besides the treatment of such cases in public dispensaries and out-door departments of hospitals for other affections, and we need not have recourse to hypothesis to account for the mischief. Taking all these and many other circumstances into consideration, I contend that the infection of small-pox in certain localities in London is ever existent, a thorough and systematic disinfection has been rendered impracticable, and the explanation of its spread through air is a confession of our inability to cope with the disease, and of our ignorance of its immediate sources. I do not deny the dissemination of contagion through air, the very word infection means it, but it is difficult to conceive atmosphere as a mere carrier of infection at long distances. Have heat, light, moisture, ozone, and other constituents of the air no influence on the economy of animal and vegetable life? Hence it becomes necessary to know whether small-pox was existent in the locality before the opening of the Fulham Hospital, on the 10th of March, 1877. We find from the returns of the Metropolitan Asylums Board, that there were 31 admissions from Fulham, 50 from Chelsea, and 115 from Kensington at other small-pox hospitals up to the latter date. During the same period the Highgate Small-pox Hospital had admitted 24 from Kensington, of which seven were from Brompton, 30 from Fulham Union, of which fourteen were from Fulham Parish, and eight from Chelsea. During the year 1876, there were 736 deaths from small-pox in London, of which ten were in Kensington, three in Fulham, and four in Chelsea, while the Metropolitan Asylums Board Hospitals had admitted 2,120 cases of small-pox. This conclusively proves that the admissions to these institutions does not mean incidence of the disease in the metropolis. A locality of which the sanitary authorities had no knowledge. Many mild cases are treated, as cases of chicken-pox, measles, skin affections, &c. Dr. Dudfield informs us, in his annual report for 1876, that during the year there were about 30 cases treated at home in Kensington. He had traced the spread of the disease through laundries, and among the victims were several ironers, manglers, and laundresses. Another feature noticed by him was, that in Brompton the victims were mostly adults, many being domestics, while in the Kensington Town Sub-district they were of all ages. The same peculiarities had been recorded by him in the epidemic of 1871-72, and they go to prove that the sources of infection in Brompton must be outside the district. On my visits to the locality in January and February, 1877, I was informed of nearly a dozen cases of small-pox in the Central Circle and mile Ring. It is evident, therefore, that the sources of infection were rapidly multiplying in the locality, and especially in the small shop-houses and laundries, with the rise of the epidemic in the metropolis before the hospital was opened. The conditions that favour the spread of small-pox are the absence of re-vaccination among adults, non-death certificate sometimes reveals an outbreak in a vaccination at all ages, overcrowding, malnutrition of the body, accumulation of filth in clothing and linen, defective sanitation in houses, free intercourse among houses and families, children playing together in streets. All these causes abound among poor people. With these facts before me I have felt surprised, not because I have not been able to account for the cases that came to my knowledge, but because of the repeated escapes of so many people in an infected locality. Mr. Power began his enquiry nearly four years after the establishment of Fulham Hospital, surrounded by such a locality, and his Report gives us no idea of the condition of the houses in the special area forming a circle round the hospital within the radius of a mile, which includes many magnificent and palatial residences in Brompton as well as wretched hovels in Fulham, and old and inferior houses in Chelsea, upon which he calculates averages, taking houses as so many units, irrespective of all other conditions, to support his dazzling theory. It was not possible that he could study the locality in a few weeks. Had he confined himself to the explanation of a few cases he enquired into I should not have felt it necessary to criticise his Report. But by the addition of a series of tables and maps, professing to explain the outbreaks of the disease in previous years by mere calculations and averages, he has tried to harmonise facts in a manner contrary to my experience as the Medical Officer of the Fulham Small-pox Hospital. With this introduction, I shall narrate the history of the hospital, and the incidence of the disease in Kensington, Fulham, and Chelsea. For the sake of convenience I shall adopt the same terms used by Mr. Power for defining several areas. Special Area (S. A.,) means the area included in a circle with a mile radius, having the hospital for its centre. Outside Special Area (O.S. A.,) area beyond the special area. The Fulham Small-pox Hospital was opened on March 10th, 1877, and during the first week it received convalescents, and during the second week some acute cases, the admissions being confined to males over 7 years of age. The children and females were either treated at home or taken to other hospitals. This arrangement was unavoidable, and it