1257POPULAR SANITATION.-INFANT FEEDING AND MILK-SUPPLY.

was present in the upper limb. Summarising his observationsDr. Gordon concludes that, without exception, in all the

cases of cerebral paralysis examined the sense of pain wasimpaired the most in all parts of the body-face, upperlimb, trunk, and lower limb. The sense of heat and cold

(temperature sense) was affected next in order of intensity,while touch (cutaneous tactile sensibility) was the leastaffected. " There was no exception to the fact that whetherin pain, touch, or temperature, the hypo-sensations [diminu-tion of sensibility] occurred in the largest number of cases,while anassthesias were met with in a comparatively smallnumber and hyperaesthesias in extremely few cases." It was

also noticed that in the largest number of cases the impair-ment of sensibility to touch, pain, and temperature occurredin the upper limb and that the face was the least affected

part of the entire individual. Verger of Paris has statedthat the impairment of sensation in the limbs in cases of

hemiplegia had a tendency to be most marked in the handsand feet and 1iO diminish towards the proximal part (shoulderor hip), an assertion which Dr. Gordon found to be correctin a large number of his cases. The stereognostic sensewas disturbed in 29 out of the 35 cases and in 22 of thesethe loss of this sense was complete. The greater the

involvement of the other sensations the more marked wasthe astereognosis, a fact which tended to favour the concep-tion of the stereognostic sense as depending upon the

integrity of the separate tactile, muscular, and othercutaneous sensations. Finally, in the one case with sym-

ptoms of hysteria, which was studied as a test case, Dr.

Gordon was able to satisfy himself that the sensory impair-ment present was parallel to that observed in other cases ofcerebral paralysis and was in no wise dependent upon theneurosis present.

-

POPULAR SANITATION.

IT is always gratifying to those who are engaged in theconflict with disease to note the extension of sanitary know-ledge and the translation of its principles into the rule andcustom of ordinary life. Happily signs of such prudentintelligence are not wanting in our own day. Cleanliness is

already for all classes of the people a word of much deeperand wider meaning than it was a quarter of a century ago.Even in its refined or "surgical" " variety it can often bedepended on with some degree of confidence in domestic

practice. The danger of infection and the responsibilitieswhich it entails are even better understood. Indeed, there isa tendency in many quarters to excessive caution in respectof it. We may reasonably hope, however, that with fullerknowledge and the passing of a transition period of

half-light this morbid over-sensitiveness will give place tocalmer views of personal and public duty. In the mean-

time we may be thankful that the national mind is awakeon this subject. The notices displayed in many streets ofthe metropolis and in public vehicles in condemnation ofthe practice of spitting afford further proof of this wakefulspirit. In the tramcars under its control the London CountyCouncil has gone the length of prohibition under a penalty.The great importance of these precautions in relation to

the danger conveyed by tuberculous sputa can hardlybe exaggerated. We congratulate the local authoritieson a method of notification so happily devised and so in-expensive. We should like to see it still further extended

by railway and shipping companies and, above all, byowners of factories, workshops, and business ofhces. Theselatter are probably the chief sources of tuberculous con-

tamination. The National Association for the Preventionof Consumption and other Forms of Tuberculosis has

drawn attention to the desirability in this connexion of

the better ventilation of railway carriages. The dread of a

draught is fortunately not now so great as it used to be.

Nevertheless, it is a fact that the necessity of ventilation byfresh air is probably the one principle essential to healthwhich is least appreciated by many persons even at the

present time ; nor is it sufficiently understood that the

partial opening of one window in a compartment implies themost trifling inconvenience to its inmates, while an evenfreer entrance of air is often desirable in their commoninterest. A little judicious advice from railway companieson this subject would go far to insure the comfort and thewell-being of passengers. On the same ground it is to be

hoped that something will be done wherever practicable toimprove the existing inlets other than windows and to-

provide exits in the roof which at present do hot exist.

THE FATE OF MISS CAMILLE HOLLAND.

I LIGHT seems now about to be cast on the mystery sur-rounding the disappearance of Miss Camille Holland fromMoat House Farm, near Clavering in Essex. On Monday last,April 27th, the persevering efforts of the police, who havefor some weeks been digging over the ground in the vicinityof the farm buildings and draining off the water fromditches and ponds, were rewarded by the discovery of awoman’s body buried in circumstances which leave no doubtas to the interment having been surreptitious. Several

persons who were well acquainted with Miss Holland aresaid to have identified the remains as being hers and thepolice, in conjunction with medico-legal experts acting onbehalf of the Home Office, may be relied on to make fulluse of all the material available for arriving at a con-

clusion. There is satisfaction in the reflection that amidthe atmosphere of suspicion which envelopes Miss Holland’sdisappearance the public have refrained from hystericaldenunciation of the man who is charged with attemptingto obtain money by forging Miss Holland’s name and

against whom additional charges will no doubt now be

brought. The absolute and incontrovertible identificationof a secretly-buried body as that of a person who has notbeen seen alive for several years may present circumstancesof considerable difficulty to the experts whose opinion willbe of paramount importance both to the prosecution and tothe defence. Strange errors of identification of personsdeceased or alleged to be deceased occur from time to-

time, and have been recorded in THE LANCET, while thelong-drawn-out controversy which centred round the Tich-borne claimant 30 years ago forms a historic example.These are the cases that lead the law to require over-

whelming testimony founded on the most stringent tests-

before identification is accepted.

