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TREATMENT OF SCABIES
347
Many medical practitioners have maintained that it reasonable that some attempt should be made to coordinate the work of the medical profession in time of war. That this should be done voluntarily accorded with the best traditions of the profession. Others considered that there was a sinister purport in it all and that the form was inquisitorial. They felt that the political views of those who for one reason was
another found themselves unable to fill in the required particulars would be suspect by the authorities. It was argued too that the General Medical Council, which already links the profession with the State, would have been the appropriate body to make the inquiry. Now comes the letter in to-day’s issue of THE LANCET which discloses an attempt to apply indirect coercion in a most offensive way, which smacks of Fascism. This anticipation of conscription creates quite the wrong atmosphere and can only arouse the distrust of those concerned. It would be well for the British Medical Association to publish a full explanation and repudiation of this high-handed action; otherwise the sympathies of many members of the profession will be alienated from the scheme. I am, Sir, yours faithfully, LEONARD F. BROWNE. or
TREATMENT OF SCABIES To the Editor of THE LANCET
SiR,—I
see
that the treatment of scabies with
sulphur receives further commendation in the report from your Budapest correspondent (Jan. 29th, p. 285), who describes it as " a new quick nascent
method."
As this is the second occasion within the
past few months that this form of treatment has been " discovered," I thought it would be worth while putting on record the fact that it was used by at least one Field Ambulance (102nd) during the late Whilst at Franvillers in the Somme
area in the of 1916 we had a large number of patients suffering from scabies and it was found that the deposition of sulphur, obtained by wetting the skin with a solution of sodium thiosulphate, followed by the application of a dilute mineral acid, gave slightly better results than those derived from the traditional use of sulphur ointment. I am, Sir, yours faithfully, W. K. FITCH.
war.
summer
CARBOHYDRATE METABOLISM IN ANOREXIA NERVOSA To the Editor of THE LANCET
SiR,-The article by Dr. Sheldon and Dr. Young in your last issue raises a number of matters for discussion. Most of these I propose to leave for treatment in a paper on the same topic which I have in preparation; but one or two points call for immediate comment. A good deal of the reasoning in this paper is based upon a series of oral glucose tolerance curves which are considered to reflect changing states of glucose tolerance. Actually they are of types commonly encountered in debilitating conditions, including prolonged starvation, which lead to disturbed tonus of the alimentary tract, their occurrence being apparently due to irregular gastric discharge and to actual changes in the efficiency of intestinal absorption. I have, for instance, a set of three curves obtained at short intervals from a case of chronic cardiac failure, which closely mimic the three types included in this series. It is becoming widely recognised of
late that oral curves alone cannot form a satisfactory basis for discussion. Evidently with some feeling of this kind, Sheldon and Young performed an intravenous glucose tolerance test upon their patient and a " control " case-" a surgical convalescent." Unfortunately, this control curve is very far from normal; in fact at only one point (70 minutes) does it fall below the usually accepted renal threshold of 180 mg. per 100 c.cm. This mishap has led to the conclusion that the case of anorexia nervosa showed greater tolerance than usual, whereas in fact her curve is quite abnormally high (its area is more than twice that of one of my normal curves)-a state of affairs which is usual in these cases. Confirmation of the view finally expressed, " that there is no need to invoke an endocrine explanation," may be derived from a study of the insulin sensitivity. Anorexia nervosa seems, in fact, to be purely a condition of inanition, usually psychogenic at first, presenting the morbid physical and chemical findings of persistent undernutrition. I am, Sir, yours faithfully, C. WALLACE ROSS, Carline Harrold research fellow, University of Birmingham.
SILICOSIS INQUIRY IN SOUTH WALES : A DISCLAIMER To the Editor of THE LANCET SIR,-During the past week several newspapers have published inaccurate accounts of the progress of the investigation into silicosis in the South Wales coalfield which is being promoted by the Medical Research Council with the assistance of their Industrial Pulmonary Disease Committee. These include a statement attributed to "a member of the Pulmonary Diseases Board " (apparently meaning one of the investigators working under the direction of the Committee), to the effect that the results’of the inquiry will make possible an immediate reduction of over 80 per cent. in the incidence of silicosis in the anthracite coalfield. The facts are that the investigation is still in an early stage ; that the results cannot yet be assessed ; and that no such opinion as that purporting to be quoted has been formed. No interview has been given to the press, and the alleged statement has not been made by the investigators. I am, Sir, yours faithfully, E. MELLANBY, Secretary, Medical Research Council. CONTROL OF A TYPHOID EPIDEMIC To the Editor of THE LANCET SIR,-Dr. Richard Taylor suggests in your last issue that mass inoculation of the Basque children prevented a major epidemic. Might I be allowed to point out that according to Dr. Taylor’s own account of the camp the fifth and last case of typhoid amongst the children was diagnosed on June 4th, 1937, and As no inoculations were performed until June 6th. all the children had arrived at the camp by May 24th, thirteen days before the inoculations were started, and as the most insanitary period of the camp was during that thirteen days, why should inoculation be given any credit for preventing typhoid ? If the children’s filthy habits were likely to cause an outbreak of typhoid, the disease would have been contracted during those thirteen days. With regard to the sanitary arrangements, Dr. Taylor himself wrote as follows (Brit. med. J. 1937 2, 760): " The latrines were provided with narrow trenches, which were disinfected several times daily with
Many medical practitioners have maintained that it reasonable that some attempt should be made to coordinate the work of the medical profession in time of war. That this should be done voluntarily accorded with the best traditions of the profession. Others considered that there was a sinister purport in it all and that the form was inquisitorial. They felt that the political views of those who for one reason was
another found themselves unable to fill in the required particulars would be suspect by the authorities. It was argued too that the General Medical Council, which already links the profession with the State, would have been the appropriate body to make the inquiry. Now comes the letter in to-day’s issue of THE LANCET which discloses an attempt to apply indirect coercion in a most offensive way, which smacks of Fascism. This anticipation of conscription creates quite the wrong atmosphere and can only arouse the distrust of those concerned. It would be well for the British Medical Association to publish a full explanation and repudiation of this high-handed action; otherwise the sympathies of many members of the profession will be alienated from the scheme. I am, Sir, yours faithfully, LEONARD F. BROWNE. or
TREATMENT OF SCABIES To the Editor of THE LANCET
SiR,—I
see
that the treatment of scabies with
sulphur receives further commendation in the report from your Budapest correspondent (Jan. 29th, p. 285), who describes it as " a new quick nascent
method."
