FROM THE LANCET, SATURDAY, Nov. 29th, 1828.

1535 is necessary to disinfect the railroad carriage, the sleeping at all." We can hardly accede to this description of mumps, car, the railroad station and the yard, even when no case of if it is to be taken to imply that a parent who thinks that his infectious or contagious disease has been known to have child has mumps is justified in neglecting to call in medical contaminated these places, seeing that such diseases may assistance. However, the poor little boy died, and it was exist in latent or mild form so that they may be difficult to left to the medical man, who then was hastily summoned, to see at a glance what the cause of death had been recognise. In America reforms in the sanitation of railway passenger and to confirm his first impression by subsequent exatrains are more needed than in Great Britain, simply because mination. Many people will be of opinion that the are that woman so are not who called herself a healer or practitioner longer, journeys persons railway infrequently compelled to live in trains for a time. In such of " Christian Science," who had been partly trained circumstances it is certainly essential that the washing as a nurse in a London hospital, and who started accommodation and the sleeping berths should be as perfect or acquiesced in the belief that the complaint was The problem of mumps, was at least as responsible as the father for the as is possible from a hygienic point of view. the "open hopper " is a difficult one to solve successfully but child’s death, which, however, must really lie at the door of until this be done careful measures of disinfection should be the founder of "Chmtian Science," Mrs. Eddy, and of all who have aided and abetted in the dissemination of her carried out in respect to the existing system. absurdities. Whether the mere prosecution and binding over of Mr. Chisholm will be sufficient to deter other parents who are members of the same fatuous sect time alone will show. There is another question, howcver, and, in our MEDICINE AND THE LAW. opinion, a still more important one, which arises out of the leniency extended by the law to the person who urges The Case of Mr. Robert Chisholm. religious belief in extenuation of his offence in breaking it. THE trial at the Old Bailey of Mr. Robert Fellowes If Christian Scientists"and others are to receive nominal Chisholm, who under the influence of I I Christian Science" sentences for allowing their own children to die, are they allowed his child to die from diphtheria without medical aid, also to be allowed to expose the children of others to the has ended in his acquittal upon the charge of manslaughter. risk of serious illness or of death with impunity ? At the He was, however, convicted of the misdemeanour of neglect- recent trial it was proved that among the pupils at the ing his child in a manner likely to cause him unnecessary school attended by Mr. Chisholm’s son three other cases of an interval after his as to suffering or injury to his health, and for this neglect he diphtheria occurred at such were traceable to it. What was not sentenced to undergo any punishment but was justify the opinion that they bound over to come up for judgment when called upon. are we to say to this, as citizens in whose midst such a comWith the finding by the jury, and with the lenient view of munity as the " Christian Scientists" has established itself ?‘! the offence taken by the judge, many will acquiesce who There can be no doubt that so far as the law relating to the take into account all the tragic circumstances of Mr. notification of infectious disease is concerned they are guilty Chisholm’s position, and who wish to make a large allowance of no offence. In order to render them punishable they must for the fact that the neglect to procure medical aid for be aware " of the nature of the illness, and this they are the patient was due to fanaticism and not to any indifference not likely to be as long as their religion forbids them to to his welfare. On the other hand, many will believe employ those who might enlighten their ignorance. The that a life may have been needlessly sacrificed and that case of Mr. Chisholm’s son and of the infection of two or three of his school-fellows is serious enough to call our a moderate punishment inflicted in a case of the kind referred to might have a deterrent effect upon other attention to the matter, but it is trifling compared with what parents. They would urge that the law being the same for might occur on other occasions or in other circumstances. all, its effect ’*should be so far as possible to give the sick The keepers of dairies or of laundries, for example, should child of the Christian Scientist" or of the member of the they embrace "Christian Science," may ignore infectious sect of Peculiar People an equal chance of life with the disease and its consequences with impunity so far as the child of parents whose religious tenets do not forbid com- criminal branch of the law is concerned, but with extremely results for their customers. The civil liability of a pliance with the practices of modern civilisation. To this serious ’’ Christian Scientist," so far as we are aware, has not yet it might be added that even when due allowance is made for in the law courts. We would suggest, however, religious fanaticism the gulf should not be unnecessarily been tested wide between the treatment accorded to the parent who that, so far as damages can compensate the sufferer, the might be made to pay where his adopts a new religion and that, for example, of the negligent followertoofuseMrs. Eddycare and precautions has caused his and possibly drunken labourer, who, partly from ignorance neglect ordinary to the breaks same law and from and partly brutality, brings neighbonrs undergo suffering and pecuniary loss. about the same tragic result. We may also suggest that although considerable leniency has been extended towards the Peculiar People the " Christian Scientistseems to find even greater indulgence extended to him when he occupies a corresponding position, and it may be asked whether this is the result of a superior social position and of an affluence which places the resources of advocacy within FROM his reach. Those who plead the cause of the children and desire that their sufferings and their lives should be con- THE SATURDAY, Nov. 29th, 1828. sidered rather than the prejudices of their fathers and mothers lay no claim as these do to work or to procure the PER-CENTAGE SYSTEM. working of miracles. They neither assert that in a particular case medical interference will certainly save life nor that in To the Editor (If THE LANCET. its absence certain death will ensue. They merely submit to the good sense of the community that the procuring of the SiR,-An invalid, suffering from the pernicious effects of best medical assistance obtainable in the circumstances is the adulterated drugs and ill-compounded medicines, for which duty, moral as well as legal, of the parent who does not the French pharmaciens are notorious, and feeling deeply for wish to see his child undergo needless suffering or run the the interest and health of my fellow countrymen, I cannot rkk of premature death. Some day he must die, whatever forbear directing your and their attention, to a system of religious belief his parent or he may hold. The particular combination between certain British physicians and French case of Mr. Chisholm’s child calls for some comment. A pharmaciens in Paris, which is now carried to such a scandalous Christian Science " healer" or practitioner"" was called in and mischievous pitch, that it has drawn upon the offenders who, having had some experience as a nurse before the ironical animadversion of the Parisian Press. she was a "Christian Scientist," possessed that little The following is copied from The Corsaire: I I A medical knowledge which is proverbially dangerous and pro- paper called the Hygie, recently gave a letter from the counced the case to be one of mumps. We note that pharmacien Beral, Rue de la Paix, to Dr. Ch-s-de, who had Mr. Justice Grantham in his summing up said with just arrived from London, for the purpose of initiating him regard to this point that " there was nothing to show into certain customs which he calls French and which conthat it was anything more than a very common infantile sist of the pharmacien engaging the doctor to send all his complaint which very likely might not require any treatment prescriptions to him ; the pharmacien consenting to pay the ,.

