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Pasteurisation and Care of Milk.

In almost all the large cities of the United States thequestion of a fairly pure milk-supply has received closeattention. In the majority of these the example of NewYork with regard to pasteurisation has been followed. The

general opinion seems to be that while pasteurising milkis not an ideal method it is the best method at hand. InCanada pasteurisation of milk is making considerable head-way, and Mr. Charles J. C. Hastings, chairman of the MilkCommission of the Canadian Medical Association, lecturingon the subject, has stated that in his opinion before nextsummer from 50 to 75 per cent. of the milk sold in Torontowould be quite safe to use. This result, he thought, wouldbe to a large extent brought aboat by pasteurisation. A

pasteurising plant has been installed in the Toronto Children’sHospital and is stated to have had an excellent effect onthe health of the inmates.

The Cold Storage of Meat.In both Canada and the United States the price of food

of every description has greatly risen within the past fewyears and is still rising. This is said to be largely due tothe abuse of the cold storage system, the charge being

brought against many of the large meat packing firms of theUnited States that food is held in cold storage frequentlyfor the sole purpose of keeping up the price by controllingthe market. The Bill, which has been introduced intothe legislature of Massachusetts to regulate the cold

. storage warehouses in that State, provides that on beingplaced in, or taken out of, cold storage all food productsshall be stamped or otherwise marked with the date

upon which such action is taken and that not longerthan three months shall intervene at any time betweenthese dates. There is, however, another aspect of thecold storage question which has not been sufficientlyconsidered-namely, the fact that meat which has beenretained in cold storage for a considerable period may

undergo deterioration and become unwholesome. In Canada itis felt that food products should not be retained in cold storagefor several months, as is stated to happen frequently hereas well as in the United States. An investigation of thechanges which take place in meat kept in cold storage for

. varying periods would be instructive, and a movement is onfoot to this end.

April 18th. ____________*______

UNITED STATES OF AMERICA.

(FROM OUR OWN CORRESPONDENTS.)

Suits for Malpractice in Leaving a S’ponge or Pad in theWould

THE number of suits for malpractice due to leaving behinda sponge or pad which has been used during an operation seem to be on the increase. The various kinds ufdefence in these cases form an interesting chapter in medicaljurisprudence. In a recent case in Switzerland two eminentsurgeons testified that the resemblance of a sponge filled withblood to the tissues of the part was so exact that the mostskilful and careful surgeon might overlook the sponge andclose the wound with it retained. On the strength of thistestimony the verdict was in favour of the surgeon. In acase in a Western State the defence was that the operationceased when the surgeon ceased to use the knife,.and there-fore the complaint that he was guilty of gross..negligence-

during the operation was not sustained, as it was admittedon the part of the prosecution that the operation was skil-fully performed. The court held, however, that the operation began with the first incision and closed with the finisheddressing. In another case in a Southern State the defencewas that the enormous amount of detail in modern operationsmade it quite possible that the most careful surgeon mightoverlook a sponge or pad. The court sustained that view andthe verdict was in favour of the surgeon. In still anothercase the defence was that the sponges were placed in the careof the nurse, and if any one was left in the wound she was

guilty of negligence and not the surgeon. The court heldthat the nurse was an agent acting under and by directionof the surgeon, and therefore he was responsible for acts

performed by her during the operation. -

Education in Tubereculosis.From the fifth annual report of the Phipps Institute,

presented by Dr. Lawrence F. Flick, the following principlesappear to stand out : That of foreign-born residents whodevelop tuberculosis in this country, a large number havecontracted it from insanitary houses here ; that work entailingexposure to dust is the greatest occupational factor ; that themortality is greater proportionately among those who usealcohol and tobacco than among those who do not ; thatfrequent change of residence is a factor, as indicating greaterliability to exposure to contagion ; that personal contagion iscontracted most frequently from those of the same genera-tion (29’37 per cent.), next from the preceding generation(25’81 per cent.), then from fellow employees (11-06 percent.), the consort’s family (8-87 per cent.), contaminatedhouses (4’64 per cent.), and, finally, from the succeedinggeneration (3’35 per cent.). Dr. Flick’s ultimate conclusionis that.. a more intimate knowledge of the subject whichhas come to us from experience shows us that education byitself cannot accomplish much in the prevention of tuber-culosis. For effective prevention isolation of the advancedcases is necessary." In this, perhaps, he overreaches hisdata. It all depends on what is meant by " education." Theeffective result of education is the creation of an efficientpublic spirit, and that is just what is needed to secure theenforcement of the practice of isolation in a popularlygoverned country. Coercive legislation that is opposed tothe general sentiment of the governed will be evaded asmuch as possible, and either be soon repealed or becomea dead-letter. History demonstrates that point over andover again. And such opposition to beneficent measuresis in the main the result of popular ignorance. Enlightenthe public at large and in due course popular sentimentwill support such restrictive and coercive measures againstthe individual as may show themselves necessary for the

public good.April 19th.

