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THE IMPERIAL VACCINATION LEAGUE AND THE EDUCATION OF THE PUBLIC.
899 did not reach normal until all the case, In the fourth case a girl, ascarides (24) were passed. was 11 aged years, suddenly seized with epileptiform convulsions. She fell down, lost consciousness, and had tonic and clonic spasms of the arms. On the following day she was restless, refused food, and had a second epileptiform crisis. As she was constipated castor oil was given. Some round worms were expelled and the symptoms disappeared. Convulsions due to round worms are an admitted possibility by most French writers, but the existence of fever from the same cause-" fievre vermineuse "-is denied by some. As to the pathology of these conditions the suggestion is made that they are due to toxins absorbed from the worms. Experiments have been performed on animals by injecting’ fluid obtained from ascarides into different parts of the body. Sometimes no effects were observed ; at other times death rapidly followed. Dr. Wettendorff suggests that the parasites secrete toxins of variable virulence, which explains the fact that they may produce no symptoms whatever in some cases and severe ones in others.
preceding
position whereby the league lost the support of the association. According to Mr. Wolstenholme the league "had decided that it could not recognise, or advise Parliament to accept, the general practitioner as a public vaccinator," but Dr. Roberts says that the league has passed no such resolution. Dr. Roberts points out that it is particularly unfortunate for the British Medical Association not to support the league just now, when the latter body is striving to educate the country into an intelligent appreciation of the mean-
ing and virtues of vaccination.
No one would regret more than ourselves that the work of the Imperial Vaccination League should be hampered, but at the same time proper allowance must be made for the somewhat difficult position of the general practitioner. Recent legislation has placed or appears to have placed the public vaccinators in antagonism to the general practitioners of the country in some localities, and every endeavour must be made to allay this friction where it exists. The public must not be able to quote any difference of opinion about the machinery necessary to render vaccination effective and general. For all practical purposes the members of the medical profession, led by the expert AUTOLYSIS IN LOBAR AND UNRESOLVED opinion of those who have studied preventive medicine, are unanimous in the view that in vaccination and revaccination PNEUMONIA. we have the most valuable safeguard against the ravages of IN the July-August number ot the University of PennAs the profession is agreed upon this essential sylvania Medical Bulletin Dr. Simon Flexner, professor of small-pox. matter all differences as to the best way to make vaccinapathology in the University of Pennsylvania, suggests that tion universal and well-performed are regrettable as tending the explanation of the failure of the exudate in unresolved to conceal the solidarity of opinion upon the greater issue. pneumonia to be absorbed readily might lie in an imper- Mr. Wolstenholme seems, doubtless unwittingly, to have done fection of the autolytic processes taking place in the inflamed the Imperial Vaccination League an injustice which we hope lung. That organs protected from decomposition tend to that the British Medical Association may yet repair. But undergo solution by a process of self-digestion was first we think it that British Medical Association did the likely accurately shown by Salkowsky in 1882. This process of not act at all, but upon the Mr. Wolstenholme’s words upon autolysis has now been studied from many different sides belief that the Imperial Vaccination League had a contrary and it has been found that the intracellular ferments causing view to that of the British Medical Association with regard autolysis form a most important and potent series of agents to the position of the general practitioner. which into under and
come both physiological play pathological conditions. There is little doubt that in many pathoTHE Local Government Board has addressed a circular logical conditions the leucocyte is the essential agent in bringto town councils and urban district councils drawing of a about The different behaviour caseous ing absorption. and croupous pneumonia, the facility with which the one and attention to the provisions of the Housing of the Working the difficulty with which the other undergoes resolution, are Classes Act (1903). Sir S. B. Provis, secretary to the Board, to be ascribed, probably in large part, to the comparative points out that this Act gives many facilities to town and absence of leucocytes from the tuberculous process and urban district councils and we hope that the circular may
their presence in
enormous numbers in the acute inflamcondition. Friedrich Muller first studied autolysis of matory the lung in croupous pneumonia and described in detail its occurrence and the chemical products, among which are lysin, leucin, tyrosin, purin bases, and phosphoric acid, of the digestive process. Dr. Flexner has found that it is in the stage of grey hepatisation that autolysis
takes place quickly and perfectly, while in the stage of red hepatisation it is very imperfect-a fact that may, he thinks, be attributed to the small number of pus cells present in the latter condition, but if the lung in unresolved pneumonia is exposed to conditions favouring autolysis the process is slow and incomplete as compared with what takes place in grey hepatisation. Unresolved pneumonia is, 1 herefore, in his opinion, an acute lobar pneumonia in which the innammatojy exudate, either because of some disproportion between the leucocytes and other constituents or other cause as yet unknown, resists autolysis, cannot be absorbed and hence undergoes organisation.
