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THE PRINCE OF WALES ON THE RELATIONS OF THE PUBLIC AND THE MEDICAL PROFESSION.
THE PRINCE OF WALES: THE PUBLIC AND THE MEDICAL PROFESSION.
1752
Section 115
supplied by effect
(3)
which is to the
following
:-
If a justice is satisfied by information on oath (a) that there is reasonable ground for such entry and that there has been a refusal or failure to admit to such premises, and either that reasonable notice of the intention to apply to a justice for a warrant has been given or that the giving of notice would defeat the object of the entry ; or (b) That there is reasonable cause to believe that there is on the said premises some contravention of this Act or of any by-law under this Act, and that an application for admission or notice of an application for the warrant would defeat the object of the entry, The justice may by warrant under his hand authorise the sanitary authority or their officers or other person as the case may require to enter the premises," &c. "
When action is taken in this way the penalty for obstruction becomes a fine not exceeding E20. It may well be considered whether
would not be
smaller
a
more
penalty
more
obtained
easily
to the purpose.
exception can well be taken from the legal to the judgment delivered by the magistrate its effects can hardly fail to be regrettable. The general public does not appreciate nice points of law and in so Although standpoint
no
the average householder familiarises himself with this case he will probably conclude that he is justified by
far
as
it in
refusing
admission to the
sanitary inspector
when
By acting in such a way he will materially impede sanitary authority in its work while unconsciously laying himself open to even greater possibilities in the matter of punishment than those which he thinks he has escaped. The position of the sanitary inspector is often more than sufficiently difficult at present. He is not a welcome visitor in general and even with the weight of influence which his uniform brings to bear he meets with as many obstacles in the execution of his duty as can be interposed without his being roused to the drastic retaliation of a summons. The gusto can well be imagined with which the sweater or
he thinks proper.
the
the purveyor of diseased meat will now shut the door in his face unless, and probably although, he comes armed with the formal warrant. to
get.
The
justice
has
a
Nor is the warrant
good
what constitutesreasonable
appears from the
leading
always easy deciding entry and, as
deal of latitude in
ground"
case
for
of Vines
Collegiate School, it is not enough inspector was acting honestly with
North London to show that the sanitary a
v.
view to the
discharge
of his duties.
Nobody-except, perhaps, the proprietor-will question expediency of having an ice-cream manufactory under close supervision by the sanitary authority, but if the authority has to be constantly hampered by the necessity of obtaining warrants the desired supervision can hardly be carried out in a satisfactory manner. It might be thought
the
that in this instance assistance could the
portion
be obtained from
of the Act devoted to the
subject
of
un-
(1) (b) "any medical officer By of health or sanitary inspector may at all reasonable times enter any premises and inspect and examine any article for the purpose of sale or of preparadeposited tion for sale," but it appears from Clause (6) of the same sound food.
......
section that
Section 47
......
entry in this
case
also is controlled
by the
already referred conditions is possibly the result of
[
given in Section 115. It some oversight in the drafting of the that the sanitary authority is so greatly restricted in its powers of entry. The matter is hardly one calling for special legislation, but when in the fulness of time the law relatingto public health is brought up to date this important branch of the subject ought not to be neglected. to
as
Act
Annotations. "
THE
PRINCE OF THE
I dinner
Ne
quid
nimis."
WALES ON THE RELATIONS PUBLIC AND THE MEDICAL PROFESSION.
