254

neat of higher powers. Page 33: When he found surfacesof hemispheres diseased there was derangement of mind.during life.Now it is quite clear that Bell recognised the motor

’character of the portio dura of the seventh nerve in opposi-tion to the statements of Dr. Waller. Dr. Waller writes :

’’Any information concerning’ the distinction between thesensory and motor portions of the fifth nerve, or any clear<lehnition of the motor character of the portio dura of theseventh nerve, would justify us in reckoning Bell as havingparticipated with Magendie in the discovery of the distinc-tion between motor and sensory nerves." It will be seenthat Bell was not certain which of the filaments conveyedsensation, but he definitely states which was motor. It is

easy to see how anyone on reading this account might beimpelled to make an improved’ experiment to decide the

point. Magemlie 3 himself writes of his further experi-ments: "Seulement ils semblent etablir que Ie sentimentn’est pas cxclusivement dans les racines posterieures, nonplus que Ie monvement dans les anterieures."

Dr. Waller makes a special point of the slight correctionsto which he has drawn attention. In my opinion, Bell

regarded these alterations as unimportant, especially in

light of the evidence I have given. He knew that anyonecould easily compare his work with the original in the

Philosophical Transactions which is in the possession of.every important scientific body. Bell made his claim imme-4iatel’v after the publication of Magendie’s work.

These emendations would show that Bell considered hehad been wrong in his opinion of the functions of some ofthe branches of the fifth nerve. Shaw (page 111) discussesthe relative actions depending on the fifth pair of nerveswhich were found perfect in facial paralysis. In this con-nexion in Gray’s Anatomy," 1880, it is stated in a foot-note : "It is doubtful whether the buccal branch conveysonly sensory power to the buccinator or motor influencelikewise." " It is very probable that Bell himself made the’discovery which led to these corrections ; no doubt some.anatomist could inform us on the point. They have, how-ever, nothing whatever to do with the point under considera-tion. Even as affecting Bell’s credit they may have beenmade by an assistant to whom Bell had delegated the task of- correcting the proofs and had passed unnoticed by Bellhimself.

Bell’s fundamental proposition was : No organ whichpossesses only one property or endowment has more thanone nerve, however exquisite the sense or action may be,but if two nerves coming from different sources are directedto one part, this is the sign of a double function performedby it. and if a part or organ have many distinct nerves, wemay be certain that instead of having a mere accumulationof nervous power, it possesses distinct powers or enters into’different combinations, in proportion to the number of itsnerves. "

The importance of these views and the experimentsraturally arising from them was thoroughly recognised inFrance at the time. In this connexion I will quote theconclusions of P. Flourens.4

On voit ce qu’ a fait M. Bell. 1. Il a eu, le premier l’idee que chaquemerf pouvait etre double, ou compose de deux. 2. Il a, le premier detous les physiologistes, porte l’exp&eacute;rience sur les 1’acines des nerfs. 3.Enfin, de son experience, quoique incomplete, il a conclu la fonctiondistincte de chaque racine. Tout cela a ete fait par M. Bell dix ansavant M..Magendie.

No one is less inclined than myself to depreciate a singlescientific fact, but men of all ages have recognised that thosewho devise new systems or propound new principles whichenable men to discover large numbers of new facts are

entitled to more credit than those who discover a singleisolated fact, no matter how important. We must notconfuse one of the supporting beams for the whole house oreven the plan which enables other houses to be built. * Inconsequence of the discussion which has ensued too much

importance has been attached to the correct deductionsmade from an isolated experiment. Who shall say whetherthis experiment as an experiment ranks higher than otherexperiments on the nervous system which are made at the

‘

present day and which are equally confirmative of Bell’s 1

3 Journal de Physiol. Exp&eacute;r., October, 1822. 4 &Eacute;loge Historique de Fran&ccedil;ois Magendie suivi d’un discussion

respectifs de MM. Bell et Magendie &agrave; la d&eacute;couverte des fonctionsdistinctes des racines des nerfs, 1858.

views ‘ Bell enunciated a certain .system and proceeded totest it in every way. He then pnblished a number of paperswhich showed the truth of his views and which made sub-

sequent discoveries an absolute certainty.I regret to see that Dr. Waller has not writteri one word of

praise of one of our greatest men, but has represented himin a most unfavourable light, and in my opinion quiteunjustifiably. Those who were living at the time and whoexamined Hell’s claim were much hetter able to judge of itstruth than the present generation from only one or twodocuments. They had evidence, as, for instance, that ofindividuals, which we do not possess, and a man would not belikely to lay claim to a cliscovery and that lie had taughtcertain things when all his pupils knew that lie had taughtthe opposite. Further information may perhaps be gainedby following the line of investigation 1 have suggested andexamining contemporary literature bearing on the subject.

In conclusion, I submit that Dr. Waller has not made outhis case against Bell in which he seeks to (leprive Bell of allcredit in the discovery of motor and sensory nerve channels.

