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ANESTHESIA AND ITS MORTALITY.
597
day nurse has keys, &c. satisfactory a factor, why
If this be so important and so should it be limited to the daytime ? But doubtless this point must be considered with the recovery-rate, which, be it noted, is at Woodilee, according to published statistics, about the lowest in Great Britain. I trust this is due to the large number of cases of dementia admitted, which should also explain the absence of keys, &c. ; surely it cannot be due to the elaborate intermingling of corrugated iron," compo " boarding, open air, and female I do not throw doubt for a moment upon Dr. nurses. Marr’s great ability, nor the entirely excellent organisation and administration of the asylum over which he so zealously presides ; this, however, has nothing to do with the subject at issue. I am, Sir, yours faithfully, MEDICAL SUPERINTENDENT, Feb. 6th, 1908. County Asylum (England). no
ANESTHESIA AND ITS MORTALITY. To the Editor of THE LANCET. SIR,-A discussion on "deaths under chloroform " at the Medico-Legal Society is reported in the lay press. Dr. F. W. Hewitt is there stated to have recommended a higher system of tuition as to the administration of anaesthetics. It would be interesting further to strengthen such a recommendation, by an inquiry as to why, at provincial, Scotch, and Irish hospitals, the percentage of deaths connected with the administration of anæsthetics is so small as compared with the London statistics. I am told that at Edinburgh the specially instructed students often administer the anæsthetic, and, in chloroform anæsthesia, only use a towel. So I am told. Is the special instruction there more thorough than here? Dr. Hewitt generally has good reason for his I am, Sir, yours faithfully, opinions. G. H. R. D. Feb. 12th, 1908.
THE SITE OF A SANATORIUM. To the Editor of THE LANCET. I am interested in the efforts of the medical profession to minimise the ravages of consumption, perhaps you will give me a few particulars as to the nature of the soil on which a sanatorium should be built. The Cork Conjoint Hospital Board has been offered, as a free gift, land on which to erect a public sanatorium. The proposed site has been described as a bog over which snipe have been shot ; bulrushes grow on it ; the surface earth to the depth of 6 or 12 inches is peat mould, under which is a deep stratum of yellow clay ; there are several small ponds or holes, from 8 to 12 feet in diameter, containing stagnant water ; and in other places surface water lies on the ground. Would this be a suitable or unsuitable site? Would it be a good or particularly good site, a bad or particularly bad site ? As I know your journal focusses medical opinion on such subjects perhaps you will excuse me for venturing to address you. I am, Sir, yours faithfully, VALETUDINARIAN. Feb. 13th, 1908.
SIR,-As
THE MEDICAL INSPECTION OF SCHOOL CHILDREN. To the Editor
of THE LANCET. SIR,-A great many opinions are finding expression
badly as they will. The Board of Education have said in their memorandum that the sanitary authorities should instruct their medical officers of health to go in and advise the education committees. This is rather cool of the Board of Education, who have nothing to do with the sanitary authorities or their medical officers of health. And here lies difficulty No. 1-that is, the complication of having the public health work of the country managed by two different sets of committees, the public health committees proper and the education committees. Unless a free hand be allowed the superintending officer to conduct the work without interference from the education committee, whose members are likely to think themselves quite capable of " directingthe work of medical inspection, the result must be confusion worse confounded. There is no direction in the memorandum of the Board of Education as to how these committees are to treat and pay their medical officers, but we know that these officers will be expected to subscribe to the farce that it is the committee and not the officer that does the work and is the responsible party. And what is the Local Government Board doing that they allow officers that erstwhile were under their own sovereign control to become the fags of a peregrine department ? As to difficulty No 2, the Board of Education’s memorandum alludes to the medical officer of health as if the office of that person were perfectly satisfactorily established and as if the public health department of every town of 20,000 inhabitants, and of every county in the land, were efficient, whereas we know it to be far otherwise. We know that three parts of the public health service that is being called upon to undertake this tremendous accession of work is hopelessly inefficient and incapable of its performance. And yet this work cannot be divorced from the public health office ; it is public health work. The medical examination of the children, which must be itself deputed to the general practitioner, must nevertheless be directed and supervised from the public health department, and this general direction is only a part of the work that will fall to the public health officer, for much more will ensue as the result of the examinations and in connexion with them. Yet with the public health service in the condition it is, what a putting of the cart before the horse is this business. Would it not be better for Parliament in the present session to pass a repealing Act, or the Board of Education to send round a notice postponing all action until we have the needed reform in the public health service ? The various and bewildered propositions as to the way the medical inspection of school children shall be carried out which are emanating from the education committees as the result of deliberations guided by competent or incompetent medical officers of health, or unguided altogether by any medical officer, only further serve to exemplify the ridiculous condition of our public health administration, and of the absurdity of supposing that a work of such special character and national effect as that in question can be accomplished nationally by the independent ungoverned action of hundreds of different committees, or, for that matter, by as many medical officers of health acting without any general governance, constraint, or co-relation. I am, Sir, yours faithfully, Feb. 17th, 1908. M.D., D.P.H., M.O.H. or as
