102

gonorrhoea as a result of infection by towels, w.c.’s,and lavatories, and the youth of a child by no meansprecludes the possibility of her having gonorrhoea,though such sexual precocity as was found in Dr.Porter’s case is rare. No towels, baths, or bedroomchambers should ever be shared by girl children ininstitutions. This should be a rule admitting of noexceptions. A similar outbreak observed this yearat a convent home for older girls in a home countywas traced to infection from one or more imperfectlycured cases of gonorrhoea by towels and baths.Facilities in this case were admittedly insufficient,as the institution, though well run in many ways, wasshort of funds.—ED. L.

TREATMENT OF ACCIDENS ON THE SPOT OR TRAUMA

1 CONICULUM PROUICIMUMTo the Editor of THE LANCET. I

SIR,-During the last few days the daily journals Ihave described many a case in which an injured person,after an accident, has died on the way to hospital, orsoon after admission. For long it has been mycontention that movement, even for a short distance,is the worst possible treatment after any injury;shock is made greater ; there is grave risk of injuringsoft and vital parts ; there is likelihood of re-starting

.1.- loss of bloody there is serious danger of embolism ;there are many possibilities of causing and increasing

jj deformities.j An illustrative episode may serve to bring this home to those who have been schooled in the present regime.

Last year I saw a severe injury-compound com-minuted fracture of two limbs-nine days after theinjury. During these days there had been a minimumof movement, the parts being left undisturbed ; andat the end of that time the patient travelled a distanceof about a mile from the scene of the injury, and came Iunder my care at a cottage in the country. To my ’,surprise I was able daily to manipulate the fragmentsinto position without causing pain, and to get anideal result. Not only so, but as the injury of onelimb was adjoining the site of an old traumaticdeformity, I was able to rectify that at the same time.The cost was trivial, and I did the nursing myself.

This incident confirmed my former conclusion ofthe wisdom of the advice : Put a case of trauma intothe nearest available bed. The occupant of the houseis not English-I had almost written British-ifadmission is refused. Some may argue that there isan absence of technical nursing in a rural house.But he is a poor over-schooled doctor who cannotquickly instruct a sister, or a neighbour, to nurse andmanage everything well. The finest result that I eversaw after complete transverse fracture of the patellahappened where a mother, unschooled but educable,tended her son in his home.

It may be urged that transport facilities are nowsuch that there is no danger. That is just the sadfallacy of it all. Let a well person travel a distance offive miles in the most elaborately equipped ambulance,assuming the posture and position of a badly-injuredpatient, and he will quickly change his mental attitudetowards the treatment of severe traumatism,i-W121

I am, Sir, yours faithfully, au -+,B(BN.IB’B&Oslash;JBBI<’R. CUNNINGHAM AFFLECK.

Edinburgh, June 30th, 1925.R. CUNNINGHAM AFFLECK.

A BELGIAN MEDICAL CRUISE.

To the Editor of THE LANCET.SiR,&mdash;After all the causes for gratitude that the

Belgian doctors, since the war, owe to the Britishdoctors, the " Medical Days of Brussels," at whichyour Government was officially represented, haveagain drawn closer together the bonds which uniteour two medical bodies. In these conditions, desirousof giving a tangible proof of our friendship, we havedecided to invite our British colleagues to take partin a medical cruise to the Near East which we are ’i

organising. I shall be grateful if you will kindlyinsert the enclosed notice. Application may be madeto me.-I am, Sir, yours faithfully,

Dr. R. BERNARD,Secretaire de la R&eacute;dact&icirc;on, Bruxelles-

July 1st, 1925. Medical, 117, rue du Tr&ocirc;ne, Brussels.

