"THE EXPERIENCES OF A PUBLIC VACCINATOR."

477 of sickness. I consider the action of the public vaccinator, SURGICAL AID SOCIETY AND ITS to say the least, ungentlemanly and presumptuous and I can METHODS. assure him, firstly, that the child in question will not be vaccinated until I consider it in a proper state of health, To the Editors of THE LANCET. and secondly, that when the child is vaccinated it will not SIRS,—Most surgeons are under the impression that this be by the public vaccinator of body has for its object the providing of surgical apparatus to But what I desire to ask you, Sirs, is whether this pro-

THE

-.

the poor, chiefly hospital patients, on the recommendation or certificate of a surgeon only as stated in their advertisements. The following incident which has recently occurred and which I am led to believe is not an isolated case shows how grievously their confidence may be misplaced and requires an explanation from the society. A little child, under my care at the Children’s Hospital, Shadwell, was recommended by me to get an apparatus and the requisite A lady interested number of letters was collected. in the child’s welfare and who originally asked me to see her took her up to Salisbury-square and was there told by an elderly official that the doctor had ordered quite the wrong thing. She was advised to see another surgeon and sent away with a printed paper bearing the name of a surgeon to the National Orthopaedic Hospital, Great Portland-street, with the cheering prospect of getting much more efficient treatment. Fortunately she refused to be cajoled by any such seductive offer and returned to me with the document. The first question I would ask is-Does the society or does it not provide apparatus as they state on the recommendation of any surgeon ? If they do not then let the profession openly know that it is provided only subject to the approval of a specialist. What is absolutely indefensible is the flagrant attempt to divert patients from one surgeon to another, to say nothing of destroying the patient’s confidence by the delicate suggestion of his incompetence. As this is a matter of great importance to hospital surgeons I trust you may find space for it in your valuable journal. I am,

Sirs,

yours HY. faithfully, BETHAM

-

ROBINSON.

MEDICAL AID ASSOCIATIONS. To the Editors of THE LANCET. SIRS,—Will you kindly allow me to ask your readers copies of reports of medical aid associations ? T

am

Cira

irniirq

faithfully

T. GARRETT

cedure is sanctioned by the Local Government Board. I may add that the father of the child is in a lucrative business, has never had any children vaccinated at the expense of the ratepayers, and was greatly astonished at the public vaccinator’s visit. I enclose the notice sent. I am, Sirs, your obedient servant,

L.R.C.P., M.R.C.S.

THE NEW VACCINATION ACT : "COMFORT FROM THE LOCAL GOVERNMENT BOARD.

"

To the Editors of THE LANCET. SIRS,—Early in December I asked my guardians to come to an agreement re the new vaccination fees. Their reply was a notification of a "resolution"(received on Dec. 31st) that they would pay the minimum fees. I then put it to the Local Government Board that the fault was not mine that no agreement had been arrived at and asked whether, if I refused the guardians’ fees, the guardians could summarily dismiss me. I also asked whether a mere " resolution " of the guardians constituted an "agreementas required by Article 4 of the General Order. The Local Government Board replies are as follows (taking the last question first) : 66 "A resolution of the guardians does not constitute an ’agreement."’ One would think from this that the Local Government Board would at once itself determine the fees to be paid in accordance with its own " General Order." But not I am informed that notwithstanding the neglect of so. the guardians to carry out the Order it is still within their power to terminate my contract should I fail to comply with their "resolution." The "comforting" part then comes : that in the event of the guardians dismissing me I shall be entitled to payment for work done up to the time of the expiration of my notice to quit. When it is remembered that the vaccination officer cannot i dismissed by the guardians a feeling of surprise creeps be ( over me. I am, Sirs, yours faithfully, X. Feb. 8th, 1899.

for

HORDER.

OF A PUBLIC VACCINATOR." To the Editors of THE LANCET.

"THE EXPERIENCES

INSTRUCTION IN ANÆSTHETICS. To the Editors of THE LANCET. SIRS,—Is it not high time that the administration of anaesthetics was systematically taught in our medical schools ? At present a medical man as soon as he is qualified is supposed to be able to administer anaesthetics, although he has probably never received systematic instruction in this subject. This is not fair either to the medical man or to the patient. I should like to offer the following suggestions : 1. There should be attached to all hospitals in connexion with,medical schools an honorary anaesthetist who should rank with the visiting staff and who should instruct the medical students, both practically and by lectures, in the 2. The General Medical administration of anaesthetics. Council should make this instruction compulsory. 3. No hospital should appoint as resident anyone who had not received such instruction. I am. Sirs. vours faithfullv. CHARLES POWELL WHITE.

