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TOXIC SYMPTOMS FROM PLASMOCHIN.To the Editor of THE LANCET.

SIR,-I have been using plasmochin in the treat-ment of malaria for over a year with very satisfactoryresults. It may be of interest therefore to recordthat within the last week I have had four casesshowing very definite toxic symptoms. All four wereBritish, two were cases of subtertian malaria, andtwo were clinically malaria, no parasites having beenfound in the blood. In no case did the amount of

plasmochin given exceed 0-06 g. in 24 hours, and inno case was the drug given for more than five con-secutive days. The symptoms were cyanosis, very ’,,marked in two cases, and abdominal pain severe

enough in two cases to prevent the patient sleepingduring the entire night. These two patients werevery much upset and complained bitterly that theyfelt that they had been poisoned. The supply fromwhich the plasmochin employed was taken was partof a new consignment which had been in the countryfor less than six weeks.

I am. Sir. vours faithfullv.H. C. SQUIRES, M.D.

MEDICAL DIATHERMY IN MIDDLE-EARDEAFNESS.

To the Editor of THE LANCET.SiE,—I read with great interest the article on

this subject by Dr. Dan McKenzie in your last issue.I have been using medical diathermy for these casesfor the last 15 months and am in agreement withhim on most points. I, too, have found that thecases most suitable for this method of treatmentare those of Eustachian catarrh and chronic otitismedia with sclerosis of the membrana tympani.My first case was a man, aged 69, who had sufferedfrom deafness and severe tinnitus aurium for 14 years,the latter preventing sleep. His condition was theresult of an old chronic otitis media. The tinnitusstopped during the first treatment and never returned,and the deafness has considerably improved. Whereaspreviously he had been deaf to the ticking of hisclock, the mewing of his cat, and the barking of dogs,all these sounds became audible. He once said :" I like to go out and listen to the traffic."My only criticism of Dr. McKenzie’s article concerns

the technique. I have tried various methods andam convinced that the following method is thebest :-

I adopt the sitting posture and find that the patientsprefer to sit than to lie on a couch, also the occurrenceof vertigo afterwards is rare. The electrodes consist oftwo equal L -shaped plates 3 in. x 2 in., cut from thin,flexible sheet metal. These are placed on the skull aroundthe meatus and beneath the pinna. The anterior limb ofeach electrode bears a short " tab," which overlaps theexternal auditory meatus and makes contact with a plugof cotton-wool soaked in saline and inserted as far as thepatient will allow. The metal electrodes are placed directlyon the skin, good electrical connexion being obtained bymeans of a thin film of soap lather (shaving soap is theeasiest to use). The electrodes are secured by two rubbersponges, one over each electrode, and a rubber bandage,which should be applied to pass over the vertex and thepoint of the chin. -

I believe this method to be superior because : (1)It allows the patient to sit comfortably and withthe minimum of restriction in an armchair and. ifhe wish, to read whilst having his treatment, whichshould last 15-30 minutes. (2) The electrodes, &c.,are simple, and are easily and quickly applied infour minutes and removed in one. (3) The soaplather ensures perfect connexion by eliminatingany danger from a greasy skin and uneven currentpenetration ; and also the gravitation and drying-upso common with saline pads. (4) The path of thediathermy current is nearly 3 in. square and traversesthe whole of the middle and inner ears and also theEustachian tubes. A picture of the electrode is to befound in Sampson’s " Practice of Physiotherapy."

One other point I must mention; one or two ofmy patients, particularly the younger cases of " oto-sclerosis," have improved in their general healthand mental outlook. From being dull and listlessand somewhat melancholic, they have becomecheerful and of a more youthful appearance. If thisis not a coincidence it can only be ascribed to thediathermy, as no other treatment of any kind wassiven.—I am, Sir. vours faithfullv,

CEDRIC BILLIARD, M.B., B.Chir. Camb.

HYGIENE AT THE ROYAL HOSPITAL

SCHOOL, GREENWICH.To the Editor of THE LANCET.

SIR,—In view of Dr. J. A. Glover’s remarks in thediscussion on Juvenile Rheumatism at the meetingof the Section of Epidemiology of the Royal Societyof Medicine on Feb. 24th (reported in THE LANCETfor March 3rd, p. 447), it would seem to be suggestedthat the Royal Hospital School, Greenwich, has beenallowed to exceed the number of bovs for whichaccommodation is adequate. If Dr. Dudley’s reportis read, it will be seen that, whatever his personalopinion may be, he expressly states that the amountof air space and floor space is adequate accordingto the most accepted hygienic requirements. It isconsiderably better than that supplied in many otherlike institutions. The attack-rate for rheumatic feverin the Royal Hospital School in the Glover reportis quoted as being 6 per 1000, in the Dudley reportit is noted as 2 per 1000 in 1921, which is the correctnumber. This lower rate has been maintained sincethat year. I should be grateful if you would insertthis letter, as, though I recognise that no reflectionwas probably in any way intended, the paragraphcontaining the remarks to which I am alluding mightbe construed to mean that those responsible for thehealth and care of the boys were lacking in thenecessary vigilance, and were behind the times.

I am, Sir, yours faithfully,PERCIVAL M. MAY,

Medical Officer to the Royal Hospital School,Greenwich.

STEREO-FLUOROSCOPY.To the Editor of THE LANCET.

SIR,—The two letters which appear in vour issue oflast week appear to charge me with a lack of fairnessto British Radiology (Mr. W. E. Schall), and to Britishmanufacturers (X-rays, Ltd.). As evidence of unfair-ness it is stated that apparatus of this kind was madeyears ago by British firms. But, did not I statein my communication of March 3rd that there wasan apparatus similar in principle, designed for usewith coils, in London, and I pointed out the difficultyof using that apparatus ? I certainly did not state,as does Mr. Schall, that the apparatus was a completesuccess, or that the problem of stereo-fluoroscopy wassatisfactorily solved. I rather agree with X-raysLtd., that the methods in question did not prove tobe of sufficient practical advantage to survive.

I can assure the gentlemen by whom these lettersare signed that I yield to no one in my appreciationof the English manufactures, nor in my patriotism forthe land of my birth, and if I travel to other countriesto see the latest developments in medical or scientificapparatus, and if I publish what I see and hear, itis not with a spirit of unfairness to British manu-facturers or lack of patriotism for England, butrather, that patients may have the advantage of thelatest and best scientific developments and perhaps,even as the mouse in the fable, to be of some smallhelp to the leonine manufacturers, in stimulatingthem to further and better efforts.

I am, Sir, yours faithfully,F. HOWARD HUMPHRIS.