1015

will no doubt be required. Biochemical tests havea limited use, owing to the slowness of growth andthe poor fermentative power of the organisms, andadvance may most reasonably be expected from theapplication of the methods developed by J. Tomcsik,3Stone and Garrod and J. T. Duncan in their

serological analyses of some of the lower fungi.

" NARCO-LOCAL " ANALGESIA

THE advantages which can be gained by the use oflocal instead of general ansesthetics for major surgicaloperations have more often been pointed out bycontinental surgeons than by those of English-speaking nations. An article, however, in theMedical Journal of Australia of July 6th, in whichMr. C. E. Corlette recounts his views and practiceafter an experience of 18 years, gives impressivesupport to those who recommend local analgesic’methods. Corlette points out clearly the dis-

advantages of purely local means of obviating painand the necessity for dealing effectively with thepsychological aspect of operation and of protectingthe patient both from mental anguish and from allmemory of any actual pain if this is inadvertentlyinflicted. The essential feature of his method,apart from gentleness in operating, is the logicaland reasoned employment of suitable premedication.This is carried out by divided doses, generally two,of morphia and scopolamine. The first injection istwo hours before operation; most surgeons who usethis premedication have erred in giving it at too shortan interval beforehand. Moreover the susceptibilityat different ages has been insufficiently studied.Corlette finds that a man of 20-25 years of age isbetween two and three times as tolerant of morphiaand hyoscine as he is thirty years later. The dosageis arranged accordingly, and the article provides atable showing the routine doses from 11 to 84 yearsof age. In practice, of course, these figures are notrigidly followed, the experienced man taking intoaccount the physical and mental features of the

patient which he knows influence susceptibility inone direction or the other. It is certain that if a

surgeon can acquire the experience and will take thenecessary trouble he can achieve by "narco-local"analgesia results which it is impossible to better,if to equal, when general anaesthetics have to berelied upon. ,

ANONYMOUS LETTERS

LAWYERS have more direct concern with thewriters of anonymous letters than have psychiatrists,but the latter can properly claim such people as

subjects for their art. A few reports on the psycho-logical aspect of this disagreeable symptom are

available. In the latest of them however Dr. KarlGross 6 shows himself cautious as to its morbid signi-ficance ; he points out that not all of those whowrite anonymously are criminals or scoundrels or

psychopaths ; they may be journalists or politicians.Apart from such obvious exceptions, questionableonly by the cynic, the majority of those who writeanonymously do so to gratify or manifest inclina-tions which are part and parcel of a psychopathicdisposition. Few of them do so on the grand scaleof a Junius; their field is often petty, and the styleappropriate to the matter ; but whatever the abilitiesor aim of the writer, his motive is constantly to befound in thwarted desires and morbid tendencies.

3 Zeit. f. Immun. Forsch., 1930, lxvi., 8.4 Jour. Path. and Bact., 1931, xxxiv., 429.5 Brit. Jour. Exper. Path., 1932, xiii., 489.6 Wien. kiln. Woch., July 12th, 1935, p. 927.

This does not mean that he is independent of hispresent milieu and driven solely by forces withinhimself. The violent suppression of opinion whichnow obtains in many countries is a manure in whichthese particular weeds sprout amazingly. Amongthe outstanding characteristics of the anonymousletter writer on which Dr. Gross remarks are obscenityand sexual attacks ; the usual decencies are castaside. Few of the writers are insane ; many of themare hysterical and given to fantastic lying; othersare hypomanic, compulsive, or paranoid. Theymay be of any age ; the majority are women, andthey are more prone than men to be salacious insuch letters. They may persist for many years intheir attentions, which are often prompted by jealousy,envy, or revenge. A craving for thrills and artisticdisplay may be evident, and occasionally othermembers of the family have been induced to joinin the business. The treatment of the psychopathshere in question is usually in the hands of the courts ;but it would be a good thing if, in deciding it, notonly the noxiousness of these people to society couldbe taken into account, but also the degree of theiraccessibility to the methods of modifying morbidtrends now at the disposal of the psychiatrist.

BERI-BERI OR TREMATODE INFECTION?

THAT cysticercus infection of the brain may mimicepilepsy has been clearly shown by Major-Gen. W. P.MacArthur. A parallel discovery, made in the

Philippine Islands,1 is that the symptoms of wet orcardiac beri-beri are sometimes traceable to infec-tion with minute trematodes of the family hetero-phyidae. These parasites have been found in 9 of108 almost consecutive autopsies at Manila, and in6 of these the naked-eye conditions, taken with thesymptoms, seemed to justify a certificate of deathfrom cardiac beri-beri or acute dilatation of theheart. The number of heterophyid worms presentin the lumen of the intestine was small, and noeggs were seen in its contents ; but such examina-tions do not disclose the weight of infection, for ifthe mucosa is scraped successive collections of flukescan be made, and sections show them in the intes-tinal wall with little reaction around them. Furtherexamination was made of the heart muscle of these

persons, and in it were found not only at least onefluke but a number of eggs ranging froml6 x 10 11- to33 x 2511- according to the species of trematode ;they lay in spaces apparently caused by rupture ofmuscle-fibres and containing also blood and muchoedematous fluid. It is thought that the sequencewas embolic blocking of capillaries by eggs from theintestine, followed by violent spasmodic contractionand breakage of the muscle-fibres. No investiga-tion of other organs or tissues was made at the time ;but if the eggs reached the coronary arteries by thecirculation they must equally have reached otherparts, and in that case it will be surprising if theyare not found to produce in them symptoms whichare at present being overlooked. In order to separatethis infection from cardiac beri-beri in those countrieswhere raw fish is eaten there is a wide and seeminglyprofitable field of research ; but it can be no easyone if, as stated, eggs are absent from the fseceswhen there is infection with these particular hetero-phyids. The lesions must be caused by side-trackedindividuals which can by no means carry on the race,but have apparently become more dangerous toman.

1 Africa, C. M., Garcia, Eusebio Y., and de Leon, Walfrido :Jour. Philippine Islands Med. Assoc., 1935, xv., 358.