1477

I suggested, which they appear to have seen held out goodevidence of its probable or at least possible success.

"

I am, Sir, yours faithfully,Wimpole-street, W., Nov. 7th, 1908. J. SIM WALLACE.J. SIM WALLACE.

DIVISION OF THE AUDITORY NERVE

FOR PAINFUL TINNITUS.

To the Editor of THE LANCET.

SIR,-In reference to the correspondence respectingdivision of the auditory nerve for painful tinnitus I shouldlike to mention that on May 25th, 1905, I divided the rightauditory nerve of a male patient, aged 32 years, who for overtwo years had suffered from very severe tinnitus and vertigowhich had prevented his following his usual occupation.From Jan. 28th, 1904, to May, 1905, he had been an out-patient at the hospital and despite many different methods oflocal treatment obtained practically no relief. Operation wasaccordingly suggested and agreed to. The internal auditorymeatus was approached through a large osteoplastic flap inthe temporal region, the temporo-sphenoidal lobe beinggradually displaced and the nerve ultimately reached byworking from above along the posterior surface of the parspetrosa. The operation, on account of the great difficultyexperienced in displacing both cerebrum and cerebellum,proved so difficult and tedious (occupying two and a halfhours) as to make it evident that some other route should infuture be selected. The patient suffered very severely fromshock for four days, but ultimately recovered and left thehospital in good health and able to resume work.Upon July 31st, 1906, I again divided the right auditory

nerve in a female patient, aged 46 years, who suffered

severely from tinnitus and had twice threatened to take herlife. This time the nerve was approached through a largeopening in the masto-occipital bone, the cerebellum beingslowly displaced by a flat-shaped spatula. The operationwas completed in one stage. Unfortunately, whether fromloss of cerebro-spinal fluid (the loss was enormous) or fromshock, the patient never rallied and died three days after-wards. The displacement of the cerebellum I found a veryreal and practical difficulty. At both operations I had theable and willing assistance of Mr. H. Lund and Mr. D.

Lindley Sewell. I am, Sir, yours faithfully,Manchester, Nov. 4th, 1908. WILLIAM MILLIGAN.

To the Editor of THE LANCET.

SIR,-I am greatly interested in the letters which appearedin THE LANCET of Oct. 31st, p. 1326, relating to divisionof the auditory nerve in cases of severe tinnitus. WithMr. M. Yearsley, however, I should like to know why Mr. C. A. Ballance did not " open and destroy thecochlea in preference to submitting the patient to themore serious cranial operation"? Mr. Richard Lake first

destroyed the cochlea in a similar case some four years agoand published the very satisfactory results shortly after-wards. "Depuis elle a ete pratiquee avec succes par un deses collègues le Dr. A. Logan Murison," as Mr. Lake (whomI followed some two years ago) observes in an article inR6vwe Hebdomadaire de Laryngologie, d’ Otologie, et de

Rhinologie.I am, Sir, yours faithfully,

’Weibeck-&treet, W., Nov. 4th, 1908. A. LOGAN MURISON.

WILLIAM MILLIGAN.

A. LOGAN MURISON.

DIRECT EXAMINATION OF THE LARYNX,TRACHEA, AND ŒSOPHAGUS BY

BRUNING’S INSTRUMENT.10 the Editor of THE LANCET.

SIR,—May I’ correct a mistake which appeared in thisarticle in your last issue ? In the description of the radio-gram, p. 1362, the double outline of the pin is caused bycardiac and not by respiratory movements as stated therein.

I am, Sir, yoms faithfully,Nov. 9th; 1908. HERBERT TILLEY. HERBERT TILLEY.

THE INTERNATIONAL CONGRESS ONTUBERCULOSIS AT WASHINGTON.

(FROM OUR SPECIAL SANITARY COMMISSIONER.)

SUCCESS OF THE CONGRESS AND GREAT CONSIDERATION-SHOWN TO THE FOREIGN DELEGATES. -TRANSLATIONS.-THE QUESTION OF THE VOTES AND RESOLUTIONS.-THE DARK SIDE OF THE CONGRESS.-CROWDED SECTIONS-AND THE ATTEMPT TO ANNUL THEIR WORK.

