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CORRESPONDENCE.
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incision-a point which the patient appreciates very highly. All

that is necessary is to apply a compress of lint soaked in the
solution, and the pain will be relieved, the inflammation disappear,
the pus give place to serum, the ' core ' separate and a healthy.
granulating surface be left."

My treatment differs from Mr. Morison's in two respects.

In the first place, whereas he applied first a paste and
afterwards a solution of the salt, I apply a solution from
the beginningj and secondly, while he used a solution containing 40 oz. of MgSO, in 30 oz. of water, I employ a
20 to 40 per cent. solution, and less as healing proceeds.
As the title of my paper indicates, I use this treatmenit
not for carbuncles only but for all surface inflammations
and suppurations (including tuberculous), and have done so
constantly for the last fifteen vears-that is, since 1909,
when it first occurred to me to use magnesium sulphate in
this way. For those who do not kniow of this mode of
treatment, perhaps you will allow me to quote a sentence
or two from what I wrote on the subject in March, 1912.
I then said:
" It does not appear to have been hitherto recognized that
magnesium sulphate has a remarkable power over inflammatory

an suppurating lesions. If a solution of this salt be directly

applied to any such lesion, the advance of the inflammation will
be at once checked, and under the continued application of the
solution the inflammation will be entirely eliminated. If pus has
formed and be discharging, the purulent discharge will give place
to one of serum, and the tissues will return to a healthy
condition."

The treatment of carbuncles is only a very small part of

its usefulness. More important is the fact that it wipes
out erysipelas. But as I have indicated, it has complete
control over all surface inflammations and suppurations,
whether it be acute dermatitis, phlebitis, cellulitis, inflamed
and suppurating wounds, puruleiit otitis media, or any
other such condition to which it can be directly applied
by bath or compress, or, as in the case of the ear, by drops.
I have also come to look upon it as the ideal initestinal
disinfectant, having a similar beneficial effect on the
bowel to that wliich it has oni the skin and underlying
tissues. I would like to warn those who have no experience of it against too highly concentrated solutions,
especially when applied to the fingers, toes, penis, scrotum,
and external ear, where the blood supply and therefore the
amount of serum is limited.-I am, etc.,
Edinburgh, April 18th.

JAMEs ALSTON.

SIR,-In your issue of April lgtli (1). 703) the late Mr.
A. E. Morison discussed the treatment of carbuncle by
magnesium sulphate. I should like to call attenition to a
miiethod I have carried out for several y-ears with iinvariable
sucecess. As soon as a case is seeil to be definiitely olne of
carbuncle I inject subcutaneously in the abdominial wall
10 c.cm. of antistreptococcus serurn (p)olyvalent). In one
case of aggravated carbuncle of the nieck I used a second
dose. A pad moistened with glycerini is applied locally.
In my experience the imiiprovement has been rapid anid
complete, without destruction of tissue alnd scarring.I ani, etc.,
R. PJICHARD, M.D., D.P.H.,
April 20th.

Medical Officer, Ely Isolation Hospital, Cardiff.

CLINICAL RESEARCH IN GENERAL PRACTICE.

SIR,-The letter by Sir James Mackenzie in the
B1RITISH MEDICAL JOURNAL of March 29th (p. 598) will,
I feel sure, have been read with interest by a large number
of practitioners who have leaniings towards the scientific
side of clinical medicine. Sir James Mackenzie states
quite truly that all the meanis at present available, includinig the most recent laboratory methods, onily detect
end-results of morbid processes. He therefore advocates
the study of the earliest symptoms in order that we may
be able to recognize a disease at its v-ery beginning, when
we might hope in some cases to be in a position to arrest
its progress. This is an aim wlichl e-eryione hopes will
one day be realized, but I suiggest tlhat, how-e-er early
we may succeed in recogniizinig the iniitial symptoms, we
cannot in many cases claim to lhav-e caught tihe disease at
the beginning. Take, for example, a case like lhaemophilia. We know it to be a Mendelian sex-linked recessive
character that occurs in a certain ntumber of male clhildren
of women who, being themselves niormal, are the offsprinig

