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SICKNESS AND MORTALITY IN THE NAVIES OF THE WORLD.
804 after his admission to
hospital
consisted of the
withdrawal of the drug and the administration
complete of
one-
some of those preparations recently introduced in which iodine is combined with a hydrocarbon basis by means of which, it is stated, the drug can be easily applied and is very
thirtieth of a grain of strychnine sulphate every fourth hour and of 20 grains of sulphonal every two hours. On the first readily absorbed. night he slept fairly well; on the second night he required no hypnotic whatever and only the medication with strychnine THE INTERNATIONAL CATALOGUE OF SCIENTIFIC LITERATURE. was continued. He rapidly became well and in a few days ’ volunteered the statement that he felt like his former self IN THE LANCET of March 9th, p. 736, will be found for the first time for many months and that time once I a letter from Dr. W. D. Halliburton dealing with this more seemed real to him. He complained of no craving for important matter.. It will be seen by his letter that the drug and was discharged from hospital a week after indexing and cataloguing commenced with all papers admission as cured, though advised to keep himself under published on and after Jan. lst of the present year and medical surveillance for a longer time. that there will be two indices-i.e., an index of authors and a subject index. The participating nations are for the indexing of papers to be severally responsible CHELSEA CLINICAL SOCIETY. in their own country, and a British bureau published THE annual clinical debate of the Chelsea Clinical Society has already been formed for Great Britain and Ireland. was commenced on March 12th, at the Jenner Institute of There is in addition a central bureau to collect, coördiPreventive Medicine, under the presidency of Dr. William nate, and publish the labours of the various national Ewart. The subject for debate was, " The Clinical Dr. Halliburton draws special attention to bureaus. and Pathological Relations of the Chronic Rheumatic certain of the more out-of-the-way subjects connected and Rheumatoid Affections to Acute Infective Rheumatism," with medicine and asks workers in these fields to and it was introduced by Dr. Archibald Garrod, who read send copies of their papers to certain gentlemen a paper which is published in full in the present issue of for the sections under which the subjects in responsible THE LANCET. Dr. Garrod was followed by Dr. F. J. Poynton, are included. We are glad to be able to conwho contributed a joint communication from himself and question the promoters of the scheme upon its active Dr. Alexander Paine. An interesting evening was closed gratulate The work will be arduous and never ending, but inception. by cuntributions from Mr. N. C. Macnamara and Dr. C. O. it has in it possibilities of the greatest value to science. Hawchorne. Our report of the discussion is deferred until The enormous growth during the past century of every next week. department of science has necessitated a corresponding growth in scientific records, and to reduce this mass of THE TREATMENT OF TUBERCULOUS matter to a form in which its details may be easily accessible PERITONITIS. will be no light task. But the benefits accruing to science DR. BURNEY YEO’S paper on this subject which we publish from such work will be commensurate with the difficulties Tuberculous of the task, and we can in another column is of unusual interest. only express our sincere wish for the peritonitis is a condition fairly frequently met with, but the success of the various committees. treatment of the condition has always been unsatisfactory. Many authorities have taken most despondent views as to the possibility of cure. Many facts connected with this disease, SICKNESS AND MORTALITY IN THE NAVIES OF THE WORLD. however, suggest that peritoneal tubercle is not possessed of DR. J. A. PORTENGEN of the Netherlands navy has made great activity or powers of resistance, and that its natural tendency to obsolescence is readily facilitated by what a praiseworthy attempt to compare the published vital appear to be but very trifling disturbances of the conditions statistics of the navies of the world, but owing to the variant under which it is developing. Dr. Yeo refers to data upon which the returns are founded the final results the results oE the surgical treatment of tuberculous of the comparison," as Dr. Portengen himself observes, "are peritonitis by which very successful results have been not very encouraging." In some instances-as, for example, .achieved, especially in the early stage and when there is in the Netherlands navy and also in our own-medical officers always more or less ascitic fluid in the peritoneal cavity. are required to include in their returns every case of illness A practitioner would naturally prefer to dispense with or injury, no matter how slight or trivial ; whereas in others, operative procedure if possible, although if he considered notably the navies of Italy and Japan, only serious diseases it the only means of cure he would certainly recommend it. are reported. The term "invaliding," too, has different Dr. Yeo draws attention to a method of treatment which he values in different countries, meaning permanent retirehas tried with success-namely, the application to the abdo- ment of the individuals invalided in some, while in men of a liniment containing iodoform or iodine, at the same others it refers also to patients sent to their homes or