90

THE LANCET.

LONDON: SATURDAY, JULY 20, 1878.

THE BILL IN EXTREMIS.

THE Government is naturally unwilling to admit theMedical Bill into the list of " innocents " to be slaughtered,but the postponement of the second reading to so late a dateas the 25th of July, coupled with the number of adversenotices of motion, may be taken as a confession that theauthors of the Bill have abandoned all hope of its becomingan Act in the present session of Parliament. The languageof Sir STAFFORD NORTHCOTE on Monday night, in reply toDr. LUSH’s advice that the Bill should be withdrawn, is notinconsistent with this view of the matter. The Chancellor

of the Exchequer said, in his speech on the course of remain-ing business : " As to the Medical Law Amendment Bill, itwould be premature at present to make any statement. It

is a matter of great interest, and I prefer taking a little timebefore deciding what course the Government will adopt inregard to it." Some may construe these words as meaningthat the Chancellor still sees hope of being able to proceedwith the Bill. But neither the language itself nor the cir-cumstances lead us to such a construction. We should

rather gather that Sir STAFFORD NORTHCOTE feels, as hesays, that the matter is of great interest-not so much tothe profession as to the public,-and that there must besomething real and significant in the opposition to the Bill,as to the similar Bill of the previous Government, whichrequires grave consideration. We hope the result will

prove that Sir STAFFORD NORTHCOTE’S words are not

merely formal, but expressive of sincere desire to perfect aBill which may be made to effect beneficially the qualityof medical education for the future. It would be diffi-

cult to name anything in which the public is more

deeply interested than in the creation of an examiningboard or boards to keep up the minimum standard

of education in medical men. In order to do this,two things are essential: first, that the examining boardsthemselves should be purely disinterested, in pecuniaryrespects, in the results of their examinations; and secondly,that the body which has to control and supervise theseboards -viz., the Medical Council-should be independent,and should possess on the one hand the confidence of the

public, as represented by the Crown, and on the other handthe confidence of the profession. It is the misfortune of the

Government that, as a matter of courtesy, they have beenobliged, in all attempts at legislation on this subject, to askfor, and to be largely guided by, the advice of the boardsand bodies needing to be reformed. The present Govern-ment is so strong that it perhaps thought it could carry anyBill through the House of Commons. But, however naturalsuch a feeling, it was neither wise nor warranted. The last

Government was as strong, and it completely failed. Such

measures as the Medical Bill are very different from merelypolitical measures. They appeal to a different set of feelingsand interests. They are essentially technical, and shouldbe dealt with in a special way and after a special inquiry.

We venture to hope that Sir STAFFORD NORTHCOTE’Swords imply that he perceives this, and is contemplatingthe reference of the Medical Bills to the consideration of a

Select Committee, with power to take evidence. If this be

so, we consider that the Government, so far from havingreason to be dissatisfied with itself, will be taking a rightcourse, and one which will have the approval of the pro-fession, and of those statesmen who have considered for halfan hour the importance of a measure to regulate medicaleducation. Even the loss of time involved in abandoningthe Medical Bill for a year will be compensated for by theadvantage of taking the evidence of those who have studiedthe working of the existing bodies which regulate admissionto the medical profession. The vacillation of which many

complain in the action of the Lord President in regard tothis measure was really not so much his fault as the fault ofcircumstances, and chiefly due to the notion, which he in-herited from former Governments, that all that is necessaryto rectify faults in the machinery of medical education andexamination is to take evidence from those whose faults

constitute the very case for legislation. We appeal tothe reasonableness of the Lord President to consider

whether this is not so. The Medical Council itself declares

that its constitution needs to be revised. It says this

with much more unanimity than that by which it

admitted the necessity for a consolidation of the licensingauthorities. And yet, while the Medical Bill provides forthe one object, it makes no provision for the other. Some

regret what they call the waste of time involved in

another session closing without the passing of a MedicalBill. But the time is not wasted. The discussion of this

session, and even all the discussion that has taken placesince the failure of Lord RiPON’s attempt to legislate, hasgreatly advanced the public and Parliamentary intelligenceon this subject ; and if the Government will concede a SelectCommittee to consider the whole subject involved in theBill, between its report and the report of the Executive

Committee of the Medical Council, they will have propermaterials for a measure that rises above the common objectsof politics, and greatly affects the welfare of the people.

