PRESENT-DAY OUTLOOK ON TUBERCULOSIS: ÆTIOLOGICAL AND THERAPEUTIC.

THE SERVICES.

Nottinghamshire. half

Practically

the

children

in

this

Correspondence.

county

underwent medical examination during the year, and out of over 19,600 3000 were found with defects. Dr. Handford, commenting on the increase

"Audi alteram partem."

of cleanliness (in 72 per cent. of girls the hair is free from nits), says that unfortunately the improvement in this direction is not yet sufficiently firmly rooted to be free from the risk of relapse on Nurses paid 2537 the relaxation of supervision. home visits in this connexion, in addition to carrying out 26,306 individual head inspections at school. The classification of the extent to which the heads of these children are infected shows a marked decrease since 1912 in the number with "very few," "few," and "many" nits, and a decrease in the number with " very many " nits until last year, when the percentage of the last class was nearly five times that of the previous year. Of 933 children with errors of refraction, there were 212 cases of squint. Myopia of 5 diopters or over was present in 17 cases. These children are examined at frequent intervals and their school work is closely watched. There were 363 children retarded two or three years, and Dr. Handford appeals for special classes for them before taking the irretrievable step of certifying them as feeble-minded. now

The Services. ROYAL NAVAL VOLUNTEER RESERVE. Lt. F. P. Nicholas to be Surg. Lt.-Comdr.

Surg.

ROYAL ARMY MEDICAL CORPS.

Lt.

The undermentioned cease to belong to the Res. of Off. on account of physical unfitness : Lt.-Cols. E. Brodribb, D. E. Curme, J. D. G. Macpherson, J. P. J. Murphy, and H. K. Palmer; Maj. and Bt. Lt.-Col. F. W. Lamballe ; and Capt. T. J. Crean. ARMY DENTAL CORPS.

Capts. :

11.

Broughton

and

TERRITORIAL ARMY.

P. Hayes to be Lt. Maj. (Bt. Lt.-Col.) R. T. Turner, having attained the age limit, is retired, and is granted the rank of Lt.-Col., with permission to wear the prescribed uniform. Capt. H. B. Whitehouse resigns his commn. and retains the rank of Capt. The undermentioned officers relinquish their commns. and retain their rank except where otherwise stated : Lt.-Cols. P. S. Hichens, D. A. Cameron, and G. C. Taylor, Majs. T. L. Fennell (with permission to wear the prescribed uniform) ; Capts. A. Rankine, C. M. Nicol, F. R. Eddison, H. J. A. Longmore, C. F. M. Saint, A. C. Alport, G. W. Shore, and W. Briggs (all granted the rank of Maj.) ; Capts..T. Green, J. C. W. Methven, C. F. Walters, J. M. Plews, A. A. McKenzie, C. S. O’Hagan, L. T. Challenor, C. C. Boyle, H. Vallow, 1. J. Davies, L. B. Cane, W. L. Holyoak, E. R. Flint, W. Johnston, H. G. Ludolf, W. Longley, W. W. N. King, L. A. Celestin, N. H. Hill, and J. Chalmers. Sanitary Company : Maj. J. Grounds and Capt. J. Inglis resign their commns. and retain their rank. TERRITORIAL ARMY RESERVE.

Lt.-Col. T. A. Green and Maj. T. P. Puddicombe, from General List, to be Lt.-Cols. Capt. N. S. Jeffrey, having attained the age limit, is

retired,

and retains the rank of Capt. The undermentioned relinquish their commns. and retain their rank : Lt.-Col. W. A. Benson ; Majs. A. T. Sissons, C. B. Whitehead ; Capts. J. A. L. Magee, H. J. Shanley, H. P. Thomason, P. McEwan, and A. H. Savage

(Sanitary Company). C. V.

Flying

D.Rose

Officer.

