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shows that the " vertebral " contact of the pancreas

is almost as direct as the heart’s "sternal" contact,whilst his statement confirms the experience of

pathologists that swelling of the gland (sometimesmuch swelling) is the rule at the early stage. The

sequel, qud localisation, is largely governed by thedecubitus, which is inevitably dorsal. Any fluidcollections, whether cystic, heamorrhagic, or

purulent, inevitably seek the dorsal plane of thethoracic and of the lumbar spinal groove, in closeapproach to the dorsal surface. In that mechanical

predicament, if we should have any use for evidencefrom physical signs, these might more probably befound in the safe exploration of the unconcerneddorsal field than in the danger zone of a tender andbadly implicated abdomen, even though, as is some-times reported, this should not be at first tumefied.To that statement there is nothing this letter can add,but to ask, Why should we strain to percuss at a peri-cardial effusion, happily seldom now fatal, nay, oftenapt to be a merely ephemeral rheumatic episode ?Why percuss the liver for congestion, or cyst, orabscess if the deadly risks of pancreatitis and of itsoperations are not an urgent appeal for physicalsigns when available ? Granted that Britishmedicine may not be singular in that lofty indiffer-ence for the aid of physical examination (wherecan this be harmlessly applied except at the back?);that safety " in numbers " adds none to the patient.He is diagnosed-normally after death; not infre-quently by the operation; rarely without it; butit would seem never by any examination for hisdorsal physical signs, which keep faith with him tothe grave. I am, Sir, yours faithfully,Upper Brook-street, W., Jan. 8th, 1915. WILLIAM EWART.WILLIAM EWART.

FROST-BITE.To the Editor of THE LANCET.

SIR,-In Mr. A. W. Mayo-Robson’s opportune articleon Frost-bite in THE LANCET of Jan. 16th I note thathe does not suggest any internal medication, andthat for prevention he only urges care of the feetand legs in various ways. In view of the analogy,pointed out by himself, between mild frost-bite andchilblains, I would like to ask whether he or anyreader of THE LANCET has tried calcium salts forprevention or cure of frost-bite. Since two days’medication with liquor calcii chloridi, ni 60 in all,proves almost a specific for chilblains, the factsuggests the possibility of its usefulness, either forprophylaxis or treatment of the graver trouble.Moreover, calcium favours the coagulation of theblood if wounds are also incurred. The lactatewould be more convenient under war conditions,and is reputed about as efficacious if fresh.

I am, Sir, yours faithfully,FRANCES EDE, L.S.A.

Upper Berkeley-street, W., Jan. 18th, 1915.FRANCES EDE. L.S.A.

THE TREATMENT OF COMPOUND GUN-SHOT FRACTURES OF LONG BONES.

To the Editor of THE LANCET.

SiR,—I was glad to see in THE LANCET ofJan. 16th that you have drawn attention to thedoubts at present subsisting as to the best treat-ment of compound fractures of the long bonesoccurring on the field of battle and caused bybullets or shells. The matter to be decided is byno means easy, and we shall be, as you say, in amuch better position to settle these questions atthe end of the war, when all the statistics will be

