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THE KING.
618
THE KING.
It was partly with a view to meeting this threatened majority of viruses, but our knowledge, especially of the latter, is very imperfect. Important features of situation that the British Pathologists Association disease such as the incubation period, infectivity, was formed two years ago. As a result of repreand immunity reactions can be paralleled in the two sentations from this Association the British Medical Association decided to constitute a consulting pathoclasses, though some minor differences have been logists group, which since its inception has been claimed in the behaviour of the antisera. The working to produce some practicable scheme for the adaptation of the agent to new species of animals provision of diagnostic facilities for insured persons. and plants by passage is a common feature of diseases It is regarded as inevitable that the charges should which are due to viruses, bacteria, or protozoa. It fall for the time being at any rate upon the patients has been possible to secure the multiplication of the receiving the benefit of the service-that is to say, viruses of certain diseases (vaccinia, Rous sarcoma) the patient pays the laboratory fees through his Although it is essential for fees to in cultures of living tissue in vitro, but this cannot be practitioner. be kept low, the group sees grave dangers in throwevidence of life. independent accepted as conclusive ing such work open to free competition, with the Research with unseen and uncultivated viruses is a possibility of fee-cutting and lowered standard of work very different thing to dealing with bacteria or It has therefore drawn up a schedule of minimprotozoa. Every determination of the presence, fees for the ordinary laboratory procedures of genera" potency, or increase of a virus must be made by tests use in clinical medicine. These fees have been calm for infectivity. The investigation of virus diseases lated on a basis of time and laboratory costs and :,of plants is in some ways still more complicated than designed to provide a reasonable remuneration t: when animals are concerned. Many plant viruses laboratory performing such work at full pressl-1fir A list ME>- booÍf compiled of pathologists in charger can only be transmitted by grafting and the proof suitable laboratories who are to undertake k that a plant is, or is not, a healthy carrier must be work at the standard rate ofwilling fees. The country . obtained by grafting it on a susceptible stock. The been divided into convenient areas, and insura ’ recent advances in ultra-microscopic photography committees will, if the scheme is adopted by the applied to the study of viruses have not yet reached representativemeeting at Manchester in July, a point where they can give practical assistance. On notified of the pathologists within their area willi The scheme as it stand the whole the evidence and balance of opinion, to undertake this work. will be of undoubted assistance to panel practitioners no means in favour of the are unanimous, though by but it suffers from the grave drawback of beinit view that most viruses are living agents, but on dependent upon the insured patient, who account of their peculiar qualities an irrefragable financially for the most part is not yet educated to spend money proof seems to be unattainable by existing methods. on mere diagnosis. Accordingly the volume of work ’
-
.
under the scheme at the outset may not be great Such a service is, however, badly needed, and whe. funds can be found for its administration as part o’ medical benefit under the Insurance Acts the existence ’ of a working scheme should save much trouble.
Annotations. "
Ne quid nimis."
THE THE KING.
WE published in THE LANCET of March 9th the official bulletin issued from Craigweil House on March 2nd. Another bulletin was issued from the same residence in the evening of Saturday, March 16th, " His Majesty the King is steadily, though as follows : slowly, regaining health. In strength, vigour, and appearance improvement is definite. The weather is restricting the opportunities for going outside the house. The ray therapy is being continued." The bulletin was signed by Sir Stanley Hewett and Lord Dawson of Penn. ____
A LABORATORY SERVICE PERSONS.
