- Email: [email protected]
FREE TREATMENT AT VENEREAL CLINICS
1279
requirements, and of making the necessary arrangements to meet them. Every person who takes advantage of this opportunity will be expected to observe the conditions above indicated, and will be required to sign an undertaking to that effect. Inquiries by letter or telephone cannot be answered. I am, Sir, yours faithfully, NORMAN C. KING, in official
all osteomalacic
the results have been cases. The usual daily dose is grs. 30, but sometimes larger amounts, up to grs. 60 daily, are given. Whatever the initial state of the blood chemistry, which varies in different patients, improvement is always associated with a normal serum calcium and a serum inorganic phosphorus as high as that found in healthy infants and young children. It may be of interest to mention that the daily ultraviolet solar radiation in Lahore in the cold weather was found to be from 3 to 8 units by the acetonemethylene-blue gauge, the average being about 5. In the highlands of Kashmir, a State in which osteomalacia is prevalent, from 8 to 16 units a day were recorded. The occurrence of the disease in nonpurdah individuals living in these regions may therefore be, to some extent, the result of a deficiency of calcium and/or phosphorus in the diet. I am, Sir, yours faithfully, T. A. HUGHES, M.D., M.R.C.P.,
Registrar, General Medical Council. 44, Hallam-street, London, W.1, June 4th, 1932.
UNDULANT FEVER
To the Editor of THE LANCET. SIR,—In view of the interest taken in undulant fever, and the work of Dr. C. P. Beattie and others, recently published in your columns, perhaps the following figures of Br. abortus incidence in milks in this area may be of interest. Between 1927 and 1931I examined for the presence of abortus agglutinin the sera of 760 guinea-pigs inoculated in this laboratory with milks (primarily for T.B.). The following are the results : 170 showed abortus
145 "
"
agglutinin at "
1 in 40 1 " 80
or
patientsand
beneficial, especially in the resistant
Professor of Clinical Medicine, Medical College, Lahore.
Bexhill, May 30th, 1932
higher =22’3% =19%
FREE TREATMENT AT VENEREAL CLINICS
"
To the Editor of THE LANCET. therefore 20 per cent. of these animals showed that they had been infected with Br. abortus, SIR,—With a practical experience of over 20 years but as the milks were nearly all mixed samples in venereal diseases, I heartily endorse all that Dr. the positive percentage might actually be higher. Wansey Bayly asserts in his letter to you. It is time Unfortunately I have but a small number of that some committee should be set up to review the controls-i.e., animals used for other purposes than whole position. The very object for which the milk inoculation. None of these showed a trace of Government voted large sums of money has been abortus agglutinin. Brucella was repeatedly isolated defeated. All and sundry flock to the clinics without from the glands, spleen, and heart blood of the fear or favour. Modern youths have no knowledge
Roughly
.
abortus agglutinin. Milk whey of the deterrents to promiscuous intercourse that shows the presence of abortus agglutinin, their fathers realised, with the result that instead of but this is no evidence of the actual presence of diminishing the incidence of venereal diseases is brucella in such milks. In a small number of whey- rising. As Dr. Bayly states, the venereal specialist positive milks I found just under half (45-4 per cent.) is facing ruin-and for whose benefit ? which gave no evidence of infection in the guineaI am, Sir, yours faithfully, M. W. BROWDY. pigs inoculated. London, W., June 4th, 1932. During the above period I examined 650 human I found sera for the presence of abortus agglutinin. To the Editor of THE LANCET. it in six cases : Once 1 in 20 only. Twice 1 in 80 SIR,—The adoption of the points of view expressed 140 1160 in the letter of Dr. Wansey Bayly would undoubtedly None of these persons was suffering from any disease lead to anti-social interference. If there is a group resembling undulant fever, and in only one case was of infectious diseases whose ravages are not limited there any history at all suggestive of a previous to any one section of the community, that group, infection. beyond question, is the venereal. It is true that venereal disease is preventable, but adequate prophyI am, Sir, yours faithfully, lactic teaching is not yet carried out-not even to A. H. PRIESTLEY, Bacteriologist to the Burnley Corporation. the extent of instruction of students of medicine. May 31st, 1932. Therefore, until this education is widely instituted, venereal disease cannot be said to be voluntarily animals
showing
frequently
,,
I
"
"
TREATMENT OF LATE RICKETS AND OSTEOMALACIA
To the Editor of THE LANCET. SIR,—Dr. D. C. Wilson’s finding that certain cases of osteomalacia in Northern India are benefited by the administration of tricalcium phosphate is in line with my experience in the treatment of this disease in the Mayo Hospital, Lahore. It was found that in some patients (none of whom had ever observed purdah), improvement was very slow or at times non-existent under treatment with vitamins A and D and sunlight, and it was assumed that the diet taken by these individuals did not contain sufficient calcium and/or phosphorus. During the past 18 months or so I have therefore been including calcium glycerophosphate in the treatment of
"
acquired. Dr. Bayly confuses two aspects of medicine : (1) the treatment of disease; (2) the income of doctors who make a living treating it. With regard first, it is in the interests of the nation that venereal disease be wiped out ; and for this simple human work treatment should be free. The second aspect can lead to alarming implications. For, carrying this to its logical conclusion, we come to the unavoidable position that it is in the interest of venereal specialists that venereal disease should not be exterminated. I do not suggest that doctors are guilty of wishing for this state of affairs, but it seems to me that we should resist any attempt to limit to the
