"UNBOILED v. BOILED MILK."

227

Among them there were two trephinings Mignot’s report runs as follows :--"During the year 1899, (both successful), four laparotomies (two deaths), four out of nearly 71,000 employés of different grades in the Posts operations for appendicitis (all successful), 13 operations and Telegraphs, 200 were certified as having died from for the radical cure of hernia (all likewise successful). tuberculosis, and 88 were retired on account of the same 23 sick men were sent for treatment to Wiesbaden, Aix, complaint, making a mortality of 281 per 10,000, and a loss Oyenhausen, and Teplitz, their disabilities being mostly from tuberculosis ,of 40 per 10,000, for it cannot reasonably be supposed that a very large number of those retired escaped chronic rheumatism, sciatica, and syphilis. death." The total loss is obtained by adding together the. DEATHS IN THE SERVICES. deaths and retirements from tuberculous disease. Retirement Surgeon-Major Frederick Robinson, at his residence from the British Post Office on account of phthisis means that He entered the service as the at Eastbourne on July 21st. patient’s decease from that complaint is assured if not Assistant Surgeon in the 74th Foot and was transferred to imminent. Applying the same method to the official He became Surgeon- statistics published the Scots Fusilier Guards in 1852. by the British Post Office we get the Major of the battalion in 1867. He accompanied the Scots result shown in the following table. The figures refer to theFusilier Guards to the Crimea and served with the battalion established staff only-every member of which is a selected at the until the termination of the war. He was

84 in number.

present

life

:-

battles of the Alma, Balaclava, and Inkerman and at the siege and fall of Sebastopol and the sortie of Oct. 26th (British medal with four clasps, Medjidieh and Turkish medals). Surgeon-Major Robinson was the author of "A Diary of the Crimean War."

GENERAL BADEN-POWELL’S HOSPITALS. The generous donors of literature and subscriptions to Lady Sarah Wilson’s fund for supplying books to the South African Constabulary Hospitals will be glad to know that the final consignment of about 700 volumes is being shipped this week, thus carrying out General Baden-Powell’s personal wish expressed in a letter to Lady Sarah Wilson as follows : " My idea was to make up the books into cases of say 50 to A case 100 volumes in strong, locked travelling cases. would be sent to each hospital for a month and then passed In this way there would be a on to the next hospital. of books." arrival of a fresh lot monthly HONOURS FOR CHINA AND SOUTH AFRICA. Colonel J. T. B. Bookey, I.M.S., has been appointed a Companion of the Bath for services rendered during the recent operations in China, and the following officers have been appointed to Companionships of the Order of the Indian Empire for services in the same operations : LieutenantColonel W. J. R. Rainsford, R.A.M.C., Major J. J. C. Watson, R.A.M.C., and Lieutenant-Colonel L. A. Waddell, I. M. S. The King has appointed Deputy Surgeon-General H. J. Blanc to be Knight Commander of the Royal Victorian Order. Sir William Thomson, C.B., has been appointed a member of the Army Medical Reorganisation Committee.

Correspondence. "Audi alteram

"THE

partem."

CONTAMINATION OFFICES."

OF

To the Editors of THE LANCET.

POST-

Table

showing Loss from Phthisis.

This table shows that there was a progressive increase in the number of retirements after 1895 and a corresponding decrease in the number of deaths, a fact which proves how close is the relation between the two sets of figures and fully confirms the method of computing the total loss from

phthisis.

So much in substantiation of the statistics of my letter. Reference is made by "P. M. 0."to other statistics"just issued" which "reveal that this disease exists only to a very limited degree amongst all grades of postal employes." If this statement be true then the Postmaster-General is wrong, for the figures I have quoted are from his annual reports. "P. M. O."must settle this with Lord Londonderry. But the most extraordinary statement is made that these statistics have been recently collected and apparently classified. " P. M. 0.,"I imagine, means " Postal Medical Officer,and I also imagine that information in the possession of postal medical officers is readily accessible to the Postmaster-General. Yet on Tuesday, June 18th last, when Sir Walter Foster asked for statistics of this very nature the Postmaster-General’s representative replied "that it would be difficult to give all the details referred to,"&c. That the men fall short in many respects in their private life I am ready to admit, and in this matter they share the ignorance of the great mass of the British public concerning the causation and prevention of consumption. But their sanitary standard owes nothing to the intelligence of the Post-office medical department which allows month-old, nay, year-old, dust to remain on the walls of the General Post Office itself, and has provided not a single spittoon nor a publicly exhibited prohibition against expectoration within the buildings.

