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" FEE-SPLITTING. "
1104
dengue shows less leucopenia, less leftward shift, no polychromasia. The hsemogram also gives warning of such complications as sepsis, haemorrhage; the blood reacts more quickly than the temperature. Like the findings of auscultation, those of the heemogram are not always easily interpreted, but experience will help. As Schilling says, it is not the blood which deceives. He wishes the clinician to tell the pathologist his (clinical) diagnosis of the case, when the clinician will be informed whether that seems probable, possible, or unlikely to the pathologist, for thus it is easy to have an objective check on diagnosis. Unexpected conditions may come to notice, of which he gives examples. I regret I can myself say no more, as Schilling’s book came my way only after I had ceased to work in
Correspondence. "Audi alteram partem."
THE DERATING OF HOSPITALS. To the Editor of THE LANCET. Sin,—I would suggest that the governing bodies of
hospitals should consider seriously the expediency of appealing for hospitals to be brought within the derating provisions of the new Local Government Bill. Their need is great, the justice of such a course is evident, and 1 do not propose to take up your space by adducing arguments. It is essential to act without
laboratories. But I submit his method is very valuable. I am, Sir, yours faithfully, W. E. HOME. Kew, Nov. 18th, 1928.
delay.
I am, Sir, yours faithfully, CHARLES W. BUCKLEY. Buxton, Nov. 17th, 1928.
THE HÆMOGRAM. To the Editor of THE LANCET. SIR,-The papers on the blood and Arneth counts you have been recently publishing and an excellent paper in the Journal of the Royal Naval Medical Service for October, by Surgeon-Commander W. I. Gerrard, who (quoting Piney) refers to Schilling, encourage me to say a word on Schilling’s haemogram. Both this and his work on the blood picture are too little, I venture to think, known in England. An assistant in Berlin University, he contributed the section on Blood Examination to the great Tropical Diseases Handbook, has written a book on The Blood Picture " (now in its sixth edition) and two students’ guides, one on general blood study, the other on the deep drop (each "
,
I
SALVARSAN TREATMENT OF ANTHRAX. To the Editor of THE LANCET. SIR,-In discussing the chemical treatment of anthrax in your Modern Technique series Dr. Adrianus Pijper, after pointing out the importance of neosalvarsan in anthrax, writes: " The salvarsan
treatment of anthrax has never failed us yet, although its theoretical foundation may be lacking." In my opinion the explanation is this. Neosalvarsan is a chemotherapeutic substance. According to Ehrlich these substances possess haptophoric and toxophoric groups. After absorption by the blood cells haptophoric groups of neosalvarsan combine with the chemo-receptor groups of the micro-organisms, while the toxophoric groups exercise baneful influence over the bacteria. The factor of stimulation may come in, as well as that of immunity. Arsenic compounds, like those of antimony, belong to a group which wields wide influence on various infections of different fetiology, while the amount of active immunity is, as we know, more marked during the beginning of infection. I think the action is bacteriotoxic rather than bactericidal.-I am. Sir. vours faithfullv. P. V. KARAMCHANDANI, M.B., I.M.S.,
in its third edition)-evidence that his work is appreciated in Germany. Schilling takes the view that the normal blood picture is a cell complex of highly differentiated cells, ripened though not of equal age, in very constant proportion, altered at one end by degeneration or loss (i.e., haemorrhage), at the other by regeneration, the work of the blood-forming organs, bone-marrow (red cells and granulocytes), lymphoid tissue (lympho- cytes), and the reticulo-endothelial tissue especially In charge, Indian Military Hospital, Pishin of the spleen and liver (monocytes). Disease alters Oct. 23rd, 1928. 