642

THE LANCET.

LONDON: SATURDAY, MARCH 19, 1892.

HEALTH ADMINISTRATION IN LONDON.

THE newly elected London County Council held its firstmeeting on Tuesday last, and its committees will shortly beat work, and will doubtless, in view of the recent decision ofthe electors, continue the policy which was pursued by therecently expired Council. This policy, so far as public healthadministration is concerned, has been one of unceasingactivity, guided by a desire to use to the utmost the powersvested in the Council for the removal of unhealthy con-ditions from London. We may briefly review the work ofthe Council in this direction since it first came into

existence.

The Council in its early days appointed a medical officerof health, and without loss of time addressed to the severalsanitary authorities a circular letter asking for informationas to the insanitary areas within their respective districts.This letter evidently met with a ready response, and fromthat moment the small staff at the disposal of the Councilmust have been severely taxed, for we learn from the

annual statement of the Chairman, Sir JOHN LUBBOCK,that the Housing of the Working Classes Committee hadunder consideration as many as 200 insanitary areas.

Until the end of the year 1890 the Council had, however,no powers other than those under CROSS’S Acts for dealingwith this subject, and as a result it could not do more thanurge upon the sanitary authorities the desirability of en-forcing as far as practicable the provisions of TORRENS’ andthe Nuisance Removal Acts. Much diffi-lulty had beenexperienced in working both CROSS’S and TORRENS’ Acts,and the first business of the Council was therefore

to propose those amendments in the law which were

necessary for immediate purposes, and to point out the

urgent need for opportunity to be given for dealingwith small areas which were not of sufficient extent

for the purposes of CROSS’S Acts and were yet unsuited forthe application of TORRENS’ Acts. The Housing of theWorking Classes Act, which received the Royal assentduring the latter part of the year 1890, supplied this

deficiency and placed the Council in a position to

undertake more seriously the work it had alreadybegun.Under this Act many hundreds of houses actually unfit

for human habitation have been closed by the orders of

magistrates, and the Council and the district authoritieshave been confronted with the difficult question whetherareas which needed complete clearance should be dealt

with under Part I. at the expense of the Council, or Part IL,either at the expense of the district authority or at the costof both. The Act provided that the Secretary of Stateshould arbitrate when this point was in dispute, and theCouncil at once made the necessary appeal in respect offive areas, two in Shoreditch and three in the district of

St. George the Martyr, which had been represented to it

under CROSS’S Acts. In each case the Home Secretary,after holding a local inquiry, decided that the Council

should bear but part of the expense, and the district!

authorities were required to effect the improvements andthe Council to contribute one-half of the cost of improvingthe first two areas, and one-third of the cost of improvingthe last three. Schemes were therefore prepared by theVestry of St. George’s for the improvement of two of theareas in its district, and the Local Government Board heldan inquiry last week with a view to determine whetherthe schemes should be approved.In numerous other instances steps have been taken for

carrying out improvement schemes in various parts of themetropolis, and these earlier negotiations between theCouncil and the district authorities may be expected veryshortly to bear fruit. Ia one instance the Council decided,after communication with the sanitary authority, itself tocarry out an improvement scheme under Part II. of the Act,and the local inquiry ordered by the Local GovernmentBoard in respect of this (the Brookes Market HolbornScheme) was held a few weeks ago.The Council has as yet prepared only one large scheme

under Part I. of this Act. The neighbourhood of Old Nichol-street, Bethnal-green, had long been known as a metropolitansore. The insanitary circumstances of this locality wereclearly brought to light during an inquiry held by order ofthe Home Secretary some five years ago, and to those whoknew this part of London well it was evident that no in.

