consequence is that the managers of the Asylums Board "are paralysed as far as prospective action is concerned." What the metropolis is now most concerned about is present, not prospective, action. It may also be observed that Dr. Brewer does not explain what the Board are doing to secure "the effectual vaccination of those liable still to the worst forms of the disease"; nor is it at all clear what is meant by that phrase.

At the last meeting of the Guild of St. Luke a paper was read on Medical Missions by the Provost, who asserted that the medical element is a necessary adjunct in any properly organised missionary enterprise. In subjects so vast, so important, so diverse, and yet so related, as medicine and theology, it was far better, for the sake of scientific completeness, that their respective professors and teachers should, while working together for the common need, be kept separate and distinct. It was better that the priest and the physician should not be united in the one person, but that each should do his own work. The practical work of any profession was best and most thoroughly performed by those specially taught, trained, and commissioned to it. What was required, then, was a body of well-educated and trained medical men, who would regard worldly advancement as of secondary importance, and be ready to devote their whole energies to missionary enterprise; and many such were to be found among students of the present time.

Where is the Medical Defence Association? At an inquiry held before Mr. Payne, the Southwark Coroner, as to the cause of death of a woman aged sixty-one, the daughter deposed that the deceased had been in ill-health for some years, but, becoming much worse recently, was seen by a person who represented himself to be Dr. Harding, of Great Suffolk-street, but who was afterwards discovered to be a chemist named Wardley. He refused to prescribe for the deceased, saying she was in no need of medicine, but only required nourishment and nursing. Accordingly, no medicine was administered, and within a week the patient died, the supposed Dr. Harding giving the witness a paper professing to be a certificate of death. This was at once refused by the Registrar, and hence the inquiry before the coroner. Dr. Brown having proved that death arose from chronic bronchitis, the Coroner, in summing up, called the attention of the jury to the fact that the man Wardley had been before him, for acting in the same illegal and dangerous manner, four or five times during the present year, and on each occasion it had transpired that he had passed for Dr. Harding, whose name was on his door. The Coroner said he had several times severely reprimanded the man, and on one occasion the jury found that his conduct had accelerated, if it had not actually caused, death. He had called the attention of the British Medical Council to the facts, but without any effect. The foreman of the jury thought it was time some steps were taken to put a stop to Mr. Wardley's proceedings. He was not a qualified man, and poor people who were induced to employ him risked their lives through his inexperience. He considered it shameful that the respectable poor, who preferred a cheap dispensing doctor to the parish infirmary, should be subjected to such a risk, and he hoped that the present case would be publicly noticed, and legal means taken to protect them. Others of the jury also expressed themselves to a like effect in strong terms. In this case, it must be observed, Mr. Wardley did not either prescribe or give medicine; and it does not appear that, in the "certificate" given by him, he signed as Dr. Harding, or assumed any medical title. But his conduct is none the less reprehensible.

As we last week shortly noticed, among the private Bills deposited for the ensuing session of Parliament is one of a

somewhat novel description, its leading provision being the abolition of smoke, fogs, and impure air in large buildings. For some time past, Captain Douglas Galton, C.B., F.R.S., Mr. Lefevre, C.E., and other engineers have been taking observations as to the altitude of fogs and smoke over London. The result proves that at a height equal to the Victoria Tower or the dome of St. Paul's, owing to the moisture of the upper atmospheric strata, the air over the metropolis is particularly free from impurities. The Bill proposes, by means of a small pipe fixed to the highest part of our principal buildings, and with the aid of a fan, to bring down the pure air from above, and force it into buildings such as St. Paul's and the Houses of Parliament, thus displacing the fogs and smoke and all impure air. At the same time, by passing this pure air through a heated chamber, the buildings can be warmed. The other feature of the Bill is the synchronising of clocks, to be placed in the chief streets and public places of London, by means of pneumatic motive power transmitted through tubes-a system which has been found to answer admirably in Paris.

