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SOME CASES OF ORCHITIS PAROTIDEA OR TESTICULAR MUMPS.
GAS FIRES.-TUBEROSE SCLEROSIS OF THE BRAIN.
118
The fire used would be consuming anything from 35 to 50 cubic feet a nebaliser. All chemical analyses of the preparation in gas per hour, whereas for a room of that size satisfactory heating question are untrustworthy, for formulae made according to of would be accomplished with a gas fire consuming not more than such analyses do not show the effects of the original prepara- 8 to 10 cubic feet per hour. I must say that if you had been tion. I have sought to determine the nature of the secret endeavouring to get the percentage of carbonic acid in the atmosphere as high as possible you could not have adopted better conditions than remedy by studying its physiologic action which is es- a room far below normal capacity, and a fire far above normal consentially as following : When sprayed into the nose, even of sumption (and probably badly fitted to the flue) for your purpose. a normal subject, there is almost an immediate translation of Mr. Jones hopes the Coal Smoke Abatement Society will the normal lung resonance to dulness or flatness (lung reflex continue its tests. May I, too, express a similar hope-i.e., of contraction). The weakness of the longitudinal fibres is that Mr. Jones will revise his own tests, using normal conalso demonstrated by my tracheal traction test, which is a ditions from which to make deductions intended for wide
of
method of recognising an asthmatic lung. In accordwith the theory propounded, I treat my asthmatics in the paroxysmal and interparoxysmal periods by respiratory exercises which tend to strengthen the longitudinal fibres. I have known asthmatics whose attacks resisted even the influence of an anaesthetic for hours and which yielded after a few minutes of systematic compressions of the thorax during
simple ance
I would not have troubled you with this letter were it not for the fact that our competing friends the electricians make as much capital as they can from such letters as the one from Mr. Jones, as is evidenced by an editorial thereupon in the Electrical Engineer of Dec. 21st in which appears the following summing-up :—
publication ?
expiration. Relative to the final question, I believe it has already been answered. Amyl nitrite acts on the fibres of the uterus with secondary constriction of the blood-vessels, just as it acts on the longitudinal fibres of the bronchial musculature and in the former action it is essentially an oxytocic. The lowering of the blood pressure must also be taken into account as cited in my previous communication. I am, Sirs, yours faithfully, DR. ALBERT ABRAMS. Paris, Jan. 2nd, 1907.
We think it will be admitted that the evidence which Mr. Jones was convincing proof of its accuracy, while his criticism of the society’s report is fair and reasonable.
produced in support of his statement
Whilst I would be the last man in the world to impute other than the highest motives to Mr. Jones, I could not, in April last, accept his own statement of his own investigations as convincing proof of their accuracy, nor am I yet able to see eye to eye with the editor of the Electrical Engineer, to whom, doubtless, °° the wish is father to the
GAS FIRES.
Dec. 24th, 1906.
To the Editors of THE LANCET. have SIRS,-I already discussed the report of the Coal Smoke Abatement Society in the columns of the Gas World (Dec. 8th) and whilst agreeing with some of the conclusions arrived at by Mr. Francis Jones as to the inadequacy of hasty tests carried out in larger rooms than ordinary living rooms, I must respectfully protest against his urging the results he himself arrived at six years ago as being of any greater value than those he now impugns. In March last Mr. Jones was good enough to send me a copy of his pamphlet, " The Air of Rooms, &c.," and in a correspondence which ensued therefrom I pointed out that the room in which his tests were made erred considerably on the side of being too small, being only of 935 cubic feet capacity. In this room Mr. Jones used a gas fire the consumption per hour and the pressure of which he never took the trouble to inquire. It had eight bunsens, and as each would oonswme five cubic feet of gas it was obviously too large for the room in which the tests were made. I gathered from his letters that the gas fire was fitted into the same flue as the coal fire without any consideration as to the satisfactory carrying away of the products. Upon the point of fixing Mr. Jones, in a letter dated April 7th last, said:I made no suggestions but wished the fire to be arranged the same way these workmen are accustomed to do in ordinary Manchester houses; if there
perfect way it would not suit my purpose commonly used. Where such an indifference is displayed is it reasonable to publish broadcast results the value of which might absolutely be nullified by the single mistake of a workman or gas-fitter ? If one is seeking after scientific truth it is important that nothing be left to the frailties of even corporation gas-fitters. Far from the fire being fitted in " the ordinary way " one can only describe both the method of procedure, the size of the fire, and the dwarfed room as were a more
since I wished to test the fire in the way it is
extraordinary. Although Mr. Jones
most
took records of the temperature of the he did not think them of sufficient importance to publish in his pamphlet! The following are extracts from my last letter dated April llth, 1906, to Mr. Jones on this
room
subject :better ventilating agent than a’ gas fire if, in the many units of heat as are generated in a coal fire. It is all a question of arrangement between the method of and the method of carrying off the products or promoting heating A coal fire
latter,
we
be
no
generate
as
can
draught.
