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the transfusion, though a previous attempt at transfusionby the " needle technique " had failed because of this.Nevertheless, it is felt that a light splint might be usedwith advantage in the case of a restless or sleepingpatient. .

Leaking has never been observed, despite the factthat the introducing needle is much larger than thecatheter. No case has shown any bruising. No phlebitishas occurred so far, and in one case the same vein wassubsequently employed for transfusion by " needletechnique."Thanks are due to the medical and nursing staff of the

wards in which these transfusions have been performed.Plastic catheters extruded to our specification were suppliedby De La Rue Insulation Ltd., of Tynemouth, who havealways been most helpful. ’

Royal Victoria Infirmary,Newcastle-on-Tyne.

WILLIAM WALKER.

SPONTANEOUS RUPTURE OF THE RECTUM

SIR,—I was interested to see the recent reports ofso-called " spontaneous ruptures of the rectum." Onecannot help wondering whether such can indeed occur" out of a blue sky " or whether some previous ulcerationis always present., Recently I had a similar case in which laparotomy

revealed a pelvis full of solid faeces which had escapedthrough a perforation about the size of a half-crownsituated in the lower sigmoid colon. At operation the,bowel appeared otherwise normal, and I was able toexteriorise the affected area. The patient’s condition,however, was very poor from the start, and heunfortunately came to autopsy.A careful search showed evidence of considerable

diverticulitis, and the presence of marked engorgementaround the perforation led us to believe that it wasalmost certainly the floor of a stercoral ulcer which hadgiven way.Ashford County Hospital,

Middlesex.ROBIN BURKITT.

LETTER TO A NEPHEW

SIR,—I was a little perturbed by the views of the"affectionate uncle " in your Students’ Number. Ido not understand why the vocational urge to be a gooddoctor should be regarded as unhealthy, or why highideals should be incompatible with being a " wise,kindly, reliable human being."The two attributes are surely independent of each

other. True, many idealists are extremely bigoted andnarrow-minded ; but there are others,, of whom thelate William Temple may be taken as an example, whoare the most human of men. I am sure that if the" affectionate uncle " were to delve into his experiencehe would find far more neurotics and other unstablepersonalities among those with low ideals than those withhigh. ,

This condemnation of idealists as freaks is deplorable.Where would the drive for achievement in any walk oflife be found if it were not for ideals ? The world woulddrift through sloth and idleness to its own destructioneven faster than it is drifting now. The man of idealsis just the very person of integrity to whom the distressedwould turn in time of trouble. Although the idealisthitches his wagon to a star, the wheels of his wagon arenone the less firmly placed upon the ground, and theskin that he has acquired in guiding them through therough journey of life makes his advice all the morevaluable in helping those who are not so successful,Idealism and realism are complementary.

I would suggest that the delightful picture that the" affectionate uncle " drew of the trusted family doctoritself demands a definite vocation. He sets an ideal inmedical practice that requires from the doctor unremit-ting service to his patients at all times of the day andnight. I believe that most men are idealists. Theyare loth to admit it, however, because of the unfor-tunate association in men’s minds of idealism with,narrow-minded fanaticism.

X.Y.Z.

PRIVATE PATIENTS NOT ADMITTED

SIR,—In your last issue you take exception to myletter to the Times of Sept. 15 in which I uphold thedecision of the Minister of Health to exclude privatepatients from the new health centres because, in myopinion, this is bound to lead to either preferential, moreconsiderate, or better treatment for them. You say-

"The truth seems to be that the great majority ofpatients remaining as private patients do so in order thatthey may suit their own convenience as to when, where,and how often, they consult their doctor."

But surely if private patients coming to the healthcentre are permitted to " suit their convenience " as

to when they see their doctor, whereas other patients,except emergencies, have to make appointments betweencertain hours, they are receiving preferential treatment,and here of course I am using the term treatment toimply service and not medical treatment for disease.

It is quite permissible to argue that to admit privatepatients to health centres might have compensatingadvantages to the doctor or even to the service as a wholeby saving the doctor’s time, but to deny that it wouldinvolve two standards is absurd.. London, S.W.1. SOMERVILLE HASTINGS.

SELECTION OF TEACHERS

SIR,—Your Students’ Number (Aug. 28) contained aconcerted attack on the problem of selecting medicalstudents. A scarcely less important problem is theselection of clinical teachers. The present system isvery inefficient-so many teachers are dull and incom-petent, so few brilliant and inspiring. Your peripateticcorrespondent’s son (Sept. 11) might be quoted.

I do not know how teachers are selected, but it seemsthat teaching ability is rarely considered. For those whohave to make the choice it is indeed very difficult toassess ; yet they never take the obvious step and askstudents. Only his audience can judge whether a teacheris lucid and capable of holding its interest. Surely, Sir,there is some way of fairly estimating a man’s abilityto teach by asking those whom he has taught ? Thisshould apply as much to the promotion of a registrar toa chief assistant’s post as to the appointment of anhonorary at a teaching hospital. It is true that there arenot enough good teachers to go round, but part of thereason is that many potentially good ones stop teachingwhen they have finished as registrars. If medical schoolauthorities could judge which of the registrars were ableteachers, they could encourage them to continue to teach.Provided their clinical and scientific ability was sufficient,an improvement in the general standard of teachingshould result. CLINICAL STUDENT.

THE CASSEL HOSPITAL

SIR,—May I make two corrections to your accountlast week of the procedure used in selecting nurses forthe Cassel Hospital for Functional Nervous Disorders ?Your heading described " The Cassel " as a mental

hospital; it is a hospital for neurosis and it has neverbeen a mental hospital nor admitted psychotic patients.The point is important in so far as your note may affectour recruitment of State-registered nurses for the year’scourse and certificate in the nursing of neurosis, or maydiscourage applicants for the Cassel bursaries, whichpermit a general trained nurse to obtain three months’intensive experience in this work, and then,to returnto her own hospital.

Secondly, Dr. C. H. Rogerson, my predecessor, isinnocent of responsibility for the procedure, which owesmuch to War Office Selection Board methods. Thesystem was introduced by the Matron, Miss D. Weddell,with the technical assistance of myself and my colleagues.

The Cassel Hospital, Ham Common,Richmond, Surrey.

T. F. MAINMedical Director.

"... The great epidemic diseases are seven in number,malaria, plague, cholera, smallpox, typhus, yellow fever, andinfluenza. Others have had episodes of widespread activity,but these seven have been the great killers...."-Dr. F. M.BURNET, F.R.s., Med. J. dust. Sept. 11, 1948, p. 283.