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to the very dregs the heady cup of politics. Official

responsibilities were thrust upon him at an early ageand at an early stage in his political career, while he con-tinued to double with the life of the statesman-not that ofthe ordinary statesman, but of the stormy statesman-thelife of the great nobleman and the man of pleasure, sport,and fashion. Eaily success prompted him to over-effort, agteat and unexpected check caused him to redouble thoseefforts, and the result of it all was ruin to his nervous consti- I

tution. No political leader of recent times, not even LordBeaconsfield, has had a more personally afEectionate followingthan Lord Randolph Churchill, and we believe that it will bea solace to his admirers to learn that during the end of hiscareer the hand of sickness was upon him, so that in consider-ing his claims upon their admiration, they must in justiceto the sound man neglect the failings of the sick man.

THE spring term of the London Post-graduate Course willcommence on Feb. 4tb, and will last eight week?. Inaddition to courses on General Medicine and Sargery, therewill be courses on Diseases of Children, Diseases of theNervous System, Diseases of the Eye, and Diseases of theSkin, Throat, and Ear, and Bacteriology. The fees are £1 ls.and ;f2 22s., according to the number of lectures in a course ;and we are requested to state that a prospectus can beobtained from the Secretary, Dr. Fletcher Little, 32, Harley-street, W., who particularly desires to hear promptly fromgentlemen intending to join the classes.

THE committee which has been appointed by the ClinicalSociety of London "to investigate the clinical value of the anti-toxin treatment of diphtheria " is now definitely fixed upon. Itconsists of Dr. Church, Dr. Stephen Mackenzie, Dr. Coupland,Dr. Hale White, Dr. Pasteur, Dr. Sidney Martin, Dr. Wash-bourn, Dr. H. P. Hawkins, and Dr. E. W. Goodall ; and wecan well believe that the profession will await with interestthe joint report of individuals so well fitted to express a

practical as well as a scientific opinion. Sir Joseph Listerwas invited to join the committee, but was unable to accedeto the request of the society.

OWING to pressure on our space we have been compelledto postpone the continuation of our report of the IndiarMedical Congress until next week.

DIFFICULTIES UNDER THE INFECTIOUSDISEASE (NOTIFICATION) ACT.

II.1

2. Nature of the visit by the Medical Officer of Health.THE medical officer of health having decided that a

personal visit by himself is desirable in a given case ofinfectious disease of which he has become aware, whetherunder the Act as to notification or otherwise, the question Iarises as to what should be the nature of that visit. This

question has given rise to much difficulty and at times tomisunderstanding and even ill-feeling.

In the first place it should be remembered that a medicalofficer of health has absolutely no 7’i!Jht, in virtue of hisoflice or under the Orders relating to his duties, to enter

on any private premises. It is true that under Section 102of the Public Health Act, 1875, it is enacted that the officersof the sanitary authority "shall be admitted into any pre-mises for the purposes of examining as to the existence of anynuisance therein," but the section contemplates the refusal toadmit these officers even for the limited purposes specified,and it is only when a magistrate has, after certain formalities,

1 Part I. was published in THE LANCET of Jan. 19th, 1895.

granted an order of admission that the actual right of entryis acquired in such form that it can be enforced. For thisreason it is always desirable that permission to inspectpremises should be asked, and, so far as we know, this

permission is rarely or never refused when the inspection inquestion is limited to what is commonly included under theterm "premises." When it becomes a question of enteringprivate apartments, and especially sick chambers, thenthe matter stands on a somewhat different footing. Tothis point we shall refer later, but for the moment

it may be accepted that the ordinary courtesies of lifeare nearly always quite sufficient to secure inspectionof premises on which infectious disease has occurxedwith a view to " inquire into the causes and cir-cumstances of such outbreak," and of advising "the

persons competent to act " as to what may be required toprevent the extension of the disease," as also of enablingthe medical officer of health to " take such measures for the

prevention of the disease as he is legally authorised to take." IThe contention that it is necessary to extend such visit, tothe sick chamber has generally been raised in connexion witha visit by the medical officer of health to the sick personconcerned ; but there have been cases where the two

questions have been dissociated, and we, therefore, deal withthem apart. 01 the question as to a visit to and examina-tion of the sick-chamber itself it has been held bythe Local Government Board that, whilst the particularcircumstances of the special case must decide whetherit is necessary to the performance of the duties quotedabove from the Order of March 23rd, 1891, that the medicalofficer of health should have access to a particular room-namely, the sick-chamber,-" in the majority of instances inwhich cases of infectious disease are notified there is no needfor a medical officer of health to personally inspect theapartment for the treatment of the sick person, and that inthe remaining instances where such visit may become neces.sary it should be remembered that, apart from cases to which

Section 102 of the Public Health Ac’-, 1875, may be applic-able, this can only be done with the consent of those havingcharge of the patient and that the cooperation of the medicalpractitioner in charge of the case should be secured if

possible." In other words, unless it is believed that there isl " nuisance " in the sick chamber and that the cause of thedisease is in some way concerned with that chamber, the

medical officer of health has no duty under the Order of theLocal Government Board and no right under the statute tainspect that chamber.

