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Ms or her "marriage lines" are considered. Thus beyonddogging through life the footsteps of the unvaccinatedwith sundty disabilities, no penalties or pains would bemencspH.rv. T am- Sirs. vnrn’s faithfnllv.

South Godstone, Surrey, May 23rd, 1898. F. W. WRIGHT.

" THE MEDICO-LEGAL ASPECT OFCREMATION."

To the Editors of THE LANCET..

SIRS,—Engrossing matters at a distance from home haveprevented my seeing the leading article on the abovesubject in THE LANCET of May 14th till to-day, whenit is, of course, too late to offer you any observationsBon it of a nature to be available for your issue ofMay 21st. Nor, to say the truth, is it at the presentmoment very clear to me how, without a greater expenditureof time and energy than have been left to me, I canhope to add anything very material to the three letterswhich within the last few months I have addressedto the editor of the Times. At the same time there issomething which I cannot-or rather which I will not-sayto the editor of the Times which I can and which I will, ifyou will only give me room for it, say to you. In the wholecourse of a long life I have held and doubtless shall continueto hold that a public newspaper is not the place in whichto discuss matters of a purely professional and technicalmature-matters of which neither the editor nor his readerscan be competent judges, and whose influence therefore it isonly possible to purchase by highly-coloured statements orby arguments which appeal rather to their prejudices thantheir judgment. For the moment I will say no more.

I am, Sirs, yours faithfully,F. SEYMOUR HADEN.

Woodcote Manor, Alresford, May 18th, 1898.

BUBONIC PLAGUE AND CATTLE DISEASE.To the Editors of THE LANCET.

SiBS,—la the following brief statement of facts I shouldlike to call attention to some coincidences which seem to meto show that diseased meat is one of the factors in thedissemination and causation of plague. Previously to theepidemics of plague in Hong-Kong in 1894 and 1896 an out-break of rinderpest occurred amongst the cattle at the Hong-Kong dairy farm. In like manner this year an outbreak ofrinderpest occurred at the dairy farm, following an epidemicof foot-and-mouth disease, which prevailed in November andDecember last in all the dairy farms of the colony, nativeand European. In connexion with this see Brigade-Surgeon-Lieutenant-Colonel Weir’s report on the epidemicof plague in Bombay, quoted in THE LANCET of Feb. 26 .h,page 602.

In 1896 an epidemic occurred amongst the pigs whicharrived here from Pakhoi. Pork, it should be explained(sun-dried pork), is one of the staple foods of the Chinese.Dr. Wilson and myself examined several pigs that died fromthe epidemic and the symptoms were almost identical withthose of rinderpest in cattle. We obtained a diplococcusfrom the spleen, mesenteric glands, and blood of these pigsalmost identical with the pest bacillus in man. Similarlythis year I have found a like bacillus in the nasal mucus,spleen, and mesenteric glands of cattle that were killed onaccount of rinderpest. Of course, I know that this theoryat present is not proven sufficiently, but any facts thatpresent themselves, like these I now adduce, appear to meto bear forcibly on the etiology of this prevalent disease.Next mail I will forward you specimens of the originalbacillus obtained from the rinderpest carcasses and culturesto the third generation of this bacillus in agar bouillon. ,

There are many cases of rinderpest in Canton just now.At a dairy kept in the Shameen (the European settlement of I

Canton), where there are 32 head of cattle (Alderneys,Guernseys, and half-breeds), an outbreak of rinderpest hasoccurred within the last two weeks, the result being that upto the present time 13 animals have been attacked and 4have died.-I am, Sirs. yours faithfullv. ,

J. M. ATKINSON, M.B. Lond., M.R.C.S. Eng.,Principal Civil Medical Officer and President of the

Sanitary Board.Hong-Kong, April th, 1HUS.

MEDICAL QUALIFICATIONS AND TITLESIN GERMANY.

(FROM OUR BERLIN COBRKSt’ONDENT.)

IN THE LANCET of Apri116tb, p. 1069, there was an anno-tation to the effect that after the commencement of nextwinter session the German Universities would only conferthe degree of M.D. on candidates who had already passedthe State examination and thereby become legally qualifiedto practise medicine. As the laws on medical qualificationand examination in Germany are quite different from thosein England a few particulars on the subject may be ofinterest to the readers of THE LANCET. In 1867 the variouslaws and regulations concerning the practice of medicinewhich were in force in the different States of the then NorthGerman Confederation (Prussia, Saxony, &c.) were replacedby a uniform system applicable to the whole Confedera-tion, the provisions of which were included in theEe7verbe-Ordnung (trade-law). In 1871, when the GermanEmpire was founded, this law was extended also tothe southern States (Bavaria, &c.) and is now an Im-perial law for the whole of Germany. Since this timeunqualified practice has not been illegal, anybody being atliberty to give medical advice; but in order that the publicmight be able to distinguish between practitioners who hadreceived a medical education and those who had not theState instituted a system of examinations of its own,the successful candidates at which receive certificatesof 11 approbation," as they are termed, and therebybecome legally qualified medical practitioners. Can-didates for this certificate must for their ordinary schooleducation spend nine years in a German gymnasium andmust pass the A biturienten, examen in general science, afterwhich they study medicine for four and a half years at a

