- Email: [email protected]
LONDON RECEIVING HOUSES FOR THE UNSOUND IN MIND.
339 attachment to the aortic theory of angina pectoris as pubin his Lane lectures, although some of Pawinski’s cases do not present a very striking likeness to the classical features of Heberden’s disease. I am, Sirs, yours faithfully, ALEXANDER MORISON. Upper Berkeley-street, W.,July 25th, 1893.
lished, for example,
number of
pupil midwives. To understand the tendency to overtraining and its disadvantages we have only to look at what has happened in the nursing calling. A trained nurse now costs at the rate of from 100 to 150 guineas a year. She (or he) has become a luxury beyond the reach of large sections of the community where there are many cases in which
a nurse
is
more or
less needed,
though the services
simple and do not call for the amount of training which is now given. Speaking as a general practitioner this THE SOCIETY OF APOTHECARIES OF But I am concerned for seems to me a serious question. LONDON AND THE GENERAL the moment at the tendency of some of those who have most humanely fought for the training of midwives to carry MEDICAL COUNCIL. it to excess. I am sure the friends of poor lying-in women To the Editors of THE LANCET. will not misunderstand me when I suggest that they will do SIRS,-I must, on behalf of the Society of Apothecaries well to proceed tentatively and slowly. Two points ought of London, take exception to the leading article in to be remembered. Firstly, that the law contemplates that THE LANCET of July 25th, p. 242, commenting upon midwifery is still to be under the care of the medical prothe recent meeting of the General Medical Council and fession and that in all its unusual forms the midwife is tothe consideration which then took place of the reports seek medical assistance. Secondly, our maternity charities upon the primary examinations of the Conjoint Board show well that with the present training of three months, In dealing with the even in and of the Society of Apothecaries. very humble homes, the lying- in mortality is reduced question of the first year’s study the statement is made to very small proportions. that the Society, following in the wake of the Conjoint I I have before me the report of the City of London Lying-in Board, has so far failed to carry out the spirit Hospital for the year ending 1902. Of 2242 women of the recommendation of the Council that it has delivered by the midwives at their own homes (subject, of accepted the last year of study of any boys’ school, course, to the supervision of the medical staff) only two in which there might be a pretence of playing at women and 31 children died. It seems reasonable to think science teaching, as the first year of the medical that the Midwives Board will do well in the first instance to curriculum. I am not concerned to inquire whether this is require but little extension of the same training that has been or is not a correct description of the teaching institutions hitherto found to be sufficient and not to endanger the recognised by the Conjoint Board but not approved by the success of the new Act by pitching too high the standard of General Medical Council, to which institutions I assume the education. I am, Sirs, yours faithfully, statement alludes, but in justice to the Society of ApotheJ. G. GLOVER. Highbury-place, N., July 27th, 1903. caries I must point out that only candidates who have required
studied
either
at
medical
recognised by the Council primary examination.
schools or at institutions admitted to the Society’s
are
are
LONDON RECEIVING HOUSES FOR THE UNSOUND IN MIND.