28. (Baluchistan), India. these organs and the variation in their output shows in the blood. There is normally a definite point in development at which these cells are drafted into " FEE-SPLITTING. " the circulation. When irritation occurs, replacement is needed, and as this need increases, the barriers to ’ To the Editor of THE LANCET. the circulation are lowered further and further and SiR,—According to the legal reports in the Times cells are sent out less and less mature. This immaturity i is shown by the Arneth count, but red cells, eosino- of Oct. 25th a lady who is principal of the Radiant Institute said in evidence that she was sent philes, &c., must also be considered, and to make this Health cases many leading specialists, and that these by is the to ensure that none is overlooked, easy, purpose of the hwmogram.1 This, when completed, gentlemen shared her fees. This statement might very shows red and white count, haemoglobin, deep drop, well be ignored but for the unfortunate fact that and most respected names of the parasites, and so on ; the white cells are charted in three of the foremost in the report in very close juxtaprofession appear great detail, basophiles, eosinophiles, neutrophiles, four groups-(a) myelocytes; (b) metamyelocytes position to this allegation. Probably these gentlemen with round nuclei (" immature "); (c) metamyelocytes felt the matter to be beneath their notice, but would with notched nuclei (" band-form " ; I submit" ribbon- it not be very desirable that they should publish a like " is more what is meant, like a capital U, the nucleus short disclaimer or require the lady in the case to the same thickness all along; (d) multilobed poly- make it quite clear that she was not referring to them ? " " " I am, Sir, yours faithfully, morphs. The names immature," band," and multiDONALD M. O’CONNOR. lobed " are from Admiral Stitt’s book in which they Nov. 1928. Wilts, 7th, Malmesbury, far as I names. so know, got English first, Ordinarily * there are 4 of (c) to 63 of (d). As the need for replaceThere are too wild to need refutation. ** charges ment increases and the reserves are hurried up, more Dr. O’Connor has perhaps taken the case of McCalman and more (c) appear ; perhaps (b), even (a). This is 1,’. Walton (Times, Oct. 25th) too seriously. Plaintiff " the shift to the left," measured by the fraction complained that defendant’s " Radiant Health Institute " had failed to give her a continuous course in a blackwater case it may be of " curative rhythm " because defendant was preor 2. Other showings must be taken into account. occupied with a project for rejuvenating elderly Of three cases of acute pyrexia with leftward shift ladies at 2500 apiece. Defendant admitted she had and leucopenia one might be a malarial relapse, had this golden vision ; a medical practitioner was to shown by polychromasia of the red cells, one sand-fly help her and three distinguished specialists (whom fever, with a very characteristic leftward shift; she named) would send patients and share fees ; but she added regretfully that the project never got 1 Obtainable in pads from Lautenschläger, Berlin, N.39. beyond the visionary stage.-ED. L..
;
dengue shows less leucopenia, less leftward shift, no polychromasia. The hsemogram also gives warning of such complications as sepsis, haemorrhage; the blood reacts more quickly than the temperature. Like the findings of auscultation, those of the heemogram are not always easily interpreted, but experience will help. As Schilling says, it is not the blood which deceives. He wishes the clinician to tell the pathologist his (clinical) diagnosis of the case, when the clinician will be informed whether that seems probable, possible, or unlikely to the pathologist, for thus it is easy to have an objective check on diagnosis. Unexpected conditions may come to notice, of which he gives examples. I regret I can myself say no more, as Schilling’s book came my way only after I had ceased to work in
Correspondence. "Audi alteram partem."
THE DERATING OF HOSPITALS. To the Editor of THE LANCET. Sin,—I would suggest that the governing bodies of
hospitals should consider seriously the expediency of appealing for hospitals to be brought within the derating provisions of the new Local Government Bill. Their need is great, the justice of such a course is evident, and 1 do not propose to take up your space by adducing arguments. It is essential to act without
laboratories. But I submit his method is very valuable. I am, Sir, yours faithfully, W. E. HOME. Kew, Nov. 18th, 1928.
delay.
I am, Sir, yours faithfully, CHARLES W. BUCKLEY. Buxton, Nov. 17th, 1928.