would have been well had the managers not opened this hospital in its then incomplete state, and thus saved one blot on the management. The southern wing, with five wards, was barely ready to receive patients. The administrative block and the northern wing were fenced off to prevent the workmen and patients mixing together. Some workmen were re-vaccinated and were engaged to finish the kitchen and laundry, which were also incomplete. A room to keep disinfected clothing had been forgotten; a wooden shed with venetian walls was soon erected as a substitute. The disinfecting chamber was put up in the engineer's workshop, as no provision was made for it. The mortuary was not ready for months, and coffins were first used to remove the dead bodies from the wards, and piled up one on the other in the room. Out of the five wards of the southern wing, one was used as a store-room and mess-room for male attendants, and another as their dormitory. The medical officer, assistant medical officer, and the One Mile Ring (1 mile R.,) means the area between steward had each a ward scullery for their resimile R., and a circle described with one mile radius. dence, offices, and dispensary. The attendants were Small-pox became epidemic in London in the summer males and their wives. Some of them slept outside of 1876, when the Stockwell Small-pox Hospital was the with their families, and had their lodgings generally in only one available for the metropolis. Very soon Walham Green. Most of the workers in the kitchen Homerton was opened, and it was followed in the and laundry slept outside. The washing of the staff November of the same year by Hampstead. In March, was sent out for weeks, while the patients' clothing 1877, Deptford and Fulham Hospitals were established. | and bed linen were left to accumulate for days, in Central Circle (C. C.,) means the area included in a circle with quarter mile radius, with the hospital for its centre. Half Mile Ring (mile R.,) means the area between the central circle and a circle described, with a half mile radius. Three Quarter Mile Ring (3 mile R.,) means the area between mile R. and a circle described with three quarter mile radius. one. expectation of the completion of the laundry. A porter's lodge had not yet been provided, and a temporary gate was put up nearest the southern wing by breaking through the boundary wall. The receptionroom was used as the gate porter's lodging-room, admission and discharge room for the patients. The non-resident staff left in the evening, to return in the morning. The resident went out every evening, and half-day once a week. Cases of small-pox occurred in their families and among their friends. They were either treated at home or sent to hospitals. The administrative block and northern wing were ready in May. The former building was unfit for its purpose, as it was wanting in rooms of every description. There was no provision for a dispensary: it was fitted up in a small corner room. There was no bath-room for superior officers, and only one bath for the rest of the staff, both males and females. There was no provision for the assistant medical officer. The steward was expected to reside outside. There was no coal-cellar for the whole of the block, excepting one for the apparatus for hot-water pipes. Only one scullery for the whole block. The washing of plates, &c., was all done in the kitchen. The sleeping accommodation for the staff was insufficient. Now and then two girls have slept in one bed, and in rooms too small for Two wards had to be used as dormitories, one for the males and the other for the females. There was no adequate provision to keep sexes among servants separate, and all manner of dereliction of duties had to be excused. The rooms were all poorly and badly furnished. The surface drainage, roads, and paths in the grounds were left unfinished by the contractors, and the passengers and ambulances had to wade through mud and stones. The firegrates and scullery fittings of the wards were condemned before they were used, and had to be gradually replaced and deficiencies gradually supplied. The washing of the staff was at first done with that of the patients, and after many remonstrances a sort of a separate provision was made. The drying horses were few, and a portion of the grounds was set apart with wooden poles and iron cords to dry washed clothing and linen in the open air. The walls of the wards and the rooms in the administrative block were left bare and dirty, as workmen left them, without paper, paint, or limewash, till the year 1880. The porter's lodge was not ready, and the proper gate was not in use till about the middle of the 1879. Many parcels and presents for the patients were brought in by the traders' carts, nurses, &c., who visited the patients' friends at home, and I had to exert a most rigid supervision to keep many improper things out of the wards. The nurses did their knitting and sewing in the wards, and carried the work outside in handbags, which were every now and then turned out of wards by me. Although they changed their dresses when going out, they always passed along the corridors, and sometimes spent hours in out-door garments in the ward sculleries and receiving-rooms when tired of walking the streets. They had no kind of recreation or sitting-room except the mess-room, which