1350

THE LANCET.

LONDON: SATURDAY, MAY 18, 1912.

THE PREVENTION OF DESTITUTION.

The Prevention of Destitution.WE have received from the honorary secretaries of the

National Conference on the Prevention of Destitution,Mr. R. V. HARCOURT, M.P., and Mr. J. W. HILLS, M.P., a

circular informing us that the second Conference is to be

held at the Caxton Hall, Westminster, on the four days fromJune llth to 14th, and requesting us to assist them bymaking known both the date of the Conference and the

proposed scope of its discussions. We do this the more

readily inasmuch as many of the subjects to be dealt withare not only of supreme interest to the medical profession,but are also of such a nature as to be materially elucidated

by medical experience; and we may therefore expect im-

portant contributions in relation to them from members of

our calling, and especially, perhaps, from medical officers ofhealth and from the medical officers of elementary schools.The former or first Conference under the same auspices washeld last year, from May 30th to June 2nd, under the

presidency of the Lord Mayor, and was divided into five

sections: that of Public Health, Education, Unemployment,Mental Deficiency, and Legal and Financial. The forthcomingConference is being organised on much the same lines asits predecessor, but its scope is to include a larger range of

subjects, while a division into five sections will again admitof the conduct of five debates simultaneously. The titles of

the sections will be : (1) Public Health; (2) Education;(3) Unemployment and Industrial Regulation ; (4) Housing;and (5) Crime and Inebriety; and specially interesting dis-cussions are anticipated in connexion with the administrationof sanatorium benefit, the minimum wage, and the preventionof juvenile crime. The success of the debates will no doubt

depend largely on the personality of the sectional presidentsand of those who are selected to open the discussions.

The programme is obviously very large, and we should likeat once to say one word of premonition. The undertaking,as described in the circular notice, bears, interestinglyenough, no inconsiderable resemblance to one of a moreambitious character which was launched in 1857 under the

title of the " Social Science Association," and held its first

meeting that year at Birmingham under the presidency of II,Lord BROUGHAM. For some years thereafter the Social

Science Association maintained a position of somethinglike rivalry with the British Association for the Advance-

ment of Science, and imitated the older body byholding its annual meetings in provincial towns, in whichit was warmly welcomed as a source of profit to hotel-

keepers and other tradesmen, and as a break in the ordinarymonotony of local affairs by a large number of the residents.Unlike the older association, however, it had little or nothingto show for its labours, and it degenerated into a mere

occasion for the utterance of talk which was seldom or never

translated into action, and of which a large proportion was ofan extremely unpractical character. At the first meeting, for

example, an estimable Member of Parliament, who is no

longer living, read a paper in which he maintained that a

complete reformation of the wage-earning classes might be

brought about by the simple expedient of teaching theirchildren, and especially their girls, to speak with carefullyand gently modulated voices, and to avoid the °° harsh

tones which he declared to be the chief exciting and

maintaining causes of domestic disputes. The Social

Science Association maintained its existence for 14 years,and finally expired at Newcastle-on-Tyne in 1870, perishingfrom a redundancy of soft parts as compared with the

stability of the skeleton supporting them. We would ventureto suggest that its history is not without instructiveness, andthat it affords a warning to the promoters of all analogousundertakings to confine themselves to the discussion of

remedies of a practical character, capable of being broughtto bear, with only slight disturbance of existing machinery,upon evils of a present and pressing character. The

initiation of a really workable scheme to deal with a con-crete ill-say a scheme for the prevention and cure of cariousteeth in children-would do more for the welfare of the

rising generation than can reasonably be expected from anyamount of discussion of general topics not having anydefinite plan of reform as their outcome. We would venture

to suggest to those medical men who take part in the pro-ceedings that they can perhaps do nothing more useful thanto restrain them within strictly practical limits, and to checkthat excursiveness over the unmapped region of things in

general which has been known before now to be charac-

teristic of system-builders and of philanthropists.It is impossible to glance over the list of subjects for dis-

cussion which we have quoted above without recognising inhow large a degree they seem to originate in a changed viewof the relations which should subsist between the individual

