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commission and members of the honourable and useful

profession of medicine. I had good opportunities of

observing the attitude of many combatant officers towardsthe medical officers, and it passes my comprehension howEnglish gentlemen of liberal education can allow themselvesto entertain ideas not only antagonistic but of positive,persistent hostility to an unoffending and most useful

department of the army. I can only characterise suchan attitude as unworthy of the profession of arms, as

ungenerous to a degree, and as one reflecting anything butcredit on officers who without just cause attempt to ostracisethe Army Medical Staff. I venture to predict that just sosurely as the volunteers have lived down and overcome theprejudice against them so surely will the medical staffreceive their just meed of official appreciation in due time.In the colonies, while we lack much that you have in

England, yet I am thankful to say we are free from un-

reasoning class prejudices. In Australia the medical officers

enjoy substantive rank and equality with combatant oflicers.The same may be said of Canada, where the most cordialgoodwill exists between all departments of the service.What strikes one most forcibly regarding the medical pro-fession in Canada is its high social and political standing.The House of Commons of Canada, the provincial Legis-latures, and the Senate contain many medical representatives.Medical men have been members of many of the cabinets.Dr. Schultz was Governor of Manitoba. Twice medical menhave been prime ministers of Canada, Sir E. Tache in 1856and Sir Charles Tupper in 1896. Now, as incredible as it

may seem to some officers of the army at home, a surgeon-lieutenant-colonel, Dr. Borden, has been made Minister ofMilitia and Defence, a corresponding position to that of

Secretary of State for War. I sincerely hope that the timeis not far distant when a fair share of official, as well ofpopular, approval will be meted out to the Army MedicalStaff. I am, Sirs, yours truly,

A COLONIAL OBSERVER.

HYDROPATHIC ESTABLISHMENTS ANDTHEIR PHYSICIANS.

To the -Editors of THE LANCET.

SIBS,—Dr. Leslie Phillips, in his paper on Medical AidAssociations recently reported in your columns, made someallusions to the employment of medical men in connexionwith hydropathic establishments. I am glad to see that heis of opinion that such employment does not necessarilycome under the heading of unprofessional conduct, but

hardly agree with him as to the feasibility of certain sug-gestions which he makes as to the proper method of remu-neration in such cases.As I have for six or seven years held appointments in

connexion with well-known and-perhaps I may add-well-conducted hydropathic establishments, my opinions as towhat is, or is not, practicable ought. I think, to carry someweight. Dr. Leslie Phillips suggests that in rural districtsthe requirements of medical ethics will be met, and the

charge of "farming" one’s services avoided, by providingthat the medical officer be not the salaried officer of theestablishment but receive all the fees earned by his skill.Xow what I wish to point out is that this arrangement,excellent as it appears at first sight, would in manycases be far more objectionable than the system it isintended to supersede. As a matter of fact it mayvery well happen - does, in fact, happen-that themedical officer of a given establishment receives, andproperly receives, considerably more than the amount heearns for the company in the shape of fees. The advan-tages of having a properly qualified medical man attachedto the interests and more or less responsible for the conductof a hydropathic establishment are by no means adequatelyrepresented by the sum paid for consulting him by those ofthe visitors who are also patients. The same advantagescould not be secured by paying a local practitioner to visitthe establishment at stated hours or by handing over to himthe amount received in fees, nor would it be to the advantageof an overstocked profession that such an arrangementshould be insisted upon in every case, even if it could beenforced. Those who in search of healthy surroundings andappropriate treatment are about to visit a hydropathicestablishment will naturally give the preference to such asare known to maintain a resident physician, and such beingthe case it is obvious that the whole profits derived from the

presence of such invalids in a given hydro. are in a senseattributable to the presence of the physician. How, then,can it be contended that the surrender of the consultationfees is a sufficient recognition on the part of the pro-prietors of the value to their institution of the socialand professional qualities of a resident physician? Itis further to be remembered that there are duties of’

organisation and instruction arising out of the employ-ment of a staff of bathing attendants, masseurs, nurses,&c., which can only be properly discharged by a

qualified medical man and which certainly will be ad-vantageously discharged by one who is either in resi-dence or otherwise identified with the inner working ofthe establishment. Constant supervision is also necessaryif the treatment is to be properly carried out, and who but aqualified medical man is competent to do this ? Althoughchronic cases are certainly much more frequent than cases ofacute illness in these institutions, it does commonly enoughhappen that these are of a sufficiently severe character torequire very close attention on the part of the medicaladviser, and in cases of emergency (which are by no means.rare or necessarily trivial) much invaluable time may belost in calling up an independent and presumably busypractitioner if there is no responsible official on the spot.Again, it may happen that the establishment is situatedin a place so thinly inhabited as to afford practicallyno opportunity for private practice outside its walls. Sucha situation may nevertheless be pre-eminently suitable froma hygienic point of view for a health resort, but it would beabsurd to expect that a medical man of any standing wouldnecessarily and from the outset receive from the visitor’s feesalone enough to enable him to keep up a separate ménage,although it might be well worth the while of the proprietorsto provide him with accommodation and to pay him as aresident a moderate stipend. In such a position, if he