was also their pantry. Reports, reprimands, discharges of servants, did them no good, and the institution every now and then lost a good servant. Numerous complaints of the spread of the disease from the hospital were made, and they were explained away in one way or another. If the complaint was that the members of the staff slept outside, they would reduce the staff and adopt some means for a time to report that no one slept outside. If the complaint was that the refuse of food caused the spread, they would stop it and report none left the premises. If the complaint was that poultices, rags, &c., that went out of wards with the dust, caused the disease, they would issue an order to burn them and report it as such. When year cases of small-pox occurred amongst friends and relations of the staff, they would suddenly disappear before they came to light or could be investigated. Many patients, and male and female servants married away from the hospital. In the Hampstead Hospital trial it was proved in court that the hospital was mismanaged as far as the safety of the public outside was concerned. Had they taken advantage of their experience, done away with many abuses, and investigated the local outbreaks, there would not have been any necessity for Mr. Power's Report, nor for pleading through a Royal Commission for their errors, nor for a compromise with the opposite party at the expense of the public purse, and acceptance of the dogma of aërial infection. Had these allegations of mine been known and considered by Mr. Power, he would not have been led astray. Let me ask those who adopt the theory of aërial infection, whether we are to forget all the foregoing facts which point to so many ways of the spread, and for a while roam in the region of fancy and philosophy to search after something new to pacify the public mind? I shall now make a detailed statement of the incidence of the locality in Kensington, Chelsea, and Fulham for the years 1877, 1878, 1879 and 1880, which will show that Mr. Power's figures of the incidence are inaccurate, and his method of counting of houses in the circles and rings of the special area misleading. (To be continued.) REPORTS OF HOSPITAL PRACTICE IN MEDICINE AND SURGERY. UNIVERSITY COLLEGE HOSPITAL. CANCRUM ORIS-SPREAD OF THE DISEASE -ABSENCE OF MICRO-ORGANISMS IN THE BLOOD-DEATH-AUTOPSY. (Under the care of Mr. CHRISTOPHER HEATH.) (We are indebted to Mr. VICTOR HORSLEY, B.S., F.R.C.S., for these notes.) CHARLES L., aged 12 years, was admitted into the hospital on January 31st. He had first noticed a blackish lump on the right side of the mouth, close to the bicuspid tooth a week ago. This has gradually spread. He has had a disagreeable taste in his mouth, and the odour from the lump has been very fetid. ago he went to see a medical man. He has no idea what started the disease. Four days On admission, the gum on the right side of the lower jaw was spongy and ulcerated, and opposite the first molar it was gangrenous, and covered with a greyish slough, more extensive on the inner than the outer side of the gum; it did not extend beyond the reflection of the mucous membrane from the jaw, on to the tongue: several of the teeth were loose, and painful when pressed upon. Strong nitric acid was applied, the patient being under chloroform. February 1st. The cauterised part had assumed a brownish-yellow colour, with very little redness or swelling around: early in the day there was little or no pain, but towards evening pain came on, and opium had to be given internally, while glycerine and belladonna were applied externally. February 2nd. The lower lip was swollen, and the gum about the incisor teeth dark red, and covered with tongue, a greyish slough the tongue remained healthy. The is sharply marked off from the remainder by a glands, both in front of and behind the sterno-mastoid hyperæmic line of demarcation. The sloughing muscles, very tender. process extends into the base of the By February 7th, the ulcer had extended consider-destroying the frænum, forming a polypoid mass ably; it was in a sloughy condition, and its base very of granulations and slough; and forcing the tender. The under-surface of the tongue and the tongue upwards and backwards. The rest of the mucous membrane of the cheek were now implicated. mucous membrane of the mouth appears to be perThe cervical glands much swollen and very tender; the fectly healthy; the oedema which is noticed as extendtemperature ranges between 101° and 103-8° F. He was ing in front of the hyperemic border in the loose fed with a tube. Mr. Heath had the patient put under connective tissues of the cheek is absent from the chloroform in the afternoon, and carefully scraped the mucous membrane of the mouth. The lymphatic surface of the ulcer with a sharp spoon, and then applied glands on both sides of the neck are enlarged, but the actual cautery, the mouth being afterwards washed more especially on the right side, some portions appearout with glycerine and carbolic solution. ing intensely congested, others, especially the medullary portion, of a pale white colour. On February 10th, the sloughing was found to be again extending; he had had his mouth swabbed out at intervals with glycerine of carbolic acid, and had used a gargle of chlorate of potash. There was noticed yesterday a copper coloured papular rash on both buttocks, and on the lower part of the legs. His chest was carefully examined, but beyond a little rhonchus, nothing abnormal was found. February 12th.