SNPr. igoS] fCORRESPONDENCE. [M.

=Z=A 755
sumptives, but this eannot be said of the Jamees Brown the BRITISH MEDICAL JOURNAL of September gth, p. 5,99 To
Sanatorium, and the Nunyara Sanatorium at Belair, near deal with the points raised seriatin:
Adelaide.-I am, etc., i. The Committee fully realizes that the period mus.t be-
Crooksbury Sanatorium, Sept. i6th. F. RUFENACHT WALTERS. long during which the child patients are kept at the sana-
torium, and the cost will doubtless be considerable,
but the question of duration of residence, and conse-
THE OPEN-AIR TREATMENT OF CONSUMPTION. quent expense, can hardly be used as an argument against
SIR,-Dr. Weatherly is reported as having said at the the necessity and desirability of providing suc-h a sanatorium
Leicester meeting: " I will not use the word ' cured,' because as is proposed. Similar sanatoriums are to be found in France
I believe that once a consumptive always a consum,ptive; and and elsewhere. Moreover, the Committee hope that, apart
however you may treat a sufferer from the disease, he is from the endowment of cots, avid annual subscriptions and
always a creaking door, and if not looked after he must donations, help will be forthcoming in the shape of contribu-
collapse." tions from friends of the patients, and from paroch;ial
This is a great swing of the pendulum, but I feel sure it is organizations, charitable societies and other hoppitals, whlich
the opinion of the majority of medical men; but how can it may send children for special treatment at the sanatQrium..
be reconciled with btiListics of various sanatoriums, in which 2. There are three doctors upon the Committee; as, the,
cures reach even go per cent; in slight cases ? My own feeling enclosed prospectus will show: one, the Secretary of the
is that " cure " is the wrong word. To be cured there should Kelling (C. 0. 5.) Sanatorium; anotber a well.known ,lady,
be neither symptoms nor physical signs. Of over a dozen doctor who has herself founded and maintains more than one-
cases I have Bent to sanatoriums during the last two years not sanatorium for adults.; and the third, a visiting physician to
one has returned without either symptoms (cough, etc.) or the London Homoeopathic Hospital.
physical signs, and the general practitioner who knows his 3. As the appearance of this gentleman's name is particu-
patient sends him to the sanatornum and watcbes him after- larly animadverted upon in your article, it may be said that
wards is undoubtedly the best judge as to whether he is cured from the first inception of the scheme, he has given valuAble
or not. My point is that these statistics of cures do harm, advice, and has rendered great service to the Cotmiibttee.
for the patient is naturally very disappointed to find there is 4. The sanatorium, however, will not be worked' upon
still something wrong after some months' residence in a homoeopathic lines, and as the main part of the treatimntt
sanatorium. I have no doubt about the good produced by will consist of skilled nursing, fresh air and sunshine, and
the treatment, but I have great doubts about the cures.-I good food, together with suitable physical exercises,, the
am, etc., question of bomoeopathy or allopathy will hardly arise..
Bath, Sept. 20th. W. H. COOKE, M.D.Brux., F.R.C.S.Eng. 5. The medical supervision will probably at fisttbe give
by a visiting physician from a neighbouring town, and'as the
IDIOSYNCRASY IN REFERENCE TO MIUSHROOM number of patients increases a resident doctor migiW be
POISONING. employed. The Committee, however, have not'5et fully.con
SIR,-With reference to Mr. Jonathan Hutchinson's letter sidered this mfatter since the scheme is only in. its iidtial
on this subject in the BRITISH MEDICAL JOURNAL of Sep- stage as yet.
tember x6th, I think the case described below will be of I may add that much welco-me support has boen,receNed
interest, although I do not consider idiosyncrasy is proved. already from various sources, but a great deal'rem4ino t6-be
The symptoms described by the patient, however, are very done before the amount asked for is obtained. so tbatt J
typical of the cases mentioned by that gentleman. earnestly ask you to give my letter the same publicity which
Sergeant-Major L., R G.A., picked some muehrooms on the your article has received, and I trust you will be able, after
morning of September 7th; these he and his wife had for reading my reply to your criticisms, to recommend, unre-
breakfast, a friend of his also partaking of them. Twenty- servedly, this splendid scheme to the many readers of your
four hours later, on waking up, he felt as. if there was a lump JOURNAL.-I am, etc.,
in his chest, and he had great difficulty in breathing; he, EDWIN C. BiDSOED.
however, bad some breakfast and went to his work. One and The Rectory, Great Ormond Street, W.C., Sept. 14th.
a-half hours after the first symptoms the pain in his chest
became very acute; it commenced just below the ensiform DYSENTERY AND ITS TREATMENT ON'-ACTLVE
cartilage and passed to the back of his chest and under the SERVICE.
left shoulder blade. SIR,-Surgeon-Major Hutton' is quite right in attributing
The pain he described as of a piercing character, and he the ipecacuanha treatment of dysentery to the late Surgeon-
found the greatest difficulty in breathing; he states he had Major Docker. He first tried it in Mauritius, and when he
never suffered such agonizing pain in his life; it became so went to Ceylon in i86i his plan was to administer 20 to 3ogr.
severe that he had to leave his work. He also states that he ipecacuanha, the patient having taken 20 to 30 drops
had a feeling of numbness in his left arm. The pain con- tr. opii fifteen minutes previously; at the same time a
tinued very severe, and was so acute in the evening that a mustard plaster was applied to the epigastrium. In case the
hypodermic injection of morphine was given this and mus- drug was not retained it was repeated, but the opiumt and
tard poultices to his chest gave him relief. Next morning mustard generally prevented vomiting. Profuse sweating
the pain was not nearly so severe, but he still had great diffi- followed, with relief to symptoms. A second dose was
culty in breathing. occasionally required-rarely a third, providedl the case was
He states that his mouth was very dry and continued so not more than of two or three da s' standing.-I amn, etc.,
for forty-eight hours after the first symptoms. A few days OWEN OWEN,
later he had a very slight attack of jaundice; his conjunctivas Cheltenham. Brlgade-Burgeon.(retired).
were yellow. I did not test his urine for bile. but from his
appearance I have no doubt it was present. The pain and HAY FEVER, CHRONIC REIIN'ITIS AND ASTHMA.
ditficulty of breathing continued for several days (five or six), SIR.-As "M. D." has so courteously supplied that' further
but not of the same acute character, and though now free explanation of his views on the sourees of the." mechanical
from all pain he still states he has a feeling of tightness over energy of the human body" for which I was genuinely
his chest and cannot breathe as freely as before. He had no anxious, I can do no less in thanking him than drop the note
diarrhoea or vomiting, and no pain whatever in the abdomen. of personal badinage.
The sergeant-major states that- his-wlfe- vomited after eating I speak only the literal truth when I say tIhat I am glad to
the mushrooms, but his friend wbo ate them had no sym- know that by an alteration in his habits "M.D." has 'suc-
ptoms of illness whatever. The patient states he has eaten ceeded in ridding himself of so distressing a complaint as
mushrooms hundreds of times, but was never ill after doing asthma, but at the same time I dissent as strongly as possible
so before.-I am, etc., from the conclusions which he has drawn from. this ex-
L. T. NASH, perience, unsupported as it is, as far as his letters go, by any
Military Hospital. Golden Hill, Lieut.-Col, R.A.M.C. similar results in his own practice.
Isle of Wight, Sept. 8th. "M.D." challenges me to "compress into:, a' shorter namo
the ideas conveyed in his somewhat long term covering his
A SANATORIUM FOR CONSUMPTIVE CHILDREN. view of the complex pathology of asthma." Well, I think
SIR,-As Chairman of the Committee of the proposed "respiratory catarrh " would meet the case. but I do not wanit
Children's Sanatorium, and Qne of the signatories to the either to compress or to expand his meaning.. If asthma is
appeal, recently published in the newspapers, I desire to synonymous with eatarrh. of the v4rious, portions of the
npake some obaervations upon the article whiph apppared in 1B RIlIlSH MEDICAL JOUHNA-L August xgt1, rg0s, p.383.
