- Email: [email protected]
BLISTERING IN CHRONIC SKIN DISEASES.
THE BATTLE OF THE CLUBS IN NEW ZEALAND.
1126
the insurance company in question has a method peculiarly ibs own in dealing with that particular branch of claims work and differing materially from most other companies’ mode of procedure in the preliminary stages of a claim. Mr. Barker quotes a case of accident which happened at some works where he had refused to go again, on account of not being paid for a previous attendance by the firm. The result, presumably owing to no other surgeon being available, was that the injured man, who it afterwards appeared had sustained a badly smashed thigh, had to stay nearly two hours on the ground without skilled attention before being at last taken to the hospital in a cab. There was no steadying apparatus applied to keep the fragments of bone in position, probably for a simple reason that any other person than a surgeon would not have diagnosed the exact nature of the injury and its possible results if proper supports were not fixed to the limb. Surely, for humanity’s sake alone, this was a case where prompt skilled attention might have saved a fellow-man much excruciating agony, possibly his life, and certainly as events proved later, permanent injury. In reality, instead of, as Mr. Barker states, the insurance companies imposing, or seeking to impose, on the medical profession a new and considerable tax and legal responsibilities without fee or reward, they have proved to be very liberal patrons of the profession and the medical men all over the country have profited very distinctly both in a professional and a pecuniary sense by the passing of the Workmen’s Compensation Acts and their application by the insurance companies. No doubt in the near future insurance companies, workmen, employers, and even medical men will be satisfied, for the next Workmen’s Compensation Act passed will be based upon the costly experience of the last few years, the various tricky points, subtle distinctions, and troublous ramifications of the present Act being merged into one harmonious whole of the future Act, so that one will be able to look back upon and say in Shakespeare’s words : by many winding nooks it strays, willing sport to the wild ocean." I am, Sirs, yours faithfully, J. DALY RICHARDSON. Liverpool, April 6th, 1903. ’* We publish this letter although the author’s remarks upon the medical profession in relation to the giving of certificates show him to be without accurate information. Mr. Barker may have implied that members of the profession are careless in giving certificates, but in our experience this is not the case ; while the tax that is sought to be put upon them in this connexion by school boards and other public bodies, employers of labour, sick clubs, &c., is very heavy.-ED. L. "And
so
With
THE BATTLE OF THE CLUBS IN ZEALAND.
NEW
n the Editors of THE LANCET. SIRS,-I inclose a copy of an advertisement which is appearing in the Australian and New Zealand papers. You will doubtless have received a former letter from me in which I told you of our fight with the friendly societies here. Well, this advertisement is the outcome of that dispute, and I want you to warn your readers against accepting such a position. Last evening we had a most united meeting of medical practitioners here and the following resolution was unanimously carried :That the members of the Auckland Section of the New Zealand Branch of the British Medical Association pledge themselves to do all in their power to prevent any medical practitioners from being appointed to the position of surgeon to the United Friendly Societies Dispensary and that they will ostracise any medical man who accepts such a position.
I have only to draw your attention to the following clauses in their conditions to enable you to judge how they wish to sweat the medical profession :Clause N.-They must attend professionally when required, either at home or at the dispensary, members, their wives, and children under 8 (children to include stepchildren and adopted children). Clatsse 4.-They will be required to consult together if necessary, to perform all necessary surgical operations, and when necessary administer chloroform, and in all cases when required vaccinate children of such members. Clause G.-All drugs, &c., will be supplied by the board. Clause 6.-All instruments are to be supplied bV the surgeon. Clause 9. -Salary to be E400 per annum, with fees for attendance children over 18 years, such fees to be fixed by the board.
on
Clause 10,-They shall be allowed to charge members’ wives the sum of E2 2s. for accouchements. Clause 11.-The surgeons shall devote their whole time and attention to the professional duties devolving upon them as the medical officers of such board and shall not be engaged in the practice of their profession other than in accordance with these conditions or such further or other conditions as may from time to time be agreed upon by such practitioners and the said board.
I may further state that I have interviewed the secretary dispensary board and he informs me that each surgeon have to attend about 800 members and their families. I am, Sirs, yours faithfully, TRACY R. INGLIS, Honorary Secretary, Auckland Section, New Zealand
to the
will
Branch, British Medical Association.
I
Auckland, N.Z., Feb. 19th, 1903.
