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REMOVAL of the entire tongue, after Regnoli’s submaxillarymethod, was performed last Saturday by Mr. Sampson Gam-gee, at the Queen’s Hospital, Birmingham. The proceedingwas quite successful; the man recovered speedily from theshock, and was reported next day as "doing admirably." Wehope to publish an early report of the case, with woodcuts, toillustrate Regnoli’s method, which is practically new to Englishsurgeons.

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AT the last meeting of the St. Pancras board of guardians,the medical officer of the Workhouse, Dr. Evans, who waslately appointed medical officer to the females in place of themales, having been stated to be very extravagant in extrasordered to the permanent inmates of the house, a letter wasordered to be forwarded to the Poor-law Board asking them todefer their approval of the appointment for a month. Mr.

Joseph H. Hill, late of the Royal Free Hospital, was electedmedical officer to the males.

FROM the mortuary returns of the North-Western provincesof India, published in the North- We8tern Gazette of Oct. 30th,1867, we learn that the mortality in the several districts inSept. 1866 was 18,000, and in Sept. 1867 it reached 26,000;the excess being due almost exclusively to cholera, the deathsfrom that disease having been 442 in the former month, and5023 in the latter.

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FROM an authentic source we are enabled to state thatwhereas the average mortality in the registration sub-districtof Guildford during the September quarters of the last sevenyears has not exceeded 51 deaths, the return for the threemonths ending 30th of last September was 100 deaths, includ-ing 43 from scarlatina, 1 from typhoid fever, 8 from diarrhoea,and 2 from diphtheria.

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WE regret to hear from Guernsey of the death of Dr. DeBeauvoir de Lisle, which occurred on the 27th ultimo. The

Guernsey Star has an article testifying most warmly to theprofessional and private worth of Dr. de Lisle, and suggestinga public memorial in his honour.

THE high death-rate from scarlatina in the metropolis, towhich we referred last week, has undergone little or no dimi-nution : 99 fatal cases occurred in the week ending Saturdaylast, as compared with 101 in the week preceding.

A NOTICE has been issued from the office of the GeneralCouncil of Medical Education to the effect that a copy of theMedical Register will be published in January next, and thatparticulars with regard to alteration of residence and titlesshould be sent to the office as soon as possible.

MANCHESTER and Salford appear to be suffering from asevere epidemic of scarlatina. The death-rate from this dis-ease is very high in London just now, but, relatively to popu-lation, it was four times more fatal in Manchester last weekthan in the metropolis.

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THE resident officers and students of the Birmingham General IHospital have presented to Dr. Wyllie, on his retirement fromthe office of resident physician, a valuable gold watch, with asuitable inscription, as a mark of their esteem. i

AT the Plymouth Board of Guardians the alleged inefficiencyof the medical arrangements of the workhouse, and the desira-bility of engaging a resident medical officer, have been broughtunder notice, and both subjects are to receive early considera-tion.

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EARL GRANVILLE has announced his intention to offer aprize for the encouragement of the study of chemistry andmechanics in the Oxford local examinations. I

A GENERAL meeting of the members of the Medical Clubwill be held at No. 9, Spring-gardens, on Wednesday next,October 14th, at 2 P.M. Sir William Fergusson, Bart., willoccupy the chair. -

THE first meeting of the Metropolitan Association of Medi-cal Officers of Health for the ensuing session will be held onSaturday, the 17th inst., at 7.30 r.M., when an address willbe delivered by Dr. Druitt on "Popular Customs, Prejudices,and Morals, as influencing Sickness and Mortality."

THE winter session of the Pharmaceutical Society opened onWednesday evening last, when an introductory address wasdelivered by Mr. Henry B. Brady, of Newcastle-on-Tyne.

THE health officer of Manchester has been instructed to givehis special attention to the enforcement of the provisions ofthe Workshops Regulation Act (1867), particularly in smallestablishments.

NATIONAL ASSOCIATION FOR THE PROMOTIONOF SOCIAL SCIENCE.

