the Irish Poor-Law medical officer; as yet his position has not been improved, although additional onerous, responsible, and dangerous duty has been inflicted upon him, viz. the examination of lunatics, the 10th section, Act 30 & 31 Vic., c. 118, distinctly providing that this most disagreeable duty, involving such risk, loss of time, and responsibility, shall be performed without fee or reward."

It is, however, to be hoped, that the valuable services rendered to the State by the indefatigable and intelligent dispensary medical officers of Ireland, will not be much longer overlooked. The justice of granting improved pay to the medical officers is the more evident as another duty, of late expected of him, has been that of sanitary officer, and the strongest evidence of his efficiency is afforded by the remarkable diminution of smallpox, and the comparatively small mortality from cholera, fever, &c.

Up to the present time the medical inspection of the dispensaries and the dispensary districts has been conducted by medical men, and with what excellent results we have seen above. In the present year, however, An Act to extend the Powers of Poor-Law Inspectors and Medical Inspectors in Ireland (31st July, 1868) was passed to enable inspectors not having the qualification of physician or surgeon to assist in carrying out the provisions of the " said Act" as fully and as effectually as if he was a qualified medical practitioner. It seems an unusual proceeding to pass an Act of Parliament conferring the powers of carrying out the duties of a medical inspector upon a gentleman (not possessed of a medical education) as "fully and as effectually as if he was a qualified medical practitioner."

What will our professional brethren say to legislation such as that; those who, of late years, have had to register their qualifications, and pay heavily to a government body for their rights as medical practitioners? The question naturally arises, what are our privileges if those who may never have devoted their thoughts for one moment to the great medical questions, which must come under the notice of every one filling the office of medical inspector, are empowered to hold medical inquiries into the best means of alleviating the severity of, or, in the language of the day, "stamping out" the cholera, typhus, or other disorder; or of holding an inquiry into the treatment of epidemic meningitis, or into the correctness of the line of treatment pursued in any particular case of a surgical, obstetrical, or purely medical nature?

Who will believe that gentlemen acting as medical inspectors, solely by virtue of an Act of Parliament, are now to sit in judgment upon the prescriptions and treatment, in all its varied details, of cases occurring in the practice of the Irish Poor-Law medical service. If the system and machinery of that service had been found wanting in the hour of trial; and if, instead of being looked to as a model

upon which the English Poor-Law authorities have founded certain alterations in their machinery,-that of appointing medical men as inspectors being a part of such alterations, and if, instead of being viewed with confidence by the people of Ireland, and of serving as one great means in alleviating the sufferings of the Irish poor, in distress and in sickness, and of being, under Providence, the great means of almost banishing smallpox, and of materially lessening the fatal effects of cholera and fever, then we should have said the whole system required reform. But when the reverse of all this is the case, we cannot see why that which has worked well for many years should be altered.

We do not hesitate to call public attention to this matter, which appears to have been made law, without having been fully under the attention of either the Parliament or the Government.

The Irish people have judgment to perceive the value of medical science, as seen in their willingness to comply with the requisitions of the Compulsory Vaccination Act; we would assert for them, therefore, the right to continue to have the benefit of all that medical men, both as Poor-Law executive medical officers and as medical inspectors, can afford them, and we should rejoice in being able to claim for the whole of the people of England the same intelligent acquiescence with a law, so replete with good as the Compulsory Vaccination Act, as that afforded by our fellow-subjects in Ireland.

ART. V.-Address on Health, delivered at the Congress of the National Association for the Promotion of Social Science, held at Birmingham, October 1868. By HENRY W. RUMSEY, M.D., President of the Health Department of the Association.

No one can refuse to Dr. Rumsey the credit of earnestness-some would go to the extent of calling him an enthusiast—whatever the opinion that might be formed of his schemes for sanitary and sanatory administrative reform. These may be practicable or they may be Utopian. However it may be, there is this to be said, that each of us who has lived to middle age has lived to see a wondrous revolution both in public sentiment and in parliamentary efficiency in regard to questions of health and education, which, if not formerly wholly disregarded, were thrown into the shade by matters of political interest of quite a different nature. We are not among those who would put down enthusiasm as a feeling destructive of all calm judgment, with the well known injunction of the great diplomatist, "Surtout, mon ami, point de zèle." On the contrary, it is from among the men who have exhibited this feeling most obviously, that we can pick out those who have been the originators of some

of the most valuable institutions, political, social, or religious, which we possess. Dr. Rumsey's book on 'State Medicine' has been now some years in the hands of the public, and the practical verdict passed upon it has been that his views upon sanitary reform are in advance of the times. That is all. Public opinion and our legislators are not yet educated up to his mark, in addition to which radical reforms are not in accordance with the genius of the nation. The utmost that we can look for is to see our public arrangements modified piecemeal, without any particular thought being given to the fitting of one bit of legislation into another. The truth is, our sanitary legislative efforts have been a muddle of compromises, and a muddle we fear they will continue to be. Le peuple le veut. But it is no less an advantage to have in our possession a well thought out plan of sanitary organisation such as Dr. Rumsey has given us in his book, which we may place before our eyes as a pattern or model towards conformity with which we might do worse than strive. We are not quite sure that we cannot trace out in the present address some conviction of this kind as settling in the mind of the author himself. The Royal Commission, to the inquiries and labours of which Dr. Rumsey looks with hopefulness, may help forward the task of reducing to something like order our present confused mass of sanitary enactments; but above and beyond this is a House of Commons which, however politically constituted, will inevitably be steeped to the eyes in the social traditions of the country they represent. A Royal Commission may prove to demonstration what ought to be done to put our sanitary code into proper working order, but we cannot be sanguine that their most logical inferences will be put to a practical use when we call to mind the discussion on the Foreign Cattle Market Bill of last session, and the result which followed.

