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method, it would be my own fault if I could not give itequally confidently and safely in London by using the samemethod ; and so far as it went (some 300 anaesthetics only inLondon) the experiment, I believe I may say with entiretruth, was a complete success.

Dr. Hewitt’s observation on the number of deaths inScotland is irrelevant, for he produces no proof that thedrug was administered by Syme’s method. The method is

everything. By all means let the present scandal of sendingout men to practise as fully qualified without practical know-ledge of the giving of anaesthetics cease, but at the sametime do not expect the present rate of mortality from chloro-form to drop in Britain so long as the method of administra-tion is that now in vogue. For several years I have been

looking in the columns of THE LANCET for the descriptionof a case of death from chloroform poisoning due to heartfailure, but although many have purported to be so not onehas borne investigation. If this is solving the chloroformproblem clinically there are some who may differ from Dr.Hewitt in considering the solution final at present.

I am, Sirs, yours faithfully,

Calcutta, Feb. 7th, 1901.CLAYTON LANE, M.D. Lond.,

Captain, I.M.S.

THE

ORGANISATION OF THE PROFESSION.

(FROM OUR SPECIAL COMMISSIONER.)(Continued from p. 582.)

The Demand for an Inarease for Family Contracts.-TAeAppointment of a Solicitor as General Sec7’ttary.- I’heSystematic Method of Proceedinq,-The Strike and itsSuccess.

THE incident which acted as a special stimulant in bring-ing about the formation of the Northumberland MedicalAssociation was the fact that the Backworth collierysurgeons had of their own initiative demanded 9d. insteadof 6d. per family per fortnight. In aaswer to this

large bills were put into circulation announcing that" The Backworth and District Medical Cooperative Associa-tion" " were going to give advice from fully qualifiedmedical practitioners with medicines of the best qualityprocurable, that the time of attendance at the surgerieswould be arranged to suit the convenience of the publicand to prevent patients having to wait, that in serious casesexpert advice would be obtained on the recommendationof the medical offier of the association entirely free of cost,that wauer-beds, air-cushions, and other appliances wouldalso be provided, and that there would be a trained andcertificated nurse at the disposal of the members. All thesemultifarious advantages were to be secured by the modestpayment of 6d. per fortnight, not for one individual,bat for a whole family. It is true that 6d. per fortnight perfamily is generally the sum paid by miners for medical aidin this district. But this sum is very often paid direct tothe colliery surgeon. There is no organisation, no cooperativesociety or medical aid company, no lay committee of

management acting as intermediary and sometimes takingupon itself to reprimand its medical officer. The more generalarrangement is that the cashier who pays the wages to theminers deducts the sum they consent to py to their medicalattendant. But here was a cooperative society stepping inbetween the surgeon and his patients and proceeding toadvertise in a tradesman-like manner. Though at that timethe Backworth practitioners had no organisation to supportthem they determined to resist, and they sent in noticethat they would not undertake to attend a whole familyfor less than 9d. per fortnight. The Backworth andDistrict Medical Cooperative Association at once con-

cluded that they would be able to import a medicalofficer, and they advertised in several papers. But bythe time these advertisements appeared the Northumber-land Medical Association had been formed and it imme-

diately inserted counter advertisements advising that noone should go, but should first communicate to the asso-ciation for information as to the dispute at issue. Also,considerable pressure was brought to bear to prevent any-one taking the place of the Backworth practitioners. TheBackworth and District Medical Cooperative Associationwere able to import a medical practitioner, but before they

achieved this they had been several weeks without anymedical men working under contract. When a case ofillness occurred the patients were obliged to seek the adviceof a practitioner in the neighbourhood and were treated asprivate patients and charged the usual 2s. 6d. fee. Thepatients, however, did not pay this fee ; it was the com-mittee of the Backworth Cooperative Society that undertookto settle these accounts. In one case the amount duereached a considerable sum, but the account was purposelyreduced to E50 so that the matter might be brought beforea county court. The Northumberland Medical Associationfinancially supported the Backworth practitioner to whomthis sum was due, for in the meanwhile he had become amember of the association and the verdict was in theirfavour, and the miners had to pay the account and the

legal costs. This verdict and the unsatisfactory result ofimporting an outsider finally broke up the Backworth andDistrict Medical Cooperative Association. The miners nowconsented to pay 9d. instead of 6d. per fortnight for eachhousehold, and thus the medical men, after a struggle thatdid not last very long, were completely successful.While this struggle was proceeding the Northumberland

