- Email: [email protected]
THE FEES OF OUR ANCESTORS.
.159 and have kept good for months
years, sometimes suddenly become blown and unfit for use. This occurrence could hardly be due to injury of the tin through rust, or even
and his
College
in
good
congratulations. THE
.as, if so, the gas
stead.
We offer him
our
best
-
ANNUAL
MEETING
OF
THE
BRITISH
produced by putrefaction, consequent on MEDICAL ASSOCIATION. entrance of air organisms, would find its way out and no THE seventy-seventh annual meeting of the British Medical blowing would result. Major BEVERIDGE, and with him will be held at Belfast on July 23rd, 24th, 26th, Association .Captain FAWCUS, have found that an organism may be and 30th next, under the presidency of Sir 28th, 27tb, 29th, present in the meat at packing, may not be destroyed William Whitla, Professor of Materia Medica and Therapeutics, ’by the so-called sterilisation, may remain inert for long in the University of Belfast. Fifteen scientific sections periods if the tins are stored at a low temperature, and have been arranged and will meet daily from Wednesday to ’finally, may develop if the temperature reaches 37° C., or Friday in the Queen’s College at 10 A.M.—viz., Anatomy and thereabouts. This bacillus is non-pathogenic to animals, but Physiology, Dermatology and Electro-Therapeutics, Hasmatology and Vaccine Therapy, Diseases of Children, Navy, - decomposes the meat and renders it unfit for and Ambulance, Hygiene and Public Health, Laryngo.As it does not develop much below the body temperature, Army Otology, and Rhinology, Medicine, Obstetrics and logy, meat might be contaminated by it and yet be kept for months Gynaecology, Ophthalmology, Pathology, Pharmacology without showing signs of decomposition or blowing if stored and Therapeutics, Psychological Medicine, Surgery, and ,in a cool place, neither would the temperature of the warm Tropical Medicine. On Tuesday, at 2.30, Sir William to the presidential chair, and will be inducted Whitla in which for a manufacturers tinned foods room," deposit will same deliver the presidential on the evening ’short time as a testing chamber, be sufficient to cause growth in the Assembly Hall, Belfast. On Wednesday, -of this bacillus. But if taken to a hot climate the whole address at 12.30 P.M., Dr. R. W. Philip will deliver 28th, -consignment might speedily become unfit for use. The July the address in Medicine in the library, Queen’s College. recommendation is accordingly made that the temperature On Thursday, July 29th, at 12.30 P.M., the address in -of the fluid in which canned-meat tins are sterilised Surgery will be delivered in the library, Queen’s College, by should be raised to 120° C. (248° F.), and that this should Mr. A. E. J. Barker. On Friday, July 30th, at 12.30 P.M., Sir ’be kept up for one hour. This is a higher and more John W. Byers will deliver the aaaress in Ubstetrics in the library, Queen’s College. At 8 P.M. a popular lecture ,prolonged sterilisation than is, we believe, usually the I will be delivered by Dr. J. A. Macdonald. As the propractice at present, but in view of the observations grammes throughout promise particularly interesting discusof Major BEVERIDGE and his collaborators appears to sion, owing to the proposed attendance of men of eminence ’us to be It is to learn that justified. satisfactory from foreign countries and various parts of the British ,no boric acid or other preservative was found to be Empire, the success of the meeting from every point of view ,present in any of the tinned-meat samples, though the is assured. nitrates, derived from the pickling fluid, were sometimes
consumption.
T
in
1
TTT
Tt_--_.
__.!1’
.:1_1!__-
l- -
_.:J..J_-_.....
!_-
W__t_u__3__
.!_-
THE FEES OF OUR ANCESTORS.
excess.
Annotations. "Ne quid nimis."
