1712

from that of nurses, landlords, or tradesmen " ; and we askour readers to consider seriously whether the way out is notthus indicated.

The feeling that payment for services rendered is the

only just system is certainly growing, and it seems to usthat it is not yet too late for medical men to consider

whether they could not take over the medical responsibilitiesof a National Insurance Bill on such a principle. At first

sight the proposal seems rash. The medical profession hasgone so far in discussing details with the understanding thatsome form of per capita payment to medical men wouldbe the physical salvation of the country (if only there couldbe settled who exactly should pay the fee and how much

exactly the fee should be) that it almost appears to

be thrusting the whole question of invalidity insurance

back into the melting-pot to make a stand now for

the abolition of contract practice. But if we look steadilyat the position, if we realise where we are really at the

present moment, it will strike us rather forcibly that at

present we are not far removed from the melting-pot.Nothing has yet taken any definite form. We have on the

one hand a very clear set of proposals from the British

Medical Association, strongly backed and with but little

doubt that this backing will remain firm when the time foraction comes. But we have, on the other hand, a

powerful Minister in charge of the Bill, who is obviouslypledged in many directions not to give way to the

exact proposals of the British Medical Association, but whohas confessed himself in public to be " in despair about thematter." There is no elegant shape about the position thatwe risk destroying by interference. Again, we have aremarkable unanimity, not only in the House of Commonsbut in the country at large, shared by the medical professionthemselves as citizens of the country, that the principle of

invalidity insurance is good, and even necessary. Thus we

are dealing with a measure which everybody wants to see onthe Statute book, but which is in considerable risk of havingits efficiency damaged, if it ever gets there, because uporthe principles of contract practice the Chancellor of th(

Exchequer and the medical profession cannot agree. We d(

not consider that to raise the question whether contract practice is itself a necessity is really to add confusion to thi,

situation ; the confusion is there already. On the contrarywe are of opinion that if the medical profession would carr;their unanimous opposition to the Bill a stage furthe

than it has yet gone, and say that there is no necessitwhatever for engrafting into the Bill the contract system cmedical attendance as a compulsory and integral part c

the Bill, the way to an honourable settlement of th

difficulties might be found. Time may be wanted, bt

no more than everyone thinks should be granted i

any circumstances, for enabling the medical professioto deal with the situation in a broader way. Tt

British Medical Association would be as powerful a he]

towards settlement in this manner as in any other. Tl

work already done by the Association would be in no wa

impaired through a revision of the position as a whole tthe medical profession, and in places where contract practi was felt to be necessary as a detail, the powerful organistion of the Association would be invaluable.

Annotations." Ne quid nimis."

THE REGISTRAR-GENERAL’S ANNUAL SUMMARYFOR 1910.

AMONG the statistical publications issued from SomersetHouse one of the most useful to our profession, as well as t&

the public, is the Registrar-General’s annual summary, thefifty-seventh number of which is now before us. This

number, which relates to the year 1910, presents several newfeatures, to the more important of which reference will herebe made. The earlier issues of these summaries related toLondon exclusively, and were therefore mainly interestingto metropolitan readers, but in recent years the informationhas been amplified and its scope extended so as to includethe principal towns of England, as well as the more import-ant cities of the colonies and of foreign countries. With

respect to at least three-fifths of the 36,000,000 personsestimated to be living in England and Wales, detailedstatistics are now available concerning the local incidence.of infectious diseases on the one hand and the distributionof the chief causes of mortality on the other. As regards.the first of these, it may be noted that the Registrar-General now furnishes particulars of the principal epidemicdiseases in every district (save one) of England and Wales.And as the summary is generally published before the com-mencement of the summer season, this knowledge will assistmedical practitioners in advising their clients respecting theselection of health resorts for convalescents seeking change-of air. With regard especially to the vital statistics of Londonand its outer ring, they are here presented in a convenient.form for reference, as well as for the preventive purposes ofthe local authorities concerned in public health administra-tion. For instance, a map is inserted in which the death-rates are shown for each of the metropolitan boroughs, com-parison being aided by the use of distinctive tints of colour.The series of diagrams showing the distribution of fatalityfrom the principal epidemic diseases, which had been inabeyance during the previous 20 years, has been restored in,the present summary. The amount of life-saving representedby the lessened mortality from preventable disease is graphi-cally shown by a series of curves by which the mortality ofthe past vicennium is contrasted with that of the period

