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OUGHT PATIENTS SUFFERING FROM TYPHOID FEVER TO BE SENT TO FEVER HOSPITALS ?
492 with regard to them." But your readers will see at once that the opinion of Mr. Carter, the expert on the Medical Acts, does not coincide with the actions of Mr. Carter, the Member of the General Medical Council, for on dipping into the minutes of the General Medical Council we find that Mr. Carter was present at the meeting on Dec. 2nd, 1895, when the Council woke up from its long sleep of thirty-six years and resolved; "That the Council instructs its Penal Committee to inquire into cases of persons offending under Section 40 of the Medical Act, 1858, and -where it sees fit to instruct the legal advisers to proceed against such
persons." It is quite possible that Mr. Carter may consider it a worthy line of reply to say that on that occasion he voted not for the suppression of unqualified practice, but for the sole and academic purpose of stopping people saying that they had a diploma when in fact they had none. If he
While English invalids armed with one another’s prescriptions are treating themselves, medical men who miss their visits had better pass their spare time reconsidering the wisdom of teaching patients to go elsewhere. If prescrip. tions were sent by the medical man direct to the druggist and kept back by him patients would be better treated and families.
less perverse, the medical man would be more often visited and be more in touch with his patients, and the druggist would again become a dispenser, as he was meant to be. T rumnin
I
Cira
yours
faithfully
D. W. SAMWAYS, M.D. Camb. and Mentone, Riviera, Aug. llth, 1896.
Paris,
D.Sc. Lond.
"SUNBURN" BY THE ROENTGEN RAYS.
To the .E’ditors of THE LANCET. should take this line then more will follow, and we shall SIRS,-With reference to the letter from Berlin in your perhaps discover why, with all his clearness of ocular in- last issue respecting the "Sun-burning" action of the ;spection, he fails to see more than about fifty sections in an Roentgen rays upon the skin, it may interest your readers to Act which actually contains fifty-five. know that Dr. Robert L. Bowles, read a paper before !?- In conclusion, Mr. Carter says as regards the views the Camera Club, on March 12th, on " Roentgen Rays of Dr. Drage and myself on the serious evils pro-: and Reflected Solar Light." He found that reflected duced by the improper powers of the President of: luminous or rays, as well as the "x"" rays, photo-chemical the Council that "it is impossible to come to close the human skin into the deeper tissues beneath, penetrate .quarters with the balderdash." Mr. Carter has, I am and produce great and important changes. That it is light, afraid, no very real desire to "come to close quarters"on and not heat merely, which causes sunburn he proved by the the subject of Sir Richard Quain’s actions ; in fact, at following facts. In Alpine climbing, the sun on snow burns present his only method of fighting for his chief is to fling; more quickly than on rocks or heated valleys, although some mud and then to run away. He need not complain to the heat necessarily must be occupied in melting the your readers that the report of my paper in the Times snow and thus becomes latent. Glass and iron workers, was "condensed " (though, by the way, perfectly accurate). to a much greater heat than is experienced though exposed ’The full text will very shortly be published in the Britishe on a sunny snow slope, do not become sun-burned. Professor Medical Journal, and I will take care that he receives a Tyndall when experimenting with the electric light at the copy. I challenge Mr. Carter to then refute, if he can, my North Foreland Lighthouse was more sun-burned than in any :statements and quotations, which I submit convict the Alpine snow, although there was no snow or heat at the President of essentially and personally despotic acts, and time. Dr. Bowles’ conclusions were : that heat qua heat is not the authority" for which is in part to be found in the the cause of sunburn ; that it is most probably caused by the standing orders, which are of such a character, offering as; violet or ultra-violet rays ; that these are modified by snow they do every opportunity of injustice and partiality, thatt and by altitude; that sunburn, snow-blindness, and sunMr. Carter cannot be credited with a useful ten years’ service, stroke are caused by the penetrating effects of luminous and -on which he is inclined to plume himself, since he has donee actinic rays ; that rays from the electric light produce the ,nothing to reform the regulations under which he is contentj same effects as rays reflected from snow ; that various to "work." pigments, chiefly those containing red and yellow, stop or As regards his final appeal, no one can dispute the com- alter reflected luminous rays ; that freckles, which are the pleteness with which Dr. Glover, Dr. Woodcock, and Dr. milder effects of luminous rays, stop the penetration of those Drage " are qualified by education, by experience, and by rays through the skin : and that the sometimes very serious professional and social position to hold their own among the inflammatory changes in sunburn and "summer eruptions" are due to the penetration of reflected luminous rays through - colleagues in whose deliberations they will take part." I am, Sirs, yours faithfully, the skin to the deeper tissues beneath. His observations VICTOR HORSLEY. lead him to conclude that the x"" rays are modifications London, Aug. 12th, 1896. only of ordinary light and that their further elucidation must go hand in hand with a further inquiry into the profound THE MEDICAL MAN AND PRESCRIBING. changes caused by reflection. I am, Sirs, yours truly, To the Editors of THE LANCET. WILLIAM RUSHTON, L.D.S. R.C.S.Eng. SIRS,-The numerous complaints constantly appearing in Harley Street, S.W., Aug. 10th, 1896. THE LANCET and elsewhere about the financial outlook for medical practitioners are very distressing, but is not the trouble the natural outcome of our own pride and folly ? By - our fancy for prescription writing we teach other people how OUGHT PATIENTS SUFFERING FROM to cure our patients and then cry for what we have thrown TYPHOID FEVER TO BE SENT TO ;away. In France, where the medical man is not permitted FEVER HOSPITALS ?
.
, ’
’
.
.
--
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I
493 the cause is known (as it is in this particular case) it should be" returned under the head of the primary cause." I can find no such heading, nor one which is in the least degree to the case. I The tables drawn up by the Society of Medical Officers of Health are much better in this respect, since they include, under the head of Dietetic Diseases (Table 3) 11 want o breast milk." In this instance I filled up the certificate as follows: Primary, deprivation of breast-milk and inability to digest artificial food ; secondary, debility and atrophy. I remain, Sirs, yours faithfully, a great number of years, and it is undesirable to alter it, as comparatively few beds are occupied by these patients. The Aug. 8th, 1896. R. BRUCE FERGUSON, M.A., M.D.Cantab. reply is that though it is true in each "fever"" hospital the number of beds allotted to typhoid fever is comparatively small, yet if all the " feverhospitals are taken together it "THE BRITISH MEDICAL BENEVOLENT will be found that in the aggregate a large number of beds are occupied by typhoid fever patients which might have SOCIETY." been utilised for really " infectious " diseases, such as scarlet To the Editors of THE LANCET. fever. One other point that has been argued is that as SIRS,—I have to pay over a legacy of Z50 under a wil typhoid fever has to be " notided " it ought to be sent to a "fever" hospital, but erysipelas and puerperal fever have to a society described in the will as "The British Medical also to be " notified " and they are not sent to fever hospitals. Benevolent Society." Can any of your readers kindly inform, I feel sure that if the ratepayers are obliged to pay enormous me, through the medium of your valuable paper, whether there is or has been in existence a society bearing that presums for the "fever" hospitals they will certainly give less cise title, and if so what is the address or office of the society? to the voluntary hospitals. The nearest to it which I find is the British Medical BeneI am, Sirs, yours faithfully, volent Fund.-I am, Sirs, your obedient servant, ROBERT S. WAINEWRIGHT. Blackheath, Aug. 8th, 1896. COUNTRY SOLICITOR. Aug. llth, 1896.
thoroughly disinfecting articles contaminated with the typhoid fever patients, and that the nurses at hospitals ought to be thoroughly instructed as to the general absolute necessity of completely disinfecting such articles. 2. The nursing staff at "fever" hospitals have been proved to be less prone to take typhoid fever than those at general hospitals. I would answer that serious epidemics occurring in the nursing staff at general hospitals prove that the drains of those hospitals are defective. 3. The custom of admitting typhoid fever patients to "fever" hospitals has obtained for for
excreta of
applicable
I
* We believe that the British Medical Benevolent Fund and th Royal Medical Benevolent College have before now put in claims to the same legacy where the vague wording ofi the will had left it in doubt which charity it had been intended by the testator to benefit.-ED. L.
