1779

Reviews and Notices of Books.Public Health Administration in Glasgow: a Mellwrial

Volume of the Writings of James Burn Russell, 8..,M.-D., LL.D., Medical Member of the Local GovernmentJf.., -&Z.-D., -MZt/cwt&e?’ o/ <Ae -Zoc 6’ceT’MMCM.Boardfor Scotland and formerly Medical Officer oj Healthof Glasgo7v. Edited by A. K. CHALMERS, M.D. Glasg.,Medical Officer of Health of Glasgow. Glasgow : Messrs.MacLehose and Sons, publishers to the University.1905. Pp. xxviii.-612, large 8vo. Price 7s. 6d.

IT was a good thought of Sir William Gairdner to suggestthat the writings of the late Dr. James Burn Russell shouldbe collected and republished in a memorial volume. The

suggestion was taken up by the public health committee ofGlasgow and has been given effect to in the work under

review. The committee was very fortunate in putting intothe hands of Dr. A. K. Chalmers, the present medical officerof health of Glasgow, the duty of collecting and arrangingand editing Dr. Russell’s writings. Dr. Chalmers hasfulfilled his task excellently well. His knowledge of his

distinguished predecessor’s work and his own thoroughlycompetent appreciation of it have enabled him to group there-published papers into such order as to constitute a realhistory of sanitation in Glasgow during the nineteenth

century. To begin with, there is a preface by Sir WilliamGairdner who acted as advisory medical officer for Glasgowfrom 1863 to 1872 and who then recommended that Dr.Russell should be appointed a whole-time officer in his

stead. The preface is followed by a biographical note bythe editor, giving a brief and very readable account of thesalient features of Dr. Russell’s life, together with a well-written appreciation of his official career.. That Dr. Russell’s days ended in time to permit hiswork to be commented on by Sir William Gairdner

suggests a remark regarding the duration of life of the

group of men who in the past 60 years in this country havedevoted themselves to increasing the national longevity.Some of these-Simon, Rawlinson, and Chadwick-enjoyedan exceptionally prolonged and useful lease of life. Others

-Seaton, Buchanan, Netten Radcliffe, and Thorne-havebeen cut off when, humanly speaking, there might stillhave remained to them long years of intellectual vigour andusefulness. Sir William Gairdner is of the former groupand we rejoice that he is still spared to adorn the profes-sion of medicine. Russell, alas, has been in the latter

category and in his last decade he was a man in brokenhealth with many periods of pain and confinement to hisroom. Yet the writings which are now re-published mightwell have occupied all the spare time of a full and healthylife, and indeed it almost appears that we are indebtedto Dr. Russell’s intervals of enforced rest from activeadministrative duty for some of his finest contributions tothe literature of public health.Though his last half-dozen years were devoted to the work

of the Scottish Local Government Board Russell was

essentially a Glasgow man. He was born close to Glasgow,was educated in its schools and University, and wasassociated there with its most distinguished teacheis-Lord Kelvin, Sir William Gairdner, and Lord Lister.The biographical note shows that Russell was possessedof a rare diversity of mental talent. < At college hewas something of a poet-and, indeed, there is a

sense in which he was a poet all his days. Aftei

completing his arts course he accepted from Professo]William Thomson, now Lord Kelvin, an assistantship or

board the Agamemnon during the first successful effort to la3the Atlantic cable between Europe and America, so that hifservices ran some risk of being altogether lost to publi<

health. Afterwards, however, he returned to the universityand graduated in medicine in 1862. Then he held appoint-ments in the Royal Infirmary and the city poorhouse, andhis entrance into the domain of public health may besaid to have begun with his appointment as physicianto Glasgow’s first municipal fever hospital, after leavingwhich he became medical officer of health. Russell, it willbe seen, was thus steeped in all the influences of Glasgow,to the amelioration and improvement of the physicalconditions of which his life was to be devoted. His writingsas here reproduced are embraced in 12 chapters. The title

of Chapter 1. is the First Half of the Century : a Period ofAwakening. It is a wonderfully interesting page of muni-cipal history. The growth of Glasgow from the latter partof the eighteenth century onwards was surprising and