ONCE again, after a lapse of eleven years, has Birminghamwelcomed with almost parental fondness the Social ScienceAssociation to its twelfth congress. The 8ociety, which firstin this place began to utter in the uncertain accents of infancyits opinions on social questions, has since reached a maturitywhich has made its utterances felt and obeyed in the legis-lative councils of the country. Well may Birmingham beproud to welcome in the vigour of its manhood the offspringwhich it nursed into life; and well may the Association rejoiceto have stirred up, as it has done by its discussions, a livelierinterest in the questions of sanitary legislation, which is destinedto influence local opinion, and produce an improved care andmore attentive regard for the social and sanitary welfare ofthe poor of this populous district. The bread cast upon thewaters eleven years ago is coming back; for, as will be seenfrom the appended report, the discussions in the HealthSection on medical officers of health, on hospital administra-tion, and on water-supply, ’have had a peculiar interest forBirmingham. Altogether some 1100 members attended theCongress.On Wednesday, the 30th ult., after the preliminary meeting

of the Council, at which Mr. R. Arthur Arnold’s essay, " Onthe Temporary Employment of Operatives and Workmen inCasual Distress," was adjudged the Lloyd prize, the proceed-ings were opened by the usual sermon, preached on this occa-sion by the Lord Bishop of Worcester. In the evening theInaugural Address was delivered by the Earl of Carnarvon,who gave, in a lengthy and eloquent discourse, an elaboratereview of the year’s progress in those subjects which the Asso-ciation especially aims at promoting. After referring to thePharmacy and Vaccination Acts, he gave a sketch of the originand objects of the Poor Relief Act--a measure to which heaccorded much praise, and which he attributed to the labours ofTHE LANCET Commission. To sanitary science, as being con-nected with the highest questions of politics, he devoted aconsiderable portion of the address, touching with much acu-men on the sewage question, the water-supply of our largetowns, the improvement of the dwellings of our artisans andlabourers,-subjects which he characterised as worthy of thedeepest attention of true statesmanship. General and specialeducation, the repression of crime, trades unions, benefitsocieties, and co-operative enterprise, were all in turn alludedto. The address throughout bore marks of a careful study andaccurate appreciation of the various problems discussed, and,no doubt, will bear fruit in social and sanitary reform.On Thursday, a most able and exhaustive address was de-

livered by Lord Lyttelton. In the Economy and Trade Sec-tion, the administration of the Poor Laws was discussed, andpapers read by Dr. STALLARD on the question as to what classesand on what conditions out-door relief should be administered.He insisted that every able-bodied man was, if destitute, en-titled to claim relief on the condition of giving labour in

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return ; that the sick, aged, and infirm, are best relieved in Itheir own homes; and that the workhouses are rapidly becomeing gigantic almshouses, supplied with every necessary com-fort, into which the worst of the aged classes are most easilyand generally admitted.Mr. NORTH (of York) advocated an exact compliance with

the workhouse test, and said that no out-door relief should begiven to able-bodied men. He complained of the insufficientarrangements for the treatment of the sick poor in their owndwellings, and strongly advocated the extension of the Irishsystem of dispensaries, which had been recently adopted forLondon, to the provincial towns.

Sir BALpwiN LEIGHTON and Mr. GEORGE BAKER also readpapers on the same subject.

In the Health Section, "The Function and Authority ofMedical Officers of Health" was discussed in papers by Mr.W. H. Hayward, Mr. John Liddle (of Whitechapel), and Dr.Mapother (of Dublin). The question must be further noticedin a future issue.On Friday, the Administration and Abuse of Hospitals

formed one of the most interesting features of the discussionsin the Health Section. The subject was introduced by Mr.C. E. MATTHEWS, who set out with the remark that our greatvoluntary hospitals were surrounded with so many formalitiesand privileges as to have become, not public refuges for thesick poor, but private institutions for the relief of subscribers’nominees. When gratuitous medical service had excited anunusual share of public attention, it would be conceded bymedical men that one of the first reforms needed was the rigidexclusion of all persons who were in no sense necessitous.Every institution which aimed at treating the largest possiblenumber of proper and deserving cases must appoint an officerto inquire into the social fitness of applicants for relief. Thisdifficult duty should form no part of the labours of a medicalofficer, but should be done by an authorised and salariedofficer directly responsible to the committee of management.In Paris, everyone who was poor enough and sick enough torequire admission was sent by a public officer into any one ofthe hospitals. The privilege system contravened the trueprinciples of Christian benevolence. The subscriber mightsend his relatives or friends or dependants into the wards. Itcould not be worked except by admitting accidents and urgentcases free-a complex method, which was the cause of never-ending finaneial embarrassment, constant changes in sub-scribers’ privileges, and ludicrous confusion. It prevented theadmission of the true hospital population, and left the selectionin the hands of persons wholly incompetent to perform the duty.The boldest beggar obt .ined the biggest loaf, and " charity" gotfilled up with chronic cases, malingerers, and hospital birds.Besides these objections, there were the cumbrous arrangementsfor admission and discharge-the patient cured on Saturdaybeing compelled to remain till the following Thursday, and/,ice vc-rset, because the hospital admits and discharges only onthat day; the f tet that medical officers dislike to dischargeprivileged pat;e:1ts, though cured or incurable, lest the sub-scriber should think that he had not had full value for hismoney; the curious arrangement by which, irrespective of thewants of a district, an hospital was full whilst the subscribershad a good stock of notes, and half empty when the stock hadbecome low; and lastly, the weary journeys of the sick insearch of tickets of admission. Mr. Matthews noticed the

