1768

The principles of ventilation are well known, but how toadopt these to climate, the speed of steamers, the limitedspace available, and such like contingencies are thedesiderata. Again, when the medical aspect of the questionis approached, and provision has to be made for sick andwounded persons, further difficulties have to be overcome.Messrs. Boyle have taken an initial step towards solving animportant problem.

THE DIAMOND JUBILEE HONOURS.The names of the following medical officers appear among

the list of Honours bestowed on the occasion of the com-pletion of the sixtieth year of Her Majesty’s reign :-Inspector- General of Hospitals and Fleets, H. F. Norbury,C.B., to be K.C.B. (Military) ; Inspector-General of Hos-

pitals and Fleets J. J. L. Donnet, to be K.C.B. (Mili-tary) ; Inspector-General of Hospitals and Fleets H. Mac-donnel, R.N., to be C.B. (Military) ; Surgeon-General C. A.Gordon, C.B , Hon. Physician to the Queen, to be K.C.B.(Military); Surgeon-Major-General C. Sibthorpe, I.M.S., tobe C. B. (Military); Brigade-Surgeon-Lieutenant-ColonelG. W. McNalty, to be C.B. (Military); Surgeon-Major-General J. Jameson, Director-General, A.M.S., to beC. B. (Civil); Deputy- Inspector- General of Hospitals andFleets H. C. Woods, to be a Member of the Fourth ClassRoyal Victorian Order ; Surgeon-Major-General Hooper,President of the Medical Board, India Office, to be C.S.I. ;Surgeon-Major-General Cleghorn, Director-General of theIndian Medical Service, to be C.S.I.

Correspondence."Audi alteram partem."

DRAFT BILL FOR THE REGISTRATION OFMIDWIFERY NURSES.

To the Editors of THE LANCET.

SiBS,—In your issue of June 19th, p. 1684, you kindlypublish extracts from my above Draft Bill. Since sending itto you I have resolved to extend this Bill so as to include,not only midwifery, but also medical, surgical, and otheramrses. I hope this will please all parties, and that we shallsoon get rid of an important subject.

I now wish to ask through THE LANCET that the Secre-tary of each Medico-ethical Society, each Branch of theBrit. Med. Assoc., and each hospital committee and- medical staff interested in this question shall now obtain- a Copy of this Draft Bill and bring it before his members.I shall be glad to answer any questions. Copies of thisDraft Bill may be obtained from my printers, Messrs. Hilland Co., 10, College-lane, Liverpool, at about the following,prices, carriage paid: 25 copies, 5s. ; 50 copies, 8s. 6d. ;100 copies, 12s.May I at the same time request practitioners to send me a

- subscription to the Society, formed for the purpose of pushingthis Bill through Parliament. Since 1890 I have expended’out of my own pocket R373 13s. 8d. in opposing the fiveMidwives Bills. Since Feb. 10th, I have expended about43. It will require a considerable sum-even to defraypostage and printing-when I sent a copy of this draft Billand a circular letter to all hospitals and Medical Societies,Colleges, Medical Schools, Universities, and Poor-lawGuardians-i e., some 1684 Boards of Guardians, 385 MedicalSocieties, and 1506 Hospitals, or a total of at least 3575cpenny stamps required. I am more than willing to give mybest time, services, and money, and the services of those inmy house, but I cannot finance work which directly concernseach practitioner.

I am, yours truly,Liverpool, June 21st, 1897. R. R. RENTOUL.

"A METHOD OF UNITING THE DIVIDEDINTESTINE."

:Z!0 C46 jtKMMrS <y THE JUANOBT.

SiRS,-Under the above heading the writer of a letter that- appealed in THE LANCET of June 19th courteously acquits meof any want of originality. For this I thank him and beg to I

assure him that after a very careful search among all recordsand inquiries among many London surgeons I neither foundnor heard of any article of his or of anybody else thatdescribed the operation I ventured to publish on May 22nd.Without a copy of the article in question it is impossible forme to know how much my operation resembles cr differsfrom that of the American surgeon.

I am, Sirs, your obediently,Harley-street, W., June 21st, 1897. G. LETHAL CHEATLE.

*** The Society of Science, Letters, and Arts of London,to which Dr. Hartigan has sent his paper, no longer exists,and was, we are informed, a bogus institution.&mdash;En. L.

.

