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THE CLINICAL RESEARCH ASSOCIATION.
1001 towels, and a laryngeal mirror ;and after the inspection of testified to the high opinion formed by the Commissioners eaoh’child’s throat the tongue depressor is carefully cleansed of the results of Mr. Schönthell’s teaching, and added in a basin of hot water, the contents of which are frequently that he had no doubt that with the more favourable con. changed. This cleansing of the spatula is a very important ditions under which, as he understood, Mr. Schöntheil was care cannot be exercised. Boiling now working, the results which would be attained would be theoretically be the safest course, but there are even more successful than heretofore. certainly practical difficultiEs in the way of using it-such, for instance, of maintaining the water at boiling point and THE ROYAL COMMISSION ON TUBERCULOSIS. CM)ing the spatula after immersion. Probably Mr. Lake’s IT will he remembered that this Commission was appointed method carefully carried out is all that is necessary, in Jaly, 1890 with the following reference : " To inquire and though perhaps the immersion of the spatula in a (Its- report what is the effect, if any, of food derived from tuberinfectant solution and then in the hot water would be culous animals on human health, and, if prejudicial, what a course better ealculated to di5arm theoretical criticisms are the circumstances and conditions with regard to the Mr. Lake’s which have to our knowledge been made. tuberculosis in the animal which that effect upon plan is to exclude from school every child presenting man." This reference resulted fromproduce the desire oE the Governthe least signs of a sore-throat, and he has succeeded ment to obtain an authoritative scientific opinion on the public in keeping most of such cases from school until the health aspect of the question before it could deal with the throat has become normal. In cases of enlarged numerous complaints made by meat and milk traders of the tonsils or elongated uvula he advises removal. Mr. Lake great diversity of practice in dealing with this class of food reports that since he has adopted the measures above that exists in different places. The Commission of 1890 met referred to he has noticed a remarkable diminution of under the chairmanship of Lord Basing, the other members diphtheria in those districts where the disease formerly being Professor Brown, Sir George Buchanan, Dr. Payne, and persisted, and that the occasion for school closure does not Professor Burdon Sanderson. On Lord Basing’s death in seem to arise either from diphtheria or scarlet fever, as in October of last year the experimental inquiries of the Comaddition to the above measures he exercises a rigid control mission were not completed, and the Commission was reover infected houses and their inmates. Mr. Lake points out with Sir George Buchanan a9 chairman. We that to some extent his practice plays havoc with the school organised urderstand that this Commission has now agreed upon its attendance as it necessitates excluding all cases of sorereport, which will be presented to Parliament in the course throat, however trivial. He thinks, however, that the Educa,-
point,
and too much
water would
tion Acts should be adapted to the times, and that children excluded by the medical officers of health should, for statis. tical purposes, be regarded as having continued their attend.
of next week.
THE CLINICAL RESEARCH ASSOCIATION.
WE have received the small handbook of the Clinical Research Association, Limited, in which are carefully and clearly set forth the aims of the association and its methods THE ORAL INSTRUCTION OF THE DEAF. of work. As there seems to be some little misunderstanding A MEETING composed of medical men and others interested as to the objects and position of this association the appearin the education of the deaf and dumb was held on the ance of this little woik is well-timed, and we cannot but 5;hicst. at 26, Golden-square, for the purpose of hearing a think that many of those who take the trouble to study its lecture from Mr. S. Sohöatheil, for many years head master of pages will come to the conclusion that it will be advisable the Jaws’ Deaf and Damb Home, on the most modern and for them to join the association. The Clinical Research scientific method of training the deaf and dumb, so as to Association has for its object the provision of a clinical enable them to use articulate speech and to give them a full laboratory equal to, or better than, many of those connected command of language. The lecturer opened the proceedings with the various schools of medicine and hospitals ; which by introducing several of his pupils and testing the results laboratory shall be open for the carrying on of the work of their training by exercises in pronunciation, lip reading, required by those engaged in general practice who, with the dictation, recitation, reading, and answering miscellaneous best will in the world, have neither time nor opportunity to questions. Through this searching ordeal the pupils passed make those irregular or tedious observations which are often very successfully. Most people are aware of the enormous required to complete a diagnosis. Sach a laboratory has difficulty entailed in teaching the deaf to speak ; where often been suggested, but the difficulty of carrying on, side a child is stone-deaf the obstacles are greatly enhanced by side, original investigation for the sake, merely, of In what is to be found oat and the same investigation and the intonation is apt to be specially faulty. this respect Mr. Sahöntheil’s