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1536 officious doctor a reasonable sum. All this may be true, but it is long since the English physicians, Morg.-Tup, and Mac-g-lin, bargained with the pharmacien Beral ; and the Dygie is wrong in saying, that these lucrative arrangements began with the French, for everybody knows, that in oommteroial affairs, the English always take the lead."

good and employment is fairly constant the provision of such dwellings ought to prove a remunerative undertaking. Much good can also be done by systematic inspection of the various ramshackle properties and by notices to remedy structural and other defects. This is a matter which has been neglected in the past. One of the principal recomAn English Journal, published in Paris, contains the mendations of the report is that a competent and wellfollowing :-" The English nobility and gentry aremost qualified inspector should be appointed without delay in respectfully informed, that a Pharmacy will shortly be replacement of the present oflicer who is 79 years of age. opened, quite in the English manner ; physicians supporting Dr. Farrar draws attention to some instructive observations this establishment, will receive as liberal a per oentage as at by Dr. S. Partridge, the medical officer of health, on the spread of enteric fever by the unnecessary visits of neighany other Pharmacy." " N.B. Each prescription will be numbered, and the bours to patients suffering from that disease and also on the relation of the exceptional prevalence of infantile diarrhoea doctors paid at the end of every month." in Darlaston to the opportunities for dissemination of infec"’Tis true, ’tis pity ; And pity ’tis ’tis true." tive particles in the form of dust or by flies. On the sanitary Cireiimstance,s and Administration of the I am, dear Sir, Windsor Rtwal District, by Dr. E. P. MANBy.2-The Your obedient servant, principal matter discussed in this report is the desirability of AN ENEMY TO THE PER CENT AGE SYSTEM. providing a main drainage system for the adjacent areas of Sunninghill, Sunningdale, and Ascot. Many of the dwellings in this part of the Windsor rural district are large houses standing in their own grounds, each of which makes its own arrangements for sewage disposal. The soil of most of the area in question consists of Bagshot sand which is not unsuitable for individual "conservancymethods. But special difficulty has arisen in providing for sewage from LOCAL GOVERNMENT BOARD. various groups of smaller dwellings built in rows, with little or no garden ground about them. In these cases emptyREPORTS OF INSPECTORS OF THE MEDICAL DEPARTMENT OF ing of cesspools often occasions serious nuisance and there is considerable difficulty in properly disposing of the contents. THE LOCAL GOVERNMENT BOARD. An Inquiry into the Sanitary Circ2cmstances and Adnainis- The greater part of the Windsor rural district is supplied by tration of tlte Urban District of Darlaston, by Dr. R. A. the South-Western Suburban Company with Thames water FARRAR.—This report gives some striking illustrations of which has undergone a more or less efficient filtration. In the way in which a district may suffer as a result of past some instances, however, local wells are resorted to, the water of which to be exposed to the risk of conneglect to supervise the construction of new dwellings. The tamination. Theappears of a complete sewerage scheme for cost urban district of Darlaston in Staffordshire has a population of some 15,000. The population is almost wholly industrial, the Sunninghill and Sunningdale area would be considerable a rate of about ls. 6d. in the the principal industry being the manufacture of iron bolts and it is reckoned that and nuts. More than two-thirds of the workmen’s houses would be required. On review, however, of the whole and in particular having regard to the expense are about 40 years old and Dr. Farrar describes them ascircumstances, now entailed on householders in connexion with emptying belonging to "the worst era ofjerry building." Practically all the older houses are built without a damp-proof course cesspools and to the probable extension of building in the I and consequently have damp walls; instances of absent ordistrict, Dr. Manby concludes that a system of drainage thoroughly efficient in the present and so planned as to defective eaves spouting are to be seen in all parts of the be capable of future extension, for removing excretal and in numerous instances rain comes the district; through roof owing to broken slates or defective ridge tiles; in someslop filth from the neighbourhood of houses aggregated" together in Ascot, Sunninghill, and Sunningdale villages cases there are no ridge tiles, the ridge slates being merely as a necessity and be established without with mortar. doors and window framesshould be regarded

