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meter test, the percentage suffering from deafnessmust be even greater than 8-5 per cent.

Experience has shown that attempts to guess areineffective, and can be easily detected. I fear thatMr. Yearsley has overlooked the fact that, by thegramophone records used with the audiometer,numbers consisting of three digits for any givenloudness of speech are used, and the chance of achild guessing them correctly is approximately 500to 1 against. If single digits were used, the chanceof a correct guess might be 9 to 1 against. Moreover,by the audiometer method there is no chance of lipreading by the child, and each ear is tested separately.’The particular advantage of numbers consisting ofthree digits is that three distinct speech sounds areused for testing hearing at various intensities, andthe children can easily write down the symbol forthese sounds-namely, the digits-without havingto bother about spelling a word, which would be thecase if words were used.For very young children, for example in age 4

to 6, who cannot write, a record using some of the.earliest words understood by a child has been pre-pared. In this case the child is asked to point to apicture of an object when the name is called, the Inames being transmitted by the headphones to theear at varying, but standard, degrees of loudness.Even such young children readily cooperate in thetest, as almost all of them have tried to listen towireless through headphones.

Mr. Yearsley’s second objection to the audiometer,because it drew attention to a case in which thecause of deafness was found to be wax, is in fact arecommendation. Already many children, with

partial deafness due to wax, have had their hearingrestored as a direct result of detection by the audio-meter, but this would not have happened if thechildren had not been tested. The detection of hear-

ing defects at the earliest possible age is of para-mount importance, and then medical examinationand treatment, and possibly special educational

care, but the detection of impaired function is thefirst step towards a solution of the problem of deaf-ness. Permanent damage to the hearing mechanism,and to the health of the child, may have occurredif the defect is not detected before it is obvious tothe patient and also to school teachers.

I am, Sir, yours faithfully,GUY P. CROWDEN.

London School of Hygiene and Tropical Medicine,Keppel-street, W.C., Dec. 8th, 1931.

ASPHYXIA FOLLOWING INJECTION OF

TARTAR EMETIC.

To the Editor of THE LANCET.

SIR,-In your issue of Oct. 10th, in a report of adiscussion on the problems of asphyxia, cardiacpuncture is mentioned as a chief method of resuscita-tion where the heart has ceased to beat duringanaesthesia. On the day before I received that copyof THE LANCET I had to deal with the case describedbelow.The patient, a female, weighing 52 kg., came to the

hospital and was found to harbour Ascaris lumbricoides inthe intestine, and ova of Schistosoma hctn2atobium in theurine. Clinical examination showed no contra-indicationsto tartar emetic treatment for the schistosomiasis, and thiswas begun by giving her one grain of the drug (6 per cent.solution) intravenously. oon I was called to see her. Ifound her thrown on the door unconscious ; the face wascyanosed, the respiration slow, laboured, and superficial,the eyes wide open, and the corneac insensitive. Thepulse could not be felt in either radial or temporal arteries,

the extremities were very cold, the heart could not beheard, either with the ear directly or with the stethoscope,and in fact the only sign of life was a very occasional feeblebut snoring respiration, occurring not more than three orfour times in a minute.

Artificial respiration was at once begun ; a mouth gagwas inserted and the tongue was drawn forward by a tongueforceps. One milligramme of strychnia and 0-5 c.cm.adrenalin (1 : 1000) were given hypodermically, and0.2 c.cm. adrenalin intravenously. Ten minutes later thecondition was still the same in spite of the artificial respira-tion. Strychnia hypodermically was repeated. The con-dition became even worse, the cyanosis was severe, andthe respirations fewer. Hot-water bottles were put toextremities and hot stupes to the heart (prsecordia), butwithout benefit.At that moment I thought that the patient would surely

die in my hands, so I gave her 0-2 c.cm. adrenalin solution(1 : 1000) intracardiac in the fifth intercostal space. As Itook out the needle I put the stethoscope over the heartregion, and, to my great relief, I heard the heart soundsclearly ; epigastric pulsations became evident, though thepulse could not be felt. After 20 minutes adrenalin(0-2 c.cm.) was again given intravenously. Respirationsbecame more frequent, the cyanosis less marked, and cornesebecame sensitive. The progress was, however, very slow.Then she was given 1 c.cm. ether intramuscularly, andcaffein 0-25 g., ephedraline 1 c.cm., and rum 15 c.cm.

hypodermically. At last she vomited a purely biliousvomit and came to herself, after one and a half hours, inwhich she had given me a really rough time. Four hourslater she left the hospital.

Of course I did not venture to continue the tartaremetic treatment. The cause of the condition musthave been a specially marked idiosyncrasy to tartaremetic, as I have not encountered such symptomsin about four years’ practice in which I have givenabout 120,000 injections of this drug.

I am, Sir, yours faithfully,A. FAKHRY,

P.M.O. Bilharzia and Ankylostoma Hospital,Kafr-El-Zayat, Egypt.

ANÆSTHETISTS IN THE UNIT SYSTEM.

To the Editor of THE LANCET.SiR,—I am glad to see that the question of pay-

ments to anaesthetists attached to surgical professorialunits has been raised. Dr. Howard Jones has, if

anything, understated the case. At most hospitalswhere this system obtains, the " Unit " operatesin the mornings, so depriving the anaesthetist of hisusual time for private work. In addition to this,the operations are frequently of a difficult and pro-longed character, rendering substitutes in the form ofhouse surgeons or resident anaesthetists undesirable.In most cases the surgeons of the unit have full-timehospital appointments, so that no recompense fromadditional private work can be expected. Whythen is the anaesthetist the only unpaid member ofthe team ? 2

It speaks well for the loyalty of anaesthetists totheir hospitals that the present system has worked atall, but this is no reason why the exploitation shouldcontinue. It is of course quite possible that the wholeprofessorial unit system will be abandoned, as hasalready been done in the case of one large hospitalin London, but while it continues the anomaly of theunpaid anaesthetists should be rectified withoutfurther delay.As it would obviously be undesirable to single out

one particular hospital in this matter I ask leave tosign myself Yours faithfully,

..

" LETHE."

PAY PATIENTd AT NEWCASTLE.-Since the pay-bedsection of the Victoria Infirmary, Newcastle-on-Tyne,was opened six months ago the 86 beds have been constantlyoccupied.