machines last longest. 5. Sleep Hygiene : A suffi ciency of rest repairs and strengthens ; too much rest weakens and makes soft. 6. Clothes Hygiene: He is well clothed who keeps his body sufficiently warm, safeguarding it from all abrupt changes of temperature while at the same time maintaining perfect freedom of motion. 7. House Hygiene: A house that is clean and cheerful makes a happy home. 8. Moral Hygiene: The mind reposes and resumes its edge by means of relaxation and amusement, but excess opens the door to the passions and these attract the vices. 9. Intellectual Hygiene: Gaiety conduces to love of life and love of life is the half of health; on the other hand, sadness and gloom help on old age. 10. Professional Hygiene Is it your brain that feeds you? Don't allow your arms and your legs to become ankylosed. Dig for a livelihood, but don't omit, to burnish your intellect and elevate your thoughts.

THE meeting of the Pathological Society of London on Tuesday, Feb. 21st, will be devoted to a discussion of the nature of Pseudo-tuberculosis. Specimens and lantern slides will be shown and it is hoped that as much material as possible will be brought together; any members willing to contribute are requested to communicate with the secretaries | of the society. One of the objects of the discussion will be to obtain a more definite idea as to what lesions should be included under the heading of Pseudo-tuberculosis. Dr. G. Sims Woodhead will introduce the discussion and other speakers will follow, including Professor Sidney Martin, F.R.S., Professor John McFadyean, Dr. J. W. Washbourn, Mr. Pakes, and Dr. Wethered.

MR. H. E. ANNETT, M.B., Ch.B. Vict., has been appointed Demonstrator of Tropical Pathology in the newly founded school of tropical diseases in Liverpool. Dr. Annett has been studying in Koch's laboratory in Berlin for the past two years. His career at University College, Liverpool, was a distinguished one. He there obtained the Lyon Jones Scholarship (Senior and Junior) and the Holt Fellowship in Pathology. Dr. Annett was also appointed Research Scholar by the Commissioners of the 1851 Exhibition.

AT an influential meeting of the Medical Committee of the Brompton Hospital for Consumption and Diseases of the Chest held recently, Dr. Green being in the chair, it was unanimously resolved that the new treatment of tuberculosis be tried at that institution, and the subject is now under consideration by the committee of management, together with that of the establishment of a sanatorium in the country, for which funds are urgently needed.

FRESH evidence accumulates day by day of the relation of tuberculosis to milk-supply. We have already published in our columns several communications on the subject which leave little doubt of the risk to which the health of the community is exposed by the consumption of milk infected The relation thus established with the tubercle bacillus. calls for vigorous control of our milk-supplies at home and abroad. Among those who were foremost in taking steps to ascertain how far the spread of tuberculosis could be referred to milk-supply was the City Council of To the credit of one of the members of Liverpool. the Health Committee, Mr. Anthony Shelmerdine, an investigation was started in December, 1896, when at his instance 50 samples were obtained from 50 different milksellers in Liverpool and were immediately submitted to bacteriological examination by Dr. Sims Woodhead and Dr. Cartwright Wood. It may be briefly stated as the result of this investigation that of the 50 samples examined five were capable of setting up tuberculosis in guinea-pigs and that accordingly 10 per cent. of the samples of milk under examination must be regarded as being infected with the The individual details of the results tubercle bacillus.

