SUPPL:EMENTT TO TH BRITISH MEDICAL JOURNAL.

LONDON: SATURDAY, DECEMBER 5TH, 1908. CONTENTS.

PAGE PAGE THE SEVENTY-SEVENTH ANNUAL MEETING OF THE ASSOCIATION NOTICES ...... 299 BRITISH MEDICAL ASSOCIATION: PROGRAMME OF BsI ...... E...... 293 GENERAL MEDICAL COUNCIL: 26th MEETINGS OF BRANCHES DIVISIONS: Thursday, NVovember 9 AND Friday,November 27th ... 300 Bath ...... and ... Bristol Branch ... 295 S 28t7i 301 rday,.November ...... Gibraltar Branch ...... 295 Saturday, November 28t h...... 301... Gloucestershire Branch ...... 295 Report of the Education Commiittee ...... 303

Metropolitan Counties Branch: Chelsea Division ...... 296 NAVAL AND MILITARY APPOINTMENTS ...... 313 City Division ...... 296 VITAL STATISTICS ...... 314 Hampstead Division.. ... 296 VACANCIES AND APPOINTMENTS ...... 314 :South-Eastern Branch: Brighton, Tunbridge Wells,Eastbourne, and Hastings Divisions ...... 297 BIRTHS, MARRIAGES, AND DEATHS ...... 315 Chichester and Worthing Division 297 DIARY FOR THE WEEK ...... 315 ...... 31 Reigate Division ...... 297DIRFOTHWEK. ,-Southern Branch: Guernsey and Alderney Division ... 297 BOOKS, ETC., RECEIVED ...... 315 South Wales and Branch: Cardiff Division 298 CALENDAR ...... 316 ... Monomnouthshire ...

THE SEVENTY-SEVENTH ANNUAL MEETING OF THE BRITISH MEDICAL ASSOCIATION,

JULY 23RD TO JULY 31ST, 1909. President: SIMEON SNELL, D.Sc., F.R.C.S.Edin., Ophthalmic Surgeon, Royal Infirmary, Sheffield. President-eiect: Sir WILLIAM WHITLA, M.D., LL.D., Professor of Materia Medica and Therapeutics, Queen's College, Belfast. Past-President: HENRY DAVY, M.D., F.R.C.P.Lond., Physician, Royal Devon and Exeter Hospital, Exeter. Chairman of Representative Meetings: JAMES ALEXANDER MACDONALD, M.D., M.Ch., R.U.I., Physician, Taunton and Somerset Hospital. Chairman of Council: EDMUND OWEN, D.Sc., LL.D., F.R.C.S., Consulting Surgeon to St. Mary's Hospital, London. Treasurer: EDWIN RAYNER, M.D.Lond., F.R.C.S., Surgeon, Stockport Infirmary, Stockport. The Seventy-seventh Annual Meeting of the British Medical Association will be held in Belfast in July, 1909. The President's address will be delivered on Tuesday, July 27th, and the Sections will meet on the three following days. The Annual Representative Meeting will begin on Friday, July 23rd, 1909. PROGRAMME OF BUSINESS. The Address in Medicine will be delivered by FREDERICK TAYLOR,, M.D., F.R.C.P., Consulting Physician, Guy's Hospital. P-rofessor KOCHER has been invited to deliver the Address in Surgery. The Address in Obstetrics will be delivered by Sir JOHN W. BYERS, M.D., Professor of Midwifery and Diseases of Womien, Queen's College, Belfast. The Popular Lecture will be delivered by Dr. J. A. MACDONALD, Physician to the Taunton and Somerset Hospital, Chairman of the Representative Meetings. THE SECTIONS. The scientific business of the meeting will be conducted that Section, and exercise the power of inviting, accepting, in fifteen Sections, which will. meet on Wednesday, or declining any paper, and of arranging the order in July 28th, Thursday, July 29th, and Friday, July 30th. which accepted papers shall be read. Communications The President, Vice-Presidents, and Honorary Secretaries with respect to papers should be addressed to one of the of each Section constitute a Committee of Reference for i Honorary Secretaries. (242) sv"=Nuw To TIM OF MEETING. -5,5 o 294- a Bm== X=I"L JOURAMI PROGRAMMEGE- ANN-UAL [DEC. TW8. A paper read in the Section must not exceed fifteen MEDICINE. minutes, and no subsequent speech must exceed ten President: Professor JAMES ALEXANDER LINDSAY, M.D., minutes. F.R.C.P., 2, Queen's Elms, Belfast. Papers read are the property of the British Medical Vice-Presidents: ARTHUR FOXWELL, M.D., F.R.C.P., Association, and cannot be published elsewhere than in the 47, Newhall Street, Birmingham; JOSEPH FRANCIS BRITISH MEDICAL JOURNAL wuithout special permission. O'CARROLL, M.D., F.R.C.P.I., 43, Merrion Square, Dublin*- LAURISTON ELGIE SHAW, M.D., F.R.C.P., 64, Harley Street, The following are the general arrangements so far as London; WILLIAM BAIRD MCQUITTY, M.D., 8, College- they are yet complete: Square East, Belfast. Honorary Secretaries: JOHN SMYTH MORROW, M.D`., ANATOMY AND PHYSIOLOGY. Eia House, Antrim Road, Belfast; LEWIS ALBERT SMITH, President: CHARLES SCOTT SHERRINGTON, M.D., F.R.S., M.D., 25, Queen Anne Street, London, W.; JOHN ELDEP Physiological Laboratory, University, Liverpool. MACILWAINE, M.D., 55, University Road, Belfast. Vice-Presidents: Professor THOMAS HUGH MILROY, M.D., F.R.S.E., Queen's College, Belfast; Professor PETER NAVY, ARMY, AND AMBULANCE. THOMPSON, M.D., King's College, Strand, London; ARTHUR President: Fleet Surgeon J. LLOYD THOMAS, R.N. PHILIP BEDDARD, M.D., F.R.C.P., 44, Seymour Street, Vice-Presidents: Inspector-General ROBBRT BENTHANT Portman Square, London, W. R.N. (retired), 22, King's Avenue, Ealing, London, W.; Honorary Secretaries: ALEX. Low, M.B., 142, Blenheim Lieut.-Colonel R. PORTER, R.A.M.C., P.M.O., Station. Place, Aberdeen; JOHN ALEX. MILROY, M.D., Queen's Hospital, Military Barracks, Belfast; Colonel THOMAS H. College, Belfast. HENDLBY, I.M.S., C.I.E., 4, Loudon Road, London, N.W. Honorary Secretaries: Captain M. LOWSLEY, R.A.M.C., DERMATOLOGY AND ELECTRO-TTHERAPEUTICS. St. Michael's Road, Aldershot; Lieutenant HERBERr President: WILLIAM CALWELL, M.D., 6, College Gardens, HUGH BLAIR CUNNINGHAM, M.D., R.A.M.C.(Mil.), 69, Uni- Belfast. versity Road, Belfast. Vice-Presidents: ROBERT BRIGGS WILD, M.D., 96, Mosley Street, Manchester; LESLIE ROBERTS, M.D., 46, Rodney OBSTETRICS AND GYNAECOLOGY. Street, Liverpool. President: JOHN CAMPBELL, M.D., Crescent House, Honorary Secretaries: JAMES HARRY SEQUEIRA, M.D., University Road, Belfast. F.R.C.P., 8A, Manchester Square, London; S. ERNEST Vice-Presidents: ROBERT ALEXANDER GIBBONS, M.D., 29, DORE, M.D., 26, New Cavendish Street, London; JOHN Cadogan Place, London; JOHN SINGLETON DARLING, M.B., CAMPBELL RANKIN, M.D., 38, University Road, Belfast. High Street, Lurgan; CHARLES EDWIN PURSLOW, M.D., 192, Broad Street, Birmingham; EWEN JOHN MACLEAN, Cardiff. DISEASES OF CHILDRENs M.D., 12, Park Place, F.R.C.S.Edin., 9, Great Honorary Secretaries: HENRY THOMAS HICKS, F.R.C.S., President: HAROLD J. STILES, Derby; ROBERT JAMES JOHNSTONE, M.B., 65, GreaL Stuart Street, Edinburgh. Victoria Street, Belfast. Vice-Presidents: JOHN MCCAW, M.D., 74, Dublin Road, Belfast; RICHARD WHYTOCK LESLIE, M.D., " St. Heliers," OPHTHALMOLOGY. Strandtown, Belfast; ROBERT CAMPBELL, F.R.C.S., 21, President: JOHN WALTON BROWNE, M.D., 10, Colleg- Great Victoria Street, Belfast. Square, Belfast. Honorary Secretaries: ANDREW FULLERTON, F.R.C.S.I., Vice-Presidents: ARTHUR W. SANDFORD, M.D., 13, St& 8, University Square, Belfast. Patrick's Place, Cork; WILLIA31 MARCUS KILLEN, M.D., 9, Clifton Street, Belfast; ALEX. HILL GRIFFITH, M.D., HAEMATOLOGY AND VACCINE THERAPY. 17, St. John Street, Manchester. President: Sir ALMROTH WRIGHT, M.D., F.R.S., 6, Park Honorary Secretaries: JAMES ANDREW CRAIG, M.B., Crescent, Regent's Park, London, N.W. 11, University Square, Belfast; LESLIEs JOHNSTON PATON, Vice-Presidents: THOMAS HOUSTON, M.D., 95, Great F.R.C.S., 1, Spanish Place, Manchester Square, London. Victoria Street, Belfast; Captain STEWART RANKIN 1)OUGLAS, I.M.S., Inoculation Department, St. Mary's Hospital, PATHOLOGY. London. President: Professor WM. ST. CLAIR SYMMERS, M.B., Honorary Secretaries: WILLIAM DUNLOP DONNAN, M.D.,, Queen's College, Belfast. 12, High Street, Holywood, co. Down; DUDLEY W. Vice-Presidents: WALTER SYDNEY LAZARUS-BARLOW, M.D.,. CARMALT-JONES, M.B., B.Ch.Oxon., 78, Wiwpole Street, Cancer Research Laboratory,AMiddlesex Hospital, London; London, W. ARTHUR EDWARD MOORE, Mi.B., Castlemahon, Blackrock,. Cork; ASTLEY VAVASOUR CLARKE, M.D., 37, London Road,. INDUSTRIAL DISEASES AND PUBLIC HEALTH. Leicester; Professor I. WALKER HALL, M.D., 9, Royal Park, President: Louis COLTMAN PARKES, M.D., 61, Cadogan Clifton, Bristol. Square, Chelsea, London. Honorary Secretaries: ALFRED EDWARD BARNES, M.B.,. Vice-Presidents: SAMUEL AGNEW, M.D., Lurgan, co. 40, Elmore Road, Sheffield; OTTO F. F. GRUNBAUM, M.D.>, Armagh; HENRY O'NEILL, M.D., 6, College Square East, 34, Wixnpole Street, London, W. Belfast; CHARLES KILLICK MILLARD, M.D., Town Hall, Leicester. PHARMACOLOGY AND THERAPEUTICS. Honorary Secretaries: CHARLES PORTER, M.D., Public President: Health Department, Town Hall, Finsbury; WILLIAM Vice-Presidents: Professor WALTER ERNEST DIXON, M.D.,. MCLORINAN, L.R.C.P., 103, Antrim Road, Belfast; THOMAS Pharmacological Lsboratory, Cambridge; NEWMAN NEILD, CARNWATH, M.B., Ladywell Sanatorium, Salford, M.D., 9, Richmond Hill, Clifton, Bristol. Manchester. Honorary Secretaries: VICTOR GEORGE LEOPOLD FIELDEN,- M.B., 84, Dublin Road, Belfast; HECTOR CHARLES CAMEaON, LARYNGOLOGY, OTOLOGY, AND RHINOLOGY. M.B., Guy's Hospital, London, S.E. President: STCLAIR THOMSON, M.D., F.R.C.P., 28, Queen Anne Street, London. PSYCHOLOGICAL MEDICINE. Vice-Presidents: ERNEST BLECHYNDEN WAGGETT, M.B., President: OUTTERSON WOOD, M.D., 40, Margaret Street, 45, Upper Brook Street, London, W. ; V. P. HENRY Cavendish Square, London. SMURTHWAITE, M.D., 8, St. Mary's Place, Newcastle-on- Vice-Presidents: GEORGE ROBERT LAWLESS, F.R.C.S.I., Tyne; J. A. KNOWLES RENSHAW, M.D., 11, St. John Street, District Asylum, Armagh; WM. RICHARD DAWSON, M.D., Manchester. 41, Upper Fitzwilliam Street, Dublin. Honorary Secretaries : ROBERT ALLEN, M.B., 5, Queen's Honorary Secretaries: WALTER SAMUEL SMYTH, M.B.,_ Elms, Belfast; HAROLD SHUTTLEWORTH BARWELL, F.R.C.S., District Asylum, Antrim; SIDNEY HERBERT CLARKE, M.B., 55, Wimpole Street, London; JOHN STODDART BARR, M.B., Leicester and Rutland Asylum, Narborough, Leicester- 13, Woodside Place, Glasgow. shire. SUPLEIIT To TU OEC. 5, igo8.] MEETINGS OF BRANCHES AND DIVISIONS. [BITSHMDICAL JOURNAL r295 SURGErRY. President: Professor THOMAS SINCLAIR, M.D, F.R.C.S., 22, University Square, Belfast. -tttmiU& of rubte & ibizi . Vice-Pre8ident8: CHARLES ALFRED BALLANCE, M.V.O., [The proceedings of the Divisions and Branches of the M.S., F.R.C.S., 106, Harley Street, W.; Sir PETER and A)'CONNELL, M.D., 9, College Square North, Belfast; whenAssociation relating to Scientif Clnical Medicine, ARTHUR JOHN DREW, F.R.C.S., Water Hall, St. Aldate's, reported by the Honorary Secretaries, are published Oxford; JOHN GALWAY COOKE, M.B., City and County in the body of the JOURNAL.] Infirmary, Londonderry; ARTHUR BROWNLOW MITCHELL, F.R.C.S.I., 18, University Square, Belfast. BATH AND BRISTOL BRANCH. THE third ordinary meeting of the session was held at Honorary Secretaries: W. THELWELL THOMAS, F.R.C.S., Bath on November 25th, Mr. PAUL BUSH, C.M.G., Presi- ,84, Rodney Street, Liverpool; G. LENTHAL CHEATLE, C.B., dent, in the chair. Thirty-seven members and visitors F.R.C.S.,117, Harley Street, London; HOWARD STEVENSON, were present. iI.R.C.S.I., 11, Clifton Street, Belfast; JAS. BERNARD MOORE, Cases and Papers.-Dr. G. H. H. ALMOND showed a baby M.B. 11, Clifton Street, Belfast. suffering from oxycephaly, and remarks were made upon it by Mr. W. M. BEAUMONT. Dr. A. E. NORBURN read a TROPICAL MEDICINE. paper on tumours of the frontal lobes, and showed a President: CHARLES WILBERFORCE DANIELS, M.B., London specimeu. Drs. PARKEY and CAREY CooMiBs discussed the 'School of Tropical Medicine, Albert Docks, London. paper. Dr. HERBERT P. TAYLER read a paper on electro- Vice-Presidents: Lieutenant-Coloael ANDREW DEANE, therapeutics in general practice, and in the discussion 1.M.S., Royal Victoria Hospital, Belfast; Surgeon-General which ensued Dr. PARKER, Dr. WILLS, Dr. WHITBY, and W. R. BROWNE, M.D., C.I.E., 5, Royal Crescent, Holland Dr. GRIFFITHS took part. Dr. RUPERT WATERHOUSE com- Park Avenue, London. municated a paper on intestinal diverticula, and remarks were made by Dr. TABOR. Dr. NEWMAN NEILD and Dr. Honorary Secretaries: JAMES COLVILLE, M.D., 7, Uni- E. V. DUNKLEY collaborated in a paper on the role of the versity Square, Belfast; Dr. ANTON BREINL, Director saliva in the transmission of tubercle. ltuncorn Research Laboratories. GIBRALTAR BRANCH. Farewell Dinner to Deputy Inspector-General James.- PROVISIONAL TIME TABLE. On October 29th the Gibraltar Branch of the British Medical Association entertained at a farewell dinner at the Grand Hotel, Deputy Inspector-General C. James, FRIDAY, JULY 23RD, 1909. R.N., late President of the Branch and a member of 11 A.M.-Annual General Meeting followed by Repre Council, who was on the point of departure to take up his sentative Meeting. new duties at the Admiralty. Dr. NEIL OMAN, the Presi- dent, presided, and the following members of the profession SATURDAY, JULY 24TH, 1909. were present: Drs. Abrines, Baca, Dowding, Gill, Lyons, and Parsons (Honorary Secretary); R.N.: Deputy Inspector- 9.30 A.M.-Representative Meeting. General Lilley, Fleet Surgeon Jeans, Staff Surgeons Hall and Ramsay; R.A.M.C.: Colonel Murray, Lieut.-Colonel MONDAY, JULY 26TH, 1909. Whaite," Majors Keble, Fowler, Berryman, and Howell. 10 A.M.-Representative Meeting. The King" having been duly honoured, Dr. NEIL OMAN 7.30 P.M.-Annual Conference of Secretaries of Divisions. proposed in a very pithy speech the health of Dr. James. This was given with musical honours. In his reply, Dr. TUESDAY, JULY 27TH, 1909. JAMES referred to the excellent work the British Medical Association had done and was doing in Gibraltar by its 10 A.M.-Council Meeting. meetings for the discussion of subjects of medical interest, 10.30 A.M.-Representative Meeting (if required). its action in the promotion of the Midwives Ordinance 2.30 P.M.-Adjourned General Meeting. and the notification of infectious diseases, and in bringing Induction of President. to the notice of His Excellency the Governor and the '8.30 P.M.-President's Address. Colonial Government sundry matters concerning medical practice in Gibraltar; in a few graceful words he thanked WEDNESDAY, JULY 28TH, 1909. the members for the honour done him. Dr. PARSONS followed with a detailed account of the personal active 9.30 A.M.-Council Meeting. work done by Dr. James for the Association, including the 10.30 A.M.-Representative Meeting (if required). leading of two deputations to His Excellency in the matter 10 A.M.-Setional Meetings. of the Midwives Ordinance and of irregular medical 12.30P.M.-Address in Medicine. 8.30P.M.-Reception. practice in Gibraltar. A meeting of the Branch was held on November 3rd THURSDAY, JULY 29TH, 1909. Dr. OMAN, President, in the chair. .9.30 A.M.-Council Meeting. Tuberculosis in Gibraltar.-The subject of tuberculosis 10 A.M.-Sectional Meetings. in Gibraltar was discussed. It was noted that about 20 ,12.30P.M.-Address in Surgery. persons died yearly of consumption in Gibraltar, and that 7.30P.M.-Annual Dinner. the number of persons continually suffering from tuber- culous disease was about 400. The meeting was strongly FRIDAY, JULY 30TH, 1909. of opinion that some form of public dispensary for diseases of thechest and a sanatoritum for the early treatment of 10 A.M.-Sectional Meetings. cases and for incurable cases were necessary in Gibraltar. 12.30 P.m.-Address in Obstetrics. The necessity of the education of sufferers in order to 8 P.m.-Popular Lecture. prevent the spread of the disease was also insisted upon. -8.30P.M.-Reception. Different sites for a sanatorium weresugg ested and the results of the discussion placed at the disposal of the SATURDAY, JULY 31ST, 1909. medical officer of health. Excursions. GLOUCESTERSHIRE BRANCH. THE first general meeting for the session 1908-9 was held Ilnrary Local Secretary- at the Cheltenham Hospital on November 19h. In the absence of Dr. Ancrum, Dr. SOUTAR WaS voted to the chair. CECIL EDWARD SHAW, M.D., M.Ch., Conftirnation of Minutes-The minutes of the last 29, University Square, Belfast. meeting were read and confirmed. ,296 75,u " 2= AND 'DIVISIONS. 296 MEETINGSMETNS OFOFBACESBRANCHES IVSOS [E.55,.196& -5UTSIDGLOUn-*Umoz Us -"L.T AZI AE [DEC- igo.x6 Lynn Thomas and Skyrme Fund.- The SECRETARY passed at the Representative Meeting in July, and it was announced that the total sum sent to the Lynn Thomas moved by Dr. BUTLER and seconded; and Skyrme Fund was £6 5s., owing to two subscriptions That this Division heartily agrees with theresolution since last meeting. aforesaid. Tie late Dr. E. W. Henley.-It was proposed by Dr. Carried nem. con. The CHAIRMAN moved: SOUTAR, seconded by Dr. CARTER, and carried, that a vote of condolence should be sent to the relations of the late That in future the proceedings at the Division meetings bbk Dr. Edward Whishaw Henley and to the staff of the reported in the JOURNAL. Gloucester County Asylum-in their bereavement. This was agreed to. President's Address. Dr. CARTER, the President for the Paper.--Mr. WILLIAM LLOYD then gave a short addres& session 1908-9, then took the chair, and delivered his on asthma, its causes and treatment. An interesting dis- presidential address, entitled, Of Drugs and Diet- cussion followed, in which several members took part. Quantum Sufficit. Dr. GARDNER claimed that chloretone was a specific foi Vote of Thanks.-A vote of thanks to the President for the paroxysms. his interesting paper was proposed by Dr. OSCAR CLARK, Vote of Thanks.-A hearty vote of thanks was passed to. seconded by Mr. HOWELL, and unanimously carried. Mr. Lloyd for his practical address. CITY DIVISION. METROPOLITAN COUNTIES BRANCH: A CLINICAL meeting was held in the new Electrical CHELSEA DIVISION. Department of St. Bartholomew's Hospital on November A MEETING of this Division was held at the Fulham Town 12th. There were present 16 members and 4 visitors. Hall on October 13th last, Dr. P. H. PARSONS in the chair. Dr. GOODALL presided. Tea was kindly provided an. Confirmation of Minutes.-The minutes of the last arrival. meeting were read and confirmed. Cases, etc.-Dr. LEWIS JONES showed the following Charges of Unprofessional Conduct.-Charges of un- cases: (1) An electric burn. (2) A case of atrophy of the professional conduct against two medical men practising pectoralis major. (3) A case of atrophy of the latissimus- in the district were discussed, and in both instances the dorsi. (4) A case of atrophy of the deltoid, biceps, andk Secretary was instructed to send warning letters. supinator longus muscles in a woman with a history of Recommendatons of Executive Committee. -Certain syphilis. (5) An extensive naevus of the face, showing, recommendations of the Executive Committee were then good scar after treatment. (6) A case of paralysis of discussed: trapezius following operation for removal of cervical (a) That a Subcommittee, consisting of the Chairman, Drs. glands of neck. Mr. SPICER showed a chronic ulcer of Young, Butler, Keen, Hamilton, and the Secretary, be eye healed after an application of zinc by the ionic appointed to inquire into the management of the clubs in method. Dr. FLAVELLE exhibited a number of interesting the area of the Division, and for that purpose to invite the plates showing injuries about the elbow-joint, also tumours. medical officers thereof to meet the members of the Division Mr. PIRIE showed benefit at a special meeting to discuss the subject. of bones. plates demonstrating of x rays in enlarged cervical glands. Dr. WALSHAWF Dr. O'SULLIVAN moved, and Dr. GARDNER seconded, its showed plates of instantaneous photography of tuberculous adoption. Carried nem. con. lungs. (b) That members of the Association who are on the staffs of Vote of Thanks.-A hearty vote of thanks was unanib- the hospitals and similar institutions in the area of the accorded to the demonstrators. Division be elected honorary members of the Division. mously Dr. BUTLER said that after further consideration he did HAMiPSTEAD DIVISION. not see any reason why they should confer any such A MEETING of this Division was held on Tuesday, Novem- honour upon the members of hospital staffs. Could any ber 24th, at the West Hampstead Town Hall, at 5 p.m.,. one name any benefits that those gentlemen had bestowed Dr. OPPENHEIMER in the chair. upon them? He mentioned one or two instances of Confirmation of Minutes.-The minutes of the last- hospital abuse, and moved as an amendment: meeting were read and confirmed. Letters.-A letter from the General Secretary on the- That the members of the staffs of local hospitals and similar of books for Divisional libraries was- institutions be invited to meet the m smbers of the Division subject supplying the- once a year to discuss,their mutual relations. read. The HONORARY SECRETARY drew attention to fact that the Committee had formally renewed the This was seconded by Dr. LINDSAY. The CHAIRMAN Warning Notice against the Hampstead Hospital. A pointed out that the object of the recommendation was to message was received from Dr. James Stewart regretting- provide opportunities for mutual intercourse between the inability to be present. members of the local hospital staffs and the general prac- Branchi Meeting.-Mr. PARSONS reported in detail the titioners, who would thus be able to indicate in what way proceedings at the Branch Council meeting of October 16th. the various forms of hospital abuse to which Dr. Butler Mr. HUMPHREYS asked if attendance and voting of repre- had referred might be remedied. The amendment was sentatives could be recorded. then put and carried by a large majority. Representative's Report.-Mr. H. W. ARMIT reported at. (c) That an annual dinner be held, at which these gentlemen length on the most importAnt proceedings of the Repre- (namely, the members of the hospital staffs referred to in sentative of 1908. He that he had been. the Meeting reported previous recommendation) and their colleagues would appointed a member of the Medico-Political Committee meet us. and of the Committee of the United Kingdom Hospitals, After deletion of all the words after " held," this recom- Conference. Mr. PARSONS proposed: mendation was carried unanimously. That the report be received and a vote of thanks passed to- (d) That the establishment of a local medical library do Mr. Armit for his valuable services. receive consideration. This was seconded by Dr. ANDERSON and carried unani- The CHAIRMAN mentioned that the Division had an offer mously. of surplus books from the Central Library, to form the School Clinics.--The HONORARY SECRETARY read resolu- nucleus of a local one. This recommendation was tions passed on October 9th by the St. Pancras Division adjourned for further consideration. opposing school clinics and asking for the support of other Doctors and Midwives. Dr. O'SULLIvAN asked if the Divisions in their opposition. He pointed out that the Division had made any suggestions to the guardians of Hampstead Division had on February 11th, 1908 (Set Chelsea or Fulham with reference to the fees for cases BRITISH MEDICAL JOURNAL SUPPLEMENT, February 22nd, attended by practitioners when called in by midwives p. 73 J), disapproved of school clinics. He therefore under the Midwives Act. The CHAIRMAN replied in the moved: negative. That the Hampstead Division support the St. Pancras- Proposed Putney Hospital Committee.-Dr. YOUNG was Division's resolutions opposing school clinics, in accordance elected to fill the vacancy on this committee caused by the with the past action of the Hampstead Division. resignation of Mr. Tanner. A letter was received from This was seconded by Dr. MACEVOY. Mr. ARMIT pointed the Honorary Secretary- of the above-mentioned com- out that the London County Council was determined to. mittee, enclosing a resolution relating thereto which was establish school clinics, and that it was the only way to, SUPPLEMENT TO T DEC. 5, izgo8.] MEETINGS OF BRANCHES' AND DIVISIONS. IBmTSH MEDICAL JOUNAL 297

