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sition would remain amongst the bulk of medical men.Certain am I that the public have but little objection, andthe poorer classes are fast becoming acquainted with thefact that a visit from the health authority, whether doctoror inspector, is in the character of friends, not policemen,and is meant for, and results in, benefit to them; and theyare thus slowly coming to understand and appreciate someof the elementary laws pertaining to health and hygiene.

I am, Sirs, yours very faithfully, .

Leicester, June 5th, 1888. HY. TOMKINS, M.O.H.

To tlae -Editors of THE LANCET.SIRS,—If you can spare me space for a few lines in

answer to the letters in your last issue touching notificationof infectious disease, I should like to say that the fact ofthe other practitioners in the neighbourhood being averseto, while I am in favour of, such notification is just thesame experience that has happened in all towns where suchnotification has been made compulsory; and history, medicalor otherwise, shows that in the sequel it is by no means themany who are always right.When Mr. Corbett speaks of a " gratuitous assumption

on my part "-as to the householder not notifying,-andgives a list of five towns where he asserts that the singleor householder notification is in force and acting well, hewill be perhaps surprised to hear that in the first three(I had not time to inquire from all) the facts are as follows.In Bradford the single notification is law, yet in ninety-nine cases out a hundred the notifications are sent to thesanitary authority by the medical attendants in stampedaddressed envelopes supplied to them by that authority. AtNottingham precisely the same thing occurs; while atNorwich the notification is compulsory upon the medicalman in attendance, and upon him alone. When Mr. Corbettobserves that " my opinion is not warranted by known factsor trustworthy evidence," the above will, I think, show thatthe boot is on the other leg, and the "assumption ratheron his own side.With regard to Dr. Atkinson’s assertion that common

sense misleads as much as statistics, I would remark thatsuch an opinion will never be endorsed by any practicalbusiness community; and when he says that I use statisticsas it suits my purpose and bring forward percentages ofdeaths as evidence of the general health of the district, hemust surely be wilfully blind not to see that the two thingsare entirely different; statistics such as death-rate, birth-rate, &c., are entirely conclusive as to the public health,while statistics of zymotic disease, as applied to notificationarguments, are just as inconclusive.

I should like to add that in the three towns I havementioned I was assured that there was not the slightestfriction between the medical men and the sanitary authority.

I am, Sirs, faithfully yours,Kingston-on-Thames, June 5th, 1888. E. M. SHIRTLIFF.

P,S.-With regard to Mr. Biddle’s letter in THE LANCETof tin 9th inst., I can quite understand that my objection tohis much-cherished statistics, as being inconclusive on thenotification question, has so roused his ire as to cause him Ito write in a more acrimonious manner than usually appearsin discussions in your columns, as it is evidently a case withhim of statistics aut preterea nihil. As to these statistics,I would remind him of a well-known axiom, that " thingsto be equal to the same must be equal to each other," andwhen he can give statistics extended over ten or fifteenyears, for two towns, one with single and one withequal circumstances in all things in both, then I shouldbe very happy to receive his statistics with more con-fidence. At present, however, I will refer him to youreditorial opinion as to the use of statistics in notification inTHE LANCET of the 19th ult., as he may receive your opinionwithout calling it an "assumption." As to his captiousremarks concerning my fifteen years’ experience, I may saythat 1 mentioned it in all modesty, thinking only that it’Would show that 1 had had sufficient time to fully appreciatethe difficulty of getting information of infectious disease intime to do any good. If Mr. Biddle thinks that, as a privatepractitioner, he has had equal opportunities of knowingthat people will, without fail, instantly forward thenotification when given, I have no objection, and wouldsimply leave it to your impartial opinion. His classingnotification of infectious disease with notification ofillegitimate births and of ascertained cases of concu-

binage is just mere clap-trap. The comparison is as badas his statistics, utterly inconclusive as to the pointin question. His idea that the chief function of medicalcfficers of health is "to register cases of disease and death"is extremely curious. Is it necessary for me to inform himthat the chief duty for which they are appointed is to-

prevent or check, as far as possible, the outbreak or spreadof infectious and all other disease, and to keep their districts.in as healthy and sanitary condition as may be in theirpower ? E. M. S.

ASSOCIATION OF MEMBERS OF THE ROYALCOLLEGE OF SURGEONS.

To the Editors of THE LANCET.

SIRS,—We are instructed by our committee to forwardyou the enclosed copy of a communication received on the8th inst. from the Privy Council, and of a letter now beingsent to the Lord President in reply thereto. The committeeis taking steps to have the matter still further ventilated inParliament. We are, Sirs, your obedient servants,

Grosvenor-road. Westminster,July 12th, 1888.

WARWICK C. STEELE, Hon.WM. ASHTON ELLIS, Secs.

[COPY]Privy Council Office, Whitehall, 7th June, 1888.

