report of the medical officer of the local government board

731

a piece of wood. Dr. Mathewson reports a case of epi-thelioma of the eyelid cured by applications of benzole andcalomel. Dr. Dennett supplies a new form of test-typefounded on correct principles, and Dr. Hasket Derby doesgood service in reporting two cases of penetration of theeyeball by scissors during the operation for strabismus. In

these cases recovery took place, but if carelessly treatedthere would be much probability of loss of vision or of theeye, with a risk of sympathetic ophthalmia.

Studies from the Biolo,gicaL Laboratorv of the Tohns

Hopkins University,’Baltimore. Edited by H. NEwELLMARTIN and W. R. BROOKS. Vol. III., No. 5.-The presentnumber is devoted to Embryology and Microscopy. Dr. II.Leslie Osborn gives a minute account of the development ofthe gill in Fasciolaria, accompanying the memoir with a platein which the successive stages are clearly shown; and Dr. H.G. Beyer communicates a paper on the structure of Lingula(Glottidia) pyramidata, with four plates of illustrations.Spasm in Chronic Nerve Disease. By SEY--Niouit SHARKEY,

M.B., F.R.C.P. London: J. and A. Churchill. 188G.—Thisbook is a reprint of the G ulstonian Lectures, delivered by itsauthor at the Royal College of Physicians of London in thespring of the year. We have already had occasion to speakin terms of much appreciation of these lectures. We neednow only say that the profession will doubtless be thankfulto the author for supplying them with his valuable fact,and inferences on spasm in chronic nerve disease in E

separU’a and easily procurable form.

REPORT OF THE MEDICAL OFFICER OF THELOCAL GOVERNMENT BOARD.

[SECOND NOTICE.]

IN our former notice of this Cholera Report we referredto the attitude of the British delegates at the Rome Con-ference in resisting the imposition of a five days’ quarantineon ships which an internationally appointed medical officermight choose to regard as infected, in the place of trustingto the system of sanitary administration which has beencarried out in this country, where an average annual expen-diture of some ;E8,000,000 is voluntarily sustained for thispurpose. This attitude, which was consistently maintainedby all the delegates from this country, evidently led to thebreak-up of the Conference, for, as Dr. Buchanan points out,after an adjournment it never met again. But it must notbethought that the labours of the Conference have been incon-clusive. Referring again to Dr. Thorne Thorne’s account ofthe proceedings of the Conference, we find that at the datewhen the delegates were originally intended to reassemble,the Italian Government, which in the meantime had hadopportunity of considering the attitude of the majority ofthe Technical Commission, including their own delegates, inthis matter, issued a Mémoire, which cannot fail, in the longrun, to have an important influence on any future inter-national gathering called together to deal with this subject.Summarising this Memoire, Dr. Buchanan explains that itindicated that an international understanding on the sani-tary reyime of the Red Sea and the Suez Canal had becomeimperative; that the existing professions of control overisolation and disinfection were utterly vain for any sanitarypurpose; that reforms of practice in the Red Sea and theCanal were imperative; and that it went on to declare thatthe adoption of the reforms indicated would allow of suchfree use being made of the canal as a highway, as Englandhad contended for at the Conference, permitting the aboli-tion of existing restrictions upon the movements of vessels,not only in the case of English shipping, but in the case ofvessels of all nations. Such a document, emanating fromthe Government of the country which called the Conferencetogether, must be regarded as of high value; and we, atleast, are satisfied to find that it entirely endorses the con-tentions of our delegates.In Dr. Thorne’s account of the distribution of cholera

in Europe, in 1884-86 we find that for each year thereis a statement of the importations of the disease intothis country. These importations were few in number,

