1460 IRISH POOR-LAW REFORM: THE REPORT OF LORD DUDLEY’S COMMISSION.

Recent Research of Br. Hughlings Jackson’s Views on the ITunctions of the Cerebellum.

AT the next meeting of the Royal Medical and ChirurgicalSociety on Tuesday, Nov. 27th, at 8.30 P.M., the specialdiscussion will be continued on the Operative Treatment ofNon-malignant ,Ulcer of the Stomach and its Chief Com-

plications. The adjourned debate will be opened by Dr.Norman Moore.

___

THE death is announced, at the early age of 36 years, ofDr. William Lloyd Andriezen. He was educated at Univer-

sity College Hospital, London, and in Paris and had done ex.cellent work on the subject of the pathology of the brain. Wehope to publish fuither details of his career in a future issue.

A TELEGRAM from the Mauritius received at the ColonialOffice on Nov. 16th states that for the week ending Nov. 15ththere were 52 cases of plague and 30 deaths from the disease.

THE next session of the General Medical Council will openon Tuesday, Nov. 27th, at 2 o’clock P.M.

IRISH POOR-LAW REFORM: THE REPORTOF LORD DUDLEY’S COMMISSION.

THE following is the Commissioners’ summary of theirrecommendations ; a leading article will be found at p. 1451commenting on the report.

1. The poverty of Ireland cannot be adequately dealt with by anypoor relief law such as that of 1838, but by the development of thecountry’s resources, which is, therefore, most strongly urged.

2. The English and Scottish Removal Acts, so lar as they relate toIreland, should be repealed.

3. The present workhouse system should be abolished.4. The various classes of inmates, except children, should be segre-

gated into separate institutions.*5. The existing hospitals, whether Poor-law or county, should.

except in a few cases, be retained in their present localities, but allshould be placed under the mauagement of county and district.committees.

6. Such hospitals should, as far as possible, be used only for the acutesick.

,7. A sufficient number of consumptive sanatoria should be estab-lished.

8. Additional cottage hospitals should be established at certainplaces in Ireland, and the system of home nursing for the poorextended.

9. A State medical service should be established and the cost thereofdefrayed out of money voted by Parliament.

10. Right of admission should be given to the district hospital nearestto a patient’s residence

11. The "aged and infirm" of all the workhouses within a con-venient area should be placed in a disused workhouse to be knownas the county or district .. alm5house," in which proper classificationcan be carried out.

12. The insane should be removed from Poor-law institutions, and bedetained in auxiliary or other asylums under the control of the lunaticasylum authorities.

13. Sane epileptics should be placed in separate institutions, for whichpurpose disused workhouses will be available.

14. Unmarried mothers should be sent to institutions under religiousor philanthropic management, or to "labour houses," and be kept apartfrom other classes.

15. The question should be considered whether a law ought not to bepassed enabling mothers to proceed in their own name against theputative fathers of their children, and to obtain arfiliatiom orders.

16. Infants should be placed in " nurseries," either under religiousand philanthropic management, or, when disused workhouses are used,under Poor-law control.

17. All children between infancy and maximum limit of age shouldbe boarded out. Certain cases might be temporarily placed in certifiedor industrial schools.

18. The Poor-law district schools of Glin and Trim should be dis-solved as Poor-law schools.

19. Casuals and vagrants should be detained for long periods undermagistrates’ warrant in " labour houses," under the control of theGeneral Prisons Board, and be maintained out of Imperial funds.

20. Genuine working men about to travel to seek employment shouldbe provided with satisfactory documentary authorisation for obtainingfrom relieving officers food and lodging during their journey.

21. Two disused workhouses should be handed over to the WarDepartment for the accommodation of pensioners, exso)diers,reservists, and militiamen, who claim support owing to destitution.

