War conditions have made of Eastern Europe a hot-bed of typhus infection during the past few years; Russia, about which there is at present little or no precise information, must be considered as a possible source of serious danger for a long time to come. There is a seriously large amount of typhus in Poland and the Ukraine.

Eastern Galicia has, during the past winter, been the principal focus of the epidemic. Information recently received from the authorities conducting the fight against typhus in Poland is as follows:

Typhus in Galicia, Jan. to May. 1920. Total Number Reported.

85 or 90% of the cases occurred in Eastern Galicia.

In Congress Poland the following number of cases of typhus have been reported for the early months of the year 1920.

Typhus in Congress Poland, Jan. to May 1920:

In comparison with this, it is interesting to note that, in April 1919, there were 27,500 cases of typhus reported in Congress Poland. That was the high point of the epidemic.

The large decline in the number of cases of typhus in Congress Poland since a year ago, and the large number of cases during recent months in Eastern Galicia, illustrates the manner in which the centre of infection of typhus moves from one region to another. The movement during the past year has been towards CzechoSlovakia. Measures for the prevention of its spread across the frontier, and within the boundaries of Czecho-Slovakia, are therefore imperative.

In Roumania, there has been much typhus during the past few years. The following figures are quoted for Old Roumania:

Typhus Cases reported in Roumania (pre-war frontiers)

Only fragmentary information is available as to the number of cases of typhus in other parts of the present territory of Roumania. In Transylvania, 142 cases of typhus were reported in January 1920. In Bucovina, for the period April 20 to 30, there were 204 new cases reported. In Bessarabia, from March 1 to 10, there were 237 new cases reported. Roumania is therefore an active source of typhus danger and the same measures should therefore be taken with travellers crossing the Czecho-Slovakia frontier, from Roumania, as from Poland and the Ukraine.

The available records of typhus cases in Hungary and Austria and the countries further south since January 1st, 1920, are as follows:

Typhus Cases reported in Hungary, Austria and the Balkans

These statistics must be used with caution, as none of these countries have a complete and efficient system of notification of transmissible diseases. In a broad way, however, the figures indicate that there is no serious intensity of typhus infection at present in these regions. No statistics are at present available as to the prevalence of typhus in Eastern Germany. Recommendations for frontier protection are for the present limited to the Polish, Ukranian and Roumanian frontiers. This is shown by shaded areas on the accompanying map. The fact must be kept in mind, however, that, in the present condition of Europe, typhus may develop quickly in unexpected quarters, and a vigilant watch must therefore be kept upon conditions beyond the frontiers for which special provision for protection is not made at present.

Uncontrolled Movement of People across Frontier.

The north-eastern frontier of Slovakia and Carpathian Russia has a length of 500 or 600 kilometres. It is crossed by seven lines of railway and by a large number of highways.

The military authorities have a cordon of posts along the frontier, which covers all the main lines of travel, and the orders of the military authorities are supposed to prevent people crossing the frontier unless provided with passports. Along this great expanse of front, however, it is utterly impossible to prevent all movement across the frontier. It is recognised that there is more or less movement and more or less traffic back and forth. It, therefore, appears important to determine whether this uncontrolled move

records not available for February.

ment across the north-eastern frontier is dangerous from the point of view of the spread of typhus infection.

In discussing this matter with various officials, it was pointed out that there is a law requiring every traveller coming into the country to establish his right to cross and to have his presence authorised. There is penalty of fine or imprisonment if he does not do this. This measure is always in effect, and is said to be enforced when cases are met with. This law is said to effectively prevent any considerable number of them from going far beyond the frontier.

This condition may be expected to contribute to the danger of the spread of typhus infection immediately about the frontier. Where infection commences to spread actively, the delousing and cleansing of villages by means of the mobile unit elsewhere described must be depended upon for the protection of the country against infection that may spread across the frontier as a result of this uncontrolled movement.

So far as the interior of the Republic is concerned, the frontier stations recommended at the points where the railways cross the frontier should be a highly effective means of preventing the spread of typhus into the country from adjoining infected regions.

Delousing and Medical Examination at the Frontier.

The procedure to be followed with travellers crossing the frontier depends upon the nature of the transmissible disease against which protection is desired. If the region from which travellers come is badly infected with small-pox or cholera, for example, so that an individual carrying the infection is in himself, without other intermediate agent, a serious source of danger to those with whom he may come in contact, he should be isolated in quarantaine for a period adequate to insure that he is no longer a carrier of the infection.

If, on the other hand, the disease against which protection is wanted is typhus, or relapsing fever, or trench fever, with reference to which the removal of the transmitting agent-licereduces to insignificance the danger of transmission of the disease, a long period of quarantaine does not have the same importance. The primary essential is the complete elimination of lice.

