RISKS OF LEUCOTOMY

1245 with a disabled employee." This seems to imply an undesirable attitude to the disabled. We also feel it to

anomaly that-in an organisation for the severely disabled-only the able-bodied have a pension or super-

be

an

annuation scheme. Do not imagine that we are ungrateful. Far from it : I have heard Remploy described as a God’s blessing." But I have also heard it called the new Marxism : " from each according to his ability ; to the most productive, 80% of the district rate." "

reference to the fact that after two years’ training ask to be considered for the full district rate. This application is discussed by the manager and a full-time trade-union official; and according to the man’s proficiency he is granted all or part of the full rate. In practice, however, he is usually kept at his old rate of 75-80%, on the grounds that he is not proficient, or "not worth a penny more "— even though his work may be quantitatively and qualitatively better than that of others in the factory receiving the same rate. In these circumstances incentive is stifled, and some of the men go sour and say " We’re here only to cut down National Assistance costs. Don’t work too hard. You’ll be paid jut the same as the mugs." This is

a

man

a

can

When production falls and wastages and costs rise, it is very often the fault of the workers, as they will admit. But it is not always their fault. The situation is often shrugged away with the comment, " Poor souls, they really can’t be expected to do very much "-an excuse which can be used to cover bad planning and buying, lack of skill, and lack of method. The mounting costs of Remploy, if not checked, must lead inevitably to the end of the experiment. The ablebodied would then find other employment ; but for almost all the disabled it would mean life-long unemployment. They would go down with the ship. FRANK CARR. Glasgow. TEXTBOOK ILLUSTRATIONS

SIR,-I quite agree with the opinions and suggestions of Mr. Engel, expressed in his letter of May 8. It may interest your readers to know that the same problem was discussed at the First World Conference on Medical Education in London last August. Since the Proceedings of the Congress have not yet appeared, I should like to repeat here a few words of criticism, as an addition to Dr. Engel’s ideas : .

"

It must be regretted that latest editions of several good textbooks published in various countries still contain illustrations-e.g. of exanthemata, bacteria, blood and bone-marrow were skilfully drawn by an artist decades cells, &c.-which ago but are no longer in keeping with the eminent progresses of colour photography. I think that some authors should be more anxious to replace the out-of-date pictures by modern ones." First Medical Department, H. WENDEROTH. University Hospital, Hamburg, Germany. ISAMBARD KINGDOM BRUNEL

SIR,—Your peripatetic correspondent’s remarks (May 29) on Isambard Kingdom Brunel as hospital architect demand

enlargement.

According

to

Dugan,l Brunel’s

portable fifteen-hundred-bed military hospital used by the War Office was prefabricated in this country and erected by eighteen men in ten weeks at Renkioi, Turkey, no part of the structure being too heavy to be carried by two men. Plumbing was included, together with an air-conditioned system " pumping 1300 cubic "

feet per minute of cooled humidified air around each bed. The apparatus Brunel designed for rapidly inverting himself and thus ejecting the sovereign lodged in his right bronchus has been likened by Dugan to the oldfashioned looking-glass on a horizontal pivot. Your correspondent states : "the manoeuvre was successful, and the coin was immediately coughed out." Lest this apparatus be thought unduly efficient and a sine 1.

Dugan, J.

The Great Iron Ship.

London, 1953.

qua non of hospital equipment, it should be pointed out that after six weeks of intermittent torture on the "rack" Brunel’s medical advisers forbade him to continue. Tracheotomy was advocated, Brunel himself sketching the special forceps to be used for reaching the This instrument is now known as the Brodie coin. forceps1 after Sir Benjamin Brodie, Brunel’s brotherin-law, who carried out tracheotomy without anæsthesia ; the operation was not successful. However, three days later Brunel, with the wound still open, took a further turn on his machine, at last coughing up the sovereign into his mouth. National Institute for Research. in

Dairying, Shinfield,

near

Reading.

C. A. E. BRIGGS

COXSACKIE INFECTIONS

SIR,—After the discovery of Coxsackie viruses,2 3 many papers reported the isolation of these viruses in a number of different conditions 4 : epidemic pleurodynia (Bornholm disease), herpangina,4 " minor illnesses,"6 and diseases of the nervous system-aseptic meningitis,5 encephalitis,710 meningo-encephalitis,8 and Guillain-Barre Coxsackie viruses were also isolated from syndrome.9 cases of poliomyelitis, but the significance of these findings was not established.llIt has been shown that in some of these diseases the strains isolated belong to a definite group-e.g., in cases of Bornholm disease, Dalldorf’s group-B strains are present, and in cases of herpangina the group-A strains are isolated.4 We have adopted the term coxsackioses for these conditions. This name is in line with those used in other infections, where the organisms produce a variety of clinical manifestations brucellosis, salmonellosis, A tentative classification of the rickettsiosis, &c. Coxsackie infections is as follows :

(1) Indefinite febrile forms.