I also regret to notice in the article statements which To the Editors of THE LANCET. the Society with the Royal Colleges in what appear to link is termed an ’’opposition " to the General Medical Council, have just had an opportunity of reading the SIRS,-I an "opposition" which, in the case of the Society, I have no Bill for the establishment of these houses in the metropolis hesitation in saying, is entirely non-existent. The Society of which has been sent down by the House of Lords to the Apothecaries is now, and always has been, most anxious House of Commons and which will shortly be discussed there. to work loyally and to the best of its ability with the Council It bears the stamp of careful consideration of all matters and has, in fact, consistently done so, recognising fully vital to the out of the scheme successfully and it is carrying that the strength and usefulness of the Council can best be calculated to meet a pressing need, always recognised by maintained by generous cooperation on the part of the those like myself, have long been engaged in caring who, it has certainly at no time in for the unsound in mind in the licensing corporations ; and great institutions of the the past taken up the position, in the words of your article, ’, counties and district. But there is one point in metropolitan of defending its rights and privileges"against aggres- ’, the Bill to which I should like to call very especial attention, sion " on the part of the Council, nor does it intend to do so and that is its A liberal and progressive phraseology. I think it is only necessary to refer to the conciliatory measure in most now. respects, it is marred by the perpetuation of terms of the Society’s reply to the recent visitors’ report on a and that of a very objectionable and degrading misnomer, the primary examination to recognise that it is kind. I refer to the word "lunatic." beside the mark to ascribe any intention of hostility or What, I ask, is the real necessity for continuing the use of opposition on the part of the Society to the General Medical what is now considered an inaccurate and opprobrious I am, Sirs, yours faithfully, Council. epithet ? What have mental disorders to do with the moon ? A. MOWBRAY UPTON, No doubt such disorders do sometimes recur and pass Clerk to the Society. July 28th, 1903. through their phases, but can it be shown or proved that thoce phases are always coincident with phases of the moon THE OVERTRAINING OF MIDWIVES. or has it ever been proved that the moon produces or even To the Editors of THE LANCET. influences mental disorders ? Turning to Dr. D. Hack Tuke’s SIRS,-It is understood that the Midwives Board is " Dictionary of Psychological Medicine"" we find the word formulating the rules for the training of midwives under the "lunatic"defined thus:"(Luna, the moon, from its Midwives Act. May I, as one who has in a humble way supposed influence in causing mental disease) A term applied supported legislation in the interest of the poorer classes of to those diseases considered to be under the influence of the moon’s phases, &c." women who have to rely in the hour of their need on The Act 16 & 17 Vict. Cap. 97, " midwives, claim to say a word at this juncture ?’! There is a declares that the term "lunatic" shall mean and tendency, perhaps a natural tendency, now that the Act has " include every person of unsound mind and every person been gained to overdo what was meant to be done by it-in being an idiot," thus including the mildest as well as the other words, to overtrain instead of training the midwife and most serious disorders of the mind. It is, doubtless, the to make her superior to the work required of her-viz., to established and probably convenient legal term, but possibly attend poor women in ordinary confinements, to nurse them we of the long-suffering medical profession have been domifor a week or ten days afterwards, and on the occurrence of nated by so-called legal necessities and technicalities too any irregularity or abnormality in mother or child to apply long for the advantage of progressive medicine in that defor medical advice and assistance. If this tendency to over- partment, especially wherein it deals with diseases and train is not checked the full blessings of the Act will not be disorders of the great nerve centres. Surely, if the will realised. If the midwife is to be trained for two years as a exist the skill and erudition of some person, be he legal or nurse, as suggested at a recent drawing-room meeting, she be he medical, will devise some words better indicating fact will be trained beyond the nature and scope of her duties, her and more appropriate generally than the words ’’lunatic " price will become prohibitive, and the poor will be driven to and "lunacy." resort to all sorts of makeshifts to dispense with her services Before closing this letter I would remark that the Bill in and will encounter the same risks as at present. I am told question invites the application of out-patients for relief to I can imagine some such would-be to know that the extension of the mid- those receiving houses. by one who ought wives’ training even to six months will seriously reduce the out-patient debating in his own mind before making such an
entirely
340 the questions, "Am I or am I not alunatic’ ? " Am I or am I not entitled to the relief offered here ? " and turning sorrowfully away, unable or unwilling to admit the soft impeachment and being thereupon for ever afterwards a chronicled "lunatic."—I am, Sirs, yours faithfully, JAMES ADAM. West Malling, Kent, July 25th, 1903.
application ’’
THE TREATMENT OF GOITRE USE OF DISTILLED OR RAIN To the Editors
of THE LANCET.
BY THE
WATER.