SIRS,-A letter in THE LANCET of July 20th, p. 171, T Sirs faithfully under the headingThe Contamination of Post-offices," " CHARLES H. GARLAND. with the intenP. M. 0. sets out laudable signed tion of enlightening the public on the very numerous inaccuracies of certain other letters. The latter part of this letter contains some reference to a previous com"UNBOILED v. BOILED MILK." munication from me. "P. M. O,"refers to my "allegations To the Editors oj THE LANCET. as to the excessive prevalence of tubercle among tele" ’’ THE LANCET of July 20th, p. 169, Dr. Robert and condiit to the SIRS,--In graphists my attributing insanitary tions of post-office buildings." I have looked up my Hutchison, by producing a large amount of experimental original letter and I find that I referred to "the high evidence, has completely refuted Dr. Dukes’s main conincidence of phthisis among certain classes of employes in tention "that the nutritive value of milk is very largely the English Post Office," those classes being sorting clerks diminished by boiling." In THE LANCET of August 20th, and telegraphists, but I made no comparison with any other 1892, p. 434, are quoted some experiments of Dr. Chamouin class and did not use the word "excessive." The most of Paris which support Dr. Hutchison’s views. Kittens careful scrutiny of my letter does not reveal the fact fed on boiled milk were twice as fat and healthy as that I attributed the phthisical mortality of the Post Office those fed on raw milk. Dr. Chamouin also investigated the to the insanitation of the buildings or to any other cause. infantile mortality of Paris and came to the conclusion that I contented myself with a statement of the facts. The ’’ thousands of infants are annually safeguarded from intesstatistics which I quoted were statistics referring to the whole: tinal disease and death by the precaution of boiling the milk postal service and were obtained from the annual reports of’ on which they feed." It appears to me that Dr. Dukes the Postmaster-General. The method of calculation I magnifies the dangers arising from boiled or sterilised milk adopted was the method employed by Dr. Mignot in calcu- and minimises those from unboiled milk- One can only form latingthe mortality in the French postal service. Dr. an opinion from one’s own experience and mine is decidedly am

yours

228 ifferent from Dr. Dukes’s.

During the

last 12 years, here and

expiration,

it

elsewhere, I have met with six milk-borne epidemics, four of incompetent, scarlet fever, and one each of diphtheria and enteric fever. these

simply means to

use

the

that he is

unable, and therefore

apparatus.

Tam. Sirs.

vmirs

faithfullv.

EDGAR WILLETT, M.B. Oxon., F.R

C.S. Eng., Administrator of Anæsthetics to St. Bartholomew’s Hospital. repeatedly proved. My experience of milk-borne epidemics may have been !Unusually large, but the frequency of their occurrence is well shown by reference to the late Mr. Ernest Hart’s papers on this subject. Dr. Dukes says that "the destruction of the BRITISH MEDICAL MEN AND GERMAN nutritive qualities of milk (by boiling) means for artificially WATERING-PLACES." reared infants rickets, infantile scurvy, and tuberculous In

epidemics

occur

value of

sterilising

No doubt rickets and infantile scurvy

diseases." to

the

milk

are

amongst children brought up by hand, but

was

prone

are

these diseases more often due to the milk being deprived of its fat by skimming and to the addition of artificial foods ? It is impossible to believe that sterilising milk produces tuberculosis ; surely it is the best method of preventing it. Everyone will agree with Dr. Dukes that much greater care should be taken to insure the purity of our milk-supply. To do this the public must be educated up to the importance of pure milk and sanitary authorities and medical officers ofhealth must be more alert to the frequency of milkborne epidemics. The regulations and requirements of the Aylesbury Dairy Company, as mentioned in THE LANCET of June 29th, and the reported intention of the borough council of Camberwell to prosecute the sellers of tuberculous milk are steps in the right direction, but until milk-supplies are much more carefully inspected and regulated I feel sure that it will be much the safest plan to boil or sterilise all our milk. I am, Sirs,yours faithfully, W. GIFFORD NASH. Bedford, July 20th, 1901. To the Editors

SIRS,-It

of THE LANCET.