The monthly return of the Registrar-General for Scotland, for November last, gives the number of births registered during the period as 3378, and the number of deaths as 2585; allowing for increase of population, this latter number is 20 under the November average of the last ten years. A comparison of the deaths registered in the eight principal towns shows that during this month the mortality was at the annual rate of 19 deaths per 1000 persons in Perth, 21 in Dundee, 23 in Aberdeen, 24 in Edinburgh and in Glasgow, 26 in Leith, 29 in Paisley, and 30 in Greenock. Of the 2585 deaths, 1068, or 41 per cent., were of children under five years of age. The miasmatic order of the zymotic class of diseases proved fatal to 481 persons, constituting 18.6 per cent. of the whole mortality; this rate was, however, exceeded in Glasgow, in Leith, and in Edinburgh, through the number of deaths from scarlatina in each of these towns. Scarlatina was, in fact, the most fatal epidemic, having caused 206 deaths, or 8:0 per cent. of the whole mortality. Fever caused 60 deaths; of these 15 were tabulated as typhus, 41 as enteric, and 4 as simple continued fever. Whooping-cough was responsible for 54 deaths, diarrhoea for 40, measles for 40, diphtheria for 27, and croup for 20. The deaths from inflammatory affections of the respiratory organs (not including consumption, whooping-cough, or croup) amounted to 646, or 25.0 per cent. Those from consumption alone numbered 227, or 8.8 per cent. Two males and five females had passed the ninetieth year of life, the eldest of whom was the widow of a landed proprietor, and was aged ninety-five years.

Her Royal Highness the Princess Christian recently opened a new Cottage Hospital at Englefield Green, near Egham, a short distance from Cumberland Lodge, Windsor Great Park. The Hospital has been built to accommodate eight adult patients and six children, and has cost about £2800, the whole of which has been subscribed by the residents of the neighbourhood, her Majesty the Queen being a liberal contributor. The children's wards have been erected at the cost of Mr. Warwick, of Englefield Green, as a memorial to a deceased daughter. After a short service, conducted by the Bishop of Winchester, the Princess proceeded to examine the arrangements of the building, and on returning to the convalescent room declared the institution open. There can be no question as to the utility of cottage hospitals, properly conducted, and there is room for many more in parts of the country remote from great centres.

At an inquest held at the St. Pancras Coroner's Court, on the body of a child a few months old, the Coroner, Dr. Hardwicke, gave the public a useful caution about castor

oils. The public ought to know, he said, that there were several qualities of castor oil, only one of which was fit for medical purposes for human beings, namely the "cold-drawn oil." Castor oil could be, and often was, obtained from oil shops, and this was frequently full of impurities, though quite good enough for horses and cattle. To give little children this common oil was simply to make them worse; and he earnestly trusted the Press would make his remarks on this subject public.

THE NAVAL MEDICAL SERVICE.

THE mills of State grind very slowly, and urgency seems to slow still more, rather than to quicken their speed. Eligible candidates have long ceased to come forward for commissions in her Majesty's Naval Medical Service, and some nine months ago the gravity of such a state of things was recognised officially by the appointment of a Department Committee to discover a remedy for it. The Committee reported, and, though "candidates for commissions in the Medical Service of the Royal Navy" are again being advertised for, no new Naval Medical Warrant has yet been made public. The lingering delay is the more strange and impolitic, as the Director-General of the Department has been authorised to state, in his notice of the examination to be held in February, that new regulations, "giving naval medical officers generally the same relative pay, position, etc., with reference to army medical officers, as formerly existed," will shortly be published.

INTERNATIONAL EXHIBITION OF HYGIENE.

WE stated last week that her Majesty's Commissioners of 1851 have expressed their willingness to grant the Committee of the Parkes Museum of Hygiene space at South Kensington for an exhibition of medical and sanitary appliances in connexion with the forthcoming International Medical Congress; and that the Committee have decided to hold such an Exhibition provided a sufficient guarantee fund be obtained. A sub-committee has since been appointed to organise the matter; and no difficulty can be expected in obtaining a sufficient number of promises to the guarantee fund, especially as the Exhibition will no doubt be self-supporting, and the guarantors will, in all probability, not be called upon at all. Such an Exhibition will be a very important feature of the Congress, and deserves every encouragement.

