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bill-posters, policemen, dock pilots, publicans, fitters, dress- tmakers, domestic servants, and labourers. It was noted that athere were several persons in the receipt of parish relief, jsome were in the receipt of club pay, and some were domestic 1servants in situations. In sixteen cases we were not able to (

ascertain the income of the patients and their families, and ]in eleven cases the heads of the families were out of work. 1

In summing up, we are decidedly of opinion-(l) that the c

"wage limit" at the Cardiff Infirmary is too high ; (2) that ]a considerable number of persons obtain letters who couldwell afford to pay private practitioners ; (3) that a very large Inumber of persons obtain letters who could well afford to i

pay the small fees of the provident dispensary ; (4) that a Ilarge proportion of the cases attending the out-patientdepartment are of a very trivial nature and could easily be Itreated in other ways ; and (5) that the only satisfactoryway to discover these persons who are not entitled to receivethe benefits of the charity is to appoint an inquiry officerwhose sole duty it would be to make personal investigationsinto the circumstances of the patients after they havereceived one attendance. We think it right to state thatpatients seeking relief in the ophthalmic department canhardly be dealt with in the same way as patients in themedical and surgical departments. Some of those attendingthe ophthalmic department could very well afford to paythe fees of a specialist; but, on the other hand, itcannot be denied that the majority could not affordto pay those fees. It is difficult to suggest a remedyunless the ophthalmic surgeons could see their way to

arrange to see patients on a certain day at their ownhouses at a reduced fee. We are given to understand thatthe ophthalmic surgeon at the infirmary has from time totime refused to attend certain out-patients, believing thatthey were well able to afford to pay the regular fees. Fromthe very large number attending this department it must bealmost impossible for the medical officers to make any sortof inquiry into the circumstances of those coming beforethem. We think that the appointment of an inquiry officerwould tend to reduce very materially the number attendingthe ophthalmic department.Through the courtesy of the committee of the Cardiff Pro-

vident Dispensary we were enabled to inspect the list of themembers and to make any other inquiry we thought fit. Thisinstitution was established in 1884, and has an acting medicalstaff consisting now of eleven practitioners. The followingis the number of patients on the roll for the years 1890 to1894: 1890, 1517 ; 1891,1482; 1892,1456; 1893, 547; and1894, 1586. There is a "wage limit" for members, and it isas follows : Single man or woman, 21s.; married men, 25s.;each child, 2s. ; and limit for man and wife and five children,35s. The two points to which we directed our attentionwere: (1) whether persons were admitted as members whocould reasonably be supposed to be able to pay the ordinaryfees of private medical practitioners, and (2) whether

systematic canvassing for members took place or not. Weare satisfied that every possible precaution is taken to preventwell-to-do people becoming members.With regard to canvassing for new members, we are

informed that this takes place. It seems to us that medicalmen who are not on the staff have good grounds for objectingto canvassing. The chief cause of complaint to the laymedical aid associations is the fact that they canvass formembers, and what is objectionable in a medical aid associa-tion must necessarily be objectionable in a provident dis-

pensary. General practitioners who have no connexion withthe dispensary are liable to lose patients. Such a system isapt to lead to reprisals on the part of private practitioners,and for this reason, if for no other, it should be dispensedwith. We think with the committee of the dispensary thatthe sphere of usefulness of that institution might be con-siderably enlarged if the committee of the dispensaryeffected a closer alliance with the out-patient departmentof the infirmary. We have no hesitation in asserting thatthe vast majority of the out-patients we saw at the infirmarywere in a position to afford the small subscription necessaryfor joining the dispensary. If ever such a close alliancecame about it would be necessary, however, to increase thestaff of the dispensary and also to establish subsidiarybranches in the outlying districts. A model provident dis-pensary would be one that included on its staff every regis-tered medical practitioner who had resided in the town for aperiod of twelve months, and who had been recommended byhis brother practitioners already on the staff.The Hamadryad Seamen’s Hospital is supported by con-

tributions from vessels belonging to the port. Patients areadmitted on the order of their captains. In the case of’

foreign ships the Consul’s order is also accepted. Sailors not

belonging to the port are admitted on the payment of 3s. aday. Destitute sailors are frequently attended as out-

patients without the production of an order. The order fromthe Consul or the captain is a contract that they will eithercontribute towards the hospital or pay 5s. a day during theperiod of treatment.

