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THE ACUTE VULVITIS OF LITTLE GIRLS: IS IT GONORRHŒAL?
1115
Correspondence. "Audi alteram partem."
THE CRAFT OF SURGERY. To the Editor
of THE LANCET. his letter speaks of the craft
-
SIR,—Prof. Tonks in of surgery and no one is better able to view surgery in this light. Being a distinguished artist himself, and having had a medical training, he knows that operative surgery is an art that requires a good deal of craftsmanship in the handling of tools. The complete success of a surgical operation depends largely upon the experience, judgment, and dexterity of the operator and the facility with which it is carried out is a test of the operator’s skill. Some training in this manual aptitude is aimed at in the operative surgery classes of the medical schools, where the student is first taught the principles of the art as illustrated in the classical operations. The pupil, however, can only attain to a limited degree of efficiency, for the cadaver imposes none of the restrictions and complications of the living. What is so often neglected, however, is instruction in the correct use of the common tools of surgery such as the chisel, the gauge, and the osteotome. It is surprising how many who, having passed through the schools, hardly know how to use the chisel. It is true that considerable practice is necessary to enable one to put these tools to their finer uses as anyone knows who has had experience in working on human bone with its varying density of texture in different individuals. But some attempt might be made to teach students the intelligent use of these instruments. The easy handling of tools is a distinguishing feature of the best craftsmen. That fine surgeon Arthur Barker, used to commend to the initiate the sewing of old kid gloves as an excellent practice for bowel stitching. And there is a worldfamed surgeon abroad, almost unrivalled in the technique of a certain difficult type of bone surgery, whose skill is attributed to the fact that earlier in his career he was a considerable craftsman in wood. He is, of course, an extreme example of what can be attained by much practice with the implements of a r.ra.ft.
I
am.
Sir.
yours
faithfullv. A. ROCYN JONES.
of adult women, the persistence of the discharge is most intimately dependent upon the general health. With improvement in the general health, a discharge which may have been present for months will
suddenly
cease.
It would ease the situation, at present so distressing both for mothers and children, if the condition could be stated to be not venereal and not gonococcal. At present the position seems to me to be doubtful. I am, Sir, yours faithfully, H. CHARLES CAMERON.
** * S. C. L. writes that Dr. Wordley’s
case
has
in common with one in his experience, in which a woman, aged 21, contracted a moderately severe urethritis and cystitis three weeks after her marriage. The infection was proved to be due to the coliform bacillus, and in our correspondent’s view was an auto-infection dependent upon two factors : (1) the trauma of the initial coitus, and (2) an error of hygiene, the anus after defæcation being cleansed some
points
from the rectum towards the vagina, thus facilitating the infection of a part already made susceptible.ED. L. ______________
THE MEDICAL SICKNESS, ANNUITY, AND LIFE ASSURANCE SOCIETY, LIMITED. To the Editor
of
THE LANCET.
SIR,—One must assume that Dr. E. F. Thomas’s reply " in your issue of Nov. 9th to Mr. Bowdler Henry’s letter was not deliberately intended to mis"
lead, but he obscures the issue, and the statements he makes "
untrue.
are
directly attacked "
Not
one
any of the
of mv resolutions of
recommendations
the board. Neither can Mr. Steadman’s nomination for election by any stretch of the imagination be construed as an " attack " on the board’s recommendation that the retiring directors should be re-elected since he was nominated three weeks before the board made any recommendations at all. No, the board cannot make Mr. Steadman’s candidature the excuse for sending out proxies. After the notices calling the annual general meeting had been issued, the board sent out a request for proxies in order to defeat my resolution fixing an agelimit for directors, and thus to keep themselves in office. This is the ethical question referred to by Mr. Henry, and I submit that this action of the board is discreditable. I am,
Sir,
yours
faithfully, HARVEY HILLIARD.
THE ACUTE VULVITIS OF LITTLE GIRLS: IS IT GONORRHŒAL?
of THE LANCET. SIR,—The contribution by Dr. E. Wordley in your issue of Nov. 16th (p. 1035) raises once more the question of the gonococcal nature of the acute vulvitis of infants and little girls. Is the diplococcus found in the discharge veritably a gonococcus ? The astonishing rarity of ophthalmia as a complication is difficult to explain if virulent gonococci are present in the profuse discharge. That the discharge is To the Editor
infective and passes from one child to another is doubtless true, yet in my experience the frequency with which cases are detected varies directly with the energy with which the necessary examinations are made. For example, so long as the scare in the ward persists so long does the epidemic continue. It dies down only by the exhaustion of all concerned.
Many little girls are attending venereal departments of hospitals and undergoing prolonged local treatment. Some of them are gravely upset by the worry and anxiety of the whole business. Some lose weight, colour, and appetite, sleep badly, or have attacks of vomiting, entirely due to the nervous upset. Yet I have the feeling that like the leucorrheeal discharges
To the Editor
of THE LANCET.
SIR,—In reply to Dr. Thomas I should like to say that my remarks were merely the expression of a. spectator desiring to see fair play. As such, and in the absence of bitterness or hostile intent, they do not "
attack." I am not concerned per se constitute an with the board’s reception of Dr. Harvey Hilliard’s resolutions ; but I am concerned to see that any of us, all equal members in this Society, contesting a vacancy upon the board, shall be ensured an impartial attitude on the part of those fellow members, who, by election, constitute the board for the time being. Last year, when Mr. R. J. McNeill Love contested a vacancy, the retiring member was compelled by decision of the board-and, as I think, rightly soto send out his own proxies at his own expense. This year, under the shelter of a general proxy,, issued sometime after intimation had been given that there would be a contestant, the board—wrongly as I maintain-took the interests of the retiring members under its (official) protection, making their battle its battle. Thus, using the Society’s funds, they converted what should surely be a private contest into,
Correspondence. "Audi alteram partem."
