THE PLAGUE IN INDIA
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198 by the Commissioners to be an exaggeration of dangers which are really "insignificant" and which they believe i would be largely, if not entirely, removed by the improve- c ments in the practice of vaccination which they recommend, c should not be of the nature of a permanent abrogation of ( the right of. the State to enforce the vaccination of the child, a as the Commissioners practically suggest, but only of a i postponement of the operation until such time as may be considered suitable for reviving the right of the State to i enforce it. 4. That the time for revival of such right is to be found when the child is required to attend school, and that it is i expedient, therefore, in any amendment of the vaccination law to make explicit provision for such revival. 5. That it should be the duty of the Registrar of Births, ( in the case of the registration of the birth of every child, 1 to deliver to the person registering the birth a notice of the a requirements of the law in regard to vaccination, together with a suitable explanation of the grounds on which the State requires that the child should be vaccinated, and that he should also inform the public vaccinator of the child’s < birth. 6. That it should be the duty of the public vaccinator at i some time, not less than six and not more than twelve ( months after the birth of the child, to visit it at its registered home, and if he shall find that the child is alive, and that it has not been effectually vaccinated, and that the operation may with safety be performed, to offer so to do ; 1 and that if the person in whose legal charge the child shall then be shall refuse to allow it to be vaccinated, or if for < any other reason the public vaccinator should think it desirable that the vaccination of the child should be post- 1 poned, he should forward a certificate to that effect to the a official who may be appointed to receive and record it. 7. That on the receipt of the certificate of the public vac- cinator that the legal guardian of a child who had arrived at the age and was fit to be vaccinated had refused to allow the child to be vaccinated, it should be the duty of the officer to be appointed for the purpose to summon such guardian before the magistrates, and that on such guardian satisfying the magistrates that he objected to the vaccination of the child they should be empowered to make an order suspending the compulsory vaccination of the child until further notice, on payment by the guardian of the court costs incurred in i the proceedings. : 8. That it should be the duty of the public vaccinator to 4 periodically visit all schools for the purpose of inquiring into the state of the children attending them in regard to vacci- nation and of effectually vaccinating and re-vaccinating such children as he may find in an unprotected or imperfectly protected condition. ! 9. That the recognition of the propriety of enforcing vaccination during the school period which would be thus established would materially facilitate the promotion of re-vaccination during the same period, at the time when in public elementary schools the child would be leaving, and that it would thus offer a guarantee for the general pro- tection of the whole population which would not be other- wise obtainable. 10. That the delay in enforcing vaccination which would be entailed on such children as might be thus temporarily exempted would not involve any serious risk either to them- selves or to the community as a whole, except in presence of an epidemic, when, as the Commissioners advise, vaccination should be compulsory, whilst, on the other hand, it would carry with it great compensatory advantages, amongst which may be especially mentioned that of relieving vaccination itself of most if not all of the risks and objections to which it would still be exposed even by the extension of the period of liability to six months, as the Commissioners propose. 11. That it is desirable that the certificate of successful vaccination and re-vaccination, whether given by the public vaccinator or by a private medical practitioner, should embody a statement of the number and aggregate area of the scars left after the vaccination punctures have healed, and that it should also carry on its face information as to the minimum conditions in regard thereto which can be reckoned on to afford effectual protection. 12. That it is expedient that the present requirements in regard to the re-vaccination of persons employed in the public services should be maintained, and that employers of labour should, if not required, be at least encouraged to promote the re-vaccination of those whom they employ. 13. That it is desirable in any legislation for the amend. ment of the vaccination law that the general administration of the medical and sanitary provisions of the law should be delegated to sanitary authorities, due regard being had in so doing to ensuring that the work shall be efficiently done, and subject always to the control of a system of proper inspection. 14 That the necessity for reorganising the machinery of vaccination, which legislation in the foregoing directions would involve, offers a convenient opportunity for dealing with the whole subject of the executive of the sanitary and medical public services, so far as regards the duties of medical officers of health, of district medical officers, and of public vaccinators, and also of meeting the recognised need of providing for the medical and sanitary supervision of public elementary schools ; that by a proper consolidation and co-ordination of these now unrelated branches of public work both efficiency and economy might be materially promoted. 