- Email: [email protected]
" OUR COLLEAGUES IN AUSTRIA"
865 be expressed in a constant unit, and the of yardstick hearing is the decibel. The aurist who fails to make use of the decibel measurement is like a fisherman describing with his hands the size of the fish that got away. The result of the examination of the patient’s hearing should be charted in decibels, when it is possible by a glance at the graph to tell with scientific exactitude the type of aid best suited to the patient. Such a chart carbon or crystal microcan tell you whether a phone will give the better definition and whether air or bone conduction should be used. can
only
I am, Sir, vours faithfullv, EDWARD CAREW-SHAW.
ONCHOCERCIASIS
To the Editor
SiR,-Reporting
of
THE LANCET
in your issue of March
.
5th
on
of onchocerciasis showing ocular complications diagnosed in this country, Dr. Adams refers to the possibility of the occurrence of similar cases in Europe. As a matter of fact, during the last six years such cases have been recorded in Germany, France, and Belgium, and now that attention has been focused on the matter it is very probable that in the future further cases will come to light. Unfortunately treatment is far from satisfactory. The surgical removal or destruction of parent worms frequently fails to achieve its object, micronlariae persisting, perhaps because of the presence of other adults, while the ocular damage remains unarrested ; chemical attempts to destroy the worms or their embryos are also unsatisfactory, as we do not possess an efficient filaricidal drug. Now opinions differ as to how much of the ocular damage is due to the mere mechanical presence of embryos in the eye, and how much is due to something in the nature of an allergic reaction associated with the presence of filarial products. As the results of orthodox treatment are uncertain and blindness is a serious condition, it seems, in view of the possibility of an allergic factor, worth considering whether the ordinary methods of treatment may not be supplemented with attempts at desensitisation by means of graduated doses of filarial antigen. This process, which was introduced by Dr. Fairley and is now being tested by us in the treatment of otherfilarialmanifestations at the Hospital for Tropical Diseases, London, appears to be of considerable value. In the case of ocular onchocerciasis it would of course be necessary to proceed with the utmost caution lest any focal reaction precipitate the very condition it is wished to a case
circumvent. T
i....
’UTI
wrniirc
fe>.it "hfllll-u
F. MURGATROYD.
British Isles
on
this
question by
I am,
Sir, yours faithfully, FREDERICK C. ENDEAN
To the Editor
of
THE LANCET
SiR,—Jewish members of the medical profession
surely have been touched by the friendly and generous terms of the letter which was recently published in your columns over the signatures of many distinguished men, dealing with the tragic plight of our colleagues in Austria. Mr. Aubrey Goodwin’s comments, however, show very clearly the difficulties that have to be overcome before goodwill can be converted into constructive help. Clearly no one has in mind admitting a large number of foreign doctors into this country, and I doubt, equally, whether anyone would advocate their complete and absolute exclusion without any regard to the merits of the individual case. The procedure which has been followed in the past may perhaps guide us in deciding on a fair and reasonable policy for the future. Since March, 1933, a total of 187 German doctors have been permitted to settle and follow their profession in this country. To see the meaning of this concession in a balanced way one must bear in mind that there are over 50,000 names on the Medical Register. For the last few years the Home Office has only granted permits in exceptional circumstances when it was conclusively shown that the applicant’s special knowledge and experience would be of benefit to the profession as a whole. May I venture to suggest that it would be reasonable to continue such a policy, because it provides full safeguards for the interests of the profession, while offering the possibility of permitting certain carefully chosen individuals to continue their work here to the advantage of medical science and for the relief of human suffering. I am, Sir, yours faithfully, SAMSON WRIGHT must
Golders
Green-road, N.W., April 5th.
To the Editor
of THE LANCET SiR,,-As there are probably many of your readers who would like to add their signatures to the letter on doctors in Austria which you published in your issue of March 26th, would you be good enough to insert the following notice ?‘ Will any members of the medical profession who in sympathy with and would like to sign the letter published on March 26th on the subject of refugees in Austria please send their names to the hon. secretary, Medical Peace Campaign, 39, Southgrove, London, N.6. are
faithfully, MARY T. DAY.
" OUR COLLEAGUES IN AUSTRIA"
of
authoritative
body.
