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UNFIT HOUSES.
1375 individual is the best that
can meanwhile be accomwhat Mr. had to say about As Treves regards plished. wounds of the abdomen it struck us as being sound, wellThat the results of battle-field reasoned out, and are most disappointing is not to be wondered at laparotomy under the circumstances. We have from the first declared that operative interference in such cases must have a very
practical.
limited application indeed under the conditions that obtain in war. The fact that so many recoveries have taken place in such wounds when caused by the Mauser bullet in Mr. Treves’s experience is a new and important point. We are glad to have his corroborative testimony as to the favourable effect of previous abstinence from food and enforced rest on the battle-field whilst the wounded are waiting to be removed from it in such cases, in other words, absence of all movements together with physiological rest. The Mauser is, on the whole, a more merciful missile than that of the Lee-Metford, but both inflict far less serious injury than did the weapons of the past. In mitigation of the sufferings of the wounded who had to remain unaided on the battle-fields of the past there is this to be said, that they were spared the meddlesome interference of the incompetent whilst Nature had the chance of doing her best. It is needless to add that we have only cursorily touched the fringe, as it were, of the subject on which Mr. Treves dilated so well and instructively at the Royal Medical and Chirurgical Society’s meeting.
necessary and desirable. The true reason for the dismissal of Mr. Randall is doubtless to be found in the fact that he has been courageous enough to point out to his council what steps should be taken to improve the sanitary condition of the town, in which we may note incidentally the death-rate from typhoid fever last year was three times as high as in the rest of the country. His suggestions have been reiterated year after year and some of the members of the council may possibly think they can shirk their duty to their constituents by closing his mouth. It is the conduct of such gentlemen as form the majority of the Maesteg District Council which has rendered necessary Clause 2 of the Medical Officers of Health and Sanitary Inspectors’ Bill which has been introduced into Parliament by Dr. Farquharson and which is down for second reading on May 16th. This clause provides that officers of health (including in this term medical officers of health and sanitary inspectors) shall hold office until they die, resign, or become insane, or are removed by, The or with the consent of, the Local Government Board. Board is practically committed to the principle of this clause, for of late years not only has sanction been given to the permanent appointment of medical officers of health, but many local authorities who have fixed definite periods have been advised to appoint permanently.
UNFIT HOUSES.
IN THE LANCET of Jan. 28th, 1899, p. 246, we commented in an article headed as above upon the Gilbertian THE TENURE OF OFFICE OF MEDICAL situation which had arisen in the parish of St. GeorgeOFFICERS OF HEALTH. tbe-Martyr, Southwark, with reference to the street known IT has always seemed an anomaly that while the principal as Red Cow-alley. So far back as November, 1895, Poor-law officials, among whom are medical officers, hold some cottages in this street were closed and dismantled office permanently, or if dismissed from office can appeal for by a magistrate’s order but were not pulled down. In reinstatement to the Local Government Board, those officers November, 1898, the Vestry of St. George’s made an of local authorities who are appointed under the Public order on the representation of Dr. F. J. Waldo, the Health Act may be elected for a term of years varying from medical officer of health, that the houses should be pulled one year upwards, and at the end of this period the electing down. This order was made in conformity with the authority without appearing to dismiss their official may provisions of the Housing of the Working ’Classes, Act, actually do so by appointing some other person in his place. 1890. The owners of the property appealed against However conscientious an officer may be he is not likely to this order to the Court of Quarter Sessions and the appeal do his work any better if he feels that he must keep the was heard on Jan. 13th, 1899. Mr. Frank Gover, who right side of" certain members of his authority and the appeared for the owners argued with an ingenuity which did feeling of irritation engendered thereby only lessens him infinite credit as follows. The word "dwelling-house" his usefulness to the community which he serves. These in the Act under which these houses are ordered to be remarks apply more especially to health officers, and if demolished means an inhabited house. Nobody lives in security of tenure of their offices should be granted these houses, ergo they are not dwelling-houses, ergo they The court to any public officials it should certainly be to these, as from cannot be pulled down under- this Act. the very nature of their work they are more likely than was struck by this quibbling and agreed to state a any of their colleagues