alternate days for an average period of 10 days (mini-mum 4, maximum 34), attaining cure in all. In viewof this success, we felt we had solved the problem, and,despite Dr. Barbers far better results with penicillinon bacteriologically proven cases, I am still wonderingwhether the erysipelothrix is the sole cause of this disease.However, penicillin is obviously the treatment of election.Brompton Hospital, London, S.W.3. E. G. DOLTON.
, SIR,While casualty officer at Charing Cross Hospitalin the latter part of 1942 and the early part of 1943I took a small part in the Septic Hand Clinic whichhad been started in the hospital some time previously.Writing from memory I should say that we treated atleast two dozen cases in six moriths. The cases werealmost invariably among kitchen-workers from the manyrestaurants in the Soho and Strand districts, and all gave ahistory of a prick, usually from a fish-bone or fowl-bone.They were interesting in several ways. First, they
never suppurated, and secondly, the greatest pain wasalways in the area of the joints of the fingers, leadingthe unwary to suspect a septic arthritis. Anotherinteresting feature in our experience was the fact that- theinfection seemed to be self-limiting ; no matter whatlocal treatment was used it cleared un in about 21 davs.Beckenham, Kent. F. G. HERMAN.
SIR,Much has been observed and written, by Schilder,Foulkes, Bion, Rickman, and others, about group therapyin illnesses of psychoneurotic and psychotic origin, butI cannot recall anyone drawing attention to the prophy-lactic effects of groups in civilian life.For seven years, while I was in general practice, I was
involved each winter in Gilbert and Sullivan operasperformed by a cast of 40 drawn from a village of 1091inhabitants, quite apart from a choral society of 30singers in another village of 300 inhabitants. In addition,I had the usual bunch of Red Cross women whom Ilectured weekly. (That was general practice, that was.)In retrospect I am amazed to recollect how exceedinglyrarely the participants in these different groups evergot ill-during the " season," at any rate. Absenteeismfrom rehearsals, practices, and lectures was exceptionaleven in the 1939 and 1932-33 epidemics of flu, when Iwas visiting more than half the cottages in the neighbour-hood. We never postponed a show ; we never playedan understudy-in fact, we never bothered to rehearseunderstudies.Wise after the event, I am drawn to the conclusion
that a group of people happily engaged in some purposefulcreative activity maintains a high average of health. Iam sure there must be other G.P.s who, by force ofcircumstance or predilection, have had to undertakevillage or parochial activities, and it would be interestingto learn whether their experience has been similar tomine. GEORGE DAY.
" LETS GO TO THE PICTURES "
SIR,There was a small but important error, probablyaccidental, in Mr. Catteralls excellent article of Feb. 16,in which he says that the people who learn more easilyfrom pictures than from the printed word form a minorityof the school-certificate class from which medical studentsare drawn. One might quote Lord Horders opinionthat " we are most of us visualists rather than auditives "
and point out the increasing tendency to illustratetextbooks. The importance of this mistake is that Mr.Catterall concludes from it that the production of factualfilms for medical students is " neither necessary nordesirable." Surely a most important use of the filmis to bring together at one time and on one screen anumber of " facts " in such a way that they can beintegrated in the students mind ?
Mr. Catterall rightly draws attention to the possibilityof students viewing films for themselves ; this wouldremove a disadvantage from the film as used at present-that it is a group method of teaching. The standard(35 mm.) viewer now costs some ;8250 ; it is to be hopedthat the substandard ones he mentioned will be far cheaper.
It is unfortunate that Mr. Catterall by implicationthe vital importance of sound ") dismisses the silentfilm; for as you pointed out in your annotation ofOct. 13, 1945, there are some important uses for silentfilms in medical teaching. One of these is for the subjects
" which could be adequately covered in very few feet offilm" mentioned by Mr. Catterall himself.
Mr. Catterall in his forceful way says that the costof first-class animation is " prohibitive.. This is anexaggeration. The resources of the Disney studios arenot needed. For the cost of Six Little Jungle Boys a veryworth-while diagram film on the development of thebody cavities could be made and would have lastingusefulness. In fact, as Mr. Catterall says of medicalteaching films in general, " the undoubted expensewould be " well iustified bv the results obtained."
RONALD MACKEITH,Chairman, Medical Committee,
Scientific Film Association.
SIR,I apologise for once again making claim on yourspace. I thank Mr. Milnes Walker and Mr. ArthurJacobs for their support. To Mr. Walker I would saythat I have utilised on two occasions the intrapelvicapproach to the vas, merely ligating it, however, withoutsectioning. The ligation of the vas, or vasectomy, atbest merely prevents a transluminal descent of infectionto the epididymis, and it appears to me infinitely prefer-able that the occasional inevitable abscess should pointunder the skin of the scrotum, where it is accessible,rather than in the depths of the pelvis. The lattercould conceivably be of serious moment, and wouldcertainly be difficult of diagnosis. I feel that theDrocedure should be condemned.London, W.1. TERENCE MILLIN.
CORRECTION OF FACIAL PARALYSIS WITHTANTALUM WIRE
SIR,-The disadvantages of using tantalum in placeof fascial strips to correct the deformity due to facialpalsy, as described by Prof. Eastman Sheehan in yourissue of Feb. 23, are that the tantalum ribbon tends tofragment, and to cut out. The result to patients can beat least one extra operation and several months delaybefore the deformity is corrected by the use of anothermethod.A recent visit to over twenty plastic centres in the
United States showed me that there was wide interestin the tantalum method, and in its complications. Fullcredit was given to the military plastic centre at whichthe method had first been explored and given an extensivetrial, and from which reports of these complications hadbeen provided for other plastic centres.
Fascial strips, ,and, for selected cases, the mobilisedmasseter, continue to be the most generally used methods
for correcting the deformity of seventh-nerve palsies.It is possible that a role of usefulness in the treatment offacial palsy will be defined for tantalum. Its use is stillexperimental. But an indication of the incidence of com-plications, and above all evidence of the moderatelylate results in cases treated, should I suggest be added toany account of the method today, some two or more
London. PATRICK CLARKSON.
CONGENITAL DEFECTS FROM GERMANMEASLES
SIR,I read with great interest your leading articleof Feb 9, and strongly support your plea for an earlyinquiry. The article is a great advance on your lastannotation on the subject, which, in my opinion, over-stressed the difficulties likely to be met with in such aninvestigation.
In my recent Blair-Bell lecture I discussed the associa-tion between congenital defects and German measle$,pointing out that although many paediatricians in thiscountry have seen isolated examples of this association(I myself have seen two), the largest number of caseshad been reported by Martin. By means of a question-naire Martin, whose contribution you do not mention,found that out of a total of 85 deaf children born during1940-41, the deafness in 13 was due to meningitis, andin 7 was hereditary, but 24 of the mothers of the remaining65 children suffered from rubella during the first fourmonths of pregnancy, and 6 other mothers probablycontracted it. -
Although considerable evidence can be obtained in ashort time by the methods you suggest, the completeproof that German measles in early pregnancy is a cause