INFANT FEEDING AND MILK-SUPPLY.

AT the annual meeting of the Metropolitan HospitalSaturday Fund, which was held at the Mansion House onApril 25th, Dr. T. D. Lister delivered an address upon the

important subject of infant feeding and milk-supply. The

subject is of the utmost importance not only as regardswaste of human life but also in respect to the future of thecountry. For the children of to-day are the fathers andmothers of the future and looking at the appalling infantmortality which exists, the puny stamina of town dwellers,and the denudation of the country districts we are remindedof the words :

" III fares the land, to hastening ills a prey,Where wealth accumulates and men decay."

A Budget of nearly 144 millions makes it all the more neces-sary that the population by whom this enormous sum has tobe found should be healthy. Dr. Lister in his address gave hishearers no information which is not perfectly known to mostpersons who have studied the subject, but he put very clearlyand emphatically the loss of infant life by bad feeding, thefact that this loss is mainly due to mothers neglecting either

1258 THE MIDWIVES ACT.

from necessity-i.e., poverty-or carelessness, the first duty-of a mammalian mother-namely, the suckling of the young-and that if children unfortunately have to be artificiallyfed they should be so fed on fresh cow’s milk and not oncondensed or preserved milk. He referred also to the

great success which has attended the principle of a muni-

cipal distribution of clean pure fresh milk and to the verycareless manner in which milk is allowed to be sold andstored in the poorer districts of London, while at the sametime he gave every credit to those firms which try to supply,and succeed in supplying, fresh clean milk. Here are Dr.Lister’s conclusions with which we thoroughly agree :-In conclusion, the facts seem to show that ignorance of the usage of

cow’s milk for infant feeding, and ignorance as to the proper handlingof milk-supply at every stage, are two great factors in excessive infantmortality.In the homes we want wider teaching of mothers and potential

mothers as to the care and feeding of children. The London SchoolBoard has recently made a step in this direction. The printed pamphletprovided by many health officers is of great use, but an organisedservice of trained women, "health visitors," or "mothers’ friends,"such as is in existence in certain towns, is of far greater value amongthe poorest and most ignorant and helpless people. Good cow’s milkis a vital necessity to those babies unable to obtain the’ naturalfood, but it cannot exactly replace it. Where the poverty is such thatskimmed milk, tinned or fresh, is all that can be bought, then propermilk should be provided by public funds, either free or at the cost ofthe materials. This limitation to the extremely poor involves no tradednjustice. It does not matter whether this be done charitably or as amunicipal preventive measure against maintaining an increasing pro-portion of the population damaged by, but surviving, bad feeling ininfancy. Many thousands of children are sacrificed annually for wantof such provision. If our common conditions compel this reproach, ourcommon interest, no less than our common conscience, should take.steps to remove it. -

THE annual dinner of the Glasgow University Club will beheld at the Trocadero Restaurant on Friday, May 29th, at

’7 o’clock. The Rt. Hon. George Wyndham, M.P., the LordRector of the University, is announced to be in the chair.

Applications for tickets should be made to Mr. James M.

Dobbs, Dover House, Whitehall, or to Dr. C. O. Hawthorne,28, Weymouth-street, Portland-place, W.

Franz Narden Koetter, or Nordenkotter, was brought up atthe Bow.street Police-court before Mr. Marsham on April 29thfor extradition on charges of obtaining money by false

pretence in Germany. His proceedings as an unqualifiedmedical practitioner in Berlin and his flight from Germanyto evade arrest were mentioned by our Berlin Correspondent Iin THE LANCET of April 4th, p. 998.

THE third annual dinner of South African civil surgeonswill take place at the Hotel Cecil on Friday, June 5th, thethird anniversary of the entry into Pretoria. Sir William

Thomson, C.B., will occupy the chair. Tickets, price10s. 6d., may be had on application to the secretaries, Mr.C. G. Watson, 44, Welbeck-street, or Dr. F. E. Fremantle,’The College, Guy’s Hospital.

Mr. A. G. R. Foulerton has resigned his post as director ofthe Cancer Research Laboratories at Middlesex Hospital,so that he may have more time to devote to his duties, latelymuch increased, as director of the clinical and bacteriologicallaboratories of the hospital. A director will be appointed todevote the whole of his time to the work of the CancerResearch Laboratories.

