1535

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 (épiciers) 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.

1536

If there is one thing which this war has brought outmore strongly than another it is not only the bravery andgallantry of our troops (regular, colonial, and volunteer

alike), but the heroism, coolness, and fearlessness of ourmedical officers and their resourcefulness. It stands to reasonthat they may not all be equally able, but whatever be theindividual differences-and such differences there must be-they seem to be all very much alike in respect of courage ;they are keen to seize any opportunity, regardless of conse-quences, to render the promptest possible aid to the woundedduring an engagement. There are other qualities, however,required on field service besides courage and the medicalservice has not been lacking, we are proud to say, inthe display of these. The Times correspondent, writing aboutthe investment of the camp at Wepener, called attention tothe resourcefulness and zeal of the medical staff. The chiefmedical officer, Surgeon-Major Faskally, was ill-suppliedwith medical stores, but he and his officers, ’’ Surgeon-Oaptains Hudson, Pierce, Grey, Perkins, and Carter, workedlike Trojans, obtained all available medical stores, re-

quisitioned a large house of Mr. J. Robertson, and speedilyfitted it up as a hospital." It would be impossible, thecorrespondent adds, to do adequate justice to their work.With few appliances, almost an entire lack of hospitalequipment, a very small stock of necessaries, and even ofmedical comforts, a house as a hospital situated in a mostdangerous position, with wounded men on the floors, in thepassages, on verandahs, and in tents, and with but a smallstaff of attendants and cooks, the wounded, well over 100in number, were treated with skill, tenderness, and con-sideration, were well fed and nursed, and in some wonder-ful cases were kept alive. One case, though not quite uniquein the history of this war, deserves notice, that of a manwho was shot with a Mauser bullet through the forehead,the bullet having emerged in the middle line behind the head.After eight days the man was not only sensible but im-proving in strength daily and promised a speedy recovery.When speaking of the courage and gallantry displayed by

the troops and medical officers in South Africa we must notforget to mention the fearless devotion of the Indian andnative dhoolie bearers. The services rendered by these mendo not stand out prominently in the public eye, but, for allthat, they are deserving of the highest commendation and weearnestly trust that when they return to India they willbe well, nay handsomely, rewarded by something more

tangible than praise, for they richly deserve i . ::..... ,-

There was a big gathering at the Royal Medical andChirurgical Society on Tuesday evening last to listen toaddresses by Mr. Clinton Dent and Sir William Mac Cormacdealing with their surgical and other experiences inSouth Africa. It is needless to say that the pro-ceedings excited great interest and that what was said waswell received and listened to with great attention. Mr.Dent’s paper not only went into a number of practical detailsof an instructive nature, but was accompanied by an interest-ing summary of suggestive observations and comments. SirWilliam MacCormac’s presence excited some well-meritedexpressions of enthusiasm. His excellent and practicaladdress is published at length in the present number ofTHE LANCET.

____

THE IMPERIAL YEOMANRY HOSPITAL.

BY ALFRED D. FRIPP, M.S., F.R.C.S.

We have now settled down to routine work and becausewe are very busy time flies with wonderful rapidity. Ourlast medical officer, Barklay Black, who joins us from NewZealand, has arrived since I wrote my previous letter. The

strength of our medical staff is therefore now 19, includingColonel A. T. Sloggett, R.A.M.C., but as three of thestaff are specialists-namely, Mr. J. F. Hall-Edwards (whois in charge of the x rays), Mr. L. V. Cargill (theophthalmologist), and Mr. F. Newland-Pedley (the dentalsurgeon), and as Colonel Sloggett’s time is entirelytaken up by army matters, it leaves us only 15 effectivemedical officers, which is five below the strength of an

ordinary military base hospital. It is true that we have 10senior medical students, but on the other hand we have aconsiderable deficiency of orderlies as compared with the

military hospitals-a deficiency which is not made up forby our 20 extra nurses. Our 520 beds are now open, butit will not be long before we shall have to increase thisaccommodation to 750 or more, and that number of beds

will tax considerably the capabilities of our comparativelysmall staff.Daring the past week we have had many operations for the

removal of bullets in various parts of the body and theoperating theatre is completely satisfactory. This climateseems to suit the patients admirably and they mostly do verywell. We make a point of having open-air smokingconcerts as often as possible for they are very muchappreciated by all. The large contingent of Guy’s men arevery active at them and some are good performers. There is-a little music with piano practice every night at the officers’mess.

H.R.H. the Prince of Wales’s flags arrived a fortnightago, but we have only just succeeded in getting polessufficiently high to display them properly. They are-

an attractive combination of his Royal Highness’s racing,colours with a red cross in the centre on a white groundand, together with the flags of the Red Cross Societywith an all white ground, which fly from other parts of thehospital, make our decorations effective.

