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THE COUNTY INFIRMARIES OF IRELAND.
163 In the third edition of " A System of Practical Surgery," by William Fergusson, F.R.S., published in 1852, speaking of erysipelas, he says on page 117: I have myself little faith in those (local measures) which are said by some to check the progress of the disease in a sudden, specific, and mysterious manner, such as the free use of nitrate of silver-a practice first inculcated by Mr. Higginbottom of Nottingham-applied either on the inflamed surface, by way of dispelling the affecbion at once, or in the vicinity, to check its progress and prevent its extending further on the surface than the line marked out by the caustic." Again, in Billroth’s "Surgery," New Sydenham Society’s Series, published in 1878, we read on page 15, vol. ii.: " As regards local treatment, a variety of measures has been adopted in order to stay the spread of the erysipelatous inflammation, and to bring it to a standstill. For this purpose the margin has been painted with a solution 11
of nitrate of silver. or with a strong solution of iodine." Here we have Dr. Woodhead’s own remedy mentioned, and that, too, in a way that would lead us to think it was an old-nay, a decrepit-remedy ; for later on Billroth says: "According to my own experience, this is of no avail, so that latterly I have quite left off the practice." Mr. Erichsen, in his seventh edition of the " Science and Art of Surgery," vol. i., page 698, says: "A boundary line of nitrate of silver is occasionally drawn round the inflamed part with a view of checking the extension of the disease. I have often done this and seen it done by others, but never apparently with any benefit; and have now discontinued it as a useless source of irritation." So Mr. Erichsen speaks, too, in 1877, as though this treatment was as ancient, shall I say, as it was useless. Painting a ring with either nitrate of silver, tincture of iodine, or liquor ferri perchloridi fortior (B. P.) beyond the margin of the area of inflammation in cases of erysipelas was frequently mentioned as one of the suggested methods of treatment, both in lectures and at the bedside, in Dublin ; and I remember the late Dr. Thomas Evelyn Little, whose opinion on matters surgical was greatly valued then, spoke highly of the use of nitrate of silver in this way, but the general impression was that the treatment was useless. It was my recollection of this procedure being spoken of as very antiquated indeed that caused me to look the matter up, when I saw it, to my surprise, set forth as a boon from the bacteriologists. It is a curious example of the truth of the saying, "There is nothing new under the sun," and if it is such a wonderful remedy as Dr. Alex. Miles’ results will doubtless (when they are published) lead us to suppose, it should make us have more respect for an empiricism that can find and lay aside as useless a mode of treatment which science disinters only after a lapse of sixty-three years, and then fondly imagines it has originated. In conclusion, I trust Dr. Alex. Miles’ experience with his iodine will be more hopeful than was that of Fergusson, Billroth, and Erichsen with it or nitrate of silver. Mayhap the leucocytes have so benefited by the strides of science during the pa9t sixty-three years that, knowing now what is expected of them, Dr. Alex. Miles’ iodine will act upon them as a red rag is said to act unon a bull. I am. Sirs. vours faithfullv. LEONARD G. S. MOLLOY, B.A., M.D. Univ. Dub.
cause a searching inquiry to be held into the working of the Poor-law system with a view to its, entire abolition, or such changes in it as would be more in accordance with the wishes of the people." In the course of my address in support of this resolution, I gave a brief outline of an alternative system, an idea of which may be gathered from the subsequent portion of this letter. Though the guardians neglected this resolution without adducing a single reason or argument against it, yet when I subsequently got the remarks I ventured to make in support of my resolution printed in pamphlet form, and sent a copy to most of the principal papers in the United Kingdom. representing every shade of politics, every one of the papers I had an opportunity of seeing devoted leading; articles to the subject, and criticised my remarks most favourably, and all were agreed that the Poor-law system at present in vogue demanded reformation. In the course of my address I pointed out that the poorin our workhouses might be divided into three classes;. the lunatics I’ did not include, as they should be sent to the asylums proper. In the first class I placed the. sick infirm-by infirm I meant those incapacitated by old age-and children under three years. For these I proposed that"Cottage Hospitals " or "Homes for the Sick and: Informshould be established. In the second class I included children over three years and under thirteen years of age. These I suggested should be kept out at nurse, as atpresent. The third class embraced the casuals and ablebodied paupers. The relief of casuals I considered should be placed under police control, as they could better discriminate the dishonest, scheming, or idle but able-bodied’ paupers, and be in a position to detect criminals. My rule for them, I pointed out, would be " work or bread-andwater.’’ The police could have tickets for lodgings and tickets for food, for which, on being presented to thelodging-house keepers, equivalents by the way of lodging and food would be given. These tickets could be purchased by charitably disposed persons and given away, but in each case the recipient would be required to present himself at the barracks to have the ticket stamped by the constabulary. For the others of this class I suggested we should do as the Americans do-viz,, appoint work masters or superintendents of labour. Their duties would be more comprehensive than those of our relieving; officers; they could keep registry offices for the unemployed and employers of labour. should have power to afford provisional relief to those in distress or difficulty, or afford’ loans recoverable by an easy process at law. All this to be under the control of a small elected committee. Such is a brief outline of the system I suggested. Now if such a system as the foregoing were adopted, those embraced in my first class—viz , the sick and infirm, as well as those treated in county infirmaries-could be housed in the "cottage hospitals"or "homes for the sick and infirm."Having pay wards attached to them, this would do away with the objections which those who are able and willing to pay have to enter the hospitals connected with the present workhouse. In any case I can see no reason for the coexistence of county infirmaries and workhouse hospitals. The voice of the people must be attended to, and the Poor-law system is bound to be reformed. With that reformation will, I hope, come the solution of the present difficulty in connexion with the county infirmaries.
