1
317 Registrarship, but would not for one moment think of ac- cepting the Assistant Registrarship. When will the graduates of the University of London en masse approach the Government of the day, and request to be allowed to govern their own University ? Surely that time has now arrived, or are we always to be legislated for by a Senate the majority of whose members have nothing in common with, are not representative of, and do not care a straw for the interests of, the graduates, as evidenced most pointedly by the appointments to the Assistant- Registrarship and Registrarship of the University ? The Senate of the University of London requires re- constitution even much more than does the Medical Council. I am, &c., Feb. 22nd, 1879. A LONDON GRADUATE. CONSULTATIONS IN LUNACY. W. F. WADE, F.R.C.P. To the Editor of THE LANCET. SIR,—I find from an article on "Lunacy Reform" in your current number that you are of opinion that the signers of lunacy certificates are " legally deprived of the advan- tages of consultation." It follows, of course, that the lunatic is also by law deprived of advantages which, if he were only suffering from jaundice or gravel, he could secure without let orhindrance. I do not know what may be the habits and customs of metropolitan practitioners, but I can assure you from considerable experience that in this part of the country consultations in lunacy are conducted just like other consultations. The consultant hears from his colleague the history of the case, a conjoint examination of the patient and, subsequently, a discussion as to the diagnosis and treatment follow. Now the question arises, whether, in pursuing this course, we are infringing the Lunacy Acts. After a careful re- examination of them, I am distinctly of opinion that we are not. What these Acts require is that, over and above the usual steps taken in ordinary diseases to ascertain the facts and arrive at an opinion, we shall, if that opinion be that the patient should be deprived of his liberty, further take the precaution of examining the patient separately from each other. This re-examination is calculated to secure the patient a last chance of demonstrating his sanity, and it insures further that the opinion arrived at should be not a joint but a several opinion also. I remain, Sir, yours, &c., Birmingham, Feb. 24th, 1879. W. F. WADE, F.R.C.P. THE CONTAGIOUS DISEASES ACTS. To the Editor of THE LANCET. SIR,—I read with great interest your article on the above subject, in THE LANCET of February 1st, and, if you will allow me, I should like to make a few remarks on Surgeon- General Balfour’s letter of the following week regarding it. I quite agree with him that it would be better to make no distinction between cases of disease contracted in and ont of a district, and by so doing to prove a less satisfactory diminution in their number, than, by deducting the latter class, to present untrustworthy returns ; but, with all deference to his very large experience, I must beg to differ from him in this respect, and to maintain that the deduction of diseases contracted out of a district is not only little liable to inaccuracy, but is really necessary to give a fair estimate of the effects of the Acts in a protected district. Dr. Balfour refers to Windsor especially as one of the stations in which careful inquiry had led himself and others to doubt the accuracy of the men’s statements ; but, after being quartered here on several occasions, my experience leads me to a very different conclusion, and I have always maintained that it is at Windsor especially, of all stations, in proportion to the smallness of its garrison, where the most useful facts can be obtained-provided that allowance is made for diseases contracted out of the district-in conse- quence of the half-yearly changes between London and Windsor, and the rapid diminution of disease in the latter station. I certainly cannot recall to my mind any instance of a man making a false statement of the kind: nor should I record his disease as contracted out of the district unless he had just returned from leave of absence; and the inspector of police informs me that the men are very ready to give all the evidence they can for the detection of the woman, though sometimes it is necessarily very meagre. Allowing, however, the possibility of an occasional, wilful, or accidental mis-statement on the part of the men, this is far more than counterbalanced by cases of disease recorded, on the statement of the men, as contracted in Windsor, which have been given by women who, living in the outskirts, thus escape the supervision of the police. This is one of the difficulties the police have to contend with here, but fortunately soldiers keep pretty well to their regular haunts, and these are seldom far removed from their barracks. Again, how can it be fair, as you have well stated in your article, to include in the statistics of protected districts the admissions of soldiers soon after their arrival from London, where specific disease is so prevalent amongst them ? Surely not ; and as the change of quarters to Windsor takes place twice a year, these early admissions alone would make a considerable difference. In conclusion, I cannot see sufficient reason why, with every desire to avoid incorrect statements, diseases con- tracted out of a protected district should not be separated from the other class ; and though such deduction is not re- quired to prove a considerable diminution of disease in pro- tected districts, it appears to me to be an essential one in order to obtain a true estimate of the effects of the Acts. I am, Sir, yours &c., I Windsor, February 10th, 1879. A. B. R. MYERS, Surgeon, Coldstream Guards. FILARIA SANGUINIS. J. FAYRER. JOHN HOYSTED. To the Editor of THE LANCET. SIR,-The accompanying case is interesting in relation to Filaria. Perhaps you may think it sufficiently so for publication. I am, Sir, yours truly, Granville-place, Feb. 21st, 1879. J. FAYRER. Norton Barracks, Worcester, Feb. 12th, 1879. DEAR SIR,-I am taking the liberty of sending you rough notes of a case of Filaria sanguinis in a dog I possessed in the Straits Settlements, which I trust may prove of interest. I sent the specimens to a colonial surgeon for microscopical investigation ; they were unfortunately lost. Dogs in China frequently suffer and die from blood parasites analogous to those I have noted. Yours very faithfully, Sir Joseph Fayrer, F.R.S., London. JOHN HOYSTED. Medical History and Post-mortem of a Terrier Bitch at Rassa Station Hospital, Sunghie Ugong, Straits Settlegize2tts. History.—Weight 30 lb. ; age 43/4 years. Had four litters of pups; was supposed to be in pup five weeks ; had good health up to the time of fatal illness ; owner noticed a tumour come and go away again in her neck for three years. Symptems : Looked dull, and had paroxysms of coughings and attempts to expel stomachic contents for three hours before death ; did not succeed in ejecting pul- monary or gastric matters ; snapped once when placed in a hot bath. On the same day she wheeled completely round, then fell on her side, breathing convulsively, and died in ten minutes. Post mortem examination.—Unduly clothed in fat. Veins of neck engorged and full of clots; tracheal tube healthy and free from foreign body. Lungs congested (venous) ; specific gravity, however, unaltered, sections floating in water; when cut the surfaces exuded frothy serum and mucus. Œsophagus healthy ; no foreign body found, as expected. The cardiac extremity contained a little pulpified food; stomachic contents similar. Mucous membrane and rugse well defined ; hollow viscera healthy (examined to rectum). Peritoneum healthy, but loaded with fatty bands. Liver slightly congested; venous channels dissected for some distance, blood-clot alone found. Kidneys congested. Brain not examined. Arteries generally found empty, veins free of blood-clot (recent). Lungs with heart attached re- moved from thoracic cavity. Ascending and descending cavæ followed up for some distance, blood-clot alone found.