"THE POSSIBILITY OF OVARIAN PREGNANCY." To the Editors of THE LANCET. SIRS,-I writing away from references, and, therefore cannot give the date of my most recent papers bearing on this subject, but they are in the Transactions of the Royal Medical and Chirurgical Society some four or five years ago, and I am somewhat disappointed that they should have escaped the notice of one so skilled in gynecological literature as Mr. Alban Doran. In these papers are given at length the reasons why such cases as that published by Dr. Oliver are to be classed as broad ligament pregnancies, and three similar have been lately described, two by myself and I have still to say what I said one by Dr. Heywood Smith. fifteen years ago that pregnancy developing in the ovary may be possible, but it has yet to be proved. I am, Sirs, yours truly, LAWSON TAIT. The Crescent, Birmingham, Aug. 8th, 1896. am
"WHY IS THE LEFT HEART STRONGER THAN THE RIGHT?" To the Editors of THE LANCET. SiES,—Dr. Alexander Morison contends that the greater resistance in the
systemic as compared with the pulmonary segessentially due to (1) the greater length of the former, (2) to the greater quantity af blood it contains. It is no
ment is
and difficult to show that both these contentions are wrong. 1. That mere length of circuit takes little part in causing resistance to the blood’now is obvious from many considerations : (a) The length of the systemic circuit is chiefly determined by the length of the larger arteries, such as the aorta, the brachials, and the femorals. Now while there can THE NOMENCLATURE OF DISEASES. be little doubt that long, narrow arteries like the spermaticTo the Editors of THE LANCET. offer considerable resistance, such is not the case with large I This fact, which I have myself experimentally Earteries. in the the of SiRs,-In suggestions" respecting filling H. death certificates to be found on the first page of the usual (demonstrated, is acknowledged by most authorities. book of forms will be found the following words : ’’ State theJacobson long ago pointed out that "the pressure in the’ arterial trunks remains very nearly identical with causes of death in terms as precise as possible and use the principal 1 names adopted in the nomenclature of the Royal College of 1that of the bulbus aortse," and more recent authorities insist. Physicians." This suggestion I make it a matter of duty to1upon the same fact. Blood pressure falls very little along. follow as closely as I can ; consequently I am disappointed twoIsuch an artery as the brachial. (b) If mere length) find that the third edition of the" Nomenclature" just pub-Iof circuit plays a large part in causing resistancelished has done nothing to help one over a difficulty which is 1the systemic veins of such animals as the whale. often met with in filling up a death certificate in a case likeand the giraffe would offer a great resistance ; bub. the following, which is no uncommon one. A child aged they do not. (c) Further, on this assumption, we should three months was brought to me because it "did not seem expect to find a greater disproportion between the two sides. to be getting on, but was falling away." The child was of the heart in animals like the giraffe, which possess a long illegitimate and had been nursed by its mother for one systemic circuit in proportion to their weight than obtains month, after which it was put out to be nursed and was fed in such an animal as the rabbit, for instance ; but I am not From that time the aware that any such disproportion exists. (d) Nothing more upon condensed milk, biscuits, &c. child wasted to mere skin and bone, and died the day after conclusively shows the small influence of length of circuit, I saw it. The cause of death was simple starvation from on resistance than the comparatively small difference in. deprivation of breast-milk and inability to digest artificial the systemic resistance, as determined by carotid pressure, in animals differing greatly in size. Thus while the carotid food. How was the death certificate to be filled in ? "Starvation"(p. 13 in the Nomenclature "), including, pressure of the horse varies from 160 to 200 mm. Hg., as it does, criminal neglect (which was absent in this case), that of the sheep, with a much shorter circuit, varied would not have been accepted by the Registrar, especially in between 155 to 210 mm. Hg. (Langely of Cambridge). 2. Dr. the case of an illegitimate child, without further inquiries, Morison’s contention that the larger quantity of blood in the and, perhaps, a coroner’s inquest, besides being a term which systemic as compared with the pulmonary circuit helps to would naturally be resented by the relatives who, un- make resistance greater in the former is even more easily fortunately, see the certificate. "Inanition"(p. 428) is disposed of. Paradoxical as it may seem, it is the very "not to be employed in the registration of disease," opposite of the truth. In so far as this larger quantity of and is as objectionable as "starvation"and for similar systemic blood is the outcome of the larger systemic capacity "Marasmus"(p. 437) is a term no longer it is actually a reason why systemic resistance should be less reasons. used. "Debility"(p. 17) is too vague, and when than pulmonary. How greatly Dr. Morison is in error here .