As this is the second occasion within the
past few months that this form of treatment has been " discovered," I thought it would be worth while putting on record the fact that it was used by at least one Field Ambulance (102nd) during the late Whilst at Franvillers in the Somme
area in the of 1916 we had a large number of patients suffering from scabies and it was found that the deposition of sulphur, obtained by wetting the skin with a solution of sodium thiosulphate, followed by the application of a dilute mineral acid, gave slightly better results than those derived from the traditional use of sulphur ointment. I am, Sir, yours faithfully, W. K. FITCH.
war.
summer
CARBOHYDRATE METABOLISM IN ANOREXIA NERVOSA To the Editor of THE LANCET
SiR,-The article by Dr. Sheldon and Dr. Young in your last issue raises a number of matters for discussion. Most of these I propose to leave for treatment in a paper on the same topic which I have in preparation; but one or two points call for immediate comment. A good deal of the reasoning in this paper is based upon a series of oral glucose tolerance curves which are considered to reflect changing states of glucose tolerance. Actually they are of types commonly encountered in debilitating conditions, including prolonged starvation, which lead to disturbed tonus of the alimentary tract, their occurrence being apparently due to irregular gastric discharge and to actual changes in the efficiency of intestinal absorption. I have, for instance, a set of three curves obtained at short intervals from a case of chronic cardiac failure, which closely mimic the three types included in this series. It is becoming widely recognised of
late that oral curves alone cannot form a satisfactory basis for discussion. Evidently with some feeling of this kind, Sheldon and Young performed an intravenous glucose tolerance test upon their patient and a " control " case-" a surgical convalescent." Unfortunately, this control curve is very far from normal; in fact at only one point (70 minutes) does it fall below the usually accepted renal threshold of 180 mg. per 100 c.cm. This mishap has led to the conclusion that the case of anorexia nervosa showed greater tolerance than usual, whereas in fact her curve is quite abnormally high (its area is more than twice that of one of my normal curves)-a state of affairs which is usual in these cases. Confirmation of the view finally expressed, " that there is no need to invoke an endocrine explanation," may be derived from a study of the insulin sensitivity. Anorexia nervosa seems, in fact, to be purely a condition of inanition, usually psychogenic at first, presenting the morbid physical and chemical findings of persistent undernutrition. I am, Sir, yours faithfully, C. WALLACE ROSS, Carline Harrold research fellow, University of Birmingham.
SILICOSIS INQUIRY IN SOUTH WALES : A DISCLAIMER To the Editor of THE LANCET SIR,-During the past week several newspapers have published inaccurate accounts of the progress of the investigation into silicosis in the South Wales coalfield which is being promoted by the Medical Research Council with the assistance of their Industrial Pulmonary Disease Committee. These include a statement attributed to "a member of the Pulmonary Diseases Board " (apparently meaning one of the investigators working under the direction of the Committee), to the effect that the results’of the inquiry will make possible an immediate reduction of over 80 per cent. in the incidence of silicosis in the anthracite coalfield. The facts are that the investigation is still in an early stage ; that the results cannot yet be assessed ; and that no such opinion as that purporting to be quoted has been formed. No interview has been given to the press, and the alleged statement has not been made by the investigators. I am, Sir, yours faithfully, E. MELLANBY, Secretary, Medical Research Council. CONTROL OF A TYPHOID EPIDEMIC To the Editor of THE LANCET SIR,-Dr. Richard Taylor suggests in your last issue that mass inoculation of the Basque children prevented a major epidemic. Might I be allowed to point out that according to Dr. Taylor’s own account of the camp the fifth and last case of typhoid amongst the children was diagnosed on June 4th, 1937, and As no inoculations were performed until June 6th. all the children had arrived at the camp by May 24th, thirteen days before the inoculations were started, and as the most insanitary period of the camp was during that thirteen days, why should inoculation be given any credit for preventing typhoid ? If the children’s filthy habits were likely to cause an outbreak of typhoid, the disease would have been contracted during those thirteen days. With regard to the sanitary arrangements, Dr. Taylor himself wrote as follows (Brit. med. J. 1937 2, 760): " The latrines were provided with narrow trenches, which were disinfected several times daily with