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CHILD WELFARE AND INDUSTRIAL INSURANCE.
CHILD WELFARE AND INDUSTRIAL INSURANCE.
898
been omitted, the issue of the case certainly seems surprising. That a man described his fellow-.workmen as having been perfectly fit for his work prior to an accident that was capable of setting up localised ataxic symptoms in the injured limb, and by his own medical attendant who had known him for years as showing no signs of ataxia at all, should be nevertheless the subject of locomotor ataxia previously to the accident; and that such ataxia, moreover, began in the upper and not in the lower limbs, and was unilateral, being confined to the injured limb, seems difficult to accept. But be that as it may, it seems to us unfortunate that an official medical referee attached to a particular court should be allowed in any circumstances to give expert evidence in the court of which he is in some sense part of the judiciary, since it is to him that the judge ordinarily looks for guidance. It is easy to see that when acting as a medical expert an undue weight would naturally, even though unconsciously, attach to his opinion.
by
CHILD WELFARE AND INDUSTRIAL
INSURANCE.1
undoubtedly -
delivered
on
Tuesday, Oct. 15th ; Wednesday, Oct. 16th ; Thursday, Oct. 17th ; and Friday, Oct. 18th, by Dr. F. M. Sandwith, Gresham professor of physic, who has taken as his subject the Relief of the Sick and Wounded in Time of War. The lectures will be delivered at the City of London are free to at 6 o’clock.
School, Victoria Embankment, E.C., women, and will
begin
each
evening
men
BEQUE°TS:-Mr. J. Slocumbe, formerly
and
of
Bristol, who died recently at Cardiff, has bequeathed Z100 to the Cardiff Infirmary, and 1000 guineas to endow a bed in that institution.-The late Mr. H. H. Wippell, of Exeter, has bequeathed .c500 to the Royal Devon and Exeter
Hospital. THE DILKE MEMORIAL HOSPITAL.-A meeting recently held at Cinderford, Gloucestershire, under the presidency of the Lord-Lieutenant of the county (Earl Beauchamp), in connexion with the Dilke Memorial Hospital. was
It
,
stated that the governors of the Gloucestershire not in favour of the scheme, and it has been suggested that the memorial to the late Sir Charles Dilke should take the form of a convalescent home. After some considerable discussion it was unanimously decided that no other memorial was advisable, and it was further resolved to proceed with the erection of the hospital. Over C2000 have I been subscribed already, and a friend has promised to I, was
Infirmary are
supplement collected.
the
subscriptions by a
sum
equal
to the amount
PHY-
INDUSTRIAL insurance may beneficially affect the welfare of the children of a nation in one of two ways: (1) indirectly, through benefits conferred on the parents ; (2) directly, through special benefits conferred on the children. Indirect benefits are probably by far the most important. Any and all measures which have as their object the prevention of, or compensation for, unemployment and invalidity of one or both parents must obviously redound to the advantage of their children, due to the raising of the general standard of living, with corresponding improvement of the child’s environment as regards diet, hygienic conditions, and other essentials. It might be well, however, to glance briefly at some of the special provisions for adults obtained through the medium of industrial insurance, which more particularly affect the welfare of the children.
Benefits of 1llateraity Insuranae. of principle maternity insurance is probably the most important of all from the standpoint of the child. Under present social conditions the presence of children is apt to be regarded as being a distinct handicap in the struggle for existence ; and, indeed, as Sydney Webb puts it, "the presence of a" large family is attended by almost penal consequences." Dr. Eder states that it is only by means of direct cash payment to women as a reward for their successful parenthood that the economic independence of married women can be secured. In the English National Insurance Act every insured woman and the wife, whether insured or uninsured, of every insured man will be entitled to a maternity benefit of 30s. on the birth of a child; while a married woman who is herself insured will be entitled to 7s. 6d. a week sick pay for the four weeks after confinement, in addition to the 30s. maternity benefit, so that she will thus receive 3in all. The beneficial effect of this provision on the welfare of the infant cannot be over-estimated. The mother, freed from mental worry and, to some extent, from the necessity of working up to the last moment, is better nourished and her milk of correspondingly better quality ; she is provided with a competent doctor and maternity nurse, who not only looks after the infant in the first weeks of its existence, but has also the opportunity of instructing the mother in the proper care and feeding of her child during its early years, and so. averting digestive and other disorders. It is computed that the maternity benefit under the National Insurance Act will involve the expenditure of .61,500,000 a year. In Germany maternity benefit to the amount of the usual sickness pay is payable for eight weeks (at least six of which must follow confinement) to women who have been insured for six months during the year preceding confinement, but in Germany confinement and sickness pay are not granted concurrently as in the English Insurance Act. The total amount expended as maternity benefit in 1910 in Germany was .6321,650, equal to Is. 9d. per head of the female membership. The municipal authorities in Halle, by granting lactation premiums (Stillprilmien) to mothers who nurse their own babies, have succeeded inreducing infant mortality from 20 to 10 per cent. in one year. There has been a movement in Karlsruhe in Baden to found a bank for maternity insurance, which, it was hoped, would be subsidised by a grant from the Government. In Paris than 20,000 working women are insured in the more I I Muttialit6 Maternelle,"with the result that their infant mortality has been reduced to 4 per cent. Afoaial and Economic Benefits. In Germany the Invalidity Insurance institutions at the end of 1911 had advanced over .E18,00O,000 for the buildingof suitable workmen’s dwellings, and had lent over .611,000,000 to building associations and other societies, while over .E3,SOO,OOO were advanced direct to insured persons ; and a sum exceeding .E24.000,00O was lent to various The
