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SUBSTITUTION RAMPANT.
1104 desired to be informed whether anyone had been injured after having treated the case for several wrote to the of the the use Electro He was told guardians asking to have his position Vigour " appliances. by as a result of this correspondence, in which Mr. that they were absolutely ineffectual for good or evil and Stephenson naturally claimed payment, he was served with appears to have taken this as a mitigating circumstance. It a red (urgency) ticket to attend the patient, the guardians does not appear to have struck him that the sale of goods expecting by this means to relieve themselves of all responsi by means of statements as to their uses which are not justi- bility as to payment. Other cases of small-pox were also sent fied by fact may involve the obtaining of money by false to the hospital but these were, it appears, attended by the pretences. It seems likely that from this point of view the port medical officer of health. His honour, the judge, in trade of quack medicine vendors may often be assailable delivering judgment held, we are glad to be able to record, that from the first assumed responsibility for where no infringement of the Medical Acts takes place, and then thought to protect themselves by throwing although convictions in the circumstances might not easily a red ticket at the medical officer’s head." It is clear that in be obtained. In conclusion we cannot too strongly point this case a very important principle has been at stake. Had out to those of our lay contemporaries who publish the the verdict gone against Mr. Stephenson it would have advertisements of’’ The Dr. McLaughlin Company" and implied that a port sanitary authority might send all its other such wicked enterpriEes that money thus obtained is ship-borne cases into the adjoining union, make them paupers, and have them treated as a matter of routine by dirty, filthy money, the taking of which in the long run will the district medical officer. This would certainly be a conreact unfavourably on their reputation and usefulness. venient method by which both the shipping authorities and the port sanitary authorities could relieve themselves of their moral and statutory duties. But fortunately there are limitations to the irregular use of the red ticket and we cordially congratulate Mr. Stephenson upon his success.
days, Mr. Stephenson, defined, but
the case the guardians
Annotations. "Ne quid nimis."
SUBSTITUTION THE
USE OF THE RED TICKET IN IRELAND.
ALTHOUGH we have from time to time to call attentio: in THE LANCET to the treatment which is accorded t district medical officers in Ireland by boards of guardian which fail to appreciate at theirjust value the worl of these devoted public servants, it is but rarely tha the defaulting guardian: we are able to record that have had to make amends for their misdeeds beforE of the law. As a rule it is an expensivE a tribunal and uncertain process to invoke the aid of the law and, it is, generally speaking, not in the interests moreover of a medical practitioner to enter the law courts as a plaintiff But on this occasion we are very glad to be able to chronicle the fact that Mr. E. F. Stephenson, who is medical officer of the Woodstown dispensary district near Waterford, has succeeded in obtaining judgment against the Waterford board of guardians for payment of his claim, as also costs on the higher scale. Unfortunately, the account of the proceedings which has reached us is not as complete as we could wish but generally the salient features appear to be somewhat as follows. A vessel came into Warerford harbour from Rosario in South America and on arrival in the harbour a member of the crew was found ta be suffering from small-pox. The case was duly reported to the Waterford corporation but it does not seem that that body was prepared to deal with it. However this may be, the medical officer of health apparently decided to have the patient entered as an inmate of the Waterford union workhouse and he was then sent to the isolation hospital which is situated in Mr. Stephenson’s district, the medical officer of health notifying to him that the case had been sent to that institution. Mr. Stephenson thereupon visited the patient but on discovering that it was a ship-borne case suffering from small-pox he wrote to the master of the Waterford union stating the facts and asking to be informed immediately if provision had been made for medical attendance on the case. To this the master replied by wire : ’’ Got no orders. Use your In these circumstances Mr. Stephenson, own discretion." discretion by the light of the humanity common interpreting to all medical men, visited the case, naturally expecting that the guardians would pay him for his attendance, more parti- 1 cularly as the clerk had previously telegraphed to him askingI from what disease the patient was suffering. Subsequently
AGAIN and again in terms in regard to the
columns
RAMPANT.
