Judical Jpius. Surgeon-Lt.-Col. B. Franklin, Surgeon to the
Viceroy, acts as Inspector-General of Civil Hospitals of the Punjaub while Surgeon-Col. Raye is on privilege leave. HONOURS TO MEDICAL OFFICERS IN CHITRAL. The medical profession will have received the news with pride of the Queen having conferred on Surgeon-Captain Whitchurch the Victoria Cross for his gallant conduct in rescuing Captain Baird, and of Her Majesty having made Surgeon-Major Robertson a K.c.s.i. A MEMORIAL TO THE LATE Dr. J. M.
COATES. There has been a general expression of feeling" out of the respect in which the late Dr. Coates was held that some permanent To monument should be raised to his memory. out we would a rethat this, carry suggest presentative Committee should be formed. In the meantime the Editor of the Gazette will be willing to receive subscriptions and publish the names of subscribers. A subscription for the same purpose has already been set 011 foot by the members of the Medical Association of India, of which Dr. Fernandez is the Secretary.
arising
LONDON LETTER. The Summer Meeting of the General Council of Medical Education and Registration was held in London from May 28th to June 5th. The principal item in its proceedings was a consideration of the " Midwives' Registration Bill," which was introduced into the House of Lords by Lord Balfour of Burleigh, and has been read The Bill -was a second time in that assembly. referred by the Lord President of the Council to the Medical Council for an expression of opinion It was thoroughly examined on its proposals. by a Committee of the Council, and the report of this Committee underwent very full discussion. The main object of the Bill is to provide for poor people who cannot afford to engage the services of a medical practitioner, the assistance of competent and qualified midwives in natural labour. It is proposed by the Bill to create a Midwives' Board analogous to the General Medical Council, under whose authority qualified midwives are to obtain the privilege of legal registration. The conditions, as regards present and future midwives under which this privilege is to be accorded, and the nature of the control and supervision under which they are to exercise
INDIAJN MEDICAL GAZETTE.
312
their
and retain their place on the which are to be settled by register, the Midwives' Board in concert with the Medical Council. The proposed legislation bristles with difficulties. How far it will hinder incompetent and unqualified women from undertaking the management of labour cases is very doubtful. Whether it will materially trench upon the practice of medical men is also questionable. The definition of natural labour is by no means easy, and who is to draw the line when the ministration of the registered midwife is to end and the aid of the skilled accoucheur is to be put in requisition. Obviously, this responsibility must rest with the midwife, and no law or regulation can define the limits of her discretion, which must depend on her knowledge, skill and temperament. It would be easy enough to expand the catalogue of difficulties which this new departure may and must involve, but that the new legislation will tend to create a better educated and qualified body of midwives there can be no doubt, and for the rest, time and experience must be left to smoothe down obstacles to the easy and safe working of the system, and adjust the professional relation of medical men and midwives to the end of securing the greatest possible good That is the main for women in childbirth. point, and administrative troubles must be made to yield in view of the necessity of achieving this purpose. The subject of the treatment of snake-bite has once again come to the front. I gather from the Annual Report of the Sanitary Commissioner with the Government of India for 1893 which has recentty come to hand that Dr. Douglas Cunningham has subjected a variety of reputed snake cures to thorough scientific testing. Nitrate of strychnia and saturated solutions of Periodate crystals have been shown to be utterly inefficacious, whether as antidotes or remedies. Calmette's injection ofa 1 per cent, solution of gold chloride gave somewhat more promising results. This material appears to possess the power of rendering cobra venom inert when mixed with it before injection, but its ability by subsequent introduction to restrain the lethal action of the venom which has previously entered the system alone seems to be very limited, and for practical purposes nil. Calmette now recommends injection of solutions of the alkaline hypochlorites and of the serum of animals which have been rendered immune by repeated injection of increasing strengths of venom. Professor T. R. Fraser of Edinburgh, has recently detailed at the Royal Society of that city the results of a series of experiments made on these latter lines. He starts with the fact of the immunity of venomous
vocation,
are matters
snakes themselves,
an
quired by absorption
immunity probably
of their
own venom.
ac-
Since
1889 he has endeavoured by experiment to establish this immunity in other animals. The results
[August
1895.
