OPEN WINDOWS IN THE TREATMENT OF CERTAIN DISEASES.

838 When these doctors first went up to Harbin the work was much obstructed by some of the local officials. Subsequently, by orders from Peking, these men were degraded, and thereafter the governor of the province and other officials did everything in their power to help the medical men in charge. The bodies of the dead were burnt to the number of about 4000, and have not been left lying about the streets as your correspondent describes. A large and efficient staff of I may add here that Dr. McIntosh and Dr. sanitary police has been employed, while house-to-house number. Fildes’s assumption that, in my statement that treat- inspection, rehousing, and isolation work have been steadily ment by "606"is symptomatic only and "not treatment carried on, with the very satisfactory results described above. of the disease itself," I "refer apparently to the spiro- Naturally, the distress and suffering have been very great, but chaste," is incorrect; the spirochaste is by no means more from the intense cold and entire dislocation of trade It is these conditions the only factor concerned in syphilis, as Sir Jonathan than even from the plague itselt. Hutchinson has well pointed out in the new edition which have made the work so extremely difficult. Part of of his book. Dr. Levy-Bing,3 who has just published the Chinese Town had to be burnt down and large numbers the results of six months’ experience with intramuscular of people had to be temporarily housed, whilst many more, as injections of "606"at the St. Lazare Hospital, Paris, also could only be expected and unfortunately could not he comes to the conclusion that this preparation only cures the prevented, scattered to other parts of the country. In consequence, the town is in some measure deserted at the symptoms of syphilis, not the disease itself. 2. Dr. McIntosh and Dr. Fildes consider that 606,’ present time. It is a pity, however, that these reports sent from St Peters. applied at properly ascertained times, will prevent the onset of symptoms with far less inconvenience and effect upon the burg should be so inaccurate and misleading, as they bring general health than" mercury." But, so far, there is no discredit on the excellent work which has been done and evidence that " 606 has any action in preventing the onset which has been fully acknowledged by the Russian medical of symptoms; in fact, according to Levy-Bing, recurrent authorities. Similar reports have previou.ly been circulated symptoms are more frequent, and often of greater severity, through St. Petersburg, an example occurring only the other after treatment by "606"" than after mercurial treatment. day, when it was stated that 18 out of 19 Chinese doctors With regard to the effect of mercury on the general health, had died of plague at Knanchengtze. The faers subsequently so far as my experience goes (and this agrees with that of telegraphed by Dr. Young, also of the Union Medical Sir Jonathan Hutchinson) the general health is generally College, Peking, were as follows: "Hospital under native doctors closed because four nurses, two doctors died. No improved by a course of mercury. 3. Dr. McIntosh and Dr. Ftldes are undoubtedly correct precautions observed." This probably refers to a hospital in stating that "’606’ will probably be used by the un- manned by untrained Chinese doctors, many of whom have skilled," but that this will be "without danger " is hardly served bravely and faithfully in spite of their insufficiency of to be believed. Apart from the deaths and other severe medical knowledge. Before leaving Peking at the end of February I had accidents following the injection of this preparation, which may in part, I admit, be attributed to faulty technique, abundant opportunity of seeing and hearing about the work there is an increasing amount of evidence to show that done to prevent the spread of the plague. In consequence "606"" has a deleterious effect on the nerves. This of ignorance of the danger and of the grievous insufficiency neurotropic action has been pointed out by Buschke and of trained medical men, the work was begun late and carried Fischer, Finger, Stern,6 and others, who have reported out under many difficulties ; but, speaking generally, the cases of paralysis of the ocular muscles and affections of necessary measures were widely and gladly adopted and the the internal ear. Buschke even goes so far as to consider officials heartily cooperated in the work. It is to be hoped, that, in addition to the directly injurious effects of arsenic, however, that the present circumstances will help to awaken "606"" may cause deposits of arsenic in the internal the Chinese Government and people to the intense need of organs, which predispose to further manifestations of national public health work, and of efficiently trained men to I am. Sir. vnurs fa.ithfnllv. Finger, on account of this neurotropic action of ca,rrv this nut. syphilis. " not consider it indicated for the treatH. V WENHAM. does 606," ordinary St. Bartholomew’s Hospital, London, E.C., March 18th, 1911. "Aus den Gesagten glaube ich zum ment of syphilis. Sohlusse kommen zu sollen, dass das Arsenobenzol sich vorla.u6g zur Anwendung in der Praxis nicht eignet." I am, Sir, yours faithfully, OPEN WINDOWS IN THE TREATMENT OF C. F. MARSHALL. London, N.W., March 18th, 1911.

they explain the undoubted healing effect of this preparation in cases of malignant syphilis, in the lesions of which, according to Buschke,2 spirochastes are absent. The explanation given by Buschke is that the action of arsenobenzol is not parasitotropic, as Ehrlich supposed, but organotropic, and that it acts in a similar way to mercury and iodides. This view also applies to the lesions of tertiary syphilis, in which spirochætes are absent or few in how

.

