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MILK IN CONNEXION WITH SEPTIC DISEASE.
166 NAVAL MEDICAL SERVICE. - The
following
appoint-
ments have been made at the Admiralty:-Staff Surgeon ’Gerard J. Irvine to the Vivid (dated Jan. 10th, 1891); Sur,geon Phillip N. Randall to the Warspite (dated Jan. 10th,
1891).
CORPS.—Artillery: lst London (City of The following announcement is substituted for that ,on the same subject which appeared in the London Gazette of Oct. 31st, 1890-viz.: Surgeon J. J. A. V. C. Raye resigns his commission.-3rd Lancashire : Edwin Haworth, M.B., to be Acting Surgeon (dated Jan. 10th, 1891).
it is wrong. At any rate, some of our great microscopists should be able to satisfy us upon this point, and put an end to all doubts on the subject. I am, Sirs, yours obediently, F. F . P. ATKINSON. Surbiton, Jan. 13th, 1891.
VOLUNTEER
London):
MIDWIVES’ REGISTRATION BILL.
To the Editors of THE LANCET. SIRS,—I had hoped that any discussion on so important a subject as the above would have been conducted seriously, and I have read Dr. Aveling’s letter with both regret and surprise. He seems to consider it sutficient to meet my criticisms of the Bill by, in the first place, making two assumptions, both of which are absolutely erroneous; secondly, by a statement which is obviously equally incorrect, and concludes with a "hope,"which he will find, Audi alteram partem." by reason of the frailty of human nature, never can be realised. Dr. Aveling says I have "not seen the Bill, MILK IN CONNEXION WITH SEPTIC DISEASE. and have contented myself with collecting the opinions of others." I beg to inform him I have the Bill before To the Editors of THE LANCET. me, and that it was sent to me by a member of Parliaimmediately on its introduction, that I have read SIRS,—With regard to my letter to Dr. Atkinson, to mentlittle of what has been written on the subject, and very " ’which Public Health" referred in your columns last week, therefore if I reiterate the opinions of others, it only shows I may say that I was not alluding to any specific infective that if those who judge for themselves, as I have done, organisms. The question as to the effect of boiling milk arrive at the same opinion as to the demerits of the Bill, good grounds for our objections. That containing these organisms can be readily settled, with Ithere must beinsome " an state mine uninviting" form is a matter of regret reference at least to two of them, by making the experito me; it is my misfortune that it should be so, but not my ment ; the organisms of diphtheria and typhoid fever can be fault. Next Dr. Aveling says I would "enforce their exobtained from most bacteriological laboratories. It would amination [i.e., of midwives], but say nothing about grantroe of even greater importance to determine whether tubercle certificates or registering them." Had he read my letter ing bacilli, when present in milk, can be destroyed by boiling ; with any care, he would have observed that I state "in because it is very probable that, in children at any rate, Ireland" each woman on passing her examination at the tubercular disease is frequently induced by the milk from end of her term of training is given a certificate," and retuberculous cows. It is quite likely that experiments of commended that this system be introduced into England; this kind have already been made, but I do not happen to and as to " registration," I really thought most of my letter of ’have read them. was about it. Finally, Dr. Aveling "hopes"" my "fears I am, Sirs, yours faithfully, are groundless" that amongst the many thousands of W. WATSON CHEYNE. women whom the Bill proposes to put on the register "a Welbeck-street, Cavendish-square, W., Jan. 13th, 1891. good many will be guilty, or at least be accused, of In fact, he appears to drunkenness, incompetence, &c." infer that the moment a woman is registered she will be To the Editors of THE LANCET. freed from the vices and defects which detract from the merits of ordinary mortals, and of which anyone who reads of character the mentioned second SIRS,—The epidemic in my previous communication ought certainly to have been the papers knows that the women at present acting as midgiven. It was one of follicular tonsillitis, and I ought to wives, and who are all to be registered as soon as the Bill have stated that my patients (though the epidemic was becomes law, seem to have their full share. Among said to be due to milk) were ordered larger quantities of medical practitioners many are annually