739THE VACANCY IN THE GENERAL MEDICAL COUNCIL.

10.06 per cent. of the daily average number resident. Theservices of an additional assistant medical officer are

obviously required.Hereford County and City Lunatic Asylum (1897).-Owing

to lack of accommodation it was found necessary to makea conditional closing order, restricting the number ofadmissions. Before having recourse to this stringent measure,inquiries were made as to the feasibility of boarding out anumber of imbeciles and harmless dements with relativesand others. Many of the friends, however, appeared dis-inclined to receive their insane relatives, and the accommo-dation offered by those who were willing was generallyfound to be unsuitable. 0 Ning to these and other causes theproject had to be abandoned. During the year 70 patientswere admitted, 40 recovered, and 23 died. Nearly one-sixthof the male admissions suffered from general para-lysis, a proportion much above the average. The generalhealth of the patients was good. Influenza, which has beenmore or less endemic since 1890, was the main cause of ill-health. In connexion with this disease Mr. C. S. Morrison re-cords a rather curious fact. He states that the influenza poisonhad the effect.in many instances of bringing the deluded andchronic maniac into a more introspective frame of mind, andfrom being wild and troublesome the patient subsided into amore orderly, if somewhat moody, individual. It would be

interesting to know whether the mental change so produced was permanent or only temporary in character, and furtherinformation on the point would be welcome. It is well fknown that all acute, bodily diseases have the effect of moreor less modifying the symptoms of mental derangement, butit is generally understood that in the majority of cases thesensory disorder resumes its sway as the physical symptomssubside.Newcastle-upon Tyne City Lunatic Asylum (1896).-The

average daily number resident during the year was 467. Theadmissions numbered 137, the recoveries 49, and the deaths54. Amongst the admissions there were 26 cases ofgeneral paralysis, 4 epileptics, 8 congenital imbeciles, and11 cases of senile insanity-all incurable cases. In 40instances the causation of insanity was attributed to moralfactors-viz., domestic trouble, adverse circumstances, andmental anxiety ; intemperance in drink caused mentaldisorder in 50 instances ; hereditary predisposition was

ascertained in 29 cases. The death-rate was high, but thisis hardly to be wondered at, considering that twenty patientsdied from general paralysis, and nine from phthisis. Thereport of the Commissioners in Lunacy indicates that Dr. ’,Calloott manages his asylum with care and ability. Theystate that they found all parts of the asylum in excellentorder, the day-rooms bright and cheerful, and facilities forthe amusement of the patients plentiful.Kirklands Asylum (1897).-The work of the asylum has

been carried on in a quiet and uneventful manner. Thehealth of the patients has been on the whole excellent.’There were 22 entries in the Register of Restraint andSeclusion referring to the restraint of 6 patients at varioustimes and for various reasons. Dr. Hkeen thinks that!restraint is sometimes beneficial, and bases his opinion onthe following grounds. It ensures rest and warmth at night;it obviates the necessity for the employment of sedativedrugs, which are often injurious and can only be used withextreme caution in those old and debilitated persons whoconstituted the class of patients to whom restraint at nightwas applied ; further, the judicious use of restraint alsorelieves the nursing staff, especially at night, of a vast dealof anxiety without in any way reducing the responsibility,and therefore without inducing a tendency to carelessnessand inattention towards the patients under their care. Inthese progressive days such opinions may appear somewhatheterodox, but there can be no doubt that there is somethingto be said in favour of Dr. Skeen’s views. The admissionswere 63; 30 patients recovered, and 18 died. The LunacyCommissioners (Scotland) comment favourably on the generalmanagement of the asylum.Barony Parookial Asylum, Lenzie (1896).-In a short report

Dr. Blair states that of 313 patients admitted, the causationof insanity in 70, or 22 3 per cent., was ascribed to organicchanges in the cerebro-spinal system, and of these nearly 11per cent. were general paralytics and 6 per cent. epileptics.Alcoholic excess was ascertained to be the cause in 17-6 percent., which is about 5 per cent. more than the records oflate years. The extension and improvements which havebeen effected within recent years make this asylum one ofthe best equipped institutions for the insane in Scotland.