--

ROYAL AIR FORCE. is granted a short service commission

E. F. N. Currey Flight Lt. -

as a

-

is granted

a

temporary commission

of THE LANCET. under this title in your issue SiR.—In his retrospect of Dec. 9th, Dr. Percy Kidd has sketched admirably the main features of the evolution-since the seventeenth century onwards-of our present-day conception of tuberculosis. The recognition of the essential unity of all its forms places the clinician of to-day on a vantage ground of inestimable importance in his outlook on the protean manifestations of tuberculosis. Dr. Kidd’s historical résumé is so excellent, that it is with some hesitation that I venture to recall some cognate considerations. In most of the current presentations of tuberculosis from the clinical side, there seems to me lacking sufficient Tcierence to the results of animal experiment in the interpretation of the varying features of the disease. In teaching, it has long been my custom to direct the approach from that point of view. I have been much impressed by the interest awakened in students-undergraduate and post-graduate-by the correlation of clinical evidence and experimental results. The primary lesion (sore), initial latent period, successive involvement of groups of glands and viscera, systemic intoxication, and recurring periods of apparent latency are illustrative and suggestive. The so-called " phenomenon of Koch " throws a flood of light on the problems of recurrent exacerbations, immunity, and re-infection. study along those lines is a sound corI Continued to limited vision in prognosis and treatment. calls for pause as to the scientific sanction for much of the local (operative) treatment at present largely in vogue. The recognition-all tco easy-of the gross and obvious-e.g., in an enlarged gland or local exudate--and the immediate and apparently satisfactory results obtainable by operation have tended to obscure the larger significance of the infective process. Local (operative) interference can seldom have more than local effect. For the greater part, whether on glands in the track of a more recent spreading process or, as lately urged, on obsolescent calcareous glands, operation is open to serious criticism. Accumulating evidence is in favour of conservatism. While the pen is still in hand, let me re-enforce another therapeutic consideration. The r61e assigned to tuberculin continues to be unduly clouded by the disappointment of exaggerated hopes, which followed Koch’s early announcement and the intemperate and hasty statement of enthusiast partisans. As one who has continuously employed tuberculin in many different ways since its introduction in 1890, I am unable to follow the disparaging tone in which reference is frequently made to its place in tuberculo-therapeutics. In innumerable cases it has served me well. Nor has serious danger ever emerged. Whether exhibited subcutaneously or percutaneously (by inunction), as I have been in the habit of teaching for the last dozen years, tuberculin has given results of very striking character. Carefully arranged controls have satisfied me that the results cannot be interpreted otherwise than as directly due to the agent employed. I have before me the records of many cases-for the most part of exceptional difficulty-which collectively yield remarkable testimony. The cases include tuberculosis of most varied type-in lung, larynx, abdominal cavity, genito-urinary organs, glands, skin, &c. Large glandular aggregations have gradually disappeared, old discharging sinuses (as many as 17 in one instance) have closed, formidable exudates have been absorbed in a great variety of situations (abdominal, genital, and other organs). Apart from definite arrest of the disease as a whole, which may not alwaysbe possible, the disappearance To the Editor

It

ARMY RESERVE OF OFFICERS.

to be

PRESENT-DAY OUTLOOK ON TUBERCULOSIS: ÆTIOLOGICAL AND THERAPEUTIC.

rective

(temp. Capt.) W. Y. Eccott to be Capt.

Capts., late Spec. List, W. H. D. Quinn.

1357

as

a

.

ERGOT AND THE FUNCTION OF THE BRITISH PHARMACOPŒIA.

1358

symptoms arrestsor of their desire to retain unchanged preparations extensive renal regarded by pharmacologists as inert. I fear that you tuberculosis, passing urine as often as 48 times per credit the editors with greater power, or influence, diem, have under the treatment been restored to than they actually possess, since they work under the normal frequency. Blood, pus, tubercle bacilli, control of the Pharmacopoeia Committee of the present in the urine, have disappeared. Many of the (General Medical Council, who, in the preface, have patients, during the greater part of the treatment, expressed indebtedness for much valuable assistance continued their ordinary life less or more completely, from a very large number of loyal workers. Probably the local improvement becoming speedily associated every teacher of pharmacology and therapeutics in the with steady gain in flesh and condition. That the United Kingdom, and every writer of a text-book on effects are lasting is evidenced by the records in these subjects, has submitted his views through one or more of the authorities consulted by the Pharnumerous instances which extend over 10, 15, and 20 macopoeia Committee. The concluding paragraph of years. It would be clearly foolish to expect uniformity of your leading article suggests that the policy of the good result. Disappointments necessarily occur. But British Pharmacopoeia should be extended. Mention they form the minority. In proportion as efficient is made of various forms of proprietary articles," treatment has been maintained for a sufficient length &c., " mostly unknown to hospital practice." It of time-a most important postulate-good results would be interesting to ascertain the views of the have been the rule. With a frankly sceptical attitude owners of proprietary articles on such proposed towards the interpretation of therapeutic results, I inclusion in the British Pharmacopoeia. Further, if feel satisfied from close and prolonged observation these articles are really " mostly unknown to hospital that tuberculin is a specific remedy of remarkable practice," may not the responsibility rest with those who have to watch over the ever-growing expenses of significance in the treatment of tuberculosis.

of graver and more distressing .attention. Thus patients with

"

I

am,

Sir,

yours

faithfully. R. W. PHILIP.