22. Special casual wards should be established in Dublin, ]3elfast,and Cork, and possibly in Limerick and Waterford.

23. Destitute respectable widows with only one legitimate childshould be eligible for outdoor relief.

24. Clause prohibiting the granting of outdoor,relief to be afforded tothe occupier of more,than a quarter of an,acre of laud should be.repealed.

I 25. The area of charge for orxtdo tr relief and for children senttemporarily to industrial and certilied schools should be the electoraldivision, with an adequate rate-in-aid as regards outdoor relief fortowns.

26. Guardians should be empowered to strike and collect a specialrate for outdoor relief.

27. The cost and maintenance nf boarded out children betweeninfancy and maximum limit of age should he a union charge.

t28. The expenditure on the sick, aged, and intirm, epileptics, lunatics,infants, and unmarried mothers in institutions should be defrayed outof a county-at-large rate.

29. Vagrants, casuals, and other classes sent by a Court of Justice fordetention in "labour-houses" should be maintained out of money votedby the House of Commons for prtsons. Those remitted by guardiansfor "test" purposes, or who euter voluntarily to be paid for out of thecounty rate.

30. All existing officers should be compensated for loss of office andbe entitled to receive pensions.

31. The reconstitution of the Poor-law official service and the con-ditions affecting it should be considered by a temporary commission.

32. The grants-in-airl of local taxation should be apportioned on thebasis of the recommendations of some of the members of the RoyalCommission on local taxation.

33. The Irish grants-in-aid should be increased as recommended bythe Koyal Commission on local taxation.

34. The accumulations of the grant for labourers’ cottages and allot-ments and future yearly sums accruing should be given to those ctis-tricts along the whole West coast that, owing to the condition of theoccupiers of land, are unable to obtain any benefits under the LabourersActs. The grant might be applied to the improvement of the sanitarycondition ot the dwellings of the occupiers of the land, and be admin-istered bvthe Congested Districts Board through parish committees.

35. Subject to the adoption of the suggestion as to the striking of arate for the support of institutions over the county at large, Poor-lawunions should not extend beyond the boundaries of one administrativecounty, except in the case of the cuunty boroughs of Cork, Limerick,Derry, and Waterford.

36. The boundariès should remain as at present in the case of CorkUnion.

37. Subject to the adoption of the sugestion as to the striking of arate for the support of institutions over the countv at large, theunions of Limerick should, in the opinion of the majority, comprisethe county borough ot Limerick and the rural district of LimerickNo 1. Simdnriy, the union of Londonderrv should comprise thecounty borough of Londonderry and the rural district of LondonderryNeo. 1. and the union of Waterford should comprise the county boroughof Waterford and the rural district of Waterford No. 1.

38. The county borough of Belfast should form the union of Belfast.39. The county borough of Dublin should form the union of Dublin

and the present North and South Unions of Dublin should bedistO ved.

40. The number of guardians throughout Ireland should be reducedto the number of elected guardians prior to the year 1898.

, 41. The Government should take over disused workhouses not

required at the time of disuse for any purpose and build suitable

hospitals in lieu thereof., 42. La.nd might he taken compulsorily by provisional order for thepurposes of public institutions.’ 43. TemporMB’ commission should be appointed to prepare for con-sideration schemes for carrying into effect the recommendations of thisCommission should they he adopted to any material extent.

* Dissented from by Mr. Murnaghan only as regards the mode ofadmission into county hospitals.

t Dissented from by Mr. Murnaghan.The ninth recommenddtion, under which, if its principles

were adopted by P,rliamenr,, an entirely new State MedicalService for Ireland would be established, may be saidto inclade within itself many of the other suggestions.The present lamentable conditions in Ireland are wellknown to all medical men and some politicians, as is theneed for wholesale reform.

ROYAL COLLEGE OF SURGEONS OFENGLAND.

