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149 OBITUARY JOHN MIDDLETON MARTIN M.D. CAMB. L.S.A., D.P.H. Dr. Middleton Martin,-who died at Cheltenham on Dec. 30 in his 70th year, was the first whole-time medical officer of health (1903-37) for Gloucester- shire. He retired two years ago still active in body and mind. Born at Exeter in August, 1870, son of John May Martin, he was educated at Exeter School and Cambridge, where he took a first class in the natural sciences tripos and was a scholar of Peterhouse, before completing his s medical studies s with distinction at University College Hospital. Quali- fying in 1896 he was resident at the Hospital for Women, Brighton, before studying for the D.P.H. and his association with shire began with his appointment to the Stroud R.D.C. He soon had similar appointments at Nailsworth and with the Stroud urban district, with charge of the joint isolation hospital. In 1903, after having done pioneer work in organising medical inspections of school-children, which resulted in an experimental scheme with 7000 children at 44 schools, he was offered the county appointment. It was then that his quali- ties began to show at their best. It was not true, as some said, that he had an official mind; it was just that he took pains in all public-health matters to use existing agencies and was therefore successful in bringing into common local action the practitioners, the nursing associations, the hospitals and their staffs. His success in this direction led to the signal honour of having his scheme cited in the Dawson report as the prototype of the future provision of medical and allied services. There was in this report a diagram of an area showing health centres, primary or second- ary, combined in one comprehensive plan; alongside this diagram appeared Middleton Martin’s plan of Gloucestershire mapped out into areas. And it was noted that the local urban authorities, the hospital authorities, and all the doctors had agreed on a scheme of services similar in its aims to the one set forth in the report. In other directions Martin was equally active. On the passing of the-Midwives Act in 1902 he was appointed executive officer for the county and succeeded in producing order and efficiency where half-hearted cooperation had been the rule. He reported to the interdepartmental committee on the results of his inspection and feeding of children attend- ing public elementary schools and the Board of Educa- tion commended his continuous records of nutrition to the imitation of other medical officers. He was active in initiating maternity and child-welfare work and made an early survey of health visitors in the county. He had a natural aptitude for preparing statistical material and three years ago he reviewed the public-health services of the county over half a century in an arresting way. His character comes out clearly enough from the record of his work. He was overflowing with nervous energy and his high standard was applied first to himself. Conscientious- ness, honesty and unfailing kindliness were the quali- ties patent to those who knew him best and who found him the staunchest of friends. Within was a mind finely tempered, fastidious, sensitive indeed to a degree which must have been irksome to a public officer. No wonder he became the counsellor and friend of all branches of the medical profession in Gloucestershire. Dr. Martin married in 1901 Louisa, daughter of Robert Holmested Rolfe, of Bocking, Essex. He leaves a widow and a daughter. HERBERT CHARLES M.R.C.S.j, D.A. THE death in London on Jan. 13 of Mr. Herbert Charles, the anaesthetist, is a great loss to the profes- sion. Genial, generous and exceedingly kind-hearted Charles, as a young man, was gifted with a fine physique and great strength and endurance. In those early days he was well known as a racing cyclist and for a while held the world-records for 12 and 24 hours’ tandem riding on the road. Entering the profession at a later age than most students he received his medical education at Middlesex Hospital, qualifying in 1906, and after a house-surgeoncy there he became one of its honorary anaesthetists, holding the appointment up to its age-limit when he was placed on the consulting staff. A keen freemason, he was the first anaesthetist appointed to the Royal Masonic Hospital when that institution was founded and he continued active in its service to within three weeks of his death. Mr. Victor Bonney writes: In assessing the calibre of an anaesthetist technical ability, the faculty of what is called clinical instinct, and temperament have all to be taken into account, and judged on this standard Charles was a very great anaesthetist indeed. Equally at home with the drop-bottle and the "Clover" as with the complicated apparatus that has replaced them, and adept in all the various forms of inhalation and injection anesthesia, he combined in himself the virtues of both the older and newer schools of thought in the practice of anaesthesia. It is unfortunate for our profession that, as advance succeeds upon advance, it too often happens that the old is so utterly put aside that not only its faults but its merits too are consigned to oblivion. With each step forward we generally slip back a little as well. The disuse of chloroform, which for certain operations is still the best of all anaesthetics, is an instance, and the deatli of Charles diminishes the already small band of expert chloroformists. Though the faculty of what is called clinical instinct can up to a point be acquired, yet in its highest degree it is a gift beyond observation and study: a power peculiar to a few individuals, not communicable to others, and in its origins not under- stood by the individual himself. An anaesthetist who has this gift is like a steersman sensing the rocks and shoals in an uncharted sea and Charles possessed it. His temperament was ideal for his calling, never ruffled or flurried or uncertain, whatever the surprise or emergency, and steady as a rock under all condi- tions. By force of circumstance every anaesthetist, more or less, becomes particularly expert in certain classes of case, and some may even be termed specialists within their specialty. Charles, though truly a general anaesthetist, had exceptional practice
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OBITUARY

