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This document contains correspondence from several doctors discussing various medical topics.
1) One doctor proposes a new classification system for arthritis that divides it into stages based on x-ray findings and involvement of cartilage and bone in the joint.
2) Another doctor argues that mastoid drainage is often delayed too long rather than being premature, as another had suggested.
3) A third doctor notes inaccuracies in media reporting on medical topics can give rise to false hopes in patients and families.
This document contains correspondence from several doctors discussing various medical topics.
1) One doctor proposes a new classification system for arthritis that divides it into stages based on x-ray findings and involvement of cartilage and bone in the joint.
2) Another doctor argues that mastoid drainage is often delayed too long rather than being premature, as another had suggested.
3) A third doctor notes inaccuracies in media reporting on medical topics can give rise to false hopes in patients and families.
This document contains correspondence from several doctors discussing various medical topics.
1) One doctor proposes a new classification system for arthritis that divides it into stages based on x-ray findings and involvement of cartilage and bone in the joint.
2) Another doctor argues that mastoid drainage is often delayed too long rather than being premature, as another had suggested.
3) A third doctor notes inaccuracies in media reporting on medical topics can give rise to false hopes in patients and families.
for their origin on the physico-chemical nature of or an isolated group of small joints. In the polyarticular colloidal matter in its reaction to the diffusion through types, however, it might necessitate the placing of a it of solutions of electrolytes, or, in certain cases, to the patient in more than one stage. It would limit the word liberation within it of such substances. From this point cure" to Stages 1 and 2, and also exclude all cases of view there may be a definite relationship between the of retrogression from Stage 2 to Stage 3. It would tend mechanism of causation of this condition and that of the to promote earlier diagnosis by emphasizing the possibility pigmentary or gaseous deposits in banded or striated of a cure or a marked improvement in the earlier stages. hairs and feathers, which are of much more common If adopted in various centres, collective information would occurrence in nature. soon be available and the results of any particular form The microscopical appearance in Tomkinson's article of treatment more accurately assessed.-I am, etc., of a single hair may be compared with the illustration given by McCall Anderson (Fig. 7, p. 59) of six hairs London, W.1, Dec. 21st, 1932. W. L. WATT. from five affected persons in the family group he recorded. -I am, etc., Mlanchester, Dec. 20th, 1932. W. J. RUTHERFURD. The Medical Profession and the Lay Press SIR,-Sir Harold Gillies (December 24th, 1932, p. 1166) raises an issue that requires solution, not only for the Mastoid Drainage protection of the interests of the medical profession, but SIR,-I should have thought that in the experience of also in order to safeguard the public. The value of new most aural surgeons the drainage of the mastoid was methods of treatment can rarely be correctly estimated rather too long delayed instead of being premature, as by the public, and editors of newspapers do not always suggested by Mr. Douglas Crow in his note in your issue appear to recognize fully their responsibility to the public of December 17th, 1932 (p. 1104). I hope this note will for medical items in their columns. My work, for instance, not lead to practitioners postponing sending their cases has recently been referred to by a section of the lay press for investigation and operation at an early date. (it is hardly necessary to say, without my personal know- I have consistently urged that an earlier mastoid opera- ledge) in a way that is grossly inaccurate. It has been tion is indicated, and although one realizes quite clearly implied that I have discovered new methods of treatment, Mr. Crow's point, yet I should have thought that most and from letters I have received it is clear that one effect aural surgeons would never have considered operation of this has been to arouse false hopes in the minds of at the stage to which he objects. Broadly speaking, I friends and relations of patients who are incurable. Even think it is necessary to impress upon practitioners that if the lay press has little concern in causing embarrass- large numbers of cases of mastoid involvement are treated ment to members of the medical profession and to their as though the disease were confined to the middle ear; work, surely it would wish that its information to the in my personal experience I have never opened a public on medical matters should not give rise through its mastoid antrum without finding a serious involvement of inaccuracy to unnecessary mental suffering.