2
1151 GENERAL MEDICAL COUNCIL: ELECTION OF DIRECT REPRESENTATIVES. accordance with my pledges I have worked in harmony with those members of the Council who are in favour of raising the standard of education, and it is satisfactory to report that during the last year or two regulations have been adopted lengthening the course of professional study and raising the standard of preliminary examinations. It is to be regretted that the Royal College of Physicians and the Royal College of Surgeons of England appear disposed to dispute the authority of the Council in regard to this matter. Although I am a Member of the College of Surgeons I feel that in all questions relating to medical education the fiat of the Medical Council should be absolute, and as long as I con- tinue to be a member of that body my action will be guided by a sincere wish to support its authority. Unless the Council’s authority be maintained medical education will soon become chaotic. 5. Increased direct representation.-On two occasions I have proposed motions calling upon the Council to make application to the Privy Council to obtain additional direct representation for England and Wales, as provided for in the Medical Act of 1886, but I regret to say that on each occasion the proposition was rejected by a large majority. If I continue to represent you on the Council I shall again press this question upon the members, but I fear nothing will be accomplished in that direction unless a direct appeal to Parliament be made. I shall do my utmost, both inside and outside the Council, to assist those who consider that their representatives on it should be elected by the graduates of the universities and the members of the corporations, and not solely by the senates and councils respectively. It is a satisfaction to me to report that during my term of office I have taken an active part in bringing about the promulgation of new regulations respecting the employment of unqualified assistants which have done more to protect the public against unqualified practice and to elevate the profession than any other measure adopted by the Council since the profession has had the privilege of sending Direct Repre- sentatives to the Council. There are other points I would have desired to mention in this address, but must deal with them at the public meetings. I would therefore conclude by thanking you for the generous consideration shown towards me during my term of office, and by giving you the assurance that should you honour me by re-electing me as one of your representatives I shall, as in the past, do all in my power to serve your interests and to uphold the honour and dignity as well as the interests of our profession. I remain, fellow practitioners, your obedient servant, 6, Gibson-square, London,’N., October, 1901. GEORGE BROWN. MR. GEORGE JACKSON’S ADDRESS TO THE REGISTERED PRACTITIONERS OF ENGLAND AND WALES. LADIES AND GENTLEMEN,—Having been invited by the Incorporated Medical Practitioners’ Association, in conjunc- tion with Mr. George Brown, to become a candidate as a Direct Representative on the General Medical Council, I have acceded to their request, and am encouraged to do so by the fact that I obtained 4082 votes at the last election, although very late in the field. On the last occasion, omitting a bye-election caused by the resignation of Dr. Rentoul, the contest turned principally on the question of the registration of midwives, the votes in favour of it being only 8443, as against 26,040. I am now, as then, opposed to the registration of midwives, the creation of an inferior order of practitioners. The only way to settle this vexed question is by the registration of all nurses, who will be obliged to act under the direct control of duly qualified medical practitioners. The objects which should engage the attention of the General Medical Council in the immediate future should be in my opinion : 1. The reform of the Medical Acts, so as to provide for direct representation of the medical profession in every case except the Crown nominees. 2. Raising the standard of the entrance examinations and limiting the age of entrance so as not to be under 17 years. 3. The one-portal system of entrance to be secured by forming a Board of Examiners, composed of delegates from the present examining bodies. 4. Such an alteration of the Acts which will give the Council power to suppress quacks, &c., who practise medicine and surgery under various forms of colourable pretences. 5. A more definite pronouncement against medical men acting as medical advisers to clubs and insurance societies whose agents tout for members. For the information of those to whom I am unknown personally I may state that I have taken an active part in medical politics for more than 20 years. In conjunction with Mr. Reginald Harrison I set on foot some 20 years ago a movement which had for its object the voting by voting papers for the election of members of the Council of the Royal College of Surgeons, which was successful. About 15 to 16 years ago I endeavoured to establish locally a medical sick assurance society, and thus helped to prepare the way for the society which at present exists, and does such good work. In 1895 I was President of the Incorporated Medical Practitioners’ Association, and had previously founded the Devon and Cornwall local branch of the- same, which has done good work in checking irregular practice and the like. Last year I was a delegate of the Plymouth Medical Society to the medical organisation meeting at Manchester, and was appointed a member of the committee, which has had a great deal to do with the reform of the British Medical Association. I have assisted in the work of establishing the Three Towns (Plymouth, Devonport, and Stonehouse) Provident Dispensary in conjunction with the local branch of the Incorporated Medical Practitioners’ Association, which works on the principle of a wage-limit, the management being, entirely in the hands of the members of the staff. Asking the favour of your vote and interest, I remain, your obedient servant, GEORGE JACKSON, F.R.C.S. Eng., ex-President and Vice-President of the Incorporated Medical Practitioners’ Association and of the Devon and Cornwall Branch of the same, and ex-President of the Plymouth Medical Society. 10, Portland-villas, Plymouth, October, 1901. DR. GLOVER. Dr. Glover has, we regret to learn, lately suffered from a bad eye ; he is now, however, much better. We are asked by him to say that he regrets much that, acting under strict medical advice, he is obliged to abstain from attending all public meetings for the present. He feels confident that his constituents will realise with what reluctance he has to decline invitations from various places where it would be a great pleasure to him to meet them for the discussion of current questions. He ventures to hope that the inconvenience to them will be lessened by the fact that his views have been fully stated and reported on several recent occasions. MR. VICTOR HORSLEY. When Mr. Horsley was elected a Direct Representative of the profession on the General Medical Council at a by- election he said that when the next quinquennial election came round he would resign and offer himself for re-election at the same time as the other candidates, thereby saving the profession the expense of multiple elections. He is now legally advised that he cannot take this course, as the wording of the Act places any man who resigns his seat on the General Medical Council in the position of a dead man. A successor must be elected ; he cannot himself be re-elected. VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN 33 of the largest English towns 6451 births and 3684 deaths were registered during the week ending Oct. 19th. The annual rate of mortality in these towns, which had been 15’6 and 15’9 per 1000 in the two preceding weeks, further rose last week to 16’8 per 1000. In London the death-rate was 16’0 per 1000, while it averaged 17-3 in the 32 large provincial towns. The lowest death-rates in these towns were 10-3 in Derby, 11’1 in Bristol, 11’2 in Croydon, and 11’5 in Huddersfield ; the highest rates were 21-9 in Salford, 22-0 in Blackburn, 26-9 in Newcastle, and 28’8 in Gateshead. The 3684 deaths in these towns last week included 467 which were referred to the principal zymotic diseases, against 525 and 485 in the two preceding weeks ; of these 467 deaths, 168 resulted from diarrhoeal diseases, 81 from measles, 71 from diphtheria, 59 from "fever" (principally enteric), 47 from scarlet

