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INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED MARCH 2ND, 1929.
578 ’in the western parts of these countries. Wurtemberg, Southern Bavaria, and Switzerland are so far little affected. From Denmark comes the news that influenza, although decreasing in the towns, is still increasing in remote rural districts. In Spain the death-rate is still high in certain towns, but the epidemic is now generally on the wane. In Iceland the epidemic reached its maximum at Reykjavik during the week ending Feb. 16th and then declined rapidly. In Madagascar influenza is epidemic at Tamatave and in various inland provinces, but is causing only a few deaths.
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INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED MARCH 2ND, 1929. Notifications.—The following cases of infectious - disease were notified during the week :-Small-pox, 288 ; scarlet fever, 1958 ; diphtheria, 1114 ; enteric
fever, 26 ; pneumonia, 5874 (last week, 4451) ; puerperal fever, 51 ; puerperal pyrexia, 146 ; cerebro:spinal fever, 13 ; acute poliomyelitis, 8 ; acute polio-encephalitis, 3 ; encephalitis lethargica, 23 ; dysentery, 5 ; ophthalmia neonatorum, 83. No case "of cholera, plague, or typhus fever was notified during the week. Notifications of pneumonia have again risen considerably, figures for the last six weeks being 1864, 2422, 3511, 3898, 3658, and 4451. Counties reporting the largest number of cases of pneumonia are as follows : London, 460 (last week 554) ; Chester, 148 (155) ; Derby, 106 (53) ; Durham, 345 (244) ; Essex, 153 (128) ; Kent, 130 (92) ; Lancaster, 862 (783) ; Leicester, 90 (52) ; Middlesex, 180 {189); Northumberland, 211 (167) ; Stafford, 462 (209) ; Surrey, 14 7(78) ; Warwick, 552 (313) ; Yorks, West Riding, 921 (597)-the North and the Midlands contributing -most of the increase. The number of cases in the Infectious Hospitals of the Metropolitan Asylums Board on March 5th-6th was as follows : Small-pox, 41 under treatment, 2 under observation; scarlet fever, 1716 ; diphtheria, 1912 ; enteric
Correspondence. "
Audi alteram partem."
THE INJECTION TREATMENT OF VARICOSE VEINS.
To the Editor of THE LANCET.
SIR,—In replying to Prof. Archibald Young’s letter I am not a little embarrassed by the fact that my recent Hunterian lecture has yet to appear in your columns. But since your annotation on this lecture has led Prof. Young to such a denunciation of injection methods, I feel it is necessary to answer his charges. The charges levelled against injection treatment are as follows. It is too simple ; it is carried out without any or sufficient justification ; it is unscientific, therefore unsurgical ; the risk of fatal and non-fatal complications is greater than is generally admitted there are many failures of the method. ; and, finally, it is not as effective as operation in cases that really require treatment. The very diversity of these charges makes it difficult to believe that the subject has been approached in a detached or critical spirit, and certain of the charges themselves suggest that criticism has
by prejudice. been Theclouded only virtue conceded to injection treatment is and this virtue Prof. its at
the
simplicity,
Young
once
converts into a vice in that it may tempt the inefficient to carry out the method. That this simplicity may conceivably lead to abuses I admitted in my lecture, but to employ such a type of -argument against a new therapeutic measure is paltry. If radium treatment should eventually prove superior to operation in the treatment of carcinoma of the breast, it would be unjustifiable to argue that it should be denied because it is technically simpler than the standard procedure. The tempta-fever, 10 ; measles, 65 ; whooping-cough, 1057 ; puerperal tions which lie in operative wait for the inefficient are not fever, 15 (plus 4 babies) ; encephalitis lethargica, 79 ; poliomyelitis, 8 ; " other diseases," 63. At St. Margaret’s confined to injection treatment. Secondly, to make the charge that a therapeutic Hospital there were 7 babies (plus 5 mothers) with ophthalmia or measure may be used without any, meonatorum. sufficient, to irrelevant means is justification, by totally attempt the Deaths.