THE CONTAGIOUS DISEASES ACTS

  • Upload
    abr

  • View
    219

  • Download
    0

Embed Size (px)

Citation preview

Page 1: THE CONTAGIOUS DISEASES ACTS

317

Registrarship, but would not for one moment think of ac-

cepting the Assistant Registrarship.When will the graduates of the University of London

en masse approach the Government of the day, and requestto be allowed to govern their own University ? Surely thattime has now arrived, or are we always to be legislated forby a Senate the majority of whose members have nothingin common with, are not representative of, and do not carea straw for the interests of, the graduates, as evidencedmost pointedly by the appointments to the Assistant-Registrarship and Registrarship of the University ?The Senate of the University of London requires re-

constitution even much more than does the MedicalCouncil.

I am, &c.,Feb. 22nd, 1879. A LONDON GRADUATE.

CONSULTATIONS IN LUNACY.

W. F. WADE, F.R.C.P.

To the Editor of THE LANCET.SIR,—I find from an article on "Lunacy Reform" in

your current number that you are of opinion that the signersof lunacy certificates are " legally deprived of the advan-tages of consultation." It follows, of course, that the lunaticis also by law deprived of advantages which, if he were onlysuffering from jaundice or gravel, he could secure withoutlet orhindrance. I do not know what may be the habitsand customs of metropolitan practitioners, but I can assureyou from considerable experience that in this part of thecountry consultations in lunacy are conducted just likeother consultations. The consultant hears from his colleaguethe history of the case, a conjoint examination of the patientand, subsequently, a discussion as to the diagnosis andtreatment follow.Now the question arises, whether, in pursuing this course,

we are infringing the Lunacy Acts. After a careful re-

examination of them, I am distinctly of opinion that we arenot. What these Acts require is that, over and above theusual steps taken in ordinary diseases to ascertain the factsand arrive at an opinion, we shall, if that opinion be that thepatient should be deprived of his liberty, further take theprecaution of examining the patient separately from eachother. This re-examination is calculated to secure thepatient a last chance of demonstrating his sanity, and itinsures further that the opinion arrived at should be not ajoint but a several opinion also.

I remain, Sir, yours, &c.,Birmingham, Feb. 24th, 1879. W. F. WADE, F.R.C.P.

THE CONTAGIOUS DISEASES ACTS.To the Editor of THE LANCET.

SIR,—I read with great interest your article on the abovesubject, in THE LANCET of February 1st, and, if you willallow me, I should like to make a few remarks on Surgeon-General Balfour’s letter of the following week regarding it.