complete method of dealing with it would prove satis’

factory. The Council therefore resolved, after representationsby the medical officers of health of -the districts of Bethnal-green and Shoreditch, to effect this improvement, and pre-pared a scheme which for comprehensiveness proved thatthe Council was not disposed to exercise in any feeble

way the powers with which Parliament had endowed

it. It is a somewhat curious commentary upon healthadministration in London that the action of the Council in

this matter did not in any way give universal satisfaction.One section of the lay press particularly failed to see thatthe mere closing and repair of houses, assuming this methodcould have been universally applied to all the houses inthis area, would not have brought out the rearrangementof buildings which was necessary. It was evidently notunderstood that owing to the ownership of these premisesbeing vested in many persons, no other action was possiblethan that adopted by the Council, and that nothing batthe purchase of the property by the metropolitan autho-rity would enable the improvements to be effected

which were so urgently needed. The Housing of theWorking Classes Act of 1890 had, moreover, providedmore favourable terms for a local authority purchasinginsanitary property under these circumstances, and it

was very necessary that experience should be gained in theshortest time of the usefulness of the new measure. It

may be expected that this scheme will give ample oppor-tunity for this purpose, and the future action of the Councilmay to some extent depend upon the results of this largeundertaking.So far therefore in the year and a half which has elapS{d

since the Council obtained its powers under the Housingof the Working Classes Act, the important work of steadily

643THE ROYAL COLLEGE OF SURGEONS.

improving London has been undertaken, and we sincerelytrusb that it may be continued until the worst of the

Lmdon slums have been finally removed.

——————————

THE settlement cf the action " STEELE v. SAVORY " has

proved advantageous to the cause of progress at the RoyalCollege of Surgeons of England. It) has removed an

obstacle which blocked the path of reform. Ib has esta-

blished the validity of the Charter and By-laws, andthereby terminated a condition of uncertainty which led todevelopments nob calculated to conciliate the governingbody of the College. It has diffused a glow of quiet satis-faetion through the breasts of the members of the Councilof the College, and has disposed them to seek peace byconciliatory measures. Ib has opened out to the Fellowsof the College a prospeet of early improvement in theirstatus and constitutional importance which will ulti-

mately prove beneficial to the Members, and it has now

resulted in the Council of the College proclaiming anamnesty for the thirty-one Members of the College whohad the courage or temerity to infringe Section xvii. of theBy-laws in February, 1889. The exact situation of affairs is

readily grasped on perusing the minutes of the proceedings ofthe Council on March 10th. In our article on March 5th

we mentioned that on Feb. llth the Council of the

College had deferred the consideration of the infraction ofBy.law xvii. till March 10th, and resolved to inform thoseconcerned in this infraction of the intention of the Council.

The intimation of this intention was conveyed to them ina letter from the Secretary of the College, with the resultthat a large majority responded to the letter, and generallyin a manner which satisfied the President and Vice-

Preddents to whom the documents were in the first in-

stance submitted. A few did not reply, but the doctrine of

supererogation appears to have been adopted by the repre-sentatives of the Council and the fund of merit formed by thecontents of the approved letters was sufficient to allow of adividend in favour of those Members who had perhaps beeninfluenced by the proverb that "speech is silvern, but silenceis golden," or had been deterred by some bidden fears fromeven acknowledging the receipt of the Secretary’s letter.However this may be, any intention which may haveexisted to vindicate further the authority of the Council andthe By-laws was abandoned, and the Council adoptedunanimously the following resolution : "That the Council,after full consideration of the infraction of Section xvil. of the

By-laws by certain Members of the College who took partin the attempt to convene an illegal meeting, hereby deter-mine to take no further action in the matter." This

decision will, we think, meet with very general approval.Had the Council drawn a distinction between those who

acknowledged their mistake and expressed regret and thosewho declined to do so, it might very probably have diiftedinto the ludicrous position voluntarily assumed by thatcelebrated official DOGBERRY, when charging the watebrr aTito "comprehend all vagrom men" and "to bid any manstand in the prince’s name ":—

Ti’atchrnan How if he will not stand?

Dogberry: Why then, take no note of him but let him go; and pre-sently call therest of the watch together, and thank God you are rid ofa knave.

