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sixteen local practitioners were able to attend. Mr. Willmore t

opened the proceedings by explaining that this was but a 1

preliminary meeting convoked for the purpose of seeing awhether any sort of action was possible. Even if for themoment nothing very startling could be done, still it wouldbe a good thing if the members of the profession couldarrange to meet each other on certain days. This would

help to rub off the corners" and lessen much of the

animosity and asperity which were so detrimental to theinterests of the profession. At the new hospital, whichwould be completed in the month of May, there wasa board-room where, if a medical’ society was formed,meetings could be held. There were many grievances tobe dealt with. Clubs might be necessary, but touting wasnot necessary. Then there were the herbalists who hadnot the qualifications of dispensing chemists and yet theygave consultations, prescribed, and made large incomes outof the practice of medicine. Druggists were also very proneto prescribe, but if such abuses were ’,to be abolished theremust be cohesion among the members of the profession.Mr. Willmore then called upon me to address the meeting.After giving what information I could crowd into a shortspeech dealing with the grievances that prevailed and theremedies that had been attempted, I insisted on the neces-sity of forming at once a medical union to deal withethical and economical questions. Some amusing thoughsomewhat despondent speeches followed. One speakerthought union was impossible because ethics in Walsallwere an unknown quantity and nothing could beworse than the actual condition of the personal relationsbetween the local practitioners. The general tone of thespeeches clearly showed how low the profession had fallen.There was a general cry of "stinking fish." One speakercomplained that touting had been set up and organised bymedical men who employed insurance canvassers and outbadeeach other by offering larger and yet larger commissions soas to secure the services of the best canvassers. Com-

petition had become an excuse for every iniquity and ithad stamped out all sense of medical etiquette. One

practitioner explained how, on arriving at Walsall, he hadstoutly refused to have anything to do with the clubs ;then, finally, he took people at 10s. a year. The resultwas that about three persons joined his private club,but, as during the first three or four months they did nothappen to fall ill, they concluded that they were paying toodearly, so they left him and went to an institution wherethe subscription was not more than 3s. 6d. a year. At lasthe found that he must do what all the other medical mendid and take what clubs he could get at the terms currentlypaid. Nor would it be easy to ask the local practitioners togive up clubs that brought them in .6100 or .6200 merely ona question of principle. Whatever clubs one medical manmight throw over other practitioners would gladly take up.Yet everyone acknowledged that club work was ruiningprivate practice.From all this it would seem as if the cause of unionism

has but poor prospects of success at Walsall. This is notthe case. The medical men who attended the meetingwere suffering from angry feelings too long pent up. Havingnow at last had their say they felt wonderfully better. Noprescription ever effected a more rapid cure. Practitionerswho had not so much as bowed to each other for two yearswere now found cordially shaking hands, and after somelittle hesitation and some desultory conversation, withone abstention and no hostile vote, a resolution wa.

carried that a committee of six members should be electecthen and there for the purpose of taking the initiator3steps necessary for the formation of a medical uniorto deal with ethical and economical questions. Th<meeting also unanimously adopted a resolution expressinfits thanks to THE LANCET for the service rendered iiraising the whole question. The committee was electe(by ballot and then the meeting adjourned. In subsequenconversations I found that some of the speakers who afirst deprecated the idea of forming a union had becomequite enthusiastic in the cause. It was pointed out thathree of the medical men who had not attended were partnerand therefore constituted but one firm, and their positioiwas such that even if they did not join the union they woulinot act against it. Others were the salaried officers o

friendly societies and scarcely free to act, so that the numbewho actually attended and voted for the formation of thunion was much larger than could reasonably have bee:

expected for a first effort. The chances of success were

therefore, greater than had been anticipated, and it wouldbe strange if with so fair a beginning good results did notaccrue. -

THE ASHANTI EXPEDITION.

(BY OUR SPECIAL WAR CORRESPONDENT.)

111.1Tlte Water-Supply of the Troops.

