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medical officer of health of Colchester, opens up more thanone question of some importance. Even those of us whoseexperience agrees with that of Mr. E. A. Hunt in the treat-ment of diphtheria by means of the injection of antitoxincannot admit that any practitioner should be coerced intousing it. At the same time, as Dr. Brown has stated that hepossesses a remedy for the disease which is of greatervalue than antitoxin and that the results of his method oftreatment "are incomparably superior and more satisfactorythan those given by the serum treatment," he must surely bein a position to prove his statement and only good couldarise by permitting others to know of the details of hismethod. Indeed, in view of the fact that the patients ofother practitioners are admitted to the fever hospital, thelatter are certainly entitled to have demonstrated to themthat the treatment in the institution will be satisfactory tothem; otherwise it is hardly to be expected that they willadvise the removal of those under their care, and the

community for the well-being of which the medical officerof health is responsible will necessarily suffer.

I am, Sirs, yours faithfully,

Hereford, Feb. 16th, 1901.

HERBERT JONES,Medical Officer of Health, Herefordshire

Combined Districts.

"ARSENICAL BEER POISONING."To the Editors of THE LANCET.

SIRS,-Permit me to point out that in your report of mycontribution to the discussion on this subject at the meetingof the Royal Medical and Chirurgical Society on Feb. 12thmy opening remarks are not quite correctly reported in thatthey perhaps seem to cast an element of reproach on myManchester oonfreres for not detectirg the cause of the

epidemic earlier, whereas nothing could have been furtherfrom my intention than to imply any such reflection. Thosewho were present at the meeting will bear me out that afterspeaking in terms of high praise of Dr. Reynolds’s discoveryof the cause of the epidemic I somewhat playfully remarkedthat in a certain work on forensic medicine, the author ofwhich I stated should be nameless, there occurred the state-ment that ’* in cases of peripheral neuritis of doubtful

origin it is advisable tc caretully examine the urine forarsenic." I, in common I am sure with many others, havenothing but admiration for the skill with which the mysteryof the epidemic has been elucidated by Dr. Reynolds,Dr. Dixon Mann, Professor Delepine, and others.

,

I am, Sirs, yours faithfully,Weymouth-street, W., Feb. 19th, 1901. ARTHUR P. LUFF.

THE COVENTRY DISPENSARY.To the Editors of THE LANOET.

SIRS,-I am sure that your readers will agree that theprofession of medicine is much indebted to the Birminghamand Midland Counties Branch of the British MedicalAssociation for their attitude in refusing to give professionalrecognition to the medical officers of the Coventry Dispensaryuntil they either bring their institution into line with pro-fessional opinion or resign the appointments they hold.Oat of some 110 members present at the meeting there werebut six dissentients, and it is gratifying to find that in sucha meeting so many men were banded together in the commoninterests of reform.

If other cities were to take a decided stand against suchinstitutions there would be less heard of professional abuse,and medical attendance upon any and all-comers irrespec-tive of their means and position for so paltry a sum as thatoften offered would cease to exist. At the same time thefact would be brought home to medical men that in visitingmembers of dispensaries and benefit clubs financially they(the medical men) would be the losers, for it is absolutelyimpossible that a few shillings a year would repay themedical man for serving a lay committee. He must sooneror later recognise that he is "farmed" by such committeeof laymen or that he is willing to give his services for

philanthropic motives.My suggestion is that immediate steps should be taken in

other localities, through the British Medical Association andthe press, to condemn any medical practitioners holdingappointments in institutions not conducted upon lines in Iaccordance with professional opinion, supposing, of course,

due and sufficient warning had been given to them. After-such condemnation, a reasonable time being allowed foralteration of their conduct, any practitioners transgressingshould be indicted before the General Medical Council asbeing the servants of laymen who exploited them for

pecuniary gain, and, if I mistake not, their positions wouldbe analogous to that of Dr. Irvine and the Birmingham.Consultative Institute.-I am, Sirs, yours faithfully,

Coventry, :Feb. 19th, 1901. EDWARD PHILLIPS.

SCARLET FEVER AND HOSPITAL ISOLA-TION.

To the Editors of THE LANCET.

SIRS,—Will you allow me to correct the report inTHE LANCET of Feb. 16th, p. 477, of my remarks atthe meeting of the Society of Medical Officers of Healthon Feb. 8th ? 7 I said a good deal more than is reported,but with this I shall not deal. I did not say that isola-tion hospitals were everywhere overcrowded-this we knowis not the case. What I did say was that they werevery commonly too small for the requirements of the districtsto which they belonged, and frequently overcrowded, whichis a very different thing. Again, I did not say that our ownhospital was grossly overcrowded, but that it had at timesbeen greatly overcrowded in the attempt with inelasticaccommodation to meet the requirements of epidemic con-ditions. It is certainly hot overcrowded at the present time.

