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who now are improvident where their personal health isconcerned. Very full and interesting appendices follow thereport of Dr. McVail and compose a most valuable record ofPoor-law administration and of particulars of Poor-lawmedical work. Both sections of the Commission havetestified their appreciation by frequent quotation andreference, particularly in Part V., Chapter II., of the

Majority Report, and in Chapter V. of the MinorityReport.

SANITATION IN INDIA.

I.WE propose to repeat this year the review of the

sanitary administration in India that we were enabled to

present to our readers last year by the courtesy of the variousauthorities who kindly placed in our hands the yearly reportsrelating thereto. We shall accordingly notice firstly thesanitary administration generally, and then that of the jails,asylums, civil hospitals and dispensaries, &c. We commenceto-day with an article on the general sanitary administrationof the empire. The reports being in most cases some twoyears old, we shall occasionally be traversing ground thathas been already gone over in our columns, but the designis to present a complete picture.

Calcutta.The report of the health officer of Calcutta for the year

1907 is rendered by Dr. T. Frederick Pearse. This officercommences his report by drawing attention to two importantpoints that require to be considered. In the first place, heshows that according to the custom in India the estimationsof the ratios of births and deaths have been made upon the

population figures of the previous census. Now, if the

population remained stationary there would be few errors,but Calcutta has grown enormously, and consequently thefarther any year is from that of the previous census the greaterare the mistakes in all the ratios calculated. The importance ofmaking allowance for this increase of the population may beillustrated by taking the general death-rate for 1907. Thisworked out on the usual plan at 37 6 per 1000, but thenumber of deaths amongst the larger estimated populationreduces the general death-rate to 33 per 1000. The second

point for consideration is more complicated. The returnsshow a great excess of males at ages 10-50 years, a

deficiency in the number of young people under 20 years,and excess of working adults 20-50 years, as compared withBengal. This deficiency of children and excess of younghealthy males lower the general death-rate and make theusually recorded rate for Calcutta appear better than it

really is. As a matter of fact, the low death-rate in Calcuttais masked to such a degree as compared with that of Bengalthat the rate, nominally 33 per 1000, is raised to 39’ 3 per1000.

’

Witn respect to tne ---ulrtns ana mrtn-raLes, tne iemaiesconstitute only about 33-4 per cent. of the population, ]whereas in Bengal the two sexes are about equal in number.Both in Calcutta and Bengal the child-bearing ages of 15-45years form about half of the total female population. The

registered births during the year 1907 amounted to 16,224, arate of 19-1 1 per 1000 on the whole census population, andof 16-7 per 1000 on the estimated total population. This

compares favourably with the partially corrected rate of 15-7for 1906. But neither of the above is the correct rate, whichis, allowing for the increase of population, 24 - 5 per 1000. Thisis a low birth-rate for India, but it is above that recorded forthe other towns of Bengal, which is 22-2. Factors causingthe birth-rate to be small are that there are a considerablenumber of births never registered, whilst the inclusion of15,000 prostitutes amongst the total number of females ofchild-bearing age also tends to make the birth-rate small.The ratio of registered births per 1000 has improved from17’7 to 19 ’1. As regards the infant mortality this continuedhigh, being 293 per 1000, but it is satisfactory to note that itwas lower than that recorded in previous years.Regarding the incidence of particular diseases, we find

that in the year under review there were two outbreaks ofcholera, one in January and the other in November andDecember. They accounted for 3803 deaths, showing amore severe incidence than has occurred in any yearduring the past decade. The northern and southern dis-tricts were chiefly affected. Again, since Feb. lst, 1908,there was a fresh outbreak following the " Ardhodaya Jog,"

