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where there are plenty of air and space and where any defector the escape of any sewer air would not do much harm.

Considering the frequent epidemics and the very high death-rate from which the inhabitants of Arles suffer, it is ardentlyto be desired that there should be no delay in draining thetown. The plans are ready, the scheme has been carefullystudied, and there is no excuse for further loss of time.

Judging by what has occurred in other towns, the death-rate of Arles could be reduced by one-third if the townwere properly drained. Taking this in conjunction withthe figures given above, it may be said that every monththis matter is postponed it means that, on an average, twentylives will be sacrificed. If the scheme is postponed for a

year, more than 200 inhabitants of the commune of Arleswill be brought prematurely to the grave.

Of course the drainage scheme implies the improvement.of the water-supply; in any case, there would no longer be’sewer outfalls just by the water intake. But it is also pro-posed to tunnel under the Rhone and there collect water after

- it has filtered through the bed of the river ; this doubtlesswould effect a great improvement ; the first measure, how-- ever, must be to cease polluting the river. The fate of theproposed reforms will be watched with anxious and sympa-thetic interest, especially by those who have to travel throughthe town on their way to Marseilles or the Riviera and whowould like to break their journey there in order to visit itsmany remarkable ruins which record the triumphs of anancient and memorable civilisation.

ROYAL MEDICAL BENEVOLENT COLLEGE.

AT the annual general meeting, held on Thursday, the 25thinst., at the office of the College in Soho-square, the follow-ing candidates for pensionerships, foundation scholarships,.and a Morgan annuity were reported by the scrutineers, Dr.M. Baines, Mr. S. Felce and Dr. J. H. Galton, to have- obtained the largest number of votes, and were declared toihave been duly elected :-

THE ROYAL BRITISH NURSES’ASSOCIATION.

THERE was a most enthusiastic gathering on May 24th at’20, Hanover-square, when the members of the Royal BritishNurses’ Association assembled, Sir William Savory being inthe chair, to hear a statement by H. R. H. Princess Christian,the President of the Association.Her Royal Highness, who rose amidst a volley of cheers,

"said : You have come together to-day in the expectation ofreceiving from me a communication of great importance andI am sure you will not be disappointed when I announce toyou without further preface that the Queen, on the advice ofher Privy Council, has determined to grant a Royal Charter’Df Incorporation to our Association. You will all feel withe that the day on which this gratifying intelligence is

published is specially appropriate as being that on whichany mother completes another year of the life which isso dear and becomes every day dearer to her people. I

need hardly remind you how deep my mother’s interest hasalways been in the great questions of public health and in allinstitutions which have for their object the better provisionfor its maintenance. On this auspicious moment in our historyit may not be out of place to say a few words in regard tothe origin and prospects of our Association. Five yearsand a half ago was set on foot the movement whichhas to-day received such a powerful and gratifying impetusIts object, as you know, was to raise the general standardof the education of nurses not only in this country, butthroughout the Empire. During the period of its existencewe have had the satisfaction of seeing its work steadilydeveloped, and hospital after hospital has been induced toextend its term of training for nurses until now the majorityhave adopted the term advocated by the Association-namely,three years-whilst the Select Committee of the House ofLords has expressed the opinion that that is the minimumperiod required for training nurses who could rightly beadvertised as thoroughly trained. Another object aimed atby the Association has also been to a great extent attained.The Association has succeeded in improving the position ofnurses, which formerly was far from being satisfactory ; bymeans of its benevolent schemes, by the establishment of homesof rest and cooperative offices for employment, measures whichwere suggested to our Association in 1888, and which havesince been set on foot by other agencies in various parts of thecountry. It is notorious that nurses have obtained thegreatest material benefits. Our association has striven andcontinues to strive to protect the public against the gravedanger to which they are exposed in times of sickness by thefact that women who have not the slightest claim to beregarded as trained nurses are, nevertheless, able to obtainemployment by means of certificates doubtfully securedor of hospital testimonials of which they have subsequentlyproved themselves unworthy. We have already compiled andpublished an alphabetical register, upon which nearly 2000trained nurses have voluntarily enrolled their names and fromwhich we have the power to remove the name of any individualwho may disgrace her calling. Thus a hopeful beginning hasbeen made of a system which has worked well in other pro-fessions. I cannot, of course, conceal from you that theseresults have not been attained without persevering effort ; forour Association has had to encounter no little opposition andgreat misrepresentation. All this has been quietly and patientlyborne, under the conviction that our cause is a just andbeneficent one, and that in the end it will most certainlyprevail. We shall not allow the success which is crowningour endeavours to make us either selfish or idle, but weshall persevere with fresh encouragement from the eventof to-day in the path of honest and laborious work. May Iexpress a hope that the authorities of hospitals throughoutthe kingdom to whom we appealed in 1889 may be persuadedto take part in our work, and by their advice to assist incarrying out those measures of nursing reform which areurgently needed for the safety of the sick, for the assistance ofmedical men and for the welfare of nurses themselves. Icannot bring these remarks to a close without paying mytribute of gratitude and admiration to all those who haveworked so zealously and unweariedly to attain the end whichour Association has in view, and I must offer to them myheartfelt congratulations on the cheering news which it hasbeen my privilege as your President to announce to you to-day. Let us one and all resolve to go forward in the spiritof the motto familiar and dear to me from my earliest daysas that of my beloved father’s family. Only let us be"Steadfast and true," and then we need have no fear for theresults of our labours.