resembles rather what we are accustomed to look for in the

great American towns in more recent times. The influence ofthe factory system was at work. Great industries were beingestablished, and though the Clyde at Glasgow was still a

small and an unimportant stream, yet commerce was

developing lower down in connexion with the city. These

changes were going on whilst there was practically entireabsence of any real knowledge, or at least of any appliedknowledge, of those principles of sanitation which are

essential to render tolerable human life in a large andpopulous town. The natural results were a terribly highdeath-rate, especially among children, and an extraordinaryprevalence of epidemic diseases including typhus fever andcholera and measles and whooping-cough.

It may be interpolated here that small-pox also had

wonderfully abounded in Glasgow previously to the intro-duction of vaccination but Jenner’s discovery was appliedso early and so extensively that in spite of the constantlydeteriorating condition of the population as regards allother infectious maladies, including consumption, the death-rate from small-pox exhibited a remarkable diminution andits course constitutes perhaps the most striking examplethat can be found of the power of vaccinia to control variolain presence of an utter neglect of every other element ofpublic health administration.No part of Dr. Russell’s writings has more historical

interest than that in which he quotes from earlier authoritiesdescriptions of the insanitation of Glasgow at various

periods in the first half of the nineteenth century.Take such a one as that relating to the year 1818 by Dr.Robert Graham, Regius professor of botany in the Uni-

versity. It is too long to quote in these columns but theconditions of life there depicted and their results are so

appalling that it is difficult to believe that municipalawakening did not become anything like complete until after

’ the first half of the century had passed.One question which began early to receive attention was

" the provision of hospital accommodation for infectious diseases. The Royal Infirmary had been opened in 1794 and’ received medical and surgical and fever cases as might be

required, but the infirmary was maintained by voluntary sub-: scriptions and subscriptions were collected not merely from’ Glasgow but from all the surrounding neighbourhood, so that, the institution received cases of infectious disease from the

country as well as from the town. Naturally, when an- epidemic occurred it soon became crowded and could take in. no more and supplementary temporary structures also were1 quickly filled. Oft-repeated discussion took place regardingz the duties of the Poor-law authorities in the provision ofi. accommodation for fevers. It was as paupers only that suchr cases could be dealt with by parochial boards. The concep-r tion of the town council as a health authority, with a duty toi isolate infectious diseases in order to protect the public, hady hardlg come into existence and it was only gradually, as as result of experience, and almost by a process of practical ex-cclusion, that the view came to be held that the city should

1780

provide for its fever patients. At last this was finally appre- Ihended and in 1865 a municipal fever hospital of 136 beds wasopened. By a remarkable stroke of good fortune Russell wasappointed its physician and, no doubt unknown to himself,his real life-work was begun. Typhus fever and small-poxwere the diseases with which he had mainly to deal. To

begin with, he became quickly impressed with one outstand-ing drawback to the performance of his new duties. He

,was there for the medical treatment of the patients but thenursing of them was an unsolved problem. Russell in the

introduction to his first hospital report for 1865-66 describesthe nursing at this time as bad beyond belief. One sentence

is typical alike of his views and of his vigour in expressingthem : "At present nursing is the last resource of female

adversity ; slatternly widows, runaway wives, servants out ofplace, women bankrupt of fame and fortune from whatevercause, fall back upon hospital nursing." The present genera-tion of medical men accustomed to the assistance of trained

hospital and private nurses can hardly realise the nursingconditions of 40 years ago.The hospital, opened in 1865, was used both for typhus fever

and small-pox and it is very interesting to note how, withregard to the latter disease, doubt by-and-by arose whetherhospital isolation was an unmixed blessing. The hospitalwas situated in the northern district of the city andsuspicion was soon aroused in the mind of the districtmedical officer that it was spreading the disease in the

surrounding neighbourhood. At first inquiry resulted in

an open verdict of "not proven," but in the springof 1873 Dr. Russell reported: "While I am not pre-