many pilgrims being affected, and the disease spreading alsoto the whole population. The mortality fell largely among-Hindus, 85 per cent. of the deaths occurring amongst them,although they formed but 65 per cent. of the total population.This rate equals about 1. in 165 of the total Hindu popula--tion. The Mahomedan had only 169 deaths, equal to 1 in500 of this portion of the population. The particularincidence amongst the Hindus was doubtless due to theircustom of bathing in the Hooghly river and Tolly’s Nullah, and.using the water for drinking and other purposes. It also wasdue to the use of the water from foul tanks, small localisedoutbreaks occurring around these tanks. Especially in thewestern areas the stand posts of filtered water are deficient,so that the people resort to other sources of water-supply.We are glad to note that this deficiency is being graduallyreduced. Cholera being the chief danger of all great Indianfestivals special preparations were made regarding the abovefair, as it was anticipated that an enormous number of

pilgrims would come to Calcutta. Thus, .filtered water postswere erected at every 100 feet along all the principal roadsleading to the temple of Kalighal, which had been,selected for the place of worship on this occasion.Suitable latrines at a large number of convenientsites were erected ; the drainage in the courtyard of the.temple was improved; the food-supplies were regularlyinspected, as also were the pilgrim houses which were pro-vided for the first time with a filtered water-supply ; a largeextra staff was enlisted for cleaning the roads, ditches,latrines, and urinals ; all the tanks in the vicinity had theirwater chemically treated; all traffic was- stopped along,Tolly’s Nullah; special cholera hospitals were establishedwith a dispensary for cases of temporary illness ; the places--from which cases of cholera were removed were thoroughlydisinfected ; and lastly, owing to the excellent police arrange-.llJ.t:alLJ, uucec vvao uv BjJ. U;::,U auu uuu mumc vl.UVVU.1llÕ- Liu UVI.L- -

sequence of these highly satisfactory arrangements the cases -of cholera were certainly not so large as had been feared.As regards the actual treatment of the cases, saline injec-tions were used in many cases with satisfactory results?The influence of the festival is shown by the fact that for thetwo weeks previous to its occurrence the deaths from cholerawere 23 and 24 respectively, whilst within a week they rose to-104, and the disease became widely disseminated over thecity. These festivals are a never-ending danger to the

population, and so long as religious feelings compel the useof the unfiltered water of the river there will be danger of,these outbreaks.With respect to small-pox, there was a marked’outbreaks

of the disease during the early part of 1907, -although it was-not so severe as in 1906, 1286 deaths being registered. In,1906 there were 2905 deaths. This disease shows itself inperiodic outbreaks, although it is hardly ever absent from thecity. The usual interval between the epidemics seems to be-five years. Unfortunately, the cases are not properly reported,.except from the hospitals, so that the sanitary department is -unable to institute early preventive measures, as there is-little or no chance of isolation unless cases are notified early,and in Calcutta there is practically no notification at all.Disinfection is useless when there is no knowledge as towhere the disease exists. Hence reliance against its spreadmust be placed on vaccination. The returns for this pro--cedure showed a diminished activity in 1907, as comparedwith 1906. There were 23,121 primary vaccinations and12,609 re-vaccinations, of which 14,160 were performed atthe several stations and 21,924 in the "homes." " Thesestatistics work out at about three only a day at each stationand less than three at the "homes." This small number Dr.Pearse rightly considers unsatisfactory. The quality of thelymph used was evidently very good, as the percentage ofsuccessful vaccinations was 98 ’ 4 for primary cases.

Plague caused 3591 deaths, the northern half of thecity being most affected. Though more severe than in1906, yet the outbreak was much less so than inother former years. With regard to malaria there is noreason to believe that it is a more fatal disease than formerly ;.on the contrary, the more accurate statistics of later yearsshow the reverse to be the case. Mosquito brigades wereformed that attended to the breeding places of theinsect, but action in this direction was spasmodic and not’persistent. Dysentery and diarrhoea were twice as high in,Districts III. and IV. as in the northern half of the city,which is doubtless due to the use of the water from the-thousand or more of foul tanks in the former. Eemales-

