- Email: [email protected]
LATE EFFECTS OF GASSING OR TUBERCULOSIS ?
585 that
a
far milder form of this disease is very
beach of any of
common
our
seaside resorts.
And if this is
indeed, and that it is characterised by slight sore- true of water open to the sea, how much more conthroat and fever and some mild gastro-intestinal taminated must water be when it is enclosed in a tide and another, symptoms. Many of our nurses at the infirmary public batli, where, between one full suffered from mild sore-throats at the time I spoke of, crowds of batltera of all kinds are splashing about, and sore-throats are not as a rule common amongst adding each his own quota to the sum total of the them; and if inquiries are made when a definite bacterial flora.-I am, Sir, yours faithfully, case of encephalitis occurs, one generally finds that W’impole-etrcet, W., Sept. 3rd, 1921. DAN McKENZlE. others in the house, especially the children, have, or have had recently, slight colds or sore-throats. A DISCLAIMER. I cannot pretend to have proved my theory, but I To the Editor of THE LANCET. think it is right to put it forward for others to criticise and possibly either to confirm or to confute ; and I SiR,—I wish to disclaim any connexion with the do so feeling that in some ways a man who practises of a paragraph in the Daily JJI ail of publication as I do as a consulting physician in a wide and somein which my name occurs with reference 31st, August what thinly populated country district is in a better I, to a case of Caesarean section, and at the same time to position for observing what one might term the protest against the exposure of such medical details natural history of diseases than those who practise in the lay press. On this occasion I am informed chiefly in our large towns. that a reporter visited the home in question and I am, Sir, yours faithfully, obtained such details as he required, in order to dish H. WILLOUGHBY GARDNER, M.D., F.R.C.P. them up for the palate of the newspaper reader. Shrewsbury, Sept. 1st, 1921.
I
I
am.
BECKWITH
Sir.
Honorary
THE SWIMMING-BATH AND EAR INFECTION.
vours
faithfullv.
WHITEHOUSE, Obstetric
M.S., F.R.C.S.,
Surgeon, General
Hospital, Birmingham. -------=------
Birmingbam, Sept. 3rd, 1921.’ To the Editor of THE LANCET. SiB,—In addition to the simple Eustachian catarrh LATE EFFECTS OF GASSING OR described by Dr. K. Amersbach, of Freiburg, in your TUBERCULOSIS ? last issue (p. 519), workers in throat and ear clinics are too well aware of the of occurrence the much To the Editor of THE LANCET. only more serious purulent otitis media as a consequence SiR,-Dr. J. B. Hawes’s experience of the late of bathing. So regularly does every warm summer effects of gas poisoning, the subject of an annotation bring cases of ear suppuration due to this cause to last week, agrees with my own experience among our notice that it would scarcely be an exaggeration tuberculous pensioners while tuberculosis officer for an to describe the incidence as epidemic to which all Carlisle. Patients suffering from the after-effects of bathers may be at some time or another exposed, do not show the usual constitutional and it is noteworthy and regrettable that the infection gas poisoning associated with tuberculosis, but on the symptoms is quite frequently of a highly virulent type, as the contrary are fairly well nourished. They complain serious sequela; show. I have just had two cases of of cough with a copious muco-purulent sputum in cerebellar abscess and lateral sinus thrombosis, both which examination fails to reveal the of which followed an acute middle-ear infection tuberclerepeated bacillus. The chest is emphysematous in induced by bathing. and in marked cases there is evident dyspnoea To suggest a method of preventing such accidents type, rest, and sometimes asthmatical attacks during is rather difficult. On a hot summer day the refresh- occur at night. The physical signs which may be ment of a cool dip is irresistible, and so people will almost confined to one lung consist of some entirely only smile at the very slight risk of ear infection. impairment of the percussion note or definite dullness Sufferers from chronic otorrhcea, however, should and faint breath sounds with prolonged expiration always be warned that bathing for them does entail accompanied by fine and coarse rales or rhonchi. On the other hand, a The vocal resonance is also diminished. The cona very serious risk indeed. person with an old, dried-up perforation in the dition remains practically unchanged under treatment. membrane is probably not any more prone to middle- There is some amelioration during the summer, ear infection than a normal subject, since