116 of orthopasdics and dermatology, from whom no contribu- President : Sir Thomas Barlow, Bart., K.C.V.O. Secretaries : tions have been received) towards meeting the expected Dr. Olive Riviere, 19, Queen Anne-street, W., and Mr. H. J. deficiency resulted in the collection of £646 Os. 6d. In Paterson, 9, Upper Wimpole-street, W. consequence, however, of editorial curtailment of some of the papers and discussions, and the unexpected receipt of a The following resolutions were passed by the sum of £347 Os. 7d. by sales of the Transactions (up to date), meeting arising out of the report:- the publishers’ provisional estimate proved to have been 1. That it be left to the officers of the Congress to decide excessive, with the result that the honorary treasurers found how the eventual balance from the general funds should be themselves with a balance of £337 19s. 8d. at the bank, as well disposed of. as with a credit balance with the publishers of .659 2s. 4d. 2. That the Royal Society of Medicine be asked to deposit Since the sum realised by the special appeal was subscribed the minute books and other records of the Congress in their for the exclusive object of completing the Transactions, the library. finance committee decided that the balance of the money should be returned to the respective donors in proportion to The meeting terminated with a brief speech from the amount subscribed, and this decision has been already the President, Sir THOMAS BARLOw, expressing the carried into effect. It may be noted that in spite of con- gratitude of all concerned in the working of the siderable curtailment the volumes of Transactions extend to Congress to the secretaries of the various sections, the formidable total of 12,498 pages. The finance com- and especially to the secretary-general, Sir Wilmot mittee wishes to draw special attention to the remarkable Herringham. ______promptitude and success with which this great undertaking has been carried out by the editorial secretaries of sections and the editorial committee, and also to the excellence with PUBLIC HEALTH ADMINISTRATION IN which the volumes, printed in three languages, have been produced, in a space of little more than six months, by the EGYPT DURING 1913. Oxford Press. Now that all expenditure has been met, a sum of Earl Kitchener, in his on the Adminis- L49 ls. 2d. lies in the hands of the treasurers, which may Report Finances, still be slightly augmented by the sale of further copies of tration, and Condition of Egypt and the Sudan in 1913, the Transactions, and it remains for the general committee publishes an annual summary of progress, in continuation to decide what shall be done with the eventual balance. of the intellectual and literary reports with which Lord Mr. D’ARCY POWER moved, and the GENERAL SECRETARY Cromer used to charm us. In of the low Nile of followed seconded, and it was resolved that the following gentlemen spite abnormally 1913, by a water was the worst on for more be nominated as members of the National Committee of shortage of which record than a the was far more Great Britain and Ireland for the purposes of the Inter- century, year’s progress satisfactory than have been the national Congresses of Medicine, with power to add to their might anticipated. Famine, necessary number : Dr. Theodore Dyke Acland, Sir Clifford Allbutt, accompaniment in the past of a very low Nile flood, was K.C.B., Professor F. W. Andrewes, Sir Charles Ball, Bart., averted by the thickening and heightening of the Assuan Mr. C. A, Ballance, M V.O., Professor H. G. Barling, Sir dam, which fortunately had just been completed. Sanitary James Barr, Dr. E. F. Bashford, Sir A. A. Bowlby, C.M G., improvements depend upon the state of the Treasury, and Mr. Stanley Boyd, Sir J. Rose Bradford, K.C.M.G., funds in rainless Egypt are dependent upon agriculture, Dr. Mitchell Bruce, Sir Lauder Brunton, Bart., Dr. which in its turn requires every year a wealth of Nile water. Sir John Sir Francis H. Dudley Buxton, Byers, Champneys, The Public Health Bart., Sir Havelock Charles, G.C.V.O., Mr. Arthur Cheatle, Department. Sir W. Watson Cheyne, Bart., C.B., Sir T. S. Clouston, Space compels us to restrict ourselves to the Public Mr. Treacher Collins, Sir James Crichton-Browne, Sir Health Department, which now, for the first time in its Anderson Critchett, Bart., C.V.O., Sir Halliday Croom, Sir