to provoke the hostility of prominent case and the houses remained as they were until ratepayers or of members of the body by whom they are November, 1899, when Mr. Justice Ridley and Mr. elected. Instances of the capricious removal from office Justice Darling sent the case back again to the Quarter of medical officers of health have been frequently Sessions to determine how much of the premises was a danger recorded. The latest example reaches us from South to public health. At the meeting of the quarter sessions Wales where in the thriving mining town of Maesteg, which in January, 1900, Mr. Gover stated that portions had been has a population of some 14,000 persons, the urban demolished and the drains sealed. The case was adjourned district council decided last week by six votes to four to until February, and the Vestry having inspected the premises dispense with the services of Mr. Wyndham Randall who for declared that they were not satisfied. On the day for hearfive years has acted as their medical officer of health and to ing the owners were only represented by a solicitor’s clerk appoint another gentleman in his place. This dismissal and the chairman adjourned the case till March. March could hardly have been owing to lack of experience in arrived and the chairman, Mr. Loveland Loveland, decided public health matters, for Mr. Randall has been medical to inspect the houses in the company of sanitary experts. officer of health to a neighbouring district for 15 years Who these experts are is unknown to the Vestry. However, and for a long period to the town of Bridgend. It the inspection came off and Mr. Loveland Loveland delivered cannot be said, too, that the Local Government Board were judgment, which was duly reported to the Vestry on dissatisfied with the work he had accomplished, for when he April 24th. The court makes no further order for demolition was reappointed by the Maesteg Council three years ago the and each side pays its own costs! Such is the mouse of Board stated that it was prepared to sanction his appoint- which the mountain of five years’ hard work on the part of ment permanently. Before approving the district council’s Dr. Waldo and the Vestry, together with much solemn new nominee the Board will surely require the strongest legislation, has brought forth. The decision may be law is to it that the evidence be placed before but it is neither justice nor common sense. We are glad to proposed change
1376
vestries
see that the facts of the case are to be laid before all entirely disappeared. In the county and town of Leicester and boards of works, and it is to be hoped that a question the reduction in phthisis during the last 60 years had been will be asked on the matter in the House of Commons. even more satisfactory than in the country at large. Taking There is one bright spot in this miserable story and that is all forms of tuberculosis together he found that in the five years 1864 to 1868 they were responsible for 33 deaths that the owners of the slum property are getting no rent. annually in every 10,000 of the population of the borough of Leicester, whilst in the five years from 1894 to 1898 PREVENTION AND TREATMENT OF they caused only 18 deaths per 10,000 of the population. TUBERCULOSIS. He believed that the decline in the mortality from pulTHE annual meeting of the Leicester and Leicestershire monary consumption would be maintained in the near future Branch of the National Association for the Prevention of as it had been in the past. Already the diminished deathConsumption and other Forms of Tuberculosis was held at rate from tuberculous diseases meant a saving of 75,000 lives Leicester on April 27th under the presidency of Sir Thomas per annum. With respect to the preventive and remedial Wright, chairman of the Executive Committee. At the measures it was necessary to guard carefully against the conoutset the chairman read a long and interesting letter from tamination of butcher’s meat and milk. The striking immunity a gentleman bearing eloquent testimony to the efficacy of from tuberculous disease enjoyed in all ages by the Jewish the means recommended by the association and describing race must be attributed in some measure to the rules as to the case of his wife who a little more than a year ago dietary laid down by Moses, and to the still stricter developed decided symptoms of phthisis. In March last ordinances of the Talmud as to the examination of the year it was arranged for her to undergo the open-air treat- carcasses of all animals used as food. An important reform ment at Bexhill-on-Sea and the results were said to be in our present system would be the abolition of all private marvellous. She rapidly lost her cough, regained flesh and slaughter-houses and the provision of municipal abattoirs strength, and in six months was practically cured, although so that all meat sold might be subjected to skilled inspecit was found that she had two considerable cavities in the tion. Having dwelt at considerable length on the prelung. She now weighed nearly 4 st. more than she did a cautionary measures necessary to secure a milk-supply year ago and was in perfect health and strength. District free from contamination, Sir James Crichton Browne councils have the power under the