pupils acquitted them- in return for a definite fee has always cropped up. selves with marked success. The lecturer explained that We are glad to see, however, that the association has in the case of several the instruction imparted to them taken the bull by the horns, and has laid down the prohad first of all proceeded on a faulty basis, and that in con- position that in pathology and clinical research the labourer sequence they had been compelled to unlearn much that is worthy of hishirejust as much as when the same labourer they had first learnt. Nevertheless, steady progrees had been is feeling a pulse and writing a prescription. The work of since achieved, and the re3ults were considered very the association ia not done for old pupils, for old teachers, or promising by the experts present. Mr. Schontheil then for personal friends, and, therefore, a fee is expected for expounded in his paper the aim of the oral method to each investigation as surely as one is expected for a conrestore the deaf to the society from which his defect sultation. The association undertakes to examine sputum tends to cut him off and laid special stress on the for tubercle bacilli and for other micro-organisms, for lung endeavour which he considered ought to be made to avoid tissue, &c. The examination of urine, blood, pus, vomit, distoitions of the face and raucous sounds. After giving and faeces is undertaken ; tumours and diseased tissues examples of the lines of thought by which the insttuotion of are investigated, and specimens taken from the throats the deaf was to be conveyed, he concluded with pointing out of diphtheria patients are examined and analyses of drinking the .trong necessity for having properly trained teachers of water and poisons are made. Although the fees for these the deaf and for devaticg special and individual attention examinations appear to be somewhat low we suppose that and kindness to each pupils. Mr. Charles E. D. Black the association can afford to send good reports in consequence formerly secretary to the Royal Commission on the Deaf, of the number of specimens that they have to examine. Iu
ance.
___
1002 fact,
it is acknowledged that a large proportion of the examinations which are undertaken could not possibly be reliable at the price charged unless the association received a large measure of support from the profession, so that a number of examinations of the same character may proceed side by side. The association already numbers over 850 members, and over 2300 specimens have been examined and reported upon during the past six months. This is an exceedingly good record, and the association, if it continues to be ag well managed as it apparently is at present, should ultimately be very successful indeed. Through its agency the best opinions are placed at the disposal of every member of the association, and the g1.in to diagnostic accuracy arising from such work must be enormous. We wish the association the success it deserves.
but only the hardiest of them survived. We, cast in more tender moulds, and require protechowever, tion by night as well as day. The feminine portion of the community will, we fear, not adopt Mr. Ashby-Sterry’s suggestion, for though, as an eminent authoress once remarked, "a woman looks so down-trodden in her nightdress," still that vesture offers opportunities for ornament which pyjamas, at best unlovely garments, never do. Perhaps the Rational Dress Society may take the matter up, and Mr. Henry Holiday might turn his attention to devising a really artistic as well as hygienic night-gear. a
are
THE AGE-CONSTITUTION AND THE DEATH-RATE. THE closer dependence of the death-rate on the age. constitution than on the sanitary condition of a community, rendering it absolutely necessary to reduce the former to a common standard before any conclusions can be drawn as regards the public health, is well known to statists, but little understood by the general public or their local repre. sentation. A strikirg illustration is given by Mr. May, medical officer of health for Aston Manor, in his report for last year. The age-constitution of the population as given at the last two censuses was :
___
THE REAPPOINTMENT OF MEDICAL OFFICERS OF HEALTH. WE have called attention in our columns from time to time to the insecurity of these appointments, and for the benefit of the community it would be well if the Local Government Board would formulate some regulations which would prevent the annual reappointment of such officers. To subject the medical officer of a district council to annual re-election is an anomaly which ought not to exist and practically is an incentive to avoid doing anything which might offend some of its members. Last week Mr. Hannah, the medical officer of health for Abram, a colliery district in Lancashire, retained his appointment by the casting vote of the chairman only. ]Ie has held the appointment for nineteen years and discharged the duties conscientiously and with great ability ; no fault could be found with him in this respect. He has, moreover, been subject to annual re-election. This time the new district council advertised the appointment, and an opponent was brought in the field-with the result that the casting vote of the chairman was required for Mr. Hannah to retain the appointment held so long by him. Why should the health officers (medical officer and sanitary inspector) be the only officers subject to such a rule ? Why not the clerk and surveyor also? Even the board itself is not subject to an annual re-election. Medical officers of health should now bestir themselves in regard to the tenure of their appointments.