-I am, etc., the structures, and this may, I think, occur at an earlier London, Dec. 24th, 1932. HUGH CAIRNS. date than is appreciated by Mr. Crow, as the fulminating type is by no means uncommon, especially when arising as a complication of influenza.-I am, etc., British and Foreign Spas Bath, Dec. 22nd, 1932. H. NORMAN BARNETT, F.R.C.S. SIR,-Dr. Geoffrey Holmes, in his letter which you published on December 17th, 1932, very successfully refutes a statement made by a medical correspondent in. Classification of Arthritis a newspaper that British spas compared with German SIR,-In trying to assess the value of any treatment spas do little for poor patients. He mentions the hos- for arthritis the chief difficulty is in the classification pitals at Bath, Buxton, and Harrogate. It is of general of the disease. There is a wide divergence of opinion interest to add that at Droitwich there are two hospitals, as to when any particular type begins, when it ends, and a clinic, a convalescent home, and a hostel, with some when it merges into another type. Since it is generally two hundred and fifty beds, available for the same class. accepted that a good x-ray negative is the best means of -I am, etc., determining the actual condition of the joint, it should Droitwich, Dec. 28th, 1932. A. R. NELIGAN. be possible to make clearly defined subdivisions according to the stage of the disease as follows: Stage 1: Articular Arthritis.-The x-ray findings are nega- Coroners and Evidence tive or in favourable cases show cloudy inflammatory changes SIR,-It is true that eminent judges have said that the in the cartilage and the joint space. coroner is not fettered by the strict rules of evidence Stage 2: Osteo-articular Arthritis.-The disease has also which prevail in ordinary common law courts. On the invaded the adjacent bone but the joint-space is still intact- other hand, if the coroner had at his elbow a voice which that is, the joint is still a cartilage-bearing one. Stage 3: Osteo-arthritis.-The joint-space is partially or first softly murmured, " You can't ask that," and then, completely obliterated and the joint is now a bone-to-bone- rather louder, " That's not evidence; don't answer," and, bearing one. finally, if a robed figure stood up beside him and re- Stages 2 and 3 to be subdivided into " hypertrophic " and marked, in a tone of pity rather than contempt, " My " atrophic " according to whether or not there is evidence friend knows he can't ask that," we might hear less of bone reaction with lipping, osteophytic overgrowths, etc. nonsense in the coroner's court. Counsel who persist after The type of disease could be added as a prefix-rheumatoid, such interruptions may receive some such rebuke as this: infective, or gouty. Without this prefix it would mean true " Mr. Jones, if what you say is right, I have yet to learn osteo-arthritis, subdivided according to its stage into osteo- my business, after forty years in the law." articular arthritis and osteo-arthritis. During the twelve years I was at the Common Law bar A classification along these lines would give a definite I came to see that examination-in-chief required even clinical picture of the actual condition of the joint at greater skill than cross-examination; that able advocates the commencement of treatment, and would be especially often reduced their cross-examinations to very few ques- valuable where the disease is limited to one or two large tions, turned .to the jury with a smile, and sat down.
Letters on the Cholera Morbus.
Containing ample evidence that this disease, under whatever
name known, cannot be transmitted from the persons of those
labouring under it to other individuals, by contact—through
the medium of inanimate substances—or through the medium
of the atmosphere; and that all restrictions, by cordons
and quarantine regulations, are, as far as regards this
disease, not merely useless, but highly injurious to the
community.
The Treatment of Hay Fever
By rosin-weed, echthyol and faradic electricity, with a
discussion of the old theory of gout and the new theory
of anaphylaxis
Observations on Madness and Melancholy
Including Practical Remarks on those Diseases together
with Cases and an Account of the Morbid Appearances on
Dissection
Every Man his own Doctor
The Cold Water, Tepid Water, and Friction-Cure, as
Applicable to Every Disease to Which the Human Frame is
Subject, and also to The Cure of Disease in Horses and
Cattle
James Robert Stull, A Minor, by His Mother, Julie Stull MacLeod and His Stepfather George Stuart MacLeod v. School Board of The Western Beaver Junior-Senior High School, 459 F.2d 339, 3rd Cir. (1972)