3
545 NOTES FROM INDIA.—PLAGUE IN AUSTRALIA.-VITAL STATISTICS. will get some pleasure out of them, though indeed the surrounding country is so entirely unfavourable that we have never unpacked oui own machines. The roads are not roads at all-they are just cart-tracks across the veldt-and the man of our staff who bicycles most generally limits his roving to a patrol of the railway-line. Deelfontein, July 23rd. NOTES FROM INDIA. (FROM OUR SPECIAL CORRESPONDENT.) The Government of India and the Plague Commission Report.—Cholera and Plague in Bombay. THE Government of India have considered the report of the Indian Plague Commission on the measures for the suppression of plague. The methods which have been employed for the discovery of plague cases are (1) notifica- tion of sickness generally or of plague in particular ; (2) surveillance of arrivals from infected areas ; (3) grant of rewards for information regarding plague cases ; (4) employ- ment of volunteer agencies ; (5) inspection of villages in the neighbourhood of infected villages; and (6) house visitation and house searches. The fifth and sixth are found to be useful only in very exceptional circumstances and the em- ployment of paid spies and informers is considered a measure which should never be adopted. The methods of obtaining information regarding the occurrence of plague deaths are by registration of deaths and by corpse inspection. The compulsory examination of dead bodies has had to be abandoned so that careful local inquiries for the purposes of fixing the exact cause of death alone remains. The imperfect registration of deaths makes the statistics of deaths far from being even approximately accurate. The Commission consider the measures to check plague under the following heads: (1) removal of plague patients to hospital ; (2) segregation of contacts ; (3) evacua- tion of towns and villages ; and (4) disinfection. The Government of India desire that the removal of patients to hospital should be compulsory only in places and under circumstances where it can be carried out so com- pletely as to render it an effectual precaution. With regard to contacts the Governor-General in Council agrees that the segregation of contacts should be abandoned. Evacuation is generally beneficial but much depends upon climatic con- ditions, and in villages and small towns up to 10,000 people complete evacuation is generally possible and provides the most effective safeguard against the spread of the disease which has yet been discovered. The Commission report that chemical disinfection is the only measure which, where effectively carried out, imme- diately destroys the infective material in a room and renders the room at once practically safe for re-occupation. The Government of India do not agree that disinfection in towns should be restricted to the houses in which either cases of plague have occurred or dead rats have been found. The Commission think very little indeed is to be gained by the disinfection of the persons of travellers and recommend I that this should be abandoned. Then there are the measures to prevent the spread of plague from infected to uninfected areas: (1) measures to prevent the spread of plague by sea ’, to foreign countries or other places in India ; (2) measures ’, taken at the place of arrival of ships from infected ports ; ’’ (3) measures to prevent the spread of plague from one part ’, of India to another by railway ; and (4) measures to prevent the spread of plague by means of communication in India other than by sea or by railway. The Commission found that the work under the terms of the Venice Convention was carried out in a most thorough and conscientious manner and so as completely to satisfy the letter and spirit of the Convention. The Government of India under the second heading direct that in future the examination of passengers arriving from one infected port in India at another shall be discontinued. Under the other heads further changes are proposed. The disinfection of the personal effects of railway travellers will be altogether abandoned and all disinfection stations maintained on the railways will be closed. The detention of the ordinary traveller because he has come from an infected area is also condemned and " cordons cannot be made an effective means for preventing the spread of plague." The summing-up of the Commission on the various measures is that in the larger places disinfection and the evacuation of specially infected quarters are the only measures to be applied. For villages they recommend inoculation, chemical disinfection, and evacuation. The Government of India lay down their opinion that certain measures should never be undertaken. These are the employ- ment of paid informers or spies, the compulsory examina- tion of corpses, the shutting up of people in infected housas, and the prevention of their movement from the infected area by means of a cordon or any other device. The Government of India also give their opinion on certain other measures which should rarely be attempted. These are house visi- tations or searches, compulsory notification of sicknesq, and the grant of rewards for information as to the existence of sickness. The prospects of the monsoon have again become very, gloomy. Very little rain has fallen in some places and the south-west current is generally weak. If more rain does not fall in the northern part of the Bombay Presidency the suffering is likely to exceed anything that has yet been endured. The numbers under famine relief still exceed 6,000,000. Within the past fortnight the outbreak of cholera in Bombay has assumed alarming proportions. The general mortality has risen, however, in greater degree and last week the total deaths registered were 1524-being 305 more than in the previous week. The registered deaths from plague have also increased. Every precaution is- being taken with regard to the water-supply and all well water is exa- mined and the wells are disinfected. Every house where a case occurs is promptly disinfected and the clothing of the patient is burnt. In other parts of India the plague con- tinues subdued. There is now very little in Calcutta and Karachi is declared to be free once more. July 26th. ________________ PLAGUE IN AUSTRALIA. (FROM A SPECIAL CORRESPONDENT.) THE returns of plague in Sydney for the week ending July 7th are as follows : Remaining at the beginning of the week, 62 ; admitted, 1; discharged, 6; died, none ; remaining at the end of the week, 57. The totals up to the end of the week are as follows: Cases, 297; deaths, 101 ; discharged, 139 ; "contacts isolated, 1689 ; "contacts remaining, 47; cases among " contacts," 7. The above figures include Chinese, of whom 10 were admitted, with eight deaths, all the other patients being whites. Down to the end of the week ending May 19th the weekly number of new cases continued high. For that week it was 24, and afterwards was in each week as follows : May 26th, 7; June 2nd, 17; June 9th, 4 ; June 16th, 10 ; June 23rd, 6; Jane 30th, 12 ; July 7th, 1. This sequence, taken together with the diminished severity of the disease, gives ground for hoping that the end of the outbreak has been nearly reached, and that it will soon be possible once more to furnish outgoing vessels with clean bills of health. In the meantime the measures and precautions hitherto taken have not been relaxed; however, the last area proposed for cleansing will be quarantined immediately, and then this method will be given up for the present. It remains to gauge its usefulness ; but this cannot be done until all the circumstances have been fully con- sidered-a business on which the staff of the Department of Public Health are now beginning to be engaged. July lOth ________________ VITAL STATISTICS. VITAL STATISTICS OF LONDON DURING JULY, 1900. IN the accompanying table will be found summarised com- plete statistics relating to sickness and mortality in each of the 43 sanitary areas of London. With regard to the notified cases of infectious diseases in the metropolis, it, appears that the number of persons reported to be suffering from one or other of the nine diseases specified in the table was equal to an annual rate of 7-0 per 1000 of the population, estimated at 4,589,129 persons in the middle of the year. In the three preceding months the rates had been 6-2, 7-2, and 6’9 per 1000 respectively. The