I am, Sir, yours To the Editor
some
THE LANCET
SiR,-liay express my entire agreement with Mr. Aubrey Goodwin’s letter in your last issue’? A further accession to the British medical profession of medical refugees from Central Europe will have very serious consequences for practices here, and will I
undoubtedly result in undue competition. This being the case I am convinced that the bulk of the profession does not agree with the signatories of the letter under the heading " Our Colleagues ill Austria in your issue of March 26th. I suggest that a vote be taken of the whole medical profession in the
TASMANIA
AND
IMMIGRANT
DOCTORS.——The
Tasmanian Pailiament has passed a Bill amending the Medical Act in view of a possible influx of doctors from Germany. Fourteen applications from German medical men have so far been made. The amending Bill requires candidates for registration to be British subjects and to possess a qualification obtained after " a complete course of training and examination in the country where the qualification was issued, at a university, college, or other institution recognised for that purpose in that country," or/and to possess "such other qualification as may be prescribed."
866
of shops now dealt in contraceptives only, and in such a way as to be an offence to a large portion of In one district alone there were the population. 36 these of stores, apart from the chemists’ shops. on March Commons 29th Mr. IN the House of a growing custom of buying these WEDDERBURN, Under-Secretary of State for Scot- There was also slot machines, and in factories and land, moved that the draft of the Housing (Scotland) things through touts were pushing these articles and workshops of be Acts (Continuation Contributions) Order, 1938, about their use. The country districts approved. This Order authorised the continuance of information were also becoming infiltrated with the same thing. subsidies for slum clearance and decrowding at the the terms of this Bill, if a dealer attempted to present rate on houses completed after March 31st, Under send these things or information about them to 1938. The present rate for slum clearance subsidy in unmarried persons under 18 he would be guilty of an Scotland was on a per capita basis of 92 10s., and offence. But there was nothing in the Bill which 22 15s. in the case of rural areas, and therefore varied would stop the sale of contraceptives to those who with the size of the family, that for two persons them, either by chemists or other stores being .85, and for six persons .615. The subsidy needed conducted in a proper manner. Mr. THURTLE opposed under the 1935 Act, however, was at a flat rate for the Bill partly on utilitarian grounds and partly each house built, and amounted to :66 15s. per house. because he believed that a private Member was not The average amount of subsidy for both decrowding the right person to bring in such legislation. He and slum clearance amounted to slightly under 211 did not know how extensive this evil might be, but per house. Mr. T. JoHNSTON said there had been in if it was a real evil it ought to be dealt with by Scotland a progressive deterioration in the amount of the Government Department concerned-namely, the the to the local authorities subsidy given during They had to remember that the past two or three years, and what the Government Home Office. practice of birth control in this country, whether were doing now was to perpetuate a position in they liked it or not, was very widespread, and while Scotland which the local authorities almost unanione wished to see advertisements regarding birth mously declared to be an impossible one, and one in no control set out in an offensive manner, or contrawhich they did not feel that they could develop a exposed objectionably, they must large-scale building programme. While the subsidy ceptive equipment recognise that this was lawful information for the was stabilised the cost of building had risen by over men and women of the country, and Parliament 25 per cent. In Scotland they had a 50 per cent. ought not to make it unduly difficult for them to in than and maternal mortality-rate England, higher get that information and the necessary equipment. was six times worse in Scotland than overcrowding in England. The poor-law relief figure in Scotland Detention under the Mental Deficiency Act was 2 times worse than in England. Almost oneAfter third of the people of Scotland were living more making full inquiry the Minister of Health has informed Mr. Logan that the action taken with than two to a room, and in the burghs there were 300,000 houses without a separate water-closet. respect to Mr. Hargreaves (see Lancet, April2nd, p. 811) was the consequence of a mistake in the office of the While the Labour Party could not vote against this Board of Control, which he deeply regrets. A sum of Order on the ground that they could not take the accepted by Mr. Hargreavesjin comresponsibility for discontinuing the subsidy they must 2200 has been emphatically protest against the Government per- pensation for his distressing experience. mitting the profiteering in house building materials in In the House of Lords on March 