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with him. He had had a wart on his shin for forty yearswhich had defied treatment. Not being an acrobat, hesaid, he could not touch it with his tongue. Besides,he knew the thing was just spoof, and he had no faith.I assured him that in the circumstances it would work ifhe applied the saliva with his finger. Either his knowledgewas insufficient or his faith greater than he knew, forthe wart faded away.

I should have hesitated to put these experiences onrecord but for the fact that Dr. Millais Culpin has toldme that in his early days at the London Hospital patientswith warts were generally referred to a certain sisterwho charmed them away. Moreover, I have heard aleading skin specialist declare his belief in the efficacy ofcharms. If tissue change can indeed be thus induced, itis reasonable to suppose that corresponding emotionalimpulses may actually cause the warts. In -my boyhoodI was warned never to wash my hands in water in whicheggs had been boiled, lest warts should result; andWynne Parry has recorded 1 how a young woman’srecurrent attacks of iridocyclitis were traced to merecontact of the unbroken skin with eggs. It is the oldstory of sexual prohibition in another disguise.

In his communication on bodily changes duringabreaction Moody 2 carries the matter further ; signifi-cant organic lesions have developed before his eyes asa result of deliberately provoked emotional stress, andthe manifestations have borne a definite relation to thenature of the emotion. His observations support the lesseasily proved dramatic phenomena I described in anarticle on sympathetic disturbance in connexion withthoughts of death by hanging.3Some day someone may link up the capricious wart

with the variable facial pimple that announces theapproach of a menstrual period, the acne that tells of adifficult adolescence, the stye that is supposed to yieldto the magic touch of a wedding ring, and-who knows ?-the malignancy that seems to hover about a chronicallyirritated nipple or mole. Irritation can come fromwithin as well as from without.

Portsmouth. W. S. INMAN.

AFTERMATH OF A CAUDA-EQUINA LESION

SIR,-In the article on this subject in your Disabilitiesseries (April 17, p. 608) the patient makes a plea for avery light calliper. For some time past I have beenexperimenting with a thin wall high-tensile steel tubing,which I have found most satisfactory. The tubinghas an outside diameter of 3/8 in. and a wall 21/1000 in.thick. The steel is the kind used for golf-clubs, and itreduces the weight of the calliper by as much as two-thirds. The tubing is supplied by Messrs. Accles &Pollock, of Birmingham.

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Physical Medicine Department,General Hospital, Northampton.

T. K. DAVIDSON.

THE GEOGRAPHICAL ORIGIN OF NURSES

SiR,-Dr. Barnet Woolf’s statistical demonstration(June 19) of where more recruits to nursing could befound is most interesting.

It may be worth while reminding ourselves once morethat compulsory residence for nurses is a relic of theNightingale rehabilitation of nursing in 1860 and after-wards. At that time young women of the type FlorenceNightingale wanted could not have lived in the neighbour-hood of most hospitals, and there was then no transportto bring them in from more respectable neighbourhoods.Florence Nightingale relied on the influence of thenurses’ home to safeguard the respectability of thenurses.

In modern times one of the disadvantages of nursingas compared with other work is payment largely in kind.If the nurse were paid a gross salary so that she hadmore command over her earnings, it would be mucheasier to compare her position fairly with that of otherstudents and employees. Girls living at home couldcontribute to the family income when necessary. Thosefor whom accommodation had to be found would enjoya greater sense of freedom if they paid for it themselves.

London, W.2. G. B. CARTER.

1. Parry, T. G. W. Brit. med. J. 1939, ii, 396.2. Moody, R. L. Lancet, 1947, i, 964.3. Inman, W. S. Med. Pr. 1939, 202, 121.

FOR AND AGAINST MYANESIN

SIR,-A short while ago I wrote 1 saying I had neverseen a thrombosis following ’ Myanesin,’ and I wonderedwhether this untoward effect could be due to errors oftechnique. It was kindly pointed out to me at the timeby leading anaesthetists that I had been very lucky andthat in time I must encounter this trouble.

I have now seen it-a thrombosis 12 in. long in theright arm, rendering the patient (who is perfectlyrecovered from her hysterectomy) unable to write, darnher husband’s socks, or tolerate the contact of the armwith her body. Since seeing is believing I now apologiseto the anaesthetists for the suggestion that errors intechnique could be the cause of the thromboses.London, W.l. KEITH VARTAN.

GROWTH-RETARDING FACTOR

SiR,-In their preliminary communication of May 15on a growth-retarding factor in maize bran, Mr. Borrowand his colleagues gave an analysis of mice weights andof diets, but they made no mention of taking a peepinside their dwarf mice. Perhaps they have forgotten thehistory of thiourea ? In 1941 New Zealand investigatorsreported retardation of growth in rats fed partly on rapeor turnip seeds. Without a consideration of imbalanceof amino-acids or multitudinous growth factors theylabelled the seeds as possessing a goitrogen because theirdwarfs had enlarged, cellular thyroid glands. Later theyisolated the goitrogen thiourea from rape and turnipseeds. It seems essential, in the present work, to eliminatesuch a possibility before entering the unknown.Regina General Hospital,

Saskatchewan. N. G. B. MCLETCHIE.

DECUBITUS IN THE MENINGEAL STAGE OFPOLIOMYELITIS

SiB,—Dr. Ryle’s interesting article of June 19 (p. 945)demonstrates the wide tendency to accept Russell’sview 2 that early immobilisation of cases of poliomyelitisdecreases the severity of paralysis. Perhaps it would notbe out of place to comment on the premises for thisconclusion.

Russell, who questioned 44 convalescents, found hecould distinguish a meningeal preparalytic phase in 41.Of the 20 cases who had had abortive or mild attacks 10had been treated in bed from the first appearance ofmeningeal symptoms, and of the 21 who developedparalysis only 1 had taken to bed during this stage.Russell’s conclusion that these figures are significantwould, however, be invalidated if an error occurredin sampling. It is here suggested that since Russell’sobservations were confined to convalescents, and sincehis cases were collected from four different cities, he onlysaw that small proportion of abortive cases whichhappened to be recognised in the meningeal stage. Thismethod of sampling was likely to reveal a much higherproportion of paralytic cases. If so, the history obtainedfrom the latter gave a more average picture of thebehaviour of patients in the meningeal phase.Paul and his co-workers,3 Casey and his colleagues,4

and Ryle have discovered abortive cases only by carefulobservation of contacts ; and these and other writersagree that the abortive cases greatly outnumber theparalytics. Casey even suggests that the ratio is 98abortive cases to 2 paralytics.

During last year’s epidemic 7 paralytic cases, 1 fatalcase, and 10 abortive cases, were treated at CatterickCamp and later described by me.5 Of the paralyticcases, 6 were treated in bed from the start of the menin-geal stage, but after thirty-six hours to four daysdeveloped paralysis. Similar early treatment was

instituted in the abortive cases. These men regardedtheir meningeal symptoms lightly, and I concluded thatin civilian life most of the paralytics would have beenadmitted to hospital only after onset of paralysis, andthat most of the abortive cases would not have come into

1. Lancet, 1948, i, 613.2. Russell, W. R. Brit. med. J. 1947, ii, 1023.3. Paul, J. R., Salinger, R., Trask, J. D. J. Amer. med. Ass. 1932, 98,

2262.4. Casey, A. E., Fishbein, W. I., Abrams, I., Bundesen, H. V.

Amer. J. Dis. Child. 1946, 72, 661.5. Dixon, G. J. Brit. med. J. 1948 i, 1175.