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Page 1: VITAL STATISTICS

1151GENERAL MEDICAL COUNCIL: ELECTION OF DIRECT REPRESENTATIVES.

accordance with my pledges I have worked in harmony withthose members of the Council who are in favour of raisingthe standard of education, and it is satisfactory to report thatduring the last year or two regulations have been adoptedlengthening the course of professional study and raising thestandard of preliminary examinations. It is to be regrettedthat the Royal College of Physicians and the Royal Collegeof Surgeons of England appear disposed to dispute the

authority of the Council in regard to this matter. AlthoughI am a Member of the College of Surgeons I feel that in allquestions relating to medical education the fiat of theMedical Council should be absolute, and as long as I con-tinue to be a member of that body my action will be guidedby a sincere wish to support its authority. Unless theCouncil’s authority be maintained medical education willsoon become chaotic.

5. Increased direct representation.-On two occasions Ihave proposed motions calling upon the Council to make

application to the Privy Council to obtain additional directrepresentation for England and Wales, as provided for inthe Medical Act of 1886, but I regret to say that on eachoccasion the proposition was rejected by a large majority.If I continue to represent you on the Council I shall againpress this question upon the members, but I fear nothing willbe accomplished in that direction unless a direct appeal toParliament be made. I shall do my utmost, both inside andoutside the Council, to assist those who consider that theirrepresentatives on it should be elected by the graduates ofthe universities and the members of the corporations, andnot solely by the senates and councils respectively. It is asatisfaction to me to report that during my term of office Ihave taken an active part in bringing about the promulgationof new regulations respecting the employment of unqualifiedassistants which have done more to protect the publicagainst unqualified practice and to elevate the professionthan any other measure adopted by the Council since theprofession has had the privilege of sending Direct Repre-sentatives to the Council.There are other points I would have desired to mention in

this address, but must deal with them at the public meetings.I would therefore conclude by thanking you for the generousconsideration shown towards me during my term of office,and by giving you the assurance that should you honour meby re-electing me as one of your representatives I shall, as inthe past, do all in my power to serve your interests and to

uphold the honour and dignity as well as the interests of ourprofession.

