must be discouraged in every way, for so long as it remains a house-dweller so long will the danger of plague continue. At present the rat is encouraged to live in and near houses by reason of grain being stored in the rooms, by scraps of food being carelessly thrown about, and by rubbish being .allowed to accumulate in which nests can be made. Sanitary measures pure and simple will not act as remedies so long as these conditions are allowed to continue. Such measures are good in their way so far as the general health of the people is concerned, but they will fail to check epidemic plague. Europeans in India enjoy practical immunity from the disease because the rat is never permitted to gain a footing in their houses. The Japanese have stamped out plague by an extraordinary campaign against rats. When the dwellers in Indian cities and villages will listen to the oft-repeated - warnings that the rat and the rat flea are their most dangerous enemies, plague in epidemic form at least will die out. ’In the Viceroy’s Legislative Council the Honourable Pandit Mohan Malaviya and Mr. Bhupendra Nath Basu, both repre- sentative members, laid stress upon the fact that Europeans in India escape the ravages of plague, whereas the Indian population suffered terribly owing to the failure of Govern- ment to carry out a policy of sanitary improvement. The reply given by Surgeon-General Lukis is worth reproducing in full. He said : " I did not intend to speak on this occa- sion, but I feel bound to correct the misapprehensions under which the hon. members who have last spoken are labcurii3g with reference to the causation of plague. They infer that the reason why Europeans escape this fell disease is that they are living in more sanitary surroundings than those which obtain in Indian cities and villages. Now, sir, if there is one thing that we have learnt in the last 13 years it is that plague has nothing whatever to do with pollution of the soil, contamination of water-supply, or defective drainage, and large sums of money have been spent by Government without any effect as regards the checking of the disease. Recent discoveries have proved that plague is essentially a disease of rats, and that the medium of com- munication between rat and man is the rat flea. What happens when plague breaks out amongst human beings is this. First of all the rats are attacked. So soon as this happens they begin to run away from the infected house, but in so doing they leave their nests behind them and in these nests a large number of rat fleas. Now, ordinarily the rat flea will not bite human beings, bat when no rats are forthcoming they are forced to do so, and thus they convey the infection to the inhabitants of the house and a plague epidemic is started. It is obvious, therefore, that the question of the prevention of plague becomes one of domestic hygiene. What is wanted is to teach the Indian public the danger of allowing the rat to remain a domestic animal, and to advise them to try and prevent this by giving up the habit of storing grain in the house, throwing remnants of food about in its vicinity, and by allowing collections of rubbish behind which rats can make their nests. So long as the rat remains a house- dweller so long will the danger of plague continue ; and until this fact is appreciated it is useless for Government to squander large sums of money on sanitary improvements of doubtful value. I wish, however, to state distinctly that I must not be understood as deprecating sanitary improve- ments on general lines. I merely wish to point out that, as regards this particular disease of plague, it is the habit of the people and not the want of care on the part of Govern- ment which is largely responsible for the persistence of the epidemic. " March 19th. __________________ NEW ZEALAND. Annual Report of the Public Health. IN his report the chief health officer (Dr. J. M. Mason) draws attention to the steady advancement which is being made towards the provision of open-air shelters for the indigent consumptive. Ever since the Department of Public Health of New Zealand was set up in 1900 the campaign against tuberculosis has been carried on most vigorously. The hospitals in New Zealand, as in most of the colonies, are supported partly from the local rates and partly from the consolidated revenue. The State established in 1902 a very fine sanatorium, capable of accommodating about 62 patients, and in most of the hospital districts there are fine annexes for the reception of cases of consumption. In the Christ- church and Wellington districts elaborate and up-to-date sanatoriums have also been provided. Good work appears to have been done at a tree-planting camp which was established for "cured" consumptives. The planting is done under the supervision of the Lands Department, and the men receive 8s. for planting 1000 trees. The camp is almost self-supporting and the Government has a first lien upon the worker’s wages for the cost of his keep, &c. This is an excellent State experiment and already several who have been hardened ofr ’ at Karere have gone back to their ordinary work quite recovered." There would appear to be the same difficulty in providing work for the " cured " consumptive in this Britain of the South as there is in England. Speaking of this Dr. Mason says : ’’ Only those in intimate contact with the lives of the men and women who pass through our sanatoria know what a hopeless dawn’ the day they leave the institution often seems to the cured.’ Though well, they are debarred by reasons of prudence from engaging in indoor work, and their physical condition does not permit of their competing in the open mart of unskilled labour. What are they to do ? 2 Friends tire of keeping them, the lodging- house-keeper is sorry but his other clients complain, and so they must seek shelter where their neighbours are less exigent. This shelter they find only amongst the poorest. Ill-fed, poorly clothed, dispirited at the non-finding of work, he soon falls back, his cough returns, and-to put it briefly- all the money, care, and skill that has been expended upon him is, from a public health point of view, wasted. It would have been cheaper, nay, in some senses it would have been kinder, to have shut the door upon him when he first knocked." Suitable work for the cured is undoubtedly the great problem. The birth-rate increased by 3’ 37 per cent. in 1908 over that of 1907. New Zealand once again holds the enviable position of having the lowest death-rate almost in the world-namely, 9- 57 per 1000 persons living. The principal causes of death were: cancer, 6-95; tuberculosis (general), 8-97; and accident, 6-03. Another case of leprosy was reported. The patient is a
Transcript
1104
and that too many of ’the older and more experienced men have been laid on the shelf. He thinks also that it is a-mistake to allow the didactic lecture to go by the board.
April 1st. __________________
NOTES FROM INDIA.
(FROM OUR OWN CORRESPONDENTS. )
Plag1le.THE plague returns for the week ending Feb. 26th show
- 18,992 deaths for all India and Burma as compared with18,922 for the week preceding. The Bombay Presidencyreported 1043, Bengal Presidency 2367, the UnitedProvinces 7936, the Punjab 3697, the Central Provinces 1583,Rajputana 1833, and Burma 357. For the week endingMarch 5th similar returns give 21,514 deaths for all Indiaand Burma, of which Bombay Presidency reported 1008,Bengal Presidency 2554, the United Provinces 8260. the
Punjab 6227, the Central Provinces 1300, Rajputana 1708,and Burma 300.
A Disscussion on Plague at the Viceroy’s RepresentativeCouncil.
The new Councils discuss many subjects, and it was notlikely that plague would escape notice, for there are somecritics who hold the Government responsible for all the illsthat afflict the people of India. When, however, it comesto assertions that official shortcomings in the matterof sanitary improvements are responsible for the pre-valence of plague, and that Europeans escape the diseasebecause their welfare is more closely regarded than thatof the people at large, it is time for plain speaking. Inthe Viceroy’s Legislative Council at a recent meeting theDirector-General of the Indian Medical Service had totraverse statements of this kind, and his remarks shouldhave some effect in influencing public opinion. Surgeon-General Lukis follows the highest scientific authorities in
tracing the causation of plague to the rat and the rat flea,and shows that the question is one of domestic hygiene andnot of general sanitation. The "domestication " of the ratmust be discouraged in every way, for so long as it remains ahouse-dweller so long will the danger of plague continue.At present the rat is encouraged to live in and near housesby reason of grain being stored in the rooms, by scraps offood being carelessly thrown about, and by rubbish being.allowed to accumulate in which nests can be made. Sanitarymeasures pure and simple will not act as remedies so long asthese conditions are allowed to continue. Such measures are
good in their way so far as the general health of the peopleis concerned, but they will fail to check epidemic plague.Europeans in India enjoy practical immunity from thedisease because the rat is never permitted to gain a footingin their houses. The Japanese have stamped out plague byan extraordinary campaign against rats. When the dwellersin Indian cities and villages will listen to the oft-repeated- warnings that the rat and the rat flea are their most dangerousenemies, plague in epidemic form at least will die out.’In the Viceroy’s Legislative Council the Honourable PanditMohan Malaviya and Mr. Bhupendra Nath Basu, both repre-sentative members, laid stress upon the fact that Europeans inIndia escape the ravages of plague, whereas the Indian
population suffered terribly owing to the failure of Govern-ment to carry out a policy of sanitary improvement. The
