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INFANT NEGLECT, INSURANCE, AND MORTALITY.
166
GEORGE RAINEY.-PRESENTATION TO LORD SANDHURST.
absolute failure. If so, the chief obstacle to their abolition will disappear. One grocer is mentioned as being ruined after he took out a wine and spirit licence. His customers contracted drunken habits, opened quarterly accounts, which they often failed to pay, while his shop assistants drank his wine and neglected their work. Another shop with two large windows-one devoted to groceries, the other to wine and spirits-had ruined two successive proprietors. A third purchaser presented himself, but only on the condition This was done, though that the liquor was removed. thought to be an act of madness ; but the result has been the creation of a prosperous and profitable business. At a third grocer’s shop, where the liquor traffic had also been abandoned, the net profits had considerably increased. It would seem that among customers who buy liquors with their groceries the proportion of bad debts is much higher. If this experience is confirmed in other quarters a great step towards the abolishing of grocers’ licences will have been taken. Such questions should be settled purely on moral grounds ; but if it so happens that the material interests of the trade will not be as disadvantageously affected as was generally imagined, we shall be all the better pleased. We have no reason and no desire to attack the interests of the grocery trade, but it is our duty to denounce all that encourages or facilitates alcoholism and thus endangers public health.
valuable even now. By means of them he discovered the nature of those structures in the synovial fringes which have been called "Rainey’s bodies," and which are now known to be the starting point of loose cartilages The Qitarttrly’Jo?trnal of Microscopical Science in joints. and the Transactions of the Microscopical Society contain papers by him on the Cutaneous Follicles of the Toad and on Methods of Illumination in Microscope Work. His laborious life was prolonged far beyond the usual term. Born in 1801 in Spilsby, Lincolnshire, he came to. London in 1824, and became a student at St. Thomas’s Hospital. In 1827 he qualified as M.R.C.S., and obtained great success as a private teacher of anatomy. His tutorial connexion with St. Thomas’s Hospital commenced about 1844, and continued for about forty years, being terminated only by his death in November, 1884, in the eighty-fourth year of his age. For this sketch of his cajeer of active usefulness we are indebted mainly to an appreciative article contributed to the St. Thomas’s Hospital Reports by his friend Mr. Wagstaffe, late senior assistant surgeon and lecturer on anatomy at the hospital.
PRESENTATION TO LORD SANDHURST. THE important services rendered by the Right Hon. Lord Sandhurst to the Middlesex Hospital as chairman of the weekly board for the last six years have been gracefully
acknowledged by his colleagues in the governing body, in conjunction with the medical staff and the resident officials. ALL St. Thomas’s men whose recollection of the hospital His lordhip, who has been appointed Governor of Bombay, extends back for fifteen or twenty years preserve kindly necessarily vacates his official position at the hospital, and memories of Mr. George Rainey, the veteran demonstrator was on the 12th inst. presented with an address together with of anatomy. Unconventional in exterior, he was largely a bowl and -four goblets in silver. An influential gathering of endowed with sterling qualities of head and heart, acknow- the subscribers to the testimonial assembled to meet his lordledged even by the light-hearted young men who learned ship, the presentation being made by Mr. J. Bell Sedgwick, from him to trace out and understand the intricacies of deputy-chairman of the board, supported by Mr. J. W. their "parts." Most teachers know how arduous a duty is Hulke, President of the Royal College of Surgeons of England the unrelaxing effort to awaken and sustain a student’s and senior surgeon of the hospital. Mr. Sedgwick delivered a interest in his work, and to lead him to an intelligent very complimentary speech, to which Lord Sandhurst replied comprehension and recollection of it, especially in a field so in appropriate terms, assuring the company of the regret wide and so full of details as anatomy. Rainey’s success in with which he retired from his congenial duties at the this direction was recognised by all who came in contact with hospital. him, including the dignified seniors who uphold the high posi- INFANT NEGLECT, INSURANCE, AND MORTALITY. tion of St. Thomas’s Hospital among schools of medicine. THE more closely we examine the practice of child ineurIn addition to his work as an instructor Rainey carried out THE LANCET in 1851 con- ance the less there appears to commend it. Notwithstanding much original investigation. tained an elaborate and thoughtful paper1 written by him on the fact that disease is much more prevalent during the early the adjustment of vision effected by the ciliary processes and years of life than later, it by no means follows that death is the pecten. Many other original memoirs by him appeared an