1237

THE L A N C E T.

LONDON: SATURDAY, NOVEMBER 16, 1895.

MEETING OF FELLOWS & MEMBERS OF ROYAL COLLEGE OF SURGEONS.

THE annual general meeting of the Fellows and Membersof the Royal College of Surgeons of England, which

took place on Thursday, Nov. 7th, was by far the most

interesting and important general meeting which has

een held at the College for several years. There

was a marked improvement in the attendance and in thetone, temper, and speeches of the Members of the College,whilst the resolutions proposed in the interest of the Mem-bers were of a moderate and practical character. There was

an air of genuineness about the proceedings which has been

acking on some former occasions, and the unanimity of

opinion which prevailed was admirable and has materiallyadvanced the cause championed by the Society of

Members. As a matter of tact, taste, and good feelingit would probably have been better if no objectionhad been raised to the adoption of Surgeon - MajorINCE’s usual motion according the thanks of the meetingto the Council "for the interesting and important reportpresented," but there was nothing churlish or offensive

in the mode in which the amendment to pass to

the next business was proposed by Mr. GEORGE BROWNand seconded by Mr. BRINDLEY JAMES, and it was

natural that in view of the solid business on the agendapaper there should have been a strong desire not to wastethe time or fritter away the energies of the meeting.The points emphasised in the motion standing in the nameof Mr. JOSEPH SMITH were the most vital points of reformwhich could have been selected, and professional opiniongenerally would be found to lean in a preponderatingforce in favour of the propositions therein embodied.

In its original form the motion ran as follows :

"That this meeting requests the Council to take steps toobtain an amended Charter which shall contain the follow-

ing provisions : (a) that no alterations in the constitution

and external relations of the College shall be effected with-out the consent of the body corporate, convened to discusssuch alterations; (b) that the present annual general meetingbe made statutory, and that the report of the Council shallbe submitted for formal adoption ; (e) that the members ofthe Council be increased to thirty-two, and that eight ofthese, who may be Members, shall be elected by the Mem-bers only, provided always that no Member who has not beena Member for twenty years shall be eligible for a seat on theCouncil." On the suggestion of the President this tripartite motion

was formally divided into three separate resolutions, eachof which was proposed by Mr. JOSEPH SMITH and secondedby Mr. DICKINSON, and carried all but unanimously. The

first resolution involves a principle which has been recognisedby the Council, but not to the full extent of its signification,and has certainly not always been acted upon by that body.The exclusion of the Apothecaries’ Society from the Con-joint Examination and the whole arrangements for thatexamination were effected by the Council without reference

to the body corporate, and the proposed cooperation withthe University of London was decided upon by the Councilfirst, and then brought before the Fellows and Members

for discussion. The second resolution embodies a pointfor which we have always contended-viz., that the

annual meeting of Fellows and Members should be statutoryand not left as at present to the good pleasure of the

Council to hold or to withhold as that body may please.It is for the good of the institution that the manage-ment of the College should be submitted every yearto the criticism of the Fellows and Members, and thatall temptation to the Council to interfere with its con-

tinuity should be removed. Moreover, if the meetingwere statutory, the Fellows and Members would have a freer

hand, and the conduct of the meeting would be brought moreinto line with the conduct of other general meetings else-where. The third resolution, providing for the addition

to the Council of eight representatives of the Members

of the College, affirms another principle for which

THE LANCET has long striven, and gives effect to that

principle in the way which is open to the least objection,inasmuch as it would deprive the Fellows of no real privilegewhich they at present possess, and would leave them to

all intents and purposes still in undisputed possession of

the control of collegiate affairs. All that it would take

away from the Fellows is the exclusive right of electingmembers to the Council, and this is a perquisite whichundoubtedly a large number of the Fellows would

rejoice to be able to abandon. The whole historyof the present century is a history of successful

struggles for the destruction of the exclusive privilegespossessed by particular classes in the community.Disabilities have been removed from Roman Catholics and