ensure the satisfactory treatment of children found to be lant and that it lowered the blood pressure, and he denied defective. Dr. MACEVOY urged that these cases could and that alcohol was of value in the treatment of disease. The shoild be dealt with by private practitioners and provident address was well illustrated by lantern slides. An animated dispensaries and by the establishment of a public medical discussion followed, some nine members speaking after the service in connexion with dispensaries. Dr. A. W. address. WILLIAMS thought that the Division would be acting from Thirty-four members attended the meeting, and twenty- selfish motives if it opposed school clinics, and moved an three members dined together at the Queen's Hotel, amendment in favour of them, which was seconded by Hastings. Mr. ARMIT. The amendment was lost. The original resolution was then put and carried. CHICHESTER AND WORTHING DIVISION. Reports of Meetings.-It was resolved on Mr. ARMIT'S A MEETING of this Division was held at Worthing on motion: Tuesday, November 17th. Mr. W. S. SIMI-SON, the Chair- That it be an instruction to the Honorary Secretary that all man, presided, and fifteen other members were present. reports of Divisional meetings published in the BRITISH Confirmation of Minutes. The minutes of the previous MEDICAL JOURNAL should only contain accounts of scientific meeting were read and confirmed. matters and resolutions passed in connexion with matters which have been referred to the Division by the Central Place of Next Meeting.-It was decided to hold the Office. No reference to matters of a local or personal nature annual meeting at Bognor. shall appear in the reports, save when a resolution to the Warning Notice re Worthing M.O.H.- This matter effect that such matter shall be included in the published was referred to the meeting by the Public Health Com- report be passed by the meeting. mittee. The Medical Secretary, Mr. SMITH WHITAKER, Presentation to Dr. Yeld.-The third dinner of the addressed the meeting and offered suggestions as to the Hampstead Division was made the occasion for presenta- best way of closing the incident. Dr. WILSHAW, the tion to Dr. Yeld of an address and a handsome marble medical officer of health, attended the meeting as a clock with bronze figures, in recognition of his services as member of the Division, and answered questions put tQ Honorary Secretary for nearly five years-a period excep- him by various members. The CHAIRMAN, Dr. EUSTACE, tionally arduous in consequence of the Hampstead Hos- Dr. HIND, and Mr. WIGGINS spoke in the discussion which pital dispute. In introducing Dr. Yeld to the Chairman, ensued, and the feeling of the meeting was that, although Dr. FORD ANDERSON expressed the high appreciation of the in the interest of the Association it might be desirable to Division and of himself of the valuable services rendered withdraw the Warning Notice, yet the late medical officer by Dr. Yeld during a period of difficult and delicate nego- of health, Dr. Camerdn, had been extremely badly treated tiation-services characterized by strenuous methodical by the Worthing Council, and that the Council had treated work and infinite tact and discretion-adding that, while the Division with great discourtesy. The motion to with- Dr. Yeld was entitled to all credit for the work, he him- draw the notice was carried by a large majority, only 2: self claimed the pleasant reflection that he had been members voting against it. the means of bringing so able and energetic a worker Paper.-Major R. H. ELLIOT, I.M.S., read a paper on into' touch with the Division. Dr. OPPENHEIMER said: lacrymal obstruction. He said as a result of 310 con- It affords me the greatest pleasure that it falls to my lot secutive operations for extirpation of the lacrymal sac he to make this presentation on behalf of the Division. was strengly of the opinion that the results are far Nobody can have been associated with Dr. Yeld on the superior to the ordinary probe treatment. In 99 per cent. Committee, no one can have attended even a single of the cases the patient was greatly relieved by the Divisional meeting without being impressed with the operation, and the wound healed by first intention in manner in which he at all times discharged the duties of 97 per cent. of his cases. Major Elliot went minutely his office. No better proof can be given of the recognition through the steps of the operation, pointing out the diffi- of his services on all sides than the fact that it appears culties and the possible complications. In one case he impossible to discover the paternity of the idea of present- had extirpated the sac in 4. minutes. He had traced ing him with this mark of our appreciation and esteem. nearly all his cases, and found that any remembrance of It arose simultaneously in several minds, and met with trouble was extremely rare. ready and generous response on all sides. In making this Dinner.-After the meeting the members dined together presentation I act only as your representative. It would at Warne's Hotel. therefore be out of place and assuming on my part to couch the feelings of his many friends in words of my own, REIGATE DivisioN. but I may be permitted to say, as a matter of personal THE autumn meeting was held at the White Hart Hotel, experience, that Dr. Yeld's work has been character- Reigate, on November 25th, Dr. WALTERS in the chair. ized by untiring industry and unswerving loyalty. Fifteen members and visitors were present. Dr. YELD thanked Dr. Oppenheimer and the Division for Confirmation of Minutes.-The minutes of the last their great kindness and generosity. He felt that his meeting were read and confirmed. virtues had been overrated and was very conscious of his Report of AnnualRepresentative Meeting.-Dr. BERRIDGE, many shortcomings and indiscretions. He was, however, as Representative of the Division, made his report on the happy in feeling that he had their forgiveness, as this most annual meeting at Sheffield, and spoke in high praise of generous testimonial evidenced. The long contest in which the amount of work done at themesting. the Division had been engaged with the Hampstead Hos- Papers.-Dr. HENRY JONES, Medical Officer of the Surrey pital had taxed the Cormmittee's energies as well as his County Council Education Committee, read an admirable own, but he hoped that the Division's reasonable wishes paper on" The system of medical inspection of schools would shortly be acceded to. For himself, he hoped to be adopted in Surrey from the administrative point of view." allowed to serve the Division and the Association as long Dr. ARTHUR SAUNDERS, Lecturer on Diseases of Children as he had strength to do so. at the West London Hospital, read an exhaustive paper on "The medical inspection of children-its medical aspect."' SOUTH-EASTERN BRANCH: These papers were followed by a discussion, which was BRIGHITON, TUNBRIDGE WELLS, EASTBOURNE, AND unfortunately curtailed, owing to lack of time. HASTINGS DIVISIONS. Dinner.-After the meeting twelve members and guests A CONJOINT meeting of the Brighton, Tunbridge Wells, dined together. Eastbourne, and Hastings Divisions was held on Saturday, November 21st, at the Queen's Hotel, Hastings. The SOUTHERN BRANCH: Chairman, Mr. F. W. S. CULHANE, received the members GUERNSEY AND ALDERNEY DIviSION. and entertained them to tea, and presided at the meeting A MEETING was held on Friday, November 20th, Dr. E. L. at 4.30 p.m. ROBINSON, President, in the chair. Confirmation of Minutes.--The minutes of the last Tuberculosis.-.The HONORARY SECRETARY reported that meeting were read and confirmed. the appointed deputation had been received by the Board Address by Sir Victor Horsley.-An address was given of Health. and explained the views of the Division with by Sir VICTOR HORSLEY, F.R.S., entitled, What is the Real reference to the incidence and prevaleince of tubercle, and Value of Alcohol as a Medicine in Disease? Sir Victor that the board had promised to give the matter their Horsley's address waslistened to with the greatest int-. consideration. rest. Sir Victor maintained that alcohol was not a stimu- Stillbirth Certificate.-The HONORARY SECRETARY also TO =2 1 MEETINGS OF BRANCHES AlqD DIVISIONS. 29298 BRMBHDmzuuzLJuNLMEDICAL JOURNALJ ETNS O RACE N IIIN.[E.5[DF,C. 59 1908.gS reported that a form of stillbirth certificate as recom- fatal cases. He also referred to the advantage of Fowler's mended by the Division had been issued. upright position with a view to the lymphatic absorption Presentation to Divisional Library.-A present of being slower from the lower part of the abdomen than upwards of 100 volumes of the New Sydenham Society's from the upper. Dr. BISHOP, referring to the modern publications had been made by Dr. Corbin to the frequency of this disease, suggested the possibility of the Divisional library. use of frozen meat, being less digestible, as a contributing Case.-Dr. COLLINGS exhibited an interesting example cause. He referred to the significance of pain, and con- of cervical rib, occurring on both sides, in a male subject. sidered a falling temperature with a rising pulse-rate as a Paper.-The PRESIDENT read a paper on appendicitis. bad sign. Dr. WALLACE suggested limiting infection by Referring primarily in detail to the anatomy of the serum injections of the Bacillus coli communis, or nucleic appendix and its variations in attachment to' the caecum, acid. Dr. WMD was doubtful of the advisability of opera- and direction, he then detailed its histological arrange- tion, reasoning from analogy of lymphoid tissue in the ment, together with its blood supply, lymphatics, and appendix with that in the tonsil; he thought it was some- innervation, and contents in a normal condition. Referring times of rheumatic, and in advanced age possibly of gouty, briefly to the classification on a clinical basis which he origin, and had successfually treated some cases on these considered as unsound, he preferred the classification by lines. Dr. CONRAD CAREY strongly advocated immediate Lockwood on a pathological basis, as follows: (1) Appendi- operation. From a recent case in his own experience citis with ulceration of mucosa, which was clinically the where vesical irritability had occurred, he believed its so-called appendicular colic; (2) appendicitis with ulcera- cause to be the infection of residual urine with Bacillus tion of mucosa and bacterial invasion, where malaise, con- coli communis. Dr. BULTEEL'S experience in severe cases stipation, iliac pain, and perhaps a rise of temperature had borne out the opinion lately given by Mansell Moullin, were present, and the appendix would be found full of pus that an appearance of betterment was a dangerous sym- and bacteria and inflammatory products, with sometimes a ptom calling for immediate operation. Dr. ROBINSON perityphlitic abscess; (3) the foregoing, with faecal concre- replied. tions, parasites, foreign bodies, and their complications, Votes of Thanks.-The meeting closed with the usual where Lockwood adduced - evidence to show that votes of thanks. the so-called faecal concretions were really masses of bacteria; (4) appendicitis with stenosis and its SOUTH WALES AND MONMOUTHSHIRE BRANCH: complications, cysts, mucocele, empyema, etc., which CARDIFF DIVISION. had no special pecaliarity, but in which the attacks AN ordinary meeting of this Division was held at the were very severe and painful; (5) appendicitis, with Cardiff Infirmary on Wednesday, November 18th, at sclerosis and obliteration of lumen, which was rare, but 3.30 p.m., Mr. W. W. LEIGH, J.P., in the chair. Nineteen must not be assumed to indicate a natural cure, for it by others were present. no means protected a patient from some of the worat Confirmca4on of Minutes.-The minutes of the last results; (6) appendicitis with lymphangitis and lymph- meeting were read and confirmed. adenitis, which gave a history of severe attacks, painful Proposed Affiliation with the Rhymney Valley Medical hard tumour, abdominal distension, and vomiting; (7) tuber- Association.-The SECRETARY stated that an application culous appendicitis was rare; and (8) appendicitis com- from the Rhymney Valley Medical Association for affilia- plicating malignant disease was probably not so uncommon tion with the Division had already been considered by the as thought, but primary carcinoma was rare. The clinical Executive, and in accordance with instructions from that symptoms were so many and varied that their enumera- committee a letter had been addressed to the Secretary of tion would be not only tedious, but of little practical value. the Rhymney Valley Medical Association asking for certain Many practitioners never talked of appendicitis in the information which could bebroughtbeforethe Division at the stage of appendicular colic, but only when a further stage present meeting. A letter was then read by Dr. BOWEN of was reached, when operation was more difficult, and the Bargoed, the Secretary of the Rhymney Valley Medical risk consequently much increased. He considered that Association, stating that all the members from Caerphilly in mild cases with recurrent attacks, with slight tender- to Pontlottyn had expressed their desire to become ness in the intervals, operation was the wisest course. In attached to the Cardiff Division, and to be known as the more severe attacks, with previous history, sharp pain, Rhymney Valley Section of the Cardiff Division. A list of vomiting, and shock, some abdominal riaidity, and some members desiring the change was enclosed, and numnbered induration could be felt on the right side, with (in pelvic twenty. It was proposed by the CHAIRMAN, seconded by cases) vesical irritability and tenderness on rectal examina- Mr. RUSSELL THOMAS, and carried unanimously: tion, with sometimes flexion of the thigh and pain in the That the Cardiff Division, having considered the application hip-by dieting and rest the symptoms might quiet down, from the Rhymney Valley Medical Association for incorpora- but if symptoms increased again, operation was called for. tion with the Cardiff Division, recommend that their request The most serious cases were those where gangrene, per- be acceded to, this recommendation to be forwarded to the foration, and septic peritonitis occurred, Without the limit- Branch Council for consideration at its next meeting. ing barrier of adhesions found in the former class. Acute Removal of Goi'tre.-Mr. WILLIAM SHEEN showed a pain, vomiting, shock, small and quick pulse, an anxious female patient twelve days after the removal of a goitre. look, and board-like rigidity were present. Here cpera- The tumour was an unusually large one and by pressing tion should be performed at once, as even some on the trachea caused difficulty in breathing. The interest apparently hopeless cases had unexpectedly recovered. of the case lay in the almost invisible scar which had been Time failed to deal with difficulties in diagnosis from obtained after closing the wound with Mitchel's clips trouble in the gall bladder and ovaries, or salpingitis, removed in forty-eight hours. which were well known. Complications sometimes Congenital Absence of Vagina.-Mr. JOHN WALLACE, occurred with typhoid, or with ulcerative colitis. In Resident Medical Officer at the Cardiff Infirmary, read neglect of early cases thrombosis of the mesenteric veins notes on a case of congenital absence of the vagina. The might give rise to symptoms of acute intestinal obstruc- patient, aged 21, was admitted to the infirmary on tion. To sum up, in doubtful chronic and subacute cases, September 12th, with the history of having swallowed rest in bed might be tried for a week or more, but if there a hairpin while drinking some water at dinner. She were still tenderness on palpation or rectal examination, complained of pain on micturition after swallowing it. with any rise of temperature, operation should be per- A skiagram Was taken showing the hairpin lying hori- formed. He concluded with a summary of the technique zontally about 3 in. above the pubes. She was then of the operation and the after-treatment thereof, and illas- anaesthetized, and it was discovered that the vulva was trated his remarks from cases occurring in his own abnornmal. There was an aperture corresponding in practice. position to the urethra, but it would admit the index A very interesting discussion followed. Dr. CARRUTHERS finger with ease. The hairpin was easily felt-and removed recited a case which showed the difficulty of diagnosis with the finger through the opening, which communicated when complicated with enteric. Colonel ROBINSON referred with the bladder. No separate urethra could be dig- to the large number of cases, years ago, of perityphlitis covered in the roof of the opening referred to. and when which were apparently always appendicalar. Dr. BRABANT examined per rectum no uterus. could be made out. referred to the grave danger of appendicitis- in the puer- A small- dimple corresponding in position with the peral state and its difficulty of diagnosis, referring to four fourchette appeared to be the only trace of vagina SUPPLEMENT TO THU 299 DEC. 5j S9o8.]- GENERAL MEDICAL COUNCIL. BRITISH JOURNAL 299 DEC. 5, xgo8.] GENERAL MEDICAL COUNCIL. MEDICAL present. The clitoris was well formed and the mammae normally developed. Pubic hair was also present. Some Interesting Skiagram8.-Mr. OWEN RHYS showed GENERAL COUNCIL skiagrams of calculi in the genito-urinary tract-one OF print showing a large stone in the bladder with a MEDICAL EDUCATION AND smaller one low down in the left ureter. He also showed REGISTRATION. prints of an obturator dislocation of the left hip with the right thigh lying at right angles owing to infantile para- WINTER SESSION, 1908. lysis, several fractures about the shoulder-joint, and prints showing catheters in the ureters lving abnormally high up. Mr. LYNN THOMAS, after making some remarks Thursday, November 26th, 1908. upon his case of obturator dislocation, congratulated Mr. Sir DONALD MACALISTER, K.C.B., President, in the Chair. Rhys on the excellent photographs he had shown and complimented him upon his work in the x-ray department STATISTICS OF THE SERVICES. at the A REPORT from the Examination Committee on the returns infirmary. as to the examinations for the services received since the Demonstration of Forms of Nasal Obstruction.-An on the extremely interesting lantern demonstration illustrating last session of the Council was received and entered the various forms of nasal obstruction was given by Dr. minutes. The committee reported that it had analysed D. R. PATERSON. The slides illustrated sections through the returns, with the result shown in the table on the nasal and naso-pharyngeal cavities from various page 300. points of view, and demonstrated most graphically such .APOTHECARIES' HALL, DUBLIN. pathological conditions as hypertrophy of the palatal A report by the Examination Committee on the reports tonsils and the tonsil of Luschka, enlargement of the by the assistant examiners in surgery appointed by the, turbinal bones, deviations of the nasal septum, rhinoliths Council on the final examinations (July" and October, and nasal polypi; and in addition pictures were also 1908) of the Apothecaries' Hall, Dublin, was received and shown demonstrating the secondary effects produced by entered on tho minutes. The reports of the assistant nasal obstruction upon the contour of the jaw, the arrange- examiners were signed by Sir Lambert H. Ormsby and ment of the teeth, and the development of the chest. Mr. Conway Dwyer, M.D., F.R.C.S.I. The report of the Vote of Thanks.-At the conclusion a hearty vote of Examination Committee was to the effect that the assistant thanks was accorded to Dr. Paterson for his interesting examiners had expressed their satisfaction with the manner and instructive demonstration. in which the examination was conducted, and considered the standard of proficiency in medicine, surgery, mid- wifery, and ophthalmology,.required from the candidate AsJa4at n £tas* was sufficient and searching in every detail. BRANCH AND DIVISION MEETINGS TO BE HELD. RESULT OF APPEAL AGAINST A DECISION OF THE COUNCIL. BORDER COUNTIES BRANCH: ENGLISH DIvISION.-A meeting an of the of this Division will be held at Workington on December 11th. A report was presented embodying Order Members wishing to read papers, show cases, or pathological Privy Council with reference to the refusal of the Council specimens are requested to commanicate with the Honorary to register a foreign dentist, Mrs. Rosalie Nadel. The Secretary, NORMAN MACLAREN, 23, Portland Square, Carlisle. circumstances are sufficiently explained in the Order, which is as follows: LANCASHIRE AND CHESHIRE BRANCH.-Several Divisions-have asked the Branch Secretary to assist them in drawing up a clinical and scientific programme for their winter meetings by AT THE COUNCIL CHAMBER, WHITEHALL, letting them know of gentlemen who would be willing to read The 4th day of June, 1908. papers or to give demonstrations at meetings of Divisions other Council. than their own. The Honorary Secretary would accordingly be By the Lords of His Majesty's Most Honourable Privy pleased to know of any members willing to give such papers or demonstrations, so that he may be able to submit them to the Present: Divisions.-F. CARLES LARKIN, Branch Secretary, Liverpool. LORD STEWARD. EARL OF CREWE. MR. SINCLAIR. LANCASHIRE AND CHESHIRE BRANCH: LEIGH DIvISION.- the Dentists as follows: A general meeting of this Division will be held at the Co-opera- WHEREAS it is enacted by Act, 1878, tive Offices, Ellesmere Street, Leigh, on Thursday, December Section 9. Wbere a person who is not a British subject, or 17th, at 8.30 p.m. Agenda: (1) Minutes. (2) Dr. Blair's report who has practised for more than ten years elsewhere than in of the Annual Representative Meeting. (3) A paper on the the United Kingdom, or in -the case of persons practising in the Clinical Importance of Acetonuria. (4) Consideration of a letter United Kingdom at the time of the passing of this Act for not from the Branch Council re the Appointments to the Office less than ten years either in the United Kingdom or elsewhere, of Medical Inspectors of School Children. (5) Other matters. shows that he has obtained some recognized certificate (as -G. H. SHAW, Honorary Secretary. hereinafter defined) granted in a foreign country, and that he is of good character, and either continues to hold such certificate, COUNTIES BRANCH: KENSINGTON DIVISION.- or has not been deprived thereof for any cause which dis- METROPOLITAN him for under this Act, such person A meeting of this Division will be held at the Kensington Town qualifies being registered without Hall on Wednesday, December 9th, at 5 p.m., to discuss the shall upon payment of the registration fee be entitled, Medical Inspection of School Children. The Education Com- examination in the United Kingdom, to be registered as a mittee of the London County Council are contemplating the foreign dentist in the Dentists' Register. establishment of school clinics for the treatment of the minor Section 10. The certificate granted in a British possession or in a country, which is to be deemed such a recognized ailments of children, and it is of the utmost importance that foreign of this shall be the opinion of the profession on this matter should be obtained certificate as is required for the purposes Act, at once.-H. BECKETT-OVERY, Honorary Secretary. such certificate, diploma, membership, degree, licence, letters, testimonial, or other title, status, or document as may be recognized for the time being by the General Council as entitling MIDLAND BRANCH: BOSTON AND SPALDING DIVISION.- the holder thereof to practise dentistry or dental surgery in A meeting of this Division will be held on Thursday, such possession or country, and as furnishing sufficient guaran- December 10th, at 4 p.m., by kind invitation of E. Percy tees of the possession of the requisite knowledge and skill for Smith, Esq., L.D.S., R.C.S.Eng., at Lindum House, Wide or dental A the efficient practice of dentistry surgery. Bargate, Boston. demonstration will be given by Dr. John If a person is refused registration as a colonial dentist or as a MacCormac of London, late House Anaesthetist to the Royal foreign dentist the General Registrar shall, if required by him, Dental Hospital, Leicester Square, on the Continuous state in writing the reason for such refusal, and if such reason Administration of Nitrous Oxide Gasand the Administration be that the certificate held or obtained by him is not such a of Ethyl Chloride. Members who intend to be present are recDgnized certificate as above defined, such person may appeal requested to intimate the fact, before December 7th, to to the Privy Council, and the Privy Council, after hearing the A. E. WILSON, the Honorary Secretary, Boston. General Council, may dismiss the appeal or may order the General Council to recognize such certificate, and such order YORKSHIRE BRANCH: BRADFORD DIVISION.-A Divisional shall be duly obeyed. supper, followed by a smoking concert, will be held at the And whereas Mrs. Rosalie Nadel, of No. 74, High Street, Great Northern Victoria Hotel, Bradford, on Wednesday, Whitechapel, Loudon, has applied to the General Council of December 9th, at 8.30 p.m. Members are cordially invited to Medical Education and Regis ration of the United Kingdom to bring guests. Tickets, price 3s. 6d. each, may be obtained from be registered as a foreign dentist under the Dentists Act on the the Honorary Secretaries.-J. B. DUNLOP, J. WHERRY WILLSON, ground that she holds a certificate granted in Russia bestowing Honorary Secretaries. upon her the title Surgeon Dentist, and giving her the right to wz=m To 300 00BaMsa KUDIAL JouAM]1 GENERAL MEDICAL COUNCIL. [DEC. 5, I908.