URANIUM SALTS IN CANCER. To the Editors of THE LANCET. SIRS,-YOU were good enough to publish a letter in THE LANCET of Feb. 14th, p. 476, in which I suggested that uranium was worth a trial in cancer, more especially at the pyloric end of the stomach. Since then Messrs. Burroughs, Wellcome and Co. have succeeded in making salicylate of uranium and this proves to be a reddish powder freely soluble in water. They have also made for me some tabloids of the acetate of uranium, containing one grain in each. My hope is that both these salts will prove less irritating than the nitrate for prolonged use. I have only just begun to try the acetate in a case of cancer too far advanced for operation and it seems to be well tolerated, though doubtless it will take some time to find the most suitable dose. Should it seem to do good I shall then try sterilised injections of the salicylate. I mention the matter at this stage in case others might care to try these salts. Apart from the action of uranium on the pyloric end of the stomach in animals it would seem to have medicinal possibilities that merit further investigation, for from uranium ore is extracted radium which attracts so much attention. Uranium has also radio-active properties though to a much feebler extent, while from radium to the x rays is but a step. Becquerel has shown that the rays both of uranium and radium can change white phosphorus into red and that the rays of radium destroy the power of germinating in the seed.-I am, Sirs, yours faithfully, ARTHUR C. WILSON, M.B., Ch.B. Vict. Formby, April 13th, 1903. --
-
--.
BLISTERING IN CHRONIC SKIN DISEASES. To the Editors of THE LANCET. of psoriasis reported by Dr. John Wishart SIRS,-The in THE LANCET of April llth, p. 1030, are of great interest from a therapeutical point of view, since it is by the accurate observation and recording of the minute details of treatment that real progress is made in the healing art. At the same time I should like to point out that although the method adopted by Dr. Wishart is a novel one considered as a separate mode of treatment for this particular disease, yet the principle of employing vesication as a remedial agent in dermatology is by no means new. In 1826 Edward Thompson1 of Whitehaven recognised the value of applying blisters in those chronic cutaneous disorders accompanied by " low inflammation " and characterised by the heaping up of the epidermis, as in psoriasis, ichthyosis, and pityriasis. He observed that a case of psoriasis of the palms which had resisted both internal remedies and external applications for 18 months readily yielded to two blisters. Musset2 in 1854 laid stress upon the importance of destroying the "state of chronicity"in such affections and he considered that the most effective agent for producing this desirable result was the blister. He rather tended to look upon vesication as a means of preparing the way for the better action of other local remedies than possessing curative properties per se. If we attempt to explain the modus operandi of the blister by supposing that the increased vascularity, and therefore a local leucocytosis, thereby produced acts unfavourably upon the materies morbi of the psoriatic patch, be it microbic or not, we should be equally justified in causing a local inflammation by other means, such as cupping, the application of strong irritants, and so cases
1 On the Use of Blisters in Certain Chronic Eruptions of the London Medical Repository, 1826, vol. iii., p. 57. 2 L’Union Médicale, Paris, 1854, tome viii., p. 343.
Skin,
THE THEORIES OF IMMUNITY.-ABORTIVE TREATMENT OF SMALL-POX.
