761

with a form of application for membership to each policesurgeon whose name I have been able to find in theConstabulary Almanack. As, however, this does not contain acomplete list, and as I am anxious to secure the membershipof every police surgeon willing to join, I will send a copy to

any who will forward to me his name and address.I am, Sirs, yours faithfully,

FRED. W. LOWNDES, Honorary Secretary. 40, Knight-street, Liverpool, March 5th, 1903.

THE CULTIVATION OF ANAEROBICBACTERIA.

To the Editors of THE LANCET.

SIRS,-Will you permit me to thank Dr. Klein for drawingmy attention to his method of anaerobic plate culture as setforth in the medical officer’s report for 1897-98. I am quitefamiliar with this method, as also with those of Gabrit-schewsky, Botkin, Hammerl, and other investigators whohave worked at this subject. But in my hands these methodshave not given uniformly satisfactory results, as, for instance,in the plate culture of such a strictly anaerobic micro-

organism as bacillus tetani.Dr. Klein’s method and mine are the same in principle but

in apparatus they differ. I use a chamber having a verysmall air space provided with most efficient seal, whereby thevacuum created by the absorption of oxygen by the pyro-gallic solation is maintained. In apparatus of the bell-glasspattern having a large air space I have found that this is notalways the case.

I am, Sirs, yours faithfully,H. S. FREMLIN.

Government Lymph Laboratories, Chelsea Bridge, S.W.,March 9th, 1903.

A DISCLAIMER.To the Editors of THE LANCET.

SIRs,-The report of an interview which appeared in theDaily Telegraph of March 3rd was published entirely with-out my authority or knowledge. I was quite unaware thatthe gentleman who engaged me in casual conversation in theoffice of the secretary of the hospital was a reporter.

I am, Sirs, yours faithfully,Cavendish-square, W., March 9th, 1903. DUNDAS GRANT.

NOTES FROM INDIA.(FROM OUR SPECIAL CORRESPONDENT.)

The Indiscriminate Sale of Cocaine in India. -ParalyticAffeetions among Men and Cattle in the Central Provinees.-TAe Crematiort S’ociety of Bengal.-The Plague Epi-demie.-Beorganiscction of the Beccltlt Department in

IBombay.THE Bombay High Court in a test case instituted at the

instance of the Government of Bombay has held that cocaineis not an intoxicating drug within the meaning of the ExciseAct. The effect of this ruling will apparently be that nolicence such as has been insisted on by the Governments ofBengal and Bombay will be necessary for the sale of cocaineand that the law as it now stands is powerless to check thecocaine habit which, as I have previously reported, is

spreading rapidly in many parts of India.In consequence of the spread of a paralytic affection

attacking human beings as well as cattle in parts of theCentral Provinces an official inquiry is to be held. The com-

plaint is due. it is believed, to the eating of certain classesof dhal, more particularly that known as kasari dhal, or

latri. As the botanical name for this is lathyrus sativus thecomplaint will probably turn out to be a long-recognised one.The natives recognise its poisonous properties in both them-selves and their animals but partake of it on account of its

cheapness. Horses and bullocks lose control over the hindlimbs, becoming paralysed. This grain is also said to producedyspnoea and roaring in horses when put to work. Manyyears ago a widespread occurrence of paralysis in Sindh,after a season of extensive inundations in which kasari wasgrown on an exceptionally large scale, drew attention to it,and in the Azanzarh district, where paralysis is common,kasari forms an important article of diet.

I The Cremation Society of Bengal, which now numbersnearly 100 members, is being registered under the CompaniesAct and hopes to obtain the control and management of thecrematorium which the corporation proposes to erect.The plague mortality continues to increase. Last week

25,870 deaths were reported throughout India, against 24,500in the previous seven days and 15,165 in the correspondingweek of last year. The Bombay Presidency returns 11,922deaths, the Bengal Presidency 2817, and the Madras Presi-dency 592. Then we have the Punjab with 3735 deaths, theCentral Provinces 206. the United Provinces 2599, theMysore State 694, the Hyderabad State 932, and Berar 462.Bombay city reported 612 deaths from plague alone,Calcutta 142, Poona 849, and Karachi 33. When it is homein mind that Poona contains only a little over 100,000 in-habitants the frightful mortality going on there will be

recognised. Dr. Shave, one of the plague medical officersnow at Sholapur, has been selected for appointment to theIndian Medical Service.The health department of the Bombay municipality has

been rearranged. Bombay is now divided into threedivisions, each under the charge of a health officer. For

purposes of registration the city has been divided intoten registration districts, in each of which there is a

municipal dispensary. At each office there are a qualifiednative medical man and three hospital assistants who inquireinto the cause of every death, investigate cases of infectiousdisease, and take action for removal to hospital. They alsotreat cases of sickness at the homes of the people in poorand urgent cases. A nurse who is a qualified midwife isattached to each district. Dr. J. A. Turner is the executivehealth officer and Dr. C. H. Cayley, Mr. W. Venis, and Dr.Sorab C. Hormusji are the divisional health officers.Feb. l2th.

