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LETTSOM'S PEDIGREE
702
.
quinine. In the intensely malarious district I refer to, full of subtertian infection, blackwater fever occurred in Europeans, who in repeated attacks of malaria doubtless took quinine and that often in large doses, but dropped the drug prematurely and wholly when the acute attack was seemingly at an end-that is to say, blackwater fever arose in subjects of subtertian malaria wrongly or inadequately treated with quinine, and neglectful of it as a prophylactic, the actual attack being precipitated often by a chill or violent exertion. What then is fundamentally the difference between the value of quinine as a prophylactic in the working coolie and in the European’? The secret in my view lies in the intensity of infection. The European in the tropics or sub-tropics lives in far more hygienic surroundings than the native. His residence is set apart from villages or coolie lines, with corresponding limitation of heavy mosquito infection. His house
bungalow is screened or partially screened, and he sleeps regularly under an efficient mosquito net.
LETTSOM’S PEDIGREE
To the Editor
of
THE LANCET
was much interested in your report of the anniversary dinner of the Medical Society of London. As a grea,t-great-grandson of Dr. Lettsom,
SIR,—I
161st
errors in it. Edward Dr. Lettsom’s son, and survived him. The doctor’s fellow twin was another Edward. Eliza Lettsom married my great grandfather, John Elliot, F.R.S., not doctor. Perhaps the thermometer mentioned was used in Dr. Lettsom’s greenhouses at his villa in Camberwell. Dr. Johnston Abraham’s excellent biography of Lettsom contains many interesting particulars both of himself and his I am, Sir, yours faithfully, family. J. H. A. ELLIOT. March 18th.
will you allow
me
to correct two
Lettsom, the imbecile,
was
BRITISH SOCIAL HYGIENE COUNCIL
or
I have never observed any sort of ill-effect from the regular administration of quinine in either sex or at any age, even over prolonged periods. Truly, quinine may be a protoplasmic poison, but like another and more popular agent credited with the same evil it must often take a very long time to work its
mischief.-I am, Sir, yours faithfully, Newport, Mon, March 12th. CHAKLES E. P. FORSYTH. A STANDARD FOR STRETCHERS
To the Editor
of THE LANCET SIR,-I should like to support the plea
of Dr. L. P. Lockhart for a standard stretcher. There is no doubt that the countless variations in stretcher patterns do cause unnecessary suffering to patients. In planning the new casualty department at this hospital this point has received very careful consideration and we have endeavoured to evolve a stretcher trolley that will take any of the stretchers we are likely to have to deal with. This has presented a good deal of difficulty and expense which is quite unnecessary. Although I think that we have produced a design that will meet the case, I hope that stretcher manufacturers will take note of Dr. Lockhart’s letter. I am, Sir, yours faithfully, H. TRUSS ON, House Governor and Secretary, Royal South March 8th.
Hants and Southampton Hospital.
FRENCH VITAL STATISTICS
To the Editor of THE LANCET SIR,—Dr. Roubakine’s views, reported by your Paris correspondent, are very interesting, but seriously misleading on one point. As the age constitution of the population may differ greatly from country to country, mainly because of the different fertilities, the health of nations cannot be compared by reference simply to their crude death-rates. A more reliable test is to compare the figures obtained by adding the birth-rate to the crude death-rate. But better still is a comparison of the mortality in the different age-groups; and if Dr. Roubakine were to make this he would find that, on the whole, France stands superior to Italy and only a little inferior to England. As to natality, it is true that the birth-rate in France is now higher than that in Sweden, Germany, and England ; but, as it is below 17 per 1000, one is not justified in saying, even in jest, that " the French are still conscientious followers of the injunction to multiply and replenish the earth." I am, Sir, yours faithfully, B. DUNLOP. Manor Fields, Putney, S.W., March 9th.
To the Editor
of
THE LANCET
SIR,—This year has seen the launching of a number of appeals to public benevolence on behalf of various useful and desirable institutions and objects. One of these has a special medical interest and importance, and we ask the courtesy of your columns to say a word in its support, and to bespeak for it the sympathy and encouragement of the profession. The British Social Hygiene Council is this year celebrating its 21st birthday, and the completion of a period of National public service of no ordinary merit. It came into being to fight the scourge of the Venereal Diseases, whose appalling ravages were disclosed, to the surprise and alarm of the public (and even of the medical profession), by the Royal Commission of 1916 and by the Army Medical Reports. Repeated tributes to the educational part played by the Council in the success of the treatment centres, set up by the Government and the local authorities, have been paid in the highest medical and administrative circles. This vital educationalworkis stillneeded if the progress made in the years immediately following the war is to be maintained. A heavy toll of private tragedy and public expenditure is still being paid. In the further pursuit of its objective, the Council (which has been fortunate in the number of distinguished laymen and medical men and women who have directed its efforts) extended its scope in 1925 to include positivehealth teaching for the younger generation, and for those responsible for its training either in schools or in youth organisations. This work has revealed a vast need (not being met otherwise) and awaits an expansion amounting to urgency, with which the present financial resources of the Council cannot cope. H.R.H. the Prince of Wales has brought before the country the supreme importance of safeguarding the health and welfare of our young people. These young people-if they are to come safely to manhood and womanhood in the diflicult conditions of to-daymust be given knowledge of themselves and be impressed with the importance, for the individual and the community, of the control of the racial instinct. We know of no organisation so well qualified in its policy, its personnel, and its equipment to help those who are undertaking this great National service. The Council’s achievements are not confined to these islands, but have Empire significance, and, in India and the Colonies, much-needed stimulus has been given to hygienic progress. Wherever it is possible, therefore, we would ask for the cooperation of members of the medical profession in ensuring the success of the appeal for
.
