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Professor Koch of Berlin ; although other microscopical plants of allied though distinct character are often present in addition to the constant and essential bacillus tuberculosis and produce modifying and generally METROPOLITAN HOSPITAL SUNDAY injurious effects. FUND. 2. That the most frequent and dangerous mode of infection by the specific bacillus in adults is by its admission to the lungs and throat. THE were the amounts received 3. That the vehicle by which the bacillus is transmitted from a sick following among principal to a healthy adult is, in the great majority of cases, the phlegm at the Mansion House during the past week in aid of this coughed up. Fund. 4. That another vehicle of infection is either occa- important milk, E d. accidental defilement with moist from a sionally by sputum consump- Parish of St. Peter’s tive or children the milk of Peter, Eaton-square:-St. patient, frequently by young drinking JE1000 9s. Peter’s 25 2s. Church,St. 2 6 cows with tuberculous 6d. ; St. Chapel, 6d. ; 1076 affected disease of the udder. Wilton-road, B70 108. 6d....John, 5. That a third, though far less frequent mode of tuberculous infec- Rosslyn-hill Unitarian Church, Hampstead ...... 123 14 5 tion is muscle and fat-which is contaminated by eating mea,t-i.e., St. Peter, Cranley-gardens ...... 471 4 0 from tuberculous disease of the lymph-glands and other parts, and Holv Trinity, Sloane-street...... ’ ... 263 16 9 has been cooked. imperfectly St. Peter, Eltham-road ...... 36 10 0 now 6. That, while it is proved that the specific bacillus is present in St. Margaret, Lee ...... 41 19 3 every case of tuberculous disease, yet there is no doubt that of the St. Stephen, Wandsworth ...... 71 17 10 two conditions which always make up a disease (the external disturb- Christ Church, Forest-hill ’" ...... , ... 61 18 6 ance and on St. John the the internal result of that disturbance), the latter depends Divine, Kennington...... ", 62 11 7 the condition of the host as much as upon the activity of the infecting L. G...... 20 0 0 parasite. West Wesleyan Mission ...... 38 1610 Aldenham Parish Church 7. That infective tuberculosis in and or pulmonary (with additions) ...... 103 0 0 general phthisis All Blackheath tuberculosis in particular, is not "catching" in the popular sense of Saints, ...... 50 0 0 London ...... the word. The disease is not the breath, nor even by West Synagogue, Upper Berkeley-street 22812 6 conveyed by St. coughing, except as a rare exception, nor is it caught by contact with a John, Paddington ...... 137 84 consumptive patient. Christ Church, Streatham-hill ...... 100 0 6 St. Columba, Font-street ...... 143 14 0 For these reasons, Dr. we cannot throw St. John’s Presbyterian Church, Forest-hill ...... 102 2 6 says Pye-Smith, St. James’s the that from household infec- Chapel Royal, ...... 57 0 5 away experience showing apart St. Luke, Westbourne-park...... 50 1 3 tion consumption appears in certain families more frequently St. Matthew, Upper Clapton, and Holy Trinity, Lea than chance can account for. Hence the importance of Bridge...... , ’" 44 10 3 strengthening the body against the invasion of tuberculosis St. George, Perry-hill ...... 37 14 10 St...... wholesome and Matthew, Ealing-common 27 11 4 by particularly by fattening food, by Upper Tooting Wesleyan Church...." ...." ... 20 0 0 increase of the colour and corpuscular richness of the blood, St. Peter, Ealing ...... 23 18 7 North by improved digestion, and by exposure to open air and Finchley Congregational Church ...... 23 1 6 Hence the of the All Saints, Woodford Wells ...... 24 0 0 light. importance general hygienic All Saints, Putney ...... 27 10 0 measures in which this country took the lead from the All Saints, Upper Norwood....., ...... ,...., 20 0 0 latter half of the present century. The result has been the St. Mark, Regent’s-park ...... 23 3 4 diminution of the number of deaths by consumption in South Kensington Presbyterian Church ...... 27 4 1 St. Peter, Hersham ...... 22 910 and Wales by one half, in. proportion to the Dr. Ludwig Mond, F.R.S...... 50 0 0 population, during the 45 years from 1851 to 1895. St. Peter, Bayswater ...... 148 8 1 The following practical points in the prevention of tuber- St. Luke, Battersea ...... 42 14 2 Holy Trinity, Anerley ...... , 26 14 7 culosis as a widespread and destrucve disease were, says Dr. Pye-Smith, inculcated by various speakers at the Congress : A.