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French speakers present on that occasion. The members ofthe French medical profession will find it difficult to com-prehend French as it is spoken in French Canada and theywill be less likely to understand English as spoken in
Massachusetts. The Boston organisers will, however, doubt-less make a point of calling upon Bostonians who knowFrench to help.The great secret of success in all these matters is to limit
the numbers. Such Congresses as those of Medicine or
Hygiene are actually menaced with extinction because theyare too numerously attended. It was said that, all told,some 7000 persons went to Madrid in 1903 for theInternational Congress of Medicine and there were only fourfirst-class hotels in the town. It was thought that byspecialising the congresses the number of members mightbe reduced, but to judge by the formidable lists publishedthere is some danger that an unmanageable crowd willassemble at Washington. Above all, a method must bedevised to reduce the number of native members, for, beingclose at hand, they can easily attend. It does not cost themas much time or money, so they come in great masses,though in spite of their numbers they can but represent onevoice in the congress-that is to say, only one nation amongthe many nations. Then it requires a very strong chairmanto prevent these numerous inhabitants of the country fromspeaking too often. The chairman has to insist that thosewho represent other nations shall have an equal hearing andthat other languages than that of the place where the congressmeets shall be heard just as readily ; indeed, if any preferenceis shown it must, of course, be to the guests. If this is notdone, and with a strong hand, an international congress willsoon degenerate into a national congress. Eminent men,some coming from great distances, have to give way tolocal nobodies and abandon the meetings, and the wholething ends in failure. This I have seen on more than oneoccasion, and this time it has occurred to me that, instead ofcriticising after the event, it might be more useful to pointout what are the difficulties while it is still time to takemeasures so that they may be overcome.
THE REVIVAL OF CHOLERA IN RUSSIA.
(FROM THE BRITISH DELEGATE ON THE CONSTANTINOPLEBOARD OF HEALTH.)
THERE has recently been a serious revival of cholera inRussia. Last year, it will be remembered, the diseasebecame epidemic in the valley of the Volga early in
July and thence spread very widely throughout Europeanand Asiatic Russia, causing a large total mortality,though with few exceptions not producing an alarmingepidemic in any particular town or district. The outbreakwas reported to have come to an end some time in Januarylast and for about six months the whole country appears tohave been free from cases of the disease. The presentrevival of cholera seems to have begun a little later than lastgear’s outbreak. Detailed information as to its origin is asyet wanting and there is some confusion in the returns bothas to dates and as to numbers of cases and deaths. Butinformation officially communicated to the Board of Healthat Constantinople indicates the course of the epidemic.On July 8th (21st) a labourer who had come from Baku
died in hospital at Astrakhan from true cholera ; on thesame date a local resident in Astrakhan also fell ill of thedisease. The subsequent returns have been rather confused ;from July 8th (21st) to 15th (28th) there were 15 cases
and 7 deaths. On the 19th (August lst) 4 new cases and 2deaths occurred ; on the 20th (August 2nd) there were? cases and 2 deaths ; and the totals from the beginning wereput at 42 cases and 19 deaths. On the 22nd and 23rd(August 4th and 5th) there were 8 fresh cases and 7 deaths,and on the 24th (August 6th) as many as 22 new cases with4 deaths. On the 25th (August 7th) a fatal case occurredin the roads on the Caspian Sea," presumably on a ship.