When such inflammation proceeds to actual suppuration Thus Longhurst3 may also obtain the same result. recorded a case of chronic eczema in the popliteal space of a man, aged 31 years, of eight years’ duration which was cured in a month after the development of an acute abscess upon the eczematous area. In this case it is, of course, possible that other factors such as antagonism between the coccigenic organisms and those of eczema may have been at work. The normal blood serum itself, when poured out in increased quantity in response to the local stimulus, may possess inherent antitoxic properties fatal to pathogenic cutaneous microbes, and we know that it certainly is capable of supplying nourishment to the tissues when administered by the mouth. It may by improving the nutrition of the cells of the rete mucosum stimulate these latter to greater activity and so assist them in their production of keratin. I will not trespass further upon your space by wild and fruitless speculations, beyond mentioning the fact that in the treatment of acne dermatologists have long been accustomed to "abort" " an initial papule not by blistering but by the application of pure phenol which will, in company with such agents as chrysarobin and iodine, also abort initial papules of other diseases, such as psoriasis. I am. Sirs, yours faithfully,G. NORMAN MEACHEN, M.D., M.R C.P. Lond.,
on. we
does not use that kind of chart. I have pleasure in joining with Dr. Henderson in testifying indebtedness to you, Sirs, for providing your readers with the admirable lectures which started this discussion. I have no doubt they give a fair account of the theories they deal with as clearly as the theories permit. I cannot, however, say with Dr. Henderson that they have "compelled me to think in new categories." Ala.", I must bleat pathetically once more, for I fear I do not "think in categories " at all. I am quite of Dr. G. Archdall Reid’s opinion that real scientific work is badly hindered by the adoption of unsuitable theories. Indeed, theories of the utmost value often lead into endless barren wastes if not severely tested by comparison with material facts. The "ring theory," for instance, in organic chemistry has developed such profusion of links and side-chains, that I, for one, believe that chemical At the progress is becoming distinctly fettered thereby. same time the fact that Ehrlich cannot prove the actual existence of his haptophores, &c., does not of itself condemn the theory. Imagination is of inestimable value in science if used as a scout in front of the regions already occupied by scientific explorers who do not fail to protect themselves by But imagination the safe intrenchments of experiment, &c. has too often proved a will-o’-the-wisp and lured whole generations of scientific workers into quagmires. Some
Physician to the Skin Department, Tottenham Hospital. New
1127
bacteriological imaginings seem to me to betray a suspicious phosphorescence, which is more likely to serve the purpose of a will-o’-the-wisp than to provide a safe light for the guidance of miners. I am, Sirs, yours faithfully,
recent
Cavendish-street, W., April llth, 1903.
THE THEORIES OF IMMUNITY. To the Editors of THE LANCET. SIRS,-Dr. J. M. Fortescue-Brickdale thinks that you
Welbeck-street, W., April 13th, 1903.
already sufficiently answered my brief letter and that, perhaps, accounts for his proceeding to deal with state-
HUGH WOODS.
have
THE
ABORTIVE
TREATMENT
OF
ments which I never made. He summarises what he supposes SMALL-POX. me to have said under three headings-i. e. (1) that I had failed to understand Dr. A. S. F. Griinbaum’s lectures on the To t7te Editors of THE LANCET. Theories of Immunity ; (2) that I believed that other medical SIRS,-With reference to a clinical note by Dr. James T. men were in a similar plight ; (3) that I consider that these 1 Neech of Halifax on the use of pure carbolic acid in theories (a) throw no light on the subject of t the treatment of small-pox, which note appeared in and are of no use to the medical generally (b) average I THE LANCET of Feb. 21st, p. 518, I beg to point out As regards (1) and (2) I never said anything of the kind. t a combination of pure carbolic acid with sulphate simply said that I could not see the use of the theories.that This being so, is it likely that a reader who failed to under-of quinine, taken internally, has exactly the same effect stand me would understand Ehrlich or Dr. Grunbaum? I in aborting the disease at its various stages without external application of any kind. My experience of this fear not. As regards (3) I did say so of Ehrlich’s theories andtreatment is as follows: in the papular stage the papules Dr. Grunbaum’s explanation of them but not of theories ’entirely disappear or if, at most, one or two become vesicular of immunity generally. Indeed, I am sometimes conscious1they quickly dry up. If the disease be treated in the of a desire to theorise on the subject myself, when the vesicular stage the vesicles dry up without one becoming conviction forces itself upon me that there is something inpustular, whilst in the pustular stage the further production common between the phenomena of the unfitness ofof pus is arrested. No pitting occurs unless treatment be soils for certain crops, the " sicknessof a field for late. The efficacy of the treatment rests entirely with the combination of the two drugs, as solutions of neither a crop grown on it too long, the production of have the same effect. The prescription is : poisons, or "toxics,by fungi in the soil where they have singly Acid. carbol. pur. (melted), nt iii. ; quininæ sulph., grown, as in the curious "fairy rings," the power of R: acid. sulph. dil., TR v. ; glycerini, ni x. ; aquam tolerating large doses of chemical