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GENERAL MEDICAL COUNCIL.

A LITTLE while ago it seemed difficult to suppose that the approaching session of the Council could be a long one, but we now know that business that may very easily give rise to a considerable amount of debate, or of conversation, has been already provided. First and foremost there is what we suppose will prove to be the pièce de résistance--the Reports of Visitations of Examinations. They are the first reports made since visitors were elected from outside the Council, and it is rumoured that they speak in by no means a honeyed or complimentary tone of at least some of the examinations commented on. We have heard that only one English licensing board has been visited, all the remaining reports being on Irish and Scottish bodies; and it is said that one of the Irish bodies altogether refused to allow the examination papers to be inspected. If, indeed, rumour speaks at all truly, we may expect some very warm and wordy speeches on the reports.

Then that long-postponed Report on Professional Education will again, we suppose, be brought up for discussion, and, if actually entered upon, will probably occupy a long time.

Dr. Aquilla Smith has given notice of motion "for the appointment of a committee to prepare a new edition of the British Pharmacopoeia, to be ready for publication in January, 1877." The committee to consist of five members, three of whom are to be appointed by the Council, and two by the Pharmaceutical Society, who are to be "associated on equal terms" with the other members. The members are to be paid for attendance at the meetings of the committee " on the same scale as members of the Executive Committee," and one of them is to be chosen to act as secretary, and to be paid something "in addition for each meeting." The notice of motion contains fourteen clauses, some of which will excite or admit of not a little discussion.

And then Sir Dominic Corrigan has given notice of a "draft of proposed Bill to amend the Medical Act of 1858."

This Bill proposes that a new board of examiners shall be established, which shall be "an examining board only, without any power to inquire into or lay down courses of education or study;" that it shall be called the "Civil Medical Board"; that it shall consist of "five examiners from England, five from Ireland, and five from Scotland," who shall be elected by the General Medical Council; that the examiners shall be appointed for three years, and shall not be eligible for re-election until after an interval of three years; and that members of the Council shall not be eligible for appointment on it. The business of the new Board is to be the examination of candidates who already "have passed the double examination in medicine and surgery, and obtained their degrees or licences to practise medicine and surgery from bodies legally entitled to grant such degrees and licences, and have been duly registered." These previously duly qualified and registered medical men may, after passing the new Board, append to their names "the letters C.M.B.," signifying Civil Medical Board; and without those magic letters no medical man is to be entitled to hold any public appointment, or to be appointed to "any friendly or other society for affording mutual relief in sickness, infirmity, or old age." Finally, the fee for

examination and certificate from the C.M.B. shall not exceed £5; and all the expenses of the new Board over and above the amount of the fees are to be paid out of her Majesty's Treasury.

Of all the proposals that have been made for the reform of the examining and licensing bodies, we have here surely the most extraordinary and impossible. A new examining board is to be added to the number of the now existing boards, and the old ones are not merely to be allowed to live, but compelled to live and examine, for every candidate for the new qualification must already possess qualifications to practise, granted by some other licensing body or bodies. The oneportal or conjoint examining board idea is ignored,—and that is not to be wondered at, seeing who is the author of the new scheme; but at the same time a thorough distrust is shown of the competency and trustworthiness of the old licensing bodies. A private individual may, as such, commit the care of his health and life to anyone he likes; but no medical man shall be considered fit for any public appointment, whatever his qualifications may be, unless he has been re-examined by the new Board, and has, in addition to other qualifications, been stamped with their brand, the C.M.B. Most probably the whole thing is a big joke on the part of the Irish baronet; and we more incline to this view on looking at Clause 6, which provides for the payment of the expenses of the C.M.B. Sir Dominic must have thought that the General Medical Council might in some strange mood be brought to accept his Bill, and he therefore took care to guard against any possibility of its ever becoming law, by inserting a clause which would make Her Majesty's Treasury liable for part of the expenses of a body over the constitution and conduct of which Her Majesty's Government would have no control whatever. Can anything be imagined less likely to receive Government support, or to be passed by Parliament ?

