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HEALTH OFFICERS AS PUBLIC ANALYSTS.
689
highest medical
attainments at your command, the
educa- against
tional status of yonr adopted candidate does not reach even the minimum required for a Poor-law medical appointment, or for the office of assistant-surgeon in the Army or Navy.
ask you to re-consider your determination, believing that the spirit of the Public Health Act will be more effectually complied with by the appointment of a fully qualified officer, who shall not only have the confidence of the public, but of the medical profession. SOLOMON SMITH. JAMES STEELE, HENRY APPLETON. JOHN LISTER. LAWRENCE BRAMLEY. JAMES ELLIOT. WILLIAM NOWELL. JOHN OAKLEY. ABRAHAM JuBB. Jos. MC. MCWILLIAMS. SYDNEY THOS. STEELE. S. CHARLES SMITH. P. AUGUSTINE SYNNOTT, C. KIRBY.
We, therefore, respectfully
THOMAS H. TURNEY. FRANCIS EDWIN MACAULEY. CHARLES E. GAMBLE. THOMAS TWEEDALE. JEREMIAH GLEDHILL. JAMES NAYLOR.
ANDREW JUKES. THOMAS M. DOLAN. FRED GEO. STRICKLAND, EDWARD STRICKLAND. KEIR DOUGALL. WILLIAM ELIOTT.
Correspondence. "Audi alteram partem."
HEALTH OFFICERS AS PUBLIC ANALYSTS.
of THE, LANCET. SIR,-The proposition has been publicly made, and commented upon, especially by THE LANCET, that the gentlemen To the Editor
holding the appointments of officers of health should seek and accept those also of food analysts under the recent Adulteration Act; and that they should engage the services of competent analysts to do the analytical work and to act under them. On this proposal I desire to offer a few remarks, as I believe it to be most objectionable, and morally as well as legally wrong. However accomplished and zealous, and however well qualified, the present health officers may be for the performance of the duties which have hitherto devolved upon them, they, as a rule, with some few notable exceptions, have no technical knowledge of adulteration, and do not possess the requisite special chemical and microscopical knowledge necessary to enable them to discharge the duties of food analysts. Were they therefore to adopt the advice offered them and accept such appointments, they would be engaging themselves to perform duties for which they are incompetent ; and such a proceeding I hold to be wrong morally. It is equally so legally. In the Act to amend the law for the prevention of adulteration of food, drink, and drugs, it is expressly stipulated that the persons to be appointed analysts shall possess competent medical, chemical, and microscopical knowledge, as analysts, of all articles of food, drink, and drugs." How, then, I ask, can officers of health, riot merely with propriety, but even legally, accept such an appointment as that of analyst, in the absence of the necessary knowled-ge and qualifications ? Of course, should any officer of health, in any special case, possess such knowledge, he will be eligible for the appointment; but my advice to him even then would be to decline the post, as his duties, if properly performed, under the new Health Act will be more than sufficient to engage the whole of his time and attention. For officers of health, not specially qualified, to accept the position of analysts, employing real analysts to do their work under their authority, would be surely as wrong and unadvisable a proceeding as it is possible to conceive; and I very much doubt whether analysts of repute would consent to hold such subordinate posts, subject to masters who in most cases are themselves incapable of making the necessary analyses, but who would still have the title of food analysts, and would derive the greater part of whatever advantages were attached to the office. There is still another important objection to be urged now
11
such appointments: these so-called food analysts monopolise a great part of the analytical work of the country, to the exclusion of men who have made it the would
business and profession of their lives. As it is, the Act would appear to inflict an enormous injury on private analysts, for, so far as I can see, it excludes their evidence from courts of law in prosecutions for the infringement of the Act. So much for the appointment of officers of health as food analysts. But the further proposition has been madeand this has been endorsed by the Association of Medical Officers of Health-that two gigantic laboratories, one on the south and the other on the north side of the Thames, should be established for London, in which all the required analyses should be made; " and that skilled assistants should be constantly engaged therein to conduct the analyses, under the superintendence and in the presence of the appointed analysts" (query, officers of health?). This proposal I also regard as highly objectionable. Every analyst of experience and position’has his own laboratory ; and surely it will be far more simple and convenient that the analyst should perform the analyses required for the district to which he is appointed at his own laboratory, which is usually at or near his own house. What analyst whose time is of any value could afford to spend so much of it in travelling to and fro, in all seasons and weathers, to the South or North London Laboratory, as the case may be-situated, as in many instances it would be, miles from his own residence ? I am of opinion, therefore, that, were the propositions which I have thus briefly discussed to be carried into effect, very serious mistakes would be committed. At the same time, I cordially concur in your remark that the practical knowledge and power of the health officers should be aided and strengthened by the skilled analysts. I remain, Sir, your obedient servant, ARTHUR HILL HASSALL, M.D. M.D.Lond. Lond. Nov. 4th, 1872.