but none of them led to any extension of the disease.As to this the annual report makes no boast, but itwith reason implies that English sanitary administra-tion may claim some credit for the result, and it proceeds todetail the action taken in this country in view of theEuropean epidemic. Under Dr. Buchanan’s supervision, andwith the aid of Dr. Ballard as a senior inspector of longexperience, a staff of medical inspectors was employedin 1884 and 1885 in visiting the port, riparian, and inlandsanitary districts; those districts being specially selectedfor inspection where the Local Government Board knew,from previous reports and visits, that conditions of soil,water, or air pollution had existed which indicated a stateof unpreparedness to resist the infection of cholera. Theseinspections were followed by interviews with the sani-tary authorities of the districts in question, who wereurged to remedy such conditions as called for remedyand to provide themselves with means for isolating firstcases of disease. The total action taken in this way isshown by means of special reports by Dr. Ballard on thesurvey generally, and by Dr. Blaxall, R.N., on the principalport and riparian districts, and the whole is summarised ina more or less tabular document covering over two hundredpages. At first sight such a report appears eminently un-interesting ; but, for all this, it is perhaps that portion ofDr. Buchanan’s report of which this country may well bemost grateful and most proud. Where responsibility forsanitary duty was found to be wanting, the inspections, weare informed, often " conduced in valuable measure towardsits development"; and where local authorities were desirousof performing their sanitary duties towards their owndistricts and the kingdom generally, they were greatlyaided by the inspectors’ visits, and have been correspond-ingly grateful to the Board for the advantage thereby

I afforded them." Such work as this, extending as it has’ done all over the country, must materially have advanced

the interests of the community in the matter of health, andwe can well believe Dr. Buchanan when he states that theduty of caring for the public health is by such measuresbecoming "increasingly apprehended by English communi-ties." So also the action taken by means of this surveygoes far to show to European and other nations that theopposition shown at the Conference to quarantine versussanitary administration was not based on any considerationsof commercial interests or economy. Although this countryhas for years past devoted large sums of money to the

’improvement of public health, the moment a Europeandanger appeared additional expense was incurred by thecentral authority on the advice of their Medical Officer, andincrease of expenditure and of vigilance was pressed uponlocal authorities. By such means the country not onlyarms itself in the best known way against invasions ofcholera, but, at the same time, it succeeds in reducingthe amount of its sickness and death from all causes.

But this tabular report has further advantages. It containsat one glance an indication of the sanitary state of a vastnumber of our sanitary districts. Thus, if a visit to theseaside is contemplated, and doubt exists as to whetherDover or Shoreham should be selected, the reader may turnto the volume and find that at Dover the town is seweredthroughout, the ventilation and flushing being satisfactory;that the watercloset system is satisfactorily arranged; thatrefuse-removal is satisfactory; that the water-supply is oneon the constant service system; that the work of themedical officer of health and inspector of nuisances issatisfactory; and that as regards other matters, progress issteadily arrived at. Turning next to New Shoreham, he willlearn that the sewers are insufficiently ventilated, whilstprivate drainage is defective and a source of nuisance;that the waterclosets are mostly without flushing arrange-ments, and, as such, are a nuisance; that refuse-removal isnot altogether satisfactory; that though the town has apublic water service, local wells are liable to surface con-tamination, and that some houses have no supply; thatthough the work of the medical officer of health is " fair,"that of the inspector of nuisances is unsatisfactory, and thatsanitary administration is " lax." Had this report beenissued earlier, perhaps some who suffered during the recentepidemic of typhoid fever in Shoreham might have escaped.Anyhow, this volume should be in the hands of everymedical practitioner who has to advise his patients as towhich localities they may visit with benefit, or which theyshould studiously avoid. The public also may well consultit in the same sense.

732 THE METROPOLITAN INTRODUCTORIES.-BONE-SETTING.

THE LANCET.

LONDON: SATURDAY, OCTOBER 16, 1886.

THE Introductories have been duly delivered, and if halfthe good thoughts and good advice they contain are takento heart by the students there will in a few years be a greatgain to the profession. We believe, after all, in a goodIntroductory. The voyage on which a medical student

enters in October, and which is to last for three or four

years, is beset with dangers as well as duties. It may be

made very pleasant or infinitely painful, and the burden ofall the Introductories is the same. They aim at inspiringthe love of truth, and encouraging its pursuit at all hazards. I IThe history of discovery, or of individual men, whose famehas added lustre to their particular school, is in turn usedby the lecturer, and used with such success that the studentmust blame himself if he enters on his great career withlow aspirations and poor motives. We should advise each

student to read all the addresses. There is much varietyof conception and execution in them, and they will

amply repay the time and trouble spent in their perusal.The thoughts of other teachers, and the history of otherschools than his own, will save him from narrowness,and will supply him with arguments in variety for