-The primary importance of free ventilation and wholesome and VITAL STATISTICS. abundant food. Improvement in the dwellings and the food of the poorer classes in this country and their increasing cleanliness and sobriety have not only diminished sickness generally, but directly HEALTH OF ENGLISH TOWNS. reduced the number of deaths from consumption until the mortality IN 33 of the largest English towns 6495 births and 3496 from this cause is less in London than in any other city. large deaths were the week B.-The prevention of infection of the the bacillus of tubercle registered during ending July 8th, lungs by rate in depends chiefly on rational treatment of the sputa of consumptive The annual of mortality these towns, which had patients, or rather, for practical purposes, of the sputa of all those declined in the three preceding weeks from 16.5 to 15’7 per with affected cough and expectoration. The phlegm should never 1000, rose again last week to 16’0. In London the rate was be deposited on the ground or on a handkerchief where it can dry up; 15’0 while it 16-6 in the 32 it should be kept moist until it can be destroyed by heat and the per 1000, averaged provincial vessel used to receive it should contain phenol or some other towns. The lowest rates in these towns were 10’6 in antiseptic solution. Croydon, 10’8 in West Ham, 11’8 in Portsmouth, and 12’1 in C.-The prevention of infection by tuberculous milk may be Bradford and in Swansea ; the highest rates were 19’4 in accomplished either bv boiling all milk given as food to children, or 21-5 in 24’2 in and 24’8 in by inspection of dairies, so as to prevent tuberculous milch-cows Salford, ’Sheffield, , being used. Manchester. The 3496 deaths included 468 which were D.-The prevention of infection by meat can be secured by careful referred to the principal zymotic diseases, against 411 and and thorough inspection of carcasses or by diagnostic testing of cattle 407 in the two preceding weeks ; of these, 133 resulted with tuberculin. This, the only undoubtedly useful application of the from 98 from 86 from so-called tuberculin, has the drawback that after the effect of the measles, diarrhoea, whooping-cough, inoculation has passed off a tuberculous animal becomes immune to it 81 from diphtheria, 35 from scarlet fever, 24 from ’’ fever" for a time, and so may be passed as healthy. (principally enteric), and six from small-pox. No death from of these was or The facts Dr. be any diseases recorded last week in Brighton in following may, however, says Pye-Smith, in the other towns caused the lowest death-rates stated as for the as well as their Derby ; they important people governors in and to be aware of :- Plymouth, Bristol, Norwich, Newcastle-upon-Tyne, and the highest rates in Liverpool, Manchester, Burnley, (a) That tuberculous disease of the bones and joints of the glands and Sheffield. The greatest mortality from measles occurred and skin and abdomen, though dangerous, is not incurable and by in Sheffield, Portsmouth, and the modern methods of operative medicine is in most cases successfully Liverpool, Burnley, Salford, cured. Manchester ; from scarlet fever in Halifax and Burnley; and (b) That tuberculosis of the lungs (phthisis or consumption) is from whooping - cough in Portsmouth, Blackburn, and more often now than frequently cured and probably formerly. Burnley. The mortality from "fever" showed no marked (c) That there is no specific drug which has direct influence upon excess in of the towns. The 81 deaths from consumption, but that many, both old and new, have valuable effects any large upon its complications. diphtheria included 31 in London, seven in Leicester, seven (d) That abundant food, particularly of a fatty nature, and a life in in Leeds, seven in Sheffield, six in Liverpool, five in West the open air, are no less valuable in the treatment than in the three in and three in Six prevention of phthisis and that the hospitals and asylums for providing Ham, Swansea, Birmingham. these essentials, which are now numerous in , and far from deaths from small-pox were registered in Hull, but not rare in England, and Hungary, France, and the United States, one in any other of the 33 large towns; and no small-pox are of essential value. patients were under treatment in any of the Metropolitan Dr. Pye-Smith’s interesting memorandum closes hopefully Asylums Hospitals at the end of last week. The number of with the following words : "The prospect of