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opinions. On the other hand, attention may be called to sug-gested measures which are likely to prove futile or obnoxiousand their failure to become law may thus be rendered morecertain.

Medical Acts Amendment Bill.

The private members’ Bill before the House of Commonswhich is of most importance in that it concerns the medicalprofession more or less as a whole is introduced by SirJohn Batty Tuke, while it further bears the names of SirJohn Gorst, Mr. James Campbell, Sir Richard Jebb, Mr.Talbot, and Sir Michael Foster. Its principal objects areto give the General Medical Council power to erase

from the Medical Register for a limited period the nameof a registered practitioner who has been guilty of a crimeor who has been adjudged guilty of infamous conduct in aprofessional respect, and to enable the medical authorities-that is to say, the universities and other bodies entitled togrant medical diplomas-summarily to deprive a practitionerwhose name has been erased from the Medical Register ofthe medical diploma obtained from that authority. A third

provision orders that, notwithstanding the provisions of anyAct in force or hereafter to be passed, all fines and penaltiesrecovered under the Medical Acts or the Dentists Act, 1878,shall go to the General Medical Council to be applied in aidof the expenses incurred by the Council in putting into forcethe Medical Acts. The changes proposed to be made requirebut little comment or commendation. At present the GeneralMedical Council can inflict but one penalty, the erasure ofthe name of the person brought before it from theMedical Register. The power to modify and to regulatethe penalty to be imposed is a highly desirable one for anvpunitive body to possess, for many reasons. One of these isthat where the necessary penalty is not one of extreme

severity offences are more likely to be complained ’of andpunished than where the accusation, if successful, must

necessarily involve the professional ruin of the accused.The second proposed change enables the bodies which grantmedical diplomas to withdraw them subject to their possiblefuture restoration where the General Medical Council hasexercised its powers of removal from the Register ; this

power to withdraw diplomas is not now possessed by all thebodies which may grant them. The third proposed changeis due to the fact that in London the penalties referred to areclaimed by the Receiver of Police under the MetropolitanPolice Courts Act, 1839.

A Public Health Bill.

The full title proposed for this measure is "The PublicHealth (Officers’ Tenure of Office and Superannuation) Act of1903." It is introduced by Sir Francis Sharp Powell and issupported by Sir Walter Foster, Mr. Talbot, Dr. Farquharson,Mr. Henry Hobhouse. Mr. Cripps, Mr. Heywood Johnstone,Sir Michael Foster, and Sir John Batty Tuke. Its main

objects are to insure that none but those properly qualifiedshall be employed as officers of health (a definition inwhich are included medical officers of health, sanitaryinspectors, and inspectors of nuisances) ; to give to theseas far as is reasonable security of tenure in their offices; andto enable them by definite contributions proportionate totheir salaries, paid to a central fund, to provide for them- ’,selves superannuation allowances to assist them in the event z,of old age or disablement. The memorandum prefixed tothe Bill calls attention to the highly technical duties per-formed by sanitary inspectors and points out that as thelaw stands urban and rural sanitary authorities may appointofficers of health on such conditions as to qualifications,tenure of office, and other matters as they deem fit. The

body of the Bill would enact that no person should be

appointed an officer of health unless he either is the holderof a certificate of the Local Government Board or of somebody for the time being approved by that Board, gained byexamination, or unless he has for three years before the

passing of the Act served as an oflicer of health. This

portion of the Bill is, no doubt, to a large extent designedto obtain the appointment of competent sanitary inspectors,the qualifications of these for their posts being less easy toappreciate in existing circumstances than those of medicalmen who offer themselves for the posts of medical officersof health. It also proposes to do away with the term

"inspector of nuisances," substituting for it the more

euphonious one of " sanitary inspector." Conditions ofsuperannuation are proposed, followed by a scale of super-annuation allowances. These range from fifteen-sixtiethsof the average annual salary of the last five years of

service, payable after a service of ten years, to forty-sixtieths, a maximum only to be obtained after 35 years’service. The proposed deductions from salary a-! con-

tributions towards these allowances are graded from 2 to 3per cent. according to the time of service. Contribution

by those already holding office is to be according to choiceand various matters of detail, financial and otherwise, areconsidered in various sections devoted to them. Enough hasbeen said to show that the measure is one of considerable

importance to the two classes directly affected by it.