history, has a strictly scientific Director-General in Sir David Bertrand Dawson, K.C.V.0., Dr. J. Gordon Dill, Professor Semple. In order to give him a freer hand for dealing with A. F. Dixon, Sir Dyce Duckworth, Bart., Sir Frederick Eve, the endemic diseases of the country two sections have been Mr. Hurry Fenwick, Sir David Ferrier, Dr. Magee Finny, pruned away ; the two lunatic asylums have been made into Sir J. Kingston Fowler, K. C. V. O., Professor Sir Thomas a separate department under Dr. J. Warnock, and the Fraser, Dr. Galloway, Dr. Garrod, Sir Alfred Pearce Gould, veterinary section and school have been transferred to the K.C.V.O., Dr. Dundas Grant, the Director-General of the Ministry of Agriculture. Historyin Egypt invariably repeats Medical Department of the Navy, the Director-General of itself, and a new Board of Health, with consultative and the Army Medical Service, the Medical Adviser to the India advisory powers only, has been created to assist the Director- Office, Dr. de Havilland Hall, Dr. C. 0. Hawthorne, General. We may hope that it will prove more useful than Sir Wilmot Herringham, Sir F. W. Hewitt, M.V.O., its predecessor, which came into existence in 1825 and was Mr. W. H. H. Jessop, Dr. Robert Armstrong-Jones, abolished in 1884, chiefly because it was incompetent to deal Mr. Robert Jones, Sir Alfred Keogh, KO.B., Dr. Percy Kidd, with the cholera epidemic which devastated Egypt soon after Mr. Ernest Lane, Sir Arbuthnot Lane, Bart., Mr. J. B. our occupation of the country. Lawford, Colonel Sir William B. Leishman, Professor J. A. For many years the energy of the Public Health Depart- Lindsay, Professor Alexander Macalister, Sir Donald ment has been principally occupied in fighting three epi- MacAlister, K.C.B., Sir Wm. Macewen, Sir John McFadyean, demic diseases-plague, cholera, and rinderpest; but Lord Mr. G. H. Makins, C.B , Professor Howard Marsh, Dr. Kitchener has now decreed that the ehief endemic diseases, Mercier, Sir J. W. Moore, Sir Henry Morris, Bart., Sir such as ankylostomiasis, bilharziasis, pellagra, and typhus Malcolm Morris, K.C.V.O., Dr. F. W. Mott, Sir Berkeley fever, must be seriously studied and taken in hand. He G. A. Moynihan, Sir Shirley Murphy, Professor G. R. rightly points out that the equipment of hospitals for treating Murray, Sir T. Myles, Dr. Newsholme, C.B., Sir the sick does not strike at the root of the evil, and that pre- Thomas Oliver, Sir William Osler, Bart., Sir George ventive measures must begin with village sanitation. He Hare Philipson, Mr. D’Arcy Power, Sir James Reid, has already persuaded the villagers to fill up many of their Bart., G. C. V. O. , K.C.B., Professor Arthur Robinson, ponds, which are fruitful sources of bilharzial and other Dr. Rolleston, Sir Ronald Ross, K.C.B., Dr. Amand Routh, infection. The land thus reclaimed is useful for providing Dr. F. M. Sandwith, Professor R. Saundby, Sir Edward open spaces for the inhabitants of the villages, which Schafer, Mrs. Scharlieb, Sir Felix Semon, K.C.V.0., Sir consist of overcrowded mud huts, unventilated, and for the Seymour Sharkey, Professor S. G. Shattock, Professor most part unprovided with latrines. With the help of prison Sherrington, Professor T. Sinclair, Dr. Percy Smith, Dr. labour 109 ponds, with an area of 98 acres, were filled in Herbert Spencer, Dr. Squire Sprigge, Professor Starling, during the year. The lines upon which he thinks sanitary Dr. G. F. Still, Dr. G. A. Sutherland, Mr. Charters Symonds, progress in the villages should proceed are (1) education of Dr. Fred. Taylor, Professor Alexis Thomson, Professor Arthur the people in the causes and prevention of their common Thomson, Sir StClair Thomson, Professor Thorburn, Sir diseases ; (2) formation of partly trained inspectors of the John Tweedy, Mr. E. F. White, Dr. Hale White, Professor sergeant class to work under the district doctors ; (3) im- Sinclair White, Sir Arthur Whitelegge, K. C. B., Sir William provement of houses and water-supply, with the gradual Whitla, Dr. Dawson Williams, and Sir Almroth Wright. introduction of simple latrines. 117

