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"INTERNATIONAL CATALOGUE OF SCIENTIFIC LITERATURE."
1234 cannot speak words of comfort and encouragement then silence is the better part. I am, Sirs, yours faithfully, GORDON SHARP. St. George’s-terrace, Leeds, April 22nd, 1901.
patient in quarters ; to pay for his board and lodging, nursing, and medical comforts, if necessary ; and at stated times to send in his account to the Admiralty.
the
I am,
Sirs,
yours
faithfully,
CHARLES COTTON, F.R.C.P. Edin. Ramsgate, April 20th, 1901.
" THE TEACHING OF ANÆSTHETICS."
SiRS,-It will probably be a couple of months before we can get Lieutenant-Colonel Lawrie’s answer to Dr. Hewitt’s letter in THE LANCET of April 20th, p. 1066. But as I came across yesterday, by a curious coincidence, an in-
concerning the administration of chloroform given foreign surgeon which supports Lieutenant-Colonel
struction
by
a
Lawrie in a statement which has drawn down on him Dr. Hewitt’s high scorn I beg that you will note it next week. Dr. Hewitt’s quotation from Lieutenant- Colonel Lawrie is: "The way to make a young child breathe regularly is to make it cry by holding the chloroform cap close down over its mouth and nose until it becomes unconscious and quiet,"on which he remarks: "It is, I think, unnecessary to further criticise the above doctrines; they speak for themselves." The quotation from Lejars’ "Chirurgie d’Urgence," which you recently criticised most favourably, is : "11 y a une autre methode qui brusque les choses: la comprease, imprégnée de chloroforme, est appliquée sur la bouche et le nez et tout de suite hermétiquement fermée. Cela réussit chez 1’enfant, et chez l’adulte entre des mains exercees." He goes on to say that he prefers persuasion, but that he has spoken as above shows, I think, that Lieutenant-Colonel Lawrie’s views are more widely held than Dr. Hewitt supposes. If Dr. Hewitt wishes to convert them he will do so more effectually by argument than by scorn. I am, Sirs, yours faithfully, HOME. April 21st, 1901.
W. E.
"THE MANAGEMENT OF HOME MILITARY
HOSPITALS." To the Editors of THE LANCET. SIRS,-Having read the article under this heading by Surgeon-Captain Pngin Thornton in THE LANCET of March 30th, p. 958, I notice that he has omitted to state what becomes of the soldier when sick on leave if not in the vicinity of a military hospital. Snch cases are constantly cropping up in this town, and it is interesting to compare the neglect of arrangements made by the military authorities with the excellent ones in force in the navy. In the case of the soldier he is probably on furlough, staying with his family or friends. He falls ill and requires medical assistance ; he is too ill to be sent to a military hospital and has therefore to be treated at home. He has to find board and lodging for himself; special diets or medical comforts, if demanded by the necessity of the case, also fall upon him. If his medical attendant gets paid for the services rendered at a critical and urgent time the soldier has to pay for them himself. But, as a matter of fact, it more often happens that the soldier requests the medical man to forward the account at the end of the attendance to his commanding officer, and the medical man, innocent of guile, having found that his bi-weekly certificates are accepted by the commeinding officer, finds it a very different thing when he sends to the commanding officer the account of his fees at the end of the attendance. In the many cases that have come under my own observation no notice whatever has been taken of these accounts when duly sent in, and there appears to be no way for recovery of the fees for the attendance. In some few cases the soldier has said at the beginning that he is himself responsible for the attendance, and has done his best honestly to meet it. In these cases I consider it a great tax that a soldier on leave should be obliged to pay for medical attendance just because he happens to be on furlough away from a military hospital. In one case it is unfair to the doctor, in the other unfair to the soldier. Now let us turn to what obtains in the sister service. The navy is mostly recruited from seaport towns, and all round the coast of the British Isles there are civil surgeons appointed by the Admiralty to the medical charge of the coastguard, and it is a part of the duty of these surgeons to attend any officer or man of His Majesty’s Navy who may fall sick when on leave. The surgeon is empowered to place
"INTERNATIONAL CATALOGUE OF SCIENTIFIC LITERATURE." To t7te Editors of THE LANCET. SIRS,—Will you allow me to add a note to the letter which appeared in your issue of March 9th, p. 736? In the list there given the section of anthropology is not mentioned. Scattered among papers of purely medical importance, however, appears a considerable number of articles bearing on anthropological questions which it will be only too easy to overlook, especially if the journals or books are not readily accessible. May I ask authors to send separate copies of their publications, or in default of that, a note of place and date of publication and of the main contents of the paper, to the Anthropological Institute, 3, Hanover-Equare, London, I am, Sirs, yours faithfully, W. NORTHCOTE W. THOMAS. Hanover-square, W.
