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MEDICAL TREATMENT OF LONDON SCHOOL CHILDREN : THE LONDON COUNTY COUNCIL AND THE CLAIMS OF THE MEDICAL PROFESSION.
1335
signed, by Lord George Hamilton, the Bishopof Ross, Sir for their petrol. The rebate allowed to medical men in tneir Henry Robinson, Sir Samuel- Provis,Mr.F. Holdsworth car tax will ; practically make no difference, for .as the duty Bentham, the Rev. Thongs. Gage Gardiner. Mr. C. S. stands at- present a medical - man paysa duty of two guineas Loch, Mr. J. Patten :MacDougall, Mr. T.. Hancock fop his car. In future- a medical - man driving a car under Nunn, .the Rev. - L. R.,{ Phelps, Professor Smart, Mrs. 16 horse-power, and we may, say. that hardly any general Helen Bosanquet, and Miss Octavia Hill, .alL of. whom practitioner drives a more highly powered one, will pay were signatories of the, English Majority Report, The exactly the same, that is to say, one half of £4 4s. The brief dissent . from a medical man .should, at. least be allowed the rebate on his very the Majority Minority Report,, the Rev. H. is Russell Wakefield, by signed petrol,..which. is to be allowed to motor omnibuses and motor Report, Mr. F. Chandler, Mr.-George Lansbury, and Mrs..Sidney cabs. For too. long has the medical profession been made Webb, all of whom, were signatories of the English Minority the scapegoat of Governments. Day by day new duties are Report; while the separate Memorandum bears, aswe-have imposed upon it without any corresponding pay, and at least said, the names of the Bishop of Ross and Sir Henry in one case with a penalty attached if the new duty is not Robinson. The labours of .the Commissioners,--as far as carried out. The recent Budget, places a heavy tax upon Ireland is concerned, were much spared bythe fact that they ,many,general practitioners, which is accompanied by a felt themselves, at leastthose who signed theMajority concession which is of ;no real value. Report did, able to adopt the greater part of the reçom-
mendations for the- reform
of the Irish
Poor-law which were in Ireland. shortly theRoyal Commission.1 An
published, by the Viceregal Commission after the
appointment
of
MEDICAL TREATMENT OF LONDON SCHOOL CHILDREN : THE LONDON COUNTY COUNCIL
CLAIMS OF THE MEDICAL PROFESSION. week this WE publish a synopsis of an interesting statement.issued to members, of the London County Council on .the subject of the medical treatment of London school (see p. 1343), and in another column (see p. 1347) . will b found a strenupus letter from Dr. H. Beckett-Overy pointing, out the risk that here is in the present eircumstances of , the medical profession being considerably exploited. -We hope andbelieve that this risk. is not so acute as Dr. Beckett-Overy seems to think, and we do not suppose for a moment that the chairmen and secretaries of bacteriologist. .the. London hospitals, whether they, agreewith any proMEDICAL MEN AND THE BUDGET. posalsmade to them by the London County Council or no, will come to any decision in the matter without WE are not a political journal, but when political proposals a proper consultation with their medical staffs. Our inseem likely to bear hardly on the members of our own proformation here is to an exactly opposite effect to Dr. fession it is our duty to protest. And there is one tax which I Beckett-Overy’s. As a matter -of fact, the whole quesas it stands at present-and the clause in the Budget which tion is at this moment before the authorities of the London levies this tax has already passed -the Commons-bids fair .and we are able to say that the just claims to weigh heavily upon an overworked and underpaid class hospitals, of themedical profession do not appear in the least of medical men-namely, the general practitioner in the likely to- go unsupported. The matter will resolve itself, of country. This tax is the impost of 3d.- per gallon on course, largely into the treatment of adenoids, deafness, petrol. One of the chief Government organs in its issue of and of various forms of inadequacy of sight and dentition, April 30th remarked :" Private motor cars are always a and to a certain extent the little patients would in any cirluxury, and often an anti-social luxury." As regards cars cumstances attend the for relief, and with perfect hospitals used by medical men, they stand on exactly the same footing for many of them belong genuinely to the class for right, as the bicycle which many working men use to carry them which the voluntary hospitals were established- and are to and from their work. If the one is a luxury so is the maintained. Referring now only to those who are proper other. Both classes use mechanical methods of transit, first objects of charity, the question is really whether special on account of cheapness, and secondly because by so doing clinics set up by the London County Council and staffed they get a little more leisure than they otherwise would. the education medical officers should do the work, or by Before