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copies, Thus up to Nov. 22nd, 35,902 copies of the Pharmacopceia and i4393 copies of the Addendum (including the Government of India Iedition) have been so](1. The stock remaining in hand of the Pharma-is 1128 copies and of the Addendum 2001 copies. It will,therefore, probably be necessary to print a fresh issue of the Pharma-copoeia before next November.The committee desire, on the retirement of Dr. Payne from the

Council, to record their grateful sense of the services which he ren-dered to the committee, especially in rclatiott to the formation andarrangement of its library of reference.Dr. Norman Moore has, at the request of the committee, undertaken

the charge of the library in the place of Dr. Payne.The committee have received with satisfaction the appended com-

munication and inclosures from the Privy Council respecting theproposed agreement on the subject of international uniformity in thepharmacopceial preparations of potent remedies. The successive stagesin the negotiations on this subject are set forth in the minutes.That so large a measure of approval should have been accorded tothe agreement by the signatory national authorities is a matter ofcongratulation. It indicates that the proposals of the InternationalConference at Brussels have been deemed by the Governments ofEurope and America to be both desirable and practicable. Thecommittee will naturally keep in mind the terms of the agreementwhen they undertake the revision of the Pharmacopoeia of 1898.The committee have been placed in communication with the

Secretary of State for the Colonies, and through the Privy Council withthe Government of India, on the subject of the drugs and preparationssanctioned for Indian and Colonial use in the Addendum of 1900. A

paper of inquiries has been drawn up hearing on the question of theultimate inclusion of these and other articles in the ImperialPharmacopeeia, and this paper has, by the courtesy of the Secretaries ofState, been brought to the special notice of the various administrativeauthorities of the Empire. It is confidently expected that the repliesto these inquiries will be of the greatest service to the committee at alater stage of their work on the Pharmacopoeia.

Dr. NORMAN MOORE seconded the motion which was

agreed to.P’inance Committee’s Report.

Dr. MACALISTER moved that the report of the FinanceCommittee be received and entered on the minutes asfollows :-

I. The committee had before them the following approximate state-ments of the estimated receipts and expenditure to the end of thepresent year, showing at a glance the position of the General andBranch Councils and the Dental Fund :-

- ùL.VV

The committee drew up the following report :-It should be remembered that the "estimated contribution" from

the branches is a sum fixed by the auclitors and based upon the ex-penditure of the three previous years. It may be (and this year prob-ably will be) found that the actual expenditure is not so great as wasanticipated. The English and Scottish branches will not be able to paytheir contributions in full out of income.The questions which appear to call for consideration are as

follows :-General Council.-There has been received from the builders next

door .E1000 for C’oneessiolls made to them and for breach of agreement.This sum cannot rightly be considered income. If the General Counciltransfer ;;C1000 to the English Branch in reduction of the mortgage theEnglish Branch can then transfer ;;C1000 to the General Council towardsthe deficit of its "estimated contribution." The result of this will be

that, by means of book entries and without the passing of cash, at theend of the year the General Council, after repaying the loan from thePharmacopoeia account and reducing the mortgage by £ 1000, will havea small cash balance.Dental Fund.—There should be about .E17CO in hand at the end of

the year provided that the English Branch repays its loan.II. The committee also considered a report relating to the provision

of a new fireproof safe and the institution of a new system for filingdocuments in connexion with the Medical Register remitted to themby the Executive Committee at its meeting on Nov. 21st, 1904, underthe following resolutions"That this report be remitted to the Finance Committee with the

expression of the opinion of the Executive Committee that it isdesirable that the suggestions in regard to the introduction of the newsystem and the provision of a new safe should be adopted and that thecommittee be requested to consider if there are any means of meetingthe expense."

RECOMMENDATIONS.I. That the General Council apply the £ 1000 received from the

builders towards the reduction of the mortgage to the English BranchCouncil of the General Council’s property.

II. That when the accounts of the Dental Fund for the year aremade up, the available surplus standing to the credit of the fund beinvested in Consols.

III. That the funds to carry out the suggestions in the report beprovided by means of a loan from the PharmaeoDceia account, bearinginterest at 3 per cent., repayable by equal annual instalments over aperiod of five years.

Dr. MCCALL ANDERSOX seconded the motion which wasagreed to.The Council then adjourned till Monday.

ANNUAL REPORT OF THE MEDICALOFFICER OF THE LOCAL GOVERN-

MENT BOARD.1

FIRST NOTICE.