At the Examination At the Examination At the Exalmiination for the Medical Depart- for the Army Medical for the Indian Medical Grand Total mnent of the Royal Summary. of Candidates Submitted Themselves Navy held on Novem- Service held on Service held in Successful who Held Qualifications from ber 2nd, 1908. July 29th, 1908. July, 1908. and I Unsuccessful Candidates. Rejected. Passed. Rejected. Passed. Rejected. Passed. Rejected. Passed. -l l -1- English Conjoint Board ...... 2 5 0 10 1 15 3 30 33 Apotliecaries' Society of London ... 0 1 0 1 0 2 2

University of Oxford...... CCambridge 0 3 0 3 3

Durham...... 0 1 0 1 0 2 2

London ...... 0 2 0 5 0 7 7 Victoria University of Manchester... 1 0 1 1

University of Birmiingham ......

Liverpool ...... 0 1 0 1

Leeds ......

Sheffield ...... Scottish Conjoint Board 1 4 1 4 5

University of Edinburgh ...... 0 2 0 7 0 9 0 18 18

Aberdeen ...... 0 2 0 1 0 1 0 4 4

Glasgow ...... 0 1 0 1 1 3 1 5 6

St. Andrews ...... 0 1 0 1 0 2 2

Irish Conjoint Board ...... 2 0 1 1 3 4

Apothecaries' Hall, Dublin ......

University of Dublin ...... 0 11 0 4 0 15 15

Royal University of Ireland ...... 0 2 - 0 2 2

Indian and Colonial universities ... _ - 0* 3* 0* 3* 3* 13 Total ...... 41 3 48 6 102 108 2 13 1

15 candidates holding 42 candidates holding 41 candidates holding 98 candidates. 98 candidates. qualifications from qualifications from qualifications from 15 bodies 42 bodies. 52 bodies. Holding qualifications from 109 bodic 8

* In these instances one candidate also withdrew. -carry on the practice of dental surgery in any part of the The evidence before the committee consisted of the oral Russian Empire: evidence of Mr. Arthur Ward. And whereas the General Medical Council have refused to register the said Rosalie Nadel, and the said Rosalie Nadel has At the conclusion of the proceedings in this case on appealed to the Privy Council: May 28th, 1908, the President announced the judgement of And whereas the Privy Council have communicated with the as follows: General Medical Council: thp Council And whereas the General Medical Council have informed the Mr. Arthur Ward: I have to inform you that the Council has Privy Council that, in their opinion, the licences or certificates carefully considered the report of the Dental Committee, and presented by the said Rosalie Nadel cto not furnish sufficient has adjourned the further consideration of your case till Novem- tguarantees of the possession of the re4uisite knowledge and skill ber, when you will be required to be present and to give evidence for the efficient practice of dentistry or dental surgery: as to your conduct in the interval, and especially in regard to Now, therefore, the Privy Council, having considered the the performance of your undertaking not to issue advertisements appeal of the said Rosalie Nadel, and the statements of the of any description in future. General Medical Council, do dismiss the said appeal, and it is hereby dismissed accordingly. Mr. Lushington appeared as Legal Assessor, Mr. Winter- A. W. FITZROY. botham as Solicitor to the Council; Mr. Turner appeared for the British Dental Association, and Mr. Coley for Strangers, by direction from the Chair, then withdrew Mr. Ward. in order that the Council might deliberate in camera. No In reply to the PRESIDENT, neither Counsel desired to public announcement was made and the Council subse- add any further facts to those contained in the report of ,quently adjQurned. the Dental Committee. Strangers were directed to withdraw. On readmission, The PRESIDENT announced the decision of the Council as Friday, November 27th, 1908. follows: 'Sir DONALD MACALISTER, K.C.B., President, in the Chair. That the Council, having further considered the charge against Arthur Ward, and the reports of the Dental Committee DENTAL DISCIPLINARY CASES. thereon, does not adjudge him guilty of infamous conduct in a The Council then proceeded to the consideration of the professional respect. facts proved against Arthur Ward, in regard to whom the Dental Committee, at its meeting on November 23rd, 1908, The Council resumed the consideration, adjourned from drew up the following Supplementary Report: May 28th, 1908, of the facts proved against William John Watson, in regard to whom the Dental Committee at its On November 23rd, 1908, the following parties attended before on 23rd a the committee, and were duly heard, namely: meeting November prepared supplementary Mr. Arthur Ward, accompanied by his solicitor, Mr. Coley. report. The complainants, the British Dental Association, represented After the supplementary report had been read by the by their counsel, Mr. Turner, instructed by Messrs. Bowman Registrar, it was resolved to adjourn the further considera- and Curtis-Hayward, solicitors. tion of the case until May, 1909. The committee find that Arthur Ward has since the date of of Charles in the hearing of this case withdrawn the pamphlet complained of The next case was that Morgan, regard and has not since issued, and undertaken in the future not to to wbom the Dental Committee had found the followin ipsue, any pamphlet or advertisement of any kind. facts: TO THEN DEC. COUNCIL. SUPPLMENT 5, I908.] GENERAL MEDICAL IBBr ISHMEDICAL JOMWAL 301 = The said Charles Morgan is on the Dentists' Register as in him. He was quite willing to give an undertaking not to practice before July 22nd, 1878, and his address in the B?egisttr do what was of in future. He further is 56, Queen Street, Cardiff. complained the The said Charles MIorgan has repeatedly advertised in the stated that the business premises were closed, and his public press by means of paragraphs containing statements agreement with Mr. Bonham terminated. of an objectionable character, and in particular containing The PRESIDENT desired to point out to the Council that laudatory commendations of his own skill and methods, and in this case the Dental Committee were unable to find, upon by implication claiming superiority over other practitioners. the had been The said Charles Morgan alleges that his advertisements were the evidence produced, that facts alleged inserted in self-defence against certain quack advertisements, proved, and therefore there was no motion that he could which he put in evidence. put before the Council. The Council had heard what had The said Charles Morgan has, since the service of the notice been stated by Mr. Davis, and he thought it would be its of inquiry, stopped his advertisemeuts, tenders an apology, and wish that he should inform Mr. Rogers and Mr. Davis that undertakes not to offend again. the facts alleged against them had not been proved to the Mr. Coley appeared for Mr. Charles Morgan, and Mr. satisfaction of the Dental Committee, and therefore the R. W. Turner, instructed by Messrs. Bowman and Curtis Council would take no further proceedings in the matter. Hayward, appeared for the British Dental Association. either of The PRESIDENT inquired whether the parties RESTORATION TO " DENTISTS REGISTER." desired to address the Council on the report. and was The Council then proceeded to discuss some private Mr. COLEY said that his client had apologized, were to prepared to give any assurance the Council thought neces- business in camerd, and strangers directed sary. His client's answer to the charge was that he did withdraw. On readmission, was of in He had been The PRESIDENT announced that the Council had directed what complained self-defence. the names driven almost out of his mind by a well-known man who the Registrar to restore to the Dentists' Register set up opposite him. Perhaps the Council would allow of Samuel Foley and Algernon Frederick Green. the case to stand over if his client promised on no account The Council then adjourned. ever to advertise again, or insert any description of advertisement. Mr. TURNER expressed his willingness that this course Saturday, November 28th, 1908. should be adopted if the Council saw its way to so doing; DONALD in the Chair. but he thought there must also be an undertaking by Sir MACALISTER, K.C.B., President, Mr. Morgan to conduct his practice in a professional The minutes of the preceding day's meeting were taken manner. as read and signed by the PRESIDENrT as correct. Mr. COLEY agreed to give this undertaking. Strangers were directed to withdraw; on their read- PUBLICATION OF REGULATIONS AS TO PROFESSIONAL. mission, CONDUCT. The PRESIDENT, addressing Mr. Morgan, said: Professor SAUNDBY was of opinion that something ought- The Council had given careful consideration to the Report of to appear on the minutes to show why it was that the the Dental Committee and has deferred the further considera- Registrar had not acted upon the resolutions, with regard tion of your case to May next, when you will be.required to be to a notice in the which were present and to offer satisfactory evidence as to your professional inserting warning Registers, conduct in the interval, with particular reference to your adopted at the last meeting. Accordingly he moved: promise to discontinue the issue of all advertisements. That having heard the opinion of the Legal Adviser the The Council next proceeded to consider the cases of Registrar be instructed iiot to take any steps to give effect Alfred Davis Rogers and Lionel Cartwright Davis, in to the resolutions at present. regard to whom the Dental Committee had found the Sir CHRISTOPHER NIXON and it was following facts proved; that seconded, adopted. 1. The said A. D. Rogers and L. C. Davis are both on the Dentists' Register as in practice before July 22nd, i878, and their PROCEEDINGS IN CAMIERA. address in the Register is 140, Edgware Road, Hyde Park, The PRESIDENT moved, and it was resolved, that a report London, W. by the Solicitor received in camerd, with regard to a judge- 2. The said A. D. Rogers is a brother of the said L. C. Davis, ment in the High Court with respect to a dentist's case be having changed his name for professional purposes. on the minutes. 3. Both the said A. D. Rogers and the said L. C. Davis deny entered that the said A. D. Rogers was a partner in, or had any con- [This report is not yet available.] nexion with the firm of Rogers and Davis at the date of the The PRESIDENT moved, and it was resolved, that a com- matter complained of, and the complainant has produced no munication from the Secretary of State for the Colonies, evidence to refute this. together with a resolution adopted by the Council in camnerd, 4. The said L. C. Davis admits that he carries on practice as be the minutes. a dentist in the name of Rogers and Davis at 140, Edgware placed upon Road, and also at 34, Liverpool Street, and 174, Victoria Street, [These documents are not yet available.] S.W., and that he is a sole partner in the firm responsible for what is done at these three places in the name of the firm. 5. A certain Mr. Bonham, an unqualified person at the time THE ADMINISTRATION OF ANAESTHETICS. of the offence alleged, acted as assistant to the said L. C. Davis The Executive Committee reported to the Council that at the Liverpool Street Branch, and on October 23rd last, the a letter dated July lst, 1908, had been received from the said Mr. Bonham scaled the teeth of a Mr. Bridge, who called Privy Council with regard to the administration of there with Mr. Matland, and charged and was paid 5s. for doing in that The letter this. It is in evidence that the said Mr. Bonham stated to anaesthetics and to instruction subject. these two witnesses that he was in the habit of performing stated that representations had been made not only to the dental operations there for Messrs. Rogers and Davis, and that Privy Council but to the Home Office on the subject, and he took entire charge of the dental practice carried on there, that a number of questions in Parliament had been asked but no other evidence was given in support of the charge. The in to it. The letter then continued as follows: said L. C. Davis denied that the said Mr. Bonham performed regard dental operations, and stated that he had instructions not to do It is asserted that those person, who administer anaesthetics so. Mr. Bonham, however, was not called. are not necessarily specially trained to do so, and are not always 6. Upon the evidence submitted the Committee are unable to registered medical practitioners; and with a view to providing find that the facts alleged in the notice of the charge-namely, greater security for the public it has been suggested (1) that the that the said L. C. Davis habitually permits the. said Mr. administration of anaesthetics should-be restricted by legisla- Bonham to attend patients and perform operations upon them, tion to duly qualified and registered medical men;. and (2). that and to practise dentistry on his behalf in the name of his firm- a course of instruction in the subject should be included in the are proved to their satisfaction, and as above stated there medical curriculum. is no evidence to show that the said A. D. Rogers was at the It seems to their Lordships to be clear that if these two sug- time in any way connected with the practice. gestions are to be carried out the first step.is to provide.th4t all registered medical men are traine#1, in the use of anaesthdtics, Mr. Davis and Mr. Rogers appeared in person. and that, until means have been taken to secure this, it would The-PRESIDkNT inquired whether either of these gentle- be of little value, to make it.compulsory, for anaesthetics to be men desired to say anything. administered only by registered medical men. Mr. ROGERS replied in the.negative. I am to request that you. will move. the General, Medical the Council to state whether it may be understood that the effect of Mr. DAvIs said he desired to throw himself on their action, as .embodied in their recommendation to tbe clemency of. the Council. He had been a number of years Licensing Bodies that a course of study in the administr4ti,pn tin practice, and there had never been anything -against of anaesthetics should be included in the curriculum, will be in SUPPLEMENT To THE I 3°.J BRBmSH MEDICAL JouRNALJ GENERAL MEDICAL COUNCIL. [DEC. 5, 1908. -I due course to provide that every registered medical practi- before a court of summary jurisdiction for such offence to a tioner will have had sufficient training in the administration of penalty not exceeding ten pounds and in the case of a second anaestheties. or subsequent conviction to a penalty not exceeding twenty I am, Sir, pounds. Provided always that a person shall not be liable to a Your obedient servant, penalty under this section if in conducting such administration A. W. FITZROY. he was acting under the immediate direction and supervision of 'The Registrar, a legally qualified medical practitioner or if the circumstances General Medical Council. attending the administration were such that he had reasonable The had been grounds for believing and did believe that the delay which following reply sent to the Clerk of the would have arisen in obtaining the services of a legally qualified Privy Council: medical practitioner would have endangered life. No. 18707. 2. All examining bodies recognized by the General Council of July 8th, 1908. Medical Education and Registration of the United Kingdom Sir,-As you are aware, there will be no meeting of the shall require that all candidates before presenting themselves General Medical Council until November, and it is therefore for their final examinations shall have received thorough theo- impossible at present to procure an offieial reply to your letter retical and practical instruction in anaesthetics, and shall have (No. 100749) of 1st inst. personally administered anaesthetics under the supervision and I have, however, consulted the President as to the probable to the complete satisfaction of their respective teachers. effect of the Council's Recommendation to the Licensing Bodies 3. This Act shall not apply to any person who having been that a course of instruction in the administration of anaestheties registered under the Dentists Act, 1878, before the passing of should be included in the curriculum. He is of opinion that while the present Act shall administer any drug or substance with such a course is already given bya large number of the teaching the object of producing a state of unconsciousness during any -bodies, it may be confidently expected that in due time all the dental operation act or procedure. bodies will make it a requirement for licence. At the next 4. The expression " court of summary jurisdiction" in this general inspection of qualifying examinations the Inspectors Act shall have the same meaning as in Subsection 11 of will be instructed to report on the manner and extent to which Section 13 of the Interpretation Act, 1899. In Scotland it shall the specific recommendation now issued has been adopted. mean any justice of the peace and also any magistrate having When the reports of the Inspectors are received the Council will the authority of a justice of the peace and also the sheriff. The be in a position to decide whether any further steps are desir- expression "the Medical Acts" shall mean the Medical Act, able to press upon the bodies the importance of the instruction 1858, and any Acts amending the same passed before the passing in question. of this Act. This is the method by which the Council has hitherto effected 5. This Act may be cited as the General Anaesthetics Act, necessary improvements in the curriculum, and the President 1908. sees no reason to doubt that in the present instance it will be as To this further communication the effective as in other cases. President sent the I am, Sir, following reply: Your obedient servant, No. 18820. H. E. ALLEN, September 3rd, 1908. Registrar. Sir,-With reference to your communication No. 101033 of The Clerk of the Privy Council. August 24th, 1908, I have to say that it will give me pleasure to On the Council lay it before the next meeting of the Executive Committee. As August 24th, 1908, Privy transmitted the this, however, will not take place before November next, I following memorandum and proposed bill dealing with the should like to point out to the Lords of the Council that administration of anaesthetics with a request that they' Clause 2 of the proposed bill appears to involve a virtual super- might be considered by the Executive Committee: session of the General Medical Council, and ultimately of the Privy Council. By Section 3 (2) of the Medical Act of 1886, the I. qualifying examinations for medical diplomas are to guarantee MEMORANDUM. the possession of the knowledge and skill requisite for the The object of this bill is to protect the public, as far as efficient practice of medicine, surgery, and midwifery. It is possible, against deaths arising directly or indirectly from the the duty of the General Council to secure the maintenance of action of general anaesthetics-a class of drugs employed for this standard of proficiency. By Section 4, any examining body producing unconsciousness during surgical and medical opera- which fails to maintain it may, on the representation of the tions, acts and procedures. General Council, be, by order of the Privy Council, removed The three following facts indicate the need for this legislative from the list of recognized bodies. And lastly, by Section 19, protection: if the General Council fails of its duty, the Privy Council may 1. General anaestheties are for the most part powerful exercise the functions of the General Council and remedy its poisons; defects. 2. They are constantly being used upon a vast and increasing Clause 2 of the proposed bill ignores the whole of this legis- scale throughout the country; lation, so far as one particular branch of the efficient practice 3. A considerable and increasing number of fatalities are of medicine, surgery, and midwifery is concerned. It legislates annually taking place in connexion with their adminis- directly for examining bodies, "recognised by the General tration. Council " (which term, by the way, includes bodies in the The promoters of the present bill are of opinion that the Colonies, in Italy, and in Japan, as well as in the United solution of the problem of reducing the number of deaths Kingdom), without reference to the General Council or the wholly or partly referable to anaesthettes is to be found in a Privy Council; and it provides no machinery for ascertaining careful study of the circumstances and symptoms which have that the examining bodies fulfil the proposed law, nor any attended the deaths hitherto recorded. Such a study clearly penalty for their breach of it. seems to them to indicate that if general anaestheties are to As President, I have little doubt that the Executive Com- be safely and successfully administered for surgical or medical mittee will think that such legislation is neither desirable in purposes it is essential that in every case the administrator itself nor likely to be effective in practice. No such provision shall be a person who has received (a) a fundamental or general is made for ensuring the skilful performance of (say) the grave medical education, and (b) thorough special or technical training surgical or obstetrical operation for which anaesthesia is in the administration of anaesthetics. incidentally induced, or the antiseptic precautions on which This bill therefore proposes, first, to make it a penal offence the life of the patient may depend. These are all included (save under certain circumstances herein specified) for any under the term "efficient practice " used in the Medical Act. person other than a legally qualified medical practitioner to I do not anticipate any difficulty in securing, through the administer a general anaesthetic for any surgical or medical existing machinery-that is, the "Recommendation" of the operation, act or procedure, or during childbirth; and, secondly, Council-aided by the pressure of "inspection," and if neces- to make it obligatory upon all examining bodies recognized sary "report to the Privy Council," that all licensing bodies by the General Council of Medical Education and Regis- shall make explicit in their regulations, as it is to all intents in tration of the United Kingdom to require that all candidates, their practice, a requirement that their candidates shall have before presenting themselves for their final examination, and received efficient instruction in anaesthetics. Without specific shall have personally administered anaestheties under the legislation ab extra they have already done so in respect of such supervision and to the satisfaction of their respectiveteachers. special branches as vaccination, surgical dressing, and the like. Clause 1of the proposed bill appears to me to contain what is II. essential for the protection of the public in this department of GENERAL ANAESTHETICS ACT, 1908. practice. It would indeed be well if it could be extended to all An Act'to regulate the administration of general anaesthetics. departments of practice by which life or limb is endangered. Be it enacted by the King's Most Excellent Majesty by and Iam, sir, with the advice and consent of the Lords Spiritual and Temporal Your obedient servant, and Commons in the present Parliament assembled and by thie DONALD MACALISTER, authority of the same as follows: President. 1. Any person other than a legally qualified medical practi- The Clerk of the Privy Council. tioner registered under the Medical Acts who shall wilfully At its meeting on November 23rd the Executive administer or cause to be administered to any other person by Committee the inhalation or otherwise any drug or substance whether solid adopted following resolution: liquid vaporous or gaseous and whether pure or mixed with any (a) That the Memorandum and proposed bill be reported to other drug or substance with the object of producing a state of the General Council, with the statement that the Execu- unconsciousness during any medical or surgical -operation act tive Committee approve the terms of the President's or procedure or during childbirth shall be liable on conviction reply dated September 3rd, 1908, addressed to the Clerk IDEC. 5, GENERAL MEDICAL COUNCIL. r SuPLMNT TO T t- C 5,xo.1908.1 EEA MDCLCUCL IBmETIN MEDICA JOUENAL 303 of the Privy Council; and the recommendation that the Council should inform the Lord President that the Council REPORT OF THE EDUCATION COMMITTEE ON THE approve the principle of first clause of the proposed bill, MEDICAL CURRICULUM. but is unable to support the provisions to which objection The Education Committee presented the following is taken in the President's letter. (b) That the Registrar be directed to communicate with the Report: licensing bodies, calling their attention to the recom- REPORT mendation of the Council of May 30th, 1907, and inquiring OF how far they had given effect to this recommendation by requiring students to produce evidence of having received THE EDUCATION COMMITTEE practical instruction in the administration of anaesthetics. ON The PRESIDENT said the first clause of the bill practically prohibited under a penalty any person not a qualiaed VARIOUS PROPOSALS SUBMITTED TO THEM REFERRING TO practitioner from administering an anaesthetic, for THE CURRICULUM IN MEDICINE. 'instance, with a view to producing unconsciousness during -any medical operation or during child-birth. That prin- MEMBERS.-Dr. Mackay, Chairman; the President; ciple the Executive Committee desired the Council to Dr. Norman Moore, Sir George Philipson, Sir John approve. Objection was taken to the proposal contained Williams, Sir John Batty Tuke, Sir John Wm. Moore, in Clause 2 of the bill on the ground that it would override Sir Christopher Nixon, Dr. Little. the function of the Council, that the existing machinery was more effective, and that as no penalty was provided PRELIMINARY STATEMENT. for infraction of the clause, it would be practically valueless. The five-years curriculum was established by a resolu- For these reasons it was held that this was not a proper tion of the Council in June, 1890. The special objects method for securing what was desired-namely, that the which the Council had in view in taking this step practice of administering anaesthetics should be part of the are briefly defined in the Report of the Education medical curriculum. Committee presented in May, 1891, from which the Sir JOHN MOORE moved, Sir CHARLES BALL seconded, and following statement is abstracted, namely: it was resolved, To give a first year for practical education in Physics, That the first part of the recommendation of the Executive Chemistry, and Biology, and the acquisition of the habits Committee be approved and remitted to the Privy Council. of observation and reasoning which such studies foster; followed by the present three years' attendance on Pro- The PRESIDENT remarked that the second part, though fessional Classes and Hospital; and to give a final year important, was merely an administrative matter. He exclusively to Clinical Work. proposed from the chair that that course be adopted, and it was agreed to. Of recent years the whole question of the curriculum has been repeatedly raised before the Council, more THE ISSUE OF WARNINGS BY THE COUNCIL. particularly by teachers identified with the subjects of The Council then proceeded to the consideration of the the Final Examination, who have complained that the following resolution adopted by the Executive Committee original intentions of the Council with respect to the on November 23rd, 1908, in regard to a communication time to be allotted to clinical study are not being given from the British Dental Association: effect to. Numerous proposals for the extension and the That the Executive Committee desire to point out that the rearrangement of studies have been brought forward, and General Council have no power to legislate or to issue reso- several of them have been remitted to the Education lutions binding upon the profession and having absolute Committee for consideration and report, in the light of prohibitive effect. And in view of their judicial functions available statistics dealing with the subject. It will in particular cases of professional misconduct, it is not all,the desirable to pass a resolution condemning any practice in prove of advantage to allude briefly to the history of later general terms until a series of cases decided before them discussions. has so clearly demonstrated the prevalence of that practice On November 25th, 1904, Dr. Lindsay Steven submitted as to call, in the opinion of the Council, for a warning notice the following proposals for the consideration of the to the profession. Education Committee: Mr. TOMES reminded the Council that practically it had (1) That the Preliminary Scientific Examination in Physics, been asked to pass a resolution which should prohibit Biology, and Chemistry should be passed before the student advertising of any description whatever amongst registered begins the qualifying study of Anatomy and Physiology; (2) that before being admitted to the Final Examination the dentists; the Council had been informed that a poll had student should produce evidence that he has devoted the last -been taken of the registered dentists, with the result that year of his curriculum exclusively to practical and clinical -a large majority were in favonr of absolute prohibition; work and study. but, as had been pointed out repeatedly, the General In December, 1905, the Committee, Medical Council had no power to do that. With reaard to without making any the resolution of the Executive Committee, the last sen- special recommendation, reported their opinion on the -tence seemed to him to be redundant and opened the way points raised. With regard to No. 1, they stated that to argument as to what a series of cases, decided before The operation of the clause might have the effectof causinng ,then, had clearly demonstrated. He proposed that the an undue amount of time to be devoted to the Preliminary Sciences with two possible subsequent results. Either the answer of the Council should be: Student will be tempted to crowd the rest of his study into the That the General Medical Council desires to point out that it remaining two or three years, as the case may be, of the five- has no power to legislate or to issue resolutions binding years curriculum, a course to be seriously deprecated, or he upon the profession and having absolute prohibitive effect, will be compelled to take one or more additional years; and, in view of their judicial functions in particular cases of professional misconduct. it was not at present desirable to And with reference to No. 2- pass any further resolution with regard to it. The Committee hold that distinct evidence of clinical and practical study in the fifth year should be produced by the Sir THOMAS MYLES seconded. Student showing that his time in that period of hiscurriculum The PRESIDENT, in reply to Dr. LATIMER, ruled that the has been mainly occupied in such work, but they would no$ Council could pass any resolution it liked on the subject, suggest any regulation which would absolutely limit the work but it would have no prohibitive or legislative effect. ,of each session of the period of professional study. Dr. SAUNDBY said the passing of such Resolutions in the This report was not formally adopted by the Council, past had done a great deal of good, and he deprecated and the whole question was thus, in a sense, left open for putting any such words as" that the Council had no power further discussion on the submission of proposals of a to legislate or to issue resolutions binding upon the more comprehensive character than those originally profession and having absolute prohibitive effect." He brought forward. Later in the same session the Council would prefer thewords," It was not desirable to pass any passed a resolution, moved by Mr. Morris, to further resolution upon thesubject." the effect: Mr. TOMES, with the assent of Sir MYLES, That it be referred to the Education Committee to consider TH1OMAS and report: (1) As to the desirability of transferring the saccepted this modification. preliminary sciences. (Biology, Physics, and Chemistry) The PRESIDENT took it that the resolution would be: from the curriculum to a stage preliminary to the com- That in particular cases of professional misconduct it was not mencement of medical studies; and (2)' as to the advisa- at bility of requiring the five-years period of medical study, present desirable to pass any further resorltion. even after,removing from the curriculum these preliminary The resolution as modified was then put and agreed to. science subjects. TO 1 3°4 BRITI8}I3 IUPPLEMENTIMEDICAL JOURNATHI GENERAL MEDICAL COUNCIL. [DEC. 5, 1908,