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suffered universally more than males, probably owing totheir more constant use of this foul water. Epidemic dropsyreappeared during the latter half of the year in an epidemicform. Dr. Pearse draws attention to the frequent occurrenceof cases indistinguishable from cases of beri-beri; thusthese showed deep-seated pain in the legs and calves, im-pairment or loss of knee-jerk, unsteadiness of gait, andcardiac trouble. Anaesthesia, which had not been noticed inprevious outbreaks, occurred in the one under notice. Deathoccurred also, sometimes suddenly. It is apparently a com-municable disease with an incubation of about three days.The report concludes with an account of the work of the

department in the laboratories, the work carried out by thefood inspectors, with other matters, and finally, variousexcellent sanitary reforms are suggested as regards privies,municipal cowsheds, and slaughter-houses. The provisionfor displaced population and for the removal of infectiouscases to hospital is also at present wholly inadequate to therequirements. This is a most admirable report.

Burma.

Major C. E. Williams, I. M.S., the Sanitary Commissionerfor Burma, furnishes the annual report for 1907. Since theretirement of his predecessor Colonel W. G. King, the officesof Inspector-General of Civil Hospitals and Sanitary Com-missioner have been separated, Major Williams being ap-pointed to the new post of Sanitary Commissioner to theprovince. With reference to the vital statistics, the total

population, which in 1901 was 8,485,980, had increased byMarch lst, 1908, to 9,731,233. There was an increase ofbirths over deaths to the amount of 52,841 ; the registrationof births and deaths, however, the Sanitary Commissionershows, is capable of much improvement. As regards therainfall, that in Lower Burma was much in excess of that in1906, whilst in Upper Burma the contrary obtained, thelatter year having showed a great decrease. No excessivesickness or mortality, however, appears to have resulted fromthis scarcity in 1907. The death-rate for the whole provincewas 26 - 60 per 1000.

Turning now to the chief diseases, we see that choleraaccounted for 8378 deaths, showing an increase of 506 overthe previous year. The Irrawady Division, as usual, sufferedmore than any other. Upper Burmah escaped entirely withthe exception of an outbreak in the Lower Chindwar whichaccounted for over 100 deaths. The Sanitary Commissionershows how the river water is the chief vehicle for the spreadof the disease. Thus at Rangoon it was practically confinedto dwellers on or by the banks of the river and main creeksnot provided with a pipe water-supply or with an efficientconservancy system. A number of samples of river waterstored in the dwellings of persons infected with cholerawere found to contain vibrios giving many of the reactionstypical of the vibrio choleras, and similar organisms werepresent in samples of water taken from the streams and creeksin the vicinity. Such water is employed in cook-rooms towash the food utensils and for other domestic purposes.The cold fresh water tanks were not under suspicion as theywere resorted to by a large population of Burmans and otherswho did not suffer from cholera, and microscopical examina-tion of samples of the water showed it to be free fromvibrios. During the last two successive years a row ofbuildings overhanging the river in the Kamakisit quarter, andoccupied by Mahomedan Khalasis employed on river launchesand steamers, supplied many cases of cholera, whilst theresidents of the adjacent rows of houses a few feet away,nearly all Burmans, escaped infection. The latrines used bythe Mahomedans overhang the mud shore, which is washedby each returning tide, and from the water thus polluted theresidents of the huts drew their supplies, which were foundstored in jars adjacent to their cooking places and drinkingwater-jars, and either supply was, no doubt, used somewhatindiscriminately by the cooks. In the North Kemmendinequarter of Rangoon the water of a certain well was

found to originate cases ; its closure put a stop to thedisease. The Sanitary Commissioner also thinks that theriver water is itself the vehicle for the spread of the cholerapoison, as the excreta of 50,000 persons fall into it directlyfrom overhanging latrines or are washed into it by therising tides or by heavy rain. To remedy thesedefeots an ample supply of fresh water is recommendedfor all purposes, whilst an efficient system of conservancymust be introduced into the riparian quarters and the

shores of the rivers and creeks must be kept free frompollution. Thus the spread of infection will be reduced,although the population afloat will still be a source of