This enormous reduction in the child population and relative increase of ages between fifteen and thirty-five, those of lower mortality, is wholly due to a continuous decline in the birth-rate during the last fifteen years, which has shown itself in a reduced death-rate, and more palpably in the fact that, though the population had increased between 1881 and 1891 from 53,842 to 68,639, the demand for school accommodation was almost stationary. Thus far the change in
constitution has had an apparently favourable influence on the death-rate, but if it continue to operate it will lead to an accumulation of persons over forty-five years of age and be followed by a steady rise in the death-rate, however excellent the sanitary condition of the district may be, when the authorities will be as eager as they are now unwilling to have the recorded death-rates "corrected."
-
ON CATCHING COLD. wrote a paper pointing out the appalgoing to bed as exemplified in bills of one For mortality. person who died out of his bed several hundreds succumbed in bed, and now we have Mr. AshbySteriy drawing attention to the same thing. Hitherto he has hymned in graceful verse pantalettes, frills, and the tempestuous petticoat, and now, qzcantum 7mdatus ab illo hectors, he lauds the pyjama. In a recent number of the Graphic he says :-
MARK TWAIN ling danger of
needil " ;
once
I
"I have a theory that most people catch cold at night after they are in bed, and it is to this fact I attribute a great deal of the violent colds, the bronchial catarrhs, ard innuerzj, which have recently been so prevalent. The temperature goes down suddenly in the night, and people catch cold when they are asleep without knowing it. This evil is to be counteracted, not by piling on a lot of heavy blankets, but by wearing thick, close-fitting garments of a py jama-like nature and warm socks on the feet. If this system were adopted I am quite certain that it would be found beneficial." There is common sense in this. People unquestionably may catch cold in bed, especially if they are at all restless and so kick the bedclothes off. In that event, if only clad in a thin cotton nightshirt, they are sure to catch cold, whereas if clad in pjmas, not necensarily thick but made of some woollen mareiial, the chance of a chill is much lessened. Our ancestors, even as late as the eighteenth century, went to bed, as Malory centuries earlier phrased it, "as naked as
I
MEDICAL CERTIFICATES FOR THE LONDON BOARD SCHOOLS.
AT a recent meeting of the London School Board a report of the school management committee was adopted to the effect that three medical men should be appointed to examine cases in which medical certificates were produced to account for non- attendance at school. Whether it is supposed by the members of the Board that medical certificates are forged by parents who desire to keep their children from school we are not informed; but that seems hardly likely to be the explanation, for the detection of a forgery would not require the services of a medical practitioner. It is, indeed, hardly possible to avoid the inference that the Board has thus put a slight upon the medical profession by affirming the necessity for the supervision of the certifying medical practitioners in respect of this trivial matter of school attendWe are sorry to be driven to this conclusion, and we ance. feel that in view of it we may fairly invite the majority of the School Board to reconsider their decision. The men whom they refuse to trust in this small matter are the same men to whose absolute discretion and approved skill the weightiest matters are unreservedly entrusted both by law and the custom of society. It is something new and by no means agreeable to the profession at large to have a .
point,
and too much
water would
tion Acts should be adapted to the times, and that children excluded by the medical officers of health should, for statis. tical purposes, be regarded as having continued their attend.
of next week.
THE CLINICAL RESEARCH ASSOCIATION.
