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A QUESTION IN EUGENICS.
472 them at the time. The suffering, the dead, and the fear of death were forgotten too soon. Now perhaps an epidemic is upon us again, and it is too late to lament over the little use made of the 18 years of respite. Of course, much has, as a matter of fact, been done, but not nearly so much as should have been done. To use a familiar simile, it is as if war had begun again. The early cases notified may be compared with the enemy’s scouts and skirmishers who may be said to have crossed the frontier and invaded our part of Europe. Will they report that they have seen food for plunder and thus entice the main body to invade our lands ; or will they return crestfallen because they found everything so clean and in such good order that it did not seem worth while attempting a general attack’?’) The cholera invasion of 1892 was not so successful as the previous outbreak of the same character, so perhaps this time the enemy may not venture on more than threats such as those recorded above. Should this, fortunately, prove to be the case, it is to be hoped that the alarm raised will suffice to draw attention to the fact that many of the obvious lessons taught by the previous epidemic have not yet been fully applied. I am, Sir, yours faithfully, ADOLPHE SMITH. Fulbam, August 8th. 1911.
A QUESTION IN EUGENICS. To the Editor of THE LANCET. SiR,—As an alienist physician and a teacher with a not inconsiderable experience of mental diseases, and being acquainted with the care of epileptics suffering from mental symptoms, I consider it to be my duty to offer advice to your correspondent (of July 29th) who desires to have his epileptic son of 12 sterilised to prevent his having children if he should live to a marriageable age. Let me be certain about the actual state of this boy. Presumably there are no (or only slight) mental symptoms, for otherwise detention in a special institution under special treatment would meet the circumstances, whilst the epilepsy itself, although it would seem not to prohibit matrimony should the son reach his majority and then care to exercise his privileges, is yet of such a nature as to disqualify for the ordinary avocations of life and is non-traumatic. Altogether this opportunity to discuss a very vexed question in eugenics acknowledges that you are conscious of the "signs of the times," and it will certainly afford the medical profession and others the means of ascertaining views presented on both horns of a very difficult dilemma and upon a matter of great
public importance. In spite of the tendency on the part of Nature towards the normal, and in spite of the apparent disposition of the germinal molecules to sustain and reproduce under favourable conditions of selection what is healthy and normal, epilepsy in my opinion, and in that of. others who have studied and written upon the subject, has been proved by irrefragable statistical evidence to be the most heritable of all the neuroses and of all mental diseases ; that is to say, .. pure " epilepsy, or even epilepsy associated with insanity, is more often the antecedent of epilepsy than is insanity of insanity ; and this is probably known to your correspodent, who by his suggestion in regard to this disease a fortiori suggests the treatment for many other less prominent neuroses-thus proposing to extinguish or at any rate to endeavour to prevent the extension of epilepsy in his own descendants. The first question is whether we, as doctors, are to consider ourselves bound mainly to do the best we can for the individual or whether our care is to be for the race, and possibly the view taken depends on the ethical standard accepted by each person who ventures upon advice. Personally I am strongly in favour of the individualist view, for I conceive the ethical end to be the "perfectionof our patient, and this in the most active, most moral, and most intelligent direction consistent with time, circumstances, and environment. As to the legal and moral aspect, a father is morally bound-i.e., by custom, by family ties, and by blood relationship-to do the best in his power for his son (or daughter), because the solidarity of the family is the essential principle to be kept in view in any community, and parental responsibility must be uppermost for the head of the family. He is bound to sustain, to preserve, and to shield his son from harm, so that his son’s mental and physical powers,