What will the Council say or do about the Conjoint Examination Board schemes? Is there any increased hope or probability that these schemes can be carried into effect? In Scotland the efforts to form one Divisional Conjoint Board have totally failed; that was openly confessed last year. In Ireland the failure seems to be nearly as complete as in Scotland; the Queen's University has refused to join in the formation of a Conjoint Board, and the Fellows of the College of Surgeons have so strongly opposed the scheme which the College had consented to be a party to, that that body has been compelled to reconsider its decision. And in England the prospect is anything but encouraging. It is true that Act the University of London obtained last year an

enabling it to unite and co-operate with other licensing bodies in conducting examinations; and that an Act has just been passed to enable the Apothecaries' Society-the only body that was till now left out in the cold-to enter the Conjoint Scheme. But there are two very important differences between the enabling Bill obtained by the Apothecaries' Society and that obtained by the University of London. First, the Medical Act (University of London), 1873, provides that no by-law made in pursuance of the Act shall be of any force unless it has the assent of one of her Majesty's principal Secretaries of State, which assent such Secretary of State may at any time revoke. But in the Apothecaries' Act Amendment Bill, the power given to the Society "to unite and co-operate with any one or more of the colleges and bodies mentioned in Schedule (A) of the Medical Act, 1858," in appointing examiners and conducting examinations, is made "subject to the approval of the Privy Council," and "may be at any time withdrawn by the said Privy Council."

The second difference is of still more vital importance as concerns the Conjoint Examination Scheme. The University of London Act provides that "it shall be lawful" for the governing body of the University "to prescribe, by a by-law under the common seal of the said University, that no person shall become a Doctor, or Bachelor, or Licentiate of Medicine, or Master in Surgery of the said University, unless," in addition to passing the examination and complying with the bylaws of the University, he shall have passed the examination and complied with the requirements of the Conjoint Examining Board. But in the Apothecaries' Amendment Act no such provision is made. The Society expressly reserves its right and its obligation to enter on its list of licentiates "any woman who shall have passed such examination and fulfilled the other general conditions imposed upon persons seeking to obtain from the said Society a qualification to be registered under the Medical Act, 1858"; and it does not take power to refuse to admit any other candidate who has complied with those conditions and passed those examinations, unless the Conjoint Board examination has been passed. cording to our reading of their Act, they will still be obliged, under their old charter, to admit to their licence any candidate who, having complied with their regulations, prefers to present himself for their single qualification to undergoing the longer and much more expensive examination of the Conjoint Board-this costing thirty guineas and the other only six. If, then, the Conjoint Board is established in England under these circumstances, men may still choose whether they will become registered practitioners through the Conjoint Board at a cost of thirty guineas, through the Apothecaries' Society of London at a cost of six guineas, or through some Scottish or Irish licensing board, from which they may get a double qualification on easier terms as to examination and cost than from the English Conjoint Board. It may be questioned whether it is not time for the General Medical Council either to give up altogether the effort to form conjoint boards, or to go to the Legislature with the confession that they cannot form them without the help of compulsory powers.

TESTIMONIALS.

Ac

DIVISION of labour is one of the greatest outcomes of civilisation. By its aid we get thousands of things, great and small, done for us which in a rude and primitive state of society each had to do for himself or to leave undone. Thus, to speak of small things, we have our notes or cards of invitation and of "return thanks" printed or lithographed for us, instead of having to write them ourselves. If we wish to send out begging-letters for votes, for aid for a charity, for what not beside, we seek the aid of the printer or lithographer; and

