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THE VALUE OF OPSONIC DETERMINATIONS.
1571 without the consent of the Local Government Board. If the London County Council does not possess these powers it would presumably establish the school clinics under the Education (Administrative Provisions) Act of last session. This enables it to "attend to the health" of the children and this seems to sanction children’s hospitals with both in- and out-patient departments and a convalescent branch at the seaside; but these would require the consent of the central education authority. Would you kindly inform us if the above is correct, and if not what the law is? I am, Sirs, yours faithfully, J. S. Nov. 25th, 1907. is an Our interesting point. We correspondent’s *** referred last week to the powers of local authorities outside the metropolis to provide hospitals for the inhabitants of The Public Health (London) Act, 1891, their districts. confers similar powers on the London borough councils. In fact, the wording of the sections are practically identical. In the metropolis the hospitals for infectious diseases are under the control of the Metropolitan Asylums Board. Moreover, power is given by the Act of 1891 to the metropolitan asylum managers to allow any of their carriages with the necessary attendants to be used for the conveyance of persons suffering from a dangerous infectious disease to and . from hospitals and places other than hospitals provided by the managers and may make a reasonable charge for that use. The metropolitan asylum managers, subject to such regulations and restrictions as the Local Government Board prescribe, may admit any person who is not a pauper, and is reasonably believed to be suffering from fever or smallpox or diphtheria, into a hospital provided by the managers. The expenses incurred by the managers for the maintenance of any such person shall be paid by the board of guardians of the Poor-law union from which he is received. The said expenses shall be paid to the board of guardians out of the metropolitan common poor fund. Borough councils must, however, obtain the sanction of the Local Government Board for the erection of hospitals. The Act passed last session, termed the "Education (Administrative Provisions) Act," gives power to a county council to establish vacation schools and means of recreation, &c., and "to provide for the medical inspection of children immediately before, or at the time of, or as soon as possible after, their admission to a public elementary school, and on such other occasions as the Board of Education direct, and the power to make such arrangements as may be sanctioned by the Board of Education for attending to the health and physical condition of the children educated in public elementary schools. Provided that in any exercise of powers under this section the local education authority may encourage and assist the establishment or continuance of voluntary agencies and associate with itself representatives of voluntary associations for the purpose." Under these provisions we are of opinion that any county council may establish children’s hospitals and convalescent homes at the seaside provided they obtain the approval of the Board of Education. These powers could not, however, be exercised for the benefit of infants under school age, fox the words of the Act are immediately before or at the time of or as soon as possible after."-ED. L.
THE VALUE OF OPSONIC DETERMINATIONS.
Diseases (Vol. 1., No. 8, Cambridge, 1907). The results arrived at are not reassuring as to the value to be attached to opsonic determinations as usually carried out. The authors, Miss M. P. Fitz-Gerald, Dr. R. J. Whiteman, and Mr. T. S. P. Strangeways, give instances of the relatively enormous divergencies in the results obtained by the same observer working with different specimens of the same blood, as well as of the variations in results obtained by different workers with the same specimens. They further show that if leucocytes are counted by fifties on the same slide great divergencies will be found in the numbers of the organisms ingested. To give really trustworthy results not less than 1000 cells must be counted-an enormous addition to the already heavy burden imposed by the test. No doubt its upholders will have a reply to make to this serious onslaught on the use of the method and it is difficult to reconcile the findings here recorded with the favourable opinion hitherto formed as to the accuracy of opsonic estimations, supported as it is by the testimony of a large number of investigators whose good faith is unquestioned. It seems to be the fate of biological tests to find acceptance at first, which is succeeded by a stage of doubt and criticism ; after this again the true value of the procedure is recognised-a value lower, indeed, than was first claimed for it but yet not inconsiderable as an addition to other methods of investigation. The opsonic index will no doubt find its level" among other methods, just as Widal’s reaction and the tuberculin test have already done. I am, Sirs, yours faithfully,
Special
Nov. 25th, 1907.
