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furnished the means of making a certain diagnosis of the idisease and of enabling the authorities to be warned of theoccurrence of cholera in time to take measures for prevent-ing its spread. Such measures would include a strict

supervision of the frontier, compulsory notification of

suspected cases, the formation of sanitary committees, theappointment of public disinfectors, institution of hospitals,prohibition of imports of fruits, vegetables, &c., from infected icountries, and the rigorous supervision of laundries, dairies,&c. The various modes of disinfection are discussed indetail: physical agencies-as desiccation, dry and moistheat; chemical agents, including gaseous disinfectants-asbromine and chlorine, and fumigations with sulphur, &c.;fluid disinfectants, restricting the term only to those agentswhich within half an hour destroy all choleraic microbesunder all circumstances-as corrosive sublimate and carbolicacid, sulphate of copper, chloride of lime and sulphate ofiron, salicylic, boric and thymic acids, laudanum (1 per cent.kills the bacilli), and chloroform (1 in 30 or 40), alcohol (1in 10). Observations follow confirmatory of Koch’s statementas to the destructive action of putrefaction upon the commabacilli; and the less need for vain attempts at disinfectinglatrines with the view of destroying the cholera virus. The

importance of disinfecting the excreta, for which a 5 percent. solution of carbolic acid is advised, and the need forobtaining pure supplies of water and food, are insisted on.The whole argument is summed up in conclusions which weregret not to be able to reproduce in detail. Suffice it toquote the following :-"17. The discovery of the comma bacillus is of the

greatest importance for diagnosing choleriform attacks ofdoubtful nature which are produced at the commencementof epidemics, and for the institution of prophylacticmeasures, the more efficacious because such early diagnosisenables them to be undertaken in time.

" 18. The application of bacterioscopic processes for thediagnosis of true cholera does not present any seriouspractical difficulties, and it would be extremely desirable,in view of the serious threats of an invasion of Belgium bycholera, that a sufficient number of medical men appointedto the sanitary service should be initiated therein with asbrief delay as possible."19. The knowledge of the biological properties of the

choleraic microbe, of its feeble resistance to desiccation, andof the absence of a stage of spore-formation, affords valuablefacts for prophylaxis. It places a limit on the excessive useof disinfection, and puts us in possession of the simplestand surest means of combating its effects."The monograph is furnished with several appendices, and

it is further admirably illustrated. Whatever be the finaloutcome of the question, this work of Dr. van Ermengen’swill rank as one of the most important contributions tothe history of the scientific investigation of the pathogenyof cholera.

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THE SANITARY CONFERENCE AT ROME.

SINCE our last notice of the proceedings of the Inter-national Sanitary Conference at Rome some substantial workhas been done by the Technical Commission, which is pre-paring a series of resolutions for submission to the entireConference, when this body, which includes the diplomaticrepresentatives, meets again. After voting that quarantine z’

measures by land were impracticable and hence useless, theCommission proceeded to discuss the question of maritimequarantine. The discussion on this point was maintainedat considerable length, the actual proposition before theCommission being one by Dr. Sternberg (United States ofAmerica), to the effect that an arbitrary time quarantine forvessels arriving from infected or suspected countries wasnot justifiable. During the course of the discussion, whichtook place on Monday, May 25th, Dr. Koch (Germany)suggested that a difference should be made between ordinarypassenger ships and vessels conveying either troops or

emigrants in large masses. Later on, the English and Indiandelegates, who were evidently in sympathy with the pro-position of Dr. Sternberg, were requested to explain thesystem which in England had superseded quarantine; andthe system of medical inspection coupled with the immediateisolation of the sick was then fully set out by Dr. ThorneThorne (Great Britain), who contended that his country was

the only one that had loyally carried out the full intentionsof the Vienna Conference of 1874 in this respect. Sir JosephFayrer (India) maintained that there was no proof that a.

vessel sailing from India had ever conveyed cholera into anyEuropean country. Dr. Rochard (France) held a differentopinion, but on being asked by the Indian delegates to namethe circumstances justifying this view, no answer was.

apparently forthcoming. Several delegates, such as the-Brazilian, felt that the subject required further elucidationand study.At the sitting of Wednesday, May 27th, Dr. Proust

