1402

the exception of one-half of Roystone, the whole districthas been provided with pipe sewers since 1873, agd thebenefits consequent on this action concern a population of24,670 people. The death-rate for 1890 is estimated at20 4 per 1000.

________

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 6391 birthsand 4293 deaths were registered during the week endingJune 13bh. The annual rate of mortality in these towns,which had been 30.9 and 28-3 per 1000 in the precedingtwo weeks, further declined to 23-8 last week. The ratewas 23’3 in London and 24-2 in the twenty-seven pro-vincial towns. During the first ten weeks of the current.quarter the death-rate in the twenty-eight towns averaged27’9 per 1000, and considerably exceeded the mean ratein the corresponding periods of the ten years 1881-90.The lowest rates in these towns last week were 14in Brighton, 16 in Plymouth, 17-1 in Derby, and 17-5 inBradford ; the highest rates were 30-9 in Preston, 31-4in Liverpool, 32 in Halifax, and 37-6 in Blackburn.The deaths referred to the principal zymotic diseases, whichhad been 357 and 359 in the preceding two weeks, declinedagain last week to 313; they included 118 from whooping-cough, 77 from measles, 35 from diarrhoea, 34 from diphtheria,26 from " fever " (principally enteric), 22 from scarlet fever,and 1 from small-pox. No deaths from these diseases wererecorded in Bolton or Huddersfield ; in the other towns thezymotic rates ranged upwards from 0-5 in Brighton and inNorwich to 2’5 in Preston, 2-6 in Liverpool and in Leicester,and 2’9 in Portsmouth. The greatest mortality from measlesoccurred in Hull and Portsmouth ; from scarlet fever in Hali-fax ; and from whooping-cougb in Manchester, Birmingham,’Salford Leicester, and Cardiff. The mortality from "fever"showed no marked excess in any of the twenty-eight largetowns. The 34 fatal cases of diphtheria included 21 inLondon, 3 in Manchester, 2 in Salford, 2 in Oldham, and 2 inBristol. One death from small-pox occurred in London,but not one in any of the twenty-seven provincial towns;7 small-pox patients were under treatment in the Metro-politan Asylum Hospitals, and not one in the HighgateSmall-pox Hospital, on Saturday last. The number ofscarlet-fever patients in the Metropolitan Asylum Hospitalsand in the London Fever Hospital at the end of the weekwas 859, against numbers declining from 927 to 885 at the endof the precedingthreeweeks; the patients admitted duringtheweek were 61, against 88 and 66 in the previous two weeks.The deaths referred to diseases of the respiratory organs inLondon, which had declined in the preceding four weeksfrom 620 to 547, further fell last week to 453, but werenearly double the corrected weekly average. The

causes of 79, or 1’8 per cent., of the deaths in the twenty-eight towns were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death wereduly certified in Brighton, Portsmouth, Wolverhampton,Oldham, and in four other smaller towns; the largest pro-portions of uncertified deaths were recorded in Bristol,Sheffield, Liverpool, and Hull.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 23-3 and 25-3 per 1000 in the preceding twoweeks, declined again to 24-2 during the week endingJune 13th, but was 0’4 above the mean rate that pre-vailed during the same period in the twenty-eight largeEnglish towns. The rates in the eight Scotch towns rangedfrom 11-8 in Perth and 19-7 in Dundee to 25-3 in Glasgowand 37’4 in Paisley. The 623 deaths in these townsshowed a decline of 28 from the number in the precedingweek, and included 26 which were referred to measles,22 to whooping-cough, 14 to diarrhoea, 10 to scarlet fever,5 to "fever," 2 to diphtheria, and not one to small-pox.In all, 79 deaths resulted from these principal zymoticdiseases, against 67 and 74 in the preceding two weeks.These 79 deaths were equal to an annual rate of 3’1 per1000, which exceeded by 1-4 the mean rate from thesame diseases in the twenty-eight English towns. Thefatal cases of measles, which had been 23 and 27 in the pre-ceding two weeks, were last week 26, of which 16 occurredin Glasgow and 7 in Paisley. The 22 deaths referred to