l Dealing with the first proposal, the Committee reported whole quLestion of the reorganization of the curriculum, that "it is not desirable at present to exclude Chemistry, In their details they are as follows: Physics, and Biology from the professional curriculum" ; That the note to Requirement III in regard to Professional and they suggested that before considering any action in Education (Minu1htes, vol. xxx, p. 80) be deleted, and that in its the direction indicated, the Council should satisfy them- place the following note should be adopted: selves that the instruction offered in the secondary schools (a) "That the Council is of opinion that the required subjects should be divided into two groups; one group com- of the country is in a real sense equivalent in kind and prehending Physics, Chemistry, Elementary Biology, Anatomy, amount to that which is at present demanded in the first and Physiology, the other comprehending all the other year of the curriculum. Evidence bearing upon the sub- subjects; and that the Council is of opinion that no licensing ject will be available when the first year examinations of body should recognize instruction in any subject comprehended the licensing bodies have been reinspected. Mr. Morris's in the second group until candidates have passed in the subjects second suggestion, though linked in form with the first, comprehended in the first group "I; or (b) " That the Council is of opinion that a minimum of two may be regarded by itself as a proposal to establish a six- years should be devoted to the subjects of the Final Examina- years curriculum in medicine, and, viewing it in this tion; and that no qualifying courses on these subjects should light, the Committee asked leave to postpone its considera- be recognized until all the previous Examinations have been tion. Along with others which have since been submitted passed "I; or (c) "That in the opinion of the Council it is desirable to, it now comes forward for discussion. divide the subjects of the Medical curriculum into three In May, 1906, another resolution on the subject of the groups-namely: curriculum put forward by Dr. Bruce was endorsed by the " (1) The subjects of the Preliminary Scientific Examina- Council, to the effect: tion ; "(2) The subjects of the Intermediate Examination That it be remitted to the Education Committee to consider "(3) The subjects of the Final Examination; how far Recommendation V of the General Medical Council and to provide that no instruction in any subject of the last -namely, "that the fifth year should be devoted to two groups be recognized until the student has passed in the Clinical work at one or more Public Hlospitals or Dis- subjects of the previous group." pensaries, British or Foreign, recognized by any of the Medical Authorities mentioned in Schedule (A) of the In May, 1907, the Education Committee issued an Medical Act (1858), provided that of this year six months Interim Report in which the statistics relating to the may be passed as a pupil to a Registered Practitioner length of the whole curriculum and the ages at entrance possessing such opportunities of imparting practical know- and at are discussed. The is ledge as shall be satisfactory to the Medical Authorities "- qualification fully Report is at present being given effect to, and if the Committee referred to for its details, but the following table may be sees fit to recommend to the Council such changes in the taken as giving a general summary of the results said resolution as would be likely more effectually to obtained: at the Council in 1890. secure the object aimed by LICENTIATES AND GRADUATES OF 1906. It may be noticed here in passing that when reporting upon Bruce's the Education Committee Average Average age Dr. proposal Average age of 949 Length of at qualifica- suggested that certain minor alterations might be made Entrants who completed Curriculum tion of those with advantage upon the Recommendations of the the Prelimiiinary Examina- in the who com- tion at or under 21. 1,111 cases mienced at Council, in particular that the reference to a period of tabulated. or under 21. pupilage should be erased, and that instruction in the administration of anaesthetics, and attendance at po8t- The sum mortem examinations, should be specially mentioned as Median Median of the two desirable. The changes were approved by the Council Mean. half-yearly half-yearly preceding and have been notified to the licensing bodies, but the colunin. column, columns. reissue of the Recommendations in the amended form has meanwhile been postponed pending the settlement of the yrs. niths. yrs. mths. yrs. mths. yrs. mths. 6 England ...... 18 7A3 18 6 7 0 25 questions raised in connexion with the curriculum. (476 entrants) In dealing with the important interrogation submitted 6 24 0 Dr. as to whether in the circumstances of the Scotland ... 18 51 18 6 5 by Bruce, (339 entrants) present day the fifth year of the curriculum is being 0 6 0 25 0 mainly devoted to clinical work, the Education Committee Ireland ...... 18 83 19 pointed out that in no instance among the licensing bodies (134 entrants) is an exclusive appropriation demanded, but that in the General. 18 7 18 6 6 6 25 0 great majority of the cases the arrangements are such that the prescribed theoretical courses can be completed The information procured was in itself interesting and by the end of the fourth year, and the student, provided important, and afforded a material basis for a preliminary that he has suffered no delay in the earlier part of the study of the subject, but it was not sufficient to enable curriculum, is free to devote his later work entirely to the Committee to come to a satisfactory judgement on the clinical study if he so desires. serious questions submitted to them. It became evident In view of the fact, however, that at every centre many that among the licensing bodies there were very con- of the students encounter retardation in some portion of siderable differences in the nature and the length of the the course, the Committee decided to ask the Council for course, and further investigation was demanded. The permission to collect statistics with the object of obtaining Committee reported that the question at issue "cannot precise information as to the length of the curriculum as be satisfactorily settled until the Council is in possession at present pursued under the several licensing bodies. By of the actual details relating to the time spent under the courtesy of the authorities of the Conjoint Examining each licensing body in preparation for each of the Board in England, the Committee were enabled at the consecutive examinations of the course." The Council time to submit, as a preliminary, an analysis of the course approved the finding of the Committee, and authorized of study as followed by 400 students who qualified under the President to apply to the licensing bodies for that body in the years 1904 and 1905. The figures showed the information required. The form of application is an average curriculum of more than six and a half years, printed as Table XXIV of the Appendix to this Report.;' of which at least three and a half were devoted exclusively The several bodies have responded to the President's to the subjects of the Final Examination. request in every case with the 'greatest courtesy, and in "The report which has been outlined briefly above was many instances at no inconsiderable labour, and -the Com- approved by tbe Council in the Autumn Session of 1906, mittee are now in a position to lay before the Council a and the 'Education Committee were instructed to procure full statement of the leading features of the curriculum statistics relating to the length of the curriculum actually of all those who registered with the General Medical pursued under the present Regulations, and the ages at Council in the year 1906. which- sttdents enter and qualify at the several.liqensing EXPLANATION OF THE STATISTICS. bodies. Further, -a number of' additional suggestions for the modificcation of the -curriculum were remitted to the The figures relate to the course of study pursued by the for. examination and These proposals Licentiates and Graduates in Medicine who registered in the Committee report. the the Committee .are ,still- before the Council,. and along wt.h thiat of Mr. year 1906. With the consent of Council, Morris, already mentioned, they bring up practically the * This form has not been reprinted here. I -DEC. 1goS.] GENERAL MEDICAL COUNCIL. aur n.Toxxu10133 5, LEBRMsMEDICL JOumAu

I have limited their analysis to the-cases of those who have In every: instance, three years' hospital attendance passed through the curriculum in seven years or less. is given, and in most final subjects, such as patho- Among those whose course extends beyond this period logy and surgery, claim a portion of the students' there; is little likelihood of overcrowding in any portion of attention in the third year. It is necessary, the curriculum. Furthermore, the Committee have that some definite principle should be arrived"athowever,upon excluded from the lists all those students who, while which an estimate may be made of the amount of time qualifying under one body, obtained exemption from any which is given to the subjects of each Period when there of its examinations on account of having already passed is overlapping study between the Periods. For the the tests of another body; this was necessitated in the purpose of making this' comparison, which is set forth in first place by the absence of sufficiently detailed informa- the table below (see p 306), the Committee have adopted tion, concerning the particulars of the course in these the plan of dividing equally between the First and Second cases; but there is an advantage in the omission inas- Periods of 'the course the months of normal overlapping much as the statistical tables as they stand furnish us study in the third year, in the bodies belonging' to with the histories of clearly defined groups of students, Class 3. each influenced- alone by the conditions and regulations of Retardation. a particular licensing body. The course may be lengthened as a whole in individual Another general statement requires to be made. Cases instances, or the First Period may be lengthened and the in which study for other degrees, as, for instance, B.A., M.A. Second correspondingly shortened by failure or delay on and B.Sc., has been carried on simultaneously with that the part of the student in passing the examinations. What for the. qualifications in Medicine, have been kept out of happens most frequently, as the statistics show, is that the tables as far as possible. The matter is not, however, the First Period is very considerably prolonged by retarda- one of much importance, as the instances are not suffi- tion, while the Second is only slightly lenuthened. It is ciently numerous in the case of any individual body to evident that the majority of the students when they suffer affect the results appreciably through their, omission. In delay in any particular examination continue the ordinary the case of the University of Dublin, however, included in course of study, and frequently make good in whole the- lists, most of the students in Medicine are required or in part in the later years the time lost in the to qualify for the degree of B.A. earlier portion of the curriculum. Thus there arises in the figures supplied by each licensing body have been all the bodies an overlapping of studies not due to incorporated in separate tables which will be found in the conditions of the curriculum, but dependent upon the Appendix." To aid the comparison there have been failure on the part of 'individual students. In making added a number of subsidiary tables in which the more comparison between the bodies the Committee have important features of the separate statements have been adopted the plan of dividing equally between the First grouped together in ordered arrangement. and Second'Periods of the course the months of over- An examination of the figures makes it evident that lapping study arising from the delay of the student in there is wide divergence among the licensing bodies in passing the First Period examination. respect of the periods allotted to the study of the subjects In the tabulated statistics, in the case of each of the pertaining to the several professional examinations. Each licensing bodies, the Actual Minimum and the Average body has what may be called a Possible Minimum Course, Course have been compared, and the total retardation of which in most cases is clearly expressed in the regulations, the latter is clearly expressed in figures. The amount of and in the others, although not absolutely defined, it may the whole retardation is made up of two elements- readily be deduced from the statistics presented as that (1) the cumulative retardation of the examinations of followed by the individual students who ,pass unchecked the First Period, and (2) the retardation arising from through the curriculum. the later examinations of the course which are grouped To simplify comparison a division of the whole course together in the statistics as the " Final Examination." into two periods has been adopted. The first includes The retardation of the Average Course of each body as the time spent in the study of the Preliminary Sciences followed out by the students who qualify in seven years and of Anatomy and Physiology, and extending to the or less may be studied from two points of view- completion of the examinatio'n in these subjects. The (1) as regards its courses, and (2) as regards its second includes all the remainder of the curriculum. separate effect upon each of the two Periods of In the preparation of the statistics Pharmacy has been the curriculum. As regards (1), the causes of the left out entirely, owing to the great diversity of the con- retardation, it is to be pointed out that the Actual ditions among the licensing bodies under which it is Minimum Course as given in the tabulated returns (1 to examined upon. In respect of the main outlines of the 16) is in effect a Minimum Course in its totality only and not curriculum, the bodies may be divided generally into three in its details. In most of the instances some of the members classes, namely: of the actual Minimum group have suffered retardation -Class 1, in which the first period of the course extends to two in the earlier examinations, and have made up for it by years, twenty-one or twenty-four months as the case may be. curtailing the period allotted under the special conditions The arrangements in this Class probably approach more closely of the licensing body to the Final Examination. Thus, as than those of the others to the original intentions of the Council regards the two elements of the total retardation shown with reference to the subdivision of the curriculum. The Class in includes the University of Dublin, the University of Durham the tables, the first, the cumulative retardation of the the University of Birmingham, and the Conjoint Examining earlier examinations, is in reality less than it should-be-; Board in Ireland. and the second, the retardation of the final examination, Class 2, in which the First Period of the course occupies less is in reality greater. Table No. XXIII has been drawn than two years, practically eighteen months, and in which the Second Period is correspondingly prolonged. This Class up to show the true sources of the retardation in each includes the Conjoint Examining Board in England and the case. A portion of the so-called final retardation, in the Conjoint Examining Board in Scotland. table of each licensing body, corresponding to the ass 3, in which more than two years are required for the difference between the Average and the Maximum Period First Period. The remaining bodies, the statistics of which of Final Study in the Minimum Course, has been have been analysed, belong to this class. -deducted The Universities of Oxford and Cambridge, the Apothe- from the Final retardation and added to that arising from caries' Society of London, and the Apothecaries' Hall of the cumulative effects of the First Period examinations. Dublin are not included among the bodies whose statistics As regards (2), the effects of the retardation in adding have been analysed for the purposes of comparison. Few to the relative length of the two Periods of the Course or none of their candidates qualify within seven years. are set forth in Table No. XXII. The months of retarda- tion arising from the cumulative effects of the First 'Period Overlapping Study. examinations have been divided equally between tb,e two It is evident from a consideration of the facts that in Periods, the seeond moiety being added to those arising the case of all the bodies included within the third from the Final examination. group there is of necessity a certain amount of what The following Tab4e gives a comparison of the Couirse may be called normal overlapping study between the of Study of the several licensing bodies. Column 3.pre- subjects of the First and Second Periods of the course. sents the Possible Minimum Course of each body, and Column 4 shows the relative time value of that course when * A series of tables giving statistics for each licensing body sepa rately have here been omitted, but the other " subsidiary" tables in theoverlapping months of study in.th.e-third year bave been whichtlheresultsare.collcted.have-been-reiodueed. -equally.divided-between the two Periodsof the-curriculum 30o6 Bs MMDICA JOmI] GENERAL MEDICAL COUNCIL. [DEC. 5, !9o?. Column 5 gives the average course of each body as nine months between the first and second examinations. followed out by the students who qualify in seven years The University of London requires two years' interval or less, and Column 6, which is to be compared with between the Preliminary Sciences and Anatomy and Column 4, gives the relative value of the average course Physiology, and an additional two years between Anatomy when the months of retardation due to the failure in the and Physiology and the final examination. A study of Examination of the First Period have been equally the statistics presented by the bodies referred to shows divided between the two Periods, the final retardation that the blocking regulations have had little or no effect, being entirely allocated to the Second Period. Column 7 and that thie paramount influence in determining the is introduced for the purpose of aiding the comparison; length of the curriculum is the severity of the examina- it represents simply the differences between Columns tions relative to the qualifications of the students. Under 4 and 6. Column 9 shows the total retardation; its the English Conjoint Board, out of 97 candidates no one figures give a clear indication of the severity of the Ex- passed the final examination at or within three months after aminations as a whole relatively to the qualifications of the expiry of the prescribed two years' period of probation the candidates of each body. The two portions-of Column 8 after passing Anatomy and Physiology, and 2 students only contrast the relative severity of the Examination of passed at or within three months of the expiry of the four each of the two Periods. It will be noticed that the years' interval required between the first and the final figures in the second portion of Column 8 are in a number examination. Under the University of London, 5 students of instances minus quantities. When this is the case it out of 30 passed the final examinationat orwithin sixmonths means that the period of undivided study occupied in pre- after the expiry of the intervals demanded between the paration for the Examinations of the Second Period of the first and second examinations on the one hand and the course is actually less in the case of the average student final examination on the other. It is possible that these than that which is provided for in the regulations of the candidates may have suffered some delay on account of body in the case of the most highly-qualified candidates the blocking regulations. who pass through the course without check in the possible minimum period. (See Table A.) CONCLUSIONS. The Committee do not think it expedient to put forward Blocking Regulation8. at present any proposal for the lengthening of the cur- Two of the bodies in the list have regulations which riculum as a whole. When this motion, in which are devised for the purpose of securing a minimum period this suggestion is embodied, was originally remitted to of undivided study for the later portions of the course. the Committee, they asked leave of the Council to post- Under the English Conjoint Board an interval of twenty- pone its consideration until the report of the Examina- one months is required between the second and the final tion Committee, on the most recent inspection of the examinations, an interval of forty-five months between Qualifying Examin&tions, had been received. Had this the first and the final examinations, and an interval of report suggested that there was general evidence of

