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David Livingstone.
840 tubercle
bacillus, and
even
at
a
solution of the
problem
of
its
possible transformation. As other criticisms of the work of the Commission Dr. ALTSCHUL regards the number of cases of human tuberculosis investigated-viz., 108 with 28 sputum experiments-as too few wherefrom to draw farreaching conclusions. It may be pointed out in reply to this, that the prolonged and laborious nature of the experiments carried out with each necessarily limited the numbers it was possible to study, and that a full study of a smaller number must certainly be more fruitful than a more superficial examination of larger collections of cases. Dr. ALTSCHUL’S criticisms practically amount to a strong plea for further investigation of the problems, or for a continuation of the work of the Commission, and we cannot do better than translate his concluding paragraph, in the hope that in its English dress it will make a
wide
appeal
researches
to
our
readers.
" By
the
by a sense of the value of time. Natural history had special attractions for him from thefirst, and, while his interest in geology, botany, zoology, and even astronomy, evoked and quickened his powers of observations, he yet saw and appreciated the value of humanistic " training, and made himself proficient enough in Latin to acquire the linguistic habit and to make thesubsequent mastery of language an easy game. With all this he had the religious instinct strengthened in him by family tradition and inculcation, redeemed, however, from. the limitations of puritanism by an unsectarian love of hiskind and, be it added, by a developed sense of humour which kept his zeal from degenerating into fanaticism. So qualified, he may be said to have gravitated by an irresistible, compelling force to the career in which hez it with
an
ardour enhanced
"
entered,
a
career
in
which he found himself at home
from the outset, and which at once stimulated and braced the powers and the energies which threw him into it, till
extensive
of
the English Commission," he says, "a multitude of valuable details in regard to the tuberculosis question have been brought to light, and that
lively
interest in its
and became
well-nigh
The "Dark
prosecution glowed an
into enthusiasm.
obsession.
powerfully to his. imagination, and so alive was he to the complexity of its problems that in choosing the missionary fie present and future generations will accord recognition and he qualified himself in every department of knowgratitude to the men who have devoted so much time to the ledge that could contribute to their solution. He investigation of one of the most important problems relating studied medicine, as supplying a supreme equipment to the public health, an undeniably great achievement. A for the reclamation of the savage races with whom rich mine has been opened up to science and knowledge, a he would have to deal, and from that coign of vantage mine in which all who desire to work further at this subject he proceeded to theology as a further strategic weapon must explore, but the whole treasure has not yet been dug -both studies made exceptionally easy for him by out, and further work is necessary. A solid foundation has his early love of natural history and by the sternly, been laid by the work of the English Commission, upon if not austerely, religious atmosphere in which he hal1 He was, indeed, as his Italian which, with persistence and confidence, may be raised the been brought up. in the "Bollettino della Society Geografica" The of organised eulogist proud structure complete knowledge." fight against tuberculosis is become a part of our national for the present month says of him, "A discoverer because policy. We submit that those who have the spending of the he was an apostle, and an apostle because he was a disfunds now available for research require to receive the coverer," both callings reacting on each other and combining careful and learned support which would ensue from a in the unique personality which explains at once his success continuance of labours that have already proved fruitful. and the admiration in which he is held by the conWhatever course the new expenditure on research may take, temporary world. Of his predecessors in the same field, the’ it will obviously be valuable to continue the work which led great Jesuit missionaries of the seventeenth century, none to the Final Report of the British Royal Commission on came near him in this ensenable of qualities. They were Tuberculosis, and this is clearly the message of Austrian simply agents of the Holy Office and its proselytising propacriticism. ganda, protagonists in the fight in which the poet-laureate of their order sings-
achievement of great importance. The Commission has carried out its work with scientific enthusiasm and with admirable diligence and perseverance. Both
is
an
Continent"appealed
Lutheri triumphos Orbe Novo reparabit ultor.
Loyola
David
Livingstone.
