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meeting to accept or to reject the annual report of theCouncil.The PRESIDENT, after consultation, said that it was not in

the power of the meeting to carry any resolution expressingadoption of the report, as the report was merely a record ofthe Council’s work for the past year. He had doubtedwhether Mr. Smith’s motion was in order but the wish tostretch a point in favour of the Members had induced himto permit it to be put on the agenda. Now, however, he feltsure that the amendment which had just been moved wasquite out of order ; he would, therefore, put to the meetingthe original motion of Mr. Smith.The motion was lost by 19 votes to 15, several of the

members of the Council voting in the majority. The resultbeing announced many of the supporters of the motionleft the theatre.

Dr. VINRACE suggested that a larger attendancewould be obtained if the annual meeting were held at4 o’clock, but the PRESIDENT stated that many years ago4 o’clock was said not to be so convenient for those in

general practice. Dr. Vinrace therefore withdrew his

suggestion.The PRESIDENT then called upon Dr. B. Walker to propose

the motion standing in his name and concerning the physio-logy portion of the first Fellowship examination, but as Dr.Walker was not present the PRESIDENT declared the meetingclosed.On the motion of Surgeon-Major INCE a vote of thanks to

the PRESIDENT was carried, which he briefly acknowledged.34 Members were present and 22 Fellows, including 14

members of the Council.

THE ANNUAL REPORT OF THE MEDICALOFFICER OF THE LOCAL GOVERN-

MENT BOARD.

THIRD NüTICE.1THE section of the report for which Dr. A. C. Houston is

responsible deals with the validity of the tests usually em-ployed in determining the bacteriological purity of drinkingwater and with various circumstances which may modify theinterpretation to be put upon the results of those tests. It is

a continuation of previous valuable investigations which weowe to Dr. Houston and to which bacteriologists and medicalofficers of health are much indebted. The pollution or

purity of a water is gauged by the presence or absence ofcertain test organisms found in sewage-viz., bacillus colicommunis, streptococcus, and the spores of bacillus enteri-tidis sporogenes, and the degree of pollution is estimated bythe number of these organisms found in a given quantity ofthe water. It is therefore highly important to determinewhether these organisms do furnish a true indication ofsewage pollution or whether, owing to the possible existence ’of sources for these organisms other than human excreta,fallacies may occur. Further, if, as we know is the case,there are many sources from which organisms groupedunder the names of bacilli coli and streptococci may bederived, is it not possible to distinguish those varieties ofthese races which are of human origin from those whichhave not that source ? It is with these problems that Dr.Houston’s report deals. In the report for 1902-03 it wasshown that in a deep well water drawing its supplies from avirgin area (Tunbridge Wells supply) bacillus coli and coli-like organisms were practically absent and the classicalbacillus coli communis invariably so. The inquiry as to theBedford water-supply, which forms part of this annualreport,2 shows how exposure of the collecting ground andcontamination may tend to pollution and the appearance ofbacillus coli in the well water. Investigation of normal faecesshowed the presence of an overwhelming abundance ofbacillus coli of which 90 per cent. were typical-or as Dr.Houston calls them, "flaginac "-and the presence of strepto-cocci to the extent of over 100,000 per gramme of fseces ;these latter organisms were all practically non-pathogenic tomice.The first division of this year’s report deals with the

excreta of healthy man and considers chiefly the atypical1 The first and second notices were published in THE LANCET of

Sept. 16th (p. 845) and 30th (p. 988), 1905, respectively.2 THE LANCET, Sept. 30th, 1905, p. 988.

non-lactose fermenting varieties of bacillus coli and thedifferential characters of the streptococci found therein.Only 2’ 34 per cent. of the bacillus coli colonies examinedwere unable to ferment lactose. On this basis any butthe typical (" flaginac") variety of bacillus coli mightbe excluded as evidence of sewage contamination if itwas quite certain that these micro-organisms did not

change their physiological characters by a sojourn inwater. The proportion of bacillus coli-like organismsto the bacillus coli in water known to be sewagepolluted is, however, much greater than this and seems toindicate a biological change in the fascal type of bacillus.The fact remains that a pure water rarely contains glucose-fermenting bacteria of any sort in 100 cubic centimetres ofwater and the absence of glucose- and lactose-fermentingorganisms is a special presumption of the absence of un-desirable fouling of a water-supply. The next section dealswith the number and biological characters of the strepto-cocci in normal stools and attempts to classify them by theuse of the tests devised by Dr. M. H. Gordon.3 The testmedia used by Dr. Gordon are likely to prove of great valuein differentiating the numerous races of streptococci found invarious forms of disease and bringing some order into whatis at present a very chaotic region. The number of strepto-cocci present is from 100,000 to 1,000,000 per gramme offasces and on the basis of the tests employed they were foundto be divisible into no less than 40 groups. Thus while thenumber found indicates that the streptococci are properlyselected as a "test" organism for sewage contaminationtheir variety diminishes the value, as non-fascal streptococciwill probably be indistinguishab’e from some of the groups.The vitality of the streptococci found is important, as attemptshave been made to estimate the date of the contaminationby the presence or absence of these organisms. It wasfound that of the streptococci tested (25 in number) 64 percent. died in sterilised tap water in ten days, while in sterilesalt solution 62 per cent. survived for 20 days. We have,however, no information as to their vitality under naturalconditions in sewage and drinking water.

