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threatened reduplication of labour. In other words,whatever he might think himself, he believed thatthe Association would regard the newly created bodyas one whose labours would lead to overlapping.The views of the Council and of the Representativesof the British Medical Association must now beawaited, the question which has to be decided bythem being whether the Association considers that,with its large and important membership anddemocratic organisation, it can itself do all whichthe new body proposes to do; or whether it willrecognise the claims of the new body toundertake much which, at any rate hitherto, haslain outside the scope of the Association. Forour own part we hope that the British MedicalAssociation will lend its cooperation to a new bodywhose institution cannot possibly detract from-theposition enjoyed by the Association as the largestunion of medical men in the country. The voice ofthe Association in any such federation of healthinterests as is postulated by the Permanent MedicalParliamentary Committee must be of the firstinfluence, and it will be heard in directions whereat present that voice is silent or misunderstood.For the Medical Parliamentary Committee pro-

poses to regard the union between medicineand the public from the public periphery ratherthan from the medical centre. Medicine inthe past may not have suffered as much as

other industries have done from assumed con-

flicts of interests between those who do the workand those for whom the work is done; but theopposition of interests, which exists, has been

exaggerated by misunderstanding. It has longbeen evident that on medical progress depend allthe best chances of an improved material and moralnational life, and the common ground of effortbetween medical and public labourers has latelybeen increasing in extent at a speed that isalmost alarming because the preparations for

co-operation are lagging behind. Whatever mayprove to be the precise scope of the work of aPermanent Medical Parliamentary Committee, noactivity can be more fruitful than that which

produces assurance in the mind of the public andof Parliament that medicine is being administeredby men of public spirit for the common weal.And the manifest unfairness of much of the publictreatment meted out to the medical profession inour conditions of service will receive swift remedyas that assurance sinks in.

The Maternal Mortality of Childbirthand the Teaching of Midwifery.ONE of the problems which will require earnest

consideration by the new Minister of Health is thepresent position of the teaching of midwifery tomedical students and midwives. Obstetric medi-cine is essentially the branch of medicine in whichprevention can and should play a very large part.There is to all intents and purposes no cure for

puerperal fever, and yet it is a disease which isalmost entirely preventable. That it is not more

often prevented is one of the anomalies, and,indeed, scandals of the present-day practice of

’

medicine. As Mr., VICTOR BONNEY -points out inhis instructive and important paper read beforethe Obstetrical Section of the Royal Society ofMedicine (see p. 775), by far the commonest causeof death in childbirth is puerperal sepsis. Evenas recently as 1915 over 1200 women lost theirlives from this cause in England and Walesalone, and yet the occurrence of a case of

septicaemia in that year, apart from militarysurgery, in a surgical ward of a well-conducted

hospital would have been regarded as an event

indicating some very serious defect in the manage-ment of the case. By the exact practice of asepsisor antisepsis surgeons are able to undertake opera-tions in any part of the body in the confident

expectation that there will be no septic infection,and yet at the present day puerperal fever, whichis, of course, only surgical septicaemia occurring inthe parturient woman, claims a very large numberof victims and has a death-rate which has altered

relatively very little during the last 70 years. Itcan be proved readily that the safest thing that canhappen to a woman in childbirth is that she shoulddeliver herself without any artificial aid, and itmay be said without fear of contradiction thatif in all cases of normal labour the patientdelivered herself without the assistance of either a,doctor or a midwife a large number of lives wouldbe saved each year. This is a hard saying, but onewhich we maintain is true; in other words, thegreat majority of women who die from puerperalsepsis are infected by their attendants.That in proper surroundings and with proper

aseptic or antiseptic precautions puerperal feveris preventable is proved by the experience of £

lying-in hospitals; why, then, is it not prevented ,

in private practice ? 2 The answer is to be foundin Mr. BONNEY’S statement that " not much morethan a bowl of antiseptic lotion stands between thepractice of the present day and that of the’ sixties.’ But a bowl of antiseptic lotion is not

Listerism." It is promising to note that the

teaching of midwifery and its defects is now

engaging the attention of those who instruct inthat subject, and there are many among the

younger teachers who recognise the changes thatmust be brought about in the near future if anyreal improvement is to be effected. The apathy ofthe medical profession and of the public in thismatter has been very marked; many writers havedrawn attention to the prevalence of puerperalinfection, the resulting morbidity and mortality ofchildbirth, and the grave consequences they entail,but the medical profession has been content to goon in the old way, and the teaching of our medicalschools has done little or nothing to remedya state of things in which, while septic infectionfollowing a surgical operation is regarded as a rareaccident to be rigorously investigated, sepsis follow-ing a confinement is looked upon almost as a

necessary evil in a certain proportion of the cases.We may not be inclined to agree with all Mr.

