MEDICAL OFFICERS OF HEALTH SOCIETY.
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14 NEWCASTLE-UPON-TYNE INFIRMARY. MOIST GANGRENE OF FOOT AND LEG TREATED BY AMPU- TATION THROUGH THE MIDDLE OF THE THIGH; RECOVERY; REMARKS. (Under the care of Mr. PAGE.) A GARDENER, aged fifty-nine years, a very intemperate man, was admitted on Sept. 13th, 1883, in consequence of moist gangrene of the right foot and leg. The disease com- menced thirteen weeks previously, and it was still pro. gressing. All the toes had separated. The whole of the foot was dead, and a large patch of gangrene had just appeared on the outer side of the leg. The stench was in- tolerable, and the man was reduced to such an extent by pain and exhaustion that it seemed probable if unrelieved he would not survive many days. His whole arterial system was in a very pronounced condition of calcareous degenera- tion. On Sept. 14th the limb was amputated through the middle of the thigh. The femoral artery was so much diseased that an attack of secondary haemorrhage was fully anticipated; but all went well, and on Sept. 24th the anti- septic dressings were discontinued, as the wound was entirely healed. The patient remained in hospital till Oct. 21st, and was then discharged with a good sound stump. ! Remarks by Mr. P AGE.- Whether it is better to amputate or not in cases of spontaneous moist gangrene, and if so, where and at what stage of the disease, are questions upon which there is room for much difference of opinion. In every instance that I have waited for a line of demarcation to form my patient has died exhausted. In this case the relief which followed the removal of the limb was imme- diate; the tongue became moist, the look of prostration soon passed away, the patient was at once able to sleep and to eat, and the wound healed by first intention. Medical Societies. MEDICAL OFFICERS OF HEALTH SOCIETY. A MEETING of this Society was held on Friday, Dec. 21st, 1883, Dr. T. O. Dudfield, President, in the chair. Dr. J. W. TRIPE read a paper on the Artisans and Labourers’ Dwellings Acts, of which the following is an abstract:-He ’ dwelt chiefly upon those sections of the Acts which were defective, and he said that much delay was occasioned by the duty of carrying out the provisions being imposed upon two different local authorities, the Board of Works and the vestries. The pecuniary position of the inhabitants of these dwellings must also be considered ; costermongers and others required a special kind of accommodation ; and then, also, there were some whose habits prevented their being received into model dwellings. Overcrowding was one cf the chief difficulties with which a medical officer of health had to contend, but if a landlord were able to obtain from the magistrate an order for the eviction of a tenant after the medical officer of health had given a certificate that the house or room was unfit for human habitation, and he then did not use his powers, he should be made to suffer the penalties inflicted on him for allowing his tenants to inhabit such houses. Uninhabitable dwellings may be divided into two classes, those which are structurally or by their surroundings unfit for human habitation, and those which could be made habitable by alterations or ordinary sanitary improvements. The value of the houses should alone be paid, taking into consideration their present condition, and without addition for compulsory pur- chase, and no house should be allowed to be occupied after it had been legally decided to be unfit for habita- tion, even during an appeal from the decision. The re- building where unhealthy dwellings have been pulled down should never be undertaken by the local autho- rity, but is most likely to succeed if left to private enter- prise, assisted by advances from persons willing to take shares in building such houses. The houses capable of improvement can be dealt with under the present laws if increased powers were given to local authorities and =their officers, and if the 35th section of the Sanitary Act were to be put in force all over the metropolis. The chief alterations of the law which are desirable may be summed up as follows :-That there should be a central authority to whom all reports of houses structurally unfit for human habitation should be referred, and that improve- ments should be made in the cost of, and the proced ure for, acquiring these houses and the land upon which they are built, as well as the regulations under which new buildings are to be erected. That houses which can be rendered fit for habita- tion without being pulled down should be dealt with by the local authority. That regulations should be made for the whole of London, under the 37th section of the Sanitary Act, for enforcing a periodical cleansing and repairing of houses let at a less rental than j620 a year, and of all houses let in lodgings ; that a register should be kept at the office of the local authority for registration of the name of the owner; that the local authority should be able to close the whole house after the owner had been summoned before a magistrate for penalties for neglect, provided that a second notice should be served upon the owner giving him a reasonable time previously to taking such a step. Mr. WYNTER