VOLUNTARY AID DETACHMENTS.

PLAGUE AMONG

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Correspondence. I’ Audi alteram

partem."

EUROPEANS. movement. For the success of this work the society has to thank many, and above all the medical men of the country, who have so generously given their assistance. I am, Sir, yours faithfully. FREDERICK TREVES, Chairman of the Executive Committee

PLAGUE

AMONG

EUROPEANS.

To the Editor of THE LANCET. SIR,—There seems to be a general impression that plague could not possibly become epidemic among Europeans. As this is likely to lead to viewing the spread of plagueinfected lower animals over different parts of the country with comparative complacency, I send you the figures which I submitted to the Colonial Office in May of 1901 regarding the plague outbreaks in Cape Town two months before the lastcase.

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Victoria-street, London, S.W., Nov. 10th, 1910.

MEDICAL ETHICS AND MEDICAL ETIQUETTE To the Editor of THE LANCET. book on the subject of " Medical Etiquette," by Dr. Surbled of Paris, which has just been translated by Dr. W. P. Grant, and for which, by desire of the author, I wrote a brief preface, I find to my great regret that the excellent lectures of my friend Professor Saundby, which he published in 1902 (second edition in 1907), had quite escaped my memory when I referred to the absence of any recent English literature on the subject. Dr. Saundby’s book on " Medical Ethics " is an admirable one. T am- Sir. vonrs fait.hfnllv. DYCE DUCKWORTH. Nov. S.W., 12th, 1910. Grosvenor-place,

SIR,—In

a

Cape Town with its suburbs is a comparatively small town. Rats had died a very considerable time before the outbreak, and when the epidemic began there were very few rats to be seen. The close connexion between rat plague and human plague was only accepted in a half-hearted manner THE FERTILITY OF THE UNFIT. -until there was a succession of cases in which dead rats were found in the houses, and in one particularly which was badly To the Editor of THE .LANCET. infected where 105 dead rats were found under the floor and SIR,—Many writers and speakers take an unfavourable, behind the wainscot and panelling. There is also another and some an alarmist, view of the prospects of maintaining impression that plague behaves always in the same way, and the vigour of our race. This is illustrated by a discussion at that because there was a small percentage of pneumonic the recent Church Congress. The unfit, we are told, are cases in India and Cape Town, whilst in Sydney until increasing faster than the fit elements of the population. recently there were no pneumonic cases at all, therefore Mrs. Pinsent of Birmingham is reported to have said that a small percentage of pneumonic cases is a law of the efforts to improve the race by ameliorating the environment disease. In 1908 on the Gold Coast there were both bubonic are futile. They only serve to perpetuate the evil conditions and pneumonic cases of plague, and instead of 4 to 8 per which they aim at removing. Heredity, it is averred, will cent. of pneumonic cases there was over 50 per cent. always beat environment into a cocked hat. A journalistic Until England can deal effectively with her influenza placard announces The Fatal Fertility of the Poor." The epidemics she cannot afford to sit down and not deal birth-rate among mentally defective persons is declared to be vigorously with the plague-infected lower animals in Suffolk high, whilst that of the middle and upper classes is artificially in the hopes that nothing may happen. She may be right ; limited. The last statement rests unhappily on a solid basis And the wisest course of statistics and of common experience, and I do not deal on the other hand, she may be wrong. is to treat the rat plague as the plague, and bring every with it here. available force to bear to get it out of the land. But statistics on the fertility of the mentally and physically I am, Sir, yours faithfully. defective portion of the population are not easy to obtain. W. J. SIMPSON, M.D. Those who have watched the working of natural laws have King’s College, Nov. 15th, 1910. reason for believing that Nature is always trying to improve the breed and to eliminate defects. From a study of VOLUNTARY AID DETACHMENTS. pedigrees and long observation of families I am inclined too To the Editor of THE LANCET. Such improvement is effected partly agree with this view. SIR,—Lieutenant-Colonel A. C. Yate in his communica- by mixing with healthier stocks, partly by sterilising those tion on the above subject is not fortunate in his comments which are defective below a certain standard. The sterilisaupon the British Red Cross Society. He says that almost all tion must be looked for, not in one generation only, but in the members of the voluntary aid detachments raised by the two or three ; that is to say, that if the pedigree of a society hold the St. John Ambulance Association certificate. defective person is traced, then either by combining with That is true ; but he omits to add that until August 8th, better strains the succession is maintained and the defect 1910, that certificate was, by an existing arrangement now gradually eliminated, or, if the defect is too great or the abandoned, the only one available for the purpose. The new stocks are also defective, the progeny dies out in one, In the words of Dr. F. W. Mott, detachments referred to were for the most part raised before two. or three generations. August, 1910, as Lieutenant-Colonel Yate must be aware. dealing with the inheritance of a tendency to insanity, "As Since that date the War Office has recognised a large series a rule, there is either a regression to the normal or the stock of certificates in first aid and among them the certificates dies out." of the county councils. It will follow from this that the Thus the unfit disappear, and the fit prevail. It will be preponderance of the St. John certificate will be much less said these are only general impressions. Yet are they not consistent with the experience of breeders of animals, with conspicuous in the future. Your correspondent states that the society has undertaken the conditions of the struggle for existence, and with a to provide two things-viz., a manual of instruction and an tendency to be traced all through vital phenomena for the inspecting staff. The manual employed by the society is the survival of the fittest ? But it is said that we have altered "Manual of the Royal Army Medical Corps,"which can be the conditions in whicb Nature is working by preserving alive obtained for 9d. A special manual has been prepared for many unfit who would have died, and by so caring for their the society by Mr. Cantlie and is ready for the printers as welfare as to enable them to increase in the community, and soon as it has received the sanction of the War Office. The that in this manner the efforts of philanthropy and the kindsociety never undertook to provide an inspecting staff, nor ness of modern civilising agencies in reality tend to the even contemplated such a provision. The organising deterioration of the race. This is a serious statement, and secretary of the society, Colonel J. Magill, C.B., undertakes can only be fully met by facts and statistics which to advise as to the formation of detachments in any district are not as yet available, but to some of which I and has done a great deal of work under that head. will allude presently. In the meantime, two consideraYour correspondent complains of the " prodigious " number tions may be advanced. In the first place, the sum of forms issued by the society. The form dealing with the total of modern efforts to improve the welfare of all whole subject under notice is one in number-viz., Form D. classes of the community, by which the unfit are made less The work of the British Red Cross Society, in raising unfit and the fit made fitter, should surely tend to help and detachments throughout the country, is proceeding rapidly not to hinder the progress of the race as a whole. Secondly, and with an enthusiasm worthy of so humane and patriotic a to enter into more detail, with regard to those who were born