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IMPERIAL ENTOMOLOGICAL CONFERENCE.
1257 rendered free from infection and required to report after resuming practice. The disinfectant measures at present employed may reasonably cover a wide range since the mode or modes in which the disease may be spread are imperfectly known.
Modern Technique
in Treatment.
A Series of Special Articles, contributed by invitation, on the Treatment of Medical and Surgical Conditions.
FOR INJECTIONS HÆMOPTYSIS. TREATMENT OF HAMMER-TOE. Copious haemoptysis is so serious a symptom PART I.—GENERAL CONSIDERATIONS : to the that effective and so alarming patient any CONSERVATIVE MEASURES. addition to the means of treating it is welcome. We publish a short clinical note from Dr. Andrew J. Prophylaxis. Morland, describing, a case in which the direct injection ’ THE of treatment hammer-toe wall a the chest of into prophylactic coagulen (Ciba) cavity through was followed by the arrest of the bleeding with deformity necessitates the use of shoes and stockings There are on the market of sufficient length in the actively growing age, and dramatic suddenness. several compounds of this kind prepared from the correct posture in standing and walking. Shoes There is some evidence should be broad in the toe portion, straight along the serum of different animals. that they are useful in cases of haemorrhage from the inner borders, and not too pointed. The tendency to ,lungs, stomach, or bowels when given by subcutaneous deformity should be detected early and rectified by the or intravenous injection. Coagulen is said to be use of metatarsal bars or anterior arch supports, and cich in thrombokinase, and its action is therefore by such active and passive movements as encourage readily comprehensible. The method would seem to the flexion power and range of the toes. While the term hammer-toe is often loosely applied to be worthy of further trial in cases where copious and repeated haemoptysis occurs. It is, of course, not any flexion deformity of the toes that may be found always easy to determine in a given case with exten- associated with various malformations of the foot, it sive disease the exact situation from which the bleeding should be more correctly reserved to describe a fixed arises, but in Dr. Morland’s case it was known that flexion deformity. Of this there are two types, the there was a large cavity, and bubbling rales were acquired and the congenital, and in both the condition is plainly audible over it while the haemorrhage was in commonly bilateral. The acquired form is the more common ; it involves progress. Experience with intratracheal injections has shown that the lung tissue will tolerate substances the second toe, and is associated with hallux valgus, like menthol, guaiacol, and olive oil, reaching it the combined deformity resulting from too short and through the air-passages. Modified serums of the type too pointed footwear in the growing age, and from the employed by Dr. Morland are usually bland sub- improper method of walking with feet everted. The stances, and it is therefore not surprising that they second phalanx is flexed on the first, and the latter is can be injected directly into a cavity within the slightly over-extended at the metatarso-phalangeal lung. It is a recognised principle in surgery that joint. The terminal phalanx is in line with the where possible the bleeding point should be dealt second, or flexed or extended on it. The approxiwith directly. Dr. Morland’s attempt to apply the mation of the tips of the great and middle toes buries the two terminal phalanges of the second toe, forcing same principle to bleeding from the lungs is rational, and it is gratifying that in his case such good results them into a vertical position, while the proximal The vertical portion of were achieved. His experience would seem to warrant phalanx remains horizontal. the toe is pinched at the top and bottom by the shoe ; further trial of this method in suitable cases. a painful corn forms on the head of the proximal phalanx and another on the tip of the terminal IMPERIAL ENTOMOLOGICAL CONFERENCE. phalanx, just at the end of the nail, which becomes THE second Imperial Entomological Conference is thickened and distorted. The tip of the toe is being held in London from June 9th to 18th at the swollen, broadened, and flattened. On the dorsum of instance of the Imperial Bureau of Entomology, and the metatarso-phalangeal joint the extensor tendons summoned by the Secretary of State for the Colonies. become contracted, maintaining the hyperextension This meeting is the outcome of the first conference held deformity at this joint. A similar contracture occurs in 1920, when it was decided to hold such meetings in the capsule and flexor tendons on the plantar every five years to further and coordinate the work aspect of the acutely flexed proximal interphalangeal