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instances in which I have seen it, which certainly have not been many, it has been caused by the use of a coil, and I ghave never been troubled by it when using a static machine, lnor have I ever heard of a case caused in this way. I think that there must be some grounds for a belief which hasbecome so general, but the relative safety or otherwise ofthe rays from different sources is difficult to ascertain andwill be so unless or until static machines become as commona source of them as coils are.

I am, Sirs, yours faithfully, ’

WM. SALISBURY-SHARPE, M.D.Durh., M.R.C.S. Eng.,L.R.C.P. Lond., D.P.H. a

Cleveland-terrace, W., Oct. 18th, 1904.

THE BRITISH MEDICAL BENEVOLENTFUND.

To the Editors of THE LANCET.

SIRS,-The letter from the President of the British MedicalBenevolent Fund which appeared a short time since inthe Times and to which reference was made in THE LANCETof Oct. 15th, p. 1095, was as eloquent an appeal forthe funds of that worthy charity as could be made,and one can only hope that the hearts of members ofthe profession and of the public will be touched, withthe result that the present ilrancial difficulties will beovercome. But the question that naturally occurs to a

business man is this : Why is an institution which exists forthe benefit of a profession numbering over 37,000 membersallowed to get into straits for money ? ? Whilst granting thatonly a few medical men are very rich, still there are a verylarge number who make a good income, whilst the majorityearn sufficient to spare, at any rate, a few shillings a year inaid of those of their less fortunate brethren who fall by theway owing to unforeseen circumstances. Looking at thematter from this practical point of view one naturally seeksfor some defect which may be remedied’ are the rules as tothe dispensing of the funds too restrictive ? is there any-thing in the working of the charity to alienate the "ym-pathies of members of the profession ? or is there somewherea lacking of that business-like organisation which is as

essential for the success of a charity as for the prospering ofa large commercial undertaking ? The answer to the first

question is very easily made. So far as the rules of the fundshow there is practically no restriction beyond the fact thatthere must be funds in hand. Apart from this, every one ofthe 37,800 medical men on the Register has a right to appealto the British Medical Benevolent Fund for himself or lor a

confrere in distress. With regard to the second ques-tion, Sir William Broadbent’s letter shows that no objec-tion can be raised as regards the working of thefund. The annuitants are appointed and the grants aremade without the delay and cost of an election, entirely onthe merits of the applicants, and according to the urgency ofthe cases which go before the committee at their monthlymeetings. This is as ideal a form of administering charitablefunds as could be imagined-no waiting, no publicity,and the grants are not given in one sum (in which casethey would frequently find their way into the hands ofthe landlord for arrears of rent), but they are paid in

monthly instalments as a rule in order that the maximumamount of good may be done in every case. We thereforecome to the last question: Is there something wantingfrom the point of view of businesslike organisation ?And here I will let the President answer in his own

words. "There are no buildings to maintain, no office ex-penses, no salaried officials." Here, I venture to suggest,is the key to the situation. However zealous honoraryofficials may be in their work (and having known successivesecretaries of this fund I can testify to the whole-heartedway in which they have worked), a charitable institutiondepending upon honorary work cannot reach the degree ofsuccess which is attained by those which have a well-paidsecretary who devotes his whole time to the interests of thecharity. And is there anything surprising in this ’? Asecretary who can command a good salary has undergone along apprenticeship in the difficult art of getting money andhe has acquired those powers of organisation which willenable him to obtain contributions in spite of passing diffi-culties, such as shortness of money, wars, and the numerousother reasons offered by charities to account for the decreasein contributions. To repeat, the obtaining of contributionsis an art and none know this better than the committees of

our leading charitable institutions who do not hesitate togive a good salary to a thoroughly qualified man, for theyknow full well that the money will be repaid ten-fold in thereturn of donations, subscriptions, and legacies.

