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"MIDWIVES' REGISTRATION BILL."
110 will
only be natural to suppose that milk is "in some death." I have seen patients recover as rapidly and well other the cause," but that the reverse is probably without quinine as with it, either because there was not the c?se if people furnish the larger number any quinine to give them, or because they declined to of victims. grown-up The adoption of a gratuitous assumption of take European medicine. It has been advanced that way
or
sort may well have made Dr. Atkinson the diminution of the death ratio from fevers in India The specific diseases with which milk is best is to be attributed to the extended use of quinine. But, known to have causal relation are scarlet fever, diph- as a matter of fact, the death-rate from all Indian theria, and enteric fever. The two former are essentially diseases has diminished, a3 I think, chielly from better diseases of childhood, the latter is more especially a sanitation, from better personal hygiene, and from the disease of young adults. Acting on the rule laid down, diph- abandonment of the spoliative treatment of former times. theria and scarlet fever occurrences would as such raise I have met many native hakeems in the East, and most in quinine. They assert it " drives suspicion of milk infection, whilst occurrences of enteric have no confidence fever would have just the opposite effect. But, whilst the fever inwards " And I think Brigade Surgeon Hunter awaiting further information on the points raised in Dr. is quite correct when he observes that " if fever is kept in Atkinson’s letter, may I venture to question whether Mr. abeyance [by quinine] a highly irritable condition of the Watson Cheyne’s answer related to the specific organisms nervous system is established." For instance, a person of either of these diseases; and until we learn that I am suffers from irregular or masked ague which he cannot wrong in this surmise may I be allowed to state that my shake off, accompanied by anomalous nervous symptoms. On experience is entirely in accord with that of 11 the autho- inquiry it will be found that he has taken large quantities rities"referred to by Dr. Atkinson. In short, as a matter of quinine, which, although credited with the power of curing of practice, it is well known amongst investigators of in- fevers, is nevertheless capable of exciting a febrile condition. fectious diseases that persons who use nothing but cooked Such a patient will not recover until quinine is discarded, milk do very largely escapefrom attacks of the three and probably not until Carlsbad salts or some other similar diseases named during epidemics in which members of the medicine has been prescribed. Then lemon juice may be same households who use uncooked milk are specially often taken with advantage. Waring long since remarked attacked by them.-I am, Sirs, yours faithfully, that "quinine is inadequate to eradicate malarious poison PUBLIC HEALTH. when it has become engrained, as it were, in the system ; it Jan. 1891. continued use exercises an appears probable that its brain and nervous system."I injurious influence on the MALARIA. will not enter on the quœstio vexata of the action of To the Editors of THE LANCET. quinine farther than by remarking that a sufficient will generally lower the temperature, and someSIRS,-In THE LANCET of Dec. 13th Brigade Surgeon dose This, how. G. Yeates Hunter mentions heat and malaria as the two times delay or even prevent an ague fit. is effects of quinine without toxic ever, rarely accomplished of the nervous in great depressants system tropical climates, which have often manifested, being and these depressing influences are regarded as intensified appeared to me to Sir Samuel Baker wrote of the counterpoise advantage. use of the There however, are, by quinine. injudicious he his travels in Africa that when arrived at a place where other agencies especially affecting the European in a tropical climate. These are the extreme liability to chill arising he could procure sweet potato whisky, "Every day I drank from the skin being debilitated by excessive action resulting hot toddy I became strong, and from that time the fever from heat; the prevalence of a scorbutic taint which may left me," quinine having failed. Both alcohol and opium be latent, or only evidenced by conditions not always appre- have been regarded as antiperiodics, and I certainly have ciated as scorbutic; disturbed sleep from very many causes; known expected paroxysms escape by taking a strong glass and not infrequently a