51

must surely mean Sir John." "Yes," she said," I do," and she hastened to add, " but I could nothave been more kindly treated had it been the sainthimself."

I am, Sir, yours faithfully,SOMERVILLE HASTINGS.

To the Editor of THE LANCET

SiR,—I have reason to be grateful to Sir JohnBland-Sutton not only for his stimulating friendshipover a long period of years, but for his help in otherways. It was in my undergraduate days thatFrederick Page told me about Bland-Sutton andrecommended me to get his book on tumours. Ihad then read his little book on ligaments, whichhad opened up to us students a new world in anatomy.The book on tumours was at once arresting andfascinating and I never read a story with greateravidity. Bland-Sutton kept up a correspondencewith Page about the treatment of the placentain advanced cases of ectopic gestation and I rememberthe glee with which we looked forward to hearingwhat he had to say in this mild controversy. Withthe arrival of the Clinical Journal on Friday nightsthere was the eager anticipation of finding somethingfrom his facile pen. I shall never forget the warmreception he gave me when I first came to look roundLondon in 1900. He invited me to see his work atChelsea and to accompany him there in a victoriawith a pair of beautiful greys. His conversationwas like his writings except for the quips, difficultto reproduce in writing, which always conveyedsome lesson. His London accent, of which I thinkhe was a little proud, seemed to heighten the pointof his remarks. He told me he had been bornwithin the sound of Bow Bells, adding "ThankGod, within easy reach of the green fields and thecountry."

Bland-Sutton’s reverence for John Hunter wasremarkable. I was once able to purchase three ofHunter’s letters and, thinking that one of them wouldbe of interest to him, I sent him a transcript. Byreturn came a characteristic note in his clear legiblehand telling me how much obliged he was for thechance of becoming familiar with the letter and

adding, " When you come to town, be sure to bringit and show it to me, but don’t trust it to the post."Later I saw a good deal of his work at the Middlesexand each time there was something which impressedthe visit on my mind. His technique, as hasbeen said, perhaps lacked finesse and in the earlydays of the rubber gloves he treated them witha certain amount of levity, but he was skilful andadept in emergency and his results were remarkable.In other people’s difficulties too he was a never-failing source of help, but his precision made hiscommunications short. When the husband of anold patient wrote him a seven-page letter describingthe symptoms from which his wife suffered andawaited in eager anticipation an equally lengthy reply,soon it came, but to this effect : "Dear Mr. 0I am quite sure an operation ought to be performed.Yours sincerely, " But it was enough. That

night I reopened the abdomen ; an uncertain illnesswas cleared up and recovery followed. His memorywas remarkable, and although it astonished othershe seemed to look upon it himself as the mostordinary thing.

I am, Sir, yours faithfully,G. GREY TURNER.

HOSPITAL AMALGAMATION IN LIVERPOOL

To the Editor of THE LANCET

SiR,-The Bill to amalgamate the four Liverpoolgeneral hospitals, in accordance with the report of theLiverpool Hospitals Commission, to which referencewas made in an annotation on Dec. 19th (p. 1474),follows closely the provisions of the BirminghamUnited Hospitals Act, 1934. There are, however,several interesting differences in detail. In theBirmingham Act the distinction between the membersof the honorary medical and surgical staffs and theresident medical officers was not so clear as in theLiverpool Bill. The Birmingham Act authorisedaccommodation to be provided for private patients inaccordance with a scheme approved by the CharityCommissioners. The Liverpool Bill does not containany reference to the Private Patients’ Act of lastsession, and apparently its use will not be necessaryespecially as there is a clause authorising " anymembers of the honorary medical and surgical staffsof the Hospital to charge fees to paying patients tothe Hospital." This raises the question whetherthe Liverpool United Hospital will have power tocontinue the present practice of allocating a per-centage of the receipts from the Merseyside HospitalsCouncil to staff funds. It would seem to be desirableto place the matter beyond doubt by the inclusionof some reference such as that contained in the Princeof Wales’s Hospital, Plymouth, Act.The governing body at Liverpool will consist of

fifty-one members as in Birmingham, with the differ-ence that there will be two persons appointed bythe University of Liverpool instead of only the deanof the faculty of medicine and two appointed byMerseyside Hospitals Council instead of threeappointed by the two corresponding organisationsin Birmingham.The Liverpool Bill contains provisions in reference

to the honorary staffs which are not contained inthe Birmingham Act. Vacancies are to be filled bya committee consisting of the members of theAssociated Voluntary Hospitals Board " other thanany medical or surgical members whom the saidBoard may by resolution exclude together with suchmedical or surgical members as the said Board mayby resolution co-opt and four persons two of whomshall be laymen and two of whom shall be membersof the honorary medical or surgical staff of the

Hospital appointed by the general committee."A layman appointed by the general committee" shall be entitled to preside and if necessary to

give a casting vote." It seems to be an omissionin the Bill that it makes no reference to the consti-tution of the Voluntary Hospitals Board. The Billalso gives a definite constitution to the medicalboard which consists of the honorary medical andsurgical staffs, and " one person two persons andfour persons respectively appointed " by the dentalsurgeons, pathologists, and anaesthetists. There isno provision for the representation of any othersection of the medical staff such as obstetricians andgynaecologists or radiologists to whom it may here-after be thought desirable to give separate recognition,though there is a power to coopt within limits of

particular offices set forth in a schedule. The medicalboard will have its own chairman and secretary." No rule regulation or recommendation of themedical board shall have any force until the minutes ofthe meeting recording the same shall have beenread to and confirmed by the general committee....The medical board shall have the supervision of the

52

medical and surgical work of the Hospital and allmatters relating to the purchase of surgical instru-ments and apparatus shall be referred to the medicalboard but that board shall not have power to

purchase any instruments or apparatus without theprevious sanction of the general committee." Themedical board will have twelve representatives onthe general committee.The extent to which the provisions of the Birming-

ham Act have been followed in the Liverpool Billshows that important precedents are being createdso that the additional provisions relating to themedical staff incorporated in the latter deservegeneral attention, especially in places where theconditions are likely to render necessary similar

legislation within the not distant future.I am, Sir, yours faithfully,

C. E. A. BEDWELL.

King’s College Hospital, S.E., Dec. 20th, 1936.

