845

THE LANCET.

LONDON: SATURDAY, MARCH 25, 1899.

THE LONDON WATER-SUPPLY.

Two books on the highly important question of the

London water-supply have made their appearance at

"what dramatic critics love to call the psychological!IDoment.1 The taking of evidence by a Royal Com-

mission on the matter-whose proceedings have been

"very fully reported in the columns of THE LANCET-camefo an end upon March 23rd ; one Bill has been introduced intoiParliament by the Government and read a second time

’which touches gently the fringe of the subject ; other Bills(promoted by the companies have passed their first reading ;-the Bill of the London County Council having for its object,the supply of London with water from Wales has been

rejected; and, lastly, politicians have imported into whatshould be a strictly sanitary question much party feeling- of the sort which does not always find its expressionan the accurate language of reasoned thought. Of Dr.

:SlSLEY’s book we cannot say much, as it is practically.a reprint of the articles which appeared in our columns

throughout the year 1897. We are glad to see that the

patient labour, accuracy, and impartiality which Dr. SISLEY"displayed when acting as our Commissioner are recognisedby reviewers whose lips are not sealed by circumstances,but we can only lay stress upon one of these qualities here-dmpartiality. The points upon which Dr. SISLEY gave up-to-.date information in our columns were-(l) sources of supply;<(2) the methods of purification ; (3) the quantities supplied;.and (4) the storage capacities and filtering arrangements of4he eight companies ; and in dealing with these points he has"excluded all political and municipal questions as beside theenark, and presented an absolutely colourless series of state-ments within the lines defined.

Dr. SHADWELL’s small book is written from a totallydifferent standpoint. The author holds a brief for

the water companies and almost insinuates that there

1i8 no fault to be found with the metropolitan water-

- supply, the anxiety of Londoners on the subject being dueot to the real urgency of the question but rather to the

persistent misrepresentations made by the London County’Council and a careless, badly informed, unscrupulous pressSIe accuses the London County Council, upon evidenc(

’which is very strong and very convincingly marshalled, 0’

lolaying the time-honoured game of the would-be purchaser-i.e., of depreciating the value of the water companies tha"they may be able to buy up the undertakings at an improperlLlow figure. It is well that this point should be thrashe(’Jut and all good citizens will be glad to read what Dr(SHADWELL has to say here, for if blind trust in the abilit;

1 (1) The London Water-supply: A Retrospect and a Survey. ByRichard Sisley, M.D. Lond. Quarto, pp. 160, with Appendices and 48Maps and Plans. London: The Scientific Press, Limited. 1899. Price&pound;1 1s. (2) The London Water-supply. By Arthur Shadwell, M.A,,M.B. Oxon. 8vo, pp. 190, with Appendix. London : Longmans, Green,and Co. 1899. Price 5s.

nd virtue of the companies is unreasoning, so is a blindistinct to fall to abusing them. Again, Dr. SHADWELL’Sriticism of the scheme of the London County Council for. metropolitan water-supply from Wales will furnish argu-aents to a large section of the community. All timid

people and some prudent people will think like him. But

mtil the Report of the Royal Commission on the subjects issued wise people will imitate Parliament and reserve;heir opinion. Dr. SHADWELL’S little book, then, is a

valuable contribution to public knowledge upon a contro-versial topic which he appears to think would not be con-troversial at all if the persons who hold other views than

himself were honest of motive and clear of wit. We do

not wholly commend this attitude, but Dr. SHADWELL

manages to take it up with neatly written moderation.The two volumes require a third to complete a trilogy that

would be ’invaluable to all metropolitan medical men,

sanitarians, and citizens who have the welfare of the greatcity of London in their thoughts. Dr. SISLEY tells

exhaustively what the present condition of the companies is,where they get their water, how they treat it, and how theydistribute it. Dr. SHADWELL takes up his cudgel, or ratherdraws his rapier, for the companies. Now we should like to

hear from a champion designing to persuade us that some

public body-perhaps the London County Council and

perhaps not-should have charge of the London water-supply.In the interests of those who hold this view we would pointout that such an author must be thoroughly well equipped inhis facts and be able to write with force as well as with

clearness and ease if he is to make an impression correspond-ing to that which Dr. SHADWELL’s book will produce.