Dairies, Cowsheds, and said that tuberculous diseases were scarcely hereditary Milkshops Order of 1885 to make regulations for securing the in the ordinary sense and yet they ran in families. It inspection of dairy cattle and milk stores, and on account of was quite possible that the bacilli might pass from a the dangers connected with the use of tuberculous milk the tuberculous mother to a child and be born with it, but Executive Committee had made inquiry of every urban and such an occurrence must be rare. exceedingly Among rural district council in the town and county of Leicester as animals there were only certain species in which to whether they availed themselves of this power, with the tubercle would become domiciled. Sheep, asses, and goats result that it was found that 18 councils had drawn up were almost immune from it, while the bovine tribe was regulations and seven had not. The committee hoped to peculiarly susceptible. Within the human species there influence the latter to make regulations on the lines of the were certain constitutions of body, racial or temperamental, model regulations of the Local Government Board. The ques- that were specially predisposed to tuberculous disease. It tion of starting a sanatorium in connexion with the Leicester was rarely encountered in Nubia, Upper Egypt, Syria, branch of the association had been considered but allowed to Arabia, and Persia, but it was disastrously common amongst stand over for the present. A letter was addressed to all negroes and in Western Europe. Large allowances must be the sanitary authorities in the county asking if they would made for differences in climate and habit of life, but he be willing to disinfect rooms occupied by consumptive believed that certain races were constitutionally prone to it patients, especially after the fatal termination of a case, whilst others were more resistant. The modern treatment, and a number of replies in the affirmative were re- initiated at Nordrach and Falkenstein, which had now taken ceived. Dr. R. Pratt, in seconding the motion for the firm hold in this country, consisted mainly of fresh air and adoption of the report, pointed out that most of the sunlight with a liberal nourishment and medical supervision. work so far done by the local branch of the association If they would only bear in mind that consumption, with had been of an educational character. Sir James Crichton its tuberculous confederates, killed upwards of 60,000 Browne then addressed the meeting on Consumption and persons in England every year, he thought they would be up Tuberculous Diseases and their Cause and Prevention. After and doing, eager to help in the good work of the prevention observing that it was the discovery of the tubercle bacillus of tuberculous disease. On the motion of Dr. F. M. Pope the that had made feasible and practicable the present crusade Council and the Executive Committee of the branch were against consumption and other tuberculous diseases he ’, re-elected. Votes of thanks concluded the meeting. remarked that no " splendid isolation " was possible in the case of science which, on the contrary, drew the nations THE LAW ON PARENTAL NEGLECT. together and associated them in the furtherance of universal A RECENT conviction in the West London Police-court human interests. Here they had France, England, and into prominence the legal responsibility of parents for in brings Germany engaged generous rivalry, harmoniously coöperative in their endeavours to stamp out these great scourges of the safety of their children. The case was not one of the race. The society under whose auspices they had met intentional cruelty but of mere indolent npglect. A mother that day hoped by the diffusion of sound knowledge, and by continued, in spite of repeated warnings and protests on the the awakening of public interest, gradually to restrict the part of neighbours, and even after one very narrow escape depredations of such maladies and finally to banish them from burning, to leave two young children alone in a altogether from these islands. During the last 60 years room with a fire which was unprotected by a fire-guard there had been an enormous decline in the mortality from After a time that which could hardly have been unpulmonary consumption. In 1838, out of every 10,000 expected happened, one child was fatally burned. Only persons living in England and Wales 38 died from the disease, one decision was possible in the circumstances and the whereas in 1898 (the last year for which returns were avail- unhappy mother was sentenced, in accordance with the Act able), of every 10,000 persons living only 13 died from it. for the Prevention of Cruelty to Children, to a term of Providing that the same rate of diminution was maintained imprisonment with the option of a fine. This case for another 30 years, pulmonary consumption would have is instructive, not only in connexion with others of
can meanwhile be accomwhat Mr. had to say about As Treves regards plished. wounds of the abdomen it struck us as being sound, wellThat the results of battle-field reasoned out, and are most disappointing is not to be wondered at laparotomy under the circumstances. We have from the first declared that operative interference in such cases must have a very
practical.