and the community. Two centuries ago, even one century

ago, the pressure of events and the tendency of publicopinion had created and maintained a very general sense of-the existence of duty as a moral obligation on the part of

every individual towards the individuals of his environment,

The individual was kept erect by the surrounding pressure,and recognised that he was called upon to accomplish hisshare of the general activity supporting him. The prevail--ing opinion to this effect was based not only upon religiousteaching and upon the example of the more highly educatedclasses, but also, and in a very large degree, upon

the practical experience afforded by the history of the

nation. We have before us an assize sermon, preached atDorchester in 1715, appealing to this sense of duty as to a.real and abiding force, and seeking to enlist it in oppositionto the inroad of the Old Pretender. Its existence was not

peculiar to England, and was perhaps never more stronglydisplayed than by revolutionary France in her uprising a&

one man against impending invasion, although in the Franceof the present day we have seen it superseded by "sabotage."Scarcely more than a hundred years ago NELSON’S call to his-men to do their duty awoke an echo to which the heart

of every Englishman responded. A similar call would

1351THE CONGRESS OF UNIVERSITIES OF THE EMPIRE.

to-day lead to much argument as to what is any particular Iperson’s duty. The change is not confined to the labouringclasses, as some, for political reasons, alas would have us

believe, but is equally manifest, to all who have eyes to see,in a good deal of the extravagance of the well-to-do. It

seems to us to strike at the root of what may be called

national cohesion, seriously to weaken our position amongthe peoples of the world, and to discount our power to

encounter any domestic trials or calamities, industrial

or other, which the future may have in store for us.

We believe that many of the social problems which arenow pressing for solution arise in great measure from

what may be called diminished national solidarity, from anincreased tendency on the part of the half-educated to fightfor what they conceive to be their personal interests with-out regard to those of the surrounding public ; and we

think that conferences and such-like agencies could scarcelybe better employed than in an endeavour to bring home tothe public mind the fact that the nation is one and in-

divisible, that no class can secure prosperity by proceedingswhich are detrimental to others or to the common weal,and that every man, owing, as he does, his food, his safety,his very life, to the conditions created by the community ofwhich he is a member, owes, in return, to that communitythe expenditure of his best endeavours for the promotion ofits welfare and its prosperity.

The Congress of Universities of theEmpire.

ON July 2nd next a Congress of the Universities of the

Empire will open in London, at which 52 universities

will be represented each by four representatives formallyappointed to speak with the authority of delegates. The

general London committee includes the chancellors of theuniversities of the United Kingdom, the Prime Minister andthe Leader of the Opposition, the High Commissioners of theDominions, the Lord Mayor, and the Chairman of the London

County Council. H.R.H. Prince ARTHUR OF CoNAUGHT

has consented to preside. The chairmen of the various

sessions will include such distinguished names as those ofLord ROSEBERY, Chancellor of the Universities of London

and Glasgow and Lord Rector of St. Andrews University ;Lord CURZON of Kedleston, Chancellor of the University of

Oxford; Lord RAYLEHm, Chancellor of the University of

Cambridge; Lord HALDAXH, Chancellor of the Universityof Bristol; and Lord STRATHCONA AND MOUNT ROYAL,Chancellor of the Universities of Aberdeen and McGill.

The subjects scheduled are : (1) Specialisation amonguniversities ; (2) inter-university arrangements for post-graduate and research students ; (3) the relation of univer-sities to technical and professional education and to

education for the public services ; (4) interchange of

university teachers ; (5) the problem of the universities

in the East in regard to their influence on character

and moral ideals ; (6) residential facilities in connexion with

universities ; (7) conditions of entrance to universities and

the mutual recognition of entrance tests ; (8) action of

universities in relation to the after-careers of their

students ; (9) university and tutorial class-work ; (10) the

establishment of a central university bureau, its constitutionand functions ; (11) the position of women at universities y(IZ) representation of teachers and graduates on the govern-ing body of a university. Two of these subjects havea special interest from a medical point of view. As

regards the relation of universities to technical and pro-fessional education, it is recognised that there are two main