Medical Cruise to the Near East Itinerary.Marseilles, Alexandria, Cairo, Port Said, Jaffa (Jerusalem),

Beyrouth (Damascus-Liban), Smyrna, Constantinople,Le Piree (Athens), Malta, Naples, Marseilles. DepartureAugust 24th ; return, Sept. 18th. Special conditions;2700 French francs each for doctor and wife, 3600 Frenchfrancs for each member of a doctor’s family. The voyageis first-class by the large and luxurious packets Cordillereand Lotus Oriental mails. There will be an opportunity ofvisiting Cairo, Jerusalem, Damascus, and Athens, and ofprolonging by 12 days the stay at Beyrouth in order tovisit thoroughly Syria and Palestine. It will also be

possible to visit Baghdad, three days by motor-car fromBeyrouth.

Dr. R. BERNARD,Secr&eacute;taire de la R&eacute;daction, Bruxelles-

M&eacute;dical, 117, rue du Tr&ocirc;ne, Brussels.

A DISCLAIMER.’

To the Editor of THE LANCET.

SrR,&mdash;My attention has been called to a report inthe Daily News of my annual hospital tea party.Although I was aware that the occasion was to beused for giving publicity to the hospital building fund,I had no knowledge that personal allusions were to bemade to myself. I much regret that in the reportreferences were made for which I am in no wayresponsible, and which are both undesirable andunnecessary. I am, Sir, yours faithfully,

London, W., July 4th, 1925. H. J. PATERSON.H. J. PATERSON.

Parliamentary Intelligence.NOTES ON CURRENT TOPICS.

The Spahlinger Treatment.THE Parliamentary Medical Committee met on July 2nd,

to consider a report from five of its members whorecently visited the establishment of Mr. Spahlinger atGeneva. The report commented favourably on the visit,and suggested that an effort should be made to raise &pound;100,000in this country by means of a public campaign to enableMr. Spa,hlinger to continue his work. The Committee passedthe following resolution z

" That the Parliamentary Medical Committee has receivedwith much interest the account of the visit to the Spahlingerestablishment which the five members of the Committee havedrawn up, not as a delegation from the Committee, but asprivate individuals. The Committee are of opinicn that aprima facie case has been made out for further investigation,but the Committee resolve that they cannot as a corporate bodytake any action in the matter."

HOUSE OF COMMONS.

WEDNESDAY, JULY 1ST.

Night-work in Bakeries.Colonel WOODCOCK asked the Minister of Labour whether

His Majesty’s Government proposed to take any step torefer to the Permanent Court of International Justice thequestion whether the draft convention in regard to night-work in bakeries proposed by the recent InternationalLabour Conference, which related to an industry which wasnot the subject of international industrial competition andwhich prohibited night-work by master bakers as well asby persons employed, was consistent with the purpose ofPart XIII. of the Versailles Treaty of Peace, and also thequestion of the competence of the conference to pass such adraft convention.-Sir A. STEEL-MAITLAND replied : Thisconvention, as finally presented to the recent InternationalLabour Conference, was not acceptable to His Majesty’sGovernment, and their representatives voted against it.It is not the intention of the Government to take anyfurther steps with regard to the convention in the directionindicated.

Persons Excluded from Pensions Bill.Mr. TREVELYAN THOMSON asked the Minister of Health

the approximate number of persons who, on account oftheir not being insured under the National Health InsuranceActs, would be excluded from all benefits under the proposedPensions Bill, and the proportion which would be wage-earners.-Sir KINGSLEY WOOD (Parliamentary Secretaryto the Ministry of Health) replied : So far as the first part

103

of this question is concerned, I would refer the hon. Memberto Tables F and G on pp. 41 and 42 of the GovernmentActuary’s Report on the Bill. These tables show in somedetail the total population of each sex and the correspondinginsured population. In regard to the second part of the Iquestion, the compulsory provisions of the Bill apply topractically all wage-earners who are either engaged inmanual labour or are employed at rates of remuneration Inot exceeding &pound;250 a year, and provision is being made for Ithe continuance, on a voluntary basis, of the insurance of Iwage-earners who cease, or have already ceased, to be Iincluded in these categories. ,

The Use of Artificial Light. IMr. KENYON asked the Minister of Health whether,

before sanctioning the setting up of institutions for the useof artificial light by local authorities, he would satisfyhimself that a doctor experienced in this work was avail-able.-Sir KINGSLEY WOOD replied : The answer is in theaffirmative.

