PARAPLEGIC BERIBERI

99 PARAPLEGIC BERIBERI SiB,—In your issue of Dec. 30 Dr. Philip Evans comments upon my case of paraplegic beriberi described in THE LANOET of Dec. 16. It would appear that the descriptive label " famine oedema " has been misleading and I am sorry I did not use instead the term "epidemic dropsy," which, in the light of Dr. Evans’s letter, might have been less ambiguous-I understood that the two terms were synonymous. However, my suggestion of a link between my case and "famine oedema" was not in respect of the (sdema, but referred to the vascular phenomena seen in the legs, the words employed being: " The deep dilated vessels about the ankles and the transient erythema of the legs suggest a link withfamine oedema,’ a disease...." As described in my paper the patient’s csdema was slight, affecting only the pre-tibial zones, ankles and dorsa of feet: it was more resistant to pressure than ordinary cardiac or renal oedema, and seemed to conform in all respects with that described as characteristic of beriberi. I did not think that nutritional oedema was present as well as beriberi. I- am afraid the serum albumin was not estimated, but I doubt if any significant change would have been present at the stage when I saw the case-even if one considers that earlier a subnormal figure might have been found. As stated in the case-record the patient had been taking a full mixed diet and eating with excellent appetite for two months before she was referred to

me. I am, Sir,

Harley Street, W.I.

yours

faithfully,

J. BRUCE YOUNG.

have come about. and in hysterical

They sought a god and a saviour projection found one in Hitler.

"May not public bodies go mad sometimes like individuals" asked Bishop Butler one day of his chaplain, for it seemed to him that nothing else could account for history. And thus it is today. Germany suffers from a psychosis whose nature is clearly delineated in the psychology of their Fiihrer. " It is an essential part of the tragic paradox of modern Germany that it cannot escape the necessity of repudiating its most exquisite poet. A nation which is involved in that compulsion is in a condition of extreme disease." Heine, the poet referred to, had always recoiled with disgust from "the " Ancient In a certain Teutons," and their prophet Jahn. tavern in Gottingen," he wrote, " I had the opportunity of admiring the precision with which my friends,’the ancient Teutons,’ prepared the lists of those who would be proscribed by them as soon as they arrived in power. Anyone who was descended, even seven generations back, from a Frenchman, a Jew or a Slav was to be condemned to exile. Anybody who had ever written anything against Jahn or the absurdities of the old Germans themselves might expect the death penalty carried out, of course with the axe and not These with that French invention, the guillotine." words portray a barbarism, an atavistic reversion such as we see again in Germany today; and a study of Hitler’s psychology that does not take account of them cannot be truly explanatory. In the words of your leading article, the real problems lie behind Hitler’s individual personality and are concerned with the disease of which he is a prominent and ugly symptom.

I am

Sir,

yours

faithfully,

THE MIND OF HITLER

author of the article A Psychiatrist Looks at Hitler in your issue of Jan. 6 is doubtless justified in seeking in Kraepelin’s writings corroboration of his diagnosis of Hitler as an hysteric; and I do not seek to contravene his thesis. Kraepelin was a great clinical cartographer in the field of psychiatry, and excelled in description of syndromes and in their classification, but much of his work has inevitably been superseded, and your contributor would have done better to follow the guidance of Kretschmer whose concept of the " hypoboulic" will in his monograph on hysteria clarifies the whole subject; but even that does not suffice, for Kretschmer neglects much that is valuable that has come to us through psychoanalytical research. The fact is that Hitler’s psychology cannot be comprehended apart from the psychology of the people whom he rules, and in this Jung is our best adviser. As is well known, Jung hypothesises a " collective " or racial unconscious, a doctrine to which Freud has not explicitly subscribed, but one which he "impliedly has accepted, as witness his statement that symbolism, a mode of expression which has never been individually acquired, may claim to be regarded as a racial heritage." Jung would regard Hitler as the focus point of the unconscious of the German people, a symbol for their repressed longings, a vehicle whereby their pent-up aggression and ambition are expressed, a savioursymbol wherein they seek salvation. Doubtless Hitler is an hysteric, but the important thing is that he is a special kind of hysteric, one who is mediumistic to the unconscious of his people, and who in a trancelike oratorical fervour " can pour back in flood what he receives from his audience in vapour." Jung it was who shortly after the last war identified amongst Germans certain warlike and archetypal dream symbols which foreshadowed the events that

SiR,-The

,

T. M.

DAVIE,

Medical Superintendent, East Riding Mental Hospital.

Beverley, Yorks.

INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED DEC. 1939

16,

otificrtions.=The following cases of infectious disease were notified during the week : Smallpox, 0 : scarlet fever, 1183 ; whooping-cough, 1072 ; diphtheria, 863 ;

enteric

fever, 16 ;

measles, 248 :

pneumonia (primary or influenzal), 450 ; puerperal pyrexia, 152 ; cerebrospinal fever, 25 ; poliomyelitis, 4 ; polio-encephalitis, 1 ; encephalitis lethargica, 3 ; dysentery, 33 ; ophthalmia neonatorum, 78. No case of cholera, plague or typhus fever was notified during the week. Deaths.-In 126 great towns, including London, there were no deaths from smallpox, enteric fever, measles or whooping-cough, 1 (1) from scarlet fever, 14 (0) from diphtheria, 29 (4) from diarrhoea and enteritis under 2 years, and 25 (4) from influenza. The figures in parentheses are those for London itself. Fatal cases of diphtheria were scattered over 12 great towns, Birmingham and Leicester each reporting 2 deaths. Birming-

ham attributed 3 deaths to influenza.

LANGLEY MEMORIAL PRIZE.—This prize of ;f21 is open to competition among officers of the Colonial Medical Service who are serving, or who have served, in West Africa. Tt will be awarded for the best paper submitted on a topic falling within tropical medicine or surgery ;

tropical hygiene and sanitation ; or tropical entomology and parasitology. Special consideration will be given to original work. Papers, which may consist of either published or unpublished work, should be delivered to the secretary, London School of Hygiene and Tropical Medicine,

Keppel

Street, Gower Street, London, W.C.l

later than Oct. 1.

’

not