pared to say horv the hospital acts I am afraid it must be

admitted that it does act in propagating the disease in thenorthern district." The result was that steps were at oncetaken to provide a hospital at Belvidere, an estate a shortdistance east of the city, and this was opened for small-poxin 1877. Commenting on the subject Russell remarked :" It will now be understood how with reference to the

prevention of small-pox the date of the shutting of a

hospital may be as noteworthy as the date of the opening ofa hospital with reference to the prevention of typhus." This

was written in 1895, no doubt in the light of Mr. W. H.Power’s investigations at Fulham. Belvidere Hospital hasnow itself become more than suspect as an agency for

spreading small-pox in the east-end of Glasgow and it in

turn is being abandoned in favour of an entirely newinstitution, to be erected on a large area of land in analmost unpopulated district.Coming now to the time when Russell gave up hospital

work and began as medical officer of health, the memorialvolume presents, for the purposes of review, quite an embar-rassment of riches. Every chapter has its own interest andtempts to quotation relating to the first efforts of the new

administration, a history of hospital accommodation, studiesin vital statistics, and the like. 1’u.tting these aside, refer-ence must be made to the remarkable series of papers on the

housing problems of Glasgow. In 1866 a City Improvement IAct had been passed but its administration had unavoidablybeen postponed for some years. Its primary purposewas the clearing away of uninhabitable houses and

areas, a most impoitant reform, but very incomplete in

the absence of sufficient power to regulate the constructionof new buildings. On this point Russell was especiallyinsistent on the evils which result from the " making down "

of larger self-contained dwellings into smaller houses ofone and two apartments. The system of housing character-istic of Scotch towns greatly favours this abuse. In

Edinburgh and Glasgow great barrack-like structures fouror five or more storeys in height are subdivided into

multiple dwellings, of which there are probably several oneach fiat, opening off lobbies or passages which themselvesopen off spiral stairways built either within the structure

itself or in a turret at the back. An old mansion house

readily lends itself to a "making-down" process by whicheach <room or couple of rooms becomes occupied as a separatedwelling, the hall and stairway forming a common entrancefor them all. The conditions of insanitation and indecencyresulting from such a system drew forth Russell’s strongindignation and an urgent appeal for improvement. He

was continually bringing the facts before public notice bylectures to local societies and institutes. Perhaps the mosteloquent of these calls for reform is a lecture on Life in OneRoom, in which, after telling how the exhausted air of suchhouses and the poor and perverse feeding produce bandy-legged children, many premature deaths, overlyings bydrunken mothers, accidents by burning or by whiskypoisoning, and so forth, he makes a fervent appeal to thebetter-off classes to assist in the remedy of such foulconditions.

This paper forms one of a group well classed by Dr.Chalmers under the title " Sociological Aspects of Sanita-tion." " Another of this series is devoted to a trenchantcriticism of Herbert Spencer’s individualistic views as

applied to sanitary measures. On this subject Dr. Russellindeed falls foul both of individualists and socialists.While he points out the utter absurdity of Spencer’s suggest-tions for the individualistic provision of street sewers andpaving and lighting, he holds that the Fabians and the

author of " Merrie England " are as far astray in the oppositedirection. The golden mean, he urges in effect, is to be foundin sanitation : "As regards public health," he says, "in itsrelation to social problems, the difference between all thesesocial architects and the sanitarian is this, the sanitarian islike the lifeboat or the lifebelt to the drowning man- a verypresent help.’ The theorist is like a lecturer on the art of

swimming-any good he may do is in the future. He

certainly will not help the drowning man."Following on the lecture devoted to sociology comes a

series of studies in epidemiology and clinical studies.These relate to all the ordinary infectious diseases andinclude papers on the Requirements of a Dairy Farm, AnimalPoisoning by means of Hair, Stimulation in Typhus Fever,and an altogether admirable Study of Small-pox with rela-tion to Vaccination, in which is illustrated very graphicallythe "drift" towards renewed susceptibility to small-pox withlapse of time after primary vaccination and the consequentneed for repetition of the operation. Other papers are a

Report on the Prevention of Tuberculosis with reference tothe executive measures which might be prudently adopted toapply the teachings of science as to the mode of spreadof that disease, two articles dealing with the Prin-

ciples and Practice of Disinfection and a concludingpaper on Dead Meat Inspection in which the author dis-

tinguishes between what he describes as the detective systemand the clearing-house system, the latter being advocated asalone trustworthy.