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545NOTES FROM INDIA.—PLAGUE IN AUSTRALIA.-VITAL STATISTICS.

will get some pleasure out of them, though indeed thesurrounding country is so entirely unfavourable that we havenever unpacked oui own machines. The roads are not roadsat all-they are just cart-tracks across the veldt-and theman of our staff who bicycles most generally limits his

roving to a patrol of the railway-line.Deelfontein, July 23rd.

NOTES FROM INDIA.

(FROM OUR SPECIAL CORRESPONDENT.)

The Government of India and the Plague CommissionReport.—Cholera and Plague in Bombay.

THE Government of India have considered the report ofthe Indian Plague Commission on the measures for the

suppression of plague. The methods which have been

employed for the discovery of plague cases are (1) notifica-tion of sickness generally or of plague in particular ; (2)surveillance of arrivals from infected areas ; (3) grant ofrewards for information regarding plague cases ; (4) employ-ment of volunteer agencies ; (5) inspection of villages in theneighbourhood of infected villages; and (6) house visitationand house searches. The fifth and sixth are found to beuseful only in very exceptional circumstances and the em-ployment of paid spies and informers is considered a measurewhich should never be adopted.The methods of obtaining information regarding the

occurrence of plague deaths are by registration of deathsand by corpse inspection. The compulsory examination ofdead bodies has had to be abandoned so that careful localinquiries for the purposes of fixing the exact cause of deathalone remains. The imperfect registration of deaths makesthe statistics of deaths far from being even approximatelyaccurate. The Commission consider the measures to checkplague under the following heads: (1) removal of plaguepatients to hospital ; (2) segregation of contacts ; (3) evacua-tion of towns and villages ; and (4) disinfection.The Government of India desire that the removal of

patients to hospital should be compulsory only in places andunder circumstances where it can be carried out so com-pletely as to render it an effectual precaution. With regardto contacts the Governor-General in Council agrees that thesegregation of contacts should be abandoned. Evacuation is

generally beneficial but much depends upon climatic con-ditions, and in villages and small towns up to 10,000 peoplecomplete evacuation is generally possible and provides themost effective safeguard against the spread of the diseasewhich has yet been discovered.The Commission report that chemical disinfection is the

only measure which, where effectively carried out, imme-diately destroys the infective material in a room and rendersthe room at once practically safe for re-occupation.The Government of India do not agree that disinfection

in towns should be restricted to the houses in which eithercases of plague have occurred or dead rats have been found.The Commission think very little indeed is to be gained bythe disinfection of the persons of travellers and recommend Ithat this should be abandoned. Then there are the measuresto prevent the spread of plague from infected to uninfected areas: (1) measures to prevent the spread of plague by sea ’,to foreign countries or other places in India ; (2) measures ’,taken at the place of arrival of ships from infected ports ; ’’

(3) measures to prevent the spread of plague from one part ’,of India to another by railway ; and (4) measures to prevent the spread of plague by means of communication in Indiaother than by sea or by railway.