reply given by Surgeon-General Lukis is worth reproducingin full. He said : " I did not intend to speak on this occa-sion, but I feel bound to correct the misapprehensions underwhich the hon. members who have last spoken are labcurii3gwith reference to the causation of plague. They infer thatthe reason why Europeans escape this fell disease is thatthey are living in more sanitary surroundings than thosewhich obtain in Indian cities and villages. Now, sir, ifthere is one thing that we have learnt in the last 13 years itis that plague has nothing whatever to do with pollutionof the soil, contamination of water-supply, or defectivedrainage, and large sums of money have been spent byGovernment without any effect as regards the checking ofthe disease. Recent discoveries have proved that plague isessentially a disease of rats, and that the medium of com-munication between rat and man is the rat flea. What
happens when plague breaks out amongst human beings isthis. First of all the rats are attacked. So soon as
this happens they begin to run away from the infectedhouse, but in so doing they leave their nests behindthem and in these nests a large number of rat fleas.Now, ordinarily the rat flea will not bite human beings,bat when no rats are forthcoming they are forced todo so, and thus they convey the infection to the inhabitantsof the house and a plague epidemic is started. It is obvious,therefore, that the question of the prevention of plaguebecomes one of domestic hygiene. What is wanted is toteach the Indian public the danger of allowing the rat toremain a domestic animal, and to advise them to try andprevent this by giving up the habit of storing grain in thehouse, throwing remnants of food about in its vicinity, andby allowing collections of rubbish behind which rats canmake their nests. So long as the rat remains a house-dweller so long will the danger of plague continue ; anduntil this fact is appreciated it is useless for Government tosquander large sums of money on sanitary improvements ofdoubtful value. I wish, however, to state distinctly that Imust not be understood as deprecating sanitary improve-ments on general lines. I merely wish to point out that, asregards this particular disease of plague, it is the habit ofthe people and not the want of care on the part of Govern-ment which is largely responsible for the persistence of theepidemic.
"
March 19th. __________________
NEW ZEALAND.
Annual Report of the Public Health.IN his report the chief health officer (Dr. J. M. Mason)
draws attention to the steady advancement which is beingmade towards the provision of open-air shelters for theindigent consumptive. Ever since the Department of PublicHealth of New Zealand was set up in 1900 the campaignagainst tuberculosis has been carried on most vigorously.The hospitals in New Zealand, as in most of the colonies,are supported partly from the local rates and partly from theconsolidated revenue. The State established in 1902 a veryfine sanatorium, capable of accommodating about 62 patients,and in most of the hospital districts there are fine annexesfor the reception of cases of consumption. In the Christ-church and Wellington districts elaborate and up-to-datesanatoriums have also been provided. Good work appears tohave been done at a tree-planting camp which was establishedfor "cured" consumptives. The planting is done under thesupervision of the Lands Department, and the men receive 8s.for planting 1000 trees. The camp is almost self-supportingand the Government has a first lien upon the worker’s wagesfor the cost of his keep, &c. This is an excellent State
experiment and already several who have been hardenedofr ’ at Karere have gone back to their ordinary work quiterecovered." There would appear to be the same difficulty inproviding work for the " cured " consumptive in this Britainof the South as there is in England. Speaking of this Dr.Mason says : ’’ Only those in intimate contact with the livesof the men and women who pass through our sanatoriaknow what a hopeless dawn’ the day they leave theinstitution often seems to the cured.’ Though well, they aredebarred by reasons of prudence from engaging in indoorwork, and their physical condition does not permit of theircompeting in the open mart of unskilled labour. What arethey to do ? 2 Friends tire of keeping them, the lodging-house-keeper is sorry but his other clients complain, and sothey must seek shelter where their neighbours are less
exigent. This shelter they find only amongst the poorest.Ill-fed, poorly clothed, dispirited at the non-finding of work,he soon falls back, his cough returns, and-to put it briefly-all the money, care, and skill that has been expended uponhim is, from a public health point of view, wasted. Itwould have been cheaper, nay, in some senses it would havebeen kinder, to have shut the door upon him when he firstknocked." Suitable work for the cured is undoubtedlythe great problem.The birth-rate increased by 3’ 37 per cent. in 1908 over that
of 1907. New Zealand once again holds the enviable positionof having the lowest death-rate almost in the world-namely,9- 57 per 1000 persons living. The principal causes of deathwere: cancer, 6-95; tuberculosis (general), 8-97; andaccident, 6-03.