whether limited
or
of the
ordinary
range, may
develop to the
greatest perfection, and so that he may derive from them the greatest use and happiness. The question of operation (or according to some " mutilation ") for mental deficiencies or bodily ailments, is, in my opinion, not one to be entertained by the father, for he is concerned only with fostering the directly self-preservative instincts of his offspring-speaking generally, those relating to his own livelihood-and not those remotely relating to posterity. Legally, therefore, he,has no option, but I am not a lawyer, and to him posterity is an unrealisable responsibility ; still, if the community should enforce such an ordinance as sterilisation for its own future welfare, which it is entitled to do, then the parent is bound to accede to such indirectly self-preservative rules as may be agreed. I have no doubt in my own mind that the race would greatly benefit in physique by such enactments, but possibly not equally so in moral and mental qualities, for I look upon the presence of human weakness as a moral appeal to the strong and as serving a useful purpose in the moral development of any people. I should like to be informed at what limit-i.e., for what defects-are such mutilations to cease ?1 Are such operations to apply only to epileptics or those who are insane, some of If for whom we know occasionally recover completely ?1 these, then why not for inebriates and criminals, or those with cancerous or tubercular tendencies, or those who are predisposed to paralysis, and if for these, again, why not for other persons who may be deficient in other forms of selfcontrol, those, for instance, who inordinately gratify appetite and passion, those who are wanting in thrift and other prudential considerations, or for that matter those who exhibit the unpardonable crime of political defection or for any other apostasy ?1 Furthermore, who is to be the final arbiter ?1 And is the father himself averse from being subjected to the operation to prevent the possibility of more epileptic descendants ?1 The treatment least trying to parents and most acceptable to the main body of opinion in this country would be the provision by the State (or the local authority), with the sanction of Parliament, of ahome " wherein such cases could be made busy and happy, in which their lives would be fully occupied with employment congenial and graded to their abilities, and where their health and pastime could be adequately supervised. In this direction alone, in my opinion, lies the best and only justifiable solution. We are as yet unprepared for the (?) moral effect of a large number of sterilised" men (and, of course, women) in the community; and even the State of Indiana, U.S.A., where 700 such persons are already said to exist, is blenching at the prospectcomunity; Let me, in conclusion, relate an experience. I once had the care of a young medical man who had been the favourite pupil and " interne of one of the physicians He developed delusions, under to the late Queen Victoria. the influence of which he so mutilated himself that he removed the whole of the external genitalia. Later, he sank into a state of unambitious passivity, without the desire or the capacity to originate conversation or to heed his surroundings. His mental state was that of careless and listless indifference to outward stimuli. He could occasionally be roused by questions referring to his past life, but he took no interest in the present or the future, which was beyond the power of any appeal to effort or action. He lounged or sat about, a slovenly inert wreck, dishevelled, self-neglectful, untidy, and personally disordered-a state of living death worse than could happen to the average epileptic who not infrequently enjoys a useful interparoxysmal life. That such a state was partly the result of sex " mutilation"" admits of no doubt in my mind, and such reducing mental conI sequences of I restrictive eugenics must not be overlooked. I am strongly of opinion, after consultation with the titular heads of the medical profession, that suggestions in regard to sterilisation are at the present moment premature and would not be tolerated. They have no moral support and certainly, at present, they have no legal justification. I am, Sir, vours faithfully, ROBERT JONES, M.D. Lond. Claybury, August 3rd, 1911. To the Editor of THE LANCET.