The Commission found that the work under the terms ofthe Venice Convention was carried out in a most thoroughand conscientious manner and so as completely to satisfythe letter and spirit of the Convention. The Governmentof India under the second heading direct that in future theexamination of passengers arriving from one infected portin India at another shall be discontinued. Under the otherheads further changes are proposed. The disinfection ofthe personal effects of railway travellers will be altogetherabandoned and all disinfection stations maintained on therailways will be closed. The detention of the ordinarytraveller because he has come from an infected area is alsocondemned and " cordons cannot be made an effective meansfor preventing the spread of plague."The summing-up of the Commission on the various

measures is that in the larger places disinfection and theevacuation of specially infected quarters are the onlymeasures to be applied. For villages they recommendinoculation, chemical disinfection, and evacuation. TheGovernment of India lay down their opinion that certainmeasures should never be undertaken. These are the employ-ment of paid informers or spies, the compulsory examina-tion of corpses, the shutting up of people in infected housas,and the prevention of their movement from the infected areaby means of a cordon or any other device. The Governmentof India also give their opinion on certain other measureswhich should rarely be attempted. These are house visi-tations or searches, compulsory notification of sicknesq,and the grant of rewards for information as to the existenceof sickness.The prospects of the monsoon have again become very,

gloomy. Very little rain has fallen in some places and thesouth-west current is generally weak. If more rain does notfall in the northern part of the Bombay Presidency thesuffering is likely to exceed anything that has yet beenendured. The numbers under famine relief still exceed6,000,000. Within the past fortnight the outbreak ofcholera in Bombay has assumed alarming proportions. The

general mortality has risen, however, in greater degree andlast week the total deaths registered were 1524-being 305more than in the previous week. The registered deaths fromplague have also increased. Every precaution is- being takenwith regard to the water-supply and all well water is exa-mined and the wells are disinfected. Every house where acase occurs is promptly disinfected and the clothing of thepatient is burnt. In other parts of India the plague con-tinues subdued. There is now very little in Calcutta andKarachi is declared to be free once more.July 26th.

________________

PLAGUE IN AUSTRALIA.(FROM A SPECIAL CORRESPONDENT.)

THE returns of plague in Sydney for the week endingJuly 7th are as follows : Remaining at the beginning of theweek, 62 ; admitted, 1; discharged, 6; died, none ; remainingat the end of the week, 57. The totals up to the end of theweek are as follows: Cases, 297; deaths, 101 ; discharged,139 ; "contacts isolated, 1689 ; "contacts remaining, 47;cases among " contacts," 7. The above figures includeChinese, of whom 10 were admitted, with eight deaths, allthe other patients being whites.Down to the end of the week ending May 19th the weekly

number of new cases continued high. For that week it was24, and afterwards was in each week as follows : May 26th,7; June 2nd, 17; June 9th, 4 ; June 16th, 10 ; June 23rd, 6;Jane 30th, 12 ; July 7th, 1. This sequence, taken togetherwith the diminished severity of the disease, gives groundfor hoping that the end of the outbreak has been nearlyreached, and that it will soon be possible once more

to furnish outgoing vessels with clean bills of health.In the meantime the measures and precautions hithertotaken have not been relaxed; however, the last area

proposed for cleansing will be quarantined immediately,and then this method will be given up for the

present. It remains to gauge its usefulness ; but this cannotbe done until all the circumstances have been fully con-sidered-a business on which the staff of the Department ofPublic Health are now beginning to be engaged.July lOth

________________ -

VITAL STATISTICS.

