1814 ’

was loose. No pail, I was assured, had been brought to thishouse ; therefore the dejections from the patient had beenthrown into the closet where the loose pan would allow somepart of the wet to escape on to the ground under the seat. Inthe next house to this one there had also been fever, noless than 5 cases. A pail had been provided and the loosetile paving in the back-yard had been repaired, but thegrate to drain this yard was in a bad position and a part ofthe’water did not reach it. There was a very nasty closesmell in this house.At one end of the street there is a narrow opening

forming a short passage leading to the long backpassage which runs between the two streets. A boardis suspended here announcing that this is the wayto the - street National School. It is true that it

only leads to the back entrance and that there is a

better way to the front entrance, but it is the shortest roadfor many of the children. One poor girl availed herself ofthis passage while I was looking on. It was pitiful to seeher efforts to keep her feet dry and to avoid the filth. Bothher arms were stretched out wide to balance herself bypressing on the walls on either side. Then she tried tostep on pebbles and small stones. There was faecalmatter on all sides and a filthy stained palliasse, thrownout here no one knows by whom, though it mightinfect the narrow passage where so many children have topass. Where are the scavengers ? 1 How is it that theseback passages remain in such a condition? 7 The passagerunning behind - and - street I found even in aworse condition. The doors which give access to the dust-bins were swinging or open. Straw, garbage, and vegetablerefuse of all sorts were lying about, and in the midst ofthis filth a drunken man had fallen and was now fast asleep.Yet while these foul things fester behind the houses, infront the cottages have a smart appearance. Some are

hardly more than four years old and the street is broad.

Judged superficially this would be thought a healthy district.In the last house I visited there was upstairs a youngwoman suffering from typhoid fever. No pail had been sentfor this patient and her dejections were thrown intothe water-closet. On removing the seat I found that hereagain the pan was quite loose. The lead pipe to deliver thewater for the flush was affixed to the pan by a bit of ragfastened round with some string. The pan rested loosely onthe trap, nor did the trap seem to have been jointed to thesoil-pipe. On the exit side of the trap there was some slighttrace of clay where there should have been cement. On theother hand, the dustbin or ashpit was carefully covered overand it was evident that only a little care was needed to makethis a sanitary dwelling. The sanitary inspector, I wasinformed, had called-he had even entered the closet and

pulled the string to see if the flush worked well, but,satisfied by this perfunctory form of inspection, he had leftthe place without ever discovering that a bit of rag and a bitof string had been substituted for plumber’s work and thatthe drains were not secure at the joints.Not far from here I had noticed some digging done to

lay the foundations of new dwellings. The earth lookedso black and forbidding that I made my way to the endto see how ground was produced by the dumping pro-cess. Here there is a bridge over some railway lines andbetween the line and the last houses there is a rubbish shoot.At the foot of the rubbish there was a large pool of greenwater. On the opposite side of the railway the corporationcarts shoot their rubbish and are thus piling up what isdenominated in the neighbourhood as " Microbe Hill." It issaid that the contents of privies are no longer emptied here.ilerbaps this is so, but the bubbling water at the foot of theserubbish shoots smells strongly of sulphuretted hydrogen. Insome places it is green, at others more like ink and it is alwaysfoul. At one " tip now used by the Northern RailwayCompany I saw much straw and what seemed to have beenmanure. Also the heap was hot and smoking, and onewonders if houses are ever built here what sort of health theinhabitants will enjoy.

After all these investigations I must confess to being over-whelmed with a deep sense of despair. When even such

easy trifles as the cementing of a closet-pan on its syphontrap are so generally neglected, though the presence of

typhoid fever in the houses should have caused all suchdefects to be promptly detected and remedied, it is impos-sible to hope with much confidence that the great andsweeping measures of sanitary reform urgently needed willbe efficaciously applied. Is it likely that an administration

which, at any rate in the past, has displayed such crasa-incapacity and has been guilty of such palpable life--destroying neglect will ever be able to produce a Hercules,capable of cleaning out these Augean stables ? 7 Does this not,rather suggest that a higher and outside authority shouldinterfere so that the law shall at last be enforced and thatthe work of efficient sanitary supervision shall be no longer-neglected ?

Correspondence.

"THE GENERAL MEDICAL COUNCIL ANDPRELIMINARY EXAMINATIONS."

"Audi alteram partem."

To the Editors of THE LANCET.