1 Hughes, T. A., Shrivastava, D. L., and Malik, K. S.: Ind. Jour. Med. Res., 1931, xix., 593.
1280 the present services for the treatment of venereal disease. On the contrary, we should extend them, and really make an effort to attack venereal diseases scientifically, that is, by propagating widespread information of prophylaxis for these social plagues.
removed in a paying ward without charge by the hospital and at a reduced fee by the surgeon, without his ordinary medical attendant even hearing of the matter unless the patient should come to him later with a ventral hernia. Now, however, I observe an The abolition of venereal disease by planned measures amendment to the rules that runs : " Normally on preventive lines should afford us pleasure which patients will only be admitted on the advice of their would adequately compensate for the sorrowful own doctor." Not a very strong safeguard, nor Dr. for us of draws the of much venereal picture Bayly help to the practitioner. It does seem really a pity that young consultants should not stick to specialist seeing ruin staring him in the face. consultant work, and I am convinced that the only I am, Sir, yours faithfully, effective method of dealing with the situation would FRANCIS LOUIS. be to notify all local medical organisations of the St. Peter’s (Whitechapel) Hospital, E., June 5th, 1932. position, and for them to advise that no cases be sent to any consultant who is prepared to act in the way suggested. THE SHUTTLEWORTH SAMARITAN FUND I am, Sir, yours faithfully, To the Editor of THE LANCET. R. GODWIN CHASE, M.B., B.Chir.Camb. June 6th, 1932. SIR,—May we ask for the hospitality of your columns in order to make known, to all who have the welfare of the mentally defective at heart, CHLOROFORM AND THE HEART that a fund is being raised to form a memorial to the To the Editor of THE LANCET. work of the late Dr. G. E. Shuttleworth ? It is now nearly four years since Dr. Shuttleworth SIR,—Might I suggest that Dr. 1. G. W. Hill should passed away, after a long life devoted to the welfare examine electrocardiographically patients under light of the mentally defective, in which cause he was a chloroform anaesthesia to whom a preliminary dose pioneer. It is proposed that the memorial should of atropine gr. 1/60 has been given one hour before. take the form of a Samaritan Fund, named after I have been giving chloroform to patients for the Dr. Shuttleworth, which should be available to last 24 years at the Manchester Skin Hospital. These help better-class people to place their children or patients have, practically speaking, never been deeply relatives in appropriate homes for care or training. anæsthetised. The majority of them move when Families of this class are prevented by many con- the operation commences. During that time I have siderations from applying for aid to public assistance seen three cases of early chloroform collapse, that is authorities, nor, in their case, even when such help pallor, sweating, dilated pupils, respiration so shallow is sought, is it easily obtainable. No other fund of the ’, as to be doubtfully perceptible, pulse so feeble as kind exists, although in many cases under post-war to be doubtfully palpable. Fortunately they all conditions, such help as it would offer has become recovered. The interesting point is that none of these essential. It is felt that this would be a particularly three had had a preliminary dose of atropine. I happy way in which to commemorate the work of found this out on inquiry after. In each case it had one who was ever ready, with a singular generosity, been forgotten. It has been my routine practice to to give his advice and aid to all who were in need. give a preliminary dose of atropine to all my patients Donations of f.1l5 have already been received, whether they were to receive ether or chloroform, and it is thought that many will be glad to havee since 1910. From the clinical standpoint I have this opportunity to show their appreciation of Dr. seen no evidence which would lead me to suppose that Shuttleworth’s great and unselfish services. Sub- ventricular fibrillation is ever a cause of death in should to be sent the the Shuttlepatients under light chloroform anaesthesia if they treasurer, scriptions worth Samaritan Fund, 