THE LONDON. COUNTY COUNCIL ANDMEDICAL AFFAIRS.

Jt/’c 7’7’MnM’M of 5okool Children.

A REPOR’I’ was presented by the Children’s Care Com-mittee to the Education Committee of the London CountyCouncil on July 17th with reference to the recent conferencebetween representatives of the Board of Education and theCouncil as to arrangements for medical treatment inLondon. 1

The Care Committee stated that the Board contemplatedthat the Council’s scheme would continue composite in

character, and might properly continue to include :-1. Hospitals with which the Council would have agreements on the

basis of that now in operation at the London Hospital, where thespecial arrangements practically constituted, a children’s treatmentcentre within the hospital. 2. Voluntary institutions of various kinds,ther than hospitals, with which the Council would have agreements.3. Medical treatment centres conducted on the lines of those now

opened at Norwood and Wandsworth, but with certain modifications.

It was understood that the grounds upon which the Boardconsidered such modifications necessary were :-

(a) That the centres as at present constituted were not sufficiently in:ouch with the Council’s system of medical inspection; (b) that the’entres were not sufficiently under the direct supervision of theCouncil; (c) that they were not available for the further examination)f school children referred by the inspecting medical officer, or for the’xamination of special cases referred by the school nurse, schoolLttendance officer, head teacher, or care committee; (d) that they werelot available for the treatment of minor ailments.

The modifications suggested by the Board for the Council’sconsideration were :&mdash;

1. The medical staff should be nominated by the committee of localuedical practitioners, but appointed by the Council, or at all eventselected by them for appointment. 2. Whether a centre was or wastot owned or rented by a committee of local medical practitioners, the,dministrative control and supervision of the work in the centre shouldbe vested in the Council. 3. The centres should be available for usen connexion with the Council’s system of medical inspection of schoolhildren, for the further examination of children, and should provideor the treatment of minor ailments. It was in the Board’s view essentialhat provision should be made at the treatment centres for the treatmentf minor ailments. The Board recognised that there would be particularreatment centres at which, owing to the exceptional circumstances,uch provision would not be required, but it considered that thexclusion of such provision should be the normal arrangement.

The Children’s Care Committee stated that, generally, itcquiesced in these views.In connexion with any arrangements that might be made

Tith hospitals, the Board stated that it was prepared tosgard as satisfactory arrangements such as were in opera-Lon at the London Hospital ; the arrangements in force atertain other hospitals, which differed not only in degree,apt in kind, could not be regarded as satisfactory. If theseould be modified so as to bring them into line with therrangements at the London Hospital the Board would berepared to regard them as a satisfactory part of the Council’s;heme of treatment, but failing this it looked forward to aradual transfer of the work done at these hospitals to otherhospitals where the arrangements were of the London

1 See THE LANCET, May 25th, p. 1428.

255

Hospital type, or to medical treatment centres or to school -1clinics of various types. 1The Board reminded the Council that the problem of the (

medical treatment of school children could not yet be said to ihave reached a final solution ; that the methods of suchtreatment were undergoing at the present time somewhat rapid evolution ; and that it should, therefore, be clearly understood that the views set out above could only representwhat the Board regarded as a reasonably satisfactory way of idealing with the needs of the area at the present time and in the near future. ,

Proposals by the Committee.In dealing with the questions raised by the Board the

Children’s Care Committee stated that it would shortly haveunder consideration the question of the possibility (1) of

establishing, in connexion with hospitals with which theCouncil had agreements, a system which would produce thesame results as were obtained at the London Hospital ; and(2) of making arrangements for re-inspection and re-

examination of children and the treatment of minor ailmentsin connexion with certain hospitals with which the Councilat present had no agreement.As regards the medical treatment centres it would be

noticed that the three important respects in which provisionwas to be made were (1) treatment for affections of the

eye and ear, nose, and throat involving operations, and

ringworm cases ; (2) the re-inspection and re-examination ofchildren ; and (3) treatment for minor ailments. Withreference to (1), the Council had already determined themain terms and conditions under which such treatmentshould be given ; but the committee made further proposalswhich it thought would meet the additional requirements ofthe Board. With regard to (2), it would be possible to

arrange with the committees of local practitioners for thecentres to be available for use by the Council in connexionwith the medical inspection of school children, and for there-examination of children. The committee suggested thatminor ailments should include discharging ears, external eyediseases-e. g., blepharitis and conjunctivitis, skin diseases,such as impetigo and sores, and such other conditions as re-quired the daily services of a nurse. It was considered thatone nurse working full-time could deal with 1100 cases a

year, and that for this number the services of a doctor workingon one half-day a week, at a cost of &pound;50 a year, would be re-quired. A sum of .6100 should be paid for nursing treatmentin connexion with each centre. This would cover the servicesof a nurse at the centre, and also nursing treatment(including dressings, lotions, &c.) to be given in the homesof the children, and all necessary equipment and travellingexpenses for the nurses. For these cases, also, some

