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these grievances are different manifestations of the onefundamental cause, the evolution of economic forces. They<can only be met by action of a politico-economiccharacter based on elevated ethical principles. The waterhas overflowed the river-wall. To deal with one grievance,to raise the embankment at one particular spot, will not..prevent the flood; the embankment must be strengthenedfrom one end to the other. Oonsequently the organisa-tion to be formed must be prepared to deal withevery phase of the economic problem at issue. Such an"organisation must be composed of men who are capable of,and who have the knowledge necessary for, accomplishingthe task. For this it is necessary to organise a wide-spread system of education and it will take a long time toaccomplish this work. But man in his weakness and

impotence longs for a short cut so as to end more rapidlyhis wearisome journey towards better destinies. Hence-the tendency to gamble rather than to toil for the slowaccumulation of fortune.

The practical question which has now to be examined iswhether the proposed alteration of the constitution of the’British Medical Association is a genuine step forward in thework of organising the profession for the defence of itseconomic interests, or whether it is but one of thosedeceptive short cuts which, instead of leading sooner tothe end, only result in disappointments. This is a question"that cannot be readily answered, because the result will

depend so much, not on the method of organisation, but on-the action of individuals. As for the method of organisa-- tion it presents obvious dangers. Will the energy and

’’

perspicacity of those most concerned suffice to overcomethese dangers? No one can tell, for men totally unknown’to-day may spring out of the ranks and lead with such skillthat every obstacle will fall before them. The policy maybe described as that of permeation and this is a double-edged-weapon, for those who embark on such a mission never know-whether they are going to permeate or whether they are goingto be permeated. There are in England from 40 to 50societies of medical men that are, comparatively speaking,ripe for the economic struggle, that do possess some

knowledge of the economic problems at issue, thatTiave very similar programmes, and that have an approxi-pnately clear conception of what should be done. Thisis a small beginning. These societies are young and

they manifest some of the weaknesses described aboveand represent but an infinitesimal minority of the pro-fession. But their influence is much greater thantheir numbers imply, for they alone are at least partiallyconscious of their class interests and they alone are tosome extent disciplined. Will this small amount of leavensuffice to raise the whole profession, or will the apathy, the’indifference, the ignorance of the great mass destroy thesegerms of progress ? Had they kept apart, working only withthose who were at one with them, they would not in anycase be crushed, but their progress would be very slow. Theexistence by their side of so great an organisation as that of- the British Medical Association is undoubtedly a very strongtemptation. There are the men, thousands and thousandsof them, there is the social influence, there is the money ;if they would only all fall in and march as one man, howeasily, how quickly, would the end be attained. This lookslike a short cut, a very tempting path to follow. But willit be possible to move this great and comparatively inertmass ? That is the problem.

Efforts are to be made to infuse new vitality into the’branches of the British Medical Association, to render thegeneral meetings more representative, and, above all, toinstitute a system of delegateship which shall be a real,parliament of the profession, the decisions of which shall bebinding on the executive of the association. But the morethe profession is fully and adequately represented the,more incoherent and contradictory will such representationbecome. Nothing could be more misleading than to imaginethat the profession, as a whole, understands its economic

position or possesses any distinct conception of what it needsand how this desideratum is to be obtained. Such knowledgeexists, and this only to a limited extent, among the membersof those few medical unions and guilds formed during thelast six or seven years to deal exclusively with economic andethical questions. It would be a grave mistake to sink suchorganisations, to allow them to be swallowed up by a largerbody that is not so well versed in the points at issue. Thatthese really militant and more competent bodies should berepresented at the meetings of the larger organisation so as

to strive to stimulate the more numerous but more inert

body is all well and good. Such propaganda will doubtlessbear fruit. But the truly militant, class conscious membersof the profession who are organised to deal with theeconomic problem, however few they may be and how-ever weak they may seem, must ever be ready to standapart, faithfully adhering to the whole of their pro.gramme. Common-sense indicates the wisdom of joiningwith others so as to realise portions of their programme,but they should never allow themselves to be merged in abigger body which has not yet accepted the whole of theirprogramme. If these small but truly conscious bodies canplay the part of the tail that wags the dog nothing bettercan be desired, but they must be prepared to standindependently on their own ground when they find that thedog attempts to wag them.The question after all is extremely simple. There are

economic forces developing that seriously menace theposition and good name of the medical profession. A fewmedical men who may be qualified as pioneers have notonly studied these economic problems but have formedorganisations and have practically dealt with some of thedifficulties. These pioneers have acquired a technique,the technique of economics as they affect the medicalprofession. They are qualified medical economists ; theirmode of procedure must not be swept away by a

majority composed of unqualified voters. That the ignorantshould be persuaded, that they should be taught, and thatevery opportunity should be given them to acquire know-ledge, is most desirable, but that they should govern bytheir votes while they still ignore the points at issue,that cannot be admitted. Every effort must be made todispel this ignorance, but while it still exists those organisa-tions that are better informed must persevere in their mission,must maintain their independent existence. They are thevanguard of the army, they must keep well to the fore. Thefact that they are not numerous is an insufficient excuse tojustify them in occasionally falling back on the main bodyof the army. This may be done temporarily to attack inforce some one particular point, but, this point carried,the vanguard must again separate itself from the main bodyand forge ahead.