PATHOLOGICAL SOCIETY OF LONDON.

THE annual general meeting of this Society, for the election of officers and for other general business, was held on the evening of Tuesday, 4th inst. The Surgical Secretary read the annual report of the Council, which testified to the continued popularity and success of the Society. Amongst those whose names have been removed by death from the list of members, special mention was made of the loss the Society had sustained by the premature decease of Dr. James Pearson Irvine. Mr. Hutchinson retires from the presidency of the Society, his successor being Dr. Samuel Wilks. In proposing the vote of thanks to the retiring President, Mr. George D. Pollock pointed out how zealously and ably Mr. Hutchinson had laboured to increase the usefulness of the Society-an opinion which the meeting most cordially endorsed. A special and well-deserved vote of thanks was also awarded to the retiring Surgical Secretary, Mr. Morrant Baker; as also to the retiring Vice-Presidents and other members of the Council. Subjoined is the list of the officials for the current year:-President : *Samuel Wilks, M.D., F.R.S. Vice-Presidents: George Buchanan, M.D.; Thomas Buzzard, M.D.; *Andrew Clark, M.D.;

James Edward Pollock, M.D.; Christopher Heath; *Jonathan Hutchinson; S. James A. Salter, F.R.S.; Septimus William Sibley. Treasurer: *George Johnson, M.D., F.R.S. Honorary Secretaries: Joseph Frank Payne, M.D.; *Henry Morris. Council: Thomas Barlow, M.D.; Evan Buchanan Baxter, M.D.; John Cavafy, M.D.; Sidney Coupland, M.D.; Sir Joseph Fayrer, K.C.S.I., M.D.; William Miller Ord, M.D.; *R. Douglas Powell, M.D.; *George Henry Savage, M.D.; Frederick Taylor, M.D.; Thomas Tillyer Whipham, M.B.; *W.Morrant Baker; J. N. C. Davies-Colley; John Warrington Haward; Henry Greenway Howse; William Bedford Kesteven, M.D.; Joseph Lister, F.R.S.; *Robert William Parker; William Johnson Smith; *Waren Tay; *William Johnson Walsham. The gentlemen whose names are marked with an asterisk (*) were not on the Council or did not hold the same office during the preceding year.

PRIMARY EXAMINATIONS.

THE first meeting of the new Board of Examiners of the Royal College of Surgeons for the examination in Anatomy and Physiology of candidates for the diploma of membership of the College was held on the 3rd inst., when 146 candidates presented themselves, to whom the following questions in Anatomy were submitted; they were required to answer four out of the six questions, viz. :-"1. Describe that portion of the innominate bone which lies internal to a line drawn vertically through the centre of the obturator foramen. 2. Describe the palmar fascia. What structures lie superficial to it, and what are exposed upon its removal? 3. Describe the attachments of the quadratus lumborum. Mention the structures with which it is in relation. 4. Describe the course and,inosculations of the anastomotica magna arteries in both upper and lower extremities. 5. What are the structures which form the root of the lung? Describe the relative position of these structures to each other, and the anatomical relations of the root of the lung on both sides of the thorax. 6. Enumerate the nerves supplying the skin and muscles of the scalp, and mention the sources from which they are derived." The following were the questions on Physiology, with the same regulations, viz. :-"1. In what manner is urine secreted? By what circumstances are its quantity and quality affected in health? 2. Describe the course of the blood in the fœtus. State the changes which the foetal blood undergoes in the placenta. 3. What is glycogen? Where is it formed in the human body? From what materials is it formed? 4. Describe the structure of the skin and its glands. 5. Describe the structure and extent of the olfactory mucous membrane. Describe the conditions requisite for the sense of smell. 6. How is absorption effected in the small intestine? State what share is respectively taken in the act of absorption by the lymphatics and bloodvessels." The names of successful candidates are published in another page.

