- Email: [email protected]
THE CIVIL SURGEON AT THE WAR.
THE POOR AND THE PLAGUE
1376
who count their gains by guineas instead of shillings to indulge in cheap sneers at the" tradesmanlike" attitude of the general practitioner, but as a descendant myself of a commercial family I fail to see the stigma of being dubbed
THE
POOR
AND
THE
PLAGUE IN
GLASGOW.
In fact, grocers, haberdashers, and others are by the same customers who go the-round of all the doctors in the place and pay no one. With regard to emergency calls in general, I have been summoned in haste to a sudden illness in a factory near by, the employé who took the message having evidently had instructions to run for the nearest medical man. In due time I presented my account to the employer for one emergency visit, which paper was returned promptly with the curt reply written across the back, " We have nothing to do with this." Now, Sirs, can you wonder that in such circumstances, and with such treatment, some people have a difficulty in procuring medical aid in their hour of need. If the legislature is going to compel us to run to any and everybody who chooses to send for any one of us, then the legislature will have to pay adequate salaries all round to thousands of those who, like myself, can subscribe themselves, Yours faithfully, a
IN;’GLASGOW.
tradesman.
(FROM
OUR
SPECIAL SANITARY
COMMISSIONER.)
too often robbed
Nov.
G. P.
llth, 1901.
THE CIVIL SURGEON AT THE WAR. To the Editors of THE LANCET. SIRS,-The position of the civil surgeon now serving in the South African war is perhaps the most curiously anomalous In a national emergency he offered his one on record. services ; his country eagerly accepted them ; he was more than necessary-they could not do without him. The authorities had succeeded in making the Royal Army Medical Corps so unpopular that, always terribly undermanned in times of peace, it was hopelessly inadequate in times of war. Surgeons must be had, and that quickly. Surgeons heard the call and responded nobly. They left their practices, their wives, and their children, not for love of martial glory or yet for greed of gain, but out of sheer pity for poor suffering humanity. They had not only the bullet to fear, they had to fight the deadliest disease as well. It has never yet been realised that they, of all others, have made the most sacrifice for their country and will receive the least reward. The civil surgeon has no position ; he holds no status in the army ; he is not even granted the temporary rank that rejoices the chaplain’s heart. Non-commissioned officers and men of the Royal Army Medical Corps pass him by without salutation-they are frequently guilty of incivility. The civil surgeon has come without a wedding garment, so to speak, and his very existence is hardly officially recognised. Some assert that he is well paid for his work. Let us see. When he signs his contract with the War Office he is given a list of things that a kindly, fatherly Government advisers"him to get-a khaki uniform is one of the items. If he wants to walk about Africa in a frock-coat and top hat the kindly Government will not stop him ; it does not command a uniform any more than it commands a waterproof sheet and a flannel shirt, but it gently recommends"what are absolutely unavoidable necessities. Thus does it slide out of its responsibilities instead of making a proper grant for the purpose. At the end of the war the civil surgeon is presented with a " gratuity " of 60 and is sent home to his family very much the worse for wear and tear, with a shattered constitution and very ragged clothes. The 60 is not lost upon him, but, unfortunately, it has " gone before" in providing the above-mentioned equipment. A chaplain receives 100—one wonders why, for his services cannot be compared to the hard round that falls to a surgeon’s lot. Day and night he is ever at work. For this he receives Plper day, 3s. 6d. field allowance, and Is. 6d. for servant, but he has no Colonial allon’ance. In view of the extraordinary expenses of South African life, where things are 100 per cent. dearer than at home, all other officers are given this Colonial allowance, but the civil surgeon has to buy his eggs for breakfast out of his own pocket should he want them (they are 9s. 6d. a dozen) or go without. An experienced miner can earn from 50 to E70 per month and cannot live in great extravagance on that. No professional man should go out to Africa in any capacity at all unless he is absolutely assured of an income of at least .S500 a year. ’
I am, Sirs, yours faithfully,
Nov. llth,
1901.
A UIVIL SURGEON.