THE UNIVERSITY OF LONDON AND
to PROVINCIAL STUDENTS. how the work of medical inspection of school children shall To the Editor of THE LANCET. be carried out, and it seems doubtful whether the uncertainty at this moment exhibited can be in any degree edifying to SIR,-May I, in the name of the numerous external the powers that be, or to the public who are acting the part students of the University of London, protest against the of lookers-on. absurd length of time they are made to stay in town when The last memorandum of the Board of Education issued sitting for the final M.B. examination ? If a candidate takes upon the subject states that the difficulties to be encountered all the subjects at one time he is kept up for three weeks. are chiefly administrative. Precisely so, but the Board of He has a good deal of his time wasted and in many instances Education do not do much to diminish these difficulties. his concluding tests are given to him after students residing The few suggestions which they have made in this behalf are in London have received theirs. In the case of a candidate sufficiently confusing. That they are desirous of linking up only taking half the examination at a time the evil is much this public health work with the other public health work is worse, for there is then an interval of eight or nine days of evident and that the medical officerof health, who is the idleness provided for him. He has either to remain in chief public health officer, must take a prominent part in the London at considerable expense, or make two or more business is equally manifest, but having given a hint of their journeys to the provinces, which may be equally expensive. desire in this direction, they have left it to the local I consider that the authorities can, if they choose, remedy education committees to make all appointments, and these this state of affairs. I am, Sir, yours faithfully, committees are to do the work as well as they can, PROVINCIAL. Feb. 18th, 1908. as
day nurse has keys, &c. satisfactory a factor, why
If this be so important and so should it be limited to the daytime ? But doubtless this point must be considered with the recovery-rate, which, be it noted, is at Woodilee, according to published statistics, about the lowest in Great Britain. I trust this is due to the large number of cases of dementia admitted, which should also explain the absence of keys, &c. ; surely it cannot be due to the elaborate intermingling of corrugated iron," compo " boarding, open air, and female I do not throw doubt for a moment upon Dr. nurses. Marr’s great ability, nor the entirely excellent organisation and administration of the asylum over which he so zealously presides ; this, however, has nothing to do with the subject at issue. I am, Sir, yours faithfully, MEDICAL SUPERINTENDENT, Feb. 6th, 1908. County Asylum (England). no
ANESTHESIA AND ITS MORTALITY. To the Editor of THE LANCET. SIR,-A discussion on "deaths under chloroform " at the Medico-Legal Society is reported in the lay press. Dr. F. W. Hewitt is there stated to have recommended a higher system of tuition as to the administration of anaesthetics. It would be interesting further to strengthen such a recommendation, by an inquiry as to why, at provincial, Scotch, and Irish hospitals, the percentage of deaths connected with the administration of anæsthetics is so small as compared with the London statistics. I am told that at Edinburgh the specially instructed students often administer the anæsthetic, and, in chloroform anæsthesia, only use a towel. So I am told. Is the special instruction there more thorough than here? Dr. Hewitt generally has good reason for his I am, Sir, yours faithfully, opinions. G. H. R. D. Feb. 12th, 1908.
THE SITE OF A SANATORIUM. To the Editor of THE LANCET. I am interested in the efforts of the medical profession to minimise the ravages of consumption, perhaps you will give me a few particulars as to the nature of the soil on which a sanatorium should be built. The Cork Conjoint Hospital Board has been offered, as a free gift, land on which to erect a public sanatorium. The proposed site has been described as a bog over which snipe have been shot ; bulrushes grow on it ; the surface earth to the depth of 6 or 12 inches is peat mould, under which is a deep stratum of yellow clay ; there are several small ponds or holes, from 8 to 12 feet in diameter, containing stagnant water ; and in other places surface water lies on the ground. Would this be a suitable or unsuitable site? Would it be a good or particularly good site, a bad or particularly bad site ? As I know your journal focusses medical opinion on such subjects perhaps you will excuse me for venturing to address you. I am, Sir, yours faithfully, VALETUDINARIAN. Feb. 13th, 1908.