Another case of leprosy was reported. The patient is a
1105
Maori. There are now some three cases known amongst theMaoris and one in a white man. There would appear to havebeen no epidemic of any severity in the Dominion in 1908,although there was a severe outbreak of enteric fever inGisborne. This, however, was traced to the generally insani-tary condition of the town. According to Dr. Pomare, thenative health officer, cancer is a rare disease amongst theMaoris, but tuberculosis claims many victims. A great dealof valuable work has been done amongst the natives andmany of the old insanitary whares " have been replaced byup-to-date houses. Some interesting observations on the
height and weight of the boys attending the Wanganuischool and of the girls attending the High School in Dunedinappeared in the last report. Further data have been collectedby Dr. J. S. Purdy with respect to Auckland. It seems a greatpity that there is no general examination of the scholarsattending the schools. It would be most interesting to seethe result upon the race of the climatic and social conditionswhich obtain in young countries like New Zealand. Generallyspeaking, it would seem that the young New Zealander is, agefor age, taller and heavier than his compeer in England. Thisstatement has, however, to be accepted with some reservationbecause of the small amount of data at the command of thechief health officer. It would appear that the European boystarts (at 10 to 11) a little taller than the Maori, but nearlyseven pounds lighter. In the matter of height the Maoristill gains upon the European until the age of 15 to 16 isreached, when the heights are equal. The weight of theMaori is maintained about equal, until at the ages of 13and 16 years the Maori boys are one stone heavier than theEuropean.A large amount of valuable work was done in the various
laboratories both in a chemical and bacteriological way,but vaccination and democracy would appear not to walkhand in hand. The returns for last year show that
only 4’7 per cent. of the children born had been vacci-nated, and this despite the ardent advocacy of the healthofficials. Some day the Dominion may regret this. In
thanking the various officers Dr. Mason intimates that he hasresigned the position of chief health officer-a post whichhe has held since the inception of the department in 1900-to take up that of consulting meoical officer to the NewZealand Government in London. Dr. Pomare, in his state-ment upon the sanitary conditions of the Maori," which isincluded in this report, pays an eloquent tribute to the
appreciation felt by the natives for the altered conditionswrought in their lives by the Health Department under Dr.Mason’s captaincy.
Obituary.FREDERIC VICTOR MILWARD, M.B., B.C. CANTAB,
F. R. C. S. ENG., L. R. C. P. LOND.
WIDESPREAD regret is felt at the death of Mr. F. V.
Milward, which occurred at his house at Edgbaston on
March 31st after a few days’ illness from pneumoniafollowing influenza. Mr. Milward was the second son ofthe late Colonel Victor Milward, a member of the well-knownRedditch needle manufacturers, and was in the fortieth yearof his age at the time of his death.Born at Redditch and educated privately until he entered
Clare College, Cambridge, he took the degrees of B.A.Cantab. in 1891 and M.B., B.C. at the same University in1895. In the same year he also qualified as M.R.C.S. Eng.and L R.C.P. Lond. He completed his curriculum at St.Thomas’s Hospital, where he held some minor appointments.His first resident appointment was that of house surgeon atthe General Hospital, Birmingham, in 1896. From there hewent to the Seamen’s Hospital, Greenwich, returning to theGeneral Hospital in 1898 as resident surgical officer. Heafterwards held the posts of casualty assistant surgeon,assistant surgeon, and surgical registrar and junior surgicaltutor at this hospital. He obtained the F.R.C.S. Eng. in theyear 1900. Shortly after this he was elected resident surgicalofficer at the General Hospital, Birmingham. Here he re-mained for some three years and was afterwards appointedone of the assistant surgeons to the hospital. He also held theposts of surgeon to the Orthopaedic Hospital and surgeon toout-patients at the Children’s Hospital, Birmingham. In his
many positions he discharged his various duties with creditto himself and to the satisfaction of the committees of the
various public institutions with which he was associated.In 1906 Mr. Milward published a work upon "Diseases ofthe Rectum," and also contributed to the study of alliedsubjects to various medical periodicals. A paper on RectalCarcinoma by him appeared in THE LANCET of Nov. 23rd,1907. Another paper, on Congenital Piles, appeared inTHE LANCET of June 1st, 1907. His last paper upon a caseof death under spinal anaesthesia, as late as March 26th,is an evidence of his conscientious desire to fairly give toothers the benefit of his own practice.