question of privilege as bearing upon the amount of each sub-scription, and noticed that where, as in Glasgow, the admis-sions are strictly privileged, there is no subscription under oneguinea; whereas in Edinburgh, where the admissions are free,out of .;87000 per annum, E4000 is contributed in sums underhalf-a-guinea each. Another important improvement wasneeded as regards the election of medical officers. The mo-ment a vacancy was announced, the canvass of the privilegedvoters was begun, involving the turmoil, expense, and excite-ment of a parliamentary election. No stranger, however emi-nent, could stand his ground; and the prize was carried off bythe candidate who could command the largest medical supportor the widest local influence. Medical appointments to hos-pitals were also far too few, and their honours and benefitswere held too long. It was an obvious truism, that the largerthe number of qualified medical men attending the poor inhospitals, the larger would be the number of experienced pri-vate practitioners. In no English hospital was the out-patientdepartment administered with success or satisfaction. Theless conscientious members of hospital staffs ignored them al-together, and left them to the charge of house-surgeons andpupils. The conscientious regarded them as a necessary evil,and struggled bravely with difficulties impossible wholly to

overcome. Mr. Matthews urged that the hospitals which de-rived a large portion of their income from the endowments andlegacies of deceased governors were as fit objects of Govern-ment inspection as colleges or grammar schools; and that itwas one of the few duties of a wise Government to regulate allmatters which concerned the maintenance of the public health.

Dr. DOBELL had prepared a paper on the Mode of Admissionto Hospitals, which was read by Dr. HARDWzCKE. He affirmedthat the new Poor-law arrangements would, if adopted, putmedical charities on a new footing as regards the poor.The large number of patients now treated at hospitals haveno claim except their poverty. This claim would cease

when such patients could get all they wanted at the Poor-lawinfirmaries and dispensaries. The only object of continuinggratuitous relief would be the reduction of the rates by privatemunificence. Medical charities should be employed solely insupplying, in cases of difficulty and importance, the consultingadvice of physicians and surgeons to three classes of appli-

cants:—1st. The better-off poor who could not afford a con-sultation fee. 2nd. The destitute, to whom the Poor-lawdispensary and infirmary would supply the place of familydoctory. 3rd. Cases of emergency.

Dr. PERCY LESLIE read a paper on Gratuitous MedicalLabour, which, as now carried on, he characterised as beingthe greatest bane of the medical profession, and one of thegreatest systems of imposture and deception now existing inany calling. He urged the payment of medical men for theirservices, and the adoption of village hospitals and providentdispensaries.

Dr. HAWKSLEY sent a paper entitled the Police of Charity,in which he recommended that all the charities of the metro-polis should contribute one per cent. of their funds to providean audit committee and system of police. He estimated theincome of this committee at no less a sum than jE50,OOOperannum, and that it should occupy itself with the regulation ofadministration and the prevention of abuse.

Dr. ALDIS (of London) opened the discussion by recom.mending an extension of the educational department of ourhospitals.Mr. GODWIN hoped that, amongst the above reforms, the

state and construction of the buildings would not be over-looked. He mentioned the fact, that 170 persons out of every1000 who die in London, die in the public hospitals; butthat the construction of some was so bad that a patient wouldhave a better chance under a hedge with nothing but a rug tocover him, and an old woman to attend upon him. He quoteda proposed alteration of the Salop Infirmary as an instance ofentire ignorance of what was needed on the part of theManaging Committee, there being an utter contempt for thesafety of the patients about to be placed therein.

Dr. STEWART (of the Middlesex Hospital) said the presentsystem was altogether rotten. He quoted the case of a ladyin Portland-place, who recommended 1500 patients in oneyear, and who used to supply all her friends with orders ofadmission for their servants. He said the British workmanwas rapidly losing his sense of independence, and that thereception of gratuitous medical aid without shame was thebeginning of pauperism.

