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A very fair estimate of the rate of progress of the disease atthe time is given by this phenomenon ; the more readily it isproduced the more acute the case, and if it cannot beobtained the phthisis is quiescent,

I am, Sirs, yours faithfully,WALTER BROADBENT, M.D. Cantab., M.R.C.P. Lond.

]Rriiybt,nn. T<’phf)i!).fT. 1900.WALTER BROADBENT, M.D. Cantab., M.R.C.P. Lond.

" DEATHS UNDER CHLOROFORM."To the Editors of THE LANCET.

SIRS,-Mr. Whiteford quotes one sentence from my lastparagraph but he ignores the sequent and governingsentence, which runs : "But I confess, now I have got usedto the Krohne inhaler and realise the significance of thesedeaths, that I should think it a crime to go back to a towelor a Skinner’s mask." Yet this very sentence, which Mr.Whiteford passes over, has since been reprinted and madethe text of an approving editorial notice by one ofTHE LANCET’S medical contemporaries.

Prior to this present decade no inhaler gave us greatersecurity or convenience than the towel or the Skinner’smask. While that was so we older men were quite scientificin sticking to the open method. But that is so no longer.Watching its effect on the pulse, respiration, and pupils is

not "a method of estimating accurately the amount ofchloroform absorbed." Such watchings give only a rule-of-thumb measure of the progression of the anaesthesia.

Mr. Whiteford now narrows down the " we " in his ques-tion so as to include only himself and me. This to shunt myreply. But Mr. Whiteford has forgotten that he publishedhis question in THE LANCET of July lst, 1899, long before Ihad turned up to assist him in the discussion. Is 1’Ir.Whiteford a prophet 7

I am, Sirs, yours faithfully,Manchester-square, W., Feb. 19th, 1900. JAMES EDMUNDS.JAMES EDMUNDS.

THE DISCUSSION AT THE ROYAL MEDICALAND CHIRURGICAL SOCIETY.

To the Editors of THE LANCET.

SiRS,-It is of small moment to myself, but the distin-guished Royal Academician Mr. Seymour Lucas may besurprised to learn that your reporter gave him credit for

re-opening the adjourned discussion on Mr. Ballance’sinteresting paper instead of

Your humble servant,Feb. 20th, 1900. R. CLEMENT LUCAS.R. CLEMENT LUCAS.

PUBLIC PRESCRIBING.To the Editors of THE LANCET.

SIRS,-We are all anxious for war news and most of usno doubt invest daily in an evening paper, but that is noreason why we should tamely submit to ba insulted as a pro-fession by the proprietors of some of these journals. WhenI open my paper and find one whole column devoted to thespecious advertisement of an anti-gout remedy and anotherto the puffing of a tonic with a portrait of the last cure

"

my bile rises and I am in want of one of the various liver-pills more modestly advertised in the same paper. Cannotwe as a profession boycott the papers which lend themselvesto this offensive practice of public prescribing 7

I am, Sirs, yours faithfully,Feb. 20th, 1900. F.R.C.S.

THE Biennial Dinner of the MetropolitanBranch of the British Dental Association will be held onSaturday, March 3rd, at 7.15 for 7.30 P.M., at the HotelCecil, in the Richelieu and Medicis Rooms. Dr. AshleyBarrett, L.D.S., will be in the chair.

BATH EYE INFIRMARY.&mdash;The annual meetingof this institution was held on Feb. 16th under the presidencyof Alderman Bartrum. The medical report stated that 268in-patients and 1749 out-patients had been treated. Thefinancial statement showed that there remained a favourablebalance of .B31. On the motion of the Rev. B. N. Thompsonit was decided that an honorarium be awarded to Mr. W.Beaumont, the honorary surgeon to the infirmary.

THE

ORGANISATION OF THE PROFESSION.GREAT YARMOUTH.&mdash;THE FRIENDLY SOCIETIES DECREE

A MEDICAL LOCK-OUT.

(FROM OUR SPECIAL COMMISSIONER.)

THE medical practitioners of Great Yarmouth have

successfully formed a strong union. For many years theyhad suffered at the hands of medical aid companies andfriendly societies, but they are now energetically copingwith the evil. According to the last census, Yarmouth hasa population of 49,334 inhabitants, but this, of course, doesnot include the immense number of visitors and holiday folkwho throng to this town during the sea-bathing season.