syphilitic taint. Continued heat, of brandy-and-water on the first symptom presenting. It more with regard to the prolonged use of however, is the most important factor. Even in a tempe- is, however, that I write in support of Brigade Surgeon quinine rate climate, a season of extraordinary heat causes loss of Hunter’s views. He has great confidence in kreat, or on nervous and its effect the appetite debility by depressant chiretta, as a substitute for quinine, and many Indian system. But the heat of a tropical climate acts still more hakeems Years use this agent in preference to quinine. of As introduction a the oxygen injuriously. consequence used in as I think both back I often dispensary practice, into the lungs is lessened in several ways, while the excretion of carbonic acid is diminished, and hepatic with economy and advantage to the patients, a tincture of by macerating 24 oz. of kreat in the same engorgement is favoured. Neither with a smaller quantity kreat made of urine is so much effete matter passed with that fluid. quantity of alcohol, and administering in doses of two or I am, Sirs, yours obediently, All this leads to blood deterioration. Dr. Forbes Watson, three drachms. W. J. MOORE, of the Bombay Army, some thirty-five years back deJan., 1891. Surgeon-General. monstrated that the red blood globules of the European in India (especially during the season of rain moisture and "MIDWIVES’ REGISTRATION BILL." heat) become smaller, lose their smooth appearance, and To the Editors of THE LANCET. are studded with refracting granules, which were regarded as of a fatty nature. Had Dr. Watson possessed more SIRS,—After reading Dr. Atthill’s letter I have come to modern instruments, it does not appear improbable that we the conclusion that he has not seen a copy of the Amended would then have had a description of those changes which Midwives’ Bill, but that he has contented himself with have been since noted to occur in connexion with the so- collecting from the medical press the opinions of others and called bacillus malariæ. But continued high tempera- presenting them to us in the uninviting form of a réchauffé ture, moisture, and other depressing influences incidental dish. I have been led to believe this because he says the to residence in the tropics are quite sufficient to induce that " title"" of the Bill indicates that its framers think anæmia from which so manysuffer in a hot climate (and which "registration"" all that is needed. Now, the title ia is usually termed " malarious eachexia") without malaria. described in the first clause as follows :-"This Act may, With regard to quinine, I long since wrote that it does for all purposes, be cited as the Midwives Act." This is a. not deserve the praise which has been accorded to it, and comprehensive title, and includes education, examination, that a very short experience in the tropics will show that certification, and registration. These are only means to an quinine is not the panacea which text-books make it. end, and that end is lost sight of by many—viz.,the prevention Paroxysmal fevers often terminate in restored health ; of women calling themselves midwives who are not competent hence many things have been credited with antiperiodic to act as such. Dr. Atthill proposes that an Act should be powers because fevers have ceased after their use. Amongst passed to encourage the education of midwives and enforce such agents are nicotine and charcoal, arsenic and cobwebs, their examination, but he says nothing about granting opium and nitrate of potash, fuming nitric acid, strychnine certificates or registering them. Examination is of little and neem bark,- carbolic acid and barbery, hyposulphites use unless the person passing it can prove the possession of and black pepper, alcohol and coffee, also water labeled it by certificate, and the certificate is of no value to one peroxide of hydrogen. As many have written enthusiasti- who holds it if others can declare they have it and there ie cally of quinine, so Hare forty years ago wrote of mercury : no register to refer to for proof against them, Dr. Atthill "No doubt that if not calomel, certainly salivation is an is satisfied with ‘ Home Rule" in Ireland as far as midantidote to malarial fevers. The instant a patient’s mouth wives are concerned, and kindly wishes to help us with the is sore the fever leaves him ; from that moment the disease management of ours. The King and Queen’s College of vanishes as if charmed the change is as if from life to Physicians of Ireland obtained a charter in 1673, enabling
the above
sceptical.