ANNUAL MEETING OF FELLOWS AND MEMBERS.THE twenty-second annual meeting of Fellows and Members

of the College was held on Nov. 15th, the chair beingoccupied by Mr. HENRY MORRIS, the President.The PRESIDENT opened the proceedings by presenting to

the meeting the annual report of the Council. He saidthat he would follow the practice of his predecessors bycommenting on a few of the items contained in the report.The regulations f<’r the first examination for the Fellowshiphad been amended and now the three winter sessions’ studyat a recognised medical school might be counted from thepassing of the preliminary examination in general education,so that c’.mdidat&ouml;t! who hd,d studied the preliminary sciencesubjects at a non-medical school should no longer be at a dis-advantage, for before this change these three winter sessionshad to be reckoned from registration as a medical student.Oa page 13 of the report a table was given showing thatthough there had been a general falling off within recentyears in the number of stu ients entering the medical pro-fession, yet there had been no falling off, but rather an

1461ROYAL COLLEGE OF SURGEONS OF ENGLAND.

increase, in the number of students entered for the final exa-mination. In 1891 there were 1111 students registered in

England, and in 1900 there were only 698, but in the five

years 1891 to 1895 (inclusive) 61’5 5 per cent. of the studentshad entered for the final examination of the College, and inthe five years from 1896 to 1900 (inclusive) 62’ 3 per cent. ofthe students had entered for the final examination of theCollege. These facts were gratifying. The figures givingthe absolute numbers of those obtaining diplomas showedsome diminution, especially in the case of the Fellowship,but the figures relating to the Fellowship varied greatly fromyear to year. In the cases of other diplomas the diminutionwas slight. There had arisen a demand for a diploma in

tropical medicine. The Council had carefully studied thequestion in conjunction with the Royal College of Physiciansof London and as a result of their deliberations it had beendecided that it was not desirable at present to grant diplomasin this subject, yet it had been resolved that it would bedesirable to take some action in the matter. The matter hadnot finally been determined and the committee of manage-ment was still considering the subject. Probably it wouldbe decided that assessors should be appointed to the examina-tions conducted by the London School of Tropical Medicineand that to those candidates who held the diplomas of theRoyal Colleges and were approved by the examiners certifi-cates, endorsed by the assessors, should be granted. Anothermatter of importance was the question of the payment ofmedical men who were called in to assist at difficult laboursby midwivas under the Midwives Act. At present therewas great injustice done to medical practitioners, as therewas no compulsion on the statutory authority to pay thesemedical men. There were only two county councils whichhad made arrangements for the payment of these fees. Onlya few years had elapsed since the passing of the Mid-wives Act and therefore it was a little early to expecta new Act to be passed, but the Council felt theinjustice of the present arrangement and the matterhad been brought before the General Medical Council.For the first time the Council of the College had had toremove from its roll Licentiates in Dental Surgery. UnderSection 13 of the Dentists Act, 1878, when the name of anyperson was erased from the Register by the General MedicalCouncil any medical authority of which such person was aLicentiate must also erase the name from the list ofLicentiates of such authority. In this matter, therefore, theCouncil of the College had no option, and the names of threeLicentiates had been removed. The Walker prize of 100had been awarded to Professor Carl Oluf Jensen of Copen-hagen for his work in connexion with cancer, and it was

satisfactory to know that everyone acquainted with the recenthistory of work on cancer had agreed with the decision.The Begley studentships were founded by the late Mrs. JaneBegley, widow of William Chapman Begley, a formerMember of the College, and Mr. Walter B. Johnson ofSt. Thomas’s Hospital had been appointed the first Begleyscholar in accordance with a report from the examiners inanatomy and physiology under the Conjoint ExaminingBoard, regarding the result of the examination completed onApril 4th, 1906. The scholarship is of the value of Z20 perannum for three years, and is awarded to the student obtain-ing the highest marks in the anatomical part of the examina-tion. The founding of this scholarship was an admirableexample, and he (the President) hoped it would be widelyfollowed. The finance of the year had been satisfactory. Itwas true that the gross income was nearly &pound; 400 less than inthe previous year but this was due mainly to lessened receiptsfrom the Fellowship and dental examinations and thebalance of income over expenditure amounted to over f:2300.It might be interesting to the meeting to learn that copies ofthe report had been sent to 3036 Members and to 684 Fellowsin accordance with the arrangement that any Fellow or

Member can have his name put on a list to receive the reporteach year when issued. The report was now open for dis-cussion.