THE fact that some cases of plague have again occurred in Glasgow renders all questions of sanitation in connexioD with that great city and port of more than usual interest. Dr. A. K. Chalmers, the medical officer of health, in his able and exhaustive report on the cases of plague which occurred in Glasgow during the autumn of 1900, says: "In the whole range of plague literature no feature in the spread of the disease is more uniformly insisted upon than its association with local conditions of grossly defective " hygiene." Further, we are reminded that of the dustmen engaged in disinfecting dwellings in Bombay it was only those who lived in bad sanitary conditions who contracted the disease. Then Mr. James Cantlie has related that the eight Chinese students who acted as attendants in a plague ward at the Hong-Kong Hospital were free from the plague, though their relations living at home in less sanitary surroundings did suffer. But to return to Glasgow, Dr. Chalmers explains that the majority of the houses where plague occurred were hotbeds of vermin and that in one of these tenements, registered as large enough to hold only four persons, there were eight tenants. The disease, fortunately, was stamped out, but after a lapse of some 12 months it has reappeared, and though this time again it does not seem as if it were going to spread, still it is impossible to avoid feeling some anxiety. It is true that Glasgow has acquired a high reputation for its spirit of enterprise in matters relating to sanitation, but in regard to immunity from epidemic disease it is not so much a question of how much has been done as of how much there is yet to do. Many improvements may be achieved and yet so many defects may still remain that a sense of security cannot be justified. This is actually the case at Glasgow. At the meetings of the British Association, and of the International Congress of Engineers, and at the Conference of Municipal Representatives on the Housing of the Poor recently held in Glasgow and described at some length in THE LANCET,l much was said which clearly indicated that the corporation of Glasgow itself was in no wire satisfied with the existing condition of the dwellings of the poor; indeed, a mere casual stroll through some of the streets, especially on the south side of the Clyde, where most of the cases of plague occurred, is sufficient to make it evident that there still remains in this great and prosperous city an appalling amount of poverty, squalor, and dirt. Then if, further, some of the houses are visited, especially at night, it will be seen that, in spite of laws and regulations, sanitary inspectors, and private philanthropy, overcrowding still prevails and this on such an extensive scale as to create a serious public danger. On the otherhand, if the record of work done is studied it seems very creditable, but unfortunately it does not suffice. The Lord Provost, Dr. Samuel Chisholm, was able to explain to the British Association that 25 years ago there was in central Glasgow a great accumulation of narrow streets, dismal lanes, and filthy closes "where disease and death held high carnival, and vice and crime lifted their heads unabashed." But special Acts of Parliament have been obtained and the larger portion of this district has been reconstructed and the remainder is being dealt with. As a result, the death-rate, which in 187& was 27-4 per 1000, is now 21-1 per 1000 for the whole town. But the death-rate of the central district was 40 per 1000, and it is still 30 per 1000. In the same interval the area of the public parks has been extended from 370 to 1055 acres and the Health Department has provided 19 open playgrounds for children. At the same time the population has increased from 510,000 in 1876 to 761,152 in 1901, so that there is much greater need of open spaces. To deal with this large population no less than 225 persons are now employed on the sanitary staff of the corporation, and yet overcrowding cannot be altogether prevented. Nevertheless, improvements are effected. For instance, the number of nuisances recorded in 1876 amounted to 13,406 md in 1900 there were no less than 44,148 complaints. 1
THE
LANCET, Oct. 5th, p. 943, and 19th, 1901, p. 1081.
1376
who count their gains by guineas instead of shillings to indulge in cheap sneers at the" tradesmanlike" attitude of the general practitioner, but as a descendant myself of a commercial family I fail to see the stigma of being dubbed
THE
POOR
AND
THE
PLAGUE IN
GLASGOW.
In fact, grocers, haberdashers, and others are by the same customers who go the-round of all the doctors in the place and pay no one. With regard to emergency calls in general, I have been summoned in haste to a sudden illness in a factory near by, the employé who took the message having evidently had instructions to run for the nearest medical man. In due time I presented my account to the employer for one emergency visit, which paper was returned promptly with the curt reply written across the back, " We have nothing to do with this." Now, Sirs, can you wonder that in such circumstances, and with such treatment, some people have a difficulty in procuring medical aid in their hour of need. If the legislature is going to compel us to run to any and everybody who chooses to send for any one of us, then the legislature will have to pay adequate salaries all round to thousands of those who, like myself, can subscribe themselves, Yours faithfully, a
IN;’GLASGOW.
tradesman.
(FROM
OUR
SPECIAL SANITARY
COMMISSIONER.)
too often robbed
Nov.
G. P.
llth, 1901.
