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THE ACCURACY OF CLINICAL THERMOMETERS.
1431
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statements made is that the temperature of the body is accurately ascertained by leaving one of the thermometers under discussion in the mouth for a period of two minutes. Such a method only ascertains in an extremely rough manner the temperature of the body, for the thermometer is under totally dissimilar circumstances when in a glass of water to that in the cavity of the mouth. Various clinicians have pointed out the serious errors which arise from this rough and ready proceeding, and the paper in your journal would tend to perpetuate this inaccurate method. I have tried many thermometers (Kew certified), and if they require two minutes in water they need 1015 minutes in the mouth, unless the mouth has previously been kept closed in a warm room. MARY H. WILLIAMS. Malvern, Nov. 10th, 1913.
Has Dr. Williams noted that in our experiments the conditions of environment of both the standard thermometer and the clinical thermometers tested were precisely the same ? Any " dissimilar circumstances of the mouthwould apply equally to the standard thermometer.ED. L. ____
To the Editor
of THE LANCET.
SIR,-The letter from Dr. J. B. Cook which appeared in THE LANCET of Oct. 4th on the results obtained by testing a batch of clinical thermometers supplied under contract to the St. Giles’ Infirmary, Cleveland-street, together with that of Mr. F. A. Hocking a week later, convey a lesson to the medical profession which should be taken to heart. A proportion of medical men in practice do regularly test the clinical thermometers which they buy and use for their patients; but the majority, I strongly suspect, omit this simple but very necessary act of precaution. Now that attention has been drawn to the point by the letters in question, it may be hoped that practitioners will
THE ACCURACY OF CLINICAL THERMOMETERS. To the Editor
of THE LANCET.
SIR,-In your issue of Nov. 8th appears an article headed " Some Experiments with Clinical Thermometers." In this article an account is given of certain experiments with clinical thermometers, in which their accuracy is tested in regard to the variations they record when plunged into water of varying temperatures. Then follows the astounding statement " On the whole, the results show that for practical clinical purposes the thermometers gave fairly accurate readings." I beg to suggest that the results recorded are highly misleading as regards clinical work. The inference to be drawn from the
take rather more trouble over this matter than most of them have been in the habit of doing. They may urge that so long as they pay a reasonable price for their thermometers, and buy them from respectable firms, the chance of error is exceedingly slight. That may be and most likely is true; but it is not a sufficient defence, for the consequences of any serious error in the graduation of a clinical thermometer can be so serious as to make the difference between life and death. There is, in fact, reason to believe that Britishmade thermometers, manufactured and sold at prices some hundreds per cent. cheaper than prevailed a few years ago, are accurate and trustworthy in a very high degree. But all thermometers are not British made, and even with respect to those that are, there is one reservation which must be made. A great many of these so-called "half-minute"thermometers do not really give true readings in that short space of time, though they may be perfectly reliable after longer incubation. As an instance of this may be quoted the following experiments recently undertaken by myself. Three thermometers sold by a well-known British firm at Is. 9d. each and two by a British private maker at 2s. 6d. each were shaken down below 950 and placed under the tongue in the usual way; all five were marked " 30 seconds." At the end of half a minute they read respectively 95’2°, 96°, 96’8°, 97°, and 97’4°. They were then incubated again for a full minute, and they then indicated 96°, 96’4°, 97’2°, 97’2, and 97’6°. They were
1432 for a further two minutes, after which June 30th to Sept 30th : Average acceptances, 1146; Total number of The visits, 136; attendances, 1164. four of them read 98’0° and one 97’6°. clear duty of every conscientious practitioner is persons who have seen me once or oftener since obvious-namely, to test every clinical thermometer April 15th, 601, or 50 per cent. of total on my list. I am, Sir, yours faithfully, he buys, in regard both to the accuracy of its . , CHAS. FRASER. and to taken in the time Nov. 1913. the 8th, Brighton, graduation reaching temperature of the surrounding medium. I am, Sir, yours faithfully, THE NATIONAL INSURANCE ACT AND PHYSICIAN. Nov. 8th, 1913. MEDICAL REFEREES. ’’:::’" These observations agree with the conclusions To the Editor of THE LANCET. published in our issue last week. We then wrote : " For really accurate observations the 30 seconds SIR,-At the recent meeting of the London thermometers give, generally speaking, more satis- Insurance Committee, of which a short report factory results when they are incubated for more appeared in THE LANCET of Nov. 1st, a recom. than 30 seconds, and according to the above experi- mendation of the General Purposes Subcommittee ments an incubation of a period of two minutes was considered which seems to me to raise queqtions of much importance. records the practical truth."