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AN UNUSUAL EPIDEMIC
290
PUBLIC HEALTH
Public Health AN UNUSUAL EPIDEMIC A. L. WALLIS M.B. Edin. GENERAL PRACTITIONER
THIS is
a preliminary report on an epidemic of an upper-respiratory-tract disorder in a rural practice about five miles from Carlisle, Cumberland. Sporadic cases were first noted in January and February, 1955 ; a large number occurred in March and April; and a few are still appearing. The clinical features as they emerged soon made a recognisable syndrome, which appeared to be a new one. The main features were conjunctivitis, which might be unilateral, pyrexia up to 104°F, malaise, sore throat, dry cough, and enlarged cervical lymph-glands. Convalescence was marked by severe listlessness which persisted for several weeks. Some of the patients affected
acute
had had influenza at the end of 1954, and several of the children had already had measles and rubella. LABORATORY FINDINGS
Investigations on about 60 cases were carried out at the Public Health Laboratory, Carlisle. No abnormal total or differential white blood-cell counts were obtained, nor were any abnormal cells discovered. The PaulBunnell test was consistently negative, as were routine complement-fixation tests against influenza viruses A and B, Q fever, psittacosis, the lymphogranulomavenereum group of viruses, and mumps v and s antigens. Some sera were tested and found negative for toxoplasmosis. Bacteriological examination of throat swabs and faecal specimens was undertaken when warranted by and signs ; these, too, proved negative. Paired acute and convalescent sera with throat-washings, conjunetival swabs, and foetal specimens are being investigated at the Virus Reference Laboratory, Central Public Health Laboratory, Colindale. So far the first few specimens examined have been negative for antibodies against the " adenoidal-pharyngeal-conjunctival " (A.p.c.)—otherwise termed " acute respiratory disease " (A.R.D.)-group of viruses.
symptoms
ILLUSTRATIVE CLINICAL RECORDS HOUSEHOLD I.-This consisted of a farmworker, his wife, and three daughters aged 12 years, 9 years, and 20 months.
At intervals of about one week during April, 1955, beginning with the mother, symptoms of this infection developed in the whole family, with the exception of the baby who was
unaffected. The father had a mild reaction with watering eyes and a feeling of weakness for a short period. The mother found her eyes watering and becoming itchy, and her right eye became pink. Malaise, headaches, occasional waves of dizziness, and nausea ensued, with sore throat and harsh irritating cough. There were also stiff neck, muscular pains in the legs, general tiredness, and depression. On examination there were no abnormal signs in the chest or abdomen. The fauces were injected, and there were red areas under the tongue with pustules in the centre. Glands of the cervical lymph chain
apparently
were
enlarged.
The disorder next developed in the 12-year-old daughter. She felt tired and listless ; the eyes watered and became pink ; and headache, stiff neck, and sore throat followed. Mild sweating occurred at night. There was a hard dry cough, but no abnormal signs in the lungs. The sore throat and pink eyes settled in a couple of days, but watering of the eyes and a feeling of debility persisted for three to four weeks. A similar picture later developed in the 9-year-old child, with severe faucial injection and conjunctivitis.
HOUSEHOLD 2.-This consisted of a farmworker, his wife, daughter aged 6 years, and a son aged 5 years. Severe conjunctivitis, worse on the left side, developed in the mother in April, 1955. This was accompanied by headache and pains up the back of the neck. There was severe a
dizziness, general tiredness, and also a sore throat and dry cough. The cervical lymph-glands were enlarged. The eye lesions and sore throat settled slowly over a fortnight, but lassitude continued for four to five weeks. The two children complained of headache, painful eyes and throat, and stiff neck, from one week after the onset of the mother’s symptoms. There was slight dry cough. For two or three days from the onset they tended to be listless and to lie about the house but were back to normal within three weeks. The father was unaffected. HOUSEHOLD 3.-This family consisted of a joiner and his wife, and two children-a schoolboy and a 20-year-old nausea,
daughter. The disorder developed first in the father, a fortnight before Easter, with sore throat and pains in the neck, back, and legs. He felt feverish and had a harsh cough, and stayed in bed for a week because he felt exhausted. He was first seen only after he had returned to work, when his wife was visited. He was then still easily tired, was depressed, and had enlarged palpable cervical glands. Within a fortnight after the onset in the father a similar syndrome developed in his wife and two children. The wife had a severe attack with a temperature of 102°F, sore throat, watering painful swollen eyes, a hard irritating cough, and general prostration. The cervical lymph-glands were palpable and tender. The acute phase lasted a week and was succeeded by debility and lassitude lasting for five to six weeks. There were no abnormal signs in the lungs. During the mother’s illness the daughter felt depressed and tired and had a poor appetite ; this lasted for about a
fortnight. Watering eyes, sore throat, and a stiff neck with greatly enlarged cervical lymph-glands developed in the son. A dry cough was present, but no abnormal signs in the lungs were noted. He recovered after about
a
week.