Government "to
They
nf Ireland—I
a.m.
Sirs.
To the Editors of THE LANCET. SIRS,—I notice that a short time ago a deputation from the surgeons of county infirmaries in Ireland waited upon the Chief Secretary for the purpose of reminding him of the necessity of providing in the coming Irish Local Government Bill some sort of protection for these institutions against the anticipated determination of the popular party (who will form the chief power in the projected County Councils) to disestablish and disendow the infirmaries. With the administration of these hospitals I have nothing for the present to do; but it seems to me an opportune time to point out that provision should be made in the coming Bill for the amalgamation of county infirmaries and the workhouse hospitals, for once we get an Irish Local Government Bill the fate of the hated workhouse is sure to be sealed. The provision I would point out as being amongst those which any future Bill should contain would be such as I pointed out to the Lurgan Board of Gaardians in January, 1888, when I brought forward a resolution calling upon the
vnnra
faithfully
E. MAGENNIS, M.D., D.P.H.,
THE COUNTY INFIRMARIES OF IRELAND.
J.P.
THE DUKES AND CARPENTER FUND. To the Editors
of THE LANCET.
pleased to see the action of the CroydoD Medical Reading Society in coming forward so promptly and generously to the rescue of their unfortunate brethren, Drs. SIRS,—I
Dukes and
am
Carpenter,
who have
innocently fallen
into the
pit prepared for them by the anomalies of the Lunacy Act.
In some of its clauses for the extreme protection of the poor lunatic the red-tapeisin of the Act borders on the ridiculous. Take, for instance, the written statement to be handed to the patient, signifying his right to be taken before ajudicial authority. Wliat au opportunity for a high flown, imperions patient to excite himself and worry his attendants ! While every effort is made to afford the lunatic protection, and to satisfy the suspicious public who are so jealous of the liberty of the individual, the safety, the dignity, and the convenience of the general practitioner are ignored or deemed
of nitrate of silver. or with a strong solution of iodine." Here we have Dr. Woodhead’s own remedy mentioned, and that, too, in a way that would lead us to think it was an old-nay, a decrepit-remedy ; for later on Billroth says: "According to my own experience, this is of no avail, so that latterly I have quite left off the practice." Mr. Erichsen, in his seventh edition of the " Science and Art of Surgery," vol. i., page 698, says: "A boundary line of nitrate of silver is occasionally drawn round the inflamed part with a view of checking the extension of the disease. I have often done this and seen it done by others, but never apparently with any benefit; and have now discontinued it as a useless source of irritation." So Mr. Erichsen speaks, too, in 1877, as though this treatment was as ancient, shall I say, as it was useless. Painting a ring with either nitrate of silver, tincture of iodine, or liquor ferri perchloridi fortior (B. P.) beyond the margin of the area of inflammation in cases of erysipelas was frequently mentioned as one of the suggested methods of treatment, both in lectures and at the bedside, in Dublin ; and I remember the late Dr. Thomas Evelyn Little, whose opinion on matters surgical was greatly valued then, spoke highly of the use of nitrate of silver in this way, but the general impression was that the treatment was useless. It was my recollection of this procedure being spoken of as very antiquated indeed that caused me to look the matter up, when I saw it, to my surprise, set forth as a boon from the bacteriologists. It is a curious example of the truth of the saying, "There is nothing new under the sun," and if it is such a wonderful remedy as Dr. Alex. Miles’ results will doubtless (when they are published) lead us to suppose, it should make us have more respect for an empiricism that can find and lay aside as useless a mode of treatment which science disinters only after a lapse of sixty-three years, and then fondly imagines it has originated. In conclusion, I trust Dr. Alex. Miles’ experience with his iodine will be more hopeful than was that of Fergusson, Billroth, and Erichsen with it or nitrate of silver. Mayhap the leucocytes have so benefited by the strides of science during the pa9t sixty-three years that, knowing now what is expected of them, Dr. Alex. Miles’ iodine will act upon them as a red rag is said to act unon a bull. I am. Sirs. vours faithfullv. LEONARD G. S. MOLLOY, B.A., M.D. Univ. Dub.