72, Denison House, 296, have had a preliminary dose of atropine. Actually, Vauxhall Bridge-road, S.W.I, or direct to the in practice I use morphia as well as atropine, but I Shuttleworth Samaritan Fund, Martin’s Bank, 68, have always supposed that it was the atropine that Lombard-street, E.C.3. safeguarded the heart from vagus inhibition, which latter is, in my opinion, the precursor of ventricular We are, Sir, yours faithfully, fibrillation. (Signed) G. A. AUDEN, I am, Sir, yours faithfully, F. G. CROOKSHANK, E. FALKNER HILL, T. N. KELYNACK, Lecturer in Anæsthetics in the University of R. LANGDON-DOWN, Manchester. Manchester, June 6th, 1932. W. A. POTTS. June ith, 1932. THE KING’S COLLEGE HOSPITAL SCHEME
of THE LANCET. SIR,—As a practitioner who has to earn his livelihood in the area served by King’s College Hospital, I am entirely in sympathy with the remarks of THE LANCET (May 28th, p. 1172) on the scheme of contract practice inaugurated by this hospital for persons of unlimited means. In its initial stages the scheme took no notice at all of the general practitioner. Anyone with an income of thousands a year taken with a suitable pain in his abdomen could go to King’s on his own account and because he had paid £11per year to the hospital his appendix would I)eJ To the Editor
GLASGOW’S NEW DENTAL HOSPITAL.—Last week Sir Ian Colquhoun, Lord High Commissioner of the Church of Scotland, paid a semi-state visit to Glasgow as representing the Prince of Wales to open a new dental hospital in Renfrew-street. This is the first time in nearly 300 years that a Lord High Commissioner, in that capacity, has visited Glasgow. The hospital, which includes a training the most modernly equipped dental school, is said to be hospital in Britain." There are 50 dental chairs with provision for a further 22, and eight children’s chairs. In addition to an X ray department there is a pathological and histological laboratory with accommodation for 50 students. A large theatre for general anaesthetics has recovery cubicles for men and women. The lecture theatre has sitting and writing accommodation for 200 students ; two smaller lecture rooms will each hold 50 students, and there is a library and museum. The cost has heen £65,000, of which .627,000 has yet to be raised. "
requirements, and of making the necessary arrangements to meet them. Every person who takes advantage of this opportunity will be expected to observe the conditions above indicated, and will be required to sign an undertaking to that effect. Inquiries by letter or telephone cannot be answered. I am, Sir, yours faithfully, NORMAN C. KING, in official
all osteomalacic
the results have been cases. The usual daily dose is grs. 30, but sometimes larger amounts, up to grs. 60 daily, are given. Whatever the initial state of the blood chemistry, which varies in different patients, improvement is always associated with a normal serum calcium and a serum inorganic phosphorus as high as that found in healthy infants and young children. It may be of interest to mention that the daily ultraviolet solar radiation in Lahore in the cold weather was found to be from 3 to 8 units by the acetonemethylene-blue gauge, the average being about 5. In the highlands of Kashmir, a State in which osteomalacia is prevalent, from 8 to 16 units a day were recorded. The occurrence of the disease in nonpurdah individuals living in these regions may therefore be, to some extent, the result of a deficiency of calcium and/or phosphorus in the diet. I am, Sir, yours faithfully, T. A. HUGHES, M.D., M.R.C.P.,
Registrar, General Medical Council. 44, Hallam-street, London, W.1, June 4th, 1932.
UNDULANT FEVER
To the Editor of THE LANCET. SIR,—In view of the interest taken in undulant fever, and the work of Dr. C. P. Beattie and others, recently published in your columns, perhaps the following figures of Br. abortus incidence in milks in this area may be of interest. Between 1927 and 1931I examined for the presence of abortus agglutinin the sera of 760 guinea-pigs inoculated in this laboratory with milks (primarily for T.B.). The following are the results : 170 showed abortus
145 "
"
agglutinin at "
1 in 40 1 " 80
or
patientsand
beneficial, especially in the resistant
Professor of Clinical Medicine, Medical College, Lahore.
