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cannot as yet offer any suggestion as to the mode

by which the micrococcus obtains entrance into the

human body the whole history of science teaches us

to expect that the knowledge of causation will be the

first step towards the attainment of control. In many other

directions the abundant material of the hospital will no

doubt admit of being utilised for the benefit of mankind,and the appeal is one which will, we trust, meet with a

prompt and sufficient response. It was a saying of

FARADAY that new knowledge is frequently passingunrecognised before our eyes, and those who are eager

to be on the watch for its appearance and its applicationsare certainly entitled to have all unnecessary difficulties

removed from their path. Of these, so far as research

is concerned, one of the most important is its costliness. Wehave the men, we have the opportunities, and what we

chiefly want is to have "the money too."

Annotations.

THE HOUSING QUESTION.

II Ne quid nimis."

IN THE LANCET of Jan. 23rd, p. 248, attention was calledto the evidence given at an inquest as to the enormous rentcommanded by those who let rooms to the poor in the East-end of London. The difficulties which beset the question ofproviding the working classes and the poor in London withsufficient and sanitary living accommodation at a price whichthey can afford to pay are not diminished by the class oftenant which has to be provided for in many instances. The

following case, which recently occupied the attention of theLord Mayor and aldermen at the Mansion House police-court on two successive days, well illustrates this and atthe same time shows the high rental exacted by land-lords for the rooms in which they allow their tenantsto huddle themselves regardless of decency and health.The danger, both physical and moral, to children broughtup in such circumstances and the fact that cases of

apparently genuine distress are carefully investigated in

the City will also be observed. On the first day of inquirythe charge was against a woman named Nowell of exposingher two boys, aged nine years and five years, by causingthem to beg in the streets. When arrested she had nine

pennies upon her and she pitifully entreated the presidingalderman not to take her children from her and to send themto an industrial school, saying that they went to schoolregularly already. The police stated that as far as they hadthen been able to ascertain the husband was a hard-workingman who had been out of employment as a dock labourerand who during the past week had only been able to gethalf a day’s work. They added that he and his wife, adaughter aged 19 years, a son aged 17 years, and three

children, aged respectively nine years, five years, and two

years, lived in a single room in Spitalfields, where they slepton the bare boards and that for this shelter they paid 7s. aweek rent. With respect to the children, the alderman, whono doubt had experience of such cases, remained obdurate,but while they were remanded for further inquiries andfor a school to be found for them, the parents werenot forgotten and the Mansion House Unemployed Com-mittee was able to send a police constable at once to

the father with the address of a firm where employmentwould be given to him. On the following day evidence wasgiven that the constable intrusted with the matter called

several times at the address of the working man butfound no one there, and that the man took no notice of

a message left for him informing him of what would bedone on his behalf and recommending him to call at the

police station. Finally, the constable went to the room

in question between 10 and 11 at night when he

found the husband drunk and quarrelling with his wife.

He gave his message but the man refused to listen

to it or to take the address of the firm which wouldhave given him work. At the same time he was abusive,declared that he would drink every halfpenny he had got,and with regard to the proffered employment said that hedid not want ’’ any of your - twopenny-halfpenny jobs." Itwill easily be understood that while parents of this class canlive upon their children’s mendicancy, and while those whogive alms indiscriminately will assist them to do so, it is diffi-cult to prevent children from being brought up in the midstof disease, starvation, and crime. The housing question isalso rendered more complicated where people of this classexist in considerable numbers. They will not go into

quarters where decency and reasonably good behaviour withthe regular payment of rent are insisted upon and as longas they can find buildings of any kind where they will betolerated they are content to live there under conditions

dangerous to their own health, that of their children, andthat of the public. To enforce universal conditions of

sanitary life in the case of a huge population, leaving as theonly alternative prison or the streets, seems hardly possible.but short of such compulsion it is not easy to see how a.

healthy and decently behaved people can be obtained orhow matters can be prevented from going from bad toworse. Any measures not universally applied tend to

increase the congestion in the districts where cleanlinessand sanitation are already most needed.

THE POSITION OF WORKHOUSE MEDICALOFFICERS.

WHILE as the result of concerted action on the part ofmembers of the profession the status of medical men in

the navy, army, and Indian services has been improved,the apathy exhibited by Poor-law medical officers has

prevented any improvement in their circumstances andhas even in some cases been productive of changes for theworse. Triumphant democracy has reversed the old socialorder and the workhouse medical officer, who has probablysome claim to be regarded as a man of culture and education,holds his post at the will of persons with whom he wouldnot in a private capacity care to associate. In a similar

way the Local Government Board still insists on includingthe control of the medical officer among the functions of amaster and a matron who are often enough a promoted gateporter and his wife. Our attention has been called to a casein which the right of a medical officer to admit a visitor to award nominally in his charge is disputed by the master andmatron and however absurd such a condition of affairs mayseem it is clear from the orders of the Local GovernmentBoard that the right can only be exercised by permission ofthe officials mentioned. Thus it was laid down, in 1847 beit noted, that one of the duties of that dignified andpotent officer the porter is "to keep the gate and to

prevent any person not being an officer of the work-house or of the union, an assistant Poor-law commis-sioner or any person authorised by law or by thecommissioners or guardians from entering into or going outof the house without the leave of the master or matron."The attitude of the Local Government Board towards the

hierarchy of the casual ward is shown by a circular letterissued in January, 1895, which runs thus : " The improve-ment that is taking place in the character of workhousenursing from the employment of trained nurses ccasionally

315

leads to objection3 being raised t) the legitimate exercise ofthe authority of the master and matron in the arrangementsconnected with the sick wards. The Board consider that

so long as these establishments are constituted as at

present the nurses should ba responsible to the medical

officer for the treatment of the patient, but should clearlyunderstand that in other matters they must defer to theauthority of the ma,ter and matron." From the views

expressad by the recent Departmental Committee on Nursingit woutd appear that the Board is not now quite so sure ofthe advisability of leaving a free hand to the master and

matron as regards nurses. Perhaps in course of time it

may recognise that the medical officer, too, has feelingsworthy of consideration.