cause a searching inquiry to be held into the working of the Poor-law system with a view to its, entire abolition, or such changes in it as would be more in accordance with the wishes of the people." In the course of my address in support of this resolution, I gave a brief outline of an alternative system, an idea of which may be gathered from the subsequent portion of this letter. Though the guardians neglected this resolution without adducing a single reason or argument against it, yet when I subsequently got the remarks I ventured to make in support of my resolution printed in pamphlet form, and sent a copy to most of the principal papers in the United Kingdom. representing every shade of politics, every one of the papers I had an opportunity of seeing devoted leading; articles to the subject, and criticised my remarks most favourably, and all were agreed that the Poor-law system at present in vogue demanded reformation. In the course of my address I pointed out that the poorin our workhouses might be divided into three classes;. the lunatics I’ did not include, as they should be sent to the asylums proper. In the first class I placed the. sick infirm-by infirm I meant those incapacitated by old age-and children under three years. For these I proposed that"Cottage Hospitals " or "Homes for the Sick and: Informshould be established. In the second class I included children over three years and under thirteen years of age. These I suggested should be kept out at nurse, as atpresent. The third class embraced the casuals and ablebodied paupers. The relief of casuals I considered should be placed under police control, as they could better discriminate the dishonest, scheming, or idle but able-bodied’ paupers, and be in a position to detect criminals. My rule for them, I pointed out, would be " work or bread-andwater.’’ The police could have tickets for lodgings and tickets for food, for which, on being presented to thelodging-house keepers, equivalents by the way of lodging and food would be given. These tickets could be purchased by charitably disposed persons and given away, but in each case the recipient would be required to present himself at the barracks to have the ticket stamped by the constabulary. For the others of this class I suggested we should do as the Americans do-viz,, appoint work masters or superintendents of labour. Their duties would be more comprehensive than those of our relieving; officers; they could keep registry offices for the unemployed and employers of labour. should have power to afford provisional relief to those in distress or difficulty, or afford’ loans recoverable by an easy process at law. All this to be under the control of a small elected committee. Such is a brief outline of the system I suggested. Now if such a system as the foregoing were adopted, those embraced in my first class—viz , the sick and infirm, as well as those treated in county infirmaries-could be housed in the "cottage hospitals"or "homes for the sick and infirm."Having pay wards attached to them, this would do away with the objections which those who are able and willing to pay have to enter the hospitals connected with the present workhouse. In any case I can see no reason for the coexistence of county infirmaries and workhouse hospitals. The voice of the people must be attended to, and the Poor-law system is bound to be reformed. With that reformation will, I hope, come the solution of the present difficulty in connexion with the county infirmaries.
Government "to
They
nf Ireland—I
a.m.
Sirs.
To the Editors of THE LANCET. SIRS,—I notice that a short time ago a deputation from the surgeons of county infirmaries in Ireland waited upon the Chief Secretary for the purpose of reminding him of the necessity of providing in the coming Irish Local Government Bill some sort of protection for these institutions against the anticipated determination of the popular party (who will form the chief power in the projected County Councils) to disestablish and disendow the infirmaries. With the administration of these hospitals I have nothing for the present to do; but it seems to me an opportune time to point out that provision should be made in the coming Bill for the amalgamation of county infirmaries and the workhouse hospitals, for once we get an Irish Local Government Bill the fate of the hated workhouse is sure to be sealed. The provision I would point out as being amongst those which any future Bill should contain would be such as I pointed out to the Lurgan Board of Gaardians in January, 1888, when I brought forward a resolution calling upon the
vnnra
faithfully
E. MAGENNIS, M.D., D.P.H.,
THE COUNTY INFIRMARIES OF IRELAND.
J.P.
THE DUKES AND CARPENTER FUND. To the Editors
of THE LANCET.
pleased to see the action of the CroydoD Medical Reading Society in coming forward so promptly and generously to the rescue of their unfortunate brethren, Drs. SIRS,—I
Dukes and
am
Carpenter,
who have
innocently fallen
into the
pit prepared for them by the anomalies of the Lunacy Act.
In some of its clauses for the extreme protection of the poor lunatic the red-tapeisin of the Act borders on the ridiculous. Take, for instance, the written statement to be handed to the patient, signifying his right to be taken before ajudicial authority. Wliat au opportunity for a high flown, imperions patient to excite himself and worry his attendants ! While every effort is made to afford the lunatic protection, and to satisfy the suspicious public who are so jealous of the liberty of the individual, the safety, the dignity, and the convenience of the general practitioner are ignored or deemed