GENERAL OBSERVATIONS
All age-groups and both sexes were affected equally. The incubation period appeared to be between five and ten days. Severe cases showed the following features: 1. An acute phase comprising conjunctivitis, sore throat, harsh dry cough, and palpable cervical lymph-glands, with pyrexia up to 104°F. This phase lasted for about a week or ten
days. subsequent phase of debility, lassitude, depression lasting for up to four weeks. 2. A
and
severe
Patients with mild attacks were commonly found in The households where there had been acute cases. common laboratory investigations have been negative. CONCLUSION
The clinical picture of cases in this outbreak resembles that ascribed in the U.S.A. to the A.P.C. group of viruses (Bell et al. 1955, see Lancet 1955). I thank Dr. D. G. Davies, director, Public Health Laboratory, Carlisle, and Dr. K. W. Newell, of the Central Public Health Laboratory, Colindale, for their help in the
investigation. REFERENCES
Bell, J. A., Rowe, W. P., Engler, J. I., Parrott, R. H., Huebner, R. J. (1955) J. Amer. med. Ass. 157, 1083. Lancet (1955) i, 289.
Guidance An attempt to secure more systematic classification of cases seen, and results obtained, at child-guidance clinics Child
made in 1953 by the National Association for Mental Health. It was evident that in dealing with the emotional disorders of children the diversity of complaints and the individuality of each problem were even greater than in adult psychiatry. In his recent annual report on the work of the Leicester child-guidance unit Dr. A. K. Graf, the psychiatrist, speaks of the difficulty he has encountered in trying to group the cases referred to him. For purposes of classification it was necessary to reduce each case to one major problem-the diagnosis recorded being the finding which appeared most important or significant. The figures thus was
291
PERSONAL PAPERS
obtained show that, during the year, behaviour problems due to factors in the environment-mainly home or school- were about equal (20) to those where the difficulties could be explained by constitutional or temperamental factors arising within the growing child himself (22). Problems arising out of backwardness (absolute or relative) were slightly less numerous (17) and equal with the largest single habit disorder-namely, bedwetting. Psychosomatic disturbances were diagnosed in 10 cases, while 19 cases could be classified as belonging to the more serious psychoneuroses.
Poliomyelitis In England and Wales notifications of poliomyelitis in the week ended July 23 numbered 177 (paralytic 93, non-paralytic 84)-an increase of 57 on notifications in the previous week. In London and the South-East Region there were 31 paralytic and 43 non-paralytic cases (including 9 non-paralytic cases in Willesden, from which no paralytic cases were notified). Barnsley and Stepney-the only notable foci-are quieter. The position is still about average for the time of year. The momentum of the curve of notifications is about the same as in 1947 and 1952 ; it is slower than in 1950 and 1953, but faster than in 1948, 1949, 1951, and 1954. The proportion of notified non-paralytic cases is unusually high. and this is having an inflationary effect on the totals.
" In 10 of the referred cases the parents could be reassured that nothing was wrong with their child from our point of view, and the complete absence of psychotic disturbances gives a very reassuring picture of the mental health of the Leicester school child. " Naturally, most of the referred children were of compulsory school age and the peak year for referral was nine years, i.e., the time when the educational strain of preparation for the secondary schools selection examination begins to make itself felt. The number of junior and secondary school children referred was about equal, but the preponderance of maladjustment in boys as compared with girls (there were 35 more boys referred) is significant in view of the fact that the female cases of nervous breakdown preamong adults "
Outbreak at London
’
Tuesday morning.
dominate."
