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HIGH-FREQUENCY CURRENTS FOR INSOMNIA.
553 the few figures given in the foregoing prove how far ahead of all nations is Japan by her Red Cross Society. As, owing to Queen Alexandra’s generous appeal, this country is at last endeavouring to create a Red Cross service worthy of Great Britain, we might learn from Japan how to organise it, although England originally was Japan’s teacher in these matters.
complaints we receive from patients whom we regarding the sanitation of the locality. My patients complain of the absolute indifference on the part of the authorities to their complaints about the drainage. One cannot understand why the authorities should be so blind to their own interests as not to take most vigorous precautions to make the sanitary arrangements, especially the drainage, as perfect as possible. I have received quite recently a number of letters from patients whom I have " Audi alteram partem." hitherto sent to St. Moritz inquiring about other winter quarters, basing their objections to return to St. Moritz upon INEBRIETY A DISEASE AND THEREFORE the faulty drainage and consequent bad smells which they allege to be the cause of the sore-throats so often seen there. TO BE TREATED BY THE MEDICAL It will be much to the advantage of St. Moritz if the local PROFESSION. authorities during this autumn will make a thorough investiTo the Editors of THE LANCET. gation and place the whole sanitary arrangements in such a condition as to be above suspicion. After this has been is now becoming generally recognised that SIRS,—It chronic inebriety is a disease but the majority of medical done a report should be sent to the medical press in order to prevent the unfavourable impressions now rapidly spreadmen have never taken its treatment seriously in hand. There are two reasons for this. First, the belief that the victim of ing regarding this famous health resort. I am. Sirs. vours faithfullv. the drink crave must be removed from his home and placed constant
send there
Correspondence.
I
in some retreat or sanatorium in order that the treatment may be successfully carried out and, second, because the drugs used and the methods of treatment adopted in these highly advertised institutions have been kept secret. Both these objections have now been removed. The methods of treatment have been published by Dr. C. A. McBride and Mr. S. Blackwell Fenn and my own results prove that the treatment can be carried out by the ordinary medical attendant without removing the patient from The hypodermic injection of atropine his own home. has undoubtedly a restraining effect upon the craving for alcohol and if with this is administered strychnine a powerful tonic effect is produced which will soon remove the terrible morning depression from which drinkers suffer. In addition to this all that is needed is a suitable diet and a medicine by the mouth to correct any disturbance which is hindering the return to health, such as calomel for the liver, bromide and chloral for sleeplessness, or cinchona and cap-icum as a pick-me up. And, indeed, these will only be required for the first few days. My cases have been treated as out-patients, coming to my house twice a day to receive the injections. There is in this more If a patient will come than one obvious advantage. of his own free will to a medical man’s house for treatment it shows that he has a real de"ire to be cured. And, again, if he gives up his drinking habits while in the midst of temptation he is likely to keep straight, avoiding as he does the risk which arises when, after treatment in a sanatorium, tne pauent recurns to tne scene or nis iormer
Of course, no treatment will insure that the man will fall again. Neither is it possible to change the
never
drunkard into a moderate drinker. If, after being an abstainer for a time, he argues thus with himself, "Now I have lost the craving for alcohol I am like other men and can take a little with safety "-if he acts upon this assumption he will soon find, to his cost, that the old craving will return. His only safety lies in being a total abstainer. Another advantage of this out-patient system of treatment is that it can be applied to the poor as well as to the rich and, again, being carried out by the family medical man, the patient is not a marked man and stigmatised as one who has been in an inebriate home. Some of my patients have been treated under most unfavourable conditions but even when living in a common lodging-house with its usual surroundings of drink and squalor the craving has gone and the patient has risen above his environment. I should like to see medical practitioners generally taking up the treatment of this disease. I am sure much good would result. Many an inebriate would be cured and many a man would be saved from falling a victim to the disease. For medical men coming into more immediate contact with the results of excess would become exceedingly cautious in prescribing alcohol and would carefully safeguard their patients lest a temporary use should lead to a fixed habit. I am
.Cire
yoursfaithfully faithfully,
vnnre
......" J
Nottingham, August 10th, 1905.
