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it does not harmonise with the assumption that the bacilliare the cause of the disease, seeing that the anatomicalchanges and amount of flakes and fluid are as marked in otherparts of the intestinal tract. But their observations aredirectly opposed to Koch’s upon the important point of thepresence of comma bacilli in the superficial layers of themucous membrane, and they detail cases in which the post-mortem examination was made very shortly after death,when they failed to detect comma bacilli within the mucousmembrane, employing the same methods as Koch. Thissuffices, they think, to dispel the notion that the commabacilli produce the disease. They say: " As must be evidentto everyone who has carefully read Koch’s description andarguments, the constant presence of crowds of the commabacilli in the mucous membrane of the lower part of theileu.m in acute typical cases of cholera forms, as it were, thefoundation for his whole theory of the relationship of thesebacilli to the disease; and therefore, if even in one singleinstance only of acute typical cholera (and with so muchgreater force in several such cases) it can be shown thatthe comma bacilli are absent from the mucosa of the lowerpart of the ileum, then the theory that these bacilli are

Iessential in producing the illness must be abandoned."Even if their absence from the tissue be conceded, it wouldbe absurd to suppose that they could be present in suchnumbers as to generate sufficient poison early in the disease,for it could not be absorbed during the attack; whereas thebacilli are often very scanty and limited in acute cases, andmoreover are only present in dead tissues-viz , mucous flakes-like other putrefactive organisms. As regards the cultureexperiments, upon which so much stress is laid as provingthat the choleraic comma bacillus differs from other comma-shaped organisms, Drs. Klein and Gibbes find that aciditydoes not inhibit the growth of the comma bacillus, and donot agree that the liquefaction of gelatine occurs in aspecially peculiar and characteristic manner. They alsomention their failure to find comma bacilli in the organs ofthe body and in the blood, and proceed to inquire whetherthere is any other micro-organism which could be reasonablysupposed to be the cause of the disease. They detected in casesexamined very soon after death mucous corpuscles whichwere filled with very minute straight bacilli, and attributeKoch’s silence about them to the fact that his examinationswere not made sufficiently soon after death. These bacilli areabout half to two-thirds the thickness of comma bacilli, andabout one-third to one-fourth their length; straight, pointedat each end. The mucous corpuscles probably come fromthe lymphatic tissue of the alimentary tract, and since noneof these bacilli were found in any living tissue, the lattermust be regarded as extraneous and unconnected with thedisease. The characters of these bacilli on cultivation arealso described. Descriptions are then given of attempts toinduce cholera by feeding animals with choleraic evacua-tions and with cultivations of comma bacilli, and alsoinoculation experiments, especially by the direct introductionof comma bacilli into the intestine; but it is needless toreproduce them. Suffice it to say that they do not bear outthe conclusions of Nicati and Rietsch, of Koch and others,and that the fatal results obtained by these observers areattributed to the effects of the operative procedure employed,and not to the introduction of cholera virus.

Drs. Klein and Gibbes have also added two appendices totheir report. One is on the relation of bacteria to Asiaticcholera, in which it is argued in detail that the knownfacts concerning cholera do not harmonise with the theorythat requires the virus-producing organism to be pre-sent within the body, and contained therefore withinthe evacuations; but rather that the virus is producedby an organism extraneous to the human body, and that thepoison gains entrance by infected water and food. Theother deals with the relation of water contaminated withcomma bacilli to cholera, and is of interest as disprovingthe inferences deduced by Koch from an epidemic sur-

rounding a tank in Calcutta. Drs. Klein and Gibbesexamined the water from this and other tanks, and foundabundance of comma bacilli therein, whilst no cholera pre-vailed among the natives, who used the water from thetanks for drinking and other purposes. We have alreadyreferred to the memorandum of the committee which wasconvened to consider this report (see THE LANCET, Nov. 21 st,p. 962), and have only further to add that the book containsthe minutes of the meetings of the committee as well asnotes upon the inquiry, furnished by Drs. Aitken, Burdon-Sanderson, N. Chevers, De Chaumont, Macpherson, Marston,Sutherland, and Sir W, Smart.

REPORT OF THE MEDICAL OFFICER OF THELOCAL GOVERNMENT BOARD.

[SECOND NOTICE.]

AFTER dealing exhaustively with the influence of vacci-nation, Dr. Buchanan states that Mr. Power,whose researchesinto the influence of the Fulham Small-pox Hospital willbe remembered, has again made further investigation intothis subject. The report summarises the conclusionsarrived at by Mr. Power in 1881, and by the RoyalCommission on Fever and Small-pox Hospitals, and

it shows how the latter conclusions have guidedthe action of the Metropolitan Asylums Board in

diminishing the number of cases of small-pox to be at

any one time admitted into London hospitals to some thirtyor forty acute cases. "It was suggested to the Commis-sioners," says Dr. Buchanan, " that such aggregation of

