TRIFID STOMACH.

495 germ cells from which they arise are vitiated nutrient medium or the rever&e." We at present know too little about heredity to say it is or is not a matter of indifference whether the germ cells are developed in a vitiated nutrient medium or not. However, with regard to permanent alterations being produced in germ cells and the resulting offspring from poisons, &c., circulating in the blood, this is probably correct. For since the child varies somewhat from the parent the germ cell from which he is derived must also have varied somewhat from the germ cell from which the parent was derived and it seems probable (neglecting the effects of conjugation) that this could only have arisen from some external cause-for example, alcohol circulating in the blood. What is denied is that such changes in the blood usually produce changes of such a kind in the germ-cell as result in variations in the offspring derived from these germ cells similar to those produced in the parent organism. For example, suppose a bicyclist develops his calf muscles to a great extent this modification may so alter the blood or nutrient parts of it as to cause an alteration in the germ cell which will, therefore, cause it to develop into an organism different from that which would otherwise have been the case. It is, however, difficult to conceive that this variation in the offspring will be of the same kind as that in the parent. In other words, it is difficult to believe that because the parent developed his calf muscles the child will have better calf muscles than he otherwise would have had. If this ever does happen-that is, if ever an acquired trait is transmitted-it must be so rare that no indisputable instance of it has yet been recorded and thus as a factor in evolution may be neglected. I pointed out in my last letter that the accumulation and transmission of acquired traits is probably the normal condition of things in low unicellular organisms, as witness the conversion of small-pox into vaccinia by passing the virus through the cow, but that such obtains in multicellular organisms, notwithstanding Dr. Wiglesworth’s statistics, there has not yet been any evidence advanced worth the time spent in its examination. I am more than sorry if I have misread any part of Dr. Wiglesworth’s first letter. In that letter he evidently insists that the actions of poisons, &c., on the germs (apart from conjugation) will cause the offspring developed from these germs to vary in certain definite directions. To that end his statistics are supposed to prove that parental drinking will cause filial intemperance or filial mental instability. The foregoing part of this letter and my last letter prove that for this contention there is not one iota of justification. Were this so then we would expect every member of a litter of pups or kittens to resemble exactly one another, for the germs have been subjected to the same conditions of environment. We know, however, that no two members of the same litter correspond in any one character or trait. Dr. Wiglesworth next refers to the "Mohammedan races which show us millions of human beings who are perfectly sober, not by virtue of such an evolution, but in consequence But of the operation of religious sanctions." Granted. though the past history of these races is well known the future has yet to be written. It must also be remembered that this craving for alcohol is not the only desire of man that has been counteracted by his religious systems. Millions and millions of men and women have denied themselves the perfectly natural gratification of sexual love because of their religious systems, and though their sexual instinct was counteracted it was never abolished. Similarly, though the desire for alcohol has been counteracted it never has been abolished. Let those races change their religion (they have done it before and may do so again) to one like the Christian religion which does not demand total abstinence, and it may be the last state of those races will be worse than the first. Again, if these races are Mohammedans and abstainers we must take into consideration the price they are paying in knowledge, belief, art, morals, law, customs, &c.-that is, in culture or civilisation. I need not follow Dr. Wiglesworth further, for any other question he raises has been answered in the preceding part of this letter or in my previous one. In his last sentence, however, he asks, "Can Dr. Reid or Dr. Niven furnish evidence to show that on the average the children alcoholic parentage are as stable and healthy as those of parents not so circumstanced?" I respectfully decline to

whether

developed

the in

a

Dr. Wiglesworth has a thing. parental drinking causes filial intemperance

asserted that and filial insanity. These statements have, I trust, been shown to be wrong. It is for Dr. Wiglesworth to prove his statements. It is no part of my business to prove an exact opposite. I may say, however, that it would be perfectly easy to give the proof he asks, but the disproof of his assertions is the beginning and end of my task. I am, Sirs, yours faithfully, C. R. NIVEN. Liverpool,.August 7th, 1902. do any such

A MINISTRY OF HEALTH. To the Editors of THE LANCET.

SIRS,-In reference

to

a

paper which I had the honour of

reading in the Section of State Medicine of the seventy-first meeting of the British Medical Association on July 31st at Swansea on the formation of a Health Ministry I am invited to reply to the following points raised by distinguished members of our profession :— 1. That friction would he caused between the proposed Minister and the Local Government Office and a deadlock in public health affairs ensue.

2. That local administration of sanitary matters would become detached from other departments of local government. 3. That the first step towards a proper State sanitary service would be the improvement in status and pay of the medical department of the Local Government Board.