Medicine, on Celsus as the "Roman Hippocrates," on the Scuola Salernitana, on Mediaeval Anatomy, on such men of light and leading as Mundino, Gentile of Foligno, Mariano Santo, and on the great medical teachers of the Renaissance, from Borelli to Valsalva, Eustachius, Morgagni, and Malpighi. Special studies will also be contributed on the History of Public Health Legislation and on the Syllabus Reductions in railway Obstetricus of Maria Dal Doune. fares and other facilities, like those conceded to the members of the Archaeological and Fine Art Congresses, will be obtainable on communicating immediately with Professor V. Pensuti, No. 47, Esedra, Rome. for 1912 will be
LESLIE, M.A., B.SC., M.D. EDIN.,
The
THE History of Medicine as One of the Sciences that Rest on Nature-study will form the main theme of a congress to be held in Rome coincidently with the International Congresses on Archaeology and the History of Fine Art, between Oct. 8th and 22nd next. Professor Domenico Barduzzi, Rector of Siena University, in which he fills the chair of skin diseases, initiated the series of the first-named congresses five years ago. The agenda paper includes addresses on Prehistoric
THE Gresham lectures
BY R. MURRAY
SENIOR PHYSICIAN, PRINCE OF WALES’S GENERAL HOSPITAL; SICIAN, ROYAL HOSPITAL FOR DISEASES OF THE CHEST.
1
A paper read before the
Congress, July, 1912.
Royal Institute
of Public
Health, Berlin
CHILD WELFARE AND INDUSTRIAL INSURANCE.
899
i of ’’ schools for mothers " is being established projects for social betterment, including f.5,250,000 for the network 1 building of hospitals and B8,250,000 for improved water-through voluntary efforts, where young mothers are being ’supply, sewerage, and other objects of public welfare. iinstructed by doctors, nurses, and health visitors in all Enormous snms have also been spent in giving treatment tomatters giv ng pertaining to the feeding and rearing of childreninsured persons, when by doing so disability could be avertedIn addition to " health talks" and practical demonstrations,
i existing invalidity diminished or removed. During theillustrative placards and leaflets are distributed similar to. preceding 1910 the insurance institutions treated1those circulated by the Hanoverian Central Association fornearly three-quarters of a million insured persons, at a costPublic Welfare. In time, no doubt, the various local of nearly 9,000,000, nearly two-thirds of this sum beinginsurance societies to be founded by the National Insurance’ Act will exercise a general supervision over these instituspent in the treatment of tuberculosis. It is thus evident that industrial insurance against accident tions and assist them with Governmental grants. Similar and invalidity has in Germany become one of the most im- schools for mothers and infant consultations are being portant factors in national health. They have also played established in other countries, and their establishment is. an important part in the economic environment of the constantly followed by a great reduction in infant mortality. working classes, and it is expected that a similar improve- The provision of maternity insurance will enormouslyment will eventually occur in England also. Representative strengthen the hands of those agencies and make it possible employers in Germany state regarding the insurance laws for their instructions to be carried out in every home in the that the security for the future afforded by them has exercised country. influence on the health, the an enormously beneficent As a direct result of the maternity provision many women,. married and unmarried, who are now compelled to go tostandard of life, and the efficiency of the working classes. It is obvious that no section of the community will derive the workhouse on the occasion of their confinement may be saved from the deteriorating influences of workhouse more benefits from this raising of the standard of life and health than the infants and children, who will necessarily environment by other and more helpful arrangements being be better fed, better housed, and generally provided with a made for them. One of the most important benefits of the English better environment for their growth and development. As time goes on, and when national insurance against un- National Insurance Act consists in the appointment of large employment and invalidity is well established, its practical numbers of specially trained health visitors, many of whom working better understood, and its rules and regulations have had hospital training, whose duty it will be to visit themodified to meet the various national requirements, it will homes of the people, and who will be directed to pay special become more and moinecessary to make special provision care to the welfare of the children. It is impossible to overfor the physically and mentally unfit and degenerate, so that estimate the benefits likely to accrue to the rising generation they will have fewer opportunities of marriage and parent- as the direct result of such a practical measure. Each Local Insurance Committee will, no doubt, have hood, and in this way the bad stocks will gradually be weeded out and the race correspondingly improved. A contributive special features of its own according to the needs of the system of national insurance will always be more eugenic district. Thus, in Germany, where there are no less than 31 than a non-contributive one, as the thrifty are encouraged at great invalidity insurance associations governed from a The children will therefore central bureau in Berlin, each institution displays features the expense of the unthrifty. not only be better nourished, but better born, and it is not of its own, so as to meet the social and economical too much to hope that the handicap of a bad heredity may requirements of the particular province over which it be greatly diminished, if not actually eliminated. Any presides. alteration in the social environment tending to discourage Special Benefitsfor Tuberculous Children. the multiplication of those persons irrevocably below the In the interim report of the British Departmental Com-national minimum of