THE DUTY OF THE PUBLIC VACCINATOR. To the Editors of THE LANCET. district appears to SIRS,—The public vaccinator of the be sending out notices to the parents of unvaccinated children irrespective of t7teiq, position, stating that he intends to call -

on a certain date to "ofEer to vaccinate" their child. This is followed in due course by the visit and a threat that the visit will be repeated at intervals until the vaccination is permitted. At least, this was done to one of my patients, the vaccination of whose child was postponed by me on account

SIRS,—I quite able

am

with many of my fellow

public

vaccinators

to confirm the statement of your correspondent as to the large amount of work and the small profit attendant on that work undertaken by him in his duties under this new Vaccination Act. But what he leaves unsaid is the loss of

mental degradation incurred in performing these duties. It is bad enough in the slums where one hears oneself announced as "a bloke as wants to vaccinate the babby"and a dirty slut, called the lady, comes down and declines one’s offer in choice slang meant to be as offensive as can be produced ; it is still worse at the villa where the maid leaves one on the steps while she puts the chain up and goes to consult her missus. After hearing interjections such asThe idea!"What next !" the girl returns with "Please missus says she isn’t at home ; she doesn’t intend to have it done at all, and it shall be done by her own doctor." In the cloud of one’s mind caused by all these contradictions one finds oneself outside and to seek the interior of one’s brougham to carry one to fresh insults. Two contiguous houses were of one mind not to open the door to me, and though I could feel the vibration of people moving about and my coachman could see the inmates through the glass above the door ascending and descending no response was made to my four visits on four separate weeks, and the only effect obtained was to produce merriment in the neighbours who looked and grinned at their windows. Cannot a new modus vivendi et operandi be agreed upon’! Cannot the vaccination officer first obtain consent of these people and then carry the names of these consenting ones to the public vaccinator and so spare him so much fruitless toil, or cannot vaccination

self-respect and

478 stations be restored where he may only meet those who wish for his services ? This present domiciliary work cannot continue if worked on its present lines. I

a.m.

NOTES FROM INDIA. (FROM OUR SPECIAL CORRESPONDENT.)

Sirs. vours faithfully.

"P V."»