CERTAIN DISEASES.

"TERRIBLE NEWS OF THE PLAGUE." To ttw Editor

of THE LANCET.

SIR,-I have read in this week’s issue of THE LANCET a report from St. Petersburg forwarded bv your Constantinople

correspondent and entitled Terrible News of the Plague." The news may be terrible, but is not in any way founded on fact. I have but a few days ago returned from Peking, travelling through Manchuria, and when at Makden met two of the workers from Harbin-namely, Dr. Wu and Dr. J. M. Stenhouse-so that I had ample opportunity of learning about the exact position of affairs. As has been already reported by your China correspondent, active and effectual antiplague work has been carried on in the Chinese town of Harbin (Fuchiatien) for the last two months or more by Dr. Wu and other Chinese doctors, assisted by Dr. J. G. Gibb. Dr. W. H. G. Aspland, and Dr. Stenhouse, who are colleagues of my own at the Union Medical College, Peking. At the beginning of February the death-rate in Fuchiatien was as high as 150 a day, but since then conditions have steadily improved, so that at the time of my leaving (Feb. 28 th) it had fallen as low as only two a day. 2

Berliner Klinische Wochenschrift, No. 1, 1911. Annales des Maladies Vénériennes, March, 1911. 4 Loc cit. 5 Wiener Klinische Wochenschrift, Nov. 24th, 1910. Deutsche Medizinische Wochenschrift, Jan. 5th, 1911. 3

6

To the Editur of THE LANCET. SIR,-About three years ago I called attention to certain facts which seemed to indicate that the prevalence of adenoids among children resulted from making them sleep during cold and damp weather with the windows open. Among other things I then noted, of 49 children who had been brought up strictly on the open-window system 22 had been operated on for adenoids, while in 69 children who had been brought up on the shut-window system only two cases of adenoids were observed. Further investigation seems to me to have confirmed the supposition that cold and damp air predisposes to, or is in some way generally associated with, the causation of adenoids, and I understand that some laryngologists now admit my contention. Indeed, one told me that he was now "absolutely convinced," and another that he had been "completely converted." Further considerations have led me to suspect the wisdom of treating certain diseases on the open-window system. That cold and damp weather has a very marked effect on the prevalence and severity of certain diseases is conclusively shown by the frequency of these diseases in winter and the mortality returns at particular periods of the year associated with cold and damp weather. On the other hand, as far as I have been able to learn, there are no satisfactory statistics which indicate that the open-window treatment of iafluenza, common colds, measles, and bronchitis is attended with more beneficent results than the shut-window system. The

839

prevalence

of such

a

deadly

disease

as

pneumonia

so

electricity

is obtained the cost for power should not be

more

1½d. per unit, and to avoid another risk also mentioned that we should at least have some very definite statistical -viz., failure of ventilation by breakdown of motor working evidence as to the effect of the open-window system in the the fans-the motors and fans should be in duplicate.

frequently following some of the diseases referred to indicates

than

treatment of these diseases during cold and damp weather. Of course, I am not suggesting that efficient ventilation by night as well as by day is not desirable, nor that there may not be more chance of infection for others in the same room,

As in my experience there are very few places where drains and sewers are sound, the value is seen of adopting some such system of sewer ventilation so nobly tried by the advanced town of Leicester, and so ably explained by your Sanitary Commissioner, and the wide publication of your report should tempt some of our good philanthropists who have the good health of the nation one of their objects. I am, Sir, yours faithfully, D. T. BOSTEL. Ebury-street, London, S.W., March 8th, 1911.

if the windows are kept closed, nor even that in good health it is not desirable to become hardened as far as possible to the ordinary climatic variations which are likely to have to be encountered. My point is, that when any of the diseases mentioned is present that is not the time, in the majority of cases at least, for anything but sheltering the patient from certain climatic vicissitudes. Open windows A DISCLAIMER. are particularly objectionable in all probability when a child To Editor of THE LANCET. the is ill and has hitherto not been habituated to the pouring in a SIR,-Mr. Dixon, Christian Scientist, lately said in the of cold and damp air through the open window. It would -Revie7v that I Ideclared openly, a few months ago, that one of the first Satitrday which be however, appear, things may that is such a mania for the removal of the appendix." there done, immediately a nurse for a sick child has been procured, is to open, and keep open, the windows dav and night Let me say that I never said anything of the kind, nor wrote anywhere. Mr. Dixon isattributing to me what somebody regardless of the nature of the disease, the kind of weather it, else to which the child hitherto been may have said.-I am, Sir, yours faithfully, or the conditions have may STEPHEN PAGET. I am. Sir, yours faithfully, Ladbroke-square, W., March 21st, 1911. accustomed. J. SIM WALLACE. Wimpole-street, W., March 7th, 1911. "

