THE NORMAL INFANT'S CHEST.

MECHANISM OF THE COCHLEA. had

no

of the value of atropine and Post mortem there was general oedema of

knowledge

adrenalin.

theory of the mechanism of the cochlea can maintain itself until it can explain this fact. Just this peculiar condition is the most common one of all, because, as the records show, the series of puffs from the vocal cords are heard as the tone of the voice-and this tone is always rising and falling in speech. A pleasant " Good morning " is heard as a delightful rise and fall of beautiful tones ; the resonance theory as at present stated would force it to be a continuous noise. With the analysis of vowelwaves according to the Fourier series this has nothing to do ; any curve, regular or irregular, can be analysed in this way. In my work on the " Study of Speech Curves " Dr. Wilkinson will find many examples. Dr. Hartridge’s very clever apparatus was devised

the kidneys were small and granular, and 11 oz. respectively. The result of treatment by atropine and adrenalin in this class of case is very striking. The atropine, doubtless, acts beneficially by diminishing or arresting the secretion from the bronchioles, but I attach considerable importance to the administration of adrenalin as well. Though the pulmonary vessels are not under the direct control of the vaso-motor system, the bronchial arteries, which are offshoots of the left

lung ; weighing 2 oz.

the systemic circulation, presumably possess motor nerves like other systemic arteries. Dr.

vaso-

Brian Melland, in a paper in which he discusses the treatment of asthma by’adrenalin (THE LANCET, 1910, vol. i., p. 1410), has called attention to this. Administration of adrenalin will stimulate the sympathetic and thus cause constriction of the bronchial arterioles, as of other systemic vessels. Its beneficial effects in this condition can therefore be readily understood. The remarkable results of the administration of adrenalin and atropine would seem to indicate that the fluid is poured out mainly from the bronchioles rather than from the capillaries of the alveoli, on which presumably atropine and adrenalin exert no influence. I have always associated acute oedema of the lung with nephritis in some form, and I note that in the case described by Dr. W. J. Tyson in THE LANCET of Oct. 21st, albuminuria was present. His case he regards as an aborted pneumonia, but in my cases there was nothing to suggest this. T

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1093

I

JOHN F. H. BROADBENT. Seymour-street, Nov. 13th, 1922.

MECHANISM OF THE COCHLEA.

to show the validity of the resonance theory. It shows exactly the opposite. If Dr. Hartridge, instead of keeping the period of his motor regular, will speed it rapidly up and down all his pendulums will jerk about in hopeless confusion ; there will be no resonYet he will hear the buzzing of ance phenomena. the motor as a clear tone that rises and falls. Mr. Wilkinson is quite right in saying that we should concentrate on the obvious. The most obvious fact of all is that the resonance theory of the cochlea cannot explain the simple fact above stated. There is another fact overlooked by this theory. The fibres of the cochlea are heavily damped. The heavier the damping of a resonator the greater is the range over which vibrations can be forced on it. With such heavy damping practically all resonators must respond to practically all constantly maintained tones. I suggest to Dr. Hartridge that he replace the metal weights of his pendulumsby visiting cards whose movements will be heavily damped by the air. Even with his motor at a constant speed I predict that all cards will move at all speeds. T

To the Editor of THE LANCET. SiR,-Mr. G. Wilkinson, in his letter in your issue of Oct. 21st, has not quite followed the problem that I have being trying to present. It can be stated as follows : If a card is held against the teeth of a revolving wheel (Savart’s experiment), a tone is heard due to the series of air-shocks produced by the snapping of the card. If the shocks come slowly the tone is a low one ; if rapidly, a high one. Now let the speed of the wheel be rapidly increased. A rapidly rising tone is heard. Let the succession of shocks be indicated by a series of upward jerks along a line as in the figure. The first shook

The second sets all the resonators in vibration. shock will oppose some of them-if they are still swinging at the time it comes-and favour others. The third shock will oppose and favour quite a different set ; the fourth shock a still different one, and so on. Under the most favourable circumstances it takes at least three regularly repeated shocks to establish any resonance to the acting tone. Here there are no three shocks at the same interval apart. Yet the ear hears the rising tone. The problem can be stated in still another way. Every resonator has its own period of free vibration. A blow to this resonator arouses its free vibration. Each succeeding blow likewise arouses its free vibration. If the blows in a series come at intervals agreeing with the period of free vibrations the free vibrations are summed up and the resonator responds loudly. If the interval does not agree, the free vibrations conflict and the resonator responds feebly or not at all. What is meant by the resonance theory of hearing is that to a tone or series of blows of a certain frequency that resonator will respond whose period of free vibration corresponds to the period of the tone, while the others will be silent. The unexplained fact that confronts the theory is that when a series of blows with rapidly changing interval strikes the ear the result is not heard as a noise but as a rapidly changing tone. No

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E. W. SCRIPTURE.

