1700

Act who has not given to the local supervising authoritysuch a notice as is mentioned in section 10 of the principalAct 1 attends any woman in childbirth in any capacity otherthan that of a midwife, and a duly qualified medical practi-tioner is not present at the time of the birth, she shall,within 48 hours from the birth, give to the local supervisingauthority notice in writing of the fact that she so attended......" From the point of view of the midwife this is

objectionable because it would tend to prevent the employ-ment by medical men of midwives as monthly nurses, incases where the midwife, because she does not practise as

such, has not given notice of an intention to do so. There

is considerable force in this contention. Under the pro-

posed clause a medical man might arrive at his patient’sbedside to find that delivery had taken place five minutes

’ before in a satisfactory manner, but that the nurse

engaged was compelled either to lay herself open to a fineof I.P-5 or to report his absence to the local supervisingauthority. Unless very good reason can be shown for theinsertion of this clause, the evasion of which would be easyif not frequent, we agree with the Midwives Institute thatit might well be omitted. But with the amendment to

Clause 13, another important modification proposed by theMidwives Institute, we are not so much in accord. The

amendment suggests that whereas Clause 13 of the Bill

seeks to enable a local supervising authority to aid

the training of midwives, it should also be empowered to imake grants in aid of their maintenance. We question the

desirability and the justice of stimulating artificially the supplyof midwives by a State bounty system." If midwives oughtto be subsidised in the practice of midwifery, why notmedical men ? And yet if there had been a proposal madebefore the passing of the Midwives Act that the local

authority should pay salaries to local medical men in con-sideration of their attending confinements at reduced fees itwould have been condemned beyond doubt as tending todeprive the working classes of habits of thrift and independ-ence, and as a suggestionafor remunerating a particular pro-fession at the expense of the ratepayer. Any such main-tenance as that proposed should, in our opinion, be leftto voluntary benevolent agencies. The other amendments

concern midwives rather than the medical profession. Their

demand for more representation upon the Central MidwivesBoard than is proposed by the Bill is not unreasonable, andthe other topics to which they call attention relate to

questions of administration and discipline as to which we donot feel called upon to express opinions.

Roman Medicine.AN interesting contribution to the history of medicine is

afforded by a book recently published by Dr. THEODORMEYER.2 We welcome the book because we believe that the

study of the evolution of our science is not only interesting Ibut valuable. Ancient medicine had its great discoveries,

1 Notice of intention to practise in any area.2 Theodorus Priscianus und die Romische Medizin, by Dr. Med. et

Jur. Theodor Meyer, Privat-Dozent für Geschichte der Medizin an derUniversität, Jena. Jena: Gustav Fischer, 1909. Pp. 352. Price,bound, 8 marks; paper cover, 7 marks.

opportunities, schisms, and set-backs. By observing their1 influence upon the science of medicine as a whole we

r may hope to avoid pitfulls into which our forefathers

. fell. Dr. MEYER points out that but little is known of

, the medicine of the Romans in the early republican period, except that it was practically no more complex1than that of primitive races, consisting chiefly of domestic! remedies of simple character and of superstitious observ-

. ances. It is remarkable that this simplicity should have

. persisted for so long, and the explanation of Dr. MEYER: is that the prejudice of the Romans against technical

, professions and business of any kind hindered develop-ment. It was in the end the closer relations with Greek

culture which gave the first impulse to the developmentof medicine on Roman soil, but even then the practitionersof medicine in Rome were for many years simply Greekslaves. This was due to the fact that free Greek physiciansrefrained from proceeding to Rome owing to the extremelyunfavourable judicial and social treatment offered to

foreigners by the Romans. As a result, the servus medicusbecame an essential feature of the household of most of

the richer Romans. The natural consequence of the prac-tice of medicine by persons of humble station and originwas that it was largely a matter of domestic remedies,since the scientific developments of Greek medicine were

beyond the capacities of the Greek slaves. This is well

demonstrated in the receipt-book of CATO the Censor, in

which side by side with measures such as pomegranate forthe treatment of worms and juniper in the treatment of

urinary difficulties, there occur incantations and exorcisms

against sprains and also other superstitious formulae.