THE NEW PRESIDENT OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND. Mr. Henry Trentham Butlin was elected unanimously President of the Royal College of Surgeons of England at the meeting of the Council held on Thursday, July 8th, at ’the College. This event was generally anticipated, for Mr. Butlin’s claims upon the titular leadership of his branch of the profession in this country are very strong. He is well known at home and abroad as an operating surgeon and pathologist. He has held almost every possible post in connexion with his College, he has won the Jacksonian Prize, he ’has delivered the Hunterian oration, the Erasmus Wilson ’lectures, and the Bradshaw lecture. But outside the College he has been equally prominent, for in addition to being consulting surgeon to and lecturer upon surgery at St. Bartholomew’s Hospital he has been President of both the Pathological and the Laryngological Societies, member of the Senate and Dean of the Faculty of Medicine of the University of London, and Vice-President of the British Medical Association. Mr. Butlin brings, therefore, to his new and important post great experience both in organisation and in the exercise of authority, while ’his well-known happiness as an orator will stand him
UNDER the above title Mr. D’Arcy Power has recently contributed to Janus an interesting little paper on the emoluments of physicians at various periods. With the art of a practised writer he at once arrests his reader’s attention by reminding him of two physicians whose custom it was never to receive a fee at all-namely, the"unmeroenary " saints Cosmas and Damian. At the opposite extreme comes the fee which Mr. Power has omitted to recall-namely, that received by Democedes of Crotona, who as a prisoner was in the service of Darius Hystaspes at Susa. Darius had dislocated his foot at the ankle-joint and Democedes was His called in after the failure of an Egyptian surgeon. treatment was successful, and he was thereupon presented with two golden fetters, a delicate allusion to his position. Having delighted Darius by asking him "whether he meant to double his punishment," that monarch told him to go through the harem as the man who had saved the king’s life. The ladies each gave him a golden vessel piled up with staters, so many of which fell on the floor that the slave who conducted him made a handsome fortune by picking them up. Hewas afterwards called in to treat Atossa the Queen for a mammary ulcer which he succeeded in curing. Such patients, however, as the Great King and his consort do not fall to every man’s lot, though in quite modern times the high feudatory princes of India have paid comparable fees. In the Middle Ages men were more mercenary, and Mr. Power gives an amusing quotation from John of Arderne (circa 1370) as to the methods of bargaining with a patient. Arderne’s highest fee for the cure of fistula in ano was L40 down, a suit of robes, and 100s. per annum during the life of the patient. Patients in the Middle Ages were no more
160 pay their fees than now, and Gilles de Corbeil, a celebrated twelfth century physician, points out in language which must surely strike an answering chord in the heart of the present Chancellor of the Exchequer, that the rich man must pay in accordance with his wealth, though he adds as a saving clause " if his mind is as wide as his purse " then-
ready to
Aggravet hie medicina manum : sumptus onerosos Exigat: hie positos debet transeendere fines." In another place he remarks that it is as well for the physician to demand his fee before the patient is wellTutius esse reor, quod certe novimus omnes, Dum dlet accipere, vel munere posse carere." Mr. Power concludes his paper with an account of eighteenth century fees. Physicians like Radcliffe and Mead charged a guinea ; country apothecaries charged much less and made their money chiefly by the sale of medicine. Mixtures, as Mr. Power reminds us, were sent out as draughts in one ounce phials with a cork which sometimes had one pill in a box stuck on to it. Draught and pill cost Is. 9d. As many of our readers will remember, the directions were written on a slip of paper attached to the neck of the bottle, and such a draught in the half light of a sick room bore a ludicrous resemblance to the human inhabitants of a Noah’s Ark as manufactured in about 1860, up to which time the custom of separate draughts endured. Readers of Swift will remember the story he tells of Stella. "A quaker apothecary sent her a vial, corked; it had a broad brim and a label of paper about its neck. ’What is that,’ said she, ’my " son?"’ apothecary’s -
MORTALITY FROM MEASLES. SATISFACTORY as have been the results on public health and longevity of improved sanitary administration in England and Wales during the last 30 years, there are . still many features in our national mortality statistics which, without undue pessimism, clearly point to distinctly preventable waste of life, especially among infants and young children. The weekly returns of the Registrar-General, for instance, have recorded during the first six months of this year no fewer than 6381 deaths from measles in 76 of the largest English towns. Of these deaths it may safely be estimated that than more 90 per cent. were deaths of infants and children under the age of five years. In the corresponding six months of 1907 and 1908 the fatal cases of measles in these 76 towns did not exceed 4596 and 2692 