perform his duties in a proper spirit and with a due senseof responsibility both to his employers and to the profession,he will find nothing derogatory to his honour any more thanin the conduct of an ordinary practice, a fact which has beentacitly admitted by the recognition accorded to his class bymodern medical opinion. It is in every way to his advantagethat the commercial and hotel department should be inother hands than his own, and the fact of his receiving afixed salary which does not necessarily depend upon thenumber of patients in residence but upon the general valueof his services, is favourable rather than the reverse to hisscientific and professional integrity.

In approaching a difficult and complex question of this kindit is above all things necessary to preserve a thoroughlyrelative standpoint and to avoid the mistake of applying to.an essentially modern set of conditions rules which were

passed for the guidance of ordinary practice in earlier andsimpler times.

If in questions of this kind absolute hard and fast rulesare prematurely laid down the inevitable result will be thatthey will prove impracticable and will be rejected by theconscience and the common sense of the profession. Andthe cause of ethical reform and professional unity will thusbe injured by the very means intended to promote it.

I am, Sirs, yours faithfully,Aug. 3rd, 1896. EXPERIENCE.

BIRMINGHAM.(FROM OUR OWN CORRESPONDENT.)

Cremation v. Burial.AT a recent meeting of the King’s Norton Rural District.

Council the General Purposes Committee recommended thatthe council should take all necessary proceedings to obtainpower to establish and maintain crematoriums. The pro--position was carried by five votes against four. Some interesting facts were adduced in support of the proposal. Itwas stated that in Birmingham and the surrounding districtthere is a population of 800,000, and that the provision forcremation could be made for two places at a cost of between.64000 and £5000. The practice has many arguments in itsfavour, though but little headway has been made in thereception of these by the public. In the congested state ofour towns, and the rapidly increasing growth of the popu-lation, existing prejudices will probably yield in the courseof time. Theological doubts and difficulties prove an

effectual barrier to the adoption of these views among many,.

414 T

and the reasoning of science and utility will find it hard to e:

break down so strong a resistance. o

11 Chocolate Chumps." 0

Under this designation a pernicious form of sweetmeat has pproved attractive to the young, unfortunately resulting in the pdeath of a little girl aged eleven years who had freely partaken

e

of this deadly dainty. In the investigation by the coroner t

for South Staffordshire the analyst stated that he found the h

three ounces of sweets submitted to contain 29½- grains ofparaffin wax which was absolutely indigestible. In viewof the fact that these sweets were eaten after a repast r

of pork-pie there seems to be no surprise that the verdict of fthe jury was death from peritonitis, in all probability caused Iby the paraffin wax in the" chocolate chumps." Thus in tthe pursuit of pleasure death lurks among the innocent and victims succumb readily to the allurement. t

The 2Ve?u General Hospital. (

The progress of this building has lately made rapid strides and anticipations of the opening functions are being indulged

l

in. It is hoped that by June, 1897, the building will be

sufficiently completed for occupation, and that this periodwill mark the time of a new era in the history of the charity.This hope is the more favoured since the occurrence of themusical festival in the following October will form another source of funds to which the authorities look for aid. In the interests of the sick poor any delay will be a matter for regret, and from a financial point of view protraction meansincreased expenses which can ill be afforded. A strong 1

appeal has yet to be made for the necessary amount to furnishand equip the building. Apropos of the area of land facingthe front of the building vigorous efforts are being made tosecure an open space. The corporation of the city, whilefeeling the desirability of this object, do not quite accept the responsibility of ceding the land they hold in trust onbehalf of the ratepayers. Some solution of the difficulty willprobably be found before the time comes for the permanentsettling of the question. The hospital committee will gladlywelcome a grant in their favour for this very laudable andalmost necessary purpose.

West Bromwich District Hospital.At the annual meeting of this institution recently held a

significant observation is embodied in the medical report.It regrets the increase in number of the out-patients, andpoints out that it had been a great tax upon the resourcesof the institution and was a sure indication that the charityhad been abused to a considerable extent. The number ofin-patients treated was 774. The number of out-patientswas 7834, against 7254 in 1895. In a district composedlargely of working men and their families, with trade

flourishing and wages high, the occurrence of a large attend-ance in the out-patient department is suggestive of otherinterests being displaced and of some explanation beingafforded.

Aug. 4th.

