173

Correspondence.

THE THORNE DEFENCE FUND.

"Audi alt eram partem."

To the Editors of THE LANCET.

SIRS,-May I express through the medium of THE LANCETmy most grateful thanks for the chivalrous and practicalsympathy which has been shown to me by colleagues andfriends, known and unknown, in relieving me of the costsand damages awarded against me in the recent action inwhich I was the defendant ? 1 The sympathy has been mostgrateful to me and has very much helped me to bear thestrain and anxiety inevitable in a case where one’s pro-fessional character has been assailed. I should also liketo express my indebtedness to the Medical Defence Union.and to Mr. Hempson, the solicitor to the Union, for the carewith which this case was conducted.

I am. Sirs. vours faithfullv.Harley-street, W., July 12th, 1904.

J

MAY THORNE.

THE PRESENT CONDITIONS OF INFANTLIFE AND THEIR EFFECTS INREGARD TO THE INFANT,

CHILD, AND ADULT.To the Editors of THE LANCET.

SIRS,-It is a mere truism to say that we are entirelydependent on the infants of the present for the adult popu-lation of the future. Yet while we do much to deal withdisease in the child and adult we are almost totally neglect-ing to care for the human being at a period of life whenexceptional care is most urgently needed. About one-fourthof the total deaths at all ages are contributed by infantsunder one year of age. This mortality is extremely ex-cessive. It appears even more so when we remember that allthe infants in the land are included in the general statistics,so that those cared for in the homes of the fairly well-to-doand of the wealthy tend to disguise the real mortality in thehomes of the poor. Dealing with this aspect of the questionDr. E. W. Hope, medical officer of health of Liverpool, wrotein his report for the year 1901 :-In the course of an inquiry into infantile mortality 1082 families in

which the death of an infant had occurred were taken consecutively.and certain particulars concerning them ascertained. The totalnumber of children born in these lamilies had been 4574, but out ofthat number 2229 had died-practically all in iniancy-representing487 deaths out of every 1000 born. The most remarkable series of- excessive mortality occurred in 12 families, in which the large total of117 infants had been born and no less than 98 had perished in infancy.These extreme examples occurred in families in which, so far asmunicipal sanitation is concerned, there was very little to choosebetween them and many of the families who rear all, or nearly all,their children.

The mortality is bad enough, but it must be doubtedwhether this is the worst result. What of those who escape,death? Do the survivors emerge uninjured by the conditionsresponsible for the death of so many of their fellows ? Mr.W. Hall of Leeds has supplied one instance of the answerto this question. Out of 2335 board school childrenexamined by him he found that more than half were

rickety. But it is idle to select instances when the resultsare devastating the country. It is scarcely credible that thepresent situation can continue when the medical professionand the public understand the issues involved. The study ofthe infant and the conditions of infant life have been almosttotally neglected and disease and deformity of every kindare the legacy of our neglect. Year by year the demand forhospital accommodation increases and we persistently shutour eyes to the real and preventable cause of this demand.No matter whether we turn to hospitals for diseases of thenervous system or to hospitals for diseases of the chest wesee the results of infantile malnutrition. In the wards andin the out-patient departments of practically every generaland special hospital we see the same thing. The asylums,prisons, and workhouses are largely dependent for theirinmates upon the mental and physical deformities arisingfrom defective structure.The predominating primary cause of these conditions is the

improper feeding of the infant. Maternal nursing is theideal method and everything should be done to encourage

this under proper conditions. But this method is im-

practicable in a very large number of cases and con-

sequently substitute feeding becomes a necessity. The

great reason for the present conditions is that the physio-logical factors involved have been almost completelyneglected. To obtain any real improvement it is essentialthat the traditional and domestic methods of artificial

feeding should be entirely abandoned. To discussthese methods in detail would be far beyond mypresent purpose. Their failure is writ large in the presentstate of affairs. Unfortunately the problem has beenrendered more complicated by the well-meant efforts ofsome of our municipalities to deal with the situation.Stock mixtures put up in bottles and then sterilised maydo a good deal to diminish the mortality in the first year.But such a benefit may be dearly purchased. The lesseningof the mortality by such means must be followed by diseaseand deformity in the later years resulting from patentdefects in the food mixtures supplied and the destruction ofimportant properties by the process of sterilisation.

Structural development in the young infant under normalconditions proceeds at a rate quite peculiar to this period oflife. The structure of nerve, brain, bone, and muscle

depends entirely on the character of the food supplied duringthis period. What is done then cannot be undone. Wecannot jerry-build without suffering from the results.

In the early part of 1903 the Infants’ Hospital was estab-lished in Denning-road, Hampstead. The result of the workthere has only been to convince me more and more of the vitalimportance to the country of radically dealing with the pre-sent situation. It is proposed to move the hospital to a centralsite as soon as possible. Without aiming at a "great" hospitalit is considered necessary that it shall be large enough tobe organised on a proper basis and fitted with every arrange-ment for the saving of infant life and the furtherance ofscientific knowledge pertaining to this end. For we need atleast one institution where the study of the many importantproblems involved can be systematically prosecuted. This

year the Infants’ Health Society has been established in theattempt to grapple with that great part of the problem notprimarily belonging to the hospital-the prevention ofdisease and the securing for every infant food adequate inquantity and quality for his physiological needs. I firmlybelieve that the present conditions of infant life most

seriously threaten the welfare of the country. And I amequally convinced that the remedy is comparatively easyif the importance of the issues is realised and dueattention is given to the technical matters necessarilyinvolved in providing a substitute for that most delicatelyconstructed food-human milk.

T am. Sirs. vours faithfullv.

Harley-street, W., July 9th, 1904. J

RALPH VINCENT.

ELECTRIC-LIGHT BATHS FORHOSPITALS.

To the Editors of THE LANCET.SiRS,—I have been for some time contemplating the idea

of making an urgent appeal to the authorities to introduceelectric-light baths into our hospitals for the use of both out-patients and in-patients. We are in this matter far behindour German eonfreres, as a visit last year to many hospitalsin several German towns convinced me. At these institu-tions for the treatment of poor people an electric-light bathis a very usual part of the therapeutic outfit.

Personal experience of this treatment in cases of rheu-matism, myalgias, &c., induces me to assert that recoveryor improvement would take place much sooner under its

employment than under the mere drug treatment of the

present day. Moreover, the electric water bath is alreadyin vogue at some of our hospitals ; why should not theequally potent light bath be introduced ? Surely in thesedays, when the so-called physical remedies are so largelyemployed, our hospital patients should have the benefit ofthis particular mode of treatment and one which our privatepatients and the public generally are already using to such alarge extent.

I would also strongly advocate a trial, at all events, of thelight baths in our fever hospitals for all cases when the rashis "suppressed" ; when we think of the power that thistreatment possesses of filling the whole superficial area ofthe skin with blood surely it could not fail quickly tobring out the rash " ; in fact, under this treatment deaths