Let us take a glance at the income of the fund for the lastten years, or, to be more correct, from 1893 to 1902, as Ihave not a later copy of the report by me. In 1902 the totalof donations and subscriptions was exactly the same as inthe year 1893, so there is evidently no progress in this

department, and in some years the total has fallen as low as£1291 and £1367, whilst it has been as high as .B18S3and .B1791. As regards the grant department, the sum ofE1866 was disbursed in 1893 and E1503 in 1902, being adecrease of £363. As to the total number of contributors Ihave not counted these but believe a very fair estimatewould be 1350. As this number includes all contributors,medical men, ladies, and those not belonging to the pro-fession, I presume we may fairly say that not more

than 1000 medical men out of the 37,000 on the MedicalRegister show sufficient interest in this invaluable in-stitution to contribute to its funds. Next as to thehonorary local secretaries-those channels through whichfunds flow so regularly into the coffers of a charity. Thereare under 100 of these, including some representing the

hospitals and schools in London. With the organisingpowers of a good paid secretary these officials ought to beincreased to 300 or 400 and if the fact were made clear that

subscriptions of half-a-crown or 5s. were welcome therewould be a great increase in the receipts. Then honorarylocal secretaries should be urged to obtain contributions fromthose outside the profession, for most persons agree that thepayment of the doctor’s bill does not anything like jepayhim for the anxiety, time, and trouble bestowed, and no morefitting way of showing gratitude can be imagined than con-tributing to an institution which exists for the purpose ofassisting medical men and their families when in need ofhelp.May I lay stress upon the fact that I do not wish to make

any refaction upon the existing honorary officials? ? In fact,they could continue to render their invaluable help after theappointment of a paid official, thus leaving him more timeto devote to organising. But I am convinced that suchappeals as the one recently issued by the Pres dent of thefund would not have to be made and 23 applicants wouldnot have to be refused help owing to lack of funds if an

experienced secretary were appointed. Business methodswould then place the financial condition of the fund on asound basis, and there would be an increasing amountavailable for distribution year by year.

I am, Sirs, yours faithfully,A LAYMAN.

It is well sometimes that we should have the oppor-tunity of seeing ourselves " as others see us" and as an

appeal has been made to the public for help we willinglyextend to "A Layman "the hospitality of our columns. Too

much praise, in our opinion, cannot be given to the honoraryofficials.-ED. L.

THE BOSTON MUNICIPAL BACTERIO-LOGICAL LABORATORY.

(FROM OUR SPECIAL SANITARY COMMISSIONER.)

Boston, Mass., U.S.A., Oct. 4th.

SOME of the most original features of sanitary administra-tion as established in the city of Boston are to be found atthe bacteriological laboratory. There a public service hasbeen organised which in minutiae of detail is well worth

studying. While the first object is of course to prevent tl-espread of disease it must also greatly facilitate the work ofthe general practitioner and relieve him of a heavyresponsibility. The laboratory, strange to say, is situatedin a flat in one of the best residential districts of Boston.Doubtless efficient precautions are taken, but even if the

pathogenic germs that are brought here every day are so wellprotected that no accident can happen with them, still thekeeping of animals for experiments in a residential flat doesnot seem quite right. Some outbuilcling near a medicalschool or hospital, and standirg on its own grounds, is

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generally chosen for a bacteriological institute. At Con- ostantinople, for instance, the Sultan managed things better. fThere the Turkish Pasteur Institute occupies a beautiful site s

all by itself, surrounded only by trees and gardens. If tanimals are kept here the noise they make does not ldisturb neighbours and should a bottle accidentally fall its tcontents, however dangerous, would not imperil other than c

experts who should be well able to take care of themselves, a

However, in spite of the immensity of the American con- ttinent there seems to be a lack of space and therefore it is 1not always possible to get exactly the sort of premises that c

are most desirable. E

On entering the flat which serves as the bacteriological laboratory of the Boston board of health the visitor is i

stopped by a counter with clerks behind and the general saspect is that of an insurance or merchant’s office or some 1

other business place. There are the desks, the clerks, and ]even string and paper hanging from the wall with patent 1

devices for cutting off promptly and exactly the piece of the I. size required for wrapping up the samples. Only on inquiry 1

is it discovered that the samples in question are the sputumof patients or swabs that have been taken from throats

thought to be affected with diphtheria. As far as appearancesgo the neat little cardboard boxes might contain the last newhair wash or a specimen bottle of ointment warranted to cureanything. On the counter which acts as a barrier to keepback the over-curious there is a lid which when lifteddiscloses a well-like compartment full of different sizedboxes of this description. Young men rush in at alltimes of the day. They deposit on the counter a few ofthese boxes, open the lid, take out more boxes, pack themup neatly with the string and paper provided, hastilymake a brief entry in a book that lies open ready at hand,and then probably hasten away, often without exchangingeither word or salutation. It might be a corn merchant’soffices with clerks and messengers running in and out from’Change to fetch samples. It is only on inquiry that thereal facts begin to reveal themselves, so well has the appear-ance of "business" been maintained. The hasty youthshave not come from any market or ’change but they are theshop assistants or messengers in the employ of dispensingdruggists. The samples they bring are of blood, sputum,pus, &c., and they take away boxes containing all that isnecessary for the collection of more specimens. Thereare in Boston 47 dispensing druggists who have depotsof these little cardboard boxes. Any medical practitionercan receive from these druggists gratuitously one or moreof these boxes. In them he places the specimen takenfrom his patient and returns the same to the druggistwho then forwards it by messenger and by hand to the

