AMPUTATION WITHOUT PERMISSION. than defeated, and a new and more insidious evil arises. is important, further, in illustrating the readier soluof in w...

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AMPUTATION WITHOUT PERMISSION. than defeated, and a new and more insidious evil arises. is important, further, in illustrating the readier soluof in water containing organic matter, such as lead bility leaves. Whatever the solvent action may be due decaying to-whether an organic acid or the carbonic acid evolved during the disintegration of the leaves,-it is evident that the adoption of non-metallic cisterns in the place of lead or zinc gives no security against the possibility of metallic poisoning unless lead or similar metallic compounds used for making the joints tight are also rigorously excluded. The conditions giving rise to the source of mischief just indicated may so easily occur that it would be well if an inspection of non-metallic cisterns could be made with the view of discovering whether an has been used. The preclusion of objectionable "stopping" " must be insisted upon. The whole case such " stoppings obviously afEords another argument in favour of the abolition of cisterns and the adoption of a direct supply.

was impressed by Mr. Spear, is Mr. Murphy and Dr. Hamer. In an appendix to Dr. Hamer’s report there is a table giving particulars of 118 cases known to have occurred in London since 1873, and it is noteworthy that a large proportion of these, especially in the earlier years, were treated at Guy’s Hospital. Of the whole number, 90 were in persons engaged in the hide and skin trade, 5 in persons engaged in slaughtering animals, 7 in persons engaged in the manipulation of horsehair or the manufacture of brushes, one was employed at a bacteriological laboratory, whilst in 15 instances the source of infection was not traceable. The growing diminution of the disease in the tanyards is shown in the fact that of 37 cases mentioned by Mr. Spear (years 1873-1883) 12 were in tanners ; whilst of 53 cases noted by Dr. Hamer (1883-1893) only 3 were in tanners. Each series shows, moreover, a preponderance amongst those persons engaged in manipulating hides before their removal from the brokers. "In almost all the cases the hides incriminated have been dry hides," and it is probable, in the two instances in which infection may have been through wet hides, that it was not really so, as the workers who were attacked may also have been in contact with dry hides. Another reason for the decreasing number of cases from the Bermondsey tanyards is to be found in the diminution in the number of these tanyards of late years and also in the tendency to deal more and more exclusively with English hides. Finally, the fact that in the trade wet hides are replacing dry hides encourages the hope that there will be a diminution of infection-a result which would be even more certainly secured could the hides be subjected to disinfection before export. The importance of early intervention in treatment by excision of the malignant pustule is also urged as a strong reason for educating the workpeople in the nature of the risks run in their trade and in the recognition of the signs of infection.

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A LAWSUIT lately took place in Germany in which the father of a girl aged seven years charged a hospital surgeon with assault-to wit, I I wounding with a dangerous instrument." The patient was under treatment for tuberculous disease of the foot. Conservative methods of treatment having failed amputation was advised, but the father refused to give his permission. From a report in a contemporary it appears that the parent proceeded to the institution with the purpose of taking his daughter away, but when he arrived she was under the influence of an anaesthetic which had been administered with a view of amputating the foot. The surgeon in charge, on being apprised of the purport of the father’s visit, is said to have remarked, " It is too late, " and proceeded to amputate. There can be no doubt, if he was aware of the father’s objection to the operation, the course he took was wrong both on legal and ethical grounds. Where a mutilating operation is necessary to ward off impending peril of death, it would be absurd to have to THE BRIGHTON SANITARY COMMITTEE. wait for permission to resort to it, but in the case under conTHE sanitary committee of the important borough of sideration no such circumstance can well have arisen. Thei has recently presented to the ratepayers of the Brighton liberty and rights of the subject cannot be allowed to be’ town and to the public generally a spectacle which is far overridden. Nevertheless, there may be much to extenuatefrom elevating. There has, it appears, been a very serious the offence, and we cannot imagine greater mitigation than difference of opinion among the members of this committee where there is conflict between a surgeon’s judgment and as to the procedure to be adopted in reference to some meat a parent’s feelings. The surgeon in question was acquitted, which had been condemned by their able medical officer of but it is said the cause is to be re-tried. Dr. Newsholme. The meat was seized and ordered


