- Email: [email protected]
OVER-CONSCIENTIOUSNESS IN WOMEN.
1359 48 hours after the rash appears. This helps to keep the mouth, pharynx, and naso-pharynx sweet and clean, and as no solid food is given putrefaction is largely prevented, and so there is less danger of mischief spreading along the Eustachian tube. I
insist on the children sleeping between sheets and that the patients be sponged down all over twice a day at least, and that they be kept cool and not have their beds was so common a
right up against a roaring fire, as OVER-CONSCIENTIOUSNESS practice in former days. I think
a fire in the bedroom is useful, for it sometimes relieves a troublesome cough, but I insist on open I ask the windows but avoidance of draughts. mother or nurse to flush the room thoroughly with fresh air twice a day at least. I tell them that the irritating cough is not due to " cold," but is the result of the poison of the measles ; that it will disappear as the poison is got rid of, and that the best channels of elimination are the skin and the kidneys. This note of explanation generally sets their minds at rest as to fresh air. I tell the attendants to keep the mouth clean and to attend to any discharge from the eyes and nose by washing with water that has been boiled and allowed to become lukewarm, and I point out the advantage of using small pieces of absorbent cotton wool or clean rag, which should be used only once and then burnt. I prescribe a mixture of ipecacuanha wine and solution of ammonium acetate and syrup, which is useful and comforting, and if there is great restlessness or if the cough is very troublesome I add thereto potassium bromide and morphine hydrochloride in suitable doses.
T
Leeds, May 4th, 1914.
a,m_
Rip.
vfynrR
faithfully.
J. GORDON
SHARP, M.D. Edin.
THE PAYMENT OF FEMALE MEDICAL OFFICERS. To the Editor of THE LANCET.
SlE,—You courteously granted me space for a on the above subject in your last issue in regard to the salaries of inspectors of the mentally letter
deficient. It is gratifying to know that the second candidate has now sent in her resignation to the Board of Control.-I am, Sir, yours faithfully, JANE H. WALKER, President of the Registered Medical Women’s Association. 1914.
Harley-street, W., May 4th,
TRAUMATIC
DISLOCATION HIP-JOINT.
OF
THE
To the Editor of THE LANCET.
SiB,—The
two
cases
of this
accident
recently
reported in THE LANCET (April 18th and May 2nd) remind me that on Nov. 20th, 1911, I had a similar case in a boy in his eighth year. I do not know his exact age, but in the dispensary ticket issued to his age was set down as 7 years. When the accident happened he was sitting in a cart drawn by a donkey. In turning a corner one wheel went up on the bank and the cart was overturned on the boy. When I saw him a few hours later I found a typical dislocation of the head of the left femur on to the dorsum ilii, the attitude of the limb exactly resembling the conventional diagram in the books. I gave the boy chloroform, and got his father to make steady traction in the direction of the limb. Of course I had no skilled assistance. With a little manoeuvring and manipulation reduction was readily brought about. No splint was applied. The legs were bandaged together. There was no other me
and the boy was able to walk in a week. In the case reported on April 18th the patient " was allowed to put weight on the limb on the twentyeighth day." That seems to have been pathetically I am, Sir, yours faithfully, timid. J. F. KEENAN, M.B. Ballinalee, Edgeworthstown, May 5th, 1914.
injury
IN
WOMEN.
To the Editor of THE LANCET.