poisons acquire1 by gr. iii.i.; Ft. mist. One ounce is to be taken every four hours. habitual use, the power of tolerating or resisting the ad 3 should ment:on that the sudden arrest of the disease, as development of infectious diseases and their toxiim, and Imanifested (in the papular stage) by the entire disappearance other phenomena by no means limited to the domain of animal life, the mere enumeration of which would occupy ofthe papules, is apt to be followed by diarrhoea, which, considerable space. Dr. Fortescue-Brickdale admits almost however, is purely eliminative and beneficial and can easily In my evidence before the all I did say when he says of the theories I condemned that be controlled when desired. "the nomenclature may be clumsy and often more discordant Plague Commission I demonstrated with figures that the than the experimental results of the various observers." To internal administration of this combination in slightly anyone who appreciates the proper position of "theory" in increased strength-viz., four drops of the melted acid with scientific work the above criticism is, if true, quite enough four grains of quinine-together with the external application of carbolic oil (1 in 30) to the glands-had resulted in to condemn Ehrlich’s theory. I quite agree with Dr. Fortescue-Brickdale’s remarks as to the desirability of a recoveries in 75 per cent. of the cases treated. I must digress to say that where the pure acid has not been available I knowledge of the sciences of bacteriology, chemistry, &c., and the devoting of considerable space in our medical have found the liquid carbolic acid of the Pharmacopoeia per cent.) in the same doses equally efficacious in journals to the modern aspects of these sciences ; but while (90 less severe than plague- e.g., small-pox, puerperal allowing that the best reading is not always the easiest," diseasesmalarial fever, carbuncles, and many other forms my experience is that the most difficult is generally the; fever, of blood poisoning. The symptoms are arrested in the most useless. A small carbuncle subsides Dr. W. E. Henderson tries to drown my " pathetic most decisive manner. under the internal circulation of this bleating " in a poetic effusion in order to prevent our airily, to disappearance whilst the largest after four days may be dropping our pilot Ehrlich overboard into an unplumbed[ combination, opened and treated surgically as an ordinary abscess, the sea which he is alleged to be navigating by the aid of The offence alleged pus having become entirely liquid. It is an undoubted fact a too complex and fanciful chart." does not seem to me to justify us in throwing Ehrlich over-. that boils will disappear under the application of pure and I have personally no doubt of its efficacy in board, but I think it is wiser to put a man at the helm who carbolic acid small-pox as shown in Dr. Neech’s cases, but if the same result can be obtained by the internal use alone of the 3 Frit. Med. Jour., 1900, vol. ii., p. 1284.
immunity mai3.
.
1126
the insurance company in question has a method peculiarly ibs own in dealing with that particular branch of claims work and differing materially from most other companies’ mode of procedure in the preliminary stages of a claim. Mr. Barker quotes a case of accident which happened at some works where he had refused to go again, on account of not being paid for a previous attendance by the firm. The result, presumably owing to no other surgeon being available, was that the injured man, who it afterwards appeared had sustained a badly smashed thigh, had to stay nearly two hours on the ground without skilled attention before being at last taken to the hospital in a cab. There was no steadying apparatus applied to keep the fragments of bone in position, probably for a simple reason that any other person than a surgeon would not have diagnosed the exact nature of the injury and its possible results if proper supports were not fixed to the limb. Surely, for humanity’s sake alone, this was a case where prompt skilled attention might have saved a fellow-man much excruciating agony, possibly his life, and certainly as events proved later, permanent injury. In reality, instead of, as Mr. Barker states, the insurance companies imposing, or seeking to impose, on the medical profession a new and considerable tax and legal responsibilities without fee or reward, they have proved to be very liberal patrons of the profession and the medical men all over the country have profited very distinctly both in a professional and a pecuniary sense by the passing of the Workmen’s Compensation Acts and their application by the insurance companies. No doubt in the near future insurance companies, workmen, employers, and even medical men will be satisfied, for the next Workmen’s Compensation Act passed will be based upon the costly experience of the last few years, the various tricky points, subtle distinctions, and troublous ramifications of the present Act being merged into one harmonious whole of the future Act, so that one will be able to look back upon and say in Shakespeare’s words : by many winding nooks it strays, willing sport to the wild ocean." I am, Sirs, yours faithfully, J. DALY RICHARDSON. Liverpool, April 6th, 1903. ’* We publish this letter although the author’s remarks upon the medical profession in relation to the giving of certificates show him to be without accurate information. Mr. Barker may have implied that members of the profession are careless in giving certificates, but in our experience this is not the case ; while the tax that is sought to be put upon them in this connexion by school boards and other public bodies, employers of labour, sick clubs, &c., is very heavy.-ED. L. "And
so
With
THE BATTLE OF THE CLUBS IN ZEALAND.