quinine. In the intensely malarious district I refer to, full of subtertian infection, blackwater fever occurred in Europeans, who in repeated attacks of malaria doubtless took quinine and that often in large doses, but dropped the drug prematurely and wholly when the acute attack was seemingly at an end-that is to say, blackwater fever arose in subjects of subtertian malaria wrongly or inadequately treated with quinine, and neglectful of it as a prophylactic, the actual attack being precipitated often by a chill or violent exertion. What then is fundamentally the difference between the value of quinine as a prophylactic in the working coolie and in the European’? The secret in my view lies in the intensity of infection. The European in the tropics or sub-tropics lives in far more hygienic surroundings than the native. His residence is set apart from villages or coolie lines, with corresponding limitation of heavy mosquito infection. His house
bungalow is screened or partially screened, and he sleeps regularly under an efficient mosquito net.
LETTSOM’S PEDIGREE
To the Editor
of
THE LANCET
was much interested in your report of the anniversary dinner of the Medical Society of London. As a grea,t-great-grandson of Dr. Lettsom,
SIR,—I
161st
errors in it. Edward Dr. Lettsom’s son, and survived him. The doctor’s fellow twin was another Edward. Eliza Lettsom married my great grandfather, John Elliot, F.R.S., not doctor. Perhaps the thermometer mentioned was used in Dr. Lettsom’s greenhouses at his villa in Camberwell. Dr. Johnston Abraham’s excellent biography of Lettsom contains many interesting particulars both of himself and his I am, Sir, yours faithfully, family. J. H. A. ELLIOT. March 18th.
will you allow
me
to correct two
Lettsom, the imbecile,
was
BRITISH SOCIAL HYGIENE COUNCIL
or
I have never observed any sort of ill-effect from the regular administration of quinine in either sex or at any age, even over prolonged periods. Truly, quinine may be a protoplasmic poison, but like another and more popular agent credited with the same evil it must often take a very long time to work its
mischief.-I am, Sir, yours faithfully, Newport, Mon, March 12th. CHAKLES E. P. FORSYTH. A STANDARD FOR STRETCHERS
To the Editor
of THE LANCET SIR,-I should like to support the plea
of Dr. L. P. Lockhart for a standard stretcher. There is no doubt that the countless variations in stretcher patterns do cause unnecessary suffering to patients. In planning the new casualty department at this hospital this point has received very careful consideration and we have endeavoured to evolve a stretcher trolley that will take any of the stretchers we are likely to have to deal with. This has presented a good deal of difficulty and expense which is quite unnecessary. Although I think that we have produced a design that will meet the case, I hope that stretcher manufacturers will take note of Dr. Lockhart’s letter. I am, Sir, yours faithfully, H. TRUSS ON, House Governor and Secretary, Royal South March 8th.
Hants and Southampton Hospital.
FRENCH VITAL STATISTICS
To the Editor of THE LANCET SIR,—Dr. Roubakine’s views, reported by your Paris correspondent, are very interesting, but seriously misleading on one point. As the age constitution of the population may differ greatly from country to country, mainly because of the different fertilities, the health of nations cannot be compared by reference simply to their crude death-rates. A more reliable test is to compare the figures obtained by adding the birth-rate to the crude death-rate. But better still is a comparison of the mortality in the different age-groups; and if Dr. Roubakine were to make this he would find that, on the whole, France stands superior to Italy and only a little inferior to England. As to natality, it is true that the birth-rate in France is now higher than that in Sweden, Germany, and England ; but, as it is below 17 per 1000, one is not justified in saying, even in jest, that " the French are still conscientious followers of the injunction to multiply and replenish the earth." I am, Sir, yours faithfully, B. DUNLOP. Manor Fields, Putney, S.W., March 9th.
To the Editor
of
THE LANCET
SIR,—This year has seen the launching of a number of appeals to public benevolence on behalf of various useful and desirable institutions and objects. One of these has a special medical interest and importance, and we ask the courtesy of your columns to say a word in its support, and to bespeak for it the sympathy and encouragement of the profession. The British Social Hygiene Council is this year celebrating its 21st birthday, and the completion of a period of National public service of no ordinary merit. It came into being to fight the scourge of the Venereal Diseases, whose appalling ravages were disclosed, to the surprise and alarm of the public (and even of the medical profession), by the Royal Commission of 1916 and by the Army Medical Reports. Repeated tributes to the educational part played by the Council in the success of the treatment centres, set up by the Government and the local authorities, have been paid in the highest medical and administrative circles. This vital educationalworkis stillneeded if the progress made in the years immediately following the war is to be maintained. A heavy toll of private tragedy and public expenditure is still being paid. In the further pursuit of its objective, the Council (which has been fortunate in the number of distinguished laymen and medical men and women who have directed its efforts) extended its scope in 1925 to include positivehealth teaching for the younger generation, and for those responsible for its training either in schools or in youth organisations. This work has revealed a vast need (not being met otherwise) and awaits an expansion amounting to urgency, with which the present financial resources of the Council cannot cope. H.R.H. the Prince of Wales has brought before the country the supreme importance of safeguarding the health and welfare of our young people. These young people-if they are to come safely to manhood and womanhood in the diflicult conditions of to-daymust be given knowledge of themselves and be impressed with the importance, for the individual and the community, of the control of the racial instinct. We know of no organisation so well qualified in its policy, its personnel, and its equipment to help those who are undertaking this great National service. The Council’s achievements are not confined to these islands, but have Empire significance, and, in India and the Colonies, much-needed stimulus has been given to hygienic progress. Wherever it is possible, therefore, we would ask for the cooperation of members of the medical profession in ensuring the success of the appeal for