It is not alone in Bombay that this state obtains-Calcutta is as bad or worse. Cholera prevails almost as extensively as in Bombay, and remittent fever of a far worse type is endemic along the whole Valley of the Ganges. The plague or Mahamurree fastens itself in the dirtiest and closest spots of the dirtiest villages as it did in 1665-66 in " the close and tortuous lanes, in which poisonous exhalations had gathered, and concentrated for centuries," and in old London before the great fire, which was the great sanitary reformer of that day.

What has been done, and is now being done to increase the sanitary state of our Jails in every part of Hindostan, is as absolutely required, and would be as worthily bestowed on the poor, but honest ryot, and on those who dwell in the immense and almost numberless towns of India.

As yet, it is only in the prevention of small-pox, that the Government of India has directly taken a decided part in the attempt to extirpate pestilence. Different methods for spreading vaccination prevail in each of the Presidencies, but in Bombay it is far more systematically carried out, and though at the same time more money is expended, such expenditure is real economy even of money, as assuredly it is of human life.

The Medical Board of Bombay has published the results of the operations of the seven Superintendents of vaccination for the official year 1854-55, and these show in the most favorable light when we find 1st that the number vaccinated in the various divisions, and by the Civil Surgeons, &c. is 2,33,368, and of these, 2,05,455 successfully.

2nd. That the total number of cases of small-pox treated in ALL THE HOSPITALS for that year was 234, and the mortality only 48. Only 2 cases of small-pox occurred among 5756 prisoners. 3rd. That the opposition to vaccination is gradually decreasing.

4th. That although it is impossible to state with certainty to what extent small-pox has prevailed in the various divisions, only in two are epidemics spoken of as being at all severe, and in those two, epidemics of small-pox have been almost of annual occur

rence.

Nothing can however be more satisfactory than the fact, that the total number of cases of small-pox treated is so small, and that the deaths are much below the average number that would have occurred in the absence of vaccination. The resolution of the Government to whom this Report was addressed evinces a highly creditable interest in the matter.

Para. 4 of that Resolution is as follows:-" Government hope that the approaching census will enable the Medical Board to show, in future vaccination Reports, what proportion the num

ber of persons vaccinated in each district bears to the total population, and number of births, and that it will be possible to define more accurately the area and population of each Superintendent's charge. In future reports also it would be well, if possible, to show the age of persons vaccinated, so far at least as to distinguish those under and above one year of age, and those vaccinat、 ed as children and adults." The total cost of vaccinating to the State, only counting successful cases, is Rs. 32-0-5 for every hundred persons. In England the cost is Rs. 50-0-0 per 100 cases exclusive of the cost of the Central Board in London.

By what means can sanitory reform be most successfully introduced? In our opinion, the first step to be taken is to ascertain, as correctly as possible, the average duration of life in India; next, to find out the causes which shorten life in one place, and lengthen it in another; then to find out the cause of, and weave our meshes round epidemics, wherever they may arise, and prevent their spread; to root out endemics, when they are influenced by causes under our control; and lastly, to endeavour to strengthen the human frame, so that it may resist the epidemic influence, which may, at any time, be abroad.

We are quite aware that even to attempt these objects at present, throughout the country, will be most difficult, and certainly to carry them out successfully a very different system must obtain, for the presidency town with its numerous staff and European inhabitants, for the cantonment, and for the purely native city and village. Sanitary measures are usually more attended to in cantonments and more practically useful than in other place. A new cantonment is always more unhealthy than one which has been for several years established. Cantonments, though often badly selected, generally have advantages over other localities. Military discipline has also greatly assisted to effect something in this way. The sepoys' huts and lines are far more cleanly than those of the class from which the regiments derive their strength.

Then bearing in mind the objects set forth, as those to which special attention must be paid, we would give the outlines of an improved system of sanitary measures 1st for presidency towns— 2nd for cantonments, and 3rd for the Mofussil generally.

Within the last 18 months, the Secretary of the Bombay Medical and Physical Society has compiled from the records of the Bombay Medical Board, a monthly epitome of the state of health, admissions to Hospitals and deaths with a few remarks on each division of the army. This has generally been published in the third or fourth month afterwards. This though a considerable stride in the right direction, is not all that is wanted. And thus much has not as yet been done in Bengal. We are not aware whether anything similar has appeared in Madras. In No. VI. of the In

dian Annals of Medicine is a most carefully drawn up statistical paper of the sickness and death among the troops in the Bombay Presidency for a period of 51 years. No one can glance at this table without perceiving its immense value. As far as it goes, it is perfect, but a table of this kind should be published monthly or quarterly. For past periods the materials are now ready, and only require collation in the office of each Superintending Surgeon. In place of the year as it now stands in that table we would insert the station and give the particulars of each corps as follows: Strength; Number of sick remaining from last month; Number admitted; Discharged; Died, and those at present in Hospital. The causes of deaths should be stated next, and then the daily average number of sick per cent. This should be done, not only for European corps, but for native corps, police prisoners, &c. with a notice of vaccination. This would entail little or no trouble as all the particulars are now regularly furnished to Superintending Surgeons. It would be of use not only with reference to India generally, but would give a full and particular topographical sanitary report. In Scotland, monthly mortuary returns are published with remarks by the Medical Superintendent of Statistics, and a quotation from remarks accompanying his Report for August last, will shew that even now an immense number of human beings are hurried out of the world by preventible or zymotic diseases. "Of the various classes of disease, the zymotic class (epidemic and contagious diseases) usually cuts off the greatest number of victims. In healthy seasons, about 22 per cent. of the total mortality is caused by this class of diseases in towns; but during the autumn this proportion is often exceeded from the prevalence of autumnal diarrhoea and bowel complaints. In Edinburgh, the zymotic diseases constituted 16 per cent. of the total mortality; in Leith 23 per cent.; in Aberdeen 24; in Perth 27; in Glasgow 33; in Paisley 33; and in Dundee and Greenock 87 per cent. of the total mortality." Now such a Superintendent is precisely what we want. The cities of Calcutta, Bombay, and Madras would surely each furnish work for such a Superintendent of Public Health; but we would give him a more extended and at the same time a more defined object for his labour.

