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THE PRESERVATION OF BODIES FOR CORONERS' INQUESTS.
573
INCUBATION, ANCIENT,, MEDIÆVAL, AND MODERN. and much .improvement followed in these also. Perfect recovery did ...net occur in every case, but there was always.some improvement and in most cases the improvement was very .marked. The xays are administered as follows: A tubular diaphragm is used and a current of large amperage employed, the focus tubes being soft. The exposures last five minutes and are repeated on every other day during the first week.and on every third day during the following weeks until there is either a marked decrease in the swelling or an x-ray dermatitis. In most of the cases fairly large.doses of liquor arsenicalis aregiven at the same time, up to 20 drops three times a day, provided the digestion is not disturbed. In slight cases Professor Beck recommends this treatment ; for cases with more severe symptoms and a greater swelling he advises the combined method, partial excision followed by.x ray treatment of the portion of gland left. For advanced cases where alarming symptoms forbid immediate operative interference the x ray treatment should preoede the operation until improvement of the .general condition occurs. Judging, from this paper we cannot doubt that the use of x rays in exophthalmic goitre deserves an extensive trial. ____
INCUBATION, ANCIENT,, MEDIEVAL, AND MODERN. THE diverting description of what may aptly be termed " sleeping in at the temple of Asklepios at Athens which has amused the readers of the Plutus of Aristophanes for so many centuries is really an account of an incubation at the shrine of the god of healing of two patients, Plutus.and, Nescleides, the latter of whom failed to derive any benefit from the visit. The cure, as described by Plutus’s servant Chremylos, appears to have been achieved by an Asklepiad priest assisted by two acolytes representing laso and Panakeia. For that the officiant was the beneficent deity in person is rendered extremely improbable by Chremylos detecting him abstracting the unconsumed cakes and comestibles from the altar and placing them in a bag for future consumption. He was, however, attended by two trained serpents, so that anyone suddenly awakened by his ministrations and mentally impressed, by the sacred site and solemnity of the occasion, .in the dim light of the sanctuary colonnade might deem his visitant to be the god himself. "
"
"
Like so much of the manners and customs of ancient Greece this system of semi-religious oneiromancy was common in Babylonia and Assyria, and also seems to have been prevalent in. the temples of Egypt That Aristophanes has -accurately depicted the story of a night’s incubation and the good results of the experiment we know from records in the classics and the many thanksgiving inscriptions that have been recently recovered from the chief Asklepian shrines. The cure may not have been immediately vouchsafed, as in the case of a young Assyrian whoslept in"at the temple of Ægea for a long period, living there apparently en pension, for he had, we are told by Philostratus, plenty of good cheer. The dreams of the sick sleepers, however, more frequently resulted in the receipt of a prescription promising, if followed, to effect a cure than in the actual -relief being afforded during the night, and it is the record of such recipes and their curative, properties that form such interesting matter in the epigraphical texts of Epidaurbs and Athens. That the practice was of high antiquity among the Hellenes is proved by Homer’s reference to the priests of Zeus at Dordona sleeping naked on the bare soil. Miss Mary Hamilton of St. Andrews has published a work treating of "Incubation; or, the Cure of Disease in Pagan Temples and in -Christian Churches," which is important because it so clearly demonstrates the taking -over. _of this . Paganpractice by- the later Christian churches at many sites. To those who know
Imhotep
*
how early ecclesiastics secured the conversion of manysimple worshippers of the oldPantheon by the easy processof canonising their deities this will cause no surprise. M. Goblet D’Alirella, considers the great value of Miss.. Hamilton’s work to consist in the proofs-which she gives, not. so much of the acceptance of the faith-healing practices of heathendom with all their essential concomitant rites, forthis was known before, and had been fully treated of by French writers upon medicine and mythology, but in the,evidence which she brings forward of the practice of incubation. under similar conditions passing over from the temples of the gods to the sanctuaries of the saints at or near the samesacred sites. Thus at Byzantium incubation flourished at. the temple of Castor and Pollux ; a little later and we find it in vogue at the same place in the church of St. Coine and ’ Damian, and tradition evenasserts -that so sudden was the transition that a patient coming for cure at the hands of the Dioscuri received the remedy from their saintly successors. The oneiromantic benefits procurable at the Asklepeia of Cos, Epidauros, Pergamos, Athens, Rome and elsewhere, or in the temples of Pluto, Dionysifis, Isis, and Serapis at such places, are met with, again in churches dedicated to St. Coine and Damian, Martin and Maximian, Therapion, St..John and’ Thecla, and scores of other apostles, saints, and martyrs. It must not be thought that these primitive practices only continued to flourish until the Middle Ages." Incubation is still prevalent in parts of Greece and Italy with the tolerance and encouragement of the priests ; and the presence of medical ex votos or models of the members healed as the result of offerings and prayers to Mary and the saints in hundreds of European, to say nothing of Latin-American churches, proves how widespread is the belief in the association of religion with medicine. The subject is one of entrancing interest in the history of humanity and will some day, we hope, be adequately treated by a scholar who will.’ need to unite in himself the qualities of a competent physician and a devout theologian and to possess a commonsense knowledge of his fellow man. Meanwhile much may be learnt from the classical side in the article on Incubation in the Greek Dictionary of Greek and Roman Antiquities of Darenberg and Saglio and from the religious point of view from M. Albert Marignan’s "La Medecine dans l’Eglise au VI. Siecle."