is

that Dr. Robert in THE LANCET of July 20th, p. 169, will induce those who contend that boiling milk appreciably impairs its nutritive value seriously to reconsider their position. I have looked in vain for any in evidence of logical support their contention. The physician above all others must not allow himself to be carried away by mere impressions ; he must subject his views to a searching investigation before giving them to the world as facts. All the more needful is this when the question at issue is one of national concern. The effect. of controversy is but too often to leave the audience in doubt as to which side is in the right, one of the reasons of this being that most men, unconsciously it may be, seek to establish the truth of their own views rather than the truth itself. Now, Sirs, in regard to the question of boiled versus unboiled milk, we cannot afford to be under any misapprehension as to the truth or we shall stand stultified before the world. On such an elementary point in dietetics we simply must not be divided. Our plain duty is to cast aside vague impressions and to be guided by the logic of evidence alone, and all the reliable evidence before us goes to show that boiling does not in any appreciable degree affect the nutrient value of milk. When, therefore, we are in the slightest doubt as to the purity of a milk-supply we need have no hesitation in advising our patients to have the milk boiled.-I am, Sirs, yours faithfully, HARRY CAMPBELL. Wimpole-street, W., July 20th, 1901.

Hutchison’s

greatly to be hoped convincing letter, published

"A SIMPLE FORM OF PUMP FOR INFLATING THE ETHER-BAG." To the Editors of THE L A N C

To the Editors

not

ET.

SIRS,--On page 153 of THE LANCET of July 20th there is

ot THE LANCET.

SIRS,--There is much in the letter of Dr. Thomas Dutton in THE LANCET of July 20th, p. 171, with which the greater part of your readers will agree, but I feel compelled to take exception to the following statement : " The majority of the cases which are sent or go to Germany for Schott’s treatment return without any benefit and would improve much better under ordinary treatment at home on account of the cases " being unsuitable for Schott’s treatment." My. experience, which is probably not second to, that of Dr. Dutton in this matter, has led me to form a precisely opposite opinion. It would, therefore, be interesting to know on what statistical basis or other data Dr. Dutton has been led to form the opinion which he has expressed. T

July 22nd, 1901.

am

Sirs

vnnre

faithfully

W. BEZLY THORNE.

REPORT OF THE CONSTITUTION COMMITTEE OF THE BRITISH MEDICAL ASSOCIATION. To the -Editors of THE LANCET. SIRS,-The committee appointed at the annual meeting of the British Medical Association last year at Ipswich for the revision of the constitution of the Association are to be congratulated upon their valuable report, published in last week’s issue of the British Medical Journal, and which is to be submitted to the annual meeting at Cheltenham on Tuesday, July 30th. An animated discussion may probably be anticipated upon several points ; two of these especially occupy a commanding position, and they are (1) the proposal regarding delegates or representatives of divisions, and (2) the payment of the travelling expenses of the members of the Council of the Association and of the various com-

mittees,

&c.

1. The clauses-16 and 19-relating to the election of delegates by the divisions will no doubt meet with considerable opposition. To my mind a body of delegates savours strongly of trade unionism ; it is foreign to other scientific and professional societies, and is unusual even in other such societies registered under the Companies’ Act; it implies distrust of the central council of the Association, and would tend to weaken alike their sense of dignity and responsibility. It would, moreover, be very expensive and, in my view, quite unnecessary, because its object, that of I I securing to the general body of members of the Association the most complete control possible over its policy and government,can be gained easily and effectively by extending to them in the general meetings and under proper conditions the power of the referendum so properly proposed to be conferred upon the central council in Clause 19. 2. The proposed payment of travelling expenses to all members of the central council, committees, &c. (Clauses 16 and 21), is also likely to encounter a large volume of disapproval. For my own part I regard this as a mercenary proposal, as one offensive and derogatory to those highminded members whose sole or chief object in accepting any office would be the interests and honour of the Association and of the profession at large, and I think it would be calculated to give fresh occasion to those unfriendly critics" some in very high places-who are prone to scoff at a breach of some rule of the medical trade union." I am, Sirs, yours faithfully, JOHN INCE, M.D. St. And., I.M.S. (retired).

letter from Mr. Herbert J. Robson with an illustration of his ’’simple form of pump for inflating the ether-bag instead of by breath inflation." From the context it is obvious that inflation by breath"of the anaesthetist is meant, which, as Mr. Robson very correctly says, is "a practice by no means pleasant or advisable either for patient I would, however, go farther than this or medical man." a,nd say with confidence that under no circumstances whatever is it necessary for the administrator to use any means other than thepatient’s breath for the inflation of the supplemental To the Editors of THE LANCET. bag. Consequently all’’ simple forms of pump " for this SIRS,--I shall esteem it a favour if you will allow me to purpose are entirely unnecessary. If the administrator cannot fill the bag by means of the patient’s breath during intimate to your readers that there will be a meeting of some a