- Email: [email protected]
HYSTERICAL DISORDERS IN CHILDREN.
366 in many otherwise intractable cases of nerve deafnessI and otosclerosis, as I explained in my paper of May 9th. I am treating a patient at present aged 54, who has suffered from chronic otitis media for 25 years and has been given up as hopeless after having tried every kind of treatment at home and abroad including the massage treatment aforesaid. When he came to me he could hear at a distance of 3 ft. on the left side and 1 ft. on the right. After 12 treatments he can hear at a distance of 15 ft. on the left side and 5 ft. on the right ; he says also that there is no comparison between the pleasantness of the two methods of I am, Sir, yours faithfully, treatment. GEORGE C. CATHCART. Upper Wimpole-street, W., Feb. 8th, 1926.
MANIPULATIVE
CHOLERA IN RUSSIA: A SATISFACTORY POSITION. To the Editor of THE LANCET. SiR,-We are informed that there has been a statement in one of the British newspapers to the effect that cases of Asiatic cholera were registered in the U.S.S.R. in 1926. According to the official information received by me to-day from the Commissariat of Public Health, the latest two cholera cases were registered in Soviet Russia in July, 1925. Not one case has been registered in the Union in 1926. I am, Sir, yours faithfully, V. N. POLOVTSEV, Representative of the Commissariat of Public Health and the Russian Red Cross, U.S.S.R. Southampton-row, W.C., Feb. 5th, 1926.
SURGERY.
To the Editor of THE LANCET. SIR,-The article by the Registrar of the General Medical Council is very interesting to those who may not have studied the Medical Acts, but I am afraid it only intensifies the feeling which exists in the minds of many medical as well as laymen that, in the case of Dr. Axham, the Council was acting outside the legal powers conferred by those Acts. From the beginning to the end of the Act it is clear it was intended to protect the public from the action of a qualified medical man passing off an unqualified one as if he were a qualified substitute. In the case of Dr. Axham he was not a principal, and his work as an anaesthetist was distinct from the manipulative part which was performed by a well-known bonesetter, and there was no attempt to mislead the patient into believing Mr. Barker (as he then was) to be a qualified medical man. From the first paragraph of the Act it is obvious that the continued existence of unqualified practitioners was contemplated. At the time when Sir Herbert Barker, following on the late Mr. Hutton, " bonebegan the practice of his work, known as " setting," but now dignified with the title of manipulative surgery," the correct and in fact only treatment taught students for dealing with sprains was an application of plaster-of-Paris bandages, and in my own early days in the Army Medical Service each invaliding day found us discharging men from the army with stiff joints as the result of the then orthodox treatment by plaster-of-Paris cases. As the profession certainly does owe its present and more rational method of treating sprains to the efforts of the oldtime bone-setter, would it not be more dignified if we admitted our indebtedness ? We might, in the future, advise the public as widely as it can possibly be done (by those who do not themselves practise this form of treatment so as to avoid the risks which would attend such advertising by those who do) that there is no longer any necessity to run risks of unqualified practitioners. New entrants into the field of bone-setting must go through a long training and period of experience (not by any means devoid of risk to the patients) before they arrive at real skill. I am, Sir, yours faithfully, BRUCE BRUCE-PORTER. Grosvenor-street, W., Feb. 8th, 1926. v
z-
CHARING CROSS HOSPITAL INSTITUTE PATHOLOGY.
OF
To the Editor of THE LANCRT. am still of opinion, in spite of the rather SiR,-I irrelevant considerations which have weighed with Dr. Piney, that it is undesirable for institutions which subsidised for other purposes to compete with are ordinary businesses in this way. May we expect, on i the same principle, the establishment of laundry services at cut rates by the Maida Vale and Charing Cross Hospitals ? The benefit to the public health, in their respective districts, would, in my opinion, be greater than will accrue from the pathological service I am, Sir, yours faithfully, offered. I J. A. MURRAY. Queen-square, W.C., Feb. 6th, 1926.