Dr. WALTER SMITH noticed that the report containedthe names of 264 Members of the College who had diedduring the year. He would like to know whether any attemptwas made by the College to reclaim the diplomas of theseMembers, as he had found that in many cases unqualifiedpersons obtained possession of the diplomas and practised onthe strength of them.The PRESIDENT replied that hitherto no steps had been

taken but he would bring the matter before the notice of theCouncil,

Dr. W. G. DICKINSON asked that the minutes of the lastmeeting might be read, as he questioned the accuracy of thereport.At the PRESIDENT’S request the SECRETARY read the

minutes of the last annual meeting and Dr. DICKINSONstated that what he objected to in the published minuteswas the omission of one motion which had been put to themeeting.Mr. F. W. COLLINGWOOD asked as to the result of the dis-

cussion with the Royal College of Physicians of London as to-the use of the title of Doctor by the holders of the diplomasof the two Colleges.The PRESIDENT explained that, though the Council of the

College of Surgeons was in favour of this, the College ofPhysicians did not see its way to agree.Mr. E. D. VINRACE wished to express his appreciation of

the historical summary published in the annual report andthe PRESIDENT explained that this had been compiled by thelate President, Sir John Tweedy.

Mr. JOSEPH SMITH then introduced the first motion :&mdash;

That this twenty-second annual meeting of Fellows and Membersagain re-affirm the desirability of admitting Members to direct repre-sentation on the Council, which, as now constituted, does not representthe whole corporation.

Twenty-two years had elapsed since he attended the firstannual meeting held under the presidency of Mr. JohnMarshall and then he had brought forward a motion couchedin almost the same terms, and at every meeting sincesimilar motions had been carried. To all these resolutionsthe Council had returned the stereotyped reply that itcould do nothing. Why should not the Members be polledto see if they as a whole desired the change or not ? TheMembers had suggested schemes for the reconstitution ofthe Council, such as the election by the Members of acertain number, say six, of the members of the Council,but it was all in vain. However, the Members did not in-tend much longer to come before the Council with suchresolutions. They would apply elsewhere. The sword ofDamocles was hanging over the Council and at any momentthe hair might give way. The Members had never reallysurrendered their rights. The time had come when some-thing must be done. The present gross and long-lastinginjustice done to the Members could not be allowed to enduremuch longer.The motion was seconded by Sir CHARLES F. HuTCHINSON.

He considered the present position of affairs to be abso-lutely anomalous in this democratic age. The Members hadno fault to find with the way in which the College wasmanaged but the Members must have their share in themanagement. The voice of the College was not listened to,in the House of Commons, for it was recognised that theCouncil was not really representative. The College shouldbe in the very van of reform.Mr. COLLINGWOOD considered that the Members should

bear the same relation to the College as the members of auniversity bore to the university.Mr. GEORGE BROWN said that at the present time the

medical profession was treated with absolute contempt bythe Government. When a high Government appointmentfell vacant, such as the presidency of the Local GovernmentBoard, where the duties required a man with knowledge ofmedicine and hygiene, they appointed someone utterlyunacquainted with the subjects with which he had to deal.When put to the meeting the motion was carried by

40 votes to 3.Dr. DICKINSON then introduced the following motionThat this meeting recommends that when the question of admitting

women to the College examinations is brought before the Fellows andMembers this should be done either by means of a corporate meetingor by a poll of the Fellows and Members, inasmuch as the meetingsas hitherto held under the regulations of the Council have noauthority to determine any question whatever, and their resolutionson other subjects are almost invatiably disregarded by the Council.