BLYTH then gave an account of the work- ing of the Artisans and Labourers’ Dwellings Acts in his district, Marylebone. He said that in only one instance had Mr. Cross’s Act of 1875 been applied, the first scheme having been submitted to the Board of Works in 1876, and then containing four blocks, or unhealthy areas. Of these, one alone was taken up by the Board, but two of the remaining three have since been dealt with under Mr. Torrens’ Act. The buildings demolished by the Board of Works contained 800 persons living in 383 tenements, and the rent was about 2s. a week; the death-rate of this area was but 18 per 1000, but that did not include the many who died in hospitals and workhouses. Two years after the representation was made a provisional order was obtained, but seven years will have elapsed before the new buildings can be erected, and of course they will all be more highly rented. The total number of people displaced since 1868 in Marylebone by the working of Mr. Torrens’ Act amounts to 1181. Successive reports had to be made in more than one case on the same premises ; thus, houses reported upon in 1877 had to be repaired twice before the surveyor con- sidered that they must be demolished. The difficulty arising from the Purchase Clause in the Act has only once, and that quite recently, occurred in all the cases with which Mr. Blyth has dealt, but he believes that it is owing to the fact that the greater part of his district is composed of large estates. The leases have been within the twenty- one years’ term mentioned in the Act, the freeholder has not objected, the leaseholder could be ignored, and in one or two cases where the section might have been applied, probably the owner was ignorant of his power. The case which occurred recently, in which notice was given to the authority to purchase, is still under arbitration, and Mr. Blyth deferred making further mention of it. As to the effect of the improvements on the poor, he stated that of the 1000 people displaced in his district a third was of the criminal class, but the rest were of the very poor, who paid with diffi- culty the comparatively low rent of their old tenements, and who could not possibly pay the higher rent of the few new houses which had been erected, If every vestry had worked the Artisans and Labourers’ Dwellings Act thoroughly, an appalling amount of misery, of overcrowding, and poverty would have been the result. The condition of the poor, therefore, admits of only one remedy-building, if it be possible as a commercial undertaking, healthy tene- ments, for which the weekly payment should not exceed a tenth of their weekly wages. In the discussion which followed, the President, Dr. James Edmunds, Dr. Dixon, Dr. Saunders, Dr. Bate, Mr. Green- well, and Mr. Jones took part. CAMBRIDGE MEDICAL SOCIETY. Slow Compression of the Spinal Cord.—Retention of Urine caused by retained Menses and Imperforate Hymen.— Paralysis of Two of the Leg Muscles. A MEETING of this Society was held on October 5th, Professor Humphry, F.R.S., President, in the chair. Mr. LAURENCE HUMPHRY narrated a case of Slow Com- pression of the Spinal Cord occurring in a gentleman, aged seventy-two, active for his age, and engaged at his profession until his last illness. He had been under the care of Mr. Carter (Cambridge) for many years, during which he was
Transcript of MEDICAL OFFICERS OF HEALTH SOCIETY.
14
NEWCASTLE-UPON-TYNE INFIRMARY.MOIST GANGRENE OF FOOT AND LEG TREATED BY AMPU-
TATION THROUGH THE MIDDLE OF THE THIGH;RECOVERY; REMARKS.
(Under the care of Mr. PAGE.)A GARDENER, aged fifty-nine years, a very intemperate
man, was admitted on Sept. 13th, 1883, in consequence ofmoist gangrene of the right foot and leg. The disease com-menced thirteen weeks previously, and it was still pro.gressing. All the toes had separated. The whole of thefoot was dead, and a large patch of gangrene had justappeared on the outer side of the leg. The stench was in-tolerable, and the man was reduced to such an extent bypain and exhaustion that it seemed probable if unrelievedhe would not survive many days. His whole arterial systemwas in a very pronounced condition of calcareous degenera-tion. On Sept. 14th the limb was amputated through themiddle of the thigh. The femoral artery was so muchdiseased that an attack of secondary haemorrhage was fullyanticipated; but all went well, and on Sept. 24th the anti-septic dressings were discontinued, as the wound wasentirely healed. The patient remained in hospital tillOct. 21st, and was then discharged with a good soundstump. !Remarks by Mr. P AGE.- Whether it is better to amputate
or not in cases of spontaneous moist gangrene, and if so,where and at what stage of the disease, are questions uponwhich there is room for much difference of opinion. Inevery instance that I have waited for a line of demarcationto form my patient has died exhausted. In this case therelief which followed the removal of the limb was imme-diate; the tongue became moist, the look of prostrationsoon passed away, the patient was at once able to sleepand to eat, and the wound healed by first intention.
Medical Societies.MEDICAL OFFICERS OF HEALTH SOCIETY.
A MEETING of this Society was held on Friday, Dec. 21st,1883, Dr. T. O. Dudfield, President, in the chair.