university. After the end of the cunioulum, in the courseof which there is a preliminary examination in anatomy,pbysiology, botany, &3.—the so-called tentam6n p7tysieum-the candidate may apply for "approbation," and is thereuponexamined by the commissioners appointed by the Govern-ment. These commissioners, although they hold examina-tions in university towns, are not necessarily universityprofessors, but may be any other medical men, such as

hospital physicians and surgeons, Government medicalofficers, &c., whom the Government sees fit to appoint for thepurpose. They are, in fact, Government officials and in theircapacity of examiners they are quite independent of theuniversities. After the candidate has passed the State exami-nation, a description of which would make the present articleunduly long, he receives the certificate of "approbation"from that state of the empire to which the universitybelongs. This certificate is valid throughout the wholeEmpire and confers on its owner the title of praktischerÅrzt, which he makes use of for his visiting-cards, forhis door-plate, and when he signs a medical certifi-cate. This title enables him to hold appointments, toenter the services, and to practise wherever he likes.A certificate of "approbation" may be revoked if it hasbeen obtained by fraudulent means, but this is the onlyground for withdrawing it, and a medical man retains itduring his whole life even though he may be convicted of acrime and punished. There is no statutory limit of age formedical practice in Germany, there is no annual sum to bepaid as a licence or tax, and the only formality which a manbeginning practice has to attend to is that he must person-ally call on the medical officer of the district, show him his"approbation," and write his signature, which is then com-municated to all the licensed chemists and to the policeofficials of the district. It is a penal offence for anyunauthorised person to use the title of praktischer Arzt orany other title or description by which the public maybe induced to believe that he is a duly qualified medical man.The courts of law have to decide in each individual casewhether a description used by an unqualified person is one bywhich the public may be deceived, and the police are autho-rised to remove door-plates which are held to be infringementsof the statute. It is, of course, very easy to secure theconviction of unqualified practitioners in cases of gross impos-ture, but many of these individuals are very ingenious in

evading the law. It results thus from the above thatunqualified practice is not. in itself an offence, but only

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pratice under au assumed is

matter of special interest for foreign medical men who dmatter of special interest for foreign medical men who dwould like to practise under their foreign qualification. If i:

they do so they must understand that they are regarded as t

unqualified and that when their foreign title is similar to aGerman one they are liable to be punished. Foreignersdesiring to become duly qualified in Germany have to passall the examinations even if they have already studiedmedicine and taken diplomas at home. This subject wasdealt with in THE LANCET of Sept. 5th, 1896, p. 666(Students’ Number). Exemption from the examination is

only allowed by law in cases when the Government desiresto appoint foreign medical men of scientific renown as

iuniversity professors, hospital physicians, &c. ; but this pro- vision has come into force only in a few caes of professors jof foreign nationality-Austrians, Swiss, Dutch, &c.-whoobtained their qualifications by a special order of the Federal Council.Altogether apart from and independent of the State

examination the universities have preserved their old-established right of conferring on medical men the degreeof M.D. (Doctor of Medicine), but this is a mere academictitle and not a legal qualification to practise medicine. Theexamination for M.D. differs greatly in the variousuniversities according to their respective statutes and by-laws. As a rule a four years’ course of study, an oralexamination, and a written thesis are required ; at someuniversities a certain number of printed copies of the thesismust be provided at the expense of the candidate. Afterthe examination has been passed a formal, old-fashioned"disputation" is held between the candidate and the" opponents," whom he may choose among his friends, andafter the disputation the dean, in full academical costume,hands the diploma to the candidate. This examination isin several universities made so easy that it is little morethan a formality. It is a common joke of German studentsto say that at some universities the degree may be takenwhile the train is waiting at the railway station. Gradua-tion expenses also vary very much and the poorer studentsnaturally prefer to take their degrees where there is least topay, for there is no objection to studying at one universityand graduating at another. Although the title of M.D. isnot necessary for practice the great majority of medical mennevertheless take it and it is indispensable for those whodesire to become privat doeenten at a university. Thedegree, being quite independent of the State examina-tion, could hitherto be taken either before or after the"approbation," but as was explained in THE LANCET ofApril 16th this state of things will now come to an end, forthe degree will only be given to those who have previouslypassed the State examination. This reform originated in thefact that in a few instances candidates who had passed theuniversity examination were rejected at the State examina-tion and when they engaged in practice it was very difficultto make out a case for prosecution because they had legallytaken their degree and avoided calling themselves prak-tischer Arzt. The public call every medical man a " doctor"even if he has only passed the State examination.Although it is almost impossible for foreigners to pass the