Medical Association amalgamated, as already described,with the Newcastle Medical Ethical Society and beganto shape out its policy. One of the first pointsagreed upon was that throughout the county the fort-

nightly subscription should be 9d. and not 6d. for a

family. Then circulars relating to the Broomhill medicalaid organisation showed that there was a good deal ofadvertising practised in that locality. A deputation fromthis body was brought to Newcastle and they promised tocease advertising and canvassing. As for paying 9d. thisthey were also willing to do, but they wanted to provide anurse and for this purpose proposed to deduct 1d. from the9d. Then they were in the habit of taking 25 per cent. fromthe remaining 8d. and providing the drugs themselves. Doubt-less this meant no loss as the drugs would probably cost2d. out of the 8d., but the objection is to intermediariesbetween the medical man and his patient. In the mining dis-tricts there is no need of societies to organise medical aid and,generally speaking, to manage the medical man’s business forhim. The paying cashier at the pit’s brow collects the sub-scription as he pays the miners their wages and the collierysurgeon can quite well attend to all the rest himself. Inregard to the particular case at Broomhill the matter for themoment stands in abeyance; canvassing and advertising havebeen abolished, the 9d. is paid, but subject to the deductionsmentioned.

In regard to the miners in general, the first step hasbeen to secure unanimity, not only among the collierysurgeons concerned, but also throughout the neighbourhood.Thus in six colliery districts on the north bank of theTyne the 18 surgeons engaged were hesitating, but thePresident of the Northumberland and Newcastle MedicalAssociation wrote personally to each surgeon and calledupon some of them and by persistent personal effort in-duced them to sign and promise to observe the rules ofthe association. Counting the practitioners of the outlyingdistricts who might have come in and done some ofthe work of the 18 colliery surgeons 36 signatures in allwere obtained for this neighbourhood. All being now readythe 18 colliery surgeons were not exposed to the unpleasant-ness of entering upon a dispute with the miners amongwhom they live. It was from Newcastle that the communi-cation was made and by the general secretary, Mr. GarforthDrury, who is a solicitor. The appointment of a solicitor asthe secretary of a medical union is a new departure, butthere is a great deal to be said for it. In this theNorthumberland practitioners followed the example of theCounty of Durham Medical Union and the work is likely tobe done in a business-like manner and there is less chance ofcommitting some legal blunder. Then there are the office,the clerks, and everything necessary available every day.The communication made was worded as follows: .. We havebeen requested by the council of the Northumberland andNewcastle Medical Association to apply on behalf of theirmembers for a fortnightly payment from the members of "-here followed the names of the miners’ organisations or

collieries-11 of 9d. from all householders and married menfor medical attendance. The members of our association in

your districts are," and here followed the names, not only ofthe 18 colliery surgeons, bat of all the surgeons in the out-

lying districts, making 36 names in all. After this displayof unanimity the notification continued: ’’ And we are

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requested to give you a fortnight’s notice from the datehereof, after which time they will, as members of thisassociation, be under an obligation to us not to accept lessthan the above rate. The reasons we advance for this rise infees are: (1) the illegality now of employing any but

qualified and registered medical men as assistants ; (2) theincreased cost of medical education, which now takes five

years to complete instead of two and a half years ; (3) theincreasing difficulty of obtaining, and greater cost of,assistants’ services ; (4) the greater cost of drugs andsurgical dressings; and (5) the increasing use of expensiveinstruments."

It will be seen that the whole responsibility is assumedby the medical union. The local practitioner who gives inhis resignation is but a pawn in the game ; he refers theminers’ committees and all their deputations to the MedicalAssociation. It is Mr. Rutherford Morison who, as President,has to answer all the objections and to receive all the abuse ;but, generally speaking, the miners have recognised that thedemands made were fair and just. In two places, however,on the north bank of the Tyne there has been opposition.In the first of these the resistance was very virulent. Themen would not pay the 9d. and the colliery surgeons had torequest the cashier at the colliery offices not to accept anymen under 9d. Thereupon a deputation was sent to Mr.Morison asking him to put off the matter for a month, andafter much discussion he consented to a postponementfor a fortnight. This delay terminated with the endof last year and then another fortnight’s prolonga-tion was accorded so that Mr. Morison might goto the district and address a meeting of miners so as

to explain the matter to them. Here he was prettysharply heckled and the next thing that occurred wasthe publication in various newspapers of an advertisementinviting medical men down to the district. The MedicalAssociation at once published counter advertisements urgingmedical men not to go to this district. Nevertheless, someapplications for the vacant post were made and the minersaccepted two medicaj men. The first candidate, however,failed to put in an appearance ; the second had settled uponthe day of his arrival, but Mr. Morison succeeded in obtain-ing his address and wrote to him at length. According tothe answer received this medical man had been misinformedas to the true state of affairs and now promised not to go.Subsequently another practitioner accepted the offer, buttelegrams were sent to him by the President of the MedicalAssociation and his arrival was also stopped. Now itis reported that someone else is coming and lettersand telegrams have been despatched to warn himoff. but the result is not yet known. This localstrike has lasted some three weeks and Mr. Druryhas written to the local practitioners to say that hewill support them in county-court actions against their

patients who do not pay the 2s. 6d. fees. Thus themethod of action is first thoroughly to blockade the districtand to prevent the arrival of any outside help, and thento county court all patients for 2s. 6d. fees till such time as

they consent to contract for 9d. instead of 6d. per fortnightper household.

