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THE HORSLEY MEMORIAL.
988 that lobar
pneumonia will develop, and so on, but this arithmetical information will gratify nobody save a chimera identified by the cartoonist of the Daily JJlIirror with an official of the Ministry of Health. But if one collected statistics of " colds " upon a slightly different the results might be more rewarding. Do the plan 6 colds’’ of sedentary workers last longer than those of out-door workers? Ceteris pcc7ibws, does keeping the house answer better than going out ? Is it true that i 6 summer colds" are the most intractable? Is the mode of onset of a common " cold " of any importance Is in its prognosis as to severity and duration ? there a secular change of type in the common " cold " ?P These are all questions not of life and death, but of importance to health and happiness. It is difficult to see how they can be answered unless the numerical method brings into this humbler sphere that replacement of vague adjectives " by "exact numerical The common standards" of which Simon spoke. " cold " has been termed the opprobrium of the profession ; perhaps we have held our heads too high and dreamed too many bacteriological dreams, forgetting that the first word must be said before the last can be added. It will be urged that we all have very decided opinions, grounded on our individual experiences, as to how each of these questions could be answered. So had our predecessors upon the topics of urban and rural mortality, upon the increase or decline of phthisis. But yet, as Simon pointed out, it really did require a Farr and the numerical method to produce anything like unanimity of opinion upon these matters. The Odes of Horace are better reading than the remarks of Caesar on the Gallic wars, but it is well to read the Gallic wars before tackling Horace. No arithmetical averages, not even with their " probable errors " ground out to the last decimal and flanked with algebra of the most imposing unintelligibility, can be a substitute for the clinical researches of a Sir James Mackenzie ; but they may serve as steppingstones along a path which many have shunned and in which others have stumbled. The plain fact is that much the greater part of the clinical experience gained by each generation dies with its possessors. Much is in truth incommunicable; we profit very little, and can profit very little, from the mistakes of our fathers. But a residuum is communicable and has been lost because there has been no common medium of exchange. A
Ministry of Health
Geschichte der Medicin, vol. ii.,
THE organisation formed in November, 1920, to secure in permanent form the recognition of the life and work of Sir Victor Horsley has now published a third list of subscriptions, promised and received, as follows :Mr. L. H. S. Scott ................................. J. S. Risien Russell ........................ Dr. Janet E. Lane-C1aypon, Dr. Foster Kennedy (New York), Dr. Herbert Spencer, Dr. Charles Hamilton, Dr. G. G. Turner, Mr. Percy Flemming, Dr. N. S. Finzi, Sir William T. Lister, Mr. Bilton Pollard, Dr. L. Gordon Hopkins, Dr. J. H. Parsons, F.R.S., Dr. Dennis each Embleton each Mr. H. J. Spratt, Mr. Dr. Anonymous (per Dr. H. Batty Miss P. Whitaker, Professor T. R. Elliott, F.R.S., Dr. A. M. H. Grav, Dr. T. H. Ionides, Dr. G. E. Waugh, Dr. Amand Routh, Sir John Williams, Dr. R. H. Marten
Dr.
..............................
John Dilloy............... Shaw), Hyde Marriott,
each (Adelaide) Professor Winkler (Utrecht) Dr. E. D. Davis, Dr. Byrom Bramwell, Dr. E. Deanesly, Mr. W. Gifford Nash, Sir E. Sharpey Schafer, Dr. H. C. G. Semon, Dr. A. G. Phear, Sir John Tweedy, Dr. J. H. E. Brock, Dr. A. J. Blaxland, Dr. B. B. Gadgil, Dr. F. G. Penrose each Dr. Charles Brook, Professor W. W. Keen (Philadelphia), Dr. A. A. Lendon (Adelaide) .................. each Sir James Barr, Dr. J. J. Powell, Dr. Charles Smith, Dr. E. B. Ffennell, Miss Kirkaldy, Dr. Seymour Taylor, Dr. G. Hall, Dr. W. S. Sheldon, Dr. Howell Rees, Dr. D. Farnell, Dr. E. H. Young, Mr. E. A. Bullmore, SurgeonCommander C. B. Fairbank, Dr. W. H. Paine, Dr. J. S. H. Roberts, Dr. S. Williams, Dr. 0. P. Turner, Dr. C. D. Holdsworth, Dr. P. J. Le Riche, Dr. G. H. each Hunter Miss M.Breay, Miss M. 1.Longfield ............ each Miss M. Lord .................................... ..............................