SIR,-One very important feature in the work of is brought to notice by the closing remarks in the third section of your Special Commissioner’s article upon panel practice in Stepney and Enfield, published on April 25th. The quality of overconscientiousness greatly mars the future prospects of many young women. Prosperity and promotion, instead of bringing greater ease, more comfort, and a healthier home life, often result in a complete collapse. Women are apt to allow their business to take too great a hold of them. They feel the anxieties, the difficulties, above all the responsibilities, too keenly. So long as they remain shop assistants or occupy some other subordinate position they continue to work and their strength and health hold out. But when they are promoted to a responsible position as manageress of a shop or a department, then they take to heart so keenly the various incidents, especially the unpleasant incidents, of their business that health gives way as a coilsequence of their hypersensitiveness or overconscientiousness. Panel doctors are, I am sure, already in a position to testify to this very important and significant fact. I was speaking recently to a lady who has been an ardent worker for the Band of Hope during now more than 20 years, and has, therefore, had time to follow up the careers of some of the girls who have been under her charge. This lady at once mentioned the case of one of her old pupils who used to earn her living very successfully and for several years as assistant at a fashionable London pastrycook’s shop. But the business was so prosperous that the owners opened another shop not far off and appointed the assistant in question as manageress. This should have meant better health and more wealth; it proved just the contrary. The strain, anxiety, and responsibility were too great. The new manageress soon became a hopeless invalid and had to give up work altogether. Another of these Band of Hope girls worked for several years as waitress at one of the A.B.C. teabut when finally she was appointed rooms ; manageress she also broke down and has now been for two years incapable of doing any work whatsoever. Then a third case-in a small sweetstuff shop in South London one of the Band of Hope girls was engaged to assist the manageress for a wage of 10s. a week. So long as the work continued on this modest basis all went well. But one day the manageress elected to leave the business, and the owner of the shop thought the assistant was not only experienced enough to be appointed manageress in her turn but and energetic enough to attend to was young the whole business herself without anyone to help her. The anxiety and responsibility destroyed her health, and amemia and nervous prostration incapacitated her for any work whatsoever. The greater amount of medical care which, in response to the National Insurance Act, is now bestowed on women workers will help to throw women
1360
I,weakns
Oertel’s views, but even propose to found legislation An interesting confirmatory case them. PRACTICAL. appears in the Weekly Bulletin of Department of April 27th, 1914. Healtli, City of New York, for April llth, which shows how unsafe are arguments for or against any "THE MENACE OF CANCER" AND theory or principle which are based on given AMERICAN VITAL STATISTICS. clinical diagnosis alone. (And this is the point of To the Editor of THE LANCET. the contention, for the medical profession in no special monopoly of such errors.) America SiR,—In regard to the discussion on the trust- A memberhas the National Guard died from typhoid of Dr. Horst worthiness of American vital statistics, fever it was certified) on March 30th, 1914, in (so Oertel takes adequate care of himself in THE LANCET had been inoculated with of April 18th against the depreciatory statement spite of the fact that he in vaccine January. Indeed, it was antityphoid by Mr. Frederick Hoffman in THE LANCET of the inoculation not only had failed to that alleged Oertel [as to April llth, that " the views of but had the disease, actually given rise to the " greatest laxity and inaccuracy" which prevent the infection. Naturally great commotion was obtains in New York City] have not been accepted that a so caused, necropsy by the coroner’s by qualified critics, although justified to a limited was when it was conclusively held, physicians extent as regards initial diagnosis in hospital shown that there was no evidence of typhoid fever, in Mr. Hoffman does not state what, practice." his judgment, constitutes a qualified critic, or but that the patient had died from malignant endo. whether he means that no qualified critics have carditis and general sepsis. I am, Sir, yours faithfully, accepted Oertel’s views, or only that some have not. ’, ANGLO-AMERICAN. 1914. 30th, April there come hand information has just to However, which seems to show that some critics undoubtedly support Dr. Oertel; whether these critics would be I THE NATIONAL INSURANCE ACT. regarded by Mr. Hoffman as " qualifiedhe alone I can say. The information is contained in a cutting (from the THE NATIONAL INSURANCE ACT AND THE BUDGET. Evening Post of New York for March 30th, one of THE Budget statement of the Chancellor of the the most weighty of American newspapers, on contained indications of the directions account of its usual trustworthiness in regard to Exchequer in which he was prepared to extend financial the of and its opinions, its facts, judicial character the to support working of the National Insurance comparative restraint of expression. From this Act. The of the Act having revealed, working cutting it will be seen that the Hospitals Investiga- as all our readers know, an amount of disease tion Committee appointed