SIR,-I am instructed by the Lord President of the Council toacknowledge the receipt of your letter of the 31st ultimo, transmitting apetition, addressed to Her Majesty in Council, praying that the petitionof 4665 Members of the Royal College to Surgeons in relation to a pro-posed Supplemental Charter to that College and other papers in connexiontherewith may be referred for the consideration of the Privy Council orsome members thereof sitting in judicial capacity.In reply, I am instructed to inform you that the petition in question,

together with all other petitions on the subject, was referred by HerMajesty to a committee of the Lords of the Council, and that as no legalquestion was involved, their Lordships did not think it necessary to hearcounsel on the subject. I am, Sir, your obedient servant,W. Ashton Ellis, Esq. C. L. PEEL.

To the Lord President of the Privy Council.14, Grosvenor-road, Westminster, S.W., June 12th, 1888.

SIR,-I am instructed by the committee of the Association of Members’of the Royal College of Surgeons of England to acknowledge the receiptof your communication of the 7th inst. I am also instructed by the saidcommittee to state that they desire respectfully to point out that noreply has as yet been vouchsafed to the prayer of the petition signed by4665 Membera of the College and lodged at the Privy Council Office onthe 3rd of May, 1887, praying for participation by the Members of theRoyal College of Surgeons of England in the management of their College-and other matters, on all of which the said committee and the genera];body of Members most anxiously await your Lordship’s answer.

I am, Sir, your Lordship’s most obedient servant,WM. ASHTON BLLIS, Hon. Sec. to the Association.

THE COUNCIL OF THE ROYAL COLLEGE OFSURGEONS.

To the Editors of THE LANCET.SIRS,—I beg to thank you for the honour you have done

me in mentioning my name in connexion with the forth-coming election of members of Council at the College ofSurgeons. There are good reasons why on the presentoccasion I should not come forward, but if next year itshould seem to be the wish of an influential number of theelectors that I should become a candidate, I shall be glad t&tender my services. I am, Sirs, yours faithfully,Plymouth, June 9th, 1888. PAUL SVAIN, F.R,C,S.

LIVERPOOL.

(From our own Correspondent.)

THE SUMMER SESSION AT THE MEDICAL FACULTY,LIVERPOOL UNIVERSITY COLLEGE.

SINCE the commencement of the summer session lastmonth the various classes of the Medical Faculty, LiverpoolUniversity College, have been well attended, there havingbeen thirty new students entered, while nearly 150 in allare in attendance upon the various classes. Mr. MitchellBanks, who has been formerly Lecturer and now Professorof Anatomy for many years, continues year by year to makefresh improvements in the anatomical rooms, and his col-leagues, wisely recognising the importance of sound anato-mical teaching as the basis of medical study, cordially aidhis efforts. The supply of subjects is ample, and the im-portance of a summer course of dissections to all studentswho wish not to forget but to remember what they have

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learned in their winter course, cannot be overrated. Theother summer classes are well worked up and numerouslyattended.

A MIDWIFE’S CERTIFICATE OF STILL-BIRTH.

Proceedings were taken against a midwife for giving afalse certificate of still-birth by the Superintendent Registrarof West Derby, whose district comprises a portion of thiscity. It appeared that the child certified to as still-bornhad in fact lived several hours. The midwife, in answer tothe charge, excused herself on the ground that she thoughtit correct to certify as still-born any infant which did notlive longer than forty-eight hours after birth. She was’fined ten shillings and costs. It would be interesting toknow how often this had been done previously.

THE CITY CORPORATION AND THE SOCIAL EVIL.

Owing to the lapse of leases and other causes a large-number of houses which had been for years used as brothelscame into the possession of the City Corporation, and as the’City Council were not so prompt in clearing out the occu-piers of these houses as some purists thought they ought tohave been, some scandal has been caused and hard thingssaid of the councillors supposed to be responsible. Actionhas been taken and the tenants of these houses dispersed.’The result will inevitably be that they will migrate to otherstreets in all parts of the city.

DEATH OF DR. HOWIE.

Another local practitioner has been cut off in his prime inthe person of Dr. James Muir Howie, who, after graduatingin Edinburgh, came here to join the late Dr. Burrows, apractitioner then of many years’ standing in Liverpool.Dr. Howie was never a robust man, having always had amore or less phthisical tendency, and this was not improved’by the very laborious nature of his practice, which involvedmuch obstetric and night work, as well as long drives inwhat is generally considered a very trying climate. Hewas extremely popular with his patients and professionalbrethren, being a most kind-hearted and genial man. Hewas a strong advocate of the temperance cause. His funeralwas attended by a very large number of professional and,other friends.

SMALL-POX AT PRESTON.

