631REGULATION OF PROSTITUTION

under review was 166.6 ; of these 1582 cases were

discharged during the period and 61 died. No mentionof the 23 cases required to make up the total.

Percentages are usually shown in relation to the totalnumber treated, and in this case in my opinion theyshould be represented in this way :

Total number of cases.. 1666 100 %Discharged...... 1582 = 95-00%Died ...... 61 = 3-64%Unaccounted...... 23= 1-36%

100-00%

In "Causes of Death the figures given in thefirst instance are-

MiliaryT.B andmeningitis 32Sepsis and amyloid disease .... 16Other causes ........ 13

but if the tabulated figures are added up we get32, 15, and 14 respectively. In an investigation ofthis kind it would probably be better to deal withonly those cases in which a conclusion has beenreached, and in this way the figures should beshown thus:

Total cases the outcome of which isknown........ 1643

Discharged ........ 1582=96-3%Died.......... 61 = 3-7 %

As figures given in THE LANCET are frequentlyquoted in support of various theories it is verydesirable that they should be clear and not capableof misinterpretation. I can offer no criticism ofclinical observations but I can check the deductionswhen figures are involved and shall continue to

dispute any theory put forward in the popular presswhich is founded on a fallacy. In the present casethe discrepancy is not great but the fact that thedeath-rate is over-stated reduces the credit due toSir Henry Gauvain for the excellence of his treat-ment which gives a death-rate only a little over

three times that of the whole population.I am, Sir, yours faithfully,

S. D. PERSY FISHER.The Crescent, Alwoodley Park, Moortown, Leeds,

March 7th.

S. D. PERSY FISHER.

AN ADDRESS IN HARLEY STREET

To the Editor of THE LANCET

SIR,-I wonder whether any of your readers havenoticed that within the last year or so the names

appearing on door-plates in the Harley Street districthave begun to introduce a continental note, so thatthe kudos of an address in this area is now inter-national rather than national. When the doors ofour hospitals and medical schools were thrown opena short while ago to medical refugees from anothercountry it was expressly stated to those of us who areteachers at the medical schools that the Home Officewere granting permits for these refugees to residein this country for the purpose of obtaining a Britishqualification, but that they would not be allowedto practise here.On this understanding we undertook, wrongly as

I think, to teach these graduates of a foreign universitywith our undergraduates in the same classes andclinics. What has been the result ? The harvestof British diplomas has been gathered, but there areno signs of our guests departing from our shores topractise elsewhere. On the contrary, hardly a weekpasses without my receiving an application fromone of the new recruits to British medicine to be oneof my clinical assistants ; there is hardly an electionfor a minor staff appointment without the appearanceas candidates of one or more ; and, as I stated inthe beginning, the crop of plates bearing continental

names increases daily. The reason given by oneapplicant for a clinical assistant post was, not thathe wished to learn more of a particular subject, butthat he thought it would help him to improve hisknowledge of English. Another applying for the

post of registrar, when asked whether it was hisintention to practise his specialty in England, said,with the greatest assurance, " Oh ! Yes" without

any idea that it was a rare privilege for him to do so.Only yesterday I received a card in an open envelopefrom one of these gentlemen in which he acquaintedme of the fact that he was a gynaecologist and surgeon,and that he had now established himself in theconsulting area.

Surely this is a matter for investigation by thosebodies representing medical interests in this country.It is already difficult enough for our younger men tomake a living. The fact that I am on the staff of oneof our teaching hospitals makes it necessary for meto claim the privilege of anonymity, but I enclosemy card. I am, Sir, yours faithfully,London, March 7th. ALBERICUS.ALBERICUS.