___________________

THE

ORGANISATION OF THE PROFESSION.(FROM OUR SPECIAL COMMISSIONER.)

The Situation at Cardiff.-The South Wales Colliery Suryeonsand the Poundage system; the Satisfactory Paamettsobtained. - The Question of Concentration or of sub-division in Medical Practice.

THOUGH, as recently described, a notable effort has beensuccessfully made to organise the profession at Swansea itmust be admitted that, taking South Wales as a whole, butlittle has been done. The only other organisation brought tomy notice was the East Glamorgan and MonmouthshireColliery Surgeons’ Medico-Ethical Society. At Cardiff, for in-stance, which is the most important town in South Wales,there is no medical union and this notwithstanding the pre-sence of Mr. T. Garrett Horder who has made praiseworthyefforts in regard to the question of hospital abuse. Neverthe-less, there seems to be a total absence of public spirit amongthe members ot the profession at Cardiff. Some of the prac-titioners appear to fear having to subscribe to yet anotherinstitution and they complain that there are already so manycalls made upon them. Nor is there any indication that

they have realised that under its new constitution the BritishMedical Association, which is to meet so near to them this

year, should be able to take economic questions in hand. Itis doubtful if anyone has prepared any sort of statementor proposal or has fully grasped the leading potentialitiesof the new conditions and methods of organisation. Onthe other hand, there is this excuse-namely, that therate of payment for contract work at Cardiff is higherthan it was at Swansea. The members of clubs for themost part pay ld. per week and these are not family clubs.It will be remembered that at Swansea the average pay was1 1/2d. per week, or 6s. 6d. per annum, for family clubs. Such

family clubs as exist at Cardiff pay, I am told, from 10s. to13s. per year per family. Nevertheless, the dockers’ medicalaid organisation only pays 8s. 8d. per family; however,this latter and smaller figure is not lower than the termsaccepted at Swansea. But, as one of the local practitionersexplained, it is not so much the amount the members pay asthe habits that prevail among them. In some societies orclubs the members may be impressed with the very justidea that as they pay so little they should only seek theadvice of their medical officer when there is really need of

762

such assistance. Others, on the contrary, fancy that theyhave a right to call on their medical officer for the mosttrivial ailment and are constantly coming for medicine whenthere is really nothing the matter with them. Such clubsdo not pay whatever the amount of their subscription.Some time ago an irsurance company attempted to estab-

lish itself.at Cardiff and it introduced a medical practitioner.This company employed a woman canvasser who went fromhouse to house extolling the advantages of insuring and thevirtues of the medical officer who was to attend all thosepersons who took out a policy. This woman canvassed thepatients of different practitioners. One well-establishedpractitioner told me that some of his patients asked himwhether he kept a club. The advantages of joining amedical aid association had, they said, been explained tothem by a lady who had called. They felt that, in justiceto themselves, they ought to join some such organisation,but rather than subscribe for the medical man whom the

lady canvasser had mentioned to them they would prefer tojoin a club with which my informant might be connected.In other words, they did not wish to change their medicaladviser, but they preferred paying ld. per week instead ofthe usual fees as private patients. As most of these peoplecan afford to pay the usual fees it will be seen what a

demoralising effect such canvassing must have upon thosewho are ever anxiously hunting in all directions for cheap-ness. They can pay for medical attendance, but they arenevertheless only in receipt of modest incomes and wouldnot at all object to reduce the cost of medical attendancejust as they would with equal eagerness gladly accept freeseats at the theatre. Of course, such persons are advised bytheir usual medical attendants not to join any club or medicalaid organisation, but such advice would have much moreforce if it could be shown that the medical practitioners ofthe town were organised against the encroachments of clubsor insurance companies and their lady canvassers. Fortu-

