HYPERTHYROIDISM AS A CAUSE OF IRRITABLE HEART IN SOLDIERS.

153 and 2’2 in Bristol. The deaths of infants (under 2 years) from diarrhoea and enteritis, which had been 68, 68, and 80 in the three preceding weeks, fell to 73, and included 14 in London and 6 each in Birmingham and Manchester. The fatal oases of diphtheria, which had been 65, 61, and 79 in the three preceding weeks, declined to 61, of which 17 occurred in London and 3 each in Hastings, Stoke-onTrent, Birmingham, and Liverpool. The deaths attributed to whooping-cough, which had been 60, 69, and 60 in the three precedmg weeks, further fell to 57 ; 12 deaths were recorded

and Shemeid, and 3 each in Liverpool and Manchester. The deaths referred to scarlet fever, which had been 19, 28, and 22 in the three preceding weeks, rose to 30, of which 6 were registered in London, 3 each in Liverpool and St. Helens, and 2 in Birmingham. The fatal cases of enteric fever, which had been 11, 9, and 14 in the three preceding weeks, fell to 10, but showed no excess in any particular town. The number of scarlet fever patients under treatment in the Metropolitan Asylums Hospitals and the London Fever Hospital, which had been 2582, 2462, and 2464 at the end of the three preceding weeks, fell to 2325 on Saturday last ; 225 new cases were admitted during the week, against 245, 206, and 254 in the three preceding weeks. These hospitals also contained on Saturday last 1483 cases of diphtheria, 60 of enteric fever, 28 of measles, and 12 of whoopmgcough, but not one of small-pox. The 1156 deaths from all causes in London were 347 fewer than in the previous week, and corresponded to an annual deathrate of 13’3 per 1000. The deaths referred to diseases of the respiratory system, which had been 357, 329, and 3t6 in the three preceding weeks, declined to 246 in the week under notice, and were 251 below the number registered in the corresponding week of last year. Of the 4990 deaths from all causes in the 96 towns, 224 resulted from different forms of violence and 456 were the subject of coroners’ inquests, while 1386 occurred in public institutions. The causes of 44, or 0’9 per cent., of the total deaths were not certified either by a registered medical practitioner or by a coroner after inquest. All the causes of death were duly certified in Manchester, Sheffield, Leeds, Bristol, West Ham, Bradford, and in 69 other smaller towns. Of the 44 uncertified causes of death, 9 were registered in Liverpool, 7 in Birmingham, 3 in London, and 2 each in West in

London, 6

each

in

Correspondence. "Audi alterain

partem."

SPECIFIC SEROLOGICAL REACTIONS.

Birmingham

To the Editor of THE LANCET.

SiR,-I read with keen interest the account of Dr. H. Warren Crowe’s investigations concerning meningococci, detailed in THE LANCET of Nov. 20th, 1915, more particularly that portion dealing with the identification of this organism, by means of an agglutination test, consisting practically of the, observation of phagocytic mixtures, spread on films according to the technique evolved by Sir Almroth Wright. In all essentials this was the method adopted by me for the biological classification of pneumococciin 1913. The purpose of this short note is to point out, two facts brought to light by further experience:> 1. In some instances a fairly thick emulsion of cocci as ordinarily used afforded no agglutination with the homologous serum of an immunised animal, whereas the same emulsion diluted 1 in 3. with normal saline gave a complete picture of agglutination. 2. In certain other instances no agglutination appeared when one volume each of serum, corpuscles, and emulsion were used, but if two, three, or four volumes of serum replaced the one volume agglutination was complete, whereas. the same alteration applied to the control serum on

occasion produced agglutination. Although these facts relate to pneumococci, there is some likelihood of their being applicable to meningococci. By of these facts I have been able to taking advantage HEALTH OF SCOTCH TOWNS. place in their correct class some pneumococci that. In the 16 largest Scotch towns with an aggregate popula- would otherwise have escaped recognition, and by tion estimated at 2,355,300 persons at the middle of this year, so doing have given rise to apparently anomalous. 1193 births and 719 deaths were registered during the week ended Saturday, Jan. 8th. The annual rate of mortality results. in these towns, which had been 197, 17-0, and 17’4 per 1000 In so far as pneumococci are concerned, subin the three preceding weeks, fell to 15per 1000 in the work on the same lines (in the course of sequent week. under notice. During the 13 weeks of last quarter the mean annual death-rate in these towns averaged which I have examined several thousands of spread 17’9, against a corresponding rate of 15’5 per 1000 in the films, prepared for this purpose alone) has in all large Enghsh towns. The death-rate during the week respects confirmed my original findings. ranged from 10-7 in Hamilton, 12-6 in C137debaiik, and 14’0 in I am, Sir, yours faithfully, Kilmarnock, to 19-0 in Aberdeen, 22-9 in Coatbridge, and 25’5 in Greenock. Florida, Transvaal, South Africa, Dec. 14th, 1915. F. S. LISTER. no

Bromwich, Dudley, Southport, Blackburn, Preston, Barrowin-Furness, and South Shields.