THE PRESERVATION OF BODIES FOR CORONERS’ INQUESTS. IN ordinary circumstances a coroner’s inquest is held on a body from which life has departed but a short time
previously to happens that
the an
holding of inquest has
the
inquest.
to be held
But it often body which’
on a
ha& been found, in the water and which has presumably been in the water for some weeks. In such circumstances putrefaction prooeeds with great rapidity when the body, already partly decomposed, is removed from the water, and accordingly identification is rendered almost impossible. Dr. F. J. Waldo, the ooroner for the City and for Southwark, has of’ late been .trying to obtain the consent of the Common, Council ,to ,the erection of a refrigerating mortuary, in which such bodies as those referred to above might be -preserved during the time which must elapse between, their finding and the inquest. The matter is under the consideration of the sanitary committee of the Common Council but at present no decisive steps have been taken. At an .inquest held on July 4th in Southwark the jury requested Dr. Waldo to forward to the London CountyCouncil to the, Local Government Board, and to the Home Secretary a resolution urging that Section 93 of the Public-Health Act (London), 1891, should be put into practice " which provides for " refrigerator mortuary accommoda.tion’
CONTRACT PRACTICE AMONGST THE WELL-TO-DO CLASSES.
574
for unidentified bodies. Some means of preserving un. contract system his income must be proportionately less. identified bodies from further decomposition is undoubtedly In fact, the family medical man’s position under such conditions would be summed up as more pay, less work, a necessity, but we are not so sure that the refrigerator mortuary is the best method of preservation. We draw for the number of patients seen is hardly a criterion of the attention of Dr. Waldo and of the municipalities work, if their examination is a mere hurried routine, and interested to an account which appeared in THE LANCET of that state of affairs would not prove satisfactory with Nov. 9th, 1901, p. 1279, of an apparatus in which the active regari to the self-respect and ultimately the credit of preservative was formic aldehyde. The adoption of a re- the practitioner, the welfare of his patients, or the frigerating system implies machinery which would involve a dignity of his profession. We have seen quite enough question of cost. Modern refrigerating methods are, however, of the evils resulting from contract practice amongst perfectly simple, the liquefaction and expansion of gases such the working classes and we are not anxious for its extension to other social spheres where it can quite well as ammonia or carbonic acid gas supplying the necessary lowering of the temperature, and then a circulatory be avoided. The system prevailing in this country in apparatus charged with brine or calcium chloride dis- dealing with the middle and upper classes " is as suitable as any that we know of, and far more so than the principle tributing the cold produced. of the retaining fee which would prove as unworkable as Even if it were adopted, to regulate a rigid tariff scale. CONTRACT PRACTICE AMONGST THE it by the amount of the house rent would lead to obvious WELL-TO-DO CLASSES. Dr. K. Haanshus of Christiania, writing in a recent issue injustices on both sides of the contract. If a contract fee of Tidaskraf for Den Norske Lœgeforening, urges upon the is to be adopted at all it should surely be based on the body of general practitioners the desirability of establishing number of persons whom the contracting practitioner is liable to treat. a fixed and uniform annual fee which shall be paid to them by all families under their medical charge. He recommends THE METROPOLITAN WATER-SUPPLY: THE this course both on behalf of medical men themselves and IMPORTANCE OF INCREASED STORAGE of their patients, for he says the status of the family pracACCOMMODATION. titioner is under the inadequate fees which
falling
absurdly
he receives at present and which cheapens his reputation and professional worth. He quotes the case of one practitioner who received a yearly remuneration of about 11s. from a family of good standing. The consequence is that the"family doctor"is only called in to attend trifling disorders and the patient relies on his own diagnosis of more serious affections to select his own specialist. Not only is this disadvantageous to him but to his children also who during their growth can be benefited so greatly by the watchful care of a regular medical attendant. The family, in other words, loses what should be amongst the greatest benefits of modern medicine, skilled hygienic and prophylactic supervision, which could be obtained by the payment of a reasonable annual retaining fee to a practitioner. This Norwegian plea for reform further discusses the difficulties of fixing an equitable amount for such a fee and suggests that the principle adopted in Copenhagen of charging the householder 10 per cent. of his yearly rent in return for regular medical attendance during