As it is, the Council has as much reason to be

grateful to the majority of the thirty-one Members for

replying Eo courteously to the Secretary’s letter as thoseMembers have for the act of grace which the Council has

unanimously passed.The termination of a struggle which has dragged

its slow length along for more than three years has

reopened the questions of constitutional reform which

had been suspended by the action of the Members

against the Council. Ib could not well be expectedthat, under the circumstances, the claims of the Membersof the College to a voice in the management would havein any wise been recognised by the Council after frequentdenials of such claims and the repetition of the opinionthat they ought to be allowed to rest. The Council is notlike Archbishop CRANMER, of whom it was said, " Do myLoid of Canterbury a shrewd turn and he will be yourfriend ever after." Even if the Council were convinced of

the propriety of making concessions to the Members,human nature might stand in the way for a time ; but, sofar as we can judge, there are only a few of the Council whoare prepared for any concession, and possibly all of thesefew would not have the courage of their opinions and facethe opposition with which they would be met. The time of

the Members has not yet come in the Council, but with theFellows it is different. The Council has acknowledgedtheir claims to be consulted, and is probably anxious tomeet their wishes. At all events, it has lost no time

in redeeming its implied pledge to take the case of

the Fellows into consideration as soon as the action STEELE

v. SAVORY was settled. Sir W. SAVORY, who was one ofthe members of the Council who met the deputation fromthe Association of Fellows in October, 1890, moved atthe last meeting of the Council on March 10th: "That

a committee be appointed to consider and report to

the Council whether any, and if so what, further advan-tages can be extended to the Fellows." This proposition wasseconded by Mr. MACNAMARA, and unanimously accepted.Thereupon Mr. WILLETT moved, and Mr. RIVINGTON

seconded, a resolution to the effect that it is desirable to

celebrate in some suitable manner the fiftieth anniversaryof the institution of the Fellowship (the Charter creatingthis order being dated Sepb. 14th, 1813), and that it bereferred to the committee appointed under the precedingresolution to report on the best means of giving effect tothis resolution. This proposal also was carried unani-

mously, and the committee appointed consisted of thePresident and two Vice-Presidents ex officio, Sir W.

SAVORY, Bart., Messre. CADGE, MACNAMARA, WILLETT,and RIVINGTON. As this committee comprises three

members who belong to the Fellows’ Association, thereseems every prospect that the main principles for whichthe Association has been contending will soon receive

official recognition. It must, however, be borne in mindthat the cup may be dashed from the lip even in the verymoment of triumph; and it will be as well for the Com-mittee of the Fellows’ Asscciation to be ready to strengthenthe case of the Fellows at a moment’s notice. It is not difficult

to suggest all kinds of technical difficulties in carryingout the simplest concession to the Fellows. What hindrancesmay not be conjured up to the provision of a common room

644 THE ROYAL COMMISSION ON METROPOLITAN WATER-SUPPLY.

at the College, and how many more to consultation of theFellows, and how many more again to the simplification ofvoting by voting papers and the election of the Presidentby the Fellows ! How easy is the utterance of non

possumus, but everything that the Fellows desire will bepossible if, like NAPOLEON, they decline to admit the

existence of the word "impossible."

THE announcement made by Mr. RITCHIE in the Houseof Commons on Monday, the 14th inst., in regard to the newRoyal Commission on Metropolitan Water-supply, is satis-factory in two respects. The scope of the inquiry is clearlydefined, and, although it is not necessary to quote theinstructions in full, our readers will see that the

points referred to the Commission are precisely those

which have been so often urged by ourselves. Before

further legislation can be attempted it is necessary to

know, first, whether the present sources of supply are suffi--cient for the requirements of London for some years tocome; secondly, whether with scrupulous care the qualityof this water-supply may be rendered safe even in times ofepidemic; thirdly, whether increased demands on the otherwaters of the Thames and Lea will inflict injury on suburbandistricts ; and, fourthly, if a distant source of supply isfound to be necessary whether such supply can be obtainedwithout injustice to provincial towns and centres.The Commission appears, on the whole, to have been

wisely chosen. In addition to two or three experiencedofficials, it includes the names of three well-known engi.neers, of Sir A. GEIKIE as a geologist, and of Professor DEWARas a chemist. No exception can be taken to any of thesegentlemen, and our only regret is that no trained bacterio-logist is included.That this is noc tne first inquiry oi tne Kina is prooaaiy

known to everyone, but no one who has not made a specialstudy of the subject can have any idea of the enormousamount of research that has been devoted to it or of the

mountain of Blue-books in which previous researches havebeen collected and fossilised. The history of the London

water-supply, the complaints, inquiries, laws, and proposalsin regard to it would, if told in detail, fill a large book,and the new Commissioners, instead of starting with atubula rasa, will be embarrassed by the great mass of

material they have to sift. A short and most imperfectsketch of the evidence already collected is all that is

at present possible, but it will not be without interest,considering the magnitude of the question.In the year 1581 PETER MORRYS, a Dutchman, obtained

permission to supply a portion of London from the Thamesby means of a water-wheel under one of the arches of