JOHN MIDDLETON MARTIN

M.D. CAMB. L.S.A., D.P.H.

Dr. Middleton Martin,-who died at Cheltenham onDec. 30 in his 70th year, was the first whole-timemedical officer of health (1903-37) for Gloucester-shire. He retired two years ago still active in bodyand mind. Born at Exeter in August, 1870, son of

John May Martin,he was educated atExeter School andCambridge, wherehe took a first classin the naturalsciences tripos andwas a scholar ofPeterhouse, beforecompleting his smedical studies swith distinction at

University CollegeHospital. Quali-fying in 1896 hewas resident at theHospital forWomen, Brighton,before studying forthe D.P.H. and hisassociation with

shire began with his appointment to the Stroud R.D.C.He soon had similar appointments at Nailsworth andwith the Stroud urban district, with charge of thejoint isolation hospital. In 1903, after having donepioneer work in organising medical inspections ofschool-children, which resulted in an experimentalscheme with 7000 children at 44 schools, he was offeredthe county appointment. It was then that his quali-ties began to show at their best. It was not true, assome said, that he had an official mind; it was justthat he took pains in all public-health matters to useexisting agencies and was therefore successful inbringing into common local action the practitioners,the nursing associations, the hospitals and their staffs.

His success in this direction led to the signal honourof having his scheme cited in the Dawson report asthe prototype of the future provision of medical andallied services. There was in this report a diagramof an area showing health centres, primary or second-ary, combined in one comprehensive plan; alongsidethis diagram appeared Middleton Martin’s plan ofGloucestershire mapped out into areas. And it wasnoted that the local urban authorities, the hospitalauthorities, and all the doctors had agreed on a schemeof services similar in its aims to the one set forth inthe report. In other directions Martin was equallyactive. On the passing of the-Midwives Act in 1902he was appointed executive officer for the county andsucceeded in producing order and efficiency wherehalf-hearted cooperation had been the rule. Hereported to the interdepartmental committee on theresults of his inspection and feeding of children attend-ing public elementary schools and the Board of Educa-tion commended his continuous records of nutritionto the imitation of other medical officers. He wasactive in initiating maternity and child-welfare workand made an early survey of health visitors in thecounty. He had a natural aptitude for preparingstatistical material and three years ago he reviewedthe public-health services of the county over half acentury in an arresting way. His character comes

out clearly enough from the record of his work. Hewas overflowing with nervous energy and his highstandard was applied first to himself. Conscientious-ness, honesty and unfailing kindliness were the quali-ties patent to those who knew him best and who foundhim the staunchest of friends. Within was a mindfinely tempered, fastidious, sensitive indeed to a

degree which must have been irksome to a publicofficer. No wonder he became the counsellor andfriend of all branches of the medical profession inGloucestershire.

