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known words and sentences of those elements of

speech he has already indefinitely heard. Thesesounds, therefore, become mnemonics, calling upwords and sentences acquired by means other thanhearing for the unvoiced or semi-voiced sounds arenot heard. No other conclusion is possible for theconsonantal elements of speech generally makeinsufficient audible appeal to be recognised by actualhearing in these extremely ha,rd of hearing cases.

lloreover, if this were not so, apart from any psychicquestion whatever, there should be no difficulty ininducing children of this description to mechanicallyreproduce any word they " hear." I have testedcases of this sort by substituting such words as

"rather" " and "lather" " for the known word,father," and found them reproduced as the latter-clear evidence that it was not actual hearingpower, but rather the association and sequenceof the heard vowels, a mnemonic phonetic memory,that accounted for the wrong reproduction.Unless, therefore, " results " in these cases are

carefully analysed and traced to their source,even the very elect, whether teachers or doctors,may easily be deceived. And this frequentlyhappens.Over 30 years since I had charge of a class formed

entirely of children with varying degrees of hearing,and 18 months’ experience of this class, using the voiceunaided or assisted as necessary by the doublespeaking tube, led me to the conviction that actualhearing power was in no way improved, but ratherthat the appreciation of what had been already heardwas made greater-a qualitative rather than a

quantitative improvement. Experience with cases

of this nature continuously during the past 30 yearsentirely confirms my earlier judgment. Teachers donot exclude any scientific possibility, but they dosay that these frequent promises for the physicalrelief of deafness, promises which they have neverseen to materialise in any real amelioration of thecondition of the deafness of children in our schools,unsettle the minds of parents of deaf children, andprevent then, in many cases, from giving suchchildren the only hope they have-namely, suitabletraining and. education. There is evidence, too, thatmedical men, including aurists, do not properlyappreciate the extreme remoteness of restoring aserviceable degree of hearing power such as wouldmake the child independent of visual means ofunderstanding, and that the best place for suchchildren is one which would not only conserve

existing hearing power, but further carry on theiroral and general education. In many cases

parents and medical men do not understand thepresent condition of schools for the deaf. Thereis no doubt that many associate such schoolsWith an atmosphere of perpetual silence, whereasin actual truth the modern school for the deaf isvocally noisier than the school for hearing childrenoften is.The attitude of teachers of the deaf towards this

question is perfectly clear. They would welcomewith open arms anything that would give to theirpupils even a serviceable modicum of hearing ability,but so far as present knowledge is concerned theyknow that for the training of residual hearing powerin deaf children, whether for increased appreciationor " sorting out " of already hazily heard speech orfor the very remote possibility of developing existinghearing power, their methods, based as they are upon ascientific study of phonetics and the practical know-ledge of the physical and psychic conditions of thedeaf child, promise more effectually than anythingYet known the fullest amelioration of the lot of thedeaf. Teachers of the deaf have for many yearsadvocated the scientific classification of deaf childrenaccording to the history and degree of deafnessand their mental condition. If this were done itwould be to the great advantage of the differenttypes, but in present circumstances, and even whenclassification is achieved, teachers of the deaf claimthat their special knowledge and experience mark

them as more qualified than any other class of teacheror trainer for those children who suffer from deafness,whether complete or partial.

I am, Sir, yours faithfully,

I Stoke -on -Trent, Nov. 4iA. J. STORY,

Chairman of the National College ofth. Teachers of the Deaf.

To the Editor of THE LANCET.

STR,-IN Dr. Arthur F. Hurst’s letter in your issueof Oct. 22nd he appears to claim that in any case ofdeaf-mutism, in which the vestibular reactions arenormal, the deafness is functional. It would beinteresting to know if Dr. Hurst is aware of thenumerous cases now on record in which microscopicexaminations of the labyrinths of deaf-mutes haveshown a perfectly normal vestibular apparatus(including the criste of the semicircular canals, themacula of the utricle, with their associated nerves andganglia), but a more or less completely degeneratedcochlear apparatus. In the majority of cases thesaccule was also affected. Functional examination ofthese patients showed a normal vestibular response.Some of them were completely deaf, while othersshowed remains of hearing, and it is these hearingremnants which Prof. Urbantschitsch was anxiousto utilise by means of his harmonica and acousticexercises.For many years otologists have been in the habit

of advising the parents of deaf-mutes with slightremains of hearing to speak to their children in aloud voice and to give the children noisy toys to playwith. Dr. Hurst’s patient efforts to educate theseextremely deaf children are to be commended, buthis assumption that the deafness is functional canhardly be accepted. Had the deafness been entirelyof this nature, one would have expected sudden andcomplete restoration of hearing. Further, it isextremely difficult, if not impossible, to believe in a.

functional disorder of hearing arising in infancy.I am. Sir. vours faithfullv.