London-bridge worked by pumps set in motion by the tide.For about 200 years a considerable supply was obtained inthis way. Complaints, however, naturally arose in regardto such water, although there were then no drains to

pollute the river with sewage, and accordingly in 1609 SirHUGH MYDDELTON, with the assistance of a grant from

King JAMES I., completed the great work which had pre-viously been beyond his means, and the New River wasopened to London. It need not be said that it has been a

priceless boon to the metropolis. In 1691 the York Buildings

Waterworks Company took water from the river near

Charing-cross. This company was transferred to the NewRiver Company in 1818, and theworks were shortly afterwardsabandoned. Following by a long interval the New RiverCompany, the Chelsea Waterworks Company was startedin 1723, and the Lambeth Company in 1785. The other

London companies date from the earlier part of the presentcentury. There are now eight water companies supplyingLondon, of whom five draw their water exclusively fromthe Thames above Hampton, while two depend in part onthe river Lea, and the last, the Kent Company, on deepchalk wells to the south of the Thames.

It is not surprising that, even in pre-sanitary times,complaints were made of water drawn and suppliedwithout filtration from the tidal portions of the river.A Committee of the House of Commons sat in 1821 ; it, how.ever, did nothing, and the complaints increased, and in 1828another Committee of the House appointed the well-knownMr. TELFORD to inquire and report. The report was pre-sented in 1834. Mr. TELFORD’s recommendations were

impracticable, and then two more committees inquired butdid nothing. In the meantime, in 1832, the cholera ap-peared in England. There was nothing to connect it withwater-supply or drainage, and therefore its dread lesson wasnot learnt ; but in 1849 another terrific visitation of choleraoccurred. The deaths in 1832 are roughly estimated at

about 5000, equal to 31-4 to 10,000 of the population. In

1849 the deaths amounted to 14,137, or 61-8 out of 10,000people. By this time much human sewage went into

the river, and so, unfiltered, into a portion of the water-supply, and subsequent investigations showed that thecholera explosion coincided pretty closely with the area ofimpure water-supply. Omitting several important in.

quiries, some of them instituted by the General Board ofHealth, which had recently been established, we come to1852, when the Metropolis Water Act, which is still in

force, was passed. This most valuable Act prohibited thecompanies from drawing any water from below TeddingtonLock, and enforced filtration and the use of covered

reservoirs. Shortly afterwards Dr. SNOW propounded thetheory of water-carriage, which, although at first regardedas visionary, was by subsequent and bitter experienceraised to the rank of a great sanitary law. In 1854 the

cholera, to which sanitation is so deeply indebted, cameonce more, and 10,758 persons died in London, equal to42’9 per 10,000. The water was better and the mortalityless.

In 1866 the last, and we may hope the final, visitation ofcholera took place. Thanks to Dr. SNOW and others the

dangers of water pollution are now well recognised. The

water-supply of London was far better, and the deaths inLondon, in spite of the greatly increased population,amounted to 5596 or 18 -4 per 10,000. Of these a very largeproportion occurred in an East-end district which was

supplied for a time with water polluted by cholera poison.The newly appointed Royal Commission, over which Lord

BALFOUR of Burleigh is to preside, will be the fourth Com-mission of the kind, for we must exclude those bearingon the closely cognate subject of sewage disposal. The

first was appointed in 1865. It issued three reportswith important appendices, the last in 1867. It is known

as the first Rivers Pollution Commission, and its three

double volumes deal with the Thames, the Lea, and theAire and Calder. This was succeeded in 1868 by the secondRivers Pollution Commission, of which Dr. E. FRANKLANDwas the presiding intelligence. The members of this Com-

mission continued and greatly extended the work of their

predecessors. They published six reports with many

appendices, including maps and plans ; the last, and

much the most important, was the well-known Sixth

Report, which appeared in 1874, in the form of

a Blue.book containing 525 pages. This may be taken

as the last public utterance on the great question.It is a monument of careful scientific study and reasoning.In 1867, a year before the appointment of the Second