SIRS,-With regard to the letters of Dr. C. A. Rayne and Dr. W. H. B. Brook in THE LANCET of July 18th (p. 185) and 25th (p. 265), I may say that the use of rain and distilled waters is no new thing in the treatment of goitre. It has been familiar to physicians in diverse parts of the world for a long time. Several cases of cure by this means have occurred in my own practice, as I pointed out in a paper read some years ago at Carlisle at a meeting of the Border Branch of the British Medical Association. I do not think that the cure depends on either rain or distilled water as a matter of fact, but on the fact that the patient is drinking a fluid free from the goitrous poison and in proof of this I may quote the following instance from the writings of St. Lager. "Keyssler says that round Schemnitz in Hungary the goitrigenous action of the waters is so evident that those who go to drink the water of a neighbouring the satisfaction of seeing their tumours disvalley have " appear." Many similar instances could be’’ quoted. Here is an interesting one, also from St. Lager. Military surgeons who have observed epidemics of goitre at Clermont and several other towns noticed that the officers and noncommissioned officers who only drank wine escaped It is a remarkable fact that goitre is the disease."" unknown in places where rain water only is used-e.g., Constantinople, Venice, parts of Holland and Belgium, &c. Cardinal Billiet has put on record a remarkable case of goitre incidence occurring in the village of Puiset in Planaise. Here he found 17 families more or less afflicted with goitre and cretinism from using the spring water of the country. One family was absolutely healthy and used rain-water only. The best results are obtained, of course, in cases of recently formed goitres as when a considerable amount of fibrous tissue is formed the results are not so good although frequently remarkable. I am, Sirs, yours faithfully, LOUIS E. STEVENSON, M.B., &c., F.G.S. Temple Sowerby, Penrith, July 25th, 1903.
his position, but I contend that the very passage which Dr. Niven quotes from Dr. Reid’s letter fully bears out the construction put on it. Dr. Reid says: "Even if the germ cells are injured, it does not follow that this injury will be perpetuated in their very remote descendants -i.e., in the body cells of the child-at a time long after the injurious agency has ceased to act" and he implies his disbelief in the possibility of such injury being his whole argument, indeed, being deso perpetuated, voted to substantiating that position, which position, if correct, certainly implies that the germ plasm is incapable of receiving permanent injury by the agency of poisons circulating in the blood-that is, of course, that the damage to individual germ cells is never of such a nature as to lead to permanent alteration in the organism which results therefrom. If any injury has been inflicted on the germ cells of a parent by the action of a poison circulating in the blood this Either can only be judged of by its effects on the offspring. a modification can be produced in the somatic cells of a child as a result of such influence or it cannot. If as a result of the development of germ cells in a vitiated nutrient medium the child resulting therefrom is modified in any direction, however slight, then a definite germinal variation has been produced through the agency of the poison in question. If, however, the effect, if any, produced on the germ cells is always more or less evanescent, and if no permanent alteration can be produced in the somatic cells of the child thereby, then it necessarily follows that the child has not been modified in any way and that no harm of any kind has been produced. As the well-being of the offspring is the only thing with which we are here concerned it is a necessary conclusion that if this cannot be permanently injured by the action of poisons on the germ cells of the parent, then it is a matter of indifference as regards the welfare of such offspring whether the germ cells from which it arises are developed in a vitiated nutrient medium or the reverse.
Dr. Niven devotes
a portion of his letter to creating for me imaginary position and then proceeding to criticise it, I suggested that there might be causes of variation other than those comprised in the union of two dissimilar germ plasms, the context clearly showing that I was referring to the possibility of such variation occurring by the direct action of poisons on the germ plasm ; but Dr. Niven chooses to assume that I was arguing in favour of the transmission of acquired characters. I argued nothing of the sort and there is not a line in my letter suggesting any opinion of the kind. As a matter of fact, I am entirely in harmony with Dr. Reid as to the non-transmission of acquired characters and have elsewhereexpressed myself in favour of the view that on this question ’’ the Weismannian position an
