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"A PERNICIOUS TYPE OF ANÆMIA."
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rhythmical dilatation and contraction of the bronchioles will make that lung dilate up and reoccupy the normal space belonging to it in the chest. This but repeats what caused that lung to dilate at birth and become a normally distended lung. If my theory is correct this rhythmical dilatation and contraction of the bronchioles explains why it is that sometimes distension of the pulmonary alveoli occurs beyond the site of obstruction by a close-fitting foreign body like a bean in a bronchus. Inspiratory
in the Army V.D. hospitals wisely includes compulsory rest in bed during the acute stage of the disease, and this is of psychological as well as physical importance in bringing home to a man the necessity of taking the disease seriously. May I also briefly refer to Dr. Sequeira’sletter of Jan. 18th on compulsory treatment of V.D. and the rejection by Parliament of various Bills thereon ? In approving its action, he dwells entirely on the debatable ground of the relative curative value of salvarsan, but surely the case for compulsory treatment rests as much on the fact that salvarsan therapy is the quickest and most efficacious method of rendering a patient non-infective to others as on 2
dilatation allows the air to pass into the bronchus past the bean, but on expiratory contraction the bronchiolar muscle clings so tightly to the surface of the bean that no air escapes, or at any rate less than the permanency of the cure of the individual. was inspired into that pulmonary area. I am, Sir, yours faithfully, I am, Sir, yours faithfully, PATRICK WATSON-WILLIAMS. W. H. DICKINSON PRIEST,
Late M.O. i/c Venereal Diseases, British Army of the Rhine. Royal Waterloo Hospital, Feb. 24th, 1930.
Clifton, Bristol, Feb. 24th, 1930.
"A PERNICIOUS TYPE OF ANÆMIA." To the Editor of THE LANCET.
pernicious type of
HOUSING AND RHEUMATIC DISEASE.
To the Editor of THE LANCET. SIR,-Dr. Avery’s report anaemia following erythraemia, appearing in your issue is certainly an important factor of Feb. 15th (p. 342), presents points of great hsemato- in SiR,—Environment the rheumatic diseases, including producing logical interest. Is it not, however, time that the rheumatoid arthritis, which are responsible for a large term " pernicious type of anaemia " be discarded ? amount of in this country. R. H. Miller It is,I think, commonly agreed that the essential has indeed invalidity remarked that environment, taken as a haematological characteristics of pernicious anaemia whole, is of such importance that rheumatism may are : reduction in the number of red corpuscles, with be regarded as an environmental disease. Of these a high colour-index; leucopenia ; and relative environmental conditions housing occupies the first lymphocytosis, together with an invariable megalo- place, and a survey of housing since the end of the cytosis. In Dr. Avery’s case the leucocytes were never great war throws much light on this subject. The below 8600 per c.mm., and at this time the lymphoshortage of houses at the end of the war necessitated cytes were 6’67 per cent. Then again, as Addison rapid erection. Wooden houses at first took the place was the first to point out, emaciation does not occur of more permanent structures, and this was followed in pernicious anaemia, whereas Dr. Avery’s post- I the adaptation of army huts. Then came jerryby mortem report states that the body was wasted. The built houses of cheap brick with walls of minimum indefinite character of the ferro-cyanide reaction in thickness, ready made staircases, doors and windowthe spleen is certainly an unusual finding in the frames of unseasoned wood. Foundations were laid typical disease. It seems that the only reason for with inefficient ventilation, no tongue and grooved regarding the aneemia as being of pernicious type is boarding was used for in low lying districts the fact that the patient improved when given houses were built on flooring; soils without efficient marshy half a pound of liver daily. One can picture what must be the condidraining. I find untenable Dr. Avery’s explanation of anaemia tion of clothing, bedding, and furniture in such houses, due to excessive irradiation as being the result of and how the plaster, the ground gases passing destruction of erythropoietic tissue and impairment between thesweating floor boards, thetimber warping and of the haemolytic function of the spleen. Mayneord leaving spaces for the admission of damp must affect and Piney (Brit. Jour. Rad., 1928) showed an extreme the health of the inhabitants. degree of haemosiderosis in the spleen of rabbits that These new houses are, I believe, a