I think that the first two points may be answered together, A Minister of Education has recently been appointed, with obvious advantage, at a time, curiously enough, when local educational and general government has been in process of unification. Thus it is clear that the Ministry of Education can cooperate harmoniously with the Local Government Office though local administration of duties is combined. In Belgium and Canada, in the United States of America, in Germany, in Sweden, and in Denmark the State public health administration is incorporated in departments of agricouncil," culture, navy, police, and education, a ’’ medical and the Ministry of Justice respectively.1 The national administration of public health services is, therefore, not confined to central offices of local government in other countries. These facts strengthen the supposition, to my mind, that discord need not arise by a separation of the medical department of the Local Government Board to form the nucleus of a Health Ministry. As regards the third point, the improvement in status and pay and numbers of the medical department of the Local Government Board is clearly essential to the promotion of a proper State sanitary service. Would this not be one of the many matters to receive the attention of the proposed Ministry of Health ? The support of the medical profession appears to be a sine qncc non to the formation of such a central medical department and it is hoped that the-e questions when raised will receive their clofe attention. I am, Sirs, yours faithfully, F. G. BUSHNELL. Plymouth, ’August 8th, 1903.

TRIFID STOMACH. To the -Editors of THE LANCET. SIRS,-In THE LANCET of August 8th, p. 415, appeared an annotation on hour-glass stomach in which, referring to an interesting case of trilocular stomach reported in the same issue (p. 388) you state: "It is, we believe, the first case of trifid stomach on which an operation has been performed." May I draw your attention to a paper which I read before the American Surgical Society on May 8tb, 1901. and published in THE LANCET of May 25th, 1901, Here I described a case (Case 22) of trifid p. 1458. stomach under the name of double hour-glass contraction of the stomach on which I performed gastroplasty and gastrolysis and cured the patient who remains well. This case preceded the one you describe as the nr:.t by more than four years and although one of the strictures was produced by adhesions and the other by cicatricial contraction the stomach was divided into three distinct cavities. The case is referred to and briefly described in the work, " Diseases of

of!f 1

See also the Case for a Ministry of Health, p. 160 et seq., by F. Scott, F.C.A., citing Palmberg, and Newsholme’s Public Health and

its

Applications.

496 the Stomach and their

Tindall, and Cox,

Surgical Treatment," p. 189 (Bailliere,

1901).

I am, Sirs, yours Park-crescent, W., August 8th, 1903.

I

faithrully, faithfully, A. W. MAYO ROBSON.

THE TRINIDAD EPIDEMIC.

from those very diseases which are directly or attributable to improper feeding—"the deathrates from ansemia, from rickets, and from diarrhoea show an increase "-and this in spite of the facts that we have now a relatively more abundant and varied supply of foods than any previous generation, that we have in general greatly improved hygienic and sanitary conditions, and that there is a diminished birth-rate, so that parents can give more individual care and attention to their children. Upon what physiological principles are " bread well Have children soaked"in milk and the like advocated ? Is it not preferable neither teeth nor salivary glands ? to let them soak their bread in saliva in the mouth ? Is there any reason for advocating food which neither stimulates the movements of the jaws, nor of the stomach, nor of the intestines, but only tends to lodge, to ferment, to derange the normal secretions, and to give rise to a continuous supply of objectionable products of decomposition ? Surely the time has come for a crusade against the soft, "refined"food of the present day. It is within the power of the medical profession to reduce rather than to increase the suffering and mortality from this cause.,I am, Sirs, yours faithfully, J. SIM WALLACE. Wimpole-street, W.,August 9th, 1903.

