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prescribed 50-100 mg. as often as every 4-6 hours. Theefficacy of the drugs prescribed by Glaser and Hervey,therefore, cannot be evaluated on an equal or a com-parable therapeutic basis. There is no doubt that the doseof diphenhydramine was too small. Further, the drugwas given too long before the start of their experiment.Rough sea was encountered 11/2-2 hours after intake ofthe drug and the soldiers were exposed to seasicknessfor 2 additional hours. Therefore diphenhydramine wasexpected to be effective for 4 hours. The experimentalreports of Landau and Gay 8 and Landau et al. 9 had longsince established that diphenhydramine is one of the

short-acting anti-histamine drugs in contrast to pro-methazine hydrochloride.

In conclusion the single-dose trials of Glaser andHervey are quite inadequate to prove which of the anti-seasickness drugs are comparably effective. Further,their failure to make use of reported experimental factsdiminishes the usefulness of their studies and militatesagainst the validity of their conclusions. I trust that intheir next trials they will use dimenhydrinate, diphen-hydramine, promethazine hydrochloride, and hyoscinein comparable and adequate dosage in a much largernumber of subjects ; and I suggest that they should notbe satisfied with a sea trip of less than 8 days, on whichthey are present as actual observers. e _

In your issue of March 8 Dr. Glaser and Dr. Herveydescribe a motion sickness in which the volunteers weresubjected to artificially induced turbulent water. I donot believe that the motion of -a ship on the high seaduring the winter months can be reproduced in thisway.

Johns Hopkins UniversitySchool of Medicine,

Baltimore, Maryland, U.S.A. LESLIE N. GAY.

*** We have shown Dr. Gay’s letter to ProfessorGlaser and Dr. Hervey, whose replies follow.-ED. L.

SiR,-Please permit - me to reply to Dr. Gay’s com-plaints about publications by Dr. Hervey and myself.

Dr. Gay states that it is not known what influence8-chlorotheophylline exerts on motion sickness. This isincorrect. In fact, Dr. Hervey and I have quoted theevidence which suggests that 8-chlorotheophylline exertsno influence on motion sickness. Dr. Gay’s references toother actions of 8-chlorotheophylline and of certain-histamine antagonists are irrelevant to the problem ofmotion sickness.

Dr. Gay criticises us for quoting Chinn et al.’s 10

findings rather than their comments. I respect Dr. Chinn’sopinions, but I think he would be the first to agree thatobservations mean more than comments. Chinn and his

colleagues did record auditory hallucinations in 1 of 88men who were given 3’25 mg. of hyoscine in 36 hours ;but a single case does not prove anything.

I do not know why Dr. Gay quotes observations aboutM.S.P. This preparation contains a trifling amount ofhyoscine, and Dr. Hervey and I were not concerned with it.

Dr. Gay blames us for giving comparatively smalldoses of one drug. He may be right, but we based ourdosage on the available data and gave the reasons forour choice.

Dr. Gay states that we gave the maximum dose ofhyoscine. This is incorrect. Holling et al.l1 gave 20%more hyoscine than we did, and Chinn et al. gave largertotal quantities.

Dr. Gay states that the effects of one of the drugs mayhave worn off before some of our tests were completed.This may be true ; but any drug which ceased to haveeffect after less than 4 hours was useless under theconditions with which we were concerned, and we did not

8. Landau, S. W., Gay, L. N. Bull. Johns Hopk. Hosp. 1948, 83, 330.9. Landau, S. W., Marriott, H. J. L., Gay, L. N. Ibid, p. 343.10. Chinn, H. I., Noell, W. K., Smith, P. K. Arch. intern. Med. 1950,

86, 810.11. Holling, H. E., McArdle, B., Trotter, W. R. Lancet, 1944. i, 127.

claim or imply that our results were valid beyond thoseconditions.

Dr. Gay believes that the motion of a ship on thehigh seas cannot be reproduced by artificial waves andhe is free to do so, but Dr. Hervey and I accepted theadvice of an Admiralty expert on wave motion who tookpainstaking records and whose data were given in ourpublications.

Since we quoted 27 references in one paper it seems oddthat we should be blamed for failing to make use ofreported experimental facts, but it is true that we didnot include some of Dr. Gay’s own claims. Ratherthan say more, I will refer to opinions held by distin-guished American scientists 12-14 and one of yourcon temporaries.15 s

Department of Physiology,University of Malaya, Singapore. E. M. GLASER.

Department of Experimental Medicine,Cambridge. G. R. HERVEY.

