77

blood-pressure dropped by 50 mm. Hg, and he was no longerprecoccupied with his heart. But to my annoyance he spoiltthis satisfactory picture of recovery by complaining of anew symptom-sudden collapse while walking. Twice while

shopping in the town he suddenly felt giddy and had to sitdown. His legs gave way beneath him ; objects tended torotate ; and he had a rather severe occipital headache, butno nausea or tinnitus. Examination showed no nystagmus ;with his phobia about tabes he has always had some romberg-ism, and to elicit the knee-jerks some reinforcement hasbeen needed.Once again I attributed the " attacks " to psychogenic

causes. I argued that this man, with his fear of angina,was collapsing out of doors as a defence against exercisethat might strain a heart he believed to be vulnerable.I reiterated my assurances about the state of his myocardium,and reduced the dose of sodium amytal to gr. 2 a day.CASE 3.-The next day I visited a woman, aged 50,

the headmistress of a school. She is of manic-depressivetemperament, and some years ago was operated on for

exophthalmic goitre. She was sleeping badly, feeling " end-of-termish," and bothered by a possessive attachment formedby a member of her staff. I prescribed sodium amytalgr. 3 at night. Some weeks later she reported that she feltextremely weak in the legs ; that it took her ten minutes towalk 200 yards to the post-box ; and that she feared to crossthe road and would not go out alone lest she collapsed.Electromyographic studies have shown that sodium

amytal lowers toni-is.1- In cats the lethal dose varies

widely, and some which partly recovered had a persistentsyndrome of altered reflexes and abnormal posture andgait ; pathological changes were confined to the Purkinjecell layer in the cerebellum.2With these findings in mind, I reviewed the 3 cases.Re-examination of the lst patient showed that she had

very flabby calf muscles ; and the ankle-jerk on the leftside could not be elicited. There was no nystagmus and noincoordination in the upper limbs. Sodium amytal wasreplaced by a bromide and soluble-barbitone mixture. A weeklater she was free of vertigo and had not collapsed again.The 2nd patient was also found to have very poor muscle

tone in the calves ; both ankle-jerks were, however, present.There was no nystagmus and no incoordination in the upperlimbs. Sodium amytal was gradually replaced by pheno-barbitone and the patient has not collapsed again.The 3rd patient had no evidence of altered tendon-reflexes

and no incoordination or ataxia ; but muscle tone was poor.Sodium amytal was stopped and phenobarbitone prescribed.In less than three days she was walking alone with confidence,and had lost the vertigo.The idiosyncrasy in these cases may have been asso-

ciated with hepatic dysfunction, which is said to increasetoxicity.3 Sodium amytal belongs to the group ofbarbiturates which are chiefly broken down in the liver(though not to the same extent as thiopentone andhexobarbitone) ; only 3-5% is excreted in the urine,compared with 25% of phenobarbitone and 30% ofallobarbitone.

Of the 3 cases described here, the 1st had no historyor evidence of hepatic disorder ; the 2nd was knownto have gall-stones and had had several attacks ofbiliary colic ; and the 3rd may be presumed to have hadhepatic dysfunction since hyperthyroidism is usuallyassociated with defective liver function.4 4

This series illustrates some of the difficulties of assessingthe origin of symptoms in patients with psychiatricor psychosomatic disorders. It is easy to accept as

functional, symptoms which actually have an organiccause ; and but for the coincidence of 3 cases arisingwithin a fortnight, this syndrome of cerebellar dysfunctionfollowing administration of amytal might easily havebeen overlooked.

Bristol. FRANK BODMAN.

1. Jacobson, E. Ann. intern. Med. 1944, 21, 455.2. Skrop, K., Gold, H. J. Pharmacol. 1945, 88, 260.3. Cushny’s Pharmacology and Therapeutics. Edited by A. Grollman,

D. Slaughter. London, 1947 ; p. 316.4. Langdon-Brown, W., Simpson, S. L. Medical Annual. Bristol,

1944; p. 319.

TRAVELLING EXHIBITIONS ON CLEANLINESS

SiR,-May I assure Dr. Forster, who wrote last week,that the Central Council for Health Education is dealingwith the problem of its present stands being rathercumbersome.

By September, 250 light frames, on which exhibitionpieces can be displayed, will be available to local healthauthorities, making treble the number of stands incirculation. These stands have been designed so thatthey can, if necessary, be carried in a private car, andassembled and dismantled in a few minutes. Reportsfrom medical officers of health indicate that wherestands have been shown in factories, they have provedvery popular, and the Council hopes that more approachesto this tvDe of audience will be arranged.

Central Council for HealthEducation, Tavistock House,

London, W.C.1.

ROBERT SUTHERLANDMedical Adviser and

Secretary.

