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THE COLOUR SENSE IN RELATION TO THE EMOTIONS.
THE COLOUR SENSE IN RELATION TO THE EMOTIONS.
683
has been used from year to year by me without seeing dose of tetanus antitoxin. I have never had a case following Several piles, but I have only once ligatured a pile. It is not to be a case of tetanus following in anything else. other men whom I know have had the same experience. assumed that the policy which I advocate is a policy leading I also know of two cases of tetanus following ligature of to laxity in our technique. A recent writer in the Indian piles by two other careful men. I know of a recent case Medical Gazette seemed to lament that the establishment of of tetanus following the strangulation of a naevus on the face Sir David Semple’s case would lead to this result. We have with a ligature by a careful man, and I also know of tetanus to deal with quite enough other germs to cause us to be as in a hysterectomy case in the British Isles by a very careful careful in our technique as if tetanus did not exist. The records of my hospital show that tetanus frequently and experienced operator, where there seemed absolutely no possibility of direct infection. The fact that many men have follows on mill injuries, often to all appearance injuries above suspicion. There are here on an average 20 never seen a case of tetanus follow a surgical operation or For over two years the subcutaneous administration of quinine, and that it is to 30 such cases in the year. very far from often following either, is no argument that it we have administered a dose of tetanus antitoxin to every does not follow. We can never tell when it may follow. One such case on admission to hospital. There has been one case I of tetanus developed in this hospital during these two years case is quite enough ; is too many if it can be avoided. brilliant young surgeon who was in such cases. That case came in nine days after the injury, once came across a unfortunate enough to have had one such case, and was and my assistant had used his judgment and considered antistruck by the fact that the idea of it had ruined his nerve, toxin unnecessary, and hence did not use it. I add this not unlikely for life. There are enough cases of tetanus paragraph to show the importance of the use of tetanus recorded, and crowds of cases unrecorded, following surgical antitoxin as a preventive in such cases. As a curative agent, operations to justify us in seriously considering its proximate when symptoms of tetanus have developed, I have found causes. it absolutely useless.-I am, Sir, yours faithfully, As far as I can judge from my own personal experience HENRY SMITH, V.H.S., and from the experience of others, both recorded and unLieutenant-Colonel, I.M.S. recorded, I believe that tetanus follows on operation for hernia very much more frequently than on any other. Up to the present time tetanus following operation has been put THE COLOUR SENSE IN RELATION TO to the charge of the surgeon. The implication has been that THE EMOTIONS. he introduced the tetanus through suture, lotions, dressings, or from his or his own hands those of To the Editor of THE LANOET. instruments, sponges, assistants-not a very comforting reflection for the surgeon. effect upon the pulse-beat of a slight emotion SIR,-The Why should this tetanus occur in spite of the utmost care on may be illustrated from the examination of a candidate I believe that the reason is the part of the surgeon ? for admission to the service of New South explained by Sir David Semple’s paper. An anaerobic area Wales. The degree of railway emotion varies with the type of has been left-the sine qui non for the development of In one man there is great anxiety to obtain a tetanus from tetanus spores. Sir David Semple has shown applicant. in another comparative indifference to the result. position, that the spores of tetanus are frequently present in the One man is stable, another is neurotic. The degree of appeal human intestine. He has shown that when tetanus spores in a railway fettler under examination for permanent employa and are injected into given area of a guinea-pig quinine ment in the service varies less than in any other injected into a distant area of the same guinea-pig, class. This railway man belongs to a rapidly disappearing class, tetanus bacilli are to be found in the anaerobic slough a large majority of whom were born and reared in the produced by the quinine and nowhere else, and that a country districts by poor hard-working