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California, while Russia was the only European countryaffected. In 1905 the mortality from plague in India fell alittle below 1,000,000. In Asia its distribution was not

materially changed. The disease was brought to Liverpoolfrom Rangoon, to Manchester from Buenos Ayres vii

Hamburg and Middlesbrough, and to Leith. In 1906 a

great decrease of plague took place in India, only 332,000deaths resulting, but the following year was marked by agreat increase, 1,200,000 deaths being reported. It invaded

new territory in Northern Africa, notably in Tunis and inAlgeria. The report includes tables, showing the distribu-tion of the disease year by year in countries and in localities,together with a list of vessels on which cases of plagueoccurred, with the names of the ports of departure andarrival.

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THE USE OF PICRIC ACID IN BURNS.

THE specific action of picric acid in the treatment of burnsat first led to the belief that an ideal curative agent hadbeen discovered, but it was soon found that when unwiselyused it produced serious toxic symptoms. The treatment

of burns is highly important because it is necessary to

prevent shock as well as to relieve pain. The value of

picric acid in this connexion is described by Dr. C. P.Martin in the International Toicrotc7, of Sitrgery for August.It has been the custom for many years to relieve the painresulting from burns by administering morphine, but Dr.Martin finds that the severity of the shock may bediminished and the pain relieved by the use of a picric aciddressing without giving morphine. Sterile gauze, soaked ina solution of picric acid containing 60 grains in 16 fluidounces of sterile water, should be applied directly tc

the burned surface, covered with rubber tissue and cottonwool, and finally held in position by a bandage. Aftej

48 hours the dressing is renewed unless any infectiorhas occurred, when the surface should be first washed with ! -,solution containing ten grains of potassium permanganate ii

JZ fluid ounces of sterile water. Then from day to da;the dressing is renewed until the surface looks hard and drywhen the dressings are discontinued and the surface i

covered with oxide of zinc, leaving the parts fully exposelto the air. One great advantage in the use of picric act’lies in the fact that the first dressing does not need removinfor 48 hours, after which time shock need no longer bfeared. The dressing absorbs the discharges from the burand thereby prevents septic absorption. Any dressin

which keeps these discharges in contact with the absorbinsurface of a burn invites the onset of severe constitution:

symptoms. Picric acid is sterile and antiseptic ar

stimulates the production of new tissue. The yellow staproduced by picric acid may be removed by first washing tlhands in weak ammonia water and then bleaching them wia pure solution of hydrogen peroxide, which may be coveniently applied on cotton wool. The staining of f

patient’s clothing need not occur if the cotton wool bearranged that it absorbs the discharges as they escape..to the fear of poisoning, Dr. Martin believes this to be duethe use of too concentrated solutions of picric acid.regard to oil dressings he points out that oilneither sterile nor antiseptic, and it may form a suable medium for the growth of organisms, even if itsterilised before use. An oily dressing will not absorb d

charges and it requires to be changed after 24 hours as itthen in a septic condition. When the parts have once b!

bathed in oil it is almost impossible to clean them thoroug]before applying other dressings. Carron oil itself, in :Martin’s opinion, has no healing properties and requiresbe followed by another dressing if rapid and satisfactresults are to be obtained. In cases of emergency, in f

in all cases of burns, it is necessary that the dressing shouldbe ready to hand. This requirement is well met by picricacid, which may be kept in the form of dry picric gauze,requiring only to be moistened just before it is applied.

MR. CARNEGIE AND MEDICAL HEROES.

THE latest of Mr. Carnegie’s apparently inexhaustiblebenefactions, which is reported to have brought up thesum of his gifts for public purposes to something over

25,000,000, has, he tells us, been prompted by the successof the "Hero Fund " in North America. This has been so

great that its founder has decided to extend its benefits tohis own land, and it is now common knowledge that thisopen-handed millionaire has paused for a moment in his sendowments of the libraries and other centres of educa-tion to hand over one and one-quarter millions of dollars tothe Carnegie Dunfermline trustees for the object which hehas set forth in a very characteristic letter. He wishes thatthose many brave men and women who suffer bodily injuryduring heroic efforts to save human life performed in times ofpeace in the British Islands and the waters thereof," shallby means of this fund be put in a financial position a littlebetter, if anything, than was theirs before their act of self-sacrifice until they are able to work again. And if a bread-winner shall have given his life to save some fellow creature