1. See
Personal
Teaching Hospital
In the outbreak of glandular fever at the Royal Free Hospital, London, the total number of cases at. midday last Tuesday amounted to 86 (59 nurses, 3 patients, 24 others), compared with 74 a week previously.! Of this total, 4-a doctor, a nurse, and 2 domestic workers-had recovered and were back at work. The outbreak seems to be waning : there were 4 new cases between last Saturday and last Monday, and none on ________
Lancet, July 30, 1955,
p. 244.
question is not why the direction of the sexual impulse is reversed, but why in some people the homosexual component predominates over, or appears to the
Papers
MALE HOMOSEXUALITY
obliterate, the heterosexual
IN the present wave of interest in male homosexuality, the person most concerned has little opportunity of expressing his point of view : and there is indeed a dearth of information about the average homosexual-the kind, that is, that neither parades his state nor falls into the hands of the police. Perhaps the views of one such person might be of interest at the present time. PREVALENCE
This raises difficulties. The world is-not divided, as many people seem to think, into heterosexuals, whose sexual feelings are all for the opposite sex, and homosexuals, whose feelings are all for the same sex. The Kinsey report-which, whatever its demerits, is the only large-scale objective study of the subject-as well as the personal experiences of interested persons, indicates that among adults there is a continuous gradation from the apparently completely heterosexual, through the bisexual, to the apparently completely homosexual. This is often strongly denied by educated Englishmen ; but there is much to suggest that the " horror " of homosexuality is largely a middle-class attitude, and sometimes a protective mechanism against the acceptance of recognised or unrecognised homosexual tendencies. I can see no reason why the Kinsey figures for the varying degrees of homosexual behaviour in American males should not be roughly applicable to this country, though Americans have stated that homosexuality is more evident in England than in America. The Kinsey figures, which anyone interested should consult, claimed that of some 5000 adult males interviewed 37% had had at least one experience with another male person, involving an orgasm, between adolescence and old age; 25% had continued to have such experiences for a period of at least three years between the ages of 16 and 55 ; whilst 4% had had no other sexual experience in their lives and could be regarded as exclusively homosexual. If for the sake of argument we accept this figure of 4% as the prevalence of real " homosexuals, then there are some 650,000 male homosexuals in England and Wales (the total male population over the age of 15 in 1948 was estimated at 16,331,000). "
aeTIOLOGY
If some degree of bisexuality, with a predominant! heterosexual component, is to be regarded as normal, I
In this I believe that one. is environment early psychological all-important. Genetic. endowment may be concerned, but there is no evidence for this. In the absence of obvious physical changes the endocrines appear to have nothing to do with the direction of the sexual impulses ; and, contrary to popular opinion, most homosexuals are indistinguishable physically from their fellows. I believe my own state can be accounted for by early environment. This opinion is based partly on objective evidence and partly on analytical findings.
family,
I was the youngest of a large and it was well known that my father wanted a daughter. I strongly suspect that my mother conceived and bore me against her will, for my earliest memory is of waking in the night to hear my father in a rage threatening to thrash her if she would not do
great
something he wanted. I believe that I was not only an unwanted child, as far as she was concerned, but also something of a reproach, a, continuing reminder that she had failed to do what it was her duty to her husband to do ; for ours was a sternly puritanical family in which duty meant more than love. I believe that the same sense of duty made my mother treat me with oversolicitude but with little love, and I grew up insecure, overdependent, and enuretic. One other incident is worth recording. A brother remembers that I was once as an infant left lying on a couch while the family had a meal. Some time later it was noticed that I was playing with an erect penis. My mother picked me up and hurried me out of the room. In view of the family attitude to such matters it is likely that stern measures were taken on that and any subsequent occasion to root out the devil that would have been thought to have taken possession of me. At any rate I grew up believing that sexual feelings of any kind were wicked and abominable, and I well remember at the age of about 15 or 16 stoutly maintaining, to the amusement of my school-fellows, that the preliminaries to procreation took place during sleep, at least among decent people. Absurd guilt over sexual feelings plagued me throughout adolescence. It was never dispelled by confessions to a priest, but it has been greatly reduced by psycho-analysis.