whooping cough were within 3 of the number in the previousweek, and included G in Edinburgh, 5 in Glasgow, and 5 inDundee. The 14 deaths from diarrhoea showed a furtherincrease upon the numbers in recent weeks. The fatal casesof scarlet fever, which had declined from 7 to 3 in the pre-ceding three weeks, rose again last week to 10, all of whichwere recorded in Glasgow. The 5 deaths referred to differentforms of "fever" exceeded by 2 the number in the previousweek, and included 2 in Glasgow. The deaths referred todiseases of the respiratory organs in these towns, which hadbeen 173 and 142 in the preceding two weeks, further de-clined last week to 139, but exceeded by 41 the number inthe corresponding week of last year. The causes of 53, ornearly 9 per cent., of the deaths in the eight towns last weekwere not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 18’8 and 21’1per 1000 in the preceding two weeks, further rose to 27during the week ending June 13th. During the first tenweeks of the current quarter the death-rate in the cityaveraged 24’4 per 1000, the rate for the same period being25 in London and 21-3 in Edinburgh. The 183 deaths inDublin during the week under notice showed an increase of47 upon the number in the preceding week, and included4 which were referred to diarrhoea, 3 to whooping-cough, 2to "fever," and not one either to small-pox, measles, scarletfever, or diphtheria ; in all, 9 deaths resulted from these prin-cipal zymotic diseases, against 1 and 3 in the preceding twoweeks. These 9 deaths were equal to an annual rate of 1’3 per1000, the rate from the same diseases being 1 ’7 in London and2 in Edinburgh. The 4 fatal cases of diarrhoea exceededthe number recorded in any week since February last. The3 deaths from whooping-cough and the 2 fatal cases of"fever" exceeded the numbers returned in recent weeks.The 183 deaths in Dublin last week included 35 of infantsunder one year of age and 45 of persons aged upwards ofsixty years; the deaths both of infants and of elderlypersons showed a marked increase upon those recorded inthe preceding week. Eight inquest cases and 5 deathsfrom violence were registered during the week, and 56, ornearly a tbird, of the deaths occurred in public institutions.The causes of 21, or more than 11 per cent., of the deathslast week in the city were not certified.

THE SERVICES

INDIAN MEDICAL SERVICE.-Bengal: Surgeons to beSurgeons-Major (dated March 31st, 1891) :-Francis FredericPerry, Pultoney William Dalzell, Stephen Little, M.D.,George Hart Desmond Gimlette, M.D., Christian BernardHunter, and Julian Carter Carington Smith.—Madras:Brigade Surgeon Charles Edwin McVittie to be DeputySurgeon-General (dated March 7th, 1891); Surgeon-MajorHenry James Hazlett to be Brigade Surgeon (datedMarch 7th, 1891). The Queen has approved of the restora.tion of the undermentioned Officers from the Half-pay Listto the Effective List :-Surgeon Edward Donald Da Costa(dated April 6th, 1891); Brigade Surgeon William SmythFox (dated April 18th, 1891); Surgeon-Major MarkRobinson (dated June llth, 1891).-Bombay.- Brigade Sur-geon Abraham Nickson Hojel (dated April 30th, 1891).NAVAL MEDICAL SERVICE.-In accordance with the

provisions of Her Majesty’s Order in Council of April 1st,1881, Inspector-General of Hospitals and Fleets JamesNicholas Dick, C.B., has been placed on the Retired Listof his rank.-The following appointments have been madeat the Admiralty : - Fleet Surgeon Anthony Gorham,M.D., to the Rodney (dated June 15th, 1891); Staff Sur-geon Herbert E. Marsh to the Impregnable (dated June 15th,1891). Surgeons: Herbert Canton to the Gannet (datedJune 15th, 1891), and J. Dowson to the Portsmouth DivisionRoyal Marine Light Infantry (dated June 25th, 1891).VOLUNTEER CORPS.—Artillery: 1st Cornwall (Duke of

