_AL"J ] AN MD PR.J effluents. In reply to this it is stated that (a) the Exeter vii. Nui8ance.-There has been no complaint of any nuisance sewage is of average strength when compared with the arising from the works by anyone in the neighbourhood of domestic sewage of other towns; and (b) that the Yeovil Exeter, Yeovil, or Barrhead, since they were first con- sewage, which is of a very foul nature, has been successfully structed. treated by this system for the past three years. Critics, how- viii. Cost.-The initial cost of erection is held to be small ever, still maintain, first, that the Exeter (that is, St. as compared with other systems, and the subsequent outlay Leonards) sewage must be exceptionally weak, since it is equally so. derived from a high-class residential neighbourhood, contain- ix. General Applicability.-The system seems to be best ing good houses, using a plentiful quantity of bath water, and adapted to small towns, villages, or large country establish- having a larger superficial ground for the catchment and ments, as for example: I. Hospitals (general and fever). The Fever Hospital at Exeter employs subsequent drainage of rain water than a poorer district with the system. small houses on a congested area. Secondly, that the chlorine 2. Country institutions. The system is used at the convent at Great is only 4 to 6 parts per ico,ooo as against 8 to 12 parts per Maplestead, and might be employed at lunatic asylums and workhouses. ioo,ooo in that of the sewage of most other towns; the volatile 3. Schools. 4. Sanatoria. solids under 30 parts per Ioo,ooo, and the free and albuminoid 5. Barracks. The system is in use at the barracks at Tipperary and ammonia 1.4 and 0.17 respectively. Thirdly, that the effluent Dublin. of Yeovil and its trade sewage is not at all so satisfactory at a 6. Standing or permanent camps. The system is in use at Okehampton. 7. Cottage lhomes. Near Manchester there are homes for over ioo lower point as it is immediately at its point of entry. children where the septic tank is used. iii. Storm Water.-In many places the overflow or storm 8. Racing stables. water is allowed to run straight into a river or stream without 9. Iarge mansions where it has been employed with good results in some any preliminary treatment whatever. This is extremely un- instances. desirable, owing to the fact that the first rush of storm water At present it would seem that the larger towns and cities is far more polluting than ordinary dry-weather sewage, would be well advised to wait until a longer experience of the because the old deposits in the sewer are swept away to the working of the system in disposing of the sewage of smaller outfall. Therefore the entire amount of storm water, or at communities has been gained. all events the earlier and fouler portions of it, should be Finally, with the fear of Sir William Crookes and Dr. Poore passed into the works before any overflow is allowed to occur. before my eyes it must be admitted that though the eeptic- Storm water has no very appreciable effect on the flow of the tank system is theoretically and practically an extremely good contents of the tank. Thus, if the velocity of the flow in the one, it is not the last word on sewage disposal. tanks, with three times the volume of the dry weather sewage passing through them, is 2 inches a minute, then, with even six or twelve times the dry-weather flow, the velocity would only be 4 or 8 inches a minute respectively; this increase NOVA ET VETERA. would scarcely be perceptible, and would not, it is believed, interrupt the processes going on in the tank, provided a suffi- AN OLD DIRECTORY. cient length of time were allowed for proper action to take place. By E. MUIRHEAD LITTLE, F.R.C.S.Eng. iv. 1wfluent.-The ultimate effluent from the septic system AMONG the " books which are nobooks " (biblia a-biblia) Charles is apparently good; it is clear, bright, and has an almost im- Lamb included directories. He looked at them from a literary perceptible smell, and does not appear to undergo any point of view. No doubt the Directory of the current year is secondary decomposition; it, morover, stands the " incubator not a fascinating study, but one only a generation old has a test " fairly well, and it is stated that an ill odour has been considerable interest. " The lives of streets are as the lives detected on rare occasions only. of men, and shall not the street preacher if Eo minded take v. Sludge.-The amount of sludge is extremely small, even for the text of his sermon the stones in the gutter?" It after the lapse of months or years, and its rate of increase is seems to me that the lives of streets in the sense in which so slow that the necessity to clear the tanks out can only arise Thackeray used the phrase are written in directories more at long intervals. It is probable that when this necessity than anywhere else, and I therefore claim the author of Philip does arise no difficulty will be found in emptying out the as my backer in the opinion that an old directory may be in- sludge. The sludge consists of a fine black ash. Its small teresting. quantity would greatly facilitate its disposal in any manner The particular one in question is the first issue of the found most convenient, and this question would only have to London Medical Directory, that for the year 1845, and is a small be considered at very long intervals. The Septic Tank Syndi- and slim octavo volume. No definition of "London" is given cate in their prospectus aver that there is no sludge, but this on the title page or in the preface ; but as Stratford-Lang- statement is one which obviously requires modification. On thorne, and Deptford in the East, and Kensington and Notting precipitation works the sludge has to be dug up, pressed into Hill in the West, Stoke Newington and Hampstead on the cakes, and dried, before any use can be made of it, and at the North, and Brixton and Clapham on the South are included, best it is a very poor manure, as all the principal manurial it would seem to have covered the whole of London and its agents pass away in the effluent. then suburbs. The number of names in this book is 2,165. vi. Waterborne Diseases.