Dr. Russell occupied a unique position in Scotland.

Though the northern kingdom is now well abreast of

England in respect of the sanitary administration of its

large cities and is, owing to good legislation, well in

advance of English standards in its rural districts, yet sorecently as 20 years ago it was far behind. Up to 1890

Glasgow was the only place in Scotland which had a whole-time medical officer, so that Russell had in great measure towork out his own problems. His eloquent pen caused whathe said to be noticed fully in the newspaper press and hishigh moral purpose and the fact that much of his teachingwas addressed rather to the public directly by!means of localsocieties and congresses than through official reports gavehim a wide audience and great influence. He was singularlywell fitted to use his influence for the general benefit andScotland to-day is unquestionably the better because of thefact that Russell lived.

1781

The whole memorial volume is one of the finest workswhich have ever been published on public health subjects.Its value is by no means confined to readers of the officialclass. All who are engaged in municipal work and who areinterested in the solution of the most pressing problems ofcity life will find it a storehouse in which suggestions forthe future flow naturally from experiences of the past.And from beginning to end the writing is so exceptionallygood, the English language is used with such skill and

force, the knowledge of the whole subject is so thorough,and earnestness of purpose is so controlled by dictates ofprudence that the book combines in quite unusual fashionthe qualities of a literary treat with those of a learned

treatise. It is published, too, at the very modest price of7s. 6d., a figure which is possible only because of a largecontribution to the cost made by the corporation of Glasgow.

Ambidexterity. By Sir SAMUEL WILKS, Bart., M.D. Lond.,LL.D.Edin., F.R.S. A lecture delivered before the

Hampstead Scientific Society on May 12th, 1905.London : Sydney C. Mayle, 70, High-street, Hampstead.Pp. 18. Price 3d. net.

A REVIEW of a work on Ambidexterity which we pub-lished on Oct. 28th, p. 1263, has induced Sir Samuel Wilksto send us a pamphlet which is a reprint of a lecturedelivered before the Hampstead Scientific Society in May,1905. We heartily commend this lecture to all who may beinterested in the subject of left-handed culture, since it pointsout in a most lucid manner the limitations of the use of theleft hand and exposes the fallacy of the belief that trueambidexterity simply consists in teaching the left hand tocopy slavishly movements which have been acquired by theright. The eminent author points out that the left handis not an exac copy of the right but if we maycoin an expression is its I I complementary inverse "-i.e.,the natural writing for the left hand is ’’ mirror writ-

ing," the thread of a screw intended to be driven in bythe left hand should be the reverse of that intended for the

right, and so forth. Hence it follows that to train the lefthand to copy the writing of the right cannot be the founda-tions of ambidexterity as some maintain but is based on anignorance of anatomical details. It must not be inferred

from this that Sir Samuel Wilks would discourage the train-ing of the left hand, far from it; what he does urge is thatthe left hand should be trained to do on the left side of the

body similar things to those performed on the other side bythe right. To do this it will naturally move in the reversedirection to that taken by the right hand.

Anatomy and PhyS’iology for N&Uacute;rse8. By LERoy LEWIS,M.B., Surgeon to, and Lecturer on Anatomy and Physio-logy for Nurses at, the Lewis Hospital, Bay City, MichiganIllustrated. London and Philadelphia : W. B. Saundersand Co. 1905. Pp. 317. Price 7s. 6d. net.

