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listening to his remarks by the bedside were

frequently to be found some of his old housephysicians who had returned to brush up theirwork. In the days when I was his house physicianhe was especially enthusiastic upon the use

of the ice-bag for pneumonia. At the beginningof our six months’ residence few of his housephysicians were so sanguine in this directionas our master, but when our time of office hadexpired most of us were converted to his views.He used to insist that the first thing to be done wasto place hot-water bottles to the feet of the patientand then to apply ice-bags not only to the dull area,but to the entire lung affected. There is no doubtthat under this treatment the area of dullnessreceded sometimes in a remarkable manner, and ifone could not state with certainty that the treat-ment aborted the disease (though at times it

appeared to do so) it gave great relief to the patient.Dr. Lees was, perhaps, best seen in his systematic

lectures, which always gave evidence of carefulpreparation and attracted large attendances. Hissterling and upright character will always remainas a bright example to those who were associatedwith him. I am, Sir, yours faithfully,City of London Mental Hospital, Dartford. R. H. STEEN.

TRENCH FROST-BITE.To the Editor of THE LANCET.

SIR,-In the " Practical Considerations for Pre-vention " suggested by the authors of the paper onthe Pathology of Trench Frost-bite,! there is anomission which seems to me important. No recom-mendation is made for the provision of high rubberboots and thigh wader attachments. If the menwere allowed to wear these there is no doubt thatthe cases of frost-bite would be few, and theother preventive measures suggested would beunnecessary. Leather boots, leggings, extra cloth-ing, and vaseline to the feet are all useless whenonce they become wet, and with water near freez-ing point 36 to 48 hours’ exposure is quite enough-to produce frost-bite. Men who have gone forseveral days on ski-ing expeditions with the

ordinary ski-boots (which are saturated with greaseand made as waterproof as possible) will recallthat at the end of a day’s march the leatheris sodden, and unless the boots are driednear the convenient hotel radiators, the next

day they begin to let the melting snow in. That

happens in running through dry, crisp snow; stand-ing in icy water continuously, the wet-resistance ofthe leather would be less.

I would suggest: 1. Two pairs of easy fittingsocks. 2. Pliable leather boots with plenty of toeroom. (It is most important that the foot be notcramped and that the toes can be easily moved.)3. High rubber boots, coming well up to the knee.4. For men going into trenches where it is knownthat the water is high, impermeable rubber-fabricwaders and breeches combined. If the men startout with warm feet thus clothed, and are encouragedto move the feet and toes, they will keep warmunless leakage of water occurs into the boot.Nothing but rubber is of any use. If the rubberboots are impracticable, then a stout rubber-treatedcanvas stocking and thigh-piece could be worn overtwo pairs of socks and inside the ordinary soldier’sboot, care being taken that the boot is extra largeand that ankles and toes are free from constriction.

I am, Sir, yours faithfully,Darley Dale, Matlock, Sept. 14th, 1915. W. CECIL SHARPE.

1 THE LANCET, Sept. 11th, 1915, p. 595.

A GREEN BACKGROUND FOR THEOPERATION AREA.

To the Editor of THE LANCET.

SIR,-It has long been the custom of surgeons touse white sterile towels or sheets around the areaupon which an operation is to be done. There are

many disadvantages in the use of white. A largeexpanse of white, especially when the sun isshining, is wearisome to the eye and causes fatigue,and it detracts from the value of the light uponand within the wound. It is not sufficiently realisedthat good illumination is not needed, except uponthe part which is concerned in the operation.Light should be concentrated upon the woundand not widely diffused. For the last twoand a half years I have used towels andsheets of green colour instead of white. Greenis a restful colour, offers no sharp contrast tothe colours of the wound surfaces, and allowsligatures and sutures to be clearly seen againstit. I have tried black towels, but the change fromblack to other colours in an operation theatre issudden and trying, and ligatures do not stand outclearly against such a background. I have paintedthe walls of my operation theatre green, and havea green coloured material on the floor. The greatrelief to ths eyes which results from the use of agreen material round the wound is remarkable.The ordinary green

" casement cloth " from which

my towels and sheets are made is of good colour,retains its colour on washing and sterilising, iseasily obtained, and is cheap.

I am, Sir, yours faithfully,Leeds, Sept. 9th, 1915. BERKELEY MOYNIHAN.

THE CAUSE OF ENLARGED TONSILS.To the Editor of THE LANCET.

SIR,—In his Hunterian lecture in THE LANCETof May 22nd Mr. F. C. Pybus does not overlook thisvery common ailment in his exhaustive account ofinfections of the tonsils. Although he rightlydescribes the condition as being the result of

repeated slight attacks of tonsillitis, I do not thinkthat he hits the mark when he speaks of measuresof prevention. He recommends good milk (probablywith tuberculosis in fear), a plain, wholesome dietand cleaner air, but says nothing at all aboutcleaner water. In a disease that is so common andslight, possible contributory causes are naturallyplentiful and inconspicuous ; but I believe that theone potent factor is impure water. I have observedfor very many years, both in London and Australia,that children who develop and suffer from enlargedtonsils habitually drink unfiltered and unboiledtap-water. This is almost, if not quite, invariablythe case in my experience. I always make theinquiry when I meet with such a case, and Icannot remember receiving a negative answer ;further than this, I am usually told thatthe child is specially addicted to drinkingfrom the tap. This is probably due to thedryness and thirst provoked by the frequentfebrile condition of slight tonsillitis; and thus themorbid condition is aggravated. When I havesucceeded in getting plain tap-water improved bybeing filtered or boiled, I am quite sure that thepatient’s condition has improved also and thatattacks of tonsillitis have been less frequent. If Iam right in my view, it ought to be a simplematter in very many cases to prevent the diseaseI should like to know the opinion of other members