-

SCIENCE IN BOYS’ SCHOOLS AND MEDICAL

EDUCATION.

AT no time probably since the introduction into this

country of compulsor.v school attendance has more generalinterest been taken in the question of the subjects andmethods of education than at the present moment. Wehave left behind us, we hope for ever, the controversy as tothe practical utility and absolute necessity of some form ofeducation for every one of our fellow subjects. We are now

entering upon what bids to be even a more prolonged con-troversy as to the matter and manner of education whichshall prove most efficacious in fitting our race to performits allotted functions. Now that it is recognised thateducation is for all it is being questioned whetherthe methods of instruction in the past may not be im-

proved upon. Doubt as to the perfection of our methodsextends through every department of learning from theboard school to th university. To our shame, but also

perhaps to our advantage at the present time, other countrieshave recognised the need of reform before us and havemade experiments in various directions from which if we arewise we may profit. As in medicine so in education, theempirical method is not always the best means of testingefficiency. It is not easy to estimate the influence of all thefactors in the environment and because good men are turnedout from our public schools it does not follow that the

character of the education in those institutions does not need

improvement. It is not only by watching the result ofdifferent forms of education that we can tell which is

the most desirable. Thoughtful consideration of the

objects to be attained by education and of the probableresults of different measures may often lead to prac-tical reforms, just as researches in the laboratory andthe contemplations of philosophical pathologists have oftengiven the clue to effective methods of treating cases

which have baflied practical physicians. In tryingto ascertain the particular scheme of school education

most suitable for an intending student of medicine it

is not sufficient even if it were possible to contrast the

respective merits of medical practitioners submitted to rivalmethods of scholastic treatment. Statistics could be put tono more futile use than to estimate the percentage ofsuccesses in final medical examinations achieved by candi-dates educated on the classical and modern sides respec-tively of our chief public schools. Nevertheless, those whoare engaged in medical education must necessarily take thekeenest interest in the preliminary instruction of their

pupils and they are generally supposed to hold strong viewsupon the much-vexed qaestion of the role of science in

school education. The belief that teachers of medicinewould naturally desire that their pupils should havestudied science at school arises from a false assump.tion as to the chief objects of a boy’s education againstwhich a strong current of opinion is now setting. The

tyranny of the examination system is causing a revolt

against the view that the acquirement of knowledge isthe main object of education. Systems of educationdominated by examinations tend to become little else thanmethods of storing facts in students’ brains, since it is thesuccess of this process which is most readily estimatedby the examiner. If a teacher of medicine desired his

pupil to be handed over to him with his brain well storedwith facts upon which subsequent knowledge could be builtthere is no doubt preference would be given to one who hadbaen instructed in a school in which natural science wasfully taught. But teachers of medicine, in common withall those whose duty it is to import instruction to

youths who have completed their school curriculum, findthat their best material is characterised not by knowledgebut by brain power. The facts which a boy has acquiredat school are of little importance compared with the

effect that the school training has had upon his intellectand his morals. A boy of high moral sense, well trainedto observe and capable of logical reasoning, will make a

better medical student though he has never had the leastsmattering of so-called Ecientific education than an un-

observant boy with an illogical brain stuffed with facts con-nected with elementary chemistry, physics, and biology.Recognising this fact the medical profession should use itsinfluence to secure that the course of study in preparatoryand public schools should be that bast suited to develop aboy’s senses and intellectual faculties regardless of the sub-sequent uses to which the facts acquired may be put.Schoolmasters are already too much harried by those,whose sole idea of education is that it shall provideuseful knowledge. Science is more or less on its

trial as a subject of education in schools and it is believedby some to be a very unsuitable subject. It would beunfortunate if the supposed needs of- the medical student ledto the retention in the school curriculum of a subject whichfailed to promote intellectual development, inasmuch as thepure science which a medical student requires can easily beprovided after school is over. There are some who are

disposed to give great credit to the medical profession forsuch share as it has had in encouraging the establishment ofscience laboratories in secondary schools. It is a questionrequiring the most thoughtful and careful considerationwhether such laboratories are of real value and in helping tosolve this problem the medical profession must not regard

, the matter from a selfish or utilitarian point of view.

ALBUMINURIA IN THE NEWLY BORN.

If is well known that the urine passed shortly after birthdiffars in several details from that passed later, notablyin being of low specific gravity, turbid from uric acid andepithelial cells, and of darker colour. Dr. Ssesenowski of

St. Petersburg has investigated the urine of infants in thefirst few days after birth with especial reference to the

presence of proteid substances and has recorded his observa-tions in the Wrasehebneia Gazette, No. 21, 1903. He-finds that in the first six days after birth traces of albumin

can be detected in 22 per cent. of the cases and traces ofmucin in nearly every case. On the first day after birth albu-min can be demonstrated in as many as 30 per cent. It i&

found more frequently where labour has been protractedand is thus more common in first-born children. The less

the absolute body-weight of the infant, and the greater therelative diminution of this in the first days of life, the morefrequent is the presence of albumin ; moreover, its presenceappears to depend to some extent upon the temperature ofthe infant. The presence of mucin is most constant on thefirst day after birth, when it can be demonstrated in 96 percent. of the cases. It gradually lessens, so that on the sixthday it can only be found in 50 per cent. Tracer of uric acidare found in 60 per cent. and both this substance and