-ED. L. The proposal was that the services of medical referees should be made available to ApprovedSocieties desiring advice (1) as to whether THE MEDICO-PSYCHOLOGICAL CLINIC. an insured person was incapacitated as a reTo the Editor of THE LANCET. sult of illness or injury which might entitle SIR,-It has been impossible to ignore the press him to receive or recover any compensation ornotices of the inaugural meeting of the Medico- wages under the Workmen’s Compensation Act,, Psychological Clinic. It is distressing to the com- 1906, or under the Employers’ Liability Act, 1880, mittee to find that a great deal of misunderstanding or otherwise as provided in Section 11 of the has arisen, and we feel bound in justice to ourselves, National Insurance Act, or (2) as to whether the to the pioneers of psychotherapy, and to the sup- insured person was suffering from a disease porters of our movement to dissociate ourselves caused by misconduct in respect of which sickness entirely and absolutely from the occult powers that benefit may be suspended under the provisions of Lord Sandwich claimed for himself. Lord Sandwich Section 14 (2) of the Act. It was further recomhas expressed his sincere regret to the committee mended that the expenditure involved could be met, for the misunderstanding he has caused, and this out of the sum of .B1000 authorised for the services terminates his association with the clinic and with of medical referees out of the Benefits Adminithe committee. stration Fund. We profess nothing but ordinary medical knowThe recommendation, I observe, met with oppoledge acquired in the ordinary way. We have no sition upon the committee, Mrs. Handel Booth gifts or methods not open to every practitioner. It moving that it should be referred back, but was. is our belief that the clinic will attract cases of accepted by a majority. It certainly appears to tend threatened nervous breakdown in a stage at which to impose upon medical referees duties outside preventive measures may avert calamity. It will those for the performance of which their appointoffer a place of study for medical practitioners who ment has appeared necessary and has been generwish to acquaint themselves with practical psycho- ally approved. Moreover, it seems to me that it therapy. The whole of the healing -art was cradled would bring them into unnecessary contact with in superstition. In the minds of many psycho- the Approved Societies and to constitute them therapy is still tinged with charlatanism, and from investigators of matters outside the expression this the clinic will help to dissociate it. of medical opinion upon questions of disease. We feel sure that the profession will appreciate As I understand the matter, the contract for to the full the difficulties and delicacy of the work medical attendance is between the medical we have in hand, the dangers to be avoided and and the Insurance Committee, and the man prejudices to be overcome, and we trust that it certificate given by the medical man should state will join with us in aiding a work which must of with accuracy the nature of the disease from which necessity be the object of adverse criticism and his patient suffers. It may be necessary or desirable unavoidable misconceptions in its early stages. that a medical referee should consider the accuracy We are, Sir, yours faithfully, of a statement as to the nature of a disease made in HECTOR MUNRO. a certificate, and it may also be necessary or desirJ. M. MURRAY. able that an Approved Society should be sure JOHN SPENCER. that its funds are not being depleted by a CONSTANCE E. LONG. person who, owing to the manner in which Endsleigh-street, W.C., Nov. 10th, 1913. his incapacity came about or his behaviour when under treatment, is not entitled to partake of them. It does not, however, follow that a medical referee THE NATIONAL INSURANCE ACT. should be employed to do more than make sure To the Editor of THE LANCET. that a medical certificate correctly states medical SIR,-The figures below are of some interest if they facts, where primâ facie there is ground for are like those of others practising amongst the suspicion that it does not do so. That the medical insured. The figures will doubtless expand during man attending a patient should have his attention the winter months, and I reckon the payment we called to the provisions of Section 11 or Section 14 receive will work out at barely Is. per professional (2) of the Act in respect of a particular case is not attendance-an inadequate sum. Total acceptances, unreasonable. But his explanation or opinion on April 15th, 1078; June 30th, 1136; average per the question involved should be specifically obtained quarter, 1107. For 1107 persons accepted for treat- before a medical referee should be invited to interment there were, visits, 187; attendances, 1261. vene, and the intervention of the medical referee
replaced
.-.