J. S. FRASER, M.B.. F.R.C.S. Edin.Edinburgh, Nov. lst, 1921.

TRYPANOCIDE.

To the Editor of THE LANCET.SiR.—With reference to the annotation on the

Treatment of Sleeping Sickness, which appeared underthis heading in your issue of Nov. 5th, I should liketo correct a misapprehension in the last paragraphunder which apparently ’Prof. Warrington Yorkelaboured when he published his recent critical reviewin a medium which precluded the possibility of a,

reply.The expressed object of the mission as endorsed by

the Colonial Office is to test out and compare variousmethods of treatment already in vogue, or which maybe put forward in the near future (the new Germanpreparation " Bayer 205 " having been specified) andfurther to place the Commission under the generaldirection of an independent scientist. As clinical andlaboratory experience is a necessity, the Associationhas approached Prof. J. W. H. Eyre, of Guy’s Hospital,who was in 1906 chairman of the working party of theMalta Fever Committee and he has signified hiswillingness to accept the post of director.With reference to Prof. Yorke’s criticism as to

absence of controls I would point out that the workdone by Marshall and Vassallo has been performed bythem as Uganda medical officers in the field and intheir spare time, without the great advantage of havingtheir patients constantly in hospital and completelyunder their control, so that they have been unable tocarry out all the controls and examinations whichwould have been possible in a well-equipped labora-tory attached to a hospital in England. Further,they have carried out a method of treatment whichthey have found highly successful in practice and haveoffered several theories to explain these results.Taking their actual results as compared with othermethods of treatment (the Tropical Disease Prevention

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Association expects to receive early in 1922 a reportembodying all the results of treatment up to that date),though some data are necessarily incomplete, thereappears every prospect of these figures entirelyjustifying the claim that this serum method is givingbetter results than any other in use up to the present,especially when cases of trypanosomiasis from thesame countries are compared.The opinion, based on a clinical observation that

" although the administration of one dose of salvarsan,neosalvarsan, or atoxyl is sufficient to sterilise theblood stream, symptoms reappear within a variableperiod averaging about four months and the diseaseprogresses to a fatal termination " comes in for adversecriticism, although in the main it corresponds withthe results revealed by an analysis of the figures putforward by Prof. Yorke and certainly agrees withthe results of animal experiments detailed bv ColonelWenyon in his article in the British lt2ectical Journalof Nov. 5th, wherein he states, " in experimentallyinoculated small animals, such as mice, it is usuallypossible, by means of a single dose of a drug, to bringabout the disappearance of trypanosomes from theperipheral blood, but almost invariably relapses occurin a comparatively short time and the animals dieof the infection."

Finally, the Tropical Disease Prevention Associationis not prejudiced in favour of any one method of treat-ment, but it does consider that fair play should be givento any method which has shown promise of success.This attitude is not conspicuous in Prof. Yorke’sreview. On the other hand, far from condemningthe value of " Bayer 205," in spite of the fact that tothe best of its knowledge this secret remedy has beenused on only one human patient, the Association is,the more readily after Colonel Wenyon’s experiments,prepared to investigate its importance. A Germanexpedition under the auspices of our Colonial Officeis now on its way to Rhodesia to test this treatmentwith the aid of our medical officers in the colony.’The expedition, which I am assured by the ColonialOffice is disinterested, is financed entirely by Germancommercial firms who, in view of the present valueof the mark and the non-existence of German colonialinterests, may or may not be disinterested also.Further, I am informed that the composition of " Bayer205 " will be revealed later. Past experience ofGerman descriptions of the method of manufactureof " 606 " leads one to anticipate that this revelationmay not enable others to reproduce the remedy inquestion.

It is, perhaps, not fully recognised by tropical expertsworking at home that treatment of such a disease as.sleeping sickness must be administratively and econo-mically practicable on a large scale as well as

scientifically effective in a hospital at home. It cannotbe stated too emphatically that the object of theAssociation is to try serum and other methods in thefield in order to gauge their respective values forstamping out sleeping sickness.

I am, Sir, yours faithfully,

Harley-street, W

E. T. JENSEN,Hon. Secretary, Tropical Disease Prevention

., Nov. 7th, 1921. Association.

BELLADONNA POISONING:AN OVERDOSE OF ATROPINE.