SiR,-The sterilisation of the unfit is legalised in the State of Indiana and also in Switzerland. In the former several hundreds of cases have been performed with very successful
473 results, but so far as I know eugenic sterilisation has never been done in Great Britain. Assuming, however, that the law permits it, in my opinion a surgeon would be morally right in acceding to the request of the parent who desired that an epileptic child should be sterilised. Nay, I would go further, and after careful delving into the family history, should it be apparent that there is some morbid flaw in the mosaic of the germ plasm of the parents, I would strongly advise that they also should be sterilised if still capable of producing offspring. The method which should be adopted is most important. Castration is crude and brutal; X rays uncertain and inefficient ; the simplest, the best, and the most permanent would be vasectomy, which makes no difference to the bodily functions, has no ill-effects, secondary sexual characters would be developed, and nothing would be prevented but the power of procreation. The answer to the question depends upon whether you regard the rights of the individual as absolute and the claims of the race as non-existent. If you do, sterilisation will be As an accursed thing ; if not, it will be gladly welcomed. marriage is the supreme eugenic institution, why should an epileptic child be permitted to grow up, marry, and produce offspring suffering from physical and mental defects ? Is marriage the intimate personal affection, the spiritual tie, the indissoluble union, which purifies the passions of the sexes and raises us above the level of the beasts ? Is marriage for the sake of parentage and parentage a trust for the race ? Must we be ever satisfied that the ghastly burden of disease of body and mind should be freely transmitted from age to age and no steps be taken to dam the overflow of this reeking cesspool ? Should we leave open the flood-gates through which has poured a devastating torrent of degraded humanity ? Mr. Roosevelt has said"A nation’s chief blessing was that it should leave its seed to inherit the land. No refinement of life, no delicacy of taste, no material progress, no sordid keeping up of riches, no sensuous developments of art and literature, can in any way compensate for the loss of the great fundamental virtues, and of these the greatest is the race’s power to great fundamental virtues " perpetuate the race." Ruskin stated that the veins of wealth are purple and that the Divine intent of all wealth is the production of a healthy race. The unfit should have the right to live, and live well-no one will question that-but the right to propagate should be denied them. The average quality of a race is but the average quality of the individuals composing it. If the physically and mentally weak be allowed to propagate, and if, as it seems to be the case at present, they reproduce themselves faster than the better strains, the relative numbers of such persons in the country must increase and the average quality of the race deteriorate. The best stocks are postponing marriage and restricting the number of their offspring. The latter are producing motor-cars, the former children. " Better, oh better, cancel from the scroll Of universe one luckless human soul, Than
drop by drop enlarge the flood that rolls
Hoarser with anguish
as
the ages roll."-FITZGERALD.
I am, Sir, yours C. T. Claybury, August 1st, 1911.
faithfully, EWART, M.D. Aberd.
SALVARSAN (" 606") AND MERCURY THE TREATMENT OF SYPHILIS.
IN
To the Editor of THE LANCET. Sm,-In to-day’s LANCET (July 29th) Major H. C. French, R.A.M.C., replies to the criticisms of myself and others on his paper on this subject that appeared in THE LANCET of June 24th. The party system in politics, by insuring searching criticism, gives the country the opportunity of arriving at an unbiassed opinion on the questions at issue ; and likewise with any new therapeutic agent it is essential that adverse critics should be found to lay before the medical public all the possible evidence against the new treatment. The medical profession must always be equally indebted to the opponents and advocates of any new "specific." Major French observes the rules of debate and with courtesy replies to criticism, and it is a matter of regret that Mr. Ernest Lane makes no attempt to reply to Mr. Lane has my criticism of his published opinion. apparently changed his mind in regard to the danger and value of salvarsan treatment, and makes it a
that I should have thought that he meant what he said in December last, which I quoted as the only record of his opinion that I can find. Major French quotes me as writing in support of the great value of inunctions and injections of mercury as shown by the Wassermann reaction. I am sorry that he my advocacy of salvarsan meant detraction of mercury. That this is not my view is shown by the paper that I wrote with Dr. A. Manuel in the Practitioner for June, where we concluded that I I salvarsan when it does produce an alteration of the serum reaction does so more rapidly than mercury. On the other hand, in the present state of our knowledge it would appear that the percentage of negative results after one or two injections is lower than that observed after a year’s course of efficient mercurial treatment." The Wassermann reaction frequently becomes negative after one or two courses of inunction or injection, but these negative reactions are rarely permanent, whereas after salvarsan apparently about 75 