accused of unboiled milk than usual; and yet, in spite of this, nearly " drunkenness, incompetence, and disgraceful conduct." all got well in about three days. The state of health of Nor are such accusations confined to members of our prothe population, in my opinion, has more to do with regu- fession ; the Bar, and even the Church, have amongst their lating the size and severity of epidemics than anything else, members not a few "black sheep." But amongst the and thus we see the weakly affected first, then thuse that 15,000 uneducated women whom the Bill proposes to put possess slightly greater power of resistance, whilst the per- on the register Dr. Aveling appears to" believe that "the fectly strong and healthy escape altogether. Children may fear"that any such should be found is groundless." be said to have less resisting power than adults. Enteric Dr. Aveling admits that in Ireland "midwives have cer’fever may in the ordinary way be said to be more tainly received more attention and been better educated" of adult life, because young children do than in England, but he appears to be annoyed that one an illness not travel about so much, and are not in consequence who for forty years has taken an active part in bringing exposed to so many fresh zymotic influences. Recent about this desirable state of affairs should " kindly wish to comers into an infected district are most likely, it is said, to help (Englishmen) with the management" of theirs. I am take on the disease, and we certainly notice that the a registered medical practitioner, and my name appears on visitors to noblemen’s mansions that are defective as regards the same Register as does Dr. Aveling’s, and I refuse to sanitary arrangements are often the chief sufferers. But admit that anything touching the welfare of the poor in where enteric fever is caused by contaminated milk the any portion of the United Kingdom is alien to me; and cases, I fancy, would be found to be more numerous in the more, it augurs ill of the spirit in which the Bill is drawn if young than the old, because the glandular system is parti- the authors of it refuse to accept "aidin this new decularly active in early life, and the intestinal glands are parture from, or even to listen with patience to the opinion very easily irritated. It is all very well to say that such of, those who, whether they are foreigners or only inhabitants and such a disease is more common at such and such a of a distant portion of the same kingdom, have experience period of life; under certain circumstances it may be so, in the matter equal at least to their own. Unbounded but under others the statement may be entirely wrong. Our self-confidence has ere this wrecked many a good cause. knowledge with regard to milk epidemics is even now so Dr. Aveling informs us tha,t "some of the objections have very imperfect, and the ages of persons who have suffered already received attention," but no intimation has been from various causes so mixed, that at the present time and given as to what these are; that alterations will be made for the present purpose they are utterly unreliable. I have grudgingly and in consequence of the opinion of others, known several epidemics in recent years put down as due which I am glad to find must have coincided with my own, to milk, while the drainage has been shown to be is evident; but when we are favoured with the knowledge thoroughly defective. "Public Healthmay call in ques- of what these concessions are, I fear they will be found tion Mr. Watson Cheyne’s statement, but surely, if he insufficient to meet the requirements of the case, and I doubts it, he ought to bring forward some sort of proof that trust that those who are really interested in endeavouring to
Correspondence. "
following
appoint-
ments have been made at the Admiralty:-Staff Surgeon ’Gerard J. Irvine to the Vivid (dated Jan. 10th, 1891); Sur,geon Phillip N. Randall to the Warspite (dated Jan. 10th,
1891).
CORPS.—Artillery: lst London (City of The following announcement is substituted for that ,on the same subject which appeared in the London Gazette of Oct. 31st, 1890-viz.: Surgeon J. J. A. V. C. Raye resigns his commission.-3rd Lancashire : Edwin Haworth, M.B., to be Acting Surgeon (dated Jan. 10th, 1891).
it is wrong. At any rate, some of our great microscopists should be able to satisfy us upon this point, and put an end to all doubts on the subject. I am, Sirs, yours obediently, F. F . P. ATKINSON. Surbiton, Jan. 13th, 1891.
VOLUNTEER
London):
MIDWIVES’ REGISTRATION BILL.
To the Editors of THE LANCET. SIRS,—I had hoped that any discussion on so important a subject as the above would have been conducted seriously, and I have read Dr. Aveling’s letter with both regret and surprise. He seems to consider it sutficient to meet my criticisms of the Bill by, in the first place, making two assumptions, both of which are absolutely erroneous; secondly, by a statement which is obviously equally incorrect, and concludes with a "hope,"which he will find, Audi alteram partem." by reason of the frailty of human nature, never can be realised. Dr. Aveling says I have "not seen the Bill, MILK IN CONNEXION WITH SEPTIC DISEASE. and have contented myself with collecting the opinions of others." I beg to inform him I have the Bill before To the Editors of THE LANCET. me, and that it was sent to me by a member of Parliaimmediately on its introduction, that I have read SIRS,—With regard to my letter to Dr. Atkinson, to mentlittle of what has been written on the subject, and very " ’which Public Health" referred in your columns last week, therefore if I reiterate the opinions of others, it only shows I may say that I was not alluding to any specific infective that if those who judge for themselves, as I have done, organisms. The question as to the effect of boiling milk arrive at the same opinion as to the demerits of the Bill, good grounds for our objections. That containing these organisms can be readily settled, with Ithere must beinsome " an state mine uninviting" form is a matter of regret reference at least to two of them, by making the experito me; it is my misfortune that it should be so, but not my ment ; the organisms of diphtheria and typhoid fever can be fault. Next Dr. Aveling says I would "enforce their exobtained from most bacteriological laboratories. It would amination [i.e., of midwives], but say nothing about grantroe of even greater importance to determine whether tubercle certificates or registering them." Had he read my letter ing bacilli, when present in milk, can be destroyed by boiling ; with any care, he would have observed that I state "in because it is very probable that, in children at any rate, Ireland" each woman on passing her examination at the tubercular disease is frequently induced by the milk from end of her term of training is given a certificate," and retuberculous cows. It is quite likely that experiments of commended that this system be introduced into England; this kind have already been made, but I do not happen to and as to " registration," I really thought most of my letter of ’have read them. was about it. Finally, Dr. Aveling "hopes"" my "fears I am, Sirs, yours faithfully, are groundless" that amongst the many thousands of W. WATSON CHEYNE. women whom the Bill proposes to put on the register "a Welbeck-street, Cavendish-square, W., Jan. 13th, 1891. good many will be guilty, or at least be accused, of In fact, he appears to drunkenness, incompetence, &c." infer that the moment a woman is registered she will be To the Editors of THE LANCET. freed from the vices and defects which detract from the merits of ordinary mortals, and of which anyone who reads of character the mentioned second SIRS,—The epidemic in my previous communication ought certainly to have been the papers knows that the women at present acting as midgiven. It was one of follicular tonsillitis, and I ought to wives, and who are all to be registered as soon as the Bill have stated that my patients (though the epidemic was becomes law, seem to have their full share. Among said to be due to milk) were ordered larger quantities of medical practitioners many are annually accused of unboiled milk than usual; and yet, in spite of this, nearly " drunkenness, incompetence, and disgraceful conduct." all got well in about three days. The state of health of Nor are such accusations confined to members of our prothe population, in my opinion, has more to do with regu- fession ; the Bar, and even the Church, have amongst their lating the size and severity of epidemics than anything else, members not a few "black sheep." But amongst the and thus we see the weakly affected first, then thuse that 15,000 uneducated women whom the Bill proposes to put possess slightly greater power of resistance, whilst the per- on the register Dr. Aveling appears to" believe that "the fectly strong and healthy escape altogether. Children may fear"that any such should be found is groundless." be said to have less resisting power than adults. Enteric Dr. Aveling admits that in Ireland "midwives have cer’fever may in the ordinary way be said to be more tainly received more attention and been better educated" of adult life, because young children do than in England, but he appears to be annoyed that one an illness not travel about so much, and are not in consequence who for forty years has taken an active part in bringing exposed to so many fresh zymotic influences. Recent about this desirable state of affairs should " kindly wish to comers into an infected district are most likely, it is said, to help (Englishmen) with the management" of theirs. I am take on the disease, and we certainly notice that the a registered medical practitioner, and my name appears on visitors to noblemen’s mansions that are defective as regards the same Register as does Dr. Aveling’s, and I refuse to sanitary arrangements are often the chief sufferers. But admit that anything touching the welfare of the poor in where enteric fever is caused by contaminated milk the any portion of the United Kingdom is alien to me; and cases, I fancy, would be found to be more numerous in the more, it augurs ill of the spirit in which the Bill is drawn if young than the old, because the glandular system is parti- the authors of it refuse to accept "aidin this new decularly active in early life, and the intestinal glands are parture from, or even to listen with patience to the opinion very easily irritated. It is all very well to say that such of, those who, whether they are foreigners or only inhabitants and such a disease is more common at such and such a of a distant portion of the same kingdom, have experience period of life; under certain circumstances it may be so, in the matter equal at least to their own. Unbounded but under others the statement may be entirely wrong. Our self-confidence has ere this wrecked many a good cause. knowledge with regard to milk epidemics is even now so Dr. Aveling informs us tha,t "some of the objections have very imperfect, and the ages of persons who have suffered already received attention," but no intimation has been from various causes so mixed, that at the present time and given as to what these are; that alterations will be made for the present purpose they are utterly unreliable. I have grudgingly and in consequence of the opinion of others, known several epidemics in recent years put down as due which I am glad to find must have coincided with my own, to milk, while the drainage has been shown to be is evident; but when we are favoured with the knowledge thoroughly defective. "Public Healthmay call in ques- of what these concessions are, I fear they will be found tion Mr. Watson Cheyne’s statement, but surely, if he insufficient to meet the requirements of the case, and I doubts it, he ought to bring forward some sort of proof that trust that those who are really interested in endeavouring to
Correspondence. "