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MEDICO-LEGAL RESEARCH.
1145
villages, anti-malaria work
is directed, and thereneed, apparently, is rest. Physicists are experibath houses in many places where schoolL menting in sound-proof rooms for the use of testing children are washed compulsorily once a week-albeit apparatuses to determine acoustic acuity. No attempt has been made to gauge the benefit of that at first this sometimes needed the assistance off the gendarmarie. That such perfection is possible inL functional rest in middle-ear inflammations ; this has never been considered as a part of the treatment and the Balkans must be seen to be believed. We were treated with the greatest possible kindness; has not been deemed necessary. Is it not possible -in five languages- by the director, Dr. Rankov andL that the continuous onslaught of sound would by conhis assistants, who were willing to give unlimited time duction vibrations keep up or aggravate congestion ? and trouble in showing their work to foreign visitors. No differential trial has been made to determine the It is a remarkably good centre for studying some ofF reaction of the inflamed ear under the ordinary the problems of malaria. Why, for instance, shouldL environment and the reaction under functional rest. blackwater fever be unknown in the Skoplje area,, The majority of patients with middle-ear inflammations while here in Greek Macedonia as many as 36 are ambulatory partly from custom, partly because it cases were reported for last year in the hospital ofis easier for the patient to come to the doctor than it is for the doctor to carry around his apparatuses. NaturNea Moudania alone ? To anyone interested in research, or in the medicall ally the patient feels that his condition is not one that organisation of a " new " country, the institute at; requires either local or somatic rest. There is a great deal of difference in the treatment of the ear and the Skoplje is a veritable happy hunting ground. meticulous care of the eye. Why ? I am, Sir, vours faithfullv, It may be impracticable to suggest sound-proof CICELY D. WILLIAMS, M.B. Oxf. rooms for aural inflammations, and of course it would Society of Friends, Salonika, May 10th, 1928. necessitate a great change in hospitals to have soundproof rooms. If that radical measure may not havea SOUND DEADENED ROOMS IN THE TREAT- utilitarian appeal, at least the endeavour to lessen sound for the treatment of aural cases would be of MENT OF AURAL INFLAMMATIONS. decided benefit. I believe also that the onset of senile deafness would be slowed by occasional rest from To the Editor of THE LANCET. noise a rest that may be partially gained by wearing we consideration to the damage occlusive SIR,—When give plugs occasionally. I make the suggestion, of the internal ear from the influence of constant noise that sound-deadened rooms should be used therefore, as seen in certain occupations where noise is confor aural inflammations and that the majority of acute comitant, we realise that the ear has not received the ear infections should not be allowed to be protection that has been given to other organs by but should at least be semi-hospitalised in aambulatory, quiet room. functional rest, especially during inflammation. The I venture to assert if would furnish soundhospitals stomach is rested by a careful diet. The heart is deadened rooms for the treatment of aural cases we helped by interdiction of the strain of exercise. The might see fewer sequelae which at present area eye is kept shaded or in a dark room or its active to aural surgery and there would be instituted function is minimised by atropine. An injured joint reproach a distinct advance in preventive medicine. is mobilised. I might cite many examples where I am, Sir, yours faithfully, functional rest is considered a sine qua non of treatGEORGE B. MCAULIFFE. ment in inflammation. No one has ever considered West 87th-street, New York City, April 21st, 1928. 26, that the ear should receive the same care. Middle-ear inflammations are allowed to pass through their course without any thought that they are prejudiced by the MEDICO-LEGAL RESEARCH. environmental clamour. The sequels of chronicity To the Editor of THE LANCET. and mastoid involvement are almost accepted as ineluctable ; we consider that we have done our best SIR,—In your leading article on Status Lymphaticus for conservation when we have opened the drum and LANCET, May 26, p. 1078) you deplore the (THE used isotonic or antiseptic irrigations with appropriate absence of a central institution in London where all therapy to the nasopharynx and the nose. A striking medico-legal work could be concentrated in the hands fact in the effect of noise on the internal ear is that of experienced pathologists to solve this and similar only the tones that reach the internal ear through the problems. One such problem is the constant occuroval window cause this degenerative change. Does it rence of suicide attributed to ridiculously inadequate not seem reasonable that the