An Anti- Vaccination Bill.

A brief Bill, containing but one operative section, wouldorder that "a vaccination officer shall not take proceedingsagainst a parent or other person under section 29 or

section 31 of the Vaccination Act, 1867, except withthe express sanction and authority in each case of theguardians of the union or parish for which he acts."This attempt to repeal the Vaccination Acts locally atthe option of a more or less uneducated majority of theenfranchised population embodies the present ambitions ofthe anti-vaccinationist, as already shown in a succession ofdefences to prosecutions and subsequent appeals. It is,perhaps, not likely to receive the serious consideration ofthe House of Commons, and it is to be hoped that if it doesits rtjection will be decisive. It is introduced by Mr.Channing and is supported by Sir John Rolleston, Mr.Goddard, Mr. Cremer, Mr. Brigg, Mr. Broadhurst, Mr.Corrie Grant, and Mr. Bell.

An .7<- MMCOM Bill.

This Bill seeks to amend 39 & 40 Vict. c. 77, the statutewhich already regulates and controls the performance ofexperiments upon live animals. Its main object appears tobe the abolition of the existing provisions for the per-formance of certain experiments under certificates, whichwithout such certificates are not permissible. Those espe-cially aimed at are no doubt those in which it may bedesired to dispense with the administration of an anses-thetic. There is also in the Bill a section ordering that"there shall be present during and throughout the wholecourse of the experiment an inspector," "and no suchexperiment shall at any time be performed or continuedsave in the presence of such inspector as aforesaid."Power is given to the Secretary of State to appoint a suffi-cient number of inspectors for this purpose. Their dutieswould, however, obviously be such as only highly qualifiedmembers of the medical profession could adequately performand the questions to be decided by them are now safely leftin the hands of the highly qualified members of the medicalprofession whose experiments at times under the existingAct lawfully include those upon live animals. These experi-ments are already subject to conditions with regard to

inspection and other matteis, the stringency of which, it isproposed, should be increased in other directions besidesthose to which we have called attention. Members of Par-liament who have considered the existing Act and are

acquainted with the statistics relating to its subject matterwill for the most part be satisfied that the protection whichit affords to dumb animals is sufficient without the additionalrestrictions proposed in a Bill which is brought in by SirFrederick Banbury, Colonel Lockwood, and Mr. MacNeill.

MEETING OF PUBLIC VACCINATORS ATPLYMOUTH.

A MEETING was held in the room of the Plymouth Medical"Society on Feb. 28th to elect a district council from amongjhe public vaccinators of South Devon and North and EastCornwall (including members and non-members of theassociation of Public Vaccinators of England and Wales).Mr. G. Jackson of Plymouth presided. The following&ecirc;esolutions were adopted unanimously :&mdash;

1. This resolution referred to the constituting of a district council.2. That the Local Government Board should be the authority to

which the administration of vaccination should be intrusted.3. That failing the entire transference of administration from boards

)f guardians to the Local Government Board it is absolutely necessaryn the public interests that the public vaccinator should be as inde-oendent in position as the vaccination officer.

4. That the minimum fees cannot be fairly reduced, and in manyJountry districts they are inadequate on account of the distance to be

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covered, and that an additional minimum fee of ls. per mile shouldbe paid for each journey over two miles for each mile or part of a mile.

5, 6, and 7. These resolved that school children should all be com-pelled to produce a certificate of successful vaccination; that thereshould be compulsory revaccination between the ages of 10 and 14

years; and that " successful" vaccination should be defined in anyfuture legislation.

