WALES.

1150 to sign the engagement first that they would continue they will have a smaller number of persons to attend. But their service for the remaining nine months of this year. in several places where this stand has been made doctors Thereupon four West-end doctors resigned, and after that, have come in from outside offering to do all that is required in the absence of those who were most interested in the for 6d. per fortnight. In the olden days, when the unions matter, it was easy for the committee to decide that were well organised and managed, the advent of such nothing could be done in regard to a wage limit. At a practitioners was promptly signalised, and they were so meeting of the Newcastle Trades Council the question of a rigorously dealt with that their departure was not long wage limit was also discussed, and one of the trade union delayed. But the merging of the local well-disciplined and representatives said "he would not think of consulting a fighting unions into the larger but not so compact British panel doctor." If there are many insured persons in New- Medical Association renders quick action less easy, and has castle who have not selected their panel doctor this is not discouraged many of the local practitioners who formerly due in the main to negligence, but to the fact that many fought so well. (To be continued.) members of the public do not care to be attended under the contract system. Thus they have, as it were, voluntarily imposed on themselves a wage limit, since they will pay fees and refuse che service of their panel doctor. Consequently WALES. the practitioners who have refused to go on the panel are OUR OWN CORRESPONDENT.) (FROM benefiting, particularly as they are not numerous. It will be seen, therefore, that in Newcastle medical men, consulting The Medieal Ogicerslbip of Health of Abertillery. merely their pockets, would not be unanimous in their views THE Local Government Board has constantly urged the of the Act. For some it has meant prosperity ; some have been hard hit by it. sanitary authorities in the Monmouthshire colliery districts to appoint whole-time medical officers of health, and in 1906 The Colliery Slw[Jeon8 and the 9d. definitely suggested the combination for that purpose of the urban districts of Abertillery, Nantyglo and Blaina, and there Neware two in the district Though only coalpits castle is nevertheless a great coal-trade centre, and it is from Ebbw Vale. The councils of these three districts were not Newcastle that the colliery surgeons were helped to organise able to come to any agreement on the matter, but about four their unions. It has been explained how these unions years ago the Abertillery council appointed, nominally as a succeeded in raising the pay from 6d. to 9d. per fortnight whole-time officer, Dr. A. E. Remmet Weaver, who was to per family, but this has been upset by the Insurance Act, hold the joint office of medical officer of health and and a new arrangement is still a matter of dispute. school medical officer, at a salary of 400 per annum. Now that those who work in the pits are insured persons Subsequently he was paid an additional E10 per annum the pitman as the head of a family refuses to pay the for acting as medical officer of the school clinic. Of 9d. per fortnight, since he is also paying for his own his total salary E250 were allocated as that of medical insurance separately and under the Act. A colliery surgeons’ officer of health, and one-half of this sum came committee does exist, but it is not easy to discover what it from the Exchequer grants, so that the contribution has done. The colliery surgeons, for the most part, have from the local rates to his salary was 285. In later been left to fight their own battle, and in their isolated, dis- years further grants were received from the Board of Educaorganised condition not a few have had to relapse into the tion, so that latterly the cost to the ratepayers has only been old terms of 6d. per fortnight for attending the non-insured E205 per annum. Dr. Weaver has been appointed medical members of a collier’s family. Undoubtedly, all the colliery officer of health for the borough of Yeovil, and the Abertillery surgeons should have been convoked so as to agree on the council is desirous of continuing to his successor the low terms they would one and all ask. Seeing that insured members salary which he has been receiving. The Local Government of each family contribute separately, it is quite natural that Board, however, is pressing for a minimum salary of S500 the colliers should expect to pay a little less for their families. per annum, which can hardly be considered extravagant for If the surgeons had unanimously offered to accept 8d. a district with a population of 39,000 persons scattered over instead of 9d. the probabilities are that this would have a hilly district with an area of ten square miles. There are A great number of colliery about 7000 school children, and the medical officer of health been generally accepted. surgeons, however, insisted on maintaining the 9d. Though is expected to attend at the fever hospital, to take charge of they would have fewer patients, they argued that the giving the school clinic, and to carry out the bacteriological of certificates would entail more trouble. Then there is examinations necessary. The avowed reason for paying so the question of the boys, on whom there is undoubtedly low a salary is that the local rates are so high. If economies a dead loss. Before the Act, when a boy reached the are to be exercised it is hardly prudent to do so by underage of 16 and descended into the pit to work, he paid paying a responsible official, the results of whose labours 6d. per fortnight for medical attendance, and in some dis- cannot always be measured in pounds, shillings, and pence. tricts he even paid the full 9d. per fortnight. At the lower The Red1wtion of Pauperism. figure this meant 13s. for the colliery surgeon. Now, and At the North Wales Poor-law Conference recently held in under the Act, the doctor only receives 7s. Under the Herbert Lewis, Parliamentary Secretary to the old system the fact that youths paid more than their share, Chester, Mr. Local Government Board, stated in his presidential address if judged by the amount of trouble they gave, served to comin Wales and Monmouthshire the rate of pauperism was that pensate the fact that the payments made for the women 25 per 1000 of the population, or a reduction of 5 per 1000 and children were insufficient. Also, before the Act if a the in past four years. In the whole of England and Wales certificate was required the colliery surgeon charged a the had been reduced in four years from 27 to 22 per rate shilling for it; now under the Act no charge can be made He suggested the desirability of appointing women for the certificates when required by insured persons. 1000. Thus a youth brings in 7s. per annum instead of 13s. as relieving officers. Pzcblio Health in the Rhondda Valleys. and has certificates for nothing instead of paying a The persistent attention that has been given in recent shilling for each. Then there is a new difficulty in regard to collecting the money from non-insured persons. years to the removal of insanitary conditions in the Rhondda When there was but one payment effected, and that urban district is at last bearing fruit, and the vital statistics was by the chief wage-earner, the colliery owner which the medical officer of health, Dr. J. D. Jenkins, deducted the amount from the wages and handed it includes in his recently issued annual report for 1912 This prevented bad debts and are of a very satisfactory character when compared with over to the colliery surgeon. But matters. to-day it is for the women and those of former years. The death-rate from all causes in that simplified children that the money has to be collected, and the colliery year was 13-8 per 1000, and the infantile mortality rate Also the money when was 127 per 1000 births. The latter rate was 26 per owners know nothing about them. collected has to be paid, not to one colliery surgeon, but to 1000 above that recorded during the same period in the different panel doctors. This the cashiers at the collieries 95 great towns of England and Wales, but it is the lowest object to do. It is not their business, and if they undertook Rhondda rate yet recorded. Among the most potent factors such work they would expect a commission of 5 to 10 per operating prejudicially to the preservation of infant life in cent. on the money handled. Thus it comes about that many the district, Dr. Jenkins mentions the abnormally high colliery surgeons insist on the 9d. as before the Act, though birth-rate, which in 1912 was 33’ 1 per 1000, the number of