The

Playue Commission.—The Nature of the Evidence.—The Progress of the Epidemic.—More Curative Scrum. THE NATIONAL ASSOCIATION FOR THE AT the second sitting of the Plague Commission at Lahore PREVENTION OF CONSUMPTION AND Captain Wilkinson was examined. He cited one instance OTHER FORMS OF TUBERCULOSIS. to show that clothes appeared to be the medium of infection apart from the person. In one village he recorded HE LANCET. To the Editors of whilst no human being was that the victims were rats SIRS,—The press, both medical and non-medical, has attacked. He knew of no only, positive proof that rats communiwelcomed with considerable cordiality the formation of this human to the cated disease beings. At the last sitting society and, as far as I am aware, nothing but goodwill has It Major Skinner gave evidence. He still disputed the theory been exhibited towards it by the medical profession. that the cases in the Shropshire regiment in Barrackpore should prove a success. Whilst sympathising deeply with the objects of the and Howrah were cases of real plague, but while he detailed Association and wishing a happy issue to its endeavours to certain symptoms and the results of his microscopic his arguments were not conclusive. prevent tuberculosis of all kinds, may I be permitted to point examinations The Plague Commission commenced to take evidence out one or two things in connexion with it which are in my Mr. Giles, the acting Comat Karachi on Jan. 23rd. opinion open to criticism ? In the first place, on looking over missioner for Sind, was examined and detailed the history of the list of names of the gentlemen forming the organising committee one cannot but be struck with its want of repre- plague in Karachi and the measures which had been taken. sentative character and this becomes more evident when one He expressed his opinions on certain means by which he plague was spread, but no scientific evidence of these subjects the list to more careful analysis. One finds, for thought means was given. Similar opinions have been expressed that of the in the for example, special hospitals metropolis but at other places, being wholly unaccompanied by the treatment of consumption, of which there are five with about 60 physicians in their service, only one has any repre- any evidence of scientific value they remain merely the sentation upon the said committee, by a consulting physician individual opinions of their exponents. Lieutenant-Colonel and a junior physician ; the others are totally unrepresented. McCloghry, the civil surgeon, attributed the second outbreak the migration of rats and to people moving from the Again, of the general hospitals in London, the four largest, to to the uninfected quarters. Contagion was due more infected for example, as far as I can make out, do not contribute to rats than to human agency. He thought that rats generally names to the list. the for any Thirdly, provincial hospitals contaminated the dwellings with their excreta. He cited consumption, such as Bournemouth, Torquay, Ventnor, and a case where human agency was perfectly excluded, tending the like have only one representative; Edinburgh and to show that contagion was entirely due to dead rats. Belfast none. As a matter of curiosity I have tried to find in the Medical Other witnesses, military and civilian, were also examined and their opinions were expressed in detail upon the value of Directory which of the 21 members of the committee are or disinfection and other sanitary measures. Similar evidence have been connected with special hospitals for consumption has been taken at other places. Why time and money are in this country but have only succeeded in the case of five or wasted in getting such evidence as this seems to me to six. Do not think that I have anything whatever to say be incomprehensible. Their opinions are only opinions on the committee that are to they except against the names and are not sufficiently supported by facts. Protests have some extent unrepresentative, or yet that it is my wish to been uttered against the examination of a hakim (a demonstrate that those who have had practical experience in native quack doctor) upon his experiences of plague in treating consumption on a large scale are any more able to Garhshanker. He was allowed to give his views freely help in the prevention of the disease than those who are not. on many medical questions, but his evidence was of no real All I desire to indicate is that it might have been more satisvalue. To recognise such men-to let it be known all over the factory if the representative principle had been taken into country that a scientific board of savants is apparently seeking consideration when the committee was formed. I am afraid their opinions-is to mislead the lowest and most uneducated that this cannot now be rectified, as the addition of further classes of the native communities. It gives these men a status names would only accentuate their absence in the first at once and therefore degrades the men who have qualified instance. after training in the Indian universities. If qualified native The other point to which I think exception may be were not available as witnesses hospital assi&ttaken is the advertisement of the Association by detailed practitioners ants who have had medical training might have been reports of meetings held under its auspices in the lay press. summoned. It is advisable to compel the hakims and vaids This, I think, has two disadvantages-that statements under pain of penalty to report all cases of infectious disease, divorced from their context are often made specially and in the absence of a Medical Act and any system of prominent by the reporters or editors who, of course, cannot medical registration this does not add to their status, but be expected to take much interest in medical subjects to accept their medical evidence is liable to misinterpretaexcept so far as they may be readable by their clients, and tion and should be done with caution. that certain statements are sometimes distinctly misleadThe mortality from all causes in city during the ing. Thus some weeks ago I saw in one of the daily papers past week was 1449, as against 1239 Bombay in the week precedinga statement with reference to heredity as predisposing to an increase of 210. The weekly mortality for consumption (based upon some remark of a speaker at one Bombay is about 500, so thataverage over 900 deaths have to be of the tuberculosis-prevention meetings in the country) which accounted for. Out of this 456 deaths from plague have might prove very mischievous. Another disadvantage in ’, been recorded and as there only is no other epidemic to account connexion with such a method of pushing the interests of the this shows how absurdly for the increased society, is that it is open to the suspicion of being a bid on inaccurate the returnsmortality The Presidency plague returns are. the part of the prominent organisers of such meetings for taken on a whole are more favourable, 343 villages publicity or public favour. We are fully aware that this is still remain infected. Last week 360 although were declared to be not the case, but it is certainly a fact that the names of the infected. Another source of confusion exists in the different; speakers at such public meetings do "catch on"with the dates to which the returns are compiled. The Presidency general public when prominently brought into notice by the returns are made up from Friday to Friday, the local hospital daily press. run from Saturday to Saturday, and the municipal I am aware that answer might be’made that it is publicity reports health cfficers returns go from Tuesday to Tuesday. The which is wanted to make the work of the Association returns are consequently all different. effective and this is perfectly true. Publicity certainly for weekly Notwithstanding the great increase of deaths from plague the excellent aims and objects of the association, but in Bombay city inoculation is proceeding very slowly. Only publicity for these alone. 388 inoculations appear to have been done for the week ending I am, Sirs, yours faithfully, Jan. 20th and these chiefly among low caste Hindus. Last AN ONLOOKER.

year when the authorities could have offeied inoculation in