He did not wish to discuss now whether women should beadmitted or not; he merely wished the Council to makearrangements to determine the opinion of the Members ofthe College. The by-laws in the Calendar stated that thesemeetings were merely consultative. On Nov. l4th, 1895,when this question came up before, the Council paid noattention to the resolution carried by the Members.The PRESIDENT pointed out that the Council had acted

on the resolution of the meeting of Members, butDr. DICKINSON, continuing, said that it was the veto of

the Royal College of Physicians of London which had reallyprevented the admission of women. These meetings of

1462 THE TRADE IN SECRET AND PROPRIEFARY MEDICINES.

Members were not genuine consultations, for the Councilpaid no heed to the advice of the Members. In medicine orsurgery such a

" consultation " would be absurd.Mr. J. BRINDLBY JAMES, in seconding the motion, expressed

the opinion that all the Members should be polled on thisquestion.Mr. EDMUND OWEN regretted that he could not support

the motion as it stood, for there was a sting in its tail,but if all the words commencing at inasmuch" wereomitted he would be happy to support it.With the consent of the meeting this portion of the motion

was omitted.The PRESIDENT, referring to a remark made by one

Member that the Council had refused to subscribe to theDefence Committee on behalf of the late Mr. R. B. Anderson,said that though the Council did not consider that the fundsof the College should be employed for such a purpose, yetevery member of the Council had put his hand into his ownpocket and had subscribed.Mr. F. G. PARSONS suggested that the decision of the

Members should be taken at a meeting and not by polling.Mr. A. DOUGLAS COWBURN seconded this amendment.Dr. DICKINSON asked whether the decision of such a

meeting would be binding on the Council and Mr. JOSEPHSMITH repeated the question.The PRESIDENT said that the Council would give the

utmost weight to the resolutions of such a meeting but theultimate decision must rest with the Council.

Mr. JOHN SMITH failed to see why these meetings were calledcorporate meetings if their resolutions were not binding.Mr. COLLINGWOOD considered polling a much better way of

eliciting the opinions of the Members.Mr. VINRACE suggested that when the polling papers were

sent round there should also be sent a paper for taking theopinion of the Members on the question of representation onthe Council, it would save double postage.When put to the meeting the amendment was lost by a

large majority.Mr. A. S. MORTON suggested that the words referring to

a corporate meeting in the motion should be omitted.Surgeon-Major J. INCE seconded this amendment which

was carried, and again as a substantive motion in the

following words :-That this meeting recommends that when the question of admitting

women to the College examinations is brought before the Fellows andMembers this should be done by a poll of the Fellows and Members.

Mr. MORTON then brought forward the following motion:-That in pursuance of their resolution in July last the Council is

hereby requested to make further representations to the Governmenturging the necessity of amending the Midwives Act next session, inorder that provision may be made to secure just remuneration for pro-fessional services rendered by medical men under that Act.

He was glad to learn that the Council had already takenaction in the matter and he hoped it would not let thesubject drop.The PRESIDENT said that as soon as possible representa-

tions would be made to the authorities.On receiving these assurances from the President the

mover, with the permission of the meeting, was allowed towithdraw the motion.

Mr. BROWN then moved-

That in view of the overcrowding and straitened circumstanceswhich exist in the profession, this meeting strongly urges the Councilto use all its influence to secure the raising of the standard of the pre-liminary examinations in general education and in science ; and thismeeting is further of opinion that the time has arrived when chemistry,physics, and biology should be treated as matters of preliminary educa-tion and an examination passed in them before the commencement ofmedical studies.

He commenced by saying that he was not responsible for the I

wording of the motion and personally he would prefer toomit the words from "in view" to "profession," as he wisheda raising of the standard for a higher reason-the improve-ment of the medical men of the future. (With the permissionof the meeting these words were omitted.) In the GeneralMedical Council he had brought forward a similar motionlast year. Young men were not so well educated as theyshould be. He hoped that the Council would draft a schemefor the institution of a special examination in preliminaryscience subjects and that students should not be registeredas medical students until this examination had been passed.

