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BETTER FO'C'SLES
990 movements enable the height of the arch to be changed. Mr. Lake says that no one but a ballet-dancer can raise and lower the arch at will, but I can assure him that the necessary movements can be learned by any " normal " person and most " flat-footed " people in a couple of minutes. The arch of the foot is not like a masonry arch which collapses by separation of the lower edges of the stones when the supporting columns are moved apart. Living joints are not designed to permit such movement. The height of the arch of the foot depends on the posture of the subastragaloid joint. Movement here is a complicated rotary one, and the arch is necessarily raised when the foot is adducted and inverted. Rotary movement is therefore essential to alter the height of the arch. Mr. Lake’s contention that the ligaments play an important part in maintaining the integrity of the arch of the foot is tenable only if it is accepted that the arch is fixed in height. If the arch really can be raised and lowered at will-and I hope to convince him of this-the ligaments cannot behave in such a way, because they have not sufficient elasticity. I am, Sir, vours faithfully. PHILIP WILES. Harley-street, W., Oct. 18th. CHRYSOTHERAPY
To the Editor
SiR,-May
I
of THE LANCET congratulate Prof. Hartfall,
others are under trial. The initial dose has been 10 mg. by Dr. Farncombe, 4 mg. at the clinic. Here, if reaction occurred, 0-4 mg. was the next dose, and in a few cases, following further reaction, 0-04 mg. As the result of some six to eight injections of gold at approximately fortnightly intervals, 50 per cent. of the cases showed a striking improvement and, on reverting to vaccines, resumed a satisfactory rate of progress. Reactions when they occurred were purely focal and exactly comparable to those produced by a slight overdose of vaccine. With this method of giving gold, in only one case was there toxic reaction of any kind. This patient was apparently goldsensitive, and after the first dose developed an itchy erythema which passed off in about three days. The treatment in this case was not pursued. The manufacturers of gold preparations state that not more than ten days should be allowed to elapse between the injections or severe reaction may follow. This suggests not a chemotherapeutic effect but some kind of immunity response. I believe that, where immunity responses are in question, the aim in view should be the administration of the smallest dose which produces an effect rather than the largest which can be tolerated. If this is correct, then there is no need for the massive doses of gold usually given. Experience will decide the issue. I am. Sir. vours faithfullv. H. WARREN CROWE. Harley-street, W., Oct. 15th.
Dr. their valuable article on BETTER FO’C’SLES chrysotherapy in 900 cases. From this everyone a idea can gain of the benefits of the treatTo the Editor of THE LANCET complete ment, as of the risks inherent in its use. The value SiR,-On behalf of the Association of Port Sanitary of gold injections is apparently great in rheumatoid Health) Authorities of the British Isles, I should (now arthritis, slight in osteo-arthritis. In which of these to like express appreciation of the generous recognition two groups is the ordinary infective arthritisThis disease is to be distinguished from rheumatoidgiven in a recent leading article (p. 809) to the part by this association in preparing the way for arthritis ; it is probably a form of osteo-arthritis played the great advances in marine hygiene that should with a high infective factor. be obtained by proper administration of the new I take exception to the statement that gold given Instructions. May I point out, however, that the on these lines is the best single method of treating association’s first set of " Recommendations re rheumatoad arthritis. At the Charterhouse RheumaHygiene of Crew Spaces " was published not in 1931 tism Clinic six times these numbers have been treated but ago as 1922. In this first series there by inoculation. As can be seen from the published were so22long and in the second revised recommendations reports, the percentage results in rheumatoid arthritis series in 1935 there were 24.’ With few published and active infective arthritis are approximately the of the all the 1935 recommendations same as those given in this paper. In true rheumatoid exceptions are reflected in the new Instructions. association arthritis before deformity and in bilateral sacroilitis, I am. Sir. vours faithfullv. which is the first stage of spondylitis adolescens, the J. GREENWOOD WILSON, figures are clearly in favour of vaccines, as the Hon. Secretary, Association of Port Health recovery-rate of each is 100 per cent. The treatment Authorities of the British Isles.’ has two further advantages over gold. It is successful City Hall, Cardiff, Oct, 16th, in osteo-arthritis, and it can be administered without risk by any doctor who takes the trouble to learn POLITICS IN THE HOSPITAL the method. In gold treatment as described by To the Editor of THE LANCET Prof. Hartfall and his colleagues one must further note the 40 per cent. of toxic reactions, which do SiR,-We read with interest and appreciation your not occur at all with vaccines properly given. No leading article on Oct. 9th. As the central body on deaths due to vaccine have been recorded at the socialist questions among medical students, we clinic in 5500 cases. thought it opportune to make clear our ideas on certain It must not be thought that gold treatment is points which have been raised. We quite agree with you when you state that entirely ruled out at the clinic. It is, in fact, under trial at the present time, though in very small doses, "political differences of opinion are compatible and i is being applied to cases of severe arthritis with friendship and everyday collaboration, and which, although somewhat better, have been under medical students ought to be well enough educated treatment for a long period and have come to a stand. to carry on this valuable tradition." Too much still. Following the method of Secher,l Dr. Farnhas been made of this bogy of political strife in the combe in Southsea and the staff of the clinic in medical schools ; like the Jabberwock it just does not London have treated some sixty cases. The preparaexist. For instance our journal, Hospital, has been tion used has been chiefly Solganal B oleosum, but sold widely amongst medical students all over the country, and has never been known to destroy one 1 Secher, K. : Traitement des maladies rheumatismales par still less provoke a free-fight, of which the friendship, la sanocrysine, Copenhagen, 1933.