Public Health

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The outer walls are sometimes delay. ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH only of half brick thickness and in one case could be IN BRITISH DEPENDENCIES. perforated by a push with a walking stick. Dr. Farrar draws special attention to the attic bedrooms, many of which The City of Melbourne.-Dr. James Jamieson, the health admitted rain freely and though often occupied and evenofficer of this city, gives the estimated population of Melovercrowded were, in his opinion, unfit for habitation. The bourne in the middle of 1905 at 68,940, the general deathback-yards and surroundings of most of the dwellings in the rate on this basis having been only 12’ 5 per 1000. There district are unpaved and allowed to remain in a very filthy has been a continued lowering in the death-rate for some condition. The type of midden privy in common use is more years past and Dr. Jamieson naturally attributes at least than usually objectionable. The contents of the privysome of such diminution to the improvement of the sanitary instead of passing directly into the midden accumulate in a condition of the city. There has been since 1886-90 a pit, the bottom of which is at a lower level than the marked and steady fall in the death-rate from enteric fever midden floor. The result is that when these middens and it is stated that the only chance of any extensive are cleansed the scavenger takes the ashes and dry epidemic of the malady at the present time is from some refuse but only so much of the excreta as has over- contamination of the public water-supply which is, on the flowed from the pit. This arrangement seems to have whole, "well safeguarded, though an undoubted further found some favour with the local sanitary authority which improvement would be the introduction of some filtration tips the contents of ashpits on land where it is proposed method." There has been, too, as in so many other places, presently to build. An arrangement which, on the one hand, a steady decrease in the death-rate from pulmonary tuberfacilitates building on polluted " made ground," and, on the culosis and Dr. Jamieson, while being quite in favour of other, involves leaving what is practically an open cesspool certain special measures, points out that it is only about just below the seat of each privy, must be considered in the five or six years since the special measures taken under highest degree objectionable. The report draws attention to what has been called the "crusade against consumpthe high general, infantile, and zymotic death-rates of the tion " have been in operation and yet there was a district, attributable partly to insanitary and partly to distinct lowering of the mortality-rate more than ten social and industrial conditions. To attempt improvement years ago. Much of the good effect now apparent must, in social conditions, including the notoriously excessive he thinks, be credited to such sanitary measures as consumption of alcohol in the district, whilst the state improved drainage, better ventilation, and generally to the of housing remains which Dr. Farrar describes, seems results of the legislation for the improvement of conditions a hopeless task. The district council has done something in shops and factories. But, he adds, " I must claim a conrecently to encourage the building of new artisans’ dwellings siderable share in that benefit as due to the steady work of a satisfactory type and Dr. Farrar points out that as wages carried on by the council for the last 20 years in the inspection and condemnation of dwellings found to be unfit 1 London, Wyman and Sons, Fetter-lane; Edinburgh, Oliver and 2 Ibid. No. 241, Boyd; Dublin, E. Ponsonby. No. 243, price 4d. price 4d. to be found.

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