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MIDWIVES’ REGISTRATION BILL.To the Editors of THE LANCET.

SIRS,-There is existing, more particularly in Liverpool,considerable opposition to any legislative action for insuringthe competence of midwives to deal with natural labour.For more than thirty years I have been endeavouring toameliorate the condition of midwives, and for many yearsthis endeavour has received the support of the whole medicalpress, of large and inuuentia.1 Societies, of the GeneralMedical Council, and Government. Now we are told thatall the time devoted to this object has been worse thanwasted, and that by attaining our end we should be damagingthe profession and injuring the poor. Dr. Bennett’s letter inyour last issue is a fair sample of the assertions and argumentsused by those who oppose the Midwives’ Registration Bill. Alarge amount of their opposition is, I believe, due to an incom-plete knowledge of the subject. For instance, Dr. Bennetttalks of the Bill adding " a horde of obstetric Gamps to ourRegister"; and adds, "for the sake of analogy, let us a ikhow clergymen would like every scripture reader andbible woman suddenly elevated to the Clergy List"? Now

anyone who has read the proposed Bill must know thatmidwives are not to be placed on "our Register," but on aspecial one of their own. There must be grades in every pro-fession, and the clergyman would never think of dispensingwith the help of the scripture reader because he was aperson of inferior education and position. Dr. Bennettalso says that in his experience he has found midwives"ignorant of the first principles of the art they profess."I ask Dr. Bennett what he would do with the hundreds ofignorant midwives now practising ? Would he abolish themor better them ? If the former, how would he do it ? Ifthe latter, what better plan can he suggest than the oneproposed in the amended Bill for the registration ofmidwives? I am, Sirs, yours, &c., Upper Wimpole-street, Nov. 1st, 1890. JAMES H. AVELING.

To the Editors of THE LANCET.SIRS,—The letter from Dr. Bennett in your issue of last

week requires some notice, if only for the party spirit itshows, and the fear that the mischief he thinks the Billmight do should carry to your readers the notion that thismischief will be done ; what the mischief is he does notexplain. I regret much the language of his letter, and theinsinuation it seems to contain that the medical men whosupport the Bill have an interest in its passing beyond thatof philanthropy. To take his own landmarks, our dutytowards the community forbids us to pass over in silencethe "horde of obstetric Gamps" who, as at present un-educated and uncontrolled, live on the sufferings of child-birth. We cannot suppress a class whose existence datesback to a time pretty well coeval with our own, and whoare recognised in all civilised countries ; therefore our dutytowards our profession is to see that the strides it is makingin obstetrics are not foiled (vide any statistics of deaths inchildbirth) in their practical application through the

ignorance of the midwife. She will exist as long as child-birth does, and all the Bill proposes to do is to see that shehas correct (if limited) knowledge, and that her practice isconfined to that knowledge, and to inflict penaltiesif she should trespass on the ground properly occu-

pied by the medical man, which cannot really-thoughin practice it does do so-include natural labour. I canstate of my personal knowledge that there is a real demandfor midwives in this district, where "cheap" doctorsabound; in country districts (when educated) they arehighly appreciated by medical men, and I do trust that thesomewhat incoherent outcries of a few members of our pro-fession will not be allowed to drown the groans of thehundreds of mothers who are yearly sacrificed on the altarof ignorance, merely because the officiating priestesseshappen to be uneducated midwives.

I am, Sirs, faithfully yours,Queen’s-crescent, N.W., Nov. 3rd, 1890. J. K, HUMPHREYS.

INTERNATIONAL CONSUMPTION OF MEAT.To the Editors of THE LANCET.

SIRS,-" M.D.," in your issue of Oct. 4th, says my systemof treating obesity is almost identical with that of Dr. Salis-bury. This certainly only applies to the first period.Dr. Butler’s pamphlet, "Hot Water as a Remedy," Salis.

bm’y’a method, was published by Simpkin, Marshall, & Co.,February, 188G. I treated myself in March, 1885, withstrict nitrogenous diet, largely diluted, finding my storedcarbon rapidly disappear, greatly to the benefit of mygeneral health. I got together some forty-two patients,who in time turned out equally satisfactory, and pub-lished the results, diet, &c., in the medical journals for theinformation of the profession. Experience has convincedme now that very obese people whose health and lives arethreatened can be safely reduced, and that the ruleshitherto laid down in dietetic works should be reconsidered.My friend, Mr. Yorke-Davies, was one who wrote stronglyon the danger to life of my system; he is now a completeconvert, and admits frankly his mistake. "M.D." wouldadd to the value of his letter if he would send to,THE LANCET Mr. Yorke-Davies’ system for the benefibof even obese medical friends. A short time back Iopened a book, "Index to Diseases," by T. H. Tanner,18GG, and on turning to obesity I find my system, andDr. Salisbury’s, forestalled, barring the diluent portion,so that in dietetics there is nothing new.

I am, Sirs, yours faithfully, Devonshire-street, W , Oct. 25th, 1890. W. TOWERS SMITH.