TABLE A.-COMPARISON OF THE COURSES OF STUDY OF THE SEVERAL LICENSING BODIES. LICENTIATES REGISTERED IN THE YEAR 1906 WHO QUALIFIED IN A PERIOD OF SEVEN YEARS OR LESS (The Figures are given in Months).

1. 2. 3. 4. 5. S. 7. 8. 90 The Relative The Average The Relative Addition The Regulation Value of Course as Value of to the Minimum or the Regulation actually followed the Average Average Origin of Possible Mini- Minimum by Students Course, allowing Course due the Retar- mum Course. Course, allowing qualifying for Overlapping to Retar- dation. for Overlapping within Seven Study. dation. 0 -I Study. Years. .0 0 I- I - Cd Licensing Body. 042 X S) 0 pi .0 0 k as0'0 P01 '0- ~;-r~P 0 4= 0 84 o d 0 " 44 '0i z 0 0 '0 0 0 0 .Hi 0 0 .2 - -4 .1. 'D 0 *-4 p4Piz eTI C4 -4 0) N P-4 k az 0 '4 pZo p4 d .4 02 0 .o '0z 0 p4 0 p-4 0 '0 0 O E-1 02 84i Sl E-4 -l -- I - -1-- - 1 - English Conjoint Board 97 18 39 57 18 39 57 30.61 1 38.66 69.27 30.611 38.66 69.27 12.62 0.35 12.62 -0.35 12.27 Scottish Conjoint Board ...... 21 18 39 57 18 39 57 30.7 35 65.7 24.35 41.35 65.7 6.35 2.35 12.7 -4 8.7

University of Dublin ...... 29 21 36 57 21 36 57 33.51 30.31 63.82 27.25 36.55 63.8 6.25 0.55 12.5 -5.7 6.8

University of Durham ...... 21 24 36 60 24 36 60 28.7 36.9 65.6 26.35 39.25 65.6 2.35 3.25 4.7 0.9 5.6 University of Birmingham ... 4 21 36 57 21 36 57 24.75 35.25 60 22.87 37.12 60 1.87 1.12 3.75 -0.75 3

Irish Conjoint Board ...... 57 21 36 57 21 36 57 32 34 66 26.5 39.5 66 5.5 3.5 11 -2 9

University of London...... 30 27 33 60 25.5 34.5 60 37.6 34.2 71.8 30.8 41 71.8 5.3 6.5 10.6 1.2 11.8

Victoria University of Manchester 23 30 27 57 27 30 57 32.48 31.52 64 28.24 35.76 64 1.24 5.76 2.5 4.5 7

University of Liverpool ...... 8 30 27 57 27 30 57 33.75 33.38 67.12 28.8 38.25 67.12 1.87 8.25 3.75 6.37 10.12

University of Leeds ...... 7 30 27 57 27 30 57 34.3 39.43 73.7 £9.15 44.55 73.7 2.15 14.55 4.3 12.4 16.7

Vniversity of Edinburgh '... 115 30 27 57 27 30 57 36.4 26-q7 63.1 30.2 32.9 63.1 3.2 2.9 6.4 -0.3 6.1

University of Glasgow . 56 30 27 57 27 30 57 40.7 24.64 65.3 32.35 32.99 65.3 5.35 2.99 10.7 -2.36 8.34

'University of Aberdeen ... 44 30 57 27 30 57 37.5 25 62.5 30.75 31.75 62.5 3.75 1.75 7.5 -2 5.5

... 27 University St. Andrews 5 30 2? 57 27 30 57 34.8 28.2 63 29.4 33.6 63 -2.4 3.6 4.8 1.2 6 .Royal University of Ireland... 48 30, 60 27 33 .60 39.2 27.3 66.5 31.6 34.7 166.5: 4.6 1.9 9.2 -2.7 6.5 I~~~~~~~ [ SUPPLIEMENT TOTIiR DEC. 5, ig9OPsi GENERAL MEDICAL COUNCIL. IBRITISH MEDICAL JOUaNiL 307 I insufficient preparation for the practice of the profession all cases in 'which study for degrees in Arts or Science has among the candidates, the Education Committee would been carried on simultaneously with that of Medicine have been have been compelled to formulate, for the consideration of omitted: the Council, proposals drawn up with the view of providing more time for the study of the main subjects of the curriculum. But at the present moment they do not find Licensing Body. No. Percetage in the facts before them sufficient to justify them in to total No. ,ecommending a change of such serious import. Under the Regulations of most of the bodies the periods University of Aberdeen ...... 44 95.65 .of study allotted to the different examinations of the curri- Irish Conjoint Board ...... 57 89 ,culum overlap one another to a greater or less degree, and it will be well in making proposals for the future to recog- University of Liverpool ...... 8 88.9 nize an arrangement which is so widely adopted. Regula- University of Durham ...... 21 87.5 tions which are designed to prevent overlapping study Royal University of Ireland ...... entirely will probably be found to act harshly upon the ... 48 85.7

... students in many cases. On the other hand, there seems University of Edinburgh ...... 115 85.1 no reason to suggest that there is of necessity disadvantage University of St. Andrews ...... 5 83.3 in the overlapping of the periods of study when it is not -carried to an undue extent. In all probability, therefore, University of Glasgow ...... 56 81.6 proposals which aim at the absolute prevention of over- University of Birmingham ...... 4 80 lapping study will not commend themselves to the approval of the Council, and the Committee believe that University of Leeds...... 7 77.8 the ends sought for by those who have submitted reso- University of Dublin ...... 29 76.3 lutions of this nature will best be secured if a reasonable Victoria University of Manchester ... 23 74.2 aninimum period of study is safeguarded for each of the iain groups of subjects. Scottish Conjoint Board ...... 21 70 The grouping of the subjects belonging to the curricu- University of London ...... 30 62.5 lum for the purpose of fixing the minimum periods of :study will demand the attention of the Council. The English Conjoint Board ...... 97 57 Committee would point out that a number of the bodies University of Cambridge ... 7 33.33 find it advantageous to combine a certain amount of the Society of London 0 0 work in Anatomy with the study of the Preliminary Apothecaries, Sciences, as they are thus enabled to provide more time University of Oxford ...... 0 0 Yor the study of Anatomy than would otherwise be pos- Apothecaries' Hall, Dublin ...... 0 0 sible, and to diminish somewhat the congestion of the later part of the course. Taking into account also that the subjects of Biology and Anatomy and Physiology are TABLE XVIII. -very closely related to one another, the Committee see no Average length of the course in the group not exceeding -reason to recommend that the First and Intermediate seven years; the number of Licentiates included in Xhe group Examinations need be divided into separate groups for the in each instance is included within brackets ( ): purpose of fixing the extent of the limit periods of study Months. to be required. University of Cambridge (7)...... 76 It will probably be found sufficient to adopt a division University of Leeds (7) ...... 73.7 ,of the whole curriculum into two Periods, and the Com- mittee would suggest this course. The further question University of London (30) ...... 71.8 .remains of the extent of the minimum limit to be assigned English Conjoint Board (97) ...... 69.27 to each of the periods. The problem is one which requires University of Liverpool (8) ...... 67.1 a careful consideration of the conditions as they are Royal University of Ireland (48) .. 66.5 found at present among the different Licensing Bodies. Irish Conjoint Board (57) ...... 66

A detailed study of these conditions as they are revealed Scottish Conjoint Board (21)...... 65.7 in the Statistical Tables contained in the Report has led. University of Durham (21) ...... 65.6 the Committee to the following conclusion: University of Glasgow (56) .. .. 65.3 Victoria University 6f Manchester (23) .. 64 Recommendation. University of Dublin (29) ...... 63.82 That the Regulations of the Licensing Bodies should be University of Edinburgh (115) ...... 63.1 so framed that not less than eighteen months of undivided University of St. Andrews (5) ... 63 study, or a period equivalent in time-value thereto, where UJniversity of Aberdeen (44) .. .. 62.5 overlapping study obtains, half-value being allowed for University of Birmingham (4) ... 60 periods of overlapping study, should be set aside for the First Period of the course, extending to the completion of the examination in Anatomy and Physiology; and that TABLE XIX. not less than the equivalent in time-value of twenty-seven Average length of the period of study extending from registra- months of undivided study, similarly calculated, be set tion to the completion of the examination in Anatomy and aside for the Second Period of the course. Physiology: The Committee desire to thank the several Licensing Months. Bodies for their courtesy and consideration in having freely University of Glasgow (56) ... 40.7 -supplied the detailed information sought for by the Royal University of Ireland (48) ... 39.2 President on behalf of the Council. University of London (30) ...... 37.6 University of Aberdeen (44) ...... 37.5 [The Tables numbered I to XVI, giving particulars of University of Edinburgh (115) ... 36.4 the courses of study followed by graduates and licentiates University of St. Andrews (5) ...... 34.8 ,of the several licensing bodies of theyear 1906, are omitted. University of Leeds (7) ...... 34.3

The Tables which follow summarize the results.] University of Cambridge (7) ... 34 University of Liverpool (8) ... 33.75 TABLE XVII. University of Dublin (29) ...... 33.51 Showing the number of those who registered as qualified Victoria University of Manchester (23) ... 32.48 -under each licensing body during the year 1906 after a period Irish Conjoint Board (57) ...... 32 -of study not exceeding seven years, and the percentage of this number in each case to the total number of the year. All cases Scottish Conjoint Board (21) ... 30.7 in which exemption from any of the examinations was granted English Conjoint Board (97)...... 30.6 -have been entirely excluded from consideration, and ih like University of Durham (21) ... 28.7 -nanner, except in the instance of the University of Dublin University of Birmingham (4) ... 24.75 -SUPP]rEXENTITO THE 308 BRITISH MEDICAL JOURNAL] GENERAL 'MEDICAL COUNCIL. (DEC. 5, 1908. I TABLE XX. TABLE XXIII.-The Source8 of Retardation. Average length of the period of study after the completion of the examination--~~inv---Anatomy andv-Physiology:. M,onths. Cumulative Retardation University of Cambridge (7) ...... 42 Retarda- of the Exami- University of Leeds (7) ...... 39.43 Total tion due aations in the Licensing Body. Retarda- to Final Preliminary English Conjoint Board (97) ...... 38.66 tion. Examina- Sciences and University of Durham (21) ...... 36.9 tion. in Anatomy University of ... 35.25 and Physio- Birmingham (4) logy. Scottish Conjoint Board (21)...... 35 University of London (30) ...... 34.2 Months. Months. Months. Irish Conjoint Board (57) ...... 34 University of Leeds (7) ...... 16.7 12.4 4.3 University of Liverpool (8) ... 33.38 English Conjoint Board (97) ... 12.27 -0.45 12.62 Victoria University of Manchester 23) ... 31.52 University of London (30) ...... 11.8 1.2 10.6 University of Dublin (29) ...... 30.31 University of St. Andrews (5) ... 28.2 University of Liverpool (8) ...... 10.12 6.37 3.75 Royal University of Ireland (48) ...... 27.3 Irish Conjoint Board (57) ...... 9 2 11 University of Edinburgh (115) ...... 26.7

University of Aberdeen (44) ...... 25 Scottish Conjoint Board (21) ... 8.7 ' -4 12.7

University of Glasgow (56) ...... 24.64 University of Glasgow (56) ... .. 8.34 -2.36 10.7 TABLE XXI. Victoria University of Manchester 7 4.5 2.5 THE MINIMIUM COURSE. (23) In the majority of instances the minimum course contains University of Dublin (29) .. 57 months; in the University of London, the University of 6.8 5.7 12.5 Durham, and the Royal University of Ireland it extends to Royal University of Ireland (48) 6.5 -2.79.2 60 months. As figured in the Statistical Tables, the minimum course, as actually followed, represents in each case the University of Edinburgh (115) 6.1 -0.3 6.4 average course of the group which completed in the minimum period. In nearly every instance members of the group have University of St. Andrews (5) ... 6 1.2 4.8 suffered retardation due to delay or failure in the earlier University of Durliam (21) ...... 5.6 4.70.9 examinations, which they have recovered at the expense of the time allotted to undivided study for the later examinations. University of Aberdeen (44) 5.5 -2 7.5 Percentage nutmber of thtose who qualified in the minimum period University of Birmingham (4) ... 3 -0.75 3.75 in the case of each Licensing Body: PERIOD OF 57 MONTHS. Per cent. Dr. MACKAY moved that the Council should approve University of St. Andrews (5) ... 60 generally of the recommendation. The report had been University of Liverpool (8) ...... 50 sent out to all the licensing bodies with a special request University of Birmingham (4) ... 50 that they should look into the statistics, and a number of Victoria University of Manchester (23) ... 43.48 them had returned opinions upon the conclusions contained University of Glasgow (69) ...... 35.71 in the report, but not all; and now that the report would UJniversity of Edinburgh (115) ... 34.7 be placed upon the minutes and become public property, University of Aberdeen (44) ...... 27.27 criticisms and suggestions would be of the greatest value Scottish Conjoint Board (21)...... 23.8. to the Committee when it came to make up its mind on Irish Conjoint Board (57) ...... 22.8 the subject. A large number of proposals had been University of Dublin (29) ... 20.7 remitted to the Education Committee, coming to a very English Conjoint Board (97)...... 14.3 large extent from gentlemen engaged in the work of the University of Leeds (7) ...... 0 final parts of the curriculum, and from practitioners University of Cambridge (7) ...... 0 engaged in practice who were deeply interested in the essentials of medical study-namely, surgery, medicine, and PERIOD OF 60 MONTHS. midwifery. The argument put forward bythose gentlemen University of Durham (21) ...... 47.6 was that they found the subjects of study for the Final Royal University of Ireland (48) ... 39.6 Examination were apt to be neglected, particularly by of London ... University (30) ... 10 those who had spent too long over the earlier subjects, and sought to make good expense TABLE the loss of time at the of XXI.-The Effects of Retardation. the later subjects. This seemed a reasonable complaint, for there could be no doubt that if this obtained the Retarda- Retarda- tendency would be to spoil the work for the Final Exa- tion tion Total Name of Licensing Body. Addition Addition Retarda- mination. That appeared to constitute a great danger, to First to Second tion. and it was to that that the Education Committee had Period. Period. turned its attention. It was necessary, however, to exa- mine the statistics see Months. Months. Months. closely, to if they suggested any- University of Leeds (7) ...... 2.15 14.55 16.7 thing of the kind; whether as a matter of fact there was general evidence that men were devoting less time to the English Conjoint Board (97) ...... 12.62 .3 12.27 final part of the curriculum than they should. One of the University of London (30) 5.3 6.5 11.8 remedies\ or proposals in the report was that the whole course University of Liverpool (8) 1.87 8.25 10.12 should be lengthened to six years, or even extended beyond that time. The Committee had con- Irish Conjoint Board (57)... 5.5 3.5 9 sidered the matter very carefully; it had referred to the Scottish Conjoint Board (21) ...... 6.35 2.35 8.7 last report of the Examination Committee on the last, cycle of examinations, but did not find in University of Glasgow (5) that report . 5.36 2.99 8.34 any justification for the very extreme step of suggesting Victoria University of Manchester (23) 1.24 5.76 7 that the whole course should -be lengthened. From the reports University of Dublin (29)... 6.25 0.55 6.8 received from the various bodies it did not appear that any of them was in favour of lengthening the course Royal University of Ireland (48) 4.6 1.9 6.5 as a whole, and he ventured to think there was no opinion in University of Edinburgh (115) .. 3.2 2.9 6.1 the profession pointing towards such a course at the present moment. The opinion seemed to be that the- of St. best, University Andrews (5) ... 2.4 3.6 6 men could get through the work in the prescribed time, of and that no in University Durham (21) ... 2.35 3.25-' 5.6 barrier should be placed their, way. What- ever the Council did, if it did anything, it, shoulynot be to University of Aberdebn (44) ... 3.75 1.75 5.5 prevent men doing as much as peseible in the time allowed. of ( University Birmingham' (4) ... 1.87 1.12 2.99 Another suggestion was ,that. Prplimiuaxyy Science should be cut out of the preliminary curriculum, as thereby [ SDPPLMNCY To THU 30 DEC. 5, I9o8.] GENERAL MEDICAL COUNCIL. IBRITIH MUDIKOA JOURAL 309