INJURY FROM ELECTRIC WASHING-MACHINES

SiR,-In the U.S.A. housewives and children are notuncommonly injured by automatic washing-machines.In this city a woman had her arm pummelled forhalf an hour before she freed it by the slow processof dragging the machine to the switch, which she turnedoff.The injury may be severe, and may be followed by

extensive loss of skin through damage to the cutaneousblood-supply. Injury to the muscles of the arm andforearm may seriously limit the activity of the fingersand hands. The condition calls for prompt treatmentin hospital. Immediate application of an efficient

pressure bandage prevents collection of subcutaneousexudate. Fine judgment is needed in the use of the

pressure bandage and of rest ; the time for startingactive treatment must be chosen with care becausecedema may recur. Though at first the damage mayappear very slight, ultimately destruction may be great.

In the late stages the victim presents with an enormoussubcutaneous hoematoma, extending over the wholelength of the forearm. There may be areas of skinnecrosis and associated infection ; and severe oedemaand puffiness develops in the hand, probably owing toobstruction of the lymphatic channels draining this

region. There is an area of relatively normal appearancearound the wrist where the skin seems to be least affected,and the whole appearance is somewhat akin to that ofan inverted champagne bottle.

Fortunately, in the British Isles domestic washing-machines with electrically operated rollers are rare,so the condition is unlikely to be seen ; but a safetydevice should be installed on any machines that have

Boston, Mass. J. D. WADE.

ANOXIA IN THE FŒTUS AND NEWBORN

SIR,—In your leading article last week you perpetuatean argument concerning periodic breathing whichdoes not seem to have any justification. You say :

" The alternating hyperpnoea and apncea commonlyseen in premature infants is a characteristic of ’mountainsickness’ and gives place to regular respirations in anoxygen-enriched atmosphere. Premature infants with

periodic respiration should therefore be given oxygen...."This suggests that the periodic breathing of the pre-mature infant has the same physiological basis as theanoxic periodic breathing of mountain sickness, and

neglects facts of fundamental importance. These are :(1) that periodic breathing is almost as common in thefull-term as in the premature infant ; (2) that whilethis periodic breathing is occurring in the newborn,generally there is no cyanosis, which sharply distinguishes

78

it from the periodic breathing of mountain sickness ;and (3) that it occurs in the infant in normal atmospheresof 760 mm. barometric pressure.

Physiology Department,St. Mary’s Hospital Medical School,

London, W.2.

A. ST G. HUGGETTK. W. CROSSPAMELA E. WARNER.

ObituarySAMUEL ERNEST DORE

M.A., M.D. CAMB., F.R.C.P.’VITH the death, in London on June 27, of Dr. Ernest

Dore, another link with the men who made the realbeginnings of British dermatology has been severed.Samuel Ernest Dore received his early education at

Mill Hill School. He took his medical training atCambridge University and St. Mary’s Hospital, London,qualifying M.R.C.s. in 1898 and graduating M.B. thefollowing year. He took the M.D. in 1906 and waselected M.R.C.P. in 1907 ; he was elected to the fellowshipin 1920.

In his earlier years he worked with the late Sir MalcolmMorris in the skin department at St. Mary’s Hospitaland in his practice. After a further spell at the MiddlesexHospital as an assistant with the late Dr. J. J. Pringle,he obtained his first important senior post. This wasat Westminster Hospital, as assistant physician fordiseases of the skin to the late Dr. Colcott Fox, whom heshortly succeeded as head of the department. Soonafter the first world war he was appointed to the staffof St. Thomas’s Hospital, and thus he had the rare

distinction of being on the staff of two London teachinghospitals at the same time. He occupied both postsuntil his retirement in 1934.

J. L. F. writes : " Dore was one of the first in thiscountry to employ radium for the treatment of smallgrowths of the skin, and he translated the early work onradium therapy by Wickham and Degrais. Startingdermatology in the old hit-or-miss days, he acceptedeach new development only after a thorough personaltrial ; and towards the end of his active career it wasthe duty of his assistants to keep him well versed in allthe latest phases of a specialty which at that time wasundergoing particularly rapid growth. He helped SirMalcolm Morris in several revisions of his Diseases ofthe Skin, and when, in 1934, he virtually re-wrote thebook with one of his assistants, he was assiduous inweeding out all matter that was by then out of date.When recent innovations were being considered forinclusion, he would argue about them deep into the nightuntil he was quite satisfied as to their worth.

" A tall, dignified figure, with a delightful sense ofhumour, he had a kindly disposition and was slow toanger, except when he felt that an injustice was beingdone. On those occasions he would speak out vehemently.He shunned the lime-light and was retiring by nature,and on this account he was perhaps a little difficult toget to know ; but after he had accepted anyone as afriend no trouble was too great for him to take on theirbehalf. He was a good teacher, and his advice wasgreatly sought by former students when they or theirfamilies suffered from dermatological ailments-a greatcompliment to any consultant. He was punctilious inhis hospital duties, priding himself that he never missed.an attendance unnecessarily. He took a great interestin the chief dermatological societies, especially in theBritish Association of Dermatology and Syphilis, fillingthe chair of all of them in turn, and never speaking forthe sake of hearing his own voice but only when he hadsomething of value to contribute to the discussion."