Mr. GEORGE JACKSON seconded the motion ; he consideredthat in one year a student could acquire a sufficient know-ledge of science subjects to be really useful to him in hisprofessional life.

I Surgeon-Major INCE looked upon this motion as veryimportant, as he thought that the average medical man wasvery deficient in natural science.

Mr. OWEN said that biology was an overgrown subjectand was a cause of professional ruin to many. The timedevoted to it was utterly wasted. He thought that the studywas worthless for a medical student.Mr. COLLINGWOOD considered that the preliminary science

subjects were merely mental gymnastics.Mr. BRINDLEY JAMES regretted the disappearance of the

apprenticeship system, for it was of the greatest value inteaching a young man the practical work of his profession.

Mr. BROWN replied. The motion was carried by 12 votesto 2.Mr. JOSEPH SMITH moved a vote of thanks to the Presi-

dent for presiding ; this was carried.57 Members were present and 23 Fellows, including 14

members of the Council.

THE TRADE IN SECRET AND PRO-PRIETARY MEDICINES.

(SPECIALLY CONTRIBUTED BY A BARRISTER-AT-LAW.)

11.

LAWS IN FOREIGN COUNTRIES AND BRITSH COLONIES.

IN the previous article reference was made to the lawswhich affect the sale of secret and proprietary medicines inGreat Britain, and it was shown that if a medicine containsno large quantity of alcohol or a scheduled poison or an

abortifacient there is no State-imposed restriction whateveron its sale. The State does not forbid the sale of any

proprietary medicine in the interests of public health and,o long as a proprietor can escape prosecution for obtainingmoney by false pretences-and it is very rarely indeed thatsuch a charge is brought-he is virtually at liberty to make,in his advertisements to the public, any statement which hethinks may increase his trade. It is proposed now to givea short statement of the laws which some foreign countrieshave deemed it necessary, or have found it practicable, tomake. It may be noted in the first place that whereas manyEuropean States have enjoyed protection against secretmedicine frauds for a comparatively long time, it is onlyduring the past two or three years that the legislatures ofthe United States of America and of Australasia have takendefinite action.The United States of America are the home of all that is

worst in the proprietary medicine trade. Whereas in GreatBritain the sale of proprietary medicines containing a largepercentage of alcohol or a scheduled poison may to somesmall extent be controlled by the Board of Inland Revenueand the Pharmaceutical Society respectively, in most of theStates of America preparations strong in alcohol andmorphine flourish exceedingly. In many of the States legis-lation has been introduced with a view to require disclosureof the contents of proprietary medicines, but in almost everycase the Bills have met with the most strenuous oppositionfrom the newspaper press, nearly the whole of which isafraid to offend the advertising nostrum manufacturers. Ithas been stated that in one Western State a Board of Healthofficer analysed a number of proprietary medicines but couldfind no newspaper willing to publish the results of his

analyses. In Massachusetts, Pennsylvania, Wisconsin, andother States all attempts at legislation have proved unsuccess.ful, and almost the only successful measure of the kind untilthe present year was that passed in North Dakota in 1904.It is now the law in that State that all medicines whichcontain ergot, poisonous narcotics, bromides, or more than5 per cent. of alcohol shall bear on the labels a statement asto the amount of those drugs present. But in some respectsthe Governments have powers which are not possessed inGreat Britain. For instance, when I I liquozone was publiclyexposed in 1905, although no attempt was made by anyGovernment department in Great Britain to take action inthe matter, the San Francisco Board of Health, exercisingpowers vested in it, promptly forbade the sale or distributionof " liquozone

" on any terms whatever within the area of the

Board’s jurisdiction.A notable step in advance was taken by the United States

1 Article I. was published in THE LANCET of Nov. 17th, 1906, p. 1390.