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THE MIND IN TUBERCLE.
262 appear to hold out any better prospect of improvement or cure of infective arthritis than the other methods of treatment in use " is not justified by the evidence given. It has little or no bearing on the value of autogenous vaccine therapy based on complete bacteriological examination of each individual patient. I am, Sir, yours faithfully, A. KNYVETT GORDON.
because months may elapse after the invader has vanished before the reading becomes normal. Hydration checks the sedimentation of the red blood corpuscles. The test depends primarily upon the chemico-physical state in which the protein particles of the plasma happen to be and not upon the number of the red blood corpuscles or the protein content of the plasma. The suspension stability of Bedford-square, W.C., Jan. 23rd, 1932. the red blood corpuscles is reduced only in those cases of anaemia where the protein particles are being subjected to dehydration, the state in which the red FILLING UP A DEATH CERTIFICATE. blood corpuscles happen to be does not influence it. To the Editor of THE LANCET. jIn aplastic anaemia the sedimentation rate is not i and in pernicious anaemia where it is the SiR,-As a medical officer of health I have to scan increased, the weekly returns of deaths sent to me by the localred blood corpuscles do not fall so fast as they do in registrars, the causes of death being compiled fromEstreptococcic septicaemia, except just before death. I am. Sir, vours faithfullv, the death certificates furnished by medical practiJ. E. R. MCDONAGH. tioners. Judging by the returns which come to my Wimpole-street, W., Jan. 21st, 1932. notice, it would appear that doctors have difficulty in allocating the causes of death as between primary and secondary causes. In this respect there seems THE MIND IN TUBERCLE. to be no difference between those recently qualified To the Editor of THE LANCET. and those who have been in practice many years. It should not be difficult to fill up a death certificate SiR,—In the paper by Dr. Andrew Morland with correctly if it is borne in mind that what is meant1this title in your last issue (p. 176), I am particularly by a primary cause of death is the disease, presentinterested in his reference to the work of Dr. H. at the time of death, which initiated the train of C’vents Banister at Papworth. Impressed by the lack of leading thereto, and not a mere secondary, contributory, treatment in sanatoria on the psychological side, or immediate cause, or a terminal condition or mode I was fortunate, some years ago, in securing the of death. of Dr. Banister, who is lecturer in experiI services Here are a few instances of gross error which mental psychology at Cambridge, and whose work have come to my notice :— : in our psychological clinic has been of great benefit 1. Primary cause, cardiac failure. Secondary, aortic to certain of our patients. I am convinced that disease. 2. Primary cause, haematemesis. Secondary, cancer of Dr. Morland is right when he states : stomach. In this struggle between health and disease the mind 3. Primary cause, exhaustion. Secondary, cancer of plays an important part, and I believe that further underbladder. standing of the mechanism by which the mind responds 4. Primary cause, heart failure. Secondary, cancer of to the stimulus of the disease would enable more rational
secondly,
-.
1
----
no--_-
I
"
"
-
"
breast. 5. Primary cause, exhaustion. tuberculosis.
and effective treatment to be
Secondary, pulmonary
applied."
the teaching of in Cambridge is medical students I could continue this list indefinitely, but I think I am sure, agree with me that a I have made it clear that more attention should be considerable, would, of knowledge psychology is of the utmost importance paid to teaching the medical student the right way to those whose work lies in the tuberculosis field, and to fill up a death certificate, and I hope the teachers as Dr. Morland so well puts it: " If the tuberculosis of public health and administration will make a could learn so to influence the minds of his note of this if they have done me the honour to read physician that they acquired a proper attitude towards patients my letter. the disease, the greatest therapeutic advance of the I am, Sir, yours faithfully, century would have been achieved." A. B. DUNNE, M.B. Camb.
Dr.
Banister, whose experience in
psychology
to
I am,
Doncaster, Jan. 22nd, 1932.
I
ERYTHROCYTE SEDIMENTATION TEST. To the Editor of THE LANCET.
yours faithfully, PENDRILL Varrier-jones. Papworth Hall, Cambridge, Jan. 23rd, 1932.
Sir,
RUPTURE OF THE ADDUCTOR LONGUS.
SiR,-An annotation in your issue of Jan. 9th refers,
to the erythrocyte sedimentation test as an index of the activity of rheumatic infection. I have performed this test in some thousands of cases since Fahraeus: sent me a copy of his book in 1922, and readings are given in all those reported in my three volumes of the " Nature of Disease " wherein also the rationale of: the test is described. My conclusion is that, as rapidL sinking of the red blood corpuscles runs pari passuL with active dehydration of the protein particles, andL as this chemico-physical change may be brought aboutj by physical agents, chemical poisons, and microorganisms, the test has no specific value and cannotj be employed to determine if a particular organ in the body is being attacked by the invader responsible for the dehydration. Nor can it be used to ascertainL when the invader ceases to be active, first, because continued activity tends to cause hydration, and .