at present holds the field." It is therefore somewhat superTo the Editors of THE LANCET. fluous for Dr. Niven to ask me for proof of doctrine which I SiRS,-The letters in the two last issues of THE LANCET on do not hold and which was in no way raised in my letter. the use of distilled or rain water in goitre induce me to give Dr. Niven goes on to say that if injury is done to the growth briefly my own experience. For the last seven years I have of the embryo during the pregnancy of a drunken mother directed patients with goitre to drink distilled water or that is not a problem in heredity. I never suggested that I have indeed elsewhere 2 drawn attention to the boiled rain water. During this period I have treated about a it was. dozen cases, some of them from other districts. I cannot say fact that in these cases any injury done to the germ that all have been successful ; one patient, a woman with a plasmwill be added to, and reinforced by, chronic alcolarge goitre of many years standing, died ; another took holic poisoning of the nervous centres of the embryo The condistilled water in considerable quantities for six months, but during the whole period of intra-uterine life." there was no improvement and she was finally cured by dition of the mother during the intra-uterine life of the hydrofluoric acid. In this case I am confident that the child is one of the disturbing factors which have to be taken patient always took the distilled water and continued to do so into account in endeavouring to form an estimate as to for 18 months after her cure. Of the other cases all were the effect of poisons upon the germ plasm itself, but in the wholly or partially cured, but I cannot be certain that they case of alcohol this disturbing factor can often be entirely always carried out the treatment. The conclusion I have eliminated as innumerable cases exist of the union of drunken fathers with sober mothers. I am not disputing the come to is that distilled water is a valuable adjunct in the It would general position which Dr. Reid has so frequently insisted treatment of goitre, but not of itself a specific. on and which Dr. Niven adopts-viz., that nations are sober be interesting to hear the experience of others on this point. in proportion to their past experience of alcohol. I think it I am, Sir.<. yours faithfully, ARTHUR C. WILSON, M.B., Ch.B. Vict. probable that such an evolution of alcohol-resistant communities has been and is going on, though I would Formby, July 26th. 19C3. remind Dr. Niven of the striking example afforded by the Mohammedan races which show us millions of human beings OF DOCTRINES HEREDITY. MEDICAL who are perfectly sober not by virtue of such an evolution, To the Editors ofTHE LANCET. but in consequence of the operation of religious sanctions. SIRS,-In THE LANCET of July 25th, p. 264, Dr. C. R. Where I differ from Dr. Reid and Dr. Niven is in the position Niven takes me to task for having, as he conceives, they take up that an unfavourable variation such as would misrepresented Dr. G. Archdall Reid’s position as set presumably be produced by the action of alcohol on the germ forth in that gentleman’s letter to you of July 4th, p. 56. plasm of the parents would necessarily go on accumulating Dr. Reid is, I am sure, well able to take care of him1 Journal of Mental Science, October, 1902. self and will be able to judge whether I have misconstrued j 2 Ibid.
lished, for example,
number of
pupil midwives. To understand the tendency to overtraining and its disadvantages we have only to look at what has happened in the nursing calling. A trained nurse now costs at the rate of from 100 to 150 guineas a year. She (or he) has become a luxury beyond the reach of large sections of the community where there are many cases in which
a nurse
is
more or
less needed,
though the services
simple and do not call for the amount of training which is now given. Speaking as a general practitioner this THE SOCIETY OF APOTHECARIES OF But I am concerned for seems to me a serious question. LONDON AND THE GENERAL the moment at the tendency of some of those who have most humanely fought for the training of midwives to carry MEDICAL COUNCIL. it to excess. I am sure the friends of poor lying-in women To the Editors of THE LANCET. will not misunderstand me when I suggest that they will do SIRS,-I must, on behalf of the Society of Apothecaries well to proceed tentatively and slowly. Two points ought of London, take exception to the leading article in to be remembered. Firstly, that the law contemplates that THE LANCET of July 25th, p. 242, commenting upon midwifery is still to be under the care of the medical prothe recent meeting of the General Medical Council and fession and that in all its unusual forms the midwife is tothe consideration which then took place of the reports seek medical assistance. Secondly, our maternity charities upon the primary examinations of the Conjoint Board show well that with the present training of three months, In dealing with the even in and of the Society of Apothecaries. very humble homes, the lying- in mortality is reduced question of the first year’s study the statement is made to very small proportions. that the Society, following in the wake of the Conjoint I I have before me the report of the City of London Lying-in Board, has so far failed to carry out the spirit Hospital for the year ending 1902. Of 2242 women of the recommendation of the Council that it has delivered by the midwives at their own homes (subject, of accepted the last year of study of any boys’ school, course, to the supervision of the medical staff) only two in which there might be a pretence of playing at women and 31 children died. It seems reasonable to think science teaching, as the first year of the medical that the Midwives Board will do well in the first instance to curriculum. I am not concerned to inquire whether this is require but little extension of the same training that has been or is not a correct description of the teaching institutions hitherto found to be sufficient and not to endanger the recognised by the Conjoint Board but not approved by the success of the new Act by pitching too high the standard of General Medical Council, to which institutions I assume the education. I am, Sirs, yours faithfully, statement alludes, but in justice to the Society of ApotheJ. G. GLOVER. Highbury-place, N., July 27th, 1903. caries I must point out that only candidates who have required
studied
either
at
medical
recognised by the Council primary examination.
