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cities Major-General SCOTT said that in America pipes were,practically allowed to run all day.

Sir ALEXANDER BINNIE said that he estimated the amountwhich would be required per head in London daily at from55 to 40 gallons. This included the amount supplied todrinking fountains. It did not, hovever, include thefountains in Trafalgar- square which had a separate sourceof supply. He did not thirk the cost of connecting the.mains of the different companies would be very great. Thewitness stated that the mains of the East London and NewRiver communicated with one another.In answer to Mr. CRIPPS, Q.C., Sir ALEXANDER BINNIP3

stated that he knew that the Thames Commissioners now hadcontrol of the entire watershed of the river and that they hadanade regulations with regard to the sanitary arrangements onriver boats. He had no complaint as to inemcieicy to makewith regard to the Thames Conservancy Board ; he thoughtthey were doing their work well. In answer to General SCOTT4he witness said that he thought a certain amount of risk wasrun in taking so much water from the Thames and Lee,which were both polluted rivers. He stated that theCharlton well had been given up by the Kent Companybecause it was situated in a polluted area.Major-General ScoTT asked the witness whether in view of

the difficulties which the water companies had it would notbe best to leave them with their own statutory liabilities andthe witness said this view had not occurred to him. Hesummed up the advantages to the consumer of placing thewater-supply of London in the hands of a representative:body as follows : I 1 1. It would put an end once andfor all to the continued inquiries in the London water ques-tion, which have been going on since 1811, carried out byRoyal Commissions and by Parliament ; at the same time itwould carry out the recommendations of the Duke of Rich-mond’s Commission, Sir William Harcourt’s Commission,Sir Matthew White Ridley’s Committee in 1891, and therecommendations contained in the report of Sir Joseph.Pease’s Committee in 1896. 2. It would place London in asimilar position to that which it has been found most expe-dient to adopt in almost all other large towns in GreatBritain and Ireland and which has been found most conduciveto the public interest in the United States of America,and it is a duty which the Government of India places inthe hands of almost all the municipal bodies in their Indianempire. 3. That according to all authorities on the subject,Lord Balfour’s Commission, the recent evidence of the watercompanies, and the investigations of the County Council, the,present water-supply of London must be more than doubledwithin the next thirty or forty years and it is expedient thatthese new works should be carried out by some public body.and not by commercial companies. The supply of waterfrom the present sources may be taken for the year1896 at 198,000,000 gallons a day. This cost in capitalexpenditure 16,531,346 or at the rate of .683,492per 1,000,000 gallons supplied per day. Had these worksbeen carried out by the Metropolitan Board of Works andthe County Council they would no doubt have been treated asthe main drainage expenditure of the metropolis has beentreated, especially when we regard the long period over which’the expenditure has ranged. In the case of the main drainageworks since 1855 about seven and three-quarter millions ofcapital has been expended, of which three and a half millionshas been paid off, so that at the present time the maindrainage debt stands at only about f:4,200,OOO. Under theabove circumstances it is expedient that the large expendi- I,ture which is inevitable in the future should be placed inthe hands of a public body rather than in the hands of’commercial companies."The next meeting of the Commissioners will take place on

Monday, Jan. 31st.

THE WATER QUESTION AT CHARD -The ChardTown Council having proposed to make trials for water uponland which they have agreed to purchase at Combe St.icbola.s, and close to the spring which supplies that villagewith water, the Combe Parish Council has intimated to theOdaid Authority that the surfaca of the ground for a con-Üderable distance around the spring is saturated withanimal excrement, and if the ground is broken up it is mostlikely the spring will be affected thereby and a seriousepidemic break out in the village.

THE SCANDAL AT THE DARENTHIMBECILE ASYLUM.

THE General Purposes Committee of the MetropolitanAsylums Bard have had before them during the week thereport of a Special Committee deputed to inquire into thecircumstances attendant upon the death at the end ofNovember last of an inmate of the Darenth Imbecile Asylumnamed Martha Dickens.The following constituted the special committee: Mr.