"THE X RAYS IN SOUTH AFRICA." To the Editors
letter
of THE LANCET.
this subject which you were good LANCET of Jan. 19th last, p. 212, I stated that the apparatus sent out by the War Office for use in the military hospitals in South Africa was that known as the " army pattern made by Apps and Newton." Mr. Harry W. Cox, of Cursitor-street, London, E.C., by order from the War Office, sent out three sets of apparatus of his own manufacture and has asked me to correct my former statement to this effect. This request, if you will grant me space to do so, I shall be glad of an opportunity of complying with. I am, Sirs, yours faithfully,
SIRS,-In
enough
to
a
on
publish in THE
W. F. STEVENSON, Colonel, R.A.M.C. Netley, April 22nd, 1901
"THE STATISTICS OF GASTRIC ULCER, WITH SPECIAL REFERENCE TO GASTRIC HÆMORRHAGE, ITS FREQUENCY AND FATALITY." To the Editors of THE LANCET. SIRS,-I hardly think I need add anything to my letter in THE LANCET of March 30th, p. 969. Let me, however, thank Mr. Mayo Robson for the references which he has published, and let me say that those references entirely confirm my statement-viz., that the mortality percentages from haemorrhage in gastric ulcer, given by the authorities which Mr. Mayo Robson quoted in his address, refer not merely to those cases of gastric ulcer in which hæmorrhage occurs, but to all cases of gastric ulcer. Let me further say that, so far as I see, it is impossible to reconcile the estimate which Mr. Mayo Robson has drawn from those figures-viz., that 7 per cent of cases of hæmatemesis from ulcer, or 3 per cent. of all persons suffering from ulcer, die as the result of bleeding-with those figuresviz., Miiller, 11 per cent. ; Welch, 3 to 5 per cent. ; BrintoD, 5 per cent. ; Debove, 5 per cent. ; Steiner, 6’36 per cent. ; Lebert, 3 per cent. ; Dreschfeld, 3½ per cent. ; and Rodman, 8 per cent.-unless, first, it be granted (and this is, as I have shown, an erroneous reading of the figures) that those figures refer to the mortality percentages in those cases of gastric ulcer in which haemorrhage occurs (which Mr. Mayo Robson estimates at 50 per cent.); and, secondly, unless the mean (7 per cent.) of the extremes (11 per cent. and 3 per cent.), and not the average, of those figures is taken. The average of the figures is just about 5½ per cent. Let me also add that the mortality percentages of Lebert and Leube (Rodman), which Mr. Mayo Robson quotes, do not, according to my reading, represent the figures of those authorities (see
addendum). I hope one
result of this discussion will be finally to "knock out of time" Brinton’s estimate-that the total
patient in quarters ; to pay for his board and lodging, nursing, and medical comforts, if necessary ; and at stated times to send in his account to the Admiralty.
the
I am,
Sirs,
yours
faithfully,
CHARLES COTTON, F.R.C.P. Edin. Ramsgate, April 20th, 1901.
" THE TEACHING OF ANÆSTHETICS."
SiRS,-It will probably be a couple of months before we can get Lieutenant-Colonel Lawrie’s answer to Dr. Hewitt’s letter in THE LANCET of April 20th, p. 1066. But as I came across yesterday, by a curious coincidence, an in-
concerning the administration of chloroform given foreign surgeon which supports Lieutenant-Colonel
struction
by
a
Lawrie in a statement which has drawn down on him Dr. Hewitt’s high scorn I beg that you will note it next week. Dr. Hewitt’s quotation from Lieutenant- Colonel Lawrie is: "The way to make a young child breathe regularly is to make it cry by holding the chloroform cap close down over its mouth and nose until it becomes unconscious and quiet,"on which he remarks: "It is, I think, unnecessary to further criticise the above doctrines; they speak for themselves." The quotation from Lejars’ "Chirurgie d’Urgence," which you recently criticised most favourably, is : "11 y a une autre methode qui brusque les choses: la comprease, imprégnée de chloroforme, est appliquée sur la bouche et le nez et tout de suite hermétiquement fermée. Cela réussit chez 1’enfant, et chez l’adulte entre des mains exercees." He goes on to say that he prefers persuasion, but that he has spoken as above shows, I think, that Lieutenant-Colonel Lawrie’s views are more widely held than Dr. Hewitt supposes. If Dr. Hewitt wishes to convert them he will do so more effectually by argument than by scorn. I am, Sirs, yours faithfully, HOME. April 21st, 1901.