THURSDAY, JULY 2ND.Water Shortage at Saltash Hospital.

Colonel DAY asked the Minister of Pensions whether,seeing that there was a shortage of water at the Ministry iof Pensions Hospital for neurasthenics at Saltash, and that450 patients and a large staff had not the necessary supplies, I,he would allow the patients to return home and continueto draw full treatment allowances.-Major G. C. TRYON Ireplied : The temporary shortage of water which prevailedfor a few days at Saltash Hospital has now disappeared.The supply for the last fortnight has been normal and isadequate for all requirements. I do not anticipate anyfurther difficulty.

Closing of Oulton Hall Hospital.Mr. LUNN asked the Minister of Pensions whether it

had been decided to close the hospital at Oulton Hall, nearLeeds ; if so, on what date he proposed to close it and forwhat reason ; was he aware that Oulton Hall was the only

neurasthenic hospital in the county of York ; that the halland grounds had been given free to the nation by the ownerto be used for this purpose; that there were 120 patientsthere, and a large number of ex-Service men who hadreceived considerable benefit from treatment at this estab-lishment ; and that there was no other way in which theycould be treated so economically ; and would he reconsiderhis decision so as to allow the good work to proceeduninterruptedly.-Major G. C. TRYON replied : In viewof the continuous decline in the number of pensionersrequiring the kind of treatment provided at Oulton Hallit has been decided, after a careful review of the positionthroughout the country, to close this hospital (where thereare at present 84 patients, only 42 of whom are drawn fromthe county of York) at or about the end of this month.In arriving at this decision, the points mentioned by the hon.Member have not been overlooked, but I have had to keepin view the general requirements and the necessity formaking the most efficient and advantageous use of thefacilities for neurological treatment at my disposal, havingregard to the reduced number of cases to be dealt with andtheir distribution over the country as a whole.

Night-work in Bakeries.Mr. TREVELYAN asked the Home Secretary what the

figures were of the final vote in favour of the ratification ofthe convention for the abolition of night baking at theInternational Labour Conference ; how many of the votesadverse to ratification represented governments and whichgovernments ; how many represented the employers ; andhow many the workers.-Sir W. JoYNSON-Hzexs replied :The figures at the final vote showed 81 in favour of thedraft convention and 26 against. Of the adverse votes, threewere given by delegates representing the British and IndianGovernments, and the remainder by employers’ delegates.There were a considerable number of abstentions.

Medical Inspection of School-children.Mr. BRIANT asked the President of the Board of Education

whether the Board had taken any steps to enforce theprovision of medical inspection for the detection and correc-tion of visual defects in those schools under the 14 localeducation authorities which the chief medical officer ofhealth, in his report of 1923, stated make no such provision.-Lord E. PERCY replied : I am glad to say that of the14 local authorities in question six have, since the reportwas issued, provided for visual treatment, and seven othershave submitted proposals for such provision. In the remain-ing case I am advised that any treatment which may berequired can be obtained without special provision beingmade by the authority.

Compensation for Mr. W. S’. Harnett.Lord HENRY CAVENDISH-BENTINCK asked the Minister of

