667THE BRITISH MEDICAL ASSOCIATION.

I

THE LANCET.

LONDON: SATURDAY, SEPTEMBER 11, 1897.

THE meeting of the British Medical Association in

Montreal, or, rather, the opening address of the distin- 1

guished President, Dr. RODDICK, Professor of Surgery in the McGill University, has called forth a somewhatsevere criticism on the Association from the limes

which cannot altogether be disregarded. The address

and the criticism form an interesting illustration of the

different conclusions to which men may come who

are presumably equally able and disinterested, showing,as most such illustrations do, the importance of difference of standpoint and of the colour of the

medium in which the object is seen. The address, or,rather, that portion of it which seems to have called forththe uncomplimentary side of our contemporary’s criticism,was spoken from the President’s chair and dealt naturallyenough with the noble objects of the Association, its im-

partial constitution, its accumulating capital, and its greatnumbers " of earnest men pitted against false dogmas andever battling for the truth." For such an Association the

President could see no future but one of increasing powerand usefulness. It was beyond his conception that anyage could come which would cease to feel its benignand mighty influence making for the amelioration and

elevation of mankind. He even expressed his belief that itwould be an important factor in bringing to a successfulissue that great scheme of Imperial Federation which nowexercises the mind and hearts of the leading statesmen ofthe empire. What must have been the President’s feelingswhen he opened the Times of Sept. lst to learn that all hiseulogy of the Association and its power was a mistake-" thetruth being that the absence of such power and influenceis one of the most remarkable characteristics of the

organisation, and one which has often occasioned much

perplexity to those who have been called upon to consider

its proceedings." Nor is this the worst that the candid

article in the Times had to say, for from other passages we

learn" that probably no statesman was ever influenced byits [the Association’s] views with regard to any matter

of legislation," that it "has made some microscopic pecu-niary grants for the promotion of scientific research and

that nothing very important has ever come of them " ; thateven at the annual meetings of the Association recreations generally preferred to science; and that all the work ofthe profession, whether scientific, charitable, or adminis-

trative, is done by independent societies. No English Pre-ident, concluded the Times in leaving that aspect of thequestion, could have employed the language which Dr.

RODDICK used "without, at least, being suspected of irony." The weakness of the profession is its want of cohesion

and concord, of organisation and unity. There are

not wanting signs of still more and graver cleavageinto sections and coteries. The one great and indivisiblerofewon is to be broken up into bits or into classes.

It is a responsible thing in the face of such facts to dis-

parage the greatest association of the profession, and wecannot but ask ourselves what explanation can be offered ofsuch disparagement, and, if possible, what excuse. We

have never been blind admirers of the Association. There

have been many things in its history which have beenunworthy of its very greatness-partialities, personalities,timidities, and favouritisms. It has not always had a soulto call its own. Last year two of the oldest members

of the Association, who have since respectively been solacedby the gift of its gold medal, were allowed to drift outof the position of direct representatives in the GeneralMedical Council when a little early and firm supportfrom the Association of which they had been lifelongsupporters would have secured their honourable return.

Of late years the annual meetings have been less attractivethan of old, not so much because of the prevalence of" I recreation "-a most legitimate and desirable part of

the duty of gatherings of scientific men-or because of

the subordination of medical science to so-called medical

politics, but because of the abstention from the councils ofthe Association of those whose influence and whose character

would have given them a status from which to deal alikewith the demands of medical politics, of medical science,and of medical ethics.

It is impossible to deny these facts with regard to theAssociation or to shut our eyes to their gravity. But when

all has been said we cannot deny the usefulness of the

Association or doubt that it has materially affected bothmedical and sanitary legislation and medical science. Its

numbers are great. If its deliberations have not directlyaffected the laws of the nation to the extent that we mightnaturally have expected they have at least educated the

rank and file of the profession and so, in an indirect manner,have instructed the public at large ; and from the positionof an improved popular opinion to an improved legislationis generally but a short step. The Association includes

nearly half the profession, and even if it never realises theideal which Dr. RODDICK has painted it necessarily hasbefore it an important future. But it must work conscious

of what that future is to be. It must be calm and well

ordered. It must have set purposes and a defined scope.In this way its members may know what to expect from

it, and by insisting upon taking an active part in its conductmay vivify it and mould it to greatness.

