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CHOLERA CAUSATION AND PREVENTION AT HOME AND AT HAMBURG.
50
CHOLERA CAUSATION AND PREVENTION AT HOME AND AT HAMBURG.
ports. In short, the application of quarantine by this country CHOLERA CAUSATION AND PREVENTION to one important European port would involve the placing in quarantine of a multitude of other ports. AT HOME AND AT HAMBURG. Quarantine was also a cruel process. That was best exemplified by reference to land quarantine, as, for example, BY R. THORNE THORNE, M.B., C.B., F.R.S. during the Egyptian outbreak of 1883, when villages and communities were surrounded by troops with loaded rifles Specially reported for THE LANCET. and bayonets. Any person taking food within the prohibited line would be subject to the same quarantine as the villagers, THE following notes taken from a lecture delivered at and it is believed that land quarantine has often destroyed St. Bartholomew’s Hospital on Tuesday last by Dr. Thorne more lives by starvation and misery than would have been sacrificed to cholera. But land quarantine, too, is essentially Thorne will at the present moment have general interest. inefficacious, the line being broken without difficulty, whether The circumstances under which Hamburg suffered from in Egypt or elsewhere, by all who can afford to pay their an epidemic of cholera whilst Altona escaped have also tribute of baksheesh. For England the abandonment of quarantine has been an an important bearing on the question of river water-supplies. The knowledge that no pretence Dr. Thorne, in the first place, explained the alternative almost unmixed good. would be made to keep out all chance of cholera in this systems adopted by continental Powers and this country to country has done more perhaps than anything else to induce prevent the importation of cholera. Up to a recent date the our sanitary authorities to spend their money on great works continental Powers had relied essentially upon a rigid of sanitation and on such improved sanitary administration quarantine system. Quarantine as applied to the Thames, as is likely to prevent the spread of any imported disease of for example, would mean the detention of all vessels coming the type of cholera. Millions have been spent to this end; on the other hand, hundreds of thousands of valuable from infected ports for a period varying from ten to five but, lives have been saved. Even if cholera should once more days according as the conclusions of the Constantinople succeed in passing the barrier of our ports and diffusing itself Conference or of the Rome Conference were accepted. During inland and cause a heavy mortality, we should still be that period healthy and sick alike would be prohibited enormously the gainers in point of human life by the system from having any communication with the shore. If during which we have so deliberately adopted ; but there is no doubt that our system is rather calculated to prevent than the quarantine detention a case of cholera occurred on to lead to such a contingency. board the whole of the crew and passengers, together with After describing in some detail the system of medical the ship, would have to go through a second period of deten- inspection with isolation that is adopted in our port districts, tion and
so on as long as any fresh attacks occurred. In the meantime shipping would be accumulating and the result for us would become a mere absurdity. And not only so, but half-a-crown would any night secure a boatman’s service for landing on the river banks. In short, the system would only have to be applied to ensure its immediate breakdown. England decided against quarantine for another reason. If the people in this country were told that a line had been drawn round England to keep out cholera a death blow to our sanitary administration would at once be dealt. Since they have been told that cholera cannot with certainty be kept out of the country, and that they themselves must be prepared to deal with it if it is imported by maintaining their districts in such a sanitary condition that the disease shall not spread if it should make its way into them, eight millions sterling have been spent in sanitary works every year and hundreds of thousands of lives have been saved The from typhoid