the advent of the motor-car many general practiwhether the hospitals should do the work. It is perfectly tioners worked with horses from 14 to 16 hours per diem, clear that the London County Council has no right to but when they gave up horses and took to a car they were the work done for nothing, and we credit it with get enabled to obtain some three -or four hours more leisure than this view and with not desiring to exploit the medical taking before. This may be luxury, but it is certainly not antiIf school clinics are founded, as seems to be social. The tax will - press heavily upon such men as -these. profession. the desire of .the majority of the special committee of the Take a concrete instance. In one district of the South-East Council dealing with the subject, it will fall to the of England are- some 40 medical- men, of whom at least 30 lot. of salaried medical officers to manage such clinics, and drive a car. The average net income of these men is from on some scale or other will duly follow. But all £600 to S700 per annum and the new tax will impose .payment the patients- are not proper objects of charity, and here it an extra burden upon- them of from £5 to £15 yearly seems inevitable that the general practitioner will have according to their mileage. In more scattered districts taken away from him a certain number of cases which he the burden will be far heavier. Many medical men in could well deal with, whether the hospitals arrange to do the ’hilly districts in Wales and Yorkshire drive from 7000 to work orwhether it is done by school clinics. In some 10,000 miles a year and will have to pay over 20 in tax general practices,the. number of. cases lost may be quite con-’ With regard to payments made to hospitals by 1 These recommendations were published at length in THE LANCET of siderable. Nov. 24th, 1906, p. 1460. London the County Council, .there will be a difference
interesting historical,’ summary of Irish Poor-law adminL stration is given in the latest Blue-book, and the various points in which the recommendatious of the Viceregal, Commission fit . with the proposals , already ,.made by the Royal Commission for Reform of the Poor-law in England are considered favourably. The -gist of the report consequently is the recommendation .of the establishment of, a Public Assistance Authority to take overthe work of boards of guardians, which will be abolished, and to control the-Dispensary Medical Service,, which -it is proposed -to:turn into a proper countyservi.ce., with a county superintendent and
AND
,,children
THE
1336 of
opinion as- to their propriety. , The hospitals oùght; two oithe most paid, as a matter of abstract justice,because there: medical profession,
eminent men in their branch of the have made experiments on rabbits with concentrated extracts of flour bleached under the plaintiffs’ process, and they made those extracts following minutely and they have administered the directions them to rabbits—a largenumber—have kept those rabbits under observation for many days after administration, and on’the rabbits beyond temporary have observed no intoxication caused by the fact that the extract was that he found no positive alcoholic." His lordship facts that the nutritive quality of the flour was deleteriously affected by the process. ’
to be is no
reason why they should gratuitously relieve the burden of the London County Council by presenting it with the results of medical skill and service. But the difficulty presented by a’ voluntary charity staffed by unpaid officers accepting payment from the’ rates for work done seems almost insuperable. Such payment, while aggravating the difficult position of the general practitioner, is a. large step towards that municipalisation of the hospitals for which we are not yet prepared, and which, if and when it comes, must bring with it the adequate payment of the medical staffs. There are some good arguments against the utilisation of the hospitals in addition to those which have already been THE NATIONAL LEAGUE OF PHYSICAL EDUCATION AND IMPROVEMENT. made known to the London County Council in the circular we who have our part in the complex Civilisatlon THOUGH statement. To mention one more only, the Council might the twentieth century be in truth the heirs of all the demand representation on the- governing bodies of the hospitals in return for its subsidies, and this demand would, ages ofscience and invention and philosophy, it is certain we take it, be refused by even those institutions now that our forefathers have not handed down to us the full It is, for favourable to the scheme. Arguments in support of the endowment of their more ancient heritage. alternative scheme of school clinics must, however, be instance, a safe assertion that the Athenians of the fifth in far higher ’regard the scanty, as we have no practical experience of their working century before Christ in this country. But we cannot see that the institution physical culture of their sons and daughters than