THE CRAFT OF SURGERY. To the Editor
of THE LANCET. his letter speaks of the craft
-
SIR,—Prof. Tonks in of surgery and no one is better able to view surgery in this light. Being a distinguished artist himself, and having had a medical training, he knows that operative surgery is an art that requires a good deal of craftsmanship in the handling of tools. The complete success of a surgical operation depends largely upon the experience, judgment, and dexterity of the operator and the facility with which it is carried out is a test of the operator’s skill. Some training in this manual aptitude is aimed at in the operative surgery classes of the medical schools, where the student is first taught the principles of the art as illustrated in the classical operations. The pupil, however, can only attain to a limited degree of efficiency, for the cadaver imposes none of the restrictions and complications of the living. What is so often neglected, however, is instruction in the correct use of the common tools of surgery such as the chisel, the gauge, and the osteotome. It is surprising how many who, having passed through the schools, hardly know how to use the chisel. It is true that considerable practice is necessary to enable one to put these tools to their finer uses as anyone knows who has had experience in working on human bone with its varying density of texture in different individuals. But some attempt might be made to teach students the intelligent use of these instruments. The easy handling of tools is a distinguishing feature of the best craftsmen. That fine surgeon Arthur Barker, used to commend to the initiate the sewing of old kid gloves as an excellent practice for bowel stitching. And there is a worldfamed surgeon abroad, almost unrivalled in the technique of a certain difficult type of bone surgery, whose skill is attributed to the fact that earlier in his career he was a considerable craftsman in wood. He is, of course, an extreme example of what can be attained by much practice with the implements of a r.ra.ft.
I
am.
Sir.
yours
faithfullv. A. ROCYN JONES.
of adult women, the persistence of the discharge is most intimately dependent upon the general health. With improvement in the general health, a discharge which may have been present for months will
suddenly
cease.
It would ease the situation, at present so distressing both for mothers and children, if the condition could be stated to be not venereal and not gonococcal. At present the position seems to me to be doubtful. I am, Sir, yours faithfully, H. CHARLES CAMERON.
** * S. C. L. writes that Dr. Wordley’s
case
has
in common with one in his experience, in which a woman, aged 21, contracted a moderately severe urethritis and cystitis three weeks after her marriage. The infection was proved to be due to the coliform bacillus, and in our correspondent’s view was an auto-infection dependent upon two factors : (1) the trauma of the initial coitus, and (2) an error of hygiene, the anus after defæcation being cleansed some
points
from the rectum towards the vagina, thus facilitating the infection of a part already made susceptible.ED. L. ______________
THE MEDICAL SICKNESS, ANNUITY, AND LIFE ASSURANCE SOCIETY, LIMITED. To the Editor
of
THE LANCET.
SIR,—One must assume that Dr. E. F. Thomas’s reply " in your issue of Nov. 9th to Mr. Bowdler Henry’s letter was not deliberately intended to mis"
lead, but he obscures the issue, and the statements he makes "
untrue.
are
directly attacked "
Not
one
any of the
of mv resolutions of
recommendations
the board. Neither can Mr. Steadman’s nomination for election by any stretch of the imagination be construed as an " attack " on the board’s recommendation that the retiring directors should be re-elected since he was nominated three weeks before the board made any recommendations at all. No, the board cannot make Mr. Steadman’s candidature the excuse for sending out proxies. After the notices calling the annual general meeting had been issued, the board sent out a request for proxies in order to defeat my resolution fixing an agelimit for directors, and thus to keep themselves in office. This is the ethical question referred to by Mr. Henry, and I submit that this action of the board is discreditable. I am,
Sir,
yours
faithfully, HARVEY HILLIARD.
THE ACUTE VULVITIS OF LITTLE GIRLS: IS IT GONORRHŒAL?
of THE LANCET. SIR,—The contribution by Dr. E. Wordley in your issue of Nov. 16th (p. 1035) raises once more the question of the gonococcal nature of the acute vulvitis of infants and little girls. Is the diplococcus found in the discharge veritably a gonococcus ? The astonishing rarity of ophthalmia as a complication is difficult to explain if virulent gonococci are present in the profuse discharge. That the discharge is To the Editor
infective and passes from one child to another is doubtless true, yet in my experience the frequency with which cases are detected varies directly with the energy with which the necessary examinations are made. For example, so long as the scare in the ward persists so long does the epidemic continue. It dies down only by the exhaustion of all concerned.
Many little girls are attending venereal departments of hospitals and undergoing prolonged local treatment. Some of them are gravely upset by the worry and anxiety of the whole business. Some lose weight, colour, and appetite, sleep badly, or have attacks of vomiting, entirely due to the nervous upset. Yet I have the feeling that like the leucorrheeal discharges
To the Editor
of THE LANCET.
SIR,—In reply to Dr. Thomas I should like to say that my remarks were merely the expression of a. spectator desiring to see fair play. As such, and in the absence of bitterness or hostile intent, they do not "
attack." I am not concerned per se constitute an with the board’s reception of Dr. Harvey Hilliard’s resolutions ; but I am concerned to see that any of us, all equal members in this Society, contesting a vacancy upon the board, shall be ensured an impartial attitude on the part of those fellow members, who, by election, constitute the board for the time being. Last year, when Mr. R. J. McNeill Love contested a vacancy, the retiring member was compelled by decision of the board-and, as I think, rightly soto send out his own proxies at his own expense. This year, under the shelter of a general proxy,, issued sometime after intimation had been given that there would be a contestant, the board—wrongly as I maintain-took the interests of the retiring members under its (official) protection, making their battle its battle. Thus, using the Society’s funds, they converted what should surely be a private contest into,