"RESPIRATORY SYMPTOMS OF TOBACCOPOISONING."

To the Edit01’8 of THE LANCET.

SIRS,&mdash;A paper by Dr. Morrow under the above headinghas recently appeared. 1 I may be permitted to state thatsome years ago I forwarded to THE LANCET a briefremark upon a case of gasping respiration, in whichnote the exhibition of the symptom, being commensuratein degree with the extent of tobacco consumption, wasattributed solely to this habit, and appeared to be a

variety of Cheyne-Stokes respiration (although somewhatdeparting from the normal type of such), certainly asbeing some kindred theme from the medullary gamut oflung rhythm. One point in my case was that the distress-ing symptom was confined to the first hours of bed and waspeculiar to the horizontal position. Dr. George Herschell, afew years ago, published a case of laryngeal spasm thecause of which, in part, he referred to tobacco-a point ofsome interest in this rapport. In conclusion, seeing thattobacco may cause perversion of central function, as in Dr.Morrow’s thesis, and since it may bring about change ofnerve structure also, as in retinal atrophy, it might be worthwhile to consider and to search out how far this universallydistributed luxury be a contributory factor in either the

genesis or the development of tabes, general paralysis,indeed, in all diseases of nerve, central or peripheral, func-tional or structural, cerebral or spinal, sympathetic, vasomotoror trophic.-I am, Sirs, yours faithfully,

G. HASSALL HUNTLEY.Lees-road, Oldham, June 7th, 1897.

THE PLAGUE IN BOMBAY.

(FROM A CORRESPONDENT.)

II.MY communication which appeared in THE LANCET of

March 27th dealt with some of the physical and social aspectsof the city of Bombay from the point of view of a sanitaryengineer, but no true appreciation of its present state,and the causes which led to it, can be arrived at without anoutline of the governing body which controls the finances andthe executive officers of the municipality. The Bombaymunicipality is the outcome of an experiment on a verylarge scale made twenty-five years ago by the Indian Govern-ment with a view to teach the Indians the art of managingtheir own local affairs. Based, of necessity, very largely onEnglish models, its defects were soon apparent, and theassumption that the whole city could produce seventy-tworepresentatives, all of them both able and willing to servethe best interests of the community gratuitously, was foundto be erroneous. Bombay has never yet sent a fourth ofthat number of good men to the municipal council at any onetime.

Among the seventy-two representatives sixteen are electedby the Bench of Justices, two by the Chamber of Commerce,two by the University, and sixteen by the Government The

corporation elects its own President, and from its membersthe standing committee of twelve is elected, eight of whomare nominated by the corporation and four by Govern-ment. They are paid for their attendance. In addition

1 Brit. Med. Jour., June 5th, 1897.

1769

to the usual executive officers and office staff, the Bombaymunicipality has a municipal commissioner, who in recentcases has been a collector and a magistrate from theCivil Service, but there is no law requiring him to belong toany branch of the Government service. He is appointed bythe Governor of Bombay, and is the paid servant of thecorporation, who have powers to dismiss him. His actual

position has no parallel in any other corporate body. Theentire executive power rests in the Commissioner. He mayprescribe the duties of, and exercise supervision and controlover, the acts and proceedings of the health officer, theexecutive engineer, the assessor, and their several sub.ordinates, and is presumed to be capable of dealing witheverything relating to these departments. The situation wasnone of his making, the pay is good, and under such circum-stanceg it is not surprising if some of the Commissionersentered so far into the spirit of their office as to nullify byinterference the responsibility of the executive officers.About a year ago the corporation voted a sum of Ra. 7000for printing a report on drainage drawn up by the Com-missioner for their instruction. It was the same official whohad already opposed the making of certain experiments to Iprovide scientific data that were wanting for the properventilation of the sewers. It is needless to say thata subject that has not yet been completely developed IIby the best engineers in India could gain nothingat the hands of an amateur without practical ex-

perience. The tendency of the Commissioner is naturallyto guide and direct the corporation, and that of the corpora-tion to have its own way. The latter has also strong parlia-mentary instincts and an innate taste for diplomacy, so theCommissioner’s party and the " opposition " form the chiefdivisions of the corporation. No standard of education isrequired of members of the corporation. Their electionsrecall the methods in vogue fifty years ago in England, andmany of them, after years of service, have only an

elementary knowlege of the Municipal Act which forms theirconstitution. There are among their number a few men ofthe best type, whose unselfishness and singleness of purposewould be an honour to any municipal body, but their work isrendered doubly onerous by the opposition of their colleagues,whose salient points are the making of long and inconsequentspeeches and the faculty of combining for voting purposes.Many of the members consider they have a right to recom-mend friends and relatives to subordinate positions in themunicipal service, leaving the heads of departments little orno choice in the matter ; others resent as an affront noticesserved upon them by the Health Department for breaches ofconservancy rules. The executive officers are elected by thecorporation.The revenue administered by the municipality amounts to