parents. They are as control guinea-pig which has similarly received an equal a rule big muscular healthy men of stable type, in many ways number of spores, but has not received any quinine, is and more than usually honest. A neurotic railway not affected by tetanus.2 How do the spores reach the childlike, A casual observer would regard him as fettler is rare. anaerobic area in this case ? I can only understand it by some but a true valuation is that within its of them travelling through the blood circuit and eventually being mentally dull, limited orbit of observation and experience the mind is becoming stranded in the area of dead anaerobic tissue, where sound in judgment. they develop into toxin-producing tetanus bacilli. In the case The to a colour-blind fettler is direct to the mind, of hernia the intestine, which may contain tetanus spores, his faceappeal shows no indication of emotional response. This is has lain stationary in the hernial sac. May tetanus spores marked during his selection of the wools. When spoken not migrate into that sac ? The time-honoured operations for very to his voice is monotonous in tone, and still more so when hernia imply a ligature of the sac, and excision of a portion to name the colours in the lantern, when he of it distal to the ligature which leaves an anaerobic hernial attempting hesitates and pauses before answering. On the frequently stump. This may have in it migrated tetanus spores, or tetanus other hand, a fettler with a good colour sense never hesitates spores may be brought to it by the blood circuit. Since or pauses when he is naming the colours in the lantern ; in reading Sir David Semple’s paper I have modified my treat- his case there is no evidence that he requires assistance from ment of the sac so as to avoid leaving an anaerobic I the mind. During the examination by the wools the fettler stump. I draw down the sac, catch it as high up as possible with a normal colour sense frequently shows a slight degree with an intestinal forceps, cut it off below the forceps, fix a of excitement, his hand may shake, and when examined catgut suture at one end of the sac behind the forceps, and physically there is frequently an increase in his pulse run a glover’s suture from the fixed point through the sac and beat. This condition is transient and may disappear I over the forceps, not tightening it until it is all inserted. before the examination is finished. When the mind of then open the forceps with the loose suture over them and a fettler realises that he has a defect which unfits him insert a stout long probe between the blades and withdraw for the service he looks depressed, but if he is a colourthe forceps. With the assistance of the probe we can with a blind person there has been none of the preliminary excitedissecting forceps draw the sutures tight, drawing out the ment frequently seen in a with a good colour sense. probe as we go along. With the probe we put the stitches Under these conditions theperson depression appears to persist on the stretch, and hence we can find them easily to tighten in a colour-blind person than in one with a keen them. I now return the stitched-up opening, and dispose of longer colour sense, and to be more sombre and uniform in its the opening in the abdominal wall in the usual way. This mood. procedure is simple ; it is as effective as any of the anaerobic from the city is One type of candidate drawn an stump methods, and it is attempt to render tetanus after not satisfactory to deal with from generally the standard of emotional hernia as rare as it is after other surgical operations. A number are neurotic, a class I endeavour to A ligatured pile is an anaerobic stump in the vicinity of appeals. exclude from the running lines of the railway service. A tetanus spores. How are we to avoid tetanus in this case ? dilated pupil, tremulous hand, rapid pulse, &c., frequently Cut off the piles and stitch up the wound, or do a Whitehead’s A mind with expeindicate the habits of a degenerate. operation, or if we decide to ligature, then give the patient a rience will endeavour to exclude such persons. 2 A growth of tetanus bacilli can be obtained by making anaerobic cultivation from the tissues at the seat of injection of the spores in both cases, and there is a growth of tetanus bacilli at the seat of injection of quinine in the quinine case.
I
am.
faithfullv. GEORGE HENRY TAYLOR, Railway Medical Officer, New South Wales. Sir.
vours
684
THE TREATMENT OF TUBERCULOSIS & THE SANATORIUM
THE INTESTINAL FLORA.
QUESTION.