it is almost but the symptoms become aggravated during damp certainly through the Eustachian tube and not weather. through the external meatus that the infection Such cases are referred by the Ministry of Pensions reaches the middle ear in most cases. This raises as tuberculosis, but I am of the opinion that the the question whether the water is itself to blame for tubercle bacillus is in no way responsible for the the infection, or whether it is not rather due’to the condition which is one of chronic interstitial pneuwashing-up of the patient’s own nasal and naso- monia. I am unable to state definitely the proportion pharyngeal secretions into the middle ear in the of these cases, but I think I came across 5 among 70 same way as when that cavity is infected by the referred to the tuberculosis dispensary. sniffing up of liquids into the nose for cleansing pensioners I am, Sir, vours faithfully. purposes. J. E. SPENCE. Eccles, Sept. 5th, 1921. that are Nevertheless, pyogenic organisms present in the water people are habitually bathing in cannot be denied, and every effort should be made to render EARLY DIAGNOSIS IN DIPHTHERIA. and to keep such water as clean as possible. This, To the Editor of THE LANCET. we must admit, must often be a difficult ideal to realise, but the matter is one for consideration by SIR,-In your issue of May 21st Dr. Frederic Thomson emphasised the great practical importance public health authorities. Fresh water swimming-baths should be emptied of early diagnosis in diphtheria, and two weeks later and refilled with clean water not once but several Dr. S. R. Collier related the steps taken by the Public times in the course of the day when there are many Health Committee of Wimbledon to ensure to the bathers, although this naturally necessitates a plentiful practitioner a ready supply of antitoxin. It certainly seems useless for teachers and authorities like Dr. supply of water. This precaution should also be adopted if possible Thomson to instil into students the need for immediate at public sea-bathing establishments. There seems antitoxin treatment on the diagnosis or justifiable to be a popular notion prevalent that sea-water has suspicion of a case of diphtheria, if we, as practitioners, the property of keeping itself pure and free from are to be hindered from carrying out such treatment germs. This, of course, is an error. Wyatt Wingrave by laymen on local district councils. I am practising in a home county town not 35 has often told me that he has always been able to grow the B. coli communis from the sea-water on the miles from London, and some time ago I had a
II
I
’
a
far milder form of this disease is very
beach of any of
common
our
seaside resorts.
And if this is
indeed, and that it is characterised by slight sore- true of water open to the sea, how much more conthroat and fever and some mild gastro-intestinal taminated must water be when it is enclosed in a tide and another, symptoms. Many of our nurses at the infirmary public batli, where, between one full suffered from mild sore-throats at the time I spoke of, crowds of batltera of all kinds are splashing about, and sore-throats are not as a rule common amongst adding each his own quota to the sum total of the them; and if inquiries are made when a definite bacterial flora.-I am, Sir, yours faithfully, case of encephalitis occurs, one generally finds that W’impole-etrcet, W., Sept. 3rd, 1921. DAN McKENZlE. others in the house, especially the children, have, or have had recently, slight colds or sore-throats. A DISCLAIMER. I cannot pretend to have proved my theory, but I To the Editor of THE LANCET. think it is right to put it forward for others to criticise and possibly either to confirm or to confute ; and I SiR,—I wish to disclaim any connexion with the do so feeling that in some ways a man who practises of a paragraph in the Daily JJI ail of publication as I do as a consulting physician in a wide and somein which my name occurs with reference 31st, August what thinly populated country district is in a better I, to a case of Caesarean section, and at the same time to position for observing what one might term the protest against the exposure of such medical details natural history of diseases than those who practise in the lay press. On this occasion I am informed chiefly in our large towns. that a reporter visited the home in question and I am, Sir, yours faithfully, obtained such details as he required, in order to dish H. WILLOUGHBY GARDNER, M.D., F.R.C.P. them up for the palate of the newspaper reader. Shrewsbury, Sept. 1st, 1921.
I
I
am.
BECKWITH
Sir.
Honorary
THE SWIMMING-BATH AND EAR INFECTION.
vours
faithfullv.
