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THE ADMINISTRATION OF THE VACCINATION ACTS IN THE COUNTY BOROUGH OF READING.
1370
patient is more or less an invalid, but without the existence of any definite organic disease. We have already called attention to the opposite opinions as to the effect of where the
transaction may be of a bonâ-fide character. In many more it is quite otherwise. After a few months it ends with the child’s death, and for some impoverished parent or unwedded bicycling on the pelvis. We may also mention that mother there is one incumbrance the less. To question theauthorities are equally divided as to the effect of bicycling existence of criminal complicity in a large number of such cases would be to ignore the most patent facts of leo-al on the perineum, some holding that the effect of bicycling on the perineum is to render the structures of the pelvic, floor evidence. As to the means employed these are not always dense or, indeed, almost cicatricial, and therefore extremely summary and certain, though the more gradual process of slow and difficult to dilate ; while others hold that the effect starvation is hardly less effectual in the end than actual is the exact opposite, and that, in patients who ride bicy- violence. Wearing, as it may do, the comparatively inno-. cles, the perineum actually dilates much mere readily, so cent aspect of an error in judgment it is, on the that the latter part of the second stage of labour is whole, safer-or at all events it is supposed to be so. In materially facilitated. There can be no doubt that bicycling judging of its reil character and motive there is need of the during a menstrual period is nnadvisable, and that to ride careful examination of circumstantial data. It is only after during pregnancy will in many women involve a special a scrutiny of these various facts that we can find ourselves liability to the occurrence of a miscarriage or of premature ina position to discuss the question of preventive treatment. labour. From what has been said it is evident that ill-effects To our own mind this docs not present any very serious due to bicycling may be immediate or remote. Among the ditliculty, but it requires to be dealt with in a decided and more serious of the immediate consequences are the propractical manner. We have always maintained that inspecdnction of ante-partum haemorrhage, or the derangement of tion is in such cases the key to the position but this method the function of menstruation. A less important immediate in order to succeed ought to be carried much further than it be abrasion of the skin of the perineum now is. It should be made to apply to the case of every consequence may and parts adjacent ; this may probably be avoided by single infant sent away from the parent to be nursed. It choosing a good form of saddle-one that presses as little as should take cognisance of the character of the intending cuspossible on the perineum. The most serious remote con- to(lian. of her fitness for her duties, and we may add, of thesequence that appears to be possible is deformity of the health, condition, and prospects of the infant. It should pelvis. At present we do not think that the occurrence of provide for periodical official supervision of the nurse and such deformity as a result of cycling has been actually child. It would also be desirable as a safeguard, and a veryproved. We publish in another column an interesting article simple matter, to provide the nurses with a code of instrucon Perineal Pressure in Cycling by Mr. A. C. Roper. His tions as to necessary points in diet and hygiene. Hitherto paper is more especially concerned with the effects of cycling the State, beyond instituting a system of partial registration, in men. In the concluding paragraph, however, he makes a has made no regular provision for the requirements of nurse few remarks on cycling for women, and expresses the children. We trust that the evidences of legislative inadeopinion that women are less liable than men to damage from quacy which from time to time have been so painfully pressure. We should be disposed to take exception to this apparent will at length, and soon, receive that practical opinion. It is true, as Mr. Roper says, that in women the recognition which can alone make amends for past neglect in urethra is not much exposed to pressure and they have no reference to this subject. prostate to be bumped about. There is, however, the effect THE ADMINISTRATION OF THE VACCINATION of pressure on the shape of the pelvis to which we have ACTS IN THE COUNTY BOROUGH OF referred above which has especial importance in women : READING. and, again, if they have no prostate there are the uterus and Dn. ASHBY, medical officer of health for Reading, has just vagina which may be displaced or prolapsed, and there are issued a special report on the vaccination of this county uterine the appendages which are prone to inflammatory mischief. An old-standing perimetritic inflammation may borough, and the document has interest from several points easily be stirred into renewed activity by over-exertion or of Biew. Dr. Ashby first shows that the increase in the