officials. The result may easily be imagined. A dissection is now ordered with a certain amount of difficulty and increased caution; and what is, in my opinion, more detrimental to the profession and to the public interest, in order apparently to lessen the amount of the increased expense of the augmented fee to the country, the dissection is now, for the first time, generally intrusted to a single medical man. Now, with all my experience, extending over a long series of years, I must protest against this copying of the reprehensible practice which too often obtains in England, viz., that in important medico-legal investigations respecting serious and mortal crimes, the testimony of only one medical witness is produced on the trial. Not only is such a course fitted to imperil the prosecution of crime, but it also adds greatly to the difficulties of the prisoner. Is it fair, is it proper, that a prisoner's life should depend on the unsupported evidence of a single professional witness, however eminent that witness may be? If the law of commonsense demands that all important facts in the preliminary investigation of crime should be spoken to by two witnesses, it is certainly equally important that those facts connected with the post-mortem examination should be satisfactorily proved by the evidence of two trustworthy medical men. I certainly shrink from the sole conduct of these delicate and important investigations; and I have to reiterate, which I have often stated, that the most experienced expert has the greatest personal satisfaction and comfort when associated with another medical man, who, although possibly comparatively inexperienced, fulfils the important function of corroborating his testimony and of speaking conclusively to the existence of possibly crucial injuries, which may prove the guilt of the prisoner at the bar, or else free him from a capital charge.

It is the duty of the profession-certainly it is, in my opinion, of this Society-respectfully to remonstrate with the action of the criminal authorities in this matter, and to urge upon them the necessity of employing two medical men in the investigation of all important crimes involving the life or honour of a fellow-citizen.

I now turn shortly to the discussion of one or two topics connected with Public Health.

In the first place, I hold it to be one of the principal duties of the health-officer to furnish to the public, through the medium of the press, a weekly statement of the health of the community to which he is attached. It is a matter of never-ending surprise to me that the great metropolis and other centres of population should not be provided with such a statement. Somewhere about Wednesday in the week a statement is furnished; but this is generally limited to a simple notice of the rate of mortality. This conveys little or no information that can interest the public or the profession; and I have always held that it is desirable that more facts should be supplied. For more than twenty years the citizens

of Edinburgh have been furnished on Monday mornings not merely with the total mortality of the preceding week, and the calculated death-rate, but also with the respective mortalities of the chief divisions of the city, the inhabitants being thus supplied with important information as to the health of the districts in which they live. Why cannot similar information be afforded to the citizens of London and other centres of population? What use can it be to the inhabitants of any of the districts of London to be informed on Wednesday of the total death-rate of a population consisting of four millions? The post-office authorities, in order to facilitate the mere delivery of letters, has subdivided London into numerous districts. Why cannot the RegistrarGeneral for sanitary or statistical purposes not make a less elaborate division, and every Monday morning let the inhabitants of important districts, such as, e.g., Kensington, know the deathrate of the surrounding population? It is a trite remark, that stale information is uninteresting and comparatively valueless; and it is not to be wondered at that citizens, when treated to statistics in many cases a fortnight old, give little heed to them, and are thus led to regard with indifference questions relating to public health. What can be of more importance to a citizen than the sanitary state of his surroundings? These directly influence the death-rate and the causes of death, a statement of which, therefore, will certainly be regarded by the householder with, at any rate, equal interest to a statement of the weekly variations of stocks. It certainly may be urged on the score of economy, that notwithstanding his army of clerks, it is less the duty of the Registrar-General to furnish this information than the various local health-officers. Were each of these officials to undertake the duty as it is done in Edinburgh, it could easily be accomplished by such division of labour with this attendant good, that the health-officer, in tabulating weekly the causes and the localities of death, gets a grip, so to speak, of his special duties, and observes for himself, and not at second-hand, what areas more especially demand his inspection. But what is the actual state of matters in the metropolis? Elaborate information is annually afforded by each health-officer in a voluminous report which, like similar documents, is too generally regarded as waste paper, and treated accordingly. Lastly, one great advantage of the plan followed in this northern metropolis of distributing the mortalitythe causes of death, the ages at death, and specially the zymotic mortality-is, that each citizen is thus enabled to observe for himself the state of prevailing diseases, and to obtain information, should he desire it, as to the steps taken by the authorities to meet any special emergency.

Since November 1879, in addition to the weekly statement of the mortality of the city, the amount of cases of the more important forms of infectious disease have also been tabulated; and

for this we are indebted primarily to the courtesy of the profession, and, secondly, to the enlightened liberality of our Town Council. The following statistics will, I have no doubt, interest my audience. Since November 1879 the total number of intimations of cases of infectious disease sent in by the medical practitioners of Edinburgh and the surrounding districts, up to the present date, amounts to 29,000; and the sum disbursed by the Town Council to the profession for this valuable information amounts to nearly £4000.

In no city in the world has the system of notification had a fairer trial or been more successful. The first result of the system was to open the eyes of the citizens and the profession to the enormous amount of preventible disease that lay simmering in our midst, the existence of which was only too tardily and partially revealed by the mortality returns; and, second, to convince our Town Council of the utter insufficiency of the accommodation provided in Edinburgh for the isolation and treatment of infectious disease. This led to instant action on the part of the authorities; and at an expense of fully £30,000, Edinburgh is now provided with a satisfactory infectious hospital, which will be available as an important adjunct to our Medical School, by affording our students and young practitioners an opportunity of studying, under favourable circumstances, those important diseases,-the treatment of which constitutes, as we all know, such a large part of ordinary medical practice.

