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cancer such as tuberculosis affecting the commonwealth Imay be supposed to be : whether the disease ought to ibe completely eradicated at once by the knife or trifledwith by the application of feeble caustics and narcotics.Experience of the latter old wives’ method of treatmenthas taught surgeons to be wary of it. With respect to theargument that the hygienic laws proposed will tend to.curtail the liberties of Englishmen, it is quite possible thatthese changes will be opposed by a sentimental anti-progressleague which will ultimately, however, be brought to itssenses when there is a danger of the nation being leftbehind in the struggle for supremacy by communities morein sympathy with scientific progress and discovery.

I am, Sirs, yours faithfully, Lampeter, Dec. 26th, 1902. E. CLUNEGLAS DAVIES.

REFLEXES: THEIR RELATION TODIAGNOSIS IN RHEUMATOID

ARTHRITIS.To the Editors of THE LANCET.

SIRS,--In Dr. R. Llewelyn Jones’s interesting paper onthe Reflexes in Rheumatoid Arthritis in THE LANCET ofDec. 27th, p. 1746, I notice a reference to "jawjerks." On his resignation as resident medical officerof the Royal Mineral Water Hospital, Bath, Dr. Jones

kindly showed me this clinical phenomenon which I havecarefully tested. The mandibular joint being so fre-

,quently affected one found plenty of material to workwith and it may be of interest to note my conclusions.Invariably where the jaw has been recently affected oneobtains a smart response to percussion, and irritability is somarked that clonus is not a rare occurrence though a singleacknowledgment to the tap is more often elicited. In caseswhere the jaw has apparently been free from trouble for

many months the jerk is still easily obtained, though in mostof thee apparently recovered joints grating or slight morningstiffness can be made out. Frequently, however, one meetswith cases giving histories of former jaw attacks and whereno evidence of any active arthritic mischief is present I havereceived a response, showing how persistent the irritabilityis. An interesting case recently in hospital gave no historybeyond that of aching teeth and on examination though nodental caries was made out yet the jaw responded. The

aching teeth, I take it, was a referred joint affection. Inmost cases, however, where jaw trouble has been com-

plained of the molars and bicuspids were degenerate or

absent, though the incisors seemed to be peculiarly resistant.A passing reference to knee-jerks is not out of place. We

notice here in rheumatoid affections of the lower extremitieswhere no joint contract ures have occurred a more than slightincrease in deep reflexes. In fact, digital percussion to thepatellar ligament not infrequently throws the affected leginto an almost epileptiform condition of clonus, and this

seemingly often out of proportion to the joint changes. Asa rule, where such a state of affairs exists the other limbpartakes in excitability though not necessarily to the sameextent. In one cae I am thinking of Dr. Carter pointed outto me the markedly spastic gait of the man. Here Babinski’sfign was absent.The most marked condition of myotatic irritability" I

have seen was in a middle-aged woman who was greatlydistressed one morning by an attack of clonic muscular

spasms of all the extremities. especially the left side. Hermuscular convulsions !-hook the bed and on firmly holdingthe arm or leg muscles rapid twitchings were to be felt.Her pulse was 160, the respirations were 40, and the tem-perature was 99.6° F. On her admission we nGticedStellwag’s symptom occurring rhythmically in both eyes,slight proptosis, and von Graefe’s sign. There was no thyroidenlargement and her morning pulse was 80. Belladonna,bromide, and digitalis seemed to cut the attack short. Some

might quote hysteria as the cause, but her general behaviourwas against it and I believe that the arthritis was closely- connected with the attack-probably of the same origin.

I am, Sirs, yours faithfully, ..

!J. W. MALIM, B. A., M.B., B C. Cantab.,

Resident Medical Officer. Royal Mineral Water Hospital, Bath.Bath, Jan. 3rd, 1903.

To the Editors of THE LANCET.

SIRS,--I have read Dr. R. Llewelyn Jones’s paper underthe above title in THE LANCET of Dec. 27th, p. 1746, with

a great amount of interest, but I should like to draw atten-tion to a statement he makes which I cannot allow to pass as

correctly representing my views as to the origin of the dis-ease. On page 1748 he says : "Dr. Bannatyne ascribes thedisease to a toxæmia affecting the anterior cornua of thecord." Now this is not my idea of the origin of the disease.To put it shortly, I look on rheumatoid arthritis as due tospecific bacteria having their nidus in the affected jointsthemselves and that the joint symptoms are the primary andessential symptoms of the disease. I look on the vaso-motorand other nerve symptoms as purely secondary, possiblycaused by absorption of the bacterial products elaborated bythe micro-organisms in the joints. My principal point is thatI look on the joint troubles as caused by the local action ofthe bacteria and not as the result of trophic changes due to atoxsemio poisoning.-I am, Sirs, yours faithfully,

GILBERT A. BANNATYNE, M.D. Glasg.Bath, Dec. 28th, 1902.

PERMANGANATE OF POTASSIUM INSNAKE-BITE.

To the Editors of THE LANCET.

SIRS,—In regard to the annotation respecting the efficacyof the subcutaneous injection of solution of permanganateof potassium referred to in THE LAXCET of D c. 20th,p. 1711, it was strikingly illustrated by experiments con-

ducted by M. Louis Perinquey and myself with the poison ofthe puff-adder and described in the Medical Prevs andCircular for June, 1886. Since then, with great caution,I have employed the same remedy, likewise subcutaneouslyinjected, in a very extreme case of blood poisoningoccurring in a man who in order to remove an obstructionin a drain-pipe had pushed his arm into it, thereby receivinga scratch, after which the whole arm gradually swelled up toan enormous size. In this condition, attended with severeconstitutional symptoms threatening imminent death, hecame to me. All hope seemed gone but he made a completerecovery. A few notes of this case, which occurred in 1894,I recorded in the British Medical Journal.

In the snake-bitten dog, although I used a strong solutionand injected it freely into the tissues and also into themuscles, there was only a small local reaction. The animalmade an astonishing recovery and it was well bittenseveral times over by the very same snake which hadcaused the death of another dog within about six hours.There were scarcely any noticeable dangerous symptomsexcept a little listlessness and sleepiness. The remedyprobably destroyed the virus. The injection of the solutiondid no harm and the dog scarcely suffered at all. Thetreatment should only be used in dangerous cases in humanbeings and always with much care and, as a rule, only insnake-poisoning should intra- muscular injections be made.

I am, Sirs, yours faithfully,Grimsby, Dec. 24th, 1902. GEORGE GRESSWELL.

THE STAFFING OF RECEPTION HOUSES.To the Editors of THE LANCET.

SIRS,-The London County Council with its habitual

progressive spirit in lunacy matters having decided toestablish reception houses for incipient mental disorders, itis very essential that these should be staffed from the outsetin the most efficient manner. The treatment of incipientmental disorder has occupied my attention for many yearspast and I trust therefoie I may not be considered aspresuming in venturing to express my views in this

particular to which I have also given very considerableattention. Many members of our own profession are in thehabit of asserting that no specal skill or exterience isneeded in the treatment of mental disorder. This view, Iconsider, is the strongest and most conclusive evidence thatcould be advanced that they know absolutely nothing of thesubject.An alienist physician of the present day must not only

have a full and long experience of mental disease but hemust be a specialist in neurology, gynaecology, ophthal-mology, and, in fact, in every pecialism, to the extentof knowing when he needs the aid of one of these

specialties. The asylum physician, it must be remembered,has unequalled opportunities in the large institutions for theinsane for observing not only mental disease, but every other