In conclusion, we think it right to state that the result ofour inquiry merits the serious attention of the committee ofthe Cardiff Infirmary, and we feel sure that if they wouldonly deal with the abuses which are pointed out they willhave the support of all those people who believe that acharity like this should be restricted to the necessitous poor. J

Cardiff. Nov. 18th. 1895.

[AERIAL SPREAD OF DISEASE—INCHANCERY.

AFTER occupying the Chancery Court for six days, an actionheard by Mr. Justice Kekewich was concluded on the 20thinst. which, by its medical evidence, illustrates the still un-settled state of professional opinion as regards the aerialspread of small-pox, and which also illustrates the increasingdifficulty which sanitary authorities have in finding an

unopposed site for the erection of a small-pox isolationhospital, at least in the southern counties.The Guildford, Godalming, and Woking Joint Hospital

Board have at present provided a cottage, and propose toerect a small hospital with some ten or fifteen beds for small-pox, on Whitemoor Cormon in Surrey, where there isa population consisting of only 20 inhabitants livingwithin a radius of a quarter of a mile, and a totalof 103 within a half - mile radius of the hospitalsite. But some of the inhabitants around, headed bythe owner of an estate whose mansion is just outsidethe half-mile radius, sought to obtain an injunction torestrain the combined Hospital Board from using the cottageor erecting a small-pox hospital there, on the ground that itwould become a " nuisance and a danger to themselves andtheir property. The hospital would be enclosed in about two-acres of land, 100 yards across, and surrounded by a doublewall enclosing a belt of trees. The site is surrounded on allsides by a common consisting of marshy ground which is.utilised for the feeding of cattle and geese. Children are inthe habit of playing on the common, and one of the plaintiffskeeps cows and earns his livelihood by selling milk andbutter. Another is a market gardener whose house is about170 yards from the proposed hospital, and others reside atdistances of 200, 250, 335, and 450 yards.There was an array of seven medical witnesses on each

side, and the verdict practically turned on the scientificevidence for and against the theory of aerial convection.Dr. Thorne Thorne, Dr. Bruce Low, Dr. Alexander Collie,Dr. Russell, Dr. Morton, Dr. Wilson (Hastings), and Dr.Sanderson were subpoenaed by the plaintiffs.Dr. Thorne Thorne, after protesting that it was not in the interests

of the public service that he and Dr. Bruce Low should be called, gaveevidence as to the danger of the proximity of a small-pox hospital. Heexpressed his firm conviction that the contagion of small-pox could beconveyed through the air in some way as yet undiscovered to a greatdistance-under certain circumstances to a distance of at least a mile.He admitted, however, that it was upon his advice, and explainedon what grounds, that the Local Government Board had adopted thepresent regulations for sanctioning the sites of small-pox hospitals. Ina letter to the Joint Hospital Board the Local Government Board hadstated that it was not their practice to sanction any loan for the erection Iof a small-pox hospital which would have within a quarter of a mile ofit 15( to c00 inhabitants, or within half a mile of it 500 to 600 inhabi-tants-numbers which largely exceeded the number of inhabitantsaround the proposed site.. Dr. Bruce Low gave similar evidence, and referred to the Hastings.epidemic of 1894, in which he believed aerial convection played animportant part.’ Dr. Collie thought that the hospital grounds were not large enough.But in a long cross-examination by Mr. Cozens Hardy, Q.C., he wouldnot commit himself to the view that small-pox could be spread throughthe air to any great distance. He admitted that the immunity of theDarenth Asylum adjacent to the small-pox camp, and other similarinstances, were against that view, finally stating that isolation in his.view meant the avoidance of corporeal contact. The plaintiffs’ othermedical witnesses supported the theory of aerial convection. I

For the defendant board, Dr. Gayton, Dr. Savill, Dr. Orme-Dudfield"(whose evidence was taken on commission on

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account of ill-health), Mr. Wellington Lake (the medical’officer of health of Guildford), Mr. Collins (Kingston), Mr.Howlin (Woking), and Dr. Reginald Dudfield (Paddington)were’called.