You do not think the size of the
room
will make any difference
you might as well seeing that the experiments were comparative put a gaslight or gas fire into a hermetically sealed box, and because the oxygen gives out assert that it is conclusive proof that gas is extremely poisorous and ought not to be used. My point is, that the size of the room compared with the type of stove or method of gaslighting used has everything to do with it, and when one is correctly adjusted to the other, the carbonic acid can be kept below 10 parts in 10,000. ......
__________________________________________
4
Ibid.
I am,
thought."
Sirs,
yours faithfully, JNO. HY. BREARLEY,
President of the Manchester District Institution of Gas Engineers.
TUBEROSE SCLEROSIS
OF
THE
BRAIN.
To the Editors of THE LANCET. SIRS,-In THE LANCET of Dec. 8th, 1906, p. 1583, appeared a description, by Dr. Margaret B. Dobson, of a case of buberose sclerosis of the brain. On Dec. 22nd, 1906, you commented upon this paper in an annotation in which you call attention to the presence in this patient of the "rare skin affection known as adenoma sebaceum." As Dr. A. W. Campbell’s work is apparently unknown to Dr. Dobson and is not mentioned in your note I venture to call the attention of your readers to his paper in Brain, 1905, p. 382. Here they will find a fall account of this curious pathological condition accompanied by a complete microscopical examination of the brain and other parts, including the kidneys, from a typical instance of this disease. His paper contains a list of the principal papers that have been written on this I am, Sirs, yours faithfully, subject. THE EDITOR OF "BRAIN." Jan. 3rd, 1907.
SOME
CASES OF ORCHITIS PAROTIDEA OR TESTICULAR MUMPS. To the -Editors of THE LANCET. SIRS,—In the early part of last November, and within
48 hours of one another, I had under my care four cases of acute orchitis. Each case presented practically the same
symptoms-rigor, high temperature, nausea, and a painful swelling of one testicle. There was no history of injury, no urethral discharge, and no swelling of the salivary glands. The disease lasted from 14 to 21 days and then disappeared. The parotids escaped from first to last. It was clear I had to deal with a specific infectious disease, an acute epidemic orchitis. I had no suspicion at the time that I was dealing with the virus of specific parotitis. Two days after I had seen my first case I was called to see a man who had had rigors, a high temperature, and who was A glance at his face now suffering from acute orchitis. showed the characteristic swellings under the lobes of the ears. This case, of course, suggested the true nature of the
epidemic.
Orchitis as a complication of mumps in the adult male frequent complication. I have known cases in which
is a the
before the parotitis. But I have never testicular mumps in which the parotids entirely escaped. On consulting O.5ler’s " Principles and Practice of Medicine " (third edition, p. 91) I find that he " In rare instances orchitis may be the only manifestasays, tion of the infection." I send you this note to call attention to a simple everyday disease which for some unexplained reason may present
orchitis seen
developed
cases
of
119
MEAT DIET AND THE TEETH.
itself in one of its rare manifestations and may thus cause considerable anxiety with the possibility of an erroneous I am, Sirs, yours faithfully, diagnosis. JOSEPH A. W. PEREIRA, M.D. Brux., L.R C.P.Lond., M.R.C.S.Eng., Medical Officer, Exeter City Workhouse. Exeter, Dec. 13th, 1906.
