- Email: [email protected]
AEROSOLS BY INHALATION
862
ingesting this organism, staphylococcal pneumonia
and another who developed and fatal pyopericarditis. The risk must be much lessened once a high concentration of penicillin is achieved ; but only then, and only if it is maintained, can I agree that suckling should be allowed. Gentle removal of the milk by hand avoids the risk, and I believe results in better drainage. British
Hospital for Mothers
Babies, London, S.E.18.
and
HAROLD WALLER.
AEROSOLS BY INHALATION very surprised not to find in your leading article of Oct. 8 any reference to the ’Aerohaler’ method of delivering micropulverised substances to the respiratory mucosa ; especially as you say : "... the need is for a simple apparatus with an accessible nebulising device which can be quickly cleaned.... It should then be possible to abort the annual attack of recurrent bronchitis, to control the acute phases of bronchiectatic inflammation...."
SIR,—I
was
The manufacturers of the aerohaler claim that this means of delivery permits a more even and wider distribution of the material, together with a greater concentration per unit area. Its simplicity is unquestionable, and its effectiveness is also beyond doubt; for confirmation one has only to consult the report on 357 cases of various respiratory infections treated by Krasno, Karp, and Rhoads,! or to question other medical men who have used it. I have myself reported on a large lung abscess dramatically cured by this method.2 D. T. O’DRISCOLL. Galway. THE DOCTOR’S CREED SIR,—I suppose that if the Archbishop of Canterbury enters the pages of a scientific journal3 it will be his wish to do so on equal terms with others, and that, since he draws upon argument rather than authority to make his case, he will not mind some of his premises being called
into question. I speak as one who has given a good deal of thought to the ethical questions raised by being a doctor and a teacher, and indeed by life itself, and this seems to be an ideal opportunity to raise what to me, with some training in scientific reasoning, is a fundamental objection to the acceptance of the doctrine, though not the ethic, of orthodox Christianity. It is quite impossible for me to believe that God is at the same time omniscient, omnipotent, and wholly benevolent. I have seen too many children die of leukaemia or nephritis to believe that " Man is the object of God’s love, as God has shown in His acts"; and if, as Dr. Fisher asserts, God understands radar, then He surely knew of Buchenwald and Auschwitz. In short it seems that we must either believe that He is powerless to intervene against the evils of Satan and of man or that they are of His own creation. This, I am well aware, is no new objection ; but just because it must be the stumbling-block of many thinking persons on the threshold of religion, so does it stand in need of an answer. Here let me anticipate the orthodox replies. To say that these are matters of Faith which we do not understand is to beg the question and renounce even the semblance of a logical approach to it. It is as if I were to say to my students " you must not question why you are to use this remedy or that ; it must be enough that I who am learned in these matters say that you should do so." To say that because I have within me an instinctive knowledge of right and wrong it must have been given to me by God is to assert what I have not contested. And to say that Buchenwald had some divine purpose incomprehensible to man is to deny completely man’s right to distinguish Good and Evil.
unsure that his beliefs will be universally Dr. Fisher throws out the challenge that a acceptable, man should accept them unless he has " a better hypothesis which will better equip him for his life and his work." As there are today many earnest doctors, and I hope beloved physicians, who do not subscribe to any orthodox religious belief, I would try to state their creed as briefly as possible. They believe that as civilised and educated men our conduct should be determined by a sense of personal responsibility ; by the inner satisfaction of doing right ; because not to do so brings a sense of personal failure ; because those whom we most admire would act thus ; and because of a respect for truth. We think that a man can obey his conscience without hope of reward in this world or belief in the next. To many in our profession the doctor’s creed is not strengthened by an attempt to believe what to us is incredible or to accept an explanation which does not
As if
a
little
consistent with experience. We prefer agnosticism unacceptable hypothesis. To state this is not to disparage others in and out of our profession who find comfort in religious faith. I can only hope, Sir, that the sincerity of my letter will to some extent pardon its obvious presumption. seem
to
ROBERT PLATT.
Manchester.
