193"OPIUM-SMOKING."-WRITER’S CRAMP.

unless it can be proved that the dog has bitten someone pre-viously." It may interest your readers to know that this isnot quite accurate. It was decided by the Court of CommonPleas as long ago as 1866 in the case of Worth v. Gilling(reported in the Law Reports, 2 C. P. p. 1), that it was notnecessary to show that the dog had previously bitten anotherperson : it is enough to show that it has to the knowledgeof its owner evinced a savage disposition-e.g., by attempt-ing to bite. It is true, however, that it is not easy to satisfythe court of the scienter of the plaintiff without proving aprevious bite. I am, Sirs, yours faithfully,

Jan. 18th, 1899. WALTER P. HART.WALTER P. HART.

"OPIUM-SMOKING."To the Editors of THE LANCET.

SIRS,-In THE LANCET of Jan. 14th Dr. Herbert Snowasks the reviewer of his book whether he can give a singleinstance in which a person has felt the slightest opiuminfluence by smoking opium in any other way than with theone form of pipe perfected by generations of Chinese. I

cannot, of course, answer for your reviewer, but I can for

myself, and I assure Dr. Snow that if a cigarette madeof good tobacco-i.e., tobacco the smoke of which can beinhaled without irritation-be dipped in an ordinary dose oflaudanum-say, 20 or 30 minims,-allowed to dry, and thensmoked and inhaled the smoker will feel the "opium-euphoria" in about five minutes unless, indeed, he is singu-larly tolerant of opium. He will also probably, if the

cigarette be smoked at night, have a bad headache nextmorning. The same effect is produced by putting from10 or 15 minims into a pipeful of tobacco. This at leastis my own experience and that of several of my friends.

I am, Sirs, yours faithfully,Jan. 16th. CREDE EXPERTO.CREDE EXPERTO.

WRITER’S CRAMP.lo tlbe Editors of THE LANCET.

SiRS,-A case presenting some unusual peculiarities hasrecently come under my notice and I shall be grateful forany help in arriving at the probable cause of the group ofsymptoms to be described.A man, aged forty-eight years, consulted me suffer-

ing from what he thought, and was told, to be writer’s

cramp. In some respects his symptoms resemble writer’scramp inasmuch as there is inability to write with a penexcept with great difficulty. This difficulty also is increasedafter any excessive exertion or unusual excitement. Here,however, the resemblance ceases. When a pencil is substi-tuted for the pen there is comparative ease in writingand yet the same set of muscles are brought into play.In my patient’s case there has never at any partof his career been any excessive use of the muscles

employed in the act of writing, as is usually thecase in a genuine case of writer’s cramp. There isno spasmodic jerking of the thumb or finger during theattempt at writing. He has never been addicted to the useof stimulants or a heavy smoker. But the most peculiarfeature in connexion with the case is the fact that everyother member of the family (which numbers seven) is, witl:perhaps one exception, affected in a similar manner. Fou]sisters complain of the same train of symptoms and in theircase also no direct cause is assignable. There is nothing irthe family history to throw any light on the matter. Theirfather is living now, aged eighty-seven years, and theirmother was seventy-eight years at the time of her deathWith respect to treatment I may say that galvanism ancmassage have been tried but with no good effect. The poin’I wish to bring into prominence is this. If this want o:

coordination of the muscles used in writing is due to somimorbid state of the nerve-centres is it not extraordinary thait should attack practically all the members of one family ?

I am, Sirs, yours faithfully,Jan. 16th, 1899.

_________________

W.W.

"THE ’OPEN-AIR’ TREATMENT OFTUBERCULOSIS."

