CARDIFF AND SWANSEA HOSPITALS.

MEDICAL PRACTICE IN SOUTH AFRICA AND ITS COMPLICATIONS.

398

also had a very bad internal strabismus in both eyes, for which she was wearing convex glasses. The case seems to me the more interesting now after reading Dr. Still’s paper, as the age of the child does not tally with the ages of those reported and also I find no mention of the pediculus capitis as a cause of head-nodding. I may say that it was always when bitting up that she rolled her head, that the movement was from side to side, that the nods were quite 1C0 to the minute, and generally lasted for a period varying between one and two minutes, but that there was no regularity of time between the spasms. I am, Sirs, yours faithfully, HAROLD MOWAT. North Kensington, W., August 1st, 1906.

many advertisements of patent medicines and for invalids. In a recent issue of the Cape Times, our leading newspaper, the following may be counted : (1) Savaresse’s Sandal Capsules ; (2) Doan’s Kidney Pills ; (3) Wolfe’s Schnapps (pictures of 18 tired men!); (4) Carter’s Liver Pills ; (5) Larola (for the skin) ; (6) Co-Do (for the mouth) ; (7) Montserrat; (8) Cockle’s Antibilious Pills ; (9) Apiol and Steel Pills ; (10) Steedman’s Soothing Powders (for children cutting their teeth) ; (11) Zam-Buk (in the news columns) ; (12) Bile Beans (in the news columns) ; (13) Sheldon’s Digestive Tabules (for indigestion, dyspepsia, &c.) ; (14) Chamberlain’s Cough

contain

so

preparations

Remedy ; (15) Jones’s Rheumaticuro (for sciatica) ; (16) Vichy-célestins (for gout, diabetes, &c.); (17) Koppa (for the hair) ; (18) Chicago Cold Cure (cures a cold in 24 MEDICAL PRACTICE IN SOUTH AFRICA hours) ; (19) Cooper Neuralgia Cure ; (20) Beecham’s Pills ; (21) Towle’s Pills (invaluable to ladies) ; (22) AND ITS COMPLICATIONS. Wood’s Great Peppermint Cure ; and (23) Dr. Shedon’s New Discovery. It may here be remarked parenthetically To the Editors of THE LANCET. that in the English papers such advertisements in the be Africa divided into two parts-the SIRS,-South may veld where there are no medical men and the towns where news columns are always marked Adv. Dutch papers may take them without any addition and as a rule there are too many. One consequence of this unequal diswith deceptive headlines. Once there was almost a tribution of the profession is that the farmer on his "plaas" quarrel between the editor and the director of Ons on the lonely illimitable veld has to treat most of the ailments of his household. He has a "pelikaan"for tooth Lccnd; the former said: "My readers must see Adv. extraction and his wife has her "apotheek"—a box full of under such articles." "No," said the latter, "our the locally renowned Dutch medicines, such as Haarlem oil, shareholders have our first care." Dr. Sanden’s electric belt an advertisement space of about 50 square Spanish fly, Hofman’s drops, &c., but these have of late been inchesoccupies in issue of our leading papers, Dutch every supplemented by pink pills, bile beans, liquozone, and the and English, but the pink pills have been much less con. host of modern remedies whose praise is in all the newsspicuous of late. Perhaps this is caused by the harshness papers. Any old tante is the midwife for the neighbour- of our legislators. Before the new Custom tariff came hood and any farmer acts as gravedigger and undertaker force on May 25th the agent for the pink pills paid into when required. Sometimes a medical man has to be fetched from a great distance, but only rich families can afford this, only a trifling ad valorem duty on 7d. per 1000, this being for the fees are a guinea an hour, and ten hours are easily the value as per invoice. But now he has to pay Blsterling for one pound avoirdupois, which is a very different thing. spent on the long roads. Medical knowledge gained by Of course, the farmers are the best customers for recognised methods of study and observation is, as a rule, medicines, but as some of them read little more thanpatent their not very highly esteemed by the "Boeren," who have a Bibles and a weekly church paper-De Kerkbode or De decided preference for the "wonderdokter," and