OCT.

2 'I

1899.1

MEDICINE AND LIFE ASSURANCE.

TM Su2m
JOWMAZ
I VMTOAT,

III7

BRITISH MEDICAL ASSOCIATION.

SUBSCRIPTIONS FOR I899.
SUBSCRIPTIONS to the Association for I89g became due on
January ist, i899. Members of Branches arerequestedto
pay the same to their respective Secretaries. Members of
the Association not belonging to Branches are requested to
forward their remittances to the General Secretary, 429,
Strand, London. Post-office orders and Postal orders should
be made payable to the British Medical Association at the
General Post Office, London.

Oritis lUeb'toral
tl%Lo4k

ournal,

SATURDAY, OCTOBER 21 sr, i 899.

MEDICINE AND LIFE ASSURANCE.
WE live in an age of congresses, and the tendency to subdivide subjects and thus to multiply these assemblies is
to have full swing next year in Paris, where a perfect
deluge of talk is to be let loose. Even this year has
seen an addition to the already long list of these
international gatherings, but the result of the Congress of Medical Officers of Life Assurance Companies
recently held at Brussels will confirm the opinion
which has already found expression that it is possible
to specialise a congress too much. In this country
at all events the medical officers to life assurance
companies regard life assurance as part, and probably only
a small part, of their daily work. There are no specialists
in this subject. It was for this reason perhaps that so few
of these British and American practitioners who take a
special interest in questions connected with life assurance
felt impelled to put in an appearance at Brussels. As it
is, a congress of life assurance medical officers at which no
English-speaking delegate spoke was too much like the
play of Hamlet with the Prince of Denmark omitted. It
may safely be affirmed that everything that relates to the
science and practice of life assurance has been more
thoroughly considered among the English-speaking peoples
than among the rest of the world, and consequently the
proceedings of the Section of Medicine in Relation to Life
Assurance at the annual meeting of the British Medical
Association last year were of great interest and practical
value. But the Committee of the Brussels Congress
appears to have acted on the assumption that very little
if anything of value had been done up to the present time
as to vital statistics and medical science in connection
with life assurance. Most of the papers w3re absolutely
lacking in the practical character which might have been
expected from the medical officers of companies.
In no respect was the absence of British delegates more
felt than in drawing up the suggestion for a universal
proposal form. Those who have much practical acquaintance with the working of life assurance know that if the
proposal form be too long and contain too many questions,
its object will be defeated. There is already a tendency to
err in this direction on the other side of the Atlantic; and
if the forms to be laid before the next meeting of the
Congress include all the questions looked upon as esseii-

tial by some of the speakers at the Brussels Congress, they

will greatly exceed the American standard. The proposal
form issued by the Life Assurance Medical Officers'
Association of London is probably as full as is desirable,
and it is to be hoped that the Committee appointed to
draw up a model form of report for presentation to the
Congress which is to be held in I9OI will take an opportunity of studying this form.
The discussion on professional secrecy 'brought out the
difference between ,the [view commonly held on the Continent and that usually received in this country. Here it
is considered that the applicant for assurance, in supplying
to the company the name of his medical adviser, tacitly
authorises that person to give any information which the
company may require. We would lay some stress on this
point, as we are frequently consulted as to the position to
be taken up by the family doctor under these conditions.
In France, on the other hand, as will be seen from our report of the meeting,' the most extreme views as to the nature
of professional secrecy are defended, and it is difficult to see
how life assurance can reach its full development in that
country until a more rational opinion is entertained. All
thinking persons must agree that life assurance is one of
the most beneficial results of modern civilisation, and anything which tends to prevent its fullest extension is contrary to the public weal. This being the case, any individual drawback must give place to the general good.
In the opinion of the majority at the Congress, the sole
duty of the medical examiner was to distinguish between
good and bad lives, and it was held that he was not called
upon to assist the companies in appraising the value of any
individual life; in other words, it seemed to be assumed
that "loading" did not come within his purview.. In recent years the acceptance of impaired lives has eonstituted
an important part of life assurance work in this country,
and it seems to us that one of the most useiul things which
a congress could do would be to discuss the factors which
require to be considered in "loading" a life. The mere
acceptance or rejection of a life is comparatively easy, but
the estimation of how far an applicant for assurance departs from the normal, either on account of personal or
family history or defective health, will exercise the utmost
skill of the examiner, and on this very important question
the Congress has practically given us no assistance.
Dr. Rend Verhoogen's paper on the early diagnosis of
general paralysis was important in view of the increasing
frequency of general paralysis among the assured, for the
condition is one which is very apt to be overlooked in its
early stages. Neurasthenia is another subject which has
not received much attention from the assurance world,
hence Dr. Mahillon's paper will be read with interest. One
of the most complete papers was that by Dr. Bayet on
syphilis and life assurance, and the conclusions he arrived
at are practically those which are adopted in this country.
On the whole, however, we cannot say that the Congress
has added much to the knowledge which may be gained by
reading one of the manuals on life assurance published in
this country or America. Still, if it furthers the spread of
assurance, and leads to more reasonable views on the relation existing between the family medical attendant and
the company, definite good will have been achieved.
1 BRITISH MEDICAL JOURNAL, October

7th, x899, p. 952.

xix8
i8

TRz BRrffw

MEDICAL JOURNAIJ

MDCLORA]OT

THE WAR.

[OCT.

21,

2,

1899.

--"

89

A RECENT PRONOUNCEMENT ON ETHER.

