1040 there is someone present at the exhibition to take parties round and to explain. Thus an immense educational work is done. There are now no less than 195 State or local associations for the prevention of tuberculosis. To show how quickly the movement has grown it suffices to consider the following few figures. At the commencement of 1905 there were only 24 associations for the prevention of tuberculosis throughout the whole of the United States and then 12 In 1906 25 new associations were new ones were created. started. In 1907 the doubling process continued, since in that year 49 new organisations sprang into existence. But the first seven months of the present year beat all former records by creating 85 new associations. The rapidity of the increase shows the popularity of the cause and the ability with which it has been advocated. As already remarked, the object is purely educational and one of the difficulties has been to check the over-zealous. Others seek to advertise themselves rather than to make themselves really useful, so that some associations have been formed which it was thought wiser not to recognise. The committee governing the National Association has been carefully selected from among eminent medical men and some laymen who have had great experience in such matters and are fully cognisant of the sort of difficulties likely to arise. Dr. Livingston Farrand, who has been very active in this organising work and who supplied me with much of this information, will give further details at Washington and the foreign members will be profitably interested in the practical information thus forthcoming. There is a book also about to appear, of which I have some proof sheets, containing a complete some practical details, of every sanain the whole of the United States intended for tuberculous patients. This will be a
list, accompanied with torium and
specially
very useful
hospital
publication.
RECENT OUTBREAKS OF PLAGUE IN THE NEAR EAST. (BY THE BRITISH DELEGATE TO THE CONSTANTINOPLE BOARD OF HEALTH.) DURING the past few months an epidemic of plague of severity has been prevailing at Bagdad. The first case of the disease there was seen by the health officer of the town on May 8th last. The patient, a Jew, was said to have been ill during the eight preceding days. Other cases were observed at the same time, but hitherto no light has been i thrown on the source from which the infection was introduced into Bagdad. The further course of the outbreak has been as follows :some
The totals up to the last-named date were 111 cases with 67 deaths. The high proportion of cases found dead " cannot escape notice. The written reports from Bagdad tend to show that the measures imposed by the local authorities have not been very adequately carried out. In the early days of the outbreak it was stated that a considerable number of dead rats had been found in the town, and the diagnosis of plague, both in human beings and in rats, was confirmed bacteriologically. Various measures were imposed to prevent the infection spreading outside Bagdad, the most important of which were : a medical inspection of passengers leaving the town by river or road, an additional medical inspection
of arrivals in Kerbela (the Shiah Holy City), the prohibition of the transport of corpses from Bagdad to the Shiah Holy Cities of Kerbela and Nedjef, and of the burial of bodies in the interior of the Kiazimieh mosciue. Medical visits werealso imposed on travellers by the river steamers from Bagdad. The outbreak seems now to be approaching extinction. The outbreak of plague in Jeddah came to an end in the month of March last. Subsequently to the returns quoted in my letter which appeared in THE LANCET of April llth (p. 1110) only a single death from the disease was observed there-on March 30th. In Yanbo, on the other hand, the outbreak lasted longer. The following figures are in continuation of those quoted in the letter just referred to:-
Apparently the outbreak in Yanbo died out at the end of May ; the total number of cases registered there since the beginning of the epidemic on Feb. 13th was 137 and that of deaths 126. A few sporadic cases of plague have recently occurred again in Adalia on the south coast of Asia Minor. It will be recalled that in the summer of 1905, and again in August, 1906, a few isolated cases of the disease were observed here. were none in 1907. In the present instance two cases occurred on July 26th ; both the patients were employed in a flour mill and it was stated that an unusual mortality among rats had been observed in the mill and also in other quarters of the town. A third case was seen on August 22nd; the patient was also employed in a mill but in one situated near the port and far removed from the other mill. Finally, a fourth case was reported on Sept. 5th. As in the former outbreaks the exact source of the infection in these cases was unknown. Plague has recently been prevalent in the Kirghiz Steppes of the Astrakhan government in south-eastern Russia. The returns have been very incomplete, but it is known that early in August nine cases of the disease with four deaths occurred among the Kirghiz in this region. A case of plague also occurred in Odessa early in August but the details have not been published. Constantinople, Sept. 17th.
There
MANCHESTER. (FROM
OUR OWN
CORRESPONDENT.)
Poor-lwv Provision and Consumption. A PAPER was read at the thirty-fourth annual meeting of the North-Western Poor-law Conference held recently at Ulverston by Mr. Macfarlane, chairman of the Chorlton union, on the question of providing, in connexion with the Poor-law, sanatoriums for tuberculous patients. He quoted with approval a statement by Dr. Nathan Raw, thatadequate provision is made by the health authorities for every disease excepting the one that kills most people and which, if taken in time, is more easily cured than most other diseases." An inquiry made the other week at the Chorlton Union Hospital showed the close connexion between pulmonary tuberculosis and poverty, andproved"also that in the majority of cases poverty, ’’ if not the dominant, was a strong contributory cause of the disease." 30 men out of 100 in the phthisis wards were asked as to their former occupations and the probable cause of their sickness. Eight only had been engaged in the " dustyor"dangerous"trades regarded as predisposing the workers to pulmonary tuberculosis-viz., one baker, one collier, one iron-grinder, one cabinet-maker, two French polishers, one grey-cloth warehouseman, and one shoe-maker. Of the remaining 22, 18 had been general labourers, who had contracted cold after cold and developed pulmonary tuberculosis. Poverty had compelled them to continue to work in inclement weather, or to forfeit part of the wage which as it was would barely support the wife and children. Mr. Macfarlane thought that there’should be combined action between health