-The pathogenic organisms of There are 6,I 17 in the London division of the Medical Directory typhoid fever and other waterborne diseases are generally for I899. supposed to be destroyed in the tank on the following grounds: The population of London in I841, according to the Registrar- (a) That they do not as a rule thrive much below 370 C.; (b) General's returns was 1,948,369. We may assume that four that the foul contents of the tank are not suitable for the years later it was 2,ooo,ooo at least. The estimated popula- growth of the organisms of cholera or typhoid fever, requiring tion of the Administrative County of London in October, I899, as they do a much purer medium for their development; and was 4,546,752. Roughly speaking the proportion of medical (c) that in all probability the other bacteria are distinctly men to population in 1899 was i in 750, while in i845 it was inimical to their existence and crowd them out. 2 These I in goo. The overcrowding of which the medical, like other statements have been called in question by many authorities, professions, complains at the present day would thus seem to but it would be as well, until our knowledge on the subject has be greater than it was fifty years ago. Yet probably doctors increased, not to be too assertive one way or the other. were, on the whole, better paid in 1845, when the Poor-law infirmaries were few and small, and the out-patients of the 28ome engineers are disposed to urge that if medical men in charge of general hospitals were few in numbers compared with the cases of typhoid fever, choler, yellow fever, etc would persuade the treated free. True, there were patient's friends to have the stools burnt immediately on their evacuation enormous crowds who are now itbis question with regard to sewage effluent, the pollution of water suP- dispensaries, and the medical journals of the " Thirties " even plies, and the dissemination of disease, would never arise. It is urged al contain bitter complaints of them, and allegations of whole- that is required is a small open space (a back yard), a few bricks, and sale abuse of these charities side by side with accusations of lenty of sawdust or shavings, and kerosene. A small crematory would of patients. ge better, and save time and trouble; and it is suggested that municipal gross carelessness or neglect in their treatment councils should keep portable crematories for distribution. It would, The iniquity of paying only 45. a year per pauper was at that however, be necessary in the case of typhoid fever at least to have the time descanted on; now medical aid aseociations consider urine burnt also, and unless conducted under skilled supervision the process might introduce new risks. uIn the 1846 Directory 5 miles from G.P.O. is stated as the limit. I Tim BRnu 87 J7AN. 13, 1900.j AN OLD DIRECTORY. IMEDICAL JOURNLL 8I that sum a handsome annual payment for those who do not ship, and the thirtieth of his authorship in comparative pretend to be paupers. anatomy) out of his income amounting in all to 6I20 6s. 6d., But to return to our Directory. Apparently medical men of the sum of.Xiio ios. was earned exclusively by oral lectures on that day, being without precedents, were, naturally enough, the favourite study of his past life! " rather at a loss as to what kind of particulars they should In 1845 consultants had not crowded to the West End of the furnish, and consequently, as the entries were not severely town to the extent to which they, following their richer pa- edited, some curious statements are to be found in this book, tients, have since done. Many of the physicians and surgeons in which more or less modest merit attempts to assert itself of the more eastern hospitals-St Bartholomew's, London, and injured worth lifts up its voice and proclaims aloud its Guy's, and St. Thomas's-lived in the city or in Finsbury. grievances. New Broad Street was favoured by the staff of the London I must confess that I am fairly " flummoxed" (to use a Hospital, and Savile Row, where Brodie lived, by St. Pickwickian phrase) by some statements. For instance, I George's. Of the other big-wigs, Liston lived in Clifford should like to know what the ";Chronothermal System of Street, Hodgkin in Brook Street, Bright in Savile Row, Medicine" is (or was) on which, and on the " Fallacies of Elliotson in Conduit Street, W. Fergusson-a rising man-in the Faculty," Dr. Samuel Dickson, of Bolton Street, wrote, Dover Street, Sir Stephen Hammick, Sir Alexander Morison, and what on earth was the "General Cemetery Assurance and Dr. Joseph Ridge, were the only medical inhabitants of Co." to whioh Dr. World was surgeon? Did it insure the Cavendish Square. In 1845, Old Burlington Street, in which denizens of cemeteries against fire, or was it a burial club, and Dr. Akenside, the poet, had lived from 1762 to 1770, was a in either case what did it want with a surgeon? Again, what street much favoured by medical men. It is a street for which was the Erectheum Club in St. James Square to which some