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THE FORTHCOMING ISSUE OF THE MEDICAL DIRECTORY.
MILD OASES OF SMALL-POX.—"WORKHOUSE NURSING."
1079
ordinary infectious diseases are always worth portraynothing of the typical rashes of typhus fever, enteric fever, scarlet fever, measles, and rubella. Perhaps there might be added some of the rarer forms of diphtheria, witli membrane on the conjunctiva or on open wounds, or of the
6. Conclicding remarks.-That the scheme, as a whole, is based on right principles and is an honest attempt to remedy the defects will probably be granted, though whether the details are likely to effect the desired objects may be fairly doubted. The provision of brevet rank, charge pay for certain large hospitals (a tardy acknowledgment of the justice of the appeal made by some executive officers in India in the past without result), devolution of powers from the head office to the principal medical officers of corps and districts, provision of means of instruction in field medical duties at the headquarters of each army corps, and the relief of clerical work, all are of unquestionable value, though the separation of the medical officers of the Household Brigade from the corps can hardly be placed in the same category. Apparently the Netley School is doomed, though a substitute is provided in the proposed military hospital and Medical Staff College (Millbank ?). The scheme falls short of that of Lord Herbert in the lack of provision for sanitary means and supervision--a detail fully justifying the exception taken by Professor A. Ogston-and this is a strange omission in view of -the fact that the primary raison d’ être of the corps is not curative but preventive medicine, and of the repetition in this war of former experiences of the enormous preponderance of
ing,
to say
illustration of the rashes which sometimes follow of antitoxic serum. 1 venture to extend the scope of the original suggestion because I do not know of any similar atlas already existing for infectious diseases. If, however, there is one, perhaps you or one of your readers. will be so kind as to inform me. I am, Sirs, vours faithfullv, F. M. SANDWITH, M.D. Durh. Cairo, Oct. 1st, 1901. even an
injections
" THE
AFTER-COMING HEAD; PREVENTION OF ASPHYXIA." To the Editors
of THE LANCET.
SIRS,-In THE LANCET of Sept. 21st, p. 815, Dr. Edwin. Smith suggests the introduction of a catheter into the child’smouth in cases of breech presentation in which the headlis. delayed in delivery. In Barnes’s Obstetric Operations," second edition, 1871, page 198, it is stated: " You may sometimes get the tip of a finger in the child’s mouth, and drawing this down, whilst you lift up and draw back the perineum, you may enable air to enter the chest. In this way I havekept a child breathing for 10 minutes before the head was born. Another plan is to pass a catheter or other tube into the mouth so as to give by means of a kind of artificial trachea communication with the external air, or better still Richardson’s bellows." It will be seen, therefore, that this. line of treatment was advocated 30 years ago. ’’ There is. nothing new under the sun," not even in midwifery. I am, Sirs, yours faithfully, C. H. L. JOHNSTON, M.D., L.R.C.S., and L.M. Edin. St. John, New Brunswick, Oct. 3rd, 1901.
disease over war injuries in the curtailment of efliciency of armies in the field. How far the scheme will bring about a corps capable of efficiently performing the duties entrusted to it to the benefit of the army and State will depend on the spirit in which it is met by the service at large-especially the combatant branch-and the official heads, and on the degree to which free play is given for action by the army and medical regulations. As was well put by Major-General Sir Ian Hamilton : "Recollecting that it was but a framework its scientific possibilities in sympathetic hands would be understood. There would come the rub-the hands must be sympathetic and kindly, and not only the hands of the War Office but those of the Government of India." Just so ; the power residing in the Secretary of State for War and in the Commander-in-ChiefTHE FORTHCOMING ISSUE OF THE including under him the army sections under his influence and sway-to make or mar the scheme is beyond doubt, a MEDICAL DIRECTORY. fact fully attested by the action taken in the past ending To the Editors of THE LANCET. in the destruction of the Magna Charta of the Medical SiRS,--If you can spare a little space in the next issueDepartment, a Royal Warrant notwithstanding. And no one who has gone through the mill"will doubt the of THE LANCET we shall feel much obliged by your warning power of army regulations and orders to bring to nought your readers of the approaching publication of the Medical. the best devised schemes which clash with the views of the Directory for 1902. It is well known that the volume cannot military caste. The unfortunate feature in all such schemes, be accurate unless all the latest information is supplied to us including warrants, is that there is no guarantee for their by the profession and various secretaries of medical institu-observance. So far as this one is concerned the aspirant for tions, and as we are now about to make up for the press anyarmy medical service may fairly rely on his pay and on additions or alterations should be posted to us at once. the recognition of his professional attainments to the rank We are, Sirs. your obedient servants, of major, but in respect to provision of the means enabling J. & A. CHURCHILL. him to meet the requirements of the numerous examinations, 7, Great Marlborough-street, London, W., Oct. 12th, 1901. in respect to promotion to the higher grades through professional merit and scientific attainments, in respect to "A MEDICO-LEGAL SOCIETY." having full scope for the abilities he possesses and the desire to work, in respect to obtaining opportunities for scientific To the Editors of THE LANCET. pursuits, he is in the hands of others, and past experience, do SIRS,—I not, of course, know who "M.D., D.P.H." unfortunately, is a warning against undue sanguineness on may but I am quite with him and willing to become an be, such and other points. original member of a medico-legal society, and to help to. I am, Sirs, yours faithfully, promote such a society. FRANCIS H. WELCH, F.R.C.S. Eng., I am. Sirs. vours faithfullv. 1901. A.M.S. Lee, Oct. 14th, Surgeon-Colonel (retired), FRED. J. SMITH, Lecturer on Medical Jurisprudence, London Hospital. Oct. 13th, 1901.