have the effect of stimulating these bodies to exercise their considerable powers under the various Housings Acts. The better housing of our poor is in medical eyes one of the chief necessities of the day. DURING the week ending August 29th only 1 case of plague has been discovered in Cape Colony-namely, that of a European female at Port Elizabeth. Plagueinfected rats have been found at Port Elizabeth, King William’s Town, and on board a ship at East London. As regards the Mauritius, a telegram from the Governor received at the Colonial Office on Sept. 18th states that for the week ending Sept. 17th there were 39 cases of plague and 28 deaths from the disease. ____
IMPERIAL VACCINATION LEAGUE AND THE EDUCATION OF THE PUBLIC.
THE annual dinner of the past and present students of the of Medicine of University College, London, will be held at the Hotel Cecil, Victoria Embankment, on Monday, Oct. 5tb, at 6.30 for 7 P.M. The chair will be taken by Further particulars can be obtained Dr. Walter Rigden. from Mr. Raymond Johnson, 11, Wimpole-street, W., or Dr. H. Batty Shaw, 7, Devonshire-street, W.
WE have received from Dr. Rees Roberts, the organising secretary of the Imperial Vaccination League, a letter alleging that when the question of a grant to the league was brought before the British Medical Association at Swansea Mr. Wolstenholme made an inaccurate statement of the
Sir William S. Church will deliver the opening lecture of the autumn session of the Post-Graduate College, West London Hospital, on Medical Education and Post-Graduate Study, at 4.30 P.M., on Tuesday, Oct. 13th. Anyone desirous
THE
Faculty
900 of attending may have a ticket on applying to the Dean, West London Hospital, Hammersmith-road, W.
in returns made by 2000 lay registrars and impossible piled with the greatest possible despatch, but the general
com-
i
results are of considerable value to the Local Government Board and are accurate enough for immediate practical Dr. Louis Parkes has been appointed by the First Com- purposes. The "annual summary" follows on these publicamissioner of Works consulting sanitary adviser to the tions and is issued in the early months of the year succeeding that to which it relates. It recapitulates the statistics Department, in succession to the late Dr. Corfield. concerning the great towns of England that are included in the weekly and quarterly returns. After briefly alluding to the decennial supplement, which is the most important publication issued from the General Register Office, treating ANNUAL REPORT OF THE as it does of occupational mortality in the ten years interREGISTRAR-GENERAL OF ENGLAND vening between the last two censuses, Mr. Dunbar goes on to say : ’’ Since entering on the duties of this office I have AND WALES. made careful inquiry as to the scope of the various statistical publications for which I have become responsible. I. As the result of this inquiry I am satisfied that the need for Two important Blue-books have recently been issued current information as to the state of the public health is met by the series of returns above referred to. by His Majesty’s Stationery Office, both of which contain effectively I further think that although the detailed annual reports information of considerable interest to our profession. One should no doubt be issued as promptly as possible it is even of them, by the medical officer of the Local Government more important, in view of their permanent character, that Board, we noticed in THE LANCET of Sept. 19th, p. 839. none of the care hitherto exercised in compiling them should The other, which is the subject of the present article, be sacrificed for the sake of early publication." For our own part we confess that we are amongst those is the sixty-fourth annual report of the Registrar-General. who think that the value of the Registrar-General’s annual Although in different ways, each of these publications bears is seriously discounted by the lateness of their reports close and very definite relations to the subject of State Notwithstanding the Registrar-General’s conpublication. Medicine. The first deals with the progress of public health tention to the contrary, we still fail to see why, as in the administration throughout the country and the last supplies present case, the issue of his report should be delayed until the means whereby that progress may be estimated and 21 months after the close of the year to which it relates. indicates by the use of statistical methods how far the We are glad, however, to note that Mr. Dunbar himself various expedients sanctioned by the legislature have been recognises the desirability of earlier publication and we effective in promoting the health and well-being of the cannot doubt that in future he will use his influence for its accomplishment. community. readers will remember that a few weeks ago the The annual report now under review is technically styled President of the Local Government Board was questioned the sixty-fourth, but a cursory examination suffices to show in Parliament as to the reason for the delay which takes that it has been almost entirely reconstructed throughout, place in the publication of this and other important reports especially as regards the tabular