allowance should be made having regard to the additionalcleaning and wear and tear involved in a more extensive useof the premises provided by the local practitioners and to thesupply by them of dressings, lotions, &c., for treatment atthe centre. Moreover, the premises would be used for thepurpose of re-inspection and re-examination. This wouldinvolve their use on Saturday mornings for which no

provision had been made, and the committee therefore

suggested that a capitation payment of 4d. for minor ail-ments would be an equitable arrangement in respect of theseextra services.The committee gave detailed particulars of the number of

cases to be dealt with at -the centres controlled by medicalpractitioners at Fulham, Hackney, Islington, Peckham, andSt. Pancras, and at the Poplar school treatment centre forear, nose and throat affections, ringworm, and minorailments. The estimated cost of the centres variedfrom R420 to .E.950 per annum. It was necessary thatsome provision should be made in the Lewisham district.It was not possible to arrange for a committee of localmedical practitioners to provide a centre in Lewisham,unless a minimum of 1760 cases was guaranteed, and as

the committee was not satisfied that it was possible to

supply this number it proposed, for the present, to acceptan offer which had been made by the Home and Infirmaryfor Sick Children to provide treatment for 250 children ayear suffering from ear, nose, and throat defects. The totalannual cost would be &pound;80. It was also proposed to acceptan offer by the St. George’s Dispensary, Blackfriars, to treat440 ’ear, nose, and throat cases. The committee also sub-mitted proposals for the treatment of eye cases at the

.ilha.m, Hackney, Islington, Peckham, Poplar, and St.uieras centres, and at the Home and Infirmary for Sicknildren, Lewisham. The cost of these proposals variedom S55 to &pound;300.The annual cost of all the schemes described in the reportould be R4672 or &pound;5527 if the maximum number of casesas treated. The annual cost of the treatment of minorIments at each centre would be E168 6s. 8d., made up as)llows : nurse and equipment, R100 ; medical man, &pound;50 ;ipitation payment (1100 cases a year at 4d. each),18 6s. 8d. The total cost at the eight centres would be1346.The Education Committee approved these proposals andecided to recommend them to the Council.

MEDICINE AND THE LAW.

Rain as an Adulterator.

AT the Mansfield police-court recently a solicitor raised1 behalf of his client, a farmer charged with milk adultera-on, a singular defence. The statement that the adulterationan be due to rain has, we believe, been heard before in the ’ourts as an excuse for the presence of an undue amountf water or lack of a proper proportion of fat in milk,ut it has not always been considered credible. In theresent instance it was apparently accepted, for the summons’as dismissed. The solicitor is reported as having put thease thus : "The deficiency was due to the hand ofleaven in allowing the cows to feed on wet grass the nightefore and permitting the rain to fall heavily while theefendant was taking his churn with a leaky toplong country lanes." The defendant gave evidencehat rain was pouring into the churn when the inspectortopped him and demanded a sample. He added: "Noational person would come out with a waterproof andmbrella and select an archway for shelter in order to buynew milk." In comment, it may be observed, assuming therguments cited to have influenced the bench who heard thease, that the farmer and not the hand of Heaven usuallylecides the question where cows are to feed, and that it isor the former also to take precautions against foreignnatter, such as water, getting into his milk churns.

Apparently on the occasion referred to there was heavy rain,)ut this occurs frequently in thundery weather, and therevas also an archway in which to take shelter until it was)ver.

dental Treatment by an Unqualified Person.At the Clerkenwell police court recently William Hawkins,

senior, of Gray’s Inn-road, trading as the Williams Artificialreeth Institute, was summoned on the information ofF. Robertson, a teacher under the London County Council,the summons alleging the use of a title or descriptionimplying registration. The evidence showed that Robertsonwas treated by the defendant, but when the certificate

necessary for production to his employers was asked for itwas not forthcoming. He alleged that before treatment hewas told that a certificate could be given him, also that asubsequent letter asking whether he was being treated by aregistered dentist was not replied to, but that on his calling-and complaining the return of his money was offered. Mr.d’Eyncourt held that even if there had been a statement thata certificate could be given it did not constitute a use oftitles implying registration, and that the evidence did notshow that the offence alleged in the summons had beencommitted, and he accordingly dismissed it.

Action by Medical Man to Recover Fees.In the Clerkenwell county court recently an action was.

brought by a medical man to recover a sum of 17s. 6d. asfees due to him from the Duke of Argyll Juvenile ForestersFriendly Society. The defendants counter-claimed for17s. 6d. paid by them to another medical man ia respectof the same case. The plaintiff’s case was to theeffect that he was called upon to attend a case for the

Friendly Society, but found that another medical man hadalready seen the case and had administered treatment, sohe declined to do anything, being of the opinion that thiswas the proper course to adopt. The second medical manstated that having been called in, he found the patient, aboy, suffering great pain and in urgent need of treatment,