How this kind of environment led to homosexuality a matter for speculation, but I believe it is really quite simple. My mother never loved me, and her oversolicitude appeared to me as a sham. To this day I have never been able to feel any spontaneous love for a woman, nor, in spite of objective evidence to the contrary and years of analytical exploration of the feelings concerned, have I ever been able to feel that any woman could ever
is
PUBLIC HEALTH
Public Health AN UNUSUAL EPIDEMIC A. L. WALLIS M.B. Edin. GENERAL PRACTITIONER
THIS is
a preliminary report on an epidemic of an upper-respiratory-tract disorder in a rural practice about five miles from Carlisle, Cumberland. Sporadic cases were first noted in January and February, 1955 ; a large number occurred in March and April; and a few are still appearing. The clinical features as they emerged soon made a recognisable syndrome, which appeared to be a new one. The main features were conjunctivitis, which might be unilateral, pyrexia up to 104°F, malaise, sore throat, dry cough, and enlarged cervical lymph-glands. Convalescence was marked by severe listlessness which persisted for several weeks. Some of the patients affected
acute
had had influenza at the end of 1954, and several of the children had already had measles and rubella. LABORATORY FINDINGS
Investigations on about 60 cases were carried out at the Public Health Laboratory, Carlisle. No abnormal total or differential white blood-cell counts were obtained, nor were any abnormal cells discovered. The PaulBunnell test was consistently negative, as were routine complement-fixation tests against influenza viruses A and B, Q fever, psittacosis, the lymphogranulomavenereum group of viruses, and mumps v and s antigens. Some sera were tested and found negative for toxoplasmosis. Bacteriological examination of throat swabs and faecal specimens was undertaken when warranted by and signs ; these, too, proved negative. Paired acute and convalescent sera with throat-washings, conjunetival swabs, and foetal specimens are being investigated at the Virus Reference Laboratory, Central Public Health Laboratory, Colindale. So far the first few specimens examined have been negative for antibodies against the " adenoidal-pharyngeal-conjunctival " (A.p.c.)—otherwise termed " acute respiratory disease " (A.R.D.)-group of viruses.
symptoms
ILLUSTRATIVE CLINICAL RECORDS HOUSEHOLD I.-This consisted of a farmworker, his wife, and three daughters aged 12 years, 9 years, and 20 months.
At intervals of about one week during April, 1955, beginning with the mother, symptoms of this infection developed in the whole family, with the exception of the baby who was
unaffected. The father had a mild reaction with watering eyes and a feeling of weakness for a short period. The mother found her eyes watering and becoming itchy, and her right eye became pink. Malaise, headaches, occasional waves of dizziness, and nausea ensued, with sore throat and harsh irritating cough. There were also stiff neck, muscular pains in the legs, general tiredness, and depression. On examination there were no abnormal signs in the chest or abdomen. The fauces were injected, and there were red areas under the tongue with pustules in the centre. Glands of the cervical lymph chain
apparently
were
enlarged.
The disorder next developed in the 12-year-old daughter. She felt tired and listless ; the eyes watered and became pink ; and headache, stiff neck, and sore throat followed. Mild sweating occurred at night. There was a hard dry cough, but no abnormal signs in the lungs. The sore throat and pink eyes settled in a couple of days, but watering of the eyes and a feeling of debility persisted for three to four weeks. A similar picture later developed in the 9-year-old child, with severe faucial injection and conjunctivitis.
HOUSEHOLD 2.-This consisted of a farmworker, his wife, daughter aged 6 years, and a son aged 5 years. Severe conjunctivitis, worse on the left side, developed in the mother in April, 1955. This was accompanied by headache and pains up the back of the neck. There was severe a
dizziness, general tiredness, and also a sore throat and dry cough. The cervical lymph-glands were enlarged. The eye lesions and sore throat settled slowly over a fortnight, but lassitude continued for four to five weeks. The two children complained of headache, painful eyes and throat, and stiff neck, from one week after the onset of the mother’s symptoms. There was slight dry cough. For two or three days from the onset they tended to be listless and to lie about the house but were back to normal within three weeks. The father was unaffected. HOUSEHOLD 3.-This family consisted of a joiner and his wife, and two children-a schoolboy and a 20-year-old nausea,
daughter. The disorder developed first in the father, a fortnight before Easter, with sore throat and pains in the neck, back, and legs. He felt feverish and had a harsh cough, and stayed in bed for a week because he felt exhausted. He was first seen only after he had returned to work, when his wife was visited. He was then still easily tired, was depressed, and had enlarged palpable cervical glands. Within a fortnight after the onset in the father a similar syndrome developed in his wife and two children. The wife had a severe attack with a temperature of 102°F, sore throat, watering painful swollen eyes, a hard irritating cough, and general prostration. The cervical lymph-glands were palpable and tender. The acute phase lasted a week and was succeeded by debility and lassitude lasting for five to six weeks. There were no abnormal signs in the lungs. During the mother’s illness the daughter felt depressed and tired and had a poor appetite ; this lasted for about a
fortnight. Watering eyes, sore throat, and a stiff neck with greatly enlarged cervical lymph-glands developed in the son. A dry cough was present, but no abnormal signs in the lungs were noted. He recovered after about
a
week.