In the meantime the disease had been spreading in theAstrakhan government. 2 cases and 1 death occurred(date not stated) in the Tsarevo district, and one fatal caseon the island of Zaiatz. In the whole government 34 casesof cholera with 16 deaths occurred between July 8th (21st)and 19th (August 1st). On July 22nd and 23rd (August 4th
and 5th) there were 16 cases and 3 deaths ; on the 24th(August 6th) 10 cases and 5 deaths ; and the totals from thebeginning were put at 105 cases with 40 deaths. Anotherreturn stated that between July 20th and 25th (August 2ndand 7th) there were 92 cases and 38 deaths in this govern-ment. On July 27th (August 9th) there were 36 fresh caseshere with 26 deaths.The Saratof government lies immediately to the north of
that of Astrakhan. The town of Tsaritsyn seems to havebeen the first infected. On July llth and 12th (24th and25th) there were 11 cases of cholera here with 8 deaths,and on the first-named date 5 cases with 3 deaths wereremoved from boats arriving at Tsaritsyn (presumably fromAstrakhan). By July 13th (26th) there had been 25 cases and14 deaths. On the 18th (31st) there were 22 new cases and12 deaths ; on the 20th (August 2nd) 11 cases and 6 deaths ;and on the 21st (August 3rd) 17 cases with 10 deaths. Thetotals up to the last-named date were 113 cases and 55deaths. In addition, 4 cases with 2 deaths occurred in theTsaritsyn district before July 18th (31st) and 8 cases with3 deaths in the same district on the 22nd (August 4th).One case was seen in the Balashef district at some dateunnamed ; 1 fatal case was recorded in the village ofOtradui on July llth (24th) ; and in the town of Saratofthere were 2 cases on the 18th (31st). 3 cases were
removed from ships on the river on the same day; 3 morecases occurred on the 19th (August 1st); 4 cases with 1 deathon the 20th and 21st (August 2nd and 3rd) ; and 4 cases onthe 22nd (August 4th).
In the government of Saratof 88 cases with 44 deathswere registered from the beginning of the epidemic down toJuly 19th (August lst) and 152 cases with 74 deaths betweenthat date and the 24th (August 6th). On July 26th
(August 8th) there were 11 fresh cases and 15 deaths in thisgovernment and on the 27th (August 9th) 30 cases with15 deaths. Among these was a fatal case in the town ofKamyshin, on the borders of the Astrakhan and Saratof
governments.In the Samara government there were 2 suspected cases
and 1 death in the village of Balakou on July llth (24th).Between the 19th and 24th (August lst and 6th) there were4 cases with 3 deaths in the government. Some timebefore the 26th (August 8th) 3 suspected cases had beenseen in the faubourg of Pokrovski and the village of Rozno.In the Simbirskgovernment 1 case was removed to the SyzranHospital from a steamer coming from Astrakhan on July 18th(31st) and a supected case occurred in the town of Simbirsksome time before the 26th (August 8th). In the govern-ment of Kazan 2 suspected cholera cases had been recordedsome time before the last-named date. So far as is knownat present this is the most northerly.point that the epidemichas yet reached.Westward the infection has spread from Astrakhan to
Rostof and the Don Territory. In the prefecture of Rostof-on-Don 2 cases of the disease were seen on July 20th(August 2nd) ; on the 22nd (August 4th) 1 fatal case
occurred in Rostof itself ; on the 26th (August 8th) therewere 14 cases here with 8 deaths ; and on the 27th(August 9th) 7 cases with 2 deaths. In Nahitchevan, close.by, 1 case was reported on July 25th (August 7th). In theDon Cossack Territory there were 2 suspected cases on
July 22nd (August 4th) in the village of Kalatal ; betweenthe 22nd and 25th (August 4th and 7th) 14 cases and 10deaths were registered in the whole territory; and on the25th and 26th (August 7th and 8th) 2 cases with 3 deaths.On July 26th (August 8th) 2 cases of cholera were seen
at the station of Taganrog ; they had presumably brought theinfection from Rostof. At Novorossiisk, on the Black Seacoast, a suspected case was seen on August lst (14th) ; thediagnosis of cholera was subsequently confirmed but the
patient recovered. On August 4th (17th) 2 suspected caseswere observed at Ghelindjik, situated 40 kilometres fromNovorossiisk. Finally, a case of cholera was imported toBaku from Astrakhan on August 1st (14tb) and on the follow-ing day a fatal case occurred there in a local inhabitant ;and from Tiflis the Turkish Consul reports the occurrence onJuly 24th (August 6th) of a suspected case.
