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THE MANCHESTER MEDICO-ETHICAL ASSOCIATION.
325
protected against dangerous industries, but not the the case two years ago. His own practice affords proof workers. Thus, lead works are put in the second category, of this, especially in the fact of the greater frequency because they do not give rise to injurious emanations, of uncomplicated cases among women than among men. and are only injurious to the workmen themselves. Such As to the question of protection, he has observed that will be the general scope of the Congress; but before the members of families who were severely attacked two years delegates of the trade unions and the workmen’s societies ago have either escaped entirely at present or been only who form the labour party discuss these problems they slightly affected ; whilst, conversely, the most serious cases will invite the best known scientific authorities on hygiene of the present time have arisen in households which the to deliver addresses to the Congress so as to enlighten the influenza spared during its earlier visitation. He notes the delegates as to the technicalities at issue. This pre- statement of Dr. Edw. Gray,2 to the effect that "many cautionary measure is at once as wise as it is modest, and persons who escaped the epidemic of 1775 were affected by denotes considerable discretion and tact on the part of that of 1782, and many who escaped the latter were affected the workmen. They will find a scientific basis for their by the former," as showing that a century ago this question of .demands and make their wants known to men of science. immunity had not passed unnoticed. Dr. Rahemann gives Thus the sympathy that already exists between workers his own experience of 55 families, numbering 193 individuals. are
with the brain and workers with the hand may be further and to the great advantage of public health.
developed,
POSITION OF THE NOSE. DR.
SIMONTON,
in the
Chicago Journal, calls
attention
to the fact that the human nose is frequently not in the centre of the face, and he emphasises the importance of this fact with reference to the accurate fitting of glasses. The difference iti the breadth of the two sides varies from one’sixteenth to one-eighth of an inch, but he has not
found it more than an eighth. Bat such a difference, he aays, is sufficient to cause much trouble and inconvenience, especially with somewhat high refractive errors, unless the classes are accurately ground with reference to the actual position of the pupil. Any adaptation of the spectacle frame, he says, would up"et their balance, so that the glass should be modified, if such an inequality, as he says is not ancommon, should exist. --
DOES
PROTECT FROM A SUBSEQUENT ATTACK?
INFLUENZA
THE question whether an attack of influenza confers protection from subsequent infection is one which must have often arisen during the experiences of the last three years, but the data for its solution are not yet fully available. The amount of information which must have been gleaned by the family practitioner in all parts of the country upon this and many other points concerning the malady would, if collated, go far to settle the matter. It is of course notorious that certain individuals have suffered from more than one attack; bub the conviction is pretty general that such eases really form but a small minority of the large numbers who have suffered. Then, again, it must be deemed possible that the degree and duration of the protection may depend on the severity which the primary attack exhibited, tor one can hardly invoke the doctrine of attenuation of "drus in the case of this disease, which shows so much variation from the ordinary course of infective disorders in general. In a highly interesting contribution upon the features of the present epidemic in Berlin, Dr. Rahemann1 ,directs especial attention to this question of protection and affords valuable evidence of it. He aptly remarks that the more gradual evolution and persistent character of the present epidemic, as compared with the rapid and stormy course of the pandemic of 1889 ’tio 1890, have afforded opportunity for more closely studying the characters of the malady, and that it (has especially enabled us to recognise more clearly ’Its nature. According to him influenza mas prevailed in Berlin ever since the beginning of last September, and he notes how on this occasion the stress of the outbreak has fallen to a far greater extent upon women and children and less upon men than was
contagious
1Deutsche Med. Wochensch., Jan. 28th.