Garland, and Dr. Goldie
on
To the Editor
SiR,-May
I
of THE LANCET congratulate Prof. Hartfall,
others are under trial. The initial dose has been 10 mg. by Dr. Farncombe, 4 mg. at the clinic. Here, if reaction occurred, 0-4 mg. was the next dose, and in a few cases, following further reaction, 0-04 mg. As the result of some six to eight injections of gold at approximately fortnightly intervals, 50 per cent. of the cases showed a striking improvement and, on reverting to vaccines, resumed a satisfactory rate of progress. Reactions when they occurred were purely focal and exactly comparable to those produced by a slight overdose of vaccine. With this method of giving gold, in only one case was there toxic reaction of any kind. This patient was apparently goldsensitive, and after the first dose developed an itchy erythema which passed off in about three days. The treatment in this case was not pursued. The manufacturers of gold preparations state that not more than ten days should be allowed to elapse between the injections or severe reaction may follow. This suggests not a chemotherapeutic effect but some kind of immunity response. I believe that, where immunity responses are in question, the aim in view should be the administration of the smallest dose which produces an effect rather than the largest which can be tolerated. If this is correct, then there is no need for the massive doses of gold usually given. Experience will decide the issue. I am. Sir. vours faithfullv. H. WARREN CROWE. Harley-street, W., Oct. 15th.
Dr. their valuable article on BETTER FO’C’SLES chrysotherapy in 900 cases. From this everyone a idea can gain of the benefits of the treatTo the Editor of THE LANCET complete ment, as of the risks inherent in its use. The value SiR,-On behalf of the Association of Port Sanitary of gold injections is apparently great in rheumatoid Health) Authorities of the British Isles, I should (now arthritis, slight in osteo-arthritis. In which of these to like express appreciation of the generous recognition two groups is the ordinary infective arthritisThis disease is to be distinguished from rheumatoidgiven in a recent leading article (p. 809) to the part by this association in preparing the way for arthritis ; it is probably a form of osteo-arthritis played the great advances in marine hygiene that should with a high infective factor. be obtained by proper administration of the new I take exception to the statement that gold given Instructions. May I point out, however, that the on these lines is the best single method of treating association’s first set of " Recommendations re rheumatoad arthritis. At the Charterhouse RheumaHygiene of Crew Spaces " was published not in 1931 tism Clinic six times these numbers have been treated but ago as 1922. In this first series there by inoculation. As can be seen from the published were so22long and in the second revised recommendations reports, the percentage results in rheumatoid arthritis series in 1935 there were 24.’ With few published and active infective arthritis are approximately the of the all the 1935 recommendations same as those given in this paper. In true rheumatoid exceptions are reflected in the new Instructions. association arthritis before deformity and in bilateral sacroilitis, I am. Sir. vours faithfullv. which is the first stage of spondylitis adolescens, the J. GREENWOOD WILSON, figures are clearly in favour of vaccines, as the Hon. Secretary, Association of Port Health recovery-rate of each is 100 per cent. The treatment Authorities of the British Isles.’ has two further advantages over gold. It is successful City Hall, Cardiff, Oct, 16th, in osteo-arthritis, and it can be administered without risk by any doctor who takes the trouble to learn POLITICS IN THE HOSPITAL the method. In gold treatment as described by To the Editor of THE LANCET Prof. Hartfall and his colleagues one must further note the 40 per cent. of toxic reactions, which do SiR,-We read with interest and appreciation your not occur at all with vaccines properly given. No leading article on Oct. 9th. As the central body on deaths due to vaccine have been recorded at the socialist questions among medical students, we clinic in 5500 cases. thought it opportune to make clear our ideas on certain It must not be thought that gold treatment is points which have been raised. We quite agree with you when you state that entirely ruled out at the clinic. It is, in fact, under trial at the present time, though in very small doses, "political differences of opinion are compatible and i is being applied to cases of severe arthritis with friendship and everyday collaboration, and which, although somewhat better, have been under medical students ought to be well enough educated treatment for a long period and have come to a stand. to carry on this valuable tradition." Too much still. Following the method of Secher,l Dr. Farnhas been made of this bogy of political strife in the combe in Southsea and the staff of the clinic in medical schools ; like the Jabberwock it just does not London have treated some sixty cases. The preparaexist. For instance our journal, Hospital, has been tion used has been chiefly Solganal B oleosum, but sold widely amongst medical students all over the country, and has never been known to destroy one 1 Secher, K. : Traitement des maladies rheumatismales par still less provoke a free-fight, of which the friendship, la sanocrysine, Copenhagen, 1933.
Garland, and Dr. Goldie
on