. 1841-1910. The statistics of mortality from pulmonarytuberculosis have been skilfully prepared. An instructive-table (No. 25) is inserted, giving the mortality of persons.belonging to the several metropolitan boroughs, and

showing the ages at death and the proportions of deaths.occurring (a) at home and (b) in hospitals, workhonses,Yand other institutions away from friends. From this.f table we gather that .whilst in the most favoured dis-

f tricts practically all the deaths from phthisis occur atu

e home, in several of the least-favoured districts considerablyt

more than half of the deaths occur in workhouses. Fortunately,.

the saving of human life represented by the steadily decreas-ning mortality from tuberculous phthisis has been fully main-n tained in amount during the year under notice, the metro-e politan death-rate from this disease being 114 per 100,000p living, or 24 below the average rate in the five pre-le ceding years. In the metropolitan boroughs the death-rate

last year ranged from 55 in Lewisham, 59 in Hampstead,and 77 in Kensington, to 174 in Southwark, 176 in

’y Bermondsey, and 198 in Holborn. Among Scottish, colonial,and foreign cities the mortality from this disease was lowest,

a- viz., 97 per 100,000 in Edinburgh and 100 in Melbourne;it was highest, viz., 356 in Trieste, 366 in Paris, and 396

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in Rio de Janeiro. Lastly, it is good reading that almosteverywhere infantile mortality continues to decrease. Withinthe last decennium the fall in London has amounted to24 per cent. In many of the foreign cities the fall hasbeen remarkable within the same period, being equal to 41per cent. in Berlin, to 44 per cent. in Melbourne, to 50 percent. in Rotterdam and in Sydney, whilst it amounted to

55 per cent. both in Stockholm and in Amsterdam.

A PROPOSED OPTICAL CONVENTION.

AN executive committee has been formed for the purposeof making arrangements for the holding of an Optical Con-vention and Exhibition of Optical and Allied Instruments inLondon in the spring or summer of next year, 1912. Pro-

fessor Silvanus P. Thompson has been nominated as Presi-dent, and among the Vice-Presidents are Sir William Abney,Professor R. B. Clifton, Mr. Horace Darwin, Sir David Gill,Dr. R. T. Glazebrook, Professor H. F. Newall, Professor J. H.Poynting, Dr. A. Schuster, Professor H. H. Turner, and Mr.R. M. Walmsley. The honorary treasurer will be Mr. JamesAitchison. A strong organising committee has been formedwith Mr. Walmsley as chairman and Mr. J. W. Gordon (113,Broadhurst-gardens, Hampstead) as honorary secretary. A

preliminary statement says that the proposal, with the

working out of which the committee is charged, has grownout of the successful Optical Convention held in the year1905, which lasted for four days, and at which many valuablepapers were read, while a collection of choice and interestinginstruments was exhibited. It was then found that con-siderable advantage accrued to the exhibitors, that the cata-logue possessed both commercial and technical value, andthat the volume of proceedings produced was of notable andpermanent interest, both this and the catalogue being stillinquired for from time to time. It is thought that after aninterval of seven years the experiment may be repeated withan assured prospect of success. Moreover, the time seems

specially opportune for such a demonstration, when theformation of an important School of Technical Optics upon anational scale and devoted to instruction of all kinds, fromthe highest to the lowest, practical and theoretical, in

connexion with optical manufacture, is engaging the seriousattention of the London education authority and those

associated with it in the development of technical education.The executive committee of the proposed Convention, whichis practically a branch of the organising committee, wasappointed in the early part of this year, and proceededforthwith to get together a guarantee fund to provideagainst the expenses incidental to the holding of the Con-vention. Their appeal, which down to the present time hasnot been publicly issued, but has been addressed only tothe members of the committee and to their more privatefriends, has been so far successful that, with the assistanceof three City Companies, they have already secured