imprudence, especially at or about the time of a menstrual number of children unaccounted for as regards vaccination period. We should say that there are many more possi- had risen from 2’0 per cent. of registered births in 1872 to bilities of harm resulting from cycling in the case of women 24 4 per cent. in 1894, and he calculates that this represented a remanet of 26 unvaccinated infants for 1872 and 231 for than in the case of men. 1894. This rate of increase must mean for the period in question between 1000 and 2000 children who have no protecTHE REFORMATION OF BABY-FARMING. tion against small-pox. Another point well worthy of notice is the fact that certificates of so-called insusceptibility to THE horrors which have recently come to light in vaccination" are on the increase in the borough. As to this must have convinced the connexion with baby-farming he recalls the statement in Thorne last of Dr. Thorne’s observer the for most indifferent report to necessity employing the Local Government eff-eeto the effect that in the hands will but as not such measures Board, only threaten, of the several To vaccinators attached to the Board’s Vaccinaof the such barbarities. recurrence tually prevent, punish the criminal is just ; it is wise, also, because in tion Department there have been, within a certain term of some degree deterrent ; but the crimea themselves, for years, over 81,500 consecutive vaccinations of children, these are but representative of a class, prove that the either from arm-to-arm or from calf-to-arm, without the remedy remains to be discovered. In order to und this occurrence of a single case of "insusceptibility." And he we must be familiar with the conditions under which further records that in the hands of the Public Vaccinator the system of foster-parentage commonly maintains itself of Reading precisely the same result has been obtained as in the present day. Such conditions in very many the result of 14,000 primary vaccinations. The obvious lesson -
__
__
merely the effect of a too selfish regard is that insusceptibility must be regarded as all but nonor personal convenience. A child for some existent when vaccination is performed with fresh lymph in - reason, usually because it is expensive or illegitimate, is either of the methods referred to, and that it is essentially a considered to be superfluous and it is boarded out. The product of vaccination with stored lymph. And if the use transfer is regarded as a confidential matter and is con- of stored lymph leads so often to absolute failure at all ducted as a rule with all possible secrecy. The result may insertions made, and this on the three consecutive occabe favourable to the child. In many cases it is so, for the sions which alone constitute statutory insusceptibility, how cases
are
for domestic
1371
captured the bodies of establishing well-nigh
the hapless Barfleurians themselves, ineradicable depots wherever the them facilities. of hair afforded In one parpresence ticular alone could it be said that the intrusive mites were deserving of commendation. Contrary to the customs prevailing among certain of their congeners they refrained from burrowing beneath the epidermis of their unwilling hosts, who consequently, as the account now before us has it, remained free from cutaneous lesions. Had the very vigorous invaders taken to sinking tunnels after the fashion of their allies, the Sarcoptes scabiei, the condition of the Barfleurians would have been truly appalling, for even GRAVES’S DISEASE WITH UNILATERAL as it was the irritation, mental as well as corporeal, due IN a recent number of Grafe’sArchiv für Ophthalmologie to their ubiquitous tormentors became so unbearable that Dr. Percy Fridenburg of New York has described an interthe prefect had to be invoked on the principle of the esting case of this nature. His paper is abstracted in a deus ex machinâ. Barfleur, however, boasts of a Conseil recent number of the Neurologisches Centralblatt. The d’Hygiene, and very naturally the provincial ruler refera was woman a member of a patient aged twenty-four, red the matter to that learned body for investigation nervous family, whose excitability and nervousness were The contaminated houses were accordingly and report. increased by family misfortunes, and who complained of noted and disinfected, but the results were negative. Nothing unusual weariness, palpitation, difficulty in breathing, was capable of dislodging the pertinacious and impertinent frequent blushing, profuse perspiration, and weakness. creatures, which actually seemed to thrive on the means The palpebral aperture on the left side was disfor their repression. At length, tired of the contest, adopted tinctly widened, so that in looking straight forward the the local authorities appealed to the Natural History Museum sclerotic was visible two millimetres above the border of of Paris, begging for advice as to the best way of obtaining the cornea. The globe was distinct but not very prominent, deliverance from this incubus. In the opinion of the museum Gräfe’s sign was present, and vision was normal. The face, savants the intruders were closely allied to the acari which especially on the left side, was distinctly red, and with the are to be met with in places where organic matter is slowly slightest excitement this became extremely marked. Other the process of dry putrefaction-as, for example, symptoms were as follows : Swelling of the isthmus and thein herbaria or on anatomical preparations, stuffed birds, right lobe of the thyroid gland, fine fibrillary tremor of the dried and candied fruits, &c.