15. That it is desirable that the Society of Medical Officers of Health should endorse generally the expediency of giving effect to the following proposals of the Royal Com- missioners-viz. : (1) to allow public vaccinators to offer calf lymph as a substitute for human lymph in all cases in which it may be preferred ; (2) to extend the peri,d within which a child is at present required to be vaccinated ; (3) to provide for the medical treatment of children after vaccina- tion so far as may be necessary to ensure good results ; (4) to. provide for the more effectual supervision of tramps and common lodging-houses ; and (5) to ensure better means than now exist for enforcing the provision of proper accommoda.. tion in every sanitary district for the isolation of small-pox and other infectious diseases. THE PLAGUE IN INDIA. WE regret that we are unable to report any abatement in the epidemic of bubonic plague in Bombay. Whatever might have been accomplished by the prompt adoption and enforcement of a system of segregation during the earlier and initial stages of the outbreak has passed away ; the disease seems to have established a firm foothold in Bombay and the enormous exodus of a panic-stricken population has probably ere this carried the disease-cause in many of the directions whither these people have migrated. The latest reports from Karachi show a rapid increase of the plague there and in a virulent form. Out of a total of 220 cases at Karachi there were 214 deaths, and of 52 fresh cases which occurred in two days all proved fatal. The public health of Bombay, apart from the plague, seems to be in a very unsatisfactory state. The number of deaths registered during the week ending Dec. 24th, 1896, was 1416, being 106 more than in the pre- ceding week, and 946 more than in the corresponding period in the preceding five years. The rate of mortality per 1000 of the population was 87’76. Among the deaths 226 arose from bubonic fever and 352 from remittent fever ; and the telegraphic intelligence since received shows, as we have said, a large increase instead of any decrease in these heavy death-ratios. It is very probable, too, that owing to the fears and apprehension of the natives regarding any official interference on the one hand and the desire on the part of the officials themselves not to increase alarm on the other, these figures may not represent the whole truth. The state of affairs in the Pre- sidency of Bombay has not only given rise to much alarm in India, but has very naturally aroused much anxious consideration on the part of the Governments of other countries-such as Russia, Turkey, Egypt, France, and Austria, for example. Surgeon-Major-General Cleghorn, the Director-General of the Indian Medical Service, has been ordered by the Indian Government to proceed to Bombay to report on the epidemic there and on the sanitary condition of the city, and to advise the Government gene- rally. Rogers Pasha, the head of the sanitary depart- ment in Egypt, and Dr. Bittar, the bacteriologist of the Egyptian Government, have likewise proceeded to Bombay with the view of advising as to the best measures to be adopted for safeguarding Egypt, especially in the direction of the Mecca pilgrims as possible vehicles for carrying the plague infection to that country and to Europe, of which in this respect Egypt may be regarded as a protecting outpost.
Transcript of THE PLAGUE IN INDIA
198
by the Commissioners to be an exaggeration of dangerswhich are really "insignificant" and which they believe i
would be largely, if not entirely, removed by the improve- c
ments in the practice of vaccination which they recommend, cshould not be of the nature of a permanent abrogation of (the right of. the State to enforce the vaccination of the child, aas the Commissioners practically suggest, but only of a i
postponement of the operation until such time as may beconsidered suitable for reviving the right of the State to i
enforce it. 4. That the time for revival of such right is to be found
when the child is required to attend school, and that it is i
expedient, therefore, in any amendment of the vaccination law to make explicit provision for such revival.
5. That it should be the duty of the Registrar of Births, (
in the case of the registration of the birth of every child, 1to deliver to the person registering the birth a notice of the arequirements of the law in regard to vaccination, together with a suitable explanation of the grounds on which the State requires that the child should be vaccinated, and thathe should also inform the public vaccinator of the child’s <
birth. 6. That it should be the duty of the public vaccinator at i
some time, not less than six and not more than twelve (
months after the birth of the child, to visit it at its
registered home, and if he shall find that the child is alive, and that it has not been effectually vaccinated, and that the operation may with safety be performed, to offer so to do ; 1and that if the person in whose legal charge the child shall then be shall refuse to allow it to be vaccinated, or if for <
any other reason the public vaccinator should think it desirable that the vaccination of the child should be post- 1
poned, he should forward a certificate to that effect to the aofficial who may be appointed to receive and record it.
