1765

to procure the disuse of all preservatives in milk. Accurate

knowledge of recent decisions is, of course, necessary for

those concerned with the enforcement of Acts of Parlia-

ment, and the editing of Mr. Lloyd has placed suchdecisions in a compendious form, with a sufficiency of

judicious comment. A note on the subject of drugsand their adulteration points out that, although a SelectCommittee, considering an amending Bill in 1879, recom-mended the adoption of the British Pharmacopoeia as

a standard for drugs in proceedings under the Food andDrugs Acts, their advice was not carried out. To a limitedextent the British Pharmacopoeia may no doubt be used as

such a standard, as, for example, when a compound namedin the Pharmaeopmia, is asked for by the title under

which it there appears, and when the Pharmacopoeiastates exactly what the constituents of the article in

question should be and in what proportions they should becombined.

The Public Health (London) Act, 1891, with an A_ppendixcontaining Statutes affecting the Metropol2s. Second edition.

By ALEXANDER MACMORRAN, M.A., one of His Majesty’sCounsel, one of the Editors of " Lumley’s Public Health";and E. J. NALDRETT of the Middle Temple, Barrister-at-Law.London: Butterworth and Co. and Shaw and Sons. 1910.

Pp. 569. Price 20s. net.-Messrs. Macmorran and Naldrett

have prepared a second edition of a work of great useful-ness which brings it up to date, or, as they would appa-rently express it, "down" to date. The Public Health

(London) Act, 1891, has not required any extensive revisionor amendment since its passage through Parliament nearly20 years ago, and the statutes affecting it which have becomelaw during that period take the form, to a great extent, ofLondon County Council (General Powers) Acts, the relevantportions of which are contained in a not over-voluminousappendix. The cases decided under the main Act, whichhave to be noted under the various sections affected,accumulate steadily, as is natural in the circumstances

of growth and development characteristic of modern

London. Thus we find that 18 pages of notes are devoted

to decisions relating to the definition of "drains" and

"sewers," very important problems for discussion when

questions -as to who should defray the costs of maintenanceare concerned. The definition of and distinction betweendrains and sewers were apparently left for inference and forelucidation in the law courts by those who framed the PublicHealth (London) Act, 1891, and as in the case of some othermatters so left to take care of themselves in Acts of Parliament,

’

the legal profession at all events can have no cause to com-plain. A late decision may be noted of a point for which theAct itself might well have provided, in the case of

J. Lyons & Co. v. The Lord Mayor, &c., of London (1909),where the local authority sought to treat as a case of traderefuse the removal from a restaurant of the debris which, inthe case of a private house, would be ’’ house refuse." At

present it seems to be established that if the refuse to be

removed is house refuse in character the mere fact that it

has been produced in the carrying on of a trade does notmake it trade refuse. The name of Mr. Macmorran is so

well known in connexion with the law of local governmentand administration that it is hardly necessary to say that abook on public health, edited by him, is an authoritative

guide to the subject with which it deals ; this second editionwill occupy the high position as a text-book hitherto

occupied by the first.

CAMBRIDGE MEDICAL GRADUATES’ CLUB. -Inconsequence of the death of his late Majesty King Edwardthe annual meeting and dinner of the club will not be heldas usual in July, but are postponed until November.

METROPOLITAN HOSPITAL SUNDAYFUND.

Up to Thursday morning, June 23rd, about £29,000 hadbeen received at the Mansion House, the collections at thechurches generally showing an increase. Among theamounts are :-

- -2- s. d.

1766 SOME MEDICAL ASPECTS OF PROPOSED POOR-LAW REFORM.

THE LANCET.

LONDON: SATURDAY, JUNE ,5, 1910.

Some Medical Aspects of ProposedPoor-law Reform.