(2) Typical forms: disease), herpangina. (3) Nervous forms:

epidemic pleurodynia (Bornholm " aseptic meningitis," encephalitis,

Guillain-Barré Department of Microbiology, School of Pharmacy, University of Brazil,

meningo-encephalitis,

Rio de Janeiro.

syndrome. PAULO DE GÓES J. TRAVASSOS.

RISKS OF LEUCOTOMY

SiR,-I have read with interest your account (May 22) of the address by Dr. Radzan and Dr. Cook, of Bexley Hospital. This reveals the overcrowding of hospital wards, which, I understand, prevails elsewhere, and the urgent need of removing the obstacle to individual and continuous observation of patients under care treatment, without which hardly any successful result can reasonably be expected. Dr. Cook is also reported as saying that sedation itself, if prolonged, produces more serious mental deterioration than electroconvulsion combined with prefrontal leucotomy. This may be so, but I know of 2 cases in which the results of leucotomy are nothing short of tragic. In suicidal and homicidal maniacs, such rapid deterioration may be beneficial, in that leucotomy renders the patient more docile and more easily managed, even if at the same time he is turned -

therapy

2. Dalldorf, G., Sickles, G. M. Science, 1948, 108, 61. 3. Dalldorf, G. Ibid, 1949, 110, 594. 4. Huebner, J. R., Beeman, E. A., Cole, R. M., Beigelman, P. M., Bell, J. A. New Engl. J. Med. 1952, 247, 249. 5. Curnen, E. C. 2nd International Poliomyelitis Conference, Copenhagen, 1952. 6. Melnick, J. L., Walton, M., Myers, I. L. Publ. Hlth Rep., Wash. 1953, 68, 1178. 7. Stanley, N. F., Dorman, D. C., Ponsford, J. Aust. J. exp. Biol. med. Sci. 1953, 31, 31. 8. Galpine, J. F., Macrae, A. D. Lancet, 1953, i, 372. 9. Forrester, R. M., Tobin, J. O’H. Ibid, 1951, ii, 663. 10. Menut, G. Arch. franç. Pédiat. 1952, 9, 978. 11. De Góes, P., Travassos, J., Pinheiro-Campos, O., Bruno-Lobo, M., Vasconcellos, J. V. An. Microbiol. 1952-53, 2, 101.

1246 a semi-idiot, without initiative, mental alertness, and responsiveness. Hastiness of action or faulty selection of cases for leucotomy may cause deep regret to all concerned-to the psychiatrist that it had ever entered his mind to recommend the operation, and to the relative whose consent was sought. It is my unalterable opinion that no such operation should ever be contemplated, and consent obtained, without telling all whom it may concern, everything about the grave risks involved

into

therein. D. W. STANDLEY.

Greenhithe, Kent.

CAROTENÆMIA

SIR,—Dr. McConaghey’s excellent articlegave

a

of this subject and a description of two cases. He did not mention oranges as a cause, so I thought a report of this case might be interesting.

complete bibliography

A girl of 17, who was putting on weight, thought of slimming herself by eating little but oranges. She used to eat from 25 to 30 oranges a day. After about six months, she and her parents noticed that she had become yellow in colour, and she was

thought

to have

jaundice. healthy, and

her temperature, pulse, and blood-pressure were normal. Her skin was yellow, especially The conjunctivæ were not coloured. on the palms and soles. No other abnormality was found on physical examination. Huemoglobin, red and white cell-counts, and the urine and stools were normal. So we thought that this might be a case of carotensemia caused by a surfeit of oranges. When she returned to a normal diet, she gradually improved and the

She looked very

yellow

colour

Oranges

disappeared

contain

in

a

few weeks.

&bgr;-carotene, lycopene, cryptoxanthine,

lutein, violaxanthin, zeaxanthin, &bgr;-citraurin, and citroxanthin.2-5 Faculty of Medicine, Alexandria University.

Egypt.

H. BAKSOUM.

TREATMENT OF DEAFNESS

SIR,—May I

add

account of my personal experience ? years ago I was a woman medical student. I consulted a leading otologist because of slight difference of acuity in hearing of my two ears. He told me I had otosclerosis and would be hopelessly deaf in two or three years, an

Forty-two

and advised me to give up medicine, which I did. Ten years later my deafness was no worse and I went to another otologist who said there was very little amiss and advised me to resume I did so, but, for personal reasons, did not my studies. subsequently qualify. In the next fifteen years I visited four or five otologists to keep the deafness under review. I was not noticeably any deafer. Eleven years ago I had a severe shock, being told that I I woke the next morning very was liable to die suddenly. deaf and have remained so. I have been treated by four otologists and three psychiatrists, all leading men, and derived no benefit from treatment including electroconvulsive

therapy. During the past two years I have had treatment by two spiritual healers, and for short periods after this treatment I have been able to hear quite well, which shows that some part, at least, of the hearing mechanism is in fair working order.

