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UNINFORMED CRITICISM?
1219 think that there is every reason to believe that the red cells themselves play an essential part in the as indicators, and that any avoidable interference with the blood is to be
test, not merely acting
deprecated.
that I am dealing here with matters but I feel that due credit should of opinion, largely be given to the standard technique of the sedimentation-rate, which I still think an excellent test and remarkably devoid of pitfalls when a proper technique is used. I am, Sir, yours faithfully, J. W. SHACKLE. I
am aware
Red Cross Clinic for Rheumatism, Peto-place, N.W., Nov. 15th.
trace of silicosis even after employment for many years in occupations which have produced many casesof silicosis. Since 1930, out of 189 such cases no evidence of silicosis was found in 122 and only very slight traces of silicosis in 67. The industries concerned are the pottery industry
140, sandstone industry 21, sandblasting 6, refractories metal grinding 5, and other industries 11.
industry 6,
The average age at death in these cases was 51-9 years and the average duration of employment 29-5 years, the longest being 60 years. This is an interesting and significant fact, since negative evidence of this character cannot fail to be of value when idiosyncrasy and selectivity It seems difficult to are attracting so much attention. explain in the case of workers exposed to siliceous dust, presumably of the same concentration of silica in the air, how and why certain of them should have escaped the effects of the dust. We have yet much to learn to explain this phenomenon." ’
UNINFORMED CRITICISM?
To the Editor ,
of
THE LANCET
SiR,-In the November number of the Practitioner I published what I thought to be an innocuous enough article on the causes of lack of progress at school and their treatment. Immediately after its appearance some of my remarks were quoted with varying degrees of prominence and accuracy in the daily press. So far so good. This was all good clean fun, except that criticisms of teachers were implied that I never made. But I now receive extracts from various provincial papers in which no less a person than Mr. R. J. Patten, president of the National Union of Teachers, criticises my statements. Amongst other comments he is reported as saying : "It is quite obvious Dr. Neustatter knows very little about the insides of our schools to-day or he would not refer to’good floggings,’ ’sarcasm,’ andmaking a child look ridiculous’ as methods of discipline generally in vogue." Actually I have been a part-time school medical officer for three and a half years to elementary and M.D. schools, and I never stated that flogging, I gave one were in general vogue now. sarcasm, &c., instance of a headmaster advocating a good flogging, and this remark was made to me. Mr. Patten also says that the teacher who " sees far more of the child than any hospital doctor " is well aware of the effect of physical conditions (malnutrition, overcrowding) on the child. I would be the first to admit this, and a quarter of my article But I had public was devoted to physical causes. as well as council school-children in mind when writing. This brings me to the point. It does seem amazing that anyone in a responsible position should make a public criticism on hearsay statements, obviously without first having verified them by looking at the original article. As I am not at liberty to reply in the lay press, I am seeking the hospitality of your columns. I am. Sir. vours faithfully. W. LINDESAY NEUSTATTER. Nov.
9th.
Devonshire-place, W., Nov. 9th. SILICOSIS
To the Editor
of THE
LANCET
SIR,—In your report of the presidential address to the Hunterian Society on Oct. 18th last there is a reference to silicosis in which it is suggested that autopsies on many cases certified as having died from this disease revealed no trace of it, the authority quoted being the annual report of the Chief Inspector of Factories. The relevant paragraph is to be found on p. 55 of this annual report (published in 1937) :— " It has been noted from the information received concerning
deaths
alleged
to be due to silicosis that the
post-mortem examination has sometimes revealed
no
The proper inference to be drawn from this report would appear to be, not that a diagnosis of silicosis is often made which is disproved by subsequent post-mortem examination, but that it is a curious and so far inexplicable fact that many persons can work for many years in an atmosphere containing siliceous dust without contracting this disease. I am, Sir, yours faithfully, DONALD C. NORRIS. City-road, E.C., Nov. 13th. PRESCRIPTIONS BY DRUGGISTS
To the Editor
of
THE LANCET
SIR,—The other day, while waiting to buy some tooth-paste in a druggist’s shop, I listened to a middle-aged woman who complained to the dispenser of some dyspeptic symptoms. He was tactful and sympathetic, confidently advised a well-known alkaline preparation, and gave exact details as to just how it was to be taken. Very impressive ; and very The that this woman has a chances reassuring. cancer, or a psychoneurosis, or anything that matters may be remote. But all the learning of the Royal Colleges could not decide so in a couple of minutes’ conversation. This is the third time within a year that I have observed pharmacists prescribing for customer’s symptoms. Of course the whole question of patent medicines is very difficult, though its ostrich-like attitude does the profession little credit. But surely the risk of such abuses makes a review of the present highly unsatisfactory position very I am, Sir, yours faithfully, urgent. m . TT T AND H. Nov. 13th. -
-
_
LYMPHOGRANULOMA INGUINALE IN THE FEMALE
of THE LANCET SIR,—The two cases of inflammatory stricture of the rectum, due to infection with the virus of lymphogranuloma inguinale, described in your last issue by Dr. Norman Whittaker are of considerable interest as typical examples of a condition which may escape correct diagnosis unless borne in mind. Members of the medical profession have been very slow in accepting the true aetiology of the several To the Editor
manifestations of this virus infection since their attention was first directed to the subject in this country by a paper read before the Royal Society of Medicine on Oct. lst, 1932, and subsequently by a book entitled " A Sixth Venereal Disease," published in 1933, a work with which Dr. Whittaker is apparently unfamiliar, but in which the pathogeny and relationship of the several manifestations of the infection to each other was exposed. Some of Dr. Whittaker’s statements need modification to be quite
test, not merely acting
deprecated.