have written in strong of fraudulent substitution which would seem to respect no trade ; the practice is universal and every word we have written is justified by daily events. We appeal once more for a system of strenuous control over this pernicious practice. Much of that which we eat, drink, or even wear is not what it professes to be and it seems to us that the public are for all practical purposes unprotected. Need further examples be quoted than the following which we have often quoted before ? A mixture of linen and cotton is sold as pure linen, a mixture of wool and cotton is sold as all wool, a mixture of silk and cotton is sold as pure silk, goods bought as pure silk are heavily loaded with mineral matter to give a spurious impression of heaviness, grain spirit is sold as grape spirit )r genuine brandy, the same spirit is sold as malt spirit or " whisky, Indian tea is passed off as China tea, 11 plantation Joffee is sold as real Mocha, and cotton-seed oil is palmed off as genuine olive oil. Again, in jam and marmalade glucose is substituted for cane sugar and glucose is also used in place of malt for making beer. The latest addition o this infamous list is the use of cardboard wickedly andwiched between the leather of the soles of boots offered ?r sale and guaranteed as "solid." A "solid " boot in the rade means an all-leather boot. The very necessity of the rm implies fraud, as does all-malt in the whisky trade. nd there are those in the boot and shoe trade, judging ’om the proceedings in a recent case, who would hold iat boots with "insoles"of cardboard and brown paper ,ight correctly be described as "solid"boots. We are ad that Judge Emden, before whom the case (a civil ;tion be it remarked) was brought, thought differently decided in favour of the plaintiff who sought to cover damages from the defendant for fraudulent mispresentation in regard to the sale of boots. We have ,d the opportunity of inspecting a specimen of the nd of boot which was supplied in answer to the description " solid." On ripping up the outer sole the fraud is at ce brought to view in the shape of strips of cardboard serted between the outer and upper soles. So far no other :ans seems to be available for laying bare the decepn and it is monstrous that such a wicked fraud cannot dealt with as a false description under the Merchandise ,rks Act. A hall-mark is wanted, so to speak, which our
we
increasing practice
1105 shall guarantee a "solid " boot and any misuse of the mark should be met with the severest penalty. Anything more brazen than calling a boot solid when by reason of its cardboard stuffing it would fall to pieces in wet weather is hard to imagine. The case of calling a piece of silk fine heavy silk" which is heavily loaded with mineral matter of a probably injurious kind is not one whit better. A few days ago we had occasion to examine a piece of silk that formed the sleeve of a blouse which set up an acute irritation of the skin. Analysis disclosed that the material was loaded with no less than 40 per cent. of mineral matter consisting, as further examination showed, of the oxides of aluminium and tin, with distinct traces of arsenic. Thus nearly half of the weightiness of this "silk"was due to metallic oxides. Is it wonderful that such a material worn next the skin should set up irritation ? When is the scandal of substitution-which is but a mild word for fraud-in such cases as we have quoted going to be adequately checked by the State ? At present the evil is growing apace; disIf it cussion about it soon subsides and nothing is done. be true that English trade is going to the dogs we think that we can find at least one reason for this decline. To be candid, there is far too much dishonesty about it.
REPORT OF THE GOVERNMENT BACTERIOLOGIST OF HONG-KONG FOR THE YEAR 1902.
The facility with which infection was secured by feeding is also a most important point and one not in accord with some previous work. The chronic character which the disease assumed in some of the animals would serve to explain certain peculiarities noticed in the epidemic spread of plague. Direct infection of man by food can, however, hardly be regarded as frequent and the work of Dr. Thompson goes far to show that the hypothesis of Simond that the parasites of the rat play an important part in the spread of plague is highly probable if not completely proved. As had been noticed at Capetown cats were shown to be susceptible. An epidemic of cholera gave opportunity for the important observation that in the many cases of pregnant women dying from the disease no choleraproducing organism was found in the foetus. Investigations of certain epidemic cattle diseases and the preparation of Haff kine’s vaccine and curative plague serum were also undertaken but the latter had to be given up owing to lack of suitable accommodation. The value of such a year’s work is self-evident and it is to be hoped that the authorities will provide such further facilities as are required to make future work still more important.