I
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MILD CASES OF SMALL-POX. "WORKHOUSE NURSING." To th-e Editors of THE LANCET. SIRS,-1 am very glad to see by your leading article of some that Mr. 21st has that the Sept. Wynter Blyth SIRS,-By process of mental gymnastics Mr. F. R. suggested Metropolitan Asylums Board should publish illustrations of Humphreys has persuaded himself that in my last letter I actual cases of mild small-pox for the benefit of those represented Miss Twining as stating that her plan had been, practitioners who are unacquainted with the disease at sight. annexed by Mr. Humphreys. Would it not be a boon to students, teachers, and pracThe opinion there expressed is my own and not that of titioners generally if the medical officers of the Board Miss Twining and it has been deliberately formed after could be prevailed upon to issue a small series of similar reading her writings, kindly sent by her and published beforeillustrations? My experience of the early erythematous Mr. Humphreys thought fit to announce the plan as his own, and hasmorrhagic eruptions of small-pox is that they and my object in drawing attention to this will have been, are seldom recognised at their onset by physicians who have attained now that Miss Twining’s rights as the author of the not had special experience of a small-pox epidemic. In scheme have been established. Is not Mr. Humphreys. common with many others I learnt to diagnose chicken-pox fluttering on rather a lofty perch when he charges me with by studying the cases erroneously sent into a small-pox hos- "flagrant conduct" because I do not humbly withdraw my pital during a small-pox epidemic. The hæmorrhagic varieties formed opinions at his august bidding ? It is an unfortunate, To the Editors of THE LANCET.
’
1079
ordinary infectious diseases are always worth portraynothing of the typical rashes of typhus fever, enteric fever, scarlet fever, measles, and rubella. Perhaps there might be added some of the rarer forms of diphtheria, witli membrane on the conjunctiva or on open wounds, or of the
6. Conclicding remarks.-That the scheme, as a whole, is based on right principles and is an honest attempt to remedy the defects will probably be granted, though whether the details are likely to effect the desired objects may be fairly doubted. The provision of brevet rank, charge pay for certain large hospitals (a tardy acknowledgment of the justice of the appeal made by some executive officers in India in the past without result), devolution of powers from the head office to the principal medical officers of corps and districts, provision of means of instruction in field medical duties at the headquarters of each army corps, and the relief of clerical work, all are of unquestionable value, though the separation of the medical officers of the Household Brigade from the corps can hardly be placed in the same category. Apparently the Netley School is doomed, though a substitute is provided in the proposed military hospital and Medical Staff College (Millbank ?). The scheme falls short of that of Lord Herbert in the lack of provision for sanitary means and supervision--a detail fully justifying the exception taken by Professor A. Ogston-and this is a strange omission in view of -the fact that the primary raison d’ être of the corps is not curative but preventive medicine, and of the repetition in this war of former experiences of the enormous preponderance of
ing,
to say
illustration of the rashes which sometimes follow of antitoxic serum. 1 venture to extend the scope of the original suggestion because I do not know of any similar atlas already existing for infectious diseases. If, however, there is one, perhaps you or one of your readers. will be so kind as to inform me. I am, Sirs, vours faithfullv, F. M. SANDWITH, M.D. Durh. Cairo, Oct. 1st, 1901. even an
injections
" THE
AFTER-COMING HEAD; PREVENTION OF ASPHYXIA." To the Editors
of THE LANCET.
