1
289 engaged in textile industries than in rural populations ; bat the influence of the grossly insanitary conditions ot ruost of our manufacturing towns, especially as to the housing of the working classes and the disposal of excre- ment by the midden system, was a disgrace to the country ; huge leaky pits often abutted on the walls of the houses, in which the liquid and solid excrement of a whole court, it might be, putrefied, andexhaled a sickening stench. It was no wonder that the medical officer of health of Crewe found the infant death-rate four times higher in the quarters where middens were in use, and he had found nearly the same at Stockport, where the infant death rate among the legitimate was 225 and among the illegitimate 594 per 1000. Indeed, the life assurance companies would not take illegitimate children under three years of age ; but he did not believe that the practice of insuring the lives of children 100 to neglect. The payment of £2 was not worth the dsk of courting inquiry, and agents of life assurance associations had assured him that the insurers belonged to the most respectable and steady of the working classes, and that the mortality was lower amongst these children (han among others. In fact, the Bill directed against was withdrawn on the ground of insufficient evidence. If children were the victims of foul play it was rather by the reckless use of soothing syrups &c, under which name, or that of syrup of violets, Dr. Jones, in his Howard Essay, stated that 39 lb. of laudanum were sold every week in one town, at d in another two druggists paid £5 each and costs rather than face the exposure of a tridl. The law at present forbade the employment of women within four weeks after confinement, and a deputation to the Home Secretary had recommended an extension of the neriod to three months : but Mr. Aquith had shown from the Registrar-General’s retarns a greater increase in some manufacturing towns, as Wolverhampton, where women were not employed, and Dr. Reid’s statistics did not take into account the simul- taneous increase in the general death-rate in the same towns. Such prohibition of female labour was impracticable ; some drunkards did live on the wife’s earnings, but more often they kept together the home of the unwilling idler, and no law could prevent "charing." " Again, the infant mortality was greater in the first month than in the second and third together, due partly to work during the later months of pregnancy, and a month’s rest before delivery would be of great, advantage. Inquiries among mill owners and overseers led him to the conviction that more stringent legislation would be impracticable, since the expected date rested on the woman’s statement, and, though often warned, their confinement generally occurred within a few hours of leaving work, sometimes indeed in the mill. Even the four weeks rule was evaded, for if the over- seer refused to readmit a woman she would get work where she was not known ; and she frequently lost her post, as it was, unless she could find an equally efficient substitute. Cièches, or public day nurseries, had been recommended and tried, both at the mills and elsewhere, but without success, for the mothers prefeired a neighbour whom they knew living near their own homes. Indian women, however, nursed their children in the mill. The only remedy he saw was the extension of the Infant Life Protection Act to all caretakers Excepting near relatives, with annual licences and inspection, and notice to the coroner of all deaths, although it would i)r3voke resistance at first. Dr. REID defended his position. In his county of Stafford there were many towns with from 10,000 to 30.003 inhabi- I tants, some wholly devoted to iron founding and others to pottery. The sanitary conditions were practically identical, bat in the former no women and in the latter many were employed. In these the increase of the infant mortality in ten years had been 23 per cent., as against 18 per cent. for manufacturing towns gfnnally. Mr. Asquith’s figures were fallacious, for in the cae of Wolverhampton, instead of com- paring the decades 1871-80 and 1881-90, he had taken the years 1885 and 1893 which happened to give the lowest and the highest infant death-rates on record. True, the infant mortality had risen in the last ten years; but then two in- dustiies had sprung up, galvanising and japanning, the one largely and the other wholly conducted by women; while prior to 1880 the sole industry of the town was the