Now just let us look back and look around us for a minute. Are we not in a muddle, and in a somewhat disgraceful muddle, for a practical nation like ours? What do we see? First, in the words of Dr. Rumsey, "The main difficulty which meets the sanitary reformer is the existence of so many different kinds of local authority, in all manner of districts, for the execution of a variety of measures, which, if distinct from each other, are nevertheless cognate, and often strictly correlative." In one place it is the town council, in another the board of guardians, in a third it is improvement commissioners, in a fourth a vestry or board of works: and the worst of all is that one part of the sanitary work of a district is often entrusted to one authority, and another part of it to a different authority; so that no harmony can exist between them, and often the one authority utterly confounds the work attempted by the other. Secondly, the attempt to engraft new cloth upon an old garment, has terminated in its proverbial result: for whereas the common law provides a

remedy of some sort for every evil under the sun, people have learned to neglect this, and look for their remedy under various Acts of Parliament at the hand of petty corporations composed of individuals who have a rooted repugnance to the task imposed upon them, who are often too ignorant to understand its importance, too stupid to learn it, and too much interested in the continuance of the present state of things, to take any trouble to alter it. Thirdly, we are suffering from the timidity of our legislators, who enact what have been termed " permissive" statutes when a bolder course was the only one likely to come to good. With all due respect to them, we must be allowed to say that, where grand social or sanitary reforms are needed, the passing of a permissive bill is nothing short of repudiation of the proper business of Parliament, and the shifting upon the local authority of the functions of the legislature. Who could ever expect a board, composed as most local boards are, for instance, to "adopt" -that is the word—the Adulteration of Food Act, or the Act for the Regulation of Workshops, or that men who never had the handling of five hundred pounds of their own would put in force such Acts as the Sanitary Act, or the Artisan's and Labourer's Dwelling Act of the last session? Of course, they don't see the use or necessity for them. Many of the persons who sit on such boards would be the first to suffer in their pockets were they to do so, and thus a fellow-feeling makes them wondrous cautious, lest they should interfere with private rights, although exercised to the endangerment and loss of of the community at large. Such sanitary legislation as this is nothing more substantial than moonshine. If we are to have local sanitary authorities-and we do not see how we are to do without them the limits of the local jurisdictions should themselves be extended. Dr. Rumsey suggests "county" authority as a form of local authority in unison with our old traditions, and at the same time one which, by judicious improvement and reinforcement, might be readily adapted to our needs. Dr. Rumsey has not much faith in compulsory legislation, nor have we, so long as we continue to have it addressed to an ignorant executive whose ruling idea is the saving of the rates. The reform which we think chiefly needed, is in the constitution of the local authority in the first place; and, if we are to have in sanitary operations petty district corporations at all, they should form merely executive bodies to carry out to the satisfaction of the justices, or of the grand jury, public works which the local authority may decide to be necessary. In the execution of penal statutes, such as the Nuisances Removal Act, responsible paid officers, reporting to, and acting spontaneously under the sanction of the local authority, would be far more efficient than the three or four gentlemen who solemnly assemble at long intervals to determine whether an open foul drain is such a nuisance as to call for their interference for its immediate removal by process of law, or whether

a dozen people shall be permitted to breed fever in a house by herding together in a room only fit to accommodate a third of the number.

It has been said of sermons that they ought to contain some grand central idea around which the observations of the preacher should revolve; and towards which they should all converge. And we say the same of addresses such as that before us. At any rate, we habitually look for such a central idea. If we have not "reviewed" Dr. Rumsey's address in the ordinary signification of that word, we have done something better, for we have, if we mistake not, picked out his central idea, in the light of which his entire discourse ought to be studied. There is a great deal in it which, if not new, is so true, that it cannot be repeated too often, or enforced too urgently. Dr. Rumsey has not spoken inconsiderately. No one knows better than he, what he is talking about, so that his address not only deserves to be read, but will be read. We have rarely perused a more comprehensive address.

ART. VI.-On Asthma: its Pathology and Treatment. By H. HYDE SALTER, M.D., F.R.S. Second Edition, 1868. Pp. 464. ACCORDING to a well-established custom in the history of books, this second edition considerably exceeds its predecessor in bulk. Custom moreover requires not only additional matter, but also a declaration on the part of the author of the work, of the alterations, emendations and additions made; a requirement that must at least receive the commendation of reviewers who are called upon to reveal such particulars to their readers. Dutifully acquiescing in this practice, Dr. Salter tells us, in the preface to the second edition of his much valued work, that he has made few alterations in the views previously expressed by him in the first edition, and that the additions relate to therapeutics and largely consist in records of cases.

At this present period of medical literature, we may safely aver that additions of this character will be particularly appreciated by those actively engaged in the practice of their profession, who are frequently disappointed, when seeking for practical suggestions to aid them in the treatment of difficult and embarassing cases, to find, after reading most able and subtle disquisitions on pathology and morbid anatomy in modern medical treatises consulted, the therapeutics of disease dismissed in a few lines of unprofitable generalities. Those who are brought into contact with medical men who are not speculative thinkers only, but active practitioners, can confirm the existence of this prevailing complaint of the little value of most modern treatises on medicine as guides to treatment. How to detect disease is a thoroughly well-worked problem; but