- Email: [email protected]
TOURS TO RUSSIA IN 1932.
700 if an exquisitely painful point is found on palpation, it should be chosen as the site of the injection. If, on the other hand, there is diffuse pain, peri-articular infiltration should be extensive. From 10 to 25 c.cm. of a 1 per cent. solution of novocain (without adrenalin) are needed for each injection which may be repeated daily until recovery is complete.
to Dr. Charles Buizard, on the occasion of his promotion to the rank of Officer of the Legion of Honour. Dr. Buizard is the popular general secretary to the
Surgeon’s Society of Paris, and it is believed that many of his colleagues and friends in other countries will be glad of the opportunity to contribute to the cost of the medal, which will be designed by the well-known
A committee has been formed to collect subscriptions for the purpose of presenting a bronze medal
artist, Mr. Turin.
be sent to MM. G. Doin and Paris (6).
Subscriptions should Co., 8, place de l’Odéon,
CORRESPONDENCE physical
attain middle age, and 50; and I assumed as To the Editor of THE LANCFT. ;the meaning of athlete that meaning which I believe Ito be in universal SIR,-Public attention is being drawn to a acceptance. It now appears that which has long been of concern to the medical pro- Prof. Plesch is referring to pathological subjects and fession. Many troubles arise in marriage that could to occupations which carry with them certain hazarhave been prevented by fuller knowledge. Some of dous associations-e.g., copper-mining. That " big these can be dealt with by a layman with special persons of excessive weight and height show a greater " experience of marriage problems, whilst others areI mortality than smaller persops is surely an observaof a definitely medical nature which, if brought to tion which will attract no contradiction. He instances light at an early stage and directed to the right the excessive mortality of 50 per cent. for stage medical authority, would respond promptly to treat- acrobats which I am quite prepared to believe; but ment. Many marry with so little knowledge of its as regards the question under consideration one physiology that their future happiness is imperilled, might as well draw conclusions about the malevolent for until recently such questions as the sex education physiological effects of high altitudes from the of children and adolescents havereceived scant mortality-rate in parachute testers. The physical attention. element in their lives may be trifling compared with Recognising this fact for the last year, the British the nervous strain inseparable from the dangers. Social Hygiene Council has enlisted the help of a Furthermore, the psychical disturbances of a somecommittee of experts in order that a handbook on what precarious occupation with the anxieties preparation for marriage might be available. This attending unemployment and the hardships which work is shortly to be published by Messrs. Jonathan necessarily result, have to be taken into consideration Cape. together with the possible influence of syphilis and But valuable though a book of this nature will of over-indulgence in alcohol and tobacco. undoubtedly be, there is no doubt that in many Prof. Plesch reiterates that the sharp rise of cases it is a personal consultation on an individual maximal blood pressure during work is certainly not problem that is required. In order to meet this without effect on the blood-vessels. It must be very need, Mrs. Neville Rolfe, the Secretary-General of difficult to assess the extent of any disadvantageous the British Social Hygiene Council and also of the effect upon a healthy vessel. As a modest contricommittee for the preparation of this handbook, has bution to the problem I have to offer the examination been asked to establish a Personal Problems Bureau. of the radial arteries of three subjects with physical This enterprise will be run on an economically self- experiences which may be germane to the issue. supporting basis with the full support and approval The first, a man of 44, has indulged in violent exercise of the Council. Consultations will be by interview The second, (running) regularly for 27 years. and letter, for which it is proposed to charge a fee aged 41, has been engaged in boat for nearly racing of 92 2s. for a personal consultation in London, and 20 14 The third, aged 42, following years of years. 1Is. by correspondence. To all cases requiring little exercise after athletics, took competitive very medical assistance a list of authorities in the special the age of 32. Sections of their radial arteries have field will be given to the client for submission to her been pronounced as free from any pathological medical adviser. change by histologists whose judgment is beyond A private consulting room in Prince’s Gate has been question. For obvious reasons it is impossible to secured. , collect a large number of subjects for such investigavVe are. Sir. vours faithfullv. I tion, and I must risk the criticism that these will be KENNETH WALKER, discredited or deprecated as "exceptional.’’ THE PROBLEMS OF MARRIAGE.
that
effort when
they
most of them die before
subject
I
I
I
A. H.
HARKNESS,
I am, Sir, yours
Honorary Medical Secretaries, British Social Hygiene Council. March 16th, 1932. London, S.W.,
ARTERIAL ATONY AND ARTERIO-SCLEROSIS To the ;dito-r of THE LANCET.
faithfully, ADOLPHE ABRAHAMS.