fever and other epidemic diseases. general mortality has also largely decreased and a Frenchman-an old fellow-student of his-who is now at the head of the public health service in France, has calculated that, according to the estimate of human life by Dr. Farr and other English authorities, taking all the millions we have spent and all the lives that have been saved (I forget the exact sum), we have just got our money back. It might almost seem as if we had done it on purpose. No greater calamity could happen to this country than to apply the system of quarantine. Quite recently the French seaports of Boulogne and Calais were both infected with cholera, but its extent did not become public and very little was known regarding the outbreak. Only a few occasional cases were heard of until THE LANCET sent a commissioner to investigate the circumstances and to elucidate the facts. Then the full extent of the epidemics in these places for the first time became known in this country. Continuing, Dr. Thorne said : But at Dover alone in one week in August 5800 people arrived at the port. What would Dover have done had she been obliged to quarantine them? They could not have them in the harbour at night, for they could easily have escaped ; they could not have them on land for a similar reason. If they had put them to sea they would probably have been sunk by the first tempestuous wind. The attempt would be perfectly ridiculous and could be attended by nothing but disaster. " But it had been asked, why could not such a port as Hamburg, where so great an epidemic prevailed, be quarantined ? The answer was, that Hamburg had practically placed itself in quarantine. Its shipping and its commerce had practically come to a standstill, but both passengers and goods reached this country by alternative routes, the Hamburgers travelling to England rii Dutch, Belgian and French
a
system which is well known to
our
readers, the lecturer
explained that a much greater approach to this system had been arrived at at Venice and again at Dresden this year. He then proceeded to give an account of the natural history and the etiology of cholera, basing his facts on the results of a recent visit to Hamburg and of personal conferences with Professor Koch and Dr. Reincke, the health officer of HamUse was also made, for the purposes of illustration, of the theory of Professor Pettenkofer, to the effect that x, the cholera bacillus, together with y, the local circumstances, and z, the personal predisposition, were all necessary to the production of cholera in the human subject. Reverting especially to the Hamburg epidemic, which caused some 18,000 cases, with over 8000 deaths, last autumn, the question arose how Hamburg received its first infection. According to Professor Koch and Dr. Reincke this might have arisen from two causes, probably from both. In the first place, cholera certainly prevailed amongst the RussoJewish emigrants who were detained in huts on the banks
burg.
B
of a dock to the south of the Elbe (D in diagram). The sewage of these people, of whom the lecturer had seen a thousand aggregated together at one time, would pass by means of tidal influence into the main body of the stream, and it was described how under the then condition of things this material could have been carried up to and beyond the point at which Hamburg takes its water-supply from the river (c). Butitcannot now be proved that recognised cholera actually prevailed amongst these emigrants from cholera-infected Russian provinces before the date of the first cases in Hamburg city. But there was another source of danger. Havre suffered from cholera before the commencement of the Hamburg outbreak, and vessels from that port were lying in the Elbe not far from the point of the Hamburg water-intake. Some vessels of differing nationality indeed were at that time moored just above the intake. Proof was then adduced to the effect that the outbreak in
ASSOCIATION OF FELLOWS OF THE ROYAL COLLEGE OF SUHGEONS.
51
Hamburg was indeed a water outbreak, and by means of diawas shown that although Hamburg and Altona are THE ASSOCIATION OF FELLOWS OF THE practically one great city, the boundary between the two ROYAL COLLEGE OF SURGEONS OF being no more marked than that between the City of London ENGLAND.
