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MEDICAL DEGREES AT HONG-KONG
404
My patient received five further transfusions without untoward result. She died of pneumonia six weeks later. So rare a complication occurring twice in one week in the same patient indicates temporary sensitisation to one of the constituents of foreign blood. As the second donor had not eaten fish, I feel we cannot incriminate the lunch eaten by his predecessor. The negative dermal reactions between the transfusions add further confusion. Allergic phenomena are so elusive that I am disinclined to draw conclusions from a single case. I remember a woman who, after a transfusion for post-partum hxmorrhage, was seized by a violent In this case, too, we must paroxysm of sneezing. take comfort from the mystic word allergy. I am, Sir, yours faithfully. GAVIN THURSTON. FOMITES IN TUBERCULOSIS
To the Editor
of
THE LANCET.
.
SiR,—Now that the Government’s Fitness Cam-
paign is coming emphasis on the
to
an
exciting
Tuberculosis
end with
special
"Service," may I
who has had opportunities of noting the varying degrees of enthusiasm or indifference with which the battle against the " white scourge " is conducted in rural areas make one elementary suggestion? It is that some uniform and efficient method of disinfecting the bed, bedding, and room of the consumptive when he dies or is otherwise removed from his cottage should be adopted. As far as my observation goes generally nothing is done at all. Sometimes the sanitary authority will come round rather belatedly and advise ordinary household cleaning ; once or twice I have known them but no energetic steps even burn a formalin lamp ; are taken to see, for example, that the blanket that has been encircling the dying consumptive’s neck is not used to wrap up the new baby. The trouble of course is the long incubation time of the tubercle bacillus. When at last this neglect becomes apparent the medical officer of health, the tuberculosis officer, and the sanitary officer are either comfortably retired or deservedly dead. Yet if there is one thing about which everyone seems to be agreed it is that massive infection should be
thousands of hours rediscovering a number of wellknown facts, I found myself being dragged into the quicksands of little understood mathematical physicochemistry and so abandoned a laborious research for which the time is not yet ripe. One point, however, has a direct bearing on Dr. Oakley’s paper. Any blood with a normal low S.R. mixed with a rapidly sedimenting blood affects a very considerable reduction in the rate. The reduction of the two-hour rate from 107 mm. to 44 mm., which occurred when 50 per cent. of blood without fibrinogen was admixed, could equally well have been produced by the addition of 50 per cent. of normal blood of the same group. Very careful control experiments would need to be done to justify the conclusion that the diminution in S.R. was due to lack of fibrinogen in the blood which was added. It would be of interest if Dr. Oakley could keep in touch with Dr. jaraefarlane’s patient and report on what happens to the S.R. in acute infections. Such observations would, I believe, be unique. I am, Sir, yours faithfully, DENYS JENNINGS. MEDICAL DEGREES
as one
.
avoided. I am, Sir, yours faithfully, C. G. LEAROYD. ERYTHROCYTE SEDIMENTATION AND THE PLASMA FIBRINOGEN
To the JE’(Mor
of
THE LANCET
SiR,—Some years ago it occurred to me to wonder whether the plasma factors responsible for the increased erythrocyte sedimentation-rate (S.R.) in malignant disease, in some juvenile diabetes mellitus. and in some forms of arterial disease were always the The technique employed was similar to that same. described by Dr. Oakley in to-day’s issue of THE LANCET. Rapidly sedimenting bloods from the different conditions were mixed together and the S.R. of the mixture was compared with that of the component bloods, the theory being that if a different excess or deficiency was responsible in the two diseases, mixing the bloods would compensate and the S.R. of the mixture would be considerably less than that of the component bloods taken separately. Unfortunately mixing bloods of different blood groups affects the S.R. and after spending some
To the Editor
of
AT HONG-KONG
THE LANCET
SiR,—My attention has been drawn to an article on Medical Careers in the Tropics by Prof. R. T. Leiper, which you published on Oct. 16th last, and I would like throughyour columns to make a slight correction to the reference to medical education in Hong-Kong. In the article it is stated that Hong-Kong, amongst other places, grants a diploma and that this diploma has recently been recognised by the General Medical Council of Great Britain. The true facts are that the Hong-Kong College of Medicine-founded exactly fifty years ago by Manson and his fellow-workersdid grant a diploma. In 1912 the University of HongKong was opened and the College of Medicine ceased to exist as such and automatically became the medical faculty of the University. The last diplomas were granted in January, 1915, and since that date the only registrable qualification obtainable in HongKong has been the M.B., B.S. of the university. The recognition of this degree by the General Medical Council of Great Britain can hardly be called recent, for the medical faculty minutes of a meeting held in September, 1913, record the receipt of a letter from the registrar of the General Medical Council to the effect : " that the Council had decided to recognise the degrees in Medicine and Surgery of the University granted after examination, for registration in the Medical Register." This recognition has been continuous throughout the intervening period. I am. Sir. vours faithfullv. L. T. RIDE, Dean, Faculty of Medicine, University Jan. 21st.
of
Hong-Kong.
