315ANNUAL GENERAL MEETING OF THE BRITISH MEDICAL ASSOCIATION.

THE LANCET.

LONDON: SATURDAY, AUGUST 7, 1897.

THE members of the British Medical Association who

hunger and thirst after medical science will this year have

to repair to Canada for their satisfaction. Those who

rather affect questions of a medico-political sort or such asbear on the constitution and duties of the Association have

already had their meeting. It really seems as if the

members of the Association were divisible into two such sects

as the above. There are, of course, a few striking excep-tions-men equally at home in the discussion of either set of

subjects ; but, as a rule, there is a sharp line of demarcation,and certain names appear in the one section which are

conspicuously absent in the other, and vice versd. Nor is

the blame one-sided. It is easy to say that the greatquestions affecting deeply the interests of the profession, its

constitution, its privileges, and its duties, are discussed

year after year by the same limited group of speakers, who

might be counted on the fingers. The fact, however, is notthe fault of the members in question. The general meetingcf the Association is open to all members, and all shouldtake a decided part in its affairs and their administration

and in its constitution. Even as an instrument for the

promotion of medical science the Association will suffer if

the great majority of its members take no part or lot inthe discussion of its duties ; and as an instrument for

affecting public and Parliamentary opinion it will suffer

great impairment if the leaders of the profession do not dotheir share in giving a tone of moderation and breadth toquestions which cannot be settled without reference to

public and Parliamentary support.The business meetings of the Association, if we may

judge from the numbers who vote, are attended by a

mere fraction of the members. At the meetings held

last week the questions discussed were of great im-

portance, such as the functions of the Council, the

constitution of the Association, the deference due re-

spectively to a general meeting of members and to the

piews of the branches carefully ascertained, the MidwivesBill, or, to speak more accurately, the Obstetric Nurses

Bill, indirectly the question whether the Association

should undertake the work of Medical Defence, the

case of Mr. R. B. ANDERSON, and the disciplinary functionof the Association in the way of excommunication.

It will not be denied that these questions involve the veryjudgment and reputation of the Association-even of the

profession-and that errors of judgment in regard to themmay not only involve the Association in discredit, but maybe disastrous to the profession, yet they were determinedby 150 or 160 members ; and it occasionally happens in theAssociation that the gravest questions are settled by halfthat number. It cannot be wondered at that the Council

are fain to refer such subjects to the branches for careful

consideration and advice, and that the judgment of

the branches is not always the same as that of

a general meeting, which is often controlled by a

handful of speakers who are apt to regard themselves

as the Association. It would be personal to specifyillustrations, but members of the Association will have

no difficulty in supplying them. It is the more un-

necessary as we seem to detect in the proceedings of

the recent annual general meeting, with one or two

exceptions, a greater spirit of responsibility and modera-tion than has often of late years been exhibited, and a

greater disposition in different sections to believe that

there is something in other views than their own.Two very different incidents in the proceedings deserve

a word of notice. The presentation of the gold medalswill be generally approved. If an association does not

emphasise such services as those of Mr. WHEELHOUSE andSir WALTER FOSTER there must be something wrong in

it. The award of the Stewart Prize to Dr. G. SiMS

WOODHEAD and of the Middlemore Prize to Dr. ALEXANDER

HILL GRIFFITH will be equally approved. The other

incident was of a painful character-the expulsion of two

practitioners from the membership of the Association for

having accepted offices under the Government of South

Australia in the General Hospital of Adelaide, vacated by thewhole staff as a protest against the conduct of the Govern-ment. The members so removed had ample opportunitiesof defending themselves. We cannot wonder at the all but

unanimity with which the Association acted in this matter.The profession must protect itself, and it would be simplylamentable if a great voluntary association were to be

stricken with the same paralysis of discipline which seemsto threaten the chartered and statutory authorities.

.

