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the auspices of the Guild of St. Luke was held on Oct. 17th.The Bishop of Rochester preached the sermon and theLondon Gregorian Choral Association-the choir consistingof 300 voices-rendered the musical part of the service ina most impressive manner._

WE regret to learn that Professor A. W. Hughes of King’sCollege, chief superintendent of the Welsh Hospital, nowreturning home on board the Saxon, is suffering from anattack of enteric fever. He is reported to be progressingfavourably. -

ON the occasion of the Annual Public Night of theMedical Society of University College, London, held in theCollege on Wednesday evening last, an interesting addresswas given by Dr. Judson S. Bury on Bias in ClinicalMedicine.

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THE London County Council have issued a circular drawnup by Mr. James Cantlie upon the signs and symptoms ofplague for the use of metropolitan medical practitioners.We shall notice this circular at length next week.

A REUTER’S telegram of Oct. 9th from Brisbane statesthat a fresh case of plague has occurred there.

THE WAR IN SOUTH AFRICA.

WE are still compelled to speak of the war in South

Africa, although it cannot any longer be properly called so,for it has degenerated into a species of what was termedin the last Burmese war, dacoity. The remains of the

.dispersed Boer forces, aided and abetted by a friendly and-sympathetic Boer population, continue to make raids in

various directions, to wreck trains and interrupt communica-tions, and to do everything in their power to harass the

British forces. The extent of territory conquered and

occupied by the Queen’s troops, the nature of the country,the length of the railway and telegraphic communica-tions, and a disaffected population, all lend themselvesto operations of this irregular kind. The news duringthe past week is indicative of a recrudescence of.a feverish activity on the part of the enemy. LordRoberts has postponed his own departure and has delayedthat of some of the colonial troops until things shall haveassumed a more settled and satisfactory aspect. However

.annoying the present state of things may be it cannot besaid to have been unexpected, and the situation has to befaced and overcome. While enteric fever has become farless prevalent than it was there is still a good deal of

dysentery-happily of the mild catarrhal and more easilytreated form, as a rule-among the troops in the field. The

.army, as a whole, however, is healthy and in excellentspirits. Lord and Lady Roberts inspected the LangmanHospital at Pretoria on Oct. 19th. Transports with invalidsfrom the seat of war are frequently arriving in this country,.and, as a rule, the health of the sick and wounded has been.greatly benefited by the voyage.

the Boer prisoners at St. Helena are healthy. Very fewof them are in hospital at the present time. Among thedeaths that have recently occurred three have been fromtuberculosis.When the history of this war comes to be written the very

gallant and plucky defence made by a small force of colonial,troops shut up at Elands river camp, Brackfontein, will formone of its brightest pages. Not only is that the opinion,of those acquainted with all of the circumstances but thecorrectness of their judgment has been since ratified and.corroborated by Lord Roberts himself in highly appreciativeterms. A brief statement of the facts is well worthyof being put on record. The force, composed of Australiansand Rhodesians, consisted of 22 officers , and 480 menunder the command of Colonel Hore. They had withthem one small 7-pounder muzzle-loader gun (for which,.there were only 100 rounds of ammunition) and two Maxims

and a large quantity of provisions and stores. It appearsthat the small garrison held a smoking concert in camp onthe night of Aug. 3rd. Early on the following morning thetroops were awakened by the bursting of shells in their camp,which covered about Jour acres on a kopje, and they soonfound themselves in a very tight place as they were

surrounded by a Boer force estimated at 3000 underthe command of Delarey. The only medical officer

present with the besieged garrison was Captain Albert Duka,Army Medical Corps, Queensland Defence Force, who hadvolunteered and had been selected to accompany the Austra-lian contingent to the seat of war. We are indebted tohis father, Surgeon-Lieutenant-Colonel Duka, a retired officerof the Indian Medical Service, for the opportunity of readinga communication from his son written from Mafeking,whither he had proceeded after the relief of the besiegedgarrison at Elands river. We cannot do better thanadhere closely to the interesting description of the siegegiven in this communication. Captain Duka’s expe-rience of the war was probably unique. The shellingof the camp began on the morning of August 4th and wenton all day. There were 32 casualties, nearly all of which(26) were severe shell-wounds. He was told that there were1800’shells sent in on that day and 700 on the next ; then,either because the Boers were running short of ammunitionor because the fighting part of the garrison were disappear-ing underground, the Boer fire became less lively, althoughnot a single man could move across the square and show hishead across the breastwork without having a large number ofbullets fired at him. This sort of thing went on for 12 days,when Lord Kitchener arrived with his division. The Boersevidently knew that he was coming and they withdrew theirguns two days before, but kept the besieged quiet by sniping.Captain Duka adds that he had no one to assist him who hadhad any previous training. His hospital consisted of threeambulance wagons and a small four-feet high parapet formedof biscuit boxes round two sides of it. After the second dayof the siege, and when the men could be spared for the work,which was all done at night, this parapet was raised anothertwo feet and strengthened by earth and stones thrown up atthe back of the biscuit boxes. He had over 70 casualtiesaltogether, five men being wounded in hospital a second tmeby shells bursting inside it. All the wagons were muchknocked about, but Captain Duka fortunately escaped beinghurt and was able to carry on his work throughout. Therewere 73 killed and wounded (51 whites and 22 natives).The great majority, 65 per cent., of the woundswere from shells, and he performed three amputationsand had 48 other operations, such as the extractionof bullets, fragments of shell, &.c. It must have been verygratifying to this medical officer to find himself on the dayafter the relief of the garrison presented by the men withthe only new pipe in the camp with an inscription cut on thebowl of it and to have heard their cheers in token of theirsense of the work which he had done. Nearly all the horsesand cattle belonging to the force were killed during the siege.General Carrington, it will be remembered, had previouslyproceeded to the relief of the very hard-pressed garrisonbut had been unable to achieve his object. As indicativeof the topographical and other difficulties of the countryCaptain Duka remarks, ia propos of the attempts to surroundDe Wet: "In the country we are in it is no wonder thatthe generals cannot catch De Wet and others, as