of school clinics would remove patients from the care of we in England to-day in spite of the boast of our the general practitioner any more than subsidized treat- national devotion to athletic pursuits, and in spite of ment at the hospitals. Of one thing we feel sure, that our scientific knowledge of the principles upon which the various committees of the hospitals will debate these sanitation must be based. We do not, of course, mean that points thoroughly, and will recognise the extreme gravity their death-rate was not more than ours (though their infant of the issues raised. Whoever does the work for the mortality was surely no greater), but that every family set London County Council ought to be paid, and the idea of up for itself an individual ideal of health unknown in modern using the honorary services of the medical staffs in England. The reason was, of course, that the Greeks were return for a grant to hospital funds seems to us inspired with an aesthetic motive that would only be monstrous. Is it not a case in which the opinion of satisfied by the training of the human body in such a these staffs might be consolidated by some meeting among manner as to fit it for the honour due to the highest themselves ? material expression of beauty, with the result that the Grecian form, perpetuated in Grecian marble, has been the OUR BLEACHED DAILY BREAD. wonder and the despair,of generations of artists in far later IN our columns on March 20th and March 27th re- centuries. And granting that the Greeks were powerless to spectively two annotations appeared under this heading protect themselves against the ravages of infectious disease, which, it has been suggested to us, require modification in granting that the communal hygienic arrangements in the view of a judgment delivered by Mr. Justice Warrington on days of Pheidias were in no degree comparable to those of a April 28th in the case of the Flour Oxidizing Company, modern city, still we believe that their intense love for Limited, v. Hutchinson. Our notes had nothing whatever to physical perfection in acountry where sunshine, fresh air, do wittingly with this case, which is not alluded to in any and good food were everybody’s birthright produced a way, and of the existence of which we had no knowledge ; national result which is as unattainable by the modern but we are informed that the statements made by Mr. E. F. social reformer as the great spirit of Grecian art is remote Ladd and Mr. H. L. White in the Chemical News, of from the modern studio. But there is more than one road March 19th, referred to by us, were made the subject up most mountains, and if we cannot expect that an improveof actual investigation in the action and that the evidence ment will be effected in our national physique by an appeal of Dr. A. P. Luff, Dr. W. H. Willcox, and Dr. W. D. to, the nation’s aesthetic perceptions, it is not too much to Halliburton led Mr. Justice Warrington to the conclusion hope that it may be brought about by first adding to the that the process, or some similar process, employed by the nation’s knowledge of the rules,of health and disease, and Flour Oxidizing Company, Limited, had no injurious effect then appealing to its common sense to apply them. Education, on flour. Mr. Justice Warrington, after pointing out that in a word, must be the spirit moving through the land to teach the method employed by the Flour Oxidizing Company the masses of our people, that what was good enough for would render it less likely to be attacked by mites their fathers inthe matter of physical well-being is not good and other organisms, went on to say, relying on experi- enough for them. Legislation and inspection may indeed ments made by Dr. Halliburton, "the result, in my afford the machinery for a faultless national hygiene, but it opinion, of the whole of those experiments, taking them must remain ineffective in the main if in the tenement as a whole, is, that so far as the bread made from houses and cottages throughout the country there is not an is which is the there is intelligent appreciation of the reasons behind sanitary laws concerned, important part, the flour no substantial difference, in point of digestibility, between and of the great benefits which will accrue to those families the bread made from the untreated flour and the bread made that scrupulously obey them. Of recent agencies which from the treated flour." Upon the question whether the have arisen for the diffusion of such knowledge, the flour had had imparted to it certain toxic qualities by theNational League of Physical Education and Improvement plaintiffs’ process, Mr; Justice Warrington considered is pre-eminently active in promulgating the gospel of that the experiments of Mr. Ladd, to which we alluded health. We havealready announced thedelivery of in our annotation on March 27th, failed to prove this several lectures, and addresses under its auspices, and now of its appeal at a Mansion point. Dr. Willcox and Dr. Luff,he said, who arehave to record