respectively. The exceptional mortality from this disease during the first half of this year has probably been mainly due to unfavourable meteorological conditions, but it is an unquestionable fact that the generally improved sanitary condition of the English population during recent years has not effected any considerable reduction in the death-rate from measles. The annual rate of mortality from measles per 1,000,000 of the English population, which was equal to 379 in the ten years 1871-80, increased to 441 in 1881-90, was 414 in 1891-1900, and has been 311 in the first eight years of the current decennium. It should, moreover, be borne in mind that these death-rates from measles, calculated on the population at all ages, understate, for comparison in the several periods, the present true rate of mortality from this disease, if corrected for the recent marked decline in the proportion of young children in the English population. It cannot be doubted that the case-mortality of measles mainly depends upon watchful nursing and care during convalescence ; it is therefore not surprising to find that measles mortality is, to a great extent, confined to those classes in which careful nursing and treatment are neglected The class-mortality statistics or are practically impossible. issued by the Registrar-General for Ireland, relating to the Dublin registration area, throw valuable light on classmortality from measles, and suggest the desirability for
similar statistics on a larger basis. During the two years 1907-08 the deaths from measles in the Dublin registration area were 304, of which only 23 occurred among the professional, independent, and middle classes, estimated to number 104,624 persons of all ages, whereas the number occurring during the same period among the general-service class (excluding artisans and petty shopkeepers), consisting of an estimated population of 154,279 persons, was 223. The calculated death-rate from measles in these two sections of the Dublin population during 1907 and 1908 was more than seven times as high among the general-service class as among the professional, independent, and middle classes. The deaths from measles in England and Wales during the past eight years of the current decennium have averaged more than 10, 000 per annum, and will this year very considerably exceed this number. It is impossible to doubt that the large majority of these deaths are distinctly preventable by careful nursing and after-treatment. Without venturing entirely to attribute the remarkable decline of the mortality from scarlet fever in recent years to hospital isolation and treatment, the experimental trial of hospital isolation and nursing for measles naturally calls for serious consideration. In connexion with this subject it is interesting to note, in the recent appeal by the London Fever Hospital for financial support, that the hospital treatment of measles has recently been adopted at that institution. The result of this experiment cannot fail to be helpful in the consideration of the desirability for the creation of facilities for the hospital treatment of measles as a possible means of checking the present waste of child-life caused by the persistent mortality from this disease.
THE REPORT OF THE LADY ALMONER TO ST. THOMAS’S HOSPITAL. NOT long ago we devoted a leading article to a consideration of the report made by Miss Norah B. Roberts to the recent Poor-law Commission upon her inquiry into the extent of hospital abuse in London, and we mentioned her recommendation that fully trained lady almoners should be appointed at all hospitals in order to limit its occur1 The report of Miss A. E. rence as much as possible. Cummins, lady almoner to St. Thomas’s Hospital, upon the work of her department from March, 1908, to March, 1909, affords a timely confirmation of Miss Roberts’s opinion, and is a document which should receive wide circulation amongst other hospitals and careful study by those responsible for their management. The lady almoner’s department at St. Thomas’s was instituted" to check the abuse of the out-patient department by patients who are either in a position to pay for treatment or who are too poor to benefit by any assistance other than that obtainable through the Poor-law; to ensure as far as possible that all out-patients to whom treatment is granted shall benefit to the full by that treatment; and that no time, consideration, or money shall be withheld, either by the patient or by charitable agencies, to enable the patient to cooperate with the hospital in carrying out the prescribed treatment." The work has now been established for four years and has been extended considerably since its inception, its plan being that only as many cases as can be dealt with thoroughly shall be undertaken at all. No routine inquiry concerning wages, rent, and so on, has been found of value in adjudicating upon the suitability of an applicant for hospital relief. In order to carry out the thorough personal investigations that are necessary the cooperation of existing charitable agencies has been secured, a plan which it will be remembered was recommended by the recent Commission for the solution of 1
THE
LANCET, May 29th, 1909,
p. 1534.
years, sometimes suddenly become blown and unfit for use. This occurrence could hardly be due to injury of the tin through rust, or even
and his
College
in
good
congratulations. THE
.as, if so, the gas
stead.