; Dr. STALLARD (of London) gave an estimate of the enormousamount of work imposed upon the consulting physicians andsurgeons of hospitals from the want of sufficient care in theselection of persons entitled to relief. He instanced a Londonhospital, where the physician informed him that they couldnot possibly get through the work of the day unless they sawfrom fifty to sixty patients per hour. It was absurd to sup-pose that such work could be really beneficial to the recipients.It was a misnomer to call it medical relief. He had practisedboth in the provinces and in London, and in the former it wasnot uncommon for labourers receiving less than £1 per weekto pay their medical attendants a small yearly bill; whilst inLondon, persons earning jE2 or £3 per week were not ashamedto attend the public hospitals. The excessive work acted alsomost injuriously upon the medical profession. It was un-

worthy of the name of scientific treatment, and its practice ledto loose reasoning and unsatisfactory results. He confirmedthe observation of Dr. Stewart, that the practice was the com-mencement of pauperism; and he maintained that, in theinterests of the ratepayers and the public, it was the boundenduty of the Government to take cognisance of a gigantic evil, toplace some restraint upon abused benevolence, and to organisecharity, that its funds may be properly and economicallyapplied.

Dr. SEATON regarded the injuries done by dispensaries tothe medical profession as far greater than was compensated bythe advantage to the poor.

495Mr. GAMGEE, after defending the Queen’s Hospital from the

charges brought against the privilege system as regards admis-sion, admitted all the evils of the out-door practice. He him-self saw his out-patients at the rate of eighty per hour, and itwas the only way he could get through the cases.Miss GARRETT, who read a paper urging the propriety of

the out-patients being seen by senior students, as in Germany,said that the patients would prefer more care being bestowedupon them by students than the few minutes of attentionwhich could be given by older physicians. She quoted areport by Dr. Graves in favour of the plan.Dr. MAPOTHER, of Dublin, stated that there were no out-

patients at the Dublin hospitals, as all such cases were attendedat seven Poor-law dispensaries supported by the rates. Thoseinstitutions were inspected by superior officers, and were mostsuccessful.The PRESIDENT (Dr. Rumsey) closed the discussion. He

had never been convinced that any distinction could be drawnbetween those who were poor and those who were not. Hethought the Irish practice solved the difficulty by classifyingin one great system all that was done by medical relief out ofhospitals. Every other system should be based upon mutualassurance. As regards admission to hospitals, he was of

opinion that the privileges of subscribers should be limited,and that inquiry ought to be made into the history and con-dition of patients. He thought Miss Garrett had proved herpoint, that senior students might be employed in seeing out-

patients, and he believed in some of the larger hospitals theydid perform such duties. Hospital construction ought to besubject to Government supervision, of which he was not inthe least afraid.On Saturday, in the Health Section, a most interesting

paper was read by Mr. Rawlinson, C.B., on River Obstruc-tions and Pollutions by Manufactories. Other papers wereread on the Disposal of the Birmingham :Sewage, and thesame subject was treated by Mr. William Fowler. Mr.Thomas Plant read a paper on the Health of Birmingham,with the object of noticing the remarkable mortality fromdiarrhoea, during the dry weather. He attributed this to

impure water, and advocated the appointment of a medicalofficer of health. There was a long and interesting discus-sion, in which it was stated that the waterworks’ water con-tained on an average 2’6 grains of organic matter per gallon ;that the ash-pits and privies were in many parts of the townin a dreadful state, and that the liquid from them contami-nated the wells. The Mayor stated that, amidst the conflict-ing and vexed questions connected with sanitary reform,they had at least so far grappled with the difficulties as tohave placed Birmingham, of all the large cities in similar mate-rial conditions, in the comparatively most healthy state. Theauthorities were determined to cope with the question in asolid, earnest, and practical manner. £200,000 had beenspent in sewers, and a new experiment was being made at anenormous prospective outlay.On Monday there was an unusually large attendance to

hear Dr. RUMSEY’S address on the Progress and Present Posi-tion of Sanitary Science. He divided his subject into thatwhich relates to air, water, and refuse. With respect to thefirst, he stated that the statistics of large towns were full offallacies, and gave by far too favourable an estimate of themortality due specially to town life. The death-roll does notreveal the actual loss of health, nor record the host of diseasesand casualties which ravage the territories of labour, and levyso heavy a tribute on produce and property. On the subjectof water-supply and sewers, he remarked that the greatwatercourses had all been defiled within the last thirty years,but that the law was now prohibiting this practice. Banburyand Tunbridge have suffered sequestration, from not havingattended to the injunction of the Court of Chancery. Thereis in this respect a sanitary " dead-lock." The water-sourcesare foul, and from our rivers nothing but sewer-water can behad. The authorities were compelled to choose between

leaving their towns undrained, in contravention of sanitaryenactments, suffering legal penalties for draining them intorivers, or making costly experiments upon sewage, in the hopeof satisfying both parties.