OF
THE Prince of Wales made an admirable speech at the in behalf of the Royal Medical Benevolent College last week, as our readers have been able to judge for themselves, and probably they consider, as we do, that the medical profession owes a deep debt of gratitude to His Royal Highness for his pronouncement upon the relations that should unite the public and the medical man. The intimate and trusted friend of his patients from their cradles to their graves was the picture which the Prince of Wales, as a member of the public, drew of the ideal medical man, and we are certain that this is the position to which all of us who are in family practice aspire. The medical man’s ministrations cannot be given merely in response to the ordinary laws of supply and demand. The grave and sacred responsibilities which he is compelled to assume beside the bed of sickness, responsibilities that may be wellnigh as important towards the patient’s family as towards the patient, make it impossible that his relations with the public should be regarded merely from the point of view of mercenary service. Not a day goes by that more is not asked of the medical practitioner by some of his patients than can ever be repaid by money ; and not a medical man among us but owns cheerfully that this is the circumstance of his life that brings sweetness into the round of toil. In the blackest hour of anxiety and in the brightest hour of hope the medical man is accepted as a friend whose sympathy may be assumed and whose unsparing efforts can be Is not this a proud position ? But taken for granted. the practical side of the medical life must not be lost sight of, and it is undoubted that the pecuniary rewards of In particular it is our professional career are not great. for the hard young practitioner to make any exceedingly in the provision early days of practice for the future, so that early death-alas, not an uncommon thing when the work to be done is so arduous and dangerous-is apt to mean poverty (poverty, perhaps, of the direst sort) for a young widow and her children. Mainly to meet such terrible cases the benevolent side of Epsom College was founded and further support is asked for it upon the grounds indicated in the Prince of Wales’s warm tribute to medical altruism. The public must always owe the medical profession a debt and they cannot pay it better than by subscribing to such an institution as Epsom College. The benevolent side of the College offers a shelter to the declining years of one set of pensioners and opportunities of a bright entry into life to another set. And whether it is the man or his widow whose medical infirmities preclude aged continuance of an unaided struggle for existence, or whether it is the little lad whose early orphanage has robbed him of his legitimate start in life-each is a legitimate object of public generosity. We are glad to see that the Prince of
SIR E. CASSEL’S GIFT FOR THE RELIEF OF OPHTHALMIA IN EGYPT.
1753
Wales, in making this claim for the foundation of Epsom vigorous babyhood. For this reason it is impossible to. College in unmistakeable terms, laid stress upon the fact that doubt the mischievous effect of fat baby shows such the College as a whole was a highly successful public school, as that recently held at Walthamstow. Baby showsno more requiring public subvention than, say, Eton. It is only properly conducted, the prizes being awarded to those. the charitable side that requires assistance and the assistance babies who manifested the largest number of really good can
be asked for with
complete dignity
as a
right.
"points"and
the clearest evidence of careful managepractical and fruitful means of educating the laity in the true principles of infant culture and at the same time would disabuse the minds of mothers of many of their misconceptions, and among others of their admiration for the hypertrophic pathological types which Raphael and others among the great masters have perpetuated on canvas as pleasing standards of vigorous babyhood to be copied and admired.
ment, would be
BABY SHOWS. THE surest way to reach a mother’s heart is through her child and commercial enterprise at Walthamstow has apparently not been slow to turn this knowledge to practical account, for we recently noticed in a morning contemporary the following paragraph : "A fat baby competition organised by a local firm of furniture dealers was one of the most popular holiday attractions at Walthamstow. Nearly 50 babies, all born in March, came to the scales which were erected in the firm’s shop window. The winner tipped the beam at 16J2- pounds. At the conUnforclusion of the weighing prizes were awarded. tunately, baby shows of this kind have a tragic as well as an amusing side, for the reason that they encourage the belief, which is far too generally entertained, even among the educated classes, that obesity in infants is It is, however, a matter of synonymous with health. clinical experience that a fat baby is unhealthy, with little resistance to disease, and likely to succumb on the least provocation to any of the so-called minor ailments of infancy. It is very greatly to be regretted that baby shows, if they are to be held at all, cannot be utilised for educating the laity to admire in babies those points"which are genuinely deserving of admiration and expressive of a physiological condition, instead of acting, as they do, as direct inducements to over-feeding with foods which fatten but do not produce sound, healthy tissues. Some little time ago Mr. Rowntree in his admirable work entitled "Poverty"drew attention to the fact that the dietaries of a large proportion of the poorer classes were deficient in nitrogen-containing or proteid foods to a degree which was incompatible with the maintenance