per cent. of cases that become negative as the result of such treatment remain so. I am entirely in accord with Major French’s quotation of Mr. Boas’s opinion as to the superiority of Wassermann’s original technique and the importance of q1UJ/ntitative estimations. My modifications are solely trifling matters of technique, with the exception that I use alcoholic extract of rabbit’s heart in place of alcoholic extract of syphilitic organs. I have made parallel experiments, using rabbit’s heart extract and syphilitic organ extract supplied from Professor Wassermann’s own laboratory, and have obtained practically identical results with both, the very slight difference being in favour of the heart extract. At the British Medical Association discussion on the Diagnostic Use of the Complement Fixation Method that took place in July, 1910, and was opened by a paper from Professor Wassermann, I had the honour of reading the I then said 1:"Many observers have tried second paper. to simplify the test and obviate the necessity for using rabbits and guinea-pigs by making use of the complement and hsemolysin for sheep’s corpuscles present in human blood serum. It seems to me, however, that the most essential of all factors in a comparative test such as this is that all factors except the one to be tested should be constant. With Hecht’s, Bauer’s, Stern’s, or Fleming’s technique, however, variants are substituted for constants, for the complement content of human serum varies greatly, and some human serums contain no basmolytic antibody to sheep’s corpuscles, while others contain some but in varying quantities." Later on I said:..I have for the last six months used two strengths of complement and so obtained a roughly quantitative measurement of the complement deviating power of the serum." In a footnote I wrote: I I This quantitative measurement can obviously not be determined by the so-called simplified methods." In the Quarterly Journal of Medioine for January, 1911, I wrote : "It is remarkable that though innumerable modifications and simplifications have been introduced during the last two years, the consensus of expert opinion is still strongly in favour of the original technique, or of such slight modifications of the original method as do not necessitate the substitution of variant factors for constant factors." Major W. S. Harrison, R.A.M.C., agrees with me that the original technique is the most reliable, and probably Major Harrison and myself have greater opportunities for extended investigations on this subject than other workers in this country. I have personally examined well over 2000 sera, and as a matter of routine determine the reaction in about 30 cases I every week. I am cordially in sympathy with Major French’s opinion as to the necessity for standardising the test, and on Dec. 2nd, 1910, said: "I am entirely in accord with Mr. Arthur Shillitoe in desiring the universal adoption of the 2 same technique for the Wassermann reaction." The points I wished to emphasise were : (1) the extremely small casualty proportion, which, being less than 0. 2 per cent. even in the early days, is almost negligible ; and (2) that salvarsan should be given as a routine in all cases except the very exceptional ones when it is contra-indicated. These points I do not think have been satisfactorily met by Major French and have been ignored by Mr. Lane. I do not suggest, and never have suggested, that the time has yet arrived when mercury can be dispensed with in
grievance
thought
2
1 Brit. Med. Jour., Nov. 5th, 1910, p. 1430. West London Medical Journal, January, 1911, p. 48.
A QUESTION IN EUGENICS. To the Editor of THE LANCET. SiR,—As an alienist physician and a teacher with a not inconsiderable experience of mental diseases, and being acquainted with the care of epileptics suffering from mental symptoms, I consider it to be my duty to offer advice to your correspondent (of July 29th) who desires to have his epileptic son of 12 sterilised to prevent his having children if he should live to a marriageable age. Let me be certain about the actual state of this boy. Presumably there are no (or only slight) mental symptoms, for otherwise detention in a special institution under special treatment would meet the circumstances, whilst the epilepsy itself, although it would seem not to prohibit matrimony should the son reach his majority and then care to exercise his privileges, is yet of such a nature as to disqualify for the ordinary avocations of life and is non-traumatic. Altogether this opportunity to discuss a very vexed question in eugenics acknowledges that you are conscious of the "signs of the times," and it will certainly afford the medical profession and others the means of ascertaining views presented on both horns of a very difficult dilemma and upon a matter of great