THE narrative of the introduction, declination, and revival
in the use of ether as an anaesthetic in England is one of
the most curious in the history of medical thought in the
nineteenth century. Mr. Pridgin Teale's article on Ether
in the recently-issued Encyclopaedia Medica presents us
with his view of the subject as an operating surgeon. In
the opening pages of this article Mr. Teale traces the story
of the revival of ether, attributing it to the well-known
paper of Joy Jeffries, Ether in Ophthalmic Practice, the
stimulus which set the pendulum of English surgical
opinion in motion, and caused it to swing back from the
almost universal advocacy of chloroform to the adoption of
the older but then obsolescent anaesthetic. At first ether
had been vaunted, and, as the pages of contemporary journals show, used by all sorts and conditions of men with
small regard to its peculiar properties, and scanty knowledge of its possibilities and limitations. It was the first
'volatile anaesthetic appealing for surgical suffrage, and was
handled with a diffidence almost amounting to fear by
those who gave it, and looked upon somewhat askance by
the operator unaccustomed to deal with humanity in a
condition of semi-anse4thesia or profound narcosis. In the
one case the delirious shouts and struggles were discomposing, and in the other the death-like calm gave rise to
misgivings. The various kinds of apparatus invented durof ether-giving were appalling in
ing the first year or
their complication and bulk, and in most instances were
extremely ill-adapted for the purpose for which they were
-designed. Then came stories of difficulties and failures.
'The pundits of surgery declared'ether was unreliable, and
probably unsafe.
At the critical moment when the more thoughtful minds
were studying-and attempting to improve the means of
administering this recalcitrant vapour, came Simpson with
a pocket handkerchief and a vial of the new anaesthetic
,ehloroform. All dangers and difficulties were to be removed, and the operating theatre, passing through what
Simpson himself called the " shambles " stage and the beargarden experiences of imperfectly-given ether, became
,calm. The surgeon could do his work without let or
hindrance, and with a free mind. The unhappy death,
however, which occurred ander the new anaesthetic within
three months of its introduction put an end to the sense
of security which at first reigned supreme. Then, as now,
imany persons contended that the anaesthetic was less to
blame than the method employed in giving it, but the increasing mortality under its use gave rise to an increasing
anxiety, and prepared the way for a revival of the popularity of ether. The Committee of the Royal Medical
and Chirurgical Society was appointed to reinvestigate the
case of chloroform v. ether, and, although admitting the
perils of the former, the Committee declared the slow
action and imperfect methods of using ether an insuperable difficulty.
This is, of course, ancient history, and Mr. Teale's work
lies not in traversing such a judgment. Clover's apparatus
and the teaching of the modern ansesthetists have done
that already and have shown that ether can be given more
rapidly than chloroform and without any of the drawbacks
of former days The whole question has at present

new phase. Given the best methods

I assumed an entirely
chloroform and of ether the conflict is still

of administering
waged between the rival camps as to which is the best allround anaesthetic. Mr. Teale after twenty years' experience
of chloroform adopted ether, and now after two more
decades in which he has used that anaesthetic affirms unhesitatingly that ether is safer, and if properly given, quite
as serviceable as chloroform.
The object of his paper is to teach how this proper
method can be acquired, but as his directions are practically those found in the special manuals on ansesthetics
we need not pause to consider them in detail. It is
interesting in view of recent discussions before the Society
of Ansesthetists to learn from Mr. Teale that he, as
a surgeon, has found ether wholly satisfactory in abdominal surgery, in throat work, and for young children
and aged persons. Those who heard the eloquent advocacy
by Mr. Warrington Haward of the use of ether for all sorts
and conditions of men, women, and children in one of
those discussions will find in Mr. Teale's pages a wholehearted agreement upon this subject.
The two stock objections urged by those who use chloroform in preference to ether has recently been its afterperils, that is, bronchitis, pneumonia, etc., and the less
profound narcosis which causes rigidity, hurried breathing,
and so on. These, Mr. Teale's experience goes to show,
are more theoretical than real. He has never seen ether
bronchitis, and agrees with those anaesthetists who regard
it as being most rare, and, when present, commonly due to
exposure of the patient to cold before, during, or after the
operation.
That surgeons like a patient to be profoundly ansesthetised is natural, but whether the condition, always one of
extreme risk, is often desirable from the patient's point of
view seems fair matter for argument. We trust Mr. Teale's
useful directions will obtain a wide hearing, as they focus
iD a small space his great experience. It is, perhaps, a pity
that Mr. Teale's space did not allow him to emphasise the
keen sense of responsibility which should exist in those
who undertake to give anaesthetics. It is a matter of
regret that this frame of mind is not always met with in
the occasional ancesthetist, and its absence is a risk both
to the surgeon and to the patient.

so

THE WAR.
WE published last week an official list of the officers of
the Royal Army Medical Corps detailed for duty in South
Africa, together with a list of the field hospitals and the
hospitals on the lines of command. It will have been
noticed that there will be twelve field hospitals, four stationary hospitals, and four general hospitals, each with
its complete staff, so that there will shortly be in South
Africa an adequate establishment for dealing with a large
number of sick and wounded. The distribution of
these hospitals will be determined by the officers
commanding in South Africa, and must depend upon
the manner in which the military operations develop.
Attention has been drawn bya contemporary to the fact that
no sanitary officer has been appointed to the Army Corps.
We presume that the Principal Medical Officer will make
sanitary arrangements on the spot when the plan of campaign is developed. Should the advance be made, as seems
probable, in more than one column, it may be thought
desirable to appoint a separate sanitary officer for each

OC'T. 21, i 899.]

PLAGUE ON AN INDIAN LINER.

------ ----

column. Particulars with regard to the dates of despatch

of the hospital staffs from this country, so far as at present
available, and some further details as to the medical and
ambulance arrangements, will be found at page I 4I.
PLAGUE ON AN INDIAN LINER.
THE P. and 0. Company's steamship Penrinsular arrived at
Plymouth on October '4th flying the yellow flag, owing to
the fact that a coal trimmer had developed plague five

The vessel was immediately visited by

Port Medical Officer of Health at
Plymouth, to whom we are indebted for the following
notes of the case: On October gth, at 1o A.M., Pharos

days previously.

Dr. F. M.

Williams,

Hassam, coal trimmer, reported himself to the ship's

surgeon suffering from great pain in the left inguinal
region, which he stated had come on suddenly. The surgeon observed that his eyes were bloodshot and the pupils
The tongue was tremulous and furred in the
but clean at the margins. There was difficulty in
articulation at times, with involuntary contraction of the
facial muscles. In the left groin there was a glandular
swelling, tender to the touch, and of the size of a walnut.
The pulse was weak and rapid; the temperature was 1020.
On the following day the patient's condition was much
worse; the temperature was IO30, the pulse feeble and
dilated.

centre,

rapid, twitchings

of the facial muscles were very

marked,

there was increased difficulty of speech, and he was very

drowsy. The swelling in the groin was extending into the
femoral region and towards the abdomen.
On October
i ith his condition was about the same.
On October i2th
he was not so drowsy, but his general condition was about
the same.
On October I3th marked improvement was
noticed; he was brighter, and the glandular swelling had
not increased. The condition of the patient when I exhim on October 14th was as follows: The
amined
pulse was feeble and intermittent. The temperature
was 99.50, there was
general prostration, and the
patient, who was drowsy and somewhat stupid, did not
answer questions readily. The conjunctivae were injected,
the pupils dilated, the tongue much furred, the skin dry,
and the urine was scanty and high-coloured.
There was
no diarrhcea.
The femoral glands on the left side were
enlarged and hard, with considerable infiltration of sur-

rounding

tissue.

