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Towards the end of the same month the ss. Dumrcc arrived at 1Bushire (on the Persian shore) from Basra; during the i

voyage three deaths from suspected plague occurred on tboard and another case (a sailor) was landed in the Bushire tlazaret. This was a case of pneumonic plague, and the Ediagnosis is said to have been confirmed bacteriologically. At spresent only telegraphic information in regard to these occur- irences has been received here. (

,

Cholera in Rll8Sia. jThe records of the cholera epidemic in St. Petersburg were i

brought down in my last letter to the week ending March 21st r(April 3rd). Since then the returns have been as follows :— .

1

Cases. Deaths. (Between March 21st (April 3rd) and March 28th (April 10th) 13 ... 2

" 29th ( llth) , April 4th ( 17th) 29 ... 3’

" April 5th ( 18th) " llth ( 24the) 19 ... 1

" 12th ( 25the) " 18th (May lst) 8 ... 2

" 19th (May 2nd) " " 25th ( 8th) 12 ... 6

" 26th ( 9th) May 2nd ( " 15th) 10 ... 2

" May 3rd ( 16th) " " 9th ( 22nd) 4 ... 1

Finally, on May 14th (27th), no fresh cases having occurredin St. Petersburg, the Russian authorities declared the citymerely" threatened " instead of ’’ I infected " with cholera. Itshould be added that all the cases and deaths mentionedabove were confined to the capital. The following revisedfigures have now been issued by the Russian authorities forthe weekly records of the epidemic in St. Petersburg sinceits beginning in August last ; the figures do not in allinstances quite agree with those published week by week :-Week ending Cases. Deaths. Week ending Cases. Deaths.

August 30th...... 197 ... 53 Jan. 10th ...... 273 ... 114

’Sept. 6th ...... 1805 ... 567 " 17th...... 193 ... 52

13th ...... 2568 ... 1113 " 24th ...... 160 ... 42

" 20th ...... 1535 ... 703 " 31st...... 141 ... 40

" 27th ...... 794 ... 381 Feb. 7th ...... 109 ... 39Oct. 4th ...... 418 ... 193 14th ...... 88 ... 25

llth ...... 257 ... 111 21st ...... 68 ... 27

18th ...... 126 ... 71 " 28th ...... 46 ... 11

" 25th ...... 103 ... 44 March 7th ...... 42 ... 6

Nov. 1st......... 105 ... 34 ,. 14th ...... 25 ... 5

, " 8th ...... 70 ... 26 " 21st...... 10 ... 3"

15th ...... 112 ... 32 " 28th ...... 13 ... 2

22nd ...... 154 ... 45 April 4th ...... 29 ... 3

: 29th ...... 171 ... 66 llth ...... 19 ... 1

Dec. 6th ...... 120 ... 40 " 18th ...... 8 ... 2

13th ...... 107 ... 38 25th ...... 12 ... 6

20th ...... 121 ... 36 May 2nd ...... 10 ... 2

27th ...... 96 ... 40 " 9th ...... 4 ... 1Jan. 3rd ...... 178 ... 46

The total number of cases recorded in St. Petersburg has,therefore, been 10,287, and that of deaths 4020. The datesin the above table are all according to the Old Style.

In the letter already referred to, I drew attention to thequestion of the water-supply and drainage of the Russiancapital ; both these questions are now being seriously takenin hand by the Russian Government. A special Commissionhas been appointed by the Minister of the Interior to inquireinto, and to report upon, the whole matter. The terms ofreference to the Commission include five main headings ;these are (briefly put) as follows : (a) system of sewers anddisposal of dry refuse ; (b) house drainage ; (e) the water-supply of the city ; (d) the financial aspects of the new

schemes ; and (e) laws and by-laws respecting drainage andwater-supply.