7. That on the receipt of the certificate of the public vac-cinator that the legal guardian of a child who had arrived atthe age and was fit to be vaccinated had refused to allow thechild to be vaccinated, it should be the duty of the officer tobe appointed for the purpose to summon such guardian beforethe magistrates, and that on such guardian satisfying the magistrates that he objected to the vaccination of the childthey should be empowered to make an order suspendingthe compulsory vaccination of the child until further notice,on payment by the guardian of the court costs incurred in ithe proceedings. :
8. That it should be the duty of the public vaccinator to 4
periodically visit all schools for the purpose of inquiring into the state of the children attending them in regard to vacci-nation and of effectually vaccinating and re-vaccinating suchchildren as he may find in an unprotected or imperfectlyprotected condition. !
9. That the recognition of the propriety of enforcing vaccination during the school period which would be thusestablished would materially facilitate the promotion ofre-vaccination during the same period, at the time when in
public elementary schools the child would be leaving, andthat it would thus offer a guarantee for the general pro-tection of the whole population which would not be other-wise obtainable.
10. That the delay in enforcing vaccination which wouldbe entailed on such children as might be thus temporarilyexempted would not involve any serious risk either to them-selves or to the community as a whole, except in presence ofan epidemic, when, as the Commissioners advise, vaccinationshould be compulsory, whilst, on the other hand, it wouldcarry with it great compensatory advantages, amongst whichmay be especially mentioned that of relieving vaccinationitself of most if not all of the risks and objections to whichit would still be exposed even by the extension of the
period of liability to six months, as the Commissionerspropose.
11. That it is desirable that the certificate of successfulvaccination and re-vaccination, whether given by the publicvaccinator or by a private medical practitioner, should
embody a statement of the number and aggregate area of thescars left after the vaccination punctures have healed, andthat it should also carry on its face information as to theminimum conditions in regard thereto which can be reckonedon to afford effectual protection.
12. That it is expedient that the present requirementsin regard to the re-vaccination of persons employed in thepublic services should be maintained, and that employersof labour should, if not required, be at least encouraged topromote the re-vaccination of those whom they employ.
13. That it is desirable in any legislation for the amend.ment of the vaccination law that the general administrationof the medical and sanitary provisions of the law should bedelegated to sanitary authorities, due regard being had in sodoing to ensuring that the work shall be efficiently done,and subject always to the control of a system of properinspection.
14 That the necessity for reorganising the machinery ofvaccination, which legislation in the foregoing directionswould involve, offers a convenient opportunity for dealingwith the whole subject of the executive of the sanitary andmedical public services, so far as regards the duties ofmedical officers of health, of district medical officers, and ofpublic vaccinators, and also of meeting the recognised needof providing for the medical and sanitary supervision ofpublic elementary schools ; that by a proper consolidationand co-ordination of these now unrelated branches of
public work both efficiency and economy might be materiallypromoted.
15. That it is desirable that the Society of Medical Officersof Health should endorse generally the expediency of givingeffect to the following proposals of the Royal Com-missioners-viz. : (1) to allow public vaccinators to offercalf lymph as a substitute for human lymph in all cases inwhich it may be preferred ; (2) to extend the peri,d withinwhich a child is at present required to be vaccinated ; (3) toprovide for the medical treatment of children after vaccina-tion so far as may be necessary to ensure good results ; (4) to.provide for the more effectual supervision of tramps andcommon lodging-houses ; and (5) to ensure better means thannow exist for enforcing the provision of proper accommoda..tion in every sanitary district for the isolation of small-poxand other infectious diseases.
THE PLAGUE IN INDIA.