danger. Amongst the preventive measures introduced weare glad to notice that facilities for boiling water wereadopted, the washing of clothes in the river was prohibitedduring the cholera season, and the erection of new dwellingsclose to the banks of the creeks was prevented in accordancewith the policy suggested by that energetic officer, ColonelKing.Regarding fevers, we note that there was an increase of 3401

cases over the return for 1906. Enteric fever was found tobe more widely distributed than was formerly supposed, thediagnosis having been confirmed by Widal’s reaction and bypost-mortem examination. Distribution of quinine by tablets,which are much preferred to powders on account of thebitter taste of the latter, takes the first place in the pre-ventive measures against malaria in this province. Othermeasures are the formation of mosquito brigades, drainageschemes, and the clearing of brushwood in the vicinity oftowns. Small-pox occurred in 1908 with less frequency inLower Burma than in 1907, there being 6371 fewer deaths,whilst in Upper Burma there were, on the contrary, 713more deaths. A vaccination manual is under preparationfor the approval of the Government defining the duties of thedistrict vaccination establishment and enabling thereby itsservices to be utilised to the fullest advantage. With respectto dysentery and diarrhoea, there was a decrease of 837deaths on the 1906 return.As regards plague, an increase of 612 over the more

tality of 1906 occurred. This increase was confined, how-ever, to Upper Burma, there being a decrease of 197 inLower Burma. The Sanitary Commissioner points out thatthe disease is really much more prevalent than the returnsshow. Thus there was an enormous unexplained rise in thedeath-rate at Prome at a time when plague was believed tobe in abeyance, and similar occurrences elsewhere lead himto think that the plague mortality has been under-estimated.The measures in force for the limitation of its spreadin already infected areas were surveillance, rat destruc-

tion, cleaning measures, chemical disinfection, earth-oiling,evacuation, and inoculation ; of these the first was ineffective.Every measure for the suppression of plague in a definedarea must aim at the destruction or exclusion of rats. Toeffect this all refuse must be removed, the dwellings con-stantly cleaned, and the quarters for domestic animals mustbe separated from those of their owner. Specially trainedgroups of men must be employed to exterminate the rats.

It has been found by Major Williams and Captain Ba Ket,I.M.S., special plague medical officer, that infection

usually starts in a neighbouring public bazaar or in the

principal stores found in its vicinity. Stables are anotherconstant centre, especially pony stables, the wooden flooringof which is so constructed as to leave a secure retreat forthe rats underneath it; in contradistinction, where a

masonry pavement was laid down not one rat was observed.The Simpson steam and sulphur fumigator, exhaustivelyapplied, did not have results coming up to expectation,and, moreover, no material for the piping was found capableof resisting the action of the combined steam and sulphurfumes, nor has the asphyxiator machine proved of muchservice. Major Williams rightly holds that where thewooden floors have been removed to get at the rats it is ofchief importance to replace the floors by a masonry plinthor to raise the floors so that inspection and cleansing of theground underneath can be efficiently carried out. 7,544,645rats were reported to have been destroyed in 1907. 18,164persons were inoculated with Haffkine’s fluid, of whomonly 60 people subsequently contracted the disease, with43 deaths. Not much benefit accrued from earth-oiling.Chemical pulicides, as a spray, such as izal or cyllin withpetrol, are claimed to have germicidal as well as pulicidalqualities, concerning which experiments are being carriedout. In conclusion, the prevalence of plague was foundduring the last six months of 1907 to have been much lessthan in the corresponding period of previous years in nearlyall towns and districts.The remaining portion of this valuable report contains an

account of the Port Health Department, of the civil sanitarywork, some remarks on the necessity of model sanitary work,with the various appendices. Last year we dwelt on theextremely able report of 1906 of Colonel King, the Sanitary

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Commissioner, and from a consideration of the one for theyear 1907 we see that his mantle has fallen on no un-

worthy shoulders. IROYAL COLLEGE OF PHYSICIANS OF

LONDON.

ELECTION OF PRESIDENT.AN extraordinary Comitia was held on April 5th,

Sir R. DOUGLAS PowELL, Bart., K.C.V.O., the President,being in the chair.The PRESIDENT announced that he had nominated Dr. W.