of biological experiment are of interest but we may omit the 45 examples which proved to yield negative results both on subcutaneous (three cubic centimetres) and intraperitoneal (two cubic centimetres) injection. As just stated, five samples of milk appeared capable of setting up tuberculosis in the guinea-pigs inoculated. In three of these samples, Dr. Sims Woodhead and Dr. Cartwright Wood remark, both of the animals inoculated developed tuberculosis, while in two other cases only one of the animals inoculated with the milk developed the disease. "As it is a very unusual thing for animals which have been injected with tubercular material to escape the infection we must consider the question why half of the animals injected with these two samples escaped and also the possibility of these animals having contracted the disease otherwise than through the samples of When a set of milk with which they were inoculated. animals are inoculated with the milk containing tubercle bacilli from a cow suffering from tuberculosis of the udder all the animals succumb to the disease. Bollinger, however, pointed out that when such a milk was diluted sufficiently (40 to 100 times) with sound milk the mixture was unable to set up the disease. He concluded from this that the milk from a dairy, in which of course the milk from a large number of cows is mixed together, would probably not be rendered infective as a whole by the presence of the tuberculous milk, but that on the other hand the dilution would Our knowtend to render the milk as a whole innocuous. ledge of other disease organisms would certainly lead us to expect that the dilution of the infective fluid would exert great influence on its virulence since it has been proved in the case of certain pathogenic germs that a certain definite number of bacilli are necessary to infect the animal and that where we pass much below this dose the animal may escape. It has also been shown that the dose required to infect varies greatly considerable range in the amount required with different with different species of animals, and no doubt there is a animals of the same species. Wyssokowitschky has tried to determine the number of tubercle bacilli necessary to infect bacilli introduced into the peritoneal cavity are necessary to a guinea-pig. He found that from eight to 30 virulent bring about infection of a guinea-pig. No doubt these results are merely approximate, as much would depend on the virulence of the bacilli experimented with and also the individual susceptibility of the guinea-pigs which can, as a rule, A CASE of bubonic plague is reported from Middelburg, be quite safely ignored in an ordinary inoculation but which

WE regret to learn the death of Mr. Thomas Cooke, F.R.O.S. Eng., which occurred suddenly from aneurysm at 40, Brunswick-square, W.O., on Wednesday afternoon. We shall publish an obituary notice in our next issue. The funeral will take place on Monday next at 2P.M. at Kensal Green Cemetery.

SUMMONSES have been issued for the usual February meeting of the Executive Committee of the General Medical Council. The meeting will be held on Monday, the 27th inst. Summonses have also been issued for a meeting of the Penal Cases Committee to be held on Tuesday, Feb. 28th.

THE Home Secretary has, in accordance with the provisions of the Inebriates Act, 1898, appointed Dr. R. Walsh Branthwaite to be an inspector under the Inebriates Acts, 1879 to 1898.

bably diluted many times with that of sound animals. The probability of the bacilli being present in very small numbers in at least two of the samples was rendered very strong by the fact of only half of the animals inoculated with these milks becoming infected and because the lesions set up were much less marked than is usually the case.

The results of this investigation indicate the desirability in the case of mixed milks-such as are obtained from a dairyof bringing under examination a larger amount of the suspected milk by making a more extensive series of animal inoculations than has up to the present been usually considered sufficient.

METROPOLITAN WATER COMPANIES'

BILL.

would here have an opportunity of displaying itself where | circumstances considering that the infected milk was prothe quantity introduced is as small as to verge on the minimal quantity necessary for infection. Although, as we have already stated, in our experience all the animals inoculated with the milk from a cow either develop tuberculosis or remain unaffected, according as the udder happens to be affected with the disease or to be free, this need not hold in the case of milk obtained from a dairy. It is quite possible, or even probable, for a tuberculous milk to be so diluted with other milks in a dairy as to be capable of giving rise to the disease in only a certain proportion of the animals inoculated. Under such circumstances we should expect the disease to manifest itself differently and to run a much more chronic course, and this, as a matter of fact, was the case. Indeed, the disease which resulted from the injections of the milks was much less advanced than one would have expected, and as there is often some difficulty in demonstrating microscopically the presence of tubercle. bacilli in such cases, we took the precaution of inoculating a second guinea-pig with some of the diseased organ which was suspected to be tubercular. As will be observed where the material was infective the disease ran a much more rapid course than in the animals primarily inoculated. This is to be accounted for by the fact that they probably received a much larger quantity of the infective agent than was present in the original milk. It will also be noted that in the cases infected directly from the milk the disease was sometimes almost localised and did not always appear to spread directly along the track of the lymphatics, but would sometimes appear to make a leap and attack some other organ, such as the spleen or liver. This is a type of the disease which we should expect to meet with where the animals had been inoculated with a weak virus or a small quantity of the infective agent. We are accordingly of the opinion that these two samples of milk contained tubercle bacilli, although the amount of the infective agent present was probably not very large. It may also be suggested, in view of these facts, that we might possibly have been able to demonstrate the presence of tubercle in some of those samples of milk which gave us a negative result if we had brought a larger quantity of the material under examination by inoculating a larger series of animals and perhaps also by allowing them a longer period in which to develop the

disease."