’---

PUBLIC and professional attention has, during the lastfew months, been prominently directed to the many responsi-bilities which attach to those who have the care of the insane.

We have seen a man unquestionably guilty of the very graveoffence of firing at a judge in the streets acquitted on theground of insanity, without the production of a particle ofmedical evidence as to his mental condition. After this

legal gaucherie, we have heard of informal visits to the

prisoner by medical men said to be permitted, rather thanempowered, to examine and report on his state. The Home

Secretary has repudiated the idea that he sought counsel ofoutsiders, and announced his intention of being guided inhis decision with respect to the destiny of this man by the re-ports of those "officially" responsible for his care in a publicasylum. Finally, to the surprise of everybody, we have beentold in the newspapers that the friends of the alleged lunaticare informed that if a certain sum of money is forth-

coming, as a guarantee, he will be discharged from custody.It is impossible to believe the real facts have transpired.That a person guilty of so serious a crime against public

91RESPONSIBILITIES OF THE CARE OF THE INSANE.

order, if not personal safety, as firing at a judge in the unless an order has been issued by a Master in Chancery, instreets, whether the intent was to injure, or only to frighten which case the patient will be under the protection of thehim, should escape punishment by being falsely described Court, and of that most useful body, the board of Lordas insane, is inconceivable. It is not, however, to this Chancellor’s Visitors of Lunatics. It is perilous in thephase of the subject we are at the moment concerned to extreme to receive a certified lunatic without giving noticepoint, but to the unfortunate way in which the responsi- to the authorities; and it is equally full of risk to receive ability of deciding upon the sanity or insanity of the prisoner patient, who may be described as insane, without certificate.has been cast upon the " officials" who are charged with his There is reason to fear that this last practice is far toocare. This is a method of procedure wholly opposed to that common. Friends have, for a variety of reasons, a greatadopted in the case of ordinary lunatics, who cannot be objection to place weak-minded but not violent persons underconfined in an asylum upon the authority of the medical certificate. The trouble and expense entailed by that pro-officers of the institution. It will be replied that DODWELL cedure are very considerable, and the strongest inducementswas not incarcerated on the certificate of Mr. GIBSON, of New- are held out to avoid taking the step. It is under some wrong

gate, or Dr. ORANGE, of Broadmoor. These gentlemen were, impression medical men are induced to waive the supposedhowever, the first, and only, medical authorities to examine "formality." Many incur the risk in ignorance, possiblythe alleged lunatic, and the law expressly requires at least one misled by the fact that no licence for the house is requiredindependent medical certificate in the case of every person con- when only one patient is to be received-a strangely ano.fined as a lunatic. We contend, therefore, that the spirit, if not malous omission in the law. Others rely on the supposedthe letter, of the law relating to lunatics was broken by the efficacy of a certificate of discharge from some asylum to

imprisonment of DODWELL. We have been jealously careful give prolonged protection, whereas perhaps the patient hasnot to comment hastily or strongly on this case, in deference relapsed and ought again to be placed under certificate.to the difficulty obviously created by the mismanagement of Some-let us hope a few only-are persuaded to acceptthe proceedings in court. It is, however, necessary to protest the danger and responsibility to oblige their clients. For

that the responsibility must not be wholly cast on the the warning of the last-mentioned class of offenders

medical officers of Newgate, Broadmoor, and Millbank. the recent case at Datchet will be useful. There are,