.........
...........................
’
.................................
Mrs.Pitt ....................................... of Hydrophobia (per Mr. .............................. (perW.Dr.Fletcher) Society Muskens)Prevention .................................
ae s. d. 25 0 0 21 0 0
5 50 5 0 0
3 30 3 00
2
20
2 00
1 10 1 0 0 0 50 0 20
Dutch Branch of International League against Epilepsy
1
00
for the
F.
5 5 0
The total acknowledged in previous lists is JE606; these lists appeared in THE LANCET, 1921, Jan. lst, p. 46, and Feb. 19th, p. 407. Further subscriptions may be paid to either of the hon. treasurers, Sir Frederick Mott, K.B.E., Maudsley Neurological Hospital, Denmark Hill, S.E.5, and Dr. H. H. Tooth, C.B., C.M.G., 34, Harley-street, W.1, or to the hon. secretaries, Sir W. Arbuthnot Lane, Bart., C.B., 21, Cavendish-square, W.1, and Mr. Edward J.
Domville, O.B.E., Symondsbury, Bridport. URBAN VITAL STATISTICS. (Week ended April 30th, 1921.)
Scheme.
English and Welsh Towns.-In the 96 English and Welsh towns, with an aggregate population estimated at 18 million persons, the annual rate of mortality, which had been 12-5 in each of the three preceding weeks, was again 12-5 per 1000. In London, with a population of 0’5 per 4 million persons, the death-rate was 1000 below that recorded in the previous week, while among the remaining towns the rates ranged from 6’4 in Grimsby, 6’5 in Rhondda, and 7’3 in Northampton, to 19’4 in Barnsley, 20-4 in Oldham, and 21-8 in Dewsbury. The principal epidemic diseases caused 204 deaths, which corresponded to an annual rate of0’6 per 1000, and comprised 60 from infantile diarrhaea. 54 from whooping-cough, 40 from diphtheria, 33 from measles, 14 from scarlet fever, and 3 from enteric fever.
I
A few months ago a committee appointed by the Minister of Health projected a scheme by means of which it was intended to make the communicable experience of all available to all. With the question whether the details of this scheme were good, bad, or indifferent we have here no concern. But the manner in which it was criticised, the principles of the opposition to it, revealed, as we think, a strange ignorance of the history of our art and of the means by which it has been improved. The historical importance of such men as Sydenham and Huxham was due to their determination to describe and record objectively the facts of their experience. "He strove," said Haeser, in the most discerning criticism of the English Hippocrates which has been produced, " not to discover mysterious arcana, but by the attentive observation of diseases, especially of the commonest sorts, to discern the nature of changes at the back of them, their being (Wesen), and by means of knowledge thus won to discover how to treat them." 10 But without the stepping-stones, the aids to clear thinking, which arithmetic affords the physician just as it does the statesman, these efforts fail. The medical officer of to-day finds Graunt more intelligible and helpful than most clinicians find Sydenham. Arithmetic, or even algebra, is a bad master, but it is a good servant. When this truth has been realised, the question of medical records will appear in better perspective and the possibility of clinical research, not for the gifted few alone, but for all, will be admitted. 10
THE HORSLEY MEMORIAL.
p.
12’1, or
Measles caused a death-rate of 1’1 in Newcastle-on-Tyne, 1’2 in Gateshead, and 1-4 in Barrow-in-Furness. There were 3255 cases of scarlet fever, 2453 of diphtheria, and 1 of small-pox under treatment in the Metropolitan Asylums Hospitals and the London Fever Hospital, against 3307, 2564, and 0 respectively at the end of the previous week; the case of small-pox was admitted from Holborn. During the week ended April 23rd only 1 case of encephalitis lethargica belonging to Southwark was notified in the County of London. The causes of 27 of the 4460 deaths in the 96 towns were uncertified, of which 6 were registered in Birmingham and 3 in South Shields. Scottish Towns.-In the 16 largest Scottish towns, with an aggregate population estimated at nearly 2 million persons, the annual rate of mortality, which had been 15’1,14’6, and 14-6 in the three preceding weeks, rose to 15’0 per 1000. The 321 deaths in Glasgow corresponded to an annual rate of 15’2 per 1000, and included 30 from whooping-cough, 6 from infantile diarrhoea, 2 each from scarlet fever and diphtheria, and 1 from enteric fever. The 123 deaths in Edinburgh were equal to a rate of 14-4 per 1000, and included 3 from diphtheria, 2 from measles, and 1 from infantile diarrhoea.