given by :pr,, Ladq,,
effect
added
of
held
____
the widening
signed, by Lord George Hamilton, the Bishopof Ross, Sir for their petrol. The rebate allowed to medical men in tneir Henry Robinson, Sir Samuel- Provis,Mr.F. Holdsworth car tax will ; practically make no difference, for .as the duty Bentham, the Rev. Thongs. Gage Gardiner. Mr. C. S. stands at- present a medical - man paysa duty of two guineas Loch, Mr. J. Patten :MacDougall, Mr. T.. Hancock fop his car. In future- a medical - man driving a car under Nunn, .the Rev. - L. R.,{ Phelps, Professor Smart, Mrs. 16 horse-power, and we may, say. that hardly any general Helen Bosanquet, and Miss Octavia Hill, .alL of. whom practitioner drives a more highly powered one, will pay were signatories of the, English Majority Report, The exactly the same, that is to say, one half of £4 4s. The brief dissent . from a medical man .should, at. least be allowed the rebate on his very the Majority Minority Report,, the Rev. H. is Russell Wakefield, by signed petrol,..which. is to be allowed to motor omnibuses and motor Report, Mr. F. Chandler, Mr.-George Lansbury, and Mrs..Sidney cabs. For too. long has the medical profession been made Webb, all of whom, were signatories of the English Minority the scapegoat of Governments. Day by day new duties are Report; while the separate Memorandum bears, aswe-have imposed upon it without any corresponding pay, and at least said, the names of the Bishop of Ross and Sir Henry in one case with a penalty attached if the new duty is not Robinson. The labours of .the Commissioners,--as far as carried out. The recent Budget, places a heavy tax upon Ireland is concerned, were much spared bythe fact that they ,many,general practitioners, which is accompanied by a felt themselves, at leastthose who signed theMajority concession which is of ;no real value. Report did, able to adopt the greater part of the reçom-
mendations for the- reform
of the Irish
Poor-law which were in Ireland. shortly theRoyal Commission.1 An
published, by the Viceregal Commission after the
appointment
of
MEDICAL TREATMENT OF LONDON SCHOOL CHILDREN : THE LONDON COUNTY COUNCIL
CLAIMS OF THE MEDICAL PROFESSION. week this WE publish a synopsis of an interesting statement.issued to members, of the London County Council on .the subject of the medical treatment of London school (see p. 1343), and in another column (see p. 1347) . will b found a strenupus letter from Dr. H. Beckett-Overy pointing, out the risk that here is in the present eircumstances of , the medical profession being considerably exploited. -We hope andbelieve that this risk. is not so acute as Dr. Beckett-Overy seems to think, and we do not suppose for a moment that the chairmen and secretaries of bacteriologist. .the. London hospitals, whether they, agreewith any proMEDICAL MEN AND THE BUDGET. posalsmade to them by the London County Council or no, will come to any decision in the matter without WE are not a political journal, but when political proposals a proper consultation with their medical staffs. Our inseem likely to bear hardly on the members of our own proformation here is to an exactly opposite effect to Dr. fession it is our duty to protest. And there is one tax which I Beckett-Overy’s. As a matter -of fact, the whole quesas it stands at present-and the clause in the Budget which tion is at this moment before the authorities of the London levies this tax has already passed -the Commons-bids fair .and we are able to say that the just claims to weigh heavily upon an overworked and underpaid class hospitals, of themedical profession do not appear in the least of medical men-namely, the general practitioner in the likely to- go unsupported. The matter will resolve itself, of country. This tax is the impost of 3d.- per gallon on course, largely into the treatment of adenoids, deafness, petrol. One of the chief Government organs in its issue of and of various forms of inadequacy of sight and dentition, April 30th remarked :" Private motor cars are always a and to a certain extent the little patients would in any cirluxury, and often an anti-social luxury." As regards cars cumstances attend the for relief, and with perfect hospitals used by medical men, they stand on exactly the same footing for many of them belong genuinely to the class for right, as the bicycle which many working men use to carry them which the voluntary hospitals were established- and are to and from their work. If the one is a luxury so is the maintained. Referring now only to those who are proper other. Both classes use mechanical methods of transit, first objects of charity, the question is really whether special on account of cheapness, and secondly because by so doing clinics set up by the London County Council and staffed they get a little more leisure than they otherwise would. the education medical officers should do the work, or by Before the advent of the motor-car many general practiwhether the hospitals should do the