We offer him
our
best
-
ANNUAL
MEETING
OF
THE
BRITISH
produced by putrefaction, consequent on MEDICAL ASSOCIATION. entrance of air organisms, would find its way out and no THE seventy-seventh annual meeting of the British Medical blowing would result. Major BEVERIDGE, and with him will be held at Belfast on July 23rd, 24th, 26th, Association .Captain FAWCUS, have found that an organism may be and 30th next, under the presidency of Sir 28th, 27tb, 29th, present in the meat at packing, may not be destroyed William Whitla, Professor of Materia Medica and Therapeutics, ’by the so-called sterilisation, may remain inert for long in the University of Belfast. Fifteen scientific sections periods if the tins are stored at a low temperature, and have been arranged and will meet daily from Wednesday to ’finally, may develop if the temperature reaches 37° C., or Friday in the Queen’s College at 10 A.M.—viz., Anatomy and thereabouts. This bacillus is non-pathogenic to animals, but Physiology, Dermatology and Electro-Therapeutics, Hasmatology and Vaccine Therapy, Diseases of Children, Navy, - decomposes the meat and renders it unfit for and Ambulance, Hygiene and Public Health, Laryngo.As it does not develop much below the body temperature, Army Otology, and Rhinology, Medicine, Obstetrics and logy, meat might be contaminated by it and yet be kept for months Gynaecology, Ophthalmology, Pathology, Pharmacology without showing signs of decomposition or blowing if stored and Therapeutics, Psychological Medicine, Surgery, and ,in a cool place, neither would the temperature of the warm Tropical Medicine. On Tuesday, at 2.30, Sir William to the presidential chair, and will be inducted Whitla in which for a manufacturers tinned foods room," deposit will same deliver the presidential on the evening ’short time as a testing chamber, be sufficient to cause growth in the Assembly Hall, Belfast. On Wednesday, -of this bacillus. But if taken to a hot climate the whole address at 12.30 P.M., Dr. R. W. Philip will deliver 28th, -consignment might speedily become unfit for use. The July the address in Medicine in the library, Queen’s College. recommendation is accordingly made that the temperature On Thursday, July 29th, at 12.30 P.M., the address in -of the fluid in which canned-meat tins are sterilised Surgery will be delivered in the library, Queen’s College, by should be raised to 120° C. (248° F.), and that this should Mr. A. E. J. Barker. On Friday, July 30th, at 12.30 P.M., Sir ’be kept up for one hour. This is a higher and more John W. Byers will deliver the aaaress in Ubstetrics in the library, Queen’s College. At 8 P.M. a popular lecture ,prolonged sterilisation than is, we believe, usually the I will be delivered by Dr. J. A. Macdonald. As the propractice at present, but in view of the observations grammes throughout promise particularly interesting discusof Major BEVERIDGE and his collaborators appears to sion, owing to the proposed attendance of men of eminence ’us to be It is to learn that justified. satisfactory from foreign countries and various parts of the British ,no boric acid or other preservative was found to be Empire, the success of the meeting from every point of view ,present in any of the tinned-meat samples, though the is assured. nitrates, derived from the pickling fluid, were sometimes
consumption.
T
in
1
TTT
Tt_--_.
__.!1’
.:1_1!__-
l- -
_.:J..J_-_.....
!_-
W__t_u__3__
.!_-
THE FEES OF OUR ANCESTORS.
excess.
Annotations. "Ne quid nimis."