Plag7le and the Tarabagan Disease. "

It has been known for many years past that in EasternSiberia and Mongolia the marmot, or "tarabagan," suffersfrequently from a fatal disease, which may be transmitted toman and produce in him symptoms indistinguishable fromthose of bubonic or pneumonic plague. From time totime I have published in THE LANCET abstracts of the

principal communications to Russian medical journals on thissubject, and have pointed out that, while clinically the6 ° tarrbayccn, disease" in man closely resembles plague,bacteriological proof that the two diseases are identical hashitherto been wanting. An article by Dr. B. A. Barykin,2dealing with this particular aspect of the question, is there-fore of special interest. Dr. Barykin in the autumn of 1906and that of 1907 made expeditions to certain districts

2 Russkii Vratch, April 18th, 1909.

known to be infected with the tarabagan disease." " He

records the following facts (the details closely resemblethose of outbreaks previously reported). From the springto the autumn of 1906 there was a high mortalityamong the marmots round the settlement of Abogaitui,situated 30 versts from the station of "Manchuria." Theinhabitants were fully aware of the danger and avoided allcontact with the sick animals-with one exception. Thiswas a Cossack, who was in indifferent health and particularlyfancied the delicate flesh of the tarabagan. On Sept. 23rdhe fell ill with the symptoms of plague and died on the 27th.The disease spread from him to others; in the end eightpersons fell ill and all died; in all the symptoms were thoseof pneumonic plague. Necropsies were made in two cases ;the organs were found to contain bacilli indistinguishablefrom those of plague ; mice were injected with juice from thespleen of one, and died in 26 hours with all the appearancesof having died from injections of Yersin’s plague bacillus.

In the autumn of 1907 a large number of marmots werekilled or caught by Dr. Barykin’s party, and examined forthe presence of disease. In one of these animals, whichshowed no external sign of being ill save a certaindegree of general malnutrition, the spleen was found to beswollen and congested, and it contained large numbers ofbacilli which presented all the morphological and culturalcharacteristics of plague bacilli. Later preparations ofthese organisms were shown to Professor Zabolotny and Pro-fessor Savtchenko, both of whom regarded them as in all

probability true plague bacilli. A fortnight after the discoveryof this infected animal the following incidents occurred in adistrict some 20 or 30 versts away. A Cossack family hadsettled in a lonely and isolated spot where marmotsabounded. The men amused themselves with hunting themarmots, and one day killed one that showed clear signsof illness. In spite of warnings from the older men theyskinned the animal ; the body was recognised as unfit forfood and was given to a girl, aged 13 years, to take back to thefields and throw away. This girl dragged the body (weighingabout 15 pounds, it is said) after her through the grass, andreturned to the settlement along the same path. She was bare-footed. On the next day she fell ill, a bubo appeared in the leftgroin, and there were all the symptoms of an attack of plague ;she died some days later. From the bubo, from a pustule onone finger, and from the spleen bacilli indistinguishable fromthose of plague were isolated ; injected into mice they causeddeath in 18 hours, with symptoms of septicaemia. It was

impossible to examine the body or skin of the animal. Themen appear to have escaped infection. In the same autumna guard at the station of Khara-Nor, and a Cossack woman atthat of Sharasun both died from a disease resembling bubonicplague; the former had hunted marmots, the latter hadskinned the dead animals. Sick marmots had been seen inthe neighbourhood in both instances. In the case of the

guard the organs were found to contain bacilli which micro-scopically were identical with those of plague. As a resultof inquiries elsewhere it was ascertained that in the districtround one station only-that of Tsagan-Oluevsk-ten out-breaks of this plague-like disease in man had occurred in thepreceding nine years. None of them were very severe, andthe people themselves took precautions to prevent its spread.

Constantinople, June 10th.

THE SCHEME FOR ENGLISH AIDTOWARDS MEDICAL EDUCATION

IN CHINA.(FROM OUR SPECIAL CORRESPONDENT.)