WHAT, we wonder, will Lord HERSCHELL and the othermembers of the defunct Royal Commission on Vaccinationthink of the manner in which their posthumous Sixth Reporthas been presented to Parliament and the public. Of tàe

187 witnesses whom the Commission examined during itsseven years’ labours this huge blue-book contains the

minutes of evidence of no less than 83. It runs to nearly800 double-columned and closely printed foolscap pages, andcontains, in addition, many maps and diagrams. It

will hardly be believed that such a volume has

been issued by Government without an index of any sortto help Members of Parliament, or the medical profession,or the anti-vaccinationists, either to digest its contents or

to find in it reference to any particular point regarding which

they may wish to consult it. It is true that the " Final.

L 3

668 THE SIXTH REPORT OF THE ROYAL COMMISSION ON VACCINATION.

Report (issued many months before this one) was withoutan index, but the difference between the final report andthis report as regards need for guidance is greater thanthe difference between the king’s highway and the mazeat Hampton Court. The previous volumes of evidence

were much less in size than this one-the four contained

amongst them the evidence of only about a hundred

witnesses-but each of them was furnished with an ampleand excellent analytical index.What may be the cause-reason there can be none-for

this extraordinary neglect we do not know. Most

certainly it has not been want of sufficient time to preparean index, for the evidence recorded in the volume began in

November, 1891, and ended in December, 1893. That

is nearly four years ago. Moreover, the preliminarynote, the so-called "Report," in which the Commissionerssubmit the evidence to HER MAJESTY, is dated Feb. 14th,1896, or more than a year and a half ago. In the

latter part of the last Session of Parliament questions were

repeatedly asked as to when the Report and Appendiceswould be published. In reply a time was mentioned, andafter the promised publication was considerably overdue thematter was again made the subject of question and

answer. Now, at length, when Parliament is not sitting,and no question can be asked, the huge tome is placedbefore the public in such a fashion that the irate reader

would be glad to know on whom the responsibility for theform in which it appears rests.

It is simply out of the question to permit this

volume to be placed on the library shelves of the countryunaccompanied by a good index, and if none is issued in

supplement before Parliament meets steps will have to betaken then to press the Government to give the necessaryorder. We need only mention that the list of witnesses,in addition to containing the names of various leadingopponents of vaccination, includes those of Dr. BARRY,Dr. BIRDWOOD, Dr. J. H. BRIDGES, Dr. MONCKTON COPE-

MAN, Dr. R. J. B. CUNNYGHAME, Dr. HIME, Dr.

HUSBAND, Dr. KLEIN, Mr. MCFADYEAN, Dr. J. C. MCVAIL,Dr. OGLE, the late Dr. BEAVAN RAKE, Dr. FREDERICK

TAYLOR, Dr. WHITELEGGE, and Dr. SIMS WOODHEAD. No

doubt it will take a good deal of trouble to prepare an index,which, judging from those of previous volumes, ought to runto some fifty pages or thereabouts. It cannot be supposedthat the Commission would spend two years listening toevidence, and give the eighty witnesses all the labour

of preparing it, and yet would in the end fold its

hands and declare that it could not supply an index of whatthese witnesses had said. The matter is justifiable fromno point of view. It is a sheer waste of paper and printingand lithographing to send forth a report (costing 14s.)without its ordinary and necessary accompaniment. And

in the interests of the literature of science it is essential

that even yet an index should be published. We stronglysuspect that when the Commission ceased to exist as

such there must already have been made some more or

less complete digest of the contents of this volume. This,indeed, is bound to have been the case, for the Final Reportcould not have been prepared without it. This digestmust be pigeon-holed somewhere. But when the Com-

mission was dissolved, its Final Report being issued, it

seems to have been nobody’s business to attend to the issueof a great bulk of valuable material on which that Reportwas largely based. For it must be recollected that not

only is there this mass of evidence taken directly bythe Commission, but there are also the very importantspecial reports on the small-pox outbreaks which occurred inDewsbury, Gloucester, Warrington, London, and Leicester,and which were investigated by Dr. SIDNEY COUPLAND,Dr. SAVILL, and Dr. LUFF. Then, also, Dr. THEODORE