I quite agree with him that it would be better to make nodistinction between cases of disease contracted in and ontof a district, and by so doing to prove a less satisfactorydiminution in their number, than, by deducting the latterclass, to present untrustworthy returns ; but, with alldeference to his very large experience, I must beg to differfrom him in this respect, and to maintain that the deductionof diseases contracted out of a district is not only littleliable to inaccuracy, but is really necessary to give a fairestimate of the effects of the Acts in a protected district.Dr. Balfour refers to Windsor especially as one of the

stations in which careful inquiry had led himself and othersto doubt the accuracy of the men’s statements ; but, afterbeing quartered here on several occasions, my experienceleads me to a very different conclusion, and I have alwaysmaintained that it is at Windsor especially, of all stations,in proportion to the smallness of its garrison, where the mostuseful facts can be obtained-provided that allowance ismade for diseases contracted out of the district-in conse-

quence of the half-yearly changes between London andWindsor, and the rapid diminution of disease in the latterstation.

I certainly cannot recall to my mind any instance of aman making a false statement of the kind: nor should I

record his disease as contracted out of the district unless hehad just returned from leave of absence; and the inspector ofpolice informs me that the men are very ready to give all theevidence they can for the detection of the woman, thoughsometimes it is necessarily very meagre.

Allowing, however, the possibility of an occasional,wilful, or accidental mis-statement on the part of the men,this is far more than counterbalanced by cases of diseaserecorded, on the statement of the men, as contracted inWindsor, which have been given by women who, living inthe outskirts, thus escape the supervision of the police. Thisis one of the difficulties the police have to contend with here,but fortunately soldiers keep pretty well to their regularhaunts, and these are seldom far removed from theirbarracks. -

Again, how can it be fair, as you have well stated in yourarticle, to include in the statistics of protected districts theadmissions of soldiers soon after their arrival from London,where specific disease is so prevalent amongst them ?Surely not ; and as the change of quarters to Windsortakes place twice a year, these early admissions alone wouldmake a considerable difference.

In conclusion, I cannot see sufficient reason why, withevery desire to avoid incorrect statements, diseases con-tracted out of a protected district should not be separatedfrom the other class ; and though such deduction is not re-quired to prove a considerable diminution of disease in pro-tected districts, it appears to me to be an essential one inorder to obtain a true estimate of the effects of the Acts.

I am, Sir, yours &c.,

I Windsor, February 10th, 1879.A. B. R. MYERS,

Surgeon, Coldstream Guards.

FILARIA SANGUINIS.

J. FAYRER.

JOHN HOYSTED.

To the Editor of THE LANCET.SIR,-The accompanying case is interesting in relation to

Filaria. Perhaps you may think it sufficiently so for

publication.I am, Sir, yours truly,

Granville-place, Feb. 21st, 1879. J. FAYRER.

Norton Barracks, Worcester, Feb. 12th, 1879.DEAR SIR,-I am taking the liberty of sending you rough

notes of a case of Filaria sanguinis in a dog I possessed inthe Straits Settlements, which I trust may prove of interest.I sent the specimens to a colonial surgeon for microscopicalinvestigation ; they were unfortunately lost. Dogs in Chinafrequently suffer and die from blood parasites analogous tothose I have noted.

Yours very faithfully,Sir Joseph Fayrer, F.R.S., London. JOHN HOYSTED.

Medical History and Post-mortem of a Terrier Bitch atRassa Station Hospital, Sunghie Ugong,

Straits Settlegize2tts.

History.—Weight 30 lb. ; age 43/4 years. Had four littersof pups; was supposed to be in pup five weeks ; hadgood health up to the time of fatal illness ; owner noticeda tumour come and go away again in her neck for threeyears. Symptems : Looked dull, and had paroxysms ofcoughings and attempts to expel stomachic contents forthree hours before death ; did not succeed in ejecting pul-monary or gastric matters ; snapped once when placed in ahot bath. On the same day she wheeled completely round,then fell on her side, breathing convulsively, and died inten minutes.

Post mortem examination.—Unduly clothed in fat. Veinsof neck engorged and full of clots; tracheal tube healthyand free from foreign body. Lungs congested (venous) ;specific gravity, however, unaltered, sections floating inwater; when cut the surfaces exuded frothy serum andmucus. Œsophagus healthy ; no foreign body found, asexpected. The cardiac extremity contained a little pulpifiedfood; stomachic contents similar. Mucous membrane and

rugse well defined ; hollow viscera healthy (examined torectum). Peritoneum healthy, but loaded with fatty bands.Liver slightly congested; venous channels dissected forsome distance, blood-clot alone found. Kidneys congested.Brain not examined. Arteries generally found empty, veinsfree of blood-clot (recent). Lungs with heart attached re-moved from thoracic cavity. Ascending and descendingcavæ followed up for some distance, blood-clot alone found.