NEW
n the Editors of THE LANCET. SIRS,-I inclose a copy of an advertisement which is appearing in the Australian and New Zealand papers. You will doubtless have received a former letter from me in which I told you of our fight with the friendly societies here. Well, this advertisement is the outcome of that dispute, and I want you to warn your readers against accepting such a position. Last evening we had a most united meeting of medical practitioners here and the following resolution was unanimously carried :That the members of the Auckland Section of the New Zealand Branch of the British Medical Association pledge themselves to do all in their power to prevent any medical practitioners from being appointed to the position of surgeon to the United Friendly Societies Dispensary and that they will ostracise any medical man who accepts such a position.
I have only to draw your attention to the following clauses in their conditions to enable you to judge how they wish to sweat the medical profession :Clause N.-They must attend professionally when required, either at home or at the dispensary, members, their wives, and children under 8 (children to include stepchildren and adopted children). Clatsse 4.-They will be required to consult together if necessary, to perform all necessary surgical operations, and when necessary administer chloroform, and in all cases when required vaccinate children of such members. Clause G.-All drugs, &c., will be supplied by the board. Clause 6.-All instruments are to be supplied bV the surgeon. Clause 9. -Salary to be E400 per annum, with fees for attendance children over 18 years, such fees to be fixed by the board.
on
Clause 10,-They shall be allowed to charge members’ wives the sum of E2 2s. for accouchements. Clause 11.-The surgeons shall devote their whole time and attention to the professional duties devolving upon them as the medical officers of such board and shall not be engaged in the practice of their profession other than in accordance with these conditions or such further or other conditions as may from time to time be agreed upon by such practitioners and the said board.
I may further state that I have interviewed the secretary dispensary board and he informs me that each surgeon have to attend about 800 members and their families. I am, Sirs, yours faithfully, TRACY R. INGLIS, Honorary Secretary, Auckland Section, New Zealand
to the
will
Branch, British Medical Association.
I
Auckland, N.Z., Feb. 19th, 1903.
URANIUM SALTS IN CANCER. To the Editors of THE LANCET. SIRS,-YOU were good enough to publish a letter in THE LANCET of Feb. 14th, p. 476, in which I suggested that uranium was worth a trial in cancer, more especially at the pyloric end of the stomach. Since then Messrs. Burroughs, Wellcome and Co. have succeeded in making salicylate of uranium and this proves to be a reddish powder freely soluble in water. They have also made for me some tabloids of the acetate of uranium, containing one grain in each. My hope is that both these salts will prove less irritating than the nitrate for prolonged use. I have only just begun to try the acetate in a case of cancer too far advanced for operation and it seems to be well tolerated, though doubtless it will take some time to find the most suitable dose. Should it seem to do good I shall then try sterilised injections of the salicylate. I mention the matter at this stage in case others might care to try these salts. Apart from the action of uranium on the pyloric end of the stomach in animals it would seem to have medicinal possibilities that merit further investigation, for from uranium ore is extracted radium which attracts so much attention. Uranium has also radio-active properties though to a much feebler extent, while from radium to the x rays is but a step. Becquerel has shown that the rays both of uranium and radium can change white phosphorus into red and that the rays of radium destroy the power of germinating in the seed.-I am, Sirs, yours faithfully, ARTHUR C. WILSON, M.B., Ch.B. Vict. Formby, April 13th, 1903. --
-
--.
