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one category those who remained with their parents and inanother those who were taken away from them. Another

point to inquire into would be, What became of children bornof decidedly delicate but not tuberculous parents ? Did such

parents transmit to their children a special predisposition totuberculosis. Individuals living in tuberculous surroundingsand remaining perfectly healthy should be examined in rela-tion to their family history and their general circumstancesand habits of life. Further information might be gained bynoting the life-history of people whose bodies after deathshowed no trace of tuberculosis. Infants and elder childrenborn of a tuberculous stock should be injected with tuberculinand the results recorded, notice being directed to the pointas to whether such infants were suckled by the mother orwere brought up by hand. In cases of deaths of individuals,apparently not tuberculous, taking place during the criticalage (from 17 to 20 years) as a result of accident, infectious ifdisease or other malady not tuberculous, the lymphaticglands should be examined as to evidences of tubercu-losis. Special attention should be paid to the tonsils.Children who have suffered from adenoids should be

kept under observation with a view to observe any possiblerelation with tuberculosis. Another question requiringanswer was, When does the " habitus phthisicus "

develop ? A comparative table should be drawn up of themeasurements of children at different ages, placing in oneclass children of healthy ancestry and in another thosewith a history of tuberculous parentage. The relation ofchlorosis to tuberculosis was another matter requiringinvestigation.

PUBLIC HEALTH IN BOMBAY.

IN his annual report for the year 1904 Dr. J. A. Turner,executive health officer of the municipality of Bombay, com-mences with the statements that the population of the city,estimated by the census of 1901, was 776,006, and that thearea of the city and the island of Bombay is 22’ 45 squaremiles. The number of births registered during 1904 was19,556 ; this is the highest number ever registered in Bombayand gives a general birth-rate of 25’ 20 per 1000 of the popu-lation. In the classification of the population according toreligion and race the highest birth-rate-namely, 40’21per 1000-occurred among the Jains who number only14,248, or less than one-fiftieth of the general popu-lation ; the proportion of Europeans is smaller still, thetotal number being 12,273, and the birth-rate among themwas 14-74 per 1000. The number of deaths during 1904,exclusive of stillborn children, was 42,676, giving an annualdeath-rate of 54’ 99 per 1000 of population, which was the ’ilowest mortality since 1897. The number of deaths fromthe 12 principal zymotic diseases was 18,397, being 8892 lessthan in the previous year and giving a zymotic death-rate of23’70 per 1000 of population. The deaths attributed tosome of the zymotic diseases were as follows : small-pox,568; measles, 229 ; plague, 13,538 ; enteric fever, 55 ;malarial fever, 2361 ; cholera, 219 ; dysentery, 921 ; andpuerperal septicsemia, 363. In every section of the citythere was a decrease in the number of plague deaths

during the year. Of the deaths from this cause registeredin each month of 1904 the lowest number was 203 in

July and the highest was 4098 in March ; the greatestnumber of deaths from plague on any one day was 187 onApril 1st. Several pages of the report are devoted to suchquestions as the cleansing of house drains, the removal ofhouse and street refuse, horse and cattle stables, bake-houses, the supply of pure milk to the poor, the providing ofbathing and washing places, the collection and disposalof night-soil, overcrowding, hospital accommodation andambulances, and- the measures to be taken againstthe importation of disease by persons coming frominfected districts. Under this last heading Dr. Turnerrecommends (1) that the names of those who arrivefrom infected localities and their addresses in Bombayshould be furnished to the health department; (2) that anyperson arriving in Bombay while suffering from plague,cholera, or small-pox should in any circumstances go to ahospital ; and (3) that all the relatives and friends travellingin contact with the patients should either go for ten days tothe camps provided by the municipality or remain underobservation in their homes. Under this proposed system

there would be no inspection of railway passengers and nodelay in traffic. The routine would be that when a city ortown was infected with plague, aholera, or small-pox thepassengers leaving the city must be provided with forms inwhich their names, destination, and address are written inEnglish or vernacular ; this form would be given up atthe destination to the railway authorities, who wouldhand it over to the sanitary authorities. With respect to thecontrol of plague in the city Dr. Turner expresses strongopinions as to the necessity for evacuating overcrowded andinfected areas and providing huts and camps for the dis-placed inhabitants. He, however, complains that the workof the health department is hampered in various ways,chiefly by the Port Trust which wishes to have the existingcamps and hospital discontinued.With regard to prophylactic inoculation against plague

Dr. Turner says The officers of the Plague Research-Laboratory are perfectly satisfied and have satisfied Govern-ment that the fluid now prepared is absolutely sterile andthat it confers a greater immunity than previously, andthat the inoculation is harmless, and that the opera-tion properly done cannot cause any ill-effects....... In.