____

A CONJOINT conference, convened by the Matrons’ Counciland by the Society for the State Registration of Trained

Nurses, will be held at 20, Hanover-square, London, W., onFriday next, May 8th, at 3 P. M. The question to be con-sidered is the State Registration of Trained Nurses as it

.affects the Community. -

THE May dinner of the Edinburgh University Club ofLondon will take place on May 20th at the CriterionRestaurant. Sir William Turner, K.C.B., principal of

Edinburgh University, will be in the chair, and amongstthose who have accepted invitations to be present are SirWilliam S. Church, Sir H. G. Howse, Sir William Huggins,and Sir William Macewen. Members intending to be

present are requested to send in their names to one of thehonorary secretaries, Dr. James Taylor, 49, Welbeck-street,W., and Dr. G. A. Sutherland, 73, Wimpole-street, W.

THE MIDWIVES ACT.

I THE following Memorandum has been issued by the LocalGovernment Board with reference to the Midwives Act,1902 (2 Edw. VII. c. 17) :-

1. Object of Act.-The object of this Act, which, except as otherwiseprovided, came into operation on the 1st of April, 1903, is to securethe better training and supervision of midwives by the establishmentof a system of certification and enrolment of women who are properlyqualified to act in that capacity.

2. ividwites roLL.-The dct accordingly makes provision for theinstitu-tion of a roll which will contain the names of midwives certified underthe Act and for the formation and constitution of a body to be calledthe Central Midwives Board, who as the central authority for carryingthe Act into effect will possess jurisdiction in regard to the issue ofcertificates and the admission to the roll of midwives and willexercise a general control over the practice of such persons. (Sections3 and 6.)

3. The Central Midwives Board has been constituted and consists ofthe following members :-W. J. Sinclair, Esq., M.D., Miss J. Wilson,F. H. Champneys, Esq., M.D., J. W. Cousins. Esq., F.R.C.S., E. P.Young, Esq., M.R.C.S., L.S.A., C. J. Cullingworth, Esq., M.D., F.R.C.P.,J. H. Johnstone, Esq., M.P., Miss R. Paget, Miss D. Oldham; secre-

tary, G. W. Duncan, Esq. The temporary office of the Board is at thePrivy Council Office, Whitehall, S.W.

4. The Central Midwives Board are to frame rules, subject to theapproval of the Privy Council, for the purposes above referred to, andthey are also required (amongst other things) to publish annually aroll of midwives who have been duly certified under the Act.(Section 3.)

5. Definition of midwife.-The term "midwife" as used in the Actis defined by section 18 as meaning a woman who is certified under theAct, unless the context otherwise requires.

6. Local supervising authorities.-The local supervision of midwivesis entrusted to the council of every county or county borough through-out England and Wales who by section 8 are made the local super-vising authority over midwives within their respective areas.

7. The same section imposes upon each local supervising authorityas thus constituted various specified duties in relation to midwives.Their first duty (section 8 (7) ) will be to give due notice of the effectof the Act, so far as practicable, to persons at present using the titleof midwife. It is understood that the Central Midwives Boardcontemplate the preparation of a form of notice for the use of localauthorities, which will be communicated to them, together with therules under section 3. The council should forthwith ascertain, so faras possible, the names and addresses of all women in the county whoare accustomed to hold themselves out as midwives.

8. The other duties enjoined upon the local supervising authority bysection 8 are as follows :-(1) To exercise general supervision over allmidwives practising within their area in accordance with the rules tobe laid down under the Act. (2) To investigate charges of mal-practice, negligence, or misconduct on the part of any midwifepractising within their area, and should a primd facie case be estab-lished to report the same to the Central Midwives Board. (3) Tosuspend any midwife from practice, in accordance with the rules underthe Act, if such suspension appears necessary in order to prevent thespread of infection. (4) To report at once to the Central MidwivesBoard the name of any midwife practising in their area convicted of anoffence. (5) During the month of January of each year to supply thesecretary of the Central Midwives Board with the names and addressesof all midwives who, during the preceding year, have notified theirintention to practise within their area, and to keep a current copy ofthe roll of midwives accessible at all reasonable times for public in-spection. (6) To report at once to the Central Midwives Board thedeath of any midwife or any change in the name or address of anymidwife in their area, so that the necessary alteration may be made inthe roll. "

9. Delegation of powers by local supervising authorities.-The localsupervising authority may delegate, with or without any restrictionsor conditions as they may think fit, any powers or duties conferredor imposed upon them by or in pursuance of the Act, to a committeeappointed by them and consisting either wholly or partly of membersof the council. The provisions of sub-sections (1) and (2) of section82 of the Local Government Act, 1888, are applied to every com-mittee appointed under this section and to every council appointingthe same, and women are made eligible to serve on any such committee.(Section 8.)

10. In addition to the general right thus conferred upon the localsupervising authorities of delegating their powers and duties underthe Act to committees, the councils of counties are empowered bysection 9 of the Act to delegate, with or without any restrictions orconditions as they may think fit, any powers or duties conferred orimposed upon them by or in pursuance of the Act to any districtcouncil within the area of the county. It is provided that thepowers and duties so delegated may be exercised by a committeeappointed by such district council and consisting either whollyor partly of members of the district council, and that women shall beeligible to serve on any such committee. Any expenses incurred by adistrict council in the execution of any powers or duties so delegatedare, to an amount not exceeding such sum as may be prescribed by thecounty council, to be repaid to the district council as a debt by the