nately, however, for the practitioners of Cardiff the medicalofficer whom the insurance company had introduced intothe town sold his practice. It was bought by a medicalman who, to his credit be it said, disapproved of the wholesystem, so that the lady canvasser and the insurance

company disappeared from the field.From Cardiff I went to Aberdare where I found that

exceptionally favourable conditions prevailed. The pay-ment at the collieries in this valley and in the Rhondda

valley is based on what is denominated the "poundage" "

system. Instead of paying a fixed sum per week the

charge is, like the income-tax, so much in the pound.This is a very fair arrangement, because those who havelow wages pay little and those who have better wages paya proportionately larger sum. The only difficulty is to

agree as to what that proportion shall be. Fortunatelyfor the medical practitioners the miners have from thefirst shown no disposition to drive a hard bargain. I

appears that at Ynysybwl, Abercynon, Treharris, MerthyrVale, in Monmouthshire, and in the whole of the RhonddaValley, the miners pay 3d. in the pound for medical attend-ance. Nor is this a recent arrangement due to specialendeavours on the part of the medical profession, for thecustom has prevailed now for more than half a century. Allthat has been necessary of recent years has been to extendthis system to a wider area. Therefore meetings of local

, practitioners were held during 1899 at Aberdare and theAberdare Valley Colliery Surgeons Society was formed-as abranch of the Medico-Ethical Society mentioned above-withDr. E. J. Trevor Jones as the secretary. All the local practi-

I

tioners, with only two exceptions, joined. These two practi-tioners are not opposed to the movement but their practiceis of a different nature. They deal with the town ratherthan with the colliery population, but the clubs formedby artisans, shop assistants, small tradesmen, &c., were

affected by the example of the colliers, and instead of

paying from 8s 8d. to 138. per annum per family, as atCardiff and Swansea these clubs pay 1 1 ls. per annum andthis directly to their medical officer. Nevertheless, the generalfeeling among the majority of the medical practitionersis against clubs of any description. They argue in favourof poundage and no intermediaries. So much per poundshould be deducted from the wages paid by the employerand forwarded directly to the medical officer selected. Thereis no need of committees, clubs, or other organisations.

In the Aberdare district the amount thus paid was, how-ever, only 2d. in the pound. Consequently, the local prac-titioners, after meeting and agreeing together, gave notice

and even placarded the district stating that they would notattend the colliers and their families for less than 3d. in thepound of wages received. Apart from the usual argumentsin regard to the increase in the cost of medical education, ofqualified assistants, of drugs, instruments, &c., which applyto medical practice in all parts of the kingdom, there is thefact that with the poundage system work has sometimes tobe done for nothing and this for a considerable period oftime. Most of the colliery surgeons, for instance, expe-rienced very severe losses during the great strike of theSouth Wales miners. As the miners then received no

wages there was no payment for medical attendance,but the medical practitioners had to continue to pay fortheir drugs, for their medical assit-tants, and for theirusual domestic necessaries. It required some years of pros-perity to recoup this loss. Then the local practitioners domore under the poundage system than under the club system.For instance, they provide cod-liver oil, castor oil, andlinseed meal, and, what is more important, attend confine-ments without extra charge. The latter, it is pointed out, isa great benefit and the miner need not endanger the life ofhis wife during this critical period by the fear of having topay an extra fee. When the poundage was 2d. this did not.include midwifery cases, but the medical officers were reallycalled in for confinements and found it a matter of nimcultyto obtain extra fees for such attendance. It would, there-fore, they urged, be better for the miners as well as for th&medical practitioners if everything was included in the onepayment and so that this might be done they proposed thatthe payment should be raised from 2d. to 3d. in the pound.After some discussion this proposal was accepted by theminers, so that all parties are satisfied and there is no

grievance on that score. Whatever difference of opinionmay exist now relates rather to the distribution of themoney paid than to the amount that should be paid. Itmay be said that the miners, generally speaking, do notbegrudge the 3d. in the pound which they pay, and on theother hand, the medical practitioners recognise that inthe circumstances this is a sufficient payment. But someminers have remarked that they do not like the mannerin which newly qualified assistants are employed. Theycome down among the miners, the latter become acquaintedwith them and learn to like them, and then just as

they begin to appreciate each other the assistant dis-

appears and some other young gentleman comes to takehis place. The miners have wondered whether there mightnot be a little bit of sweating going on within the ranks ofthe medical profession itself, and whether in the employmentof qualified assistants there is not a tendency to get rid assoon as possible of the more able and popular of theseassistants for fear that they might settle down as inde-

pendent practitioners in the district. Ought we, said theminers, to pay our 3d. per week in such a manner as tocreate a monopoly of medical practice ?The other side of this question is ably represented by