I am, Sirs, yours faithfully,Nottingham, Feb. 16th, 1901. PHILIP BOOBBYER.

"MEDICAL CERTIFICATES AND THELONDON SCHOOL BOARD."

To the JJJditO’r8 of THE LANCET. .

SIRS,-It is surely obvious that the certificate system ofthe School Board wants alteration and I would suggestthat some such arrangement as the following shouldbe agreed upon. In the case of a child or of a

teacher, if the patient or the patient’s legal guardianscan pay for a certificate let them do o. If theyare too poor, and the medical man in attendance likesto give one out of charity let him do so, but if not,when a patient under the board cannot get a certificate thefact might be reported to the board. The medical officermight then write to the practitioner in attendance and in-form him that it is his duty to see the patient and he shouldask the practitioner to fix a time when they could meet overthe case. If the practitioner chose to attend he should geta fee of, say, ls., after the scale for notification of infectious-disease as regards a patient connected with a public institu-tion. If he did not choose to attend he would get no feeand the medical officer of the board would be in a perfectlycorrect position. The medical officer draws a large salaryand it seems to me that it is his plain duty to sign medicalcertificates for the board when required. The shilling shouldbe paid by the board, for I do not fancy that many caseswould arise where the above arrangement would have to becarried out. I am, Sirs, yours faithfully,

INTERESTED.

NOTES FROM INDIA.(FROM OUR SPECIAL CORRESPONDENT.)

Reforms and Improvements in the Indian Medical Service.-Further Increase oj the Plague Epidemic.-Miscellaneo2ctNews.

IN order to relieve officers of the Indian Medical Serviceproceeding on furlough the Government of India havesanctioned the engagement of 20 private medical prac-titioners. In addition to this temporary measure I under-stand that it has been practically settled to increase the

permanent strength of the service, and in addition also to-

create an asylum service, which will be open to officerswho have had special experience of the insane. The pay forthis branch also will be sufficiently attractive to draw in

men from outside. I understand also that the jail servicewill be improved so that those officers who wish to devotetheir energies in this direction for a long period will be duly

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rewarded. The long-looked-for re-opening of leave is dailyexpected, as in addition to the assistance sanctioned fromoutside 20 officers have returned from China. It is said thatthe constant work of the past few years has caused officersto break down at their posts and that the amount of invalid-ing is becoming serious. The private medical practitionerswill be engaged for one year. The pay offered is Rs.600 a-month for those holding a diploma in public health andRs.500 a month for others not so qualified.The plague deaths throughout India have again increased

in number this week-viz., from 3277 to 3396. The increaseis entirely in Western Bengal and Bombay city. The figuresfor Bengal are 2261 against 2181 last week. Patna returns1231 deaths ; Saran, 543; Monghyr, 284; Gya, 181; andCalcutta, 54. In Mysore there is a decline from 367 to 272,.and in the Punjab from 55 to 23. In Bombay city, however,there has been a great rise. Last week 308 deaths wererecorded, whereas the deaths to-day are put at 427. Thereare six European cases in hospital, all mild. Of the totaldeaths from plague last week there were only seven children.Since these figures were published the mortality has risenstill further, the deaths for Jan. 30th alone having exceeded100. The general mortality of the city is very high, 1419deaths having been reported during the past week-arate of 89 per 1000 per annum. During the past weekplague has threatened to break out in two other quarters-viz., at Karachi and at Benares. In the district of thelatter city several cases apparently occurred before thedisease was recognised. Two villages are infected. Karachi- city is once more threatened. An indigenous case is reportedand large numbers of dead rats have been found in themarket quarter.The hospital ship Carthage has just arrived from Taku

.after a splendid voyage, bringing three medical officers incharge of 82 native invalided soldiers and about 100followers. The alterations in the hospital ship Gwaliorhaving been completed she will leave Calcutta for Hong-Kong on March 6th.A severe outbreak of beri-beri has continued in the 2nd

Madras Infantry for some time, causing sickness in about25 per cent. of the regiment. The mortality has been lowand most of the men have been able to return to duty.

Feb. 2nd.

THE

ORGANISATION OF THE PROFESSION.

(FROM OUR SPECIAL COMMISSIONER.)