I 6 more time would be gained for other work. The tion he thought there should be a further opportunity for Committee did not tie itself to any step in that direc- discussing them. tion, and whatever was ultimately done, the general Sir THOMAS MYLES strongly opposed the recommenda- opinion throughout the country, supported by the almost tions. unanimous decision of the Council, was that it was Dr. NORMAN MOORE thought that the period of clinical not desirable at the present moment to cut out study should be unaffected by any other study, and in any Preliminary Science from the preliminary part of the regulation it should be made clear that the period of curriculum. It had been proposed that overlapping study clinical study should not be entered upon until' a man should not be recognized. After all, what was essential had finished his anatomy and physiology. s, not to prevent overlapping study, but to see that Dr. NORMAN WALKER had had the opportunity of discuss- whatever the course might be an adequate time should be ing the report with three different bodies, and' in each given to each of the particular subjects. Therefore the case there had been the same difficulty of' understanding Committee did not see its way to make any proposal to it-the same misunderstanding as he thought had been the Council which would have the 'effect of putting a stop evidenced there that day; but after full' discussion each of to overlapping study. That being the case, there appeared those bodies had come to see that the report was a very to remain only one solution of the difficulty, namely, that reasonable one, and that the recommendations should be the Committee should suggest that a reasonable period given effect to. The very moderate proposal that two should be set aside for the study of these subjects, years and three months should be given to clinical study and, however much more may be given, in no case was a thing which should recommend itself to every should the study fall below a certain minimum. That, teacher. The licensing bodies and the universities had ih fact, was what had been done. The Committee had in their own discretion the regulation of the earlier educa- divided the course into two periods-the first period tion; all the Council insisted upon was that the student extending up to the completion of Anatomy and Physi- should be well instructed in clinical surgery and medicine. ology, the second embracing the remaining subjects. Mr. IIODSDON believed it would be beneficial if the pro- The Committee had suggested that the second posals were carried out, but there was one point as to period, which was the most important, should never which he was not quite clear, and that was with regard to fall below the equivalent of twenty-seven months of the exemptions of Indian and Colonial students. Before it undivided study. The object was to secure that, allowing came up for further discussion he hoped that further a certain reasonable limit of delay in the earlier examina- consideration would be given to it. tions, the Final examination should not suffer. The other Dr. LINDSAY STEVEN agreed that anything which would proposals referred to the setting of a limit for the earlier permit of the student finishing his preliminary science subjects. The limit chosen-namely, eighteen months- subjects before he actually began hospital work would, in was at first sight short, but what had actually been done his opinion as a clinical teacher, have a great beneficial was to take the limit as it at present existed among the effect on medical education. He agreed with those who licensing bodies. In course of time no doubt it might thought the object of the report was to ensur.e that a happen that Preliminary Science would drop out of the longer time might be devoted to clinical study. The body curriculum and be put in a period before the period of pure which he represented had carefully considered it, and was medical study, but at the present moment, under the of opinion that no regulations for lengthening the curri- regulations of the Council, it counted as a part of culum should be made by the Council; it was more in the medical curriculum. The practical working of favour of a block system. It also wished to emphasize these proposals would not affect the position of the desirability, if possible, of devoting the fifth year Colonial students who came over to British uni- almost exclusively to practical and clinical work. versities and licensing bodies. In every case where Mr. HENRY MORRIS did not think the Council had had exemption was granted by a licensing body, the an opportunity of considering the matter thoroughly-; studept would be required to show that he had taken an further discussion of it was desirable. equivalent course and to produce the details of it. If that The PRESIDENT said the essential point which the Edu- course were satisfactory he would be accepted; if not, he dation Committee had had to consider was the impression, would not. The Council should take an interest not very strong in the minds of teachers all over the country, merely in examination, but in the teaching of medical and also in the mind of the profession itself, that the subjects, and this would be an important step, although a earlier subjects encroached on the time that ought to be small one, in that direction. g;ven to the later subjects. To verify whether or not that Sir CHRISTOPHER NIXON seconded the motion. impression was right required very careful analysis of the Dr. SAUNDBY'S duty was to express on behalf of the facts. That analysis had been made by the expenditure of University of Birmingham its very great dislike to any enormous labour and ingenuity at the instance of the further limitations of the curriculum. As it was, it was an Chairman of the Education Committee, and he was sure exceedingly difficult matter to arrange, and the proposal the whole profession was profoUndly indebted to him. seemed to him to make it still more so. He was not quite Did the figures bear out the impression? No one sure how these regulations would operate, and no harm could doubt that a very considerable encroachment on the would be done if the matter were postponed, as he would final stage of the curriculum did take place by reason of the like to have more time for consideration and consultation. undue prolongation of the period given to the earlier Sir CHRISTOPHER NIXON said the proposals could only subjects. That fact was ascertained for good. The ques- be regarded as the pious opinion of the General Medical tion was, What was the remedy? He understood the Conncil, and would not be generally adopted. He was remedy suggested at this stage was to say that not less quite sure that, as far as the body he represented was than a certain time, whatever that might be, should be concerned, it would not consent to any arrangement which allotted to the subjects in the final stage. That the time would p;event a student attending a hospital at an earlier allotted to the subjects which were essential for a proper period than his third year. medical education was too short in many cases was an Sir JOHN MOORE, speaking as a clinical teacher, was of ascertained fact which had to be met, and, he hoped, opinion that, although it might not be the counsel of per- cured. His own impression was that, in a resolution of fection to postpone attendance at hospitals till the third this kind, all reference to the earlier subjects should be it would be a great day for the medical profession left out, and that the Council should concentrate its atten- ,year,when such a regulation was compulsory. tion on deciding what was the minimum period which Mr. THOMSON ventured to think that the report had not ought to be devoted to the subjects of medicine, surgery, gone to the root of the matter. It was from the education and midwifery. If the Council did that it would get at the side that the defects had to be looked at; and, after all, kernel and produce something intelligible which would not sufficient conditions and restrictions were imposed on the only enlighten members of the Council, but enlighten the unfortunate medical student as it was. governing bodies, the universities, and the profession. He Sir CHARLES BALL did not see what machinery could be thought if the matter was to go back to the Committee it introduced practically to comply with, the recommenda- should be limited to that point. tions. The recommendations as they existed at present Dr. MACKAY, in replying, suggested that he should with- were both colourless and ineffective, and they should be draw the resolution for the time being, and that' the more definite. He hoped they would not be passed as Education Committee shouild very carefually consider the they stood, and as the subject required much considera- matter in the light of the debate that had taken place. SUPPLEMENT TO THE 1 310 BRITISH MEDICAL JOUIRNAL I GENERAL MEDICAL COUNCI5. [DEC. 5, 1908. The difference had been, so far, the question of over- Sir JOHN MOORE pointed out that Preliminary aExamina- lapping of the work in Iepartments. Some had strongly tion of the Conjoint Board of the Royal Colleges was con- expressed the opinion that there should be no overlapping, ducted by a special examiner chosen by Cambridge- but on the other hand a very large number of the bodies University, and not by its own members, and there was- allowed overlapping, and that to a large extent; the nothing to prevent candidates from the Apothecaries' Hall, Council would find it difficult to stop it. It was a matter passing that examination. for very careful consideration in the interval, but if that The PRESIDENT agreed with Sir John Moore that the- difficulty could be got over a solution could be reached. examination of the College of Physicians and Surgeons Dr. SAUNDBY moved as an amendment- was in reality one held by a separate body of examiners, That the Report be remitted back to the Education Com- and was open to all who wished to go in for it. If the- mittee in order that they may report further upon it at Apothecaries' Hall, Dublin, deliberately went back on what another stage. every other body had agreed to do, it would be putting. Sir CHARLES BALL seconded. itself in opposition to the policy of the General Medical Dr. MACKAY, with the permission of the Council, Council, which would be justified in making representations accepted the amendment, and the matter was referred to the Privy Council to that effect. back. Dr. ADYE-CURRAN asked the Council to postpone further consideration of the matter until the next session, and he PROPOSED ARTS EXAMINATION BY THE APOTHECARIES' would ask the Apothecaries' Hall in the meantime not to HALL, DUBLIN. institute any examination. The Council then proceeded to consider the Report by The PRESIDENT thought the Council should have the- the Education Committee upon an intimation received opportunity of adopting the report now. He accordingly from the Apothecaries' Hall, Ireland: put the motion, which was agreed to, Dr. Adye-Carran That after April 1st, 1909, the usual Preliminary Examination alone voting against it. iu General Education which was held by this body for so many years would be resumed. CURRICULUM FOR D.P.H. Mr. THOMSON moved: Report of Education Committee. That it be referred to the Public Health Committee to con- This is an intimation that the authorities of the Apothe- sider the advisability of substituting in Rule I of the resolu- caries' Hall, Dublin, intend next year to revive the Pre- tions and rules relating to public health, the words " nine liminary Examination in Arts, which, in deference to the months" in place of the words "twelve months," as at express wish of the Council, they have for many years present. discontinued. The Committee are unaware of any circum- The rule as it stood at present added an additional threer stances which would justify so serious a reversal of the months to the prescribed, curriculum of nine months, educational policy which, at the Council's instance, has during which the candidate might be doing nothing, and been generally adopted by the licensing bodies, including he ventured to think that in certain cases this was a hard- the Apothecaries' Hall. The Committee, therefore, strongly ship. It was a hardship in cases where graduates might, deprecate the proposed re-establishment of a preliminary wish to proceed with all possible haste to the Colonies, examination conducted by a professional body which has but, before doing so, wished to obtain this special qualifica- no special relation to questions of general education. tion. Having gone through the specified curriculum or Should such an examination be notwithstanding instituted mine months, they were at present by the rules prevented for candidates seeking the licence of the Dublin Apothe- for three months from entering upon the examination, and caries'-Hall, it will rest with the Council to decide whether penalized to the extent that they must stay in this country it should be recognized for the purpose of the registration another three months. He asked the Council to consent, of students in general. Such recognition would affect in a to this matter being remitted to the Public Health practical way the arrangements of other licensing bodies in Committee for their consideration and report. regard to preliminary examinations. Accordingly, the Com- Dr. NORMAN WALKER seconded, and it was agreed to. mittee, in view of the grave educational issues involved, recommend that the Council's approval should not be THE BRITISH PHARMACOPOEIA. given to the step contemplated by the Apothecaries' Hall, The Council then proceeded to the consideration of the Dublin. following report of the Pharmacopoeia Committee: of the Education Committee, Dr. MACKAY, Chairmin From May 25th to November 21st, 1908, the number of copies said that the Apothecaries' Hall, Dublin, had made a of the British Pharmacopoeia (1898) sold by the publishers was similar intimation in 1903, and a resolution was then 537. The total number of copies sold in the year beginning passed by the Council in certain definite terms. The November 18th, 1907, was 1,125. Up to the present time 40,306 Education Committee had carefully considered the matter, copies of the Pharmacopoeia and 4,447 copies of the Indian andy no reason to its mind, had replied in Colonzial Addenidutm have been sold. The stock of the Pharnma- and, seeing change copoeia now on hand consists of 2,724 copies, together with 1,887 the identical words of the resolution of 1903. The policy copies of the Addenditm. of the Education Committee had been to try to reduce A third interim report from the Committee of Reference in the number of preliminary examinations, and to see that Pharmacy has been received, containing suggestions for the such examinations were only conducted by bodies ap- revision of certain monographs of the Pharmiacopoeia (1898), with propcsals respecting the official tests for lead, and the proved by education authorities. He moved that the articles to which these tests should be applied. It is proposed report be received and entered on the minutes. to publish the three reports now presented, in order that the Dr. LINDSAY STEVEN seconded. Pharmacopoeia Committee may have the advantage of noting Dr. ADYE-CURRAN said that the' Apothecaries' Hall, the criticisms or other comments which may be publicly made Ireland, was empowered by its Charter to conduct its own upon the suggestions therein contained. A tabular analysis of the suggestions made by the Medical examinations, and that this Council had no control over it Licensing Bodies of the United Kingdom, for the inclusion or in this respect; it simply had control in that it remained omission of articles in the next Pharmacopoeia, has been pre- with it to say whether it considered that examination pared by the Secretary, Dr. Tirard. Similar suggestions are sufficient or otherwise. So far as he could judge, the old now being received from the various British Medical Authorities was a stiff if it was allowed to outside the United Kingdom. When the whole of the informa- examination very one, and tion from these sources is ready for consideration, the Com- be conducted aaain it would be conducted on equally mittee will be in possession of a body of material which will be straight lines, and by men appointed by the universities. of great value to them in their task of adapting the new On this ground he opposed the report of the Committee. Pharmacopoeia to the needs of the Empire at large. Sir CHRISTOPHER NIXON observed that for the past eleven Dr. NORMAN MOORE moved, and it was resolved: years the policy of the Council had been to divo:ce the conduct of the preliminary examination from the body That the report of the Pharmacopoeia Committee be received that conferred the licence, and that policy had resulted in and entered on the minutes. no non-professional body being allowed to hold a prelimi- Sir HUGH BEEVOR moved, Dr. NORMAN MOORE nary examination, except the Conjoint Board of the seconded, and it was resolved: College of Physicians and the College of Surgeons in Ire- That the report of the Students' Registration Committee be land. It would be a complete reversal of the policy of received, entered on the minutes, and approved. the Council now to permit a second body, dealing with The Council then proceeded to the consideration of the professional education, to conduct its preliminary exami- report from the Unqualified Practice Prevention Com- nation. mittee. r SUPPLEMENT TO THE I Dnc. 5, 1908.] GENERAL MEDICAL COUNCIL. ITISH MEDICAL JOURNAL 31 = I UNQUALIFIED PRACTICE. Appended to the report is a digest, occupying 200 pages, of the The of the Practice laws in the British Empire and foreign countries showing what following report Unqualified Preven- provisions exist for the prevention of medical practice by other tion Committee was received and entered on the minutes than legally qualified persons. on the motion of Dr. LANGLEY BROWNE (Chairman) seconded Dr. LANGLEY BROWNE said the Committee was by Dr. LATIMER: appointed Report. to ascertain, first, the legal provisions that existed in the Members.-Dr. Langley Browne (Chairman), The Presi- colonies and dependencies of the Empire and in foreign dent, Mr. Morris, Dr. Saundby, Sir John Moore, Dr. countries for the prevention of medical practice by other Dr. than properly qualified persons; and, secondly, to consider McManus, Latimer, Dr. Norman Walker, Dr. Kidd. what steps should be taken in order to secure effective On November 26th, 1907, it was resolved, on the motion legislation for the same purpose for Great Britain and of Dr. Langley Browne, seconded by Dr. McManus: Ireland. The desired information had been obtained That a Committee be appointed to ascertain what legal pro- through the proper channels; it was most voluminous, visions exist in the Coloniesand Dependencies of the Empire and contained in almost every instance copies of the and in foreign countries for the prevention of medical prac- actual Acts in in as different as tice by other than legally qualified persons, and to consider force, many languages what steps should be taken to procure effective legislation there were countries. The information thus obtained was for the same purpose in the United Kingdom of Great Britain of the greatest value to the Committee. The President and Ireland. himself and the whole staff of officers had given an immense On December 12th, 1907, the Registrar, by diiection of amount of time to the matter, and the Committee were very the forwarded a communication to the grateful to them for the digest of what was really President, Privy valuable which he believed Council requesting that the Lord President would be so information, had not existed good as to communicate with the Secretary of State for hitherto in any shape or form. The Committee put Foreign Affairs, the Secretary of State for India, and the forward this digest as an appendix to its report. The -Secretary of State for the Colonies, in order that through Committee could have given the Council a great deal of the channels the information desired Council information as to the evil effects of unqualified practice, proper bythe but it came to the conclusion that the Council was aware mnight be obtained. This the Lord President kindly con- sented to do, and the information which he has obtained of the very great dangers which existed unchecked. If Jhas from time to time been forwarded by him to the the recommendation was approved, the Committee should Council. It has been and in be reappointed, in order that it might collect evidence and digested tabulated the form lay it before a Royal Commission, should it be appointed. now presented as an appendix to this report. This digest ,of all laws in force within the British Empire and in He moved that the recommendation above referred to be foreign countries shows what provisions exist for the pre- adopted. vention of medical practice by other than legally qualified Dr. LATIMER, in seconding, wished to associate himself It has been drawn the with Dr. Langley Browne's expression of gratitude to the persons. up by officers of the Council, officers of the Council for the assistance had rendered and has given them a large amount of extra work; but it they is very complete and valuable, and it contains much in connexion with the report. His own belief was that if information not hitherto published. The Registrar has they went at the proper time to the Government they to the would get a sympathetic response. applied Embassy of the United States with a request Dr. NORMAN MOORE considered for the same kind of information as to the laws in the the report a most valu- .several States of the American Union and its territories, able contribution to the literature on the subject. The but no answer has been received. only part which seemed not perfect was that referring to yet The digest has, the United Kingdom. No doubt a Royal Commission therefore, been supplemented by a statement drawn up by Dr. Bateman from the Medical Acts of the different would make a report which would be of extreme interest Federal States and from the Provincial and of some value in the attempt to restrict unqualified Acts in the practice, but it must be recognized that it would be most Dominion of Canada. This statement forms an appendix to the digest of the official information supplied difficult to convince the public that it should be suppressed. the Office. through He strongly supported the motion. Foreign The motion was then put and agreed to nem. con. The Committee now presents the digest and the appendix to the Council in fulfilment of the instructions contained in the ASSISTANT EXAMINER, APOTHECARIES' SOCIETY, LONDON. first part of its reference. Sir HUGH BEEVOR moved, and it was resolved: The Committee assumes that every member of the medical That Mr. Charles Stonham, C.M.G., F.R.C.S.Eng., be Council, and, indeed, every practitioner, is aware reappointed Assistant Examiner to the Apothecaries' Society of the injury done to the public by the practice of un- of London for a period of two years from June 16th, 1908. -qualified persons and companies which is carried on with impunity in this country. THE TUBERCULOSIS PREVENTION (IRELAND) BILL. It believes that sufficient protection against such injury The Council then proceeded to consider the following is not afforded to the public by the present Medical Act; report from the Irish Branch Council: that the injury is grave and is increasing; and that a must be found in such as exists in most REPORT. remedy legislation "The Irish Branch Council met on November 25th, and, inter -civilised countries. alia, had before it the Tuberculosis Prevention (Ireland) Bill The Committee, however, recognizes that, before remedial now awaiting third reading in the House of Commons. The legislation can be looked for, it is necessary that the public Branch Council desires to bring under the notice of the General -should be made more fully aware of the dangerous abuses Medical Council that it is proposed by Clause 1, Subelause 2, which exist under that ' the Local Government Board, after consulting with the present conditions. To this end it is Irish Branch of the General Council of Medical Education and desirable that full inquiry should be made by the authority Registration of the United Kingdom, shall from time to time, ,of His Majesty's Government, and the Committee is pre- by order, prescribe the forms and stages of tuberculosis to pared to assist in the production of evidence should such which, and the circumstances in which, this Section shall an be instituted. apply.' The Irish Branch Council, while quite willing to under- inquiry take the duty, is of opinion that it would be inequitable that the expenses incurred in discharging this duty should fall on the RECOMMENDATION. Irish Branch or on the General Council, and desires an The Committee accordingly recommends that the fol- expression of the opinion of the General Medical Council on this lowing resolution should be adopted by the Council, and subject." transmitted to the Lord President of the Privy Council: Moved by Sir JOHN MOORE, seconded by Sir CHRISTOPHER "That the General Medical Council, being of opinion NIXON, and resolved: that the present Medical Acts do not sufficiently enable That the report of the Irish Branch Ccuncil be received and 'persons requiring medical aid 'to disbinguish qualified entered on the minutes. from unqualified practitioners,' and that it is contrary to Dr. LITTLE considered that it would be hardly fair that the interest of the public that medical and surgical practice this expenditure should fall on the finances of the Branch should be carried on with impunity by persons holding no Council, or the General Council, and therefore the Com- recognized qualifications, requests the Government to take mittee suggested, if the Council approved, that it should steps for the appointment of a Royal Commission to address a remonstrance to the Government that a clause inquire into the evil effects produced by the unrestricted should be inserted providing for financial aid in order to practice of medicine and carry out the proposals contained in it. surgery by unqualified persons." I 31I2 SUPPLEMENT TO THE z oS8@ 31 BRITISH MJEDICAL JOURXALJ GENERAL MEDICAL COUNCIL. [DEcG ,, zgo8. Dr. NORMAN MOORE inquired if the College of Physicians powerful order of practitioners throughout the country. and College of Surgeons, or both, had been consulted on He had had very large opportunities of- seeing the matter, because that seemed to be the natural something of nurses, and he believed that would be course. the main effect of the bill. There were at the present, Sir JOHN MOORE: No, and the Irish Branch Council time, as most of those in general practice were aware, has not been consulted. nurses who were consulted by families instead of the Dr. SAUNDBY understood that the Irish Branch Council medical practitioner, and the bill would tend in that direc- had no objection to undertaking the duties suggested, but tion. Therefore it ought to be very carefully watched by it possessed no funds to meet the expenses of acting in the such a body as the General Medical Council, which was in matter. charge of the Medical Register. Sir CHRISTOPHER NIXON was of opinion that the bill was Mr. HENRY MORRIS thought it most desirable that the objectioniable in many points, and was extremely cumbrous. Council should have the opportunity of making direct It would involve a useless expenditure of money, and representation to the Privy Council before the regula- would not accomplish any good. He did not think the tions were adopted. This was found to be a dis- Council should take any action which would imply that it tinct advantage in respect of the Midwives Bill, and was favourable to it. it was most desirable in connexion with nurses' The PRESIDENT took it that the opinion was that the registration. Council should call the attention of the Government Dr. LANGLEY BRGWNE considered that some answer must- to the fact that the duty imposed by the bill on the be sent to the Privy Council with regard to this matter. Iris'h Branch Council was one which would involve He never knew a subject on which the medical proz expense, not only on that Council, but on the General fession were so unanimous as with regard to the Medical Council; that neither the Council nor the Branch registration of nurses. It had not only been ap- Council possessed funds which could be devoted to purposes proved by the members of the British Medical Associa- outside medical education, and, therefore, could not under- tion at its Annual Meeting, but it had been sent to, take these duties unless funds were provided for the pur- every Branch, and he believed in only one case had any- pose of meeting the expenses which would be incurred, thing like objection been shown towards it. It was a, and- that the Council expressed no opinion on any other measure desired by the general body of the profession, and part of the bill. If it was the wish of the Council he was considered to be an enormous advance in the right. would write a letter to that effect. direction. This was agreed to. Sir CHRISTOPHER NIXON had no doubt it would be a great advance to the nurses, but would it be an advance to the, ? The Council was asked to REGISTRATION OF NURSES. general practitioner take action on a bill as to which it did not have the opportunity The PRESIDENT stated that he lhad received a letter from of considerina how it would affect the profession generally. the Privy Council calling attention to Clause 4 (1) (c) of It would establish a new order of practitioners, who would the Nurses' Registration Bill which provides for the seriously interfere with general practitioners, and why appointment by tne General Medical Council of one repre- they supported it he could not understand. He submitted sentative on the General Council for the Registration of that an important measure such as this should have been Nurses in the United Kingdom proposed to be established discussed fully. by the bill. The letter from the Privy Council concluded Dr. LINDSAY STEVEN was, on the whole, opposed tco by stating that the bill was not one for which His MIajesty's the registration of nurses, which would take place upon Government was responsible. the lines of the registration of medical men. He cordially The President said that the bill differed from the Mid- supported the motion of Sir John Moore that a clause wives Bill in that, first, the General Medical Council was should be inserted in the bill giving the Council direct given direct representation on the governing body, and, coutrol. He would like to oppose the bill altogether; but, secondly, that the rules were not to be submitted to the if that was not he feared the Council was not in General possible, Medical Council before their approval by the Privy a position at so late a period of the session to con- Council. sider it. Sir JOHN MOORE moved The PRESIDENT took a show of hands as to whether the Council generally objected to have the nomination of a. That it is expedient that the General Mledical Council should on the Central Board for Nurses' stand in the same representative Registra- relation to the proposed General Council was clear that the of the Council for the Registration of -Nurses in the United Kingdom as tion, and said it majority the said General Mledical Council does to the Central would rather have it. If they took Sir John Moore's Midwives Board under Sections 3 and 16 of the Midwives motion to mean as in the Midwives Bill, they could vote Act, 1902. upon it. At the same time, ought not representation to be made to the effect that it would involve the Council in He accepted the statement that this was not a Govern- considerable expense? ment bill, but the fact that it was introduced into the Dr. LATIMER thought that should be done. House of Lords, backed by Lord Ampthill, and finally Dr. MACKAY did not vote either way on such a small accepted by the Earl of Crewe, showed that the Govern- detail; but this was one of the most important proposals, ment approved it even if it was not its own. Considering as far as the profession was concerned, that had the very close relationship between the nurse's calling been before Parliament since the Medical Act of 185& and the medical profession, it was most desirable It was practically a creation of an inferior department of that so influential a body as the General Medical Council the medical profession. The British Medical Association, should have a say in the rules which were to be adopted as Dr. Langley Browne had told them, had decided that by the proposed Nurses' Council. It was most important this department should be created. Speaking for himself, that the medical profession should see that those rules he had not seen the bill, and did not know anything about should not in any way countenance the practice of medi- it. It was not a Government bill, but it had got the cine or surgery, even in the smallest phase, by the nurses Government dress, and might pass during the present- who were to be admitted to the Nurses' Register; and the session. He thought at all events that the Council only way of doing that was to have the rules submitted should' give an opinion as to whether it approved to the approval of such a body as the Council. He of this as a separate provision, because a great- was quite aware that representation was given to the, deal that was done by the doctor amongst the' General Medical Council on the proposed Nurses' poor and in country places would be done by the Council, but he very much preferred that the Council nurses. They would undoubtedly begin to practise minor should be placed in the same relation to nurses' registra- surgery and minor medicine. All this might be right tion that it had been placed in with regard to midwives' enough in the public interest, but it was not in the' registration. interests of the profession. This was an extremely Dr. NORMAN MOORE thought the bill raised very serious serious matter, and, if it was going to create an inferior consideration. It was highly desirable that its working branch of practitioners in medicine and surgery, as it should be brought to some extent into relation with seemed to him it would, he should want more time to' .the Council, as the motion proposed. One effect of considerit', the bill might be to establish an inferior but very Sir CHRISTOPHER NIXON moved [ SUPPLEMENT TO TIlE DEC. 5, i908.] NAVAL AND MILITARY APPOINTMENTS. lBRFITISH MEDICAL JOURNiL 3 r3

