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SMALL-POX AND AMAAS IN SOUTH AFRICA.
205 forms of tuberculosis. If he were it seems to unlikely that he could state that immunisation acted merely by a process of suggestion. He must have used very non-specific antigens or very impotent intravital germicides. It seems perhaps invidious for me to suggest that he might read two small books in English instead of voluminous tomes in French or German and find there that the subject had already been disentangled. I am. Sir. vours faithfullv. W. M. CROFTON. University College, Dublin, Jan. 18th, 1923.
I wrote to the press and pointed out the serious the disease was virulent small-pox, but failed in my efforts to convince the public. A deputation of doctors from Cape Town arrived and examined the cases, but left without establishing a definite diagnosis. I saw that some more decisive and impressive step must at once be taken. I despatched pieces of skin from a white man unvacoinated who had died from the disease (one to The Lancet and one to the British Medical Journal), and both authorities stated it was virulent small-pox and warned the public about instant vaccination. I took the photo of a baby who To the Editor of THE LANCET. was born covered all over with small-pox, and forwarded it to the home medical papers. One man Dr. out of Claude SIR,—The correspondence arising remarked of this that it ought to be reprinted in every Lillingston’s paper in your issue of Jan. 13th, while book dealing with small-pox. both interesting and suggestive, appears to me to The verdicts of The Lancet and British Medical to rather loose as some of show the essential thinking factors underlying the treatment by rest and graduated Journal impressed the members of the Kimberley exercise respectively. It seems to be assumed that town council, who requested me to vaccinate all and graduated exercise only. acts by inducing auto- sundry in Kimberley. At the time I had no lymph inoculations and that the absence of temperature after but remembered a baby who had been vaccinated. such exercise depends on " tolerance " to auto- From the baby I got three or four tubes of lymphtuberculin. May I suggest that the case that does best the vesicles were at the seventh day. I vaccinated four young kafir boys who were closely examined on graduated exercise is one in which the lesions are and seemed as pure in blood as young spring bucks so well shut off by cellular reaction and proliferation that the auto-inoculations are minimal. Such a case on the veldt-a relay of these boys was always kept is usually one of reinfection in a relatively resistant up. Well, in brief, I vaccinated 10,000 kafirs in six when the epidemic was stamped out. On one subject, and owing to his power of sharp reaction, is weeks, a hospital would become empty and not another day and for case." an easily diagnosed passes " early What such a patient requires is re-education in the case would arrive. Three scrutineers were appointed watch the vaccination. No manager complained respiratory function which has been partially lost to I hurt his boys ; there were no septic arms and no the illness that reinfection. during accompanied his He can stand this re-education because his auto-inocu- deaths. Dr. Jameson, during the epidemic, was lations are minimal ;and his gain in weight, condition, prosecuted for admitting a contagious disease into a and general health is perhaps as much the result of general hospital. A courf. case resulted, and the usual increased metabolism and good food as of the small bickerings took place. A witness was put into the auto-inoculations that may occur. It is a mistake to box who swore I treated his wife for cancer when, in fact, she was pregnant. The magistrate, seeing suppose that such a man is " tolerant." An injection of tuberculin is usually sufficient to prove that patients me in the court, stated that as this was sprung upon of this type are really " intolerant " or " allergic," a me unawares I could reply. I stated it was absolutely fact to which they probably owe their power of shutting false. I looked up the case afterwards, and found I was treating her for pregnancy with Hewlett’s in their tuberculous foci. and pepsin mixture. Nobody who has seen the results of graduated bismuth Towards the close of the vaccination I asked Mr. exercise in sanatoria run on " Marcus Paterson " lines can doubt the value of this form of treatment in Denis Doyle, the sanitary inspector, to bring in all suitable cases when carefully controlled by temperature and sundry still unvaccinated, and he succeeded one records. But for cases of a less " balanced " type, morning in producing 1000 natives composed of every where the lesions are still in an exudative stage, and type of aboriginal in South Africa. These were auto-inoculations are easily induced and considerable vaccinated on a Sunday morning, and with that the closed.--1 am, Sir, yours faithfully,, in amount, treatment by rest is imperative and even WM. ROBERTSON. There is a dangerous. graduated exercise may well be " South Nov. 1922. Mossel Bay, Africa, 14th, that the advocates of rest " on the one hand danger " and of exercise " on the other may come to be regarded as belonging to opposite camps. Surely it or other me very
position-that
Ili epidemic
isauto-inoculations and fortheexercise forofthe bothcontrol " restof" skilledphysician his instruments to makeuse and of metabolism "
"
as
the graduation
to meet the needs of the individual case. I am, Sir, yours faithfully, S. L. CUMMINS. University College, Cardiff, Jan. 20th, 1923.