IN the Bradford district-the home of the wool-sorters’

disease-another case of death from anthrax recentlyoccurred, in time, it is to be hoped, to check the

withdrawal of certain restrictions which, from time

to time, have been placed on the sorting of wool. But

whatever means be adopted in the sorting-room, there

must necessarily, from the nature of the dust in which theanthrax spores are carried, be very great danger, at somepoint or other of the process, to those engaged in wool-sorting or, as Dr. BELL, of Bradford, points out, in the

removal of the dust from the vessel in which it accumulates.It appears that the time for the general consideration ofthe carriage of infective material in hides, hair, and rags hasarrived ; and although the destruction of none of the patho-genic organisms with which we are at present acquaintedpresents quite the same difficulties as are associated withthe destruction of anthrax spores, there can be little doubt

that the question of sterilisation in bulk is one that will

have to be faced sooner or later.

As has been pointed out by the Dangerous Trades

Committee of the Home Office, there are certain districts-

notably Asiatic Turkey, Persia, Cashmere, South Africa,and Peru-from which fleeces from animals that have died

from anthrax-fallen fleeces-are constantly being sent,whilst hides from some of these places and from China,and hair from Russia and Siberia, are often taken from

316 THE COMMERCIAL TRANSMISSION OF ANTHRAX AND PLAGUE.

cattle and horses that have succumbed to anthrax. It

is, of course, evident that the ideal method of treat-

ing such material would be by sterilisation before

the goods are baled; but that being out of the

question, it is all-important that some plan of sterilisingin bulk, if possible, or in loosened bulk, if necessary, shouldbe devised. In the case of hair, through which steam andliquids percolate most readily, the difficulty should not bevery great, but in the case of pressed wool and baled hidesthe obstacles to thorough disinfection are necessarily verymuch greater. A dense mass of wool exposed to super-heated steam, even for a very considerable period, could beaffected on the surface only, whilst such treatment

of leather would ruin it for all commercial purposes.

We cannot think, however, that a committee, composedof practical men accustomed to deal with these various

goods, of one or two thoroughly capable medical officers of-health, and of a similar number of expert bacteriologists,would be unable to draw up a satisfactory report on thevarious means of dealing with goods-coming from schecluleddistricts. Any one of these sets of men alone would beutterly- incapable of dealing with the subject; but the

whole of them, looking at the question from various

points of view and with the benefit of each other’s

advice, should be able to draw up a workable scheme

which would approve itself to all concerned. If the

question could be settled as regards anthrax it would

be settled for every other disease from which we have

anything to fear from the carriage of infection throughthe agency of imported goods. In a letter published in ourcolumns last week it is pointed out that if certain observa- Itions as to the persistence of vitality of the rinderpest virus ’,be correct, it is essential that the-hides from " dangerous "

districts should be submitted to a process of disinfection

before they are admitted to this country. Any measures thatwould be sufficient for the sterilisation of the anthrax hides

would be, of course, more than sufficient for the sterilisationof rinderpest hides ; but at present there are no methodsknown by which even baled rinderpest hides could be

rendered free from the virus if it were present.As regards the possibility of the carriage of the infection of

plague to this country, considerable light has been thrown onthe question by the various recent workers at the life-historyof the plague bacillus. All are agreed that, except under veryfavourable conditions, the plague bacillus very rapidly diesout, whilst even under th’e most favourable conditions it is

difficult, without constant re-inoculation and passage

through living animals or human beings, for the organismto maintain a high degree of virulence. It follows therefore

that wherever a long voyage has to be made, even in thesedays of rapid transit, the bacillus as a rule dies a naturaldeath, and although the organism may be present and alivein goods that leave Bombay, it has lost its virulence, andusually also all vitality, by the time that it reaches-this

country, say. Quite recently Dr. KOCH and the BombayCommission have fully confirmed these statements as to theshort life of the plague bacillus. Still, it is obvious that

under certain conditions it might be necessary to disinfect

rags and flock from plague-stricken districts ; but in mostcases this could be done with comparative ease, owingto the nature of the fabrics in which the infective

material might possibly be lodged. This whole question’is one of very great importance. It has even been

suggested by the Dangerous Trades Committee that,

" Government should be empowered to stop the land

ing of hides on receipt of information that they comerfrom infected areas." They also suggest that horsehair

and bristles from Russian and Siberian animals should?

