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from a mountainous area. The medical officer of healthmust be given confidence ; he did not know how to tread.Parliament could not deal with local problems ; they mustbe dealt with locally. Parliament could legislate, but thework must be done in the locality. If the foothold of thelocal officers was a slippery one they could not do theirwork ; it was impossible when a man was liable to be dis-missed at three months’ notice. As Mr. Domville had said,it was not easy for a medical officer of health to begin a newcareer, because his training and experience incapacitatedhim for a class of work to which he might otherwise havedevoted himself-namely, the building-up of a private practice.Therefore, when the community invited men to do work whichwas the most important they could undertake, it was the dutyof the community to stand at their backs and protect them.He was whole-heartedly in sympathy with the demand

put forward. So important did the Government considerthe position of local medical officers of health that whenthe Budget was being framed, and it was a question of dis-tribution of grants, it was felt that there ought to be

specific grants for the payment of a substantial partof salaries of local officers. That put the central

authority in a position to demand better terms from localauthorities, and it was an important feature of the grant.The great majority of local authorities would welcomethe change, although there might be interests which wouldbe opposed, for he was sorry to say that in some areas

people got elected purely to protect certain interests.He understood the President of the Local GovernmentBoard was considering the question of superannuation,but that he was not satisfied with the scheme put forwardas far as medical officers of health were concerned.Meanwhile, it was important that medical officers ofhealth should have a superannuation scheme, because, forone reason, it was the only way of getting rid, withouthardship, of men who were past their work. He was gladto see Members of Parliament on both sides of the Housepresent with the deputation. No Government was all-

powerful in a Parliament. In order to carry throughmeasures of this kind, which were non-contentious, whichdid not arouse partisan zeal, and so did not get behind themthat sort of hydraulic pressure which ensured their passing-in respect of such measures it was necessary to obtain acons iderable amount of support from both sides of the House,and he would invite Members on both sides to negotiatethat kind of support for a measure which would deal withthis problem.Mr. Lloyd George then left to meet a deputation

elsewhere.Mr. HERBERT SAMUEL said that the claims of the

deputation really divided themselves into two parts : First,those relating to the tenure of their offices, and, secondly,those relating to the superannuation of medical officers ofhealth and sanitary inspectors. With respect to the ques-tion of security of tenure, he had held the view for manyyears, and had expressed it on more than one occasion,that the country could not expect really efficient adminis-tration of the health laws unless officers concernedwere protected from the injustice which might now

penalise them as a result of conscientious work. He pro-posed to take the question in hand straightway andfirst to consider how much could be done under theclauses of the Finance Bill to obtain this security of tenurewithout legislation, because he believed it might be possibleto effect a great deal without waiting for the slow processesof Parliament and the chances of a Bill. One of the diffi-culties placed in the path of medical officers of health wasthe fact that nearly four-fifths of them were engaged inprivate practice and their work might be affected by theprivate interests of patients. Therefore it had long been thetendency of the Local Government Board to urge that when-ever possible whole-time appointments should be created. Theexhortation had not always fallen on willing ears. Localauthorities sometimes, because they liked to keep entire con-trol over the appointments they made, were unwilling to com-bine with their neighbours. Whenever possible medicalfunc-tions were combined, and the Local Government Board and theBoard of Education had made it a practice to encouragethe combination of education medical officership and publichealth appointments, and that policy would continue. Butwhen the question of security of tenure was being considered it had to be taken into account that while the principle

was wholly right for whole-time men, where part-timemen were concerned it might be advisable not to maketheir positions permanent, but to pave the way for theirsupersession by whole-time officers. In general he agreedthat there should be security of tenure also for sanitaryinspectors. With regard to a superannuation and pensionscheme, Mr. Samuel said that in many cases medicalofficers of health retained their posts until they reached75, 80, or more years ; they could not afford to give upthe posts, and the local authorities would not inflictthe hardship of calling upon them to retire. He wasadvised that the Superannuation Bill introduced by SirPhilip Magnus last year was not actuarially sound ; thatthe benefits proposed could not be provided by the con-

tributions which the Bill suggested, and therefore theGovernment could not advise Parliament to assent to it.Furthermore, he found it difficult to distinguish the case ofthe medical officers of health and sanitary inspectors inregard to superannuation from that of other local authorityofficers. As to security of tenure, there was a differencebecause of the fact that other officers were not exposed tothe same difficulties as medical officers of health and sanitaryinspectors. But in regard to superannuation, all that hadbeen said by the deputation might be said with equal truthby representatives of other classes of officials of localauthorities, and he was receiving this month a deputationfrom the National Association of Local Government Officers,who would come to urge the very arguments that the medicalofficers of health and sanitary inspectors had urged. Hethought it would be wise for him to reserve any remarkshe had to make on this subject until he had heard thatdeputation.’ Mr. HERBERT JONES reminded Mr. Samuel that he had

not referred to the subject of travelling expenses.Mr. SAMUEL : That seems to be a matter for you to discuss

with local authorities when making agreements with them.Do you suggest that the Local Government Board, bylegislation or by some other means, should make it obligatoryon the part of local authorities to pay expenses ? Whatmeans do you suggest ? Mr. HERBERT JONES said the payment of travelling

expenses by local authorities should be obligatory.Mr. J. A. PEASE remarked that if there was one branch ofthe Government service which was keenly concerned abouthealth it was the Board of Education. The problem ofeducation was primarily physical, and it was absurd toexamine children medically in the schools and to have themtreated if they returned from healthy schools into slums andunhealthy surroundings.