Public opinion will not be less scandalised than professional however, cases in respect to which reasonable doubt exists,

opinion has been, by the bungling conduct of the case and it would be well if the uncertainty could be removed.

throughout, if it be allowed to go out to the world that the Obviously the authorities are not anxious to multiplyfate of a man acquitted on the plea of lunacy without medical grounds upon which a patient must be certified. It is

evidence is left to be determined by the officials of the clearly recognised that there are cases of "nervous diseaseGovernment prisons and asylums ; and, strangest circum- requiring medical supervision, which are not to be classed asstance of this imbroglio, that the destiny of this lunatic, or insane. It is not easy to draw the line where nervousness

subject of a propitious blunder (whichever he may be), is ends and insanity begins. Sometimes aged and even

now dependent on the accident of his friends being able to younger persons with excitable temperaments and eccentricraise a sufficient sum of money as a guarantee. What is it habits have strange fancies. They take strong likes andthis money is to assure ? If the man is not insane, the dislikes ; they conceive the most extravagant notions of

Government has no right to propose his liberation on surety. those around them, and of occurrences. Do these mental

Unless it is Her Majesty’s pleasure to confine a sane person phenomena constitute madness ? If they do, then a veryin a lunatic asylum, DODWELL, however worthy of punish- large proportion of the so-called "nervous" " and " weak-ment, must (supposing him to be sane) be allowed to leave minded" patients now received by medical men withoutBroadmoor with full control of his person and property; certificates ought to be certified. We are strongly inclinedand if he is not sane he cannot leave at all. There is no to the opinion that this is the fact; and we venture to urgemiddle course. It is easy to see how heavy must be the that in any and every case of doubt, a joint communication

responsibility of the medical officers who are required to should be addressed to the Commissioners in Lunacy, bycertify that he is sane. We offer no opinion as to the mental the friends and the medical man in charge of such cases,state of the prisoner, as we have no means of judging. stating the facts, and asking counsel. We have no desire

Nothing has transpired to supply the basis of a professional to burden the Commissioners, who are already severelyjudgment. Meanwhile it is obvious the position in which taxed by work and responsibility, but it is important, in thethe matter now stands is unfortunate, and, on public grounds, interests of the public, and a large section of the medical

unsatisfactory. profession, that a line of distinction between insane and

Again attention has been called to the responsibility in- nervous patients should be at least roughly traced. The

cnrred by medical men who receive into their households communications we have received show beyond questionpatients who are not under certificate. We revert to this that much doubt prevails; and as the Commissioners are,subject in response to an appeal which has been made to us we believe wisely, beginning to take strong action in theon behalf of the very large number of medical practitioners matter, it would be only fair, and a timely and kindly pro-who have a " single patient" under their care, and who are cedure, to issue an order which will not only define the re-thrown into some doubt as to their legal position. No sponsibility, but, coming promptly after the recent case,licence, for the premises, is required in the case of a single lead to necessary reforms.

patient; but no "lunatic" can be lawfully received without Another serious matter in connexion with this subject, tocertificate, and when received with certificate notice should which attention is, at the present moment, painfully at-be sent without delay to the Commissioners in Lunacy, tracted, is the responsibility which arises out of the employ-

92 SUPERNUMERARY MAMMÆ.

ment of attendants to whom the personal care of the insane and of far greater rarity in men. LEICHTENSTERN, how-is unavoidably entrusted. The deplorable case at Gloucester, ever, having been on the look out for the condition, is

now subjudice, has been commented upon in the daily press inclined to attribute the supposed rarity rather to the

with scant recognition of the embarrassing position in which absence of observation than to the infrequency of the mal-medical superintendents, whether of public or private asy- formation, and his experience leads to the conclusion thatlums, are placed. The custody of patients must be confided cases of rudimentary nipples (polythelia), with or withoutto their attendants, and these not unfrequently abuse the additional glands (polymastia), occur pretty frequently intrust. It is the not uncommon experience of medical men both sexes, and at least as frequently in men as in

