1324 REFORM IN THE ROYAL COLLEGE OF SURGEONS OF ENGLAND.

of death were general paralysis in 12 cases, phthisis pul-monalis in four. atrophy of the brain in 20, influenza in 20,while cancer of the liver gave the alarming total of eightdeaths. The want of an isolation block for infectious casesis strongly urged by the medical superintendent.

Devon County Lunatic Asylurn (t1nn7lal Report for 1898) -The population of this asylum consists of 1116 patients-viz.,454 males and 662 females. The admissions during the yearamounted to 146, of which 73 were males and 73 females.The discharges numbered 81 and consisted of 36 malesand 45 females. Among the discharges 44 patients (19males and 25 females) were classed as recovered, whichis 3 9 per cent. of the average number resident-alow recovery rate. The average number resident was con-siderably in excess of any former year. Dr. G. J. S.Saunders, the medical superintendent, states in his

report to the committee that the doors were often closedto all but acute and urgent cases ...... the difficulty of

providing make-shift room for new-comers was verygreat ...... and the depressing and injurious effects of over-crowding, on the mental and bodily health of the community,are of equal, if not greater, importance. Disorders attribut-able to defective hygienic conditions were too common, suchas tuberculosis, diarrhoea and dysentery, erysipelas, andfurunculoid diseases....... Patients not infrequently are

suffering on admission from tubercular diseases of variouskinds, but such disease ought not to originate in the

asylum....... Conditions in Devon are most favourable tothe open-air treatment." There were 57 deaths-28 beingmales and 29 females. 14 deaths were due to generalparalysis, eight to phthisis or other forms of tuberculosis,five to cardiac disease, four to senile decay, and three tccancer.

,jut,//I, Counties Asylum, Carmartnen (Annual Report Tor 11898).-The average number of patients resident during the Iyear was 618 and consisted of 307 males and 311 females.There were admitted during the year 87 patients-viz ,49 males and 38 females The following causative agentswere ascertained regarding the admissions. 37 were due toheredity, 16 to alcoholic excess, 14 to trouble and adversity,11 to the climacterium (in women), seven to epilepsy, six eachto mental shock and to senility, four each to onanism and tocranial injury. In 11 there existed a considerable congenitalbasis for the insanity. Of the admissions 14 were activelysuicidal. Dr. E. Goodall, the medical superintendent, statesthat 31 per cent. of the patients admitted were in feeblehealth and should have been brought in earlier beforethey had become reduced physically by refusal of foodand insomnia." The number of cases discharged as

recovered amounted to 26, or 4’2 per cent. of the averagenumber of patients resident. The number of deathsamounted to 53, a ratio of 8-5 per cent. as calculated onthe same basis. Eight of the deaths were due to generalparalysis, four to chronic cerebral atrophy, five to Bright’sdisease, and 15 to pulmonary tuberculosis. The mortalityfrom pulmonary tuberculosis is " undesirably high " and it isadmitted that separation of such cases in a detached blockfor open-air treatment would be desirable, though this wouldentail a considerable original outlay. All the milk suppliedto the institution is boiled before being used as a routinepractice. A few cases of enteric fever and of colitis have

appeared. Many alterations in warming and ventilation arein progress.Lanark Distriet Asylum (Annual Report for 1898).-The

average daily population during the year was 522, and con-sisted of 283 males and 239 females. There were 256admisions during the year, an amount considerably in excessof those of previous years. " A larger proportion than usualappeared to be hopeless as regards any chances of recovery,for 38 gave evidence of organic brain disease, 35 of chronicmental disease, and 17 were hopeless senile cases." Dr. A.Campbell Clark, the medical superintendent, further statesthat nine patients were admitted in a moribund condition. 93patients were discharged as recovered, a ratio of 17-8 percent. of the average population. The deaths amounted to 58,a ratio of 11’1 per cent. as calculated on the same basis. Asevere and prolonged epidemic of influenza prevailed forabout six months. " It affected the officials in a larger pro-portion than the patients, and for this reason the manage-ment was seriously handicapped for a long time." A male

patient died at the age of 73 years after 21 years ofresidence, while another died at the age of 48 years after 23years’ residence.

REFORM IN THE ROYAL COLLEGE OFSURGEONS OF ENGLAND.

STATEMENT PRESENTED TO THE LORD PRESIDENT OF THEPRIVY COUNCIL ON BEHALF OF THE SOCIETY OF

MEMBERS OF THE ROYAL COLLEGE OF

SURGEONS IN REFERENCE TO THEAPPLICATION BY THE COLLEGE

COUNCIL FOR A SUPPLE-MENTARY CHARTER.

