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dreams than he does awake. The recurrence of the feeling 6will perhaps suggest to him that there is a meaning 1(other than fear in the hunt) behind the manifest content 1which is worth his analysing out. From the passage on i

p. 1183 it might be inferred that Dr. Jung uses hisword-association test in analysing dreams. This would be anerror. He employs what Dr. Brown calls the more naturalmethod" (although anything less "natural" than psycho-analysis I do not know). In fact, Dr. Jung now rarely,if ever, employs word-association in psycho-analysis.

Lastly, may I ask Dr. Brown which followers of Freudmaintain that the wishes forming the dream thoughts orlatent content of dreams are always of a sexual nature."There are one or two persons who have separated themselvesfrom Freud to whom this might apply, but it is hardly fairto call them ’’ followers" " of Freud unless it is literallymeant that they come after Freud. Freud himself writes’’ that there are many dreams satisfying other than-in thewidest sense-erotic needs, as dreams of hunger, thirst,convenience, 5;,c."

"

Dr. Jung and the Ziirich school would allow a largenumber of dreams whose latent content betrays no sexualcharacter. If 1 may be allowed to call myself a follower ofFreud, I have published some dream analyses from mypatients of a non-sexual character. It must be, however,remembered that in Freud’s hypothesis there are impressionsreceived in childhood which never reach consciousness.These impressions are not so much repressed as hinderedfrom entering consciousness. It is these wishes thus checkedthat Freud regards as the real inciter of the dream. Thereis so much tentative in the theories underlying psycho-analysis, and there are so many pitfalls for us merely medicalworkers, that I would like to express my delight at havingreasoned criticism from so distinguished a psychologist asDr. Brown and one so sympathetic to this work.

I am, Sir, yours faithfully,M. D. EDER.

TREATMENT OF TYPHOID FEVER BYTINCTURE OF IODINE.

To the Editor of THE LANCET. I

SIR,—In THE LANCET of April 5th you note an article in tthe ,7oM7’K de ]I[édeeine et de (’Itirpirgie Pratiljlles upon the iTreatment of Enteric Fever by Tincture of Iodine. You (

state that although the therapeutic use of iodine in that s

disease was suggested so far back as 1859, and reference has 1been directed to the matter since, notably by Dr. DavidWalsh in 1907, no extensive trial seems to have been made iof this method." Dr. G. Perez, in the above-mentioned 1

journal, urges that the time has arrived to put this method ito an extensive practical test. Perhaps I may be allowed to (

make a few remarks on this subject. :

My experiences of enteric fever came in the early days of i

practice, and the results of the simple treatment in question 1amounted to a revelation. A mixture of equal parts of 1tincture of iodine and of pure carbolic acid was prescribed,with directions for two or three drops of the mixture to be Iadded to a tumblerful of water, which was to stand con-etantly by the patient’s bedside, to be renewed as requiredand to be taken freely by the patient. Under this treat-ment, in every case so far as I now remember, the tongueCleaned rapidly, the temperature fell steadily, diarrhoeaceased-in a word, the fever was cut short and robbed of itsdangers, and normal convalescence ensued. I had manyopportunities at one time of seeing enteric fever treatedin this way as well as by the ordinary expectant andsymptomatic plan, and the comparison was all in favour ofthe iodine method.

My interest in enteric fever was maintained in later yearsas a dermatologist, for it seemed to me that in the entericrash we had a suggestive picture of the etiology of a largegroup of symptomatic eruptions. The bacillus typhosushas been found in the " rose spots," showing, from mypoint of view, a probable attempt on the part of the bodyto throw off a generalised infection by the skin channel,a process described by me in other words as that of

"excretory irritation." Further, irritation of alternative

excretory outlets in enteric fever not infrequently sets up suchinflammations of renal and respiratory channels of excretion.On purely logical grounds, applying the general law of’irritation of excretory outlets to the particular case of

scarlet fever I suggested in 1897 (11 Excretory Irritation,"p. 37), that it was desirable to disinfect the urine as well asthe other excreta in that complaint. For some years past Iunderstand that course has been adopted in the MetropolitanFever Hospitals. A similar suggestion was extended to theurine of enteric fever patients.As you remark, I I treatment based on bacteriological

observations has of recent years attracted so much attentionthat the employment of drugs has not been fullyinvestigated." That species of neglect certainly seems tohave overshadowed the iodine treatment of enteric fever.Had this method been applied in the South African war, Ihave little doubt that many valuable lives would have beensaved in our camps.

It always seemed to me possible or probable that the goodeffects were in all probability due to the iodising of the bloodserum. It is not clear how the iodine could exercise a directeffect upon the intestinal ulcers, unless, indeed, it were firstabsorbed from the stomach and excreted later into theintestine. Then, again, it is interesting to speculate how farthe therapeutic result would be attributable to the merefact of supplying the patient with drinking water in whichthe ordinary bacteria were no longer in a living state, butreached the stomach charged with various endogenous thera-peutic potentialities. However, these and other interestingproblems, possibly of much practical importance, wouldnaturally occur to any scientific investigator who mighttake up the matter.