In 1889-90 there were 61 cases of influenza, among this group, whilst in the present outbreak only 40 have been attacked, and, what is of especial interest, only 5 out of this number were affected (and that but slightly) two years ago, whilst of the 64 then attacked, only 4 have again become victims. Should this prove to be anything like the general experience it would go far to substantiate a fact that has hitherto been much disputed, even to the extent of declaring that one attack predisposes to another. That one individual may have several recurrences during the prevalence of a single epidemic does not, in Dr. Rahemann’s opinion, mitigate against the general doctrine of protection, since he thinks many such recurrences may be explained by lack of caution on the part of patients against exposing themselves to fresh infection before they are restored to full health. That influenza does protect from a second infection should reassure many persons who, having once suffered severely from it, dread a repetition of so depressing a malady ; and it may be a further comfort to them to learn that the more they have suffered at first, the less likely are they to suffer at all again. If, then, inflaenza shares this common property of all infective diseases, it is not so remarkable that it should not apparently select the young in preference to the adult and aged, seeing that the whole community is more or less" unprotected"" when it first reappears after an absence (in pandemic form) of years.
THE MANCHESTER MEDICO-ETHICAL ASSOCIATION. WE have been favoured with the
forty-fourth
annual
report of the Manchester Medico-Ethical Association. It reports 11 a spirit of activityin the work of the Association. By way of increasing the interest of members aid usefulness of the Association, the committee ventured to initiate an extension of the usual programme by securirg a series of papers on the following questions of public interest :-A Presidential Address on Infant Mortality, by Dr. Ashby ; the Disposal of the Dead, by Dr. Wahltuch ; the Relation of Unhealthy Dwellings to the Etiology of Phthisis, by Dr. T. Harris; the Influence of the Drink Traffic on the Death-rate, by Mr. Meacham ; and the Laws and By-laws regulating the Sanitary Arrangements of the City of Manchester, by Dr. J. Tatham. The attendThe ance at the reading of these papers was very good. committee took an active part in opposing the Midwives’ Registration Bill, and in drawing attention to serious defects in the Factory and Workshop Act. On the subject of increased representation of the profession on the Medical Council the subcommittee suggested that it should be secured rather by some of the Crown nominations being given to members of the profession in general practice than by Not the mere addition to the numbers of the Council. least interesting question mooted in the Society was that, 2
Thompson’s Annals, p. 110.
326 of establishing a black list. The question was referred to a from the direct and indirect effecbs of the present inflllenz1 subcommittee, which took counsel’s opinion thereon. The epidemic, from which, so far, Manchester has been c-ompara subcommittee consider counsel’s opinion to be in favour of tively free. The Registrar-General’s quarterly return for such a list, but they think that it will require to be so the last three months of 1891 enables us to state that the, carefully drawn up that the whole question should stand death-rate of Greater Manchester was last year equal tc. The profession will 26-5 per 1000, which, although 3-2 per 1000 below the, over for consideration next session. of action the Association in disastrously high rate in 1890, was only 4v below await with interest the further the mean annual raue in Old Manchester during the ten, this delicate matter. It would have been thought that suchyears 1881-90. ___
A LIFE FOR A LIVING.
an infinitesimal result on the death-rate from the in. clusion of so large a suburban area within the city wouldd AFTER another period abstinence, lasting to within a few hours of forty-four days, and maintained in have been a serious discouragement to those who never spite of gastric irritation, severe cold, London fog, and tire of writing on the so-called "fallacies about our death. the indifferent atmosphere of his apartment, the Italian rate." This discouragement becomes the more serious Sucoi, has found it needful to give way to nature, and when it is admitted that the inclusion of this large to forego the last week of his self-allotted fast. We suburban population cannot have been without effect in have no regret for this result, but rather for the fact reducing the death-rate, from which it follows that the that he will still persist in endming for a time a modi- death-rate in Old Manchester last year must have fied starvation on lemons, oranges, and water. During been, if not as high as in 1890, considerably above the period above mentioned he has lost almost a third the mean rate in the ten years 1881-90. The