When at length Greek learning and philosophy received

encouragement at Rome it was chiefly rhetoric and

jurisprudence which were studied at first, but later

the cultured Roman began to include science within

his purview, and thus medicine began to be studied, as

may be seen in the encyclopaedic works of VARRO, CELSUS,and others.

At first such study led to but little, if any, advance

in the practice of medicine, which still remained in the

hands of the humbler classes. The first attempt of freeGreek physicians to settle in Rome towards the end of the

third century B. c. failed, but during the course of the second

century matters changed. Rome evolved from a simplecapital to the world’s metropolis, a proletariat large in

comparison with the well-to-do citizens arose, and freed

slaves began to practise medicine; moreover, the prejudiceagainst paid professions began to lessen. Later, the bestowal

by CÆSAR of citizen rights upon all free foreign physicianspractising in Rome gave a further impetus to medical sciencewhich the pioneer work of ASCLEPIADES had given to Rome.When he began in about the year 90 B.C. to introduce a,

higher medicine to the Romans he had to contend againstthe popular character of its practice on the one hand,and the abstract interest taken in medicine as a science

by the educated Romans on the other. He graftedhis medical teaching upon the fashionable Epicureanismof the time, and thus afforded the Romans a scientific

medicine after their own taste, and at the same time hereformed the practical treatment of disease. He opposed

1701

polypharmacy and the excessive use of - emetics and

purgatives, but encouraged a natural treatment by means

comprehensible by the people. According to Dr. MEYER, his

personality was also an important factor in his success. He

describes him as a mixture of a thoughtful scientific physi- cian and an experienced practitioner with a slight tinge of

charlatanry. The further development of medicine upon thefoundations laid by ASCLEPIADES soon occurred. A suc-

cessful cure of AUGUSTUS by MUSA led to an advancementof the free practitioners in Rome to the knightly class andfull citizen rights, with the result that the Romans them-

selves in increasing numbers adopted the medical calling.THEMISON, the most distinguished pupil of ASCLEPIADES,was the founder of the Methodical school, which exertedits influence for more than four centuries and reached

its highest development in the work of SORANUS. In

the teachings of ASCLEPIADES there was only a super-ficial compromise between the two divergent aspects of

medicine, the theoretical and the practical. THEMISON

endeavoured to find certain general indications of disease,and discovered, as he believed, that, stripped of accidentalor non-essential features, they all showed certain simplecommon, general features, more especially in regard to theconditions of the secretions and excretions. In explanationof this he adopted the view of ASCLEPIADES in regard tothe " pores" of the body, which were regarded as inter-

stices between the solid constituents, these being re-

garded as composed of atoms. THEMISON separated threestates-a "status strictus," in which the pores were con-

stricted ; a " status laxus," in which they were relaxed ; anda "status migtus," in which both conditions co-existed indifferent parts of the body. Dr. MEYER emphatically deniesthe view which is now often expressed that this doctrineof the common features of diseases was the sum and

substance of Methodism. It was, he maintains, merelythe basis upon which the Methodists built up and

evolved their methods of treatment. They dealt but

little with considerations of anatomy and physiology, and

they concerned themselves with the study of causation less,or, as in the case of THEMISON, not at all. On the other

hand, they went deeply into matters of pathology, sym-ptomatology, and treatment; indeed, Dr. MEYER charac-

terises their descriptions of disease as revealed to us in their

writings, more particularly those of CÆLIUS AURELIANUS,as masterly. Their treatment was based upon their theo-

retical conceptions of disease, the " status strictus" beingdealt with by relaxing agencies, and so forth, but they alsowere the first to differentiate between acute and chronic

diseases and to modify their treatment accordingly. More-

over they did not confine themselves to a system of generaltreatment, but adopted measures for the relief of symptoms,not necessarily suggested by the I I status " of the patient.The long duration of Methodism depended upon its empha-

sising the practical aims of medicine, and in this connexionDr. MEYER endeavours to vindicate the good name of a much-abused disciple of Methodism, THESSALUS of Tralles, whois quoted by GALEN as affirming that he could teach theart of medicine in six months. Dr. MEYER maintains that

in this apparently boastful claim he only meant that he could

impart the theoretical basis of medicine in that period, for he

laid great stress upon the practical demonstration of diseaseand its treatment, and was, in fact, the first to deliver

systematic instruction at the bedside. SoRANus appears to

have done most to bring together the practical tendenciesof the Romans and the scientific principles of the Greeks.He was perfectly educated in anatomy at Alexandria and waswell versed in physiology, but he adopted the views of theMethodists, and his works demonstrate more than those of

any other writer the catholicity and adaptability of this

school. The great influence of the Methodical school evenin its early period is demonstrated in the writings of