PRISON MANAGEMENT.To the Editors of THE LANCET.

SIRS,-As a member of the executive committee of theHoward Association, London, and as one having had a wideexperience in visiting various prisons, convict and local,allow me to say that I do not think that the association ofprisoners is carried out to any extent at the present time.Association in wards (in the infirmaries) is necessary andwise ; but my experience of the last twelve years teachesme that cellular association is very uncommon. I had anintimate knowledge of the largest and newest convict prisonin the kingdom-viz Wormwood Scrubs. The late governor,Capt. W. T. Harvey, being a personal friend of my own, Ivisited this prison at all times of the day. Cellular asso-ciation there was unknown.

I am, Sirs, your obedient servant,GEORGE RAYLEIGH VICARS, M.A., M.B.

Boston, Lines., Nov. lst, 1890.

VALUE OF THE INTRA-UTERINE STEM.To the Editors of THE LANCET.

SIRS,—My attention having been directed to a letter ofDr. Robert Barnes, in THE LANCET for Oct. 25th, I beg to,say that my spiral wire stem differs essentially from his(galvanic stem), which he would seem to imply is similar tomine. I may state that I never had seen Dr. Barnes’ wirestem before mine was designed; and the very purpose forwhich it was intended also differs from his. Mine is openat the point for drainage, is not so long, and has a flange abbase which makes it self-retaining, thus differing in threeimportant particulars from his.

I remain, Sirs, yours faithfully,- _ - _ _Dublin, Nov. 3rd, 1890. ALEXANDER DUKE, F.R.C.P.I.

LIVERPOOL.(FROM OUR OWN CORRESPONDENT.)

The Visit of H.R.H. the Duke of Clarence and Avondale.ALTHOUGH so large and important a city, the situation of

Liverpool places it out of the line of Royal visitors, Royalvisits being therefore few and far between. The recentvisit of the Duke of Clarence was looked forward to withinterest, and watched with much pleasure by a very largenumber of citizens of all classes. Besides giving eclat to allthe proceedings connected with the opening of the newinfirmary, the Prince’s visit was undoubtedly the means oflargely increasing the funds of the infirmary in the shape ofpurses presented to his Royal Highness. As was pointedout by more than one speaker, the annual expenditure of so,enlarged an institution will be greatly increased. Thoughextremely liberal by fits and starts, the public of Liverpoolhave yet to learn how to provide such an annual income asshall keep their medical and other charities free from debt.It is greatly to be wished that the opening of the infirmary

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may be the advent of a largely increased number of annualsubscribers.

Burial Clubs and Deaths from Drink.At an inquest held upon the body of a man who had died

from the results of intemperance the city coroner expresseda very strong opinion that club money ought not to be paidin such cases. There would probably be some difficulty, but,as clubs decline to pay for those suffering from venerealdiseases, the coroner’s suggestion possesses the merit ofbeing logical.

Bishop Byle and the New Infirmary.Soon after his arrival in Liverpool as its first Bishop the

Right Rev. Dr. Ryle was asked to preside at the opening ofthe medical school, and did so. Among other subjects onwhich he spoke was that of the infirmary, remarking that anew infirmary was even more imperatively needed than anew cathedral. There can be no doubt that the Bishop’sremark gave great impetus to the movement, which hadalready been incubating in the minds of the members of themedical staff and of others, for it was not very long afterthat the committee of the infirmary began seriously todiscuss the question of a new building. It is the morenecessary to do this justice to Bishop Ryle for two reasons.It was magnanimous on his part to advocate a new

infirmary before a new cathedral, the cathedral church ofSt. Peter being even more hopelessly ugly, both inside andout, than the old infirmary. Again, his lordship made onthe same occasion a remark which attracted much atten-tion at the time, and tended to detract from the other andwiser one. This latter was prophetic, the new infirmaryhaving been completed at a total cost of £170,000, while thenew cathedral is as yet in the far future.

The Medical Institution.The opening of the Medical Institution on the 9th ult.

took place under most favourable auspices. The president,Mr. Mitchell Banks, took a somewhat new departure,making the occasion one of pleasant recreation rather thanof a scientific display of microscopical specimens &c., ofwhich there will be a liberal supply for the next six months.The only professional subject introduced was the President’saddress, an abstract of which appeared in TnE LANCET ofthe lst inst., though erroneously given as the address tothe medical school. There was of course no discussion, buta cordial vote of thanks was accorded to the President.After this the members, who were all in evening dress, pro-ceeded to the upper part of the building, where, withvaluable etchings on the walls, lent by the president andother friends, with light refreshments, enlivened by someglee singing, a most agreeable evening was spent.

The Dedication of the New Infirmary Cha ,pel.On Sunday, the 2nd inst., the Chapel of the New Infirmary

was opened with a dedication service by the Lord Bishop ofthe diocese, assisted by the chaplain, the Rev. WilliamSmith. The chapel is a very handsome one, containing abeautiful organ, the gift of Mr. James Barrow. The staff ofthe infirmary, with ladies and gentlemen who had beeninvited, made a good congregation. A short service, con-sisting of part of the morning prayer, a special psalm,special lesson, and two hymns preceded the sermon, whichwas preached by the Bishop from the text, Acts x , v. 38,"Who went about doing good."Liverpool, Nov. 3rd.