children, in whom they constitute a strong predisposition to
caries. The conclusions drawn from these observations are as follows : (a) The great increase in the consumption of meat in the past 50 years, to which I have recently drawn attention, is not an important factor in the development of dental caries, the increasing prevalence of which was proved by the recent investigation by a departmental committee ; and A NEW METHOD OF PROTECTING THE (b) in view of the deficiency of lime in the meat diet and of the imperfect development of the osseous system generally SCALP OR SKIN FROM THE X RAYS. under this regime, as described in THE LANCET of Dec. 8th, To the Editors of THE LANCET. 1906, the results of this research to my mind conclusively SIRS,—Whilst working with the x rays in St. Mary’s Ring- negative the view that a deficiency of lime salts in the dietary makes the teeth susceptible to caries. Dr. Sim Wallace is worm School, Eltham, there appeared to me very great therefore right in assuming that the facts ascertained from in of tinea to areas difficulty exposing contiguous accurately the x rays. The methods of using circular lead glass tubes this research support his teaching on this subject. I am, Sirs, yours faithfully, or sheet lead invariably left small sections of scalp unCHALMERS WATSON. treated between the diseased areas. To obviate this it Edinburgh, Jan. 6th, 1907. occurred to me to apply to the head a plastic mass, impermeable to the x rays, leaving only that portion THE USE OF CLAY IN SURGERY. of the scalp exposed to the rays which it was deI to sirous to treat. 10 the Editors of THE LANCET. Accordingly, began experiment with plasticine, the material with which children model. SIRS,-Respecting the annotation in THE LANCET of To this plasticine I added the salts of different metals Jan. 5th, p. 44, on the use of clay in surgery, may I say that and even the powdered metal itself in varying proportions, in 1865, when I was dresser in Lord Lister’s wards, a sheet to see if I could make a mass impermeable to the rays ; of pure tinfoil and a thick layer of "antiseptic putty " were when I had succeeded in obtaining it the mass was so dry used as the ordinary dressing to surgical wounds of almost that it had lost all its plasticity and was useless. I found, I am, Sirs, yours faithfully. all kinds. a suitable substitute in a lead putty, merely howevei, T. BATES. Jan. 7th, 1907. Worcester, ordinary putty with a fair amount of red lead added ; this, even in a thin layer, was impermeable to the rays, which I was able to prove by covering the free end of a lead glass THE CASE OF MR. PEERS. tube with it and using the fluorescent screen. To use the To the Editors of THE LANCET. putty I roll out a sheet of it about 15 inches square and a of an this I on inch the thick ; quarter place patient’s head, SIRS,-Please permit me to offer my sincere thanks to all moulding it smoothly over, then with a blunt spatula I who have expressed their disapproval of the county court remove a window over the area to be treated and no matter judgment and their sympathy with me in such a kind and how irregular in shape this space may be the hair epilates acceptable manner. The amount I have received (£35 6s.) uniformly after exposure to the rays and no untreated or will practically reimburse me, but I value far more the overtreated sectors occur. generous feeling displayed towards me by my fellow I shall be very pleased to show this method to anyone practitioners and by the distinguished men who have joined interested in the x ray treatment of ringworm or allied with them in their expression of sympathy. To them and to diseases, and if any difficulty is found in making the putty it you, Sirs, for placing your columns at my service I once can be obtained from Mellin and Co., chemists, High-street, more tender my grateful thanks. Eltham, London, S.E.-I am, Sirs, yours faithfully, I am, Sirs, yours faithfully, JOHN D. RICE, M.B., B.Ch. R.U.I. T. H. PARKES PEERS. New Eltham, S.E., Dec. 29th, 1906. Surrey-square, Old Kent-road, London, S.E., Jan. 7th, 1907.
MEAT DIET AND
THE
TEETH.