-In aggregate of great towns including London there was no death from small-pox, 3 (0) from to obscure the issue as to the exact value of that enteric fever, 94 (4) from measles, 17 (4) from scarlet measure. Such charges might be made against many established therapeutic methods, but they do not in fever, 275 (86) from whooping-cough, 48 (4) from themselves detract from the true value of those from diarrhoea and under enteritis diphtheria, 60 (14) two years, and 2183 (424) from influenza. The figures methods, but are rather reflections on the weakness and cupidity of certain individuals. Prof. Young in parentheses are those for London itself. that treatment given with insufficient The number of deaths from influenza during the previous suggests has to swell the statistics, but in a justification -eight weeks was 99, 122, 179, 321, 652, 987, 1243, and 1764 disorder which isgone fundamentally progressive patients respectively, the figures for London during the same weeks being 18, 34, 39, 77, 198, 331, 393, and 473. In the week are, as a rule, unwilling to undergo, or surgeons to under review deaths were attributable to influenza in advocate, operation at a comparatively early stage. Birmingham, 229 ; Leeds, 139 ; Sheffield, 74 ; Stoke-on- At a late stage few surgeons will advise operative Trent, 73 ; Manchester, 71 ; Oldham, 57 ; Leicester, 56 ; treatment. In my own series of over 200 cases more Hull, 45 ; Sunderland, 37 ; Bradford, 33 ; Middlesbrough, than 50 per cent. were considered inoperable either on 31 ; Bolton and Newcastle-on-Tyne, each 30. (Glasgow account of age, general condition, or owing to the ,reported only 12, Edinburgh 21, Dublin 19, and Belfast 6.) The figures for the week ended March 2nd to complete the presence of ulcers or dermatitis ; 40 per cent. were Registrar-General’s comparative table of influenza death- considered suitable cases for operation; and only rates (printed last week but one) are as follows : Aggregate, 10 per cent. could be classed as early ones-that is, 5.78 ; North, 6-26 ; Midland, 7-57 ; South, 4-52; Wales, casesin which the surgeon would not advocate and 187 ; Greater London, 5-04; Birmingham and Liverpool the patient would not willingly accede to operation. each reported 13 deaths from measles, Sunderland and from the point of view of rational therapy these .Cardiff each 7. Deaths from whooping-cough are still Surelycases are the ideal ones to get before symptoms are early the from Bolton widely distributed, highest figures coming The and Manchester, each 13; Salford, 12; West Ham and severe and before complications have arisen. Oldham, each 11; Leeds, 10. No great town has more than preponderance of the other groups is a witness to the 8 deaths to report from diarrhoea. failure of operative treatment to deal at all adequately The number of stillbirths registered during the week with the situation. Prof. Young’s third contention is that injection was 289 (corresponding to a rate of 43 per thousand treatment is unscientific and therefore unsurgical. births) including 45 in London. His letter does not contain one single argument in The Registrar-General continues his instructive table support of this statement. If, as I suppose, it is of the number old deaths, especially among -showing people, based on the assumption that the production of and from influenza and from respiratory circulatory diseases in London during the recent severe weather. The supple- intravenous thrombosis is necessarily unsound, it is in the ordinary mentary figures (namely, 424, 212 ; 828, 405; 634, 463) are certainly fallacious. What happens and excision operation on varicose veins ? ’with the exception of the last all considerably lower than ligature The answer is that thrombosis occurs in the blind in the preceding week.
I
I
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED MARCH 2ND, 1929. Notifications.—The following cases of infectious - disease were notified during the week :-Small-pox, 288 ; scarlet fever, 1958 ; diphtheria, 1114 ; enteric
fever, 26 ; pneumonia, 5874 (last week, 4451) ; puerperal fever, 51 ; puerperal pyrexia, 146 ; cerebro:spinal fever, 13 ; acute poliomyelitis, 8 ; acute polio-encephalitis, 3 ; encephalitis lethargica, 23 ; dysentery, 5 ; ophthalmia neonatorum, 83. No case "of cholera, plague, or typhus fever was notified during the week. Notifications of pneumonia have again risen considerably, figures for the last six weeks being 1864, 2422, 3511, 3898, 3658, and 4451. Counties reporting the largest number of cases of pneumonia are as follows : London, 460 (last week 554) ; Chester, 148 (155) ; Derby, 106 (53) ; Durham, 345 (244) ; Essex, 153 (128) ; Kent, 130 (92) ; Lancaster, 862 (783) ; Leicester, 90 (52) ; Middlesex, 180 {189); Northumberland, 211 (167) ; Stafford, 462 (209) ; Surrey, 14 7(78) ; Warwick, 552 (313) ; Yorks, West Riding, 921 (597)-the North and the Midlands contributing -most of the increase. The number of cases in the Infectious Hospitals of the Metropolitan Asylums Board on March 5th-6th was as follows : Small-pox, 41 under treatment, 2 under observation; scarlet fever, 1716 ; diphtheria, 1912 ; enteric
Correspondence. "
Audi alteram partem."
THE INJECTION TREATMENT OF VARICOSE VEINS.
To the Editor of THE LANCET.