IS IT NECESSARY TO FEEL WHETHER THE CORD IS ROUND THE CHILD’S NECK AFTER THE BIRTH OF THE HEAD P
IN almost every text-book of midwifery, whether written JusT at present it is the fashion to seek both commercial for f the use of students or midwives, the attendant is recomand scientific salvation in the methods of every country butmended in a case of normal labour after the birth of the x our own and to echo the cry, Can any good thing come out of t head to feel whether or not the cord is placed round the ( neck. If it be found in this abnormal position then England? It is not easy to trace the grounds for this child’s in the face of such a as that ] he is told to slip it over the child’s head or over the pessimism report now;under consideration, containing as it does a record of much soundshoulders, or if these two manoeuvres be found impracscientific work and valuable additions made to our knowledge ticable to divide it between two ligatures. In the Centralof practical hygiene and sanitation. That similar goodblatt für Gynäkologie of Sept. 19th is a very interesting work comes from all parts of the empire the article byarticle by Professor Schultze in which he throws grave doubts Dr. J. Ashburton Thompson, the chief medical officer of upon the correctness of this teaching. As he points out, the Government of New South Wales, which appears in the dangers of such a position of the cord are threefold. the current issue of THE LANCET, gives proof. Per- There is, first, the danger of the pressure of the cord upon haps in England there is an inherent tendency to belittle the vessels of the neck, producing stoppage of the circulation ourselves and to believe what others say in their own through the child’s brain ; secondly, the danger of the praise, but one cause of the prevailing gloomy view pressure to which the cord is in its turn subjected by the seems to be ignorance of the good work done, an ignorance neck arresting the circulation through the former ; and lastly, due in many cases to the conservative traditions of many the danger of the cord being compressed between the neck of Government departments which leads to the hiding, some- the child and the anterior wall of the pelvis towards the times to the extinction, of their lights under a bushel. In end of the second stage of labour. Naegele was the the Colonial office, however, at any rate this tradition should first writer to call special attention to the last of these be a thing of the past. In addition to the ordinary bacterio- dangers. Veit has recorded 2250 cases of vertex prelogical investigations the care and management of the public sentation, in 442 of which the cord was round the mortuary and of the Government Vaccine Institute are child’s neck. Amongst these latter the foetal mortality was included in the duties of the Government bacteriologist of 1 in 61, and the number of children born asphyxiated was Hong Kong. In the public mortuary no fewer than 2816 1 in 7. In the cases in which the cord was not round bodies were examined in the year and Dr. W. Hunter, the the neck the corresponding numbers were 1 in 92 and bacteriologist, remarks that no institution, given suitable 1 in 25. If, however, we consider the figures for primiparae accommodation, apparatus, and assistance, would afford and multiparse separately we find that amongst the former greater scope for pathological and bacteriological re- when the cord was round the neck the number of children search. Though apparently without suitable accommo- born asphyxiated was three and a half times as great as dation and hampered by the loss by shipwreck of the when it was not and the mortality was almost twice as whole of his original outfit of bacteriological apparatus great, whilst amongst the latter there were no deaths, Dr. Hunter has shown that this is true. Plague investiga- although the number of cases of asphyxia that occurred was tions formed, of course, a most important part of the work four times as great as in cases of normal labour. Since the and between 2000 and 3000 rats were examined weekly. conditions as regards the pressure of the cord on the vessels A most valuable series of experiments was undertaken of the neck and the pressure of the neck in its turn on the in conjunction with Dr. W. J. R. Simpson and forms vessels of the cord would be the same in the two series of part of his report to the Colonial Office on the Causes and cases these figures tend to show that the main danger of this Continuance of Plague in Hong-Kong. By these abnormality is almost entirely due to the compression of the ments it was definitely shown that human plague was cord between the neck of the child and the anterior pelvic municable to a large number of domestic animals and birds, wall. It is obvious that the chances of such compression such as calves, pigs, hens, and ducks, and that, further, the occurring to a dangerous degree are considerably greater in disease from which these animals suffered was infectious. the case of the prolonged second stage in primiparæ than in
expericom-
days, Mr. Stephenson, defined, but
the case the guardians
Annotations. "Ne quid nimis."
SUBSTITUTION THE
USE OF THE RED TICKET IN IRELAND.
ALTHOUGH we have from time to time to call attentio: in THE LANCET to the treatment which is accorded t district medical officers in Ireland by boards of guardian which fail to appreciate at theirjust value the worl of these devoted public servants, it is but rarely tha the defaulting guardian: we are able to record that have had to make amends for their misdeeds beforE of the law. As a rule it is an expensivE a tribunal and uncertain process to invoke the aid of the law and, it is, generally speaking, not in the interests moreover of a medical practitioner to enter the law courts as a plaintiff But on this occasion we are very glad to be able to chronicle the fact that Mr. E. F. Stephenson, who is medical officer of the Woodstown dispensary district near Waterford, has succeeded in obtaining judgment against the Waterford board of guardians for payment of his claim, as also costs on the higher scale. Unfortunately, the account of the proceedings which has reached us is not as complete as we could wish but generally the salient features appear to be somewhat as follows. A vessel came into Warerford harbour from Rosario in South America and on arrival in the harbour a member of the crew was found ta be suffering from small-pox. The case was duly reported to the Waterford corporation but it does not seem that that body was prepared to deal with it. However this may be, the medical officer of health apparently decided to have the patient entered as an inmate of the Waterford union workhouse and he was then sent to the isolation hospital which is situated in Mr. Stephenson’s district, the medical officer of health notifying to him that the case had been sent to that institution. Mr. Stephenson thereupon visited the patient but on discovering that it was a ship-borne case suffering from small-pox he wrote to the master of the Waterford union stating the facts and asking to be informed immediately if provision had been made for medical attendance on the case. To this the master replied by wire : ’’ Got no orders. Use your In these circumstances Mr. Stephenson, own discretion." discretion by the light of the humanity common interpreting to all medical men, visited the case, naturally expecting that the guardians would pay him for his attendance, more parti- 1 cularly as the clerk had previously telegraphed to him askingI from what disease the patient was suffering. Subsequently
AGAIN and again in terms in regard to the
columns
RAMPANT.