limited application indeed under the conditions that obtain in war. The fact that so many recoveries have taken place in such wounds when caused by the Mauser bullet in Mr. Treves’s experience is a new and important point. We are glad to have his corroborative testimony as to the favourable effect of previous abstinence from food and enforced rest on the battle-field whilst the wounded are waiting to be removed from it in such cases, in other words, absence of all movements together with physiological rest. The Mauser is, on the whole, a more merciful missile than that of the Lee-Metford, but both inflict far less serious injury than did the weapons of the past. In mitigation of the sufferings of the wounded who had to remain unaided on the battle-fields of the past there is this to be said, that they were spared the meddlesome interference of the incompetent whilst Nature had the chance of doing her best. It is needless to add that we have only cursorily touched the fringe, as it were, of the subject on which Mr. Treves dilated so well and instructively at the Royal Medical and Chirurgical Society’s meeting.
necessary and desirable. The true reason for the dismissal of Mr. Randall is doubtless to be found in the fact that he has been courageous enough to point out to his council what steps should be taken to improve the sanitary condition of the town, in which we may note incidentally the death-rate from typhoid fever last year was three times as high as in the rest of the country. His suggestions have been reiterated year after year and some of the members of the council may possibly think they can shirk their duty to their constituents by closing his mouth. It is the conduct of such gentlemen as form the majority of the Maesteg District Council which has rendered necessary Clause 2 of the Medical Officers of Health and Sanitary Inspectors’ Bill which has been introduced into Parliament by Dr. Farquharson and which is down for second reading on May 16th. This clause provides that officers of health (including in this term medical officers of health and sanitary inspectors) shall hold office until they die, resign, or become insane, or are removed by, The or with the consent of, the Local Government Board. Board is practically committed to the principle of this clause, for of late years not only has sanction been given to the permanent appointment of medical officers of health, but many local authorities who have fixed definite periods have been advised to appoint permanently.
UNFIT HOUSES.
IN THE LANCET of Jan. 28th, 1899, p. 246, we commented in an article headed as above upon the Gilbertian THE TENURE OF OFFICE OF MEDICAL situation which had arisen in the parish of St. GeorgeOFFICERS OF HEALTH. tbe-Martyr, Southwark, with reference to the street known IT has always seemed an anomaly that while the principal as Red Cow-alley. So far back as November, 1895, Poor-law officials, among whom are medical officers, hold some cottages in this street were closed and dismantled office permanently, or if dismissed from office can appeal for by a magistrate’s order but were not pulled down. In reinstatement to the Local Government Board, those officers November, 1898, the Vestry of St. George’s made an of local authorities who are appointed under the Public order on the representation of Dr. F. J. Waldo, the Health Act may be elected for a term of years varying from medical officer of health, that the houses should be pulled one year upwards, and at the end of this period the electing down. This order was made in conformity with the authority without appearing to dismiss their official may provisions of the Housing of the Working ’Classes, Act, actually do so by appointing some other person in his place. 1890. The owners of the property appealed against However conscientious an officer may be he is not likely to this order to the Court of Quarter Sessions and the appeal do his work any better if he feels that he must keep the was heard on Jan. 13th, 1899. Mr. Frank Gover, who right side of" certain members of his authority and the appeared for the owners argued with an ingenuity which did feeling of irritation engendered thereby only lessens him infinite credit as follows. The word "dwelling-house" his usefulness to the community which he serves. These in the Act under which these houses are ordered to be remarks apply more especially to health officers, and if demolished means an inhabited house. Nobody lives in security of tenure of their offices should be granted these houses, ergo they are not dwelling-houses, ergo they The court to any public officials it should certainly be to these, as from cannot be pulled down under- this Act. the very nature of their work they are more likely than was struck by this quibbling and agreed to state a any of their colleagues to provoke the hostility of prominent case and the houses remained as they were until ratepayers or of members of the body by whom they are November, 1899, when Mr. Justice Ridley and