SiRS,—In the letter of the Registrar of the General MedicalCouncil which appears in this week’s number of THE LANCET’the incorrectness of the figures given in the report of theEducation Committee with regard to cases of I I deficiency-in general education," reported by the Examining Boards ofthe " Navy, Army, and Indian Medical Services," isadmitted, and it is explained that the limitation of these.

reports to the three services was due to an oversight .

in the drafting of the report which has, however,already been issued to the public in the half-yearly volume ofthe Council’s minutes, is printed in THE LANCET of Dec. 3rd,has been made the subject of general comment in the press,and has been officially communicated to this College. The

oversight is, to say the least, unfortunate, as the report, inthe form in which it was presented to the Council, was calcu-lated to convey a most erroneous impression as to the extent,of the alleged " deficiency in general education " attachingto persons who had registered as medical students on the-certificates of this College.

It is now stated that the figures given in the report com-prise the whole of the cases reported by the various-Examining Boards, "including those for the Navy, Army,and Indian Medical Services," and that out of these 14 arethose of candidates who had passed their preliminaryexamination at the College of Preceptors. With regard to the-accuracy or otherwise of the figures given in the table in theregistrar’s letter, it may be sufficient to say that the total -number of cases reported is, after the most carefulexamination of the published minutes, found to be, as.

set out in the accompanying table, not 58 but 84, or,exclusive of cases not traced, 65. The number of the casesattributed to the College of Preceptors is apparently arrivedat by including some cases in which under the old "piece

"

meal" regulation of the General Medical Council candidateswere registered on certificates obtained from more thanone examining body. As it would be impossible to

say whether the subject of "English," in which the

spelling test is usually included, was passed at one or

the other examination, it seems only fair that all suchcases should be eliminated and the number for which the

College of Preceptors may be held to be responsible wouldthen be reduced to 11-,11 cases in seven years out of a totalof 2133 candidates who during that period have come onthe Medical Students’ Register by means of College ofPreceptors’ certificates. The proportion of cases traced tothe College is therefore represented by the fraction -i , orabout 2 per cent. The total number of medical studentsregistered during the past seven years amounts to 12,526.The average of traced cases of deficiency would therefore be1 in 193, or 2 per cent., the same proportion as that attribut-able to the College of Preceptors. But if only the number ofthose who have qualified on one or other of the jzcnior orpreliminary examinations in the United Kingdom be considered the proportion would be 65 out of 8467, or 1 in 130.or about 4 per cent.The proportion of reported cases of " deficiency in general

education" amongst candidates who have qualified duringthe same period on certificates of the Irish Intermediate-Education Board is represented by the fraction 3/166, or nearly2 per cent., which is a somewhat different ratio from 11/2333.Nevertheless this examination is retained on the list, as are.also the public entrance and other pre-graduate examinations.of Trinity College, Dublin, with a proportion taken together-of 4 ,-u, or nearly 3 per cent. The mere statement of these

1815

facts reduces the whole matter to its true proportions andexhibits in the clearest light the triviality of the charge thathas been brought against the College of Preceptors’ examina-tion and made so prominent a feature in the report drafted,as was stated by the chairman of the committee, by Dr.MacAlister. I am, Sirs, yours faithfully,

H. W. EVE,Dean of the College of Preceptors.

Bloomsbury-square, W.C., Dec. 27th, 1898.

Table shoming the Numbers of Candidates reported as havingbeen Deficient in General Education with the PreliminaryExaminations in which they Qitalified for .Registration asMedical Students during the Years 1892-1898.

H. W. EVE,Dean of the College of Preceptors.

"THE SEAMEN’S HOSPITAL SOCIETY ANDITS VISITING STAFF."

To the Editors of T H E LANCET.

SIRS,-The letter in your issue of last week, signed JohnCurnow, M.D., F.R.C.P., John Anderson, M.D., F.R.C.P.,G. R. Turner, F.R.C.S., might lead readers to infer that invarious publications I had deliberately assumed a title towhich I had no claim, that knowing that this descriptionwas untrue I had designated myself " Physician to the Sea-men’s Hospital, Greenwich." In self-defence I am con-strained to ask you to allow me space to make the followingstatement.