There has been no cholera reported recently in Czecho-Slovakia.

Civil Doctors in Slovakia.

The Ministry of Hygiene of Czecho-Slovakia has a main division chief at Bratislava for Slovakia. Slovakia is divided into 16 political divisions called Zupa. Each of these, in turn, is divided into several parts called Okres, and each of these into districts. The scheme of organisation of the Ministry of Hygiene provides in general for one or more doctors as official representatives in each

of these political divisions. Also in certain large towns, and in certain grand communes.

A summary prepared in the office of Dr. Ivan Halek, chief for Slovakia, at Bratislava, is as follows:

The doctors in the Military Medical Service are not included in the above. The total number of civil doctors, not including those whose duties lie in the hospitals, is 649. The population of Slovakia is stated to be about 3,500,000. There is thus one civil doctor for about 54,000 people.

It is entirely superfluous to make the comment that this number is insufficient. The fact is recognised by everyone. A deficiency of 30% is the responsible personnel of a public health organisation, to say nothing of the scarcity of doctors in private practice, at the very time when epidemic disease is all about and threatens the country, is a serious matter. Obviously this organisation cannot be brought up to its proper strength and a high state of effectiveness in a day, but, in view of the many serious problems that face the public health authorities of Czecho-Slovakia, the policy of progressive increase in personnel promises to put the organisation in a strong position.

No definite information is at hand as to the number of civilian doctors in Carpathian Russia. From general statements, it would appear, however, that there is a serious shortage there too.

There are about 186 military medical officers in Slovakia of whom about 8% have purely administrative duties and are not available for strictly medical service. There are also 23 military doctors in Carpathian Russia.

Hospitals.

In Slovakia, there are 29 civil hospitals with a total of about 4,830 beds. There are also 17 military hospitals with a total of about 4,100 beds. This includes 2 military tubercular hospitals and 4 camp hospitals.

In all of Carpathian Russia, the records show only 6 civil and 2 military hospitals. Information as to the number of beds is not at hand.

General Sanitary Conditions.

Only a few of the large cities of Slovakia and Carpathian Russia have municipal water supplies. Among all the cities of 4,000 population or more.

10% of the cities have a supply of 70 litres per man per day.

20 to 60 litres per man per day. no public water supply.

6% 840/0

The water system of the large cities are in general well built and designed to assure a safe supply.

In most of the towns, villages and rural districts, one sees very commonly the dug well with its long sweep. The water level is usually not far below the surface of the ground—perhaps from 3 or 4 up to 8 or 10 metres. 10 metres. The surroundings, the proximity of dwelling houses, cesspools, barns and barn yards, manure piles, etc., and the frequent poor construction of the well curb and the neglect of careful drainage about the well, form accumulative evidence that the people are unaware of, or indifferent to the dangers of polluted well water. The fact that typhoid fever and other intestinal diseases are endemic in many regions is therefore not surprising.

ITEMS.

The University of Glasgow has conferred upon Lieut.-General Sir David HENDERSON, Director-General, League of Red Cross Societies, the degree of Doctor of Laws.

Monsieur Jacques DUVAL, representative of the Department of Publicity and Publication of the League in France and Belgium, gave a lecture on September 14 at the International University of Brussels on the origin, aims and activities of the League.

The medical commission, sent by the League to Poland last January, to assist the Polish government in its campaign against typhus fever, has returned to Geneva. The commission was composed of Colonel Henry A. SHAÆ, Medical Corps, U. S. Army; Lt. Col. George FORDHAM, Major R. M. TAYLOR and Major L. H. DUNN, Medical Reserve Corps, U. S. Army.

PUBLICATIONS OF THE LEAGUE.

The following is a summary of the contents of the second number of the International Journal of Public Health.

Original Articles. - CUMMINS, S. LYLE: Tuberculosis in primitive tribes and its bearing on the tuberculosis of civilized communities. GOUGEROT, H. : The saprophytism of venereal organisms and its dangers. Gosio, B. Science and practice in the fight against malaria. STRONG, RICHARD, P. The anti-typhus campaign in 1915 in Serbia considered in connection with the present typhus epidemic in Poland (continued).

League Reports. WOLBACH, S. B., Todd, J. L., PALFREY, F. W.: Notes on typhus. A preliminary report from the Typhus Research Commission. Resolutions of the Medical Advisory Board.

Reviews and Abstracts. Communicable diseases. Social Hygiene. — Child Welfare and Nutrition. Tuberculosis. — Hygiene and Sanitation. Nursing. Demographical Notes. At the beginning of the new era. Vital Statistics for the city of Vienna. Alsace-Lorraine during the war. - Infant mortality in Europe.