be excluded from our ports on the same grounds that

infected animals are not allowed to be sent into the country.As we have already pointed out, no evidence can be collectedthat there is any danger of the conveyance of the plague tothe United Kingdom through the wool that arrives from

ports where plague is prevalent, and in this case the expe-rience of those engaged in following the history of outbreaks’of disease is entirely at one with the most recent scientific.evidence. In the same way we have as yet no evidence that.the rinderpest virus can be carried and remain active for-

any length of time in baled goods ; even the laboratoryexperiments concerning the vitality and virulence of rinder-

-pest virus do not afford grounds for definitely supportingthis opinion, and anything that has been advanced has been.in the form of suggestion rather than of actual statementsIn the case of anthrax, however, we are dealing with a,very different state of affairs. Owing to the conditions.

under which the anthrax organism finds its way into the-

wool and hair of animals that have died from anthrax.spores are almost invariably formed before the organismdies. These spores are extremely resistant to drying and, infact, to all agents and agencies which might prove fatal to-less resistant organisms. Their powers remain dormant

apparently for years, and only come into play-but thenwith all their original intensity and virulence-when theconditions of moisture and nutrition are again sufficientlyfavourable for the development of the potential energyof the spore. This very fact renders it exceed"

ingly difficult to sterilise any substances into which

these organisms have found their way ; but there can:

be no doubt that it is our duty to find some means,

by which these organisms may be rendered harmless

before the fleeces or the skins come into the hands of the,wool-sorters and the leather-dressers.

..

WE shall continue next week our Commissioner’s reporton hospital abuse at Birmingham, and take this oppor--

tunity of thanking our many supporters who havo-

borne witness in public and private to the value that thisbranch of our work has in their eyes, and of assuring themthat our policy in the past with regard to this important,question will be our policy in the future. We shall continue

in these articles to report facts obtained from trustworthysources, or founded upon the personal investigation of our’Commissioner, and we shall attempt to draw a moral from’

these facts that, haply, order may spring out of chaos, and,

a problem, or a series of problems, which now defies the:i remedial measures of all experts in charitable matters,,

; may become simpler of solution in the light of more

accurate special knowledge. Remedies academic or com-

prehensive will probably suggest themselves by comparison; of the different troubles in different localities-but the first

thing is to get the facts.

317ABUSE-HOSPITAL AND OTHER.

In this connexion we have pleasure in calling attention toDr. ROBERT SAUNDBY’S letter upon our Commissioner’s

first article dealing with hospital abuse in Birmingham,which appeared in THE LANCET of July 31st. Dr.

SAUNDBY’S letter will be found upon page 331 of our

present issue. Dr. SAUNDBY’S name is probably known to

many of our readers as President of the Council of the

British Medical Association, and he is described in the

Medical Directory of 1897 as Physician to the BirminghamGeneral Hospital, Consulting Physician to the BirminghamEye Hospital, Consulting Physician to the Birminghamand Midland Hospital for Women, and Examiner in Medicineto the English Conjoint Board - among other titles

to respect. So that from more than one point of

view we might have anticipated thoughtful criticism

of our work from him. We might have credited

him, as a pluralist in hospital appointments, with beingaware that the efficiency of the hospital work of the

kingdom has been much crippled by the distribution of

indiscriminate charity, especially in the out-patientdepartments. We might, again, have felt secure that weshould find him, as a high officer in the British Medical Asso-

ciation, quick to comprehend all sides of a topic the

settlement of the inherent difficulties of which is a matter

of such urgent importance to the general practi-tioner. In each capacity-whether as one of the chief ,officials of the British Medical Association or as a physicianprominent in public charitable work-we might have fairlyconcluded that we should obtain from Dr. SAUNDBY a

judgment of our work inspired by fairness as well as byspecial knowledge. Moreover, we might have expectedfrom a gentleman who has held such responsible posts inthe profession and who is a physician of experience andculture the usual courtesies of debate. Instead of which we

