- Email: [email protected]
INFANTICIDE
293
CORRESPONDENCE THE MEDICAL PROFESSION IN NATIONAL EMERGENCY
To the Editor
of
THE LANCET
SIR,-May I draw the attention of members of the profession to a highly undesirable method that has been employed, in at least one area, to induce doctors to fill in the forms, recently sent them, inquiring what they would be willing to do in the event of a "national emergency." These forms were sent out by the British Medical Association. One doctor, who had not completed his form, subsequently received a letter of which the following is a substantial part :It would be an extremely unpleasant duty for
and milk is pasteurised, so that the role of antityphoid inoculation is merely one of academic interest. In many parts of the world to-day cities are being blasted to pieces and the question of typhoid control must be of real practical interest. The British Government is making plans to evacuate our own children from densely populated areas to emergency camps if the occasion should so arise. I have so much belief that inoculation controlled the Basque typhoid outbreak that I should not hesitate to repeat this measure under similar I am, Sir, yours faithfully, conditions. RICHARD TAYLOR. Barnes, Jan. 24th. INFANTICIDE
"
to have to report that no return could be obtained from you and, therefore, that it was to be assumed that you are not prepared to help in any way in the event of a national emergency arising. " I would also point out that those doctors who have been given choice of Home Service will be the last to be called upon, should an emergency arise, for active service abroad. Those doctors who have not returned their forms will probably not receive the same consideration." me
In these words there are implications, though which are regrettable and which your readers will perceive at once. The whole extract savours unpleasantly of an authoritarian I am, Sir, yours f aithfully, - regime. D. McGAVIN.
perhaps unintentional,
CONTROL OF A TYPHOID EPIDEMIC
To the Editor
of
THE LANCET
SiR,-In your last issue Prof. Topley gave an exhaustive review of the available evidence on typhoid immunisation. He emphasised the value of sanitation and hygiene, pointing out the risks of inoculation during the incubation period, and the danger of
provocation typhoid. In May of last year I had the privilege of being in charge of the Basque refugee camp. The story of how these unfortunate children left Spain and arrived in England has been fully described in THE LANCET. They had been undernourished for many months, frightened by constant warfare, shaken by a rough sea-voyage, and finally herded into an emergency canvas camp crowded to capacity. The camp conditions were far from ideal and sanitation proved a very difficult problem. Two cases of typhoid were taken from the s.s. Habana on May 23rd and three more cases occurred up to June 4th. A major epidemic appeared inevitable. Some years ago in general practice I had experienced two small outbreaks of enteric which were successfully controlled by contact inoculation, and I therefore decided to inoculate the Basque camp of roughly 4000 children and 300 adults; risking an occasional provocation typhoid in the hope that a general immunity might be obtained. There were no further cases of typhoid. All the proved cases had been in closest contact with the rest of the camp and it seems unlikely that no more cases were incubating. Typhoid is not prevalent in the Basque province and there is no reason to suppose that the rest of the children were immune. I suggest that mass inoculation
prevented a major epidemic. Prof. Topley visualises a future state under perfect public health control, where water is always pure
To the Editor
of THE
LANCET
SiR,-In your leading article last week it
was
implied that infanticide is usually a symptom of puerperal insanity. This view, although it was put forward by earlier authorities-e.g., Clouston-can scarcely be maintained now. The late Dr. J. H. Morton found that only three of the sixty-four women referred to Holloway between 1923 and 1932 because they had killed their " newly born " child had shown definite signs of insanity, and in two of these the patient’s mental condition had cleared up by the time of the trial; six women had to be certified as mentally defective. This has an obvious bearing on any proposal that such women should be referred to a mental hospital. Measures of this sort would be more readily applicable to the numerically smaller group of those (formerly classed as suffering from lactational insanity) who have killed their child at a later period during the first year of its life ; they are as a rule manifestly in need of institutional treatment, and have made up the majority of the cases of infanticide at Broadmoor. I am, Sir, yours faithfully, HILDA LEWIS. THE DANGERS OF THOROTRAST
To the Editor
of
THE LANCET
SiR,-In your last issue Dr. Leitner recalls that in 1932 he and his colleagues published in Germany the results of animal experiments with Thorotrast which led them to sound a warning against the use of this preparation in man. In the same year, at a meeting of the Royal Society of Tropical Medicine and Hygiene, Dr. Mather Cordiner and Dr. Hamilton Fairleyshowed sections and X ray photographs of rabbits that had received thorotrast. At the same meeting I demonstrated2 in rabbits and in human cases the effects of the preparation which, by the courtesy of the firm of von Heyden, I had been able to introduce for experimental purposes into this country from Germany in the previous year. The dangers associated with the use of the substance were subsequently emphasised in a paper published conjointly with Whitaker and Davie3 in which we concluded that the effects of the preparation, including those resulting from the intrinsic radio-activity of the thorium dioxide, could not lightly be dismissed and that its use should be restricted to cases in which the adoption of a fruitful line of treatment 1 Cordiner, G. R. M., and Fairley, N. H., Trans. R. Soc. trop. Med. Hyg. 1932, 26, 318. 2
3 Whitaker,
J. Med. 1933,
Murgatroyd, F., Ibid, p. 323. Davie, T. B., and Murgatroyd, F., Quart. 2, 49.
