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UNDULANT FEVER
1279
requirements, and of making the necessary arrangements to meet them. Every person who takes advantage of this opportunity will be expected to observe the conditions above indicated, and will be required to sign an undertaking to that effect. Inquiries by letter or telephone cannot be answered. I am, Sir, yours faithfully, NORMAN C. KING, in official
all osteomalacic
the results have been cases. The usual daily dose is grs. 30, but sometimes larger amounts, up to grs. 60 daily, are given. Whatever the initial state of the blood chemistry, which varies in different patients, improvement is always associated with a normal serum calcium and a serum inorganic phosphorus as high as that found in healthy infants and young children. It may be of interest to mention that the daily ultraviolet solar radiation in Lahore in the cold weather was found to be from 3 to 8 units by the acetonemethylene-blue gauge, the average being about 5. In the highlands of Kashmir, a State in which osteomalacia is prevalent, from 8 to 16 units a day were recorded. The occurrence of the disease in nonpurdah individuals living in these regions may therefore be, to some extent, the result of a deficiency of calcium and/or phosphorus in the diet. I am, Sir, yours faithfully, T. A. HUGHES, M.D., M.R.C.P.,
Registrar, General Medical Council. 44, Hallam-street, London, W.1, June 4th, 1932.
UNDULANT FEVER
To the Editor of THE LANCET. SIR,—In view of the interest taken in undulant fever, and the work of Dr. C. P. Beattie and others, recently published in your columns, perhaps the following figures of Br. abortus incidence in milks in this area may be of interest. Between 1927 and 1931I examined for the presence of abortus agglutinin the sera of 760 guinea-pigs inoculated in this laboratory with milks (primarily for T.B.). The following are the results : 170 showed abortus
145 "
"
agglutinin at "
1 in 40 1 " 80
or
patientsand
beneficial, especially in the resistant
Professor of Clinical Medicine, Medical College, Lahore.
Bexhill, May 30th, 1932
higher =22’3% =19%
FREE TREATMENT AT VENEREAL CLINICS
"
To the Editor of THE LANCET. therefore 20 per cent. of these animals showed that they had been infected with Br. abortus, SIR,—With a practical experience of over 20 years but as the milks were nearly all mixed samples in venereal diseases, I heartily endorse all that Dr. the positive percentage might actually be higher. Wansey Bayly asserts in his letter to you. It is time Unfortunately I have but a small number of that some committee should be set up to review the controls-i.e., animals used for other purposes than whole position. The very object for which the milk inoculation. None of these showed a trace of Government voted large sums of money has been abortus agglutinin. Brucella was repeatedly isolated defeated. All and sundry flock to the clinics without from the glands, spleen, and heart blood of the fear or favour. Modern youths have no knowledge
Roughly
.
abortus agglutinin. Milk whey of the deterrents to promiscuous intercourse that shows the presence of abortus agglutinin, their fathers realised, with the result that instead of but this is no evidence of the actual presence of diminishing the incidence of venereal diseases is brucella in such milks. In a small number of whey- rising. As Dr. Bayly states, the venereal specialist positive milks I found just under half (45-4 per cent.) is facing ruin-and for whose benefit ? which gave no evidence of infection in the guineaI am, Sir, yours faithfully, M. W. BROWDY. pigs inoculated. London, W., June 4th, 1932. During the above period I examined 650 human I found sera for the presence of abortus agglutinin. To the Editor of THE LANCET. it in six cases : Once 1 in 20 only. Twice 1 in 80 SIR,—The adoption of the points of view expressed 140 1160 in the letter of Dr. Wansey Bayly would undoubtedly None of these persons was suffering from any disease lead to anti-social interference. If there is a group resembling undulant fever, and in only one case was of infectious diseases whose ravages are not limited there any history at all suggestive of a previous to any one section of the community, that group, infection. beyond question, is the venereal. It is true that venereal disease is preventable, but adequate prophyI am, Sir, yours faithfully, lactic teaching is not yet carried out-not even to A. H. PRIESTLEY, Bacteriologist to the Burnley Corporation. the extent of instruction of students of medicine. May 31st, 1932. Therefore, until this education is widely instituted, venereal disease cannot be said to be voluntarily animals
showing
frequently
,,
I
"
"
TREATMENT OF LATE RICKETS AND OSTEOMALACIA
To the Editor of THE LANCET. SIR,—Dr. D. C. Wilson’s finding that certain cases of osteomalacia in Northern India are benefited by the administration of tricalcium phosphate is in line with my experience in the treatment of this disease in the Mayo Hospital, Lahore. It was found that in some patients (none of whom had ever observed purdah), improvement was very slow or at times non-existent under treatment with vitamins A and D and sunlight, and it was assumed that the diet taken by these individuals did not contain sufficient calcium and/or phosphorus. During the past 18 months or so I have therefore been including calcium glycerophosphate in the treatment of
"
acquired. Dr. Bayly confuses two aspects of medicine : (1) the treatment of disease; (2) the income of doctors who make a living treating it. With regard first, it is in the interests of the nation that venereal disease be wiped out ; and for this simple human work treatment should be free. The second aspect can lead to alarming implications. For, carrying this to its logical conclusion, we come to the unavoidable position that it is in the interest of venereal specialists that venereal disease should not be exterminated. I do not suggest that doctors are guilty of wishing for this state of affairs, but it seems to me that we should resist any attempt to limit to the