SMALL-POX AND AMAAS IN SOUTH AFRICA. To the Editor of THE LANCET. reference SIR,—A by Dr. J. A. Mitchell, Chief Health Officer, Union of South Africa, in THE LANCET of Oct. 14th, 1922, to an outbreak of small-pox at Kimberley in 1882, induces me to give a short record of experiences in that epidemic. When small-pox began, the mine owners feared that if the disease was mentioned the farmers would take fright and not bring in fuel. The term " chicken-pox " was adopted and Dr. Jameson clung to this diagnosis for a time and then shifted to pemphigus, although a lady in Cape Town was informed it was small-pox, but it would not do to frighten people, &c. Meanwhile the
epidemic was devastating thekafirs, who were dying *in scores, as well as unvaccinated whites who believed Dr. Jameson’s diagnosis of chicken-pox or pemphigus.
SULFARSENOL IN THE TREATMENT OF SYPHILIS.
To the Editor of THE LANCET. SIR,—Dr. M. W. Browdy in his letter to THE LANCET of Jan. 20th, commenting on my article of Jan. 13th, stated that those cases of syphilis that react badly to arsenobenzol compounds can be still treated by these compounds if certain precautionary measures are adopted, such as avoiding exposure to cold, allowing a certain amount of food before injection, and by giving contramine intramuscularly. No one can dispute that these precautions are of great help, but several of my patients have taken all these safeguards before an injection, besides glucose given by the mouth or intravenously, and also injections of adrenalin, and still had severe after-effects. When it was found that these cases had no after-effects following sulfarsenol, we had to conclude that this was the best drug to give them. In the complications of gonorrhoea I have found that neither intramine nor contramine has anything like such a dramatic and permanent As regards contramine being effect as sulfarsenol. safer, a 0-12 dose of sulfarsenol contains about 3 gr of arsenic, and can be safely given to a child. I am, Sir, yours faithfully, Harley-st., W., Jan. 22nd, 1923. F. CARMINOW DOBLE.
’
I wrote to the press and pointed out the serious the disease was virulent small-pox, but failed in my efforts to convince the public. A deputation of doctors from Cape Town arrived and examined the cases, but left without establishing a definite diagnosis. I saw that some more decisive and impressive step must at once be taken. I despatched pieces of skin from a white man unvacoinated who had died from the disease (one to The Lancet and one to the British Medical Journal), and both authorities stated it was virulent small-pox and warned the public about instant vaccination. I took the photo of a baby who To the Editor of THE LANCET. was born covered all over with small-pox, and forwarded it to the home medical papers. One man Dr. out of Claude SIR,—The correspondence arising remarked of this that it ought to be reprinted in every Lillingston’s paper in your issue of Jan. 13th, while book dealing with small-pox. both interesting and suggestive, appears to me to The verdicts of The Lancet and British Medical to rather loose as some of show the essential thinking factors underlying the treatment by rest and graduated Journal impressed the members of the Kimberley exercise respectively. It seems to be assumed that town council, who requested me to vaccinate all and graduated exercise only. acts by inducing auto- sundry in Kimberley. At the time I had no lymph inoculations and that the absence of temperature after but remembered a baby who had been vaccinated. such exercise depends on " tolerance " to auto- From the baby I got three or four tubes of lymphtuberculin. May I suggest that the case that does best the vesicles were at the seventh day. I vaccinated four young kafir boys who were closely examined on graduated exercise is one in which the lesions are and seemed as pure in blood as young spring bucks so well shut off by cellular reaction and proliferation that the auto-inoculations are minimal. Such a case on the veldt-a relay of these boys was always kept is usually one of reinfection in a relatively resistant up. Well, in brief, I vaccinated 10,000 kafirs in six when the epidemic was stamped out. On one subject, and owing to his power of sharp reaction, is weeks, a hospital would become empty and not another day and for case." an easily diagnosed passes " early What such a patient requires is re-education in the case would arrive. Three scrutineers were appointed watch the vaccination. No manager complained respiratory function which has been partially lost to I