Mr. elected. Instances of the capricious removal from office Justice Darling sent the case back again to the Quarter of medical officers of health have been frequently Sessions to determine how much of the premises was a danger recorded. The latest example reaches us from South to public health. At the meeting of the quarter sessions Wales where in the thriving mining town of Maesteg, which in January, 1900, Mr. Gover stated that portions had been has a population of some 14,000 persons, the urban demolished and the drains sealed. The case was adjourned district council decided last week by six votes to four to until February, and the Vestry having inspected the premises dispense with the services of Mr. Wyndham Randall who for declared that they were not satisfied. On the day for hearfive years has acted as their medical officer of health and to ing the owners were only represented by a solicitor’s clerk appoint another gentleman in his place. This dismissal and the chairman adjourned the case till March. March could hardly have been owing to lack of experience in arrived and the chairman, Mr. Loveland Loveland, decided public health matters, for Mr. Randall has been medical to inspect the houses in the company of sanitary experts. officer of health to a neighbouring district for 15 years Who these experts are is unknown to the Vestry. However, and for a long period to the town of Bridgend. It the inspection came off and Mr. Loveland Loveland delivered cannot be said, too, that the Local Government Board were judgment, which was duly reported to the Vestry on dissatisfied with the work he had accomplished, for when he April 24th. The court makes no further order for demolition was reappointed by the Maesteg Council three years ago the and each side pays its own costs! Such is the mouse of Board stated that it was prepared to sanction his appoint- which the mountain of five years’ hard work on the part of ment permanently. Before approving the district council’s Dr. Waldo and the Vestry, together with much solemn new nominee the Board will surely require the strongest legislation, has brought forth. The decision may be law is to it that the evidence be placed before but it is neither justice nor common sense. We are glad to proposed change
1376
vestries
see that the facts of the case are to be laid before all entirely disappeared. In the county and town of Leicester and boards of works, and it is to be hoped that a question the reduction in phthisis during the last 60 years had been will be asked on the matter in the House of Commons. even more satisfactory than in the country at large. Taking There is one bright spot in this miserable story and that is all forms of tuberculosis together he found that in the five years 1864 to 1868 they were responsible for 33 deaths that the owners of the slum property are getting no rent. annually in every 10,000 of the population of the borough of Leicester, whilst in the five years from 1894 to 1898 PREVENTION AND TREATMENT OF they caused only 18 deaths per 10,000 of the population. TUBERCULOSIS. He believed that the decline in the mortality from pulTHE annual meeting of the Leicester and Leicestershire monary consumption would be maintained in the near future Branch of the National Association for the Prevention of as it had been in the past. Already the diminished deathConsumption and other Forms of Tuberculosis was held at rate from tuberculous diseases meant a saving of 75,000 lives Leicester on April 27th under the presidency of Sir Thomas per annum. With respect to the preventive and remedial Wright, chairman of the Executive Committee. At the measures it was necessary to guard carefully against the conoutset the chairman read a long and interesting letter from tamination of butcher’s meat and milk. The striking immunity a gentleman bearing eloquent testimony to the efficacy of from tuberculous disease enjoyed in all ages by the Jewish the means recommended by the association and describing race must be attributed in some measure to the rules as to the case of his wife who a little more than a year ago dietary laid down by Moses, and to the still stricter developed decided symptoms of phthisis. In March last ordinances of the Talmud as to the examination of the year it was arranged for her to undergo the open-air treat- carcasses of all animals used as food. An important reform ment at Bexhill-on-Sea and the results were said to be in our present system would be the abolition of all private marvellous. She rapidly lost her cough, regained flesh and slaughter-houses and the provision of municipal abattoirs strength, and in six months was practically cured, although so that all meat sold might be subjected to skilled inspecit was found that she had two considerable cavities in the tion. Having dwelt at considerable length on the prelung. She now weighed nearly 4 st. more than she did a cautionary measures necessary to secure a milk-supply year ago and was in perfect health and strength. District free