there are any amount of parallel, or nearly parallel,valleys. One day a patrol of 70 men was out; theBoers knew where we were going and sent 200 men ofDelarey’s force with a quick-firing gun to catch us, but wecarne back by another road and although it was only twomiles off as the crow flies they either did not know we werepassing or could not get at us." It is not hard under suchconditions to realise the ease with which the Boers, whoknow every inch of the country, can elude us. Again,"The reason why convoys are lost is because too fewmen are in charge, or, as in our case, mountedtroops without guns are left to take care oflarge stores, and although they may manage to keepthe post and stores they become practically useless as

their horses are destroyed and their mobility lost." In thecase of the Elands river the difficulty of the defence, hadthe siege been prolonged, would have been want of water.There was an ample supply of stores with the force and itwas the anticipated capture of these no doubt that led tothe attack being made. The Boers never risk fighting in theopen if they can help it, but usually keep at a long distance

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(1500 yards) off, unless they can secure a strong kopje andwell protected position.

MALARIAL EPIDEMIOLOGY.

A FURTHER " Contribution to the Study of the Epidemio-logy of Malaria in the Light of Recent Views of its

Etiology," by Professor A. Celli, appears in the Supplementoal Polielinico, anno vi., No. 48. Researches have been

carried on not only on the estate of Carvelletta in the

Roman Campagna, but at various other stations in differentparts of the Italian peninsula-namely, at Trinitapoli in theprovince of Foggia, at Argenta near Ferrara, at Mantuain the Ospedal Maggiore of Milan, and at Cumignanoin the province of Cremona. Observations were alsomade in several localities in the province of Novara(Trecate, Cerano, Vercelli, Asigliano), and in the Alpinevalley of Sondrio. In this way Professor Celli was

enabled to control the facts elicited by a study of thestatistics and clinical reports of large hospitals, suchas those of Vercelli, Novara, Mantua, and Ferrara, byobservations in the Campagna and at the homes of thepatients themselves. He was thus able to study not onlythe mild cases which never find their way to a hospital, butalso those which are treated at home and those occurringamong persons who leave after the field work is over. Notewas taken of the following points. 1. The distribution ofthe malarial parasite in the peninsula exclusive of Latium.2. The occurrence of multiple infections and of relapses.3. The relations of the epidemic with mosquitoes, withagricultural life, and with the temperature.As regards the first of these, parasites of malignant forms

predominate in the provinces of Foggia and Salerno as they doin the Roman Campagna. Professor Celli was surprised to findthem also common in the valley of the Po where malaria ofthe summer-autumn type is distinguished by the peasantryas "August fever," although by medical men, includingeven Golgi, its existence there was not admitted. He wasstill more surprised to find a spot in the Alpine valley ofSondrio where at the middle of September all the fever caseswere of this grave type. The plain of the Adda in the LowerValtellina, at an elevation of from 400 to 700 metres, formerlyvery malarious, still has foci of disease-as, for instance, atPlatèda, near Sondrio, where there were bad autumn tertiansand where in a neighbouring marsh larvas of mosquitoes wereto be found. Although these grave tertian forms, with aclinical history similar to that which they present in theRoman Campagna, are common in the valley of the Po thecases, so numerous in Latium, of deadly pernicious malariaare rarely met with. The free use of quinine probablyexplains this scarcity of pernicious cases, although it has beenpowerless to diminish the zone of diffusion of malaria in