GERMAN CONGRESS OF INTERNALMEDICINE.

(FROM OUR BERLIN CORRESPONDENT.)(Concluded from p. 1367.)

Acute Myelitis.PROFESSOR VON LEYDEN (Berlin) read a paper on this

disease, discussing it from the clinical point of view. Hesaid that there were four forms of the disease: transversemyelitis, disseminated myelitis, poliomyelitis, and com-

pression myelitis. Inflammation, softening, and haemorrhageof the spinal cord were the principal anatomical lesions ofmyelitis. With respect to the etiology it was very probablethat the disease was caused by infection ; the majority of thecases were, in fact, subsequent to infective diseases, such asinfluenza, enteric fever, rheumatic sore-throat, phlegmon, &c.He had observed cases of myelitis following gonorrhoea,tuberculosis, and syphilis. Apart from infection myelitismight be caused by various injuries. The clinicalsymptoms differed according to the localisation ; therewas a dorsal, a cervical, and a bulbar form. The diseasemight develop either suddenly or gradually and by intervals.Myelitis might advance to the bulb and so constitute animmediate danger to the patient’s life, or it might spread ina transverse direction. Neuro-paralytic symptoms, such asparesis of the bladder and rectum, bedsore, &c., appearedsomewhat early and made the prognosis unfavourable. Thedisease, as a rule, terminated fatally, but in some cases

recovery had been observed. Sometimes the disease becamechronic. Good nursing of the patients was especiallynecessary.

Professor REDLICH (Vienna) discussed the pathologicalanatomy of myelitis. He said that the late ProfessorCharcot was of opinion that in poliomyelitis the ganglia alonewere affected ; this, however, was the fact only in slightcases. In the great majority of cases not only the gangliabut also the other parts of the spinal cord were involved. Indisseminated myelitis of the young there was an infiltration

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of the grey substance. In other cases the disease wascharacterised by a degeneration and necrosis of the nervoussubstance. Meningitis was not unfrequently combined withmyelitis. With respect to the etiology he said thatbacteria had been detected in but few cases. They werespread by the vessels, the subarachnoidal and the centralcanal. The essential cause seemed to be the action of toxins.The etiology was not yet by any means clear and must bestudied farther by the aid of puncture of the lumbararachnoid.

Professor voN STRTMPELL (Erlangen) pointed out thatmyelitis might be caused by bacteria as well as by toxins.In two cases in which lumbar puncture was made staphylo-coocus albns was found in one, but in the other the fluid wassterile.

Dr. SCHULTZE (Bonn) said that a new growth of the

.spine sometimes gave rise to the same symptoms as myelitis.Professor voN KAHLDEN (Freiburg) said that a degenera-

tive lesion of the parenchyma was the primary, and

degeneration of the vessels the secondary, lesion. In polio-myelitis the ganglia were first affected.

Dr. RITTER (Berlin) reported six cases of myelitis inchildren. He concluded from his investigations that theywere caused by ptomaines.

Epidemic Cerebro-Spinal Meningitis.Dr. J&Auml;GER (Konigsberg) said that this disease did not by

any means always appear in the epidemic form, but thatisolated cases might occur throughout the whole year, as hadbeen found by bacteriological examination. In all suspected- cases even when the disease was not prevalent thearachnoidal fluid should be examined bacteriologically.The statistics of the disease were still insufficient. Theenormous spread of cerebro-spinal meningitis in denselycrowded districts in America, as, for instance, in New York,Massachusetts, &c., was very striking and the disease wasvery probably imported from there directly to Hamburg orindirectly through Copenhagen where epidemics are veryfrequent also.

Alterations of the Blood in Rabies.Professor COURMONT (Lyons) read a paper on the poly-

nuclear neutrophite leucocytosis which, according to hisresearches, is characteristic of this disease. He has foundthat one of the first symptoms of rabies was an enormousincrease of the leucocytes. In the lungs of animals often85 per cent. of polynuclear leucocytes were present. Hesaid that the significance of this symptom could not be over-estimated, for there was no rabies without polynuclearleucocytosis. This observation was of great importance inrelation to early diagnosis.

Serum Diagnosis of Tuberculosis.Professor COURMONT also gave an account of a method

used by Dr. Arloing and himself for the purpose of ascertain-ing the presence of tuberculosis by bacteriological examina-tion of the blood. According to Dr. Arloing tubercle bacillicaused the serum of the blood of tuberculous persons tobecome cloudy. This application of serum diagnosis wasvery much used in the country of its originators, but had notproved trustworthy in Germany. Dr. Courmont said thatonly tubercle bacilli of great virulence gave this reaction.When the virulence of a culture was verified day by day themethod never failed, as was shown by a long series ofexperiments made on animals in Lyons.

