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HEARTBURN.
907 "
If, as sometimes happens, 2 or 3 in. of electrode pass synonymous, is employed to describe water-brash," through the cervix into the uterus a corresponding an entirely different phenomenon. amount of current must be passed. Obviously before we pursue its causes further we To record the temperature in the cervix a special require more clinical information about the symptom thermometer-electrode must be used. It cannot be itself, and the circumstances connected with it. In done by stopping the treatment and then taking the perusing Galton’s Enquiries into Human Faculty " temperature, as the loss of heat is too rapid. In the recently, I was much struck by the interesting and early days we had some slight burns but no harm has sometimes valuable information which the author A burn of the cervix is no reason for obtained in regard to certain mental phenomena by ever resulted. stopping the treatment if care is taken not to superadd the process of circulating his inquiries to men and the effects of another burn. women of intelligence in scientific circles and to We have been very interested in Drs. Milner and others likely to prove reliable observers. It occurred Maclachlan’s results and are gratified that their results to me that it might be possible to accumulate useful ’
"
go to confirm
I
our own.
I
am.
Sir,
Oct. 10th, 1923.
vours
faithfullv. C. A. ROBINSON.
AN UNIDENTIFIED PORTRAIT BUST. To the Editor of THE LANCET.
SIR,-The accompanying photograph is of
the
a
museum
bust in the
of
Middlesex Hospital Medical School. We have made great efforts to find out who the bust represents, but we have never been able to do so. Possibly some reader of THE LANCET might be able to help us in identification. It has probably been in the medical school about 80 years. Inscribed on the back of the bust is the
following
:-
questionnaire,
seem
to initiate
or
aggravate
the
8. What artificial measures (e.g., drugs, &c.) bring relief ? 9. What is the momentary effect on the symptom of swallowing : (a) Nothing ; (b) hot fluids ; (c) cold nuids ; and (d) solids ? 10. What associated symptoms have you noticed (e.g.,
HEARTBURN.
j
and ’, accessory clinical methods have done much to advance our understanding of symptoms and their mode of production, there are still many subjective manifestations of ill-health for which no adequate explanation is forthcoming, and of which the treatment in con" Heartburn is sequence remains unsatisfactory. such a symptom. Probably most people experience it at some time in their lives ; with others it is a frequent and distressing complaint. Apparently it may occur either in the presence or absence of an organic lesion; it i may occur with or without other digestive symptoms; I it may accompany the physiological disturbances of pregnancy in women who are never troubled with it at other times ; radiography and chemical methods have failed to throw any conclusive light upon it; it is ’, met with, I believe, in persons with achlorhydria as ’, well as in persons with hyperchlorhydria ; alkalies give relief, but this does not necessarily signify that abnormal acidity is a factor ; it cannot be produced with solutions of hydrochloric acid; whether the organic acids found in the stomach can produce it I do not yet know ; it is even disputed whether it expresses a mechanical or a chemical irregularity ; and finally there is no absolute agreement as to what the symptom is, different persons employing the term to describe different sensations, or confusing " heartburn " with other gastro-oesophageal discomforts. " Acidity " and " cardialgia " are used as alternative descriptions. " Pyrosis," however, which should be "
a
7. Under what natural conditions does relief occur ?
Oct. 13th, 1923.
of THE LANCET. experiment
men
symptom ?
yours faithfully, A. E. WEBB-JOHNSON, Dean of the Middlesex Hospital Medical School.
physiological
commoner
to to which those with personal experience might themselves provide the answers, while others gleaned them from their more intelligent and trustworthy patients. If such a method should appeal to any readers of THE LANCET I would suggest that an attempt to secure answers to the appended questions be made, and would ask for the information to be forwarded to me at Guy’s Hospital. Replies would, of course, be fully acknowledged, and names and addresses treated confidentially. A favourable response might serve not only to direct and stimulate further inquiry of an experimental kind, but also to pave the way for similar inquiries into allied problems of symptomatology. In addition, it would afford to colleagues in general practice an opportunity of cooperating in a piece of practical clinical research for which their observations would provide the basic material.
medical
the symptom ? 6. What factors, if any,
Sir,
To the Editor
of the
to " Heartburn." 1. What is the nature or character of the symptom 2. How long have you been familiar with it ? 3. At what vertical level or levels is it experienced 4. At what depth from the body surface and over what surface area does it seem to be felt ? 5. What is the maximum, minimum, and mean duration of
Published 1832, London."