SIRS,-In THE LANCET of Sept. 21st, p. 815, Dr. Edwin. Smith suggests the introduction of a catheter into the child’smouth in cases of breech presentation in which the headlis. delayed in delivery. In Barnes’s Obstetric Operations," second edition, 1871, page 198, it is stated: " You may sometimes get the tip of a finger in the child’s mouth, and drawing this down, whilst you lift up and draw back the perineum, you may enable air to enter the chest. In this way I havekept a child breathing for 10 minutes before the head was born. Another plan is to pass a catheter or other tube into the mouth so as to give by means of a kind of artificial trachea communication with the external air, or better still Richardson’s bellows." It will be seen, therefore, that this. line of treatment was advocated 30 years ago. ’’ There is. nothing new under the sun," not even in midwifery. I am, Sirs, yours faithfully, C. H. L. JOHNSTON, M.D., L.R.C.S., and L.M. Edin. St. John, New Brunswick, Oct. 3rd, 1901.
disease over war injuries in the curtailment of efliciency of armies in the field. How far the scheme will bring about a corps capable of efficiently performing the duties entrusted to it to the benefit of the army and State will depend on the spirit in which it is met by the service at large-especially the combatant branch-and the official heads, and on the degree to which free play is given for action by the army and medical regulations. As was well put by Major-General Sir Ian Hamilton : "Recollecting that it was but a framework its scientific possibilities in sympathetic hands would be understood. There would come the rub-the hands must be sympathetic and kindly, and not only the hands of the War Office but those of the Government of India." Just so ; the power residing in the Secretary of State for War and in the Commander-in-ChiefTHE FORTHCOMING ISSUE OF THE including under him the army sections under his influence and sway-to make or mar the scheme is beyond doubt, a MEDICAL DIRECTORY. fact fully attested by the action taken in the past ending To the Editors of THE LANCET. in the destruction of the Magna Charta of the Medical SiRS,--If you can spare a little space in the next issueDepartment, a Royal Warrant notwithstanding. And no one who has gone through the mill"will doubt the of THE LANCET we shall feel much obliged by your warning power of army regulations and orders to bring to nought your readers of the approaching publication of the Medical. the best devised schemes which clash with the views of the Directory for 1902. It is well known that the volume cannot military caste. The unfortunate feature in all such schemes, be accurate unless all the latest information is supplied to us including warrants, is that there is no guarantee for their by the profession and various secretaries of medical institu-observance. So far as this one is concerned the aspirant for tions, and as we are now about to make up for the press anyarmy medical service may fairly rely on his pay and on additions or alterations should be posted to us at once. the recognition of his professional attainments to the rank We are, Sirs. your obedient servants, of major, but in respect to provision of the means enabling J. & A. CHURCHILL. him to meet the requirements of the numerous examinations, 7, Great Marlborough-street, London, W., Oct. 12th, 1901. in respect to promotion to the higher grades through professional merit and scientific attainments, in respect to "A MEDICO-LEGAL SOCIETY." having full scope for the abilities he possesses and the desire to work, in respect to obtaining opportunities for scientific To the Editors of THE LANCET. pursuits, he is in the hands of others, and past experience, do SIRS,—I not, of course, know who "M.D., D.P.H." unfortunately, is a warning against undue sanguineness on may but I am quite with him and willing to become an be, such and other points. original member of a medico-legal society, and to help to. I am, Sirs, yours faithfully, promote such a society. FRANCIS H. WELCH, F.R.C.S. Eng., I am. Sirs. vours faithfullv. 1901. A.M.S. Lee, Oct. 14th, Surgeon-Colonel (retired), FRED. J. SMITH, Lecturer on Medical Jurisprudence, London Hospital. Oct. 13th, 1901.
I
--
MILD CASES OF SMALL-POX. "WORKHOUSE NURSING." To th-e Editors of THE LANCET. SIRS,-1 am very glad to see by your leading article of some that Mr. 21st has that the Sept. Wynter Blyth SIRS,-By process of mental gymnastics Mr. F. R. suggested Metropolitan Asylums Board should publish illustrations of Humphreys has persuaded himself that in my last letter I actual cases of mild small-pox for the benefit of those represented Miss Twining as stating that her plan had been, practitioners who are unacquainted with the disease at sight. annexed by Mr. Humphreys. Would it not be a boon to students, teachers, and pracThe opinion there expressed is my own and not that of titioners generally if the medical officers of the Board Miss Twining and it has been deliberately formed after could be prevailed upon to issue a small series of similar reading her writings, kindly sent by her and published beforeillustrations? My experience of the early erythematous Mr. Humphreys thought fit to announce the plan as his own, and hasmorrhagic eruptions of small-pox is that they and my object in drawing attention to this will have been, are seldom recognised at their onset by physicians who have attained now that Miss Twining’s rights as the author of the not had special experience of a small-pox epidemic. In scheme have been established. Is not Mr. Humphreys. common with many others I learnt to diagnose chicken-pox fluttering on rather a lofty perch when he charges me with by studying the cases erroneously sent into a small-pox hos- "flagrant conduct" because I do not humbly withdraw my pital during a small-pox epidemic. The hæmorrhagic varieties formed opinions at his august bidding ? It is an unfortunate, To the Editors of THE LANCET.
’