general.The occurrence of multiple infections-that is, of two or

three in the same individual-was observed very frequently.An interesting study, and one of great importance, is that ofrelapses. True relapses are to be distinguished from psendo-relapses where we have to deal not with a relapse proper butwith a fresh infection of a previously malarious patient. Thedistinction is not yet possible in the mild tertian, but in thequartan a diagnostic guide is afforded by the fact thatgametes are very abundant in the circulating blood of truerelapses, whereas they are absent or extremely scarce in thepseudo-relapses. In autumn tertian the differential diagnosisis still easier, the successive attacks of true relapsesgradually diminishing so much in force that the patientis able to walk about during their occurrence, whereasa new infection always prostrates, even when the patienthas previously suffered from malaria. In true relapsessemilunar bodies are present, while they are never foundin primary infections. It is interesting to note the courseof true relapses in the different types of fever and inthe various months of the epidemic year, which ProfessorCelli claims he has shown to extend from one summerto the next. When the fresh infections of autumn tertiancome to an end in October, as happened last year, they areat their maximum in August and September, gradually de-clining in number through June and July. The relapsesof quartan, on the contrary, gradually increase in fre-quency from October on into July and August, and thesummer-autumn tertian re-commences before the quartan,

which in Latium, as well as in northern and southernItaly, is the last to yield relapses and the last to beginthem. The mild tertians have their maximum of relapses inthe spring, as may be well seen in Lombardy, where theyprecede the development of grave tertians in June. Why theperiod for the relapses of summer tertian should not

correspond with the approach of its epidemic year, as is thecase with quartan and spring tertian, has not yet been madeclear. Long intervals may elapse between the relapses ofsummer tertian and of spring tertian Quartan is more

persistent and continuous in its relapses in spite of the useof quinine.As to the relation between mosquitoes and epidemics of

malaria, Professor Celli found anopheles wherever there wasfever. The commonest variety was the anopheles claviger, butin the neighbourhoods of Ferrara and Vercelli the anophelespictus and the anopheles pseudo-pictus were also abundant,and in the alpine zone the anopheles bifurcatus. The

presence of anopheles was, however, noted in localities whichwere perfectly healthy and at great altitudes where malariahad never been known. These insects may therefore be con-veyed with man and his belongings, hay, animals, vehicles,&c., far from genuine malarious centres and hence thegeographical distribution of anopheles cannot coincide withthe geographical chart of malaria. Consequently it cannotbe asserted absolutely that the anopheles is always and ofitself a sure indication of malaria. But wherever anophelesare present, and there are men with malarial gametes intheir blood whom they can bite, and where at the same timethe temperature is suitable for the development of theparasite in the mosquito’s bcdy, it may be confidently pre-dicted that an outbreak of malaria will occur. In thisrespect epidemiological studies confirm the experimentalobservations of Ross, Grassi, Bignami, and Bastianelli onthe multiplication in the middle intestine of the anophelesof the parasite of human malaria and on the negative r6leplayed by the culex in the propagation of this disease. Thecity of Mantua offers a typically demonstrative instance ofthis fact, its central part being infested by culex but quitefree from malaria, while in some quarters at. its peripherywhere there are innumerable anopheletes in the houses andlarvse of anopheles in the neighbouring lakes and ditches asevere epidemic of malaria has prevailed during the last two

years.It is interesting, Professor Celli remarks, to note the rela-

tion in various particulars between malaria and agriculture.Epidemics may arise in connexion with the cultivation notonly of the essentially malarial crops such as rice, but also.

, of crops in themselves dry and healthy, when these latter, demand the presence of work-people during the un-

, healthy months for the reaping and threshing of wheat,.the harvesting of maize, and the cultivation and in-

gathering of beetroot. Professor Celli distinguishes two

epidemic types. To the one, with its minimum number-of cases in June, belong the epidemics of Milan, Pavia,Crema, and Ferrara, and this type is, therefore, speciallyconnected with irrigation crops ; to the other, with itsminimum of cases in January and February, belong those

,

of Rome, Cagliari, Vercelli, and Mantua. In the firstcase the epidemic, mostly of mild tertian, commences in

June with the cleaning of the rice and reaches its height, during the reaping and threshing, when the "August, fevers" above mentioned are at their maximum. In the

second type the fevers are rare in June, more common inJuly, and reach their maximum in August after the thresh-ing season. When the summer is prolonged, and in thewarmer zones such as the Pontine Marshes, the harvesting ofmaize in September and October gives rise to a late epidemic.

The ever-extending cultivation of beetroot under very ineani-tary conditions will certainly augment the malaria epidemic.

The tanks for the maceration of textile plants (hemp andflax), with their collections of stagnant or nearly stagnantwater, by favouring the development of mosquitoes likewisefavour that of malaria. The process of maceration itself,regarded as so dangerous that special sanitary regulations

are in force regarding it, has, Professor Celli believes, a

contrary effect by destroying or retarding the growth ofi arvs.

Finally, with regard to the relation between the atmo-. spheric temperature and epidemics of malaria, Professor

Celli says that it would appear that the latter must be

preceded and accompanied by a temperature of about 25° C.(77° F.) but on this point he reserves any definite opinion forthe present.