THE ACTION AGAINST THE "INDIAN MEDICAL GAZETTE." WE learn that the editor and the publisher of the Indian Medical Gazette appealed to the Allahabad High Court of Justice against the judgment of the magistrate of Allahabad in the action for defamation brought against them by Surgeon G. C. Hall; and the appeal was successful. The judgment of the Court had not been delivered when the mail left India, but at the close of the hearing the Chief Justice of the Court, Sir Robert Stuart, said: "My present opinion, and I have no doubt it will remain, is that I shall set aside the conviction and direct the fines to be remitted. I am quite decided on this point, and reserve judgment only to consider how to express my views on the case."

THE PARIS WEEKLY RETURN.

THE number of deaths for the fifty-first week, ending December 23, was 979, and among these there were from typhoid fever 27, small-pox 10, measles 17, scarlatina 4, pertussis 13, diphtheria and croup 47, erysipelas 5, acute tubercular meningitis 38, and puerperal infections 4. There were also 49 deaths from acute bronchitis, 61 from pneumonia, and 47 from infantile athrepsia (28 of the children having been brought up wholly or in part at the breast), and 24 violent deaths. Thus the mortality has decreased from 1031 last week to 979, whereas at this time of the year it generally increases. The births have increased from 1117 to 1144, and the marriages from 421 to 481. Diphtheria still continues with little difference, being the most destructive of all the epidemic affections. Of the 1144 children born during the week, 597 were males, (viz., 431 legitimate and 166 illegitimate), and 547 females (viz., 424 legitimate and 123 illegitimate).

THE LETTSOMIAN LECTURES.

THE Lettsomian Lectures will be delivered before the Medical Society of London by Sir Joseph Fayrer, on Mondays, January 10, 24, and February 7, 1881, at 8.30 p.m.; subject— "Tropical Dysentery and Diarrhoea." Subject of Lecture 1 (January 10)-Dysentery: Introductory; brief historical notice; the geographical distribution and prevalence in India, and other countries, of dysentery and diarrhoea; definition of dysentery-its various types and forms; etiology; symptomatology.

INTERNATIONAL MEDICAL CONGRESS, 1881. THE following is the proposed list of subjects for discussion in Section 14-that of Military Surgery and Medicine:1. By what arrangements can the practical difficulties in the way of employing antiseptic surgery (Listerism) in the treatment of wounds inflicted in the field in time of war be most readily overcome? [The discussion to include (a) the system on which the treatment can be most efficiently carried out; and (b) the fittest material means to be employed in it, under the circumstances in which armies are placed while on active service.] 2. To what extent, and in what special directions, has conservative surgery advanced in field practice, as shown by statistical results of the treatment adopted for gunshot wounds during the wars of the last ten years? and what indications have been afforded, if any, by the experience gained during this period for making further advances in the conservative treatment of such injuries? 3. What are the most reliable, and at the same time practicable, means of immobilising the parts involved in gunshot fractures of the spine, pelvis, and femur in field practice? 4. On improvements in field hospital and transport equipment, for use with armies moving in uncivilised or partially civilised countries, suggested by the experience gained during the recent military operations by British troops in South Africa. 5. On the prevalence and prevention of typhoid fever among young soldiers in India. The officers of the section are:-Surgeon-General Professor Longmore, C.B.-President. Sir William Muir, M.D., K.C.B., Director-General Army Medical Department; SurgeonGeneral Sir Joseph Fayrer, K.C.S.I., M D., LL.D., F.R.S., India Office; Dr. J. W. Reid, Director-General Medical Department of Navy-Vice-Presidents. Dr. W. H. Lloyd, Fleet Surgeon R.N.; Surgeon-Major Sandford Moore, Aldershot; Surgeon A. B. R. Myers, Coldstream Guards-Secretaries. All communications regarding the section should be addressed to Surgeon A. B. R. Myers, Coldstream Guards Hospital, Vincent-square, London, S.W.

ANIMAL VACCINATION IN MADRAS.