fitness and employability must ultimately mittee on Tuberculosis certain definite recommendations in redound to the advantage of the nation. to children have been made, which it is hoped will beDr. Zahn claims that in Germany the insurance legislation regard as an integral part of the National Insurance adopted has developed into a great system of social hygiene, which scheme in respect to tuberculosis. has effected a marked improvement in the entire health of It is recommended that (a) children suffering from the community. Not only are the adult workers in general tuberculosis shall, whenever practicable, be sent pulmonary less exposed to, and more capable of resisting, the dangers of to residential sanatorium children affected with schools ; sickness, infirmity, and accident, but the rising generation osseous tuberculosis shall be sent (b) to residential sanatorium is at the outset healthier and robuster, and the increase of schools equipped with all necessary appliances for conservavital force thus effected benefits not only the individual but5tive treatment (2000 additional beds being recomsurgical the nation as a whole. mended for this purpose) ; (c) glandular and other forms of Encouragement of Prophylactic Measures against the Ailments: tuberculosis shall mainly be dealt with by means of open-air schools, playground classes, night camps, &c. ; (d) instituof Children. The preventive treatment of the sick forms at present one: tions shall also be established to deal with the large number of the most important factors in the operation of the! of children who are suffering as the result of conditions and Invalidity Insurance Scheme. In Germany it has beenfrom ailments which, if neglected, are likely to lead to theproved to be a "paying proposition" to establish a compre- development of tuberculosis. It is further recommended’ hensive scheme of preventive measures, as it is found to be! that the school medical officer who periodically medically This; examines the children in elementary schools shall be in more economical to prevent disease than to cure it. has been particularly the case in regard to so-called children’sclose touch with the neighbouring tuberculosis dispensary,
or
four years
.
one of which is to be established for every urban district ailments and tuberculosis. In this connexion one might refer to what is now being&c edil; with a population of from 150,000 to 200,000 persons. done in the province of Hanover. In this province there isThe Departmental Committee believes that childhood ’ what is called the " Central Association for Public Welfare," forms the best opportunity for detecting and dealing with which works in close cooperation with the Hanoveriani tuberculosis, and that the factors which tend to weaken the Invalidity Insurance Institution. The Central Associationi defensive powers of children, particularly malnutrition, can acts (to quote the words of Mrs. Kanthack de Voss) as a easily be brought under control at an early age, and that species of intelligence department for the Invalidity Insur- the more the resistant power of children is increased, theance Institution, which, in its turn, financially assists all 1 lighter will be the burden of tuberculous disease in the projects of the Central Association which are designed to3 adults of the next generation. The English National diminish debility, tuberculosis, and other conditions of f Insurance Act expressly provides for the sanatorium treat-protracted ill-health. The Central Association publishess ment of uninsured members of an employed contributor’s and distributes striking illustrative leaflets which are widely y family. circulated amongst the working mothers, indicating the e In Hanover it is thoroughly realised how important it is importance of breast-feeding of infants in regard to thee to make provision for tuberculous children, as well as for prevention of rickets and tuberculosis, while instruction iss advanced cases of adult tuberculosis. Charlottenburg mainr tains a holiday colony for children,while the German. also given in the correct feeding and proper care of oldei children, so as to prevent many of the maladies from whichh Pension Boards, as part of their anti-consumption crusade, contribute towards the cost of tuberculosis dispensaries. they suffer in the early years of life. intended for children. Numerous institutions. In this connexion it may be mentioned that in England a -
a exclusively
SIR CHARLES BELL AND MOTOR AND SENSORY NERVE CHANNELS.
900
,1ul.ve been established in Germany, not only for the cure of barrier to any parent according to his or her financial the children who have been infected, and have shown ability making further provision by means of voluntary - symptoms of the disease, but also for delicate and scrofulous premiums to insurance societies for more valuable benefits children whose lungs have not yet become affected. Open- to accrue to their families in the event of invalidity, .air schools, too, have been established, not to mention the unemployment, or death. Indeed, it is more probable that various homes for recovery for the reception of convalescent the universal existence of some form of insurance will give children debilitated from illness or other cause. an additional impetus to the whole question of provision Provision of Special Institutions other than Sanatoriums for against all emergencies inoidental to modern life amongst all classes, with the result that the children of the nation will the Benefit of Children. be still further protectedand their future welfare still further In Germany, and to a less extent in England, institutional I look forward with hope to a great treatment for th various ailments and disorders of children guaranteed. Personally extension of the principle of voluntary maternity insnranee, as being established, including children’s convalescent which, indeed, may be the key to many social problems homes, orthopaedic and medico-mechanical institutions, (including the diminution of the birth-rate, infant mortality, - forest ’health resorts, recreation grounds, medicated bath and child which are exercising the minds of some of welfare) - establishments, cripples’ homes, creches, holiday colonies, our ablest and most patriotic citizens. various outdoor cures, most of which in Germany are
Pensions for Children.