Rivers Pollution Commission, a Royal Commission on

Water supply was appointed under the presidency of theDuke of RICHMOND. Unfortunately, no chemist was

nominated on this Commission, and the value of the con-elusions arrived at are somewhat impaired by the omission.The report of this Commission, with two valuable

appendices, appeared in 1869.We n.ua leave untold much that will be of vital import.

ance in the labour of the new Commission. The Rivers

Pollution Commissioners and the Commissioners on Water.

supply diffr diametrically from one another in their con-dusionp. Many schemes for future water-supply, some

highly interesting, some absurd, were brought before eachCommission and must now be reconsidered. Finally,bacteriology in its relation to disease has developed sorapidly in the last few years that it may almost be said tohave been unknown in 1874, when the last great Blue-bookwas published.

MR F. W. LowrlnES, surgeon to the Liverpool police, haspublished in pamphlet form a paperl which he recently readat the Medical Institute of Liverpool, in which he sets forthfrom a medical standpoint some of the reasons whythe office of coroner could better be filled by a member ofthe medical profession than by a solicitor or a barrister.There is much force in many of his arguments on the

subject of this curious "survival of mediævalism," inrespect of which " a general opinion prevails that muchmore security than exists for the election of suitableofficials is needed." In ancient times the coroner was not

thought to require special knowledge of either law or physic.He was a knight of the shire, who was "required to

go upon information to the places where any be slain

or suddenly dead, or wounded, and to summonfour or fiveor six persons to aid him in inquiring when, and where, andhow the deceased came to his or her death." Mr. LAWSON

TAIT pointed out quite recently that the coroner’s functionas it exists now is " purely one of inquiry, the theory ofwhich is that the inquiry shall be directed in all cases ofdeath where the method of death is not clearly satisfac-tory." And The Times in like manner observes that "the

operation of disease may be mysterious, or there may bereason to suspect violence. As soon as the coroner’s courthas ascertained the manner in which the fatal result was

MEDICAL AND LEGAL CORONERS.

1 " Reasons why the office of Coroner should be held by a Member ofthe Medical Profession," by F. W. Lowndes, M.R.C.S.Eng., surgeon tothe Liverpool police.

reached, its business is at an end." Mr. LOWNDES devotes

himself to the question whether, in elucidating the

mysteries of disease or the probabilities of violence, a

knowledge of the laws which govern disease and health, andan intimacy with the modes of death, should not be the firstessentials for adequate enlightenment. On the other hand,he asks whether familiarity with legal phrases and modesof detailing evidence should have the most weight, and ifmedical knowledge should be viewed as of secondary im.portance to an exact solution in a matter so restricted. Vaguegeneralities, such as "found dead," "excessive drinking,""natural causes," and other equally unsatisfactory proofs ofinability to state the true cause of death, need not entailmuch knowledge at all, either legal or medical; but neithercan they be held to give an adequate verdict of the cause ofdeath, which is the primary function of the court. He

suggests that if every legal coroner had associated withhim a medical assessor whom he would be bound to consult

in every case where a discretionary power had to be

exercised, the result would be different. Records of

inquests held before the period of medical coroners are

full of astonishing results arising from ignorance of the

simplest medical facts on the part of coroners. In many a clearcase of poisoning a verdict has been brought in and acceptedby the coroner certifying that the deceased had " died by thevisitation of GOD." From time to time incidents occurred

which moved the tardy wheels of the Legislature in

regard to this office, but the remedies were generally of a" meagre, miserable, and worthless character." The lack

of medical evidence was deplorable, and the question of these"useless, expensive, and pernicious exhibitions" becomingone of national importance, a Select Committee of theHouse of Commons was appointed to inquire into the