I have a great regard, becauee I am persuaded that it is the gentlemen were so proud to belong that they mentioned the Old Parr Street in which the great Dr. Brand Firmin lived. It fact? Dr. Brown was equally proud to tell the admiring is thus described by Thackeray:-- public that he was one of the first to prescribe minute doses Old Parr Street has been a habitation for generations of surgeons and physicians. I suppose the noblemen for whoseuse the street was intended of mercury, and that he was a member of the Marylebone in the time of the early Georges, fled, finding the neighborhood too Club. Another practitioner stated that besides being a mem- dismal, and the gentlemen in black coats came and took possession of the ber of the Ethnological Society, he was a " Candidate at the gilded, gloomy chambers which the sacred mode vacated. . . . . It is later issues of the a funereal street, Old Parr Street, certainly; the carriages which drive Athenaeum Club." A search through there ought to have feathers on the roof, and the butlers who open the Directory might show whether he was elected or blackballed. doors should wear weepers-so the scene strikes you now as you pass The surgeons to the Honourable Society of Ancient Britons along the spacious empty pavement. and to the Friendly Boiler Makers jostle the author of a Generally speaking the consultants lived in the quadri- treatise on the Pendulous Belly for a place in the public lateral bounded by Regent Street, Park Lane, Piccadilly, and esteem, while it was the proud boast of a certain ex-naval Oxford Street. Other members of hospital staffs lived in surgeon that he had invented a sympathetic ink which Bloomsbury; and indeed the juniors were scattered about, proved of essential service to the Polish refugees assembled at living either close to their hospitals, or as far away as Plymouth in 1830, and the Secretary of the College of Myddelton Square is from Guy's or Northampton Square from Chemistry recorded the fact that he had discoursed on the Charing Cross, for it does not seem that it was incumbent on connection of diseases and remedies with the truths of revela- the struggling consultant to pretend that he was overwhelmed tion. The surgeon to the Dake of Cambridge, Mr. Stafford,2 with patients. must have been a man after the heart of Gilbert's Mikado, for On the north side of Oxford& Street there were few con- he was not only the inventor of the spine elongator and lateral sultants. Harley Street contained only six medical men, of rocker, which savours of the Holy Office, but he was also the whom only three were consultants. Now there are I48 brass proposer of a plan of pouring melted wax into deep ulcers, a plates among 150 doors. witbout counting those cdentists who proposal which I am sure would have seemed something have only dental qualifications; but at thjat time the late Sir humorous and lingering to the father of Nanki Poo. Let us Richard Quain, who was credited with having started the hope he only proposed it. Harley Street fashioD, was House-Physician to University It is pleasant to think that the inventor of the papier-machd College Hospit4l, and his namesake and cousin the surgeon anatomical figures for the education of the native surgeons of dwelt in Keppel Street, Russell Square; William Bowman India not only supplied the company with forty such, but lived in Golden Square; while Albert Richard Smith, who was paid 2,000 guineas for the same. But what am I say of described himself in this Directory as " author of a pamphlet William Vesalius Pettigrew? In these days it is difficult to against phrenology, and several novels, dramas, tales, songs, believe that any practitioner-and he a graduate of Glasgow burlesques, etc., and contributions to Punch," was a surgeon- University-could be so ignorant of the first principles of the dentist in Percy Street, Bedford Square; W. Jenner was a gentle art of self-advertisement as to have published an anony- general practitioner in Albany Street, and William Gull mous medical work. Apparently he saw his error somewhat Resident Medical Assistant at Guy's Hospital. late, and hence inserted this claim to the authorship of " an Uip to the date of this Directory, the most successful con- anonymous work On. the Diseases of Children, their Clothing, sultants lived, as might be expected, near to their most im- Diet, Education, etc." portant patients, that is to say, wherever the wealthy Signs of the dissatisfactions which the exclusiveness of the merchants and the nobility were to be found. In the six- College of Physicians caused are to be found in the following: teenth century they were still in the city. Thus Linacre Dr. Mann Burrows was the first to be elected a Fellow of the Royal lived in Knightrider Street, and bequeathed his house there College of Physicians after having been a member of both the College of to the of Physicians, which he had founded. Dr. Surgeons and the Society of Apothecaries and a general practitioner. The College Eliza- -date of his election. therefore, was at the period when the College aban- William Turner in 1568 dedicated his Herbal to Queen doned the previously rigid exclusion from the Fellowship of medical men beth "Irom my house in Crossed Fryers." He had a botanical who had been in general practice. The late Dr. Babington, who was also garden there, as well as at Kew and Wells. Fellow, had been ResidentApothecary to Guy's Hospital, but he belonged to James I and to neither of these corporations, nor had he been in general practice. Harvey, who was Physician Extraordinary This Dr. George Mann Burrows, of