MANCHESTER.

(FROM OUR OWN CORRESPONDENT.)

Ancoats Hospital.THE annual meeting of Ancoats Hospital was held on

July 22nd, the chair being occupied by Sir W. H. Holds-worth, Bart., M.P. The report stated that though thework presented no very startling facts there had beena large amount of activity in all departments and the

in-patients continued to increase in numbers. There hadbeen 6316 accidents, and there was still an average of 16or 17 a day, many of which were serious and requiredimmediate attention. The home-patients numbered 2205,the out-patients 3713, the in-patients 1051, and the dentalcases 291. From the Hospital Saturday and Sunday Funds607 10s. had been allotted, and from the Workpeople’sCommittee 355 7s. During the year a legacy of .6600had been received from Mrs. Fraser, the widow of thelate Bishop of Manchester, one of 5000 from the late Mr.William Berry, and one of £500 from the late Mr. EdwardPinder, while the committee recorded with gratitude the giftof f.1000 from an Ancoats friend. There is a convalescenthome at Wilmslow which has been found to be of advantageto the women and children who had been inmates. Duringthe year f.1427 had been received from subscriptions. The

expenditure had reached .65307, which included a balanceowing to the bank of .61172, and there was now the amountof .6362 still due to the bank. The actual receipts for thepast year amounted to .B3988. The report contains an ex-pression of hope from the committee that in a short time anextension of the convalescent home at Wilmslow will enablethe men as well as the women and children to obtain thebenefit of pure air during convalescence.

Death from Sunstroke.Much sympathy is felt for Dr. C. J. Renshaw, of Ashton-

upon-Mersey, who has just lost a son twenty-one years of agefrom sunstroke. He was found lying insensible near a fieldpath, his breathing being short and jerky, and was removedto a neighbouring cottage, where he died the same evening.Sunday, July 12th, was one of the very hot days we have hadthis summer. Dr. Herbert Renshaw of Sale, whose help wasobtained, said there were no symptoms of opium or anyother form of poisoning, and in his opinion death was causedby heat apoplexy or sunstroke, and a verdict to this effectwas returned.

Suicide of a Nurse.The recent suicide of a nurse at the Pendlebury Hospital

raises some questions worth consideration. It appears thatshe inhaled chloroform, was partially restored, but relapsedand died. During a short period of consciousness she saidsomething to the effect that the work and the sense ofresponsibility were more than she could bear. There is agreat rush for the nursing career among girls of the middle,and in many cases of the upper-middle, class from all sortsof motives. Many of them have been brought up withoutany very definite aim and find their home lives, as they thinkor fancy, empty, frivolous, or in some way uncomfortable.Some have a sentimental idea that they could more willinglygive to sick strangers the kindly and somewhat wearyingattention required by their own kith and kin. Others take tonursing from straitened circumstances and courageouslydetermine to get their own living. A few have been "crossedin love," but one and all they dream that a life spent innursing sick humanity will be a panacea for all their real orimaginary troubles. The physical labour and the long hours,even in these days of lawn-tennis and cycling, are too muchfor some of them to stand for any long period, and, coupledwith actual contact with disease in its realism-robbed ofall romantic associations-soon break down their strengthboth of body and mind. Suicide is happily rare, and withgood health and its accompaniment, good spirits, manynurses, perhaps the majority, enjoy their hospital work andlead happy lives. These young ladies have frequently beendelicately and tenderly brought up, and some of them areill fitted for their vocation. For their own sakes, as well asfor the sake of the patients, it is desirable that admissionto the calling of nurse should be prefaced by a stricter andmore careful consideration of their fitness both as to physicalstrength and mental qualities than is sometimes the case at

present. A nurse equal to her work, sufficiently sensible ofher duty and of the responsibility of her calling, is worthyof all respect and even reverence, but there is no room forthose who look upon nursing as a pleasant pastime, especiallyas it can be carried on in a costume so picturesque andattractive that its assumption by others than nurses is not avery rare occurrence. In many hospitals the nurses are

worked much too heavily, and if their work were a littleeasier it would be so much the better accomplished.

JULY 28th.

SCOTLAND.(FROM OUR OWN CORRESPONDENTS.)

University of Glasgow.THE University Commissioners, in the ordinances they

issued dealing with the conditions governing graduation inmedicine, left to the discretion of the authorities of thedifferent universities the enactment of various details deter-mining the amount of attendance required in classes treatingof certain special subjects. In pursuance of this responsi-bility the senate of the University of Glasgow, with the

approval of the University court, has now determinedthat each candidate for the degrees of M. B. and Ch.B.shall be required to attend: 1. Demonstrations in thepost-mortem room of a recognised hospital with instruc-tions in making post-mortem examinations ; not less