Bombay during the last eight years the case-rate or

the number of persons attacked is 25 per 1000 and themortality-rate is 85 per cent. of those attacked. The latestinoculation figures give the case-rate amongst the inoculatedas 18 per 1000 and the mortality as 23 per cent. of thoseattacked." He goes on to say that from his personal know--ledge of the people he is sure that unless some great induce-ment to accept inoculation is offered to them very little canbe done. He considers that a sufficient inducement mightbe constituted by a system of life insurance in accordance-with which the Government would pay 100 rupees to thenearest relatives of inoculated persons who die from plague-within one year after inoculation.In one of the appendices to Dr. Turner’s report Dr. N. H.

Choksy, the special assistant health officer, devotes con-

siderable space to a criticism of certain views on the patho--logy of plague propounded by Dr. William Hunter ofHong-Kong. With regard to the treatment of the disease-Dr. Choksy describes the results obtained in Bombay by theemployment of carbolic acid, izal, adrenalin chloride, andfive various serums. Of all these adrenalin seemed to bethe most useful ; among 668 cases treated with it there were463 deaths, or a mortality of 69’ 3 per cent. In another

appendix on the treatment of cholera Dr. Choksy speaksfavourably of the administration of cyanide of mercury as

suggested by Dr. A. Mayr in 1900. The cyanide is given indoses of one-tenth of a grain dissolved in an ounce

of water with a little simple syrup. This is repeatedevery two or three hours according to the frequency of themotions until they cease. If the patient is in the collapse-stage with infrequent motions only a few doses are required.Rectal injections, consisting of a pint of warm water towhich are added a drachm of sodium chloride and one and a-half drachms of sodium bicarbonate, are given at intervalsvarying from four to six hours, every effort being made toprevent rapid expulsion by elevating the hips, raising thefoot of the bed, &c. ; these injections are rapidly absorbedand the secretion of urine is quickly re-established. Noalcohol is given : the only food allowed is hot strong blackcoffee without milk or sugar.

THE ADMINISTRATION OF POOR-LAWINFIRMARIES.

ONE of the principal subjects discussed at the annual

meetings of the North Midland Poor-law Conference at

Leicester on Oct. 18th and 19th had reference to the

administration of the Poor-law infirmaries.Dr. JOHN DODD, the medical officer at Leicester work-

house infirmary, who introduced the subject, said it had

always been the custom and practice to look on Poor-law infirmaries as places for the aged and sick to diein. The position was this,-Was a town which spent, say,between ,86000 and .E.7000 a year on an infectious diseaseshospital and anything from <E12,000 to 16,000 a year onlunatics justified in spending such a sum as would insurethe proper treatment of Poor-law infirmary patients-someof whom had been a valuable economic asset to thecountry, whilst the economic value of others could be-

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restored by proper treatment ? A few years ago ideaswith regard to tramps centred mainly in repression ; nowit was reformation by labour colonies. Sickness, espe-cially among the poor, was a serious economic lossto the individual and to the community. The number ofpatients in Poor-law infirmaries in the country was

much larger than in voluntary hospitals and the questionwhich arose was, Were they to be properly housed, fed,nursed, and treated ? That question must be answered byevery board of guardians one way or the other. It seemedto him that the successful administration of Poor-lawinfirmaries was comprised in the carrying out of the ideasrepresented in four words-system, method, detail, andcoordination. If the work of the infirmary was carried outin the spirit of those words by the admini&tra.tive committeeand the executive officers the result would be highly satis-factory. What were the means or ideas by which efficiency wasto be secured ? There was frequently misconception as to theobjects of an it firmary. It did not, or ought not to, exist asa monument to the genius of the architect or an object to begazed at by the ca-ual visitor and admired as a fine rangeof buildings. An infirmary existed for the treatment of ipatients and the principle ought to be carried out literally ’,!.nd practically, money which might be spent in ornamenta-tion being devoted to equipping the institution in an up-to-date manner for :’,4hting disease. The first care ought to beto provide suf3r:.cnt and e.ficient medical attendance, andmedicine and medical and surgical appliances ought to besupplied by the guardians without stint. If expense was aconsideration let other estimates less important be cut down.With regard to the nursing-a most important element in theworking of an infirmary&mdash;emciency ought to be the keynote.This meant trainirrr by lectures and practical instructionand he (Dr. Dodd) did not see why the medical officer or

superintendent should not be specially subsidised for thispurpose. In conclusion Dr. Dodd said he thought that it waseconomically sound te restore wage- earners to health as soonas possible, and this, no doubt, would be the main work ofPoor-law infirmaries, mental cases, epileptics, and the agedbeing cared for in different instituticns. Patients from thesmaller unions requiring special treatment might well besent to the larger infirmaries, tl.us freeing to a great extentthe voluntary hospitals. The modern infirmary should beof educational value to the inmates by reason of goodcooking, nursing, and cleanliness. There had recently beena great development in Poor-law infirmary buildings. Duringthe next decade or two these institutions would be on theirtrial and it was important that accusations of extravaganceand incapacity should not impair their efficiency in theinterests of the very poor.The Hon. Mrs. CROPPER (Kendal Union) said that nursing

bv the inmates in Poor-law infirmaries ought not to beallowed. Inmates could be very useful to the nurses but theguardians should not reckon on such help in the real work ofnursing. It almost seemed as if some guardians hung backfrom improvements owing to a sort of idea that by keepingthe sick and senile rather uncomfortable and inadequatelyattended to they could keep down the number of inmatesof their workhouse. It would be fairer perhaps to say thatthey were afraid to make the sick too comfortable lest moreshould come in. The points which required considerationwere : the need for more nurses ; the inefficiency of verysmall workhouses ; and more attention to the needs of bothnurses and patients.