NORTHERN COUNTIES NOTES.

(FROM OUR OWN CORRESPONDENT.)

Nitric Acid Poisoning.A CORRESPONDENCE has arisen out of the unfortunate

disaster to the three firemen at Messrs. Mawson and Swan’s ’,as to the proper treatment in nitric acid poisoning. Correspondence between medical men in newspapers as to itreatment is not as a rule edifying, but there may beexceptions, and I think this last is a case of that kind.Mr. T. H. Walker, surgeon and F.C.S., of this city, andanalyst for Carlisle, writes to point out that the deaths oftwo of the firemen were undoubtedly due, not to nitric acid,but to nitrous fumes which were generated by the action ofnitric acid on the sawdust (in which the bottles were packedand broken). These fumes, he says, are very deadly.’They combine with the haemoglobin of the blood-corpuscles

to form methæmoglobin, changing its colour from red tobrownish yellow (exactly as is the case when an overdose-live to ten grains-of nitrate of soda is taken). Mr. Walker isquite certain that the treatment adopted by the medicalmen in attendance on the firemen was the correct one-viz.,the inhalation of oxygen &c.; for when the corpuscles,whose function it is to absorb oxygen from the air andcarry it to the tissues, were partly destroyed, and thepatients were dying from inability t) obtain sufficientoxygen, obviously the rational treatment was to supplythe deficiency.

Death by Lead Poisonind at Blyth.An inquest has been held at Blyth on the body of a

child aged three years and a half, who died from con-vulsions. It was shown at the inquest that the deceasedhad been suffering from lead poisoning received throughdrinking "herb beer" drawn through lead pipes. Therelatives are retailers of herb beer, of which they regularlypartake; and last month the father of the deceaseddied from lead poisoning-as noted in this correspondenceat the time. The lead pipes were immediately cut off, andhad not been used since, but it appeared that the childhad previously absorbed sufficient of the poison to act fatally.Mr. Crombie of Blyth, who had attended the father, alsoattended the child throughout the illness, and gave evidence.

The Outbreak of Typhoid Fever on Tees-side.Dr. Ba.rry, the commissioner appointed by the Local

Government Board to inquire into the prevalence of entericfever in the Tees districts, met the Darlington Town Councilto report to them the result of his investigations, anddetailed what he had seen, and he gave statistics to showthat fever broke out wherever Tees water was used. Hementioned many places where sewage entered the river, butat Barnard Castle and neighbourhood it entered wholesale,and laid on the foreshore a slimy black mass, which wasswept down in the flood-time and polluted the river. Thisevil, he said, from Barnard Castle sewage had greatly in-creased in the last five years. Formerly there was a weirthere, which kept the water high, and the sewage was insolution, and did not come away altogether at flood-time.Dr. Barry considered that this was one of the clearest casesof fever outbreak from using polluted water that he everhad to do with. He also made certain recommendations asto the draining of ash-pits, condemning their present con-struction.

Stockton and Middlesbrough : abatement oj the Fever.At Stockton, the medical officer of health, Mr. Clegg, has

reported a considerable abatement in the epidemic oftyphoid fever during the last bwo weeks, there havingbeen twenty-seven cases of typ’.ioid and five of continuedfever, as compared with sixty-ven cases of typhoid andtwenty of continued fever in the previous fortnight. At

Middlesbrough, also, the medical officer of health, Dr.Malcomson, has reported a subsidence of the epidemic.

Sunderland : Death of Mr. James Smith, Surgeon.Mr. James Smith, one of the oldest members of the pro-

fession in Sunderland, died at his residence in Bishop-wearmouth on Thursday, Oct. 30th, in his seventy-secondyear. Mr. Smith, who was L.R.C.S. and L.R.C.P.Edin.,came at an early age to Sunderland from Duns, in Scotland,and commenced practice in the Monkwearmouth district,where he acquired a large general practice. About sevenyears ago he retired in favour of his son-in-law, Dr. Strachan.two of his sons are also, I believe, in the profession.

Bequests to Newcastle Charities.Under the will of the late Mrs. Margery Fenwick of

Whitley the following institutions have been benefited :-Royal Victoria Asylum for the Blind, Newcastle, £100;Northern Counties Institution for the Deaf and Dumb,£100 ; Northern Counties Institution for Boys, £50;Northern Counties Institution for Girls, £50; Royal In-firmary, £100 ; Homes for Girls, Whitley, X150; Con-valescent Home, Whitley, £100.

Alnwick: Complimentary and Farewell Dirzner toDr. Candtislt.

Dr. Candlisb being about to retire from practice inAlnwick, in which town he has worked for thirty years, hismany professional and other friends decided upon enter-taining him at a public dinner, which took place last weekin the principal hotel at Alnwick. Over seventy guests sat