WHITEHOUSE, Obstetric
M.S., F.R.C.S.,
Surgeon, General
Hospital, Birmingham. -------=------
Birmingbam, Sept. 3rd, 1921.’ To the Editor of THE LANCET. SiB,—In addition to the simple Eustachian catarrh LATE EFFECTS OF GASSING OR described by Dr. K. Amersbach, of Freiburg, in your TUBERCULOSIS ? last issue (p. 519), workers in throat and ear clinics are too well aware of the of occurrence the much To the Editor of THE LANCET. only more serious purulent otitis media as a consequence SiR,-Dr. J. B. Hawes’s experience of the late of bathing. So regularly does every warm summer effects of gas poisoning, the subject of an annotation bring cases of ear suppuration due to this cause to last week, agrees with my own experience among our notice that it would scarcely be an exaggeration tuberculous pensioners while tuberculosis officer for an to describe the incidence as epidemic to which all Carlisle. Patients suffering from the after-effects of bathers may be at some time or another exposed, do not show the usual constitutional and it is noteworthy and regrettable that the infection gas poisoning associated with tuberculosis, but on the symptoms is quite frequently of a highly virulent type, as the contrary are fairly well nourished. They complain serious sequela; show. I have just had two cases of of cough with a copious muco-purulent sputum in cerebellar abscess and lateral sinus thrombosis, both which examination fails to reveal the of which followed an acute middle-ear infection tuberclerepeated bacillus. The chest is emphysematous in induced by bathing. and in marked cases there is evident dyspnoea To suggest a method of preventing such accidents type, rest, and sometimes asthmatical attacks during is rather difficult. On a hot summer day the refresh- occur at night. The physical signs which may be ment of a cool dip is irresistible, and so people will almost confined to one lung consist of some entirely only smile at the very slight risk of ear infection. impairment of the percussion note or definite dullness Sufferers from chronic otorrhcea, however, should and faint breath sounds with prolonged expiration always be warned that bathing for them does entail accompanied by fine and coarse rales or rhonchi. On the other hand, a The vocal resonance is also diminished. The cona very serious risk indeed. person with an old, dried-up perforation in the dition remains practically unchanged under treatment. membrane is probably not any more prone to middle- There is some amelioration during the summer, ear infection than a normal subject, since it is almost but the symptoms become aggravated during damp certainly through the Eustachian tube and not weather. through the external meatus that the infection Such cases are referred by the Ministry of Pensions reaches the middle ear in most cases. This raises as tuberculosis, but I am of the opinion that the the question whether the water is itself to blame for tubercle bacillus is in no way responsible for the the infection, or whether it is not rather due’to the condition which is one of chronic interstitial pneuwashing-up of the patient’s own nasal and naso- monia. I am unable to state definitely the proportion pharyngeal secretions into the middle ear in the of these cases, but I think I came across 5 among 70 same way as when that cavity is infected by the referred to the tuberculosis dispensary. sniffing up of liquids into the nose for cleansing pensioners I am, Sir, vours faithfully. purposes. J. E. SPENCE. Eccles, Sept. 5th, 1921. that are Nevertheless, pyogenic organisms present in the water people are habitually bathing in cannot be denied, and every effort should be made to render EARLY DIAGNOSIS IN DIPHTHERIA. and to keep such water as clean as possible. This, To the Editor of THE LANCET. we must admit, must often be a difficult ideal to realise, but the matter is one for consideration by SIR,-In your issue of May 21st Dr. Frederic Thomson emphasised the great practical importance public health authorities. Fresh water swimming-baths should be emptied of early diagnosis in diphtheria, and two weeks later and refilled with clean water not once but several Dr. S. R. Collier related the steps taken by the Public times in the course of the day when there are many Health Committee of Wimbledon to ensure to the bathers, although this naturally necessitates a plentiful practitioner a ready supply of antitoxin. It certainly seems useless for teachers and authorities like Dr. supply of water. This precaution should also be adopted if possible Thomson to instil into students the need for immediate at public sea-bathing establishments. There seems antitoxin treatment on the diagnosis or justifiable to be a popular notion prevalent that sea-water has suspicion of a case of diphtheria, if we, as practitioners, the property of keeping itself pure and free from are to be hindered from carrying out such treatment germs. This, of course, is an error. Wyatt Wingrave by laymen on local district councils. I am practising in a home county town not 35 has often told me that he has always been able to grow the B. coli communis from the sea-water on the miles from London, and some time ago I had a
II
I
’