-The sloughing in the mouth was extending, his tongue was raised, and pushed wards and upwards, and was rather swollen. February 15th.-The boy begins to be very anæmic. His blood was examined for organisms; but none were found. On counting the corpuscles there seemed to be a diminution in the number, both of the white and the red. February 16th.--Condition remained about the same. The blood was again examined; there was an excess of white corpuscles, many of which were undergoing fatty degeneration; some of the red discs were breaking down; the blood when fresh drawn had a thin watery appearance; there were still no organisms. February 18th.-The patient passed a restless night; he was constantly crying out, refused nourishment; now ne lies in a semi-conscious condition, very much exhausted. The lips are covered with dark sordes. The blood is still more watery in appearance, and coagulates feebly. In ten squares of the hæmocytometer there were only forty-five red and eight white corpuscles. Under the microscope, no organisms were detected; the white corpuscles appeared larger than normal, some showed amoeboid movements, and some granular fatty degeneration. Death. The pleuræ contain about three ounces each of pale straw-coloured serum, which coagulates into a firm jelly on the addition of blood; there are a few petechiae on the right side. The peritoneum is apparently normal. Parietal pericardium shows a few petechiae The heart cavities contain a small quantity of fluid blood. The visceral layer of the pericardium on the anterior surface of the right ventricle shows a mass of petechiae along the disback-tribution of the left coronary artery: a similar condition is found on the posterior surface. The endocardium is rather bloodstained a few petechiae are found on the septum. The petechiae in places extend into the muscular substance for a distance of about 3 mm. The heart muscle is everywhere pale, but preserves its normal density. Valves all healthy; aorta healthy. Lungs: Right. The outer and under surface of the upper lobe is covered with recent lymph, and there are small patches scattered about elsewhere: there are also a few petechia here and there. The bronchial mucous membrane is perfectly normal, except in one branch in the upper lobe, where it is congested in places. The upper lobe is oedematous, airless, and of a dark red colour, showing on section broncho-pneumonic patches; middle lobe presents small areas here and there of congestion, is otherwise normal; lower lobe slightly congested; left lung much in the same condition; none of these congested areas are more than 3 mm. in diameter; liver is normal in shape, but increased in size; it has a homogeneous, ground-glass appearance; bile ducts are distended. The spleen is slightly enlarged, but not otherwise markedly changed. Intestines: In the cæcum there are two small ulcers, each surrounded by a hyperæmic border. The right kidney presents a few petechiæ beneath the capsule; the organ on section is pale and bloodless; left kidney on section is found in the whole of its depth, to be of a pale yellowish-white colour, surrounded by a congested border; both kidneys are normal in size: nothing noteworthy in the intestines, or bladder, or pancreas. On the under surface of the dura mater, covering the posterior half of the left inferior frontal convolution, and the lower half of the fissure of Rolando, there is an effusion of blood, and beneath this, the whole of this side of the vertex is sprinkled over with numerous hæmorrhages, especially along the line of the intraparietal sulcus. These hæmorrhages run in the line of the cerebral veins. On the right side there is a similar patch of hæmorrhage over the posterior half of the middle frontal convolution; the rest of the dura mater covering the vertex is similarly sprinkled with small hemorrhages. The arachnoid and pia mater are infiltrated and oedematous, and there are also scattered about small hæmorrhages. Autopsy by Mr. Horsley:-The skin is dusky; rash has disappeared; there is a hard thickening on the right side, extending from the angle to just beyond the symphysis of the lower jaw. On cutting through the tissues in front of the neck, they are found to be oedematous as low as the upper third of the pectoralis major muscle. The gangrene has reached the corium at a point opposite the middle of the body of the lower jaw. On reflecting the skin, the right cheek is found to be destroyed for its anterior and lower half. The buccinator muscle is converted into a foul, dark grey slough, the fat covering it is infiltrated and œdematous, and is hard on section; it, however, still preserves its yellow-white appearance. This infiltration of the fat extends for about one inch beyond the margin of the slough. On exposing the jaw, the right half is found to be bared as far as the tip of the coronoid process, the attachment of the temporal muscle separating from it, owing to the suppuration, which has reached back to the pterygoid region. Posteriorly, the limit of exposed bone corresponds to the line of attachment of the masseter and internal pterygoid muscles respectively. Below, it reaches to the lower border of the