THE TREATMENT OF TUBERCULOSIS AND
To the Editor of THE LANCET. THE SANATORIUM the above title A. in Dr. Distaso To the Editor of THE LANCET. SIR,—Under gives your issue of Feb. 24th what he describes as a " brief summary of SIR,—It is a thousand pities that " F R.C.P." should stir the results of my researches, the details of which will appear up strife in the medical profession by his remarks as to the soon in extenso." I have been much interested of late years in constitution of the advisory committee on tuberculosis. the subject of the possible causation of some kinds of mental one regrets the absence of certain names, every disorder, or of phases of such, through the absorption into Although member of this committee is well known and distinguished the circulation of toxic material from the intestinal contents. for work done (and well done) in this department of preI am therefore looking forward with interest to the detailed ventive medicine ; and the inclusion of a few more specialists account of his researches which Dr. Distaso foreshadows. He or general practitioners would not have added appreciably will probably give in this the evidence for certain statements to the strength of the committee. which appear in the summary just published. The inference From the remarks made by "F.RC.P."on sanatoriums from this observation is that he has as yet given no evidence would imagine that they were opposed to dispensaries one for them ; and this is precisely what I desire to affirm. I instead of supplementing and completing their work. would call the attention of your readers, and of Dr. Distaso, Even that every case can be cured by tuberculin to the following weighty statements which he makes without, at a supposing (which most authorities on tuberculin dispensary in my judgment, adducing any evidence :— treatment would not admit) we still have to deal with the The flora of the normal adult is certainly harmful, and, far from hygienic) causes leading to the tuberculous illness, defending the organism against infection, it may be said to help it (mostly cannot often be done in working-class households which (sic). In the colon indol and other bodies belonging to the heterocyclic without at least some training in a sanatorium. Example These bodies, when and aromatic series are elaborated and absorbed. is always more powerful than precept, and the habits of a absorbed, severely tax the functions of the body and therefore of the liver. This fact may throw some light on the etiology of diseases of lifetime are more easily changed when the value of the the liver. [What "fact" is referred to?] Moreover, change is demonstrated at a sanatorium. Not only is there intoxication by the products of bacterial growth, but man in his senses would treat a febrile consumpno the disappearance of the bacteria indicates a process of autolysis, the tive with tuberculin as an outpatient or in a workingproducts of which when absorbed cannot fail to be harmful. Constipation and the resulting intoxication are caused by the class home if better conditions were available. It is the intestinal flora. [It is apparently taken for granted that all chemical febrile consumptive who has to be treated as a rule, and no changes in the intestinal contents which result in the production of arrangements are adequate which leave this fact out of toxin are due to bacteria.] Doubtless the products of the intestinal bacteria, by increasing ’. consideration. secretions inhibiting the submucous plexuses, give rise to stasis. Further, recovery from pulmonary tuberculous illness, I am. Sir. vonrs faithfnllv. however treated, is conditional ; if habits and conditions of EDWIN GOODALL. life are unsatisfactory relapse or reinfection usually takes place sooner or later. Not every tuberculous person needs treatment. Many such go through life without tuberculous illness ; but if a tuberculous person has more than a very ELECTRIC METALLIC COLLOIDS AND limited quiescent lesion, if the bodily health is in any way affected by the tuberculous focus, and if his habits or condiTHEIR THERAPEUTICAL tions of life are unsatisfactory, he is in danger of a breakAPPLICATIONS. down and requires treatment, directed not only against the To the Editor of THE LANCET. tubercle as such, but against all other contributory causes. We need open-air schools, training in domestic hygiene, better has been to a attention called communicajust SIR,—My tion in your issue of Feb. 3rd, over the signature of Mr. housing, early diagnosis based upon physical examination C. E. A. MacLeod, bearing on my article on the electric in addition to the tuberculin test, systematic treatment by hygienic means as well as by tuberculin and other remedies, colloids of Jan. 13th. measures for after-care in the shape of hygienic Nothing was farther from my intention than to call in and adequateand homes, night camps, and the like. For sach a day of the and if I the did not "collosols," efficacy question we need the open-air school, the dispensary, the programme this was due to the fact refer to them by name that, as the writer himself admits, their introduction into therapeutics is sanatorium, hospital, or home, the health colony or camp; and we need them all. I am, Sir, yours faithfully, so recent that sufficient time has not elapsed for it to have F. R. WALTERS. been possible to subject them to adequate clinical trial. The is no a colloids in means new of therapeutics by employment thing, for it is many years since the attention of the profession was first called thereto, and electrargol, with which CYSTITIS AND URINARY ANTISEPTICS. most of my personal observations were made, has been tried To the Editor of THE LANCET. on such an extensive scale that each one of its indications is