R. M. Hensley (chairman), Sir Edwin Galsworthy, chairmanof the Metropolitan Asylums Board; Mr. J. Hardcastle,Mr. J. Hunt, Mr. J. R Hill, M.R C.S. Eng., L.R.C.P. Lond.,Mr. A. C. Scovell, and Dr. W. R. Smith. They examined Mr.A. T. O. White, the acting medical superintendent of theasylum ; Dr. W. L. Andriezen, the assistant medical super-intendent ; Mr. H. A. Good, in temporary medical employ-ment at the asylum ; Mr. Stamford Felce, the chairmanof the Darenth Committee ; Dr. A. H. N. Lewers, obstetric

pbybician to the London Hospital; and Mr. T. DuncombeMann, the secretary to the Metropolitan Asylums Board.The Special Committee did not take into consideration the

revolting circumstances of the pregnancy which led toMartha Dickens’s death, though it is well known to the

public that before her death she had charged a late attend-ant at the asylum with the paternity. Their report dealtonly with the circumstances relating to the unfortunatewoman’s confinement and subsequent death and ran as

follows :-

"1. Inasmuch as Dr. White, the acting medical superintendent, hashad no obstetrical experience since his student days, prior to 1882, wethink that he was very unwise in undertaking what was likely to provea difficult case. We do not find that he ever expressed unwill1ngnessor made any protest. He, however, states that in conversation withmembers ot the committee (whose names he cannot give) he suggestedin the interests of the institution that the woman should be sent awayfor her confinement.

"2. Although Dr. White became aware of the pregnancy onJuly 22nd we find no entry in the case book until after her death,Nov. 30th. Neitner bed-card ncr written instructions as to the conductof the case from day to day exist. In fact, there is a total absence.ofrecords

"3. We do not find any report of the pregnancy among the actingmedicat superintendent’s written reports to the committee.

"4. We do not find that any qualified or experienced nurse was pro-vided to attend the case or that any application was made to the com-mittee by Dr. White for the employment of such a person.

’’5. We find that no commumcatonwas made to the c,.,roner. Thoughnot legallv obligatory, this would, we think, have been prudent underthe sptcial circumstances.

"6. There was no post-mortem examination."

To this they add that-" Dr. White and his assistants appear to have spared no pains and

neglected no attention suggested by their experience for the welfare ofthe patient during her confinement, but we consider the above-mentioned errors ot judgment and omissions of duty so serious on thepa,rt of Dr. White that we feel bound to recommend the immediatetermination of his engagement." Although there id no report by the acting medical superintendent

on the subject of the pregnancy the Darenth Committee were aware ofthe facts, tor in their report of Dec. 13th, 1897, they state that theclerk to the board and the chairman of the committee made minuteinquiries into the facts and a special meeting of the committeethereon was held on Aug. 12th, 1897.

" 1’he Darenth Committee do not appear to have taken into con-sideration Dr. White’s want of experience in confinement cases and itdoes not appear to have occurred to them to provide a qualified orexperienced nurse notwithstanding that the occurrence of a birth in anasylum of this character is so unexpected and exceptional as to bequite unprovided for." The Darenth Committee in the same report give the substance of

the first portion of the reply of the Commissioners in Lunacy ofAug. 25th on this case, but emit any mention of the latter portion ofthe same letter animadverting on the administration of the asylum.

" We consider that in failing to apprehend the gravity of the situa-tion and in neglecting to make proper arrangements for the case bysecuring experienced medical and nursing attendance, and in omittingto report to this Board the full contents of the letter of the Commis-sioners in Lunacy, the Darenth Committee have failed to discharge asthey ought the dut’es entrusted to them."

The Special Committee conclude their report by approvingof the action of a sub-committee previously appointed inobtaining the expert assistance of Dr. Lewers, and by recom-mending that the Managers of the Metropolitan AsylumsBjard should call for the resignation of the acting medicalsuperintendent.The report will be fully debated by the Board next

Saturday, until after which debate it will be well thatjudgment should be suspended. But a circumstance whichhas come to our ears upon good authority should be put onrecord at once. Although Mr. White did not write out the

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facts of the case as a report, he mentioned them to the 1committee, so that he cannot be accused of any attempts at iconcealment. This does not sufficiently clearly appear inthe Special Committee’s report.