Brook-street, W., March 19th,
1932.
TOURS TO RUSSIA IN 1932.
To the Editor of THE LANCET. SiR,-In 1931 the Society for Cultural Relations SiR,—I greatly appreciate Prof. Plesch’s courteous i endeavour to reconcile my objections to his original I, arranged two tours in 1T.S.S.R. to enable scientists statements ; but in so doing he appears to me to and doctors to see the present activities in science and introduce an elasticity of terminology which tran- medicine ; 62 scientists and doctors, including several scends reasonableness. I demurred to his assertions eminent specialists, joined these tours. The Society that athletes show marked calcification by the age proposes to organise similar tours in 1932 but with a of 35 or 40 ; that they are seldom capable of greatI wider scope of scientific interests and subjects.
I
701 It hopes to arrange parties for physical, biological, and agricultural scientists, engineers, chemists, medical doctors, and anthropologists. The parties will be limited to groups of about 20 persons ; if the applications should exceed this number, two or more groups will be arranged. The travelling arrangements will be made by Intourist, Ltd., Bush House, Aldwych, London, W.C.2. The parties will be assisted by competent guides and interpreters provided by Voks, the Soviet organisation for cultural relations with foreign countries. The period of the tours will be between July 15th and Sept. 15th, and the inclusive cost of travel, accommodation, and guiding will be about ;E35, the tours lasting about one month, from departure to return to London. We are, Sir, yours faithfully, JULIAN HUXLEY, P. CHALMERS MITCHELL, E. RUTH MANSELL-MOULLIN
TUBERCULOSIS IN CHILDHOOD.
To the Editor
of
THE LANCET.
SIR,—In both of the cases which Dr. Fletcher illustrates -with serial radiograms there is no mention of the personal symptoms, and the X ray appearances in both are compatible with an unresolved pneumonic condition. As Drs. Toussaint and Maclntyre point out, radiology is a good servant but a bad master. Some of Dr. Fletcher’s diagnoses are apparently based almost entirely on radiological findings. An exact interpretation of the chest skiagrams demands a careful consideration of the history, symptoms, and clinical signs in conjunction with the radiogram. The radiologist and the clinician should work together -the physician interpreting the physical signs which he has found in the chest, correlating them with the history and symptoms of the case and, finally, comparing them with the interpretation of the shadows which the radiologist finds in the skiagram. Then, (Chairman). and only then, can the diagnosis be fairly assured. l, Montague-street, London, W.C., March 16th, 193. Dr. Kerley suggests a revision of the somewhat obsolete conclusions of the Committee of the SCHLAMM-FIEBER. National Tuberculosis Association of America. And I cannot fail to admire his suggestions, although I ’]’0 the Editor of THE LANCET. cannot altogether agree with the views he puts SiR,-The term Schlamm-fieber, as your editorialforward. With Dr. Brooke I would question note to Dr. Parkes Weber’s letter last week states if the recent advancesBlyth in radiological technique " have (p. 644), is applied to a condition which may occur enabled us to discover with any degree of after drinking bad water. There is a certain amount really the value of every pathological lesion in certainty of evidence that it is a leptospirosis due either to a the chest which throws a shadow on the screen or specific leptospira pathogenic among the harmless plate." Most of us, I am sure, will be inclined to water leptospirae, or to the possible acquirement of agree with him when he states that those with a clinical pathogenicity by one of the latter. Zuelzer and as well as a radiological experience will answer that others have shown that some of the water leptospirse it has not. I agree with him when he says that " many are pathogenic to guinea-pigs, and L. icterohaemorof thepneumonic conditions ’ in children described rhagiae of Weil’s disease can be contracted from are either tuberculous or in nature, infected water (see Trop. Dis. Bull., 1931, xxviii., 315). with Koch’s bacillus as epituberculous a primary or secondary Tarassow has recently reported cases in Moscow and but many are not." His subsequent its environs, and expresses the opinion that the infecting agent, confirms my own experience with explanation leptospira in question is specific. It does not set up numerous children examined and serially X rayed. jaundice, but gives rise to symptoms which have, in It would appear that some of these cases do end the past, been mistaken for those of atypical typhoid in bronchiectasis or in chronic non-tuberculous and paratyphoid, toxic influenza, and even typhusfibrosis. pulmonary and reported as such. I am, Sir, yours faithfully, I am, Sir, yours faithfully, R. G. PROSSER EVANS, H. HAROLD SCOTT. Assistant Tuberculosis Physician, King Edward VII. Bureau of Hygiene and Tropical
Welsh National Memorial Association.