grams it
and the Holborn district, yet a dotted map showed the occurrence of the cholera in the individual houses and streets, and proved conclusively that the boundary line between the two towns formed the line of division between an epidemic diffusion of cholera on one side and the absence of an epidemic on the other. One diagram showed this very effectively. At many points, and especially along the river side, no difference existed between Hamburg and Altona except that of a different water-supply. Hamburg taking the water within its own Elbe precints, distributed it in polluted its original state direct to the city-and its means of pollution bave already been indicated. But whence did Altona get its water? The remarkable fact remains that Altona takes the Elbe water also, and at a point considerably further down the river; and not only so, but it takes it after it has received the sewage of some 800,000 people living in Hamburg and in Altona, and after it had last autumn received the cholera discharges of some 18,000 persons attacked with that disease; and further, the point of intake (B) is at a spot where, according to Professor Koch, the sewage hugs the bank of the stream. But Altona, unlike Hamburg, has a system of filtration, the water being carefully filtered through sand and gravel filters. But it was not sand and gravel filtration that prevented the cholera organisms from being delivered to Altona. On the contrary, whenever by an accident the sand filtration alone was in operation, Altona did, as a matter of fact, a,t once get occurrences of cholera within its boundaries. The comparative safeguard, according to Professor Koch, was supplied by a slimy coating which formed on the surface of the filter beds. This coating consisted of the deposit of river mud, organic matter, débris and micro-organisms. And it was this slimy coating which, whilst admitting of the passage of the water through it, was found capable of holding back most of the vast number of micro-organisms with which the water in its natural state was charged. Some crucial instances in proof of this were afforded accidentally. Thus, when, owing to frost, the layer of slime and mud had frozen and had to be removed, its removal was followed by an outbreak of cholera in Altona. And, as bearing on the question of water pollution, a diagram was exhibited of a court within the Hamburg precincts (A) containing a large aggregation, amounting to 400 in number, of precisely those classes amongst which cholera so much prevailed, but amongst which no single case occurred during the whole epidemic, and this although the spot-map showed that the disease prevailed all around in Hamburg. Owing to certain local difficulties the Hamburg water could not be laid on to this large yard, and permission was obtained to convey water to the inhabitants from the Altona mains. Other instances, of similar proof as to water pollution being the cause of the cholera, had been procured by Professor Koch. It was, however, urged that, even according to Professor Koch himself, the "very best filtration " cannot be relied on to "keep back all micro-organisms,"whether of cholera or other diseases. The lecturer concluded by a reference to river valleys as affording the y of Professor Pettenkofer under circumstances most favourable to cholera recrudescence, and it was claimed for England that although there remain communities which were exposed to risk of cholera should the x be imported and gain access to her polluted rivers and gathering-grounds from which public water-services are derived, yet for fifty years work had steadily been going on which tended every year more and more to remove the y which Professor Pettenkofer held to be essential to cholera. And it was urged that quite apart from the question as to the necessary existence of the y in facilitating the diffusion of the infection, it was the bounden duty of all sanitary authorities to assume, in so far as their administration was concerned, that w alone, which was derived from the alimentary discharges of the sick, should never gain access to their water-services and should never be admitted into drains or sewers unless first destroyed by disinfection or otherwise.
ROYAL COLLEGE
OF
SURGEONS
IN
IRELAND.-
The following have been elected Examiners for the Conjoint Examinations of the College and the Apothecaries’ Hall :— Anatomy : Montgomery A. Ward ; Surgery: Arthur Chance ; Physiology, Histology and Biology : George White ; Pathology : Charles Coppinger ; Ophthalmology : F. Odevaine.
MEETING
01<’
COMMITTEE.
A MEETING of the Committee of the Association of Fellows of the Royal College of Surgeons of England was held on June 21st at 5 r.M. Mr. George Pollock, the president, occupied the chair, and was well supported. The minutes of the last meeting were read and confirmed. Letters of regret at inability to attend were read from Mr. Mayo Robson, Mr. Vincent Bell (Rochester) and Mr. George Jackson (Plymouth). The arrangement of the agenda for the annual meeting of the Association fixed for the following day was the chief subject which occupied the attention of the committee, and after its completion a list of officers for the ensuing year was drawn up for submission to that meeting. A discussion arose concerning the conduct of meetings of Fellows of the College, as illustrated by the proceedings at the meeting of Fellows called last year by the Council ot the College, and held in the theatre of that institution on the day of the annual election. It was unanimously resolved to bring under the attention of the Council of the College the expediency and desirability of framing the proceedings of these meetings in accordance with the rules which usually govern the conduct of meetings of other public bodies. The honorary secretary reported that he had sent out to all the Fellows of the College whose addresses were known the circular letter which had been drawn up by a subcommittee and had been adopted by the committee at the last meeting. He also reported that he had issued to the members of the Association a postcard with the following announcement :
39, Welbeck-street, Cavendish-square, W., June 17th, 1893. DEAR Sm,-The committee of the Association of Fellows of the Royal College of Surgeons of England has invited Mr. Macnamara, Mr. A. T. Norton and Mr. Al-iyo Robson to represent the Association at, the Council election in July next. It is earnestly hoped that you will be
able to record your vote in their favour. Voting papers should be applied for on or before Saturday, June 24th, and returned to the College not later thm Monday. July 3rd, 1893. The annual general meeting of the Association will be held at the Medical Society’s rooms on Thursday, June 22nd, at 5 P.11., Mr. George Pollock, president, in the chair. Yours faithfully, Signed on behalf of the Committee, H. PERCY DUNN, Hon. Sec.
