1
1263 occurs at the height of inspiration. Further, although the tracing is a close likeness, it is not a true picture of the pulsus alternans ; one feature is alien-namely, the length of the downstroke of the weaker beat which equals the length of the downstroke of the stronger beat. In descriptions of the pulsus alternans hitherto given no mention is made of the relative length of the downstroke of the beats. To determine this relationship I have examined a large number of tracings, and I find in true pulsus alternans that although the downstroke of the weaker beat may be longer than its upstroke, it is never so long as the downstroke of the stronger beat. On these considerations I submit, with all deference, that the presence of true pulsus alternans in Fig. 6 cannot be accepted without demur. With regard to the prognostic significance of pulsus alternans this has not been worked out, so far as I know, except in one group of cases-namely, when it occurs in association with myocardial and arterial disease in aged people. I published notes of a number of these cases in the Quarterly Journal of Medicine, July, 1913, and at that time ten of the patients were living; since, all except one have died, and none of the lot lived much over three years. In other conditions in which the pulsus alternans occurs present experience only warrants this conclusion, that it adds to the gravity of the outlook. In my own experience it is not met with in rheumatic heart disease, or acute illnesses in the absence of other signs of danger. I am, Sir, yours faithfully, June 5th, 1915. J. DAVENPORT WINDLE. J. DAVENPORT WINDLE. THE GRATUITOUS TREATMENT OF DEPENDENTS. To the Editor of THE LANCET. SIR,-I think it is time, if conscription is approaching, for the profession to reconsider their attitude towards the wives and children of those men who are serving either at the front or training in Britain. The number is increasing daily, and is likely to go on doing so. At the present time we are not paid for the insured among these men-a considerable loss to those with a large panel list- and we appear to be in danger of having our prac- tices still further decreased by a large increase in the number of " dependents." There is no lack of loyalty in the writer of this letter; he has done his share so far, but the future has to be borne in mind. Loyalty will not feed the doctor and educate his family. There is no wish to pile extra burdens on those whose men are fighting for us, so surely this is a matter for Government to arrange. I am, Sir, yours faithfully, May 31st. 1915. M.D. THE USE OF TRAINED NURSES FOR ORDINARY DUTIES. To the Editor of THE LANCET. SIR,-I have before me letters from two trained nurses at present serving in stationary hospitals with the Expeditionary Force. One takes spells of duty as cook and housekeeper, while the other has to cook her own meals and wash up afterwards. Both are thoroughly good nurses and both, I believe, are thoroughly bad cooks. I bring the matter forward in the hope that the authorities may be able to prevent such an apparently un- necessary waste of our nursing material. Trained nurses are scarce, but there are many experienced housekeepers, and the women of France have a deservedly high reputation as cooks. I am, Sir, yours faithfully, June 4th, 1915. H. B. THE MEDICAL PROFESSION AND THE NEEDS OF THE ARMY. To the Editor of THE LANCET. SIR,-The doubtful manner in which the records of our naval and military successes, no less than of our failures, have reached us-the hesitation as to the real significance of any news vouchsaf ed-has been as bad almost as silence. Just as in general affairs it makes for good if as much information as is possible, having regard always to the military and political exigencies of the campaign, were pub- lished in clear language, so the medical man would be helped by definite information. No one knows better than he how seriously anxiety that is perhaps not justifiable, and puzzledom that need not exist, militate against the output of good work. As a whole we are an educated people, and the desire to understand before we act has increased among us. The feeling is there, and though its manifes- tations are sometimes inconvenient, it should not be ignored, for that only leads to its aggravation. The output of the munitions of war is stated to have been delayed and even now to be jeopardised by alcoholic habits in certain centres. The state- ment, while reiterated by some and flatly con- tradicted by others, has a basis of fact which we should think by this time has been exposed suffi- ciently to the nation. But the position might have been made clear sooner, when much ill-will would have been avoided, and possibly ready remedies for some of the evil would have been found already. It seems still to be in doubt how far most stringent calls are yet to be made on the medical profession, and no definite guidance is given to the medical profession as to how such calls should be met. I am, Sir, yours faithfully, SENEX. SCIENCE IN CATALONIA. To the Editor of THE LANCET. SlB,—The book noticed last week under this heading may be taken to prove the vitality of the revival of the Catalan language, and we should all wish the revival success. For small states and small nationalities have a precarious existence to look forward to, should the centralisation and unification of nations and countries so vigorously prosecuted by Germany gain any general adoption in Europe. The principle of nationality for which Germany stands is entirely averse from the employment of their native tongues or dialects by subject races, thus contrasting with the principle of encouraging national individuality practised by ourselves. At no period of her history has Spain produced many men of science of European reputa- tion, a fact in striking contrast to her centuries of eminence in the fields of literature and art. Catalonia certainly gave birth to an alchemist of note in the thirteenth century-namely, Raymond Lully-if, indeed, it be not the case that the alchemical writings ascribed to him are forgeries of the fourteenth and fifteenth centuries. The present revival of the Catalan tongue undoubtedly gives an admirable opportunity for the revival of the study of science in Catalonia. May the opportunity be seized ! I am, Sir, yours faithfully, HISPANICUS.

