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have disproved, I think, that the approach is narrowand cramped. I have today removed without anydifficulty a prostate weighing 355 grammes. I would askMr. Hey to try the approach, and perhaps he will beconverted, like others not unacquainted with his opera-tion. I believe that he will find the access more direct,and the postoperative course easier.Does Mr. Morson (Jan. 19) still believe that the supra-

pubic tube is the handmaiden of sepsis ? If so, whydoes he continue to employ it in such a high proportionof his cases, when he too very properly stresses asepsis ?To Mr. Bailey (Jan. 12) and his hankering after the

osteoplastic trapdoor, I would say : please try theretropubic approach. Why open both doors of the

garage to get his bicycle out ? I can find descriptionsby Beer (1924) of 12 cases of periostitis of the pubisfollowing suprapubic cystostomy, and since then 17 caseshave been published, the last 3 in 1941 ; so, bearing inmind that it is a form of surgical failure, and thereforeunlikely to be reported as often as success, it cannot beso very uncommon.London, W.1. TERENCE MILLIN.

ERYSIPELOID

SER,—Dr. Barber and her colleagues draw attention(Jan. 26) to 7 cases of this rare condition resulting fromwounds incurred while handling beef or rabbit duringthe later months of 1945. Dr. Singer (p. 124) reportsa case following the handling of a dead pig. During thissame period a woman was referred to the skin depart-ment at the South London Hospital with the reportthat she was the third case of the same type recentlyseen. The three patients were workers in differentfish shops, and all gave histories of injury by a fish-bone. In all of them, raised red patches had developedat the site of the injury, which was painful, and had spread.The patches bore a resemblance to erysipelas, but theborders were not so definitely demarcated ; lymphangitiswas present ; the lesions did not suppurate. 1BTo patho-logical investigation was made.It is of interest that all these 11 cases were seen within

a few months at hospitals in London. Barber et al. suggestthat the present increased incidence of this affection maybe due to meat which in times of plenty would havebeen condemned being passed for human consumption.This hypothesis is supported by recent reduction fromtime to time of the Jewish ration because rabbis havenot passed meat released for general distribution.London, W.I.

’ ELIZABETH HUNT.

SIR,-In the two articles in the Lancet of Jan. 26,pp. 124 and 125, the condition is referred to as ratherrare, but it was fairly common in my last practice inDorset, and responded very rapidly to gr. 7! sulphanil-amide every 4 hours for 24 hours. The condition wouldusually clear up in 48 hours on this treatment, butoccasionally it might recur two days later, when asecond course completed the cure.

n

Cirencester, Glos. R. E. HOPE SIMPSON.

ORGANISERS AND THE GROWTH OF BONE

SiE.,—Referring to your annotation of Jan. 5, p. 23,I realise that it may have been difficult to summarisein one column a subject which I needed several papersto approach. But if it was to be attempted at all, therewas surely no need to be inaccurate, make misleadingor amazing statements, and misquote or disguise myopinions.You write in one sentence : " Fibroblast cells gathered

round the transplanted cubes... -a ’typical inductionphenomenon ’ is Lacroix’s comment " ; which is ofcourse ridiculous. My text read : " The formationof this bony ring is a typical example of an inductionphenomenon," which is quite different. Furthermorethe meaning of this observation cannot be grasped if thereader is not told beforehand of the presence of the samebony ring in the normal ossification groove, a fact over-looked so far and which should have been mentioned.You write : " alcoholic extracts of the long bones

where I said " from the cartilaginous epiphyses of thelong bones." You refer to Blum’s experiments as beingconcerned with injections " of kidney phosphatase "whereas Blum’s very words (Lancet, 1944, ii, 75) were’’ phosphatase was prepared from the long bones andkidneys." "

I laid stress on the high degree of organisation shownby the results of my injections, this being in sharpcontrast with the low degree of organisation obtainedup to now in the production of ectopic bone. Youseem to suggest that if I am to admit the participationof an organiser in these highly specialised processes,I might as well be led to admit that an ill-fitting shoeorganises blisters. Is this a proper way to present anauthor’s opinion PNow to come to the best example of scientific objective-

ness. Before even seeing my illustrations, the fullreport ,still being in the press, you foresee that " noneof these results will surprise those familiar with theexperimental production of ectopic bone : gall-bladderand urinary epithelium will do as much."

I might go on like this. Need I say more to convinceyour readers-who deserve better consideration-that,if they happen to be interested in the subject indicatedby the title, they had better not rely on the annotationbut should refer to the following original publications ? I

P. LACROIX.Institute of Anatomy, University of Louvain, Belgium.* * We are sorry that Professor Lacroix feels that the

twofold digestion of his work-in Nature and in ourannotation-has done him an injustice ; we felt that,inadequate as the presentation must be, his empiricalresults were of sufficient importance to justify an imme-diate mention. We are still by, no means convincedthat he is justified in describing the phenomena he hasput on record as

" inductions," and we still feel thatparticular mention should have been made of the r61eof phosphatase in the formation of ectopic bone. Butwe heartily endorse Professor Lacroix’s recommendationthat those -who are interested in the subject should readhis original papers. It is to encourage this that ourannotations are written.-ED. L.

WEIL’S DISEASE

. Sm,—May we make the following request to clinicalbacteriologists in Great Britain ? We should be greatlyobliged if all who have been carrying out the serologicaldiagnosis of Weil’s disease would let us know how manycases they have diagnosed during the years 1940 to1945, and (if quite easy) the number of sera they havetested for this purpose.

Sir William Dunn School ofPathology, University of Oxford.

A. D. GARDNER.J. A. R. WYLIE.

TUBERCULOUS RHEUMATISM

SiR,-Like Dr. Wilfrid Sheldon (Jan. 26) I have beeninterested in tuberculous rheumatism. The cases out-lined below were seen in five years among 750 personalcases of active pulmonary tuberculosis.CASE 1. Arthralgia.-A boy of 6 with a strong family

history of rheumatic fever had debility and cough in October,1945. During November he had a sore-throat, and developedfleeting pains (without swellings) in the right ankle, knee,and hip. The erythrocyte-sedimentation rate (E.s.R.) was20 mm. in one hour. He was admitted to hospital for sub-acute rheumatism, but fever persisted despite salicylates ; hehad a positive Mantoux (1 : 10,000), and on radiography a largeshadow was seen around the right hilum. Observationconfirmed the diagnosis of tuberculosis.Sheldon stated that a fleeting pericarditis without an

accompanying arthritis may indicate recent tuberculousinfection, but said he had not seen any such instancesrecorded.

CASE 2. Pericarditis tznd arthralgia.-A girl of 15 wasadmitted with acute pericarditis going on to effusion, com-plicated by collapse of the left lower lobe of the lung. Shehad pain in the left shoulder for one night only. The con-dition was treated as acute rheumatic fever. Abnormal signsdisappeared and the fever subsided, but tachycardia persisted.Five months after admission rates were heard at the left apexof the lung, and tubercle bacilli were recovered from the

gastric juice.CASE 3. Chronic rheumatism.-A woman, aged 19, had had

pains in her hands and feet for two years, and, for a few

1. Mém. Acad. R. Belg. 1943, 2, fasc. 2 ; Arch. Biol., Paris, 1945,56, 185 ; Anat. Rec. 1945, 92, 433 ; Arch. Biol., Paris, 1945,56, 351 ; Nature, Lond. 1945, 156, 576 ; Bull. Acad. R. Belg(1946) in the press.