980

and lost no remuneration by attending court, on thegrounds that such an allowance conflicted with thedirections in the Home Office circular, was recentlychallenged, and it was contended that the particularwitness had not been compensated for trouble or loss oftime which. attendance at court necessarily involved.An application for the reconsideration of the fees to be

allowed in this case and for a ruling on the principle tobe applied was heard by Mr. Justice Devlin in chambers.It was argued that para. 5 of the Home Office circularwas too narrow, as, if the doctor had been an ordinarygeneral practitioner, he would have incurred the expenseof having to employ the services of another doctor toattend to his patients during the time he was absent atcourt, -or, if he did not adopt this course, he would haveto see his patients in time which he might otherwisehave -devoted to leisure.

Mr. Justice Devlin agreed with this contention andstated that he would direct the clerk of assize thatthe directions in para. 5 of the Home Office circular(re’pofessional witness fees to salaried officers) were toonarrow, and the mere fact that a practising doctor doesnot lose income is not sufficient to reduce him to thestatus of an ordinary witness. He further stated thatit was for the - clerk of assize to assess what amountshould be paid for the trouble and loss of time.

It is suggested, therefore, that salaried doctors whofind themselves in a similar position of having beenrefused a professional witness allowance in accordancewith the scale described in the Witnesses AllowancesRegulations, 1948, should argue the point whenever itarises, and should appeal to the judge or chairman ofthe court if the taxing officer refuses the appropriateallowance, making use of the opinion expressed byMr. Justice Devlin as described above.

This legal ruling will be brought to the notice of theHome Office, and it is hoped that the offending paragraphin the circular will be revised.

ALISTAIR FRENCHSecretary, The Medical Protection Society.

Victory House, Leicester Square,.

- London, BV.O.1.

THE MEDICAL ILLUSTRATOR

SIR,—ii medical students were to become scientistsalone, _and not clinicians, I could more easily understandDr. Lawrie’s distaste for the caricature diagram (May 21).

It is not suggested that this method of teaching shouldplay a major part in the teaching of medicine, but thatit should be supplementary to the universal methodsDr. Lawrie mentions. When employed correctly, itseems to serve to impress facts which perhaps do notreceive their correct emphasis elsewhere. Lest it shouldbe thought, however, that this type of instruction isconsidered tried and proved by paediatric students atGuy’s, I should like to point out that it has been onlyrecently introduced by Dr. Mac Keith. If on furtheracquaintance it is found to insult our intelligence, weshall not hesitate to say so.

Guy’s Hospital, London, S.E.1.D. J. STOKER

Fourth-year Student.

THE NEIGHBOURS’ CHILDREN

SiB,’—I write in a spirit of inquiry, and in the hopethat others may quash my forebodings with an over-whelming volume of evidence in rebuttal. I have adaughter (adopted) aged five and a bit : she is healthy,happy, supremely secure, and apparently well adjusted.But among her circle of a dozen or more friends of thesame age there is not one child who does not show signsof some psychological trouble, in many cases severe

enough to induce comment by its parents in the courseof casual social conversation.

Is this a general experience, and do others live amongcommunities where psychoneurosis is as prevalent as inmy suburb ? If the answer is No, then there is materialfor investigation of the local cause. If the answer isYes, then I would ask whether these children are sufferingfrom the effects of birth and infancy in the doodle-bugera, or whether they are the unfortunate victims of aparental prolongation of the pre-war suburban neurosis."

If such a state of affairs is widespread, I fear thatthere is little hope for an improvement in family security,

and all that accrues from it, in the coming years, unlessa greatly increased child-guidance service can stabilisethe personalities of these children. But I hope that myexperience is unusual, and that such gloomy thoughts.are needless. I dislike anonymity as, much as anybody,but I ask you for obvious reasons to accept the signatureof

PRO JUVENTUTE.

A PLAN FOR THE AGED

SiR,-Dr. J. V. Walker’s letter of May 14 reveals thatmy article, to which he refers, was not sufficiently clear.Instead of emphasising the hospital treatment of theaged sick., I was urging that the problem was one ofsocial and preventive medicine which could only be metby a combination of preventive and therapeutic measures,with the emphasis on the former. I agree that possiblythe maternity and child-welfare service provides a betteranalogy than the tuberculosis service, and I certainlyagree that the next great development in the field ofpublic health will be in the care of the ased.

London, S.W.I. C. A. BOUCHER.

DECAMETHONIUM IODIDE IN ANÆSTHESIA

SiR,-In view of the four articles on this substance, inyour issues of May 7 and 14, and the general release ofthe drug to the medical profession, I feel that it is myduty to sound a warning note.The combined committee of the Medical Research

Council and the Royal Society of Medicine (of which Iam a member) has not yet issued, its full report, and Ipersonally do not believe that the drug has yet beenadequately tested and its effects on the human subjectfully explored. I feel sure that indiscriminate use of thispotent relaxant will lead to avoidable fatalities, andthe utmost caution should be observed by anaesthetists.

St. Albans. C. LANGTON HEWER.

STRANGULATED HERNIA TREATED BYNATIVE ENTEROSTOMY

SiR,—I was interested to read in your issue of April 9Dr. Browne and Dr. Waddy’s description of the sequelaeof native treatment of strangulated hernia, by enteros-tomy with the actual cautery. I saw a similar case inNavrongo, in the Northern Gold Coast, in 1946, not farfrom the scene of Browne and Waddy’s surgicaltour-de-force.

My patient was rather more skilful than theirs, and heincised the anterior wall of his inguinal canal with a sharpknife ; this relieved the strangulation without injuring thebowel. Unfortunately the bowel herniated through the

incision, and the patient was left to contemplate several feetof his ileum emerging from his little wound.The patient applied cow-dung, powdered charcoal, and other

patent native remedies, to the herniated intestines, but afterthree days they had not returned to the abdomen; hetherefore wrapped them in a dirty cloth, mounted his donkey,and rode ten miles to the main road, whence he obtained alift to hospital on a passing lorry.When I saw the patient he was surprisingly fit, but with

about four feet of bowel, covered with every sort of filth,.nestling on his right thigh. It was obviously impossible toreturn the bowel to the abdomen, so the whole horrible masswas amputated. The free ends of bowel were anastomosed,and the incision (made by the patient) closed after debride-ment. The patient never gave a moment’s anxiety, andrecovered rapidly and completely. I often saw him duringthe following year, and his hernia recurred, since I had madeno attempt to remove the sac. I successfully persuaded himthat any further surgical intervention by a physician, in aso-called hospital unequipped for major surgery, might betempting Providence once too often.One cannot but admire the courage and resource of

these patients, living as they do out of range of medicalcare, who by rough native surgery enable their lives tobe preserved and the results tidied up by a doctor. Itis to be hoped that one day governments will be estab-lished in our Colonies which will provide medical servicesthat will render cases such as these unbelievableanachronisms, instead of common occurrences.

Medical Research Institute,Accra, Gold Coast.

MARK HUGHES.