Upper Gower Street, Physician in Ordinary to Charles I, no doubt lived near the described himself as " Physician (specially engaged in the Court when he was on duty, for it was from his lodgings at treatment of insanity)," and must not be confused with Dr. Whitehall that his papers were taken and destroyed during (afterwards Sir) George Burrows of Queen Anne Street. the rebellion, but his permanent dwelling seems to have been Perhaps the longest notice in the book is that following the with his brothers in the city at Lawrence Pountney Hill and -honoured name of Dr. Grant, who wag distinguished as at Cockayne Hall. Lecturer on Comparative Anatomy at University College. Gradually the great physicians followed the Court west- After stating his grievance in being debarred from practice in ward. Sydenham began to practise in King Street, West- London by the Medical Corpnrations, and enumerating the minster, but soon afterwards-in 1664-moved to a house in many learned societies to which he belonged, and some of his Pall Mall. It was here, as the story goes, that the stout old works, he " mentions the remarkable fact as connected with captain of Cromwellian Horse was sitting at a window with the history of comparative anatomy, that in the year 1844 (the his pipe and silver tankard, when a thief snatched the latter and ran off. He was pursued " as far as Bond Street, where seventeenth of his professorship, the twentieth of his lecture- in Bow Jacksonian Prizeman, I826, on Diseases of Spine. they lost him in the bushes." Radcliffe lived St.reet {D, TEN BwR IP AN OLD DIRECTORY. LJAN. 13, I190o, °°MDIQCLJOVRA 88c-AN OLD DiRECTORY. IJAN. 13, 1900. fromI687 to 1704, when he moved to Bloomsbury Square, the later pre-Reformation years. But even if Sir Walter where he entertained Prince Eugene, who hated France and Besant is right we have yet to find a cause for this congrega- all things French, with a lain English dinner of barons of tion itself. Some years ago the coachmakers were crowded beef, jiggets of mutton, and legs of pork, washed down by ale together in Long Acre, as-to compare great things with small seven years old. In this house he was succeeded by -the bird fanciers were in Great St. Andrew Street. Both Mead, who afterwards moved to Great Ormond Street, where these streets, however, have gradually become less and less the Hospital for Sick Children now stands. Mead was born specialised at the same time that the doctors have been and bred at Stepney, and only removed to Crutched Friars crowding together within sneering dietance of one another when he was appointed Assistant Physician to St. Thomas's near Cavendish Square, and the bicycle makers have Hospital in 1703. It was probably while he was living in the established themselves on the Holborn Viaduct. Thus we City, either at Crutched or Austin Friars, that he and Dr. find centripetal and centrifugal forces acting at the same time Woodward, one of the professors of Gresham College, fell out in different places. over a medical queEtion, caned one another in Bishopsgate The bicycle makers, I venture to think, supply a key to the Street, and then fought with swords in the courtyard of difficulty. Many of us can remember how twenty-five years Gresham College. Woodward had the worst of it, and Mead ago, when the high bicycle, with its steel spider wheels and said scornfully to his prostrate foe," Take your life!" " Any- rubber tyres,was beginning to replace the wooden boneshaker, thing but your physic !" Woodward retorted. " Other times one of the best known and most enterprising manufacturers, other manners." Happily the representatives of the profes- the Coventry Machinists Co., ventured to open a large shop sion bandy nothing worse than words nowadays. After he on the Viaduct, where there were then many empty build- ceased to live in the city, Mead used to go to Batson's Coffee ings. Their success was marked, and first one and then House in Cornhill, against the Royal Excbange, meet all the another of their rivals followed them into the Wilderness apothecaries, hear them, and prescribe. This was a common until there are now eighteen bicycle shops between Holborn practice in those days, and Batson's was a favourite resort of Circus and the Old Bailey, without counting motor car builders SirRichard Blackmore and a house of call for physicians. and offices without open shops. In like manner the great Sir W. Blizard, Surgeon to the London Hospital, regularly success of Dr. Quain is said, I know not with what truth, attended Batson's for consultations, and is said to have been to have started the movement northwards across Oxford the last to observe this custom. Street. It is recorded that Pope lay ill at Cheselden's house in There is no moral that I know of to be got out of this Direc- Queen's Square, Westminster (now Queen Anne's Gate). tory, except the old one of nothing new under the sun, for I Soho Square, which was so fashionable at the end of find various improvements of later years claimed by some of the seventeenth and beginning of the eighteenth centuries, those whose names are here printed. For instance: Sir John was not invaded by the surgeons till its decline, when Sir (then Mr.) Erichsen ends a long record of his work with the Charles Bell and Sir Anthony Carlisle had houses there. statement, "Inventor of an instrument for the inflation of Heberden the elder lived in Nell Gwynne's house in Pall the lungs with oxygen gas in extreme cases of asphyxia." Mall. Dr. Douglas (Pope's Douglas of the "soft obstetric Not long ago an officer in the Royal Engineers reproved the hand") accused