JUNE 28, 1902.] CORRESPONDENCE. [i>LJJ 6IN proved them to have died from plague, and the gardens were promptly closed to the general public. The mode of infection CORRESPONDENCE. of these animals has not been definitely proved, but it is a significant fact that shortly after the gardens were closed, and LONG FOX MEMORIAL. when the buildings were being put into a thoroughly sanitary SIR,-At a meeting in the Chapter House of Bristol state, some dead rats were found in one of the houses. It is Cathedral on May 29th, the following resolution was unani- presumed that the plague-infected rats gained access to the mously adopted: animals' quarters from the Moore Park "tip." So far in "That a memorial be established to the late Dr. Edward Sydney we have been very fortunate in the fact that none of Long Fox, and that it include: (i) The placing of a tablet in the medical staff of the Board of Health have become infected the cathedral; (2) the founding of an annual lecture at with the disease; but in Brisbane, last week, Dr. Wray, the University College, Bristol, on some subject connected with Government health officer, contracted plague, it is said from medical science, to be called the "Long Fox Lecture"; performing necropsies on plague patients, and died after a (3) the partial supporting of a medical missionary student at few days' illness. A day or two ago, Dr. Maclean, the senior University College, Bribtol, to which the balance of the fund resident medical officer at the Brisbane Hospital, was taken collected will be devoted after providing for (i) and (2)." suddenly ill with symptoms which have been proved definitely We shall be glad to receive any contributions fr-om friends to be due to plague infection. He is now in a precarious of the late Dr. Fox.-We are, etc., state. W. W. ASQuITH, A The New South Wales Branch of the British Medical Asso- 34, College Road, Clifton, Honorary ciation has recently been brought prominently before the E. MARKHAM SKERRITT, 8eCretartes. general public in consequence of the attitude adopted towards Edgecumbe House, Richmond Hill, Clifton, the Australian Natives' Association. The latter body has June 21St. just held their annual session and indulged in unlimited SIR LAUDER BRUNTON'S MODEL SANATORIUM. abuse of the profession in general, but specially of the mem- SIR,-[ trast the critics of my paper will not be offended if bers of the British Medical Association. They have been I venture to point out to them that I have not described attempting to excite a quarrel between the recognized Wehrawald as the best sanatorium that it is possible to build Friendly Societies and the profession, but their machinations but only as the best sanatorium that has yet been built. nave to a large extent failed, and the Friendly Societies see Almost every year we see an Atlantic liner built which sur- that they have nothing to gain, but every thing to lose by passes in speed any previous one, end perhaps the next year it supporting the Australian Natives' Association. A determined is itself surpassed by another. Competition now takes place attempt has been made to compel the Australian Natives, not merely between rival firms but between rival nations, Association to withdraw from the United Friendly Societies and I hope that the account I have given of a foreign sana- Association, and at the annual committee of the Independent torium will lead to the erection in England of sanatoria which Order of Oddfellows, Manchester Unity, it was an instruction surpass all others. While my critics have discussed various to their delegates on the Board of Directors of the Friendly points about Wehrawald as being imperfect they have not Societies' Association to support any motion to expel any semi- mentioned any single sanatorium to surpass it. If they will political society from the Association. Another feature in show me any other existing sanatorium that is better than the present "Battle of the Clubs" here is a movement Wehrawald I shall be ready to acknowledge and apologize for amongst the registered pharmacists in sympathy witlh the my error.-l am, etc., medical men. They also are awaking to the fact that they Cavendish Square, June 23rd. LAUDER BRUNTON. need to make a stand against the Australian Natives' Associa- tion as a medical benefit society. As a remedy for their INTRATRACHEAL INJECTIONS IN PHTHISIS. various troubles the Australian Natives' Association is now Sia,-I confess I am uinable to understand Dr. Philip's letter taking steps to start an Australian Medical Association. This in the BRITISH MEDICAL JOURNAL of June 218t. It was evi- will be a regular Cave of Adullam, to harbour all the mal- dently conceived in a moment of deep anxiety; and like a contents of the profeasion. It is said that the Australian maternal impression-dread fear still haunts him lest any of Natives' Association will manufacture its own doctors or im- your readers should also receive from my paper "the im- port them from elsewhere, but any medical man who comes pression that the method is recommended as a new departure here under a contract with this body will probably have cause which its author doubtless did not intend to convey." to regret his bargain. Dr. Philip's method is, I suppose, not uncommon amongst On the occasion of opening a new wing of the hospital at critics who, after scanning the last chapter, proceed to con- Junee, the Premier of this State referred again to the large demn a book. He