of a normal standard of health. Unfortunately, with few exceptions tissue-forming or proteid foods are expensive, while the nitrogen-free varieties such as the carbohydrates are comparatively cheap and hence there are economic reasons why the small wage-earner should, in the belief that he is laying out his money to the best advantage, provide himself and his family with foods which are quite unsuitable. The effect of this injudicious dieting is even more serious in the case of children than in the case of adult persons, for in addition to the necessity for the proteid elements of food for the repairing of tissue there is a necessity for them to satisfy the needs of growth. An examination of the dietaries of that considerable number of infants of the poorer classes who are artificially fed discloses the fact that while they are relatively starved as far as proteids and fats are concerned they are grossly overfed in respect of the carbohydrate "
elements, with the consequence that in addition
to
an
unnecessarily large storage of glycogen and fat in such infants there is also a large predominance of physiologically unsound tissue approximating somewhat closely to the embryonic type, deficient in nitrogen and liable to undergo degenerative changes of the hyaline, mucoid, or carbohydrate type. The appearance of these carbohydrateor sugar-fed infants is highly characteristic. There is a curiously translucent and almost opalescent appearance of the tissues ; they are hypertrophic square-headed infants and to the touch they are cold, gelatinous, and flabby, with none of the elasticity and tone which characterise the tissues of the vigorous, healthy, breast-fed infant. It is these sugarfed, gelatinous babies who receive the prizes at infant shows and are held up by their proud parents as paragons of
a
-
SIR
ERNEST CASSEL’S GIFT FOR THE OF OPHTHALMIA IN EGYPT.
RELIEF
Sir Ernest Cassel having given a large sum of money Egyptian Government for the relief of ophthalmia in Egypt it has been decided to send travelling dispensaries into the country for the relief of those sufferers who are unable to attend the already existing hospitals. There will be at first one of these dispensaries or ambulance hospitals which will have a couple of tents with beds for operation cases and for the more serious treatment of cases. This will travel about from place to place under the direction of an ophthalmic surgeon who will have under him an Egyptian assistant surgeon. If the experiment is successful the number of dispensaries will be increased. Mr. A. F. MacCallan has been appointed by the Egyptian Government to organise and to direct the enterprise with the title of "inspector of travelling ophthalmic dispensaries in Egypt." Mr. MacCallan was formerly senior house surgeon at the Royal London Ophthalmic Hospital (Moorfields) and at the present time holds the post of chief clinical assistant at the hospital. He will leave for Egypt immediately and has clearly the necessary qualifications to start the quaint experiment upon a sound basis. But what will be regarded as a sufficient measure of success to justify the making of further experiments, and who is to judge what is a success and what is a failure ? to the
____
PARALYSIS
AGITANS.
A VALUABLE "symposium" on paralysis agitans appears in the New York Medical Journal of May 2nd, and among the contributors are Dr. Joseph Collins, Professor M. Allen Starr, and Dr. Bernard Sachs. The facts observed and collected cover a very extensive field and refer mainly to the etiology, pathology, and treatment of this affection in their latest developments. Dr. Collins states in his paper that among 50 cases recently under his care 34 were males and 16 were females or 68 per cent. and 32 per cent. respectively. The average age at which the disease developed was 51 years. The youngest patient was 32 years of age and the oldest 72. He found paralysis agitans to be frequent among persons of Celtic descent and rare among the Hebrews. There was a history of neuropathic heredity in 13 of the cases or 26 per cent. and a history of paralysis agitans in the parents or uncles in six cases. Syphilis and alcohol were conspicuous by their absence as etiological factors. Worry and anxiety were traceable in seven cases and injury was assigned as a cause in the same number of cases. Dr. Collins stated his belief that "paralysis agitans was a disease of early senility, occurring as the reward of virtue." Professor Starr stated that a hereditary predisposition to the disease was met with in about 4 or 5 per cent. of cases, but that anxiety and injury appeared to him to bear a distinct etiological relation to paralysis agitans. He had never seen a patient absolutely cured of
1752
Section 115
supplied by effect
(3)
which is to the
following
:-
If a justice is satisfied by information on oath (a) that there is reasonable ground for such entry and that there has been a refusal or failure to admit to such premises, and either that reasonable notice of the intention to apply to a justice for a warrant has been given or that the giving of notice would defeat the object of the entry ; or (b) That there is reasonable cause to believe that there is on the said premises some contravention of this Act or of any by-law under this Act, and that an application for admission or notice of an application for the warrant would defeat the object of the entry, The justice may by warrant under his hand authorise the sanitary authority or their officers or other person as the case may require to enter the premises," &c. "
When action is taken in this way the penalty for obstruction becomes a fine not exceeding E20. It may well be considered whether
would not be
smaller
a
more
penalty
more
obtained
easily
to the purpose.