SIR,—In replying to Prof. Archibald Young’s letter I am not a little embarrassed by the fact that my recent Hunterian lecture has yet to appear in your columns. But since your annotation on this lecture has led Prof. Young to such a denunciation of injection methods, I feel it is necessary to answer his charges. The charges levelled against injection treatment are as follows. It is too simple ; it is carried out without any or sufficient justification ; it is unscientific, therefore unsurgical ; the risk of fatal and non-fatal complications is greater than is generally admitted there are many failures of the method. ; and, finally, it is not as effective as operation in cases that really require treatment. The very diversity of these charges makes it difficult to believe that the subject has been approached in a detached or critical spirit, and certain of the charges themselves suggest that criticism has
by prejudice. been Theclouded only virtue conceded to injection treatment is and this virtue Prof. its at
the
simplicity,
Young
once
converts into a vice in that it may tempt the inefficient to carry out the method. That this simplicity may conceivably lead to abuses I admitted in my lecture, but to employ such a type of -argument against a new therapeutic measure is paltry. If radium treatment should eventually prove superior to operation in the treatment of carcinoma of the breast, it would be unjustifiable to argue that it should be denied because it is technically simpler than the standard procedure. The tempta-fever, 10 ; measles, 65 ; whooping-cough, 1057 ; puerperal tions which lie in operative wait for the inefficient are not fever, 15 (plus 4 babies) ; encephalitis lethargica, 79 ; poliomyelitis, 8 ; " other diseases," 63. At St. Margaret’s confined to injection treatment. Secondly, to make the charge that a therapeutic Hospital there were 7 babies (plus 5 mothers) with ophthalmia or measure may be used without any, meonatorum. sufficient, to irrelevant means is justification, by totally attempt the Deaths.-In aggregate of great towns including London there was no death from small-pox, 3 (0) from to obscure the issue as to the exact value of that enteric fever, 94 (4) from measles, 17 (4) from scarlet measure. Such charges might be made against many established therapeutic methods, but they do not in fever, 275 (86) from whooping-cough, 48 (4) from themselves detract from the true value of those from diarrhoea and under enteritis diphtheria, 60 (14) two years, and 2183 (424) from influenza. The figures methods, but are rather reflections on the weakness and cupidity of certain individuals. Prof. Young in parentheses are those for London itself. that treatment given with insufficient The number of deaths from influenza during the previous suggests has to swell the statistics, but in a justification -eight weeks was 99, 122, 179, 321, 652, 987, 1243, and 1764 disorder which isgone fundamentally progressive patients respectively, the figures for London during the same weeks being 18, 34, 39, 77, 198, 331, 393, and 473. In the week are, as a rule, unwilling to undergo, or surgeons to under review deaths were attributable to influenza in advocate, operation at a comparatively early stage. Birmingham, 229 ; Leeds, 139 ; Sheffield, 74 ; Stoke-on- At a late stage few surgeons will advise operative Trent, 73 ; Manchester, 71 ; Oldham, 57 ; Leicester, 56 ; treatment. In my own series of over 200 cases more Hull, 45 ; Sunderland, 37 ; Bradford, 33 ; Middlesbrough, than 50 per cent. were considered inoperable either on 31 ; Bolton and Newcastle-on-Tyne, each 30. (Glasgow account of age, general condition, or owing to the ,reported only 12, Edinburgh 21, Dublin 19, and Belfast 6.) The figures for the week ended March 2nd to complete the presence of ulcers or dermatitis ; 40 per cent. were Registrar-General’s comparative table of influenza death- considered suitable cases for operation; and only rates (printed last week but one) are as follows : Aggregate, 10 per cent. could be classed as early ones-that is, 5.78 ; North, 6-26 ; Midland, 7-57 ; South, 4-52; Wales, casesin which the surgeon would not advocate and 187 ; Greater London, 5-04; Birmingham and Liverpool the patient would not willingly accede to operation. each reported 13 deaths from measles, Sunderland and from the point of view of rational therapy these .Cardiff each 7. Deaths from whooping-cough are still Surelycases are the ideal ones to get before symptoms are early the from Bolton widely distributed, highest figures coming The and Manchester, each 13; Salford, 12; West Ham and severe and before complications have arisen. Oldham, each 11; Leeds, 10. No great town has more than preponderance of the other groups is a witness to the 8 deaths to report from diarrhoea. failure of operative treatment to deal at all adequately The number of stillbirths registered during the week with the situation. Prof. Young’s third contention is that injection was 289 (corresponding to a rate of 43 per thousand treatment is unscientific and therefore unsurgical. births) including 45 in London. His letter does not contain one single argument in The Registrar-General continues his instructive table support of this statement. If, as I suppose, it is of the number old deaths, especially among -showing people, based on the assumption that the production of and from influenza and from respiratory circulatory diseases in London during the recent severe weather. The supple- intravenous thrombosis is necessarily unsound, it is in the ordinary mentary figures (namely, 424, 212 ; 828, 405; 634, 463) are certainly fallacious. What happens and excision operation on varicose veins ? ’with the exception of the last all considerably lower than ligature The answer is that thrombosis occurs in the blind in the preceding week.
I