Dr. Martin married in 1901 Louisa, daughter ofRobert Holmested Rolfe, of Bocking, Essex. He leavesa widow and a daughter.

HERBERT CHARLES

M.R.C.S.j, D.A.

THE death in London on Jan. 13 of Mr. HerbertCharles, the anaesthetist, is a great loss to the profes-sion. Genial, generous and exceedingly kind-heartedCharles, as a young man, was gifted with a fine

physique and great strength and endurance. Inthose early days he was well known as a racingcyclist and for a while held the world-records for 12and 24 hours’ tandem riding on the road. Enteringthe profession at a later age than most students hereceived his medical education at Middlesex Hospital,qualifying in 1906, and after a house-surgeoncy therehe became one of its honorary anaesthetists, holdingthe appointment up to its age-limit when he wasplaced on the consulting staff. A keen freemason,he was the first anaesthetist appointed to the RoyalMasonic Hospital when that institution was foundedand he continued active in its service to within threeweeks of his death.Mr. Victor Bonney writes: In assessing the calibre

of an anaesthetist technical ability, the faculty of whatis called clinical instinct, and temperament have allto be taken into account, and judged on this standardCharles was a very great anaesthetist indeed. Equallyat home with the drop-bottle and the "Clover" aswith the complicated apparatus that has replacedthem, and adept in all the various forms of inhalationand injection anesthesia, he combined in himself thevirtues of both the older and newer schools of thoughtin the practice of anaesthesia. It is unfortunate forour profession that, as advance succeeds upon advance,it too often happens that the old is so utterly putaside that not only its faults but its merits too areconsigned to oblivion. With each step forward wegenerally slip back a little as well. The disuse ofchloroform, which for certain operations is still thebest of all anaesthetics, is an instance, and the deatliof Charles diminishes the already small band of expertchloroformists. Though the faculty of what is calledclinical instinct can up to a point be acquired, yetin its highest degree it is a gift beyond observationand study: a power peculiar to a few individuals, notcommunicable to others, and in its origins not under-stood by the individual himself. An anaesthetist whohas this gift is like a steersman sensing the rocks andshoals in an uncharted sea and Charles possessed it.His temperament was ideal for his calling, never

ruffled or flurried or uncertain, whatever the surpriseor emergency, and steady as a rock under all condi-tions. By force of circumstance every anaesthetist,more or less, becomes particularly expert in certainclasses of case, and some may even be termedspecialists within their specialty. Charles, thoughtruly a general anaesthetist, had exceptional practice

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in the surgery of the breast and pelvis. His experi-ence of Wertheim’s operation was far beyond that ofany other anaesthetist, for he administered full etherwith spinal anaesthesia to between 500 and 600 patientsundergoing that operation without a death-a remark-able record. A surgeon looking back over many yearson his work in the operating theatre, with all itsstrenuous endeavour, must with a humble and gratefulheart acknowledge how much of his success has beendue to the self-abnegating and often poorly acknow-ledged work of those who, at the ano3sthetist’s end ofthe table, with the patient’s life in their hands, madethat success possible. The writer feels this verydeeply and, in bidding farewell to a dear old friendand colleague, rests assured that he will not be heldto disparage the many great anaesthetists with whomhe has worked when he writes that the greatest ofthem all has gone.

JAMES ALEXANDER STEPHEN

M.B. ABERD. D.P.S., J.P.

