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A RED CROSS CLINIC FOR CIVILIANS.
297 otherwise willingly send them to school. The waste of it and the pity of it sickens one. In a word, the circular menaces a serious blow at the very root of one of the most elficient departments of the education system of the country. That everyone, save those who are responsible for extravagances, is crying out, for economy is undoubted, but such foolish acts as those with which education is at present threatened are not acts of economy. They are. indeed, the reverse, since they will have for effect the ultimate throwing of more useless persons upon State aid. That the education methods of the country generally need thorough investigation and reform cannot be denied, but false economies will accentuate rather than effect it. Nor is the present education of the deaf perfect, but it is making steady progress, and any such action as that foreshadowed by the Board of Education will seriously retard its forward march. I am, Sir, yours faithfully, MACLEOD YEARSLEY, Consulting Aural Surgeon to the London County Council. Welbeck-street, W., Feb. 5th, 1922.
B-VITAMIN AND PIGEON BERI-BERI. .
To the Editor f)/ THE LANCET. a letter in your issue of Jan. 14th Dr. W. H. de Wyss, following Prof. W. R. Hess. maintains that the symptoms of B-vitamin deficiency are due to inhibition of the oxidative processes of the tissues, and suggests that the B-vitamin furnishes the structural basis of the oxidative ferments of the body. The evidence on which this theory is based is twofold-experiments in vitro with tissues of pigeons suffering from beri-beri are said to show reduction of the oxidative processes compared with the normal controls, and the symptoms of beri-beri are said to be produced on injecting potassium cyanide, which is known to inhibit oxidation in living cells. It must be pointed out, however, that even if we agree that the oxidative processes are depressed in fully developed beri-beri, we cannot at once conclude therefrom that the point of action of the vitamin is It must first be demonon the tissue cells in general. strated that the effect described immediately follows the removal of the vitamin from the diet. In the experiments I detailed in your issue of Dec. 10th, 1921, I demonstrated that within 24 hours of with-
SIR,—In
holding the vitamin, symptoms of insufficiency of the alimentary canal, such as diminished intake of food and paresis of the gut, make their appearance, and that these symptoms are immediately relieved The intestinal on re-adding the vitamin to the diet. phenomena mentioned can be noted when the animal appears to be otherwise in perfect health, and cannot therefore be regarded as part of a general depression of the tissues throughout the body. Thus the primary site of action of the vitamin is the alimentary canal, and the diminution in the oxidative powers of the tissues which Hess observed in animals suffering from an advanced stage of beri-beri, can be explained by the intoxication which is secondary to the condition of ileus produced by withholding the vitamin from the diet. The experiments of Messerli, quoted by Dr. de Wyss, are not conclusive to the contrary, as owing to the abnormal condition of the intestine it is not certain that charcoal would succeed in completely removing alimentary toxins which were being continuously elaborated. The conception underlying the theory of Hess, that the B-vitamin is a substance which is essential to the life of all cells, has already been criticised by Dr. W. Cramer in a recent issue of THE LANCET (Dec. 10th, 1921). The evidence there brought forward showed that this attitude can no longer be successfully maintained. I am, Sir, yours faithfully, SAMSON WRIGHT. Department of Physiology, Middlesex Hospital, W., Jan. 25th, 1922.