Public Health By-laws
for Cleaner Food
THE Minister of Food has issued to local authorities in and Wales a model for by-laws to secure the observance of cleanly conditions in connexion with the handling, wrapping, and delivery of food for human consumption. These by-laws will supplement existing statutory measures. The model has been prepared in consultation with local-authority and trade associations. Some desirable provisions have had to be excluded because of shortage of materials and equipment, and the model may be added to from time to time. The suggested provisions, which cover such matters as personal hygiene, cleanliness and good order of equipment, cleanliness of wrapping material, and the deposit and removal of refuse, have been drafted with a view to their application in both urban and rural areas, and In making byto every type of food-handling trade. laws local authorities are not bound to follow the precise terms of the model, which is intended as a guide to provisions which are reasonable and enforceable having regard to present-day conditions. The Minister has expressed the hope that all local authorities which havee not already done so will consider adopting by-laws based on the model.
England
Births, Marriages, and Fertility in 1947 Part 11 of the Registrar-General’s Statistical Review for 19471 reveals that in England and Wales the birthrate again rose, illegitimacy continued to decrease, and the stillbirth-rate was the lowest country up to that time.
ever
recorded in this
-
Births.—There was 881,026 live births which represented birth-rate of 20-5 per 1000 total population ; this was au increase of 1-3 per 1000 over the previous year and was the highest rate since 1921 when it was 22-4. This post-war rise in the birth-rate was not maintained in 1948, when the rate fell to 17-9 (provisional). Of the live births, 196 were to mothers under 16 years of age, and 16 to mothers aged 50 or over (3 of whom were aged 55 or over). There were 46,603 illegitimate live births, compared with 53,919 the year before -5-3 and 6-6% of all live births. Stillbirths numbered 21,795, representing a rate of 24 per 1000 total live and still births, compared with 22,915 and a rate of 27 in the previous year. This was the lowest rate recorded up to that time, but it is now known that the 1948 rate was 23 (provisional). a
1.
Krasno, L., Karp, M., Rhoads, P. S. Ann. intern. Med. 1948, 28, 607. 2. O’Driscoll, D. T. Lancet (in the press). 3. Fisher, G. Ibid, Oct. 29, p. 775.
1. The Registrar-General’s Statistical Review of England and Wales H.M. Stationery Office. Part II. Civil. for 1947. Tables. Pp. 150. 3s.
ingesting this organism, staphylococcal pneumonia
and another who developed and fatal pyopericarditis. The risk must be much lessened once a high concentration of penicillin is achieved ; but only then, and only if it is maintained, can I agree that suckling should be allowed. Gentle removal of the milk by hand avoids the risk, and I believe results in better drainage. British
Hospital for Mothers
Babies, London, S.E.18.
and
HAROLD WALLER.
AEROSOLS BY INHALATION very surprised not to find in your leading article of Oct. 8 any reference to the ’Aerohaler’ method of delivering micropulverised substances to the respiratory mucosa ; especially as you say : "... the need is for a simple apparatus with an accessible nebulising device which can be quickly cleaned.... It should then be possible to abort the annual attack of recurrent bronchitis, to control the acute phases of bronchiectatic inflammation...."
SIR,—I
was
The manufacturers of the aerohaler claim that this means of delivery permits a more even and wider distribution of the material, together with a greater concentration per unit area. Its simplicity is unquestionable, and its effectiveness is also beyond doubt; for confirmation one has only to consult the report on 357 cases of various respiratory infections treated by Krasno, Karp, and Rhoads,! or to question other medical men who have used it. I have myself reported on a large lung abscess dramatically cured by this method.2 D. T. O’DRISCOLL. Galway. THE DOCTOR’S CREED SIR,—I suppose that if the Archbishop of Canterbury enters the pages of a scientific journal3 it will be his wish to do so on equal terms with others, and that, since he draws upon argument rather than authority to make his case, he will not mind some of his premises being called
into question. I speak as one who has given a good deal of thought to the ethical questions raised by being a doctor and a teacher, and indeed by life itself, and this seems to be an ideal opportunity to raise what to me, with some training in scientific reasoning, is a fundamental objection to the acceptance of the doctrine, though not the ethic, of orthodox Christianity. It is quite impossible for me to believe that God is at the same time omniscient, omnipotent, and wholly benevolent. I have seen too many children die of leukaemia or nephritis to believe that " Man is the object of God’s love, as God has shown in His acts"; and if, as Dr. Fisher asserts, God understands radar, then He surely knew of Buchenwald and Auschwitz. In short it seems that we must either believe that He is powerless to intervene against the evils of Satan and of man or that they are of His own creation. This, I am well aware, is no new objection ; but just because it must be the stumbling-block of many thinking persons on the threshold of religion, so does it stand in need of an answer. Here let me anticipate the orthodox replies. To say that these are matters of Faith which we do not understand is to beg the question and renounce even the semblance of a logical approach to it. It is as if I were to say to my students " you must not question why you are to use this remedy or that ; it must be enough that I who am learned in these matters say that you should do so." To say that because I have within me an instinctive knowledge of right and wrong it must have been given to me by God is to assert what I have not contested. And to say that Buchenwald had some divine purpose incomprehensible to man is to deny completely man’s right to distinguish Good and Evil.