J.
S. BOLTON, M.D. Edin.
SANITATION AT ST. MORITZ. To the Editors of THE LANCET. a great kindness on your part if you will allow me through your columns to draw the attention of the local authorities of St. Moritz, Upper Engadine, to the
1905.
T. W. PARKINSON.
HIGH-FREQUENCY CURRENTS FOR INSOMNIA. To the Editors of THE LANCET. treatment of sleeplessness and pain has lately SIRS,—The been a subject for discussion. I would like to draw the attention of fellow practitioners to the value of the highfrequency currents as an agent for the cure of sleeplessness and the relief of pain. I have now had several years’ experience of this form of treatment and am fully convinced of its value. It may be that the high-frequency currents, like other therapeutic departures, have suffered from too enthusiastic testimonies of injudicious friends, but this should not blind us to their true value. I have endeavoured to observe their effects with an impartial mind and have no doubt of their real usefulness in certain conditions. It is an undoubted fact that they do produce an effect on the functions of the nervous system, though it may not be possible to say exactly how this effect is brought about. Quite a common experience is that patients under the influence of the high-frequency currents find them.,elves relieved of sleeplessness. Electricity in this form will not, of course, meet a more or less sudden emergency where sleep is absent in consequence of acute pain or severe mental distress. In such circumstances one or other of the
powerful hypnotic drugs there is
temptation.
SIRS,-It will be
Sloane-street, S.W., August 8th,
habit of
can
hardly
be avoided.
But when
insomnia the value of the highfrequency currents is considerable. After a series of applications varying in different cases from 15 to 40, patients almost invariably acquire the habit of sound sleep. There are also other advantages-that the sleep is natural and refreshing and is not followed by any of the ill-effects attached to the use of narcotic drugs. To obtain the best results I find it essential to utilise a large output of electricity, ranging from 400 to 800 milliamperes in men and from 250 to 700 milliamperes in women. Used under these conditions I venture to say that the high-frequency currents will rarely be employed in vain in cases of insomnia due to mental worry and other allied conditions. With regard to the use of the high-frequency currents in the relief of pain-here again they can hardly compete with morphine in the promptness with which it overcomes pain due to acute inflammation. Nor are they generally capable of allaying the acute pain of organic disease. But in the treatment of various neuralgias their value is considerable. In neuralgia of the face and forehead and in intercostal, brachial, ;;nd sciatic neuralgias I have repeatedly proved their efficacy. The same is true of lumbago and of muscular rheumatism in various parts of the body. In reference to sciatica, it is necessary to remember that when the condition depends upon peri-neuritic adhesions the high-frequency currents render little or no help. It is because this is not invariably recognised that disappointment has sometimes resulted. But with a true neuritis or with a pure neuralgia the highfrequency currents may ’ue confidently counted upon after a few applications to produce permanently beneficial results. In all these instances the method of treatment has the advantage of being grateful and not disagreeable to the patient and in addition it may be stated that the highfrequency currents form one of the best nervine tonics, and therefore while they cure insomnia and relieve pain they a
persistent
554 also at the same time greatly improve the general nervous condition of the patient. I have never had experience of any unpleasant or injurious effects resulting from the careful application of the high-frequency currents. It may be advisable here to remark that the treatment by high frequency currents should be intrusted to qualified medical practitioners only and that it is unwise and irregular for members of our profession in practice to send their patients for any form of electrical treatment to the various unrecognised electrical institutes which are advertised in the I am. Sirs. yours faithfullv. lav Dress. August 14th, 1905. W. F. SOMERVILLE, M.D. Glasg.