University of Edinburgh, Dec. 9th, 1922.

the

dispensary ?

I am, Sir, yours faithfully, NESTOR TIRARD. Harley-street, W’., Dec. 16th, 1922.

JUSTIFIABLE FŒTICIDE.

DORMANT FILARIAL INFECTION. To the Editor of THE LANCET. To the Editor of THE LANCET. SIR,-In your issue of Dec. 2nd (p. 1182) under this SIR,-The note by Dr. K. Playfair on this subject heading occurs the following statement: " It seems in THE LANCET of Sept. 30th raises several interesting that the doctor in certain and possible circumstances In the first place it would be useful to learn has not only the right but is under an obligation to points. which of the microfilariae was present in this case kill the child if thereby he can more certainly safe- and how it was possible, if they were not numerous, guard the life of the mother." THE LANCET has to distinguish between Mf. diurna and Mf. bancrofti. undoubtedly many Catholic readers besides the present I am not disputing the existence of a double infection writer, but you will find none of them agree with this for it seems to be commoner than a single infection, statement. The teaching of the Church with regard but I have not yet been able to hear of a method by to craniotomy is quite clear and definite, it is not which in the infections a reliable differentia! " slighter In permissible under any possible circumstances. can be made. diagnosis doceri non licitam esse scholis Catholicis tuto posse, The reason " scant attention is paid to the operationem quam craniotomiam appellunt." This blood picture "why in most cases is quite easy of explanaand decision was given at Rome, August 19th, 1888, what exact tion, and I would like to ask Dr. repeated with the Papal approbation on July 24th, significance he would attach to thePlayfair blood picture in a 1895.—I am. Sir. vours faithfullv. case of filariasis in which the usual parasites, such as DOM FRANCIS IZARD, O.S.B., M.R.C.S., ankylostomes, schistosomes, tapeworms, and trichinae, L.R.C.P. are present also. It seems rare to find a case of Abbaye de St. Benoit, Maredsous par Maredret filariasis uncomplicated by the presence of one, if not Prov de Namur, Belgique, Dec. 5th, 1922. all, of these parasites, not to mention a host of others ** Dom Francis Izard writes from a Benedictine may or may not cause an eosinophilia. House, famous alike for its learning and its study of I am, Sir, yours faithfully, plain chant. The Papal decision is well known, but N. A. DYCE SHARP. surely, to say that it is not safe to teach a doctrine is Kaduna, Nigeria, West Africa, Nov. 16th, 1922. not the same thing as to prohibit such teaching in all possible circumstances. We can imagine situations when the prohibition quoted by Dom Francis Izard ANTRAL SUPPURATION AND DENTAL would lay a heavy responsibility indeed upon the INFECTION. shoulders of medical men.-ED. L. To the Editor of THE LANCET. SIR,-The condensed report in your issue of Dec. 16th ERGOT AND THE FUNCTION OF THE of my remarks at a recent meeting of the Odontologiest BRITISH PHARMACOPŒIA. Section of the Royal Society of Medicine does not To the Editor of THE LANCET. adequately convey my meaning. I quoted Grun wald’s statement that out of 98 cases of antral sup SIR,-In the report of the recent discussion on only 14 were definitely due to dental infec.ergot, I am represented as having mentioned that puration out of 101 of my own cases, 12 were of dentat tion ; a large number of prescriptions were " analysed Antral suppuration of dental origin can be officially."1 I regret that this erroneous statement origin. distinguished clinically from that of nasal origin : (1, should have been substituted for what was actually the presence of an alveolar abscess or pyorrhœ By in not one of these that " did said-viz., prescriptions of certain teeth. (2) By the fact that the antrum is any official preparation of ergot appear." Proprietary the only cavity of the nose involved. (3) By the preparations of ergot were mentioned in an extremely character of the pus, which is very foul, smelling small number of the prescriptions, but these were strongly of B. coli, and has a greyish sandy deposit. outside the scope of the discussion. On the other hand, antral suppuration of na-4.-t! While I am in cordial agreement with many of your is more chronic and produces muco-pus ot origin editorial remarks on the Function of the British or fusty odour. (4) By the fact that the dental slight said I of having any- antrum is more Pharmacopœia,2 am not aware cured by drainage than that ot thing about a conservative view held by the editors, nasal origin. Dr.easily P. Watson-Williams spoke of nasal antral infection producing an apical abscess of the 1 THE LANCET, Dec. 16th, p. 1277, line 18 from top. 2 teeth. I have never seen this, and would call attention Ibid., p. 1285.

which