On the completion of the foregoing business, which occupied about an hour and a half, the committee adjourned. ANNUAL GENERAL MEETING. The annual general meeting of the Association of Fellows of the Royal College of Surgeons of England was held at 5 r.M. on Thursday, June 22nd, at the rooms of the Medical Society of London. In the unavoidable absence of Mr. George Pollock, the President, who had been called from town, Mr. William Allingham occupied the chair. Several members of the Association sent letters of regret at inability to attend and a telegram from Mr. Gant was received to a similar effect. In the course of his address the chairman reviewed the proceedings and progress of the Association during the past year, and dwelt especially on the concessions which, at the instance of the committee of the Association, the Council of the College had made to the Fellows, especially in regard to calling the Fellows together separately from the Members for consultative purposes. A meeting of Fellows had been called and held in the theatre of the College after the election on July 7th last year, but that was not a favourable instance of what such meetings should be, as no notice was given to the Fellows of the subjects they were summoned to discuss, and the proceedings were marred by a regrettable incident which was still fresh in the memories of the Fellows and need not be more particularly recalled. It was so far satisfactory in that it was an acknowledgment on the part of the Council of the expediency of calling the Fellows together, but it left much to be desired and accomplished, for there were no agenda, and the only matter submitted to the meeting was the proposal of the Council to celebrate the jubilee of the Fellowship in July 1893. The gratifying success obtained by the Association in the election of Mr. Tweedy, who stood second on the poll, was a clear indication that the Association was making progress in the
CHOLERA CAUSATION AND PREVENTION AT HOME AND AT HAMBURG.
ports. In short, the application of quarantine by this country CHOLERA CAUSATION AND PREVENTION to one important European port would involve the placing in quarantine of a multitude of other ports. AT HOME AND AT HAMBURG. Quarantine was also a cruel process. That was best exemplified by reference to land quarantine, as, for example, BY R. THORNE THORNE, M.B., C.B., F.R.S. during the Egyptian outbreak of 1883, when villages and communities were surrounded by troops with loaded rifles Specially reported for THE LANCET. and bayonets. Any person taking food within the prohibited line would be subject to the same quarantine as the villagers, THE following notes taken from a lecture delivered at and it is believed that land quarantine has often destroyed St. Bartholomew’s Hospital on Tuesday last by Dr. Thorne more lives by starvation and misery than would have been sacrificed to cholera. But land quarantine, too, is essentially Thorne will at the present moment have general interest. inefficacious, the line being broken without difficulty, whether The circumstances under which Hamburg suffered from in Egypt or elsewhere, by all who can afford to pay their an epidemic of cholera whilst Altona escaped have also tribute of baksheesh. For England the abandonment of quarantine has been an an important bearing on the question of river water-supplies. The knowledge that no pretence Dr. Thorne, in the first place, explained the alternative almost unmixed good. would be made to keep out all chance of cholera in this systems adopted by continental Powers and this country to country has done more perhaps than anything else to induce prevent the importation of cholera. Up to a recent date the our sanitary authorities to spend their money on great works continental Powers had relied essentially upon a rigid of sanitation and on such improved sanitary administration quarantine system. Quarantine as applied to the Thames, as is likely to prevent the spread of any imported disease of for example, would mean the detention of all vessels coming the type of cholera. Millions have been spent to this end; on the other hand, hundreds of thousands of valuable from infected ports for a period varying from ten to five but, lives have been saved. Even if cholera should once more days according as the conclusions of the Constantinople succeed in passing the barrier of our ports and diffusing itself Conference or of the Rome Conference were accepted. During inland and cause a heavy mortality, we should still be that period healthy and sick alike would be prohibited enormously the gainers in point of human life by the system from having any communication with the shore. If during which we have so deliberately adopted ; but there is no doubt that our system is rather calculated to prevent than the quarantine detention a case of cholera occurred on to lead to such a contingency. board the whole of the crew and passengers, together with After describing in some detail the system of medical the ship, would have to go through a second period of deten- inspection with isolation that is adopted in our port districts, tion and
