plague in australia

1908

CHELTINE FOODS.To the Editor. of THE LANCET.

SIRS,-Referring to your remarks on Cheltine Foods inTHE LANCET of June 16th, when treating of the exhibits atthe Medical, Surgical, and Hygienic Exhibition, we beg tostate that the wording on the tins of diabetic food " Cannotturn into sugar " was a clerical error. Correction was madeon our pamphlets two months ago but was unfortunatelyomitted on the diabetic tins. This has now been corrected,and in future all tins containing diabetic food issued by thiscompany will have written on them " Will not form diabeticsugar."-We are, Sirs, yours faithfully,

WORTHS FOODS SYNDICATE, LTD.Cheltine Works, Cheltenham, June 18th, 1900.

WORTHS FOODS SYNDICATE, LTD.

"CORONERS’ INQUESTS ON PERSONSDYING UNDER ANÆSTHETICS."

To the Editors of THE LAN CET.

SIRS,—On reading your excellent leading article icTHE LANCET of Jane 23rd, p. 1811, with regard to thequestions propounded by Dr. Danford Thomas to be put,I presume, to medical witnesses at future inquests on deathsfrom ansesthetics, I could not help wondering whether thewell-known coroner can possibly have any practical knowledgeof the difficulties of complying with the suggestions which hisquestions would imply. A large number of the cases in whicha general practitioner is called to give an anaesthetic arecases more or less of emergency, perhaps in some countryvillage miles away from any professional assistance, cases inwhich there would be no time to make the thorough examina-tion of the patient and the surroundings as suggested, or evenif that were possible cases in which even unfavourable con-ditions might have to be ignored more or less. By allmeans let us have scientific inquiry with regard to

anaesthetics, but I cannot help thinking that the generalpractitioner is being somewhat hampered by all the minutiasof detail expected of him, which will make many men almostshrink from giving an anesthetic. For instance, one of thequestions suggested by Dr. Thomas is the experience of theanaesthetist. True, the more experience an anaesthetist hashad the better for the patient and everybody. But it is notpossible for all to have the same experience and many a younggeneral practitioner may be called upon as a bounden dutyto give an anaesthetic whether he has had experience or not.If the questions propounded by Dr. Thomas are to be put onevery occasion of a fatality and the jury are to give their

verdict according to the answers received, I for one, althoughI have had a fairly large experience of anaesthetics—i.e.,ether and chloroform-hope I may never have to give anymore if I am to run the risk of having my professionalcredit upset by a jury who are certainly not a competenttribunal on those matters.

I am, Sirs, yours faithfully,June 26th, 1900. M.B., M.R.C.S.

THE NATIONALISATION OF TRINITYCOLLEGE, DUBLIN.

To the Edito’l" (If THE LANCET.SiRs,-Although I am unable to discern that the columns

of a medical journal are the proper arena for the discussion ofthe Irish Catholic University question I feel bound to contestyour conclusion, as set forth in an annotation in THE LANCETof June 23rd, p. 1815, that the proposal to nationaliseTrinity College is " as useless as it is impracticable." Ihold, on the contrary, that the nationalisation of the College,which I understand to be the same thing as the completede-sectarianising of it, would be most useful because itwould remove for ever the only complaint which IrishCatholics can justly make against the Dublin Universitysystem. Trinity College is, indeed, national already but forone thing. Its education in arts, science, medicine, law,and engineering, and its degrees in these faculties, are asfreely open, with all the honours of the higher grades, toRoman Catholics as to the students of any other religion.No questions are asked or any exclusion practised towardsthem, and many Roman Catholics who have passed throughTrinity with honour have testified to that fact, and nogrievance can be truthfully averred respecting the educa-tional treatment of students of that or any other Church.

There is, however, that within the University and its Collegewhich unfortunately affords grounds for the complaint thatRoman Catholics are liable to be exclusively dealt withtherein. The atmosphere is very strongly redolent ofProtestantism, and the governing body, the Professors andFellows and officials, are almost universally Irish Church-men, and it would be no more reasonable to expect IrishChurchmen to feel comfortable in their studies at Maynooththan to expect Roman Catholics to feel comfortable atTrinity.That the Protestant atmosphere is so thick in Trinity is

