686

conditions as syphilis and rheumatism, he does not commithimself on the subject of cancer, though aware of the exist-ence of organisms in the discharges from cancerous ulcers.Marten quotes frequently from the writings of the micro-

scopists whose wonders were then attracting all the scientificworld, and the suggestion of his theory may be traced to aremarkable passage by Frederick Slare which, havingappeared in 1683, antedated the discovery of bacteria byLeeuwenhoeck which is often referred to the year 1687.In the Philosophical Transactions, Vol. XIII., 1683, p. 93,is "An Abstract of a letter from Dr. Winckler, Chief

Physitian of the Prince Palatine ...... to Dr. Fred. Slare...... containing an account of a Murren in Switzerland."In a postscript to this letter Dr. Slare wrote as follows : -"I lately received an account of Two Ingenious Travellers who

assured me the contagion had reached their quarters on the borders ofPoland, having Passed quite through Germany....... They told me thecontagion was observed to make its progress dayly spreading near twoGerman Miles in twenty-four hours ...... that it continaally withoutintermission made progressive voyages and suffered no neighbouringParish to escape : so that it did not at the same time infect places atgreat distances. They added that cattle secured at rack and mangerwere equally infected with those in the Field. It were worth the con-sidering whether this infection is not carryed by some volatile Insectthat is able to make only such short flights as may amount to such com-that is able to make only sztch short flights as may cemoztnt to such com-putations. For the account of the Ancients is very little satisfactory tothis Age, who derive it from a blind putrefaction, from incantations ofill men, or from conjunctions of inauspicious Planets. I wish Mr. ;Leeiveithoeck had been present at some of the dissections of these infected animals, am perswaded he would have discovered some strangeInsect or other in them." (Italics by Editor.)

Marten’s book appeared in 1720, but was dated " Frommy House in Theobald’s Row near Red Lyon Square inHolbourn, Sep. 1st, 1719," and although a second edition, orrather reprint, appeared in 1722, the book seems to haveattracted very little attention from the medical profession ofthe day, and there are certain indications that the demandwhich called for a second issue may have been a popularrather than a scientific one.

It is interesting to note how Marten (exactly like Pasteurmany years later) used epizootics and the phenomena pre-sented by scabies as an illustration of the parallel nature ofthe infectious fevers in man.

Information as to the life and personal character ofBenjamin Marten is almost wholly lacking. He was not aMember of the Royal College of Physicians, nor does he seemto have been a graduate of either of the English universities.His Latinity was not of a high order, while all, or

nearly all, the works from which he quotes were eitherin English or French, or were available in translations intothose languages. He writes, however, a witty and racyEnglish style, and had evidently read carefully the recentscientific literature which had appeared in the vulgartongues.

I have been unable to find any other works of BenjaminMarten, though there were several contemporary authorsbearing the same name. Information concerning so sug-gestive an author and one of such exceptional foresightwould be very welcome, and may, perhaps, be elicited bythis short account of his work. 2

2 A fuller account of Marten’s book has been given by me in theissue of "Janus " for February, 1911.

-

WORKING-CLASS ORGANISATIONS AND SCHOOLCLINICS -On March 4th Mr. George Lansbury, M.P.,presided at a conference held at Caxton Hall, Westminster,of delegates representing 177 trade unions, independentlabour branches, and other working-class organisations toconsider the method adopted by the London County Councilfor dealing with the medical treatment of school children.On the motion of Mr. Pearce of the Hampstead TradesCouncil, seconded by Miss Benton, a resolution protestingagainst the present system adopted by the County Council ofsubsidising London hospitals for the medical treatment ofschool children was adopted. The resolution included ademand for the establishment of special centres supported iby grants from the Imperial Exchequer and adequatelystaffed with medical men, including dentists and nurses. Onthe motion of Mr. T. W. Kelly, seconded by Miss MacMillan, it was proposed that all working-class organisations should i

withdraw their financial support from voluntary hospitals as E

a protest against this use of the hospitals by the London County Council. This proposition was, however, at the I

suggestion of the chairman, amended so that it should apply i

only to hospitals which had made contracts with the LondonCounty Council. The motion was then carried.

THE QUESTION OF COMPULSORY STATEINSURANCE OF EMPLOYERS’ LIABILITYUNDER THE WORKMEN’S COMPENSA-

TION ACT, 1906.BY ALBERT BENTHALL, F.R.C.P. EDIN.