Mr. Evan Jones and his son, Dr. E. J. Trevor Jones ofAberdare. Mr. Evan Jones from the first has laid down.that it is better to pay L1000 a year to one or twomedical practitioners of the very highest standing whowould employ qualified assistants than to pay 500 sepa-rately to eight practitioners. The eight practitioners at .S500’a year each cannot have all the instruments, operating-tables, and means of treatment that can be provided atone central and better equipped surgery. It must be re-

membered, also, that in this neighbourhood there is no

general hospital available, but only a small private cottagehospital supported mainly by the Marquis of Bute. Yetfearful accidents occasionally occur in the mines whichnecessitate the most difficult operations. Mr. Evan Jonesurges that considering the great responsibility this involvedthere should be one chief surgeon and no other. Theminers should be free to elect whom they pleased, but onceelected his authority should be undivided. If many medicalofficers are appointed they can have but small incomesand will be too poor to secure proper assistants and toundertake every sort of work. They must thereforesend the more serious cases to the hospitals and theseare too far away. Mr. Evan Jones and Dr. TrevorJones have between them some 10,000 miners on their listand they employ six qualified a,sbtants. Also they can fallback upon the cottage hospital established by the Marquis ofBute. This, then, is in itself a huge organisation and it ismaintained that this sort of collective medical combinationgives better results than the splitting up of the work into

763

individual practice. ’lhis opens out an interesting scientitic,practical, and economical problem. Is it better to have two

leading men employing on the wages system six assistantsand concentrating the responsibility and the work in theirown hands, or else to have eight independent practitioners,each with his own individual practice and his small incometo carry it out ? Thus among the colliers and in regard tothe methods obtaining for their treatment in sickness hasthe economic struggle between the rival principles ofcollectivism and individualism manifested itself. This isone of the several ways in which the economical evolutionaffects medical practice as it affects all the other economicconditions of modern civilisation.

MANCHESTER.

(FROM OUR OWN CORRESPONDENT.)

The Royal Infirmary.ALDERMAN SIR JAMES Hoy, the late Lord Mayor, has

prepared a report on the question of the Royal Infirmary{-ite and its proposed purchase by the Manchester CityCouncil. It has been approved by the subcommittee andwill be presented for approval to the special committeeappointed some time ago by the council to consider the

question. It may be remembered that the late infirmaryboard fixed the price at E400,000 and the present board isnot likely to accept less, for it considers that it is worth farmore than the 20 a yard at which it is offered. It couldnot, indeed, very well do so, as it is stated that it hashad a definite offer by a syndicate of E700,000, which putsthe lowering of the price below the .E400,000 out of the

question. This sum, indeed, is much less than what it wouldaccept from any purchaser but the city itself. If the citycouncil fails to secure this Piccadilly site, the finest in

Manchester, for a great civic purpose it will illustrateonce more the timidity and short-sightedness which lost itTrafford Park. That lesson, however, was a severe one whichit may be assumed is not yet quite forgotten. The reporthas not been made public but is said to contain suggestionsforming an admirable basis of agreement. It is desirablethat, while there is no ill-judged haste, there shall be nowaste of time, for the pressure on the infirmary is very great.Indeed, Mr. John Thomson, the chairman of the board, saidpublicly on March 5th that" he had only that day con-sulted with the doctors as to the practicability of erecting atemporary corrugated iron annexe." " He hoped that the

corporation would buy the site and so enable a large andbetter infirmary to be built elsewhere.

Manchester and Salford Sanitary Association.The annual meeting of the Manchester and Salford

Sanitary Association was held in the town-hall on Feb. 27th.After the adoption of the report, which gave an account ofthe previous year’s work, a motion was passed approvingof the efforts of the association to spread among the peoplea knowledge of the laws of health, to promote cleanliness,temperance, and thrift, to obtain a purer atmosphere, to

improve the dwellings of the poor, and to preserve the livesof their children," and declaring that these efforts " deserveda more adequate support from the general public." Major-General Sir F. Maurice addressed the meeting on the subjectof the national health.

The Salford School Board and the Physical Training ofChi ldre n.