THE reports having arrived of the meeting in the MansionHouse of the China Emergency Committee, to which SirRobert Hart lent his aid, it might be advisable to commenton the scheme from the local point of view. Those of uswho are on the spot and are interested in the cause ofmedical education on Western lines among the Chinese, findour chief difficulty lies in the stolid indifference of the

people and the greater part of the official class (roughlyabout eight-tenths of the latter) to the benefits of modernmedicine and surgery. The foreign hospitals find most oftheir work lies in the treatment of surgical ailments. Amongthe better classes medical treatment is comparatively rarely

1865

sought, and it must be admitted that the empiric methods ofthe native doctors are often successful in the end. Anofficial once told me that his chief objection to foreigndoctors lay in the fact that their dietetic ideas were so totallydifferent from what he had been all his life accustomed to,and that he found the regimen of milk, eggs, and cod-liveroil, which he had been ordered, nauseated him. At the TungWa Hospital at Hong-Kong (under Government auspices),where the patient has the option of choosing whether hewill be treated on foreign or native lines, it has beenfound that, according to the returns, of 2687 whowere treated in one year, 1422 elected to place themselvesunder foreign treatment, while 1265 chose the Chinesemethods. There was a total of 884 deaths, of which 400occurred under European treatment and 484 on the nativeside, but the figures lead to no deductions worth anything.The public mortality in China is far too high for us to

stand idly aside and not use every endeavour to impart thebenefits which we know Western science can bring, and theall-important consideration is as to how best to do this.And there can be little doubt that the main item must bethe supply of teachers to MfJisting instit7dions-men whocan face the task of studying the language and of gettinga sufficient grasp of it to talk fluently and come into

personal contact with their students. A point of difficulty isthat foreign education in China is in the hands of medicalmissionaries, and there are many better-class Chinese whofight shy of sending their sons to religious institutions.The native medical "profession " is not greatly respected-long ages of charlatanism have relegated it to a placeanalogous to that occupied in England in the timeof the barber-surgeons, and it is not looked upon as

an honourable calling to any extent. But China is

changing rapidly; a few years ago a military career

was looked down upon by civilian officials, whereasat present cadets are being sent from good families tobecome army officers. There is therefore no reason whya number of good examples of native scientific medical menshould not open the eyes of the officials and people to theadvantages obtainable. The Oriental makes a first-classstudent; he is logical, persevering, intelligent, and memoriseswell. Practical anatomy is not as yet legal in China, butteaching from models has, so far, been found satisfactory.A number of students, taught by Dr. W. W. Myers of Formosa,were recently sent from there to Shanghai to be examined.As there happened to be material available for dissection inthe public mortuary, they were examined on it, and althoughit was the first acquaintance they had had with human dis-sections they all passed the tests most satisfactorily.The biggest foreign medical college is at Peking. There

are also medical schools at Tientsin, Hankow, Hangchow,and Shanghai, but they are scarcely able to take studentsthrough a whole course by reason of their limited staff, who,in addition to teaching, have their hospital and missionaryduties to attend to. It would therefore be advisablefor the China Emergency Committee to obtain particularsfrom already established colleges as to what subjects aremost urgently in need of lecturers, and having found these,to concentrate its efforts in obtaining professional menwilling to sign an agreement for a sufficiently long time torepay their enforced language study period of at least oneyear after arrival. An experience of a few years in theseinstitutions will be all to the good when the time comes forexpansion in opening medical colleges in which, as far asthe Chinese are concerned, there is no religious influence.In Peking, at any rate, the medical teaching missionarieshave been broad-minded enough to forego the impositionof any religious tests on their students. Medical educationis not a thing of creeds and sects, and while China is underan incalculable debt to missionary enterprise, there is roomfor the establishment of medical science among a largeclass who refrain from sending their sons to missionaryschools. The past year has seen the establishment in

