THE FIFTEENTH INTERNATIONAL CONGRESS OF MEDICINE.
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possible within the four corners of a single Act to bringall law and order into disrepute. The most effective methodsof preventing juvenile smoking would be those adopted bythat able officer of His Majestys navy, Mr. Falcon, asrecounted by Peter Simple, but it is to be feared thatmodern sentiment would not allow such obvious interferencewith the liberty of the subject.Apart from the futility of the particular measure
the question of the desirability of interference withjuvenile smokers, and especially of interference to beconfined within a new and arbitrary age limit, is onethat calls for careful consideration. If there is to beinterference at all, why should it cease at the age of 16years and why should it not extend to the period at whichyoung people become legally independent and responsiblein all other directions? The sole basis of the proposedlegislation is that smoking is believed to be injuriousto the bodies of the immature, just as extravagancewould be injurious to their estates. A minor is notallowed by law to dissipate his estate ; why should he beallowed to persist in an indulgence which would dissipatehis health ? The positive evidence which we possessof the poisonous action of tobacco is mostly, if notentirely, furnished by adults. The subjects of tobaccoblindness are usually men in middle life and it is,perhaps, rare to recognise tobacco as a cause of any definiteailments under 30 years of age. Lord Roberts has recentlysent a message to the boys of Birmingham in which hetells them that they cannot be "thoroughly fit" if theybegin smoking when they are growing lads. He adds thatsmoking affects the nerves and prevents a boy from becominga good rifle shot. It affects the heart and may render theboy incapable of undergoing the hardships of active servicewhen he is grown up. Lord Roberts, no doubt, is abso-lutely convinced of the accuracy of these statements, andI am so far from desiring to question them that Ithink they are very probably well within the truth.But if they are true for growing lads they are probablytrue also, if possibly in a less degree, for adults. LordRoberts advises boys not to smoke until they havepassed the age of 18 years, while Dr. MacnamarasBill would fix 16 years as the age for commencement.What is the evidence in favour of either limit ? orwhat reason is there to believe that a practice which isinjurious at 17 years of age would be harmless or even..:1 :- -........._4-t..... lLOo.4-,.,.....f)
Are we not in need of careful physiological inquiry into theaction of tobacco, and do we really know much about itbeyond the admitted facts that it is highly injurious in acertain proportion of smokers, and apparently harmless to themajority, who, moreover, would not pursue an expensivehabit unless they derived some sort of gratification from it ?Many persons are of opinion that a race which had grown upoutside the influence of narcotics would be in every respectbetter, stronger, more capable, and, in a word, moremanly, than a race which had become dependent uponthem ; and it is certain that history would not assignto the users of such agents a high position among the irulers of the world. Looking beyond quite modern times, Ithe Turks have been the greatest consumers of tobacco andthe Hindoos and Chinese of opium, and the examples setby these nations are not entirely encouraging to those whofollow them. Neither the heavy smokers of our own day northe habitual consumers of morphine, of cocaine, or of othervegetable narcotics are likely to be largely contributory tothe success of the Imperial idea, and if we put asidepreconceptions arising from personal tastes or socialhabits it is difficult not to conclude that the undruggedman is likely to be in all respects better than thedrugged one. The history of opinion upon the subject is farfrom being satisfactory and it is high time that opinion wasreplaced by knowledge. A physiological inquiry into theaction of tobacco, if carefully and impartially conducted,would be likely to furnish results of much practical value tomankind. I am. Sirs. vours faithfully.
April 9th, 1906. F.R.C.S.
THE ARMY MEDICAL RESERVE.- /!? the ffditors of THE LANCET. I
SIRS,-The idea of forming a Royal Army Medical Corps Ireserve out of young surgeons who would be obliged to gothrough a definite course of training may be a very good one,although it remains to be seen how the method will work I
when put into operation, the first essential to its origin beingthe supply of men to train. Will enough men be found todevote the time not only for initial but for annual training ? 7For as years went on medical men would not find it easy toleave their work for a month in the year to be devoted solelyto military reserve training. But what about the hundredsof civil surgeons who went through a long training andgained experience in the South African war ! 1 Why isthere no scheme to utilise the services of men whoreceived not one month in a year but 12 months ormore of active service abroad r! It cannot be that these wereof no use and that they did not gain experience. It wouldappear that there is a reserve ready made if the War Officewould but bring it out-at least, amongst such men asobtained satisfactory reports for services rendered. TheWar Office should have created a strong Royal Army MedicalCorps reserve after the South African war of men who hadseen hard and long training and service.