Travelling Hospitals : Campaign against Ankylostomiasis. that the vigorous personality of the present Agent and Consul-General is them to bear fruit. The The success of the travelling ophthalmic hospitals and causing practical dispensaries, which take the operator and treatment into area of the country infected by plague remains as before, but the total number of cases fell the from 884 the heart of the country, has been so great that the Public during year Health Department determined to imitate this system, and to 654. The School of Medieine.-Edueation Girls. accordingly last September a temporary ankylostoma hos- of pital was opened outside the town of Kaliub, about one The School of Medicine continues to flourish, with a total hour’s distance by train from Cairo. The ankylo,,,tomiasis of 258 students, but it is still difficult to find young campaign will also include investigation into bilharziasis Egyptians who are willing to devote their lives to the purely and pellagra, because the unfortunate peasant is often the scientific and less remunerative branches of the medical victim of all three scourges, and in order to ensure that it profession. Three additional posts have been created, which be started with all proper experience of organisation and of for long have been wanted, assistants to the professors of the habits and customs of the people it has been placed biology, chemistry, and anatomy. There are also 209 directly under the control of Mr. A. F. MacCallan, who Egyptian students who are now studying medicine in Europe, will, therefore, be unable to concentrate his energy ex- mostly unconnected with the Egyptian Government. clusively upon the campaign against ophthalmia. This The ruined condition of the buildings at Kasr-el-Ainy latter can safely be trusted to other hands, for there are now Hospital in Cairo, where all the young men and women who 17 special ophthalmic hospitals in various parts of the enter the profession are trained in hospital life, is not country, all provided during the last few years. The referred to in this report, but it is obvious that a mili- oculists, English and Egyptian, had the satisfaction during tary barrack, constructed more than a century ago and the year of curing some 25,000 patients and of performing now past repair, is unfitted to serve as a model of what a 30,000 operations, mostly on young people, for the relief of great hospital ought to be. The most at work in is the trachoma and ingrowing eyelashes. When a travelling wonderful change Egypt In ophthalmic hospital has been in one of the small towns for recent public interest in the education of girls. six months and has been crowded every day with eager out- any country this would be noteworthy, but in Egypt, patients, it is now not uncommon for the local Egyptian where only two women in every 1000 can read their own this constitutes authorities to wake up to the need of a permanent eye language, while still fewer can write it, dispensary, which is thus sometimes provided from the a silent revolution of the greatest possible importance. local rates. Elementary schools for girls are springing up, in which The first ankylostoma hospital consists of 100 beds for needlework, cooking, laundry, and elementary hygiene are both sexes, sheltered in tents or huts of matting, the taught, in addition to reading, writing, arithmetic, and the only camp furniture necessary being wooden trestle beds Koran. In defiance of all tradition and without losing caste, with matting to lie upon and blankets to lie beneath. it is now possible for an unmarried Egyptian girl, who has as a her and Great attention is paid to the latrines, which are screened been trained teacher in Cairo, to leave home by walls of matting, because their cleanliness and the migrate to the provinces to take charge of one of these new the breadwinner microscopical examination of the excreta are obviously ofschools for girls. She thus often becomes of for her rise to £300 a educative value, a value not less important than ridding the the family, salary may year, perhaps times more than her own father has ever earned. After individual of his intestinal parasites. Since 17 per cent. often of both men and women seem to be the Egyptian lunatics are found to be pellagrous, it is surelycenturies prejudice time to find out how many of the sane are affected, and werealising] a verse of the Koran : A man can find Paradise are glad to see that Lord Kitchener looks forward to " a pro-at his mother’s feet." longed, well-organised, and thoroughly scientific investiga- tion of pellagra in connexion with the ankylostomiasis campaign." VITAL STATISTICS.

