1471UNITED STATES OF AMERICA.-OBITUARY.

that every possible thing was done in his opinion to meet theexigencies and requirements of the moment. It has beensaid that the Turk would never submit to anaesthesia forvarious religious scruples. Mr. Osborn, who had been toldthis before he left England, found that it was an idle story.The wounded Turkish soldiers took anaesthetics quitewillingly, submitted obediently to operation, and their

gratitude afterwards was profound. The bravery of theTurks on the field of battle is known, and it is certain thatthe smashing defeat which they have sustained was at anyrate not due to the superior courage of the Bulgarians, butto the complete unpreparedness of the Ottoman army.Nov. llth.

UNITED STATES OF AMERICA.

(FROM OUR OWN CORRESPONDENTS.)

Poliomyelitis among Eskimos.ACCORDING to reports received by Surgeon-General Blue,

of the United States Public Health and Marine HospitalService, from the officers in charge of the health of theEskimos of Alaska, poliomyelitis has appeared among thesepeople for the first time on record. At St. Michael’s fivecases of the disease have been reported with one death, andat Unkaleet, 45 miles distant from the former place, tencases with two deaths. At Sitka also a few cases have been

reported.Child Hygiene in New York City.

Dr. Ira S. Wile has been appointed a member of the NewYork City Board of Education. The Board has provided forthe appointment of two additional medical men for theexamination of mentally deficient children, of an assistantinspector of ungraded classes, and of a social worker tovisit the parents of children of this class.

Unnecessary Street Noises.In the interesting correspondence of THE LANCET’S

Special Sanitary Commissioner at Washington on the recentInternational Congress of Hygiene and Demography,special attention is directed to the paper read by Dr.

George M. Kober on street noises. Nowhere in theworld, perhaps, are street noises so persistent’ and insistentas in the large cities of the United States and Canada.In New York street noises continue day and night,and to one who lives near an avenue through whichelevated trains and tramcars run, the noise is more evidentand unpleasant by night than by day. The CanadianJournal of Medicine and Surgery for November commentseditorially on the street noises of Toronto, and records theopinion of Sir George Reid, High Commissioner for Australia,who recently visited that city, that the Toronto tramcarswere more noisy than any he had ever heard. He had notvisited the United States at that time. In another paperread at the above-mentioned Congress, Dr. C. J. Blake,professor of otology at Harvard Medical School, showedthat the deleterious effect of unnecessary noise was

evident, not only in the changes occurring in the organ of

hearing, but also in the consequent fatigue effect and func-tional disturbance of the nervous system. A great deal ofthe noise incidental to modern life is avoidable. A societvhas been formed in the United States for the suppression ofunnecessary street noises, and near the hospitals of NewYork zones of silence have been established. It is well thatattention should have been drawn to the subject at theInternational Congress of Hygiene and Demography.

Death of Dr. George Montgomery Tuttle.Dr. G. M. Tuttle, a well-known gynaecologist of New

York, died at his house, 38, West Fifty-second Street, onOct. 29th, from angina pectoris. Dr. Tuttle was born inRochester, New York, on Oct. 2nd, 1856. He was

educated at Dresden, Germany, and at Phillips’s Academy,Andover, U.S.A. He graduated in arts at Yale Universityin 1877 and in medicine at Columbia University in1880. He was interne in the New York Hospital from1880 to 1881: physician-in-chief of the New York State

Emigrant Hospital from 1881 to 1883; attending physicianat Bellevue Hospital from 1883 to 1889 ; and professor of

gynaecology at the College of Physicians and Surgeons,New York, from 1886 to 1893. From 1884 up to the time of

his death Dr. Tuttle was attending gynaecologist at theRoosevelt Hospital, New York, and for a part of that timeseived as president of the medical board of that hospital. Hewas also consulting physician to the New York Infirmary forWomen and Children. He was a member of the New YorkAcademy of Medicine. Dr. Tuttle was an important con-tributor to the "American Text-book of Gynæcology." Nov. 12th.

Obituary.ROBERT FLETCHER, M.D. COLUMB.,

M.R.C.S.ENG., L.S.A.,OF THE SURGEON-GENERAL’S LIBRARY, WASHINGTON, U.S.A.

ONE outcome of the Civil War in the United States wasthe collection of a medical library, which has grown to bethe most important in the world. Much of its value dependsupon the colossal work begun by Dr. John S. Billings in1873, as the volumes of the Index Catalogue of the Surgeon-General’s Library are the most important contribution evermade to medical bibliography. Connected from the outsetwith this undertaking was an English physician, Dr. RobertFletcher, and a student of the Bristol School and of theLondon Hospital, whose death, at the age of 90, has just beenannounced by cable. Shortly after taking the diploma of theRoyal College of Surgeons of England in 1844, Dr. Fletcherwent to the United States, and for some years practised inCincinnati. At the outbreak of the Civil War he was appointedsurgeon to the lst Regiment of Ohio Infantry. For two yearshe served in the field, and then took charge of a large hospitalat Nashville, Tennessee. He retired from the army with therank of lieutenant-colonel, and afterwards the rank ofcolonel was conferred upon him for his service duringthe war.