R;.6,300,000 per annum, and the population last year was823,000, but after an existence of a quarter of a century thecorporation generally does not understand its duties, and thepresent condition of the city is directly traceable to itsadministration. Shortly before the outbreak of the plagueoccurred the steadily increasing mortality in the cityattracted the attention of the Grant College Medical Society,which, after three full meetings, passed three importantresolutions which attributed the rise in mortality to the

increasing foulness within and around the dwellings. The

society made a careful investigation of the matter, which itpresented in the form of a report to the corporation.Instead of promptly recognising the great value of thistimely communication on the insanitary state of Bombaythe leaders in talk derided the report and jeered at thesociety that sent it, and the corporation refused to allow itto be read. The epidemic that followed is now a matter of

history.When it was authoritatively established that plague was

raging in the city a member of the corporation proposed tohis colleagues the establishment of a vigilance committee,with full powers to incur any necessary expenditure forstamping out the disease, which was then confined to one ortwo districts cnly. The idea conveyed in the proposal wasto establish a permanent Plague Committee, but the corpora-tion agreed not to touch the business, but to place thewhole responsibility on Government and hold Governmentresponsible for everything, including, of course, the expense.Government, as has been seen, accepted the position, at least,as far as administration was concerned.The limited area of the city and its commercial prosperity

have resulted in a constant dearth of houses and an increaseof rents unknown in the interior. After careful inquiry I

I learn that the net return on various classes of house property,including ground rent per annum, is as follows :- ___ ___,

- ..___ _- _-_ _______.__ -... . _.

Many of the most insanitary habitations which have beendestroyed by the Plague Committee as unfit for humanhabitation belonged to some of the wealthiest and mostprominent citizens or to members of the corporation. Chawlproperty, consisting of buildings of from one to three storeys.constitutes two-thirds of the dwellings in Bombay. It wasthe supineness of the municipality in the early weeks of theplague that brought about the interference of the Governmentand the appointment of the Plague Committee under GeneralGatacre, which practically superseded the municipality inall matters dealing with the epidemic. The most powerfulfaction in the corporation is, of course, that of the houseproprietors, who, at the beginning of this year, numberedthirty-one, or 43 per cent. of the whole. Of the twenty-sixremaining Indian members it is reasonable to suppose thata certain number, although not owners of property, willvote for various reasons, not all connected with the publicinterest, on the side of the house proprietor on all questionsaffecting his interests. The landlords form a body whichhas the greatest personal interests at stake in the corpora-tion, and, whatever they may have done for the rest of thecitizens, they have given the strictest attention to theirown affairs, and in this way the worst vices of structuralarrangement of dwellings have been maintained, conservancyrules and regulations have been set at nought, and thewater-supply has been misused until it is recognised as animportant factor in contributing to the death-rate of the city.Bombay possesses one of the finest water-supplies in theworld. It is derived from storage reservoirs among the hillsto the north and north-east of the city. and it arrives bygravity. The three reservoirs-Vehar, Tulsi, and Tausa-were constructed in succession to meet the growing consump-tion of the city, which now receives about 42 gallonsper head per day of water collected during the five months ofrain and stored during the seven dry months. The actualconsumption of water by Indian populations has been carefullynoted by many observers-that is to say, the amount actuallyused by the people. What they will waste, if unchecked,is limited only by their facilities. In Cawnpore the maxi-mum average consumption per head per day was 7t gallons,including that used for flushing the street gutters before theconstruction of the waterworks. At that time all water fordomestic use had to be drawn from wells having a depth offrom thirty-five to fifty-five feet. After the waterworks hadbeen in use for three years the average daily consumption ofwater from the pipes was 5’35 gallons for all purposes. The