exclusively acute and severe cases might have in it somenew form of danger of its own; that it might perhaps tendto an intensification of small-pox, giving it either greatervirulence in the individual or fresh power of exten-sion to the neighbourhood." Whether this has beenproved to be the case, or whether it is that small num-bers of small-pox cases are, when aggregated, invariably*potent for mischief, is not certain; but we are now assured,as the result of the Fulham inquiry of 1884, "that excess ofsmall-pox in the neighbourhood of the hospital was quite,and specially, remarkable at a time when the total admissionsto hospital had not exceeded nine." And Dr. Buchanan is ofopinion that of the facts on which this conclusion is based, andof the validity of the inference from the facts, there cannotbe any question. As in 1881, so in 1884, the manifestationof small-pox around the hospital was not consistent withthe theory of human communication between the sick andhealthy ; and the fact becomes more and more evident thatsmall-pox hospitals in the metropolis are a distinct sourceof danger to their neighbourhoods. Finally, the LocalGovernment Board are urged by their own officer to authorisesuch inquiries as to this as will tend to set the matter at rest.The auxiliary scientific investigations which have been

carried out have embraced several difficult problems con-cerning infection and disinfection. Drs. Klein and HeneageGibbes have made inquiry into the mechanism of tuberclecommunication from one animal to another, the workspecially undertaken having been to test the capability oftubercle to be communicated along with food; and ithas been proved that when tubercular matter containingbacilli is administered to certain rodents, whether fromhuman or bovine sources, an identical disease is produced.No subject could well be of more importance, especially ina country where pulmonary phthisis is so fatal. It has formany years past been contended that the milk of tubercularcows constituted a danger to infants, but as yet proof as tothis has not 1 een forthcoming. We are, however, promisedthat this question of tubercle communication will receivefurther study, and that the transmission of the infectionthrough the secretions of infected animals will receivespecial attention. In the meantime, and having regard tothe extent to which tubercle prevails amongst milch cows,we have another indication that it is of great importanceonly to use milk which has been boiled.Another paper deals with croupous pneumonia and the

peculiar micrococcus found in the characteristic sputa ofthat disease, Dr. Klein coming to the conclusion, as theresult of inoculations, cultivations, &c., that such micro-cocci as are really infective in the sputa are accidental, andhe implies that they have access to the sputa during expec-toration. This view receives confirmation as the result ofthe labours of Dr. Sternberg of the United States Army,who has, independently of Dr. Klein, and without the know-ledge of the latter, just issued a paper dealing with muchthe same subject.Some further progress has been made in our knowledge of

chemical disinfectants, but for certain reasons investigationinto this subject progresses but slowly. Several briefpapers sum up our existing knowledge as to this, and,amongst other points, Dr. Buchanan holds that the valueof acid reaction per se to all processes of disinfectionby chemical agencies is fully exhibited. On the ques-tion of disinfection by heat a good deal of informa-tion is supplied, as the result of a somewhat exhaustive in-

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quiry which has been made by Dr. Parsons, in conjunctionwith Dr. Klein. The most stable infective matter withwhich to test the value of heat as a disinfectant was foundto be the virus of anthrax, and this having been settled, along series of experiments was instituted to ascertain thedegree of heat that had to be attained, the combinationsof moisture with heat that were most useful, and themechanism by which the needful conditions for heat dis-infection could best be obtained. For such articles as can bethoroughly penetrated by the process of boiling this methodof disinfection is the best; for articles that cannot be sotreated, high-pressure steam, with an arrangement to securepenetration, may be trusted to destroy any infective poison;and for the few articles that might be injured by steam,exposure to a dry heat of 240° F. suffices, but in the latterprocess the exposure has to be so prolonged as to cause in-convenience when compared with the high-pressure steamprocess. Dr. Parsons, in his report, describes the variousappliances that have been constructed for disinfection pur-poses, and his statements concerning them will be of con-siderable value to sanitary authorities who are desirous ofproviding themselves with an efficient apparatus. To thisportion of the report we hope shortly to recur.An important advance is also reported as having been

made in connexion with the chemical analysis of potablewaters ; Dr. Dupré showing that microphytes may be dis-tinguished from dead organic matter polluting a water, byreason of the fact that during their active existence in waterthey have the property of consuming oxygen for their ownlife processes; and that by observing whether, duringkeeping, a change occurs in the amount of oxygen presentin the dissolved air of a water, the presence or absence ofmicrophytes can be ascertained. Dr. Dupre further indicatesa way in which we may come to recognise micro-organismsin their spore state, and he hopes to be able to distinguishsome microphytes from others.

Dr. Buchanan’s report also deals with other matters, suchas European cholera in 1884, both as regards its epidemicprevalence, and as to the scientific merits of some of thepathological work carried out concerning its etiology.These and other matters we are now unable to refer to, butenough has been said of the report to show that it con-stitutes one of the most important contributions to a seriesof volumes in which the science of hygiene and public healthis dealt with from the point of view of public usefulness.

ROYAL COLLEGE OF SURGEONS OF ENGLAND.