No one can carefully study the report for 1902-03, which isthat at present before us, without arriving at the conclusionthat the traditions of the medical department of the LocalGovernment Board with regard to thoroughly scientific

inquiries and reports are being fully maintained under theexisting regime. In fact, a study of this report makes usregret two things-firstly, that time does not allow ofthe production of more documents of an equally exhaus-tive nature ; and, secondly, that these reports of themedical department do not receive a wider circulation than isat present the case. Unfortunately, in one way, these

reports are so thorough and comprehensive and are so wellillustrated with plates, maps, and diagrams that the cost,although in no sense prohibitive, is such that the volumes arenot likely to find their way to the private libraries of everymedical officer of health throughout the country. We areafraid, too, that many of the smaller local authorities inthis country will hesitate before providing their medicalofficers of health with this very necessary literature. More-over, in a very large number of public health offices thereis practically nothing to. which the name of a public healthlibrary could be properly applied. We think, however, thatevery medical officer of health should make application tothe local authority for these volumes and that they shouldbecome not the private property of the medical officer ofhealth but part of the library which should be found in theoffice of every sanitary authority.The report proper consists of an introduction addressed by

the present medical officer, Mr. W. H. Power, C.B., F.R.S.,to the President of the Local Government Board. Thisintroduction, which practically summarises the medical

inspectors’ reports which are contained in the volume inthe form of an appendix, is admirable and it contains, wefear, as much expression of the personal opinion of Mr.Power as we are likely to get under the present system ofadministration. We confess, however, that it would be bothinspiring and refreshing if we could have the benefit of themedical officer’s views upon questions such as the provisionof isolation hospitals, the value of sanatoriums for pulmonarytuberculosis, and other problems concerning which the out-side public health service would be glad of the light whichMr. Power could undoubtedly throw upon them were hefree to express his views. And now as regards the actualcontents of the current volume.

1 Thirty-second Annual Report of the Local Government Board1902-03. Supplement containing the report of the medical officer for1902-03. London : Eyre and Spottiswoode. 1904. Pp. li.-709, withmaps and illustrations. Price 8s. 3d.

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In the matter of vaccination it is encouraging to findthat the figures for 1901, which are those here dealtwith, show that the improvement which was noticed in1898 has been almost continuously maintained and thatthe percentage of children remaining unvaccinated, whichin 1898 was 26’6, has. been in succeeding years up to1901 26’8, 19’9, and 17’3 per cent., and such increase invaccination has been on the whole general throughout thecountry. There have been an increase of infantile vaccinationin all the 43 counties of England and a decrease during thesame period of " conscientious objection " in 50 per cent. ofsuch counties. It is also satisfactory to learn that theNational Glycerinated Calf Lymph Establishment has beenequal to the demands which were made upon it during1902-03 by public vaccinators. Some idea of such demand

may be gathered from the facts that between April lst, 1902,and March 3rd, 1903, no fewer than 800,100 charges of

glycerinated calf lymph were issued.In commenting upon the administrative measures taken

to control the prevalence of small-pox the medical officerinferentially criticises the slack administration of certainprovincial boards of guardians who, with small-pox at theirgates and the public clamouring for facilities to obtain

prompt revaccination, refused to open stations whereat suchrevaccination could be performed not only expeditiously butat a cost to the guardians of half the amount which wouldhave to be paid were such revaccinations performed at thehomes of the people. Mr. Power speaks sympathetically-we might almost say encouragingly-of those sanitaryauthorities whose districts were inflicted not only withsmall-pox but also with antagonistic boards of guardiansand who at once acted qtltra vires by practically supersedingthe defaulting guardians. It is, Mr. Power adds, "much tobe desired that action in the above sense be legalised andchief responsibility for vaccination administration in theface of small-pox transferred from the guardians to the

public health authority." As we have recently pointed outin our columns action on these lines has now been takenin respect of the urban district council in the Dewsburyunion. aTurning to the appendices of the volume we find in