persons." It is quite possible that Mr. Carter may consider it a worthy line of reply to say that on that occasion he voted not for the suppression of unqualified practice, but for the sole and academic purpose of stopping people saying that they had a diploma when in fact they had none. If he
While English invalids armed with one another’s prescriptions are treating themselves, medical men who miss their visits had better pass their spare time reconsidering the wisdom of teaching patients to go elsewhere. If prescrip. tions were sent by the medical man direct to the druggist and kept back by him patients would be better treated and families.
less perverse, the medical man would be more often visited and be more in touch with his patients, and the druggist would again become a dispenser, as he was meant to be. T rumnin
I
Cira
yours
faithfully
D. W. SAMWAYS, M.D. Camb. and Mentone, Riviera, Aug. llth, 1896.
Paris,
D.Sc. Lond.
"SUNBURN" BY THE ROENTGEN RAYS.
To the .E’ditors of THE LANCET. should take this line then more will follow, and we shall SIRS,-With reference to the letter from Berlin in your perhaps discover why, with all his clearness of ocular in- last issue respecting the "Sun-burning" action of the ;spection, he fails to see more than about fifty sections in an Roentgen rays upon the skin, it may interest your readers to Act which actually contains fifty-five. know that Dr. Robert L. Bowles, read a paper before !?- In conclusion, Mr. Carter says as regards the views the Camera Club, on March 12th, on " Roentgen Rays of Dr. Drage and myself on the serious evils pro-: and Reflected Solar Light." He found that reflected duced by the improper powers of the President of: luminous or rays, as well as the "x"" rays, photo-chemical the Council that "it is impossible to come to close the human skin into the deeper tissues beneath, penetrate .quarters with the balderdash." Mr. Carter has, I am and produce great and important changes. That it is light, afraid, no very real desire to "come to close quarters"on and not heat merely, which causes sunburn he proved by the the subject of Sir Richard Quain’s actions ; in fact, at following facts. In Alpine climbing, the sun on snow burns present his only method of fighting for his chief is to fling; more quickly than on rocks or heated valleys, although some mud and then to run away. He need not complain to the heat necessarily must be occupied in melting the your readers that the report of my paper in the Times snow and thus becomes latent. Glass and iron workers, was "condensed " (though, by the way, perfectly accurate). to a much greater heat than is experienced though exposed ’The full text will very shortly be published in the Britishe on a sunny snow slope, do not become sun-burned. Professor Medical Journal, and I will take care that he receives a Tyndall when experimenting with the electric light at the copy. I challenge Mr. Carter to then refute, if he can, my North Foreland Lighthouse was more sun-burned than in any :statements and quotations, which I submit convict the Alpine snow, although there was no snow or heat at the President of essentially and personally despotic acts, and time. Dr. Bowles’ conclusions were : that heat qua heat is not the authority" for which is in part to be found in the the cause of sunburn ; that it is most probably caused by the standing orders, which are of such a character, offering as; violet or ultra-violet rays ; that these are modified by snow they do every opportunity of injustice and partiality, thatt and by altitude; that sunburn, snow-blindness, and sunMr. Carter cannot be credited with a useful ten years’ service, stroke are caused by the penetrating effects of luminous and -on which he is inclined to plume himself, since he has donee actinic rays ; that rays from the electric light produce the ,nothing to reform the regulations under which he is contentj same effects as rays reflected from snow ; that various to "work." pigments, chiefly those containing red and yellow, stop or As regards his final appeal, no one can dispute the com- alter reflected luminous rays ; that freckles, which are the pleteness with which Dr. Glover, Dr. Woodcock, and Dr. milder effects of luminous rays, stop the penetration of those Drage " are qualified by education, by experience, and by rays through the skin : and that the sometimes very serious professional and social position to hold their own among the inflammatory changes in sunburn and "summer eruptions" are due to the penetration of reflected luminous rays through - colleagues in whose deliberations they will take part." I am, Sirs, yours faithfully, the skin to the deeper tissues beneath. His observations VICTOR HORSLEY. lead him to conclude that the x"" rays are modifications London, Aug. 12th, 1896. only of ordinary light and that their further elucidation must go hand in hand with a further inquiry into the profound THE MEDICAL MAN AND PRESCRIBING. changes caused by reflection. I am, Sirs, yours truly, To the Editors of THE LANCET. WILLIAM RUSHTON, L.D.S. R.C.S.Eng. SIRS,-The numerous complaints constantly appearing in Harley Street, S.W., Aug. 10th, 1896. THE LANCET and elsewhere about the financial outlook for medical practitioners are very distressing, but is not the trouble the natural outcome of our own pride and folly ? By - our fancy for prescription writing we teach other people how OUGHT PATIENTS SUFFERING FROM to cure our patients and then cry for what we have thrown TYPHOID FEVER TO BE SENT TO ;away. In France, where the medical man is not permitted FEVER HOSPITALS ?