,
)
; ) ) )
a )
°
statements made is that the temperature of the body is accurately ascertained by leaving one of the thermometers under discussion in the mouth for a period of two minutes. Such a method only ascertains in an extremely rough manner the temperature of the body, for the thermometer is under totally dissimilar circumstances when in a glass of water to that in the cavity of the mouth. Various clinicians have pointed out the serious errors which arise from this rough and ready proceeding, and the paper in your journal would tend to perpetuate this inaccurate method. I have tried many thermometers (Kew certified), and if they require two minutes in water they need 1015 minutes in the mouth, unless the mouth has previously been kept closed in a warm room. MARY H. WILLIAMS. Malvern, Nov. 10th, 1913.
Has Dr. Williams noted that in our experiments the conditions of environment of both the standard thermometer and the clinical thermometers tested were precisely the same ? Any " dissimilar circumstances of the mouthwould apply equally to the standard thermometer.ED. L. ____
To the Editor
of THE LANCET.
SIR,-The letter from Dr. J. B. Cook which appeared in THE LANCET of Oct. 4th on the results obtained by testing a batch of clinical thermometers supplied under contract to the St. Giles’ Infirmary, Cleveland-street, together with that of Mr. F. A. Hocking a week later, convey a lesson to the medical profession which should be taken to heart. A proportion of medical men in practice do regularly test the clinical thermometers which they buy and use for their patients; but the majority, I strongly suspect, omit this simple but very necessary act of precaution. Now that attention has been drawn to the point by the letters in question, it may be hoped that practitioners will
THE ACCURACY OF CLINICAL THERMOMETERS. To the Editor
of THE LANCET.
SIR,-In your issue of Nov. 8th appears an article headed " Some Experiments with Clinical Thermometers." In this article an account is given of certain experiments with clinical thermometers, in which their accuracy is tested in regard to the variations they record when plunged into water of varying temperatures. Then follows the astounding statement " On the whole, the results show that for practical clinical purposes the thermometers gave fairly accurate readings." I beg to suggest that the results recorded are highly misleading as regards clinical work. The inference to be drawn from the
take rather more trouble over this matter than most of them have been in the habit of doing. They may urge that so long as they pay a reasonable price for their thermometers, and buy them from respectable firms, the chance of error is exceedingly slight. That may be and most likely is true; but it is not a sufficient defence, for the consequences of any serious error in the graduation of a clinical thermometer can be so serious as to make the difference between life and death. There is, in fact, reason to believe that Britishmade thermometers, manufactured and sold at prices some hundreds per cent. cheaper than prevailed a few years ago, are accurate and trustworthy in a very high degree. But all thermometers are not British made, and even with respect to those that are, there is one reservation which must be made. A great many of these so-called "half-minute"thermometers do not really give true readings in that short space of time, though they may be perfectly reliable after longer incubation. As an instance of this may be quoted the following experiments recently undertaken by myself. Three thermometers sold by a well-known British firm at Is. 9d. each and two by a British private maker at 2s. 6d. each were shaken down below 950 and placed under the tongue in the usual way; all five were marked " 30 seconds." At the end of half a minute they read respectively 95’2°, 96°, 96’8°, 97°, and 97’4°. They were then incubated again for a full minute, and they then indicated 96°, 96’4°, 97’2°, 97’2, and 97’6°. They were
1432 for a further two minutes, after which June 30th to Sept 30th : Average acceptances, 1146; Total number of The visits, 136; attendances, 1164. four of them read 98’0° and one 97’6°. clear duty of every conscientious practitioner is persons who have seen me once or oftener since obvious-namely, to test every clinical thermometer April 15th, 601, or 50 per cent. of total on my list. I am, Sir, yours faithfully, he buys, in regard both to the accuracy of its . , CHAS. FRASER. and to taken in the time Nov. 1913. the 8th, Brighton, graduation reaching temperature of the surrounding medium. I am, Sir, yours faithfully, THE NATIONAL INSURANCE ACT AND PHYSICIAN. Nov. 8th, 1913. MEDICAL REFEREES. ’’:::’" These observations agree with the conclusions To the Editor of THE LANCET. published in our issue last week. We then wrote : " For really accurate observations the 30 seconds SIR,-At the recent meeting of the London thermometers give, generally speaking, more satis- Insurance Committee, of which a short report factory results when they are incubated for more appeared in THE LANCET of Nov. 1st, a recom. than 30 seconds, and according to the above experi- mendation of the General Purposes Subcommittee ments an incubation of a period of two minutes was considered which seems to me to raise queqtions of much importance. records the practical truth."