1651

Referring to cerebro-spinal fever Dr. Newsholme observesthat attacks of that disease probably occur not infre-

quently undetected, because meningitis may be caused byinfections other than the meningococcus, for instance, bythe pneumococcus or by pyogenic organisms, and the

symptoms caused by invasion of the meninges by these

organisms simulate those of epidemic cerebro-spinal fever,due to the meningococcus.

(To be concluded.) .

BRITISH MEDICAL BENEVOLENT FUND.AT the November meeting of the committee 33 cases were

considered and grants amounting to .E318 made to 30 of theapplicants. The current account is consequently overdrawnto the extent of no less than .S457, and the committeeurgently appeals for the help which is absolutely necessaryunless next month’s applications are to be passed over.

Contributions may be sent to the honorary treasurer, Dr.Samuel West, 15, Wimpole-street, London, W. The follow-ing is an abstract of the cases relieved :-

Daughter, aged 31. of late M.R.C.S. Is a black-and-white artist, buthas been unable to obtain work for several months, and is consequentlyin great distress. Health feeble. Mother a candidate for an Epsompension. Voted JB10.Widow, aged 74, of L.R.C.P. Edin. Has supported herself since her

husband’s death 25 years ago by letting lodgings, but finds increasingdifficulty in doing so. Only income 5s. a week, an old-age pension.Voted 212.Daughter, aged 37, of late L.R.C.P. Edin. Used to live with her

mother in Paris and maintain herself by giving English lessons, but hasbeen in bad health for the last two years and is now quite penniless.Hopes to shortly obtain pupils or a situation. Voted 25.Widow, aged 44, of M.R.C.S. No income, and dependent on the

help given by a step-son and what can be earned by letting a room.Relieved three times, jE36. Voted 212.Widow, aged 81, of M.R.C.S. Has a small income, but is obliged to

support her grown-up children, of whom three are deaf and dumb, andthe fourth only able to do a little needlework. Relieved nine times,JE60. Voted :E5.M.R.C S., aged 70. Is quite incapacitated and dependent on his

wife, whose income is very small. Relieved once, JE10. Voted 1::5.Widow, aged 69. of M.R.C.S. Has maintained herself for 30 years by

letting lodgings at a watering-place, but is now becoming crippled byrheumatoid arthritis. Voted :E12.Daughter, aged 63, of L.R.C.P. Edin. Is matron at a small orphanage,

but has been obliged for many years to devote most of her salary toassist an invalid mother, recently deceased, and now asks for a littlehelp towards the funeral expenses. Voted 1::5.Daughter, aged 37, of late M.R.C.S. Has held good engagements as

governess and companion, but for the last few months has been unableto obtain a post. and has exhausted her small savings. Voted 1::5.

L.S.A., aged 66. Used to have a fair practice in a London suburb, buthad a long illness with consequent pecuniary difficulties, and is nowendeavouring to make a fresh connexion. Relieved once, .S10.Voted :210.L.R.C.P. Irel., aged 65. Practised for manv years in London, but was

obliged to give up two years ago on account of ill-health, and is nowquite incapacitated. No income; wife supplements slight help fromfriends by letting lodgings. Relieved twice, :E36 Voted :E18.Widow, aged 60, of L.R.C.P. Edin. Endeavours to support herself by

nursing, but for the last few years has found it most difficult to getengagements, and is now practically dependent on a small temporarysrant from a charitable society; health indifferent. Relieved once, ;S12.Voted :E12.Widow, aged 66, of M.R.C.S. Since husband’s death has supported

herself by acting as housekeeper, &c., but is now unable to obtain anypost and quite dependent on this Fund and the uncertain help offriends. Relieved three times, E36. Voted E12.L.R.C.P. Edin., aged 54. Has been incapacitated for several years by

spastic paraplegia and is dependent on relations who can ill afford tohelp. Relieved seven times, E84. Voted £ 12.Daughter, aged 64, of late M.R.C.S. Assisted her mother in keeping

a boarding-house to maintain her father during a many years’ illnessand now helps two sisters who have a school but can give applicant nosalary ; health feeble. Relieved three times, :E36. Voted :S12.Daughters, aged 6 L and 52, of late M.R.C.S. Endeavour to support

themselves by taking boarders and ask for help to tide over the winter.Relieved twice, JE28. Voted :E18.Daughter, aged 63, of late M.R.C.S. Dependent on two brothers

whose help is uncertain and is in very feeble health. Relieved fivetimes..860. Voted ae:12.Widow, aged 70, of L.R.C.P. Edin. Only income an old-age pension

of 5.,. a week and is crippled by chronic rheumatism. Relieved fourTimes, jE48. Voted :E12.