established by a large number of published reports. SIR,—I have been much interested in the two exceedingly Then, too, as far as I can gather from the somewhat scanty able and full articles on "Cystitis"" by Dr. David Newman There are, howreferences given by Mr. MacLeod, the"collosols " do not which have appeared in your recent issues. appear .to have been employed for the same purposes as the ever, certain small points with reference to the action of electric colloids. As a matter of fact, the writer of the urinary antiseptics in the second paper on treatment, which letter in question only mentions a certain number of local are so entirely at variance with the conclusions that I have applications, and he barely touches the constitutional appli- formed on the matter that I cannot forbear criticism. I cations which have conquered for electrargol a place in have been doing experimental work on this subject for some contemporaneous therapeutics (pneumonia, broncho-pneu- time (the results of much of which will be found in monia, influenza, suppurative infections, cholera, puerperal the Bio-Chemicul Journal, Vol. V., Nos. 6 and 7, and in the most recent Transactions of the Section of Pharmacology fever, eruptive fevers, &c.). With regard to stability, I do not wish to call in question of the Royal Society of Medicine), and this is my excuse for that of the "collosols,"but this does not impugn the fact discussing a subject where Dr. Newman’s clinical experience that the stability of the electric colloids has been practically is so incomparably greater than mine. Dr. Newman states, demonstrated many years since. I mention this merely to in referring to the giving of urotropine and helmitol in cases show that in therapeutics each preparation must stand on its of mild B. coli infections, that "in cases where the urine is own merits, and must establish its own indications for use. acid, as in B. coli infections, formalin is liberated from these The electric colloids have rendered great service to a large preparations and creates irritation, but if the urine be number of practitioners other than myself, but I feel justified rendered neutral or alkaline by potash or lithia salts this in stating that the results obtained are their individual difficulty is overcome." These words appear to me to imply attributes, and in the absence of specific confirmation cannot that Dr. Newman considers that the liberation of formalsafely be assumed to be possessed by other varieties of dehyde by acid urine from urotropine is in the nature of an incident, not desirable in itself, and which it may be I am, Sir, yours faithfully, colloids. desirable to prevent.. As a matter of fact, there is, I think, B. G. DUHAMEL, M.D.
QUESTION.
......
683
has been used from year to year by me without seeing dose of tetanus antitoxin. I have never had a case following Several piles, but I have only once ligatured a pile. It is not to be a case of tetanus following in anything else. other men whom I know have had the same experience. assumed that the policy which I advocate is a policy leading I also know of two cases of tetanus following ligature of to laxity in our technique. A recent writer in the Indian piles by two other careful men. I know of a recent case Medical Gazette seemed to lament that the establishment of of tetanus following the strangulation of a naevus on the face Sir David Semple’s case would lead to this result. We have with a ligature by a careful man, and I also know of tetanus to deal with quite enough other germs to cause us to be as in a hysterectomy case in the British Isles by a very careful careful in our technique as if tetanus did not exist. The records of my hospital show that tetanus frequently and experienced operator, where there seemed absolutely no possibility of direct infection. The fact that many men have follows on mill injuries, often to all appearance injuries above suspicion. There are here on an average 20 never seen a case of tetanus follow a surgical operation or For over two years the subcutaneous administration of quinine, and that it is to 30 such cases in the year. very far from often following either, is no argument that it we have administered a dose of tetanus antitoxin to every does not follow. We can never tell when it may follow. One such case on admission to hospital. There has been one case I of tetanus developed in this hospital during these two years case is quite enough ; is too many if it can be avoided. brilliant young surgeon who was in such cases. That case came in nine days after the injury, once came across a unfortunate enough to have had one such case, and was and my assistant had used his judgment and considered antistruck by the fact that the idea of it had ruined his nerve, toxin unnecessary, and hence did not use it. I add this not unlikely for life. There are enough cases of tetanus paragraph to show the importance of the use of tetanus recorded, and crowds of cases unrecorded, following surgical antitoxin as a preventive in such cases. As a curative agent, operations to justify us in seriously considering its proximate when symptoms of tetanus have developed, I have found causes. it absolutely useless.