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DR. R. R. RENTOUL AND THE MIDWIVES BILL.
274 t acquainted with a description of glandular fever, and generally due, not to strangulation of the omentum, but to became constriction within the abdomen of some portion of intestine aalthough I had not noticed any enlargement of lymphatic which is bound down by an omental band continuous withglands it seemed probable that these three cases were the pedicle of the piece of omentum contained within the Eexamples of that disease. That conclusion as to their nature i In the interesting editorial article on the may not have been correct, but they drew my attention to sac of the hernia. 1 the existence of glandular fever, and since that time I have case which appears in THE LANCET of Jan. 16th it is 1 on the lookout for it. Not, however, until the last pointed out that under these circumstances two courses of been treatment are open-viz., (1) to follow up the omentumweek or two have I seen any case that seemed to be an unto the crural ring; or (2) to perform laparotomy; the doubted example. A fortnight ago I was asked to see a girl latter course being recommended as preferable if theaged eleven years who only a few weeks ago returned to patient’s condition will admit it. It is my experienceClifton from the house of a medical friend in North Ireland, that without proceeding to the more serious operation where she had been laid up with a prolonged attack of of laparotomy relief will be afforded if-after ligaturing the rheumatism which seriously affected the heart. I found her pedicle and removing the omentum-the pedicle is carefully looking very ill and disinclined to move, the disinclination separated from all adhesions at the neck of the sac and then being largely due to pain in the neck on turning the head. allowed to slip back into the cavity of the abdomen. In this There was swelling in the region of the anterior triangle on way, by liberating the omentum, the strangulation of the either side of the neck, and on palpation the lymphatic intestine within the abdomen is at once relieved. This glands lying in front of the anterior border of the sterno’treatment I have found successful in four cases of strangu- mastoid muscle were found to be enlarged and very lated (?) femoral omental hernia, one of which I have markedly tender. The lymphatic glands in the posterior reported in detail in THE LANCET.1 In each instance triangles were not then examined, but a few days later recovery took place, removal of the omentum in’ the hernial it was mentioned that the back of the neck was noticed sac and liberation of the pedicle being at once followed by to be tender when the head was laid on a pillow. The a subsidence of the symptoms of abdominal obstruction. glands in these triangles were then found to be enlarged. The condition, which apparently is not very uncommon, I Those in the axillæ and groins were not affected. There have only met with in old irreducible omental hernias of the was some difficulty of swallowing owing to a sense of ’femoral variety. constriction in the throat, but nothing abnormal could I am, Sirs, yours faithfully. be seen. The temperature was raised for five days, F. A. SOUTHAM. reaching to between 1020 and 103° in the evening and falling Manchester. Jan. 18th, 1897. to 101° in the morning. There was obstinate constipation while the temperature remained raised. Two other children, aged nine years and thirteen years, had previously been "THE GLANDULAR FEVER OF similarly affected, but to a much slighter degree. Curiously CHILDHOOD." enough, two adults also, between the ages of forty-five and fifty years, had suffered from tender, swollen glands in the To the Editors of THE LANCET. neck, but nothing else had attracted their attention. There SIRS,—In calling the attention of the profession to the apparently had been no indication of fever and no diffiprimâ facie reasons for regarding glandular fever as a clinical culty of swallowing. Another case which I consider to be entity Dr. Dawson Williams has, I think, done valuable an example of this disease is at present attending the outservice. It is largely on the observation and inferences of patients’ department at the Children’s Hospital and I intend those engaged in general practice that further definite to ask other medical men if they have noticed similar cases. knowledge of the subject must depend, for the probable comI am, Sirs, yours truly, municability and benignity of the disease must tend to THEODORE FISHER. Clifton, Bristol, Jan. 18th, 1897. - exclude it to a great extent from the scope of ward and consulting practice. I am induced at this moment to write these few lines by having lately seen a child suffering from marked anaemia and other symptoms of ill-health whose "LIQUID VACCINE VIRUS." ailments dated from an attack which, as described to To the Editors of THE LANCET. me, seemed in all ascertainable points to tally with the SIRS,-I have seen an annotation under the above heading account given by Pfeiffer of glandular fever. Two other children had suffered in the same way; all had had the in THE LANCET of Jan. 2nd, but owing to my absence from glands on the neck enlarged and tender, none had had any England have been unable to take earlier notice of the marked throat trouble, and the affection was regarded as matter. The statement is made on the authority of your mumps with a difference, there having been