improved scarlet fever patients in these hospitals and in the London success in the treatment of tuberculosis in general, and of Fever Hospital on Saturday last, July 8th, was 2526, against consumption in particular, by the advance of pathology and numbers increasing from 2161 to 2430 at the end of the the progress of surgery and medicine is a hopeful one, seven preceding weeks ; 315 new cases were admitted during almost as hopeful as that of limiting the spread of the disease the week, against 262, 335, and 302 in the three preceding by preventive measures. weeks. Influenza was certified as the primary cause of 11 179 deaths in London. The deaths referred to diseases of the respiratory organs in London, which had been 190 and 159 THE SERVICES. in the two preceding weeks, rose again last week to 194, and were 11 above the corrected average. The causes of ARMY MEDICAL STAFF. 41, or 1’1 per cent., of the deaths in the 33 towns were SURGEON-GENERAL THOMAS MAUNSELL, C.B., is placed a medical or not certified either by registered practitioner on retired pay. Colonel Thomas O’Farrell, R.A.M.C., to be by a coroner. All the causes of death were duly certified in Surgeon-General, vice T. Maunsell, C.B. Bristol, Manchester, Bradford, Leeds, and in 15 other smaller ROYAL ARMY MEDICAL CORPS. towns; the largest proportions of uncertified deaths were registered in West Ham, Leicester, Liverpool, and Sheffield. Lieutenant-Colonel Wallis, retired pay, has been appointed to the medical charge of the 50th Regimental District, HEALTH OF SCOTCH TOWNS. Maidstone. Colonel T. J. Gallwey, C.B., takes up the post of Medical Officer in the Home District at the The annual rate of in the Scotch Principal mortality eight towns, close of the manoeuvres on Plain. E. had been 16’7 and 17’7 1000 in the two Salisbury Major which per preceding has arrived in the Home District for declined to 16’9 the week Eckersley duty. weeks, again during ending D. D. Shanahan and R. J. W. but was 0’9 1000 above the mean rate Captain Captain Mawhinny July 8th, per during have embarked for Natal. the same period in the 33 large English towns. The rates in the eight Scotch towns ranged from 5’1 in ARMY MEDICAL RESERVE OF OFFICERS. Perth and 12-8 in Greenock to 18-1 in Glasgow and 19’1 in Surgeon-Lieutenant David Smart, 2nd Volunteer Battalion Dundee. The 515 deaths in these towns included the King’s (Liverpool Regiment), to be Surgeon-Captain. 24 which were referred to measles, 24 to diarrhoea, VOLUNTEER CORPS. eight to whooping-cough, six to scarlet fever, three to 11 : 1st Volunteer Battalion the fever," and one to diphtheria. In all, 66 deaths Rifle King’s (Shropshire resulted from these diseases, 62 Light Infantry) : Surgeon-Captain F. K. Pigott to be Sur- principal zymotic against 3rd Volunteer Battalion the Manchester and 66 in the two preceding weeks. These 66 deaths were geon-Major. Regi- ment : H. Irwin his com- to an annual rate of 2’2 1000, which ex- Surgeon-Lieutenant resigns equal per slightly mission. Middlesex ceeded the mean rate last week from the same diseases in 7th (London Scottish) : Surgeon- J. A. Watson to be the 33 towns. The’ fatal cases of measles, Captain Surgeon-Major. Surgeon- large English J. A. Watson his also is which had been 16 and 15 in the two preceding weeks, rose Major resigns commission ; again to 24 last week, of which 21 occurred in Glasgow and granted the rank of Surgeon-Lieutenant-Colonel, with per- two in The deaths referred to mission to continue to wear the uniform of the corps on Edinburgh. eight whooping- his retirement. cough showed a slight further decline from recent weekly numbers and included three in Glasgow and three in Leith. THE PEACE CONGRESS. The fatal cases of scarlet fever, which had been 10 and The Congress at the Hague has failed to accomplish any- eight in the two preceding weeks, further fell to six last thing important. Germany is strongly opposed to any plan for week, of which five occurred in Glasgow. The three deaths reducing her armaments and refused to do so. The fact is from "fever" corresponded with the number recorded in that it would undermine and upset the whole system of con- the preceding week, and the fatal case of diphtheria scription and organisation on which the military power of occurred in Leith. The deaths referred to diseases of the Germany is founded. While no doubt seems to be enter- respiratory organs in these towns, which had been 74 and tained as to the personal good faith