.
, ’
’
.
.
--
-
I
493 the cause is known (as it is in this particular case) it should be" returned under the head of the primary cause." I can find no such heading, nor one which is in the least degree to the case. I The tables drawn up by the Society of Medical Officers of Health are much better in this respect, since they include, under the head of Dietetic Diseases (Table 3) 11 want o breast milk." In this instance I filled up the certificate as follows: Primary, deprivation of breast-milk and inability to digest artificial food ; secondary, debility and atrophy. I remain, Sirs, yours faithfully, a great number of years, and it is undesirable to alter it, as comparatively few beds are occupied by these patients. The Aug. 8th, 1896. R. BRUCE FERGUSON, M.A., M.D.Cantab. reply is that though it is true in each "fever"" hospital the number of beds allotted to typhoid fever is comparatively small, yet if all the " feverhospitals are taken together it "THE BRITISH MEDICAL BENEVOLENT will be found that in the aggregate a large number of beds are occupied by typhoid fever patients which might have SOCIETY." been utilised for really " infectious " diseases, such as scarlet To the Editors of THE LANCET. fever. One other point that has been argued is that as SIRS,—I have to pay over a legacy of Z50 under a wil typhoid fever has to be " notided " it ought to be sent to a "fever" hospital, but erysipelas and puerperal fever have to a society described in the will as "The British Medical also to be " notified " and they are not sent to fever hospitals. Benevolent Society." Can any of your readers kindly inform, I feel sure that if the ratepayers are obliged to pay enormous me, through the medium of your valuable paper, whether there is or has been in existence a society bearing that presums for the "fever" hospitals they will certainly give less cise title, and if so what is the address or office of the society? to the voluntary hospitals. The nearest to it which I find is the British Medical BeneI am, Sirs, yours faithfully, volent Fund.-I am, Sirs, your obedient servant, ROBERT S. WAINEWRIGHT. Blackheath, Aug. 8th, 1896. COUNTRY SOLICITOR. Aug. llth, 1896.
thoroughly disinfecting articles contaminated with the typhoid fever patients, and that the nurses at hospitals ought to be thoroughly instructed as to the general absolute necessity of completely disinfecting such articles. 2. The nursing staff at "fever" hospitals have been proved to be less prone to take typhoid fever than those at general hospitals. I would answer that serious epidemics occurring in the nursing staff at general hospitals prove that the drains of those hospitals are defective. 3. The custom of admitting typhoid fever patients to "fever" hospitals has obtained for for
excreta of
applicable
I
* We believe that the British Medical Benevolent Fund and th Royal Medical Benevolent College have before now put in claims to the same legacy where the vague wording ofi the will had left it in doubt which charity it had been intended by the testator to benefit.-ED. L.