WE have received the small handbook of the Clinical Research Association, Limited, in which are carefully and clearly set forth the aims of the association and its methods THE ORAL INSTRUCTION OF THE DEAF. of work. As there seems to be some little misunderstanding A MEETING composed of medical men and others interested as to the objects and position of this association the appearin the education of the deaf and dumb was held on the ance of this little woik is well-timed, and we cannot but 5;hicst. at 26, Golden-square, for the purpose of hearing a think that many of those who take the trouble to study its lecture from Mr. S. Sohöatheil, for many years head master of pages will come to the conclusion that it will be advisable the Jaws’ Deaf and Damb Home, on the most modern and for them to join the association. The Clinical Research scientific method of training the deaf and dumb, so as to Association has for its object the provision of a clinical enable them to use articulate speech and to give them a full laboratory equal to, or better than, many of those connected command of language. The lecturer opened the proceedings with the various schools of medicine and hospitals ; which by introducing several of his pupils and testing the results laboratory shall be open for the carrying on of the work of their training by exercises in pronunciation, lip reading, required by those engaged in general practice who, with the dictation, recitation, reading, and answering miscellaneous best will in the world, have neither time nor opportunity to questions. Through this searching ordeal the pupils passed make those irregular or tedious observations which are often very successfully. Most people are aware of the enormous required to complete a diagnosis. Sach a laboratory has difficulty entailed in teaching the deaf to speak ; where often been suggested, but the difficulty of carrying on, side a child is stone-deaf the obstacles are greatly enhanced by side, original investigation for the sake, merely, of In what is to be found oat and the same investigation and the intonation is apt to be specially faulty. this respect Mr. Sahöntheil’s pupils acquitted them- in return for a definite fee has always cropped up. selves with marked success. The lecturer explained that We are glad to see, however, that the association has in the case of several the instruction imparted to them taken the bull by the horns, and has laid down the prohad first of all proceeded on a faulty basis, and that in con- position that in pathology and clinical research the labourer sequence they had been compelled to unlearn much that is worthy of hishirejust as much as when the same labourer they had first learnt. Nevertheless, steady progrees had been is feeling a pulse and writing a prescription. The work of since achieved, and the re3ults were considered very the association ia not done for old pupils, for old teachers, or promising by the experts present. Mr. Schontheil then for personal friends, and, therefore, a fee is expected for expounded in his paper the aim of the oral method to each investigation as surely as one is expected for a conrestore the deaf to the society from which his defect sultation. The association undertakes to examine sputum tends to cut him off and laid special stress on the for tubercle bacilli and for other micro-organisms, for lung endeavour which he considered ought to be made to avoid tissue, &c. The examination of urine, blood, pus, vomit, distoitions of the face and raucous sounds. After giving and faeces is undertaken ; tumours and diseased tissues examples of the lines of thought by which the insttuotion of are investigated, and specimens taken from the throats the deaf was to be conveyed, he concluded with pointing out of diphtheria patients are examined and analyses of drinking the .trong necessity for having properly trained teachers of water and poisons are made. Although the fees for these the deaf and for devaticg special and individual attention examinations appear to be somewhat low we suppose that and kindness to each pupils. Mr. Charles E. D. Black the association can afford to send good reports in consequence formerly secretary to the Royal Commission on the Deaf, of the number of specimens that they have to examine. Iu
ance.
___
1002 fact,
it is acknowledged that a large proportion of the examinations which are undertaken could not possibly be reliable at the price charged unless the association received a large measure of support from the profession, so that a number of examinations of the same character may proceed side by side. The association already numbers over 850 members, and over 2300 specimens have been examined and reported upon during the past six months. This is an exceedingly good record, and the association, if it continues to be ag well managed as it apparently is at present, should ultimately be very successful indeed. Through its agency the best opinions are placed at the disposal of every member of the association, and the g1.in to diagnostic accuracy arising from such work must be enormous. We wish the association the success it deserves.