I had him and his native attendant

removed to the Pique hospital ship, where his condition

has improved.
Every preoaution had been taken by the
surgeon, the patient being isolated in a deck cabin. This
was disinfected under my supervision immediately the
patient was removed, and instructions were given that
after a lapse of twelve hours the cabin was to be
opened and scrubbed with carbolic solution. The ship's
surgeon, who is familiar with plague, had the assistance
of Dr. L. W. Richards, who has been on plague duty
in Bombay and Poona for the past two years, and
who was a passenger by the vessel.
He also saw
the patient with
me, his diagnosis being that it
was an undoubted case of plague of a mild type.

explanation
may
abnormally prolonged.

given
period

No satisfactory
could be
of the
the infection, it
have been that the
of
tion was
The crew were all
in Bombay and
examined before
The Peninsular left there on

origin of
incuba-

shipped
medically
embarking.
September 23rd, calling at
Aden, Suez, and Port Said, arriving at Marseilles on
October gth, a period of sixteen days. There is a possibility that the patient did not report himself at the commencement of bis illness, nor was his condition discovered
at the daily medical inspection of the crew. He may have
been infected after leaving Bombay by inoculation from
the dejecta
of infected rats on board the vessel,
although there is no direct evidence of this. Search has
made, but no dead rats have been found about the
vessel. The patient is at present convalescent, the glandubeen

lar

swelling in

the left

groin

hI

inclined to

suppurate,

and

II
T[
BMD
mJOURAL
LU1IA
[MEDICAL
IZ

at night there is a rise of temperature of IO. At my visit

on October 17th the temperature was normal, the condition
of pulse had improved, and the patient was taking his
nourishment well. The urine was normal in quantity, but
contained a slight trace of albumen. Theltreatment followed was the administration of brandy (5ij) in milk
every two hours, milk, beef-tea, fish, and custard pudding.
A mixture containing strychnine and carbonate of ammoni&
was given every four hours, and boric acid fomentations
were applied to the glandular enlargement. Free ventilation is maintained, and the body is sponged twice daily
with carbolic solution. All dejecta are treated with disinfectants.
HOUSING OF THE WORKING CLASSES;
AT the meeting of the London County Council this week
a very important series of recommendations were submitted by the Housing of the Working Classes Committee
dealing with schemes for clearances of notoriously insanitary areas in St. Luke's at a cost of 175,750, i n Holborn at
a cost of 220,500, and in Southwark at a cOst of 187,950.
These, together with a smaller scheme in Poplar, involving
a cost of i6,soo, will be dealt with by the Council at its
next meeting. At the same meeting, the Council approved
certain applications recommended by the Highway Committee, under the Light Railways Act, I896, for the extensions of the tramway system to the boundaries of the
county. The advantage of facilitating locomotion for the
industrial population and its bearing on the housing
problem was emphasised in the course of the debate.
THE INEBRIATES ACT, 1898.
AT the weekly meeting of the London County Council on
Tuesday the Special Committee on the Inebriates Acts, of
which Dr. Collins is chairman, presented a further report,
which was adopted unanimously by the Council. It
will be remembered that the Committee as a temporary
measure made arrangements with the Duxhurst House.
Reformatory at Reigate, and the St. John's Reformatory
for Roman Catholic Women at Ashford, to receivewomen, under which immediate accommodation was.
secured for i6 Protestant and 56 Roman Catholic
women. The Committee, however, was unable to make
arrangements for the reception of male inebriates,.
and have now recommended the Council to establish a
reformatory of its own, as they believe that such a course.
is justified both by the requirements of London and the
probable benefits of such an institute to inebriates. They
recommend that an institution for 40 patients should be,
forthwith provided, and that an estate of 374 acres
at Charlwood near Horley should be acquired. The
Government inspector has already visited the premisee,.
and has reported that in his opinion they are suitable for
the purposes proposed, and can without difficulty be,
adapted to comply with the requirements of the Home
Office. The estimate of the cost of the site, of making the
necessary structural alterations and additions to the
premises, and of furnishing them, will not exceed 14,250.
The annual cost in respect to up-keep and interest, if the
payment is spread over sixty years, would be about 50o
The average weekly cost of maintenance was
a year.
estimated by the Departmental Committee at i5s. gd.;
the Committee of the London County Council state that in
praetical working it appears, judging by the terms of
contribution towards maintenance they have received, that
the actual cost would work out at 148. a week, which, as
the Government contributes ios. 6d. a week, would leave
the actual cost to the Council at 35. 6d. a week. There is,
however, they add, a possibility of some recoupment of
maintenance charges from the property of inmates, since
the Act gives a power of recovery where there is more than
sufficient to maintain the family of an inmate, and of still
greater recoupment from the labour of inmates. Looking

Tni BiLmm 1
Kjm,cAL
jouRNAL,
TNBITNIT

[OCT. 21, I1899.