apparently no New York Correspondent that, as the result of a series of swelling of the face. In the family, the mother, who was experiments, the Public Health Department has decided that quite young, had also suffered slightly, but soon recovered the best vaccine material is to be obtained by triturating the completely. Most of those who see sick children are aware: vesicle pulp with glycerine. This method of preservation is of cases, of no very infrequent occurrence, with fever described as ncyv, but I think I may justly claim that this is and some degree of cervical adenitis which are not to be hardly the case, seeing that I demonstrated this means of associated with any marked pharyngeal trouble, but are still producing absolutely pure vaccine lymph as long ago as 1891 (owing to glandular fever being, as Dr. Dawson Williams at the meeting of the International Congress of Hygiene, says, ignored) attributed to a hypothetical tonsillitis or other held in London. On many subsequent occasions also, and affection that has escaped observation. The examination,, especially in my evidence before the Royal Commission on in future, of the lymphatic glands of the body generally andL Vaccination,l I have had occasion to direct attention to the of the liver and spleen, in all such cases may go far towardss value from a bacteriological point of view of this method. giving us definite and important knowledge on this subject,, When properly applied it ensures the destruction of all to the literature of which Dr. Williams has given so) extraneous microbes, such as those concerned in the various interesting and practical a contribution in THE LANCET off processes of an inflammatory nature which may happen to be I am, Sirs, yours faithfully, Jan. 16th. present in the contents of the vaccine vesicle at the time of collection. Although this is the case, the addition of H. B. DONKIN. Harley-street, W., Jan- 18th, 1897. glycerine in no way impairs, but rather increases, the specific activity, as vaccine, of the resulting mixture. To the -Editors of THE LANCET. I am, Sirs, yours faithfully, S. MONCKTON COPEMAN. SIRS,-I have read with interest the paper by Dr. Dawson Savoy Hotel, Berlin, Jan. 9th, 1891 Williams on Glandular Fever in THE LANCET of Jan. 16th. Four years ago, when registrar to the Hospital for Children and Women, Waterloo-bridge-road, three cases of fever of DR. R. R. RENTOUL AND THE MIDWIVES five or six days’ duration, in which abdominal pain and very BILL. marked constipation were present, led me to think it possible To the Editors of THE LANCET. that there might be an undescribed fever of short duration with constipation as a prom:nent symptom. I subsequently and fallacies in Dr. Rentoul’s mis-statements SIRS,—The address have most of them been refuted. As some may 1 A Case of Intestinal Obstruction Relieved by Liberating the 1 Final Omentum from an Omental Hernia.—THE LANCET, Aug. 14th, 1886. report of Royal Commission on Vaccination, para. 448.
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275 -still be misled by them, we ask permission to point out a handsome and prompt response of the profession in many few of the most important. He says : ’Owing to the action cases-e.g., Dr. Culliugworth’s expenses—no difficulty should of a few practitioners, who contend that the wives of the be experienced in raising this money for such important poorer and wage-paid classes should have no one to help objects. We have Dr. Rentoul’s statement that he cannot them during their confinements but midwives ......" We advance any more money for these purposes, although he is know of no one who advocates this. He speaks of a clause both willing and ready to give both work and time. Donations will be gladly received by Dr. A. Cox (Gateshead) which proposes to hand over all confinements, natural and abnormal, to the sole control of the midwife." There is no and will with your permission be acknowledged in your such clause. No one ever proposed to do such a thing. columns.-We are, Sirs, yours truly, "All practical practitioners know that no labour can be COLIN CAMPBELL, FRAS. J. A. WARING, J. A. MYRTLE, DONALD FRASER, definitely defined as‘natural’ until some hours or days after the labour is over." Justso. No man can be pronounced WALTER LATTEY, CLEMENT H. SERS, J. WHEELER O’BRYEN, JOHN E GARNER, healthy till he has been well examined after death, but a man can be pronounced healthy up to a certain point, and W. E. BARTON, W. A. WETWAN, so can a labour be pronounced normal up to a certain JOHN R. WILLIAMS, J. B. CLOSE, J. M. FERGUSON, ALFRED COX (Hon. Sec.). ,point. "This threat to supply the poor with midwifery in trained and West Jan. View, 20th, 1897. Gateshead-on-Tyne, practitioners only partly midwifery wholly untrained in medicine and surgery......" There is no such threat. Our effort is to replace untrained midwives by trained midwives. Dr. Rentoul says that " THE LATEST VIEWS ON PHTHISIS." Dr. Matthews Duncan states that one woman in every To the Editors of THE LANCET. fifteen died in her first confinement. Dr. Matthews Duncan have been very greatly interested in the letter of never said anything of the kind. ’’ The proposal to establish SIRS,—I a partially trained class of midwifery practitioners for theyour correspondent at Rome on the above subject, because poor only is a crime-producing proposal." There is no such in all the editions of my book I have mentioned facts tending proposal. The