STAMMERING

To the Editor of THE LANCET

SIR,-Mr. St. John Rumsey suggests that I seemto contradict myself but does not indicate in whatway. In case, however, I did not make myselfsufficiently clear in my letter of Feb. 22nd permitme to restate the matter. It is now definitelyestablished that stammering is a psychic troublewhich deranges the natural coordination of themuscles of respiration, voice, and articulation,bringing about faulty action of all of these. Conse-quently neither psychic treatment alone nor elocu-

tionary instruction alone-nor indeed elocutionarytreatment at all-can effect cure. Psychic analysisto remove fear and relaxation treatment to removethe muscular contractions caused by the fear areessential. These must be followed by re-educationand coordination of all the muscles concerned in

speech. To employ elocutionary measures is tofocus the stammerer’s attention on the symptoms,making matters infinitely worse. The most difficultcases to treat have in my experience been thosewhere elocutionary instruction has been tried.The dictionary tells us that elocution is " The art

of effective speaking, more especially of publicspeaking, regarding solely the utterance or delivery ;eloquence " (the italics are mine). Obviously there-fore elocution does not in any way touch the causeof stammering.-I am, Sir, yours faithfully,

KATE EMIL-BEHNKE.Earl’s Court-square, S.W., March 9th.

KATE EMIL-BEHNKE.

REGULATION OF PROSTITUTION

To the Editor of THE LANCET

SiR,-Some of your correspondents have expresseddoubt at my statement (in your issue of Nov. 9th,1935, p. 1078) that the Congress of Dermatologymeeting at Budapest last autumn " accepted as

a fact that syphilis and gonorrhoea could be madeextinct throughout the world within a single yearif all who suffer from them would have themselves

fully treated." It is true that no such direct state-ment was made from the rostrum, but from thediscussion held on Sept. 13th, in No. 4 hall of theHungarian Scientific Academy, on the internationalcampaign against venereal diseases the inferencecould be drawn that, with adequately thoroughtreatment, gonorrhoea as well as syphilis, at what-ever stage of the disease, could be brought within

632 PARLIAMENTARY INTELLIGENCE

a year or so to such a phase as not to be infec-tious any more. Hereditary syphilis, as stated byHoffmann (Bonn) and Guszmann (Budapest), willshortly disappear from all civilised States. I quotetheir statements literatim.

Prof. J. GuszMANN (Budapest): In the domain ofsyphilidology I see the greatest progress in the fact thatto-day we are justified in asserting that congenital syphiliswill shortly disappear entirely in all cultured countriesand their terrible consequences will remain unknown tothe next generation of physicians.

Dr. E. HOFFMANN (Bonn) : As I have already empha-sised in articles which have appeared in the Wien. klin.Woch. and the Wien. med. Woch., with the aid of ourpresent methods of intensive treatment congenital syphilisis well avertable and certainly curable. In consequenceof this fact stillborn and macerated foetuses have entirelydisappeared at many places (Germany, Denmark) whereintensive and persistent treatment is applied.

From these premisses we can infer, without undueoptimism, that sexual diseases could be made extinctwithin a year or so, if during this time we couldenforce the strict and complete isolation of the patients,whereby the source of infection could be blocked.It is equally reasonable to imagine that by theenforcement of severe procedures-eventually punish-ment and internment-adopted internationally againstvenereal patients caught or reported to spread thediseases at large and by applying treatmenton them the infectivity of such patients wouldcease and as a consequence venereal disease woulddisappear. Laws to this effect are already in forcein Germany and Rumania ; a draft Act has justbeen prepared in Hungary.

I am, Sir, yours faithfully,YOUR BUDAPEST CORRESPONDENT.

Budapest, Feb. 27th.

PARLIAMENTARY INTELLIGENCENOTES ON CURRENT TOPICS

Home Office Administration

ON March 5th, on a vote for the Civil and RevenueDepartments, Mr. BENSON raised the subject of the

PSYCHOLOGICAL TREATMENT OF DELINQUENTS

He acknowledged with gratitude the sympathetic wayin which the Home Office had dealt with this matterin the past. The first official recognition of thepsychological problem or the possibility of thepsychological treatment of delinquents and criminaloffenders was in a Departmental Report issued in 1932.The Home Office immediately appointed a psychiatristwho he believed was working at Wormwood Scrubs.His object in raising the matter that day wasto appeal to the Home Office to go a little bitfurther.