on many other intersocial and business occasions these artists save time and labour for us.. No doubt, however, many new fields await the application of this grand principle-the division of labour, and we have just seen what, according to our experience, is one of the latest developments of is, if not the latest. A very important chair is vacant in one of our northern universities, and we have before us, from two of the candidates for the vacant professorship, lithographed or zincographed letters of application for testimonials. In one letter at least the name of the university appears to have been written in, as though the letter were a stock-form kept in readiness for any opportunity that might arise; but all else is lithographed, we believe,—even the signatures of the candidates. Of course, the name of the gentleman to whom the letter is addressed is written in at the foot. Now, we must suppose that these letters are distributed broadcast-are sent to every man whose reputation or position is such that his name may be thought likely to influence the electors. If not, why are the letters lithographed ? Probably the men whose judgment and knowledge of the fitness of any candidate for the appointments in question ought to have any great weight might be counted on the fingers of two hands, and they might therefore have very easily been written to. Is it not, then, a fair inference that the mere number of testimonials sent in is expected to tell in favour of a candidate? And, unhappily, in so far as the gathering of a mass of more or less complimentary writings goes, this system of testimonial-touting is only too likely to be successful. Few men like to refuse to send back some kind of a complimentary reply, and fewer still would have strength of mind enough to write what, in a vast number of cases, would be the bare truth-to say, for instance, "I have never had the pleasure of hearing Mr. So-and-So lecture, and do not know anything practically of his teaching power; nor have I time to read any of his works, a list of which he has been kind enough to send me, but I understand that he has done such-and-such things, and therefore I have much pleasure in," etc., etc. But the multitudinous testimonial system is, we venture to say, & thoroughly bad one. It is derogatory to those who thus hunt to pile up the testimonials; it is an irksome and thankless tax on those who are applied to to write them; and a grievous burden and nuisance to those who ought to examine and value the piles of testimonials sent in to them; and the mass of the testimonials gained by it have no real value whatever. We will allow, however, that this plan of lithographed circulars has one virtue-it very nearly amounts to a reductio ad absurdum of multitudinous testimonialism. Two things more would make the absurdity complete. Lithographed forms of recommendation, varying in force, and having a blank space left for the name of the candidate, should be kept on hand, and two or three of them (so as to admit of a choice), and a ready addressed and stamped envelope, should be enclosed with the letter of application; and a certificate should also be sent from the candidate's publisher, testifying what books of his had been published, their price and weight, and the number of copies that had been sold.

This certificate would have quite as much real value, to say the least, as a list from the candidate himself of all his writings, with laudatory comment on them, extracted from notices in reviews, journals, and newspapers, even though these should make up, as in one of the instances before us, an octavo pamphlet of fifty pages.

We will, however, add one word of warning to candidates who put their trust in quantity of testimonials. Some, at least, of any board or committee of electors, may probably think that while, to adopt Mr. Disraeli's apothegm regarding votes, testimonials should be weighed as well as counted, yet that the weighing thereof should not be by avoirdupois

measure.

THE NATURE AND ORIGIN OF TYPHOID FEVER CONSIDERED MORE ESPECIALLY WITH REGARD TO ITS PREVENTION AND TREATMENT. (a)

II.

NOTHING Seems more surprising in the history of fevers than the long time which elapsed before enteric fever was recognised by the majority of the profession as a separate and distinct form of fever. Only towards the middle of last century do we find distinct intimation of its existencefirst in the writings of Ebenezer Gilchrist, of Dumfries, and a few years later in a more distinct and unmistakable fashion, by Huxham in his celebrated “Essay on Fevers." The name then commonly given to it was "nervous fever"; and Huxham especially draws a clear distinction between it and the putrid malignant petechial fever, then well enough known, and now distinguished as typhus. Why this should be we can hardly explain, for morbid anatomy had been studied long before this; and surely the lesions of typhoid are plain enough and manifest enough to have attracted the attention of morbid anatomists, even of those days. The only way in which, it seems to us, this absence of (strictly speaking) enteric phenomena can be accounted for is by the universal prevalence and great fatality of petechial fever, which carried off those who, in times when this fever is less common, are carried off by typhoid. But this notable absence, if we can call it so, points strongly to the specificity of typhoid, and the necessity of something more than mere filth to generate it.