THE NEW PRESIDENT OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND. Mr. Henry Trentham Butlin was elected unanimously President of the Royal College of Surgeons of England at the meeting of the Council held on Thursday, July 8th, at ’the College. This event was generally anticipated, for Mr. Butlin’s claims upon the titular leadership of his branch of the profession in this country are very strong. He is well known at home and abroad as an operating surgeon and pathologist. He has held almost every possible post in connexion with his College, he has won the Jacksonian Prize, he ’has delivered the Hunterian oration, the Erasmus Wilson ’lectures, and the Bradshaw lecture. But outside the College he has been equally prominent, for in addition to being consulting surgeon to and lecturer upon surgery at St. Bartholomew’s Hospital he has been President of both the Pathological and the Laryngological Societies, member of the Senate and Dean of the Faculty of Medicine of the University of London, and Vice-President of the British Medical Association. Mr. Butlin brings, therefore, to his new and important post great experience both in organisation and in the exercise of authority, while ’his well-known happiness as an orator will stand him
UNDER the above title Mr. D’Arcy Power has recently contributed to Janus an interesting little paper on the emoluments of physicians at various periods. With the art of a practised writer he at once arrests his reader’s attention by reminding him of two physicians whose custom it was never to receive a fee at all-namely, the"unmeroenary " saints Cosmas and Damian. At the opposite extreme comes the fee which Mr. Power has omitted to recall-namely, that received by Democedes of Crotona, who as a prisoner was in the service of Darius Hystaspes at Susa. Darius had dislocated his foot at the ankle-joint and Democedes was His called in after the failure of an Egyptian surgeon. treatment was successful, and he was thereupon presented with two golden fetters, a delicate allusion to his position. Having delighted Darius by asking him "whether he meant to double his punishment," that monarch told him to go through the harem as the man who had saved the king’s life. The ladies each gave him a golden vessel piled up with staters, so many of which fell on the floor that the slave who conducted him made a handsome fortune by picking them up. Hewas afterwards called in to treat Atossa the Queen for a mammary ulcer which he succeeded in curing. Such patients, however, as the Great King and his consort do not fall to every man’s lot, though in quite modern times the high feudatory princes of India have paid comparable fees. In the Middle Ages men were more mercenary, and Mr. Power gives an amusing quotation from John of Arderne (circa 1370) as to the methods of bargaining with a patient. Arderne’s highest fee for the cure of fistula in ano was L40 down, a suit of robes, and 100s. per annum during the life of the patient. Patients in the Middle Ages were no more
160 pay their fees than now, and Gilles de Corbeil, a celebrated twelfth century physician, points out in language which must surely strike an answering chord in the heart of the present Chancellor of the Exchequer, that the rich man must pay in accordance with his wealth, though he adds as a saving clause " if his mind is as wide as his purse " then-
ready to
Aggravet hie medicina manum : sumptus onerosos Exigat: hie positos debet transeendere fines." In another place he remarks that it is as well for the physician to demand his fee before the patient is wellTutius esse reor, quod certe novimus omnes, Dum dlet accipere, vel munere posse carere." Mr. Power concludes his paper with an account of eighteenth century fees. Physicians like Radcliffe and Mead charged a guinea ; country apothecaries charged much less and made their money chiefly by the sale of medicine. Mixtures, as Mr. Power reminds us, were sent out as draughts in one ounce phials with a cork which sometimes had one pill in a box stuck on to it. Draught and pill cost Is. 9d. As many of our readers will remember, the directions were written on a slip of paper attached to the neck of the bottle, and such a draught in the half light of a sick room bore a ludicrous resemblance to the human inhabitants of a Noah’s Ark as manufactured in about 1860, up to which time the custom of separate draughts endured. Readers of Swift will remember the story he tells of Stella. "A quaker apothecary sent her a vial, corked; it had a broad brim and a label of paper about its neck. ’What is that,’ said she, ’my " son?"’ apothecary’s -