guarantees to the extent of .E650. They think themselveswarranted in expecting that when their public appeal is madea further sum of .S350 at the least will be forthcoming,and they count therefore upon being able to make their pre-liminary arrangements upon the basis of a guarantee fundof not less than a thousand guineas. It is proposed, thispreliminary condition having been fulfilled, to secure a

suitable hall, centrally situated, at which the exhibition canbe housed for six days, and where convenient rooms will beavailable for the holding of sectional meetings and thegiving of demonstrations. Promises of support in the

way of exhibits, demonstrations, and papers, have

already been received from many influential personsand firms, and the committee entertain no doubt thatin these respects the Convention of 1912 will fullyrealise the hopes and expectations with which its promoters

have entered upon the task of organising such a gathering.There remains the question of membership to be considered,and it is chiefly in this connexion that the committee desireto strike out a new line, and well in advance to secure

promises of support in the way of membership to such anextent as may make the more expensive forms of advertisingunnecessary. The committee are therefore bringing theirproposal to the notice of all the principal scientificsocieties and bodies in London and the provinces, in thehope that by the kind cooperation of the officers and membersof these societies they will be able to obtain an early andeffective publicity for their proposals, and such promises ofgeneral support as will make it unnecessary for them tomake any demand whatever upon their guarantors. It is

thought that if a sufficient number of members are securedat an individual subscription of 5s., the whole expenses ofthe Convention will be defrayed, and that the amount

realised from the public sale of the catalogue and pro-ceedings, and otherwise, will all be available as the nucleusof a permanent guarantee fund, which will facilitate the

holding of similar conventions in the future. The hopes ofthe committee ought to be justified, for they should surelybe able to secure the cooperation of the officers and membersof the scientific bodies to whom their appeal is expresslymade. There is, we think, every scientific reason for theholding of the proposed Optical Convention.

THE ADVERTISING OF PATENT MEDICINES.

Two well-known and widely diffused periodicals, issuedunder the direct authority of the Church of Scotland, are, itseems, in the habit of advertising patent medicines not onlyin the columns set apart for advertisements, but also betweenthe pages reserved for theological matter. The practice, as areprehensible one, came before the General Assembly of thatChurch recently, when a motion was introduced byProfessor Curtis of Aberdeen purporting to exclude from

the said periodicals " all advertisements of secret or

patent remedies of a medical or quasi-medical descrip.tion " in order that "the disinterestedness and Christiancharacter of accredited organs of the Church mightbe above suspicion in that respect." " Professor Curtis

strengthened his motion by an appeal to the practice of re.cognised organs of medical opinion, and vindicated as

I I sorely needed" their "crusade against the indiscriminatepuffing of remedies of a patent or secret character "-puffingwhich told heavily on the poor of the land, who were, not;unnaturally, impressed in favour of the "remedies by theI respectable," not to say "unworldly " pose of the adver-tising medium. Drawing attention to the analyses of these"remedies," he evoked the laughter of the Assembly bystating on expert authority that a very popular drug con.sisting of three substances-aloes, ginger, and soap-worthat prime cost less than ¼d., was sold at fifty times the price.Other instances of the constituents and cost of wares advertisedas "infallible remedies" followed, and certainly justifiedProfessor Curtis in his conclusion that it was scarcely in

keeping with the dignity of the National Church of Scotlandto make money and to finance its periodicals by suchadvertisements. A discussion ensued, pro et contra, whichconcluded with the adoption, by a large majority, of anamendment refusing adhesion to Professor Curtis’s motion.One argument that seemed to weigh with the supportersof the amendment was neither more nor less than an

"appeal to Mammon," its purport being that one of themagazines in question was largely supported by, if indeedit did not owe its existence to, its advertising connexion.Another argument in the same sense had also its supporters,to wit, that the Church should " let well alone " and leavethe business of the periodicals to their managers. The

