1566 BUDAPEST.-NOTES FROM INDIA.

Albert Apponyi, Minister of Public Instruction. The

building is a good blend of hygienic and architecturalfeatures. It can accommodate altogether 160 insane

patients. In a middle pavilion are the administrative officesand behind these are the laboratories and lecture halls. The

patients, male and female, are accommodated in separatepavilions according as they are quiet or inclined to beviolent, while a separate building is reserved for those

suffering from infective diseases. The director of the newclinic, who has been appointed by the King, is ProfessorErno Moravesik, formerly professor of forensic psychiatry inthe University. The admission of patients will begin withthe new year.

The Position of Practice in Bzcdrxpest.Only a few weeks ago the Berlin practitioners complained

of the excessive growth of the number of specialists in theircity. To-day the Budapest practitioners also have to makethe same moan. Every single branch of the medical scienceand art has representatives, many of whom are unable toearn their livelihood but still are able to spoil the practiceof the general practitioners. An increase of polyclinics andother free institutions for medical attendance has followedand is also inimical to general practice. There is in

Budapest a sick club with 120,000 members who have a rightto free medical treatment. The State medical institutes keepup outdoor departments, where everybody can get medicaladvice without any regard to his financial circumstances, forthe simple reason that in this way better statistics of work canbe shown. The managers of these institutions like the greatdisplay of activity, though the quality of the work done isnot what is shown but only the quantity. In order to

alter somehow these conditions the general practitionersof Budapest propose to make an organised attemptto influence the leaders of the University so that thelatter may insure free medical attention being given onlyto actual paupers. The specialist question will also be dealtwith, it being sought that nobody shall be allowed to callhimself a specialist unless he has spent five years in specialstudy at a corresponding clinic. Such a radical enact-ment would much improve the material condition of the

practitioners.Thc New (Third) Medical Clinic.

In some five or six years the numbers of medical studentsin Budapest have trebled. While in the year 1900 thenumber of first year students amounted to 150, this year thenumber is 450. This great increase of students hasnecessitated the extension of the University Clinic. Newhospitals have been built in quick succession, but still therewere such crowds in the lecture halls that in the interest ofthose seeking instruction it became necessary to buildextensively. The head of the clinic has already beenappointed by the King of Hungary in the person of Pro-fessor Ernst Jendrassik who has gained his reputation as aneurologist, and his father, it may be recollected, was pro-fessor of physiology at the University of Budapest.Nov. 14th.

NOTES FROM INDIA.

(FROM OUR OWN CORRESPONDENTS.)

Sanitary Conference in United Provinces: GeneralConclusions.

THE following is a precis of the general conclusions of theUnited Provinces Sanitary Conference held at Naini Tal byorder of the Lieutenant-Governor.The conference considered at length the possibility of

decreasing malaria, and notes on the subject by ColonelMurray, I.M.S., and Major J. Chaytor White, I.M.S., wereconsidered. A special officer has been appointed to inquireinto the prevalence of malaria in the United Provinces andhis report will no doubt show what works should be under-taken in specially malarial tracts. Meanwhile, as a practicalmeasure the conference recommends that a map of eachdistrict showing by the mortality returns the most malarialtracts should be prepared in the office of the Sanitary Com-missioner. On the basis of this map district boards cancarry out a detailed sanitary investigation into the conditionof these tracts and systematic measures can then be takenfor drainage, filling up insanitary pits and hollows, removal

of noxious vegetation, and distribution of quinine. Theconference has already proposed amendments to the VillageSanitation Act enabling the local authorities to prevent newexcavations within or in the neighbourhood of inhabitedsites and to fill up old excavations. It also suggests thatthe filling up or draining of existing railway burrow pits nearinhabited sites is a question needing the consideration ofGovernment, and that both railways and the Public Works

Department should be prohibited from making such pits nearinhabited sites in future. The distribution of quinine shouldbe very considerably extended. The conference is informedthat in an inquiry made in the Dinajpur district (in Bengal)three-fourths of the deaths from acute malaria were found tooccur in children under ten years of age, and mostly in theautumn months. It therefore suggests that district boardsshould distribute quinine through village schoolmasters whoare in a position to know when a child is absent from fever.Not only do children constitute the majority of victims, butit is in the blood of untreated children that the parasitesthrive best and are conveyed by mosquitoes to adult persons.For the treatment of children some more palatable method ofadministering the drug than the bitter sulphate of quininepowders is essential. Distribution in the tabloid form has

proved successful in the Duars tea gardens and mightbe tried in these provinces. The dose should not beless than ten grains ; and although the sale of thisamount at one pice (a farthing) involves a loss the expendi-ture would be well incurred. Another most important pointwhich the conference wishes to emphasise is the extension ofmasonry surface drainage in towns large and small. Themost dangerous varieties of anopheles breed in the earth-lined and grass grown roadside drains and are much morerarely found in tanks and small puddles. A most potentcause of malaria is thus situated at the doors of the inhabi-tants of the majority of Indian towns. Municipal boardsshould organise mosquito brigades to apply crude kerosine tocollections of water in which the insects breed. The,