THE BATTLE OF THE CLUBS.1

THE BRITISH MEDICAL ASSOCIATION AND THE BECKENHAMAND PENGE MEDICAL SOCIETY.

THE Beckenham and Penge Medical Society have, at a fullmeeting, unanimously decided to send to the Council of theBritish Medical Association the following petition :-We, the members of the Beckenham and Penge Medical Society’

assembled in formal meeting, do humbly petition your honourableCouncil as follows : That having regard to the difficulties attendingthe working of the medical departments of Sick Benefit societies, whichhave recently become acute in many districts throughout the country,your.honourable Council do appoint a commission with authority tohear evidence and examine witnesses so that a definite plan may bearrived at whereby such societies can receive medical attendance,which, without pressing too hardly on the working class, shouldprovide an honourable position and a sufficient remuneration to themedical officer. Your petitioners feel that your Council has such far-reaching weight and influence that recommendations issued by themafter such careful inquiry would be accepted by the profession as asolution of the problem.

And your petitioners do ever-pray.F. STURGES, President,

Signed on behalf of the Society H. FRANGLEY, Vice-President,( PRIMROSE WELLS, Hon. Sec.THE INAUGURATION OF THE ESSEX SUBURBAN MUTUAL

MEDICAL PROTECTION SOCIETY.A largely attended meeting of medical practitioners was

held at the Congregational school-rooms, East Ham, onTuesday, Jan. 25th, to consider what steps should be taken toprevent abuse of medical charities in suburban Essex.Dr. F. J. Smith presided and the meeting was addressed byhim, Mr. A. W. Beaumont, medical officer of health of EastHam, Dr. Harry Campbell, Dr. Butler-Hogan, and others.The work of the Provisional Committee was endorsed and itwas unanimously resolved to form the Suburban EssexMutual Medical Protection Society and to call a meeting ofall registered medical men practising in suburban Essex atStratford on Tuesday, Feb. 8th, to draw up rules andcombine for the suppression of abuse of medical charities inthe district and the promotion of professional amity. Onlytwenty-four hours’ notice was given and fifty-five practi-tioners attended.

l’ -q

1 A reprint of the previous articles on the above subject has been pub-lished in book form entitled, "The Battle of the Clubs," and can beobtained from THE LANCET Office, price 1s.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN thirty-three of the largest English towns 6679 birthsand 4440 deaths were registered during the week endingJan. 22nd. The annual rate of mortality in these towns,which had declined in the three preceding weeks from 24’9to 20’6 per 1000, was again 20’6 last week. In London therate was 23-4 per 1000, while it averaged 18-8 in the thirty-two provincial towns. The lowest rates in these townswere 10 in Birkenhead, 13’5 in Cardiff, 14’8 in Swansea, and15’1 in Croydon; the highest rates were 21-1 in Birmingham,219 in Wolverhampton, 22 0 in Preston, and 22’8 in Liverpool.The 4440 deaths included 521 which were referred to theprincipal zymotic diseases, against 547 and 525 in thetwo preceding weeks ; of these, 228 resulted from measles,134 from whooping-cough, 55 from diphtheria, 42 from"fever" (principally enteric), 39 from scarlet fever, and23 from diarrhoea. The lowest death-rates from these diseaseswere recorded in Portsmouth, Norwich, Bolton, and Preston,and the highest rates in Salford, Halifax, Gateshead, andBlackburn. The greatest mortality from measles occurredin Brighton, Swansea, Oldham, Blackburn, Halifax, andSheffield ; from scarlet fever in Sunderland and in Wolver-hampton; from whooping-cough in Liverpool, Leeds, andGateshead; and from "fever" in Salford and Halifax.The 55 deaths from diphtheria included 33 in London,7 in Leeds, and 3 in Cardiff. No fatal case of small-