WE learn from the Indian Medical Gazette that the Government at Madras has sanctioned a monthly allowance of 100 rupees for the maintenance of a depôt where a regular supply of animal lymph will be available. The lymph from which the present series of successful calf-vaccinations was started was obtained from Bombay. The supply is not intended to supplant or supersede arm-to-arm vaccination, but to be used as a means of distribution, and in cases where scruples are entertained regarding the use of humanised lymph.

THE INFLUENCE OF MENSTRUATION ON THE PROGRESS OF PULMONARY CONSUMPTION.

DR. DAREMBERG, of Mentone, has been writing in the Archives Générales de Médecine upon this subject. There is no question that disturbances of the menstrual function very commonly accompany phthisis; and the view of their relationship to one another which is commonly accepted in this country, is that the latter is the cause, and the former the effect. Dr. Daremberg has seen reason for thinking that the state of the menstrual function has a distinct influence upon the lung-disease. His experience leads him to make the following statements upon this subject:Menstruation is sometimes a cause of phthisis; in the sense that women become phthisical who would not have done so had they been free from the monthly loss of blood. When phthisical changes have begun, the menstrual function may lead to attacks of congestion, either around old foci of disease, or in healthy parts of the lung, which may go on to hæmorrhage or to inflammation. When the catamenial flow is suppressed, the ovarian molimen being still present, these congestions are liable to become more intense and more dangerous. If the discharge should persist after ovulation has disappeared, it becomes simply a cause of anæmia, but does not provoke reflex congestions. When the two functions, uterine and ovarian, are suppressedthat is, when the menopause has completely taken placemenstrual congestions are no more to be dreaded. After delivery, similar pulmonary congestions of reflex origin are to be feared. The abrupt suppression of the menses cannot per se bring about tuberculosis; but it may cause its development in women predisposed to it. From these pathological generalisations he draws the following principles of treatment. In phthisical women the lungs should be carefully watched during the menstrual period, and at the least sign of mischief the nervous and vascular excitement should be calmed by the moderate use of digitalis, bromide of potassium, and quinine; absolute rest should be advised, and the pulmonary organs should be acted on by energetic revulsives (blisters, croton oil, etc.), and this during several successive periods. If the menstrual flow should cease while the ovarian molimen continues its course, the same treatment should be carried out, with the addition of external means to bring back the discharge (blisters, friction, hot baths, leeches to the lower extremities); and if these do not succeed, then the careful employment of purgatives and internal emmenagogues (general stimulants, such as alcohol and acetate of ammonia; local excitants, as rue, savin, aloes, uva ursi, apiol, ergot of rye, borax ; and tonics, viz., strychnia and quinine). These measures, he holds, will do good, even if they should not re-establish menstruation. When the discharge persists after ovulation has ceased, we should with caution endeavour to diminish it, bearing in mind that its sudden suppression may be dangerous; and the same remark applies to leucorrhoea. When both functions (uterine and ovarian) have disappeared, we should keep from seeking to re-excite the flow, for it will then be useless and cause anæmia. When, after a long absence, the menses reappear,

without any great improvement being evident in the local and general condition, it is necessary to be very cautious about giving a favourable prognosis; for this apparent return of menstruation often indicates grave disturbance of the circulation, and is the precursor of serious mischief.

THE METROPOLITAN WATER-SUPPLY FOR NOVEMBER LAST.