Appendix A a series of valuable reports by the medical

inspectors of the Board and these reports are, as a whole,of a decidedly higher academic level than has been the casefor some years past. Dr. G. S. Buchanan’s report on epi-demic small-pox in the union of Orsett in 1901-02 is anexcellent piece of work which should be carefully studiedby those whose knowledge of the influence of small-poxhospitals has been derived from certain text-books theauthors of which have not, we fear, taken the trouble tomaster thoroughly the literature of the subject. It is wellthat writers upon public health should appreciate the factthat the theory of aerial convection does not rest upon certainremarkable occurrences which took place about the FulhamHospital on one occasion only but that such occurrences

recurred again and again in connexion with the operationsof that hospital. Moreover, as Dr. Buchanan points out,occurrences of a similar nature, whatever may be their ex-planation, have since been observed at Sheffield in 1887-88 ;Oldham, 1893 ; Warrington, 1892-93 ; Bradford, 1893; andGlasgow 1900-01. It is regrettable that in text-books inwhich the subject is discussed references to these later

phenomena are sometimes entirely omitted. Dr. H. ’1’imbrellBulstrode’s report of the remarkable outbreak of enteric feverand other illnesses which followed the mayoral banquets atWinchester and Southampton and which was traced withan altogether exceptional clearness to the oysters derivedfrom the Emsworth oyster ponds, has been already noticed inour columns.3 One of the most interesting features about thisoutbreak was the very large number of persons who sufferedfrom attacks of gastro-enteritis which came on at varyingintervals after the banquets and in such fashion as to suggestthat multiple poisons, in addition to the specific infection ofenteric fever, were at work.

Dr. L. W. Dana Mair contributes a highly interestingand instructive report upon outbreaks of throat illness atLincoln in 1902 and 1903 which presented some very puzzlingbut nevertheless suggestive features. The outbreaks were ofshort duration and the first one, which affected nearly 200people, more closely approached scarlet fever in its clinicalfeatures than any other of the exanthemata. But many of

2 THE LANCET, Oct. 29th, 1904, p. 1227.3 THE LANCET, July 18th, 1903, p. 172.

the cases were quite anomalous and the general trend ofmedical opinion was that the disease was not scarlet fever.To us the clinical description of some of the cases savoursof typical scarlet fever and we suggest that perhaps toomuch may have been made of the absence of albuminuriaand of any evidences of infectivity in summing up the case.In some years both these factors may be very largely inabeyance. Certainly, however, many of the cases seem

to have been absolutely atypical and this fact suggeststhat not improbably. there may have been two infectionsat work, the vehicle of infection in both instances

having been the same-i.e., the milk-supplies with whichthe vast majority of the cases in each of the twooutbreaks was associated. The bulk of the victimswere adults but this incidence upon adults seems to havebeen largely due to the age distribution of the populationwhich consumed the infected milk. Dr. Klein and Dr. M. H.Gordon were unable in the first outbreak to discover in thefauces of those attacked anything like the streptococcusscarlatinas but they found in three cases an organism re-sembling the yeast of alcoholic fermentation and this wheninoculated into animals led to disease and death. Dr.Klein thinks it not improbable that this yeast may havebeen responsible for the first of the two outbreaks.Perhaps the best suggestion to account for the outbreak was

that offered by Mr. Page, the deputy town clerk of Lincoln,who observed in the autumn of 1901 that the grass in thefield which separated the cowsheds of the suspected dairyfrom the grazing meadows was diseased and it appears thatsuch grass was actually affected with ergot. But what Mr.Page saw was not ergot but some brownish-red algous growthwhich covered his boots with powder and which was probablywhat is known as "rust," a diseased condition from which,also, the grass in the adjoining field appears to have suffered.The view that both of these outbreaks may have been due tothis fungus receives support from the fact that these out-breaks occurred in the spring and the udders of the cowsmay have become infected by the animals lying on the grass.But it has to be observed that in the second outbreak, whichoccurred in the spring of 1903, the symptoms resembledscarlet fever and the outbreak was associated with definiteillness among the cows in the implicated dairy. Dr.Klein found that two of the cows presented a vesicular erup-tion on the udders and teats somewhat similar to thatdescribed by him in the case of the historical " Hendondisease." "

The value of the bacteriological as contrasted with thechemical examination of water is shown in striking fashionby a report by Dr. Bulstrode on the water-supply of the

Bridgend urban district in South Wales. This water-

supply was derived from springs in the carboniferouslimestone, such limestone being permeated with fissuresand with " swallow holes, or " pots " as they are termedin geological language. The report of the chemisthad always been favourable to this water which was

supplied unfiltered to Bridgend and at first the bacterio-

logist also spoke not unfavourably of the water.. Butsoon the bacteriological examination raised suspicion thatthe water was polluted and owing to the persistencewith which the bacteriologist-Dr. W. G. Savage, the

present medical officer of health of Colchester-pressed thispoint the local authority invoked the aid of the LocalGovernment Board. Dr. Bulstrode found that the springfrom which the water was derived flowed into an open basinin the rock and that the evidence pointed strongly to theconclusion that this spring was liable to pollution, boththrough fissures and through "swallow" holes. Moreover,this basin was within a short distance of the sea and on theside of a polluted river. Hence, when the high spring tidesforced the polluted water back such water flowed over intothe spring basin and polluted its contents. Samples of thespring water were taken and were condemned by thebacteriologist but approved by the chemist. It is satis-factory to find that the inspector’s advice that the watershould be carefully filtered was at once adopted by the watercompany.

