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1368 SANITARY AFFAIRS AND THEIR ADMINISTRATION IN WEYMOUTH. but, we did it in a htrrry and, like most things done in a hurry, it was not done well. We said, first of all, that the women should be called obstetric nurses or midwifery nurses, that nursing duties should be imposed upon such nurses, find that their functions should be strictly limited. We had a most rigid appendix added which iudicated the conditions under which the nurse was to call in medical aid. I now think that we should go further and that wo ought to have some sort of legislation which shall secure the attendance of a registered practitioner in cases of confinement. But I have not seen any other alternative scheme which has been good in my judgment. There was a scheme suggested by Dr. Bedford Fcnwick when Mr. George Brown was connected with the Medical Times and Iloapital Gazette and that scheme was published. But, there was this significant comment in that paper to which I have alluded, something which aroused my suspicion : "ft appears to us that the consequence would bo that many medical men would gladly employ nurses so efficiently trained in attendance upon their poor and parish patients, knowing that sue)) parturient women would therefore receive every care aud attention, and in the event of any abnormality showing itself medical assistance would he immediately summoned." This is imposing the responsibility of diagnosing an abnormality on the nurse or midwife; site was apparently to determine when a medical man was to be called in. This was very much like the reintroduction of the unqualified assistant in petticoats. What has been alluded to as occurring in Saddleworth goes a little further than that. I should like to read vou what is called a draft scheme, merely suggestions from the Manchester Medical Guild. It is a very difficult thing making a suggestion in drawing up an Act which is likely to prove acceptaltle to Parliament. The preamble is that in view of the fact that the high mortality and morbidity amongst parturient women and the newly-born in the poorer classes are undoubtedly due to their being attended by ignorant untrained women and their not having the services of fully-qualified practitioners, the committee are of opinion that legislation is urgently required with the sole object of putting within reach of the poorer classes the assistance both of trained nurses and of qualified medical practitioners. The scheme is that obstetric nurses should he adequately trained and registered, and that they should be employed by the local authority and should have facility for calling in any medical man in the neighbourhood, and that he should be paid hy the State. I think that the State should make provision for the adequate remuneration of the medical men who are expected to assist women of this kind-whether these women practise as at present in an un- fettered sort of way or whether some scheme is introduced whereby they should be registered in some way. I think strongly that local cont- mittees should be formed all over the country for the local adminis- tration of the scheme, that each local committee should engage one or more registered obstetric nurses, and that they should issue to each suitable certificates and instructions. The only point upon which I have a strong objection to this scheme is this, that the woman who is attending the case determines what practitioner shall be called in. I do not think it is right that these women should he able to attach themselves to one medical man and that it should be said that llr. So-and-So follows Mrs. So-and-So. I think every patient should decide what practitioner shall be called in to her case. Let us in any case look at the matter in a practical way ; let us have a scheme whereby the safety of the public shall be secured and the interests of the profession protected, and to which it may be likely that Parlia- ment will lend an ear, and then we shall have some innucncc in guiding the legislation which may take place in the near future. A discussion followed, in which Dr. SMITH, Mr. F. E. BROMLEY, and Mr. R. F. ToMLly took part, and Mr. BROWN and Dr. WooDCOCK replied. Mr. JACKSON having been compelled to leave early for the purpose of returning to Plymouth. Mr. Brown denied his responsi- bility for the article about midwifery nursing in the Medical Times and Hospital Gazette. The meeting terminated with the usual votes of thanks to the President (Dr. Smith) and to the speakers, which were suitably acknowledged. SANITARY AFFAIRS AND THEIR ADMINI- STRATION IN WEYMOUTH. CONSIDERABLE discussion took place in our columns a short while ago concerning the use of isolation hospitals in dealing with scarlet fever and the advantages which these hospitals afford both in safeguarding the community against the disease and in benefiting the individual patient. As we then insisted, much depends upon what is meant by isolation in hospital and how it is utilised. A report to the Local Government Board by Dr. R. D. Sweeting, affords a striking example of what to avoid in this matter. In Weymouth from February, 1900, to March, 