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persons who would be ashamed either to ask for charity inany other form or to receive it feel no compunction inentering a hospital where their board and lodging are paidfor by the subscribers." The out-patient abuse is statedwith equal clearness. ’Of the out-patients a considerablenumber are people earning good wages." The demoralisngeffect on the unfit patients is well brought out : ’’ the firstvisit leads to subsequent ones, until at last the very notionthat it is part of their duty to provide themselves withmedical attendance seems to dropout of their consciousness."One deep root of the evil is shown to be in the rivalry ofthe hospitals to show numbers and in the desperate strugglefor existence. The special hospitals are proved, by the verynature of their origin, to be special sinners. The articleends by approving of the formation of a central board asadvocated by the Lords’ Committee and the CharityOrganisation Society. The letters published in the papersequally support the contention of reformers. " One who hasbeen driven to the Hospitals " writes in the Times that theincrease of consultants’ fees is a great factor. But thereare younger consultants whose fees would be quite practic-able to such patients who have no business in hospitals andwho take up beds which are meant for the poor.

WHAT CONSTITUTES PLAGUE?

THE highly interesting paper on the spread of plague,by Dr. Cantlie, read recently before the Epidemio-logical Society of London, which was partly repro-duced in our columns last week and which is com-

pleted in our present issue, raises, together with the

discussion which followed it, some important points.From an epidemiological standpoint the more practicallyimportant question is as to what is the precise nature ofcertain glandular swellings, with or without fever, whichthere is evidence to show are at times not uncommon, whenwhat is recognised as true plague is prevailing, but as tothe nature of which there is much difference of opinion.Dr. Cantlie’s mental attitude towards the question is clearlyan open one, but he has obviously been much impressed bythe recent news from Calcutta of the discovery of a bacillusstrongly resembling that of plague in cases to which thename of "pestis ambulans " is given by some, and he referredalso to certain peculiar glandular swellings, whether of thegroin, armpit, or neck, which were noticed among persons atHong-Kong and elsewhere, but which were, it appears,never accurately diagnosed. By some observers, however,certain of these glandular swellings have been regarded asbeing venereal in character, but it is not at all clear from theevidence forthcoming whether the glandular swellings in

question may not have been of more than one sort ; that, infact, there is truth in all the observations. Dr. Manson, forinstance, pointed out that in the East non-venereal buboesare very common, and he raised the question whether possibly"river fever," which is frequently accompanied by buboes,might not turn out to be a phase of " pestis minor." It isclear that if during certain prevalences of plague there existglandular swellings which are not regarded as due to thepoison of plague, but which, for aught we know to thecontrary, may be potent for infection, the preventive measureswith regard to the disease will have to be much extended.That there should occur during epidemics of plague a

number of more or less anomalous cases is what, upongeneral epidemiological principles, is, perhaps, to be ex-

pected. A similar condition of affairs is frequently observedin epidemics of diphtheria, scarlet fever, typhus fever, andenteric fever. The question is certainly one of great prac-tical importance, as may be inferred from the fact that theexodus from Bombay has now amounted to between 100,000and 150,000 persons. Dr. Lowson’s valuable observations asto the bacteriology of the disease were very full and sug-gestive, and he threw much doubt upon the discovery of the

true plague bacillus in the soil of Hong-Kong as also

upon the value of certain methods of treatment. His

experiences with regard to the inoculation of pigeons withplague bacillus were somewhat reassuring, as if, as hasbeen stated, these animals can act as the winged messengersof plague it would be necessary to limit their movementsas far as practicable. The question of the infection ofrodents is one upon which more light is needed, as it seemsdoubtful whether rats are, as has been believed, infectedprior to the human species or whether only the incubationperiod in rats is shorter than in man. In this connexion

Dr. Cantlie’s observations as to the similarity in geographicaldistribution between plague and a certain sub-family of ratsseem to call for further investigation. The question raised byDr. Lowson as to the presence of plague at Singapore is one

which may have a very material bearing on the spread of thedisease eastward.

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AN INTERNATIONAL JOURNAL.

WE notice elsewhere the contents of the first issues of anew literary venture of a peculiarly attractive and interestingnature, for which we hope much practical support will begiven by the medical profession in this country. We refer tothe revival of the periodical Janus, which in the Fiftiesobtained a notable position from the character of its con-tributions and the eminence of those who wrote in it. Thatit did not then obtain a permanent footing is, perhaps,explicable on the ground that its subject-matter-thatdealing ’with the history of medicine-failed to attract a

sufficiently large circle of readers. At the present time,when students of medical literature have so vastly in-creased in number, we may hope that no such draw-

back will be found to exist. The editor of the new

series of Janits is Dr. H. F. A. Peypers of Amsterdam,L and the basis on which the journal is established is strictlyinternational. Amongst the names of those in this country, who have cooperated in its foundation are Sir Joseph Fayrer,r Dr. J. F. Payne, Dr. C. Creighton, and Dr. A. Davidson.r It must not be supposed that it is intended to limit the scope9 of the journal to matters of purely archaic interest, for it isexpressly stated that medical geography as well as history1 will be represented in its pages. Thus there should be founde in this review articles written in all parts of the world con-t cerning the distribution and character of endemic diseases, that may be of great value. As we have indicated, the

, numbers already issued augur well of the success whichs should attend an enterprise that ought to stimulate and

extend the study of questions in which all medical mencannot fail to feel an interest.

SUFFOCATION IN A WELL.

A FATAL case; of asphyxia has occurred at the waterworksof the Hastings Corporation at Brede. The well, which hadbeen sunk for two years, was sixty feet deep and was linedwith iron cylinders for twenty feet, with brick-work for theremaining forty feet. There were fourteen feet of water,and the well was left open, but was under a shed. At a

depth of seventeen feet one of the workmen named Williams,was suddenly overcome and fell into the water. Anotherman followed to help him and got down about forty feetwhen he was overcome and was hauled up by the feetunconscious. Suspecting foul air, the men sent to Hastingsfor a fan and then got the body out. Men who hadbeen in the well "hundreds of times" said they hadnever before known foul air to be in it. It was usual to

let a lighted candle down to test the air, but on this occasionthis small formality had apparently been omitted until afterthe catastrophe, when it was repeatedly extinguished at adepth of twenty feet. The man Britt, who went to the rescue,said he smelt damp air about thirty or forty feet down,