Mr. HERBERT, the Local Government Board Inspector forthe Leicester district, said that there was no country in theworld where the sick poor were better looked after than inEngland. In London one out of every three of the popula-tion died in public institutions, in Leicester 16 per cent.,and in Nottingham 18 per cent. He did not like largeinstitutions but preferred the small ones.

Mr. TURNER (Chesterfield) said he did not think that theepileptics and the mentally feeble were treated as theyshould be in the Poor-law infirmaries. He emphasised thenecessity of erecting buildings outside the town areas sothat epileptics could be removed altogether from the work-hont-e.The Hon. F. STRUTT said the question of epileptics was

being carefully considered in London and he hoped that ampleevidence would be submitted to the Commission appointedto deal with the subject to show the want which was felt inthe midland counties for an institution for treating thisunfortunate class. To his mind it seemed a scandal thatthe Local Government Board, the Commissioners in Lunacy,

and the Home Office had not insisted upon county authoritieserecting proper places where the young of this unfortunateclass might be trained and kept in order in a certain way soas to make them less useless members of the community.The CHAIRMAN (Mr. T. KEMP of Leicester) said that when

the scheme for a new Poor-law infirmary for Leicester wasput before the Local Government Board the latter knockedout that part having reference to the proposed erection

of special pavilions for the treatment of imbeciles and

epileptics. The Leicester guardians were informed by theauthorities at l hitehall that this was a matter which was

having the careful attention of a Commission which wasthen sitting. It seemed to him (the Chairman) that theCommission had been a long time sitting and he hopedthat some tangible result would eventually accrue.

Dr. DODD, in replying to the discussion, advocated theGerman system of dealing with epileptics.At the close of the conierence a number of the delegates

paid a visit to the Leicester Poor-law infirmary at North

Evington.THE INTERNATIONAL CONGRESS ON

TUBERCULOSIS AT PARIS.

(FROM OUR SPECIAL CORRESPONDENT.)

THE SECTIONS.

FOURTH SECTION.

Eco,to?7i,ie Ca1lSeS in the Social Etiology of Tu&ograve;{rc1l70s&Icirc;s.THE economic conditions governing the social etiology of

tuberculosis formed the subject of a striking report by Dr.R. RomME of Paris. He commenced by stating that the defini-tion of tuberculosis as a " social malady " was emphaticallyendorsed by the Berlin Congress of 1899. Articles have been

published attributing tuberculosis to unwholesome dwell-

ings, to defective sanitation in workshops and factories,to insufficient wages, to alcoholism, and other similarcauses. Dr. Romme thinks that all these causes are inter-twined and that in all times there have been the economiccauses which constitute the framework, and the political.administrative, social, and religious institutions which formthe facade of the social edifice. The chief economiccharacteristic of modern society is the progressive substitutionof mechanical for manual labour. The logical consequenceis the concentration of the means of production and exchangeof which the Trust is the last expression. Dr. Romme then

quoted M. E. Vandervelde’s work, " L’Exode Rural et leRetour aux Champs (Paris, 1903), showing that agricultureis not a permanent work and must be supplemented inthe winter months by such home industries as weavingand spinning, pottery work, basket making, and a

hundred and one other manual occupations. Now mostof this work is done by machinery and there is littleor no remunerative occupation for the peasant during thewinter months. Hence the great exodus of the small

peasantry, abandoning the land on which they can no longerlive and crowding into the towns. At the threshold of theproblem the migration of the rural population to the indus-trial centres is one of the primary causes of the increase oftuberculosis. M. Georges Bourgeois, in his work, "ExodeRural et Tuberculose " (Paris, 1905), says the census of 1901shows that out of 2,657,335 persons living in Paris1,694,898 had migrated to the town and only 963,437 wereactually born in Paris. So that of 100 Parisians only 37are natives and 63 were born elsewhere. Of the natives39’7 per 10,000 die annually from tuberculosis and of theimmigrants 43-2 per 10,000 die from the same cause. Thedifference of 3 5 per 10,000 is the price paid for acclimatisa-tion. This is the average, but if we enter into the details itwill be seen that, for instance, persons coming from the

departments of Haute-Marne, Haute-Loire, the Vosges, andthe Morbihan experience when in Paris a death-rate fromtuberculosis which is twice as high as that prevailing in theprovinces from which they came. Nor is this all, for afurther allowance must be made when dealing with thedepartments and villages from which these immigrantscome. Rural districts are not all similar. Thus, M.Durozoy in "La Tuberculose au Village" (Paris, 1904)takes three categories of villages in the departmentof the Oise. The first consists of three thoroughly