1714

counter plea that not only the poor of the land " but the an(

clergy themselves "should be protected against those me

advertisements," proved unavailing to affect the final vote, Chand so the National Church of Scotland is made to connive pa at, if not to condone, a practice not only discountenanced eni

but pointedly condemned by its sister profession as hurtful thc

to the community, individually and collectively, especially wo

the poor I -

nu

the THE GREEK PLAY AT BRADFIELD COLLEGE. in

FOLLOWING the triennial custom of the school, a Greek tri

play-the Agamemnon of Æschylus-was presented by the Br

boys of Bradfield College on June 10th, being repeated on the th

12th and 13th, 15th and 17th, in the beautiful Greek theatre "

near the college grounds. This theatre was constructedafter the model of the theatre at Epidaurus in 1888, thestage buildings being framed on the pattern of a Greektemple. The semicircular banks of seats, hewn out ofa disused chalk-pit, rising tier upon tier to steep walls mof foliage roofed only by the domed blue sky, surround in

the orchestra from whose thymele the fragrance of incense sufrused the auditorium. Large as the audience was on the occasion we are recording, it preserved throughout a spirit of tl

interested attention, and without break for two hours every word of the actors was distinctly audible. Hence even thoee H

to whom all that remained of the Hellenic labours of their s:

schooldays was the power to read the Greek characters were itenabled to follow the course of the dialogue in the text on d

the left-hand page of the book of the play ; while from the a

English verse translation on the right-hand page-a version, c

in the main, of strength and insight-prepared by the s

scholars themselves, they followed the significance of the t

action of the play. It would hardly be in place in a

medical journal to enter on a disquisition concerning the Agamemnon of Æschylus or an excursus into the Greek

drama ; but the interrelations of passion and crimeare too familiarly known to medical men for the story of i

the death of Agamemnon at the hands of his guilty wife, and the arguments wherewith she justifies her act, to fail of interest to them. As a spectacle, with its strictly archæo- logical setting (save that the actors were" made up " insteadof wearing masks), the play was a harmony of colour in costume, and of solemn, rhythmic movement. The

plaintive and modulated melody of cithara and aulos,played by pupils whose excellent training reflects greatcredit on the music master, Mr. E. Bayliss, mingledin a grave undertone with the singing of the chorus.For the acting, that, too, deserves full meed of praise,not only for the actors, but for Mr. J. H. Vince, thesixth-form master, who is responsible for their coaching.Mr. W. R. Hay, who, as Clytæmnestra, made a woman ofstriking physical beauty, but cruel, strong, and ruthless as thepart demands, played with dignity and force an exactingrole, delivering his speeches well, save for an occasional

lapse into a lowered intonation at the end of a sentence.

The prayer to Zeus for the fulfilment of her purpose,when Agamemnon has at last been induced to enter

the palace, was delivered with triumphant force. Mr.

J. I. Cohen, as the herald, also was forceful, particularlyin the description of the storm that had separated Menelausfrom his friends. The Agamemnon of Mr. A. R. Toppingwas somewhat grandiose and the Ægisthus of Mr. S. M.

Bourne, as well as the Watchman of Mr. A. Furze, was wellrendered. But it is to the alternations of patheticwoe, of mystic frenzy, and of righteous anger, to whichthe Cassandra of Mr. W. Ll. Jones gave full expressionboth in action and in speech, that we think the palmmust on the whole be accorded. As for the Chorus,in appearance, in gesture, in gait, they were veri-table ancients, and their excited chattering of counsel

and counter-counsel on hearing the death-cry of Aga-emnon was admirable. The Coryphaeus, Mr. F. J. M.

hubb, sustained a trying and almost continually speakingart with great tact and discretion. Two points in theitire performance call for special commendation. First,the remarkably distinct enunciation, which rendered everyord intelligible in spite of the English school pro-anciation ; and second, the strict attention of all

ie actors to the play. There were no "supers,".i the invidious sense ; each one contributed, however,ivial his part, to the construction of a harmonious picture.tradfield College does a service, in our opinion, to

lie community at large in keeping alight the beacon lamp of the humanities."

____

THE TREATMENT OF TETANUS BY SUB- CUTANEOUS INJECTIONS OF PHENOL.