schools or at institutions admitted to the Society’s
are
are
LONDON RECEIVING HOUSES FOR THE UNSOUND IN MIND.
I also regret to notice in the article statements which To the Editors of THE LANCET. the Society with the Royal Colleges in what appear to link is termed an ’’opposition " to the General Medical Council, have just had an opportunity of reading the SIRS,-I an "opposition" which, in the case of the Society, I have no Bill for the establishment of these houses in the metropolis hesitation in saying, is entirely non-existent. The Society of which has been sent down by the House of Lords to the Apothecaries is now, and always has been, most anxious House of Commons and which will shortly be discussed there. to work loyally and to the best of its ability with the Council It bears the stamp of careful consideration of all matters and has, in fact, consistently done so, recognising fully vital to the out of the scheme successfully and it is carrying that the strength and usefulness of the Council can best be calculated to meet a pressing need, always recognised by maintained by generous cooperation on the part of the those like myself, have long been engaged in caring who, it has certainly at no time in for the unsound in mind in the licensing corporations ; and great institutions of the the past taken up the position, in the words of your article, ’, counties and district. But there is one point in metropolitan of defending its rights and privileges"against aggres- ’, the Bill to which I should like to call very especial attention, sion " on the part of the Council, nor does it intend to do so and that is its A liberal and progressive phraseology. I think it is only necessary to refer to the conciliatory measure in most now. respects, it is marred by the perpetuation of terms of the Society’s reply to the recent visitors’ report on a and that of a very objectionable and degrading misnomer, the primary examination to recognise that it is kind. I refer to the word "lunatic." beside the mark to ascribe any intention of hostility or What, I ask, is the real necessity for continuing the use of opposition on the part of the Society to the General Medical what is now considered an inaccurate and opprobrious I am, Sirs, yours faithfully, Council. epithet ? What have mental disorders to do with the moon ? A. MOWBRAY UPTON, No doubt such disorders do sometimes recur and pass Clerk to the Society. July 28th, 1903. through their phases, but can it be shown or proved that thoce phases are always coincident with phases of the moon THE OVERTRAINING OF MIDWIVES. or has it ever been proved that the moon produces or even To the Editors of THE LANCET. influences mental disorders ? Turning to Dr. D. Hack Tuke’s SIRS,-It is understood that the Midwives Board is " Dictionary of Psychological Medicine"" we find the word formulating the rules for the training of midwives under the "lunatic"defined thus:"(Luna, the moon, from its Midwives Act. May I, as one who has in a humble way supposed influence in causing mental disease) A term applied supported legislation in the interest of the poorer classes of to those diseases considered to be under the influence of the moon’s phases, &c." women who have to rely in the hour of their need on The Act 16 & 17 Vict. Cap. 97, " midwives, claim to say a word at this juncture ?’! There is a declares that the term "lunatic" shall mean and tendency, perhaps a natural tendency, now that the Act has " include every person of unsound mind and every person been gained to overdo what was meant to be done by it-in being an idiot," thus including the mildest as well as the other words, to overtrain instead of training the midwife and most serious disorders of the mind. It is, doubtless, the to make her superior to the work required of her-viz., to established and probably convenient legal term, but possibly attend poor women in ordinary confinements, to nurse them we of the long-suffering medical profession have been domifor a week or ten days afterwards, and on the occurrence of nated by so-called legal necessities and technicalities too any irregularity or abnormality in mother or child to apply long for the advantage of progressive medicine in that defor medical advice and assistance. If this tendency to over- partment, especially wherein it deals with diseases and train is not checked the full blessings of the Act will not be disorders of the great nerve centres. Surely, if the will realised. If the midwife is to be trained for two years as a exist the skill and erudition of some person, be he legal or nurse, as suggested at a recent drawing-room meeting, she be he medical, will devise some words better indicating fact will be trained beyond the nature and scope of her duties, her and more appropriate generally than the words ’’lunatic " price will become prohibitive, and the poor will be driven to and "lunacy." resort to all sorts of makeshifts to dispense with her services Before closing this letter I would remark that the Bill in and will encounter the same risks as at present. I am told question invites the application of out-patients for relief to I can imagine some such would-be to know that the extension of the mid- those receiving houses. by one who ought wives’ training even to six months will seriously reduce the out-patient debating in his own mind before making such an
entirely
340 the questions, "Am I or am I not alunatic’ ? " Am I or am I not entitled to the relief offered here ? " and turning sorrowfully away, unable or unwilling to admit the soft impeachment and being thereupon for ever afterwards a chronicled "lunatic."—I am, Sirs, yours faithfully, JAMES ADAM. West Malling, Kent, July 25th, 1903.