Douché, the French cook who came out to look after the-culinary needs of the patients, evolves the most excellentsoups, stews, and puddings out of very unpromising materials.It is perfectly extraordinary the amount of food those whoare not on special diets get through in this climate. All ourkitchen equipment has not yet arrived, and our admirable-cook still has to do his work among the karoo bushes andboulders for the permanent kitchen is at-present occupied bybeds. However, nothing daunts him and he emergessmiling from thunderstorms and does not seem to mindhaving to make his soups and so on in galvanised zinc baths.We cannot get any beer from the Army Medical Service

Corps now, for their entire attention is devoted to the re-victualling of Bloemfontein, so that the generous supplies ofwines and spirits sent to us by Gilbey and Co. are ingreat demand by the many patients who need a littlestimulant after their deprivations at the front. It is verystriking how delighted all the patients, officers and menalike, are to find themselves once more able to get sweets.We are able to give them jam very liberally and they con-sume enormous quantities of sugar; and any little extrassuch as lollipops, chocolates especially, are run after by these-stern and tired warriors almost as if they were little children.I wish some of our friends would send us out supplies ofsweets of all kinds, but especially chocolate. Some of themen would rather have a tin of chocolate than tobacco,although delighted with the latter. One of our difficulties isthat coal is very expensive and oil is very difficult to get.The laundry is at last in full working order. Miss Cheesemanand four of her ward maids do the lighter work, the heavierbeing done by the blacks and the machinery being managedby two men who came out for that purpose. The laundrywork is very heavy, especially as great care has to be takenin the disinfection of all linen from the enteric fever huts.We have been rather bothered of late by petty looting on.

the part of some of the blacks employed in our service, but,I anticipate it will not be difficult to stamp it out. Amongother things three rifles were found the other day in theircamping ground some quarter of a mile from our huts buried’beneath their fireplaces, which seems to be the site theygenerally choose for concealing stolen goods.We are all thoroughly devoted to this site which seems-

to us a most suitable place. So many of the hospitalsnearer the seat of war contain such a large number ofenteric fever and other medical cases that the surgicalones are sent as soon as possible to the various hospitals.south of the Orange river. We therefore get a consider-able proportion of surgical cases. We are fortunate in.

having an excellent water-supply and in not having largebodies of troops near us, for we are 27 miles south of thedepôt at De Aar, to which place we are sufficiently near tocollect the cases from the western border as well as from the:line of Lord Roberts’s advance. Surgeon-General W. D.Wilson, P. M.O., paid us a visit, and I am glad to say expressedhimself as completely satisfied with the Imperial Yeomanryhospital. I wish he could tell us some reliable method ofseeping the flies under, for they are a terrible nuisance. Weiave been fortunate in the fact of our Ladies’ Committee inLondon with their business advisers, General Eaton and Mr.Oliver Williams, having thought of almost everything thatvould be necessary to our wants. There is now hardly any-,hing needful in connexion with our work which we do not)ossess.

The detachment of men from the St. John Ambulance

1537

Brigade and from the London Fire Brigade have workedmagnificently. They have, indeed, had much to do, but I

hope that now that the hospital is approaching completionthey will have an easier time. The nurses and sisters, too,will find thtir work run more smoothly. I think by June lst-that is to say, exactly six months after the letter to theTimes from Lady Georgiana Curzon and Lady Chesham-thehospital will be in complete working order.The large supply of spiritine sent by Sir James Blyth

and the ingenious little frames for holding the kettlethat came with it have been most useful. Thewine, too, that he and his brother kindly sent and thetobacco forwarded by Messrs. Wills have all been mostwelcome. I wish these gentlemen could see the pleasuretheir kindliness has caused. Most of the packages of

pyjamas, socks, caps and so on are found to contain verywelcome additions of scent, tobacco, pipes, toothbrushes, &c.We are also very thankful to Messrs. Down Bros., who gaveus our aseptic metal furniture for our operating theatre andto the many firms dealing in medical and surgical stores andapparatus who contributed valuable gifts.Deelfontein, April 3Cth.

THE ROYAL COLLEGE OF PHYSICIANSOF LONDON.

AN extraordinary meeting of the Comitia was held on

May 17th, Dr. W. S. CHURCH, the President, being in thechair.The following gentlemen were admitted as Fellows: Dr.

Robert Bridges, Dr. Frederick Foord Caiger, Dr. HenryAlbert Caley, Dr. Clement Dukes, Dr. Herbert MorleyFletcher, Dr. Leonard George Guthrie, Dr. Charles MontaguHai2dfield. Jones, Dr. Henry Head, Dr. Amand JulesMcConnel Routh, Dr. Seymour Taylor, and Dr. RichardThomas Williamson.A communication was received from the President of the

Tenth International Congress on Hygiene and Demographyto be held in Paris from August 10th to 17th next, invitingthe College to send a representative. The PRESIDENTnominated Professor W. Corfield, who is acting as Presidentof the English Committee in connexion with the Congress.The REGISTRAR (Dr. E. Liveing) moved that By-laws LXV.