iron- works, employing only men. He maintained that the increase in the geueral death-rate alleged by Dr. Porter was wholly due to the rise in the mortality among infants. He still advocated the three months’ absence from work, which would carry the infant through the most critical period ; wherEas one month was of no advantage to the child, since it was mt worth the mother’s while to nurse an infant for so fhort a time, and the husband’s wages were, as a rule, sufficient, though the additional twelve or fifteen shillicga earned by the wife were a temptation. Dr. TURNER could not aree with Dr. Porter, for the infant mortality from diarrhoea was not confined to the more insanitary towns. It was wholly a question of artificial versits " asepic " breast feeding. The infant death rate was formerly the same at Leicester as at Ports- mouth, but on the introduc ion of the shoe trade, owing to disputes at Northampton, it rose in one ear 50 per cent., and a further iise followed the traubfer in 1860 of the silk ribbon industry from Coventry, where it was superseded by the cycle and sewing machine manufacture. There the release of the women led to a corresponding fall in the infant deaths, except in 1870, when the Franco-German war caused a transitory revival of the silk indastiy. Infant diarxhoaa was almost unknown in Old London, insani- tary as it was, just because feeding bottles had not been invented. At Much Hddham, a large village where the children were invariably breast-fed, the opening np of an ill-constructed system of communicating cesspits and sewers was followed by an outbreak of diarrhoea which spared the infants even when their mothers were attacked. Df. SPOTTISWOODE CAMERON, Dr. REGI:8ALD DUDFIELD, and others having spoken, Df. PoRrER replted. He did not deny the importance of female labour as a cause, but main- tained that it was one of many, and he deprecated exaggera- tion and the advocacy of measures which, hoivever debirable in themselves, would be found impracticable. ÆSCULAPIAN SOCIETY OF LONDON. Exhibition of Ca3es.-Straitgitlated Hernia.-Diphtheria. A MEETING of this society was held on Friday, Jan. 25th. Dr. A. T. DAVlES exhibited a young woman the subject of extensive superficial Lupus of the Face and Neck who had been under treatment for seven months with thyroid extract. Steady and marked improvement resulted, the patches fading and becoming more flattened. There was no history of syphilis cr tubercle. Df. Davies regarded the effect of the thyroid treatment as suggesting a possible relationship between myxcedema and tubercle -Mr. F. C. WALLIS men- tioned two cases of severe lupus invading the nose and adjacent parts in which great benefit resulted from a com- bination of skin grafting with the thyroid treatment. He also showed a broad and sharp-edged knife devised by him for shaving off large portions of skin for grafts.—Mr. STEPHEN PAGET showed a case of Acromegaly. Reference was made to a similar case observed in the dissecting-rooms at Edin- burgh University seventeen years ago, in which the pituitary body was then noticed to be much enlarged Mr. PAGET read a paper giving details of twelve cases of Strangulated Hernia in which the bowel was found on opera- tion to be gangrenous. Only one of the twelve recovered. Almost every case was practically hopeless when admitted to hospital. The reluctance of patients to undergo operation, the want of due insistance by practitioners, the deceptive character of such attacks, and partially successful reduc- tion had each their share of responsibility for the fatal delay in (perating. As regards the operation, resection was in several cases impossible on account of the extent and position (the large intestine) of the gangrene. Extreme gentleness and care in examination of the hernial mass might have done something-possibly not much-to alter the result, but the whole series of cases formed a protest against the danger of delay. Dr. B. G. MoRiSON read notes of three well-marked cases of Diphtheria, two of them severe and relapsing, treated successfully with antitoxin diphtherias. The false membrane cleared rapidly and no sequelae hai been observed. In one case laryngeal symptoms were present and disappeared after the injection. _____________ MIDLAND MEDICAL SOCIETY. Exhibition of Cases -Post partum lltvmorrkage. THE fifth ordinary meeting of this society was held on Wednesday, Jan. 6th, Mr. T. F. CHAVASSE, President, being in the chair. Dr. LESLIE PHILIPS showed a curious case of Pityriasis