public importance. In spite of the tendency on the part of Nature towards the normal, and in spite of the apparent disposition of the germinal molecules to sustain and reproduce under favourable conditions of selection what is healthy and normal, epilepsy in my opinion, and in that of. others who have studied and written upon the subject, has been proved by irrefragable statistical evidence to be the most heritable of all the neuroses and of all mental diseases ; that is to say, .. pure " epilepsy, or even epilepsy associated with insanity, is more often the antecedent of epilepsy than is insanity of insanity ; and this is probably known to your correspodent, who by his suggestion in regard to this disease a fortiori suggests the treatment for many other less prominent neuroses-thus proposing to extinguish or at any rate to endeavour to prevent the extension of epilepsy in his own descendants. The first question is whether we, as doctors, are to consider ourselves bound mainly to do the best we can for the individual or whether our care is to be for the race, and possibly the view taken depends on the ethical standard accepted by each person who ventures upon advice. Personally I am strongly in favour of the individualist view, for I conceive the ethical end to be the "perfectionof our patient, and this in the most active, most moral, and most intelligent direction consistent with time, circumstances, and environment. As to the legal and moral aspect, a father is morally bound-i.e., by custom, by family ties, and by blood relationship-to do the best in his power for his son (or daughter), because the solidarity of the family is the essential principle to be kept in view in any community, and parental responsibility must be uppermost for the head of the family. He is bound to sustain, to preserve, and to shield his son from harm, so that his son’s mental and physical powers,
whether limited
or
of the
ordinary
range, may
develop to the
greatest perfection, and so that he may derive from them the greatest use and happiness. The question of operation (or according to some " mutilation ") for mental deficiencies or bodily ailments, is, in my opinion, not one to be entertained by the father, for he is concerned only with fostering the directly self-preservative instincts of his offspring-speaking generally, those relating to his own livelihood-and not those remotely relating to posterity. Legally, therefore, he,has no option, but I am not a lawyer, and to him posterity is an unrealisable responsibility ; still, if the community should enforce such an ordinance as sterilisation for its own future welfare, which it is entitled to do, then the parent is bound to accede to such indirectly self-preservative rules as may be agreed. I have no doubt in my own mind that the race would greatly benefit in physique by such enactments, but possibly not equally so in moral and mental qualities, for I look upon the presence of human weakness as a moral appeal to the strong and as serving a useful purpose in the moral development of any people. I should like to be informed at what limit-i.e., for what defects-are such mutilations to cease ?1 Are such operations to apply only to epileptics or those who are insane, some of If for whom we know occasionally recover completely ?1 these, then why not for inebriates and criminals, or those with cancerous or tubercular tendencies, or those who are predisposed to paralysis, and if for these, again, why not for other persons who may be deficient in other forms of selfcontrol, those, for instance, who inordinately gratify appetite and passion, those who are wanting in thrift and other prudential considerations, or for that matter those who exhibit the unpardonable crime of political defection or for any other apostasy ?1 Furthermore, who is to be the final arbiter ?1 And is the father himself averse from being subjected to the operation to prevent the possibility of more epileptic descendants ?1 The treatment least trying to parents and most acceptable to the main body of opinion in this country would be the provision by the State (or the local authority), with the sanction of Parliament, of ahome " wherein such cases could be made busy and happy, in which their lives would be fully occupied with employment congenial and graded to their abilities, and where their health and pastime could be adequately supervised. In this direction alone, in my opinion, lies the best and only justifiable solution. We are as yet unprepared for the (?) moral effect of a large number of sterilised" men (and, of course, women) in the community; and even the State of Indiana, U.S.A., where 700 such persons are already said to exist, is blenching at the prospectcomunity; Let me, in conclusion, relate an experience. I once had the care of a young medical man who had been the favourite pupil and " interne of one of the physicians He developed delusions, under to the late Queen Victoria. the influence of which he so mutilated himself that he removed the whole of the external genitalia. Later, he sank into a state of unambitious passivity, without the desire or the capacity to originate conversation or to heed his surroundings. His mental state was that of careless and listless indifference to outward stimuli. He could occasionally be roused by questions referring to his past life, but he took no interest in the present or the future, which was beyond the power of any appeal to effort or action. He lounged or sat about, a slovenly inert wreck, dishevelled, self-neglectful, untidy, and personally disordered-a state of living death worse than could happen to the average epileptic who not infrequently enjoys a useful interparoxysmal life. That such a state was partly the result of sex " mutilation"" admits of no doubt in my mind, and such reducing mental conI sequences of I restrictive eugenics must not be overlooked. I am strongly of opinion, after consultation with the titular heads of the medical profession, that suggestions in regard to sterilisation are at the present moment premature and would not be tolerated. They have no moral support and certainly, at present, they have no legal justification. I am, Sir, vours faithfully, ROBERT JONES, M.D. Lond. Claybury, August 3rd, 1911. To the Editor of THE LANCET.
