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TYPHOID FEVER AND THE PAIL SYSTEM AT NOTTINGHAM.
1659 his only object is to hit the wicket, but the course of the ball is different. Here the two limbs are on an equality. But in
of the conversion of some 40,000 pail-closets into waterclosets and the incidence of such expense as between the property owners and the local authority. The water-supply,
this same case of handwriting, the making of screws, &c., equality does not exist. There must be two kinds of writing both as to quantity and cost, and the disposal of the large and right- and left-handed screws ; this also is practically addition to the liquid sewage of the city, are also very impossible. I think, therefore, little is to be said in favour of important points to be taken into consideration. ambidexterity in the meaning usually given to it ; at the same My corporation have given the whole matter their serious time I should say, Educate the left hand as far as possible. attention for some time past and they have recently made an It seems to be forgotten that the body is made up of two important step towards the disposal of large quantities of halves and it is the different sensation produced by feeling an house and other refuse by the erection of two sets of object with both which gives the idea of extension, just as destructors of the most modern type. the different impression on each eye gives the sense of I am, Sirs, yours faithfully, F. R. MUTCH, M.D. Aberd,, solidity. Good reasons have been suggested for speech being located on one side of the brain and I think the question of Nottingham, Dec. 9th, 1902. Chairman of the Health Committee. right-handedness, or rather one-handedness, must have a larger consideration given to it than has been usually I am, Sirs, yours faithfully, employed. DEGREES FOR LONDON MEDICAL SAMUEL WILKS. Dec. 9th, 1902. STUDENTS.
the
THE AMBULANCE SERVICE OF LONDON. To the Editors of THE LANCET.
SIRS,—I have frequently been confronted with
the same to which Dr. A. S. Morton refers in THE LANCET of Nov. 29th, p. 1485-that of removing to hospital patients seriously ill without danger to themselves and with as much comfort as the circumstances of the case admit. In cases of "infectious disease"when there is accommodation at a fever hospital-and it is only rarely that such is not the case-on notice being given to the local sanitary authority the patient is removed frequently within two hours or so of the application. Where the services of the Invalid Transport Corps of the St. John Ambulance Association can be obtained the care and comfort with which the patient is conveyed to hospital or elsewhere This service, however, does leave nothing to be desired. not deal with c infectious" cases. Again, the fee is beyond the means of the poor. In several cases of my own, however, where the friends of the patient could not afford the full fee, the removal has very kindly been undertaken by the association at a reduced fee. There still remain many cases among the poorer classes where neither of these excellent services is available. For these I know of no means of safely removing patients. Many have to fall back upon the ordinary four-wheeled cab which, although much improved of late by the addition of rubber tyres, is by no means always suited for the transport of the sick ; nor is it desirable that ordinary cabs shoulct be used for the conveyance of persons suffering from all sorts of diseases. It appears to me that a public ambulance service is much wanted where for a small fee-say, 2s. 6d. or 5s., according to distance-a patient might be suitably removed to or from hospital, &c. The Poor-law ambulances are only available for cases under the care of the Poor-law medical officers. Might not the Poor-law ambulance service be extended and made available for the use of non-pauper patients ? I have known a poor patient arrive at a Poor-law infirmary dead, having been brought thither in a hansom cab and dying on the journey, probably from syncope. Such a provision as a readily available ambulance service such as I have indicated would probably be the means of saving many lives, besides much suffering. I have had to have a case of haemoptysis, taken ill in a public vehicle, removed in the police ambulance, which is neither the best for such a case nor likely to be agreeable to the feelings of a poor but respectable patient.-I am, Sirs, yours faithfully,
difficulty
G. F. POLLARD, M.D. Durh.
Liverpool-road, N.,
Dec. 3rd, 1902.
TYPHOID FEVER AND THE PAIL SYSTEM AT NOTTINGHAM.
To the Editors of THE LANCET.