VARIOUS, indeed, have been the causes adduced for the-roduction of malarial or coast remittent fever. For

instance, some have suggested "planetary influence," others’ ‘ want of elasticity in the air"; not a few have thought"withdrawal of elasticity from the human body" hadsomething to do with it, whilst the majority believe thedisease has its origin in decomposed organic animal and-vegetable matter and general impurity of the water, the last.of these coming in for the lion’s share of professional sus-picion. It was at one time thought that sulphurettedhydrogen gave rise to the complaint, even so celebrated a.traveller as Humboldt to a certain extent favouring this idea ;-but various expeditions sent to the west coast of Africasince his time have in no way helped to solve the problem ordone anything to satisfy us on the point in dispute. Theablest scientific researches, carefully conducted by medical-officers sent out for the purpose of recording their obser-vations, have one and all rather disproved than other--wise the accuracy of any single suggestion. Whatever maybe believed about the admixture of salt and fresh waterbeing capable of producing a special form of fever at the-deltas of rivers, the same cause ceases to operate at anydistance from the coast or at places away from the direct,influence of the sea, such as at Ashantiland, where remittent.fever of a virulent character exists probably in an endemic-form the whole year round.

Recognising, however, the very great importance attachedto a proper supply of good wholesome water for the use ofour troops engaged on an expedition such as that to..Kumasi, I took care to make a careful chemical examinationof nearly all the sources-from Cape Coast Castle to*Kumasi-from which a supply had been obtained, and with.only two exceptions did I discover en route any positivelybad water or see the fluid in such an impure conditionthat it could not, after boiling or filtering, have beenpartaken of by the men with impunity. Of the two,

places referred to where the water was qute unfit foruse even after precautions had been adopted, one was.

at Yacumba on this side, and the other at Akusirem,on the further side, of the Prah. Moreover, I thought-.it best to corroborate my qualitative examinations bysending some specimen water carefully obtained from ariver at the rest camp called Mansu to England, so that it.might be subjected to a qualitative and quantitative analysisin THE LANCET Laboratory. This said sample, a very fairall-round specimen of what was drunk by the troops out.there, has turned out to be quite usable after boiling, for,as the report from THE LANCET Laboratory says : " The-water submitted for examination contained a marked amount:;of organic matter held in solution, yet it was less open"to objection because there was no indication that thesematters were of animal origin or derived from animal-,excreta. It was slightly turbid, containing a deposit which,on microscopical examination, proved to consist of vegetable-d&eacute;bris. The sample only measured 10 oz., so that itwas not possible to make a very exhaustive analysis.On withdrawing the cork a distinct smell of sulphu-retted hydrogen was evident, proved by the blackening

- of a slip of lead paper introduced therein. The pre-

’

sence of this sulphuretted hydrogen, however, could’ easily be attributed to a reduction of sulphates during

transit in a closed bottle by the vegetable matters held insolution, for the water in its original state does not appear’ to contain any trace of this gas whatever. The totalamount of solid matter amounted to 11-9 grains per gallon.On ignition charring occurred and a smell was evolved ofE vegetable but not of animal matter burning. The reaction

rfor phosphates in the residue was hardly perceptible. There

1 Nos. 1 and 2 were published in THE LANCET of April 4th and 11th1896, respectively.

1172

was an entire absence of chlorides. The free ammoniaamounted to 0’028 grain per gallon and the albuminoidammonia, which came off very slowly, to 0’042 grain pergallon." The report concludes: I I As might be expected inthe presence of sulphuretted hydrogen, neither nitrites nor’nitrates were to be found." These views correspond withthose expressed by myself after examination of the water at’the various rest camps, and must go a long way to show thatthe water-supply has not proved nearly so impure as wasexpected, and that the bulk of the water after boiling orpassage through a filter might be partaken of without fear ofr-anpleasant results.

At Yacumba, the first halting station, only some sevenmiles distant from Cape Coast Castle, the supply of waterhad to be brought to our camp from a sluggish stream some’two miles distant from our camping ground. Its colour’was of a reddish brown. Moreover, it was quite devoid.-of transparency and possessed a disagreeable foetid odour.The rivulet ran through a sort of glen, and its bed wastprobably some thirty or forty feet below the higher land.cn which the native huts were erected. Into it several- surface drains evidently emptied their contents by a common- duet, which could be traced to and communicated with the.native township above. Hence the source of native pollution.could without difficulty be most easily accounted for.-Chemical tests gave positive evidence of its impurity and- clearly showed its unsuitability for either drinking or

. culinary purposes. Major Sinclair, R.E., lost no time in

- communicating these facts to the headquarters’ staff, so as toavoid the use of it by the troops on coming up.