Jews, close boroughs have been abolished, municipal bodiesreformed, and the franchise exi ended to the working classes aand by all these reforms the State has been enormou lystrengthened. Reasons of a similar character to those which

were urged in favour of these changes can be adduced fothe removal of disabilities in the medical profession. How

greatly would the Royal College of Surgeons of England gainin power and influence by the contentment and elevation ofits grand constituency of members. Accidental circum-

stances have delayed this concession of representation to theMembers and the consummation of an act of good policy and

justice, but these reforms cannot .be much longer delayedwithout seriously weakening the institution and renderingstill more critical the present critical state of its firances.Elected as the Council of the College at present is bythe Fellows alone, it could not of its own good pleasureand mere motion at once accede to the request of the

Members-the Fellows of the College must first be con-

sulted. It may be said that the Fellows were consulted

some years ago and that the answer was not favourable to.

the claims of the Members, but the circumstances underwhich they were consulted were widely different from thoseprevailing at the present time, and the mode in which theywere consulted was so oracular and ambiguous that it wasnot a fair test of the balance of opinion ; and yet even

under such adverse conditions the number of the Fellows s

prepared to do justice to their fellow Members was considers-able. Moreover, the present proposal is in a form which

1238 CONFLICT BETWEEN OWNERS OF PROPERTY & SANITARY AUTHORITIES.

deprives the main objection to the original proposalsof all its force. The cry then was that the Fellows would

be swamped at the poll, and that the Members of the

Council would be elected no longer by the Fellows but bythe Members of the College. This cry cannot be

uttered again. So that now there is every reason for

consulting the Fellows of the College again, and if the

Council puts the matter on one side and takes no action

whatever, a grave responsibility will be incurred. There

were many Fellows at the annual general meeting, and but onewas found to hold up his hand against the third resolution,and several Fellows there were who held up their hands in

its support. A gradual process of conversion is proceedingamongst the Fellows of the College, and if the Council ofthe College were now again to consult them, either bycircular or at one of the half-yearly meetings, we should be

greatly surprised if the opposition to the concession of repre-sentation to the Members of the College did not provealtogether insignificant.

About the question of the admission of women to the

examinations for the diploma of the College, which occupiedthe remainder of the time of the meeting, little need be

said, for the adverse decision of the Fellows of the

Royal College of Physicians of London had deprived thediscussion of any immediately practical importance. The

result of the voting showed that opinion on this sub-

ject is nearly equally divided, and it was curious to note

that the fact that so many portals had been opened I,,to women for obtaining medical and surgical diplomaswas used as an argument both in favour of admittingwomen and in favour of excluding them from the examina-tions for the diploma of Member of the Royal College of

Surgeons of England. For the time being the question is

probably settled, but so great has been the change of opinionin the profession on the general question that when the nextapplication to the two Royal Colleges of London is made bythe London School of Medicine for Women no one need be

surprised if the present decision should be reversed at bothinstitutions.

THE medical officer of health cloes not lie on a bed of

roses, but his object is to make his district sweet and

healthy. His pride must be to have it in such a sanitarycondition as will compare favourably with that of other

districts similar in size, situation, and population. His

powers under recent Acts are certainly great and admit of

being used in a way which to some, especially to the

owners of property, may seem harsh and tyrannical. But

his responsibilities are great. The law has recognised thisand has made it the interest of large communities to

pay such salaries to their medical officer as to make

him independent of private practice, and has still further

.secured his independence by making his dismissal by thesanitary authority conditional on the consent of the LocalGovernment Board. Preventable disease, as His RoyalHighness the Prince of WALES said, ought to be pre-vented. The prevalence of it is the opprobrium of

the sanitary authority, and ultimately of the medical

officer of health, on whose advice chiefly the sanitaryauthority acts. The Acts under which such powers

are conferred are comparatively new. The property in

regard to which they are used is for the most part old.

Hence it is not difficult to understand that a serious

collision of feeling is apt to happen between the sanitaryauthority in its intolerance of preventable disease and theowner of property that answered all the old-fashioned

purposes of property, and especially that of returning a

good rent to its owner, but which is capable of har-

bouring or emitting poisons which either kill outright ortend to degrade the health and morale of the inmates.A sharp collision of this kind may be studied at the

present moment in the case of Islington. Mr. ERNEST

EDWARDS, Secretary of the Metropolitan House Investmentand Agency Company, Limited, has addressed a letter,which we publish in another column, to every member of the

