- Email: [email protected]
THE IMPERIAL VACCINATION LEAGUE.
1838
European disease " ; that (p. 138) " the specific theory more closely embraces the military data than any other and is thE only one which meets the requirements of the facts " ; thai evidence in support of this conclusion so far as India was concerned was not wanting ; and that (p. 193) the "chief
obstacle to the view of a derivation of the enteric fevei among the military from the civil population rests in a disbelief on the part of some, and a statement of denial on the part of a few, that this disease is one from which the natives of India suffer." Yet even at that time the susceptibility of the native (half-caste also) to the disease, both in his own country and when outside it, was beyond all doubt, the only questions open being the degree to which the disease prevailed, the modifications it possibly assumed, and the period of life during which it was mainly represented among them. It was on these points noted that according to the Annual Health Report of Calcutta for 1880 a considerable amount of fatal fever of a continued type existed among natives irrespective of race and that among children under one year of age there were many deaths from "a combination of fever and diarrhoea," and the suggestion was made that the reason why enteric fever was so seldom observed among adults coming under the notice of European medical men was that as in small-pox, so in this disease, an immunity had been purchased by The means of diagnosis of the an attack in early life. Indian fevers now available were not then existent and actual proof of the presence of enteric fever among natives as a common disease was not forthcoming and hence the continuance of doubt, but what was then wanting has now been fully supplied by the application Some years ago Surgeonof Widal’s test to the blood. Major Freyer of the Army Medical Service brought forward some results of the application of this method to the blood of adult natives in which the outcome of his observations suggested a prior attack of the disease as a possible and probable explanation, and the publication referred to in the early part of this letter may, I take it, be regarded as conclusive of the subject under consideration. Captain Rogers (p. 1504) writes : "The above brief summary is sufficient to prove that typhoid fever is a common continued fever of the natives of India and that it differs in no noteworthy respect from the same disease in Europeans in this country," and (p. 1508) "the so-called ’ non-malarial remittent’ fever in natives has been shown by the serum test to be nothing but typhoid fever." And the notice in the Army Medical Report, 1901 (p. 160), is : " It is now generally admitted not only that enteric fever does attack natives of India but that cases are by no means of such rare occurrence as was at one time supposed. At Kirkee seven natives were treated for the disease during the year in the native section of the station hospital, the diagnosis in each case being verified by Widal’s test. At Peshawur, during the time that enteric fever was most prevalent among the troops, there were several suspicious deaths from fevers in the Royal Artillery and Light Infantry Bazaars, and at Quetta cases resembling enteric fever occurred among natives just before the disease broke out in barracks. In the Barrackpore report the occurrence of enteric fever among the native population is put forward as an explanation of isolated cases among the troops." And, indeed, so far as the last sentence is concerned this is the view taken and enunciated by some of us for the last 20 years at least. Hence, then, the view taken by your reviewer of the Report of the Sanitary Commissioner with the Government of India for 1897 in THE LANCET of August 19th, 1899, p. 495, that, assuming enteric fever to be a parasitic disease, "the bacillus must be very widely distributed in India,"and to which I replied in a letter to you2 giving details tending to meet that requirement, is confirmed beyond all reasonable doubt, and now I presume that we may all settle down in the conviction that enteric fever, wherever met with and in whatever race, is one and the same disease and that, so far as the army is concerned, the source of its disease, putting aside occasional importation and occasional transfer in its own coterie, is everywhere the civil and native community of the country in which it is quartered, and that the means for its curtailment (the idea of elimination not being reasonable under the conditions which exist) are to be sought in the reduction of the very susceptible human material sent out to 2
THE
LANCET, Sept. 9th, 1899,
p. 739.
India and elsewhere and the safeguarding as far as possible communication between the native and sections.-I am, Sirs, yours faithfully, FRANCIS H. WELCH, Lee, June 15th, 1903. Surgeon-Colonel (retired), A.M.S.
military
of the lines of
---
THE IMPERIAL VACCINATION
LEAGUE.