AN interesting paper was read by Dr. MAJOR GREENWOODbefore the Medico-Legal Society on May 24th, in which he

discussed the past history of the Poor-law and some of the

proposals of the Royal Commission in their relation to the

work of the medical man both in and outside the Poor-law

medical service. If we take Dr. GREENWOOD’S last para-

graph as summarising the conclusions which he desired to

lay before the Medico-Legal Society they are that reform inthe administration of our charities should go hand in hand

with Poor-law reform and that this is much more likely totake place under a well-considered reconstruction of our pre-sent Poor-law than by its ruthless breaking up." He considersin this connexion that the revenue from charitable sources is

so great that "if our charities were properly organised and.a stop put to the numerous impositions upon them " charitywould step in to aid those who otherwise would come underthe destitution authority, and that the Poor-law would sufficefor the assistance of those not so prevented from havingrecourse to it. This appears to be an opinion in supportof the scheme of Mr. CHARLES BOOTH, the best planyet put forward for making use of the existingmachinery. The difference between such a scheme and

those propounded by the majority and by the minority ofthe Royal Commission is that these both contemplate the

inauguration of a system of organised effort independentof the pecuniary relief of destitution when it has occurred,and having as an object the prevention of the circumstancesin which Poor-law relief, as we understand it, is required.This prevention Dr. GREENWOOD believes to be impossible,a,t any rate upon any large scale.The preventive aspect of the question involves the general

problem of reform, many phases of which have been

discussed recently in our columns. Of these, one of

the most interesting is the question whether in the

future the treatment of disease, as an object of publicassistance, should be transferred to the hands of the

sanitary authority. The majority of the Commissioners,with whom Dr. GREENWOOD must here be in accord,say E° No " ; the minority are responsible for, and

warmly support, the suggested combination of services. Dr.

GREENWOOD, in protesting against anything that would

include the risk of an extension of free medical aid,claims to establish a distinction of principle between

such existing free services as the sanitary service,vaccination, and education, and the provision of medical

treatment as part of the sanitary service. He suggeststhat the first three are instituted primarily for the Igood of the State, and only in a secondary degree for that

of the individual. The medical attendance accorded

under the Poor-law, he appears to think, is promptedprimarily by consideration for the individual. We cannot

appreciate the distinction which he draws. The actual

attendance of the Poor-law medical practitioner affects

the individual precisely as does that of the public vac-

cinator or the school teacher, but the object before the

eyes of the Royal Commissioners who signed either report,as of any legislative change which may follow, will be the

good of the community. Whether the combination of medical

and sanitary service would prove advantageous to the publicin practice is another matter not easily to be settled withouta practical test. The proposal has, however, a great deal tocommend it, and it is not necessary to assume either, as its

opponents are prone to do, that it would necessarily extend

widely the provision of free medical aid or, as its advocatesseem to do, that there could be no room in such a schemefor a’part-time medical officer of health. The MinorityReport contemplates such an extension as part of its generalpolicy, but the combination of sanitary and medical servicesis not altogether inconsistent with the establishment of a

public assistance authority as contemplated by the MajorityReport, or, indeed, with the retention of the present Poor-law system in an amended form. It might be a difficult

thing to organise a combined service working either

under one authority (a health authority) or under the jointsupervision of two authorities (that of public assistance

and the sanitary authority), but that is not the same thingas to say that it is impossible, or that it might not have

practical advantages to outweigh its drawbacks.

The question of the general effect upon the medical pro-fession of carrying out the proposals of one or other of the

reports of the Royal Commission has been frequently dis-cussed. Dr. GREENWOOD raises it again and is of the

opinion that if the medical recommendations either of the

majority or the minority are carried out, it means disaster

for that profession." If by the medical profession is meantthose engaged in private practice it appears that consider-able disturbance and loss to individual practitioners might bethe result ot carrying out in its entirety and with completesuccess either scheme. At the same time, in considering thiswe must bear in mind that both majority and minority aim at

aiding the work of the Poor-law by keeping out of povertydue to ill-health the greatest possible number of workers.Both parties intend, in other words, that there shall be an

important increase in the amount of work done by themedical profession as a whole among the workingclasses, and also that the increase shall be paid for

in part or wholly out of public moneys. This may

imply disturbance of existing conditions of private andofficial medical practice, but it can hardly bring about

disaster to the medical profession, and it certainly is notdesired or expected that it should do so, either by the

majority or the minority. Those who wish to studythe case for a medical service such as the minoritywould approve put with the force of an able advocate

will find it in a paper read little more than a year

ago by Mr. GEORGE BERNARD SHAW to the society

1 THE LANCET, Feb. 27th, 1909, p. 617.