elsetime administering internally a pill containing iodoform and where on account of temporary disability and liable to be creasote. He believes that when iodoform is rubbed into recalled to duty on the expiration of their sick leave. The the skin of the abdomen in a young person it probably death-rate in our navy, as well as in that of Japan, comprises rapidly enters the blood and is, if regularly applied, the mortality from all causes, but in the German navy the continuously eliminated in the secretions, including the deaths occurring under medical treatment are alone included secretions into the serous cavities, and as these do not pass in it. During the decade referred to in the subjoined table out of the body as the secretion of the kidney does they the English mortality is swollen owing to the loss of the must in course of time become richly charged iodine Serpent off the coast of Spain, of the Vietoria in the rate so to act as antitoxin to Mediterranean, and of a boat’s crew in China; but the at sufficiently any compounds, the tubercle toxin or as anti-bacterial to the bacilli. This German rate is exclusive of the losses in the Adler, the Eber, suggestion is a plausible one and this method of treatment and the ntis. In the vital returns of the Danish navy all will doubtless receive further and more extended trial. It pilots and dockyard artificers, together with their wives and is a fatal mistake to extol any therapeutic measure that has families, are included in the totals, which are thus rendered not passed the ordeal of extended experience, but we shall useless for the purposes of comparison ; while in the navies await with interest the reports of Dr. Burney Yeo and other of Spain, Portugal, and Chili the statistical information that observers who may adopt the line of treatment suggested has been issued is too imperfect and fragmentary to be of 43y the above theory. It might be found advantageous to use service. Up to the present the naval authorities of France, -
‘
____
with
805 :Sweden and Norway, Turkey, Greece, and Argentina have abstained from publishing any vital statistics whatever, but according to a notification recently issued by the French Marine Minister, M. de Lanessan, this reproach will shortly cease to be applicable with regard to the first-named country. It is much to be desired in the interests of sanitary science that the vital statistics of - all naval Powers should be drawn up in a uniform manner, admitting of comparison .and compilation.
Invaliding, and Mortality per 1000 of in the Navies of the Under mentioned Countries the Decade 1888-1897.
Annual sickness.
Strength during
be
worthy
of
consideration, but they
Dr. E. any assent in that direction. out that there had never been any
had never given D. Kirby pointed necessity for the
scheme, for any general practitioner could always get
CHILD
LABOUR
IN
ITS HYGIENIC ASPECTS.
subject of child labour in its social and hygienic aspects has again recently come up for notice in an important statement which has been prepared by Mr. A. Spencer, chief officer of the Public Control Department of the London County Council. Reference was made in these columns two years ago to the report on the subject laid before the London School Board and the observations made thereon by Dr. T. J. Macnamara. Shortly afterwards the subject was referred to in Parliament by Sir John Gorst, Vice-President of the Council of Education, in his speech on April 28th, 1899, when submitting the education estimates. In a powerful and sympathetic speech Sir John Gorst analysed the statistical returns and the records of the histories of board school boys and girls who among- the poorer classes bad often to toil for 50, 60, or 70 hours a week, before and after school hours, to earn a living ; he described the hardships and sufferings of these overworked and underfed children in passages of genuine eloquence and pathos, and gave several illustrative cases with every detail of their squalid and wretched lives, " a picture which," as was observed by the newspaper press at the time, " would haunt the memory for many a day after." The School Board returns in their aggregate show that the total number of children entered as employtd is 144,026. The occupations of these school children, mostly boys, include-hawking goods, 4235; agricultural work, 6115; boot and knife cleaning, &c., 10,636; selling newspapers, 15,182; working in shops and running enands, 76 173; needlework (girls), 4019; and domestic work (girls), 20 849. Of these schoolboys and schoolgirls 30,807 belong to the County of London, and work on an average from 40 to 70 honrs a week, eight boys working between 71 and 80 hours, and two over 80 hours a week. The pay given to the children is generally very small. In 40,240 cases it was from ls. to 2s. per week, in 47,273 cases it was between 6d. and is., and in 17,084 cases it was under 6d. per week. In 104,600 cases out of a total of 144,000 the children were paid 2s. a week or less. The average wage of the total number was about ls. a week, but in home cases meals, and occasionally clothes, wera given. The report laid before the School Board in February, 1899, said : "Probably some (of the children) die as a direct result of the severity of the toil inflicted upon them in their early years, and certainly many more of them must become a permanent and heavy charge upon the public purse because of the physical incapacity resulting from the rigour of their early THE
THE
BIRMINGHAM CONSULTATIVE MEDICAL AND SURGICAL INSTITUTION.
