261PROBABLE POSTPONEMENT OF THE MIDWIVES’ BILL.

THE LANCET.

LONDON: SATURDAY, JANUARY 31, 1891.

ACCORDING to present appearances’there is every prospectthat the Midwives’Bill will not be rushed through Parliament.We are assured on good authority that an understandinghas been arrived at between influential men on both sides

of the House that time and opportunity shall be given forascertaining the facts of the case-both those which, in theopinion of some, constitute a reason for legislation, and thosewhich, in the judgment of others, constitute a reason for

declining all legislation on the subject. It would go far to

satisfy all parties if the evidence of experienced and

responsible persons were taken on both sides of the question,such as coroners, registrars of births and deaths, medicalpractitioners, and others. Such an inquiry would have thefurther advantage of raising the question into an

impartial atmosphere. We ourselves would suggest theappointment of a select committee of the House of Commons.It need not occupy any great length of time. The facts to

be ascertained are not in their nature abstruse or difficult;but they are very important. They involve enormous issuesof life and death and suffering. It is greatly to be desiredthat they should be thoroughly ascertained. If legislationmust take place, it should not exceed the demands of thecase, or be unmindful of the principle so fully recognised byParliament in its last Medical Act that midwifery is a partof medical science, and cannot be practised satisfactorilyexcepting by persons trained in the three great bianches ofour art-medicine, surgery, and midwifery.Some of the opposition to the Bill in our own ranks is

reasonable enough from the medical point of view. Medical

men know the risks of maternity, and know well that nocases in practice require more care or more judgment, ormore medical insight and skill than puerperal cases. A

painful case was reported in all the papers last week,where a midwife was committed for manslaughter byconveying puerperal fever-and so death-in three cases, Ithough it is stated that she was warned by medical

men, and even generously promised their assistance

if she would desist from practice. It transpired thatshe knew nothing of puerperal fever, and thought all

pyæmic conditions implied a cut finger. Yet this Iwoman had attended 900 cases of midwifery ! The Iwhole character of the obstetric art has been raised sinceit passed from the hands of midwives into those of medicalmen, and became a recognised part of medical practice. On

the other hand, the existence of midwives to the numberof many thousands cannot be ignored, the majority of thembeing uneducated and untrained. The compulsion of lawin medical matters is very light. If a man breaks hisleg, it does not compel him to have a regular surgeon. If

a woman is to be confined, it does not and it never will

compel her not to employ a midwife. The compulsioncan only take the form of requiring that personscalling themselves " midwives" shall show some justifica-

tion for using the title and of restricting their practice to a

simple class of cases,’and in default of compliance with theseconditions of imposing penalties. These penalties should beexplicit and effective. It will be far better for the State

to leave the subject untouched than to legislate on it in ahalf-hearted way, and, while giving a kind of status to

trained midwives, either permit them to exceed their func-

I tion, or allow others to practise and to pose as " midwives."If, as we hope, a select committee should be appointed,the profession should try to agree on a rational and har.monious representation of the medical aspects of the case.Those who are altogether opposed to such legislation should

candidly say so in the meetings of the profession or in its

press. Their arguments point in this direction, though theyseem to think it better policy to appear as only opposingthis particular Bill, which, by the way, is practicallythe same as the Bill of last year. It is not easy

Ito believe that the bulk of the medical profession really! propose to prop up and perpetuate an order of "Gamps,"and to allow women without intelligence or principleto go on attending a large number of cases. We can

see no proof that medical men generally are prepared to

undertake so great a responsibility, or to argue before acommittee of the House of Commons that the correction

of this evil will be fraught with darger to the medical pro-fession. The attempts to commit the profession to so ex.treme and undignified a view have signally failed.

i It may be argued that there is a deeper opposition to

legislation than finds expression. We cannot deny thepossibility of such a feeling, but unless those who

believe in its existence can produce proofs of it theyshould seriously ask themselves whether they would notdo well to combine with the rest of the profession to

get the Bill so amended as to restrict midwives to the

simplest cases and to take some guarantees of their respect-ability and training. If the profession goes before a com-mittee harmoniously with such views, it will have much

influence in controlling, the shape of the Bill. If extreme

views are pressed, it will lose all such influence and placeitself in an undignified position. Though we report a disposi-tion in Parliament to investigate all the bearings of thisquestion, we have heard nothing to lead us to doubt thatsome such legislation will sooner or later take place.