Pasteur as the representative of the College at the 350thanniversary of the foundation of the University of Genevato be held in July next.The PRESIDENT expressed his thanks to the College for the

expression of sympathy on the death of Lady Douglas Powell,passed at the last Comitia.The PRESIDENT then delivered his annual address, in

which he offered congratulations to those Fellows, Members,and Licentiates of the College who had received Royalhonours during the past year. He also referred to theawards of medals, prizes, and scholarships by the Collegeand drew attention to the Harveian oration and the lectureswhich had been delivered at the College. He mentionedthe gifts to the College, particularly that of the lateMr. Charles Coates of Bath who gave .&1000 for the pur-poses of the hospitality of the College. The financial con-dition of the College was satisfactory. He alluded to theincreased number of colonial graduates who had appliedto be admitted to the examinations, and also to theaction which had been taken to oppose the charter or certainof its clauses which was being asked for by the BritishMedical Association. The President then proceeded to readobituary notices of those Fellows who had died during thepast year :-Dr. C. J. Cullingworth, Dr. Edwin Rickards, Dr.B. L. Abrahams, Di. Henry Ashby, Sir Thomas Stevenson,Sir Henry A. Pitman, Dr. Charles E. Beevor, Dr. PeterHorrocks, Mr. Charles Coates, and Dr. Arthur Gamgee. Heconcluded by expressing his thanks to the officers, censors,and Fellows of the College for the services which they hadrendered him during his year of office.The SENIOR CENSOR (Dr. NORMAN MooRE) moved, and the

SECOND CENSOR (Dr. F. DE HAVILLAND HALL) seconded, thatthe President should permit his address to be printed. Thiswas carried and the request was acceded to.

Sir R. Douglas Powell then vacated the chair. A vote ofthanks to him for his services during the past year wasmoved by Sir W. S. CHURCH and seconded by Dr. C.THEODORE WILLIAMS, and carried with acclamation.The election for President then took place, when Sir R.

Douglas Powell was re-elected by a very large majority. The

charge and insignia were delivered by the SENIOR CENSOR.The PRESIDENT then gave his faith to the College, andthanked the Fellows for the honour once more conferred

upon him.The following communications were received : 1. From

the secretary of the Royal College of Surgeons of England,reporting the proceedings of its council on Feb. llth andApril lst last. 2. From Miss Amy Maxwell, offering throughSir William Allchin for the acceptance of the College aphotographic copy of a miniature portrait of her grandfather,Dr. Anthony Todd Thomson, a former Fellow of the

College. The gift was accepted and the thanks of the

College were ordered to be returned to the donor.After some discussion the following by-law for the

admission of women to the examinations of the Collegefor qualifications was enacted for the first time -Women shall be eligible for admission as Licentiates and Members of

the College and for the grant of a Diploma in Public Health on the sameterms and conditions as men, and so far as is necessary to give effect tothis by-law, words in the by-laws and regulations importing themasculine gender shall include females, and all proper alterations shallbe made in the forms of the Letters Testimonial and the Licence grantedby the College. Provided always that women shall not be eligible forelection as Fellows of the College or be entitled to take any part in thegovernment, management, or proceedings of the College.A communication was received from the Harveian librarian

(Dr. J. F. Payne) on a proposed commemoration of the400th anniversary of the birth of Dr. Caius, formerly Presi-dent and benefactor of the College. Negotiations were pro-ceeding with Gonville and Caius College, Cambridge, for

reprinting some of Caius’s works.

A report from the Committee of Management, datedMarch 9th, was received and adopted. The report recom-mended that the University of St. Andrews be added to thelist of institutions at which the complete curriculum of pro-fessional study required for the diplomas of the RoyalColleges may be pursued and whose graduates may be ad-mitted to the final examination of the Examining Board inEngland, on production of the required certificates ofstudy.The PRESIDENT then dissolved the Comitia.