New York, Oct. 9th.ON all sides we hear loud congratulations of the work of

the Congress and all Americans in asking for an opinionupon its work do so in a manner that admits of no doubt asto the answer they expect. Certainly it has been a wonderfulmanifestation. Nothing but praise can be uttered when thewhole-hearted enthusiasm of the crowd of members andalso of the general public is considered. This has been a

great uprising of public opinion, led by the medical profes-sion, but eagerly followed by thousands who, though nottechnicians in any way, are eager to learn how best they canhelp to fight the great white scourge. Last night I wasassured the Congress had enrolled more than 6000 mem-bers. The press throughout the country is talking abouttuberculosis, so that good educational work is being done.As for the delegates from abroad, they can but gratefullyacknowledge that every effort was made to welcome them,to fete them, to honour them; and, what is more rare andmore difficult, to give them every opportunity of speaking.Writing before the Congress had met, I pointed out whatwere the shortcomings of such gatherings. On that occasionI indicated the great danger that arose from the inevitableexcess of local members as compared to the number ofmembers able to come from foreign countries. This seemedto me all the more necessary as Washington is so far awayfrom Europe that the foreign contingent was likely to beexceptionally small. There was a risk that, what with thedifference of languages and the overwhelming number ofEnglish-speaking delegates, the representatives of othercountries would hardly be heard. To-day, however, I am

glad to state that the American organisers and the chairmen,of the various meetings did their work well and with thespirit of true hospitality. The foreign delegates were notonly able to obtain a full hearing but some official trans--lators were appointed and speeches were translated intoEnglish and German. In this latter respect the Third Inter-national Congress on Tuberculosis has been an improvementon the preceding Congress and on many other international’scientific congresses.On the other hand, and as far as the resolutions are con-

cerned, the present Congress has taken a step backwards.I know that the whole question of resolutions is open tomuch criticism and I have on more than one occasion

expressed some scepticism as to the value of the vote given.by the plenary sitting when at the close of the Congress theresolutions adopted in the sections are confirmed by theentire Congress. Often such votes are given out of polite-ness rather than from conviction. In any case he must be abold man to rise before the whole Congress and challengethe decision of a section, this, too, when the end of the Con-gress is close at hand and most persons are anxious to getaway. But if it is thus possible to criticise and to belittlethe value of the votes given by the entire Congress at thefinal meeting such arguments cannot in any way apply to theresolutions adopted in the sections. Here, that is in the

sections, there is full opportunity for discussion and for the-moving of amendments. The votes of sections are of real.value, have frequently helped in the framing of laws, andserve as guides to the legislators of many countries. It is,therefore, most important that they should be read out beforethe entire Congress, that all present should know what the,sections have done, and that this should be repeated by thenewspapers. Otherwise the work of the sections wouldremain buried so far as the general public is concerned. The-value of the vote given by the entire Congress endorsing theresolutions carried in the sections may- be challenged; the-value of making the work of the sections known cannot bedisputed. Now, at Washington, these resolutions were notread out at the final sitting and, of course, no vote was takenon them,

1478

There are, then, two blots on the Washington Congress.The first I have already explained in my last letter. Itrelated to the unwilling attitude of the authorities, or at leastthe representatives of the authorities ; they refused to grantthe requests made to them by the American medical menwho were striving to organise the Congress and hoped, amongother things, to obtain permission to hold the meetings inthe Capitol. The second is connected with this question ofthe resolutions. It appears that on the last day but one,the Friday, a self-appointed committee sat where besidesProfessor Koch hardly any foreign delegate was present.Though these persons could not possibly have had anyauthority to interfere with the well-established course fol-lowed at international congresses they took upon them-selves to decide that no resolutions whatsoever should bepresented to the Congress. The meeting for the closing ofthe Congress was to take place on the morrow, the Saturday,at 11 A.M., and as usual the International Committee wasto meet an hour previously to put the resolutions from thesections in order for their presentation to the entire Con-gress. Unfortunately, the Americans, who had been generallyvery punctual, came late to the meeting. Then, to theintense surprise of the majority present, it was announcedthat it had been decided not to read out any of the resolu-tions. Fortunately, the foreign delegates are not accustomedto such closures. Professor Landouzy, Dean of the ParisFaculty of Medicine, sprang to his feet and loudly expressedhis astonishment that in so-called free America no respectwas shown for the work and the votes of such an imposingCongress. He inquired whether he was expected to go backto Europe empty-handed, with nothing whatsoever to show asthe result of a week’s work and discussions. Never, inthe most despotic countries of Europe, Professor Landouzyinsisted, would anyone have dared to trifle with the workof such learned specialists as those who had assembled atWashington. He finally defied the Americans present toproduce any sort of evidence to show that at any Europeancongress such an autocratic interference with the principle ofrepresentation had been attempted. I do not guarantee that ’,these were Professor Landouzy’s words but such appeared to be the spirit and meaning of his most energetic, almost I

violent, protest. Professor Arloing and Professor Calmette Iwere equally emphatic. Then the British, the Danish, someSouth Americans, and finally some of the Americansthemselves joined in the protest. The position becamethreatening, the Congress might have broken up in con-

fusion, therefore the promoters of this remarkable innova-tion gave up the attempt and withdrew their proposal.But so much time had been wasted that it was impos-sible to go through all the resolutions. The majorityof the International Committee therefore decided to try tosummarise some of the points in a general resolution. Thiswas impossible, and the few somewhat anodyne resolutionsthat were read out at the end of the Congress in no wiserepresented what the Congress had done.

