OXALURIA.

1630

leading part, and with such a view I am entirely in accord. point out that, with the exception of some mental1 conditions, unless such an appeal is accompanied by somee .

But I must

material form of treatment it will fail in most cases. I am stating this as a matter of practical experience, not of theory. Moreover, there is no reason why the material means used to support the suggestion should not be such as to possess a therapeutic efficacy of its own ; indeed, I have repeatedly upheld the view that it is in such combinations that suggestion should find its rational place in our

therapeutic

armoury.

mystery with which suggestive therapeutics is often surrounded, the induction of the hypnotic state which is by The

considered to be an essential accompaniment of suggestion in treatment, the laying-on of hands and other manipulations in use, all act in the same way, I believenamely, by impressing the patient with the idea that he is being subjected to some extraordinary curative force, and so strengthening in this way the suggestions made, not by any specific virtues of their own. And if the same result can be brought about, as I am quite satisfied that it can be, by methods more in accordance with our notions of what a medical man’s work should be, I think that most practitioners will be in agreement that it is time that the more mysterious, and indeed more doubtful, adjuncts of suggestive therapeutics were dropped once and for always. It is my hope that those who have at heart the development of the better side of suggestive therapeutics, not as a specialty or specific but as an adjunct of routine treatment, will come forward in support of the views I am here expressing, and which have, I think, in intent been expressed both in your valuable comments on the subject and in Dr. Morison’s letter. I am, Sir, yours faithfully, EDWIN L. ASH, M.D. Lond. Harley-street, W., Nov. 21st, 1909. some

OXALURIA. To the Editor of THE LANCET. SIR,-In THE LANCET of Nov. 6th there was an interesting paper by Dr. R. Maguire upon this subject, and a large part of it is taken up with the endeavour to prove that the condition when mild is due bo "a disorder in metabolism,""an accident or incident in the metabolism of carbon," but when more severe

to " an

exaggerated production accompanied by

and dyspeptic symptoms," and he cites a case which he thinks supports his hypothesis, but I would suggest that there is not much which bears it out, and that the oxaluria can be explained in another way. Anyone who frequently examines urinary deposits with the microscope will know how very commonly crystals of oxalate of lime are found, and these are not always (as Dr. Maguire himself allows) accompanied by nervous and dyspeptic symptoms even in the severe cases where oxalic calculi form. In my experience in a general practice such symptoms are quite uncommon ; the one complaint which patients sometimes make in the cases without calculi is slight pain in the course of a ureter; as a rule, there is no other sign of ill-health, even in caloulous cases. Therefore, oxaluria and dyspepsia may occur separately or together, and when together I believe they are a coincidence and not caulle and effect, and my reason for this belief is that in my clinical experience the urine can always be cleared of oxalate crystals by attention to diet alone in a few days. Put the patient on an oxalate-free diet and the urine will soon become free from oxalate crystals. Dr. Maguire mentions that his patient was not relieved by a three weeks’ stay at Vichy, but then his diet was composed mostly of vegetables J Not much improvement was to be expected. (By-the-bye, I suppose he was put upon a vegetable diet as a result of the pernicious theory that oxalic acid in the urine is a result of a decomposition of uric acid.) But Dr. Maguire later ordered rest, a change of diet and dilute nitric acid, and the deposit of calcium oxalate in the urine lessened, as he says, "almost pari passu with the improvement in digestion," but also, be it noticed, it coincided with a change to " a liberal diet of white meat "-that is, to a more oxalatefree diet. It seems to me that in his case the dyspepsia was nervous

due to "mental and physical fatigue," "great overwork, and sleeplessness," and the oxaluria was due to error

anxiety,

in diet; at any rate, no other hypothesis as to "a disorder in metabolism" is required. I am, Sir, yours faithfully, REGINALD PRATT, M.D.Lond. Leicester, Nov. 9th, 1909. --

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CIVILISATION AND THE CORSET. To the Editor of THE LANCET. SIR,-The attention which Mr. W. Arbuthnot Lane has drawn to the benefits of corsets is particularly pertinent, because for some years past they have been strenuously decried by certain exponents as being detrimental to muscular development and to liberty of limb. The fact is, women have found by centuries of accumulated experience that corsets are to them structurally indispensable, whilst modern science has also shown that they are physiologically

beneficial. of Greece, and of Rome all wore for service and not for fashion. These ancient corsets consisted of three parts. First, there was the loin band or zone, which was the essential piece, and was persistently worn; then there was the thoracic band or strophion, which gave mammary support as required ; and, lastly, there was the waistband, which intermediated between the other two. It is the conjunction of these three pieces that has given rise to the present corset, in which it is still the loin portion that is indispensable, whilst the other parts are merely adjunctive. And not only have women in all ages and in all climates found the girding of the loins" to be a necessity, but even men in sultry and atonic countries have acted, and still act, similarly. The ancient Israelite and the Roman legionary were wont to gird their loins for effort, whilst the Indian and the Arabian of to-day still do the The

women

of

corsets, and did

Egypt,

so

same.

But it may be asked, Why is it that all the women of the world as well as the men of tropical races should find such artificial support needed? The answer is that the human abdomen has certain structural disabilities and for obvious reasons. Man, as every morphologist knows, His abdominal is built on the quadruped pattern. are similar to those of and their encasement organs If his body was always horizontal, as it a horse or a dog. is in quadrupeds, then his abdominal organs would have in addition to their peritoneal slings the whole of the anterior walls of the abdomen as a hammock of support. But as man has chosen to become biped and erect this abdominal hammock is no longer available, and the organs, having to depend only on their peritoneal slings, which very easily stretch, tend to gravitate downwards and to unduly huddle the lower front wall of the abdomen. It is true that against " nature has striven to aponeurotically strengthen this front wall, as, indeed, Sir Astley Cooper pointed out in his work on hernia, and this before Darwin wrote or the term evolution was coined. But up to the present this effort of nature in the roll of centuries is incomplete, and hence it is that the women of all races and the men of certain races have found for themselves the advantages of girding their loins and thereby artificially supporting the lower abdomen. It is scarcely necessary to point out why women need this girding more than men. The extra organ they possess, its situation in the lower abdomen, and its mutability in the exercise of its functions, all point to the need for quietude and steadiness. Nature has ordained that women should breathe pectorally so as not to perturb this abdominal organ, and any artificial support of the incompetent abdominal walls acts also in the direction that nature has indicated. Hence the use of the corset by women is in agreement with the dictates of nature and not contrary to them, as some critics would maintain. One further point remains. What is the effect of compression over the lower abdomen upon the body generally : is it deleterious or beneficial ? The answer to this has been most carefully investigated and given. In 1888 Professor Ray and Professor Adami delivered a conjoint address before the British Association on the "Physiological Bearing of Waist-belts and Stays," as the result of experiments they had made not only on humanity but also upon animals. Without going into the details (which are available in the volume of Proceedings), they found that a large amount of waste blood lay in the abdominal viscera, and that if these latter were gently compressed by a corset this