THE proposed Charter is intended to enable the Council toconfer Honorary Fellowships on persons of distinction as ameans of celebrating the centenary of the granting of the.

original Charter in 1800. The Lord President may be awarethat unsatisfactory relations have existed for many yearsbetween the Council of the College and the Fellows andMembers. It is submitted that the provisions of the pro-posed Charter are very inadequate, inasmuch as they do nottend in the slightest degree to terminate the dissensionswhich have so long prevailed.At the time of the application for the last Supplementary

Charter of 1888 the attention of the Privy Council wascalled to the grievances of the Members by a petition signedby 4665 of their number and by a statement presented by theAssociation of Fellows of the College. To these documents

(presented to the Privy Council in May, 1887) the LordPresident is referred. The Supplementary Charter was thengranted, but only EO far as it related to subjects on whichthere was no controversy with the Fellows and Members.Unfortunately, this method of dealing with the disputedmatters was far from successful. Within a very short timethe College Council and the Members were engaged in litiga-tion on the question of the right of the latter to meet in theirown College, and there have subsequently been continuousdisputes on numerous points, all arising out of the persistentrefusal of the Council to grant the Members a limited repre-sentation on the governing body of the College.The Council some years ago passed a resolution agreeing

to consult the Fellows and Members on all important mattersaffecting the external relations of the College. Accordinglya meeting was held on July 5th last for the consideration ofthe present draft petition and Charter. After full discussionthe following resolution was then carried with only eightdissentients :-That this meeting of Fellows and Members, summoned by the

Council to consider the terms of a proposed new Charter, is of opinionthat the powers asked for are inadequate and that no Charter should begranted which does not give to the Members some representation on thaCouncil. ‘

The following was also carried unanimously :—

That this meeting requests the Council to postpone a final decision asto the terms of the new Charter until a memorial which is in course ofsignature has been received and considered.

This memorial, which has been printed in THE LANCET, wassigned by over 700 Members in less than a fortnight, but, likeevery other attempt to propitiate the Council, it failed. Thememorialists were informed that the Council was introducingonly one matter into the Supplementary Charter and that theinclusion of anything else would be "inopportune."The attention of the Lord President is particularly drawn

to the fact that the Council having called a meeting toconsider the draft Charter entirely disregarded the resolu-tion passed by that meeting declaring the provisions of theCharter to be inadequate. This is in harmony with the ’habitual practice of the Council owing to its non-respon-sibility to the Members. It is in the power of the PrivyCouncil to put an end to the present anomalous state ofaffairs by refusing to sanction any Charter which does notgrant the Members a reasonable representation.By the Charters the body corporate of the College is

declared to consist of the Members ; the entire property of! the College is vested in them and they provide by far the’ greater part of the annual income, yet they have no controlwhatever over the expenditure and no share in the govern-. ment. Their difficulties are not understood by the Council,’ which is entirely composed of hospital surgeons, and their. requests are persistently refused. They have to obey by-. laws made by persons who have interests distinct from their; own and by a body in which they have no representation.fThey are governed by an irresponsible oligarchy and in all3 collegiate matters they are as far as possible ignored.

The present mode of government of the College is an

1325PUBLIC HEALTH AND POOR LAW.-VITAL STATISTICS.

anachronism and is out of harmony with the representativeinstitutions of our country. It is therefore respectfully-urged that your lordship will, on grounds of public policy,either refer this Supplementary Charter back to the Councilof the College in order that provision may be made for the-representation of Members, or that, before granting anyCharter, you will hear the Society of Members of the RoyalCollege of Surgeons by counsel.

Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

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

On Enteric F’ever in the Ilkeston Registration Sub-district,by Dr. S. W. WH.EATON.1-Ilkeston registration sub-districtcomprises the borough of Ilkeston, the Heanor Urban District,.and the three rural parishes of Basford district. The popula-tion of the whole area was 31,455 in 1891, but the number ofinhabitants has largely increased since that date owing toincreased work at coal-mines, ironworks, and factories in theneighbourhood. Ilkeston and Heanor are essentially collierytowns: the former Dr. Wheaton contrasts favourably withother mining districts in regard to its situation, the open spaceabout its dwellings, and the cleanliness of its streets, whilethe latter is in large measure a new town built in severalways advantageously for its working population. The wholeregistration sub-district has suffered from an excessive pre-valence of enteric fever during past years, notably in theautumn months of 1897 and of 1898. Dr. Wheaton reviewsthe several sanitary conditions obtaining in Ilkeston andHeanor, in which during the last two years nearlyall the attacks of enteric fever in the registrationsub-district have occurred. There are many insanitaryconditions common to both places which could beconsidered as conducing to the maintenance of endemictyphoid fever. In each town are privies and middens ofobjectionable type which occasion extensive fouling ofsoil near dwellings. Ilkeston has also a large numberof wooden-pail closets, but in view of the way in whichthe " cleansing " of pails is reported to be performedthese closets cannot present much sanitary advantageover midden privies. Yards in each town are usuallyunpaved, and accumulations of house-refuse are frequentlymet with in the corners of such yards, no receptacleshaving been provided. Dairies, cowsheds, and milkshopsare often highly objectionable. In each instance isolationaccommodation is inadequate and has been available for asmall proportion only of the cases of enteric fever. At Ilkestonpatients are admitted to hospital only upon payment of 3s.a day by their friends or by the guardians. In neitherplace is there any disinfecting apparatus. Both Ilkestonand Heanor are sewered, though the methods of sewage-disposal leave much to be desired. But notwithstandingtheir similar circumstances Dr. Wheaton does not attributethe endemic typhoid fever in the two places to the samecause. In Ilkeston grave suspicion fell upon the publicwater-supply of the district. This is a mixed supply,obtained partly by pumping from a disused coalpit andpartly from the Nut Brook. The latter stream andits tributaries seem to be the common sewers of several