To the -Editors of THE LANCET. SIRS,-The Imperial Vaccination League has now been in existence for a year. It has had in view two objects : first, to study the working of the Vaccination Act of 1898 in order to consider if in any way the Act or its administration can be improved and the opposition to vaccination diminished ; and, secondly, to press upon the attention of all classes of the community the immense value of vaccination and revaccination as a protection against epidemic smaLl-pox. The league has so far been mainly occupied in making a critical study of the Vaccination Act of 1898. As a result of this study it recommends the general compulsory revaccination of children before leaving school ; the extension of the conscience clause to revaccination as well as to primary vaccination ; the transference of the vaccination laws from the Poor-law to some other authority charged with public health functions ; that the same security of tenure be given to the public vaccinator as is now enjoyed by the vaccination officer ; and that all establishments for the preparation in England of calf lymph be placed under Government inspection or control. The league does not approach the subject of the administration of the Vaccination Act from the point of view of the interests of the medical profession or of the public vaccinators. It inquires only what will best promote vaccination among those sections of society now prejudiced against it. Should it appear on investigation that the cost of vaccination under the Act of 1898 has been in some cases unreasonably great the league would favour its being reduced. It believes it to be of the utmost importance that the medical profession should be moderate in its pecuniary demands, that nothing should be done to make martyrs of anti-vaccinationists, and that vaccination and revaccination should be efficient as well as
obligatory.
The league was formally constituted at a large and influential meeting of its members, over which the Duke of Northumberland presided, on Dec. 12th, 1902. On Jan. 14th,
deputation representing merchants, bankers, shiplarge employers of labour, municipal authorities, dockyard companies, heads of public schools and colleges, solicitors, insurance companies, sanitary authorities, the Royal Colleges of Physicians and Surgeons, wharfingers, traders, givers of concerts and influential persons generally, waited on the Right Hon. Walter Long, M.P., President 1903,
a
owners,
of the Local Government Board, to urge upon him the importance of making revaccination obligatory before the legal age for employment and of providing an adequate supply of
lymph available for all classes of the Many sheets of signatures of influential persons in support of obligatory revaccination were handed to Mr. Long by members of the deputation. The President, in. reply, urged the league to extend its work into the country, and especially to assist candidates at Parliamentary elections to meet the pressure put upon them by the opponents of vaccination. The league desires to act It has recently issued a paper upon Mr. Long’s advice. entitled, ’’ Ten Answers to Questions on the Subject of Vaccination for the Use of Parliamentary Candidates which can be had from the Secretary of the Imperial Vaccination League, 53, Berners street, London, W. A political secretary (Dr. Rees Roberts) has been appointed whose duty it will be to attend Parliamentary elections and glycerinated community.
calf
"
to form local committees in defence of vaccination.
For this extension of the work of the league an additional sum of ;2500 a year for three years will be required. The executive committee desires to find 100 friends who will each promise five guineas a year for three years, or a larger number who will make up the amount wanted in smaller sums. It is not probable that the effort to produce a Revaccination Act need last much more than three years. Such an Act can be passed within that time if the Government and the country desire it. If, on the other hand, people deliberately frequent epidemics of small-pox to vaccination they must have their own way and take the consequences. Meanwhile the league will do what is possible to convert the
prefer
1839 be given to the unfortunate sufferer that unless he desists from his work until he is no longer infectious his plight must be revealed to his employer-a threat, the legality of which is perhaps doubtful. Dr. French should ascertain the views of the hospital authorities. This is important.-ED. L.
other and more social views. Subscriptions or donations to the funds of the league may be sent by crossed cheque to the Secretary, Imperial Vaccination League, 53,
majority to
Berners-street, London, W., I am,
Sirs,
yours f-I
or
to
might
myself.
faithfully,
E. GARRETT ANDERSON, Honorary Secretary, Imperial Vaccination League.
4, Upper Berkeley-street, London, W., June 20th, 1903.
APPENDICITIS: A SUGGESTED REASON FOR ITS INCREASE.