Infant Mortality.-Duties of the Village Barber. HEALTH OF ENGLISH TOWNS. Lord Kitchener has shown his interest in public health IN the 97 English and Welsh towns with populations problems by devoting one-seventh of the report to their exceeding 50,000 at the last Census and whose aggregate consideration, and he is evidently well aware of the population at the middle of this year is estimated at were waste of life caused the rate of infantile mor- 18,120,059 persons, 8507 births and 4421 deaths by high the ended 4th. The He finds that this is due to the registered during week Saturday, July tality. mainly complete annual rate of in these which had been of the midwives and of mothers. It is to mortality towns, ignorance hoped 13’5, 12-9, and 12-1 per 1000 in the three preceding weeks, remedy this backward civilisation by increasing the number rose again to 12’7 per 1000 in the week under notice. of maternity schools and children’s dispensaries. In the During the 13 weeks of last quarter the mean annual death- former the village midwives receive a course of training rate in these towns averaged 13’8, against 13’1 per 1000 in under an matron, and in the dispensaries, which are London during the same period. Among the several towns English in more with the than the Government the death-rate last week ranged from 5’1 Edmonton, popular poor hospitals, 5-5 in 5-9 in and in and 6’1 in the children are treated medical men who volunteer for Devonport, Ealing Swindon, by Wimbledon, to 18-8 in Plymouth, 19-3 in Barnsley, 19-4 in the purpose, while the mothers are instructed by an English Walsall, 19-9 in Bootle, and 20’0 in Oldham. nurse in the principles of cleanliness, nursing, and diet of The 4421 deaths from all causes were 228 more than the sick children. number in the previous week, and included 444 which were The village barber, unpaid by the Government, but recog- referred to the principal epidemic diseases, against 390 and 444 nised as the humblest rank of the sanitary hierarchy, is 394 in the two previous weeks. Of these deaths, 130 authorised to and resulted from measles, 116 from infantile diarrhœal diseases, legally vaccinate, circumcise, apply 95 from 64 from 23 from vessels, and but he is whooping-cough, diphtheria, leeches, cupping simple dressings, scarlet fever, and 16 from enteric fever, but not one from forbidden to other duties he has to prescribe drugs. Among small-pox. The mean annual death-rate from these examine male corpses and to cause such diagnosis as he thinks diseases was equal to 1’3 per 1000, and was 0-2 more than fit to be entered in the village register as the official cause of the rate in the previous week. The deaths attributed to death. Attempts are now being made to provide a better measles, which had been 119, 140, and 144 in the three class of man, able to read and write, and trained in a hospital preceding weeks, fell to 130 last week, and caused the for three months, when, if he the examina- highest annual death-rates of 1’3 per 1000 in Liverpool passes necessary and in Preston, 1-7 in Rochdale, and 3’5 in Oldham. The tion, he is certified as ’’ trained in first aid." The number of fatal cases of whooping-cough, which had been 111, 99, seen the barber when he returns to his patients by village and 93 in the three preceding weeks, rose to 95 last week; varies, of course, and, like other forms of practice, depends the highest death-rates from this disease were 1’3 in Salford, upon the personality of the man. We are told of one very 1’5 in West Bromwich, 1-8 in Great Yarmouth, and 1’9 in successful barber who during the year saw 256 ophthalmic Barnsley. The deaths from diphtheria, which had been 56, patients, 334 ordinary cases, and sent three others for treat- 40, and 35 in the three preceding weeks, rose to 64 last week ; the death-rate from this disease was 1’1 in Cardiff. ment to the medical officer. On the other hand, some highest The fatal cases of diarrhoea and enteritis infants barbers little or no The (among get practice. provincial councils under 2 years), which had been 69, 79, and 79 in the the £2700 on barbers and spent during year training village three preceding weeks, rose to 116 last week, and included supplying them with first aid equipment. Many of these 26 in London, 11 in Birmingham, 9 in Liverpool, 8 in Man- reforms were begun some years ago, but there is no doubt chester, and 6 each in Birkenhead and in Sheffield. The