deathof his body weight, and has, it is clear, come within rate from "fever" (mainly enteric or typhoid), as wen a hair’s breadth of actual suicide. Why? For this is as from diphtheria and from whoopfrsg-cough, was’ the essence of the question whether such performances considerably higher last year in Greater Manchester than For the settlement of scientific the mean rates from the same diseases in Old Manchester are justidable or nob. or the shall we doubts, say, proof of moral supremacy over in the ten preceding years. So with infant mortality, which= these ends have already been attained by was equal to 192 per 1000 births last year in Greater Man. appetite ? No, of and methods research by personal experience. chester (although the diarrhoea, rate in 1891 was low), precise in such excuses be If, therefore, urged the present connexion, whereas in Old Manchester the mean rate of infant mortality The during the ten years 1881-90 was 1.79 per 1000, a rate far in we need not look far for the means of refuting them. is or as we now find no recluse him, fasting man, companion excess of the rate in most of our other large towns. If we of a few skilled observers merely. He is the constant compare last year’s death-rate in Greater Manchester with notoriety of show companies, the central interest of curious that in Greater London, the result is not more satisfactory crowds, and, finally, the sharer in substantial money profits. to those who have to live in Manchester. The Greater With him abstinence is a mere business, needless and Manchester rate was, as we have stated, 26"5 per 1000, dangerous in itself, detrimental to the discharge of more while in Greater London the rate was only 19-6. This fruitful duties, and certainly not elevating to the moral signifies that during last year, of equal numbers living, 135 As much may be said of the woman persons died in Manchester to each 100 dying in London. sense of onlookers. reported to be similarly employed in Paris. The prohibition To those who can read aright the logic of these figures, last of such disgraceful and inexcusable exhibitions would be year’s mortality statistics of Greater Manchester abundantly prove that there is no fallacy in the excess of Manchester nothing less than a public benefit. mortality. We shall look with much interest for Dr. Tatham’s report on the health of the city in I8S1, which THE DEATH-RATE IN GREATER MANCHESTER. will probably throw some useful light upon the local asser. DURING the year 1890, when the death-rate in the city of tions that the high death-rate of the city is merely theManchester, as it then existed, was for a considerable time result of fallacy. above the high rate of 30 per 1000, the efforts of the Corporation to extend its limits were crowned with success. CASE OF SHOCK FROM A TELEPHONE WIRE This success afforded the opportunity to certain ill-advised DR. JOSEPH COLLINS relates in the New York Medical persons to declare that the high death-rate was merely a to due the restricted boundaries a curious accident which happened to a pa.tient of fallacy, mainly artificially of the city, and to assert that this extension would his. The latter was a man of thirty-one, who in September so reduce the death-rate as to prove that the 1890, was engaged in repairing a telephone wire, and whiiesexcess of Manchester mortality, about which so much engaged he received a shock through having touched a wire fuss had been made, was merely the result of a faulty at a point where it had become accidentally uninsulated. He system of mortality statistics. The extension came said that for two or three seconds he retained coninto operation, so far as the vital statistics of the city were sciousness, and at this time he had no pain, but a sensaconcerned, on Jan. 1st, 1891, and its effect was to add to the tion that he was filled with something, and a conviction population under the sanitary control of the City Corpora- that as soon as that sensation ceased he would die. He lost tion more than 100,000 persons. It will not be without consciousness, fell down about twenty-five feet, and struck interest to refer to the mortality statistics of what on a butcher’s cart between the wheel and the body of the has been called Greater Manchester for the year 1891, and vehicle, thence falling to the ground on his head and neck. to compare it with the figures relating to Old Manchester On recovering consciousness, which he did in a very short for preceding years. This interest will not be lessened from time, he was a little dazed. He had great weakness of hie the fact that in certain local quarters muchjubilation has shoulder, and this became worse. At first the faradaic rebeen expressed because the Manchester death-rate has in action was retained in his deltoid, but it disappeared recent weeks compared much more favourably with the rates later, and again returned, and he regained the use of his in the other large English towns than was the case in 1890, shoulder. He subsequently, however, developed numbbefore the last city extension. This, as can easily be proved, ness of one side and hemi-anaesthesia.—a condition appais not due to any remarkable decline in the recorded death- rently functional in character, from which he recovered rate of Manchester, but to the fact that so many of the after being hypnotised. After the accident he also had two large towns have in recent weeks been suffering severely large burns, one on the left side of his neck and the other
