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the medical profession, trusts that in the coming year nothing willdeter the Council from discharging its duty to its Fellows and Membersas firmly and as faithfully as it has done in the year that is past.Mr. Hardy recounted the action of the Council in

declining to join the proposed committee to carry out theAct, but consenting to assist in drafting an amending Act,and referred to the fact that the Council had been scolded

by Mr. Lloyd George, who had told the Council that itwas unfit for its duties and that the lowest strike committeein the country would have acted better. It was clear that no

satisfactory arrangement could be made without an amendingAct. Even the British Medical Association, after a greatattempt to secure reasonable terms, had given up in despair.Mr. Lloyd George had endeavoured for a long time to compelthe medical profession to accept terms, which now he con-fessed were insufficient for proper remuneration, yet hethreatened that if they did not accept his present offer hewould set up a whole-time service. Although he had

improved his offer to a slight extent he had added newduties. Mr. Lloyd George could not be trusted.Mr. E. B. TURNER seconded the resolution, but he pointed

out that he could hardly agree with the proposer that theBritish Medical Association had given up the struggle indespair, for the Association was still fighting, and wouldcontinue to fight. He had been present on the previous daywhen the meeting of Representatives had sat till past12 o’clock at night, and he knew that the meeting had beenvery enthusiastic. It was not understood by the public thatthe money question was the least important of the mattersfor which they were fighting.

Sir VICTOR HORSLEY said that the question of theamount of payment had always been the central subject.

After Dr. DAY and Mr. COLLINGWOOD had spoken, Dr.ATKINSON suggested the omission of the later words of theresolution, and in this he was supported by Dr. DENNISVINRACE.

Dr. DICKINSON then moved as an amendment thatall the words be omitted after the first occurrence ofthe word Act, and that the words so far as it has

gone " should be added, so that the resolution wouldread: "That this meeting of Fellows and Members

approves and endorses the action of the Council taken

during the past year in reference to the National InsuranceAct so far as it has gone." This amendment was secondedby Dr. LAWRENCE.

Dr. GEORGE JONES urged that it was at present impossibleto guess the effect of the Act, and suggested that timeshould be allowed for seeing how it worked.When the resolution was put to the meeting it was

carried, but many of those present did not vote on eitherside.

Representation of ]ýIembers on Cmlncil.Sir VICTOR HORSLEY then introduced the following

resolution-That this twenty-eighth annual meeting of Fellows and Members

again flffirrns the desirability of admitting Members to direct representa-tion on the Council, which as now constituted only represents thoseMembers who also hold the Fellowship ; and that it does so in orderthat the constitution of the Royal College of Surgeons of England shallbe in keeping with modern ideas of true representation.

He said that the Members of the College had been deprivedof their rights ; the only right left them appeared to be thatthey had the privilege of providing a very large proportionof the income of the College. The Council by its action haddeclared that it did not consider the Members to be fit

persons to be represented on the Council, and yet no reasonhad been given for such an opinion. At the annual meetingin 1910 Sir Henry Morris had declared that the Council’sreasons for refusing the right of representation to theMembers had been set out in a statement by theCouncil some years before, but Sir Victor Horsley hadfound that the only statement made by the Councilwas contained in a memorandum sent by the Councilto the Privy Council, after the Members had presenteda petition to the Privy Council in 1907. This statement bythe Council really contained no arguments, but merely saidthat the Members were unfit for representation. The

present constitution of the College was neither one thing northe other ; it was neither a medieval guild nor a moderninstitution, for even in 1435 the rules of the Guild of

Surgeons stated that all the members of the Guild should ’,meet vearlv and choose the officers of the year.

Dr. J. OLDFIELD seconded the resolution, and complained

that in spite of the repeated demands from the Members theCouncil always returned the same answers.