Diseases,
Grove-place, Swansea, March 21st, 1932.
Keppel-street, W.C., March 18th, 1932.
PARLIAMENTARY INTELLIGENCE NOTES ON CURRENT TOPICS. VETERINARY SURGEONS BILL. IN the House of Lords on Thursday, March 17th, the Royal Assent was given to a number of Bills, including the Veterinary Surgeons (Irish Free State Agreement) Bill. ____
HOUSE OF COMMONS.
I
WEDNESDAY, MARCH 16TH.
Insanity
and Divorce.
ordinary boots and then send them to the Ministry for adjustment ; and whether he would revert to the practice of the free supply of surgical boots and repairs to all pensioners whose legs were shortened one inch or more as the result of war injury.—Lieut.-Colonel HEADLAM (Parliamentary Secretary to the Ministry of Pensions) replied : There has been no such rule as that suggested in the last part of the question, nor has the supply of surgical boots been withdrawn. It has always been the duty of the responsible medical officer to order what was necessary either by way of modification of the man’s own boots or, if this was not practicable, by the construction of a special boot, according as in his judgment was necessitated by the surgical requirements of the case, due regard being had to the appearance of the finished product. With the lapse of time, as the hon. Member will realise, the disability will in
Mr. VYVYAN ADAMS asked the Attorney General if he cases have reached a final condition such as may no would introduce legislation to facilitate divorce where one many the supply of a specially constructed boot. of the spouses had become insane after marriage.--Sir T. longer require I am unable to say what saving may be effected in such INSIUP replied : No. Sir. cases.
I
’
Medical and Dental Services in the Navy. Mr. GORDON MACDONALD asked the Minister of Pensions I Mr. PARKINSOX asked the First Lord of the Admiralty what economy had been effected by withdrawing the supply how many dental officers, surgeon-captains, were employed I of surgical boots from men suffering from shortening of in the Navy at a remuneration of £3 9s. a day ; where they leg due to war injury, and compelling the pensioner to buy carried out their duties ; and whether the duties were
Supply
of
Surgical
Boots to Pensioners.
to Dr. Charles Buizard, on the occasion of his promotion to the rank of Officer of the Legion of Honour. Dr. Buizard is the popular general secretary to the
Surgeon’s Society of Paris, and it is believed that many of his colleagues and friends in other countries will be glad of the opportunity to contribute to the cost of the medal, which will be designed by the well-known
A committee has been formed to collect subscriptions for the purpose of presenting a bronze medal
artist, Mr. Turin.
be sent to MM. G. Doin and Paris (6).
Subscriptions should Co., 8, place de l’Odéon,
CORRESPONDENCE physical
attain middle age, and 50; and I assumed as To the Editor of THE LANCFT. ;the meaning of athlete that meaning which I believe Ito be in universal SIR,-Public attention is being drawn to a acceptance. It now appears that which has long been of concern to the medical pro- Prof. Plesch is referring to pathological subjects and fession. Many troubles arise in marriage that could to occupations which carry with them certain hazarhave been prevented by fuller knowledge. Some of dous associations-e.g., copper-mining. That " big these can be dealt with by a layman with special persons of excessive weight and height show a greater " experience of marriage problems, whilst others areI mortality than smaller persops is surely an observaof a definitely medical nature which, if brought to tion which will attract no contradiction. He instances light at an early stage and directed to the right the excessive mortality of 50 per cent. for stage medical authority, would respond promptly to treat- acrobats which I am quite prepared to believe; but ment. Many marry with so little knowledge of its as regards the question under consideration one physiology that their future happiness is imperilled, might as well draw conclusions about the malevolent for until recently such questions as the sex education physiological effects of high altitudes from the of children and adolescents havereceived scant mortality-rate in parachute testers. The physical attention. element in their lives may be trifling compared with Recognising this fact for the last year, the British the nervous strain inseparable from the dangers. Social Hygiene Council has enlisted the