DYKE ACLAND made inquiry into many cases of allegedinjury from vaccination. All this has to be published and allthis has to be indexed. In so far as these special reports will,be much less voluminous than the minutes of evidence now

issued their indexing will be easier, but none the less theduty should not be left to the public. If there is now no one

responsible for all this work then it is imperative that someone should forthwith be appointed. The delay that has

already taken place is much to be regretted, but that thelong-waited-for reports should in the end be launched likeships without rudders or compasses is indefensible.

0

THE Commissioners of Prisons are to be congratulatedon the many satisfactory features of the present report.It breathes a spirit of progressive and enlightened policywhich augurs well for the future. Amongst other thingswhich have occupied the attention of the Board may be

mentioned the treatment of juveniles on special lines,the segregation of first offenders, the differentiation of the

occasional from the habitual criminal, the care and

treatment of the weak-minded, and the better preparationof convicts for liberty. All these are steps in the rightdirection. The number of training schools for prisonofficers has been increased, and a scheme for the future

organisation of aid societies throughout the country hasbeen framed. The numbers of the prison population con.tinue to decrease, and there has also been a satisfactorydiminution in the number of the criminal insane. The

vexed question of insanity in prisons, on which of

late so much attention has been concentrated, and regaxd-ing which much ignorance has been displayed by writersinnocent of any practical knowledge of the subject,bulks largely in the remarks of the Commissioners and

also in the notes of the medical inspector. The matter

is discussed at considerable length, and reports from the

governors and medical officers of the various convict prisonsare given, which should tend to allay the public apprehen-sion concerning the alleged injurious effect of penal servitudeon the mental health of prisoners. Anyone who cares to

peruse the factors of insanity as set forth in the annualreports of the Commissioners in Lunacy cannot fail to

observe that the convict is shielded from the operationof the most dangerous of the insanity-producing causes.

His life is regular, his diet is wholesome, he is not

over-worked, and his labour is, for the most part, done

in association and in the open air ; he has a plentiful supplyof books, and he is under continual medical supervision.All these are conducive to sanity, and without doubt exercisea beneficial effect on prisoners who are predisposed to mentaldeterioration. It must be borne in mind that many of these

men have led vicious lives, and have contracted disease,

669REPORT OF COMMISSIONERS OF PRISONS & DIRECTORS OF CONVICT PRISONS.

the insidious and damaging effect of which on the nervous

system is well understood ; a proportion also are hereditarilytainted, the degenerate offspring of degenerate parents.Possibly the strain of imprisonment on the nervous systemis greatest during the first months of imprisonment-during the period of separate confinement. Nowadaysa sentence of penal servitude is the measure of punish-ment awarded for a crime of some magnitude ; in

connexion with this, the period of suspense before

trial, the excitement of the legal proceedings, the

subsequent reaction, and the prolonged process of intro-

spection which necessarily follows, are calculated to exercisea somewhat disturbing effect on the higher levels of the

nervous system, and in persons of unstable nervous organi-sation the results may in some instances be unfavourable.

The Commissioners, however, with commendable fore-

thought, have foreseen this contingency, and have directedthat any prisoner who shows the slightest premonitorysymptoms of nervous disorder shall be specially treated, and,if necessary, removed to a prison where he may have thebenefit of associated outdoor labour. It is apparent that theauthorities are displaying an anxious solicitude for the

protection of the criminal in all that pertains to his mentalwell-being.

