CORRESPONDENCE
`
`MICoL
`recover spontaneously, but I feel that there is a very,
`strong case for supposing that these lax hips also
`include nearly all, if not all, the congenital dislocations.
`I am well aware of the view that congenital dislocation
`can occur after birth either when the legs are extended
`or when the child first walks, but is this a proven point,
`or is it a surviving conception and belief of ancient
`medicine ?-I am, etc.,
`T. G. BARLOW.
`Salford.
`SIR,-It was good to read Mr. Norman Capener's
`letter (July 1, p. 47) and to see that the work of von
`in Malmo was being,
`colleagues
`and his
`Rosen
`appreciated in Britain.
`I thought that your readers might like to see the way
`the Chinese in Hong Kong treat their children from
`birth. The picture shows the method of carrying the
`infants in Hong Kong, which is both practical and
`convenient, the mother often working with the child
`happily asleep on the back.
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`SEPT. 2, 1961
`
`Our claim is that by this method we can obtain all that
`can be obtained by the use of the " Yes/No " method, but
`with greater precision.
`It appears from their statement,
`"For these purposes the simple Yes/No answer seems to
`work pretty well," that Drs. Fletcher and Tinker are willing
`Surely it is much sounder
`to accept a low level of accuracy.
`to gather data in the most accurate way practical, even
`Drs. Fletcher and
`though some may be discarded later.
`Tinker admit that their technique breaks down in "some
`borderline cases which are arbitrarily classed as negative,"
`left to resolve any
`is the patient who is
`but when it
`ambiguities it is impossible to estimate how many decisions
`are borderline, so the amount of negative bias is unknown.
`Drs. Fletcher and Tinker suggest that their method is
`validated by a comparison of the results of two independent
`surveys on the "relationship between answers to questions
`and winter sputum volumes in two male populations"
`(Table VIII, May 27, p. 1495). By their technique the patient
`has three alternatives, " Not at all," " Part of -the time," and
`It is apparent that the middle category
`"All the time."
`contains all but the two extremes and so is much wider than
`Hence it is not surprising that
`the other two categories.
`the results of the two independent surveys show no disagree-
`ment for the two extreme categories but show a significant
`(p= 0.05) disagreement for the middle category.
`Had a
`continuous scale been used in place of the three categories
`by asking the question, " How much of the time do you
`bring up sputum ?" the results of the two surveys could
`have been compared with greater accuracy.
`With regard to the question of fallible memories, we
`fully recognize the dangers of retrospective surveys, but
`consider that any such objection applies equally to all
`In the one investigation we
`questionary techniques.
`have conducted in which it has been possible to estimate
`the importance of distortion due to the time elapsed
`between the events and their recall, it was found to be
`negligible compared with the main effects in which we
`However, there can be no general
`were interested.
`solution to this problem; it needs to be examined afresh
`in each investigation.-We are, etc.,
`J. L. GEDYE.
`R. C. B. AITKEN.
`HELEN M. FERREs.
`
`R.A.F. Institute of Aviation Medicine,
`Farmborough, Hants.
`Congenital Dislocation of the Hip
`SIR,-Mr. Gavin C. Gordon's letter on congenital
`dislocation of the hip (July 29, p. 311) raises a point
`of very considerable interest, but first let me point out
`an error. He states, "All newborn infants have slack
`or loose hips to some extent." This is not correct. Out
`of 8,200 children examined in the first week of life only
`113 had lax hips, in all the others the hips were
`absolutely stable.
`Mr. Gordon then goes on to say "many cases of
`congenital dislocation of the hip do not make their
`. ." There
`appearance until the child begins to walk. .
`is of course a difference in being present and making
`Can Mr. Gordon, or anyone else,
`their appearance.
`prove that these hips had not been dislocated for a long
`Out of these 8,200
`time before they were found ?
`children 5,865 are now 1 year old, and so far not a
`single child among those who started with normal hips
`It would
`has subsequently developed any abnormality.
`therefore seem likely that if congenital dislocation
`makes its appearance after birth such an event must
`be extremely rare.
`that
`agree with Mr. Gordon when he says
`I
`" clunking " or " clonking " can frequently be elicited
`in newborn children, and that the majority of these
`
`647
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`It may interest you to know that in the past ten years,
`we have seen ten cases of congenital dislocation of the
`hip among a population of three million odd, and that
`in each case the baby had not been carried on the
`mother's back, but had been brought up in Western style
`with bulky napkins and the legs pulled down and
`I am,
`contained within blankets in a pram and cot.
`etc.,
`Orthopaedic Department,
`University of Hong Kong.
`
`A. R. HODGSON.
`
`Skin Disease in Africa
`letter
`in reply to Dr. James
`SIR,-I write
`this
`Marshall's inquiry regarding skin disease in Africa
`(May 27, p. 1544).
`I have collected the following common skin diseases
`one sees in Ghana: (1) onchodermatitis, which manifests
`pruritus,
`(b)
`reaction,
`itself as (a) acute urticarial
`(c) generalized septic dermatitis, (d) generalized oval
`plaques brownish-purple in colour,4e) patches of
`depigmentation; (2) tinea (all forms): T. corporis, T.
`cruris, T. capitis, T. pedis; (3) dermatitis (various);
`(4) furunculosis; (5) impetigo; (6) malnutrition with
`skin manifestations (avitaminosis and kwashiorkor could
`(8) prickly heat;
`be included here); (7) urticaria;
`(9) leprosy; (10) yaws, post-yaws "ichthyosis," plantar
`either
`Florid yaws,
`pintoid
`hyperkeratosis,
`yaws.
`primary or secondary, is a rarity.
`
`Petitioner Ex. 1066 Page 1