I remain, fellow practitioners, your obedient servant,6, Gibson-square, London,’N., October, 1901. GEORGE BROWN.

MR. GEORGE JACKSON’S ADDRESS TO THE REGISTEREDPRACTITIONERS OF ENGLAND AND WALES.

LADIES AND GENTLEMEN,—Having been invited by theIncorporated Medical Practitioners’ Association, in conjunc-tion with Mr. George Brown, to become a candidate as aDirect Representative on the General Medical Council, Ihave acceded to their request, and am encouraged to do soby the fact that I obtained 4082 votes at the last election,although very late in the field.On the last occasion, omitting a bye-election caused by

the resignation of Dr. Rentoul, the contest turned principallyon the question of the registration of midwives, the votes infavour of it being only 8443, as against 26,040. I am now,as then, opposed to the registration of midwives, the creationof an inferior order of practitioners. The only way to settlethis vexed question is by the registration of all nurses, whowill be obliged to act under the direct control of dulyqualified medical practitioners.The objects which should engage the attention of the

General Medical Council in the immediate future should bein my opinion :

1. The reform of the Medical Acts, so as to provide fordirect representation of the medical profession in every caseexcept the Crown nominees.

2. Raising the standard of the entrance examinations andlimiting the age of entrance so as not to be under 17 years.

3. The one-portal system of entrance to be secured byforming a Board of Examiners, composed of delegates fromthe present examining bodies.

4. Such an alteration of the Acts which will give theCouncil power to suppress quacks, &c., who practise medicineand surgery under various forms of colourable pretences.

5. A more definite pronouncement against medical men

acting as medical advisers to clubs and insurance societieswhose agents tout for members.

For the information of those to whom I am unknown

personally I may state that I have taken an active part inmedical politics for more than 20 years. In conjunction withMr. Reginald Harrison I set on foot some 20 years ago amovement which had for its object the voting by votingpapers for the election of members of the Council of theRoyal College of Surgeons, which was successful. About 15to 16 years ago I endeavoured to establish locally a medicalsick assurance society, and thus helped to prepare the wayfor the society which at present exists, and does such goodwork. In 1895 I was President of the IncorporatedMedical Practitioners’ Association, and had previouslyfounded the Devon and Cornwall local branch of the-same, which has done good work in checking irregularpractice and the like. Last year I was a delegate of thePlymouth Medical Society to the medical organisationmeeting at Manchester, and was appointed a member of thecommittee, which has had a great deal to do with the reformof the British Medical Association.

I have assisted in the work of establishing the ThreeTowns (Plymouth, Devonport, and Stonehouse) Provident

Dispensary in conjunction with the local branch of the

Incorporated Medical Practitioners’ Association, which workson the principle of a wage-limit, the management being,entirely in the hands of the members of the staff.Asking the favour of your vote and interest,

I remain, your obedient servant,GEORGE JACKSON,

F.R.C.S. Eng., ex-President and Vice-President of the IncorporatedMedical Practitioners’ Association and of the Devon and CornwallBranch of the same, and ex-President of the Plymouth MedicalSociety.

10, Portland-villas, Plymouth, October, 1901.

DR. GLOVER.

Dr. Glover has, we regret to learn, lately suffered from abad eye ; he is now, however, much better. We are asked

by him to say that he regrets much that, acting under strictmedical advice, he is obliged to abstain from attending allpublic meetings for the present.

’ He feels confident that his constituents will realise withwhat reluctance he has to decline invitations from variousplaces where it would be a great pleasure to him to meetthem for the discussion of current questions. He venturesto hope that the inconvenience to them will be lessened bythe fact that his views have been fully stated and reportedon several recent occasions.