of tropical and subtropical entomological research joint, which after a time prevents straightening of the throughout the Empire. Particular interest should toe at this joint by passive movements. Occasionally attach to this conference as it follows so closely on the the flexion deformity is in the terminal and not the international conference held in London last month1 proximal joint. under the auspices of the League of Nations, for the The congenital form differs from the acquired in that purpose of setting up an international commission to the middle toe is always involved, alone or together study sleeping sickness in tropical Africa. The present with the fourth and fifth. The proximal, and chairman of the Imperial Bureau of Entomology is particularly the terminal, joints are both flexed to Lord Buxton, and the director is Mr. G. A. K. Marshall, some degree ; and the terminal phalanx is rotated D.Sc., F.R.S., assisted by Mr. S. A. Neave, D.Sc. The and twisted, underlying its mesial neighbour. In subjects which are being discussed at the Royal Society’s infancy the toes can be straightened by passive moverooms in Burlington House during the sitting of the con- ments, and are therefore amenable to conservative ference deal with the widest aspects of entomology, and treatment. A slight adduction of the little toe alone, Prof. Warrington Yorke on Monday, June 15th, will and with no disability, is so common that it cannot be - consider the medical aspect in a paper on Coordination considered abnormal. of Effort in Tsetse-fly Investigation. In its less strict application " hammer-toe " may denote flexion deformity of the toes, associated with of the long arch (pes cavus). All the Mr. S. P. Vivian, whose name appeared in the exaggeration five toes are involved, and usually bilaterally. These Birthday Honours List with a C.B., was intimately should be described as " clawed " rather than associated with drawing up the medical benefits " hammer" toes. Hyperextension contracture of regulations under the National Health Insurance the joints is more marked than metatarso-pbalangeal since his as Acts, and, appointment Registrar-General, in real hammer-toe. Both the terminal joints are has been freely accessible to suggestions for increasing the usefulness of his department to those engaged flexed, but the toes are drawn towards the dorsum of the foot, with no pressure effects on the tips, and the in health administration. terminal flexion is more easily corrected by passive 1 THE LANCET, May 30th, p. 1155. stretchings than in real hammer-toe.
INTRAPULMONARY INTRACTABLE
CXXVI.—THE
I
I
’
Modern Technique
in Treatment.
A Series of Special Articles, contributed by invitation, on the Treatment of Medical and Surgical Conditions.
FOR INJECTIONS HÆMOPTYSIS. TREATMENT OF HAMMER-TOE. Copious haemoptysis is so serious a symptom PART I.—GENERAL CONSIDERATIONS : to the that effective and so alarming patient any CONSERVATIVE MEASURES. addition to the means of treating it is welcome. We publish a short clinical note from Dr. Andrew J. Prophylaxis. Morland, describing, a case in which the direct injection ’ THE of treatment hammer-toe wall a the chest of into prophylactic coagulen (Ciba) cavity through was followed by the arrest of the bleeding with deformity necessitates the use of shoes and stockings There are on the market of sufficient length in the actively growing age, and dramatic suddenness. several compounds of this kind prepared from the correct posture in standing and walking. Shoes There is some evidence should be broad in the toe portion, straight along the serum of different animals. that they are useful in cases of haemorrhage from the inner borders, and not too pointed. The tendency to ,lungs, stomach, or bowels when given by subcutaneous deformity should be detected early and rectified by the or intravenous injection. Coagulen is said to be use of metatarsal bars or anterior arch supports, and cich in thrombokinase, and its action is therefore by such active and passive movements as encourage readily comprehensible. The method would seem to the flexion power and range of the toes. While the term hammer-toe is often loosely applied to be worthy of further trial in cases where copious and repeated haemoptysis occurs. It is, of course, not any flexion deformity of the toes that may be found always easy to determine in a given case with exten- associated with various malformations of the foot, it sive disease the exact situation from which the bleeding should be more correctly reserved to describe a fixed arises, but in Dr. Morland’s case it was known that flexion deformity. Of this there are two types, the there was a large cavity, and bubbling rales were acquired and the congenital, and in both the condition is plainly audible over it while the haemorrhage was in commonly bilateral. The acquired form is the more common ; it involves