Self-denying, devoted men they undoubtedly were, aye, SELDOM has a pioneer in geographical discovery and, in even enlightened enough to perceive, partly to utilise, its sequela, the reclamation, physical and moral, of the the value of medicine as an auxiliary in their enterprise;y races "brought to light," been so largely and effectively but proselytisers first and last, and civilians incidentally endowed with the qualities requisite to his task as DAVID rather than of set purpose. But this distinction between LIVINGSTONE, the centenary of whose birth the whole them and LIVINGSTONE explains the success of the one ancl civilised world is now commemorating. Of humble origin, the comparative failure of the other-Spain and Portugal though come of a vigorous stock, he was, from his boyhood, having neither of them made their tropical acquisitions inured to self-reliance-in other words, to the development of, permanent for good, while Great Britain owes to the methods. his innate gifts which, under conditions less restricted, might typified by LIVINGSTONE the fact that among all ther have dwindled or rusted from lack of stimulus or motive for European forces working in the Dark Continent hers stand exertion. He had to earn his livelihood almost concurrently out as the most progressive, the most enduring, and, with acquiring the elementary knowledge necessary for a politically speaking, the most conducive to the power and start in life, devoting his spare hours to study, and pursuing; influence of the source from which they emanate. ’
r
841 It is in this point of view that the life and work of LmNGSTONE appeal most impressively to the outlying world-to that "foreign opinion"which, in the words of Madame DE STAEL, is "that of a contemporaneous posterity." Precisely from among those Powers, France,
Italy, in which colonial expansion is promoted, come the most appreciative, the most enthusiastic, eulogies of the many-sided explorer, apostle, and civiliser, seeing as they do the solid, and in the best sense remunerative, acquisitions made in Germany, and
now
most valued and
the Dark Continent which
he
laid
on
the lines and
carried
and
out.
Of
on
the methods
those
eulogies
that from the pen of the accomplished nature-student and publicist, Professor ADRIANO AUGUSTO MICHIELI, repre-
Free Hospital, which indeed possesses a medical school,. and therefore might reasonably have been included. At a number of the hospitals omitted from the earliersurgical club"" the surgical staffs have decided that theexample set them might usefully be followed, and a second surgical "club" has been formed. Among thein this second scheme are the hospitals comprised Free for the Sick Royal Hospital, Children, Hospital Great Ormond-street, the Temperance Hospital, and several others, and a beginning was made last week, when some16 surgeons assembled at the Royal Free Hospital and witnessed a number of operations performed by the surgical staff. The schemes have proved certainly successful in bothinstances, and should result in benefit to the surgeons of London.
THE CITY
AND ITS
IMMUNITY
OF MADRAS senting the Italian Geographical Society, is not the least FROM EPIDEMIC PLAGUE. felicitously inspired and morally glowing. Having, for THE question has often been asked why during the past better or worse, acquired a foothold on the Red Sea littoral, 17 years, when plague has been visiting nearly the whole of in Somaliland on the Indian Ocean, and in the Tripolitania India, and ravaging in a disastrous manner many thicklyon the Mediterranean, Italy finds it the most urgent of populated communities, the disease has never succeeded in problems to recoup herself for the blood and treasure gaining a foothold in the city of Madras with its population she has lavished on their conquest, to convert them from of over half a million. Notwithstanding repeated importabeing a drain on her resources, and to become an outlet tions of the infection there has been no outbreak, with theof a comparatively slight epidemic in 1905-06’ for her rapidly increasing population and a treasure-house exception limited to the fishing population living on the extremeof financial development. Follow in the footsteps of outskirts of the municipal boundary and therefore hardly the British explorer, imitate, nay, if possible, improve upon, to be regarded as being within the city itself. Madras is the his methods, assimilate his humanitarian spirit, and so third city in India in point of population, and as a seaport. conquering on the lines ofconciliation’ make the ranks fifth in importance, having a large trade by shippingintruding, innovating power thenursing mother’ of with eastern ports, and particularly with Rangoon, whereis often epidemic, and from which large quantities ofprogress, prosperity, and peace "-such is the burden of plague rice or other grain are brought, such cargoes attracting rats Italian, nay, of European, eulogy on DAVID LIVINGSTONE. on board ship at the place of loading. On the landward And safely may it be said that no consummation could side Madras is in close communication by rail with other have been more gratifying, more compensating to that great, of now India in is which plague annually epidemic, parts simple-minded, and modest philanthropist, discoverer, and including Mysore, and especially the town of Bangalore in "
rehabilitator than the realisation that his achievement in
Equatorial
Africa had become
an
inspiration
of universal
Christendom to "go and do likewise"and to be thriceblest in the process and its result.
Annotations. 11
Ne
quid nimis."