Welb2ck-strect, W.

THE NORMAL INFANT’S CHEST. To the Editor of THE LANCET. SiR,-Dr. Stanley Melville’s letter in your issueof Nov. 4th calls for some comment. We did not suggest that radiologists do not recognise the existenceof shadows in the normal lung ; but we have been unable to find in the literature any systematic description of the appearances of the chest of thehealthy infant, and until the normal has been determined the loose writing to which he refers will inevitably continue. His suggestion of bandaging the infant to a padded board is unfortunately impracticable. We fear thathe has not quite realised the conditions under which We wish to inducesuch work must be done. mothers to bring their healthy babies to us for examination ; any suggestion of the use of apparatus or bandaging would, we believe, quickly cut off oursupply. Our procedure is to place the infant on its back upon the couch while its body and limbs are maintained in position by the mother and nurse. Thetube is then centred with the greatest care at the level of the third costal cartilage. The wide variations in position and size of the heart shadow in our radiograms. cannot be entirely due, as Dr. Melville appears to believe, to distortion from faulty position or inaccuratecentring. Nor can they be due to movement duringexposure, as is shown by the perfect definition in the original films. In our earlier attempts, of which the reproductions in THE LANCET are examples, we gave insufficient attention to the position of the head, which, we believe, is of great importance. We hope to publish later results in which this defect is to some extent corrected, but for perfect accuracy a fixing apparatus would berequired which would immobilise not only the trunk but also the head and neck. We

are

Sir.

yours

faithfully. J. HUNTER P. PATON,

A. ROWAND. St. Andrews Institute for Clinical Research, Fife, Nov. 7th.

GASTRO-ENTEROSTOMY CLAMPS.-AUENBRUGGER’S BICENTENARY.

1094

NOTIFICATION OF JUVENILE SUFFERERS FROM VENEREAL DISEASE.

I think, however, each of his points is answered by the following letter published in the British Medical Journal of Oct. 21st last (p. 780):-

To the Editor of THE LANCET. SIR,-The entire lack of provision for the treatment of venereal disease occurring amongst natives in Durban has rendered it necessary to return them to their kraals, often in a highly infectious condition. It is probable that a large number of these recover without treatment of any kind, but there is always the danger that they may be instrumental in the spread of venereal diseases in outlying districts, especially when the obvious signs of their condition become less evident to themselves and their friends. Although this danger has been recognised by the Government, no suitable provision has so far been rnade, and the problem was aggravated when, in December, 1921, the Government hospital refused to treat any cases of venereal disease occurring amongst even Europeans who were resident in the borough. The matter has recently been taken up by the Juvenile Affaire Department who approached the Minister for Public Health, urging that facilities for early treatment sufferers in the interests oi should be afforded to all juveniles, and, further, that venereal disease occurring amongst juveniles up to the age of 18 years should be notifiable to the medical officer of health for the borough. Although due consideration had been given to the reasons that had been advanced against the notification of venereal disease occurring amongst adults, it was felt that juveniles were unlikely tc realise the seriousness of the disease so far as they were concerned, and that, in the interests of the young patient, his relations, and those who occupied thE same dwelling-house, the necessary treatment should be undertaken in a suitable ward at the earliest possible moment after the condition had been diagnosed. This step may well meet with the approval oi others who are interested in this aspect of disease

"Irishman" asks for advice in the treatment of very profuse in a case of pulmonary tuberculosis; the patient is 32 ; thearea of lung involved is quite moderate, as also are the evening temperature and the amount of sputum ; the hygienic conditions are superb and two nurses are in attendance ; the routine remedies are futile.....

prevention.-I

am,

Sir, yours faithfully, F. G. CAWSTON, M.D. Camb.

Durban, Oct. 24th, 1922.