To the Editors of THE LANCET.SIRS,-It seems to me very important at the present

moment to decide the question whether the proposed homesor sanatoria for the open-air treatment of tuberculosis inEngland or Scotland will be of any use. I acknowledge we

cannot get the rarefied air and the amount of sunshine whichis obtained naturally in the Engadine and that therefore wehave disadvantages, but I maintain we have counterbalancing,advantages of several kinds. One is that by having glass-houses we have entire control of wind and temperature andcomplete absence of damp mist in bad weather. Next, as to-purity of air. I visited some years since one of the finesthotels in the Engadine. specially advertised on account of its-splendid system of ventilation, in which subject I have formany years taken great interest, and the manager was goodenough to show me all the details. Pure air was brought inbelow ground in the neighbourhood of underground kitchens,was heated by two boilers and carried by shafts to all thebedrooms and sitting-rooms; the air from the shaft wasadmitted at the lower part of each room and another openinginto the same shaft at the top of the room was supposed tocarry away the impure air of the room. I said at once to the

manager that the smell of cooking or tobacco would be-carried from one part of the building to another and heanswered they had found it to be so and were going to alterthe system entirely.A lady who had resided many years at another place

told me that the physicians attached so much importanceto fresh air that they had their patients’ windows nailedopen all the winter, but I am puzzled to understandhow delicate persons can bear the temperature in the absenceof good, wholesome, open coal fires such as we should havein England and which present one of the advantages over theEngadine where I saw nothing but closed stoves which warmone’s head more than one’s feet. Then we can have warmand dry air driven over hot water radiators by a fan through’our glass houses and bedrooms, so that they may be kept full,of pure air and at the same time comfortable ; this is done atmany schools, Leicester for example, so that it is practicable.In glass houses exercise can be taken at all times, and if large-enough, as at Welbeck, riding exercise and tennis can be-

practised at all times day and night with the aid of theelectric light, and glass houses appear to increase the powerof the sun’s rays in winter very considerably. Sydenhamobserved that riding exercise is a specific for phthisis.Passive exercise in the open air is one of the most important.remedies for tuberculosis undoubtedly and it would be

possible, I think, almost as often in our climate during the-winter as in the Engadine, on account of our warmer climate.There are other points involved in this matter besides rarefiedair and sunshine. One is that expressed by the medicalsuperintendent of a sanatorium for phthisical patients inSaxony, about 1200 ft. above the sea-"the teaching of

hygienic rules to patients" ; another is the isolation of’

phthisical patients from crowded, ill-managed, damp houses-’

so that they may not spread disease and so that they may,

have opportunity to recover ; and a third is that not one in.

-

10 or 20 can afford to go to the mountains, for the expense-’ to a second-class patient at the Engadine hospitals is 25s. per

week besides the expense of going, and even if homes wereestablished there English people, especially the poor, would

! object to going so far from their friends, and thus the

primary object of isolation from crowded damp homes wouldbe defeated.As to the purity of the air that of the German Ocean or

British Channel is as pure as, or more so than, that of Davosor St. Moritz, though I believe it is not so dry. Dr.J. C. Taylor gives us for six months (October, 1886, to.

March, 1887) at Davos: average number of hours ofsunshine per month 114’3, while in December there were-ronly 42 3/4°; snow fell on 55 days and rain on 9 of the sixmonths. The mean relative humidity was 83’1, being the-

mean of three daily observations. "There were 70 calm

t days, 57 breezy, and 55 windy and stormy; there was a

total of 104 clear or sunny days and 78 more or

less densely clouded." The average of three years.e 1886-1889 is nearly the same as the above. The mean’t relative humidity in our locality for the corresponding

six months of 1897 was 87’5 and the average numberof hours of sunshine per month 53’3, including 24 inDecember. The number of rainy days was 105, so that.there would be 77 days fairly clear, and probably exercise inthe open air could have been taken almost every day if the-patients were only educated to understand that pure air istheir most precious food and medicine. Dr. Taylor says o:"As to myself, I suffered very much more from the cold

Lt there than in England, as did also those relations of mine,s who were with me and who were in good health." This..

n agrees with my own short experience in the Engadine.’e There is one very important advantage which would