TWO SURGICAL "CLUBS"
IN
LONDON.
that
State, where the disease has of late years been veryprevalent. But in spite of these and other opportunities for contracting the infection Madras has, with the slight exception mentioned above, remained free from epidemicplague during the past 17 years, and only sporadic cases, spread over that period and resulting in a total of 125 deaths, have been recorded in the city. Yet Bombay and’ Calcutta have suffered severely year after year, the former, with a population of 979,445, having had no fewer than 178,440 plague deaths, and the latter, with 1,222,313inhabitants, having had over 61,000 in the period in question. With the purpose of discovering, if possible, thereasons for this apparent immunity of the city of Madras, from plague epidemics, the Advisory Committee, appointed jointly by the Secretary of State for India, the Royal Society, and the Lister Institute, some little time agoordered an inquiry to be made by its expert officers into. the matter, and the results of this have recently been
IT is a curious fact that the hospital surgeons of London rarely have the opportunity of witnessing the performance of operations by any other surgeons than those of the hospital to which they are themselves attached, and therefore it is not at all improbable that many niceties of method become known to only a small circle. In order to remedy this state published in the " Seventh Report on Plague Investigationsof affairs a surgical club" " was started among the members in India."1 This report states that the conditions of house of the surgical staffs of those hospitals in London to which construction in the city of Madras are not unfavourable to. are attached medical schools, and arrangements were made the establishment of epidemic plague, and that suitable to invite the surgeons of these hospitals to visit in turn the climatic conditions for this prevail during the winter months. different institutions. A beginning was made in February, Though neither rats nor rat-fleas are so plentiful as in otherwhen some 30 surgeons visited St. Bartholomew’s Hospital, places which have been examined by the committee’s experts, and saw a number of operations performed by various still there are probably enough of both to maintain plague if members of the surgical staff. Great interest was shown, were introduced. Moreover, the local rats (Mus rattus). and it is clear that the experiment is likely to be have been shown by experiment to be exceptionally suscepa success. This scheme being limited to general hospitals tible to plague infection. It therefore appears that the city and those possessing medical schools omitted several 1 Vide the The Journal of Hygiene, Plague Supplement II. important hospitals, and amongst these was the Royal Cambridge University Press. Jan. 13th, 1913. Price 7s. net.
I it
bacillus, and
even
at
a
solution of the
problem
of
its
possible transformation. As other criticisms of the work of the Commission Dr. ALTSCHUL regards the number of cases of human tuberculosis investigated-viz., 108 with 28 sputum experiments-as too few wherefrom to draw farreaching conclusions. It may be pointed out in reply to this, that the prolonged and laborious nature of the experiments carried out with each necessarily limited the numbers it was possible to study, and that a full study of a smaller number must certainly be more fruitful than a more superficial examination of larger collections of cases. Dr. ALTSCHUL’S criticisms practically amount to a strong plea for further investigation of the problems, or for a continuation of the work of the Commission, and we cannot do better than translate his concluding paragraph, in the hope that in its English dress it will make a
wide
appeal
researches
to
our
readers.
" By
the
by a sense of the value of time. Natural history had special attractions for him from thefirst, and, while his interest in geology, botany, zoology, and even astronomy, evoked and quickened his powers of observations, he yet saw and appreciated the value of humanistic " training, and made himself proficient enough in Latin to acquire the linguistic habit and to make thesubsequent mastery of language an easy game. With all this he had the religious instinct strengthened in him by family tradition and inculcation, redeemed, however, from. the limitations of puritanism by an unsectarian love of hiskind and, be it added, by a developed sense of humour which kept his zeal from degenerating into fanaticism. So qualified, he may be said to have gravitated by an irresistible, compelling force to the career in which hez it with
an
ardour enhanced
"
entered,
a
career
in
which he found himself at home
from the outset, and which at once stimulated and braced the powers and the energies which threw him into it, till
extensive
of
the English Commission," he says, "a multitude of valuable details in regard to the tuberculosis question have been brought to light, and that
lively
interest in its
and became
well-nigh
The "Dark
prosecution glowed an
into enthusiasm.
obsession.