Vestry of St. Mary, Islington, to the vestry clerk, and to the

Islington Gazette, complaining bitterly of the way in whichthe sanitary authority of Islington and its medical officerare using the powers conferred on them by the Public HealthActs. Mr. EDWARDS shows that his company owns 68

houses in the parish, and collects the rents of 51 other

houses, making in all 119 houses, of the aggregate netannual ratable value of .E3500, or thereabouts, and repre-senting an invested capital of .640,000. He states that all

the houses are in excellent repair, and all let to most

respectable tenants, the rentals varying from £30 to £50. He

complains of the constant demand of the sanitary authorityon the company to have the drains entirely relaid, ventilationshafts erected, &c. The cost of such alterations is from 30

to ;E35. Mr. EDWARDS alleges that the houses of the com-

pany are made the special objects of the sanitary authority’sattention and demands in a way in which other property isnot. But he may be comforted in this respect by a similar

complaint addressed to the Islington Gazette by Messrs.

NOKES and NOKES, who manage ouses in Islington and

other parts of London for various lients, and who allegethat the demands of the sanitary authority are "far morenumerous" " than in any other parish. These gentlemen goso far as to suggest that a petition should be presented tothe Local Government Board asking for an inquiry to bemade into the management of the sanitary departmentof the Islington Vestry. The same grievance is expressedin the same paper by Mr. C. J. GARD on behalf of

the " Central Property and Investment Company." He

declares that owing to the fads of the sanitary authorityproperty in Islington is hardly worth having. He

makes a still more serious charge, which the Islingtonauthorities would do well to call on him to establish, that

they serve notices to do work on people which the department knows it cannot enforce by law."We cannot pretend to decide between parties whose point

of view and whose interests are so different-our sympathiesare naturally with all reasonable attempts to make housesfit places to live in. Toleration of ill-laid drains or inade-

quate and defective waterclosets on the part of landlords isnext thing to a crime. They convert the house, which oughtto be a means of life and health, into a source of disease,and possibly into a death-trap. We have no sympathywith mere " fads," or with mere gratuitous exactions

from owners of property. In all conscience local rates

are high enough, and local indebtedness is inereasin-

1239DISCUSSIONS ON PUBLIC HEALTH AT LOWESTOFT.

fa6t enough, without giving any encouragement to the

wanton use of great powers conferred only for grave

public purposes. But do these letters establish any such

case against the Islington authorities ? We think not.

Two things strike us in the letters-firstly, they are

written by the representatives of companies, and com-

panies are apt to look very much to their own interests,and to be out of sympathy with the tenant’s view and case ;and, secondly, they are reticent as to the health of the

tenants. They do not tell us whether they have had sicknesson the premises or other reason for complaint. Now this

omission is radical. But it is supplied by Mr. HARRIS, themedical officer of Islington, in a letter to the Local Govern-ment Board on Mr. EDWARDS’S letter. Mr. HARRIS saysthat in every instance the premises were visited either byreason of the occurrence of infectious disease or through complaint having been made to me of their insanitary con-dition." The alterations may have been excessive, but unlessthis statement can be refuted we must assume the contrary.;E30, or £35, may seem a large sum to owners of property;but it does not seem a large sum to make faulty housespermanently sound in a sanitary sense. The contest is an

interesting and an inevitable one, but public sympathy willbe with the law that requires a landlord to put his houseinto such a condition that it shall not endanger life or evenhealth. Islington is the most populous parish in England,and sanitarily compares favourably with most other metro-politan parishes, and even with some rural ones. The generaldeath-rate of Islington and the death-rate from zymoticdisease are markedly less than in any of the great groups of

sanitary areas as given in the last quarterly return of the

Registrar-General (July, August, and September). This, inthe long run, must be in the true interest of the parish andof its property owners.

THE report of the last quarterly meeting of the town

council of Lowestoft includes a discussion on public healthmatters which would afford amusement to many were it not

that the interests of health and life are involved. Lowestoft

had a heavy rate of mortality during the month endingOct. 19th; it reached no less than 50-18 per 1000, 19 per 1000

being due to measles and 10’3 to diarrhoea. Monthly ratesare not often of much value, but this one is so excessive

that it called for investigation, and the medical officer

of health did his duty in reporting on it to the sanitarycommittee. This led to the chairman of that committee

condemning the principle of such reports being "reduced to

writing " and hence becoming known to the public, with theresult of damaging what he calls the general interests ofthe borough." If this chairman means that visitors are thus