The 719-deaths from all causes were 63 fewer than the number in the previous week, and included 72 which were referred to the principal epidemic diseases, against 50 and 74 in the two preceding weeks. Of these 72 deaths, 19 resulted from diphtheria, 18 from scarlet fever, 17 from measles, 10 from infantile diarrhceal diseases, 6 from whooping-cough, and 2 from enteric fever, but not one from small-pox. The mean annual death-rate from these diseases was equal to 16, agamst 0-9 per 1000 in the large English towns. The deaths attributed to diphtheria, which had been 14, 8, and 11 in the three preceding weeks, further rose to 19, and included 4 each in Glasgow, Edinburgh, and Aberdeen, and 3 each in Dundee and Paisley. The deaths referred to scarlet fever, which had been 11, 12, and 21 in the three preceding weeks, fell to 18, of whijh 6 were recorded in Edinburgh, 5 in Glasgow, and 2 in Aberdeen. The fatal cases of measles, which had been 24, 16, and 26 in the three preceding weeks, fellto 17, and included 6 in Greenock, 4 in Glasgow, 3 in Edinburgh, and 2 in Coatbridge. The deaths of infants (under 2 years) from diarrhoea and enteritis, which had been 8, 11, and 11 in the three preceding weeks, were 10 last week, and included 3 each in Glasgow and Aberdeen. The 6 deaths attributed to whooping-cough, of which 3 occurred in Aberdeen, were 3 in excess of the weekly average recorded last quarter. The fatal cases of enteric fever were registered in Glasgow and Ayr. The deaths referred to diseases of the respiratory system, which had declined from 322 to 155 in the six preceding weeks, 1u,ther fell to 139 in the week under notice, and were 126 below the number registered in the corresponding week of last year. The deaths from violence numbered 42, against 28 and 32 in the two preceding weeks.

HYPERTHYROIDISM AS A CAUSE OF IRRITABLE HEART IN SOLDIERS. To the Editor of THE LANCET.

SIR,-I have read with much interest the noteupon the above subject by Dr. Percival White and Dr. F. Hernaman-Johnson in THE LANCET of Jan. 8th. There is no mention in their paper of the extent of the area of cardiac dullness nor of the state of the blood pressure in their cases. I have had under my care several cases of irritable irregular hearts. due to anxiety and over-strain in of6.cers, and I have in most cases found that there was some increase in the area of cardiac dullness, especially towards the right side, and some rise of blood pressure. The irregularity of the cardiac beat has always been due to one of two causes, either auricular or ventricular premature contraction. In the cases that have come before my notice I have not found any enlargement of the thyroid gland although I have looked for it in each case; it. 1 Specific Serological Reactions with Pneumococci from Different. Sources, South African Institute for Medical Research, Dec. 22nd, 1913.

154

is, therefore, evident that this gland is not always at fault in cases of irritable heart in soldiers. In the cases I have seen the symptoms have been due to a weakened, dilated myocardium, a raised blood pressure, and a general nervous debility. I have found that the administration of bromide of potassium and digitalis, combined with a quiet life, a little daily exercise, regular hours, and a course of Nauheim baths, is the best treatment. The heart is soon quietened down to a normal rate, the blood pressure falls, the area of cardiac dullness is reduced to normal, and the cardiac irregularity is the last symptom to disappear, though this may continue for a considerable In some cases compound lymphoid capsules time. I find these cases are very helpful as a tonic. do not do well if kept in bed for more than a few days at the commencement of the treatment, and there is no doubt that moderate exercise is helpful. In all the cases I have seen there has been some " previous history that points to heart strain " or a 44 weak heart" in earlier days, and I am inclined to believe that this condition is extremely uncommon in men who have sound hearts to begin with. The object of this letter is to draw attention to the importance of the estimation of the cardiac dullness and blood pressure in these cases. I am, Sir, yours faithfully, LESLIE THORNE THORNE. Harley-street, W., Jan. 8th, 1916. FUNCTIONAL NERVOUS DISEASE. To the Editor of THE LANCET.