Glasgow,
SECONDARY FACTORS IN THE MORTALITY AND TRANSMISSIBILITY OF PULMONARY TUBERCULOSIS. To the Editors of THE LANCET. SIRS,—With regard to my preliminary note on Secondary Factors in the Mortality of Pulmonary Tuberculosis, of which you have kindly published a summary in your issue of July 8th, p 98, I beg to point out that in my last letter I must have left out the words
"
" after " pure culture and "healthy " before "pulmonary tissues"" in the wording of the aphorism which you have quoted and which should read : " That the tubercle bacillus in pure culture, per se, is incapable of developing in the healthy pulmonary tissues either the anatomical lesions or the clinical symptoms of confirmed pulmonary tuberculosis." I am. Sirs. vours faithfully. CARLOS J. FINLAY. Havana, July 21st, 1905.
"per
se
MISTAKES IN THE DIAGNOSIS OF INFECTIOUS DISEASES. To the Editors of THE LANCET. SIRS,-A few years before the lat small-pox epidemic I was called to see a man in South Hornsey, North London, suffering from ordinary febrile symptoma, plus a rash, just beginning to appear. The man had been working in St. John’s Wood. I diagnosed variola as probable and without waiting for any further development I had the man removed and isolated. The case turned out to be virulent small-pox and owing to my promptness the disease never spread to even a member of the family and was stamped out there and then. I risked the I’ mi,,take"and saved the ratepayers a large sum of money. For many years where children are swarming in any house and one is down with some supposed infectious disease, to save lives and to save the ratepayers, it has been my custom to have the patient removed within afeiv kO’1W8 after examination. I risk the" mistake," and if I am wrong in my opinion once in 15 times-about the average for each of us medical men-the saving to the community after deducting the cost of " mistakes ’’ must be enormous. Yesterday I was called to see a child, aged five years. Apparently typical scarlet fever. House full of children. Mother informs me, when I tell her I shall have her child removed in a few hours, that the boy has only just come home four days from the fever hospital convalescent from scarlet fever! I nevertheless act with my usual promptness and I risk the " erroragain to save both lives and the pockets of the already over-burdened ratepayers. In a few hours the child was once again back in his old hospital. If medical men, through these grossly unjust remarks about their mistakes, will stand, in future, on their rights and wait till the disease is fully developed and infection has spread, instead of a los to the ratepayers of ,c12,OOO the reckoning will be nearer £120,000. I calculate that after deducting the cost of my mistakes " the various parishes that I have to do with have been saved at least £10,000 by
must take ezoeption to his statement that effervescent baths can be equally well applied at home. The natural waters containing bicarbonate of iron, calcium and sodium chlorides, &.c., are capable of -holding a much larger proportion of carbonic acid gas than those artificial waters where the 002’has been dissolved by pressure, as in the natural waters the gas has been under pressure for some considerable time. This can :be proved by the fact that a bottle of soda water when opened soon loses its CO2 under normal atmospheric pressure alone and if heat be subsequently applied very little more gas can be driven off. On the contrary, if a natural gaseous water be exposed to the air the greater proportion of CO, can only be driven off by the, . aid of heat. I have lately returned from a visit ’to Spa, Belgium, where there exists an ideal supply of effervescent ferruginous water which is brought to the bath house by a conduit and supplied directly to the various baths and when heated by means of steam the quantity of CO, driven off is Whilst at Spa I was shown over the establishenormous. ment and purposely picked out indiscriminately four different baths and found the effects identical in all. Dr. Williams mentions Nauheim as the pioneer with its long 24 hours’ journey, truly an undertaking not lightly to be considered by a cardiopath, Royat, Contrexéville, and many others equally far distant, but he has altogether omitted any mention of the town of Spa itself in Belgium, only 11 hours from London and reached by a very comfortable route where the treatment is receiving the greatest attention in a most luxurious establishment fitted with all the latest appliances. The climate, unlike Nauheim, is perfection, with bracing air, and the town, facing south, is particularly well sheltered by surrounding hills where delightful scenery abounds; and lastly, the mental comfort of the patient is catered for by excellent arrangements of concerts, race meetings, and a hundred other amusements.
arguments I
T am Sirs
I
Stony Stratford, August
8th, 1905.
vours J ---
fn.ithfn1Iv P. LAKE HOPE.