111 midwives, and punish all who scirrhous breast, the patient presented herself with enlarged licencp. Midwives have certainly axillary glands. In consultation, it was advised that they received more attention and been better educated in the should be extirpated. I proposed, however, to inject them sister isle. "As a rule," Dr. Atthill says, "they are with acetic acid, and, with the consent of my colleagues, efficient and well conducted." He, however, thinks tbia was done. On the following Wednesday she again the English midwives we propose to educate and presented herself, when it was found that the enlarged .register will not be so satisfactory, for he says " a glands had disappeared, and that the axilla was in a good many will be guilty, or at least be accused of perfectly normal condition, there being no trace of enlarged being guilty of drunkenness, incompetence, infamous or glands, either superficial or deep. This patient returned Let us hope this fear is ground- several times to the hospital, but I never saw any further .disgraceful conduct, &c." less. Some of the objections which Dr. Atthill mentions appearance of disease, and, so far as I know, she rehave already received attention, and will be remedied after mained perfectly well. Also, having removed a cancerous the Bill has been read a second time; but a number of breast, assisted by Mr. Pick, Mr. Csesar Hawkins being them are due to incomplete knowledge or misapprehension present, the enlarged axillary glands were injected, and the of the intention and powers of the Bill. These will most result was equally satisfactory as in the former case. I have frequently since employed these injections, and with varying certainly disappear with further enlightenment. I am, Sirs, yours faithfully, results ; but lately I have used them to the breast itself. In a case now under my care the breast has resumed its normal JAMES H. AVELING. Jan. 1891. Upper Wimpole-street, character except that it has become smaller, and seems yet to be undergoing atrophy. With your permission I will To the Editors of THE LANCET. send you detailed reports of some of these cases. I am, Sirs, yours faithfully, SIRS,—Every member of our profession will cordially agree B. E. BRODHURST. Grosvenor-street, W., Dec. 16th, 1890. with the first part of your leading article on the above subject, but with the sentence, " We are not prepared to say that the State should refuse all recognition of midwives," objections begin. Indeed, the tenour of the first part of the article is contradictory to the latter. Everyone is RESULTS OF COMPULSORY NOTIFICATION. To the Editors of THE LANCET. agreed that the lying-in woman should have the best available attendance-viz., the registered medical pracSIRS,—With your kind permission I should like to make means which will titioner. The difficulty is as to This difficulty will surely a few remarks on two contributions which have recently ensure this desirable end. not be met by providing a second-rate uneducated class appeared in THE LANCET-namely, the letter of Dr. Russell, to compete with him on terms which make competition medical officer of health of Glasgow (Nov. 29th, p. 1188), the annotation on Dr. Cameron’s report to the Corpùraimpossible on his part. Now the difficulty that has arisen and in connexion with this Bill is due to the method of its tion of Leeds (Dec. 20th, p. 1315). In both pre-notification introducers and backers. It is almost incredible that and post-notification figures are contrasted, and we are left certain members of our profession should have allied them- to infer that notification is triumphantly vindicated. In the case of Glasgow eighteen weeks only of each of two selves with a body like the Midwives’ Institute to legislate for us in this matter, instead of taking their own profession years are taken, and reference is made to but one diseaseinto their confidence and ascertaining in a reasonable way scarlet fever-with the following result: first whether legislative steps were necessary or desirable. The course adopted demonstrates clearly the necessity of the better representation of the views of the profession at large, and a representative body to give expression to those views. At present the only views which have a ready ,expression are those of cliques and corporations, which are It is difficult to determine what this table was intended not representative. Now, Sirs, I am entirely opposed to to establish, except that more cases have been removed to on and I do this subject, not agree with the legislation in 1890, that the death-rate per case treated in hosstatement that we cannot permanently avert it. We can, if hospital is lower, and that the epidemic has not been nearly so pital we are sufficiently of one mind in the matter. The reasons ,of my opposition are : First, no one has made out any case severe as in 1880 (that is, of no nearly so virulent a type). Of those taken to hospital, 1 in 8 died in 1880; but in 1890, in favour of the necessity of legislation. Dr. Aveling, at the similar period, only 1 in 29. The figures in 1880, British Gynecological based his case on figures and during a reliable as regards the