The reports of the examination of the samples thus referred to we append :

SAMPLE (No. 11 IN THE REPORT). The "subcutaneous" guinea-pig when killed on the thirtyfourth day was found to be apparently quite healthy in all the organs and no trace of tubercle could be found.

The "intraperitoneal" guinea-pig was killed on the thirtyfourth day. On opening into the abdominal cavity a small yellow point apparently tuberculous in its origin was observed on the abdominal wall. The spleen contained one small nodule but was otherwise unaffected. The mesenteric glands were enlarged and harder than normal but in one case contained a small mass of caseous material from which cover-glass preparations were made and a guinea-pig was inoculated. Microscopic examination showed the presence of tubercle bacilli. The inoculated guinea-pig was killed on the forty-eighth day. The inguinal glands on both sides were enlarged, but not extensively. The spleen, liver, lungs, and glands at the root of the lungs were all extensively

tuberculous.

SAMPLE (No. 44 IN THE REPORT).

The "subcutaneous" guinea-pig was killed on the thirtysixth day. The inguinal gland on the side of injection was very much enlarged and filled with cheesy pus. Cover-glass preparations of this pus showed the presence of tubercle bacilli. None of the other organs were manifestly affected. A guinea-pig inoculated with the pus from the abscess on being killed 48 days after was found to have developed tubercle. The inguinal glands, spleen, liver, lungs, and glands at the root of the lung were all affected with tubercle.

The "intraperitoneal" guinea-pig was killed on the thirtieth day but a careful examination failed to show the presence of tubercle in any of the organs.

As already stated, three other samples gave immediate evidence of tuberculous infective property.

The direct microscopical examination of these milks for the presence of tubercle bacilli gave in every case a negative result, as indeed might have been expected under the

WE have already announced that the Metropolitan Water Companies' Bill' has passed through the Private Bills Office. The Bill is drawn up very much on the lines suggested in the resolutions passed by the directors of the associated companies which were placed before the Royal Commission now sitting and which were published in extenso in THE LANCET of Jan. 28th, p. 242. The Bill, although not of great length, is one of considerable importance; it consists of 24 sections.

The preamble states that it is expedient, with the view to time of drought or by reason of accident or emergency, that obviate the possibility of a deficiency of water-supply in provision should be made for improving the intercomand that the metropolitan water companies ought therefore munication between the mains of the different companies, to be allowed temporarily and with the sanction of the Local Government Board to abstract when necessary an increased amount of water from the Thames. It is stated that since the last session of Parliament certain work has been done by some of the metropolitan water companies which would have been legal had the present Bill been passed by Parliament and it is suggested that the Bill should be retrospective as far as work already carried out is con-

cerned.

the water companies, or in their default the Local GovernIt is suggested that it is expedient that. ment Board, should appoint an arbitrator who should settle any differences which may arise under the Bill, and it is further suggested that the companies should be allowed to raise money on debenture stock to carry out the provisions of the Act. The Acts which it is proposed to incorporate are the Waterworks Clauses Act of 1847 (with respect to breaking up streets, &c.), the Lands Clauses Act (except those provisions respecting the purchase of land otherwise than by agreement), and Part 3 (debenture stock) of the Companies. Clauses Act, 1863, as amended by the Act, 1869.

All the metropolitan water companies are interested in the promotion of the Bill.

Under the provisions of the Bill it is proposed that within six months after it becomes an Act the water companies shall prepare and submit to the Local Government Board a statement describing the work which they propose to undertake for the improvement of intercommunication of mains. The Local Government Board are to have the power to direct inquiries with regard to the matters affecting intercommunication of the mains and are to possess the powers idenHealth Act, 1875. The expenses of such inquiries are to be tical with those which they now have under the Public paid by the metropolitan water companies. The companies are to have power to lay new mains in the streets and to do any work necessary for that purpose in streets, bridges, &c., not only within their own limits of own limits of supply but other of the metropolitan companies by permission of that within the limits of the statutory area of supply of any

company.

