VOL. III.

Ellustration.

PROFESSOR ACLAND, F.R.S.

HENRY WENTWORTH ACLAND, the subject of our present memoir, was born in August, 1815. He is the fourth son of the late Sir Thomas Dyke Acland, Bart., and brother to the present baronet. His education began at Harrow, where he spent some years. He then entered at Christ Church, Oxford, where in 1840 he graduated in Arts. In the year mentioned his first publication, entitled "The Plains of Troy," appeared after a personal visit to the Troad, and it was favourably noticed by the leading periodicals. After being elected a Fellow of All Souls' College, Acland began the study of Medicine at St. George's Hospital, and received private instruction from Mr. Bullock, Mr. Squire, and Professor Quekett. In 1843 he entered the University at Edinburgh, and for more than a year lived with Dr. Alison. In the following year he gained the gold medal in the class of Medical Jurisprudence by an essay on "Feigned Insanity." This was not published, but a few copies were printed for private circulation. Having graduated in Medicine at Oxford in 1846, Dr. Acland devoted himself to the discharge of the duties of Lee's Readership in Anatomy, to which office he had been appointed in 1845, and at once commenced the formation of that extensive physiological series since removed from Lee's Anatomy School of Christ Church to the Oxford Museum. Of this collection he published a synopsis in 1855. Meanwhile he had been appointed physician to the Radcliffe Infirmary (1847), and in the same year was elected Fellow of the Royal Society, and appointed local secretary to the British Association when it met for the second time at Oxford. A few years later he was elected president of the Ashmolean Society. About this time he instituted courses of practical physiological instruction and formed microscopic classes, which were attended by members of the

No. 32.

university of all ages. In 1854, when Oxford was visited by cholera, the sanitary regulations for the city were placed mainly under the direction of Dr. Acland, who afterwards prepared an elaborate memoir on the circumstances attending the spread of the epidemic. This is one of the most precise and important of all the local reports on the same subject, and forms a valuable contribution to sanitary science. Some of its statements concerning the sanitary condition of a city so favoured with wealth and learning were startling, and soon led to great improvements. Although Oxford is not a locality suited to afford striking examples of Dr. Farr's rule— that "the elevation of the soil has a more constant relation with the mortality from cholera than any other known element"-this law is nevertheless corroborated by Dr. Acland's observations on the comparatively level district of Oxford and its neighbourhood. In connection with this topic may be noticed Dr. Acland's persevering and successful efforts to press upon the Government the consideration of the condition of river basins. In his evidence before the Select Committee on the Sewage of the Metropolis he supported his former statement that "the condition of the Thames Valley was a national disgrace," and contended that the drainage of the basin should be systematically worked as a whole. Into this question a Royal Commission was appointed to inquire in 1875.

A contribution of sanitary and educational services marked Dr. Acland's career at Oxford. From the year 1847 onwards he continued to take an active part in the work of reorganising and collecting, into one museum, with all appliances for making them available, the scientific collections of the university. Few persons are aware of the great amount of labour involved in such an undertaking. In this department, indeed, he performed, on a smaller scale, a task analogous to the gigantic work of Professor Owen in the Hunterian Museum of the College of Surgeons. On the death of Dr. Kidd, in 1851, Dr. Acland was elected Radcliffe Librarian.

museum.

He brought about, in 1862, the transfer of the scientific books from the Radcliffe Library to the newly-erected museum, and the opening of the building as a public reading-room. After having lectured for twelve years as Lee's Reader in Anatomy, he became in 1857, on the death of Dr. Ogle, Regius Professor of Medicine. He then commenced a pathological collection of the new museum, and effected in 1864 the purchase of Van der Kolk's private pathological He had in the meantime taken a very active part in obtaining new buildings at the Radcliffe Infirmary. Dr. Acland was attached to the suite of the Prince of Wales on his journey to America in 1860, and on his return was made Honorary Physician to His Royal Highness. The various services to medical science and to the progress of educational and sanitary improvements which have been briefly noticed are represented in Dr. Acland's contributions to literature. On sanitary topics, besides the Memoir on Cholera at Oxford in 1854, already noticed, Dr. Acland has published a short but practically important brochure entitled "Fever in Agricultural Districts;" "Notes on Drainage, with especial reference to the Sewers and Swamps of the Upper Thames;" a "Report on the General and Sanitary Condition of Cowley Industrial School;" and "Forms for Registering the Condition of Cottages, for the use of Landowners, District Visitors, and others."