MR. VICTOR HORSLEY.When Mr. Horsley was elected a Direct Representative of

the profession on the General Medical Council at a by-election he said that when the next quinquennial electioncame round he would resign and offer himself for re-electionat the same time as the other candidates, thereby saving theprofession the expense of multiple elections. He is now

legally advised that he cannot take this course, as the

wording of the Act places any man who resigns his seat onthe General Medical Council in the position of a dead man.A successor must be elected ; he cannot himself bere-elected.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 33 of the largest English towns 6451 births and 3684deaths were registered during the week ending Oct. 19th.The annual rate of mortality in these towns, which hadbeen 15’6 and 15’9 per 1000 in the two preceding weeks,further rose last week to 16’8 per 1000. In London thedeath-rate was 16’0 per 1000, while it averaged 17-3 inthe 32 large provincial towns. The lowest death-ratesin these towns were 10-3 in Derby, 11’1 in Bristol, 11’2 inCroydon, and 11’5 in Huddersfield ; the highest rates were21-9 in Salford, 22-0 in Blackburn, 26-9 in Newcastle, and28’8 in Gateshead. The 3684 deaths in these towns lastweek included 467 which were referred to the principalzymotic diseases, against 525 and 485 in the two

preceding weeks ; of these 467 deaths, 168 resulted fromdiarrhoeal diseases, 81 from measles, 71 from diphtheria,59 from "fever" (principally enteric), 47 from scarlet

Page 2: VITAL STATISTICS

1152 VITAL STATISTICS.-THE SERVICES.

fever, 30 from whooping-cough, and 11 from small-pox.No deaths from any of these diseases occurred in Croydonor in Derby ; in the other towns they caused the lowestdeath-rates in Cardiff, Swansea, and Halifax, and the highestrates in West Ham, Norwich, Blackburn, Sheffield, and’Gateshead The greatest proportional mortality from measleswas recorded in Norwich, Blackburn, and Sheffield ; fromscarlet fever in Salford ; and from diarrhoeal diseases inWest Ham, Hull, Gateshead, and Newcastle. The mortalityboth from whooping-cough and from fever" " showedno marked excess in any of the large towns. The71 deaths from diphtheria included 33 in London, six in

, Sheffield, five in Leicester, four in Brighton, three in Ports-mouth, and three in Leeds. Eleven fatal cases of small-poxwere recorded in London, but not one in any other of the33 large towns ; there were 172 cases of small-pox undertreatment in the Metropolitan Asylums hospitals on

Saturday, Oct. 19th, against numbers increasing from 11to 175 on the 10 preceding Saturdays ; 47 new cases

were admitted during the week, against 44, 51, and 37 inthe three preceding weeks. The number of scarlet feverpatients in these hospitals and in the London Fever

Hospital, which had risen from 2994 to 3280 at the end ofthe six preceding weeks, had further increased to 3346 onSaturday last; 407 new cases were admitted during theweek, against 460, 426, and 422 in the three precedingweeks. The deaths referred to diseases of the respiratoryorgans in London, which had been 137, 132, and 186 in thethree preceding weeks, further rose last week to 196, but were’72 below the corrected average number. The causes of 39,or 1.1 per cent., of the deaths in the 33 towns last weekwere not certified either by a registered medical practitioneror by a coroner. All the causes of death were dulycertified in Nottingham, Bradford, Leeds, Hull, and in 12-other smaller towns ; the largest proportions of uncertifieddeaths were registered in Birmingham, Leicester, Liverpool,Blackburn, and Sunderland.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 14’5 and 16’1 per 1000 in the two pre--ceding weeks, further rose to 16’9 per 1000 during the weekending Oct. 19th, and was slightly above the mean rate

during the same period in the 33 large English towns.The rates in the eight Scotch towns ranged from 11-8 inAberdeen and 13-4 in Leith to 18-9 in Perth and 22-9in Greenock. The 537 deaths in these towns included.30 from diarrhoea, 15 from measles, 12 from diphtheria,12 from whooping-cough, five from scarlet fever, and fivefrom "fever." In all. 79 deaths resulted from these

principal zymotic diseases last week, against 82 and 62 inthe two preceding weeks. These 79 deaths were equal toan annual rate of 2’5 per 1000, which was 0-4 above the ezymotic death-rate last week in the 33 large English towns.The fatal cases of diarrhoea, which had declined from 53 to32 in the four preceding weeks, further fell last week to

- 30, of which 11 occurred in Glasgow, five in Dundee, fourin Edinburgh, three in Aberdeen, and three in Paisley.The deaths from measles, which had been 12, 14, and sixin the three preceding weeks, rose again to 15 last week,and included 14 in Glasgow. The fatal cases of diphtheria,which had been six in each of the two preceding weeks,increased last week to 12, of which seven were registered in

