Академический Документы
Профессиональный Документы
Культура Документы
Regarding the ingenious use of a standard candle, we under- did not arise-and of a prediction which I made in your Journal
stand, however, that this may under varying conditions of of September 16, 1939 (p. 621). Perhaps you will allow me to
draught, temperature, and humidity give rise to considerable quote from my letter the words of a famous surgeon: " Every
errors in illumination. tuberculous person turned forth is like a bomb thrown among
If we may suggest it, the test should be described as a valuable the public." I spoke of " the unwitting power of spreading the
rapid test for approximately testing night vision, but any con- infection to those about them " by the tuberculous, " a power
clusions arrived at on the assumption that the test is exact much more evident in crowded and unaccustomed conditions
should be treated with some reserve.-I am, etc., than in the familiar state of pre-war society." Is it necessary
Research Department, E. W. GODDING. to postulate anything else?-I am, etc.,
The Crookes Laboratories, N.W.10, Oct. 13. Cheam, Surrey, Oct. 21. S. LYLE CUMMINS.
*** We have referred this letter to Mr. Bishop Harman,
whose reply follows.-ED., B.M.J. Diagnosis of Early Venereal Disease
SIR,-The points that arise in the letter of Mr. E. W. Godding
SIR,-In view of the importance of the subject at the present
the following remarks may not be out of place.
regarding testing night vision are of interest and must certainly It is a continual source of astonishment to me to find that
be considered. If I may say so, I think that it is inevitable the last twenty-four years have seen very little change in the
that Mr. Godding, from the closeness of his work with the attitude of the medical profession generally towards early
production of the precious vitamins, would think of this night- syphilis. The importance of diagnosing syphilis microscopically
vision problem almost exclusively in terms of health. He will before the Wassermann reaction is positive is not realized.
naturally suspect those with poor night vision to be deficient in At the risk of hearing the remark from the more knowledgeable,
healthy vitamins. But it is ciear from the character of the 700 "Elementary, my dear Watson," may I say that genital sores
subjects put through my test, and whose records are charted, in either sex should have a saline dressing applied, and the
that all of them were us well equipped with every vitamin that patients should then be referred to the nearest V.D. clinic or
human beings could be. The 200 children belonged to a first- V.D. specialist for " dark-ground " examination of the exudate.
class school in a most delightful part of the country. They I think it is time someone protested against the practice of
were as fine and lively a lot of boys and girls as could be first dosing patients with sulphonamides and then referring
found. Indeed, their liveliness made a long-timed testing in them to V.D. clinics for diagnosis. The condition is thus dis-
the dark tiring to an elder. The Canadian soldiers were as guised effectually both from a clinical and from a bacteriological
stalwart and well-fed a group of men as could be collected any- point of view. Particularly in females, chronic gonorrhoea is
where. The "eleers" were all well-to-do residents of the dis- difficult enough to diagnose without anyone throwing a spanner
trict. All the subjects, therefore, were without doubt in first- into the works, so to speak.-I am, etc.,
class health. The tests prove that night vision may vary as Sunderla4d, Oct. 20. NOEL F. ROWSTRON.
much as colour vision. The variations are in the natural make-
up of the subject. Indeed, I have some evidence that defective Treatment of Haemorrhagic Disease of the Newborn
night vision may be hereditary in a few cases.
The fifteen-minutes-time adaptation to the dark is questioned SIR,-The article bv Dr. A. I. S. Macpherson and the letter
since the subjects came into the dark in groups, so some got by Dr. John J. Robb on the treatment of haemorrhagic
more time than others. My tests were carried on through many disease of the newborn (September 27, p. 433, and Octo-
days. Each day I checked the reaction with my own eyes, and ber 11, p. 526) are of interest to every practitioner, because
since I am over a long way in the "elder" group and wear this is an emergency which anyone may meet with, and
glasses, that was a severe check. I could always get my full "something must be done at once" if only to pacify
range of 5 metres in five minutes, even when I came into the the parents of the infant. You were kind enough to
dark from the sunshine. In my experience fifteen minutes is publish two notes on this subject (Journal, December 22, 1923,
ample time. Further, subjects who responded badly to the test p. 1218)-one from me-when its treatment by injections of
were put back at the end of the waiting line of candidates to paternal whole blood was being discussed in your columns, and
try if a longer time gave them better vision. That is shown since then it has been my fortune to treat seventeen cases (with
in my paper regarding the school boys, who wanted to do one death). all in general practice.
better than they had done, but who after half an hour in the At first I used 8 c.cm. of paternal whole blood with 2 c.cm.
dark showed no change in their reaction. of warm saline injected into the infant's buttock, and repeated
The standard candle test was chosen because it is the most this in twelve or twenty-four hours. Later five cases received
" standard." No electric light can be so certain in the exact- the two blood injections plus 2 c.cm. of haemoplastin, and the
ness of its measure. We ophthalmic surgeons know that in the next three were given one injection of blood and two of haemo-
use of our convenient electric ophthalmoscopes. The candle plastin. Five years ago I was called at I a.m. to a four-day-old
box is so arranged that the conditions of draught and tempera- infant which had passed blood by the bowel sufficient to soak
ture (when, as is inevitable, the test is done in enclosed premises) its clothing and mattress, and appeared to be about to die.
are as uniform as can be. So far as humidity is concerned, I The father was a bus driver and could not be found, the
cannot think that this would affect the candle light unless the mother had fainted, and the only help was a neighbour. More
damp amounted to a mist or a fog, and I cannot think that any with the idea of "doing something" than with much hope of
eye man would attempt such a test in a fog. saving life, I injected 2 c.cm. of colloidal calcium with ostelin
This disk-spotting test was arrived at after some other (Glaxo), which happened to be in my bag, and 3 minims of
methods of testing night vision had been tried. That is stated adrenaline. Half an hour later the child was still alive, and the
in my first paper of April 26. These preliminary tests were injections were repeated. No more haemorrhage occurred, but
made with medical colleagues, whose criticisms were helpful. an injection of this calcium preparation was given daily for a
In my opinion these experiences justify the conclusion "that week, and the child is perfectly well to-day. Since then I
the disk-spotting test can be of use in testing large numbers have met with seven cases, all of which have been treated with
of people with comparative ease and with exactness." Perhaps the same preparation. All have survived; the last case hap-
I should have written, " and with as much exactness as any test pened as recently as four weeks ago.
of human reactions can be."-I am, etc., The only case in the series which ended fatally was treated
Edenbridge. Kent, Oct. 17. N. BISHOP HARMAN. with maternal whole blood and haemoplastin, and there seems
to be accord that the mother's blood is less effective than the
father's in the treatment of this condition.
The Increase of Tuberculosis Vitamin K deficiency may be the explanation of why some
SIR,-There are now many records of increased incidence and infants bleed and others do not. It may also be the explanation
death rate from tuberculosis and many theories as to why this of why some women fall easier victims to infection at confine-
increase has come upon us. May I remind you of the turning ment, and why maternal blood is of less value than the father's
out from our sanatoria of a great many tuberculous persons at in controlling the alarming condition of haemorrhage in the
the beginning of the war to make room for the casualties which newborn.-I am. etc..
were then expected to occur-an expectation which, fortunately, Stockport, Oct. 17. F. J. K .