WE learn from the preface that this book is the outcomeof numerous requests made to the author by those whom hehad instructed in anatomy and physiology. The volume is notvery large and the field which he has attempted to cover is veryextensive. Accordingly, although the statements made appearon the whole to be fairly accurate, the book lacks life and

interest. The anatomy appears in the form of bald tabula-tions of the origins, insertions and actions of muscles, of therelations and branches of arteries, of the names and tribu-taries of veins, and of the names and distributions of nerves.Although illustrations have been freely added it is obviousthat any attempt to gain a useful knowledge of anatomy fromsuch a tabulation is foredoomed to failure unless accom-

panied by appropriate demonstrations. The physiologicalside of the book will appeal much more to the class ofreaders for whom it is intended but we doubt if an attemptto teach nurses anatomy on the lines adopted in this book isanything more than a great waste of time and it appears

calculated to induce a condition of mental weariness whichis most detrimental, for there is nothing to be done but tocommit to memory/parrot-wise, a mass of dry and uninterest-ing details. The sooner this is recognised the better for allconcerned. To the medical student anatomy becomes a livingscience owing to the opportunities of dissection and observa-tion. To nurses only such anatomy should be taught as canbe actually demonstrated ; to expect them to commit tomemory a mass of other details is sheer folly.

Ellis’s Demonstrations of Anatomy. Twelfth edition, revisedand edited by CHRISTOPHER ADDISON, M.D., B.S. Lond.,F.R.C.S. Eng., Lecturer on Anatomy, Charing CrossHospital Medical School ; formerly Hunterian Professor,Royal College of Surgeons, England ; Examiner in

Anatomy, Royal College of Surgeons, England, &c.Illustrated by 306 engravings on wood, of which 75 arein colour. London: Smith, Elder, and Co. 1905.Pp. 851. Price 12s. 6d. net.

NOT many years ago Ellis’s Demonstrations was thefavourite guide for dissecting-room use and an attempthas now been made to reinstate the book in its old position.The volume has been thoroughly revised and re-arrangedby Dr. Addison. As might be expected, the most ex-

tensive alterations are found in those sections which deal

with the abdominal and thoracic viscera. The descrip-tions here have been brought abreast of modern knowledgeand the editor has incorporated some of his excellentand well-known diagrams illustrative of visceral topography.The arrangement of the book has been altered, inasmuch asit now follows the ordinary course of dissection, beginningwith the extremities, but the general character remains asbefore. The marginal notes and tables of vessels and nervesare still retained. They are decidedly useful for revisionpurposes. We notice many new illustrations ; the arteriesnow appear in colour and coloured diagrams indicate thebony attachments of muscles. The volume retains its

handy size and lightness. Of necessity the type is rathersmall but it is clear, and the inclusion of the whole in onevolume as in former editions quite counterbalances this fault.Those who wish to have a sound and useful anatomicaltreatise in one volume may still be recommended to considerthis book. It is eminently practical and devoid of super-f[uous matter.

LIBRARY TABLE.

Guide to Finger-Print Identification. By HE’-,Ry FAULDS,L.F.P.S. Glasg., late Surgeon-Superintendent of TsukijiHospital, Tokio, Japan. Hanley : Wood, Mitchell, and Co.1905. Pp. 80. Price 5s. net.-This work contains a clearaccount of the principles of dactylography or finger-printstudy ; a description of the various methods of examiningand vivifying dull prints chemically ; hints as to ways of

enlarging them by photography ; and methods of meetingthe various practical difficulties of finger-print identification.Each important point is illustrated by diagrams, finger-prints, and photographic enlargements. Mr. Faulds’s bookaims at giving in a compact and portable form, and withoutunnecessary technicalities, the main facts and principleslikely to be found useful in medical and legal inquiriesinvolving identification by this method. The author rightlythinks that the readings of finger-print evidence should besubmitted to the scientific expert who alone can keep thiskind of evidence free from fallacy ; to depend upon partiallyskilled persons must be a grave danger from a public pointof view.

The Cathed?’al8 of England and TVale8. By T. FRANCISBUMPUS. First Series. London : T. Werner Laurie. 1905.

Pp. 282. Price 6s. net.-A well-known author recently adviseda neurotic friend " to bathe himself in Gothic," and in this,the first instalment of the work, Mr. Bumpus, who is wellknown as an accomplished and a travelled ecclesiologist, has