It was true, he said, that the psychological treatmentof delinquents was in a purely experimental stage, butso was the treatment of cancer. In practically all medicalmatters treatment and experiment were bound to gohand in hand. With regard to psychiatry particularlyas applied to delinquency it was essential that psychiatristsshould be encouraged in their work on the subject andallowed every possible facility for the treatment of delin-quents in order that they might extend and improve theirtechnique and bring it out of the experimental stage.At present the work was extremely haphazard very largelyowing to the shortage of facilities. It was not that theHome Office was responsible for that. There was a bril-liant band of psychological specialists working on thismatter but unfortunately they had to apply a long,arduous, and extremely difficult technique, and they weregravely hampered by lack of funds, lack of buildings, andlack of almost everything that would make either theirexperiments or their treatment efficient and helpful.At the present moment there was a single Governmentpsychiatrist he thought at Wormwood Scrubs, and therewere six London hospitals which had psychologicalclinics, and these occasionally took delinquents. Therewas the Institute of Medical Psychology, where againthe treatment of delinquency was a side line, though theyhad done most valuable work and had gathered veryvaluable data. There was also one small new body-theInstitute for the Scientific Treatment of Delinquency-which was the only specialist body in the countrydealing with the psychiatric treatment of crime andcriminals.

The type of case that came before these clinicsfor treatment was extraordinarily varied. It wasnot merely the sex case as so many people seemed toimagine. In 1934 and 1935 the following cases came

into the hands of the Institute for the ScientificTreatment of Delinquency :-Attempted murder 1 Theft (including four bur-Violence ..... 7 glars) ..... 46

Shop lifting .... 14

Attempted suicide . 9 Embezzlement, forgery,Sex cases 36 and false pretences 26Wandering 13 Other kinds of cases 29

In dealing with this subject, Mr. Benson con-

tinued, the Home Office would have to get thecooperation of judges and magistrates. In Londonhe was glad to say the magistrates were awakeningto the importance of the matter. In 1935 they sentto the Institute for the Scientific Treatment ofDelinquency twice as many cases as they sent in1934. In the second place the Home Office wouldhave to realise the necessity for the provision oftreatment for cases in which it was recommendedby the courts. In London the possibilities for thistreatment were hopelessly inadequate and in theprovinces they were entirely non-existent. It was areally staggering fact that outside London there wereonly four doctors with the qualification of theInstitute of Psycho-Analysis. All the rest of thedoctors with that qualification were in London.There was one doctor in Manchester, one in Reading,one in Southsea, and one in Edinburgh. The HomeOffice would have to face this problem because thepsychiatric treatment, not merely of delinquents butof any neurotic person, was fundamentally differentfrom that given by the hospitals. To allow this typeof treatment to depend on the voluntary work of asmall handful of specialists was out of the question.If this problem was to be thoroughly tackled theHome Office sooner or later would have to provide itsown trained psychiatrists and to regard this as acurative branch of the prison service.

SILICOSIS-MINERS’ NYSTAGMUS

Mr. HOLLINS drew attention to the position ofhundreds of thousands of workers engaged in occu’pations in which the dreadful disease of silicosis haddeveloped. He would prefer that there should not bethe present limitation with regard to silicosis becauseSection 47 of the 1925 Act only scheduled the occu’pation and not the disease. Wherever a workmancontracted this dreadful disease as a result of followingan occupation he should be allowed to make a claimfor compensation. Under the scheme of Section 47of the 1925 Act, and the amending Act of 1931,medical boards were introduced and the experienceof the pottery industry was that these boards wereoperating in a perfectly satisfactory manner. Theworkers would prefer the medical boards to thesystem of medical referees and certifying surgeons.They preferred that there should be a second orthird opinion rather than that the decision should be