Mortality of Pneumonia.Dr. HAMPELU (Riga) read some statistics of the mor-

tality of pneumonia. He had found that the mortality,differed considerably according as the patients were treatedat home or in a hospital, being much greater among thehospital patients. He was of opinion that the higher death-rate was due to the effects of the journeying from thepatient’s home to the hospital, a danger which ought to bemet by the employment of properly constructed ambulances.

Dr. GEORGE MEYER (Berlin) pointed out that as far as thegreater towns of Germany were concerned the arrangementsfor the conveyance of patients were, as a rule, satisfactory.Other papers read before the Congress dealt with the

following subjects : the Skiagraphy of the Heart, by Dr.MORITZ (Munich) and Dr. LEVY-DoRN (Berlin) ; PulmonarySyphilis (preparations shown), by Professor voN HANSEMANN(Berlin); * Febris Hepatica, by Dr. M&Uuml;NZER (Prague) ;the Synthesis of Uric Acid in the Animal Organism,by Dr. WIENER (Prague), &c. Professor Naunyn (Strass-hurg) was elected President of the next congress which willbe held at Wiesbaden.

MANCHESTER.

(FROM OUR OWN CORRESPONDENT.)

Heaton Park.IT seems not unlikely that the Corporation of Manchester

will repeat the fiasco they succeeded in accomplishing overthe Trafford Park Estate. As may be remembered, thisvaluable property was snapped up by a wide-awake syndicatewhile the corporation was soliloquising "to be or not to be."It may be eminently respectable for civic authorities not tobe wide-awake, but it is unfortunate when the multitudesuffers for it. Manchester is growing rapidly, extendingamoeba-like, and absorbing every green spot she touches.Her weakly, stunted, pallid population of workers livesunder conditions not favourable to healthy development.It is therefore desirable that the open spaces within reachof the city should not be covered with bricks and mortar,for even if there are many who will not directly visit themthey will be benefited by the healthful breezes which sweepover such tracts of land as Heaton Park and carry freshen-ing influences into the streets and lanes of the city. This

park, of 650 acres, together with the hall and other build-ings, has been offered to the corporation for .6230,000. Thesub-committee having the matter in hand was prepared torecommend the corporation "to pay .B190,OOO for the park,with its buildings, walls, and minerals, and such fixtures andfittings as might be agreed on." This has been declined,Lord Wilton and his advisers considering that the priceasked was a low one. The sub-committee thought that.6190,000 was a full price. The week before last the ParksCommittee had the matter again under consideration, whentwo propositions were submitted and rejected. The firstwas that .6210,000 should be offered, and the other that theamount should be .6200.000. The council at its monthlymeeting to-morrow, June 5th, is to consider the questionagain. A decision must be arrived at by June 12th, as LordWilton’s offer is only open till then. This is the last

opportunity of acquiring a large open space in the imme-diate neighbourhood of Manchester. All have gone butHeaton Park, and if this goes it will be a matter for never-ending regret.

Proposed Small-pox Hospital for Warrington.An inquiry was held at Warrington on June lst by Dr.

Manby, Local Government Board inspector, into the appli-cation of the Warrington Corporation for sanction to borrow.69979 for the provision of a small-pox hospital at GreatSankey, and E8702 for the extension of the borough infec-tious diseases hospital. The Mayor in his evidence referredto the serious lack of accommodation during the small-poxepidemic of 1892-93, which " carried away many valuablelives, laid large numbers of families under serious financialobligations, and cost the borough over &pound;10;000." Theinfectious hospital was occupied with fever cases,and an old foundry had to be fitted up as a tem-

porary hospital. Since that time sites have beenvisited, and one was decided on, but for various reasons hadto be abandoned. A provisional agreement has been made topurchase 1121 acres at Great Sankey for &pound;1750. The residents,of course, as all residents do, object to the scheme, mainly,it is said, on the ground that the site is unsuitable, but alsobecause of the danger of infection " from the hospital sewageeffluent and the foul air which would be given off by thehospital when in use." In answer to the inspector the

opponents of the scheme said they had no alternative tosuggest. With our semi-compulsory, semi-voluntary dealingas to vaccination a small-pox hospital should be providednot only for Warrington but for many other places.

Proposed Cooperative Convalescent Home.It speaks well for the intelligence of the northern section

of the Cooperative Union, which comprises the counties ofNorthumberland, Durham, Cumberland, Westmorland, andthe North Riding of Yorkshire, that they should considerseriously the question of providing a convalescent home fortheir members. One idea was to build a home at Rothburyat a cost of .BI0,OOO. but in the meantime the Shaws Hotelat Gilsland with adjoining property has been offered for saleby the proprietors to the northern section of the union. Ata meeting held at Gilsland on June lst it was agreed thata report on the whole matter should be presented to thesocieties. If the scheme should be carried to completion it isto be hoped that the medical arrangements will be dealt with