State examination every facility is afforded them for takingthe degree of M.D. They are put at an advantage in com-parison with Germans as they may begin to study at a

university without the certificate of a German gymnasium.They are only bound to prove that they are qualified for medical study according to the laws of their respectivecountries. They can present themselves for the M.D.examination after a much shorter time of study than isrequired of Germans who intend to pass the State examina-tion and the time spent at foreign universities is countedin a liberal manner. A great number of foreignmedical men, especially Americans, take the GermanM.D. under this condition, a system which is notwithout drawbacks. For instance, Germans of deficientgeneral education have gone to America and after becomingAmerican citizens have returned to Germany for the purposeof taking the M.D. degree as foreigners and have thenentered on practice in America as German medical men. Asthe public abroad know little about German qualificationsthis fact has undoubtedly lowered the credit of the Germanmedical profession. The above described reform, however,will not refer to foreigners, as they will in future be entitledto take the degree without having previously passed theState examination. The whole question of practice and ofqualification is a rather complicated one. It would certainly

be the best plan to confer the title of Doctor eo ipso on everyduly qualified man, as in Austria, but this reform is not yetin sight, as it would interfere with the ancient privileges ofthe universities.

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MANCHESTER.(FROM OUR OWN CORRESPONDENT.)

The Training of Feeble-minded Children.! THE best mode of educating and training feeble-mindedchildren, of enabling them-generally, perhaps, with a littlekindly help-to earn their own living, and of saving themfrom pauperism and crime, is a problem which has long beenforcing itself on the attention of the Manchester SchoolBoard. So far the board has been collecting informationonly, but there is some hope of action being takenbefore long. Miss Dendy, a lady who was previouslyto the last election a member of the school board,.has voluntarily undertaken an enormous amount of labourin order to ascertain the mental condition of suchchildren and the proportion they bear to the wholenumber. On May 19th she gave an address on thesubject of Dull and Defective Children in ElementarySchools and their Treatment, in which she acknow-

ledged the aid she had received from Dr. Ashby andDr. Shuttleworth. Her inquiries showed that some 5001children in Manchester board schools were unequal, as Dr.. Woodcock said, ’’ to the ordinary strain of school life andhad not the capacity to be benefited by the ordinary teach-ing which obtained in the elementary schools." He con-sidered that there were 1000 children who had claims for-special help. They are not imbeciles, or idiots, or lunatics,but are more or less feeble in mind, over whom the guardians.have no jurisdiction unless they are paupers, and even thenthey cannot be sent to asylums unless certified as lunatics.If a working-man has a child mentally below the normalstandard he cannot get instruction for the same while-at home, and the few institutions for such childrenare far beyond his means. At present Manchester has.no provision for such children. As Miss Dendy statedthe school boards in London, Leicester, Birmingham, Brad-ford, Bristol, and Brighton have already provided specialclasses for such children and it is strange to find that Man-chester, which sometimes thinks itself advanced, should lagso far behind. It must not be forgotten that the factsascertained as to board school children will obtain equallyin all probability with those attending voluntary schools, andit will be equally incumbent on those responsible for theirmanagement to provide for the training, of their feeble--minded children.

, The Present Stage of the Sewage Question.

On May llth the adjourned summons at the instances. of the Mersey and Irwell Joint Committee against the Cor-,

poration of Manchester for pollution of the River Irwell anc’the Manchester Ship Canal came on for hearing at the;county police-court before Mr. J. M. Yates, Q.C., the

stipendiary, and other magistrates. The Corporation applied. for an extension of time. The decision was given on the- 14th and the application was dismissed with costs. Mr. Yates,reviewed the history of Manchester, dealing with its sewage,r its unwillingness to purchase the 200 acres of land required by the Local Government Board, and its inability to persuade. the Board to alter their views. He concluded by saying 9 " The bare facts are that the sewage of an ever-increasing. population, now amounting to 600,000, is being turned into-1 an almost stationary body of water unpurified ; that thi&i haa been going on to a greater or lesser degree for at leastifive years; and that the corporation are no nearer a finalt settlement of the question than they were in 1893. If thet court were still to prolong this period it would, we think...Dy be stultifying itself and the order made by it by consente of the parties in 1896. We therefore unanimously andn unhesitatingly refuse the application." On the 17th thes stipendiary granted an application for summonses whichs were made returnable for June 8th. The Rivers Committee"11 on the 16th resolved to recommend the City Council to., appeal at the Salford Hundred Quarter Sessions against thisd decixion, and further recommended the Council to call ine three experts to give evidence as to the condition of affairs’of at the Davyhulme Sewage Works-viz., a civil engineer tospeak as to the fitness of the land for the construction