WARTS

349 It is interesting to note, also, that of two of the characters for pregnancy, one is the picture of a pregnant the woman from the left side and now has the usage of which life " and the the whole other, pictures body, self, her from the right side, means " shame, to conceal, hide." There is a rich realm of medical history to be enjoyed in the study of Chinese characters. J. R. ROSE. Sandwich. "

TREATMENT OF TETANUS WITH CHLORPROMAZINE AND NITROUS-OXIDE ANÆSTHESIA

interested in the article by Dr. Bodman as I recently had the opportunity to observe the effects of chlorpromazine for twentyseven hours in a 7-year-old mare with tetanus.

SIR,-I

and his

was

colleagues (July 30)

Signs of tetanus, appeared fourteen days after an untreated stab wound close to the right hock. Three minutes after an intravenous injection of 450 mg. chlorpromazine in.5 % solution (approximately 1 mg. per kg. body-weight) the generalised stiffness of the muscles of the head and neck was abolished, the marked protrusion of the membrana nictitans became less, ptosis was evident, and nostril-flaring disappeared. There was relaxation of the abdominal and tail muscles ; and respirations, which were previously laboured, became much easier and were reduced to 10 per minute. Six minutes after the injection the animal sank to her knees, but she regained the standing position two minutes later. Hypersesthesia was considerably reduced and she was now able to masticate and swallow. Signs of tetanus reappeared after five hours and were again controlled by further injections of the drug. Treatment was not continued, because the owner requested destruction of the animal for economic reasons. Veterinary Hospital, L. N. OWEN. University of Liverpool. CIRCUMCISION AND PENILE CANCER

SiR,—I was interested in correspondence in your columns on the relation of carcinoma of the penis to circumcision.1 During six years’ practice among the Hottentots of South-West Africa, I found that epithelioma of the penis was the commonest malignant The Hottentots do not tumour in male Hottentots. and rather a circumcision, practise tight and elongated a racial to be characteristic. prepuce appears Vasco, Cape Town,

J. HELMAN.

South Africa.

A BARBITURATE ANTAGONIST

SiR,-Last year

an

obese

woman was

admitted to this

hospital having been found sleeping deeply the evening before. In the stomach-washings were found considerable quantities of barbiturates. Despite vigorous treatment

the patient contracted pneumonia and died 4:3/4 days after having been found asleep. Blood taken a few hours before death contained 58 mg. of barbiturate per 100 ml. ; and the urine last voided contained 16 mg. of barbiturate per 100 ml. (In the last 24 hours of life she voided just over 1000 ml. of urine.)

On the 5th

of intoxication she retained, therefore, she would have excreted only a small portion of this by the 6th day, when a trial of ’Megimi(le’ would have been advisable as in the case described by Dr. McElligott.2 These figures confirm the estimate of Dr. Wright,3 as opposed to Professor Shaw’s view4 that on the 6th day only little barbiturate is left in the body.

day

large amounts of barbiturates, and

I am indebted to Dr. Hirsch and his staff of the Government Central Laboratories, Jerusalem, for the barbiturate estimations. Shaarei Zedek Hospital, J. LEURER. Jerusalem. 1. 2. 3. 4.

Lancet, 1953, ii, 337, 401, 449, 456, 567, 568, 623, 734, McElligott, M. Ibid, 1955, i, 820. Wright, J. T. Ibid, p. 1073. Shaw, F. H. Ibid, p. 969.

1263.