Cornwall’s) Western Division, Royal Artillery: JohnAlfred Fox, Gent., to be Acting Surgeon (dated June 13th,1891).-3rd Volunteer Battalion, the Welsh Regiment:Surgeon and Surgeon-Major (ranking as Major) J. L. W.Ward resigns his commission; also is permitted to retain hisrank, and to continue to wear the uniform of the Battalionon his retirement (dated June 13th, 1891).-2nd Volunteer

1403

Battalion, the Essex Regiment: Honorary Assistant Sur-geon W. G. Gimson, M,D., resigns his commission; also ispermitted to retain his rank, and to continue to wear theuniform of the Battalion on his retirement (dated June 13th,1891).-17th (North) Middlesex: Horace Sanders, Gent., tobe Acting Surgeon (dated June 13th, 1891).VOLUNTEER MEDICAL STAFF CORPS.—The Glasgow

Division: Captain George Thomas Beatson, M.D., fromthe 1st Lanarkshire Artillery Volunteers, to be ActingSurgeon (dated June 13th, 1891) -Infantry : South WalesBrigade: Brigade Surgeon John W. Mulligan, from theSevern Infantry Volunteer Brigade, to be Brigade Surgeon,ranking as Lieutenant-Colonel (dated June 13th, 1891).

Correspondence.

THE ELECTION AT THE ROYAL COLLEGEOF SURGEONS OF ENGLAND.

" Audi alteram partem."

To the Editors of THE LANCET.

SIRS,—With your permission I should like to say a fewwords in regard to my candidature for a seat in the Councilof the Royal College of Surgeons of England. If I hadfollowed my own feelings and judgment, I should haveabstained from coming forward this year, when only oneabsolute vacancy has occurred, and should have beenmore than content to leave Mr. Lawson Tait, who polledmore votes than I did last year, to be the representative ofthe Fellows who desire to see their constitutional statusraised to a level with that of the Fellows of other professionalcolleges. As, however, it was the wish of those with whomI have been working for the attainment of this end that Ishould stand again, I consented to do so, and I cannot butthink that the moderate proposals embodied in the tem-perate circular just issued will commend themselves to allFellows who thmk and act independently in regard to whatare called College politics, and who have the welfare of theCollege at heart.

It may be as well to explain that my active connexionwith the Association of Fellows did not commence till June,1889, when I accepted office as a member of the committee,because I felt that it was only by combined action thatdesired improvements could be effected. For the policy ofthe Association prior to that date I am not responsible, butwith all that has been done by the committee during thelast two years I have been closely identified, workingsteadily with my colleagues to secure for the Fellows thoseprivileges the concession of which would, in our opinion,materially conduce to the good of the institution and of theprofession at large. I took part in that deputation of theCommittee of the Association to the Council last year,which commended itself to Sir Spencer Wells, and joinedin urging upon the Committee of Council the expediencyof occasional consultation of Fellows of the College sepa-rately from the Members, granting to the Fellows a commonroom, modification of restrictive regulations in regard to theuse of voting papers at the election of councillors, and sub-mission of the proposed scheme of conjoint examination forthe medical degrees of the University of London to theFellows before its final ratification by the Council. Thisaction of the Association was not without success, for anauthoritative legal opinion has been obtained favourable toseparate meetings of Fellows ; a common room will doubt-less be set apart for the Fellows in due time, for some of themembers of Council expressed themselves as favourable tothe proposal ; our suggestions in regard to voting paperswere only lost in the Council by the bare majority of one ;and everyone admits that if the Fellows are to be consultedat all, it is the best course to consult them before instead ofafter the final ratification of any new proposal. If theFellows of the College agree with me in thinking that itwould be for the good of the College that they should be amore homogeneous, united, and influential body than theyare at present, and think that if elected to the Council Icould help to advance this object, I should esteem it ahonour to have the opportunity of serving them to the bestof my power. I am, Sirs, yours &c.,

Finsbury-square, E.C. WALTER RIVINGTON.WALTER RIVINGTON.

