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CLIMATIC BUBO
"NOSE CLOSING" RAYS CLIMATIC BUBO To the Editor
of
THE LANCET
issue of last week (p. 1365) article under the above title by Surg. Lt.-Cdr. E. R. Sorley and Surg.-Cdr. P. L. Gibson. The authors very truly point out that recent researches have advanced our knowledge of climatic bubo (and lymphogranuloma inguinale, the same condition recognised in temperate countries) very considerably. They then proceed to describe the results they have obtained by a particular form of treatment, completely disregarding the axioms which our newer knowledge has taught us. In evaluating any particular form of treatment of a given condition it is essential that the diagnosis should be first established. The authors have treated 20 cases of " climatic bubo and allied diseases." The allied diseases are chancroid and gonorrhceal infections--conditions which are in no way allied to climatic bubo. For their " criteria " in diagnosis of climatic bubo they rely on statements enunciated nine years ago which do not hold good to-day in view of recent observations. The authors are not aware, apparently, that there is an initial lesion in climatic bubo infections and that double infections with other venereal diseases may be seen. Difficulties were encountered by them in attempting to carry out Freil’s test, so that there was no confirmation or otherwise of the diagnosis in their cases. Of the 20 cases, 8 were chancroid infections with venereal bubo, 4 were cases of gonorrhcea and venereal bubo, and in 8 the clinical diagnosis was climatic bubo. To base any conclusions upon the results obtained in 8 unconfirmed cases of climatic bubo is, I believe, unwarranted, even though those conclusions in regard to shortening of the invalidity period be correct. The modified method of treatment which the authors put forward as superior to other forms " consists in giving the drug [tartar emetic intravenously] rapidly enough to ensure the production of a reaction "-" a well-marked though transitory reaction." What the reaction consists of is not explained. It would be interesting to know whether this mode of treatment is not in reality a form of shock therapy,rather than a treatment by tartar emetic. Without going into detail it may here be stated that while antimony has been found useful by many observers in the treatment of early cases of climatic bubo, some form of shock therapy has found more supporters, as might be expected since the disease is due to an ultramicroscopic virus. I am, Sir, yours faithfully,
SIR,-In
there
your
appeared
an
HUGH S. STANNUS.
London, W., Dec. 18th, 1933.
IMPACTED MOLAR TEETH To the Editor
of
THE LANCET
the wisdom teeth to slow eruption and the surface of the gum, give rise to
SiR,—I have observed that or
their
ulceration
neighbours, owing on
disturbing pathological changes in the mouth. Necrosis and parotideal abscess of some formidableness with severe rigidity of the jaw may follow. Thereby Stenson’s duct becomes affected like an inflamed appendix. Acute toxaemia gives cause for anxiety unless the surgeon recognises the tooth before the jaw is spasmodically fixed. Among the natives of India, the lascars or sailors, impacted ulcerative crowns produce sometimes severe parotideal inflammatory swellings. On the removal
1447
of the offending tooth, with hot fomentations and oral disinfection, the subject recovers. A facial incision to let out pus may be necessary. I have seen several of these cases, it being almost impossible to open their mouths. As the wisdom teeth are often ill-formed it is not difficult to remove them by the proper route. When I was registrar to the Cancer Hospital a case was admitted with cachexia and wasting in which a suspicion of cancer had arisen ; but after a piece of dead bone was removed and the mouth cleaned, the patient completely recovered and rigidity disappeared. If this letter seems unduly long, it is to encourage my professional brethren to reply to Mr. Bowdler Henry’s letter in THE LANCET of Nov. 4th (p. 1064), and to support him in a lecture at the Royal College of Surgeons on the above subject. A scientific address from an odontologist should be very enlightening to those who do not recognise the importance of impacted molars in causing disease. I am,
Sir, yours faithfully, JOHN FRED. BRISCOE.
Authors’ Club, Whitehall-court, S.W., Dec. 19th, 1933.
" NOSE CLOSING " RAYS
To the Editor
of
THE LANCET
SiR,-Mr. A. F. Dufton and Mr. T. Bedford, to whose experiments you alluded last week (p. 1385), have not chosen to visit my laboratory or use my methods of research. I found that in those with a restricted nasal air-way increased obstruction and actual closing of one or even of both nostrils may be brought about by exposure to certain sources of infra-red rays. The effect of the rays on wide-nosed people can only be evidenced by first restricting their nasal air-way by means of a screw nose-clip applied to the wings of the nostrils. Dufton and Bedford have inserted a tube in one nostril and connected this with an aneroid recording tambour, leaving the other nostril open for breathing through. Now the opening of one nostril in wide-nosed people is much larger than is needed for the quiet breathing which pertains in the resting position, and it is easy to show with the help of a water manometer that the air-way of the one open nostril can be greatly diminished without significantly altering the small negative pressure produced by inspiration. The method used by Dufton and Bedford can then only give results in those who have the one open nostril greatly restricted. My critics do not appear to have worked out the energy distribution of the sources of heat used by them or to have consulted the paper read by me at the 2nd Light Congress, Copenhagen, 1932 (Quart. Jour. Exper. Physiol., 1933, xxiii., 35). In this paper are given the energy distributions as worked out by my physicist colleague, Dr. H. J. Taylor. To test my claim that a bright source acts as a "nose opener " and a dull source as a " nose closer," Dufton and Bedford have chosen to use two electric fires, one bright and the other dull, but both were backed by reflectors, and the fires were placed so that the full effect of the reflectors fell upon the subject’s face, as shown by the illustration in their paper. Now the reflectors give off infra-red rays which suffice to neutralise any difference of brightBoth these fires are "nose closers " to those ness. with a restricted nose-way. Their experiments therefore do not refute my observations. There are many other points in their paper which can be dealt with in a paper which I am reading to the Institution
