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STAMMERING
692 A
which results from a full understanding of the mechanism of speech. I am, Sir, yours faithfully, H. ST. JOHN RUMSEY, M.A.,
QUESTION OF PROFESSIONAL CONFIDENCE
To the Editor
SiE,—Particulars of
of
THE LANCET
recent
March 16th.
tragedy
may serve as a warning to more than one section of your readers. A is a practitioner attending a family in which B is a general servant. B develops what A thinks is an "acute abdomen" - and is sent into hospital for operative treatment. In hospital B is found to be suffering from gonococcal salpingitis not requiring operation and is transferred to the " V.D." ward. While in this ward B is visited on the ordinary visiting day by A who, without permission and in the presence of the nurse, takes down and reads the case record on the bed-card. Two days later, and while still in bed in the ward, B receives notice of dismissal from her mistress who is A’s patient. B, whose previous record is highly creditable, is now contemplating suicide. I should like to know what my fellow practitioners think of A’s action. It is important to add that B is still on his panel. a
I am, Sir, yours
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED MARCH 7TH, 1936
VocetoMS.—The following cases of infectious disease were notified during the week: Small-pox 0, scarlet fever 2491, diphtheria 1162, enteric fever 28, pneumonia (primary or influenzal) 1431, peurperal fever 44, puerperal pyrexia 152, cerebrospinal fever 26, acute poliomyelitis 3, encephalitis lethargica 6, dysentery 49, ophthalmia neonatorum 86. No case of cholera, plague, or typhus fever was notified during the week.
acute
The number of cases in the Infectious Hospitals of the London County Council on March 13th was 5656, which included : Scarlet fever, 973 ; diphtheria, 1069 ; measles, 2138 ; whoopingcough, 729 ; puerperal fever, 17 mothers (plus 11 babies) At St. encephalitis lethargica, 283 ; poliomyelitis, 4. Margaret’s Hospital there were 28 babies (plus 15 mothers) with ophthalmia neonatorum.
faithfully,
It will be noted that the number of
* * The case raises medico-legal issues that are repeatedly cropping up in practice. We think A’s conduct cannot be defended, because (1) he made use without permission of case records belonging to the hospital; (2) information might be contained in these records which B’ did not desire to disclose to A ; (3) if A communicated to B’s mistress (presumably without B’s knowledge and consent) information which led to the notice of dismissal two days after his visit to the hospital, A committed a serious breach of professional confidence ; (4) if the dismissal was the result of information conveyed by A as to the nature of B’s illness, his conduct must be held responsible for the nervous upset made manifest by B’s threatened suicide. The fact that B’s previous record was " highly creditable " suggests an inquiry whether the diagnosis of gonococcal salpingitis waE correct. Was the gonococcus identified in the discharge from the cervix ? Was a cultivation madeI If not, the precise nature of the salpingitis could hardly be determined unless the tubes were inspectec and examined under the microscope. Tuberculous i salpingitis may occasionally be acute, or, what if more common, salpingitis may complicate appendicula: or colonic inflammation. Infection from contra ceptive appliances must also be excluded befor assuming a venereal infection. On the other hand if the diagnosis were correct it is the business of th, hospital to make sure that B is treated until sh is no longer a possible source of infection, when sh could have resumed her employment.-ED. L. , . ’
-
STAMMERING
To the Editor
of THE
cases
of measles
now
hospitalised in London amounts to 2183, which is :409 more than last week, and is evidence of the rapid spread of the epidemic of measles in the county.
IATROS.
March 1st.
Speech Therapist, Guy’s Hospital.
LANCET
SIR,-Miss Kate Emil-Behnke and her family have contributed so much to the literature and analysis of the technique of speech that I am not prepared to argue with her, but she seemed to me to advocate the use of elocution and, in almost the same breath, to say that it was useless. As a selfcured stammerer long before I undertook the cure of other stammerers I believe that the coordination of all the muscles concerned in speech-that is, true elocution-will correct stammering, which is first of all due to unbalanced speech or lack of coordination. From personal experience I know the confidence
Deaths.-In 121 great towns, including London, there was no death from small-pox, 3 (0) from enteric fever, 84 (22) from measles, 3 (1) from scarlet fever, 37 (9) from whooping-cough, 41 (1) from diphtheria, 64 (20) from diarrhoea and enteritis under two years, and 112 (28) from influenza. The figures in parentheses are those for London itself. It will be noticed that the mortality from measles is rising,
although not rapidly, the figures for the last six weeks (working backwards) being 84, 88, 78, 58, 34, 41 for the country as a whole and 47, 38, 18, 14, 13, 9 for Greater London. There is a corresponding or even larger rise in the number of cases for which hospital treatment has been sought at L.C.C. hospitals.