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NOTES FROM INDIA.

(FROM OUR OWN CORRESPONDENTS.)

Plague.THE plague returns for the week ending March 19th show

27,642 deaths, but these include some returns for a fortnight.The Bombay Presidency reports 1035, Bengal 3261, theUnited Provinces 9211, the Punjab 10,787, Burma 332, theCentral Provinces 1068, and Rajputana 1775. There is agreat increase in mortality in the Punjab. It is curious tonote that the incidence of plague in Bengal varies in aremarkable way from year to year. Thus for 1905 the mor-

tality was 126,000 ; in the next year it dropped to less thanhalf this number ; but in 1907 it again rose to 83,600. In1908-09 the disease died down except in a few centres, and

, less than 16,000 deaths were reported. The epidemic was avery local one, as two-thirds of the mortality was in thePatna division, the Monghyr district alone returning nearlyone-fifth of the deaths. Bengal has never suffered to thesame extent as the Bombay Presidency, the United Provinces,and the Punjab. Calcutta has been spared the terrible mor-tality which has swept cities such as Bombay and Poona,but plague retains its hold upon parts of Behar and thewestern districts. It is officially stated that inoculation isstill viewed with great distrust by the people, and not more’than five or sixcthousand persons submit themselves to thisprophylactic treatment each year. Villagers prefer toevacuate their houses, and in this way some good is effected.It is to be regretted that plague has again appeared in

epidemic form in Bengal, a weekly mortality of over 2000being now reported.

A Pasteur Institute for Assam.The question of establishing a Pasteur Institute in Assam

was raised by Mr. J. R. Macnamara so far back as 1906, whenthere had been a succession of cases of dog-bites among theemployees of the Assam Company. But at that time nostation could be found in the province with a sufficiently lowtemperature for the manufacture of the antirabic serum.Scientific discoveries have since then made it possible toprepare the serum in comparatively high temperatures, and lastyear the subject was reopened. The India Tea Association was

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communicated with, and eventually a small committee, con-sisting of Mr. Macnamara, Dr. G. C. Winchester, and Dr. W. A.Murray, was appointed to investigate the question. Their reporthas just been published, and it shows how necessary it is toestablish a Pasteur Institute in Assam. During the last fouror five years 260 cases of bites by rabic animals have beenreported in the province, and of these 16 were sent to Kasauli.There were 60 deaths among the persons bitten. These figuresrelate only to Assam, and it is probable that they wouldbe doubled or trebled if there had been any record ofcases in the more densely populated tracts of Eastern Bengal.The cost of sending patients to Kasauli is heavy, andthe long journey, extending in some instances to seven days,lessens the chance of successful treatment. The advantages,therefore, of a local institute are obvious, and it could alsobe a centre of research for tropical diseases such as kala-azar and blackwater fever. The staff would have ampletime for this kind of research work, and as trained bacterio-logists would be employed the general results gained wouldbe of the highest value. The committee considers that therewould be possibilities for the carrying out of research workunrivalled in any part of the world. The expense involvedis not excessive. A capital expenditure of Rs.35,000, in thefirst instance, would have to be met, and there would be anannual outlay of Rs.9600, if the services of a director andhis assistant were given by Government. The small stationof Haflong, which is on the railway, seems indicated as asuitable place for the institute. Considering the enormousamount invested in the tea-gardens of Assam there should belittle difficulty in raising the sum required. Burma has

recently provided Rs.160,000 for a Pasteur Institute, andEastern Bengal and Assam should be equal to finding morethan this, as the big firms in Calcutta and London interestedin the tea industry might be asked to subscribe. An endow-ment fund would have to be provided, and the Governmentwould doubtless give a helping hand.

Sikh Officers in the Indian Medical S’ervice.It is officially notified that Sikhs serving in the Indian

Medical Service are permitted to retain their hair uncut (inaccordance with their caste custom) and to wear puggrisinstead of helmets when in uniform. This order is also

applicable to Sikhs undergoing probationary courses at theRoyal Army Medical College, London, and Royal ArmyMedical Corps Depot at Aldershot.