That the General Medical Council, not having had an oppor- tunity of examining the particulars of the Nurses' Registra- tion Bill, declined to express any opinion as to whether the abal athi iIita qpitn . Bill was desirable or not. ROYAL NAVY MEDICAL SERVlCE. Dr. LINDSAY STEVEN seconded. THE following appointments have been made at the Admiralty: Fleqt The PRESIDENT reminded the Council that it had again Surgeon GEORGE T. BROATCH, M.B., for the Royal Naval Hospital, Yar- mouth, January 5th, 1909; Staff Surgeon PERCIVAL K. Nix, M.B., to the and again recommended to the Government and the Privy Cornwall, January 5th, 1909; Staff Surgeon JAMES, MOWAT, M.B., to the Council the registration of nurses in the interests of the Triumph, on recommissioning, November 25th; Surgeon HAROLD G. T. MAJOR, to the Spanker, on recommissioning, undated; Surgeon PERcY public. His recollection went back to a very early date. M. RIVAZ, M.B., to the Vivid, additional, for disposal, November 18th, On November 30th, 1889, a resolution to that effect was and to the Triumph, November 29th; Surgeon FREDERICK M. V. SMITH, the late Sir John Simon and adopted, and to the Vivid, Novemnber 18th; Surgeon G. W. MI. CUSTANCE, to t:he. proposed by Cressy, November 24th; Staff Surgeon CECIL R. RICHARD, to the Ganges, now the Council was invited to go back on a resolution additional, for Shotley sick quarters, January 9th, 1909; Surgeon which had been so long on record. FREDERICK C. ROBINSON, to the Pem7bro7ke, January 1st, 1909; Surgeon GEORGE S. DAVIDGE, to the Sapphtire, January 1st, 1909; Surgeon Sir CHRISTOPHER NIXON observed that they might all be BRYAN Picx, to the Esp)iesle, additionial, for Dartmouth College, in favour of a certain measure of registration for nurses, January 1st, 1909; Surgeon HENRY M. BRAITHWAITE, M.B., to the but Victory, additional, for disposal, Novemiiber 24th; Surgeon JOHN H. L. it did not follow that they were in favour of an PAGE, to the Amethyst, on recommissioning; Surgeon G. NUNN, to the elaborate bill which created an inferior department of the Vivid. January 5th, 1909. profession. Mr. H. J. SATCHWELL, civil practitioner, has been appointed Surgeon Dr. MCMANUS pointed out that the Council was not deal- and Agent at Wakering Haven, November 27th. ing with any new form of minor practitioners; they ARMY MEDICAL SERVICE. already had the nurses. All that the general prac- ROYAL ARMY MEDICAL CORPS. titioner desired was to when he called in a nurse CAPTAIN L. WOOD to be Adjutant of a School of Instruction, know, October 30th. in a poor district, that he had got a woman that had been ,Captain F. M.. PARRY, M.B., to be Adjutant of a School of Instruction, properly trained, who had been properly examined, and as vice Captain L. N. LLoyd, D.S.O., whose tenure of that appointment. has expired, Novemiiber 1st. to whom there was some guarantee of her conduct and CaptainL. N. LLOYD, D.S.O., to be Adjutant of a School of Instruc- respectability. Under the present state of affairs any tion, vice Captain E. T. Inkson, V.C., whose tenure of that appointment. woman of a doubtful character rehabilitated herself by has expired, November 1st. putting on a cloak and calling herself a nurse, and the INDIAN AIEDICAL SERVICE. were deluded; whereas, if this bill were passed, and COLONEL WV. G. H. HENDERSON, BomIbay, has retired from the service, public November 14th. He entered his department as an Assistant Surgeon, rules prepared, these women would be prevented from March 31st, 1876, and becalne Colonel, November 11th, 1905. He was in foisting themselves on the public and on the members of the Burmese camipaign in 1887-8, for which Hart's Army List credits him with a ilmedal and clasp), but the Oticial Qutarterly Armi List omits. the profession, and the profession would have some this. guarantee that persons who professed to act as nurses Lieutenant-Colonel W. H. W. ELLIOT, D.S.O., M.B., Bengal, also were persons of good character and qualified to perform retires from the service, from Novemiiber 15th. He was appointed Surgeon, September 30th, 1886, and was imiade Lieutenant-Colonel, the duties for which they were required. March 31st, 1907. His war record is as follows: Kazara expedition, 188& Dr. LATIMER observed that the more control the pro- (medal with clasp); first Miranzai expedition, 1891; North-West fession over Frontier of India campaign, 1897-8 (medal with clasp); South African had the nurses the more certain it would be war, 1899-1901, being lpresent in op)erations in Natal, including the actiopn that the women would be properly trained. The Act was at Lombard's Nek and thedefence of Ladysmith, including the action one which the nurses had a to call for, and it would of January 8th; he was afterwards present in operations in Natal and right ill the Transvaal, was m-entioned in dispatches, granted the D.S.O., and put an end to the anomalous state of affairs to which received the Queen's mi-edal with three clasps. Dr. McManus had called attention. The promotion of Lieutenant-Colonel W. A. Quayle, M.B., Madras,. which has been already announced in the BRITISH MEDICALJ JOURNAL, Sir JOHN MOORE, in reply, said that he was astonished at has received the approval of the King. the admissions of some members of the Council that they His Majesty has likewise sanctioned the retirement from the service knew pro- of the undersuentioned officers, all of which announcements have, nothing about the bill. It had been before the already appeared in the BRITISH MIEDICAL JOURNAL: Colonel G. J. fession for months. He held a document in his hand, KELLIE, Bengal; Lieutenant-Colonel S. J. THOMSON, C.I.E., Bengal; anc dated November, 1908, which contained a sheet of amend- Lieutenant-Colonel J. B. GIBBONS, Bengal. ments drawn up by the College of Physicians, Ireland, to RESERVE OF OFFICERS. this very bill. In spite of opposition, registration of nurses THE undermentioned officers, from the late Royal Army Medical Corps was sure to come, and he thought it would come within a (Militia), having assented to be transferred, are appointed officers of few months. the Reserve of Officers, with effect from September 20th, 1908, retaining the rank and seniority which they held in the Militia:-Captains. The amendment was then put and declarEd lost. HERBERT E. DALBY, SAMUEL T. BEGGS, M.B., and Lieutenant DANIEID At the request of Sir CHRISTOPHER NIXON the names and V. M. ADAMS, M.B. numbers were taken that 3 voted down, when it appeared ARMY MEDICAL RESERVE OF;OFFICERS. for, 14 against, 4 did not vote, and 10 were absent. CONSEQUENT on the disbandlient of the Army Medical Reserve of The resolution was then put and agreed to. Officers, as constituted by the Royal Warrant of 1888, the undermen- tioned officers cease to be officers therein: Surgeoni-Lieutenant-Colonels. R. H. COOMBS. M.D., G. S. ELLISTON, J. K. ANDERSON, M.D., P. B. GILES, F.R.C.S.E., A. CLARH, W. R. SMITH, M.D., D. MCFADYEN, PROIPOSED INCREASE OF DIRECT* REPRESENTATIVES. J. DUNCAN, M.B., T. FORT, H. W. KING, M.D., W. S. CHEYNE, M.D., -Dr. LANGLEY BROWNE, with the consent of his seconder, E. J. LLOYD, M.D., E. WILLIAMA, S. B. MASON, R. R. BROWN, C. ARROL, withdrew the resolution in for M.D., W. J. NAISMITH, D.S.O., M.D., F.R.C.S. (Edin.), E. W. SYMES, standing his name, asking M.D., R. DE LA POER BERESFORD, AI.D., R. B. SMITH, E. B. RECKTTT, an additional direct representative, on the ground that at M.D., A. S. DALY, A. CHAWNER, E. J. LAWLESS, R. L. SPARROW, F. J. that late period of the session there was not time WALKER, M.D., A. T. WEAR, M.D., W. FERGUSON, M.D., J. ADAM, M.D.. E. J. HUNTER, F. K. PIGOTT, W. M. ROOCROFT, A. D. FRASER, M.D., adequately to discuss so important a matter. C. GODSON, M.D., A. A. WATSON, H. W. ROBERTS, W. H. PACKER, M.D.,. J. J. DE Z. MARSHALL, J. P. MASSINGHAM, A. B. WADE, M.B., F. W. GIBBON, G. M LOWE, M.D., T. PHILIP, M.B., C. N. LiE;3E, M.B., J. W. T. PROCEEDINGS IN CAMERA. GILBERT, D. LENNOX, M.D., W. NETTLE, J. TURTON, W. MACKENZIE, Dr. NORMAN MOORE and it was resdlved, that it J. MILL, M.B., G. HOLLIES, C. A. MACMUNN, M.D., C. G. GRANT, moved, T. MCC. FOLEY, R. B. GRAHAM, F.R.C.S. (Edin.), W. C. JAmEs, be delegated to the Chairman of the Business Committee M.D., C. L. FRASER, H. C. LAMPORT, M.B., and J. ADAMS, M.B. and the Registrar, as on previous occasions, to adjust the Surgeon-Majors A. A. ABRAHAM, J. A. JONES, J. W. ELLIS, E. EVANS, M.B., T. F. DEWAR, M.B., J. V. W. RUTHERFORD, M.B., E. W. BARNESB minutes of the Council in camera arising out of the busi- W. A. DINGLE, M.D., W. B. MACKAY, M.B., A. P. ARNOLD, M.D., R. ness in the present session, and that the President be STIRLING, M.D., W. 0. EVANS, R. J. BRYDEN, R. R. SLEMAN, M.D., P. B. authorized to as BENTLIF, R. T. MEADOWS, M.D., F. V. ADAMS, E. H. MOORE, R. J. M. sign them correct. COFFIN, S. S. HOYLAND, W. KINNEAR, M.D., H. R. BRAMWELL, M.B., The proceedings then terminated. J. A. RIGBY, M.D., J. T. THOMAS, W. L. EDWARDS, H. J. MACHAY, M.B., D. TODD, H. D. BROOK, J. H. G. WHITEFORD, M.B., W. P. WHITCOMBE, XV. A. ATKINSON, M.D., R. MITCHELL, M.D., T. E. STUART, W. B. COCKILL, C. R. LAURIE, H. T. CHALLIS, H. DICKIE, M.B., A. THORNE, M.B., S. A. M. COPEMAN, M.D., F.R.S., J. H. STACY, J. M. MOIR, M.D., DISCIPLINARY CASE. A. B. LYON, M.D., C. BOYD, J. A. CLARK, M.B., T. HOLT, M.B., R;:E. On Wednesday and Thursday the Council was engaged BEVERIDGE, M.B., J. S. MACKAY, M.D., E. M. CALLENDER, J. P. S. WARD, R. T. FERGUSON, M.B., A. L. JONES, S. J. J. KIRBY, A. P. NUTTALL, in hearing a charge of misconduct with female patients M.D., A. D. DuCAT, M.B., C. G. MACLAGAN, M.B., A. H. VERNON, against a registered practitioner. A considerable part of D. SMART, M.B., B. H. MUMBY, M.D., W. RICHARDSON, M.D., was in on the case in E. W. LIVESEY, L. W. POCKETT, G. MELVILLE, I.B., J. CAMERON, Friday's sitting spent deliberating R. H. LUCE, M.B., W. P. PEARE, G. G. OAKTEY, and W. K. CLAYTON, cazmerd. On the resumption of the public sitting the Surgeon-Captains F. H. THORsPSoN, H. L. DR LEGH, M.D., J. H. P. PRESIDENT announced that the facts alleged had not been GRAHAM, J. P. BROWN, M.B., C. T. GREEN, H. WAITE, T. THOMPSON, T. KAY, M.B., W. H. VICKERY, C. A. CORKE, J. TAYLOR, M.D.,. J. 0. proved to the satisfaction of the Council. We are unable WRIGHT, M.B., D. R. DOBIE, M.D., E. U. F. MACW. BOURKE, A. this week to publish a report of this case. HENDERSON, M.B., E. E. DYER, M.B., J. S. SWAIN, H. M. BROWNfIEL SUPPLEMENT TO THX 314 1BITISH MEDICAL JOUBNALJ VACANCIES AND APPOINTMENTS. [DEC. 5, 190oS. = H. N. A. TAYLOR, M.D., A. EHRMANN, A. HILTON, E. GRAY, F. A BIRMINGHAM AND MIDLAND EYE HOSPITAL.-House-Surgeon. BROOKS, N. P. WATT, M.B., C. W. MARSHALL, M.B., W. CURTIS, G. F' Salary, £70 per annum. WHYTE, M.B., A. A. MACKEITH, M.B., F. D. WOOLLEY, G. R. LIVING- BlRMINGHAM UNIVERSITY.-Lecturer in Physiological Depart- STONE, M.B., V. GRAHAM, S. M. SLOANT, M.B., H. E. DALBY, J. R. ment. Stipend, £150 per annum. WILLIAMS, M.B., A. R. BADGER, J. BRUCE, M.B., T. BEARD. H. W. BRECKNOCK COUNTY AND BOROUGH INFIRMARY.-Resident THOMSON, M.D., W. J. REID, C. R. BROWNE, M.D., W. R. MATTHEWS, ' M.B., F. H. GERVIS, G. THOMSON, M.B., W. RITCHIE, M.B., E. H. House-Surgeon. Salary, £120 per annum. 'TIPPER. A. E. L. WEAR, M.D., F. E. FREEMANTLE, M.B., L. A. AVERY, BRIGHTON, HOVE, AND PRESTON DISPENSARY.-House- M. S. W. GUNNING, J. N. MAC;ULLAN, R. A. DRAPER, R. C. GAY.R, Surgeon. Salary, £160 per annum. H. STALLARD, A. Y. GREENWOOD, M.B., A. MACKENZIE, J. C. HERBERT- BRISTOL ROYAL INFIRMARY.-(1)House-Physician. (2) Ophthalmic ~SON, M.D., H. G. SMEETH, M.D., P. J. O'SULLIVAN, J. S. WARRACK, and Obstetric House-Surgeon. Salary, £75 per annum. M.D., F. E. BISSELL, M.D., H. R. R. FOWLER, M.D.; Surgeon-Lieutenant CAMBRIDGESHIRE, ETC., ASYLUM, Fulbourn.-Second Assistant H. MEGGITT. Medical Officer. Salary, £120 per annum, increasing to £150. SPECIAL RESERVE. CANCER HOSPITAL, Fulham Road, S.W.-Assistant Anaesthetist. SURGEON-LIEcTENANT R. H. COOMBE, M.D., 3rd Battalion the Bedford- Honorarium, 25 guineas per annum. shire Regiment, having assented to be transferred, is appointed an CARDIFF INFIRMARY.-House-Surgeon. Honorarium, £30 for six ,Officer of the Special Reserve of Officers, from June 21st, 1908. months. CARSHALTON: CHiLDREN'S INFIRMARY.-(1) Senior Assistant ROYAL ARMY MEDICAL, CORPS. Medical Officer; salary, £250 per annum. (2) Assistant Medical THE undermentioned officers, fr. m the late Royal Army Medical Corps Officer; salary, £150, increasing to £180. (Militia), having assented to be transferred, are appointed officers of COLOMBO MUNICIPALITY.-Assistant Medical Officer of Health. ,the Special Reserve of Officers. from September 20th. 1908, retaining with annual etc. the rank and seniority which they held while in the Militia:-Majors: Salary, Rs.5,000, increments, .H. E. MORTIs and W. K. STEELE. Captains: J. CLERKE, J. H. P. DUBLIN: DR. STEEVENS'S HOSPITAL.-House-Surgeon. Salary, 'GRAHAM, E. U. BARTHOLOMEW, Honorary Major W. V. SINCLAIR, S. G. £100 per annum. McALLUM, M.B., J. C. FURNESS, S. M. SLOAN, M.B., and F. E. BISSELL, DUDLEY GUEST HOSPITAL.-Senior Resident Medical Officer. M.D. Lieutenants: J. C. MCCARROLL, M.B., D. MURPHY, R. A. Salary, £100 per annum, increasing to £120. O'DONOVAN, R. J. STIRLING, and W. RANSON. EXETER: ROYAL DEVON AND EXETER HOSPITAL.-Assistant House-Surgeon. Salary, £60 per annum. MILITIA. GLOUCESTER GENERAL INFIRMARY.-Assistant Physician. ROYAL ARMY MEDICAL CORPS. HOPITAL FRANqAIS, Shaftesbury Avenue, W.C.-Resident Medical 'THE undermentioned officers resign their cominissions, dated Sep- Officer. £70 annum. tember Salary, per 30th, 1908: Captain H. J. L. BULLEN, Lieutenant H. H. B. HUDDERSFIELD INFIRMARY. - Male Senior House-Surgeon. CUNNINGHAM, F.R.C.S.I., Lieutenant P. J. CARROLL, M.B. Salary, £100 per annum. LIVERPOOL EYE AND EAR INFIRMARY.-House-Surgeon (male). ROYAL GARRISON ARTILLERY (VOLUNTEERS). Salary, £80 per annum. SURGEoN-LIEUTENANT H. C. ADAMS, 1st Devonshire, resigns his LONDON TEMPERANCE HOSPITAL, Hampstead Road, N.W.- commission, April 1st. 1908. Assistant House-Surgeon (non-resident). Honorarium at the rate Surgeon-Lieutenant (Honorary Captain in the Army) C. J. J. HARRIS, of £75 per annum. M.D., 7th Lancashire, resigns his commission, March 31st, 1908. MANCHESTER DENTAL HOSPITAL.-Honorary Anaesthetist. MANCHESTER EYE AND EAR HOSPITAL.-Honorary Anaesthetist. MANCHESTER ROYAL INFIRMARY.-(M) Medical Officer to the Central Branch; salary at the rate of £100 per annum. (2) Medical Registrar. MANCHESTER: ST. MARY'S HOSPITAL FOR WOMEN AND CHILDREN.-Third and Fourth House-Surgeons. Honorarium, HEALTH OF ENGLISH TOWNS. £25 for six months. IN seventy-six of the largest English towns, including London, 7,591 MEDICAL MISSION Doctor births and 4,847 deaths were registered during the week ending Satur- HOSPITAL, Canning Town.-Assistant -day last, Novem-iber 28th. The annual rate of mortality in these towns, for Dispensary. which had been 15.9 and 15.6 per 1,000 in the two preceding weeks, was MIDDLESEX HOSPITAL, W.-Medical, Surgical, and Obstetrical again 15.6 per 1,000 last week. The rates in the several towns ranged Registrars. -from 4.7 in East Ham, 5.8 in Burton-on-Trent, 5.9 in Coventry, 6.2 in NORTHAMPTON GENERAL HOSPITAL.-Senior Resident Medical Hornsey, 6.5 in Northampton, 6.7 in York, and 6.9 in Handsworth Officer. Salary, £120 per annum. (Staffs), to 21.6 in Merthyr Tydfil, 21.7 in Tynemouth, 22.4 in Swansea, NOTTINGHAM CHILDREN'S HOSPITAL.-Lady House-Surgeon. 23.4 in Stockport, 23.5 in Walsall and in Stockton-on-Tees, 25.4 in Salary at the rate of £80 per annum. Rotherham, and 26.2 in Middlesbrough. In London the rate of DISTRICT Medical Officer. mortality was 15.8 per 1,000, while it averaged 15.5 in the seventy-five PERTH ASYLUM, Murthly.-Assistant other large towns. The death-rate from the principal infectious Salary, £120 per annum, rising to £140. diseases averaged 1.3 per 1,000 in the seventy-six towns; in London also PLYMOUTH: SOUTH DEVON AND EAST CORNWALL HOS- -this rate was equal to 1.3 per 1,000, while among the seventy-five other PITAL.-House-Surgeon. Salary, £100 per annum. large towns these infectious diseases caused death-rates ranging PRESTON ROYAL INFIRMARY.-Junior House-Surgeon. Salary, upwards to 3.0 in West Bromwich, 3.3 in Oldham, 3.6 in Stockport, 3.7 £60 per annum. in Warrington, 5.6 in Leicester, 7.4 in Rotherham, and 7.6 in Middles- ROYAL EAR HOSPITAL, Soho.-Non-resident House-Surgeon. .brough. Measles caused a death-rate of 1.2 in Tottenham and in Salary at the rate of £40 per annum. Derby, 1.5 in Oldham, 2.2 in Huddersfield. 2.5 in Stockport, 4.6 in Leicester, 4.9 in Rotherham, and 6.0 in Middlesbrough; scarlet fever ST. LUKE'S HOSPITAL FOR MENTAL DISEASES, Old Street, E.- of 1.5 in Handsworth (Staffs); diphtheria of 1.4 in Newport (Mon.); and Clinical Assistant. -diarrhoea of 1.3 in Devonport and in Preston, 1.5 in West Bron-iwich, in SALFORD ROYAL HOSPITAL.-Junior House-Surgeon (male). Warrington, and in Oldham, 1.6 in Rotherham, and 1.9 in Tynemouth. Salary at the rate of £50 per annum. The mortality fromi whooping-cough and from enteric fever showed no SHEFFIELD: JESSOP HOSPITAL FOR WOMEN.-House-Surgeon. marked excess in any of the large towns, and no fatal case of small- Salary £60 per annum. pox was registered during the week. The number of scarlet-fever STAFFORDSHIRE RURAL DISTRICT COUNCIL.-Medical Officer patients under treatment in the Metropolitan Asylums Hospitals and of Health and Medical Officer of Isolation Hospital. Salary, the London Fever Hospital, which had been 3,851, 3,859, and 3,809 at combined, £110 per annum. -the end of the three preceding weeks, had risen again to 3,831 at the AND EYE end of last week; 495 new cases were admitted during the week, SWANSEA GENERAL HOSPITAL.-House-Surgeon, against 5121 500, and 421 in the three preceding weeks. Salary, £75 per annum. THROAT HOSPITAL, Golden Square, W.-Three Assistant Surgeons. HEALTH OF SCOTTISH TOWNS. WESTMINSTER GENERAL DISPENSARY, Gerrard Street, W.- DURING the week ending Saturday last, November 28th, 786 births and Honorary Surgeon. 577 deaths were registered in eight of the principal Scottish towns. The WESTMINSTER HOSPITAL, S.W.-Fourth Assistant Surgeon. annual rate of mortality in these towns, which had been 16.9 and 17.3 WEST RIDING OF YORKSHIRE: WAKEFIELD.-Assistant to per 1,000 in the two preceding weeks, fell again to 16.4 per 1,000 last County Medical Officer. Salary, £250 per annum, increasing to week, but was 0.8 per 1,000 above the mean rate during the same period £400. in the seventy-six large English towns. Among these Scottish towns WINDSOR: KING EDWARD VII HOSPITAL AND DISPENSARY.- -the death-rates ranged from 12.1 in Paisley and 14.8 in Perth to 18.2 in per annum. Greenock and 18.4 in Aberdeen. The death-rate from the principal House-Surgeon. Salary, £110 infectious diseases averaged 1.6 per 1,000 in these eight towns, the WORCESTERSHIRE OPEN-AIR SANATORIUM, Knightwick.- highest rates being recorded in Dundee and Aberdeen. The 270 deaths Resident Medical Officer, with wife to act as Matron. Joint :registered in Glasgow included 2 which were referred to scarlet fever, salary £150 per annum. .3 to diphtheria, 11 to whooping-cough, and 2 of diarrhoea. Four fatal CERTIFYING FACTORY SURGEONS.-The Chief Inspector of cases of scarlet fever, 2 of whooping-cough, and 2 of diarrhoea were Factories announces vacancies at Rothwell, co. Northampton; r-ecorded in Aberdeen; and 6 of diarrhoea in Dundee, 3 in Leith, and Paddington and Marylebone, co. London; St. Pancras and 2 in Edinburgh. Islington, co. London. APPOINTMENTS. ARCHIBALD, William, M.D.Glas., D.P.H.Camb., Medical Officer of Health to the Luton Town Council. BEIRNE, J. W., M.B., B.Ch., Certifying Factory Surgeon for the 1rhis list of vaanees is com nl from our awvertfseent oohlme, Ballaghaderrin District, co. Roscommon. wherefu4lpartioujars will be found. To ensure noti in this column, BRIDE, J. W., M.B., B.S.Lond., M.B., Ch.B.Vict., House-Surgeon to the advertisments must be reoeived not later than the first post on Wed Manchester Infirmary. nesa morning. DUNCAN, William, M.R.C.P.Lond., F.R.C.S.Eng., Consulting Obstetric VACANCIES. Physician to Middlesex Hospital. ETTLES, Wm., M.D., C.M.Aberd., F.R.C.S.Edin., Pathologist to the ABERDEEN: CITY (FEVER) HOSPITAL.-Resident Physician. Eye vice R. W. resigned. £100 annum. Royal Hospital, Allen, M.A., M.B.Lond., Salary commencing per HAMLTON, W. Crosbie, M.B., C.M.Edin., Assistant Surgeon to South -3ETHLEM HOSPITAL.-Two 'Resident House-Physicians. Honor- Devon and East Cornwall Hospital, Plymouth. arium, £25 each per quarter. Dental to B3ETHNAL GREEN INFIRMARY. - Assistant Medical Officer. HERN, William, M. L.D.S., Consulting Surgeon Salary, £100 per annum. Middlesex Hospital SUPPLEMENT TO THES DEC. 5, 1908.] DIARY. LBBITISH MEDICAL JOURNAL 315