It will be seen from the above that information on thecourse of the outbreak is in many instances very incompleteand spasmodic. The totals for the whole country have beenstated to be as follows : between July 8th and 19th(July 21st and August lst) 98 cases and 47 deaths, and
766
between the last-named date and July 26th (August 8th)262 cases and 125 deaths. This would bring the totals fromthe beginning down to August 8th (New Style) to 360 caseswith 172 deaths. It is probable that these figures are some-what less than the actual numbers.
In consequence of this serious extension of cholera inSouthern Russia the Constantinople Board of Health has
imposed the following measures on arrivals from Russian
ports. Persons arriving from any port on the Black Sea andSea of Azof situated between Sulina (excluded) and Batum(included) will be subjected to a medical visit, and theeffects of third-class passengers and crews will be dis-infected. These measures will be applied "facultatively" "in the lazaret of Sinope or in that of Monastyr Aghzi (at themouth of the Bosphorus). Arrivals from Rostof, Taganrog,Novorossiisk, and Batum will be subject to five days’ quaran-tine and disinfection, to be applied in the Sinope lazaret ;passengers from these ports will further be liable to five
days’ surveillance in their place of destination. The impor-tation of the following objects from Russia to Turkey isprohibited: caviare, fish (fresh, smoked, or salted), soiledbody linen and clothes (imported as merchandise), beddingand furniture that have been used, rags, old papers and
journals, carpets and embroideries that have been in use, oldsacks and baskets, fresh animal products, hoofs, claws, horse-hair, down, raw silks and wool, raw hides, untanned skins,and fresh skins.
Pilgrim ships from any Russian ports in the Black Sea willbe subjected to five days’ quarantine, disinfection, and ratdestruction, to be applied in the Sinope lazaret ; the five
days will begin to count only from the moment when thedisinfection process is completed. Such ships will passthrough the Bosphorus and Dardanelles in quarantine ; theirpilgrims will not be allowed to land anywhere before reach-ing the Hedjaz ; they will go straight to the Abu-Saad lazaret,near Jeddah. The ships may, however, take in water, coals,provisions, and other pilgrims in the lazarets of MonastyrAghzi, Clazomene (Smyrna), and Beirut. Ships with morethan 1 per cent. of pilgrims on board (calculated on theirregistered tonnage) will be treated as pilgrim ships. Shipswith large numbers of emigrants or similar masses will besubject to the same measures as pilgrim ships in the Sinopelazaret. Finally, it may be noted that the AlexandriaQuarantine Board has prohibited pilgrims from Russia,Turkey, and the Balkan countries from landing in Egypt;they must pass the Suez Canal in quarantine. This decisionhas caused some dissatisfaction here, as Turkey and theBalkan countries are so far entirely free from cholera or
other disease.Constantinople, August 20th.
BIRMINGHAM.
(FROM OUR OWN CORRESPONDENT.)
The Universty and the Working Classes.THE University course of Social Study Lectures, which
was promoted in the interests of the working classes, hasproved so successful that an attempt is being made to
develop and to extend it and to establish a workers’ college.As a preliminary to a more ambitious attempt the Universityhas placed at the disposal of the Workers’ Education Asso-ciation a lecture-room, a reading-room, and a library. The
object is to popularise definite and serious study and to
encourage discussion and social intercourse. Any workingman or woman may become a member and it is hoped thateach student will pursue a systematic course of reading andwrite exercises or essays. The subjects proposed for thecoming term include economics, industrial conditions, lawfor social workers, British institutions, and sanitation andhygiene. The lectures upon sanitation and hygiene are tobe delivered by Dr. John Robertson and from a medicalpoint of view are of the greatest importance, for by theirmeans a knowledge of the essentials of healthy life maygradually be scattered amongst the people.