so on as long as any fresh attacks occurred. In the meantime shipping would be accumulating and the result for us would become a mere absurdity. And not only so, but half-a-crown would any night secure a boatman’s service for landing on the river banks. In short, the system would only have to be applied to ensure its immediate breakdown. England decided against quarantine for another reason. If the people in this country were told that a line had been drawn round England to keep out cholera a death blow to our sanitary administration would at once be dealt. Since they have been told that cholera cannot with certainty be kept out of the country, and that they themselves must be prepared to deal with it if it is imported by maintaining their districts in such a sanitary condition that the disease shall not spread if it should make its way into them, eight millions sterling have been spent in sanitary works every year and hundreds of thousands of lives have been saved The from typhoid fever and other epidemic diseases. general mortality has also largely decreased and a Frenchman-an old fellow-student of his-who is now at the head of the public health service in France, has calculated that, according to the estimate of human life by Dr. Farr and other English authorities, taking all the millions we have spent and all the lives that have been saved (I forget the exact sum), we have just got our money back. It might almost seem as if we had done it on purpose. No greater calamity could happen to this country than to apply the system of quarantine. Quite recently the French seaports of Boulogne and Calais were both infected with cholera, but its extent did not become public and very little was known regarding the outbreak. Only a few occasional cases were heard of until THE LANCET sent a commissioner to investigate the circumstances and to elucidate the facts. Then the full extent of the epidemics in these places for the first time became known in this country. Continuing, Dr. Thorne said : But at Dover alone in one week in August 5800 people arrived at the port. What would Dover have done had she been obliged to quarantine them? They could not have them in the harbour at night, for they could easily have escaped ; they could not have them on land for a similar reason. If they had put them to sea they would probably have been sunk by the first tempestuous wind. The attempt would be perfectly ridiculous and could be attended by nothing but disaster. " But it had been asked, why could not such a port as Hamburg, where so great an epidemic prevailed, be quarantined ? The answer was, that Hamburg had practically placed itself in quarantine. Its shipping and its commerce had practically come to a standstill, but both passengers and goods reached this country by alternative routes, the Hamburgers travelling to England rii Dutch, Belgian and French
a
system which is well known to
our
readers, the lecturer
explained that a much greater approach to this system had been arrived at at Venice and again at Dresden this year. He then proceeded to give an account of the natural history and the etiology of cholera, basing his facts on the results of a recent visit to Hamburg and of personal conferences with Professor Koch and Dr. Reincke, the health officer of HamUse was also made, for the purposes of illustration, of the theory of Professor Pettenkofer, to the effect that x, the cholera bacillus, together with y, the local circumstances, and z, the personal predisposition, were all necessary to the production of cholera in the human subject. Reverting especially to the Hamburg epidemic, which caused some 18,000 cases, with over 8000 deaths, last autumn, the question arose how Hamburg received its first infection. According to Professor Koch and Dr. Reincke this might have arisen from two causes, probably from both. In the first place, cholera certainly prevailed amongst the RussoJewish emigrants who were detained in huts on the banks
burg.