WE regret that we are unable to report any abatement inthe epidemic of bubonic plague in Bombay. Whatever
might have been accomplished by the prompt adoption andenforcement of a system of segregation during the earlier andinitial stages of the outbreak has passed away ; the diseaseseems to have established a firm foothold in Bombay and theenormous exodus of a panic-stricken population has probablyere this carried the disease-cause in many of the directionswhither these people have migrated. The latest reports fromKarachi show a rapid increase of the plague there and in avirulent form. Out of a total of 220 cases at Karachi there were214 deaths, and of 52 fresh cases which occurred in twodays all proved fatal. The public health of Bombay, apartfrom the plague, seems to be in a very unsatisfactory state.The number of deaths registered during the week endingDec. 24th, 1896, was 1416, being 106 more than in the pre-ceding week, and 946 more than in the corresponding periodin the preceding five years. The rate of mortality per 1000 ofthe population was 87’76. Among the deaths 226 arose frombubonic fever and 352 from remittent fever ; and thetelegraphic intelligence since received shows, as we
have said, a large increase instead of any decrease in theseheavy death-ratios. It is very probable, too, that owingto the fears and apprehension of the natives regardingany official interference on the one hand and the desireon the part of the officials themselves not to increasealarm on the other, these figures may not representthe whole truth. The state of affairs in the Pre-
sidency of Bombay has not only given rise to muchalarm in India, but has very naturally aroused much anxiousconsideration on the part of the Governments of othercountries-such as Russia, Turkey, Egypt, France, andAustria, for example. Surgeon-Major-General Cleghorn,the Director-General of the Indian Medical Service, hasbeen ordered by the Indian Government to proceed toBombay to report on the epidemic there and on the sanitarycondition of the city, and to advise the Government gene-rally. Rogers Pasha, the head of the sanitary depart-ment in Egypt, and Dr. Bittar, the bacteriologist of theEgyptian Government, have likewise proceeded to Bombaywith the view of advising as to the best measures to be adoptedfor safeguarding Egypt, especially in the direction of theMecca pilgrims as possible vehicles for carrying the plagueinfection to that country and to Europe, of which in thisrespect Egypt may be regarded as a protecting outpost.
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Russia, speaking through a portion of her press, appa-rently advocates the adoption of some joint internationalsanitary measures for preventing the spread of the diseaseto other countries ; and the Austrian delegate to the In-ternational Sanitary Council at Constantinople (Dr. Hagel)proposed to prohibit this year’s pilgrimage from India toMecca in view of the present prevalence of plague in India,and the remaining members of the council agreed with Dr.Hagel ; but the Turkish delegate was opposed to the sugges-tion because to prohibit the pilgrimage would trench uponan essential part of the Mussulman faith. From a Paris
paper we learn that Dr. Netter and Dr. Brouardel regardthe outbreak in India as a calamity which is bound to
engage the attention of Europe, although these authoritiesbelieved that owing to the rigorous measures adopted at thevarious ports, the European continent would be preservedfrom contagion. Dr. Brouardel urged that England shoulddiscourage the Indian pilgrimage to Mecca and exercise thesame strict surveillance over ships in the Gulf of Persia aswas done in the case of the Suez Canal. The Governmentof this country is often called upon to play a part on theinternational stage that falls to the lot of no other Power,and a most difficult part it is-namely, to practically recon-cile very grave questions of State policy with those of inter-national sanitary considerations and public health hygiene.
MEETING OF INFIRMARY TRUSTEES ATMANCHESTER.
A SPECIAL general meeting of the trustees of the Man-chester Royal Infirmary was held on Jan. lltb to receive theformal statement of the result of the poll in December lastLord Derby presiding. It may be remembered that of 1349
voting papers issued 853 were returned, one of which wasbad, and that of the 85Z votes recorded 449 were in favour of,while 403 were given against, re-building. The chairmanformally announced the result, a majority of 46 in favourof the resolution of the Board. This was the whole of thebusiness, but many questions were asked and a good deal ofdiscussion took place, the chairman saying that though themeeting was practically dissolved and the business con-
cluded " he had endeavoured to give such satisfactionas he could to gentlemen who had asked ques-tions." An informal meeting was then held, LordDerby again presiding, on the suggestion of the LordMayor. After much discussion it was proposed by SirJohn Harwood, who said the city council had done all
they could to be conciliatory and "had shown the mostfriendly spirit in relation to the board and to the trustees,"that a committee be appointed in equal numbers from theboard and the corporation, and he thought that an agree-ment might be come to which would be "satisfactory allround." Sir Forbes Adam assured Sir John Harwood thatit was the wish of the board, acting for the trust, to meetthe city council in the most friendly spirit possible. He
suggested that the committee should consist of six membersof the city council and six of the infirmary board. Mr.J. W. Maclure, M.P., stated that "there was a timewhen Sir Joseph Heron (the late town clerk) and the
corporation prevented the sale of the site to the Govern-ment for Post-office purposes." Lord Derby doubted whetheras a matter of form the resolution would carry any weight,the meeting being informal, and suggested that "as they hadhad very valuable expressions of opinion in favour of itthey should accept the assurance of the board of the in-
nrmary on the one side and of the city council on the other.that bodies of gentlemen would be appointed in equalnumbers to meet and discuss the subject." And so for thepresent the matter rests.
ROYAL COLLEGE OF SURGEONSOF ENGLAND.