THE VACANCY IN THE GENERALMEDICAL COUNCIL.

FOR the information of those who may intend to seek the

suffrages of the profession for the seat on the GeneralMedical Council as a Direct Representative, rendered vacantby the resignation of Dr. Rentoul, we would point out thatprocedure is regulated strictly by the Act of Parliament.The first step has already been taken by the President, whohas notified the vacancy, and the rest follow as a matter ofcourse. They are:-Notice of election to be published ......... Sept. 10th-Precept to be issued by returning officer ...... Sept. 25th.Final day for receipt of nomination papers ... Sept. 27th.Meeting of the English Branch Council to

receive precept ..................... Sept. 28th.Issue of voting papers.................. Oct. 2nd.Last day for return of voting papers......... Oct. 9th.Counting of votes ..................... Oct. llth.Meeting of Branch Council to certify result of

election ........................ Oct. 15th.Declaration of poll by the returning officer Oct. 15th or 16th.

We have received the following addresses from candi-dates :-

To THE REGISTERED MEDICAL PRACTITIONERS OF ENGLANDAND WALES.

GENTLEMEN,-By the resignation of Dr. Rentoul a seat in the MedicalCouncil has quickly became vacant, and is to be filled as the will of theelectorate may determine. I beg leave, therefore, to represent to youmy readiness to stand as a candidate for the honour of your suffrages,and to state that the principles I ventured to lay before you previous tothe last election are those which I would now submit as mme. Theyare detailed in THE LANCET of Oct. 31st last year on page 1253; and asbearing upon the whole of the paragraphs there written I would say thatthe Direct Representatives should act with the other members of theCouncil in full confidence that all ate engaged in seeking the welfare ofthe profession ; but at the same time he should realise tne special buei-ness which belongs to him as the representative of the general practi-tioner, and be ready to act according to the dictates of common sense,as the opportunities for his intervention may occur.The number of gentlemen who availed themselves at the last election

of their privilege as voters was unusually small; and this fact gaveopportunity to those who are not friendly to the representation of thegeneral practitioner upon the Medical Council to comment adverselyto our interests in this particular. It will be a pity if these commentsshould appear justified on the present occasion, for while the wholeprofession of medicine has greatly advanced as a science and an art, tothe benefit of the individual, so now it is surely moving, by the forceof its intrinsic national importance, towards that dignified position inthe State which farseeing men have in the past predicated for it; andwho are they that should show interest in this movement of ourcommon profession if the bulk of us who practise it do not ? The answershould be given in a good poll next month.The gentlemen who stood so well by me last November may see fit

again to support my candidature. To them, therefore, as well as tothose others who will do me the like honour, I would submit that any-thing approaching an active candidature otherwise than through themedical press is entirely beyond my power. Hence I would respect-fully ask them to acquit me of any discourtesy in not communicatingwith them directly, and to generously use their influence for securingvotes in favour of the principles I have enunciated. Because if eachvoter will in his goodness consider himself a centre for influencingothers, success is to that extent rendered, if not absolutely certain, atall events more likely.In conclusion, I beg to state that if I be elected your representative

the tone of my influence at the Council Board will be the tone of thisaddress. But if I be not elected, in whatever place my name mayappear. I shall be ready to believe that the choice of the electorate hadfallen upon a man whose sentiments are not less worthy than thosewhich I myself hold. In this assumed case, however, I should addthat his capacity and his willingness to serve your interests would pro-bably be in no way greater than my own.

I am, Gentlemen, your faithful servant,E. DIVER, M.D. St. And., M.R.C.S. Eng.

To THE REGISTERED MEDICAL PRACTITIONERS OF ENGLANDAND WALES.

