914 Nov. i17, 1928] CORRESPONDENCE.
f Tx
arc reflected bv the mirror under the microscope. A half-
inch objective suffices to show up the portal venules, hepatic
venules, and network of capillaries joining the two, and
the blood is seen scurrying along in continuous stream,
with nio sign of stasis or of pulse in successful preparations.
In less successfully made preparations, as respiration
becomiies feeble stasis a')ppears, and as the state of shock
increases becomes general.
A pressure of 2 to 3 mm. of merciury- suffices to stop the
flow from the portal ven-ules, anid eveni to reve-se this flow
and blanch the edge of the lobe; this is compressed between
the membrane of the apparatuis and a glass cover, which is
brought gently down upon the edge of the liver so as
barely to touch it; a drop of Ringer's soluition enisures
that the comlpression is equally applied. Thie membrane
closes a chamber with glass floor for transmitting light;
the chamber is in connexion with a manometer and a
tubing for producing compression. The edge of the liver
pulsates with each respiration, and this is taken as a sign
of freedom from compression, as should be the case when
the pressure in the apparatus stands at zero. The low
pressure which suffices to maintain the flow in the capil-
laries is balanced by the tissue pressure of the liver, the
whole being enclosed in the capsule of the liver. There is
then no adequate pressure for produlcinig a filtration of
lymph in the liver, as has been assnmed. As in other
organs, both secretion and flow of lymph are governed by
the action of the living liver cells.-I am, etc.,
LEONARD HILL,
National Institute for Medical Research,
November 7th. Hampstead, N.W.3.
MODERN PROBLEMS IN NEUROLOGY.
SIR,--It is an old and rather discredited method in
criticism, to assign views to an author whlichl he does not
hold or in so mainy words state, and then to proceed to
demolish them. The writer of your leading article review-
ing a recent book of mine has inone the less resorted to this
particular techniquie.
I do not attr ibute the escape of emotional reflexes
-" exclusively " to lesions involvinig cortico-ponitine and
cortico-bulbar paths. I do not ascribe various Parkinsonian
symptomis mnentioned by youir review-er solely- to rigidity.
In each of these instances (and, indeed, in still another)
mv vieus have been misrepresente-d miiore or less seriously,
as might easily be shown by citationi.
I ama also criticized for under-estimating the importance
of the constitutional- factor in epilepsy. As I was not
coDcernied with etiology, and mention it only inicidentally,
this is mere palra-criticism, to wlhiclh there is no end.-
I am, etc.,
London, WV.1, Nov. 10th. S. A. KINNIER WILSON.
HYPOCHONDRIA.
SIR, Dr. Crichton-Miller's letter (November 10th,
p. 866) on this topic has raised several points on which he
professes disagreement with the views propounded by me
at the discussion at the Royal Society of Medicine. I do
not know on what ground he can base his criticisms, since
he cannot have read more than the relatively br-ief summary
given in youir colutmns, and since, so far as I know, he
was not present at the discuissioai. If he was lpresent he
did -not air his contribution theni.
- Most wr-iters on hypochondria refer not -only to an
arterio-sclerotic factor in manv cases, buit to a variety of
other predisposing conditions of an organic nature.
Vagotoniia, however, I did not mention; some personal
inquiries made some years ago into that topic taught me
that vagotonia is a doubtful concept to play witlh.
I am glad that Dr. Crichton-Miller is, even unwittinigly,
in agreement with me on what I emphasized in the dis-
cussion-namely, the absence of anxiety in the clinical
sense in the true hypochondriac. I also mentioned the
probable etiological role of excessive egocentricity in some
cases at least. It is a source of regret to me thlat in my
endeavour to clarify the distinction between hypoehondria
and hysteria I should appear to Dr. Crichton--Miller merely
to obfu.scate the issue. But these anid a nulmber of
other points he will find described, in more detail than
was possible at -the discussion, in a paper now in the
rpess for the forthcoming number of the Gtuy's Hospital
R?eports, of which I propose to gi-ve myself the pleasure of
Ksending him a copy, if he will be .kind enough to accept
it.-I am, etc.,
London, W.1, Nov. 10th. R. D. GILLESPIE.