work. It is perfectly tioners worked with horses from 14 to 16 hours per diem, clear that the London County Council has no right to but when they gave up horses and took to a car they were the work done for nothing, and we credit it with get enabled to obtain some three -or four hours more leisure than this view and with not desiring to exploit the medical taking before. This may be luxury, but it is certainly not antiIf school clinics are founded, as seems to be social. The tax will - press heavily upon such men as -these. profession. the desire of .the majority of the special committee of the Take a concrete instance. In one district of the South-East Council dealing with the subject, it will fall to the of England are- some 40 medical- men, of whom at least 30 lot. of salaried medical officers to manage such clinics, and drive a car. The average net income of these men is from on some scale or other will duly follow. But all £600 to S700 per annum and the new tax will impose .payment the patients- are not proper objects of charity, and here it an extra burden upon- them of from £5 to £15 yearly seems inevitable that the general practitioner will have according to their mileage. In more scattered districts taken away from him a certain number of cases which he the burden will be far heavier. Many medical men in could well deal with, whether the hospitals arrange to do the ’hilly districts in Wales and Yorkshire drive from 7000 to work orwhether it is done by school clinics. In some 10,000 miles a year and will have to pay over 20 in tax general practices,the. number of. cases lost may be quite con-’ With regard to payments made to hospitals by 1 These recommendations were published at length in THE LANCET of siderable. Nov. 24th, 1906, p. 1460. London the County Council, .there will be a difference
interesting historical,’ summary of Irish Poor-law adminL stration is given in the latest Blue-book, and the various points in which the recommendatious of the Viceregal, Commission fit . with the proposals , already ,.made by the Royal Commission for Reform of the Poor-law in England are considered favourably. The -gist of the report consequently is the recommendation .of the establishment of, a Public Assistance Authority to take overthe work of boards of guardians, which will be abolished, and to control the-Dispensary Medical Service,, which -it is proposed -to:turn into a proper countyservi.ce., with a county superintendent and
AND
,,children
THE
1336 of
opinion as- to their propriety. , The hospitals oùght; two oithe most paid, as a matter of abstract justice,because there: medical profession,
eminent men in their branch of the have made experiments on rabbits with concentrated extracts of flour bleached under the plaintiffs’ process, and they made those extracts following minutely and they have administered the directions them to rabbits—a largenumber—have kept those rabbits under observation for many days after administration, and on’the rabbits beyond temporary have observed no intoxication caused by the fact that the extract was that he found no positive alcoholic." His lordship facts that the nutritive quality of the flour was deleteriously affected by the process. ’
to be is no
reason why they should gratuitously relieve the burden of the London County Council by presenting it with the results of medical skill and service. But the difficulty presented by a’ voluntary charity staffed by unpaid officers accepting payment from the’ rates for work done seems almost insuperable. Such payment, while aggravating the difficult position of the general practitioner, is a. large step towards that municipalisation of the hospitals for which we are not yet prepared, and which, if and when it comes, must bring with it the adequate payment of the medical staffs. There are some good arguments against the utilisation of the hospitals in addition to those which have already been THE NATIONAL LEAGUE OF PHYSICAL EDUCATION AND IMPROVEMENT. made known to the London County Council in the circular we who have our part in the complex Civilisatlon THOUGH statement. To mention one more only, the Council might the twentieth century be in truth the heirs of all the demand representation on the- governing bodies of the hospitals in return for its subsidies, and this demand would, ages ofscience and invention and philosophy, it is certain we take it, be refused by even those institutions now that our forefathers have not handed down to us the full It is, for favourable to the scheme. Arguments in support of the endowment of their more ancient heritage. alternative scheme of school clinics must, however, be instance, a safe assertion that the Athenians of the fifth in far higher ’regard the scanty, as we have no practical experience of their working century before Christ in this country. But we cannot see that the institution physical culture of their sons and daughters than of school clinics would remove patients from the care of we in England to-day in spite