matter. It is obviously concerning the public health which are issued annually by fitting that the opening year of a new century should The following remarks of the Registrar- have been chosen as the occasion for revising the statistical his authority. General go far to explain, if they do not justify, this delay details of this important document in accordance with the which, as regards the present year at any rate, we believe requirements of modern science. We fully recognise that "Before concluding these remarks," the modifications now introduced are decided improvements, to be exceptional. " I wish to call attention to the fact and we think that the fact that the report has been comsays Mr. Dunbar, that the statistics respecting births, deaths, and marriages pletely remodelled would have justified the adoption of a in England and Wales which are presented therein, and in title indicating that the present is the first of a new seriesthe accompanying letter from Dr. Tatham on the causes of for such it is in reality. The section of this report which has for our profession the death, have been compiled after a detailed analysis of the ’ certified copies’ of the registers which are deposited at greatest interest is naturally that which relates to mortality. regular intervals in this department. The process of com- That section of the Registrar-General’s reports has of course pilation can only be commenced after these certified copies, always been written by the medical member of the staff containing in the aggregate about 1,700,000 entries in a and for the first 40 years it was duly authenticated by his year, have been subjected to close scrutiny and the numerous signature. In the present report we are gratified to find that points of doubt have been cleared up by correspondence ; it after a considerable interval the aforesaid practice has been must further be borne in mind that a large proportion of this resumed. This is indicated in the introductory remarks of work can be performed only by specially trained clerks. In Mr. Dunbar, in the course of which, after intimating that the present instance the revision of an enormous number of this section of the report would be contributed by Dr. death-rates relating to the years from 1891 to 1900 has been Tatham, he makes graceful allusion to the services rendered required in accordance with the detailed results of the recent to this department by our profession in the following words : " It occurs to me that the medical practitioners of this census, and an important rearrangement of the form in which the statistics of the causes of death are tabulated has country, on whose generous cooperation the accurate comalso been adopted." He then goes on to explain that pend- pilation of vital statistics so largely depends, will in this ing the publication of the annual reports other summaries way more readily appreciate the fact that the particulars and statistics, necessarily less elaborate and only approgi- they contribute concerning the causes of death are analysed mately accurate, but still of great value in relation to publicand the results authenticated by a member of their own proIn health, are periodically issued. First appears the " weekly changes subsequently made in return " which is prepared with all possible despatch and is the system of disease classification which was originally made available to the public every Wednesday morning. devised by Dr. Farr, and which was eventually adopted by This return consists of a detailed analysis of the causes of the Royal College of Physicians of London in the arrangedeath in every town in England containing a population of ment of its nomenclature, Dr. Tatham tells us that the Next comes the "quarterly records of at any rate the chief causes of death, according more than 50,000 inhabitants. return " which relates to the entire population of the country to Dr. Farr’s method, are still comparable for the 60 years and is issued about a month after the end of each quarter which have elapsed since the establishment of civil registraof the year. This return gives particulars of the mortality tion and may be found in the successive reports of thefrom some of the principal causes for each of the registration Registrar-General. In appreciation of the work of his dissub-districts of England ; it also records (and this is an tinguished predecessor he remarks that "although in conentirely new feature) the number of notified cases of in- sequence of recent advances in medical knowledge the fectious disease as returned from certain of the larger towns. etiological classification of Dr. Farr may now be regarded This return further contains a summary of the mortality as somewhat out of date, nevertheless it deserves to be tables relating to the great towns dealt with in the remembered that his efforts to impress upon medical pracweekly returns and additional tables respecting 163 other titioners and students the duty of searching beyond symptoms towns containing between 25,000 and 50,000 inhabitants. for the actual causes of disease possessed high educational Niceties of statistical classification would be obviously value at the time-a value which nowadays is perhaps hardly
(FOR 1901)
Our
..
