THE MEANING OF TACHYCARDIA.

288 It are not mutually protective. will be interesting to hear what has been the experience of others who have had to deal with the present outbreak. I am, Sir, yours faithfully, CHARLES R. Box. Devonshire-place, VT., Jan. 24tb, 1920.

fever, and that they

following vagus depression, irritability, or atony is compensatory. Reference is, certainly, made to a recent contribution of Professor F. A. Bainbridge, in which it is remarked that acceleration of the pulse can "

for lessened contractile power in maintainthe output of the heart per minute," a conclusion, I presume, which Professor Bainbridge in no way desires to be regarded as original or novel. I think the impression must be general that this is a venerable commonplace of physiology. In any case it has for long and frequently been impressed on the clinician, and putting aside the less acute enfeeblements with which Dr. Wilson deals, is observed in a very demonstrable manner in the more serious phenomena associated with cardiac failure in angina pectoris. In this connexion I have myself termed the state which usually followsthe shock of cardiac pain (if I may be permitted to regard the pain as cardiac) as a " rescuing augmentation and acceleration of the heart’s beat." Indeed, the now hoary and usually beneficent experience of the acceleration produced by the nitrites in such cases declares the compensatory nature of tachycardia under these circumstances. In the cases to which Dr. Wilson refers he will, however, agree that the sooner tachycardia ceases the better will it be for the patient, and that the most efficient remedies are not so much drugs as the posture and relief from activity which reduce heart ratenamely, resting and the employment of such means as will remove the cardiac enfeeblement of which tachycardia is the expression and the rescuing effort. I am. Sir. vours faithfullv.

compensate

ing REINFECTION IN TUBERCULOSIS. To the Editor

SIR,—Doubtless all

are

of THE LANCET. in sympathy with Dr. Batty

Shaw in doing the utmost for the liberty and comfort of the consumptive, but all cannot agree with him in basing a prejudice against the theory of reinfection on such sympathy. Dr. Shaw admits (THE LANCET, Jan. 24th, p. 180) that " it remains a fact that children are universally infected by the tubercle bacillus of the human form." If, then, the sources of infection are so abundant, and if infection is so common that all are infected in childhood, by what new law or new circumstance does reinfection become excluded? Unless a new factor of immense and far-reaching power can be shown to exist, is it not unreasonable to exclude reinfection as of ordinary and frequent occurrence? Nor does the theory or fact of auto-infection affect the question ; for if the supposed immunising effect of one focus of infection does not protect from reinfection by bacilli from that focus, how can such supposed from reinfection from immunising effect without ? It is difficult to understand the pessimism of the hour, a pessimism that loosens our hold on ascertained facts, in order to launch us once again into a sea of uncertainties. May we not suppose that Dr. Shaw himself recommends patients for sanatorium treatment, warns them against spreading infection, and even wa.rns relations ? We all know that by these measures we are Until reinfection is disdoing good, and not harm. proved (and the onus of proof rests with the opponents of the theory), surely notification must continue, and the elementary precautions usually enjoined must be followed. At the same time, such aids as the adoption of anti-catarrhal measures will be welcomed. When will the purifying of the atmosphere of our cities become a practical question with our public health authorities? I am, Sir, yours faithfully, R. M. FENN. London, Jan. 26th, 1920.

protect

ALEXANDER BLACKHALL-MORISON.

I

THE MEANING OF TACHYCARDIA. To the Editor of THE LANCET, read with interest the article by Dr. McNair Wilson under the above heading in THE LANCET of Jan. 17th. Tachycardia is a comprehensive term, and the writer admittedly does not deal with the conditi on in all its aspects or with its origin from all known causes, but with the instability of heart which is I frequently observed after various enfeebling ailments and some enfeebling circumstances not infective. It is not my intention at the moment to question the persistence or otherwise of the toxins to which some such enfeeblements may be assumed to be due, but to welcome the evidence afforded by this article of a recognition of the importance of the neural factor in such conditions. It is not long since some who regarded themselves as specially enlightened exponents of cardiology would have treated the matter with little reference The " excitatory to the innervation of the heart. " system would have been found fully capable of accounting for all the phenomena in question irrespective of any nervous endowment, which was, indeed, usually denied it because such had not been demonstrated. Even the sinu-auricular node, however, -the " pace-maker "-has now been shown to be fully innervated, although modesty forbids my indicating the reference more particularly ! There is also some experimental evidence that the ’’ pace-maker " is preponderantly endowed by the right and the auriculo-ventricular node and bundle by the left pneumo-gastric nerve and, of course, also by the sympathetic. But there is another point which also interests me in this article, inasmuch as it appears to be regarded as novel-nanlely. the view that cardiac acceleration

SIR,-I have

London, Jan. 19th, 1920.

A PROFESSOR OF MILITARY MEDICAL HISTORY FOR OUR INDIAN WARS. To the EcMo7’ 0/ THE LANCET. SIR,-We have had during our tenure

of India all over that country, and in each case much loss of life has occurred. If one tries to trace out the history of the Indian Medical Service and the part they took with the British Army Medical Service it is exceedingly difficult to find any historic books from which officers could learn to benefit by our failures and obtain fuller instructions when such campaigns recur. I would propose that a medical officer of the Indian Army be appointed as a "Historian of the Indian Medical Service " in peace and war, and of the British troops who fought side by side with them in the endless Indian wars. Such an officer would be a member of the headquarters staff of the army in India, and would deliver each year a course of instruction on medical war history in various parts of the continent of India.

unceasing

wars

I am, Sir, vours faithfullv.

GEORGE J.

H. EVATT, Major-General,

British Army Medical Staff, retired. Junior United Service Club, Jan. 16th, 1920.

THE VERMIN REPRESSION SOCIETY. To the Editor

of

THE

LANCET.

SIR,-I note with very great satisfaction that in your issue of Jan. 17th you give prominence to the fact that the Government representative, at the Vermin Repression Society’s dinner, pointed out that the Vermin Repression Society was only at the beginning of its work. As the society is just about to be incorporated under special licence of the Board of Trade and it has correspondents in Burmah, Egypt, India, and Australia, and also it has the flourishing section in Bristol, I think the time will not be far distant when its original founder and honorary organiser, Lieutenant Alfred E. Moore, the British Emil Zuschlag, will be caricatured as " The Modern Rat Robespierre" ; for it cannot be too well known that it is owing to Lieutenant Moore, who initiated the movement against the rat in 1907, and who has never ceased, in season and out of season, to organise against the rat, that the present success is due, and that he refuses to accept a 1

The Nervous System and Visceral Diseases, Edin., 1899, p. 98.