8. That in the public interests all the institutions for the provision’ofcalf vaccine in this country should be open to Government inspectionand that no imported lymph should be used from any institutionwhich is not recognised by the English Government.

9. That there should be a Government vaccination station for thesupply of lymph in all numerous centres of population.

10. That " efficient vaccination should be denned as at present fixedby the Local Government Board as four insertions and half a squareinch of cicatrix, and that the number of insertions and successfulpustules be named in the certificate and registered by the vaccinationofficer.

11. That every medical practitioner not acting as public vaccinatorwho forwards a certificate to the vaccination officer of any efficientvaccination be paid a fee for the certificate, provided that such certi-ficate states the number of insertions and successful pustules, and thatsuch fee should not interfere with that charged for the operation.

Public Health and Poor Law.LOCAL GOVERNMENT BOARD.

REPORTS OF INSPECTORS OF THE MEDICAL DEPART1IENT OF

.

THE LOCAL GOVERNMENT BOARD.

On Epidemaie Small-pox in the Union of Ursett, 1901-02,by Dr. G. S. BUCHANAN. 4-The Union of Orsett, which hasa population of some 33,000, is situated in South Essex andext,ends from west to east about 14 miles and from north tosouth about seven miles, the Thames forming its southern

boundary throughout. The most populous portions of theunion are the riverside neighbourhoods between Purfleet onthe west and Tilbury on the east. The town of Grays liesmidway between Purfleet and Tilbury and forms the Graysurban district ; the rest of the union is comprised in theOrsett rural district. During the ten months from September,1901, to June, 1902, small-pox appeared in 12 out of 17

parishes in Orsett rural district, the attacks per 1000of the population in those parishes being 18’5; while in

Grays urban district 16 per 1000 of the population sufferedfrom the disease. The epidemic was thus of great severity.It may be contrasted with the London borough of Holbornwhich suffered most heavily during the recent outbreak inthe metropolis, where the attacks of small-pox per 1000during 11 months ending June, 1902, were no more than 7’2.Dr. Bu,;hanan gives tables showing the incidence of small-pox week by week on the population and on dwellings invarious subdivisions of the union. The epidemic had itsbeginning (from September to November, 1901) among thesmall community of Pur fleet and in persons living else-where in the union where the attacks could be referredto infection from others who had contracted infectionat Purfleet. From the middle of November, 1901, onwardsthe disease became prevalent over the whole of thesouthern portion of the union, its incidence being espe-cially severe upon the villages of West Thurrock andSouth Stifford, which lie between Purfleet and Grays, andupon the parish of Aveley which adjoins Purfleet on thenorth. The report deals in detail with the condition of thepopulation of the union at the beginning of the epidemic inregard to vaccination. Since 1891 neglect of infantile vac-cination had increased and from 1895 to 1900 more thanone-third of the children whose births were registered hadnot been vaccinated. With the exception of certain specialcommunities (which entirely escaped small-pox) compara-tively few persons of ten years of age or upwards were alreadyrevaccinated when the epidemic began. Having regard tothe large number of unvaccinated children, it was fortunatethat no instances occurred of the spread of small-pox inschools such as happened in Gloucester in 1896. Nevertheless,it is noteworthy that out of a total of 519 cases admittedto the local small-pox hospital no fewer than 100 wereunvaccinated children under the age of ten years and that22 of these children died. During the same period onlyten vaccinated children under the age of ten years wereadmitted, each suffering from discrete small-pox, and nodeath occurred among them. An instructive table preparedfrom data obtained by Mr. Rea Corbet shows with regard

