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midwife unless she is armed with ordinary therapeuticagents, such as antimony, ergot, opium, chloral, chloroform,or any other mortal drug ? If she is allowed to usethem she becomes, as Dr. Rentoul tersely puts it,a member of " an inferior order of medical practitioners" ;if otherwise, and the State handicaps her from adoptingthe necessary treatment, the parturient woman might, andprobably with greater safety would, be left in the hands ofthe Gamp. If, however, I am wrong as to these fatalitiesbeing rare-that is to say, the mortality being such as thepromoters of registration appear to affect-let them thenhave the courage of their convictions, steer clear of allquackery, and move for an amendment of the Medical Actsso as to render it illegal for unqualified persons to practisemidwifery for the purposes of gain-a procedure quite justi-fiable under such circumstances, and, moreover, consonantwith the times, and infinitely preferable to bringing the rankand file of our profession in petty competition with a classof females ; and God only knows (and I use the expressionreverentially) where these will begin or where they will end.

I am, Sirs, yours truly, _

Queen’s-road, Peckham, April 3rd, 1897. CLEMENT H. SEES.

"A VERY GRAVE SCANDAL."To the Editors of THE LANCET.

SIRS,-Having been favoured with a copy of THELANCET and a marked paragraph in it, I fear I mightmot be showing that respect for your journal which I havealways felt if I passed over in silence the matter underlying"A Very Grave Scandal." Whether some correspondenthas veiled his inaccuracies under anonymity, or whether thematter is a cutting from a newspaper or an annotation of

your own, there is not even so much as an invertedcomma to indicate. Out of regard to my own time and yourspace I do not propose to correct inaccuracy, but contentmyself with answering the question which you put in thelast sentence. I might have shown that my telegram wasdesignedly sent in emphatic terms in order to prevent avery grave scandal. The question you want answered is-In case the man ran amok at the workhouse and killedsomeone, who would be responsible ? The answer cannotbe given in a word-it is a complex one. The personsimmediately responsible would be the guardians, becausethe case was remitted to their care by the justice ;then the justice, for making an order for the reception ofa lunatic into a workhouse where there is (not) properaccommodation (see Sec. 21, Lunacy Act, 1890) ; but, takingthem in inverted order, primarily the local authority(Sec. 238, Lunacy Act, 1890). The local authority is definedin Sec. 240 of the same Act to be the council of everyadministrative county-a council which is well repre-sented on the Eastbourne bench of magistrates ; and, if Imistake not, one of its most influential members was thevery justice before whom this might-be dangerous lunaticwas taken. The county council, then, is the power youmust arraign in your court of censure for not having pro-vided asylum accommodation.As the person, perhaps, more immediately concerned than

any other individual in the trouble and annoyance due towant of asylum accommodation, I am not likely to makelight of the incident described as a very grave scandal; butthere are proper and improper ways of discussing it, and agood case needs no exaggeration to bolster it up. But, Sirs,"all’s well that ends well," and instead of giving you theopportunity of inserting another sensational headline, therehas been no "horrible discovery" or other tragic outcome ofa lunatic being remitted to a workhouse for fourteen days(as other lunatics are constantly being sent for variousreasons other than want of accommodation in the countyasylums). Rather a comedy than a tragedy has been

enacted ; for when the lunatic in question was againtaken before the justice so that a reception order mightbe made for his admission into the county asylum in whichthere was then a vacancy, the ’’ dangerous " lunatic wasallowed to escape. He did not " run amok," but made hisway peaceably enough into another union, where, I am told,he is now detained. I repeat your question-If, when he wasin charge of the workhouse officials and escaped from them,he had run amok, who would have been responsible ?Sensational headlines are not in harmony with the usualmatter we expect to find in THE LANCET; but I dare say theinsertion of the paragraph which has called forth this answer

will have served someone’s purpose, although it has failed tosecure your endorsement.

I am, Sirs, your obedient servant,THE MEDICAL SUPERINTENDENT.

East Sussex County Asylum, Hayward’s Heath, April 5th, 1897.

"THE OFFER OF THE ’ROYAL RED BOOK.’"To the Editors of THE LANCET.

SIRS,--Our attention has been drawn to a paragraph inTHE LANCET concerning the suggested introduction into our" Royal Red Book " of a list of the various physicians andsurgeons practising specially. We should be greatly obligedif you would publish the notice that the scheme has beenwithdrawn entirely. On receipt of a great deal of corre-spondence commenting on it from all points of view we laidthe matter before the Royal College of Physicians, who havecondemned it, and it is therefore withdrawn without demur,and we have returned the subscriptions already received.At the same time we should like to point out that we raisedthe question, "Would it not be unprofessional?" and theprofessional gentleman who proposed it to us was of opinionthat it would not. Moreover, we have received a good manyorders from well-known medical men ; we think, there-fore, that we may fairly be excused for falling into the error,our desire being always to take advantage of suggestions wethink likely to increase the usefulness of the work. Welooked upon it as an ordinary subscription to a book. Wetrust that you will publish this letter in order that as manyof the profession as possible may be acquainted with thefacts, so that any sense of irritation they may still feel maybe speedily allayed.

We are, Sirs, your obedient servants,THE PROPRIETORS OF " WEBSTER’S ROYAL RED BOOK."Piccadilly, April, 1897.

* ** We are glad to learn of this very proper decision onthe part of the Proprietors of the " Royal Red Book."-ED. L.

LIVERPOOL.

(FROM OUR OWN CORRESPONDENT.)

Royal Infirmary.THE election committee of the Royal Infirmary met on

March 24th to fill up the vacancy caused by the resignationof Dr. Davidson. As was anticipated, Dr. James Barr,junior physician to the Liverpool Northern Hospital, was

the successful candidate. The intelligence of the death ofMr. Heywood Bright, the recently appointed chairman of theRoyal Infirmary, which took place on March 24th. after anillness extending over some weeks, was received in the citywith much regret. His term of office as chairman was butof short duration, he having been elected as recently asFeb. llth, in succession to Mr, H. B. Gilmour, who resignedat the annual meeting. He had never been able to presideover the meetings of the committee, as at the time of his

,

election to the chair he was suffering from the illness whichterminated fatally. The deceased was related to the late

, Dr. Bright, the physician who first accurately described the, disease now so well known as "Bright’s disease."

Liverpool Medical Club.Dr. F. H. Barendt read a paper on Specialism before the

members of the above club a fortnight ago. He treated hissubject from four points of view : (1) specialism in general;(2) specialism in relation to the lay public; (3) specialism inrelation to the general practitioner ; and (4) specialism inrelation to the specialist. In tracing the gradual growth ofspecialism he predicted that the general consultant wouldgradually be replaced by the specialist-in fact, manypresent consultants had attained eminence in theprofession through the special study of some system ororgan. He urged the importance of a knowledge oflanguages, and quoted Sir James Simpson in supportof this qualification. With regard to the general prac-titioner, he ventured to suggest that in his consultationshe should seek the advice of those who had become qualifiedby special study of the disease in question, and who avoidedall semblance of entering into rivalry with him. He con-sidered it futile to expect that the relationship between