(France), with a view of defining more precisely the pointsto be debated, submitted a scheme dealing first with the-measures of prevention at the ports of departure, then withthe sea passage, and lastly with the ports of arrival. Thisbeing unanimously accepted as the basis of discussion, Dr.Sternberg (United States) proposed that in all ports medicalofficers appointed by the consuls should have power to

inquire into the sanitary state of the port and shipping.Owing to the abstentions this was lost. Dr. da Silva diAmado (Portugal) proposed that, since the consuls had to-endorse the documents relating to the freedom from disease-in ports, they ought to be allowed to take part in the inspec-tion of the sanitary state of vessels leaving for the ports ofcountries they severally represented. The abstentions were-again numerous, but a small majority carried the proposition.Dr. Proust’s proposals were next considered. The firstrelated to measures of sanitation to be adopted at ports ofdeparture whenever cholera was prevalent. The lading of’vessels was only to be effected after cleansing, and, if needbe, disinfection of the holds, &c.; and the medical officer ofthe ship, who in the case of all infected ports was to beapproved and maintained by the Government, was, togetherwith the captain, to certify as to the proper sanitary state’of the vessel. Passengers were always to be examinedbefore embarking, and all sick of cholera or suspectedpersons were to be refused. Luggage, linen, &c., was to be,carefully looked after, and, if need be, disinfected, the-clothing of persons having suffered from cholera being-always disinfected. Any case of cholera occurring on boardduring the stay in the port was to be immediately removedto hospital, cleansing and disinfection of the ship, &c., tOofollow.On Friday, the 29th, a number of resolutions were passed

with reference to the action to be taken as to suspectedships during the sea passage. They related mainly tOomeasures of cleanliness, disinfection, and ventilation, andreceived an all but unanimous assent. These resolutions.were followed by others relating to ships actually sufferingfrom cholera during the passage, and they were in the mainsuch as have long been adopted in this country.At the sitting on Saturday, the 30th, a series of proposals,.

formulated by a subcommittee with reference to the passage-of vessels from the East to the Mediterranean by the Red Seaand the Suez Canal, were submitted for discussion. Theywere taken seriatim. The first related to a compulsorymedical inspection at Suez by an officer to be appointed bysome International Commission, and who would have autho-rity to decide if the vessel was to be regarded as "suspect"’or not. If not, it would at once pass the canal freely. TheBritish and Indian delegates opposed this. Sir Joseph Fayrerexplained that he and his colleagues were in no way opposedto inspection for the mere purpose of ascertaining the state-of health on board; but he refused to allow that any locallyappointed medical officer should supersede a British medicalofficer in deciding whether anyone on board an English shipwas suspected of having some choleraic affection or not.Sir G. Hunter demanded that British ships should, under allcircumstances, have free passage through the Suez Canal,provided they did not touch the shore. This was refused.Dr. Thorne maintained that the proposal of the subcommitteewas not one of inspection only, but that it was the first steptowards the imposition of quarantine, which England hadopposed, and which had been proved to be useless. The pro-posal was, however, carried by a large majority of delegates.Later on it was proposed that if the visiting medical officersuspected any case of cholera on board any ship, all pas-sengers and crew should be landed, and that the ship shouldbe detained for five days to see if any further cases occurred.Dr. Lewis at some length contended that the danger did notlie in shipping, and that although cholera always prevailedin India, a country with which Australia was in constantcommunication, yet that the disease had never been con-veyed to Australia. Other delegates demanded a much longer

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period than five days, the Spanish delegate insisting on atleast ten days after the last case had occurred amongstthose landed. Sir Joseph Fayrer once more offered all in-formation at Suez, so that local officials could report to theirrespective Governments, and Dr. Thorne maintained that ifvast masses of passengers and crews were landed in thehorrible lazarets of the Red Sea shore, disease would not bestayed, but spread ; also that we had no right to deposit inthe midst of Egyptian populations that which we feared toreceive on our own shores. The Conference had, however,decided in favour of the quarantine system, and the deten-tion of all passengers with suspected cases on board was,carried by a large majority. Some abstained from voting.

Several subcommittees are at work daily, as well as the’Technical Commission. The subcommittees are dealing with’disinfectants, regulations as to small vessels, pilgrimages, &c.On Wednesday, the 27th, his Majesty the King of Italy

.gave a State banquet to the members of the Conference.Before the banquet the presentations were made, and the3iing then conversed for some time with each of his guests.The diplomatic corps and the officers of the king’s house-hold attended the dinner.

POOR-LAW MANAGEMENT IN ST. PANCRAS.

MR. T. KccLESTO CriBB, who has just resigned the oihce-of clerk to the guardians of St. Pancras, has issued an in-teresting statement on Poor-law management in that parish- during the last five years. In this period much effort hasbeen made to prevent out-door relief becoming the means ofpauperising those who are in necessitous circumstances. In

the form of medical out-door relief State aid presents the first- opportunity for the poor to become dependent; it is, as

Mr. Gibb says, the first downward step in the career ofpauperism, and the need for intelligent relieving officers is’therefore urgent. During the last five years the amount

