Embed Size (px)
Citation preview
246 NEW INVENTIONS.
New Inventions.IMPROVED FORCEPS.
THE accompanying illustration shows a forceps made tomy design by Messrs. Allen and Hanburys, of 48, Wigmore-street, London, W., to facilitate the performance ofKocher’s invagination operation for the radical cure of
inguinal hernia. As will be noted, the shaft of theforceps has a gentle curve bringing the head to thelevel of the handles. Ttie head is bullet-shaped, i,bearing a slot on either side. The head of the forcepscarrying the invaginated sac protrudes the parietal
peritoneum into the opening made by separating the fibres ofthe internal oblique and transversalis muscles, and here it issecured. Through the button-hole now made in the
peritoneum the sac is very readily picked up by insertingthe teeth of a tenaculum forceps into the slots in the headof the hernia forceps. The forceps have proved very satis-factory and render the performance of this excellent opera-tion very simple, and if working single-handed or on a
muscular subject they are invaluable.HARRY CRiCHTON, M D., B.S. Durh.,
South Shields. Assistant Surgeon, South Shields Infirmary.HARRY CRICHTON, M D., B.S. Durh.,
Assistant Surgeon, South Shields Infirmary.
POOR-LAW MEDICAL OFFICERS’ ASSOCIA-TION OF ENGLAND AND WALES.
A COUNCIL meeting of this association was held at 34,the Copthall-avenue, London, E.C., on Jan. 20th, andchair was taken by Surgeon-General G. J. H. Evatt, C.B.,President of the association. The following matters, amongOthers, came before the council. The honorary secretarysubmitted a letter from a provincial member asking foradvice under the following circumstances. He had been
appointed medical officer to a certain district with a perma-nent tenure of office, but had inadvertently moved out of hisdistrict by a few hundred yards. He hoped that he wouldhave no difficulty in getting re-elected periodically when histerm of office periodically expired. In this, however, he wasdisappointed, for he had lately had notice that he would not Ibe re-elected at the expiry of his present term of office. Thecouncil were of opinion that it was very unwise to act in thismanner. By so doing this officer had placed himself entirelyin the hands of the guardians and must lose his office unlesshe could induce his guardians to re-elect him. It could notbe too strongly impressed on district medical officers that
they could only have security of tenure in their office
throughout the country generally so long as they resided intheir districts.A letter was read from another member complaining
that his guardians had objected to a surgery he had con-structed adjoining his house on the ground that it wasnot built of brick and roofed with slate, although theyhad permitted the use of similar surgeries by other medicalofficers in the union. The council considered that this wasa matter for the sanitary authority, and if the latter saw no
objection to the construction of the surgery the guardianshad no right to object.
Another letter was read from a country member, 65 yearsof age, who stated that he held a second Poor-law districtoutside his own union, and after holding it for 11 years hewas now called upon to resign it. Could he claim anypension on account of it without resigning his other Poor-lawappointments, as he had had deductions from his salary forthis appointment ? The Council considered that he should
resign all his appointments and take his pension on the
whole if he wished to insure himself against loss, as he wasnot entitled to any pension so long as he held any Poor-lawappointment.A letter was also read from another member dealing with
the same point, but in this case he had not reached the agefor retiring, and had held the outside appointment for13 years. In this case it appeared that the officer would bebound to forfeit all his deductions of salary under the
Superannuation Act unless he could retire within the nextfour years, as only the average salary during the last fiveyears could be estimated in fixing the pension. The Council
thought this very inequitable, and that such an appoint-ment ought always to be allowed for in reckoning theretiring pension, or that at least the officer should be entitledto claim a return of all deductions from the salary of thatappointment for superannuation purposes.
Another country member wrote that the guardians of hisunion had sent round a circular stating they had decided thatthe present salaries of the medical officers should be fixed asa " maximum " for their apoointment. Could the guardiansfix such a " maximum " ? He also asked if it were legal forthe district medical officers of a union to contract out of the
special fees for operations, &c., laid down by the generalorder of 1847. The council was of opinion that in neithercase would this be legal unless with the consent of theLocal Government Board.The honorary secretary reported that he ar.d the other
delegates of the association had been present at the firstmeeting of the Poor-law Conference held at Norfolk Houseon Dec. 9th last.