BLISTERING IN CHRONIC SKIN DISEASES. To the Editors of THE LANCET. of psoriasis reported by Dr. John Wishart SIRS,-The in THE LANCET of April llth, p. 1030, are of great interest from a therapeutical point of view, since it is by the accurate observation and recording of the minute details of treatment that real progress is made in the healing art. At the same time I should like to point out that although the method adopted by Dr. Wishart is a novel one considered as a separate mode of treatment for this particular disease, yet the principle of employing vesication as a remedial agent in dermatology is by no means new. In 1826 Edward Thompson1 of Whitehaven recognised the value of applying blisters in those chronic cutaneous disorders accompanied by " low inflammation " and characterised by the heaping up of the epidermis, as in psoriasis, ichthyosis, and pityriasis. He observed that a case of psoriasis of the palms which had resisted both internal remedies and external applications for 18 months readily yielded to two blisters. Musset2 in 1854 laid stress upon the importance of destroying the "state of chronicity"in such affections and he considered that the most effective agent for producing this desirable result was the blister. He rather tended to look upon vesication as a means of preparing the way for the better action of other local remedies than possessing curative properties per se. If we attempt to explain the modus operandi of the blister by supposing that the increased vascularity, and therefore a local leucocytosis, thereby produced acts unfavourably upon the materies morbi of the psoriatic patch, be it microbic or not, we should be equally justified in causing a local inflammation by other means, such as cupping, the application of strong irritants, and so cases
1 On the Use of Blisters in Certain Chronic Eruptions of the London Medical Repository, 1826, vol. iii., p. 57. 2 L’Union Médicale, Paris, 1854, tome viii., p. 343.
Skin,
THE THEORIES OF IMMUNITY.-ABORTIVE TREATMENT OF SMALL-POX.
When such inflammation proceeds to actual suppuration Thus Longhurst3 may also obtain the same result. recorded a case of chronic eczema in the popliteal space of a man, aged 31 years, of eight years’ duration which was cured in a month after the development of an acute abscess upon the eczematous area. In this case it is, of course, possible that other factors such as antagonism between the coccigenic organisms and those of eczema may have been at work. The normal blood serum itself, when poured out in increased quantity in response to the local stimulus, may possess inherent antitoxic properties fatal to pathogenic cutaneous microbes, and we know that it certainly is capable of supplying nourishment to the tissues when administered by the mouth. It may by improving the nutrition of the cells of the rete mucosum stimulate these latter to greater activity and so assist them in their production of keratin. I will not trespass further upon your space by wild and fruitless speculations, beyond mentioning the fact that in the treatment of acne dermatologists have long been accustomed to "abort" " an initial papule not by blistering but by the application of pure phenol which will, in company with such agents as chrysarobin and iodine, also abort initial papules of other diseases, such as psoriasis. I am. Sirs, yours faithfully,G. NORMAN MEACHEN, M.D., M.R C.P. Lond.,
on. we
does not use that kind of chart. I have pleasure in joining with Dr. Henderson in testifying indebtedness to you, Sirs, for providing your readers with the admirable lectures which started this discussion. I have no doubt they give a fair account of the theories they deal with as clearly as the theories permit. I cannot, however, say with Dr. Henderson that they have "compelled me to think in new categories." Ala.", I must bleat pathetically once more, for I fear I do not "think in categories " at all. I am quite of Dr. G. Archdall Reid’s opinion that real scientific work is badly hindered by the adoption of unsuitable theories. Indeed, theories of the utmost value often lead into endless barren wastes if not severely tested by comparison with material facts. The "ring theory," for instance, in organic chemistry has developed such profusion of links and side-chains, that I, for one, believe that chemical At the progress is becoming distinctly fettered thereby. same time the fact that Ehrlich cannot prove the actual existence of his haptophores, &c., does not of itself condemn the theory. Imagination is of inestimable value in science if used as a scout in front of the regions already occupied by scientific explorers who do not fail to protect themselves by But imagination the safe intrenchments of experiment, &c. has too often proved a will-o’-the-wisp and lured whole generations of scientific workers into quagmires. Some
Physician to the Skin Department, Tottenham Hospital. New
1127
bacteriological imaginings seem to me to betray a suspicious phosphorescence, which is more likely to serve the purpose of a will-o’-the-wisp than to provide a safe light for the guidance of miners. I am, Sirs, yours faithfully,
recent
Cavendish-street, W., April llth, 1903.
THE THEORIES OF IMMUNITY. To the Editors of THE LANCET. SIRS,-Dr. J. M. Fortescue-Brickdale thinks that you
Welbeck-street, W., April 13th, 1903.
already sufficiently answered my brief letter and that, perhaps, accounts for his proceeding to deal with state-
HUGH WOODS.