in official charge of lunatics that the task of controlling the women. He believes that the frequency should be esti-

attendants is more onerous and difficult than that of super- mated at about one in five hundred, and that a very largevising their patients. Unfortunately the difficulty is not number of instances might readily be collected if those wholessened as time goes on. The " experienced" attendant is inspect large numbers of men, such as military surgeons,even less to be trusted than the unlearned-in asylum arts had their attention directed to it. Many supernumeraryand practices. Many of the most expert and successful of nipples are mistaken for nævi or spots of molluscum. In

superintendents are unwilling to employ men and women women it has often happened that the real nature of such awho come armed with testimonials of service. They prefer spot was discovered only when pregnancy caused it to

to train their servants themselves. Perhaps one of the most assume a functional activity. The circumstance that inuseful measures of precaution which could be taken is that women attention is thus attracted to the anomaly, while insuggested by common sense, and which we have so often men it passes unnoticed, is probably the reason why itsadvocated in these columns-namely, that the employment occurrence has been noted so much more frequently inand dismissal of attendants should be left entirely to the women than in men (in the proportion of seven to two),physicians. The interference of a committee in this matter The cases which have come under LEICHTENSTERN’S own

is wholly unreasonable. The attendants of an asylum are notice corroborate this view, for nine of them were in men,the agents of the medical tieatment; they, so to say, repre- and four in women.

sent the drugs and appliances by which the mental malady In the great majority of cases (91 per cent.) the additionalis to be cured or relieved. The medical man should be left nipples were situated on the anterior aspect of the thorax.as completely unfettered in his choice and use or dismissal In extremely rare cases they have been met with in theof a particular attendant as in the adoption or abandon- axilla, on the back, over the acromion, and on the outerment of a special medicament. When this principle comes side of the thigh. The frequency with which they are metto be recognised in asylum management, responsibility will with in these irregular situations has been much exaggerated,be better defined, and, we venture to think, "accidents" and in consequence DARWIN concluded that but little

and "offences"- generally convertible descriptions of the weight could be attached to them as evidence of atavism.unfortunate—will be less frequent. The care of the insane When found on the anterior aspect of the thorax, they areis, under every aspect, a highly responsible function, and placed in most cases (94 per cent.) beneath the normal

nothing will more conduce to its satisfactory discharge than mammillae, between them and the edge of the ribs. Some-

a full and sharp definition of personal power and duty. times the malformation is unilateral, sometimes bilateral,and in the latter case the additional organs are arranged

AMONG the congenital malformations which excite the symmetrically or unsymmetrically. In rare cases, the

surprise of those ignorant of teratological facts, and arouse appendages occur above the normal nipples, and then,the especial interest of the evolutionist, is the occurrence of without exception, are placed outside the normal nipple*supernumerary mammae and nipples, so that instead of the line. In two cases only were the extra nipples situated inusual sufficient and even superfluous complement, three or the middle line of the body. When the addition is unilateraleven four distinct and separate structures are found. In all it is much more frequently on the left than on the right side,ages they have attracted notice, and lately in this country in the proportion of seven to two. Why this should be is.Dr. SNEDDON, and abroad M. BARTELS and Professor not clear, but it is worth remembering that the normalLEICHTENSTERN, have directed attention to them. The breast on the left side is more developed, on the average,work of the latter, which appears in VIRCHOW’s Archiv, than that on the right side. This was associated by HYRTLis especially comprehensive, being based on the parti- with the circumstance that the left breast is more used thanculars of thirteen cases which have come under his own the right, on account of the facility with which a child canobservation, and ninety-two which he has found recorded in be held upon the left arm, and the right remain free; butmedical literature. The object for which he has compared this explanation is doubted by LEICHTENSTERN on thethem is especially to ascertain the frequency of the occurrence ground that the same preponderance of the left side is to beof this anomaly, its most common form and its associations- noted in young persons, and because when one breast is.