B. and XXIX. B., for the Election of Representatives of theCollege in the Senate of the University of London, be enactedfor the second time.-The SENIOR CENSOR (Dr. Pye-Smith)seconded the motion, which was adopted 1The REGISTRAR also moved the amendment of certain

other by-laws necessitated by the alteration of the by-lawsreferred to above.-This was seconded by the SENIORCENSOR and adopted.A report was received from the Committee of Management

on three subjects :-1. The Report of the Public Health Com-mittee of the General Medical Council detailing certainrecommendations in reference to the regulations for diplomasin public health. 2. Recommending that the followinginstitutions, all of which have been visited by a member ofthe committee and reported on as fulfilling entirely the

requirements of the Board, be added to the list of institu-tions recognised by the Examining Board of England :Berkhamstead School; Stonyhurst College, Blackburn ;Central Higher Grade Board School, Bolton ; and MerchantTaylors’ School, London. 3. Recommending that the Uni-versity of Manitoba be added to the list of recogniseduniversities at which candidates may complete the curriculumof professional study for the examinations of the Board andwhere graduates may be exempted from the first and secondexaminations of the Board.

Dr. NORMAN MOORE explained the details of the report,which was adopted.The PRESIDENT then dissolved the Comitia.

ASYLUM REPORTS.

Derby Borough Asylum (Annual Report for 1899).-Theaverage number of patients resident during the year was 322,and comprised 154 males and 168 females. During the year98 patients were admitted-viz., 49 males and 49 females,

1 These By-laws were published in the report of the Comitia held onApril 9th, THE LANCET, April 21st, 1900, p. 1161.

and of these 41 of each were first admissions. Dr. S.Rutherford Macphail, the medical superintendent, states inhis report that this is the largest annual number of patientsadmitted during the last 11 years, the average annualadmission of rate-supported patients since the openingof the asylum having been 72. Only three private patientswere admitted, and nine were out-borough patients receivedunder contract from Middlesex County Asylum. "Eightmen and eight women had formerly been under treatmentin this asylum. 12 of the 16 cases were relapses afterprevious recovery....... The mean age of the patientsadmitted was 40 6 years ; the youngest was eight years, theoldest 87 years. We have never admitted so many hopelesscases as regards the prospect of mental recovery. In only 42of the 98 cases could the disease be looked upon as curable,so that recovery could be reasonably hoped for." The admis-sions included 11 general paralytics, six epileptics, four con-genital imbeciles, five patients over 70 years of age, 11 chroniccases insane for years, and four cases dying from advancedmalignant disease. In 58 cases suicidal tendencies were

present and five of them required surgical treatment for self-inflicted injury before admission. Two patients were admittedwith broken ribs. ’’The general health of the patientsadmitted was as unsatisfactory as usual. Over two-thirds ofthe cases suffered from recognisable physical disease andonly 12 were in average bodily health. Five patients wereadmitted in a moribund condition and died within 10 days."One feature of the admissions was the large number of casesof general paralysis, the most fatal of grava brain diseases.The number of cases in which alcoholic excess was

assigned as the cause was less than usual. "The number ofinstances in which influenza preceded the illness increaseseach year." The existence of an insane heredity was ascer-tained in 33 cases and it may be taken as certain that itexisted in many more. Six cases of puerperal insanity wereadmitted as compared with a total of 18 cases admitted inthe previous 10 years. During the year 32 patients were discharged as recovered, or 9-9 per cent. of the average numberresident. " This is with one exception the lowest recoveryrate in the history of the asylum and is entirely due to the-hopeless character in regard to prospect of recovery of the.majority of the admissions....... One-half of the recoveries.obtained was among patients admitted in previous years-amost unusual occurrence." The number of deaths was 38,19 males and 19 females, being 11-8 per cent. of the averagenumber resident. Four deaths were due to senile decay, fiveto epilepsy, seven to gross organic cerebral disease (hæmor-rhage, softening, &c.) and nine to general paralysis. Onlyone death was due to tuberculosis.

Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Bournemouth Urban District.-Mr. Philip Nunn, themedical officer of health of this district, tells us in his currentannual report that the Bournemouth Council is applying forParliamentary powers to erect a crematorium in theBournemouth East Cemetery. Mr. Nunn thinks that a

provision of this nature will be "appreciated by the majority,of the residents as well as by numerous visitors." Wewonder whether those who appreciate the crematorium will;also set an example by making use of it.

Eastbourne Urban District.-In discussing the origin ofthe cases of enteric fever which were notified in Eastbourne.during 1899 Dr. W. G. Willoughby states that out of siximported cases two were of nurses from London hospitals.Of the local cases four, and probably seven, were traceable.to infected oysters, while direct infection was the cause inthe case of a nurse. He tells us, too, that one of the nursesat the sanatorium contracted the disease by direct infection,.an occurrence which, he adds, is not common. Certainlyout of the 22 cases notified in Eastbourne during Isst year aconsiderable proportion were nurses by occupation, and theexperience of the hospitals of the Metrop0li1 a’l AsylumsBoard tends to show that the staff engaged in nursing casesof enteric fever are not infrequently attacked by the disease.There is, indeed, much evidence tending towards the conclusion that the infectivity of enteric fever has been con-siderably underrated.