Health whether he would advise the Government to pay to

Mr. William Smart Harnett an adequate sum in compensa-tion for his wrongful detention in various mental hospitals,having regard to the fact that Mr. Harnett had been foundby a jury to have been sa,ne when detained by Dr. Bondand for the rest of his detention, that this opinion had notbeen upset by either the Court of Appeal or the House ofLords, by which tribunals Mr. Harnett’s case had beenheard, and having regard to th3 fact that, although havingthus been found to be sane, Mr. Harnett was to-day practi-cally a ruined man on account of the legal expenses of thethree actions in which he was concerned and the heavyexpenses of his confinement, in all a sum of over &pound;25,000.-Mr. NEVILLE CHAMBERLAIN replied : I do not think thatany claim for compensation out of public funds can besubstantiated in this case. In any event, no servant of theCrown was involved other than Dr. Bond, and, as my noblefriend is no doubt aware, a new trial has been orderedagainst Dr. Bond, and the matter is therefore still sub judice.I must not, however, be taken as admitting that the questionaccurately states the facts, for I observe that the LordChancellor in his judgment dismissing Mr. Harnett’s appealexpressly pointed out that it was not in fact proved at thetrial, nor found by the jury, that the appellant was ofsound mind between the date of his alleged detention byDr. Bond and his subsequent escape from custody.

Ophthalmic Benefit.Mr. BENNETT asked the Minister of Health whether he

was aware that, as a result of the new model scheme forthe provision of ophthalmic benefit by approved societies,which stipulated that an applicant for the benefit must,at the cost of 1s., have obtained and furnished his societywith a written recommendation from a panel doctor, thecharge for the necessary ophthalmic examination of theapplicant had increased from 5s., which was the fee paid toqualified opticians, to &pound;1 1s., which was the fee charged byophthalmic surgeons ; and whether, in view of the satisfac-tory nature of the service heretofore rendered by qualifiedopticians, he would suspend the order until the RoyalCommission on the disposal of the surplus funds of thevarious approved societies could investigate and reporton the matter.-Mr. NEVILLE CHAMBERLAIN replied : Iam aware that the cost of ophthalmic benefit under thenew scheme may, in certain cases, show an increase as statedby the hon. Member over the cost of optical benefit underthe existing schemes, but there will be no charge for theinsurance doctor’s recommendation, and the new arrange-ments have been generally accepted by approved societies.It is impra.cticable to adopt the suggestion in the latterpart of the question, inasmuch as the new schemes forsocieties and branches, valued as at Dec. 31st, 1922, are dueto commence on Monday next.

High Infant Mortality at Market Drayton.Mr. GRIFFITH asked the Minister of Health whether he

had seen a report of a recent meeting of the Market DraytonNursing and the Maternity and Infant Welfare Associations,where Dr. Wheatley, the medical officer for Shropshire,alluded to the high infant mortality of Market Drayton,and said that the principal causes of the high rate of infantmortality were bad housing and ignorance, and that theremedies were education and better housing ; and whetherhe would at once publish the report of his own medicalwoman inspector on Market Drayton, to show what washer view of the causes of, and remedies for, the high infantmortality.-Mr. NEVILLE CHAMBERLAIN replied : Theanswer to the first part of the question is in the affirmative.As regards the second part, I would refer the hon. Memberto the answer which I gave on this subject on May llth.

Sewage Pollution of the River Lee.Captain GARRO-JoNEs asked the Minister of Health

whether he was aware that the River Lee, which passedthrough thickly populated London districts, was at presentbadly polluted with crude sewage ; that the pollution wasnow worse than it had ever been ; that the state of the riverwas not only offensive to the many rowing clubs which usedit but was detrimental to the health of the dense riparianpopulation ; that the powers under the Rivers PollutionPrevention Acts were, as respects this river, divided betweenthe Middlesex County Council and the Lee ConservancyBoard ; and that most of the pollution originated fromtributaries within the control of the Middlesex County Council ;and whether he would consider the desirability of promotinga short Bill to make the Lee Conservancy Board the riverspollution prevention authority for the whole length of theriver and its tributaries, and immediately urging the urbandistricts in Middlesex and the Middlesex County Council,in the interests of public health, to cease discharging sewageinto the River Lee and its tributaries.-Mr. NEVILLECHAMBERLAIN replied : I am aware of the unsatisfactorycondition of this river. I am not satisfied that it would bedesirable to promote a Bill as suggested. The right remedyis to obtain treatment and disposal of the sewage, and my

104

efforts have been directed to that end. Two of the largelocal authorities are now spending large sums in improvingtheir disposal works, and a Bill is now before Parliamentfor taking the sewage of two others into the London maindrainage system. When these improvements have beeneffected, conditions should be very much better.