THE ADMINISTRATION OF CHLOROFORM. To the Editor of THE LANCET. SIR, In the clinical remarks on chloroform by Dr. Poore.. in THE LANCET of Oct. 26th, after pointing out the danger arising from administering it in strong doses, he says that of the inhalers that have been devised for regulating the proportion of chloroform to the air the only one which is of any use is Clover’s apparatus. " With Clover’s apparatu& you can be absolutely sure that you are not giving your patient a dangerously concentrated atmosphere of chloroform." He then gives as objections to it that °°it leads to want of attention to the state of the patient," that in " long operations you must leave the patient to replenish the bag," and that "in some cases the mixture is not strong enough to fully anaesthetise the patient." I venture to think that these objections when examined will be seen to have no solid foundation. It seems to me that the very fact of taking care to limit the dose accurately implies that the substance is of a nature to require watching, and that the statement 11 there is no use in accurately measuring the amount of chloroform poured on the lint" is more likely to lead to inattention to its effects. I have found so little inconvenience in replenishing the bag when the patient has been already fifteen minutes under chloroform, that although I have long known how to remedy it, I have only done so since the demand has come for ether and mixtures containing ether. When the patient has inhaled three-fourths of the contents of the bag, he ought to be, from time to time, allowed to breathe pure air for thirty seconds, and that is quite time enough for adding another bellowsful or two. The remedy is to have a small tube leading from the evaporating box to the bag, by which tube, whilst the patient is inhaling, the bag can be replenished. This is especially useful in operations inside the mouth. As to the mixture not being strong enough to anaesthetise some patients, there can be only one explanation of this, and that is that either the face-piece did not fit, or the valves were out of order, or the bag was not properly charged. A few patients breathe as little as they can, and so cause delay, but large doses are as dangerous to them as to any,
highest medical
attainments at your command, the
educa- against
tional status of yonr adopted candidate does not reach even the minimum required for a Poor-law medical appointment, or for the office of assistant-surgeon in the Army or Navy.
ask you to re-consider your determination, believing that the spirit of the Public Health Act will be more effectually complied with by the appointment of a fully qualified officer, who shall not only have the confidence of the public, but of the medical profession. SOLOMON SMITH. JAMES STEELE, HENRY APPLETON. JOHN LISTER. LAWRENCE BRAMLEY. JAMES ELLIOT. WILLIAM NOWELL. JOHN OAKLEY. ABRAHAM JuBB. Jos. MC. MCWILLIAMS. SYDNEY THOS. STEELE. S. CHARLES SMITH. P. AUGUSTINE SYNNOTT, C. KIRBY.
We, therefore, respectfully
THOMAS H. TURNEY. FRANCIS EDWIN MACAULEY. CHARLES E. GAMBLE. THOMAS TWEEDALE. JEREMIAH GLEDHILL. JAMES NAYLOR.
ANDREW JUKES. THOMAS M. DOLAN. FRED GEO. STRICKLAND, EDWARD STRICKLAND. KEIR DOUGALL. WILLIAM ELIOTT.
Correspondence. "Audi alteram partem."
HEALTH OFFICERS AS PUBLIC ANALYSTS.