due not to any desire on the part of the Protestants toboycott the Roman Catholics but to the refusal of theCatholic priesthood to allow their co-religionists to bear ahand in any form of Irish education over which they brenot, practically, despotic control. They have pursuedtowards Trinity the same policy which they pursued towardsthe Queen’s Colleges, using every effort to make themfailures and then screeching that the institutions should besuperseded because they are failures. No one in Ireland, Iimagine, entertains any hope that the Catholic hierarchywill abandon this position until they must and the parade ofimaginary grievances will no doubt continue, but if the nationrecognises that the education of the people ought not to bechopped up for division amongst a number of sects andcompels the Government to turn a deaf ear to the clamour ofthe Irish priests and to force Trinity to accept liberalisationand desectarianism the Irish University question will besolved as the nation desires. It may be true, just at present,that "no statesman of any party would attempt to interferewith Trinity College," but when we had a strong hand at theMinisterial helm instead of the time-serving Governmentwhich now rules the attempt was made and nearly suc-ceeded and there is no doubt that the liberal voice ofthe British electors would now support any Govern-ment which would have the courage to ignore theassumed indignation of the Irish priests and proceedto eradicate all traces of sectarianism from the University ofDublin. To effect this latter purpose it would be essentialsto transfer in its entirety the Divinity school of TrinityCollege to the outside custody of the Church of Irelandwith a grant to that Church equivalent to that now made tothe sectarian education at Maynooth and elsewhere. With-out this the Roman Catholics will always have a reasonablegrievance and the priests a good cry for a separate Catholicuniversity, and I see no insuperable difficulty in doing itwhenever the nation has a Government whose regard forjustice and for the interest of the people will restrain it fromtrafficking with parties for votes.

I am, Sirs, yours faithfully,June 26th, 1900. A.M., M.D. DUB. UNIVERSITY.A.M., M.D. DUB. UNIVERSITY.

PLAGUE IN AUSTRALIA.(FROM A SPECIAL CORRESPONDENT.)

THE returns of plague in Sydney for the week endingMay 12th are as follows: remaining at the beginning ofthe week, 99 ; admitted, 23 ; discharged, 26 ; died, 10;remaining at the end of the week, 86. The totals up tothe end of the week are as follows : cases, 216; deaths, 73;discharges, 57. "Contacts," 1242; "contacts" remain-ing, 153 ; cases among "contacts," seven. The popula-tion of Sydney should, perhaps, have been mentionedat an earlier date; it is about 456,000. Its composition isa matter much misunderstood in some quarters, in which itseems to be supposed to resemble that of South Africantowns. The truth is far otherwise. Australia is a whiteman’s country, and it will not be the fault of the presentgeneration if it does not remain so. The people are white,European or of European descent on both sides, and in pre-ponderating proportion British. The only coloured peoplepresent in number of importance, in relation to vitalstatistics for instance, are the Chinese; but only 3465 wereenumerated at the census of 1891, since when restrictivelaws have prevented their immigration, hence nearly all theplague patients have been whites which might be inferredalso from the gross death-rate. Only five coloured peoplehave suffered ; all of them were Chinese. Three have died,while two are likely to die.Another point on which something may be said usefully is

as to the completeness of the returns which have been given

1909

from week to week. No doubt is entertained in any quarterthat they are complete. That the first case discoveredwas the first case in reality is most probably the truth.It was certainly-the word is here used deliberately-notpreceded by any important number of minor or of ambulantcases; one or two such there may have been ; more theresurely cannot have been. And if early in the epidemic itshould be guessed that there may have been some oversightof declared or bubonic cases they diminished very quickly atall events; but the general feeling is that there never canhave been more than (say) half a dozen at the outside. Thisis the opinion of all in a position to judge-of the residentstaffs at the hospitals, for example, and of the staffs of thedepartment of public health. As regards the latter, nodoubts are entertained by it ; it has the confidence of theprofession which knows that its members will be rationallydealt with. A good many cases have been reported rather late,and even occasionally after death under medical care ; butno one who has been puzzled by early symptoms fears that hewill be rudely brought to book under the law, or thathe will be asked publicly to explain his delay in reporting.On the other hand, all have learned that anything like wilfulconcealment or gross delay in reporting (in the case of otherinfectious diseases dealt with under the same law) is dealtwith strictly. But the distant critic unacquainted with localconditions will be inclined to argue that wilful concealment of

cases has occurred. He will refer to the early cases-if,indeed, cases of plague they were-in Calcutta. But the truthis that no evidence which would enable a reader to form anopinion was adduced regarding them; a bare statement thatthe bacillus was observed comprised it. What, exactly, itwas that was seen was not described; and whatever thebacteriological competency of an observer may be that, in acase where the possibilities of mistake are many, is not

enough. From other quarters the evidence of precedentcases of ambulant plague-those, namely, in which there isrecognised glandular swelling-is that practitioners remem-bered meeting with such cases which " must havebeen " plague, only after plagne had become epidemic.Now, at first, attention was often drawn in Sydneyto instances of glandular swelling, but they were almostalways easily traced to one or other of the recognisedcauses and in reality were reported for protection ; hardlyever had the patient any symptom of general illness, but theswelling was chronic, or at least of long standing. In oneor two cases the cause of the swelling could not be madeout, but then the most careful consideration and bacterio-logical examinations failed to afford the slightest support toa diagnosis of plague. In short, with as thorough a know-ledge of plague as could be got from epidemiological andclinical study of accounts of the disease and its outbreaks,