WARTS

SiR,—Your annotation last week brings home to us how common are these undesirable excrescences, and the medical officers of health who have collected the information are to be congratulated. The arduous and unrewarding duty of treatment falls to the skin department, whose staff are naturally discouraged by finding a never-ending line of patients queuing up for treatment. Nor can the weary registrars and house-physicians derive any comfort from your quotation of the opinion that " measures designed to combat plantar warts are illogical and are unlikely to succeed unless their scope be extended to include warts of other types." The prophylactic approach to plantar warts is not so hopeless as this opinion suggests. Warts on the feet are spread by persons with warty feet leaving the infection on floors. Upon the infected floors tread yet unsullied feet. If they are shod they will escape infection, but if they are bare and unprotected who can wonder if they eventually blossom with warts ?z? I have some figures relative to the effect of wearing shoes upon the incidence of plantar warts at school, which date from 1949 and refer to Cambridge schools. It happened that some schools in Cambridge did their gym and dancing in bare feet and some in shoes. The school medical officers very kindly gave me details of the school habits and the numbers of pupils in the schools. 1769 children wore shoes for gym and dancing and 1845 did not. Among the 1769 shod children I had 1 with plantar warts and among the 1845 unshod children I had 10. Further analysis of these figures by sex provides a clue as to why girls are more prone than boys to plantar warts, for the 1845 barefoot children were composed of 466 boys and 1379 girls. The boys provided 2 of the cases of plantar warts and the girls the other 8. The figures may be tabulated thus :

The greater exposure in

doubt one of the reasons in girls. Another reason is that the female skin is more vulnerable. I noticed this during the late war when vaccinating the A.T.S. after having practised exclusively on the male skin. The stroke which was ideal in men drew blood from the weaker skin of the other sex. What goes for the arm does not necessarily go for the sole but I should be surprised if it did not.

why plantar

warts

girls

is

no

are commoner

The remedy is easy-in theory. The children must shoes for dancing and gym. But headmistresses and Shoes, they say, cramp the gym teachers disagree. style of the dancer or gymnast who must be free to express herself. It seems that in this age of untrammelled wear

expression we are expected to accept plantar warts as part of the price of freedom. I cannot accept the view that plantar warts stem from warts of other parts to any significant extent. Plantar warts are a race apart. They are recognisable not only by their histology-to which you refor-but also by their clinical features, which can be summarised as deep, soft, plump, and painful. Ordinary warts do certainly occur on the soles and by comparison they are hard, shallow, wizened, and painless. They are known as mosaic warts and they cling to life with a fanatical zeal unknown to the true plantar wart. Plantar warts in their turn occur on the hands where they maintain their clinical character. They have a particular liking for the paronychial and subungual tissues and the finger pulp of mothers whose daughters have plantar warts. No doubt the darningneedle lets in the virus present on the stockings. That these ectopic plantar warts present an unfamiliar face is plain because they get treated as whitlows, and many are the poultices, knives, and syringes of penicillin that are arrayed against them. Swimming-baths, shower-baths, and bathroom floors are not blameless and I would not attempt to exonerate

350

They are unrewarding environments in which to attempt prophylaxis. Something might be done to sensitise the public conscience against those people with plantar warts who attempt to share them with the rest of the community by going barefoot in public places. As a long-term ideal this is excellent, but as a practical measure for immediate action I would suggest that schoolchildren should wear gym shoes. Perhaps some of your other readers have ideas on this painful subject. them.

ALAN LYELL.

Aberdeen.

If there be a case against capital punishment, it is a pity that none of your correspondents is willing to pay it the compliment of a lucid and logical statement: making it clear whether, and how far, he takes his stands on ethics, upon grounds of simple expediency, because his sensibilities are affronted by the behaviour of a section of press and public when an execution is pending, or upon all these grounds each in its specified

degree.

B

Yet, it has to be conceded that the principles and of ethics, in which any such case must be no .part of the training or experience of the doctor.’This may be why, like Everyman, when he meets something he dislikes ’ he finds it easiest to blow off steam : persuading himself that he has made a contribution to the problem, whereas he has done no more than relieve his feelings, and detonated a number of explosive " adjectives. Whether this be an "ethical activity I leave to Dr. Hamilton to pronounce. F. M. R. WALSHE. London.

language

SiR,-The East Anglian report on the high prevalence of plantar warts in school-children, particularly in girls,

suspicion that the practice of barefoot and dancing gymnastics is responsible. Barefoot gymnastics and dancing appear to be somewhat of a passion at present and might account for the spread of infection by contamination of gymnastic apparatus and floors. Girls do more dancing and I suspect more barefoot gymnastics than boys. Also, judging by the dirt accumulated on the soles after a lesson even in a well-kept gymnasium, this might lead to an increase in the cloak-room infections if the girls wash their feet as they need to do before putting on shoes again. Perhaps the East Anglian medical officers of health may be able to correlate the prevalence of plantar warts with the practice of barefoot physical culture and if it is proved to be connected, a return to the old-fashioned gym-shoe might have its rewards. After all, the knowledge that plantar warts spread by, barefoot walking, especially in institutions, is not lends colour to my

new.