I am, Sirs, yours faithfullv,April 9th, 1906. WAR DOG.
THE FIFTEENTH INTERNATIONALCONGRESS OF MEDICINE.(FROM OUR SPECIAL COMMISSIONER.)
Lisbon, April 12th.WHAT THERE IS TO BE SEEN AND STUDIED AT LISBON.THE members of the International Congress of MeUcine
will find that apart from the debates and business of theL7 sections there is much to observe and study in Portugal.All travellers have admired the beauty of the site, the aspect3f the seven hills now comptised within the extendedboundary of Lisbon, and the majestic expanse of the Tagus,with its many ships of war and of peace lying at anchor infront, and, as ic were, at the very feet, of the ancientcapital. The quaint, steep, winding, narrow, old streets,the broad tree- and flower-planted modern avenues, theseand many other characteristic features of the capital ofPortugal will not fail to charm and to impress the visitor.But apart from such general attractions the members of theCongress will find a great deal that is of special technicalinterest to them as medical men and as sanitary reformers.
It is, indeed, curious how little seems to be known inEngland about Portugal. Certainly it is but a small country,yet in the periodical literature of England, the newspapersand the magazines, articles and dissertations abound aboutsuch small countries as Holland, Belgium, and Switzerland.On the other hand, Portugal is but rarely mentioned.Perhaps the Fifteenth International Congress of Medicinewill help to remedy this omission. If the members canonly find time to go about and to investigate some specialquestions, to visit some of the institutions in which theyare particularly interested, they will discover that inmany respects Portugal is quite abreast of the times.It may even be said that in some important mattersLisbon leads the way. For instance, how much Londonwould gain if it possessed a model slaughter-house such asthat which was built long ago at Lisbon. How extremelyinteresting also is the long and arduous struggle of theauthorities to secure cheap and wholesome meat for thepeople. Some years ago the cattle-dealers formed a "ring"or
" combine " so as to control the market. Instead of com-peting with one another they agreed to pay less for cattleand to increase the sale price of meat. Thus theywon on both sides and this at the cost of the cattle-breedersand of the consumers of meat. Thereupon the municipalitythought it would break up this "combine" by itselfbuyirg cattle and selling meat. Municipal butchers shopswere therefore opened in various parts of the town and evenhawkers were sent round to sell the municipal meat onbarrows. The cattle-breeders, however, failed to appreciatethis action, though it was intended to protect their interests.Instead of supporting the municipality they allied them-selves with the cattle-dealers and so arranged matters thatthe municipality had to pay a very high price tor the cattlewhich it bought ; on the other hand, as the municipalitysold the meat very cheaply it soon incurred a heavy loss. Butthe greatest disappointment of all was the fact that hardlyany poor people profited by this action ; they rarely gothold of any of the municipal meat. It was for the most
part bought up by hotel keepers and people who were richenough to bribe the intermediaries. A special municipalcommittee was then appointed to investigate the question.
After a long inquiry the present system was instituted.A sort of monopoly was offered and tenders were invited. The- concessionaire or monopolist would be the so:e personauthorised to buy cattle, but, on the other hand, he had so toarrange matters that the meat could be retailed to the publicat an average price of about lOd. pf r pound. A regular tariff-is established in regard to the various parts of meat and theretail price at which it is to be sold. The number of butchersshops allowed is limited and the police watch constantly to:see that the meat is sold at the prices fixed by the tariff.But the object was not only to prevent such speculations andcombinations as would tend to increase the retail price ofmeat ; it was also thought desirable to encourage the homebreeders of cattle. Therefore the concessionaire was alsobound down by the terms of the contract to purchase hiscattle from the Portuguese cattle-breeders. If, however,through some exceptional or other circumstance-theshortage of supply or the outbreak of cattle disease-rortuguese cattle becomes too dear for the meat to beretailed at the regulation price then the concessionaire is
The School of Medicine, Lisbon, w. er3 the Congress holds its meetings.