FOR
INSURED
THE fact that while money can be found for almost any sort of treatment for insured patients none is available for diagnosis has long been recognised as one of the most serious deficiencies of the National Heath Insurance Acts. The necessity for a laboratory
diagnostic service was recognised by the Royal Commission of 1924-26, and the demand for such a service has been graving in strength ever since, but on the plea of lack of funds the Government has taken no steps in the matter. Meanwhile various insurance committees have attempted to make such service available for patients under their charge. Their schemes have differed widely ; some have been of such a nature as to throw upon the rates a charge which ought to fall upon insurance funds, others have depended upon arrangements between insurance committees and voluntary hospitals of a type which
PREVALENCE OF APPENDICITIS.
opinions on the incidence of appendinon-European races that Dr. Elsa Uhlenhuth,l of the Tubingen School of Tropical Medicine, has made a special study of the literature in the hope of getting at the facts. The general So various citis among
are
impression is that native races suffer little from appendicitis, but Dr. Uhlenhuth is not sure that this is correct. The greatest mass of information comes from China, where it is the most experienced physician that reports most cases. Many do not come to notice, the Chinaman being slow to consult the foreign doctor, especially for abdominal trouble, for which these " foreign devils " are apt either to prescribe a
starvation diet, very unpleasant to a Chinese, or an operation whose outcome is uncertain. The patient, .therefore, trusts himself to his domestic remedies, notably opium, which at worst gives him the painless death which he prefers to a life of discomfort. Dr. Uhlenhuth notes that the reports consulted are seldom statistical; rarely does the reporter state what he means by " few " or " many." Much is said about diet being the cause of the disease, but little exact information is given about the diet concerned. There are some who say appendicitis is rare in nonEuropeans by reason of the different anatomy of their appendix, but no such difference has been proved. The conclusion reached from this survey is that while appendicitis occurs in all races of men of whom we
have
information, although
few
figures
are
available to show relative frequency, it does seem to be less common in Indians than in English people living in India ; also few cases have been reported from Africa. To provide a standard we may say that under the Act of 1928 became ultra vires. There in the years 1924-26, among an average of 290,000 seemed, indeed, to be a risk of the establishment of a men in the Army and the Navy, case-rate per 1000 series of totally unrelated schemes, without proper was as follows : (1) In the Army : officers, at home 9, supervision, some of them illegal and the result being 1 Arch. für Schiffs- u. Tropen-Hygiene, 1929, xxxiii., 105. chaos. ’
THE KING.
It was partly with a view to meeting this threatened majority of viruses, but our knowledge, especially of the latter, is very imperfect. Important features of situation that the British Pathologists Association disease such as the incubation period, infectivity, was formed two years ago. As a result of repreand immunity reactions can be paralleled in the two sentations from this Association the British Medical Association decided to constitute a consulting pathoclasses, though some minor differences have been logists group, which since its inception has been claimed in the behaviour of the antisera. The working to produce some practicable scheme for the adaptation of the agent to new species of animals provision of diagnostic facilities for insured persons. and plants by passage is a common feature of diseases It is regarded as inevitable that the charges should which are due to viruses, bacteria, or protozoa. It fall for the time being at any rate upon the patients has been possible to secure the multiplication of the receiving the benefit of the service-that is to say, viruses of certain diseases (vaccinia, Rous sarcoma) the patient pays the laboratory fees through his Although it is essential for fees to in cultures of living tissue in vitro, but this cannot be practitioner. be kept low, the group sees grave dangers in throwevidence of life. independent accepted as conclusive ing such work open to free competition, with the Research with unseen and uncultivated viruses is a possibility of fee-cutting and lowered standard of work very different thing to dealing with bacteria or It has therefore drawn up a schedule of minimprotozoa. Every determination of the presence, fees for the ordinary laboratory procedures of genera" potency, or increase of a virus must be made by tests use in clinical medicine. These fees have been calm for infectivity. The investigation of virus diseases lated on a basis of time and laboratory costs and :,of plants is in some ways still more complicated than designed to provide a reasonable remuneration t: when animals are concerned. Many plant viruses laboratory performing such work at full pressl-1fir A list ME>- booÍf compiled of pathologists in charger can only be transmitted by grafting and the proof suitable laboratories who are to undertake k that a plant is, or is not, a healthy carrier must be work at the standard rate ofwilling fees. The country . obtained by grafting it on a susceptible stock. The been divided into convenient areas, and insura ’ recent advances in ultra-microscopic photography committees will, if the scheme is adopted by the applied to the study of viruses have not yet reached representativemeeting at Manchester in July, a point where they can give practical assistance. On notified of the pathologists within their area willi The scheme as it stand the whole the evidence and balance of opinion, to undertake this work. will be of undoubted assistance to panel practitioners no means in favour of the are unanimous, though by but it suffers from the grave drawback of beinit view that most viruses are living agents, but on dependent upon the insured patient, who account of their peculiar qualities an irrefragable financially for the most part is not yet educated to spend money proof seems to be unattainable by existing methods. on mere diagnosis. Accordingly the volume of work ’
-
.