hurt his boys ; there were no septic arms and no the illness that reinfection. during accompanied his He can stand this re-education because his auto-inocu- deaths. Dr. Jameson, during the epidemic, was lations are minimal ;and his gain in weight, condition, prosecuted for admitting a contagious disease into a and general health is perhaps as much the result of general hospital. A courf. case resulted, and the usual increased metabolism and good food as of the small bickerings took place. A witness was put into the auto-inoculations that may occur. It is a mistake to box who swore I treated his wife for cancer when, in fact, she was pregnant. The magistrate, seeing suppose that such a man is " tolerant." An injection of tuberculin is usually sufficient to prove that patients me in the court, stated that as this was sprung upon of this type are really " intolerant " or " allergic," a me unawares I could reply. I stated it was absolutely fact to which they probably owe their power of shutting false. I looked up the case afterwards, and found I was treating her for pregnancy with Hewlett’s in their tuberculous foci. and pepsin mixture. Nobody who has seen the results of graduated bismuth Towards the close of the vaccination I asked Mr. exercise in sanatoria run on " Marcus Paterson " lines can doubt the value of this form of treatment in Denis Doyle, the sanitary inspector, to bring in all suitable cases when carefully controlled by temperature and sundry still unvaccinated, and he succeeded one records. But for cases of a less " balanced " type, morning in producing 1000 natives composed of every where the lesions are still in an exudative stage, and type of aboriginal in South Africa. These were auto-inoculations are easily induced and considerable vaccinated on a Sunday morning, and with that the closed.--1 am, Sir, yours faithfully,, in amount, treatment by rest is imperative and even WM. ROBERTSON. There is a dangerous. graduated exercise may well be " South Nov. 1922. Mossel Bay, Africa, 14th, that the advocates of rest " on the one hand danger " and of exercise " on the other may come to be regarded as belonging to opposite camps. Surely it or other me very
position-that
Ili epidemic
isauto-inoculations and fortheexercise forofthe bothcontrol " restof" skilledphysician his instruments to makeuse and of metabolism "
"
as
the graduation
to meet the needs of the individual case. I am, Sir, yours faithfully, S. L. CUMMINS. University College, Cardiff, Jan. 20th, 1923.
SMALL-POX AND AMAAS IN SOUTH AFRICA. To the Editor of THE LANCET. reference SIR,—A by Dr. J. A. Mitchell, Chief Health Officer, Union of South Africa, in THE LANCET of Oct. 14th, 1922, to an outbreak of small-pox at Kimberley in 1882, induces me to give a short record of experiences in that epidemic. When small-pox began, the mine owners feared that if the disease was mentioned the farmers would take fright and not bring in fuel. The term " chicken-pox " was adopted and Dr. Jameson clung to this diagnosis for a time and then shifted to pemphigus, although a lady in Cape Town was informed it was small-pox, but it would not do to frighten people, &c. Meanwhile the
epidemic was devastating thekafirs, who were dying *in scores, as well as unvaccinated whites who believed Dr. Jameson’s diagnosis of chicken-pox or pemphigus.
SULFARSENOL IN THE TREATMENT OF SYPHILIS.
To the Editor of THE LANCET. SIR,—Dr. M. W. Browdy in his letter to THE LANCET of Jan. 20th, commenting on my article of Jan. 13th, stated that those cases of syphilis that react badly to arsenobenzol compounds can be still treated by these compounds if certain precautionary measures are adopted, such as avoiding exposure to cold, allowing a certain amount of food before injection, and by giving contramine intramuscularly. No one can dispute that these precautions are of great help, but several of my patients have taken all these safeguards before an injection, besides glucose given by the mouth or intravenously, and also injections of adrenalin, and still had severe after-effects. When it was found that these cases had no after-effects following sulfarsenol, we had to conclude that this was the best drug to give them. In the complications of gonorrhoea I have found that neither intramine nor contramine has anything like such a dramatic and permanent As regards contramine being effect as sulfarsenol. safer, a 0-12 dose of sulfarsenol contains about 3 gr of arsenic, and can be safely given to a child. I am, Sir, yours faithfully, Harley-st., W., Jan. 22nd, 1923. F. CARMINOW DOBLE.
’