/
i
f
fession.
reviewing the
preceding
position whereby the league lost the support of the association. According to Mr. Wolstenholme the league "had decided that it could not recognise, or advise Parliament to accept, the general practitioner as a public vaccinator," but Dr. Roberts says that the league has passed no such resolution. Dr. Roberts points out that it is particularly unfortunate for the British Medical Association not to support the league just now, when the latter body is striving to educate the country into an intelligent appreciation of the mean-
ing and virtues of vaccination.
No one would regret more than ourselves that the work of the Imperial Vaccination League should be hampered, but at the same time proper allowance must be made for the somewhat difficult position of the general practitioner. Recent legislation has placed or appears to have placed the public vaccinators in antagonism to the general practitioners of the country in some localities, and every endeavour must be made to allay this friction where it exists. The public must not be able to quote any difference of opinion about the machinery necessary to render vaccination effective and general. For all practical purposes the members of the medical profession, led by the expert AUTOLYSIS IN LOBAR AND UNRESOLVED opinion of those who have studied preventive medicine, are unanimous in the view that in vaccination and revaccination PNEUMONIA. we have the most valuable safeguard against the ravages of IN the July-August number ot the University of PennAs the profession is agreed upon this essential sylvania Medical Bulletin Dr. Simon Flexner, professor of small-pox. matter all differences as to the best way to make vaccinapathology in the University of Pennsylvania, suggests that tion universal and well-performed are regrettable as tending the explanation of the failure of the exudate in unresolved to conceal the solidarity of opinion upon the greater issue. pneumonia to be absorbed readily might lie in an imper- Mr. Wolstenholme seems, doubtless unwittingly, to have done fection of the autolytic processes taking place in the inflamed the Imperial Vaccination League an injustice which we hope lung. That organs protected from decomposition tend to that the British Medical Association may yet repair. But undergo solution by a process of self-digestion was first we think it that British Medical Association did the likely accurately shown by Salkowsky in 1882. This process of not act at all, but upon the Mr. Wolstenholme’s words upon autolysis has now been studied from many different sides belief that the Imperial Vaccination League had a contrary and it has been found that the intracellular ferments causing view to that of the British Medical Association with regard autolysis form a most important and potent series of agents to the position of the general practitioner. which into under and
come both physiological play pathological conditions. There is little doubt that in many pathoTHE Local Government Board has addressed a circular logical conditions the leucocyte is the essential agent in bringto town councils and urban district councils drawing of a about The different behaviour caseous ing absorption. and croupous pneumonia, the facility with which the one and attention to the provisions of the Housing of the Working the difficulty with which the other undergoes resolution, are Classes Act (1903). Sir S. B. Provis, secretary to the Board, to be ascribed, probably in large part, to the comparative points out that this Act gives many facilities to town and absence of leucocytes from the tuberculous process and urban district councils and we hope that the circular may
their presence in
enormous numbers in the acute inflamcondition. Friedrich Muller first studied autolysis of matory the lung in croupous pneumonia and described in detail its occurrence and the chemical products, among which are lysin, leucin, tyrosin, purin bases, and phosphoric acid, of the digestive process. Dr. Flexner has found that it is in the stage of grey hepatisation that autolysis
takes place quickly and perfectly, while in the stage of red hepatisation it is very imperfect-a fact that may, he thinks, be attributed to the small number of pus cells present in the latter condition, but if the lung in unresolved pneumonia is exposed to conditions favouring autolysis the process is slow and incomplete as compared with what takes place in grey hepatisation. Unresolved pneumonia is, 1 herefore, in his opinion, an acute lobar pneumonia in which the innammatojy exudate, either because of some disproportion between the leucocytes and other constituents or other cause as yet unknown, resists autolysis, cannot be absorbed and hence undergoes organisation.