the year for himself and his family should be extended to Christiania. We are not informed as to whether this fee includes either attendance at confinements,, or such operative procedures as the general practitioner usually undertakes, or the supply of drugs andappliances, but looking at the matter broadly it amounts to nothing but an elegant form of contract practice, such, we are glad to say, as has gained a very slight foothold in this country. It is true that a similar system has been adopted in India in the civil practice of officers of the Indian Medical Service, who are very generally paid by Government servants a fixed proportion of their pay for attendance on their wives and families. We believe that plan works well enough, but the conditions are far removed from those of civil medical practice in Europe. An Indian medical officer at any particular station is extremely unlikely to have a greater number of Europeans under his charge than be But applying the contract princan look after properly. or district with a large populatown to an English ciple tion there is obviously an extreme temptation for a medical man to swell his income by undertaking the care of more families than he can possibly attend to in a satisfactory manner, especially in epidemic and other times of stress. His brother practitioner, with fewer patients, can give them much better attention, but being bound by the
Dr. A. C. Houston’s report summarising the results of the chemical and bacteriological examination of the London waters for the twelve months ending March 31st, 1908, was issued as an appendix to the reports of committees under the Metropolitan Water Board which were considered at the meeting of that body on July 17th. The lesson of the report may be summed up in one word-storage-as is shown most graphically in a table occurring on an early page, which illustrates the effect of the rainfall on the flow of the river Thames and the resultant effect on the quality of the river water above the Board’s intakes, and indicates the need for judicious selection of ranv water and provision for its adequate storage, so as to prevent the filtered water from being adversely affected during times of flood. We have repeatedly called attention to the need for such provision, and the table is so instructive in its bearing on the matter that we quote it in part :-
The
figures in italics exceed their respective averages
INCUBATION, ANCIENT,, MEDIÆVAL, AND MODERN. and much .improvement followed in these also. Perfect recovery did ...net occur in every case, but there was always.some improvement and in most cases the improvement was very .marked. The xays are administered as follows: A tubular diaphragm is used and a current of large amperage employed, the focus tubes being soft. The exposures last five minutes and are repeated on every other day during the first week.and on every third day during the following weeks until there is either a marked decrease in the swelling or an x-ray dermatitis. In most of the cases fairly large.doses of liquor arsenicalis aregiven at the same time, up to 20 drops three times a day, provided the digestion is not disturbed. In slight cases Professor Beck recommends this treatment ; for cases with more severe symptoms and a greater swelling he advises the combined method, partial excision followed by.x ray treatment of the portion of gland left. For advanced cases where alarming symptoms forbid immediate operative interference the x ray treatment should preoede the operation until improvement of the .general condition occurs. Judging, from this paper we cannot doubt that the use of x rays in exophthalmic goitre deserves an extensive trial. ____
INCUBATION, ANCIENT,, MEDIEVAL, AND MODERN. THE diverting description of what may aptly be termed " sleeping in at the temple of Asklepios at Athens which has amused the readers of the Plutus of Aristophanes for so many centuries is really an account of an incubation at the shrine of the god of healing of two patients, Plutus.and, Nescleides, the latter of whom failed to derive any benefit from the visit. The cure, as described by Plutus’s servant Chremylos, appears to have been achieved by an Asklepiad priest assisted by two acolytes representing laso and Panakeia. For that the officiant was the beneficent deity in person is rendered extremely improbable by Chremylos detecting him abstracting the unconsumed cakes and comestibles from the altar and placing them in a bag for future consumption. He was, however, attended by two trained serpents, so that anyone suddenly awakened by his ministrations and mentally impressed, by the sacred site and solemnity of the occasion, .in the dim light of the sanctuary colonnade might deem his visitant to be the god himself. "
"
"