The inference may be drawn either that the disease is not severe form or that the prompt measures taken in London to get serious cases into surroundings where they can be looked after have been successful. Liverpool reported 8 deaths from measles during the week, Willesden and Manchester each 5, Ilford, Leeds, and Preston each 3. Deaths from influenza throughout the country remain nearly constant. This week they are scattered over 51 great towns, Middlesbrough reporting 5, Newcastle-upon-Tyne, South Shields, and Birmingham each 4, Ealing, Leeds, Sheffield, Leicester, and Nottingham each 3. Manchester reported 6 deaths from whooping-cough, Leeds 3, no other great town more than 2. Deaths from diphtheria were reported from 27 great towns, 3 each from Hull, Liverpool, and Newcastle-
present in
upon-Tyne.
The number of stillbirths notified during the week was 300 (corresponding to a rate of 44 per 1000 total births), including 44 in London. The number 300 has not been reached before since official notification was instituted.
Ivory CROSS FUND.-The annual general meetof the Ivory Cross National Dental Aid Fund was held on March 12th. The council confirmed the decision of the executive committee, publicly announced over a year ago, not to accept donations which are the proceeds of gambling parties, nor in future to be associated with anyone employing such methods for raising money. The hope was expressed that their action would be widely followed by many charitable organisations which in the past had, under the pressure of need, accepted money that had been raised in this way. It was announced that the executive, committee were negotiating with the commissioner for the special areas with a view to extending the work of the Ivory Cross Fund in certain special areas, with particular reference to the treatment of adolescents at junior instruction centres and at juvenile clubs. In present circumstances youths from 14 or 15 to 19 years of age are not entitled to dental benefit under the present health insurance Acts which, in any case, only give dental benefit to 50 per cent. of the male and 30 per cent. of the female members of approved societies.
ing
which results from a full understanding of the mechanism of speech. I am, Sir, yours faithfully, H. ST. JOHN RUMSEY, M.A.,
QUESTION OF PROFESSIONAL CONFIDENCE
To the Editor
SiE,—Particulars of
of
THE LANCET
recent
March 16th.
tragedy
may serve as a warning to more than one section of your readers. A is a practitioner attending a family in which B is a general servant. B develops what A thinks is an "acute abdomen" - and is sent into hospital for operative treatment. In hospital B is found to be suffering from gonococcal salpingitis not requiring operation and is transferred to the " V.D." ward. While in this ward B is visited on the ordinary visiting day by A who, without permission and in the presence of the nurse, takes down and reads the case record on the bed-card. Two days later, and while still in bed in the ward, B receives notice of dismissal from her mistress who is A’s patient. B, whose previous record is highly creditable, is now contemplating suicide. I should like to know what my fellow practitioners think of A’s action. It is important to add that B is still on his panel. a
I am, Sir, yours
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED MARCH 7TH, 1936
VocetoMS.—The following cases of infectious disease were notified during the week: Small-pox 0, scarlet fever 2491, diphtheria 1162, enteric fever 28, pneumonia (primary or influenzal) 1431, peurperal fever 44, puerperal pyrexia 152, cerebrospinal fever 26, acute poliomyelitis 3, encephalitis lethargica 6, dysentery 49, ophthalmia neonatorum 86. No case of cholera, plague, or typhus fever was notified during the week.
acute
The number of cases in the Infectious Hospitals of the London County Council on March 13th was 5656, which included : Scarlet fever, 973 ; diphtheria, 1069 ; measles, 2138 ; whoopingcough, 729 ; puerperal fever, 17 mothers (plus 11 babies) At St. encephalitis lethargica, 283 ; poliomyelitis, 4. Margaret’s Hospital there were 28 babies (plus 15 mothers) with ophthalmia neonatorum.