, his widow and children may claim support from the funduntil such time as they can support themselves. The fund

i may have a higher function than simple compensation, forl it may actually rehabilitate some obscure hero who has risenito his opportunity out of a miry past of which he would fain1 hide the traces. Such a one is to be eligible for his

3 pension so long as he behaves himself without any questions1 being raised of his antecedents. Mr. Carnegie deprecatesr strongly any suggestion that his fund shall replace thetl compensation offered in cases of accident resulting froma heroism by private or public agencies already existing.n These should bear their burden willingly, he thinks,y but he desires to make it absolutely sure that full pro-r, vision may be made for every case. It is not surprisingis to anyone who has read the terms of this new trust

d to learn that it has the support and sympathy ofd the highest in the land, whose word is to be law

Lg in certain questions of its administration. It would, how-)e ever, hardly concern us to chronicle it, save inasmuch as

m every premium upon courage and self-sacrifice makes

ig for the well-being of the State, were it not for the

ig fact that Mr. Carnegie in his letter specifies in par-al ticular only two classes as being notably productive of3.d heroes, although we are quite sure that he makes no

,in mental distinction between the bravery displayed in timehe of need by, say, the miner whom he does not mention and.th the railroad employee whom he does. But his most prominentm- instance is this: "No action is more heroic than that ofhe doctors and nurses volunteering their services in the case ofso epidemics." We take it for an especial virtue in Mr.As Carnegie that in his benefactions he does not forget theto members of a profession the simple exercise of whichIn in the eyes of so large a number of people shouldis bring its own reward, but we must confess to some

lit- surprise at his having chosen out an almost routine dutybe of its practitioners for special illustration of the quality

lis- of heroism. It is true that Mr. Carnegie limits his instance toj is medical ministry during epidemics but we can hardly thinkeen that he holds less lightly the action of "doctor and nurse"

"

hly who attend any patient suffering from a dangerous infectiousDr. disorder even though it be not widespread in the community.; to Indeed, it might be said that their service is less heroic

;ory in attending a rich person at a time when they would befact liable to the disease, whether they attended him or not, than

1026

it would be in exposing themselves to the risk of infection ata time when there would be no likelihood of their taking itif they held aloof from that one particular case. The idea

of a medical practitioner or nurse running away to a non-infected area in times of epidemic is, we hope, inconceivable.But we are ready and proud to admit that cases of specialmedical heroism in such times do occur which are

particularly worthy of such practical recognition as

Mr. Carnegie offers. Ready instances may be quoted fromIreland where it happens often that a district medical officerhas to treat typhus fever with no available assistance andperhaps in opposition to an ignorant and frightenedpeasantry. Many will recall the death of William Smythseven years ago after his splendid struggle waged againstthe waves of Donegal and still more against the humancowardice that refused him and his brave colleague,Dr. McCarthy, any aid in rowing over a crazy boat

to fetch the patients suffering from typhus fever underhis charge from their hovels on Arranmore Island to the

hospital on the mainland where they could be treated

properly. It will be remembered how Smyth contracted thedisease and died, a martyr to duty, if ever there was one.At that time in appealing for a memorial fund to help hiswidow and eight children we wrote : "If he ever knew thathe had accomplished the work that he set himself to do he diedwithout thought of the praise his deed would earn for hismemory but only with the consciousness that he was leavingthose he loved to face the world before he had time to make

provision for them." " That bitterness may now be spared tothe medical man whose life shall be required of him as theprice of his admission to the ranks of such heroes. The

profession will be no less grateful that their brothers whohave suffered severely in the cause of science or humanitybut who have escaped with their lives will be rememberedunder the benefits of Mr. Carnegie’s new trust fund, and inthis connexion there will be a general hope that its

administration may have the case of Mr. J. Hall-Edwards,whose civil list pension is incommensurate with his injuries,brought prominently before them. Whilst he and manyothers have sustained grievous hurt in the legitimate pursuitof science it is perhaps well to point out that some haveto show less honourable because unnecessary scars.