equally certain factor in the table of probabilities. Well in the Annual Reports of St. Thomas’s Hospital, the Trans- tended, well nourished, and within reach of prompt and skilful actions of the Royal Medical and Chirurgicl Society, the medical service qualified by no exorbitant fee, the prospects His first important of infant life even among the poor, if they be careful also, Transactions of the Royal Society, &. on Ascent was a botanical and Descent of are hopeful in a high degree. Life, not death, is the natural paper subject-the the Sap. It was read before the Royal Society in 1842 and outlook, and the necessity for insurance is proportionately appeared in book form with some additions in 1847. Botany less. The social status of so young a child, moreover, as a and physics were combined in an investigation en the Forma- rule is absolutely trivial. Compensation for its de’ith We cannot, tion of Starch Granules, the results of which were read argues a loss which is incalculably small. before the British Association in 1859. In conjunction therefore, find in such reasons as these facts afford with his duties as demonstrator of anatomy he held any real justification of the system of insurance. Nor a position as a practical microscopist which was at is the position of those who would advocate this system that time almost unique. Fifty years ago the microscope greatly improved when we pass to the question of ways and means as connected with the event of an infant’s death. was in the hands of trained specialists only, and was far from being reckoned, as it now is, one of the ordinary Simple in the extreme are all the needful arrangements for a. accessories of a medical education. R3.Îney was an adept funeral. Their cost would not overtax the slender means of in microscopical manipulation and demonstration as then almost ary family which is maintained by honest work and practised. Transparent injections were not at that time in thrift, so that even from this point of view insurance has It is to be noted also use, but his specimens of tissues injected with opaque somewhat the aspect of a superfluity. of that those who were to a marvel his contemporaries, and are materials very many parents pay their weekly contributions in token of their prudent fears are at the same time 1 THE LANCET, July 26th, 1851. On the Function performed by the by a neglect of their offspring and a selfCiliary Processes and by the Pecten in the Adjustment of the Eye to distinguished which are not less than criminal. Distinct Vision at Different Distances. Among 629 indulgence GEORGE RAINEY.
-
THE NATURE AND TREATMENT OF LEPROSY.
subjected to cruel treatment during the past month it is reported by the organ of the National Society for their protection that 1237 were known to be insured. So, too, was an unfortunate infant whose death was recently investigated by the coroner for the West Middlesex district. The parent could not afford medical aid (which he mightI have had for a mere pittance), but he did not neglect to pay his insurance premiums. Facts like these tend to sicken the public conscience. They strongly suggest a necessity for drastic reforms in a system of somewhat doubtful and limited advantage. Among such reforms we should, for our own part, insist upon two at least-namely, that the sum insured should no more than discharge the bare cost of funeral arrangements, and that evidence of such criminal neglect or mismanagement as might account for a child’s death should disqualify for the receipt of the sum insured. Medical practitioners have a special duty in this connexion, and ought to be scrupulous in refusing to grant the customary death certificates in cases where they believe that such mismanagement has occurred. children
-
CONSERVANCY AND WATER CARRIAGE SYSTEMS FOR THE REMOVAL OF EXCREMENT. DR. BOOBBYER has presented to the health committee of the town council of Nottingham a valuable contribution to the literature bearing on the important subject of excrement disposal in large urban centres. The report is primarily intended to aid the committee in considering their future attitude towards the existing pail system in the borough ; but it seems to be suited to the necessities of many towns where a like system obtains and where the sanitary authority are desirous of securing for their town competent advice given as the result of knowledge of the methods in vogue in a wide variety of places and circumstances. Dr. Boobbyer’s report covers a wide area, being based on information obtained from seventy-eight towns (including the " great towns ") of Great Britain and Ireland, a comprehensive tabular statement making his deductions all the more useful. Briefly stated, there is a general discontent with the conservancy system-the midden privy, pail closet, cesspool, and so on-only four towns openly advocating it-namely, Darwen, Hull, Warrington, and Rochdale-the latter for many years famous for the system" to which it has given its name; but the opinion of these towns is far outweighed by the general condemnation resulting from experience in the other towns where the air, soil, and waterpolluting conservancy methods find tolerance. One interesting fact given is that the nightsoil from