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MIDDLE-EAR DISEASE IN INFANCY
1310
T
X radiation of the whole body and endocrine glands over a year. In view of the uncertainty of the effects of whole-body radiation only these three cases had been treated up to two years ago. Here is a method by which there is some possibility of a great advance, yet there is nothing in the report of the British Empire Cancer Campaign about research in this direction, nor the radiation of large areas of the body with a view to increasing the patient’s resistance to the cancerous invasion and increasing the radiosensitivity of malignant growths. I am, Sir, yours faithfully,
was
extending
WILFRID GARTON. TRACHOMA IN REFUGEE CHILDREN To the Editor of THE LANCET
SIR,-Lord Lloyd in the House of Lords last night performed a public service by asking a question as to the incidence of trachoma among the refugee children from Spain who have arrived in this country. It is known that in many of the provinces of Spain the disease is practically universal. Lord Lloyd was informed that a voluntary body called the National Joint Committee for Spanish Relief sent out some doctors to examine the children before they left Bilbao. It is not reported that any of these gentlemen had any experience of trachoma or even any special knowledge of ophthalmology. The examination of the eyes of 4000 children by port medical officers on arrival at Southampton was an absolute impossibility. It is therefore still unknown what proportion of the children if any is trachomatous. The difficulty in making a diagnosis in the early stages of the disease, its contagious nature, the long period required for treatment, and its devastating effects on visual acuity make it important to decide the matter. If the children are to be kept segregated in a camp no danger will accrue to the surrounding inhabitants. On the other hand, if a few of them are trachomatous and are temporarily placed in Salvation Army or other homes in contact with other children there is every expectation of a recrudescence of the disease in this country. In this matter the responsibility of the Ministry of Health is very great. I am, Sir, yours faithfully, A. F. MACCALLAN, President of the International Organisation London, May 26th. against Trachoma. MIDDLE-EAR DISEASE IN INFANCY
To the Editor
of
THE LANCET
Sir,- was very interested in the leading article in your last issue. At the Hospital for Sick Children, Great Ormond-street, it has been recognised for some years that pus in the middle ear and mastoid is a frequent autopsy finding, especially in infants dying of gastro-enteritis. I have just looked through the post-mortem records of the past two years and observe that out of the 170 autopsies in which the middle ears were examined, just over 50 per cent. had pus in one or both. This agrees closely with Dr. Ebbs’s figures for a much larger series. All but a small proportion of these positives were in children under two years of age. Another fact that emerges is that a much higher proportion of children dying from gastro-enteritis have pus in their middle ears than those dying from other diseases. Thus 33 (65 per cent.) out of 43 cases of gastro-enteritis had one or both ears infected whereas of 100 children under two dying of some other disease only 44 had pus in one or both middle ears. From these figures it seems that the infant suffering from gastro-enteritis is particularly liable to a middle-
The gastro-intestinal infection is, I ear infection. think, undoubtedly in some cases secondary to the otitis media ; but, in my view, in the majority of the otitis supervenes during the course of the gastro-enteritis and, as Dr. Ebbs suggests, may contribute to the fatal issue. All who have to deal with these patients know how difficult of diagnosis the otitis media may be. Not only are there no symptoms but frequently the appearance of the drum is normal. It must be a common experience for the ears to be pronounced normal only to find them full of pus at the autopsy a day or two later. One should never hesitate to incise a drum should there be any suspicion, such as a sudden unexplained rise of temperature would provoke, that the middle ear has become infected. The ventilation of this difficult subject at the Royal Society of Medicine discussion should stimulate both otologists and paediatricians to cooperate in investigating this widespread malady. I am, Sir, vours faithfully. cases
G. H. NEWNS. Hospital for Sick Children, Great Ormond-street, May 25th. A REMEDY FOR HÆMORRHOIDS
To the Editor
of THE LANCET of May 22nd (p. 1261)
SiR,-In your issue you refer to a very recent paper in the Revista sudamericana de endocrinología immunologia y quimioterapia in which an oily solution of an extract of the earthworm Jlicroscolex dubius (Fletcher) is recommended as a remedy for piles. It may perhaps interest your readers to learn that this is a very ancient treatment. Stephenson, in his monograph on the Oligochseta, quotes Damiri, the author of an Arabic treatise on the life of animals, written in A.D. 1371, as saying that suppositories made from earthworms fried in olive oil and powdered are highly beneficial to persons suffering from piles. I am, Sir, yours faithfully, C. C. A. MONRO British Museum (Natural History), Cromwell-road,
S.W., May 22nd.