available to which the war will give rise ; but thematter is urgent, and the medical department ofthe army with its civil consulting surgeons will do -well to give the matter immediate attention. Myobject, however, is not so much to insist on theimportance of a consideration of the general treat-ment of these serious conditions, but to expressmy personal opinion as to the undesirability ofever plating or wiring any of these compoundfractures. In civil practice, with all the facilitieswhich are afforded by well-found hospitals, it hasgradually come to be recognised by most surgeonsthat compound fractures should never be wired orplated. This opinion has been of only slow growth;for a long time it was felt that, as in a compoundfracture the bone was already exposed, the surgeonwas more readily justified in applying a plateimmediately than in a simple fracture ; but theresults of this practice have shown that almostinvariably compound fractures plated immediatelydo badly, and sooner or later the plate has to beremoved. If such unsatisfactory results are almostcertain in peace time, how can we expect betterresults when the operation has to be performedunder greater difficulties, and in wounds probablymuch more septic than commonly found in civilpractice, and when, further, a greater length oftime has elapsed since the infliction of the injury ?Moreover, the need to remove the plate later isonly the least of the evils which may follow thismethod of treatment. It may lead to loss of thelimb or even loss of life itself. I am writing withno personal knowledge of the work on the otherside of the Channel, but I have heard that suchattempts have been made, and I feel strongly thatthese heroic attempts to obtain perfect results mayoften lead to utter failure and loss of life or limb.Will not some of those who have seen wiring andplating of compound fractures in this war tell usdefinitely what results have been obtained? Weshall all receive the information gratefully, and,provided care is taken to make the statistics correct.such information must prove of great benefit tous all.

I am, Sir, yours faithfully,Jan. 18th, 1915.

____ ____

F.R.C.S.

"TENDIMUS HUC OMNES."

To the Edit"". of THE LANCET.

SiR,—Under this heading there appeared inTHE LANCET of Jan. 9th a letter from " A. M. D."criticising the prevalent impression that the loss oflife among soldiers in war time greatly exceedsthat which is experienced by non-combatants inthe civil population. Your correspondent quotesthe statement of Mr. E. B. Phelps, editor of theAmerican Underwriter, who in an essay on loss oflife in time of war expresses the opinion that thesoldier’s dangers in war time, ominous though theybe, "are really but little greater than are thecivilian’s dangers of dying before he has had timeto set aside the necessary nest-egg for hisdependents." This essay contains a table showingthe average mortality among combatants in theprincipal wars of the last half century, and inrelation thereto the average mortality prevailing in

, the entire population of the American United States. in the year 1914.

After carefully reading this essay I would joinissue with " A. M. D." in the inference which, withouti reference to the context, he draws from Mr. Phelps’si figures. In all statistical investigations absolute

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comparability of the data involved is an indis-pensable condition, but in the present instance thisprecaution appears to have been neglected. It isfamiliar knowledge that the army consists exclu-sively of picked men, chosen from their fellows afterstrict medical examination, the health and physiqueof the troops after enlistment having been raisedas far as practicable by careful training as well asby suitable feeding and exercise and by hygienicenvironment. We cannot compare the vitality ofsuch troops with that of the general community,which includes large proportions of paupers,criminals, and other undesirable units, as well asof invalids and lunatics whose vitality and powerof resistance to disease are manifestly inferior.The common impression, which attributes excep-tional loss of life to the forces engaged in modernwarfare, is the right impression. " A. M. D." con-cludes by offering helpful counsel to the host of prob-able sufferers from the present war in the event ofits long continuance. He emphasises the dutyincumbent on every man, whether civilian or com-batant, to make provision for his family againstthe possibility of his premature demise. In a

campaign of the present dimensions seriouscasualties are inevitable ; but of the privation anddistress thereby caused neither the incidence northe intensity can possibly be foreseen. The desira-bility of securing the needful protection by meansof life assurance is one of the significant lessons ofthe existing European conflict.

I am, Sir, yours faithfully,Jan. 18th, 1915. MEDICAL STATISTICIAN.

Obituary.JOHN ROBINSON, L:R.C.P. EDIN., L.F.P. & S. GLASG.