In:Germany, under the amended Insurance Law of 1911, should an invalid pensioner have children under 15 years of age, ’his pension is increased ’for each such child by onetenth to a maximum of 50 per cent. additional. In the English "National Insurance Act one of the "additional benefits" scheduled is the increase of sickness or disablement benefit in the case of members of the society who have any children, or any specified number of children, wholly or in part dependent upon them. In Germany, under the new scheme of ’’ Survivor Insurance," pensions are paid on the death of an insured father to children under 15 years, born in wedlock, and also to the fatherless children of an insured woman, whether ’, ’iegttnaa.te or not, up to the same age ; and provision is also made that if an insured person leaves behind orphan grand-children, under 15 years of age, who are wholly or mainly dependent upon him, they have an equal claim to Orphans’ Pension " so long as they are in need. Pensions are also paid to invalid widows on the death of their husbands. Should a widow receive no "Survivor Pension " owing to the fact that she is in receipt of. or by virtue of her own contributions has a claim to, a larger invalidity pension, she receives on the death of her husband a single payment in the form of "widow’s money" and " dowry money " for each child on its reaching the age of 15 years. The amount of the widow’s money is equal to twelve monthly instalments of the "widow’s pension" and that of the "orphan’s dowryto eight monthly instalments of the " orphan’s pension," the Imperial Government adding 50 marks (£210s.) in the former case and 16 2/3 marks (16s. 8d.) in the latter. A similar scheme of widows’ and orphans’ pensions will, no doubt, be drawn up and scheduled under the English National Insurance Act.
Medical Inspection of School Children. England the medical inspection of school children is arranged for by the Board of Education separately from National Insurance, but it is now universally agreed that it is only by close cooperation between the local Education Committees and the local Insurance Committees that really satisfactory results can be obtained. It is of little use for the various defects to be diagnosed and noted unless In
arrangements are forthwith made with the various curative institutions for their treatment. In process of time, therefore, there is certain to be a linking up of the Educational, Public Health, and National Insurance Departments for the good of the rising generation.
Supplementary Irolzcrctccry Insurance. The English critics of the principle of compulsory.National Insurance lay much stress upon the theory that Industrial Insurance may act as a check on individual thrift and enterprise. They assert, and with a considerable amount of truth, that the best and most thrifty individuals in the community had already through the agency of insurance offices and Friendly Societies built up various comprehensive schemes of insurance against invalidity (whether sickness or accident), in many eases including provision for the benefit of their families as best suited their individual requirements. The obvious reply to this criticism is to state that the mere existence of a compulsory minimum for all need not in any -,way ;interfere with individual enterprise on the part of the Thus there is no more thrifty sections of the community.
ON THE CLAIM OF
SIR CHARLES BELL TO THE DISCOVERY OF MOTOR AND SENSORY NERVE CHANNELS. BY A. D. WALLER, M.D. ABERD., F.R.S. (From the Physiological Laboratory of the University of London, South Kensington.) UNDER the above title an article appeared in THE LANCET of July 27th, 1912, p. 253, by Dr. F. W. Edridge-Green, from the Institute of Physiology, University College, London, which dealt at length with one of the side issues of the BellMagendie controversy, of which the main issue was very fully discussed last year in a correspondence between Professor Arthur Keith and myself under the limited title ’’Charles Bell and the Motor and Sensory Functions of Spinal
Nerves."
Statement of
Questions at Issue.
I do not wish to go back to that correspondence, but in order to keep the main issue free of obscurities it is necessary to restate the original question, Did Bell or Magendie discover the motor and sensory functions of the anterior and posterior roots of the spinal nervesTo this clear and simple question two diametrically opposed answers have been given : Professor Keith1 asserted that at an early date (1810) 11 Bell recognised that the spinal roots were different in function, and that the anterior root was , sensible’ (motor in modern terminology) in function, and the posterior ’insensible,’ or sensory.’ I had asserted (and still assert) that " the discovery of the distinction between the motor and sensory functions of the anterior and posterior nerve-roots was made by Magendie in 1822. Charles Bell (1811), to whom the discovery is commonly ascribed, observed motion on excitation of the anterior roots of a recently killed animal, and inferred that the anterior orcerebral’ roots are motor and sensory, and that the posterior or cerebellar roots serve to govern vital actions." And I justified my statement in THE LANCET of March 4th, 1911. Two further contributions have since been made towards the settlement of this question: (1) A paper ° ° On the Claim of Sir Charles Bell to the Discovery of Motor and Sensory Nerve Channels (an Examination of the Original Documents of 1811 to 1830), "published in the Report of the British Association of last year-Portsmouth, 1911, p. 287-in which I have given a careful summary of the facts of the case, and which was recommended for publication by the Sectional Committee on Physiology after examination of the original documents by a special subcommittee ; and (2) a valuable historical review of anatomy in Scotland from 1823 to 1899, by Professor Keith, in the Edinburgh Medical Journal of January, 1912 (the first Struthers lecture at the Royal College of Surgeons of Edinburgh, Nov. 17th, 1911), in which the following sentence occurs (p. 10) : ’’ His [Sir C. Bell’s] reputation does not rest on a quibble as to who discovered the exact function of nerve roots, but on the fact that he was the first man that realised that the anatomy of our brain and nerves could be explained." And although an "acknowledgment," if I may so term it, is implied rather than expressed, not quite happily indeed, it may be regarded, on 1
THE LANCET, March 18th, 1911, p. 764.
