1052

CORRESPONDENCE

SWEEPSTAKES AND VOLUNTARY HOSPITALS.

To the Editor of THE LANCET.

SIR,—The success of the Irish sweepstakes andthe transfer of such large sums of money from thiscountry to Ireland have naturally aroused publicinterest, especially in connexion with the hospitals."Why," it is asked, "if such substantial financialassistance can be given to Irish hospitals out of the sweepstakes cannot the same help be given ona larger scale to English hospitals which are so muchin need of it."

So far as this particular part of the question isconcerned it can easily be answered. It is certainthat no one individual hospital would be allowedto run a sweepstake for its own exclusive benefit.If permission were given to one hospital there couldbe no reason for refusing it to any other hospitalor charity, and as there are in England and Walesnearly 1000 hospitals and about 49,000 charitiesof different kinds there would be such a deluge ofsweepstakes as to be self-destructive, and such anintolerable nuisance that even the generous and

long-suffering British public would rise in revolt.If it be granted that sweepstakes could only be

legalised on the Irish basis and given a nationalcharacter, there might then be three or four largesweepstakes organised during the year, say on theLincoln Handicap, Grand National, Derby, and

Leger. The greater part of the money receivedmust, of course, go to the prizewinners and the

hospitals could not expect to get more than 20 or 25per cent. Suppose that this resulted in a sum of£1,000,000. This would have to be divided, as Isaid above, among nearly 1000 hospitals which atonce takes almost all the gilt off the gingerbreadso far as each individual hospital is concerned, andthen there are all the other charities to be considered.They would naturally clamour for some of the cake,and the end would be that the £1,000,000 woulddisappear in innumerable small grants which wouldbe of little practical use to the hospital and wouldundoubtedly alienate many of its existing supporters.I am told that there is already a marked fallingoff in subscriptions to the Irish hospitals, subscribersrather naturally taking the view that as the hospitalsare getting such a large subvention from the sweep-stakes, their own subscriptions are not so muchneeded and can be reduced or cancelled altogether.

This is the purely material side of the question.There is also the moral side, but it seems to me

unnecessary to dwell on it as the answer given tothe material side is so conclusive. Hospitals wouldquite certainly lose by " sweepstakes for hospitals,"and they would doubly lose if, in the eyes of nota few people, gambling were to climb into legalityon the hospitals’ backs.But I have a suggestion to make. I received a

letter a few days ago from the chairman of a smalland very good provincial hospital. He said thata considerable part of their income was derivedfrom a sweepstake got up every year and managedby the working people of the district, and for whichall the prizes were in kind and were given. Surelythis could not be called " gambling," and no onecould possibly have any real objection to these

people who are already interested in the hospitalhelping it in this way. The same position existsin connexion with " raffles " at bazaars and similar

happy hunting-grounds of charities. These, as

the law stands, are illegal, and any little girl rafflingthe indigestible-looking cake that auntie has made,and for which she has been told to get at least tenshillings, is bringing herself within the stern gripof the law. This is, of course, quite ridiculous,and if it hasn’t led to "bootlegging" it can onlybe because we are, in the main, a patient and law-abiding race.My suggestion is that these sweepstakes, lotteries,

or raffles, by whichever name they may be called,shall be legalised, subject to the following conditions:-

1. The prizes shall all be in kind and no prize shall be inmoney.

2. The prizes shall all be given and shall not be paid forout of the money taken for tickets.

3. The whole proceeds shall go to the hospital or " charity"concerned subject to a very small deduction for expenses(such as the printing of tickets, &c.).

Surely the most determined opponent of gamblingcould see no offence in an arrangement of this kind.The winner gets the cake very cheaply, the sellergets a much better prize than would otherwise beobtainable, the charity gets the whole of the money,and the unfortunate holders of losing tickets are

not likely to grudge their threepence or sixpencegoing to the charity in which presumably they arealready interested.

I put this forward as a serious suggestion. Ibelieve that it would result in very considerable

aggregation of small sums for the benefit of hospitalsand charities, especially the smaller ones, and I donot see how it could offend even the most sensitiveconscience. T a.m Sir vnnrc faitlifnilv

ARTHUR STANLEY.Treasurer’s House, St. Thomas’s Hospital, S.E.

To the Editor of THE LANCET.

SIR,—You ask me, as chairman of the HospitalSaving Association, whether I think it wise to raisemoney for voluntary hospitals by sweepstakes.The Hospital Saving Association exists to enable

those who expect some day to be treated in hospitalto save their money while they are earning wages,so that, when they fall ill, they may not have todepend on charity. Our contributors open theireyes and look bravely at one of the unpleasant factsof life. They realise that they and their dependantswill, in the ordinary course of nature, fall seriouslyill once or twice before they die, and they join togetherin our Association to prepare themselves and to

organise mutual support for this emergency.Illness is not a gamble, and it would not accord

with the principles on which the Hospital SavingAssociation appeals to its members to base the financeof healing on the unstable foundation of gambling.

I am, Sir, yours faithfully, .

5, Fenchurch-avenue, London. ALAN G. ANDERSON.

To the Editor of THE LANCET.- SIR,-In reply to your letter with reference to

sweepstakes for hospitals, I think it is sufficient tosay that sweepstakes in this country are at presentillegal. In my capacity as treasurer of St. Bartho-lomew’s Hospital, I would not be prepared to takepart in any unlawful scheme. Ergo, I would not beprepared to organise a sweepstake on behalf of thehospital. But if the Government decided to legalise

1053ORTHODOXY AND HETERODOXY IN SURGERY.

sweepstakes the position would be different, and itwould be my duty to consider the desirability orotherwise, from the point of view of the best interestsof the hospital, of the accepting of funds raised bythis means. I am, Sir, yours faithfully,

St. Bartholomew’s Hospital, E.C. STANMORE.ORTHODOXY AND HETERODOXY IN SURGERY.