’expended upon out-door relief has been gradually reduced bymore than one-third. This reduction has been brought aboutby a rearrangement of the duties of relieving officers, givingbetter opportunity for a more thorough investigation intothe condition of those applying for assistance, by a recogni-tion of the principle that destitution and not simply povertyis the only claim to relief that the law recognises, andfurther, by offering to applicants admission into the work-Glouse, instead of granting a dole which is in practiceinsufficient for their maintenance. The effect has natu-rally been to increase the expense of in-door relief, butMr. Gibb tells us that scarcely one-fifth of the applicantsrfor relief who were offered an order for the workhouse ac-cepted it, the remainder, with few exceptions, having goneon without any relief at all. The extra cost has nottherefore been excessive, and in its effect upon the parishhas been distinctly beneficial, for while the cost of out-doorrelief falls upon the parish, that of in-door relief is partially.chargeable to the common poor fund. The same principlehas been adopted in the case of widows with children; itihas often been found sufficient to remove one or two of the- children to the schools at Leave<den to enable the motherto maintain the rest of her family; and this is obviously afar better course than the administration of out-door relief,which would educate all the children in the knowledge thatthey could always rely upon the same agency for assistancewhenever it was required. Here, again, the operation ofthe common poor fund is beneficial in encouraging theguardians to maintain children in suitable schools, for whilethe cost of maintenance under these circumstances, togetherwith a share in the salaries and other expenses, is charge-able upon the common fund, every child maintained inthe workhouse deprives the guardians not only of fivepenceiper day in respect of each child, but also the amount whichmight have been recovered had the place of the child in theworkhouse been occupied by an adult.

After referring to the savings thus effected, Mr. Gibb points- out how they have been lost by an increase of expenditure-over which the guardians have no control; thus, the sumpaid to the Metropolitan Asylums Board has during the lastfour years been at the rate of more than XIO,000 a year morethan in the previous four years; and the whole of this has:arisen through that Board receiving into its hospitals forinfectious disease persons who were not paupers. Again,

the care of lunatics has during the latter period entailed anincreased cost of over E2000 a year.

Mr. Gibb leaves his readers to draw their own conclusionsfrom his story. Upon the judicious administration of poorrelief depends whether the assistance given to necessitouspersons shall be beneficial or responsible for considerableharm. It is within the power of the ratepayers to electrepresentatives who will properly appreciate their duties inthis respect, or, as often in past times, to leave the control ofpoor relief in the hands of those who will receive in pay-ment of rent the sums which have been given to the poor.

IRISH MEDICAL ASSOCIATION.

Ti-iE annual meeting of this Association was held on thelst inst., the chair being occupied by the President, Dr.

Hemphill. The Council in their report referred to theMedical Act Amendment Bill, and to a revision of the lawrelating to superannuation of Poor-law medical officers,neither of which do they expect will come before Parliamentthis session. The question as to whether medical officers ofhealth are entitled to special remuneration for inspectinglabourers’ dwellings and reporting on their condition has,after a prolonged struggle and considerable expense, beenfinally settled in a satisfactory manner by the Court of Appeal.The report also referred to several cases in which prisonsurgeons were summoned from country districts to giveevidence before the Prisons Commission in Dublin, and werecompelled to pay the substitutes appointed to discharge theirduties during their absence, and this though in one instancethe judge of assizes ruled that the authorities, and not thesurgeon were liable. The report was adopted, also thefollowing resolutions :-"That the council be instructed afresh to continue to urge

the Government to adopt the amendments of the MedicalAct Amendment Bill approved of by this Association,including one securing uniformity of final examination fee,and that, in the event of such amendments as seem to themnecessary not being introduced into the future Bill, thesupport of this Association shall not be given to thatmeasure. That this Association, having observed withgreat regret that, in consequence of the persistentlycontinued opposition given to it by certain members forIrish constituencies, the Union Officers’ Superannuation Billhas not been pressed upon the attention of Parliament, againasserts its opinion that the Poor-law medical officer isentitled, in equity, to receive a pension, as a matter of right,whenever he shall be incapacitated from the discharge ofhis duty. This Association therefore earnestly urges theGovernment to exercise its influence to pass a measure sogenerally approved and admittedly so just in its principle;and furthermore desires that the council will continue touse its best endeavours to have such a measure promoted onevery opportune occasion. That this Association desiresto express its great gratification at the success of themeasures taken by the council in establishing in the lawcourts the right of medical officers of health to payment fortheir services under the Labourers (Ireland) Act, as well asin vindicating many other principles important to theprofession in Ireland."The members and several guests dined together in the

Albert Hall of the Royal College of Surgeons in Ireland,presided over by the President for the ensuing year, Dr.Edward Hamilton.

CHOLERA IN JAPAN.

T HE report of the director of the Central Sanitary Bureauof Japan upon the epidemic of cholera which occurred inthat country in 1879 has just been published. It con-tains a short history of the disease in Japan in that year,an account of the operations then carried out by the HomeDepartment in connexion therewith, and the imperialdecrees and Government notifications bearing on the samesubject. The disease first showed itself on March 14th, andthe last case occurred on December 7th; the first appear-ance of cholera in Japan having been in 1877. The totalnumber of persons attacked was 162,637; the deaths