BLOOD PRESSURE. To the Editors of THE LANCET. SIRS,-I have to thank your correspondent Dr. C. P. White, writing in THE LANCET of June 20th, p. 1767, for
To the Editors
THE LANCET.
of
SIRS,-The occurrence at the same time in one’s own " correction-the term "cubic" having unfortunately private practice of three cases of appendicitis, each demandoperation, is provocative of thought. Ten years ago cases crept into the type-written copy of my addressin con- ing nexion with millimetres of mercury pressure, that term of "perityphlitis"came under notice occasionally and a number of people were taken ill and died from "inbeing, as he says, the measure of volume. With regard certain to Dr. White’s reference to the diminution of the partial flammation of the bowels " or "acute peritonitis " in whom an appendicitis was probably at the root of the mischief. My pressure of the oxygen in the higher altitudes being possibly the cause of the rise in blood pressure, it may, I think, be an recollection is that such cases were rare and I do not at the Royal Infirmary, important factor in the background as it were ; but I am remember one appendicectomy of studentship, 1887-91. At, during my Liverpool, period to think that other are at work. concauses disposed My clusions were strictly limited to the data observed, which the present time appendicitis is about us on every hand. I reason for its sudden increase has yet to be shown. pointed to the proximate causes of the rise. I am satisfied The be to of the believe it to due do not evolution ; any process the effect of altitude is to lower the that primary arterial pressure and that in winter this effect is apparent same people are having appendicitis now who did not have in the medium altitudes ; but that in the higher altitudes it ten years ago. The cause, whatever it is, must be one other factors of causation step in which raise the pressure. affecting the mass of the people, rich and poor ; it must be It is possible, for instance, that temperature is one of these. common to all countries of high civilisation and big towns ;. The whole subject requires further investigation. When the it must be coincident with the increase in the disease. i The present conditions of food-supply and distribution may Yungfrau railway is extended to 13,366 feet a good opporthe key to the situation. Probably four-fifths of the tunity for this inquiry will be afforded, inasmuch as the give chief perishable comestibles are frozen or chilled for transwill the conditions rest of railway carriage provide important Chilled The interesting paper of Dr. mission or collection before reaching the consumer. and equable temperature. are Theodore Zangger in your issue of this week shows the or frozen meat, fish, poultry, rabbits, game, &c., prone to rapid decomposition when removed from necessity for such an inquiry and I am looking forward to an notoriously ; also, they degenerate more rapidly after cooking opportunity of doing further work in this direction. Dr. cold store unfrozen articles. Following the White mentions the increased pulse-rate in ballcon ascents argument it may be the ingestion of chilled or frozen food especially liable that to the is but of which 24,000 feet, may up height interesting, rapid decomposition may result in a more septic state of not the psychological element in ballooning somewhat impair the reliability of any conclusion as to the effect of altitude on the intestine than in the pre-cold storage days, and this greater septicity may in its turn account for the greater the pulse-rate ? virulence of those irritations to which the cæcum and I am, Sirs, yours faithfully, appendix have always been prone. GEORGE OLIVER, M.D., F.R.C.P. Lond. I am, Sirs, yours faithfully, Harrogate, June 20)th, 1903. S. KELLETT SMITH, F.R.C.S. Eng. Liverpool, June 22nd, 190;3. a
than to ,
SYPHILIS—A QUESTION OF PROCEDURE. To the Editors
of THE LANCET.