functions of the coroner. If it is urged that matters havebecome more satisfactory with advancing years, it is onlynecessary to refer to recent correspondence on the wholequestion.Apart from these aspects of the subject, Mr. LOWNDES

maintains that a medical man can administer the oath

just as well as a barrister or solicitor, and looks upon theproceeding of "viewing the body undertaken by personswho have had no previous medical training as a "farce."The object of this procedure is to obtain identification uponoath, and the due registration of all details, the latter

especially when identification is impossible. The Bill

to amend the Coroners Act of 1887, which Sir WALTERFOSTER has laid before Parliament, aims at dispossessingthe jury of the function of viewing the body on which theinquest is to be held, unless the coroner or a majority ofthe jury should regard that procedure as essential. It

may be readily questioned whether in the case of legalcoroners their discretionary powers should be extended

in this direction. Then there is the question whethera legal coroner is competent to decide the purely medicalquestion of cause, in cases of sudden death, or of uncertifieddeath, especially in those brought to his notice, but inwhich no inquest has, according to the exercise of his dis-cretion, been deemed necessary. The ability of the medicalcoroner to obtain and deal with evidence has been frequentlydisputed by the members of the legal profession. Mr.

LowNDES answers the objection by remarking’ "After

646

years of medical practice, taking the evidence of witnessesin the Coroner’s Court would be a very simple matter in-deed." But, after all, it is necessary to grasp intelligentlythe meaning of evidence before it can be sifted. The

medical witnesses are often embarrassed in giving evidenceby having, as it were, to explain to the legal coroner the useof medical terms. Numberless instances of misconceptionmight be recorded from the published reports of coroners’inquests. Dr. BENJAMIN WARD RICHARDSON refers tothis. " For seven or eight years," he says, 11 I had much

practice of this kind. There was at that time one of the

most remarkable men in London as coroner for this district

(the Central Middlesex)-Mr. WAKLEY,—a man of intenseearnestness, force of character, indomitable courage, andsound freedom of expression in the views which he took.He was a medical coroner, and I remember well how verydifferent a matter it was to give evidence before him com-

pared with giving it before a coroner who knew nothingabout medicine. It was simply impossible to make a

mistake before Mr. WAKLEY, for there he was, ever readyto test the truth down to the bottom. If it came to be a

question of chemistry, anatomy, or pathology Mr. WAKLEYwas ready. The result was that never have the publicinterests been so well served as from the time when

Mr WAKLEY as a coroner took them in hand. It is

natural that a witness should be more exact if he goesbefore a man who is a competent judge than if he goesbefore one who has no knowledge of the subject beyond therest of the community."

Indeed, a great part of the lifework of the founder ofTHE LANCET was directed to effect reforms in the Coroner’s

Court which he held to be of supreme importance to thepublic interests. In the discharge of his duties he neverfailed to exercise his opportunities either as a coroner oras a Member of Parliament for the public benefit, and wenotice that Mr. LOWNDES characterises as absurd the con-

tention of those who consider that coroners and their inquestsare supedlllous, and should be ended instead of mended. In

the bands of duly qualified coroners, that Court has beenproductive of much influence for goud. To take only oneexample, the abolition of flogging in the army, and subse-quently in the navy, can be traced back directly to vigorousaction taken in the Coroner’s Court. It cannot be too

often reiterated that the abolition of this barbarity wasdue to the courage of the first medical coroner, alreadyreferred to, who, in spite of the most strenuous efforts

made against him, fearlessly and determinedly overcameevery obstacle, and exposed to the public in all its cruel

reality the story of the unfortunate soldier who had

been flogged to death at Hounslow. It seems to us unfor-

tunate that of the 331 coroners in England only fifty-one have any medical qualification. The curiosities in the

way of verdicts arising out of this condition of things aresupplied by some 247 coroners having merely legal quali-fications, and it has been for the last seventy years ourfrequently expressed opinion that the anomalies, too

apparent and frequent in connexion with coroners’ inquests,might to an enormous extent be prevented if purely legalknowledge were replaced by medical knowledge, and

technicalities and subtleties gave place to accurate and

intelligent comprehension of observed fact. This, however,

will not be possible unless for the vacancies which occursuitable medical candidates are forthcoming.