that I am dealing here with matters but I feel that due credit should of opinion, largely be given to the standard technique of the sedimentation-rate, which I still think an excellent test and remarkably devoid of pitfalls when a proper technique is used. I am, Sir, yours faithfully, J. W. SHACKLE. I
am aware
Red Cross Clinic for Rheumatism, Peto-place, N.W., Nov. 15th.
trace of silicosis even after employment for many years in occupations which have produced many casesof silicosis. Since 1930, out of 189 such cases no evidence of silicosis was found in 122 and only very slight traces of silicosis in 67. The industries concerned are the pottery industry
140, sandstone industry 21, sandblasting 6, refractories metal grinding 5, and other industries 11.
industry 6,
The average age at death in these cases was 51-9 years and the average duration of employment 29-5 years, the longest being 60 years. This is an interesting and significant fact, since negative evidence of this character cannot fail to be of value when idiosyncrasy and selectivity It seems difficult to are attracting so much attention. explain in the case of workers exposed to siliceous dust, presumably of the same concentration of silica in the air, how and why certain of them should have escaped the effects of the dust. We have yet much to learn to explain this phenomenon." ’
UNINFORMED CRITICISM?
To the Editor ,
of
THE LANCET
SiR,-In the November number of the Practitioner I published what I thought to be an innocuous enough article on the causes of lack of progress at school and their treatment. Immediately after its appearance some of my remarks were quoted with varying degrees of prominence and accuracy in the daily press. So far so good. This was all good clean fun, except that criticisms of teachers were implied that I never made. But I now receive extracts from various provincial papers in which no less a person than Mr. R. J. Patten, president of the National Union of Teachers, criticises my statements. Amongst other comments he is reported as saying : "It is quite obvious Dr. Neustatter knows very little about the insides of our schools to-day or he would not refer to’good floggings,’ ’sarcasm,’ andmaking a child look ridiculous’ as methods of discipline generally in vogue." Actually I have been a part-time school medical officer for three and a half years to elementary and M.D. schools, and I never stated that flogging, I gave one were in general vogue now. sarcasm, &c., instance of a headmaster advocating a good flogging, and this remark was made to me. Mr. Patten also says that the teacher who " sees far more of the child than any hospital doctor " is well aware of the effect of physical conditions (malnutrition, overcrowding) on the child. I would be the first to admit this, and a quarter of my article But I had public was devoted to physical causes. as well as council school-children in mind when writing. This brings me to the point. It does seem amazing that anyone in a responsible position should make a public criticism on hearsay statements, obviously without first having verified them by looking at the original article. As I am not at liberty to reply in the lay press, I am seeking the hospitality of your columns. I am. Sir. vours faithfully. W. LINDESAY NEUSTATTER. Nov.
9th.
Devonshire-place, W., Nov. 9th. SILICOSIS
To the Editor
of THE
LANCET
SIR,—In your report of the presidential address to the Hunterian Society on Oct. 18th last there is a reference to silicosis in which it is suggested that autopsies on many cases certified as having died from this disease revealed no trace of it, the authority quoted being the annual report of the Chief Inspector of Factories. The relevant paragraph is to be found on p. 55 of this annual report (published in 1937) :— " It has been noted from the information received concerning
deaths
alleged
to be due to silicosis that the
post-mortem examination has sometimes revealed
no
The proper inference to be drawn from this report would appear to be, not that a diagnosis of silicosis is often made which is disproved by subsequent post-mortem examination, but that it is a curious and so far inexplicable fact that many persons can work for many years in an atmosphere containing siliceous dust without contracting this disease. I am, Sir, yours faithfully, DONALD C. NORRIS. City-road, E.C., Nov. 13th. PRESCRIPTIONS BY DRUGGISTS
To the Editor
of
THE LANCET
SIR,—The other day, while waiting to buy some tooth-paste in a druggist’s shop, I listened to a middle-aged woman who complained to the dispenser of some dyspeptic symptoms. He was tactful and sympathetic, confidently advised a well-known alkaline preparation, and gave exact details as to just how it was to be taken. Very impressive ; and very The that this woman has a chances reassuring. cancer, or a psychoneurosis, or anything that matters may be remote. But all the learning of the Royal Colleges could not decide so in a couple of minutes’ conversation. This is the third time within a year that I have observed pharmacists prescribing for customer’s symptoms. Of course the whole question of patent medicines is very difficult, though its ostrich-like attitude does the profession little credit. But surely the risk of such abuses makes a review of the present highly unsatisfactory position very I am, Sir, yours faithfully, urgent. m . TT T AND H. Nov. 13th. -
-
_
LYMPHOGRANULOMA INGUINALE IN THE FEMALE
of THE LANCET SIR,—The two cases of inflammatory stricture of the rectum, due to infection with the virus of lymphogranuloma inguinale, described in your last issue by Dr. Norman Whittaker are of considerable interest as typical examples of a condition which may escape correct diagnosis unless borne in mind. Members of the medical profession have been very slow in accepting the true aetiology of the several To the Editor
manifestations of this virus infection since their attention was first directed to the subject in this country by a paper read before the Royal Society of Medicine on Oct. lst, 1932, and subsequently by a book entitled " A Sixth Venereal Disease," published in 1933, a work with which Dr. Whittaker is apparently unfamiliar, but in which the pathogeny and relationship of the several manifestations of the infection to each other was exposed. Some of Dr. Whittaker’s statements need modification to be quite