AT an extraordinary meeting of the Council of the

Royal College of Surgeons, held on November 24th, at

which all the members were present, the minutes of the lastmeeting were read and confirmed. It was agreed to summon.a meeting of the Fellows and Members of the College forThursday, December 17th next, as we stated in our last

issue, to receive a statement from the Council in referenceto the resolutions carried at the meeting of Fellows andMembers held on October 29th. The Council wish it to beunderstood that this meeting is not an adjourned one fromthat date, but is summoned to receive and to discuss thestatement, but not to go beyond it.

Report, dated 16th November,from the Council.At a meeting of Fellows and Members of the College, held

On Oct. 29th, the following resolutions were carried:-" 1. That the Council of the Royal College of Surgeons nothaving accepted the principle that Members as well as

Fellows should take part in the election of the Council, inthe opinion of this meeting steps should at once be taken tomemorialise Parliament and the Crown, so as to secure, in’the interest of the public and of the profession, the right torepresentation in the administration of the affairs of theCollege for its 16,500 legally qualified Members. 2. That, inthe opinion of this meeting, no alteration in the Constitutionor in the relations of the College or in any of its bye-laws orordinances shall be effected without the consent of theFellows and Members convened to discuss the same."On these resolutions being reported to the Council on

Nov. 12th, the following resolutions were unanimouslyadopted by the Council" 1. That the Council think it notdesirable to diminish the privileges of the fellowship of the

College by depriving Fellows of the exclusive rights ofelecting to the Council and of being eligible to becomemembers thereof. 2. That, in the opinion of the Council, it isquite impracticable to act on the proposal contained in thesecond resolution adopted at the meeting of Fellows andMembers."With reference to the first resolution of the meeting, the

Council have carefully considered the question which someMembers of the College have recently raised, and it does notappear to the Council that the main argument which theseMembers advance to support their claim, that all the Mem-bers should be entitled to vote in the election of membersof the Council, is a valid one. It is founded on the analogywhich is assumed to exist between the payment of a fee forexamination and the diploma and the payment of taxes.The statement is in effect this: that inasmuch as the pay-ment of taxes by an individual confers on him the right toa vote in the choice of a representative, so the fee which ispaid by a candidate to the College, when he receives from ita diploma which gives him the legal right to practise, alsocarries with it a right to a vote in the election of the Council.The Council are of opinion that the two cases are not alike.The only advantage which the taxpayer secures by the pay-ment of taxes is derived from the outlay of the money whichis thus raised, and it is therefore reasonable that he shouldhave some voice in the manner in which it is spent. But forthe fee which a candidate pays in becoming a Member of theCollege he receives the full value in his diploma. Nay, itmust be said that in his diploma he receives far more thanthe equivalent of his money in the rights, privileges, andimmunities which he thereby acquires. Moreover, there canbe no doubt that the membership of the College carries withit, beyond the right to practise, professional and socialadvantages which are directly derived from the Collegeitself. The argument that the Members of the Collegebeing more numerous than the Fellows, are consequentlyentitled to vote in the election of the council, is to be metby referring to the Charter of 1843, by which a constituencyof Fellows only was provided. The Council would point out(1) that Members of the College, prior to the date of thatCharter are eligible for election as Fellows ; (2) that Membersof a later date can become Fellows by passing the requiredexamination; and (3) that the Council already possess thepower of electing annually two eminent Members of twentyyears’ standing to the fellowship-a power which has been,and may at any time be, exercised. The College of Surgeonshas of late been often spoken of as if it were only a corpora-tion, and the Council had no responsibility or relation exceptto its Fellows and Members. It is a corporation, but itis something more; and the Council are not only therepresentatives of the Fellows, and have not only responsi-bilities to the Fellows and Members, but the College holdsan important relation, and its Council have grave responsi-bilities, to the whole profession, the general public, and theState. The Council cannot regard the Members of theCollege as mere taxpayers to a corporation, and they cannotdiscover in this view, which appears to them inadequate,any support to the claim which is now urged by some Mem-bers. Moreover, this claim could not be conceded withoutserious interference with the privileges of the Fellows. Theexclusive rights of electing members of the Council, and ofbeing eligible for a seat on the Council, are among the chiefadvantages which the College itself confers on the fellow-ship. It appears to the Council neither wise on behalf ofthe College, nor just to the Fellows themselves, to deprivethem of this distinction. The Council passed the resolutionunanimously, as they are strongly of opinion not only thatthe existing rights of the Fellows should be preserved, butthat their rank in the College of Surgeons should be fullyrecognised; for they are anxious, in the highest interestof surgical education, to encourage Members of the Collegeto obtain the fellowship.In reply to the second resolution of the meeting, the

Council regret that they cannot assent to the terms of thesecond resolution of the Fellows and Members. In theiropinion the conduct of the business of the College would beliable to serious hindrance if, for instance, no change in abye-law or ordinance could be effected without the consentof a general meeting of the Fellows and Members. This wouldoften create inconvenient delay, and, in the event of any greatdifference of opinion between the meeting of Fellows andMembers and the Council, lead to complete obstruction. Forthe Council cannot admit that the Fellows and Members ingeneral can be such competent judges of what is required in