Impetuous youth, especially, in medicine as in all other

fields of effort, will continue to mistake carelessness for

courage and foolhardiness for devotion to duty. We hopethat this fund may not seem to put a premium upon such pro-fessional rashness, and we could almost wish that its trusteeswould debar from its benefits any who, for example, sufferdirect infection in a bacteriological laboratory throughhabitual disregard of common-sense precautions, or whoseek to remove diphtheritic membrane from a tracheotomytube by sucking it, a proceeding which is quite unnecessarywhen proper provision has been made for emergency, butone which seemingly has an evergreen appeal to popularsentiment.

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CATS AS PREVENTERS OF PLAGUE.

THE Indian Medical Gazette for August prints another c

article by Lieutenant-Colonel Andrew Buchanan, I.M.S., 1

advocating the up-keep of cats as the best method of counter- 1

acting plague. The paper is rather discursive, but it never- 1

theless contains a large amount of interesting and valuable ainformation. During the past plague season, says the writer, 1

there have been epidemics of plague in 54 towns and villages ]

in Amroati district, and investigations have been made in l

nearly all of these to find how far the presence or absence of (

the disease could be accounted for by the absence orpresence of cats. The investigations were made by ’’ assistant i

surgeons, hospital assistants, tahsildars, patwaris, police, ]

vaccinators, and others," but the results were verified in ageneral way by Colonel Buchanan himself. The reports thathe received were too numerous and too voluminous for theinclusion of even a brief outline of them all in a short paper,but it was, he said, "perfectly clear from a perusal of themthat the keeping of cats is the method of preventingplague." " To all other methods, in his opinion, there are

objections more or less grave, but to the keeping of catsthere are next to none. Hindus object to killing ratsbecause the rat is the S’o7vari (means of locomotion) of theirgod Gunpati. Some of them even catch rats in order to letthem go free in the fields. Jains, it is true, object to cats,but in small towns they are few in number and in villagesthey are rarely to be found. In Saur plague was severeamong the Bhowani Dhers, but the Mallies, who keep,buffaloes and consequently cats, which are attracted

by the milk, escaped completely. The Dher is notallowed to keep cats because when a cat has kittensor dies in his house he is put out of caste. Some Dhers

living in wattle huts escaped the plague entirely. Thisat first puzzled Colonel Buchanan until he found that rats donot harbour in that kind of structure. Other Dhers living inmud huts were severely visited by the plague. So greatlywas the Dher community impressed by these facts that nowmany of them keep male cats, thus avoiding the caste

penalty so far as the birth of kittens is concerned. " It is-a

great pity," continues Colonel Buchanan, that the membersof the recent Plague Commission did not make some

experiments on the cat as a rat destroyer. Neitherthe members of the Plague Commission nor Professor

Haffkine in his recent lecture on the ’Present Methodsof Combating Plague ’ have, as far as I have seen, said

a word about the cat. One member of the Commission givesa whole page of figures to show that, in spite of vigorousefforts for a whole year, the number of rats could not be con-

siderably reduced by traps. He does not tell us whether

there was one trap or fifty, but I can assure him that his wholeargument would be completely upset if a few cats were

introduced." " Colonel Buchanan looks upon rat destruc-tion and inoculation as temporary expedients capable in

certain circumstances of yielding useful results but both inthe main hurtful because they distract, attention from theonly true remedy. ’’ The more attention we give to

inoculation," he says in conclusion, "the less we are

certain to give to the only sound common-sense method ofpreventing plague-viz., the keeping of the natural enemyof the animal that is responsible for spreading the disease."

MORTALITY FROM TUBERCULOUS DISEASE INTHE UNITED KINGDOM.

THE annual report relating to 1907 recently issued by theRegistrar-General for Ireland contains an interesting com-parison of the relative death-rates from tuberculous diseasein England and Wales, Scotland, and Ireland during the 43years 1864-1906. A diagram in this report shows that inthe year 1864 the death-rate from all forms of tuberculousdisease was equal to 3’ 3 per 1000 of the estimated popula-tion in England and Wales and to 3 - 6 per 1000 in Scotland,whereas it did not exceed 2’ 4 per 1000 in Ireland. We

referred to this diagram and to several other points whichare raised in the communication which follows, but many ofthe remarks of our correspondent are interesting, so that wepublish them in spite of the occasional repetitions. In

England and Wales the annual death-rate from tuber-culous disease has steadily declined during the 43

years referred to, and had fallen to 1 6 6 per 1000in 1905 and in 1906, this decline being equal to’51-5 5per cent. In Scotland the annual death-rate from this