1252 THE PROGRESS OF REFORM IN EGYPT.

relate to a large number of samples, were quite satis-

factory, as may be gathered from the following examples. In

the first instance, a prescription was presented containingliquor arsenicalis and tinctura ferri perchloridi as its

important constituents. The amount of arsenic in the

mixture worked out at 0’036 grain per half fluid ounce andthe iron at 0’91 grain per half fluid ounce. In one prescrip-tion the amounts of arsenic and iron found were 0’ 038 grainand 1’0 grain respectively. At another shop the medicinewas found to contain 0’045 grain of arsenic and 1’46 grainsof iron respectively per half fluid ounce. On anotheroccasion quinine hydrochloride with hydrobromic acid wasordered, five grains of the former and hydrobromic acidequivalent to 1’82 grains per fluid ounce. The amountsof quinine hydrochloride and hydrobromic acid found inthe medicine made up at one shop were respectively5’05 grains and 2’ 0 grains. At another shop the amountsrespectively found were quinine hydrochloride 4’90 grainsand hydrobromic acid 1 80 grains per fluid ounce. In athird instance a mixture was ordered containing per fluidounce 10 grains of ammonium bromide, five grains of sodiumbromide, and five grains of potassium bromide. Analysissubsequently showed 11-06 grains of ammonium bromide,4’50 grains of sodium bromide, and 5’2 grains of potassiumbromide. As time permits we hope to continue this inquiry,but meanwhile the results so far show that as ’a rule

prescriptions are made up with distinct accuracy. Weshould be surprised if it were otherwise, as the pharmacistrealises the pains and penalties which he is likely to riskby stepping from the path of integrity and he knowsthat he may at any time be subjected to an official test.

THE PROGRESS OF REFORM IN EGYPT.

THE Earl of Cromer’s annual report is more interestingthis year than usual, His Majesty’s Agent and Consul-general having decided that the moment was opportune forthe introduction of a historical retrospect extending overthe last 20 years. It is as well, he says, that the Egyptiansof the rising generation, to whom a good deal of rather wildtalk is at times addressed, should be reminded of the realfacts of the case. In 1878 a commission of inquiry, ofwhich Lord Cromer himself was a member, summed up the-situation as it then existed in the following terms : " 11 s’agit,en effet, de creer tout un systeme fiscal, et cela avec un

personnel tres restreint ; present presque rien n’existe dece qui doit exister." " The commission found that theabuses which had grown up in every branch of the

Egyptian body politic were so general and so deeplyrooted as to defy the application of any remedy whichwould be effectual and at the same time speedy."They had to deal, not with a patient suffering froma single malady, but with one whose constitution was

shattered and whose every organ was diseased." The task

- set before Lord Cromer and his select band of reformerswas truly herculean, demanding as it did a reduction of

excessive taxaticn and at the same time the introduction of

expensive reforms in every direction, but more especially inthe direction of drainage and irrigation. During the 20

years from 1882 to 1901 the total revenue from all sourcesamounted to ;6E.224,206,151, while the outlay during the

same period came to E. 213,765,415, the balance of

..BE. 10,440,736 representing the sums in reserve whichare at present at the disposal of the Commissioners

of the Debt. Irrespectively of the relief to the popula-tion in general by the reduction of the salt tax and bythe lowering of the postal, railway, and telegraph rates,taxation to the amount of about £ E.32, 000, 000 has beenremitted, and this in spite of an extra charge of upwards ofsix and a quarter millions which has resulted from the re-

occupation of the Sudan. The aggregate amount granted to

. the sanitary department during the 20’years was £ E.1, 852, 515,or less than 1 per cent. of the entire expenditure. The, greater part of this money was devoted to medical rather: than to sanitary work, and in addition " considerable sums

were spent on hospitals, being debited against the publicworks budgets. In this connexion Lord Cromer says :"Some further expenditure, notably in the direction of

making proper provision for lunatics, will probably berequired in the purely medical branch of this department."His lordship also says that it would be a great mis-

take to suppose that of late years nothing has been

done to improve the sanitary condition of the country. Suchits far from being the case. Suitable sites for cemeteries

have been provided for almost every village in Egypt. The

important and difficult work of placing the mosques in agood sanitary condition has been steadily proceeding for