Dr. James Stephen, who died on New Year’s Dayat the age of 66, was the first officer for maternityand child welfare in Aberdeen. From 1919 until Juneof last year he was responsible not only for theinception and development of this branch of public

health but for its gladacceptance by thepoorer mothers of thecity. Son of the minis-ter-schoolmaster at St.Andrews - Lhanbryde,Stephen had qualities ofkindly and sinceredirectness and enthusi-asm which made him afriend both to innumer-able patients and to

generations of Aberdeenmen to whom he taughthis subject. Intenselyinterested in the morescientific aspects of hiswork he never allowedthis side to cloud hisview that common

sense, humility andsympathy are the fundamental qualities of thegood doctor. After graduating in medicine in1900 he was appointed assistant in anatomy in theuniversity and during this time he took his public-health diploma. From 1901 to 1914 he carried on alarge practice in Elgin, where he was a member ofthe school board and medical officer for the burghs ofLossiemouth and Burghead,-and after serving throughthe war in France he returned to Aberdeen to his truemetier. In the years which followed he played a bigpart in the eradication of rickets from the area, thehalving of the infant mortality-rate from 128 per1000 births, the establishment of welfare centres inevery district in the city, the provision of nurseryschools and homes, and the building of the newmaternity hospital. With so much executive androutine work Stephen had little time for writing butthe report (which became a model) on maternal mor-tality and puerperal sepsis in Aberdeen from 1918 to1927, issued by the Scottish Board of Health, wasprepared by him and two colleagues. It was in 1917that Matthew Hay realised the advantages of a routineinquiry into every maternal death and Stephen wasamong the first to make the detailed records. Othersubjects on which he wrote include sudden death in

pneumonia, salmonella infections, and the role of thematernity hospital in preventive medicine. In 1930he gave in London the presidential address at thematernity and child welfare group of the Society ofM.O.H.’s.

Dr. D. Rorie writes: My friendship with JamesStephen dated back to 1914 when he left his Elginpractice to join the 1/2nd Highland Field Ambulanceof the 51st Division; and it was cemented during thethree years we spent together before he left us to becomean O.C. ambulance train. He was by no means ayoungster when he, took his R.AM.C., T.F., commission,but he faced up to the subsequent campaigning as ajunior officer of the unit with his usual equanimity,even when on one occasion he was sent by corps ordersto a C.C.S. with a party of nursing orderlies andfound they were detailed to dig drains! i But all thatfell his way he did cheerfully and well, seeing thefunny side of even humourless brass hats, and underthe most trying, conditions maintaining a placidity ofoutlook which most of his colleagues frankly envied.When he left us and took to "wheels" all membersof the unit, officers and men alike, missed him badly.It was not long after demobilisation that he gave upgeneral practice to become the first maternity andchild welfare medical officer in Aberdeen. His innatephilanthropy and benevolence, his wide experience ofhuman nature gained in general practice, his tact,his wholesome common sense, and his quaintlydetached. outlook were all valuable assets in winningthrough to success. Although he was by then farfrom physically fit, he did his part in the spadeworkof last year’s annual B.M.A. meeting in Aberdeen,acting as one of the two deputy local secretaries. His

family life was a full and happy one. His wife,who shared his professional interests, died shortlybefore the onset of his own last illness, and it was aloss that he found hard to bear. He leaves two sons,one a captain, R.A.M.C., now serving abroad, theother studying divinity at Aberdeen; and a marrieddaughter living in England.

ARCHIBALD GALBRAITH FAULDS

M.B. GLASG., F.R.F.P.S.

Dr. Faulds, who died last week at Bearsden, Dum-bartonshire, was one of the pioneers in radiologicalwork in this country. He was born in 1860 in Glasgowand graduated at Glasgow University in 1888. Fouryears later he was demonstrator of anatomy in St.Mungo’s College, Glasgow, and in 1895 was appointedassistant to the professor of surgery. He became afellow of the Royal Faculty of Physicians andSurgeons of Glasgow in 1906, and in 1910 he wasappointed consulting surgeon to Glasgow corporation.He acted as examiner in physics for the RoyalFaculty in Glasgow and for the Royal Colleges ofPhysicians and Surgeons in Edinburgh. Dr. Fauldswas an assistant surgeon in the Glasgow RoyalInfirmary for a time and professor of physiologyat St. Mungo’s College and was a widely popular andrespected teacher of surgery, physiology and radi-ology. To his credit goes the taking of the firstX-ray photograph in Scotland, and during his earlywork in radiology he was associated with the lateDr. John McIntyre. It is only lately that Dr. Fauldsretired from private practice in Glasgow.