At Akusirem, another rest camp on the other side of thedRiver Prah, matters were even worse. This halting place was- selected by one of the colonial authorities, and the camp’dwellings were erected by an officer in their employ. Of.all the camp sites selected en ’l’Otde to Kumasi, this onewithout a doubt was the very worst selection. To com-- Tnence with, it was approached and surrounded by a succes-sion of wretched, dismal, offensive-smelling, malarial-

’reeking swamps. The site was very low, and, to crownall, possessed no proper water-supply whatever. True,.on its northern side there existed a sort of mud holecontaining a collection of dark-coloured, offensive-smelling’Suid which by no stretch of imagination could ever

’be called usable water, for it consisted simply of drainage(percolating through loose sand from an old plantain.garden (very possibly a disused native burial ground) aboveit. To all tests it gave unanswerable results. When seenits impurity was recognised by the principal medical.officer, and on his suggestion the desertion of the camp was’determined on by the staff as soon as they had arrived on’ the ground; but this decision was arrived at some timeafter my own report regarding the character of the waterand the other insanitary conditions of the locale had beenrtelegraphed back by an officer. Why any delay at all shouldhave occurred in deserting it after the receipt of that’telegram by the executive remains yet to be explained, con-sidering that two white officers were then very ill in bed withsevere attacks of remittent fever. I am not prepared to say i’what definite position the civil medical profession held

I

with reference to the military out there ; but this I do’know, that many of the surgeons in the employ of the

’colony (in fact, I was told so by them) looked principally"for instructions issued by the head of their own department,;and scarcely considered themselves in a position or at libertyto act under any other authority. There is a trite saying,’"between two stools one is apt to come to the ground,".and this is particularly applicable to military medical

.organisation. In the field there should be only one

responsible head of the department-the principal medical. officer, and his position should be unquestioned and his-orders unhesitatingly carried out by the civil as well as the<military element acting in concert under him.

Barracou village is situated higher than any of the rest.camps this side of the Prah, being some 500 ft. above sea level.’Its surroundings are free from objectionable swamps, while thewater procured from a running stream near the native villageIProved excellent on examination. This place was a rest camp.during the previous Ashanti War, but was not used as such in.the later expedition. Its exclusion from the number of sites.ohosen probably arose from mileage considerations, the locale,mot dovetailing in with the requisite length of marches decided.on. Be that as it may, Barracou is an excellent site for arest camp and much more suitable from a sanitary point of"view than Assin-Yankumasi, which had been selected in its

. stead, possibly because It is a few miles more distant froml the Prah.

At Assin - Yankumasi the water was obtained from a

. stream, and although not quite so transparent as one could’ wish, it nevertheless gave negative results with nearly all the

tests employed except Nessler’s solution, which showed aj slight colouring of the fluid when compared with a tube full; of distilled water.I During my stay at the Prah River the Pasteur-Chamberland, filters, six in number, were brought up. Their arrival was,

hailed with considerable satisfaction, because it was hoped thatthe officers and men who had up to that time been forced todrink (previously boiled) river water would now be suppliedwith a purer and much more wholesome fluid. Being presentwhen their component parts were being put together by theman in charge I had an opportunity of judging of theirsuitability for the rather rough use incidental to a campaignlike that on which we were then engaged, and I must franklyadmit that the parts seemed to me to be too numerous andthe internal fittings too complicated and likely to get out oforder for the rough-and-tumble work to which they wereinevitably to be subjected.To begin with, each of the large galvanised cisterns, sup-

posed to contain many gallons of water, is supported bythree long, round, half-inch metal legs. More than one ofthese bent under the superimposed weight when the tank hadbeen filled with water, or perhaps sank deeper into the earththan its two fellows, and by reason of the list given to thecistern was apt to throw the whole apparatus out of workingorder. Then, again, there was considerable delay as well asdifficulty experienced after getting the bougies into positionto secure the lids properly. The rubber bands did not appearto fit in the grooves as neatly as they might be expected todo. Vulcanised material, as everybody knows, perishes orbecomes unfit for use very soon after exposure to air in atropical climate, and its adaptability for the exclusion of airin an apparatus of this kind was not by any means satis-factorily shown as far as I could see. It took some hoursbefore one of these filters could be brought into anythinglike working order, and when this was accomplished thesupply of filtered water fell considerably short of what wasexpected. After some trials it was found absolutely neces-sary to do away at once with the useless metal tripods. Amore solid foundation for the cisterns in the shape of woodentrestles was supplied. The metal tanks were placed onthese supports and relays of natives requisitioned to turn thehandles and keep the supply of water up, but in spite of allefforts the result was unsatisfactory, only some forty gallonsof filtered water being the result of over six hours’ work.Naturally such a result was extremely disappointing.During my stay of some days at the Prah these several filterswere more than once taken to pieces-overhauled and care-fully cleansed-in order to ascertain if any accumulation ofdirt or debris interfered with the working of them, but all tono purpose in effecting any decided improvement in theirefficiency, for instead of turning out a sufficient supply ofpurified water for some 300 or 400 soldiers, as they wereexpected to do, they failed to afford a third of the amountrequired for the daily consumption of our men. The resultof this failure was that an order had to be issued by theheadquarter staff that all the filtered water was to bereserved for the use of the sick, and the healthy had oncemore to return to the drinking of what was collected by theriverside. Not only were our filters at Prahsu breakingdown, but we learnt that at Fosu, where two filtershad been left, the authorities were complaining of theirinefficiency. " One worked very indifferently and theother not at all." Need I add what a disappointmentthis proved to us all, who had been led to expect so muchfrom the Pasteur-Chamberland filter? An expert whohad been summoned from Cape Coast Castle with a viewof setting matters right told me they were larger cisternsthan he had been accustomed to. If this be so or