bacteriological laboratory. The specimen is forthwithexamined and a postcard answer is immediately sent printedin red if pathogenic germs have been found and in blackif they have not. These are called positive and negative post-cards. At the same time, when it is a case of infectiousdisease then a second card is sent to the board of healthand thus the compulsory notification is effected. Formerlythe messengers were paid by the municipality for every I

sample they took to the laboratory but this provedtoo expensive ; now they only receive 20 cents, or 10d.,per trip however many samples they may take. Tothe medical practitioner this system means a greatsaving of time, for he has only to go to the nearest

dispensing druggist. The medical practitioner does notreceive any fee for notifying cases of infectious disease,but as all necessary bacteriological research is done for himgratuitously and expeditiously this it is thought amounts toquite as much in the saving of time as the fees given inEngland. Also, it gives a better guarantee to the publicbecause, as the examination can be done, and donethoroughly, without cost to the patient or his medicalattendant, there is no temptation to defer such investigationand a better prospect is secured of nipping the evil in thebud.The laboratory is situated in Boylston Chambers, Boylston-

street, Room 501, nearly opposite the Harvard MedicalSchool, the art galleries, and above all the public librarywhich, with its painting and mural decorations, constitutesthe apple of the eye for every true Bostonian. Specimens arereceived here from 8.30 A.M. to 6 P.M. every day except holi-days. But there is an ingenious device by which samples maybe delivered even after the laboratory is closed. A special doorhas been fitted out. Here there is an aperture for letters ;no sample box can pass through. Then there is a square

opening through which the box containing the swabs usedfor diphtheria alone can enter. These fall into an incubatorso that the process of incubation commences the momentthe sample is delivered and while the attendants of the

laboratory are away. In this manner no time is lost. Onthe other hand the boxes for specimens of blood in casesof suspected typhoid fever can only be introduced throughanother and irregularly shaped opening. Thus the sorting ofthe samples is rendered indispensable, otherwise they cannotbe passed through the door. This very useful and practicalcontrivance is considered unique. I am not aware that itexists in any other laboratory and it is thought to be a

pure Bostonian invention. The outfits, as they are called,for diphtheria consist of a serum tube, containing two

swabs, and a card for the medical practitioner to fill

up with the details of the case. Also, there is a

paper giving directions. The card-board box containingthese is carefully disinfected with formaldehyde gas eachtime it is sent out. Before using such a box it is necessaryto look at the serum and if dry or liquefied it must be sentback to the laboratory and another taken in its stead. Oneswab is intended for the nose and the other for the throat,and both are inoculated in the same serum tube. If separatediagnosis is desired then two outfits must be used. Thedirections say that ’’ when a rapid or swab examination fordiagnosis is contemplated it is well to rub the swab on the

suspected area in the nose or throat a second time after theinoculation of the serum. The swab is then returneddirectly to the swab tube. This procedure increases the

reliability of the swab results by increasing the amount ofmaterial made available for examination."

These are placed in an incubator over night at 370 C. or

else worn in the night garment of the patient and thusincubated at body temperature. This latter mode ofprocedure hails, it appears, from Chicago. But there isnot merely the question of ascertaining the presence ofdisease, there is also the all-important matter of determiningwhen the patient ceases to be a danger to his neighbours.

