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CLINICAL RESEARCH.
775 of medicine ? I would suggest that in such advice be given to the doctor, and only such treatment given to the patient as cannot be given by his private doctor. (3) Extended Use of Hospital Contributory Schemes.Large numbers of patients who contribute to such schemes as the Hospital Savings Association attend the voluntary hospitals for minor ailments, and receive medicinal treatment. No charge is made to these patients. I would suggest that under such schemes only such treatment should be given as cannot be given by a general practitioner, and that such contributions should be reserved for such things
supply cases
as, I
believe, they
originally intended--e.g.,
were
in-patient treatment, operations, consultations, X ray, physiotherapy.-I am, Sir, yours faithfully, Westbourne Park-road, March 29th, 1930.
CLINICAL To the Editor
J. COHEN.
RESEARCH.
of
THE LANCET.
SIR,—It is always of interest to learn the views of others; and for this reason Dr. Frewen Moor’s letter in your issue of March 29th (p. 724) is deserving of
notice. It helps to explain many things. Let me give an instance. Some time ago I saw a case of typical sprue which had been under treatment over a continuous period at the hands of four medical
London.
Great Britain. British Medical Association. Canadian Medical Association. University of Birmingham: Faculty of Medicine and Dental Clinical Board. University of Durham: Faculty of Medicine. King’s Coll. Hosp. Med. School. St.Thomas’s Hosp.Med.School.
anaemia. As Dr. Moor justly remarks, there are many methods of treating the same disease, but I cannot agree that all are equally effective ; for No. 3 had all the patient’s teeth extracted, although they do not seem to have been at all bad, and subjected him to a course of arsenic in increasing doses (this was in 1929). There was still no improvement, and the patient steadily deteriorating in health, decided to return to England, as he feared, to die. On his arrival he went to see No. 4, who during the war had had tropical experience and who had no hesitation in correctly diagnosing sprue. With appropriate treatment the improvement, in the patient’s own words, was " a miracle." It would appear to the ordinary individual that in such a case diagnosis comes first. not only in order of time, but also of importance. It is possible to recall many similar instances: subacute combined degeneration of the cord, with pernicious ansemia, diagnosed and treated as locomotor ataxy ; early locomotor ataxy with lightning pains treated for two years as rheumatism ; glycosuria due to a lowered renal threshold diagnosed and treated as diabetes mellitus, and so ad infinitum. I am one of the old school, and believe that all treatment, to be successful, must be based upon an accurate diagnosis. Dr. Moor appears to agree with this in his concluding paragraph. I am, March 28th, 1930.
Sir,
yours
faithfully, M.D., F.R.S. EDIN.
ADDRESS.
Dr.
Maynard
Horne.
Dr. Cecil Hughes. Dr. A. E. Idris. Miss E. M. Joyce. Prebendary F. Wayland Joyce. Dr. S. Johnston. Dr. T. P. C. Kirkpatrick. Mr. T. P. Legg, F.R.C.S. Dr. A. Livingstone. Mr. C. E. Lloyd. Miss E. M. Lloyd. Dr. F. W. Longhurst. Dr. C. J. Loosely. Dr. W. A. Low. Mr. V. Warren Low, F.R.C.S. Dr. W. J. McCardie. Dr. N. McDonald. Dr. I. W. Magill. Dr. A. W. Matthew. Dr. Z. Mennell. Mr. and Mrs. Moriarty. Dr. G. 1. Moriarty. Mr. G. Northcroft. The Bishop of Norwich. Mr. H. Max Page, F.R.C.S. Dr. G. R. Phillips. Dr. H. R. Phillips. Dr. M. Phillips. Dr. K. B. Pinson. Dr. H. Pinto-Leite. Dr. E. Playfair. The Earl of Plymouth. Dr. L. Powell. Mr. F. L. Pradier, L.D.S. Dr. H. A. Richards. Dr. A. White Robertson. Sir Humphry Rolleston, M.D. Mrs. Rotton. Dr. E. S. Rowbotham. Dr. J. F. Ryan. Sir Percy Sargent, F.R.C.S. Mr. C. Schelling, L.D.S. Sir F. E. Shipway, M.D. Dr. J. H. Shirley. Mr. H. F. Shuker. Mr. H. H. Shuker. Mrs. Sievers. Mr. F. W. Sievers. Mr. R. F. Sievers. Dr. Harold Sington. Miss Skeather. Dr. H. R. Spencer. Dr. W. Stobie. Rev. H. Summerhayes. Mr. John Sumner. Dr. Edward Tate. Dr. L. K. Thomas. Miss Blanche Thompson (and