Daughter, aged 41, of late L.R.C.P.Edin. Endeavours to earn aliving by nursing, but has had no case for some weeks and sees noprospect of one. Relieved seven times, :E56. Voted E5.Daughter, aged 56, of late M.R.C.S. Is subject to attacks of insanity

and obliged to live very quietly in the country at the expense of threehalf-sisters who all earn their living. Relieved seven times, ae:66.Voted :E5.Widow, aged 75, of M.D. Lond., who was physician to a special

hospital. Only income two o small annuities which are insufficient forthe little comforts necessitated by applicant’s age and infirmities.Relieved six times, :E36. Voted JE5.Daughter, aged 58, of late M.D. Lond. Has earned as much as

possible "i!];ce father’s death many years ago ty giving lessons in

painting, &c., but is now in ill-health and quite dependent on a half-sister. Relieved 28 times, 2208. Voted JE10.Daughter, aged 49, of late L.S.A. Is mentally deficient and entirely

denendent on a sister, who is a nurse. Relieved six times, B68.Voted .e12.

Daughters, aged 59 and 54, of late M.R.C.S. Ko income; smallearnings from needlework and slight help from friends. Relieved seventimes, E94. Voted .S20.Daughter, aged 54, of late M.R.C.S. No income and incapable of earn--ing a living. Relieved four times, JB37. Voted .815. "Daughter, aged 57, of late L.S.A. Is in feeble health and depen-

dent on a sister-in-law, who is a widow. Relieved 11 times, 105.Voted .e15.Widow, aged 51, of L-S.A. Quite unprovided for at husband’s death

from cancer a few years ago and dependent on a son earning JB1 a aweek; is very deaf and in feeble health. Relieved five times, jE68.Voted £ 18.Widow, aged 63, of M.R.C.S. Unprovided for at husband’s death

several years ago and entirely dependent on her children. Relieved13 times, E166. Voted 22.Widow, aged 56, of M.B. Glasg. Has maintained herself for several

years by letting lodgings and by needlework, but is now frequentlyincapacitated by illness. Slight help from two daughters earning.small weekly wages. Relieved three times, .e42. Voted .e12.Widow, aged 54, of L.R.C.P.Edin. Fract4e-ally no provision at

husband’s death a few years ago and endeavours to support herself bytaking boarders. Relieved once, .elO. Voted £ 10.

PUBLIC HEALTH IN INDIA.(Concluded from p. 1577.)

II. HOSPITALS AND DISPENSARIES.THE reports which we have received regarding hospitals

and dispensaries refer, as we intimated in our last issue,to the triennial period, 1908-10.

Eastern Bengal and Assam.Colonel R. Neil Campbell, I. M. S., speaks of the urgent need

that exists for female medical aid. Thousands of poor women

go without treatment from the feeling that it is improper tobe treated by a male medical attendant, and because nowomen doctors or medical assistants are available. Heconsiders that there should be at every district headquartersboth a female sub-assistant surgeon, and, if possible, amidwife ; at the larger subdivisional headquarters, one of-the former ; and at the smaller, one of the latter. He hasdrawn up a scheme for the gradual introduction of such asystem in the Province out of public funds, but considers thatit is an object which should strongly appeal to publiccharity. He draws attention to the urgent need of a newhospital at Dacca, now the provincial capital. Encouragingresults are reported from the nastin treatment of leprosy,but the numbers are too small as yet to warrant anyconclusion being drawn from them. The hypodermic injec-tion of Forster’s vaccine has been tried for dysentery in 177’cases with somewhat indefinite results. Intraperitonealsaline injections in collapsed cholera cases have beensuccessful in 37 out of 41 instances.