SiB,—I should like to endorse Dr. Glaser’s reply toDr. Gay. -.The 25 mg. of benadryl given by us was not such a very

small dose. It contained as much diphenhydramine as46 mg. of dramamine ; and we have referred to tworeports showing no statistically significant differencebetween the effectiveness of benadryl and dramamine,given in doses in the ratio of 1 : 2, in preventing motionsickness. We did give phenergan, which appeared to bemore effective, in a larger dose during the later series ofexperiments, with little difference in the results.

It is, of course, only claimed that our results were validfor the conditions under which they were obtained, and" a sea trip of not less than eight days " would obviously

have been better in some ways. None the less, protectionfor a short time is sometimes required in practice (e.g., inassault craft). Our experiments were designed to

investigate protection for short periods, to give statis-

tically valid results and to avoid any possible effects ofbias on the part of the observers or subjects.

12. Nickerson, M. Science, 1950, 111, 312.13. Tyler, D. B. Ibid, 1949, 110, 170.14. Tyler, D. B., Bard, P. Physiol. Rev. 1949, 29, 311.15. Brit. med. J. 1949, i, 855.

Medicine and the Law

A Question of FeesA REPORT by its ophthalmic services committee

that was approved by the London Executive Councilwhen it met on June 26 draws attention to a coursewhich, without specifically violating the terms of service,is regarded as " clearly an undesirable and unworthypractice."The patients’ version of the facts appears to have

been accepted. Mrs. A had her sight tested underSupplementary Ophthalmic Services arrangements byMr. X, an ophthalmic medical practitioner on the LondonOphthalmic List. Forms o.s.c. 1 and 2 were completedand no charge was made. Mrs. A was accompaniedby Mrs. B (her mother), who asked to have her ownsight tested. Mr. X fixed an appointment for this

purpose and later Mrs. A arranged with him by telephonethat on the same occasion he would also test Miss C(her aunt). When Mrs. B and Miss C attended at hisconsulting-room, he asked them for " a small fee of1:1 Is. each." This surprised them because they supposedthey were being treated (like Mrs. A) under the NationalHealth Service ; but they paid the fee and were, theysaid, assured by Mr. X that they would obtain theirglasses free under the scheme on his prescription. Headvised them to go to a named firm of dispensingopticians, and he telephoned details to the firm. Whenthey visited the firm to get their glasses, they weretold that they could not have them until the duly

95

authorised forms o.s.c.2 were handed over. Mrs. A

thereupon reported the matter to the committee.. Mr. X told the committee that he had regarded theladies as private patients. He said he had been advised

by a legal organisation specialising in medical mattersthat there was nothing to prevent his seeing a patientprivately one day and their returning to him anotherday to obtain a copy of the prescription on o.s.c.2.The organisation denied having so advised. The com-mittee pointed out that such a course would result inthe practitioner receiving two fees for the one service-viz., a fee from the patient for the " private" consulta-tion- and, after the prescription had been copied on toform o.s.c.2, a sight-test fee under National HealthService arrangements. The committee conceded that apractitioner practising under the National Health Serviceis not thereby debarred from accepting private patients.As no National Health Service form was initiated byMr. X for Mrs. B and Miss C, the committee could notdefinitely decide that he had accepted them as N.H.S.patients. The committee, however, were satisfied ofhis awareness that the two patients wished their sightto be tested under the N.H.S. and of his having deliber-

lately diverted them into " private" channels. It wasthis practice which, as already stated, the committeestigmatised as undesirable and unworthy. If persistedin, it might furnish grounds for representations to thetribunal that the continued inclusion of Mr. X in the

Ophthalmic List would be prejudicial to the interestsof the service. In view of his statements the committeefound themselves inclined to conclude that he soughtto induce the patients to come back to him for a furtherconsultation for which a sight-testing fee could be claimedfrom public funds.

In formulating their recommendations the committeeannounced that they found no failure by Mr. X tocomply with the Terms of Service. They thought,nevertheless, that he should be warned that persistencemight lead to the removal of his name from the

Ophthalmic List, and they recommended that the specialattention of the Minister of Health be directed to theacts disclosed in the case.