Dr. Gayton, after an experience of small-pox extending over nearly a’quarter of a century in the hospitals of the Metropolitan AsylumsBoard, did not agree that a very large area around a hospital was tieces- j isary. He thought aerial convection was a theory which was not worthy- of much practical consideration, and the facts on which it was basedwere capahle of other explanations.

Dr. Savill, from his inquiry at Warrington on behalf of the Vaccina-tion Commission, and elsewhere, believed that a sufficient belt of’space around a hospital was very desirable, but solely for thepurpose of efficient ventilation, not to avoid aerial convection, to whichlie could not subscribe. It was universally conceded that freefresh air was the best known natural germicide, and lie failed to under-stand how it could become the vehicle for carrying contagion to suchdistances as had been alleged. There were also other grounds for dis-believiug that it could take place. Cross-examined by Mr. Warrington,on the plans of Whitemoor Common, he thought the site a goodone. He admitted that infection could be taken within the limits of anordinary room or ward by a person who simply breathed the patients’respiratory impurities, but not beyond this limit in presence of freshnir.

Dr. Orme Dudfield’s evidence dwelt on the necessity of properudministration within the hospital in preference to a large area aroundit as the best means of preventing spread.The other medical witnesses for the defence gave similar

evidence.Mr. Justice Kekewich, in the course of a long and

- elaborate judgment, first excluded from his considerationsuch points as the alleged greater suitability of other sites,and the accessibility of this one. The question was, ’’ Isthere here a real apprehension of real danger to theinhabitants or damage to their property or their trade ? "

If the existing cottage, and arrangements as now made,were used for small-pox patients the evidence went to:-;how that there would be danger by reason of direct:nfection. In that sense, therefore, it constituted a- nuisance," and the plaintiffs were entitled to a verdictso far as the present arrangements were concerned. Butthe plaintiffs also sought to restrain the defendant Boardfrom erecting a suitable small-pox hospital on this site.lit had been shown in evidence that a properly built andadministered hospital could be erected here, and the onlyquestion which remained was concerning the area of unin- ihabited space around, and whether small-pox could be con- Iftracted by persons frequenting and dwelling on the adjacent ’Iiand. The real question, then, was, "Is aerial convectiona theory sufficiently established to enable the Court

judicially to say this constitutes a source of danger Iagainst which the defendants have to provide 1" But !iMs lordship had not been satisfied by the evidence before ’IMm that such a theory had been conclusively proved to Iexist, nor that the particulate matter " referred to by onemedical witness could be conveyed a mile, half a mile, or.even a quarter of a mile. Under such circumstances it would ’ibe entirely wrong to grant an injunction against the ’defendants erecting this hospital, which would be an ’advantage to the public, because some learned men, ’,whose opinions were entitled to great respect, came tothe conclusion, though they could not prove it, that

small-pox was the subject of aerial convection. Thecase came before him almost as a res i’nte.r;ra, for his

lordship had not found any reported case to assist him in

coming to a conclusion. 1 But on the evidence he was of

opinion that he should be going much too far in saying thatthere was any real apprehension of a real danger. Theverdict would therefore be for the defendant board upontheir undertaking (as they had consented to do) not to usethe existing cottage and site for small-pox patients until aproper hospital had been erected ; but, as each side hadfailed in part of the action, no order would be made as tocosts.

ROYAL COLLEGE OF PHYSICIANS OFLONDON.

A MEETING of the Comitia of the Royal College of

Physicians was held on Friday, the 22nd inst., the President,Sir J. Russell Reynolds, Bart., being in the chair.The President announced that he had nominated Dr. J. F.