GENERAL OBSERVATIONS
All age-groups and both sexes were affected equally. The incubation period appeared to be between five and ten days. Severe cases showed the following features: 1. An acute phase comprising conjunctivitis, sore throat, harsh dry cough, and palpable cervical lymph-glands, with pyrexia up to 104°F. This phase lasted for about a week or ten
days. subsequent phase of debility, lassitude, depression lasting for up to four weeks. 2. A
and
severe
Patients with mild attacks were commonly found in The households where there had been acute cases. common laboratory investigations have been negative. CONCLUSION
The clinical picture of cases in this outbreak resembles that ascribed in the U.S.A. to the A.P.C. group of viruses (Bell et al. 1955, see Lancet 1955). I thank Dr. D. G. Davies, director, Public Health Laboratory, Carlisle, and Dr. K. W. Newell, of the Central Public Health Laboratory, Colindale, for their help in the
investigation. REFERENCES
Bell, J. A., Rowe, W. P., Engler, J. I., Parrott, R. H., Huebner, R. J. (1955) J. Amer. med. Ass. 157, 1083. Lancet (1955) i, 289.
Guidance An attempt to secure more systematic classification of cases seen, and results obtained, at child-guidance clinics Child
made in 1953 by the National Association for Mental Health. It was evident that in dealing with the emotional disorders of children the diversity of complaints and the individuality of each problem were even greater than in adult psychiatry. In his recent annual report on the work of the Leicester child-guidance unit Dr. A. K. Graf, the psychiatrist, speaks of the difficulty he has encountered in trying to group the cases referred to him. For purposes of classification it was necessary to reduce each case to one major problem-the diagnosis recorded being the finding which appeared most important or significant. The figures thus was
291
PERSONAL PAPERS
obtained show that, during the year, behaviour problems due to factors in the environment-mainly home or school- were about equal (20) to those where the difficulties could be explained by constitutional or temperamental factors arising within the growing child himself (22). Problems arising out of backwardness (absolute or relative) were slightly less numerous (17) and equal with the largest single habit disorder-namely, bedwetting. Psychosomatic disturbances were diagnosed in 10 cases, while 19 cases could be classified as belonging to the more serious psychoneuroses.
Poliomyelitis In England and Wales notifications of poliomyelitis in the week ended July 23 numbered 177 (paralytic 93, non-paralytic 84)-an increase of 57 on notifications in the previous week. In London and the South-East Region there were 31 paralytic and 43 non-paralytic cases (including 9 non-paralytic cases in Willesden, from which no paralytic cases were notified). Barnsley and Stepney-the only notable foci-are quieter. The position is still about average for the time of year. The momentum of the curve of notifications is about the same as in 1947 and 1952 ; it is slower than in 1950 and 1953, but faster than in 1948, 1949, 1951, and 1954. The proportion of notified non-paralytic cases is unusually high. and this is having an inflationary effect on the totals.
" In 10 of the referred cases the parents could be reassured that nothing was wrong with their child from our point of view, and the complete absence of psychotic disturbances gives a very reassuring picture of the mental health of the Leicester school child. " Naturally, most of the referred children were of compulsory school age and the peak year for referral was nine years, i.e., the time when the educational strain of preparation for the secondary schools selection examination begins to make itself felt. The number of junior and secondary school children referred was about equal, but the preponderance of maladjustment in boys as compared with girls (there were 35 more boys referred) is significant in view of the fact that the female cases of nervous breakdown preamong adults "
Outbreak at London
’
Tuesday morning.
dominate."