under the scheme at the outset may not be great Such a service is, however, badly needed, and whe. funds can be found for its administration as part o’ medical benefit under the Insurance Acts the existence ’ of a working scheme should save much trouble.
Annotations. "
Ne quid nimis."
THE THE KING.
WE published in THE LANCET of March 9th the official bulletin issued from Craigweil House on March 2nd. Another bulletin was issued from the same residence in the evening of Saturday, March 16th, " His Majesty the King is steadily, though as follows : slowly, regaining health. In strength, vigour, and appearance improvement is definite. The weather is restricting the opportunities for going outside the house. The ray therapy is being continued." The bulletin was signed by Sir Stanley Hewett and Lord Dawson of Penn. ____
A LABORATORY SERVICE PERSONS.
FOR
INSURED
THE fact that while money can be found for almost any sort of treatment for insured patients none is available for diagnosis has long been recognised as one of the most serious deficiencies of the National Heath Insurance Acts. The necessity for a laboratory
diagnostic service was recognised by the Royal Commission of 1924-26, and the demand for such a service has been graving in strength ever since, but on the plea of lack of funds the Government has taken no steps in the matter. Meanwhile various insurance committees have attempted to make such service available for patients under their charge. Their schemes have differed widely ; some have been of such a nature as to throw upon the rates a charge which ought to fall upon insurance funds, others have depended upon arrangements between insurance committees and voluntary hospitals of a type which
PREVALENCE OF APPENDICITIS.
opinions on the incidence of appendinon-European races that Dr. Elsa Uhlenhuth,l of the Tubingen School of Tropical Medicine, has made a special study of the literature in the hope of getting at the facts. The general So various citis among
are
impression is that native races suffer little from appendicitis, but Dr. Uhlenhuth is not sure that this is correct. The greatest mass of information comes from China, where it is the most experienced physician that reports most cases. Many do not come to notice, the Chinaman being slow to consult the foreign doctor, especially for abdominal trouble, for which these " foreign devils " are apt either to prescribe a
starvation diet, very unpleasant to a Chinese, or an operation whose outcome is uncertain. The patient, .therefore, trusts himself to his domestic remedies, notably opium, which at worst gives him the painless death which he prefers to a life of discomfort. Dr. Uhlenhuth notes that the reports consulted are seldom statistical; rarely does the reporter state what he means by " few " or " many." Much is said about diet being the cause of the disease, but little exact information is given about the diet concerned. There are some who say appendicitis is rare in nonEuropeans by reason of the different anatomy of their appendix, but no such difference has been proved. The conclusion reached from this survey is that while appendicitis occurs in all races of men of whom we
have
information, although
few
figures
are
available to show relative frequency, it does seem to be less common in Indians than in English people living in India ; also few cases have been reported from Africa. To provide a standard we may say that under the Act of 1928 became ultra vires. There in the years 1924-26, among an average of 290,000 seemed, indeed, to be a risk of the establishment of a men in the Army and the Navy, case-rate per 1000 series of totally unrelated schemes, without proper was as follows : (1) In the Army : officers, at home 9, supervision, some of them illegal and the result being 1 Arch. für Schiffs- u. Tropen-Hygiene, 1929, xxxiii., 105. chaos. ’