30th the Royal Scotland and thus permitting a depreciation in the Assent was given to the Blind Persons Act, the Mr. ELLIOT, Secretary of value of the subsidy. Population (Statistics) Act, and the National Health State for Scotland, said it was common knowledge Insurance (Amendment) Act. that there was great disquietude in the House of Commons and in Scotland as to the housing situation. In the House of Lords on April 5th, on the motion They had already large building programmes, but it of Viscount GAGE, the following noble Lords were fell short. They were was in execution that they to join with a committee of the House of not getting inferior grants in Scotland to those in appointed Commons in the consideration of the Food and England, but the question really was, why they Drugs Bill: the Earl of Onslow, the Earl of Birkencould not make as good use of them in Scotland as head, Lord Teynham, the Earl of Listowel, Lord south of the border. Local authorities should give O’Hagan, Lord Addington, and Lord Doverdale. attention to alternative methods of building, parIn the House of Commons on March 31st Sir ticularly to the timber house, as a possible source of relief. The number of houses being built and Douglas Thomson introduced the Nursing Homes approved was still as high as it had ever been, even Registration (Scotland) Bill, which provides for the during the trough-of low prices. That showed that registration and inspection of nursing-homes in the rise in cost had not discouraged local authorities Scotland. from going on with houses. They must concentrate QUESTION TIME upon the most desperate problem-namely, the getting rid of the terrible dens and slums which WEDNESDAY, MARCH 30TH existed. After that they would move on to other H.M.S. Caledonia problems, but when there was only so much labour Mr. GALLACHER asked the First Lord of the Admiralty available they must in this case take the worst he had any information concerning the outbreak whether first. things of disease among boys on board H.M.S. Caledonia how NOTES ON CURRENT TOPICS Housing in Scotland
’
Sale of Contraceptives On March 30th in the House of Commons Mr. R. J. RUSSELL introduced a Bill to regulate the public display in shops of contraceptives and matter descriptive thereof, to prohibit street trading in such articles, and to restrict their public advertisement. He emphasised the increasing development throughout the country, especially in the metropolitan area, of publicity with regard to contraceptives and their display and sale. By inquiry he had found that of 280 chemists’ shops only seven did not stock and distribute contraceptives. In addition a large number
had been
of scarlet fever, middle-ear how many had been removed to shore hospitals with rheumatic hearts ; and what steps were being taken to cope with this situation. - Mr. DuFF CooPEn replied : The number of cases of scarlet fever and rheumatic fever that have occurred among boys in H.M.S. Caledonia since May 10th, 1937, when the first entries were made, are 74 and 31 respectively. The number of cases of middle-ear disease to Dec. 31st, 1937, was 20 ; since then there have been 30 cases of ear trouble but how many of these were middle-ear disease is not known. I am obtaining the many
cases
reported
disease, and rheumatic fever ;
only
I am, Sir, vours faithfullv, EDWARD CAREW-SHAW.
ONCHOCERCIASIS
To the Editor
SiR,-Reporting
of
THE LANCET
in your issue of March
.
5th
on
of onchocerciasis showing ocular complications diagnosed in this country, Dr. Adams refers to the possibility of the occurrence of similar cases in Europe. As a matter of fact, during the last six years such cases have been recorded in Germany, France, and Belgium, and now that attention has been focused on the matter it is very probable that in the future further cases will come to light. Unfortunately treatment is far from satisfactory. The surgical removal or destruction of parent worms frequently fails to achieve its object, micronlariae persisting, perhaps because of the presence of other adults, while the ocular damage remains unarrested ; chemical attempts to destroy the worms or their embryos are also unsatisfactory, as we do not possess an efficient filaricidal drug. Now opinions differ as to how much of the ocular damage is due to the mere mechanical presence of embryos in the eye, and how much is due to something in the nature of an allergic reaction associated with the presence of filarial products. As the results of orthodox treatment are uncertain and blindness is a serious condition, it seems, in view of the possibility of an allergic factor, worth considering whether the ordinary methods of treatment may not be supplemented with attempts at desensitisation by means of graduated doses of filarial antigen. This process, which was introduced by Dr. Fairley and is now being tested by us in the treatment of otherfilarialmanifestations at the Hospital for Tropical Diseases, London, appears to be of considerable value. In the case of ocular onchocerciasis it would of course be necessary to proceed with the utmost caution lest any focal reaction precipitate the very condition it is wished to a case
circumvent. T
i....