deaths at home, are though probably facts which were clearly shown to be erroneous, and I have as regards the number of cases. But it is an misleading been at present unable to find anyone who can produce in 1890 the proportion of deaths to cases fact that interesting either figures or facts upon which to base the plea. My is the same at hospital as at home : in both 1 in 29. So second reason is that it is impossible to provide any legal much for sanitation at Glasgow. machinery to prevent the enfranchised class outstepping the now to Dr. Cameron’s report, I see that he selected Coming limits of its province, and, at any rate, there are no prowith an aggregate population of eight boroughs large visions in the Bill at present before us which are sufficient. I will simply, by the way, remind you what has happened 1,293,305 in 1881, but the average density is not before me. mean annual death-rate from the four notifiable diseases in the case of the pharmaceutical chemist. My third The - viz , small-pox, scarlet fever, diphtheria, and "fever"— reason is, that the establishment of a second grade of practitioners will be detrimental to the science and the profes- was 2-1 per 1000 living before notification and 0’8 after. This an annual saving of life per 1000 of 1’3. But it sion, and the first part of your article clearly points in this represents a singular fact that in Liverpool, Birmingham, Bristol, is direction. The old apothecary class was, I presume, done and Wolverhampton even more was effected without notifi.away with, because it was found unsatisfactory. It appears cation. The aggregate population of these four towns in to me that it is for the authors and backers of the Bill to 1881 was 1,239,872, and their average density 57’3 persons show that legislation is necessary, and that what they to an acre. In the period 1871-76 their average death-rate propose to do is adequate to produce the desired result and from the diseases above named was 2’64 per 1000 (or 0’5 is for the benefit of the science of midwifery. Until they above that of Dr. Cameron’s eight towns in the precan bring sufficient evidence to prove these points the Bill notification period) ; whereas for 1881-86 it was reduced to ,must be opposed to the bitter end. 1-01, and in 1887 to 0-82. The saving of life indicated I am, Sirs, yours faithfully, between 1871-76 and 1881-86 was 1-53 per 1000 annually, LOVELL DRAGE. Hatfield, Dec. 13th, 1890. and, if we take 1887 alone, it reached 1-82. Taking everything into consideration, Leeds and Brighton may well ON THE TREATMENT OF CANCER BY THE pause before incurring the expense of the Notification Act. Doncaster and other wary towns have decided to do as they INJECTION OF ACETIC ACID. have done, and calmly await the promised proof of the To the Editors of THE LANCET. efficacy of the much-belauded system, a proof which cerI first SIRS,—It is several years since injected acetic acid tainly seems long in coming. I am, Sird, yours faithfully, into cancerous glands. One of the first cases occurred at D. D. BIDDLE. St. George’s Hospital, Some months after amputating a Kingston-on-Thames, Dec. 22nd, 1890. them to examine and license
practised without
a
the
Society,
g
only be natural to suppose that milk is "in some death." I have seen patients recover as rapidly and well other the cause," but that the reverse is probably without quinine as with it, either because there was not the c?se if people furnish the larger number any quinine to give them, or because they declined to of victims. grown-up The adoption of a gratuitous assumption of take European medicine. It has been advanced that way
or
sort may well have made Dr. Atkinson the diminution of the death ratio from fevers in India The specific diseases with which milk is best is to be attributed to the extended use of quinine. But, known to have causal relation are scarlet fever, diph- as a matter of fact, the death-rate from all Indian theria, and enteric fever. The two former are essentially diseases has diminished, a3 I think, chielly from better diseases of childhood, the latter is more especially a sanitation, from better personal hygiene, and from the disease of young adults. Acting on the rule laid down, diph- abandonment of the spoliative treatment of former times. theria and scarlet fever occurrences would as such raise I have met many native hakeems in the East, and most in quinine. They assert it " drives suspicion of milk infection, whilst occurrences of enteric have no confidence fever would have just the opposite effect. But, whilst the fever inwards " And I think Brigade Surgeon Hunter awaiting further information on the points raised in Dr. is quite correct when he observes that " if fever is kept in Atkinson’s letter, may I venture to question whether Mr. abeyance [by quinine] a highly irritable condition of the Watson Cheyne’s answer related to the specific organisms nervous system is established." For instance, a person of either of these diseases; and until we learn that I am suffers from irregular or masked ague which he cannot wrong in this surmise may I be allowed to state that my shake off, accompanied by anomalous nervous