functional activity of the reasons. The oft-told of " recent pains in the story middle ear may aggravate congestion and increase the head and strangeness of manner " usually ends with a potentiality of the aural sequelae ? We see so often verdict of temporary insanity, with no attempt to aural inflammations which are beginning to show discover by expert investigation the essential disease operative necessity resolve completely when hos- leading to such disaster. New light on the pathogenesis much more benefit accrue to would pitalised ; how of such cases would help to prevent some of these this partial rest by a more or less complete functional calamities. rest ? The influence of silence on the course of One would like to feel there is a likelihood of your laryngeal affections has been demonstrated and important suggestion leading to some such central appreciated. institute being organised. The ear stands alone of all the organs in that it gets I am, Sir, yours faithfully, no real rest during the 24 hours. The ossicles and PATRICK WATSON-WILLIAMS. drum membrane are receiving all sounds and transmitting them even in sleep. That we do not perceive all the sounds is due to the sleep of the higher centres RHAZES AND AVICENNA. resulting in a lack of attention. How much influence may over-function have in starting up the peculiar To the Editor of THE LANCET. degeneration of the ear in otosclerosis ? Why does the spongifying osteitis start around the place of SIR,—The eloquent and learned Linacre Lecture greatest functional activity-the oval window ? We by Sir George Newman published in your issue of may give due credit to the influence of endocrine May 12th, cannot but have given great pleasure to all dysfunction, to hereditary dyscrasy, to changes in who heard it or have read it. I hope, however, he calcium content or to other theories of this insidious, will allow me to offer an amplification of the sentence, progressive, and incurable deafness, but we cannot in which he numbers Rhazes and Avicenna among the explain why it begins at the foot plate of the stapes, Arab physicians. It is true that they practised the place of greatest functional activity of the ear. Arabian medicine, visited Bagdad, and wrote in Senile deafness, appearing more early in life and before Arabic, the scientific language of their day, but they senescence of other special organs, is due to the over- were both Persians and were, as Sir George himself stimulation of our modern environment. The clamant makes clear, original thinkers as well. Rhazes was
the
are even
.
villages, anti-malaria work
is directed, and thereneed, apparently, is rest. Physicists are experibath houses in many places where schoolL menting in sound-proof rooms for the use of testing children are washed compulsorily once a week-albeit apparatuses to determine acoustic acuity. No attempt has been made to gauge the benefit of that at first this sometimes needed the assistance off the gendarmarie. That such perfection is possible inL functional rest in middle-ear inflammations ; this has never been considered as a part of the treatment and the Balkans must be seen to be believed. We were treated with the greatest possible kindness; has not been deemed necessary. Is it not possible -in five languages- by the director, Dr. Rankov andL that the continuous onslaught of sound would by conhis assistants, who were willing to give unlimited time duction vibrations keep up or aggravate congestion ? and trouble in showing their work to foreign visitors. No differential trial has been made to determine the It is a remarkably good centre for studying some ofF reaction of the inflamed ear under the ordinary the problems of malaria. Why, for instance, shouldL environment and the reaction under functional rest. blackwater fever be unknown in the Skoplje area,, The majority of patients with middle-ear inflammations while here in Greek Macedonia as many as 36 are ambulatory partly from custom, partly because it cases were reported for last year in the hospital ofis easier for the patient to come to the doctor than it is for the doctor to carry around his apparatuses. NaturNea Moudania alone ? To anyone interested in research, or in the medicall ally the patient feels that his condition is not one that organisation of a " new " country, the institute at; requires either local or somatic rest. There is a great deal of difference in the treatment of the ear and the Skoplje is a veritable happy hunting ground. meticulous care of the eye. Why ? I am, Sir, vours faithfullv, It may be impracticable to suggest sound-proof CICELY D. WILLIAMS, M.B. Oxf. rooms for aural inflammations, and of course it would Society of Friends, Salonika, May 10th, 1928. necessitate a great change in hospitals to have soundproof rooms. If that radical measure may not havea SOUND DEADENED ROOMS IN THE TREAT- utilitarian appeal, at least the endeavour to lessen sound for the treatment of aural cases would be of MENT OF AURAL INFLAMMATIONS. decided benefit. I believe also that the onset of senile