-I am, Sir, yours faithfully, As far as I can judge from my own personal experience HENRY SMITH, V.H.S., and from the experience of others, both recorded and unLieutenant-Colonel, I.M.S. recorded, I believe that tetanus follows on operation for hernia very much more frequently than on any other. Up to the present time tetanus following operation has been put THE COLOUR SENSE IN RELATION TO to the charge of the surgeon. The implication has been that THE EMOTIONS. he introduced the tetanus through suture, lotions, dressings, or from his or his own hands those of To the Editor of THE LANOET. instruments, sponges, assistants-not a very comforting reflection for the surgeon. effect upon the pulse-beat of a slight emotion SIR,-The Why should this tetanus occur in spite of the utmost care on may be illustrated from the examination of a candidate I believe that the reason is the part of the surgeon ? for admission to the service of New South explained by Sir David Semple’s paper. An anaerobic area Wales. The degree of railway emotion varies with the type of has been left-the sine qui non for the development of In one man there is great anxiety to obtain a tetanus from tetanus spores. Sir David Semple has shown applicant. in another comparative indifference to the result. position, that the spores of tetanus are frequently present in the One man is stable, another is neurotic. The degree of appeal human intestine. He has shown that when tetanus spores in a railway fettler under examination for permanent employa and are injected into given area of a guinea-pig quinine ment in the service varies less than in any other injected into a distant area of the same guinea-pig, class. This railway man belongs to a rapidly disappearing class, tetanus bacilli are to be found in the anaerobic slough a large majority of whom were born and reared in the produced by the quinine and nowhere else, and that a country districts by poor hard-working parents. They are as control guinea-pig which has similarly received an equal a rule big muscular healthy men of stable type, in many ways number of spores, but has not received any quinine, is and more than usually honest. A neurotic railway not affected by tetanus.2 How do the spores reach the childlike, A casual observer would regard him as fettler is rare. anaerobic area in this case ? I can only understand it by some but a true valuation is that within its of them travelling through the blood circuit and eventually being mentally dull, limited orbit of observation and experience the mind is becoming stranded in the area of dead anaerobic tissue, where sound in judgment. they develop into toxin-producing tetanus bacilli. In the case The to a colour-blind fettler is direct to the mind, of hernia the intestine, which may contain tetanus spores, his faceappeal shows no indication of emotional response. This is has lain stationary in the hernial sac. May tetanus spores marked during his selection of the wools. When spoken not migrate into that sac ? The time-honoured operations for very to his voice is monotonous in tone, and still more so when hernia imply a ligature of the sac, and excision of a portion to name the colours in the lantern, when he of it distal to the ligature which leaves an anaerobic hernial attempting hesitates and pauses before answering. On the frequently stump. This may have in it migrated tetanus spores, or tetanus other hand, a fettler with a good colour sense never hesitates spores may be brought to it by the blood circuit. Since or pauses when he is naming the colours in the lantern ; in reading Sir David Semple’s paper I have modified my treat- his case there is no evidence that he requires assistance from ment of the sac so as to avoid leaving an anaerobic I the mind. During the examination by the wools the fettler stump. I draw down the sac, catch it as high up as possible with a normal colour sense frequently shows a slight degree with an intestinal forceps, cut it off below the forceps, fix a of excitement, his hand may shake, and when examined catgut suture at one end of the sac behind the forceps, and physically there is frequently an increase in his pulse run a glover’s suture from the fixed point through the sac and beat. This condition is transient and may disappear I over the forceps, not tightening it until it is all inserted. before the examination is finished. When the mind of then open the forceps with the loose suture over them and a fettler realises that he has a defect which unfits him insert a stout long probe between the blades and withdraw for the service he looks depressed, but if he is a colourthe forceps. With the assistance of the probe we can with a blind person there has been none of the preliminary excitedissecting forceps draw the sutures tight, drawing out the ment frequently seen in a with a good colour sense. probe as we go along. With the probe we put the stitches Under these conditions theperson depression appears to persist on the stretch, and hence we can find them easily to tighten in a colour-blind person than in one with a keen them. I now return the stitched-up opening, and dispose of longer colour sense, and to be more sombre and uniform in its the opening in the abdominal wall in the usual way. This mood. procedure is simple ; it is as effective as any of the anaerobic from the city is One type of candidate drawn an stump methods, and it is attempt to render tetanus after not satisfactory to deal with from generally the standard of emotional hernia as rare as it is after other surgical operations. A number are neurotic, a class I endeavour to A ligatured pile is an anaerobic stump in the vicinity of appeals. exclude from the running lines of the railway service. A tetanus spores. How are we to avoid tetanus in this case ? dilated pupil, tremulous hand, rapid pulse, &c., frequently Cut off the piles and stitch up the wound, or do a Whitehead’s A mind with expeindicate the habits of a degenerate. operation, or if we decide to ligature, then give the patient a rience will endeavour to exclude such persons. 2 A growth of tetanus bacilli can be obtained by making anaerobic cultivation from the tissues at the seat of injection of the spores in both cases, and there is a growth of tetanus bacilli at the seat of injection of quinine in the quinine case.