THE GENERAL MEDICAL COUNCIL AND SIRS,-I should very much like to know what is the THE ROYAL COLLEGES OF PHYproper course of procedure in the following case. SICIANS OF LONDON AND A patient is seen at the out-patient department of a hosSURGEONS OF with and is found to have ulcerapital secondary syphilis tions of tonsils, lips, &c. He states that he is a baker’s ENGLAND. assistant and that whilst not handling the dough he handles To the Editors of THE LANCET. the baked loaves just prior to their being sent out for consumption. On being told that he must not continue this work he of Dr. R. W. C. Pierce in THE LANCET letter SIRS,-The of June 20th, p. 1768, is interesting as evidence of a refuses, saying that he cannot afford to give up his "job." What course should I adopt ? 1. Should I write to his "reversal of policy " on the part of the Colleges. This is to employer ? If in this case he is dismissed, do I render be expected. The increasing number of universities in the myself liable for damages in a court of law ? 2. Should I provinces and the establishment of facilities for obtaining communicate with the medical officer of health of the medical degrees in London tend to diminish the demand for district? And if he is subsequently dismissed owing to this the Conjoint diploma, for no man will take a diploma when officer’s action, do I still render myself liable ? 3. Should I he has reasonable facilities for taking a degree, provided the take no notice and allow this filthy state of things to respective standards nearly approximate. It is on these continue ? grounds that the Colleges should, I submit, be merged intoI am, Sirs, yours faithfully, the University of London, for though the Colleges have J. GAY FRENCH, M.B. Lond., M.R.C.S. Eng., done good work in the past the days of the diploma are L.R.C.P. Lond. quickly passing by. June 22nd, 1903. I am, Sirs, yours faithfully, ’
.-
** 1. The employer cannot be written to without a breach of professional confidence. But the breach would, we think, be pardonable. It is a complete answer to any civil proceedings for libel or slander that the statement complained of is true, and to any criminal proceedings that it has been made in the public interest. 2. The medical officer of health might be communicated with but his power of interference is not evident to us as syphilis is not a notifiable disease. 3. We think that a distinct warning 1
THE LANCET, June 13th,
1903, p. 1643.
I
FREDK. W. COLLINGWOOD.
Brighton, June 20th, 1903.
MOLYNEUX’S PROBLEM. To the Editors of THE SIRS,-Dr.
a.
M.Ramsay
’s
report
LANCET. 01
une
case oi
a Man
Blind from
Congenital Gataract who- Acquired Sight after an Operation when he was 30 years of age, given in, THE LANCET of May 16th, p. 1364, is of extreme interest There is one point on which to students of psychology. further explanation would be welcomed. Dr. Ramsay says: " When asked to
distinguish
between
a
ball and
a
toy
.
European disease " ; that (p. 138) " the specific theory more closely embraces the military data than any other and is thE only one which meets the requirements of the facts " ; thai evidence in support of this conclusion so far as India was concerned was not wanting ; and that (p. 193) the "chief
obstacle to the view of a derivation of the enteric fevei among the military from the civil population rests in a disbelief on the part of some, and a statement of denial on the part of a few, that this disease is one from which the natives of India suffer." Yet even at that time the susceptibility of the native (half-caste also) to the disease, both in his own country and when outside it, was beyond all doubt, the only questions open being the degree to which the disease prevailed, the modifications it possibly assumed, and the period of life during which it was mainly represented among them. It was on these points noted that according to the Annual Health Report of Calcutta for 1880 a considerable amount of fatal fever of a continued type existed among natives irrespective of race and that among children under one year of age there were many deaths from "a combination of fever and diarrhoea," and the suggestion was made that the reason why enteric fever was so seldom observed among adults coming under the notice of European medical men was that as in small-pox, so in this disease, an immunity had been purchased by The means of diagnosis of the an attack in early life. Indian fevers now available were not then existent and actual proof of the presence of enteric fever among natives as a common disease was not forthcoming and hence the continuance of doubt, but what was then wanting has now been fully supplied by the application Some years ago Surgeonof Widal’s test to the blood. Major Freyer of the Army Medical Service brought forward some results of the application of this method to the blood of adult natives in which the outcome of his observations suggested a prior attack of the disease as a possible and probable explanation, and the publication referred to in the early part of this letter may, I take it, be regarded as conclusive of the subject under consideration. Captain Rogers (p. 1504) writes : "The above brief summary is sufficient to prove that typhoid fever is a common continued fever of the natives of India and that it differs in no noteworthy respect from the same disease in Europeans in this country," and (p. 1508) "the so-called ’ non-malarial remittent’ fever in natives has been shown by the serum test to be nothing but typhoid fever." And the notice in the Army Medical Report, 1901 (p. 160), is : " It is now generally admitted not only that enteric fever does