points on which the statements in medical literature vary absent, or small, it is almost always the right breast whichmuch. This knowledge is essential if we would obtain an thus suffers. KLEBS associates this lateral relation with

answer to the further question of the origin of the anomaly, the rotation to the left of the anterior segment of thewhether it is to be regarded as bizarre and accidental, or as foetus in the amniotic investment, and points out that con-the result of some impeded or excessive developmental genital defects in the lung are more frequent on the left

effort. than on the right side. The congenital absence of one breastIt is commonly asserted that extra rudimentary breasts occurs in cases of congenital defective formation of one half

or nipples are occurrences of considerable rarity in women, of the thoracic wall, muscular or osseous. On the other

93THE BRITISH MEDICAL ASSOCIATION AND WOMEN.

hand, however, the presence of supernumerary mammea in position of these accessory organs might be a difficulty inhas never been seen in conjunction with thoracic defect. regarding them in the light of a reversion to an earlier type;Very different statements have been made regarding the but, as LEICHTENSTERN has shown, this irregularity is much

hereditary transmission of this anomaly. In the immense less than has been hitherto supposed.majority of cases certainly no such transmission can be -traced. Occasionally, however, it appears indubitable. In TARDILY, reluctantly, but at last effectually, the Com-this respect the condition resembles some other congenital mittee of Council of the British Medical Association have

anomalies. undertaken the consideration of the admission of women toIt has been said that in the lower animals the number of the membership of the Association, and of the attendance at

mammæ diminishes according to the developmental grade the general and other meetings of the women already mem-of’,the animal possessing them; but this, which has been bers. Mr. BOSANQUET, of the Oxford Circuit, and Mr. J.enunciated as a law, is of but partial application, and does P. BENJAMIN, Q.C., were requested to confer and advisenot obtain when different sorts of animals are compared. upon the rights of female members of the Association, andWhat is, however, of perhaps greater significance in regard on the powers of the Association with regard to them andto the question under consideration is that in each order other women who might hereafter be desirous of becomingconsiderable individual variations are observed. In the dog, members. Both these gentlemen are of opinion that Mrs.for instance, the number of teats varies, under normal cir- GARRETT-ANDERSON is a member of the incorporatedcumstances, from seven to ten. CUVIER enunciated the Association, having been elected a member of the old un-

law, which is no doubt accurate, that the greater the varia- incorporated Association, and having signed the agreementtion in the number of breasts in the same species, the mentioned in the fourth Article of Association. Mrs.

larger is the number normally possessed. The latter is HOGGAN, on the other hand, having been elected after thecommonly proportioned to the number of young borne by incorporation of the Association, at a period when nothe animal; most of those with two breasts-such as the election could be legally made, is not now a member of

apes, the solipeds, the Cetacea, and the Edentata-having, the Association, and can only become so if duly qualified.as a rule, only one young at a time. In the same tribe as The reasoning of the learned gentlemen in this matter

the Pachydermata, species with two breasts-such as the is as follows. The fifth of the Articles of Association

elephant, hippopotamus, and tapir-have only one young at is the only one which provides for persons who were

a time; while the sow, with ten breasts, bears from eight to not members of the old unincorporated Association be-ten young. A popular idea has long obtained in Germany, coming members of the incorporated Association; and thatand has been shared even by medical men, that women with article provides that the terms and conditions upon whichaccessory breasts are disposed to twin conception. The such persons are to become members shall be prescribed bypolymastia was regarded as an indication of a more highly the Association in general meeting. The bye-laws were not,developed generative system, just as the imperfect develop- however, made till the 3rd of August, 1875, and as noment of the breasts may accompany the imperfect develop- provision for the election of members existed before thatment of the uterus. In the last century the question was date, all elections between the time of incorporation andasked, first of Professor SOClN of Basle, and then of the the adoption of the bye-laws were void. In order to remedyMedical Faculty in Tubingen, whether a certain woman in the difficulty thus raised, power may now be given by theBasle who possessed four breasts might marry without in- Association at a general meeting to the Committee of