exception can well be taken from the legal to the judgment delivered by the magistrate its effects can hardly fail to be regrettable. The general public does not appreciate nice points of law and in so Although standpoint
no
the average householder familiarises himself with this case he will probably conclude that he is justified by
far
as
it in
refusing
admission to the
sanitary inspector
when
By acting in such a way he will materially impede sanitary authority in its work while unconsciously laying himself open to even greater possibilities in the matter of punishment than those which he thinks he has escaped. The position of the sanitary inspector is often more than sufficiently difficult at present. He is not a welcome visitor in general and even with the weight of influence which his uniform brings to bear he meets with as many obstacles in the execution of his duty as can be interposed without his being roused to the drastic retaliation of a summons. The gusto can well be imagined with which the sweater or
he thinks proper.
the
the purveyor of diseased meat will now shut the door in his face unless, and probably although, he comes armed with the formal warrant. to
get.
The
justice
has
a
Nor is the warrant
good
what constitutesreasonable
appears from the
leading
always easy deciding entry and, as
deal of latitude in
ground"
case
for
of Vines
Collegiate School, it is not enough inspector was acting honestly with
North London to show that the sanitary a
v.
view to the
discharge
of his duties.
Nobody-except, perhaps, the proprietor-will question expediency of having an ice-cream manufactory under close supervision by the sanitary authority, but if the authority has to be constantly hampered by the necessity of obtaining warrants the desired supervision can hardly be carried out in a satisfactory manner. It might be thought
the
that in this instance assistance could the
portion
be obtained from
of the Act devoted to the
subject
of
un-
(1) (b) "any medical officer By of health or sanitary inspector may at all reasonable times enter any premises and inspect and examine any article for the purpose of sale or of preparadeposited tion for sale," but it appears from Clause (6) of the same sound food.
......
section that
Section 47
......
entry in this
case
also is controlled
by the
already referred conditions is possibly the result of
[
given in Section 115. It some oversight in the drafting of the that the sanitary authority is so greatly restricted in its powers of entry. The matter is hardly one calling for special legislation, but when in the fulness of time the law relatingto public health is brought up to date this important branch of the subject ought not to be neglected. to
as
Act
Annotations. "
THE
PRINCE OF THE
I dinner
Ne
quid
nimis."
WALES ON THE RELATIONS PUBLIC AND THE MEDICAL PROFESSION.
