THE TREATMENT OF THE MORPHIA HABIT BY "PANTOPON."

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Sir Frederick Treves and Sir Arthur Conan Doyle. Thelatter wrote from South Africa ten years ago a most touchingtribute (possibly in your columns) to the courage anddevotion of the St. John Ambulance hospital orderly. Theformer stated at the banquet given by the Reform Club onApril 30th, 1900, in honour of Sir William Mac Cormac andhimself, that "there had never been a campaign in whichthe horrors of war had been so mitigated and the treatmentof the wounded so complete " as in South Africa. To thisnoble work the St. John Ambulance Association contributed2300 men, of whom about 70 died during the war.

I am. Sir, vours faithfully.The Athenæum, Oct. 7th, 1910. A. C. YATE.

- , Since our correspondent’s letter was received the WarOffice has entered into an agreement with the St. JohnAmbulance Association under which the Army Council canregister St. John Ambulance Brigade and County Companies,under certain conditions, as Voluntary Aid Detachments.In this way further provision is made for the sick andwounded of the Territorial Force in case of war.-ED. L.

THE ETIOLOGY AND DIAGNOSIS OFGERMAN MEASLES (RUBEOLA).

To the Editor of THE LANCET.

SIR,—Dr. C. Beards and Mr. W. L Goldie, in their paperon German measles, published in your issue of Oct. 1st, makemention of certain "small yellowish plaques usually on themucous membrane behind the last molar teeth of the lower

jaw," and state that "as they are occasionally present inmorbilli and scarlet fever they are of little value in

diagnosis.’’ In my experience these plaques or spots arenot confined to patients suffering from rubella, morbilli, orscarlet fever, but will occasionally be found in children whoare in good health. They usually form a group of which theposterior are much larger than Koplik’s spots, though theanterior may closely resemble them. They are of a faintorange-yellow colour.

I think it is a pity that the writers of the paperdo not employ the word "rubella" instead of "Germanmeasles or "rubeola." The term "rubella" has sufferedless misuse than any other designation ; its brevity makesit better than "German measles " ; it raises no falseidea of origin, and avoids confusion. Further, it has been

adopted by the majority of writers on infectious diseases ofrecent years to signify the disease in question. The term"German measles" is misleading and a little cumbrous."Rubeola" is also misleading. It has been applied tomeasles (morbilli), e g., by Oorlett in his "Treatise on theAcute Infectious Erythemata" " (1902). This writer agreeswith others in the use of the word rubella. "

I am, Sir, yours faithfully,E W. GOODALL.

The Eastern Hospital, Homerton, N.E., Oct. 5th, 1910.

THE TREATMENT OF THE MORPHIAHABIT BY "PANTOPON."

To the Editor of THE LANCET.

SIR,—The preparation of opium referred to by Dr. OscarJennings in THE LANCET of Oct. 8th as Pantopon isknown in Great Britain as " Omnopon," and represents thetotal alkaloids of opium in the form of hydrochloric salts.The average dose is 1/5th to 1/3rd of a grain three times aday. For internal medication, tablets have been preparedconsisting of Omnopon "l/lOth of a grain triturated withsugar of milk. This form is suitable for the continuous useof Omnopon " in suitable cases. Ampoules of 1 cubic centi-metre of a 2 per cent. sterile solution of " Omnopon " areplaced on the market. One cubic centimetre of this sterilesolution equals 1/3rd of a grain Omnopon. " In addition toDr. Oscar Jennings’ work on Morphinisme et Morphino-manie." other references to Pantopon will be found inManchener Medizinische V’oehensc7crift, No. 25, 1910,(Sahli); "Therapie der Gegenwart," 1910, Book 5(Hallervorden); Therapeutische Monatshefte, January, 1909

(Sahli) ; and Münchener Medizircisehe Wochenschrift, No. 7,1910 (Heimann).-We are, Sir, yours faithfully,

THE HOFFMANN-LA ROCHE CHEMICAL WORKS, LTD.Idol-lane, E.C., Oct. 11th, 1910.

COMPULSORY INSURANCE AGAINSTSICKNESS IN GERMANY:

ITS BEARING ON THE MEDICAL PROFESSION.

(FROM A CORRESPONDENT.)

Industrial Conditions Leading to Compulsory Insurance.THE introduction of steam power gave birth to those vast

industries that now form a great part of a nation’s assetsand the developments of electricity tend to multiply thoseindustries indefinitely. As a result of the conditionsunder which they work, the thousands of hands employedin manufactories and allied enterprises recently beganto form a distinct body of the community at large.These workers are dependent for their livelihood on their

daily wage, they have no personal interest in the fruits oftheir labours, and are not bound by any strong ties to a

particular locality, but are free to seek their work accordingto momentary phases regulating demand and supply. Inthis they contrast with the tradesman or holder of land,however small the title to independence and ownership may be.Many workers are either not in a position or feel no inclinationto save for the proverbial rainy day, and thug, when over-taken by some catastrophe, as sickness or want of employ-ment, not only they but those dependent upon their earningsare cast upon the charity of the remainder of the community.This question marks one of our gravest social problems, all themore difficult to solve as the political element has enteredlargely into the minds of those actively engaged on thesubject.For some time past various countries have taken steps

towards effecting a remedy in this state of affairs, and thegranting of old-age pensions was the first step taken byGreat Britain towards breaking with the time-honouredcustom of leaving the individual subject to work out’hisown salvation. This may quite soon be extended by thecompulsory insurance against sickness. A Governmentmeasure of this kind will naturally affect to a certainextent the interests of the medical profession, and it wouldbe well to consider in time the points likely to be raised. Asmatters are at present, an agreement between a sick club orfriendly society and a medical man is to all intents and

purposes a purely business question, largely influenced bycompetition in the struggle for life. When the State, how-ever, decides to introduce some social reform, it would belacking in its duty towards safeguarding the interests of thewhole nation it embodies by conferring benefits on a few tothe exclusion of others, and ie is here that the medical man’sinterests must be taken into consideration.

State -Tnsurance against Sickness in Germany.Among those countries that have already introduced State

insurance against sickness, Germany, as the pioneer country,will serve as an apt illustration. The regulations regardingcompulsory insurance against sickness, which are to a certainextent distinct from the insurance against accidents and theinvalidity and old-age pensions, may be briefly summarisedas follows :-Every male or female person, regardless of age, whether

unmarried or married, German subject or foreigner, employedin the country in any form of trade or work, receiving asalary or pay not exceeding £100 per annum, is compelledto be insured against sickness. Legally freed from thisobligation are soldiers, officials, and servants of the

empire, states, or municipalities, for which other provisionhas been made, also pharmaceutical assistants and

apprentices. All persons whose income is under .E100a year may voluntarily insure themselves. The insuredbecome members of a distinct sick club, of which manykinds are recognised. They may be divided into twoclasses :-1. Sick clubs composed of members belonging tothe same profession or branch of trade in a certain locality.These are called local sick clubs, and each must have atleast 100 members. Or the workers in a certain trade may