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1007 ROYAL COMMISSION ON PRISONS IN IRELAND. IN our issue of Nov. 17tb, when adverting to this impor taut subject, we gave some few particulars concerning the evidence the gaol surgeons tendered before the Royal Com mission. Their evidence, as we then stated, might b roughly divided into two classes-viz, : (1) That referring ti the health and treatment of prisoners, and (2) what th. surgeons conceive are the disadvantages they labour unde personally. Some details are at hand which we feel j ustifiec in stating for the information of the profession, and which we trust, may induce the Commission to formulate a schem( which may secure a more harmonious working of the Priaor Act in the future. It is evident that the position of a gao surgeon is one which requires, for the due performance oj his duty, considerable discrimination and tact. No hard-and fast rules can be laid down which fetter the officer, and oi all branches of the service this one at least should be free from the thraldom of red-tapeism. The very essence of the duty consists in standing, as it were, between the strict carrying out of the letter of the law and the humane prin. ciples inherent in our civilised code of justice. In the Prison Act a special section in Clause 53 was interpolated, whereby a surgeon might, under particular circumstances, of which he alone was to be the judge, call in additional medica! assistance ; but unfortunately recent minutes of the General Prisons Board have so modified this rule that it practically ceases to be of the wide usefulness intended for it. So with regard to attendance; the Board have fixed the hour of twelve o’clock as the latest at which medical officers are to visit. This was not unly fixed, but the various governors of the prisons were desired to report any omission of such duty. The medical officers stated that as a rule this was carried out, and that not only was it convenient for the prison, but also for themselves, as generally medical men pay visits to all institutions early in the day; but they asked the Com- missioners, very properly, to have this rule modified, so that its literal non-fulfilment might not be considered a breach of duty. A hardship the surgeons labour under in relation to sick leave is one which we cannot believe the Royal Com- mission can overlook. If sudden or severe illness overtake an officer he must supply a substitute at has own expense, such substitute to be fully approved by the General Prisons Board. The custom prevailing in the Lunacy and Poor-Law systems is more generous in this respect, and has been found to work satisfactorily. A fee of three guineas per week for a limited period is allowed, and we cannot understand why a similar advantage is denied to gaol sur- geons; their scale of salaries is ridiculously small, and withholding from them such privileges is not calculated to increase their zeal in the service. When the Prisons Act came into force the duties of medical officers were defined in the 53rd section. These increased and modified very largely those duties which were laid down in the 72ndsec. of the 7 Geo. IV. c. 74, and which goverred the surgeons of local prisons in Ireland up to that date. On the basis of the new Act certain salaries were allocated to the surgeons of the various prisons. On March 22nd, 1878, the new rules were issued by the General Prisons Board. No. 101 was to the effect that surgeons should visit the prison at least twice a week. But on Nov. 13th, 1882, the Board issued new rules, the first of which was that the surgeons should visit the prison every day, and not later than 12 o’clock. We do not consider the first part of this new rule unreasonable ; on the contrary, we think it a judicious and humane arrangement; but if the atteudance of medical officers is thus arbrtrarily required, in common fairness they are entitled to a considerable aug- mentation of the salary which was fixed on the basis of a by-weekly attendance. This first rule contains the proviso that daily visits to individual sick prisoners shall also be paid. We understand that the medical officers do not object in the slightest to this, and for their own protection it is absolutely necessary that this rule should be stringently observed ; but they very strenuouly and reasonably object to the interpretation whi’h the Board have placed on the word "sick," making it include all prisoners on extra diet. As we pointed out in our issue of the 17th ult., this in- yolves an enormous amount of extra work of an unnecessary character, and manifestly impedes the surgeons in the exercise of their proper functions. We have every reason to believe that the Commission will considerably modify the interpre- tation of the executive in this particular. We have all the more reason to believe this when we recall the existence of the Circular of May 3rd, 1879, signed by the Chairman of the Prisons Board and addressed to all medical officers of prison’-!, stating "that the surgeons in question were no longer prison otficers, and could only become -o in the event of their receiving that appointment from His Grace the Lord Lieutenant." How such an interpretation could have been placed on the 27th section of the Prison Act, which provided that " all officers attached to prisons at the date of the passing of the Act should hold their office in like terms and conditions as if the Act bad not passed," it is difficult to imagine ; but, at all events, the position taken up in the Circular alluded to was erroneous, and had eventually to be abandoned. We are of opinion an analogous state obtains in the present instance with regard to the word "sick" in the first of the new rules, and the attempt to foist arduous duties on the surgeons in consequence is alike discreditable and illegal. That the Prisons Board are earnestly attempting to carry out the intentions of the Act, and to make that Act successful in its working, we believe ; but that they have not conciliated their medical officers, on whom so much depends, we also believe. Their failure to effect this may rest to a great extent on the personnel of the Board; but, as we pointed out previously, there is only one safeguard, and till that is adopted no ente2ite cordiale can subsist betwefn the heads of an important public department and the officers on whom they must chiefly rely. In the appointment of a medical member to the Board or an efficient medical inspector lies the solution of all difficulties. Public Health and Poor Law. LOCAL GOVERNMENT DEPARTMENT. REPORTS OF INSPECTORS TO THE MEDICAL DEPARTMENT OF THE LOCAL GOVERNMENT BOARD. Diphtheria at Great Dunmow, by Dr. Airy.1-After a considerable absence of diphtheria for several years past, some thirty-six attacks of diphtheria occurred early this year in the Dunmow rural sanitary district, and twenty of them terminated fatally. Twenty-three of the attacks occurred in Great Dunmow, where, although there had been no recent fatal diphtheria, sore-throats had been common during the preceding quarter, some being followed by symptoms which appeared to point to the diphtheria poison. So far aa the cause of the disease is concerned, the most interesting points have reference to the national school, where the disease in the main attacked boys only, these all sitting in one special class; and where, according to Dr. Airy, a defective and broken watercloset is credited with haviug led to the first attack. Various circumstances which might have conduced to its spread are discussed, but there are strong grounds for believing that, in the main, the infection was diffused owing to personal contact between the sick and the healtby. Another portion of the report deals with a subject which we have on several recent occasions discussed—namely, the fre- quent concurrence of scarlet fever and diphtheria-a concur- rence which has been noted so often as to lead to the belief in many minds that an actual affinity exists between the two diseases. In the outbreak now under discussion it is recorded how a young woman returns to her home after convalescing from scarlet fever, and how within eight days of her return one of her sisters sickens with and dies of "malignant sore- throat," this being immediately followed by three more attacks of the same disease, two of them terminating fatally. The death, in one case at least, was regarded as distinctly due to diphtheria. At the same date, however, a child of another family, but living under the same roof, was attacked with a sore-throat, which was followed by the rash of scarlet fever and by desquamation. A woman, too, who helped to nurse the several children was seized with a fatal attack of diphtheria. The facts in this case are not so striking as they have been in some others which have been recorded, but they form part of a steadily increasing group of cases which go far 1 To be had of Messrs. Knight and Co., 90, Fleet-street, E.C. ; Messrs. Shaw and Sons, Fetter-lane; Messrs. Hadden, Best, and Co., 227, Strand; and Messrs. P. S. King and Son, King-street, Westminster.