To the Editor of THE LANCET. ISIR,-In the address on this subject in your issue

of April 25th Mr. Ogilvie says : " those operationsthat aim at making an anastomosis between thestomach and duodenum are based upon unsound

physiology and are unprofitable in practice." Amongstsuch operations he mentions gastro-duodenostomyand duodenectomy-two very different things. Ofthe latter I have little first-hand knowledge, but ofthe former I have had a considerable experience,and I can assure Mr. Ogilvie, who states that " whenan anastomosis is made between them (that is, thestomach and duodenum) bleeding is troublesome atthe time, and leakage is not uncommon afterwards,"that so far as gastro-duodenostomy is concernedthese statements are entirely contrary to my experi-ence. I never use a clamp on the duodenum and yetbleeding is no more troublesome than it is from thejejunum when doing a gastro-jejunostomy, where

again I use a clamp only on the stomach. Norhave I ever seen a case where leakage has occurredfrom the anastomotic line. I think bleeding fromthe gastro-duodenal artery might be very trouble-some in doing a duodenectomy for a posterior duodenalulcer ; one has even heard of an injury to the commonduct in similar circumstances ; if Mr. Ogilvie is

referring to this operation it would be fairer if hemade a distinction between duodenectomy, whichfor duodenal ulcer I consider a thoroughly badoperation, and gastro-duodenostomy, which myexperience leads me to put at least equal to posteriorgastro-jejunostomy as an operation. I think Mr.

Ogilvie would find, on inquiry, that this is the kind of. opinion he would receive about gastro-duodenostomyfrom most surgeons in the first rank-" in thosecases where I have performed gastro-duodenostomyI have been well satisfied with the results ; however,I usually do posterior gastro-jejunostomy becausethe conditions are more often favourable for the

performance of this operation." In other words, Ithe reason why gastro-duodenostomy is not more I

often performed is neither that the results are inferiornor that the physiology is less sound than that of

gastro-jejunostomy as Mr. Ogilvie asserts.One of the reasons given for the advocacy of gastro-

duodenostomy according to Mr. Ogilvie is that thefood leaving the stomach enters that part of thesmall intestine which is most -used to the presenceof an acid medium ; this, he says, is no more than anunsupported statement. It is not, however, in myopinion, quite the right way of stating the case.

If he had said that the food enters that part of theintestine, into which nature intended it should pass fromthe stomach, more nearly than after gastro-jejunostomy,he would perhaps agree that mixing of the digestivejuices and bile with the food has a sounder physio-logical arrangement than is the case after gastro-jejunostomy.The real position seems to be this-there is only

one good reason why gastro-duodenostomy is notmore generally done, and that is the anatomicalcircumstances are more often unfavourable thanotherwise, though in my opinion less often so than is

generally thought; the results are certainly equalto those of gastro-jejunostomy, and the physiologicalarrangements are less disturbed by gastro-duodenos-tomy than by gastro-jejunostomy (what functionalvalue, if any, there is in this it is not easy to determine).The aspersions cast by Mr. Ogilvie on anastomoses

between the stomach and duodenum are, in myexperience, quite unfounded so far as gastro-duo-denostomy is concerned. Indeed, I think he is

damning an operation which has won for itself quitean honourable position in the treatment of certaincases of duodenal ulcer.

I am, Sir, yours faithfully,Leeds, April 30th, 1931. E. R. FLINT.

INSULIN AND PRESERVATIVE.

To the Editor of THE LANCET.

SIR,-The doubts of Dr. Leyton and Dr. Poulton,as to whether the addition of antiseptic to insulin- solutions would be a benefit, must be shared by thevast majority of physicians having long practicalexperience of the use of this substance. I can myselfstate that I have never come across any sign of ill-effect due to the absence of antiseptics in the solutionswhich have been in use up to the present time. Itis perhaps doubtful whether the introduction of suchsubstances could have any ill-effect, but it seemsalmost certain that no good can thereby be broughtabout, and it is also worthy of note that some manu-facturers, advised by scientific experts of the highestauthority, have such strong objection to the suggestedchange that the particular brands of insulin madeby them may, in such circumstances, be withdrawnfrom the market. This alone would be most

regrettable.It is to be hoped the Ministry of Health will not

proceed with the contemplated Bill until an oppor-tunity has been given to all shades of medical opinionto express views as to the wisdom of the proposedmeasure. I am, Sir, yours faithfully,London, W., May 2nd, 1931. T. IZOD BENNETT.

CAVERNOUS SINUS THROMBOSIS AND

FACIAL INFECTIONS.

To the Editor of THE LANCET.

SiR,-Mr. Scott Brown in your issue of May 2nd(p. 960) points out the peril of thrombophlebitis ofthe cavernous sinus from seemingly trivial infectionsabout the face.- He agrees with observations recordedby many that infection usually occurs via the facialvein. Surely then the rational procedure is to fore-stall spread of infection by this route. This can be

accomplished by ligating the angular vein. I havedealt fully with this preventive operation. Secondly,I wish to reiterate the teaching of Ochsner that toincise or excise a carbuncle of the lip is most dan-

gerous. Local treatment with ample hot moist

dressings of magnesium sulphate preceded by peri-pheral auto-injections of whole blood is attended byfar better results than excision. Lastly, whencavernous sinus thrombosis is established, but thepatient has yet a good hold on life, may I drawattention to Eagleton’s operation described in his

thoughtful book, " Thrombophlebitis of the Cavernous

Sinus " (New York, 1926).I am, Sir, yours faithfully,

Harley-street, May 2nd, 1931. HAMILTON BAILEY.

1 Surgery, Gynecology, and Obstetrics, April, 1928.