" The news that S. E. Dore has died," adds R. M. B.McK., " will sadden many who remember gratefullythis most kindly and sympathetic of teachers. He wasnot one who dominated his clinics with a strident person-ality, nor were his lectures filled with quips and sallies ;probably his abilities were underestimated by many ofthe generations of undergraduates who attended hissessions in the outpatient department. It was not untilone-was a postgraduate that one could appreciate thatbehind the unhurried serenity of his approach there laya keenly observant mind, great ability in diagnosis, and

a wide knowledge of the literature of his specialty,particularly of the French school. -It was not untilone was a little more senior that one appreciated thatwhen Dore spoke among his colleagues, they listenedto his views with respect.

" Few men have devoted more time to the outpatientwork of the great voluntary hospitals of London, andfew on their retirement could, like Dore, claim emeritusrank at two major teaching hospitals as well as at St.John’s Hospital for Diseases of the Skin and at theEvelina Hospital. Those of us who were his pupils, andwho now remember the serenity and equanimity behindwhich he hid the forcefulness of his purpose, can begrateful that we were privileged to pass the early stagesof our careers under his tutelage."

Dr. Dore is survived by his widow.

BETHIA MUIR NEWLANDSM.B. ABERD., D.P.H.

Dr. Bethia Newlands, a senior assistant medicalofficer in the Middlesbrough health department, diedin Aberdeen on June 2. She received her medical educa.tion at the University of Aberdeen, where she graduatedM.B. in 1919. After holding house-posts at the RoyalVictoria Infirmary, Newcastle upon Tyne, and in theChildren’s Hospitals of Nottingham and Bradford,Dr. Newlands joined the staff of the Aberdeen public.health department. In 1925 she took the D.P.H., and ;

three years later she was appointed a school medicalinspector in the West Riding of Yorkshire, where sheremained for fourteen years. In the last two years ofher service she was senior administrative medical officerin the maternity and child-welfare and school medicalservice.

During the late war she held the post of acting M.o.H.for Brighouse, and in 1946 she took up her post atMiddlesbrough.

J. C. writes: ’’ Although Dr. Newlands was of retiringdisposition her breadth of vision and eye for detail madeher an excellent organiser. Right to the end of herworking life, despite the handicap of mortal illness,she showed untiring zeal and was endlessly painstakingin the performance of her duties-to an extent thatcompelled the admiration even of those who are tempted,in moments of weakness, to act on Talleyrand’s cynicaladmonition in the matter."

Appointments

HowAT, D. D. C., M.B. Lond., D.A. : consultant anaesthetist,Nottingham group of hospitals.

NORMAN, A. P., M.B.E., M.A., M.D. Camb., M.R.C.P., D.c.H. : physician,Hospital for Sick Children, Great Ormond Street, and deputydirector, Institute of Child Health.

Appointed Factory Doctors:CURRAN, P. H., M.B. N.u.i. : Northampton district.FLAHERTY, K. A., M.B. N.U.I.: Slaithwaite district.HOLGATE, R. S., M.B. Lpool : Saddleworth district.LYTLE, J. D. M., M.R.C.S., D. OBST. : Cobham district.STEPHEN, W. R., M.B. Aberd. : Fochabers district.

Diary of the WeekJULY 9 TO 15

Tuesday, 11thEDINBURGH POST-GRADUATE BOARD FOR MEDICINE

4.30 P.M. (Anatomy Lecture Theatre, University, Edinburgh.) E,Prof. R. A. Willis : Some Principles of Antenatal Patho-logy.

Thursday, 13thROYAL CoLLEGE OF PHYSICIANS, Pall Mall East, S.W.1

5 P.M. Prof. E. C. Dodds, F.R.S. : Bearing of Protein Structure onClinical Problems. (Bertram Lewis Abrahams lecture.)

ROYAL COLLEGE OF SURGEONS, Lincoln’s Inn Fields, W.C.25 P.M. Dr. Gunnar Bauer (Sweden) : Diagnosis and Treatment of

Acute Deep Venous Thrombosis.UNIVERSITY OF EDINBURGH

5 P.M. (Anatomy Lecture Theatre, University New Buildings.}Prof. L. S. Stone (Yale University): ExperimentalStudies on the Eye based upon the Regeneration of theNeural Retina and the Lens. (Macarthur lecture.)

Friday. 14thROYAL COLLEGE OF SURGEONS .

3.45 P.M. Prof. Lester Cahn (New York) : The Jaws in GeneralisedSkeletal Disease. (Charles Tomes lecture.)

5 P.M. Prof. A. B. P. Amies (Melbourne): Epulides. (Charles Tomeslecture.) ,

.