help of a Furthermore, the psychical disturbances of a somecommittee of experts in order that a handbook on what precarious occupation with the anxieties preparation for marriage might be available. This attending unemployment and the hardships which work is shortly to be published by Messrs. Jonathan necessarily result, have to be taken into consideration Cape. together with the possible influence of syphilis and But valuable though a book of this nature will of over-indulgence in alcohol and tobacco. undoubtedly be, there is no doubt that in many Prof. Plesch reiterates that the sharp rise of cases it is a personal consultation on an individual maximal blood pressure during work is certainly not problem that is required. In order to meet this without effect on the blood-vessels. It must be very need, Mrs. Neville Rolfe, the Secretary-General of difficult to assess the extent of any disadvantageous the British Social Hygiene Council and also of the effect upon a healthy vessel. As a modest contricommittee for the preparation of this handbook, has bution to the problem I have to offer the examination been asked to establish a Personal Problems Bureau. of the radial arteries of three subjects with physical This enterprise will be run on an economically self- experiences which may be germane to the issue. supporting basis with the full support and approval The first, a man of 44, has indulged in violent exercise of the Council. Consultations will be by interview The second, (running) regularly for 27 years. and letter, for which it is proposed to charge a fee aged 41, has been engaged in boat for nearly racing of 92 2s. for a personal consultation in London, and 20 14 The third, aged 42, following years of years. 1Is. by correspondence. To all cases requiring little exercise after athletics, took competitive very medical assistance a list of authorities in the special the age of 32. Sections of their radial arteries have field will be given to the client for submission to her been pronounced as free from any pathological medical adviser. change by histologists whose judgment is beyond A private consulting room in Prince’s Gate has been question. For obvious reasons it is impossible to secured. , collect a large number of subjects for such investigavVe are. Sir. vours faithfullv. I tion, and I must risk the criticism that these will be KENNETH WALKER, discredited or deprecated as "exceptional.’’ THE PROBLEMS OF MARRIAGE.
that
effort when
they
most of them die before
subject
I
I
I
A. H.
HARKNESS,
I am, Sir, yours
Honorary Medical Secretaries, British Social Hygiene Council. March 16th, 1932. London, S.W.,
ARTERIAL ATONY AND ARTERIO-SCLEROSIS To the ;dito-r of THE LANCET.
faithfully, ADOLPHE ABRAHAMS.
Brook-street, W., March 19th,
1932.
TOURS TO RUSSIA IN 1932.
To the Editor of THE LANCET. SiR,-In 1931 the Society for Cultural Relations SiR,—I greatly appreciate Prof. Plesch’s courteous i endeavour to reconcile my objections to his original I, arranged two tours in 1T.S.S.R. to enable scientists statements ; but in so doing he appears to me to and doctors to see the present activities in science and introduce an elasticity of terminology which tran- medicine ; 62 scientists and doctors, including several scends reasonableness. I demurred to his assertions eminent specialists, joined these tours. The Society that athletes show marked calcification by the age proposes to organise similar tours in 1932 but with a of 35 or 40 ; that they are seldom capable of greatI wider scope of scientific interests and subjects.
I
701 It hopes to arrange parties for physical, biological, and agricultural scientists, engineers, chemists, medical doctors, and anthropologists. The parties will be limited to groups of about 20 persons ; if the applications should exceed this number, two or more groups will be arranged. The travelling arrangements will be made by Intourist, Ltd., Bush House, Aldwych, London, W.C.2. The parties will be assisted by competent guides and interpreters provided by Voks, the Soviet organisation for cultural relations with foreign countries. The period of the tours will be between July 15th and Sept. 15th, and the inclusive cost of travel, accommodation, and guiding will be about ;E35, the tours lasting about one month, from departure to return to London. We are, Sir, yours faithfully, JULIAN HUXLEY, P. CHALMERS MITCHELL, E. RUTH MANSELL-MOULLIN
TUBERCULOSIS IN CHILDHOOD.
To the Editor
of
THE LANCET.