THIS question is in the air, at present in a nebulous con-dition, without form, and void, but, as it will be of the

greatest possible moment to the medical profession, it shouldbe considered in all its bearings before condensation takesplace, and it becomes tangible in the form of a Draft Act ofParliament.For the proper consideration of the question the working

of the present Act must be borne in mind, with its admittedfaults and difficulties, so that the experience gained in thelast 3t years may be used to advantage in the formation of ascheme, certain to come sooner or later, and perhaps soonerthan many expect. Compulsory insurance must take one oftwo forms : (1) that all employers shall be compelled toinsure with a department of the State ; (2) or only those whodo not insure with an insurance company which has compliedwith the regulations of the Board of Trade, and which istherefore approved and accredited by the State.To anyone conversant with the working of the Workmen’s

Compensation Acts of 1897 and 1906, and the losses whichhave been incurred by various insurance companies, whohave in the past insured employers against liability underthese Acts, there would appear to be many difficulties in theway of insurance by the State, unless the State is willing tosustain the immense loss heretofore made by insurers, anda large additional loss also. It is clear that the State couldnot exercise the intimate individual and personal attentionto claims which has been applied by the various offices, alsoit could not attempt to select business or decline un-

profitable risks. Here a large question arises. If every onehas to insure with the State, the State will fix its own rates,and these might be absolutely prohibitory if there were nocompetition. On the other hand, if the present insuranceoffices of undoubted standing are allowed to continue theirbusiness they should be placed on all fours with the State,and the regulations applying to State insurance should be

applied to them. I should like to point out some of theprominent defects of the present Act which entail un-avoidable but perfectly useless loss to every one concerned-employers, those who insure them, and the workmen.

1. Notice of injury : (a) At present a medical certificate isnot required. (b) Need not be sent in reasonable time.Note -1. Any person claiming on a club has to provide amedical certificate, and any workman unable to work in con-sequence of accidental injury must require medical treatment.It would therefore be no hardship to require a short medicalcertificate on a form to be obtained at any post-office, to besent with the notice of accident. 2. Notice of accidentshould be given at once if possible, but certainly within 14days.

2. There is no power to insist in proper medical treatmentbeing obtained. Note.-If a man is sufficiently injured tooe able to claim under the Act he should be compelled toeek the advice and submit himself to the treatment of a

qualified medical practitioner or attend at some hospital.3. There is no method of determining whether a workman

s fit or unfit for work, nor can the workman obtain his halfjay if it is withheld except by expensive litigation, entailingieavy costs. Note.-Employers are therefore severely hit, andnany boni-flde injured workmen suffer.

4. There is no power of reference to a medical refereeexcept by a judge’s order or consent of both parties. Note.-.t is a well-known fact that if one side has a doubtful case anedical reference is objected to, as it is considered better tohreaten expensive proceedings, in the hope of getting aettlement.

5. There is no power of contracting out of the Act with theonsent of a registrar by previously injured, diseased,weakly, or aged persons, who are thereby shut out frommployment. Note.-An increasing number of persons areeing thrown out of employment and become a charge on theates when they are anxious and willing to do such work as, within their power.6. The registrars have no machinery for obtaining the

dvice of medical referees when required to register or refuse

687

registration of settlement. Note.- Registrars have to acceptor refuse registration of settlements, without any knowledgeof the real facts, and they are often hoodwinked bymendacious statements made by one side or the other.

7. There are no uniform rules as to medical assessors

sitting with the county court judges either as to their em-ployment or their procedure. Note.-There is no obligationfor a judge to call an assessor to sit with him, or to act onhis advice, as to the medical points, if he has called one.There are no rules as to procedure : some medical assessorsexamine the man alone, some allow medical men acting onbehalf of the employer and workman to be present.

8. There is no provision of consulting-rooms and appli-ances for the proper examination of workmen at countycourts. Note.-It is impossible for any medical assessor toproperly examine a workman in a bare room, without even acouch in many cases, without any appliances for making anytest, and without authority to administer an anmsthetic forthe relaxation of muscles.

9. There is no appeal from the decisions of medical referees,which are 11 final and conclusive." Note.-Various suggestionshave been made as to an appeal, but the views are so dis-cordant, and many impracticable, that I prefer to deal withthe matter later, under the essentials of State insurance.

If the foregoing and other defects of the present Act wereremedied, so that the b6na-fide workman could be sure of hishalf wages being paid immediately after notifying theaccident, and the employers, and those who insure them,could be protected against fraudulent and exaggeratedclaims and heavy costs, compulsory insurance would beunnecessary except for those who decline to insure. If com-pulsory State insurance should be enacted I venture tosubmit that the following points would be essential in theinterest of the public, the profession, employers, andworkmen.

1. That the State must not be allowed to fix its own ratesof insurance. It should be in healthy competition withaccredited insurance offices of standing, otherwise employerswould be heavily hit with no redress.

2. The State or registrars must have notice of injurywithin a fortnight on a simple form to be obtained at any postoffice, clearly stating the nature of the injury and signed bythe medical attendant of the workman.

3. Medical practitioners in every district should bE

appointed as medical examiners, and they should examineand report on every notified case of accidental injury withouldelay.

4. If the report of the medical examiner should not beapproved and accepted by the workman, acting under theadvice of his medical attendant, the matter should be atonce referred to a medical referee, whose decision should befinal unless appealed from within seven days. This wouldbe on all fours with the procedure as to lead and otherindustrial poisoning, which are reported on by factorySurgeons, and referred to a medical referee when cases are in

dispute.5. The Employers’ Liability Act should be repealed, so

that the questions of law would be few, the only questionsbeing whether the workman was able to work or not, andwhat work, if any, he was capable of performing.