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289

engaged in textile industries than in rural populations ;bat the influence of the grossly insanitary conditions otruost of our manufacturing towns, especially as to the

housing of the working classes and the disposal of excre-

ment by the midden system, was a disgrace to the country ;huge leaky pits often abutted on the walls of the houses, inwhich the liquid and solid excrement of a whole court, itmight be, putrefied, andexhaled a sickening stench. It was nowonder that the medical officer of health of Crewe found theinfant death-rate four times higher in the quarters wheremiddens were in use, and he had found nearly the same atStockport, where the infant death rate among the legitimatewas 225 and among the illegitimate 594 per 1000. Indeed,the life assurance companies would not take illegitimatechildren under three years of age ; but he did not

believe that the practice of insuring the lives of children100 to neglect. The payment of £2 was not worth thedsk of courting inquiry, and agents of life assurance

associations had assured him that the insurers belonged tothe most respectable and steady of the working classes,and that the mortality was lower amongst these children(han among others. In fact, the Bill directed against waswithdrawn on the ground of insufficient evidence. If childrenwere the victims of foul play it was rather by the recklessuse of soothing syrups &c, under which name, or that of

syrup of violets, Dr. Jones, in his Howard Essay, stated that39 lb. of laudanum were sold every week in one town, at din another two druggists paid £5 each and costs ratherthan face the exposure of a tridl. The law at presentforbade the employment of women within four weeks afterconfinement, and a deputation to the Home Secretary hadrecommended an extension of the neriod to three months :but Mr. Aquith had shown from the Registrar-General’sretarns a greater increase in some manufacturing towns, asWolverhampton, where women were not employed, andDr. Reid’s statistics did not take into account the simul-taneous increase in the general death-rate in the same towns.Such prohibition of female labour was impracticable ; somedrunkards did live on the wife’s earnings, but more oftenthey kept together the home of the unwilling idler, and nolaw could prevent "charing."

"

Again, the infant mortalitywas greater in the first month than in the second andthird together, due partly to work during the latermonths of pregnancy, and a month’s rest before deliverywould be of great, advantage. Inquiries among millowners and overseers led him to the conviction thatmore stringent legislation would be impracticable, sincethe expected date rested on the woman’s statement, and,though often warned, their confinement generally occurredwithin a few hours of leaving work, sometimes indeed in themill. Even the four weeks rule was evaded, for if the over-seer refused to readmit a woman she would get work whereshe was not known ; and she frequently lost her post, as itwas, unless she could find an equally efficient substitute.Cièches, or public day nurseries, had been recommended andtried, both at the mills and elsewhere, but without success,for the mothers prefeired a neighbour whom they knew livingnear their own homes. Indian women, however, nursed theirchildren in the mill. The only remedy he saw was theextension of the Infant Life Protection Act to all caretakersExcepting near relatives, with annual licences and inspection,and notice to the coroner of all deaths, although it wouldi)r3voke resistance at first.

Dr. REID defended his position. In his county of Stafford there were many towns with from 10,000 to 30.003 inhabi- Itants, some wholly devoted to iron founding and others topottery. The sanitary conditions were practically identical,bat in the former no women and in the latter many wereemployed. In these the increase of the infant mortality inten years had been 23 per cent., as against 18 per cent. formanufacturing towns gfnnally. Mr. Asquith’s figures werefallacious, for in the cae of Wolverhampton, instead of com-paring the decades 1871-80 and 1881-90, he had taken theyears 1885 and 1893 which happened to give the lowest andthe highest infant death-rates on record. True, the infantmortality had risen in the last ten years; but then two in-dustiies had sprung up, galvanising and japanning, the onelargely and the other wholly conducted by women; whileprior to 1880 the sole industry of the town was the iron-works, employing only men. He maintained that the increasein the geueral death-rate alleged by Dr. Porter was whollydue to the rise in the mortality among infants. He stilladvocated the three months’ absence from work, which wouldcarry the infant through the most critical period ; wherEas

one month was of no advantage to the child, since it was mtworth the mother’s while to nurse an infant for so fhort atime, and the husband’s wages were, as a rule, sufficient,though the additional twelve or fifteen shillicga earned by thewife were a temptation.