1 Hughes, T. A., Shrivastava, D. L., and Malik, K. S.: Ind. Jour. Med. Res., 1931, xix., 593.
requirements, and of making the necessary arrangements to meet them. Every person who takes advantage of this opportunity will be expected to observe the conditions above indicated, and will be required to sign an undertaking to that effect. Inquiries by letter or telephone cannot be answered. I am, Sir, yours faithfully, NORMAN C. KING, in official
all osteomalacic
the results have been cases. The usual daily dose is grs. 30, but sometimes larger amounts, up to grs. 60 daily, are given. Whatever the initial state of the blood chemistry, which varies in different patients, improvement is always associated with a normal serum calcium and a serum inorganic phosphorus as high as that found in healthy infants and young children. It may be of interest to mention that the daily ultraviolet solar radiation in Lahore in the cold weather was found to be from 3 to 8 units by the acetonemethylene-blue gauge, the average being about 5. In the highlands of Kashmir, a State in which osteomalacia is prevalent, from 8 to 16 units a day were recorded. The occurrence of the disease in nonpurdah individuals living in these regions may therefore be, to some extent, the result of a deficiency of calcium and/or phosphorus in the diet. I am, Sir, yours faithfully, T. A. HUGHES, M.D., M.R.C.P.,
Registrar, General Medical Council. 44, Hallam-street, London, W.1, June 4th, 1932.
UNDULANT FEVER
To the Editor of THE LANCET. SIR,—In view of the interest taken in undulant fever, and the work of Dr. C. P. Beattie and others, recently published in your columns, perhaps the following figures of Br. abortus incidence in milks in this area may be of interest. Between 1927 and 1931I examined for the presence of abortus agglutinin the sera of 760 guinea-pigs inoculated in this laboratory with milks (primarily for T.B.). The following are the results : 170 showed abortus
145 "
"
agglutinin at "
1 in 40 1 " 80
or
patientsand
beneficial, especially in the resistant
Professor of Clinical Medicine, Medical College, Lahore.
Bexhill, May 30th, 1932
higher =22’3% =19%
FREE TREATMENT AT VENEREAL CLINICS
"
To the Editor of THE LANCET. therefore 20 per cent. of these animals showed that they had been infected with Br. abortus, SIR,—With a practical experience of over 20 years but as the milks were nearly all mixed samples in venereal diseases, I heartily endorse all that Dr. the positive percentage might actually be higher. Wansey Bayly asserts in his letter to you. It is time Unfortunately I have but a small number of that some committee should be set up to review the controls-i.e., animals used for other purposes than whole position. The very object for which the milk inoculation. None of these showed a trace of Government voted large sums of money has been abortus agglutinin. Brucella was repeatedly isolated defeated. All and sundry flock to the clinics without from the glands, spleen, and heart blood of the fear or favour. Modern youths have no knowledge
Roughly
.
abortus agglutinin. Milk whey of the deterrents to promiscuous intercourse that shows the presence of abortus agglutinin, their fathers realised, with the result that instead of but this is no evidence of the actual presence of diminishing the incidence of venereal diseases is brucella in such milks. In a small number of whey- rising. As Dr. Bayly states, the venereal specialist positive milks I found just under half (45-4 per cent.) is facing ruin-and for whose benefit ? which gave no evidence of infection in the guineaI am, Sir, yours faithfully, M. W. BROWDY. pigs inoculated. London, W., June 4th, 1932. During the above period I examined 650 human I found sera for the presence of abortus agglutinin. To the Editor of THE LANCET. it in six cases : Once 1 in 20 only. Twice 1 in 80 SIR,—The adoption of the points of view expressed 140 1160 in the letter of Dr. Wansey Bayly would undoubtedly None of these persons was suffering from any disease lead to anti-social interference. If there is a group resembling undulant fever, and in only one case was of infectious diseases whose ravages are not limited there any history at all suggestive of a previous to any one section of the community, that group, infection. beyond question, is the venereal. It is true that venereal disease is preventable, but adequate prophyI am, Sir, yours faithfully, lactic teaching is not yet carried out-not even to A. H. PRIESTLEY, Bacteriologist to the Burnley Corporation. the extent of instruction of students of medicine. May 31st, 1932. Therefore, until this education is widely instituted, venereal disease cannot be said to be voluntarily animals
showing
frequently
,,
I
"
"
TREATMENT OF LATE RICKETS AND OSTEOMALACIA
To the Editor of THE LANCET. SIR,—Dr. D. C. Wilson’s finding that certain cases of osteomalacia in Northern India are benefited by the administration of tricalcium phosphate is in line with my experience in the treatment of this disease in the Mayo Hospital, Lahore. It was found that in some patients (none of whom had ever observed purdah), improvement was very slow or at times non-existent under treatment with vitamins A and D and sunlight, and it was assumed that the diet taken by these individuals did not contain sufficient calcium and/or phosphorus. During the past 18 months or so I have therefore been including calcium glycerophosphate in the treatment of
"
acquired. Dr. Bayly confuses two aspects of medicine : (1) the treatment of disease; (2) the income of doctors who make a living treating it. With regard first, it is in the interests of the nation that venereal disease be wiped out ; and for this simple human work treatment should be free. The second aspect can lead to alarming implications. For, carrying this to its logical conclusion, we come to the unavoidable position that it is in the interest of venereal specialists that venereal disease should not be exterminated. I do not suggest that doctors are guilty of wishing for this state of affairs, but it seems to me that we should resist any attempt to limit to the
1 Hughes, T. A., Shrivastava, D. L., and Malik, K. S.: Ind. Jour. Med. Res., 1931, xix., 593.