I am, Sir, yours faithfully,DAVID WALSH.

INTRAVENOUS INJECTIONS OF IODOFORMIN PULMONARY TUBERCULOSIS.To the Editor of THE LANCET.

SIR,-Will you kindly permit me to refer to some points inthe report in THE LANCET of May 3rd on the discussion atthe meeting of the Royal Academy of Medicine in Ireland onthe use of iodoform in pulmonary tuberculosis.

Dr. J. B. Coleman condemns the intramuscular iodoform-

benzoyl-chloride treatment. He may be right. I haveno experience of it. But I must protest against thatmethod being confused with the one I laid beforethe profession in 1903 and have advocated since. Itis iodoform in ether alone. The introduction of "benzoyl-chloride " has completely altered this treatment, and

any inferences to be drawn from it. My method isuseless unless the iodoform is introduced intravenously.As Dr. W. G. Smith pointed out, a powerful and extremelyirritating compound " with independent actions of its ownhas been added, and these require single and separateinvestigation, otherwise there will be confusion. Dr.Coleman then went on to point out the low germicidalaction of iodoform, and inferentially, therefore, its

inutility. If so, why is it still so extensively used all overthe world? Surely the profession cannot all be mistaken intheir belief in its value. He also stated that drypowdered iodoform may contain living germs. So maydry boracic acid and dry corrosive sublimate wool,and so I understand may most high germicides inthe dry state unless sterilised and hermetically sealed.But there is no comparison between dry iodoformand iodoform in solution in ether. Dry powdered iodo-form is a very stable body, an ethereal solution of itis extremely zmstccble, decomposing rapidly, and liberatingfree iodine under the influence of light in the presence ofoxygen or moisture. Freshly dissolved it is pale strawcoloured. If this is exposed to direct sunlight it becomes asdark as the liniment of iodine in a few minutes. Continuing,Dr. Coleman emphasised the toxic properties of iodoform,giving the names of a number of distinguished medical mento support his statement. But in the ieport of his paperno account was given of the mode of application, the quanti-ties used, or the duration of treatment before toxic svm-ptoms supervened. These I maintain are necessary. Becausetoxic symptoms can follow the use of arsenic, strychnine,or morphia, are they to be generally condemned Finally,he asserted that in pulmonary tuberculosis the intra-venous injection of iodoform was attended with specialdangers " which he enumerated. Does Dr. Coleman makethis assertion after a prolonged personal experience ofthe intravenous injection of an ethereal solution of iodo-form, or is it supposititious? There are probably few

1347

practitioners in the country who have given as many intra-venous injections of an ethereal solution of iodoform as Ihave, and yet I have never once met with any symptoms ofiodoform poisoning. For years I have used it in doses

varying from t gr. to 1 gr. and even more, regulating it

according to the type and extent of the disease. At presentI have eight patients in hospital. Seven of these receive1 gr. every day for ten days, and the eighth gr. After aweek’s interval the injections are resumed. Dr. Smithsaid there was justifiable doubt as to whether half agrain exercised any influence. If 1/200th gr. of nitro-

glycerine, 1/60th gr. of strychnine, or t gr. of morphinecan profoundly affect a patient, why may not t gr. or

1 gr. of iodoform ? We may have to abandon the ideaof a directly germicidal effect, but when patients recoverand remain well for years, does it not look as if our pre-conceived notions as to the dosage and mode of action ofdrugs may be wrong ?

It is right that every treatment for pulmonary tuber-culosis should be searchingly criticised, but only after trialand investigation. I feel sure that Dr. Coleman has nowish to condemn unfairly, or to be the cause of de-

terring others from trying iodoform, but it seems to me thathis criticism is a little misleading. As Dr. Etienne Burnet,of the Pasteur Institute, Paris, says in his book on

"Microbes and Toxins": "Things do not go on in theliving body exactly as in a test tube. This fact so

often referred to already must be insisted upon again.Atoxyl does not act in 1)itro, but acts in the livingbody. Chemical therapeutics is, therefore, not likelyto become more simple. There is nothing to exclude thepossibility of a drug therapy in bacterial infections, and it isalways possible that our vaccines of to-day, and in particularour sera, marvellous discoveries as they are, and originatingin the most scientific empiricism, may give place to physico-chemical remedies better defined and more direct. It isfrom chemistry that we have to expect advances in the

healing art. The phrase of Duclaux is very apt in this con-nexion-With Pasteur chemistry invaded the field of medicineprobably never to leave it.

" -

I am, Sir, yours faithfully, --- -

THOMAS W. DEWAR.

THE LATE MR. R. B. ETHERINGTON-SMITH.

To the Editor of THE LANCET.SIR,-At a meeting held at St. Bartholomew’s Hospital

on May lst it was decided to open a subscription list fora memorial to the late R. B. Etherington-Smith. It is

suggested that the memorial should take the form of pro-viding and endowing separate sick quarters at St.Bartholomew’s Hospital for the use of the medical,surgical, and resident staff, and of providing a suitablememorial at Cambridge.Etherington-Smith’s life work was so bound up with St.