in 1899 there was in the Transvaal a famous specimen of the last- Vereeniging-it is no wonder that even these religious papers mentioned class of practitioner. During the war he was in get a good share of advertisements from the patent medicine vendors, so that next to a highly poetical and edifying Cape Town and the Dutch Afrikanders there believed in him. His fame had, in fact, spread all over South Africa. The explanation of some passage of Holy Writ there may be Afrikanders are like one big family-what happens in the found a most prosaic paragraph on diseases and their Transvaal is soon known in Cape Town and vice versi. treatment. Every druggist keeps a fairly complete stock of " Dr. Eugen," as he was called, was quite a celebrity. patent medicines as far as he can get hold of them, but From far and near the farmers travelled to Pretoria in 1899 to some nostrums are not yet to be found in any drug store, consult him. There was always a file of carts and wagons in because the agents do not wish to surrender any portion of his street and inside his door was a crowd peacefully waiting. their profits. Medical men are not popular with the people, not even with A consultation always lasted five minutes and the fee was town people, partly because they are said to charge very the As soon as the patient came forward the one guinea. fees and partly because they are supposed to be required high hands "dokter" laid both his on the former’s head and for treating diseases of the teeth and for performing only an was like electric current to something supposed pass in which cutting and sewing are necessary. In operations between healer and subject. The "dokter" knew at once cases of internal ailments the general idea is that the what was wrong. He did not prescribe medicines as he was not possessed of any diploma, but the leading feature of his cheapest and easiest way is to go to a chemist and ask his treatment consisted in regulation of the patient’s diet. advice. In 1901 and 1902 there was perhaps as much venereal After his electrical diagnosis he sat in his big armchair and disease in Cape Town as in any town on the globe, and most consulted his " spirits" about the different foodstuffs and of these cases of syphilis and gonorrhoea were treated without a medical man. One druggist had 500 venereal patients beverages to be given or withheld. As a rule the farmer in a month and all dealers in medicinal substances laid in had to give up his coffee and wine, which was indeed a very hard trial to the Boer. During winter "Dr. Eugen"left full stocks of mercurials and santal midi to be disposed of Pretoria for the river Zambesi, where he lived on "drill fish," to customers coming for advice and treatment. As a rule the Boers succeed very well in rearing their In this way he got as they call the torpedo or cramp fish. Sometimes large number of children. At Standerton there is a family a new store of electricityfor the next season I him rich farmer fetched for an case to his house. with 29 children. When I lived in a farming district in the a urgent This was extremely expensive and the I I doctor" would never Transvaal for a year I found that between 10 and 15 in every house was the average and very few infants take the ordinary food placed before the Boer and his family children died. In Cape Town, however, more than 50 per cent. of the but only a fowl prepared in his own way. Oom Paul Kruger, children die in their first year and even among the white President of the Transvaal had faith late little the Republic, the death-rate is large. Our town council discussed in this"wonderdokter." He sent for him once but when people the question in January last with the result that a duly his to "consult the President asked spirits" Eugen began nurse now goes round to the houses where there him to what kind of spirits he was talking. "Are they in qualified are infants, examines the little ones, and gives the parents heaven ? "II do not think so,"was the answer. Then I am, Sirs, yours faithfully, good advice. go," said Oom Paul. Town. C. J. VAN RIJN. Cape the of world in there is no which patent Perhaps part "

