- Email: [email protected]
STAMMERING
348 and perhaps also because of the formation of antihormones. I saw such a patient quite recently who had taken 15 grains of thyroid daily for eighteen months .and had remained well, except for a tachycardia of’106120. It took more than six months to reduce the dose to 1½—2 grains dailv. V. C. MEDVEI. London. S.W.3. STAMMERING SIR,—Speech therapists should be indebted to Dr. Chrysanthis (Feb. 15) for his data on the incidence of stammering in the Greek elementary schools of Nicosia, Cyprus. A number of factors mentioned in this con-
proteins,
v
nexion—such as anthropological peculiarities, intelligence, handedness, and sex-are still so controversial that they cannot be discussed briefly. I must, however, challenge
the statement that " according to many investigators, stammering is unknown among the Chinese, whose language consists of monosyllables." This opinion can be traced back to Colombat d’Isères ,(Trait,- de tous les vices de la parole et en particulier du Begaiement, Paris, 1840). He mentions that a boy born of a Chinese mother and a French father was able to speak Chinese perfectly but stammered when speaking French. With reference to Colombat’s opinion, James Hunt, in his book on stammering (London, 1865), explicitly says that " the assertion which has been made on various occasions, on very slender grounds, that there are no stutterers in China is refuted by the fact that the Chinese language possesses a term for impediments of speech." Kussmaul (Pathologie der Sprache, 1877) again gives it out to be an established fact that there are no stammerers in China. He attributes stammering to a lesion of a hypothetical centre of syllable coordination, and it is therefore probable that he adduced Colombat’s statement concerning the absence of stammering in people speaking a monosyllabic language in support of his theory. Kussmaul was a great expert on the pathology of speech, and it is therefore not surprising that, on his authority, other authors took the statement for granted. Chinese physicians whom Gutzmann (Sprachheilkunde, 1912) asked about the truth of Colombat’s statement were greatly astonished and declared that stammering was just as common in China as in Europe. They also informed him that the Chinese term was kchi-ko. For the sake of historical accuracy I should be grateful if you would publish these lines, particularly as the erroneous statement ,has since then been quoted in the
dailv
Dress.
LEOPOLD STEIN.
Tavistock Clinic, London, W.1.
BENIGN
LYMPHOCYTIC MENINGITIS AND GLANDULAR FEVER
interested in Sir Henry Tidy’s article of Dec. 7, particularly because by chance I recently discovered another study of this relationship from America. Coogan and colleaguesconcluded that " a suggestion is contained here that at least some cases of lymphocytic meningitis are really cases of infectious mononucleosis with meningismus." They quote Huber,2 who reported 3 cases of glandular fever exhibiting meningismus, 2 of which showed a lymphocytosis in the spinal fluid.
SIR,—I
of those who have been unfortunate enough to be given a low fistula. The use of the suprapubic catheter is to provide adequate drainage during the period before the development of automatic bladder activity or the return of voluntary micturition, while at the same time preventing serious or ascending infection. In my experience it does this more safely and certainly than the urethral catheter, even with tidal drainage. E. W. RICHES. London, W.I. THE PERIODICALS SIR,—The suspension of the periodicals, and the manner in which it was effected, raise considerations whose importance has not, I submit, been fully appreciated. Two explanations of the suspension, conflicting with one another and with the facts, were given in the two Houses of Parliament, but in both Houses all pretence of any statutory sanction was immediately abandoned. On Feb. 25 in the Commons, the Prime Minister, challenged at question time for the statutory authority upon which suspension had been made, declared, twice over, that it was " done by agreement " between the Periodical Proprietors Association (P.P.A.) and the Government. Lord Chorley, replying for the Government in the Lords
(Feb. 27), repudiated the " agreement " argument. "Suspension of publication was secured," he said, " by an instruction issued after consultation with bodies representing major interests in the newspaper and periodical press." Speaking with all the authority of a professor of law in the University of London, he declared categorically that " instruction is the word which I think most accurately describes " the procedure adopted.
The ascertained facts are that Mr. Shinwell had issued the " instruction " three days before any consultation with the P.P.A. was attempted. The " instruction" had, and was intended to have, all the appearance of an imperial rescript. The P.P.A. taking that view of it, and confronted with an accomplished fact, had no alternative but to " agree." E. GRAHAM-LITTLE. House of Commons.