DR. PURDY of Chicago has recently published in the

columns of the New York Iledical Journal the results of his

researches into the distribution of Bright’s disease in theUnited State, with the special object of showing the in.fluence of climate upon the malady in question. He takes

the year 1880 for a standard of comparison, and finds that inthis year the deaths from morbus Brightii were 75,386-aproportionate mortality of 7 ’11 per 1000 deaths. The heaviestmortality is found in the States of New Jersey, New York,Connecticut, Massachusetts, and New Hampshire, whilethe lowest mortality is found in the States of Tennessee,Georgia, Nebraska, North Carolina, and Arkansas. Speakinggenerally, the eastern coast line of the Union would seemthe most affected (its middle region most of all), then thenorthern portion, and, lastly, the southern. The first of

these districts shows a mortality of 19’73 per 1000 deaths,and the northern coast region 17’38 per 1000 deaths, or, in

262 D1S1’RlBurl0N OF BRIGHT’S DISEASE IN THE UNITED STATES.

other words, the rate is here from twice to three times thegeneral average. In the south-western States the mortalityfrom Bright’s disease falls to from 1’5 to 2 per 1000 deaths,or about a fourth of the general average.From these statistics Dr. PURDY draws certain conclu-

sions regarding the influence of meteorological conditionsupon the causation of Bright’s disease. He relies upon his

facts to prove that the conditions which favour the genesisof the malady are cold, damp, and variability of tempera-ture, and that, on the contrary, heat, dryness, and equabilitytend to diminish the liability to Bright’s disease. He

believes that cold is effective chiefly when associated witha high degree of humidity, and that a low temperature isreadily tolerated when the air is dry. Similarly he main-tains that humidity is inoperative if accompanied by heatand equability.These conclusions do not present any feature of novelty,

and are quite in accord with established opinions and reco-gnised facts. It seems obvious a priori that the subject ofrenal disease needs above all things such conditions of

climate, occupation, clothing, and diet as will promote a

free action of the various emunctories, above all of the skin.A dry climate, not too prone to sudden oscillations of

temperature, permitting a maximum amount of exercise

in the fresh air, and affording abundant sunshine,would seem best to meet the indications of the

case; but it must be remembered that in very

dry climates equability of temperature is simply a meteoro-logical impossibility. We pay for abundant sunshine anddryness the price of great differences between sun and shadetemperatures, and between the thermometric range of dayand night. This cannot be helped, and the obvious lessonis that we must strive to obtain the maximum advantagefrom a climate of this class by a very careful regulation ofclothing, habits, hours of exercise, &c. It is by no meansso clear that a hot, moist, and equable climate is adaptedto cases of Bright’s disease. Such a climate tends to de-

press the system, but it has the. very great advantage ofprotecting against chills and inflammations; and since weknow how prone albuminuric patients are to inflammatoryaffections of the serous and mucous membranes, and to freshexacerbations of the renal malady, it is obvious that a

climate of this class may have its utility in some cases ofBright’s disease. Its effect is probably less curative than

palliative, and tends to protect the patient against the acci-dents and complications of his malady rather than to exer-cise any decided influence over the disease itself.

We are, however, disposed to doubt whether Dr. PURDY’Sstatistics afford any sure ground for attributing a pre-

ponderant influence to climate in the etiology of Bright’sdisease. It is significant that by far the heaviest mortalityis found in those portions of the States which were firstcolonised, where, consequently, the density of population isgreatest, and the struggle with mal-hygienic conditions ofexistence probably most severe. To compare Boston and NewYork with Arkansas and Tennessee, and to attribute all thedifferences in liability to disease simply to geographical posi-tion, would be an obvious fallacy which Dr. PURDY wouldcertainly not perpetrate. The question, so far from beinga simple one, is really most abstruse. It can be decided

only by a careful attention to such points as proportionate

density of population, the occupations and habits of the

people, their food and drink, their clothing, amusements,&c., as well as climate and geographical position, which aren many ways, direct and indirect, very influential factors;it is only by such an exhaustive survey of the subject thatwe are likely to throw any light upon complicated questionsof etiology. The race factor, again, cannot be left out ofaccount in a country presenting such a multiplicity of racesas the United States. The varying liability of different

races to different diseases is a well-known and significantfact, and although the evidence on the subject is at presentscanty, it will no doubt be some day thoroughly workedout. What can be more striking than the comparativeimmunity of the negro from yellow fever and his remarkableproclivity to small.pox? It is said that the Irish in America