appears to have read only an article of amount of money contributed by the Government towards the mine which was in reality a postscript to a previous publica- hospitals. He stated that during the year I900 the total tion, and from this very imperfect acquaintance with his revenue of the hospitals of the State was £191,272, of which subject he ventures to lay down the law. the Government contributed £88,683. Of this amount the I will briefly point out the essential differences between the country hospitals received £42,17II the metropolitan hospitals intrapulmonary methods, of which we have published reports, and the Coast Hospital, Little Bay, £16,731. and the system to which I have called attention. First as to ,29,78i;In the report of the vital statistics of Sydney for the month material and bulk injected: of April by the Government statistician, it is stated that A. Rosenberg (1887) used menthol, olive oil, dose I gram: Behag (i888), menthol, olive oil, I or 2 drachms; Jameson, Djownie, Bramwell (i889), during the month the births numbered 1,o96. This total is menthol, creosote, or acid carbol, or gusiacol, or ol. eucalypt., olive oil, Iio greater than the average for this month for the past five In 1 to 2 drachms; Grainger Stewart (I892), menthol, guaiacol, olive oil, years. This record is very favourable, the rate of 2.18 per I to Is drachms; McNaught (I893), menthol, guaiacol, olive oil, In 30; I,ooo exhibiting an advance on the rate for April during each Campbell (1894). various glycerine solutions, 2 to 4 drachms; Leggat (1902, referring to Edinburgh doses in I892), - to minimsa Campbell (1901-2), of the last five years. The deaths numbered 472, or 26 more izal, etc., glycerine, I to 3 oz. than the quinquennial average for April, leaving a balance of I regret to have been unable to trace any puiblished accounts births over deaths of 624. Amongst persons aged 70 years and of Dr. Philip's trials of thymol, eucalyptus, terebene, iodo- upwards there were 52 deaths at the following ages: 35 ranging form, balsam of Peru, with castor oil or glycerine and other from 70 to 79, i6 from 8o to 89, and one aged go. " germicidal agents." I have not, however, been able to refer to his work on Pulmonary Tuberculosis, mentioned in his letter; THE Sixth Congress of Flemish Scientists and Medical and most unfortunately an article with the same heading, Practitioners will be held at Courtrai on September 6th. mentioned as contributed by him (in the Medical Directory), A GERMAN Society for the Prevention of Venereal Diseases seems to have been omitted from the Encyclopedia Medica, has been formed on the lines of the similar organization for I901. the repression of tuberculosis and alcoholism. Among those The differences are obvious, but require a word of explana- who have taken the initiative in the matter are Professor tion. I have gone into the question of oil versus glycerine very Lesser and Dr. A. Blaschko of Berlin, Professor Neisser of fully elsewhere, and shall be pleased to. send any one Breslau, and Professor A. Wolff of Strassburg. The Pro- interested a. copy of the paper; the practical difference is visional Secretary is Dr. A. Blaschko. that whilst oil blocks the bronchioles and checks expectora- 1620 MZTIC"L JKAL 1 CORRESPONDENCE. [JUNE 28, 1902 tion, glycerine increases secretion and promotes free expec- Under 10. toration. The increased dosage practised by me is not merely an increase in bulk, the proportion of active drug or Cases. Fatality per zoo Cases. chemical contained Total being proportionately increased. Popula- And now we come to what Dr. Philip pronounces "the tion. Vaccin- Unvaccin- Vaccin- Unvaccin- only new factor," namely, the bacillicide, izal, on which, how- ated. ated. ated. ated. ever, he is "not inclined to lay stress" ; perhaps he will permit me to do so. Speaking under correction, I do not think that any one of the string of " germicidal agents " men- 5404 33 32 6.o tioned by him has ever been shown to be capable of inhibit- Warrington... cent. 67.5 cent. ing the growth of B. tuberculosis in sputum, whereas Pro- Leicester ... 184,547 2 107 0.0 per cent. 14.0 per cent. fessor Del6pine has demonstrated that this power is possessed by izal. What more likely than Dr. Philip's dismal, hopeless story of failure? He was not far wrong when he likened Over 10. his methods to catching birds by putting salt on their I00 tails! Cases. Fatality per Cases. But despite failure, Dr. Philip will not hear of any attempt at improved methods. He thinks it worth while objecting to Vaccinated. Unvaccinated. Vaccinated. Unvaccinated. a safe syringe because his glass one never smashed! I have administered over 2I9,000 separate injections, and syringes have broken on four occasions only; but surely precautions Warrington. 