Dr. SMALLEY, the new medical inspector who succeededto the post on the resignation of the late Dr. GovER, con-tributes an interesting summary of the year’s work in themedical department. In the local prisons, excludingexecutions, suicides, and one accident, the number of

deaths was 104, giving a death-rate of 7’4 per 1000, whichis slightly higher than that recorded last year. Death

supervened in less than a month after reception in 41

cases, or 2’9 per thousand. This is more than a third of

the total number of deaths, and indicates the wretchedstate of health in which prisoners are often received into

prison. In 45 cases pulmonary disease in one form or

another was the cause of death. Heart disease provedfatal in 18 and kidney disease in 12 instances. There

were five suicides. Considering the large number-namely,175,604-of all sorts of men and women received during the

year this number is small and speaks well for the vigilanceand supervision exercised. Seventy-five prisoners were

released on medical grounds ; they include the cases of

44 females released on account of advanced pregnancy.Dr. SMALLEY deals with the question of insanity in prisonsin a clear and convincing manner. He shows how futile it

is to attempt a comparison between the rate of lunacy in the

prisons and that of the general population, the conditionsbeing so different and so unequal. The number of cases of

insanity in local prisons was 380, a decrease of 98 as

compared with the number last year; of this number,however, 216 consisted of prisoners either unconvicted orremanded for observation, or found insane on arraignment,or found " guilty but insane " at their trial. Hitherto

it has been the custom to include these cases and

also the cases of prisoners found insane in prison after

conviction in one table-a method which showed an undulylarge proportion of insane to the prison population. Hence

arose in great measure those erroneous impressions basedon false deductions which tended to raise alarm in the

public mind. It is neither reasonable nor fair to include

the cases of unconvicted prisoners as cases of prisoninsanity, and, accordingly, they have been excluded thisyear from the insanity statistics. The remaining 164 caseswere convicted and sentenced; of these, 121 were foundinsane on reception and 43 subsequently. It appears from

this that many persons are convicted and sent to prison,their insanity being either ignored or undetected at their

trial.

In the convict establishments fifteen prisoners were

certified insane and removed to asylums. There were no

suicides. The death-rate was 9-7 per 1000. An importantfeature, from a medical point of view, was the decision ofthe directors to send all weak-minded prisoners, or any

showing a tendency to mental deterioration, to ParkhurstPrison. The scheme seems to be working well; they areunder special supervision and are employed at laboursuited to their physical and mental condition. On

their release efforts will be made to assist them and

give them a helping hand. This is a wise, humane,and judicious decision, for such men frequently find

their way into prison. On account of their mental

infirmity they are unable to obtain suitable occupation,and in the stress and hurry of the busy world they arecast aside, and, almost of necessity, have recourse to actsof an anti-social nature. The prevention of crime and thetreatment of criminals are important and far-reaching ques-tions which are being made the subject of inquiry and

investigation by many able workers, both in this countryand abroad, and it is pleasing to note that the Prison

Commissioners are addressing themselves to the work in a

scientific and progressive spirit.

Annotations." Ne quid nimis. ’

EASTBOURNE AND VACCINATION.

THE curious muddle into which the Eastbourne guardianshave got with regard to vaccination affords another illustra-tion of the need for immediate legislation on the subject.Some months ago a vaccination officer was advertised for andappointed. It seems that he had been told by the board thathe would be supported in doing his duty. Having prepareda list of defaulters he wrote to ask for instructions, and thecommittee before whom the request was laid resolved " thatfurther consideration of the letter be deferred for twomonths." A local newspaper reports that at the guardians’meeting the Rev. J. W. Parrington said the board had

repeatedly stultified itself by refraining from carrying out reso-lutions which it had arrived at to enforce the Vaccination Act,and he opposed any further stultification. At the same timethe vaccination officer was understood to be likely to take legalproceedings against the guardians if they failed to supporthim in carrying out the Act. On the other side it was urgedby Mr. Luck that although the vaccination officer" was

appointed to do the work the board had no right to

enforce the law; it was optional." He also made theremarkable assertion "that the Royal Commission unani-

mously decided that prosecutions should be discontinued,"and when a statement of this sort was called in question bythe clergyman who had previously spoken, Mr. Luck’s retortcourteous was that when Mr. Parrington understood what hewas talking about he would listen to him. Mr. Luck himself