A RED CROSS CLINIC FOR CIVILIANS. 7’o the Editor of THE LANCET. SIR,—As is generally known the Kensington and other divisions of the County of London Branch of the British Red Cross Society have developed clinics for the treatment of ex-Service men with massage, electricity, radiant heat, and remedial exercises. Although, owing to the closing of the Fulham Clinic, the Kensington division finds that its work for pensioners must continue for a further indefinite period, yet the executive committee recognise that within a comparatively short time there will not be enough of this work to justify the maintenance of the clinic, and they have, after consultation with some local representative medical practitioners, including the Mayor of Kensington, decided to open a clinic for the general public, members of which, however, will only be able to avail themselves of the services of the clinic on the recommendation of a medical practitioner. A medical expert in physico-therapeutics will be in charge of the medical and surgical side of the work, while the administration will be in the hands of the Kensington division, B.R.C.S., who, in professional matters, will be assisted by an advisory committee of medical men. Fees will be charged on a graduated basis up to a maximum of 5s. per treatment, anybody able to pay more than this sum being ineligible for treatment at the clinic. The clinic was opened for civilians on Feb. 3rd, the hours of attendance being from 2.30 to 9 P.M. At a time when the development of municipal clinics has aroused much opposition in the ranks of the medical profession, it is to be hoped that credit will be given to the Kensington division of the British Red Cross Society for its endeavour to further the interests of the general public, the medical profession, and the masseurs and masseuses. Moreover, some at least of the provisional medical advisory committee hope that this attempt of the B.R.C.S. to develop, in conjunction with the medical profession, a muchneeded physical treatment centre may serve as an example of how clinics may most usefully be developed, and suggest the solution of many difficulties now confronting the medical profession. I am, Sir, yours faithfully, HAROLD H. SANGUINETTI, Hon. Sec., Provisional Medical Advisory Committee. Feb. 3rd, 1922.
THE ERECT POSTURE. To the Editor of THE LANCET. SIR,—Dr. Knox Thompson’s conclusion regarding the liability of the pulmonary apices to be compressed by the ribs can be tested by the results of postmortem examinations. Is there any post-mortem evidence of a special tendency on the part of the apices to collapse or semi-collapse ? My observations on the living subject suggest that the inspiratory muscles attached to the upper part of the chest are at great pains to keep the lungs expanded. Am I not right in saying that even in the last stages of phthisis they contract powerfully ? Respecting the influence of the upright posture on the cerebral circulation Dr. Thompson writes (Feb. 4th, p. 251): " It must be remembered, too, that the cerebral vessels are poorly supplied with vasomotor fibres, and that the onus of regulating the intracranial blood pressure rests largely with the splanchnics, the resistance of the cerebral arterioles altering very little." It has always seemed to me that Dr. Leonard Hill (whose teaching Dr. Thompson is following here) has exaggerated the part played by the splanchnics in regulating the cerebral circulation. No doubt these nerves exercise an important influence in regulating the general arterial blood pressure, but I much doubt whether they play an appreciably greater part in regulating the cerebral circulation than the circulation elsewhere. The local circulation of the brain, as of other parts, is, I believe, regulated by the
B-VITAMIN AND PIGEON BERI-BERI. .
To the Editor f)/ THE LANCET. a letter in your issue of Jan. 14th Dr. W. H. de Wyss, following Prof. W. R. Hess. maintains that the symptoms of B-vitamin deficiency are due to inhibition of the oxidative processes of the tissues, and suggests that the B-vitamin furnishes the structural basis of the oxidative ferments of the body. The evidence on which this theory is based is twofold-experiments in vitro with tissues of pigeons suffering from beri-beri are said to show reduction of the oxidative processes compared with the normal controls, and the symptoms of beri-beri are said to be produced on injecting potassium cyanide, which is known to inhibit oxidation in living cells. It must be pointed out, however, that even if we agree that the oxidative processes are depressed in fully developed beri-beri, we cannot at once conclude therefrom that the point of action of the vitamin is It must first be demonon the tissue cells in general. strated that the effect described immediately follows the removal of the vitamin from the diet. In the experiments I detailed in your issue of Dec. 10th, 1921, I demonstrated that within 24 hours of with-
SIR,—In
holding the vitamin, symptoms of insufficiency of the alimentary canal, such as diminished intake of food and paresis of the gut, make their appearance, and that these symptoms are immediately relieved The intestinal on re-adding the vitamin to the diet. phenomena mentioned can be noted when the animal appears to be otherwise in perfect health, and cannot therefore be regarded as part of a general depression of the tissues throughout the body. Thus the primary site of action of the vitamin is the alimentary canal, and the diminution in the oxidative powers of the tissues which Hess observed in animals suffering from an advanced stage of beri-beri, can be explained by the intoxication which is secondary to the condition of ileus produced by withholding the vitamin from the diet. The experiments of Messerli, quoted by Dr. de Wyss, are not conclusive to the contrary, as owing to the abnormal condition of the intestine it is not certain that charcoal would succeed in completely removing alimentary toxins which were being continuously elaborated. The conception underlying the theory of Hess, that the B-vitamin is a substance which is essential to the life of all cells, has already been criticised by Dr. W. Cramer in a recent issue of THE LANCET (Dec. 10th, 1921). The evidence there brought forward showed that this attitude can no longer be successfully maintained. I am, Sir, yours faithfully, SAMSON WRIGHT. Department of Physiology, Middlesex Hospital, W., Jan. 25th, 1922.
