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EPITHELIOMA OF THE TONGUE IN WOMEN.
1083
part of the nineteenth century and yet be Mr. ineffective until far more recent times. Hoffman’s remarks on British administration in many directions have exactly the same justification. In places where Mr. Hoffman contradicts Dr. Bashford he is himself contradicted by the Department of Commerce: Bureau of the Census of the United States.-ED. L. the earlier
practically
AERIAL INFECTION.
I
the Editor of THE LANCET. in THE LANCET of March 28th annotation SIR,-The on the Passing of the Doctrine of Aerial Infection raises some important questions. Whatever the danger from air-borne infection may be, it is at any rate certain that no infectious disease has been brought by precautions against it, such as isolation EPITHELIOMA OF THE TONGUE IN hospitals, under such control as has been obtained WOMEN. in a series of diseases, ranging from enteric to To the Editor of THE LANCET. yellow fever, by other means. The advantages secured for the individual or the family are not in SiR,—The case of epithelioma of the tongue question, but only those for the nation. in a woman referred to in an annotation in Is it then not probable that the scheme for preTHE LANCET of March 28th is important as calling the spread of tuberculosis devised by the venting attention to the comparative infrequency of this Astor Commission and adopted by the Insurance This infrequency affection in the female sex. to carry out which sanatoriums are being built Act, But is not so much recognised as it should be. all over the country, is founded on a mistaken idea, besides carcinoma of the tongue it applies to cancer and may even check the diminution of mortality of all parts of the mouth, pharynx, and larynx. from pulmonary phthisis which began about 1850, This is shown by the Registrar-General’s reports. before sanatoriums were dreamt of, proving that In the past 11 years there have been in Woolwich there are indirect methods by which this disease 182 cases of cancer of the head, face, mouth, jaw, be diminished ? may tongue, oesophagus, pharynx, larynx, and neck Few diseases are less capable of effective isolation and 47 only among men among women. than phthisis. Isolate as one may, the air will still The connexion of cancer of the tongue with contain bacilli enough to infect the really suscepsmoking is well known, though it is usually tible. The larger the number of cases in which an attributed specially to clay pipes. Recent inquiries arrest of this disease is obtained the more numerous made in this borough point to the fact that any will be the descendants from the more easily kind of smoking is a cause of cancer of the mouth infected stocks. It is impossible to abrogate the and throat, especially when connected with law that a race is weakened by encouraging the Of 33 from of alcoholism. cancer persons dying survival of those unfit for the conditions under the mouthrand throat 45 per cent. took alcohol which they have to live, but it is possible to eexcessively, and 76 per cent. smoked excessively. improve those conditions so that more may be Of 109 persons dying at advanced ages from other able to survive with advantage to themselves and diseases 17 per cent. only were excessive smokers others.-I am, Sir, yours faithfully, and 18 per cent. excessive drinkers. Of 25 excessive MICHAEL THOS. SADLER, M.D. Lond. smokers who died of cancer of the mouth and Brook Green, S.W., March 28th, 1914. 15 8 briar smoked chiefly clay pipes, or tongue other form of pipe, 1 cigars, and 2 cigarettes. Among the non-cancer cases there were 40 smokers INFANT MORTALITY AND THE WELFARE (excessive and moderate); 23 of these smoked OF INFANCY. clay pipes, 16 briar, and only 1 cigarettes. Out To the Editor of THE LANCET. of 33 cases of cancer of the mouth and tongue SIR,-Will you allow me to say a word on the there were only two who did not smoke. One of of your annotation in THE LANCET of subject in in the other one, as these had bad teeth, and March 28th on the representation made to the the case reported by you, there was no obvious General Medical Council the National Associaby source of the cancer. tion for the Prevention of Infant Mortality regardI am. Sir. vours faithfullv. ing the necessity for including in the curriculum a SIDNEY DAVIES. Woolwich, March 30th, 1914. course of training in infant hygiene ? Everyone will agree with you in deprecating the To the Editor ot THE LANCET. addition of even a feather’s weight to the burden SIR,-In an annotation in THE LANCET of imposed upon the student, and will assent to your March 28th the occurrence in the female sex of proposition that in a readjustment of that burden And in the epithelioma of the tongue is referred to as being lies the true direction of reform. to the proposal in you give enlightened support in rare. This statement is accordhardly extremely you indicate that the " little more"it ance with the facts. Keyser1 quotes 14 sets of question involves should, in fact, provide the necessary statistics of epithelioma of the tongue bearing readjustment. I wish to offer testimony in favour on the relative frequency of the disease in women; the highest estimate, that of Hayn, is 43 per cent., of this view, for I believe that such training while the average of all the statistics gives a will at once vivify, reinforce, coordinate, and percentage of over 18. A feature of some of the illuminate the whole course of academic study. I can best illustrate the point at issue by a referrecorded cases is the youth of the patient. 1 Keyser refers to five cases in which the patients ence to a remarkable paper by Dr. James Mackenzie, in which he presses home, in a were under 25 years of age, and in a case of my ownthe patient, whose disease had existed for 21 masterly way, a criticism of the prevalent tendency of the methods of clinical teaching, and points the months, died at the age of 26 years. T C;,. TJ"A"I"1"1"’C’l4!’n;.f-1..-fnllT"r realisation of the way to a better and fuller S ir,y o ur s f ai in talents of our teachers and the resources the C. HAMILTON WHITEFORD. material at their disposal, on which the advance of Plymouth, March 2ftb, ISlt. To
.",-.
t
, hfully
1
2
Bristol
THE LANCET, Sept. 17th, 1904, p. 829. Medico-Chirurgical Journal, March, 1906,
1
p. 45.
On the
1914.
Teaching
of Clinical
Medicine, Brit. Med. Jour.,
Jan.