and sincerity of 77 in the two preceding weeks, declined to 57 last week and the Czar in putting forward his proposals very grave were 49 below the number in the corresponding period doubts exist as to the policy of the Russian Government as of last year. The causes of 30, or nearly 6 per cent. of the a military power and it cannot be said that recent events deaths in these eight towns last week were not certified. in regard to Finland have done much to strengthen the idea that Russia is entering upon any new or more liberal policy making for peace and progress. We are still not within any HEALTH OF DUBLIN. measurable distance of the time when the strength of military The in which had been and 23’0 death-rate Dublin, 21’3 medical services will be reduced in consequence of the per 1000 in the two preceding weeks, further rose to 23’3 reduction of armies and armaments. during the week ending July 8th. During the 13 weeks of last quarter the rate of mortality in the city averaged 26’5 THE PHILIPPINES. per 1000, the rate during the same period being 16-6 in The hot and rainy season has led to a period of inactivity London and 17’8 in Edinburgh. The 156 deaths registered on both sides in the Philippines, but we may expect that in Dublin during the week under notice showed a slight field operations will begin again as soon as the climatic increase upon the number in the preceding week and in- conditions are more favourable. Our experience in Burma cluded 14 which were referred to the principal zymotic shows how tedious and protracted this sort of warfare is. The diseases, against six and 11 in the two preceding weeks; Americans estimated the difficulties to be overcome too lightly of these, five resulted from measles, four from whooping- and their journals exaggerated the importance of most of their cough, three from diarrhcea, one from diphtheria, and one so-called battles, for the majority of the fights were on a very from whooping-cough, but not one either from small-pox small scale and not likely to have had any serious or per- or scarlet fever. These 14 deaths were equal to an manent effect. It is surprising that we hear so little of the annual rate of 2’1 per 1000, the zymotic death-rate amount or nature of the sickness among the American during the same period being 1-8 in London and 1’4 in troops occupying the country. An attempt will probably be Edinburgh. The five deaths from measles exceeded the made later to increase largely the force at General Otis’s number recorded in any week during the current year. The disposal so as to crush the rebellion by energetic and sus- deaths referred to different forms of "fever," which had tained operations against the insurgents, for the people in been three and one in the two preceding weeks, rose again the United States are getting very tired of the war. to four last week. The from and from mortality diphtheria NAVAL MEDICAL SUPPLEMENTAL FUND. diarrhoea corresponded with that recorded in the preceding week. The 156 deaths in Dublin last week included 27 of At the quarterly meeting of the Directors of the Naval Medical held on infants under one year of age and 31 of persons aged Supplemental Fund, July llth, Inspector- General A. in the the sum of 265 upwards of 60 years; the deaths of infants showed a Turnbull, M.D., chair, was distributed the several further increase, while those of elderly persons showed a among applicants. further decline from recent weekly numbers. Six inquest DEATHS IN THE SERVICES. cases and three deaths from violence were registered; and Brigade-Surgeon John Bennett, late Bengal Medical or more than a of the deaths occurred in 57, third, public Department, on June 28th, at Beau Desert, Jersey, aged institutions. The causes of or seven, nearly 5 per cent., of 59 years. He entered the service in March, 1865, and was the deaths in the city last week were not certified. promoted Brigade-Surgeon in January, 1889. ASSAM. THE DEVON AND EXETER HOSPITAL.-T.R.H. The year 1897 was a very unhealthy one in Assam, accord- the Duke and Duchess of York visited the Devon and Exeter ing to the Commissioner’s report, but 1898 has shown some There had been a great of cholera, Exeter, on July 4th. Afterwards a garden party improvement. prevalence Hospital, malarial fevers and kala azar in 1897. was held in the grounds and 120 little girls presented the Duchess with purses of .65 each on behalf of the hospital. The present session of the Army Medical School, Netley