On the question respecting the improved systems of education, Dr. Acland, in his evidence given before the Public Schools Commission in 1863, especially recommended the study of Physics, Chemistry, and Physiology, while at the same time he spoke against any great addition to the work already given to boys, and expressed his fears that the cramming system in use might be injurious to the physicians of coming generations. His general views on education may be found in the several brochures entitled "Health, Work, and Play," published in 1856; "Remarks on the Extension of Education at the University of Oxford;" a "Note on Teaching Physiology in the Higher Schools ;" and a letter to the Chancellor of the Exchequer on "The Formation of the Initiative Board in the University at Oxford." Besides these writings may be mentioned a biographical sketch of Sir Benjamin Brodie, written for the proceedings of the Royal Society; and "Remarks on the Oxford Museum."

In 1860, Professor Acland was made Honorary Student at Christ Church, and Honorary LL.D. of Cambridge in 1863. In June, 1855, he delivered the Harveian Oration at the Royal College of Physicians, "The Doctrine of Final Causes," and treated it with special reference to Comte's denial of the use of the crystalline lens. In the

course of the address the speaker paid a worthy tribute to the genius of Harvey, and defended his methods of observation. This was the first occasion on which the Harveian Oration was ever given in the English tongue. In the year 1871 was published Dr. Acland's "National Health," in compliance with a desire expressed by the President and Council of the Royal College of Physicians, and it embodied the substance of a lecture which he had delivered in the College. In 1868 Acland was elected to the chair of the British Medical Association, which for the third time held its annual meeting at Oxford. He succeeded Professor Stokes, of Dublin, who in the course of his valedictory address remarked as follows:-" To be chosen to preside over a society of more than four thousand educated gentlemen, all zealous for the advancement of human knowledge, many of them distinguished in the paths of literature and science, and not a few practical doers of Christ's work upon earth, is a distinction of which any man might be proud, for which any man should be thankful. For though the place of meeting influences the selection of President, the character of him who is to preside influences—at least, among other things— the choice of the place of meeting."

Professor Acland is one of the very few medical men out of the military profession honoured by the State. He was created a C.B. (Civil) in the year 1883, and in the present year (May 24th) was gazetted a K.C.B. Perhaps when the State recognises the services of the profession a change may be hoped for in this respect.

THE Gaulois expresses a suspicion that some deaths from Asiatic cholera have already occurred in Paris, and that the matter is being hushed up by the authorities, as was done in Toulon in the earlier period of the outbreak. Deaths have certainly occurred from what is officially reported as "cholerine" and "sporadic cholera;" but as a summer never passes without some mortality from these diseases, there are really no good grounds for discrediting the official returns. One case is that of an old man of seventy-five, who died with strong choleraic symptoms a day or two ago; but it was proved that he had been drinking iced beer and brandy to excess-to keep up his courage probably, as M. Clovis Hugues has been accused, it seems, of doing at Marseilles. Such a debauch in such weather at such a time of life is surely enough to account for a fatal result. The cholera is not a very rapid traveller, and is hardly due in Paris yet. It The cholera of 1832 was imported from England. appeared in Calais on the 1st of March, and only arrived in Paris on the 29th of March. It is true there were no railways then; and the Paris, Lyons, and Mediterranean Railways offers the same facilities for rapid locomotion to the microbe as to ordinary travellers. One humourist, indeed, takes the initial letters of the name of the line"P. L. M."-to stand for "Pour les Microbes,"

THE POOR LAW MEDICAL SERVICE : ITS PAST, PRESENT, AND FUTURE.

IV.

The Future-Extract from letter in British Medical Journal of Aug. 11th, 1883-The Commission on the Dwellings of the Poor-Sickness and the Poor-Poor Law machinery-The Sick Poor who have friendsThe Sick Poor who have no friends-Suggestions of Mr. Chadwick The Poor Law medical officer and sanitation-Higher grade inspectors for local districts-The Poor Law medical officer left at present to his own devices-The concours suggested by Sir D. Carrigan-Inapplicable at present-A New Scheme-A Civil Medical Service, embracing Sanitary Measures, Education, Prisons, Poor Law Service, Police, Lunacy, Factories, etc.-General outlines of the scheme-Its feasibility-Appointments to be secured by competitive

examinations.