temporarily prevented from visiting Lowestoft, then his sug-gestion as to privacy pending an epidemic of measles is

one so intolerable that we trust it will be resented by hisown constituents. Can he possibly mean that he wants, bya policy of secrecy, to attract families with young childrento a place where they will run an exceptional risk of

death ? But we cannot take this chairman au, sérieux in

view of his next statements. First, he announced that themedical officer’s views as to the cause of this exceptionalmortality were wrong; they were, indeed, " but the opinionsof one man," whereas he (the chairman), who disclaimed all

medical training, though "but one man," had had his own

experience," which enabled him to " trace a disease." The

results of his etiological investigations were next pro-

pounded by means of an announcement, which he saw noobjection to make quite public, to the effect that the sewersof Lowestoft were inadequately ventilated and gave forthoffensive odours, and "were a fruitful cause of disease."The public will note this frank declaration of the chairmanof the sanitary committee, who evidently will have no

secrecy when his views as to the state of the sewers are in

question, and they will not forget what the medical officerof health says as to the condition of the middens in relation

to a diarrhoea death-rate of 10’3 per 1000 of the population.The next point discussed was a definite proposal to

include measles among the notifiable diseases, the proposerreminding the council that both the present and former

medical officer of health had advocated it. But it seems

to be the practice of some in Lowestoft to deal with health

questions in a spirit of levity, for a second councillor imme-

diately urged that such a recommendation should "not betaken too seriously," especially as it related to a "compara-tively innocent" disease-one, he forgot to add, that kills

from 11,000 to 16,000 of the population of England andWales every year-and then this authority on public health

actually announced that he did not know a town n

which measles was included in the list of notifiable

diseases." We cannot, of course, take him " too

seriously" as to this, otherwise his constituents mightsuggest to him to learn the elements of his duties beforehe next addresses an audience on a matter so serious as

that relating to public health. Fortunately, the Mayordiverted the discussion into a serious groove and an-

nounced that if notification of measles could stay such a

grave mortality "it was worth any expense, no matter what.’For his information we may say that the question of thenotification of measles is a difficult one. Where the noti-

fication has been properly used at the onset of an epidemic bystrictly preventing children from going to school from infectedhouses it has achieved excellent results ; where that earlystage has been allowed to pass without careful attention tothe question of school attendance in every case, the expendi-ture on notification has been wasteful, and the subsequentclosure of schools often useless.

Indeed, the question whether in a given place exclu-

sion from school of infected scholars or total closure

of schools should be practised must be a matter for

medical judgment. No general rule can be laid down as tothe inclusion of measles as a notifiable disease. It mainlydepends on the use to which the newly acquired knowledgewill be put ; but it also depends on other local circum-

stances. The whole matter is, we are informed, beingstudied by the Medical Department of the Local Govern-

ment Board, but the problems involved are numerous. One

thing we believe to be certain-namely, that if properlyused in a place like Lowestoft, such notification oughtsubstantially to save life and prevent needless interferencewith elementary education.

THE Bradshaw Lecture, delivered by Dr. BRADBURY

before the Royal College of Physicians of London, and

1240

published in another column of our present issue, forms an

interesting record of the extension of investigations over

ground which has already attracted many experimentalworkers. The possibility of influencing the size of the

arterioles, and of thus regulating the supply of blood to

the capillaries, has long fascinated experimental physio-logists, while the evils of high tension have been more

grudgingly allowed in some directions by clinical observers.It has been freely admitted that some cases of anginapectoris were benefited by employment of nitrite of amyland of nitro-glycerine, and these substances have been freelyemployed in various ways. The gains from nitrite of amylhave often been found to be evanescent, although it has

the advantage of rapidity of action, while nitro-glycerine,although its effects last somewhat longer, has often givenrise to headache, and even now it can scarcely be said

to have found general acceptance at the hands of the

medical profession. The fact is that the nitrites alreadyknown and nitro-glycerine agree in being at once too

powerful in action and too transient in effect, and more

recent researches have been directed towards the discoveryof some substances able to produce a prolonged fall

of blood pressure. Dr. BRADBURY mentioned the work

of previous investigators-LEECH, MATTHEW HAY, and

LAUDER BRUNTON-and he indicated the reasons which had

led him to work more particularly with the nitrates of thehigher alcohols and their allies. It is needless here to follow