SIR,-Although
some
subjective symptoms by similarly circularising
Questions Relating
Joseph Deare, Sculpt., I am,
information in regard to
flatulence, nausea, vomiting, salivation, gastric pain, regurgitation of food, bile, acid or bitter juice) ? 11. Has a diagnosis of any organic disease ever been made
suggested in your case, and if so, on what evidence ? 12. Have you been investigated by X rays with the opaque meal or by a test-meal, and if so, with what result ? I enclose my card, and am, Sir, or
Yours faithfully, HEARTBURN INVESTIGATION COMMITTEE, GUY’S HOSPITAL.
SECRETARY Oct. 9th, 1923.
OF THE
________________
INTESTINAL DISINFECTION. To the Editor of THE LANCET. SIR,-My attention has been called to the following statement made by Prof. Dixon of Cambridge, before the Pharmaceutical Society, as published in THE LANCET of Oct. 13th (p. 846) : " Disintectants have so far been ineffectual to diminish materially the intestinal flora-they poison the body before the bacteria." THE LANCET, in a laboratory report on April 9th, 1921, stated the claims of dimol, adding : " It is possible to destroy all bacteria in the fluid contents of the intestinal tract with a duodenal douche of dimol." If Prof. Dixon would care to have particulars of the method by which these results are obtained, he will find them in a brochure entitled " Colonic and Duodenal Lavage, with a Suggested Improvement in the Plombieres Treatment " (London: H. K. Lewis and Co., Ltd.). I am, Sir, yours
faithfully,
J. T. AINSLIE Ludgate-hill, London, Oct. 13th, 1923.
WALKER.
If, as sometimes happens, 2 or 3 in. of electrode pass synonymous, is employed to describe water-brash," through the cervix into the uterus a corresponding an entirely different phenomenon. amount of current must be passed. Obviously before we pursue its causes further we To record the temperature in the cervix a special require more clinical information about the symptom thermometer-electrode must be used. It cannot be itself, and the circumstances connected with it. In done by stopping the treatment and then taking the perusing Galton’s Enquiries into Human Faculty " temperature, as the loss of heat is too rapid. In the recently, I was much struck by the interesting and early days we had some slight burns but no harm has sometimes valuable information which the author A burn of the cervix is no reason for obtained in regard to certain mental phenomena by ever resulted. stopping the treatment if care is taken not to superadd the process of circulating his inquiries to men and the effects of another burn. women of intelligence in scientific circles and to We have been very interested in Drs. Milner and others likely to prove reliable observers. It occurred Maclachlan’s results and are gratified that their results to me that it might be possible to accumulate useful ’
"
go to confirm
I
our own.
I
am.
Sir,
Oct. 10th, 1923.
vours
faithfullv. C. A. ROBINSON.
AN UNIDENTIFIED PORTRAIT BUST. To the Editor of THE LANCET.
SIR,-The accompanying photograph is of
the
a
museum
bust in the
of
Middlesex Hospital Medical School. We have made great efforts to find out who the bust represents, but we have never been able to do so. Possibly some reader of THE LANCET might be able to help us in identification. It has probably been in the medical school about 80 years. Inscribed on the back of the bust is the
following
:-
questionnaire,
seem
to initiate
or
aggravate
the
8. What artificial measures (e.g., drugs, &c.) bring relief ? 9. What is the momentary effect on the symptom of swallowing : (a) Nothing ; (b) hot fluids ; (c) cold nuids ; and (d) solids ? 10. What associated symptoms have you noticed (e.g.,
HEARTBURN.