allowed to import cattle from abroad and this with- ,,out having to pay any duty. Finally, in case ofextreme emergency, the importation of frozen meat would be sanctioned. But this latter contingency is con- sidered so improbable and viewed with so much dislikethat no cold storage rooms exist at the slaughter-house. Itwould be necessary to build such places before frozen meatcould be imported. Therefore visitors to Lisbon will enjoyfresh meat and will not be called upon to eat any coldstorage meat. ,
In this arrangement, however, two important and Idominating factors were not taken into consideration. Itwas forgotten that as it was almost impossible to prevent ISpanish cattle straying over into Portugal and Portuguesecattle wandering away into Spain, causing any amount offrontier disputes and " incidents," a treaty had been Iconcluded abolishing all duties on cattle between the itwo countries. The second omission was that no account I-was taken of the varying value of gold. Some years Iago, when Portuguese credit was at a low ebb, the Spaniard,with cheaper gold, had every advantage in buying cattle in I- Portugal.But in time the conditions altered, gold became :
cheaper in Portugal ; there was a moment during the warbetween Spain and the United States of America when goldwas at 100 per cent. premium in Madrid, and even to-day it isat 30 per cent. premium. Therefore it is the Portuguese whohave every advantage in buying Spanish cattle, particu-larly if these can be passed off as Portuguese cattle andsold at the enhanced price artificially created so as toencourage cattle breeding in Portugal. Thus now a greatdiscussion has arisen as to what constitutes a cattle breeder.There is a cattle market not far from the slaughter-house.Here there is, and can be, only one purchaser, but there aremany to sell. Here the live cattle are inspected by veterinarysurgeons and the one purchaser has every interest to seethat cases of disease are detected ; he has also every interestto prove that the cattle are not home bred, because ifthere are not enough Portuguese cattle he may bargainand beat down the price of imported cattle. Havingsecured the necessary amount of cattle the concessionairehas to hand them over to the municipal authodties at theslaughter-house and pays them for killing. This, from thepublic health point of view, is the most important partof the proceeding. All the slaughterers. all the workerswho prepare the meat and carry out the multifarious other
processes connected with the killing of animals for food, areI mployed by the municipality. No one has any interestto i-erve in i-aving from destruction any unwholesome meat.The retail butcher. who, by the way, is not a butcher sincehe does not kill, has every interest in having only soundmeat, since it does not come from his own cattle. Thebutcher has no cattle, he is simply a tradesman, and his onlyinterest is in so satisfying his customers so as to keep themand increase their number. Thus it will be seen that, what-ever criticism may be made of the present system, it in anycase contributes vejy materially to secure wholesomefood for the public. The concession described above, itmust be added, only applies to cattle that produce beefand veal. For hogs and sheep anybody may buy orsell, but no one must kill. If an individual was tokill his own pig or sleep he would be severely punished.At the municipal slaughter-house only, and by themunicipal employees, is the killing of any animal forfood allowed. No one may do this work who has theslightest interest in passing on to the public unwholesomemeat. The consumption of meat at Lisbon amounted in1898 to an average of 31-7 7 kilogrammes per inhabitant. In
a special study on the hygiene of slaughter-houses I hope todescribe in detail the technicalities of the Lisbon slaughter-house together with the abattoirs of several other towns.This will form part of the controversy in regard to theChicago stockyards. For the moment I will only say thatall members of the International Congress of Medicine whotake an interest in such public health questions should notfail to visit the model abattoir of Lisbon. They will be allthe more surprised with the excellence of the arrangements,the abundance of space, air, and light, when informed thatthis is no new institution but was built so far back as 1871.To assist such inquiries the organisers of the Congress
have just published an excellent medical guide to Lisbon. Ofthe map which it contains mention has already been made andthere is an excellent index, so that the information desiredcan be obtained in a moment. First we find statistics as tothe climate, followed by vital statistics. In 1886 ten sur-rounding parishes were added to the city, thus raising thepupulation from 187,404 to 242,297 according to the censusof 1878, but in October, 1905, independence was restoredto a couple of these parishes, reducing the population of thecapital from 311,206 to...