B
of a dock to the south of the Elbe (D in diagram). The sewage of these people, of whom the lecturer had seen a thousand aggregated together at one time, would pass by means of tidal influence into the main body of the stream, and it was described how under the then condition of things this material could have been carried up to and beyond the point at which Hamburg takes its water-supply from the river (c). Butitcannot now be proved that recognised cholera actually prevailed amongst these emigrants from cholera-infected Russian provinces before the date of the first cases in Hamburg city. But there was another source of danger. Havre suffered from cholera before the commencement of the Hamburg outbreak, and vessels from that port were lying in the Elbe not far from the point of the Hamburg water-intake. Some vessels of differing nationality indeed were at that time moored just above the intake. Proof was then adduced to the effect that the outbreak in
ASSOCIATION OF FELLOWS OF THE ROYAL COLLEGE OF SUHGEONS.
51
Hamburg was indeed a water outbreak, and by means of diawas shown that although Hamburg and Altona are THE ASSOCIATION OF FELLOWS OF THE practically one great city, the boundary between the two ROYAL COLLEGE OF SURGEONS OF being no more marked than that between the City of London ENGLAND.
grams it
and the Holborn district, yet a dotted map showed the occurrence of the cholera in the individual houses and streets, and proved conclusively that the boundary line between the two towns formed the line of division between an epidemic diffusion of cholera on one side and the absence of an epidemic on the other. One diagram showed this very effectively. At many points, and especially along the river side, no difference existed between Hamburg and Altona except that of a different water-supply. Hamburg taking the water within its own Elbe precints, distributed it in polluted its original state direct to the city-and its means of pollution bave already been indicated. But whence did Altona get its water? The remarkable fact remains that Altona takes the Elbe water also, and at a point considerably further down the river; and not only so, but it takes it after it has received the sewage of some 800,000 people living in Hamburg and in Altona, and after it had last autumn received the cholera discharges of some 18,000 persons attacked with that disease; and further, the point of intake (B) is at a spot where, according to Professor Koch, the sewage hugs the bank of the stream. But Altona, unlike Hamburg, has a system of filtration, the water being carefully filtered through sand and gravel filters. But it was not sand and gravel filtration that prevented the cholera organisms from being delivered to Altona. On the contrary, whenever by an accident the sand filtration alone was in operation, Altona did, as a matter of fact, a,t once get occurrences of cholera within its boundaries. The comparative safeguard, according to Professor Koch, was supplied by a slimy coating which formed on the surface of the filter beds. This coating consisted of the deposit of river mud, organic matter, débris and micro-organisms. And it was this slimy coating which, whilst admitting of the passage of the water through it, was found capable of holding back most of the vast number of micro-organisms with which the water in its natural state was charged. Some crucial instances in proof of this were afforded accidentally. Thus, when, owing to frost, the layer of slime and mud had frozen and had to be removed, its removal was followed by an outbreak of cholera in Altona. And, as bearing on the question of water pollution, a diagram was exhibited of a court within the Hamburg precincts (A) containing a large aggregation, amounting to 400 in number, of precisely those classes amongst which cholera so much prevailed, but amongst which no single case occurred during the whole epidemic, and this although the spot-map showed that the disease prevailed all around in Hamburg. Owing to certain local difficulties the Hamburg water could not be laid on to this large yard, and permission was obtained to convey water to the inhabitants from the Altona mains. Other instances, of similar proof as to water pollution being the cause of the cholera, had been procured by Professor Koch. It was, however, urged that, even according to Professor Koch himself, the "very best filtration " cannot be relied on to "keep back all micro-organisms,"whether of cholera or other diseases. The lecturer concluded by a reference to river valleys as affording the y of Professor Pettenkofer under circumstances most favourable to cholera recrudescence, and it was claimed for England that although there remain communities which were exposed to risk of cholera should the x be imported and gain access to her polluted rivers and gathering-grounds from which public water-services are derived, yet for fifty years work had steadily been going on which tended every year more and more to remove the y which Professor Pettenkofer held to be essential to cholera. And it was urged that quite apart from the question as to the necessary existence of the y in facilitating the diffusion of the infection, it was the bounden duty of all sanitary authorities to assume, in so far as their administration was concerned, that w alone, which was derived from the alimentary discharges of the sick, should never gain access to their water-services and should never be admitted into drains or sewers unless first destroyed by disinfection or otherwise.