To the Editors of THE LANCET. SIRS,-In his letter in THE LANCET of Jan. 5tb, p. 51, Dr. J. Sim Wallace points out that some facts mentioned in my paper to the Pathological Society of London have a bearing on an important and keenly debated question in dental pathology and he asks for a fuller statement of the observations and conclusions drawn from them. In the first place, I desire to point out that any credit which may be due for the observations on the teeth referred to at that meeting and reported in your issue of Dec. 29th, 1906, p. 1777, should be given to G. W. Watson, L.D.S., and Dr. J. H. Gibbs, who made the investigation and gave a demonstration of their results to the Physiological Society in June, 1906. Two series of observations were made into the state of the teeth in meat-fed rats. In one series young rats when weaned were fed on an ox-flesh diet, this regime being continued for from five to eight months ; eight animals were employed for this investigation, an equal number of bread-and-milk fed subjects from the same litters being taken as controls. The second series comprised the progeny of meat-fed rats, 30 in number, with a like number of controls ; the ages of these animals, which were also fed on an exclusive meat diet, ranged from one day to three months. The methods of investigation were : (1) a naked-eye examination of the size and general appearance of the teeth ; (2) grinding down the teeth and submitting to microscopic examination; and (3) comparison of the histological appearances of the decalcified tissues. All the teeth examined in the meat-fed and breadand-milk-fed animals alike appeared perfectly normal with three exceptions. One of these was a meat-fed animal and two were control bread-and-milk-fed subjects. These showed developmental defects, which, Dr. Gibbs informs me, are identical with those frequently present in the teeth of
THE TREATMENT OF INFECTED EARS. To the Editors of THE LANCET. SIRS,-As an old advocate of conservative methods in the
I
treatment of infective otitis I am interested in Dr. F. Spicer’s letter. Of course, many cases of suppurative otitis will recover after a partial operation on the membrane with subsequent efficient attic irrigation. The membrane often heals, sometimes too readily, for one should be sure that the cavities are disinfected before allowing it to close; and this is by no means easy to be sure of. I have always taught that every case should be treated on its merits and some But I have seen many cases require no operation at all. cases in which unsuspected mischief has been progressing behind a healed membrane, and, except in comparatively recent cases, I believe it to be the safer practice to remove the membrane completely. Some time back I performed a post-mortem examination on a case of meningitis. In this case both membranes were entire but there was caries of the attic roof the result of old middle ear disease. My other point is that, as Mr. M. Yearsley points out, the hearing is often far better after removal of the membrane. Some years ago I showed a number of patients with good hearing who had had both membranes completely removed. I could have shown at the same time several patients who had apparently recovered with healed membranes. More than one of these latter cases has since developed symptoms requiring operation. Removal of the membrane will sometimes restore hearing in advanced cases of chronic progressive deafness. Yesterday a lady came to see me whoe left membrane I removed in 1904. At that time she was absolutely deaf in the left ear in spite of much advice. She can now hear a sermon in church, though the right ear, which was also affected, is now absolutely deaf.
118
The fire used would be consuming anything from 35 to 50 cubic feet a nebaliser. All chemical analyses of the preparation in gas per hour, whereas for a room of that size satisfactory heating question are untrustworthy, for formulae made according to of would be accomplished with a gas fire consuming not more than such analyses do not show the effects of the original prepara- 8 to 10 cubic feet per hour. I must say that if you had been tion. I have sought to determine the nature of the secret endeavouring to get the percentage of carbonic acid in the atmosphere as high as possible you could not have adopted better conditions than remedy by studying its physiologic action which is es- a room far below normal capacity, and a fire far above normal consentially as following : When sprayed into the nose, even of sumption (and probably badly fitted to the flue) for your purpose. a normal subject, there is almost an immediate translation of Mr. Jones hopes the Coal Smoke Abatement Society will the normal lung resonance to dulness or flatness (lung reflex continue its tests. May I, too, express a similar hope-i.e., of contraction). The weakness of the longitudinal fibres is that Mr. Jones will revise his own tests, using normal conalso demonstrated by my tracheal traction test, which is a ditions from which to make deductions intended for wide
of
method of recognising an asthmatic lung. In accordwith the theory propounded, I treat my asthmatics in the paroxysmal and interparoxysmal periods by respiratory exercises which tend to strengthen the longitudinal fibres. I have known asthmatics whose attacks resisted even the influence of an anaesthetic for hours and which yielded after a few minutes of systematic compressions of the thorax during
simple ance
I would not have troubled you with this letter were it not for the fact that our competing friends the electricians make as much capital as they can from such letters as the one from Mr. Jones, as is evidenced by an editorial thereupon in the Electrical Engineer of Dec. 21st in which appears the following summing-up :—
publication ?
expiration. Relative to the final question, I believe it has already been answered. Amyl nitrite acts on the fibres of the uterus with secondary constriction of the blood-vessels, just as it acts on the longitudinal fibres of the bronchial musculature and in the former action it is essentially an oxytocic. The lowering of the blood pressure must also be taken into account as cited in my previous communication. I am, Sirs, yours faithfully, DR. ALBERT ABRAMS. Paris, Jan. 2nd, 1907.