United Provinces.The government of these Provinces has made an important

modification in hitherto existing rules by allowing districtboards to open dispensaries where they are considered to berequired without demanding that public funds necessary forthe whole upkeep shall be provided. These dispensariescan now be started if private subscriptions are available toassist in their support, and grants in aid may now bemade to existing private institutions of a desirablekind, which will thus be encouraged and strengthened bythis official support. Great efforts were made to cope with theexcessive prevalence of malaria, and travelling dispensarieswere established in four of the most stricken districts.More than 31, 000 patients were treated in this way. Freedistribution of quinine was also carried out extensively. Theexcessive infant mortality has been inquired into systemati-cally at Cawnpore by a lady doctor and two trained nativefemale nurses ; the chief cause was found to be tetanus, due tothe unclean methods of local midwives ; a scheme has beenbrought into operation for the training of these nurses. It isstated that the nastin treatment for leprosy has been tried,but without satisfactory results. It was expected that the-new medical college at Lucknow would be opened in Octoberof this year ; training will be provided for the full medicalcurriculum, but it is not yet decided whether the course willbe for four or for five years. Colonel C. C. Manifold, I.M.S.,

. does not speak very hopefully of the preventive treatment of

plague ; he considers it useless to expect effective limitation

1652

of rats where food supplies are accessible ; inoculation, theone successful and scientific means of combating the disease,has not been accepted by the people ; evacuation is notcarried out for a long enough time, the people returning totheir infected houses only to become victims of the disease ;he has more hope from the travelling dispensaries. Someidea of the work done in the hospitals and dispensaries ofthis province may be gained from these figures : 4,543,746cases were treated : 196,759 operations were performed.

Ccnt1’al Provinces and Berar.Lieutenant-Colonel A. Buchanan in his report mentions a

severe and unusual outbreak of guinea-worm disease in a

village near Nagpur ; over 100 persons were affected, all ofwhom drank water from one well, while the people who usedthe other four wells in the village were entirely free from thedisease ; a few persons drank water from the infected well,but filtered it through cloth ; none of these were affected. Thecyclops, which is the host of the guinea-worm (but which isnot a small insect" " as described in the report), was removedfrom the water by straining through the cloth. Another

interesting point is the mention of the occurrence of 25cases of enteric fever at Ohindwara among Indianswith symptoms nearly the same as in Europeans ; it isnot stated to what native race these patients belonged.

B1l’rma.

The principal item of interest in the report on Burma is theopening of the new general hospital at Rangoon, which, how-ever, is not yet finished, though patients are now accom-modated there. It is gratifying to note the large increase inwomen and female children treated ; the numbers have risenfrom 8852 in 1908 to 14,586 in 1910. A considerable increasein syphilis admissions in Burma is noted, especially inRangoon ; venereal diseases are also prevalent at Mandalay ;these points are deserving of the particular attention of theGovernment. Scientific work in the laboratory is carried onunder difficulties in the climate of Rangoon ; bacteriologicalinvestigations are, however, now conducted with success ;one of considerable importance to the public health of thecity was the detection of cases of glanders among men livingin close contact with cab-horses.

III. JAILS.These reports refer to the year 1910.

Bengal.In this province a reduction in the average numbers in jail

took place in 1910 from 15,065 to 13,163, due mainly to thegood season of 1909-10, in which the petty thefts and minoroffences of a population affected by scarcity and high priceswere less numerous. Lieutenant-Colonel W. J. Buchanan,inspector of prisons, writes strongly against the presentsystem of the employment of convicts as warders, manybeing appointed to positions of trust, even to be nightguards, who were not eligible, but had to be employedowing to insufficiency of the regular warders. The questionof alterations in the prison dietary is now under considera-tion, consequent on Major D. McCay’s recent investigations.1The death-rate of prisoners was only 18’6 per 1000, thelowest yet recorded (except 17’ 5 in 1907). The improvementthat has taken place has been extraordinary; in the quin-quennium 1875-79 the death-rate was 65. The chief causefor this good result in 1910 was absence of overcrowding inthe jails, owing to the prosperity of the province consequenton the excellent harvests. Dysentery was much less prevalent,also tuberculosis. Lieutenant-Colonel Buchanan alludes tothe effects of the unrest in Bengal during the last few years ;the prisoners are not so manageable as formerly, and thework of the jail officers has been rendered more difficult andharassing.