his account of the preparation and properties of the bodieswith which he chiefly experimented-viz., erythrol tetra-

nitrate and mannitol hexa-nitrate-but the experiments bywhich he has determined their pharmacological actions

will be found to be careful extensions of the methods of

previous workers, and they appear to prove conclusively thatthese substances possess an action similar to that of nitro-

glycerine, but that their effects are weaker, though more

prolonged. He employed the perfusion method of LUDWIGto determine the purely local action of these bodies, and hefound that for practical purposes the general effects werethe same when the experiments were conducted with

the organs of warm-blooded or cold-blooded animals.

These experiments were confirmed by blood pres-sure tracings from rabbits under the influence of

urethane, and further by pulse tracings from actual patients.One of the most interesting features of the lecture was theexhibition of a diagram showing the relative effects of the

various members of the "nitrite group," in which the

nitrates of erythrol and mannitol were shown to be inactive

during the period immediately following their administra-

tion, while their effect, which was gradually produced, wasmarkedly prolonged.The practical outcome of these experiments, the applica-

tion of these new vaso-dilators to suitable cases of disease,must naturally form the most attractive feature of this seriesof experiments, and here Dr. BRADBURY appears to treadupon less certain ground. It will be noted that he speaks ofdiseases in which these drugs maight prove useful, instead ofgiving details of cases in which they have already estab-lished their claim to consideration. Admitting all that

can be said in favour of "diminishing the work of the

heart and the pressure upon each unit of area of the artery,"we imagine that most practitioners might feel some hesita-

tion about the advisability of attempting to keep the

tension constantly below a certain level." It is possiblethat angina-like pains may be not only relieved bynitro - glycerine and nitrite of amyl, but even averted

by the longer acting remedies such as erythrol nitrate,and that in this direction the new vaso - dilator

may find its future scope of usefulness. But Dr.

BRADBURY himself admits that many cases of cardiac painare better treated with morphine than with vaso-dilators,while for others he notes the value of purgatives and ofattention to the general health. With regard to chronic

Bright’s disease, the condition which beyond all others isassociated with a high tension pulse, it is possible that manyof the troublesome symptoms-headache, mental ineptitude.weariness, and the like-may be relieved by the newvaso-dilator, but it must not be forgotten that manyobservers claim that the high tension in this disease is theresult of conservative changes in the vascular walls, whichtend to protect the tissues from an impure condition

of the blood; while relieving symptoms, therefore, by theadministration of vaso - dilators, it must be remem-

bered that simultaneous measures must be taken to rid

the blood of impurity so far as possible. The other

conditions enumerated by Dr. BRADBURY-aneurysm, &y-naud’s disease, various forms of dyspnœa, the headache ofhigh tension and various forms of nervous diseases-mayperhaps be found to offer more suitable fields for employ-ment, but this is for the future to determine. Dr. BRAD-

BURY is certainly to be congratulated upon the introductionof new drugs which will keep down the blood pressurefor a length of time ; but their future employmentwill depend largely upon the view taken of the evil effects.

of high arterial tension. Meanwhile, although in their

infancy, it is satisfactory to find that no evil effects have,

yet followed their administration ; but it is disappointingto learn that they do not produce certain results in all

cases and that some individuals are insusceptible to their

action.

Annotations."Ne quid nimis."

MUNICIPAL HONOURS TO MEDICAL MEN.

IT is not every medical man, however much he may desireto do so, who can find time to attend to the manifold dutiesinvolved in the office of mayor, but in few other capacities asa citizen does the medical man possess more power for goodthan as the occupant of the civic chair. As a medicalman he should be fully acquainted with the sanitaryand hygienic needs of his borough, and the positionof mayor offers excellent opportunities for seeing thathe necessary reforms are properly carried out. Weare sorry, therefore, to note that the list of medical

mayors this year falls considerably below the average.Up to the present we have only been notified offour: Dr. E. Jepson, Mr. Richard R. Daglish, Dr. T. W.

Thursfield, and Mr. H. F. Townshend Chambers. Of thesethe first three have been re-elected. Alderman E. Jepson,M.D. Durh., &c., was elected mayor of Durham last yearand re-elected this year for another term of office. He has

rendered good service to his borough by endeavouring to