SIR,-In Dr. D. Forsyth’s address on this subject, published in THE LANCET on Dec. 25th, 1915, occurs the following passage : "The neurasthenia of civil practice-i.e., the nervous exhaustion characterised by lassitude and emotional depression, sensations of spinal irritation, pressure on the head, is known to be the flatulence, dyspepsia, &c.-which specific result of excessive onanism." The passage I have italicised is quite unjustifiable, and is a cruel calumny upon a class of very unfortunate What sensations of spinal irritation persons. I do not know, but the other symptoms be may enumerated are, with the exception of lassitude, not characteristic of neurasthenia, though, of course,they may accompany neurasthenia, as they may accompany any other disease. It happens, Sir, that you have in your hands, awaiting publication, a paper of mine referring to the fact that

the causation of nervous disease by onanism was exploded at least a quarter of a century ago. It is as destitute of proof as any of the doctrines of astrology, phrenology, or humoral pathology. It is never safe to assume that a doctrine, however completely discredited, has no adherents. When I gave, two years ago, my lectures on astrology in medicine, I assumed that astrology was utterly extinct and had no living adherents; but I was astonished to find that it still survives in a little coterie of persons who cultivate the mummeries of triplicities, houses of heaven, horoscopes, and the rest of the nonsense. I ought not therefore to be surprised to find that the onanistic origin of disease is still believed in, even by a doctor of medicine and of science in the University of London and a Fellow of the College of Physicians. Was not Peter Woulfe, F.R.C.P., a convinced astrologer as late as the early years of the last century ? He was a hundred years behind his age, and Dr. Forsyth is belated by only a quarter or a third of that time. That onanism may be discovered among the antecedents of some cases of neurasthenia I am not

concerned to deny. It may be discovered among the antecedents of some cases of every disease in the male, and it may be discovered among the antecedents of many cases of robust health also; but in many cases of neurasthenia there is no such antecedent, and when it can be found as an antecedent there is no reason to suppose that it is a cause. Such a belief is on a par with the belief of gardeners that canker in fruit-trees is due to sourThere is no evidence that the ness in the subsoil. subsoil is sour, or, if it were, that the sourness could produce canker. There is another passage that calls for comment in Dr. Forsyth’s address. " One patient who had broken down under shell-fire proved on analysis to be a case of unconscious homosexuality with marked anal eroticism." Unconscious pain, unconscious homosexuality, unconscious CEdipus complex, and other unconscious states of consciousness of the psycho-analysts, meaningless self-contradictions as they are, were a great puzzle to me until I learnt from one of their victims what these expressions mean. This poor man had suffered many things for many months from many psycho-analysts, until at last he turned upon his tormentors, so he informed me, with these words: "It is true," said he, " that I now have these filthy thoughts, but it is you that have put them into my mind." This, I take it, is what the psycho-analysts mean when they say, "it was proved to be a case of unconscious homosexuality," or unconscious CEdipus complex, or what not. They mean a filthy thought which the patient will not own to. He will not own to it because he does not possess it until it is instilled into his mind by the insidious suggestions of the psycho-analyst. I know that CEdipus complex. It comes from Vienna. I have met with it myself-in patients who have been subjected to psycho-analysis. A short time ago I was consulted by a patient, a feeble creature, suffering from mild neurasthenic depression, which cleared up in a month. He had been psycho-analysed for nine months, and the only alteration the treatment had effected was to make him believe that he, a man of 50, cherished an incestuous passion for his father, a man of more than 80 years of age1 I found it much more easy to persuade him that his supposed passion was all tommy-rot than his previous advisers had found it to persuade him it was genuine. After a couple of short interviews it disappeared, whereas to instil it had taken many months of assiduous suggestion, poured into his mind for several hours three or four days a week by the combined efforts of several accomplished psycho-anal-ists. I am,

Sir, yours faithfully, CHAS. A. MERCIER.

Jan. lst, 1916.

MIDWIVES’ GRIEVANCES. To the Editor of THE LANCET. -

SiR,-As medical officer of health of a metropolitan borough council, I read the letter of your Fair Play" with regard to the correspondent above subject in THE LANCET of Jan. lst, with "

interest. Your annotation on the of Midwives in the of the Practice Supervision same issue also interested me. In both efforts the portions relating to the exercise of control I have over lying-in homes appealed to me most. heard some talk of the advantages that might accrue to expectant mothers if they were seen from time to time during the period of expectancy by someone working under the medical officer of considerable