SIR,-As
THE MEDICAL INSPECTION OF SCHOOL CHILDREN. To the Editor
of THE LANCET. SIR,-A great many opinions are finding expression
badly as they will. The Board of Education have said in their memorandum that the sanitary authorities should instruct their medical officers of health to go in and advise the education committees. This is rather cool of the Board of Education, who have nothing to do with the sanitary authorities or their medical officers of health. And here lies difficulty No. 1-that is, the complication of having the public health work of the country managed by two different sets of committees, the public health committees proper and the education committees. Unless a free hand be allowed the superintending officer to conduct the work without interference from the education committee, whose members are likely to think themselves quite capable of " directingthe work of medical inspection, the result must be confusion worse confounded. There is no direction in the memorandum of the Board of Education as to how these committees are to treat and pay their medical officers, but we know that these officers will be expected to subscribe to the farce that it is the committee and not the officer that does the work and is the responsible party. And what is the Local Government Board doing that they allow officers that erstwhile were under their own sovereign control to become the fags of a peregrine department ? As to difficulty No 2, the Board of Education’s memorandum alludes to the medical officer of health as if the office of that person were perfectly satisfactorily established and as if the public health department of every town of 20,000 inhabitants, and of every county in the land, were efficient, whereas we know it to be far otherwise. We know that three parts of the public health service that is being called upon to undertake this tremendous accession of work is hopelessly inefficient and incapable of its performance. And yet this work cannot be divorced from the public health office ; it is public health work. The medical examination of the children, which must be itself deputed to the general practitioner, must nevertheless be directed and supervised from the public health department, and this general direction is only a part of the work that will fall to the public health officer, for much more will ensue as the result of the examinations and in connexion with them. Yet with the public health service in the condition it is, what a putting of the cart before the horse is this business. Would it not be better for Parliament in the present session to pass a repealing Act, or the Board of Education to send round a notice postponing all action until we have the needed reform in the public health service ? The various and bewildered propositions as to the way the medical inspection of school children shall be carried out which are emanating from the education committees as the result of deliberations guided by competent or incompetent medical officers of health, or unguided altogether by any medical officer, only further serve to exemplify the ridiculous condition of our public health administration, and of the absurdity of supposing that a work of such special character and national effect as that in question can be accomplished nationally by the independent ungoverned action of hundreds of different committees, or, for that matter, by as many medical officers of health acting without any general governance, constraint, or co-relation. I am, Sir, yours faithfully, Feb. 17th, 1908. M.D., D.P.H., M.O.H. or as
THE UNIVERSITY OF LONDON AND
to PROVINCIAL STUDENTS. how the work of medical inspection of school children shall To the Editor of THE LANCET. be carried out, and it seems doubtful whether the uncertainty at this moment exhibited can be in any degree edifying to SIR,-May I, in the name of the numerous external the powers that be, or to the public who are acting the part students of the University of London, protest against the of lookers-on. absurd length of time they are made to stay in town when The last memorandum of the Board of Education issued sitting for the final M.B. examination ? If a candidate takes upon the subject states that the difficulties to be encountered all the subjects at one time he is kept up for three weeks. are chiefly administrative. Precisely so, but the Board of He has a good deal of his time wasted and in many instances Education do not do much to diminish these difficulties. his concluding tests are given to him after students residing The few suggestions which they have made in this behalf are in London have received theirs. In the case of a candidate sufficiently confusing. That they are desirous of linking up only taking half the examination at a time the evil is much this public health work with the other public health work is worse, for there is then an interval of eight or nine days of evident and that the medical officerof health, who is the idleness provided for him. He has either to remain in chief public health officer, must take a prominent part in the London at considerable expense, or make two or more business is equally manifest, but having given a hint of their journeys to the provinces, which may be equally expensive. desire in this direction, they have left it to the local I consider that the authorities can, if they choose, remedy education committees to make all appointments, and these this state of affairs. I am, Sir, yours faithfully, committees are to do the work as well as they can, PROVINCIAL. Feb. 18th, 1908. as