1151 stillbirths, the early age of

the mother at marriage, the urban conditions of life, domestic insanitation, housing conditions, and the ignorance and carelessness of mothers. In many north country towns, among the insanitary conditions which are said to increase the number of deaths among young children there is usually included the presence of privy middens or of the accumulation It is interesting on household premises of house refuse. to learn from Dr. Jenkins that water-carriage is practically universal in the Rhondda urban district, for nearly 27,000 houses are provided with water-closets, and at only 146 houses are there privy middens or pail closets. Fixed ashpits are also non-existent, for there is a daily removal of all household refuse, the collection being completed before 1 P.M. each day. The ultimate destination of this refuse is, however, not at all satisfactory. For about ten years and until two years ago a small destructor was in use, but it dealt with quite an inappreciable quantity of the refuse collected, and the greater part was deposited on huge tips in various parts of the district. With the large amount of building that has been going on there has been an increasing difficulty in obtaining sites for this deposit, and dwellings have crept nearer and nearer to the existing tips. There is now to be erected at Porth a modern destructor capable of dealing with about 82 tons of refuse daily, or about one-third of the total amount produced in the whole district. The heat derived from the use of the destructor is to be used by the Electric Power Distribution Company, and if Dr. Jenkins’s advice is carried out it will also be available for a steam disinfector to supplement that at the isolation hospital some five miles distant. Among other recommendations made by Dr. Jenkins are the erection of municipal slaughter-houses ; the application of provisions contained in the special Acts of Parliament of the district for the control of the milksupply, with special reference to the spread of infectious disease; and the acquisition of plots of land situated in localities at present unprovided for and suitable for purposes of recreation. Oct. 14th. _________________