Bexhill, May 30th, 1932
higher =22’3% =19%
FREE TREATMENT AT VENEREAL CLINICS
"
To the Editor of THE LANCET. therefore 20 per cent. of these animals showed that they had been infected with Br. abortus, SIR,—With a practical experience of over 20 years but as the milks were nearly all mixed samples in venereal diseases, I heartily endorse all that Dr. the positive percentage might actually be higher. Wansey Bayly asserts in his letter to you. It is time Unfortunately I have but a small number of that some committee should be set up to review the controls-i.e., animals used for other purposes than whole position. The very object for which the milk inoculation. None of these showed a trace of Government voted large sums of money has been abortus agglutinin. Brucella was repeatedly isolated defeated. All and sundry flock to the clinics without from the glands, spleen, and heart blood of the fear or favour. Modern youths have no knowledge
Roughly
.
abortus agglutinin. Milk whey of the deterrents to promiscuous intercourse that shows the presence of abortus agglutinin, their fathers realised, with the result that instead of but this is no evidence of the actual presence of diminishing the incidence of venereal diseases is brucella in such milks. In a small number of whey- rising. As Dr. Bayly states, the venereal specialist positive milks I found just under half (45-4 per cent.) is facing ruin-and for whose benefit ? which gave no evidence of infection in the guineaI am, Sir, yours faithfully, M. W. BROWDY. pigs inoculated. London, W., June 4th, 1932. During the above period I examined 650 human I found sera for the presence of abortus agglutinin. To the Editor of THE LANCET. it in six cases : Once 1 in 20 only. Twice 1 in 80 SIR,—The adoption of the points of view expressed 140 1160 in the letter of Dr. Wansey Bayly would undoubtedly None of these persons was suffering from any disease lead to anti-social interference. If there is a group resembling undulant fever, and in only one case was of infectious diseases whose ravages are not limited there any history at all suggestive of a previous to any one section of the community, that group, infection. beyond question, is the venereal. It is true that venereal disease is preventable, but adequate prophyI am, Sir, yours faithfully, lactic teaching is not yet carried out-not even to A. H. PRIESTLEY, Bacteriologist to the Burnley Corporation. the extent of instruction of students of medicine. May 31st, 1932. Therefore, until this education is widely instituted, venereal disease cannot be said to be voluntarily animals
showing
frequently
,,
I
"
"
TREATMENT OF LATE RICKETS AND OSTEOMALACIA
To the Editor of THE LANCET. SIR,—Dr. D. C. Wilson’s finding that certain cases of osteomalacia in Northern India are benefited by the administration of tricalcium phosphate is in line with my experience in the treatment of this disease in the Mayo Hospital, Lahore. It was found that in some patients (none of whom had ever observed purdah), improvement was very slow or at times non-existent under treatment with vitamins A and D and sunlight, and it was assumed that the diet taken by these individuals did not contain sufficient calcium and/or phosphorus. During the past 18 months or so I have therefore been including calcium glycerophosphate in the treatment of
"
acquired. Dr. Bayly confuses two aspects of medicine : (1) the treatment of disease; (2) the income of doctors who make a living treating it. With regard first, it is in the interests of the nation that venereal disease be wiped out ; and for this simple human work treatment should be free. The second aspect can lead to alarming implications. For, carrying this to its logical conclusion, we come to the unavoidable position that it is in the interest of venereal specialists that venereal disease should not be exterminated. I do not suggest that doctors are guilty of wishing for this state of affairs, but it seems to me that we should resist any attempt to limit to the
1 Hughes, T. A., Shrivastava, D. L., and Malik, K. S.: Ind. Jour. Med. Res., 1931, xix., 593.
1280 the present services for the treatment of venereal disease. On the contrary, we should extend them, and really make an effort to attack venereal diseases scientifically, that is, by propagating widespread information of prophylaxis for these social plagues.
