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ten beds which are all that we can provide in this house. Wehave learnt, too, after repeated efforts, that it is impossibleto rent a house for such a purpose ; and we have found thatthe one we now occupy is in many ways unsuited to our

work-it entails great and unnecessary physical exertion onour staff, some want of comfort to the patients, and it lacksthe complete sanitary arrangements which we need. Andthis is very important, especially as most of our patients are’dying either of consumption or cancer, and the question of’ventilation and sanitation becomes therefore imperative. Weare, therefore, forced to the conclusion that the only courseopen to us is to buy a house and adapt it to our purpose ; and’for the funds for this (.E5000 would cover all expenses) we aregoing to appeal to the public. It would be rash to expectbusiness men to give the money on our unsupported appeal,though we have a right to make it, for though we are in a:sense private the work is public. We make no private stipula-tions ; if the case is medically eligible we offer the next

’vacancy (it is all now that we have to offer) ; but if you, whohave known and watched our work from the beginning and:seen our books, would endorse the appeal, then there could besmall doubt that what is needed would be provided.

"I am. dear Mr. Brvant. vour obedient servant." CLARA MARIA HOLE,

"Mother Superior, St. James’s Servants of the Poor."The Hostel of God, 58, The Chase, Clapham, S.W."

QUALIFIED NURSES (?).To the Editors of THE LANCET.

S!:RS,—It has often struck me as a remarkable fact that,although London appears literally to swarm with "hospitalnurses " in picturesque and appropriate costumes, it stillfemains as difficult to obtain a really efficient nurse uponshort notice as it has ever been within my recollection. The

following instructive example of the great ease and rapiditywith which the modern "trained nurse" is manufacturedmay perhaps throw some light upon the curious discrepancyobserved between the quantity and the quality of theseladies. A uniformed and certificated nurse was recentlysent to me with the highest recommendation by a relative.of a lady who was under my care. The nurse expressedher readiness to take charge of my patient-a seriousand somewhat complicated medical case. Upon inquiryI ascertained that this "trained nurse " had never re-

ceived any systematic instruction in medical or surgicalnursing, that her entire professional training had been

accomplished in eight 7veeks at a certain lying-in hospital inLondon, and that at the expiration of the above period ofprobation she had obtained from the authorities of thishospital a "first class certificate" as a monthly nurse. In,-answer to an expression of surprise and alarm on my part thenurse assured me that her training had been exceptionallylong, since the majority of the pupils of this beneficentcharity obtained their certificates at the end of five weeks.

I am, Sirs, yours truly.JOHN CAHILL.

"DRASTIC TREATMENT OF EARLYGONORRHŒA."

To the Editors of THE LANCET.

SIRS,-In your obituary notice of the late Mr. Cotes it isstated that "he advocated in the pages of THE LANCET adrastic treatment of early gonorrhoea, supporting his views,which have since been fairly generally adopted, by a largenumber of successful cases. " Assuming this to mean thatthe treatment described in February, 1892, has been fairlygenerally adopted, " there must be by this time in existence:a large body of evidence concerning its value, and I ventureto suggest that if some of those who have had experience ofthe treatment would publish the results the latter would pro-bably be of interest to many readers of THE LANCET.

I am, Sirs, yours truly,ARTHUR COOPER.

ASEPSIS AND SUPPURATION.To the Editors of THE LANCET.

SiBS,—In the interests of the rising generation of medicalstudents I venture to make the following protest. Mr.Silcock in an address that he read before the Harveian

Society on May 5th, 1893, used these words :—" Occasionallyowing to the use of a septic ligature or some inadvertence inthe endeavour to maintain asepsis more or less suppurationmay and does occur, and that it should occur is not sur-

prising." Now, Sirs, it seems to me that this is not a state-ment that will encourage the rising medical students to paythat particular and detailed care to the points that train andinfluence a successful antiseptic or aseptic surgeon. Ofcourse, I do not presume to criticise the speaker’s methods,but I do want it to be generally recognised that to somesurgeons "more or less suppuration " is not only a surprise,but also a reproach, and is a result that stimulates them toexert every endeavour in their power to prevent a recurrenceof such a complication.-I am, Sirs, yours faithfully,

G. L. CHEATLE.

" DEATH CERTIFICATION."To the Editors of THE LANCET.

SiRS,—In the course of my examination before the SelectCommittee I was asked (with reference to a proposal that nilcases of uncertified deaths should be referred to the policesurgeon of the district) some questions as to the appointmentand position of police surgeons generally, and as regards thoseoutside the metropolitan area I was able to give only the verylimited amount of information which I had gathered fromcommunications received from various parts of the countrywhilst acting as honorary secretary of the MetropolitanPolice Surgeons’ Association ; nor do I know where thereis any further information available. Will you, therefore,permit me to ask through the columns of THE LANCETthose members of the profession who act in this capacityto be kind enough to write to me stating : (1) Thename of the force for which they act ; (2) by whomthey are appointed ; (3) the mode and average amount oftheir remuneration?-l am. Sirs. vonrs faithfullv.