definite cause of had been exposed to large doses of X rays. Further- rheumatism and fibrositis. Rheumatism may be more, in cases of chronic myeloid leukaemia with induced in an individual in one district, whereas living severe secondary anaemia irradiation of the bones in another district not many miles away he may be only is often followed by reduction in the number of quite free from pain and inconvenience. There are, leucocytes and a rise in the number of red corpuscles. for instance, two places in the Thames valley within I in that conclusion May express my gratification reach of London less than a mile apart but there still remain writers who, in spite of the modern easy the river. In one of these districts separated fashion, will publish accounts of singular cases of rheumatismbyis almost unknown, while in the other it such great interest as the one under discussion. is extremely prevalent. The former is flat with gravel I am, Sir, yours faithfully, soil and a limited number of trees. It is on the level A. PINEY. of the river. The latter abounds with trees, has a The Cancer Hospital, Fulham-road, S.W., Feb. 21st, 1930. heavy loam and gravel soil, and is 40 feet higher than the river. They have the same water-supply, and the climate is identical. A man well known to REST IN THE TREATMENT OF GONORRHŒA. me removed from the former to the latter, and within a few weeks could only roll out of bed in the mornings. To the Editor of THE LANCET. Six months later he moved back again on account of SiR,-Dr. Byles’s insistence on the importance of the rheumatism which had become so severe. Within rest in bed in gonorrhoea cannot be too strongly two days he could rise in the mornings without emphasised. Surely, however, the time has hardly discomfort, and except for a few fibrous nodules the yet come when " the onus of refusing to lie up must rheumatism disappeared. In another district 250 be put on the unhappy victim." " Propaganda and miles from London rheumatism is very prevalent. leanets " may, as Dr. Byles says, have " made these This district is flat with the subsoil water only a few complaints a subject of ordinary conversation in inches below the surface ; there are few trees and the mixed companies’," but in the previous sentence he town is bleak and windswept. It is surrounded by admits the " still persisting taboo, disgrace, and miles of flat marshy land and is at sea-level. At one I secrecy " involved. There are few walks of life in ’i point where numerous dwellings abound the subsoil which the required rest in bed can always be carried water is 4 inches from the surface; ground gases out without disclosing the real nature of the illness, are most prevalent. The soil is sandy and the watersooner or later. The routine treatment of gonorrhoea supply is derived from artesian wells, the water being on a
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rhythmical dilatation and contraction of the bronchioles will make that lung dilate up and reoccupy the normal space belonging to it in the chest. This but repeats what caused that lung to dilate at birth and become a normally distended lung. If my theory is correct this rhythmical dilatation and contraction of the bronchioles explains why it is that sometimes distension of the pulmonary alveoli occurs beyond the site of obstruction by a close-fitting foreign body like a bean in a bronchus. Inspiratory
in the Army V.D. hospitals wisely includes compulsory rest in bed during the acute stage of the disease, and this is of psychological as well as physical importance in bringing home to a man the necessity of taking the disease seriously. May I also briefly refer to Dr. Sequeira’sletter of Jan. 18th on compulsory treatment of V.D. and the rejection by Parliament of various Bills thereon ? In approving its action, he dwells entirely on the debatable ground of the relative curative value of salvarsan, but surely the case for compulsory treatment rests as much on the fact that salvarsan therapy is the quickest and most efficacious method of rendering a patient non-infective to others as on 2
dilatation allows the air to pass into the bronchus past the bean, but on expiratory contraction the bronchiolar muscle clings so tightly to the surface of the bean that no air escapes, or at any rate less than the permanency of the cure of the individual. was inspired into that pulmonary area. I am, Sir, yours faithfully, I am, Sir, yours faithfully, PATRICK WATSON-WILLIAMS. W. H. DICKINSON PRIEST,
Late M.O. i/c Venereal Diseases, British Army of the Rhine. Royal Waterloo Hospital, Feb. 24th, 1930.
Clifton, Bristol, Feb. 24th, 1930.
"A PERNICIOUS TYPE OF ANÆMIA." To the Editor of THE LANCET.
pernicious type of
HOUSING AND RHEUMATIC DISEASE.