dutifulness and virtue. A very short experience will

suffice to introduce a student in any school to men

who affect to be wiser than their teachers, and who receivethe loftiest thoughts with indifference or something worse.An Introductory Lecture to them is no gain. Nothing in itexcites their admiration. They speak as if they had livedlonger and seen more than their teachers, and as if it were afavour in them to be present, even if their object be to dis-tract and disturb those who come to listen and to profit.Such men are in a minority, and it is very desirable the

minority should be a still smaller one. Let any well-

meaning student study the Introductories, and regard withsome suspicion those who disparage them. It is impossible,and it would be somewhat invidious, to single out individuallectures for praise or blame. It would be useful for each

student to put down on a piece of paper the great points inthe Address of each lecturer and bear them in mind duringhis whole course of study. The character of medical

students is well vindicated by Dr. WADHAM, and also byDr. Biss in his lecture at the Middlesex Hospital. Dr. Biss

showed that at Cambridge during the last eight years, whilethe number of medical students has increased from fifty toover three hundred, there has been an immense gain to order,decency, and morality. Dr. WADHAM argued with muchability against the necessity for providing home disciplineand accommodation for medical students. The argumentshowed the complicated nature of the question, and the diffi-culty of giving to any Collegiate authority in London thepowers enjoyed by the Universities of Oxford and Cambridge.Sir BENJAMIN BRODIE’S experience, that the ranks of medicalstudents contain a large number of young men diligent in thepursuit of knowledge and decorous in their general conduct,is very valuable, and was certainly never more true than it

is to-day. But no wise student would underrate the value

of a home in which home virtues can be cultivated, and

something like home authority used to promote regularityof habits and steady application to work. St. Thomas’s

Hospital was fortunate in having Dr. BRISTOWF, to tell itshistory, and to pronounce the existing arrangements andprospects of the hospital worthy of its past, and muchbetter than they might have been when some of the

errors of the past are considered. Dr. GEORGE JOHNSON

spoke with authority against all narrow specialismin medicine, and was very happy and forcible in his

illustrations. His prophecies of the doom of those

who despise vaccination will not immediately affect the

fanatics of Leicester; but they will be realised some dayby many who laugh at them now. JENNER’S agsociation

with vaccination is trite, but his association with the violinis not so well known, and it was a happy idea of

Mr. BLACK, in urging the cultivation of music by medicalstudents, to remind his hearers of the solace that JENNERderived from playing the violin and the flute when thecares of his great discovery weighed heavily upon him.One of the most thoughtful Introductory Addresses of thesession is that of Air. MALCOLM MoBRis, at St. Mary’s, onMysticism, Materialism, and Scepticism in Medicine. We

insert Mr. MoBBis’s address in full this week, and have

only now to say that it is a masterly and yet reverent

exposure of some of the worst faults of medicine, ancientand modern, the study of which will make us all more safe

against error, and more helpful in raising the reputationof medicine. For much of the affected mysticism anddogmatism of the professors of medicine in the past, Mr.MORRIS blames th8 public who loved to have it so. But

the public and the profession, too, are both strong enoughnow to dispense with all such aids to authority, and torespect those advisers most who show the greatest desire tointroduce simplicity and truth into medical treatment.

Mr. BAn=,n’s Address at University College indicated

the claims of medicine to more recognition by the

public, and to more honour from the State. He was

especially happy in showing how medical men, as a

rule, steer clear, beyond most men, between errors of

superstition on the one hand and a degrading materialismon the other. No doubt medical men are " lightly esteemed"as yet by the State. They have no place in the House ofLords. So much the worse for the House of Lords. The

House of Lords would be much stronger to-day againstattack, and in the respect and affections of the people, if itcontained the eminent men of all professions, and especiallyof our own. For the welfare of the State the advice andcounsel of the best of all its citizens are needed, and in theSecond Chamber of the near future we may hope suchcitizens will not be conspicuous by their absence. But,after all, the chief reward of medical men must be of adifferent character from any that the State can give. It mustbe the approval of men of science generally. The peers ofmedical discoverers must themselves be men of science, andthis recognition of medicine has already begun, and cannotfail to grow as the discoveries of medicine multiply andappeal to the admiration and gratitude of mankind.

THERE are probably few more lucrative departments ofthe healing art than "bone-setting." Unfortunately for the