not I am unable to say ; but all I can vouch for is thatthey in no way accomplished what was expected of them.The principle (hydraulic pressure) upon which the Pasteur-Chamberland filter is constructed is unquestionably a goodone. No one having seen the apparatus in operation candoubt this for a moment. However dirty or discoloured thewater may be on introduction, whatever quantity is passedthrough the filter comes away as bright and clear aspossible, every impurity is arrested and may easilybe seen and scraped off the surface of the bougies when thelids are removed and the candles are unscrewed for the

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1174

purpose of cleaning them. The failure that occurred out inAshanti was, therefore, one concerning quantity more than’quality, and a little more care in their construction maypossibly obviate this defect in the future. All use of vul-,canised rubber should be avoided, and, if it were possible,- automatic rather than manual power should be employed fortheir operation. In war time, especially during the forward’march of troops, it may be rather difficult at times to securesufficient men to turn the handles of these filters, whichmanipulation must be provided for if a proper supply-of pure and wholesome water has to be kept up. Speakingone day to Surgeon-Colonel Taylor about the unsatisfactoryworking of the filters that had been supplied for the use of’the expedition, he happened to remark that., he had noticeda small narrow stream crossing the road about half a mile- out of camp and had seen natives collecting water thereat,"and " he wondered whether this was of better qualitythan that obtained from the river," and " could I trace,it up to its source? " Of course I consented, and lefthim with the determination of searching for the

- spring of this rivulet as soon as I could. The oppor-tunity for starting on this search presented itself very- early the following morning. About 4 A.M. I left camp;and came upon the stream in question about three-quarters,of a mile on the Barracou road. It was scarcely six inches inibreadth. Tracing it in a north-north-east direction for somehalf a mile or so I found it divided, one branch, the north-east portion, running to the River Prah, while the othercoursing but a short distance seemed to be joined byanother little rivulet down which water very clear and

bright seemed to be coming from a south-south-east-direction. I had much difficulty from the immense.amount of tangled undergrowth that lined its banks in

tracing this stream up to its source, some four hours being-occupied in the endeavour, but its spring was at last dis-- covered and I had the satisfaction of bringing back to- camp a bottle of the clearest and best water that was- ever secured en route. Surgeon-Colonel Taylor was

delighted with the pure supply that I had through hishint been enabled to discover. From this time no more’river water was required during our stay at Prahsu.

Across the Monsi Hill I had another opportunity of test-’ing a spring of really excellent water, which coursed down,and supplied the troops at the rest camp of Kwissa (viderillustration).

MANCHESTER.(FROM OUR OWN CORRESPONDENT.)

Manchester and Saljord Sanitary _lssociation.ON Sunday evening a sermon was preached in the Man-

chester Cathedral on behalf of the above association by theSRev. C. V. Gorton, Vicar of Morecambe. His subject was11 The Laws of Health, the Laws of God." He said that inithe Scriptures the word cleanliness was synonymous withholiness, and that the Mosaic priest was really the medical-officer of health. The old Greeks, whose aim was the pby-sical perfection of the man, deemed sanitary law a portion of?the moral code. He quoted Xenophon as giving one of thebest descriptions of the officer of health : ’’ When people.are sick, physicians cure them ; they are menders of oldgarments. But your care is to be of another kind : it is for