Dr. ADDISON then thanked the Ministers for receivingthe deputation, and said he believed he oould say, on

behalf of fellow Members of Parliament who were

interested in this question, that they would take theChancellor’s hint as to non-political cooperation and act

upon it.The proceedings then terminated.

ROYAL COLLEGE OF SURGEONS OFENGLAND.

MEETING OF COUNCIL.

AN ordinary meeting of the Council was held on June llth,Sir RICKMAN GoDLEE, the President, being in the chair.A report was read from the Board of Examiners in

Anatomy and Physiology for the Fellowship, stating that atthe recent examination 122 candidates were examined, andof these 40 were approved.A report was read from the Court of Examiners, stating

that at the recent examination for the Fellowship therewere 75 candidates, and of these 40 acquitted themselvessatisfactorily.

In was resolved to issue Diplomas of Fellowship to thesuccessful candidates. It was resolved to issue Diplomas ofthe Licence in Dental Surgery to 7 successful candidates.

In accordance with the recommendations of the Nomina-tion Committee the following examiners were appointed forthe ensuing year -Elementary Biology : George P. Mudgeand Walter G. Ridewood. Anatomy under the ConjointBoard : John Cameron, J. E. S. Frazer, and A. Melville

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Paterson. Physiology under the Conjoint Board: C. F.

Myers-Ward and Herbert E. Roaf. Anatomy for the Fellow-- shiv : W. H. Clayton-Greene, R. W. Reid, Gordon Taylor,.and William Wright. Physiology for the Fellowship : G. A.Buckmaster, John S. Edkins, H. W. Lyle, and A. RendleShort. Midwifery under the Conjoint Board : H. R.

.Andrews, W. Blair Bell, C. H. Roberts, and G. DrummondRobinson. Public Health : Part 1, R. T. Hewlett; Part 2,.’Sir Shirley F. Murphy. Tropical Medicine and Bacteriology:J. W. H. Eyre. Diseases of Tropics : C. W. Wilberforce.

It was agreed to nominate a representative of the College- on the managing committee of the Maternity Hospital and’School for the Higher Training of Midwives which it is pro-posed to establish at Woolwich under a scheme of the Charity

’ Commissioners.A letter was read from Sir Henry Morris reporting the

proceedings of the General Medical Council at their recentsession. The best thanks of the Council were given to Sir

"Henry Morris for acting as the representative of the College.A letter was read from Mr. F. Richardson Cross reporting his

attendance before the Royal Commission on Venereal Diseases’ ’to give evidence as requested by the Council.

The PRESIDENT reported that Mr. William Pearson, owing’ to the state of his health, wished to retire from the post ofProsector.

It was resolved, on the motion of Sir ALFRED PEARCE- <GOULD&mdash;

That a committee be set up to watch the development of theInsurance Act. and in particular the steps to be taken to set up clinicallaboratories and to appoint consultants for the assured.

The PRESIDENT reported that a meeting of Fellows wouldbe held on Thursday, July 2nd next, to elect five members of.’Council in the vacancies occasioned by the retirement in rotation of Sir Henry Morris, Bart., Mr. F. Richardson Cross,- and Mr. C. A. Ballance, M.V.0. (of whom Sir Henry Morris"and Mr. Cross do not offer themselves for re-election),and by the resignation of Mr. R. Clement Lucas and Mr.Jonathan Hutchinson. I

A vote of thanks was accorded to Sir Henry Morris and Mr. Cross for their services on the Council.

ROYAL COMMISSION ON VENEREALDISEASES.

AT the forty-first meeting of the Royal Commission on-Venereal Diseases evidence was given by Mr. J. SmithWhitaker, medical member and deputy chairman of theNational Health Insurance Commission (England) and amember of the National Health Insurance Joint Committee.

Mr. Whitaker explained the working of the panel system,"and said that an insured person suffering from venerealdisease was entitled as part of his medical benefit to receivemedical attendance and treatment and to be supplied withnecessary medicines a,nd appliances exactly in the same

way and to the same extent as for other diseases. As a’matter of fact, a large number of cases of venereal diseasewere being treated by panel doctors. It might be said

- generally that the position of the insured as regards theadequacy of the treatment which they received when sufferingfrom these diseases did not differ substantially from that ofthe ordinary population when under the care of general

practitioners, and in cases requiring treatment by specialistsboth sections of the population stood exactly on the samefooting. In certain cases a person might under the Insur-ance Act be allowed to make his own arrangements for treat-