’
898
been omitted, the issue of the case certainly seems surprising. That a man described his fellow-.workmen as having been perfectly fit for his work prior to an accident that was capable of setting up localised ataxic symptoms in the injured limb, and by his own medical attendant who had known him for years as showing no signs of ataxia at all, should be nevertheless the subject of locomotor ataxia previously to the accident; and that such ataxia, moreover, began in the upper and not in the lower limbs, and was unilateral, being confined to the injured limb, seems difficult to accept. But be that as it may, it seems to us unfortunate that an official medical referee attached to a particular court should be allowed in any circumstances to give expert evidence in the court of which he is in some sense part of the judiciary, since it is to him that the judge ordinarily looks for guidance. It is easy to see that when acting as a medical expert an undue weight would naturally, even though unconsciously, attach to his opinion.
by
CHILD WELFARE AND INDUSTRIAL
INSURANCE.1
undoubtedly -
delivered
on
Tuesday, Oct. 15th ; Wednesday, Oct. 16th ; Thursday, Oct. 17th ; and Friday, Oct. 18th, by Dr. F. M. Sandwith, Gresham professor of physic, who has taken as his subject the Relief of the Sick and Wounded in Time of War. The lectures will be delivered at the City of London are free to at 6 o’clock.
School, Victoria Embankment, E.C., women, and will
begin
each
evening
men
BEQUE°TS:-Mr. J. Slocumbe, formerly
and
of
Bristol, who died recently at Cardiff, has bequeathed Z100 to the Cardiff Infirmary, and 1000 guineas to endow a bed in that institution.-The late Mr. H. H. Wippell, of Exeter, has bequeathed .c500 to the Royal Devon and Exeter
Hospital. THE DILKE MEMORIAL HOSPITAL.-A meeting recently held at Cinderford, Gloucestershire, under the presidency of the Lord-Lieutenant of the county (Earl Beauchamp), in connexion with the Dilke Memorial Hospital. was
It
,
stated that the governors of the Gloucestershire not in favour of the scheme, and it has been suggested that the memorial to the late Sir Charles Dilke should take the form of a convalescent home. After some considerable discussion it was unanimously decided that no other memorial was advisable, and it was further resolved to proceed with the erection of the hospital. Over C2000 have I been subscribed already, and a friend has promised to I, was
Infirmary are
supplement collected.
the
subscriptions by a
sum
equal
to the amount
PHY-
INDUSTRIAL insurance may beneficially affect the welfare of the children of a nation in one of two ways: (1) indirectly, through benefits conferred on the parents ; (2) directly, through special benefits conferred on the children. Indirect benefits are probably by far the most important. Any and all measures which have as their object the prevention of, or compensation for, unemployment and invalidity of one or both parents must obviously redound to the advantage of their children, due to the raising of the general standard of living, with corresponding improvement of the child’s environment as regards diet, hygienic conditions, and other essentials. It might be well, however, to glance briefly at some of the special provisions for adults obtained through the medium of industrial insurance, which more particularly affect the welfare of the children.
Benefits of 1llateraity Insuranae. of principle maternity insurance is probably the most important of all from the standpoint of the child. Under present social conditions the presence of children is apt to be regarded as being a distinct handicap in the struggle for existence ; and, indeed, as Sydney Webb puts it, "the presence of a" large family is attended by almost penal consequences." Dr. Eder states that it is only by means of direct cash payment to women as a reward for their successful parenthood that the economic independence of married women can be secured. In the English National Insurance Act every insured woman and the wife, whether insured or uninsured, of every insured man will be entitled to a maternity benefit of 30s. on the birth of a child; while a married woman who is herself insured will be entitled to 7s. 6d. a week sick pay for the four weeks after confinement, in addition to the 30s. maternity benefit, so that she will thus receive 3in all. The beneficial effect of this provision on the welfare of the infant cannot be over-estimated. The mother, freed from mental worry and, to some extent, from the necessity of working up to the last moment, is better nourished and her milk of correspondingly better quality ; she is provided with a competent doctor and maternity nurse, who not only looks after the infant in the first weeks of its existence, but has also the opportunity of instructing the mother in the proper care and feeding of her child during its early years, and so. averting digestive and other disorders. It is computed that the maternity benefit under the National Insurance Act will involve the expenditure of .61,500,000 a year. In Germany maternity benefit to the amount of the usual sickness pay is payable for eight weeks (at least six of which must follow confinement) to women who have been insured for six months during the year preceding confinement, but in Germany confinement and sickness pay are not granted concurrently as in the English Insurance Act. The total amount expended as maternity benefit in 1910 in Germany was .6321,650, equal to Is. 9d. per head of the female membership. The municipal authorities in Halle, by granting lactation premiums (Stillprilmien) to mothers who nurse their own babies, have succeeded inreducing infant mortality from 20 to 10 per cent. in one year. There has been a movement in Karlsruhe in Baden to found a bank for maternity insurance, which, it was hoped, would be subsidised by a grant from the Government. In Paris than 20,000 working women are insured in the more I I Muttialit6 Maternelle,"with the result that their infant mortality has been reduced to 4 per cent. Afoaial and Economic Benefits. In Germany the Invalidity Insurance institutions at the end of 1911 had advanced over .E18,00O,000 for the buildingof suitable workmen’s dwellings, and had lent over .611,000,000 to building associations and other societies, while over .E3,SOO,OOO were advanced direct to insured persons ; and a sum exceeding .E24.000,00O was lent to various The