SIRS,-As the scheme for the association for examination purposes of the University of London and the Royal Colleges of Physicians of London and Surgeons of England is still in embryo, beyond which stage I devoutly hope it will never develop, it is, I think, pertinent to ask, not, is such a scheme desirable ? but, is it possible?-that to say, is it possible to formulate a scheme which As one who holds will be equitable to both sides ? both the degree and diploma I do not hesitate to reply emphatically in the negative, and I confess to surprise at the silence of London graduates on a subject which concerns them so closely. I do not propose to compare the two sets of examinations step by step, but, taken as a whole, the standard of knowledge required for the degree is higher than that required for the diploma and with this contention It I think most people competent to judge will agree. follows, therefore, that if the University is to keep good faith with its present graduates it will demand in the proposed association precisely that standard of knowledge in all subjects from the matriculation to the final M.B. which it has demanded in the past. That, I think, will be conceded. Such is the aspect from the graduates’ standpoint. The Conjoint men, on the other hand, complain, to put it succinctly, that their diploma is not a degree. But surely this was well known to them when they started as students, though to judge by some of the correspondence that has appeared on this subject one might suppose th& fact had but now dawned upon them, and that they had, so to speak, been decoyed into entering for the diploma of the Royal Colleges under false pretences. If it was a degree they desired their course was obvious, and in this connexion it is significant that in spite of the supposed advantages of the M.B. Lond. yet so far more London men enter for the diploma of the Royal Colleges than for the degree. The explanation is simple. More study is required for the latter, which has an enviable reputation in consequence, and for the Conjoint men to demand that they shall, at the last, enter on equal terms with those who have laboured through the heat of the day, seems to me hardly reasonable. Into the ethical question of sacrificing the minority for the benefit of the majority I do not propose to enter, though no doubt it would be upon this point that the issue would turn, with a result which no great perspicuity is needed to foresee. As things are at present a curious impasse is presented to us. On the one hand, the standard of the M. B. Lond. should not be lowered in justice to the present graduates ; on the other, that of the diploma of the Royal Colleges should not be raised in justice to those students who have already entered for it. A compromise would be unjust to both. How, then, is it possible to formulate a scheme equitable to both parties ? I confess I do not know, but as the originators of all this pother appear to have such a rooted objection to obtaining a degree in the usual way I would suggest to them that they approach some other university the standard of whose examinations is more on a level with their own. I am, Sirs, yours faithfully, 0---- T? D T ......7 -1 T? D !Y G ... FRANCIS STEELE, C. U-.-.........,. M.B. Lond., M.R.C.S. Eng., L.R.C.P. Lond. London, Dec. 3rd, 1902.
is
To tAe Editors of THE LANCET. desired by my committee to call your attention to an inaccuracy in the article Typhoid Fever and the Pail System at Nottingham " which appeared in your issue of the 29th ult. It is there stated that the only obstacle to the abolition of the pail system is apparently the compensation that the contractors who actually carry out the pail system might claim. This is not the fact, as no contract exists, the To the Editors of THE LANCET. work being carried out by a staff employed by, and SIRS,-Allow me to corroborate, in my own experience, the immediately under the control of, the health committee. The real difficulty is primarily the question of the expense statements made in THE LANCET of Nov. 29th, p. 1488,
SIRS,-I
am
-.Yr<
of the conversion of some 40,000 pail-closets into waterclosets and the incidence of such expense as between the property owners and the local authority. The water-supply,
this same case of handwriting, the making of screws, &c., equality does not exist. There must be two kinds of writing both as to quantity and cost, and the disposal of the large and right- and left-handed screws ; this also is practically addition to the liquid sewage of the city, are also very impossible. I think, therefore, little is to be said in favour of important points to be taken into consideration. ambidexterity in the meaning usually given to it ; at the same My corporation have given the whole matter their serious time I should say, Educate the left hand as far as possible. attention for some time past and they have recently made an It seems to be forgotten that the body is made up of two important step towards the disposal of large quantities of halves and it is the different sensation produced by feeling an house and other refuse by the erection of two sets of object with both which gives the idea of extension, just as destructors of the most modern type. the different impression on each eye gives the sense of I am, Sirs, yours faithfully, F. R. MUTCH, M.D. Aberd,, solidity. Good reasons have been suggested for speech being located on one side of the brain and I think the question of Nottingham, Dec. 9th, 1902. Chairman of the Health Committee. right-handedness, or rather one-handedness, must have a larger consideration given to it than has been usually I am, Sirs, yours faithfully, employed. DEGREES FOR LONDON MEDICAL SAMUEL WILKS. Dec. 9th, 1902. STUDENTS.
the
THE AMBULANCE SERVICE OF LONDON. To the Editors of THE LANCET.