GASTRO-ENTEROSTOMY CLAMPS. To the Editor of THE LANCET. SIR,-Surgeons who use clamps in gastroenterostomy will be interested in the suggested improvement in their design described by Mr. Norman M. Dott in your issue of Sept. 23rd. In a well-illustrated paper, which appeared in Surgery, Gynecology, and Obstetrics, August, 1916, vol. xxiii., p. 225, Dr. Joseph Eastman described a clamp on exactly the same principle under the title of " An Uncomplicated and Convenient Intestinal Anastomosis Clamp." In Mr. Dott’s design, no doubt arrived at independently, the absence of the short handle, the separation of each element, and the bullet-shaped nut instead of a heart-shaped nut, appear to be improvements on Dr. Eastman’s clamp. T

arr)

Cir

yours

fa.it.hfnllv.

IAN MACDONALD, M.D.

Huelva, Spain, Nov. 10th,

1922.

NIGHT SWEATS. To the Editor of THE LANCET.

SIR,-My friend, Dr. F. R. Walters, in his letter to THE LANCET of August 12th suggests that I was ambiguous as to the use of slumber mats. I think my reference to the " Shibboleths of Tuberculosis " made it quite plain that I only recommended these mats after hygienic means had failed to prevent the sweats; he also suggests that my experience is abnormal. He .goes on to say that " one ought to regardnight ’

sweats as presumptive evidence of insufficient ventilation or other hygienic blunder." As I had distinctly stated we had severe night sweats here, there would be no ambiguity in my taking this statement as a very severe reflection on the administration of Colindale.

sweating

Here is the early case-to which type I referredsweating in spite of the best possible conditions and therefore eminently suitable for a slumber mat. I am, Sir, yours faithfully, MARCUS PATERSON. Colindale Hospital, Hendon, Nov. 13th, 1922.

AUENBRUGGER’S BICENTENARY. To the Editor

of THE LANCET.

SIR,-I think that it has escaped general attention that this year marks the bicentenary of the birth of the discoverer of the first important step in the clinical examination of the chest-namely, the method of percussion. This advance was made by Auenbrugger. The following extract from my grandfather’s (Dr. Thomas Davies) lectures on " The Diseases of the Lungs and Heart," delivered at the London Hospital, and published in the Medical Gazetle in 1835, states " that Leopold Auenbrugger was born at Graets in Styria in 1722-he became physician to the Imperial Hospital of the Spanish Nation at Vienna. There it was that he prosecuted, as he expressed it, his studies inter taedia et labores on the subject for a period of seven years, and in the year 1763 he published a work which he calledInventum Novum ex Percussione Thoracis humani ut signo, abtrusis interni pectoris morbo detegendi.’ No notice was taken of his book until 1770, when Roziere de la Chassaque, of Montpellier, translated it, avowing he knew nothing of the subject practically, and the inference he would lead you to draw is that he did not think much of the himself. discovery " The pamphlet seemed now consigned to oblivion. However, Stoll, Van Swieten, and Cullen in his First Lines ’ make some mention of it, but declared they knew nothing of it practically. Corvisart, when preparing his celebrated clinical lectures, first met with the subject on reading Stoll’s work. He immediately commenced a series of experiments, which he continued for 20 years, and in 1808 published anew translation of Auenbrugger with his own commentaries, a work that has been translated into every European ’

language." It seems to me to be fitting and to recall these historic facts. T

OYVll

Sir

yours

worthy of interest

faithfully

ARTHUR T. DAVIES, M.D., F.R.C.P. Tokenhouse Yard, E.C., Nov llth, 1922.

THE MENSTRUAL CYCLE AND CALCIUM CONTENT OF THE BLOOD. To the Editor of THE LANCET. SIR,-Miss Widdows, B.Sc., in THE LANCET of Nov. llth, p. 1037, states that the increase in the calcium content of the blood during menstruation " might be expected." Why during ? Is it not more reasonably expected just antecedent to the period? May I also ask why Miss Widdows chooses the time midway to contrast with the menstrual time ? Is she not aware of what is called on the Continent the Mittelschmerz ? By choòsing the time midway between the periods to contrast with the periods she chooses the one time in the cycle which is not a contrast, but is of the . comparable. A realisation of the significance chart published some years ago in " Married Love " would have saved this confusion. I

Sir.

fa,ithfnllv. MARIE U. STOPES. Leatherhead, Surrey, Nov. 13th, 1922. am.

yours