We think it will be admitted that the evidence which Mr. Jones was convincing proof of its accuracy, while his criticism of the society’s report is fair and reasonable.
produced in support of his statement
Whilst I would be the last man in the world to impute other than the highest motives to Mr. Jones, I could not, in April last, accept his own statement of his own investigations as convincing proof of their accuracy, nor am I yet able to see eye to eye with the editor of the Electrical Engineer, to whom, doubtless, °° the wish is father to the
GAS FIRES.
Dec. 24th, 1906.
To the Editors of THE LANCET. have SIRS,-I already discussed the report of the Coal Smoke Abatement Society in the columns of the Gas World (Dec. 8th) and whilst agreeing with some of the conclusions arrived at by Mr. Francis Jones as to the inadequacy of hasty tests carried out in larger rooms than ordinary living rooms, I must respectfully protest against his urging the results he himself arrived at six years ago as being of any greater value than those he now impugns. In March last Mr. Jones was good enough to send me a copy of his pamphlet, " The Air of Rooms, &c.," and in a correspondence which ensued therefrom I pointed out that the room in which his tests were made erred considerably on the side of being too small, being only of 935 cubic feet capacity. In this room Mr. Jones used a gas fire the consumption per hour and the pressure of which he never took the trouble to inquire. It had eight bunsens, and as each would oonswme five cubic feet of gas it was obviously too large for the room in which the tests were made. I gathered from his letters that the gas fire was fitted into the same flue as the coal fire without any consideration as to the satisfactory carrying away of the products. Upon the point of fixing Mr. Jones, in a letter dated April 7th last, said:I made no suggestions but wished the fire to be arranged the same way these workmen are accustomed to do in ordinary Manchester houses; if there
perfect way it would not suit my purpose commonly used. Where such an indifference is displayed is it reasonable to publish broadcast results the value of which might absolutely be nullified by the single mistake of a workman or gas-fitter ? If one is seeking after scientific truth it is important that nothing be left to the frailties of even corporation gas-fitters. Far from the fire being fitted in " the ordinary way " one can only describe both the method of procedure, the size of the fire, and the dwarfed room as were a more
since I wished to test the fire in the way it is
extraordinary. Although Mr. Jones
most
took records of the temperature of the he did not think them of sufficient importance to publish in his pamphlet! The following are extracts from my last letter dated April llth, 1906, to Mr. Jones on this
room
subject :better ventilating agent than a’ gas fire if, in the many units of heat as are generated in a coal fire. It is all a question of arrangement between the method of and the method of carrying off the products or promoting heating A coal fire
latter,
we
be
no
generate
as
can
draught.
You do not think the size of the
room
will make any difference
you might as well seeing that the experiments were comparative put a gaslight or gas fire into a hermetically sealed box, and because the oxygen gives out assert that it is conclusive proof that gas is extremely poisorous and ought not to be used. My point is, that the size of the room compared with the type of stove or method of gaslighting used has everything to do with it, and when one is correctly adjusted to the other, the carbonic acid can be kept below 10 parts in 10,000. ......
__________________________________________
4
Ibid.
I am,
thought."
Sirs,
yours faithfully, JNO. HY. BREARLEY,
President of the Manchester District Institution of Gas Engineers.
TUBEROSE SCLEROSIS
OF
THE
BRAIN.
To the Editors of THE LANCET. SIRS,-In THE LANCET of Dec. 8th, 1906, p. 1583, appeared a description, by Dr. Margaret B. Dobson, of a case of buberose sclerosis of the brain. On Dec. 22nd, 1906, you commented upon this paper in an annotation in which you call attention to the presence in this patient of the "rare skin affection known as adenoma sebaceum." As Dr. A. W. Campbell’s work is apparently unknown to Dr. Dobson and is not mentioned in your note I venture to call the attention of your readers to his paper in Brain, 1905, p. 382. Here they will find a fall account of this curious pathological condition accompanied by a complete microscopical examination of the brain and other parts, including the kidneys, from a typical instance of this disease. His paper contains a list of the principal papers that have been written on this I am, Sirs, yours faithfully, subject. THE EDITOR OF "BRAIN." Jan. 3rd, 1907.