THE VACCINATION OFFICER
AND HIS DUTIES.
OFCRADHSDTEto the fact that the majori ty of the patients will have some with that of registration, could be provided:for in another
have to be taken to keep
knowledge of a trade or profession, that they will in most way, but care would, of course,
instances be, to a large extent, physically rehabilitated the sanitary authority in touch with the registration
within a comparatively short time of their admission, and machinery, so that that body and its officers would
that their conditions of labour will be made as encouraging be promptly informed of all that they need to know
as possible, and afford them the opportunity of earning for for the protection of the public health, in the same
themselves as well as the institution, the Committee be- way as is now done in the case of general morlieve that the recoupment from labour is likely to be not tality and infectious sickness. The suggestion is that
matters
inconsiderable, and that the charge for maintenance may prosecutions should be left to the police, as in the
not in the end greatly exceed that in the prisons or asy- of dog licensing and muzzling, and that they should be
lums. In the prisons the average rate per head, after de- placed under the general supervision of the Registrar of
ductions for labour, etc., is 98. id. per week, and the charge Births and Deaths. This official is generally a
for maintenance in the London asylums is 9S. i id. per lawyer, and holds a very independent position.
As he is in touch with the local subregistrar
week.
of births, in whose hands it will probably be found
convenient to leave the work of vaccination registration,
THE VACCINATION OFFICER AND HIS DUTIES.
this arrangement might probably work satisfactorily. If
A CORRESPONDENT of the Times, who signs himself " M.D.," this course were adopted, it is difficult to see who could
has called attention to the pressing importance of this object to it. Indeed, from a reply from a "Poor-law
question,
which, as will be seen from the article in the Guardian," who is, he says, a member of the AntivaccinaBRITISH MEDICAL JOURNAL of September 30th, is rapidly tion League, it appears, rather strangely, that even this
a burning one in some localities. The leading body would not oppose the change. There is every reason
becoming
case of Leicester is prominently before the public, and the to believe that most Boards of Guardians would be very
Government will shortly have to consider the legislation glad to be relieved of what is now a constant bone of conwhich interferes greatly with their proper work.
they will introduce next session. The Act of I898 was tention,
under conditions which, as we have more than There is, however, one consideration which should be
passed
once indicated, bind the Government to complement kept in mind bythosewho aredisposed to urgethisview. Itis
that admittedly imperfect measure by further legislation this. The Government has made a promise regarding reIt [has made no promise regarding the
on the subject of revaccination. But the writer of the vaccination.
letter referred to urges that, however great may be the other matters, and it is a question whether if 'it were
need for legislation in furtherance of the revaccination of asked to go beyond the subject of its-:promise it might
children about the time they leave school, the reconstruc- not use the request as a reason for delaying all further
tion of the machinery for the local administration of the legislation until the end of the five years to which the
vaccination law is even more important. We cannot go so recent Act is limited. In its own interest it should
far as this with him, but we heartily agree that both ques- proceed in the next session of Parliament to deal both with
tions are ripe for legislation. It is useless to make laws, revaccination and with the arrangements for prosecutions,
or even to ordain facilities for the promotion of vaccination, but in the public interest it would certainly be better that
if the machinery provided for the purpose will not work. it should take up the former question at once rather
The investment of Boards of Guardians with the duties of than leave both to the end of the quinquennium.
vaccination authorities may have been unavoidable and
1120

112

EV

CIAIN

*even unobjectionable in I840, when the first Vaccination

Act was passed; their maintenance in that position at the
time is an anachronism, and "M.D." argues that
present
,even if the constitution of Boards of Guardians were such
as to qualify the class of persons who are generally elected
to them for undertaking important sanitary work, such as
-the local administration of vaccination is, it is essentially
absurd that that this branch of sanitary organisation
should be divorced from all other local sanitary work, and
be retained in the hands of bodies who have no sanitary
duties or interests whatever, and who were only intended
*to deal with the relief of destitution. It is unnecessary
-to labour this side of the question, for no one disputes the
anomaly. There is some reason for thinking that the indisposition the Government has shown hitherto to deal
with this subject is due to the objection which has been
from some influential quarters that if the local
pressed
administration were transferred from Boards of Guardians
to District Councils, who are the most approbodies to carry it on, little would be gained
priate
in the way of defeating the organised agitation now carried
on against vaccination, which has lately sought to find a
new vantage ground for itself by embroiling Boards of
Guardians with their vaccination officers. District Councils,
it is said, are elected by the same constituencies as elect
Boards of Guardians, and in rural districts, at any rate,
these bodies are composed of practically the same persons.
M.D.," however, suggests that it is neither necessary nor
to transfer the whole local vaccination machinery
expedient
en bloc to District Councils.
The legal element of the
he thinks, should be separated from the
machinery,
medical, and the latter alone transferred to the local sanitary authorities. The legal work of vaccination, together

OT

FOOD POISONING.
A SERIES of cases of " food poisoning " is reported to have
occurred at Sheffield on October i ith. No fewer than 23
individuals were affected and the ages ranged from 2 to 89
years. With the exception of one who went under the care of
her own medical man all the cases were treated at the Royal
Infirmary by Dr. Barker, house-surgeon, and as far as can
be ascertained they all had partaken at their midday meal
of corned beef purchased at the same shop. The tin from
which the meat was taken had been opened by the shopkeeper that morning. He states that he did not detect
any smell, neither did the appearance lead him to suppose
that it was unfit for food. In all the patients sickness and
purging were the initial symptoms, followed by giddiness
and prostration. At the infirmary the patients were
promptly 'treated by the stomach pump add emetics. Nine
were enabled to return to their homes, but 14 were
detained. With one exception, a child of 3, the cases have
recovered. The child died the next day, and the coroner
has adjourned the inquest, which he opened on October
13th, until a bacteriological report which is being prepared by Dr. Robertson, Medical Officer of Health, is
ready.
THE INFLUENCE OF ZADIG ON THE PROGRESS
OF MEDICINE.
SuciI was the title of the address delivered by Dr. G. W.
Balfour at the inaugural meeting of the York Medical
Society for the present session. He characterised Zadig's
philosophy, which was also that ,of Sherlock Holmes, as
the application of common sense to matters of everyday

I 899.]
OCT. 21,I8qq.1
OcT.

21

CAMBRIDGE.
MEDICINE AND SCIENCE AT CMRDE.I1
MEIIE

CENEA

observation; and described the great change that had

occurred in the practice of medicine within the last fifty
years. At the middle of the century bloodletting was the
chief remedy for diseases, especially those of an inflammatory character; on the other hand it had lately fallen into
such disuse that few doctors now living had seen this
method of treatment practised. For a time, however, the
overturning of the old beliefs was followed by a period of
comparative chaos, and this again by the promulgation of
an entirely new system of pathology and of perfectly novel
methods of treatment, which promised to have unheard-of
influence on the life-history of mankind, not only as regarded the cure of disease, but still more as regarded its
prevention. The method of Zadig had played no unimportant part in the discoveries of Pasteur, who became
convinced that behind the phenomenon of fermentation
there lay some great general law. His conclusions were
legitimate deductions from observations made by himself,
and every step was proved by careful experiment before it
was accepted as truth. Pasteur's ideas had been paraphrased in these words:
All chaniges, nauglht is lost: the forms are changed,
And that which lhas been is niot wlhat it was,
Yet that which has been is.