proposal is to replace untrained persons by to show that phthisis is quite as likely to prove a disease of trained persons. Dr. Rentoul asks if we are "therefore to nutrition as of infection, or a mixture of both ; and, as will hand over this branch of the practice of physic to persons be seen in my third edition (p. 300), these facts have gained I should like whose poverty, if not their will, would press them to perform considerably in importance of late years " direct the also to attention of readers to the think We that the better are your illegal operations ? persons trained and controlled the less likely they will be to do recent writings of Professor T. J. Mays of Philadelphia and his treatment of phthisis by excess of albuminous ’illegal things. We observe other mis-statements, but we have mentioned food and large and long-continued doses of strychnia.2 ’enough. It should not, however, pass without notice that I have recently had a case under my care which I showed at Dr. Rentoul holds the opinion that 11 the poorer classes can the Esculapian Society treated by this method, in which the do without midwives," and that the public rates should pay results appeared to be quite as good as those recorded in ’for proper attention to parturient women, "that the fee America, and greatly exceeded my previous expectations. should be uniform for all kinds of labour, and that such fee I am well aware how dangerous it is in a disease like should be 40s." The midwife already exists in large numbers phthisis to build anything at all upon a few cases, and but and cannot be suppressed by any words or schemes of for your correspondent’s letter I should not have mentioned Dr. Rentoul. The only practical question is, not how she the matter just now. Still, I do think that the above facts are well worthy of the careful attention of those who, like shall be supplanted, but how she can be improved. the Milanese and some American pathologists, are prepared I am, Sirs, yours faithfully, to look all round the bacillus. ROWLAND HUMPHREYS, L.R.C.P. LOND., I am, Sirs, yours faithfully, Honorary Secretary Midwives Bill Committee. 12, Buckingham-street, Strand, W.C., Jan. 19th, 1897. ALEXANDER HAIG. Brook-street, W., Jan. 18th, 1897. ,
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DR. R. R. RENTOUL’S ELECTION EXPENSES. To the Editors of THE LANCET.
QUACKS AND UNCERTIFIED DEATHS.
To the -Editors of THE LANCET. SIRS,—The enclosed cutting from a weekly paper of some SIRS,-The result of the General Medical Council election standing and with a large circulation in this county may be must be gratifying to the supporters of Dr. Rentoul’s policy. of interest to you as showing the publicity, and therefore at times given by the press to the efforts of We, the undersigned, think this an opportune moment for encouragement, to hoodwink the public. doctors quack to notice of the these supporters heavy expendibringing the In some districts in this county unqualified medical ture in which it has involved Dr. Rentoul, the sum of £85 17s. 6d. having been spent by him in stamps, stationery, practice prevails extensively ; in one urban district, for and travelling. We feel that practitioners upon whose instance, of 18,000 population over 33 per cent. of the deaths behalf he has so faithfully striven should defray this out-of- during 1896 were uncertified, as the result of unqualified and the Durham county council, pocket expenditure. Also, we would state that since 1890 medical attendance; the of such practice and the fact dangers recognising Dr. Rentoul has spent ..E375 13s. 8d. in opposing the four Midwives Bills. Of this, £351 12s. has at various times that it interferes with the accuracy of the vital been refunded, thus leaving £ 24 Os. 112d. still owing, statistics and with the precautionary measures taken exclusive of interest. Dr. Rentoul is, like most of against the spread of infectious diseases, have, by reprethe Local Government Board, the Registrarourselves, in general practice, and we feel it to be sentationsandtothe General Medical Council, been endeavouring General, him to ask to not his work unfair time and (which only give have been and are invaluable to the cause) but also his to put a stop to such illegal practice. Such newspaper reas the enclosed, however, are calculated to encourage money on our behalf. We, therefore, with confidence ask ports his supporters to subscribe to a fund for the repayment of unqualified practice and are in my opinion much to be this £109 18s. 5id. By this means practitioners will show regretted. The Dr." Steele referred to in the cutting was a year or two ago successfully prosecuted and heavily fined practical appreciation of good work done, and willfor an offence against the 40th section of the Medical Act, pave the way for more. We would point out that this is not a question of a testimonial, although if the 1858, his occupation to within eighteen months of the date of the prosecution having been that of a coalminer. Such response were as hearty as it ought to be this m1ght also be considered. It is firstly and chiefly a questionpunishment, however, instead of acting as a deterrent appears of paying back money out of pocket, spent-and to have enlisted the sympathy for the offender of many most cheerfully and usefully spent-in furthering ourpersons in the district, with the result that not only has his interests. At the same time we would add that no timepractice not diminished, but he was very soon afterwards should be lost in establishing a Guarantee Fund so as to beelected a member of the district council. At their last meeting, I believe, the General Medical ready to fight the next Midwives Bill, and to help in drafting and securing the passing of a Bill for Increased Direct 1 THE LANCET, Jan. 16th, 1897, p. 214 Representation upon the General lledical Council. For these 2 American Medico-Surgical Bulletin, May 15th, 1894, and May 9th, purposes about R1500 will be required, and considering the 1896. See also New York Medical Journal, Feb. 15th, 1896. ’