SOME
CASES OF ORCHITIS PAROTIDEA OR TESTICULAR MUMPS. To the -Editors of THE LANCET. SIRS,—In the early part of last November, and within
48 hours of one another, I had under my care four cases of acute orchitis. Each case presented practically the same
symptoms-rigor, high temperature, nausea, and a painful swelling of one testicle. There was no history of injury, no urethral discharge, and no swelling of the salivary glands. The disease lasted from 14 to 21 days and then disappeared. The parotids escaped from first to last. It was clear I had to deal with a specific infectious disease, an acute epidemic orchitis. I had no suspicion at the time that I was dealing with the virus of specific parotitis. Two days after I had seen my first case I was called to see a man who had had rigors, a high temperature, and who was A glance at his face now suffering from acute orchitis. showed the characteristic swellings under the lobes of the ears. This case, of course, suggested the true nature of the
epidemic.
Orchitis as a complication of mumps in the adult male frequent complication. I have known cases in which
is a the
before the parotitis. But I have never testicular mumps in which the parotids entirely escaped. On consulting O.5ler’s " Principles and Practice of Medicine " (third edition, p. 91) I find that he " In rare instances orchitis may be the only manifestasays, tion of the infection." I send you this note to call attention to a simple everyday disease which for some unexplained reason may present
orchitis seen
developed
cases
of
119
MEAT DIET AND THE TEETH.
itself in one of its rare manifestations and may thus cause considerable anxiety with the possibility of an erroneous I am, Sirs, yours faithfully, diagnosis. JOSEPH A. W. PEREIRA, M.D. Brux., L.R C.P.Lond., M.R.C.S.Eng., Medical Officer, Exeter City Workhouse. Exeter, Dec. 13th, 1906.
children, in whom they constitute a strong predisposition to
caries. The conclusions drawn from these observations are as follows : (a) The great increase in the consumption of meat in the past 50 years, to which I have recently drawn attention, is not an important factor in the development of dental caries, the increasing prevalence of which was proved by the recent investigation by a departmental committee ; and A NEW METHOD OF PROTECTING THE (b) in view of the deficiency of lime in the meat diet and of the imperfect development of the osseous system generally SCALP OR SKIN FROM THE X RAYS. under this regime, as described in THE LANCET of Dec. 8th, To the Editors of THE LANCET. 1906, the results of this research to my mind conclusively SIRS,—Whilst working with the x rays in St. Mary’s Ring- negative the view that a deficiency of lime salts in the dietary makes the teeth susceptible to caries. Dr. Sim Wallace is worm School, Eltham, there appeared to me very great therefore right in assuming that the facts ascertained from in of tinea to areas difficulty exposing contiguous accurately the x rays. The methods of using circular lead glass tubes this research support his teaching on this subject. I am, Sirs, yours faithfully, or sheet lead invariably left small sections of scalp unCHALMERS WATSON. treated between the diseased areas. To obviate this it Edinburgh, Jan. 6th, 1907. occurred to me to apply to the head a plastic mass, impermeable to the x rays, leaving only that portion THE USE OF CLAY IN SURGERY. of the scalp exposed to the rays which it was deI to sirous to treat. 10 the Editors of THE LANCET. Accordingly, began experiment with plasticine, the material with which children model. SIRS,-Respecting the annotation in THE LANCET of To this plasticine I added the salts of different metals Jan. 5th, p. 44, on the use of clay in surgery, may I say that and even the powdered metal itself in varying proportions, in 1865, when I was dresser in Lord Lister’s wards, a sheet to see if I could make a mass impermeable to the rays ; of pure tinfoil and a thick layer of "antiseptic putty " were when I had succeeded in obtaining it the mass was so dry used as the ordinary dressing to surgical wounds of almost that it had lost all its plasticity and was useless. I found, I am, Sirs, yours faithfully. all kinds. a suitable substitute in a lead putty, merely howevei, T. BATES. Jan. 7th, 1907. Worcester, ordinary putty with a fair amount of red lead added ; this, even in a thin layer, was impermeable to the rays, which I was able to prove by covering the free end of a lead glass THE CASE OF MR. PEERS. tube with it and using the fluorescent screen. To use the To the Editors of THE LANCET. putty I roll out a sheet of it about 15 inches square and a of an this I on inch the thick ; quarter place patient’s head, SIRS,-Please permit me to offer my sincere thanks to all moulding it smoothly over, then with a blunt spatula I who have expressed their disapproval of the county court remove a window over the area to be treated and no matter judgment and their sympathy with me in such a kind and how irregular in shape this space may be the hair epilates acceptable manner. The amount I have received (£35 6s.) uniformly after exposure to the rays and no untreated or will practically reimburse me, but I value far more the overtreated sectors occur. generous feeling displayed towards me by my fellow I shall be very pleased to show this method to anyone practitioners and by the distinguished men who have joined interested in the x ray treatment of ringworm or allied with them in their expression of sympathy. To them and to diseases, and if any difficulty is found in making the putty it you, Sirs, for placing your columns at my service I once can be obtained from Mellin and Co., chemists, High-street, more tender my grateful thanks. Eltham, London, S.E.-I am, Sirs, yours faithfully, I am, Sirs, yours faithfully, JOHN D. RICE, M.B., B.Ch. R.U.I. T. H. PARKES PEERS. New Eltham, S.E., Dec. 29th, 1906. Surrey-square, Old Kent-road, London, S.E., Jan. 7th, 1907.
