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position by their patients being members of the districcouncils and owners of property against which they mighhave to report. There were 12 county councils which ha(appointed medical officers at salaries ranging from .f:500 tlZ800 to devote their whole time to the duties ; 12 othe:

counties had appointed officers at small retainingfees to compile reports from those presented by th<

medical officers of the district councils, and 25 counties

had not yet done anything. After the seconding oi

the motion the next speaker said that the present sanitaryActs were administered by the district councils; he had

found that the medical officers under the district councils

did their work efficiently ; and in his opinion the appoint-ment of a county medical officer of health would be simplya waste of money. Colonel Anderson maintained that therewere many arguments in favour of having a county medicalofficer of health, but when the motion was put to the meet-ing, at which some 40 members were present, only fourvoted for it.

___

ON May 22nd Sir William Walrond moved in the Houseof Commons that a Select Committee be appointed to con-sider the question of hospitals being relieved from rates.

The motion was agreed to and the committee constituted asfollows : Mr. Bonsor, Dr. Farquharson, Mr. Hayes Fisher,Sir Cameron Gull, Sir John Maclure, Mr. M’Crae, Mr.

Pickersgill, Mr. Round, Mr. T. W. Russell, Mr. Tomlinson,Mr. Lawson Walton, Mr. Warr, and Sir James Woodhouse.It will be remembered that a deputation on the matter wasrecently received by Mr. Chaplin-a circumstance uponwhich we commented in our issue of March 1OLh.

THE annual dinner of the Association of British PostalMedical Officers will be held in the Whitehall Rooms of theHotel Metropole, London, on Thursday, June 21st, at

7.30 P.M. The honorary secretary of the association is Dr.Ritchie Giddings, Hillsborough House, Mansfield-road,Nottingham.

-

A TELEGRAM from the Governor of Mauritius, Sir C. Bruce,to Mr. Chamberlain, received at the Colonial Office on

May 18th. states that no cases of bubonic plague for theweek ending May 17th have been reported.

DR. BUZZARD has been elected a member of the Council of

King’s College, London.

THE PLAGUE IN ALEXANDRIA IN 1899.1

THE manner in which the infection of plague was intro-duced into Egypt in the early part of last summer has neverbeen clearly demonstrated and, as has been the case in somany other places where plague has appeared, the closestinquiry has failed to explain how, when, and from wherethe disease was brought to the country. The earliest caseswere believed to have occurred in the first quarter of theyear, but it was not until May that the presence of the BIdisease was recognised with certainty, and it was on

May 20th that Alexandria was officially declared a plague-infected city. On July 4th the Egyptian Maritime and 1Quarantine Sanitary Council appointed a commission fromamong its members to inquire into the origin of the disease. IThe commission consisted of four members-namely, Dr. Rist ]of Egypt, M. Asdery of Greece, Dr. Torella of Italy, andDr. Legrand of France. The Report of the commission, rwhile it does not succeed in explaining how and whence tthe infection of plague came to Alexandria, has brought ttogether a number of interesting facts in connexion (J

1 Rapport pr&eacute;sent&eacute; au Conseil Sanitaire Maritime et Quarentenaire"d’Egypte par la Commission charg&eacute;e de rechercher l’Origine de la PesteAlexandrie en 1899. Alexandrie. 1899.

ct with the epidemic which are deserving of notice. After

ht a brief avant-propos the report plunges at once into the

d midst of things with a clinical description of three cases ofthe disease. The first is that of a grocer’s assistant, a Greek,

o aged 16 years, who was taken ill on April 2nd and admitted3r to hospital on the 5th with high fever, delirium, and cruralg adenitis. lie recovered after suppuration and incision of thele bubo. The second case is that of another Greek, of the same

;s occupation, aged 22 years, who was apparently taken ill on

f April 29th and was admitted to hospital on May 2nd. He) had the same symptoms as the first, and in this case a

Ysuspicion as to the true nature of the disease arose, but ad bacteriological examination of the contents of the bubo (ons the fifth day of the disease) failed to reveal the presence of

- the plague bacillus, and the case was therefore not regarded,

as one of plague. The third case described is that of aY Greek boy, aged 13 years, a cigarette-seller. He was taken ill&bgr; on May 15th and admitted to hospital on the 17th. The1 symptoms in this case were high fever, delirium, and an. enlarged axillary gland. On May 20th cultures made fromr the contents of the gland were found to contain the plague

bacillus and the official announcement was consequentlypublished declaring that plague was in Alexandria.Upon inquiry it was ascertained that certain cases of a

suspicious character had occurred at a considerably earlier. date. Some of these proved to be cases of simple or venereal

adenitis, but a group of three cases, the symptoms of which: are described in detail, presented some distinctly suspicious

features. The three cases occurred in members of onefamily, living in a house on the banks of the MahmoudiehCanal, the lower story of which was occupied by a dirty Arabbakal, or grocer’s shop, and by a grain store. The first