HYSTERICAL DISORDERS IN CHILDREN. To the Editor of THE LANCET. SiR,—Dr. Wyllie, in his paper on Hysteria in Children, refers in his remarks on sympathetic vasomotor instability to the absence of bleeding on pin-prick which may be associated with the coldness and cyanosis of a hysterically palsied limb. It happens often, but not always, that we may thread a sharp pin, without the loss of a drop of blood, through the skin of a part which as a result of hysteria is anaesthetic It also often happens that the or palsied or both. anaesthetic skin of organic disease—e.g., tabes dorsalis-may similarly be bloodlessly transfixed, the risk of anaesthesia by suggestion being guarded against. Bloodless transfixion of the skin has come to be associated with hysterical conditions, but it has seemed to me that when it can be performed in an area of skin which is analgesic it depends on the loss of cutaneous sensibility rather than on any special condition which is giving rise to the analgesia. I am, Sir, yours faithfully. Harley-street, W., Feb. 8th, 1926. HILDRED CARLILL.
INTRA-URETHRAL NEGATIVE PRESSURE DURING COITUS. To the Editor
of THE LANCET.
SIR,-In a footnote to a letter of mine with this title which appeared in your issue of Jan. 23rd you state that " we need more material on which to base opinions as to the value of prophylaxis." A mass of most convincing evidence as to the value of prophylaxis was laid before the Trevethin Committee by medical witnesses who had practical first-hand experience of its use on a large scale, while criticism of the value of prophylaxis was based on theory and confined to medical witnesses who honestly stated that they had no personal experience to record. Twenty-five authoritative medical witnesses endorsed the value of prophylaxis, based on practical experience in England, Scotland, Egypt, Mesopotamia, Russia, and in the navy. You, Sir, are doubtless aware that the Conference of the United States Public Health Services and State Venereal Disease Control Officers, held at Hot Springs, Arkansas, in December, 1924, passed a resolution to the effect that " Measures of immediate disinfection to those exposed to these diseases have been proved to be scientific and
practicable." I venture, therefore, to
think that it is not so much material on which to base opinions " that is required as a wider publicity of the material that we "
more
already
possess. I am,
Sir,
yours
faithfully, H. WANSEY BAYLY.
Harley-street, W., Feb. 4th, 1926.
WREXHAM HOSPITAL.-A
new
hospital,
of which
the cost, including site and furnishings, amounts to 2100,000, is now approaching completion at Wrexham. Several thousand pounds have been subscribed by miners and workpeople in weekly payments.
MANIPULATIVE
CHOLERA IN RUSSIA: A SATISFACTORY POSITION. To the Editor of THE LANCET. SiR,-We are informed that there has been a statement in one of the British newspapers to the effect that cases of Asiatic cholera were registered in the U.S.S.R. in 1926. According to the official information received by me to-day from the Commissariat of Public Health, the latest two cholera cases were registered in Soviet Russia in July, 1925. Not one case has been registered in the Union in 1926. I am, Sir, yours faithfully, V. N. POLOVTSEV, Representative of the Commissariat of Public Health and the Russian Red Cross, U.S.S.R. Southampton-row, W.C., Feb. 5th, 1926.
SURGERY.