SiR,-The sterilisation of the unfit is legalised in the State of Indiana and also in Switzerland. In the former several hundreds of cases have been performed with very successful
473 results, but so far as I know eugenic sterilisation has never been done in Great Britain. Assuming, however, that the law permits it, in my opinion a surgeon would be morally right in acceding to the request of the parent who desired that an epileptic child should be sterilised. Nay, I would go further, and after careful delving into the family history, should it be apparent that there is some morbid flaw in the mosaic of the germ plasm of the parents, I would strongly advise that they also should be sterilised if still capable of producing offspring. The method which should be adopted is most important. Castration is crude and brutal; X rays uncertain and inefficient ; the simplest, the best, and the most permanent would be vasectomy, which makes no difference to the bodily functions, has no ill-effects, secondary sexual characters would be developed, and nothing would be prevented but the power of procreation. The answer to the question depends upon whether you regard the rights of the individual as absolute and the claims of the race as non-existent. If you do, sterilisation will be As an accursed thing ; if not, it will be gladly welcomed. marriage is the supreme eugenic institution, why should an epileptic child be permitted to grow up, marry, and produce offspring suffering from physical and mental defects ? Is marriage the intimate personal affection, the spiritual tie, the indissoluble union, which purifies the passions of the sexes and raises us above the level of the beasts ? Is marriage for the sake of parentage and parentage a trust for the race ? Must we be ever satisfied that the ghastly burden of disease of body and mind should be freely transmitted from age to age and no steps be taken to dam the overflow of this reeking cesspool ? Should we leave open the flood-gates through which has poured a devastating torrent of degraded humanity ? Mr. Roosevelt has said"A nation’s chief blessing was that it should leave its seed to inherit the land. No refinement of life, no delicacy of taste, no material progress, no sordid keeping up of riches, no sensuous developments of art and literature, can in any way compensate for the loss of the great fundamental virtues, and of these the greatest is the race’s power to great fundamental virtues " perpetuate the race." Ruskin stated that the veins of wealth are purple and that the Divine intent of all wealth is the production of a healthy race. The unfit should have the right to live, and live well-no one will question that-but the right to propagate should be denied them. The average quality of a race is but the average quality of the individuals composing it. If the physically and mentally weak be allowed to propagate, and if, as it seems to be the case at present, they reproduce themselves faster than the better strains, the relative numbers of such persons in the country must increase and the average quality of the race deteriorate. The best stocks are postponing marriage and restricting the number of their offspring. The latter are producing motor-cars, the former children. " Better, oh better, cancel from the scroll Of universe one luckless human soul, Than
drop by drop enlarge the flood that rolls
Hoarser with anguish
as
the ages roll."-FITZGERALD.
I am, Sir, yours C. T. Claybury, August 1st, 1911.
faithfully, EWART, M.D. Aberd.
SALVARSAN (" 606") AND MERCURY THE TREATMENT OF SYPHILIS.