the 40,000 pail closets and the 500 privies in Nottingham amounts annually to 500 tons, these figures permitting of an estimate for other places in like circumstances. Replies from fortytwo large towns were strongly in favour of waterclosets both for in-door and out-door use ; but the question of frost is not overlooked in regard to the latter use of waterclosets, though the damage so caused seems to be less than is popularly supposed. Dr. Boobbyer treats also of slop-water and trough closets, in favour of which Dr. Parsons has already some time back reported to the Medical Department of the Local Government Board, although the advantages of these forms of closet are not without some counter drawbacks, choking and difficulty of cleansing being among the latter. But, again, slop-water closets admit of being readily converted into waterclosets. At any rate, twentythree towns look upon these forms of excrement removal very favourably, extended adoption leading to more pronounced views in their behalf, the tipping basin being the most generally adopted form of flush, and a three-gallon flusl being regarded as a desirable minimum. One important point touched upon is that several towns offer a subsidy ir aid of the conversion of dry to water carriage systems
167
much as f.3in regard to each There is satisfaction in obsolete closet so converted. learning that in only three towns is the objectionable cesspool in wide use’; but what is of very serious moment. is the fact elicited that no fewer than fifteen of the larger towns-excluding London-with an aggregate population of some 2,750,000 inhabitants, discharge the bulk of their sewage in a practically crude state into inland waterways. Truly the Rivers Pollution Prevention Acts have been anything but that which their name implies, in so far as only too many of our populous towns are concerned. The matter calls for the earnest attention of county and parish councils and for the formation and sustained action of joint committees for the suppression of thepollution of our rivers. For the rest, Dr. Boobbyer shows the superiority of the watercloset for general indoor use and the desirability of automatic slop- or waste-water closets in poorer neighbourhoods and for outside use, though these latter, equally with trough closets (which, by the way, are liable to injury by frost), call for supervision by a staff of men attached to the Health Department. Trough closets,. however, require a special (clean) water-supply, unlike the slop closet, which is self-feeding from the liquid waste of houses. We commend Dr. Boobbyer’s report to all sanitary bodies interested in the question of excrement disposal. It. is written in a lucid style and contains valuable standing, matter fcr reference in its tables and summary.
Stafford
proposing to offer as
THE NATURE AND TREATMENT OF LEPROSY.
interesting article on the above subject appears in the American Journal of the Medical S‘azeace,, by Dr. R. H. L. Bibb, who has examined thirty cases of tuberculous and five cases of macular leprosy with reference to the AN
presence of bacilli, and has never failed to find them in sections of tubercles, in blood drawn directly therefrom, in discharges from leprous ulcers, and occasionally in thesputum and the secretions from the nose ; but he has never found them in the fasces, urine, or blood, except when the latter was taken directly from a tubercle, although other investigators—Kobner, according to Thoma and Cantlieclaim to have found them in the blood current. After referring at some length to the opinions of different writers as regards the nature of the bacillus and the question of heredity and mode of spread of the disease, Dr. Bibb discusses the treatment of leprosy. He has during the past ten years employed a great many drugs in treating a great many lepers ; and while he has seen some truly marvellous results-results he was in nowise prepared to witness-follow the use of certain measures, he is not prepared to assert positively that he has brought about a radical cure of a single case of leprosy in either of its. stages. Preparations of arsenic, mercury, and iodine when the disease was not associated with syphilis-it is often thus associated-he has found to be worse than useless; but he has seen very marked improvement in all three stages of leprosy follow the systematic use of Chaulmoogra, oil internally and locally (associated with an improved dietary and personal hygiene), and this in a sufficient number of cases to induce the belief that while in no sense a specific, as regarded by Berg6, if commenced early in the disease and continued long enough and unintermittingly and associated with proper food and hygiene, it will cure the patient in many instances. Of course, there are many cases it will not benefit, probably a large majority, but Dr. Bibb has never seen it properly used without notable improvement ensuing, especially in the tuberculous stage. He has seen tubercles absorbed, ansesthesia removed, eruptions disappear, ulcers heal, pains quieted, suppleness and elasticity of the skin restored, and hope take the place of despair under its use. He begins treatment with ten drops of the
GEORGE RAINEY.-PRESENTATION TO LORD SANDHURST.