To the Editor of THE LANCET. SIR,-The article by the Registrar of the General Medical Council is very interesting to those who may not have studied the Medical Acts, but I am afraid it only intensifies the feeling which exists in the minds of many medical as well as laymen that, in the case of Dr. Axham, the Council was acting outside the legal powers conferred by those Acts. From the beginning to the end of the Act it is clear it was intended to protect the public from the action of a qualified medical man passing off an unqualified one as if he were a qualified substitute. In the case of Dr. Axham he was not a principal, and his work as an anaesthetist was distinct from the manipulative part which was performed by a well-known bonesetter, and there was no attempt to mislead the patient into believing Mr. Barker (as he then was) to be a qualified medical man. From the first paragraph of the Act it is obvious that the continued existence of unqualified practitioners was contemplated. At the time when Sir Herbert Barker, following on the late Mr. Hutton, " bonebegan the practice of his work, known as " setting," but now dignified with the title of manipulative surgery," the correct and in fact only treatment taught students for dealing with sprains was an application of plaster-of-Paris bandages, and in my own early days in the Army Medical Service each invaliding day found us discharging men from the army with stiff joints as the result of the then orthodox treatment by plaster-of-Paris cases. As the profession certainly does owe its present and more rational method of treating sprains to the efforts of the oldtime bone-setter, would it not be more dignified if we admitted our indebtedness ? We might, in the future, advise the public as widely as it can possibly be done (by those who do not themselves practise this form of treatment so as to avoid the risks which would attend such advertising by those who do) that there is no longer any necessity to run risks of unqualified practitioners. New entrants into the field of bone-setting must go through a long training and period of experience (not by any means devoid of risk to the patients) before they arrive at real skill. I am, Sir, yours faithfully, BRUCE BRUCE-PORTER. Grosvenor-street, W., Feb. 8th, 1926. v
z-
CHARING CROSS HOSPITAL INSTITUTE PATHOLOGY.
OF
To the Editor of THE LANCRT. am still of opinion, in spite of the rather SiR,-I irrelevant considerations which have weighed with Dr. Piney, that it is undesirable for institutions which subsidised for other purposes to compete with are ordinary businesses in this way. May we expect, on i the same principle, the establishment of laundry services at cut rates by the Maida Vale and Charing Cross Hospitals ? The benefit to the public health, in their respective districts, would, in my opinion, be greater than will accrue from the pathological service I am, Sir, yours faithfully, offered. I J. A. MURRAY. Queen-square, W.C., Feb. 6th, 1926.
HYSTERICAL DISORDERS IN CHILDREN. To the Editor of THE LANCET. SiR,—Dr. Wyllie, in his paper on Hysteria in Children, refers in his remarks on sympathetic vasomotor instability to the absence of bleeding on pin-prick which may be associated with the coldness and cyanosis of a hysterically palsied limb. It happens often, but not always, that we may thread a sharp pin, without the loss of a drop of blood, through the skin of a part which as a result of hysteria is anaesthetic It also often happens that the or palsied or both. anaesthetic skin of organic disease—e.g., tabes dorsalis-may similarly be bloodlessly transfixed, the risk of anaesthesia by suggestion being guarded against. Bloodless transfixion of the skin has come to be associated with hysterical conditions, but it has seemed to me that when it can be performed in an area of skin which is analgesic it depends on the loss of cutaneous sensibility rather than on any special condition which is giving rise to the analgesia. I am, Sir, yours faithfully. Harley-street, W., Feb. 8th, 1926. HILDRED CARLILL.
INTRA-URETHRAL NEGATIVE PRESSURE DURING COITUS. To the Editor
of THE LANCET.
SIR,-In a footnote to a letter of mine with this title which appeared in your issue of Jan. 23rd you state that " we need more material on which to base opinions as to the value of prophylaxis." A mass of most convincing evidence as to the value of prophylaxis was laid before the Trevethin Committee by medical witnesses who had practical first-hand experience of its use on a large scale, while criticism of the value of prophylaxis was based on theory and confined to medical witnesses who honestly stated that they had no personal experience to record. Twenty-five authoritative medical witnesses endorsed the value of prophylaxis, based on practical experience in England, Scotland, Egypt, Mesopotamia, Russia, and in the navy. You, Sir, are doubtless aware that the Conference of the United States Public Health Services and State Venereal Disease Control Officers, held at Hot Springs, Arkansas, in December, 1924, passed a resolution to the effect that " Measures of immediate disinfection to those exposed to these diseases have been proved to be scientific and
practicable." I venture, therefore, to
think that it is not so much material on which to base opinions " that is required as a wider publicity of the material that we "
more
already
possess. I am,
Sir,
yours
faithfully, H. WANSEY BAYLY.
Harley-street, W., Feb. 4th, 1926.
WREXHAM HOSPITAL.-A
new
hospital,
of which
the cost, including site and furnishings, amounts to 2100,000, is now approaching completion at Wrexham. Several thousand pounds have been subscribed by miners and workpeople in weekly payments.