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pure consultant he must inquire from his family medicaladviser ; this is strict etiquette. The pure consultant ishe attached to the staff of one of the 11 Londonteaching schools of medicine. Or it may apply to Edin-burgh, Dublin, or any city of the United Kingdom or GreatBritain beyond the Seas where there are also teachingschools of medicine. His fee is usually £2 2s. or e3 3s. athis house in Harley-street or Cavendish-square or elsewhere.How often are discussions of this kind brought forward andthe iron kindled to red heat and then allowed to cool.Cannot something, however, on this occasion be done toprove the exception to the usual termination of such dis-cussions? Something really tangible to lead to fruit bywaking up the apathy of those who have had their day, yetsit in the highest chamber of the profession in idle content-ment of worn-out rules and college regulations ?

I am, Sir, yours faithfully,Feb. 24th, 1908. VIRTUTEM SEQUOR.

WEST AFRICAN MEDICAL SERVICE.To the Editor of THE LANCET.

SIR,-I have heard from two sources that my name hasappeared in your paper as having resigned, or been retiredfrom, the colonial service. Will you please have thiscontradicted at once. I have neither resigned noi beenretired. On the 28th inst. I return to my duties in WestAfrica. I am, Sir, yours faithfully,March 17th, 1908. CHAS. R. CHICHESTER.

* * We insert Dr. Chichester’s letter with pleasure.The notice of his retirement, which we published inTHE LANCET of Feb. 8th, p, 473, was sent to us in an officialdocument from the Colonial Office dated Jan. 24th.-ED. L.

"AN OFFENCE UNDER THE LUNACY

ACT, 1890."

To the Editor of THE LANCET.

SIR,-I notice that you only give in your issue relating tothis case the statements of the prosecution. There was no

question of I I suggested defence of ignorance." I maintainthat on Feb. 26th, 1907, Ethel May Davies was, in myopinion, not a certifiable lunatic according to the Act. WhenI saw her two days after this her condition had changed andat my request the person in charge communicated with themother of patient to that effect, instructing her to place thecase in an asylum. No attention was paid, and I hereemphatically state that all my responsibility ceased. I didnot see the patient for six weeks after this time.The reason I was found guilty of a " technical breach of

the law " is as follows. The original summons was foraiding and abetting and procuring some one to take care of,in an unlicensed house, an alleged lunatic. When the prose-cutors became aware that I had a complete answer to sucha charge by doing my best to get the Act complied with bythe mother the summons was amended and made "con-tinuous "-in other words, the fact that the patient ulti-mately became insane and remained in the home to whichI advised her being placed made me responsible of a" technical breach of the lunacy law." It was not a ques-tion of ignorance, as I do not admit this in any way, and Imust ask you to contradict this. As I was informed at thecommencement of the case as to the decision on thistechnical point there was absolutely no use in any defencebeing set up. The case was decided ex parte ; my evidence

would have shown conclusively that the patient was notinsane on Feb. 26th, 1907, that the lady who had care of thecase did not make the statements which are alleged againsther and to which great prominence is given in your issue.That she held the highest testimonials from official visitorsas to her capability to take care of patients, having held theposition of committee of several Chancery patients. Also thefact that from first to last I had no interest in the patient orhome in any way financially and never received, directly orindirectly, any payment, gratuitous services being given.

I am, Sir, yours faithfully,Burwood-place, W., March 18th, 1908. FORBES WINSLOW.

THE VENTILATION OF THE HOUSE OFCOMMONS AND INFLUENZA.

To the Editor of THE LANCET.

SIR,-I have read the article in THE LANCET ofFeb. 29th, p. 652, upon the above important question, andalso have in mind complaints of the bad condition of theatmosphere of other buildings-the Law Courts, Old Bailey,&c.-by all who have to be in these buildings, even for apart of the day only, and these complaints and your verypractical remarks confirm an opinion I have long held, inthat all the systems that have up to the present been adoptedfail because they are not sufficiently automatic, so that whenthe atmosphere becomes unpleasant it shall be quicklypurified without causing a reverse, the result of which isoften as bad as, or worse than, the cause of the original, andthe incoming air is injected with too much force, or too hot,or too cold.Of course, one has to consider constructional difficulties

engineers have to encounter, especially from the archi-tectural point of view; it ought not, however, to be impossibleto ventilate buildings by a system such as I venture to

suggest. In my humble opinion the remedy will never beaccomplished all the time reliance is made upon velocity orquantity of air injected or ejected. With respect to yourquery could the House meet in the open air, I think memberswould suffer almost as badly when the atmosphere wasabnormal either way if they occupied the area of pavedground. I am, Sir, yours faithfully,

Ebury-street, London, S.W., March 10th, 1908. D. T. BOSTEL.

THE CRITIC ON THE HEARTH.To the Editor of THE LANCET.