faithfully,
It will be noted that the number of
* * The case raises medico-legal issues that are repeatedly cropping up in practice. We think A’s conduct cannot be defended, because (1) he made use without permission of case records belonging to the hospital; (2) information might be contained in these records which B’ did not desire to disclose to A ; (3) if A communicated to B’s mistress (presumably without B’s knowledge and consent) information which led to the notice of dismissal two days after his visit to the hospital, A committed a serious breach of professional confidence ; (4) if the dismissal was the result of information conveyed by A as to the nature of B’s illness, his conduct must be held responsible for the nervous upset made manifest by B’s threatened suicide. The fact that B’s previous record was " highly creditable " suggests an inquiry whether the diagnosis of gonococcal salpingitis waE correct. Was the gonococcus identified in the discharge from the cervix ? Was a cultivation madeI If not, the precise nature of the salpingitis could hardly be determined unless the tubes were inspectec and examined under the microscope. Tuberculous i salpingitis may occasionally be acute, or, what if more common, salpingitis may complicate appendicula: or colonic inflammation. Infection from contra ceptive appliances must also be excluded befor assuming a venereal infection. On the other hand if the diagnosis were correct it is the business of th, hospital to make sure that B is treated until sh is no longer a possible source of infection, when sh could have resumed her employment.-ED. L. , . ’
-
STAMMERING
To the Editor
of THE
cases
of measles
now
hospitalised in London amounts to 2183, which is :409 more than last week, and is evidence of the rapid spread of the epidemic of measles in the county.
IATROS.
March 1st.
Speech Therapist, Guy’s Hospital.
LANCET
SIR,-Miss Kate Emil-Behnke and her family have contributed so much to the literature and analysis of the technique of speech that I am not prepared to argue with her, but she seemed to me to advocate the use of elocution and, in almost the same breath, to say that it was useless. As a selfcured stammerer long before I undertook the cure of other stammerers I believe that the coordination of all the muscles concerned in speech-that is, true elocution-will correct stammering, which is first of all due to unbalanced speech or lack of coordination. From personal experience I know the confidence
Deaths.-In 121 great towns, including London, there was no death from small-pox, 3 (0) from enteric fever, 84 (22) from measles, 3 (1) from scarlet fever, 37 (9) from whooping-cough, 41 (1) from diphtheria, 64 (20) from diarrhoea and enteritis under two years, and 112 (28) from influenza. The figures in parentheses are those for London itself. It will be noticed that the mortality from measles is rising,
although not rapidly, the figures for the last six weeks (working backwards) being 84, 88, 78, 58, 34, 41 for the country as a whole and 47, 38, 18, 14, 13, 9 for Greater London. There is a corresponding or even larger rise in the number of cases for which hospital treatment has been sought at L.C.C. hospitals.
The inference may be drawn either that the disease is not severe form or that the prompt measures taken in London to get serious cases into surroundings where they can be looked after have been successful. Liverpool reported 8 deaths from measles during the week, Willesden and Manchester each 5, Ilford, Leeds, and Preston each 3. Deaths from influenza throughout the country remain nearly constant. This week they are scattered over 51 great towns, Middlesbrough reporting 5, Newcastle-upon-Tyne, South Shields, and Birmingham each 4, Ealing, Leeds, Sheffield, Leicester, and Nottingham each 3. Manchester reported 6 deaths from whooping-cough, Leeds 3, no other great town more than 2. Deaths from diphtheria were reported from 27 great towns, 3 each from Hull, Liverpool, and Newcastle-
present in
upon-Tyne.
The number of stillbirths notified during the week was 300 (corresponding to a rate of 44 per 1000 total births), including 44 in London. The number 300 has not been reached before since official notification was instituted.
Ivory CROSS FUND.-The annual general meetof the Ivory Cross National Dental Aid Fund was held on March 12th. The council confirmed the decision of the executive committee, publicly announced over a year ago, not to accept donations which are the proceeds of gambling parties, nor in future to be associated with anyone employing such methods for raising money. The hope was expressed that their action would be widely followed by many charitable organisations which in the past had, under the pressure of need, accepted money that had been raised in this way. It was announced that the executive, committee were negotiating with the commissioner for the special areas with a view to extending the work of the Ivory Cross Fund in certain special areas, with particular reference to the treatment of adolescents at junior instruction centres and at juvenile clubs. In present circumstances youths from 14 or 15 to 19 years of age are not entitled to dental benefit under the present health insurance Acts which, in any case, only give dental benefit to 50 per cent. of the male and 30 per cent. of the female members of approved societies.
ing