 756 BIO ] ORRESPONDENCE.
respiratory mucous membrane enumerated in his definition,
how does he account for the extremely common cases of
such catarrh which are familiar to every one, but which pre-
sent none of the symptoms ordinarily connoted by the word
"'asthma?1' Whatever asthma may be, it certainly is not
"catarrh " or any other kind of inflammation; and no pre-
liminary array of Greek roots or even Sanskrit roots will
justify a definition that ends with t,he Greek word " catarrb."
Such an attempt at "definition" is merely a misleading
confusion of ideas.
However, the main point of " M.D.'s" letter is the attempt
to juastify his statement that the food we take is not the source
of the energy of the body. It is here that his mind soars into
those transcendental regions whither I follow him with
diffidence. He asks us to believe that this energy, instead of
being liberated by the chemical processes going on in the
body, is somehow "received" during sleep, which "enables
the body to receive an amount of vital energy from the limit-
less stores surrounding it." This is very pretty and very
transcendental, but, as Bishop Butler said of the doctrine of
Necessity, " Even if it be true, it is for us as though it were
not true," and I fail to see that " M.D.'s " somewhat nebulous
dissertation on the relation of matter to gravitation adds any
plausibility to his contention. However, he says, after draw-
ing various analogies, "I conceive, then, that vital energy
beas- to the body the same relation that electrical energy
bears to the tram motor." Herein I agTee with him entirely,
but I must remind him that the current in the overhead wire
does not get there mysteriously oat, of the " Ewigkeit," but is
the direct outcome of the combustion of certain tons of coal
at the nearest generating station! "M.D." admits that the
combustion of food is the source of the heat of the body; he
admits that it might be partially converted into energy, but
refuEes to admit that any of it is actually so converted. He
prefers the hypothesis that mechanical energy drops down to
us in some mystic fashion fr(m interplanetary space. Now
we know that the best mod?rn steam engine, in developing the
erergy demanded of it, wastes from 8o to go per cent. in the
development of heat. The proportion is probably similar in
the case of the living bady, but the superiority of the body as
a machine lies in this, that both heat and energy are required
and used.
When "M.D." comes down from this doubtful dealing In
imperfect analogies to mere facts and figures he betrays the
same habit of loose thinking. In basing certain conclusions
on his observation of a siugle case, he is content to tell us
that he "roughly calculated that it requires the expenditure
of 780 foot-pounds of heat energy to raise i-lb. weight of the
human body 10 F. in temperature." After this we are not
impressed by his dictum that " on anything like this basis it
is' impossible to account for my patient's work out of her
food." Quite so. " Rough calculations" are no use in physi-
ology, and I recommend to " M.D." a reperueal of Sir Michael
Foster's textbook.
The fact is, Sir, that the processes which lead to the pro-
duetion of energy in the mammalian body are so well ascer-
tained, and so perfectly analogous to the processes of other
forms of the conversion of energy, that it would only be waste
of your valuable space to write any more in demolishing the
fanciful and ill- considered theories of "M.D." I am, etc..
Leigh, Lancashire, Sept. i6th. FRED. E. WYNNR, M.B.
THE IMPORTANCE OF VAGINAL EX&MINATION
EARLY IN PREGNANCY.
SIR,-Under the above heading an anonymous country
do3tor in the BRITISH MEDICAL JOURNAL of September i6th
gave short notes of two recent cases where, for want of it,
COesarean section had to be resorted to on account of tumour
ob3truction. Now I have no doubt that most medical men
cuild cite similar cases, and others where the routine practice
of early vaginal and, I would add, abdominal examination
would have prevented many of the accidents of pregnancy.
Some or the most painful cases I have seen in this connexion
have been those of false pregnancy, where patients. after en-
gaging doctor and nurse, and made the other needful prepara-
tions, are, after months of joyful expectation, confronted by
the ghastly fact that they are not pregnant at all.
Many years ago I remember being called in to assist in a
supposed difficult labour, where I found the patient in bed
tugging at a roller towel and being assisted In her efforts by
sympathetic neighbours, and it certainly was not likely to
increase her respect for the profession to be told that her baby
clothes would not be required.