F.R.C.S. ________________
CHOLERA IN
RUSSIA, TURKEY,
AND
PERSIA. (FROM
THE
BRITISH DELEGATE ON THE CONSTANTINOPLE BOARD OF HEALTH.)
SINCE the date of my last letter on this subject1 there has been a wide extension of the cholera epidemic through European and Asiatic Russia and in portions of Turkey and Persia adjoining the Russian frontiers. At the same time, however, as this enlargement of the infected area has occurred there has been a lessening of the intensity of the epidemic in places already infected, so that the weekly totals have, on the whole, progressively diminished. This is shown by the following figures : the total cases recorded in the whole of the Russian Empire in the week ending August 28th (Old Style) was 1007 ; in that ending Sept. 4tb,2 1163; in that ending Sept. llth, 911; in that ending Sept. 18th, 724 ; and in that ending Sept. 25th (Oct. 8th), 866. Since the beginning of the outbreak on July 3rd (16th) the total number of cases recorded down to Oct. 2nd (15th) was 8299 and that of deaths 3995. In the town of Samara, where it will be recalled cholera first broke out, the numbers of cases returned in the last four of the above five weeks were respectively 42, 30, 27, and 5; and of deaths 32, 18, 16, and 3. The totals from the beginning of the epidemic to Sept. 24th were given as 371 In the Samara government the cases cases and 191 deaths. in the five weeks numbered 66, 140, 81, 95, and 67, and the deaths 21, 73, 39, 47, and 15 ; the totals from the beginning to Sept. 24th being returned at 503 cases and 250 deaths. In the town of Saratof the returns in the five weeks in question were respectively 55 cases ’and 14 deaths, 37 cases and 20 deaths, 22 cases and 6 deaths, and 33 cases with 9 deaths. In Tsaritsyn in the last four of the five weeks the cases recorded numbered 158, 101, 56, and 21, and the deaths 79, 46, 26, and 11 respectively. In the Saratof government in the same five weeks there were recorded 231, 79, 54, 79, and 28 cases, with 131, 53, 23, 28, and 16 deaths. In the town of Astrakhan, in the last four of the five weeks the cases numbered 252, 88, 38, and 12, and the deaths 145, 44, 26, and 11. In the Arkhierei suburb and the Cossack stanitza of Ataman, both opposite the town of Astrakhan, the cases in the same weeks amounted to 48, 25, 8, and 7, while the deaths numbered 28, 15, 1, and 2. In the government of Astrakhan, in the five weeks the cases were returned as follows: 579, 139, 107, 54, and 24, and the deaths 380, 63, 39, 30, and 8. At Tcheliabinsk, the terminus of the Trans-Siberian railway, in the government of Orenburg, 4
To the Editors of THE LANCET. the SIRS,-That investigation of opsonic indices leaves room for the entrance of the personal equation, and that other sources of inaccuracy in the results obtained are difficult to avoid, must often have occurred to those who have employed the method or read of the investigations of others. A very careful series of observations made with the object of ascertaining the degree of accuracy attain1 THE LANCET, Oct. 19th, p. 1119. able in such work has been published in the August 2 Where not otherwise issue of the Bulletin of the Comntittee for the Study of according to the Old Style. indicated all the dates
mentioned
are
THE VALUE OF OPSONIC DETERMINATIONS.