have the effect of stimulating these bodies to exercise their considerable powers under the various Housings Acts. The better housing of our poor is in medical eyes one of the chief necessities of the day. DURING the week ending August 29th only 1 case of plague has been discovered in Cape Colony-namely, that of a European female at Port Elizabeth. Plagueinfected rats have been found at Port Elizabeth, King William’s Town, and on board a ship at East London. As regards the Mauritius, a telegram from the Governor received at the Colonial Office on Sept. 18th states that for the week ending Sept. 17th there were 39 cases of plague and 28 deaths from the disease. ____
IMPERIAL VACCINATION LEAGUE AND THE EDUCATION OF THE PUBLIC.
THE annual dinner of the past and present students of the of Medicine of University College, London, will be held at the Hotel Cecil, Victoria Embankment, on Monday, Oct. 5tb, at 6.30 for 7 P.M. The chair will be taken by Further particulars can be obtained Dr. Walter Rigden. from Mr. Raymond Johnson, 11, Wimpole-street, W., or Dr. H. Batty Shaw, 7, Devonshire-street, W.
WE have received from Dr. Rees Roberts, the organising secretary of the Imperial Vaccination League, a letter alleging that when the question of a grant to the league was brought before the British Medical Association at Swansea Mr. Wolstenholme made an inaccurate statement of the
Sir William S. Church will deliver the opening lecture of the autumn session of the Post-Graduate College, West London Hospital, on Medical Education and Post-Graduate Study, at 4.30 P.M., on Tuesday, Oct. 13th. Anyone desirous
THE
Faculty
900 of attending may have a ticket on applying to the Dean, West London Hospital, Hammersmith-road, W.
in returns made by 2000 lay registrars and impossible piled with the greatest possible despatch, but the general
com-
i
results are of considerable value to the Local Government Board and are accurate enough for immediate practical Dr. Louis Parkes has been appointed by the First Com- purposes. The "annual summary" follows on these publicamissioner of Works consulting sanitary adviser to the tions and is issued in the early months of the year succeeding that to which it relates. It recapitulates the statistics Department, in succession to the late Dr. Corfield. concerning the great towns of England that are included in the weekly and quarterly returns. After briefly alluding to the decennial supplement, which is the most important publication issued from the General Register Office, treating ANNUAL REPORT OF THE as it does of occupational mortality in the ten years interREGISTRAR-GENERAL OF ENGLAND vening between the last two censuses, Mr. Dunbar goes on to say : ’’ Since entering on the duties of this office I have AND WALES. made careful inquiry as to the scope of the various statistical publications for which I have become responsible. I. As the result of this inquiry I am satisfied that the need for Two important Blue-books have recently been issued current information as to the state of the public health is met by the series of returns above referred to. by His Majesty’s Stationery Office, both of which contain effectively I further think that although the detailed annual reports information of considerable interest to our profession. One should no doubt be issued as promptly as possible it is even of them, by the medical officer of the Local Government more important, in view of their permanent character, that Board, we noticed in THE LANCET of Sept. 19th, p. 839. none of the care hitherto exercised in compiling them should The other, which is the subject of the present article, be sacrificed for the sake of early publication." For our own part we confess that we are amongst those is the sixty-fourth annual report of the Registrar-General. who think that the value of the Registrar-General’s annual Although in different ways, each of these publications bears is seriously discounted by the lateness of their reports close and very definite relations to the subject of State Notwithstanding the Registrar-General’s conpublication. Medicine. The first deals with the progress of public health tention to the contrary, we still fail to see why, as in the administration throughout the country and the last supplies present case, the issue of his report should be delayed until the means whereby that progress may be estimated and 21 months after the close of the year to which it relates. indicates by the use of statistical methods how far the We are glad, however, to note that Mr. Dunbar himself various expedients sanctioned by the legislature have been recognises the desirability of earlier publication and we effective in promoting the health and well-being of the cannot doubt that in future he will use his influence for its accomplishment. community. readers will remember that a few weeks ago the The annual report now under review is technically styled President of the Local Government Board was questioned the sixty-fourth, but a cursory examination suffices to show in Parliament as to the reason for the delay which takes that it has been almost entirely reconstructed throughout, place in the publication of this and other important reports especially as regards the tabular matter. It