Certain side issues bearing on a subject which has recentlyattracted much attention-namely, the contamination ofoysters and other shell-fish in estuarial waters-form thethird division of the report. The bacillus coli test beingaccepted as an evidence of sewage contamination, is thereany risk of condemning shell-fish unnecessarily owing topollution of the water, not by sewage, but by the excreta ofbirds and fishes ? The excreta of gulls contained manybacilli coli and streptococci, while the intestine of the guil-lemot was free from these organisms, and no doubt the dif-ference in the intestinal flora is due to the difference in thefood of these birds. The gulls are garbage feeders and nodoubt owe their bacilli coli and streptococci to feedingon sewage-polluted food, so that these organisms, thoughpassed through the gull’s intestine, are really of humanorigin. The fact that bacillus coli increases in the bird’sintestine might tend to an over-estimate of the amount ofpollution reaching the water and therefore of the amount ofdanger involved. The bacillus coli derived from humanexcreta may be taken as a test of the probability of dangerfrom other organisms, such as bacillus typhosus and spirillumcholeras, but we have no knowledge that such a conclusionis justified when the bacillus coli is due to soiling by birds.In fishes caught remote from sewage pollution bacillus colihas been found but Dr. Houston’s results seem to show thatthis is very rare and that the number of microbes is verysmall, so that fish can hardly be regarded as a disturbingfactor in the analysis of estuarial waters.The report deals finally with the effect of storage

and filtration on the biological purity of a water andthe results of a bacteriological examination of Londonfiltered waters. It has long been known that storagewill purify a water and that the number of microbesis diminished, but here and elsewhere in the report Dr.Houston evidently inclines to the opinion that thequalities of the organisms also undergo a change, and headvances the opinion, cautiously, it is true, that it is notunlikely that a specifically polluted water might becomeharmless owing to the loss by the specific microbes of theirpathogenic properties. He appears inclined to attributeto this modifying action the comparative immunity ofLondon from typhoid fever notwithstanding that the water-supply is contaminated with sewage and that the filtered

3 Local Government Board Reports, 1903-04, p. 388; and THE LANCET,Nov. 11th, 1905, p. 1400,

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waters contain coli and coli-like organisms. With regard tothe filtered waters the -reduction in the number of organismsproduced by the process was conclusively shown by the:Franklands. In the present report the samples were testedas to the number of the test organisms already mentionedwhich were found. On the basis of Dr. Houston’s suggestedclassification of waters considered in relation to theircontent of bacillus coli ("naginac") 68 per cent. of thesamples examined were first-class waters, while about 4 percent. sank to the fourth class and would be grouped asobjectionable.The difficulty of finding really trustworthy evidence of the

purity of drinking water is great but it is by such patient andcareful work as is described in this report that we may hopeto reach the desired end.

ORTHODOX MEDICAL GYMNASTICS ANDMEDICAL MASSAGE.

THAT medical gymnastics, accompanied by properlyapplied massage, have assumed a very important position inthe treatment of many ailments, both medical and surgical,is becoming more and more evident. Indeed, it is onlynecessary to think of the wide range of troubles which areincluded in, and associated with, rheumatism, heart disease,various forms of paralysis, and neurasthenia on the medicalside, and sprains, strains, dislocations, fractures, and someconditions of curvature on the surgical side, to realise whata scope there is for such treatment. In such a pathologicallist we must also include all those cases of deficient orill development which are in many instances greatlybenefited by properly regulated drill and instruction inmedical gymnastics. In answer to the wide demand thusindicated there has grown up a considerable "supply" ofservice directed to various therapeutic ends but no one cansay that this supply has generally speaking been at allsatisfactory.