-but preserves, tongue and hand, strong, occasionally intermittent cardiac inasmuch as the precise species could not be determined at impulse, accentuated second sound in the pulmonary area, a distance an would be designated to hold an expert diffuse impulse, increased cardiac dulness to the left, and on the spot. M. Perrier having been selected a loud bruit over the jugular vein. There was no sign of investigation for the duty consequently proceeded to Barfieur, and after valvular defect, and the pulse was 120. Respiration was some time succeeded in completely unmasking the enemy. superficial. Considerable improvement took place under theThe acarus which Barfleur has been so seriously by influence of rest, strophanthus, and bromide. The case turns out to be the Glyciphagus domesticus, a is an interesting example of Graves’s disease in which the hitherto regarded as extremely rare ; but although variety exophthalmos was one-sided, and the writer has collected might have been thought soothing to the feelings of the out of the literature of the subject as many as thirteen victims to learn that their visitors were such distinguished similar cases. members of the Arachnidae, they were nevertheless prosaic enough to maintain that the chief matter at issue was how A PLAGUE OF ACARI. to get rid of them. On this point, however, they were ONE of the weirdest conceptions of the talented writer of reassured by the museum authorities, who drew speedily "The Time Machine"is the monstrously overgrown centi- attention to the fact, which apparently was outside the ken pede putting to flight the degenerate human beings as it of the Conseil d’Hygiene, that the sulphur treatment comes looping along with armour-plates rattling, its gigantic systematically employed is almost infallible. Further interAfter head towering higher than the tallest elephant. esting details will be found in our Paris correspondent’s myriads of years the indomitable insect race, breaking letter in THE LANCET of May 9th. through the fixed limitations of the old dispensation, has at length been rewarded by corporeal growth comPREVENTION OF CRUELTY TO CHILDREN. mensurate with its courage and perseverance, while, on the other hand, pleasure loving and pain-fearing mortals THAT admirable body The National Society for the have degenerated into loathsome pigmies. It is fortunate Prevention of Cruelty to Children"held its annual public for the inhabitants of Barfleur that Mr. Wells’s blood- meeting upon May 12th at the Mansion House, and we are curdling vision is referable to the remotest future and glad to see that the society is flourishing, although the mere that the barrier restraining the potentiality of the insect fact of its existence discloses a most lamentable state world not only still remains impassable, but is also of things. Sir Richard Webster in moving a resolution likely to continue so for some considerable time to come. pointed out that although the society had an exceedingly With marvellous suddenness an entire quarter of the ancient difficult task to perform, and although naturally they seaport was recently invaded by a veritable horde of occasionally made mistakes, yet in the cases which acari, huge in respect of number if not individually, and they brought before the courts 96 per cent. convictions plenteously endowed with the energetic, not to say aggres- were obtained. We have lately commented in these columns sive, qualities so greatly belauded by the ingenious Mr. upon some specially gross cases of cruelty, and it Wells. With persistency worthy of a better cause the is gratifying to think how much brutality has been minute raiders commenced operations by entrenching them- stopped from going further, how many human fiends have selves securely in furniture and hangings and then sallied been punished and, we hope, made to pause and consider forth on marauding expeditions until kitchens, storerooms, before beginning systematic torture by the operation and wardrobes were all occupied by outlying parties. of this society. Weare glad to see that funds are Next they attacked the food and clothing, and finally they plentiful and that the society has become national, with
numerous must
be the occasions where
several insertions fail and only
one or more
out of
partial protection is ? Dr. Ashby properly protests against the granted’? Lastly, in a borough such as Reading with its 60,000 which position population is placed by the delegation of vaccination to the gaardians. Not only have the town council no right of intervention in this matter in their capacity as sanitary authority, but they are actually kept in the dark as to state of their borough as regards vaccination, and they are without remedy in the matter. a
the
SIGNS.