Professor Guido Baccelli of Rome, who introduced thenethod of treating cases of tetanus by means of subcutaneousnjection of carbolic acid, gives a statistical review of the)ublished cases of this treatment in a paper published in the8erliner Klinische Wochenschrift of June 5th. He maintains

,hat if given in sufficient doses far better results are

)btained by its means than by the use of anti-tetanus serum.Ele believes that it exerts a sedative effect upon the nervous

system, and thus acts beneficially upon the paroxysms, thatit lowers temperature, and, further, that it possessesdistinct antitoxic properties. He also claims that there isabundant experimental evidence in favour of the use of carbolic acid in tetanus, since Tizzoni and Cantini in 1890showed that carbolic acid destroyed the toxicity of tetanustoxin in vitro, and in 1891 Kitasato showed that a5 per cent. solution of carbolic acid rendered culturesof the tetanus bacillus sterile within half an hour,a fact confirmed by Tizzoni and Babes in 1895. Babes

also succeeded in immunising animals against tetanus byinjecting serum from other animals rendered refractoryto it by carbolic acid. Professor Baccelli states that hisobservations have established the remarkable tolerance whicheven the most severe cases have for this drug. He com-menced with a 2 or 3 per cent. solution in water, giving dailydoses which did not exceed 0-3 to 0-5 grm. of phenol, theurine being carefully watched; but he soon increased the

dose, and now sometimes gives as much as 1 to 1. 5 grm. in repeated injections within 24 hours. Greater doses than thisshould only be given in very severe cases and by gradual increases. Maragliano employs a 5 per cent. solution msterilised oil to render the local reaction more mild. From

the literature during the period from 1888 to the presenttime Professor Baccelli has been able to collect 190 cases

treated by his method, and recorded with sufficient details to be of value. He excludes all cases with slow invasion and

long prodromal stage, and with mild convulsive attacks,since these often recover spontaneously, and divides theremainder into two groups-the severe and very severe cases.In the first of these he includes 94 cases, of which 9Zrecovered. He believes that all of these cases were ofsuch severity that they would have proved fatal apart from treatment, and he therefore claims that the use of injectionsof phenol has reduced the mortality from 100 per cent. to2 12 per cent. In the very severe group there were 38 cases with 16 deaths. In 11 of the fatal cases the dailydose was much below half a gramme, and Professor Baccelli maintains that in very severe cases the dose should not beless than 1 grm. per day. He therefore excludes these11 cases, and claims a reduction of the mortality in theremaining 27 cases from a probable 100 per cent. without.treatment to 18-5 per cent. with carbolic treatment. The

results are sufficiently striking to demand careful attention.but the administration of the large doses of carbolic acid

1715

recommended requires considerable courage and belief inthe value of the treatment.

BRIGHTON SCHOOL CLINIC.

THE Brighton education authority has agreed upon itsscheme of medical treatment for the year 1911-12.

Inasmuch as the arrangements for providing medicaltreat-ment for elementary school children have been growing inextent throughout the country, the Brighton authority con-’8idered it inevitable that expenditure from public funds onthe provision of such treatment must gradually increase,though it is to be hoped that the whole of the extra cost willnot have to be defrayed from the local rates. Care is beingtaken, as required by the Act of Parliament, to see that

parents able to pay are made to defray the whole or part ofthe cost of treatment. In view of the excellent results thatmust accrue it would be unfair to find fault with the cost of

the scheme in a town the size of Brighton, with its

elementary school population of roughly 20,000. The total

expenditure for the twelvemonths is as follows, the items-under the head of "other expenses" being tabulated

according to the requirements of the Board of Education :—

Furnishing of school clinic, JB20; drugs, JB5 5 ... ... £25 X ray apparatus ........................... 50Provision of spectacles ........................ 25

Subscriptions to hospitals ..................... 100Other expenses-

Proportion of salary of school doctor ... ... £27 Proportion of salary of school nurse ...... 16

Proportion of rent, rates, and taxes ofclinic ........................... 20

Proportion of cost of maintenance of clinic... 20... 83

Total ... ... ... ... ... ... ... ... ... £283

As to the purchase of X ray apparatus, the authority con-fidently expects that in the course of a few years the costwill be covered by the increased Government grant that willbe obtained owing to the children being able to return toschool much sooner than under any other method of treatmentof ringworm. As regards spectacles, it has been found thatmany children do not receive the full benefit of education

owing to defective eyesight, and, generally speaking, this

defect would become worse unless spectacles were provided.Spectacles are obtained at a cost of from 9d. to 2s. per pair,and here, again, parents who are able to pay are expected todo so. Through the subscriptions to the hospitals letters areobtained to be given by the school doctor to school childrenrequiring medical or surgical treatment for which their

parents are not in a position to pay. In this course the

authority is acting in accordance with the advice of theBoard of Education in endeavouring to make use of existinginstitutions before putting forward proposals which wouldprobably be more expensive, under which medical and

surgical treatment would be given in separate institutionsspecially provided by them for the purpose.