* * * Like the Economist, we felt that some latitude of authority should be conceded to His Majesty’s Government, if they are acting in good faith in an undoubted" national emergency," but we trust that " instructions of this kind will never be issued again. The P.P.A. agreed with the Ministry that, in order to equalise sacrifices, duplicated issues should not be published; and our membership of the P.P.A. therefore prevented production of the token issues by which we had hoped to maintain continuity of publication.-ED. L. WELFARE OF DEAF CHILDREN
was
C.R.S., Brancepeth, Co. Durham.
R. N. JOHNSTON.
TRAUMATIC PARAPLEGIA SIR,—In your account of the recent discussion on traumatic paraplegia at the Royal Society of Medicine (Jan. 4, p. 23) you misquote my instructions for the It should be introduction of a suprapubic catheter. inserted at the highest point of bladder dullness, or midway between the umbilicus and the symphysis-whichever is the lower. There is no advantage, and some possible danger, in a tube put in higher than the mid-
point. Your leading article of Feb. 15 (p. 258) seems to infer that I advocate permanent suprapubic drainage for these This is far from being the case, and I have pointed cases. out that one of the advantages of the small high suprapubic fistula is the readiness with which it closes when the tube is removed. The majority of our cases at Stoke Mandeville have their bladders closed, and much of my time there is spent in closing surgically the bladders 1. Coogan, T. J.,
Martinson, D. L., Mathews,
1945, 87, 296.
W. H.
2. Huber, W. Schweiz. med. Wschr. 1938, 68, 892.
Illinois med. J.
SIR,—My attention has been drawn to the letter of Miss Edwardes, secretary of the Deaf Children’s Society,
in your issue of Dec. 21 (p. 923). There is much to be commended in this letter but it raises some points which call for a reply. Deaf children have suffered too -long from lack of proper facilities and from the fact that their parents have been given incomplete or inaccurate advice. There is not sufficient accommodation at the moment for all deaf children to be admitted to schools immediately their affliction is diagnosed, but it is essential that practitioners, and the parents of deaf children, should be made aware of the best and only satisfactory method of providing for their education. Your correspondent says that the young deaf child need not be instructed by a fully qualified teacher. But the whole foundation of the deaf child’s education and his whole outlook on life depend on the training in his early years. Only the qualified teacher can meet the needs of the young deaf child. It is to be hoped that the efforts of parents and such societies as that represented by your correspondent will be directed to ensuring increased facilities for young deaf children under fully qualified teachers. A further point is the advisability of young deaf children attending a residential sehool. There are comparatively few deaf children whose homes are so situated that it is convenient or suitable for them to attend day schools even when they have reached normal schoo Even in the large age let alone nursery-school age. cities the travelling involved would often be much more a young child could be expected to undertake, and ,
’
than
proteins,
v
nexion—such as anthropological peculiarities, intelligence, handedness, and sex-are still so controversial that they cannot be discussed briefly. I must, however, challenge
the statement that " according to many investigators, stammering is unknown among the Chinese, whose language consists of monosyllables." This opinion can be traced back to Colombat d’Isères ,(Trait,- de tous les vices de la parole et en particulier du Begaiement, Paris, 1840). He mentions that a boy born of a Chinese mother and a French father was able to speak Chinese perfectly but stammered when speaking French. With reference to Colombat’s opinion, James Hunt, in his book on stammering (London, 1865), explicitly says that " the assertion which has been made on various occasions, on very slender grounds, that there are no stutterers in China is refuted by the fact that the Chinese language possesses a term for impediments of speech." Kussmaul (Pathologie der Sprache, 1877) again gives it out to be an established fact that there are no stammerers in China. He attributes stammering to a lesion of a hypothetical centre of syllable coordination, and it is therefore probable that he adduced Colombat’s statement concerning the absence of stammering in people speaking a monosyllabic language in support of his theory. Kussmaul was a great expert on the pathology of speech, and it is therefore not surprising that, on his authority, other authors took the statement for granted. Chinese physicians whom Gutzmann (Sprachheilkunde, 1912) asked about the truth of Colombat’s statement were greatly astonished and declared that stammering was just as common in China as in Europe. They also informed him that the Chinese term was kchi-ko. For the sake of historical accuracy I should be grateful if you would publish these lines, particularly as the erroneous statement ,has since then been quoted in the
dailv
Dress.
LEOPOLD STEIN.
Tavistock Clinic, London, W.1.
BENIGN
LYMPHOCYTIC MENINGITIS AND GLANDULAR FEVER
interested in Sir Henry Tidy’s article of Dec. 7, particularly because by chance I recently discovered another study of this relationship from America. Coogan and colleaguesconcluded that " a suggestion is contained here that at least some cases of lymphocytic meningitis are really cases of infectious mononucleosis with meningismus." They quote Huber,2 who reported 3 cases of glandular fever exhibiting meningismus, 2 of which showed a lymphocytosis in the spinal fluid.
