example, shortly beforefor the scholarship examination latter the a
Correspondence. VARIOLA MAJOR AND MINOR.
family holiday-but possibility of only obtaining an " attenuated measles after a long a
incubation period " might make the dates more inconvenient. A fellow student of mine, some 30 years ago, developed measles at an awkward time in his medical curriculum, and his father, who was a, doctor, told me he would deliberately expose his children to the infection of such illnesses, if he could have his time over again. Without going as far as this, if I were advising the medical profession with regard to their own children, I should say that the first time a child is exposed to the infection of measles is probably the most convenient and the safest time to have the disease. To prevent that attack, with a short-lived immunity, leaves an added responsibility for the future, and should only be attempted when some exceptional circumstances make measles particularly unfortunate at that season. When a child develops measles in a hospital ward Isero-prophylaxis would be invaluable for the other children, because the administrative responsibilities of measles in a children’s ward are very serious. I am, Sir, yours faithfully, HUGH BARBER. Derby, March 10th, 1930.
To the Editor of THE LANCET. SiB,—I have read with much appreciation the paper by Dr. R. W. Jameson, appearing in your issue for March 8th. I wish strongly to support his contention that the time has come when the distinction between the two forms of small-pox, major and minor, should be officially recognised. As he points out, whilst it may not be easy to decide the nature of the first case in an outbreak it should always be possible to decide after a series of cases have occurred. I believe that no real doubt exists about the nature of any outbreak which has occurred in this country since the war, and it is only in the post-war period that the existence of variola minor as a distinct form of small-pox has been suspected. Dr. Jameson draws attention to the confusion and other disadvantages resulting from the present plan of calling both forms " small-pox," without distinction. We may well ask what value our present casemortality statistics will havein years to come when it will be impossible to know what proportion of the cases lumped together as " small-pox " were of the major or minor variety respectively. The terms "variola major" and " variola minor"have, as Dr. Jameson states, been accepted in the last Decennial International Conference on the Nomenclature of Causes of Death, and I venture to suggest that the Ministry of Health would be moving in the right direction if they invited medical officers of health in reporting small-pox cases to specify whether the cases were major or minor. I am, Sir. yours faithfully, C. KILLICK MILLARD,
SOCIAL CUSTOMS AND INFANT MORTALITY. To the Editor
SIR,-Indian obstetrical methods and social usages
come in for severe and entirely unmerited criticisms in THE LANCET in a note on a contribution to the Hibbert Journal by Miss Eleanor Rathbone entitled Has Katherine Mayo Slandered Mother India ? Miss Mayo’s book having received previously a favourable notice in the same paper. We did not take these uninformed and biased criticisms seriously, but now they have begun to colour all official and unofficial health reports. The constructive suggestions made in THE LANCET about the education of women and the training of Medical Officer of Health. the indigenous dai are valuable, if by education is Health Offices, Leicester, March 11th, 1930. meant real education ; but it seems almost incredible that THE LANCET, while discussing the death-rate of Indian infants, should have sedulously omitted PROTECTION AGAINST MEASLES. all reference to the appalling economic conditions. To the Editor of THE LANCET. and trotted out Indian social customs as the sole SiR,-Your interesting leading article last week is cause of the high Indian death-rate. That social customs, good, bad, or indifferent, have comparaa valuable contribution in the study of immunity, but raises one or two practical considerations in tively little effect on the health of the people and relation to private practice. " The importance of that proper nourishment is the all-engrossing factor. this work," you say, " lies in the fact that it brings form an obvious proposition. In 1925 the Mississipi the sero-prophylaxis of measles within the range of inundated a large tract of country and the Government of America pressed into service a flotilla of measures practicable to the family doctor, for one or other of the parents is almost certain to have had aeroplanes and dropped tinned provisions to the measles, and thus the donor is immediately available." sufferers. A serious development of pellagra occurred. That is to say, we are now considering the individual not as a result of starvation but due to lack of vitamin B in the diet during the short period of relief. child or family. That a parent’s serum may still carry the Who argues that this absence of stamina on the part immunising properties is so convenient that the of the American people was to be ascribed to their procedure should be quite simple. But it isan social customs ? Also who has ever heard in India important consideration how long any such passive of the occurrence of a single flood leaving the people immunity may last; because measles is a very in the grip of pellagra ?P Judged by this incident harmless disease in small children, when efficiently Indians have the greater stamina, so that, if social treated-that is to say, in bed, in a room that is customs are the dominant factor, American social really warm, with a minimum of washing-whereas customs make a poor show by comparison. Again, in young adults it tends to be much more serious, and during the great European war the central States most of us know of fatal cases. I believe that the of Europe were compelled to go without some only most experienced medical officers of public schools are of the essential foodstuffs for not even four years. afraid of the boys who have not already had measles. This short course of restricted diet broke down the I believe the evidence that measles should be treated constitution of the populations so completely that at home during childhood, rather than at school or in for years afterwards Vienna, for example, showed an lodgings or hospital later on, is so convincing that immense rise in the occurrence of rickets and tuberprophylactic inoculation against measles, producing culosis. If this is to be laid at the door of social a short-lived passive immunity, is a doubtful advancustoms the sooner European social customs are tage for young children, who might otherwise have improved the better. The people of India have.. developed an active immunity by having measles at with their social customs, been inured to hardships home with no disadvantage other than the loss of and privations of every sort, and from their cradlca few Christmas parties or some day-school lessons. been faced with famine and flood. A short-lived passive immunity might be of the I I undertook last year a private census of 800 births utmost importance in exceptional circumstances—top amongst persons with an average income of L.200 a