Payne as Harveian Orator for 1896. He also reported to theCollege that at a meeting held on the previous day at the

1 The case of Hill v. Metropolitan Asylums Board was finally con-cluded by arbitration.

University of London, Sir James Paget presiding, delegatesof various bodies concerned in the question of the recon-struction of the University were selected to attend a deputa-tion to the Duke of Devonshire on Nov. 28th. The delegatesof the Royal College of Physicians were the President, theRegistrar, Dr. Norman Moore, and Dr. Allchin.The College seal was set to a deed declaring and accepting

on the part of the College the Weber-Parkes prize trust.A letter of thanks was received from the Cambridge

Antiquarian Society for permission to photograph certainobjects of interest possessed by the College.A letter was read from the secretary of the Royal College

of Surgeons reporting the proceedings of its Council.A letter was read from Sir Arthur Watson resigning the

office of standing counsel, which he had held since 1872.On the motion of the Registrar, seconded by the SeniorCensor, Sir A. Watson’s resignation was accepted, and acordial vote of thanks passed to him for his valuable services.On the motion of Dr. J. K. Fowler, seconded by Dr.

Poore, permission was renewed to the Fellows’ Club to dine inthe College.The report of the delegates of the two Royal Colleges on

the proposed third and fourth examinations under the fiveyears’ scheme was received. The Registrar reviewed thevarious steps taken in the framing of the original scheme,and stated that the present revised plan was almost exactlythe same as that which had been recommended in 1871 bythe delegates of the College on the Committee of Manage-ment. The scheme, which would come into force inJanuary, 1896, established the third examination (medicine,surgery, and midwifery) at the end of the fifth year,with certain extensions over the present examination; andpermitted the examination in midwifery to be passed at anytime after the completion of the fourth year of professionalstudy, provided one year has elapsed since passing theanatomical and physiological examination. It also establishedan examination in pharmacology to be passed at any timeafter the completion of the fourth year of professional study,provided that the anatomical and physiological examinationhas been passed. Amongst other matters it recommendedthat the subject of elementary anatomy be eliminated fromthe first examination. Considerable discussion arose uponthe desirability of instituting a separate examination in

pharmacology, in which Dr. Curnow, Dr. Payne, Dr. Church,Dr. Fowler, Dr. S. West, Dr. I. Owen, Dr. Ewart,Dr. Poore, Dr. Cayley, Dr. Coupland, and Dr. Taylor tookpart. Eventually it was moved by Dr. Church, secondedby Dr. Curnow, and carried, that the report of the

delegates be adopted, but that the Royal College of Surgeonsbe informed that this College would regard it as an improve-ment if the subject of pharmacology were included with theother subjects of the medicine examination, and not made adistinct examination by itself. Dr. Griffiths moved, andDr. Play fair seconded, that the subject of midwifery anddiseases of women be placed on the same footing as medicineand surgery-i.e., relegated to the end of the fifth year. Themotion was negatived by sixteen votes to nine.On the motion of Dr. Champneys, seconded by Dr.

Playfair, a committee was appointed to prescribe the properconduct of a practitioner when brought into relation with acase of acknowledged or suspected criminal abortion. Thecommittee consists of the four censors, the mover andseconder, and Dr. Black.

A TEACHING UNIVERSITY FOR LONDON.

AT a meeting held at the University of London, onThursday, the 21st inst., Sir James Paget, Bart., in the

chair, and attended by delegates from institutions named inthe report of the Royal Commission on the Gresham

University, by members of that Commission and of theearlier Commission on a Teaching University for London,and by others interested in the establishment of a Teach-ing University, the following resolution was unanimouslypassed :-"That the Government be requested to introduce, at an early date, a

Bill, similar to Lord Playfair’s London University Commission Bill,1895, appointing a Statutory Commission. to carry out the recommenda-tions of Lord Cowper’s Commission, but with an added clause giving [inaccordance with precedent Acts of a similar tenor] to all institutions orpersons directly affected by any Statute or Ordinance proposed by theStatutory Commission a right of appeal to the Privy Council for the