In 1892 I was appointed a physician to the Seamen’sHospital Society. My duties, I was informed, were sole- charge of the medical cases in the society’s Branch Hospital,Albert Docks ; to visit convalescents at the DreadnoughtHospital, Greenwich, when transferred there from the BranchHospital; to take part in the meetings of the society’shonorary visiting staff. In discharge of these duties Ivisited the Seamen’s Hospital, Albert Docks, twice a

week, and the Seamen’s Hospital, Greenwich (Dread-nought), once a week, and attended most, if not all,of the meetings of the medical staff to which I was.summoned. At the time of my election I was not informedthat my office carried with it any particular title ; but asI performed all the duties of a hospital physician at both ofthe Seamen’s Hospitals I naturally inferred that I was a

pnysician to oom or mese nospnais ana Lnat i naa a penectright to designate myself as such. Accordingly, and in con-formity with medical custom, I called myself, or was calledin various publications, sometimes " Physician to theSeamen’s Hospital, Greenwich," sometimes "Physician tothe Seamen’s Hospital, Greenwich, and Seamen’s Hospital,Albert Docks."Some three years ago I was pained and surprised to be

informed by the secretary of the Seamen’s Hospital Societythat my colleagues (as I regarded them) at the Dreadnou,,q7tt(Seamen’s Hospital, Greenwich) had collectively and officiallyrepresented to him that I had assumed a title to which I hadno right and that he had been asked officially to request thatI should discontinue the practice. If I am not mistaken

(unfortunately I have destroyed the correspondence) I was

requested to write to the medical press and publiclyintimate that I was not a physician to the Seamen’sHospital, Greenwich, and that I had no right so to describemyself. I protested. After some correspondence, in the courseof which I intimated that I considered that my colleaguesmight have spoken to me privately if they thought I was inerror or considered themselves aggrieved, I expressed regretif I had unwittingly arrogated to myself a title to which Ihad no claim. In consequence of the want of considerationshown me by my colleagues at the Dreadnought I have ceasedto visit there, feeling that my seniors did not care to beassociated with me, and myself not caring to be associatedwith those who, I considered, had treated me with scantcourtesy, not to say fairness or friendliness.At the time of the correspondence referred to I did consider,

as I still consider, that I had a perfect right-in fact as muchright as either Dr. Curnow or Dr. Anderson had-to designatemyself "Physician to the Seamen’s Hospital, Greenwich." I

regret now that, shrinking from a petty squabble and forthe sake of peace, I gave way on what at the time seemed tome to be a most trivial matter.

I am, Sirs, yours faithfully,PATRICK MANSON.

Queen Anne-street, Cavendish-square, Dec. 28th, 1898.PATRICK MANSON.

"CLEANSING THE LESSER PERITONEALCAVITY."

To the Editors of THE LANCET.

SIRS,-Will you kindly allow me to reply to Mr. Furner’sletter in your issue of Dec. 24th? ? My note" " was headed" Perforated Gastric Ulcer and dealt for the most part withtwo points other than that of cleansing the lesser peritonealcavity. The facts are very simple. Some time ago, as my" note " says, I read a case of death from the giving way ofa second ulcer opposite to one on the anterior wall whichhad perforated and which I had closed. At that time I

pointed out that it would be well to adopt a practice ofexamining the posterior wall to prevent this disaster.Mr. Furner, when reading his paper, spoke of my case

and of my suggestion that the posterior wall should beexamined, I did not, when advocating this, make anyallusion to cleansing the cavity or the preventionthereby of the formation of an abscess. What Iclaim to have advised (a simple but not unimportantcustom) no one who heard me read my case will deny that Idid advise. Again anyone fairly reading my "note" in yourpaper will see that as between Mr. Furner and myself I givehim full credit for drawing attention to the need of cleansingthe lesser peritoneal cavity and the good which would arisefrom doing it as a matter of routine.

I had a perfect right to draw the attention of surgeons totwo points I thought my experience had shown me wereimportant and not generally recognised. Had I knownMr. Furner was about to publish his paper I would certainlyhave left out any allusion to his point of cleansing the cavity.I must add, however, that I am not conscious of havingtreated him unfairly by accident even, certainly not bydesign. I am, Sirs, yours faithfully,Brighton, Dec. 26th, 1898. T. JENNER VERRALL.T. JENNER VERRALL.

" FIRES IN LUNATIC ASYLUMS."To the Edi.tors of THE LANCET.

SIRS,-Your note on the recent fire at this house scarcelydoes justice to the staff.The patient whose life was lost was not merely arousEd