Other deaf people have given me similar accounts of inconsistent though firm opinions from experts ; and I would suggest to Mr. Robin and other otologists that dogmatic condemnation of any method of helping deaf people should ’be avoided. The impression I have formed is that hearing depends partly on factors which are not yet measurable, and may improve under treatment which appears incapable of affecting the physical lesions on which attention is usually concentrated. A DEAF PATIENT. 1. McConaghey, R. M. S. Lancet, 1952, ii, 714. 2. Zechmeieter, L., Tuzson, P. Naturwissenschaften, 1931, 19, 307. 3. Vermast, P. G. F. Ibid, p. 442. 4. Zechmeister, L., Tuzson, P. Ber. dtsch. chem. Ges. 1936, 69, 1878. 5. Karrer, P., Jueker, E. Helv. chim. acta, 1944, 27, 1695; Ibid, 1947, 30, 536.

Obituary ANDREW OLIVER FERGUSSON ROSS M.D. Edin., D.P.H. Dr. A. 0. Fergusson Ross, director of venereal-diseases clinics in the city and port of Liverpool, died on June 3

at Birkenhead. He was born at Scone in 1895 and he was educated in Edinburgh at George Watson’s School and at the university. During the first world war he served as a surgeon probationer in the Royal Navy. He returned to Edinburgh to take his M.B. in 1917, and later he became a specialist in genito-urinary surgery and in venereal diseases at the Royal Naval Hospital at Haslar. After he was demobilised he spent some years in consultant practice in Glasgow before he moved to Liverpool in the late ’20s. He was appointed v.D. consultant to the Royal Liverpool United Hospitals and the Liverpool Seamen’s Dispensary, and later he became the regional adviser in venereology and lecturer to the

university. R. J. M. writes: " Though a man of world-wide Ross always .retained the humility of the true student, and in the art and practice of his profession his own interest and comfort were matters of least moment. In his last illness his sense of duty led him to prepare and deliver six brilliant lectures for the World Health Organisation in Rotterdam. Indeed he never lost the urge to question, to seek, and to verify, and all his teaching bore these hallmarks. Everyone who met him was impressed by his deep love of humanity, by his unfailing courtesy, and by his forgetfulness of self. No man ever loved the quiet things of life more than he did : his family, his friends, his garden, the way of the countryside ; the thrust and parry of good conversation, and the story that was apposite." He leaves his wife with three sons and a daughter.

repute, Fergusson

ANDREW JAMES MOYES BUTTER M.M., M.A., M.D. Edin.

Dr. A. J. M. Butter died on June 3 at his home in North London, where he had been in general practice for some 30 years. He was born in Perth 59 years ago, and at the outbreak of the first world war he was studying arts at Edinburgh University. He immediately volunteered and was soon in France, where, as a sergeant, he won the Military Medal with the special gas company of the Royal Engineers, in which regiment he was later commissioned. At the end of the war he returned to Edinburgh, and after completing his M.A. began to study medicine. He graduated M.B. in 1923, and he held house-appointments at the Royal Infirmary and the Royal Hospital for Sick Children, Edinburgh. He came to London as house-physician in Queen Mary’s Hospital for the East End, Stratford, and later entered general practice in North London. He graduated M.D. with commendation in 1925. Despite the demands of a large private practice he found time to join the staff of Wood Green and Southgate Cottage Hospital, and to act as medical officer in charge of St. David’s Hospital for Epilepsy. In recent years he had published a number of valuable papers on the treatment of this disease. For many years he was also secretary of the local medical society-the Ganglion Club. J. A. B. Y., a contemporary of his Edinburgh years, writes : " Butter played a leading part in the social life of the university. A member of the Students’ Representative Council and the debating society, he was also president of the Philomathic Society and of the University Union. When Mr. Lloyd George was installed as Lord Rector in 1923, at the luncheon in the union speeches were made by several great men of the time, but many who heard Butter speak that day felt that he outshone everyone. At heart he was rather a shy person, and he would rise to speak with a diffidence that enhanced the wit of his remarks. " Andrew Butter became a gifted physician whose presence in the sickroom never failed to comfort his patient-he was so kind, so gentle, and so patient. Many of his colleagues and their families had reason to be grate-