In 1876 he became associated with Dr. Billings in theSurgeon-General’s Library, and together they undertook theherculean task of issuing the famous catalogue. In thefirst volume, acknowledging the valuable assistance received,Dr. Billings remarked that without Dr. Fletcher it wouldhave been impossible to carry out the work ; only those whouse the volumes realise its magnitude. Since 1880 32 foliovolumes have been issued, usually of about 1000 pages each,embracing, as a rule, 10,000 author titles, and representingfrom 4000 to 5000 bound volumes, and from 7000 to 10,000pamphlets. Now in the second series, finishing the letter"S," it forms the catalogue of a library which last yearcontained 176,690 bound volumes and 315,414 pamphlets.To issue the volumes regularly, and with the greatest degreeof bibliographical accuracy, has been the ambition of theauthors. After Dr. Billings’s retirement the work of theIndex Catalogue was carried on by Dr. Fletcher, with theassistance of late years of Dr. Fielding Garrison. In1878 Dr. Fletcher became associated with Dr. Billingsin the Index Medicus, a monthly journal giving the currentmedical literature of all languages. When, after a lapse ofseveral years, the Index Medicus was revived by the CarnegieInstitution of Washington, Dr. Fletcher was chosen editorin chief. For the extraordinary accuracy of both the IndexCatalogue and the Index Medicus Dr. Robert Fletcher wasvery largely responsible. To the last volume every page ofthe Index Catalogue was read by him in proof.

For many years Dr. Fletcher lectured on Medical Juris-

prudence at one of the Washington schools, and subsequentlygave an annual course of lectures on the subject at theJohns Hopkins Hospital School, Baltimore. He wrote

many interesting papers on anthropology, on folk-lore,and on the older English dramatists and poets, inthe literature of which he was thoroughly versed. Dr.Fletcher enjoyed an old age of great mental vigour, andwas at work almost to the end. A few years ago he had aserious illness with a slow recovery, but he got into harnessagain and retained an unfailing interest in the library. The

great Washington Library has exercised a far-reachinginfluence on the profession in the United States, and, underthe fostering care of successive surgeons-general, has becomea centre of research for students from all parts of the

I country. It has the two essential requisites of a publiclibrary-what you ask for you get ; and you are treated with

! courtesy. For its organisation and efficiency two men have

1472 THE NATIONAL INSURANCE ACT.

been chiefly responsible, Dr. John S. Billings, the presenthead of the New York Public Library, and Dr. RobertFletcher.

____

ARTHUR HENRY BENSON, M.A., M.B. DUB.,F.R.C.S. IREL.,

SURGEON TO THE ROYAL VICTORIA EYE AND EAR HOSl’ITAL,DUBLIN, ETC.

THE death occurred on Nov. 6th, at the age of 60,of Mr. Arthur H. Benson, of Dublin. He had been inbad health and unable to work for some eighteen monthspast, and for a week or more before its occurrence hisdeath was expected daily. A son of the late ProfessorCharles Benson, late President of the Royal Collegeof Surgeons in Ireland, and a younger brother of SirHawtrey Benson, late President of the Royal College ofPhysicians of Ireland, Arthur Benson was educated in TrinityCollege, receiving his M. B. degree in 1876. He proceededto the Fellowship of the Royal College of Surgeons in 1881.Taking up the study of diseases of the eye and ear, hewas appointed surgeon to St. Mark’s Hospital, and aural andophthalmic surgeon to the Royal City of Dublin Hospital.On the amalgamation of St. Mark’s Hospital with theNational Eye and Ear Infirmary, he became surgeon to theRoyal Victoria Eye and Ear Hospital, of which institutionhe remained a surgeon to his death. He contributednumerous papers to the medical journals dealing with

ophthalmology. He was President of the Section of Patho-

logy of the Royal Academy of Medicine in Ireland from1909 to 1911.

Mr. Benson was a man of singular charm and amiability,who won respect both by his personal character and byhis professional ability. He was fond of outdoor sports,particularly of sailing and golf. His widow and brother

may be assured of the sympathy of his professional brethren.

DEATHS OF EMINENT FOREIGN MEDICAL MEN.-The deathsof the following eminent foreign medical men are announced :We regret to learn from La Semana Mediecc, of Buenos

Aires, of the death of a distinguished Argentine physicianand philosopher, Dr. Porfirio Parra, President of the Physio-logical Section of the National Academy of Medicine. Heencountered a good deal of opposition in his literary andphilosophical work, as his views were not those heldin favour by the generality of Argentine writers. Hischief published work was entitled "A New System ofInductive and Deductive Logic," in which he followedgenerally the principles of Mill and Bain.-Dr. RobertoLloveras, a distinguished Buenos Aires physician, aged61. His services to the Argentine Republic duringthe epidemic of cholera in 1887, when he was oneof the Commission appointed by the Government to takemeasures for combating the disease, were greatly valued.In early life he visited the London and Paris medicalschools and paid special attention to laryngology andotology. -Dr. V. Camparan, formerly Senator for theHaute Garonne.-Dr. Henri Dor, of Lyons, formerly pro-fessor of ophthalmology in the University of Berne.-Dr. H.Hildebrandt, privat-docent of pharmacology in the Universityof Halle, in consequence of an Alpine accident.-Dr.Wilhelm Ebstein, medical Privy Councillor and emeritus pro-fessor of medicine in the University of Gottingen, at the