Again, it cannot be doubted that this weekly statement of the number of cases of infectious diseases in the three leading divisions of our city must be of interest and value to the medical practitioner. His attention is thus pointedly directed to the leading forms of zymotic disease in our midst and their relative prevalence; and he is thus enabled, in many cases, to make a more rapid and trustworthy diagnosis.

But other and equally important advantages have attended the introduction of the notification of these diseases. In intimating them, as I have been repeatedly informed by my medical brethren, the profession as a body has been reminded of its duty to society in preventing, as far as possible, the spread of the disease by suitable isolation, and by taking every step that science has suggested for removing those conditions that favour its propagation. It is gratifying to observe that year by year the number of calls made on the municipal authorities to convey cases to hospital has increased; and it is to be hoped that, with the ample accommodation now afforded, every suitable case will be isolated in our hospital wards. Equally gratifying results have attended the notification in the marked attention now paid by the profession to the sanitary conditions in which the patients live. I have again and again been told that the mere filling up of the intimation card has led the practitioner to reflect on the surroundings of

his patient, and to call on the authorities to remedy sanitary defects which otherwise might, in the hurry of practice, be overlooked and never remedied, until such a mortality, or such amount of illness, was caused that they imperatively called for summary remedy.

This system of notification has been attended with such marked success, mainly by the cordial assistance afforded by my professional brethren; and also, it must be allowed, in consequence of the recognition, inadequate though it may appear, by the municipality of the value of their services. It was my duty, as the medical adviser of the corporation, to insist upon some recognition, and I am bound to state that my representations were at once given effect to; and so important has the system of notification appeared to the municipality, and so necessary for the maintenance of the reputation of our city as one of the healthiest in the country, that the medical grant has always been most cheerfully paid by the ratepayers, and no grumble has ever been made, even in these, for all classes of society, economizing and unpropitious times. This is a sufficient answer to those of our English and Scotch brethren who, failing to recognise the importance of early intimation of infectious disease, and refusing to avail themselves of our northern experience, obstinately shut their eyes to the advantages of this important measure. All the evils that were prophesied by gentlemen, regarded as leading authorities in sanitary science, when the system was boldly inaugurated in Edinburgh, have by our experience been proved to be groundless; and my presence in the distinguished position of your President and the influential audience I have the honour to address, conclusively prove that intimation of infectious disease is no sham, but an accomplished fact; and that it can be carried out in a large city and in the midst of a powerful Medical School, without the slightest infringement of medical etiquette, and in such a manner as to secure the co-operation of every member of our profession.

Without some such measure it is utterly impossible, in my opinion, to cope successfully with infectious disease. Were notification generally adopted, the country would have been saved the danger and the scandal of a chronic epidemic of smallpox in London, and of this and other diseases in other large towns. But the important lesson we have learnt in Edinburgh must not be forgotten, viz., that along with a system of notification there must be ample means for suitable isolation. Unless these be combined, little effect will be exercised on the spread of these diseases; and the whole history of the present discussion as to vaccination and smallpox goes to show that, in order to stamp out that disease, notification and revaccination are required, and, in addition, the speedy isolation of every suitable case in a well-appointed hospital. The mention of this loathsome disease reminds me that our ex

perience in Edinburgh of the benefits attending suitable isolation has been strangely overlooked in the interminable discussions, in the southern medical journals, as to the danger incident to smallpox hospitals. Here in 1871 we were visited with a severe outbreak of smallpox, and advantage was taken by the municipal authorities of Watson's Hospital - the well-known educational institution which occupied the site of our present Royal Infirmary -and in the course of a few days upwards of 300 cases were under treatment. The circumstances were interesting in a sanitary point of view. The building had to be improvised as a hospital; and owing to the operations of reconstruction having been begun, the enclosing walls and railings were imperfect, and permitted of free access to the building on all sides. The inhabitants in the immediate neighbourhood were naturally alarmed. Another large school-Heriot's Hospital-was separated only by a thoroughfare from this smallpox hospital; and almost as near we had George Square, inhabited by highly respectable citizens; and, as I have mentioned, a busy thoroughfare formed the northern boundary, while to the south there was a favourite walking resort of the inhabitants. A more crucial test to determine the distance to which the germs of smallpox could be carried through the atmosphere can hardly be imagined; and yet in not a single case was the disease propagated from the hospital to the neighbouring houses. Not a whisper of a suspicion was ever heard that this hospital acted as a centre of infection to any portion of the citizens. Its neighbourhood enjoyed an unusual immunity from the disease; and as the ratepayers were on the alert, and Edinburgh has an active local press, in which the citizens find ample space to ventilate any grievance, I am sure you will agree with me that had any case been traceable to proximity to the hospital, the public and the authorities would have quickly heard of it. This remarkable immunity was dwelt on by the late Sir R. Christison at the last meeting of the Social Science Congress at Edinburgh. It was effected by a very simple arrangement. The hospital was regarded as an infected and highly dangerous place, and was, therefore, subjected to a rigorous but easily arranged system of quarantine. The assistance of the police was obtained, and a special set of officers-both in uniform and as detectiveswas told off to watch the building by night and by day. Our daily experience showed us how easily, under ordinary precautions, smallpox hospitals become centres of infection to the neighbourhoods in which they are placed. The anxiety of convalescents to communicate with the outside world, the determination of relatives and friends to maintain correspondence with patients and nurses are such, that special means of prevention must be employed. This, as our experience showed, can only be satisfactorily accomplished with the assistance of the police. An argument, were one required, to show the importance of amicable relations subsisting

EDINBURGH MED. JOURN., VOL. XXXI.—NO. VII.

4 н