by the Board of Estimate women which was unexpected, the Governamong of New York City, after an exhaustive study of the number of necropsies performed in Bellevue and ment will make a substantial grant to societies Allied Hospitals, and of mistakes made in diagnoses whose resources have been depleted as a result, the and in clinical examinations, recommend that the danger of malingering being guarded against. It is State law as to necropsies be changed so as to proposed to establish a system of medical referees enable hospitals to perform a much larger per- "who will not merely be a check on malingering but be a class of doctor whom the societies can call centage of necropsies than at present. Dr. Oertel’s will in to decide whether a case is doubtful and figures are quoted to establish the fact that of the who will be consultants." Such are orMr.not, Lloyd 482 cases that came to necropsy, in 47’7 per cent., or close on one-half, the necropsy findings did not George’s words, and it is clear that the officers confirm the clinical diagnosis. If this percentage whom he has in his mind will have very delicate duties to perform, and that the opportunities for can be extended to the total of 3170 deaths, which friction It is proposed to be numerous. according to Dr. Oertel’s figures took place in establish will clinics at convenient centres for the one year in Bellevue Hospital, it would indicate on the panels in assistance of the practitioners or in1521 deaths from conditions unknown difficult cases where cooperation is useful, and also correctly diagnosed. The report further points to organise a system of health lectures. A certain out that at Bellevue necropsies are performed on amount of encouragement is also promised to only about 10 per cent. of those dying in hospital, whose numbers appear to be contributors, deposit as against 84 per cent. at University College Hosfalling. 99’9 cent. at the per Allgemeines pital, London, Krankenhaus, Vienna, and 90 per cent. at most of THE GLAMORGAN INSURANCE COMMITTEE AND A the German hospitals. Every opportunity for postQUESTION OF POWERS. mortem examination is afforded by Bellevue, which a a At recent in its pathological buildings morgue meeting of the Glamorgan Insurance incorporates 225 four Committee an of bodies, accommodating important question was raised by a necropsy capable rooms, and undertakers’ rooms, but it is exceedingly letter from Dr. Marcus S. Paterson, the medical difficult to secure permission for necropsies from director of the Welsh Memorial, who had written relatives and friends, while in the case of unclaimed to say that bacilli of tuberculosis had been found in bodies the existing law, as interpreted by the late the sputum of a certain man who was living in a Commissioner of Charities, forbade necropsies house with young children, the local medical thereon, and ordered them to be distributed intact practitioner reporting that the conditions of the among the medical colleges. The new law now pro- house were not suitable for the treatment of The man, however, continued to posed by the committee recommends that accredited the disease. hospitals shall be allowed to perform necropsies in live in the house and apparently refused to cases where no objection is made within 48 hours leave it. The chairman of the committee exby,the next of kin. It seems obvious from the fore- pressed the view that the Insurance Act was defecgoing that there are certainly some presumably tive in providing no machinery for enabling any qualified critics who not only have accepted Dr. compulsory steps in such matters, and it was
light on their special weaknesses and their special requirements.-I am, Sir, yours faithfully,
upon
_
"
____
insist on the children sleeping between sheets and that the patients be sponged down all over twice a day at least, and that they be kept cool and not have their beds was so common a
right up against a roaring fire, as OVER-CONSCIENTIOUSNESS practice in former days. I think
a fire in the bedroom is useful, for it sometimes relieves a troublesome cough, but I insist on open I ask the windows but avoidance of draughts. mother or nurse to flush the room thoroughly with fresh air twice a day at least. I tell them that the irritating cough is not due to " cold," but is the result of the poison of the measles ; that it will disappear as the poison is got rid of, and that the best channels of elimination are the skin and the kidneys. This note of explanation generally sets their minds at rest as to fresh air. I tell the attendants to keep the mouth clean and to attend to any discharge from the eyes and nose by washing with water that has been boiled and allowed to become lukewarm, and I point out the advantage of using small pieces of absorbent cotton wool or clean rag, which should be used only once and then burnt. I prescribe a mixture of ipecacuanha wine and solution of ammonium acetate and syrup, which is useful and comforting, and if there is great restlessness or if the cough is very troublesome I add thereto potassium bromide and morphine hydrochloride in suitable doses.
T
Leeds, May 4th, 1914.
a,m_
Rip.
vfynrR
faithfully.
J. GORDON
SHARP, M.D. Edin.
THE PAYMENT OF FEMALE MEDICAL OFFICERS. To the Editor of THE LANCET.
SlE,—You courteously granted me space for a on the above subject in your last issue in regard to the salaries of inspectors of the mentally letter
deficient. It is gratifying to know that the second candidate has now sent in her resignation to the Board of Control.-I am, Sir, yours faithfully, JANE H. WALKER, President of the Registered Medical Women’s Association. 1914.
Harley-street, W., May 4th,
TRAUMATIC
DISLOCATION HIP-JOINT.
OF
THE
To the Editor of THE LANCET.