To the Editor of THE LANCET. SIR,-Dr. Avery’s report anaemia following erythraemia, appearing in your issue is certainly an important factor of Feb. 15th (p. 342), presents points of great hsemato- in SiR,—Environment the rheumatic diseases, including producing logical interest. Is it not, however, time that the rheumatoid arthritis, which are responsible for a large term " pernicious type of anaemia " be discarded ? amount of in this country. R. H. Miller It is,I think, commonly agreed that the essential has indeed invalidity remarked that environment, taken as a haematological characteristics of pernicious anaemia whole, is of such importance that rheumatism may are : reduction in the number of red corpuscles, with be regarded as an environmental disease. Of these a high colour-index; leucopenia ; and relative environmental conditions housing occupies the first lymphocytosis, together with an invariable megalo- place, and a survey of housing since the end of the cytosis. In Dr. Avery’s case the leucocytes were never great war throws much light on this subject. The below 8600 per c.mm., and at this time the lymphoshortage of houses at the end of the war necessitated cytes were 6’67 per cent. Then again, as Addison rapid erection. Wooden houses at first took the place was the first to point out, emaciation does not occur of more permanent structures, and this was followed in pernicious anaemia, whereas Dr. Avery’s post- I the adaptation of army huts. Then came jerryby mortem report states that the body was wasted. The built houses of cheap brick with walls of minimum indefinite character of the ferro-cyanide reaction in thickness, ready made staircases, doors and windowthe spleen is certainly an unusual finding in the frames of unseasoned wood. Foundations were laid typical disease. It seems that the only reason for with inefficient ventilation, no tongue and grooved regarding the aneemia as being of pernicious type is boarding was used for in low lying districts the fact that the patient improved when given houses were built on flooring; soils without efficient marshy half a pound of liver daily. One can picture what must be the condidraining. I find untenable Dr. Avery’s explanation of anaemia tion of clothing, bedding, and furniture in such houses, due to excessive irradiation as being the result of and how the plaster, the ground gases passing destruction of erythropoietic tissue and impairment between thesweating floor boards, thetimber warping and of the haemolytic function of the spleen. Mayneord leaving spaces for the admission of damp must affect and Piney (Brit. Jour. Rad., 1928) showed an extreme the health of the inhabitants. degree of haemosiderosis in the spleen of rabbits that These new houses are, I believe, a definite cause of had been exposed to large doses of X rays. Further- rheumatism and fibrositis. Rheumatism may be more, in cases of chronic myeloid leukaemia with induced in an individual in one district, whereas living severe secondary anaemia irradiation of the bones in another district not many miles away he may be only is often followed by reduction in the number of quite free from pain and inconvenience. There are, leucocytes and a rise in the number of red corpuscles. for instance, two places in the Thames valley within I in that conclusion May express my gratification reach of London less than a mile apart but there still remain writers who, in spite of the modern easy the river. In one of these districts separated fashion, will publish accounts of singular cases of rheumatismbyis almost unknown, while in the other it such great interest as the one under discussion. is extremely prevalent. The former is flat with gravel I am, Sir, yours faithfully, soil and a limited number of trees. It is on the level A. PINEY. of the river. The latter abounds with trees, has a The Cancer Hospital, Fulham-road, S.W., Feb. 21st, 1930. heavy loam and gravel soil, and is 40 feet higher than the river. They have the same water-supply, and the climate is identical. A man well known to REST IN THE TREATMENT OF GONORRHŒA. me removed from the former to the latter, and within a few weeks could only roll out of bed in the mornings. To the Editor of THE LANCET. Six months later he moved back again on account of SiR,-Dr. Byles’s insistence on the importance of the rheumatism which had become so severe. Within rest in bed in gonorrhoea cannot be too strongly two days he could rise in the mornings without emphasised. Surely, however, the time has hardly discomfort, and except for a few fibrous nodules the yet come when " the onus of refusing to lie up must rheumatism disappeared. In another district 250 be put on the unhappy victim." " Propaganda and miles from London rheumatism is very prevalent. leanets " may, as Dr. Byles says, have " made these This district is flat with the subsoil water only a few complaints a subject of ordinary conversation in inches below the surface ; there are few trees and the mixed companies’," but in the previous sentence he town is bleak and windswept. It is surrounded by admits the " still persisting taboo, disgrace, and miles of flat marshy land and is at sea-level. At one I secrecy " involved. There are few walks of life in ’i point where numerous dwellings abound the subsoil which the required rest in bed can always be carried water is 4 inches from the surface; ground gases out without disclosing the real nature of the illness, are most prevalent. The soil is sandy and the watersooner or later. The routine treatment of gonorrhoea supply is derived from artesian wells, the water being on a
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