Dr. S. Monckton Copeman furnishes a very instructivereport of an outbreak of casual cow-pox among the cows ona farm near Reigate to which attention was called inthe first instance by Mr. E. L. Jacob. The steps by whichthe malady was conveyed from one farm to another and tothe hands of the milkers were very clearly determined andset oub but the attempt to discover whether the disease wastraceable directly or indirectly to small-pox in the human

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subject was not so successful. Dr. Copeman carried out someinoculation experiments in connexion with this interestingoutbreak and he was able to show conclusively that the

cow-pox in this instance was true " and not " spurious."The question arose as to whether the milk of the cows affectedwas fit for human consumption but fortunately the accommo-dating attitude of the farmer rendered it quite unnecessaryto resort to a legal tribunal for the settlement of the

difficulty.Dr. R. Bruce Low completes Appendix A by an exhaustive

summary of the progress and diftusion of plague throughoutthe world in 1902 and in our second notice we shall deal with

Appendix B which relates to the experimental work carried

I’out under the direction of the Board’s medical department.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 7596 births and 5075deaths were registered during the week ending Nov. 26th.The annual rate of mortality in these towns, which hadbeen 14 9, 15 7, and 16 6 per 1000 in the three precedingweeks, farther rose to 17’ 3 per 1000 last week. In Londonthe death-rate was 16 8 per 1000, while it averaged17’ 6 per 1000 in the 75 other large towns. The lowestdeath-rates in these towns were 9’ 3 in West Bromwich,10’ 2 in Kings Norton, 11 - 0 in Hastings and in Huddersfield,11’3 3 in Boumemouth, 11’ 8 in Willesden and in Devonport,12’ 2 in Blackburn and in York, and 12 ’ 6 in Northampton ;the highest rates were 21 ’0 0 in Grimsby, 21’ 6 in Liverpool,22 . 4 in Wigan, 22 - 8 in Birmingham, 23’ 0 in St. Helens,24’ in Stockport, and 24-8 in South Shields. The5075 deaths in these towns last week included 400which were referred to the principal infectious diseases,against 425,, 380, and 444 in the three precedingweeks; of these 400 deaths, 120 resulted from measles,73 from diphtheria, 68 from diarrhoea, 53 from whooping-cough, 48 from scarlet fever, 36 from "fever" (princi-pally enteric), and two from small-pox. No death fromany of these diseases was registered last week in Hastings,Brighton, Bournemouth, Southampton, Reading, Hands-worth (Staffs.), West Bromwich, Kings Norton, Warrington,or Swansea ; while they caused the highest death-rates inEast Ham, Hanley, Grimsby, St. Helens, Salford, Rochdale,West Hartlepool, South Shields, and Rhondda. The greatestproportional mortality from measles occurred in Grimsby,Liverpool, St. Helens, and Tynemouth ; from scarlet feverin Rochdale; from diphtheria in Ipswich, Grimbsy, WestHartlepool, and Merthyr Tydfil ; from whooping-cough in

Coventry, Huddersfield, and South Shields ; from "fever" "

in Rhondda ; and from diarrhoea in Hanley and Barrow-in-Furness. One fatal case of small-pox was registeredlast week in Oldham and one in South Shields, but none inany other of the large towns ; and only one case of small-pox remained under treatment at the end of the weekin the Metropolitan Asylums hospitals. The number ofscarlet fever patients in these hospitals and in the LondonFever Hospital, which had been 2782, 2843, and 2773 on thethree preceding Saturdays, had declined again to 2741 onSaturday, Nov. 26th ; 262 new cases were admitted during theweek, against 294, 294, and 259 in the three preceding weeks.The deaths in London referred to diseases of the respiratoryorgans, which had been 285, 324, and 361 in the three

preceding weeks, further increased to 385 last week, butwere 17 below the number in the corresponding periodof last year. The causes of 70, or 1’4 4 per cent., ofthe deaths in the 76 towns last week were not certifiedeither by a registered medical practitioner or by a

coroner. All the causes of death were duly certified inWest Ham, Bristol, Leicester, Manchester, Bradford, Leeds,Hull, Newcastle-on-Tyne, and in 46 other smaller towns ;while the largest proportions of uncertified deaths wereregistered in Birmingham, Liverpool, St. Helens, Burnley,Sheffield, Sunderland, South Shields, and Gateshead.

