784 THE LOCAL GOVERNMENT BOARD AND THE COLLEGE OF PHYSICIANS. - |of a vessel which entered the dock at Sutton Bridge, was onhis way to Plymouth on the 26th when he was suddenlyseized with symptoms very characteristic of cholera. The

vessel came from near Archangel, Russia, and had onlytouched at Bergen, whence no cholera has been reported.Hence the case must for:the moment remain undetermined.

But, excluding this case, it is satisfactory to note thatduring the month in which cholera has been making its wayinto our ports twenty-six cases have reached us, and in no

instance has the disease spread beyond the actual individualsarriving from abroad. Precisely the same remark applies totwo cases at Glasgow and two cases at Grangemouth in theFirth of Forth.

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Annotations.

THE LOCAL GOVERNMENT BOARD AND THEROYAL COLLEGE OF PHYSICIANS.

"Ne quid nimis."

THERE can be no doubt that the correspondence betweenSir Hugh Owen, the Secretary of the Local Government

Board, and the President of the Royal College of Phy-sicians has led to some misapprehension as to the scope ofthe instructions asked from the latter body. In Sir HughOwen’s letter it is stated without limitation that the local

sanitary authorities are required to "provide and to dispensewithout charge medicines and medical appliances forthe sick," but a correspondent points out in anothercolumn that Section 133 of the Public Health Act em-

powers the local authority to provide, or to contract

with any person to provide, a temporary supply of medicineand medical assistance for the poorer inhabitants of thedistrict. If this limit had been appreciated by the RoyalCollege of Physicians that body would hardly have takenupon itself to publish general instructions for the manage-ment of health in view of the prevalence of diarrhoea

and of cholera, and appear to supersede the medicaladvisers of the Local Government Board, on whom reststhe duty of framing and carrying out the regulationswhich are deemed necessary for the prevention of thesediseases. The medicines best adapted to the immediatemedical treatment of patients suffering from the diseasewould have then been the only consideration for the

Fellows of the College. The College wisely declines to

give instructions for the treatment of cholera. "Every caseof this disease requires separate consideration and manage-ment ; no stereotyped plan of treatment would prove to beeither wise or safe, and usually before the choleraic natureof an attack could be established medical assistance wouldhave been procured." But the details concerning the

management of looseness of the bowels go much beyond theformer recommendation of ten grains of aromatic powder ofchalk and opium or five minims of laudanum. It is scarcelyhypercritical, we think, to remark that the treatment in itsentirety would be somewhat difficult to carry out in thehouses or rooms of the "poorer inhabitants," and wouldnecessitate skilled nursing and medical attendance.

STREET DUST, WOOD PAVEMENTS AND CHOLERA.A SERIOUS accusation has been brought against one of the

most popular of many conveniences enjoyed by the moderntownsman. The sanitary condition of wood pavement hasbeen called in question, and that with special reference toits influence as a possible nidus for the cholera germ.Placed as we are in the near neighbourhood of ports infected

by that disease, we would be the last to discourage anyrational sanitary precaution, however trivial it might appearto be. We fully recognise the importance of maintaining atall times as perfect cleanliness as possible on the street aswell as in the household ; at the same time, we cannot ignorethe strenuous and successful efforts put forth in this direc-tion by local vestries and municipal councils, neither can weregard as inevitable the suggested connexion between the dustof wooden or other pavements and the spread of cholera. Nosuch connexion has hitherto been proved in respect of otherepidemic diseases which from time to time have prevailed inour cities. Furthermore, we must remember that the develop.ment of a given infectious malady requires the initial contactof its particular virus or germ. Now it is, on the whole, ahappy circumstance that most of this morbific matter findsits way underground by way of the domestic drain pipe. In.fection of street refuse is by no means impossible, but this, inby far its greater proportion, consists only of mud, manureand particles of old wood. Doubtless its purification is alwaysdesirable. It is also comparatively feasible if, as often

happens, the streets be freely washed with disinfectant fluids.We would advise the vigilant observance of every suchmethod. We confess, however, that in so doing we are in.stigated less by the dread of a special contagion than by aregard for the permanent advantages of general cleanliness.

SEA-SICKNESS.

MOST of those who have experienced the miseries of sea-sickness, however they might differ in minor details of state-ment, would agree in ascribing this most dispiriting maladyto one main cause-the motion of the ship. In so far thewhole medical faculty would concur in their decision. This,then, is the central fact which confers upon the disorder itsunique position. It is really not a pathological but a

physiological disturbance. It has no natural connexion with

dyspepsia. The robust and healthy, by a strange contradiction,suffer from it for the time hardly less than the weak and ill.Its variations of intensity are felt to be counterparts of merebodily oscillation. Some find relief from it in change of

posture, others in active occupation, all more or less

when their storm-tossed vessel sails under the lee ofland. Custom and use commonly secure immunity. Theseare circumstances which one and all point to mechanicalcausation as the source of the discomfort. It is the un-

accustomed rise and fall, the jerk and relaxation of looselyattached abdominal viscera, mainly, perhaps, but not alone,of the stomach, acting upon the central nervous connexions,which must bear the brunt of accusation. It follows that

successful treatment cannot be guaranteed by any one methodor panacea. Recumbency, pure deck air, moderately firmbandaging of the body are all useful. Drugs have their placeand their partial utility ; but, as we have already suggested,there is no remedy equal to a lee shore. Nothing can bemuch more depressing than sea-sickness, and for this reasonwe should strongly advise all weak persons not to encounter,if possible, the risk of its occurrence. It is astonishing howsoon and how completely those who are favoured with a fairmeasure of constitutional elasticity recover from its depres-sion. In their case the benefits of a sea trip may thus, withcompensations of air, diet, and appetite, be even enhanced bya few hours of mechanical nausea. It is, in truth, for suchpersons only that tours of this kind are advisable.

THE WINTER SESSION, 1892-93.THE winter session of the medical schools throughout

England was inaugurated by the opening of Mason College,Birmingham, on the 30th ult., with an address by Sir GeorgeM. Humphry. To-day (Oct. 1st) Dr. Bowles addresses thestudents at St. George’s Hospital, the same date witnessingthe opening of King’s College and the University of Durham.