attack natives of India but that cases are by no means of such rare occurrence as was at one time supposed. At Kirkee seven natives were treated for the disease during the year in the native section of the station hospital, the diagnosis in each case being verified by Widal’s test. At Peshawur, during the time that enteric fever was most prevalent among the troops, there were several suspicious deaths from fevers in the Royal Artillery and Light Infantry Bazaars, and at Quetta cases resembling enteric fever occurred among natives just before the disease broke out in barracks. In the Barrackpore report the occurrence of enteric fever among the native population is put forward as an explanation of isolated cases among the troops." And, indeed, so far as the last sentence is concerned this is the view taken and enunciated by some of us for the last 20 years at least. Hence, then, the view taken by your reviewer of the Report of the Sanitary Commissioner with the Government of India for 1897 in THE LANCET of August 19th, 1899, p. 495, that, assuming enteric fever to be a parasitic disease, "the bacillus must be very widely distributed in India,"and to which I replied in a letter to you2 giving details tending to meet that requirement, is confirmed beyond all reasonable doubt, and now I presume that we may all settle down in the conviction that enteric fever, wherever met with and in whatever race, is one and the same disease and that, so far as the army is concerned, the source of its disease, putting aside occasional importation and occasional transfer in its own coterie, is everywhere the civil and native community of the country in which it is quartered, and that the means for its curtailment (the idea of elimination not being reasonable under the conditions which exist) are to be sought in the reduction of the very susceptible human material sent out to 2
THE
LANCET, Sept. 9th, 1899,
p. 739.
India and elsewhere and the safeguarding as far as possible communication between the native and sections.-I am, Sirs, yours faithfully, FRANCIS H. WELCH, Lee, June 15th, 1903. Surgeon-Colonel (retired), A.M.S.
military
of the lines of
---
THE IMPERIAL VACCINATION
LEAGUE.
To the -Editors of THE LANCET. SIRS,-The Imperial Vaccination League has now been in existence for a year. It has had in view two objects : first, to study the working of the Vaccination Act of 1898 in order to consider if in any way the Act or its administration can be improved and the opposition to vaccination diminished ; and, secondly, to press upon the attention of all classes of the community the immense value of vaccination and revaccination as a protection against epidemic smaLl-pox. The league has so far been mainly occupied in making a critical study of the Vaccination Act of 1898. As a result of this study it recommends the general compulsory revaccination of children before leaving school ; the extension of the conscience clause to revaccination as well as to primary vaccination ; the transference of the vaccination laws from the Poor-law to some other authority charged with public health functions ; that the same security of tenure be given to the public vaccinator as is now enjoyed by the vaccination officer ; and that all establishments for the preparation in England of calf lymph be placed under Government inspection or control. The league does not approach the subject of the administration of the Vaccination Act from the point of view of the interests of the medical profession or of the public vaccinators. It inquires only what will best promote vaccination among those sections of society now prejudiced against it. Should it appear on investigation that the cost of vaccination under the Act of 1898 has been in some cases unreasonably great the league would favour its being reduced. It believes it to be of the utmost importance that the medical profession should be moderate in its pecuniary demands, that nothing should be done to make martyrs of anti-vaccinationists, and that vaccination and revaccination should be efficient as well as
obligatory.
The league was formally constituted at a large and influential meeting of its members, over which the Duke of Northumberland presided, on Dec. 12th, 1902. On Jan. 14th,
deputation representing merchants, bankers, shiplarge employers of labour, municipal authorities, dockyard companies, heads of public schools and colleges, solicitors, insurance companies, sanitary authorities, the Royal Colleges of Physicians and Surgeons, wharfingers, traders, givers of concerts and influential persons generally, waited on the Right Hon. Walter Long, M.P., President 1903,
a
owners,
of the Local Government Board, to urge upon him the importance of making revaccination obligatory before the legal age for employment and of providing an adequate supply of
lymph available for all classes of the Many sheets of signatures of influential persons in support of obligatory revaccination were handed to Mr. Long by members of the deputation. The President, in. reply, urged the league to extend its work into the country, and especially to assist candidates at Parliamentary elections to meet the pressure put upon them by the opponents of vaccination. The league desires to act It has recently issued a paper upon Mr. Long’s advice. entitled, ’’ Ten Answers to Questions on the Subject of Vaccination for the Use of Parliamentary Candidates which can be had from the Secretary of the Imperial Vaccination League, 53, Berners street, London, W. A political secretary (Dr. Rees Roberts) has been appointed whose duty it will be to attend Parliamentary elections and glycerinated community.