Sir WILLIAM SAVORY said that the announcement of herRoyal Highness must be a subject of hearty congratulationto everyone concerned. Had it not been for her Royal High-ness they might have had to wait several years for thatwhich they had now obtained, and this rapid success, whichhad exceeded their most sanguine expectations, was entirelydue to the Princess.

Sir JOSEPH FAYRER, in proposing a vote of thanks to herRoyal Highness, also spoke of the unwearied interest takenin the Association by Princess Christian, and called upon themeeting to accord a vote of thanks, not only for the presentbut for the past interest shown by her Royal Highness in theinstitution.

Sir DycE DUCKWORTH said it gave him great pleasure tosecond the motion. He had always felt confidence in theAssociation, and now that they had obtained the RoyalCharter they would go forward with renewed energy.

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Sir RICHARD QUAIN said that, notwithstanding the hard,up-hill work they had experienced, her Royal Highness hadnever deserted them. Words would fail to express his gratifi-cation at the results obtained.

Miss STFWART, Matron of St. Bartholomew’s Hospital, alsosupported the motion.H.R.H. Princess CHRISTIAN in replying said : "I thank

you all very heartily for your thanks, which I know are as

sincere as they have been unanimous. I can assure you thatwhat I have been able to do has been to me a labour of love. "

Dr. BEZLY THORNE, one of the honorary secretaries ofthe Association, then brought forward a draft scheme pre-pared by the executive committee for the constitution ofnational branches of the Association in Scotland and Ireland,and a vote of thanks to the chairman terminated the pro-ceedings.

Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Surrey County Sanitary District.-Dr. Seaton is to be con-gratulated on the appearance of his report at this compara-tively early date. We are aware that there are great diffi-culties in getting together all the information necessary for areport of this kind, but there can be little doubt that theinterest in a report bears a direct relation to the date of itsappearance. The total population of the county of Surrey isestimated at 420,062. The general death-rate for 1892 was14-7 and the average as estimated for the last four years14’1. Dr. Seaton is of opinion that, with good sanitaryadministration, the average county death-rate should be re-duced by at least 2 per 1000 during the next decade. Theinfantile mortality varied from 117 per 1000 births in the urbanto 103 in the rural districts, whilst the phthisis death-rate was1 35 per 1000 in the urban and 1 -15 in the rural. Dr. Seatonin his valuable report discusses several questions, both of

general and local interest, but space will only admit ofour noticing a few. With reference to the subject of thepollution of the rivers, the report enumerates the works whichare actually in progress to divert sewage &c. from the riversThames, Wey, Wandle and Mole, and, whilst expressing hissatisfaction with these, Dr. Seaton points out that, if visibleimprovement is to be produced in the condition of the Weyand the Wandle, additional powers must be conferred uponthe sanitary authorities to compel manufacturers to adoptpracticable measures for preventing the pollution of rivers.During the autumn of last year Dr. Seaton, owing to thedanger of cholera being imported into this country, made asurvey of those districts where suspicion was attached to thewater-supply, and he hopes to be able shortly to record sub-stantial improvement in this respect. As regards the Housingof the Working Classes Act, Part 3 still remains a dead letterin the county, although action has been taken in some ofthe districts under the provision of Part 2. He gives asummary of the prevalence of epidemic disease throughoutthe county, and in discussing enteric fever tells us that in thecase of Richmond he was able to demonstrate that the exces-sive prevalence of the disease was due to the conditions ofhouse drainage and water-supply. In reference to the notifica-tion of enteric fever the report states : "If it be assumed thatthe proportion of fatal cases does not exceed one in six, itappears from the reports that in the districts of Croydon,Kingston, Richmond and Farnham sanitary authorities halfthe cases are unnotifled," and he thinks that notification indifferent parts of the county is carried out in very varyingdegrees of thoroughness. As the subject of isolation accommo-dation was fully dealt with by Dr. Seaton in a special report,which we noticed at the time of its issue, he refrains frommuch reference to the subject ; but he points out that " toexpect medical officers of health to check the spread of scarletfever without providing them with hospitals is like telling thepeople to make bricks without straw.’ " In reviewing thereports of the medical officers of health Dr. Seaton highlycompliments Mr. Jacob upon the exceptional merits of hisreports, and whilst discussing the terms of appointments ofhealth officers shows how much better the work is, as a rule,performed by those who devote the whole of their time to theduties of their office than by those who are engaged in private