Dr. Balfour described the experiments and reasoning by

which Pasteur laid the foundation of the germ theory of
disease, of curative antitoxins, and immunising vaccines,
and discussed Lord Lister's application of the theory to
surgery and medicine, and the enormous benefit thereby
accruing to mankind. Thus, in spite of much oppositioD,
advance had been made, under the influence of Zadig
and the guidance of Pasteur, within the limits of one
generation from a stage in which knowledge was dark and
chaotic into one whei e light and order prevailed. Many
diseases, the scourges of the last generation, such as
septicaemia and pyiemia, had been all but banished from
surgery. By appropriate vaccines protection could now be
attained against plague, typhoid fever, and other fatal disorders, and the mortality from diphtheria had been
enormously reduced. Thus, by a strict following of
Zadig's method, medicine had attained its present development, whilst a vista of possibilities undreamt of fifty years
ago was opened up. What had been achieved was a mere
beginning, and, as Pasteur had said, "You will see how it
will all grow by-and-by. Would that my time were longer."
A vote of thanks to Dr. Balfour, proposed by Dr. Ramsay,
and seconded by Mr. E. T. Wilkinson, was carried by
acclamation and duly acknowledged. In the evening the
members of the Society and their guests dined together at
the Station Hotel, York, under the presidency of Mr.
Henry Foster, the President.

[KXWMAZ!=U

1121

eldest daughter Susannah. Mrs. Hall was then a widow,

and there seems to have been a little difficulty in the
transaction, which is recorded by Cooke as follows:
" Being in my art an attendant to parts of some regiments
to keep the pass at the bridge of Stratford-on-Avon, there
being then with me a mate allyed to the gentleman that
writ the following observations in Latin, he invited me to
the house of Mrs. Hall, wife to the deceased, to see the
books left by Mr. Hall. After the view of them she told
me she had some books left, by one that professed physick,
with her husband for some money. I told her, if I liked
them, I would give her the money again. She brought
them forth, among which was this [to wit, Select Observations, to be more particularly referred to presently], with
another of the author's, both intended for the presse. I
being acquainted with Mr. Hall's hand, told her that one
or two of them were her husband's, and showed them to
her. She denyd; I affirmed, till I perceived she began to
be offended. At last I returned her the money." Professor
Clark shows that Mr. Sidney Lee has fallen into error in
assuming that the negotiation did not end in a " deal." An
English translation of one of the manuscripts bought by
Cooke was published by him in 1657, under the title of Select
Observation of English Bodies; or Cures both Empiricall
and Historicall performed upon very Eminent Persons in
Desperate Diseases. The work is described on the title-page
as "First written in Latin by Mr. John Hall, physician,
living at Stratford-on-Avon in Warwickshire, where he was
very famous, as also in the countries adjacent, as appears
by these Observations drawn out of several hundreds of his
choicest." It has been coDjectured that among the papers
sold to Cook by Mrs. Hall there may have been some unpublished writings of Shakespeare. Professor Clark, however, thinks this very improbable, on the ground that
Cooke, though a Puritan, was too good a man of business
to destroy what Mr. Wemmick would have called " portable
property " which even at that time must have had a
considerable money value. In the Supplementum Chirurgiw
he treats of fevers, small-pox, measles, etc. The book contains one of the earliest descriptions of rickets in the
English language. " This disease," he says, "' is as new; so,
as peculiar to children, it hath received several names, as
Ptedesplanch nosteocaces; this I saw in print, in a Thesis
long before the Doctor's [Glisson] Tract on the subject [published in 1650]; others Cachexia Scorbutica, and Doctor's
the Rachitis, nearly bordering on the vulgar name Rickets,
and signifying the spinal disease, the spine being the first
and principal, amongst the parts affected in this evil."
One may venture to express thankfulness that among the
numerous burdens and grievances under which the medical profession groans to-day, it has been mercifully
delivered from the affliction of such a term of art as

"Paedesplanch nosteocaces."
A RARE MEDICAL BOOK
Glasgow Medical Journal for October, Professor
MEDICINE AND SCIENCE AT CAMBRIDGE.
Henry E. Clark gives an account of an old work, the
Supplementum Chiruzrgix, or the Supplement to the Marrow DR. ALEX HILL, Master of Downing College, in his
of Chyrurgerie, by James Cooke, "practitioner in Physick speech to Congregation on resigning the office of Viceand Chirurgery," London, i655. The book is extremely Chancellor of the University of Cambridge, stated that
IN the

rare, and Professor Clark has found it mentioned only in

the catalogue of the British Museum, which possesses two
copies. James Cooke, of Warwick, was a well-known
surgeon in the seventeenth century. His Mellificium
Chirurgix, or Marrow of Surgery, passed through many
editions, and in England appears to have taken the place
of Maister Peter Lowe's Discourse of the Whole Art of
ehirurgerie. Cooke was born in I614, and died in i688,
thus living through one of the most critical periods of our
rough island story. He had a very large practice, chiefly
among the nobility and gentry in the Midlands. He had
a powerful patron in Lord Brooke. and was probably
.himself a Roundhead. While at Stratford-on-Avon in
I642 he bought some manuscripts and books that had
Jbelonged to Dr. John Hall, who married Shakespeare's

the amount already received towards the Benefaction

Fund instituted at the meeting over which the Duke
of Devonshire presided at Devonshire House amounted
at the end of the financial year to 5o,ooo. It had
thus been made possible to consider the erection of
new buildings for law, medicine, botany, and archaeology.
The response, however, had not been sufficient to warrant
any of the new developments of University work which
many friends of the University desired. In the interests
of national progress, Dr. Hill said, it was greatly to be
desired that laboratories of applied science should not be
isolated, but should be established in connection with
schools which were already strong in pure science.
Technical training in any limited sense of the expression was impossible. In every subject of practical

TM
I11112
2 T2
UDCAL-aR
JOURJCALJI

DAN GERS OF THE GASOLIER.

application-whether it were to a learned profession

or an industrial art-success depended upon breadth
of knowledge of the sciences upon which the profession or art was based. Advances in technology
were almost invariably due to the application by
practical men of principles discovered by those who
carried out investigations in pure science. Conversely the
strength and vitality of a school of pure science was
largely increased when opportunities were afforded to students of passing on to its applications. The remarkable
progress of natural science in Cambridge was closely associated with the growth of the medical school. During the
past twelve years a larger number of students had entered
for the Natural Science Tripos than for any other examination for honours, notwithstanding the fact that but few
students were in a position to allow their prospects in life
to depend upon the discovery in themselves of a special
aptitude for pure science. Almost all those who had since
distinguished themselves in various branches of science
had commenced their career by preparing to qualify for a
profession. The majority of the graduates, for example,
who were at present prosecuting researches in the physical,
chemical, botanical, zoological, physiological, anatomical,
and pathological laboratories, making, to the great credit
of the University, additions to knowledge which were not
exceeded, if they are equalled in amount, by any other
university in the world, entered as medical students.
DANGERS

OF

THE

GASOLIER.