calf
"
to form local committees in defence of vaccination.
For this extension of the work of the league an additional sum of ;2500 a year for three years will be required. The executive committee desires to find 100 friends who will each promise five guineas a year for three years, or a larger number who will make up the amount wanted in smaller sums. It is not probable that the effort to produce a Revaccination Act need last much more than three years. Such an Act can be passed within that time if the Government and the country desire it. If, on the other hand, people deliberately frequent epidemics of small-pox to vaccination they must have their own way and take the consequences. Meanwhile the league will do what is possible to convert the
prefer
1839 be given to the unfortunate sufferer that unless he desists from his work until he is no longer infectious his plight must be revealed to his employer-a threat, the legality of which is perhaps doubtful. Dr. French should ascertain the views of the hospital authorities. This is important.-ED. L.
other and more social views. Subscriptions or donations to the funds of the league may be sent by crossed cheque to the Secretary, Imperial Vaccination League, 53,
majority to
Berners-street, London, W., I am,
Sirs,
yours f-I
or
to
might
myself.
faithfully,
E. GARRETT ANDERSON, Honorary Secretary, Imperial Vaccination League.
4, Upper Berkeley-street, London, W., June 20th, 1903.
APPENDICITIS: A SUGGESTED REASON FOR ITS INCREASE.
BLOOD PRESSURE. To the Editors of THE LANCET. SIRS,-I have to thank your correspondent Dr. C. P. White, writing in THE LANCET of June 20th, p. 1767, for
To the Editors
THE LANCET.
of
SIRS,-The occurrence at the same time in one’s own " correction-the term "cubic" having unfortunately private practice of three cases of appendicitis, each demandoperation, is provocative of thought. Ten years ago cases crept into the type-written copy of my addressin con- ing nexion with millimetres of mercury pressure, that term of "perityphlitis"came under notice occasionally and a number of people were taken ill and died from "inbeing, as he says, the measure of volume. With regard certain to Dr. White’s reference to the diminution of the partial flammation of the bowels " or "acute peritonitis " in whom an appendicitis was probably at the root of the mischief. My pressure of the oxygen in the higher altitudes being possibly the cause of the rise in blood pressure, it may, I think, be an recollection is that such cases were rare and I do not at the Royal Infirmary, important factor in the background as it were ; but I am remember one appendicectomy of studentship, 1887-91. At, during my Liverpool, period to think that other are at work. concauses disposed My clusions were strictly limited to the data observed, which the present time appendicitis is about us on every hand. I reason for its sudden increase has yet to be shown. pointed to the proximate causes of the rise. I am satisfied The be to of the believe it to due do not evolution ; any process the effect of altitude is to lower the that primary arterial pressure and that in winter this effect is apparent same people are having appendicitis now who did not have in the medium altitudes ; but that in the higher altitudes it ten years ago. The cause, whatever it is, must be one other factors of causation step in which raise the pressure. affecting the mass of the people, rich and poor ; it must be It is possible, for instance, that temperature is one of these. common to all countries of high civilisation and big towns ;. The whole subject requires further investigation. When the it must be coincident with the increase in the disease. i The present conditions of food-supply and distribution may Yungfrau railway is extended to 13,366 feet a good opporthe key to the situation. Probably four-fifths of the tunity for this inquiry will be afforded, inasmuch as the give chief perishable comestibles are frozen or chilled for transwill the conditions rest of railway carriage provide important Chilled The interesting paper of Dr. mission or collection before reaching the consumer. and equable temperature. are Theodore