have written in strong of fraudulent substitution which would seem to respect no trade ; the practice is universal and every word we have written is justified by daily events. We appeal once more for a system of strenuous control over this pernicious practice. Much of that which we eat, drink, or even wear is not what it professes to be and it seems to us that the public are for all practical purposes unprotected. Need further examples be quoted than the following which we have often quoted before ? A mixture of linen and cotton is sold as pure linen, a mixture of wool and cotton is sold as all wool, a mixture of silk and cotton is sold as pure silk, goods bought as pure silk are heavily loaded with mineral matter to give a spurious impression of heaviness, grain spirit is sold as grape spirit )r genuine brandy, the same spirit is sold as malt spirit or " whisky, Indian tea is passed off as China tea, 11 plantation Joffee is sold as real Mocha, and cotton-seed oil is palmed off as genuine olive oil. Again, in jam and marmalade glucose is substituted for cane sugar and glucose is also used in place of malt for making beer. The latest addition o this infamous list is the use of cardboard wickedly andwiched between the leather of the soles of boots offered ?r sale and guaranteed as "solid." A "solid " boot in the rade means an all-leather boot. The very necessity of the rm implies fraud, as does all-malt in the whisky trade. nd there are those in the boot and shoe trade, judging ’om the proceedings in a recent case, who would hold iat boots with "insoles"of cardboard and brown paper ,ight correctly be described as "solid"boots. We are ad that Judge Emden, before whom the case (a civil ;tion be it remarked) was brought, thought differently decided in favour of the plaintiff who sought to cover damages from the defendant for fraudulent mispresentation in regard to the sale of boots. We have ,d the opportunity of inspecting a specimen of the nd of boot which was supplied in answer to the description " solid." On ripping up the outer sole the fraud is at ce brought to view in the shape of strips of cardboard serted between the outer and upper soles. So far no other :ans seems to be available for laying bare the decepn and it is monstrous that such a wicked fraud cannot dealt with as a false description under the Merchandise ,rks Act. A hall-mark is wanted, so to speak, which our
we
increasing practice
1105 shall guarantee a "solid " boot and any misuse of the mark should be met with the severest penalty. Anything more brazen than calling a boot solid when by reason of its cardboard stuffing it would fall to pieces in wet weather is hard to imagine. The case of calling a piece of silk fine heavy silk" which is heavily loaded with mineral matter of a probably injurious kind is not one whit better. A few days ago we had occasion to examine a piece of silk that formed the sleeve of a blouse which set up an acute irritation of the skin. Analysis disclosed that the material was loaded with no less than 40 per cent. of mineral matter consisting, as further examination showed, of the oxides of aluminium and tin, with distinct traces of arsenic. Thus nearly half of the weightiness of this "silk"was due to metallic oxides. Is it wonderful that such a material worn next the skin should set up irritation ? When is the scandal of substitution-which is but a mild word for fraud-in such cases as we have quoted going to be adequately checked by the State ? At present the evil is growing apace; disIf it cussion about it soon subsides and nothing is done. be true that English trade is going to the dogs we think that we can find at least one reason for this decline. To be candid, there is far too much dishonesty about it.
REPORT OF THE GOVERNMENT BACTERIOLOGIST OF HONG-KONG FOR THE YEAR 1902.
The facility with which infection was secured by feeding is also a most important point and one not in accord with some previous work. The chronic character which the disease assumed in some of the animals would serve to explain certain peculiarities noticed in the epidemic spread of plague. Direct infection of man by food can, however, hardly be regarded as frequent and the work of Dr. Thompson goes far to show that the hypothesis of Simond that the parasites of the rat play an important part in the spread of plague is highly probable if not completely proved. As had been noticed at Capetown cats were shown to be susceptible. An epidemic of cholera gave opportunity for the important observation that in the many cases of pregnant women dying from the disease no choleraproducing organism was found in the foetus. Investigations of certain epidemic cattle diseases and the preparation of Haff kine’s vaccine and curative plague serum were also undertaken but the latter had to be given up owing to lack of suitable accommodation. The value of such a year’s work is self-evident and it is to be hoped that the authorities will provide such further facilities as are required to make future work still more important.