application ’’
THE TREATMENT OF GOITRE USE OF DISTILLED OR RAIN To the Editors
of THE LANCET.
BY THE
WATER.
SIRS,-With regard to the letters of Dr. C. A. Rayne and Dr. W. H. B. Brook in THE LANCET of July 18th (p. 185) and 25th (p. 265), I may say that the use of rain and distilled waters is no new thing in the treatment of goitre. It has been familiar to physicians in diverse parts of the world for a long time. Several cases of cure by this means have occurred in my own practice, as I pointed out in a paper read some years ago at Carlisle at a meeting of the Border Branch of the British Medical Association. I do not think that the cure depends on either rain or distilled water as a matter of fact, but on the fact that the patient is drinking a fluid free from the goitrous poison and in proof of this I may quote the following instance from the writings of St. Lager. "Keyssler says that round Schemnitz in Hungary the goitrigenous action of the waters is so evident that those who go to drink the water of a neighbouring the satisfaction of seeing their tumours disvalley have " appear." Many similar instances could be’’ quoted. Here is an interesting one, also from St. Lager. Military surgeons who have observed epidemics of goitre at Clermont and several other towns noticed that the officers and noncommissioned officers who only drank wine escaped It is a remarkable fact that goitre is the disease."" unknown in places where rain water only is used-e.g., Constantinople, Venice, parts of Holland and Belgium, &c. Cardinal Billiet has put on record a remarkable case of goitre incidence occurring in the village of Puiset in Planaise. Here he found 17 families more or less afflicted with goitre and cretinism from using the spring water of the country. One family was absolutely healthy and used rain-water only. The best results are obtained, of course, in cases of recently formed goitres as when a considerable amount of fibrous tissue is formed the results are not so good although frequently remarkable. I am, Sirs, yours faithfully, LOUIS E. STEVENSON, M.B., &c., F.G.S. Temple Sowerby, Penrith, July 25th, 1903.
his position, but I contend that the very passage which Dr. Niven quotes from Dr. Reid’s letter fully bears out the construction put on it. Dr. Reid says: "Even if the germ cells are injured, it does not follow that this injury will be perpetuated in their very remote descendants -i.e., in the body cells of the child-at a time long after the injurious agency has ceased to act" and he implies his disbelief in the possibility of such injury being his whole argument, indeed, being deso perpetuated, voted to substantiating that position, which position, if correct, certainly implies that the germ plasm is incapable of receiving permanent injury by the agency of poisons circulating in the blood-that is, of course, that the damage to individual germ cells is never of such a nature as to lead to permanent alteration in the organism which results therefrom. If any injury has been inflicted on the germ cells of a parent by the action of a poison circulating in the blood this Either can only be judged of by its effects on the offspring. a modification can be produced in the somatic cells of a child as a result of such influence or it cannot. If as a result of the development of germ cells in a vitiated nutrient medium the child resulting therefrom is modified in any direction, however slight, then a definite germinal variation has been produced through the agency of the poison in question. If, however, the effect, if any, produced on the germ cells is always more or less evanescent, and if no permanent alteration can be produced in the somatic cells of the child thereby, then it necessarily follows that the child has not been modified in any way and that no harm of any kind has been produced. As the well-being of the offspring is the only thing with which we are here concerned it is a necessary conclusion that if this cannot be permanently injured by the action of poisons on the germ cells of the parent, then it is a matter of indifference as regards the welfare of such offspring whether the germ cells from which it arises are developed in a vitiated nutrient medium or the reverse.