of his experiments are summarised in the following cutting:? Experimenting on rabbits, among other animals,
he first satisfied himself as to the amount of the poison which constituted the minimum lethal dose. He then proceeded to inject quantities below this amount, and found that he could gradually increase them to fifty times the dose originally fatal. But not only that, for a buck rabbit which he exhibited, and which was then in about the 150tli day of treatment, had gained enormously in weight, from 2000 grammes, to 3,000 grammes, and had increased greatly in strength, and especially in virile power. Again, he found that the mixture of 1/240 cc. of serum obtained from a rabbit immunised to thirty times the minimum lethal dose with cobra venom averted a fatal result on injection, while the injection of a similar serum half an hour after the injection of a venom which otherwise proved fatal in one hour, promptly stopped the symtoms which had already commenced and saved the life of the animal. He called this protective He also serum by the name of Anti-venine. mentioned as an interesting fact that the rabbit above referred to had received during the months of treatment enough cobra poison to kill two horses, or about 280 rabbits if unprotected. Not only are Professor Fraser's results of the greatest value for the treatment of snake-bite in India and other tropical countries, but, as he himself remarked, they possess a deeper significance, in accentuating, as they do, the wonderful progress made in serum-therapy during the last few years, and are an earnest of still more wonderful discoveries yet to be made in the same direction. It appears also that immunising an animal with the venom of one kind of serpent protects from the poison of other species. Meantime I note that, the number of deaths by snake-bite registered in British India in 1873 was
23,773.
The vital statistics of London for the year 1894 have recently been published. The estimated population is 4,349,166, covering an area of 121 square miles. This gives a density of 58 persons per acre; but the various districts comprised in the gross area of the city present very different figures rising from 30 persons per acre in Hampstead, Lewisham, Wandsworth and Woolwich to 196 in Whitechapel. The marriagerate was 17, the birth-rate 30*1, and the deathrate 17'8 per 1000. The first two rates are below the average, but the last is the lowest that has been recorded. The rate for the four preceding years was 20 7, and the saving of life in 1894, as compared with the preceding decennium, amounted to 11,660. This is a very substantial gain, and must be placed to the credit of sanitation. The death-rates of other large towns in England varied from 13*2 (Croydon) to 2-'j-8 (Liverpool). Measles and diphtheria were the diseases of the
August
1895.]
SMALL-POX IN CALCUTTA.
class which presented the most noteThe latter has beer) unprecein London for some years past. The Annual Meeting of the British Medical Association is to take place in London at the end of July, and will probably be largely attendThe subject of the serum treatment of ed. diphtheria is down for discussion in the Medical Section. A vast amount of material has now been accumulated and recorded on this question, and it is very desirable that some guiding decision should be arrived at regarding the value and risks of this plan of treatment, regarding which there is at the present time much dispute and doubt.
zymotic
worthy excess. dently prevalent
14tli June 1895.
3I3
Viceroy, acts as Inspector-General of Civil Hospitals of the Punjaub while Surgeon-Col. Raye is on privilege leave. HONOURS TO MEDICAL OFFICERS IN CHITRAL. The medical profession will have received the news with pride of the Queen having conferred on Surgeon-Captain Whitchurch the Victoria Cross for his gallant conduct in rescuing Captain Baird, and of Her Majesty having made Surgeon-Major Robertson a K.c.s.i. A MEMORIAL TO THE LATE Dr. J. M.
COATES. There has been a general expression of feeling" out of the respect in which the late Dr. Coates was held that some permanent To monument should be raised to his memory. out we would a rethat this, carry suggest presentative Committee should be formed. In the meantime the Editor of the Gazette will be willing to receive subscriptions and publish the names of subscribers. A subscription for the same purpose has already been set 011 foot by the members of the Medical Association of India, of which Dr. Fernandez is the Secretary.
arising
LONDON LETTER. The Summer Meeting of the General Council of Medical Education and Registration was held in London from May 28th to June 5th. The principal item in its proceedings was a consideration of the " Midwives' Registration Bill," which was introduced into the House of Lords by Lord Balfour of Burleigh, and has been read The Bill -was a second time in that assembly. referred by the Lord President of the Council to the Medical Council for an expression of opinion It was thoroughly examined on its proposals. by a Committee of the Council, and the report of this Committee underwent very full discussion. The main object of the Bill is to provide for poor people who cannot afford to engage the services of a medical practitioner, the assistance of competent and qualified midwives in natural labour. It is proposed by the Bill to create a Midwives' Board analogous to the General Medical Council, under whose authority qualified midwives are to obtain the privilege of legal registration. The conditions, as regards present and future midwives under which this privilege is to be accorded, and the nature of the control and supervision under which they are to exercise
INDIAJN MEDICAL GAZETTE.
