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VACCINATION ON THE THIRD DAY
744 than
one
living
under better conditions.
district conditions
In this
distinctly bad, even for the country. The result is a drug-cost per prescription practically twice that for urban populations ; to take one example, grs. 10 or 15 of salicylate of soda are needed where I personally should use 7 t in a town. The explanation which knowledge of actual conditions prompts for these drug figures in my individual practice is borne out by other figures. In an insured population of about 650 there were in the same period 690 panel visits and 2140 panel consultations. Taking 40 per cent. as the number of patients one may expect to see in the year, this would give 690 visits and 2140 consultations to be divided between 260 people. are
This is 2-65 visits and 8-23 consultations for each of these 260 people ; or, if it assumed half were sick at home and half came to the surgery, 5-30 visits per person treated at home and 16.46 attendances at the surgery for persons treated there. The last figure is obviously too high ; clearly more than 260 insured persons were treated in the year ; and these figures, with a low visiting figure and a high consultation figure, show that people are doing what they should, and attending for treatment in the early stages of their illnesses. Treatment then, which means buying drugs for them, certainly lessens the severity of illness and probably lessens its duration, and may keep a man at work. If the man waits till he is too ill to work before seeking treatment the visiting figures go up and the drug figures do not go down, for it will take at least the same amount of drugs to put him right then as it would do to treat him if he seeks treatment when he should. In other words, the drug expenditure prevents a good deal of payment of sickness benefit by the approved societies. It would be worth while to correlate the figures of sickness benefit payments in the areas where drug costs are low with those in the areas where drug costs are high ; but, particular points like this apart, if I can account for my high drug costs by knowing what actual conditions here are, is it not possible that similar explanations may be available for the variations within England ? Sometimes" comparable areas " are not really comparable ; and I cannot remember to have seen an assessment of the whole cost of insured persons, including sickness benefit payment, for " comparable areas." I am, Sir, vours faithfully, C. T. NORRIS. Manea, March. Cambs., Sept. 21st, 1935. .
treasurer, book-keeper, architect, and
even a
priest.
all matters that cropped up were put before the committee and the opinion of everybody concerned was asked. Short discussion followed, and the final decision by the director-i.e., the chief physician-was declared and put in writing. Such
Questions
on
matters as canalisation, purchase of a new dynamo, church furniture, plans for the new buildings, all went to the committee for final decision.
all the years that I acted as assistant physician, chief physician and director, I cannot remember any dissatisfaction or any inefficiency. I have published a book (a copy of which may be found in the British Museum) about the administration of Imperial sanatoriums in Russia in 1913, and the conclusion is that in order to attain a high standard in medical institutions the doctor ought to be an administrator.-I am, Sir, yours faithfully, B. A. PEROTT. London, Sept. 21st.
During
VACCINATION
ON
To the Editor
of
THE THIRD DAY
THE LANCET
SIR,-Dr. Paterson is very dogmatic about the harmfulness of vaccination and circumcision in the first three weeks of an infant’s life. Coming as it does from an authority on children’s diseases, this pronouncement is bound to influence profoundly the action of would-be circumcisors and vaccinators, with the result that many infants will be left unvaccinated and uncircumcised until the necessity for one or both has been forgotten by the person interested in the welfare of the infant. One instance is hardly enough evidence to condemn the practice. In my own experience, amounting to nearly 800 cases of circumcision and vaccination performed within ten days of each other in the first three weeks, I have never had cause for regret. The Jewish race could hardly be so well established, and increasing, if early circumcision were detrimental; their method allows an almost bloodless operation to be carried out without anaesthetic or ligatures, an advantage that cannot be enjoyed by infants of riper months. In a similar way, vaccination performed during the first month (taking for granted that only one scarifica. tion is made) has the double advantage of a painless procedure and efficient care by the monthly nurse before she leaves the infant to the care of a nanny. I am, Sir, yours faithfully, AUBREY GOODWIN. Queen Anne-street, W., Sept. 19th. .
THE DOCTOR AS ADMINISTRATOR
To the Editor
of
THE LANCET
SiR,-It may be of interest to relate my practical experience in support of the view that the doctor ought to be an administrator, as this is the best way to bring full prosperity and success to any medical institution. I have held the position of not only chief physician but director of the Imperial sana-
AMOUNT OF HÆMOGLOBIN IN THE BLOOD To the Editor
of
THE LANCET
SIR, The paper from the medical unit at the London
Hospital in your issue of Sept. 21st will be most valuable to hsematologists. I have been for some time endeavouring to find a method of determining the percentage of haemoglobin that can be used by the general practitioner at the bedside. For this toriums in Russia. These sanatoriums covered a very more than 1500 acres. There were more purpose dilution methods are seldom practicable, big area, and it is important that the observations shall be made than a hundred buildings, including quarters for doctors, male and female nurses, and employees. on’ fresh blood. The Dare apparatus has the disadvantage that the We had our own church, electric station, water of the scale is much too steep. Furthermore, a and i station, post telegraph office, big farm, withgraduation it is originally expensive ; replacement of parts is more than fifty cows, poultry, and so on. Every department had its own head, but the whole even more so, and they have to be obtained from administration was governed by the chief physician. America. The chief difficulty about the Tallqvist Every week there was a committee meeting under method, which is clinically convenient, lies in the fact that there is a considerable difference in the tint of the chairmanship of the chief physician in his capacity different scales, some being too blue and others too as a director. The committee consisted of the doctors, assistants, heads of all departments, secretary, yellow. If however the comparison with the blood
:
one
living
under better conditions.