THE USE OF TRAINED NURSES FOR ORDINARY DUTIES

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1263

occurs at the height of inspiration. Further,although the tracing is a close likeness, it is nota true picture of the pulsus alternans ; one featureis alien-namely, the length of the downstroke ofthe weaker beat which equals the length of thedownstroke of the stronger beat. In descriptionsof the pulsus alternans hitherto given no mentionis made of the relative length of the downstroke ofthe beats. To determine this relationship I haveexamined a large number of tracings, and I find intrue pulsus alternans that although the downstrokeof the weaker beat may be longer than its upstroke,it is never so long as the downstroke of the strongerbeat. On these considerations I submit, with alldeference, that the presence of true pulsus alternansin Fig. 6 cannot be accepted without demur.With regard to the prognostic significance of

pulsus alternans this has not been worked out, sofar as I know, except in one group of cases-namely,when it occurs in association with myocardial andarterial disease in aged people. I published notesof a number of these cases in the Quarterly Journalof Medicine, July, 1913, and at that time ten of thepatients were living; since, all except one havedied, and none of the lot lived much over threeyears. In other conditions in which the pulsusalternans occurs present experience only warrantsthis conclusion, that it adds to the gravity of theoutlook.In my own experience it is not met with in

rheumatic heart disease, or acute illnesses in theabsence of other signs of danger.

I am, Sir, yours faithfully,June 5th, 1915. J. DAVENPORT WINDLE.J. DAVENPORT WINDLE.

THE GRATUITOUS TREATMENT OFDEPENDENTS.

To the Editor of THE LANCET.

SIR,-I think it is time, if conscription is

approaching, for the profession to reconsider theirattitude towards the wives and children of thosemen who are serving either at the front or trainingin Britain. The number is increasing daily, and islikely to go on doing so. At the present time weare not paid for the insured among these men-aconsiderable loss to those with a large panel list-and we appear to be in danger of having our prac-tices still further decreased by a large increase inthe number of

"

dependents."There is no lack of loyalty in the writer of this

letter; he has done his share so far, but thefuture has to be borne in mind. Loyalty will notfeed the doctor and educate his family. There isno wish to pile extra burdens on those whose menare fighting for us, so surely this is a matter forGovernment to arrange.

I am, Sir, yours faithfully,May 31st. 1915. M.D.

THE USE OF TRAINED NURSES FORORDINARY DUTIES.

To the Editor of THE LANCET.

SIR,-I have before me letters from two trainednurses at present serving in stationary hospitalswith the Expeditionary Force. One takes spellsof duty as cook and housekeeper, while the otherhas to cook her own meals and wash up afterwards.Both are thoroughly good nurses and both, I

believe, are thoroughly bad cooks. I bring thematter forward in the hope that the authoritiesmay be able to prevent such an apparently un-necessary waste of our nursing material. Trained

nurses are scarce, but there are many experiencedhousekeepers, and the women of France have a

deservedly high reputation as cooks.I am, Sir, yours faithfully,

June 4th, 1915. __________________

H. B.

THE MEDICAL PROFESSION AND THENEEDS OF THE ARMY.

To the Editor of THE LANCET.

SIR,-The doubtful manner in which the recordsof our naval and military successes, no less than ofour failures, have reached us-the hesitation as tothe real significance of any news vouchsaf ed-hasbeen as bad almost as silence. Just as in generalaffairs it makes for good if as much information asis possible, having regard always to the militaryand political exigencies of the campaign, were pub-lished in clear language, so the medical man wouldbe helped by definite information. No one knowsbetter than he how seriously anxiety that is

perhaps not justifiable, and puzzledom that neednot exist, militate against the output of good work.As a whole we are an educated people, and the desireto understand before we act has increased amongus. The feeling is there, and though its manifes-tations are sometimes inconvenient, it should notbe ignored, for that only leads to its aggravation.The output of the munitions of war is stated tohave been delayed and even now to be jeopardisedby alcoholic habits in certain centres. The state-ment, while reiterated by some and flatly con-tradicted by others, has a basis of fact which weshould think by this time has been exposed suffi-ciently to the nation. But the position might havebeen made clear sooner, when much ill-will wouldhave been avoided, and possibly ready remedies forsome of the evil would have been found already.

It seems still to be in doubt how far moststringent calls are yet to be made on the medicalprofession, and no definite guidance is given to themedical profession as to how such calls shouldbe met. I am, Sir, yours faithfully,

SENEX.

SCIENCE IN CATALONIA.To the Editor of THE LANCET.

SlB,—The book noticed last week under thisheading may be taken to prove the vitality of therevival of the Catalan language, and we should allwish the revival success.For small states and small nationalities have a

precarious existence to look forward to, should thecentralisation and unification of nations and countriesso vigorously prosecuted by Germany gain any generaladoption in Europe. The principle of nationalityfor which Germany stands is entirely averse from theemployment of their native tongues or dialects bysubject races, thus contrasting with the principleof encouraging national individuality practised byourselves. At no period of her history has Spainproduced many men of science of European reputa-tion, a fact in striking contrast to her centuriesof eminence in the fields of literature and art.Catalonia certainly gave birth to an alchemist ofnote in the thirteenth century-namely, RaymondLully-if, indeed, it be not the case that thealchemical writings ascribed to him are forgeries ofthe fourteenth and fifteenth centuries. The presentrevival of the Catalan tongue undoubtedly gives anadmirable opportunity for the revival of the studyof science in Catalonia. May the opportunity beseized ! I am, Sir, yours faithfully,

HISPANICUS.