curring great risk of bearing twins. The answer was that Council to elect, or declare elected, any of the persons whoshe might, and the result justified the conclusion. In the were elected between the incorporation of the Associationcases collected by LEICHTENSTEIN, among seventy women and August 3rd, 1875, but whose election was invalid onwith polymastia there occurred only three twin conceptions. account of there being no provision then in existence for theGlandular structure commonly exists, and the additional election of members. The sub-committee appointed to con-

breasts may, in very rare instances, be employed for sider the question of female members have recommended

suckling a child. In most cases, however, they are use- that proper notice of motion should be given, enabling theless for this purpose, and frequently, when the infant Committee of Council to declare elected those male persons

is put to one breast, from the other upon the same side who were intended to be elected during the above-namedmilk flows. The symmetrical and regular situation of the period. Any member who may desire to retain the com-

accessory mammæ in the human subject is very similar panionship of women in the Association may of course,

to the position of those of animals which naturally possess if he think fit, move an amendment to this resolution,more than one pair. Even the axillary position has its at the annual meeting, to the effect that Mrs. HOGGAN should

analogies in some animals. It is noticeable, however, also be declared elected. There is, however, little likelihoodthat the accessory nipples often present a very embryonal of such an amendment being carried. On the contrary, thecharacter, and possess still the furrow by which the develop- the line should not be drawn there. Bye-law No. 3 legalisesment of all nipples commences. These facts incline LEICH- the arbitrary expulsion of any member without reason orTENSTERN to the opinion of DARWIN, that the accessory cause assigned, and under this bye-law the Association hasbreasts and nipples are really a reversion to distant primitive the power to expel Mrs. GARRETT-ANDERSON. The terms

ancestors, and announce the existence in man of a latent of the bye-law are : "Any member may be expelled from thedevelopmental tendency to the production of more than two Association by a resolution of the Committee of Council, ifbreasts, and these observations show that such an event carried by three-fourths of the members present, subject tooccurs less rarely than has been supposed. The irregularity confirmation by the next ensuing annual meeting, and he

94

shall thereupon cease to be a member, and shall not b

eligible for re-election. One month’s notice shall be give]to any member affected thereby." In consequence of thi

last proviso, the bye-law cannot be put in force’this year, athe legal notice cannot be given. Beyond this, it seems

nothing can be done to prevent female members attend

ing the meetings of the Association, and taking part in th.discussions thereat, without contravening the Memorandunof Association, which the Companies Acts do not allow to b<

altered.

The exclusion of women from membership of the Association in future will be secured by an alteration of the fifth ojthe Articles of Association, by inserting before "person’the word "male." The branches of the Association (themetropolitan branch elected Mrs. GARRETT-ANDERSON

will be prohibited from electing female members of thc

Association by the following addition to Bye-law No. 1

" Provided that the power of such Branch Council shaL

only extend to the election of male persons."

DURING the past week our daily journals have beenbusily engaged, among other things, in telling the Britishpublic "all about" Cyprus, and anxious questions have beenasked in Parliament. Mr. BARING is there already as HerMajesty’s civil representative, and Sir GARNET WOLSELEYis on his way thither with a staff of officers, all of whom are

specially picked men. Judging from the information affordedus up to the present time, it would appear that the materialsout of which to hewthe history of Cyprus are singularly scanty.It is the easternmost island of the Mediterranean, and maybe said to command, in some sort of way, the southern

coasts of Asia Minor, and also those of Egypt, and socan be utilised as a "house of call " in going to either ofthese countries. The island is about one hundred and fiftymiles long, has a width varying from fifteen to forty miles,possesses five or six important towns, and a total estimatedpopulation of 200,000 persons. The products of Cyprus arecotton, wine, silk, and fruits, and (in spite of what has beenrecently written to the contrary) there are in the mountainranges large forests of very good timber.We are unable at present to place on record reliable