6. No settlements should be allowed to be made by theState unless registered by a registrar of a county court

acting on the advice of a medical referee.7. The decisions of medical referees should not be " final

and conclusive." It should be possible to appeal from theirdecisions, and this is a very difficult subject, and varioussuggestions have been made. (a) That three medicalreferees from neighbouring circuits should form a court ofappeal-that is, they should examine the workman and reporteither in favour of or against the decision of the medicalreferee. (b) That as many more medical referees would berequired than there are at present, many of their decision!would be certain to be appealed from, and the appeal shoulcbe to a medical board of hospital surgeons, nominated by the Home Office in each district. (c) That consulting surgeon.should be appointed by the Home Office to examine ant

report on decisions of medical referees referred to them b:county court registrars, whose decision should be " final antconclusive." This latter would be cheaper, as only one fewould have to be paid instead of three or more.

8. Lay inspectors would have to be appointed in everdistrict, so that the State should be in touch with injure

workmen to insure their having proper medical treatmentand the obtaining of work as soon as they are able to do it.

9. Stringent penal clauses should be inserted, dealing withthose workmen who malinger or exaggerate.As there are many thousands of small employers who do

not insure, and who have not the means of paying compensa-tion if a claim is made on them, some kind of compulsoryinsurance is necessary, but if by the State, the State must beprotected. Many other points will have to be considered,especially those relating to legal questions, which do notcome within my province, but the above points closely affectthe medical profession, which must in the near future bemore largely employed in safeguarding the interests of theirpatients, or of employers, than even now ; while when

compulsory State insurance does come in one form or

another the State will have to rely upon the medicalprofession for its protection against loss.

THE SMALL-POX EPIDEMIC IN LONDON.

THE following is a brief account of the epidemic of small-pox in the east of London since its outbreak.On Feb. 5th a girl named Annie L-, 12 years old, of

Key-street, Mile End, was admitted into a general ward inthe Mile End Infirmary, where there were some 60 otherpatients. She was suffering from an eruption with severeindisposition, which was thought to be chicken-pox. Herfriends visited her daily. No suspicion of its beingsmall-pox occurred until late at night on Feb. 20th,when the medical superintendent of the infirmary, beingsuspicious of the condition of two other patients in theward, called in consultation Dr. A. F. Cameron of theSouth-Eastern Fever Hospital. These cases were diagnosedas small-pox, and attention was thus drawn to thegirl Annie L——, when it was found that her disease alsowas small-pox. In the early morning of Feb. 21st thesethree patients were removed to the Joyce Green Small-pox Hospital. On the same day four other cases-an un-vaccinated girl, aged 3 (since dead), a probationer nurse,a ward scrubber, and Sarah L——, aged 11, a sister ofAnnie L-, none of them vaccinated since infancy, wereremoved to hospital. Two sisters of Annie L——, viz.,Leah, aged 15, and Rebecca, aged 8, were then found suffer-ing from small-pox. Rebecca had been to school on

Feb. 20th and 2lst, so that the school became infectedfrom that date. On Feb. 22nd Felix K-, aged 1 month,unvaccinated (since dead), and Theresa C-, aged 21, aprobationer, unvaccinated since infancy, were taken to

hospital.On Feb. 23rd the following 11 cases were removed

from the same ward of the Mile End Infirmary : a

woman, aged 23, a nurse, vaccinated in infancy only ; a

woman, aged 35, vaccinated in infancy only ; a woman, aged43, vaccinated in infancy only (since dead) ; a girl, aged 4,vaccination doubtful; a woman, aged 54, vaccinated in

infancy only ; a woman, aged 49, vaccinated in infancyonly ; a woman, aged 22, vaccinated in infancy only ; a

woman, aged 45, vaccinated in infancy only ; a girl, aged 4,vaccination doubtful; a woman, aged 51, vaccinated in infancyonly ; a woman, aged 46, vaccinated in infancy only; alsoanother member of the family, a man, aged 20,vaccinated in infancy only. There were also two cases,one each from Poplar and Pimlico. On Feb. 24th three caseswere removed from the infirmary, viz. : a boy, agedU, not vaccinated ; a boy, aged 4, not vaccinated (since

, dead); and a nurse, aged 24, not vaccinated. On Feb. 25th. six cases were removed, five being from the infirmary, viz. :l a girl, aged 2, not vaccinated (since dead) ; a woman,; aged 65, vaccinated in infancy (since dead) ; a man, aged 42, vaccinated in infancy ; a girl, aged 16, vaccinatedi in infancy; a girl, aged 15, not vaccinated ; and one

; case from outi-ide the infirmary, viz. : a woman, aged 30,s vaccinated in infancy only ; also a case from Hackney.1 On Feb. 26th two cases were removed to the hospital, onefrom outside and one from the infirmary. The latter, how-3 ever, was found not to be.suffering from small-pox. Thee other case, a woman, aged 67 years, had previously been a

patient in the infirmary and was discharged on Feb. 13th.y She was vaccinated in infancy. There was one case fromd Bethnal Green. On Feb. 27th two cases were removed to the