example of the Mizapur district board which is placingfish in large permanent tanks might be followed. A generalthinning of trees and shrubs on scientific lines in some of thetowns of this province is also essential and power should begiven to municipal authorities to deal with trees and shrubsin private enclosures on the lines of Section 99 of theCantonment Code, 1899, care being taken to obtain expertadvice in the case of any general felling of trees. The

question of restricting irrigation in the neighbourhood oftowns and villages is of great importance. In a resolution

passed in January, 1855, to give effect to the Canal Act ofthat day, the following limits were laid down :-

From military stations .................. 5 miles.From towns with over 10,000 population ......... 1 mile.

" " 5,000 " ......... 1/2 "

From large villages with over 1,000 population ...... From villages with less than 1000 population ...... 200 yards.

These provisions have not been enforced and would causeconsiderable hardship and loss of revenue if now insistedon. Canal irrigation has been restricted in the neighbour-hood of towns in various instances-e.g., Barant, Shamli,Kosi, and Jansath. The conference accepts the generalprinciple that where it is possible with due regard to agri-cultural interests it is desirable to exclude canal irrigationfrom certain areas round towns and villages. What thisarea should in each case be should be fixed by the sanitaryauthorities and the enforcement or non-enforcement of theexclusion should be carried out by the revenue authoritiesin consultation with the sanitation department. Rule 7of the rules made under the Canal Act, 1873, should becommunicated to municipal boards in canal districtsand incorporated in the Municipal Manual. Thisrulepro-vides that the divisional canal officer may, with the pre-vious approval of the Commissioner, prohibit the use ofcanal water for the irrigation of any khartf crop, when theland to be irrigated is situated within one mile of the utter-most houses of any town if such irrigation be objected to bythe municipal committee. A note furnished by Mr. Streatfieldshows that practically the entire programme for drainageworks in canal districts in connexion with canals has beencompleted, with the exception of a few works on the EasternJumna Canal. The conference suggests that the irrigationdepartment should take up the question of drainage in otherthan canal districts, the staff if necessary being strengthenedfor the purpose. The special officer deputed to inquire

1567NOTES FROM INDIA.-OBITUARY.

into the subject of malaria should be directed to investi-gate the question of drainage also. His inquiries shouldshow what further drainage lines are desirable. Theconference suggest no modifications in the methods

adopted against plague which are the outcome of the

years of experiment and experience. The result of the

experiments now being made at Gorakhpur to render housesrat-proof should be awaited. The use of wire netting inthe floors and walls of houses should prevent incursions byrats. A circular should also be issued recommending localauthorities to encourage the keeping of cats. The questionof the possibility of directly diminishing infant mortalityhas been considered. A note on the subject preparedby Major White, I.M.S., officiating sanitary commis-

sioner, United Provinces, shows that the chief causes ofthe high mortality of infants in India are the immaturityand ignorance of mothers, improper feeding, and the

exposure of infants to all the influences of an insanitaryenvironment. Other causes are the want of skilled midwives,neglect of treatment of infantile diseases, disregard of primaryrules of sanitation in the lying-in rooms, low nutritive valueof food for mothers, poor clothing, and poor houses. An

analysis of a table of infantile deaths submitted to theCalcutta municipality shows that convulsions, tentanus, andbronchitis carry off the largest proportion of infants.Tetanus is probably caused by the custom of rubbing dryearth or earth mixed with cow dung into the navel and care-less exposure explains the large incidence of pulmonarydiseases. The conference suggests that a certain number ofwomen of the professional midwife classes should be trainedfor the purpose of serving as peripatetic dais under districtboards. It considers that cheap maternity hospitalsshould be erected in the large towns, separate and distinctfrom the Dufferin hospitals. Such institutions would be underthe charge of trained dais and be intended for theuse of the poorer classes. The conference has before

suggested that at least one model dairy should be estab-lished in each large town and has proposed additions to theMunicipal Act giving boards greater control over cattlesheds and cow houses. It recommends that with a viewto ascertaining more definitely the causes of infant mortalityin these provinces a special inquiry should be conductedduring one year in a typical town, preferably Cawnpore.The conference considers that in view of the popularity ofAlmora as a health resort by consumptives and the de-

sirability of not only affording facilities for treatment tosuch persons, but also protecting Almora itself against infec-tion, a hospital should be constructed outside the town tobe used mainly by paying patients. Finally, the conferencerecognising that the main hope for improvement in thefuture lies in the education of the rising generation, recom-mends that sanitation and hygiene of an elementary charactershould be taught in all boys’ and girls’ schools up to theeighth class, and that the course should be compulsory up tothat class and optional afterwards. Simple sanitary rulesshould be issued free or at a nominal price by districtboards.