Zangger in your issue of this week shows the or frozen meat, fish, poultry, rabbits, game, &c., prone to rapid decomposition when removed from necessity for such an inquiry and I am looking forward to an notoriously ; also, they degenerate more rapidly after cooking opportunity of doing further work in this direction. Dr. cold store unfrozen articles. Following the White mentions the increased pulse-rate in ballcon ascents argument it may be the ingestion of chilled or frozen food especially liable that to the is but of which 24,000 feet, may up height interesting, rapid decomposition may result in a more septic state of not the psychological element in ballooning somewhat impair the reliability of any conclusion as to the effect of altitude on the intestine than in the pre-cold storage days, and this greater septicity may in its turn account for the greater the pulse-rate ? virulence of those irritations to which the cæcum and I am, Sirs, yours faithfully, appendix have always been prone. GEORGE OLIVER, M.D., F.R.C.P. Lond. I am, Sirs, yours faithfully, Harrogate, June 20)th, 1903. S. KELLETT SMITH, F.R.C.S. Eng. Liverpool, June 22nd, 190;3. a
than to ,
SYPHILIS—A QUESTION OF PROCEDURE. To the Editors
of THE LANCET.
THE GENERAL MEDICAL COUNCIL AND SIRS,-I should very much like to know what is the THE ROYAL COLLEGES OF PHYproper course of procedure in the following case. SICIANS OF LONDON AND A patient is seen at the out-patient department of a hosSURGEONS OF with and is found to have ulcerapital secondary syphilis tions of tonsils, lips, &c. He states that he is a baker’s ENGLAND. assistant and that whilst not handling the dough he handles To the Editors of THE LANCET. the baked loaves just prior to their being sent out for consumption. On being told that he must not continue this work he of Dr. R. W. C. Pierce in THE LANCET letter SIRS,-The of June 20th, p. 1768, is interesting as evidence of a refuses, saying that he cannot afford to give up his "job." What course should I adopt ? 1. Should I write to his "reversal of policy " on the part of the Colleges. This is to employer ? If in this case he is dismissed, do I render be expected. The increasing number of universities in the myself liable for damages in a court of law ? 2. Should I provinces and the establishment of facilities for obtaining communicate with the medical officer of health of the medical degrees in London tend to diminish the demand for district? And if he is subsequently dismissed owing to this the Conjoint diploma, for no man will take a diploma when officer’s action, do I still render myself liable ? 3. Should I he has reasonable facilities for taking a degree, provided the take no notice and allow this filthy state of things to respective standards nearly approximate. It is on these continue ? grounds that the Colleges should, I submit, be merged intoI am, Sirs, yours faithfully, the University of London, for though the Colleges have J. GAY FRENCH, M.B. Lond., M.R.C.S. Eng., done good work in the past the days of the diploma are L.R.C.P. Lond. quickly passing by. June 22nd, 1903. I am, Sirs, yours faithfully, ’
.-
** 1. The employer cannot be written to without a breach of professional confidence. But the breach would, we think, be pardonable. It is a complete answer to any civil proceedings for libel or slander that the statement complained of is true, and to any criminal proceedings that it has been made in the public interest. 2. The medical officer of health might be communicated with but his power of interference is not evident to us as syphilis is not a notifiable disease. 3. We think that a distinct warning 1
THE LANCET, June 13th,
1903, p. 1643.
I
FREDK. W. COLLINGWOOD.
Brighton, June 20th, 1903.
MOLYNEUX’S PROBLEM. To the Editors of THE SIRS,-Dr.
a.
M.Ramsay
’s
report
LANCET. 01
une
case oi
a Man
Blind from
Congenital Gataract who- Acquired Sight after an Operation when he was 30 years of age, given in, THE LANCET of May 16th, p. 1364, is of extreme interest There is one point on which to students of psychology. further explanation would be welcomed. Dr. Ramsay says: " When asked to
distinguish
between
a
ball and
a
toy
.