It had there been decided that each section of the Poor-law Service should formulate through its respective associa-tion what reforms it considered necessary for the bettermentof its particular service. He had forwarded to the con-ference all the resolutions that had been duly passed up tothe present, but he thought it desirable that the various
points of medical Poor-law reform should be put forward inmore detail, especially as a Departmental Committee hadbeen appointed by the Local Government Board to revise theGeneral Orders.
After a careful consideration the council decided thatthe following recommendations should be put forward onbehalf of the Poor-law medical officers of England andWales :-
1. That the provisions of the Metropolitan Dispensaries’ Order, as faras possible, should be made to apply to the country generally, and thatall appliances and drugs for the use of State patients shall in all casesbe provided at the expense of the State.
2. That there should be a revision of the scale of payments for opera-tions, and more facilities granted for obtaining assistance, and payingfor the same. This specially applied to the provision of an anæsthetist.The medical officer should not be at the mercy of the Poor-lawauthority with regard to this assistance : it should be left entirely inhis hands, with only some reasonable check to prevent abuse.
3. In all cases where called in to attend a confinement in his officialcapacity he should have an inalienable right to his fee. If the case bean improper one from a Poor-law point of view the authority shouldbe left to recover payment from the husband.
4. The Poor-law authority should be compelled to contract with theworkhouse medical officer or superintendent of infirmary to vaccinateall infants in the workhouse or infirmary and to carry out the Vaccina-tion Acts generally.
5. The notification of measles and whooping-cough should be carriedout in the same manner as has been recently adopted in the case oftuberculosis of the lungs.
6. The salaries of Poor-law medical officers should be on a more liberalscale, due regard being taken of the average mileage in the case of visitsto sick patients. That to meet exigencies of changes of population themedical officer should always have a right to claim a revision of hissalary when his work has been greatly increased by such change.
7. That an allowance should be made by the Poor-law authority forthe carrying out of the Poor-law work of a medical officer during hisannual holiday and during sickness.
8. That length of service, as in other public services, should con-stitute a ground for increase of salary, apart from other considerations.
9. That a common fund be instituted to receive all payments underthe Poor-law Officers’ Superannuation Act, so that the expense ofpensions should not directly fall on a particular locality.
10. That in all cases where for public reasons the office of a Poor-lawmedical officer is determined, if he or she be not entitled to a pension,an allowance shall be made of a sum equal to the average emolumentsderived from that office during the period of two years. Providedalways that such determination be not due to misconduct on the part ofthe officer.
11. That in no ease shall it be lawful for the local Poor-law authorityby bargaining with individual medical officers to reduce the amountpaid at any time annually in medical salaries for attendance on its poor,unless it can be clearly shown that owing to local changes the sicknessclaims have very materially diminished in that area.
12. That in all cases where, owing to residence outside his district, amedical officer has only been appointed for a year or a term of years, ifthe said appointment has been continued for a period of seven or moreyears the said medical officer shall thereafter be entitled to hold officeon the same terms as if he resided in his district.
247ANNUAL REPORT OF MEDICAL OFFICER OF LOCAL GOVERNMENT BOARD.
THE LANCET.
LONDON: SATURDAY, JANUARY 28, 1911.
Annual Report of the MedicalOfficer of the Local Govern-
ment Board.SHORTLY after Christmas the annual report of the medical
officer of the Local Government Board for 1909-1910 was
published. As year by year we peruse these valuable volumeswe cannot help wondering whether it might not be practic-able to issue one annual report, not only upon the British Islesas a whole, but also upon the health conditions of the empire.But we fear that this might prove a difficult matter, and
perhaps, after all, the different practices which obtain inScotland and in Ireland furnish us with comparative studiesfrom which each local government authority selects that
which best suits its needs ; although, on the other hand, thereis in certain directions necessity for more uniform action inthe three divisions of the United Kingdom than is at presentthe case. We must confess, too, that we should like to seethe annual report of the English Local Government Board
embody some sort of summary or review of the health con-ditions obtaining in Scotland or in Ireland and in the
colonies, and perhaps the best means of accomplishing this<end would be to make the President of the Local Government
Board Imperial Minister of Health, a step which has beenoften suggested for many reasons, and one which would
tend to centralise all information relative to health matters
in one Government office. It must not be inferred that we
are in any sense disparaging the work of the Local Govern-ment Board ; rather must we be understood as implying thatthe work of the medical department has always been main-tained at such a high level of excellence that we should liketo see its sphere of influence materially extended.The report just issued differs but little from its long
line of predecessors ; it contains an introduction by Dr.