17te Ilcccltlt of tlae City.Dr. Robertson’s report upon the quarter ending June 27th
last repeats the tale with which we are getting so familiar-a low and decreasing death-rate and a still more rapidlyfalling birth-rate. The death-rate was 14 ’ 8 per 1000, that
being a record for the second quarter. The birth-rate was28 - 4 per 1000, which contrasts badly with the average of31 - 9 for the past ten years. Measles was decidedly lessprevalent than in the same quarter last year and was
responsible for only six deaths, whilst in 1907 it provedfatal in 155 cases. Whooping-cough, on the contrary, was.decidedly more prevalent and more fatal, resulting in 119deaths, as against 62 in the same quarter of the previous.year. The results as regards scarlet fever, enteric fever,and tubercle were not greatly different from those of thesame quarter of 1907, except that the enteric fever was ofa somewhat virulent type, but the number of cases of
diphtheria (161) was decidedly less than in the same period of1907, when 245 cases were notified.
West Bromrvich -District Hospital.The financial report presented at the annual meeting of
the governors of the West Bromwich District Hospital mustbe the cause of serious concern to all well-wishers of thehospital, for it reveals a deficiency account of £ 176fas contrasted with E1217 in the previous year. Somereference was made to abuse of the out-patient depart-ment, especially by people who claimed that they subscribedto the institution through the Hospital Saturday Fund, butthe matter was dropped when it was stated that a conferencewas to be held to deal with the whole question of the out-patient department.
Sept. lst. _________________ ’
MANCHESTER.
(FROM OUR OWN CORRESPONDENT.)
Ptomaine Puisoning.THE repeated occurrence of attacks of illness, often fatal,
from ptomaine poisoning after eating what has seemed to beperfectly wholesome food is a proof, if any were needed,that the subject is well deserving of the attention of thosespecially skilled in preventive medicine. At present thevictims are helpless. There was an inquest the other weekat Greenfield, near Saddlewortb, on a boy aged 13 years.He was a member of a band which was playing at a cricketmatch. During an interval he and a companion went toa shop and bought a pie which the two ate betweenthem. One died and the other was said to be in a dangerouscondition. The medical man in attendance, Mr. G. Stone-house, in giving evidence, said that others were sufferingfrom ptomaine poisoning and that all his patients had eatenpies made by the same firm. He considered this diseaseto be a bacterial infection and that bacteria were still alivein the boy’s body, because he was ’ breaking out inblotches." He believed the jelly in the pies was the peccantmatter and that the recent hot weather would favourbacterial growth and development, while the putrefactionwould not be perceptible to taste or smell. The maker ofthe pies deposed that they were made on the Thursday after-noon, that he and other employees partook of them, and thatnone of them were affected. "The pies were jellied afterbeing made, the jelly being made from bones and cowheels."It does not appear whether the pies were eaten by the makerand his workpeople before or after being ’’ jellied." Bones maybe fresh or otherwise and cowheels likewise, but the jury,after giving the verdict of ptomaine poisoning, added that noblame attached to the makers of the pies. A woman ate
part of a pie on August lst ; she was taken ill and diedafter a few days’ illness. Tinned salmon was the cause ofillness in a boy living near Burnley and possibly caused thedeath of his father, for after eating some of the salmon hewent to bed and was found dead the next day. At Hanleya verdict of ’’ Death from ptomaine poisoning from eatingpork " was returned on August 7th. A young man, aged 26years, was taken ill after eating a pork chop for his dinnerand died in hospital. Mr. J. M. Longford, in hisevidence, said that pork and shell-fish were peculiarlyliable to contain " ptomaine poison in hot weather." On
August 24th an inquest was held at Mossley on a case ofsuspected ptomaine poisoning. A woman about a fortnightbefore her death had some potted meat. She was seen somedays afterwards by Dr. A. W. Harrison who suspected poison-ing and said that the whole of the symptoms pointed tobacterial infection. He was of opinion that septic pneu-monia from which she died was caused by something that