H. NELSON HARDY.

"THE VACCINATION DEBATE."To the Editors of THE LANCET.

SIRS,-It is generally regarded as a work of supererogationto flog a dead horse, but if even the corpse of a one-timerefractory quadruped gives a post-mortem kick, and especiallyif such a ruling parsion strong in death has the sympathyof some portion of the community and the benevolent or cal-culating neutrality of the Government, an additional lash maybe justifiable. In your leading article on the vaccinationdebate you have administered such an additional castigationwhich it is to be hoped will produce in the dead horse of anti-vaccination the becoming quiescence of an orderly corpse.A cynical but profound philosopher-Thomas Carlyle-con-soled himself in the presence of outre popular upheavals, or,indeed, upheavals however initiated, with the reflection thatif a wall is built off the plumb it will fall and the teachingof experience will rectify the ravings of misconception. Onthis principle those capable of appreciating and weighingevidence might be vaccinated and allow others to take thechances of non-vaccination. In the case of those who hadattained to years of discretion and remained deaf to the

teaching, the unanswerable teaching, of experience, probablythe only argument (which, indeed, might fail to convincethem) would be an attack of confluent small-pox emphasisedduring a lifetime by the possession of a mutilated hide. But,in the interests of those incapable of defending themselvesor of judging for themselves-namely, children-it is scarcelyworthy of the Government of the country to run the risk ofallowing the sins of the obdurate parents to be visited upontheir innocent offspring. This, however, in the comparativelyisolated action of Sir Walter Foster, the Government may besaid to have practically done, and in view of the close balanceof the political parties of the hour their action may be

election ally prudent. The purchase, however, of a momentaryadvantage at the cost of a sacrifice of the teaching of expe-rience may be dearly earned. The weak in a civilised Statedemand the protection of the strong and cannot be betrayedby either party in view of the political exigencies of the hourand of the next general "counting of noses." Your out-spoken utterance, therefore-not that of the professionmerely, but of the inevitable conclusions of "commonsense"-deserves the thanks of the community.Debating a subject even with the ignorant may, however,

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have its uses, and there are two points upon which this re-newed agitation may have a beneficial eNect—namely,first, the desirability of the exclusive use of fresh calf

lymph after cleansing the skin of the arm with boiled waterand, of course, by means of a thoroughly clean lancet ;and, secondly, some special provision for the certification ofcases "insusceptible" to vaccination. The latter, of whichI have seen no instance, although I have successfullyvaccinated those so certified, should not be accepted asinsusceptible without the direct supervision of a responsibleGovernment inspector. Such a functionary would rarely betroubled; and, if he were at all frequently called upon, thecases might be safely regarded as requiring revaccination,which, properly effected, would probably be successful andanother suspected source of danger would thus be avoided.

I am, Sirs, yours faithfully,May 20th, 1893.

________________

M. D.

MANCHESTER.(FROM OUR OWN CORRESPONDENT.)

Jewish Workshops.THE ladies’ society for visiting the Jewish poor in Man-

chester has lately been extending its operations on linessimilar to those adopted with great success for some timepast by the ladies’ branch of the Manchester and SalfordSanitary Association. A female district visitor has for severalyears past been engaged in looking after the Jewish poor inRed Bank, a neighbourhood much affected by members ofthe Hebrew community, but at the recent annual meeting ofthe society, at which the Chief Rabbi was present, it wasannounced that another district visitor had just been

appointed for the neighbourhood of Strangeways, which iswell known as being also largely inhabited by Jewish tailorsand others of the same persuasion. Both the districtvisitors have the advantage of carrying on their labours underthe direct supervision of the city medical officer of health,who, in turn, receives no small assistance from the visitorswith respect to the whereabouts of cases of infectious diseaseand of insanitary conditions generally amongst the Jewishmembers of the community. A few weeks ago Miss Collett,one of the inspectors of the Labour Department, paid a visit toManchester for the purpose of inquiring into the condition ofthe Jewish workshops. She appears to have received valuableassistance from the district visitors in her inquiries amongstthese people and no doubt gleaned useful information forthe department, for the Jews are fairly numerous in Man-chester, and, on the whole, their business arrangementsare carried on under favourable conditions. Miss Collett’s

report, when published, will doubtless contain instructive read-ing for persons interested in the industrial circumstances ofour Jewish poor.