many years. Pure drinking water has been provided inseveral of the larger provincial towns, the main difficultybeing to get the people to use it. Many of the birkets,or stagnant ponds, which exist in the neighbourhood of mostEgyptian villages have been filled up. Heavy expenditurehas also been incurred at the quarantine establishment atTor. At the same time it is certain that much remains to bedone. "My personal opinion, continues Lord Cromer, "isthat it would be a delusion to suppose that sanitation, which,it must be remembered, is a comparatively modern science,can produce in this country anything like the results obtainedin Europe until, with the advance of knowledge and education,the ideas and habits of the mass of the population undergo amaterial change. Nevertheless, I fully recognise that, to

some extent, the Government must take the lead in a matterof this sort. When funds are available more money should

certainly be spent on sanitation." This is a highly satis-factory declaration. The exigencies of finance have hithertointerfered sadly with the development of sanitation in

Egypt, but in 1890 Lord Cromer was able to announce thewelcome fact that " financial equilibrium was secured andhe now adds that the "moment has arrived when fiscalreform need no longer be placed in the front rank.

" That

the necessary funds for sanitation on a large scale will soonbe available is probable. In 1905 the increased revenue tobe derived from the construction of the reservoirs will beginto flow into the treasury. "From that time onwards, there-fore," says Lord Cromer in conclusion, "it may be hopedthat administrative reform, in so far as it depends onfinancial policy, may occupy a more prominent place in theGovernment programme than heretofore. I may add that,in my opinion, the points which most require attention arethe Police, the Department of Justice, and Sanitation."

AN IMPORTANT STEP.

THE pecuniary difficulty which may beset the youngmedical man who decides upon continuing work at his

hospital after qualification and the holding of resident

appointments is often an overwhelming factor in causinghim to alter his decision. As matters stand at present it isoften the case that the man who by nature and ability isbest fitted to continue hospital work and to devote himselfentirely to one particular branch of his profession is unableto do so because of the inadequate rewards attaching tothe posts which for many years he will be called uponto fill. That this should be the case is obviously a pity,not only from the point of view of the medical professionbut also of the general public Unfortunately, it is not

always as obvious to the lay mind as it is to the mind of themedical man that services such as those rendered by regis-trars, curators, and pathologists at hospitals are in reality ofas vital importance as those of the physicians and surgeons.The work of the latter is palpable and appeals to the mostuninformed; the necessary work of the former does not

1253IS PLAGUE SPREAD BY FLEAS ? ‘!

equally strike the mind of the general observer and its in-trinsic importance and its bearing upon the general progressof medicine and surgery are therefore apt to be over-

looked. We can, therefore, speak in terms of commenda-tion of the recent action of the governors of St. George’sHospital in deciding to award to the posts of registrar,curator, and assistant curator the yearly sums of 200 for theregistrars (two:medical and one surgical) and curator and£100 for the assistant curator. In making these awards theboard, very largely composed of laymen, shows a just appre-ciation of the services to which we have referred and hasthe satisfaction of knowing that at its own hospital at

least it is open to every man, however straitened his mean

may be, to devote himself to the work for which he is mostwanted and for which his talents best fit him.

HERPES OF THE OPHTHALMIC DIVISION OF THE

FIFTH NERVE WITH OPTIC NEURITIS.

HERPES of the ophthalmic division of the fifth nerve is

sometimes complicated by conjunctivitis or iritis ; more

rarely there is paralysis of some of the ocular muscles or theoptic nerve is affected. Very few cases of optic neuritis andatrophy, unilateral or bilateral, in the course of herpes of theophthalmic division of the fifth nerve have been published.In the Gazette Hebdomadaire des Sciences Medicales de

Bordeaux of April 12th Professor Cabannes has publishedthe following case. A man, aged 30 years, was admitted tohospital on Jan. lst with pain and inflammation of the lefteye and side of the face. On Dec. 24th, without apparentcause, the attacks suddenly began with redness and lacryma-tion of the eye and pain in the forehead and upper lid onthat side. On the first day the pain was moderate but onthe following days the redness and pain increased and visionin the left eye diminished. On Dec. 28th the redness, tillthen confined to the eye, rapidly involved both lids, the lefthalf of the nose, the left side of the forehead, and thecorresponding half of the cranium in its anterior andmiddle part. The erythema was accompanied by consider-able swelling of the skin which was swollen, tense, and

shining. The very cedematous eyelids prevented the eyefrom being opened and the conjunctiva was intenselyinjected. After some hours little pruriginous vesicles

appeared in confluent groups. The contents were at first

lemon-coloured or haemorrhagic but soon became purulent.On admission erysipelas was diagnosed. At this time