Like so much of the manners and customs of ancient Greece this system of semi-religious oneiromancy was common in Babylonia and Assyria, and also seems to have been prevalent in. the temples of Egypt That Aristophanes has -accurately depicted the story of a night’s incubation and the good results of the experiment we know from records in the classics and the many thanksgiving inscriptions that have been recently recovered from the chief Asklepian shrines. The cure may not have been immediately vouchsafed, as in the case of a young Assyrian whoslept in"at the temple of Ægea for a long period, living there apparently en pension, for he had, we are told by Philostratus, plenty of good cheer. The dreams of the sick sleepers, however, more frequently resulted in the receipt of a prescription promising, if followed, to effect a cure than in the actual -relief being afforded during the night, and it is the record of such recipes and their curative, properties that form such interesting matter in the epigraphical texts of Epidaurbs and Athens. That the practice was of high antiquity among the Hellenes is proved by Homer’s reference to the priests of Zeus at Dordona sleeping naked on the bare soil. Miss Mary Hamilton of St. Andrews has published a work treating of "Incubation; or, the Cure of Disease in Pagan Temples and in -Christian Churches," which is important because it so clearly demonstrates the taking -over. _of this . Paganpractice by- the later Christian churches at many sites. To those who know
Imhotep
*
how early ecclesiastics secured the conversion of manysimple worshippers of the oldPantheon by the easy processof canonising their deities this will cause no surprise. M. Goblet D’Alirella, considers the great value of Miss.. Hamilton’s work to consist in the proofs-which she gives, not. so much of the acceptance of the faith-healing practices of heathendom with all their essential concomitant rites, forthis was known before, and had been fully treated of by French writers upon medicine and mythology, but in the,evidence which she brings forward of the practice of incubation. under similar conditions passing over from the temples of the gods to the sanctuaries of the saints at or near the samesacred sites. Thus at Byzantium incubation flourished at. the temple of Castor and Pollux ; a little later and we find it in vogue at the same place in the church of St. Coine and ’ Damian, and tradition evenasserts -that so sudden was the transition that a patient coming for cure at the hands of the Dioscuri received the remedy from their saintly successors. The oneiromantic benefits procurable at the Asklepeia of Cos, Epidauros, Pergamos, Athens, Rome and elsewhere, or in the temples of Pluto, Dionysifis, Isis, and Serapis at such places, are met with, again in churches dedicated to St. Coine and Damian, Martin and Maximian, Therapion, St..John and’ Thecla, and scores of other apostles, saints, and martyrs. It must not be thought that these primitive practices only continued to flourish until the Middle Ages." Incubation is still prevalent in parts of Greece and Italy with the tolerance and encouragement of the priests ; and the presence of medical ex votos or models of the members healed as the result of offerings and prayers to Mary and the saints in hundreds of European, to say nothing of Latin-American churches, proves how widespread is the belief in the association of religion with medicine. The subject is one of entrancing interest in the history of humanity and will some day, we hope, be adequately treated by a scholar who will.’ need to unite in himself the qualities of a competent physician and a devout theologian and to possess a commonsense knowledge of his fellow man. Meanwhile much may be learnt from the classical side in the article on Incubation in the Greek Dictionary of Greek and Roman Antiquities of Darenberg and Saglio and from the religious point of view from M. Albert Marignan’s "La Medecine dans l’Eglise au VI. Siecle."
THE PRESERVATION OF BODIES FOR CORONERS’ INQUESTS. IN ordinary circumstances a coroner’s inquest is held on a body from which life has departed but a short time
previously to happens that
the an
holding of inquest has
the
inquest.
to be held
But it often body which’
on a
ha& been found, in the water and which has presumably been in the water for some weeks. In such circumstances putrefaction prooeeds with great rapidity when the body, already partly decomposed, is removed from the water, and accordingly identification is rendered almost impossible. Dr. F. J. Waldo, the ooroner for the City and for Southwark, has of’ late been .trying to obtain the consent of the Common, Council ,to ,the erection of a refrigerating mortuary, in which such bodies as those referred to above might be -preserved during the time which must elapse between, their finding and the inquest. The matter is under the consideration of the sanitary committee of the Common Council but at present no decisive steps have been taken. At an .inquest held on July 4th in Southwark the jury requested Dr. Waldo to forward to the London CountyCouncil to the, Local Government Board, and to the Home Secretary a resolution urging that Section 93 of the Public-Health Act (London), 1891, should be put into practice " which provides for " refrigerator mortuary accommoda.tion’
CONTRACT PRACTICE AMONGST THE WELL-TO-DO CLASSES.