CARDIOVASCULAR EFFECTS OF BENZEDRINE

To the Editor of THE LANCET, SiB,—In a very interesting article in THE LANCETof Dec. 12th, 1936, Drs. Anderson and Scott describecardiovascular effects induced by benzedrine in sixpatients out. of a series of twenty. The patientsselected were mild neurotics and psychotics, and itis stated a certain number of normal subjects were

also investigated. It would be interesting to knowwhat proportion of the series were normals, and if

any of the normal individuals complained of pain inthe chest, palpitations, or faintness. Case No. 6 hadsevere collapse eleven hours after the administrationof 30 mg. of benzedrine. It is stated that an examina-tion showed a 1-4 heart-block with an occasionalextrasystole. Although nothing abnormal was

detected in the cardiovascular system before the

experiment, it would be interesting to know theresult of an electrocardiogram taken after recoveryfrom the attack, to see if any organic lesion of theheart was demonstrated.The effect of benzedrine on normal persons has

been investigated at this hospital on members ofthe resident medical staff. The series included eightindividuals. On the first occasion four of them were

given 30 mg. of benzedrine by mouth, and on a sub-sequent occasion the other four had 40 mg. each bymouth. The results after taking 40 mg. were littledifferent from those seen after taking 30 mg. Blood-

pressure and pulse-rate readings were made everyhalf-hour sitting down. All cases showed a rise ofblood pressure, which reached its maximum in

12 2 hours, and had returned to normal after 4 hours.The systolic pressure rose from 20 to 30 mm. andthe diastolic from 10 to 20 mm. The pulse-rate inthe majority of cases showed a slight increase after

i hour, but later was slowed in all individuals, andwas slowest 12 2 hours afterwards when the bloodpressure was highest.

Although the rate was slow while sitting downit was very unstable, and the slightest exertion, suchas getting up and walking around, caused greatincrease in rate. The first subjective symptom notedwas a slight feeling of the head not being quite clear.Flushing of the face was experienced by some, anddryness of the mouth coming on after about one hourby nearly all. The only unpleasant feelings notedwere by two individuals who on standing up had atransient feeling of faintness. In both the pulse-rate had suddenly increased to about 130. On

sitting down the feeling quickly passed off and the

pulse-rate in about ten minutes became again slowerthan normal.The euphoria was well marked in all and after

1-2L hours conversation was at a maximum. Manyinteresting and remarkable stories were told, mostlyreminiscences of the past. All wished to talk andnone to listen. The drug was taken at 8 P.M., and itseffect on sleep was well demonstrated. The amountof sleep varied from 2-3 hours to none at all.

I am, Sir, yours faithfully,J. H. FISHER,

Medical Registrar, General Hospital,Southend-on-Sea.

MORTGAGED PRACTICES

To the Editor of THE LANCET

Sm,-The letter from Mr. Carmichael in yourissue of Dec. 19th, 1936, does not appear to us tobe more than a statement that the scheme offeredby his finance company is the cheapest and leastonerous available to doctors, no matter what thecircumstances of the particular applicant may be,or whether he requires the whole or only a part of thepurchase price. Such an assertion, however, does notnecessarily make it true in fact. We have been closelyinto all the various schemes in force and would makeno such sweeping statement about any of them.The value given for money is often as importantas, or more important than, the exact price paid ;the cheapest is not always the best.

Plenty of doctors would rather not pay a grossrate of 6! per cent. (with a return of the income-taxon the interest at the end of the year and a promiseof a rebate of 1 per cent. in certain circumstances)when the loan can be secured elsewhere at a net rateof 3 per cent. Plenty of doctors again might prefera life policy which can be continued after the loan isrepaid to one which provides decreasing cover andceases when the loan is repaid, with the possiblerisk that health may prevent the doctor from securinglife assurance which he is almost certain to need.There are many points which need considering,and true and impartial advice will seldom, if ever,take the form of recommending exactly the samescheme for everybody, no matter what his particularcircumstances may be.

We are. Sir. vours faithfully.LEE AND MARTIN LTD.

THE FUTURE OF TEETH

To the Editor of THE LANCET

SiR,—Sir Norman Bennett’s paper at the recentPublic Health Congress is mainly an expose of presentconditions and a plea for the intensification of effortsto deal with a deplorable state of affairs. But thereis no hope that way. The dental profession is tryingto push back the ocean with a mop, and until the(political) engineer builds a good tariff wall againstsugar and white flour, I fear that the blood and tearsof children will continue to flow needlessly in ourclinics.

Nearly 40 years’ experience makes me think thatdental disease is being neither treated nor preventedin the real meaning of those terms. For those whoare in earnest about it my experience would suggestthe following action. Abolish the beet-sugar subsidyand tax sugar like whisky, until sweets and tooth-ache, like spirits and cirrhosis, become the luxuriesof the rich. Prohibit the importation of white flourand start an unceasing propaganda for well-bakedwholemeal bread having a legal maximum of water.