"ment, and this would cover the case of treatment by an un-’ registered practitioner. The number of Insurance Committeeswho had permitted arrangements of this kind was, however,very small indeed, and it was not likely to become common.With regard to sickness benefit&mdash;i.e., periodical paymentsmade to the insured person whilst rendered incapable ofwork by some specific disease-it was possible for an

Approved Society to provide by its rules for the withholdingof this benefit in cases in which the sickness was caused bythe insured person’s own misconduct, and this applied to

many cases of persons suffering from venereal diseases. Itwas the usual practice, and had been for many years, forsocieties to class venereal diseases as a disease caused by

-misconduct.Mr. Whitaker said that the Insurance Commission had no

special information regarding the extent to which medicalmen might need facilities for laboratory methods as an aidto diagnosis, but if facilities were afeorded practitionersattending the insured could be required to take allsteps in their power and within their competencewith a view to obtaining the benefit of such assist-ance in the treatment of their insured patients.Looking at the future, Mr. Whitaker thought it was

very important that provision made for the treatment ofparticular diseases or particular groups of persons should belooked at not only from the point of view of those diseasesor those persons but from the broad point of view of therelation of that part of the administration to the whole bodyof treatment by medical practitioners of all kinds through-out the country. Any scheme of administration that mightbe devised, for example, for dealing with venereal diseasesshould be so framed that it would develop the abilities ofmen already in practice, the general practitioners, andmake them more efficient for their general functions as thefirst line of defence of the country. It was quite con-ceivable that simplicity of administration might tend to asystem that would to a great extent ignore the generalpractitioners ; he wished to suggest that that would be, apartfrom the merits ’of the question of the actual treatment ofvenereal diseases, prejudicial to the general public interest.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN the 97 English and Welsh towns with populationsexceeding 50,000 persons at the last Census and whoseaggregate population at the middle of this year is estimatedat 18,120,059 persons, 9511 births and 4687 deaths were

registered during the week ended Saturday, June 13th. Theannual rate of mortality in these towns, which had steadilydeclined from 15’1 to 13’2 per 1000 in the seven precedingweeks, rose to 13’5 per 1000 in the week under notice.During the first ten weeks of the current quarter themean annual death-rate in these towns averaged 14-1, against13’3 per 1000 in London during the same period. Among theseveral towns the death-rate last week ranged from 6’1 inWimbledon, 6’7 in Dewsbury, 6’8 in Enfield, 6’9 in Ilford,and 7-2 in Cambridge, to 20-3 in Liverpool, 21-2 in Grimsby,21-4 in Middlesbrough, and 22-7 in Carlisle.The 4687 deaths from all causes were 101- in excess of the

number in the previous week, and included 395 which werereferred to the principal epidemic diseases, against 391 and401 in the two preceding weeks. Of these 395 deaths, 119resulted from measles, 111 from whooping-cough, 69 frominfantile diarrhoeal diseases, 56 from diphtheria, 24 fromscarlet fever, and 16 from enteric fever, but not one fromsmall-pox. The mean annual death-rate from thesediseases was equal to 1-1, against 1-1 and 1-2 per 1000in the two preceding weeks. The deaths attributed tomeasles, which had been 143, 139, and 131 in the three pre-ceding weeks, further declined to 119 last week, and causedthe highest annual death-rates of 1-2 in Liverpool and inSheffield, 1’4 in Smethwick, in Oldham, and in Burnley, and2’1 in Warrington. The deaths referred to whooping-cough,which had been 144, lll, and 117 in the three preceding weeks,fell to 111 last week, of which 27 occurred in London, 8 inManchester, 8 in Sheffield, 5 in Birmingham, 4 in Bristol,and 4 in Salford. The fatal cases of diarrhoea and enteritis(among infants under 2 years), which had been 83, 52, and 80in the three preceding weeks, fell to 69 last week; 15 deathswere registered in London, 4 in Birmingham, 4 in Liverpool,4 in Manchester, and 3 each in Leicester, Wallasey,Bolton, and Salford. The deaths attributed to diphtheria,which had been 51, 47, and 38 in the three preceding weeks,rose to 56 last week, of which 13 occurred in London, 7 inBirmingham, 4 in Liverpool, 4 in Manchester, and 3 inSunderland. The deaths referred to scarlet fever, whichhad been 34, 31, and 26 in the three preceding weeks, furtherfell to 24 last week, and included 4 deaths in London,4 in Liverpool, 4 in Manchester, and 2 in Salford. The fatalcases of enteric fever, which had been 13,11, and 9 in the threepreceding weeks, rose to 16 last week, of which 5 wereregistered in London.The number of scarlet fever patients under treatment in

the Metropolitan Asylums and the London Fever Hospitals,which had increased from 2862 to 2970 in the four precedingweeks, had further risen to 2993 on S aturday last ; 391new cases were admitted during the week, against415, 377, and 339 in the three preceding weeks. Thesehospitals also contained on Saturday last 1095 cases ofdiphtheria, 362 of whooping-cough, 98 of measles, and 34of enteric fever, but not one of small-pox. The 1108deaths from all causes in London were 11 in excess of the