Dr. TURNER could not aree with Dr. Porter, for theinfant mortality from diarrhoea was not confined to themore insanitary towns. It was wholly a question ofartificial versits " asepic " breast feeding. The infantdeath rate was formerly the same at Leicester as at Ports-mouth, but on the introduc ion of the shoe trade, owing todisputes at Northampton, it rose in one ear 50 per cent.,and a further iise followed the traubfer in 1860 of the silkribbon industry from Coventry, where it was superseded bythe cycle and sewing machine manufacture. There therelease of the women led to a corresponding fall in theinfant deaths, except in 1870, when the Franco-German warcaused a transitory revival of the silk indastiy. Infantdiarxhoaa was almost unknown in Old London, insani-tary as it was, just because feeding bottles had notbeen invented. At Much Hddham, a large village wherethe children were invariably breast-fed, the opening npof an ill-constructed system of communicating cesspits andsewers was followed by an outbreak of diarrhoea whichspared the infants even when their mothers were attacked.

Df. SPOTTISWOODE CAMERON, Dr. REGI:8ALD DUDFIELD,and others having spoken, Df. PoRrER replted. He did not

deny the importance of female labour as a cause, but main-tained that it was one of many, and he deprecated exaggera-tion and the advocacy of measures which, hoivever debirablein themselves, would be found impracticable.

ÆSCULAPIAN SOCIETY OF LONDON.

Exhibition of Ca3es.-Straitgitlated Hernia.-Diphtheria.A MEETING of this society was held on Friday, Jan. 25th.Dr. A. T. DAVlES exhibited a young woman the subject of

extensive superficial Lupus of the Face and Neck who hadbeen under treatment for seven months with thyroid extract.Steady and marked improvement resulted, the patches fadingand becoming more flattened. There was no history ofsyphilis cr tubercle. Df. Davies regarded the effect of thethyroid treatment as suggesting a possible relationshipbetween myxcedema and tubercle -Mr. F. C. WALLIS men-tioned two cases of severe lupus invading the nose andadjacent parts in which great benefit resulted from a com-bination of skin grafting with the thyroid treatment. Healso showed a broad and sharp-edged knife devised by himfor shaving off large portions of skin for grafts.—Mr. STEPHENPAGET showed a case of Acromegaly. Reference was madeto a similar case observed in the dissecting-rooms at Edin-burgh University seventeen years ago, in which the pituitarybody was then noticed to be much enlarged

Mr. PAGET read a paper giving details of twelve cases ofStrangulated Hernia in which the bowel was found on opera-tion to be gangrenous. Only one of the twelve recovered.Almost every case was practically hopeless when admitted tohospital. The reluctance of patients to undergo operation,the want of due insistance by practitioners, the deceptivecharacter of such attacks, and partially successful reduc-tion had each their share of responsibility for the fatal

delay in (perating. As regards the operation, resection wasin several cases impossible on account of the extent andposition (the large intestine) of the gangrene. Extremegentleness and care in examination of the hernial mass mighthave done something-possibly not much-to alter the result,but the whole series of cases formed a protest against thedanger of delay.

Dr. B. G. MoRiSON read notes of three well-marked casesof Diphtheria, two of them severe and relapsing, treatedsuccessfully with antitoxin diphtherias. The false membranecleared rapidly and no sequelae hai been observed. In onecase laryngeal symptoms were present and disappeared afterthe injection.

_____________

MIDLAND MEDICAL SOCIETY.

Exhibition of Cases -Post partum lltvmorrkage.THE fifth ordinary meeting of this society was held on

Wednesday, Jan. 6th, Mr. T. F. CHAVASSE, President, beingin the chair.

Dr. LESLIE PHILIPS showed a curious case of Pityriasis