There is no more interesting record than the mode in which our knowledge of typhoid or enteric fever was by degrees developed. No one did more in this direction than Dr. A. P. Stewart when working in the Glasgow Fever Hospital; but it was reserved for Sir William Jenner especially, in one of the most admirable series of lectures ever published in the columns of this journal, to demonstrate the essential characters of this malady. But whilst our knowledge of the disease itself was increasing rapidly, our knowledge of its causation long remained mysterious. Dr. Stewart had remarked, that whereas typhus as a rule originated from effluvia from living bodies in close and ill-ventilated localities, typhoid often appeared in country places and in well-ventilated houses; but "beyond this all was vague and uncertain." Bretonneau, the distinguished physician of Tours, whose views were published between 1820 and 1829, and who was one of the first to insist on the specificity of the disease, also insisted that it spread directly by contagion. Even in 1858, Dr. Tweedie, lecturing here in London before the College of Physicians, held that the origin of typhoid was "obscure and unknown"; but in that same year Dr. Murchison, in an admirable essay read before the Royal Medical and Chirurgical Society, undertook to show that whereas putrefying animal matter, especially sewage, had long been held to be among the causes of fever, it invariably gave rise to one form of the malady only, and that was the so-called enteric fever. "This mode of origin," he held, "explained why enteric fever was endemic in many places, but often epidemic in circumscribed localities; why it attacked the rich as well as the poor; why it occurred in isolated country houses as well as in large towns; and why it was most prevalent in autumn and in warm seasons." importance of these views it would be hard to over-estimate;

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the influence they have had in promoting sanitary measures in town and country is incalculable; and there cannot be the slightest doubt but that this influence is an 1 has been highly beneficial. Nevertheless, their soundness is doubtful, and it behoves us to look most carefully into the grounds which are advanced as sufficient for receiving them. In dealing with such evidence, it is hardly possible, even were it not demanded by the rigorous rules of logic, to overlook its nature. We proceed solely by the rules of exclusion. Given an outbreak of typhoid fever in a certain locality, to find its cause we proceed to find out what is common to all the instances and what belongs to each exclusively. Say we find nothing in common but a water-supply which is tainted by sewage. Whether this be enough or not to cause the outbreak, is the point at issue; but if we can go a step further, and show that the tainted water is tainted with typhoid dejections, it would surely be stopping short of demonstration to say that it was the sewage matter, and not one particular kind of sewage matter, which caused the outbreak.

So, too, it seems to us, is the logic defective when sewer-gases are called into play as the agents of contamination. Surely no one cognisant of the rudiments

of sanitary knowledge would say that sewer-gases invariably cause typhoid fever, or where, alas would we Londoners be under certain conditions of the atmosphere when the houses are mainly ventilated through the water-closets. But if, therefore, sewer-gases do not invariably produce typhoid or any one specific form of disease, but only produce them occasionally, we must seek for something specific in those forms or kinds of sewer-gas which do so. In short, on this argument it is not sewer-gas which generates typhoid fever, but sewer-gas plus something which we must find out, and which many say are the specific germs of typhoid, as specific as those of small-pox or scarlet fever. Moreover, recent experience has clearly shown that there are modes whereby typhoid fever may be propagated, which were altogether unsuspected when some of the earlier outbreaks were recorded; and until these possible modes of infection can be eliminated, which now is impossible, any attempt to clearly and distinctly trace their exact causation must be given up in despair.

THE HOSPITAL SUNDAY FUND.