absolute failure. If so, the chief obstacle to their abolition will disappear. One grocer is mentioned as being ruined after he took out a wine and spirit licence. His customers contracted drunken habits, opened quarterly accounts, which they often failed to pay, while his shop assistants drank his wine and neglected their work. Another shop with two large windows-one devoted to groceries, the other to wine and spirits-had ruined two successive proprietors. A third purchaser presented himself, but only on the condition This was done, though that the liquor was removed. thought to be an act of madness ; but the result has been the creation of a prosperous and profitable business. At a third grocer’s shop, where the liquor traffic had also been abandoned, the net profits had considerably increased. It would seem that among customers who buy liquors with their groceries the proportion of bad debts is much higher. If this experience is confirmed in other quarters a great step towards the abolishing of grocers’ licences will have been taken. Such questions should be settled purely on moral grounds ; but if it so happens that the material interests of the trade will not be as disadvantageously affected as was generally imagined, we shall be all the better pleased. We have no reason and no desire to attack the interests of the grocery trade, but it is our duty to denounce all that encourages or facilitates alcoholism and thus endangers public health.
valuable even now. By means of them he discovered the nature of those structures in the synovial fringes which have been called "Rainey’s bodies," and which are now known to be the starting point of loose cartilages The Qitarttrly’Jo?trnal of Microscopical Science in joints. and the Transactions of the Microscopical Society contain papers by him on the Cutaneous Follicles of the Toad and on Methods of Illumination in Microscope Work. His laborious life was prolonged far beyond the usual term. Born in 1801 in Spilsby, Lincolnshire, he came to. London in 1824, and became a student at St. Thomas’s Hospital. In 1827 he qualified as M.R.C.S., and obtained great success as a private teacher of anatomy. His tutorial connexion with St. Thomas’s Hospital commenced about 1844, and continued for about forty years, being terminated only by his death in November, 1884, in the eighty-fourth year of his age. For this sketch of his cajeer of active usefulness we are indebted mainly to an appreciative article contributed to the St. Thomas’s Hospital Reports by his friend Mr. Wagstaffe, late senior assistant surgeon and lecturer on anatomy at the hospital.
PRESENTATION TO LORD SANDHURST. THE important services rendered by the Right Hon. Lord Sandhurst to the Middlesex Hospital as chairman of the weekly board for the last six years have been gracefully
acknowledged by his colleagues in the governing body, in conjunction with the medical staff and the resident officials. ALL St. Thomas’s men whose recollection of the hospital His lordhip, who has been appointed Governor of Bombay, extends back for fifteen or twenty years preserve kindly necessarily vacates his official position at the hospital, and memories of Mr. George Rainey, the veteran demonstrator was on the 12th inst. presented with an address together with of anatomy. Unconventional in exterior, he was largely a bowl and -four goblets in silver. An influential gathering of endowed with sterling qualities of head and heart, acknow- the subscribers to the testimonial assembled to meet his lordledged even by the light-hearted young men who learned ship, the presentation being made by Mr. J. Bell Sedgwick, from him to trace out and understand the intricacies of deputy-chairman of the board, supported by Mr. J. W. their "parts." Most teachers know how arduous a duty is Hulke, President of the Royal College of Surgeons of England the unrelaxing effort to awaken and sustain a student’s and senior surgeon of the hospital. Mr. Sedgwick delivered a interest in his work, and to lead him to an intelligent very complimentary speech, to which Lord Sandhurst replied comprehension and recollection of it, especially in a field so in appropriate terms, assuring the company of the regret wide and so full of details as anatomy. Rainey’s success in with which he retired from his congenial duties at the this direction was recognised by all who came in contact with hospital. him, including the dignified seniors who uphold the high posi- INFANT NEGLECT, INSURANCE, AND MORTALITY. tion of St. Thomas’s Hospital among schools of medicine. THE more closely we examine the practice of child ineurIn addition to his work as an instructor Rainey carried out THE LANCET in 1851 con- ance the less there appears to commend it. Notwithstanding much original investigation. tained an elaborate and thoughtful paper1 written by him on the fact that disease is much more prevalent during the early the adjustment of vision effected by the ciliary processes and years of life than later, it by no means follows that death is the pecten. Many other original memoirs by him appeared an equally certain factor in the table of probabilities. Well in the Annual Reports