pneumonia will develop, and so on, but this arithmetical information will gratify nobody save a chimera identified by the cartoonist of the Daily JJlIirror with an official of the Ministry of Health. But if one collected statistics of " colds " upon a slightly different the results might be more rewarding. Do the plan 6 colds’’ of sedentary workers last longer than those of out-door workers? Ceteris pcc7ibws, does keeping the house answer better than going out ? Is it true that i 6 summer colds" are the most intractable? Is the mode of onset of a common " cold " of any importance Is in its prognosis as to severity and duration ? there a secular change of type in the common " cold " ?P These are all questions not of life and death, but of importance to health and happiness. It is difficult to see how they can be answered unless the numerical method brings into this humbler sphere that replacement of vague adjectives " by "exact numerical The common standards" of which Simon spoke. " cold " has been termed the opprobrium of the profession ; perhaps we have held our heads too high and dreamed too many bacteriological dreams, forgetting that the first word must be said before the last can be added. It will be urged that we all have very decided opinions, grounded on our individual experiences, as to how each of these questions could be answered. So had our predecessors upon the topics of urban and rural mortality, upon the increase or decline of phthisis. But yet, as Simon pointed out, it really did require a Farr and the numerical method to produce anything like unanimity of opinion upon these matters. The Odes of Horace are better reading than the remarks of Caesar on the Gallic wars, but it is well to read the Gallic wars before tackling Horace. No arithmetical averages, not even with their " probable errors " ground out to the last decimal and flanked with algebra of the most imposing unintelligibility, can be a substitute for the clinical researches of a Sir James Mackenzie ; but they may serve as steppingstones along a path which many have shunned and in which others have stumbled. The plain fact is that much the greater part of the clinical experience gained by each generation dies with its possessors. Much is in truth incommunicable; we profit very little, and can profit very little, from the mistakes of our fathers. But a residuum is communicable and has been lost because there has been no common medium of exchange. A
Ministry of Health
Geschichte der Medicin, vol. ii.,
THE organisation formed in November, 1920, to secure in permanent form the recognition of the life and work of Sir Victor Horsley has now published a third list of subscriptions, promised and received, as follows :Mr. L. H. S. Scott ................................. J. S. Risien Russell ........................ Dr. Janet E. Lane-C1aypon, Dr. Foster Kennedy (New York), Dr. Herbert Spencer, Dr. Charles Hamilton, Dr. G. G. Turner, Mr. Percy Flemming, Dr. N. S. Finzi, Sir William T. Lister, Mr. Bilton Pollard, Dr. L. Gordon Hopkins, Dr. J. H. Parsons, F.R.S., Dr. Dennis each Embleton each Mr. H. J. Spratt, Mr. Dr. Anonymous (per Dr. H. Batty Miss P. Whitaker, Professor T. R. Elliott, F.R.S., Dr. A. M. H. Grav, Dr. T. H. Ionides, Dr. G. E. Waugh, Dr. Amand Routh, Sir John Williams, Dr. R. H. Marten
Dr.
..............................
John Dilloy............... Shaw), Hyde Marriott,
each (Adelaide) Professor Winkler (Utrecht) Dr. E. D. Davis, Dr. Byrom Bramwell, Dr. E. Deanesly, Mr. W. Gifford Nash, Sir E. Sharpey Schafer, Dr. H. C. G. Semon, Dr. A. G. Phear, Sir John Tweedy, Dr. J. H. E. Brock, Dr. A. J. Blaxland, Dr. B. B. Gadgil, Dr. F. G. Penrose each Dr. Charles Brook, Professor W. W. Keen (Philadelphia), Dr. A. A. Lendon (Adelaide) .................. each Sir James Barr, Dr. J. J. Powell, Dr. Charles Smith, Dr. E. B. Ffennell, Miss Kirkaldy, Dr. Seymour Taylor, Dr. G. Hall, Dr. W. S. Sheldon, Dr. Howell Rees, Dr. D. Farnell, Dr. E. H. Young, Mr. E. A. Bullmore, SurgeonCommander C. B. Fairbank, Dr. W. H. Paine, Dr. J. S. H. Roberts, Dr. S. Williams, Dr. 0. P. Turner, Dr. C. D. Holdsworth, Dr. P. J. Le Riche, Dr. G. H. each Hunter Miss M.Breay, Miss M. 1.Longfield ............ each Miss M. Lord .................................... ..............................
.........
...........................
’
.................................