have
THE
ABORTIVE
TREATMENT
OF
ments which I never made. He summarises what he supposes SMALL-POX. me to have said under three headings-i. e. (1) that I had failed to understand Dr. A. S. F. Griinbaum’s lectures on the To t7te Editors of THE LANCET. Theories of Immunity ; (2) that I believed that other medical SIRS,-With reference to a clinical note by Dr. James T. men were in a similar plight ; (3) that I consider that these 1 Neech of Halifax on the use of pure carbolic acid in theories (a) throw no light on the subject of t the treatment of small-pox, which note appeared in and are of no use to the medical generally (b) average I THE LANCET of Feb. 21st, p. 518, I beg to point out As regards (1) and (2) I never said anything of the kind. t a combination of pure carbolic acid with sulphate simply said that I could not see the use of the theories.that This being so, is it likely that a reader who failed to under-of quinine, taken internally, has exactly the same effect stand me would understand Ehrlich or Dr. Grunbaum? I in aborting the disease at its various stages without external application of any kind. My experience of this fear not. As regards (3) I did say so of Ehrlich’s theories andtreatment is as follows: in the papular stage the papules Dr. Grunbaum’s explanation of them but not of theories ’entirely disappear or if, at most, one or two become vesicular of immunity generally. Indeed, I am sometimes conscious1they quickly dry up. If the disease be treated in the of a desire to theorise on the subject myself, when the vesicular stage the vesicles dry up without one becoming conviction forces itself upon me that there is something inpustular, whilst in the pustular stage the further production common between the phenomena of the unfitness ofof pus is arrested. No pitting occurs unless treatment be soils for certain crops, the " sicknessof a field for late. The efficacy of the treatment rests entirely with the combination of the two drugs, as solutions of neither a crop grown on it too long, the production of have the same effect. The prescription is : poisons, or "toxics,by fungi in the soil where they have singly Acid. carbol. pur. (melted), nt iii. ; quininæ sulph., grown, as in the curious "fairy rings," the power of R: acid. sulph. dil., TR v. ; glycerini, ni x. ; aquam tolerating large doses of chemical poisons acquire1 by gr. iii.i.; Ft. mist. One ounce is to be taken every four hours. habitual use, the power of tolerating or resisting the ad 3 should ment:on that the sudden arrest of the disease, as development of infectious diseases and their toxiim, and Imanifested (in the papular stage) by the entire disappearance other phenomena by no means limited to the domain of animal life, the mere enumeration of which would occupy ofthe papules, is apt to be followed by diarrhoea, which, considerable space. Dr. Fortescue-Brickdale admits almost however, is purely eliminative and beneficial and can easily In my evidence before the all I did say when he says of the theories I condemned that be controlled when desired. "the nomenclature may be clumsy and often more discordant Plague Commission I demonstrated with figures that the than the experimental results of the various observers." To internal administration of this combination in slightly anyone who appreciates the proper position of "theory" in increased strength-viz., four drops of the melted acid with scientific work the above criticism is, if true, quite enough four grains of quinine-together with the external application of carbolic oil (1 in 30) to the glands-had resulted in to condemn Ehrlich’s theory. I quite agree with Dr. Fortescue-Brickdale’s remarks as to the desirability of a recoveries in 75 per cent. of the cases treated. I must digress to say that where the pure acid has not been available I knowledge of the sciences of bacteriology, chemistry, &c., and the devoting of considerable space in our medical have found the liquid carbolic acid of the Pharmacopoeia per cent.) in the same doses equally efficacious in journals to the modern aspects of these sciences ; but while (90 less severe than plague- e.g., small-pox, puerperal allowing that the best reading is not always the easiest," diseasesmalarial fever, carbuncles, and many other forms my experience is that the most difficult is generally the; fever, of blood poisoning. The symptoms are arrested in the most useless. A small carbuncle subsides Dr. W. E. Henderson tries to drown my " pathetic most decisive manner. under the internal circulation of this bleating " in a poetic effusion in order to prevent our airily, to disappearance whilst the largest after four days may be dropping our pilot Ehrlich overboard into an unplumbed[ combination, opened and treated surgically as an ordinary abscess, the sea which he is alleged to be navigating by the aid of The offence alleged pus having become entirely liquid. It is an undoubted fact a too complex and fanciful chart." does not seem to me to justify us in throwing Ehrlich over-. that boils will disappear under the application of pure and I have personally no doubt of its efficacy in board, but I think it is wiser to put a man at the helm who carbolic acid small-pox as shown in Dr. Neech’s cases, but if the same result can be obtained by the internal use alone of the 3 Frit. Med. Jour., 1900, vol. ii., p. 1284.
immunity mai3.
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