1141

CORRESPONDENCE

TUBERCULOUS CERVICAL GLANDS

To the Editor of THE LANCET

SiB,—It was with some surprise and disappoint-ment that I read in your issue of April 25th (p. 946)Dr. Brian Thompson’s universal condemnation ofexcision in the treatment of tuberculous cervical

lymphadenitis. I have always felt that the forma-tion of a sinus in this condition, in any but excep-tional cases, should be considered as a failure intreatment; it has been my experience that excisionin cases with localised disease, which has advancedto caseation or suppuration, is followed by highlysatisfactory results, which can be termed cures.

It is, however, essential at operation to excise com-pletely all tuberculous tissue, often a tedious andmeticulous procedure, which is, however, rewardedby the fact that there is neither sinus formation norlocal recurrence-results which appear to have beenonly too common in the cases which Dr. Thompsonhas observed, and which have determined his rejec-tion of this form of treatment.

I am, Sir, yours faithfully,London, W., May 7th. VERNON C. THOMPSON.VERNON C. THOMPSON.

ENCEPHALITIS LETHARGICA AND THE LAW

To the Editor of THE LANCET

SIR,-Recently at the Leeds Assizes a man of thename of Turner, who, according to the evidence ofthe police surgeon, had a history of sleepy sickness,was sentenced to two years’ hard labour for assaultingfour small boys by caning them. He had previouslytwice been convicted of similar offences, and said inhis evidence, "I I know it is wrong but I cannot

help it." "Some years ago I published in your columns the

case of an ex-Service man who was sent first to

prison and later, for a subsequent offence, to a

criminal lunatic asylum for assault, and at his post-mortem examination, following suicide, a piece of

shrapnel was found in his brain. Later I happenedto be attending the Norwich Assizes when I wasasked if I would give expert evidence in a case of asexual offence. I did so-the case was one offetishism-and after laying my views before the

court, to which judge, jury, and bar listened withinterested attention, the man was acquitted. Counselassured me that if chance had not taken me into thecourt for another case the accused would certainlyhave been convicted.Surely the time has come, and indeed is long

overdue, when the law should be altered so that

persons suffering from morbid mental conditions, theresult of illness, accident, or heredity, should betreated as irresponsible mental cases rather than asresponsible criminals-even though they may nothave any obvious delusions.The bench, the bar, solicitors, and juries are quite

naturally ignorant of morbid psychology and itappears to be a grave miscarriage of justice, forwhich legislators rather than lawyers are responsible,that morbid mental states should be punishable bylaw. Judges in their proper disgust at the actscommitted, and in ignorance of the irresponsibility ofthe unfortunate victim of brain damage, too oftenpermit themselves to express opinions which to thosewho have medical knowledge appear to be not onlyunjust but vindictive. The medical history of everycase that suggests the possibility of a mental kink

should be gone into most carefully and the accusedshould be given the benefit of the opinion of a medicalexpert, while the police surgeon’s evidence, thoughdoubtless given in all good faith, should not be

accepted as final.I have drawn the attention of the Home Secretary

to Turner’s case.I am, Sir, yours faithfully,

Harley-street, W., May 10th. H. WANSEY BAYLY.H. WANSEY BAYLY.

TREATMENT OF MAMMARY ABSCESS

To the Editor of THE LANCET

SIR,-Reading in your issue of Feb. 22nd (p. 440)of Messrs. Battle and Bailey’s dissatisfaction with theresults of incision and drainage in mammary abscess,I should like to tell you something of my own

experience. As a student I saw mammary abscesstreated with incision ; after pressing out the pus,we put in a tampon of vioform gauze, renewed everyday until the wound healed. The treatment wasvery painful but the result was good. As a youngpractitioner I treated mammary abscess with incision,insertion of a tampon of gauze, saturated with Goulard’slotion or alcohol, covered with Billroth batist, thetampon being renewed every day. The treatmentwas painful but the result was good. Not contentwith this, I tried a stock vaccine known as Propidon,giving three injections of 5 c.cm. at an interval oftwo to three days. After each injection the woman hasa rigor and the temperature rises to 104° F. Some-times this drastic treatment leads to cure ; but itmay be necessary to open the abscess. More recentlyI have been in the habit of applying an ice bag forabout five days while the patient rests in bed, followed,if this does not suffice, with local application of 10 percent. iodine pot. iod. ointment and hot poulticing.When the presence of pus is certain I make anincision 3 cm. long, put in a pair of forceps and afterpus is evacuated place in the cavity a tampon ofgauze saturated with common cod-liver oil, coveredwith Billroth batist, leaving this for four days, whenthe woman is cured. During this period thetemperature remains normal, there is no pain, some-times a disagreeable odour-but that is no matter.The method is easy, safe, and quick. All my recentcases have done well.

I am, Sir, yours faithfully,Nijmegen, April 28th. H. FEIKEMA.H. FEIKEMA.

MENTAL SICKNESS AND CERTIFICATION

To the Editor of THE LANCET

SiR,-The account given in THE LANCET of May 9thof the new hostel to deal with mental sickness whichis to be built in association with the Institute ofMedical Psychology will be welcomed by all who arefamiliar with the pressing need for such facilities oftreatment in London, and indeed throughout thecountry. At the same time it compels attention tothe unsatisfactory state of the law in relation tomental patients, and of the difficult position in whichthe Board of Control is likely to be placed when suchspecial hospitals are established.As the law now stands, patients who are con-

sidered to be certifiably of unsound mind must notbe kept for treatment except in a place licensed orapproved by the Board of Control and subject tovisitation by the Commissioners. This introduces