647

law of public health. The sooner this consolidating Bill isready the better will it be for all concerned ; but even ifanother session had to elapse before it could be put intoshape it would be better to wait for this than in the mean-time to place on the statute book a measure which even itsauthor acknowledges to be both temporary and incomplete.We fail to see that there should be any great difficulty in

compassing the whole task during the present session. LordBalfour is unquestionably following the safe and states-manlike course with regard to the individual clausesof his amending Bill. He is ransacking the Englishand London Acts for what is best in them, and in

adapting the provisions of these Acts to Scotland hewill be able to urge that he is only introducingwhat has already stood the test of experience. Let himcontinue to do this with regard to his consolidating Bill-which he says is at present on the stocks-and there needbe little delay in getting it launched into the House ofLords. Its launching, indeed, might appropriately followon the completion in committee of the adjustment of theamending clauses which he has already put before Parlia-ment. And these clauses, till then held in retentis, could becomfortably bestowed wherever they would be most useful inthe newly-launched consolidating Bill; but, above all, let himbe dissuaded from attempting to float the clauses independentlyof the all-inclusive Bill. Scotchmen are credited with beingdistinctively and naturally logical. Lord Balfour, we mayalmost assume, is logical enough to know that his purpose,both primarily and ultimately, ought to be not to complicate,but to simplify and systematise any legislation which hewishes to see carried into practical effect. The legislation isnot to be for mere show, but for the solid advantage of thecountry which he is so well able to represent in Her Majesty’sGovernment.

AUTOCARS FOR MEDICAL MEN.

IN THE LANCET of Jan. 4th we published an illustratedarticle on horseless carriages, believing that the intro-

duction of the autocar into this country will be widelyappreciated by members of our profession. From a

hygienic aspect the introduction of horseless carriagesupon our metropolitan thoroughfares will be of far-reach-

ing importance, while from the points of view of utilityand economy the question is one of great interest. In

France and other countries self-propelled vehicles havebeen in practical use for some time. In this country, how-ever, a promising enterprise is checked by the laws relatingto road locomotion, and until these laws are altered little orno progress can be made in testing practically the generalusefulness of the cars and motors already on the market.Public opinion, however, is strongly in favour of removingthe present restrictions, and strenuous efforts are being madeto interest our legislators in the matter. Early last montha deputation from the Self-propelled Traffic Association, in-troduced by Sir David Salomons, waited upon Mr. Chaplinto discuss the question of remedial legislation concerninghorseless carriages, and received from the President of theLocal Government Board assurances to the effect that he

fully sympathised with their object; that a Bill dealing withthe subject was now in an advanced stage ; and that, withMr. Russell, he would do his best to carry the Bill through.From this assurance, and from the fact that various municipalbodies have expressed their approval of an amendment of thepresent laws relating to the matter, there seems every reasonto hope that it will not be long before the right to run self-propelled vehicles upon highways will receive legal sanction.It is a good augury for the movement that the Princeof Wales is taking an active interest in the question.Quite recently His Royal Highness paid a visit to the

Imperial Institute and personally tested some autocarsplaced in that building preparatory to the opening of an"International Exhibition of Motors (Motor Carriages,Cycles, &c.) and their Uses," which will be held at theImperial Institute from May 9th to August, 1896. At thisexhibition the latest developments of carriages whose motivepower is oil, steam, electricity, or compressed air will beshown and demonstrated as well as the practical applicatiorof motors to all kinds of vehicles. Another exhibition oj

great interest will, we understand, be held at the CrystalPalace during June (International Horse and Horselesl

Carriage and Roads Locomotion Exhibition), and it twillembrace the whole subject of road locomotion in ancient as-well as modern times.For horseless carriages to become generally popular with

individual owners they must present certain features of utilityand practicability which are perhaps not so necessary in thecase of a public conveyance. Mr. Claude A. P. Truman,L.R.C.S. Irel., &c., who is taking a great interest in thequestion, has written to us suggesting that the followingpoints are essential in an autocar for medical men : (1) itmust be moderate in price ; (2) light and handy; and(3) elegant in appearance. With regard to the first pointthe prices at present asked for these carriages will haveto be considerably lowered if they are to become universallypopular. From E180 to Z200 is too high a figure, but thereis reason to believe that the two exhibitions we have referredto will promote competition and reduce the prices to amore reasonable level. With reference to the second point,judging from the carriages we have already seen, therewill probably be little difficulty. That the carriages mustbe elegant in appearance goes without saying, and there isno reason why the conventional style of carriage shouldnot be modified and the assthetic combined with the useful.Until we have had an opportunity of examining a largernumber of vehicles it would be invidious to compare themerits of the few accessible motors on the market, but itwould appear that in point of speed the petroleum motorslead the way. Electricity and steam are also being used.as a motive power, and their relative merits will shortly,.we hope, be put to practical test.