For this purpose the board of health required that culturesfrom both the throat and the nose should be examined with

. negative results and this not once but on two consecutive, occasions. If only the second examination reveals the

presence of the diphtheria bacillus then the first examination’ does not count and two further negative examinations arenecessary before the patient can be released.r For tuberculosis the outfit consists of a small, stumpy,

square, wide-mouthed bottle. The mouth is wide enoughi for the patient to spit into with ease and this he is requiredt to do. Inside the bottle there is a small quantity of a 5 percent. carbolic acid solution. The acid not only kills thei bacilli but acts as a mordant and improves their staining1 qualities. When the box containing this bottle reaches the laboratory, it is opened and everything is exposed to- the vapour of formajin all night and in a tightly closeds receptacle so as to kill any bacilli that may have fallenh outside the bottle during the process of collecting they specimen of sputum. It is therefore on the morning follow-y ing the day of the receipt of the specimen that it is examined.d If any doubt exists as to the result of the examination, it may be necessary in some cases to inoculate guinea-o pigs and there are always some of these animals ready at,t hand in the laboratory.;t For typhoid fever the specimens can be, and are, sent byt post. The outfit consists of two tongue-shaped pieces of alu-’, minium foil on which the blood is dropped and smeared andn dried by rubbing these two little pieces of metal together..0 A small copper-wire loop is used to collect the one drop ofn blood and to place it on the foil. The accompanying formulaic c with directions is filled up by the medical attendant, thee whole is elaborately folded up and covered over and thenil placed in a manilla envelope and posted to the laboratory.!n For malaria a specimen of blood also is collected, but ine regard to dysentery and summer diarrhoea this system has

not proved satisfactory. A pipette is now being employed1- so as to obtain a larger quantity of blood. By these methodsal it is hoped that valuable aid will be obtained in the diagnosis’y of intestinal disease. es Altogether free examinations are made at this laboratoryre for tuberculosis, diphtheria, typhoid fever, influenza, andi- other bacterial diseases and malaria, if the specimen is senty by a qualified practitioner. For veterinary surgeons freeor examinations are made in regard to glanders and rabies.s In addition to this work of detecting and proving there presence of disease-and the number of samples sent has

1181

steadily increased-many examinations have recently been 1made of the bacteria contained in the milk supplied to the town of Boston. As many as 600 samples of milk have been bacteriologically examined in the course of a single month.

It will be seen, therefore, that this municipal bacterio-logical institute has been very active and is doing good work.Three specially trained men, two medical practitioners and achemist, an office boy, and a clerk are employed at the

laboratory, yet the cost to the municipality only amounts to£2200 annually. There are but few institutions that haverendered so much service at so small an expense. :

BIRMINGHAM.

(FROM OUR OWN CORRESPONDENT.)

University Notes.THE annual conversazione, which was held on the evening

of Oct. 3rd, was unusually well attended and the largeaudience listened with great interest to the address whichwas delivered by Dr. P. H. Pye-Smith, vice-chancellor of theUniversity of London. After the delivery of the address re-freshments were served and a number of exhibitions of variouskinds were open to inspection.-Two former students of theuniversity, who were subsequently teachers therein, havebeen appointed to chairs in the University of Manitoba. Dr.T. Swale Vincent, who graduated at the University of Londonafter pursuing his medical studies at Mason College, was forsome time demonstrator in the physiological department.His work in connexion with the function of the suprarenalcapsules is well known. He has been appointed to the chairof physiology in the University of Manitoba. To the chairof botany (with geology) in the same University has beenappointed Mr. A. H. R. Buller, Ph.D. and D.Sc. Birming-ham. Dr. Buller was also a student of Mason College andsubsequently studied in Germany where he made a specialtyof plant diseases. On his return from Germany he wasappointed demonstrator in the botanical department of theUniversity. This post, which becomes vacant on account ofhis new appointment, has been given to Mr. A. J. Ewart, M.A.,D.Sc. Lond., Ph.D.Leipsic. While speaking of resignationsI may note that Professor W. MacNeile Dixon, Litt.D., theoccupant of the chair of English language and literature anddean of the Faculty of Arts, has left the city, he havingbeen appointed to the same chair in the University of

Glasgow. Though unconnected with the medical professionhimself Professor Dixon had many friends amongst its ranksand being an assiduous cultivator of the game of golf hadfrequent bouts with the numerous members of our professionwho are also addicted to that game.-The new club-housefor the male students of the University is now somethingmore than a thing to be talked about, for work has actuallybeen commenced upon the building and the sanguine hope thatit may be in full operation by the commencement of the nextwinter session. The preliminary details have been in thehands of a committee which has Dr. W. Wright, the

popular lecturer on osteology, as its chairman and thiscommittee has been advising Alderman Beale, the vice-chancellor of the University, to whose initiative and energythe club house will owe its origin.

Pollution of the River Tame :Action against OldbueryCozcncil.