THE fatality which occurred recently in Norwich once

more draws attention to a household danger of which
everyone knows, but which not
practically
existence are too careless to prevent.

few who admit

A young lady,
iLts
before retiring to bed, went into the library to obtain a
book, and drew down the sliding gasolier in order to light
the gas. She turned out the gas, but omitted to push the
gasolier up again before going to her bedroom, which was
situated immediately above the library. As a result, the
escaping gas accumulated below the library ceiling, and
found its way in large volume into the bedroom above.
The next morning the lady was found unconscious, and
continued so until her death on the afternoon of the succeeding day. Such accidents emphasise the importance of
seeing that the space between the two tubes of every sliding
gasolier is converted into a shifting"gas-tight"1 joint by
keeping it filled with liquid. Water is commonly used
for the purpose, but is open to the objection that it is liable
to evaporation-rapid in the high temperature attained in
the upper part of a gas-lighted and ill-ventilated apartment-while the gas can itself pass through it more slowly
by continuous solution. The difficulty can be met fairly
well by covering the surface of the waterseal by an inch or
so of oil; or by using some hygroscopic liquid, such as
glycerine, in the place of water. It is important to see
that the glycerine is not acid in reaction; and a good class
of "heavy'" paraffin oil-such as that used for high-class
machinery- should be used rather than ordinary oils,
which are prone to damage the metal work or
to become "gummy
by oxidation in course of
time. There is, however, another point which is
far from being generally understood. The ordinary
plaster ceiling is, after all, only a porous diaphragm, permeable by gases with considerable freedom. The air of a
gas-lighted sitting-room, occupied for five or six hours in
the evening, becomes, especially in its upper strata, highly
charged with the effete products of human respiration and
of combustion. Not a little of this passes through the
ordinary ceiling into the room above; and if this latter be
a bedroom the result is not to the advantage of its occu"

LOCT.

21, 1899.

stitution of incandescent electric lamps for gas or oil would.

avoid a part of the mischief, and it is not impossible to,
make ceilings and floors practically impermeable to gases.
But this is very seldom accomplished in practice. Since
economy forbids our houses being built of one storey only,
the sanitary alternative would consist in sleeping on the

ground floor, and living, working, and cooking in rooms on

the upper floors, where the light and air so needed during
working hours are much more easily obtainable. Such a
revolution in our acquired habits may seem difficult, but,
there is not a little to commend it. Amongst other con-2
siderations we might suggest that the burglar would be less
attracted to a house whose inhabitants would be so much
more easily aroused by an attempt at illegitimate entrance.
PAINLESS EXECUTION.
OUR American cousins" are-in spite of an occasional " deviain the direction of lynching-a
tion from humanity
tender-hearted people. For a long time they dropped the
tear of sensibility over murderers who were subjected to.
the barbarous procedure of being "worked off," to use,
the classic phrase of a great artist in that line. In
deference to this delicate sentiment hanging was some
years ago abolished in New York State, and victims of
the law were helped to shuffle off their mortal coil with
ease and despatch by electrocution. But still the Transatlantic philanthropist is not happy. Electrocution is
said to be uncertain in its action; and, indeed, it has even
been suggested that the post-mortem examination which is
made immediately after the sentence of the law has been
carried out, is intended to be the coup de grdce, or at any
rate to "mak' sikkar." Moreover, it is believed that in
some cases at least electrocution causes pain. With the
view of making execution painless, therefore, it was
recently suggested in a paper read before the American
Association for the Advancement of Science to inflicts
the last penalty of the law by the administration of hydrocyanic acid under conditions that will ensure death being
painless. For this purpose the criminal is to be taken to a
"death chamber," which is to be connected by pipes with
retorts generating the poisonous vapour, and some time
when the patientis asleep the letbal gas is to be turned on,
and he will quietly be absorbed into the infinite. The,
plan only requires the addition of a little slow music to
make it realise the aspiration of the poet who prayed that
he might drift through sweet sounds to a dream, and
through a dream to death. To prevent any needless harrowing of the criminal's feelings by the contemplation of
a steadily approaching end, the date of execution is not to
be fixed, but is to be left to the discretion of the authorities within certain limits, extending over a period of several
months. The idea does the greatest credit to thehumanitarian sentiment to which it owes its conception. The plan
appears to us, however, to have one trifling drawback: the
prospect of soluxurious an exit from the stage of this, dull
world is likely to lead to a large increase of capital offences.
Who, indeed, some may be disposed to exclaim, would
fardels bear to grunt and sweat under a heavy, life when
he might
find such a quietus by the easy and pleasant.
method
of sticking a bare bodkin into some one whom he
?
disliked

SANATORIA FOR CONSUMPTIVES.

"
TIIE erection of sanatoria in Germany for the "1open-air
treatment of phthisis proceeds apace.One of the latest to
be opened is the Edmundsthal at Geesthacht, near Hamburg. Situated in a little pine wood, some go feet above
the Elbe, the sanatorium is sheltered on three sides by hill
pants, Let any sceptic compare his bodily and mental and wood, while to the south it facesa-little valley. It is
sensations after sleeping in such a room and in one an H-shaped edifice, consisting of a basement and two.
situated over a similar room well ventilated and not occu- storeys, and provides accommodation for ioo male patients.
pied or illuminated by gas during the evening. The sub- The more southerly of the two long buildings is given up

OCT. 21, 1899.]

MARK TWAIN ON CHRISTIAN SCIENCF.