of remarkable
-
I Record
briefly
I
protected against dangerous industries, but not the the case two years ago. His own practice affords proof workers. Thus, lead works are put in the second category, of this, especially in the fact of the greater frequency because they do not give rise to injurious emanations, of uncomplicated cases among women than among men. and are only injurious to the workmen themselves. Such As to the question of protection, he has observed that will be the general scope of the Congress; but before the members of families who were severely attacked two years delegates of the trade unions and the workmen’s societies ago have either escaped entirely at present or been only who form the labour party discuss these problems they slightly affected ; whilst, conversely, the most serious cases will invite the best known scientific authorities on hygiene of the present time have arisen in households which the to deliver addresses to the Congress so as to enlighten the influenza spared during its earlier visitation. He notes the delegates as to the technicalities at issue. This pre- statement of Dr. Edw. Gray,2 to the effect that "many cautionary measure is at once as wise as it is modest, and persons who escaped the epidemic of 1775 were affected by denotes considerable discretion and tact on the part of that of 1782, and many who escaped the latter were affected the workmen. They will find a scientific basis for their by the former," as showing that a century ago this question of .demands and make their wants known to men of science. immunity had not passed unnoticed. Dr. Rahemann gives Thus the sympathy that already exists between workers his own experience of 55 families, numbering 193 individuals. are
with the brain and workers with the hand may be further and to the great advantage of public health.
developed,
POSITION OF THE NOSE. DR.
SIMONTON,
in the
Chicago Journal, calls
attention
to the fact that the human nose is frequently not in the centre of the face, and he emphasises the importance of this fact with reference to the accurate fitting of glasses. The difference iti the breadth of the two sides varies from one’sixteenth to one-eighth of an inch, but he has not
found it more than an eighth. Bat such a difference, he aays, is sufficient to cause much trouble and inconvenience, especially with somewhat high refractive errors, unless the classes are accurately ground with reference to the actual position of the pupil. Any adaptation of the spectacle frame, he says, would up"et their balance, so that the glass should be modified, if such an inequality, as he says is not ancommon, should exist. --
DOES
PROTECT FROM A SUBSEQUENT ATTACK?
INFLUENZA
THE question whether an attack of influenza confers protection from subsequent infection is one which must have often arisen during the experiences of the last three years, but the data for its solution are not yet fully available. The amount of information which must have been gleaned by the family practitioner in all parts of the country upon this and many other points concerning the malady would, if collated, go far to settle the matter. It is of course notorious that certain individuals have suffered from more than one attack; bub the conviction is pretty general that such eases really form but a small minority of the large numbers who have suffered. Then, again, it must be deemed possible that the degree and duration of the protection may depend on the severity which the primary attack exhibited, tor one can hardly invoke the doctrine of attenuation of "drus in the case of this disease, which shows so much variation from the ordinary course of infective disorders in general. In a highly interesting contribution upon the features of the present epidemic in Berlin, Dr. Rahemann1 ,directs especial attention to this question of protection and affords valuable evidence of it. He aptly remarks that the more gradual evolution and persistent character of the present epidemic, as compared with the rapid and stormy course of the pandemic of 1889 ’tio 1890, have afforded opportunity for more closely studying the characters of the malady, and that it (has especially enabled us to recognise more clearly ’Its nature. According to him influenza mas prevailed in Berlin ever since the beginning of last September, and he notes how on this occasion the stress of the outbreak has fallen to a far greater extent upon women and children and less upon men than was
contagious
1Deutsche Med. Wochensch., Jan. 28th.