of
THE LANCET
issue of last week (p. 1365) article under the above title by Surg. Lt.-Cdr. E. R. Sorley and Surg.-Cdr. P. L. Gibson. The authors very truly point out that recent researches have advanced our knowledge of climatic bubo (and lymphogranuloma inguinale, the same condition recognised in temperate countries) very considerably. They then proceed to describe the results they have obtained by a particular form of treatment, completely disregarding the axioms which our newer knowledge has taught us. In evaluating any particular form of treatment of a given condition it is essential that the diagnosis should be first established. The authors have treated 20 cases of " climatic bubo and allied diseases." The allied diseases are chancroid and gonorrhceal infections--conditions which are in no way allied to climatic bubo. For their " criteria " in diagnosis of climatic bubo they rely on statements enunciated nine years ago which do not hold good to-day in view of recent observations. The authors are not aware, apparently, that there is an initial lesion in climatic bubo infections and that double infections with other venereal diseases may be seen. Difficulties were encountered by them in attempting to carry out Freil’s test, so that there was no confirmation or otherwise of the diagnosis in their cases. Of the 20 cases, 8 were chancroid infections with venereal bubo, 4 were cases of gonorrhcea and venereal bubo, and in 8 the clinical diagnosis was climatic bubo. To base any conclusions upon the results obtained in 8 unconfirmed cases of climatic bubo is, I believe, unwarranted, even though those conclusions in regard to shortening of the invalidity period be correct. The modified method of treatment which the authors put forward as superior to other forms " consists in giving the drug [tartar emetic intravenously] rapidly enough to ensure the production of a reaction "-" a well-marked though transitory reaction." What the reaction consists of is not explained. It would be interesting to know whether this mode of treatment is not in reality a form of shock therapy,rather than a treatment by tartar emetic. Without going into detail it may here be stated that while antimony has been found useful by many observers in the treatment of early cases of climatic bubo, some form of shock therapy has found more supporters, as might be expected since the disease is due to an ultramicroscopic virus. I am, Sir, yours faithfully,
SIR,-In
there
your
appeared
an
HUGH S. STANNUS.
London, W., Dec. 18th, 1933.
IMPACTED MOLAR TEETH To the Editor
of
THE LANCET
the wisdom teeth to slow eruption and the surface of the gum, give rise to
SiR,—I have observed that or
their
ulceration
neighbours, owing on
disturbing pathological changes in the mouth. Necrosis and parotideal abscess of some formidableness with severe rigidity of the jaw may follow. Thereby Stenson’s duct becomes affected like an inflamed appendix. Acute toxaemia gives cause for anxiety unless the surgeon recognises the tooth before the jaw is spasmodically fixed. Among the natives of India, the lascars or sailors, impacted ulcerative crowns produce sometimes severe parotideal inflammatory swellings. On the removal
1447
of the offending tooth, with hot fomentations and oral disinfection, the subject recovers. A facial incision to let out pus may be necessary. I have seen several of these cases, it being almost impossible to open their mouths. As the wisdom teeth are often ill-formed it is not difficult to remove them by the proper route. When I was registrar to the Cancer Hospital a case was admitted with cachexia and wasting in which a suspicion of cancer had arisen ; but after a piece of dead bone was removed and the mouth cleaned, the patient completely recovered and rigidity disappeared. If this letter seems unduly long, it is to encourage my professional brethren to reply to Mr. Bowdler Henry’s letter in THE LANCET of Nov. 4th (p. 1064), and to support him in a lecture at the Royal College of Surgeons on the above subject. A scientific address from an odontologist should be very enlightening to those who do not recognise the importance of impacted molars in causing disease. I am,
Sir, yours faithfully, JOHN FRED. BRISCOE.
Authors’ Club, Whitehall-court, S.W., Dec. 19th, 1933.
" NOSE CLOSING " RAYS
To the Editor
of
THE LANCET
SiR,-Mr. A. F. Dufton and Mr. T. Bedford, to whose experiments you alluded last week (p. 1385), have not chosen to visit my laboratory or use my methods of research. I found that in those with a restricted nasal air-way increased obstruction and actual closing of one or even of both nostrils may be brought about by exposure to certain sources of infra-red rays. The effect of the rays on wide-nosed people can only be evidenced by first restricting their nasal air-way by means of a screw nose-clip applied to the wings of the nostrils. Dufton and Bedford have inserted a tube in one nostril and connected this with an aneroid recording tambour, leaving the other nostril open for breathing through. Now the opening of one nostril in wide-nosed people is much larger than is needed for the quiet breathing which pertains in the resting position, and it is easy to show with the help of a water manometer that the air-way of the one open nostril can be greatly diminished without significantly altering the small negative pressure produced by inspiration. The method used by Dufton and Bedford can then only give results in those who have the one open nostril greatly restricted. My critics do not appear to have worked out the energy distribution of the sources of heat used by them or to have consulted the paper read by me at the 2nd Light Congress, Copenhagen, 1932 (Quart. Jour. Exper. Physiol., 1933, xxiii., 35). In this paper are given the energy distributions as worked out by my physicist colleague, Dr. H. J. Taylor. To test my claim that a bright source acts as a "nose opener " and a dull source as a " nose closer," Dufton and Bedford have chosen to use two electric fires, one bright and the other dull, but both were backed by reflectors, and the fires were placed so that the full effect of the reflectors fell upon the subject’s face, as shown by the illustration in their paper. Now the reflectors give off infra-red rays which suffice to neutralise any difference of brightBoth these fires are "nose closers " to those ness. with a restricted nose-way. Their experiments therefore do not refute my observations. There are many other points in their paper which can be dealt with in a paper which I am reading to the Institution