ALTHOUGH at first it was thought, from the considerable falling off in the amounts collected at several of the larger City churches on June 14, that this year's Hospital Sunday Fund would not amount to nearly as much as that of last year, we hear that the sum received at the Mansion-house up to the present time already exceeds the entire result of last year's appeal, about £28,000 having been paid in up to Thursday. This result is chiefly due to two causes- —(1) a large addition to the number of churches whose offertories on Hospital Sunday were devoted to the Fund, and (2) a marked increase in the collections at many churches, notably those of the West-end. The following is a list of the larger places of worship whose offertories exceeded those of 1873, and the amounts collected on each occasion:

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Thus twenty churches exhibit an aggregate increase of more than £760, whilst there are a considerable number which have contributed this year for the first time. Of these the most important are-Quebec Chapel, Marylebone, £407 8s.; St. Jude's, South Kensington, £260 4s. 10d.; St. Peter's, Onslowgardens, £253 2s. 6d.; St. James's, Piccadilly, £232 68. 3d.; St. Paul's, South Hampstead, £120 28. 4d.; City Temple, £114 3s. 9d.; St. Marylebone Parish Church, £102 14s. ld.; St. Peter's, Bayswater, £121; St. Paul's, Onslow-square, £145 12s. 1d.; St. Mary Abbot's, Kensington, £124 28. 6d.; St. George's, Hanover-square, £141 15s. 9d.; St. John's, Notting-hill, £81 178. 2d.; Christ Church, Kensington, £58 2s. 6d.; St. James's, Buckingham-gate, £56 4s. 6d.; Holy Trinity, Clapham, £57 16s. 6d.; St. Saviour's, Upper Chelsea, £60 148. 9d.; and Christ Church, Marylebone, £76 18s. 6d. At the following large and important places of worship the collections exhibit a decrease from last year, amounting in the aggregate to more than £700::

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There are also several churches, which contributed large sums last year, from which no remittances for the present year have as yet been received at the Mansion-house. It is possible that the collections from some of these may yet be forthcoming, or the sums may have been given to local charities. Be that as it may, it must be admitted that Hospital Sunday has this year proved to be rather a disappointment, for if last year, with imperfect organisation, £27,000 was realised, a very much larger sum should have been forthcoming this year. Indeed, had the total reached £50,000, it would not have exceeded in proportion the amounts usually realised by the Hospital Sunday collections in Manchester, Liverpool, and other provincial towns.

THE WEEK.

TOPICS OF THE DAY.

THE Act of Parliament of 1863 for the regulation of bakehouses seems to have been a dead letter in Sunderland. The local authorities of the borough, strange to say, have never enforced its provisions in any way. They, however, appear now to have awakened to a sense of the importance of this longneglected duty. Dr. Yeld, the Medical Officer of Health, has recently inspected the whole of the bakehouses in the borough, and his report to the Health Committee shows that almost

every clause in the Act has been infringed. He reports that the number of persons employed under eighteen years of age is twenty-six; that in forty-one out of 144 bakehouses the ventilation is insufficient-in five instances it is described as bad, and in three as very bad. The condition of the bakehouses as to cleanliness is that 117 are returned as clean, eighteen dirty, and nine very dirty, and that twenty-five bakehouses are also used as sleeping-rooms in direct contravention of the Act. The Medical Officer, under a proper sense of the culpability of the local authorities in the matter, has seen that it would be invidious to prosecute the offending parties under the circumstances, and has recommended that copies of the regulations be printed and issued to every occupier of a bakehouse, giving notice that the regulations of the Act must be strictly adhered to, and that any infringement of the same will be dealt with as the law directs. We hope these recommendations of the Medical Officer will be adopted by the Committee, and that the law will no longer be permitted to remain a dead letter.

We understand that the representatives of the German Government, at the approaching International Congress at Brussels, have been instructed to bring before the Assembly, on the Geneva Convention being discussed, the desirability of making all officers and all soldiers acquainted with the conditions of the Convention respecting ambulances, surgeons, and the wounded and their treatment. It appears that the German surgeons, who were obliged after the battle of Weissenburg to take up wounded French soldiers in their hospitals, found that the latter did not in most cases even know what the white band with the red cross signified. French surgeons of high rank, who appeared in the same hospitals afterwards to look after their fellow-countrymen, did not, it is said, even possess the badge ordered to be worn by the Geneva Convention.