THE MEDICAL INSPECTION OF LONDONSCHOOL CHILDREN.

THE London County Council at two recent meetings hadunder consideration an important report signed by its Educa-tion Committee in December last and containing the recom-mendations of its subcommittee appointed in July, 1907, toinquire into : (1) the existing provision for the medical treat-ment of the Council’s school children; (2) the extent towhich this provision could be rendered more available by theaction of (a) the hospitals, (b) the Council; (3) what addi-tional provision, if any, is desirable; and (4) how this pro-vision should be supplied. The Council had also before it acomment by the Finance Committee upon this report, ofwhich we now print a summary together with a short accountof the Council’s debate upon the matter. The subcommitteewho presented the report was constituted as follows :-Members of the Council or of the Edueation Committee-TheChairman of the Education Committee, the Vice-Chairmanof the Education Committee, Miss N. Adler, Mr. A. A. Allen,Dr. R. M. Beaton, Mr. S. J. G. Hoare, Mr. E. A. H. Jay, MissA. Susan Lawrence, the Hon. H. Lygon, Mrs. Wilton Phipps,Dr. A. Salter, Major Skinner, and Mr. Graham Wallas.Representatives of outside institutions-Mr. Norman G. Bennett(British Dental Association), Sir Victor Horsley (BritishMedical Association), Dr. Sidney Phillips (Central HospitalCouncil for London), Dr. Charles Gray (Charity OrganisationSociety), the Right Hon. Lord Cheylesmore, C.V.O, (Metro-politan Hospital Sunday Fund), Mr. Douglas Owen (LondonHospital), Mr. Robert J. Bland (Royal London OphthalmicHospital), and Dr. H. Morley Fletcher (St. Bartholomew’sHospital). This subcommittee held ten meetings, at whichthe following witnesses were examined :-Mr. HerbertParsons, Dr. J. H. Sequeira, the late Dr. L. Abrahams, Mr. P.Macleod Yearsley, Mr. Wallis, Mr. Bishop Harman, MissWright (head mistress of Shepperton-road L.C.C. school),Miss Foxlee (head mistress of Haseltine-road L.C.C. school,and formerly head mistress of Waterloo-road L. C, C. school),and Miss E. M. Phillips (head mistress of Hanbury-streetL.C.C. school), Mr. Warren, and Mr. Hancock Nunn. Italso considered a report of the section of the day schoolssubcommittee on the work of the medical officer, memorandaby Mr. Norman Bennett, Mr. Herbert Parsons, and Mr.Bishop Harman, a memorandum prepared by the BritishDental Association, and a report from Dr. G. Cunninghamon the working of the Cambridge School Dental Clinic.The following inquiries were addressed to 50 hospital

authorities in a circular letter :-

(i.) What number of children of school age is being treated at thehospitals.

(ii.) What number could be so treated.(iii.) What number of cases falling under the following heads could be

dealt with :-(a) refraction, (b) discharging ears, (c) chronic parasiticdiseases, (d) dental.

(iv.) What measures are adopted in the hospitals for relief of the largenumber of chronic debilitated children suffering from various super-ficial troubles of eye, ear, and nose, lack of nutrition, and nervousdebility.

(v.) Whether the hospital authorities are satisfied with what they areable to do in regard to children with tubercular bone diseases.

A further letter was addressed to 198 hospitals, dispen-saries, and kindred institutions within the county, asking,

(i.) What number of children under 14 was treated during the years1906 and 1907 for various ailments of the teeth, distinguishing betweentreatment (a) for preservation ; (b) extraction of teeth ?

(ii.) What number of children under 14 was treated during the years1906 and 1907 for various affections of the eyes, distinguishing between(a) errors of refraction ; (b) actual diseases ?

(iii.) What accommodation exists for the treatment of children under(i.) and (ii.) respectively ?

(iv.) Would it be practicable (a) to treat larger numbers of childrenduring the regular hours of work of the institution; or (b) to use theinstitution under special arrangements outside the regular hours for the

exclusive treatment of elementary school children.