1. See
Personal
Teaching Hospital
In the outbreak of glandular fever at the Royal Free Hospital, London, the total number of cases at. midday last Tuesday amounted to 86 (59 nurses, 3 patients, 24 others), compared with 74 a week previously.! Of this total, 4-a doctor, a nurse, and 2 domestic workers-had recovered and were back at work. The outbreak seems to be waning : there were 4 new cases between last Saturday and last Monday, and none on ________
Lancet, July 30, 1955,
p. 244.
question is not why the direction of the sexual impulse is reversed, but why in some people the homosexual component predominates over, or appears to the
Papers
MALE HOMOSEXUALITY
obliterate, the heterosexual
IN the present wave of interest in male homosexuality, the person most concerned has little opportunity of expressing his point of view : and there is indeed a dearth of information about the average homosexual-the kind, that is, that neither parades his state nor falls into the hands of the police. Perhaps the views of one such person might be of interest at the present time. PREVALENCE
This raises difficulties. The world is-not divided, as many people seem to think, into heterosexuals, whose sexual feelings are all for the opposite sex, and homosexuals, whose feelings are all for the same sex. The Kinsey report-which, whatever its demerits, is the only large-scale objective study of the subject-as well as the personal experiences of interested persons, indicates that among adults there is a continuous gradation from the apparently completely heterosexual, through the bisexual, to the apparently completely homosexual. This is often strongly denied by educated Englishmen ; but there is much to suggest that the " horror " of homosexuality is largely a middle-class attitude, and sometimes a protective mechanism against the acceptance of recognised or unrecognised homosexual tendencies. I can see no reason why the Kinsey figures for the varying degrees of homosexual behaviour in American males should not be roughly applicable to this country, though Americans have stated that homosexuality is more evident in England than in America. The Kinsey figures, which anyone interested should consult, claimed that of some 5000 adult males interviewed 37% had had at least one experience with another male person, involving an orgasm, between adolescence and old age; 25% had continued to have such experiences for a period of at least three years between the ages of 16 and 55 ; whilst 4% had had no other sexual experience in their lives and could be regarded as exclusively homosexual. If for the sake of argument we accept this figure of 4% as the prevalence of real " homosexuals, then there are some 650,000 male homosexuals in England and Wales (the total male population over the age of 15 in 1948 was estimated at 16,331,000). "
aeTIOLOGY
If some degree of bisexuality, with a predominant! heterosexual component, is to be regarded as normal, I
In this I believe that one. is environment early psychological all-important. Genetic. endowment may be concerned, but there is no evidence for this. In the absence of obvious physical changes the endocrines appear to have nothing to do with the direction of the sexual impulses ; and, contrary to popular opinion, most homosexuals are indistinguishable physically from their fellows. I believe my own state can be accounted for by early environment. This opinion is based partly on objective evidence and partly on analytical findings.
family,
I was the youngest of a large and it was well known that my father wanted a daughter. I strongly suspect that my mother conceived and bore me against her will, for my earliest memory is of waking in the night to hear my father in a rage threatening to thrash her if she would not do
great
something he wanted. I believe that I was not only an unwanted child, as far as she was concerned, but also something of a reproach, a, continuing reminder that she had failed to do what it was her duty to her husband to do ; for ours was a sternly puritanical family in which duty meant more than love. I believe that the same sense of duty made my mother treat me with oversolicitude but with little love, and I grew up insecure, overdependent, and enuretic. One other incident is worth recording. A brother remembers that I was once as an infant left lying on a couch while the family had a meal. Some time later it was noticed that I was playing with an erect penis. My mother picked me up and hurried me out of the room. In view of the family attitude to such matters it is likely that stern measures were taken on that and any subsequent occasion to root out the devil that would have been thought to have taken possession of me. At any rate I grew up believing that sexual feelings of any kind were wicked and abominable, and I well remember at the age of about 15 or 16 stoutly maintaining, to the amusement of my school-fellows, that the preliminaries to procreation took place during sleep, at least among decent people. Absurd guilt over sexual feelings plagued me throughout adolescence. It was never dispelled by confessions to a priest, but it has been greatly reduced by psycho-analysis.
How this kind of environment led to homosexuality a matter for speculation, but I believe it is really quite simple. My mother never loved me, and her oversolicitude appeared to me as a sham. To this day I have never been able to feel any spontaneous love for a woman, nor, in spite of objective evidence to the contrary and years of analytical exploration of the feelings concerned, have I ever been able to feel that any woman could ever
is