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A new point raised by Mr. Mellanby is whether" serious research-workers " who have performed harmfulexperiments on human beings without their consentare guilty of a crime. He appears to doubt whether theyare guilty, and in an interview given before his departurefor Germany is represented as deprecating Russian actionin trying and condemning certain eminent Germanscientists for this offence. But the answer to this is simple.The actions performed are admittedly criminal in anysystem of national or international law, and scientistsare as subject to the law as other persons ; they canclaim no personal immunity on the grounds that theircrimes are committed for disinterested motives.

Mr. Mellanby’s reference to the use of condemnedmurderers as volunteer experimental subjects, thoughinteresting, is scarcely relevant. This practice is or waslegal in certain States of the U.S.A. (Goldberger’s classicalexperiments on pellagra are an example) ; and manymight be prepared to argue that it should be made legalhere on the same conditions-namely, that the condemnedman be allowed entire freedom of choice in the matter,and the death penalty remitted if they survive. There

appears to be no evidence that any such choice wasallowed to the subjects of the Nazi experiments.

DENIS HERBERTHon. Secretary, Medical Sciences Committee, A.Sc.W.

ACUTE INFECTIOUS LYMPHOCYTOSIS

SiR,-In connexion with Dr. Steigman’s paper (Dec. 28)we should like to report the following case.The patient, a girl of 3 years, was admitted, under the care

of Dr. H. H. Chodak-Gregory, on Nov. 22, solely on accountof failure to gain weight during the previous twelve months.The home conditions were not good, but the child had beengiven iron for anaemia and vitamin C for some months as anoutpatient of a London hospital.

Clinically there were few signs-one or two enlargedcervical glands and a rather bulky liver, hut no splenomegaly.Routine blood examination revealed a white-cell count of79,200 per c.mm., with 62-5% small, and 17% large, lympho-cytes. The character of the blood-cells did not suggest eitherleukadmia (there were only 1% lymphoblasts) or infectiousmononucleosis. There was no evidence of whooping-coughand no fever.The white-cell count has gradually fallen to 16,450 per

c.mm., and the proportions of polymorphonuclear leucocytesand lymphocytes are now approximately normal.

We think that this must be a case of acute infectiouslymphocytosis.

E. V. FOYLER. J. REYNOLDS.

Three Counties Emergency Hospital,Arlesey, Beds.

TREATMENT OF TUBERCULOSIS

SiR,-Dr. Houghton and Dr. Corrigan (Dec. 14)have shown that in certain patients amphetaminerelieves apprehension-a useful contribution. It nowappears that other forms of treatment which they agreeare of great benefit have also extreme disadvantages ;according to Dr. Brailsford (Dec. 28) these are so greatas to make it advisable to treat the patients at home.That apprehensive patients are to be found amongthose with tuberculosis is clear, but it is going too far tosuggest that a modern sanatorium is a place of universalanxiety and alarm. If it be so, it is a strange reflectionon the power of the physician to suggest confidenceand to raise and maintain morale. More than chemistryis needed then.Many types of temperament and reaction are found

among tuberculous patients. Only today one patientin this hospital said that he had spent such a goodChristmas that he hoped he would be able to havethoracoplasty done and prolong his stay to enjoy another.This statement was no more a joke than the apprehensionsof others ; but it does not warrant a theory of generalindifference to mutilation. I find that the majority ofpatients here accept the need for active interferencewithout emotional upset and weigh sensibly the con-siderations which so seriously affect their future.

This is not to deny that the physical effects of tuber-culosis, with its serious mortality, may be depressing,.and that the social and economic distress may be severe.

It is surprising that cheerfulness keeps breaking inand that wards of tuberculous patients who are in

hospital for long periods contain so many who face theirdifficulties with understanding and balanced optimism.Vere Pearson and Morland first helped us to under-

stand the psychology of the tuberculous, and the former’srecently published autobiography answers effectivelyDr. Brailsford’s question as to the place and value ofsanatorium treatment. Does Dr. Brailsford think thatthe anxieties and stresses of the patient are absent athome ? They are often setiological factors in the illness.For many patients a spell of sanatorium treatment putsinto better perspective their distorted view of their ownmental and physical state. " Long rest with mentalserenity " is often easier to obtain than in the home." Think of the housewife trying to rest where she canhear every footstep... of the business man equallyfretted by business or family disquiets " (Pearson).

Let us judge our patients according to their individualneeds ; some may be better at home, but many willprofit by a period in a suitable sanatorium. Let usalso take a reasonable view of the extent of apprehensionand alarm in sanatorium patients.

F. A. H. SIMMONDS.Clare Hall County Hospital,

South Mimms, Barnet.

POSTOPERATIVE CHESTS

SiR,-The importance of the " freedom of the bed "is emphasised in your leading article of Dec. 21. Surelythis argues in favour of local or spinal as opposed toether inhalation anaesthesia ? With a local or spinalanaesthetic freedom is from the first complete, except forreflex inhibition from the operation area, and immobilityof the legs with spinal anaesthesia. The patient cominground from ether narcosis, on the other hand, undergoesa varying period of complete decubitus, with associatedreduction of pulmonary ventilation.

M. HAYDON-BAILLIE.Worksop.

IMPENDING DEATH UNDER ANÆSTHESIA

SiB,—I was very interested in Mr. Hamilton Bailey’sarticle last week, for I had a similar case some five yearsago.

This was a woman of 60 for whom I did a partialgastrectomy for gastric ulcer, using spinal anaesthesia(light ’ Duracaine ’). I had got about halfway throughthe operation when she stopped breathing and shortlyafterwards the heart ceased beating. Rhythmical pres-sure on the chest failing to produce any response, massageof the heart through the diaphragm was begun, andadrenaline was injected into the heart. We did nottime the duration of stoppage of the heart from thebeginning, but there was no return of cardiac contractionsfor 5 minutes from the moment when timing was started,and I should guess this as fully 2 minutes after the heart-beats had been noticed as absent. Weak and irregularbeats then began and gradually returned to strongcontractions ; the operation was eventually finishedwithout further incident. The patient was mentallyconfused for some forty-eight hours, but eventuallymade a complete recovery from every point of view.

This was an interesting though alarming experience,but the real interest lay in the method I used to restartthe respiratory movements. As there was no responseto the usual methods and my hand was in the region ofthe oesophageal opening in the diaphragm I draggedon this muscle with my forefinger placed in the opening,and immediately it was obvious that the lungs werebeing well inflated at each stroke. Alternately drawingdown the diaphragm and relaxing it kept up artificialrespiration most effectively, and with so little expenditureof muscular effort on my part that it could have beenkept going for hours with ease had it been necessary ;in about 10 minutes spontaneous respirations were

established.On two occasions since (without cardiac stoppage)

I have found the same manoeuvre act most efficiently,and in my opinion it is much the most effective way ofrestarting breathing in any case in which the abdomenis open. I have not seen or heard of this method beingused before, though it is an obvious thing to do, and it iscertainly most efficient.

Leeds. V

E. R. FLINT.