A POSSIBLE CAUSE OF CHLOROFORM FATALITIES. To the Editors of THE LANCET.
SIRS,—Some time since, when seeking for tests whereby organo-therapeutic substances might be recognised, I found that some of them had an extraordinary power of decomposing chloroform when in solution, chlorine gas becoming rapidly evolved. In the recently published report of Merck Trillat ascribes a similar property to many organic substances, and it is suggested that as the dangerous body phosgene is formed by the contact of chloroform with the
human skin it may also arise from contact with the mucous membranes in certain conditions. It seems probable then that in such circumstances the mucous membrane of the respiratory tract may have the power of decomposing chloroform, and where chlorine gas is liberated a fatal result is not to be wondered at. I am, Sirs, yours faithfully.
J. C. MCWALTER, August 12th, 1905.
F.F.P.&S. Glasg., M.D. Brux.
MIDGES.
To the Editors of THE LANCET. this SIRS,—At holiday season I should be grateful if you ’ would allow me some space in your columns to elicit the opinions of your readers about midges and their bites. These small pests seem to be particularly active this year and their " bites certainly give rise to an immense amount of oedema and irritation. I have seen people, both men and women, Your humble servant with swellings on their ankles, wrists, and neck just above the collar, varying in size from a hazel-nut to a walnut. CONSTABLE. Endymion-road, N., August Has the nature of the poison injected by these insects ever been worked out? Is there anything which will keep them THE SPA TREATMENT OF CIRCULATORY away short of a thick coating of grease, which is impossible in this land ? And can anything be done to lessen the DISORDERS. irritation, which in my own case lasts for about a week? I 10 the Editors of THE LANCET. might add that I myself am not particularly susceptible to SIRS,—I have read with great pleasure the long and able insect bites. Although I have travelled a good deal in the article by Dr. Leonard Williams on the Spa Treatment of East, mosquitoes, bugs, and lice never gave me any trouble. I am, Sirs, yours faithfully, Circulatory Disorders in THE LANCET of August 5th, p. 347, and whilst agreeing with him in the main points of his M.D. August 15th, 1905.
15th, 1905. SAML.
complaints we receive from patients whom we regarding the sanitation of the locality. My patients complain of the absolute indifference on the part of the authorities to their complaints about the drainage. One cannot understand why the authorities should be so blind to their own interests as not to take most vigorous precautions to make the sanitary arrangements, especially the drainage, as perfect as possible. I have received quite recently a number of letters from patients whom I have " Audi alteram partem." hitherto sent to St. Moritz inquiring about other winter quarters, basing their objections to return to St. Moritz upon INEBRIETY A DISEASE AND THEREFORE the faulty drainage and consequent bad smells which they allege to be the cause of the sore-throats so often seen there. TO BE TREATED BY THE MEDICAL It will be much to the advantage of St. Moritz if the local PROFESSION. authorities during this autumn will make a thorough investiTo the Editors of THE LANCET. gation and place the whole sanitary arrangements in such a condition as to be above suspicion. After this has been is now becoming generally recognised that SIRS,—It chronic inebriety is a disease but the majority of medical done a report should be sent to the medical press in order to prevent the unfavourable impressions now rapidly spreadmen have never taken its treatment seriously in hand. There are two reasons for this. First, the belief that the victim of ing regarding this famous health resort. I am. Sirs. vours faithfullv. the drink crave must be removed from his home and placed constant
send there
Correspondence.
