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bring doctor and patient together at suitable intervals,whenever anything in the nature of a potent or dangerousdrug is in question ; it applies to private and publicpatients alike, and it assumes that doctors are reasonablyinterested in their patients’ welfare. If we don’t disputethis, what exactly,are we grumbling at ? That a smallernumber of people than hitherto will be able to imbibemedicines to their hearts’ content and without guidance ?-Or that the State is at fault for refusing to pay fordrugs and services the usefulness of which is to bejudged entirely by the patient ? It seems risky enoughto leave it to the judgment of the doctor, if he regardsthe patient’s visit as a tiresome reminder that anotherprescription is due, instead of as an opportunity towatch progress and change or withold drugs accordingto the results obtained.The number of conditions which need constant medi-

cation with relatively innocuous drugs are relativelyfew-quite certainly not enough to make prescription-writing a nuisance. Where the nuisance exists, theconditions must be absent, and it just shows how wisethe State is in restricting malpractice of this kind bydiscouraging its perpetrators. -

PRACTITIONER.

BINOCULAR MICROSCOPES

Srp,—The lessened eyestrain resulting from the useof binocular microscopes has led to their being employedvery largely by those of us who have to work with themall day. Until the beginning of the century the Wenhamand Greenough binoculars were the only practicalinstruments of this kind, but they were restricted tolow powers, the former (which used one objective)because of the nature of the Wenham prism, the latterbecause to increase stereoscopy two objectives were used.With the introduction of efficient half-silvered prisms,it became possible to make binocular attachments forthe ordinary microscope, all the ordinary powers of themicroscope being now usable with them. In spite ofthe single objective, a considerable amount of stereoscopyis obtainable in this way, and it can even be exaggeratedby suitable eyepiece-caps.

In the Wenham and Greenough binoculars convergingtubes were used, largely for structural reasons, butthe more modern binocular microscopes, as made on theContinent and in America, have parallel eyepieces. Thereason for this is clear enough. One of the mostelementary pieces of instruction to beginners with themicroscope is to work with relaxed accommodation,partly because this is the most restful way to work,and partly (when a monocular instrument is used) torender the image seen by the unoccupied eye as vagueand ill-defined as possible so that it may be the moreeasily disregarded.

Lately, however, two English manufacturers haveattempted to reintroduce converging oculars in theirbinocular microscopes, the reason given being that,since the object is ten inches away, there is a tendencyto imagine that you are looking at it direct, and thattherefore you accommodate and converge your eyes.Furthermore, they say that it facilitates stopping towrite notes, as you do not have to briDg your eyes backfrom infinity. There is certainly increased difficulty indoing this after the age of 45 or thereabout, but micro-scopes are surely not made exclusively for workers overthat age, and workers over this age may well havedifficulty in accommodating to the ten inches laid downby the makers. The decision to change to convergingoculars was apparently made at a conference of opticalmanufacturers, and one can only say that it is a pitythey did not consult a competent physiologist beforemaking the decision. For it is surely impossible simul-taneously to converge your eyes and relax your accom-modation without resultant eyestrain. The answer Ihave obtained from both manufacturers in response toinquiry has been that you do not in point of fact workwith relaxed accommodation at all-an answer thatseems to me at variance with the facts. All the experi-enced pathologists of my acquaintances work withrelaxed accommodation as ascertained by careful testing.Where you are working (as with a microscope) with twofocusing systems-the accommodation and the fineadjustment of the microscope-both focusing on an

object at no clearly defined distance away, it is obviouslybest to keep one fixed and move only the other. Sincethe accommodation is powerless to do any but a smallfraction of the huge focusing that is necessary, it isclearly the accommodation that must remain fixed, andit can only do so comfortably at its limit-i.e.. at completerelaxation.Whatever may be the theory of the matter, the

practical aspect is decisive. The parallel-tube instru-ments are comfortable to work with all day-I havedone so myself for many years. But I have also oneof the converging type, and it only takes about fifteenminutes’ work with this to make my eyes ache and water.

It seems to me important to get this point settled,and it would be a great help if a physiologist such asProfessor Hartridge would give us the benefit of hisopmion.London, W.l. J. W. SHACKLE.

BALSIR,—SIR,-

Ignoramuses like meThink the Editor might see

Ambiguities should beMade as plain as plain can be :

Judge today then my surpriseThat you did not put us wise

Thinking that we should surmiseWhat BAL might epitomise.

As a favour, Sir, you might ,

For those others in my plightLet me that key-word indite-

British Anti-Lewisite.ZETA.

** The new approved name for BAL is dimercaprol(July’31, p. 193).-ED. L.

Medicine and the Law

Dismissal of Suspected Typhoid CarrierA CASE recently heard in the High Court at Dublin

underlines the need for close adherence to regulations insecuring exclusion of a suspected typhoid carrier fromwork involving food-handling.

In May, 1945, a medical officer of health in Eirereceived a letter from another medical officer of health,notifying him that a young woman believed to be workingat a hotel in the first M.o.H.’s area had contractedtyphoid in the previous July and had been employedas cook " on the Great Northern dining-car with whichan outbreak of typhoid was connected." On dischargefrom hospital, the letter added, she had been certifiedas free from Salmonella typhi. ’

On receipt of this letter the’ M.o.H. visited the hotelin question and confirmed that the woman had recentlytaken up an appointment there as cook. He explainedto the manageress that it might be dangerous to employher as a’food-handler. When interviewed the womanadmitted that she had been employed in the dining-car.After further discussion with the manageress the M.o.H.telephoned the hospital where her condition had beeninvestigated and was told that investigation had pointedto her as the cause of the outbreak. The 3T.o.n. againsaw the manageress and said that he was afraid hewould have to stop this young woman from preparingand handling food. He did not tell her to sack the girl.He told her that the hospital doctor had said that thegirl should not be employed as a food-handler, and hefelt that it was his duty to implement this becausethis doctor had said that she might be a precociouscarrier. He telephoned the Department of Health andwas told by an official that the girl should not, in hisopinion, be employed as a food-handler, but that thedecision would have to rest with the M.o.H. He thenwrote a letter to the manageress which included thesewords : ,

" I am sorry to say that she is possibly a precociouscarrier of typhoid fever. She must not be employed byyou in any position connected with the preparation orhandling of food."

.

The manageress then dismissed the girl. The M.O.H.wrote down the patient’s name in his register but he