district conditions
In this
distinctly bad, even for the country. The result is a drug-cost per prescription practically twice that for urban populations ; to take one example, grs. 10 or 15 of salicylate of soda are needed where I personally should use 7 t in a town. The explanation which knowledge of actual conditions prompts for these drug figures in my individual practice is borne out by other figures. In an insured population of about 650 there were in the same period 690 panel visits and 2140 panel consultations. Taking 40 per cent. as the number of patients one may expect to see in the year, this would give 690 visits and 2140 consultations to be divided between 260 people. are
This is 2-65 visits and 8-23 consultations for each of these 260 people ; or, if it assumed half were sick at home and half came to the surgery, 5-30 visits per person treated at home and 16.46 attendances at the surgery for persons treated there. The last figure is obviously too high ; clearly more than 260 insured persons were treated in the year ; and these figures, with a low visiting figure and a high consultation figure, show that people are doing what they should, and attending for treatment in the early stages of their illnesses. Treatment then, which means buying drugs for them, certainly lessens the severity of illness and probably lessens its duration, and may keep a man at work. If the man waits till he is too ill to work before seeking treatment the visiting figures go up and the drug figures do not go down, for it will take at least the same amount of drugs to put him right then as it would do to treat him if he seeks treatment when he should. In other words, the drug expenditure prevents a good deal of payment of sickness benefit by the approved societies. It would be worth while to correlate the figures of sickness benefit payments in the areas where drug costs are low with those in the areas where drug costs are high ; but, particular points like this apart, if I can account for my high drug costs by knowing what actual conditions here are, is it not possible that similar explanations may be available for the variations within England ? Sometimes" comparable areas " are not really comparable ; and I cannot remember to have seen an assessment of the whole cost of insured persons, including sickness benefit payment, for " comparable areas." I am, Sir, vours faithfully, C. T. NORRIS. Manea, March. Cambs., Sept. 21st, 1935. .
treasurer, book-keeper, architect, and
even a
priest.
all matters that cropped up were put before the committee and the opinion of everybody concerned was asked. Short discussion followed, and the final decision by the director-i.e., the chief physician-was declared and put in writing. Such
Questions
on
matters as canalisation, purchase of a new dynamo, church furniture, plans for the new buildings, all went to the committee for final decision.
all the years that I acted as assistant physician, chief physician and director, I cannot remember any dissatisfaction or any inefficiency. I have published a book (a copy of which may be found in the British Museum) about the administration of Imperial sanatoriums in Russia in 1913, and the conclusion is that in order to attain a high standard in medical institutions the doctor ought to be an administrator.-I am, Sir, yours faithfully, B. A. PEROTT. London, Sept. 21st.
During
VACCINATION
ON
To the Editor
of
THE THIRD DAY
THE LANCET
SIR,-Dr. Paterson is very dogmatic about the harmfulness of vaccination and circumcision in the first three weeks of an infant’s life. Coming as it does from an authority on children’s diseases, this pronouncement is bound to influence profoundly the action of would-be circumcisors and vaccinators, with the result that many infants will be left unvaccinated and uncircumcised until the necessity for one or both has been forgotten by the person interested in the welfare of the infant. One instance is hardly enough evidence to condemn the practice. In my own experience, amounting to nearly 800 cases of circumcision and vaccination performed within ten days of each other in the first three weeks, I have never had cause for regret. The Jewish race could hardly be so well established, and increasing, if early circumcision were detrimental; their method allows an almost bloodless operation to be carried out without anaesthetic or ligatures, an advantage that cannot be enjoyed by infants of riper months. In a similar way, vaccination performed during the first month (taking for granted that only one scarifica. tion is made) has the double advantage of a painless procedure and efficient care by the monthly nurse before she leaves the infant to the care of a nanny. I am, Sir, yours faithfully, AUBREY GOODWIN. Queen Anne-street, W., Sept. 19th. .
THE DOCTOR AS ADMINISTRATOR
To the Editor
of
THE LANCET
SiR,-It may be of interest to relate my practical experience in support of the view that the doctor ought to be an administrator, as this is the best way to bring full prosperity and success to any medical institution. I have held the position of not only chief physician but director of the Imperial sana-
AMOUNT OF HÆMOGLOBIN IN THE BLOOD To the Editor
of
THE LANCET
SIR, The paper from the medical unit at the London
Hospital in your issue of Sept. 21st will be most valuable to hsematologists. I have been for some time endeavouring to find a method of determining the percentage of haemoglobin that can be used by the general practitioner at the bedside. For this toriums in Russia. These sanatoriums covered a very more than 1500 acres. There were more purpose dilution methods are seldom practicable, big area, and it is important that the observations shall be made than a hundred buildings, including quarters for doctors, male and female nurses, and employees. on’ fresh blood. The Dare apparatus has the disadvantage that the We had our own church, electric station, water of the scale is much too steep. Furthermore, a and i station, post telegraph office, big farm, withgraduation it is originally expensive ; replacement of parts is more than fifty cows, poultry, and so on. Every department had its own head, but the whole even more so, and they have to be obtained from administration was governed by the chief physician. America. The chief difficulty about the Tallqvist Every week there was a committee meeting under method, which is clinically convenient, lies in the fact that there is a considerable difference in the tint of the chairmanship of the chief physician in his capacity different scales, some being too blue and others too as a director. The committee consisted of the doctors, assistants, heads of all departments, secretary, yellow. If however the comparison with the blood
: