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DERMATITIS FROM DYED FABRICS
225
DERMATITIS FROM DYED FABRICS
injury or a sprain. Rarely has the practitioner the equipment in his surgery to deal with these. Being short of apparatus he lacks the knowledge derived from experience in its use. For such cases specialised treatment is advised and sought. This may be obtained at the out-patient department of hospitals or at special clinics. How are such cases to be treated without a great expenditure of time on the patient’s part The poor especially have to pay heavily in discomfort, loss of work, and in suffering as well as in time when they are affected. Four solutions can be suggested. 1. Enlarge hospital out-patient departments, increase the staff, and organise the attendances just as you would in a business or in a factory. Attach out-patient departments to what were once the poor-law infirmaries but are now well-equipped hospitals. 2. Extend municipal clinics. Many municipalities provide an excellent school medical service. When the boys and girls now at school grow up will they not ask, Why not continue it for us 3. Attempt to induce some wealthy approved or insurance society to set up clinics for the treatment of those who insure with them. An appeal might be
bone of the profession, the general practitioner, would gain in skill, work, and reward. The fourth alternative is the one which I prefer. I am, Sir, yours faithfully, A. R. FRIEL. Jan. 23rd, 1933. London, W.,
MANCHESTER AND PASTEURISATION To the Editor
of THE LANCET SiR,-Are we to remain apathetic while communities generally enlightened, such as Manchester, lose their "reputation for sound sense " Your annotation (Jan. 21st, p. 152) makes me wonder what, after all, the medical profession as a body has done to lead public opinion on the pasteurisation of milk. If ever there was a case of " doctors differ, patients die," surely we have it here. The fine efforts of the Reading researchers have been made, through misrepresentation, partly responsible for Manchester’s continuance to purvey tuberculous milk to the public. The lead given by both the Ministry of Health and the expert committees working with the People’s
League of Health has shown us the road ; Manchester in attempting to take that road has been worsted by made to the new rich to assist the new poor in setting the dragons in the path described as organised vested interests." If the profession does nothing now up such clinics. 4. The establishment of " medical houses " owned it appears to be putting its own vested interests in by medical practitioners. A start might be made alignment with those that have been successful in by a number of medical men who could afford it defeating Manchester’s Bill. You invite Manchester putting down in common enough money to buy a to " think again " ; but surely it is the whole medical "
house, equip it with apparatus for physical treatment, profession up and down the country that should be engage sufficient nursing help, and also a clerical staff to arrange appointments and keep records and the books. The spirit of exclusiveness should be absent from a medical house; any medical man who decided to pay a share either in starting the house or in paying rent for his room would be able
thinkingI
I am, Sir, yours faithfully, ESTHER CARLING. Berks and Bucks Joint Sanatorium, Peppard Common, Jan. 23rd, 1933.
there and treat them there as made in a small way at first till the scheme was tested, its strong points ascertained, and its weak points ascertained and remedied. As the doctors would own the medical house and be responsible for its expenses the incentive to efloit to make it a success and a paying propositionL would be strong. The incentive to effort on the patient’s part, if he is not worn out by long andL ineffective treatment carried out in an unbusinesslike manner, would also be strong. He wants to get" well. Some patients would prefer to pay for treatment when they needed it; others would prefer to) enter into some insurance scheme so as to be assuredL of treatment if and when they needed it. The meaical1 house should be run on a cash basis. This would bee easier than medical practice is at present. Theree would be an office at which payment would be madee for any physical treatment given. The pooling off overhead charges would result in a reduction off expenses to the medical men. This would enablee them to concentrate on developing methods of treatment. The result of establishing such a medical house would be that the stanaard of everyday medical treatment would be greatly raised. Moreover, the public would have their confidence increased. It would follow that approved specialists in radioø logy, pathology, and other recognised branches would attend at stated intervals. They would pay their share in the expenses of the medical house and receive payment for their work. The problem of the out-patient department of our hospitals would in course 01 time be solved, to the great benefit of the hospital, the patients, and the doctors. The back-
to
see
all his
patients
well. The attempt should be
DERMATITIS FROM DYED FABRICS To the Editor
of THE
LANCET
SiR,-Clinical observation and biological investigation have, I think, established that the dermatitis arising from the use of paraphenylenediamine and allied chemicals in hair and fur dyes is allergic in nature.1 This clears the confusion which previously existed owing to the assumption that chemical irritation was causative. The question of dermatitis arising from dyed fabrics must be dealt with on its merits as each case arises. The majority of cases will, no doubt, be dependent upon idiosyncrasy, as have all cases so far investigated by Dr. Killick and myself. The object of our paper (Jan: 14th, p. 77) was to draw attention to dermatitis resulting from the wearing of dyed fabrics, which had received little or no attention in the literature.
-
-
I am,
I
Sir,
Leeds, Jan. 21st, 1933.
yours
faithfully, JOHN T. INGRAM.
1 Roxburgh, A. C. : Brit. Jour. Derm., 1925, xxxvii., 126 ; Percival, G. H. : THE LANCET, 1931, ii., 417 ; Ingram, J. T. : Brit. Jour. Derm., 1932, xliv., 422.
INSTITUTE
FOR
THE
SCIENTIFIC
TREATMENT
OF
DELINQuENcy.-A lecture on the Law of Scotland with reference to Young Delinquents will be given by Mr. George Morton, K.C., at 8.30 P.M. on Friday, Feb. 3rd, at University College, Gower-street, London, W.C. Dr. J. A. Hadfield will preside and admission is free. Particulars of further lectures may be had from the hon secretary of the institute, 56, Grosvenor-street, W.1.
DERMATITIS FROM DYED FABRICS
injury or a sprain. Rarely has the practitioner the equipment in his surgery to deal with these. Being short of apparatus he lacks the knowledge derived from experience in its use. For such cases specialised treatment is advised and sought. This may be obtained at the out-patient department of hospitals or at special clinics. How are such cases to be treated without a great expenditure of time on the patient’s part The poor especially have to pay heavily in discomfort, loss of work, and in suffering as well as in time when they are affected. Four solutions can be suggested. 1. Enlarge hospital out-patient departments, increase the staff, and organise the attendances just as you would in a business or in a factory. Attach out-patient departments to what were once the poor-law infirmaries but are now well-equipped hospitals. 2. Extend municipal clinics. Many municipalities provide an excellent school medical service. When the boys and girls now at school grow up will they not ask, Why not continue it for us 3. Attempt to induce some wealthy approved or insurance society to set up clinics for the treatment of those who insure with them. An appeal might be
bone of the profession, the general practitioner, would gain in skill, work, and reward. The fourth alternative is the one which I prefer. I am, Sir, yours faithfully, A. R. FRIEL. Jan. 23rd, 1933. London, W.,
MANCHESTER AND PASTEURISATION To the Editor
of THE LANCET SiR,-Are we to remain apathetic while communities generally enlightened, such as Manchester, lose their "reputation for sound sense " Your annotation (Jan. 21st, p. 152) makes me wonder what, after all, the medical profession as a body has done to lead public opinion on the pasteurisation of milk. If ever there was a case of " doctors differ, patients die," surely we have it here. The fine efforts of the Reading researchers have been made, through misrepresentation, partly responsible for Manchester’s continuance to purvey tuberculous milk to the public. The lead given by both the Ministry of Health and the expert committees working with the People’s
League of Health has shown us the road ; Manchester in attempting to take that road has been worsted by made to the new rich to assist the new poor in setting the dragons in the path described as organised vested interests." If the profession does nothing now up such clinics. 4. The establishment of " medical houses " owned it appears to be putting its own vested interests in by medical practitioners. A start might be made alignment with those that have been successful in by a number of medical men who could afford it defeating Manchester’s Bill. You invite Manchester putting down in common enough money to buy a to " think again " ; but surely it is the whole medical "
house, equip it with apparatus for physical treatment, profession up and down the country that should be engage sufficient nursing help, and also a clerical staff to arrange appointments and keep records and the books. The spirit of exclusiveness should be absent from a medical house; any medical man who decided to pay a share either in starting the house or in paying rent for his room would be able
thinkingI
I am, Sir, yours faithfully, ESTHER CARLING. Berks and Bucks Joint Sanatorium, Peppard Common, Jan. 23rd, 1933.
there and treat them there as made in a small way at first till the scheme was tested, its strong points ascertained, and its weak points ascertained and remedied. As the doctors would own the medical house and be responsible for its expenses the incentive to efloit to make it a success and a paying propositionL would be strong. The incentive to effort on the patient’s part, if he is not worn out by long andL ineffective treatment carried out in an unbusinesslike manner, would also be strong. He wants to get" well. Some patients would prefer to pay for treatment when they needed it; others would prefer to) enter into some insurance scheme so as to be assuredL of treatment if and when they needed it. The meaical1 house should be run on a cash basis. This would bee easier than medical practice is at present. Theree would be an office at which payment would be madee for any physical treatment given. The pooling off overhead charges would result in a reduction off expenses to the medical men. This would enablee them to concentrate on developing methods of treatment. The result of establishing such a medical house would be that the stanaard of everyday medical treatment would be greatly raised. Moreover, the public would have their confidence increased. It would follow that approved specialists in radioø logy, pathology, and other recognised branches would attend at stated intervals. They would pay their share in the expenses of the medical house and receive payment for their work. The problem of the out-patient department of our hospitals would in course 01 time be solved, to the great benefit of the hospital, the patients, and the doctors. The back-
to
see
all his
patients
well. The attempt should be
DERMATITIS FROM DYED FABRICS To the Editor
of THE
LANCET
SiR,-Clinical observation and biological investigation have, I think, established that the dermatitis arising from the use of paraphenylenediamine and allied chemicals in hair and fur dyes is allergic in nature.1 This clears the confusion which previously existed owing to the assumption that chemical irritation was causative. The question of dermatitis arising from dyed fabrics must be dealt with on its merits as each case arises. The majority of cases will, no doubt, be dependent upon idiosyncrasy, as have all cases so far investigated by Dr. Killick and myself. The object of our paper (Jan: 14th, p. 77) was to draw attention to dermatitis resulting from the wearing of dyed fabrics, which had received little or no attention in the literature.
-
-
I am,
I
Sir,
Leeds, Jan. 21st, 1933.
yours
faithfully, JOHN T. INGRAM.
1 Roxburgh, A. C. : Brit. Jour. Derm., 1925, xxxvii., 126 ; Percival, G. H. : THE LANCET, 1931, ii., 417 ; Ingram, J. T. : Brit. Jour. Derm., 1932, xliv., 422.
INSTITUTE
FOR
THE
SCIENTIFIC
TREATMENT
OF
DELINQuENcy.-A lecture on the Law of Scotland with reference to Young Delinquents will be given by Mr. George Morton, K.C., at 8.30 P.M. on Friday, Feb. 3rd, at University College, Gower-street, London, W.C. Dr. J. A. Hadfield will preside and admission is free. Particulars of further lectures may be had from the hon secretary of the institute, 56, Grosvenor-street, W.1.