IN
To the Editor of THE LANCET. Sm,-In to-day’s LANCET (July 29th) Major H. C. French, R.A.M.C., replies to the criticisms of myself and others on his paper on this subject that appeared in THE LANCET of June 24th. The party system in politics, by insuring searching criticism, gives the country the opportunity of arriving at an unbiassed opinion on the questions at issue ; and likewise with any new therapeutic agent it is essential that adverse critics should be found to lay before the medical public all the possible evidence against the new treatment. The medical profession must always be equally indebted to the opponents and advocates of any new "specific." Major French observes the rules of debate and with courtesy replies to criticism, and it is a matter of regret that Mr. Ernest Lane makes no attempt to reply to Mr. Lane has my criticism of his published opinion. apparently changed his mind in regard to the danger and value of salvarsan treatment, and makes it a
that I should have thought that he meant what he said in December last, which I quoted as the only record of his opinion that I can find. Major French quotes me as writing in support of the great value of inunctions and injections of mercury as shown by the Wassermann reaction. I am sorry that he my advocacy of salvarsan meant detraction of mercury. That this is not my view is shown by the paper that I wrote with Dr. A. Manuel in the Practitioner for June, where we concluded that I I salvarsan when it does produce an alteration of the serum reaction does so more rapidly than mercury. On the other hand, in the present state of our knowledge it would appear that the percentage of negative results after one or two injections is lower than that observed after a year’s course of efficient mercurial treatment." The Wassermann reaction frequently becomes negative after one or two courses of inunction or injection, but these negative reactions are rarely permanent, whereas after salvarsan apparently about 75 per cent. of cases that become negative as the result of such treatment remain so. I am entirely in accord with Major French’s quotation of Mr. Boas’s opinion as to the superiority of Wassermann’s original technique and the importance of q1UJ/ntitative estimations. My modifications are solely trifling matters of technique, with the exception that I use alcoholic extract of rabbit’s heart in place of alcoholic extract of syphilitic organs. I have made parallel experiments, using rabbit’s heart extract and syphilitic organ extract supplied from Professor Wassermann’s own laboratory, and have obtained practically identical results with both, the very slight difference being in favour of the heart extract. At the British Medical Association discussion on the Diagnostic Use of the Complement Fixation Method that took place in July, 1910, and was opened by a paper from Professor Wassermann, I had the honour of reading the I then said 1:"Many observers have tried second paper. to simplify the test and obviate the necessity for using rabbits and guinea-pigs by making use of the complement and hsemolysin for sheep’s corpuscles present in human blood serum. It seems to me, however, that the most essential of all factors in a comparative test such as this is that all factors except the one to be tested should be constant. With Hecht’s, Bauer’s, Stern’s, or Fleming’s technique, however, variants are substituted for constants, for the complement content of human serum varies greatly, and some human serums contain no basmolytic antibody to sheep’s corpuscles, while others contain some but in varying quantities." Later on I said:..I have for the last six months used two strengths of complement and so obtained a roughly quantitative measurement of the complement deviating power of the serum." In a footnote I wrote: I I This quantitative measurement can obviously not be determined by the so-called simplified methods." In the Quarterly Journal of Medioine for January, 1911, I wrote : "It is remarkable that though innumerable modifications and simplifications have been introduced during the last two years, the consensus of expert opinion is still strongly in favour of the original technique, or of such slight modifications of the original method as do not necessitate the substitution of variant factors for constant factors." Major W. S. Harrison, R.A.M.C., agrees with me that the original technique is the most reliable, and probably Major Harrison and myself have greater opportunities for extended investigations on this subject than other workers in this country. I have personally examined well over 2000 sera, and as a matter of routine determine the reaction in about 30 cases I every week. I am cordially in sympathy with Major French’s opinion as to the necessity for standardising the test, and on Dec. 2nd, 1910, said: "I am entirely in accord with Mr. Arthur Shillitoe in desiring the universal adoption of the 2 same technique for the Wassermann reaction." The points I wished to emphasise were : (1) the extremely small casualty proportion, which, being less than 0. 2 per cent. even in the early days, is almost negligible ; and (2) that salvarsan should be given as a routine in all cases except the very exceptional ones when it is contra-indicated. These points I do not think have been satisfactorily met by Major French and have been ignored by Mr. Lane. I do not suggest, and never have suggested, that the time has yet arrived when mercury can be dispensed with in
grievance
thought
2
1 Brit. Med. Jour., Nov. 5th, 1910, p. 1430. West London Medical Journal, January, 1911, p. 48.