SIR,—In both of the cases which Dr. Fletcher illustrates -with serial radiograms there is no mention of the personal symptoms, and the X ray appearances in both are compatible with an unresolved pneumonic condition. As Drs. Toussaint and Maclntyre point out, radiology is a good servant but a bad master. Some of Dr. Fletcher’s diagnoses are apparently based almost entirely on radiological findings. An exact interpretation of the chest skiagrams demands a careful consideration of the history, symptoms, and clinical signs in conjunction with the radiogram. The radiologist and the clinician should work together -the physician interpreting the physical signs which he has found in the chest, correlating them with the history and symptoms of the case and, finally, comparing them with the interpretation of the shadows which the radiologist finds in the skiagram. Then, (Chairman). and only then, can the diagnosis be fairly assured. l, Montague-street, London, W.C., March 16th, 193. Dr. Kerley suggests a revision of the somewhat obsolete conclusions of the Committee of the SCHLAMM-FIEBER. National Tuberculosis Association of America. And I cannot fail to admire his suggestions, although I ’]’0 the Editor of THE LANCET. cannot altogether agree with the views he puts SiR,-The term Schlamm-fieber, as your editorialforward. With Dr. Brooke I would question note to Dr. Parkes Weber’s letter last week states if the recent advancesBlyth in radiological technique " have (p. 644), is applied to a condition which may occur enabled us to discover with any degree of after drinking bad water. There is a certain amount really the value of every pathological lesion in certainty of evidence that it is a leptospirosis due either to a the chest which throws a shadow on the screen or specific leptospira pathogenic among the harmless plate." Most of us, I am sure, will be inclined to water leptospirae, or to the possible acquirement of agree with him when he states that those with a clinical pathogenicity by one of the latter. Zuelzer and as well as a radiological experience will answer that others have shown that some of the water leptospirse it has not. I agree with him when he says that " many are pathogenic to guinea-pigs, and L. icterohaemorof thepneumonic conditions ’ in children described rhagiae of Weil’s disease can be contracted from are either tuberculous or in nature, infected water (see Trop. Dis. Bull., 1931, xxviii., 315). with Koch’s bacillus as epituberculous a primary or secondary Tarassow has recently reported cases in Moscow and but many are not." His subsequent its environs, and expresses the opinion that the infecting agent, confirms my own experience with explanation leptospira in question is specific. It does not set up numerous children examined and serially X rayed. jaundice, but gives rise to symptoms which have, in It would appear that some of these cases do end the past, been mistaken for those of atypical typhoid in bronchiectasis or in chronic non-tuberculous and paratyphoid, toxic influenza, and even typhusfibrosis. pulmonary and reported as such. I am, Sir, yours faithfully, I am, Sir, yours faithfully, R. G. PROSSER EVANS, H. HAROLD SCOTT. Assistant Tuberculosis Physician, King Edward VII. Bureau of Hygiene and Tropical
Welsh National Memorial Association.
Diseases,
Grove-place, Swansea, March 21st, 1932.
Keppel-street, W.C., March 18th, 1932.
PARLIAMENTARY INTELLIGENCE NOTES ON CURRENT TOPICS. VETERINARY SURGEONS BILL. IN the House of Lords on Thursday, March 17th, the Royal Assent was given to a number of Bills, including the Veterinary Surgeons (Irish Free State Agreement) Bill. ____
HOUSE OF COMMONS.
I
WEDNESDAY, MARCH 16TH.
Insanity
and Divorce.
ordinary boots and then send them to the Ministry for adjustment ; and whether he would revert to the practice of the free supply of surgical boots and repairs to all pensioners whose legs were shortened one inch or more as the result of war injury.—Lieut.-Colonel HEADLAM (Parliamentary Secretary to the Ministry of Pensions) replied : There has been no such rule as that suggested in the last part of the question, nor has the supply of surgical boots been withdrawn. It has always been the duty of the responsible medical officer to order what was necessary either by way of modification of the man’s own boots or, if this was not practicable, by the construction of a special boot, according as in his judgment was necessitated by the surgical requirements of the case, due regard being had to the appearance of the finished product. With the lapse of time, as the hon. Member will realise, the disability will in
Mr. VYVYAN ADAMS asked the Attorney General if he cases have reached a final condition such as may no would introduce legislation to facilitate divorce where one many the supply of a specially constructed boot. of the spouses had become insane after marriage.--Sir T. longer require I am unable to say what saving may be effected in such INSIUP replied : No. Sir. cases.
I
’
Medical and Dental Services in the Navy. Mr. GORDON MACDONALD asked the Minister of Pensions I Mr. PARKINSOX asked the First Lord of the Admiralty what economy had been effected by withdrawing the supply how many dental officers, surgeon-captains, were employed I of surgical boots from men suffering from shortening of in the Navy at a remuneration of £3 9s. a day ; where they leg due to war injury, and compelling the pensioner to buy carried out their duties ; and whether the duties were
Supply
of
Surgical
Boots to Pensioners.