’
,
undergoing
mummies,
disturbed
it
____
’f
it er
’
patient is more or less an invalid, but without the existence of any definite organic disease. We have already called attention to the opposite opinions as to the effect of where the
transaction may be of a bonâ-fide character. In many more it is quite otherwise. After a few months it ends with the child’s death, and for some impoverished parent or unwedded bicycling on the pelvis. We may also mention that mother there is one incumbrance the less. To question theauthorities are equally divided as to the effect of bicycling existence of criminal complicity in a large number of such cases would be to ignore the most patent facts of leo-al on the perineum, some holding that the effect of bicycling on the perineum is to render the structures of the pelvic, floor evidence. As to the means employed these are not always dense or, indeed, almost cicatricial, and therefore extremely summary and certain, though the more gradual process of slow and difficult to dilate ; while others hold that the effect starvation is hardly less effectual in the end than actual is the exact opposite, and that, in patients who ride bicy- violence. Wearing, as it may do, the comparatively inno-. cles, the perineum actually dilates much mere readily, so cent aspect of an error in judgment it is, on the that the latter part of the second stage of labour is whole, safer-or at all events it is supposed to be so. In materially facilitated. There can be no doubt that bicycling judging of its reil character and motive there is need of the during a menstrual period is nnadvisable, and that to ride careful examination of circumstantial data. It is only after during pregnancy will in many women involve a special a scrutiny of these various facts that we can find ourselves liability to the occurrence of a miscarriage or of premature ina position to discuss the question of preventive treatment. labour. From what has been said it is evident that ill-effects To our own mind this docs not present any very serious due to bicycling may be immediate or remote. Among the ditliculty, but it requires to be dealt with in a decided and more serious of the immediate consequences are the propractical manner. We have always maintained that inspecdnction of ante-partum haemorrhage, or the derangement of tion is in such cases the key to the position but this method the function of menstruation. A less important immediate in order to succeed ought to be carried much further than it be abrasion of the skin of the perineum now is. It should be made to apply to the case of every consequence may and parts adjacent ; this may probably be avoided by single infant sent away from the parent to be nursed. It choosing a good form of saddle-one that presses as little as should take cognisance of the character of the intending cuspossible on the perineum. The most serious remote con- to(lian. of her fitness for her duties, and we may add, of thesequence that appears to be possible is deformity of the health, condition, and prospects of the infant. It should pelvis. At present we do not think that the occurrence of provide for periodical official supervision of the nurse and such deformity as a result of cycling has been actually child. It would also be desirable as a safeguard, and a veryproved. We publish in another column an interesting article simple matter, to provide the nurses with a code of instrucon Perineal Pressure in Cycling by Mr. A. C. Roper. His tions as to necessary points in diet and hygiene. Hitherto paper is more especially concerned with the effects of cycling the State, beyond instituting a system of partial registration, in men. In the concluding paragraph, however, he makes a has made no regular provision for the requirements of nurse few remarks on cycling for women, and expresses the children. We trust that the evidences of legislative inadeopinion that women are less liable than men to damage from quacy which from time to time have been so painfully pressure. We should be disposed to take exception to this apparent will at length, and soon, receive that practical opinion. It is true, as Mr. Roper says, that in women the recognition which can alone make amends for past neglect in urethra is not much exposed to pressure and they have no reference to this subject. prostate to be bumped about. There is, however, the effect THE ADMINISTRATION OF THE VACCINATION of pressure on the shape of the pelvis to which we have ACTS IN THE COUNTY BOROUGH OF referred above which has especial importance in women : READING. and, again, if they have no prostate there are the uterus and Dn. ASHBY, medical officer of health for Reading, has just vagina which may be displaced or prolapsed, and there are issued a special report on the vaccination of this county uterine the appendages which are prone to inflammatory mischief. An old-standing perimetritic inflammation may borough, and the document has interest from several points easily be stirred into renewed activity by over-exertion or of Biew. Dr. Ashby first shows that the increase in the imprudence, especially at or about the time of a menstrual number of