197

probably acute appendicitis. However, so long as thecondition is recognised at operation and properly treatedby excision of the mass, a surgical cure will be achieved.Ashington General Hospital,

Northumberland.R. REJTHAR.

ESTIMATION OF PROTHROMBIN-TIME

SiE,—I was most interested in Dr. Lehmann’s letterof June 17 (p. 1133), in which he ascribed the irregularresults obtained in the estimation of prothrombin-timesto the use of soapless detergents for cleaning the glass-ware. This has also been noted by several investigators,including myself, working in different laboratories inthe United States and employing a variety of thrombo-plastin preparations-e.g., Maltine-Chilcott,’ ’ Difco’,and Copley’s placental thromboplastin.1 In our labora-

tory, we have excluded soapless detergents for cleaningany glassware which is to be used in coagulation studies.We therefore welcome the attention which Lehmannhas drawn to this important source of error. His findingsrequire further study in regard to their theoreticalimplications.New York Medical College. A. L. COPLEY.

THE ALEXANDER LIBEL ACTION

SiR,—I read Dr. Barlow’s article, in your issue of

July 1, with the greatest interest. I should like to drawyour readers’ attention to two passages in his account ofthe action :

" Prof. Samson Wright dealt carefully with this pointand established that what Alexander was referring to ashis primary control’ has nothing whatever to do withMagnus’s concept of the Zentralapparat which refers tocentres in the brain-stem."

Summing up on this point, the Appeal Judges said :, ... The expert witnesses called for the defence say that

Alexander’s knowledge of these subjects is very limited andsome of them suggest that he never read any description ofMagnus’s experiments but was given a second-hand accountof them which he did not understand.’ "

I have had an intimate association with Mr. Alexanderfor close on twenty-two years and have been with himwhen he was reading the account of Magnus’s experi-ments, as described in THE LANCET over twenty yearsago, and when he was reading the account given in theLane lectures. Further, I was at least one person whogave him " a second-hand account of them " inasmuchas I provided him with a translation from the originalGerman in which Magnus wrote his book ICdfpeeHMtKjr,and gave him what I considered to be the meaning of thepassages on p. 619. I understood these passages as

describing the anatomical foundations of a central

integrating apparatus, its manner of operation, andits place of operation in the operation of the cerebro-spinal, sensory-motor, and muscular mechanisms of theanimal as a whole within the range of animals on which

Magnus had experimented.I can claim no expert standing as a German scholar

and may have been responsible for laying Mr. Alexanderopen to a charge that he relied upon a person who was notcompetent to guide him. May I suggest that a reliabletranslation of these passages should now be made inorder that their meaning in English may cease to be amatter of dispute ’?My reasons for this suggestion are that F. Matthias

Alexander, the late Rudolph Magnus, and the lateG. E. Coghill, all working quite independently, all

working experimentally, and, by the nature of theirorigins and education, working largely without pre-conceptions about the subject with which they worked,came to the conclusion that they could demonstratewhat they variously called a " primary,"

" central," orprimordial and indigenous" integrating guidance and

1. Copley, A. L. Science, 1945, 101, 436.

direction of the living "psycho-physical" or " psycho-organismal " whole. In his work with living persons,Alexander has transcended the work of Magnus andCoghill by providing a technique whereby a person maymake use of primary control and may thus guide andcontrol the manner of the performance of his reactionsin the best possible way.

Alexander may appear to stand quite alone in makinghis experiments and in drawing his conclusions fromthese experiments ; but it is possible, as I contend,that he would not be quite alone were the woxds writtenby Magnus about Zentralapparat translated withoutprejudice.

Bolton. MUNGO DOUGLAS.

SUPPLY OF HEARING-AIDS

SiR,—The recent statement in the House of Commons 1that the delay in issuing of the ’ Medresco ’ aids is

largely due to inability of technicians to fit them fast

enough certainly gives a very erroneous impression ofwhat is the actual fact in certain hearing-aid distributioncentres. One to which I am attached had the supply ofaids suddenly reduced, a month ago, to almost exactlyhalf the number per month, which meant a heartbreakingrearrangement of appointments for issue. The onlybenefit noticed has been the increase in time available tothe technicians to attend to the enormous numberof minor repairs necessary for the mass-producedinstruments.One accessory for which there is a great delay was not

mentioned: the individual plastic moulds for theinserted earpieces are not being produced nearly as

quickly as the demand requires.London, W’.1. IAN G. ROBIN.

INTRAVENOUS PROCAINE AND ANTI-

HISTAMINE DRUGS IN BRONCHIAL ASTHMA

SiR,-In 1941 Dos-Ghali, Bourdin, and Guiot 2 reportedthat procaine administered intravenously had provedeffective and safe in the treatment of bronchial asthma.I report here on the treatment of 12 cases of severeasthma and 21 of severe asthmatic bronchitis withintravenous procaine and an anti-histamine drug.Of the 12 cases of asthma, 7 had status asthmaticus, 2

having been in bed for over a month. The 12 patientsincluded a child aged 7 years, and 4 aged about 15 years.The remainder comprised 4 women and 3 men in their twenties,each with a history of recurrent attacks of asthma sincechildhood. Most of these patients were confined to bed whenfirst seen, owing to the severity of the attacks ; ephedrine,adrenaline, and theophylline with ethylenediamine hadbeen tried either by other doctors or by myself before startingthe new treatment, which was applied only where thesehad proved unsatisfactory. Each patient was thoroughlyexamined and his chest was radiographed ; and in each casestools were examined for parasites. In 7 of the 12 cases ofasthma no underlying organic case was found.The patients were submitted to a skin-test for

sensitivity to procaine, and thereafter were given upto 10 ml. of 1% procaine hydrochloride (without adrena-line) intravenously. Immediately after the injectionthe patient feels light-headed-a sensation which lastsfor a few minutes and is followed by a sense of relief andwell-being. The spasm is much decreased but not totallyabolished. He is then given 0-2 g. of ’ Neoantergan’by mouth ; and the drug is continued in a daily dosageof 1 g., in four divided doses, for a week, after whichthe dose is gradually reduced to a maintenance level.In only 2 cases was it necessary to give a second injectionof procaine, on the day after the first.

In the 7 cases of asthma where no cause was apparentthe attacks became mild and infrequent ; the remain-

1. See Lancet, July 15, 1950, p. 113.2. Bull. Soc. méd. Hôp. Paris, 1941 ; Pr. méd. 1943.