PROPOSED INCREASE IN THE NUMBER OFDIRECT REPRESENTATIVES ON THE

MEDICAL COUNCIL.To the Editors of THE LANCET.

SIRS,—May I, through your columns, ask medical prac-titioners heartily to take up the petition, which I forwardto you for publication, to the Privy Council, asking for anincrease in the number of direct representatives of themedical practitioners in the United Kingdom from five to.

eight ? We have in accordance with the Act of Parliament

petitioned the General Medical Council last year to move;in securing the above increase. But the Council has notmoved. Our next step is to petition the Privy Council. Ifa sufficient number of petitions are sent in, there is little-doubt but that our prayer will be granted. If we do not.send sufficient in, then the cry will be raised that the pro-fession is careless, and does not want any increase. It will beremembered that although the Medical Act (1858) providedfor the formation of the Medical Council, yet no direct repre-sentation was granted until the Medical Act of 1886 waspassed. Dr. Waters, Mr. Wheelhouse, Dr. Leech, and Dr.Wade were the chief workers in securing for us such repre-sentation. Further, it is evident that the draftsmen of theAct of 1886 clearly saw a time would come when the growthof the profession would be such as to require an increase ofdirect representatives. That time has come. It seems verystrange that although the income of the Medical Council ischiefly obtained from the registration fees of medical prac-titioners, the said practitioners have up till 1886 beengiven no voice whatever on the Council. It seems evenstranger that, although twenty universities and medicalcorporations are represented on the Council, not one pennyis given to the Medical Council by these bodies. This is stillmore palpable when it is further stated that we practitionersactually pay each university and corporation representativeabout £170 a year. The case stands thus: The universityrepresentatives are paid by us, but their universities do notcontribute to the income. The medical practitioners payfor all, and are only allowed five representatives. Further,it certainly seems strange that although the Privy Councilis given the power to elect, and does elect, five repre-sentatives on the Council, not one farthing is contributedby the Privy Council to the income of the Medical CounciLHere, again, medical practitioners are given the pleasureof paying for those who do not represent them. In politicallife it is a maxim that if the Government is represented ona body, and is given part control over the actions of thatbody, then the Government must contribute. This is seenin educational, poor-law, and sanitary legislation. Whynot in ours ? The Government has as great a right to makean annual grant for the part defraying of the expenses ofthe Medical Council as it has to make a grant to theCouncil of Education. The Medical Council is a body actingpurely and simply in the interest of the public. It doesnot, certainly, act in the personal interests of the profes-sion. Further than making a grant in aid, many of us holdthat the Privy Council would do good service if it from timeto time elected as one of its five representatives on the MedicalCouncil two members who represented truly the great massof the profession. All along the Privy Council has in realitynominated those who represent the universities and colleges.Those who read the reports of the proceedings of the MedicalCouncil must notice the genuine work performed by ourdirect representatives, more especially that of the English.If we had three additional representatives, I believe ourMedical Council would become a truly national institution,and cease to be a representative of diploma-granting bodies.

I would urge that the different Medical and Medico-Ethical Societies pass a resolution in favour of granting anincrease in the number of direct representatives, and forwardsuch resolutions to the Privy Council. If, further, a depu-tation to the Lord President took place, it would greatlytend to ensure success. It has been said that the twentyrepresentatives of the universities and corporations repre-sent the graduates of these bodies ; but I find from repliesthat the councils of the universities and corporations, andnot the mass of the graduates, elect the above twenty.

I am, Sirs, yours faithfully,Liverpool, June, 1891. ROBERT REID RENTOUL.

To the Right Honourable Viscount Cranbrook, Lord President, and theRight Honourable the Members of Her Majesty’s Privy Council.

The petition of the undersigned registered medical practitioners ofand its vicinitv. humblv sheweth-

1. That the Medical Act, 1886, Section 8, provides for the election of

ROBERT REID RENTOUL.