MEAT DIET AND
THE
TEETH.
To the Editors of THE LANCET. SIRS,-In his letter in THE LANCET of Jan. 5tb, p. 51, Dr. J. Sim Wallace points out that some facts mentioned in my paper to the Pathological Society of London have a bearing on an important and keenly debated question in dental pathology and he asks for a fuller statement of the observations and conclusions drawn from them. In the first place, I desire to point out that any credit which may be due for the observations on the teeth referred to at that meeting and reported in your issue of Dec. 29th, 1906, p. 1777, should be given to G. W. Watson, L.D.S., and Dr. J. H. Gibbs, who made the investigation and gave a demonstration of their results to the Physiological Society in June, 1906. Two series of observations were made into the state of the teeth in meat-fed rats. In one series young rats when weaned were fed on an ox-flesh diet, this regime being continued for from five to eight months ; eight animals were employed for this investigation, an equal number of bread-and-milk fed subjects from the same litters being taken as controls. The second series comprised the progeny of meat-fed rats, 30 in number, with a like number of controls ; the ages of these animals, which were also fed on an exclusive meat diet, ranged from one day to three months. The methods of investigation were : (1) a naked-eye examination of the size and general appearance of the teeth ; (2) grinding down the teeth and submitting to microscopic examination; and (3) comparison of the histological appearances of the decalcified tissues. All the teeth examined in the meat-fed and breadand-milk-fed animals alike appeared perfectly normal with three exceptions. One of these was a meat-fed animal and two were control bread-and-milk-fed subjects. These showed developmental defects, which, Dr. Gibbs informs me, are identical with those frequently present in the teeth of
THE TREATMENT OF INFECTED EARS. To the Editors of THE LANCET. SIRS,-As an old advocate of conservative methods in the
I
treatment of infective otitis I am interested in Dr. F. Spicer’s letter. Of course, many cases of suppurative otitis will recover after a partial operation on the membrane with subsequent efficient attic irrigation. The membrane often heals, sometimes too readily, for one should be sure that the cavities are disinfected before allowing it to close; and this is by no means easy to be sure of. I have always taught that every case should be treated on its merits and some But I have seen many cases require no operation at all. cases in which unsuspected mischief has been progressing behind a healed membrane, and, except in comparatively recent cases, I believe it to be the safer practice to remove the membrane completely. Some time back I performed a post-mortem examination on a case of meningitis. In this case both membranes were entire but there was caries of the attic roof the result of old middle ear disease. My other point is that, as Mr. M. Yearsley points out, the hearing is often far better after removal of the membrane. Some years ago I showed a number of patients with good hearing who had had both membranes completely removed. I could have shown at the same time several patients who had apparently recovered with healed membranes. More than one of these latter cases has since developed symptoms requiring operation. Removal of the membrane will sometimes restore hearing in advanced cases of chronic progressive deafness. Yesterday a lady came to see me whoe left membrane I removed in 1904. At that time she was absolutely deaf in the left ear in spite of much advice. She can now hear a sermon in church, though the right ear, which was also affected, is now absolutely deaf.