The medical profession is, however, more concerned withthe resident population, who belong for the most partto the seafaring, working, and tradesman classes.There is not a large upper middle-class and wealthyresidential population ; still, there are the dealers in theexport fish business and the import timber trade whopossess some wealth. Then the season is very heavy whileit lasts, so that hotel and lodging-house keepers must makesome considerable profits. Of late, also, a few very goodhigh schools have been established at Yarmouth and theyhave increased the residential population, as the parents ofchildren sometimes come and live near these educationalinstitutions. Nevertheless, even when all this is takenfully into account, it is on comparatively poor patients thatthe medical practitioners must rely for the greater part oftheir income. It is therefore very necessary that those whocan afford to pay small fees should not be able to avoid doingso by joining semi-charitable institutions. There are inYarmouth many persons who appear to be poor when they arenot so. By letting lodgings in the summer months and bysuccessful fishing expeditions considerable sums are some-times earned. Very otten these people do not live up to theirincome and the balance is put in a bank or devotedto the gradual purchase of a house ; others, on the contrary,squander this surplus in drink. In either case it may justlybe urged that those persons who in the course of a yearcan earn not only enough to maintain their homes but arealso able to spend in dissipation or to bank considerablesums should pay proper fees to their medical attendants. In

practice, however, this is not done. Because these peopleare content with a low standard of living they imagine thatthey have a right to avail themselves of provident organisa-tions which were originally established only for the benefitof the poor. Nevertheless, even this was to some extenttolerable so long as it applied only to the bread-winner, thehead of the family. By attending the members of a benefitsociety for ld. per week the practitioner obtained fees at theusual rate when members of his family were taken ill, andthus this contract work helped to build up a private practice.Of late, however, female lodges were founded and both womenand children were brought in, so that the indirect advantageof contract work was seriously menaced.

There was no organisation capable of dealing withthis grievance. Certainly Yarmouth possessed a Medico-Social Club, but it did not include all the practitionersof the district. The members met at each other’shouses, read scientific papers, and then terminated the

proceedings by having supper together. During thecourse of these social gatherings a pamphlet was circu-lated among the members, entitled 11 An Open Letterto the Profession," which urged practitioners to unite andto fight against various evils, notably against the contractsystem. Mr. W. E. Wyllys spoke on the questions raised bythis pamphlet, and finally it was resolved to get up a meet-ing of the local profession to discuss the subject. Thismeeting was held in March, 1896, in the mayor’s parlour ofthe town-hall. 19 practitioners attended, including somewho had come from the neighbouring district of Gorleston.At Yarmouth, as in many other places, there existed aprimary diniculty : who was to take the initiative in the move-ment ? 7 This is a delicate matter, for it does not often happenthat a practitioner holds so prominent a position that hecan without question or cavil take the lead. The Yarmouthpractitioners avoided this difficulty by transferring the

responsibility to an outside body. They resolved to form

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themselves into a branch of the Incorporated Medical Practtioners’ Association. Then they applied to the central angoverning body of this association, sent up their subscriltions, and received official sanction to form a branch. Bthus making use of this central body they readil

persuaded all the local practitioners to meet and no onwas accused of taking too much on himself or c

attempting to thrust himself fjrward. At their secon

gathering, which was also held in March, 1896, the medicapractitioners of Yarmouth met as a branch of the IncorporateMedical Practitioners’ Association and proceeded to appointheir officers-namely, a committee of five, a president, aniMr. W. E. Wyllys (25, King-street) as secretary and treasure!a post which he retains to this day. They calleithemselves the Great Yarmouth District Committee of th

Incorporated Medical Practitioners’ Association.Even at this early date they began to discuss the questioi

of female Foresters. This debate was forced upon the association, perhaps somewhat prematurely, inasmuch as one othe members had resigned his position as medical officer two Ifemale lodge of Foresters because several women who possesse<good incomes had been admitted as members. The femaliForesters had already applied to other practitioners to accepthe vacated position, but the latter very loyally replied thathey would wait till after the meeting before giving an answerThe meeting after some discussion decided that the medicaofficer in question had better withdraw his resignation fo:a period of three months so as to give the newly formecmedical union the time to negotiate. From the very firslthe profession had displayed great unanimity, and thereforEthere was some hope that such negotiations might provEsuccessful. At the first meeting 19 names were given in, buithis included three practitioners from Gorleston, and as i1was subsequently found that the two districts could not beworked together the Gorleston practitioners ultimatelywithdrew. There remained 16 Yarmouth practitioners, whowith few exceptions, included all the members of thE

profession in active practice. There are other medical merat Yarmouth, but for this reason or that they certain]3would not take up contract work and are no longeidependent on medical practice. It may be thought thatthis is a very small number of medical men for so large atown, but this can be explained by the very peculiar topo-graphical situation of Yarmouth. There are no suburbs ; onthe one side there is the sea and on the other side the marshes.Yarmouth is situated on a narrow tongue of land that runsfrom north to south. To reach any of the inland residencesbeyond the marshes it is necessary to go a long way roundand this means a journey of some 20 miles. A town

practice generally includes a certain number of countryresidences which, though at some distance, are accessibleby a direct route, but this is not the case at Yarmouth.The members of the District Committee met every month