"

medicines have such

a

vogue

as

in South Africa.

Since the

greater part of the population come into the world, live, and die without professional aid domestic medicines and some hereditary skill on the part of the farmers have the field much to themselves. No wonder that in this country the papers and periodicals, whether daily, weekly, or monthly,

news-

1

Many pharmaceutical chemists announce in gold letters windows that they sell Dutch medicines.

on

their

CARDIFF AND SWANSEA HOSPITALS. 7o the Editors

of THE LANCET. SIRS,-The grounds for your unfavourable criticism in THE LANCET of July 28th of the management of the Swansea

Hospital as compared with that of Cardiff for the year 1905 appear to be the relative cost per bed as furnished by your correspondent. These were-Swansea, .67119s. ;; Cardiff,

THE INSPECTION OF PORK IN IRELAND.

399 the case,

it is your

Your correspondent in arriving at these results your treatment has prejudiced clearly of Swansea taken the total ordinary expendi- duty to report that to the patient’s commanding officer ; ture, .E8214. and divided it by the average number of beds unless, of course, your withers are wrung and conscience tells occupied (114’ 12), with the result (£71 19s )as the cost per you you can do better next time. In this case pocket your bed, but in the case of Cardiff has taken from the total ordinary experience and put it to profit. I am, Sirs, yours faithfully, expenditure, £12,745, a sum of .62606, leaving a balance of R. N. £10, 139, which he has divided by the average number of July 31sat, 1906. beds occupied (157’77) with the result (£64 5s.) as the cost per bed. These results are two totally different costs per INSPECTION OF PORK IN IRELAND. bed, there being no connexion whatever between them, and any comparison must be absurd. When the expenditure of (FROM A CORRESPONDENT.) both hospitals is compared according to the standard laid down by Sir Henry Burdett and adopted almost universally A QUESTION of great importance came before the Belfast by the London and provincial hospitals, and taking into account the out-patients, painting, and bank charges in both corporation on August 3rd-that is, how to deal with the cases, the result would be as follows :carcasses of swine affected with tuberculosis. The market committee carried a motion1 to the effect that when the lesion was strictly confined to the glands of the neck the head and neck should be destroyed and the rest of the carcass returned to the owner, but that where two or more organs were affected the whole of the carcass should be destroyed. The committee followed in its regulation the practice in Glasgow, Dublin, and Edinburgh, and in Germany. but when the matter came up for confirmdtion before the city council it was decided to send back the resolution to the markets committee for further consideration on the ground that the 1898 Royal Commission on Tuberculosis had stated that "in view of the greater tendency to generalisation of tuberculosis in the pig we consider that the presence of tubercular deposit in any degree shall involve seizure of the " This is not time to criticise the standard adopted by Sir whole carcass and of the organs This matter raises several very interesting subjects for Henry Burdett or to question the right of the Cardiff authorities to adopt any standard they may think fit but if discussion. Everyone admits that proper and thorough the expenditures of two hospitals are to be compared it can inspection is necessary, but many believe that the view Commission cannot, with the evidence of the 1898 only be done satisfactorily by adopting a common standard accumulated Royal since it reported, be maintained. First, on for both.-I am, Sirs, yours faithfully, what evidence is it established that there is a " greater W. LLEWN. MORGAN, Lt.-Colonel. tendency to generalisation of tuberculosis in the pig" ?2 In Swansea, August 7th, 190S. Chairman, House Committee. the cae of the very pigs seized recently in Belfast the most careful experiments made microscopically and by injecting the flesh of the animals into guinea-pigs (which are so JUVENILE SMOKING. sensitive to tuberculosis) have totally failed to demonTo the Editors of THE LANCET. strate or to produce the disease, though in these same pigs the glands removed were tuberculous. Among SIRS,-Your annotation in THE LANCET of July 28th, the most complete and authoritative treatises on meat leaves untouched p. 241, on Juvenile Smoking absolutely the point made months ago by the Lord Advocate of inspection is that of Dr. Ostertag, professor in the High School at Berlin, and in the fourth Scotland-viz., that cigarettes can be fetched by the Veterinary his edition of "Handbook of Meat Inspection," bigger boys and secretly sold or given by them to their translated in 1904great Dr. Wilcox, veterinary editor, Experiby in which the or brothers way companions, proposed mental Station Record, younger Washington, with an introduction legislation would be rendered a dead letter. To suggest that this difficulty is insuperable seems absurd. Yet amid all the by Dr. Mohler, chief of the Pathological Division, United writers on the subject not one has told us how to meet the States Bureau of Animal Industry, the whole question is very discussed. It is demonstrated that the experience of point, nor, strange to say, does the Select Committee make fully anatomists shows in the most unambiguous the pathological I am, Sirs, yours faithfully, any suggestion. manner that the meat of tuberculous animals plays only OBSERVER. July 30th, 1906. of human tuberculosis. an role in the

£64 5s. 4d. has in the

case

THE

inconspicuous

TWO POINTS OF MEDICAL ETHICS. To the Editors of THE LANCET. SIRS,-With reference to the letter of "I.M.S."" in THE LANCET of July 28th, p. 258, I submit the following

opinions. 1. As to shameful"diseases your first duty is to your The medical officer is employed by the Crown- , the person who pays the piper calls the tune-and the sick person has joined the service in full understanding of this fact and, of course, the disease must be stated accurately on the returns. No one can expect you to make and sign an incorrect official statement. Take the case of a man unfit for duty from alcoholism. When you are sure of your diagnosis it must be at once officially reported. If not, you probably show a bad example to, and thereby degrade, your subordinates; you prejudice the service ; you very rarely gain anything for your patient, except a putting off of the evil day which will come, and the trouble which follows generally recoils on yourself and serves you right. 2. Officers under treatment by private practitioners. It is most unlikelythat a civil practitioner would see without inquiry an officer who was, « priori, probably the patient of another. In the unlikely case (I am not talking of consultations which I always encouraged, they comfort the patient and often help you) you may deal with the civil practitioner directly and, of course, if the interruption of

employer.

etiology

With reference to the view generally entertained that in undoubted cases of local tuberculosis the meat is harmless, Dr. Ostertag says: " The assumption of the harmlessness of meat in cases of undoubted local tuberculosis will probably remain for all time as an immutable dogma of meat inspection " ; while in reference to the current notion that the generalisation of tuberculosis is always associated with a harmful property of meat Dr. Ostertag says that this can no longer be maintained, for, according to him, "only under certain conditions, and not uniformly, does the generalisation of tuberculosis produce a harmful property in the meat." It is clear that the opinion of the 1898 Royal Commission cannot be regarded as unchallenged, however perfect the counsel conveyed. Secondly, even were such a rigid meat inspection found to be necessary, it is absurd that it should be applied by one local authority and not put in force by another. Why should carcasses be condemned in one place which would pass in another where there is a less rigid inspection, or none at all ? It is common in several of the smaller Irish towns for pigs to be bought and "cured" without any inspection at all, and what is still more meat of these animals is sent into Dublin and Belfast where it is used without being inspected at all in its "cured"state. Many hold that meat inspection should be taken out of the hands of the local authorities. The Government could then adopt one uniform method

ridiculous, the

1

See THE LANCET, August 4th, 1906, p. 327.