j
and ’, accessory clinical methods have done much to advance our understanding of symptoms and their mode of production, there are still many subjective manifestations of ill-health for which no adequate explanation is forthcoming, and of which the treatment in con" Heartburn is sequence remains unsatisfactory. such a symptom. Probably most people experience it at some time in their lives ; with others it is a frequent and distressing complaint. Apparently it may occur either in the presence or absence of an organic lesion; it i may occur with or without other digestive symptoms; I it may accompany the physiological disturbances of pregnancy in women who are never troubled with it at other times ; radiography and chemical methods have failed to throw any conclusive light upon it; it is ’, met with, I believe, in persons with achlorhydria as ’, well as in persons with hyperchlorhydria ; alkalies give relief, but this does not necessarily signify that abnormal acidity is a factor ; it cannot be produced with solutions of hydrochloric acid; whether the organic acids found in the stomach can produce it I do not yet know ; it is even disputed whether it expresses a mechanical or a chemical irregularity ; and finally there is no absolute agreement as to what the symptom is, different persons employing the term to describe different sensations, or confusing " heartburn " with other gastro-oesophageal discomforts. " Acidity " and " cardialgia " are used as alternative descriptions. " Pyrosis," however, which should be "
a
7. Under what natural conditions does relief occur ?
Oct. 13th, 1923.
of THE LANCET. experiment
men
symptom ?
yours faithfully, A. E. WEBB-JOHNSON, Dean of the Middlesex Hospital Medical School.
physiological
commoner
to to which those with personal experience might themselves provide the answers, while others gleaned them from their more intelligent and trustworthy patients. If such a method should appeal to any readers of THE LANCET I would suggest that an attempt to secure answers to the appended questions be made, and would ask for the information to be forwarded to me at Guy’s Hospital. Replies would, of course, be fully acknowledged, and names and addresses treated confidentially. A favourable response might serve not only to direct and stimulate further inquiry of an experimental kind, but also to pave the way for similar inquiries into allied problems of symptomatology. In addition, it would afford to colleagues in general practice an opportunity of cooperating in a piece of practical clinical research for which their observations would provide the basic material.
medical
the symptom ? 6. What factors, if any,
Sir,
To the Editor
of the
to " Heartburn." 1. What is the nature or character of the symptom 2. How long have you been familiar with it ? 3. At what vertical level or levels is it experienced 4. At what depth from the body surface and over what surface area does it seem to be felt ? 5. What is the maximum, minimum, and mean duration of
Published 1832, London."
SIR,-Although
some
subjective symptoms by similarly circularising
Questions Relating
Joseph Deare, Sculpt., I am,
information in regard to
flatulence, nausea, vomiting, salivation, gastric pain, regurgitation of food, bile, acid or bitter juice) ? 11. Has a diagnosis of any organic disease ever been made
suggested in your case, and if so, on what evidence ? 12. Have you been investigated by X rays with the opaque meal or by a test-meal, and if so, with what result ? I enclose my card, and am, Sir, or
Yours faithfully, HEARTBURN INVESTIGATION COMMITTEE, GUY’S HOSPITAL.
SECRETARY Oct. 9th, 1923.
OF THE
________________
INTESTINAL DISINFECTION. To the Editor of THE LANCET. SIR,-My attention has been called to the following statement made by Prof. Dixon of Cambridge, before the Pharmaceutical Society, as published in THE LANCET of Oct. 13th (p. 846) : " Disintectants have so far been ineffectual to diminish materially the intestinal flora-they poison the body before the bacteria." THE LANCET, in a laboratory report on April 9th, 1921, stated the claims of dimol, adding : " It is possible to destroy all bacteria in the fluid contents of the intestinal tract with a duodenal douche of dimol." If Prof. Dixon would care to have particulars of the method by which these results are obtained, he will find them in a brochure entitled " Colonic and Duodenal Lavage, with a Suggested Improvement in the Plombieres Treatment " (London: H. K. Lewis and Co., Ltd.). I am, Sir, yours
faithfully,
J. T. AINSLIE Ludgate-hill, London, Oct. 13th, 1923.
WALKER.