DR. H. WARD IRVINE having announced his retirement from the post of consultant to the Birmingham Consultative Medical and Surgical Institution it remain td for those interested in that body to consider what they should do next. An advance in this direction was made on March 7th, when the delegates of the Birmingham Hospital Fund met in the Council Chamber to receive and consider a report from their executive committee upon the situation. Mr. Alderman Cook was in the chair and was supported by Mr. Arthur Chamberlain and Mr. Councillor Nettlefold. Tne executive committee asked the delegates to agree that a successor to Dr. Irvine should be immediately secured. The chairman, in asking the meeting to approve the recommendation of the executive committee, pointed out that the institution during the nine months of its existence had been applied to by 400 persons. In the discussion which followed Mr. Morgan, a delegate, asked whether the successor to Dr. Irvine, if he felt that he could not rely upon his own judgment, could transfer the case to a consultant at a fixed charge of half a guinea. The chairman pointed out that they could not make i-uuh an arrangement. If the consultants offered to adopt this course it would
Saturday
a con-
sultation for his patient at any fee which he thought that the patient was able to pay. He moved that the report should be referred back. The amendment, however, was not seconded and the motion to accept the report was agreed to. Mr. Chamberlain then addressed the meeting. He said that they would not quarrel with the medical profession about fees. The medical officers would be offered either all that remained over of the fees after paying expenses or else a fixed salary. Instead of one medical man he suggested two, three, or even four, and he considered that the medical men might meet and see whether they could not agree upon some such scheme. So this is the latest idea of the Birmingham Consultative Medical and Surgical Institution-a medical aid society pure and simple, run by a lay committee. At p:esent the institution is without a medical officer, so we will defer further comment until it obtains one.
1 2
THE LANCET March 11th, 1899, p. 707. THE LANCET, May 13th, 1899, p. 1309.
hospital
consisted of the
withdrawal of the drug and the administration
complete of
one-
some of those preparations recently introduced in which iodine is combined with a hydrocarbon basis by means of which, it is stated, the drug can be easily applied and is very
thirtieth of a grain of strychnine sulphate every fourth hour and of 20 grains of sulphonal every two hours. On the first readily absorbed. night he slept fairly well; on the second night he required no hypnotic whatever and only the medication with strychnine THE INTERNATIONAL CATALOGUE OF SCIENTIFIC LITERATURE. was continued. He rapidly became well and in a few days ’ volunteered the statement that he felt like his former self IN THE LANCET of March 9th, p. 736, will be found for the first time for many months and that time once I a letter from Dr. W. D. Halliburton dealing with this more seemed real to him. He complained of no craving for important matter.. It will be seen by his letter that the drug and was discharged from hospital a week after indexing and cataloguing commenced with all papers admission as cured, though advised to keep himself under published on and after Jan. lst of the present year and medical surveillance for a longer time. that there will be two indices-i.e., an index of authors and a subject index. The participating nations are for the indexing of papers to be severally responsible CHELSEA CLINICAL SOCIETY. in their own country, and a British bureau published THE annual clinical debate of the Chelsea Clinical Society has already been formed for Great Britain and Ireland. was commenced on March 12th, at the Jenner Institute of There is in addition a central bureau to collect, coördiPreventive Medicine, under the presidency of Dr. William nate, and publish the labours of the various national Ewart. The subject for debate was, " The Clinical Dr. Halliburton draws special attention to bureaus. and Pathological Relations of the Chronic Rheumatic certain of the more out-of-the-way subjects connected and Rheumatoid Affections to Acute Infective Rheumatism," with medicine and asks workers in these fields to and it was introduced by Dr. Archibald Garrod, who read send copies of their papers to certain gentlemen a paper which is published in full in the present issue of for the sections under which the subjects in responsible THE LANCET. Dr. Garrod was followed by Dr. F. J. Poynton, are included. We are glad to be able to conwho contributed a joint communication from himself and question the promoters of the scheme upon its active Dr. Alexander Paine. An interesting evening was closed gratulate The work will be arduous and never ending, but inception. by cuntributions from Mr. N. C. Macnamara and Dr. C. O. it has in it possibilities of the greatest value to science. Hawchorne. Our report of the discussion is deferred until The enormous growth during the past century of every