receive the little letter to which we have already referred. Inthis letter we read of our Commissioner as a "self-sufficient

gentleman," while lower down the eye catches the politephrases, "spiteful misrepresentation," "cowardly and cruellibel," "suffering from the effects of the dog-days,""monstrous accusation," "interference of outsiders"-to

cull a few blossoms, surely already a little faded, fromDr. SAUNDBY’S epistolary rhetoric. Not one word of

justification does Dr. SAUNDBY condescend to employ. Our

Commissioner has written, as he will continue to write, infull detail of the situation in Birmingham. On no pointor points whatever does Dr. SAUNDBY controvert his

statements. In not one single instance does he exhibit and

gibbet the cowardice, cruelty, and misrepresentation ofwhich he writes. He prefers to be vague and abusive,for we can use no other word to cover the phraseologywe have quoted. °

And here we might fairly leave the matter, for Dr.

SAUNDBY has shown himself to be so unable to form an

unbiased judgment of our aims that we might hold his

estimate of our work valueless. We might respond thathe was at liberty to think what he liked and saywhat he liked, but that we should be unable to afford

him the gratification of taking him seriously. But we con-

sider it important to dwell upon one point in Dr. SAUNDBY’Sletter. We are bound to reflect that the myopia whichDr. SAUNDBY has exhibited, although in the enjoyment of

unexceptional opportunities for insight into the difficultiesthat surround the question of hospital abuse, may be shared

by others of our readers less fortunately placed. Therefore,we invite all readers of THE LANCET to peruse Dr.

SAUNDBY’S letter and to note in it the untenable position ofprivacy from discussion that is there assumed for affairs thatare clearly of public interest. Dr. SAUNDBY talks of "inter-

ference of outsiders," and reports certain of the professionat Birmingham as having told our Commissioner "to mindhis own business." Our Commissioner, who gives us a truerview than Dr. SAUNDBY of the kindness and good sense ofthe practitioners in Birmingham, was minding his business-i.e., THE LANCET’S business-when he made his inquiriesinto a matter of the first interest to the medical

profession. It is imperative that all should understand

that the hospitals do not belong to the medical staff.

It is imperative that the medical profession should realisethat public charities must be administered for the publicgood, and that public deeds are open to public criticism.At the present moment the suffering poor, the charitable

public, and the general practitioners alike suffer from the

lax methods of the distribution of hospital benefits. As

good men, as just citizens, and as kindly fellow practitioners,all medical men should do their utmost to help in arriving atbetter methods, if better methods can be devised. As

medical journalists we have our share in this work,

and we shall continue to discharge our duty as seems

proper to ourselves, secure in our knowledge that whatwe have done has borne good fruit, and deeply conscious

that had not it been for the hearty cooperation of the

medical profession in so many localities the information

which we have already been able to diffuse could not havebeen obtained.

Annotations.

A PLEA FOR A STATE MEDICAL SERVICE.

11 Ne quid nimis."

IN a recently published pamphlet Dr. James Erskine,lecturer on Aural Surgery in Anderson’s College Medical

School, Glasgow, advocates a complete departure from thesystem of medical practice as at present constituted. The

multiplication of hospitals, the gratuitous treatment ofinfectious disease at the public expense, the growth of theprovident society organisations, and even the recent im-provements in the practical parts of medicine and sur-

gery, whereby methods have been introduced more andmore difficult to apply in private dwelling - honseswith the assistance of an amateur nurse, have all ofthem bad the effect of seriously encroaching on the fieldof the time-honoured family medical man. Dr. Erskine putsthe case accurately in describing this unsatisfactory con-dition of things as "an undeserved Nemesis overtaking themedical profession for their beneficent labour," and he doesnot hold out any prospect of an improvement under presentconditions. His remedy is a nationalisation scheme, mostof the details of which he leaves to be supplied by others,his main recommendation being that hospitals ought tobe uniformly free and accessible both as regards illnessand locality." For some years the hospital questionhas, he says, been discussed mainly from the point of

view of so-called abuse by patients in a position to