patient, a child, aged 10 years, fell ill on Jan. 27th and diedon Feb. 1st. The second, a man, aged 59 years, fell ill onFeb. 8th and ultimately recovered. The third, a man, aged19 years, fell ill on Feb. 15th and also recovered. In thefirst patient there was severe pain in one groin, but it wasuncertain whether a bubo developed ; in the second a buboappeared in the right crural region, followed by one in theright inguinal region, both of which suppurated; in thethird a bubo, which did not suppurate, developed in thecrural region on one side. The members of this family alsoasserted that some of their neighbours had suffered fromattacks of fever, with pain and swelling under the arm, andthe commission succeeded in seeing one patient, a child, inwhom a cicatrix in the groin remained at the site where asuppurating bubo had been incised.Upon these facts the commission came to the conclusion

that the infection of plague had been present in Alexandriaas early as January or February, 1899, and that unrecognisedcases of the disease may have occurred between that dateand the time of the recognised cases in April and May.The second chapter of the report deals with the evidence

of the infection of rats during the epidemic of plague inAlexandria. The first instance of anything of the kindoccurred in a shop on the banks of the Mahmoudieh Canaland therefore in the same quarter of the city as that inwhich the three cases of suspected plague just describedoccurred. The shop was one where rags and bones weresold, and on March 10th a barge laden with rags arrivedopposite the shop. To make room for the new consignmenta quantity of old rags had to be removed from the shop andin doing so a considerable number of dead rats and micewere discovered lying in groups of eight or ten together.Such an occurrence was said to have been unprecedented.The bodies were removed by the Arab employes of the shop,but none of these persons were attacked by the disease.About the same time-that is to say, from March 10th to23rd-in other shops of the same establishment, a number ofrats were seen which, instead of running away when theshops were opened in the morning, allowed themselves to beeasily caught by the hand. After March 23rd no rats wereto be seen, and it was not until towards the beginning ofSeptember that these animals began to be common again.Some cases of plague occurred in this quarter of the city butlone among the employes of this establishment.The second instance of rat mortality occurred in the

leighbourhood of the Sailors’ and Soldiers’ Institute. About,he end of March and the beginning of April the director ofhe institute stated that he had observed an unusual numberf rats in and near the building. Every morning he saw,bout 30 sick or dead animals in the lane which separatedds house from the store-rooms of a certain grocery establish-aent, and it is noteworthy that it was in this establishment

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that the second patient above described (the Greek admittedto hospital on May 2nd) was employed. That patient alsostated that some 15 or 20 days before he was taken ill anunusual mortality occurred among the rats in the store-roomsin question, some 10 dead bodies of these animals beingfound every day. Several dead mice and one dead cat werealso found. Nothing of the kind had ever happened before.A similar mortality among rats was observed in some otherplaces-notably in a certain French- bazaar-at no greatdistance from the Sailors’ and Soldiers’ Institute, but thefacts are dwelt on at much less length by the authors of thisreport. Two cases of plague also occurred in the MoharumBey police barracks, where 10 days previously a largenumber of dead rats had been discovered ; the two menattacked had helped to remove the dead bodies of the rats.At certain French mills, situated on the banks of the

Mahmoudieh Canal, but at a considerable distance from thepart of the city originally infected, two of the employeswere attacked with plague on June 7th and June 10threspectively. About the middle of May a large number ofdead rats and mice had been found in the granaries in con-nexion with the mills. The bodies had been swept up andthrown into the furnaces, and after a few days there was acomplete disappearance of these animals from the mills. Itwas suggested that the infection of plague might have beentaken to the mills in grain sacks which were carried back-wards and forwards between the mills and a retail flour shopsupplied by them in the quarter of the city where plaguewas somewhat widely present in May ; but if this was,indeed, the case it is at least remarkable that of a certainnumber of employes whose special occupation was thecleaning and repair of these sacks not one was attacked bythe disease. In closing the discussion on the subject of theinfection of rats the authors of the report ascribe to theseanimals a very considerable share in the spread of plagueduring the early period of the outbreak in Alexandria ;later, when the germ of the disease was more

widely diffused, it appeared to be carried in clothesor-though this mode of spread was thought tobe of very much rarer occurrence than the others-bydirect spread from man to man. In support of the view thatrats largely helped in the early diffusion of the diseasespecial stress is laid on the fact that so many of the earlycases occurred in persons whose place of occupation or ofresidence was peculiarly frequented by rats, such as groceryshops, a mill, a house in or near which was a baker’s shop,a grain-store, or a bakal.A brief chapter is devoted to a discussion of the questions

as to when and where the disease first appeared in the city.Suspicious cases were traced as far back as the month ofJanuary, 1899, but it was impossible to assert that the infec-tion had not been present in the city from an even earlierdate. The part of the city first affected was believed to have ’,been the Minet-el-Bassal or Gabbari quarter, in the neigh-bourhood of the mouth of the Mahmoudieh Canal and theGabbari goods station. The general progress of the diseasewas from west to east. Attention is also drawn to theremarkable fact that all the early cases, both those officiallyrecognised and those still earlier ones brought to light bysubsequent inquiry, were in Europeans, either Maltese orGreeks, and that not one occurred at this time in a native.

