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LIBRARIES AND LEARNED PERIODICALS
369
disposal all available information. Mr. Reddington writes of possible damage to the foetus by X rays ; but such damage has never been proved and surely cannot occur in the later months of pregnancy, when the determination of disproportion is undertaken. I would not go so far as to say that every primigravida should have her pelvic measurements confirmed by X rays, but after a thorough clinical examination has been made, cases where a doubt remains should have the benefit of an X-ray examination by a reliable technique. Such measurements have saved some patients from a second caesarean operation. They are of special value when there has been a previous stillbirth, for in these cases a timely induction gives most satisfactory results. Lydta, Beynon Maternity Hospital, NORA L. KEEVIL. Newport, Mon. LIBRARIES AND LEARNED PERIODICALS
SiR,-The plea made by the librarian of the London School of Hygiene in your issue of July 17 for a representative and impartial body to arrange for the best possible allocation of available copies of scientific and medical periodicals to fill the gaps in libraries caused by war conditions will be welcomed by many who remember
the difficulties experienced in obtaining such journals, and the high prices that were exacted for them, in the competitive scramble after the last war. The proposed consolidated Union Catalogue of periodicals in British libraries to which Mr. Barnard refers in his more recent letter (Aug. 21) may perhaps be needed after this work of allocation has been done, but I hope that his larger scheme for reviewing present holdings of periodicals in libraries so that there may be an interchange of stock to eliminate broken sets and to build up complete sets where these are most needed will receive priority of support from library authorities and from any body that may be considering the granting of funds to aid in postwar library reconstruction. The preliminary survey of holdings of medical periodicals which has been proceeding with such promise of success under the auspices of the university and research section of the Library Association has shown the readiness of the more enlightened medical librarians to cooperate in such a reform. R. L. SHEPPARD, Bureau of Hygiene and Tropical Diseases, W.C.1. Secretary. FERTILITY SiR,-Dr. MacDonald in his letter of July 31 gave what he regards as statistical evidence against Ogino’s theory of the fertility period. He analysed a series of 100 cases in which conception followed a single coitus, and his fig. 1 arranged these according to the date of coitus in the menstrual cycle. Allowing for experimental error, he showed that conception followed coitus on all but the first four days of the cycle, and while he admitted a greater probability of conception between the 8th and 12th days he concluded that no safe period existed. To justify this conclusion it would be necessary to have more information than Dr. MacDonald offers about the length of the menstrual periods of the women questioned. He says that they " kept no records of their menstrual cycles for the most part, but they were askedWhat is the usual interval from the first day of one now to the first day of the next ? ’ " Even this method of questioning showed that 39 out of the 100 did not have a regular cycle of average length 28 days. Holt found that one-quarter of the female population have a short cycle, of less than 25 days ; so one-quarter of Dr. MacDonald’s cases may be assumed to have fallen into this group. These would account for the incidence of conception between the 5th and 14th days. The commonest cycle form (25-30 days) would account for the incidence of conception between the 7th and 19th days, and the overlapping of these two groups would produce the peak incidence on the 10th day. The less frequent cycles of 31-36 days would account for all conceptions between the 19th and 25th days, which tend naturally to diminish in incidence, as is clearly shown in fig. 1 except that there is a sudden rise on the 24th and 25th days. The rising incidence on the 24th and 25th days, together with conceptions following coitus on subsequent dates, may well be attributable to the effects of anxiety in delaying ovulation. Dr. MacDonald states that 95%
of the women were wives of Service men. In times of social insecurity the prospect of pregnancy is often distressing, and it is possible that during the weeks preceding their husbands’ leave some of these women become so anxious on this score that ovulation was postponed and consequently coincided with the date of coitus. (The fact that there was only a single coitus is perhaps significant.) Emotional excitement from anticipation of the husband’s return might have the same effect. In his fig. 2 Dr. McDonald shows the dates of fertile coitus in 61 cases said to have an average cycle of 28 days. This graph would certainly disprove Ogino’s theory if the cases in question had an exact cycle length of 28 days, but no such assurance is given. The use of the word " average " may be taken in two ways ; as a true mathematical average, or as an assumption on the part of the patient that she menstruated " about the 29th day." From the data given, this average obviously is not a true mathematical average ; for then it would include cases with short cycles at one end of the series and long cycles (31-36 days or more) at the other, and Dr. MacDonald could not present it as evidence against Ogino’s theory. More probably the average is an assumption by the patient. Holt has clearly shown how inaccurate these assumptions are in reality, and-since they are not facts -they cannot satisfactorily be used as evidence. Dr. MacDonald gives no information on the regularity. of the cycles over the whole group, nor the state of physical health of the subjects-factors that Holt considered essential for practical application of Ogino’s theory. Before his graphs could be accepted as statistically valid it would be necessary to separate the cases into groups of identical cycle form, and before he could reasonably dis-t credit Ogino’s theory he would have to show that conception took place outside the estimated fertility period of the particular woman, in the absence of any of those physical and psychological factors that are already known to disturb the regularity of the cycle. In my opinion the graphs appear to prove rather than disprove Ogino’s theory ; but they also demonstrate the possible Holt sources of error in applying it to contraception. has drawn attention to these errors, and has recommended specific precautions against them. F. A. FRANK.