- Glasgow and two in Greenock. The deaths from whooping-- cough, which had declined from 13 to five in the four

preceding weeks, rose again to 12 last week, andincluded eight in Glasgow and three in Edinburgh. Thefatal cases of scarlet fever, which had been seven in each ofthe two preceding weeks, declined last week to five, of whichtwo occurred in Glasgow and two in Greenock. The deathsreferred to different forms of "fever." which had been six in -each of the two preceding weeks, decreased to five last week,and included three in Edinburgh. The deaths attributed todiseases of the respiratory organs in these towns, whichhad been 101, 77, and 75 in the three preceding weeks, roseagain last week to 97, but were 20 below the number inthe corresponding period of last year. The causes of 22, ],or more than 4 per cent., of the deaths in these eight townslast week were not certified. :

-

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 17 -8, 19 -9, and1.9’7 per 1000 in the three preceding weeks, rose again to19’9 per 1000 during the week ending Oct. 19th. During the

past four weeks the death-rate has averaged 19 ’3 per 1000,the rates during the same period being 15’2 in Londonand 15-6 in Edinburgh. The 143 deaths of persons belong-ing to Dublin registered during the week under noticewere within one of the number in the preceding week,and included 10 which were referred to the principalzymotic diseases, against 17, 20, and 21 in the three

preceding weeks; of these, five resulted from diarrhoea,three from "fever," one from diphtheria, and one

from whooping-cough. These 10 deaths were equalto an annual rate of 14 per 1000, the zymoticdeath-rates during the same period being 1’8 in Londonand 2-0 in Edinburgh. The fatal cases of diarrhoea,which had been 11, 9, and 14 in the three precedingweeks, declined again to five last week. The deaths referredto different forms of "fever," which had been three, eight,and six in the three preceding weeks, further declinedlast week to three. The 143 deaths in Dublin last weekincluded 36 of children under one year of age and 42of persons aged upwards of 60 years ; the deaths of infantscorresponded with the number recorded in the precedingweek, while those of elderly persons showed a very markedincrease. Six inquest cases and three deaths from violencewere registered ; and 47, or about one-third, of the deathsoccurred in public institutions. The causes of four, or nearly3 per cent., of the deaths in Dublin last week were notcertified.

____________

THE SERVICES.

REFORM IN THE WAR OFFICE.THE following statement has been issued by the War Office

with regard to the War Office Council.1. The Secretary of State has directed that in future the

War Office Council shall be constituted as follows :—

President-The Secretary of State for War.

Members-The Commander-in-Chief.

, The Parliamentary Under-Secretary of State.!, The Permanent Under-Secretary of State.’ The Financial Secretary.

The Quartermaster-General.The Inspector-General of FortificationsThe Director-General of Ordnance.The Adjutant-General.The Director-General of Mobilisation and Military In-

telligence.The Director-General, Army Medical Department (for

medical and sanitary questions).The Secretary of the Council.And such other members of the Staff of the War Office as

may be specially summoned from time to time.2. In the absence of the Secretary of State the Commander-

in-Chief will act as President.3. The Council will meet on Mondays, unless otherwise

ordered. at 12 o’clock, in the Secretary of State’s room.4. The Council will discuss such matters as may be referred

to it by the Secretary of State and any question broughtbefore it by individual members. In order that a rprécis maybe prepared notice of the matters for discussion, together .

with the office papers on the subject, should reach the

Secretary not later than the Wednesday evening before eachmeeting.

5. Records of the proceedings will be kept and copies willbe supplied to each member.

In addition to the foregoing there is to be a PermanentExecutive Committee of the War Oifice, under the presidencyof the Permanent Under-Secretary of State, or in his absenceof the Assistant Under-Secretary of State, with certainmilitary and other officials, and the Deputy-Director-General,Army Medical Department, or an officer selected by theDirector-General, as members ; and the present Army Board,of which the Director-General of the Army Medical Serviceis constituted a member, will be continued. Special depart-mental committees will also be formed on approval of theSecretary of State for War whenever required, and forwardtheir reports in the first instance marked to the Secretary ofthe War Office Council.

ROYAL NAVY MEDICAL SERVICE.The following appointments are notified :-Staff Sur-

geon T. J. Crowley to the President, additional, for three