NASO-PHARYNGEAL INFECTIONS AND EPIDEMIC JAUNDICE.

95 and difficulties of the general medical practitioner. underlying hepatic disturbance, may precipitate an Having been approached on the matter, we venture attack. There is probably some disturbance of the blood to solicit the support of the profession as two general practitioners representing industrial and rural areas calcium as well in patients who get colds. Dr. J. A. respectively. We are both in the active pursuit of Glover evidently had this metabolic aspect of the our profession, and have had a good deal of experience question in view when he recommended the inclusion of administrative and medico-political work, which in the diet of oranges, vegetables, salads, and watercress. The border-line between these cases of colds we hope would be of value if the profession should One of us (J. W. with disturbed hepatic function and those of epidemic see fit to endorse our candidature. I do not Bone) has had 32 years in general practice, private catarrhal jaundice seems to me slight. and contract, in the industrial area of Luton, has refer to those cases of jaundice definitely due to the served on the Insurance Acts Committee for five Lept08pira icterohaemorrhnqiae. I agree with Buchanan years, and at the present time has the honour to and Ross, quoted in your leading article, when they be a member of the Council of the British Medical propose a bacteriological examination of the nasoAssociation and chairman of its Medico-Political pharynx and intestine in cases of epidemic jaundice. Committee. The other (E. K. Le Fleming) is familiar I would go further and suggest that not only bacteriowith other aspects of private and contract practice logical but biochemical investigation is required. In through 27 years’ work in the rural area of Wimborne ; epidemics of catarrhal colds, or influenza, I have whilst in addition to serving on the Council of the often wondered to what extent the jaundice assoBritish Medical Association and the Insurance Acts ciated with some of those cases was primarily due to Committee he has been honoured by the confidence the catarrhal organisms, or to a previous hepatic of the insurance practitioners for the past five years disturbance caused by some bowel organism--e.g., as chairman of the Conference of Local Medical and B. roli, which has become pathogenic. It is not Panel Committees of the United Kingdom. easy to explain the fact that organisms in the nose Our experience in interpreting the collective views and throat seem only sometimes to become pathoof our fellow practitioners and our willingness to genic. My reading of it is that the soil has been devote whatever time and energy may be necessary prepared for them by metabolic and biochemical disto the proper fulfilment of the duties of a Direct turbances through atmospheric conditions, improper Representative embolden us to solicit the support diet, overcrowding, insufficient fresh air and exercise, of the profession generally. so that it is easy for activated organisms to find We are. Sirs. vours faithfullv. suitable soil when propagated by droplet infection. JOHN W. BONE. This droplet infection does not explain the numerous E. K. LE FLEMING. cases of colds which seem to spring up perhaps July 7th, 1928. on the same day, at the very start of a catarrhal season, often in scattered parts of the town and NASO-PHARYNGEAL INFECTIONS AND country, and in people who have not been exposed to infection, but suggests auto-activation. EPIDEMIC JAUNDICE. The special frequency of post-operative pneumonia To the Editor of THE LANCET. in cases of gall-bladder disease, gastric and duodenal 30th a issue of June ulcers, where the toxaemia factor is always more or SiR,-In your you publish report of a discussion on naso-pharyngeal epidemics in less in evidence, is an allied problem which demands public schools and an interesting leading article on investigation. I am, Sir. yours faithfully, epidemic jaundice in Great Britain. I have already R. CHALMERS, M.D., F.R.C.S.E. in communications to the medical journals expressed Darlington, June 30th, 1928. my views as to the aetiology of the common cold, pointing out that the bacteriological aspect of these conditions does not cover the whole question; in fact, that bacteria may not be the primary agent at all, " MANSON HOUSE." but that there is an underlying biochemical aspect To the Editor of THE LANCET. which may be more essential. Organisms which were the report in your issue of June 30th on formerly harmless saprophytes may become patho- . SiB,—In the a result of the anniversary dinner of this society and as disturbed twenty-first infective, genic biochemistry of the intestine, liver, and blood stream. Dr. Andrew Balfour is quoted as saying that " over Routine examination of the urine of people in ill- 23000 had been raised towards the provision of a Society." The verbatim, report health has shown me the frequent occurrence, about manson house for the " I should like to speak of the and prior to a catarrhal season, of cases showing before me reads, evidence of disturbed intestinal hepatic function, Manson Fund to provide what is going to be called possiblyManson House.’ I say possibly because as indicated by the presence of indican, bile oxalates, and other bodies in the urine. The finding of similar there is a distinguished member of our Council who, evidence in many patients with catarrhal colds has so little faith in the sobriety of his fellow Fellows (probably these might be regarded as carriers) led that he feels that’Manson House ’ might be mistaken me to think that the metabolic disturbance was the for the building near the Bank or some celestial and he has proposed that it should be underlying cause of the activation of the organisms habitation, in the nose and throat. It is difficult to be dogmatic calledPatrick Manson House’ to prevent any I hope it will be calledPatrick on this point, since one is not called to see these such difficulty. patients until the catarrhal attack develops ; but Manson House.’" Comment is not required. I am, Sir, yours faithfully, I have had suggestive cases. One in particular who CLAYTON LANE, came to me in the height of summer because he was Joint. Hon. Secretary, Royal Society of Tropical Medicine out of sorts. Examination did not reveal much and Hygiene. wrong objectively, except that the urine contained 11, Chandos-street, Cavendish-square, London, W., bile. Treatment, directed to this conditionJuly 4th, 1928. ammonium chloride with alkalies-resulted on the third or fourth day after in his developing an acute , LIVER TREATMENT IN PERNICIOUS ANÆMIA. fulminating catarrhal cold. Recent American writers have been leaning to To the Editor of THE LANCET. this metabolic aspect of the common cold and have claimed that it is due to a mild acidosis ; and that SIR,-Dr. T. H. Anderson in your issue of they could precipitate an attack by the administration March 31st (p. 674) wishes to know if Orientals have of calcium chloride or ammonium chloride. One long been using powdered liver for pernicious anaemia. cannot subscribe to this view entirely, since many It may interest him to learn that desiccated flesh of patients take these drugs without evincing any signs a carnivorous crow has for ages been used by the of a cold ; but their exhibition, when there is an Indian vaid (herbalist) for a condition allied to I

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