ROYAL COLLEGE
OF
SURGEONS
IN
IRELAND.-
The following have been elected Examiners for the Conjoint Examinations of the College and the Apothecaries’ Hall :— Anatomy : Montgomery A. Ward ; Surgery: Arthur Chance ; Physiology, Histology and Biology : George White ; Pathology : Charles Coppinger ; Ophthalmology : F. Odevaine.
MEETING
01<’
COMMITTEE.
A MEETING of the Committee of the Association of Fellows of the Royal College of Surgeons of England was held on June 21st at 5 r.M. Mr. George Pollock, the president, occupied the chair, and was well supported. The minutes of the last meeting were read and confirmed. Letters of regret at inability to attend were read from Mr. Mayo Robson, Mr. Vincent Bell (Rochester) and Mr. George Jackson (Plymouth). The arrangement of the agenda for the annual meeting of the Association fixed for the following day was the chief subject which occupied the attention of the committee, and after its completion a list of officers for the ensuing year was drawn up for submission to that meeting. A discussion arose concerning the conduct of meetings of Fellows of the College, as illustrated by the proceedings at the meeting of Fellows called last year by the Council ot the College, and held in the theatre of that institution on the day of the annual election. It was unanimously resolved to bring under the attention of the Council of the College the expediency and desirability of framing the proceedings of these meetings in accordance with the rules which usually govern the conduct of meetings of other public bodies. The honorary secretary reported that he had sent out to all the Fellows of the College whose addresses were known the circular letter which had been drawn up by a subcommittee and had been adopted by the committee at the last meeting. He also reported that he had issued to the members of the Association a postcard with the following announcement :
39, Welbeck-street, Cavendish-square, W., June 17th, 1893. DEAR Sm,-The committee of the Association of Fellows of the Royal College of Surgeons of England has invited Mr. Macnamara, Mr. A. T. Norton and Mr. Al-iyo Robson to represent the Association at, the Council election in July next. It is earnestly hoped that you will be
able to record your vote in their favour. Voting papers should be applied for on or before Saturday, June 24th, and returned to the College not later thm Monday. July 3rd, 1893. The annual general meeting of the Association will be held at the Medical Society’s rooms on Thursday, June 22nd, at 5 P.11., Mr. George Pollock, president, in the chair. Yours faithfully, Signed on behalf of the Committee, H. PERCY DUNN, Hon. Sec.
On the completion of the foregoing business, which occupied about an hour and a half, the committee adjourned. ANNUAL GENERAL MEETING. The annual general meeting of the Association of Fellows of the Royal College of Surgeons of England was held at 5 r.M. on Thursday, June 22nd, at the rooms of the Medical Society of London. In the unavoidable absence of Mr. George Pollock, the President, who had been called from town, Mr. William Allingham occupied the chair. Several members of the Association sent letters of regret at inability to attend and a telegram from Mr. Gant was received to a similar effect. In the course of his address the chairman reviewed the proceedings and progress of the Association during the past year, and dwelt especially on the concessions which, at the instance of the committee of the Association, the Council of the College had made to the Fellows, especially in regard to calling the Fellows together separately from the Members for consultative purposes. A meeting of Fellows had been called and held in the theatre of the College after the election on July 7th last year, but that was not a favourable instance of what such meetings should be, as no notice was given to the Fellows of the subjects they were summoned to discuss, and the proceedings were marred by a regrettable incident which was still fresh in the memories of the Fellows and need not be more particularly recalled. It was so far satisfactory in that it was an acknowledgment on the part of the Council of the expediency of calling the Fellows together, but it left much to be desired and accomplished, for there were no agenda, and the only matter submitted to the meeting was the proposal of the Council to celebrate the jubilee of the Fellowship in July 1893. The gratifying success obtained by the Association in the election of Mr. Tweedy, who stood second on the poll, was a clear indication that the Association was making progress in the