SiB,—The
two
cases
of this
accident
recently
reported in THE LANCET (April 18th and May 2nd) remind me that on Nov. 20th, 1911, I had a similar case in a boy in his eighth year. I do not know his exact age, but in the dispensary ticket issued to his age was set down as 7 years. When the accident happened he was sitting in a cart drawn by a donkey. In turning a corner one wheel went up on the bank and the cart was overturned on the boy. When I saw him a few hours later I found a typical dislocation of the head of the left femur on to the dorsum ilii, the attitude of the limb exactly resembling the conventional diagram in the books. I gave the boy chloroform, and got his father to make steady traction in the direction of the limb. Of course I had no skilled assistance. With a little manoeuvring and manipulation reduction was readily brought about. No splint was applied. The legs were bandaged together. There was no other me
and the boy was able to walk in a week. In the case reported on April 18th the patient " was allowed to put weight on the limb on the twentyeighth day." That seems to have been pathetically I am, Sir, yours faithfully, timid. J. F. KEENAN, M.B. Ballinalee, Edgeworthstown, May 5th, 1914.
injury
IN
WOMEN.
To the Editor of THE LANCET.
SIR,-One very important feature in the work of is brought to notice by the closing remarks in the third section of your Special Commissioner’s article upon panel practice in Stepney and Enfield, published on April 25th. The quality of overconscientiousness greatly mars the future prospects of many young women. Prosperity and promotion, instead of bringing greater ease, more comfort, and a healthier home life, often result in a complete collapse. Women are apt to allow their business to take too great a hold of them. They feel the anxieties, the difficulties, above all the responsibilities, too keenly. So long as they remain shop assistants or occupy some other subordinate position they continue to work and their strength and health hold out. But when they are promoted to a responsible position as manageress of a shop or a department, then they take to heart so keenly the various incidents, especially the unpleasant incidents, of their business that health gives way as a coilsequence of their hypersensitiveness or overconscientiousness. Panel doctors are, I am sure, already in a position to testify to this very important and significant fact. I was speaking recently to a lady who has been an ardent worker for the Band of Hope during now more than 20 years, and has, therefore, had time to follow up the careers of some of the girls who have been under her charge. This lady at once mentioned the case of one of her old pupils who used to earn her living very successfully and for several years as assistant at a fashionable London pastrycook’s shop. But the business was so prosperous that the owners opened another shop not far off and appointed the assistant in question as manageress. This should have meant better health and more wealth; it proved just the contrary. The strain, anxiety, and responsibility were too great. The new manageress soon became a hopeless invalid and had to give up work altogether. Another of these Band of Hope girls worked for several years as waitress at one of the A.B.C. teabut when finally she was appointed rooms ; manageress she also broke down and has now been for two years incapable of doing any work whatsoever. Then a third case-in a small sweetstuff shop in South London one of the Band of Hope girls was engaged to assist the manageress for a wage of 10s. a week. So long as the work continued on this modest basis all went well. But one day the manageress elected to leave the business, and the owner of the shop thought the assistant was not only experienced enough to be appointed manageress in her turn but and energetic enough to attend to was young the whole business herself without anyone to help her. The anxiety and responsibility destroyed her health, and amemia and nervous prostration incapacitated her for any work whatsoever. The greater amount of medical care which, in response to the National Insurance Act, is now bestowed on women workers will help to throw women
1360
I,weakns
Oertel’s views, but even propose to found legislation An interesting confirmatory case them. PRACTICAL. appears in the Weekly Bulletin of Department of April 27th, 1914. Healtli, City of New York, for April llth, which shows how unsafe are arguments for or against any "THE MENACE OF CANCER" AND theory or principle which are based on given AMERICAN VITAL STATISTICS. clinical diagnosis alone. (And this is the point of To the Editor of THE LANCET. the contention, for the medical profession in no special monopoly of such errors.) America SiR,—In regard to the discussion on the trust- A memberhas the National Guard died from typhoid of Dr. Horst worthiness of American vital statistics, fever it was certified) on March 30th, 1914, in (so Oertel takes adequate care of himself in THE LANCET had been inoculated with of April 18th against the depreciatory statement spite of the fact that he in vaccine January. Indeed, it was antityphoid by Mr. Frederick Hoffman in THE LANCET of the inoculation not only had failed to that alleged Oertel [as to April llth, that " the views of but had the disease, actually given rise to the " greatest laxity and inaccuracy" which prevent the infection. Naturally great commotion was obtains in New York City] have not been accepted that a so caused, necropsy by the coroner’s by qualified critics, although justified to a limited was when it was conclusively held, physicians extent as regards initial diagnosis in hospital shown that there was no evidence of typhoid fever, in Mr. Hoffman does not state what, practice." his judgment, constitutes a qualified critic, or but that the patient had died from malignant endo. whether he means that no qualified critics have carditis and general sepsis. I am, Sir, yours faithfully, accepted Oertel’s views, or only that some have not. ’, ANGLO-AMERICAN. 