VITAL STATISTICS OF LONDON DURING JULY, 1900.IN the accompanying table will be found summarised com-

plete statistics relating to sickness and mortality in each ofthe 43 sanitary areas of London. With regard to thenotified cases of infectious diseases in the metropolis, it,appears that the number of persons reported to be sufferingfrom one or other of the nine diseases specified in thetable was equal to an annual rate of 7-0 per 1000 of thepopulation, estimated at 4,589,129 persons in the middleof the year. In the three preceding months the rates

had been 6-2, 7-2, and 6’9 per 1000 respectively. The

Page 2: VITAL STATISTICS

546 VITAL STATISTICS OF LONDON DURING JULY, 1900.

Page 3: VITAL STATISTICS

547THE SERVICES.

rates were considerably below the average in Kensington,Westminster, Limehouse, Bermondsey, Battersea, and Wands-worth ; while they showed the largest excess in Fulham,Holbom, Whitechapel, St. George-in-the-East, Rotherhithe,Lee, and Plumstead sanitary areas. Thirteen small-poxcases were notified during July, of which three belongedto St. Pancras, two to Hammersmith, and two to Fulhamsanitary areas ; 12 small-pox patients were admitted intothe Metropolitan Asylums Hospitals during the month, and11 remained under treatment on Saturday, July 28th. The

prevalence of scarlet fever showed a slight decline from thatrecorded in the preceding months; among the various sani-tary areas this disease was proportionately most prevalentin Stoke Newington, Holborn, Whitechapel, St. Olave South-wark, Lee, and Plumstead. The Metropolitan AsylumsHospitals contained 1804 scarlet fever patients at theend of July, against 1619, 1735, and 1788 at the endof the three preceding months; the weekly admissions

averaged 210, against 174, 198, and 202 in the three pre-ceding months. The prevalence of diphtheria showed amarked increase last month ; the greatest proportionalprevalence of this disease was recorded in Fulham, BethnalGreen, Whitechapel, Rotherhithe, Lambeth, and Lee sanitaryareas. There were 1256 diphtheria patients in the Metro-politan Asylums Hospitals at the end of July, against 1131,1402, and 1212 at the end of the three preceding months ;the weekly admissions averaged 183, against 135, 172, and151 in the three preceding months. The prevalence ofenteric fever showed a further slight decline from thatrecorded in recent months; among the various sanitaryareas this disease was proportionally most prevalent inSt. Pancras, Whitechapel, St. George-in-the-East, Mild EndOld Town, Poplar, and Rotherhithe. The MetropolitanAsylums Hospitals contained 129 enteric fever patients atthe end of July, against 208, 176, and 148 at the end of thethree preceding months; the weekly admissions averagedZO, against 27, 24, and 21 in the three precedingmonths. Erysipelas was proportionally most prevalent inSt. Giles, Holborn, Shoreditch, Whitechapel, Rotherhithe,and Plumstead sanitary areas. The 12 cases of puerperalfever included two in Marylebone, two in Battersea, andtwo in Camberwell sanitary areas.The mortality statistics in the table relate to the deaths of

persons actually belonging to the various sanitary areas ofthe metropolis, the deaths occurring in the public institu-tions of London having been distributed among the

sanitary areas in which the patients had previously resided.During the four weeks ending July 28th the deaths of 5522persons belonging to London were registered, equal to anannual rate of 15-7 per 1000, against 20-2, 16’6, and 14-8 inthe three preceding months. The lowest death-rates lastmonth in the various sanitary areas were 6’6 in St. Martin-in-the-Fields, 7’3 in Hampstead, 8’0 in St. George Hanover-square, 9’6 in St. Olave Southwark, and 11’5 in Wandsworthand in Lee; the highest rates were 21.8 in St. Luke, 22’0 inMile End Old Town, 22-4 in St. Saviour Southwark, 26-7 inSt. George-in-the-East, 26’8 in Holborn, and 28’1 in Lime-house. During the four weeks of July 926 deaths werereferred to the principal zymotic diseases in London ; ofthese, 161 resulted from measles, 25 from scarlet fever, 93from diphtheria, 167 from whooping-cough, 41 from entericfever, two from simple continued fever, and 437 fromdiarrhoea. These 926 deaths were equal to an annual rateof 26 per 1000, against 1’8, 1-8, and 1-7 in the three

preceding months. No death from any of these diseasesoccurred last month in St. James Westminster ; in the othersanitary areas they caused the lowest death-rates in St.George Hanover-square, St. Martin-in-the-Fields, City ofLondon, St. Olave Southwark, Wandsworth, and Woolwich,and the highest rates in Shoreditch, St. George-in-the-East, Limehouse, Mile End Old Town, Poplar, and Plumstead.The 161 deaths from measles were 74 below the averagenumber in the corresponding periods of the ten precedingyears ; this disease was proportionally most fatal inHolbom, Whitechapel, Limehouse, Mile End Old Town,Woolwich, and Plumstead sanitary areas. The 25 fatal casesof scarlet fever showed a decline of 46 from the correctedaverage number ; the greatest proportional mortality fromthis disease occurred in Fulham. Stoke Newington, BethnalGreen, St. George-in-the-East, Limehouse, and Plumsteadsanitary areas. The 93 deaths from diphtheria were 71below the average number in the corresponding periods ofthe ten preceding years ; among the various sanitary areasthis disease was proportionally most fatal in Fulham,