-ED. L. The proposal was that the services of medical referees should be made available to ApprovedSocieties desiring advice (1) as to whether THE MEDICO-PSYCHOLOGICAL CLINIC. an insured person was incapacitated as a reTo the Editor of THE LANCET. sult of illness or injury which might entitle SIR,-It has been impossible to ignore the press him to receive or recover any compensation ornotices of the inaugural meeting of the Medico- wages under the Workmen’s Compensation Act,, Psychological Clinic. It is distressing to the com- 1906, or under the Employers’ Liability Act, 1880, mittee to find that a great deal of misunderstanding or otherwise as provided in Section 11 of the has arisen, and we feel bound in justice to ourselves, National Insurance Act, or (2) as to whether the to the pioneers of psychotherapy, and to the sup- insured person was suffering from a disease porters of our movement to dissociate ourselves caused by misconduct in respect of which sickness entirely and absolutely from the occult powers that benefit may be suspended under the provisions of Lord Sandwich claimed for himself. Lord Sandwich Section 14 (2) of the Act. It was further recomhas expressed his sincere regret to the committee mended that the expenditure involved could be met, for the misunderstanding he has caused, and this out of the sum of .B1000 authorised for the services terminates his association with the clinic and with of medical referees out of the Benefits Adminithe committee. stration Fund. We profess nothing but ordinary medical knowThe recommendation, I observe, met with oppoledge acquired in the ordinary way. We have no sition upon the committee, Mrs. Handel Booth gifts or methods not open to every practitioner. It moving that it should be referred back, but was. is our belief that the clinic will attract cases of accepted by a majority. It certainly appears to tend threatened nervous breakdown in a stage at which to impose upon medical referees duties outside preventive measures may avert calamity. It will those for the performance of which their appointoffer a place of study for medical practitioners who ment has appeared necessary and has been generwish to acquaint themselves with practical psycho- ally approved. Moreover, it seems to me that it therapy. The whole of the healing -art was cradled would bring them into unnecessary contact with in superstition. In the minds of many psycho- the Approved Societies and to constitute them therapy is still tinged with charlatanism, and from investigators of matters outside the expression this the clinic will help to dissociate it. of medical opinion upon questions of disease. We feel sure that the profession will appreciate As I understand the matter, the contract for to the full the difficulties and delicacy of the work medical attendance is between the medical we have in hand, the dangers to be avoided and and the Insurance Committee, and the man prejudices to be overcome, and we trust that it certificate given by the medical man should state will join with us in aiding a work which must of with accuracy the nature of the disease from which necessity be the object of adverse criticism and his patient suffers. It may be necessary or desirable unavoidable misconceptions in its early stages. that a medical referee should consider the accuracy We are, Sir, yours faithfully, of a statement as to the nature of a disease made in HECTOR MUNRO. a certificate, and it may also be necessary or desirJ. M. MURRAY. able that an Approved Society should be sure JOHN SPENCER. that its funds are not being depleted by a CONSTANCE E. LONG. person who, owing to the manner in which Endsleigh-street, W.C., Nov. 10th, 1913. his incapacity came about or his behaviour when under treatment, is not entitled to partake of them. It does not, however, follow that a medical referee THE NATIONAL INSURANCE ACT. should be employed to do more than make sure To the Editor of THE LANCET. that a medical certificate correctly states medical SIR,-The figures below are of some interest if they facts, where primâ facie there is ground for are like those of others practising amongst the suspicion that it does not do so. That the medical insured. The figures will doubtless expand during man attending a patient should have his attention the winter months, and I reckon the payment we called to the provisions of Section 11 or Section 14 receive will work out at barely Is. per professional (2) of the Act in respect of a particular case is not attendance-an inadequate sum. Total acceptances, unreasonable. But his explanation or opinion on April 15th, 1078; June 30th, 1136; average per the question involved should be specifically obtained quarter, 1107. For 1107 persons accepted for treat- before a medical referee should be invited to interment there were, visits, 187; attendances, 1261. vene, and the intervention of the medical referee
replaced
.-.