be destroyed, but the town clerk refused to prosecute the owners of the meat without the sanction of A REPORT on the subject of the prevalence of anthrax, the sanitary committee. When, however, this body was especially in the Bermondsey tanyards and in connexion withconsulted they declined to take proceedings, and on reference the foreign hides trade, was recently made to the LondonL to the town council their attitude was supported in canterd, County Council by the medical officer, Mr. Shirley Murphy. by 22 votes to 18. From the reports that have reached It is based on an inquiry instituted by Dr. Hamer, theus we learn that five members of committee have resigned One member in referring to his resignation assistant medical officer, which is of no small interest andtheir seats. in to the action of the committee, that reference Dr. Hamer’s that constates, inquiry supplements importance. I felt bound to refuse "to further share the responsiducted by the late Mr. Spear of the Local Government Boardhe I, in 1883. Although more cases have been recorded in London bilities of their neglect." Another member is of opinion since that time than before it, yet that there has been anL ’, that "a certain interest is too strongly represented on the actual increase is more than doubtful, the fact being that ; committee," and another that the decision in regard to a anthrax is more readily recognised ; indeed, since the date I prosecution should not have been brought before them, since "it was exceedingly hard to compel them to sit in of Mr. Spear’s report there has been only one case of on one of their own committee." The gentleman the most in London. valuable judgment anthrax reported Perhaps point in the whole report is the demonstration of Dr. Hamer of just referred to further mentioned in a letter to the public the decrease in cases in the tanyards owing to the growth of announcing his resignation that in regard to the more recent the practice of employing wet hides instead of dry hides, the proceedings of the council "it was with great difficulty that latter being far more prone to carry infection. On the other personal violence was prevented." The whole affair is, we hand, the disease is just as prevalent amongst the sorters must confess, most deplorable, and if visitors to Brighton and labourers in the hide-brokers’ warehouses, where dry are to be dependent on the administration of a sanitary foreign hides are manipulated. The need for the dissemina- committee such as this we can well understand their having tion amongst the workmtn of the knowledge of the risks certain misgivings as to their food-supply and the sanitary

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condition of the houses in which they temporarily reside. infant mortality was far wider ; the rate did not exceed 102 If the opinion of the sanitary committee is to override that per 1000 in Hampstead and 128 in Lewisham, while it ranged of the medical officer of health on a matter such as the upwards to 202 in Clerkenwell, 205 in Limehouse, 206 in St. detection of tubercle, or proper proceedings are not to follow George Southwark, 209 in St. George-in-the-East, 214 in the exposure of diseased meat for sale, then the sooner this Holborn, and 219 in Strand sanitary area. Although infant sanitary committee is replaced by another of higher aims the mortality may be more directly governed by maternal care better for the health of the inhabitants of Brighton. We and attention than by what is generally understood as sanitary take it, however, that the remedy is in the hands of the condition, it is well to bear in mind that as a general rule ratepayers themselves. Meanwhile we trust the rest of the infant mortality-that is, the rate of mortality under one committee, and, indeed, the town council as a whole, will year of age-bears a constant relation to the death-rate at not resign, but will, by their presence, aid in effecting a all ages, which few now venture to disregard as evidence of reformation. sanitary condition. There are, however, some strange anomalies in the Metropolitan rates of infant mortality which call for investigation. It is not by any means clear why in THE ANTHROPOMETRIC MEASUREMENT OF CRIMINALS. West London, where the death-rate from all causes is so disWE are glad to learn that Dr. John G. Garson, who for a tinctly below that in the rest of. London, the rate of infant should materially exceed that which prevails in the long period assisted Sir William Flower as Conservator of mortality the Anatomical Museum of the Royal College of Surgeons of north and south groups of districts ; or why the death-rate of in Fulham should considerably exceed the mean rate England, has been appointed by the Home Secretary the first infants in the whole of London. We commend the subject of infant for the measurement superintendent of the Bertillon method of criminals, the introduction of which into this country wasmortality in London and its wide variations to the notice of decided upon as the result of a report made to the Homethe medical officer of the London County Council. Office by a very competent Committee early this year. The duties attached to the post of scientific adviser to and THE USE OF THE WORD "VETERINARY." superintendent of the new Anthropometric Office will include THE Times reports that at the North London Policethe instruction of the prison warders in the details of court, Frederick Browning, a farrier, of Howard-street, at first it would sight practical anthropometry. Although South Hornsey, was charged with acting as a veterinary seem to be an easy task to take accurate measurements of without the necessary qualification, under Section 17 certain skull diameters and bone lengths with properly con- surgeon of the Veterinary Surgeons Act, which sets forth that no trived mechanical assistance, as a matter of fact-and this who was not a member of the college, or who was was proved by the evidence taken before the Committee person not registered as a practitioner, or holder of the veterinary the possible sources of error are numerous ; and we pointed certificate of the Highland Agricultural Society of Scotland out when the report of those proceedings was published, and at the time of passing the Act, should be allowed to practise with special reference to Professor Arthur Thomson’s inter- I as a The defendant did not call himself esting remarks, that for the effective use of "Bertillonage" a veterinary surgeon.but he veterinary surgeon, put on his sign "Veterinary much practice and skill in anthropometry would be on the judgment of Justices Hawkins Forge." Relying demanded from the warders. They could not be in better and Williams, Mr. G. Fletcher argued that this was a hands to this end than in those of Dr. Garson. pretence of special veterinary knowledge. Mr. C. V. Young, in the face of that judgment, made no attempt to defend. INFANT MORTALITY IN LONDON—1893. The defendant was let off with a fine of 20s. (though liable to ONE of the most unsatisfactory features of English mor-one of 20), and 23s. costs. It is said that there are twenty tality statistics, taken as evidence of sanitary condition, isother farriers who employ some such title as "Veterinary the comparatively slow rate of decrease of infant mortality.Forge." There are materials here for consideration by the The death-rate at all ages in England and Wales in the tenexecutive committee of the General Medical Council in years 1881-90 was 15 per cent. below the rate in the tenreporting on the proposed amendment of the Medical Act. I years 1861-70-that is, before the passing of the PublicThe fortieth clause must be so amended as to cover any Health Acts of 1872 and 1875. The decrease in the death- words that mislead the public, though falling short of an rate of infants under one year of age in the same period actual false title. It cannot be permitted that Acts framed did not, however, exceed 8 per cent., although it is with the object of protecting the public from deception in the first year of life that the excess of mortality should be more explicit in the case of horses than in that of If we man. due to distinctly preventable causes is largest. look at the London figures we find that while the mean rate of mortality at all ages declined 16 per cent. in the THE METROPOLITAN ASYLUMS BOARD AND twenty years above referred to, the decline in the rate of CONTAGION. mortality among infants did not exceed 6 per cent. It is is axiom in IT an sanitation that no means should be left also disappointing to find that in the first three years of the which are even likely to prevent the spread of current decennium, 1891-93, the mean rate of infant unemployed infectious disease. The principle involved, as we showed in mortality considerably exceeded the mean rate in the a recent article,l enjoyed an established reputation long ten years 1881-90, both in England and Wales and in before the birth of the present generation. It is when we London. This result was in great measure due to the fact come to practice that difficulties appear, and with them that in recent summers, but especially in 1893, the arises a strong inclination to compromise matters with conmean temperature was considerably above the average. venience. Those of us who, coming much into contact with The proportion of deaths under one year of age in the routine usages of household life, are the more open to London to registered births was last year equal to this form of temptation may learn something from the 164 per 1000, and exceeded the rate in any year wholesome, if rather excessive, orthodoxy exhibited in a since 1874, when it was the same. The rate of infant recent resolution passed by the Metropolitan Asylums mortality last year ranged in the five groups of registra- Board. This decision is intended to exclude any workmen tion districts from 158 per 1000 in the north, to 175 in the other than permanent hospital servants from such occasional east, and 181 in the central group of districts. In the 41 1 THE LANCET, July 7th, 1894. metropolitan sanitary areas, however, the range of rates of ____