411

SPLENECTOMY IN ICTERUS GRAVIS

SIR,-The paper by Hardwick and Lloyd in yourissue of Sept. 20 will have been read with interest bypaediatricians. Recovery in this case does not justifythe assumption that splenectomy is of any value in thetreatment of this disease. The operation was practisedfor a short time in the United States, but this treatmentis now regarded as irrational. It is generally acceptedthat the splenomegaly is a reaction to the disease ratherthan the cause. In the last few years I have observedabout fifty cases of erythroblastosis of which icterusgravis is the commonest clinical type. Many wereclosely studied from the time of birth in a maternityhospital. Spontaneous recovery often occurs and therecognised sequelas are exceptional. I have recordedseveral cases (Trans. Edinb. obstetr. Soc. 1939, p. 63), andhave since seen a number of others, in which a veryactive reticulocytosis and rapid rise of haemoglobinoccurred without any treatment. So long as thesetiology remains obscure, blood transfusion is likely toremain the therapeutic mainstay. The object of bloodtransfusion is to maintain the hsemoglobin at a safelevel until the rate of regeneration outstrips that ofhaemolysis. Definite blood coagulability with hsemor-rhagic signs often occurs in severe cases of the diseaseand can be efficiently treated by the administration ofvitamin K.

J. L. HENDERSON.Dept. of Child Life and Health, Edinburgh.

WAR-TIME BEHAVIOUR

SrR,-The Mental Health Emergency Committee hasbeen making an inquiry into the behaviour of childrenand adults under war conditions. Questionnaires havebeen sent out to child guidance clinics, mental treatmentclinics, psychiatric wards of emergency hospitals, and topsychiatric social workers in reception areas. Thisinquiry was intended to be only a, preliminary surveyand before proceeding further the committee would bemuch interested to learn whether any similar investiga-tions are being carried out, either by groups or byindividuals, and if so would welcome opportunities ofcooperation.

- -

Mental Health Emergency Committee,24, Buckingham Palace Road, S.W.1.

EVELYN FOX,Hon. Secretary.

Public Health

From the School ReportsHOLLAND (LINCS)

Dr. W. G. Booth throws some light on the cost of theschool medical service in a small county. The numberof school-children on the roll at the end of 1940 was10,180, and the net cost of their medical service was5202, or 10s. a head per annum. The Board of Educa-tion grants supplied 23282, the remainder came fromthe rates and absorbed 2d. out of the general elementary-education rate of 4s.The use of paper towels was continued in some schools,

and it was hoped to extend this system throughout thecounty, but that is of course impossible at present. Inview of the increasing prevalence of scabies this isunfortunate, for the communal school towel is open tosuspicion of spreading the acarus. Mr. C. A. Johnston,senior school dentist, calls attention to the very badstate of the mouths of school entrants. Caries of thetemporary teeth seems to be increasing in spite of theundoubted improvement in the general nutrition ofchildren and of expectant mothers.

_ KETTERING

The average number of children on the school registersin 1940 was 4119 and the number of received childrenwho remained in the borough at the end of the year was2863. The ebb and flow of the evacuated population,most of which came from London, is interesting. Therewas a steady reduction from 2533 in January to 1434 inAugust, the number doubled in September, and inOctober reached 4397. It has not been fully realisedhow great is the strain of this fluctuation on billetingand education in reception areas. During the year 112children were admitted to hostels because they were unfit

for billeting. Of these 26 were taken home by theirparents and 65 were returned to billets because they werecured. Dr. Cecil Hogg, in his school report, gives someinformation on unsatisfactory evacuees which will beuseful in the future, for evacuation has given us the onlychance we have ever had to find out the number of objec-tionable children, what percentage of them can be curedand how long it will take to cure theen.

Infectious Disease in England and WalesWEEK ENDED SEPT. 20

Notifications.-The following cases of infectious diseasewere notified during the week : smallpox 0 ; scarletfever, 1140 ; whooping-cough, 2289 ; diphtheria, 957 ;paratyphoid, 125 ; typhoid, 27 ; measles (excludingrubella), 612 ; pneumonia (primary or influenzal), 434 ;puerperal pyrexia, 134 ; cerebrospinal fever, 121 ;poliomyelitis, 28 ; polio-encephalitis, 3 ; encephalitislethargica, 6 ; dysentery, 102 ; ophthalmia neonatorum,76. No case of cholera, plague or typhus fever wasnotified during the week.The number of civilian and service sick in the Infectious Hospitals

of the London County Council on Sept. 17 was 1266 ; includingscarlet fever, 129 ; diphtheria, 252 ; measles, 28 ; whooping-cough,571 ; enteritis, 22 ; chicken-pox, 24 ; erysipelas, 20 ; mumps, 6 ;poliomyelitis, 2 ; dysentery, 14 ; cerebrospinal fever, 21 ; puerperalsepsis, 12 ; enteric fevers, 45 ; german measles, 3 ; malaria, 1 ;polio-encephalitis, 2 ; other diseases (non-infectious), 44 ; not yetdiagnosed, 75.

,

Deaths.-In 126 great towns there were no deathsfrom enteric fever, 1 (0) from measles, 1 (0) from scarletfever, 14 (1) from whooping-cough, 23 (1) from diphtheria,38 (1) from diarrhoea and enteritis under 2 years, and8 (0) from influenza. The figures in parentheses are thosefor London itself.Birmingham reported 9 deaths from diarrhoea. There were 3

fatal cases of diphtheria at Liverpool.

The number of stillbirths notified during the week was170 (corresponding to a rate of 32 per thousand totalbirths), including 14 in London.

ObituaryROBERT THIN

M.B., LL.D. EDIN., F.R.C.P.E.

Dr. Thin who died at Stow on Sept. 18 in his 81st yearhad spent the greater part of his professional life ingeneral practice in Edinburgh where his energy andkindly disposition earned him the esteem and admirationof colleagues and patients. For fifty years he wasassociated with the Royal College of Physicians, becom-ing president 1931-33 when the LL.D. Edin. was con-ferred on him. After qualifying in 1887 and working inthe Royal Infirmary and Maternity Hospital he went toVienna and Prague studying diseases of the ear, noseand throat and the use of obstetrical forceps. Then asassistant to Dr. George Hunter of Linlithgow he lived inSouth Queensferry where he was assistant surgeon to theForth Bridge works during the period of erection.Later his practice became very large and he did not findmuch time for writing, but he recorded in the EdinburghMedical Journal a study of five generations of familialcysteinuria. He was a lively member of the OldEdinburgh Club and his’antiquarian interest foundexpression in " The Old Infirmary and Earlier Hos-pitals " and " Medical Quacks of the Eighteenth Cen-tury," while at the request of his college he wrotebiographical sketches for the portraits hung on thecollege walls. He carried his own years lightly andcontinued in practice until a few weeks of his death.

WILLIAM NEIL CAMPBELLM.D. EDIN., 1Z.R.C.P.E.

THE death of Dr. Neil Campbell is announced fromAfrica where he was serving with the South AfricanForces. Dr. Campbell graduated in Edinburgh in 1927,taking the M.D. in 1939. After a house appointment atthe Royal Infirmary he went out to Natal and set upin practice at Durban where his ability was recognisedby his election to the staff of the King Edward Hospital,Durban. During his student days he was a keen anglerand athlete with a good record at rugby and fieldathletics. He leaves a widow and two young children.