Needless to say this grave incident has led to muchconversation and gossip. Professor Arloing is determinedto speak publicly and strongly when he reaches his homeat Lyons. Several members present at this memorable inter-national committee meeting have appealed to me to givefull publicity to the attentat against free discussion, as theoccurrence has more than once been described. Of course,if a murder is committed, the first question asked is whetheranyone is interested in the death of the victim. Now itis quite clear that the medical profession in America is notinterested in this wholesale massacre of all the Washingtonresolutions. It is known that in Germany there are strongpolitico-agrarian interests involved in the question of bovinetuberculosis and doubtless there may be some Germans whowould not be sorry to minimise the work of the Congress.However this may be they were signally unsuccessful if suchan attempt was really made. On that question the Congressdid make an emphatic pronouncement. It is on the questionof housing that the Congress has gone back and has failed toproduce emphatic pronouncements such as were made atParis three years ago. The speculators in building landsand the individuals who grow rich on the rents gatheredfrom unhealthy dwellings would have felt their positionmenaced if this great congress had repeated the Parisresolutions. Nor would they have been pleased by the resolu-tions carried unanimously in the fifth section at Washington,when members of the Commission of Inquiry on the

Housing at New York were present. One of the resolutionswhich hit the sky-scrapers was worded as follows :-Be it resolved that the International Congress on Tuberculosis in

Washington recommends that the height of buildings and the pro-portion of the site that may be covered be restricted in all sections ofcities not yet built upon, the regulations varying according to thedistance from the centre of the city and local conditions.

There was also another resolution in the fifth section to theeffect that the authority and the householders shouldcombine to establish a sort of sanitation fund and that " incase of insanitary conditions the authority may sue the

culprit, whether it be the occupier or the owner." It shouldalso be observed that in some of the discussions in the fifthsection Americans brought forward American resolutions.

These, however, were withdrawn as the purport of the

Congress was not to give a pronouncement on Americanaffairs and the section rightly decided to vote only onmatters that were of international interest. It is veryunfortunate that the work thus done in the sections shouldbe buried in the reports of those sections. Never at anyinternational congress have I seen the sectional meetingsso well attended. Section V. was especially crowded, oftenit was impossible to get a seat, and there were always severalhundred persons present. In regard to attendance and ardourin following the discussions the Washington Congress hascertainly greatly distinguished itself and that renders theattempt to smother up the results of all this work themore unwarrantable. The medical profession in America hasnot hesitated before now to attack the most powerful financial interests in the public cause, and it must be taken for grantedthat the suppression of the resolutions was merely a graveblunder.

WORK OF THE SECTIONS.

WEDNESDAY, SEPT. 30TH.On Wednesday evening, Section I. was joined by Sec-

tion VII. in order to discuss the relations of bovine andtiuman tuberculosis and to see whether an understanding3ould not be reached as to the transmissibility of the bovinetype to human beings. The presence of Professor Koch3timulated popular interest in the meeting, while the prac-ical importance of the issue caused the discussion to befollowed by many publicists ; for much pending legislationllay be influenced by its results. As much remained to besaid when the adjournment was taken a special continuance)f the session was arranged for Friday morning.l It was,aowever, held in private, in order to prevent journalists fromobtaining information which might be used for an object)ther than scientific. Admission was by card only and yourcorrespondent had the good fortune to be present. The

proceedings will be published in full in about three monthsas soon as each speaker can revise the report of his remarksas taken by the official stenographer. As a result of the

meeting it appears that Professor Koch stands nearly alonein the belief he enunciated in 1901 at the London Congressthat bovine tuberculosis is of comparatively little importanceo human beings.Professor ROBERT KOCH read the following paper on

The Relations of ITzcmczn and Bovine Tuberculosis.EIe said : The question whether or not human and bovinetuberculosis are identical is indeed of high theoreticalinterest. But the practical importance of the question whichconcerns the prevention of tuberculosis is of far greaterimportance. For this reason I will confine myself solely toa consideration of the practical side of the subject. Torheobald Smith of Harvard belongs the credit to have)een the first to call attention to certain differencesbetween the tubercle bacilli found in man and in cattle.It was his work which induced me to take up this;ame study. In cooperation with Schutz I have under-taken a series of experiments for which we selected;attle, these animals being specially suited for such work.rhe results of these experiments have led me to conclu.;ions which I have first communicated to the Britishcongress on Tuberculosis in 1901. They are in substance as

1 It will be seen that our local correspondent, who was present at theprivate or semi-private meeting, does riot take so serious a view of thepolicy pursued as has been taken by our Special Sanitary Commissioner,who, however, may be taken to voice the opinion of the foreign dele-gates generally. It will be noticed that both of our contributors alludeto the fact that political reasons were at the bottom of the departurefrom accepted custom.