"THE POSSIBILITY OF OVARIAN PREGNANCY." To the Editors of THE LANCET. SIRS,-I writing away from references, and, therefore cannot give the date of my most recent papers bearing on this subject, but they are in the Transactions of the Royal Medical and Chirurgical Society some four or five years ago, and I am somewhat disappointed that they should have escaped the notice of one so skilled in gynecological literature as Mr. Alban Doran. In these papers are given at length the reasons why such cases as that published by Dr. Oliver are to be classed as broad ligament pregnancies, and three similar have been lately described, two by myself and I have still to say what I said one by Dr. Heywood Smith. fifteen years ago that pregnancy developing in the ovary may be possible, but it has yet to be proved. I am, Sirs, yours truly, LAWSON TAIT. The Crescent, Birmingham, Aug. 8th, 1896. am
"WHY IS THE LEFT HEART STRONGER THAN THE RIGHT?" To the Editors of THE LANCET. SiES,—Dr. Alexander Morison contends that the greater resistance in the
systemic as compared with the pulmonary segessentially due to (1) the greater length of the former, (2) to the greater quantity af blood it contains. It is no
ment is
and difficult to show that both these contentions are wrong. 1. That mere length of circuit takes little part in causing resistance to the blood’now is obvious from many considerations : (a) The length of the systemic circuit is chiefly determined by the length of the larger arteries, such as the aorta, the brachials, and the femorals. Now while there can THE NOMENCLATURE OF DISEASES. be little doubt that long, narrow arteries like the spermaticTo the Editors of THE LANCET. offer considerable resistance, such is not the case with large I This fact, which I have myself experimentally Earteries. in the the of SiRs,-In suggestions" respecting filling H. death certificates to be found on the first page of the usual (demonstrated, is acknowledged by most authorities. book of forms will be found the following words : ’’ State theJacobson long ago pointed out that "the pressure in the’ arterial trunks remains very nearly identical with causes of death in terms as precise as possible and use the principal 1 names adopted in the nomenclature of the Royal College of 1that of the bulbus aortse," and more recent authorities insist. Physicians." This suggestion I make it a matter of duty to1upon the same fact. Blood pressure falls very little along. follow as closely as I can ; consequently I am disappointed twoIsuch an artery as the brachial. (b) If mere length) find that the third edition of the" Nomenclature" just pub-Iof circuit plays a large part in causing resistancelished has done nothing to help one over a difficulty which is 1the systemic veins of such animals as the whale. often met with in filling up a death certificate in a case likeand the giraffe would offer a great resistance ; bub. the following, which is no uncommon one. A child aged they do not. (c) Further, on this assumption, we should three months was brought to me because it "did not seem expect to find a greater disproportion between the two sides. to be getting on, but was falling away." The child was of the heart in animals like the giraffe, which possess a long illegitimate and had been nursed by its mother for one systemic circuit in proportion to their weight than obtains month, after which it was put out to be nursed and was fed in such an animal as the rabbit, for instance ; but I am not From that time the aware that any such disproportion exists. (d) Nothing more upon condensed milk, biscuits, &c. child wasted to mere skin and bone, and died the day after conclusively shows the small influence of length of circuit, I saw it. The cause of death was simple starvation from on resistance than the comparatively small difference in. deprivation of breast-milk and inability to digest artificial the systemic resistance, as determined by carotid pressure, in animals differing greatly in size. Thus while the carotid food. How was the death certificate to be filled in ? "Starvation"(p. 13 in the Nomenclature "), including, pressure of the horse varies from 160 to 200 mm. Hg., as it does, criminal neglect (which was absent in this case), that of the sheep, with a much shorter circuit, varied would not have been accepted by the Registrar, especially in between 155 to 210 mm. Hg. (Langely of Cambridge). 2. Dr. the case of an illegitimate child, without further inquiries, Morison’s contention that the larger quantity of blood in the and, perhaps, a coroner’s inquest, besides being a term which systemic as compared with the pulmonary circuit helps to would naturally be resented by the relatives who, un- make resistance greater in the former is even more easily fortunately, see the certificate. "Inanition"(p. 428) is disposed of. Paradoxical as it may seem, it is the very "not to be employed in the registration of disease," opposite of the truth. In so far as this larger quantity of and is as objectionable as "starvation"and for similar systemic blood is the outcome of the larger systemic capacity "Marasmus"(p. 437) is a term no longer it is actually a reason why systemic resistance should be less reasons. used. "Debility"(p. 17) is too vague, and when than pulmonary. How greatly Dr. Morison is in error here .