practice. We hope that those who have the making of theseappointments will carefully read this part of the report.Although Dr. Seaton praises when he considers praise is due;he does not hesitate to express a different opinion when.necessary, and he enumerates the respects in which he con- -siders the reports are deficient, and submits extracts in illus--tration of his points. We have no space to enter into the,subject here, but it is obvious that the medical officer oi’health of the Surrey County Council does not intend toleave matters where they are if he can effect an improvement.An elaborate statistical review is embodied in this report,and it also contains a diagram of the sanitary districts of the.county, which conveys a capital idea of the relation of its.various parts. We hope all county medical officers of healthwill be able to supply a similar diagram with their reports.

St. Helens Urban Sanitary Distriet.-The birth-rate ciSt. Helens is one of the highest in the kingdom and during"1892 amounted to 39-77 per 1000. Out of 1000 persons livingin the district there are 150’3 under five years of age, as.

compared with 136 in the urban and 134 in the rural districts.of England. In spite of this fact the death-rate is only 20-82.There are, however, comparatively few persons over fifty-five-years of age in the district, and the infantile mortality is but,147 per 1000 births. Only once during the last twenty years.has the general death-rate of St. Helens been as low as atpresent, and the zymotic death-rate (2-26) is 50 per cent.below the average of the last ten years. During the-

year small-pox was introduced into the district from,Warrington and led to the occurrence of eighteen cases.

Most energetic steps were taken to stay the spread ofthe disease, and to a large extent they were successful.St. Helens has an unfortunate reputation of possessing one..of the highest death-rates in England from enteric fever---i.e., 0’34 per 1000,-and Mr. McNicoll draws attention to thethree most potent factors which exist in the town for fostering,the disease-i.e., defective sewerage and drainage, privymiddens and other filth nuisances. In each case that occurs.a very thorough investigation seems to be made and every-thing is done to rectify any defects which may exist. The-death-rate from diarrhoea is very high-1 14 per 1000-and’!a chart accompanies the report which shows the relation’between the prevalence of diarrhcea and the temperature-of the soil at a depth of four feet. In discussing the needfor further isolation accommodation Mr. McNicoll refers.to the difficulty of carrying out proper isolation arrange-ments at home; and the report contains an account of;the provision the sanitary authority have now determinedto make. A separate small-pox hospital is to be erectedand the present building and hite are to be much enlarged,"quarantine" accommodation is to be provided in thehospital grounds, and also proper disinfecting apparatus.As regards drainage and sewerage it has been decided to,extend the intercepting sewer and complete the seweragesystem of the town-the sewage is finally to undergo subsi-dence in tanks and the effluent to be turned into Sankey’s.Brook, the contents of which are said, from the "chemicaldrainage " contained therein, to efficiently disinfect theSt. Helens sewage. It appears that the brook exercises a re-

markably destructive action on the micro-organisms con-tained in the sewage, as samples taken before its introduction...into the brook contained 89,600 organisms per cubic centi metre, whilst another series taken after its admixture with’

Sankey’s Brook fluid contained but ninety organisms in the-cubic centimetre-after, we presume, due allowance for dilu--tion had been made. It would be interesting to hear of what-the "chemical drainage" consists. The black smoke nuisance-still persists, and, as Mr. McNicoll remarks, the need for

improvement in this respect is apparent when we are toldthat "about 1,000,000 tons of coal are burnt annually inSt. Helens, with its small area, whilst only one-fourth more-than this is burnt in London, with its large area. "

Parish of St. Luke, Middlesex -This district has an esti,mated population of 42,387, figures which represent a slightdecrease on the last census enumeration. The general death-rate was considerably lower than that recorded during the-last three years, being 25 57 per 1000. In view of the pro-bable importation and development of cholera it was decided!to carry out several of Dr. Yarrow’s recommendations ;amongst others, to appoint three medical men who should act=.under the supervision of the medical officer of health, and who.should treat gratuitously, at their own homes, cases of cholera,which could not be removed to hospital. It was further de-cided to secure, if possible, twenty suites of rooms for thereception of families from infected houses. With reference to