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1411 PUBLIC HEALTH AND POOR LAW.-VITAL STATISTICS. He said he hoped that this motion would meet with more sympathy from the Council as it was not m any way in opposition to the Council. The matter was of the greatest importance; the harm done to medical practitioners by medical aid associations was incalculable, and this in con- junction with the overcrowded state of the profession was rendering the condition of the general practitioner unbear- able. Then there was the very important consultation question. He did not on the whole object to the decision of the Council refusing to prohibit consultations with the prac- titioners serving under the medical aid associations, because the matter had to be looked at from the point of view of the public as well as from the point of view of the profession, but he considered that consultants would be less willing to give their services than they are if the College would speak definitely on the subject. The decisions contained on page 13 of the report were not what was wanted. In 1893 the Royal College of Physicians of Ireland expressed its disapproval of its Licentiates accepting appointments to medical aid associations. A case had occurred recently in which the medical man, a Licentiate of the Royal College of Surgeons in Ireland, attached to a medical aid association had resigned on receiving from his College a letter pointing out the impro- priety of his holding such a post. In 1888 the Royal College of Physicians of London had declared it to be undesirable that any Fellow or Member of that College should hold a post in an association for treating patients for profit ; but it would have been of more value if this resolution had applied also to their Licentiates. Mr. BRINDLEY JAMES seconded the resolution and said that the lot of the general practitioner was very hard ; his patients were taken from him by the medical aid associa- tions, by the hospitals, and by the consultants. Dr. BEVERLEY (of Norwich) said he was deputed by his professional brethren to thank the council for the action they had taken as mentioned on page 13 of the report, but also to express the great dissatisfaction they felt at the reply, for if the By-laws did not permit the Council to abate such evils as those described, then the By-laws must be altered. Dr. ALDERSON considered the resolution of great import- ance to general practitioners ; even such clubs as the Foresters did a great deal of harm. Mr. MOXON (of Yarmouth) said the Council had expressed its sympathy with those who were injured by these trading associations; but they wanted more than sympathy, they wanted a clear pronouncement that the Council disapproved of this " sweating " of medical men. Mr. GEORGE BROWN considered that it was clearly a matter of discipline ; in the case already referred tc, when a graduate of the College of Surgeons of Ireland had resigned on receiving the opinion of the College on his conduct, the medical aid association had been stopped. Why should not the College of Surgeons of England do what had been done by the College of Surgeons of Ireland ? Mr. ALFRED WILLETT asked that specific instances of the action of its members should be brought to the notice of the Council of the College. From beginning to end the Council had never had brought to its notice the conduct of any individual; the complaints had always been’ in general terms. Surgeon-Major INCE said canvassing for patients was legal and could not be stopped. The PRESIDENT before putting the resolution to the meet- ing said that the Council was very anxious to do its utmost in the matter, but it was useless merely to express a pious opinion; if a particular instance of canvassing for patients were brought to its notice with satisfactory evidence the Council would consider the case carefully. The motion was carried and with a vote of thanks to Sir William Mac Cormac for presiding the meeting dissolved. WATER-SUPPLY OF SALISBURY.-The Salisbury sanitary authority have recently submitted samples of the water-supply of that city for analysis. The analyst reports the supply of the city proper to be good and that of the Close fair; but he condemns the Wyndham-park district supply on the ground that it is contaminated with sewage. This is supposed to be owing to defective water-closet fittings, and consequently on Nov. 19th the sanitary authority cut off the water-supply at all houses where the existence of bad fittiugs made possible a communication between the soil pipes and the water service. Until these defects are remedied the inhabitants of these houses will be supplied from stand-pipes in the streets of the district. I Public Health and Poor Law. LOCAL GOVERNMENT DEPARTMENT. ’ REPORTS OF MEDICAL OFFICERS OF HEALTH. ’ .Derbyshire County District-The registration county of Derbyshire is not the administrative county presided over by the county council, and hence the valuable statistics of the former are not applicable to the latter. Dr. Sidney Barwise- trusts that the necessary modifications will soon be effected, and that when the time for the 1901 census arrives there will be but one Derbyshire. There seems in the case of thisr county to be no serious difficulty in the way. Out of the population of the county no less than 95 per cent. are under the protection of the Notification Diseases Act, and Dr. Barwise thinks that the remaining 5 per cent. will remain obdurate until the Act is made compulsory. Among what may be the recalcitrant authorities we note with astonish- ment that of Matlock. The subject of infantile mortality is being attacked in a very practical manner by the people of Chesterfield, who have engaged a trained nurse to visit all houses in which births have recently occurred and there to offer advice as to the feeding and general management of infants. The nurse obtains each week. from the registrar a copy of the births registered. In advocating greater stringency with regard to dairies, cow- sheds, and milkshops Dr. barwise reters to the excellent example set by the Corporation of Manchester, who,. in advertising for tenders for milk, state that preference will be given to those who undertake that the milk shall be derived from cows which have been examined and tested by the tuberculin test by officers- appointed by the corporation. This is certainly a decided step in the right direction. But little reference is made in the district reports as to the Factories and Work- shops Act of 1895, and Dr. Barwise thinks that the Act will not be thoroughly enforced until local medical officers of health have proper security of tenure. The prevention of rivers" pollution in Derbyshire is making steady progress ; but in several instances there is difficulty in arriving at the best means of sewage treatment. In connexion with this subject of the purification of sewage Dr. Barwise has prepared a special report which should be of much use to members of local bodies who are endeavouring to make themselves familiar with the questions upon which they are in large part called upon to decide. Oldham Sanitary District.-During 1896 Oldham added a. small-pox hospital to its equipment, and we may reasonably hope that no more will be heard of the baneful infiuence of the Westhulme Hospital when cases of small-pox were treated in it. Doubtless Dr. Niven, of Manchester, will read with satisfaction of this improvement in the district over which he formerly presided. Typhus fever is not yet extinct, in Oldham, and last year there was a localised outbreak of this disease. There were seven cases and two deaths, one of the deaths, we are sorry to see, being that of a nurse who had attended upon the sick. Mr. Tattersall is far from being. satisfied with the manner in which the notification of puerperal fever is carried out, and he states that in his own district no cases are reported unless death occurs or is thought to be likely to occur. Smoke abatement in Oldham has made some progress recently, and Mr. Tattersall tells us that there are fewer offenders now that the limit for black smoke is four minutes per half-hour than there were when this limit was nine minutes per hour. He thinks that if the limit was- still further diminished the manufacturers would be capable of meeting it. VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN thirty-three of the largest English towns 6744 births and 3927 deaths were registered during the week ending Nov. 20th. The annual rate of mortality in these towns, which had increased in the four preceding weeks from 16’9 to 19 0 per 1000, declined again last week to 18-6. In London the rate was 18 9 per 1000, while it averaged 18’4 in the thirty-two provincial towns. The lowest death- rates in these towns were 11’3 in Bradford, 13’4 in Ports- mouth, 13’8 in Croydon, and 13’9 in Plymouth ; the highest