views, each influenced by circumstances. Some maintain

that the true function of the university lies in providing for-

the student the super-position on a broad general education.of a philosophic grasp of the principles and coordinationof those necessary basic sciences or departments of know

ledge upon which the subsequent technical training can beimposed without tending to narrowness of view and mere

craftsmanship. This attained, the special professional ortechnical training in details should be sought at technicalor professional schools, after which the student, on satisfyinghis university of his fitness, should receive its cachet. In

other words, the university should confine itself to education

in general principles; the technical or professional schoolto instruction in the particular application of those

principles. That plan is, in fact, to a large extent in

force at the two older English universities; at any rate, as

regards medicine, where the student, after a preliminarytraining in the basic sciences and those ancillary to medicine,betakes himself to centres of professional instruction, return-

ing in due course to submit himself for examination by the

university authorities, the satisfactory issue of which gainsfor him the hall mark of his al1na mater in a degree. This

plan must comment itself to all who feel that there is

altogether too great a tendency in these days to com-

mercialise the spirit of the university, the proper aim of

which should be, not specifically to train the student for hisfuture occupation, but to fit him to enter on the study of £

it with a broader grasp, a wider horizon, than that of themere craftsman, however skilful.But while we must all grant that principles, not methods,

should be the objective of university training, the fact is

that as regards certain universities the latter must be soughtby the medical student in a technical school. Facts will

be acquired the more masterfully in proportion as the previoustraining has been of a comprehensive and coordinatingcharacter ; but at many universities the medical schools, indirect association with great hospitals, are themselves an

integral part of the university, and the student can go from

principle to practice under the immediate asgis of the

university. Sir MICHAEL FOSTER once pointed out in anaddress at Johns Hopkins University, while urging that theuniversity student should have the opportunity of devotinghimself to those particular kinds of knowledge which are

best suited for his future calling, that the knowledgeimparted to him must not merely be a knowledge of factsbut must bring with it the power of thinking-he shouldlearn how to acquire knowledge of a particular kind and to

recognise that which will be useful to him and that whichwill not. At the technical or professional school he will be

given the opportunity to apply that knowledge so as to gain16 experience," which is so often, yet so wrongly, confoundedwith knowledge, but it does not follow that the technical

school cannot in many cases be affiliated with the university.,

1352 THE TROPICAL DISEASES BUREAU.

and the tendency of the modern university is Lto promotethese loose unions with:practice. In regard to medicine itseems to us that the harmonisation of entrance requirementsis a more important thing to aim for than either the union ofthe technical school to the university or its divorce therefrom.The student once admitted as an undergraduate, the universitythat has accepted him should be free to follow its own

individuality in his future training, according to the specificcharacteristics that have been evolved by it under the con-ditions of its own specific environment. But it is in the highestdegree unfair to parents, to youth, and to those whose duty itis to prepare youth for a university career, that such varyingrequirements should exist as to render years of careful pre.paration for entrance to a particular university practicallyuseless if chance or circumstance should subsequently rendera change of university necessary. It is highly desirable thatan adequate preparation for admission to one universityshould qualify pro tanto :for admission to any university in

regard to all those subjects that all have in common, even

though particular universities may deem it necessary to add

specific additional tests,:as a consequence of their specificindividual bent. We hope that these points will receive i

careful consideration at the Congress. I

Annotations.

THE TROPICAL DISEASES BUREAU

II Ne quid nimis. "

IN a Memorandumlissued this weekly the Colonial Officethe important announcement is made that from July lst nextthe Sleeping Sickness Bureau will be known as the TropicalDiseases Bureau. The Memorandum gives an account of theorigin and progress of the present Bureau. At the Inter-

national Conference on Sleeping Sickness held in Londonin June, 1907, and March, 1908, it was proposed to founda Central International Bureau "to extract and circulate