W. E.
"THE MANAGEMENT OF HOME MILITARY
HOSPITALS." To the Editors of THE LANCET. SIRS,-Having read the article under this heading by Surgeon-Captain Pngin Thornton in THE LANCET of March 30th, p. 958, I notice that he has omitted to state what becomes of the soldier when sick on leave if not in the vicinity of a military hospital. Snch cases are constantly cropping up in this town, and it is interesting to compare the neglect of arrangements made by the military authorities with the excellent ones in force in the navy. In the case of the soldier he is probably on furlough, staying with his family or friends. He falls ill and requires medical assistance ; he is too ill to be sent to a military hospital and has therefore to be treated at home. He has to find board and lodging for himself; special diets or medical comforts, if demanded by the necessity of the case, also fall upon him. If his medical attendant gets paid for the services rendered at a critical and urgent time the soldier has to pay for them himself. But, as a matter of fact, it more often happens that the soldier requests the medical man to forward the account at the end of the attendance to his commanding officer, and the medical man, innocent of guile, having found that his bi-weekly certificates are accepted by the commeinding officer, finds it a very different thing when he sends to the commanding officer the account of his fees at the end of the attendance. In the many cases that have come under my own observation no notice whatever has been taken of these accounts when duly sent in, and there appears to be no way for recovery of the fees for the attendance. In some few cases the soldier has said at the beginning that he is himself responsible for the attendance, and has done his best honestly to meet it. In these cases I consider it a great tax that a soldier on leave should be obliged to pay for medical attendance just because he happens to be on furlough away from a military hospital. In one case it is unfair to the doctor, in the other unfair to the soldier. Now let us turn to what obtains in the sister service. The navy is mostly recruited from seaport towns, and all round the coast of the British Isles there are civil surgeons appointed by the Admiralty to the medical charge of the coastguard, and it is a part of the duty of these surgeons to attend any officer or man of His Majesty’s Navy who may fall sick when on leave. The surgeon is empowered to place
"INTERNATIONAL CATALOGUE OF SCIENTIFIC LITERATURE." To t7te Editors of THE LANCET. SIRS,—Will you allow me to add a note to the letter which appeared in your issue of March 9th, p. 736? In the list there given the section of anthropology is not mentioned. Scattered among papers of purely medical importance, however, appears a considerable number of articles bearing on anthropological questions which it will be only too easy to overlook, especially if the journals or books are not readily accessible. May I ask authors to send separate copies of their publications, or in default of that, a note of place and date of publication and of the main contents of the paper, to the Anthropological Institute, 3, Hanover-Equare, London, I am, Sirs, yours faithfully, W. NORTHCOTE W. THOMAS. Hanover-square, W.
"THE X RAYS IN SOUTH AFRICA." To the Editors
letter
of THE LANCET.
this subject which you were good LANCET of Jan. 19th last, p. 212, I stated that the apparatus sent out by the War Office for use in the military hospitals in South Africa was that known as the " army pattern made by Apps and Newton." Mr. Harry W. Cox, of Cursitor-street, London, E.C., by order from the War Office, sent out three sets of apparatus of his own manufacture and has asked me to correct my former statement to this effect. This request, if you will grant me space to do so, I shall be glad of an opportunity of complying with. I am, Sirs, yours faithfully,
SIRS,-In
enough
to
a
on
publish in THE
W. F. STEVENSON, Colonel, R.A.M.C. Netley, April 22nd, 1901
"THE STATISTICS OF GASTRIC ULCER, WITH SPECIAL REFERENCE TO GASTRIC HÆMORRHAGE, ITS FREQUENCY AND FATALITY." To the Editors of THE LANCET. SIRS,-I hardly think I need add anything to my letter in THE LANCET of March 30th, p. 969. Let me, however, thank Mr. Mayo Robson for the references which he has published, and let me say that those references entirely confirm my statement-viz., that the mortality percentages from haemorrhage in gastric ulcer, given by the authorities which Mr. Mayo Robson quoted in his address, refer not merely to those cases of gastric ulcer in which hæmorrhage occurs, but to all cases of gastric ulcer. Let me further say that, so far as I see, it is impossible to reconcile the estimate which Mr. Mayo Robson has drawn from those figures-viz., that 7 per cent of cases of hæmatemesis from ulcer, or 3 per cent. of all persons suffering from ulcer, die as the result of bleeding-with those figuresviz., Miiller, 11 per cent. ; Welch, 3 to 5 per cent. ; BrintoD, 5 per cent. ; Debove, 5 per cent. ; Steiner, 6’36 per cent. ; Lebert, 3 per cent. ; Dreschfeld, 3½ per cent. ; and Rodman, 8 per cent.-unless, first, it be granted (and this is, as I have shown, an erroneous reading of the figures) that those figures refer to the mortality percentages in those cases of gastric ulcer in which haemorrhage occurs (which Mr. Mayo Robson estimates at 50 per cent.); and, secondly, unless the mean (7 per cent.) of the extremes (11 per cent. and 3 per cent.), and not the average, of those figures is taken. The average of the figures is just about 5½ per cent. Let me also add that the mortality percentages of Lebert and Leube (Rodman), which Mr. Mayo Robson quotes, do not, according to my reading, represent the figures of those authorities (see
addendum). I hope one
result of this discussion will be finally to "knock out of time" Brinton’s estimate-that the total