ROYAL COMMISSION ON TUBERCULOSIS

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health of seamen who are well known to suffer beyond theaverage from rheumatism and its train of concomitantdiseases. A coating of granulated cork on the iron is goodas a palliative procedure, but the only effectual method ofdealing with the nuisance is to have a wooden deck over theiron and the under surface completely lined with the samematerial close up to the deck, all beams being encased.The instructions to surveyors last issued by the Board ofTrade prohibited the placing of bunks under an unsheatheddeck, but the operation of this section was postponed.Another matter in the port which calls for attention is the

condition of the cabins of lighters and other "dumb" craft.Tne Merchant Shipping Act and Canal Boats Act provide forthe comfort of persons living in craft registered under theseActs, but in the case of lighters, though the cabins cannotstrictly be considered as dwellings, they have to serve astemporary habitations, often for considerable periods. ThePort Sanitary Authority is now, since the Public Health Act,1896, practically the health authority for the port, and itsmedical officers have discretionary powers as to the detentionof vessels in reference to the diseases named. During thehalf-year eighty-eight cases of infectious disease came underthe notice of the authority’s officers. Two cases of plague,the diagnosis being verified by bacteriological examination,were admitted into the Seamen’s Hospital in 1896. The firstcase was that of a native of Bombay admitted on Sept. 19th,who had apparently been ill for twelve days or less, and whodied five hours after admission. The other case was

that of a patient ill for four days, who was admittedon Sept. 29th and who died on Oct. 3rd. Careful instruc-tions were given to the boarding medical officers as to

dealing with suspected cases found on vessels. The orderof the Local Government Board requiring in certain circum-

,

stances the disinfection of rags imported from abroadhas been rescinded. Details of nuisances dealt with

are given, and in consequeace of the continuance of the

practice of pumping filthy bilge-water into the docks andriver a special notice has been published as a warning.Particulars are given of some cases of overcrowding, andespecially insanitary condition, found on some foreign vessels.At the hospital of the authority 29 patients were treatedduring the half-year, of whom only 4 died ; the averagenumber of patients under treatment daily was 3 6, and theaverage number of days spent in hospital by each patientwas 21’7. A considerable number of seizures of unsoundfood was made during the six months, comprising 2758carcases and 1469 pieces of mutton and lamb, 14 quartersand 30 pieces of beef, 2 tons of bacon and hams, 18 casksof horse beef, 496 tins of meat, 45 cases of salmon, 2909lobsters in jelly, 41 cases of desiccated soup, 4270 tinsand 74 cases of rabbits, 198 cases of condensed milk,7100 crates of bananas, 5000 boxes of oranges, 146

packages of fruit and vegetables, sundry small parcelsconsisting of apricots, bacon, brawn, cheese, chestnuts,confectionery, currants, hams, kidneys, olives, ox tails,peaches, persimmons, pickles, pines, suet, sultanas, tomatoes,tongues, tripe, &c. An additional new launch has been addedto the service of the Port Sanitary Authority, whereby theduties of inspection have been greatly facilitated, thoughit has only been at work since September. The number ofcanal boats inspected was 668, a slight increase; 114 boatswere found. to be in some way infringing the regulations. Thenumber of women and children carried shows a slight increasefor the past two years, being to some extent due to thegreat frost of 1895 which, paralysing the canal traffic as ii

did, compelled many boatmen to break up their homes orshore and take their families afloat - a serious matteras canal boats are not a desirable habitation from either I

moral, sanitary, or educational view for women aD<children. A new order respecting cattle ships was issued o]Dec. 8th last, which makes several concessions to ship-owner

for which they have striven for some years. Reference ismade to the report by the medical officer of the LocalGovernment Board on oyster culture in relation to disease,several oyster lays being within the jurisdiction of the

Port Sanitary Authority, though it does not appear that a

sanitary authority has any definite power to act in thematter of oysters at these places. The subject is consideredan important one, and a strong case exists for propersystematic supervision.

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ROYAL COMMISSION ON TUBERCULOSIS.

THIS Commission sat at 7, Whitehall-place on April 8thand 9th, Sir Herbert Maxwell, Bart., M.P., being in thechair. The other Commissioners present were Dr. R. ThorneThorne, C.B., F.R.S., Professor G. T. Brown, C.B., Mr.

Shirley F. Murphy, Mr. T. Cooke-Trench, and Mr. J. Speir,Evidence was heard from the following gentlemen :-Dr.Smyth, medical officer of Naas dispensary district, as to thesubject of tuberculosis in the small towns and rural districtsof Ireland; Mr. Thomas Nuttall, representing the Centraland Associated Chamber of Agriculture, as to his experienceof the prevalence of the disease in the district of Leicester-shire ; Mr. J. Lang and Mr. Scarlett, of the Paisley UnitedFleshers’ Society, as to the action of the local authority incondemning carcases affected with tuberculosis, and the

system of insurance adopted by the butchers to protectthemselves from the losses sustained in consequence of such

action; and Mr. J. Bell, President of the Carlisle and DistrictButchers’ and Insurance Association, as to similar action inCarlisle.

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MEDICAL FEES IN AMERICA.

MEDICAL fees in America, taken all round, are higherthan those in England. It has been computed that thereare two or three consultants in New York who make 20,000a year, five or six who make 1.0,000, and several who make.,5000 -P and upwards. Locality has, of course, a great dealto do with the rate of fees, for a man who settles in thecountry naturally does not expect to have so large an incomeas one who takes a house in a rising town or in a large city.Fees in New York are somewhat higher than elsewhere inAmerica. As a rule, in that city a family attendantreceives an amount varying from$2 to$5-i.e., from8s. to .E1-per visit, and the average fee of those whosepractice lies wholly among the wealthy is from$5 to

$10. Consultants’ fees range from$10 to$25. Visits at a

distance from home are at the rate of from$10 to$20 perhour, not including travelling expenses, and a fee of$25 forthe consultation itself. Fees for surgical operations runfrom$100 into several thousands. In the lower district ofNew York a practitioner must be content with a fee of$1(i.e., 4s.) for a home consultation and from$1 to$1.50 fora visit. In the other large towns of America the ordinaryfee for advice is from$1 to$2, and never less than$0’50 ;for a visit the charge is from$1 to$5. and never less than$1. Midwifery fees vary from$10 to$50. The fact mustalso be borne in mind that in the States a medical man

. rarely does his own dispensing, and the druggist charges, for making up the requisite medicine a sum of at least

i$0.50, so that in all cases advice and medicine will cost thepatient at the lowest estimate$1. In many of the smaller towns a physician is glad to give advice at his house forI$0.50 (Le., 2s.) and to make a visit for$1. Such an institutionj as the cash practice, where advice and medicine may be hadi for 6d. or 4d., is absolutely unknown in America, and it may, be asserted without fear of contradiction that the averaget income of a medical man there is higher than in England.1 One drawback, however, is attached to the practice ofi medicine in the States which does not exist to the same

s egtent in Great Britain, this being the greater difficulty