is obviously concerning the public health which are issued annually by fitting that the opening year of a new century should The following remarks of the Registrar- have been chosen as the occasion for revising the statistical his authority. General go far to explain, if they do not justify, this delay details of this important document in accordance with the which, as regards the present year at any rate, we believe requirements of modern science. We fully recognise that "Before concluding these remarks," the modifications now introduced are decided improvements, to be exceptional. " I wish to call attention to the fact and we think that the fact that the report has been comsays Mr. Dunbar, that the statistics respecting births, deaths, and marriages pletely remodelled would have justified the adoption of a in England and Wales which are presented therein, and in title indicating that the present is the first of a new seriesthe accompanying letter from Dr. Tatham on the causes of for such it is in reality. The section of this report which has for our profession the death, have been compiled after a detailed analysis of the ’ certified copies’ of the registers which are deposited at greatest interest is naturally that which relates to mortality. regular intervals in this department. The process of com- That section of the Registrar-General’s reports has of course pilation can only be commenced after these certified copies, always been written by the medical member of the staff containing in the aggregate about 1,700,000 entries in a and for the first 40 years it was duly authenticated by his year, have been subjected to close scrutiny and the numerous signature. In the present report we are gratified to find that points of doubt have been cleared up by correspondence ; it after a considerable interval the aforesaid practice has been must further be borne in mind that a large proportion of this resumed. This is indicated in the introductory remarks of work can be performed only by specially trained clerks. In Mr. Dunbar, in the course of which, after intimating that the present instance the revision of an enormous number of this section of the report would be contributed by Dr. death-rates relating to the years from 1891 to 1900 has been Tatham, he makes graceful allusion to the services rendered required in accordance with the detailed results of the recent to this department by our profession in the following words : " It occurs to me that the medical practitioners of this census, and an important rearrangement of the form in which the statistics of the causes of death are tabulated has country, on whose generous cooperation the accurate comalso been adopted." He then goes on to explain that pend- pilation of vital statistics so largely depends, will in this ing the publication of the annual reports other summaries way more readily appreciate the fact that the particulars and statistics, necessarily less elaborate and only approgi- they contribute concerning the causes of death are analysed mately accurate, but still of great value in relation to publicand the results authenticated by a member of their own proIn health, are periodically issued. First appears the " weekly changes subsequently made in return " which is prepared with all possible despatch and is the system of disease classification which was originally made available to the public every Wednesday morning. devised by Dr. Farr, and which was eventually adopted by This return consists of a detailed analysis of the causes of the Royal College of Physicians of London in the arrangedeath in every town in England containing a population of ment of its nomenclature, Dr. Tatham tells us that the Next comes the "quarterly records of at any rate the chief causes of death, according more than 50,000 inhabitants. return " which relates to the entire population of the country to Dr. Farr’s method, are still comparable for the 60 years and is issued about a month after the end of each quarter which have elapsed since the establishment of civil registraof the year. This return gives particulars of the mortality tion and may be found in the successive reports of thefrom some of the principal causes for each of the registration Registrar-General. In appreciation of the work of his dissub-districts of England ; it also records (and this is an tinguished predecessor he remarks that "although in conentirely new feature) the number of notified cases of in- sequence of recent advances in medical knowledge the fectious disease as returned from certain of the larger towns. etiological classification of Dr. Farr may now be regarded This return further contains a summary of the mortality as somewhat out of date, nevertheless it deserves to be tables relating to the great towns dealt with in the remembered that his efforts to impress upon medical pracweekly returns and additional tables respecting 163 other titioners and students the duty of searching beyond symptoms towns containing between 25,000 and 50,000 inhabitants. for the actual causes of disease possessed high educational Niceties of statistical classification would be obviously value at the time-a value which nowadays is perhaps hardly
(FOR 1901)
Our
..
/
i
f
fession.
reviewing the