Sir ALFRED PEARCE GouLD said that as a member ofCouncil he felt that he must express the reasons of theaction of the Council. The duties of the Council were not

legislative or political ; the duties of the Council were threein number. In the first place they had to take care of theincomparable Hunterian Museum ; secondly, to take care ofthe valuable library which the College possessed ; and thirdly,to superintend and to conduct the examinations in surgery.Could it be maintained that the addition of Members to theCouncil of the College would in any way assist in the

carrying out of these duties ? Moreover, it must beremembered that there were over 17,000 Members, and thecarrying out of an election with so many constituents wouldbe a very expensive matter, costing several hundred pounds.He did not consider that it would be either wise or

practicable to grant to the Members representation on theCouncil.

Dr. FITZGERALD believed that the Members were as fullyfitted for looking after the museum as the Fellows.

Mr. CoLLINGWOOD urged that the request was reasonable,and he was sure that the Members had no wish to interferewith the administration of the College.

Dr. JOSEPH SMITH expressed his agreement with thespeeches of the mover and seconder of the resolution.

Dr. VINRACE claimed that it was incorrect to say that themembers of the Council were not legislators, for they hadto legislate. He appealed to the Council to act in a moreup-to-date manner.

Dr. Roxl3oxouGH was in favour of giving the power ofelecting the President of the College to the Members, and hemaintained that the position would be one of much moredignity than it was at the present time. The rectorship of aScotch university was a position of great importance anddignity, and yet the rector was elected by a popularelectorate.

After Sir VICTOR HoRSLEY had briefly replied theresolution was put to the vote, and it was carried neg2iiiwcontradicente.

Dr. DICKINSON then introduced the following resolution :-That this meeting regrets that the Council has not called a special

general meeting of Fellows and Members to consider the NationalInsurance Act.

Dr. LAWRENCE seconded and it was carried.There were present 86 Members and 18 Fellows, including-

10 members of Council.

Public Health.REPORTS OF SCHOOL MEDICAL OFFICERS.

Connty Borough of Halifax.-As a commentary on thefigures for pulmonary tuberculosis in the county ofCumberland it is interesting to note those obtained byexaminations in Halifax by Dr. D. M. Taylor. Among 2363children inspected there were 25 cases of pulmonary tuber-culosis, or only 0-9 per cent., the methods used for

diagnosis being careful physical examination. The differ-ence between 2-9 per cent. or 2-2 per cent. and 0’9 percent. can hardly depend on difference in incidence in twoplaces in the North of England, and suggests forcibly theneed for adjusting methods of diagnosis to some definitestandard. With regard to attendance, it is noted thatexternal eye diseases, skin diseases, impetigo, vermin,itch, and ringworm account for 30 per cent. of the attend-ances lost during 1911, and that all these defects could betreated in a properly equipped room. One epidemic ofimpetigo was traced to infection by plasticine. Methods oftreatment are not, however, satisfactory, only 50 per cent.of cases of enlarged tonsils and adenoids needing activetreatment obtained it, and very little is done for teeth,although 34 per cent. had four or more carious teeth. A

large part of the report is devoted to the open-air school atBermerside, and some good photographs are given. Therewere 144 scholars on the admission register, and improve-ment was noted in a large proportion, but a persistentform of ansemia was noted which improved little. Two-thirds of the pre-tubercular cases benefited, 50 per cent. ofthe early phthisis group, the tubercular gland cases cleared

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up, neurotic cases did well, rickets also, and the con-

valescence of the later stages of chorea was shortened. TheBermerside residential open-air school for 30 children is alsoreported on at length, and, although too lately establishedto warrant much emphasis on results, has yielded somestriking immediate benefits. The average increase in weightfor the first batch of scholars during the three months,December, January, and February, was 4’7 7 lb. Dr. Taylorthinks that in the end residential open-air schools may befound cheaper than open-air day schools.

- 2?c?*oMA of Great YarJJ1o11th.-Mr. A. N. Stevens notes thatGreat Yarmouth was the first town to institute an InspectionClinic, and 11 per cent. of the total number of children

passed through it during the year. A great reduction in

ringworm cases is observed during the four years of work.No arrangements for treatment by the authority exist, andout of 1007 children needing medical treatment only 206obtained it. A special class has been formed for mentallydefective girls. Two school nurses are employed who alsoact under the sanitary authority as lady health visitors.