1 London : Eyre and Spottiswoode, East Harding-street; Edinburgh Oliver and Boyd; Dublin: E. Ponsonby. Price 1s. 6d.

to adults that the fatality from small-pox in the unvac-cinated was much greater than in the primarily vaccinatedand this, not only at ages from 10 to 25 years (unvaccinatedrate 14.3 per 100, primarily vaccinated rate 3’9), but also atages over 25 years. 18 cases were admitted in which revaccina-tion was stated to have been successfully performed at someperiod or other before infection by small-pox. In four casesthis period was less than ten years, in one instance nomore than six years. The progress of the epidemic causeda complete change in the attitude of the majority ofthe population towards vaccination. By March, 1902, as

many as 6763 persons had been recently revaccinated andmany children over one year. had been recently vaccinatedby the public vaccinators, while a large amount of revaccina-tion and vaccination was performed by medical practitionerswho were not public vaccinators. No case of small-poxoccurred among persons recencly revaccinated save thosewho were already incubating small-pox at the date ofrevaecination. The most striking facts of the epidemic,however, were the severe and long-continued prevalenceof small-pox in Purfleet and the evidence obtainedwhich referred small-pox in other parts of the unionto infection contracted in Purfleet. In this villagethroughout the epidemic cases kept on occurring week afterweek and month after month ; altogether 41 out of the 110dwellings in the place were affected. During the wholeepidemic period in Purfleet and elsewhere there was nofailure in the arrangements for isolation, cases of small-poxbeing removed within !i4 hours of notification ; 11 contacts

"

were kept under observation ; and disinfection, on thewhole, was satisfactory. There was little or no evidencethat small-pox in Purfleet was maintained by undetectedcases or by supposed chicken-pox. Moreover, revaccinationin Purfleet was freely resorted to. On a liberal estimatethose inhabitants who at the end of March, 1902, were

not vaccinated children, revaccinated or recently vacci-nated adults, cr persons who had suffered from small-

pox did not exceed 40. Nevertheless, cases of small-poxsubsequently occurred among these 40, while other latercases in Purfleet were persons newly arrived in the place.These considerations, along with a number of others inthe report which space does not allow us to summarise, areimportant in their bearing on the question of the convectionof small-pox infection from the Metropolitan Asylums Board’ssmall-pox hospital ships which are moored in the Thamesoff the Kent shore, opposite Purfleet, from which they areseparated by nearly half a mile of water. There was no

personal communication between the ships and Purfleetthroughout the epidemic and in considering the influence ofthe ships, as Dr. Buchanan puts it, we have to choosebetween aerial convection or nothing."As to the latter alternative I would say at once that if the presence

of the small-pox ships in Long Reach had no concern with the Purfleetepidemic, then, while making every allowance for opportunities of localspread of the disease, I am nevertheless quite unable to suggest anyreason for the extraordinarily heavy and long-sustained prevalence ofsmall-pox there. If, on the other hand, the ships did exert influence onthe epidemic, infective particles being from time to time, under favour-ing meteorological conditions, conveyed to the area of Purfleet andthere reinforcing small-pox already prevalent, or setting small-poxgoing anew, then not only is the Purfleet experience intelligible, butthe hypothesis invoked to explain it is one that has been shown to benecessary, in our present knowledge, if the characteristic peculiaritiesin the distribution of small-pox in the neighbourhood of small-poxhospitals are to receive anything approaching a suftictent explanation.

Those who are interested in the question will note withinterest the abundance of circumstantial evidence given inthe report that the ships were responsible for disseminatinginfection in their neighbourhood in the way in which theLondon hospitals of the Metropolitan Asylums Board usedto do when they received acute cases of small-pox. Instanceswere traced, for example, in which members of the crew ofvessels moored for a while in Long Reach sickened withsmall-pox about 12 days afterwards. It is, of course,

impossible to test the matter in this case by looking for

graduated intensity of incidence of small-pox in dwellingsnear the hospital ships ; there are, practically speaking, nodwellings within a mile of the ships save those in Purfieetand the Dartford marshes to the south of the ships are un-inhabited. But during the period under consideration largenumbers of workmen were employed opposite the ships onthe Kent shore in the erection of temporary buildings andamong these men cases of small-pox occurred almost by thescore. Unlike the inhabitants of Purfleet these men mayhave had opportunities of "mediate" infection by associa-tion undetected by the authorities with members of the