ARMY MEDICAL REPORT FOR 1894.

(THIRD NOTICE.l)AS regards the army serving abroad we may say that,.

speaking generally, the health of the troops in 1894 was.good and that there was no severe epidemic or matter ofunusual importance to be chronicled during that year. At.

Gibraltar the death-rate was only 2’97 per 1000, althoughthe admission and constantly sick rates had somewhat..increased, as compared with those of the previous year andwith the similar average ratios for the preceding ten years.Enteric fever caused 26 admissions and 6 deaths, being inthe ratios of 55 and 1-27 per 1000 respectively. Otherforms of continued fever caused 112 admissions. Themedical officer of the station hospital considers that themilder and shorter cases differ in their etiology from thesevere and more protracted ones ; the latter, he believes,being due to some specific cause, such as drain effluvia.None of these cases, however, proved fatal, thus differingfrom cases of enteric fever, which in some respects theyresemble. At Malta, with an average strength in 1894 of’7911 (excluding the Royal Malta Artillery), the death-ratewas 5’81 and the admission rate 639’5 per 1000 respectively.Febrile and venereal diseases were the chief causes of sick-ness, but these were nevertheless less prevalent than usual.Enteric fever caused 42 admissions and 12 deaths, givingratios which are lower than those of the preceding year orthe average rates for the previous ten years. Dysentery wasthe cause of 24 admissions and 1 death. Under the head of

simple continued fever there were 834 admissions and4 deaths. At Gozo there were two epidemics of influenza.Altogether 126 cases of that disease occurred in the garrisonin 1894. There was some overcrowding of the barracks, butas about half the troops slept during the summer months.under canvas in their vicinity no injury to health couldbe traced to this cause. The new barracks at Imtarfawere not completed in 1894. Separate buildings forthe treatment of infectious diseases, and hospital accom-modation for the women and children, are referredto as important requirements for this garrison. We maypass over Cyprus, with its death-rate of 3’45 per 1000,with the remark that there was no case of eruptive feverin 1894 and enteric fever had not appeared since 1890,but there were 34 admissions from simple continued feverand only 1 case of ague in that year. There is nothingcalling for remark under the head of Canada, but as regardsBermuda the state of health of the troops stationed there

1 The First and Second Notices were published in THE LANCET ofFeb. 22nd and 29th respectively.

648

during 1894 and in previous years is not so good as it shouldbe. The climate is delightful during the winter and attractsmany visitors from the United States, and though hot andmoist in summer it is not unhealthy or apparently malarious.The death-rate from all causes in 1894 was 8’51 per 1000.Enteric fever is, however, far too prevalent in Bermuda. Itcaused 22 admissions and 5 deaths, being in the ratios of 15’6and 3 54 per 1000 respectively. St. George’s seems to havebeen the chief sufferer, where 10 cases occurred-all of severetype. We strongly suspect that either the method of storingthe water at this and other stations in Bermuda or the stateof the drainage in allowing of soakage into the soil(coralline formation) is to blame. The somewhat regularrecurrence of this fever and the liability to outbreaks ofit in different years-at St. George’s, for instance-callfor careful sanitary investigation, in view of determiningwhether its causes cannot be removed. At the Mauritius,with a strength of 583, the admission rate was 1301-9, thedeath-rate 1029, and the invaliding rate 20’58 per 1000 in1894, which are nevertheless an improvement on those of pre-vious years. Malarial fevers gave rise to 347 admissions and 3deaths, being in the equivalent ratios of 595 and 5’14 per1000 respectively. Of the total admissions under this head210 were from remittent fever, 136 from ague, and there was1 case of malarial cachexia. What a field this station and theWest Coast of Africa present for the study of malaria andthe microscopic examination of the blood for Laveran’s bloodparasite-the plasmodium and its varieties. The professionin this country would be glad to know what has been donein connexion with such ample opportunities as are affordedin this respect at these stations. The medical history ofthe Mauritius in regard to malarial fever is a somewhat

singular and striking one. The island used to be healthyand not exceptionally malarious, but many years ago quitean extensive epidemic of malarious fever and dysenteryoccurred and was very fatal, the death-rate was enormous,and since that time this fever has been much more prevalent,especially at Port Louis and along the seaboard. The troopshave of late years been to a great extent stationed in theuplands-at Curepipe-away from Port Louis. As regardsIndia the health of the troops serving in the three commandsis shown in the following table :-