1901, 168 cases of scarlet fever were notified, and of these no less than 116 were removed to hospital. The hospital in question belongs, not to the Town Council of Weymouth, but to the Weymouth Port Sanitary Authority, which undertakes to receive cases from the town on certain terms. It contains four wards of six beds each, and an observation wdrc1 intended for one bed-25 beds in all. Into this hospital in December last as many as 43 scarlet-fever patients were newly admitted from Weymouth, while cases were also being taken from outside districts, with the result that at one time 72 patients were crowded into the wards and nurses’ rooms, and children were packed two in a bed. The staffing of the hospital was altogether inadequate. The caretaker’s wife was paid by salary, out of which it was her duty to provide nurses, and the result of this amazing arrangement may be guessed. Only one trained nurse was engaged, the rest of the "nursing staff" being merely amateur helpers. It is scarcely surprising that the con- clition of the hospital in these circumstances became little short of a scandal. Parents, moreover, were required to under- take to repay the cost of the maintenance of their children, and the nature of the demands made for this purpose gave rise to much dissatisfaction. An establishment charge of 10s. 6d. a week was made for each patient and in addition the food was in each case charged for in separate items by the caretaker, who sent separate orders to each tradesman each day for each patient. Patients’ friends were allowed to visit the hospital at will, and these visitors in several instances appeared to have contracted scarlet fever. Ar, least four patients were sent home while still desquamating and "return cases " resulted. The extraordinary part of the story is that all this time the most strenuous efforts were- being made by the medical otticer of health of the borough to compel every notified case of scarlet fever to be "isolated" in this hospital. Justices’ orders for compulsory removal were sought and obtained, and in better-class houses the medical oflicer went so far as to inform the householders that unless they consented to the notified scarlet fever case going to hospital it would be necessary for him to insist on the dismissal of the domestic servants. In this matter it is quite clear that zeal was allowed to outrun both authority and discretion, and it is not surprising that as a result both the profession and the public in Weymouth have made a determined protest. As Dr. Sweeting points out, it is to be feared that it will be a long while before the educated classes of Weymouth will recover their faith in hospital isolation, and hence the task of establishing a satisfactory municipal hospital for Weymouth will be very difficult. A sanitary authority that can tolerate such a state of things is hardly likely to be found doing efficient work in other directions, and this view is confirmed by the account which Dr. Sweeting gives of the sanitary condition and administration of Weymouth. The town council appears to have been deaf to representations about insanitary house property and to take no care in the supervision of the building of new dwellings. Defects of house drainage are reported as being common, the system of collecting refuse is unsatisfactory, by-laws and regulations as to slaughter- houses, lodging-houses, and dairies are not enforced, and the work of the inspector in the sanitary department is stated to be unsatisfactory in many respects. A watering- place which is largely frequented by visitors has an ex- ceptional obligation to perfect its sanitary organisation. and Dr. Sweeting’s report will hardly encourage careful people to stay at Weymouth until substantial reform is assured. ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH. A QUARTERLY meeting of the College was held on Nov. 5th, Dr. FRASER, the President, being in the chair.-The PRESIDENT communicated a letter which he had received from the Secretary of State for Scotland in acknowledgment of the message of condolence sent by the College to His Majesty the King on the occasion of the death of the Dowager Empress Frederick of Germany, and a similar acknowledgment from Count Metternich in response to the message sent to the German Emperor.-The PRESIDENT referred in sympathetic terms to the loss which the College had sustained through the death of two Fellows of the College-Dr. John Connel and Dr. James Foulis.-Dr. David Graham, M.R.C.P. Edin., was admitted by ballot to the Fellowship of the College, and the following candidates were admitted to the Membership of the College after examina- tion : Harold Sherman Ballantyne, M.B., C.M.Edin. ; David Whiteside Maclagan, M.B., Ch.B.Edin.; and Guy Verney Fletcher, L.R.C.P., L. R. C. S. Edin.—By vote of the College Richard Wallace was deprived of his licence to practise as granted by the College and of all his rights and privileges as Licentiate. DRAINAGE OF FALMOUTH.—An inquiry was held at Falmouth on Nov. 7th by Mr. E. A. Fawcett of the Local Government Board with regard to the application of the corporation to borrow over .618,000 for sewerage purposes. ’