P. H., n.s.
CORRESPONDENCE THE MEDICAL PROFESSION IN NATIONAL EMERGENCY
To the Editor
of
THE LANCET
SIR,-May I draw the attention of members of the profession to a highly undesirable method that has been employed, in at least one area, to induce doctors to fill in the forms, recently sent them, inquiring what they would be willing to do in the event of a "national emergency." These forms were sent out by the British Medical Association. One doctor, who had not completed his form, subsequently received a letter of which the following is a substantial part :It would be an extremely unpleasant duty for
and milk is pasteurised, so that the role of antityphoid inoculation is merely one of academic interest. In many parts of the world to-day cities are being blasted to pieces and the question of typhoid control must be of real practical interest. The British Government is making plans to evacuate our own children from densely populated areas to emergency camps if the occasion should so arise. I have so much belief that inoculation controlled the Basque typhoid outbreak that I should not hesitate to repeat this measure under similar I am, Sir, yours faithfully, conditions. RICHARD TAYLOR. Barnes, Jan. 24th. INFANTICIDE
"
to have to report that no return could be obtained from you and, therefore, that it was to be assumed that you are not prepared to help in any way in the event of a national emergency arising. " I would also point out that those doctors who have been given choice of Home Service will be the last to be called upon, should an emergency arise, for active service abroad. Those doctors who have not returned their forms will probably not receive the same consideration." me
In these words there are implications, though which are regrettable and which your readers will perceive at once. The whole extract savours unpleasantly of an authoritarian I am, Sir, yours f aithfully, - regime. D. McGAVIN.
perhaps unintentional,
CONTROL OF A TYPHOID EPIDEMIC
To the Editor
of
THE LANCET
SiR,-In your last issue Prof. Topley gave an exhaustive review of the available evidence on typhoid immunisation. He emphasised the value of sanitation and hygiene, pointing out the risks of inoculation during the incubation period, and the danger of
provocation typhoid. In May of last year I had the privilege of being in charge of the Basque refugee camp. The story of how these unfortunate children left Spain and arrived in England has been fully described in THE LANCET. They had been undernourished for many months, frightened by constant warfare, shaken by a rough sea-voyage, and finally herded into an emergency canvas camp crowded to capacity. The camp conditions were far from ideal and sanitation proved a very difficult problem. Two cases of typhoid were taken from the s.s. Habana on May 23rd and three more cases occurred up to June 4th. A major epidemic appeared inevitable. Some years ago in general practice I had experienced two small outbreaks of enteric which were successfully controlled by contact inoculation, and I therefore decided to inoculate the Basque camp of roughly 4000 children and 300 adults; risking an occasional provocation typhoid in the hope that a general immunity might be obtained. There were no further cases of typhoid. All the proved cases had been in closest contact with the rest of the camp and it seems unlikely that no more cases were incubating. Typhoid is not prevalent in the Basque province and there is no reason to suppose that the rest of the children were immune. I suggest that mass inoculation
prevented a major epidemic. Prof. Topley visualises a future state under perfect public health control, where water is always pure
To the Editor
of THE
LANCET
SiR,-In your leading article last week it
was
implied that infanticide is usually a symptom of puerperal insanity. This view, although it was put forward by earlier authorities-e.g., Clouston-can scarcely be maintained now. The late Dr. J. H. Morton found that only three of the sixty-four women referred to Holloway between 1923 and 1932 because they had killed their " newly born " child had shown definite signs of insanity, and in two of these the patient’s mental condition had cleared up by the time of the trial; six women had to be certified as mentally defective. This has an obvious bearing on any proposal that such women should be referred to a mental hospital. Measures of this sort would be more readily applicable to the numerically smaller group of those (formerly classed as suffering from lactational insanity) who have killed their child at a later period during the first year of its life ; they are as a rule manifestly in need of institutional treatment, and have made up the majority of the cases of infanticide at Broadmoor. I am, Sir, yours faithfully, HILDA LEWIS. THE DANGERS OF THOROTRAST
To the Editor
of
THE LANCET
SiR,-In your last issue Dr. Leitner recalls that in 1932 he and his colleagues published in Germany the results of animal experiments with Thorotrast which led them to sound a warning against the use of this preparation in man. In the same year, at a meeting of the Royal Society of Tropical Medicine and Hygiene, Dr. Mather Cordiner and Dr. Hamilton Fairleyshowed sections and X ray photographs of rabbits that had received thorotrast. At the same meeting I demonstrated2 in rabbits and in human cases the effects of the preparation which, by the courtesy of the firm of von Heyden, I had been able to introduce for experimental purposes into this country from Germany in the previous year. The dangers associated with the use of the substance were subsequently emphasised in a paper published conjointly with Whitaker and Davie3 in which we concluded that the effects of the preparation, including those resulting from the intrinsic radio-activity of the thorium dioxide, could not lightly be dismissed and that its use should be restricted to cases in which the adoption of a fruitful line of treatment 1 Cordiner, G. R. M., and Fairley, N. H., Trans. R. Soc. trop. Med. Hyg. 1932, 26, 318. 2
3 Whitaker,
J. Med. 1933,
Murgatroyd, F., Ibid, p. 323. Davie, T. B., and Murgatroyd, F., Quart. 2, 49.
P. H., n.s.