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MANCHESTER.(FROM OUR OWN CORRESPONDENT.)

Provision for Phthisis.A" DISCUSSION took place at the last meeting of the

Chorlton board of guardians with regard to the treatment ofthe phthisical patients chargeable to the Chorlton union.So; long ago as January, 1909, a resolution was passeddeciding that special accommodation for phthisical patientschargeable to the union be immediately provided." Im-

mediately, however, is an adverb of indeterminate elasticityas regards time, and so far nothing has been done to convertthe words of the resolution into deeds. Some progress, how-ever, was made at the last meeting, for it was proposed byone lady guardian, and seconded by another, to whom shouldbe given the honour they deserve, ’’ That steps be taken toprovide a sanatorium or special hospital for the treatment ofcases of consumption, the hospital to be chargeable to theChorlton union." She said that they had enough patients tofill a sanatorium of their own, and suggested the appointmentof a committee to carry out her proposal, ’’ which wasthe most economical way of dealing with the problem." After some discussion, and objection on the partof one member of the board to anything being doneuntil it was seen what would become of a proposalfor the consolidation of the Manchester unions, theresolution was adopted. Hitherto these cases have beensent elsewhere for treatment. The chairman remarked thatless than two years ago the board approached the corporationon this question, and the corporation promised "to takesteps to do something." So far, however, as the board knew,those steps were not taken yet, and the responsibility ofmaking some attempt to save the lives of these poor con-sumptives rested on the board. It is satisfactory to knowthat throughout the land determined and well-advised effortsare being made to combat the scourge of consumption. Apartfrom humane feelirg, it is said that one-seventh of thepauperism of the country is due to consumption, so that itimposes a costly burden. The magnitude of the questionbecomes more apparent if reference is made to Dr. JamesNiven’s special report on this question. He points outthat over 1000 deaths per year in Manchester are

attributed to phthisis, and assuming that the patientsare infective for three years, on an average, beforedeath, there are 3000 cases to be dealt with. Thenthere are a number of other infective cases with

open tuberculous disease, chiefly in children, numberingprobably another 1000. He shows that in 1909 thetotal loss in wages in 1041 cases was .&48.129, towhich must be added the loss by unnotified patientswho are not working, and by patients who were notified inprevious years and who are now out of work. It wouldtherefore be worth while to spend a large sum of money if agreat reduction could be made in this serious loss. InManchester there are now 585 beds available for consumptivecases. Dr. Niven suggests the somewhat revolutionaryscheme of amalgamation between the three unions ofManchester, Prestwich, and Chorlton, and that the Prestwichunion hospital at Booth Hall should be handed over to thecorporation to deal with phthisis. In favourable cases

under hospital treatment the disease may last many years,so that to deal effectually with the great array of poor con-sumptives in the more advanced stages "it would be

necessary to obtain powers of compulsory detention and tomake a provision greatly in excess of any now contemplated."The report suggests that a system of compulsory insurance,such as that adopted in Germany, would meet the require-ments of the case ; but until such a system is established itwould be necessary to provide a sum for the assistance ofhouseholds invaded by tuberculosis. Dr. Niven thinks that.f.5000 would go far to meet such a need. He estimates the totalcost per year, including hospital accommodation, public instruc-tion, &c., at .E.21,000. This scheme will take some little timebefore it is received very cordially by the general public, butif when thoroughly carried out it were to drive tuberculosisfrom our midst it would prove not only life-saving buteconomical. It is not everywhere, however, that by-lawsand regulations have advanced to present-day requirements.A few weeks ago, at a meeting of the Bolton council, Dr.J. H. Thompson said that as to dealing with consumption withthe building by-laws as they were the authorities were ashelpless as little children, and he spoke of them as a standing

disgrace. He said, what seems almost incredible, that "inhouses being built to-day the sleeping rooms were not aparticle better than the cellars of ancient times." He con-sidered it high time" to say that dwellings should not bebuilt to foster and generate disease." Building by-lawshave a good deal to answer for, not only in Bolton but inmany other places.

Fatal Operations.On Monday an inquest was held at Preston on a case where

the patient died three hours after an operation for intestinalobstruction. The senior house surgeon at Preston Infirmarysaid that if the operation had not been performed the mancould not have lived more than a few hours, an operationbeing his only chance of life. It seems that the case hadnot been reported to the coroner, but, having heard of it,he considered it his duty to hold an inquest. The house

surgeon, in answer to the coroner, said that during the threeyears he had been at the infirmary there had been about adozen such cases which had not been reported to the coroner,as he did not think that reporting them was a part of hisduty. He had known cases where surgeons, recognising thatoperations might end fatally, had decided to give patientstheir only chance of living by performing such operationswhich had repeatedly been successful in the saving of life.He was of opinion that if inquests were held in all suchcases in future medical men would not undertake theresponsibility of performing operations, and the odiumattached to them." He had heard medical men saythey would not operate in these desperate cases. "Theyhad to consider their own reputation." The coroner saidthat personally he failed to see why the operation should nothave taken place, "because there was a certain amount ofpublicity attached to it." If, therefore, it had of necessityto be performed in a poor house, in " a mean street," wouldthe absence of publicity be a bar to an operation ? Dr. F. W.Collinson, who was also called, said that in this desperatecase they might have found a condition which would haveled to the man being cured. He said he had operated onnine similar desperate cases in three years, and five patientswere living to-day. ’’ Whatever was said outside, doctors must,of course, do their best." The verdict was that the man had" died about three hours after a professional operation hadbeen performed for obstruction of the bowels, and that suchdeath was accelerated by the operation." One juryman heldout against the latter portion of the verdict, believing it mightfrighten the public into not allowing their relatives to undergooperations, but, not converting the others to his opinion, hegave way to theirs. It is not clear that there was anyevidence to show that the poor fellow’s life was shortened,and the latter part of the verdict was speculative and doesnot seem to be justified. Be this as it may, such cases are

very anxious ones. Where possible, of course, the consentof the patient or his nearest relations would be obtained;but if this cannot be done then the surgeon will use his own

judgment, and act according to it, without regard to whatthe consequences to himself may turn out to be.

Sept. 27th. __________________

SCOTLAND.(FROM OUR OWN CORRESPONDENTS.)

Clo.,?ing of the Corporation Milk Depot, Glasgow.THE end of an interesting experiment has been seen in

Glasgow by the determination of the corporation to closethe milk depot established by it some years ago to supplythe infants of the poorer districts of the city with milkspecially prepared and suitably diluted according to the ageof each child. At the time the depot was instituted therewas difficulty in getting into touch with the mothers ofnewly-born infants, but since the Notification of BirthsAct and the establishment of consultations for infants,together with the appointment of a nurse and theaid which the Infant Health Visitors’ Association renders,a more satisfactory means than the milk dep6t of dealing withinfant mortality has been provided. During the early daysof the depot, when the milk was issued without restrictions,the daily sales reached an average of 700. When approvalof the family medical attendant or of the medical officer wasintroduced a shrinkage took place until the establishment ofthe Lord Provost’s fund for the relief of distress, when thedaily sales again reached between 600 and 700. But on the