To the Editor ol THE LANCET. SIR,—In his Robert Jones Essay on injuries of tendons and muscles, Mr. H. C. Edwards deprecates (THE LANCET, Jan. 9tli, p. 70) immediate operative treatment of rupture of the adductor longus. This leads me to record the following case. A rupture of the adductor longus was sustained while playing polo. The gap in the muscle was easily palpable, being rather more than two fingers’ breadth in extent. Operation was carried out on the following day, and the lesion, which was situated below the pubic attachment, retained by suture. Apart from three weeks’ rest in bed no after-treatment was carried out. The injury was sustained in May, in August horse exercise was resumed, and in October racing and polo. I am, Sir, yours faithfully, Berlin, Jan. 21st, 1932. LAURENCE O’SHAUGHNESSY.
because months may elapse after the invader has vanished before the reading becomes normal. Hydration checks the sedimentation of the red blood corpuscles. The test depends primarily upon the chemico-physical state in which the protein particles of the plasma happen to be and not upon the number of the red blood corpuscles or the protein content of the plasma. The suspension stability of Bedford-square, W.C., Jan. 23rd, 1932. the red blood corpuscles is reduced only in those cases of anaemia where the protein particles are being subjected to dehydration, the state in which the red FILLING UP A DEATH CERTIFICATE. blood corpuscles happen to be does not influence it. To the Editor of THE LANCET. jIn aplastic anaemia the sedimentation rate is not i and in pernicious anaemia where it is the SiR,-As a medical officer of health I have to scan increased, the weekly returns of deaths sent to me by the localred blood corpuscles do not fall so fast as they do in registrars, the causes of death being compiled fromEstreptococcic septicaemia, except just before death. I am. Sir, vours faithfullv, the death certificates furnished by medical practiJ. E. R. MCDONAGH. tioners. Judging by the returns which come to my Wimpole-street, W., Jan. 21st, 1932. notice, it would appear that doctors have difficulty in allocating the causes of death as between primary and secondary causes. In this respect there seems THE MIND IN TUBERCLE. to be no difference between those recently qualified To the Editor of THE LANCET. and those who have been in practice many years. It should not be difficult to fill up a death certificate SiR,—In the paper by Dr. Andrew Morland with correctly if it is borne in mind that what is meant1this title in your last issue (p. 176), I am particularly by a primary cause of death is the disease, presentinterested in his reference to the work of Dr. H. at the time of death, which initiated the train of C’vents Banister at Papworth. Impressed by the lack of leading thereto, and not a mere secondary, contributory, treatment in sanatoria on the psychological side, or immediate cause, or a terminal condition or mode I was fortunate, some years ago, in securing the of death. of Dr. Banister, who is lecturer in experiI services Here are a few instances of gross error which mental psychology at Cambridge, and whose work have come to my notice :— : in our psychological clinic has been of great benefit 1. Primary cause, cardiac failure. Secondary, aortic to certain of our patients. I am convinced that disease. 2. Primary cause, haematemesis. Secondary, cancer of Dr. Morland is right when he states : stomach. In this struggle between health and disease the mind 3. Primary cause, exhaustion. Secondary, cancer of plays an important part, and I believe that further underbladder. standing of the mechanism by which the mind responds 4. Primary cause, heart failure. Secondary, cancer of to the stimulus of the disease would enable more rational
secondly,
-.
1
----
no--_-
I
"
"
-
"
breast. 5. Primary cause, exhaustion. tuberculosis.
and effective treatment to be
Secondary, pulmonary
applied."
the teaching of in Cambridge is medical students I could continue this list indefinitely, but I think I am sure, agree with me that a I have made it clear that more attention should be considerable, would, of knowledge psychology is of the utmost importance paid to teaching the medical student the right way to those whose work lies in the tuberculosis field, and to fill up a death certificate, and I hope the teachers as Dr. Morland so well puts it: " If the tuberculosis of public health and administration will make a could learn so to influence the minds of his note of this if they have done me the honour to read physician that they acquired a proper attitude towards patients my letter. the disease, the greatest therapeutic advance of the I am, Sir, yours faithfully, century would have been achieved." A. B. DUNNE, M.B. Camb.
Dr.
Banister, whose experience in
psychology
to
I am,
Doncaster, Jan. 22nd, 1932.
I
ERYTHROCYTE SEDIMENTATION TEST. To the Editor of THE LANCET.
yours faithfully, PENDRILL Varrier-jones. Papworth Hall, Cambridge, Jan. 23rd, 1932.
Sir,
RUPTURE OF THE ADDUCTOR LONGUS.
SiR,-An annotation in your issue of Jan. 9th refers,
to the erythrocyte sedimentation test as an index of the activity of rheumatic infection. I have performed this test in some thousands of cases since Fahraeus: sent me a copy of his book in 1922, and readings are given in all those reported in my three volumes of the " Nature of Disease " wherein also the rationale of: the test is described. My conclusion is that, as rapidL sinking of the red blood corpuscles runs pari passuL with active dehydration of the protein particles, andL as this chemico-physical change may be brought aboutj by physical agents, chemical poisons, and microorganisms, the test has no specific value and cannotj be employed to determine if a particular organ in the body is being attacked by the invader responsible for the dehydration. Nor can it be used to ascertainL when the invader ceases to be active, first, because continued activity tends to cause hydration, and .
To the Editor ol THE LANCET. SIR,—In his Robert Jones Essay on injuries of tendons and muscles, Mr. H. C. Edwards deprecates (THE LANCET, Jan. 9tli, p. 70) immediate operative treatment of rupture of the adductor longus. This leads me to record the following case. A rupture of the adductor longus was sustained while playing polo. The gap in the muscle was easily palpable, being rather more than two fingers’ breadth in extent. Operation was carried out on the following day, and the lesion, which was situated below the pubic attachment, retained by suture. Apart from three weeks’ rest in bed no after-treatment was carried out. The injury was sustained in May, in August horse exercise was resumed, and in October racing and polo. I am, Sir, yours faithfully, Berlin, Jan. 21st, 1932. LAURENCE O’SHAUGHNESSY.