Smellie, the obstetrician, who lived in the profession for their ignorance of this" new' means of resus- same street, of hanging out a paper lantern bearing the legend citation. " Midwifery taught here for five shillings." William Hunter Alfred Smee, whose name is so well known as the inventor lived with Smellie when he first came to London in 1741. of a galvanic battery, states that he is also the inventor of Askew. who died in 1774, lived in Queen Square, Blooms- an "electro-magnetic apparatus for the detection of needles bury. Pitcairn lived in Lincoln's Inn Fields, and died in in the human body," and one modern advance in the surgery 1797 in Dover Street. John Hunter lived in Jermyn Street, of the chest seems tohave been forestalled by Mr. Robert R. and afterwards in Leicester Square. Abernethy lived in Storks in a paper on a Case of Tuberculous Cavern Treated by Bedford Row when he was assistant surgeon to St. Bartholo- an Opening Made in the Walls of the Thorax. An ancestor mew's Hospital. Lettsom lived and died in Basinghall Street of the binaural stethoscope is plainly indicatedby Dr. William (t8I5). Baillie, who succeeded Pitcairn as President of the Stroud, who "claims to have invented the flexible stetho- College of Physicians, practised in Grosvenor Street, and died scope." at 25, Cavendish Square, in 1823. His successor in the Is the present congregation of the profession likely to be Presidency, Sir Henry Halford, had died in Curzon Street the long-enduring, or will the tide which has flowed so quickly year before that of our Directory. ebb as fast? Who can tell? So little is known of the causes It will thus be seen that until after I845 there was no medi- of the flow that its course cannot be prognosticated. Perhaps cal quarter in London. The names of 120 members of the the year 2000will find our successors once more scattered or staffs of ten general hospitals with schools are to be found in congregated about Shepherd's Bush or Putney Bridge. this Directory. They lived in sixty-four streets, and seven is the largest number to be found in any one street. This was the number in Savile Row and New Broad Street. Of the MEDICAL SICKNESS AND ACCIDENT SOCIETY. 255 members of the staffs of eleven general hospitals with THE usual monthly meeting of the Executive Committee of schools, who are in active practice, and whose names are in the Medical Sickness, Annuity, and Life Assurance Society the Medical Directory for 1899, I find sixty-six in Harley was held at 429, Strand, London, W.C., on December 29th, 1899. Street, where there are also fifty-two other consultants and In the absence of the Chairman, Dr. de Havilland Hall, specialists. Probably almost as many may be found in Wim- the chair was taken by Dr. MAJOR GREENWOOD, and there were pole Street. also present Dr. J. B. Ball, Mr. J. Brindley James, Dr. W. The laws of congregation and dispersion of trades and call- Knowsley Sibley, Mr. F. S. Edwards, and Mr. Edward ings seem to be unknown. Of course everybody knows that Bartlett. in the Middle Ages and the two or three succeeding centuries The death was announced of Mr. H. R. Jennings, of 46, the members of the same trade were made to dwell together. Great Ormond Street, London, W.C., who had acted as auditor Thus, in London, on each side of the great market, or Cbhepe, to the Society since its commencement in I884. He was one there are a number of streets the names of which to this day of the public auditors appointed under the Friendly Societies' record the trades in which their former inhabitants were en- Act. His successor will be elected at the general meeting of gaged. Sir Walter Besant gives the following explanation of the members to be held in May next. this: The claim list presented showed elear signs of an epidemie This custom of congregation was useful in more ways than one; it gave of influenza, and there is little doubt that during the coming dignity to the craft and inspired self-respect for the craftsman; it kept up a large sum the standard of good work; it made craftsmen regard each other as spring the Society will once more have to disburse brethren, not a3 enemies; it gave them guilds of which our trades in sickness benefit from this cause. The more, recent claims unions, who think of nothing but wages, are the degenerate successors, from influenza have been for the most part of short duration, and it brought each trade under the salutary rule of the Church. but they are rapidly becoming more numerous, and the total If congregation did all these things for the craftsman, expenditure caused by them bids fair to be of large amount. there is small wonder that it flourished. Opinions will differ The final figures for the year I899 could not be placed before as to how far the rule of the Church was salutary, at least in the Committee till the meeting in January, but the accounts F rxuBIrti9 89 JAN. 133,-1 1900.]- INDIA IN '897 IMUDICA'L JoURAL 9 produced showed that during the year the amount of sickness preceding five years, and in all except the Punjab and Bengal pay disbursed by the Society was the largest that has ever higher than those of the preceding year. The Central Pro- been paid in twelve months since the commencement of the vinces, where the famine was worst, presented the high ratio of business. This is only what must be expected. The number 69.34, followed by Assam with 6o.6i, Berar 52.6, Coorg 5o.o3, of the members has steadily grown and with it their average North-West Provinces 40.46, and Bombay 39.84. In some age, and, accordingly, every year the number of weeks of sick- provinces, not themselves famine-stricken, increased mortality ness expected and provided for by the tables must increase. was caused by famished fugitives from destitute areas. During 1899 more than six hundred weeks of sickness benefit Infantile mortality was enormous in famine tracts. Cholera, had been paid by the Society to members who were incapable of small-pox, fevers, and bowel complaints were all in excess; ever resuming practice, and were in this way drawing from the the death-rates per i,ooo of population being respectively 2.55, funds a solid and permanent provision. 