removed in a paying ward without charge by the hospital and at a reduced fee by the surgeon, without his ordinary medical attendant even hearing of the matter unless the patient should come to him later with a ventral hernia. Now, however, I observe an The abolition of venereal disease by planned measures amendment to the rules that runs : " Normally on preventive lines should afford us pleasure which patients will only be admitted on the advice of their would adequately compensate for the sorrowful own doctor." Not a very strong safeguard, nor Dr. for us of draws the of much venereal picture Bayly help to the practitioner. It does seem really a pity that young consultants should not stick to specialist seeing ruin staring him in the face. consultant work, and I am convinced that the only I am, Sir, yours faithfully, effective method of dealing with the situation would FRANCIS LOUIS. be to notify all local medical organisations of the St. Peter’s (Whitechapel) Hospital, E., June 5th, 1932. position, and for them to advise that no cases be sent to any consultant who is prepared to act in the way suggested. THE SHUTTLEWORTH SAMARITAN FUND I am, Sir, yours faithfully, To the Editor of THE LANCET. R. GODWIN CHASE, M.B., B.Chir.Camb. June 6th, 1932. SIR,—May we ask for the hospitality of your columns in order to make known, to all who have the welfare of the mentally defective at heart, CHLOROFORM AND THE HEART that a fund is being raised to form a memorial to the To the Editor of THE LANCET. work of the late Dr. G. E. Shuttleworth ? It is now nearly four years since Dr. Shuttleworth SIR,—Might I suggest that Dr. 1. G. W. Hill should passed away, after a long life devoted to the welfare examine electrocardiographically patients under light of the mentally defective, in which cause he was a chloroform anaesthesia to whom a preliminary dose pioneer. It is proposed that the memorial should of atropine gr. 1/60 has been given one hour before. take the form of a Samaritan Fund, named after I have been giving chloroform to patients for the Dr. Shuttleworth, which should be available to last 24 years at the Manchester Skin Hospital. These help better-class people to place their children or patients have, practically speaking, never been deeply relatives in appropriate homes for care or training. anæsthetised. The majority of them move when Families of this class are prevented by many con- the operation commences. During that time I have siderations from applying for aid to public assistance seen three cases of early chloroform collapse, that is authorities, nor, in their case, even when such help pallor, sweating, dilated pupils, respiration so shallow is sought, is it easily obtainable. No other fund of the ’, as to be doubtfully perceptible, pulse so feeble as kind exists, although in many cases under post-war to be doubtfully palpable. Fortunately they all conditions, such help as it would offer has become recovered. The interesting point is that none of these essential. It is felt that this would be a particularly three had had a preliminary dose of atropine. I happy way in which to commemorate the work of found this out on inquiry after. In each case it had one who was ever ready, with a singular generosity, been forgotten. It has been my routine practice to to give his advice and aid to all who were in need. give a preliminary dose of atropine to all my patients Donations of f.1l5 have already been received, whether they were to receive ether or chloroform, and it is thought that many will be glad to havee since 1910. From the clinical standpoint I have this opportunity to show their appreciation of Dr. seen no evidence which would lead me to suppose that Shuttleworth’s great and unselfish services. Sub- ventricular fibrillation is ever a cause of death in should to be sent the the Shuttlepatients under light chloroform anaesthesia if they treasurer, scriptions worth Samaritan Fund, 72, Denison House, 296, have had a preliminary dose of atropine. Actually, Vauxhall Bridge-road, S.W.I, or direct to the in practice I use morphia as well as atropine, but I Shuttleworth Samaritan Fund, Martin’s Bank, 68, have always supposed that it was the atropine that Lombard-street, E.C.3. safeguarded the heart from vagus inhibition, which latter is, in my opinion, the precursor of ventricular We are, Sir, yours faithfully, fibrillation. (Signed) G. A. AUDEN, I am, Sir, yours faithfully, F. G. CROOKSHANK, E. FALKNER HILL, T. N. KELYNACK, Lecturer in Anæsthetics in the University of R. LANGDON-DOWN, Manchester. Manchester, June 6th, 1932. W. A. POTTS. June ith, 1932. THE KING’S COLLEGE HOSPITAL SCHEME
of THE LANCET. SIR,—As a practitioner who has to earn his livelihood in the area served by King’s College Hospital, I am entirely in sympathy with the remarks of THE LANCET (May 28th, p. 1172) on the scheme of contract practice inaugurated by this hospital for persons of unlimited means. In its initial stages the scheme took no notice at all of the general practitioner. Anyone with an income of thousands a year taken with a suitable pain in his abdomen could go to King’s on his own account and because he had paid £11per year to the hospital his appendix would I)eJ To the Editor
GLASGOW’S NEW DENTAL HOSPITAL.—Last week Sir Ian Colquhoun, Lord High Commissioner of the Church of Scotland, paid a semi-state visit to Glasgow as representing the Prince of Wales to open a new dental hospital in Renfrew-street. This is the first time in nearly 300 years that a Lord High Commissioner, in that capacity, has visited Glasgow. The hospital, which includes a training the most modernly equipped dental school, is said to be hospital in Britain." There are 50 dental chairs with provision for a further 22, and eight children’s chairs. In addition to an X ray department there is a pathological and histological laboratory with accommodation for 50 students. A large theatre for general anaesthetics has recovery cubicles for men and women. The lecture theatre has sitting and writing accommodation for 200 students ; two smaller lecture rooms will each hold 50 students, and there is a library and museum. The cost has heen £65,000, of which .627,000 has yet to be raised. "