of St. Thomas’s Hospital, the Trans- tended, well nourished, and within reach of prompt and skilful actions of the Royal Medical and Chirurgicl Society, the medical service qualified by no exorbitant fee, the prospects His first important of infant life even among the poor, if they be careful also, Transactions of the Royal Society, &. on Ascent was a botanical and Descent of are hopeful in a high degree. Life, not death, is the natural paper subject-the the Sap. It was read before the Royal Society in 1842 and outlook, and the necessity for insurance is proportionately appeared in book form with some additions in 1847. Botany less. The social status of so young a child, moreover, as a and physics were combined in an investigation en the Forma- rule is absolutely trivial. Compensation for its de’ith We cannot, tion of Starch Granules, the results of which were read argues a loss which is incalculably small. before the British Association in 1859. In conjunction therefore, find in such reasons as these facts afford with his duties as demonstrator of anatomy he held any real justification of the system of insurance. Nor a position as a practical microscopist which was at is the position of those who would advocate this system that time almost unique. Fifty years ago the microscope greatly improved when we pass to the question of ways and means as connected with the event of an infant’s death. was in the hands of trained specialists only, and was far from being reckoned, as it now is, one of the ordinary Simple in the extreme are all the needful arrangements for a. accessories of a medical education. R3.Îney was an adept funeral. Their cost would not overtax the slender means of in microscopical manipulation and demonstration as then almost ary family which is maintained by honest work and practised. Transparent injections were not at that time in thrift, so that even from this point of view insurance has It is to be noted also use, but his specimens of tissues injected with opaque somewhat the aspect of a superfluity. of that those who were to a marvel his contemporaries, and are materials very many parents pay their weekly contributions in token of their prudent fears are at the same time 1 THE LANCET, July 26th, 1851. On the Function performed by the by a neglect of their offspring and a selfCiliary Processes and by the Pecten in the Adjustment of the Eye to distinguished which are not less than criminal. Distinct Vision at Different Distances. Among 629 indulgence GEORGE RAINEY.
-
THE NATURE AND TREATMENT OF LEPROSY.
subjected to cruel treatment during the past month it is reported by the organ of the National Society for their protection that 1237 were known to be insured. So, too, was an unfortunate infant whose death was recently investigated by the coroner for the West Middlesex district. The parent could not afford medical aid (which he mightI have had for a mere pittance), but he did not neglect to pay his insurance premiums. Facts like these tend to sicken the public conscience. They strongly suggest a necessity for drastic reforms in a system of somewhat doubtful and limited advantage. Among such reforms we should, for our own part, insist upon two at least-namely, that the sum insured should no more than discharge the bare cost of funeral arrangements, and that evidence of such criminal neglect or mismanagement as might account for a child’s death should disqualify for the receipt of the sum insured. Medical practitioners have a special duty in this connexion, and ought to be scrupulous in refusing to grant the customary death certificates in cases where they believe that such mismanagement has occurred. children
-
CONSERVANCY AND WATER CARRIAGE SYSTEMS FOR THE REMOVAL OF EXCREMENT. DR. BOOBBYER has presented to the health committee of the town council of Nottingham a valuable contribution to the literature bearing on the important subject of excrement disposal in large urban centres. The report is primarily intended to aid the committee in considering their future attitude towards the existing pail system in the borough ; but it seems to be suited to the necessities of many towns where a like system obtains and where the sanitary authority are desirous of securing for their town competent advice given as the result of knowledge of the methods in vogue in a wide variety of places and circumstances. Dr. Boobbyer’s report covers a wide area, being based on information obtained from seventy-eight towns (including the " great towns ") of Great Britain and Ireland, a comprehensive tabular statement making his deductions all the more useful. Briefly stated, there is a general discontent with the conservancy system-the midden privy, pail closet, cesspool, and so on-only four towns openly advocating it-namely, Darwen, Hull, Warrington, and Rochdale-the latter for many years famous for the system" to which it has given its name; but the opinion of these towns is far outweighed by the general condemnation resulting from experience in the other towns where the air, soil, and waterpolluting conservancy methods find tolerance. One interesting fact given is that the nightsoil from the 40,000 pail