0.77, 23.12, and i.86, against 2.17, o.6s, 21.05, and I.io. In the Prospectuses and all particulars on application to Mr. Central Provinces the rates were 6.01, 0.38, 40 98, and 8.53. F. Addiscott, Secretary, Medical Sickness and Accident Both cholera and bowel complaints were no doubt exception- Society, 33, Chancery Lane, London, W.C. ally aggravated by the coarse food which the people consumed under pressure of the scarcity. Plague caused a largemortality in the Bombay Presidency. Deaths were extensively con- INDIA IN 1897. cealed for fear of domestic interference, but the Sanitary Com- THE REPORT OF THE SANITARY COMMISSIONER. missioner considers the death-rate to have been not far short THE Report of the Sanitary Commissionerwith the Govern- of 5 per i,ooo. In other provinees the incidence was limited, ment of India for the year I897, in which is recorded all the and death-rates inconsiderable. available statistical and sanitary information regarding the general population of the Indian Empire, and the troops and PRISONERS. prisoners belonging to the several military commands and Of the three sections of the Indian population under skilledr civil provinces, gives a comprehensive and instructive view of medical observation and management, whose vital statistics the events of the year and the health of the country. The are quite reliable-namely, European and native troops and data are clearly and summarily set forth, and year by year, as prisoners-the latter might reasonably be expected to partici- knowledge and experience grow, the comments upon them pate most in the unfavourable influences affecting the country become more valuable. A notable feature in this and some at large. Numerous releases took place in consequence of the preceding reports is that on each of the more prominent Jubilee, yet the prison population rose from IIo,I86 to I18,107, matters of interest there is a pr&cui of the literature of the the increase being no doubt due to the aggravation of crime subject, with references to the original publications, brought always associated with scarcity of food. The death-rate rose down to the date of the issue of the report. These sketches from 27.68 in 1896 to 38 75, the rate for the decennitum I886-95 are admirably compiled, and must be of great service to being 32.20. In the Central Provinces the rate was 134.98, an Indian medical men whose opportunities of maintaining their appalling figure, followed- longo intervallo -by 52 82 iD knowledge are necessarily somewhat limited. Madras, 46.23 inAssam, 37.21 in Bombay, and 35.44 in the North-West Provinces. Ague caused 36 per cent. and bowel FAMINE AND DISEASE. complaints 17 of the sickness. There was an increase under The year -I897 was for India a very tryingTand'disastrous both heads, and under cholera, scurvy, and debility. Dysen- period. Following a year of drought and famine, which left tery caused 29 per cent. of total deaths, pneumonia Ii, and large areas sterile and multitudes of human beings destitute cholera io. Both dysentery and cholera caused nearly twice ands tarving, dependent on the relief efforts of a humane the ordinary mortality. Cholera broke out in 75 gaols. In Government, the first half of it partook generally of the most instances the admissions were single or few; but in character of its predecessor. It was hot and dry, and afforded some gaols smart epidemics occurred, notably in Coimba. no succour to the famishing millions. Generous and tore, where 280 cases were admitted, and in Rajamundry, abundant rain came with a somewhat retarded monsoon. The where admissions amounted to 201. In contrast with these fall was copious and well distributed, and in time supplied cases plague only occurred in 4 gaols, namely, the Bombay excellent crops, but, soaking into a parched soil, it occasioned house of correction (33 admissions and 17 deaths), the Bom- conditions favourable to the evolution of malarious disease, bay common gaol (2.2), Jerrowda central prison (i.I), and which wrought exceptional havoc upon an enfeebled popula- Karachi district gaol (i). tion, and was accompanied by a heavy onslaught of dysentery and diarrhcea. Cholera in some parts of India is favoured by THE EUROPEAN AND NATiVE ARMIES. drought and in others by moisture. Both conditions pre- The health and mortality of the European and native vailed, and the disease was rampant. The plague which armies were affected by the morbific qualities of the year and broke out in the city of Bombay in September, I896, was ex- by the circumstances of the frontier war, in which 6 per cent. tensively spread by fugitives throughout the Western Presi- of the former and 9 per cent. of the latter were engaged. The dency, and made its appearance in some parts of the Punjab, admission-rates for European troops was 1,557, the constant North-Western Provinces, and Madras. There was a severe sick-rate ioi, and the death-rate 22.93 per I,000, figures which earthquake in Assam in June which disturbed the natural greatly exceed the experience of recent