SIR,-A movement is being organised in London with theobject of persuading urban authorities throughout the.kingdom to penalise the emission of smoke from domesticas well as industrial chimneys. The use of smokeless fuelis already enforced in New York and nearly all the greatcities of America. The adoption of a similar regulation inthis country, although long desired by sanitary reformers,has been prevented hitherto by the Englishman’s devotionto the open hearth. It is urged that this obstacle has nowbeen overcome not only by the improvements in gas andelectric fires both for cooking and heating, but by thesuccessful adaptation of open grates to the smokeless con-sumption of anthracite and other varieties of hard coal, andby the introduction of coalite, a fuel consisting of soft coalpurged of the products which ordinarily hinder combustionand pass up the chimney as smoke.Mr. Ollis, chief officer of the public control committee of

the London County Council, in a report which he has justsubmitted to that body, says: "If it is not practicable towean the Englishman from his love of the open fire, it doesappear possible for him to be supplied with a fuel...... theuse of which will not foul the atmosphere." It is probablethat the Council will take some steps in the direction ofencouraging the use of smokeless fuels in domestic grates,but a number of sanitary reformers are pleading for a com-pulsory ordinance which, they aver, could now be enforcedto the great benefit alike of the urban community and theindividual consumer; and to this end a vigorous campaignis to be undertaken in London and the other great cities ofthe kingdom. I am, Sir, yours faithfully,

.... ......,.... M TMarch 9th, 1908. M.D.

SMALL-POX AND DISINFECTION ONBOARD SHIP.

To the Editor of THE LANCET.SIR,—An epidemic of small-pox occurred recently on a

ship of which I happened to be medical officer. We weredetained for some days at the quarantine station and duringthis time the whole boat was very thoroughly disinfectedwith formaldehyde. Can you or any of your readers referme to articles or records of experiments which indicate thevalue of this agent used in such circumstances? I amled to ask because of the following somewhat curious fact.The ship was infested with large numbers of cockroaches(not the ordinary one seen in our kitchens but a smaller,

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brown species, the scientific name of which I do not know).These insects, though causing no real inconvenience,were in the habit of walking about our cabins withan annoying air of ownership. Our efforts to getrid of them were fruitless and we congratulated our-

selves that in formaldehyde they would at last meetan enemy whose attack they could not survive. After

my room had been subjected to the disinfectant forover 16 hours the fumes were still so pungent that not forsome minutes subsequent to the opening of the doors was Iable to go inside. Then I saw five or six cockroaches invarious places all lying still and apparently dead. Within afew minutes, however, they began slowly to crawl away andbefore long had quite recovered their normal activity. Mybrother officers noticed exactly the same thing happen intheir rooms. I wondered, and am still wondering, how theorganisms or materials which it was assumed might conveysmall-pox fared when the insects were inconvenienced tosuch a slight extent. Is there any reason to think thatdisinfection of this kind is of any real value ? The technique,I am sure, was very thorough. I might add, if it is of anyinterest, that among 24 Europeans on board who had beenrevaccinated there was one mild case of small-pox, and ofsix who had not been done since infancy only one has up tothe present escaped the disease.

I am, Sir, yours faithfully,..... -,- T Tl,March 16th, 1908. J. F. B.

MEDICAL OFFICERS AND THE TERRI-TORIAL FORCE.

To the Editor of THE LANCET.SIR,-Perhaps some of your readers could give some

reliable information about the following points as regard!service in the " Territorial Army."

1. In transferring from a regimental unit, e.g., as a

medical officer to a Volunteer battalion can one transfeiwith, and retain, one’s rank and seniority when exchanginginto a field ambulance "-whatever that may be-as I havebeen asked to do ?

2. What pay and allowances are we as officers of theTerritorial Army to draw when undergoing training in

camp? Is there to be any distinction other than that otwhich branch of the service is concerned-e.g., is myeonfrere in the Yeomanry as medical officer to draw 25s. aday pay and allowances, in the Militia his Militia pay, andthe unfortunate Volunteer officer to be fobbed off with a

visionary grant of 8s. a day-a grant which he never touchesand which in the case of a medical officer does not even payfor his locum-tenent ?

3. In the case of officers of the Territorial Army beingembodied or called out in a national emergency will theystill be entitled to the gratuity of £100 a year over and abovetheir pay-with a subsequent £100 or Z50 per annum, aslaid down in the allowance regulations ? Will these para-graphs be retained and is it intended that they should be so ?

4. Will officers of the Territorial Army take rank andprecedence according to their respective position in the ArmyList or will the present vogue be maintained-i.e., "withbut after"? Will a captain of Volunteers say of eight orten years’ service find himself junior to a captain of Militiaor Yeomanry of possibly a week’s service ?

5. In the event of officers being embodied in a nationalemergency and so serving with regular troops, will they begazetted to temporary army rank, and if so will the gazettebe published in reasonable time and not be kept back andthen antedate some two years ?