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-immediate or remote-of haemdiphilic males. What ig

wanted is not a means of recognizing a haemophilic in
the early stages, but a method that will detect the hetero.
zygote female carrier of this disease. The same applies
to pseudo-hypertrophic muscular paralysis and a few other
conditions that are transmitted in a similar manner.
Huntington's chorea is another interesting example.
The disease, which behaves like a Mendelian dominant, does
not set in till about the age of 35 years, when the person
is already married and the parent of children, 50 per
cent. of whom will develop the disease when they reach the
age of 30-40 years. Until we can find some method of
discovering which of the children are the heterozygotes
that will certainly develop the disease and transmit it to
50 per cent. of their children, it is impossible to know which
of them to allow anid which to forbid marriage. Glaucoma
and diabetes (mellitus and insipidus) are examples of
similar nature, but the most cogent is the case of feeblemindedness. We know that this condition behaves as a
Mendelian recessive, so that there must be a large number
of normal people who carry this trait as a recessive.
Indeed, it has been shown that whilst the large number of
feeble-minded form only 0.3 per cent. of the population,
the number of normal carriers of feeble-mindedness constitute no less than 7 per cent. of the population. Intermarriage between such normal heterozygotes will result in
progeny 25 per cent. of whom will be feeble-minded and
50 per cent. will be again heterozygotes. What we want is
a certain means of detecting these heterozygote carriers.
Until this is achieved we cannot hope to reduce the
number of feeble-minded, from whom a large number of
the criminals, prostitutes, and insane are recruited.I am, etc.,

W. M. FELDMAN, M.D.Lond., F.R.S.Edin.

London, W., March 31st.

MRS. JEM'S ATTACK OF SWINE-POX.

SIR,-In connexion with the article (April 12th, p. 671)
on Mrs. Jem's attack of swine-pox, I may say that I have
recently received an MS. diary kept by my great-grandmother, Mrs. John Barclay Clibborn, of Anner House,
Clonmel, from 1800 to 1817.
On several occasions she mentions that lher children had
attacks of swine-pox, which I concluded were attacks of
chicken-pox, and not, as is suggested, modified small-pox.
I am confirmed in this theory by the fact that my great,
grandmother was an enthusiastic advocate of vaccination.
She had a small clinic at her house, and she herself vacciniated many of her employees and tenants, and she records
that all her children were vaccinated at an early age.I am, etc.,
Beaminster, Dorset, April 15th.

ARTHUR A. PIM.

" BAYER 205."

SIR,-The BRITISH MEDICAL JOURNAL for March 8th

contains an article on " Synthetic therapeutic agents "
by Sir William J. Pope, in which the author points to

a publication of the Times (August 25th, 1922), that " at a

meeting of the Association of Tropical Diseases held in
Hamburg the statement was made that ' Bayer 205 ' is
the key to tropical Africa, and consequently to all tlle
colonies, and that the German Governnment miust ' be
required to safeguard this discovery for Germany; its value
is such that any privilege of a share in it granted to other
nations must be made conditional upon the restoration to
Germany of her cololnial empire.' "
May I beg to inform you that I already, in 1922 (Arch iv
fIir Schiffs- und Tropen-Hygiene, 1922, p. 332), have publicly
stated that in the meeting of our association no such",
statement was made, and that the question of " Bayer 205
has not at all been treated in the meeting? In fact, it
may be that a German politician has miiaintained a sentence
like that quoted above in a political gazette, but niot a word
of such or a similar idea has been uttered in any scientific
meeting or by any German medical man.
I would be very much obliged if you would publish this
letter in your JOURN-AL.-I am, etc.,
PIIOFESsoIc DR. NOCHT,
Hlamburg, April 16tlh.

President of the German Association of

Tropical Diseases.