2 See Order, March 23rd, 1891.

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of letters which have emanated from the Local Government

Board medical officers of health have been urged not to forget"the customs that usually govern the relations of medicalpractitioners to each other." This, indeed, is the one meansby which, above all others, difficulties arising under the Actas to notification can best be avoided.

It has, however, been asked whether a medical officer ofhealth ought not always to assume that, in the sick chamberof a person notified to be suffering from infectious disease,there is something of the nature of a "nuisance" whichdemands his entry and inspection. Such a view is an

- sitremely strained one. We doubt if any magistrate would,on evidence limited to the existence of a case of infectiousillness only, ever grant an order of entry under the PublicHealth Act ; and it is evident that the Local GovernmentBoard take the same view. Thus, in a letter written by them,it is stated "that the Board do not regard the existence ofevery case of notified infectious disease as necessarily in-volving reasonable cause to suspect the existence of a

nuisance on premises such as is contemplated in Section 102 Iof the Public Health Act, 1875." "

But the point that has caused most discussion and troubleas been the practice of some medical officers of health tovisit and examine the sick person. Some seem to have donethis as a matter of course in the performance of their regularduties and quite apart from any special reason in the indi-vidual cases ; others, again, have done it by way of satisfyingthemselves or the authority whom they serve as to thecorrectness or otherwise of the certificate of notification.Those who have adopted this course as a matter of habitualpractice have in certain instances contended that it was theirduty so to do. Such was certainly never the intentionof the Act relating to notification, and this is the more,obvious because no increase of salary to the health officerwas made one of the conditions of the adoption of that Act ;although it is evident that if the medical officer of health wasexpected to visit every person notified to be suffering frominfectious disease his duties would become very largelyincreased. And, in answer to appeals made to the LocalGovernment Board on that point that department has againand again announced that "they do not consider that eitheithe Infectious Disease (Notification) Act or any Order of theBoard imposed upon a medical officer of health any obliga-tion to visit each case notified to him under the Act " ; andthey have further reminded authorities that any such

examination can only be made with the consent of the?atient or of those having charge of the patient," and thatsuch a practice is not only no duty of the health officer, butthat it is, as a rule, "undesirable."There may, however, be exceptions which may call for

departure from the general rule that it is undesirable that themedical officer of health should in virtue of his office makEa personal examination of a patient, and two of thes(

exceptions have been recognised by the central authorityBoth of them apply to special cases only. The first exceptiorhas to do with certificates that are assumed to be fraudulentIn such cases the medical officer of health doubtless has a

duty towards his authority, and however much he may regre,o perform an unpleasant task it cannot be held that he act!

improperly if he protects his authority against that which ibelieved to involve a breach of good faith on the part of thcertifier. The views of the Local Government Board as to

Ais are set out in several letters, one of which w

quote in full because it also explains what are th

special precautions which should be adopted in visitin, patient with a view to revise the diagnosis thahas been made in the notification certificate. Th

better, which was addressed on Oct. lst, 1890, to th:own clerk of Bolton, is as follows : It appears to tbBoard to be undesirable that the medical officer of healtshould in general undertake a personal diagnosis of tl:

notified cases in order to test the accuracy of the certifi-cates. In some cases, as where there is reason to doubtthe good faith of the certifier, or where the disease is onewhich, in itself or owing to the attendant circumstances,threatens exceptional danger to the community, it may bedesirable that the medical officer of health should make a

personal diagnosis; but it must be remembered that thiscan only be done with the consent of the patient, or thosehaving charge of the patient, and that the medical practi-tioner in charge of the case should always be communicatedwith and his cooperation secured if possible." But wantof good faith is not to be assumed merely because themedical officer of health doubts the accuracy of the

diagnosis. Quite the contrary, for as the clerk to the

Foleshill rural authority was informed by the Local Govern-ment Board on March 12th, 1892, 11 the certifier’s statementof the nature of the disease should be accepted unless thereis strong reason to believe that he is not acting in goodfaith."We have heard of instances in which the medical officer of