History and Formation of the Northumberland and NewcastleMedical Association.-The Amalgamation with the New-castle Medical Ethical Society.A FEW months ago the dissatisfaction of the Tyneside

colliery surgeons reached an acute phase and consequentlya desire to organise was manifested by various practitionersof the county of Northumberland. Close by, on the otherside of the Tyne, at Gateshead, the parent association forthis part of England, the union of the medical men of thattown had given the example of- useful and successfulorganisation. There was also at Newcastle a medicalethical society, but the idea then germinating was in favourof the more widespread organisation of a county rather thanthat of a mere local society. For this there was also an

example close at hand in the County of Durham MedicalUnion. On the other hand, the latter society was naturallyparticularly anxious to see their nearest neighbours organiseon similar lines to themselves. Indeed, this is how themovement is likely to spread. First the practitioners of atown form a union, then they find that their efforts arelikely to miscarry because the practitioners in the outlyingdistricts and surrounding country have not adopted the sameprinciples and policy as themselves, consequently effortsare or will be made to bring the whole county into union. ’,But hardly is this achieved than the county, as a unit, feels ’,itself at a disadvantage if the neighbouring counties are notlikewise organised, and thus the movement, to be thoroughand absolutely effective, must spread from county to countytill the medical men in all parts of the kingdom are unitedtogether for the maintenance of the same principles, theenforcement of the same means of action, and the defence ofthe same interests.

In Northumberland matters were brought to a head bydifficulties which arose between the Backworth miners andthe colliery surgeons of that district. The County of DurhamMedical Union thought that the psychological moment hadarrived when something might be done to crystallise thesomewhat vague aspirations of the Northumberland medicalpractitioners. They consequently arranged to hold a meet-ing at the County Hotel, Newcastle-upon-Tyne, on

August 23rd, 1900, and inserted advertisements in thelocal press inviting medical men to attend. The responsewas not very encouraging, for only a few practitioners werepresent. This, it should be noted, is what very generallyhappens. The first step is always the most difficult, andno experienced organiser would allow himself to be dis-

couraged because the earlier efforts meet with but slightsupport. The meeting, though small, did good work. Theydetermined to form a society and appointed Mr. RutherfordMorison as the President pro tem. They also selected asecretary, decided that a draft of rules should be prepared,and circulars were sent to all the practitioners inviting themto another meeting at which the union should be definitelyconstituted. This convocation differed from most of theother similar efforts that have been made, for it not onlyurged the advantages of organisation, but proposed imme-diate action and took the form of a plébiscite. With thecircular there was a card which was to be returnedto the secretary with answers to the following ques-tions :-

1. Are you in favour of an increase of the rate of professionalremuneration from 6d. to 9d. per fortnight for every adult workman ?

2. Will you support a combined effort on the part of the medicalprofession to obtain this object?

. The second meeting was held in the library of -the Royal

Infirmary on Sept. 6th and this time there was a goodattendance. It was then definitely decided to form amedical union, and a committee was appointed carefully toexamine and revise the proposed rules and to study thequestion of the remuneration for contract work according tothe information that was now coming in from all parts ofthe country. Then a third and final meeting was held onSept. 20th when the rules were adopted and the society wasdefinitely constituted. The adoption of rules often causesmuch discussion and loss of time. In this case, however,the precedent established in the county of Durham served asa guide and it required hardly more than an hour to explainand vote upon the rules. Thus it will be seen that asexperience extends the work of organisation becomes

simplified. The dispute with the Backworth miners and theprogramme for future action was not so readily settled ; butit was very generally felt that it was absolutely necessary tofix definitely a minimum rate of remuneration for collierycontracts ; that not only must all members pledge them-selves to observe this rule, but that it was necessaryto create a fund to compensate those who might bevictimised in this effort to improve the position of the pro-fession. For the general purposes of the medical union eachmember was called upon to pay an annual subscription ofhalf a guinea ; but the indemnity fund, as it is called,is maintained by supplementary and voluntary subscrip-tions collected as the emergency arises, according tothe necessities of the case and the means of the sub-scribers.The next step was to effect an amalgamation with the

Newcastle Medical Ethical Society, which had been inexistence for more than a year and which had done excellentpioneer and educational work. This society was, however,limited to the town of Newcastle, and both organisationsfelt that it would be to their mutual advantage to

amalgamate, and this was effected on Nov. 6th. The ruleswere slightly modified so as to comprise the principles of thetwo organisations and the amalgamation thus brought aboutis entitled the Northumberland and Newcastle MedicalAssociation. Its object as the rules now stand is :-To protect the interests of members of this association generally, but

more particularly from unfair competition and from any attempts thatmay be made to induce or compel medical practitioners to accept insuf-ficient remuneration for professional services. To establish and maintainminimum rates of payment for medical contract work in relation to allclasses of workmen, members of friendly societies, sick and other clubs,lodges, insurance and other companies, and societies. To coöperatewith and assist (when requested) the members of all approved localmedical associations in carrying into effect any of the resolutionspassed by such associations as may be approved by a majority of themembers of this association in general meeting assembled.

On Dec. 20th another general meeting was held and a