PRIVATE PRACTICE.
SIR,-Ti1 the Supplem7ent to youri issulel of Novenmber 3rd
is published the draft report of the Pri-ate Practice Comii-
mllittee whichl Nas constituted b- the Couincil of the British
Medical Association after an enthusia.stic resoluition passed
by the Representative Body to inquire inlto the enclroacih-
meats on pr-ivate practice, now sQ prevalenit, and to suggest
remnedies for that state of affairs. Everv Division shlould
study it most carefully and also read the very admiirable
report by Dr. Cox on his visits to differ-ent areas of the
country to collect pertin-ent information. The Cominmittee
suggests various recommendations to deal with the ques-
tion. All iiiembers of the Associationi should stud'- these
carefullY before deciding to accept or reject them.
There will be plenty of opportunity for (lebate on th1e
revised report when it conmes before the CoIncil, thle
Divisions, and the Represenitative Meetin1g, so I shall onily
now draw attention to one of the reecommenldations whiCch
suggests as a solution of most of the difficulties a system
of insurance. This is, in my'opinion, a decent camoiuflage
for a policy of extending the Inisurance Act to all or man1y
of the depel1dants of insured person1s, and th1erefore
d-eserves very careful consideration. Were this ever adopted
it would indeed cut the Gordian kiot, as, for all except a
very few millions of the better off and upper classes, it
would do away with private practice altogether. Such a
state of affairs would be in direct conflict with the declared
opinion and policy of the Association, whichi is -thiat the
best form of practice is that carried on between. doctor
and patienit, subject only to the conUnon law of the land
a'id the ethics of the p)rofession, anid that colntract practice
-should oilly be tolerated in such conditions that ordinary
private plractice is impossible.
If such an extension of insuranice services were ever set
up in such circumstanlces the work of the inisuranice practi-
tioner would be, increased far beyond what might be
.expected; for woomen and young children in every class of
the community require more attendanice than the mere
male; and a very great deal miiore of that work would
entail home visiting. A dyspeptic workman cani walk to
the consulting room. It would not be right to expect a
younig child with earlv measles or inicipient bronchitis to
wait its tu'rn in the. surgery. Also, I am lnot an expert
on remlluneration for such services, but I will take the
dictum of one who is, and who stated in the Council, wheii
the question of the inclusion of dependants was con-
sidered some years ago, that the practitioner could niot
expect to get the same capitation fee for dependants as
that paid at that time under the Inisurance Act, kut that
he would be lucky to get three-quarters of it, or it miglht
be even less.
The whole financial question looms large. How would
the eniormoius sum of money required be raised? (1) By
conitribuitions from employer, wor-kmain, and State, as in
the paneel system; (2) by tlle employer only; (3) by the
wor-kman onilv; (4) by the State. There are tremendous
objectionls to each of these methods whichl in miiercy to your,
space I will niot particularize at present; but every practi-
tioner should decide for himself and niake his voice heard,
w-hether he wishes to continue, even if only in part, a
" p1rivate -practitioner," or become onie of a unit in a
system of conti'act work, regulated, inspected, and limited,
which will extend a most definiite invitationl to any
Government, in the interests of econiomny anid ease of
adminiistration, to set np a wih.ole-time State-salar ied
service, which I miyself, as a looker-.on who hias seen1
most of the game all over the kinigdlom diurinig thle
last tea years, consider would be exceedingly bad, botlh for,
the health of the community, for. the well-being of what
is still a learlned professionl, anid the science anid art of
nmedicinie and surgery.-I am, etc.,
Loni(lon, W., Nov. 9th. E. B. TuRNER.