health has allowed himself to be habitually used by hissanitary authority as a reviser of notification certificates.Such action is naturally resented by his fellow practitioners,and it distinctly lowers the status of the health officer. If itcan be more objectionable in one class of official than inanother, it is so in the case of medical officers of health whoare themselves in general practice, and who thus lay them-selves open to the accusation that they are "competitors"for practice. Happily such action is rare, and we trust itwill cease altogether.The Foleshillletter refers to another class of cases-namely,

notifications announcing or indicating the existence ofdiseases which " threaten exceptional danger to the com-munity." Thus a first notification of cholera or of typhus feverin a district where no such disease has for some time past beenknown to exist may not only justify but may necessitate apersonal inspection of the sick person for the purposes of con-firming the diagnosis with a view to the adoption of excep-tional measures of prevention. In such a case the object of thevisit would solely be to enable the medical officer of healthto advise his authority as to the needed administrative action,and not for the mere purpose of testing the accuracy of thediagnosis. Under such circumstances the visit should be paidjointly by the medical officer of health and the medical

practitioner in attendance, and the ordinary rules followedin consultations should as far as possible be observed.Similar necessity may arise when a group of notifications underan indefinite heading, such as "continued fever," eithergives rise to a suspicion of typhus fever or fails to indicate tothe medical officer of health what are the measures of pre-vention which it is his duty to advise or carry out. If by

any chance, in these and similar cases, the medical practi-tioner should, notwithstanding that the ordinary courtesies

of professional life have been observed, decline assent to thehealth officer’s visit, then it may well happen that the latter, may properly hold that his duty towards the public requireshim to secure, if possible, a personal inspection of the sickj person. But even then he cannot demand it; the visit can3only be paid with the consent of the sick person or of those3 in charge of that person ; and it will be more than everdesirable that the visit should be paid under such condi-

tions as to avoid all possible complaint on the part of thee several persons concerned. As a matter of fact, continuouse obseivance of official courtesies in all branches of the duties

5 of the medical officer of health should in themselves sufficet to prevent difficulties from arising in such a case as we havee described.e Summarising the points thus far adverted to, it may bee laid down : 1. That the question of a personal visit by theh medical officer of health is a matter to be decided by thee medical officer of health, he being the judge as to what

242

constitutes an "outbreak" for the purposes of the Order

relating to his duties. 2. No duty attaches to a medicalcfficer of health to "visit ......the spot " in every case ofnotified disease. 3. When he deems it his duty to paysuch a visit he should remember that, apart from a

magistrate’s order, he cannot claim a right of entry toany premises, and that both as regards the occupier and themedical practitioner in attendance their voluntary coöpera-tion should be sought. 4. That the existence of a case ofinfectious disease in a given apartment cannot be deemed tomean the probable existence of a nuisance in that apartment ;and that a medical officer of health should not thereforeclaim a right of entry on such grounds. 5. That themedical officer of health has no right to inspect patients,that such inspection is as a rule very undesirable, andthat it should not be contemplated, even when it is

necessary, except after communication with, and if possiblein co-operation with, the medical practitioner in attend-ance on the case.

(To be continued.)

A TEACHING UNIVERSITY FOR LONDON.

ON Tuesday last the Prime Minister received three deputa-tions, who laid before him their views on the Gresham

University scheme. One, the first, was composed of the

representatives of the bodies within and without the existingUniversity of London not in favour of the adoption of thescheme, and it will be seen that King’s College has comeinto line with the other important educational bodies ofLondon. The other two deputations represented thegraduates of London University desirous of maintaining the Imperial characters of the University," and the GreshamScheme Amendment Committee. These two deputationswere received together as jointly opposing the Greshamscheme, though upon several grounds.

The Depuatation in favour of the Scheme.The deputation included the Right Hon. T. H. Huxley,

Professor Rucker, and Sir Henry Roscoe (representing theProfessorial Association) ; Sir John Russell Reynolds, Bart.,and Dr. Allchin (representing the Royal College of Physiciansof London) ; Mr. J. Whitaker Hulke (representing the RoyalCollege of Surgeons of England) ; Sir John Eric Erichsen,Bart., and Sir George Young. Bart. (representing UniversityCollege) ; Rev. Prebendary Wace and Sir William Priestley(representing King’s College) ; Sir Julian Goldsmid, SirWilliam S. Savory, Bart., and Mr. Anstie, Q.C. (representingthe Senate of the University of London) ; Professor SylvanusThompson (representing the Committee of Graduates) ; andDr. Frederick Taylor (Guy’s Hospital), Dr. Sidney Coupland(Middlesex Hospital), Mr. Hutchicsoo, jun. (London Hos-pital), Dr. Payne (St. Thomas’s Hospital), Mr. Herbert Page(St. Mary’s Hospital), Mr. Spencer (Westminster Hospital),Dr. Isambard Owen (St. George’s Hospital), Dr. Shore (St.Bartholomew’s Hospital), and Mr. Stanley Boyd (Charing-cross Hospital). Representatives of other educational andscientific institutions of the metropolis were also present.