HEALTH OF SCOTCH TOWNS.The annual rate of mortality in eight of the principal

Scotch towns, which had been 17-8, 17-5, and 17-3 per1000 in the three preceding weeks, rose again to 18’ 0per 1000 during the week ending Nov. 26th, and was0’7 7 per 1000 in excess of the mean rate during the same

period in the 76 large English towns. The rates in the

eight Scotch towns ranged from 11’ 0 in Leith and 13’ 7in Aberdeen to 20’ 7 in Dundee and 20 ’ 9 in Greenock. The594 deaths in these towns last week included 21 whichwere referred to whooping-cough, 18 to diarrhoea, nineto diphtheria, eight to measles, three to "fever," and oneto scarlet fever. In all, 60 deaths resulted from these

principal infectious diseases last week, against 58, 59,and 47 in the three preceding weeks. These 60 deathswere equal to an annual rate of 1’8 8 per 1000, which was0-4 per 1000 above the mean rate last week from thesame diseases in the 76 large English towns. The fatalcases of whooping-cough, which had been 17, 20, and 19in the three preceding weeks, rose again last week to 21,of which 18 were registered in Glasgow and two in Aberdeen.The deaths from diarrhoea, which had been 27 and 19 in thetwo preceding weeks, further declined to 18 last week, andincluded 11 in Glasgow and four in Dundee. The fatal casesof diphtheria, which had been eight, three, and two in thethree preceding weeks, rose again last week to nine, ofwhich five occurred in Glasgow and three in Edinburgh.The fatal cases of measles, which had been nine, eight,and five in the three preceding weeks, increased again toeight last week, and included five in Aberdeen. Of thethree deaths from "fever" registered last week two wererecorded in Glasgow. The deaths attributed to diseases ofthe respiratory organs in these towns, which had been119, 136, and 154 in the three preceding weeks, furtherrose last week to 174, and were 26 in excess of thenumber in the corresponding period of last year. Thecauses of 20, or more than 3 per cent., of the deaths

registered in these eight towns last week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 21’ 5, 20’2,and 24’2 per 1000 in the three preceding weeks, declinedagain to 22’ per 1000 during the week ending Nov. 26th.During the past four weeks the death-rate has averaged 22’ 1per 1000, the rates during the same period being 16 0in London and 16’ 7 in Edinburgh. The 164 deaths of

persons belonging to Dublin registered during the weekunder notice showed a decline of 12 from the number in the

preceding week and included 21 which were referred to theprincipal infectious diseases, against 13, 12, and 20 in thethree preceding weeks ; of these, 12 resulted frommeasles, four from whooping-cough, four from diarrhoea,and one from scarlet fever, but not any from small-pox,diphtheria, or "fever." These 21 deaths were equal to anannual rate of 2’ 9 per 1000, the death-rates last week from theprincipal infectious diseases being 0 ’ 8 in London and 0 ’ 6 inEdinburgh. The deaths from measles, which had been six,seven, and eight in the three preceding weeks, furtherincreased last week to 12. The four fatal cases of whooping-cough corresponded with the number in the preceedingweek, while the four deaths from diarrhoea showed a slightdecline. The 164 deaths in Dublin last week included 28 ofchildren under one year of age and 48 of persons aged 60years and upwards ; the deaths of infants were slightlyfewer than in the preceding week, but the deaths of elderlypersons showed an increase. Seven inquest cases and eightdeaths from violence were registered; and 55, or more thana third, of the deaths occurred in public institutions. Thecauses of 8, or nearly 5 per cent., of the deaths registeredin Dublin last week were not certified.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.THE following appointments are notified :-Fleet Sur-

geons : C. S. Woodwright to the Irresistible, on recommission-ing, and V. G. Thorpe to the Hercu1es, temporary.

ROYAL NAVAL VOLUNTEER RESERVE.The undermentioned gentleman has been appointed a

Surgeon :-Thomas Caldwell Litler Jones (dated Nov. 25th,1904).

ROYAL ARMY MEDICAL CORPS.Lieutenant MacDonald has left Aldershot for service in

India. Major H. D. Rowan is held in readiness to embarkfor India for service in the Punjab. Lieutenant-ColonelE. M. Wilson, C.B., C.M.G., D.S.O., retired-pay, is