age of 75. He was a student under Frerichs, Romberg,Traube, and Virchow. His first appointment was inBreslau, but in 1874 he was invited to become pro-fessor of medicine in Göttingen. His papers and articlesin medical encyclopaedias were numerous, and dealt chieflywith food, the organs of digestion, and gout. He also wrotevaluable articles in various journals on medical and semi-medical subjects, including many of a historical nature.-Dr. Diims, president of the Leipsic Rescue and SamaritanSocieties, at the age of 62. He was surgeon-general inthe Saxon army.-Dr. M. Jacoby, medical councillor,of Friedrichshagen.-Dr. F. Giinnemann, of Lemgerich,medical councillor.-Dr. N. Nahm, of Frankfort, medicalcouncillor.-Dr. 0. Lowe, of Dresden, who was also a doctorof philosophy.-Dr. Haustaedt, of Elgersburg, Gotha,medical councillor.-Dr. 0. J. Lauper, chief surgeon ofthe Interlaken District Hospital, after an operation whichwas performed on him in Berlin. He was privat-docent ofsurgery in the University of Berne.--Dr. Heinrich Kadyi,

professor of anatomy in the University of Lemberg, in con-sequence of extremely virulent septic poisoning, contractedwhile embalming the body of a member of the localnoblesse.--Dr. Descroizilles, formerly physician to theParis hospitals.-Dr. E. de Cyon, of Paris, formerly pro-fessor in the Faculty of Science of the University of St.Petersburg.-Dr. Boucaucl, of Bordeaux, formerly physicianto the Lyons hospitals.

THE NATIONAL INSURANCE ACT :

THE SPECIAL REPRESENTATIVE MEETING OF THE

BRITISH MEDICAL ASSOCIATION.

THE Representative Body of the British Medical Associa-tion began its sixth meeting since the introduction of theGovernment’s scheme for National Health Insurance on

Tuesday, Nov. 19th, at 10 A.M., in the Connaught Rooms,London. For permission to publish the following accountof the proceedings up to the time of our going to press weare again indebted to the Executive of the Association. Withthe consent of the Representative Body a member of thestaff of THE LANCET was present during the meeting, whichwas private throughout, though an official account of the

proceedings has been given to the press. The purpose ofthe meeting was to receive and consider the report of theCouncil (published in our issues of Nov. 2nd and Nov. 9th)and to pass resolutions connected with that report.The chair was taken by Mr. T. JENNER VERRALL, the chair-

man of Representative Meetings, whose fairness and abilityin this position had already gained for him the confidence ofall members. After the disposal of formal business thechairman drew attention to the fact that by the Articles ofthe Association it was necessary for a decision of the Repre-sentative Body to be passed by a two-thirds majority inorder to become valid as the. policy of the Association.Whilst recognising the existence of a division of opinionupon certain vital points, he appealed to the Representativesto do their utmost to preserve the integrity of theAssociation.A debate which lasted some time was then opened by Dr.

T. A. HELME upon the order in which the business of the

meeting should be taken, and it was agreed that the Repre-sentative Body should not discuss the Council’s report untilit had decided by vote whether service should be acceptedor not under the conditions laid down by the Regulations andexplained by the Chancellor of the Exchequer. A motion

by the Bradford Division was then discussed at length, andafter both sides had been heard this was carried in the

following amended form :-That in the opinion of this Representative Meeting the Regulations

issued by the Insurance Commissioners and the latest proposals of theChancellor of the Exchequer are unworkable and derogatory to theprofession. As a consequence, the medical profession declines to takeservice under the Act and Regulations as at present constituted.The discussion at this stage mainly centred around the

form of words in which the general feeling of the meetingshould be conveyed. When this had been settled anothervery long debate began upon the question of reopeningnegotiations with the Commissioners and the Government.As had been foreshadowed by the published decisions ofmany Divisions of the Association, the Representative Bodyshowed a complete cleavage of opinion upon this matter, andeach side was vigorously represented. --

As an amendment to a motion paving the way to a con-ference with the Chancellor of the Exchequer, with a view tothe settlement of the points on which the demands of theprofession had not yet been met, it was proposed by Mr.R. HARDING, and seconded by Dr. HELME :-That this Representative Meeting instructs the medical secretary to

forward to the Chancellor of the Exchequer a copy of the resolutionpassed this morning by an overwhelming majority, and to inform himthat any further proposal of the Government for meeting the graveobjections of the profession shall receive the most careful considerationof the Association.

In the discussion arising out of this motion and throughoutthe day many speakers emphasised the fact that the con-ditions of service proposed by the Regulations, and not theterms of remuneration, lay at the root of the objectionof the medical profession to take service under the Act.When the above amendment, which in the chairman’s view