MUSCULAR SPASM IN CARIES OF THE SPINE. EYE-STRAIN IN RELATION TO GENERAL To M6 Nattor or THE LANCET. HEALTH. SIR,-While being naturally gratified at the appreciation To the Editor of THE LANCET. of my work, which so well-known an authority on spinal SIR,—It is not easy to grasp the point of Mr. Kenneth curvatures as Mr. Roth has been kind enough to express, Campbell’s letter in THE LANCET of March 18th. I take it I must confess some surprise at his protest against my be admits the possibility of local cerebral congestion, though suggestion that muscular spasm is a factor of importance in contradicted by experimental research, and denies that such the production of deformity in spinal caries. a factor could cause the symptoms usually attributed to Mr. Roth’s assertion that I have assumed the action "eye-strain "in view of the fact that the brain is insensi- of a whole group oF muscles which do not exist is tive." Headache is one of the commonest results of so-called unwarranted ; his appeal to you to admit that such "eye-strain," it is also the result of many other conditions- muscles exist only in my imagination is almost pathetic ; If then the sensitiveness of the brain while his toxic, traumatic, &c. sneer at an eminent orthopaedic surgeon. whose has anything to do with the subject I would be glad to hear views may not coincide with his own, is undignified. in what way. I am, Sir, yours faithfully, Mr. Roth has not appreciated the fact that an anterior spinal A. A. BRADBURNE. Manchester, March 20th, 1911. EXPERIMENTS IN SEWER VENTILATION AT LEICESTER. To the Editor

SIR.—The report of

oj THE LANCET.

Sanitary Commissioner in THE LANCET of March 4th, p. 618, points once more to the efforts of THE LANCET in continually making publicly known anything likely to assist in improving the health and comfort of the people all over the world in general The truly and of the United Kingdom in particular. scientific system of sewer and drain ventilation of Shones cannot be questioned by any practical man, and it is a great pity it is not more largely adopted throughout the kingdom, especially in so-called health towns, which should be compeiled by Act of Parliament to have every drain and sewer fitted or a similarly effectual system. Your Commissioner in his very thorough report calls attention to the difficulties encountered at Leicester after the system had been put in operation, especially when it was found that air was drawn into the drains and sewer through unsound and leaky joints and not through the down-cast ventilation pipes. To my mind, this is evidence of one of the valuable points of the system, because it exhibits a serious weakness that under the present system of sewer or drain ventilation would never be discovered, especially as now there are methods of making drain and pipe sewer joints sound (air and water tight) without greatly disturbing the surface ground under which drains and sewers are laid at a reasonable cost. The very great health advantage would be added to the district of having sound sewers and drains scientifically ventilated, with the advantage, as your Commissioner also points out, of having all foul smells drafted away from the town and district where they can be filtered, cremated, or destroyed. Another great advantage also accrues in that the sewage is continually being aerated, and in places where sewers have slight gradients the flow would be doubtlessly accelerated. Your Commissioner mentions cost of electric current at 3d. per with but now in most places where an efficient installation of your

muscle is by no means synonymous with a muscle anterior to the spine. In the paper he refers to, which you honoured me by printing in the columns of THE LANCET, I was dealing essentially with the mechanical treatment of spinal caries during recumbency. I indeed prefaced my description of the apparatus I employ by a short allusion to the factors which produce deformity, and emphasised the influence of muscular spasm. That it is a factor in the production of deformity of extreme importance I am convinced, but that its action is very complex, I think, cannot be doubted. I hope indeed later to be able tn publish a separate paper on this subject, but to have dealt with it at length in the original paper was an impossibility. Mr. Roth has deigned to criticise my remarks somewhat hastily and without due consideration. If he will dispassionately consider the factors which produce deformity in spinal caries in any particular case, he should, in the light of the suggestion I have made as to the importance of muscular spasm, soon grasp the importance of the action of the anterior spinal muscles-i e., the anterior of the muscles investing the spine-which act to the greatest mechanical advantage in the dorsal region, and not, as he conceives they should, in the cervical or lumbar. Mr. Roth has betrayed a lack of comprehension of muscular action about the spine. Perhaps his kindly hint that I should examine the cadaver might be amicably reciprocated by me. I did not venture to advance my views until I had anticipated his advice and supplemented the information I thus gained by extensive clinical observation. In any case, even if Mr. Roth is unable to appreciate the effects of muscular spasm in spinal caries, yet still he may care to adopt the mechanical methods I have advocated, methods which are the outcome of a study of muscular spasm in this condition. In that case I can promise him with confidence that the cases of spinal caries under his care will not become more deformed, that deformity which has not commenced will not appear, and that that portion of deformity which may be present which is due to existing muscular spasm may be safely and certainly corrected. I am, Sir, yours faithfully, H. J. J. GAUVAIN. Alton, Hants, March 20th, 1911.