OF
THE Prince of Wales made an admirable speech at the in behalf of the Royal Medical Benevolent College last week, as our readers have been able to judge for themselves, and probably they consider, as we do, that the medical profession owes a deep debt of gratitude to His Royal Highness for his pronouncement upon the relations that should unite the public and the medical man. The intimate and trusted friend of his patients from their cradles to their graves was the picture which the Prince of Wales, as a member of the public, drew of the ideal medical man, and we are certain that this is the position to which all of us who are in family practice aspire. The medical man’s ministrations cannot be given merely in response to the ordinary laws of supply and demand. The grave and sacred responsibilities which he is compelled to assume beside the bed of sickness, responsibilities that may be wellnigh as important towards the patient’s family as towards the patient, make it impossible that his relations with the public should be regarded merely from the point of view of mercenary service. Not a day goes by that more is not asked of the medical practitioner by some of his patients than can ever be repaid by money ; and not a medical man among us but owns cheerfully that this is the circumstance of his life that brings sweetness into the round of toil. In the blackest hour of anxiety and in the brightest hour of hope the medical man is accepted as a friend whose sympathy may be assumed and whose unsparing efforts can be Is not this a proud position ? But taken for granted. the practical side of the medical life must not be lost sight of, and it is undoubted that the pecuniary rewards of In particular it is our professional career are not great. for the hard young practitioner to make any exceedingly in the provision early days of practice for the future, so that early death-alas, not an uncommon thing when the work to be done is so arduous and dangerous-is apt to mean poverty (poverty, perhaps, of the direst sort) for a young widow and her children. Mainly to meet such terrible cases the benevolent side of Epsom College was founded and further support is asked for it upon the grounds indicated in the Prince of Wales’s warm tribute to medical altruism. The public must always owe the medical profession a debt and they cannot pay it better than by subscribing to such an institution as Epsom College. The benevolent side of the College offers a shelter to the declining years of one set of pensioners and opportunities of a bright entry into life to another set. And whether it is the man or his widow whose medical infirmities preclude aged continuance of an unaided struggle for existence, or whether it is the little lad whose early orphanage has robbed him of his legitimate start in life-each is a legitimate object of public generosity. We are glad to see that the Prince of
SIR E. CASSEL’S GIFT FOR THE RELIEF OF OPHTHALMIA IN EGYPT.
1753
Wales, in making this claim for the foundation of Epsom vigorous babyhood. For this reason it is impossible to. College in unmistakeable terms, laid stress upon the fact that doubt the mischievous effect of fat baby shows such the College as a whole was a highly successful public school, as that recently held at Walthamstow. Baby showsno more requiring public subvention than, say, Eton. It is only properly conducted, the prizes being awarded to those. the charitable side that requires assistance and the assistance babies who manifested the largest number of really good can
be asked for with
complete dignity
as a
right.
"points"and
the clearest evidence of careful managepractical and fruitful means of educating the laity in the true principles of infant culture and at the same time would disabuse the minds of mothers of many of their misconceptions, and among others of their admiration for the hypertrophic pathological types which Raphael and others among the great masters have perpetuated on canvas as pleasing standards of vigorous babyhood to be copied and admired.
ment, would be
BABY SHOWS. THE surest way to reach a mother’s heart is through her child and commercial enterprise at Walthamstow has apparently not been slow to turn this knowledge to practical account, for we recently noticed in a morning contemporary the following paragraph : "A fat baby competition organised by a local firm of furniture dealers was one of the most popular holiday attractions at Walthamstow. Nearly 50 babies, all born in March, came to the scales which were erected in the firm’s shop window. The winner tipped the beam at 16J2- pounds. At the conUnforclusion of the weighing prizes were awarded. tunately, baby shows of this kind have a tragic as well as an amusing side, for the reason that they encourage the belief, which is far too generally entertained, even among the educated classes, that obesity in infants is It is, however, a matter of synonymous with health. clinical experience that a fat baby is unhealthy, with little resistance to disease, and likely to succumb on the least provocation to any of the so-called minor ailments of infancy. It is very greatly to be regretted that baby shows, if they are to be held at all, cannot be utilised for educating the laity to admire