increasing indirectly

To the Editors of THE LANCET. SIRS,—With reference to the controversy regarding the true nature of the epidemic prevailing in certain parts of the West Indies and alleged in many of the islands to be chicken-pox, I inoculated a monkey with variolous matter taken from a case of so-called varicella at the Colonial Hospital. Four insertions were made by a series of cross scratches as in ordinary vaccination, two being with matter from vesicles six days old and two from vesicles of the seventh day. Four days later there was a distinct raised papule surrounded by a zone of inflammation at the site of each insertion. About the sixth day (the day on which the photograph was taken) vesiculation, though not very perfect, was apparent and scabbing commenced. As it is well agreed that chicken-pox is not an inoculable disease it is to be hoped that in view of the success of this simple experiment the last has been heard, among medical men, at any rate, of the term "varicella " in connexion with the present outbreak of small-pox in the West Indies. THE MOTOR-CAR BILL. I am, Sirs, yours faithfully, To the Editors of THE LAN C E T. GEORGE H. MASSON, M.D., B. Sc., M.R.C.P. Edin. Port of Spain, Trinidad B.W.I., July 31st, 1903. SIRS,-It is with sincere sorrow that one reads’your the monkey ** Dr. Masson incloses a photograph annotation on the above Bill in THE LANCET of August 8th, showing the vesicles very clearly.-ED. L. Since the days "when Cooper’s nevvy cut for p. 415. stone" THE LANCET has always been in the forefront THE ADMINISTRATION OF SOMNOFORM. of liberal progress, so that it gave one quite an unpleasant shock to read the old-fashioned ideas expressed To the Editors of THE LANCET. in the annotation. I have driven a motor-car for five years SIRS,—In THE LANCET of August lst, p. 323, appeared in my work and for my pleasure, and can claim to be one a description of yet another excellent apparatus for the of the first medical motor drivers in this country, but there administration of somnoform. I have found the following are now very many practitioners using the new vehicle with plan so simple and to work so well that it appears to advantage to themselves and to their patients. May I thereme that no special apparatus is required. I take the fore be allowed to point out one or two matters in which ordinary Clover’s bag, such as every practitioner who is in your remarks are open to question ? the habit of giving anaesthetics must possess, and fit it You say, "Our present highways were laid out for horse directly on to an ordinary rubber face piece. The latter is traffic ...... and if a motor-car goes faster than 15 or 18 miles’ lined with wool, leaving, however, the opening into the bag per hour the road is being used " for unsuitable purposes. quite free. On this wool the somnoform is syringed and Now this speed is practically slow for a car or even more so administered in the usual way. The wool lining keeps per- for a motor bicycle (which scores of medical men are using fectly in place without any spring such as is required for daily), and yet it is clear to every unprejudiced person that a. lint ; moreover, it absorbs the somnoform well and is readily car or cycle at this speed is more safe on a high-road than removed and replaced. About from three-quarters to two- a four-in-hand and is infinitely more under control, for one thirds of the dose marked on the bottle is ample, as a rule, chief reason that there is only one brain concerned in driving for an anaesthesia of three minutes. a car. But is the progress of locomotion to stand still because I am, Sirs, yours faithfully, the roads are old-fashioned ? Surely the obvious thing is W. BERNARD SECRETAN, M.B. Lond., F.R.C.S. Eng. to improve the roads, as, indeed, followed the use of bicycles. Leeds,August loth, 1903. Motor-cars are per se no more dangerous to traffic than any other form of vehicle, and a motor-car driver is a good deal more careful than a coachman or butcher-boy driving OBSERVATIONS ON MASTICATION. horses ; in the motor the driver is usually driving his own car To the Editors of THE LANCET. which has cost him from .E200 to .E150a and he is not parSIRS,-For some few years I have been looking forward to ticularly anxious to smash it and himself up by recklessr the time when physicians would seriously consider the much- driving, knowing also that he gets no sympathy if he does, neglected subject of mastication. It was therefore with great whereas the horse driver can be drunk or incapable and if an pleasure that I read Dr. H. Campbell’s recent communica- accident happens "the horse took fright and got beyond tions. He has certainly presented arguments which strongly control and no blame attached to anyone." " Your annotation says that the cars "cut up the roads." support his contentions, while at the same time he has made a very grave indictment on current ideas of correct feeding. What road is ever so soft as to be cut up by pneumatic or The subject is at the present moment being forced upon us even solid rubber tyres ? Why even a private gravel drive is in other ways, for the cry has been raised that the national untouched by a motor-car, while a rough hollow is always physique is degenerating. This has arisen from the condi- in the centre where the horses’ feet cut up the ground. tion of the men who have presented themselves for enlist- Again, is there no dust on the road till a car comes ? ment in the army. Among other things we find that a large Does no dust arise when a four-in-hand drives along ? If and increasing percentage have been rejected on account of the dust is intolerable it shows that the road is badly made the shockingly defective state of their teeth. Unfortunately and kept and the obvious conclusion is that the roads want the evil does not end here, for in such cases the mouth modernising to cope with newer methods of locomotion than becomes a receiving and distributing centre for disease, tiie one-hoss shay." As to smell, I find horses quite as instead of acting with the stomach as it should, as a offensive as motors ; if they are not, why do people insist veritable death-trap for almost every pathogenic micro- on the stables being as far as possible from a house The organism which enters it. If the Royal Commission which psychology of the present opposition to motor-cars is preis likely to inquire into the degeneracy of the national cisely the same as that made against the making of railways physique would only direct attention to the physical pro- and, as I well remember, against cyclists when I used to perties of the food and carefully consider the ultimate cycle in the "seventies" and early "eighties." Opposieffects of the pap-feeding of children they would confer an tion has been the lot of every machine of new principle introduced-the spinning-wheels, power-looms, saw-grinding incalculable benefit on suffering humanity. Many have probably observed that the mortality has been machinery, railway trains, steamers, bicycles, and now

of

I