LEPER-HOUSES.

944 certain

of dullness indicate

"new sign"

"

abdominal pain with other signs of gastro-intestinal disturbance in neurotic patients in whom thorough physical examination failed to discoverthe cause of the trouble or routine treatment to. cure. The treatment recommended was arsenic with bromide of ammonium, the mixture being a lung. 1. As it has been ably pointed out by Dr. W. nerve tonic and sedative. These lectures, together Ewart, dullness may be due to mechanical causes, with Sir Samuel Wilks’s remarks on what he such as the position of the patient during per- termed " a mad semilunar ganglion," made a great cussion, to well-developed or thickness of the impression on my mind, and subsequent experience muscles of the chest, to reflex action, to tonic con- has convinced me of the soundness of the conclusions traction of chest muscles from hard or prolonged arrived at by these distinguished physicians. Sir Clifford Allbutt will kindly correct me if I have in, percussion, &c. 2. More important still, impaired resonance may any way misinterpreted the gist of his lectures. be physiological. (a) Civilised conditions of life Dr. Herbert French has called attention in your tend to defective breathing, to stooping posture in issue of to-day’s date to unilateral nervous furring of clerks, typists, carpenters, shoemakers, and other the tongue, and has brought forward two striking occupations bringing about a deficient aeration of illustrative cases where lesion of the third division the lungs and dullness in healthy subjects. Dr. of the fifth nerve was responsible for furring of the A. G. Auld gives an extreme case of this kind in tongue on the same side. It is, however, to a more THE LANCET of Sept. 4th. (b) I have seen children common cause of this condition in which the same living in unhygienic surroundings, with insufficient nerve is involved that I wish to refer-the more or food and air, develop a condition which is clinically less definite unilateral furring of the tongue assoseen in dullness and deficient expansion of the ciated with carious teeth on the same side. I have Dr. wrote last Cornelia de of seen this in innumerable instances, and I have lung. Lange, Holland, year giving a word of warning as to the frequency found the tongue become clean on removal of this. with which such cases were diagnosed as tuber- source of irritation. Although a purge is often culosis in children.! (c) I have records of cases of required in these cases " stomach and liver" anemia in women presenting signs of impaired medicines are obviously useless. resonance at the apex with crepitations and even a I have at times met with cases where the aural small irregular rise of evening temperature. All branch of the same nerve has been irritated at the these three sets of cases get quite well within a same time, and I have known warm oil to be very short time when they are put under such diligently used for relief of the earache when all hygienic treatment as fresh air, rest, nourishing that was required was attention to the tooth. I am, Sir, yours faithfully, food, and breathing exercises. It is only when dullness with harsh breathing is accompanied with CHARLES W. CHAPMAN, Harley-street, W., Oct. ]6th, 1915. a rise of temperature which is more or less persistent and a rapid pulse that one is justified in COMPARATIVE FOOD PRICES. suspecting early phthisis, though I admit the possia of mistaken even with To the Editor of THE LANCET. making bility diagnosis, some or all these symptoms. The truth is,the more SIR,-Dr. A. K. Chalmers’s article on "Economy we study the more we are puzzled at the compliin Food during War," published in THE LANCET of cated nature of tuberculosis. For the last few years Sept. 4th, set me asking prices on Vancouver we have been so profoundly influenced by the Island. I place them side by side with his :German school of thought that we have not Vancouver Island. Dr. Chalmers’s. seriously considered the question that tuberculosis Meat (per lb.) ......... 17d.......... 1Od. may in the pretuberculous and early stages be more Bread (" " )......... 2d.......... 2d. physiological than pathological, more constitutional 10(l .......... lad. Cheese(,, ) than contagious, more due to some biochemical 2d.......... 24d. Milk(perpint) changes in the blood than of bacterial origin, more Potatoes (per lb.) is d. 4cL ......... an insufficiency (of air, food, and rest) than Salmon ( " ,, ) 64d. infectious disease. At any rate this much is 3. Herring ( ,,) certain, that it would be a risky thing, as Dr. Auld 1......... 2. Egg (one) Butter (per oz.)......... 1......... ld.. hinted, to diagnose a case as pulmonary tubercunone losis merely from the presence of impaired resonMargarine Oatmeal (per Ib.) ance at the apex or any other part of the lung. 2:, (I .......... 3d. Lentils ( 4d......... 64d. I am, Sir, yours faithfully, ,,) C. MUTHU. Wells, Oct. llth, 1915. I am, Sir, yours faithfully, W. E. HOME, Victoria, B.C., Oct. 2nd, 1915. areas

a

pulmonary tuberculosis a question of greater clinical importance presents itself-viz., how far we are justified in diagnosing early disease merely from the presence of dullness over a portion of the of

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NERVOUS FURRING OF

THE

TONGUE.

To the Editor of THE LANCET.

SiR,-In the interesting correspondence in THE LANCET started by Sir James Goodhart on this subject I have not seen any reference to the very suggestive lectures on the abdominal neuroses by Sir Clifford Allbutt over 30 years ago which were reported in the medical journals at the time. I do not find reference to the lectures (or papers) " in Neale’s Digest." So far as my memory serves me, Sir Clifford Allbutt called attention to cases of 1

THE

LANCET, Sept. 19th, 1914, p. 758.

......

LEPER-HOUSES. To the Editor

of THE LANCET.

SIR,-In an address on "Leprosy"" appearing in THE LANCET of Sept. 4th, Dr. C. M. O’Brien states: " We have it on the authority of Matthew Paris that there were 19,000 leper-houses in Christendom in the thirteenth century." This is an error, which has been handed down from one writer to another. In 1903, I took occasion to refer to this point in an article on Leprosy, and also in a short note 1

Quarterly Review, No. 394, April, 1903,

p. 390.