THE domestic servant is an important factor in modemlife. She (for we are speaking more particularly now of thefemale domestic servant) is in ever-increasing demand andher occupation is one for which there is an ever-lesseningcompetition. The position is so unusual that as between

herself and her mistress she threatens to become the more

independent party of the two and the more able to dictateterms. It is not impossible that certain classes who now

rely on servants will have to do without them eventuallyand that all classes will have to learn to be less dependent.There are still many fine specimens of the good old sort ofservant, in whom

" ......... appears

The constant service of the antique world,When service sweat for duty, not for meed"-

who appreciate good masters and mistresses and are wonder-fully blind to the faults of bad ones, but this class does not

appear to be so numerous as of old. Explanations vary asto the reason of this. Some fall back upon the universal

explanation of all changes, good or bad-the ElementaryEducation Act and the board schools ; some on the

attraction of other forms of employment which leave

young women with more liberty and spare time and perhapswith more remuneration. It is not for us. to dis-

cuss minutely the explanation of all the political and

economic changes affecting the position of women which

have altered the conditions of supply and demand of

domestic servants. It is, however, important to note that

these have been altered, with the double result that the

846

classes who employ domestic servants have been multipliedand that the classes whence they are drawn have becomemore independent and have a much wider range of choice in

selecting an employment than was the case when manu-

facturing industries, the Post Office and the TelegraphicDepartment, clerical work and board schools, did not offer

occupation to women on such a large scale as they do at

present.An intelligent study of these conditions will do much to

enable families and ladies at the head of families to under-

stand the problem of getting and of keeping good servants.It is well within the experience of medical men that the

worry connected with servants and with the constant changesof the domestic staff is a fruitful source of much annoyanceand even of ailment among housewives. Ours is a pro-fession which has insight into household work and its cares

not vouchsafed to men of other callings. It is not, there-

fore, beyond our province to give a few hints with a

medical bearing which may tend to make the wheels of

domestic work revolve more smoothly. One thing which muststrike most medical practitioners is a disposition to ignorethe ailments of servants. This disposition is seen often atthe time when the servant is a mere applicant for work.Mistresses who will keenly inquire into the character or

temper of a girl will turn a blind eye on her state of

health. Domestic servants are probably not much more

subject to ailments than other people but it is an un-

mistakeable fact that they are not without ailments. Their

life is not always a healthy one, though it might often bemade more so by a little effort on their own part or goodnature on the part of their mistresses. The dailyroutine is apt to be dull and monotonous and it maybe very laborious and exhausting. Those who have onlyto tell a maid to do things which they can easily do them-selves are very apt to abuse the relationship and to throw

quite an unreasonable amount of work upon their servants.Such evil is often unintentional. It is wrought by want of

thought and not by want of heart. But it is wrought all thesame and the life of the servant becomes a drudgery with noleisure, no protection, no break. Servants may not be more

delicate than others, but as we have said the conditions

under which they work are such as to generate moodiness,perhaps ill-health, and sometimes exhaustion and disease.

Besides the conditions of work which tend to generatesickness and even disease there are two other pointsto be taken into account-age and distance from

home. A large proportion of servants, in London

especially, are at sensitive ages, and a large number are

far away from home ; they have come from the country andfrom provincial towns, often from Scotland, and easilybecome home-sick, especially if there should be a lack

of sympathy and a failure to make them feel welcome.

One of the commonest of ailments in domestic servants is

chlorotic anaemia and it is amazing to see how often thiscondition is allowed to go on without notice and without

treatment where the symptoms in a child of the familywould quickly command all the resources of medicine.

The neglected chlorosis drifts into chronicity with conse-quent impaired health or reaches a crisis in a gastrichaemorrhage and so commands attention. Short of such

extreme cases the health of servant maids is often sapped

i in a way which impairs their energy and depresses theire spirits, but which would admit of complete relief if dulyi attended to. These are the servants, by the way, who- complain of their food. It is the appetite not the food3 that is generally at fault, for, despite the behaviour of

r Mrs. Nicholls and Miss Brass, the modern servant is

t generally well fed-almost invariably much better fed thanshe ever could have been in her own home.

) It will be asked what is the remedy ? We have a strong. conviction that the remedy lies in a little more sympathy

and a little more effort on the part of families to place them-selves in imagination in the servants’ situation and to re-

member that they are of our own flesh and blood, as Mr.GLADSTONE said of the unenfranchised voters. In matters

of open air and of hours of leisure servants should ber .