accommodation and treatment provided for the poorer class in the hospitals and that for the well-to-do given in expensive private homes. It is an extension of a pioneer institution in Rutland-square. At a public meeting in Edinburgh in 1911, under the chairmanship of Sir Robert Usher, Bart., a committee was formed, with Lord Dunedin as chairman, Professor Lodge, chairman of executive, and Dr. D. Chalmers Watson, the initiator, as honorary secretary, to appeal for the sum of 13,500 to defray the cost of building and furnishing, when the home, at the moderate fees it was intended to charge patients, could be made selfsupporting. Of that sum over f.13,000 have been raised. Three continuous villa residences were purchased in Chalmersstreet, and under the supervision of Mr. T. Duncan Rhind, A. R. 1. B. A., the intericu:s were reconstructed to fit them for their new purpose. All coriaices and skirting have been eliminated to reduce the lodgment of dust to a’minimum. The home, available for both sexes and either medical or surgical treatment, contains about 50 beds ; two wards each of 8 beds; five of 3 beds; one of 2 beds ; twelve private rooms with 1 bed ; and a children’s nursery, 4 beds. The charges range from
nursing

Free Blood Examinations in

SCOTLAND. (FROM OUR OWN CORRESPONDENTS.)

Edinburgh University :the New Cltair of Bacteriology. Professor James Ritchie delivered his inaugural lecture in the McEwan Hall on Oct. 7th, in the presence of a large gathering of students and of the public. Principal Sir William Turner presided, and was accompanied on the platform by a number of professors and lecturers. Professor Ritchie took as his subject the Place of Bacteriology among the Sciences. Olinical Instr2cetion in Edinburgh Royal Infrmzary. Sir Thomas Fraser, in his opening address to the combined classes of clinical medicine at the Royal Infirmary, which is reported in another column, outlined the new scheme which is now adopted, and which has already been described in THE LANCET. A successor to Professor Greenfield has not yet been appointed, but the joint committee of the University Court and the infirmary managers met on Oct. llth to recommend a leet of two to the University Court, in order that one of them may be appointed to the Moncrief[ Arnott chair of Clinical Medicine. It is understood that the committee selected from the list of applicants for the new chair Dr. William Russell and Dr. Graham Brown. These names will be submitted to the University Court, which will make the appointment. Scarlet Fever Outbreak in Edinburgh. There has recently been a considerable outbreak of scarlet fever in the city, with the result that between 20 and 30 cases are under treatment at the city fever hospital. The public health office, acting with commendable celerity, at once traced the milk-supply of the sufferers to its source, with the result that the origin of the disease was discovered, and risk of an epidemic almost certainly averted. Queen Mary’s Nursing Home for Patients of Limited Means, Edinburgh. nursing home, Chalmers-street, Edinburgh, recently opened by Lord Balfour of Burleigh, is intended to bridge the gap between the supply of The

new

Glasgow.

Provision has been made in the Public Health Laboratory of Glasgow for carrying out free of charge to medical men the Wassermann reaction and other tests mentioned in the resolution of the corporation of April 17th. The requisite equipment for collecting the sample to be examined will be supplied on application by medical men, and this should be returned to the medical officer of health with the information requested in the schedule accompanying the equipment. The name of the patient need not be given, but the age, sex, and occupation, together with the leading symptoms present, and the name of the ward of the city in which the patient resides, must be stated. The test should be had recourse to only where external manifestations of specific disease are absent and the symptoms otherwise obscure. A fee of 2s. 6d. will be paid for each sample of blood forwarded for examination.

Diphtheria in Aberdeen. The number of cases of diphtheria notified last week in Aberdeen was 92 up to Friday morning. For the same period in the previous week only 60 cases were notified. The cases continue for the most part to be mild, there having been very few deaths so far. Not only is there no sign of abatement of the epidemic, but the number of children affected increases daily. The school water is still cut off, and on the advice of the medical officer of health the children are urged to gargle with a disinfectant three times a day. The teachers are also endeavouring to keep articles such as pen, pencils, &c., from circulating in the classes.

Typltoid

Fever in Aberdeen.

The report of Dr. Matthew Hay, medical officer of health, the typhoid outbreak which occurred in Aberdeen last year has now been laid before the public health committee of the Aberdeen town council. The report is divided into four parts, the first part dealing with the previous history of typhoid fever in Aberdeen, the second part dealing with last year’s outbreak, the third with paratyphoid cases, and the fourth giving additional information regarding the persons attacked in the outbreak of typhoid and paratyphoid. With regard to the outbreak in 1912, the report states that on