THE recent death of Mr. John Robinson, of

Runcorn, removes a distinct personality. He was

greatly beloved and respected by those among whomhe worked, and was typical of a class which wouldbe styled old-fashioned and out of date by thepresent generation. Transfer Ian Maclaren’s Dr.Maclure from the Highlands to Runcorn, and sub-stitute the bargees of Mr. Jacobs for crofters, andthe characters are identical. ’His manner of dresswould have been eccentric if worn by another;winter and summer a short, thick, double-breastedpilot cloth coat, buttoned up to the chin, affordedno opportunity for the display of linen, for whichJohn Robinson had no use. He wore no heels onhis boots. His head was covered with a shaggythick crop of iron-grey hair, and he was quiteunconscious that his appearance differed from theman in the street.Having served an apprenticeship before com-

mencing his scientific studies, he believed that thepractical experience and knowledge of humannature acquired during this period was of infinitelymore value than the preliminary scientific studiesof the medical student to-day. His day’s work,year in and year out, was not interrupted byweek-ends and holidays, for which he felt noneed. Busy morning and evening with surgerywork and plenty of it, with long rounds inthe afternoons, Sundays and Bank Holidays notexcepted, he was ready at any moment to tacklea case of difficult labour, to fight a pneu-monia, or perform an operation for strangulatedhernia, for his clients could not afford the luxury of

a specialist and his work had to be done withthe assistance of a brother practitioner andthe district nurse. Instead of the appointmentsof an up-to-date surgical theatre, his operationroom was often the bedroom in a cottage.A correspondent writes : " He once showed me

a knife carried among other miscellanies inhis pocket with which he had done 20 hernias.I asked him how many of the patients haddied; he retorted not more than the averageof a city hospital." His recreation was gardening,and he regularly read his Greek Testament,Thus his life work was done day in and dayout, assisting arrivals and easing departures, prac-tising his profession as a vocation, not as a meansof gaining wealth. He used his power to help andhis skill to advise those among whom his life worklay. John Robinson would be more than contentwith the respect and affectionate memories of hisfriends, workers in humble spheres, rather thanthat of the so-called upper classes.

HUGH WARNOCK, M.R.C.P.IREL., J.P.Mr. Hugh Warnock, who died recently at his

residence, Clogher, co. Tyrone, as the result of anattack of cerebral hoemorrhage, was a native of theDromore district of co. Tyrone. For the past 38years he practised in Clogher, where he was dis-pensary medical officer and medical officer of health.He was also medical attendant at the workhouse

hospital for the past 13 years, and a magistrate forco. Tyrone. A skilful practitioner of medicine, athorough man of business, and generally popular,Mr. Warnock will be very much missed.

ETHEL FRANCES LAMPORT, M.D. BRUX., L.S.A.WE regret to learn that Dr. Ethel Frances

Lamport died very suddenly on Dec. 27th, 1914,whilst driving to church. Miss Lamport enteredthe London Hospital as a probationer in 1884, andafter completing her training was made sister ofone of Sir Frederick Treves’s wards, a post whichshe held for several years. After leaving theLondon Hospital Miss Lamport took the diploma ofsanitary inspector and then decided to studymedicine, entering the London (Royal Free Hospital)School of Medicine for Women in 1891. On qualifyingDr. Lamport at once returned to the East-end ofLondon and began to practise in Bow, where sheworked unremittingly for over 11 years for the im-provement of the physical and social conditions ofthe women and children who came under her care.She also held the post of public vaccinator inMillwall (Isle of Dogs) for 10 years. When failinghealth made it impossible for Dr. Lamport to con-tinue her arduous life of work amongst the sickpoor, she retired to Well Manor, near Long Sutton,Hampshire, where she quickly endeared herself toher neighbours by her genial manner and the

kindly interest she took in them. Dr. Lamportwill long be remembered in Bow and Poplar for herunselfish devotion to the sick poor in thosedistricts.

ROYAL COLLEGE OF SURGEONS OF ENGLAND.-At a meeting of the Council of the College held on Jan. 14ththe diploma of M. R. C. S. was conferred upon Mr. StephenAbraham Liebson, of Guy’s Hospital, and licences to prac-tise dental surgery were granted to Mr Percy Gordon BarlowGriffin, of Liverpool University, and Mr. Harry AustinHutson, of Middlesex and National Dental Hospitals, all ofwhom have complied with the regulations.