Tzu Bai
I.4EDICAL JOURICAt

1123

entirely to patients. In the basement are baths, lavatories' " Soul is God, unchangeable and eternal; and Man coexists
etc., at its extremities are wards, while the spacious cor- with and reflects Soul, for the All-in-all is the Altogether,
ridors adjoining them form day rooms. Outside each and the Altogether embraces the All-one, Soul-Mind, Mindcorridor is a verandah. In the basement of the short con- Soul, Love, Spirit, Bones, Liver, one of a series, alone and
necting limb of the H are kitchen and offices, above them a without an equal." Here Mark Twain was moved to reflect
-dining hall. The ends of the other long limb of the H also on the effect which Christian Science has upon the verbal
form wards. The latter are of three sizes. Three small bowels; it made him think of a dictionary with the
wards have a single bed apiece, the next holds four, and the cholera.
The lady went on to inform him that
largest twenty beds respectively. The large wards are divided Mrs. Eddy, the "revered and sacred Founder" of
into sections by T-shaped wooden partitions, 5 feet 6 inches Christian Science is distinctly referred to and her
high, covered with linoleum. A" comfortable corner" is coming prophesied in the twelfth chapter of the
thus provided for each bed, and a certain amount of Book of Revelations where it is said that "there appeared
privacy ensured. It is said that the partitions are not high a great wonder in heaven-a woman clothed with the sun
,enough to interfere appreciably with the ventilation. The and the moon under her feet, and upon her head a crown
total cost of building, laying out grounds, etc., amounted to of twelve stars." Further on it is stated that " the woman
nearly 17,3oo, no less than I2,5co, of which was given fled into the wilderness, where she had a place prepared of
by Herr Siemers, of Hamburg. The Hamburg authorities God," the said place being considerately explained by this
presented the site, and are to contribute 3,000 a year for newest biblical commentator to be Boston. When the infive years towards the expenses. The sanatorium has spired writer goes on to say, "And I saw another mighty
already made a good start, and will, we hope, soon be able angel come down from heaven clothed with a cloud, and a
to do without this contribution. This happy combination rainbow was upon his head, and his face was as it were
.of private generosity and public support is worthy of the the sun, and his feet as pillows of fire; and he had in his
consideration of our countrymen. The foundation stone hand a little book," is it not plain that he referred to Mrs.
of the German Sanatorium at Davos will be laid on October Eddy's latterday bible, Science and Health? Mark Twain
22nd. The estimated cost is i86,ooo marks, and the funds read this work, and the effect of it upon his mind may be
already in hand for the maintenance of free beds amount gathered from his statement that " of all the strange and
to 96,200 marks.
frantic and incomprehensible and uninterpretable books
which the imagination of man has created, surely this one
MARK TWAIN ON CHRISTIAN SCIENCE.
is the prize sample." Our readers have already had an
MARK TWAIN has fallen among the Christian Scientists, opportunity of forming a judgment on this extraordinary
and relates his experiences in the October number of The production, and nothing more need be said of it here.
,Co8mopolitan. Last summer, on his way back to Vienna Mark Twain believes that the book was written by somefrom the Appetite Cure in the mountains, he fell over a one for Mrs. Eddy, as that otherwise gifted lady cannot
cliff and " broke some arms and legs and one thing or write English; but that is a small matter, for if it be true,
another." He was taken to a neighbouring village, where the revered and sacred Founder of Christian Science is by
there was no surgeon. There happened, however, to be no means alone among prophets of healing in needing the
lady from Boston, who was a Christian Science doctor, help of mortals with a tincture of grammar to translate
and could cure anything. So she was sent for. But the their inspired revelations into human speech. Mark Twain
shades of night were falling, and she could not con- admits, as everyone who knows the healing power of faith
that cures are wrought in certain cases by
veniently come; she sent word, however, that it did not in must admit,
the least matter, as she would applv " absent treatment " Christian Science as well as by the Mind Cure, the Faith
and call in the morning. In the meantime the sufferer Cure, the Prayer Cure, and the Mental Science Cure; but he
was bidden to make himself tranquil and comfortable, and believes that it might be shown that all the "mind" sects,
remember there was nothing the matter with him. The except Christian Science, have " lucid intervals-intervals
patient was in some doubt whether the diagnosis had been in which they betray some diffidence, and in effect confess
made with sufficient care, but he tried to make himself that they are not the equals of the Deity; but if the
believe that his pain was a delusion. Morning brought Christian Scientist even stops with being merely the equal
the Christian Scientist, who declined even to listen to of the Deity, it is not clearly provable by his Christian
the recital of his symptoms, assuring him that there is Science Amended Bible. In the usual Bible the Deity
no such thing as feeling, and that nothing exists but mind, recognises pain, disease, and death as facts, but the
which cannot feel pain. "You should never," said she, Christian Scientist knows better. Knows better and is not
4' allow yourself to speak of how you feel, nor permit diffident about saying so.
others to ask you how you are feeling; you should never
concede that you are ill; nor permit others to talk about
IMPORTANCE OF' TEACHING DOMESTIC SCIENCE.
-disease, or pain, or death,.or similar non-existences in your AT the recent Congress of the Institute of Public Health,
presence. Such talk only encourages the mind to continue Dr. Rogers McNeill, County Medical Officer, Argyllshire,
its empty imaginings."
On the unfortunate sufferer contributed a paper in which he contended that " domestic
pleading that he was full of imaginary tortures, which science " should be taught as an aid towards the improve-could not make him more uncomfortable if they were ment of public health. Under the head of "domestic
real, and asking what he could do to get rid of them, he science " he included the elements of hygiene and physiwas told that there was no occasion to get rid of them ology, the theory and practice of cooking, laundry work,
since they did not exist, but were mere illusions propa- dressmaking, and housewifery or general household
gated by matter which itself had no existence. Mark Twain management; in fact, " all the duties of a woman in charge
attempted to argue this point, since, as he put it, if there is of a house and family," " so as to keep herself and all the
aio such thing as matter, how can matter propagate things? other occupants, from the youngest to the oldest in a
In pity for his dulness of perception the Christian Science healthy state of body and mind "; and this, too, " at the
priestess condescended to inform him that it was quite lowest possible cost or least possible waste." The difficulty
simple: " The fundamental principles of Christian Science at present is apparently to find capable teachers of
explain it, and they are summarised in the four following domestic science; there are a few in towns, but in
self-evident propositions: (i) God is All in all. (2) God is rural districts thev are very scarce.
Very few
good. Good is Mind. (3) God, Spirit, being all, Nothing is mothers can teach their daughters, themselves not
Matter. (4) Life, God, omnipotent Good deny death, evil, having sufficient knowledge or capacity, time or inclinasin, disease." By way of further elucidation she added: tion for the purpose. But, wherever it is taught, domestic
a

THE PATHOLOGICAL SOCIETY OF LONDON.

Ii~
~~~~~~H

1124

science is said to stimulate the intelligence of the pupils

and to make school life brighter and more pleasant. It is
a subject of primary education in Germany, especially in
Baden, where the present system dates from I891; in
Switzerland and Belgium also great attention is given to the
subject. In London some progress has been made, but at
The course covered three stages in
seven centres only.
three years, commencing in Standard V, and taking
Standards VI and VII in the second and third years.
The lessons, which are both theoretical and practical,
comprise in the first year elementary food and cookery,
clothing, and laundry work; in the second year they
include food and cookery again and elementary housewifery; and during the third year housewifery and home
nursing. Outside London very few School Boards have as
yet taken up the subjects in this systematic manner. In
fact, housewifery has only been recently recognised as a
grant-earning subject. In some counties schools of
domestic economy have been founded, which are assisted
by grants from county technical education funds; also
in London and elsewhere pontinuation schools teach
domestic science. But all school authorities should
strive to obtain instruction for those under their charge
in this most important subject. When this comes to pass,
we may expect that, as Dr. McNeill observes, "in the
aggregate the nation will be enormously strengthened to
work out its destiny in the ages to come.'
DIPHTHERIA BACILLI IN HEALTHY PEOPLE.

Among the knotty problems which have yet to be solved by

bacteriology two of great importance are those of the identification of the Klebs-Loeffler bacillus and of the significance of its occurrence in healthy persons. While Kober's
work' does not solve these problems it throws valuable
light on some points in connection with them. In the
matter of distinguishing the Klebs-Loeffler from the pseudobacilli Kober relies on four tests: (i) Microscopic examination of the serum culture six hours after it is made. Stress
is laid on the importance of this early examination. At
this time the development of the Klebs-Loeffler bacillus is
at its height and the majority of the bacilli are of the
shape described by Loeffler as typical; later on they
assume a variety oF forms, spindle, pear, dumbbell, lancet,
and half-moon-shaped. At this early period the pseudobacilli are relatively undeveloped and therefore not
likely to be mistaken for the Klebs-Loeffler. Of the xerosis
group, for instance, only an occasional bacillus is "plump,"
the majority are thin and easily distinguished from the
true diphtheria bacillus. While Kurth and others found
that occasionally pseudo-bacilli were encountered which
took up (2) Neisser's double stain, Kober asserts that this
does not take place with young bacilli (that is, from a culture six hours old). (3) The pseudo-bacilli either produce
no acid or much less than is formed by the Klebs-Loeffler.
(4) The effect on animals is not a trustworthy test where
negative, as numerous instances have been known of true
Klebs-Loeffier bacilli proving non-virulent in animals.
Kolbe examined the throats of 6oo healthy school children,
and found diphtheria bacilli in i5;
of these 15 had been
in contact, more or less remotely, with diphtheria patients,
for example, by playing in the same playground, etc. Injected in guinea-pigs the bacilli from 5 of these proved to
be virulent, were harmless. Of I28 persons brought into
closer connection with patients, the diphtheria bacilli were
found in i5, and in every case the guinea-pigs inoculatedl
died. Little is known about these variations in virulence.
At the Breslau Laboratory for the Investigation of Diphtheria, of 139 persons who were in attendance on diphtheria patients, and whose throats were not quite healthy,
the Klebs-Loeffier bacilli were found in 69.7 per cent.
According to the literature on the subject, says Kober, the
so

io

io

Max

Kober, Zeit?cA. f. Hyg. und Infect., July 31st, 1899.

[O,cT. 219

1899.

percentage in people with healthy throats in similar positions is i8.8, but according to his own researches it is only
8.i per cent. The length of time the bacilli are found in
the throat varies apparently with their virulence. In the
I5 (out of 6oo) children, the average for the virulent was
IO.2 days, for the non-virulent 6.3 days. In the case of the
other I5 persons the average was i6.8 days (it ranged from
I I to 28 days).
While the bacilli may cling for a long time
to articles used by the patient, Kober agrees with Reger in
thinking that inanimate objects play only a secondary part
in the spread of the infection.
THE MEDICAL PROFESSION IN HUNGARY.
A CONGRESS of Hungarian medical practitioners was held
last month at Grosswardein, for the consideration of questions affecting the interests of the profession. Some 350
practitioners attended. The Congress, which was presided
over by Professer K6tli, was formally received by Cardina)
Schlauch, the Burgomaster, and other officials and representatives of the local Medical Committee. Resolutions
were passed asking that the Pablic-health law should be
modified so as to safeguard the moral and material interests
of the profession; that quackery should be suppressed;
and that the conditions of hospital assistance should be
reformed.

THE PATHOLOGICAL SOCIETY OF LONDON.

DURING its coming session an important new departure
will be made in regard to the meetings of this Society.
Four of the fifteen meetings which have hitherto been held
at the rooms of the Royal Medical and Chirurgical Society
are to be held at different London laboratories, in connection or not, with medical schools, the object being that
demonstrations may be given which it would be extremely
difficult or impossible to carry out elsewhere. This is the
realisation of a proposal made some years ago by the late
Professor Roy. The advantages likely to accrue from such
laboratory meetings are obvious, for it is a matter of great
moment that the resources of scientific education should
be within the reach of all members of the profession who
may care to avail themselves of such. It is only in this
way that the scientific advance of medicine and surgery
can be ensured. It has, moreover, been determined that
the report of an author's communication or demonstration
given at anv of the four laboratory meetings shall be
made public only if the author himself so wish. The
chief reason for this regulation is that the work being
carried out at laboratories may be at such a stage of progress when brought forward that its publication would be
premature and injudicious. The next meeting of the
Society will be held at the Jenner Institute of Preventive
Medicine on November 7th, and subsequent laboratory
meetings will be held at University College, London (February 6th), at the Laboratories of the Royal Colleges of
Physicians and Surgeons (March6th), and at King's College
(May Ist).

PROFESSOR CLIFFORD ALLBUTT will give an address

Local and Constitutional Disease at a meeting of the
Medical Society of University College, London,
Wednesday, November Ist, at 8 P.M.

on

on

THE muzzling order has been revoked in the' West Riding

of Yorkshire, and in Worcestershire, Warwickshire, and Staffordshire by order dated October x6th.
CARE OF INSANE IN WORKHOuSES.-At the recent meeting
of the Northern and Midland Division of the MedicoPsychologial Association at the West Riding Asylum,
Menston, Leeds, the question of the care of the insane in
workhouses was discussed, and it was unanimously agreed b'
the members present that in union workhouses in which
insane persons are detained nurses properly qualified and
trained in mental nursing should be employed.