years. The ad- drainage of the province, and intensified the malaria always mission-rate of troops on service was 2,500, and the death-rate severe in those parts; and a cyclone with accompanying storm 91.62; the admissions on service constituting 9, and the, wave ravaged the Chittagong district in October, and caused deaths 22 per cent. of the whole. Cholera, fevers, dysentery, directly and indirectly much loss of life. and diarrhcea gave increased admissions, and there was an increase of deaths from bowel complaints, cholera, enteric- BIRTHS AND DEATHS. and other fevers, heat stroke, and hepatic abscess. The pre- Under these circumstances it is not surprising to find that valence and mortality of cholera were higher than in I896i high death-rates and low birth-rates were the rule of the year but lower than in the decennium I886-95. No new fact in most Indian provinces. Birth and death registration are of importance is recorded as regards causation and preven- still very defective, and will remain so " as long as the col- tion, but fresh evidence was obtained of the advantage of lecting agency in rural areas remains illiterate, and until suf- movement in severe attacks among both troops and prisoners. ficient pressure is put upon municipal bodies to enforce the The admission-rate of enteric fever rose from 25.5 to 32.4, and by-laws under which registration is legally compulsory in the death-rate from 9 31 to 9.01. The subject is discussed at towns." The conditions of I897probably intensified these imper- great length, but no substantial addition to our knowledge of fections, and the returns of the year are no doubt greatly below causation and prevention is adduced, and the efforts which the mark from both habitual and exceptional causes. The have been made to purify water by boiling and salting do not birth-rates of I897 were in every province, except Berar, below appear to have been productive of much if any benefit. Only those of I896, and in 6 out of the io these rates fell short 5 non-fatal cases of plague occurred in the European army, of the death-rates, the differences amounting in 4 cases 3 in Bombay and I each at Poona and Purandhar. The ad- to 43, 30, I8, and 13 per 1,ooo. The death-rates were in mission rate from venereal diseases fell from 5 Ii.6 to 485.7 ; the every province except the Punjab higher than those of the reduction is attributed to so many men being on field service; THE BiTITsH 1 '90 MEDTCAL JOURNLLJ NOTES ON HEALTH RESORTS. lJAN. 13,-1 1900.-

A pathetic observation is recorded that the famine increased origin, methods of classification, modes of action of their the number of prostitutes. The death-rates of officers of the solid and gaseous components on the body, etc. Valuable British and Indian armies were 23.04 and 18.92 respectively, hints are given concerning the benefit likely to be derived the excess over the preceding year being due to service. by the use of mineral waters and baths in various diseases Deaths from enteric fever were more numerous. The health and morbid conditions. Two chapters are likewise devoted to of women was better and of children worse than in I896. In hydrotherapeutic methods, mud baths, etc., and their em- the native army the figures of 1897 are higher than in I896, ployment for medical purposes. Possibly some of the author's but below those of the previous decennium. The admission- remarks in Chapter vIIi are open to discussion, and differences rate was 839, constantly sick-rate 31, and death-rate of opinion on many points are likely to exist. For instance, 14.90. The cantonment admission-rate was 798 and death- on page 66, we read: "The light alkaline carbonated chaly- rate 14.48; the corresponding service-rates being I,242 and beates may also be used with advantage in enlarged cervical 40.31; the admissions and deaths constituting 22 and 21 per glands, tabes mesenterica, etc." So, further on: " In chronic cent. of the whole. Fevers and fluxes were the principal lead poisoning the sulphuric acid waters are valuable, form- causes of sickness, and pneumonia of mortality. There was ing inert and insoluble sulphates of lead, which are eliminated no increase of cholera cases or deaths, but there were more in this form by the emunctories." Surely, although sulphuric admissions from enteric fever, which, however, constitutes a acid is required in certain cases of plumbism, the medical very inconsiderable cause of morbility and mortality among man is hardly likely to select mineral waters in these cases on native troops and prisoners. The death-rate of European account of any free sulphuric acid they may contain. On the troops from enteric fever was nearly five times as great as preceding page (p. 65) we are told: "The iodic waters are that of native troops from fevers of all kinds: 131 cases of esteemed as possessing the power of reducing splenic enlarge- plague with 82 deaths occurred in the native army. The ment, and removing other evidences of the paludal or malarial cases occurred in i6 bodies of men mostly in the Bombay cachexia." It is certainly open to doubt whether it is the Presidency. The severest outbreak was, however, in the iodine in these waters which brings about the good result in 26th Madras Infantry at Belgaum. Interesting details are such cases. We hardly think it a probable suggestion (p. 64) given regarding these outbreaks, and the information which that possibly "the borated waters may be found useful in is recorded on the bacteriological pathology and epidemi- epilepsy and chorea." The author admits, however, that ex- -ology of plague is exceedingly valuable. It