next week. department of science has necessitated a corresponding growth in scientific records, and to reduce this mass of THE TREATMENT OF TUBERCULOUS matter to a form in which its details may be easily accessible PERITONITIS. will be no light task. But the benefits accruing to science DR. BURNEY YEO’S paper on this subject which we publish from such work will be commensurate with the difficulties Tuberculous of the task, and we can in another column is of unusual interest. only express our sincere wish for the peritonitis is a condition fairly frequently met with, but the success of the various committees. treatment of the condition has always been unsatisfactory. Many authorities have taken most despondent views as to the possibility of cure. Many facts connected with this disease, SICKNESS AND MORTALITY IN THE NAVIES OF THE WORLD. however, suggest that peritoneal tubercle is not possessed of DR. J. A. PORTENGEN of the Netherlands navy has made great activity or powers of resistance, and that its natural tendency to obsolescence is readily facilitated by what a praiseworthy attempt to compare the published vital appear to be but very trifling disturbances of the conditions statistics of the navies of the world, but owing to the variant under which it is developing. Dr. Yeo refers to data upon which the returns are founded the final results the results oE the surgical treatment of tuberculous of the comparison," as Dr. Portengen himself observes, "are peritonitis by which very successful results have been not very encouraging." In some instances-as, for example, .achieved, especially in the early stage and when there is in the Netherlands navy and also in our own-medical officers always more or less ascitic fluid in the peritoneal cavity. are required to include in their returns every case of illness A practitioner would naturally prefer to dispense with or injury, no matter how slight or trivial ; whereas in others, operative procedure if possible, although if he considered notably the navies of Italy and Japan, only serious diseases it the only means of cure he would certainly recommend it. are reported. The term "invaliding," too, has different Dr. Yeo draws attention to a method of treatment which he values in different countries, meaning permanent retirehas tried with success-namely, the application to the abdo- ment of the individuals invalided in some, while in men of a liniment containing iodoform or iodine, at the same others it refers also to patients sent to their homes or elsetime administering internally a pill containing iodoform and where on account of temporary disability and liable to be creasote. He believes that when iodoform is rubbed into recalled to duty on the expiration of their sick leave. The the skin of the abdomen in a young person it probably death-rate in our navy, as well as in that of Japan, comprises rapidly enters the blood and is, if regularly applied, the mortality from all causes, but in the German navy the continuously eliminated in the secretions, including the deaths occurring under medical treatment are alone included secretions into the serous cavities, and as these do not pass in it. During the decade referred to in the subjoined table out of the body as the secretion of the kidney does they the English mortality is swollen owing to the loss of the must in course of time become richly charged iodine Serpent off the coast of Spain, of the Vietoria in the rate so to act as antitoxin to Mediterranean, and of a boat’s crew in China; but the at sufficiently any compounds, the tubercle toxin or as anti-bacterial to the bacilli. This German rate is exclusive of the losses in the Adler, the Eber, suggestion is a plausible one and this method of treatment and the ntis. In the vital returns of the Danish navy all will doubtless receive further and more extended trial. It pilots and dockyard artificers, together with their wives and is a fatal mistake to extol any therapeutic measure that has families, are included in the totals, which are thus rendered not passed the ordeal of extended experience, but we shall useless for the purposes of comparison ; while in the navies await with interest the reports of Dr. Burney Yeo and other of Spain, Portugal, and Chili the statistical information that observers who may adopt the line of treatment suggested has been issued is too imperfect and fragmentary to be of 43y the above theory. It might be found advantageous to use service. Up to the present the naval authorities of France, -
‘
____
with
805 :Sweden and Norway, Turkey, Greece, and Argentina have abstained from publishing any vital statistics whatever, but according to a notification recently issued by the French Marine Minister, M. de Lanessan, this reproach will shortly cease to be applicable with regard to the first-named country. It is much to be desired in the interests of sanitary science that the vital statistics of - all naval Powers should be drawn up in a uniform manner, admitting of comparison .and compilation.
Invaliding, and Mortality per 1000 of in the Navies of the Under mentioned Countries the Decade 1888-1897.