Hampstead, Clerkenwell, Shoreditch, Bethnal Green, andLambeth. The 167 fatal cases of whooping-cough wereslightly in excess of the corrected average number; thisdisease showed the highest proportional fatality in Mile EndOld Town, St. Saviour Southwark, Newington, Bermondsey,Lewisham, and Plumstead sanitary areas. The 43 deathsreferred to "fever" exceeded by ten the average number inthe corresponding periods of the ten preceding years ; amongthe various sanitary areas the "fever" death-rate was highestin Stoke Newington, St. Giles, Strand, Whitecbapel, Poplar,and Bermondsey. The 437 fatal cases of diarrhoea showeda decline of 318 from the corrected average number; thisdisease was proportionally most fatal in St. Luke, Shoreditch,St. George-in-the-East, Limehouse, Mile End Old Town, andPoplar sanitary areas. In conclusion, it may be statedthat the aggregate mortality from these principal zymoticdiseases in London during July was nearly 35 per cent.below the average.

Infant mortality in London last month, measured by theproportion of deaths of children under one year of age toregistered births, was equal to 158 per 1000. The lowestrates of infant mortality were recorded in St. GeorgeHanover-square, Hampstead, Stoke Newington, Strand, St.Olave Southwark, and Lee; and the highest rates in West-minster, Holborn, St. George-in-the-East, Limehouse, MileEnd Old Town, and St. Saviour Southwark sanitary areas.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following qualified candidates for the Naval Medical

Service have been appointed to be Surgeons in Her Majesty’sFleet :-George Ross, John Scarbrough Dudding, WilliamBastian, Charles Thomas Baxter, Robert William BasilHall, Henry Cyril Adams, Llewellyn Lindop, Noel HughHarris, William Ernest Gribbell, Hardy Vesey Wells, JohnMarcus Hobson Conway. Robert Bernard Scribner, JohnWhelan, Arthur Izod Sheldon, John Verdon, and CecilRodney Rickard.

-

IMPERIAL YEOMANRY.4th Battalion: The appointment of R. Mervyn Wilson as

Medical Officer, with the temporary rank of Captain, whichwas notified in the London Gazette of Feb. 2nd, 1900, iscancelled.

___

ROYAL ARMY MEDICAL CORPS.The undermentioned Majors to be Lieutenant-Colonels :—

George Holden Sylvester, William John Macnamara, DanielO’Sullivan, Edwin Oswald Milward, Charles RollestonWoods, John Oldfield Greatrex Sandiford, Robert

Lindsay Love, Henry Walker Murray, MichaelWilliam Kerin, Alfred Peterkin, Edward Lewis Maunsell,William Heffernan, Ronald William Edward Huntly Nichol-son, James Grove White Crofts, William Dugdale, DelawareLewis Irvine, Edward Russell Cree, and Denham FrancisFranklin.

INDIA AND THE INDIAN MEDICAL SERVICES.The following appointments to the Indian Medical

Service are submitted for Her Majesty’s approval :-To beLieutenants: James Drummond Graham, Cuthbert Allan

Sprawson, Maxwell MacKelvie, William Lapsley, WilliamHenry Cazaly, Percy Alfred Browne, Walter Valentine

Coppinger, Alfred Spitteler, James Charles Stewart Oxley,Henry Richard Macknee, Leonard Joseph Montague Deas,William Mitchell Houston, William David Acheson Keys,George Joseph Grafton Young, James Good, AlexanderChalmers, William Gavin Hamilton, and Samuel RobertGodkin.

ARMY MEDICAL RESERVE OF OFFICERS.

Surgeon-Captain J. W. Ellis to be Surgeon-Major.VOLUNTEER MEDICAL STAFF CORPS.

The Manchester Companies: Robert William Beesley tobe Surgeon-Lieutenant.

VOLUNTEER CORPS.

Artillery : 1st Aberdeenshire : Henry Mcllree WilliamsonGray to be Surgeon-Lieutenant. Royal Engineers (Volun-teers) : lst Hampshire : Surgeon-Lieutenant A. B. Wrightresigns his commission. lst Newcastle-on-Tyne: Surgeon-Captain H. H. Gourley, from the 4th Durham (Western