945

Lcpra, Bibliotheca Internationalis different from those adopted by dental surgeons in Long before that, a writer this country when called upon to treat these cases. in Rees’s Cyclopaedia (1819) (article on Leprosy) There is, however, one exception-no modern trained had referred’to the mistranslation from the works dental surgeon would descend to transplanting a of Matthew Paris, who really stated that the septic tooth into the jaw of another individual. hospitalers possessed 19,000 manors. I found There seems to be an idea in some circles that the following reference in Matthaei Parisiensis Lieutenant Valadier’s work is different from that of Opera: "Habent insuper Templarii in Christiani- other dental practitioners-this is not so ; and it is, tate novem millia maneriorum, Hospitalarii vero I think, a slight on the dental profession in this novem decim, prseter emolumenta et varios proucountry that the authorities should not have ventus ex fraternitatibus et praedicationibus employed more extensively the dental surgeons provenientes, et per privilegia sua accrescentea attached to our teaching institutions. Many of these men have had considerable experience of these cases (Paris, MDCXLIV., p. 417, vol. i.). Professor Ehlers of Copenhagen suggested in a in civilian practice and are quite capable of dealfootnote to my article in Lepra that the lazar- ing with them. Wounded soldiers are lying in houses may not have been greatly inferior in our hospitals with seriously injured jaws, and are number, to the manors belonging to the Knights doomed to life-long deformities, simply because the of St. Lazarus (Hospitalarii), and that attached to authorities refuse to call to their aid the services of nearly all their manors there was a lazar-house, skilled dental practitioners. I am, Sir, yours faithfully, great or small. This is open to some doubt, for he goes on to say that in the reign of St. Louis there DENS. Oct. 18th, 1915. were 1502 lazar-houses in France.2 As to the number of lepers, as I have pointed out in my Quarterly Review article, it is probable that many individuals THE BELGIAN DOCTORS’ AND with extensive and disfiguring cutaneous diseases PHARMACISTS’ RELIEF FUND. such as bad cases of psoriasis, syphilis, mycosis fungoides, and so forth, made worse confounded by such conditions as scabies and pediculosis, THE WEEK’S SUBSCRIPTIONS. found their way into the lazar-houses. Howbeit, THE subscriptions to the Belgian Doctors’ and Matthew Paris mentioned 19,000 manors and not Pharmacists’ Relief Fund received during the week 19,000 leper-houses. have been as follows :I am, Sir, yours faithfully,

contributed to

(vol. iii., 1903, p. 143).

"

GEORGE

London ,’W., Oct. 13th, 1915.

PERNET, M.D. Paris.

NECROSIS OF HALF A PATELLA. To the Editor of THE LANCET.

SiR,-With reference

to

a

note upon

a case

of

Subscriptions to the Fund should be sent to the patella, published treasurer of the Fund, Dr. H. A. Des Voeux, at in THE LANCET of August 14th, I should like to say London, S.W., and should 14, Buckingham-gate, that many years ago I had a somewhat similar case to be made the payable Belgian Doctors’ under my care. The patient was a delicate boy, Relief and Pharmacists’ crossed Lloyds Fund, 9 years of age. He had been kneeling in snowLtd. Bank, slush, and the skin for a radius of three inches round the patella sloughed, and later the anterior THE APPEAL FOR SURGICAL INSTRUMENTS. half of the patella and corresponding portion of The Master of the Society of Apothecaries the quadriceps extensor tendon necrosed. acknowledges the receipt of surgical instruments I am, Sir, yours faithfully, kindly contributed by the following donors :A. BOWES ELLIOTT, F.R.C.S. Eng. Lady Georgina Home Drummond, per Dr. R. Dods Brown Abergele, Oct. 15the,1915. (second donation), Perth ; Mr. W. A. S. Royds, Sidcup ; Dr. necrosis of the anterior half of

a

A PROPHYLACTIC INTERDENTAL SPLINT. To the Editor of THE LANCET.

SIR,-In the report you give in your issue of Oct. 16th of the Exhibition of Fracture Apparatus at the Royal Society of Medicine reference is made to the methods for treating fractured jaws, shown by Lieutenant A. C. Van Valadier. It is stated that "one splint he called the prophylactic interdental

splint," and I think the readers of your report would naturally assume that it was the conception of Lieutenant Valadier. In justice to British dental surgeons, it should be stated that the type of splint shown

was suggested several years ago by Mr. Lewin and is usually known as Payne’s cradle splint. The methods shown by Lieutenant Valadier are no

Payne

2 Cabanès: La Lèpre et les Lépreux en France, Jour. des Mal. 1892, p. 6C0. 3 See also the present writer’s article on Syphilis in the Quarterly

Cut., &c,

Review, July, 1914.

Watson Williams, Clifton, Bristol; Rangoon ; Anonymous, Weymouth.

Surgical instruments Society of Apothecaries

Dr. N. N.

Parakh,

should be sent to the of London, Blackfriars,

London, E.C. WELSH NATIONAL MEDICAL SCHOOL.-At a meeting of the board of management of the King Edward VII. Hospital, Cardiff, held on Oct. 13th, a letter from the Treasury was read deprecating the immediate completion of the building scheme for a Welsh National Medical School, rendered possible by the munificence of Sir W. J. Thomas, in view of the position created by the war, and proposing the appointment of a Royal Commission to deal with the whole question. The board thereupon passed resolutions accepting the decision at which the Government might arrive, based on the findings of the proposed Commission, hoping that the proceedings of the Commission might be expedited. and that permission might meanwhile be given to the donor to complete the building scheme if no workmen eligible for war service were employed thereon.