pox was registered during the week under notice,

either in London or in any other of the thirty.three large towns, and no small - pox patients were-under treatment in any of the Metropolitan AsylumHospitals. The number of scarlet fever patients inthese hospitals and in the London Fever Hospitalat the end of last week was 3149. against 3572. 3450,and 3253, on the three preceding Saturdays ; 248 new

cases were admitted during the week, against 273, 239’,and 215 in the three preceding weeks. The deaths re-

ferred to diseases of the respiratory organs in London,which had been 533 and 516 in the two preceding weeks,rose again last week to 567, but were 144 below the cor-rected average. The causes of 60, or 1-4 per cent., of thedeaths in the thirty - three towns were not certified eitherby a registered medical practitioner or by a coroner. Allthe causes of death were duly certified in Nottingham,Salford, Leeds, Newcastle-upon-Tyne, and in thirteen othersmaller towns the largest proportions of uncertified deathswere registered in West Ham, Birmingham, Liverpool, andSheffield.

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HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 24’3 and 20’4 per 1000 in the two precedingweeks, further declined to 19 0 during the week endingJan. 22nd, and was 1’6 per 1000 below the mean rate duringthe same period in the thirty-three large English towns.The rates in the eight Scotch towns ranged from 13.6 inLeith and 16 0 in Edinburgh to 23 8 in Perth and 27-0 inAberdeen. The 57Z deaths in these towns included 21from whooping-cough, 15 from diarrhoea, 11 from measles,9 from scarlet fever, 5 from diphtheria, and 3 from "fever."In all, 64 deaths resulted from these principal zymoticdiseases, against 76 and 57 in the two preceding weeks.These 64 deaths were equal to an annual rate of2.2 per 1000, which was slightly below the mean rate lastweek from the same diseases in the thirty-three largeEnglish towns. The fatal cases of whooping-cough, whichhad declined from 27 to 11 in the three preceding weeks,rose again to 21 last week, of which 12 occurred in Glasgow,4 in Greenock, and 3 in Dundee. The 11 deaths from measlesshowed a decline of 4 from the number in the precedingweek, and included 10 in Glasgow. The fatal cases of scarletfever, which had been 8, 14, and 7 in the three precedingweeks, rose again to 9 last week, of which 3 occurred inEdinburgh, 2 in Dundee, and 2 in Greenock. The deathsfrom diphtheria, which had been 9 and 2 in the two pre-ceding weeks, rose to 5 last week, and included 2 inGreenock. The 3 fatal cases of " fever ",were all recordedin Glasgow. The deaths referred to diseases of the respira-tory organs in these towns, which had been 177 and 15$in the two preceding weeks, further fell to 139 last week,and were 23 below the number in the correspondingperiod of last year. The causes of 30, or more than 5 percent., of the deaths in these eight towns last week werenot certified.

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HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 31’0 and 31vper 1000 in the two preceding weeks, further rose to 33.0during the week ending Jan. 22nd. During the past threeweeks of the current quarter the death-rate in the city hasaveraged 31’9 per 1000, the rate during the same periodbeing 23-1 in London and 20-2 in Edinburgh. The 221deaths registered in Dublin during the week under noticeshowed an increase of 8 upon the number in the precedingweek, and included 21 which were referred to the principalzymotic diseases, against 18 and 12 in the two precedingweeks ; of these,.8 resulted from " fever," 6 from diphtheria,3 from diarrhoea, 2 from scarlet fever, and 2 from whooping-cough. These 21 deaths were equal to an annualrate of 3’1 per 1000, the zymotic death-rate during thesame period being 3’1 in London and 1’1 in Edin-burgh. The deaths referred to different forms of " fever,"which had,been 6 and 2 in the two preceding weeks, roseagain to 8 last week. The 6 fatal cases of diphtheria showeda farther increase upon recent weekly numbers, and exceededthose recorded in any week for some years past. The deathsfrom scarlet fever, which had been 5 and 3 in the twopreceding weeks, further declined to 2 last week. The 221deaths in Dublin last week included 31 of infants underone year of age and 60 of persons aged upwards ofsixty years ; the deaths both of infants and of elderly