in babies those points"which are genuinely deserving of admiration and expressive of a physiological condition, instead of acting, as they do, as direct inducements to over-feeding with foods which fatten but do not produce sound, healthy tissues. Some little time ago Mr. Rowntree in his admirable work entitled "Poverty"drew attention to the fact that the dietaries of a large proportion of the poorer classes were deficient in nitrogen-containing or proteid foods to a degree which was incompatible with the maintenance of a normal standard of health. Unfortunately, with few exceptions tissue-forming or proteid foods are expensive, while the nitrogen-free varieties such as the carbohydrates are comparatively cheap and hence there are economic reasons why the small wage-earner should, in the belief that he is laying out his money to the best advantage, provide himself and his family with foods which are quite unsuitable. The effect of this injudicious dieting is even more serious in the case of children than in the case of adult persons, for in addition to the necessity for the proteid elements of food for the repairing of tissue there is a necessity for them to satisfy the needs of growth. An examination of the dietaries of that considerable number of infants of the poorer classes who are artificially fed discloses the fact that while they are relatively starved as far as proteids and fats are concerned they are grossly overfed in respect of the carbohydrate "
elements, with the consequence that in addition
to
an
unnecessarily large storage of glycogen and fat in such infants there is also a large predominance of physiologically unsound tissue approximating somewhat closely to the embryonic type, deficient in nitrogen and liable to undergo degenerative changes of the hyaline, mucoid, or carbohydrate type. The appearance of these carbohydrateor sugar-fed infants is highly characteristic. There is a curiously translucent and almost opalescent appearance of the tissues ; they are hypertrophic square-headed infants and to the touch they are cold, gelatinous, and flabby, with none of the elasticity and tone which characterise the tissues of the vigorous, healthy, breast-fed infant. It is these sugarfed, gelatinous babies who receive the prizes at infant shows and are held up by their proud parents as paragons of
a
-
SIR
ERNEST CASSEL’S GIFT FOR THE OF OPHTHALMIA IN EGYPT.
RELIEF
Sir Ernest Cassel having given a large sum of money Egyptian Government for the relief of ophthalmia in Egypt it has been decided to send travelling dispensaries into the country for the relief of those sufferers who are unable to attend the already existing hospitals. There will be at first one of these dispensaries or ambulance hospitals which will have a couple of tents with beds for operation cases and for the more serious treatment of cases. This will travel about from place to place under the direction of an ophthalmic surgeon who will have under him an Egyptian assistant surgeon. If the experiment is successful the number of dispensaries will be increased. Mr. A. F. MacCallan has been appointed by the Egyptian Government to organise and to direct the enterprise with the title of "inspector of travelling ophthalmic dispensaries in Egypt." Mr. MacCallan was formerly senior house surgeon at the Royal London Ophthalmic Hospital (Moorfields) and at the present time holds the post of chief clinical assistant at the hospital. He will leave for Egypt immediately and has clearly the necessary qualifications to start the quaint experiment upon a sound basis. But what will be regarded as a sufficient measure of success to justify the making of further experiments, and who is to judge what is a success and what is a failure ? to the
____
PARALYSIS
AGITANS.
A VALUABLE "symposium" on paralysis agitans appears in the New York Medical Journal of May 2nd, and among the contributors are Dr. Joseph Collins, Professor M. Allen Starr, and Dr. Bernard Sachs. The facts observed and collected cover a very extensive field and refer mainly to the etiology, pathology, and treatment of this affection in their latest developments. Dr. Collins states in his paper that among 50 cases recently under his care 34 were males and 16 were females or 68 per cent. and 32 per cent. respectively. The average age at which the disease developed was 51 years. The youngest patient was 32 years of age and the oldest 72. He found paralysis agitans to be frequent among persons of Celtic descent and rare among the Hebrews. There was a history of neuropathic heredity in 13 of the cases or 26 per cent. and a history of paralysis agitans in the parents or uncles in six cases. Syphilis and alcohol were conspicuous by their absence as etiological factors. Worry and anxiety were traceable in seven cases and injury was assigned as a cause in the same number of cases. Dr. Collins stated his belief that "paralysis agitans was a disease of early senility, occurring as the reward of virtue." Professor Starr stated that a hereditary predisposition to the disease was met with in about 4 or 5 per cent. of cases, but that anxiety and injury appeared to him to bear a distinct etiological relation to paralysis agitans. He had never seen a patient absolutely cured of