villages and hamlets above the intake. Dr. Wheaton

gives a detailed account of the several pollutions to whichthese small streams are exposed, stating in conclusion that"it is hardly possible to imagine a more dangerous and dis-gusting source of water." The filtration of the mixed wateris clearly inadequate. There are two sand filters, each 241square yards in area, which, to obtain a sufficiently slowrate of filtration, should hardly deal with more than 150,000gallons a day, a figure clearly much below ’the actualconsumption. The filters habitually work under as greata pressure as 11 feet. Dr. Wheaton points to thedistribution of enteric fever in the town and to othercircumstances which are consistent with this supplyhaving been the agency by which fever was distributed.

1 London, Eyre and Spottiswoode, East Harding-street; Edinburgh,John Menzies and Co.; Dublin, Hodges, Figgis, and Co. Price 3d.

His conclusions in the matter are the more noteworthyas it appears that at no time during 1897 or 1898 wasthere any sudden outburst of fever such as we have beenled generally to associate with water-borne contagion. It isunfortunate that at Ilkeston the materials available in the

sanitary department for study of this question seem to havebeen in many respects meagre, even the notification returnsbeing incomplete. It seems almost certain that pollution ofthe Nut Brook above the intake with infectious sewage fromcases of enteric fever took place in each of these two years,and the relation between the character of filtration andthe circumstance that Ilkeston suffered endemically, but notepidemically, forms an interesting subject for speculation.For the prevalence of fever at Heanor, the public water-supply of which is from deep wells apparently free from riskof pollution, Dr. Wheaton considers multifarious sanitarydefects, making for wholesale soil-pollution, to be mainlyresponsible. It should be added, however, that both Heanorand Ilkeston seem to have encouraged fever in the other’sdistrict. Heanor workmen have contracted enteric fever inIlkeston and infectious Heanor sewage has been dischargedinto waters flowing to the Ilkeston waterworks-a trulyvicious circle.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

1 IN 33 of the largest English towns 6749 births and 41203 deaths were registered during the week ending Nov. 4th.3 The annual rate of mortality in these towns, which had

increased from 18’6 to 21’1 per 1000 in the three preceding weeks, declined again last week to 18’8. In London the

rate was 18’6 per 1000, while it averaged 19 0 in the 32provincial towns. The lowest death-rates in these townswere 11-3 in Derby, 11-8 in Brighton, 13-1 in Huddersfield,

and 13’5 in Cardiff ; the highest rates were 22-9 in Salford,, 23 6 in Bristol, 24’1 in Wolverhampton, and 25 7 in Bolton.1The 4120 deaths in these towns included 429 which were

. referred to the principal zymotic diseases, against 435, 456,and 489 in the three preceding weeks; of these 97 resultedfrom diphtheria, 94 from "fever" (principally enteric), 77from measles, 74 from diarrhœa, 41 from whooping-cough,40 from scarlet fever, and six from small-pox. No

. fatal cases of any of these diseases occurred last week in

Plymouth, in Derby, or in Huddersfield ; in the othertowns they caused the lowest death-rates in Brighton,Cardiff, and Gateshead ; and the highest rates in Leicester,Birkenhead, Bolton, Blackburn, Sheffield, and Hull. The

greatest mortality from measles occurred in Birkenheadand Bolton ; from scarlet fever in Bolton, Burnley, andHalifax; from whooping-cough in Salford ; from "fever"in Wolverhampton, Leicester, Nottingham, Sheffield, andBirkenhead ; and from diarrhœa in Blackburn. The 97deaths from diphtheria included 38 in London, 15 inSheffield, 10 in Leicester, six in West Ham, and six in Leeds.Six fatal cases of small-pox were registered last weekin Hull, but not one in any other of the 33 large towns,and no small-pox patients were under treatment in anyof the Metropolitan Asylums Hospitals. The number ofscarlet fever patients in these hospitals and in theLondon Fever Hospital on Saturday last, Nov. 4th, was3539, against 3317, 3408. and 3504 at the end of thethree preceding weeks; 331 new cases were admitted duringthe week, against 455, 447, and 414 in the three precedingweeks. Influenza was certified as the primary cause

of 19 deaths in London. The deaths referred to diseasesof the respiratory organs in London, which had increasedfrom 133 to 477 in the seven preceding weeks, declined againto 418 last week, but were 55 above the corrected average.The causes of 41, or 1’0 per cent., of the deaths in the 33towns were not certified either by a registered medicalpractitioner or by a coroner. All the causes of death were

duly certified in Manchester, Salford, Bradford, Newcastle.and in 12 other smaller towns ; the largest proportions ofuncertified deaths were registered in Birmingham, Liverpool,Blackburn, Preston, and Hull.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 17’3 and 17 9 per 1000 in the two precedingweeks, further rose to 18’8 during the week ending Nov. 4tb,and corresponded exactly with the mean rate during the sameperiod in the 33 large English towns. The rates in the