To the Editor of THE LANCET.

SiR,—In connexion with several cases of belladonnapoisoning reported lately the following note may beof interest.A boy of 19, of not a very high intellectual standard,

on being discharged from hospital was given a prescriptioncontaining some citrate of potash. This prescription heignored, and did not even take to the dispensary, but heabstracted from my consulting room a small 2 oz. glassstoppered bottle containing about an ounce of the " B.P."solution of atropine sulphate. This he took home withhim, and about 2.30 P.M. took, on an empty stomach,a teaspoonful of the solution. Fortunately he did not takea tablespoonful, as he had been ordered to take of the citrateof potash mixture. About 4 P.M. he felt " queer " and his

panel doctor was sent for, who gave him an emetic, andabout 8.30 r.M. he was sent to the hospital, where I saw himon admission. He was restless and delirious, trying to

get off the stretcher, though he could not stand. His pupilswere widely dilated, and his mouth and throat very dry,but at no time was there noticed any scarlatiniform rash.A note from his doctor explained the circumstances of thecase. No further emetic was given, but morphia (gr. j)and nitrate of pilocarpine (gr. ) were injected, the urinedrawn off to prevent any reabsorption, and 2 or 3 pints ofstrong hot coffee administered. At 11 he was no worse-a smaller dose of morphia and pilocarpine was

administered-the urine again drawn off and more hotcoffee given. At midnight he recognised the night sisterand myself, and at 8 A.M. the next morning he was prac-tically all right-the pupils were, however, still dilated.At noon he ate the usual hospital dinner, and the next dayhe was discharged.

I obtained the actual teaspoon used to measure thedose: " brimming full" it contains 90 minims,ordinarily " full " about 60 to 70 minims, so thatwith 1 gr. in 110 minims he must have taken at leastgr., and possibly more, of sulphate of atropia on anempty stomach.

I am, Sir, yours faithfullv,H. NEVILLE TAYLOR, M.A. Camb., M.D. Dub.,

F.R.C.S. Edin.,Surgeon, Ebbw Vale Hospital ; Consulting Medical

Officer. Ebbw Vale Medical Society.

I Ebbw Vale, Nov. st, 1921. --- ---.------ ----."-

OCCIPITO-POSTERIOR PRESENTATIONS.

To the Editor of TuB LANCET. ,SiR,-May I call attention to a feature of modern

obstetrics ? It appears to me that persistent occipito-posterior presentations are not only commoner thantext-books would lead us to believe, but tend yearlyto become more frequent. In a recent BritishMedical Association lecture, Prof. W. Blair Bell saidthat,

" Owing to the fact that this presentation, ifleft alone, almost invariably rotates into the occipito-anterior position, the frequency of the occipito-posterior position as a primary presentation hasprobably been much underestimated." My expe-rience does not teach me that " almost invariably" "

patience will resolve the awkward presentation intosomething simpler. Rather am I impressed by themultiplicity of cases in which labour proceeds untilthe persistence of this presentation leads to exhaustionof the maternal resources and constitutes a menaceto mother and infant. Conversation with fellowpractitioners and maternity nurses strengthens myconviction that such cases are on the increase. Fromrough notes of cases within my own limited experience,I find that in the year 1909 (out of 116 full-timelabours attended) 8 were persistent occipito-posteriorpresentations ; in 1918 (of 163) 22 ; in 1919 (of 115)24 ; and in 1920 (of 126) 31. Reduced to percentages,these figures work out as 6-8 in 1909, and 13’1, 20,8,and 24-6 respectively for the last three years.For various reasons I do not pause to discuss what

evolutionary processes contribute to bring aboutthis development. But I see that, if its reality beconceded, it is time that those who instruct potentialobstetricians were agreed upon the method bestcalculated to meet this contingency in labour.Because, in a majority of cases, delay or faultymanipulation means damage to maternal structures-and the tale of injury may not end there. Quarterof a century ago, as a student, I heard of the methodwhich I still deem best-application of forceps,rotation of the foetal head, and traction-but myprofessor never’ himself practised the trick, and,indeed, towards the end of his life showed pride inthat fact. Such an attitude, or at best a little bending,is still widely prevalent. Yet the manceuvre issimplicity itself. Chloroform anaesthesia is desirablebut not imperative for its performance. Essentialto success are (a) correct diagnosis of the " lie " ofthe head and accurate adjustment of the forceps;(b) secure maintenance of the " lock " until deliveranceof the head, or its deposition within manual control

1 Delivered before the Bradford Division, May, 1921.