Dental Hospital: Medical Committee. Oxford : Faculty of University of Medicine. Bath and Bristol Surgical Club. Hunterian Society. Royal Society of Medicine: Odontological Section and Section of Anaesthetics. A.C. Mr. A. W. Adams, F.R.C.S. Dr. R. E. Apperly. Lady Berry, M.D. Dr. W. R. Bett. Mrs. Bettridge and descendants of Hickman’s daughter, Hannah. Dr. A. D. Blackadder. Dr. J. Blomneld. Dr. H. E. Boyle. Mr. C. Carter Braine, F.R.C.S. Dr. E. Chittenden Bridges. Sir Bruce Bruce-Porter, M.D. Dr. D. W. Buxton. Sir Farquhar Buzzard, M.D. Dr. H. Charles. Sir G.Lenthal Cheatle,F.R.C.S. Dr. R. J. Clausen. Dr. F. W. Cock. Dr. S. W. Coffin. Mr. F. Coleman, L.D.S. Dr. C. Corfield. Miss E. Courtauld, M.D. Dr. H. P. Crampton. Mr. A. W. Cuff, F.R.C.S. Mr. W. Dall, L.D.S. Dr. A. S. Daly. Lord Dawson of Penn. Dr. E. V. Dunkley. Dr. W. J. Essery. Dr. F. T. Evans. Mr. H. A. T. Fairbank, F.R.C.S. collections). Mr. C. A. Thompson. Dr. H. P. Fairlie. Miss E. A. Thompson. Dr. H. W. Featherstone. Mr. F. H. Thompson. Mrs. Fitton. Mr. G. Hickman Thompson. Dr. A. C. Flemming. Miss Isabel Thompson. Dr. E. W. Gandy. Sir StClair Thomson, F.R.C.S. Dr. H. B. Gardner. Sir J. W. Thomson-Walker, Dr. A. G. Gibson. Mr. Richard Gill, F.R.C.S. F.R.C.S. Dr. T. S. Good. Dr. J. F. Trewby. Mr.E.L. Pearce Gould,F.R.C.S. Mr. Wilfred Trotter. F.R.C.S. Dr. C. F. Hadfield. Dr. E. W. Ainley Walker. Dr. J. K. Hasler. Dr. Henry S. Wellcome. Dr. C. L. Hewer. Sir William Wheeler, F.R.C.S. General T. E. Hickman. Mr. A. J. Wright, F.R.C.S.
under the care of No. 2. No. 2 made a very thorough examination of the patient as a result of which he stated that the patient was suffering from tuberculosis, and after several weeks of treatment, recommended him to go to the south of France, where he met No. 3. No. 3 also carried out a routine examination, and at all events deserves credit for having recognised the " sore tongue," on the evidence of which, together with the patient’s general condition, he diagnosed
pernicious
DAWSON’S
THE Committee report that the total sum received amounts to £256 10s. 6d., and that the appeal is now closed. Hickman’s family grave and tombstone have been restored and renewed and a tablet engraved by Mr. Eric Gill is to be unveiled in Bromfield Parish Church, Ludlow, by Sir StClair Thomson, late President of the Royal Society of Medicine, to-day (Saturday), April 5th, at 2.45 P.M. This will be followed by a dedication by the Rt. Rev. The Lord Bishop of Hereford. The balance of the fund will be devoted to establishing and endowing a medal for research and original work of merit in connexion with anaesthesia. Further particulars, including the names of the Trustees appointed, will be published later. The letter announcing the closing of the appeal, which is signed by Lord Dawson of Penn, Sir StClair Thomson, Mr. V. Warren Low, Hon. Treasurer, and Dr. Cecil Hughes, Hon. Secretary, expresses on behalf of the Committee cordial thanks to the numerous colleges, faculties, learned societies, and individuals who have so readily supported this appeal. The list of subscribers is as follows :College of Physicians of Mr. C. W.M. Hope, F.R.C.S.
Royal College of Surgeons of England. Royal College of Surgeons of Edinburgh. Royal Society of Medicine. Association of Surgeons of
No. far as
came
APPEAL CLOSED.—LORD
Royal
men.