from contamination, Sir James Crichton Browne councils have the power under the Dairies, Cowsheds, and said that tuberculous diseases were scarcely hereditary Milkshops Order of 1885 to make regulations for securing the in the ordinary sense and yet they ran in families. It inspection of dairy cattle and milk stores, and on account of was quite possible that the bacilli might pass from a the dangers connected with the use of tuberculous milk the tuberculous mother to a child and be born with it, but Executive Committee had made inquiry of every urban and such an occurrence must be rare. exceedingly Among rural district council in the town and county of Leicester as animals there were only certain species in which to whether they availed themselves of this power, with the tubercle would become domiciled. Sheep, asses, and goats result that it was found that 18 councils had drawn up were almost immune from it, while the bovine tribe was regulations and seven had not. The committee hoped to peculiarly susceptible. Within the human species there influence the latter to make regulations on the lines of the were certain constitutions of body, racial or temperamental, model regulations of the Local Government Board. The ques- that were specially predisposed to tuberculous disease. It tion of starting a sanatorium in connexion with the Leicester was rarely encountered in Nubia, Upper Egypt, Syria, branch of the association had been considered but allowed to Arabia, and Persia, but it was disastrously common amongst stand over for the present. A letter was addressed to all negroes and in Western Europe. Large allowances must be the sanitary authorities in the county asking if they would made for differences in climate and habit of life, but he be willing to disinfect rooms occupied by consumptive believed that certain races were constitutionally prone to it patients, especially after the fatal termination of a case, whilst others were more resistant. The modern treatment, and a number of replies in the affirmative were re- initiated at Nordrach and Falkenstein, which had now taken ceived. Dr. R. Pratt, in seconding the motion for the firm hold in this country, consisted mainly of fresh air and adoption of the report, pointed out that most of the sunlight with a liberal nourishment and medical supervision. work so far done by the local branch of the association If they would only bear in mind that consumption, with had been of an educational character. Sir James Crichton its tuberculous confederates, killed upwards of 60,000 Browne then addressed the meeting on Consumption and persons in England every year, he thought they would be up Tuberculous Diseases and their Cause and Prevention. After and doing, eager to help in the good work of the prevention observing that it was the discovery of the tubercle bacillus of tuberculous disease. On the motion of Dr. F. M. Pope the that had made feasible and practicable the present crusade Council and the Executive Committee of the branch were against consumption and other tuberculous diseases he ’, re-elected. Votes of thanks concluded the meeting. remarked that no " splendid isolation " was possible in the case of science which, on the contrary, drew the nations THE LAW ON PARENTAL NEGLECT. together and associated them in the furtherance of universal A RECENT conviction in the West London Police-court human interests. Here they had France, England, and into prominence the legal responsibility of parents for in brings Germany engaged generous rivalry, harmoniously coöperative in their endeavours to stamp out these great scourges of the safety of their children. The case was not one of the race. The society under whose auspices they had met intentional cruelty but of mere indolent npglect. A mother that day hoped by the diffusion of sound knowledge, and by continued, in spite of repeated warnings and protests on the the awakening of public interest, gradually to restrict the part of neighbours, and even after one very narrow escape depredations of such maladies and finally to banish them from burning, to leave two young children alone in a altogether from these islands. During the last 60 years room with a fire which was unprotected by a fire-guard there had been an enormous decline in the mortality from After a time that which could hardly have been unpulmonary consumption. In 1838, out of every 10,000 expected happened, one child was fatally burned. Only persons living in England and Wales 38 died from the disease, one decision was possible in the circumstances and the whereas in 1898 (the last year for which returns were avail- unhappy mother was sentenced, in accordance with the Act able), of every 10,000 persons living only 13 died from it. for the Prevention of Cruelty to Children, to a term of Providing that the same rate of diminution was maintained imprisonment with the option of a fine. This case for another 30 years, pulmonary consumption would have is instructive, not only in connexion with others of