BONNEY’S statements or conclusions, but we cannot

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deny that he has laid bare the real cause of theevil and that he has propounded the appropriateremedy. Some of his critics may think it right tomake fun of his dislike of the anus and his proposalto paint the perineum with one or other of the

coloured aniline antiseptics, but we are glad tothink that he has had the courage not only toexpose the faults which are associated with present-day midwifery practice but also to lay down theonly sound principles upon which the neededremedies can be based.The present methods of teaching midwifery to

medical students are extremely faulty, and if the

conditions in London are not comparable in alldetails to those at certain other educational

centres, none the less they call for urgentreform. The provision of sufficient. accommoda-tion in properly equipped (and properly staffed)lying-in hospitals, to which any woman whodesires can obtain admission, is most pressing-itis one of the first problems which the new Ministryof Health must consider; while the education of thepublic in the urgency and importance of thesematters calls for the cooperation of every memberof the medical profession, and is a part of the solu-tion of the problem in which everyone can takehis or her share. The defective training of thestudent is mainly due to the fact that the majorpart of the teaching is done by registrars and resi-dents who are themselves in the position oflearners and often have had but little experience.While in medicine and surgery most of the practicalwork is done by members of the honorary staff ofthe hospital in surroundings which lend themselvesto proper and efficient teaching, in midwifery prac-tical teaching of this kind is not done at all or iscarried out by junior men, sometimes in the lying-inward of a general hospital, of which there are onlythree in London, or more often in the extern

maternity department, among the entirely unsuit-able surroundings which are portrayed so vividlyby Mr. BONNEY. There is only one remedy-theteaching of midwifery must be done in the future inproperly equipped lying-in hospitals under the samEfavourable conditions which obtain in the case oj

medicine and surgery. If the plan of providingwhole-time properly paid teachers is to obtain in thElatter two subjects, then the same must apply to midwifery, and in this way only, in view of the speciaconditions surrounding the practical training, wilit be possible for the student to obtain his teachingin midwifery from teachers of equal experienc4and standing to those who are engaged in teachinjhim medicine and surgery. This will entail thlprovision of spacious central institutions properlyequipped and officered, sufficiently large to enableall the students in London, for example, to htrained in them, and furnished with all the laboratory facilities necessary, not only for the carryiniout of the pathological investigations necessitatelby the treatment of the patients, but also for thcarrying on of efficient research. In such sui

roundings only will it be possible for the studento be taught on the lines laid down by Mr. BONNE1with which we are in complete agreement.

Euthanasia.UPON one or two recent occasions the suicide of

persons known to have been sick and sufferinggreat bodily pain has formed the subject of investi-gation at inquests. Observations made upon theseoccasions by coroners and others have evolved aquestion, often raised before, which the public presshas labelled as "the right to die," and which is .

undoubtedly of considerable interest from a socialand legal point of view. Put broadly, the sug-gestion is this : that the religious, ethical, and legalsanctions which forbid suicide are of too com-

prehensive and inelastic a character, and that,in the case of illness from which there can

be no recovery, and which is sure to entail a

lingering and painful death for the person affected,it should be recognised that he is justified,legally and morally, in putting an end to his life.It is further proposed that the medical man attend-ing the sick person should either advise him informing his decision and confirm it, or shouldhimself become his patient’s executioner. We donot propose to discuss here the religious aspectsof suicide, or to review the history of the lawsrelating to it in Christian and other countries. Themedical profession, however, is deeply interestedin the suggestion that its members should becomeofficial arbiters of life and death, where beforeit has been their duty only to use their powersto mitigate suffering and to prolong existence.Almost every doctor of fairly wide experience musthave wished that death might speedily release fromsuffering a patient for whom he could foresee nofuture prospect save only increasing pain, andonly one inevitable ending. He may even havewished that he himself, without becoming at law amurderer, and without any infringement of theethics of his profession, might shorten the life ofone who perhaps entreated him to do so. Butwhatever his instinctive desire, such action hasalways seemed out of question.

,

What would be the feelings of the medical pro-fession on learning that there had been allotted to

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them the obligation definitely to advise patients: to die ; on learning that it was their duty to bring: to a patient the means of death, or to use them: with the patient’s consent and approval? Even from a general and superficial contemplation of. the points which appear to have recently attractedL public notice it is difficult to believe that theL nation would deliberately impose such responsi-, bility upon the practitioner, or that he would

: willingly accept it. The provision of legal’

euthanasia for cases of hopeless suffering could be approved of with a clearer conscience, moreover,3 if we knew how a

"

hopeless " case is to be defined7and recognised. The answer to the question is an3 invariable one-this function must be entrusted to3 the medical profession. The medical profession,- however, would disclaim anything approachingC1 the infallibility which would justify it in under-

taking the task of discrimination in every case

which might arise. Medicine can give instances,e no doubt, in which it might have no difficulty in itsprognosis of certain pain and of no less certaint death within a limit, not too certain, of time. There -’) would, however, be a wide range of instances where

very painful conditions and a lingering death would