children unaccounted for as regards vaccination period. We should say that there are many more possi- had risen from 2’0 per cent. of registered births in 1872 to bilities of harm resulting from cycling in the case of women 24 4 per cent. in 1894, and he calculates that this represented a remanet of 26 unvaccinated infants for 1872 and 231 for than in the case of men. 1894. This rate of increase must mean for the period in question between 1000 and 2000 children who have no protecTHE REFORMATION OF BABY-FARMING. tion against small-pox. Another point well worthy of notice is the fact that certificates of so-called insusceptibility to THE horrors which have recently come to light in vaccination" are on the increase in the borough. As to this must have convinced the connexion with baby-farming he recalls the statement in Thorne last of Dr. Thorne’s observer the for most indifferent report to necessity employing the Local Government eff-eeto the effect that in the hands will but as not such measures Board, only threaten, of the several To vaccinators attached to the Board’s Vaccinaof the such barbarities. recurrence tually prevent, punish the criminal is just ; it is wise, also, because in tion Department there have been, within a certain term of some degree deterrent ; but the crimea themselves, for years, over 81,500 consecutive vaccinations of children, these are but representative of a class, prove that the either from arm-to-arm or from calf-to-arm, without the remedy remains to be discovered. In order to und this occurrence of a single case of "insusceptibility." And he we must be familiar with the conditions under which further records that in the hands of the Public Vaccinator the system of foster-parentage commonly maintains itself of Reading precisely the same result has been obtained as in the present day. Such conditions in very many the result of 14,000 primary vaccinations. The obvious lesson -
__
__
merely the effect of a too selfish regard is that insusceptibility must be regarded as all but nonor personal convenience. A child for some existent when vaccination is performed with fresh lymph in - reason, usually because it is expensive or illegitimate, is either of the methods referred to, and that it is essentially a considered to be superfluous and it is boarded out. The product of vaccination with stored lymph. And if the use transfer is regarded as a confidential matter and is con- of stored lymph leads so often to absolute failure at all ducted as a rule with all possible secrecy. The result may insertions made, and this on the three consecutive occabe favourable to the child. In many cases it is so, for the sions which alone constitute statutory insusceptibility, how cases
are
for domestic
1371
captured the bodies of establishing well-nigh
the hapless Barfleurians themselves, ineradicable depots wherever the them facilities. of hair afforded In one parpresence ticular alone could it be said that the intrusive mites were deserving of commendation. Contrary to the customs prevailing among certain of their congeners they refrained from burrowing beneath the epidermis of their unwilling hosts, who consequently, as the account now before us has it, remained free from cutaneous lesions. Had the very vigorous invaders taken to sinking tunnels after the fashion of their allies, the Sarcoptes scabiei, the condition of the Barfleurians would have been truly appalling, for even GRAVES’S DISEASE WITH UNILATERAL as it was the irritation, mental as well as corporeal, due IN a recent number of Grafe’sArchiv für Ophthalmologie to their ubiquitous tormentors became so unbearable that Dr. Percy Fridenburg of New York has described an interthe prefect had to be invoked on the principle of the esting case of this nature. His paper is abstracted in a deus ex machinâ. Barfleur, however, boasts of a Conseil recent number of the Neurologisches Centralblatt. The d’Hygiene, and very naturally the provincial ruler refera was woman a member of a patient aged twenty-four, red the matter to that learned body for investigation nervous family, whose excitability and nervousness were The contaminated houses were accordingly and report. increased by family misfortunes, and who complained of noted and disinfected, but the results were negative. Nothing unusual weariness, palpitation, difficulty in breathing, was capable of dislodging the pertinacious and impertinent frequent blushing, profuse perspiration, and weakness. creatures, which actually seemed to thrive on the means The palpebral aperture on the left side was disfor their repression. At length, tired of the contest, adopted tinctly widened, so that in looking straight forward the the local authorities appealed to the Natural History Museum sclerotic was visible two millimetres above the border of of Paris, begging for advice as to the best way of obtaining the cornea. The globe was distinct but not very prominent, deliverance from this incubus. In the opinion of the museum Gräfe’s sign was present, and vision was normal. The face, savants the intruders were closely allied to the acari which especially on the left side, was distinctly red, and with the are to be met with in places where organic matter is slowly slightest excitement this became extremely marked. Other the process of dry putrefaction-as, for example, symptoms were as follows : Swelling of the isthmus and thein herbaria or on anatomical preparations, stuffed birds, right lobe of the thyroid gland, fine fibrillary tremor of the dried and candied fruits, &c.