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275 -still be misled by them, we ask permission to point out a handsome and prompt response of the profession in many few of the most important. He says : ’Owing to the action cases-e.g., Dr. Culliugworth’s expenses—no difficulty should of a few practitioners, who contend that the wives of the be experienced in raising this money for such important poorer and wage-paid classes should have no one to help objects. We have Dr. Rentoul’s statement that he cannot them during their confinements but midwives ......" We advance any more money for these purposes, although he is know of no one who advocates this. He speaks of a clause both willing and ready to give both work and time. Donations will be gladly received by Dr. A. Cox (Gateshead) which proposes to hand over all confinements, natural and abnormal, to the sole control of the midwife." There is no and will with your permission be acknowledged in your such clause. No one ever proposed to do such a thing. columns.-We are, Sirs, yours truly, "All practical practitioners know that no labour can be COLIN CAMPBELL, FRAS. J. A. WARING, J. A. MYRTLE, DONALD FRASER, definitely defined as‘natural’ until some hours or days after the labour is over." Justso. No man can be pronounced WALTER LATTEY, CLEMENT H. SERS, J. WHEELER O’BRYEN, JOHN E GARNER, healthy till he has been well examined after death, but a man can be pronounced healthy up to a certain point, and W. E. BARTON, W. A. WETWAN, so can a labour be pronounced normal up to a certain JOHN R. WILLIAMS, J. B. CLOSE, J. M. FERGUSON, ALFRED COX (Hon. Sec.). ,point. "This threat to supply the poor with midwifery in trained and West Jan. View, 20th, 1897. Gateshead-on-Tyne, practitioners only partly midwifery wholly untrained in medicine and surgery......" There is no such threat. Our effort is to replace untrained midwives by trained midwives. Dr. Rentoul says that " THE LATEST VIEWS ON PHTHISIS." Dr. Matthews Duncan states that one woman in every To the Editors of THE LANCET. fifteen died in her first confinement. Dr. Matthews Duncan have been very greatly interested in the letter of never said anything of the kind. ’’ The proposal to establish SIRS,—I a partially trained class of midwifery practitioners for theyour correspondent at Rome on the above subject, because poor only is a crime-producing proposal." There is no such in all the editions of my book I have mentioned facts tending proposal. The proposal is to replace untrained persons by to show that phthisis is quite as likely to prove a disease of trained persons. Dr. Rentoul asks if we are "therefore to nutrition as of infection, or a mixture of both ; and, as will hand over this branch of the practice of physic to persons be seen in my third edition (p. 300), these facts have gained I should like whose poverty, if not their will, would press them to perform considerably in importance of late years " direct the also to attention of readers to the think We that the better are your illegal operations ? persons trained and controlled the less likely they will be to do recent writings of Professor T. J. Mays of Philadelphia and his treatment of phthisis by excess of albuminous ’illegal things. We observe other mis-statements, but we have mentioned food and large and long-continued doses of strychnia.2 ’enough. It should not, however, pass without notice that I have recently had a case under my care which I showed at Dr. Rentoul holds the opinion that 11 the poorer classes can the Esculapian Society treated by this method, in which the do without midwives," and that the public rates should pay results appeared to be quite as good as those recorded in ’for proper attention to parturient women, "that the fee America, and greatly exceeded my previous expectations. should be uniform for all kinds of labour, and that such fee I am well aware how dangerous it is in a disease like should be 40s." The midwife already exists in large numbers phthisis to build anything at all upon a few cases, and but and cannot be suppressed by any words or schemes of for your correspondent’s letter I should not have mentioned Dr. Rentoul. The only practical question is, not how she the matter just now. Still, I do think that the above facts are well worthy of the careful attention of those who, like shall be supplanted, but how she can be improved. the Milanese and some American pathologists, are prepared I am, Sirs, yours faithfully, to look all round the bacillus. ROWLAND HUMPHREYS, L.R.C.P. LOND., I am, Sirs, yours faithfully, Honorary Secretary Midwives Bill Committee. 12, Buckingham-street, Strand, W.C., Jan. 19th, 1897. ALEXANDER HAIG. Brook-street, W., Jan. 18th, 1897. ,
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DR. R. R. RENTOUL’S ELECTION EXPENSES. To the Editors of THE LANCET.