is satisfactory to perience as to their utility is lacking. On the whole Dr. observe that the admissions and deaths from respiratory dis- Crook is cautious and moderate in his estimates of the thera- -ease generally and pneumonia in particular were lower than peutic virtues of mineral waters, as the following passage in I896, notwithstanding the number of men who were (p. 35) serves to show: "It is a fact which few will deny -employedon frontier service. The admission-rates and death- that most persons visiting a spa during the summer rates from dysentery were, however, higher. The ratio of months experience, almost from the beginning, an improve- venereal admissions (40.8) was somewhat higher than usual; ment in their physical condition, and in many instances 137 admissions from beri-beri were returned, of which 135 return to their homes fully restored to health. This can be occurred in Madras regiments. There were noadmissions accounted for to a great extent by the change of air, food, and from this cause in the European army, and only 6o in prisons. surroundings, and the escape from the worry and cares of Another remarkable contrast is shown by the admissions for business. Perhaps numerous caEes would do as well at guinea worm, which numbered 563 in the native army summer resorts where there are no springs; yet, after a and 436 in prisons, while no case occurred in the European liberal deduction for all other assignable influences, we may army. justly attribute a large share of the good results to the. aid The report contains in addition to the information above rendered by a properly-selected mineral water. An obstinate summarised sections on vaccination, civil and military work, case of chronic constipation or catarrhal jaundice is not apt to and some special points which have engaged the attention of yield readily to a mere change of diet and environment, and the sanitary office. The most important of these is Major the same may be said of protracted eases of rheumatism, uric Ross's work on the malaria parasite, which has already been acid gravel, and numerous other conditions." The book will be fully made known in the BRITISH MEDICAL JOURNAL. found not only a useful reference book for American practi- tioners, but likewise a volume of great interest to medical men of all countries who are interested in balneology. NOTES ON HEALTH RESORTS. MINERAL WATERS OF THE UNITED STATES. ASSOUAN. DR. J. K. CROOK'S work' is doubtless the most comprehensive Egypt will be more and more visited by tourists, and Dr. yet published on the mineral waters of the United States. The KiNGSFORD'S small books presents in a popular manner the greater part of the work is taken up by a description of the attractions of its southernmost health resort. Assouan has mineral springs and wells, with the topographical and climatic much of the desert influence-warmth, sun, dryness and features of each State and territory. Immense trouble must comparative purity of the air. There is a resident English have been taken in collecting and arranging the information physician and an English nurse, whilst a new hotel with -contained in this section of the work, which fills 471 pages. modern sanitary arrangements is to be opened in the coming In the analyses of the different springs the solid constituents season. Dr. Leigh Canney, whose Winter Meteorology of are expressed as grains per gallon (standard gallon of the Egypt was reviewed in the BRITISH MEDICAL JOURNAL of United States), and the gases as cubic inches per gallon. The January 29th, I898, recommends, amongst affections suitable author, who thinks that two-thirds of the analyses of American for Assouan, non-erethic cases of phthisis, hmemorrhagic isprings conform to this standard, has had the remaining cases, non-acute cases of the first or second stage, chronic analyses converted in accordance with recognised rules quiescent phthisis, and cases associated with bronchitis. (a conversion table is given). We are convinced, how- Amongst Egyptian resorts, Dr. Canney gives the first, place ever, that the results of analyses of mineral waters are best to Assouan in chronic bronchitis and emphysema and in expressed on the decimal system, the solids being reckoned as Bright's disease and albuminuria. Many other conditions, grams per I,ooo grams, or grams per litre, by which means the such as convalescence from pneumonia, asthma associated (quantitative comparison of the active ingredients with those with bronchitis, mental overwork, and premature senility, are in European springs is greatly facilitated. America is rich in likely to be benefited. mineral waters, as a glance at the book will show, and fresh springs will doubtless still be discovered,whilst many mineral 2 A88ouan as a Health Resort. By W. E. Kingsford. Lndon: Simpkin, water stations, as yet little visited, will in time develop Marshall, Hamilton, Kent, and Co. I899. (Pp. 52, illustrated with into useful and popular health resorts. The first part views.) -of Dr. Crook's book relates to balneology and hydro- therapeutics in general. It contains much suggestive POST-GRADUATE LECTURES AT THE UNIVERSITY OF GRETFS- information concerning mineral waters, their probable WALD.-The professors, acting with the, Privatdocenten and Assistants of of will hold a t The Mineral Water8 of the United State8 and their Therapeutic Uses. (New the University GreiVswald, post- York and Philadelphia: Lea Brothers and Co. z899. Roy. 8vo, pp. 588, graduate course towards the end of July. The course will last 3.5o dols.) about a fortnight. Further particulars will be published later.