Dr. J. W. TRIPE read a paper on the Artisans and Labourers’Dwellings Acts, of which the following is an abstract:-He ’dwelt chiefly upon those sections of the Acts which weredefective, and he said that much delay was occasionedby the duty of carrying out the provisions being imposedupon two different local authorities, the Board of Worksand the vestries. The pecuniary position of the inhabitantsof these dwellings must also be considered ; costermongersand others required a special kind of accommodation ; andthen, also, there were some whose habits prevented theirbeing received into model dwellings. Overcrowding wasone cf the chief difficulties with which a medical officer ofhealth had to contend, but if a landlord were able to obtainfrom the magistrate an order for the eviction of a tenantafter the medical officer of health had given a certificate thatthe house or room was unfit for human habitation, and hethen did not use his powers, he should be made to sufferthe penalties inflicted on him for allowing his tenantsto inhabit such houses. Uninhabitable dwellings may bedivided into two classes, those which are structurally or bytheir surroundings unfit for human habitation, and thosewhich could be made habitable by alterations or ordinarysanitary improvements. The value of the houses shouldalone be paid, taking into consideration their presentcondition, and without addition for compulsory pur-chase, and no house should be allowed to be occupiedafter it had been legally decided to be unfit for habita-tion, even during an appeal from the decision. The re-building where unhealthy dwellings have been pulleddown should never be undertaken by the local autho-rity, but is most likely to succeed if left to private enter-prise, assisted by advances from persons willing to takeshares in building such houses. The houses capable ofimprovement can be dealt with under the present lawsif increased powers were given to local authorities and=their officers, and if the 35th section of the SanitaryAct were to be put in force all over the metropolis. The
chief alterations of the law which are desirable may besummed up as follows :-That there should be a centralauthority to whom all reports of houses structurally unfitfor human habitation should be referred, and that improve-ments should be made in the cost of, and the proced ure for,acquiring these houses and the land upon which they are built,as well as the regulations under which new buildings are to beerected. That houses which can be rendered fit for habita-tion without being pulled down should be dealt with by thelocal authority. That regulations should be made for thewhole of London, under the 37th section of the SanitaryAct, for enforcing a periodical cleansing and repairing ofhouses let at a less rental than j620 a year, and of all houseslet in lodgings ; that a register should be kept at the officeof the local authority for registration of the name of theowner; that the local authority should be able to close thewhole house after the owner had been summoned before amagistrate for penalties for neglect, provided that a secondnotice should be served upon the owner giving him areasonable time previously to taking such a step.Mr. WYNTER BLYTH then gave an account of the work-
ing of the Artisans and Labourers’ Dwellings Acts in hisdistrict, Marylebone. He said that in only one instancehad Mr. Cross’s Act of 1875 been applied, the first schemehaving been submitted to the Board of Works in 1876, andthen containing four blocks, or unhealthy areas. Of these,one alone was taken up by the Board, but two of theremaining three have since been dealt with under Mr.Torrens’ Act. The buildings demolished by the Board ofWorks contained 800 persons living in 383 tenements, andthe rent was about 2s. a week; the death-rate of this areawas but 18 per 1000, but that did not include the many whodied in hospitals and workhouses. Two years after therepresentation was made a provisional order was obtained,but seven years will have elapsed before the new buildingscan be erected, and of course they will all be more highlyrented. The total number of people displaced since 1868 inMarylebone by the working of Mr. Torrens’ Act amountsto 1181. Successive reports had to be made in more thanone case on the same premises ; thus, houses reported uponin 1877 had to be repaired twice before the surveyor con-sidered that they must be demolished. The difficultyarising from the Purchase Clause in the Act has only once,and that quite recently, occurred in all the cases with whichMr. Blyth has dealt, but he believes that it is owingto the fact that the greater part of his district is composedof large estates. The leases have been within the twenty-one years’ term mentioned in the Act, the freeholderhas not objected, the leaseholder could be ignored, and inone or two cases where the section might have been applied,probably the owner was ignorant of his power. The casewhich occurred recently, in which notice was given to theauthority to purchase, is still under arbitration, and Mr. Blythdeferred making further mention of it. As to the effect ofthe improvements on the poor, he stated that of the 1000people displaced in his district a third was of the criminalclass, but the rest were of the very poor, who paid with diffi-culty the comparatively low rent of their old tenements,and who could not possibly pay the higher rent of the fewnew houses which had been erected, If every vestry hadworked the Artisans and Labourers’ Dwellings Actthoroughly, an appalling amount of misery, of overcrowding,and poverty would have been the result. The condition ofthe poor, therefore, admits of only one remedy-building, ifit be possible as a commercial undertaking, healthy tene-ments, for which the weekly payment should not exceed atenth of their weekly wages.
In the discussion which followed, the President, Dr. JamesEdmunds, Dr. Dixon, Dr. Saunders, Dr. Bate, Mr. Green-well, and Mr. Jones took part.
CAMBRIDGE MEDICAL SOCIETY.
Slow Compression of the Spinal Cord.—Retention of Urinecaused by retained Menses and Imperforate Hymen.—Paralysis of Two of the Leg Muscles.A MEETING of this Society was held on October 5th,
Professor Humphry, F.R.S., President, in the chair.Mr. LAURENCE HUMPHRY narrated a case of Slow Com-
pression of the Spinal Cord occurring in a gentleman, agedseventy-two, active for his age, and engaged at his professionuntil his last illness. He had been under the care of Mr.Carter (Cambridge) for many years, during which he was