A RED CROSS CLINIC FOR CIVILIANS. 7’o the Editor of THE LANCET. SIR,—As is generally known the Kensington and other divisions of the County of London Branch of the British Red Cross Society have developed clinics for the treatment of ex-Service men with massage, electricity, radiant heat, and remedial exercises. Although, owing to the closing of the Fulham Clinic, the Kensington division finds that its work for pensioners must continue for a further indefinite period, yet the executive committee recognise that within a comparatively short time there will not be enough of this work to justify the maintenance of the clinic, and they have, after consultation with some local representative medical practitioners, including the Mayor of Kensington, decided to open a clinic for the general public, members of which, however, will only be able to avail themselves of the services of the clinic on the recommendation of a medical practitioner. A medical expert in physico-therapeutics will be in charge of the medical and surgical side of the work, while the administration will be in the hands of the Kensington division, B.R.C.S., who, in professional matters, will be assisted by an advisory committee of medical men. Fees will be charged on a graduated basis up to a maximum of 5s. per treatment, anybody able to pay more than this sum being ineligible for treatment at the clinic. The clinic was opened for civilians on Feb. 3rd, the hours of attendance being from 2.30 to 9 P.M. At a time when the development of municipal clinics has aroused much opposition in the ranks of the medical profession, it is to be hoped that credit will be given to the Kensington division of the British Red Cross Society for its endeavour to further the interests of the general public, the medical profession, and the masseurs and masseuses. Moreover, some at least of the provisional medical advisory committee hope that this attempt of the B.R.C.S. to develop, in conjunction with the medical profession, a muchneeded physical treatment centre may serve as an example of how clinics may most usefully be developed, and suggest the solution of many difficulties now confronting the medical profession. I am, Sir, yours faithfully, HAROLD H. SANGUINETTI, Hon. Sec., Provisional Medical Advisory Committee. Feb. 3rd, 1922.
THE ERECT POSTURE. To the Editor of THE LANCET. SIR,—Dr. Knox Thompson’s conclusion regarding the liability of the pulmonary apices to be compressed by the ribs can be tested by the results of postmortem examinations. Is there any post-mortem evidence of a special tendency on the part of the apices to collapse or semi-collapse ? My observations on the living subject suggest that the inspiratory muscles attached to the upper part of the chest are at great pains to keep the lungs expanded. Am I not right in saying that even in the last stages of phthisis they contract powerfully ? Respecting the influence of the upright posture on the cerebral circulation Dr. Thompson writes (Feb. 4th, p. 251): " It must be remembered, too, that the cerebral vessels are poorly supplied with vasomotor fibres, and that the onus of regulating the intracranial blood pressure rests largely with the splanchnics, the resistance of the cerebral arterioles altering very little." It has always seemed to me that Dr. Leonard Hill (whose teaching Dr. Thompson is following here) has exaggerated the part played by the splanchnics in regulating the cerebral circulation. No doubt these nerves exercise an important influence in regulating the general arterial blood pressure, but I much doubt whether they play an appreciably greater part in regulating the cerebral circulation than the circulation elsewhere. The local circulation of the brain, as of other parts, is, I believe, regulated by the