SIRS,—I have frequently been confronted with
the same to which Dr. A. S. Morton refers in THE LANCET of Nov. 29th, p. 1485-that of removing to hospital patients seriously ill without danger to themselves and with as much comfort as the circumstances of the case admit. In cases of "infectious disease"when there is accommodation at a fever hospital-and it is only rarely that such is not the case-on notice being given to the local sanitary authority the patient is removed frequently within two hours or so of the application. Where the services of the Invalid Transport Corps of the St. John Ambulance Association can be obtained the care and comfort with which the patient is conveyed to hospital or elsewhere This service, however, does leave nothing to be desired. not deal with c infectious" cases. Again, the fee is beyond the means of the poor. In several cases of my own, however, where the friends of the patient could not afford the full fee, the removal has very kindly been undertaken by the association at a reduced fee. There still remain many cases among the poorer classes where neither of these excellent services is available. For these I know of no means of safely removing patients. Many have to fall back upon the ordinary four-wheeled cab which, although much improved of late by the addition of rubber tyres, is by no means always suited for the transport of the sick ; nor is it desirable that ordinary cabs shoulct be used for the conveyance of persons suffering from all sorts of diseases. It appears to me that a public ambulance service is much wanted where for a small fee-say, 2s. 6d. or 5s., according to distance-a patient might be suitably removed to or from hospital, &c. The Poor-law ambulances are only available for cases under the care of the Poor-law medical officers. Might not the Poor-law ambulance service be extended and made available for the use of non-pauper patients ? I have known a poor patient arrive at a Poor-law infirmary dead, having been brought thither in a hansom cab and dying on the journey, probably from syncope. Such a provision as a readily available ambulance service such as I have indicated would probably be the means of saving many lives, besides much suffering. I have had to have a case of haemoptysis, taken ill in a public vehicle, removed in the police ambulance, which is neither the best for such a case nor likely to be agreeable to the feelings of a poor but respectable patient.-I am, Sirs, yours faithfully,
difficulty
G. F. POLLARD, M.D. Durh.
Liverpool-road, N.,
Dec. 3rd, 1902.
TYPHOID FEVER AND THE PAIL SYSTEM AT NOTTINGHAM.
To the Editors of THE LANCET.
SIRS,-As the scheme for the association for examination purposes of the University of London and the Royal Colleges of Physicians of London and Surgeons of England is still in embryo, beyond which stage I devoutly hope it will never develop, it is, I think, pertinent to ask, not, is such a scheme desirable ? but, is it possible?-that to say, is it possible to formulate a scheme which As one who holds will be equitable to both sides ? both the degree and diploma I do not hesitate to reply emphatically in the negative, and I confess to surprise at the silence of London graduates on a subject which concerns them so closely. I do not propose to compare the two sets of examinations step by step, but, taken as a whole, the standard of knowledge required for the degree is higher than that required for the diploma and with this contention It I think most people competent to judge will agree. follows, therefore, that if the University is to keep good faith with its present graduates it will demand in the proposed association precisely that standard of knowledge in all subjects from the matriculation to the final M.B. which it has demanded in the past. That, I think, will be conceded. Such is the aspect from the graduates’ standpoint. The Conjoint men, on the other hand, complain, to put it succinctly, that their diploma is not a degree. But surely this was well known to them when they started as students, though to judge by some of the correspondence that has appeared on this subject one might suppose th& fact had but now dawned upon them, and that they had, so to speak, been decoyed into entering for the diploma of the Royal Colleges under false pretences. If it was a degree they desired their course was obvious, and in this connexion it is significant that in spite of the supposed advantages of the M.B. Lond. yet so far more London men enter for the diploma of the Royal Colleges than for the degree. The explanation is simple. More study is required for the latter, which has an enviable reputation in consequence, and for the Conjoint men to demand that they shall, at the last, enter on equal terms with those who have laboured through the heat of the day, seems to me hardly reasonable. Into the ethical question of sacrificing the minority for the benefit of the majority I do not propose to enter, though no doubt it would be upon this point that the issue would turn, with a result which no great perspicuity is needed to foresee. As things are at present a curious impasse is presented to us. On the one hand, the standard of the M. B. Lond. should not be lowered in justice to the present graduates ; on the other, that of the diploma of the Royal Colleges should not be raised in justice to those students who have already entered for it. A compromise would be unjust to both. How, then, is it possible to formulate a scheme equitable to both parties ? I confess I do not know, but as the originators of all this pother appear to have such a rooted objection to obtaining a degree in the usual way I would suggest to them that they approach some other university the standard of whose examinations is more on a level with their own. I am, Sirs, yours faithfully, 0---- T? D T ......7 -1 T? D !Y G ... FRANCIS STEELE, C. U-.-.........,. M.B. Lond., M.R.C.S. Eng., L.R.C.P. Lond. London, Dec. 3rd, 1902.
is
To tAe Editors of THE LANCET. desired by my committee to call your attention to an inaccuracy in the article Typhoid Fever and the Pail System at Nottingham " which appeared in your issue of the 29th ult. It is there stated that the only obstacle to the abolition of the pail system is apparently the compensation that the contractors who actually carry out the pail system might claim. This is not the fact, as no contract exists, the To the Editors of THE LANCET. work being carried out by a staff employed by, and SIRS,-Allow me to corroborate, in my own experience, the immediately under the control of, the health committee. The real difficulty is primarily the question of the expense statements made in THE LANCET of Nov. 29th, p. 1488,
SIRS,-I
am
-.Yr<