progress. Experience with intratracheal injections has shown that the lung tissue will tolerate substances the second toe, and is associated with hallux valgus, like menthol, guaiacol, and olive oil, reaching it the combined deformity resulting from too short and through the air-passages. Modified serums of the type too pointed footwear in the growing age, and from the employed by Dr. Morland are usually bland sub- improper method of walking with feet everted. The stances, and it is therefore not surprising that they second phalanx is flexed on the first, and the latter is can be injected directly into a cavity within the slightly over-extended at the metatarso-phalangeal lung. It is a recognised principle in surgery that joint. The terminal phalanx is in line with the where possible the bleeding point should be dealt second, or flexed or extended on it. The approxiwith directly. Dr. Morland’s attempt to apply the mation of the tips of the great and middle toes buries the two terminal phalanges of the second toe, forcing same principle to bleeding from the lungs is rational, and it is gratifying that in his case such good results them into a vertical position, while the proximal The vertical portion of were achieved. His experience would seem to warrant phalanx remains horizontal. the toe is pinched at the top and bottom by the shoe ; further trial of this method in suitable cases. a painful corn forms on the head of the proximal phalanx and another on the tip of the terminal IMPERIAL ENTOMOLOGICAL CONFERENCE. phalanx, just at the end of the nail, which becomes THE second Imperial Entomological Conference is thickened and distorted. The tip of the toe is being held in London from June 9th to 18th at the swollen, broadened, and flattened. On the dorsum of instance of the Imperial Bureau of Entomology, and the metatarso-phalangeal joint the extensor tendons summoned by the Secretary of State for the Colonies. become contracted, maintaining the hyperextension This meeting is the outcome of the first conference held deformity at this joint. A similar contracture occurs in 1920, when it was decided to hold such meetings in the capsule and flexor tendons on the plantar every five years to further and coordinate the work aspect of the acutely flexed proximal interphalangeal of tropical and subtropical entomological research joint, which after a time prevents straightening of the throughout the Empire. Particular interest should toe at this joint by passive movements. Occasionally attach to this conference as it follows so closely on the the flexion deformity is in the terminal and not the international conference held in London last month1 proximal joint. under the auspices of the League of Nations, for the The congenital form differs from the acquired in that purpose of setting up an international commission to the middle toe is always involved, alone or together study sleeping sickness in tropical Africa. The present with the fourth and fifth. The proximal, and chairman of the Imperial Bureau of Entomology is particularly the terminal, joints are both flexed to Lord Buxton, and the director is Mr. G. A. K. Marshall, some degree ; and the terminal phalanx is rotated D.Sc., F.R.S., assisted by Mr. S. A. Neave, D.Sc. The and twisted, underlying its mesial neighbour. In subjects which are being discussed at the Royal Society’s infancy the toes can be straightened by passive moverooms in Burlington House during the sitting of the con- ments, and are therefore amenable to conservative ference deal with the widest aspects of entomology, and treatment. A slight adduction of the little toe alone, Prof. Warrington Yorke on Monday, June 15th, will and with no disability, is so common that it cannot be - consider the medical aspect in a paper on Coordination considered abnormal. of Effort in Tsetse-fly Investigation. In its less strict application " hammer-toe " may denote flexion deformity of the toes, associated with of the long arch (pes cavus). All the Mr. S. P. Vivian, whose name appeared in the exaggeration five toes are involved, and usually bilaterally. These Birthday Honours List with a C.B., was intimately should be described as " clawed " rather than associated with drawing up the medical benefits " hammer" toes. Hyperextension contracture of regulations under the National Health Insurance the joints is more marked than metatarso-pbalangeal since his as Acts, and, appointment Registrar-General, in real hammer-toe. Both the terminal joints are has been freely accessible to suggestions for increasing the usefulness of his department to those engaged flexed, but the toes are drawn towards the dorsum of the foot, with no pressure effects on the tips, and the in health administration. terminal flexion is more easily corrected by passive 1 THE LANCET, May 30th, p. 1155. stretchings than in real hammer-toe.
INTRAPULMONARY INTRACTABLE
CXXVI.—THE
I
I
’