THE future of the Poor Law medical service ought to be easy to forecast. A writer in the British Medical Journal, of August 11th, 1883, thus hopefully says:-"I consider that there is an immense future before the existing or fully developed Poor Law medical service: they are the germs of a civil medical service combining sanitary and medical duties which will one day cover the three kingdoms with a network of public servants paid by the State to watch over the health of the people. The future does not lie in the State-supported hospital, nor in the provident dispensary, for both those institutions do but treat the man when sick; it is the noble aim of the Poor Law and Sanitary Service to put men in such good sanitary surroundings, as will kill out disease and keep men in health instead of letting them get sick, and then curing them." This is a view with which I am disposed to coincide.

I have endeavoured to show how far the State has advanced in making provision for the sick poor. At the present time a Commission is sitting on the dwellings of the toiling classes with a view to provide, not only remedies for the evil conditions under which they are now living, but to secure for that class in the future habitations which will combine the great requisites to health, pure air, light, efficient drainage, etc. Though the dwellings of the poor may be improved, yet unavoidable sickness will invade their homes, and the practical outcome of this Commission will be to a great extent nullified, unless provision is made for the early treatment, amongst this class, of disease of all kinds. The machinery exists ready to hand, and the value of that machinery can be tested by a reference to Chadwick's "Report on the Dwellings of the Poor," to which reference has already been made. The sanitary service of the country will gain by the addition to it of the parochial medical officers. Principiis obsta is the principle on which we should act. If we would truly grapple with disease, especially infectious disease, we must begin with that strata of society in which we find disease most prevalent. The parochial medical officers, by their constant visits to the poor, are well qualified for the position of assistant sanitary officers. The principal sanitary medical officers would be able to derive valuable information from such assistants as Chadwick derived it, and in this way the sanitary service of the country would be more effectually provided for. I look upon it as a thorough retrogression to have dissociated the sanitary service from the Poor Law medical service. I trust it is not too late to alter the spirit of the regulations on this point, and that the President of the Local Government Board may be induced to reconsider the policy instituted by his predecessor. There are two classes of sick poor-the

sick poor who have friends, and the sick poor who have no friends. The former is a large class: the voluntary hospitals provides for a large number of them, but not always for the most deserving; governors' letters are secured by those who know how to go about obtaining them, and by charitable ladies who take an interest in philanthropic work.

Oppert may be considered a good authority on the subject of governors' letters. On this point he says: "Those who most require admission are not the class known to the governors. To be afflicted with sickness should be the only valid and sufficient reason on which a poor person is entitled to admission. If the patients are admitted by letter, those often become inmates of the hospital who are much better out of it, and those are not admitted who live in wretched lodgings. In the country you often find the hospitals filled with trivial cases, especially in the first half of the year, when the governors are well provided with letters; the poor, who suffer from the most acute and serious diseases, are treated at their homes, where the conditions for recovery may be marred by want of the necessary cubic space, nursing, and proper food. Even in London delay and difficulties arise when a sick and poor person wants to be admitted, as letters are only given out on one day in the week." The voluntary hospitals provide for a certain number of sick who are not necessarily poor. The abuses of our hospitals have for some years been attracting attention, and we have now a voluminous literature on the subject, so that I need not swell it. The poor who have no friends are by far the largest class, and this is the class for whom the State considers it its duty to provide a medical service. This is the class for whom we are now preparing to legislate, and this is the class which may become dangerous to society by neglect.

Chadwick, in his Report, 9th July, 1842, made some suggestions which are well worth at the present time resuscitating. He has one heading in his Report "On the Importance of the functions of Medical Officers in connection with Boards of Guardians." This Report should be read by all who are interested in the new Commission on the Dwellings of the Poor. He suggested in 1842* "that it shall be required of the parochial medical officer as an extra duty, for the due performance of which he should be fairly remunerated, that on visiting any person at that person's dwelling, on an order, for medical relief, he shall, after having given such needful immediate relief as the case might require, examine or cause to be examined any such physical and removable causes as may have produced disease, or acted as a predisposing cause to it; that he shall make out a particular statement of them, wherein he will specify any things that may be and are urgently required to be immediately removed. ment should be given to the relieving officer, who should thereupon take measures for the removal of the nuisance at the expense of the owner of the tenement, unless he, upon notice which shall be given to him, forthwith proceed to direct their removal." We here see the value of having parochial medical officers connected with the sanitary service of the country. Had this suggestion been carried out to the letter, how many lives would have been spared!

This state

Chadwick makes another important suggestion. "Cases of difficulty," he says, "requiring superior medical experience and skill occur frequently amongst the paupers. For general supervision, as well as for the elucidation of

* Report, etc., 1842.