all new literature on sleeping sickness," but this projectfell through because the delegates of the various countriescould not come to an agreement as to the site ofthe Bureau or even the necessity for its separate existence.Arrangements were therefore made by Lord Elgin, thenColonial Secretary, for the establishment of a British Bureaumaintained by Imperial funds, with a contribution from theSoudan Government, and the Royal Society generously con-sented to house the Bureau. During its four years of existencethe Bureau, under the direction of Dr. A. G. Bagshawe, hasissued 37 numbers of its Bulletin, each containing an accountof current work in the field and laboratory on sleeping sick-ness and other trypanosome diseases ; and last year it com-menced the issue of a quarterly Bulletin on kala-azar underthe editorship of Dr. C. M. Wenyon. These publications haveproved extremely helpful to investigators, and many of thenumbers have been reviewed from time to time in the I

columns of THE LANCET. Among its many other usefulfunctions the Bureau has, of course, also initiated the

despatch of special expeditions to investigate sleeping sick-ness in tropical Africa. The Memorandum, in explanationof the forthcoming change of title, says that it soon

became evident that what the Bureau was doing for

sleeping sickness could be done in the same way for

tropical diseases generally. Lord Crewe and his successor

at the Colonial Office, Mr. L. Harcourt, have both interested

themselves in the expansion of the Bureau, and the arrange-ments for this purpose are now complete. The TropicalDiseases Bureau will be quartered at the Imperial Institute,since the accommodation at Burlington House is no longersufficient. It will deal with all exotic diseases prevalent intropical and sub-tropical regions, and will publish at frequentintervals a Tropical Diseases Bulletin, which will take theplace of the present publications. The director will have the

help of an assistant director and a number of experts eachresponsible for his own subject. The tropical diseases of

animals will be dealt with in a separate publication, and forthis purpose Sir John Macfadyean and Mr. Stewart Stockmanhave joined the committee as representatives of veterinaryscience. We welcome the new Bureau and endorse the

anticipation expressed in the Memorandum that through itthe results of the most recent researches on every tropicaldisease in every country, as well as new methods of treat-ment and improved means of prevention, will quickly becomeavailable for the remote worker in the tropics.

THE TIME TO OPERATE IN APPENDICITIS.

FRUM almost the very beginning of the recognition of

appendicitis there has been much discussion as to the mostsuitable time for operation. The question is, Shall the

surgeon proceed to operate directly the diagnosis of

appendicitis has been made, or shall he postpone the

operation to the interval after the inflammatory signs havedisappeared, except in certain cases where an immediateoperation is required owing to the fac!i that the appendixis sloughing ? Each of these opinions is held by manysurgeons, but the relative proportions of those who hold theone opinion or the other has varied greatly from time totime. On the whole, it may be said that at the presentday the majority of surgeons advocate an immediate opera-tion in practically all cases of appendicitis. In the last issueof THE LANCET there was published a lecture by Sir GeorgeThomas Beatson, in which he expressed his opinion as to theright time to operate in appendicitis. He holds that ifdiffuse suppurative peritonitis is present an immediate opera-tion is desirable, and the peritoneum should be drained

through a right iliac incision, a suprapubic opening beingalso made; the appendix is only removed if it is easilyfound. He also operates if any collection of pus pointsexternally, but, except in these circumstances, he operatesonly in the interval period. When the blood count remains

high he takes this as an indication not to operate, but towait for three or four weeks until the pus becomes sterile.

The results of this plan of treatment in Sir GeorgeBeatson’s hands are certainly very good. In the last

14 years he has treated 273 cases of appendicitis,of whom 264 left the hospital well ; of these he

had operated on 256, while 8 refused operation; but

of the whole number only 9 died. This represents a

mortality of less than 3 per cent. Statistics are given ofthe death-rates of some other surgeons, and in every case

they are much higher, so that so far as we may depend onstatistics there is much to be said for his method. It

is, of course, impossible to say with certainty that thecases were absolutely comparable, but the probabilitiesare that there was no very great difference. Sir GeorgeBeatson operates immediately in some cases ; and the

real problem consists in the difficulty of recognisingthose cases in which an immediate operation is neces-

sary and those in which the operation may be postponedto the time when the pulse, the temperature, and the bloodcount have returned to the normal. Each surgeon must judgefor himself as to the cases which he feels he may leave with

safety, and it is difficult, if not impossible, to lay down rules;but Sir George Beatson has done good service in drawing