details as to the climatic or sanitary aspects of the island ;but it appears, naturally enough, to be generally similar to ,,

the countries adjacent. Very hot summers and intenselycold winters prevail. The soil is chalky, sunstroke is byno means uncommon, and the burning winds of Africa

sometimes visit it. Water is scarce, for there is but one

river worthy of the name, and in summer the mountaintorrents are usually dried up. Animal food is said to be

poor in quality; butter is scarce ; bread and vegetables areplentiful, good, and cheap; and, in common with all placeson or surrounding the Mediterranean, fruit is abundant, andthere is great variety. Cyprus has, however, its malariouslocalities ; leprosy is reported to be common ; and cases ofelephantiasis are seen occasionally. All records (but these

appear to be eminently hazy in character) seem to agree that,in common with Constantinople, Smyrna, and most otherLevantine places where many people congregate, materialsfor the manufacture and perpetuation of the continuedfevers exist in great abundance and variety, and have beenfostered up to the present time by the dolce far niente

mode of government peculiar to the Turk. Hence,even under the judicious and energetic supervision of SirANTHONY HOME (just appointed principal medical officeron Sir GARNET WoLSELEY’s staff), we must expect, in theearlier days of occupation, some sickness in our little armyof a kind similar to that which occurred at Varna, Bourgas,and other places on the Black Sea during the first monthsof the Crimean War. With the scanty knowledge now inour possession, we may class the climate of Cyprus as neitherbetter nor worse than that of other Mediterranean districts.

The scarcity of water is a serious evil, and this, with otherinsanitary conditions, will give the medical officer and his col-

’ leagues plenty of work to do for some time. But Cyprushas, in hygienic aspects, many manifest advantages overMalta. It is larger, the population is, comparatively speak-ing, scanty, and it is incomparably more fertile. If, as maybe reasonably conjectured, our term of occupation is likelyto be of long duration, there can be no doubt as to the im.portance of organising, deliberately and carefully, a sys.tematic set of sanitary measures, an important item in whichwould be what is popularly known as quarantine. The annexa-tion of Fiji was followed by an unhappy illustration of themischief that may ensue if preventive measures afloat are notcarefully administered and properly attended to, and ourreaders hardly need to be reminded that the geographicalposition of Cyprus (taken with the fact of our occupation ofthe island) is superlatively important in connexion with thetransmission of well-known diseases that the East sends to

the West free of duty. The experiences of Sir ANTHONY,not only at Ashanti and elsewhere, but on Mr. SiMON’sstaff at Whitehall, will stand him in good stead on thisoccasion. But we believe that the Government will, as

things progress, probably find it advisable to strengthen themedical staff in sanitary work by sending out one or moremen of the " health officer type, whose duties will of

course be wholly preventive and civilian in character.

Meanwhile, no better man in the army than Sir A. HOMEcould possibly have been chosen for a post the responsi-bilities connected with which are of a very grave and im-

portant character. For an opportunity will most assuredlyoccur at Cyprus to test the comparative merits of the

antiquated and cruel system called " quarantine " and theplan now adopted in this country called " sanitary super-vision afloat. "

Annotations."Ne quid nimis."

SCOTCH FEELING AND THE BILL.

WE thought that the resolutions passed by the Glasgowand West of Scotland Branch of the British Medical Associa-tion did not really represent the feeling of the profession onthe questions raised by the Medical Bills, and expressed ahope that Scotland would yet take a more impartial view ofthem. Our hope is already partially fulfilled. The ScottishMidland and Western Medical Association have, at a recentmeeting, to which members of the profession at large wereinvited, passed the following resolution unanimously, movedby Dr. Fairless, seconded by Dr. Cardwell :-" That thismeeting petition in favour of the Lord President’s Bill, andof the addition of a clause providing for the direct repre-sentation of all registered practitioners in the General Medi-