An Officer of Public Health should be appointed for each of the five Presidency towns. Means of tracing out disease somewhat like the following should be placed at their disposal: Weekly, or even oftener in times when epidemics are rife, every medical practitioner should be required to state, in a short written form, what diseases prevail in the district in which he practises, and what quarters or streets have furnished the greatest number of patients; he should also state if he is aware of any cause for their prevalence. The Superintendent of Health should as early as possible visit these places, and always within 48 hours those places

which might seem most urgently to demand it. He should then furnish an emergent requisition on the Executive Engineer to enforce attention to any matters which seem urgently demanded, to mitigate or prevent the spread of the disease.

The duties of this Officer of Health should also extend to a surveillance of the places in which new houses are being built. It should be imperative that every house should be numbered, and every street also numbered, or named, and the town should be mapped out into quarters so as to facilitate reference. The municipal authorities, where such exist, should be made responsible that all removable dirt and filth is removed: if no municipal authorities exist, it should be peremptory that every householder be responsible for the effectual cleansing of the portion of street appertaining to his house. Public latrines should be established and kept clean at the expense of the quarter in which they are placed. These should be purified by a quantity of chloride of lime, or by the cheapest materials that can be procured, which answer the purpose; of these are lime, charcoal, charred saw dust, burnt gypsum, &c., which are of more or less benefit for the same purpose. Small quantities of sulphur burnt in these receptacles would also assist in the decomposition of gases producing effluvia, and carrying infection. The contents of each of these receptacles should be removed during the night, and the deodorising and disinfecting materials should then be freely used. Facts recorded lately in England by Dr. Budd, and others, seem completely to prove that cholera has been in many instances propagated from the latrines used by those affected, and nothing can excuse the culpability of those who allow any probable means of disseminating disease to remain in operation, after it has been prov ed distinctly, that cholera has been spread by means of causes, so completely under our control.

Places where animals are kept should also be subjected to visits and should be in such a state of cleanliness, as is requisite for health, or their removal enforced. As far as consistent with Hindoo prejudices no animals should be allowed to remain in dwelling houses. Such are the additional matters to those which are universally allowed as causes of disease to which attention should be specially directed. Those causes of disease which all allow to be such, as insufficient drainage, stagnant water, and filth, should not be tolerated for an hour.

The surveillance of these matters in each Presidency town should be specially entrusted to a medical officer to be called the Superintendent of Public Health. He should also be required to lecture on the subject to the students of educational establishments, where the scholars are sufficiently advanced in English to comprehend the scope of such a subject.

The public health of cantonments and towns adjoining should be made a matter of duty for a selected medical officer at each station, and Monthly Reports, embracing the topics previously alluded to, should be required. Regimental bazars should be made, as much as possible, patterns for surrounding villages and towns.

In the mofussil generally, a far harder task awaits our attempts to systematize sanitary reform. It would seem that the Civil powers in the various districts are the channels through whom such attempts should be made. What is chiefly required is information on the following points-Population of the various Collectorates, whether increasing or decreasing, migratory or settled. A monthly return should be required from the head of each village, of births and deaths, with the causes assigned for the latter, and the age of each inhabitant who has died.

Collectors, Vaccinators, and Police Officers should be directed, while on their tours, to inspect and furnish short reports on the state of the various villages in their districts. Plain instructions in the vernacular, should be distributed to the headman in every village, and these instructions should urge upon every cultivator of the soil the benefit he would derive from restoring to the land which he cultivates the debris of the village. Upon the villagers it should be urged how much themselves and their families would benefit by the removal of every nuisance, and the obstacles to a pure atmosphere.

These are the chief present desiderata. None are very costly. What is chiefly wanted to enable a good system to be devised is knowledge of the vital statistics of the land, as then plans might be arranged which should have special reference to these requirements. If the difficulties in the way of our scheme are great, the benefits are greater. The object is grand and philanthropic, and will amply repay all the time, trouble, and expense, that can be expended on it. But in this, as in all other reforms, what is wanted more than information, system or ought else, is a man of energy, and purpose, with Dictator's powers to root out mischief, and carry out his own views. Many fitting men are in the ranks of the Indian Medical Service. What Walker and Hansbrow have done for the Agra Jail, Hathaway for the Punjab prisons, and Mouat is now doing for Bengal may be done for the country at large. They have more than earned their salaries. A Sanitary Inspector would soon save his a hundred times over.