Annual sickness.
Strength during
be
worthy
of
consideration, but they
Dr. E. any assent in that direction. out that there had never been any
had never given D. Kirby pointed necessity for the
scheme, for any general practitioner could always get
CHILD
LABOUR
IN
ITS HYGIENIC ASPECTS.
subject of child labour in its social and hygienic aspects has again recently come up for notice in an important statement which has been prepared by Mr. A. Spencer, chief officer of the Public Control Department of the London County Council. Reference was made in these columns two years ago to the report on the subject laid before the London School Board and the observations made thereon by Dr. T. J. Macnamara. Shortly afterwards the subject was referred to in Parliament by Sir John Gorst, Vice-President of the Council of Education, in his speech on April 28th, 1899, when submitting the education estimates. In a powerful and sympathetic speech Sir John Gorst analysed the statistical returns and the records of the histories of board school boys and girls who among- the poorer classes bad often to toil for 50, 60, or 70 hours a week, before and after school hours, to earn a living ; he described the hardships and sufferings of these overworked and underfed children in passages of genuine eloquence and pathos, and gave several illustrative cases with every detail of their squalid and wretched lives, " a picture which," as was observed by the newspaper press at the time, " would haunt the memory for many a day after." The School Board returns in their aggregate show that the total number of children entered as employtd is 144,026. The occupations of these school children, mostly boys, include-hawking goods, 4235; agricultural work, 6115; boot and knife cleaning, &c., 10,636; selling newspapers, 15,182; working in shops and running enands, 76 173; needlework (girls), 4019; and domestic work (girls), 20 849. Of these schoolboys and schoolgirls 30,807 belong to the County of London, and work on an average from 40 to 70 honrs a week, eight boys working between 71 and 80 hours, and two over 80 hours a week. The pay given to the children is generally very small. In 40,240 cases it was from ls. to 2s. per week, in 47,273 cases it was between 6d. and is., and in 17,084 cases it was under 6d. per week. In 104,600 cases out of a total of 144,000 the children were paid 2s. a week or less. The average wage of the total number was about ls. a week, but in home cases meals, and occasionally clothes, wera given. The report laid before the School Board in February, 1899, said : "Probably some (of the children) die as a direct result of the severity of the toil inflicted upon them in their early years, and certainly many more of them must become a permanent and heavy charge upon the public purse because of the physical incapacity resulting from the rigour of their early THE
THE
BIRMINGHAM CONSULTATIVE MEDICAL AND SURGICAL INSTITUTION.
DR. H. WARD IRVINE having announced his retirement from the post of consultant to the Birmingham Consultative Medical and Surgical Institution it remain td for those interested in that body to consider what they should do next. An advance in this direction was made on March 7th, when the delegates of the Birmingham Hospital Fund met in the Council Chamber to receive and consider a report from their executive committee upon the situation. Mr. Alderman Cook was in the chair and was supported by Mr. Arthur Chamberlain and Mr. Councillor Nettlefold. Tne executive committee asked the delegates to agree that a successor to Dr. Irvine should be immediately secured. The chairman, in asking the meeting to approve the recommendation of the executive committee, pointed out that the institution during the nine months of its existence had been applied to by 400 persons. In the discussion which followed Mr. Morgan, a delegate, asked whether the successor to Dr. Irvine, if he felt that he could not rely upon his own judgment, could transfer the case to a consultant at a fixed charge of half a guinea. The chairman pointed out that they could not make i-uuh an arrangement. If the consultants offered to adopt this course it would
Saturday
a con-
sultation for his patient at any fee which he thought that the patient was able to pay. He moved that the report should be referred back. The amendment, however, was not seconded and the motion to accept the report was agreed to. Mr. Chamberlain then addressed the meeting. He said that they would not quarrel with the medical profession about fees. The medical officers would be offered either all that remained over of the fees after paying expenses or else a fixed salary. Instead of one medical man he suggested two, three, or even four, and he considered that the medical men might meet and see whether they could not agree upon some such scheme. So this is the latest idea of the Birmingham Consultative Medical and Surgical Institution-a medical aid society pure and simple, run by a lay committee. At p:esent the institution is without a medical officer, so we will defer further comment until it obtains one.
1 2
THE LANCET March 11th, 1899, p. 707. THE LANCET, May 13th, 1899, p. 1309.