In the case of drought any metropolitan company

is to allow passage of water through their mains for the use
of a company requiring an extra supply, but the mains are
not to be so used to the prejudice of the arrangements for
the supply of the customers of the company through whose
pass.
mains the water is to
The Local Government Board are to have power to

authorise or require companies to abstract from the Thames

The

THE winter session of 1898-99 was brought to a close on Jan. 31st, when the results of the recent examination were announced and the prizes were distributed by Sir Ralph Knox, K.C.B., Permanent Under-Secretary of State for War, in the presence of Surgeon-General Jameson, C.B., DirectorGeneral, A.M.S., Lieutenant-General Sir Baker Russell, K.C.B., commanding the Southern District, Surgeon-General Cuffe, C.B., P.M.O. of Portsmouth, the military staff of the Royal Victoria Hospital, Netley, and Hospital, Netley, and a distinguished company of visitors.

or its tributaries an additional amount of water should THE ARMY MEDICAL SCHOOL, NETLEY. occasion require. The Local Government Board are to have power to require any company to increase their pumping power and to enforce orders and regulations to ensure the carrying out of these provisions. Board are also to have power to attach penalties for the omission of such orders and regulations, to recover them in a summary manner, and to apply them in any way they may direct. The metropolitan companies are to have power to acquire fland and easements for carrying out the provisions of the Act. An arbitrator is to be appointed within three months of the passing of the Act by the companies or, should they fail to agree, by the Local Government Board. The arbitrator so appointed is to hold his office for some period not greater than three years. His remuneration is to be settled by the water companies or, should they fail to agree, by the Local Government Board and he is to be paid by the water companies or some of them as they may agree in such proportion as the companies may from time to time agree upon or, should they not agree, as the arbitrator himself may appoint. An important clause relates to the retrospective action of the Act. It is provided under Section 13 that

13. Anything done by any one or more of the metropolitan water companies before the passing of this Act which would have been valid and within their respective powers if this Act had been passed in the session of Parliament holden in the year one thousand eight hundred and ninety-eight and the expenditure of money by such company or companies in reference thereto is hereby sanctioned and confirmed.

The companies are to be allowed to raise money on debenture for the purposes of carrying out the Act. New debenture stocks are to be offered by auction or tender; the purchase-money of the capital sold by auction is to be paid within three months. Notice is to be given to certain officials as to the sale of the shares. The officials to be notified are the clerk of the London County Council, the town clerk of the City of London, the secretary of the London Stock Exchange, and the clerks of the various county councils who might be affected, and in the case of the East London Company the clerk of the Borough of West Ham. The stock which is not sold by auction or tender is to be offered to shareholders. Should there be a premium arising from the stock it is to be applied for the purposes of the Act. The amount of stock is limited to £600,000. Certain provisions are made between the companies as to the payment of interest of debenture stock.

Colonel NOTTER, Professor of Hygiene, aunounced the results, reporting that the work of the session had been satisfactory, that the whole of the 50 surgeons on probation who had undergone the final examination had proved themselves fitted to receive Her Majesty's commission, that in general ability they were of fair average, and that their conduct while passing through the school had been excellent. The subjoined lists show the final positions of the officers with the marks which they obtained at the examinations and the prizes gained at the Army Medical School.

MEDICAL QUALIFICATIONS IN FRANCE
AND THE POSITION OF THE ALIEN
MEDICAL MAN.

IN our issue of Dec. 10th, 1898, we published a communication from our Paris correspondent upon the above important subject. In this our correspondent was made to say: "The diplôme d'Université .......... does not authorise the holder to practise outside France herself. ...... Foreigners who wished to practise in France were allowed to do so as before under easy conditions, but they were only to receive the diplôme d'Université." This statement of course implied that foreigners could practise in France with the diplôme d'Université. This, however, is not correct and we regret that owing to an error, and one which in justice to our Paris correspondent we wish to say was in no way due to him, the statement should have appeared in our columns. Our attention was called to the matter by a correspondent and we submitted his statement to our Paris correspondent who has sent us the following: "The diplôme d' Université granted by the faculty of Paris gives no right to practise in France. The medical study for it is the same as for the other diploma, but greater facilities are granted to foreigners for obtaining it and studies already gone through in their own countries are allowed to count. The diplôme d'état alone gives the right to practise in France or her colonies and to obtain it the student before commencing his medical studies must undergo in France the examination for the baccalauréat (bachelier de l'enseignement secondaire classique) and a preliminary examination in physics, chemistry, and natural science. No remission of the preliminary examination is granted to anyone, be he Frenchman or foreigner."