ARTHUR NEWSHOLME, the medical officer, reports by themedical inspectors, some of which have been alreadypublished and have been reviewed in our columns, memo-randa issued by the Board upon various subjects, increas-
ingly depressing figures relative to the administration
of vaccination, and, finally, an account of the auxiliaryinvestigations carried out during the year. As it is our
intention to deal in one or more special articles with someof the more interesting features of the report we shall here
mainly confine ourselves to an indication of the general scope,of the volume. The most interesting innovation is a review
by Dr. H. FRANKLIN PARSONS, the senior assistant medical
officer, upon epidemic diseases in England and Wales during1909, a contribution which really amounts to a sketch of thebehaviour of measles, whooping-cough, scarlet fever, diph-theria, enteric and typhus fevers, small-pox, influenza, andepidemic diarrhoea over the years for which reliable figures
are available. Dr. PARSONS, the author of classical works
upon disinfection, influenza, and many other subjects, is
well qualified for supplying reviews of this character, sincehis intimate knowledge of epidemiology and cyclical waves ofdisease enables him to avoid the pitfalls into which more
superficial workers are so liable to be precipitated owing totoo restricted a review of the past history of disease. It is
much to be hoped that these annual reviews will be con-
tinued, although we are afraid that Dr. PARSONS, who, we
believe, is approaching the age limit of the Civil Service,
may not be much longer available for the purpose. But
possibly in his well-earned retirement after so many yearsof silent service he may, unfettered by the exigenciesof office, take up his pen and write of epidemiology.Dr. R. BRUCE Low contributes, as in past years, his usefulsummaries of the progress of plague and cholera, and hisreview as to plague progress and prevalence makes especiallyinteresting reading at the present time owing to the tendencyof this disease towards general diffusion. Dr. S. W. WHEATON,one of the inspectors, furnishes an interesting report uponenteric fever prevalence in the county of Durham, and thishas already, we believe, been published.
Dr. G. S. BUCHANAN reviews the work of the food
inspectors, dealing with the action taken under the PublicHealth (Regulations as to Foods) Act, 1907, the local
arrangements made for meat and food inspection, work inrelation to the Sale of Food and Drugs Acts, and foreignand colonial food legislation. Dr. BUCHANAN’S report is
reviewed in another column of this issue of THE LANCET.
Dr. J. C. G. LEDINGHAM’S report on enteric fever carriers isalso embodied in the volume before us, and this was fully re-viewed in our columns when it was firkit issued.l Amongstwhat are known as the auxiliary scientific investigations is a
report of work carried out by Dr. F. W. ANDREWES upon thebehaviour of the leucocytes and the changes in the bonemarrow in relation to infection. Numerous organisms weresubjected to test during the course of the experiments, andthe general conclusions arrived at show that the human
economy responds in different fashion according to the
nature of the organisms employed-that is to say, that themethod of defence depends upon the character of the attack.Dr. W. G. SAVAGE has continued his investigations upon theGaertner group of bacilli in prepared meats, and the laterexperiments have tended to emphasise the former con-
clusions that outbreaks and isolated cases of food-poisoningare due to specific infection of the food and not to non-
specific excretal contamination. The important subject ofthe bacterial measurement of milk-pollution is also dealt
with by Dr. SAVAGE, who is of opinion that the most
reliable inferences can be drawn by estimating the numberof bacillus coli and its near allies, and of the sporesof the bacillus enteritidis sporogenes, as well as of a
microscopical examination of the centrifugalised deposit.We are glad to see, too, that Dr. SAVAGE advocates that
bacteriological examination shall be carried out side by sidewith inquiries at the sources of the supply of the milk.
The chemical aspects of epidemic diarrhœa, have been
investigated by Dr. H. A. SOHÖLBERG and Mr. MACKENZIE
1 THE LANCET, Dec. 3rd, 1910, p. 1631.