symptoms. On experience is entirely in accord with that of 11 the autho- inquiry it will be found that he has taken large quantities rities"referred to by Dr. Atkinson. In short, as a matter of quinine, which, although credited with the power of curing of practice, it is well known amongst investigators of in- fevers, is nevertheless capable of exciting a febrile condition. fectious diseases that persons who use nothing but cooked Such a patient will not recover until quinine is discarded, milk do very largely escapefrom attacks of the three and probably not until Carlsbad salts or some other similar diseases named during epidemics in which members of the medicine has been prescribed. Then lemon juice may be same households who use uncooked milk are specially often taken with advantage. Waring long since remarked attacked by them.-I am, Sirs, yours faithfully, that "quinine is inadequate to eradicate malarious poison PUBLIC HEALTH. when it has become engrained, as it were, in the system ; it Jan. 1891. continued use exercises an appears probable that its brain and nervous system."I injurious influence on the MALARIA. will not enter on the quœstio vexata of the action of To the Editors of THE LANCET. quinine farther than by remarking that a sufficient will generally lower the temperature, and someSIRS,-In THE LANCET of Dec. 13th Brigade Surgeon dose This, how. G. Yeates Hunter mentions heat and malaria as the two times delay or even prevent an ague fit. is effects of quinine without toxic ever, rarely accomplished of the nervous in great depressants system tropical climates, which have often manifested, being and these depressing influences are regarded as intensified appeared to me to Sir Samuel Baker wrote of the counterpoise advantage. use of the There however, are, by quinine. injudicious he his travels in Africa that when arrived at a place where other agencies especially affecting the European in a tropical climate. These are the extreme liability to chill arising he could procure sweet potato whisky, "Every day I drank from the skin being debilitated by excessive action resulting hot toddy I became strong, and from that time the fever from heat; the prevalence of a scorbutic taint which may left me," quinine having failed. Both alcohol and opium be latent, or only evidenced by conditions not always appre- have been regarded as antiperiodics, and I certainly have ciated as scorbutic; disturbed sleep from very many causes; known expected paroxysms escape by taking a strong glass and not infrequently a syphilitic taint. Continued heat, of brandy-and-water on the first symptom presenting. It more with regard to the prolonged use of however, is the most important factor. Even in a tempe- is, however, that I write in support of Brigade Surgeon quinine rate climate, a season of extraordinary heat causes loss of Hunter’s views. He has great confidence in kreat, or on nervous and its effect the appetite debility by depressant chiretta, as a substitute for quinine, and many Indian system. But the heat of a tropical climate acts still more hakeems Years use this agent in preference to quinine. of As introduction a the oxygen injuriously. consequence used in as I think both back I often dispensary practice, into the lungs is lessened in several ways, while the excretion of carbonic acid is diminished, and hepatic with economy and advantage to the patients, a tincture of by macerating 24 oz. of kreat in the same engorgement is favoured. Neither with a smaller quantity kreat made of urine is so much effete matter passed with that fluid. quantity of alcohol, and administering in doses of two or I am, Sirs, yours obediently, All this leads to blood deterioration. Dr. Forbes Watson, three drachms. W. J. MOORE, of the Bombay Army, some thirty-five years back deJan., 1891. Surgeon-General. monstrated that the red blood globules of the European in India (especially during the season of rain moisture and "MIDWIVES’ REGISTRATION BILL." heat) become smaller, lose their smooth appearance, and To the Editors of THE LANCET. are studded with refracting granules, which were regarded as of a fatty nature. Had Dr. Watson possessed more SIRS,—After reading Dr. Atthill’s letter I have come to modern instruments, it does not appear improbable that we the conclusion that he has not seen a copy of the Amended would then have had a description of those changes which Midwives’ Bill, but that he has contented himself with have been since noted to occur in connexion with the so- collecting from the medical press the opinions of others and called bacillus malariæ. But continued high tempera- presenting them to us in the uninviting form of a réchauffé ture, moisture, and other depressing influences incidental dish. I have been led to believe this because he says the to residence in the tropics are quite sufficient to induce that " title"" of the Bill indicates that its framers think anæmia from which so manysuffer in a hot climate (and which "registration"" all that is needed. Now, the title ia is usually termed " malarious eachexia") without malaria. described in the first clause as follows :-"This Act may, With regard to quinine, I