BREAST FEEDING.

1763 Mr. Frank Kidd (May 10th, p. 1342) admits that he cannot tell which cases are going to fulminate and which to quiet down ; he wishes that he could. So does But as soon as a case of almost every other surgeon. appendicitis is admitted into his wards it is put up in the sitting position, starved, and watched, and an hourly chart If at the of temperature, pulse, and breathing is taken. end of four hours these are all falling and the pain is less, ’’ the patient is allowed to settle down into an interval"" That is, I take it, the operation is done later. case. I am going to insist that now and then a case is met with in which pulse, breathing, temperature, and I tenderness are all quieting down, and yet the appendicular " disease is stealthily advancing. Such are the" surprise" Has not Mr. Kidd met with them? cases. Nothing but immediate operation can render such cases safe. Mr. Kidd says that if the hourly or four-hourly examination presages ill, "an operation is at once performed, and, so far, I have had no reason to doubt from the operative findings that the peritonitis was spreading."(The italics are mine.) But inasmuch as the surgeon can no more guide a case of peritonitis than he can foretell what course it will take, it must surely be safer to remove the inflamed appendix before it has had the chance of setting up a peritonitis. I am, Sir. yours faithfully, EDMUND OWEN.

BREAST FEEDING. To the Editor of THE LANCET. SIR,-The leading article and the three original communications which appear in THE LANCET of June 14th on the subject of breast feeding cannot fail to call attention to one of the chief reasons for the premature weaning and artificial feeding of infants. I refer to the many difficulties which beset the path of the best intentioned mothers in I know well that their first essays at breast feeding. many mothers are only too glad to avoid their natural responsibilities and to relegate their duties to the nurse, but on the other hand a very large number of mothers are driven by despair and apparent failure to adopt the same course-a course which, through want of knowledge, is often encouraged by the medical attendant and by the The practical details which are essential to ensure nurse. successful breast feeding are, as Mrs. L. Naish has so forcibly demonstrated, but little understood by the majority of mothers, hence breast feeding does not always prove a success, and the descent to bottle feeding is easy. In spite of the shortcoming of the test-feed, to which Dr. David Forsyth has very properly called attention, it is by means of the " testfeed"" that the obvious disadvantages of premature weaning can be best avoided. It has been the universal experience of the few persons in .this country who have consistently availed themselves of the information which the test-feed affords to find that as a means of diagnosis of the causes of indigestion and malnutrition in breast-fed infants it is the most valuable expedient we possess, that its evidence is the most effective argument against premature weaning, and that it affords invaluable data on which to base supplementary feeding. I have had some eight years’ experience of the method, and some of the results which I have obtained are truly remarkable. The most interesting ca"es are those of wasting infants, whose mothers assure me that they have a good supply of milk, and that their infants secure a good amount of milk at each feeding. At the time of the "test-feed" "I invariably ask the following question: "Do you think your baby has had a good feed? Not infrequently the mother says : "Yes, it has had a good feed," when the evidence of the experiment proves beyond question that the amount of milk the baby has secured is quite negligible, possibly less than two teaspoonfuls. Starved babies of this kind show enormous improvement under judicious supplementary feeding. One baby brought a few weeks ago to the Queen’s Hospital for Children gained 2 lib. 2 oz. in one week as the result of supplementary feeding after prolonged starvation of this kind. This is the record gain registered at the hospital, but I have seen several of 1- lb., and a few of 1 lb. I am, Sir, yours faithfully, ERIC PRITCHARD. "

-

SKIN GRAFTING WITHOUT DRESSINGS. To tAe Editor of THE LANCET.

SIR,-It may be of interest to state that about 14 years ago I

began to treat all cases of skin-grafting without application of any dressings, and I feel sure I was not

the the

first in this country to do so. The first time I adopted this treatment was with the skilful aid of my house surgeon, Mr. J. R. Benson, who is now practising at Bath. We skin-grafted the ulcer that remained after the extensive removal of the left breast. Mr. Benson made a little cage, which we covered with double cyanide gauze. Complete healing at once took place under its protection. Since then I have adopted this mode of procedure with complete success. I see in your annotation upon this subject in THE LANCET of June 14th that Dr. Wiener, whom you quote, packs suppurating sinuses with iodoform gauze. In an article which I wrote on Surgical Technique in "System of Treatment," edited by Dr. A. Latham and Mr. T. Crisp English (vol. i., p.77), I drew attention to the fact that much of the iodoform gauze sold in this country is either fraudulent or the gauze does not contain its reputed strength of iodoform. In many cases it was artificially stained to appear yellow, and instead of 10 per cent. or 20 per cent., as its strength was reputed to be, sometimes it was 1 per cent. or even less. I must hasten to add that most of the iodoform gauze made by British manufacturers was accurate in strength and not in The antiseptic gauzes which we any way tampered with. found very seriously at fault were those chiefly imported from abroad and sold in this country. The only way in which I can see we could be protected from this grave state of affairs would be to make these gauzes pharmacopoeial

preparations. One other point to which allusion should be made whilst dealing with this subject. The gauzes now being sold are too frequently of an inferior quality. The meshes are too large and too irregular ; they should be small and regular. The matter is fully dealt with in the article in the book to which I have alluded. I am,

Sir, yours faithfully,

-.

G. LENTHAL CHEATLE.

ST. GEORGE’S HOSPITAL AND THE KING’S FUND. To the Editor of THE LANCET. SiR,-At a meeting of the court of governors of St. George’s Hospital on Thursday, June 12th, the principal business considered concerned the relations existing between the hospital and King Edward VII.’s Hospital Fund for London. At this meeting we had the advantage of hearing Sir Henry Burdett, who is a member of the committee of that Fund. Sir Henry Burdett, speaking as a governor of the hospital. but under what, from the attitude of his audience, must have been a very lively sense of his responsibility as a. member of the King’s Fund committee, gave what must be regarded as the common committee view of the question under discussion, as he repudiated any special knowledge or investigation. If this be so, since this account bore so little resemblance to the facts, it can only be assumed that the committee had never had the hospital’s case put before it, but only garbled versions which have filtered through subcommittees or the reports of permanent officials. It is not surprising that Sir Henry Burdett’s account was confused, as the grounds of complaint against the hospital alleged by the committee have ranged through heterodox-bookkeeping, diversions of the h0spital’s funds to medical school purposes, and too large an expenditure on the bacteriological department, and in the last report the onus is laid on the pathological department and museum. This last complaint will cause searching of heart and much difficulty in explaining the balance sheets of some hospitals whose officials have a place on the committee. Being challenged as to the authority by which the King’s Fund determined, under the guise of a financial control, the amount to be spent by the hospitals on special lines of treatment, Sir Henry Burdett made the surprising but enlightening statement that those that paid the piper should call the He apparently forgot that it is the public and not the tune. committee of the King’s Fund which pays the piper, and