but only the hardiest of them survived. We, cast in more tender moulds, and require protechowever, tion by night as well as day. The feminine portion of the community will, we fear, not adopt Mr. Ashby-Sterry’s suggestion, for though, as an eminent authoress once remarked, "a woman looks so down-trodden in her nightdress," still that vesture offers opportunities for ornament which pyjamas, at best unlovely garments, never do. Perhaps the Rational Dress Society may take the matter up, and Mr. Henry Holiday might turn his attention to devising a really artistic as well as hygienic night-gear. a
are
THE AGE-CONSTITUTION AND THE DEATH-RATE. THE closer dependence of the death-rate on the age. constitution than on the sanitary condition of a community, rendering it absolutely necessary to reduce the former to a common standard before any conclusions can be drawn as regards the public health, is well known to statists, but little understood by the general public or their local repre. sentation. A strikirg illustration is given by Mr. May, medical officer of health for Aston Manor, in his report for last year. The age-constitution of the population as given at the last two censuses was :
___
THE REAPPOINTMENT OF MEDICAL OFFICERS OF HEALTH. WE have called attention in our columns from time to time to the insecurity of these appointments, and for the benefit of the community it would be well if the Local Government Board would formulate some regulations which would prevent the annual reappointment of such officers. To subject the medical officer of a district council to annual re-election is an anomaly which ought not to exist and practically is an incentive to avoid doing anything which might offend some of its members. Last week Mr. Hannah, the medical officer of health for Abram, a colliery district in Lancashire, retained his appointment by the casting vote of the chairman only. ]Ie has held the appointment for nineteen years and discharged the duties conscientiously and with great ability ; no fault could be found with him in this respect. He has, moreover, been subject to annual re-election. This time the new district council advertised the appointment, and an opponent was brought in the field-with the result that the casting vote of the chairman was required for Mr. Hannah to retain the appointment held so long by him. Why should the health officers (medical officer and sanitary inspector) be the only officers subject to such a rule ? Why not the clerk and surveyor also? Even the board itself is not subject to an annual re-election. Medical officers of health should now bestir themselves in regard to the tenure of their appointments.
This enormous reduction in the child population and relative increase of ages between fifteen and thirty-five, those of lower mortality, is wholly due to a continuous decline in the birth-rate during the last fifteen years, which has shown itself in a reduced death-rate, and more palpably in the fact that, though the population had increased between 1881 and 1891 from 53,842 to 68,639, the demand for school accommodation was almost stationary. Thus far the change in
constitution has had an apparently favourable influence on the death-rate, but if it continue to operate it will lead to an accumulation of persons over forty-five years of age and be followed by a steady rise in the death-rate, however excellent the sanitary condition of the district may be, when the authorities will be as eager as they are now unwilling to have the recorded death-rates "corrected."
-
ON CATCHING COLD. wrote a paper pointing out the appalgoing to bed as exemplified in bills of one For mortality. person who died out of his bed several hundreds succumbed in bed, and now we have Mr. AshbySteriy drawing attention to the same thing. Hitherto he has hymned in graceful verse pantalettes, frills, and the tempestuous petticoat, and now, qzcantum 7mdatus ab illo hectors, he lauds the pyjama. In a recent number of the Graphic he says :-
MARK TWAIN ling danger of
needil " ;
once
I
"I have a theory that most people catch cold at night after they are in bed, and it is to this fact I attribute a great deal of the violent colds, the bronchial catarrhs, ard innuerzj, which have recently been so prevalent. The temperature goes down suddenly in the night, and people catch cold when they are asleep without knowing it. This evil is to be counteracted, not by piling on a lot of heavy blankets, but by wearing thick, close-fitting garments of a py jama-like nature and warm socks on the feet. If this system were adopted I am quite certain that it would be found beneficial." There is common sense in this. People unquestionably may catch cold in bed, especially if they are at all restless and so kick the bedclothes off. In that event, if only clad in a thin cotton nightshirt, they are sure to catch cold, whereas if clad in pjmas, not necensarily thick but made of some woollen mareiial, the chance of a chill is much lessened. Our ancestors, even as late as the eighteenth century, went to bed, as Malory centuries earlier phrased it, "as naked as
I
MEDICAL CERTIFICATES FOR THE LONDON BOARD SCHOOLS.
AT a recent meeting of the London School Board a report of the school management committee was adopted to the effect that three medical men should be appointed to examine cases in which medical certificates were produced to account for non- attendance at school. Whether it is supposed by the members of the Board that medical certificates are forged by parents who desire to keep their children from school we are not informed; but that seems hardly likely to be the explanation, for the detection of a forgery would not require the services of a medical practitioner. It is, indeed, hardly possible to avoid the inference that the Board has thus put a slight upon the medical profession by affirming the necessity for the supervision of the certifying medical practitioners in respect of this trivial matter of school attendWe are sorry to be driven to this conclusion, and we ance. feel that in view of it we may fairly invite the majority of the School Board to reconsider their decision. The men whom they refuse to trust in this small matter are the same men to whose absolute discretion and approved skill the weightiest matters are unreservedly entrusted both by law and the custom of society. It is something new and by no means agreeable to the profession at large to have a .