1914. 30th, April there come hand information has just to However, which seems to show that some critics undoubtedly support Dr. Oertel; whether these critics would be I THE NATIONAL INSURANCE ACT. regarded by Mr. Hoffman as " qualifiedhe alone I can say. The information is contained in a cutting (from the THE NATIONAL INSURANCE ACT AND THE BUDGET. Evening Post of New York for March 30th, one of THE Budget statement of the Chancellor of the the most weighty of American newspapers, on contained indications of the directions account of its usual trustworthiness in regard to Exchequer in which he was prepared to extend financial the of and its opinions, its facts, judicial character the to support working of the National Insurance comparative restraint of expression. From this Act. The of the Act having revealed, working cutting it will be seen that the Hospitals Investiga- as all our readers know, an amount of disease tion Committee appointed by the Board of Estimate women which was unexpected, the Governamong of New York City, after an exhaustive study of the number of necropsies performed in Bellevue and ment will make a substantial grant to societies Allied Hospitals, and of mistakes made in diagnoses whose resources have been depleted as a result, the and in clinical examinations, recommend that the danger of malingering being guarded against. It is State law as to necropsies be changed so as to proposed to establish a system of medical referees enable hospitals to perform a much larger per- "who will not merely be a check on malingering but be a class of doctor whom the societies can call centage of necropsies than at present. Dr. Oertel’s will in to decide whether a case is doubtful and figures are quoted to establish the fact that of the who will be consultants." Such are orMr.not, Lloyd 482 cases that came to necropsy, in 47’7 per cent., or close on one-half, the necropsy findings did not George’s words, and it is clear that the officers confirm the clinical diagnosis. If this percentage whom he has in his mind will have very delicate duties to perform, and that the opportunities for can be extended to the total of 3170 deaths, which friction It is proposed to be numerous. according to Dr. Oertel’s figures took place in establish will clinics at convenient centres for the one year in Bellevue Hospital, it would indicate on the panels in assistance of the practitioners or in1521 deaths from conditions unknown difficult cases where cooperation is useful, and also correctly diagnosed. The report further points to organise a system of health lectures. A certain out that at Bellevue necropsies are performed on amount of encouragement is also promised to only about 10 per cent. of those dying in hospital, whose numbers appear to be contributors, deposit as against 84 per cent. at University College Hosfalling. 99’9 cent. at the per Allgemeines pital, London, Krankenhaus, Vienna, and 90 per cent. at most of THE GLAMORGAN INSURANCE COMMITTEE AND A the German hospitals. Every opportunity for postQUESTION OF POWERS. mortem examination is afforded by Bellevue, which a a At recent in its pathological buildings morgue meeting of the Glamorgan Insurance incorporates 225 four Committee an of bodies, accommodating important question was raised by a necropsy capable rooms, and undertakers’ rooms, but it is exceedingly letter from Dr. Marcus S. Paterson, the medical difficult to secure permission for necropsies from director of the Welsh Memorial, who had written relatives and friends, while in the case of unclaimed to say that bacilli of tuberculosis had been found in bodies the existing law, as interpreted by the late the sputum of a certain man who was living in a Commissioner of Charities, forbade necropsies house with young children, the local medical thereon, and ordered them to be distributed intact practitioner reporting that the conditions of the among the medical colleges. The new law now pro- house were not suitable for the treatment of The man, however, continued to posed by the committee recommends that accredited the disease. hospitals shall be allowed to perform necropsies in live in the house and apparently refused to cases where no objection is made within 48 hours leave it. The chairman of the committee exby,the next of kin. It seems obvious from the fore- pressed the view that the Insurance Act was defecgoing that there are certainly some presumably tive in providing no machinery for enabling any qualified critics who not only have accepted Dr. compulsory steps in such matters, and it was
light on their special weaknesses and their special requirements.-I am, Sir, yours faithfully,
upon
_
"
____