560 36 6 4 per cent. 33.3 per cent. against recurrence are wise? And as regards the laryngeal Leicester I971 5I i.o per cent. 7.8 per cent. mirror now in use, its safety or danger is not settled because Dr. Philip " cannot believe." The simple question is, can it The table, as now stated, is a compendium of the evidence be sterilized? If not it is a dangerous instrument. in favour of vaccination. It would be interesting to learn how Dr. Philip effectually (a) Leicester is a town in which infantile vaccination has sterilizes his glass mirror and its metal frame when he with- been greatly neglected. In Warrington this neglect is com- draws it from the tuberculous throat; or what he considers paratively small. In the former the proportion of the total "suitable cleansing measures." Doubtless they are thoroughly cases of small-pox under Io is great; in the latter it is small. scientific, as he has " never yet seen any ill-effects follow its (b) Among those attacked, in Warrington the fatality under use"; but how would he recognize the "ill-effects" if they IO years of age is eleven times higher among unvaccinated were caused? and, believing his instrument to be above sus- than among vaccinated children, while in Leicester no vac- picion, would he attribute the " ill-effects " to it? Dr. Philip cinated children died and only 2 were attacked. At ages over reasons in a circle. IO the fatality in Warrington was five times and in Leicester There are two small matters to which I would like to refer; nearly eight times as great among unvaccinated as among first, an error in the case mentioned in the JOURNAL of June vaccinated. 7th to which my attention has been called. The quantity of But " the children in Leicester were better off, and so were pure izal oil injected per day should have been 3 se, not 3j the adults," than in Warrington. That is true, if it is meant as stated; secondly, in the same article I said I hoped to be that out of the total population fewer children and fewer allowed to give a demonstration of the introduction of adults were attacked than in Warrington. Even in Leicester large quantities of fluid at the Manchester meeting. an epidemic of small-pox cannot arise without contact with I regret that this will not be allow9d.-I am, etc., cases of the disease, and while its sanitary and nursing staff Southport, June 23rd. COLIN CAMPBELL. are efficiently revaccinated. For what will happen in an un- vaccinatedcommunitywhen earlycases are unrecognized or not isolated one must refer to places like Gloucester. But in Leicester the same or even greater differences between the AGE-INCIDENCE OF SMALL-POX. fatality among vaccinated and unvaccinated patients respec- SIR,-Mr. Paul in his letter to the BRITISH MEDICAL JOURNAL tively are visible, as in Warrington; and this and the attack- of June 21st creates almost hopeless confusion by mixing up rate among vaccinated and unvaccinated respectively when two problems, namely, first, the proportion of juvenile to exposed to infection constitute the problem when we are dealing adult small-pox in two towns, and, secondly, the total amount with small-pox in relation to vaccination. of the disease occurring in these two towns. Oa the first Mr. Paul draws my attention to a table in the Dissent of point he further fails to recognize or to state the fact that the Dr. Collins and Mr. Picton, giving the incidence of small- ox possible fallacies of the first test are checked by the collateral to io,ooo of total population in each of four towns. This table, statement of the attack-rate and death-rate from small-pox at like the one given by Mr. Paul in his last letter, simply begs each age-period. the point at issue. When the facts in this table are separated I showed in my letter of the 14th inst. that when the neces- -like those relating to Warrington and Leicester above-for sary corrections for varying age-constitution of the contrasted vaccinated and unvaccinated respectively, they show very populations were made, the proportional excess of juvenile the afforded by vaccination.-I etc., small-pox was greater in ill-vaccinated towns than it had strikingly protection am, been stated in the report of the Royal Commission to be. Brighton, June 23rd. ARTHUR NEWSHOLME. Now Mr. Paul argues as if this had some connexion with *** Owing to the numerous calls on our space at the present the size of the epidemic in the contrasted towns. The size of time it will be impossible to publish further letters on this an epidemic depends on a number of factors. If the first eubject. cases of small-pox are diagnosed early, if the attendants on these cases are revaccinated, thus forming a ring of protected HOW TO BE HAPPY THOUGH A DOCTOR. persons, the epidemic may be small in extent, as has hap- SIR,-The most excellent article on the above-named sub- pened in Leicester; though other ill-vaccinated communities ject which appeared in the BRITISH MEDICAL JOURNAL for like Gloucester have had a calamitous experience. The ques- May 3xst will have been read with keen interest. The article tion as bearing on the influence of vaccination, Is what was stands criticism well, and it deserves more than mere reading the relative experience of vaccinated and unvaccinated during -it deserves considering. theepidemic ? Small-pox, again, is a disease which varies The subject of happiness is always attractive, and, like naturally in virulence. In Leicester it was less virulent than lovers' walks, is always found off the main road. But these in Warrington. But here again, so far as the influence of vac- "heaven draughts" are distributed more by chance than by cination is concerned, the question is-What is the experience any aim of humankind. A German philosopher said he of vaccinated and unvaccinated respectively ? never knew of a happy man unless it were Shakespeare when Mr. Paul's table in his letter of June 21st conceals these he was writing A Midsummer Night's Dream. The very points. The following expansion of his table unveils these thought of our having to " endure going hence " must mar to acts: some extent our fancied happiness, and cause our "casti-