Mrs.Pitt ....................................... of Hydrophobia (per Mr. .............................. (perW.Dr.Fletcher) Society Muskens)Prevention .................................
ae s. d. 25 0 0 21 0 0
5 50 5 0 0
3 30 3 00
2
20
2 00
1 10 1 0 0 0 50 0 20
Dutch Branch of International League against Epilepsy
1
00
for the
F.
5 5 0
The total acknowledged in previous lists is JE606; these lists appeared in THE LANCET, 1921, Jan. lst, p. 46, and Feb. 19th, p. 407. Further subscriptions may be paid to either of the hon. treasurers, Sir Frederick Mott, K.B.E., Maudsley Neurological Hospital, Denmark Hill, S.E.5, and Dr. H. H. Tooth, C.B., C.M.G., 34, Harley-street, W.1, or to the hon. secretaries, Sir W. Arbuthnot Lane, Bart., C.B., 21, Cavendish-square, W.1, and Mr. Edward J.
Domville, O.B.E., Symondsbury, Bridport. URBAN VITAL STATISTICS. (Week ended April 30th, 1921.)
Scheme.
English and Welsh Towns.-In the 96 English and Welsh towns, with an aggregate population estimated at 18 million persons, the annual rate of mortality, which had been 12-5 in each of the three preceding weeks, was again 12-5 per 1000. In London, with a population of 0’5 per 4 million persons, the death-rate was 1000 below that recorded in the previous week, while among the remaining towns the rates ranged from 6’4 in Grimsby, 6’5 in Rhondda, and 7’3 in Northampton, to 19’4 in Barnsley, 20-4 in Oldham, and 21-8 in Dewsbury. The principal epidemic diseases caused 204 deaths, which corresponded to an annual rate of0’6 per 1000, and comprised 60 from infantile diarrhaea. 54 from whooping-cough, 40 from diphtheria, 33 from measles, 14 from scarlet fever, and 3 from enteric fever.
I
A few months ago a committee appointed by the Minister of Health projected a scheme by means of which it was intended to make the communicable experience of all available to all. With the question whether the details of this scheme were good, bad, or indifferent we have here no concern. But the manner in which it was criticised, the principles of the opposition to it, revealed, as we think, a strange ignorance of the history of our art and of the means by which it has been improved. The historical importance of such men as Sydenham and Huxham was due to their determination to describe and record objectively the facts of their experience. "He strove," said Haeser, in the most discerning criticism of the English Hippocrates which has been produced, " not to discover mysterious arcana, but by the attentive observation of diseases, especially of the commonest sorts, to discern the nature of changes at the back of them, their being (Wesen), and by means of knowledge thus won to discover how to treat them." 10 But without the stepping-stones, the aids to clear thinking, which arithmetic affords the physician just as it does the statesman, these efforts fail. The medical officer of to-day finds Graunt more intelligible and helpful than most clinicians find Sydenham. Arithmetic, or even algebra, is a bad master, but it is a good servant. When this truth has been realised, the question of medical records will appear in better perspective and the possibility of clinical research, not for the gifted few alone, but for all, will be admitted. 10
THE HORSLEY MEMORIAL.
p.
12’1, or
Measles caused a death-rate of 1’1 in Newcastle-on-Tyne, 1’2 in Gateshead, and 1-4 in Barrow-in-Furness. There were 3255 cases of scarlet fever, 2453 of diphtheria, and 1 of small-pox under treatment in the Metropolitan Asylums Hospitals and the London Fever Hospital, against 3307, 2564, and 0 respectively at the end of the previous week; the case of small-pox was admitted from Holborn. During the week ended April 23rd only 1 case of encephalitis lethargica belonging to Southwark was notified in the County of London. The causes of 27 of the 4460 deaths in the 96 towns were uncertified, of which 6 were registered in Birmingham and 3 in South Shields. Scottish Towns.-In the 16 largest Scottish towns, with an aggregate population estimated at nearly 2 million persons, the annual rate of mortality, which had been 15’1,14’6, and 14-6 in the three preceding weeks, rose to 15’0 per 1000. The 321 deaths in Glasgow corresponded to an annual rate of 15’2 per 1000, and included 30 from whooping-cough, 6 from infantile diarrhoea, 2 each from scarlet fever and diphtheria, and 1 from enteric fever. The 123 deaths in Edinburgh were equal to a rate of 14-4 per 1000, and included 3 from diphtheria, 2 from measles, and 1 from infantile diarrhoea.