THE Charter of the proposed Gresham University hasbeen remitted by the Government to the Privy Councilfor reconsideration, and it is understood that this will

result in the whole question of a Teachirc, Universityfor London being again submitted to a Royal Commission.This means a delay of a twelvemonth or more. It is

intended that this Commission shall be formed by suchof the former Commissioners as choose to again serve

on the inquiry, and of some three or four others, so as

to make up the number to nine or ten. It seems quitecertain that one or more of the former Commissioners will

decline to serve, and the name of Lord SELBORNE, the

chairman, has been included amongst these. This is muchto be regretted, as his lordship is more familiar with thenecessities of the higher education in London and of thepeculiar position of our medical students than almost

any other public man. He not only presided at the

sittings of the former Commission, but drew up the

main report, and he was also the most active memberof the Select Committee of the Privy Council. The

questions he put to the various counsel engaged bythe numerous bodies interested in the problem amplyshowed how well versed he was in the subject, andhow anxious he was to clear up and arrange the con.

fiicting views put before the Committee. We can well

understand that the abandonment by the Government ofthe judicial decision of the Privy Council drawn up by himand his colleagues is sufficient to cause his retirement fromany farther action in the matter, but his absence will in

every way give cause for regret. The other members of

the Royal Commission were Lord HANNEN, Vice.

Chancellor Sir JOHN T. BALL, Sir WM. THOMSON (nowLord KELVIN), Sir G. G. STOKES, and Mr. J. G WELLDON.Lord SELBORNE, Lord HANNEN, and Vice Chancellor

BALL signed the report urging a reconstitution of the

University of London, whilst the inability of that bodyto carry out such a reform, as was shown by the vote ofthe graduates in Convocation in May last, was accuratelypredicted by the three members who had had practical ex.perience in university teaching. We would strongly urgeupon the Government, when adding other members to

the Commission, not merely the justice, but the abso.

lute necessity, of nominating some member of our pro.fession who is conversant with the needs of London

medical education, and who may be relied on to investi.gate and clearly bring into prominence the disadvantagesunder which the London medical student ifl now placed,since the University of London only gives degrees on suchonerous conditions as to constitute them really "honours"degrees, as declared by the former Commission. The exist,

, ence of the Victoria University, and the freedom of its

Colleges from the restrictions under which they laboured, when affiliated only to the examining University of London,

afford the clearest proof that there is a need of, and a pre.cedent for, the establishment of a medical degree to rankbetween the London degree and an ordinary qualification,

, with which latter it is not proposed to interfere. The

647

opposition of the provincial schools of medicine was most I

ungracious and .unwarranted, for the charge of an intentionto lower degrees brought against the London teachers ofmedicine had been expressly and authoritatively refuted

by their representatives again and again; but we are

sure that another Royal Commission will only make itstill more clear that to London medical students must be

granted similar facilities for graduation as those existingat Manchester, Edinburgh, or Glasgow. Throughout thewhole agitation in the press, at public meetings, and inParliament the medical side of the question has receivedtoo little attention. We doubt whether the University ofLondon, even though it may again make the attempt, cangather under its wing the various University Colleges inthe provinces and in Wales, King’s and University Colleges,unattached and collegiate students, and the London medicalschools and those in the provinces, and mete out equaljustice to its past graduates and to the future collegiatestudent in arts or science, much less in medicine. Its

former scheme was the most unwieldy that could havegravely been put forward. The Gresham Charter presenteda compact workable scheme, and, under a council composedof the various teachers as well as of the Crown nominees,would have done much to advance and consolidate medical

teaching in London. We question very much whether theUniversity of London can do a similar good service, whilstthose who look to some great thing being the outcome ofthe Commission to be presently nominated will probablysuffer much disappointment. The " democratic universityof the future," and its establishment on a scale worthy of Ithe metropolis, belong to the land where dreams are

dreamed rather than to that which is guided by sober

aspirations of practical teachers.

Annotations.

THE IMPORTATION OF INFECTION BY SHIPPING.

" Ne quid nimis."