There are of course a certain number of excellent masseursand masseuses but the bulk of those who affect such titles, aswell as the title of "medical gymnast," are ùf little practicaluse to the patients, and some bring great discrpdit on thewhole line of treatment. The fault lies not always in theindividuals. Putting charlatans aside, there are many whoaspire to assist the physician and surgeon in these directionswho have not had sufficient training, while such trainingin this country is but imperfectly systematised. On thisaccount those who have received their instruction inSweden, where the course to be gone through is a definiteand also an exhaustive one, are in favour with the medicalprofession. A word of acknowledgment is due to twoinstitutions in Sweden-viz., the Central Institute and Dr.Arvedson’s Gymnastic Institute for Women-not only forpresenting in a complete way the latest theory and practiceof medical gymnastics but also for a scheme of training, ina proper sense of the word, a number of students. Aninstitute for giving similar instruction to female studentsin this country has now been started in Kensingtonunder the direction of two medical practitioners, Dr.Mary Coghill Hawkes and Dr. Mina L. Dobbie. Theinstruction of the students is carefully arranged on thelines that have proved successful at Dr. Arvedson’s cliniqueat Stockholm, where the principals went through a ]ullcourse themselves. The course extends over a completeyear, and that time cannot be considered too long when acertain knowledge of anatomy, physiology, and hygiene,besides a practical acquaintance with the theory of move-ment and educational and medical gymnastics, have to bemastered. A visit to this institute found one class ofstudents studying the theoretical part of their work,while another in a large room, fitted up with the necessaryappliances, were carrying out the detailed movements andmanipulations under careful instruction. Having perfectedthemselves by practice on each other they are allowed toassist the seniors in manipulating patients, selected fromamong those sent to the institute by medical men, the insti-tute being open every morning for benevolent cases. Theprocess of teaching, it struck us, was one of theory andpractice properly combined, the rationale of every movementbeing recapitulated and dwelt upon in such a way as tomake massage and gymnastic exercise appear purposeful. A

case-book contained a history and ful description of thecondition of each patient at the commencement of treatmentwith notes :as to the progress that had been made. Thevarious exercises which bad been ordered in each case werewritten down and carried out seriatim, all the work beingcarefully supervised by the principals so as to insure it beingcarried out with the important avoidance of undue strain onthe patient. At the end of the oourse the student is

required to pass an examination in I the theory and practiceof Swedish medical gymnastics, massage, and anatomy,and to have previously obtained the certificate of the

Incorporated Society of Trained Masseuses." This ex-

amination is carried out by Mr. James Berry, surgeonto the Royal Free Hospital, in conjunction with an in-

dependent authority upon Swedish gymnastics. On passingthis examination a certificate is granted stating that the-owner is qualified to treat patients under the supervision ofa registered medical practitioner." Patients sent for treat--ment to the institute are referred at intervals to theirown medical adviser, without whose knowledge and approvalno step is taken.We have devoted considerable space to the notice of this.

institute, but it seems to us to be a carefully organised schoolthe pupils of which should be distinctly useful to the medicalprofession and through that profession to the public. It isquite time that some such means should be available in thiscountry for masseuses to be enabled to acquire a thoroughknowledge of the Swedish system. It is time also that thosewho take up this line of work and advertise their willingnessto assist the medical profession should realise that a courseof desultory instruction for a few weeks is quite inadequateif it is desired to attain to a proper knowlege of the subject.

ASYLUM REPORTS.

Dorset Co2nty Asyl1un (Report for 1904-05),-The yearbegan with 761 patients on the register and ended with810. The increase took place chiefly amongst out-countyand private patients. The admissions from the countynumbered 125, of whom 104 were first admissions. 44

private patients were received. Not for many yearshave the cases admitted been so hopeless. Dr. P. W.MacDonald, the medical superintendent, comments on

the practice of sending people over 70 and 80 years of

age to an asylum simply because they are peevishand irritable. These cases are not fit to be amongstthe insane proper. He says: "The growing disposition onthe part of the home circle to be relieved of the burdenof caring for the aged is much to be regretted."

"

Ofthe cases admitted 13 per cent. were over 65 years andseveral were over 80 years. Dr. MacDonald rightly con-siders that the workhouse infirmary is the proper place forsuch cases if they cannot be kept at home. The subject ofthe deficiency of workhouse accommodation and the practiceresulting therefrom of sending these old people to asylumsis dwelt upon in some detail by the Commissionersin Lunacy in their last report, which was dealt with inTHE LANCET of Nov. 18th, p. 1500. Cases of prematuredementia are much more frequent now amongst the admissionsat this asylum than formerly and cases of epileptic insanityhave also greatly increased. This last-mentioned fact is con-nected with the considerable role played by heredity in thecounty of Dorset. Over 50 per cent. of the epilepticsresident are of the congenital class. The continued rise innumbers resident at the asylum is ascribed less to anyincrease in the number of first admissions than to an accu-mulation of senile and feeble-minded cases. Amongst causesof insanity, hereditary predisposition was present in over I50 per cent. of the cases received. Alcohol is not regardedas responsible for more than between 3 and 5 per cent. ofthe cases of insanity occurring in Dorset. The recovery-rate for in-county patients was 38 9 per cent., which issurprisingly good considering the nature of the cases ad-mitted. Of the total admissions (192) 76, or nearly 40 percent., were in the most favourable class for treatment

(first attack and within three months of admission). Ofthe recoveries (58) 47 had been in residence from one tonine months. In a number of these recoveries there is

thought to be but little hope of permanency. Deaths duringthe year numbered 65, or 8’ 29 per cent. on the averagenumber resident. Of these 30 per cent. were patients over70 years of .age, showing the accumulation of aged eases.