THE report of the examination made of the water supplied by the Metropolitan Water Companies during the month of November last shows that the state of the water in the Thames at Hampton, Molesey, and Sunbury was indifferent in quality from the 1st to the 7th of that month, when it improved, and remained good until the 15th, after which it became bad, and continued more or less in that condition for the remainder of the month. The water in the river Lea was also generally bad during the greater part of November. These remarks refer to the condition of the water previous to filtration; it is, therefore, more satisfactory to ind from Dr. Frankland's report that the water drawn from the Thames by the Chelsea, West Middlesex, Southvark, Grand Junction, and Lambeth Companies, in spite of is generally bad condition at the intakes, exhibited a narked improvement in quality upon that supplied during the months of August, September, and October, and that i had been in all cases efficiently filtered before delivery. He also remarks that the water drawn from the Lea by the New River and East London Companies was of superior quality to that supplied during the month of October, the supply sent out by the New River Company being considerably better than Thames water, whilst that distributed by the East London Company was equal to average Thames water. Referring to the question of constant supply, which it has been generally admitted is not only desirable but necessary, Colonel Bolton remarks that as considerable pressure has been put upon the water companies to take the initiative in its introduction, it would be well if the public were to render the companies every assistance, instead of raising difficulties for them to encounter in changing the system of supply, amongst which difficulties may be enumerated the obstinacy of many landlords and tenants in refusing to perform their part of the work.

WEST KENT MEDICO-CHIRURGICAL SOCIETY.

THE second meeting of the present session was held at the Royal Kent Dispensary, Greenwich, on November 5, 1880 (Mr. H. W. Jackson in the chair), when W. Rivington, Esq., F.R.C.S.E., Surgeon to the London Hospital, read a paper on "A Wound in the Knee-joint treated Antiseptically." Mr. Bivington first gave a detailed account of the case and treatment. This went to show that it was a severe wound of the joint, which made a perfect recovery under the Listerian treatment. Mr. Rivington then said that it was unlikely that the case would have gone on so well under the old treatment, and compared the issue of cases treated in former years under the old system, and cases now treated under the protection of carbolic acid and carbolic gauze, admitting that excellent results were obtained in the perfectly pure atmosphere of the country with a modified antiseptic procedure, and even without antiseptic precautions. Mr. Rivington said that the comparison must only be made between those cases which were treated under such conditions and those in the loaded atmosphere of great cities and hospitals.

SMOKE ABATEMENT.

A MEETING is to be held this day (Friday), at the Mansion House, under the presidency of the Right Hon. the Lord Mayor, to consider and promote the best means of remedy

ing the present smoke-laden condition of the atmosphere of London. The Lord Mayor will be supported by G. J. ShawLefevre, Esq., M.P., Mr. Spottiswoode, the President of the Royal Society, Professor Richmond, R.A., and other wellknown gentlemen. The joint committee of the National Health and Kyrle Societies have arranged to hold an exhi bition, in South Kensington, of the various smokeless coals and other fuels, and of various appliances applicable to household and manufacturing purposes for the reduction of smoke, and propose to test the same for the information of the public.

ST. THOMAS'S HOME, ST. THOMAS'S HOSPITAL.

ADMISSION OF PAYING PATIENTS.

THE following is an account of the first stage of a transaction which, we believe, is without precedent in the history of a Royal Hospital. Misfortunes cannot be avoided at all times, but the management which has brought St. Thomas's to this pass must surely leave something to be desired :

The Governors of St. Thomas's Hospital, acting under the authority of the Charity Commissioners, will be prepared in the course of the present month to receive into St. Thomas's Home persons of the upper and middle classes who are able and willing to pay for the benefits of medical attendance and nursing therein-benefits which have hitherto been confined to the poor alone. In order to carry this into effect, the Governors have appropriated two wards in the Hospital, which are distinct from the other or ordinary wards, and are situate in one of the end blocks, and approached by a separate gate and entrance. These two wards have been fitted up and furnished expressly for the purpose of accommodating patients of the classes above mentioned. Each patient will have a separate sleeping compartment, curtained off with thick impervious linen curtains from the others, and each compartment is lighted by a large window and is appropriately and comfortably furnished. The ward on the ground floor, which has sixteen of these compartments besides two small rooms, is intended for females. The ward on the first floor, which has twenty-four of these compartments besides a small ward or room, is intended for males. Both wards have a large day or sitting-room distinct from the wards, and which are well and comfortably furnished and thoroughly warmed and ventilated. There are warm and cold baths, and every requisite of the best description. As the Hospital is situate in a large garden facing the river Thames and the Albertembankment, and is also in close contiguity to Lambeth Palace, the occupants of the Home will have the advantage of these open spaces and good air. The patients in the Home will be under the professional charge of a resident officer of superior medical and surgical qualifications, and of him exclusively, for their ordinary treatment, but every patient will have the option of employing at his or her expense any legally qualified medical practitioner in consultation with such resident medical officer. The governors have elected as such officer a gentleman of the highest medical and surgical attainments, and every way qualified to carry out the duties of his office satisfactorily and efficiently. The minimum charge for each patient will be 8s. a day, but the governors reserve to themselves the right to take into consideration the state, position in life, and circumstances of each patient, and the nature of the case, and to require a higher daily charge when necessary. Patients having the use of one of the separate small rooms will be charged according to the circumstances. Such payments will entitle the patients to their board, medical and surgical attendance, medicine, and appliances, and also to be nursed and attended by trained and experienced nurses selected from the nursing staff of the Hospital, and who will be under the immediate supervision and control of the Matron. It is not intended to admit as patients any persons suffering under any chronic, incurable, or infectious diseases.