: treated with consideration. So far from spoiling them webelieve that such consideration is appreciated by them and’

, it certainly is necessary if they are to be kept in.

health. When servants fall’ off in health, still more

, if they become really ill, they should receive atten-

tion. If necessary they should be made to keep theirbed for a day or more. Devices for sparing them

unnecessary labour should, then, be multiplied. The

absence of such ingenuity in kind and well-to-do familiesis often surprising. An anasmic girl will be sent up

long flights of stairs on trivial errands, or a willing maidwill be made to do nursing duty till her feet swell and sheis on the point of breaking down. It is, we believe, no partof a master’s liability to provide medical attention for

his domestic servants. All the same, or, rather, all

the more, it is well to provide it for them. Servants

often prefer their own medical man, but few of them

are insensible to the kindness of a mistress who will

offer her personal attention together with the advice of

the medical man whom she consults for her own ailments

and those of her children. These may seem to be partialand inadequate suggestions for the solution of a great social

problem, but we do not profess to speak except from amedical point of view. We believe that the alternative

employments which draw girls from domestic service wouldnot be so effective if good mistresses determined to face the

problem and to make their servants feel that they are in ahome where their health and their comfort are considered

in a kindly and generous spirit.

IN THE LANCET of March 18th we dealt with the action

which the Government have decided to take with a view to

the prevention of tuberculosis in man in so far as milk is con-cerned ; and whilst we admitted that some progress in thisdirection would probably result, we expressed our regretthat a number of important matters were left untouched

by reason of the unwillingness of the Government to

ask for any new legislative powers as to tuberculosis.

Since the issue of the new Order and Regulations as

to Dairies, Cowsheds, &c., a very important depu-tation has been received by Mr. CHAPLIN and Mr.

WALTER LONG, presidents respectively of the Loca3

Government Board and of the Board of Agriculture, andthis deputation raised the same question in so far as

it affects our meat supplies. The deputation included

847

Members of Parliament and a large number of representativesof societies concerned in the sale of meat and of agriculturalassociations, and it was introduced by Mr. W. FIELD, M.P.,who gave evidence before the Royal Commission on

Tuberculosis of 1896 in his capacity of President of the

National Federation of Butchers and Meat Traders of the

Three Kingdoms.The demands made by the deputation may be dealt with

under three headings. Firstly, the butchers and the farmersinterested in our meat-supplies asked for uniformity in the

system of meat inspection and in the conditions affectingthe seizure of meat on account of tuberculosis, and theyalleged that in certain towns the stringency in this matter isexceptional, unnecessary, and vexatious. This demand is

most reasonable and it can largely be attained by the sub-stitution of public for private slaughter-houses in all largecentres of population, by the requirement that meat

inspectors shall have some skilled knowledge of their duties,and by the adoption of a code indicating that which oughtto be and that which need not be seized in the interests of

public health. We shall revert later to the first point.As regards the second Mr. CHAPLIN explained to the

deputation that he hoped much from the circular letter whichhe addressed to district councils when he issued his recent

Dairy and Cowshed regulations. In this circular he followed

one of the recommendations of the Royal Commission and

urged that no inspectors should be appointed for meat-

inspection unless possessed of knowledge under three

headings which he specified. Unfortunately, the unwilling-ness to legislate leaves this matter in the position of mereadvice which cannot be enforced and we must wait to see

how far it will be successful. Much the same applies to thethird point, but still the matter is different. The medical

officer of health must, after all, be responsible for the actionhe takes in seizing or not seizing a carcass or a piece ofmeat from a tuberculous carcass and no legislation can

be expected to free him from this responsibility. Bui

subject to this consideration an instruction of advice has

now been issued in which, again following the terms of ! arecommendation of the Royal Commission, Mr. CHAPLIN

has indicated what are the conditions of meat whicl

should or should not be deemed to justify seizure. Mos

medical officers of health when giving evidence before the

Royal Commission expressed their willingness to take an;such authoritative statement as a guide for their action anIwe hope that a fair trial will be given to procedures undethe new conditions. If this is done then we agree wit]

Mr. CHAPLIN that this grievance will be practically re

moved.