unsure that his beliefs will be universally Dr. Fisher throws out the challenge that a acceptable, man should accept them unless he has " a better hypothesis which will better equip him for his life and his work." As there are today many earnest doctors, and I hope beloved physicians, who do not subscribe to any orthodox religious belief, I would try to state their creed as briefly as possible. They believe that as civilised and educated men our conduct should be determined by a sense of personal responsibility ; by the inner satisfaction of doing right ; because not to do so brings a sense of personal failure ; because those whom we most admire would act thus ; and because of a respect for truth. We think that a man can obey his conscience without hope of reward in this world or belief in the next. To many in our profession the doctor’s creed is not strengthened by an attempt to believe what to us is incredible or to accept an explanation which does not
As if
a
little
consistent with experience. We prefer agnosticism unacceptable hypothesis. To state this is not to disparage others in and out of our profession who find comfort in religious faith. I can only hope, Sir, that the sincerity of my letter will to some extent pardon its obvious presumption. seem
to
ROBERT PLATT.
Manchester.
Public Health By-laws
for Cleaner Food
THE Minister of Food has issued to local authorities in and Wales a model for by-laws to secure the observance of cleanly conditions in connexion with the handling, wrapping, and delivery of food for human consumption. These by-laws will supplement existing statutory measures. The model has been prepared in consultation with local-authority and trade associations. Some desirable provisions have had to be excluded because of shortage of materials and equipment, and the model may be added to from time to time. The suggested provisions, which cover such matters as personal hygiene, cleanliness and good order of equipment, cleanliness of wrapping material, and the deposit and removal of refuse, have been drafted with a view to their application in both urban and rural areas, and In making byto every type of food-handling trade. laws local authorities are not bound to follow the precise terms of the model, which is intended as a guide to provisions which are reasonable and enforceable having regard to present-day conditions. The Minister has expressed the hope that all local authorities which havee not already done so will consider adopting by-laws based on the model.
England
Births, Marriages, and Fertility in 1947 Part 11 of the Registrar-General’s Statistical Review for 19471 reveals that in England and Wales the birthrate again rose, illegitimacy continued to decrease, and the stillbirth-rate was the lowest country up to that time.
ever
recorded in this
-
Births.—There was 881,026 live births which represented birth-rate of 20-5 per 1000 total population ; this was au increase of 1-3 per 1000 over the previous year and was the highest rate since 1921 when it was 22-4. This post-war rise in the birth-rate was not maintained in 1948, when the rate fell to 17-9 (provisional). Of the live births, 196 were to mothers under 16 years of age, and 16 to mothers aged 50 or over (3 of whom were aged 55 or over). There were 46,603 illegitimate live births, compared with 53,919 the year before -5-3 and 6-6% of all live births. Stillbirths numbered 21,795, representing a rate of 24 per 1000 total live and still births, compared with 22,915 and a rate of 27 in the previous year. This was the lowest rate recorded up to that time, but it is now known that the 1948 rate was 23 (provisional). a
1.
Krasno, L., Karp, M., Rhoads, P. S. Ann. intern. Med. 1948, 28, 607. 2. O’Driscoll, D. T. Lancet (in the press). 3. Fisher, G. Ibid, Oct. 29, p. 775.
1. The Registrar-General’s Statistical Review of England and Wales H.M. Stationery Office. Part II. Civil. for 1947. Tables. Pp. 150. 3s.