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successful in obtaining an apology and withdrawal of a

charge of immoral conduct agamst a doctor. In the matterof a member against whom an action for libel had beenbrought it was resolved that the solicitors be requested todefend him. The action of the Emergency Committee inaccepting service on behalf of another member, againstwhom an action for libel was brought by a man who con-founded the significance of the word "infectious" with" venereal," was approved. Several other matters of minorinterest were dealt with.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 5909 birthsand 3362 deaths were registered during the week endingOct. 24th. The annual rate of mortality in these towns,which had been 18-4 and 18-2 per 1000 in the precedingtwo weeks, rose again last week to 18’6. The rate was17’7 in London and 19’4 in the twenty-seven provincialtowns. During the first three weeks of the current quarterthe death-rate in the twenty-eight towns averaged 18’4 per1000, and was 1’6 below the mean rate in the correspondingperiods of the ten years 1881-90. The lowest rates inthese towns last week were 13’5 in Hull, 14-2 inNottingham, 15’4 in Leicester, and 16’3 in Portsmouth ;the highest rates were 22-3 in Manchester, 23’2 inLiverpool, 23’4 in Sunderland, and 25’1 in Black-burn. The deaths referred to the principal zymoticdiseases, which had declined in the preceding four weeksfrom 600 to 445, further fell last week to 390; they in-cluded 136 from diarrhoea, 72 from whooping-cough, 66from "fever" (principally enteric), 47 from measles, 43from diphtheria, 26 from scarlet fever, and not one fromsmall-pox. The lowest death-rates from these diseaseswere recorded in Bristol, Bolton, Oldham, and Plymouth ;and the highest in Wolverhampton, Cardiff, Norwich, andSunderland. The greatest mortality from measles occurredin Wolverhampton, Norwich, and Sunderland; fromscarlet fever in Cardiff; from whooping-cough in Bradfordand Wolverhampton ; from "fever" in Leicester, Sunder-land, and Birkenhead ; and from diarrhcea in Birmingham,Manchester, Preston, Sunderland, and Blackburn. The43 fatal cases of diphtheria included 29 in London,2 in Norwich, and 2 in Newcastle-upon-Tyne. Nodeath from small-pox was registered in any of the twenty-eight towns, and no case of this disease was under treat-ment either in the Metropolitan Asylum Hospitals or inthe Highgate Small-pox Hospital. The number of scarletfever patients in the Metropolitan Asylum Hospitals andin the London Fever Hospital at the end of the weekwas 1352, against numbers increasing from 947 to 1289on the preceding seven Saturdays ; the patients admittedduring the week were 159, against 172 and 179 in the pre-vious two weeks. The deaths referred to diseases of therespiratory organs in London, which had increased in thepreceding three weeks from 171 to 237, further rose lastweek to 286, but were 70 below the corrected average.The causes of 52, or 1’5 per cent., of the deaths in thetwenty-eight towns were not certified either by a registeredmedical practitioner or by a coroner. All the causes ofdeath were duly certified in Portsmouth, Nottingham,Manchester, Newcastle-upon-Tyne, and in eight othersmaller towns; the largest proportions of uncertified deathswere recorded in Brighton, Leicester, and Sheffield.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 200 and 18-7 per 1000 in the preceding twoweeks, rose again to 19’8 during the week endingOct. 24th, but was 0’4 above the mean rate that prevailedduring the same period in the twenty-eight large Englishtowns. The rates in the eight Scotch towns ranged from17’1 in Leith and 17’2 in Greenock to 19’7 in Glasgow and26’5 in Paisley. The 490 deaths in these towns showed anincrease of 8 upon the number in the preceding week, andincluded 15 which were referred to diarrhoea, 9 to "fever,"8 to measles, 8 to whooping-cough, 7 to scarlet fever, 5 todiphtheria, and not one to small-pox. In all, 52 deathsresulted from these principal zymotic diseases, against75 and 61 in the preceding two weeks. These 52 deaths

were equal to an annual rate of 2-0 per 1000, whichwas slightly below the mean rate from the same

diseases in the twenty-eight English towns. The fatalcases of diarrhoea, which had declined in the precedingfour weeks from 47 to 32, further fell last week to 15, ofwhich 6 occurred in Glasgow and 5 in Dundee. Thedeaths referred to different forms of "fever," which hadbeen 14 and 11 in the previous two weeks, further declinedto 9 last week, all of which were recorded in Glasgow.The 8 fatal cases of measles exceeded by 3 the number inthe preceding week, and were all registered in Glasgow.The deaths from scarlet fever, which had been 6 and 10 inthe previous two weeks declined to 7 last week, of which3 occurred in Glasgow, where 4 of the 5 fatal cases of diph-theria were also recorded. The deaths referred to diseasesof the respiratory organs in these towns, which had increasedfrom 66 to 111 in the preceding three weeks, declined to98 last week and were 32 below the number in the corre-sponding week of last year. The causes of 40, or more than8 per cent., of the deaths in the eight towns last week werenot certified.