In the second district where resistance has been offeredthe miners, as explained above, offered to pay the 9d.,but wanted to provide the drugs themselves and to deducta portion of the money for that purpose. Here the objectionis against the formation of lay committees acting as

intermediaries between the practitioners and their patients.Altogether and up to this date applications have been madein 17 collieries, and in 13 cases the increase of remunerationwas acceded to without demur. In at least three out of thefour other cases the Northumberland and Newcastle MedicalAssociation has succeeded in preventing any outside

practitioners answering the advertisements published andtaking up the vacancies. Thus the efforts made have been,on the whole, very successful, a success in which the minersthemselves have largely contributed by the reasonablenessand fairness which they have shown in the vast majority ofthe cases.

Newcastle, Feb. 25th.

PREVENTION OF PHT]EIISIS.-A public meet-ing of the Gloucester, Somerset, and Wilts Branch of theNational Association for the Prevention of Consumptionand other Forms of Tuberculosis will be held at theGuildhall, Bath, on March 6th, under the presidency of themayor, when an address will be given by Sir James CrichtonBrowne.

BIRMINGHAM.

(FROM OUR OWN CORRESPONDENT.)

The Health of the City.THE report of the medical officer of health, Dr. Alfred Hill,

for the fourth quarter of the year 1900 presents some interest-ing details, among others an exceptionally low birth-rate andan unusually satisfactory death-rate, the former being 29 4per 1000, the latter 18-2 per 1000. Certain parts of the cityshow marked contrasts. Dr. Hill points out that the value ofthe zymotic death-rate has been greatly depreciated in recentyears by the use of the term enteritis" " as a synonym fordiarrhoea and expresses the hope that in future the complaintwill be certified as due to 11 zymotic " or "epidemic enteritis."The cases of diphtheria were less numerous ; 30 of thosereported occurred in the Blue Coat School, the scholars hav-ing to be disbanded. A recurrence took place among a fewscholars on their return. Advantage was taken of bacterio-logical knowledge for no less than 455 specimens from thethroats of the scholars were examined at the Universitylaboratory. Certain sanitary defects in the school were

remedied and no more cases happened.

7/M! jf!foM Gas Scheme.

Questions of health and comfort are closely connected withpurity of the atmosphere. This depends largely on the com-mercial undertakings in manufacturing areas. In andaround this city are many large works and manufactorieswhich contribute greatly to the vitiation of the surroundingair by pouring forth dense volumes of smoke and emittingfumes of a noxious and disagreeable character. Some ofthese evil results, it seems, may be combated and renderedfar less detrimental by the aid of scientific discoveries ofrecent date. The subject was discussed on Feb. 21st at animportant meeting of those interested in the industriallife of the Midlands. The object of the meeting was theconsideration of the Bill now before Parliament for con-ferring powers upon the South Staffordshire Mond Gas(Power and Heating) Company. It was stated upon highauthority that the introduction of this gas into the districtwould be an enormous benefit and advantage, because thegas could be made cheaply and the sulphate of ammoniacontained in the fuel could be preserved instead of beingthrown away as it has been for so many years. Itwould be suitable for driving machinery and would saveall cost of stoking and clearing away ashes, besides beingfree from tar and dust. It was stated by Sir AlfredHickman that the use of Mond gas as compared withordinary gas was analogous to the use of charcoal as com-pared with coal. Principal Lodge of the Birmingham Uni-versity expressed his opinion that so long as they continuedto burn crude coal in a fashion which he condemned asbarbarous and half-civilised so long would the chimney shedits sombre shadow on our industrial existence. It may bethe beginning of an evolution in our town life if the pro-motel of this scheme realise their aspirations in the projECtbefore them.

The Value of District Nurses.

The twenty-ninth annual meeting of the friends of the

Birmingham District Nursing Society was held on Feb. 19thunder the presidency of the Lord Mayor (Alderman Edwards).The report showed that during the past year 2501 cases werenursed and 57,432 visits were paid by the society’s nurses.The expenditure had increased and an adverse balance of E40was shown. The value of the work done was pointed out inforcible terms, and also that while the work had greatlyincreased the number of nurses had not been increased inproportion owing to the want of adequate funds. The com-parison with other large towns, such as Manchester andLiverpool, in this particular kind of nursing showed thatBirmingham was much behind. Thus in Manchester andSalford there were 55 nurses and five homes, while in Bir-mingham with much the same population there were 17nurses only. The subscriptions in the two places were notablydifferent, Manchester raising some E3000 per annum, whileBirmingham secured only .E579 for the same purpose.Various remedies were proposed which may be successfulin placing this useful institution upon the better footingwhich it deserves.

Feb. 26th.