Civil Surgeoncies in India. !At a recent meeting of the Imperial Legislative Council

held at Calcutta, His Excellency the Viceroy presiding, theHon. Mr. Hague asked for information concerning thenumber of civil surgeoncies held by the assistant surgeonbranch of the subordinate medical department. Replying toMr. Hague’s questions, Sir Harvey Adamson said that thenumber of civil surgeoncies to be transferred to civil assistantsurgeons has-been increased since 1899 from 28 to 33. Fourof the five new appointments have been added to the listduring the last year. Civil assistant surgeons hold 22 ofthese appointments substantively, 3 in Madras, 3 in Bombay,1 in Bengal, 4 in the United Provinces, 3 in the Punjab, 4 inBurma, 3 in Eastern Bengal and Assam, and 1 in theCentral Provinces. Eleven more medical officers of thisclass were officiating as civil surgeons on Jan. 1st last.Of the 7 appointments in Bengal, which it was decidedin 1899 to transfer to civil assistant surgeons when oppor-tunities offered, 4 are now allotted to Bengal properand 3 to Eastern Bengal and Assam. It was recognisedin 1899 that the arrangement could not be given effect topending the retirement of the uncovenanted medical officers,European and Indian, then employed in the several pro-vinces. The local governments concerned are aware thatthe appointments still to be transferred are to be given tocivil assistant surgeons when opportunities offer, and theGovernment of India do not think that it is necessary forthem to issue any further orders on the subject. TheGovernment of India have given full and sympathetic con-sideration to the memorials of civil assistant surgeons in

Bengal and to the proposals made to them by the Governmentof Bengal. They are now about to address the Secretary ofState on the subject, and are consequently unable at presentto give the information asked for by the honourable member.

Cinchona Bark.

In the Bengal Budget for 1910-11 provision is made for the

purchase of no less than two lakhs worth of cinchona bark tosupplement the out-turn of the Government plantations. Itwould be of interest to know whether the purchase is to bemade in Holland as heretofore or whether there will bedirect buying in Java. The latter course would seem to bethe more economical one, as otherwise the bark bought willhave travelled all the way from Java to Europe and half-wayback again before it reaches the Bengal factory. It is to be

hoped that an effort will be made to keep down the prices ofquinine sold by State agency, as in the last few years thesehave compared very unfavourably with the rates quoted bywholesale chemists in India.April 2nd.

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NOTES FROM CHINA.

(FROM OUR OWN CORRESPONDENT.)

The Water-sq,,pply of Peking.THE establishment of a water-supply in Peking, a city

of over 600,000 inhabitants and covering an area of25 square miles is an event of the first importance inpublic health and sanitary engineering. Hitherto the capitalhas been dependent on a supply from domestic shallowwells, of which there are thousands. These wells yielda very hard (over 30 degrees), impure water, which increasesthe sick-rate and is only kept within limits here by beingrarely drunk unboiled, thanks to the tea-drinking habits of thepeople. Notwithstanding this, intestinal complaints, such astyphoid fever, dysentery, diarrhoea, and worms abound. Inthe Quartier Diplomatique deep wells, ranging from 170 to300 feet, have been sunk in the various Legations and yieldan unlimited supply of pure bacteria-free water averaging10 degrees of hardness. But with the progressive spiritso much in evidence it was felt that a supply of good,soft, upland-surface drinking water would be appreciatedsufficiently to make its installation a paying concern. AChinese company, with no foreign participation, was there-fore formed with a capital of 3,000,000 taels (about £400,000).A good supply of water was available from the Sha Ho, one ofa series of rivers running south-east from the great mountainrange lying north-west of Peking separating China fromMongolia. This is a shallow river with sandy bed rarely over2 feet in depth and liable to flood in summer. In winter,though frozen over, the current is too strong for it to freezethrough its whole extent and water can always be drawn frombeneath the ice coating. Leaving the mountains it passesthrough cultivated land with a scattered population. Nosewers empty into it, as all excreta are applied directly to thefields by the farmers, and the organic matters are thus oxidisedby atmospheric oxygen. The intake pipe is at a spot on theriver bed 10 miles north-east of Peking. At this place it isestimated that 35,000,000 gallons a day flow past the opening,and of this quantity the waterworks could take up and dealwith 3,500,000 gallons or about 150,000 gallons per hour.This is very largely in excess of the demand as not more than160,000 gallons are used daily. As there had been some dis-cussion as to the advisability of substituting "Jaid-on" waterfor that from the deep wells I recently visited the company’sworks and was very favourably impressed. From the intakepipe the water is drawn through two centrifugal pumps andsent by them to settling tanks. From these it flows over anumber of covered filtration beds, where it percolates througha layer of bricks, 4 feet of fine river sand, and 1 foot ofgravel. After this it enters the main engine room and ispumped on to the city station, where there are three coveredreservoirs of 400,000 gallons capacity each. At this stationthere is also a water tower, 160 feet high, up which thewater is pumped, whence it flows by gravitation throughoutthe city, being supplied to consumers by street hydrants.of which there are 420, each in charge of a coolie,So little demand has been made for private supply that thereare not more than 20 meters at present in use. The mainand distributing pipes are of the best type-a German patentcalled the Mannesmann process, by which a tube of solidforged steel is immersed in a bath of boiling asphalt, whichis ingrained in the metal to such an extent that pipes which,

have lain in sea-water for 30 years have been found quiteunaffected. The machinery is also German made and theworks have been built under the superintendence of an

experienced Danish engineer, Mr. Gimbel. The cost to