Obituary WILLIAM PASTEUR CB, CMG, M D 10ND, F R C P THE death of Dr. Wm. Pasteur, on Sept. 1, in his 88th year, has broken a link in the chain between the complete hospital physician of yesterday and the unit of a team of
experts today. Pasteur qualified from University College Hospital in 1880, and after postgraduate work in Vienna took his MD Lond. and was appointed medical registrar to the Middlesex Hospital. Here he became successively assistant physician in charge of the children’s department, assistant physician to outpatients and then full physician till his retirement in 1921. He was also physician to the Queen’s Hospital for Children, Hackney. He served the Middlesex school with energy
and distinction as dean, as lecturer on forensic medicine, on hygiene and on medicine ; after retirement he continued to lecture on clinical medicine. He examined for the Universities of London and Birmingham and for the Conjoint Board. With Kingston Fowler he worked for the incorporation of the London medical schools within the university. The Pasteurs came from Geneva, the father was a director of the Oceana Company, and William spoke both French and German fluently. This gift of tongues proved a boon to his colleagues and to foreign visitors, and he was for some years physician to the French Hospital. For his services during the last war as consulting physician to the troops in France, he was awarded the CB and CMG, and it was during these strenuous years that the Medical Society of London chose him as their president. As became a physician to a general hospital, Pasteur’s medical interests were wide, but nervous diseases and their relation to respiratory condi-. tions were his specialty, and his many papers to clinical societies included an account of an epidemic of poliomyelitis in members of the same family, while in his
disposal all available information. Mr. Reddington writes of possible damage to the foetus by X rays ; but such damage has never been proved and surely cannot occur in the later months of pregnancy, when the determination of disproportion is undertaken. I would not go so far as to say that every primigravida should have her pelvic measurements confirmed by X rays, but after a thorough clinical examination has been made, cases where a doubt remains should have the benefit of an X-ray examination by a reliable technique. Such measurements have saved some patients from a second caesarean operation. They are of special value when there has been a previous stillbirth, for in these cases a timely induction gives most satisfactory results. Lydta, Beynon Maternity Hospital, NORA L. KEEVIL. Newport, Mon. LIBRARIES AND LEARNED PERIODICALS
SiR,-The plea made by the librarian of the London School of Hygiene in your issue of July 17 for a representative and impartial body to arrange for the best possible allocation of available copies of scientific and medical periodicals to fill the gaps in libraries caused by war conditions will be welcomed by many who remember
the difficulties experienced in obtaining such journals, and the high prices that were exacted for them, in the competitive scramble after the last war. The proposed consolidated Union Catalogue of periodicals in British libraries to which Mr. Barnard refers in his more recent letter (Aug. 21) may perhaps be needed after this work of allocation has been done, but I hope that his larger scheme for reviewing present holdings of periodicals in libraries so that there may be an interchange of stock to eliminate broken sets and to build up complete sets where these are most needed will receive priority of support from library authorities and from any body that may be considering the granting of funds to aid in postwar library reconstruction. The preliminary survey of holdings of medical periodicals which has been proceeding with such promise of success under the auspices of the university and research section of the Library Association has shown the readiness of the more enlightened medical librarians to cooperate in such a reform. R. L. SHEPPARD, Bureau of Hygiene and Tropical Diseases, W.C.1. Secretary. FERTILITY SiR,-Dr. MacDonald in his letter of July 31 gave what he regards as statistical evidence against Ogino’s theory of the fertility period. He analysed a series of 100 cases in which conception followed a single coitus, and his fig. 1 arranged these according to the date of coitus in the menstrual cycle. Allowing for experimental error, he showed that conception followed coitus on all but the first four days of the cycle, and while he admitted a greater probability of conception between the 8th and 12th days he concluded that no safe period existed. To justify this conclusion it would be necessary to have more information than Dr. MacDonald offers about the length of the menstrual periods of the women questioned. He says that they " kept no records of their menstrual cycles for the most part, but they were askedWhat is the usual interval from the first day of one now to the first day of the next ? ’ " Even this method of questioning showed that 39 out of the 100 did not have a regular cycle of average