’ acquired long before the disease actually appeared here,nothing at all has been observed to support the notion thatthose causes of incompleteness in the epidemiological accountswhich have existed or have been assumed in other cases haveoccurred here. The great importance of this matter inrelation to certain etiological views is a good reason for

writing upon it at some length.There is little of interest to note except the diminished

number of new cases for the week already shown above.The Millard house on having its floor taken up revealed a drysandy soil and nothing else. The newly admitted casesshow the same degree of virulence in the infection as at firston the average. Inoculation has recommenced; arrange-ments have been made for inoculating the inhabitants of theinfected area and those employed there in preference toothers, but comparatively little interest is shown by thepublic. On the first two days a few more and a few less tthan 100 respectively presented themselves.May 15th.

______________

1 Papers relating to the Outbreak of Bubonic Plague in India toMarch, 1897.

THE DURHAM MEDICAL GRADUATEB’ ASSOCIA-TION.—The annual meeting of this association, followed bya dinner, is held alternately in London and Newcastle-on-Tyne. This year the turn of Newcastle came, very oppor-tunely on the eve of the visit of the Prince of Wales. ManyDurham graduates practising in London were present. Theassociation is prosperous and betrays a warm affection forits alma M67*. The dinner was held at the Grand Hotel,Barras Bridge, and was ably presided over by Dr. W. C.Beatley.

THE UNIVERSAL EXHIBITION AT PARIS.

(FROM OUR SPECIAL COBRESPOBDE1T.)

Opening of the International Congress Season.- G’1’aplwlogy.- Agrwult1tre and Health. - (grocers and Health.-11-onzeib’s Work and Health.-The Housing (If the Poor.

THE season for international congresses has now fairlybegun. There were only three such congresses in the monthof May, but 23 are taking place during the course of thismonth. The congress which in the month of May attractedthe most general attention was that of graphology ; a

fact which is not surprising when we remember how

experts in handwriting quarrelled over the celebrated

Dreyfus bordereau. I am not aware, however, that any-thing was said about the graphology of medical prescriptionsthough this was certainly a subject on which a very interest-ing paper might have been written, beginning with someaccount of the mystic invocation to Jupiter which heads aprescription and concluding with some sarcastic allusions tothe art of illegibility. Among the congresses that havealready been held this month was that of the friendly andbenefit societies called Le Congres de la Mutuality. Whenthe medical profession is better organised it should contriveto have a voice at such gatherings so that the other side ofthe questions treated may be brought forward. As it was we.were treated to panegyrics on the advantages of thrift andon the benefit and growth of organisations the principal’object of which it is to provide for a rainy day. Of courseall this is excellent so far as it goes, but to accumulate vast.reserve funds at other people’s expense is not quite so esti-mable a performance. That the working classes and thesmall trading classes should be praised for such foresight.and economy as they have displayed is quite rightand proper, but at the same time it should be knownthat a part of these funds is not the result of economy andsaving but the direct profit obtained by sweating membersof the medical profession. It does not suffice to say thisoutside; it should be repeated within such congresses, so

that it might be heard and understood by those who areresponsible for the widespread grievances that afflict a largesection of the medical profession in most countries. Anotherimportant congress was that of the grocers. I have notmuch to say about this meeting beyond mentioning thefact that there was an imposing British delegation ofover 100 members. Considering how at scientific inter-national congresses, such as that of hygiene, GreatBritain is often very feebly represented, I must confessto a feeling of discouragement when I found thatthe grocers manage these things much better than themedical profession. But the grocers had also some thingsto say that affect public health. They were loud andbitter in their complaints against the truck system andagainst trusts which not only ruined legitimate tradebut which, by abolishing competition, placed the public atthe mercy of the monopolists. Such monopolists could moreeasily foist unwholesome articles on to the public, or sell.things at exorbitant prices. The delegates, though theyrepresented the master grocers, very generally agreed thatthe hours of labour for their shop assistants were too longand that they should be reduced. In this respect Englandwas mentioned as a model nation where there is not onlycomplete rest on Sundays but generally a half holiday in the?middle of the week. It would be worth while holding suchcongresses if for no other purpose than to spread this customto other nations among whom the exaggerated duration ofthe day’s work for shop assistants has a very detrimentaleffect on’public health.M. Casimir-Perier, formerly President of the French

Republic, presided over the Congress on AgriculturalEducation. He eloquently urged that every effort should bemade to render education in agriculture at once attractiveand easy, for it was most necessary to check the continualmigration of the rural populations to the great towns.Though most of the speakers supported this view from theeconomical standpoint its importance as a question ofnational health and national defence was also admitted. Itis from country districts that the best soldiers are recruited,

and this for the simple reason that rural populations are

healthier than town populations. In the name of the FrenchGovernment M. Jean Dupuy, Minister of Agriculture, wished