Dr. WiLHELM NEUMANN, late of Baden-Baden, diedon Dec. 29 at Leamington, aged 55, a few weeks aftefsettling there with a view to practice in cardiovasculardisorders. He was one of the best type of health-

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resort practitioners, a close observer both of mentaland’bodily states, keeping well abreast of advancingknowledge in his subjects, and always courteous, kindlyand encouraging. Before the last war he practised inwinter at Nervi, studying in Swiss and German clinicsin the summer. During that war, in the Germanmilitary medical service at Baden-Baden, he becameinterested in hydrological methods, and subsequently

settled there as a spa practitioner in rheumatic andcirculatory affections: When obliged to leave Ger-many, he transferred his practice to San Remo.Neumann was a member of the International Societyof Medical Hydrology and of the International Leagueagainst Rheumatism, and the author of numerous

papers dealing with tuberculous, rheumatic and circu-latory diseases. He leaves a widow and one daughter.

MEDICAL NEWS

Royal College of Surgeons of EnglandAt a meeting of the council held on Jan. 11 with Mr.

Hugh Lett, the president, in the chair Sir HumphryRolleston, chairman of the executive committee of theImperial Cancer Research Fund since 1924, and Sir ThomasDunhill, serjeant-surgeon to the King, were admitted tothe honorary fellowship. Sir Hugh Devine, president ofthe Royal Australasian College of Surgeons, has acceptedthe honorary fellowship.The Hallet prize, granted on the result of the primary

fellowship examination, was awarded to James GraytonBrown, of Melbourne.The council decided to institute a new series of lectures

in physiology and a new series of demonstrations in

pathology. Mr. D. H. Patey was elected Erasmus Wilsondemonstrator and Mr. Gwynne Williams has agreed to

give six demonstrations in pathology before May next.Mr. Arthur Burgess was appointed Hunterian orator for1941, Sir Alfred Webb-Johnson Bradshaw lecturer for1940, and Dr. Arnold Chaplin Thomas Vicary lecturer for1940.The posts of resident surgical officer and house-surgeon

at the Clayton Hospital and Wakefield General Dispensarywere recognised for the six months’ surgical practice requiredof candidates for the final examination for the fellowship.The following diplomas were granted, jointly with the

Royal College of Physicians :D.P.M.-A. L. Abeyewardene, C. D. Amarasinha, G. F.

Andrews, P. L. Backus, J. L. Barford, D. R. Davis, P. E. F.Frossard, D. W. T. Harris, A. J. Matheson, A. G. Moore, F. D.Paterson, T. P. Riordan, H. R. Rollin, Alice I. Roughton,A. M. Spencer and R. F. Tredgold.. -D.L.O.—J. H. Appleton, Richard Chignell, C. S. David,A. H. Farid, A. T. George, W. C. Gledhill, Maurice O’Regan.D. Y. Richardson, Alexander Russell, H. C. Saksena, andG. S. M. Wilson.

Francis Amory Septennial Prize.Under the will of the late Francis Amory, the American

Academy of Arts and Sciences administers a fund to

provide a septennial prize for "

conspicuously meritoriouswork performed through experiment, study or otherwise, inthe treatment and cure of diseases and derangement of thehuman sexual generative organs in general, and moreespecially for the cure, prevention or relief of the retentionof urine, cystitis, prostatitis, etc." during the years preced-ing the award. If there is work of a quality to warrant it,the first award will be made this year. The total amountof the prize will exceed 10,000 dollars and may be givenin one or more awards. While formal nominations are not

expected and no essays or treatises in direct competition’for the prize are desired, the committee invites suggestionswhich should reach them, care .of the American Academyof Arts and Sciences, 28 Newbury Street, Boston, Mass.,U.S.A., not later than May 15. The members of theFrancis Amory Fund committee are : Dr. Roger I. Lee(Chairman), Dr. Walter B. Cannon, Dr. David Cheever,Prof. Leigh Hoadley, Dr. William C. Quinby, Dr. E. E.Tyzzer and Dr. Soma Weiss (Secretary).Service Appointments .

