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the Thames valley and that the extreme prevalence here isdue to the charging of the atmosphere with the products ofincomplete combustion of coal. The statistics of the Meteoro-logical Office prove that we lose in winter 50 per cent. of thesunshine which districts adjoining London enjoy and alsoprove that on days when there is no fog in London the atmo-sphere is so charged with particles as to become opaque in ashort distance ; for instance, it has been proved that duringDecember and January (on days when there is no fog) thetop of St. Paul’s Cathedral is not visible from the top ofWestminster Abbey, a distance only of one and one-thirdmiles. The fogs which we have experienced lately in Londonwere prevalent also down the central parts of Englandand it was not likely that we should escape them, but inspite of your statement that they were "as bad and as

dense " as ever I cannot bring myself to believe it, for,bad and irritating as they were, it has been a matter ofcommon observation by all those with whom I have dis-cussed them that they were the least black of all the fogswe have ever experienced. There was not one day (at anyrate, in the West End) in which they were either thickyellow, or brown, or black, and although all the conditions were present for producing the " London particular " it wasconspicuous that the "pea-soup" " condition was absent.Your columns have always been so friendly to any effortsmade in the direction of diminishing smoke that I venture tohope that your article will not have the effect of destroyingyour readers’ hopes of future improvement.The efforts of the Coal Smoke Abatement Society are now

being continued with renewed energy and the society truststhat those authorities, one of which is referred to inTHE LANCET of Dec. 3rd, who have not yet come into linewith other more advanced bodies will do so ere long. Whensmoke from factory chimneys has ceased the domesticproblem will have to be tackled and when it is consideredthat there are 600,000 kitchen chimneys in London, all ofwhich might be made smokeless, it will be seen that the

problem is not so insoluble as some think. Cook has noobjection to smokeless cookery, it saves dirt and consequenttrouble to her, and she is but human !

I am. Sirs. vours faithfullv.H. A. DES VŒUX,

Honorary Treasurer, Coal Smoke Abatement SocietyBuckingham-gate, S.W., Dec. 6th, 1904.

A CORRECTION.lo tfte Editors of THE LANCET.

SIRS,—In your otherwise accurate report of what I saidn the debate on school certificates furnished by laymen(THE LANCET, report of the proceedings of the GeneralMedical Council, Dec. 3rd, p. 1596) the final sentence, " Hehoped ...... advice," has crept in by some accident. It wouldhave been irrelevant to the question and would not agreewith what I have elsewhere said in Council on the subject.

I am, Sirs, yours faithfully,Dec. 3rd, 1904. P. H PYE-SMITH.

THE RESULTS OF COLECTOMY IN CAR-CINOMA OF THE COLON.

To the Editors of THE LANCET.SIRS,—In Mr. A. W. Mayo Robson’s interesting Bradshaw

lecture reported in THE LANCET of Dec. 3rd, p. 1553, theresults obtained by me in the treatment of carcinoma of thecolon by colectomy are referred to in detail. It is stated

quite correctly that I reported 1 seven colectomies for car-cinoma without a death, but the other details given by Mr.Robspn are curiously inaccurate. Not only are the intervalsof time between operation and report wrongly given butrecurrences of the disease unbeknown to myself are men-tioned. By way of correction I give you the followingextract from my paper 2 : "With the exception of the firstpatient on the list, who lived in complete comfort for fouryears and then died suddenly from heart disease, all thepatients are alive and in good health at the present timeand they have all put on flesh. All the patients havebeen examined recently and no evidences of recurrencecan be detected either from the presence of symptomsor by physical examination of the abdomen. In three casessufficient time has elapsed to give good grounds for hoping

1 Brit. Med. Jour., Jan. 23rd, 1904, p. 175.2 Ibid., p. 181.

s that the cure in them will be permanent. One case wasf operated upon over four years ago, another two and a halfyears ago, and the third two years and two months ago. The3 remaining three cases were operated upon too recently-) nine, six, and two months ago-to warrant any predictionregarding ultimate prognosis."

Twelve months have elapsed since the paragraph just quoted was written and the six patients are still alive and! well and free from any known recurrence. During these’ 12 months I have done two more colectomics for carcinomal of the colon. Both patients made normal recoveries and arenow alive and well without recurrence.

I am, Sirs, yours faithfully,Harley-street, W., Dec. 3rd, 1904. BILTON POLLARD.

THE USE OF ALCOHOL IN THE TREATMENT OF ENTERIC FEVER.

10 the Editors of THE LANCET.SIRS,--A great change has occurred in recent years in our

estimate of the value of alcohol in the treatment of theacute zymotics. In scarlet fever and small-pox, I believe,alcohol is now comparatively little used. Even in diphtheria,where the tendency to cardiac failure was supposed to be anindication for its routine use, it is much less used thanformerly, and high authorities have confessed that theyhave largely lost faith in it. In no zymotic disease,however, did the position of alcohol appear to be more

firmly established than in the case of enteric fever andin none perhaps was it more largely prescribed. Buteven in this disease expert opinion appears to be

changing. Dr. F. Foord Caiger, medical superintendent ofthe South-Western Fever Hospital, in his very able BradshawLecture on the Treatment of Enteric Fever, 1 says :- " I rankmyself with those who hold that in most cases of entericfever not only is alcohol not required, but that its employ-ment is occasionally distinctly harmful even when given inquantities which would not be considered excessive." Dr.Caiger does not contend that in every case of enteric feveralcohol is useless, but I think it is evident he holds, as manyof us do, that the value of alcohol in the treatment of thisdisease has been very much over-estimated and that it

certainly ought not to be regarded as a " sheet anchor,"to be freely prescribed as a routine measure in almost allsevere cases of the disease.In order to satisfy oneself of the special value of a new

drug in the treatment of a disease it is desirable to treat acontinuous series of cases with the drug. Similarly, inorder properly to appreciate the supposed, but doubtful,value of an old drug it is desirable to treat a continuousseries of cases entirely without it. I may therefore mentionthat in the isolation hospital of this town the practice ofprescribing alcohol in enteric fever (or in any zymoticdisease) has been entirely discontinued for the last three

years, during which period over 100 cases have been treated.The numbers are, of course, too small for any argument tobe based upon the case-mortality (which, however, has beenbelow the figures that Dr. Caiger gives as the averagefor this disease), but speaking from our own experiencewe have seen no reason to return to the old practice. The

history of medicine, unfortunately, abounds with instancesin which individual drugs or therapeutic measures have

acquired altogether false or at least greatly exaggeratedreputations. In the true interests of the healing art it is.

obviously much to be desired that whenever this is the c,tse

we should learn to appreciate such drugs or measure-! attheir true value. But in the case of alcohol there is an ,

additional and all-important consideration which shouldmake every medical man loth to prescribe it if he can

possibly avoid doing so. I refer, of course, to the alcoholhabit with all its attendant misery and degradation and tothe undoubted encouragement which the medical prescriptionof alcohol gives to the self-prescription of it.There are not many therapeutic indications to meet whiei t

the Pharmacopoeia provides only a single remedy, and for anyiven purpose for which alcohol is usually prescribed-be itts stimulant, tonic, antipyretic or hypnotic-a little thoughtvill generally enable some other and less objectionable drug;o be substituted with equal if not better results. ,

I am, Sirs, yours faithfully,

Leicester, Nov. 28th, 1904.U. KILLICK MILLARD,Medical Officer of Health.

1 THE LANCET, Nov. 26th, 1904, p. 1475.