3rd,
part of the nineteenth century and yet be Mr. ineffective until far more recent times. Hoffman’s remarks on British administration in many directions have exactly the same justification. In places where Mr. Hoffman contradicts Dr. Bashford he is himself contradicted by the Department of Commerce: Bureau of the Census of the United States.-ED. L. the earlier
practically
AERIAL INFECTION.
I
the Editor of THE LANCET. in THE LANCET of March 28th annotation SIR,-The on the Passing of the Doctrine of Aerial Infection raises some important questions. Whatever the danger from air-borne infection may be, it is at any rate certain that no infectious disease has been brought by precautions against it, such as isolation EPITHELIOMA OF THE TONGUE IN hospitals, under such control as has been obtained WOMEN. in a series of diseases, ranging from enteric to To the Editor of THE LANCET. yellow fever, by other means. The advantages secured for the individual or the family are not in SiR,—The case of epithelioma of the tongue question, but only those for the nation. in a woman referred to in an annotation in Is it then not probable that the scheme for preTHE LANCET of March 28th is important as calling the spread of tuberculosis devised by the venting attention to the comparative infrequency of this Astor Commission and adopted by the Insurance This infrequency affection in the female sex. to carry out which sanatoriums are being built Act, But is not so much recognised as it should be. all over the country, is founded on a mistaken idea, besides carcinoma of the tongue it applies to cancer and may even check the diminution of mortality of all parts of the mouth, pharynx, and larynx. from pulmonary phthisis which began about 1850, This is shown by the Registrar-General’s reports. before sanatoriums were dreamt of, proving that In the past 11 years there have been in Woolwich there are indirect methods by which this disease 182 cases of cancer of the head, face, mouth, jaw, be diminished ? may tongue, oesophagus, pharynx, larynx, and neck Few diseases are less capable of effective isolation and 47 only among men among women. than phthisis. Isolate as one may, the air will still The connexion of cancer of the tongue with contain bacilli enough to infect the really suscepsmoking is well known, though it is usually tible. The larger the number of cases in which an attributed specially to clay pipes. Recent inquiries arrest of this disease is obtained the more numerous made in this borough point to the fact that any will be the descendants from the more easily kind of smoking is a cause of cancer of the mouth infected stocks. It is impossible to abrogate the and throat, especially when connected with law that a race is weakened by encouraging the Of 33 from of alcoholism. cancer persons dying survival of those unfit for the conditions under the mouthrand throat 45 per cent. took alcohol which they have to live, but it is possible to eexcessively, and 76 per cent. smoked excessively. improve those conditions so that more may be Of 109 persons dying at advanced ages from other able to survive with advantage to themselves and diseases 17 per cent. only were excessive smokers others.-I am, Sir, yours faithfully, and 18 per cent. excessive drinkers. Of 25 excessive MICHAEL THOS. SADLER, M.D. Lond. smokers who died of cancer of the mouth and Brook Green, S.W., March 28th, 1914. 15 8 briar smoked chiefly clay pipes, or tongue other form of pipe, 1 cigars, and 2 cigarettes. Among the non-cancer cases there were 40 smokers INFANT MORTALITY AND THE WELFARE (excessive and moderate); 23 of these smoked OF INFANCY. clay pipes, 16 briar, and only 1 cigarettes. Out To the Editor of THE LANCET. of 33 cases of cancer of the mouth and tongue SIR,-Will you allow me to say a word on the there were only two who did not smoke. One of of your annotation in THE LANCET of subject in in the other one, as these had bad teeth, and March 28th on the representation made to the the case reported by you, there was no obvious General Medical Council the National Associaby source of the cancer. tion for the Prevention of Infant Mortality regardI am. Sir. vours faithfullv. ing the necessity for including in the curriculum a SIDNEY DAVIES. Woolwich, March 30th, 1914. course of training in infant hygiene ? Everyone will agree with you in deprecating the To the Editor ot THE LANCET. addition of even a feather’s weight to the burden SIR,-In an annotation in THE LANCET of imposed upon the student, and will assent to your March 28th the occurrence in the female sex of proposition that in a readjustment of that burden And in the epithelioma of the tongue is referred to as being lies the true direction of reform. to the proposal in you give enlightened support in rare. This statement is accordhardly extremely you indicate that the " little more"it ance with the facts. Keyser1 quotes 14 sets of question involves should, in fact, provide the necessary statistics of epithelioma of the tongue bearing readjustment. I wish to offer testimony in favour on the relative frequency of the disease in women; the highest estimate, that of Hayn, is 43 per cent., of this view, for I believe that such training while the average of all the statistics gives a will at once vivify, reinforce, coordinate, and percentage of over 18. A feature of some of the illuminate the whole course of academic study. I can best illustrate the point at issue by a referrecorded cases is the youth of the patient. 1 Keyser refers to five cases in which the patients ence to a remarkable paper by Dr. James Mackenzie, in which he presses home, in a were under 25 years of age, and in a case of my ownthe patient, whose disease had existed for 21 masterly way, a criticism of the prevalent tendency of the methods of clinical teaching, and points the months, died at the age of 26 years. T C;,. TJ"A"I"1"1"’C’l4!’n;.f-1..-fnllT"r realisation of the way to a better and fuller S ir,y o ur s f ai in talents of our teachers and the resources the C. HAMILTON WHITEFORD. material at their disposal, on which the advance of Plymouth, March 2ftb, ISlt. To
.",-.
t
, hfully
1
2
Bristol
THE LANCET, Sept. 17th, 1904, p. 829. Medico-Chirurgical Journal, March, 1906,
1
p. 45.
On the
1914.
Teaching
of Clinical
Medicine, Brit. Med. Jour.,
Jan.
3rd,