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this procedure was original in my own mind. Mr. Little- not only on this institution but on myself. As the matter wood has not published any dates of operations performed stands it shows a deplorable want of care in the collection of either in the paper to which Mr. Ward refers or subse- the facts and reflects on the veracity of other statements. quently. It remains with him or with Mr. Ward to put I am, Sirs, yours faithfully, forward now the date of his first operation. THOMAS YOUNG SIMPSON, This, then, is my reply to Mr. Ward: First, so far as M.D., B.S. Durh, M.R.C.S. Eng., L.R.C.P. Lond. concerns the clamp. Mr. Littlewood has never given a Royal Albert Hospital, Devonport, May 14th, 1906. written hint to the effect that he considers himself to be introducing a new method into the technique of intestinal suture. Had he made any claim to authorship in this matter it could not, in my judgment, and by reason of the evidence PELLAGRA NEAR . with himself as one of the have I have submitted, witnesses, (FROM A CORRESPONDENT.) been sustained. If Mr. Ward now makes such a claim for him I shall be interested to hear by what arguments he proposes to establish it. But whether Mr. Littlewood’s THE LANCET is kept well informed of the efforts of the precedence is or is not asserted is immaterial so far as I am Italian Government, aided by many benevolent societies, to for neither nor in or concerned, verbally writing, directly by fight the disease which is caused by eating bad maize, or have I ever forward a claim for I implication, put myself. that cereal dried or ill In discuss- I make quite to Mr. Ward. What I have insufficiently preserved. hope myself plain this it cannot be too often observed that been able to do in the matter of the use of clamps is ing question healthy accurately stated by Dr. Mayo, who says that I have maize does not produce pellagra, for the dreaded disease is " popularised " them. That I hope and believe to be true. apparently caused by one or more moulds present in the so far as concerns the excision of the I Secondly, mucosa, corn, the toxic spores chiefly suspected being the aspergillus have from the first and always claimed this as a procedure fumigatus and the penicillum glaucum. The aspergillus with Mr. Littlewood himself I original myself. cannot, occurs chiefly during the warm months in and be in doubt about The facts think, any my opinion. upon seems to be the more important of the two, for though which my opinion is based have been published in every in a test-tube it is killed at 100° it is found to " C., relevant detail for five years. If there has been " omission live for at least 25 minutes at 85° to 90° C., which is or " I inadvertence it I be to cannot, think, justly imputed probably quite as high a temperature as that of any oven used me. by the Italian peasants for baking their bread. Their Mr. Ward in his as to the details of the method wonder bread consists of a mixture of maize flour, 16 per cent., and which name to Dr. Mayo attached my shows that he has not rye flour, 84 per cent. The Italian law of 1902 makes done me the honour of the of the reading description opera- pellagra a notifiable disease ; it prohibits the sale of bad tion of I which I gastro enterostomy (as then performed it) maize ; and it makes compulsory on the local authorities the read before the American Surgical Association in 1903. In construction of houses for maize and the treatment " drying two essential features I have altered the operation since and maintenance of pellagrous patients in their homes and then. What I now consider them will be seen by reference in special retreats ; the expenses are partly borne by the to and on pp. 157 158 of my book "Abdominal Opera- central Government. But, like many other things in Italy, it tions." I there chief and the one give eight points only is to be feared that these regulations, so excellent on paper, common to the as I and Mr. Little- operation practise it, are not very thoroughly carried into practice. I can, however, wood’s method described in the to which Mr. Ward paper vouch for the utility of one of the chief retreats-that for refers, is the excision of the mucosa. In the operation as I the province of Milan at which I lately had the practise it to- day there are many "essential points " (as I pleasure of visiting with the enthusiastic director, Dr. G. consider some be them) ; may possibly original, many may Friz, who has devoted some 30 years to the consideration be adopted from one surgeon or another, but the complete of pellagra and to attempting to improve the condition is a different from with which the procedure operation any of the poorer peasants. The retreat is built in the literature of the makes me subject acquainted. midst of agricultural fields, for the accommodation of some I am, Sirs, yours faithfully, 50 young people aged from 12 to 24 years, most of whom B. G. A. MOYNIHAN. Leeds, May 14th, 1906. are children of pellagrous parents and have already shown the first signs of the disease. The early symptoms dis- covered are usually giddiness, stupidity, depression of THE EMPLOYERS’ LIABILITY BILL AND spirits, general debility, loss of appetite, a feeling of burning PRACTITIONERS IN MEDICINE. or of fulness at the epigastrium, diarrhoea and erythema or skin on the dorsum of the hands and feet To the Editors THE LANCET. dry desquamating of or at the neck. The retreat has been constantly used since SIRS,—Now that the above Bill is before Parliament I it was founded in 1890, since when about 1200 boys and girls would suggest that the different divisions and branches of have undergone a six months’ treatment, for each sex is the British Medical Association and other medical societies treated in turn. The average gain in weight is from four to take immediate action so that all medical practitioners 26 pounds during the six months, which shows that the shall be included in the above Bill. Almost all the rations are good. The diet is varied and once a week they illnesses and accidents which attack us come through our are allowed to have maize flour in their favourite polentcc. dangerous occupation, while each year finds the majority They are taught by some devoted sisters of mercy with the less able financially to provide against sickness, accidents, result that whereas only 6 per cent. can read and write on infirmity, and old age. I am, Sirs, yours faithfully, admission 42 per cent. have acquired these arts before Liverpool, May 15th, 1906. ROBERT R. RENTOUL. leaving. Every day they have one hour’s lecture on elementary personal hygiene and the rest of the day is spent in work out of doors. The boys till the fields round the DEATHS UNDER ETHYL CHLORIDE. house and are specially taught why bad seed should not be and cereals must not be harvested and To the Editors of THE LANCET. planted, why unripe, must be well dried and then kept dry. The girls are taught SIRS,-In reference to the death under ethyl chloride sewing and knitting and everything relating to silkworms reported in THE LANCET of May 5th, 1906, p. 1236, Case 10, and their successful development, including some knowledge by Dr. T. D. Luke, as having occurred at this institution, of the mulberry tree, which is so common in that district. on page 1236 it is stated that " the administrator was a Dr. Friz also visits the homes of the young people in order student who had practically no experience of anassthetics to see whether the parents are really poor and to keep an and the operator was a house surgeon who had performed eye on the patients who have passed through his hands. this operation only on half a dozen previous occasions." The number of peasants in Milan province now affected by Both these statements are incorrect. The anaesthetic was pellagra is said to be 12 per 1000, while at Bergamo the given by the assistant house surgeon who was fully qualified number is 20 per 1000. It is interesting to remember that and I was the operator. I have performed this operation the first hospital for the treatment of pellagra was opened in very many times, as many, I venture to say, as Dr. Luke has 1784 at under the auspices of the Council of the administered ethyl chloride, not half a dozen as stated. . The total number of pellagrous cases in I think Dr. Luke should have ascertained the correct Italy is now said to be 72,000. facts before publishing any which, if true, would reflect I took the opportunity while in this neighbourhood of