In the second place the deputation demanded compensation for the value of carcasses seized in the interests of publihealth. The full bearings of this question of compensatiocannot be adequately discussed in this article ; it is also on

as to which the Royal Commission were not unanimouf

The majority, however, decided against this demand anSir RICHARD THORNE who was one of the majority has Sf

out in his recently published Harben Lectures on tl:

Administrative Control of Tuberculosis the several grouncon which presumably this decision was come to. M

CHAPLIN only referred to three reasons which ar

embodied in the report of the Commission, but 1

particularly emphasised the fact that our vital statistics,so far as they go, tend to disprove the allegation that theproduction of tuberculosis through the consumption of meatis a substantial evil, and the still further fact that, althoughthe Commissioners again and again asked for witnesses whocould give them evidence of personal loss through seizuresfor tuberculosis, nearly all the witnesses produced, includingMr. FIELD, M.P., had to admit that in a lifetime of activebusiness they had hardly suffered at all. Mr. CHAPLIN

naturally assumed that such "weighty objections"to the system of compensation for a trade risk

would have been challenged either in the minorityreport of the Royal Commission or by the depu-tation, but he found no answer from either one

or the other, and hence he was not prepared to lay down

the entirely new principle that a purchaser who, havingbought an article at a known risk with a view of placingit on sale, " should receive the whole profit of his trans-

action if he has escaped loss but should demand compensa-tion from the public if his transaction has not been fortu-nate." He urged, indeed, that the system of insurance suchas has already been found to work well and without anyburden should be adopted generally. But the deputationhad come for compensation and declined, for the moment atleast, to entertain this proposal.

In the third place the deputation urged the retention of

private slaughter-houses and they went so far as to say theydid so in the interests of the public. This attitude must

have been aimed, we assume, at getting compensation forany loss that may be incurred under any new legislation, forthe reasons alleged in favour of the retention of these privateestablishments do not bear investigation in so far as publicinterests are concerned. We have already referred to the

, provision of public slaughter-houses in another part of this!

article and we would recall the fact that a number of

witnesses before the Royal Commission admitted that the

j uniformity of administration which this deputation alsosasked for can only be attained by the substitution of publicL for private slaughtering places. This is also the view taken

by the Royal Commissioners whose recommendations on the1 subject are most clear and distinct, and we can only hopethat the Government will do all they can to facilitate theerection of public slaughter-houses in all large centres

of population and thus to secure that the slaughter-ding shall be controlled and supervised by an efficient

r staff.

h On the whole, we doubt whether the deputation are likelyto gain much so long as they take up an attitude which inone important respect is so obviously opposed to public

L- health interests, whilst pleading, on the other hand, thatc they should receive compensation for action which theyn allege is taken in the same interests. For the present thee prospect of progress in this matter of the prevention ofs. human tuberculosis through the use of meat will mainlyd depend on compliance with the suggestions contained int the circular letter issued by the Local Government Board.ie But just as we regretted that no change or progress is

is proposed as regards the control of our milk-supplies in sor. far as tuberculosis is concerned (except that which can bere effected under the existing defective law), so also we cannotie but feel disappointed that in the matter of our meat-supplies

848

the Government also limit themselves to mere advice instead

of acquiring new statutory powers to deal with the wholematter in a comprehensive manner.

Annotations.

THE PRESIDENCY OF THE ROYAL COLLEGE OFPHYSICIANS OF LONDON.

"Ne quid nimis."

THE choice of a President by the Fellows of the RoyalCollege of Physicians of London is a matter which no longerconcerns merely the select circle of that body, for the

position which the College holds in the medical world, theimportant part which it plays in conferring diplomas to

practise, not to mention its influence in the promotion andmaintenance of a high standard of ethics, have given a wideinterest to those occasions when a change has to be madein the occupant of the Presidential chair. That sucha change is about to take place is no secret. SirSamuel Wilks, the eminent and highly esteemed physicianwho has borne the burden of office since he was calledto fill the vacancy caused by the illness of the lateSir J. Russell Reynolds, has earned a well-merited retirementafter three years’ service and will carry with him the sincerethanks and good wishes of the College. When theComitia meets on March 27th some difficulty may be experi-enced in arriving at a decision of the question-who shall be elected to fill the Presidential chair? Manyphysicians have been mentioned as eminently qualified tohold office. Other things being equal, no doubt seniorityof standing and past services rendered to the Collegewill have due weight in guiding the choice of the