Sept. 14th, 1897.LADIES AND GENTLEMEN,—I beg to offer myself as a candidate for

the present vacancy amongst the Direct Representatives on the GeneralMedical Council. I am encouraged to take this step by the fact thatat the election last November I polled 4082 votes, and was therefore atthe head of the unsuccessful candidates, and that I have now receivedthe assurance of the support of the Incorporated Medical PractitionersAssociation and of other medical bodies. It is my duty once morebriefly to state my views on the crucial questions of the day in theirrelations to the General Medical Council.

I venture to traverse the opinion which has been influentiallyexpressed that the Midwives Bill does not concern the Council. Tomy mind, the fact that the Government have sought the opinion of theCouncil on the matter proves that the question is one of vital import-ance to the medical profession, and therefore deserves the most carefulattention of its governing body. From this it follows that the opiniona

740 OUR FRONTIER TROUBLES IN, INDIA.

of the great body of the profession which is strongly opposed to mid-wives legislation shall be represented on the General Medical Council.

If elected I should also advocate :-1. Reform of the Medical Acts so that the Council should be, at any

rate, in a larger proportion than at present, elected by, and repre-sentative of, the profession generally.

2. The assimilation of the Acts governing the profession more nearlyto those which govern the legal profession. By this means more powerwould be given to the General Medical Council to protect the publicagainst quacks and unqualified practitioners.

3. The raising of the standard of entrance examination and theestablishment of one conjoint compulsory examination for each divisionof the United Kingdom.

’

.Finally, if you do me the honour to elect me as one of your DirectRepresentatives, I would devote my whole energies to fulfil the trustreposed in me. I have the honour to be, ladies and gentlemen,

Your obedient servant,GEO. JACKSON, F.R.C.S.Eng.,

Vice-President and Ex-President of the IncorporatedMedical Practitioners Association; Vice-Presidentand Ex-President of the Devon and CornwallBranch of the Incorporated Medical Practitioners. Association.

OUR FRONTIER TROUBLES IN INDIA.

THE Government of India has been subjected to muchadverse criticism for its want of promptitude in not

advancing up the Khyber and at once recovering the

positions captured by the Afridis. No doubt a decreaseof British prestige attended our loss of Lundi Kotaland Ali Musjid, although these were held by nativelevies only. But there are other points to be consideredbesides promptitude of action ; possible failure has to beguarded against, and means have to be taken to ensure thatthe force is strong enough and sufficiently provisioned tohold the posts when captured as long as required. Itis comparatively easy under the present system ofmilitary organisation and administration in India tomobilise and concentrate a force on any given pointof the Indian frontier, but for mountain waifareagainst the Afridis and other tribes a large amountof animal transport is needed, as well as an abundance offood and stores to maintain an army in the field until we canensure sufficient security for future peace before the forces are withdrawn. Moreover, the season has hitherto been bad as regards the health of the troops of any expeditionaryforce. Up to the middle of September the -heat in the i

valleys is very great, but a month later there is a greatchange in this respect: the valleys are much cooler and themountains are very cold, and the climate is much morefavourable for our operations. The strength of the forces Iunder the respective commands of General Blood and GeneralElles should make it pretty certain that the rising of theM9mands will soon be overcome, and the punitive expedi-tion to Tirah, the centre of the Afridi territory, will deal withand crush the power of the Afridis. We do not at all believethat a combined and simultaneous action among all the tribeson the north-west frontier can take place, but the extent andgeneral character of the rising on this occasion indicate thatthere must be some common cause in operation for the wide-spread feeling that undoubtedly exists. This is attributed atPeshawar to the strong resentment that is felt amongst thetribes against our occupation of the Swat Valley, which is-being interpreted as annexation by the mullahs. Be this asit may, the time has now come for the rising to be forciblyput down with as little delay as practicable. It alreadylooks as if there were a combination of the Oraksai andAfridi tribes-a combination which is new in border history.There has of late been a good deal of sharp fighting in variousdirections, and the hostite tribes have made several resoluteattacks on our forces. Anyone looking at a map of -thismountainous and nearly sterile country will easily appreciateits obstacles and difficulties as a scene for militaryoperations and can form some idea of the amount of animaltransport required for the conveyance of ammunition andwarlike stores and commissariat supplies. The supply ofwater for the troops during the hot season will also