I
in some retreat or sanatorium in order that the treatment may be successfully carried out and, second, because the drugs used and the methods of treatment adopted in these highly advertised institutions have been kept secret. Both these objections have now been removed. The methods of treatment have been published by Dr. C. A. McBride and Mr. S. Blackwell Fenn and my own results prove that the treatment can be carried out by the ordinary medical attendant without removing the patient from The hypodermic injection of atropine his own home. has undoubtedly a restraining effect upon the craving for alcohol and if with this is administered strychnine a powerful tonic effect is produced which will soon remove the terrible morning depression from which drinkers suffer. In addition to this all that is needed is a suitable diet and a medicine by the mouth to correct any disturbance which is hindering the return to health, such as calomel for the liver, bromide and chloral for sleeplessness, or cinchona and cap-icum as a pick-me up. And, indeed, these will only be required for the first few days. My cases have been treated as out-patients, coming to my house twice a day to receive the injections. There is in this more If a patient will come than one obvious advantage. of his own free will to a medical man’s house for treatment it shows that he has a real de"ire to be cured. And, again, if he gives up his drinking habits while in the midst of temptation he is likely to keep straight, avoiding as he does the risk which arises when, after treatment in a sanatorium, tne pauent recurns to tne scene or nis iormer
Of course, no treatment will insure that the man will fall again. Neither is it possible to change the
never
drunkard into a moderate drinker. If, after being an abstainer for a time, he argues thus with himself, "Now I have lost the craving for alcohol I am like other men and can take a little with safety "-if he acts upon this assumption he will soon find, to his cost, that the old craving will return. His only safety lies in being a total abstainer. Another advantage of this out-patient system of treatment is that it can be applied to the poor as well as to the rich and, again, being carried out by the family medical man, the patient is not a marked man and stigmatised as one who has been in an inebriate home. Some of my patients have been treated under most unfavourable conditions but even when living in a common lodging-house with its usual surroundings of drink and squalor the craving has gone and the patient has risen above his environment. I should like to see medical practitioners generally taking up the treatment of this disease. I am sure much good would result. Many an inebriate would be cured and many a man would be saved from falling a victim to the disease. For medical men coming into more immediate contact with the results of excess would become exceedingly cautious in prescribing alcohol and would carefully safeguard their patients lest a temporary use should lead to a fixed habit. I am
.Cire
yoursfaithfully faithfully,
vnnre
......" J
Nottingham, August 10th, 1905.
J.
S. BOLTON, M.D. Edin.
SANITATION AT ST. MORITZ. To the Editors of THE LANCET. a great kindness on your part if you will allow me through your columns to draw the attention of the local authorities of St. Moritz, Upper Engadine, to the
1905.
T. W. PARKINSON.
HIGH-FREQUENCY CURRENTS FOR INSOMNIA. To the Editors of THE LANCET. treatment of sleeplessness and pain has lately SIRS,—The been a subject for discussion. I would like to draw the attention of fellow practitioners to the value of the highfrequency currents as an agent for the cure of sleeplessness and the relief of pain. I have now had several years’ experience of this form of treatment and am fully convinced of its value. It may be that the high-frequency currents, like other therapeutic departures, have suffered from too enthusiastic testimonies of injudicious friends, but this should not blind us to their true value. I have endeavoured to observe their effects with an impartial mind and have no doubt of their real usefulness in certain conditions. It is an undoubted fact that they do produce an effect on the functions of the nervous system, though it may not be possible to say exactly how this effect is brought about. Quite a common experience is that patients under the influence of the high-frequency currents find them.,elves relieved of sleeplessness. Electricity in this form will not, of course, meet a more or less sudden emergency where sleep is absent in consequence of acute pain or severe mental distress. In such circumstances one or other of the
powerful hypnotic drugs there is
temptation.
SIRS,-It will be
Sloane-street, S.W., August 8th,
habit of
can
hardly
be avoided.