Employee’s Duty to Disclose DisabilityThe Court of Appeal has modified the award of damagesto the widow in the case of Cork v. Kirby Maclean Ltd.,lwhere the husband who suffered from epilepsy had afatal fall from the platform on which he was working.His employers had been at fault inasmuch as the plat-form was not of the width and was not equipped withthe guard-rails required by the Building (Safety, Healthand Welfare) Regulations. The defendant employerscontended that the deceased had been subject to epilepticfits for 10 years and had been under treatment for

epilepsy only 10 days before his death ; his doctor hadwarned him that he must not work above ground leveland he had promised to obey ; he had not, they said,disclosed these facts to them. Mr. Justice Donovan heldthat the fatality must be deemed due to the employers’breach of their statutory duty unless they proved thecontrary. He was following, it seems, a dictum of LordJustice Scott in Vyner v. Waldenberg Bros. (1945)-acase of injury by a circular saw where the protectiveguards required by the Woodworking Machinery Regula-tions had not been provided.Lord Justice Singleton 2 expressed the view that Lord

Justice Scott’s opinion went too far. Mr. Cork’s fatalinjury had two causes. One was the employers’ breachof the regulations ; the other was the workman’s failure(a breach of his duty towards his employers and hisfellow-workmen) to disclose his disability. Both sideswere at fault and the Court of Appeal was unable todecide that one party was more negligent than the other.

1. See Lancet, 1952, i, 824.2. Times, July 1.

Applying the Law Reform (Contributory Negligence) Actof 1945, it ruled that each side was responsible for halfthe damage. Accordingly Mr. Justice Donovan’s award-to the widow is reduced by one-half.

ObituaryPERCIVAL HORTON-SMITH-HARTLEY

Kt., C.V.D., M.A., M.D. Camb., F.R.C.P.Sir Percival Horton-Smith-Hartley, consulting physican

to St. Bartholomew’s Hospital, who died on June 30at the age of 84, came of a family eminent in the legalprofession. Perhaps it was the influence of this inheritancethat made him unique among the physicians of his tithe.The eldest son of Mr. R. H. Horton-Smith, K.c.,

he was educated at Marlborough and St. John’s College,Cambridge. After taking a double first in the naturalsciences tripos he continued his medical studies atSt. Bartholomew’s Hospital, where he qualified in1893. After holding house-appointments at Bartsand a fellowship at St. John’s--- - ---- 11 --1, -- -- - ..

College, he spent some yearsof postgraduate study in Parisand Vienna. Soon after hisreturn to London he joinedthe staff of the Metropolitan andBrompton Hospitals. In 1899he was elected F.R.c.p., andthe following year he deliveredthe Goulstonian lectures on

typhoid. In 1906 he becameassistant physician to Barts.He was appointed c.v.o. in

1912 and created a knightbachelor in 1921. For manyyears he was a member of thecourt of the Company of Iron-mongers and in 1942 he waselected master.

" Despite an orthodox medical ..

[Vandyk

education," writes -b. it. Jb., " Sir Percival was an

individualist and he differed in many ways from hiscontemporaries, for his interests and abilities led -himalong original paths in his professional as well as hisprivate life. His wide culture enabled him to enjoyhis life to the full, and the many fields into which his.trained intelligence attracted him were a constant,surprise to his acquaintances. His kindliness, his.sympathy, and his interest in human beings had a,

therapeutic value for his patients, -perhaps of even greaterimportance than his knowledge of scientific medicine,and the example he gave- by his care for his patients was.of greater educational value than his formal instruction.He would have made a wonderful family doctor, but.his erudition and his mental abilities marked him out.for a career in academic surroundings where his educa--tional value had a wider scope. The scientific age and.the rapid advances in medical science that occurred.during his time had little influence on his professionallife and he remained essentially a humanitarian scholarand a wise physician. As the wife of a colleague once:said ’ Sir Percival is a dear.’

" To the younger generation he is best known as the-author with Sir Richard Douglas Powell of the latereditions of the textbook on Diseases of the Lungs andPleurce, and the versatility of his interests is seen in thebook which he wrote with Mr. H. R. Aldridge of theBritish Museum on Johannes de Mirfield of St. Bartholo-mew’s, Smithfield and his article in the British MedicalJournal (1939) on the Longevity of Oarsmen. He would.surprise his friends by offering them seats at Lord’s fora test match. In preparing his lectures he took greatpains, and his fluency and correct use of words were a,delight and a lasting example. He will be greatlymissed by his students and colleagues, and his gentleinfluence on their way of life, their ideals, and theirsense of values will never die."

Sir Percival married in 1895 Miss Josephine Hartley,of Hartley, Kent, and in 1904 he assumed the addi-tional surname of Hartley. She survives him with adaughter and a son who is a master at Eton College..