the eye was not painful but the lids were greatlyswollen and glued together by muco-purulent secretion,there was chemosis of the conjunctiva, and the cornea

had lost its polish and was a little opaque. The patientsaid that he had never felt ill during the attackbut after admission his temperature several times reached100.4° F. On Jan. 12th the eyes were more thoroughlyexamined. The left upper lid was rosy and so osdema-tous that the orbito-palpebral wrinkle was effaced. On

separating the lids with the fingers the ocular and palpebralconjunctiva showed a uniform rosy injection. There wasthen no chemosis. In the internal and central part of thecornea was a small diffuse opacity of the size of a lentil,cloudy, and difficult to appreciate in consequence of its

slight intensity. The affected part of the cornea was

insensible to contact and to pricking. The externalthird of the cornea was completely transparent and its

sensibility was normal. The line of transition between anæs-thesia and sensibility was vertical. The anterior chamberwas deep. The pupil was dilated and immobile. (Somedays before a single drop of atropine solution had been

put in the eye.) Vision in the right eye was normal ; in

the left it was almost entirely lost, light could scarcely be perceived. The left fundus was difficult to examine, not

only because of the state of the cornea but also because the

vitreous was cloudy. The optic disc was a little pale, thearteries could scarcely be seen, but the veins were turgescentand tortuous. There was no swelling of the disc. Near thedisc were two flame-like hæmorrhages parallel to the courseof the veins. The ocular tension seemed to be slightlydiminished. The redness of the forehead had muchdiminished and the skin showed brown pigmentationespecially around the crusts left by the vesicles. The-whole affected region, which was sharply limited bythe middle line and externally by an irregular line

running from the external angle of the eye to the

parietal region, was hypæsthetic. On Jan. 27th the eyewas still red and watery and its tension was diminished ;

the cornea was completely transparent and showed onlya slight loss of polish in its internal part, but the anoes-thesia persisted. There was already somewhat advancedatrophy of the optic nerve. The disc was markedly pale7.the arteries were considerably narrowed, and the veins werecongested. The haemorrhages had disappeared. Professor

Cabannes calls attention to the characters of the opticneuritis-early onset in the disease, intense conger ttonwithout oedema or marked strangulation of the vessels, andthe haemorrhages. In these the process resembled the opticneuritis of the acute infectious diseases such as typhoidfever and secondary syphilis. We may add that this is,

interesting in the light of the modern view that herpes zosteris a nervous complication of infectious diseases. Thus the

optic neuritis, like the motor paralysis which sometimesalso occurs, may be regarded as of similar origin.

IS PLAGUE SPREAD BY FLEAS?

AT a meeting of the Bombay Medical and Physical’Society held on Feb. 13th Captain W. Glen Liston, I.M.S.,read a paper on Some Facts which would appear to associateFleas with the Spread of Plague. He said that the reportof the Indian Plague Commission showed that the common,mode of the entrance of the plague bacillus into the human,organism was through the skin. With regard to rats thecommission concluded that the infection of these animals,either through the alimentary canal or through the mucousmembrane of the nose, could not be very common. It wouldtherefore appear that both human beings and rats are forthe most part infected through the skin. It is also well

known that plague spreads in a certain class of houses-

namely, in those which are dirty, dark, overcrowded, andvermin-infested, whereas in houses or hospitals which areclean and have a sufficient access of air and light it may beintroduced again and again without the infection spreadingfrom man to man or man to rat. Dr. Simond was the first.

to suggest that plague might be communicated by fleas notonly from man to man and rat to rat but from rat to manand man to rat: his paper on the subject was published inOctober, 1898, in the Annales de l’Institut Pasteur. The

arguments on which he relies are, however, far from beingconclusive, and in connexion with the theory of the con-

veyance of plague by rats it has always been found difficultto explain why certain epidemics of plague among rats havenot been followed by epidemics among men and vice vers â

Captain Liston suggested that an explanation might perhapsbe found in differences existing between the human flea

(pulex irritans) and rat fleas. When in England he haddescribed the common rat flea of India to the Hon. Charles

Rothschild, a great authority on the Siphonaptera, whobelieved that it was probably similar to pulex pallidus, aspecies which had been found in South Africa and Australia.The common rat flea of India is at first sight very likethe human flea, but close examination reveals certaindifferences between the two species, principally (1 in thesize and shape of the claws on the legs in both sexes and