THE MEDICAL LIBRARY ASSOCIATION OFAMERICA.

THE Medical Library Association of America has now beenin existence some 13 years, the idea of its formation havingoriginated with Dr. Gould of Philadelphia. He it was who

-first conceived the idea of forming an association wherebythe wasted medical literature all over the world may beutilised." So far as Canada and the United States are

concerned, the wastage and overlapping of medical literaturehave certainly been arrested, for by means of a libraryexchange the Transatlantic medical libraries are enabled tobring all their most useful books into a common stock bywhich all those who in the United States and Canada takean interest in medical literature are benefited. The American

Library Exchange is apparently in good working order.Its rules, printed in red, are before us as we write,and one of them at least is so draconian as to,

suggest the most healthy activity. "No member," saysChapter III., "shall make application for exchange material,if such exchange material is duplicate of what that memberowns at the time said application is made. Violation of thisrule shall be cause for expulsion from the association."

This, we take it, means that members must not ask for

what they already possess. Yet bibliographers frequentlydesire to take a view of other copies of their treasures

In practical America, however, we can imagine that this

desire is rarer than here. The aim of the American medicalreader is to see all that is most germane to some practicalscientific purpose. And that is very natural. He must not,of course, be asking for books for the mere sake of collatingthem. The American Association is to be congratulated on its solid progress. The fourteenth annual meeting of theMedical Library Association was held on May 9th and10th at the Marlborough-Blenheim Hotel, Atlantic City.Dr. J. H. Musser, the distinguished President, of Phila-

delphia, delivered an address, and this was followed by aseries of valuable papers on Hospital Records in Relation tothe Hospital Librarian, by Mrs. Grace W. Myers of Boston,Mass. ; on the Establishment of Medical Libraries in CountyMedical Societies, by Dr. Carl Black of Jacksonville, III. ; qand on the Changes in Medical Periodical Literature sinceJanuary, 1909, by Mr. C. Perry Fisher of Philadelphia. Weshould much like to peruse these papers in print-the lastespecially, coming as it does from an eminent medicallibrarian of world-wide reputation. Our own Medical

Library Association continues to do admirable work underthe presidency of Professor Osler, and its members regardwith respectful interest the medical library movements of thecountry that has given and still gives to the world thatgreat clas&ic, "The Index-Catalogue."

CORONATION HONOURS TO THE MEDICALPROFESSION.

THE list of Coronation Honours includes the names of

many members of the medical profession, and our readerswill join us in heartily congratulating the gentlemen whomwe now mention upon their well-merited distinctions.The following have been made Baronets of the United

Kingdom :-Mr. H. T. Batlin, Professor W. Oaler, Dr. J. F.Goodhart, Sir C. B. Ball, Sir W. Thornley Stoker.The following have received the honour of Knighthood :—’

Mr. A. A. Bowlby, Mr. R. Brayn, Dr. Alexander Dempsey,Dr. F. W. Hewitt, Dr. the Hon. J. MoCa.11, and Mr. F. C.Wallis.The following have been appointed Knights Commander of

the Bath :-Inspector-General D. M. Shaw, Inspector-General T. D. Gimlette, Surgeon-General W. L. Gubbins,Surgeon General A. S. Reid, Professor Ronald Ross, andDr. B. A. Whitelegge.

Dr. Rose Bradford and Dr. J. Pringle have been appointedK.C.M.G. Dr. Bertrand Dawson h:1s been appointedK.C.V.O.

In every instance the public and scientific services ofthese gentlemen are so well known to our readers thatit would be almost superfluous to point out the reasons whythey have been selected for titular honours. All our readerswill join us in offering them congratulations. We shall-

publish the full list next week.

WE regret to announce the sudden death on Friday nighiilast of Sir Rubert Boyce, professor of pathology in the Uni-versity of Liverpool, at the early age of 48 years.