QUACKS AND UNCERTIFIED DEATHS.
To the -Editors of THE LANCET. SIRS,—The enclosed cutting from a weekly paper of some SIRS,-The result of the General Medical Council election standing and with a large circulation in this county may be must be gratifying to the supporters of Dr. Rentoul’s policy. of interest to you as showing the publicity, and therefore at times given by the press to the efforts of We, the undersigned, think this an opportune moment for encouragement, to hoodwink the public. doctors quack to notice of the these supporters heavy expendibringing the In some districts in this county unqualified medical ture in which it has involved Dr. Rentoul, the sum of £85 17s. 6d. having been spent by him in stamps, stationery, practice prevails extensively ; in one urban district, for and travelling. We feel that practitioners upon whose instance, of 18,000 population over 33 per cent. of the deaths behalf he has so faithfully striven should defray this out-of- during 1896 were uncertified, as the result of unqualified and the Durham county council, pocket expenditure. Also, we would state that since 1890 medical attendance; the of such practice and the fact dangers recognising Dr. Rentoul has spent ..E375 13s. 8d. in opposing the four Midwives Bills. Of this, £351 12s. has at various times that it interferes with the accuracy of the vital been refunded, thus leaving £ 24 Os. 112d. still owing, statistics and with the precautionary measures taken exclusive of interest. Dr. Rentoul is, like most of against the spread of infectious diseases, have, by reprethe Local Government Board, the Registrarourselves, in general practice, and we feel it to be sentationsandtothe General Medical Council, been endeavouring General, him to ask to not his work unfair time and (which only give have been and are invaluable to the cause) but also his to put a stop to such illegal practice. Such newspaper reas the enclosed, however, are calculated to encourage money on our behalf. We, therefore, with confidence ask ports his supporters to subscribe to a fund for the repayment of unqualified practice and are in my opinion much to be this £109 18s. 5id. By this means practitioners will show regretted. The Dr." Steele referred to in the cutting was a year or two ago successfully prosecuted and heavily fined practical appreciation of good work done, and willfor an offence against the 40th section of the Medical Act, pave the way for more. We would point out that this is not a question of a testimonial, although if the 1858, his occupation to within eighteen months of the date of the prosecution having been that of a coalminer. Such response were as hearty as it ought to be this m1ght also be considered. It is firstly and chiefly a questionpunishment, however, instead of acting as a deterrent appears of paying back money out of pocket, spent-and to have enlisted the sympathy for the offender of many most cheerfully and usefully spent-in furthering ourpersons in the district, with the result that not only has his interests. At the same time we would add that no timepractice not diminished, but he was very soon afterwards should be lost in establishing a Guarantee Fund so as to beelected a member of the district council. At their last meeting, I believe, the General Medical ready to fight the next Midwives Bill, and to help in drafting and securing the passing of a Bill for Increased Direct 1 THE LANCET, Jan. 16th, 1897, p. 214 Representation upon the General lledical Council. For these 2 American Medico-Surgical Bulletin, May 15th, 1894, and May 9th, purposes about R1500 will be required, and considering the 1896. See also New York Medical Journal, Feb. 15th, 1896. ’
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