[SPT 23 1905.
It seems to me remarkable that our schools of medicine
should allow men to enter upon practice so careless of the
grave responsibility which a midwifery engagement involves;
that in very few cases do they do more than enter the name
and address amongst their engagements, with frequent results
such as in your correspondent's practice and others with a less
hRppy ending. Every medical man should adopt the custom
of satisfying himself by a full examination as to the local and
general condition of the patient, and decline to attend any
one who refuses this necessary measure. Moreover, he should
make it a point to keep the selection of the nurse In his own
hands. Many painful recollections of lives sacrificed through
ignorance and carelessness, when the usaual method of leaving
it to the patient or her friends makes me emphasize this
precaution.-I am, etc.,
Nottingham, Sept. igth. GEORGE ELDER, M.D.
SIR,-Ia reply to "A Country Practitioner of Twenty-five
Years' Standing" on the importance of vaginal examination
early in pregnancy, I should like to say that when I learnt my
midwifery at the Victoria University and St. Mary's Hospital
f or Women, Manchester, the importance of this early examina-
tion was always insisted upon by Sir William Sinclair and
Dr. Donald, my teachers, and that I have found it recognized
and practised by all men who conduct their cases in scientific
method.
I need hardly say it is my own practice; and in the case of
so-called " good-class " practice, as my midwifery practice is,
a simple statement of its importance quite reconciles the
patient to the procedure in the large majority of cases. In
the one or two instances where there has been any demur
and the necessity questioned, I have adopted the plan of
saying that not to examine as I propose incurred a certain
amount of risk to the patient of later complications, but that
if she chose to run them I had done my duty in warning her
and suggesting the precautionary treatment.-I am, etc.,
A Tows PRLCTlTIONER OF SIX YEARS' STANDING.
Eep4ember x6th.
TEETHING AND CORNEAL ULCERS.
Sit,-Dr. A. G. Fraser draws attention in the BRITISH
MEDICAL JOURNAL of September i6th to the fact that at this
year's meeting- of the Section of Dental Surgery no mention
was made of the relation betwepn "dentition and corneal
ulcers," I presume as an example of reflex irritation. Is it
not time this respectable but antiquated bogey were buried ?
I feel so confident that the perpetuation by the profession of
the fallacy that teething is the cause of so many ailments is
accountable for many deaths, becauee, instead of going deeper
for the cause of an illness, so -many rely on the diagnosis of
teething, and it may be as a cloak also for ignorance. If this
purelyphysiological process-namely, the normal growthof the
teeth causing absorption of the gum, does lead to such patho-
logical conditions as corneal ulcer, convulsions, eczema,
bronchitip, etc., then why not account for " growing
pains" in the same way? We hear a great deal of the
diseases of dentition, but never as the result of carious teeth,
which most adults know from experience can be painful
enough, nor yet of any disturbance from an impacted wisdom
tooth. Strange that so much reflex mischief should follow
one particular physiological process. A whole mass of semi-
digested, fermenting, and decomposing food may pass down a
long length of highly sensitive intestine, inflating the same
with the products of decomposition, presinguponplexuses of
nerves, setting up a poisoned state of blood, yet nothing is
heard of it; but a harmless and necessary tooth is no sooner
found exposed than all the previous ailments are at once put
down to its charge.-I am, etc.,
Darwen,:Sept. x8th. F. G. HAWORTH, M.B., C.M., D.P.H.
TREATMENT OF RINGWORM OF THE SCALP BY THE
X RAYS.
Siu,-I must congratulate Dr. Macleod upon the very
ingenious apparatus which is figured in the BRITISH MEDICAL
JOURNAL 01 September i6th for the treatment of ringworm of
the scalp by the x rays.
Considering that we have at present no really reliable
radiometer to measure the rays directly, and that when
various tubes are used under apparently similar conditions,
the readings of the radiometers are not comparable as regards
therapeutic effect. The idea of regulating the exposure by the
number of interruptions in the primary circuit is certainly an
imlr)vement on present methods, though it may seem likie a