THE CIVIL SURGEON AT THE WAR. To the Editors of THE LANCET. SIRS,-The position of the civil surgeon now serving in the South African war is perhaps the most curiously anomalous In a national emergency he offered his one on record. services ; his country eagerly accepted them ; he was more than necessary-they could not do without him. The authorities had succeeded in making the Royal Army Medical Corps so unpopular that, always terribly undermanned in times of peace, it was hopelessly inadequate in times of war. Surgeons must be had, and that quickly. Surgeons heard the call and responded nobly. They left their practices, their wives, and their children, not for love of martial glory or yet for greed of gain, but out of sheer pity for poor suffering humanity. They had not only the bullet to fear, they had to fight the deadliest disease as well. It has never yet been realised that they, of all others, have made the most sacrifice for their country and will receive the least reward. The civil surgeon has no position ; he holds no status in the army ; he is not even granted the temporary rank that rejoices the chaplain’s heart. Non-commissioned officers and men of the Royal Army Medical Corps pass him by without salutation-they are frequently guilty of incivility. The civil surgeon has come without a wedding garment, so to speak, and his very existence is hardly officially recognised. Some assert that he is well paid for his work. Let us see. When he signs his contract with the War Office he is given a list of things that a kindly, fatherly Government advisers"him to get-a khaki uniform is one of the items. If he wants to walk about Africa in a frock-coat and top hat the kindly Government will not stop him ; it does not command a uniform any more than it commands a waterproof sheet and a flannel shirt, but it gently recommends"what are absolutely unavoidable necessities. Thus does it slide out of its responsibilities instead of making a proper grant for the purpose. At the end of the war the civil surgeon is presented with a " gratuity " of 60 and is sent home to his family very much the worse for wear and tear, with a shattered constitution and very ragged clothes. The 60 is not lost upon him, but, unfortunately, it has " gone before" in providing the above-mentioned equipment. A chaplain receives 100—one wonders why, for his services cannot be compared to the hard round that falls to a surgeon’s lot. Day and night he is ever at work. For this he receives Plper day, 3s. 6d. field allowance, and Is. 6d. for servant, but he has no Colonial allon’ance. In view of the extraordinary expenses of South African life, where things are 100 per cent. dearer than at home, all other officers are given this Colonial allowance, but the civil surgeon has to buy his eggs for breakfast out of his own pocket should he want them (they are 9s. 6d. a dozen) or go without. An experienced miner can earn from 50 to E70 per month and cannot live in great extravagance on that. No professional man should go out to Africa in any capacity at all unless he is absolutely assured of an income of at least .S500 a year. ’
I am, Sirs, yours faithfully,
Nov. llth,
1901.
A UIVIL SURGEON.
THE fact that some cases of plague have again occurred in Glasgow renders all questions of sanitation in connexioD with that great city and port of more than usual interest. Dr. A. K. Chalmers, the medical officer of health, in his able and exhaustive report on the cases of plague which occurred in Glasgow during the autumn of 1900, says: "In the whole range of plague literature no feature in the spread of the disease is more uniformly insisted upon than its association with local conditions of grossly defective " hygiene." Further, we are reminded that of the dustmen engaged in disinfecting dwellings in Bombay it was only those who lived in bad sanitary conditions who contracted the disease. Then Mr. James Cantlie has related that the eight Chinese students who acted as attendants in a plague ward at the Hong-Kong Hospital were free from the plague, though their relations living at home in less sanitary surroundings did suffer. But to return to Glasgow, Dr. Chalmers explains that the majority of the houses where plague occurred were hotbeds of vermin and that in one of these tenements, registered as large enough to hold only four persons, there were eight tenants. The disease, fortunately, was stamped out, but after a lapse of some 12 months it has reappeared, and though this time again it does not seem as if it were going to spread, still it is impossible to avoid feeling some anxiety. It is true that Glasgow has acquired a high reputation for its spirit of enterprise in matters relating to sanitation, but in regard to immunity from epidemic disease it is not so much a question of how much has been done as of how much there is yet to do. Many improvements may be achieved and yet so many defects may still remain that a sense of security cannot be justified. This is actually the case at Glasgow. At the meetings of the British Association, and of the International Congress of Engineers, and at the Conference of Municipal Representatives on the Housing of the Poor recently held in Glasgow and described at some length in THE LANCET,l much was said which clearly indicated that the corporation of Glasgow itself was in no wire satisfied with the existing condition of the dwellings of the poor; indeed, a mere casual stroll through some of the streets, especially on the south side of the Clyde, where most of the cases of plague occurred, is sufficient to make it evident that there still remains in this great and prosperous city an appalling amount of poverty, squalor, and dirt. Then if, further, some of the houses are visited, especially at night, it will be seen that, in spite of laws and regulations, sanitary inspectors, and private philanthropy, overcrowding still prevails and this on such an extensive scale as to create a serious public danger. On the otherhand, if the record of work done is studied it seems very creditable, but unfortunately it does not suffice. The Lord Provost, Dr. Samuel Chisholm, was able to explain to the British Association that 25 years ago there was in central Glasgow a great accumulation of narrow streets, dismal lanes, and filthy closes "where disease and death held high carnival, and vice and crime lifted their heads unabashed." But special Acts of Parliament have been obtained and the larger portion of this district has been reconstructed and the remainder is being dealt with. As a result, the death-rate, which in 187& was 27-4 per 1000, is now 21-1 per 1000 for the whole town. But the death-rate of the central district was 40 per 1000, and it is still 30 per 1000. In the same interval the area of the public parks has been extended from 370 to 1055 acres and the Health Department has provided 19 open playgrounds for children. At the same time the population has increased from 510,000 in 1876 to 761,152 in 1901, so that there is much greater need of open spaces. To deal with this large population no less than 225 persons are now employed on the sanitary staff of the corporation, and yet overcrowding cannot be altogether prevented. Nevertheless, improvements are effected. For instance, the number of nuisances recorded in 1876 amounted to 13,406 md in 1900 there were no less than 44,148 complaints. 1
THE
LANCET, Oct. 5th, p. 943, and 19th, 1901, p. 1081.