With a view to the prosecution of the parties answerable for sending the girl Fox, whilst suffering under small-pox, from Hastings to London, and thence on to Willesden by railway, the Metropolitan Asylums Board brought the matter to the notice of the Local Government Board. The latter have replied to the communication, and stated that they did not see that the law had been infringed by any person but Mary Fox herself. The Metropolitan Asylums Board deem this answer so unsatisfactory that at their meeting on Saturday last they resolved to write again to the Local Government Board and state "that it is the opinion of the managers, the case of Mary Fox is of such importance as to require, in the interests of the public, further investigation."

Dr. Watson, who has filled the office of Senior Demonstrator of Anatomy in the University of Edinburgh, is a candidate for the recently instituted Chair of Anatomy at Owens College, Manchester.

There is a vacancy at the Westminster Hospital School of Medicine for a Demonstrator of Anatomy, in consequence of the resignation of Mr. George Brown, M.R.C.S., who acted as Joint-Demonstrator with Mr. Cook during last winter session.

RECRUITING FOR THE ARMY.

It is reassuring to find that the subject of recruiting for the army is not allowed to drop out of sight, but that one General after another brings the question before Parliament, in each instance pointing out the unsatisfactory state of affairs as they now stand. On the 26th ultimo, Lord Strathnairn moved for certain correspondence in connexion with general orders issued in 1871, relating to recruiting, and in doing so he charged the late Government with a breach of faith in not maintaining the long-service system intact, so far as concerned those soldiers who chose to enlist under it, by which means the soldier had no longer any chance of obtaining a pension.

Lord Cardwell defended the measures taken by himself and his colleagues, and stated that as the Act relating to shortservice enlistment was only passed in 1870, the large addition to the reserve which he had calculated on could not be looked for until the year 1876. Earl Grey maintained that the state of both army and reserve was very unsatisfactory, contending that whilst the system of short service was the only one on which it was possible to have an efficient reserve, the proper measures had not been adopted to make this policy successful, the great necessity being that a soldier should in every instance have an assurance of obtaining a pension after a certain period of service. The Duke of Cambridge explained that the longservice enlistment for the infantry had only been suspended for a time; the suspension had now terminated, and both long and short terms of enlistment were again in operation, subject to this condition: that a certain number of recruits must be enlisted in either way.

The smallest concession which will tend to increase the popularity of the service must be looked upon as a step in the right direction. The number of vacancies annually occurring from death, invaliding, and desertion, already tax our powers severely to keep up a thoroughly effective army, and it was with something like a feeling of dismay that we read the following startling information in a contemporary:—

"It is a curious fact that, as sanitary improvements increase in India, the health of our forces appears every year to be becoming more precarious. Instead of long marches in a primitive manner, the men are now moved from place to place by rail, and on scientific principles. We study the age most suitable for Indian recruits. Instead of soldiers being abandoned to idleness, sensible officers in command of regiments encourage the men to work of various kinds-physical and mental. Water-supply, quality of food, regulation of hours for parade, for meals, and for all besides, have become reduced to an elaborate and minute system. Yet still our end is not attained. Officers of experience say that the men are more languid and listless than in the old days, when a regiment was marched, by easy stages, over immense distances, and when sanitary philosophy, as applied to military affairs, was in its infancy. On the other hand, when a regiment is leaving India, there are generally plenty of volunteers to remain. The men like the country when once they have become accustomed to it, and in many cases prefer to stay under the hot sun to returning home. If they are deteriorated in stamina they are not conscious of the deterioration, or are willing to waive the question, in view of the social advantages secured in India. In view, however, of possible contingencies, the question of the health and stamina of our army in India is of the first importance. Our forces ought to be second to none in the world for perfection of physique, as well as for quality of arms and efficiency in discipline. History presents never-tobe-forgotten records of the deterioration of armies in consequence of their transfer from a cold to a warm climate, or from a land where men are expected to attend to their own wants to a land where a soldier has servants, camp-followers, etc. Perhaps this is the strongest argument in favour of the amalgamation of the Imperial and the Indian armies. The Crown can secure, as the Company could not, a constant flow of men to and from the East."