Boot7i’s 6%<M’H’t<M.At a meeting of the Salford town council last week the

subject of the administration of these excellent charitiescame up for discussion on a motion by one of the aldermenthat the benefits of the charities, hitherto confined to thetownship of Salford, should be extended to the other por-tions of the borough. If one may judge from the discussionwhich took place on Monday week in the council chamber,there appears to be something to be said on both sides of thequestion. Those who advocate the maintenance of thestatus quo contend that under present circumstances thealmoners of the charities are enabled to distribute amongstthe deserving poor really substantial relief, amounting to asmuch as 5s. or even 6s. per week for each family ; whereas ifthe area of distribution were increased so as to include thewhole county borough the amount available for each familywould be so much reduced that it would amount to littlemore than parish relief-a state of affairs which is just whatthe donors of the fund are believed to have wished to provideagainst. On the other hand, there are those in the councilwho argue that, as the charity deeds contain no limitations asto the area of distribution beyond the condition that all recip-ients of the charity shall be resident in Salford, it is only fairthat the fund should be available for the deserving poor of thewhole borough as enlarged by the addition of outside districtssince the death of the beneficent founder of the charities.No harm can be done by the freest and fullest ventilation ofthis subject. The sum available for distribution, which onthe death of the donor amounted to not more than ;flOOO perannum, has now increased fourteenfold in consequence of I

the enormous advance in the value of the land from whichthe income is derived. This sum of 14,000 per annum atpresent provides a comfortable means of subsistence for morethan 800 poor folk ; but as it appears likely that theassistance of the Charity Commissioners will be called in

by one or the other party to the present dispute there is afair guarantee that the present arrangements will not be dis-turbed without sufficient reason.

Loconaotines and Smo7ee Nuisance.

On the 15th inst. at Altrincham the Manchester, Sheffielaand Lincolnshire Railway Company were summoned by a,gentleman resident at Baguley for committing a nuisance byemission of dense smoke from their locomotives. There werefour informations, but only one was gone into, which thebench held to be proved and fined the defendant company f5 6and costs. In the remaining cases the prosecutor withdrewthe informations, his object being, through the intervention oithe bench, to induce the company to suppress the nuisance.

,

The Small-pox Epidemic.There is, as yet, no sign of any cessation of the small-poa

prevalence either in the city or in the neighbouring districtsof Lancashire, Yorkshire and Derbyshire. Accounts fromthe whole north-western area show that the disease still holdsits own and in some districts even increases in amount astime goes on. Thus from Bradford, Leeds, Halifax andWakefield reports have arrived here of the occurrence of manyfresh cases during the past week ; and, coming nearer home,the boroughs of Oldham and Chadderton still continue to actas centres for the distribution of infection to the outlying dis-tricts and, of course, to those parts of this city which aregeographically continuous with those areas. In Manchesteritself the weekly number of fresh cases is about thesame as it has been for some weeks past-namely, fromtwenty to thirty cases. The type of the disease stillcontinues to be very severe. During the last fortnight, accord-ing to the official returns, two hasmorrhagic and several con-fluent cases have proved fatal, and it is certain that a farheavier mortality would have resulted but for the admirablecare of the sick which is taken both by the medical and thenursing staff at Monsall Hospital. Most of the fatal casesare reported to have been either totally unprotected by vacci-nation or so imperfectly protected as practically to come underthe designation I un vaccinated.’’ There are now largernumbers of small-pox cases both at Monsall and at ClaytonVale than there have been for some weeks past.May 23rd, 1893.

NORTHERN COUNTIES NOTES.

(FROM OUR OWN CORRESPONDENT.)

17ie ITItite Lead Industry.A DEPARTMENTAL COMMITTEE appointed by the Home

Secretary to inquire into the action of white lead and leadsubstances upon those engaged in its manufacture has beensitting in Newcastle for some days, and the Governmentofficials have since proceeded to Glasgow to pursue a similarinquiry there. Drs. Oliver and Baumgartner were the prin-cipal medical men who gave evidence at Newcastle. Thelatter spoke as to fatal cases coming under his observation.Women workers who had been employed in the white leadindustry for years attributed the illness which affected theworkers to a want of cleanliness and care on their part.The fore part of each day was occupied by the committee invisiting the various white lead works in the district and seeingfor themselves the process of manufacture as well as the

precautions taken to maintain the health of the workers.estmerland and Cumberland.

Last Sunday was the day appointed for the usual hospitalcollection, and as it was particularly fine the church andchapel collections for the most part show a marked increaseIt is feared, however, that there may be a falling off in theSaturday collections owing to the depression of trade. An

epidemic of scarlet fever is reported from Kendal, mostlyamongst school children, and in consequence the BritishSchool in Castle-street has been closed. The school is a largeone and very numerously attended and a large number ofscarlet fever cases have been taken to the sanatorium.Scarlet fever is said to be rife at Brampton and there havebeen some fatal cases also of measles, about sixty cases

altogether having been under treatment. The Board Schools