But when
insomnia the value of the highfrequency currents is considerable. After a series of applications varying in different cases from 15 to 40, patients almost invariably acquire the habit of sound sleep. There are also other advantages-that the sleep is natural and refreshing and is not followed by any of the ill-effects attached to the use of narcotic drugs. To obtain the best results I find it essential to utilise a large output of electricity, ranging from 400 to 800 milliamperes in men and from 250 to 700 milliamperes in women. Used under these conditions I venture to say that the high-frequency currents will rarely be employed in vain in cases of insomnia due to mental worry and other allied conditions. With regard to the use of the high-frequency currents in the relief of pain-here again they can hardly compete with morphine in the promptness with which it overcomes pain due to acute inflammation. Nor are they generally capable of allaying the acute pain of organic disease. But in the treatment of various neuralgias their value is considerable. In neuralgia of the face and forehead and in intercostal, brachial, ;;nd sciatic neuralgias I have repeatedly proved their efficacy. The same is true of lumbago and of muscular rheumatism in various parts of the body. In reference to sciatica, it is necessary to remember that when the condition depends upon peri-neuritic adhesions the high-frequency currents render little or no help. It is because this is not invariably recognised that disappointment has sometimes resulted. But with a true neuritis or with a pure neuralgia the highfrequency currents may ’ue confidently counted upon after a few applications to produce permanently beneficial results. In all these instances the method of treatment has the advantage of being grateful and not disagreeable to the patient and in addition it may be stated that the highfrequency currents form one of the best nervine tonics, and therefore while they cure insomnia and relieve pain they a
persistent
554 also at the same time greatly improve the general nervous condition of the patient. I have never had experience of any unpleasant or injurious effects resulting from the careful application of the high-frequency currents. It may be advisable here to remark that the treatment by high frequency currents should be intrusted to qualified medical practitioners only and that it is unwise and irregular for members of our profession in practice to send their patients for any form of electrical treatment to the various unrecognised electrical institutes which are advertised in the I am. Sirs. yours faithfullv. lav Dress. August 14th, 1905. W. F. SOMERVILLE, M.D. Glasg.
Glasgow,
SECONDARY FACTORS IN THE MORTALITY AND TRANSMISSIBILITY OF PULMONARY TUBERCULOSIS. To the Editors of THE LANCET. SIRS,—With regard to my preliminary note on Secondary Factors in the Mortality of Pulmonary Tuberculosis, of which you have kindly published a summary in your issue of July 8th, p 98, I beg to point out that in my last letter I must have left out the words
"
" after " pure culture and "healthy " before "pulmonary tissues"" in the wording of the aphorism which you have quoted and which should read : " That the tubercle bacillus in pure culture, per se, is incapable of developing in the healthy pulmonary tissues either the anatomical lesions or the clinical symptoms of confirmed pulmonary tuberculosis." I am. Sirs. vours faithfully. CARLOS J. FINLAY. Havana, July 21st, 1905.
"per
se
MISTAKES IN THE DIAGNOSIS OF INFECTIOUS DISEASES. To the Editors of THE LANCET. SIRS,-A few years before the lat small-pox epidemic I was called to see a man in South Hornsey, North London, suffering from ordinary febrile symptoma, plus a rash, just beginning to appear. The man had been working in St. John’s Wood. I diagnosed variola as probable and without waiting for any further development I had the man removed and isolated. The case turned out to be virulent small-pox and owing to my promptness the disease never spread to even a member of the family and was stamped out there and then. I risked the I’ mi,,take"and saved the ratepayers a large sum of money. For many years where children are swarming in any house and one is down with some supposed infectious disease, to save lives and to save the ratepayers, it has been my custom to have the patient removed within afeiv kO’1W8 after examination. I risk the" mistake," and if I am wrong in my opinion once in 15 times-about the average for each of us medical men-the saving to the community after deducting the cost of " mistakes ’’ must be enormous. Yesterday I was called to see a child, aged five years. Apparently typical scarlet fever. House full of children. Mother informs me, when I tell her I shall have her child removed in a few hours, that the boy has only just come home four days from the fever hospital convalescent from scarlet fever! I nevertheless act with my usual promptness and I risk the " erroragain to save both lives and the pockets of the already over-burdened ratepayers. In a few hours the child was once again back in his old hospital. If medical men, through these grossly unjust remarks about their mistakes, will stand, in future, on their rights and wait till the disease is fully developed and infection has spread, instead of a los to the ratepayers of ,c12,OOO the reckoning will be nearer £120,000. I calculate that after deducting the cost of my mistakes " the various parishes that I have to do with have been saved at least £10,000 by