’

Birmingham Hospital Bill.St. Mary’s Church, Birmingham, and General Hospital

Bill was read a third time.

FRIDAY, JULY 3RD.

Infant Death-rate in Bombay.Colonel DAY asked the Under Secretary of State for

India whether he was aware of the increasing practice inBombay of women employed in cotton factories administer-ing opium to their babies before proceeding to their workand that, as a result, the infant death-rate in Bombay wasapproximately two in three ; and would he make representa-tions to those concerned suggesting that opium be made lessaccessible.-Earl WINTERTON replied : I am aware of thepractice, but not that it is increasing. The average annualfigures of infant mortality from all causes for the three yearsfrom 1922 to 1921 was 411 per 1000, as compared with624 in the previous three years. As regards the last partof the question, the Government of India have addressedinquiries to all local governments as to the extent of thepractice referred to and the question of taking measuresspecially designed to check it; my noble friend proposesto await the results of these inquiries.

MONDAY, JULY 6TH.Indian Medical Service.

Sir RICHARD LUCE asked the Under Secretary of Statefor India if the Government had yet arrived at conclusionsas to the future of the Indian Medical Service ; and whetherit was their intention to carry out the proposals of the LeeCommission in this respect, especially in the matter of estab-lishing provincial medical services the members of whichwould not be under the control of the Secretary of State.-Earl WINTERTON replied : The Government of India’sproposals are now under the consideration of my noblefriend the Secretary of State, who hopes to arrive at earlydecisions. Meanwhile I regret that I am unable to makeany further statement.

Medical Services in Tanganyika.Mr. BARCLAY-HARVEY asked the Secretary of State for

the Colonies the amount spent on medical and sanitaryservices and research work by the Germans in Tanganyikain the year 1913 ; and what were the corresponding figuresfor the year 1923-24.-Mr. AMERY replied : Owing to thedifference in the system on which the British and Germanestimates are presented, the comparison is by no meanseasy. The amount provided for the services referred to inthe German estimates for 1913 is approximately .899,000,converting the mark at 20 to the &pound;. But this does notinclude expenditure by certain local bodies to which grantswere made for a variety of purposes, including expensesconnected with hospitals and sanitation, which are notshown separately in the estimates. The amount providedfor similar services in the estimates for 1923-24 was

approximately .8116,700, which included all expenditureon buildings.

Lieut.-Colonel JAMES asked if the right hon. gentlemanwas satisfied that the amount spent was sufficient to fightepidemic disease in Tanganyika.

Mr. AMERY: No, Sir ; I should like to spend a greatdeal more.

New Tuberculosis Order.Mr. ALBERT ALEXANDER asked the Minister of Agriculture

whether he would have the draft of the Order he was proposingto make, directing the slaughter of cattle affected with tuber-culosis on the lines of the Tuberculosis Order of 1914, placedin the Library of the House before the discussion takes placeon the Diseases of Animals Financial Resolution.-Mr.WOOD replied : Yes, Sir ; I hope to place a copy of thedraft. Order in the Library towards the end of the presentweek.

Food Preservative Regulations.Sir ROBERT GowER asked the Minister of Health whether

he had received a communication from the Bakery AlliedTraders’ Association representing that the result of theproposed Public Health (Preservatives, &c., in Food)Regulations, 1925, would mean dearer food and an acuteshortage of supplies, with actual starvation in sight shoulda national emergency arise ; and whether he had any state-ment to make upon the matter.-Sir KINGSLEY WOODreplied : Yes, Sir, my right hon. friend has received thecommunication referred to, which has had very carefulconsideration. He cannot, however, admit that there is anysubstantial ground for the apprehension expressed in thelatter part of my hon, friend’s question.