-

are

SiB,—I have read with great interest the correspondence that followed your editorial on capital punishmentchiefly that having recourse to Aristotle’s Ethics. Aristotle’s Ethics are undemocratic, based on inequality, and anchored to the idea that a few men are infallible sages, who can dictate what virtue should be. Any deviation from this is wrong and unethical. Those sages are the legislators whose duty it is to make the young acquire moral habits so that eventually they practise virtue without the compelling power of the law. If the pupils acquire bad habits by listening to the same legislators they must be punished so that " justice be satisfied. However sensible Aristotle’s teachings may have been, to the modern mind, to say the least, they are devoid of common There is no benevolence in them : the sufferings of sense. mankind are things to be discussed intellectually only and no man must take a passionate interest in another man’s nnhappiness. Aristotle never learnt from human experience ; he is absolutely barren of emotional considerations, and the deepest aspects of moral life never crossed his mind. His Ethics are absolutely repugnant to modern free-thinking and democracy ; and his reactions to human beings are not far related to those of the hardened post-mortem attendant and have nothing in common with the kind and sympathetic approach of the true doctor, whose main concern is the preservation of life. "

H. A. FRIEDLANDER.

Manchester.

THE DEATH PENALTY

interested in Dr. Hamilton’s assurance SiR,—I in your issue of Aug. 6, with its exposition of his private notion of ethics. Yet, whatever he may say, ethics is part of philosophy, a subject not included in the medical curriculum and one not to be understood without some study. It is indeed a complex problem that he solves to his own satisfaction in half a column of The Lancetone that has occupied the minds of men of genius for over two thousand years. However, I must repeat, though I burden your patience, that if there be a valid case against capital punishment, your correspondent does not state it, nor appear to understand in what it must consist. For example, he writes : " Ethic (sic) is not given us from some hypothetical source, nor does it grow on trees, nor in philosophic systems. It is slowly built up in society by the ethical activities of society." He does not define an ethical activity," nor tell us how we may recognise it as such. It remains something undefined and of hypothetical source, and without definitions of his operative terms, his sentences are devoid of rational content, and mean precisely nothing. If ethics, like Topsy, " just growed," when do the activities of Society become ethical, and how do we know that they are so ?What qualities-at the critical timemake ethical what was not so beforeWhich came first, the hen or the egg, the activities or the ethics ? Dr. Hamilton has no answers to these questions. It has not occurred to him that any are called for. In reason, ethics must consist in principles that are applicable to human behaviour in all circumstances, though the science of ethics itself is not responsible for applying them in practice. They are not principles derived from conduct, but principles that should inform it. Dr. Hamilton confuses what he believes to be the growth of " ethical activities " in society with the principles that must precede and determine this am

"

growth.

couched,

No-one has better summed up the Ethics of Aristotle than that great contemporary philosopher Bertrand Russell : " What he has to say is what will be useful to comfortable men of weak passions ; but he has nothing to say to those who are possessed by a god or a devil, or whom outward misfortune drives to despair." Thames

Ditton, Surrey.

L. R. CELESTIN.

to discuss the death penalty but there would seem to be at least two its continuance which do not involve emotional considerations. The result of a fair legal procedure, like the result of scientific work, can be expressed only as a probability. It would be as well, therefore, to inflict only such penalties as are reversible. Secondly, it has been shown that evidence as to the deterrent effect of capital punishment is equivocal. In other words, it is doubtful whether the ordinary citizen need feel that his already remote chance of being murdered would be increased were the death penalty abolished. The police are entitled to think differently about this matter, but perhaps the provision of very severe penalties against the unauthorised carrying of lethal weapons would provide them with a better

SiR,-It is difficult

unemotionally, points against

safeguard. Ilkley, Yorkshire.

T. D. DAY.

’