prove a difficulty. The expense attending this frontierwarfare is very great, and in the present embarrassed stateof Indian finance tbis is greatly to be deplored. We areglad to learn that the wounded are doing well and that thehealth of the troops engaged is good, that the pluck andendurance of the native and European troops are admirable;;, and that the great mass -of the population in India is well

affected to British rule. That there will be a successfulending to the present state of- affairs may be regarded ascertain, but it is also certain that it will cost a great deal ofmoney and necessarily much loss of life to bring this about.The extent of the rising and the nature of the country

will probably require a large force divided into differentcolumns operating in different - directions, with, of course, acommon object in view, and it may possibly take a longertime-to achieve complete success than many people imagine. -The diseases to which the troops will be liable will be,.various forms of fever-mainly of a malarious type-anddysentery. Cases of enteric fever among the British troops.will also occur, but it is scarcely likely that this fever willprevail to any extent during the cold season. Among thenative troops and the native followers malarious fever,dysenteric-diarrhoea, and pulmonary diseases are almost,sure to prevail ; but as regards the latter much may be done ’ ,.to prevent their occurrence by an adequate supply ofclothing and blankets, the avoidance of overcrowding, andthe provision of plenty of, food. During the last Afghanwars there was an enormous amount of sickness andmortality among the camels and baggage animals. Mulesand ponies are hardier and much superior to camels astransport animals for expeditions of this kind.

Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF INSPECTORS OF THE MEDICAL DEPARTMENTOF THE LOCAL GOVERNMENT .BOARD..

On the Sanitary Condition of Swanage, by Dr. S. W.WHEATON.—Swanage is one of a by no means small numberof watering-places which profess to attract to themselvespersons who are seeking health as well as pleasure, but whichpersistently maintain conditions that are not only a con-stant risk to health but which actually amount to obviousnuisance. The inspection dealt with in the report nowbefore us is the third which the Local Government Board’ T

have found it necessary to make at Swanage within a com-jparatively brief period. In 1886 inspection became neces-sary by reason of a severe epidemic of - enteric fever ; in 189&Swanage was one of the suspicious places in England which’were especially selected for a visit when the country was °

exposed to the Eoropean "prevalence of cholera ; and now, again, in 1897 we have another visit and report by reason ofthe frequent complaints which are made as to the nuisances -’prevalent in the place and as to’the maladministration of the-urban district council. The main grievance arises in this’way. The town borrowed .E6000 in 1893 to provide sewersconverging to an outfall sewer discharging into the sea belowlow-water mark north of the southern headland boundingSwanage Bay. But, having performed one part of theirundertaking, the urban council seemed to think they haddone enough. - The consequence is that the new sewers havebeen turned into an old culvert ’discharging on the fore- ’shore, that the old sewers have not been removed, that manydwellings have not been connected with the new system, that’in places the old and new sewers run side by side; the old onereceiving sewage and the rew one none, and that, to quote ’Dr. Wheaton, the .E4500 spent have so far been of’very doubtful benefit " The bathing places, to whichvisitors of both sexes are attracted, are also stated to’lie " between two points of discharge for sewage." Butthese are not ’all the insanitary features of Swanage. Vault

privies still seem fairly general notwithstanding the moneyspent on sewers, and they are so constructed that there isalways more or less escape of their contents into the

surrounding soil. The cleansing of these structures and the’renewal of ashpits is left to occupiers, unless they apply tothe urban council, who then make a charge for the work.This we believe to be absolutely illegal. The Public Health’Act of 1875 only recognises two methods-one in which the’work is undertaken by, and at the cost of, the occupiers ;.*and the other in which it is undertaken by the sanitaryauthority at the cost of the ratepayers. But further, the’Swanage Urban Council will not even learn by experience. In- 1886 the outbreak of’ typhoid fever’ was due to.-milk, and they were urged -by the Local Government Board