574
for unidentified bodies. Some means of preserving un. contract system his income must be proportionately less. identified bodies from further decomposition is undoubtedly In fact, the family medical man’s position under such conditions would be summed up as more pay, less work, a necessity, but we are not so sure that the refrigerator mortuary is the best method of preservation. We draw for the number of patients seen is hardly a criterion of the attention of Dr. Waldo and of the municipalities work, if their examination is a mere hurried routine, and interested to an account which appeared in THE LANCET of that state of affairs would not prove satisfactory with Nov. 9th, 1901, p. 1279, of an apparatus in which the active regari to the self-respect and ultimately the credit of preservative was formic aldehyde. The adoption of a re- the practitioner, the welfare of his patients, or the frigerating system implies machinery which would involve a dignity of his profession. We have seen quite enough question of cost. Modern refrigerating methods are, however, of the evils resulting from contract practice amongst perfectly simple, the liquefaction and expansion of gases such the working classes and we are not anxious for its extension to other social spheres where it can quite well as ammonia or carbonic acid gas supplying the necessary lowering of the temperature, and then a circulatory be avoided. The system prevailing in this country in apparatus charged with brine or calcium chloride dis- dealing with the middle and upper classes " is as suitable as any that we know of, and far more so than the principle tributing the cold produced. of the retaining fee which would prove as unworkable as Even if it were adopted, to regulate a rigid tariff scale. CONTRACT PRACTICE AMONGST THE it by the amount of the house rent would lead to obvious WELL-TO-DO CLASSES. Dr. K. Haanshus of Christiania, writing in a recent issue injustices on both sides of the contract. If a contract fee of Tidaskraf for Den Norske Lœgeforening, urges upon the is to be adopted at all it should surely be based on the body of general practitioners the desirability of establishing number of persons whom the contracting practitioner is liable to treat. a fixed and uniform annual fee which shall be paid to them by all families under their medical charge. He recommends THE METROPOLITAN WATER-SUPPLY: THE this course both on behalf of medical men themselves and IMPORTANCE OF INCREASED STORAGE of their patients, for he says the status of the family pracACCOMMODATION. titioner is under the inadequate fees which
falling
absurdly
he receives at present and which cheapens his reputation and professional worth. He quotes the case of one practitioner who received a yearly remuneration of about 11s. from a family of good standing. The consequence is that the"family doctor"is only called in to attend trifling disorders and the patient relies on his own diagnosis of more serious affections to select his own specialist. Not only is this disadvantageous to him but to his children also who during their growth can be benefited so greatly by the watchful care of a regular medical attendant. The family, in other words, loses what should be amongst the greatest benefits of modern medicine, skilled hygienic and prophylactic supervision, which could be obtained by the payment of a reasonable annual retaining fee to a practitioner. This Norwegian plea for reform further discusses the difficulties of fixing an equitable amount for such a fee and suggests that the principle adopted in Copenhagen of charging the householder 10 per cent. of his yearly rent in return for regular medical attendance during the year for himself and his family should be extended to Christiania. We are not informed as to whether this fee includes either attendance at confinements,, or such operative procedures as the general practitioner usually undertakes, or the supply of drugs andappliances, but looking at the matter broadly it amounts to nothing but an elegant form of contract practice, such, we are glad to say, as has gained a very slight foothold in this country. It is true that a similar system has been adopted in India in the civil practice of officers of the Indian Medical Service, who are very generally paid by Government servants a fixed proportion of their pay for attendance on their wives and families. We believe that plan works well enough, but the conditions are far removed from those of civil medical practice in Europe. An Indian medical officer at any particular station is extremely unlikely to have a greater number of Europeans under his charge than be But applying the contract princan look after properly. or district with a large populatown to an English ciple tion there is obviously an extreme temptation for a medical man to swell his income by undertaking the care of more families than he can possibly attend to in a satisfactory manner, especially in epidemic and other times of stress. His brother practitioner, with fewer patients, can give them much better attention, but being bound by the
Dr. A. C. Houston’s report summarising the results of the chemical and bacteriological examination of the London waters for the twelve months ending March 31st, 1908, was issued as an appendix to the reports of committees under the Metropolitan Water Board which were considered at the meeting of that body on July 17th. The lesson of the report may be summed up in one word-storage-as is shown most graphically in a table occurring on an early page, which illustrates the effect of the rainfall on the flow of the river Thames and the resultant effect on the quality of the river water above the Board’s intakes, and indicates the need for judicious selection of ranv water and provision for its adequate storage, so as to prevent the filtered water from being adversely affected during times of flood. We have repeatedly called attention to the need for such provision, and the table is so instructive in its bearing on the matter that we quote it in part :-
The
figures in italics exceed their respective averages