SIR,—I
of those who have been unfortunate enough to be given a low fistula. The use of the suprapubic catheter is to provide adequate drainage during the period before the development of automatic bladder activity or the return of voluntary micturition, while at the same time preventing serious or ascending infection. In my experience it does this more safely and certainly than the urethral catheter, even with tidal drainage. E. W. RICHES. London, W.I. THE PERIODICALS SIR,—The suspension of the periodicals, and the manner in which it was effected, raise considerations whose importance has not, I submit, been fully appreciated. Two explanations of the suspension, conflicting with one another and with the facts, were given in the two Houses of Parliament, but in both Houses all pretence of any statutory sanction was immediately abandoned. On Feb. 25 in the Commons, the Prime Minister, challenged at question time for the statutory authority upon which suspension had been made, declared, twice over, that it was " done by agreement " between the Periodical Proprietors Association (P.P.A.) and the Government. Lord Chorley, replying for the Government in the Lords
(Feb. 27), repudiated the " agreement " argument. "Suspension of publication was secured," he said, " by an instruction issued after consultation with bodies representing major interests in the newspaper and periodical press." Speaking with all the authority of a professor of law in the University of London, he declared categorically that " instruction is the word which I think most accurately describes " the procedure adopted.
The ascertained facts are that Mr. Shinwell had issued the " instruction " three days before any consultation with the P.P.A. was attempted. The " instruction" had, and was intended to have, all the appearance of an imperial rescript. The P.P.A. taking that view of it, and confronted with an accomplished fact, had no alternative but to " agree." E. GRAHAM-LITTLE. House of Commons.
* * * Like the Economist, we felt that some latitude of authority should be conceded to His Majesty’s Government, if they are acting in good faith in an undoubted" national emergency," but we trust that " instructions of this kind will never be issued again. The P.P.A. agreed with the Ministry that, in order to equalise sacrifices, duplicated issues should not be published; and our membership of the P.P.A. therefore prevented production of the token issues by which we had hoped to maintain continuity of publication.-ED. L. WELFARE OF DEAF CHILDREN
was
C.R.S., Brancepeth, Co. Durham.
R. N. JOHNSTON.
TRAUMATIC PARAPLEGIA SIR,—In your account of the recent discussion on traumatic paraplegia at the Royal Society of Medicine (Jan. 4, p. 23) you misquote my instructions for the It should be introduction of a suprapubic catheter. inserted at the highest point of bladder dullness, or midway between the umbilicus and the symphysis-whichever is the lower. There is no advantage, and some possible danger, in a tube put in higher than the mid-
point. Your leading article of Feb. 15 (p. 258) seems to infer that I advocate permanent suprapubic drainage for these This is far from being the case, and I have pointed cases. out that one of the advantages of the small high suprapubic fistula is the readiness with which it closes when the tube is removed. The majority of our cases at Stoke Mandeville have their bladders closed, and much of my time there is spent in closing surgically the bladders 1. Coogan, T. J.,
Martinson, D. L., Mathews,
1945, 87, 296.
W. H.
2. Huber, W. Schweiz. med. Wschr. 1938, 68, 892.
Illinois med. J.
SIR,—My attention has been drawn to the letter of Miss Edwardes, secretary of the Deaf Children’s Society,
in your issue of Dec. 21 (p. 923). There is much to be commended in this letter but it raises some points which call for a reply. Deaf children have suffered too -long from lack of proper facilities and from the fact that their parents have been given incomplete or inaccurate advice. There is not sufficient accommodation at the moment for all deaf children to be admitted to schools immediately their affliction is diagnosed, but it is essential that practitioners, and the parents of deaf children, should be made aware of the best and only satisfactory method of providing for their education. Your correspondent says that the young deaf child need not be instructed by a fully qualified teacher. But the whole foundation of the deaf child’s education and his whole outlook on life depend on the training in his early years. Only the qualified teacher can meet the needs of the young deaf child. It is to be hoped that the efforts of parents and such societies as that represented by your correspondent will be directed to ensuring increased facilities for young deaf children under fully qualified teachers. A further point is the advisability of young deaf children attending a residential sehool. There are comparatively few deaf children whose homes are so situated that it is convenient or suitable for them to attend day schools even when they have reached normal schoo Even in the large age let alone nursery-school age. cities the travelling involved would often be much more a young child could be expected to undertake, and ,
’
than