’UTI
wrniirc
fe>.it "hfllll-u
F. MURGATROYD.
British Isles
on
this
question by
I am,
Sir, yours faithfully, FREDERICK C. ENDEAN
To the Editor
of
THE LANCET
SiR,—Jewish members of the medical profession
surely have been touched by the friendly and generous terms of the letter which was recently published in your columns over the signatures of many distinguished men, dealing with the tragic plight of our colleagues in Austria. Mr. Aubrey Goodwin’s comments, however, show very clearly the difficulties that have to be overcome before goodwill can be converted into constructive help. Clearly no one has in mind admitting a large number of foreign doctors into this country, and I doubt, equally, whether anyone would advocate their complete and absolute exclusion without any regard to the merits of the individual case. The procedure which has been followed in the past may perhaps guide us in deciding on a fair and reasonable policy for the future. Since March, 1933, a total of 187 German doctors have been permitted to settle and follow their profession in this country. To see the meaning of this concession in a balanced way one must bear in mind that there are over 50,000 names on the Medical Register. For the last few years the Home Office has only granted permits in exceptional circumstances when it was conclusively shown that the applicant’s special knowledge and experience would be of benefit to the profession as a whole. May I venture to suggest that it would be reasonable to continue such a policy, because it provides full safeguards for the interests of the profession, while offering the possibility of permitting certain carefully chosen individuals to continue their work here to the advantage of medical science and for the relief of human suffering. I am, Sir, yours faithfully, SAMSON WRIGHT must
Golders
Green-road, N.W., April 5th.
To the Editor
of THE LANCET SiR,,-As there are probably many of your readers who would like to add their signatures to the letter on doctors in Austria which you published in your issue of March 26th, would you be good enough to insert the following notice ?‘ Will any members of the medical profession who in sympathy with and would like to sign the letter published on March 26th on the subject of refugees in Austria please send their names to the hon. secretary, Medical Peace Campaign, 39, Southgrove, London, N.6. are
faithfully, MARY T. DAY.
" OUR COLLEAGUES IN AUSTRIA"
of
authoritative
body.
I am, Sir, yours To the Editor
some
THE LANCET
SiR,-liay express my entire agreement with Mr. Aubrey Goodwin’s letter in your last issue’? A further accession to the British medical profession of medical refugees from Central Europe will have very serious consequences for practices here, and will I
undoubtedly result in undue competition. This being the case I am convinced that the bulk of the profession does not agree with the signatories of the letter under the heading " Our Colleagues ill Austria in your issue of March 26th. I suggest that a vote be taken of the whole medical profession in the
TASMANIA
AND
IMMIGRANT
DOCTORS.——The
Tasmanian Pailiament has passed a Bill amending the Medical Act in view of a possible influx of doctors from Germany. Fourteen applications from German medical men have so far been made. The amending Bill requires candidates for registration to be British subjects and to possess a qualification obtained after " a complete course of training and examination in the country where the qualification was issued, at a university, college, or other institution recognised for that purpose in that country," or/and to possess "such other qualification as may be prescribed."
866
of shops now dealt in contraceptives only, and in such a way as to be an offence to a large portion of In one district alone there were the population. 36 these of stores, apart from the chemists’ shops. on March Commons 29th Mr. IN the House of a growing custom of buying these WEDDERBURN, Under-Secretary of State for Scot- There was also slot machines, and in factories and land, moved that the draft of the Housing (Scotland) things through touts were pushing these articles and workshops of be Acts (Continuation Contributions) Order, 1938, about their use. The country districts approved. This Order authorised the continuance of information were also becoming infiltrated with the same thing. subsidies for slum clearance and decrowding at the the terms of this Bill, if a dealer attempted to present rate on houses completed after March 31st, Under send these things or information about them to 1938. The present rate for slum clearance subsidy in unmarried persons under 18 he would be guilty of an Scotland was on a per capita basis of 92 10s., and offence. But there was nothing in the Bill which 22 15s. in the case of rural areas, and therefore varied would stop the sale of contraceptives to those who with the size of the family, that for two persons them, either by chemists or other stores being .85, and for six persons .615. The subsidy needed conducted in a proper manner. Mr. THURTLE opposed under the 1935 Act, however, was at a flat rate for the Bill partly on utilitarian grounds and partly each house built, and amounted to :66 15s. per house. because he believed that a private Member was not The average amount of subsidy for both decrowding the right person to bring in such legislation. He and slum clearance amounted to slightly under 211 did not know how extensive this evil might