deafness would be slowed by occasional rest from To the Editor of THE LANCET. noise a rest that may be partially gained by wearing we consideration to the damage occlusive SIR,—When give plugs occasionally. I make the suggestion, of the internal ear from the influence of constant noise that sound-deadened rooms should be used therefore, as seen in certain occupations where noise is confor aural inflammations and that the majority of acute comitant, we realise that the ear has not received the ear infections should not be allowed to be protection that has been given to other organs by but should at least be semi-hospitalised in aambulatory, quiet room. functional rest, especially during inflammation. The I venture to assert if would furnish soundhospitals stomach is rested by a careful diet. The heart is deadened rooms for the treatment of aural cases we helped by interdiction of the strain of exercise. The might see fewer sequelae which at present area eye is kept shaded or in a dark room or its active to aural surgery and there would be instituted function is minimised by atropine. An injured joint reproach a distinct advance in preventive medicine. is mobilised. I might cite many examples where I am, Sir, yours faithfully, functional rest is considered a sine qua non of treatGEORGE B. MCAULIFFE. ment in inflammation. No one has ever considered West 87th-street, New York City, April 21st, 1928. 26, that the ear should receive the same care. Middle-ear inflammations are allowed to pass through their course without any thought that they are prejudiced by the MEDICO-LEGAL RESEARCH. environmental clamour. The sequels of chronicity To the Editor of THE LANCET. and mastoid involvement are almost accepted as ineluctable ; we consider that we have done our best SIR,—In your leading article on Status Lymphaticus for conservation when we have opened the drum and LANCET, May 26, p. 1078) you deplore the (THE used isotonic or antiseptic irrigations with appropriate absence of a central institution in London where all therapy to the nasopharynx and the nose. A striking medico-legal work could be concentrated in the hands fact in the effect of noise on the internal ear is that of experienced pathologists to solve this and similar only the tones that reach the internal ear through the problems. One such problem is the constant occuroval window cause this degenerative change. Does it rence of suicide attributed to ridiculously inadequate not seem reasonable that the functional activity of the reasons. The oft-told of " recent pains in the story middle ear may aggravate congestion and increase the head and strangeness of manner " usually ends with a potentiality of the aural sequelae ? We see so often verdict of temporary insanity, with no attempt to aural inflammations which are beginning to show discover by expert investigation the essential disease operative necessity resolve completely when hos- leading to such disaster. New light on the pathogenesis much more benefit accrue to would pitalised ; how of such cases would help to prevent some of these this partial rest by a more or less complete functional calamities. rest ? The influence of silence on the course of One would like to feel there is a likelihood of your laryngeal affections has been demonstrated and important suggestion leading to some such central appreciated. institute being organised. The ear stands alone of all the organs in that it gets I am, Sir, yours faithfully, no real rest during the 24 hours. The ossicles and PATRICK WATSON-WILLIAMS. drum membrane are receiving all sounds and transmitting them even in sleep. That we do not perceive all the sounds is due to the sleep of the higher centres RHAZES AND AVICENNA. resulting in a lack of attention. How much influence may over-function have in starting up the peculiar To the Editor of THE LANCET. degeneration of the ear in otosclerosis ? Why does the spongifying osteitis start around the place of SIR,—The eloquent and learned Linacre Lecture greatest functional activity-the oval window ? We by Sir George Newman published in your issue of may give due credit to the influence of endocrine May 12th, cannot but have given great pleasure to all dysfunction, to hereditary dyscrasy, to changes in who heard it or have read it. I hope, however, he calcium content or to other theories of this insidious, will allow me to offer an amplification of the sentence, progressive, and incurable deafness, but we cannot in which he numbers Rhazes and Avicenna among the explain why it begins at the foot plate of the stapes, Arab physicians. It is true that they practised the place of greatest functional activity of the ear. Arabian medicine, visited Bagdad, and wrote in Senile deafness, appearing more early in life and before Arabic, the scientific language of their day, but they senescence of other special organs, is due to the over- were both Persians and were, as Sir George himself stimulation of our modern environment. The clamant makes clear, original thinkers as well. Rhazes was
the
are even
.