AGED TRIPLETS.-Triplet brothers, aged seventy, celebrated their birthday in Westport, Conn., a few days ago.Louisville Medical News, December 11.

THE

INTERNATIONAL CONGRESS ON HYGIENE, HELD AT MILAN IN AUGUST, 1880.

THE year 1880 was an eventful one in the history of the intellectual revival that has accompanied and followed the political regeneration of Italy. That classic land of art, letters, and science has been the scene of nearly a dozen congresses, for the discussion of subjects connected with medical and social science, during the past summer; which, while they have enabled Italian thinkers to compare themselves with those of other lands, have also shown the existence of an amount of intellectual life and scientific progress in that country of which foreigners had little idea. There has been, perhaps, too great a tendency to speak disparagingly of Italian physicians as no better than nineteenth-century Sangrados, and to believe that all true medical science was confined to England, France, and Germany, but no one can carefully study the reports of these congresses without recognising that the nation which could boast in days gone by of Morgagni and Malpighi, Galileo, Volta, Galvani, Toricelli, and Spallanzani is far from being effete, and that in the ranks of Italian physicians there are many men worthy to be compared with Matteucci, Canizzaro, Melloni, and Secchi in the collateral sciences.

The biennial International Congress on Hygiene, which met in 1876 at Brussels and in 1878 at Paris, assembled this year in Milan.

The Acting-President, Professor Pacchiotti, was supported by a crowd of distinguished statesmen and men of science, every country in Europe, with the exception perhaps of Spain, being more or less represented.

As might have been expected, at a meeting where the debates were conducted in Italian or French, natives of those countries and of Belgium took the leading parts; but when one considers that, with all our shortcomings, we have achieved more success than most nations in practical hygiene, we must regret that, while the eloquent address of a German was greeted with loud applause, the countrymen of Parkes and Chadwick should, from their weakness in foreign tongues, have been conspicuous for their silence. This was especially unfortunate in the discussion of the measures to be taken for the exclusion of cholera from individual countries when it has already invaded Europe. All were agreed as to the impracticability, on commercial grounds, of a strict enforcement of quarantine, but no one was found to refer to the success which, in 1873, attended the assiduous inspection by Dr. Harry Leach and our other port sanitary officers of all ships coming from infected seaports, when England alone remained free in Europe, and the cholera, conveyed by emigrants from Hamburg, ravaged the United States.

The business of the Congress was divided among the following sections:

1. General and International Hygiene. 2. Industrial and Professional Hygiene. 3. Hygiene of Children and Schools.

4. Veterinary Hygiene.

5. Military and Naval Hygiene.

6. Agriculture and Chemistry in their relations to Public Health.

In the first section, M. Fauvel, who, as one of the Plague Commissioners sent out to the East by the French Government in 1847, and a member of every subsequent commission of like character, spoke with a weight of experience and authority enjoyed by few, read an able paper on the measures to be taken to preserve (a) Europe against the invasion of such epidemics as cholera, plague, and yellow fever, and (b) each several country when any of these diseases has already invaded others; directing his observations, however, mainly to the prevention of cholera, since the other two were, as he remarked, matters of almost purely local interest.