Medicine, on Celsus as the "Roman Hippocrates," on the Scuola Salernitana, on Mediaeval Anatomy, on such men of light and leading as Mundino, Gentile of Foligno, Mariano Santo, and on the great medical teachers of the Renaissance, from Borelli to Valsalva, Eustachius, Morgagni, and Malpighi. Special studies will also be contributed on the History of Public Health Legislation and on the Syllabus Reductions in railway Obstetricus of Maria Dal Doune. fares and other facilities, like those conceded to the members of the Archaeological and Fine Art Congresses, will be obtainable on communicating immediately with Professor V. Pensuti, No. 47, Esedra, Rome. for 1912 will be
LESLIE, M.A., B.SC., M.D. EDIN.,
The
THE History of Medicine as One of the Sciences that Rest on Nature-study will form the main theme of a congress to be held in Rome coincidently with the International Congresses on Archaeology and the History of Fine Art, between Oct. 8th and 22nd next. Professor Domenico Barduzzi, Rector of Siena University, in which he fills the chair of skin diseases, initiated the series of the first-named congresses five years ago. The agenda paper includes addresses on Prehistoric
THE Gresham lectures
BY R. MURRAY
SENIOR PHYSICIAN, PRINCE OF WALES’S GENERAL HOSPITAL; SICIAN, ROYAL HOSPITAL FOR DISEASES OF THE CHEST.
1
A paper read before the
Congress, July, 1912.
Royal Institute
of Public
Health, Berlin
CHILD WELFARE AND INDUSTRIAL INSURANCE.
899
i of ’’ schools for mothers " is being established projects for social betterment, including f.5,250,000 for the network 1 building of hospitals and B8,250,000 for improved water-through voluntary efforts, where young mothers are being ’supply, sewerage, and other objects of public welfare. iinstructed by doctors, nurses, and health visitors in all Enormous snms have also been spent in giving treatment tomatters giv ng pertaining to the feeding and rearing of childreninsured persons, when by doing so disability could be avertedIn addition to " health talks" and practical demonstrations,
i existing invalidity diminished or removed. During theillustrative placards and leaflets are distributed similar to. preceding 1910 the insurance institutions treated1those circulated by the Hanoverian Central Association fornearly three-quarters of a million insured persons, at a costPublic Welfare. In time, no doubt, the various local of nearly 9,000,000, nearly two-thirds of this sum beinginsurance societies to be founded by the National Insurance’ Act will exercise a general supervision over these instituspent in the treatment of tuberculosis. It is thus evident that industrial insurance against accident tions and assist them with Governmental grants. Similar and invalidity has in Germany become one of the most im- schools for mothers and infant consultations are being portant factors in national health. They have also played established in other countries, and their establishment is. an important part in the economic environment of the constantly followed by a great reduction in infant mortality. working classes, and it is expected that a similar improve- The provision of maternity insurance will enormouslyment will eventually occur in England also. Representative strengthen the hands of those agencies and make it possible employers in Germany state regarding the insurance laws for their instructions to be carried out in every home in the that the security for the future afforded by them has exercised country. influence on the health, the an enormously beneficent As a direct result of the maternity provision many women,. married and unmarried, who are now compelled to go tostandard of life, and the efficiency of the working classes. It is obvious that no section of the community will derive the workhouse on the occasion of their confinement may be saved from the deteriorating influences of workhouse more benefits from this raising of the standard of life and health than the infants and children, who will necessarily environment by other and more helpful arrangements being be better fed, better housed, and generally provided with a made for them. One of the most important benefits of the English better environment for their growth and development. As time goes on, and when national insurance against un- National Insurance Act consists in the appointment of large employment and invalidity is well established, its practical numbers of specially trained health visitors, many of whom working better understood, and its rules and regulations have had hospital training, whose duty it will be to visit themodified to meet the various national requirements, it will homes of the people, and who will be directed to pay special become more and moinecessary to make special provision care to the welfare of the children. It is impossible to overfor the physically and mentally unfit and degenerate, so that estimate the benefits likely to accrue to the rising generation they will have fewer opportunities of marriage and parent- as the direct result of such a practical measure. Each Local Insurance Committee will, no doubt, have hood, and in this way the bad stocks will gradually be weeded out and the race correspondingly improved. A contributive special features of its own according to the needs of the system of national insurance will always be more eugenic district. Thus, in Germany, where there are no less than 31 than a non-contributive one, as the thrifty are encouraged at great invalidity insurance associations governed from a The children will therefore central bureau in Berlin, each institution displays features the expense of the unthrifty. not only be better nourished, but better born, and it is not of its own, so as to meet the social and economical too much to hope that the handicap of a bad heredity may requirements of the particular province over which it be greatly diminished, if not actually eliminated. Any presides. alteration in the social environment tending to discourage Special Benefitsfor Tuberculous Children. the multiplication of those persons irrevocably below the In the interim report of the British Departmental Com-national minimum of fitness and employability must ultimately mittee