you to prevent the army from becoming sick." (If our

.military authorities looked at matters more like Xenophon,there would be less cause for discontent in the Army MedicalService.) "It was strange," he said, "that in the early’days of the development of Christianity and after the fall ofthe Roman Empire we looked in vain amongst European,peoples for that regard for the law of God. The Church

prayed, From plague and pestilence, good Lord, deliver us,’but was content to remain unmindful that national judg-ement was a natural consequence of national negation of thelaw of God." He reminded his hearers of Lord Palmerston’sreply to a deputation requesting the appointment of a day ofhumiliation and prayer on the outbreak of cholera about themiddle of the present century from the neglect of sanitary1.aw: " When man has done his utmost for his own safety thenis the time to invoke the blessing of heaven to give effect to’his exertions." It was, he said, a good thing that theManchester Sanitary Association was doing its best to

improve all this. "It would be still better if the societywere so supported that it could inaugurate branches in every

town in the country which would investigate the physical. causes of disease, note the rise of epidemics, educate public

opinion, and organise the working classes to demand pure airand pure water, and not only a grave to be buried in, butsuilicient space in which to properly live." It might havebeen as well if he had suggested to the "working classes"that when they got their pure air they should not do all theycan, as is too much the case at present, to pollute or excludeit from their dwellings.

CM?* -M-SMty.Under the auspices of the Milk Dealers’ Protection Society

of Manchester, Salford, and Surrounding Districts, a lecturewas given on April 20th by Mr. W. Cox on Milk as

Food in relation to Health. The chair was taken by amember of the city council, who said " the associationexisted for the purpose of protecting from undue inter-ference a trade in an article that was indispensable tohealth. It, had no sympathy with any milk dealer whoviolated the rules that were necessary for safeguarding thepublic health." He considered that the association wasright in suggesting that the work of the corporationinspectors should not be confined within the city, but shouldbe extended to the shippons and dairies from which themilk came ; and in this we should all agree. Mr. Cox in hislecture did not speak from the standpoint of the man ofscience, and he would apparently laugh to scorn the patientlabours of the bacteriologist, for he is reported as follows:"The idea that the germs of disease were spread by milk hedescribed as ‘a craze."’ Save in exceptional cases, in whichthe germs of scarlet fever or typhoid fever had been directlycommunicated to the milk by the persons manipulating it,milk had never proved injurious. These are pretty con-siderable exceptions to start with. He then contended thatthe facts (lisproved the idea that the "tubercle bacteria"could be communicated from the affected animal through themilk to the consumer of the milk. May it be inferredfrom this that Mr. Cox would advise the giving ofmilk from tuberculous cows to delicate children so

long as the poor creatures were able to supply it?"He believed that such infantile diseases as were oftenattributed to milk were due either to the lack of milk orto the insanitary condition of the houses of the poor;and he said that the healthiness of the children of farmersand dairymen was the best answer to those who said thatmilk was not healthy." He believed that greater attentionshould be paid to the periodic inspection of shippons and dairiesbut apart from that everything that was necessary was atpresent one to ensure the purity of our milk-supply." The retaildealers are, of course, immaculate and always take the mostscrupulous care to avoid contamination by any even of those" germs which Mr. Cox holds in such contempt. It is a

pity that anyone should discourage the efforts made to securegood quality and purity in a food of such importance asmilk, and especially that such discouragement should comefrom a member of the veterinary profession.

Ancoats Healthy Homes Soeiety.This society, of which Mr. Aldred is president, gave the

last lecture and entertainment for the season on Thursdayevening last, when Mr. W. P. Montgomery, assistant surgeonto the Ancoats Hospital, addressed about 800 people onExercise and Training. The primary object of the society isto give instruction of a useful kind, and this work has beencarried on for several years amongst the poorest people of theworking-class district of Ancoats ; but in order to bringtogether those who without some such attraction would notattend the additional bait of musical performances, betweenwhich the lectures are sandwiched, has been found verysuccessful. The young people in Manchester as elsewhereare open to this influence, and these combined attractionshave been successful in securing an average attendance of650 people at the twenty-nine lectures given during the lastsession. The lectures and the services of the musical helpersare entirely gratuitous and admission to the entertainment isfree. 11 useful information is given and something done tobrighten what to most of us would seem the dull monotonyof the daily life of these poor mill hands.

77<6’ Manchester and Salford Refor1llatory.The fortieth annual report of this institution contains a

very important little point. Referring to the falling off inthe number of admissions, the report says that if this werelue to a diminution of crime it would be a subject for con-gratulation, but the governors desire deliberately to place