AN important point has been raised by the Health andSanitary Committees of the Corporation of Liverpool. Itrelates to the different procedures adopted under our presentlegislation with regard, on the one hand, to diseases theinfection of which is practically endemic with us ; and, onthe other, to those, like cholera, which we deem to be offoreign origin. Small-pox, imported by vessels into the

port of Liverpool, is allowed to spread, the sanitary authoritygetting little or no knowledge or power over it; and to thisis attributed the fact that some forty cases of that diseaseare now under treatment in the corporation hospital. Then,again, it is pointed out that the distribution of authority inthis country is most inconvenient, and calculated to preventprompt action. Thus, when infection on board a vesselarriving in a port is in question, we have firsb the customsauthorities and their powers; next comes the Privy Council,with their quarantine functions ; then the Board of Tradeare concerned ; and lastly comes the Local GovernmentBoard, both as a central authority and as concerned withthe administration of the Public Health Act by the localauthority. The result is that Liverpool has decided toapproach the Local Government Board on the basis of thefollowing resolution :-" That the committee approve ofthe recommendation of the medical officer of healbh with

reference to the more effective system of inspection of

vessels coming into the port of Liverpool, and that theLocal Government Board be rei-peotfdily requested to

obtain such an alteration of the Quarantine Act as wouldtransfer the power of dealing with all infectious disease onshipboard to the Local Government Board, and also to

obtain an alteration of the Shipping Act relating to thepassengers and the sanitary arrangements on shipboard."It must be admitted that our system for the sanitarycontrol of vessels reaching our ports, and with regard todealir g with different diseases thus coming to our shores, isone that could never be defended if it were set out as anew scheme. It has grown up bit by bit, with increasingknowledge as to the necessity of preventive action; but earlyits stages preceded the formation of a public health depart-ment ; and we now have to face the difficulty due to a

number of departments dealing with the same or kindredsubjects, and several of them clinging with tenacity to

functions which they are ill-fitted to perform, but whichmust before very long be taken from them and amalgamatedunder one depattment. Whilst we would, for the present,avoid expressing any opinion as to whether increased po rversshould be given as to the control of individuals who are

merely suspected of being bearers of infections that arecurrent with us, we cordially agree in the main conten-tion which Liverpool has embodied in the above-quotedresolution.

LIFE ASSURANCE AND DEATH CERTIFICATES.

A "Doctor of Medicine," upon whose letter to The

Times we recently commented, writes us to reassert that hehas good ground for saying that " there are members in ourprofession who would tone down death certificates." He edoes not, however, adduce any instances of the di gracefulconduct which in general terms he attributes to his pro-fessional brethren, and the only passage from experiencewhich he gives us is the fact that he has himself been akedto examine for life assurance a patient who was sufferingfrom cancer of the uterus. Our correspondent very properlyrefused to make the examination, knowing what hedid know as to the condition of the person proposed forassurance, and he is not able to say what happened next.It is not necessary, therefore, to assume that the patientobtained a favourable medical report or a life assurance

policy, or that any impropriety was committed by anyperson in this instance. We have the satisfaction of know-

ing that one medical man acted exactly as he ought to actin such circumstances, and we do not see any reason formaking injurious assumptions about any others. While,therefore, we feel no doubt that a "doctor of medicine isfully convinced that he bas ample reason for the seriouscharges which he makes against his professional brethren,and while we quite agree with him that such conduct, ifpractised, should be strongly denounced and even severelypunished, we must point out that it is the manifest: culpa-bility of such conduct which makes us loth to believe thtit prevails in any part of the country. We, of course, donot pretend to believe in the probity and inttguty of evc-iyman who holds a medical diploma. There are, as the old

saying runs, "black sheep in every flock." But the char e,as we understand it, is that medical men in certatll

parts of the country are accustomed to fill up dea1 hcertificates in such a way as to lend themselves to

fraudulent life assurance. If that be so, the man

who exposes the practice will be a public benefactor.But an accusation so terrible can only be made good byevidence precise, verifiable, and convincing We cannotconsent to take our opinions on such a matter at second-hand, even from the best informed and most judicious ofour readers. A pseudonym which anybody in the kingdommight have assumed led us at first) rather to suspect than