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED MAY 1937
15TH,
Notifications.-The following cases of infectious disease were notified during the week : Small-pox, 0 ; scarlet fever, 1440 ; diphtheria, 781 ; enteric fever, 24 ; pneumonia (primary or influenzal), 798 ; puerperal fever, 26 ; puerperal pyrexia, 108 ; cerebrospinal fever, 30 ; acute poliomyelitis, 5 ; acute polio-encephalitis, 2 ; encephalitis lethargica, 5; continued fever, 1 (Nuneaton) ; dysentery, 16; ophthalmia neonatorum, 76. No case of cholera, plague, or typhus fever was notified during the week. The number of cases in the Infectious Hospitals of the London County Council on May 21st was 2967 which included : Scarlet fever, 783 ; diphtheria, 856 ; measles, 76 ; whooping-cough, 496 ; puerperal fever, 17 mothers (plus 12 babies) ; encephalitis lethargica, 283 ; poliomyelitis, 0. At St. Margaret’s Hospital there were 20 babies (plus 12 mothers) with ophthalmia neonatorum.
Deaths.-In 123 great towns, including London, there was no death from small-pox, 3 (0) from enteric fever, 13 (0) from measles, 3 (0) from scarlet fever, 20 (6) from whooping-cough, 19 (3) from diphtheria, 57 (13) from diarrhoea and enteritis under two years, and 36 (5) from influenza. The figures in parentheses are those for London itself. The fatal cases of enteric fever were at Portsmouth, Southampton, and Southend-on-Sea. Liverpool reported 3 deaths from whooping-cough. Diarrhoea was fatal in 3 cases each at Liverpool and Nottingham. The number of stillbirths notified during the week was 277 (corresponding to a rate of 43 per 1000 total births), including 51 in London.
T
X radiation of the whole body and endocrine glands over a year. In view of the uncertainty of the effects of whole-body radiation only these three cases had been treated up to two years ago. Here is a method by which there is some possibility of a great advance, yet there is nothing in the report of the British Empire Cancer Campaign about research in this direction, nor the radiation of large areas of the body with a view to increasing the patient’s resistance to the cancerous invasion and increasing the radiosensitivity of malignant growths. I am, Sir, yours faithfully,
was
extending
WILFRID GARTON. TRACHOMA IN REFUGEE CHILDREN To the Editor of THE LANCET
SIR,-Lord Lloyd in the House of Lords last night performed a public service by asking a question as to the incidence of trachoma among the refugee children from Spain who have arrived in this country. It is known that in many of the provinces of Spain the disease is practically universal. Lord Lloyd was informed that a voluntary body called the National Joint Committee for Spanish Relief sent out some doctors to examine the children before they left Bilbao. It is not reported that any of these gentlemen had any experience of trachoma or even any special knowledge of ophthalmology. The examination of the eyes of 4000 children by port medical officers on arrival at Southampton was an absolute impossibility. It is therefore still unknown what proportion of the children if any is trachomatous. The difficulty in making a diagnosis in the early stages of the disease, its contagious nature, the long period required for treatment, and its devastating effects on visual acuity make it important to decide the matter. If the children are to be kept segregated in a camp no danger will accrue to the surrounding inhabitants. On the other hand, if a few of them are trachomatous and are temporarily placed in Salvation Army or other homes in contact with other children there is every expectation of a recrudescence of the disease in this country. In this matter the responsibility of the Ministry of Health is very great. I am, Sir, yours faithfully, A. F. MACCALLAN, President of the International Organisation London, May 26th. against Trachoma. MIDDLE-EAR DISEASE IN INFANCY
To the Editor
of
THE LANCET
Sir,- was very interested in the leading article in your last issue. At the Hospital for Sick Children, Great Ormond-street, it has been recognised for some years that pus in the middle ear and mastoid is a frequent autopsy finding, especially in infants dying of gastro-enteritis. I have just looked through the post-mortem records of the past two years and observe that out of the 170 autopsies in which the middle ears were examined, just over 50 per cent. had pus in one or both. This agrees closely with Dr. Ebbs’s figures for a much larger series. All but a small proportion of these positives were in children under two years of age. Another fact that emerges is that a much higher proportion of children dying from gastro-enteritis have pus in their middle ears than those dying from other diseases. Thus 33 (65 per cent.) out of 43 cases of gastro-enteritis had one or both ears infected whereas of 100 children under two dying of some other disease only 44 had pus in one or both middle ears. From these figures it seems that the infant suffering from gastro-enteritis is particularly liable to a middle-
The gastro-intestinal infection is, I ear infection. think, undoubtedly in some cases secondary to the otitis media ; but, in my view, in the majority of the otitis supervenes during the course of the gastro-enteritis and, as Dr. Ebbs suggests, may contribute to the fatal issue. All who have to deal with these patients know how difficult of diagnosis the otitis media may be. Not only are there no symptoms but frequently the appearance of the drum is normal. It must be a common experience for the ears to be pronounced normal only to find them full of pus at the autopsy a day or two later. One should never hesitate to incise a drum should there be any suspicion, such as a sudden unexplained rise of temperature would provoke, that the middle ear has become infected. The ventilation of this difficult subject at the Royal Society of Medicine discussion should stimulate both otologists and paediatricians to cooperate in investigating this widespread malady. I am, Sir, vours faithfully. cases
G. H. NEWNS. Hospital for Sick Children, Great Ormond-street, May 25th. A REMEDY FOR HÆMORRHOIDS
To the Editor
of THE LANCET of May 22nd (p. 1261)
SiR,-In your issue you refer to a very recent paper in the Revista sudamericana de endocrinología immunologia y quimioterapia in which an oily solution of an extract of the earthworm Jlicroscolex dubius (Fletcher) is recommended as a remedy for piles. It may perhaps interest your readers to learn that this is a very ancient treatment. Stephenson, in his monograph on the Oligochseta, quotes Damiri, the author of an Arabic treatise on the life of animals, written in A.D. 1371, as saying that suppositories made from earthworms fried in olive oil and powdered are highly beneficial to persons suffering from piles. I am, Sir, yours faithfully, C. C. A. MONRO British Museum (Natural History), Cromwell-road,
S.W., May 22nd.
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED MAY 1937
15TH,
Notifications.-The following cases of infectious disease were notified during the week : Small-pox, 0 ; scarlet fever, 1440 ; diphtheria, 781 ; enteric fever, 24 ; pneumonia (primary or influenzal), 798 ; puerperal fever, 26 ; puerperal pyrexia, 108 ; cerebrospinal fever, 30 ; acute poliomyelitis, 5 ; acute polio-encephalitis, 2 ; encephalitis lethargica, 5; continued fever, 1 (Nuneaton) ; dysentery, 16; ophthalmia neonatorum, 76. No case of cholera, plague, or typhus fever was notified during the week. The number of cases in the Infectious Hospitals of the London County Council on May 21st was 2967 which included : Scarlet fever, 783 ; diphtheria, 856 ; measles, 76 ; whooping-cough, 496 ; puerperal fever, 17 mothers (plus 12 babies) ; encephalitis lethargica, 283 ; poliomyelitis, 0. At St. Margaret’s Hospital there were 20 babies (plus 12 mothers) with ophthalmia neonatorum.
Deaths.-In 123 great towns, including London, there was no death from small-pox, 3 (0) from enteric fever, 13 (0) from measles, 3 (0) from scarlet fever, 20 (6) from whooping-cough, 19 (3) from diphtheria, 57 (13) from diarrhoea and enteritis under two years, and 36 (5) from influenza. The figures in parentheses are those for London itself. The fatal cases of enteric fever were at Portsmouth, Southampton, and Southend-on-Sea. Liverpool reported 3 deaths from whooping-cough. Diarrhoea was fatal in 3 cases each at Liverpool and Nottingham. The number of stillbirths notified during the week was 277 (corresponding to a rate of 43 per 1000 total births), including 51 in London.