-but preserves, tongue and hand, strong, occasionally intermittent cardiac inasmuch as the precise species could not be determined at impulse, accentuated second sound in the pulmonary area, a distance an would be designated to hold an expert diffuse impulse, increased cardiac dulness to the left, and on the spot. M. Perrier having been selected a loud bruit over the jugular vein. There was no sign of investigation for the duty consequently proceeded to Barfieur, and after valvular defect, and the pulse was 120. Respiration was some time succeeded in completely unmasking the enemy. superficial. Considerable improvement took place under theThe acarus which Barfleur has been so seriously by influence of rest, strophanthus, and bromide. The case turns out to be the Glyciphagus domesticus, a is an interesting example of Graves’s disease in which the hitherto regarded as extremely rare ; but although variety exophthalmos was one-sided, and the writer has collected might have been thought soothing to the feelings of the out of the literature of the subject as many as thirteen victims to learn that their visitors were such distinguished similar cases. members of the Arachnidae, they were nevertheless prosaic enough to maintain that the chief matter at issue was how A PLAGUE OF ACARI. to get rid of them. On this point, however, they were ONE of the weirdest conceptions of the talented writer of reassured by the museum authorities, who drew speedily "The Time Machine"is the monstrously overgrown centi- attention to the fact, which apparently was outside the ken pede putting to flight the degenerate human beings as it of the Conseil d’Hygiene, that the sulphur treatment comes looping along with armour-plates rattling, its gigantic systematically employed is almost infallible. Further interAfter head towering higher than the tallest elephant. esting details will be found in our Paris correspondent’s myriads of years the indomitable insect race, breaking letter in THE LANCET of May 9th. through the fixed limitations of the old dispensation, has at length been rewarded by corporeal growth comPREVENTION OF CRUELTY TO CHILDREN. mensurate with its courage and perseverance, while, on the other hand, pleasure loving and pain-fearing mortals THAT admirable body The National Society for the have degenerated into loathsome pigmies. It is fortunate Prevention of Cruelty to Children"held its annual public for the inhabitants of Barfleur that Mr. Wells’s blood- meeting upon May 12th at the Mansion House, and we are curdling vision is referable to the remotest future and glad to see that the society is flourishing, although the mere that the barrier restraining the potentiality of the insect fact of its existence discloses a most lamentable state world not only still remains impassable, but is also of things. Sir Richard Webster in moving a resolution likely to continue so for some considerable time to come. pointed out that although the society had an exceedingly With marvellous suddenness an entire quarter of the ancient difficult task to perform, and although naturally they seaport was recently invaded by a veritable horde of occasionally made mistakes, yet in the cases which acari, huge in respect of number if not individually, and they brought before the courts 96 per cent. convictions plenteously endowed with the energetic, not to say aggres- were obtained. We have lately commented in these columns sive, qualities so greatly belauded by the ingenious Mr. upon some specially gross cases of cruelty, and it Wells. With persistency worthy of a better cause the is gratifying to think how much brutality has been minute raiders commenced operations by entrenching them- stopped from going further, how many human fiends have selves securely in furniture and hangings and then sallied been punished and, we hope, made to pause and consider forth on marauding expeditions until kitchens, storerooms, before beginning systematic torture by the operation and wardrobes were all occupied by outlying parties. of this society. Weare glad to see that funds are Next they attacked the food and clothing, and finally they plentiful and that the society has become national, with
numerous must
be the occasions where
several insertions fail and only
one or more
out of
partial protection is ? Dr. Ashby properly protests against the granted’? Lastly, in a borough such as Reading with its 60,000 which position population is placed by the delegation of vaccination to the gaardians. Not only have the town council no right of intervention in this matter in their capacity as sanitary authority, but they are actually kept in the dark as to state of their borough as regards vaccination, and they are without remedy in the matter. a
the
SIGNS.
’
,
undergoing
mummies,
disturbed
it
____
’f
it er
’