City of Bristol.-Dr. T. A. Green urges the establishmentof an open-air school on the ground of "the increasingnumber of children excluded for phthisis and other diseases."Ringworm treatment is conducted at five centres, a semi-deaf class is held, and the medical inspectors of the DeafInstitution and an Industrial School treat such cases of illnessas may arise amongst the children. A total number of

14,439 children were inspected, and 23’ 53 per cent. found tobe free from defects needing treatment. There are twoschools for mentally defective children who remain under thecare of an after-care committee on leaving school. 141

physically defective children are also provided for in

premises used for the mentally defective. Treatment ofdefects found does not appear to be very thorough, and thecare committee organisation does not appear altogethersatisfactory. The work of the authority in segregatingspecial groups of cases, semi-deaf, semi-blind, mental andphysical defectives, is, however, admirable.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN the 95 largest English towns, with an aggregate popular Ition estimated at 17,639,881 persons at the middle of thisyear, 8185 births and 5091 deaths were registered during theweek ended Saturday, Nov. 23rd. The annual rate of

’mortality in these towns, which had been 14’0, 14’8,and 14’1 per 1000 in the three preceding weeks, rose

- to 15’ 0 per 1000 in the week under notice. During the first-eight weeks of the current quarter the mean annual death-rate in these large towns averaged 13’ 9 per 1000, against 14’ 8in London during the same period. The death-rates in theseveral towns last week ranged from 5-6 in Ilford, 5-8 inDewsbury, 6’1 in Blackpool, 7’1 in Derby, and 7-2 in

Ealing and in Enfield, to 21-4 in West Ham, 21-5 inMiddlesbrough, 22-0 in Stockton-on-Tees, 22-2 in Preston,and 26-4 in Bootle.The 5091 deaths from all causes in the 95 towns were 330

tin excess of the number in the previous week, and included.552 which were referred to the principal epidemic diseases,against numbers rising from 421 to 513 in the four pre-ceding weeks. Of these 552 deaths, 334 resulted from measles,86 from infantile diarrhceal diseases, 49 from whooping--cough, 41 from diphtheria, 25 from scarlet fever, and 17-from enteric fever, but not one from small-pox. The meanannual death-rate from these epidemic diseases last week- was equal to 1’ 6 per 1000, against 1’ 5 in each of the twopreceding weeks. The deaths attributed to measles,which had been 224, 296, and 293 in the three

preceding weeks, rose to 334 last week, which was

the highest number recorded in any week of thecurrent year ; the highest annual death-rates lastweek from this disease were 2-9 in Northampton, in

Birmingham, in Middlesbrough, and in Newcastle-on-Tyne, 3-3 in Coventry, 3-8 in East Ham, 4-1 in WestHartlepool, 5-1 in Bootle, and 6-6 in West Ham. Thedeaths of infants under 2 years of age referred to diarrhoeaand enteritis, which had been 107. 82, and 85 in the threepreceding weeks, were 86 last week, and included 27 inLondon, 8 in Liverpool, 6 in Manchester, 4 in Birmingham,.3 in Nottingham, 3 in Burnley, and 3 in Sheffield. The

fatal cases of whooping-cough, which had been 36, 30, and41 in the three preceding weeks, rose to 49 last week ;17 deaths were registered in London and its suburbandistricts, 6 in Liverpool, 4 in ’Stoke-on-Trent, and3 in Bristol. The deaths attributed to diphtheria,which had been 43, 52, and 52 in the three precedingweeks, declined to 41 last week ; 5 deaths occurred in

London, 4 in Portsmouth, 4 in Manchester, 3 in Birmingham, and 3 in Preston. The deaths referred to scarlet fever,which had been 24, 32, and 27 in the three preceding weeks,were 25 last week, and included 6 in London, 5 in Birming-ham, and 2 in St. Helens. The fatal cases of enteric fever,which had been 15, 18, and 14 in the three preceding weeks,were 17 last week, of which 2 were registered in London and2 in Birmingham.