If the foregoing view of the case be the correct one, there is additional and urgent reason why the question of recruiting should be thoroughly and comprehensively dealt with until such a system has been devised as shall insure an ample and efficient supply of men to counteract the steady and continuous drain which is annually taking place.

MEETING OF THE GENERAL MEDICAL COUNCIL.

Ar two o'clock the President took his seat for the first time under a roof which may be said to belong to the Council itself, and which, though yet in an unfinished state, is certainly far superior to the old quarters in Soho-square. That the Council has been able to meet here is, we may say, almost entirely due to the indefatigable exertions of Dr. Quain, who has laboured

night and day for this desirable consummation. The rooms are most commodious, and will, when properly fitted, be admirably adapted for their purpose, but we reserve our description until we see them more complete. On calling the roll all members replied to their names save Sir Dominic Corrigan and Dr. Leet, who were absent on important business at the Houses of Parliament. Forr new members had to be introduced. Dr. Warburton Begbie, who occupies the first position as consulting physician in Scotland, succeeds Sir Robert Christison as a representative of the Crown, and certainly there could be no more worthy successor to such an able predecessor. Dr. Alexander Wood will be missed, not only for his business qualities-which were great, but also for his eloquence, which often held the Council, we might almost say, spellbound. To him succeeds Dr. Rutherford Haldane, as representative of the Edinburgh College of Physicians; and, if report says truly, Dr. Haldane is not one whit worse business man than Dr. Wood. Dr. Turner also appears in the room of Dr. Macrobin, as representative of the Universities of Aberdeen and Edinburgh-a worthy addition to the Scottish phalanx. From Dublin comes Mr. Macnamara, in the room of Mr. Hargrave, whose position with regard to the Irish College of Surgeons had become untenable.

These having been in succession introduced, and taken their seats, Dr. Paget proceeded to deliver his opening, and at the same time valedictory address. This we elsewhere print in full, and of it there can be but one opinion that it is in every respect worthy of the high character of its author. The closing passages are, we think, most dignified, and alike worthy of the speaker and his audience. On its conclusion Dr. Paget left the chair, and Dr. Stokes was called to it for the time being, when a hearty vote of thanks to the retiring President was proposed by Dr. Andrew Wood, seconded by Dr. Aquilla Smith, and carried with acclamation. The same two gentlemen next proposed that Dr. Paget be re-elected President, and this too was carried unanimously. In thus electing Dr. Paget to a second term of office the Council may be congratulated on being able to retain the services of one who has filled the post of President most efficiently in every way. We may be sure that if Dr. Paget undertakes these responsible duties he will do his utmost to fulfil them as they ought to be fulfilled, at whatever loss of personal comfort and convenience. It is always a great loss when one so intimately conversant with business as is Dr. Paget resigns office, and we think the profession at large is indebted to him for his disregard of self in again undertaking such onerous duties.

THE SANITARY STATE OF HACKNEY.

DR. TRIPE, Medical Officer of Health of Hackney, in his full and elaborate report for the past year, draws attention to the civil condition of persons aged fifteen and above in Hackney, and to the fact of the very early age at which a rather large number of the wives had married-145 being under fifteen, and 1770 under twenty years of age. The total deaths were 2591; 443, or 17.1 per cent., belonged to the epidemic class. The deaths from the chief epidemic diseases were much below the average of most preceding years, 380 only having been registered, against 490 in 1872, 751 in 1871, and 451 in 1870. Dr. Tripe here remarks that he does not expect so favourable a report for 1874 or 1875, "as it is most probable that measles will prevail in the former year, and scarlet fever in both years, being worst in 1875, or the epidemic of scarlet fever may not occur until 1875, reaching its culminating point in 1876. There were 10 deaths from these causes in each 68 deaths, but only 1 death in each 355 inhabitants, which is very small." The infant mortality was very high, owing to the large number of infantile deaths from diarrhoea, convulsions, bronchitis, prema ture birth debility, and atrophy. The total number of deaths

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