MORTALITY FROM MEASLES. SATISFACTORY as have been the results on public health and longevity of improved sanitary administration in England and Wales during the last 30 years, there are . still many features in our national mortality statistics which, without undue pessimism, clearly point to distinctly preventable waste of life, especially among infants and young children. The weekly returns of the Registrar-General, for instance, have recorded during the first six months of this year no fewer than 6381 deaths from measles in 76 of the largest English towns. Of these deaths it may safely be estimated that than more 90 per cent. were deaths of infants and children under the age of five years. In the corresponding six months of 1907 and 1908 the fatal cases of measles in these 76 towns did not exceed 4596 and 2692 respectively. The exceptional mortality from this disease during the first half of this year has probably been mainly due to unfavourable meteorological conditions, but it is an unquestionable fact that the generally improved sanitary condition of the English population during recent years has not effected any considerable reduction in the death-rate from measles. The annual rate of mortality from measles per 1,000,000 of the English population, which was equal to 379 in the ten years 1871-80, increased to 441 in 1881-90, was 414 in 1891-1900, and has been 311 in the first eight years of the current decennium. It should, moreover, be borne in mind that these death-rates from measles, calculated on the population at all ages, understate, for comparison in the several periods, the present true rate of mortality from this disease, if corrected for the recent marked decline in the proportion of young children in the English population. It cannot be doubted that the case-mortality of measles mainly depends upon watchful nursing and care during convalescence ; it is therefore not surprising to find that measles mortality is, to a great extent, confined to those classes in which careful nursing and treatment are neglected The class-mortality statistics or are practically impossible. issued by the Registrar-General for Ireland, relating to the Dublin registration area, throw valuable light on classmortality from measles, and suggest the desirability for
similar statistics on a larger basis. During the two years 1907-08 the deaths from measles in the Dublin registration area were 304, of which only 23 occurred among the professional, independent, and middle classes, estimated to number 104,624 persons of all ages, whereas the number occurring during the same period among the general-service class (excluding artisans and petty shopkeepers), consisting of an estimated population of 154,279 persons, was 223. The calculated death-rate from measles in these two sections of the Dublin population during 1907 and 1908 was more than seven times as high among the general-service class as among the professional, independent, and middle classes. The deaths from measles in England and Wales during the past eight years of the current decennium have averaged more than 10, 000 per annum, and will this year very considerably exceed this number. It is impossible to doubt that the large majority of these deaths are distinctly preventable by careful nursing and after-treatment. Without venturing entirely to attribute the remarkable decline of the mortality from scarlet fever in recent years to hospital isolation and treatment, the experimental trial of hospital isolation and nursing for measles naturally calls for serious consideration. In connexion with this subject it is interesting to note, in the recent appeal by the London Fever Hospital for financial support, that the hospital treatment of measles has recently been adopted at that institution. The result of this experiment cannot fail to be helpful in the consideration of the desirability for the creation of facilities for the hospital treatment of measles as a possible means of checking the present waste of child-life caused by the persistent mortality from this disease.
THE REPORT OF THE LADY ALMONER TO ST. THOMAS’S HOSPITAL. NOT long ago we devoted a leading article to a consideration of the report made by Miss Norah B. Roberts to the recent Poor-law Commission upon her inquiry into the extent of hospital abuse in London, and we mentioned her recommendation that fully trained lady almoners should be appointed at all hospitals in order to limit its occur1 The report of Miss A. E. rence as much as possible. Cummins, lady almoner to St. Thomas’s Hospital, upon the work of her department from March, 1908, to March, 1909, affords a timely confirmation of Miss Roberts’s opinion, and is a document which should receive wide circulation amongst other hospitals and careful study by those responsible for their management. The lady almoner’s department at St. Thomas’s was instituted" to check the abuse of the out-patient department by patients who are either in a position to pay for treatment or who are too poor to benefit by any assistance other than that obtainable through the Poor-law; to ensure as far as possible that all out-patients to whom treatment is granted shall benefit to the full by that treatment; and that no time, consideration, or money shall be withheld, either by the patient or by charitable agencies, to enable the patient to cooperate with the hospital in carrying out the prescribed treatment." The work has now been established for four years and has been extended considerably since its inception, its plan being that only as many cases as can be dealt with thoroughly shall be undertaken at all. No routine inquiry concerning wages, rent, and so on, has been found of value in adjudicating upon the suitability of an applicant for hospital relief. In order to carry out the thorough personal investigations that are necessary the cooperation of existing charitable agencies has been secured, a plan which it will be remembered was recommended by the recent Commission for the solution of 1
THE
LANCET, May 29th, 1909,
p. 1534.