In 1889-90 there were 61 cases of influenza, among this group, whilst in the present outbreak only 40 have been attacked, and, what is of especial interest, only 5 out of this number were affected (and that but slightly) two years ago, whilst of the 64 then attacked, only 4 have again become victims. Should this prove to be anything like the general experience it would go far to substantiate a fact that has hitherto been much disputed, even to the extent of declaring that one attack predisposes to another. That one individual may have several recurrences during the prevalence of a single epidemic does not, in Dr. Rahemann’s opinion, mitigate against the general doctrine of protection, since he thinks many such recurrences may be explained by lack of caution on the part of patients against exposing themselves to fresh infection before they are restored to full health. That influenza does protect from a second infection should reassure many persons who, having once suffered severely from it, dread a repetition of so depressing a malady ; and it may be a further comfort to them to learn that the more they have suffered at first, the less likely are they to suffer at all again. If, then, inflaenza shares this common property of all infective diseases, it is not so remarkable that it should not apparently select the young in preference to the adult and aged, seeing that the whole community is more or less" unprotected"" when it first reappears after an absence (in pandemic form) of years.
THE MANCHESTER MEDICO-ETHICAL ASSOCIATION. WE have been favoured with the
forty-fourth
annual
report of the Manchester Medico-Ethical Association. It reports 11 a spirit of activityin the work of the Association. By way of increasing the interest of members aid usefulness of the Association, the committee ventured to initiate an extension of the usual programme by securirg a series of papers on the following questions of public interest :-A Presidential Address on Infant Mortality, by Dr. Ashby ; the Disposal of the Dead, by Dr. Wahltuch ; the Relation of Unhealthy Dwellings to the Etiology of Phthisis, by Dr. T. Harris; the Influence of the Drink Traffic on the Death-rate, by Mr. Meacham ; and the Laws and By-laws regulating the Sanitary Arrangements of the City of Manchester, by Dr. J. Tatham. The attendThe ance at the reading of these papers was very good. committee took an active part in opposing the Midwives’ Registration Bill, and in drawing attention to serious defects in the Factory and Workshop Act. On the subject of increased representation of the profession on the Medical Council the subcommittee suggested that it should be secured rather by some of the Crown nominations being given to members of the profession in general practice than by Not the mere addition to the numbers of the Council. least interesting question mooted in the Society was that, 2
Thompson’s Annals, p. 110.
326 of establishing a black list. The question was referred to a from the direct and indirect effecbs of the present inflllenz1 subcommittee, which took counsel’s opinion thereon. The epidemic, from which, so far, Manchester has been c-ompara subcommittee consider counsel’s opinion to be in favour of tively free. The Registrar-General’s quarterly return for such a list, but they think that it will require to be so the last three months of 1891 enables us to state that the, carefully drawn up that the whole question should stand death-rate of Greater Manchester was last year equal tc. The profession will 26-5 per 1000, which, although 3-2 per 1000 below the, over for consideration next session. of action the Association in disastrously high rate in 1890, was only 4v below await with interest the further the mean annual raue in Old Manchester during the ten, this delicate matter. It would have been thought that suchyears 1881-90. ___
A LIFE FOR A LIVING.
an infinitesimal result on the death-rate from the in. clusion of so large a suburban area within the city wouldd AFTER another period abstinence, lasting to within a few hours of forty-four days, and maintained in have been a serious discouragement to those who never spite of gastric irritation, severe cold, London fog, and tire of writing on the so-called "fallacies about our death. the indifferent atmosphere of his apartment, the Italian rate." This discouragement becomes the more serious Sucoi, has found it needful to give way to nature, and when it is admitted that the inclusion of this large to forego the last week of his self-allotted fast. We suburban population cannot have been without effect in have no regret for this result, but rather for the fact reducing the death-rate, from which it follows that the that he will still persist in endming for a time a modi- death-rate in Old Manchester last year must have fied starvation on lemons, oranges, and water. During been, if not as high as in 1890, considerably above the period above mentioned he has lost almost a third the mean rate in the ten years 1881-90. The deathof his body weight, and has, it is clear, come within rate from "fever" (mainly enteric or typhoid), as wen a hair’s breadth of actual suicide. Why? For this is as from diphtheria and from whoopfrsg-cough, was’ the essence of the question whether such