1 diagnosed the case as dysentery, mainly, as can be ascertained, from the fact that the patient had lived in the tropics. There can be no doubt of the assiduity with which the treatment was carried out, for the patient had a course of emetine, followed by antidysenteric serum (presumably polyvalent), and finally a period of lavage of the colon. Eventually he recommended a " change of air " to the seaside, where the patient, much emaciated,
HENRY HILL HICKMAN MEMORIAL.
Royal
supply cases
as, I
believe, they
originally intended--e.g.,
were
in-patient treatment, operations, consultations, X ray, physiotherapy.-I am, Sir, yours faithfully, Westbourne Park-road, March 29th, 1930.
CLINICAL To the Editor
J. COHEN.
RESEARCH.
of
THE LANCET.
SIR,—It is always of interest to learn the views of others; and for this reason Dr. Frewen Moor’s letter in your issue of March 29th (p. 724) is deserving of
notice. It helps to explain many things. Let me give an instance. Some time ago I saw a case of typical sprue which had been under treatment over a continuous period at the hands of four medical
London.
Great Britain. British Medical Association. Canadian Medical Association. University of Birmingham: Faculty of Medicine and Dental Clinical Board. University of Durham: Faculty of Medicine. King’s Coll. Hosp. Med. School. St.Thomas’s Hosp.Med.School.
anaemia. As Dr. Moor justly remarks, there are many methods of treating the same disease, but I cannot agree that all are equally effective ; for No. 3 had all the patient’s teeth extracted, although they do not seem to have been at all bad, and subjected him to a course of arsenic in increasing doses (this was in 1929). There was still no improvement, and the patient steadily deteriorating in health, decided to return to England, as he feared, to die. On his arrival he went to see No. 4, who during the war had had tropical experience and who had no hesitation in correctly diagnosing sprue. With appropriate treatment the improvement, in the patient’s own words, was " a miracle." It would appear to the ordinary individual that in such a case diagnosis comes first. not only in order of time, but also of importance. It is possible to recall many similar instances: subacute combined degeneration of the cord, with pernicious ansemia, diagnosed and treated as locomotor ataxy ; early locomotor ataxy with lightning pains treated for two years as rheumatism ; glycosuria due to a lowered renal threshold diagnosed and treated as diabetes mellitus, and so ad infinitum. I am one of the old school, and believe that all treatment, to be successful, must be based upon an accurate diagnosis. Dr. Moor appears to agree with this in his concluding paragraph. I am, March 28th, 1930.
Sir,
yours
faithfully, M.D., F.R.S. EDIN.
ADDRESS.
Dr.
Maynard
Horne.
Dr. Cecil Hughes. Dr. A. E. Idris. Miss E. M. Joyce. Prebendary F. Wayland Joyce. Dr. S. Johnston. Dr. T. P. C. Kirkpatrick. Mr. T. P. Legg, F.R.C.S. Dr. A. Livingstone. Mr. C. E. Lloyd. Miss E. M. Lloyd. Dr. F. W. Longhurst. Dr. C. J. Loosely. Dr. W. A. Low. Mr. V. Warren Low, F.R.C.S. Dr. W. J. McCardie. Dr. N. McDonald. Dr. I. W. Magill. Dr. A. W. Matthew. Dr. Z. Mennell. Mr. and Mrs. Moriarty. Dr. G. 1. Moriarty. Mr. G. Northcroft. The Bishop of Norwich. Mr. H. Max Page, F.R.C.S. Dr. G. R. Phillips. Dr. H. R. Phillips. Dr. M. Phillips. Dr. K. B. Pinson. Dr. H. Pinto-Leite. Dr. E. Playfair. The Earl of Plymouth. Dr. L. Powell. Mr. F. L. Pradier, L.D.S. Dr. H. A. Richards. Dr. A. White Robertson. Sir Humphry Rolleston, M.D. Mrs. Rotton. Dr. E. S. Rowbotham. Dr. J. F. Ryan. Sir Percy Sargent, F.R.C.S. Mr. C. Schelling, L.D.S. Sir F. E. Shipway, M.D. Dr. J. H. Shirley. Mr. H. F. Shuker. Mr. H. H. Shuker. Mrs. Sievers. Mr. F. W. Sievers. Mr. R. F. Sievers. Dr. Harold Sington. Miss Skeather. Dr. H. R. Spencer. Dr. W. Stobie. Rev. H. Summerhayes. Mr. John Sumner. Dr. Edward Tate. Dr. L. K. Thomas. Miss Blanche Thompson (and