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HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 23’0 and 24-6per 1000 in the preceding two weeks, declined again to 23’0during the week ending Oct. 24th. During the pastthree weeks of the current quarter the death- rate in the cityaveraged 23.5 per 1000, the rate for the same period being17-1 in London and 16-0 in Edinburgh. The 153 deathsin Dublin during the week under notice showed a

decline of 11 from the number in the preceding week, andincluded 10 which were referred to diarrhoea, 5 to " fever,"4 to whooping-cough, 1 to diphtheria, and not one eitherto small-pox, measles, or scarlet fever. In all, 20 deathsresulted from these principal zymotic diseases, equalto an annual rate of 3’0 per 1000, the zymoticdeath-rate during the same period being 2’1 in Londonand 0-8 in Edinburgh. The fatal cases of diarrhoea,which had declined in the preceding four weeks from 20to 9, were 10 last week. The deaths referred to diffe-rent forms of "fever," which had been 5 and 9 in theprevious two weeks, declined again to 5 last week. The2 fatal cases of whooping-cough showed a decline of 2from the number in the preceding week The 153 deathsregistered in Dublin included 33 of infants under one yearof age, and 31 of persons aged upwards of sixty years; thedeaths both of infants and of elderly persons were belowthose recorded in the previous week. Two inquest casesand 3 deaths from violence were registered; and 39, or

. one-fourth, of the deaths occurred in public institutions.: The causes of 15, or nearly 10 per cent., of the deaths in

the city were not certified.

THE SERVICES.

INDIAN MEDICAL SERVICE. - The Queen has approvedof the following admissions to the Indian Medical Service :-To be Surgeons, ranking as Captains (dated July 28th,1891).-Bengal: Fredk. Hewlett Burton-Brown, BenjaminHobbs Daare, Benjamin Curwen Oldham, Robert Bird,M.D., Sidney Browning Smith, William Henvey, JohnStuart Shepherd Lumsden, George Hewitt Frost, EdmundWilkinson, George Francis William Ewens, M.D., CharlesDuer, and Henry Stotesbury Wood.-Madras: JamesEntrican, M.D., Walter George Pridmore, Chas. Donovan,M.D., Jeremiah Penny, Arthur Thomas Brown, DouglasHenry McDonnell Graves, Stuart Alexander Chas. Dallas"and Charles Henry Leet Palk.-Bombay: Thomas WalterIrvine.NAVAL MEDICAL SERVICE. - The following announce-

ment is substituted for that which appeared in the LondonGazette of Jan. 30tb, 1891 :-Staff Surgeon Herbert MackayEllis has been promoted to the rank of Fleet Surgeon inHer Majesty’s Fleet (dated Jan. 27th, 1891) -The followingappointments have been made at the Admiralty :-FleetSurgeon Robert Grant to the Stvijtsure (dated Oct. 22nd,1891). Staff Surgeon Edward Ferguson to the Assistance,for temporary service (dated Oct. 22nd, 1891).-Surgeons: o

, Patrick B. Handyside to the Victory (additional), Williami W. Jacobs to the Camperdown, Edward G. Swan to thet Wildfire, and Robert Hickson to the Pembroke (all dated

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Oct, 22nd, 1891); Alexander Maclean to the Orlando (datedNov. 1st, 1891); Alexander F. Harper to the Mosquito (datedNov. 9iih, 1891)1VOLUNTEER CORPS. - Royal Engineers (Fortress and

!Railway Forces).- 2nd West Riding of Yorkshire (Leeds):Acting Surgeon James William Henry Brown to be Surgeon(dated Oct. 24th, 1891).-Rifle : 3rd Volunteer Battalion,’the Royal Fusiiiers (City of London Regiment): WarwickChas. Steele, M.D., to Be Acting Surgeon (dated Oct. 24th,891).

Correspondence.

THE ELECTION OF DIRECT REPRE-SENTATIVES.

11 Audi alteram partem."

To the Editors of THE LANCET.SIRS,—I have none but the best wishes for the re-election

of the three direct representatives for England, but theridiculous assumptions contained in the circular they haveissued call for comment from someone who is in a positionto do so. The " almost continuous attention of the Educa-tion Committee" was in. no way inspired from that quarter,and needed none. As chairman of that committee I shouldknow. That committee has had much higher aims thanthe appearance of some revival of the old apprenticeshipsystem. The Council has, on the reports and recommenda-tions of that committee, secured a higher general education,and (in the first of the coming five-years’ course) a trainingin the methods of the sciences of physics, biology, andchemistry, the two steps most needed to raise the status ofthe profession and to fit its future members for the intelli-.gent practice of modern medicine. From neither of thethree members in question did the committee receive theslightest inspiration or suggestion in regard to these im-portant steps. Nor were the other members of the com-mittee a bit behind their direct representative colleagues intheir desire to recommend the fifth year to be given up topurely practical work. The Council can only recommendthat ; the first two it can compel.Then as to "the practice tooeloselyfollowedof filling Crown

