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It is stated by the trade that baker’s eczema was notunknown in this country prior to 1911-the year inwhich persulphate flour-improvers were first patented-but it is obvious from the continually recurringinterest in this subject that it is much more commonnow than formerly. I agree with Dr. White that"

improvers " are not the whole story, but I cannotsubscribe to his statement that " no improvers areused in the confectionery trade." Confectioners maynot " add " improvers to the flour they use, but theycertainly often use flour containing " improvers " addedby the millers. It may be that the comparativeimmunity of the bakers in the United States and Franceis in part accounted for by a more general use ofmachinery, as distinguished from the handling of wetdough practised here in many small bakeries. Never-theless, I am convinced that baker’s eczema has arisenin this country, in known instances recorded by me,by reason of the employment of these foreign chemicalswhich have been added to flour. Such additions are,in my opinion, unjustifiable on any ground.

I am, Sir, yours faithfully,ARNOLD ROWSBY TANKARD, F.I.C.,

City Analyst, Hull.June 5th, 1925.

COLLOIDAL KAOLIN.To the Editor of THE LANCET.

SIR,-The authoritative statements of Sir Wm. J.Pope and Prof. John W. H. Eyre in your issue ofMay 30th add weight to the rapidly accumulatingevidence regarding the curative properties of colloidalkaolin. Since you published my original paper(THE LANCET, 1923, i., 432) the medicinal use ofcolloidal kaolin has extended widely. The KayleneCompany (which prepared colloidal kaolin for medicinaluse at my suggestion) is now producing four prepara-tions : Kaylene, plain ; kaylene saline (i.e., colloidalkaolin with saline aperient) ; kaylene mint (colloidalkaolin with oil of peppermint) ; and kaylene lax(colloidal kaolin with phenol-phthalein).

Experience is fully bearing out the claims I madefor it, and while I have nothing essential to add, Idesire to emphasise a few points : 1. Colloidal kaolinmust be of guaranteed purity and sterility and in thefinest attainable state of mechanical subdivision.2. Colloidal kaolin counteracts the toxsemia whichresults from the ingestion of unsuitable food-i.e.,food that is apt to decompose in a toxic bowel.. It isunwise, however, to exploit this way of escaping theconsequences of wrong feeding. Obviously the bestresults are to be obtained by taking colloidal kaolinwhile using the diet and regime most suited to therelief of stasis. 3. Liquid paraffin as well as colloidalkaolin is nearly always needed in stasis. 4. Colloidalkaolin should not be given-in the hope that it willcure-without first deciding by X ray investigationthat no mechanical block (kink, controlling appendix,scar of an ulcer, or neoplasm) needs surgical treatment. I

1 am, Sir, yours faithfully,,

Upper Wimpole-st., W., June 6th. ALFRED C. JORDAN.

BLOOD CHANGES IN SPRUE ANDPERNICIOUS ANÆMIA.

To the Editor of THE LANCET.SiR,-I am sorry to have overlooked Dr. William

Hunter’s criticism in your issue of Jan. 31st, p. 255,of my calculation of colour-indexes (THE LANCET,Jan. 10th, p. 75). I can easily show that these objec-tions are founded on a misunderstanding. I estimatedmy haemoglobin values with the original hsemometerof Sahli, manufactured by E. Büchi at Bern. In allmy publications the numbers under the heading" Haemoglobin (Sahli)" are haemometer degrees (Sahli),and not percentages ; 80 degrees (Sahli) correspond to100 per cent. haemoglobin, which is normal. To getpercentages one has to calculate them ; 20 Sahli isequal to 20 X 100 —80, or 25 per cent. haemoglobin.As in Sahli’s first haemometer the degrees gave thepercentages ; on the Continent the bad habit tospeak of per cent. (Sahli) when haemometer degrees

(Sahli) of Sahli’s new haemometer are meant is still

maintained. I hope this will do to elucidate thematter.To understand how Dr. Hunter could find greater

differences than 1/5, I re-calculated my indexes withthe following result : Of my 18 indexes I found nowfor 11 the same value as in the blood tables in myarticle; for 3 a value of 0-01 higher or lower, for 2 avalue 0-1 higher; and for 2 others a value of 0-03 and0-07 lower than in the tables. Only the two latterre-calculations are in the advantage of Dr. Hunter’s.presumption that my indexes should be too high.The differences can probably mostly be explained ina different way in which the decimals are neglectedin the calculations, and even if slight errors are made,these are too small to have any practical significanceand do not affect the conclusions, which have to bedrawn from my figures.

I trust that Dr. Hunter and the English reader willbe satisfied with this elucidation and that I have-convinced Dr. Hunter that I use the usual standards.In conclusion, I wish to thank him for having curedme from a bad habit.

1 am, Sir, yours faithfully, -The Hague, June 6th. C. ELDERS.

POST-GRADUATE TEACHING IN MIDWIFERY,To the Editor of THE LANCET.

SIR,-I was most interested in reading Dr. MargaretBalfour’s recent letter (THE LANCET, May 23rd,p. 1104) as my own experiences in seeking post--graduate work in midwifery after the war, in 1919,were much the same as hers, both in London andat the Rotunda. Having graduated elsewhere, anddesiring to see something of London’s methods, Iapplied to the Fellowship -of Medicine, but the-obstetrician to whom I was referred from there received-me unwillingly and advised me to return to my ownmedical school or else to go to Dublin, saying Londoncould receive no new students. After various similarinquiries I wrote to the Rotunda contemplating sixmonths’ work there, but the nature of the tuition wassuch that I transferred from there when one monthhad elapsed, like very many other graduates recentlydemobilised. At the Rotunda the clinics were crowdedwith students, graduates, and large numbers of pupilmidwives, the Master turning to the latter for a correctreply when this was not furnished by the particulargraduate or student whom he questioned !

If greater facilities for post-graduate tuition andopportunity for work in obstetrics are provided here-fewer doctors will go to Vienna and Paris and othercontinental schools, as they at present do.

T <>1’"I<.lA<’" 1’ynr r.arr7 anrl QTrt qir -uniiiq fqifbfiillv

June 6th, 1925. M.B., Ch.B., L.M.

A DISCLAIMER.To the Editor of THE LANCET.

SiR,-May I ask you to publish a disclaimer of myhaving been in any way responsible for the inspirationand publication in the current issue of the Ebbw ValeWeekly Argus of a paragraph entitled " Doctor’sSplendid Record : Two Medical Men Exoneratedfrom Blame."An inquest-held after the death of a patient from

pneumonia supervening upon " radical operation "for inguinal hernia-was held at the instance of thedeceased’s relatives to establish the fact that thetrain of circumstances which led up to his death wasthe result of an accident-i.e., the original rupture.But when a death occurs after an operation there iswont to arise a suspicion that something went wrongwith the operation-and the subtitle "medical menexonerated " suggests this view.

I simply mentioned the usual percentage of deathsafter the " radical cure operation " to show that myaverage was well within the record.

I am. Sir. vours faithfnllv.H. NEVILLE TAYLOR.

The Hospital, Ebbw Vale, June 3rd, 1925.