majority of the Indian people wear very little clothing. Theirbedding is scanty, and they have no table linen. Theirindustries are established near rivers, wells, or tanks, and donot yet depend on water-works supplies. From informationrecently obtained the consumption of pipe water per head perday in Agra is 6-44 gallons; in Ahmedabad, 10’0; Delhi,6-0 ; Simla, 80; Lahore, 729; Hyderabad (Sind), 96 ;.Colombo, 19-0; Quetta, 20 0; Ajmere, 5 0; Peshawar,583 ; Madras, 16-0; Karachi, 23-8; and Bandra, 2.12 gallons. Madras and Karachi ate sewered, and havesewage farms which’ practically purchase the sewageeffluents. Bandra has to pay Bombay 12 annas per1000 gallons of water supplied from th3 waterworks ofthe latter town, and the consumption, as shown above,averages only 2 12 gallons per head per day. The Bombaysupply, averaging 42 gallons per head per day, indicatesunchecked waste on an enormous scale. This waste hasbeen the subject of annual protests on the part of the healthofficer, who said that the soil had become waterlogged, that4 000,000 gallons of the daily supply were not accountedfor at the sewer outfall, and that the rate of mortalitywas steadily rising. Every known method of check uponwaste has been determinedly opposed by the corpora-tion, who, so long as they paid their rates by assessment,could waste water in gardens and stables without check.The result is that the cost of waterworks has been increased.

1770

u.ntil the water has to be charged when sold by meter at therate of 12 annas per 1000 gallons, while water at Cawnpore,Agra, Delhi, and Lucknow, which is pumped from rivers i

and again pumped into the mains, is sold at 4 annas per 1000 i

gallons. If waste were rigidly checked and the surplus waterwere sold for irrigation it would be possible to lower the price of water in Bombay. In 67 large towns in Europe, all of them sewered, the average daily consumption of water per head is 20’1 gallons, and they have among them 83,988 water meters. Two years ago the filter beds serving Malabar Hill,

.

the most fashionable suburb of Bombay, were found to be ina horrible condition from neglect. The reservoir water was’fouled in its passage through them, and the water engineer,who was absent on leave, was severely censured by the- corporation. On his return he produced official corre-

spondence proving that the corporation had refused tosanction the expenditure for cleansing the filters. This

.gentleman took the first opportunity to find another place.- Interfering with the duties and responsibilities of its

- executive officers is an incorrigible fault of the Bombay’corporation. The construction of buildings by unqualifiedpersons has led to frequent and fatal accidents, for every’Indian who can pay for a new house, or even an alteration,considers himself qualified to design it with the aid of aforeman builder, whose advice is, of course, gratis. House

property is bought without any proper survey, no questions.are asked provided the price is low enough, and storeys areadded regardless of the state of the lower part of a building.This went on for years without any movement on the part ofthe corporation either to check builders or to provide a,salvage corps to rescue the victims. This scandal mighthave continued had not the daily papers entered a vigorousprotest against the municipality on an occasion when their- engineer stopped the search in the d&eacute;bris of a fallen house forbodies, dead or alive, at nightfall, on the pretext that it wasdangerous. The defective constitution of the corporation ofBombay seems to have penetrated all its committees, which,.-as their numbers increase, seem to lose all individual respon-sibility. Instead of thrashing out the question before themon its merits these committees divide deliberately intofactions and contend for the orator who is most likely toinfluence votes when the time comes for making resolutions.This taste for what is supposed to be eloquence is a verycommon vice among public men in India. It has had the.effect of keeping capable European business men out of themunicipal council. They look on it as a waste of time. The

Europeans who at present serve as councillors are mostlynominees of the Government or of certain public institutions.The recent drastic treatment of the Calcutta corporation

by the Lieutenant-Governor of Bengal has led the public toindulge in the hope that in view of recent events and of itspast history important changes may be introduced at anearly date into the constitution of the Bombay municipality.There is another corporation in Bombay from which manyuseful lessons might be derived. The Bombay Port Trust is.administered by a board of thirteen trustees, six of whomare elected by the Chamber of Commerce and seven by theGovernment. The board administers an annual revenue of.about Rs. 5,000,000, and its meetings are remarkable for anabsence of speechifying and a capacity for gettingthrough work. Such a body could not be brought togetherin India by any popular election. The experience of a

quarter of a century of municipal administration in Bombayhas proved that no body composed principally of Indians canbe counted on to initiate and apply vigorously the regula-tions that are necessary for the well-being of a denselycrowded city. Their feelings are on the side of their friendsand constituents, and the latter are ever ready to claim the