body both in front and behind. The whole of the alveolar border is blackened, more especially along the canine and incisor sockets. The mucous membrane, where ulcerated, is covered with a greyish-yellow slough, and Remarks by Mr. Victor Horsley :-In the foregoing case there are two points of interest. (1) The continuance of the disease, and (2) the immediate cause of death. As for the first it may be fairly assumed, in view of the most recent observations of the necrosis of tissues following the growth of organisms in the same, that the cauterising agents failed to reach the foci of development of the parasite, and that the disease scepticism. The affection has not yet proved its right simply spread unchecked. Microscopically, however, to official recognition, but is quite entitled to claim a the spreading border of the gangrene simply exhibits fair hearing. edema, and infiltration of the loose tissues with leucocytes, and I have only been able to demonstrate the existence of bacterium termo in those parts which were putrid during life. (The post-mortem was performed within half-an-hour after death, and the tissues were put into absolute alcohol.) As negative evidence this fact is of course worth very little, and it is only mentioned here in the hope that other cases will be -examined in the same direction. The cause of death appears to have been a simple case of sapræmia, the excessively foul condition of the ulcerated mouth affording constant and large supplies. of sepsin, which was swallowed by the patient in considerable quantity, even soon after his admission. The certain absence of organisms in the blood during life, and the whole post-mortem appearances point in the same direction. In connection with the latter it must be remarked that the ulceration of the cæcum is a very slight representative lesion, when the results of experimental sapræmia are remembered. Medical Times and Gazette. SATURDAY, MAY 17, 1884. THE relative merits of the various modes of treating fractured patella were once more discussed at the meeting of the Clinical Society, on Friday last. True to a pledge which he had given at a meeting of the Society six months ago, Mr. Christopher Heath produced for inspection a case which he had then treated by the immediate application of a plaster of Paris bandage. Mr. Henry Morris, who had been called upon to treat a case upon the same day, also produced his patient. In both cases firm fibrous union had taken place, and in both, the patients had been able to walk freely with artificial support to the knee-joints. These results, admirable as they are at the present time, can hardly be reckoned upon as the ultimate outcome of the treatment. The experience of all surgeons would seem to agree that some further separation of the fragments is sure to follow upon fibrous union, as soon as artificial support is dispensed with, and hence no close union, other than that by true bone, can be looked upon as a permanent condition. True bony union, however, is only to be obtained by means of the operation of wiring, and a very general opinion seems to prevail that this operation is at present only justifiable in very skilful hands, as, e.g., in those of its originator, Sir Joseph Lister. (In another column we have given an account of some foreign views with regard to the treatment of this accident.) With each successive Ar the meeting of the Ophthalmological Society on Thursday se'nnight, a good deal of business was done. There were not so many patients as we have sometimes seen, but there were some very good drawings on view. Amongst them were two of Mr. Nettleship's, one of A CASE of abdominal section, undertaken for the central guttate choroiditis, the other of peculiar lines relief of internal strangulation of bowel, was read by in the choroid, the exact interpretation of which might Mr. H. H. Clutton. The author was deservedly conbe open to some doubt. Mr. Morton showed a draw-gratulated, not only upon its triumphantly successful ing of a hemorrhage at the macula, dependent on gout, issue, but upon the skill displayed in dealing with a the chief interest being the shape of the hæmorrhage, case of extreme difficulty. Mr. Milles recorded a nævus of the choroid, which, we victory over the dangers attendant upon intrabelieve, has not hitherto been subjected to the proof of abdominal surgery, confidence becomes proportionately a microscopical examination. Dr. Stephen Mackenzie increased, and we would cordially re-echo the hope added another to his list of cases of tortuous vessels in expressed by many of the speakers in the subsequent debate, that operations for the relief of internal herniæ may be placed upon a similar footing to those for the commoner forms of external rupture. To delay an inevitable operation, when the benefit of the doubt is so rarely found to be a benefit to the patient, seems somewhat irrational, and has long since been abandoned in the simpler class of cases. the retina. DR. FITZGERALD described some cases of acute spasm of accommodation, and Mr. Higgens summed up his experiences in the operation for extraction of cataract on 200 cases, since his paper on the same subject was read a few years ago at the Royal Medical and Chirurgical Society. The paper which attracted most interest, however, was the joint production of Dr. James Anderson and