on Tuberculosis certain definite recommendations in redound to the advantage of the nation. to children have been made, which it is hoped will beDr. Zahn claims that in Germany the insurance legislation regard as an integral part of the National Insurance adopted has developed into a great system of social hygiene, which scheme in respect to tuberculosis. has effected a marked improvement in the entire health of It is recommended that (a) children suffering from the community. Not only are the adult workers in general tuberculosis shall, whenever practicable, be sent pulmonary less exposed to, and more capable of resisting, the dangers of to residential sanatorium children affected with schools ; sickness, infirmity, and accident, but the rising generation osseous tuberculosis shall be sent (b) to residential sanatorium is at the outset healthier and robuster, and the increase of schools equipped with all necessary appliances for conservavital force thus effected benefits not only the individual but5tive treatment (2000 additional beds being recomsurgical the nation as a whole. mended for this purpose) ; (c) glandular and other forms of Encouragement of Prophylactic Measures against the Ailments: tuberculosis shall mainly be dealt with by means of open-air schools, playground classes, night camps, &c. ; (d) instituof Children. The preventive treatment of the sick forms at present one: tions shall also be established to deal with the large number of the most important factors in the operation of the! of children who are suffering as the result of conditions and Invalidity Insurance Scheme. In Germany it has beenfrom ailments which, if neglected, are likely to lead to theproved to be a "paying proposition" to establish a compre- development of tuberculosis. It is further recommended’ hensive scheme of preventive measures, as it is found to be! that the school medical officer who periodically medically This; examines the children in elementary schools shall be in more economical to prevent disease than to cure it. has been particularly the case in regard to so-called children’sclose touch with the neighbouring tuberculosis dispensary,
or
four years
.
one of which is to be established for every urban district ailments and tuberculosis. In this connexion one might refer to what is now being&c edil; with a population of from 150,000 to 200,000 persons. done in the province of Hanover. In this province there isThe Departmental Committee believes that childhood ’ what is called the " Central Association for Public Welfare," forms the best opportunity for detecting and dealing with which works in close cooperation with the Hanoveriani tuberculosis, and that the factors which tend to weaken the Invalidity Insurance Institution. The Central Associationi defensive powers of children, particularly malnutrition, can acts (to quote the words of Mrs. Kanthack de Voss) as a easily be brought under control at an early age, and that species of intelligence department for the Invalidity Insur- the more the resistant power of children is increased, theance Institution, which, in its turn, financially assists all 1 lighter will be the burden of tuberculous disease in the projects of the Central Association which are designed to3 adults of the next generation. The English National diminish debility, tuberculosis, and other conditions of f Insurance Act expressly provides for the sanatorium treat-protracted ill-health. The Central Association publishess ment of uninsured members of an employed contributor’s and distributes striking illustrative leaflets which are widely y family. circulated amongst the working mothers, indicating the e In Hanover it is thoroughly realised how important it is importance of breast-feeding of infants in regard to thee to make provision for tuberculous children, as well as for prevention of rickets and tuberculosis, while instruction iss advanced cases of adult tuberculosis. Charlottenburg mainr tains a holiday colony for children,while the German. also given in the correct feeding and proper care of oldei children, so as to prevent many of the maladies from whichh Pension Boards, as part of their anti-consumption crusade, contribute towards the cost of tuberculosis dispensaries. they suffer in the early years of life. intended for children. Numerous institutions. In this connexion it may be mentioned that in England a -
a exclusively
SIR CHARLES BELL AND MOTOR AND SENSORY NERVE CHANNELS.
900
,1ul.ve been established in Germany, not only for the cure of barrier to any parent according to his or her financial the children who have been infected, and have shown ability making further provision by means of voluntary - symptoms of the disease, but also for delicate and scrofulous premiums to insurance societies for more valuable benefits children whose lungs have not yet become affected. Open- to accrue to their families in the event of invalidity, .air schools, too, have been established, not to mention the unemployment, or death. Indeed, it is more probable that various homes for recovery for the reception of convalescent the universal existence of some form of insurance will give children debilitated from illness or other cause. an additional impetus to the whole question of provision Provision of Special Institutions other than Sanatoriums for against all emergencies inoidental to modern life amongst all classes, with the result that the children of the nation will the Benefit of Children. be still further protectedand their future welfare still further In Germany, and to a less extent in England, institutional I look forward with hope to a great treatment for th various ailments and disorders of children guaranteed. Personally extension of the principle of voluntary maternity insnranee, as being established, including children’s convalescent which, indeed, may be the key to many social problems homes, orthopaedic and medico-mechanical institutions, (including the diminution of the birth-rate, infant mortality, - forest ’health resorts, recreation grounds, medicated bath and child which are exercising the minds of some of welfare) - establishments, cripples’ homes, creches, holiday colonies, our ablest and most patriotic citizens. various outdoor cures, most of which in Germany are
Pensions for Children.