CELSUS, which afford a clear view of the state ofmedicine in Rome in the middle of the first century A.D.Rome was at this time the arena for all philosophicaland metaphysical contests, the practice of medicine wasfor the most part in the hands of trained physicians,but the old institution of the servus medicus still

lingered, and some of the educated laity studied

medicine, among them CELSUS. His work was simplya critical and eclectic review of the scientific medicine

of his time. This is the reason that his writings are

ignored by his contemporaries and why he exerted no

influence upon Roman medicine. A similar review of the

common or domestic medicine of the second half of the first

century is afforded in the writings of PLINY, showing themixture of the rational and the superstitious, in which the

original popular factors can be differentiated from the Greekand Oriental additions. PLINY’S aversion to the Greek

physicians and his neglect of their methods serve also toindicate the opposition which the inquiring minds of thecultured physicians had to contend against. One strikingfeature of the Roman medicine of the Imperial period is itspractical character and the large number of the various

recipes and directions for treatment. Although a

pneumatic school arose in opposition to the Methodists,after the teaching of ATHENÆUS, and although its tenets

were adopted by HERODOTUS and ARCHIGENES, amongstothers, the therapeutic principles of the Methodists were

more or less generally adopted, and their influence is visibleeven in GALEN, the champion of eclectic principles.

In summing up the influence of this remarkable man Dr.MEYER epigrammatically remarks that " GALEN was for

mediaeval medicine an epoch, for Roman times merely an

episode." This he attributes to his endeavour to raise

medicine from the grade of an art to that of a science. He

was an investigator rather than a practitioner, whereby the

practical was less in the foreground of his work, thus

rendering his views foreign to the practical minded Romans.As Dr. MEYER sagely observes, it demonstrates the power ofthe Methodists that GALEN, who afterwards dominated

mediaeval thought for a thousand years, fought against itstendencies in vain in his own lifetime. After GALEN, adecline in medicine as a science occurred side by side witha decline in all branches of the higher culture. Later

writings often consist of compendia of treatment-some

prepared to supply the needs of a non-medical public,others for the use of physicians. Among these works

may be included the writings of RUFUS, who probablylived in Rome in the time of TRAJAN, a work of

ATHENÆUS, the "Compositiones" of ScRiBONius LARGUS,

1702

and the Euporista of THEODORUS PRISCIANUS. It is

this work to the consideration of which Dr. MEYER devotes

his book. He gives a brief review of the few facts knownabout THEODORUS PRISCIANUS and translates the text of his

writings into German. He was a pupil of VINDICIAN, wholived in the time of VALENTINIAN I., so that his work must

belong to the end of the fourth century A.D. or the beginningof the fifth. Dr. MEYER agrees with VALENTINE ROSE that

THEODORUS PRISCIANUS used the writings of GALEN as the

basis of his own, more particularly in his first and second

books. His third book was derived from SoRANUS. He

deals with external and internal diseases and with diseases of

women. The only surviving fragment we possess of a fourthbook gives some remedies against headache and epilepsy.Enough, however, remains of THEODORUS PRISCIANUS to

warrant this introduction of him to our notice, while, as wehave pointed out above, the study of the history of medicineshould be part of the education of the cultured practitionerof medicine. Dr. MEYER’S book is a notable contribution to

the history of Roman medicine. The subject has recentlybeen before our readers in the interesting FitzPatrick lecturesdelivered before the Royal College of Physicians of London

by Sir T. CLIFFORD ALLBUTT, and published in THE LANCET.1Dr. MEYER’S views seem to be in general accord with those ofSir CLIFFORD ALLBUTT, more particularly in assigning toASCLEPIADES a higher scientific position than has generallybeen accorded to him. We commend Dr. MEYER’s book and

Sir CLIFFORD ALLBUTT’s lectures to the notice of those

interested in the history of medicine.