312
their
and retain their place on the which are to be settled by register, the Midwives' Board in concert with the Medical Council. The proposed legislation bristles with difficulties. How far it will hinder incompetent and unqualified women from undertaking the management of labour cases is very doubtful. Whether it will materially trench upon the practice of medical men is also questionable. The definition of natural labour is by no means easy, and who is to draw the line when the ministration of the registered midwife is to end and the aid of the skilled accoucheur is to be put in requisition. Obviously, this responsibility must rest with the midwife, and no law or regulation can define the limits of her discretion, which must depend on her knowledge, skill and temperament. It would be easy enough to expand the catalogue of difficulties which this new departure may and must involve, but that the new legislation will tend to create a better educated and qualified body of midwives there can be no doubt, and for the rest, time and experience must be left to smoothe down obstacles to the easy and safe working of the system, and adjust the professional relation of medical men and midwives to the end of securing the greatest possible good That is the main for women in childbirth. point, and administrative troubles must be made to yield in view of the necessity of achieving this purpose. The subject of the treatment of snake-bite has once again come to the front. I gather from the Annual Report of the Sanitary Commissioner with the Government of India for 1893 which has recentty come to hand that Dr. Douglas Cunningham has subjected a variety of reputed snake cures to thorough scientific testing. Nitrate of strychnia and saturated solutions of Periodate crystals have been shown to be utterly inefficacious, whether as antidotes or remedies. Calmette's injection ofa 1 per cent, solution of gold chloride gave somewhat more promising results. This material appears to possess the power of rendering cobra venom inert when mixed with it before injection, but its ability by subsequent introduction to restrain the lethal action of the venom which has previously entered the system alone seems to be very limited, and for practical purposes nil. Calmette now recommends injection of solutions of the alkaline hypochlorites and of the serum of animals which have been rendered immune by repeated injection of increasing strengths of venom. Professor T. R. Fraser of Edinburgh, has recently detailed at the Royal Society of that city the results of a series of experiments made on these latter lines. He starts with the fact of the immunity of venomous
vocation,
are matters
snakes themselves,
an
quired by absorption
immunity probably
of their
own venom.
ac-
Since
1889 he has endeavoured by experiment to establish this immunity in other animals. The results
[August
1895.
of his experiments are summarised in the following cutting:? Experimenting on rabbits, among other animals,
he first satisfied himself as to the amount of the poison which constituted the minimum lethal dose. He then proceeded to inject quantities below this amount, and found that he could gradually increase them to fifty times the dose originally fatal. But not only that, for a buck rabbit which he exhibited, and which was then in about the 150tli day of treatment, had gained enormously in weight, from 2000 grammes, to 3,000 grammes, and had increased greatly in strength, and especially in virile power. Again, he found that the mixture of 1/240 cc. of serum obtained from a rabbit immunised to thirty times the minimum lethal dose with cobra venom averted a fatal result on injection, while the injection of a similar serum half an hour after the injection of a venom which otherwise proved fatal in one hour, promptly stopped the symtoms which had already commenced and saved the life of the animal. He called this protective He also serum by the name of Anti-venine. mentioned as an interesting fact that the rabbit above referred to had received during the months of treatment enough cobra poison to kill two horses, or about 280 rabbits if unprotected. Not only are Professor Fraser's results of the greatest value for the treatment of snake-bite in India and other tropical countries, but, as he himself remarked, they possess a deeper significance, in accentuating, as they do, the wonderful progress made in serum-therapy during the last few years, and are an earnest of still more wonderful discoveries yet to be made in the same direction. It appears also that immunising an animal with the venom of one kind of serpent protects from the poison of other species. Meantime I note that, the number of deaths by snake-bite registered in British India in 1873 was
23,773.
The vital statistics of London for the year 1894 have recently been published. The estimated population is 4,349,166, covering an area of 121 square miles. This gives a density of 58 persons per acre; but the various districts comprised in the gross area of the city present very different figures rising from 30 persons per acre in Hampstead, Lewisham, Wandsworth and Woolwich to 196 in Whitechapel. The marriagerate was 17, the birth-rate 30*1, and the deathrate 17'8 per 1000. The first two rates are below the average, but the last is the lowest that has been recorded. The rate for the four preceding years was 20 7, and the saving of life in 1894, as compared with the preceding decennium, amounted to 11,660. This is a very substantial gain, and must be placed to the credit of sanitation. The death-rates of other large towns in England varied from 13*2 (Croydon) to 2-'j-8 (Liverpool). Measles and diphtheria were the diseases of the
August
1895.]
SMALL-POX IN CALCUTTA.
class which presented the most noteThe latter has beer) unprecein London for some years past. The Annual Meeting of the British Medical Association is to take place in London at the end of July, and will probably be largely attendThe subject of the serum treatment of ed. diphtheria is down for discussion in the Medical Section. A vast amount of material has now been accumulated and recorded on this question, and it is very desirable that some guiding decision should be arrived at regarding the value and risks of this plan of treatment, regarding which there is at the present time much dispute and doubt.
zymotic
worthy excess. dently prevalent
14tli June 1895.
3I3