Small-pox has recently appeared epidemically in Sheffield,and to a great extent in Manchester, two localities withinhourly communication with Liverpool. It reflects the.greatest credit upon the local health authorities that not-withstanding this, there have been very few cases of small-pox here, and the death-rate has been the lowest ever’known. But danger threatens from Preston, or, as its in-habitants have it, "Proud Preston," where small-pox hasassumed the character of a very formidable epidemic withinthe last few days. If the Preston authorities are wise, theywill take the opportunity of securing a better right to theterm " Proud " by purging the town of its many insanitary’blots. It is within a very short journey of Liverpool, onthe line of route by two railways to the north of England,and communication is frequent. This last danger will taxG11 the watchfulness which local authorities can bestow."Liverpool, June 12th.

MANCHESTER.

(From our own Correspondent.)

EXCESSIVE MORTALITY OF MANCHESTER.

WHETHER the interest which has lately been aroused in’the high mortality of our city will culminate in any,practical steps being taken to counteract and diminish itmay be doubtful, but certainly never before has so muchpublic attention been directed towards it as within the pastfew weeks. The conference held under the auspices of the’Manchester and Salford Association at least served to showthe widespread feeling that exists that something moreought to be done by somebody, but the what and the whoare less distinctly defined. ’the meeting was of an in-fluential and representative character: Church (Catholicand Protestant) and Medicine were both largely represented;guardians and town councillors, together with manyphilanthropists-ladies as well as gentlemen,—met to

discus?, to listen, and to learn. The general tenourof the remarks, as well as of the resolutions passed,tended towards the conclusion that, although considerably

more might be done by the health authorities, stillvery much also depended upon the mass of the peoplethemselves; education in the elementary principles ofhealth, less neglect of little children, less drmking anddepraved habits, were all necessary before Manchester couldshake from itself the disgrace of having the higbe6t death-rate of any town in the kingdom, reaching as it does atpresent 50 per cent. higher than the country at large. TheBishop of Salford, in moving a resolution that the work ofthe Health Committee required reorganising, expressed theopinion that the time had arrived when experts should givesome definite idea as to what was the maximum number ofpersons which should be allowed to dwell on a given area inour large towns, and that this number should not be permittedto be exceeded, in the same way that we at present forbidovercrowding in buildings, schools, lodging-houses, &c.

HEALTH REPORT FOR 1887.The officer of health’s report on the health of the city

during 1887 has appeared very opportunely, whilst thesematters are occupying the public mind. According to hisfigures, the death-rate for last year was 27’2 per 1000, whilstthe Registrar-General gives it as high as28’7. There appearsto be a little confusion as to what deaths are, or should be,included as " Manchester deaths." It ought, however, not tobe a very difficult matter to state the number with approxi-mate accuracy, by including the deaths of Manchesterresidents who are taken to hospitals and infirmaries out-side the city boundaries, and excluding the deaths ofthose who come for treatment into the various hospitalsinside the city, but who are resident outside. Mr. Leighhas devoted much of his report to the consideration ofthe increasingly high death-rate, and thinks it unfairto compare Manchester with other large towns, seeingthat the bulk of the population here, resident withinthe city boundaries, are of the poorer and labouringclasses, with a very small proportion of the betterclasses of society, which in most other places tend to

equalise the death-rate for the whole district. Measles andscarlatina were very fatal, 700 deaths being due to theformer alone. There were 500 cases of typhoid fever re-ported, but only a very small number of these were admittedto hospital for treatment. Owing, it appears, to the dualarrangement respecting the management of the FeverHospital between the Corporation and the Royal Infirmary,there has been some difficulty in this matter; the infirmaryauthorities, although the owners of the Fever Hospital, sayit is not their business to treat these patients, and themunicipal authorities, on the score of expense, will not sendthem, and so between the two the fever-stricken patient isleft at home. In this matter alone is shown need for reform.

OWENS COLLEGE.

The soiree of Friday night last was a great succees; thenew buildings were thronged, though not uncomfortably so,with upwards of 4000 guests. The entrance-hall and grandstaircase is a very handsome piece of work, in much thesame style of architecture as that of the staircase at theTown Hall. The Whitworth Laboratory (engineering) wasa source of much attraction, with its elaborate and powerfulpieces of machinery, and is probably unique as formingpart of the teaching "plant" of a collegiate institution.The vacant chair in Surgery will now shortly be filled, asthe tima has expired for receiving applications for the same.

ROYAL INFIRMARY.

A useful and sensible decision has been arrived at here toteach the administration of anaesthetics in a systematicmanner, under the supervision and direction of Dr. Wilson,who has for nearly two years been anaesthetist to the infir-mary. Apropos of the desirability of the medical chairs atthe College and the posts at the infirmary being more or lessconnected, it may be mentioned that for some time pastthere have been communications between the College andthe infirmary relating to the clinical teaching carried on atthe latter, it appearing to the College authorities that con-siderable improvement is desirable and might be effected.At present the College has no voice or part in the electionto the infirmary staff, this resting entirely with a committeeselected from the general body of subscribers. Possiblysome modification of this will ultimately be arrived at; ifso, it is important that it should not be long delayed, asbefore very many months have passed trere will be at leastthree vacancies to be filled up.Manchester, June 12th.