&aelig;gis of religious custom-and consequently toleration-forevery insanitary habit. This was the plea that was broughtforward against the closing of a graveyard in the heart of thetown in which victims of the plague were being buried a fewweeks ago. Religious custom also required that about twenty-eight hospitals should be constructed in and around Bombayto receive plague patients of the various communities, manyof whom would have been ceremonially defiled by being sickor dying in the same room with people of another caste.’Each of these hospitals had its own staff- even if it containedonly one patient. Caste prejudice enters largely into thedetails of sanitary engineering. The sweeper, who removes

nightsoil from dwellings, is looked down on by nearlyevery community. Neither Parsee, Hindu, nor Muslim willallow him to enter his house. The domestic latrines are so

.arranged that the sweeper can only approach them from

without. They are consequently never properly cleansed,and if any member of the family should contract any diseaseof a contagious character the latrine plays an important part,in the spread of the disease.Complete freedom of movement without passports, and the

enjoyment of his " customs," good and bad, almost withoutrestriction, have combined to render the Indian averse to allchange and impatient under new conditions. He does notsuspect that in some other countries an epidemic of plaguewould have brought the city under martial law, with all its

summary methods of procedure.The Bombay. municipality as at present constituted is.

quite unfit to manage the affairs of the city. It hasfailed signally in the management of the water-supply, thedrainage, and the conservancy of the municipal area. Thecommissioner has too much power and too little-toomuch for his technical knowledge and too little forthe knowledge of public business he brings to his task.He arrives profoundly ignorant of many things he iscalled upon to adjudicate, and at the end of a fiveyears’ apprenticeship he is liable to be called to otherduties when he is of most use to the city, to give place toanother man as little au fait as he was at first in thework.As the need of good government increases with the

population-which cannot spread freely-the present timeoffers an excellent occasion for a complete reform of themunicipal constitution of Bombay. It is no question ofexpelling the Indian, for without his aid local self-govern-ment could not succeed completely. Means must be foundto attract the best men-native and foreign-to keep downthe dangerous element to a minimum and to increaseindividual responsibility all round. There is no lack ofgood material for a governing body in Bombay. What iswanted is the means to get it together.Bombay, May 15th, 1897.

MANCHESTER.

(FROM OUR OWN CORRESPONDENT.)

Overcrowding in Red Bank.THOUGH much has been, and is still being done, in Man-

chester to prevent overcrowding and to open out the slumsof the city, such cases as the following show that the workis still far from completion. An inquest was held at theCity Coroner’s Court on Monday week on the bodies of thetwin children of a Polish Jewess living in a court off RedBank. These infants were said to have been healthy atbirth, three weeks before. Their bodies were in a dirty,neglected condition, and " bore a number of sores." One, aboy, weighed 4 lb. 1 oz., and the other, a girl, 3t lb.,instead of about 9lb. each. The boy died from cerebralhaemorrhage, and the girl " from lack of food." Thewoman had been deserted by her husband, but hadfor some time been living with another man, a com-

patriot, and four children, in a room 9 ft. by 6 ft.This district is largely occupied by the poorest of

poor Jews, most of them foreigners, many, like the

mother of these children, unable to speak English, livingsometimes in squalid abundance, at others in a state of semi-starvation, but almost invariably with persons and dwellingsdisgustingly filthy. And yet, as Dr. Niven tells us, thedeath-rate among the Jews in Manchester, is remarkablylow.

The City Industrial Schools., The fiftieth annual report of the Manchester CertifiedIndustrial Schools has just been issued, and shows workvaluable to the community as well as to those rescued fromlives of wretchedness and crime. The admissions duringthe year have been 145. At the school at Ardwick there are51 boys, and 73 at the Barnes Home a few miles out ofManchester, while at Sale there are 21 girls. Of these, 5boys were found begging; 71 boys and 12 girls were foundwandering without proper home or guardianship; 26 boysand 3 girls were charged with theft or living with reputedthieves ; 12 boys and 3 girls were sent to the schools as

incorrigible ; 8 boys and 1 girl were charged under theElementary Education Act: and 2 boys and 2 girls werefound living in houses of ill-fame. In the three schools there