long since wrote that it does for all purposes, be cited as the Midwives Act." This is a. not deserve the praise which has been accorded to it, and comprehensive title, and includes education, examination, that a very short experience in the tropics will show that certification, and registration. These are only means to an quinine is not the panacea which text-books make it. end, and that end is lost sight of by many—viz.,the prevention Paroxysmal fevers often terminate in restored health ; of women calling themselves midwives who are not competent hence many things have been credited with antiperiodic to act as such. Dr. Atthill proposes that an Act should be powers because fevers have ceased after their use. Amongst passed to encourage the education of midwives and enforce such agents are nicotine and charcoal, arsenic and cobwebs, their examination, but he says nothing about granting opium and nitrate of potash, fuming nitric acid, strychnine certificates or registering them. Examination is of little and neem bark,- carbolic acid and barbery, hyposulphites use unless the person passing it can prove the possession of and black pepper, alcohol and coffee, also water labeled it by certificate, and the certificate is of no value to one peroxide of hydrogen. As many have written enthusiasti- who holds it if others can declare they have it and there ie cally of quinine, so Hare forty years ago wrote of mercury : no register to refer to for proof against them, Dr. Atthill "No doubt that if not calomel, certainly salivation is an is satisfied with ‘ Home Rule" in Ireland as far as midantidote to malarial fevers. The instant a patient’s mouth wives are concerned, and kindly wishes to help us with the is sore the fever leaves him ; from that moment the disease management of ours. The King and Queen’s College of vanishes as if charmed the change is as if from life to Physicians of Ireland obtained a charter in 1673, enabling
the above
sceptical.
111 midwives, and punish all who scirrhous breast, the patient presented herself with enlarged licencp. Midwives have certainly axillary glands. In consultation, it was advised that they received more attention and been better educated in the should be extirpated. I proposed, however, to inject them sister isle. "As a rule," Dr. Atthill says, "they are with acetic acid, and, with the consent of my colleagues, efficient and well conducted." He, however, thinks tbia was done. On the following Wednesday she again the English midwives we propose to educate and presented herself, when it was found that the enlarged .register will not be so satisfactory, for he says " a glands had disappeared, and that the axilla was in a good many will be guilty, or at least be accused of perfectly normal condition, there being no trace of enlarged being guilty of drunkenness, incompetence, infamous or glands, either superficial or deep. This patient returned Let us hope this fear is ground- several times to the hospital, but I never saw any further .disgraceful conduct, &c." less. Some of the objections which Dr. Atthill mentions appearance of disease, and, so far as I know, she rehave already received attention, and will be remedied after mained perfectly well. Also, having removed a cancerous the Bill has been read a second time; but a number of breast, assisted by Mr. Pick, Mr. Csesar Hawkins being them are due to incomplete knowledge or misapprehension present, the enlarged axillary glands were injected, and the of the intention and powers of the Bill. These will most result was equally satisfactory as in the former case. I have frequently since employed these injections, and with varying certainly disappear with further enlightenment. I am, Sirs, yours faithfully, results ; but lately I have used them to the breast itself. In a case now under my care the breast has resumed its normal JAMES H. AVELING. Jan. 1891. Upper Wimpole-street, character except that it has become smaller, and seems yet to be undergoing atrophy. With your permission I will To the Editors of THE LANCET. send you detailed reports of some of these cases. I am, Sirs, yours faithfully, SIRS,—Every member of our profession will cordially agree B. E. BRODHURST. Grosvenor-street, W., Dec. 16th, 1890. with the first part of your leading article on the above subject, but with the sentence, " We are not prepared to say that the State should refuse all recognition of midwives," objections begin. Indeed, the tenour of the first part of the article is contradictory to the latter. Everyone is RESULTS OF COMPULSORY NOTIFICATION. To the Editors of THE LANCET. agreed that the lying-in woman should have the best available attendance-viz., the registered medical pracSIRS,—With your kind permission I should like to make means which will titioner. The difficulty is as to This difficulty will surely a few remarks on two contributions which have recently ensure this desirable end. not be met by providing a second-rate uneducated class appeared in THE LANCET-namely, the letter of Dr. Russell, to compete with him on terms which make competition medical officer of health of Glasgow (Nov. 29th, p. 1188), the annotation on Dr. Cameron’s