Bartholomew’s Hospital that this form of memorial will doubt-less commend itself, not only to his colleagues in the pro-fession, but also to the larger body of men who knew andadmired him as an oarsman and friend. The scheme hasreceived the cordial approval of his family.Subscriptions will be received by the honorary treasurer,

Dr. T. W. Shore, dean of the Medical School, St. Bartholo-mew’s Hospital, E.C., or they may besentto 11 TheEtherington-Smith Memorial Fund " at the Bank of England.

We are, Sir, yours faithfully, -- -

ANTHONY A. BOWLBY, C.M.G.,Senior Surgeon to St. Bartholomew’s Hospital.

W. B. CLOSE, C.U.B.C.G. ACTON DAVIS,

Acting Treasurer, St. Bartholomew’s Hospital.J. H. GIBBON, C.U.B.C.HARCOURT GOLD, O.U.B.C.W. P. HERRINGHAM,

Senior Physician to St. Bartholomew’s Hospital.R. C. LEHMANN, C.U.B.C.,

Secretary to the Fund.HOWARD MARSH,

Professor of Surgery, Cambridge University.S. D. MUTTLEBURY, C.U.B.C.GUY NICKALLS, O.U.B.C.G. D. ROWE, O.U.B.C.H. T. STEWARD, Leander R.C.

LIVERPOOL.

(FROM OUR OWN CORRESPONDENT.)

The Radium Fund for the Royal Infirmary.AT a meeting of the general committee of the Royal

Infirmary held on May lst, under the chairmanship of Mr.H..Wade Deacon, the following resolution was carried :-That the committee desires to express its great appreciation of the

kindly thought which prompted the editor of the Daily Post and.,I-rercqt,ry to make an appeal for funds for the purchase of radium for theRoyal Infirmary; and it further desires to thank him for the chequefor ,cZ079 10s. lOd. now received, and through him to express its gratitude to all the subscribers to the fund.

A few pounds have since been received (the total amountingto Z2115 4s. 10d.) and will be forwarded to the committeewhen the list is finally closed.The National Ins2cranee Act and the Health Department of

the City C01bnciZ.Under the provisions of the National Insurance Act three

assistant tuberculosis officers have been added to the staff ofthe medical officer of health. The hospitals committee,through which the appointments have been made, hasselected Dr. S. W. McLellan, Dr. B. T. J. Glover, and Dr.D. J. Clark for these positions. At present only one centraldispensary is in operation, but another at the south end ofthe city will be opened in a few days. The question of a.

dispensary for the northern parts of the city has not yet beenfinally settled. The hospitals committee has practicallydecided to devote the whole of the Parkhill Hospital to-sanatorium purposes. Only tuberculosis cases have beentreated there for some considerable time.

Proposed State Subsidy for County Asylnms.A proposal from the committee of the Rainhill Asylum,

near Liverpool, will be submitted to the Lancashire AsylumBoard at its next quarterly meeting to be held at Preston.The recommendation is to the effect that the Governmentshould be asked to subsidise the board to an extent adequateto cover the salaries of the board’s pathological staffs, theirresearch work for the prevention of lunacy being acharge which ought to be defrayed from the nationalexchequer, and not levied upon the ratepayers of the

large cities and towns which bear the chief burdenof the heavy cost of public asylums. The Rainhill com-mittee has taken up the question because of the

special development of pathological research there, a

museum and other facilities being offered to medicalstudents. Liverpool has had to pay a largely increasedshare in the cost of lunacy in Lancashire since the basis oflevying the rate has been altered from "value" to percapita. Any relief therefrom will be welcomed the moreheartily in this city and port, too often the dumping-groundfor foreign lunatics not easily to be transferred to their nativelands.

A Fatal Case of Small-pox in Liverpool.A fatal case of small-pox occurred in Liverpool the week

before last. The infection in question was of outside origin,and all persons who came into contact with the deceasedbefore removal to hospital had passed through a period ofobservation and shown no suspicious symptoms. With the

exception of a single case which terminated fatally on boarda steamer in the river, this was the only fatal case of small-pox that had been recorded in Liverpool during the lastseven years. Liverpool, fortunately, is an exceptionallywell-vaccinated city. Immediately on the occurrence ofsmall-pox the medical officer of health communicates withthe public vaccinators to revaccinate, if possible, all con-tacts, the majority of whom acquiesce without demur.

The Royal Albert Institution.The annual meeting of the Liverpool committee of the

Royal Albert Institution was held on April 29th, under thepresidency of Mr. G. D. Killey. There are 24 Lancashirecandidates for the 16 vacancies allotted to the county, 6of the applicants being from the Liverpool district. Thereare at the present time nearly 700 feeble-minded inmatesunder care, and the applicants for admission are numerous’and urgent. The chairman stated that the annual meetingheld in Liverpool in October last proved successful, resultingin donations which increased to Z938 Liverpool’s contributionto the farm colony fund. A donation of £500 had since