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lies the main province of the orthopaedist, to assistin the establishment of right use of the body whereverand however it may have gone wrong.

I am, Sir, yours faithfully,W. A. COCHRANE.

To the Editor of THE LANCET

SIR,-I read with great interest your last week’sleading article on the convalescent treatment ofchronic arthritis in adults. For some years we havebeen treating cases of Still’s disease at the Children’sHeart Hospital (belonging to the Invalid Children’sAid Association) at West Wickham, Kent. The

progress they have made in open-air country sur-

roundings has been very satisfactory, and a greatcontrast to their lack of improvement whilst in cityhospitals. I think that Dr. Fortescue Fox’s sug-gestion should receive wide support, but those whoundertake the supervision of such convalescent homesshould realise that more than a few months’ treatmentwill be necessary in many cases. Moreover, as Dr.Fox has emphasised in his scheme, facilities for

physiotherapeutic treatment, skilled massage, andorthopaedic measures to,prevent contractures occurring,will be a necessary part of each establishment.

I am, Sir, yours faithfully,BERNARD SCHLESINGER.

Portland-place, W., Feb. 1st.

To the Editor of THE LANCET

SIR,-In your leading article last week occurs thestatement, " Dr. Fox himself attaches value to theuse of pure sulphur waters in the treatment (ofrheumatoid arthritis), and such waters are notavailable nearer than Wales, Ireland, or the north ofScotland." Presumably the word " pure " indicatesvirtual absence of chlorides, sulphates, &c., implyingthat sulphide is the characteristic ion. In this casethe Harrogate springs, such as the Harlow, Beck-with, and Oakdale, are as fittingly placed in thatcategory as those in the districts mentioned. Neitherby road nor rail can Harrogate be termed remote.Although the strongly salinated waters foundedHarrogate’s reputation, the diversity of springs, dueto the geological complexity of the underlying rocks,has given to medical hydrology a great variety ofmedia. I am, Sir, yours faithfully,

A. WOODMANSEY.

DERMATITIS AND MOTOR FUMES

To the Editor of THE LANCET

SiR,—Dr. Whitfield’s note on dermatitis frommotor fumes is of interest and indicates an obscureexternal cause for some cases of eczema of face andneck. In October, 1936, I saw a lorry-driver withmarked irritation and variable dermatitis of face andneck in which I suspected fumes as a possible cause.As his work involved the loading of barley on to hislorry, I patch-tested him against petrol and barley.He gave a strong positive reaction to petrol, a negativereaction being obtained in other control subjectswho were tested. I have little doubt that this wasthe explanation of his dermatitis which has persistedsince he has not been able to change his work.I shall now try the effect of his driving with an openwindow in view of Dr. Whitfield’s suggestion.

I am, Sir, yours faithfully,JOHN T. INGRAM.

INFLUENZA AND LEUCOPENIA

. To the Editor of THE LANCETSIR,-The recent research work on the aetiology of

influenza and numerous letters and articles latelyin the medical press relevant to the symptomatologyand treatment of this disease prompt me to callattention to an article published fifteen years agoin your columns (Lancet 1922, 1, 116) by the lateDr. F. M. Gardner-Medwin and myself. Influenzain its present and recent form in this country is farfrom being the fatal disease which we know that itcan at times become ; it is very different now fromthe dreadful pandemic of 1918-19, but there canbe no assurance that it may not yet again reassumethe malignant form. A healthy dislike of anything sug-gesting commercialism and the pontifical utterancesof many of our leading physicians have encourageda non-possumus attitude in regard to treatment.We are told to fold our hands, to rely on rest inbed, warmth, and nursing, and to avoid any attemptto influence the course of the malady by any methodof chemotherapy. This is doubtless good advicein regard to the treatment of the vast majority ofcases of the present type ; but I think it is to be

regretted if it is to be applied invariably.In 1918 and 1919, working at the 17th General

Hospital in Alexandria, Gardner-Medwin and I cameto the conclusion that influenza was due to a ffltrablevirus ; that this caused a leucopenia which was anindex of the inhibition of reactionary defence by thebody; that the state of defencelessness therebyinduced laid the host open to attack not only by theprimary virus but by various germs-normallyharmless, but potentially pathogenic--which are

commonly to be found in the throat and upper respira-tory tract; that prognosis depended on the numberof circulating polymorphonuclear leucocytes (granu-locytes), since the severity of the symptoms bore adirect relationship to the degree of leucopenia andrecovery was always preceded and accompanied bya rise in the white blood count; and that if one couldprovoke such a leucocytosis-e.g., by the injectionof such a drug as sodium nucleinate, the nucleotidesnot being known in those days-the disease wasdramatically cut short and recovery ensued. It isnot suggested that the granulocytes, per se, are neces-sarily the only defence mechanism, though I thinkthat they are an integral part of it ; and even thenwe inclined to the view that they were an index ofthe capacity of the host as a whole to respond tothe infection by the production of antibodies againstboth virus and secondarily invading bacteria. Inother words, we thought that the body itself coulddeal with the infection if only we could overcomethe curious paralysing effect, on its defence forces,of the virus. Piney offered the ingenious explanationthat the virus had a negative chemotactic effect onthe leucocytes and that the nucleinate acted as a" chemotactic whistle " to call them out.In the beginning we adopted a system of control

by dividing the whole series of cases into two. The

general treatment was the same in each but onlythose in alternate beds received the nucleinate.After a little while we found such a striking differencein the mortality-rate-those who received the nuclei-nate for the most part recovering and those who didnot for the most part dying-that we did not feeljustified in continuing to withhold it from the controlcases. The only criterion was the presence of a

leucopenia ; naturally, in every case repeated bloodcounts were done to gauge the effect of the treat-ment. We observed two phases of the epidemic,