’ Dirty Fruit from Turkey.’

Dr. HADEN GUEST asked the Parliamentary Secretary tothe Overseas Trade Department whether his attentionhad been called to the existence of dirty and insanitaryconditions prevailing in the transport, handling, and packingof dried fruit at Smyrna, Anatolia, and to the rates of wagesand conditions of labour of the workpeople employed ;and whether he would make inquiry to determine whataction, through the consular service or otherwise, wasrequired to protect the consumer against dirt contaminationand the Dominions fruit-grower against unfair competition.-Mr. A. M. SAMUEL replied : This matter has engaged the

, attention of the Ministry of Health and my departmentvery fully for some considerable time, and I have been infrequent communication on the subject with both theMinistry of Health and H.M.’s Consul General at Smyrna.I will consider in conjunction with my right hon. friendwhat action it is possible to take after further reports,which I have called for, have been received fromSmyrna.

Prohibition of Night Baking in Foreign Countries.Mr. TREVELYAN asked the Minister of Labour how many

European countries had already abolished night baking ;and in how many of those countries there had been anyresultant rise in the price of bread.--Mr. BETTERTON(Parliamentary Secretary to the Ministry of Labour)replied : The information available shows that legislationprohibiting night work in bakeries is in force in the followingEuropean countries : Austria, Belgium, Czecho-Slovakia,Denmark, Finland, France, Germany, Greece, Hungary,Italy, Netherlands, Norway, Poland, Soviet Russia, Spain,Sweden, Switzerland (two cantons). This legislation does notnecessarily follow the lines of the convention recentlyadopted by the International Labour Conference. I amunable to state from the official records of retail priceswhich are available how far any rise which may have takenplace in the price of bread in the respective countries isattributable to the operation of such legislation. ’

TUESDAY, JULY 7TH.

lIIiners’ Phthisis.

Mr. DAVID GRENFELL asked the Secretary for Mineswhether he was in a position to report upon the inquiries ofhis department into the incidence of miners’ phthisis amongmen engaged in rock-drilling by the use of compressed airmachines.-Colonel LANE-Fox replied : I am not in a

position to give any general conclusions, for the inquiryin question was confined to three mines. But its result wasto support the apprehension that, in those mines, rock-drilling may be dangerous to health. I have arranged fora more extensive inquiry to be put in hand at once. Mean-time the inspectors are taking up the question of pre-cautionary measures at the three mines.

State Contributions to National Insurance.

Mr. RHYS DAVIES asked the Minister of Health if he wouldgive the ratio of State contributions towards the nationalhealth and widows’, orphans’, and old age pensions insuranceschemes, respectively, based on each &pound;1 benefit payable oron any other unit of calculation.-Sir KINGSLEY WOODreplied : As the hon. Member is aware the State contribu-tion towards the National Health Insurance system istwo-ninths of the expenditure on benefits, exclusive of thecost of central administration ; including this item the Statecontribution is just over one-quarter. It is estimated thatthe State contribution to the new pensions system will beequal, on the average, to one-quarter of the expenditureon benefits in the first ten years of the scheme and thatafter this period it will be approximately two-fifths of theexpenditure.

Food Preservatives Regulations.Mr. ALEXANDER asked the Minister of Health when the

Public Health (Preservatives, &c., in Food) Regulationswere to be laid before Parliament; whether any alterationsin the published draft were proposed ; and, if so, whetherinformation as to the nature of these alterations could besupplied to Members before the regulations were finallymade and laid before Parliament.-Sir KINGSLEY WOODreplied : My right hon. friend hopes that the regulationswill be laid before Parliament adjourns. Considerablemodifications have been made in the original draft as aresult of full discussion between my right hon. friend’sofficers and the interests involved. The actual coming intoforce of the regulations will be postponed to enable necessaryadjustments to be made by the trades concerned, and duringthat period my right hon. friend would hope that a dis-cussion might be arranged in this House if there is a general

desire for it.