Ptinjabi Women and Vaccination.

To overcome the opposition of the women is one of theproblems confronting the vaccination department of the

Punjab. In many places, we are told, women still regard avisit to Mata Devi as a far more efficacious protection againstsmall-pox than vaccination. During the last three years thenumber of primary vaccinations performed show a persistentannual decline, though the total for the three years is

greater than the total for the previous triennium. TheLieutenant-Governor accepts plague and the consequentreductions in births as the explanation of this, though thefluctuations in the figures of particular districts are probablyaffected chiefiy by the popularity and energy or the absenceof these qualifications in the vaccinators. The fraction ofthe population which submits to revaccination is minute.The personal equation appears to enter largely into thecalculations of the success of the operations, for while oneDeputy Sanitary Commissioner found 61 per cent. of successesin revaccinations, the other found 99 per cent. ; and similarlyin the same districts the different inspecting officers recordvery different proportions of success. It can hardlybe that the facts which came under the notice ofthe different officers differed so greatly as the statisticswould imply, and it would seem that a more accurate

definition of what is a successful revaccination is re-

quired. The Lieutenant-Governor is inclined to doubtwhether the present very elaborate system of inspection ofvaccinated persons by a supervising establishment is to becommended. The purpose of inspection is to see that thevaccinators do their work properly, and surely it is not

necessary in order to secure this that babies should be hailedtwice or possibly three times before an inspecting officer.It is probable that the trouble of these inspections and thelong waits of the mothers with their children, even if thereare no tiring tramps for them, do more to deter the womenfrom producing their children for vaccination than thenuisance of the vaccination itself. The propriety of

reducing the inspecting staff will be considered. TheVaccine Institute has worked well and the cost of vaccineis now 10 annas per gramme. The most important event inthe history of the triennium has been the transfer at thebeginning of this year of the vaccinating staff from the

sanitary commissioner to the local bodies by which the staffis paid, a step which it is hoped will help to popularisevaccination.Oct. 22nd.

_________________

Obituary.PETER WILLIAMS, M.R.C.S. ENG., L.M., L.S.A.

THERE passed away at Ferryside on Oct. 29th, in theperson of Mr. Peter Williams, aged 77 years, a member ofa medical family who have practised in Carmarthenshirefor nearly a hundred years. The son of Mr. E. Williams,surgeon, of Carmarthen, he was a pupil of his brother Dr.John Williams of the same town, who also had as a pupilDr. Frederick T. Roberts. Entering St. Bartholomew’s Hos-pital he became fully qualified in 1856. At first he joinedhis brother at Carmarthen, but in 1860 he started in prac-tice at the seaside resort of Ferryside, Carmarthenshire.Here he worked for nearly 50 years and never was a medicalman more beloved ; rich and poor alike appreciated hisservices. His manner was so sympathetic and he took suchinfinite pains with his patients that he soon acquired a reputa-tion which reached far beyond the bounds of Ferryside.About three years ago he practically retired in favour of hisson, and was presented on the occasion with a chequefor k300 and a handsome piece of plate, this being thesecond testimonial which he received during his medicalcareer. In April last he showed signs of serious

organic heart trouble, and was then so ill thathis life was despaired of, but he recovered to a

certain extent; however, this was the beginning of theend, for on Oct. 29th he had another serious attackwhich ended fatally notwithstanding all the efforts of hisson. His funeral was a public one and the whole neigh-bourhood was represented. There were representatives frompublic bodies at Carmarthen, Kidwelly, and Ferryside, alsofrom the villages far and near. The body was carried tothe old church of St. Ishmael’s and was followed by alarge concourse of people. Never has there been a

more impressive funeral service in that church. Itwas by the wish of his widow entirely in Welsh. Thechurch was full to overflowing and the evidences of griefwere so profound that they testified to the great love whichthe people had for him. The chief mourners were Dr.Lewis Williams, Mr. Lloyd Williams, Mr. E. Williams,and Mr. H. Williams, sons ; Dr. A. Glover Williams,nephew ; the Rev. D. Morris, rector of Penally; the Rev.J. Rees, rector of Letterston ; Lady Greaves ; and the Rev.E. Rowlands. Amongst those attending the funeral was SirJohn Williams, Bart., M.D., a personal friend of the deceased,who showed him many acts of kindness during his illness.

EDWARD WHISHAW HENLEY, L.R.C.P. LorTD.,M.R.C.S. ENG.,

MEDICAL SUPERINTENDENT OF THE GLOUCESTER COUNTY ASYLUMS.

Mr. E. W. Henley died in Gloucester on Nov. 14th, afteran operation for appendicitis. He received his medicaleducation at St. George’s Hospital and qualified M.R.C.S.Eng. and L. R. C. P. Lond. in 1875 and 1876 respectively.