report to the Corpùraimpossible on his part. Now the difficulty that has arisen and in connexion with this Bill is due to the method of its tion of Leeds (Dec. 20th, p. 1315). In both pre-notification introducers and backers. It is almost incredible that and post-notification figures are contrasted, and we are left certain members of our profession should have allied them- to infer that notification is triumphantly vindicated. In the case of Glasgow eighteen weeks only of each of two selves with a body like the Midwives’ Institute to legislate for us in this matter, instead of taking their own profession years are taken, and reference is made to but one diseaseinto their confidence and ascertaining in a reasonable way scarlet fever-with the following result: first whether legislative steps were necessary or desirable. The course adopted demonstrates clearly the necessity of the better representation of the views of the profession at large, and a representative body to give expression to those views. At present the only views which have a ready ,expression are those of cliques and corporations, which are It is difficult to determine what this table was intended not representative. Now, Sirs, I am entirely opposed to to establish, except that more cases have been removed to on and I do this subject, not agree with the legislation in 1890, that the death-rate per case treated in hosstatement that we cannot permanently avert it. We can, if hospital is lower, and that the epidemic has not been nearly so pital we are sufficiently of one mind in the matter. The reasons ,of my opposition are : First, no one has made out any case severe as in 1880 (that is, of no nearly so virulent a type). Of those taken to hospital, 1 in 8 died in 1880; but in 1890, in favour of the necessity of legislation. Dr. Aveling, at the similar period, only 1 in 29. The figures in 1880, British Gynecological based his case on figures and during a reliable as regards the deaths at home, are though probably facts which were clearly shown to be erroneous, and I have as regards the number of cases. But it is an misleading been at present unable to find anyone who can produce in 1890 the proportion of deaths to cases fact that interesting either figures or facts upon which to base the plea. My is the same at hospital as at home : in both 1 in 29. So second reason is that it is impossible to provide any legal much for sanitation at Glasgow. machinery to prevent the enfranchised class outstepping the now to Dr. Cameron’s report, I see that he selected Coming limits of its province, and, at any rate, there are no prowith an aggregate population of eight boroughs large visions in the Bill at present before us which are sufficient. I will simply, by the way, remind you what has happened 1,293,305 in 1881, but the average density is not before me. mean annual death-rate from the four notifiable diseases in the case of the pharmaceutical chemist. My third The - viz , small-pox, scarlet fever, diphtheria, and "fever"— reason is, that the establishment of a second grade of practitioners will be detrimental to the science and the profes- was 2-1 per 1000 living before notification and 0’8 after. This an annual saving of life per 1000 of 1’3. But it sion, and the first part of your article clearly points in this represents a singular fact that in Liverpool, Birmingham, Bristol, is direction. The old apothecary class was, I presume, done and Wolverhampton even more was effected without notifi.away with, because it was found unsatisfactory. It appears cation. The aggregate population of these four towns in to me that it is for the authors and backers of the Bill to 1881 was 1,239,872, and their average density 57’3 persons show that legislation is necessary, and that what they to an acre. In the period 1871-76 their average death-rate propose to do is adequate to produce the desired result and from the diseases above named was 2’64 per 1000 (or 0’5 is for the benefit of the science of midwifery. Until they above that of Dr. Cameron’s eight towns in the precan bring sufficient evidence to prove these points the Bill notification period) ; whereas for 1881-86 it was reduced to ,must be opposed to the bitter end. 1-01, and in 1887 to 0-82. The saving of life indicated I am, Sirs, yours faithfully, between 1871-76 and 1881-86 was 1-53 per 1000 annually, LOVELL DRAGE. Hatfield, Dec. 13th, 1890. and, if we take 1887 alone, it reached 1-82. Taking everything into consideration, Leeds and Brighton may well ON THE TREATMENT OF CANCER BY THE pause before incurring the expense of the Notification Act. Doncaster and other wary towns have decided to do as they INJECTION OF ACETIC ACID. have done, and calmly await the promised proof of the To the Editors of THE LANCET. efficacy of the much-belauded system, a proof which cerI first SIRS,—It is several years since injected acetic acid tainly seems long in coming. I am, Sird, yours faithfully, into cancerous glands. One of the first cases occurred at D. D. BIDDLE. St. George’s Hospital, Some months after amputating a Kingston-on-Thames, Dec. 22nd, 1890. them to examine and license
practised without
a
the
Society,
g