A table at page 107 of the report shows the influence oflength of service in the country on the sickness, mortality,and invaliding, from which it may be gathered that the first

year’s service furnishes the highest admission-rate, theratios of succeeding periods gradually diminishing. The

highest ratio of mortality is among men in their first andsecond years of Indian service and lowest in their fifth, afterwhich it steadily rises. Venereal disorders, ague, and entericfever were the prevalent diseases ; the latter (enteric fever)caused 1069 admissions into hospital and 300 deaths in theBengal Army in 1894. The disease occurred in every districtand, with five exceptions, in every station in the command.At Umballa, where there were 68 admissions and 20 deaths,the medical officer considers the character of the water-

supply excludes water-borne typhoid as the explanation, andlooks to defective surface- and subsoil drainage, with a fouledstate of the soil, saturated with all kinds of impurities afterrain, for the origin of this fever. But the difficulty ofexcluding contaminated sources of water-supply and otherchannels of impurity outride the regimental lines comes inhere. Within the lines all may be sanitary, but outside themquite the contrary. Officers serving in India appear to beextremely liable to enteric fever, but children seem to be

relatively but little affected by the disease in that

country. We have in previous numbers of THE LANCETdealt with the remarkable outbreak of cholera at Lucknowin the East Lancashire Regiment, and need not, therefore,refer to it now.The general health of the troops serving in Egypt, both in

Cairo and Alexandria, during 1894 shows a marked improve-ment, and the mortality also was much reduced comparedwith the previous year, when almost all the troops, it isstated, had been but a short time in the country. The

report on the Egypt command is an interesting one, butinformation about events in 1894 possesses comparativelylittle value when published in 1896. The Appendix containsProfessor Notter’s report on the progress of hygiene for theyear 1895, which is always instructive, a list of operations atthe Royal Victoria Hospital, Netley, with remarks on someof the operation cases, and other papers, among which wemay refer to some interesting "notes" by Surgeon-CaptainRussell on " Revisiting the Medical Schools," and an articleon " Certain Forms of Injury to the Eye," by Surgeon.Major Simpson, M.A., M.B., derived from the results of hispractice while doing duty at the Royal Arsenal, Woolwich.

ELECTION OF DIRECT REPRESENTATIVEFOR IRELAND ON THE GENERAL

MEDICAL COUNCIL.

THE BRITISH MEDICAL ASSOCIATIONAND MEDICAL DEFENCE.

A GENERAL MEETING of the Metropolitan Counties Branchof the British Medical Association was held at 20, Hanover-square on March 2nd to discuss (1) The Relation of theAssociation to the Question of Medical Protection and

Defence ; and (2) The Relation of the Profession to MedicalAid Societies. Owing to want of time only the first questionwas discussed.

Sir WILLIAM PRIESTLEY, the president, opened the meet-ing by pointing out the great importance of the subjectunder consideration and the desirability of taking as wide aview of it as possible.

Dr. LOVELL DRAGE, after pointing out some great defectsin the organisation of the medical profession as a politicalbody, moved the following resolution : That in the opinionof the Metropolitan Counties Branch the time has arrivedwhen the Association should take up the matter of medicaldefence individually and collectively."

This was seconded by Mr. NELSON HARDY, who dwelt onthe necessity for immediate action and commented on thetardiness of previous councils.

Sir WALTBB FOSTER, M.P., said that in the past thecouncils had to deal with legal difficulties which within thelast few years had been removed, so enabling the memorandaof association to be altered to meet the present case muchmore easily than in former times.

Dr. DOCKRELL wished to clearly understand what wasmeant by medical defence, and proposed an amendment tothe effect that all legal disabilities should be got rid ofbefore taking any further steps in the matter. This amend-ment, however, after some debate was withdrawn.The resolution was then put to the meeting and carried

unanimously.Mr NELSON HARDY, seconded by Dr. ALDERSON, proposed

that a special general meeting of the British Medical Asso-ciation be called to consider alterations of the memoranda