closets and the 500 privies in Nottingham amounts annually to 500 tons, these figures permitting of an estimate for other places in like circumstances. Replies from fortytwo large towns were strongly in favour of waterclosets both for in-door and out-door use ; but the question of frost is not overlooked in regard to the latter use of waterclosets, though the damage so caused seems to be less than is popularly supposed. Dr. Boobbyer treats also of slop-water and trough closets, in favour of which Dr. Parsons has already some time back reported to the Medical Department of the Local Government Board, although the advantages of these forms of closet are not without some counter drawbacks, choking and difficulty of cleansing being among the latter. But, again, slop-water closets admit of being readily converted into waterclosets. At any rate, twentythree towns look upon these forms of excrement removal very favourably, extended adoption leading to more pronounced views in their behalf, the tipping basin being the most generally adopted form of flush, and a three-gallon flusl being regarded as a desirable minimum. One important point touched upon is that several towns offer a subsidy ir aid of the conversion of dry to water carriage systems
167
much as f.3in regard to each There is satisfaction in obsolete closet so converted. learning that in only three towns is the objectionable cesspool in wide use’; but what is of very serious moment. is the fact elicited that no fewer than fifteen of the larger towns-excluding London-with an aggregate population of some 2,750,000 inhabitants, discharge the bulk of their sewage in a practically crude state into inland waterways. Truly the Rivers Pollution Prevention Acts have been anything but that which their name implies, in so far as only too many of our populous towns are concerned. The matter calls for the earnest attention of county and parish councils and for the formation and sustained action of joint committees for the suppression of thepollution of our rivers. For the rest, Dr. Boobbyer shows the superiority of the watercloset for general indoor use and the desirability of automatic slop- or waste-water closets in poorer neighbourhoods and for outside use, though these latter, equally with trough closets (which, by the way, are liable to injury by frost), call for supervision by a staff of men attached to the Health Department. Trough closets,. however, require a special (clean) water-supply, unlike the slop closet, which is self-feeding from the liquid waste of houses. We commend Dr. Boobbyer’s report to all sanitary bodies interested in the question of excrement disposal. It. is written in a lucid style and contains valuable standing, matter fcr reference in its tables and summary.
Stafford
proposing to offer as
THE NATURE AND TREATMENT OF LEPROSY.
interesting article on the above subject appears in the American Journal of the Medical S‘azeace,, by Dr. R. H. L. Bibb, who has examined thirty cases of tuberculous and five cases of macular leprosy with reference to the AN
presence of bacilli, and has never failed to find them in sections of tubercles, in blood drawn directly therefrom, in discharges from leprous ulcers, and occasionally in thesputum and the secretions from the nose ; but he has never found them in the fasces, urine, or blood, except when the latter was taken directly from a tubercle, although other investigators—Kobner, according to Thoma and Cantlieclaim to have found them in the blood current. After referring at some length to the opinions of different writers as regards the nature of the bacillus and the question of heredity and mode of spread of the disease, Dr. Bibb discusses the treatment of leprosy. He has during the past ten years employed a great many drugs in treating a great many lepers ; and while he has seen some truly marvellous results-results he was in nowise prepared to witness-follow the use of certain measures, he is not prepared to assert positively that he has brought about a radical cure of a single case of leprosy in either of its. stages. Preparations of arsenic, mercury, and iodine when the disease was not associated with syphilis-it is often thus associated-he has found to be worse than useless; but he has seen very marked improvement in all three stages of leprosy follow the systematic use of Chaulmoogra, oil internally and locally (associated with an improved dietary and personal hygiene), and this in a sufficient number of cases to induce the belief that while in no sense a specific, as regarded by Berg6, if commenced early in the disease and continued long enough and unintermittingly and associated with proper food and hygiene, it will cure the patient in many instances. Of course, there are many cases it will not benefit, probably a large majority, but Dr. Bibb has never seen it properly used without notable improvement ensuing, especially in the tuberculous stage. He has seen tubercles absorbed, ansesthesia removed, eruptions disappear, ulcers heal, pains quieted, suppleness and elasticity of the skin restored, and hope take the place of despair under its use. He begins treatment with ten drops of the