Dental Hospital: Medical Committee. Oxford : Faculty of University of Medicine. Bath and Bristol Surgical Club. Hunterian Society. Royal Society of Medicine: Odontological Section and Section of Anaesthetics. A.C. Mr. A. W. Adams, F.R.C.S. Dr. R. E. Apperly. Lady Berry, M.D. Dr. W. R. Bett. Mrs. Bettridge and descendants of Hickman’s daughter, Hannah. Dr. A. D. Blackadder. Dr. J. Blomneld. Dr. H. E. Boyle. Mr. C. Carter Braine, F.R.C.S. Dr. E. Chittenden Bridges. Sir Bruce Bruce-Porter, M.D. Dr. D. W. Buxton. Sir Farquhar Buzzard, M.D. Dr. H. Charles. Sir G.Lenthal Cheatle,F.R.C.S. Dr. R. J. Clausen. Dr. F. W. Cock. Dr. S. W. Coffin. Mr. F. Coleman, L.D.S. Dr. C. Corfield. Miss E. Courtauld, M.D. Dr. H. P. Crampton. Mr. A. W. Cuff, F.R.C.S. Mr. W. Dall, L.D.S. Dr. A. S. Daly. Lord Dawson of Penn. Dr. E. V. Dunkley. Dr. W. J. Essery. Dr. F. T. Evans. Mr. H. A. T. Fairbank, F.R.C.S. collections). Mr. C. A. Thompson. Dr. H. P. Fairlie. Miss E. A. Thompson. Dr. H. W. Featherstone. Mr. F. H. Thompson. Mrs. Fitton. Mr. G. Hickman Thompson. Dr. A. C. Flemming. Miss Isabel Thompson. Dr. E. W. Gandy. Sir StClair Thomson, F.R.C.S. Dr. H. B. Gardner. Sir J. W. Thomson-Walker, Dr. A. G. Gibson. Mr. Richard Gill, F.R.C.S. F.R.C.S. Dr. T. S. Good. Dr. J. F. Trewby. Mr.E.L. Pearce Gould,F.R.C.S. Mr. Wilfred Trotter. F.R.C.S. Dr. C. F. Hadfield. Dr. E. W. Ainley Walker. Dr. J. K. Hasler. Dr. Henry S. Wellcome. Dr. C. L. Hewer. Sir William Wheeler, F.R.C.S. General T. E. Hickman. Mr. A. J. Wright, F.R.C.S.
under the care of No. 2. No. 2 made a very thorough examination of the patient as a result of which he stated that the patient was suffering from tuberculosis, and after several weeks of treatment, recommended him to go to the south of France, where he met No. 3. No. 3 also carried out a routine examination, and at all events deserves credit for having recognised the " sore tongue," on the evidence of which, together with the patient’s general condition, he diagnosed
pernicious
DAWSON’S
THE Committee report that the total sum received amounts to £256 10s. 6d., and that the appeal is now closed. Hickman’s family grave and tombstone have been restored and renewed and a tablet engraved by Mr. Eric Gill is to be unveiled in Bromfield Parish Church, Ludlow, by Sir StClair Thomson, late President of the Royal Society of Medicine, to-day (Saturday), April 5th, at 2.45 P.M. This will be followed by a dedication by the Rt. Rev. The Lord Bishop of Hereford. The balance of the fund will be devoted to establishing and endowing a medal for research and original work of merit in connexion with anaesthesia. Further particulars, including the names of the Trustees appointed, will be published later. The letter announcing the closing of the appeal, which is signed by Lord Dawson of Penn, Sir StClair Thomson, Mr. V. Warren Low, Hon. Treasurer, and Dr. Cecil Hughes, Hon. Secretary, expresses on behalf of the Committee cordial thanks to the numerous colleges, faculties, learned societies, and individuals who have so readily supported this appeal. The list of subscribers is as follows :College of Physicians of Mr. C. W.M. Hope, F.R.C.S.
Royal College of Surgeons of England. Royal College of Surgeons of Edinburgh. Royal Society of Medicine. Association of Surgeons of
No. far as
came
APPEAL CLOSED.—LORD
Royal
men.
1 diagnosed the case as dysentery, mainly, as can be ascertained, from the fact that the patient had lived in the tropics. There can be no doubt of the assiduity with which the treatment was carried out, for the patient had a course of emetine, followed by antidysenteric serum (presumably polyvalent), and finally a period of lavage of the colon. Eventually he recommended a " change of air " to the seaside, where the patient, much emaciated,
HENRY HILL HICKMAN MEMORIAL.
Royal