Eastern Bengal and Assam.Lieutenant-Colonel B. J. Singh reports a steady increase

in the number of prisoners since the formation of the newprovince in 1905, the daily average being now 8136. He com-

plains that magistrates continue to commit juvenile offendersof 10 to 12 years of age to jail for short periods, in spite ofrecent orders by the Government. No suitable accommoda-tion exists for these juveniles, and the risk of their contami-nation by the older criminals is very great ; moreover, thejails were constantly overcrowded. The death-rate was 32-57per 1000, a higher ratio than in any year of the decennium ;

1 See THE LANCET, Oct. 22nd, 1910, p. 1217.

dysentery and tubercle of the lungs were the chief causes ofthe increase. Lieutenant-Colonel Singh believes that thereis a close connexion between the former disease and oralsepsis, and states that wherever medical officers had interestedthemselves in the proper care of the prisoners’ gums and dis-infection of their mouths the results were satisfactory.Forster’s vaccine was not found to be effective as a dysenteryprophylactic. Tubercle of the lungs was in many casesacquired before admission to jail, but the overcrowding andwant of separate accommodation were largely responsible forits spread.

United Provinces.In the United Provinces the jail death-rate was only 15’ 6

per 1000, compared with 23’7 in the previous year. Thisdenotes a return to normal health after the famine andmalarial epidemic of 1908-09. Dysentery was less frequentand fatal. Lieutenant-Colonel C. Mactaggart believes thatthis was because the prisoners were in better health andcondition when received into jail. Tubercle of the lungs wasalso less severe; malaria was much less prevalent. It is

interesting to learn that a female prisoner escaped from theprison at Benares by climbing over the wall, though she was70 years of age. In her youth she had been an acrobat. Buteven so, the vigilance does not seem to have been up to themark.

Central Pr01.Jinees.At Raipur jail dysentery caused 195 admissions and 49

deaths. Lieutenant-Colonel W. B. Lane states that thedisease was introduced into the jail by a batch of prisonersfrom the Bastar State, and that it spread rapidly. At

Nagpur jail, also, there was an epidemic of 90 cases with11 deaths. In Lieuoenant-Colonel Lane’s opinion the diseaseis due to excess of food, the " unaccustomed plenty " of thejail.

Bombay.In the Bombay Presidency the jail death-rate was 14.5 per

1000, a very satisfactory figure. No epidemic disease occurredof any importance.

.2?w?’m.In the jails here the death-rate was only 11 - 98 per 1000,

the lowest but one on record. An unfortunate misadventureoccurred at one jail where a prisoner surreptitiously took adose of concentrated solution of quinine, stated to have beenat least 300 grains (!) ; he died in two hours.

IV. LUNATIC ASYLUIS.

In Bengal the rate of mortality among asylum patients wasvery low, being only 6’58 per cent. of the inmates, a lowerfigure than that obtaining in the county and borough asylumsin England for 1909, which was 9’96. There were no deathsat all from fever. In Eastern Bengal and Assam the

mortality rate was 11.81, tubercular disease having causedmore than half the deaths at Tezpur Asylum ; this wasattributed to overcrowding, and the construction of a tubercleward will be carried out during the current financial year.With the increased accommodation provided in the new hos-pital of the Punjab Asylum, by which all cases of tubercle,ankylostomiasis (from mud eating), and bowel affections aresegregated, there has been considerable improvement inhealth. The majority of cases in the Indian asylums, ofwhich reports have been received, were, as usual, cases ofmaniacal insanity.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 77 of the largest English towns, having an estimatedpopulation of 16,157.797 persons in the middle of this year,7472 births and 4869 deaths were registered during theweek ending Dec. 2nd. The annual rate of mortality inthese towns, which had risen from 13’1 to 14’2 in thethree preceding weeks, further rose to 15 - per 1000 in theweek under notice. During the first nine weeks of thecurrent quarter the mean annual rate of mortality in thesetowns averaged 14’ 2 per 1000, and was O. 3 per 1000higher than that recorded in London during the same

period. The annual death-rates in the 77 towns lastweek ranged from 7’5 in Walthamstow, 8-7 in North-ampton, 10-2 in King’s Norton, and 10’6 in Tyne-mouth to 21-4 in Sunderland, 21-6 in Wigan, 225 5