length 28 days. Holt found that one-quarter of the female population have a short cycle, of less than 25 days ; so one-quarter of Dr. MacDonald’s cases may be assumed to have fallen into this group. These would account for the incidence of conception between the 5th and 14th days. The commonest cycle form (25-30 days) would account for the incidence of conception between the 7th and 19th days, and the overlapping of these two groups would produce the peak incidence on the 10th day. The less frequent cycles of 31-36 days would account for all conceptions between the 19th and 25th days, which tend naturally to diminish in incidence, as is clearly shown in fig. 1 except that there is a sudden rise on the 24th and 25th days. The rising incidence on the 24th and 25th days, together with conceptions following coitus on subsequent dates, may well be attributable to the effects of anxiety in delaying ovulation. Dr. MacDonald states that 95%
of the women were wives of Service men. In times of social insecurity the prospect of pregnancy is often distressing, and it is possible that during the weeks preceding their husbands’ leave some of these women become so anxious on this score that ovulation was postponed and consequently coincided with the date of coitus. (The fact that there was only a single coitus is perhaps significant.) Emotional excitement from anticipation of the husband’s return might have the same effect. In his fig. 2 Dr. McDonald shows the dates of fertile coitus in 61 cases said to have an average cycle of 28 days. This graph would certainly disprove Ogino’s theory if the cases in question had an exact cycle length of 28 days, but no such assurance is given. The use of the word " average " may be taken in two ways ; as a true mathematical average, or as an assumption on the part of the patient that she menstruated " about the 29th day." From the data given, this average obviously is not a true mathematical average ; for then it would include cases with short cycles at one end of the series and long cycles (31-36 days or more) at the other, and Dr. MacDonald could not present it as evidence against Ogino’s theory. More probably the average is an assumption by the patient. Holt has clearly shown how inaccurate these assumptions are in reality, and-since they are not facts -they cannot satisfactorily be used as evidence. Dr. MacDonald gives no information on the regularity. of the cycles over the whole group, nor the state of physical health of the subjects-factors that Holt considered essential for practical application of Ogino’s theory. Before his graphs could be accepted as statistically valid it would be necessary to separate the cases into groups of identical cycle form, and before he could reasonably dis-t credit Ogino’s theory he would have to show that conception took place outside the estimated fertility period of the particular woman, in the absence of any of those physical and psychological factors that are already known to disturb the regularity of the cycle. In my opinion the graphs appear to prove rather than disprove Ogino’s theory ; but they also demonstrate the possible Holt sources of error in applying it to contraception. has drawn attention to these errors, and has recommended specific precautions against them. F. A. FRANK.
Obituary WILLIAM PASTEUR CB, CMG, M D 10ND, F R C P THE death of Dr. Wm. Pasteur, on Sept. 1, in his 88th year, has broken a link in the chain between the complete hospital physician of yesterday and the unit of a team of
experts today. Pasteur qualified from University College Hospital in 1880, and after postgraduate work in Vienna took his MD Lond. and was appointed medical registrar to the Middlesex Hospital. Here he became successively assistant physician in charge of the children’s department, assistant physician to outpatients and then full physician till his retirement in 1921. He was also physician to the Queen’s Hospital for Children, Hackney. He served the Middlesex school with energy
and distinction as dean, as lecturer on forensic medicine, on hygiene and on medicine ; after retirement he continued to lecture on clinical medicine. He examined for the Universities of London and Birmingham and for the Conjoint Board. With Kingston Fowler he worked for the incorporation of the London medical schools within the university. The Pasteurs came from Geneva, the father was a director of the Oceana Company, and William spoke both French and German fluently. This gift of tongues proved a boon to his colleagues and to foreign visitors, and he was for some years physician to the French Hospital. For his services during the last war as consulting physician to the troops in France, he was awarded the CB and CMG, and it was during these strenuous years that the Medical Society of London chose him as their president. As became a physician to a general hospital, Pasteur’s medical interests were wide, but nervous diseases and their relation to respiratory condi-. tions were his specialty, and his many papers to clinical societies included an account of an epidemic of poliomyelitis in members of the same family, while in his