The Salford School Board has for some time devotedmuch attention to the physical welfare and training of thechildren in its schools and more especially since the

appointment of a medical officer to the board in 1898.Careful inquiries are made as to the eyesight and hearing ofthe children and the medical officer makes a personalexamination of those below the normal standard. Whereglasses are advisable the parents are recommended to ceekmedical advice, and so also in many cases of defective hear-ing medical advice is suggested. The head teachers of theolder scholars have been directed to arrange for a course ofinstruction on the laws of health A syllabus of lessons hasbeen drawn up by the medical officer, including air-supply,water-supply, food, sunlight, cleanliness, clothing, exercise,rest, dwelling-house, and the avoidance of active causes ofdisease. The state of the young adults of the Manchesterpopulation, as shown by the rejection of 8000 out of 11,000 Iwould-be recruits, has been noted by the Salford School

Board and it seems to be making an earnest effort to dowhat it can to arrest the decadence that has alreadybecome so alarming. A record is being taken by a committeeof the board of the weight and measurement ot the childrenat different ages and of the committee of four three aremedical men. Three schools have been chosen for theinquiry, as they are typical of the different classesof children coming under their care. The records are

taken by the medical officer with the cooperationof the committee, but it is intended to have theteachers instructed so that they can carry out thework. The height, weight, chest measurement, and cir-cumference of the head are taken and inquiry is being madeas to there being any correlation between the physical con-dition of the children and their home circumstances. Allthis is preliminary to the further consideration as towhether anything can be done, in addition to what is nowdone, to improve their physical condition. At presentphysical training is given in all the board schools in accord-ance with the model scheme of the Board of Educationwhich the adult teachers have become competent by specialtraining to carry out. It is to be hoped that with the newEducation Act without neglecting the mind more attentionwill be given throughout the country to the bories of thechildren, for hitherto they have had less than they havedeserved.

-Food Inspection in Manchester.Although from the hygienic point of view the destruction

of unwholesome food is necessary, yet when the tendency torise in price that seems to prevail almost universally is con-sidered it is deplorable that there should be so much lossyear by year as is shown in the report of the market com-mittee of the city council. Last year 176,754 pounds ofmeat were condemned and destroyed in Manchester. Of thisenormous quantity there were 117.498 pounds of beef, 48,312pounds of fish, 31,195 pounds of shell-fish, 5901 rabbits,besides hundreds of hares, grouse, pheaants, quails, poultry,&c. With the exception of 913 pounds of meat, 1078 poundsof fish, and some tins of preserved food-stuffs which wereexposed for sale all was surrendered after being con-

demned by the inspectors. The meat and fish were dis-covered at the wholesale and retail markets, at railwaystations, shops, on hawkers’ carts, at farms, in the cold-airstores, and other places. The hawkers’ carts, however, werenot bad by comparison. The great bulk of the meat wascondemned at the abattoirs and markets. Of the rabbitsand game condemned at the Smithfield Market the formeiare the more numerous, as one would expect. Black currantsseem to bear transport and to keep worse than most otherfruits, nearly 1000 boxes having to be destroyed. It seemscurious that no mention is made of partridges, though quailsand ortolans (93), pigeons, turkeys, &c., come in for con-demnation. In addition to the inspection of the abattoirsand markets, 3916 visits were made to the private slaughter-houses, of which there are still a number in Manchester,14,059 carcasses were examined, and 5829 visits were

made to shops in the poorer districts of the city. This isa very brief and imperfect sketch of the work doneby the inspectors, but enough has been said to showthat supply and demand do not adjust themselvesautomatically and that food preservation and distributionstill leave room for improvement and better organisation.That it would be worth while to do what can be done tomend matters is evident from the fact that all this wastetakes place in one town, with a population of less than600,000 and that there is no reason to suppose that Man-chester differs from other parts of the country in beingcareless and improvident. The loss of food that mustbe going on in a population of about 41,000,000 is deservingof more attention than we often give to it, and perhapsnone the less so because it must be difficult to prevent.

Legacy to the Salford Hospital.The late Mr. William Hatton of Manchester has by his

will left a sum of .E6500 to the Salford Royal Infirmary.A Presentation Portrait.

A. number of friends have subscribed for a portrait of Mr.E. S. Heywood who was for many years the chairman ofbhe Royal Infirmary Board. It will be presented to the

infirmarv and hung in the board-room. It has been paintedby Mr. Ralph Peacock and is described " as a characteristicMid faithful likeness of the sitter and as a singularlyvigorous and attractive painting." Mr. Heywood, it maybe remembered, together with most other members of