Professor HUXLEY, in introducing the deputation, said thatin a matter of this kind the general feeling on educationalmatters in London would naturally be led by the Universityof London. The deputation represented the University,its Senate, Convocation, and graduates ; in addition, all theprincipal London colleges, the great medical corporations,the medical schools, and several important provincialinstitutions were also represented. Finally, an associa-tion including practically all those engaged in science(of which he had the honour to be president) was alsorepresented there in his person. He then referred sympa-thetically to the domestic reasons which bad prevented theVice-Chancellor of the University, Sir James Paget, fromintroducing the deputation. The ideal of a university, Pro-fessor Huxley considered, ccu1d not be subject to more

divergent views than must the best nractical manner of givingreality to any ideal under the circumstances which obtainedamong the educational institutions of the metropolis, whichbad grown up, as it were, spontaneously and without plan.This was not the fint time that some attempt had been

made to introduce order into what, without disrespect, bethought he might almost term chaos. Sixty years ago theattempt was made, and although what the projectors ofthat scheme desired was not eventually granted to them

they obtained a something, which had undoubtedly provedto have had an immense influence upon the progress of

general and professional education and to have done a vastamount of good work. But it was not what the original pro..posers wanted, which was to have a teaching and learningcorporation; that which was eventually established was a,purely examining body-the present University of London.The question of the position of educational affairs in Londor.,had been under much discussion. Since 1888 two Royal Commissions had occupied themselves with it. They had devotedan immense amount of labour, time, and acumen to thc-consideration of enormous masses of evidence, and he thought.that it would be probably impossible to devise any opinionupon that topic which had not been before the CommissionsThe report of the second Commission was admitted to bL-thoroughly comprehensive, well matured, and weighty, and.their principal business there that day was to say that, inprinciple, they accepted the recommendations of that Com-mission, and asked that they might be carried into effectwith as little delay as possible. At a full meeting of the-’University of London, held in July last, it was resolved to.be desirable to memorialise Government to take immediatesteps for the appointment of a Statutory Commission taframe statutes in accordance with the representation of-’the Gresham Commission, with power to make such modi-.fications as may seem to them expedient after considering-any representations made to them by the Senate, Convoca.tion, or any other bodies affected ; and that resolution was.not only carried in a very full meeting with only two dis-sentients, but similar resolutions had been passed by the.body of delegates referred to in the report of the Commission.and by the association of which he had the honour to bepresident. Whatever modification a particular body mightdesire, all were of one mind in desiring two things : (1) hbe-formation of a University of London as an organic wholeby the voluntary cooperation of the various institutions forlearning, teaching, and examining, and (2) the appointmentof a statutory authority as the indispensable instrument for

‘

effecting the organisation.Sir JULIAN GOLDSMID briefly supported Professor Huxley

and said that under the Gresham scheme the existing,standards would not be lowered.

Dr. ALLCHIN said that the Royal College of Physiciansin London cordially concurred in the recommendations ofthe Gresham Commission, and earnestly hoped that a

Statutory Commission would be appointed forthwith to giv&Effect to them. At the same time the College fully sym-pathised with the desire expressed by the various institu-tions referred to in the scheme, and who had signifiedapproval of it, that the Statutory Commission shouldbe empowered to make such modifications in detailas might appear desirable after hearing the representa--tions of the bodies concerned. The College was im-pressed with London’s need for a teaching university,in which the teachers should have a direct and considerableshare in the management, so that the higher instruction might,be coordinated and brought into line with the examinations.The Royal Colleges of Physicians of London, and of Surgeonsof England, were not primarily educational bodies, and thesuccess of the new University on the lines proposed wouldbring them disadvantage in pecuniary position and in.influence within the medical profession, for at present theyexamined and qualified the great bulk of the practitionersof England and Wales, while if the new University were con-stituted a far larger number of medical students would take-University degrees, and consequently fewer would take thediplomas of the Conjoint Board. Nevertheless, so impressed.were they with the necessity for the new University that theyurged his lordship to consider it pressing. In one otherrespect the College occupied a peculiar position. In view oftheir long experience and perfection of arrangements forconducting highly technical examinations they claimed to be-associated for examination purposes with the new University.The claim had been recognised by the Senate of the LondonUniversity and by the late Royal Commission. He was.

instructed further to submit that if the Government con-

sented to the appointment of a Statutory Commission some-one thoroughly conversant with the relations of the Collegesto each other, to the medical schools, and to medicaleducation generally should be appointed to the Statutory