must take ezoeption to his statement that effervescent baths can be equally well applied at home. The natural waters containing bicarbonate of iron, calcium and sodium chlorides, &.c., are capable of -holding a much larger proportion of carbonic acid gas than those artificial waters where the 002’has been dissolved by pressure, as in the natural waters the gas has been under pressure for some considerable time. This can :be proved by the fact that a bottle of soda water when opened soon loses its CO2 under normal atmospheric pressure alone and if heat be subsequently applied very little more gas can be driven off. On the contrary, if a natural gaseous water be exposed to the air the greater proportion of CO, can only be driven off by the, . aid of heat. I have lately returned from a visit ’to Spa, Belgium, where there exists an ideal supply of effervescent ferruginous water which is brought to the bath house by a conduit and supplied directly to the various baths and when heated by means of steam the quantity of CO, driven off is Whilst at Spa I was shown over the establishenormous. ment and purposely picked out indiscriminately four different baths and found the effects identical in all. Dr. Williams mentions Nauheim as the pioneer with its long 24 hours’ journey, truly an undertaking not lightly to be considered by a cardiopath, Royat, Contrexéville, and many others equally far distant, but he has altogether omitted any mention of the town of Spa itself in Belgium, only 11 hours from London and reached by a very comfortable route where the treatment is receiving the greatest attention in a most luxurious establishment fitted with all the latest appliances. The climate, unlike Nauheim, is perfection, with bracing air, and the town, facing south, is particularly well sheltered by surrounding hills where delightful scenery abounds; and lastly, the mental comfort of the patient is catered for by excellent arrangements of concerts, race meetings, and a hundred other amusements.
arguments I
T am Sirs
I
Stony Stratford, August
8th, 1905.
vours J ---
fn.ithfn1Iv P. LAKE HOPE.
A POSSIBLE CAUSE OF CHLOROFORM FATALITIES. To the Editors of THE LANCET.
SIRS,—Some time since, when seeking for tests whereby organo-therapeutic substances might be recognised, I found that some of them had an extraordinary power of decomposing chloroform when in solution, chlorine gas becoming rapidly evolved. In the recently published report of Merck Trillat ascribes a similar property to many organic substances, and it is suggested that as the dangerous body phosgene is formed by the contact of chloroform with the
human skin it may also arise from contact with the mucous membranes in certain conditions. It seems probable then that in such circumstances the mucous membrane of the respiratory tract may have the power of decomposing chloroform, and where chlorine gas is liberated a fatal result is not to be wondered at. I am, Sirs, yours faithfully.
J. C. MCWALTER, August 12th, 1905.
F.F.P.&S. Glasg., M.D. Brux.
MIDGES.
To the Editors of THE LANCET. this SIRS,—At holiday season I should be grateful if you ’ would allow me some space in your columns to elicit the opinions of your readers about midges and their bites. These small pests seem to be particularly active this year and their " bites certainly give rise to an immense amount of oedema and irritation. I have seen people, both men and women, Your humble servant with swellings on their ankles, wrists, and neck just above the collar, varying in size from a hazel-nut to a walnut. CONSTABLE. Endymion-road, N., August Has the nature of the poison injected by these insects ever been worked out? Is there anything which will keep them THE SPA TREATMENT OF CIRCULATORY away short of a thick coating of grease, which is impossible in this land ? And can anything be done to lessen the DISORDERS. irritation, which in my own case lasts for about a week? I 10 the Editors of THE LANCET. might add that I myself am not particularly susceptible to SIRS,—I have read with great pleasure the long and able insect bites. Although I have travelled a good deal in the article by Dr. Leonard Williams on the Spa Treatment of East, mosquitoes, bugs, and lice never gave me any trouble. I am, Sirs, yours faithfully, Circulatory Disorders in THE LANCET of August 5th, p. 347, and whilst agreeing with him in the main points of his M.D. August 15th, 1905.
15th, 1905. SAML.