IS IT NECESSARY TO FEEL WHETHER THE CORD IS ROUND THE CHILD’S NECK AFTER THE BIRTH OF THE HEAD P
IN almost every text-book of midwifery, whether written JusT at present it is the fashion to seek both commercial for f the use of students or midwives, the attendant is recomand scientific salvation in the methods of every country butmended in a case of normal labour after the birth of the x our own and to echo the cry, Can any good thing come out of t head to feel whether or not the cord is placed round the ( neck. If it be found in this abnormal position then England? It is not easy to trace the grounds for this child’s in the face of such a as that ] he is told to slip it over the child’s head or over the pessimism report now;under consideration, containing as it does a record of much soundshoulders, or if these two manoeuvres be found impracscientific work and valuable additions made to our knowledge ticable to divide it between two ligatures. In the Centralof practical hygiene and sanitation. That similar goodblatt für Gynäkologie of Sept. 19th is a very interesting work comes from all parts of the empire the article byarticle by Professor Schultze in which he throws grave doubts Dr. J. Ashburton Thompson, the chief medical officer of upon the correctness of this teaching. As he points out, the Government of New South Wales, which appears in the dangers of such a position of the cord are threefold. the current issue of THE LANCET, gives proof. Per- There is, first, the danger of the pressure of the cord upon haps in England there is an inherent tendency to belittle the vessels of the neck, producing stoppage of the circulation ourselves and to believe what others say in their own through the child’s brain ; secondly, the danger of the praise, but one cause of the prevailing gloomy view pressure to which the cord is in its turn subjected by the seems to be ignorance of the good work done, an ignorance neck arresting the circulation through the former ; and lastly, due in many cases to the conservative traditions of many the danger of the cord being compressed between the neck of Government departments which leads to the hiding, some- the child and the anterior wall of the pelvis towards the times to the extinction, of their lights under a bushel. In end of the second stage of labour. Naegele was the the Colonial office, however, at any rate this tradition should first writer to call special attention to the last of these be a thing of the past. In addition to the ordinary bacterio- dangers. Veit has recorded 2250 cases of vertex prelogical investigations the care and management of the public sentation, in 442 of which the cord was round the mortuary and of the Government Vaccine Institute are child’s neck. Amongst these latter the foetal mortality was included in the duties of the Government bacteriologist of 1 in 61, and the number of children born asphyxiated was Hong Kong. In the public mortuary no fewer than 2816 1 in 7. In the cases in which the cord was not round bodies were examined in the year and Dr. W. Hunter, the the neck the corresponding numbers were 1 in 92 and bacteriologist, remarks that no institution, given suitable 1 in 25. If, however, we consider the figures for primiparae accommodation, apparatus, and assistance, would afford and multiparse separately we find that amongst the former greater scope for pathological and bacteriological re- when the cord was round the neck the number of children search. Though apparently without suitable accommo- born asphyxiated was three and a half times as great as dation and hampered by the loss by shipwreck of the when it was not and the mortality was almost twice as whole of his original outfit of bacteriological apparatus great, whilst amongst the latter there were no deaths, Dr. Hunter has shown that this is true. Plague investiga- although the number of cases of asphyxia that occurred was tions formed, of course, a most important part of the work four times as great as in cases of normal labour. Since the and between 2000 and 3000 rats were examined weekly. conditions as regards the pressure of the cord on the vessels A most valuable series of experiments was undertaken of the neck and the pressure of the neck in its turn on the in conjunction with Dr. W. J. R. Simpson and forms vessels of the cord would be the same in the two series of part of his report to the Colonial Office on the Causes and cases these figures tend to show that the main danger of this Continuance of Plague in Hong-Kong. By these abnormality is almost entirely due to the compression of the ments it was definitely shown that human plague was cord between the neck of the child and the anterior pelvic municable to a large number of domestic animals and birds, wall. It is obvious that the chances of such compression such as calves, pigs, hens, and ducks, and that, further, the occurring to a dangerous degree are considerably greater in disease from which these animals suffered was infectious. the case of the prolonged second stage in primiparæ than in
expericom-