In a historical summary he reminded his hearers that the conference held at Constantinople in 1866 had adopted a plan of defence drawn up by himself, and based on the fact that cholera, endemic in India, invariably enters Europe by one of

two routes-the one being that of the Red Sea, whither it is carried by pilgrims to Mecca, and thence by those returning to their homes in the Levant, and by commercial intercourse between Egypt and the seaboards of Europe; the other being by means of caravans through Persia and vid the Caspian ports into Russia, whence it is conveyed overland into Germany, and by the Baltic trade to France, England, and America.

Thanks to the vigilance of the British Indian Government and the intelligent co-operation of that of Egypt, the former position has been successfully held ever since, and two threatened invasions from that quarter in 1872 and 1878 have been averted. Whether the Russian Government has showL equal energy we have no means of knowing, but the fact remains that from 1869 to 1873 a series of cholera waves have entered Europe from that side.

At the Vienna Conference of 1874, and that of Stuttgard: in 1879, the questions of quarantine by sea and land were discussed with considerable diversity of opinion, the representatives of the maritime states of Western Europe viewing them with favour, while the Russian and German delegates were firmly convinced of the futility of all attempts at maintaining sanitary cordons across a continent. Some, again, admitting the efficacy of restrictive measures on maritime traffic, held that on commercial grounds they were impracticable. The difficulties of maintaining an effective barrier on land can, indeed, scarcely be exaggerated; but the success already achieved in Egypt, and we may add in England, by a systematic inspection of suspected vessels, together with the gravity of the danger which constantly menaces Eastern Europe, urgently calls for redoubled efforts on the part of the Russian Government to do all that lies in its power to secure the Asiatic frontier and the shores of the Persian and Caspian Seas. To devise and to superintend these measures, M. Fauvel urged the appointment of a really representative International Sanitary Commission, to be located permanently at some central and convenient position in Eastern Europe.

Dr. Finkelburg, of Bonn, in an eloquent address supported the recommendations of M. Fauvel, but would have the commission take cognisance of many other questions than the mere prevention of epidemics-such, for example, as the etiology of these and other diseases, vital statistics, traffic in rags, hides, etc., export of adulterated goods, the sanitary condition of shipping; in fact, of everything relating to public health, the knowledge of which might be aided by international co-operation. He drew a strong argument in favour of the permanence of such a commission-which he compared to the staff of the German army preparing, in time of peace, plans for future campaigns-from the ludicrous failure of the European Commissioners last year to reach the scene of the plague at Astrakhan until the disease had disappeared. This international commission, the functions of which should, he maintained, be deliberative rather than executive, should be in constant correspondence with a central sanitary board in each country, composed partly of men of high scientific reputation, and partly of men of political and administrative ability, the president being chosen from the latter, and independent of changes in political parties. A model for such a board might, he observed, be found in the General Board of Health at Washington, U.S.

Dr. Zucchi, of Milan, then described an elaborate scheme for the organisation of the sanitary administration of a country, which Dr. Van Overbeck de Meijer, of Utrecht, justly condemned as far too complex and costly, requiring for its working an army of medical officials, and explained the system which had been established in Holland since 1865, where, besides a body of inspectors similar to those of our Local Government Board, there is in each arrondissement a provincial council, composed, for the most part, of local medical men known to have given special attention to sanitary matters. Dr. Felix, of Bucharest, made some remarks which seem very pertinent to the demand of many of our profession for the creation of a Minister of Health. He was decidedly of opinion that the head of the sanitary service should not occupy the position of a Minister, but be entirely independent of political fluctuations. He only insisted that he should be in direct correspondence with the Minister of the Interior, and responsible to him alone. At all costs, he said, we should avoid the state of things which exists in Austria, where the Director of the Sanitary Bureau, himself a physician, is compelled to communicate with his ministerial superior through another and non