and one of their first acts was to draw up a letter which wasaddressed to all the benefit societies urging that a jointconference should be held so as to discuss the existinggrievances. The terms on which the medical practitionerswere willing to take up contract work were also fixed andthese were printed and sent round to all the clubs. In

reply, the benefit societies adopted a lofty tone and themajority refused to entertain the proposals made by themedical practitioners. Two benefit societies did, however,accept the new rules and conceded to their medical officerthe right to refuse those members whom he thought were toowell off to belong to such societies. They also agreed toan increase in the amount to be paid as subscriptions.The other benefit societies adopted a course which wassingularly devoid of tact and showed that they in no wiseappreciated the situation. They held a large meeting atwhich the following resolution was adopted :-This representative meeting requests the doctore to withdraw their

circular and retain their position on the old terms and take females onthe same terms as the males.

The medical men were further called upon not to raise thequestion in future. In a word, there was to be no improve-ment, and the medical officers were to pledge themselvesnever in future to seek to obtain any such ameliorations.This resolution was passed in October, 1896, and the medicalofficers at once replied that they adhered to their formerdemands: at the same time they decided that they wouldnot resign but that they would wait to be dismissed. Thebenefit societies had put themselves in an awkward position,for they had called upon their medical officers to pledgethemselves not to raise these questions in the future. Of

, course, they all very naturally refused thus to pledge them-. selves, and this demand being rejected the benefit societies

thought themselves bound to dismiss their medical officers.Thus the onus of dismissal fell upon the benefit societies ; itwas not a strike but a lock-out.At the time when matters had come to a head the

Yarmouth practitioners addressed a memorial to all themedical licensing bodies of the United Kingdom callingattention to the evils and abuses of the clubs and medicalaid societies, and expressing the desire that these licensingbodies should give their opinion on the conduct ofthose of their graduates and holders of diplomas who byaccepting appointments in such institutions aided andabetted in the perpetration of the abuses in question.This memorial set forth that well-to-do persons were

admitted to institutions which were meant primarilyfor the relief of the poorer classes; that women andchildren were admitted at rates of payment that wereabsolutely inadequate; and that industrial assurance com-panies had organised a system of indiscriminate canvassingwhereby the private patients of other medical men weresolicited directly for the company and indirectly for itsmedical officers. These lay organisations conducted medicalpractice purely as a commercial speculation, in some casespaying their medical officer a fixed salary and appropriatingfor themselves whatever medical fees were received over andabove this sum. At Yarmouth these societies hadrefused to come to an understanding with their medicalofficers and had dismissed them. They then adver-tised in the lay press for other medical men to take upthis work, the medical journals having refused to insertsuch advertisements. Though fairly warned that suchconduct was condemned by the general voice of the pro-fession, some medical men had accepted these appointmentsthus "knowingly, wilfully, and openly assuming the posi-tion of assisting a certain section of the public to defeat thelocal medical men in a matter involving the vital interests ofthe profession." The memorial to the licensing bodies thenwent on to relate that ;-

One of our members had previously acted as the medical officer of anindustrial assurance company offering medical aid as an attraction toits insurers, paying its medical officer a fixed salary and canvassing forpatients from door to door. This office he has resigned, but in theabsence of any declaration as to these appointments by the GeneralMedical Council or by the universities and colleges granting medicalqualifications the company has, we believe, easily found a substitute.Such facts as we have recited can be quite paralleled in the experienceof other towns and districts of the United Kingdom and appear to us tocall for the careful attention of the various governing bodies entrustedwith the granting of medical qualifications and with the control ofthose qualified.The memorialists concluded by inquiring whether the

holding of such positions was compatible with the degreeor diploma granted, and if it did not contravene existingregulations, would it not be possible to enact a new by-lawforbidding such practice ? And was it not desirable that theGeneral Medical Council should declare such conduct to beinfamous from a professional point of view ? This memorialwas signed by 15 of the Yarmouth practitioners; and it isworth noting that though it often happens that Irish medicalmen are the offenders in regard to such club practice, themost sympathetic and encouraging replies were received fromthe Irish licensing bodies.Great Yarmouth.

(To be eeaztiazaed.)

BIRMINGHAM.(FROM OUR OWN CORRESPONDENT.)

Health of the City.THE report of the medical officer of health, Dr. A. Hill, for

1899 has been issued by the Health Committee. It containsmuch useful and valuable information. The birth-rate for the

year was 34-3, a higher figure than in any year since 1885.The death-rate was 20-5 per 1000 ; this is an increase overthe average and is due to mortality from diarrhoea andenteritis during the hot months. The zymotic death-ratewas small, being 2 9 per 1000. No case of small-pox hasoccurred for three years past. Typhoid fever shows an in-crease owing to a severe outbreak in the autumn, the numberof deaths being 119, or 20 more than the average. Dr. Hillexpresses his strong conviction with regard to the infectious-ness of this disease-that direct contact with the person or