CONTROL OF A TYPHOID EPIDEMIC
To the E
of
TmE CET
SiR,—In your last issue you published a letter from Major R. F. E. Austin. In his capacity as vicepresident of the National Anti-Vaccination League, his antipathy to all forms of prophylactic inoculation or vaccination is comprehensible, but as one who has belief in this form of treatment I fail to understand his arithmetic. The two cases of enteric landed from s.s. Habaiza had contracted the disease in Spain while the three subsequent cases diagnosed on May 30th, June lst, and June 4th were probable
My patient received five further transfusions without untoward result. She died of pneumonia six weeks later. So rare a complication occurring twice in one week in the same patient indicates temporary sensitisation to one of the constituents of foreign blood. As the second donor had not eaten fish, I feel we cannot incriminate the lunch eaten by his predecessor. The negative dermal reactions between the transfusions add further confusion. Allergic phenomena are so elusive that I am disinclined to draw conclusions from a single case. I remember a woman who, after a transfusion for post-partum hxmorrhage, was seized by a violent In this case, too, we must paroxysm of sneezing. take comfort from the mystic word allergy. I am, Sir, yours faithfully. GAVIN THURSTON. FOMITES IN TUBERCULOSIS
To the Editor
of
THE LANCET.
.
SiR,—Now that the Government’s Fitness Cam-
paign is coming emphasis on the
to
an
exciting
Tuberculosis
end with
special
"Service," may I
who has had opportunities of noting the varying degrees of enthusiasm or indifference with which the battle against the " white scourge " is conducted in rural areas make one elementary suggestion? It is that some uniform and efficient method of disinfecting the bed, bedding, and room of the consumptive when he dies or is otherwise removed from his cottage should be adopted. As far as my observation goes generally nothing is done at all. Sometimes the sanitary authority will come round rather belatedly and advise ordinary household cleaning ; once or twice I have known them but no energetic steps even burn a formalin lamp ; are taken to see, for example, that the blanket that has been encircling the dying consumptive’s neck is not used to wrap up the new baby. The trouble of course is the long incubation time of the tubercle bacillus. When at last this neglect becomes apparent the medical officer of health, the tuberculosis officer, and the sanitary officer are either comfortably retired or deservedly dead. Yet if there is one thing about which everyone seems to be agreed it is that massive infection should be
thousands of hours rediscovering a number of wellknown facts, I found myself being dragged into the quicksands of little understood mathematical physicochemistry and so abandoned a laborious research for which the time is not yet ripe. One point, however, has a direct bearing on Dr. Oakley’s paper. Any blood with a normal low S.R. mixed with a rapidly sedimenting blood affects a very considerable reduction in the rate. The reduction of the two-hour rate from 107 mm. to 44 mm., which occurred when 50 per cent. of blood without fibrinogen was admixed, could equally well have been produced by the addition of 50 per cent. of normal blood of the same group. Very careful control experiments would need to be done to justify the conclusion that the diminution in S.R. was due to lack of fibrinogen in the blood which was added. It would be of interest if Dr. Oakley could keep in touch with Dr. jaraefarlane’s patient and report on what happens to the S.R. in acute infections. Such observations would, I believe, be unique. I am, Sir, yours faithfully, DENYS JENNINGS. MEDICAL DEGREES
as one
.
avoided. I am, Sir, yours faithfully, C. G. LEAROYD. ERYTHROCYTE SEDIMENTATION AND THE PLASMA FIBRINOGEN
To the JE’(Mor
of
THE LANCET
SiR,—Some years ago it occurred to me to wonder whether the plasma factors responsible for the increased erythrocyte sedimentation-rate (S.R.) in malignant disease, in some juvenile diabetes mellitus. and in some forms of arterial disease were always the The technique employed was similar to that same. described by Dr. Oakley in to-day’s issue of THE LANCET. Rapidly sedimenting bloods from the different conditions were mixed together and the S.R. of the mixture was compared with that of the component bloods, the theory being that if a different excess or deficiency was responsible in the two diseases, mixing the bloods would compensate and the S.R. of the mixture would be considerably less than that of the component bloods taken separately. Unfortunately mixing bloods of different blood groups affects the S.R. and after spending some
To the Editor
of
AT HONG-KONG
THE LANCET
SiR,—My attention has been drawn to an article on Medical Careers in the Tropics by Prof. R. T. Leiper, which you published on Oct. 16th last, and I would like throughyour columns to make a slight correction to the reference to medical education in Hong-Kong. In the article it is stated that Hong-Kong, amongst other places, grants a diploma and that this diploma has recently been recognised by the General Medical Council of Great Britain. The true facts are that the Hong-Kong College of Medicine-founded exactly fifty years ago by Manson and his fellow-workersdid grant a diploma. In 1912 the University of HongKong was opened and the College of Medicine ceased to exist as such and automatically became the medical faculty of the University. The last diplomas were granted in January, 1915, and since that date the only registrable qualification obtainable in HongKong has been the M.B., B.S. of the university. The recognition of this degree by the General Medical Council of Great Britain can hardly be called recent, for the medical faculty minutes of a meeting held in September, 1913, record the receipt of a letter from the registrar of the General Medical Council to the effect : " that the Council had decided to recognise the degrees in Medicine and Surgery of the University granted after examination, for registration in the Medical Register." This recognition has been continuous throughout the intervening period. I am. Sir. vours faithfullv. L. T. RIDE, Dean, Faculty of Medicine, University Jan. 21st.
of
Hong-Kong.
CONTROL OF A TYPHOID EPIDEMIC
To the E
of
TmE CET
SiR,—In your last issue you published a letter from Major R. F. E. Austin. In his capacity as vicepresident of the National Anti-Vaccination League, his antipathy to all forms of prophylactic inoculation or vaccination is comprehensible, but as one who has belief in this form of treatment I fail to understand his arithmetic. The two cases of enteric landed from s.s. Habaiza had contracted the disease in Spain while the three subsequent cases diagnosed on May 30th, June lst, and June 4th were probable