I
am.
faithfullv. GEORGE HENRY TAYLOR, Railway Medical Officer, New South Wales. Sir.
vours
684
THE TREATMENT OF TUBERCULOSIS & THE SANATORIUM
THE INTESTINAL FLORA.
QUESTION.
THE TREATMENT OF TUBERCULOSIS AND
To the Editor of THE LANCET. THE SANATORIUM the above title A. in Dr. Distaso To the Editor of THE LANCET. SIR,—Under gives your issue of Feb. 24th what he describes as a " brief summary of SIR,—It is a thousand pities that " F R.C.P." should stir the results of my researches, the details of which will appear up strife in the medical profession by his remarks as to the soon in extenso." I have been much interested of late years in constitution of the advisory committee on tuberculosis. the subject of the possible causation of some kinds of mental one regrets the absence of certain names, every disorder, or of phases of such, through the absorption into Although member of this committee is well known and distinguished the circulation of toxic material from the intestinal contents. for work done (and well done) in this department of preI am therefore looking forward with interest to the detailed ventive medicine ; and the inclusion of a few more specialists account of his researches which Dr. Distaso foreshadows. He or general practitioners would not have added appreciably will probably give in this the evidence for certain statements to the strength of the committee. which appear in the summary just published. The inference From the remarks made by "F.RC.P."on sanatoriums from this observation is that he has as yet given no evidence would imagine that they were opposed to dispensaries one for them ; and this is precisely what I desire to affirm. I instead of supplementing and completing their work. would call the attention of your readers, and of Dr. Distaso, Even that every case can be cured by tuberculin to the following weighty statements which he makes without, at a supposing (which most authorities on tuberculin dispensary in my judgment, adducing any evidence :— treatment would not admit) we still have to deal with the The flora of the normal adult is certainly harmful, and, far from hygienic) causes leading to the tuberculous illness, defending the organism against infection, it may be said to help it (mostly cannot often be done in working-class households which (sic). In the colon indol and other bodies belonging to the heterocyclic without at least some training in a sanatorium. Example These bodies, when and aromatic series are elaborated and absorbed. is always more powerful than precept, and the habits of a absorbed, severely tax the functions of the body and therefore of the liver. This fact may throw some light on the etiology of diseases of lifetime are more easily changed when the value of the the liver. [What "fact" is referred to?] Moreover, change is demonstrated at a sanatorium. Not only is there intoxication by the products of bacterial growth, but man in his senses would treat a febrile consumpno the disappearance of the bacteria indicates a process of autolysis, the tive with tuberculin as an outpatient or in a workingproducts of which when absorbed cannot fail to be harmful. Constipation and the resulting intoxication are caused by the class home if better conditions were available. It is the intestinal flora. [It is apparently taken for granted that all chemical febrile consumptive who has to be treated as a rule, and no changes in the intestinal contents which result in the production of arrangements are adequate which leave this fact out of toxin are due to bacteria.] Doubtless the products of the intestinal bacteria, by increasing ’. consideration. secretions inhibiting the submucous plexuses, give rise to stasis. Further, recovery from pulmonary tuberculous illness, I am. Sir. vonrs faithfnllv. however treated, is conditional ; if habits and conditions of EDWIN GOODALL. life are unsatisfactory relapse or reinfection usually takes place sooner or later. Not every tuberculous person needs treatment. Many such go through life without tuberculous illness ; but if a tuberculous person has more than a very ELECTRIC METALLIC COLLOIDS AND limited quiescent lesion, if the bodily health is in any way affected by the tuberculous focus, and if his habits or condiTHEIR THERAPEUTICAL tions of life are unsatisfactory, he is in danger of a breakAPPLICATIONS. down