SINGER, Charles, M.A., M.B., B.Ch.Oxon., M.R.C.S., L.R.C.P.Lond., Threatened Abortion; Dr. Keyworth (introduced by Medical Registrar of the Research Department of the Cancer Dr. Fairbairn), Uterus and Appendages from a Fqtal Hospital. Case of Accidental Haemorrhage showing Intra- SmYTH, A., M.B., C.M.Glas., Certifying Factory Surgeon for the peritoneal Bleeding through the Fallopian Tubes; Mr.. Leuchars District, co. Fife. J. Bland-Sutton, Diffuse Adenomyoma of the Uterus. STOKES, K. H., M.B., B.S., M.R.C.S., L.R.C.P., House-Physician to FRIDAY, 'University College Hospital. ROYAL SOCIETY OF MEDICINE: STRUTIHRS, J. W., M.B., Ch.B., F.R.C.S.Edin., Assistant Surgeon to CLINICAL SECTION, 20, Hanover Square, W., 8.30 p.m.-- the Royal Infirmary, Edinburgh. Cases: Mr. Openshaw, Paralysis of the Lower Ex- THORNTON, G., M.D.Edin., M.R.C.P.Lond., Medical Superintendent of tremities; Mr. Raymond .Johnson, Renal Hyper- the General Hospital, Colombo, Ceylon. nephroma of Three Years' Duration; Dr. E. I. Spriggs, TURNER, H. Watson M.R.C.S., L.D.S., Assistant Dental Surgeon to Exophthalmic Goitre, with Rheumatoid Arthritis,. Middlesex Hospital. Dr. G. A. Sutherland, Dr. Herringham, Dr. Rose TURTON, Edward, M.D., B.Sc., Ch.B., Honorary Consulting Bradford, Dr. Weber, Dr. Spriggs, Dr. French, and Dr. M.R.C.P., Rolleston will show cases of Anomalous Oedema; Dr. Physician to the Hull Hospital for Women and Orthopaedics. Parkes Weber, Apparent Muscular Hypertrophy fol- WALLER, Miss M. I., M.B., B.S.Lond., Resident Assistant Medical lowing Oedema of Left Leg. Short paper: Dr. Parkes Officer of the Oldham Union Workhouse. Weber, Mediastinal Lymphadenoma, with Extreme WILSON, G. R., M.B Camb., Medical Officer of the Children's Homes Osteoarthropathy. of the Hackney Union, Ongar. YEATS, William, M.D.Aberd., Honorary Consulting Physician to the POST-GRADUATE COURSES AND LECTURES. Nicholls Hospital, Manchester. HOSPITAL FOR NERVOUS DISEASES, Welbeck Street, W.-Thursday, 5 p.m.: Syphilitic Affections of the Nervous System. HOSPITAL FOR SICK CHILDREN, Great Ormdnd Street, W.C.- BIRTHS, MARRIAGES, AND DEATHS. Thursday, 4 p.m.: Pyelitis in Children. Iheocharge {or insrting annoumemts ot Births. Marriages, and LONDON SCHOOL OF CLINICAL MEDICINE.-Daily arrangements: Out- Deaths i8 8s. 64., which sum should be forwarded in vost-office orders patient Demonstrations, 10 a.m.; Medical and Surgical or stamps with the notice not later than Wedaedav morning, in order Clinics, 2.15 p.m. and 3.15 p.m. respectively; Opera- to ensure insertion in the ourrent issu. tions, 2 p.m. Special Clinics: Ear and Throat, at noon and 4 p.m. Monday, and noon Thursday; Skin, at noon BIRTHS. and 4 p.m. Tuesday, and noon, Friday; Eye, 11 a.m. BILLINGTON.-On November 18th, at 9, Easy Row, Birmingham, the Wednesday and Saturday; Radiography, 4 p).m. Thurs- wife of William Billington, M.B., M.S.Lond., F.R.C.S., of a son. day. Special Lectures: Mon(day, December 7th, GIBBINS.-On November 22nd, at Holmdale, Parkstone, Dorset, the 2.15 p.m., Dyspepsia due to Alcoholic Abuse; Thurs- wife of K. Mayoh Gibbins, M.B., B.S.Lond., M.R.C.S., L.R.C.P., day, December 10th, 3.15 p.m. of a son. MEDICAL GRADUATES' COLLEGE AND POLYCLINIC, 22. Chenies Street, W.C.-The following clinical demonstrations have been DEATHS. arranged for next weeK, at 4 p.m. each day: Monday, STEEL.-On November 25th, at his residence, Dynq House, Aber- Skin; Tuesday, Medical; Wednesday, Surgical . gavenny, Samuel Hopkins Steel, M.B.Lond., M.R.C.S.Eng., Thursday, Surgical: Friday, Eye. Lectures at J.P. co. Mon., aged 87. No flowers. 5.15 p.m. each day will be given as follows: Monday, WHITBY.-On October 18th, at Colchester, Rose Edith Morton Whitby, Flat-foot; Tuesday, General Meeting of College; Wed- wife of Dr. Henry Whitby, L.R.C.P.I., L.R.C.S.I., daughter of the nesday, The Pupil in Health and Disease: Thursday, late Major A. M. Festing, of West Africa, and niece of the late Some Points in the Surgery of the Biliary Passages. General Sir F. W. Festing, A.D.C., aged 43. MOUNT VERNON HOSPITAL (OUT-PATIENT DEPARTMENT). 7, Fitzroy- Squre, W.-Thursday, 5 p.m.: Pain in the Chest. NATIONAL HOSPITAL FOR THE PARALYSED AND EPILEPTIC, Queenr DIARY FOR THE WEEK. Square, W.C.-Tuesday, 3.30 p.m.: Ep.ilepsy. Friday, 3.30 p.m.: Surgery of the Nervous System. NORTH-EAST LONDON POST-GRADUATE COLLEGE, Prince of Wales's. TUUESDAY. General Hospital, Tottenham, N.-Monday, 10 a.m., ROYAL SOCIETY OF MEDICINE: Surgical Out-patient Clinic; 2.30 p.m., Medical Out- SURGICAL SECTION, 20, Hanover Square, W., 5.30 p.m.- patient Clinic; Nose, Throat, and Ear Clinic; X rays; Paper: Dr. W. Ironside Bruce, X-ray Examination of 4.30p im., Medical In-patient Clinic; Tuesday, 10 a.m., Medical Out-patfent Clinic; 2.30 p.m., Operations, the Urinary Tract. Surgical Clinic, Gynaecological Clinic. Wednesday, PATHOLOGICAL SECTION, Lister Institute, Chelsea Gardens, and Clinic: . Dr. 2.30 p.m., Medical Out-patient, Skin, Eye S.W., 8.30 p.m.-Papers: Henderson-Smith and Dr. 4.30 p.m., Demonstration of Cases of Mental Disease at Candler, The Wasserman Reaction in General Para- the Colney Hatck Asylum. Thursday, 2.30 p.m., lysis of the Insane (with demonstration); Dr. Harden Gynaecological Operations. Medical Out-patient and and Dr. Thompson, Anairobiosis; Dr. Armit, Anaphy- Surgical Clinic; X rays; 3 p.m., Medical In-patient laxis; Professor Minchin, Demonstration of Trypano- Clinic of Clinic: Friday, 10 a.m., Surgical Out-patient - somes, including the Trypanosome the Perch 2.30 p.m., Operations, Medical Out-patient and Eye- (showing Myonemes); Dr. Bainbridge, On the Nature Clinic; 3 p.m., Medical In-patient Clinic; 4.30 p.m., and Efficiency of certain Rat Viruses; Dr. Kennaway Optic Neuritis. and Dr. Leathes, Preliminary Note on the Examination Lecture-Demonstration, of the Fat in Normal and Diseased Livers. POST-GRADUATE COLLEGE, West London Hospital, Hammersmith Road, W.-The following are the arrangements for WEDNESDAY. next week:-Daily: 2 p m., Medical and Surgical. BRITISH BALNEOLOGICAL AND CLIMATOLOGICAL SOCIETY, 20, Hanover Clinics; X rays; 2.30 p.m., Operations. Monday and Square, W.. 5.30 p.m.-Ordinary meeting. Papers: Thursday and Wednesday and Saturday, 2 p.m., Dr. Brodribb (Hastings), The Therapeutic Use of Sea Diseases of the Eyes. Tuesday and Friday, 10 a.m.,. Water; Dr. Midleton (Bournemouth), Rheumatic Affec- Gynaecological Operations; 2 p m. (Wednesday and& tions Treated by Counter-irritation of the Spine. Saturday, 10 a.n.). Diseases of the Throat, Nose, and 7 p.m., the Fellows will dine together at Pagani's Ear; 2.30 p.m., Diseases of the Skin. Wednesday and Restaurant, Great Portland Street, W. Saturday, 10 a.m., Diseases of Children. Lectures: HUNTERIAN SOCIETY, London Institution, Finsbury Circus, E.C., Monday and Thursday, 10 a.m., Demonstration on the Surgical Cases; Monday, 12 noon, Pathological Demon-- 8.30 p.m.-Clinical Evening. stration; Wednesday and Friday, 12.15 p.m., Practical ROYAL SOCIETY OF MEDICINE: Medicine. At 5 o'clock, Monday, Anaesthetics; Tues-- SECTION OF ANAESTHETICS, 20, Hanover Square, W., day, Bilharziosis; Wednesday, Medicine; Thursday, 8.30 p.m.-Paper: Dr. N. H. Alcock, Fifty Cases Practical Surgery. At 3 p.m., General Symptomatology Anaesthetized with Known Percentages of Chloroform, of Insanity (at Claybury Lunatic Asylun). with a description of the apparatus employed. ST. JoHN's HOSPITAL FOR DISEASES OF THE SKIN, Leicester Square, UNITED SERVICES MEDICAL SOCIETY, Royal Army Medical College, W.C.-Thursday, 6 p.m.: Fungous Diseases of the Millbank, S.W., 8.30 p.m.-Paper: Fleet Surgeon 0. W. Hair. Andrews, R.N., Recent Research Work on the Use and Abuse of Alcohol. THURSDAY. BOOKS, ETC., RECElVED. HARVEIAN SOCIETY OF LONDON.-8.30 p.m., at the Stafford Rooms, Titchborne Street, Edgware Road, W.:-Paper: Dr. Instinct and Health. By W. Hutchinson, A.M., M.D. New York: Victor Bonney, Carcinoma of the Cervix. Dodd, Mead, and Goo. 1908. $1.20. OPHTHAL OLOGICAL SOCIETY OF THE UNITED KINGDOM, 11, Chandos Diseases of the Skin. By Sir M. Morrls, K.C.V.O. New edition. Street, W., 8 p.m.-Card Exhibits. 8.30 p.m.-Papers: London: Cassell and Co., Ltd. 1908. 10s. 6d. Mr. G. Brooksbank James, A Note on the Operative Porzellanftillungen und deren Imitationen. Von Zahnarzt Dr. C.. Treatment of Strabismus; Major Elliot, I.M.S., Some 1908. M.2. Observations on Cataract Extraction; Dr. A. Bronner, Fritzsche. Berlin: J. Springer. Iridectomy in Cases of Acute Iritis in which the Pupil An Organic Chemistry. By A. E. Dunstan, B.Sc. London: Methuen Cannot be Dilated. and Co. 2s. 6d. University of London. University College Calendar. Session 1908-9. IOYAL SOCIETY OF MEDICINE: 1908. OBSTE:TRICAL AND GYNAECOLOGICAL SECTION, 20, Han- London: Taylor and Francis. over Square, W. - Revised Agenda, 7.45 p.m.- Arcana of Nature. By H. Tuttle. Introduction by E. Densmore. Papers: Drs. Arnold Lea and Sidebottom, Organ- M.D. London: Swan Sonnenschein and Co.; New York: Stillman isms Present in the Uterine Secretion during Publishing Co. 6s. an Afebrile Puerperium ; Mr. Alban Doran, Opera- Bombay: Government Central Press. 1908: tion at end of Fifth Month for Extrauterine University of Bombay, Calendar for the Year 1908-9. Vol. I. Gestation with Living Fetus: Recovery with- R.1.80. out Recurrent and Secondary Haemorrhage; Mr. Vol. II. Examination PaPers of 1907-8. Ri.1 Herbert J. Paterson, A Case of Extrauterine Preg- Principles and Methods of Physical Education and Hygiene. By' nancy: Operation during the Sixth Month of W. B. University Tutorial Pregnancy. Specimens: Dr. J. H. Dauber, Hysterec- W. P. Welpton, B.Sc. London: Clive, tomy for Cervical Fibroid during Pregnancy; Dr. Press. 1908. 4s. 6d. J. 'S. Fairbairn, Necrobiotic Fibroma Removed from The Bias. By M. Curtis. Edinburgh and London: Blackwood and. a Patient Three Months pregnant, with Sigus of Sons. 1908. 6s. sv"m=m To mm 3;6 NXiDICAV4,700MA&I CALENAR. 5, 1908. 1 SUMOR [DE;C,

1. CAL AIR -OF TIEI ASSOCIATION.

Date. Meetings to be Held. Date. IYMeetings to be Held. DECEMBER. DECEMBER (Continu&ec). 6 S5unbat (LEIGH DISION, Lancashire and ? MONDAY 17 THURSDAY.. Cheshire Branch, Co-operative Offices, Organization Committee,- Ellesmere- Street,, Leigh, 8.30 P.m. 8'TXJEB3DAYTUESDAY ..~{°LONDON10.30 a.m. 18 FRIDAY BRADFORD DIVISION, Yorkshire Branch, 19 SATURDAY Divisional Supper followed by 20 Sutba Smoking Concert, Great Northern Victoria Hotel, Bradford, 8.30 p.m. 21 MONDAY KENSINGTON DIVISION, Metropolitan 22 TUESDAY Counties Branch, Kensington Town 23 WEDNESDA 9 WEDNESDAY Hall, 5 p.m. LANCASHIRE AND CHESHIRE BRANCH, 24 THURSDAY Council Meeting, Manchester, 25 FRIDAY Christmas Day. 4.30 p.m. RICHMOND DnISION, Metropolitan 26 SATURDAY . Bank Holiday. Corunties Branch, MIedico-Political 27 Sunbap Meeting, Royal Hospital, Richmond, 28 MONDAY 8.30 p.m. 29 TUESDAY BIRMINGHAM BRANCH, Medical Jnsti- tute, Edmund Street, 3.30 p.m. 30 WEDNESDALY 10 THURSDAY .. BoSTON AND SPALDING DIVISION, Mid- 31 THURSDAY . . land Branch,- Lindum House, Wide Bargate, Boston, 4 p.m. JANUARY, 1909. 11 FRIDAY * (ENGLISH DIVSION, Border Counties 1TFRIDA_t_. _ 7I 1T LnT^ C UiIA .LLVb:iC .II MnAlhlLt 1 FRI AY .1 bUB§CNRIPTIONS 'UO UllG jorusia ffeca Branch, Worki-ngton. ( Association for 1909 become due. 12 SATURDAY.. 2 SATURDAY.. 13 Istnbat 3 Atnba . 14 MONDAY 4 MONDAY Health 5 TUJESDAY L{LONDON: Public Committee, (LONDON: Central Ethical Committee. 3 P.M. 15 TUESDAY .. HAMPSTEAD DIVISION, Metropolitan 6, WEDNES{DAY LONDON: Medico-Political Committee, Counties Branch. WEDNESDAY2.15'p.m. (LONDON : Medico-Political Contract 7 THURSDAY0.. LONDON : Hospitals Committee, WEDNESDAYS Practice Subcommittee, 2.30 p.m. 2.30 p.m. DLONDON: South-Eastern Branch Coun- .FRIDAY 0LONDON; Central Ethical Committee, cil, 3 p.m. ~2 p.m

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