Shanghai of a German medical college in which the in-struction is given in German. It is well supported fromthe Fatherland and is in possession of a splendid equip-ment. Certain instrument-makers have sent out a com-

plete supply of surgical instruments, two firms have eachpresented Roentgen-ray apparatus, while some booksellershave supplied a splendid library of up-to-date Germanmedical literature, and a plentiful supply of drugs has beengiven by a number of drug firms to the pharmacy. The

teaching staff has been formed of men specially sent out whostand high in the profession in Germany and are alreadymaking their school one of the best in the Far East. Inthis practical way are our Teutonic neighbours going ahead.Every student who will pass through that school is a

Germanophile and will use German instruments and be aprescriber of German drugs, which are being imported inannually increasing quantity.We should get rid of the idea that China is calling with

outstretched hands for our philanthropic charity. Such isnot the case. Whenever China can oust the foreigner fromher schools she will do so ; she intends to follow in Japan’sfootsteps in this respect as soon as she conveniently can.During the past year she has dismissed the internationalforeign staff of the Peking Imperial University, even theJapanese professors have been sent back. As far as medicine-is concerned the more enlightened officials recognise theyhave much to learn. It therefore behoves us to make use ofthe present opportunity for the people’s sake to put her inpossession of a body of well-trained Chinese medical menwho will be the educators of her future students on soundlines-a question of the next ten years if one might hazard aguess from experiences of similar educational movements.May 13th.

______________

NEWCASTLE-UPON-TYNE.(FROM OUR OWN CORRESPONDENT.)

Health of Nerceccstle.Dr. H. E. Armstrong, medical officer of health of New-

castle, in his thirty-sixth annual report, states that the death-rate from all causes during the year was 17’3 per 1000population, the lowest but one on record. The death-ratefrom the seven chief zymotic diseases-i.e., small-pox,measles, scarlet fever, diphtheria and membranous croup,whooping-cough, fever, and diarrhoea-was 1.32 per 1000population, against a corresponding rate of l’ 58 for the 76largest English towns.

Vaccination -Fees in Nemeastle-7lpon- Tyne.The question of the fees to be paid in respect of vaccina-

tions to the officer of one of the districts in the city is stillbeing actively discussed. It may be remembered that, asnoted in these columns, the guardians recently decided by asomewhat narrow majority to retain the old scale of paymentof 4s. 6d. per case to the officer to be appointed to a vacantdistrict, rejecting the recommendation of their finance com-mittee that the fee be reduced to 2s. 6d. The matter hasnow been taken up by the ratepayers’ association, and at ameeting of this body last week a resolution was passed pro-testing against the action of the guardians in fixing the feeat 4s. 6d. Copies of this resolution are to be sent to theLocal Government Board, the district Government auditor,and to the board of guardians. A deputation was furtherappointed to wait upon the guardians in the matter.

Opening of a Sanatorium at Oheste’J’-le-St’J’eet.A couple of years ago the Chester-le-Street local authorities

were compelled by the Local Government Board and thecounty council to build a hospital for the treatment of small-pox. A building was therefore erected at a cost of 2500.Small-pox having been banished from the district it occurredto the local authorities that inasmuch as the building hadnever been once used for that purpose for which it was origin-ally intended it might be utilised in another way. The

building, after some alterations and a further outlay of somefive or six hundred pounds, has now been formally opened asa sanatorium for the treatment of consumption, 26 beds beingavailable. The need for such an institution being great inthe district the township is to be congratulated on its effortsin this direction.

lnter-ii,iziversity St7ldents’ Congress at D?trka7it.About 50 delegates from the various universities will be

present at this Congress, which will commence on June 29thand continue until July 3rd. In supplement of the businesssessions to be held a considerable programme of social

arrangements has been made, amongst these being a recep-tion at the College of Medicine on July 1st at the invitationof the President and Council of the College. In connexionwith the Congress, some inter-university sports will be held inthe College of Medicine athletic grounds in Newcastle.June 21st.