Diseases (Vol. 1., No. 8, Cambridge, 1907). The results arrived at are not reassuring as to the value to be attached to opsonic determinations as usually carried out. The authors, Miss M. P. Fitz-Gerald, Dr. R. J. Whiteman, and Mr. T. S. P. Strangeways, give instances of the relatively enormous divergencies in the results obtained by the same observer working with different specimens of the same blood, as well as of the variations in results obtained by different workers with the same specimens. They further show that if leucocytes are counted by fifties on the same slide great divergencies will be found in the numbers of the organisms ingested. To give really trustworthy results not less than 1000 cells must be counted-an enormous addition to the already heavy burden imposed by the test. No doubt its upholders will have a reply to make to this serious onslaught on the use of the method and it is difficult to reconcile the findings here recorded with the favourable opinion hitherto formed as to the accuracy of opsonic estimations, supported as it is by the testimony of a large number of investigators whose good faith is unquestioned. It seems to be the fate of biological tests to find acceptance at first, which is succeeded by a stage of doubt and criticism ; after this again the true value of the procedure is recognised-a value lower, indeed, than was first claimed for it but yet not inconsiderable as an addition to other methods of investigation. The opsonic index will no doubt find its level" among other methods, just as Widal’s reaction and the tuberculin test have already done. I am, Sirs, yours faithfully,
Special
Nov. 25th, 1907.
F.R.C.S. ________________
CHOLERA IN
RUSSIA, TURKEY,
AND
PERSIA. (FROM
THE
BRITISH DELEGATE ON THE CONSTANTINOPLE BOARD OF HEALTH.)
SINCE the date of my last letter on this subject1 there has been a wide extension of the cholera epidemic through European and Asiatic Russia and in portions of Turkey and Persia adjoining the Russian frontiers. At the same time, however, as this enlargement of the infected area has occurred there has been a lessening of the intensity of the epidemic in places already infected, so that the weekly totals have, on the whole, progressively diminished. This is shown by the following figures : the total cases recorded in the whole of the Russian Empire in the week ending August 28th (Old Style) was 1007 ; in that ending Sept. 4tb,2 1163; in that ending Sept. llth, 911; in that ending Sept. 18th, 724 ; and in that ending Sept. 25th (Oct. 8th), 866. Since the beginning of the outbreak on July 3rd (16th) the total number of cases recorded down to Oct. 2nd (15th) was 8299 and that of deaths 3995. In the town of Samara, where it will be recalled cholera first broke out, the numbers of cases returned in the last four of the above five weeks were respectively 42, 30, 27, and 5; and of deaths 32, 18, 16, and 3. The totals from the beginning of the epidemic to Sept. 24th were given as 371 In the Samara government the cases cases and 191 deaths. in the five weeks numbered 66, 140, 81, 95, and 67, and the deaths 21, 73, 39, 47, and 15 ; the totals from the beginning to Sept. 24th being returned at 503 cases and 250 deaths. In the town of Saratof the returns in the five weeks in question were respectively 55 cases ’and 14 deaths, 37 cases and 20 deaths, 22 cases and 6 deaths, and 33 cases with 9 deaths. In Tsaritsyn in the last four of the five weeks the cases recorded numbered 158, 101, 56, and 21, and the deaths 79, 46, 26, and 11 respectively. In the Saratof government in the same five weeks there were recorded 231, 79, 54, 79, and 28 cases, with 131, 53, 23, 28, and 16 deaths. In the town of Astrakhan, in the last four of the five weeks the cases numbered 252, 88, 38, and 12, and the deaths 145, 44, 26, and 11. In the Arkhierei suburb and the Cossack stanitza of Ataman, both opposite the town of Astrakhan, the cases in the same weeks amounted to 48, 25, 8, and 7, while the deaths numbered 28, 15, 1, and 2. In the government of Astrakhan, in the five weeks the cases were returned as follows: 579, 139, 107, 54, and 24, and the deaths 380, 63, 39, 30, and 8. At Tcheliabinsk, the terminus of the Trans-Siberian railway, in the government of Orenburg, 4
To the Editors of THE LANCET. the SIRS,-That investigation of opsonic indices leaves room for the entrance of the personal equation, and that other sources of inaccuracy in the results obtained are difficult to avoid, must often have occurred to those who have employed the method or read of the investigations of others. A very careful series of observations made with the object of ascertaining the degree of accuracy attain1 THE LANCET, Oct. 19th, p. 1119. able in such work has been published in the August 2 Where not otherwise issue of the Bulletin of the Comntittee for the Study of according to the Old Style. indicated all the dates
mentioned
are