MEETING OF FELLOWS.A HALF-YEARLY meeting of the Fellows of the College was
held on Jan. 7th. Mr. N. C. MACNAMARA, the SeniorVice-President, was in the chair in the absence of thePresident. At four o’clock, when the meeting should have
commenced, it was found that there were not thirty Fellowsin the room, and it was not until nearly ten minutes laterthat the Secretary announced that a quorum was present.The CHAIRMAN moved a resolution to the effect that, °’ At
this meeting of Fellows of the Royal College of Surgeonsheld on Jan. 7th, 1897, the Council be requested to forwarda letter on behalf of the Fellows to Sir Joseph Lister, con-gratulating him on his elevation to the Peerage." Sir JosephLister was the first member of the profession who had beenraised to the Peerage for purely professional reasons. What-ever their views as to his work, he was sure that he expressedthe opinion of all the Fellows when he said that they hopedthat Sir Joseph Lister would be spared for many years towatch the development of the system which he had taughtand which had done so much for humanity at large. He con-sidered that such a letter of congratulation would comemuch better from the Fellows than merely from the Council.
Mr. LANGTON seconded, and the resolution was carriedunanimously.The CHAIRMAN then reported that the resolution carried
at the last meeting of Fellows had been reported to theCouncil on July 9th. 1896, and that in reference thereto theCouncil had adopted the following resolution, viz. :-"That Mr. Bryant be requested to forward in the General Medical
Council in every way which seems feasible the objects of the CivilRights Defence Committee in the case of Mr. R. B. Anderson."
Mr. TIMOTHY HOLMES moved the resolution standing inhis name :-
" That this meeting desires to call the attention of the Council to thepublished reports of the proceedings of the General Medical Council inthe case of Mr. R. B. Anderson, and to the remarks and action of Mr.Bryant on the occasion, and to ask the Council whether their repre-sentative has in this instance correctly construed their instructions."
He said that he moved the resolution as a member of theCivil Rights Defence Committee, and that he wished to dis-claim all idea of finding fault with Mr. Bryant’s proceedingsin this matter, but he had to think of the prospects ofMr. Anderson in the future. If Mr. Bryant were correctlyreported in the journals Mr. Anderson would find additionaldifficulty in obtaining justice. At a meeting of the GeneralMedical Council Dr. Glover moved a resolution that theCouncil should memorialise the Government on the case ofMr. Anderson ; this resolution was opposed by Mr. Bryant.Now, Mr. Holmes continued, it was not Mr. Bryant’sopposition to the resolution that was criticised, as evenif it had been passed very little good would have beendone, but when speaking in opposition to the resolutionMr. Bryant had made several remarkable statements. Hewas reported to have said that though there could beno doubt that Mr. Anderson had been badly treated,yet there could be no further action in the courts,as the law would not allow it. And yet at the very timethis was said an action was impending in the House ofLords. Again, Mr. Bryant had said that it was not withinthe scope of the College or the Council to help on theinterests of an individual in such a way as to make them-selves partisans against the law of the country. Surely theCouncil could not have instructed Mr. Bryant to this effect.Mr. Bryant had further said "that he hoped that Mr. Ander-son would be satisfied with a vote of sympathy on the partof the Council and that the Council would not address theGovernment on any subject unless their cause was strong andthey felt it was a question of principle." Surely the verypoint of the whole matter was that it was a question ofprinciple. He felt that Mr. Bryant had not acted on theinstructions of the Council, for what he had said was cal-culated rather to harm Mr. Anderson’s cause than tofurther it.
Mr. MANSELL MOULLIN, in seconding the resolution, saidthat many of the Fellows had hoped that the representativeof the College on the Council would assist Mr. Andersonbefore the General Medical Council. Mr. Bryant had notdone so, but he had said that there were some weak pointsin Mr. Anderson’s case, though he did not say what theywere.
The CHAIRMAN wished to point out that a great deal hadbeen said about Mr. Bryant’s " instructions," but the Councilhad never given any instructions. The resolution of theCouncil had " requested Mr. Bryant to forward in every waywhich seemed feasible the objects of the Civil RightsDefence Committee." It was quite within Mr. Bryant’sprovince to say all he had been reported to have said ; hewas perfectly free to express his own opinions.
Mr. R. B. ANDERSON asked permission to say a few words.He quite agreed with what the Chairman had said about