of the boast of our the general practitioner any more than subsidized treat- national devotion to athletic pursuits, and in spite of ment at the hospitals. Of one thing we feel sure, that our scientific knowledge of the principles upon which the various committees of the hospitals will debate these sanitation must be based. We do not, of course, mean that points thoroughly, and will recognise the extreme gravity their death-rate was not more than ours (though their infant of the issues raised. Whoever does the work for the mortality was surely no greater), but that every family set London County Council ought to be paid, and the idea of up for itself an individual ideal of health unknown in modern using the honorary services of the medical staffs in England. The reason was, of course, that the Greeks were return for a grant to hospital funds seems to us inspired with an aesthetic motive that would only be monstrous. Is it not a case in which the opinion of satisfied by the training of the human body in such a these staffs might be consolidated by some meeting among manner as to fit it for the honour due to the highest themselves ? material expression of beauty, with the result that the Grecian form, perpetuated in Grecian marble, has been the OUR BLEACHED DAILY BREAD. wonder and the despair,of generations of artists in far later IN our columns on March 20th and March 27th re- centuries. And granting that the Greeks were powerless to spectively two annotations appeared under this heading protect themselves against the ravages of infectious disease, which, it has been suggested to us, require modification in granting that the communal hygienic arrangements in the view of a judgment delivered by Mr. Justice Warrington on days of Pheidias were in no degree comparable to those of a April 28th in the case of the Flour Oxidizing Company, modern city, still we believe that their intense love for Limited, v. Hutchinson. Our notes had nothing whatever to physical perfection in acountry where sunshine, fresh air, do wittingly with this case, which is not alluded to in any and good food were everybody’s birthright produced a way, and of the existence of which we had no knowledge ; national result which is as unattainable by the modern but we are informed that the statements made by Mr. E. F. social reformer as the great spirit of Grecian art is remote Ladd and Mr. H. L. White in the Chemical News, of from the modern studio. But there is more than one road March 19th, referred to by us, were made the subject up most mountains, and if we cannot expect that an improveof actual investigation in the action and that the evidence ment will be effected in our national physique by an appeal of Dr. A. P. Luff, Dr. W. H. Willcox, and Dr. W. D. to, the nation’s aesthetic perceptions, it is not too much to Halliburton led Mr. Justice Warrington to the conclusion hope that it may be brought about by first adding to the that the process, or some similar process, employed by the nation’s knowledge of the rules,of health and disease, and Flour Oxidizing Company, Limited, had no injurious effect then appealing to its common sense to apply them. Education, on flour. Mr. Justice Warrington, after pointing out that in a word, must be the spirit moving through the land to teach the method employed by the Flour Oxidizing Company the masses of our people, that what was good enough for would render it less likely to be attacked by mites their fathers inthe matter of physical well-being is not good and other organisms, went on to say, relying on experi- enough for them. Legislation and inspection may indeed ments made by Dr. Halliburton, "the result, in my afford the machinery for a faultless national hygiene, but it opinion, of the whole of those experiments, taking them must remain ineffective in the main if in the tenement as a whole, is, that so far as the bread made from houses and cottages throughout the country there is not an is which is the there is intelligent appreciation of the reasons behind sanitary laws concerned, important part, the flour no substantial difference, in point of digestibility, between and of the great benefits which will accrue to those families the bread made from the untreated flour and the bread made that scrupulously obey them. Of recent agencies which from the treated flour." Upon the question whether the have arisen for the diffusion of such knowledge, the flour had had imparted to it certain toxic qualities by theNational League of Physical Education and Improvement plaintiffs’ process, Mr; Justice Warrington considered is pre-eminently active in promulgating the gospel of that the experiments of Mr. Ladd, to which we alluded health. We havealready announced thedelivery of in our annotation on March 27th, failed to prove this several lectures, and addresses under its auspices, and now of its appeal at a Mansion point. Dr. Willcox and Dr. Luff,he said, who arehave to record
given by :pr,, Ladq,,
effect
added
of
held
____
the widening