powerfully to his. imagination, and so alive was he to the complexity of its problems that in choosing the missionary fie present and future generations will accord recognition and he qualified himself in every department of knowgratitude to the men who have devoted so much time to the ledge that could contribute to their solution. He investigation of one of the most important problems relating studied medicine, as supplying a supreme equipment to the public health, an undeniably great achievement. A for the reclamation of the savage races with whom rich mine has been opened up to science and knowledge, a he would have to deal, and from that coign of vantage mine in which all who desire to work further at this subject he proceeded to theology as a further strategic weapon must explore, but the whole treasure has not yet been dug -both studies made exceptionally easy for him by out, and further work is necessary. A solid foundation has his early love of natural history and by the sternly, been laid by the work of the English Commission, upon if not austerely, religious atmosphere in which he hal1 He was, indeed, as his Italian which, with persistence and confidence, may be raised the been brought up. in the "Bollettino della Society Geografica" The of organised eulogist proud structure complete knowledge." fight against tuberculosis is become a part of our national for the present month says of him, "A discoverer because policy. We submit that those who have the spending of the he was an apostle, and an apostle because he was a disfunds now available for research require to receive the coverer," both callings reacting on each other and combining careful and learned support which would ensue from a in the unique personality which explains at once his success continuance of labours that have already proved fruitful. and the admiration in which he is held by the conWhatever course the new expenditure on research may take, temporary world. Of his predecessors in the same field, the’ it will obviously be valuable to continue the work which led great Jesuit missionaries of the seventeenth century, none to the Final Report of the British Royal Commission on came near him in this ensenable of qualities. They were Tuberculosis, and this is clearly the message of Austrian simply agents of the Holy Office and its proselytising propacriticism. ganda, protagonists in the fight in which the poet-laureate of their order sings-
achievement of great importance. The Commission has carried out its work with scientific enthusiasm and with admirable diligence and perseverance. Both
is
an
Continent"appealed
Lutheri triumphos Orbe Novo reparabit ultor.
Loyola
David
Livingstone.
Self-denying, devoted men they undoubtedly were, aye, SELDOM has a pioneer in geographical discovery and, in even enlightened enough to perceive, partly to utilise, its sequela, the reclamation, physical and moral, of the the value of medicine as an auxiliary in their enterprise;y races "brought to light," been so largely and effectively but proselytisers first and last, and civilians incidentally endowed with the qualities requisite to his task as DAVID rather than of set purpose. But this distinction between LIVINGSTONE, the centenary of whose birth the whole them and LIVINGSTONE explains the success of the one ancl civilised world is now commemorating. Of humble origin, the comparative failure of the other-Spain and Portugal though come of a vigorous stock, he was, from his boyhood, having neither of them made their tropical acquisitions inured to self-reliance-in other words, to the development of, permanent for good, while Great Britain owes to the methods. his innate gifts which, under conditions less restricted, might typified by LIVINGSTONE the fact that among all ther have dwindled or rusted from lack of stimulus or motive for European forces working in the Dark Continent hers stand exertion. He had to earn his livelihood almost concurrently out as the most progressive, the most enduring, and, with acquiring the elementary knowledge necessary for a politically speaking, the most conducive to the power and start in life, devoting his spare hours to study, and pursuing; influence of the source from which they emanate. ’
r
841 It is in this point of view that the life and work of LmNGSTONE appeal most impressively to the outlying world-to that "foreign opinion"which, in the words of Madame DE STAEL, is "that of a contemporaneous posterity." Precisely from among those Powers, France,
Italy, in which colonial expansion is promoted, come the most appreciative, the most enthusiastic, eulogies of the many-sided explorer, apostle, and civiliser, seeing as they do the solid, and in the best sense remunerative, acquisitions made in Germany, and
now
most valued and
the Dark Continent which
he
laid
on
the lines and
carried
and
out.
Of
on
the methods
those
eulogies
that from the pen of the accomplished nature-student and publicist, Professor ADRIANO AUGUSTO MICHIELI, repre-
Free Hospital, which indeed possesses a medical school,. and therefore might reasonably have been included. At a number of the hospitals omitted from the earliersurgical club"" the surgical staffs have decided that theexample set them might usefully be followed, and a second surgical "club" has been formed. Among thein this second scheme are the hospitals comprised Free for the Sick Royal Hospital, Children, Hospital Great Ormond-street, the Temperance Hospital, and several others, and a beginning was made last week, when some16 surgeons assembled at the Royal Free Hospital and witnessed a number of operations performed by the surgical staff. The schemes have proved certainly successful in bothinstances, and should result in benefit to the surgeons of London.