THE HÆMOGRAM. To the Editor of THE LANCET. SIR,-The papers on the blood and Arneth counts you have been recently publishing and an excellent paper in the Journal of the Royal Naval Medical Service for October, by Surgeon-Commander W. I. Gerrard, who (quoting Piney) refers to Schilling, encourage me to say a word on Schilling’s haemogram. Both this and his work on the blood picture are too little, I venture to think, known in England. An assistant in Berlin University, he contributed the section on Blood Examination to the great Tropical Diseases Handbook, has written a book on The Blood Picture " (now in its sixth edition) and two students’ guides, one on general blood study, the other on the deep drop (each "
,
I
SALVARSAN TREATMENT OF ANTHRAX. To the Editor of THE LANCET. SIR,-In discussing the chemical treatment of anthrax in your Modern Technique series Dr. Adrianus Pijper, after pointing out the importance of neosalvarsan in anthrax, writes: " The salvarsan
treatment of anthrax has never failed us yet, although its theoretical foundation may be lacking." In my opinion the explanation is this. Neosalvarsan is a chemotherapeutic substance. According to Ehrlich these substances possess haptophoric and toxophoric groups. After absorption by the blood cells haptophoric groups of neosalvarsan combine with the chemo-receptor groups of the micro-organisms, while the toxophoric groups exercise baneful influence over the bacteria. The factor of stimulation may come in, as well as that of immunity. Arsenic compounds, like those of antimony, belong to a group which wields wide influence on various infections of different fetiology, while the amount of active immunity is, as we know, more marked during the beginning of infection. I think the action is bacteriotoxic rather than bactericidal.-I am. Sir. vours faithfullv. P. V. KARAMCHANDANI, M.B., I.M.S.,
in its third edition)-evidence that his work is appreciated in Germany. Schilling takes the view that the normal blood picture is a cell complex of highly differentiated cells, ripened though not of equal age, in very constant proportion, altered at one end by degeneration or loss (i.e., haemorrhage), at the other by regeneration, the work of the blood-forming organs, bone-marrow (red cells and granulocytes), lymphoid tissue (lympho- cytes), and the reticulo-endothelial tissue especially In charge, Indian Military Hospital, Pishin of the spleen and liver (monocytes). Disease alters Oct. 23rd, 1928. 28. (Baluchistan), India. these organs and the variation in their output shows in the blood. There is normally a definite point in development at which these cells are drafted into " FEE-SPLITTING. " the circulation. When irritation occurs, replacement is needed, and as this need increases, the barriers to ’ To the Editor of THE LANCET. the circulation are lowered further and further and SiR,—According to the legal reports in the Times cells are sent out less and less mature. This immaturity i is shown by the Arneth count, but red cells, eosino- of Oct. 25th a lady who is principal of the Radiant Institute said in evidence that she was sent philes, &c., must also be considered, and to make this Health cases many leading specialists, and that these by is the to ensure that none is overlooked, easy, purpose of the hwmogram.1 This, when completed, gentlemen shared her fees. This statement might very shows red and white count, haemoglobin, deep drop, well be ignored but for the unfortunate fact that and most respected names of the parasites, and so on ; the white cells are charted in three of the foremost in the report in very close juxtaprofession appear great detail, basophiles, eosinophiles, neutrophiles, four groups-(a) myelocytes; (b) metamyelocytes position to this allegation. Probably these gentlemen with round nuclei (" immature "); (c) metamyelocytes felt the matter to be beneath their notice, but would with notched nuclei (" band-form " ; I submit" ribbon- it not be very desirable that they should publish a like " is more what is meant, like a capital U, the nucleus short disclaimer or require the lady in the case to the same thickness all along; (d) multilobed poly- make it quite clear that she was not referring to them ? " " " I am, Sir, yours faithfully, morphs. The names immature," band," and multiDONALD M. O’CONNOR. lobed " are from Admiral Stitt’s book in which they Nov. 1928. Wilts, 7th, Malmesbury, far as I names. so know, got English first, Ordinarily * there are 4 of (c) to 63 of (d). As the need for replaceThere are too wild to need refutation. ** charges ment increases and the reserves are hurried up, more Dr. O’Connor has perhaps taken the case of McCalman and more (c) appear ; perhaps (b), even (a). This is 1,’. Walton (Times, Oct. 25th) too seriously. Plaintiff " the shift to the left," measured by the fraction complained that defendant’s " Radiant Health Institute " had failed to give her a continuous course in a blackwater case it may be of " curative rhythm " because defendant was preor 2. Other showings must be taken into account. occupied with a project for rejuvenating elderly Of three cases of acute pyrexia with leftward shift ladies at 2500 apiece. Defendant admitted she had and leucopenia one might be a malarial relapse, had this golden vision ; a medical practitioner was to shown by polychromasia of the red cells, one sand-fly help her and three distinguished specialists (whom fever, with a very characteristic leftward shift; she named) would send patients and share fees ; but she added regretfully that the project never got 1 Obtainable in pads from Lautenschläger, Berlin, N.39. beyond the visionary stage.-ED. L..
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