D. S. Harvey
J. M. Sloan

H. E. Haymes

NOMINATED SURGEONS-ON-PROBATION.

F. J. Brakenridge

G. O. Phipps

N. J. C. Rutherford
G. J. A. Ormsby...

The positions of these gentlemen are determined by the marks gaine at Netley.

* Gained the Herbert Prize of £20, Martin Memorial Medal, the De Chaumont Prize in Hygiene, and the Second Montefiore Prize.

† Gained the First Montefiore Prize of 20 guineas and medal.
** Gained the Parkes' Memorial Medal.

tt Gained the Maclean Prize for Clinical and Ward Work.
Gained the Pathology Prize presented by Surgeon-General Hooper,
'O.S.I.

Sir RALPH KNOX after distributing the prizes and saying who entered the Army Medical School by nomination and a few words to each prize-winner, especially to Mr. Harvey who, he said, by his diligence had shown that nomination had proved a success, addressed the young officers in a speech of which the following is an abstract. He said he feared that his selection for the performance of the function was not peculiarly happy, for though for many years he had known much about army medical officers he had to confess that most of his thoughts were directed to ascertaining how few of them would suffice for their work and what was the minimum remuneration which would induce them to join the service. He, however, could say that his interest in the service had been very great and that he had served on many committees dealing with important questions connected with their duties. Now, he had to give them a word of encouragement on starting on their career in life. He first congratulated them on at last having completed that terrible examination period of life through which it appeared that all young men nowadays had to pass and he was very pleased to hear that the standard of their work was so high and the general results so satisfactory, and he thought that they might look forward with confidence to their lives as

Hertfordshire County Council, and asked some questions about the wells.

low level as the tide is rising in order to keep up the Navigation water to its proper head and to make up the loss caused by the lockage of barges going out into the Thames. The amount of water which the Conservators of the Lee have a right to take for the purposes of navigation is 5,400,000 gallons daily. This amount is made up partly by water pumped by the East London Company in the manner mentioned and partly by water which flows down the Lee Navigation. By pumping up the tidal water the company are enabled to take more water for the supply of their customers. Mr. DE BOOK PORTER asked whether the Lee Conservancy Board acquiesced in this arrangement. The witness replied that it was a statutory arrangement and that in the Act of Parliament there was a clause which enabled the company to pump from pound to pound and to provide part of the statutory quantity by this means.

In answer to Sir JOHN DORINGTON, the witness said that the company put up temporary pumps to raise the water from one pond to another. The water is pumped up beyond Tottenham Lock but never into the reach which supplies water from the intake of the company.

In answer to Sir JOHN DORINGTON the witness said that the water of the Lee runs down the Navigation and is not under the control of the East London Company.

The witness explained to the Commissioners exactly how the water was pumped and pointed out on a map the situation of the various places to which he referred. Briefly the evidence amounted to this: The East London Company pump from the old tidal channel of the river Lee into the Lee Navigation at Bromley Lock; they occasionally pump at Old Ford Lock which is slightly higher up the Navigation channel. This water flows into the Bottom Pound Lock and the reach into which the water is pumped is four miles in length and extends to Tottenham. Above Tottenham water is pumped into the Navigation channel. The water so | pumped does not go beyond Stone Bridge Lock. No brackish water is pumped to any place through which it could pass to the intake of the company near Enfield Mill. The pumping station near Bromley Lock is a permanent station; at other places the pumping is effected by portable engines.

In answer to the CHAIRMAN the witness said that during the water famine of last year there was a great deal of wilful waste and the company received a large number of letters from their customers calling attention to the waste in different places and asking them to put a stop to it. On the other hand, the company received letters from people saying that they would allow the water to run away in order to spite them."

The CHAIRMAN said that this was a serious statement and Mr. PEMBER suggested that the letters should be produced. The witness said he had none with him but that they could be produced.

Sir JOHN DORINGTON asked the witness whether he agreed with Sir Alexander Binnie's inference that powers granted by corporations could not safely be given to water companies with regard to measures for the prevention of waste of water, and with regard to powers for testing the fittings which were used by the water consumers. The witness said that in one of their bills they had inserted clauses copied from the Manchester Corporation Waterworks Acts which dealt with these matters. The local authorities in whose districts the company gave their supply strongly objected to this supervision and the clause was therefore withdrawn.