Dr. Niven devotes
a portion of his letter to creating for me imaginary position and then proceeding to criticise it, I suggested that there might be causes of variation other than those comprised in the union of two dissimilar germ plasms, the context clearly showing that I was referring to the possibility of such variation occurring by the direct action of poisons on the germ plasm ; but Dr. Niven chooses to assume that I was arguing in favour of the transmission of acquired characters. I argued nothing of the sort and there is not a line in my letter suggesting any opinion of the kind. As a matter of fact, I am entirely in harmony with Dr. Reid as to the non-transmission of acquired characters and have elsewhereexpressed myself in favour of the view that on this question ’’ the Weismannian position an
at present holds the field." It is therefore somewhat superTo the Editors of THE LANCET. fluous for Dr. Niven to ask me for proof of doctrine which I SiRS,-The letters in the two last issues of THE LANCET on do not hold and which was in no way raised in my letter. the use of distilled or rain water in goitre induce me to give Dr. Niven goes on to say that if injury is done to the growth briefly my own experience. For the last seven years I have of the embryo during the pregnancy of a drunken mother directed patients with goitre to drink distilled water or that is not a problem in heredity. I never suggested that I have indeed elsewhere 2 drawn attention to the boiled rain water. During this period I have treated about a it was. dozen cases, some of them from other districts. I cannot say fact that in these cases any injury done to the germ that all have been successful ; one patient, a woman with a plasmwill be added to, and reinforced by, chronic alcolarge goitre of many years standing, died ; another took holic poisoning of the nervous centres of the embryo The condistilled water in considerable quantities for six months, but during the whole period of intra-uterine life." there was no improvement and she was finally cured by dition of the mother during the intra-uterine life of the hydrofluoric acid. In this case I am confident that the child is one of the disturbing factors which have to be taken patient always took the distilled water and continued to do so into account in endeavouring to form an estimate as to for 18 months after her cure. Of the other cases all were the effect of poisons upon the germ plasm itself, but in the wholly or partially cured, but I cannot be certain that they case of alcohol this disturbing factor can often be entirely always carried out the treatment. The conclusion I have eliminated as innumerable cases exist of the union of drunken fathers with sober mothers. I am not disputing the come to is that distilled water is a valuable adjunct in the It would general position which Dr. Reid has so frequently insisted treatment of goitre, but not of itself a specific. on and which Dr. Niven adopts-viz., that nations are sober be interesting to hear the experience of others on this point. in proportion to their past experience of alcohol. I think it I am, Sir.<. yours faithfully, ARTHUR C. WILSON, M.B., Ch.B. Vict. probable that such an evolution of alcohol-resistant communities has been and is going on, though I would Formby, July 26th. 19C3. remind Dr. Niven of the striking example afforded by the Mohammedan races which show us millions of human beings OF DOCTRINES HEREDITY. MEDICAL who are perfectly sober not by virtue of such an evolution, To the Editors ofTHE LANCET. but in consequence of the operation of religious sanctions. SIRS,-In THE LANCET of July 25th, p. 264, Dr. C. R. Where I differ from Dr. Reid and Dr. Niven is in the position Niven takes me to task for having, as he conceives, they take up that an unfavourable variation such as would misrepresented Dr. G. Archdall Reid’s position as set presumably be produced by the action of alcohol on the germ forth in that gentleman’s letter to you of July 4th, p. 56. plasm of the parents would necessarily go on accumulating Dr. Reid is, I am sure, well able to take care of him1 Journal of Mental Science, October, 1902. self and will be able to judge whether I have misconstrued j 2 Ibid.