Air-Commodore H. E. Whittingham, whose promotionto the acting rank of air vice-marshal we announced lastweek, has been appointed director of hygiene to the RoyalAir Force Medical Services. ’

Sir Harold Fawcus has been appointed an honorarycolonel commandant of the Royal Army Medical Corps.

Colonel A. J. Orenstein has been appointed director-general of medical services with the-British East Africanforces.

London Ambulance Service.On the outbreak of war the system of dealing with tele-

phone calls for ambulances received by this service wasdecentralised and a war-time organisation was set up underwhich calls are dealt with by the control-centres of eachmetropolitan borough. By arrangement with the LondonCivil Defence regional headquarters it has now been decidedto revert to the peace-time system except for streetaccident and emergency cases. Applications for ambu-lances should be made as follows :For fever or smallpox cases-Call Waterloo 3311.For street accidents or other emergencies-Dial 999. The caller

will then be connected with the ambulance officer at the appro-priate borough control-centre who will arrange for the despatchof an ambulance.For admission to Council’s general hospitals. The medical

superintendent of the hospital should be informed and thenecessary arrangements will be made by him. In cases ofextreme urgency application for the ambulance may be madedirect to the London Ambulance Service (WATerloo 3 311) beforecommunicating with the medical superintendent. A medicalcertificate that the patient is fit to be moved should be providedin every case.

All other ambulance inquiries, including applications forthe hire of ambulances, should be made to WATerloo 3311.

Broadcasts in February. The Friday talks at 10.30 A.M. on health matters will be

continued in February. In the broadcasts to schools thesubjects for February on the series, Our Daily Life, -byA. D. Peacock and R; G. Garry are : Mackenzie studies theheart (Feb. 7) ; blood and iron (Feb. 14) ; strength andforce (Feb.’21) and ductless glands (Feb. 28):Maternity Services in Lanarkshire

It is announced that during,the six months to November,1939, 1308 maternity cases, or 63 per cent. of the mothersin the county confined in their own homes in Lanarkshire,were dealt with under the new maternity service schemewhich came into operation last May. This scheme, one of35 covering 37 of the 55 local authorities in Scotlandresponsible for maternity services, was started under theMaternity Services (Scotland) Act, 1937, to enable everyexpectant mother to obtain in her own home, at a reason-able charge, or free if need be, the services of a qualifiedmedical practitioner and midwife. The assistance of aspecialist obstetrician can also be obtained for the all-infee. It is hoped that this service will lead to a valuablereduction in the amount of postpartum morbidity and inthe number, of deaths. Patients whose family incomesbring them under the national health insurance limit areasked to pay 30s. for the all-in service ; those with incomesover the limit pay :E3 5s. These charges, however, are notimmutable and may be scaled down where the patient’sfinancial circumstances warrant it. In Lanarkshire 18out of the 2081 cases booked since the start of the schemepaid the maximum fee of E3 5s., 1753 paid 30s., 193 paidsums varying from 25s. downwards and 117 were unableto make any payments. The total cost of the scheme inthe county during the six months amounted to 1:4729, ofwhich more than a third has been returned in patients’fees. Up to now most of the women attended by the servicebelong to the population insured under the nationalinsurance provisions, but as the service becomes betterknown larger numbers of women in higher income groupswill no doubt take advantage of it. No restriction of thelocal authority schemes is expected as the result of thewar, and it is understood that the Government’s intentionis to encourage further development not only in Lanark-shire, but throughout the other parts of Scotland. Inaddition to the 35 schemes already in operation a further15 are in an advanced stage of preparation.


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