Dr. ALFRED HILL, Professor of Chemistry at Queen’sCollege, and Oflicial Analyst for the Borough of Birmingham,read a paper on the Relation of Water-Supply of large Townsto the Health of the Inhabitants. He showed that impurewater is a source of disease, and presented an account of thewell-waters of Birmingham which was perfectly frightful,many of them containing 150 grains and upwards of organicmatters.

Dr. GARDNER, of Glasgow, gave some details of the Glas-gow supply. Looking to the epidemics of cholera in 18321848-49, 1854, and 1866, there was a great diminution ofdeaths, which was coincident with an improvement in thewater-supply. The wells of Glasgow were found to be in avery bad condition, and they are now all shut up, and thecity supplied with Loch Katrine water.Mr. RAWLINSON thought it a disgrace to Birmingham, that

in a quarter of a century only £200,000 had been expended insanitary improvements. It was a mere flea-bite. No commu-nity ought to be satisfied whilst the water-supply was in thehands of a private company.On Tuesday, a paper was read by Dr. ROBERT PRINGLE on

Stamping-out Contagious Diseases. He treated the case inreference to small-pox, and insisted on the absolute practica-bility of the suggestions made by Sir J. Y. Simpson, Bart.Mr. FURNEAUX JORDAN read the next paper, on the Desira-

bility of Extending the Operation of the Contagious DiseasesAct. The Chairman expressed the gratification he felt inobserving that many clergymen recognise that the cure of thesad consequences of crime and immorality was not to be de-clined on account of any supposed recognition or encourage-ment thereby afforded to vice.Mr. HUNT described the Sanitary Condition of Country

Villages. He said the mortality of villages was often extremelylow, because the aged were removed to die in workhouses,and the sick in hospitals. As the population increases, thestrong and healthy also emigrate. He complained of thegrudging and inefficient manner in which relief is dispensed tothe sick poor, whereby disease is protracted for want of thenecessaries of life. The same parsimony is extended to theremuneration of medical officers, and where such is the case itcannot be expected but that there will be neglect.

Dr. STEWART, having read the statements made by theMayor as to the sanitary state of Birmingham, had himselfvisited a number of courts, and though in London he had seenmany bad cases, he had seldom seen any courts in so filthyand abominable a state. Privies were only emptied threetimes a year, and then not more than half done; and in theimmediate vicinity of these horrible accumulations of refusewere the public wells, from which the population derived alarge portion of their water-supply.On Wednesday, the congress was brought to a close by an

address by the Earl of Carnarvon, reviewing generally thelabours of the meeting. He alluded particularly to the necessityof some general supervision of hospital administration, theresponsibility of medical officers of health and of paying theman adequate salary, and to the desirability of extending theContagious Diseases Act to the larger towns. He observedthat it was absolutely impossible for any one man to deal withthe many questions which had been considered, and it was bythe combination of the men of power in this Association, bymind coming into contact with mind, that sparks were struckout, and that great results were finally achieved.

ST. GEORGE’S HOSPITAL.

THE proceedings at St. George’s Hospital on Thursday lastwere of more than usual interest, marking as they did the be-ginning of a new era in the history of the medical school. Attwo o’clock, the Opening Address was delivered by Dr.

Acland, the Regius Professor of Medicine in the University ofOxford, which was listened to with profound attention. Itwas delivered in the large theatre of the new school,which hasalready been described in a former number, the arrangementsof which were much praised by the numerous visitors onThursday. Conspicuous in the theatre is a clock, the gift ofthe late Dr. Page, bearing the inscription-

Quod adest mementoCompollere sequug......

After the address had begun, reference being made to theillustrious names of Hunter and Brodie, Dr. Acland utteringthe words "You are entering a new school," Sir BenjaminBrodie came in ; the lecturer, holding out his hand, repeatedthe words to Sir Benjamin and thus welcomed him, amidgeneral applause. The address being over, the visitors dis-persed themselves over the building, and also visited the newwing, a ward of which, the Belgrave ward, has already beenopened. It is extremely well arranged, having this advantage