Mr. Milward was a man of upright, manly, and straight-forward character. The keynote of his life was thoroughness ;to whatever he put his hand, whether it was work or play, hegave his best. Careful and painstaking in the performanceof his duties, his accurate knowledge and large surgicalexperience gave strength and value to his opinions. Naturallyof a retiring disposition, "showiness" in method or manner-was not deemed worthy of cultivation, but no service wasaccounted too heavy when the welfare of his patients had tobe considered, and his loyalty to them and to his friends wasunbounded. His amiable disposition, generous bearing, andmany fine qualities of mind united to him a largeicireleof friends, who now mourn his premature decease. To thelocal medical societies he made many contributions, and atthe time of his death he was surgical secretary to the MidlandMedical Society. Besides his strictly professional work, Mr.Milward interested himself and did much strenuous spade--work as honorary secretary to the Birmingham Branch of theRed Cross Society, and to his efforts the present flourishingcondition of this particular city branch, as distinguished from,the county branch, is due. In the Territorial Army he rankedas captain, à la suite, in connexion with the 1st SouthernGeneral Hospital, Territorial Force. He was looked upon asone of the most promising and skilful operators whose highideals and unselfish character exemplified the best traditionsof the medical profession. Mr. Milward married the daughterof Mr. B. Tilley of Edgbaston; he leaves a widow and onechild. The funeral at Harborne Church on April 4th was-conducted by the Archdeacon of Birmingham and the Rev.Canon Moss, and was attended by a large number of hiscolleagues and friends and representatives of various publicinstitutions, whose presence testified to the high regard inwhich he was held during a short life affording a bright.prospect of success.
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DEATHS OF EMINENT FOREIGN MEDICAL MEN.-Thedeaths of the following eminent foreign medical men areannounced :-Dr. C. Botez, professor of external pathologyin the University of Jassy.-Dr. Hennequin, member of theParis Surgical Society.-Dr. Grebant, professor of generalphysiology in the Museum of Natural History and memberof the Paris Academy of Medicine.-Dr. Wilhelm Camerer,whose researches on the pathology of metabolism and otherproblems of physiological chemistry brought his name
prominently before the medical public some years ago. The
University of Tubingen conferred an honorary doctorate uponhim in 1895 in recognition of his physiologico-chemicalresearches. His age at his death was 67 years.
AN EXHIBITION OF FRACTURES.-The SociétéInternationale de Chirurgie has just issued a circular withreference to an °° Exposition de Fractures," to be held atBrussels in September, 1911, on the occasion of the third
congress of the society. Dr. J. Lucas-Championniere is thepresident of this congress, M. A. Depage is the secretary-general, and M. L. Mayer is the secretary. Everythingrelating to the study of fractures will be exhibited, par-ticularly various types of rare fractures ; radiograms,drawings, plaster-casts, and moulds of the same ; apparatusfor the bloodless treatment, the rigid treatment, and theambulatory treatment; extension apparatus ; exhibits anddocuments relating to osteo-synthesis, and so on. Theobjects intended for exhibition should reach the secretary-general at 75, Avenue Louise, Brussels, from Aug. 20th to31st, 1911, who will arrange for their receipt, installation,and return on the expiration of the congress. Exhibitorswill be able to make demonstrations of their apparatus duringthe congress, and subjects will be placed at the disposal ofexhibitors who require them. Special railway rates, it is
hoped, will be obtained, as they were for the Cancer Exhi-bition in 1908. Further information and forms to fill up for-those who intend to enter objects will be supplied by the--secretary-general on demand.