present a liability to Bright’s disease out of all proportionto their numbers; but we cannot feel sure how far this

liability is racial, and how far due to destitution and

poverty.On the whole, the evidence regarding the etiology of

Bright’s disease would incline us to the view that the mostimportant cause of the malady is improper food, unwhole.some occupations, and insanitary dwellings. The study ofthe question leads us, in fact, to the same conclusion as thestudy of phthisis-viz., that the chief danger of humanity atthe present day is that the growth of great cities may lead tothe neglect of some of those primitive conditions of health-fresh air, light, exercise, plain food, healthy housing,-without which the vigour of the organism cannot be longmaintained. It does not follow that large cities are

necessarily and inevitably unhealthy, but there can be

little doubt that the concentration of great masses of

population makes the attainment of the primary conditionsof health more difficult. It is one of the hopeful features ofthis age that we are becoming more and more alive to thesedifficulties, and more solicitous for their removal.

A SUB-COMMITTEE was appointed by the Glasgow TownCouncil a few months since to inquire into the greening ofFrench vegetables with sulphate of copper. The committee

approved of the report which was presented to them, andrecommended that intimation be made to dealers in canned

vegetables that the sanitary officials would institute pro.

ceedings whenever the circumstances in connexion with

their re-greening were sufficient to warrant a prosecution.The report is signed by the medical officer of health, the

sanitary inspector, and the analysts of the city, who, in theevidence they furnish, quote the opinions of the Frenchauthorities upon the subject. That preserved peas are inmany instances greened by means of a salt of copper seemswell established. This treatment with copper salt, it maybe remarked, is not at all necessary for the preservation ofthe vegetables. Sealing them up hermetically after ex-

posure for a time to a temperature above boiling-point isall that is required. This was the simple method discoveredby APPERT at the close of the last century, and early in thepresent century it was put into practice on a large scale,and rapidly grew, particularly in France, into an impor-tant industry. The preserving process, as might be ex-

pected, causes the vegetables to loe their natural

263THE GREENING OF VEGETABLES WITH SULPHATE OF COPPER.

colour and to acquire a somewhat stale flavour. Ilence,and in order that the preserved article may become

more attractive to the public eye, reverdissage or re-greeningis resorted to, and this is accomplished by steeping the vege-tables for from five to fifteen minutes in a hot solution of

sulphate of copper of variable strength, the proportion useddepending apparently on the caprice of the manu-

facturer. In actual practice the vegetables are washedand placed in tin boxes, which are filled up with sea-

salt and sugar, soldered down, and subjected to a tem-perature varying between 220° F. and 239° F. The quan-

tity of copper salt retained undfr this treatment amountsto from 8 to 27 parts per 100,000 of the dried vegetables.Compounds of copper are unquestionably poisonous, andsmall doses continued for some time are known to producesevere abdominal pain, impairment of digestion, and diarrhoea.Bearing in mind well-known toxicological facts like these,it is surely absurd to suppose that small quantities takencontinuously in food are harmless. The action of the

French Government in this matter in 1853 was somewhat

experimental. They prohibiced the use of copper salts inpreserved articles of food, at first in Paris, but the prohibitionseven years later was extended to the whole country onthe recommendation of appointed experts, who were of theopinion that, although the quantities extracted from certainsamples were small and not likely to produce serious

accidents, yet the presence of a highly poisonous sub-

stance in proportions without a fixed limit involved a

risk which should not be permitted to exist. But here

was a pronouncement calculated to be fatal to the

successful working of an industry which employed no lessthan 20,000 persons, and representing a business of

40,000,000 francs. Appeals were, of course, made againstthis decision, and toleration was urged to the extent indi-cated in the following curious conditions: (1) That amaximum limit of the quantity of copper salt should

be fixed; (2) that on every box the nature of the agentshould be legibly inscribed; (3) that greening for exportshould be permitted, but not for hone use. At length itwas reported by the Consulting Committee in 1889 thatthe position of the information which they possessed as tothe noxious influence of salts of copper, there was no real

ground for prohibiting the practice of re-greening preservedvegetables with those salts. The prohibition was with-

drawn, and the practice of reverdissage continues to the

present day. The cultivation of vegetables such as peas inthis country, it is pointed out, is considerably handicappedby the substitution of the re-greened, stale, and probablyless digestible article of foreign growth, which there