of THE, LANCET. SIR,-The proposition has been publicly made, and commented upon, especially by THE LANCET, that the gentlemen To the Editor
holding the appointments of officers of health should seek and accept those also of food analysts under the recent Adulteration Act; and that they should engage the services of competent analysts to do the analytical work and to act under them. On this proposal I desire to offer a few remarks, as I believe it to be most objectionable, and morally as well as legally wrong. However accomplished and zealous, and however well qualified, the present health officers may be for the performance of the duties which have hitherto devolved upon them, they, as a rule, with some few notable exceptions, have no technical knowledge of adulteration, and do not possess the requisite special chemical and microscopical knowledge necessary to enable them to discharge the duties of food analysts. Were they therefore to adopt the advice offered them and accept such appointments, they would be engaging themselves to perform duties for which they are incompetent ; and such a proceeding I hold to be wrong morally. It is equally so legally. In the Act to amend the law for the prevention of adulteration of food, drink, and drugs, it is expressly stipulated that the persons to be appointed analysts shall possess competent medical, chemical, and microscopical knowledge, as analysts, of all articles of food, drink, and drugs." How, then, I ask, can officers of health, riot merely with propriety, but even legally, accept such an appointment as that of analyst, in the absence of the necessary knowled-ge and qualifications ? Of course, should any officer of health, in any special case, possess such knowledge, he will be eligible for the appointment; but my advice to him even then would be to decline the post, as his duties, if properly performed, under the new Health Act will be more than sufficient to engage the whole of his time and attention. For officers of health, not specially qualified, to accept the position of analysts, employing real analysts to do their work under their authority, would be surely as wrong and unadvisable a proceeding as it is possible to conceive; and I very much doubt whether analysts of repute would consent to hold such subordinate posts, subject to masters who in most cases are themselves incapable of making the necessary analyses, but who would still have the title of food analysts, and would derive the greater part of whatever advantages were attached to the office. There is still another important objection to be urged now
11
such appointments: these so-called food analysts monopolise a great part of the analytical work of the country, to the exclusion of men who have made it the would
business and profession of their lives. As it is, the Act would appear to inflict an enormous injury on private analysts, for, so far as I can see, it excludes their evidence from courts of law in prosecutions for the infringement of the Act. So much for the appointment of officers of health as food analysts. But the further proposition has been madeand this has been endorsed by the Association of Medical Officers of Health-that two gigantic laboratories, one on the south and the other on the north side of the Thames, should be established for London, in which all the required analyses should be made; " and that skilled assistants should be constantly engaged therein to conduct the analyses, under the superintendence and in the presence of the appointed analysts" (query, officers of health?). This proposal I also regard as highly objectionable. Every analyst of experience and position’has his own laboratory ; and surely it will be far more simple and convenient that the analyst should perform the analyses required for the district to which he is appointed at his own laboratory, which is usually at or near his own house. What analyst whose time is of any value could afford to spend so much of it in travelling to and fro, in all seasons and weathers, to the South or North London Laboratory, as the case may be-situated, as in many instances it would be, miles from his own residence ? I am of opinion, therefore, that, were the propositions which I have thus briefly discussed to be carried into effect, very serious mistakes would be committed. At the same time, I cordially concur in your remark that the practical knowledge and power of the health officers should be aided and strengthened by the skilled analysts. I remain, Sir, your obedient servant, ARTHUR HILL HASSALL, M.D. M.D.Lond. Lond. Nov. 4th, 1872.
THE ADMINISTRATION OF CHLOROFORM. To the Editor of THE LANCET. SIR, In the clinical remarks on chloroform by Dr. Poore.. in THE LANCET of Oct. 26th, after pointing out the danger arising from administering it in strong doses, he says that of the inhalers that have been devised for regulating the proportion of chloroform to the air the only one which is of any use is Clover’s apparatus. " With Clover’s apparatu& you can be absolutely sure that you are not giving your patient a dangerously concentrated atmosphere of chloroform." He then gives as objections to it that °°it leads to want of attention to the state of the patient," that in " long operations you must leave the patient to replenish the bag," and that "in some cases the mixture is not strong enough to fully anaesthetise the patient." I venture to think that these objections when examined will be seen to have no solid foundation. It seems to me that the very fact of taking care to limit the dose accurately implies that the substance is of a nature to require watching, and that the statement 11 there is no use in accurately measuring the amount of chloroform poured on the lint" is more likely to lead to inattention to its effects. I have found so little inconvenience in replenishing the bag when the patient has been already fifteen minutes under chloroform, that although I have long known how to remedy it, I have only done so since the demand has come for ether and mixtures containing ether. When the patient has inhaled three-fourths of the contents of the bag, he ought to be, from time to time, allowed to breathe pure air for thirty seconds, and that is quite time enough for adding another bellowsful or two. The remedy is to have a small tube leading from the evaporating box to the bag, by which tube, whilst the patient is inhaling, the bag can be replenished. This is especially useful in operations inside the mouth. As to the mixture not being strong enough to anaesthetise some patients, there can be only one explanation of this, and that is that either the face-piece did not fit, or the valves were out of order, or the bag was not properly charged. A few patients breathe as little as they can, and so cause delay, but large doses are as dangerous to them as to any,