1345HELMINTHS AND PELLAGRA.-OBITUARY

ARTERIAL DISEASE OF THE EXTREMITIES

To the Editor of THE LANCETSIR,-In a very comprehensive and interesting

article in THE LANCET of last week, Mr. A. DicksonWright refers to a condition known by the formidablename of erythrocyanosis crurum puellarum frigida.He states, and to the best of our knowledge quitecorrectly, that "no ganglionectomies have beenrecorded for this disease...." May we beg the favourof your space to state that in our series of 98

ganglionectomies we have performed this operationon nine young women suffering from this condition.The results have been uniformly excellent and thesymptoms have been completely abolished.Minor degrees of the disease are, of course, very

common, but in the severe cases associated withdistress and disability from pain, chilblains, andrecurrent ulcers we can strongly recommend theperformance of a bilateral lumbar ganglionectomy.Four of these nine patients have now been watchedduring two years and the results remain completelysatisfactory. There has been no relapse in any ofthe nine patients and in each case normal activityfor both work and play has been fully restored.

We are, Sir, yours faithfully,

Manchester, Dec. 4th, 1933.

E. D. TELFORD,JOHN S. B. STOPFORD.

HOT-WATER BOTTLES AFTER BASALNARCOSIS

To the Editor of THE LANCETSiR,-Since avertin and the other so-called basal

narcotics have come into such general use beforeanaesthesia, a word of warning appears to be necessaryin the use of hot-water bottles during the long sleepwhich follows the use of these drugs. It is this

prolonged sleep, low blood pressure, and theappearance of low vitality with perhaps a chillyfeel which tempts nurses, quite naturally, to puthot-water bottles in the beds of these patients.Under no conditions should this be allowed, as thesepeople are particularly prone to burns, even thoughthe bottle is only just warm, covered and used outsideblankets. A hot-water bottle is a potential dangerafter any anaesthetic, but becomes an actual dangerafter the use of basal narcotics, and should be rigidlyprohibited.-I am, Sir, yours faithfully,

Harley-street, W., Dec. 2nd, 1933. Z. MENNELL.

HELMINTHS AND PELLAGRA

To the Editor of THE LANCET

SIR,-In your issue of Nov. 25th Major A. G. Biggamand Dr. Paul Ghalioungui report that they found inpellagrous patients in Egypt a higher helminthicinfection-rate than was the average for that country,and suggest that such infection may play a part inproducing pellagra, and may account for its occurrencein certain members only of a family all of whom areon the same ill-balanced diet. It is interesting toturn back to an evidently forgotten letter in THELANCET of May 29th, 1920, in which Dr. H. M.Woodcock, writing of the same country, gave hisreasons for concluding that in addition to deficientnutrition as an essential factor in the production ofpellagra another might be necessary-namely, thepresence of a helminthic infection. Since two separateinvestigators have, evidently independently, reachedthe same conclusions, these, it is clear, cannot infuture be disregarded.

I am, Sir, yours faithfully, Ealing, Deci 5th, 1933. CLAYTON LANE.

LETTSOM

To the Editor of THE LANCETSiB,—Mr. J. Johnston Abraham, writing in your

issue of Nov. llth, is quite correct, of course, inattributing the permanence of the 1817 edition to itshand-made paper ; but is certainly in error inpreferring so-called art paper for his own recent" Life of Lettsom "-that is, a paper of unknownbase, almost certainly esparto, with a coating of

china-clay-on the ground of durability. The reportof the Library Association on the durability of paperwas against the use of art paper.There is all the difference between news paper,

printed on disintegrated wood-pulp, and a goodsound chemical wood paper as recommended in the

report. The publisher’s difficulty is always, whereillustrations are scattered amidst the text, that thebest way of printing for this purpose-namely,photogravure, which enables any good uncoated paperto be used for photographic illustrations-is onlyeconomical where at least 5000 copies of a book areprinted. There are other methods also.On bulky books the authors of the report had no

mercy. I am, Sir, yours faithfully, -

Bedford-square, W.C., Nov. 30th, 1933. ONE OF THEM.

OBITUARYJOSEPH FRANCIS PORTER, D.S.O., M.D. Dub.THE death is announced of Dr. J. F. Porter, at his

home in Helmsley, at the great age of 93, on Dec. 4th.He entered the profession when already about 30

years of age, and graduated in arts at Trinity College,Dublin, in 1868. He took the M.B. degree in 1873,proceeding to the doctorate four years later, havingalready qualified as M.R.C.S. Eng. Dr. Porter wasfor 50 years closely and importantly connected withmedical and social life in Helmsley, where he actedas medical officer of health for nearly half a century.He was one of the oldest magistrates on the NorthRiding of Yorkshire Bench, and was county coronerduring the greater part of his career, being probably,at the time of his death, the oldest coroner in thecountry. The duties of this office he dischargedactively without assistance until quite recently. Earlyin life he had served as surgeon in a volunteer regiment,and for his sound work in training V.A.D. detachmentsbefore the war he was appointed O.B.E.

EDWIN AWDAS NEATBY, M.D. Brux.WE regret to announce the death of Dr. Edwin

Awdas Neatby, which occurred at his home at EastGrinstead on Dec. lst. He received his medical

training at the London Hospital, where he was asurgical scholar, took the diploma of M.R.C.S. in 1880,and that of L.R.C.P. Lond. in the following year,and served as house surgeon to the hospital. He

graduated as M.D. Brux. in 1882, and becameprominent in homoeopathic circles, acting as presidentof the British Homoeopathic Society, and on oneoccasion presiding over the annual congress. Dr.

Neatby wrote upon the treatment of uterine fibroids,and cooperated in .the production of a Manual of

Homoeopathy.

MATERNITY AND CHILD WELFARE IN SOUTH AFRICA.The Government of the Union has decided to appointa woman medical officer of health, with three healthvisitors, for child welfare work in the country districtsof South Africa. This appointment is made in responseto the repeated demands of the South African NationalCouncil for Child Welfare and other organisations.