is good reason to suppose is not infrequently palmedoff as the genuine, fresh, home-grown product. The

majority of those who have any concern in the im-

portant question of food in its relation to health willshare generally in the views which are expressed bythe medical officer of health, sanitary inspector, and

the analysts of the city of Glasgow in the concluding sen-tences of their report. They are of the opinion that theprocess of re-greening is fraudulent in its intention and

injurious in its commercial results; that re-greening withsulphate of copper does not make vegetables more but pro-

bably less wholesome; that the public ought when pur-chasing preserved vegetables to ask for ungreened or atleast vegetables free from copper; that the guardians ofthe public health ought to come to an understanding as tothe sale of vegetables containing copper, while holding them-selves free to act according to the circumstances of the caseand the scientific evidence obtainable from time to time.

A CONFERENCE was held at Spring-gardens last weekbetween members of the Housing of the Working ClassesCommittee of the London County Council and delegates fromthe several vestries and district boards. The meeting receiveda report from the medical officers of health of the different

authorities, prepared in compliance with a request that theyshould endeavour to prescribe the conditions which mayrender a house dangerous or injurious to health so as to beunfit for human habitation. We recently pointed out that,seeing that the question of degree enters largely into theconsideration whether a house is be regarded in this light,it is impossible to define these conditions so that anyfixed rule may be laid down. The medical officers of

health have themselves pointed this out to the con-

ference, but they have, besides, given some account

in the briefest manner of the principles which guide them,and have enumerated such conditions as faulty site, insuffi-cient light and ventilation, and dilapidations, as those uponwhich they rely. They have also expressed a preference fordealing with filth and defective drainage under the NuisancesRemoval and Sanitary Acts, but have stated their opinionthat where these are associated with other conditions

they justify proceedings under the Housing of the WorkingClasses Act.

Although they have not been able to carry into effectthe wishes of the conference, their labours cannot be saidto be wholly wasted if they have made clear to the

representatives of local authorities that houses faulty inone and another particular must be dealt with on their ownmerits, and that it is therefore necessary to exercise inde-

pendent judgment in each case. The medical officer of

health may recommend proceedings for the abatement

of nuisances, and the improvement of houses under theNuisances’ Removal Act, and he must necessarily be guidedby the whole of the circumstances whether the house shouldbe closed.

But the question arises whether the closing, if this be

necessary, should be effected under the Nuisances’ Removal

Act or under the Housing of the Working Classes Act-whether, in fact, the latter statute gives greater powers thanthe former. There does not appear to be very much

difference between the two, but under the Housingof the Working Classes Act, if the house after closingbecomes dangerous to the health of the neighbourhood, thelocal authority may make an order for its demolition.With this possibility hanging over the owner, and withrisk of greater penalty, he is more likely to comply withthe requirements of the authority. The newspapers have

afforded considerable evidence that the Act of last year has

been systematically enforced in many parts of London, and

probably it will not be long before its effects come to be

264 RAILWAY SERVANTS AND LONG HOURS OF DUTY.

fully appreciated. We observe, however, that magistrateshave in many instances not imposed penalties. This leniency,we think, is unfortunate, for if a reasonable standard of houseconditions is to be maintained in London, owners must bemade to recognise that it is their interest not to allow

houses to fall into bad condition. The Act, to be usefulin the best sense, must be preventive as well as curative,and for this purpose the willingness of the magistrates topunish offenders must not be a matter of doubt. We desireto commend this thought to their attention; without

such assistance as they can render, the maintenance of astaff of inspectors, imposing considerable expense uponthe ratepayers, is unavoidable.

Annotations." Ne quid nimis,"

RAILWAY SERVANTS AND LONG HOURS OFDUTY.