and requires treatment, directed not only against the To the Editor of THE LANCET. tubercle as such, but against all other contributory causes. We need open-air schools, training in domestic hygiene, better has been to a attention called communicajust SIR,—My tion in your issue of Feb. 3rd, over the signature of Mr. housing, early diagnosis based upon physical examination C. E. A. MacLeod, bearing on my article on the electric in addition to the tuberculin test, systematic treatment by hygienic means as well as by tuberculin and other remedies, colloids of Jan. 13th. measures for after-care in the shape of hygienic Nothing was farther from my intention than to call in and adequateand homes, night camps, and the like. For sach a day of the and if I the did not "collosols," efficacy question we need the open-air school, the dispensary, the programme this was due to the fact refer to them by name that, as the writer himself admits, their introduction into therapeutics is sanatorium, hospital, or home, the health colony or camp; and we need them all. I am, Sir, yours faithfully, so recent that sufficient time has not elapsed for it to have F. R. WALTERS. been possible to subject them to adequate clinical trial. The is no a colloids in means new of therapeutics by employment thing, for it is many years since the attention of the profession was first called thereto, and electrargol, with which CYSTITIS AND URINARY ANTISEPTICS. most of my personal observations were made, has been tried To the Editor of THE LANCET. on such an extensive scale that each one of its indications is established by a large number of published reports. SIR,—I have been much interested in the two exceedingly Then, too, as far as I can gather from the somewhat scanty able and full articles on "Cystitis"" by Dr. David Newman There are, howreferences given by Mr. MacLeod, the"collosols " do not which have appeared in your recent issues. appear .to have been employed for the same purposes as the ever, certain small points with reference to the action of electric colloids. As a matter of fact, the writer of the urinary antiseptics in the second paper on treatment, which letter in question only mentions a certain number of local are so entirely at variance with the conclusions that I have applications, and he barely touches the constitutional appli- formed on the matter that I cannot forbear criticism. I cations which have conquered for electrargol a place in have been doing experimental work on this subject for some contemporaneous therapeutics (pneumonia, broncho-pneu- time (the results of much of which will be found in monia, influenza, suppurative infections, cholera, puerperal the Bio-Chemicul Journal, Vol. V., Nos. 6 and 7, and in the most recent Transactions of the Section of Pharmacology fever, eruptive fevers, &c.). With regard to stability, I do not wish to call in question of the Royal Society of Medicine), and this is my excuse for that of the "collosols,"but this does not impugn the fact discussing a subject where Dr. Newman’s clinical experience that the stability of the electric colloids has been practically is so incomparably greater than mine. Dr. Newman states, demonstrated many years since. I mention this merely to in referring to the giving of urotropine and helmitol in cases show that in therapeutics each preparation must stand on its of mild B. coli infections, that "in cases where the urine is own merits, and must establish its own indications for use. acid, as in B. coli infections, formalin is liberated from these The electric colloids have rendered great service to a large preparations and creates irritation, but if the urine be number of practitioners other than myself, but I feel justified rendered neutral or alkaline by potash or lithia salts this in stating that the results obtained are their individual difficulty is overcome." These words appear to me to imply attributes, and in the absence of specific confirmation cannot that Dr. Newman considers that the liberation of formalsafely be assumed to be possessed by other varieties of dehyde by acid urine from urotropine is in the nature of an incident, not desirable in itself, and which it may be I am, Sir, yours faithfully, colloids. desirable to prevent.. As a matter of fact, there is, I think, B. G. DUHAMEL, M.D.
QUESTION.
......