In regard to the question as to how the infection ofplague was introduced into Alexandria the commissionwas unable to find any conclusive evidence. The nearestplace to Alexandria in which plague had been prevalent wasJeddah, but with the exception of a small number of cases ofthe disease in the crew of a steamer called the Mehallawhich arrived in Suez from Jeddah in May, 1898, there wasnothing to indicate that the infection had at any time beencarried to the Egyptian shores from that port. The Moslempilgrims returning from the Hedjaz in 1899 were also, so faras could be ascertained, in no way responsible for the intro-duction of the disease into Alexandria. The fact that somany of the earlier patients were Greeks employed in groceryshops (&eacute;piciers) gave rise to the suggestion that the Greeksor Jews who provide the pilgrims in Jeddah with articles offood might, some of them, have come to Alexandria andbrought the disease with them. But there was nothing topoint to such an occurrence, and, moreover, the suggestionfailed to explain why the cases occurred in several quartersof the town and among persons who, though of the sameoccupation, had no relations whatever with each other. Theexplanation favoured by the authors of the report is that thecentres for the sale of comestibles became infected and that

the disease was spread from them by persons employed in thesale of such articles and by rats.The theory that the disease was imported from Bombay

i either by human beings or by rats is very briefly dismissed.It had been suggested that it might have been brought

i thence by a man accompanied by three Galician prostitutes,who arrived in Alexandria from Bombay on April 2nd,

. and after a short stay left for Trieste. But there wasnothing whatever to show that they brought the infection

i with them, and it is pointed out that the disease was almost: certainly in the city a considerable time before the date of

their arrival. The possibility of the importation of the in-: fection by goods brought from Bombay is also discussed.

Every month some 3000 or 4000 sacks of sesame arrive atAlexandria from Bombay; the great majority of other classes

: of goods from India to Egypt are landed at Port Said and: thence trans-shipped to Alexandria. Had the infection been: imported by such means to the latter city the persons most. likely to have been first attacked would have been the men: at the docks who landed the goods, but this, it is pointed. out, was not the case.. In closing the report the authors repeat, in the form of" six " conclusions," the facts stated above, and they add thatj in regard to the mode of introduction of the disease intoL the city they are unable to come to any positive conclusion. at all. They are content with saying that the infection mayI have been brought either from India, the extreme East, or

from Arabia, and by means of either (1) an infected person, in whom the disease was not diagnosed, or (2) a person withL the disease in the stage of incubation, or (3) by con-

taminated goods, or (4) by clothes or dirty linen, or (5) byrats on board a ship.

THE WAR IN SOUTH AFRICA.

THERE is no longer any doubt about the success of

our troops at Mafeking. Colonel-now Major-General-Baden-Powell’s heroic garrison have been relieved, to theextreme satisfaction and delight of everybody, after a siegeof seven months. Unmistakeable signs of the collapsingpower of the Boer forces are becoming more and moreevident and the news from the theatre of war is

eminently satisfactory, although it is still too early to feelconfident that there will be any immediate end of theconflict. Looking back on all that has taken place sincethe beginning of this war we may well pause and ask our-selves whether, after all, any other nation would have donebetter, or even done as well, under all the exceptional anddifficult circumstances that have presented themselves. TheBoers have not suceeded in capturing any one of the threeplaces which they have besieged, while their real strategicalobjects have been delayed and frustrated. They knewevery inch of the country, and moreover they had some sixweeks’ start in disposing of their forces to the best advantagein a land which, geographically and topographically, wasadmirably adapted to defensive warfare and to their tacticsas well as to the use of all the modern rifled arms and

implements of war. There was no general rising in Natal,the Boers did not mass their forces to the south of the

Tugela and seize the railway or occupy Pietermaritzburgand Durban, which were most important strategical con-

siderations, at the time when our troops in South Africawere altogether outnumbered by them. That the Boers havethroughout exhibited great tactical skill, and that theyhave shown themselves adepts in the use of ambushes andin effecting their retreat from untenable positions with theirguns and stores-all this is undoubted. Not only this country,but every other country, has learned great practical lessonsfrom this war. There is no need to enumerate them, but wemay refer to one-namely, the enormous resources which areavailable in the present day for defensive warfare and thepossibility of applying these with the greatest advantageon the north-western frontier of India. But the matterswith which we as medical journalists are chiefly concernedare : the revolution which the war has brought about inour surgical knowledge of gunshot wounds, in our methodsof treatment, and in all that concerns field hospitaladministration, transport, army hygiene, and the necessity-to speak generally-for the reorganisation and unificationfor war purposes of all the medical aids at our disposal.