A very important proceeding which the Staffordshire countycouncil brought against the Oldbury district council underthe Local Government Act, 1888, and the Rivers PollutionPrevention Acts, 1876 and 1893, was heard in part a few daysago. The plaint set forth that the defendants at variouspoints within their districts caused to fall or to flow andknowingly permitted solid and liquid sewage matter to becarried into a stream being a tributary of the river Tame insuch a state as to cause the pollution of that river. Anorder was therefore applied for under the Rivers PollutionPrevention Act requiring the defendants to abstain fromthe commission of the offence. Counsel on behalf ofthe plaintiffs explained that the sewage was dischargedinto a tributary of the Tame, which tributary flowed througha populous district into an area dealt with by the BirminghamTame and Rea Board. For a considerable time the governingbodies which have dealt with the county council of Stafford-shire and the Birmingham Tame and Rea Board had donea great deal towards the purification of the Tame and bothof them had for years been doing everything in their power

to prevent the pollution of that river. Some of the autho-rities had dealt with their sewage in a proper manner butothers had failed to do so and amongst these was the

Oldbury district council which, in spite of all the pressurewhich had been brought to bear upon it, had done nothingand was still a very serious offender in respect of thatparticular stream. Oldbury had a population of about25,000 and sewage from about 22,000 was conveyed tothe Oldbury sewage works. It was contended thatthe method of treatment adopted at Oldbury was unsatis-factory and that the works were of insufficient capacityto deal with the large volume of sewage. Moreover, therewere exceptional difficulties owing to the presence in thesewers and at the works of chemical waste which made itvery hard to deal with the sewage of the district. Therewere 40,000 gallons per diem of chemical waste running intothe sewers which was not treated and the presence of whichrendered the works at Oldbury incapable of dealing with theordinary sewage of the locality. The result was that therewas flowing from those works into the river Tame a filthyeffluent which was a nuisance to the district throughwhich it passed for a considerable distance. The chemicalwaste which escaped into the river and its tributarieswas destructive to fish life, although the water inother parts away from the Oldbury district would supportfish. A correspondence between the two parties was thenread, in the course of which a letter from the clerk tothe Oldbury district council stated that the pollution wascaused by trade waste from manufactories and particu-larly from the works of Messrs. Chance and Hunt. Further,he added, to require this firm to cease from dischargingwaste liquid into the sewer would mean the stoppage oftheir works and would be of very serious consequence toOldbury, as they were amongst the largest ratepayers. Healso contended that both above and below the place wherethe Oldbury effluent entered the stream there were pollu-tions. The Local Government Board had declined to inter-fere between the two bodies. Counsel claimed that the

inquiry had nothing to do with the difficulties of Messrs.Chance and Hunt who, as a business concern, were appa-rently creating a nuisance and should be restrained by thedistrict council. It was for the court to find out what wasthe source of the pollution and if he proved that it camefrom the Oldbury sewers then he was entitled to an order torestrain any further pollution. They could not consider theposition of Messrs. Chance and Hunt in the matter but

they were only entitled to consider how far the local autho-rity, in consequence of that position, was reasonablyentitled to some mitigation of the severity of the order.Dr. George Reid, county medical officer of health, gaveevidence and stated that he had on several occasions visitedthe Oldbury sewage works and from his observation of thestate of the effiuent prior to 1903 it was very foul and had avery bad odour. In February, 1903, an inquiry was held atOldbury into an application for a loan to extend the sewersso as to take in the sewage of a larger population, but this,in his opinion, would only increase the evil. He opposedthe scheme on that account, because it would increase thevolume of sewage going into the outfall and would consequentlymake the works worse than before. He did not know that

anything was done to enlarge or to improve the purificationworks. Dr. Reid gave a full account of the system at workat Oldbury and said that the contact beds were insufficient,having regard to the daily flow of sewage at the works.These beds were 56 per cent. below the lequirements of theLocal Government Board, which lie did not think were overthe mark. After hearing Dr. Reid’s evidence the further

consideration of the case was postponed until the end ofNovember, when I shall hope to acquaint your readerswith the termination of the case.’ Oct. 17th.

________________

LIVERPOOL.(FROM OUR OWN CORRESPONDENT.)

University of Liverpool : Department of Anatomy : A Tributeto the late Sir William Banks.

Ia the course of his opening lecture delivered on Oct. 4thProfessor A. M. Paterson commented on what he describedas "two events of importance in the annals of the anato-mical department." In the first place, he said, they enjoyedthe privilege of occupation of their completed new buildingsand the University now possessed an anatomical institute