Mr. Gunn, on a case of alleged uniocular diplopia. The paper itself deserves the highest praise, for it was very thoughtful and thoroughly impartial. As to the general question whether such a disorder can be bonâ-fide, we shall probably express the opinions of the majority when we say that the natural attitude of ninety-nine men out of a hundred would be one of absolute incredulity. We think, however, that it is only fair to the authors of this paper and of previous communications on this subject to the Society, that so active a form of disbelief should be exchanged for some more passive AN interesting case of old-standing hydrocephalus, leading to insanity and death, was read by Dr. Whipham, and two remarkable cases of rupture of the brachial plexus were exhibited by Mr. C. J. Symonds. Towards the close of the meeting attention was called by the President to the number of papers still remain ing unread on the eve of the last meeting of the session. No definite expression of opinion was elicited on his proposal to hold an additional meeting, and the question will be decided at the next meeting, on May 23rd. This practice and that of indefinitely extending the time of individual meetings, is one which has grown of late in other societies, as well as in that presided over by Sir Andrew Clark. The appetite for work displayed by the attendant members is in the highest degree satisfactory; but the custom is in itself unbusiness-like and inconvenient, and is one which we believe but few members are willing to see extended. AT the meeting of the Royal Medical and Chirurgical Society on Tuesday last, two papers were read. That by Mr. Gant, on the removal of a pelvic tumour, not offering much scope for discussion, was soon disposed of. The paper by Dr. George Harley, on an easy and safe method of sounding for impacted gallstones, was, however, vigorously discussed. The boldness and originality of Dr. Harley's procedure were admitted, but it was pointed out that the argument that most organs of the body have been punctured with a fine exploring needle without ill result, is not a very strong one in favour of a further application of this practice. THE third General Meeting of The Hospitals Association will be held at No. 11, Chandos Street, Cavendish Square, W., on Wednesday, the 21st May, 1884, at 8 p.m., when Mr. Henry C. Burdett will read a paper entitled, "How can the Hospital Sunday and Saturday Funds be made more useful to the Hospitals?" WE may hope that the action of Friday last will be allowed to close the series of persecutions to which Messrs. Bower and Keates have been subjected. The issue was as satisfactory to the defendants as, under the circumstances, it could be, and that without the necessity for placing in the witness-box several eminent medical authorities who were ready to give evidence for the defence. Some compassion may be extended to the father of the dead child, who has evidently become a prey to the haschisch of litigation, and is bent on running a-muck, regardless of consequences to himself. It is to be hoped, however, that his career in the law courts will at length be checked, or at any rate that his attacks may be directed in another quarter. Messrs. Bower and Keates have been sufferers without a parallel in the history of medical prosecutions. THE Inaugural Dinner of the Oxford Graduates Medical Club will take place on Thursday, 22nd inst., at 7 p.m. The chair will be taken by Dr. Fincham, and a large gathering is expected. It is hoped that any gentlemen who have not received notices of the Club's formation, will at once communicate with the Secretaries, Dr. Samuel West, or Mr. John H. Morgan. THE most significant fact in the Registrar General's weekly return is the increase of the small-pox epidemic. During the week the number of cases in hospital rose from 502 to 737, and the fatal cases numbered nineteen. We are evidently in for a considerable epidemic. The number of deaths from other zymotic diseases still continued high, viz., 264, or 57 above the ten years' a ̈erage. The chief culprits were still measles and THE return of Dr. Koch and his fellow-labourers, Dr. Gaffky and Dr. Fischer has been celebrated during the past week in Berlin with the enthusiasm which their recent labours in Egypt and India so fully justify. Whatever be the ultimate result of their researches upon the progress of cholera in either country, there can be but one opinion amongst all scientific workers in the four quarters of the globe as to the vigour, perseverance, and honesty of purpose which have characterised their endeavours to unravel the tangled skein of causes which combine to originate and maintain the ravages of epidemic disease in the East. The congratulations of their own countrymen, from the veteran Emperor downwards, have been lavishly bestowed, and no one in our own or any other nation will begrudge them the honours which they have reaped. Good work is nowhere more thoroughly appreciated than in England, but it is not the British custom to praise the workman before his work is concluded, and hence no public expression of gratitude has as yet found its way to the distinguished leader of the German Cholera Commission. DR. KOCH and his comrades, however, are to receive something more than barren praise. A proposal has been laid before the German Reichstag to divide |