The Manchester Milk-supply.THE control of the milk-supply, more particularly of that

of large towns, is a subject of great significance in regard tothe public health, and one with very important medical andeconomic aspects. It is a matter of distinct regret that

administrative and political difficulties have so far preventedthe adoption of general and uniform measures to ensure a

satisfactory solution of the problem. It is therefore of specialinterest to notice the results obtained by the enlightened and

public-spirited endeavours of the Manchester Health Depart-ment to ensure, so far as is consistent with their powers,that the supply of milk to the city shall be free from the

dangers of tuberculous infection. A valuable record of the

measures adopted, and of the results obtained, is given in a

report on the investigations in the public health laboratoryof the University of Manchester upon the prevalence andsources of tubercle bacilli in cow’s milk,2 by Professor

SHERIDAN A. DELÉPINE; in a paper read by him beforethe Manchester Statistical Society on Nov. 10th, 1909, onthe Manchester Milk-supply from a Public Health Point of

View ; and in a paper published in THE LANCET of May 14tb,p. 1326. The history of the movement is briefly that

in 1897, on the recommendation of Professor DELEPINE and asa result of his observations on milk from tuberculous cows,

Dr. J. NIVEN, the medical officer of health of Manchester,made arrangements for inspecting, and as far as possible

1 THE LANCET, Nov. 27th, 1909, p. 1565.2 Extract from the Annual Report of the Medical Officer of the Local

Government Board for 1903-1909. London: Printed for His Majesty’sStationery Office. Darling and Son. 1910.

controlling, the sources of the milk-supply, utilising the

powers afforded under the Infectious Diseases Notification

Act, 1890. The work was carried on tentatively for two

years, but in 1899 the Health Department put in effect the

powers obtained under the Milk Clauses of the Manchester

General Powers Act, 1899, and has since systematicallysupervised the milk-supply. Professor DELEPlNE’s papers

give a résumé of the work done since that time.

Samples of cow’s milk intended for consumption are

obtained at the railway stations or elsewhere within the

city by the food and drugs inspectors under specialprecautions devised by Professor DELÉPINE and are submittedto bacteriological examination. All samples found to be

capable of producing tuberculosis are traced to their sourcesby the medical officer of health and the veterinary surgeon.The latter inspects the cows on the farms sending tuberculousmilk, and takes samples of the milk of each cow that appearsto be tuberculous. The samples are tested in the publichealth laboratory, and when the milk of a cow proves to betuberculous the farmer is required by the medical officer ofhealth to isolate the affected cow, and is advised to have the

animal slaughtered in the presence of the veterinary surgeon,advice which is generally followed. The methods adoptedfor the examination of the milk are the measurement of

sediment or ‘° slime obtained by centrifugalisation, the

microscopical examination of small portions of this sedimentfor cells, bacteria, and other foreign bodies, and inoculation

experiments to determine whether virulent tubercle bacilli are

present. The population of Manchester was 643,158 in 1908,and it is calculated that in the same year 62, 000 gallons of milkentered the city daily. Some idea of the magnitude of thework involved in testing the milk may be formed from thefacts that during the 122 years, 1897 to 1909, with which the

report deals 4997 samples were taken from cans of milk

arriving in Manchester and 1048 samples of milk were

collected at the farms from individual cows. Various charts

and maps were prepared to indicate the districts from whichthe tuberculous milk was obtained, and on examining theconditions prevailing in the farms in these places it

was found that the retention of old stock and unsatisfactoryhousing of the cattle were commonly present. In youngcattle tuberculosis is seldom extensive, but as ageadvances numerous organs become attacked, including theudders. That the measures adopted have been produc-tive of good is shown by the fact that the percentage of

samples of milk collected at the railway stations found

to be tuberculous has diminished ; thus during 1897-1898the percentage was as high as 17’2, while during 1907it was 5-7, in 1908 it was 8-9, and in the first half

of 1909 it was as low as 3 ° 8. Repeated examinations of

certain farms showed that the disease tended to recur

in some of them even after a comparatively long period offreedom. Professor DELEPINE states that the disease mayreach the udder of one cow from another, while it is

obvious that some farmers will buy inferior stock, which isnot infrequently diseased ; therefore he urges that so long asdrastic measures for the eradication of tuberculosis in cattle

are not adopted frequent inspection of farms is a necessityto secure a milk even comparatively free from tuberculousinfection. In regard to the care of the milk after milking,