THE CITY
AND ITS
IMMUNITY
OF MADRAS senting the Italian Geographical Society, is not the least FROM EPIDEMIC PLAGUE. felicitously inspired and morally glowing. Having, for THE question has often been asked why during the past better or worse, acquired a foothold on the Red Sea littoral, 17 years, when plague has been visiting nearly the whole of in Somaliland on the Indian Ocean, and in the Tripolitania India, and ravaging in a disastrous manner many thicklyon the Mediterranean, Italy finds it the most urgent of populated communities, the disease has never succeeded in problems to recoup herself for the blood and treasure gaining a foothold in the city of Madras with its population she has lavished on their conquest, to convert them from of over half a million. Notwithstanding repeated importabeing a drain on her resources, and to become an outlet tions of the infection there has been no outbreak, with theof a comparatively slight epidemic in 1905-06’ for her rapidly increasing population and a treasure-house exception limited to the fishing population living on the extremeof financial development. Follow in the footsteps of outskirts of the municipal boundary and therefore hardly the British explorer, imitate, nay, if possible, improve upon, to be regarded as being within the city itself. Madras is the his methods, assimilate his humanitarian spirit, and so third city in India in point of population, and as a seaport. conquering on the lines ofconciliation’ make the ranks fifth in importance, having a large trade by shippingintruding, innovating power thenursing mother’ of with eastern ports, and particularly with Rangoon, whereis often epidemic, and from which large quantities ofprogress, prosperity, and peace "-such is the burden of plague rice or other grain are brought, such cargoes attracting rats Italian, nay, of European, eulogy on DAVID LIVINGSTONE. on board ship at the place of loading. On the landward And safely may it be said that no consummation could side Madras is in close communication by rail with other have been more gratifying, more compensating to that great, of now India in is which plague annually epidemic, parts simple-minded, and modest philanthropist, discoverer, and including Mysore, and especially the town of Bangalore in "
rehabilitator than the realisation that his achievement in
Equatorial
Africa had become
an
inspiration
of universal
Christendom to "go and do likewise"and to be thriceblest in the process and its result.
Annotations. 11
Ne
quid nimis."
TWO SURGICAL "CLUBS"
IN
LONDON.
that
State, where the disease has of late years been veryprevalent. But in spite of these and other opportunities for contracting the infection Madras has, with the slight exception mentioned above, remained free from epidemicplague during the past 17 years, and only sporadic cases, spread over that period and resulting in a total of 125 deaths, have been recorded in the city. Yet Bombay and’ Calcutta have suffered severely year after year, the former, with a population of 979,445, having had no fewer than 178,440 plague deaths, and the latter, with 1,222,313inhabitants, having had over 61,000 in the period in question. With the purpose of discovering, if possible, thereasons for this apparent immunity of the city of Madras, from plague epidemics, the Advisory Committee, appointed jointly by the Secretary of State for India, the Royal Society, and the Lister Institute, some little time agoordered an inquiry to be made by its expert officers into. the matter, and the results of this have recently been
IT is a curious fact that the hospital surgeons of London rarely have the opportunity of witnessing the performance of operations by any other surgeons than those of the hospital to which they are themselves attached, and therefore it is not at all improbable that many niceties of method become known to only a small circle. In order to remedy this state published in the " Seventh Report on Plague Investigationsof affairs a surgical club" " was started among the members in India."1 This report states that the conditions of house of the surgical staffs of those hospitals in London to which construction in the city of Madras are not unfavourable to. are attached medical schools, and arrangements were made the establishment of epidemic plague, and that suitable to invite the surgeons of these hospitals to visit in turn the climatic conditions for this prevail during the winter months. different institutions. A beginning was made in February, Though neither rats nor rat-fleas are so plentiful as in otherwhen some 30 surgeons visited St. Bartholomew’s Hospital, places which have been examined by the committee’s experts, and saw a number of operations performed by various still there are probably enough of both to maintain plague if members of the surgical staff. Great interest was shown, were introduced. Moreover, the local rats (Mus rattus). and it is clear that the experiment is likely to be have been shown by experiment to be exceptionally suscepa success. This scheme being limited to general hospitals tible to plague infection. It therefore appears that the city and those possessing medical schools omitted several 1 Vide the The Journal of Hygiene, Plague Supplement II. important hospitals, and amongst these was the Royal Cambridge University Press. Jan. 13th, 1913. Price 7s. net.
I it