Comitia. Again, owing to the high position which

the President of this College holds as the leader of

English medicine other reasons than those based on purelyprofessional distinction will no doubt have considerableinfluence in determining the result of the election. Amongstthose who may reasonably be expected to receive support areDr. F. W. Pavy, F.R.S., who was elected a Fellow in 1861;Dr. W. H. Dickinson, elected in 1865; Sir W. H. Broadbent,F.R.S., elected in 1869; and Dr. W. S. Church, elected in1870. The scientific attainments and personal attributes ofthese gentlemen are so well known that we have no doubtthat any one of them would discharge the duties ofPresident with ability and discretion. Dr. Pavy’s researchesin the physiology of digestion, and especially his illuminat-ing work on diabetes, which have been pursued for manyyears, Dr. Dickinson’s pathological investigations and his

recent occupancy of the Presidential chair of the RoyalMedical and Chirurgical Society, and Sir William Broad-bent’s contributions to clinical medicine and his enthusiastic

support of movements for the furtherance of public healthand education will all doubtless be recalled when the choiceis about to be made ; whilst the services of Dr. Church withinthe College itself and his intimate acquaintance with itsaffairs give him a high claim to its chief office. In addi-tion to the above the names of other distinguished Fellowssuggest themselves and will doubtless secure support on this occasion, such as those of Sir R. Douglas Powell, Sir Dyce Duckworth, Dr. Gee, Dr. Hughlings Jackson, and Dr. lCharlton Bastian.

-

FOOD POISONING.

THE following case, related by M. Louis R&eacute;non at the

meeting of the Soci&eacute;t&eacute; M&eacute;dicale des Hopitaux on Feb. 17th,is important as a contribution to the comparatively unknownsubject of food poisoning and interesting on account of a I

very uncommon symptom-arthritis. M. Renon remarked

that various chemical agents-lactic acid, the poisons of’

uraemia, uric acid, tuberculin, and therapeutical serums--may cause "pseudo-rheumatism." So may food poisoning ;,in 1760 Boissier de Sauvages wrote: I I Fish caught in the’island of Bahama excite violent pains in the joints of those.who eat them. These pains terminate in a certain time in a.sensation of itching which lasts three days." But arthritis.

from such a cause as exemplified in the following:case is not common. A young man, aged 20 years,had a mild attack of influenza ; on the third day tbe"

temperature was normal and the pains had disappeared.He took at lunch on the fourth day a small portion ofchicken, a sole, and a dozen oysters. A few hours after-wards he had a feeling of weight and pain in the abdomen.Urticaria appeared at 6 P.M. and during the night he became-covered with large wheals ; on the following morningthey were’retrogressing, but movement of the left arm was.

painful, and the right hand was oedematous on the dorsalsurface, red and painful, and every movement caused himto cry out. The metacarpo-phalangeal joints of the index:finger and the little finger were swollen; they were verytender to pressure and to the least movement of extension.or flexion. The sheaths of the extensor tendons were equallytender. The wrist presented the same pain on the least.movement. Supination, flexion, and extension of the fore--arm were painful, but the pain was less than in movement ofthe other joints. There was no fever. The tonguewas indicative of dyspepsia and the abdomen was.

a little tympanitic. There had been constipation for 36hours. The other organs were normal. "Pseudo-rheu-matism " due to poison by the oysters or fish was diagnosed.The treatment consisted of milk diet, purgation, and the’drinking of large quantities of fluid. On the fourth day of’the poisoning the eruption and the oedema of the hand had’disappeared. The metacarpo-phalangeal joints and the’

synovial sheaths were not painful, but the pain persisted inthe wrist and elbow. On the sixth day all the symptoms.had gone. What was the nature of the articular and

tendinous inflammation ? Acute rheumatism was excludedin consequence of the absence of fever, the rapid evolution,and the other signs of gastro-intestinal intoxication. In--fluenza was not the direct cause, because it had lasted

scarcely 24 hours, was extremely mild, and had passed offtwo days previously. Perhaps the influenza had led to slowerelimination of the poisons. The gastric symptoms and the-urticaria point to the fish or oysters as the cause. Curiouslythe arthritis developed in the places first attacked byurticaria but it did not recede as rapidly.

THE REGISTRATION OF STILLBIRTHS.

WE have received a copy of a petition to be presented tc..the House of Commons from the members of the BritishInstitute of Undertakers with regard to the present require-ments for the purpose of interment of a stillborn child. The,

petition shows that at the present time all that is necessaryis the production to the cemetery authorities of what pur.ports to be a certificate of the delivery of such stillborn childsigned by a medical practitioner or a midwife, no registration.with the district registrar being required. It further points.out that there can be no ready means of testing the veracityof such certificates, written as they often are on scraps ofpaper or even in pencil, and yet as a rule they are acceptedby most of the cemetery authorities without demur. The:

British Institute of Undertakers believe, and we can,

well imagine that such is the case, that the present.method of certifying the birth of a stillborn childis open to serious abuses which could be avoided by a.proper certificate being issued by a proper authority. We-have on several previous occasions drawn attention tQ this