performances considerably higher last year in Greater Manchester than For the settlement of scientific the mean rates from the same diseases in Old Manchester are justidable or nob. or the shall we doubts, say, proof of moral supremacy over in the ten preceding years. So with infant mortality, which= these ends have already been attained by was equal to 192 per 1000 births last year in Greater Man. appetite ? No, of and methods research by personal experience. chester (although the diarrhoea, rate in 1891 was low), precise in such excuses be If, therefore, urged the present connexion, whereas in Old Manchester the mean rate of infant mortality The during the ten years 1881-90 was 1.79 per 1000, a rate far in we need not look far for the means of refuting them. is or as we now find no recluse him, fasting man, companion excess of the rate in most of our other large towns. If we of a few skilled observers merely. He is the constant compare last year’s death-rate in Greater Manchester with notoriety of show companies, the central interest of curious that in Greater London, the result is not more satisfactory crowds, and, finally, the sharer in substantial money profits. to those who have to live in Manchester. The Greater With him abstinence is a mere business, needless and Manchester rate was, as we have stated, 26"5 per 1000, dangerous in itself, detrimental to the discharge of more while in Greater London the rate was only 19-6. This fruitful duties, and certainly not elevating to the moral signifies that during last year, of equal numbers living, 135 As much may be said of the woman persons died in Manchester to each 100 dying in London. sense of onlookers. reported to be similarly employed in Paris. The prohibition To those who can read aright the logic of these figures, last of such disgraceful and inexcusable exhibitions would be year’s mortality statistics of Greater Manchester abundantly prove that there is no fallacy in the excess of Manchester nothing less than a public benefit. mortality. We shall look with much interest for Dr. Tatham’s report on the health of the city in I8S1, which THE DEATH-RATE IN GREATER MANCHESTER. will probably throw some useful light upon the local asser. DURING the year 1890, when the death-rate in the city of tions that the high death-rate of the city is merely theManchester, as it then existed, was for a considerable time result of fallacy. above the high rate of 30 per 1000, the efforts of the Corporation to extend its limits were crowned with success. CASE OF SHOCK FROM A TELEPHONE WIRE This success afforded the opportunity to certain ill-advised DR. JOSEPH COLLINS relates in the New York Medical persons to declare that the high death-rate was merely a to due the restricted boundaries a curious accident which happened to a pa.tient of fallacy, mainly artificially of the city, and to assert that this extension would his. The latter was a man of thirty-one, who in September so reduce the death-rate as to prove that the 1890, was engaged in repairing a telephone wire, and whiiesexcess of Manchester mortality, about which so much engaged he received a shock through having touched a wire fuss had been made, was merely the result of a faulty at a point where it had become accidentally uninsulated. He system of mortality statistics. The extension came said that for two or three seconds he retained coninto operation, so far as the vital statistics of the city were sciousness, and at this time he had no pain, but a sensaconcerned, on Jan. 1st, 1891, and its effect was to add to the tion that he was filled with something, and a conviction population under the sanitary control of the City Corpora- that as soon as that sensation ceased he would die. He lost tion more than 100,000 persons. It will not be without consciousness, fell down about twenty-five feet, and struck interest to refer to the mortality statistics of what on a butcher’s cart between the wheel and the body of the has been called Greater Manchester for the year 1891, and vehicle, thence falling to the ground on his head and neck. to compare it with the figures relating to Old Manchester On recovering consciousness, which he did in a very short for preceding years. This interest will not be lessened from time, he was a little dazed. He had great weakness of hie the fact that in certain local quarters muchjubilation has shoulder, and this became worse. At first the faradaic rebeen expressed because the Manchester death-rate has in action was retained in his deltoid, but it disappeared recent weeks compared much more favourably with the rates later, and again returned, and he regained the use of his in the other large English towns than was the case in 1890, shoulder. He subsequently, however, developed numbbefore the last city extension. This, as can easily be proved, ness of one side and hemi-anaesthesia.—a condition appais not due to any remarkable decline in the recorded death- rently functional in character, from which he recovered rate of Manchester, but to the fact that so many of the after being hypnotised. After the accident he also had two large towns have in recent weeks been suffering severely large burns, one on the left side of his neck and the other
of remarkable
-
I Record
briefly
I