THE report made by Major Marindin upon the collisionwhich occurred on the 21st ult. at the Brindle Heath Junc-tion of the Lancashire and Yorkshire Railway, coming as itdoes while the railway strike for shorter hours is pending inScotland, will have, it may be hoped, a salutary effect inriveting public attention upon what is a crying abuse inrailway management. The collision was a very serious one,involving injury to twenty-five passengers, and in at leastone instance a fatal result. The blame of it is cast

by Major Marindin entirely upon a goods train driverwho had been on duty for twelve hours and three-quarters,and had still another two hours to work. The excuse is alame one, for although such hours are excessive, they arenot so excessive as to afford an explanation of the veryculpable incompetency which the driver appears to haveexhibited. But in awarding blame it is impossiblenot to feel that a share, and not a small share withal,is due to the managers, who are responsible for a systemso thoroughly bad as that which imposes fourteen hours’continuous labour upon men entrusted with the heavyresponsibilities which devolve upon locomotive enginedrivers. Moreover, not only is a share of the blame theirdue, but it is at the present moment a matter of the

greatest public interest that they should receive it. Thecriminal law deals, and deals fairly effectively, with

delinquent railway servants, but the responsibilities in thisconnexion of directors and managers can only be enforcedby public opinion. Public opinion, moreover, laboursunder the peculiar disadvantage of being very badlyinformed upon the point. Such a conclusion is, at least,inevitable if we may trust a communication which appearsin one of our provincial contemporaiies, and has been

brought to our notice by a correspondent. The following isgiven there as an actual instance of a week’s work :-

Time on duty.On duty Monday morning, off Tuesday ... 21 hours.On Wednesday midday, off Thursday morn-

ing........................... 10 "

On Friday night, off Saturday afternoon ... 16 "

Total ..................... 56 hours.

Now it will be seen that these men were on duty threetimes during the week for an "excessive number of hours ata stretch," but their total hours were only 56. Instead,therefore, of having " overtime pay," they will get fourhours less than a week’s money. V’hether the public

danger or the private injury involved in the impositionof such excessive labour is considered, the conclusion is

equally inevitable that means must be found of endingthe system. -

THE ILLUSTRATION OF DISEASE.

THE methods at our disposal for recording the aspect ofdisease at some particular period in its progress, if thatdisease presents features which cause alteration in the out-line or the colour of the surface of the body, have muchimproved of late years. The faithful representations whichwe owe to photographic skill or the trained pencil meet therequirements in many instances where mere change in out-line or form is required to be shown ; but where one wishesto closely represent affections, much of the successful ex.position of which depends upon the colouring of the repro.duction, for fidelity to nature and close resemblance to theoriginal there is nothing equal to the models in wax or com-position material. The museum of St. Louis, Paris, standspre-eminently in advance of those of all European or otherhospitals. It possesses some two thousand models in waxor other material prepared by M. Baretta. This representsthirty years’ work of this celebrated artist. Guy’s HospitalMuseum has also procured this important aid to teachingthrough the work of the late Mr. Toune. However, althoughmost medical museums have a few of such models, theyare usually only copies of foreign works, and generally ofan anatomical character, and are easily and cheaplyreproduced. Not so with clinical and pathologicalspecimens, which, being original, require expert handling.We have had an opportunity of inspecting two wax modelswhich have lately been purchased by the Royal College ofSurgeons from Messrs. Baillière, Tindall, and Cox, themedical publishers ; they are very beautiful and artistic

productions, and appear both in form and colour to faith-fully represent the respective original diseases to which

they refer. The above firm have established a studio attheir publishing establishment for the production of anato-mical, clinical, and pathological models in wax or othersuitable materials. The studio is under the supervisionof Mr. W. Swainson and an expert staff. For the teachingof our students such models are invaluable, and should, wethink, form part of the equipment of all the museumsconnected with our medical schools. We trust, therefore,that the authorities of the schools will at once see their

way to take advantage of acquiring such useful adjunctsto their teaching.

-

THE BETHNAL-GREEN AREA.

EARL COMPTON carried through the London CountyCouncil on Tuesday the recommendations of the Housingof the Working Classes’ Committee as to the procedure indealing with the area in Bethnal-green and Shoreditch,represented under Part 1 of the Housing of the WorkingClasses Act. The proposals of the committee were sub-mitted to severe criticism, and in some instances the

speakers discussed the desirability of the scheme. One ofthe recommendations of the committee, that a compara-tively small proportion of the houses should be closed assoon as the Council obtained possession, was thought bysome to indicate that the houses in the area were not in so

unsatisfactory a condition as had been represented, and appa-rently the point was overlooked that the Council would desireto displace as few as possible of the inhabitants at once,and would do such temporary repairs in many of the housesas would give longer time for the inhabitants to find otherhomes. No doubt much of the opposition was due to the

’ fear that the committee, in seeking for permission to acquirea neighbouring site, was desirous of undertaking buildingoperations, which would eventually place the Council in the