In:Germany, under the amended Insurance Law of 1911, should an invalid pensioner have children under 15 years of age, ’his pension is increased ’for each such child by onetenth to a maximum of 50 per cent. additional. In the English "National Insurance Act one of the "additional benefits" scheduled is the increase of sickness or disablement benefit in the case of members of the society who have any children, or any specified number of children, wholly or in part dependent upon them. In Germany, under the new scheme of ’’ Survivor Insurance," pensions are paid on the death of an insured father to children under 15 years, born in wedlock, and also to the fatherless children of an insured woman, whether ’, ’iegttnaa.te or not, up to the same age ; and provision is also made that if an insured person leaves behind orphan grand-children, under 15 years of age, who are wholly or mainly dependent upon him, they have an equal claim to Orphans’ Pension " so long as they are in need. Pensions are also paid to invalid widows on the death of their husbands. Should a widow receive no "Survivor Pension " owing to the fact that she is in receipt of. or by virtue of her own contributions has a claim to, a larger invalidity pension, she receives on the death of her husband a single payment in the form of "widow’s money" and " dowry money " for each child on its reaching the age of 15 years. The amount of the widow’s money is equal to twelve monthly instalments of the "widow’s pension" and that of the "orphan’s dowryto eight monthly instalments of the " orphan’s pension," the Imperial Government adding 50 marks (£210s.) in the former case and 16 2/3 marks (16s. 8d.) in the latter. A similar scheme of widows’ and orphans’ pensions will, no doubt, be drawn up and scheduled under the English National Insurance Act.
Medical Inspection of School Children. England the medical inspection of school children is arranged for by the Board of Education separately from National Insurance, but it is now universally agreed that it is only by close cooperation between the local Education Committees and the local Insurance Committees that really satisfactory results can be obtained. It is of little use for the various defects to be diagnosed and noted unless In
arrangements are forthwith made with the various curative institutions for their treatment. In process of time, therefore, there is certain to be a linking up of the Educational, Public Health, and National Insurance Departments for the good of the rising generation.
Supplementary Irolzcrctccry Insurance. The English critics of the principle of compulsory.National Insurance lay much stress upon the theory that Industrial Insurance may act as a check on individual thrift and enterprise. They assert, and with a considerable amount of truth, that the best and most thrifty individuals in the community had already through the agency of insurance offices and Friendly Societies built up various comprehensive schemes of insurance against invalidity (whether sickness or accident), in many eases including provision for the benefit of their families as best suited their individual requirements. The obvious reply to this criticism is to state that the mere existence of a compulsory minimum for all need not in any -,way ;interfere with individual enterprise on the part of the Thus there is no more thrifty sections of the community.
ON THE CLAIM OF
SIR CHARLES BELL TO THE DISCOVERY OF MOTOR AND SENSORY NERVE CHANNELS. BY A. D. WALLER, M.D. ABERD., F.R.S. (From the Physiological Laboratory of the University of London, South Kensington.) UNDER the above title an article appeared in THE LANCET of July 27th, 1912, p. 253, by Dr. F. W. Edridge-Green, from the Institute of Physiology, University College, London, which dealt at length with one of the side issues of the BellMagendie controversy, of which the main issue was very fully discussed last year in a correspondence between Professor Arthur Keith and myself under the limited title ’’Charles Bell and the Motor and Sensory Functions of Spinal
Nerves."
Statement of
Questions at Issue.
I do not wish to go back to that correspondence, but in order to keep the main issue free of obscurities it is necessary to restate the original question, Did Bell or Magendie discover the motor and sensory functions of the anterior and posterior roots of the spinal nervesTo this clear and simple question two diametrically opposed answers have been given : Professor Keith1 asserted that at an early date (1810) 11 Bell recognised that the spinal roots were different in function, and that the anterior root was , sensible’ (motor in modern terminology) in function, and the posterior ’insensible,’ or sensory.’ I had asserted (and still assert) that " the discovery of the distinction between the motor and sensory functions of the anterior and posterior nerve-roots was made by Magendie in 1822. Charles Bell (1811), to whom the discovery is commonly ascribed, observed motion on excitation of the anterior roots of a recently killed animal, and inferred that the anterior orcerebral’ roots are motor and sensory, and that the posterior or cerebellar roots serve to govern vital actions." And I justified my statement in THE LANCET of March 4th, 1911. Two further contributions have since been made towards the settlement of this question: (1) A paper ° ° On the Claim of Sir Charles Bell to the Discovery of Motor and Sensory Nerve Channels (an Examination of the Original Documents of 1811 to 1830), "published in the Report of the British Association of last year-Portsmouth, 1911, p. 287-in which I have given a careful summary of the facts of the case, and which was recommended for publication by the Sectional Committee on Physiology after examination of the original documents by a special subcommittee ; and (2) a valuable historical review of anatomy in Scotland from 1823 to 1899, by Professor Keith, in the Edinburgh Medical Journal of January, 1912 (the first Struthers lecture at the Royal College of Surgeons of Edinburgh, Nov. 17th, 1911), in which the following sentence occurs (p. 10) : ’’ His [Sir C. Bell’s] reputation does not rest on a quibble as to who discovered the exact function of nerve roots, but on the fact that he was the first man that realised that the anatomy of our brain and nerves could be explained." And although an "acknowledgment," if I may so term it, is implied rather than expressed, not quite happily indeed, it may be regarded, on 1
THE LANCET, March 18th, 1911, p. 764.
’