In answer to Sir JOHN DORINGTON the witness said that the local authorities thought that the company was trying to get too much power into their own hands. He did not know, however, whether the local authorities themselves would have been inclined themselves to exercise such powers on behalf of the company had they been entrusted to them.

In answer to Mr. FREEMAN, who cross-examined on behalf of the London County Council, the witness said that the Lee Conservators had power over the water of the river and took what they wanted. He could not say what amount of water was actually taken by the Conservators for the purposes of navigation. He was unable to say how much was pumped up into the lower reaches of the river. The pumps used were centrifugal pumps and it was not possible to estimate what the amount pumped actually was. The Navigation water was kept up to its proper level and the pumping arrangements were made to effect this. When the right height of water was obtained pumping operations operations

ceased.

Lord ROBERT CECIL cross-examined on behalf of the

The CHAIRMAN said that the Commissioners had "nothing to do with deciding whether or not the New River Company and the East London Company are injuring wells and springs in Hertfordshire."

Lord ROBERT CECIL contended that the case for Hertfordshire was that the supply in that county had already been drawn upon more than the supplies from the heavens warranted. If the chairman told him that the Commission would safeguard the interests of Hertfordshire he would not wish to examine further.

The CHAIRMAN said: We have nothing to do with the interests of Hertfordshire, you must take care of yourselves. Lord ROBERT CECIL said: It is very material to Hertfordshire and it is very material for the supply of water to London.

The CHAIRMAN said: We are not inquiring into the supply of water to London but into the expediency of transferring the supply of water to London from the companies to a purchaser.

The forty-ninth sitting of the Royal Commissioners was held at the Guildhall, Westminster, on Feb. 6th. The Chairman (Lord Llandaff) and all the Commissioners were present. The witnesses examined were Mr. Isaac A. Crookenden, secretary of the East London Waterworks Company, and Sir Henry Knight, chairman of the Southwark and Vauxhall Company. Vauxhall Company. Supplemental papers referring to the East London Waterworks Company's financial state were put in. Sir Henry Knight put in tables referring to the financial state of the Southwark and Vauxhall Company.

At the commencement of the proceedings Mr. PEMBER, Q.C., on behalf of the East London Company, made a statement with regard to the statistics which had been put in referring to the probable increase in the population of the district within the company's area of supply. Three different estimates had been made. Lord Balfour's Commission had suggested that the decennial increase of the district would be 25.8 per cent., and if this proved correct in the year 1937 the population would amount to 3,165,445. At an average daily supply per individual of 35 gallons, 110,790,000 gallons of water a day would be required and the cost of the work necessary to carry out this was estimated at £4,238,000. The directors of the East London Company, however, found that the increase of the population had been 17.1 between the years 1886 and 1896, and they therefore thought that the estimates made by the Balfour Commission were in excess of the amount of population which they would probably be called upon to supply.

Mr. CROOKENDEN, in answer to the CHAIRMAN, explained how the estimate of a decennial increase had been obtained and, in answer to further questions, said that between the years 1891 and 1898 the population had increased at the rate of 22.65 per cent.

The CHAIRMAN pointed out that as the average increase of the population of the East London Company's area had been higher than the average of 18.2, which was the estimate given by Lord Balfour's Commission for the whole of London, it did not seem safe to take that average as a basis for future calculations of the East London Company's

district.

Mr. BALFOUR BROWNE cross-examined the witness with regard to the profits made by the company immediately before the water famine of last year and asked for an explanation of how it was that the expenses had been reduced and the profits at the same time increased. The witness pointed out that the expenses of 1896 were larger than those of 1897, because in the former year a considerable outlay had been caused by repairing the damage done by the frost of the year 1895.

The witness gave some particulars with regard to the profits recently made by the East London Company. He had not come with the figures worked out and as Mr. Pember on behalf of the East London Company had to correct the figures at a subsequent meeting of the Royal Commissioners it is useless to publish them. [Mr. Pember explained at the fiftieth sitting held on Feb. 7th, that Mr. Crookenden was unwell when he gave his evidence.]

Mr. BALFOUR BROWNE asked the Chairman to what decision the Commissioners had come with regard to addresses by counsel at the conclusion of their reception of evidence. He contended that the counsel for the companies