appointments with distin guisbed members of the teaching and’8xamining bodies." The tbree Crown mem bersfor England areSir Richard Quain, Mr. Pridgin Teale, and Sir John Simon.The Council has shown its estimation of the services of thefirst by electing him their President. Than Mr. Teale, amore fair-minded man, more in sympathy with the practicalin medical education, and more respected by the profession,search all England, it would not be easy to find. ThanSir John Simon, there is no more valuable and reveredmember in the Council-a man who, as the world knows,has done more for that for which the medical professionexists than any living man in the whole United Kingdom.So much for the accuracy and modesty of the circular of ourthree "direct" friends. Our Crown members, in fact, arethe most independent members of the whole Council- Iindeed, the only really independent members; and that the"direct" members are the least so is a matter of Icommon observation. As to "the complete isolationof the direct representatives in the division on Sir WalterFoster’s motion for increasing their number," that musthave been written with a smile. It was quite understood to bewhat politicians call a "red herring," in the near prospectof an election. It is always pleasant to see Sir Walter’sbeaming countenance, even when he is telling the Councilthat it should be swept away. In that I would agree withhim so far that I would have it reduced to half the presentnumber, and all appointed by the Crown-

T am Sirs. vonrs faithfully,JOHN STRUTHERS.

The following letter, addressed to a friend by Dr. Wilks,is sent to us for publication with the sanction of Dr.Wilks :-Thanks for a copy of the circular. I am very well pleased

with it, as it confines itself to the main objects for which the-Council was established. I hope the old members will be suc-cessful in the election, and keep their seats at the Board. I

say this for two reasons-first, that the Council may stillhave the advantage of their experience ; and, secondly, lestwe might have the presence of some gentleman, the so-calledrepresentative of general practitioners, who would do hisbest to destroy the institution. Nothing has astonished memore than these discussions on direct representation, as itshows that most medical men have never taken the troubleto acquaint themselves with the Act of Parliament-to askthemselves what is the Medical Council, what is its raisond’être, and wbat are the objects it has in view in itsbiennial meetings ? I gather this from the remarkable dis.cussion that took place at Bournemouth in August, whenmen spoke of what the Council should do, In the firstplace, no one used the right designation, which is the" General Council of Medical Education and Registration."The Act and all its clauses pertain to the proper qualificationof men before they can be put on the Register, and this is tobe done for the protection of the public; there is not a wordsaid about professional interests. There may be some otherpowers attaching to the assembly, but, as far as I see, itsduties end in carrying out properly for the benefit of thepublic what its name impliesYou may remember the origin of the Act. After a futile

attempt to obtain the one portal system, the Governmentby their Medical Act conferred powers on all the existinguniversities, colleges, and corporations to give qualifica-tions ; but, seeing how varied and incomplete these were,the representatives of these bodies with other nominees wereto form a Council, whose object should be to make all thoseexaminations a uniform as possible, or at least see that noone should be qualified to practise unless he had -reached acertain standard of knowledge, and he might then be put onthe Register. The duties of the Council are mainly, if notwholly, to keep a strict watch over the medical man’s edu.cation and protect the Register. The Council of MedicalEducation and Registration was clearly created for thebenefit of the public and for the general good. Over andover again members of the Board have declared that theysat there in the interests of the public and for the good ofthe State. Not a word have they said about the interests ofthe profession (now charged against them), and have alwaysrepudiated the idea of their being mere delegates from theircolleges and;endeavouringto uphold the bodies they represent.It seems to me, therefore, a complete error to speak of themembers of Council as representing the interests of the pro-fession. It is only in the most indirect manner that they doso. There seems to me a very widespread delusion existing inthe profession in this matter, and which makes me believethat most medical men have never taken the trouble to readthe Act or the constitution and objects of the 11 GeneralCouncil of Medical Education and Registration." It wasspoken of at Bournemouth as if it was an assembly intendedto represent different sections of the profession, and thatthe general practitioners had not their fair proportion ofmembers. Some gentlemen actually-used the expression"medical parliament." Nothing can be more erroneous orfarther from the intentions of the Legislature. One gentle-man, writing of the Midwives Bill and his objection to it,alluded to the lowering of the fees of medical men if it cameinto action, and theretore the necessity of representatives ofthe general practitioners in the Council of Medical Educa-tion and Registration to see to this. If that gentleman hadbeen on the Board, and this subject of payment seriouslydiscussed, the President of the Privy Council would haveturned us out and locked the door, saying we were there inthe public interest, and not to look after our own pockets.

I cannot remember at the present time what the cry waswhich caused ’the addition of general practitioners to theBoard, but I do know the reason of the ready acceptance ofthe proposition by the Board. It would be clearly seen thatthe examining boards might send out men with their mindscrammed with knowledge and yet deficient in some im-portant practical acquirements. It would therefore be anadvantage to have on the Board men who can see ifthis be the case, and how these wants may be repaired.Dr. Glover told us that the art of midwifery was weak,and the subject was discussed during a whole sittingof the Council. Mr. Wheelhouse showed how a kind ofknowledge which could be gained only by living with ageneral practitioner was also wanted. His views weresupported in a modified form by the Council; but, seeingthat we have five representatives of general practitioners,as well as representatives of the two Apothecaries’ Halls, Ishould have thought we already possessed the means of