.. n .... u. ",

The number ot scarlet tever patients in tne iuetropoutanAsylums and in the London Fever Hospital, which hadbeen 2279, 2350, and 2335 at the end of the three precedingweeks, were 2336 on Saturday last; 296 new cases of thisdisease were admitted to these institutions during the week,against 279, 326, and 254 in the three preceding weeks.These hospitals also contained on Saturday last 913 cases ofdiphtheria, 699 of measles, 233 of whooping-cough. and 46 ofenteric fever, but not one of small-pox. The 1354 deathsfrom all causes in London were 104 in excess of the numberin the previous week, and were equal to an annual death-rate of 15’ 6 per 1000. The deaths referred to diseases ofthe respiratory system, which had been 274, 227, and 243 inthe three preceding weeks, rose to 283 last week, and were40 in excess of the number in the corresponding week oflast year.Of the 5091 deaths from all causes in the 95 towns last

week, 191 resulted from different forms of violence and426 were the subject of coroners’ inquests. The causes of 34,or 0’7 per cent., of the total deaths were not certifiedeither by a registered medical practitioner or by a

coroner after inquest. All the causes of death were dulycertified in Sheffield, Leeds, Bristol, West Ham, Bradford,Newcastle-on-Tyne, Nottingham, and in 68 ’other smallertowns. The 34 uncertified causes of death last weekincluded 8 in Birmingham, 5 in Liverpool, 2 in Stoke-on-Trent, 2 in Bootle, and 2 in South Shields.

HEALTH OF SCOTCH TOWNS.

In the 18 largest Scotch towns, with an aggregate popula-tion estimated at 2,182,400 persons at the middle of this year,1040 births and 753 deaths were registered during the weekending Saturday, Nov. 23rd. The annual rate of mortality inthese towns, which had been 16’1, 15’4, and 16’3 3 per 1000in the three preceding weeks, further rose to 18’ 0 per 1000in the week under notice. During the first eight weeks ofthe current quarter the mean annual death-rate in theseScotch towns averaged 15’0 per 1000, against 13’9 in the95 large English towns during the same period. Amongthe several Scotch towns the death-rates last week rangedfrom 10’ 0 in Motherwell, 10’ 6 in Hamilton, and 12-4 in Ayr,to 20’8 8 in Paisley, 22 5 in Kilmarnock, and 25’1 in Leith.The 753 deaths from all causes were 70 in excess of the

number in the previous week, and included 48 which werereferred to the principal epidemic diseases, against 43 and37 in the two preceding weeks. Of these 48 deaths, 15resulted from whooping-cough, 11 from infantile diarrhcealdiseases, 10 from diphtheria, 6 from scarlet fever, 2 fromenteric fever, 2 from measles, and 2 from small-pox. These48 deaths from the principal epidemic diseases were equalto an annual death-rate of 1-1 per 1000, against 1-6 6per 1000 in the 95 large English towns. The deaths attri-buted to whooping-cough, which had been 14, 8, and11 in the three preceding weeks, rose to 15 last week,and included 10 in Glasgow and 3 in Govan. Thedeaths of infants under two years of age referred todiarrhoea and enteritis, which had been 16, 12, and 10 intne cnree preceaing weeKS, were 11 last week, ot wmcu

number 5 were registered in Glasgow and 2 in Dundee.The fatal cases of diphtheria, which had declined from 12to 6 in the four preceding weeks, rose to 10 last week,and included 6 in Glasgow. The 6 deaths attributed toscarlet fever were 2 in excess of the average in the earlierweeks of the quarter, and included 3 deaths in Glasgow.The fatal cases of measles occurred in Glasgow andFalkirk respectively, those of enteric fever in Aberdeen andLeith respectively, and those of small-pox in Kirkcaldy.