be, but per house. Mr. T. JoHNSTON said there had been in if it was a real evil it ought to be dealt with by Scotland a progressive deterioration in the amount of the Government Department concerned-namely, the the to the local authorities subsidy given during They had to remember that the past two or three years, and what the Government Home Office. practice of birth control in this country, whether were doing now was to perpetuate a position in they liked it or not, was very widespread, and while Scotland which the local authorities almost unanione wished to see advertisements regarding birth mously declared to be an impossible one, and one in no control set out in an offensive manner, or contrawhich they did not feel that they could develop a exposed objectionably, they must large-scale building programme. While the subsidy ceptive equipment recognise that this was lawful information for the was stabilised the cost of building had risen by over men and women of the country, and Parliament 25 per cent. In Scotland they had a 50 per cent. ought not to make it unduly difficult for them to in than and maternal mortality-rate England, higher get that information and the necessary equipment. was six times worse in Scotland than overcrowding in England. The poor-law relief figure in Scotland Detention under the Mental Deficiency Act was 2 times worse than in England. Almost oneAfter third of the people of Scotland were living more making full inquiry the Minister of Health has informed Mr. Logan that the action taken with than two to a room, and in the burghs there were 300,000 houses without a separate water-closet. respect to Mr. Hargreaves (see Lancet, April2nd, p. 811) was the consequence of a mistake in the office of the While the Labour Party could not vote against this Board of Control, which he deeply regrets. A sum of Order on the ground that they could not take the accepted by Mr. Hargreavesjin comresponsibility for discontinuing the subsidy they must 2200 has been emphatically protest against the Government per- pensation for his distressing experience. mitting the profiteering in house building materials in In the House of Lords on March 30th the Royal Scotland and thus permitting a depreciation in the Assent was given to the Blind Persons Act, the Mr. ELLIOT, Secretary of value of the subsidy. Population (Statistics) Act, and the National Health State for Scotland, said it was common knowledge Insurance (Amendment) Act. that there was great disquietude in the House of Commons and in Scotland as to the housing situation. In the House of Lords on April 5th, on the motion They had already large building programmes, but it of Viscount GAGE, the following noble Lords were fell short. They were was in execution that they to join with a committee of the House of not getting inferior grants in Scotland to those in appointed Commons in the consideration of the Food and England, but the question really was, why they Drugs Bill: the Earl of Onslow, the Earl of Birkencould not make as good use of them in Scotland as head, Lord Teynham, the Earl of Listowel, Lord south of the border. Local authorities should give O’Hagan, Lord Addington, and Lord Doverdale. attention to alternative methods of building, parIn the House of Commons on March 31st Sir ticularly to the timber house, as a possible source of relief. The number of houses being built and Douglas Thomson introduced the Nursing Homes approved was still as high as it had ever been, even Registration (Scotland) Bill, which provides for the during the trough-of low prices. That showed that registration and inspection of nursing-homes in the rise in cost had not discouraged local authorities Scotland. from going on with houses. They must concentrate QUESTION TIME upon the most desperate problem-namely, the getting rid of the terrible dens and slums which WEDNESDAY, MARCH 30TH existed. After that they would move on to other H.M.S. Caledonia problems, but when there was only so much labour Mr. GALLACHER asked the First Lord of the Admiralty available they must in this case take the worst he had any information concerning the outbreak whether first. things of disease among boys on board H.M.S. Caledonia how NOTES ON CURRENT TOPICS Housing in Scotland
’
Sale of Contraceptives On March 30th in the House of Commons Mr. R. J. RUSSELL introduced a Bill to regulate the public display in shops of contraceptives and matter descriptive thereof, to prohibit street trading in such articles, and to restrict their public advertisement. He emphasised the increasing development throughout the country, especially in the metropolitan area, of publicity with regard to contraceptives and their display and sale. By inquiry he had found that of 280 chemists’ shops only seven did not stock and distribute contraceptives. In addition a large number
had been
of scarlet fever, middle-ear how many had been removed to shore hospitals with rheumatic hearts ; and what steps were being taken to cope with this situation. - Mr. DuFF CooPEn replied : The number of cases of scarlet fever and rheumatic fever that have occurred among boys in H.M.S. Caledonia since May 10th, 1937, when the first entries were made, are 74 and 31 respectively. The number of cases of middle-ear disease to Dec. 31st, 1937, was 20 ; since then there have been 30 cases of ear trouble but how many of these were middle-ear disease is not known. I am obtaining the many
cases
reported
disease, and rheumatic fever ;