6. In the event of honorary rank in the army being con-ferred at the conclusion of any such emergency will allofficers employed share alike-whether of Militia, Yeomanry,or Volunteer origin ? In the South African war all Militiaofficers received honorary rank, whether employed at homeor abroad, but only those Volunteer officers who servedabroad received this reward, and thus though I served athome for five years with the A.M.S, and R.A M.C. I havenothing to show for it.-I am, Sir, yours faithfully,

---

March 16th, 1908. A. M. n.

*** The rates of pay were published in THE LANCET ofNov. 2nd, 1907, p. 1271.—ED. L.

MEDICAL GRADUATES’COLLEGE AND POLYCLINIC.—The annual general meeting of the Medical Graduates’College and Polyclinic will be held at 22, Chenies-street,London, W.C., on Friday, March 27th, at 5 P.M. Dr.C. Theodore Williams will occupy the chair.

THE ORGANISATION OF THE MEDICALPROFESSION IN FRANCE.

(FROM OUR SPECIAL COMMISSIONER.)

THE UNITY OF INTEREST BETWEEN THE PATIENT AND HISMEDICAL ATTENDANT.-THE EFFORT TO FREE THE MEDI-CAL PROFESSION FROM POLITICAL INTRIGUE.-THE DIFFI-CULTY OF APPEALING FROM THE MEDICAL PROFESSIONTO THE GENERAL PUBLIC.-A REACTION AGAINST T19HMEDICAL DEMANDS.-THE ABUSES COMMITTED BY

MEDICAL OFFICERS AND ALSO BY LOCAL AUTHORITIES.-ACTION OF THE MEDICAL SYNDICATES TO CONTROLTHEIR OWN MEMBERS.

Paris, March 7th, 1908.THE various accounts published in these columns con-

cerning the organisation of the medical profession containfrequent allusions to the demand made by medical practi-tioners that the patient shall always have the right to selecthis own medical adviser. Formerly when medical men were .

only called upon by the authorities to give expert advice orevidence the matter was left to their discretion. Whateverservice the State, the local authorities, or the police might re-quire a medical man to render, such service did not constitutea serious form of competition against other practitioners. To-day, however, the position has changed and even greaterchanges are likely to occur in the near future. This is dueto the ever-increasing number of new laws which in Franceare very appropriately described as laws of social solidarity.But the problems created by such legislation do not affectFrance alone. Similar laws have been enacted in allcountries and they are numerous in Great Britain. There-fore, what is said and done in France in regard to thesematters applies also to Great Britain, to far at least as thegeneral principles at issue are concerned, and also in regardto many of the details. The whole series of articles on theI I Battl of the Clubs," as waged in England, containedprotest after protest against the destruction of the medicalpractitioner’s independence by making him the salariedemployee of a federation of benefit societies, of a club, or ofan insurance company. The degrading effect which this hadon the exercise of the practice of medicine was pointed outover and over again. To-day our French colleagues areenergetically protesting that the new laws will bring intoexistence an army of medical State functionaries ; and,whether the salary be paid by the State, the municipality, ora mutual benefit society or club, the medical man loses hisindependence and the patient his freedom of choice."Freedom of choice" has thus become the battle cry of

the medical profession. But it is earnestly urged that thisis no selfish class cry. The necessity of such freedom is aspressing so far as the interests of the general public are con-cerned as in regard to the special and personal requirementsof medical practitioners. The interests of the public are notdifficult to define. The public desires to enjoy good healthand to be cured as rapidly and effectively as possible when ill.For this the public is obviously concerned in medical educa-tion and in placing the medical practitioner in such a posi-tion as will enable him to develop his art and to acquire thegreatest possible skill. Then the patient, when he is ill,naturally desires to consult the practitioner in whom he hasthe greatest confidence. Obviously, if a patient dislikes or hassome prejudice against a particular practitioner he had betterconsult someone whom he finds more sympathetic. The benefitsociety, however, corrpels the patient to call the medicalofficer who is in its service and thus destroys free choice.To-day this evil may be seriously extended by the action ofnew laws on acci.lpnts, on poor relief, on compulsoryinsurance, or, as in England, on employers’ liability, whichmake employers rather than the workers insure, and similarlegislation. Such measures are calling into existence a largenumber of State or municipal medical functionaries, andonce a medical practitioner is in receipt of a regular salaryfrom one of these public bodies he can take matters easily.In many cases politics rather than medical skill would bethe surest road to success. Of this we have painful experi-ence in Ireland. How many Roman Catholic medical menare employed as dispensary surgeons in Ulster and how manyProtestants in the dispensaries of the Roman Catholic partsof Ireland ? What chance would a Roman Catholic andRoyalist medical man in France have of obtaining a medicalpost from a Freethinking and Republican municipality ? Butall this is theology and politics and the sick man wants