THE ROYAL COLLEGE OF SURGEONS IN IRELAND.

THE RETARDED PULSE WAVE IN AORTIC REGURGITATION.

1616

from the operation. I graduate the width of the strip to be removed according to the severity of the signs present (rarely exceeding six millimetres) and I make a point of removing all the subconjunctival tissue right down to the sclerotic and of dissecting up the flap as close to the cornea as possible. When only a small patch of pannus remains at one point I do a partial peritomy there. Should the result of the first operation not be as complete as one could wish, the circumcorneal tissue may be carefully destroyed at a subsequent sitting with the actual cautery. When a few large feedervessels can be distinctly traced into the still persisting area of vascularisation, I prefer gently to pick these out with the cautery for a few millimetres along the length of each. I never find chloroform necessary except in nervous children. I am, Sirs, yours faithfully. R. H. ELLIOT, M.B., B.S. Lond., F.R.C.S. Eng., Captain I.M.S. Edinburgh, May 31set, 1903.

RETARDED PULSE WAVE IN AORTIC REGURGITATION. To tAe Editors of THE LANCET. SIRS,—If some physiologist of repute will assure me, either through your pages or in private, that the tracings published by Dr. Walter Broadbent in THE LANCET of May 23rd, p. 1443, represent anything definite I may then congratulate him on having come to the conclusion that the pulse in aortic regurgitation is not " always retarded or delayed "-a distinct statement made by Sir William BroadTHE

bent from which he cannot extricate himself. I am afraid that my critics do not realise that the tracings I have given are of a totally different standing ; they will pass muster in any first-rate physiological laboratory and they are in themselves the clear evidence of what goes on. Not so my comments upon them. But as to the question asked by Dr. Broadbent at the conclusion of his communication, I might be permitted to call his attention to the explanation which I have givenof the slowness of propagation of the wave in aortic regurgitation compared with the high velocity of the wave created by impact when the valves I am, Sirs, yours faithfully, are intact. PAUL M. CHAPMAN, M.D., F.R.C.P. Lond.,

Council of the

Surgeons in Ireland. Thisa plea against Direct. Representatives being members of the governing bodies of universities or colleges, as dual interests are obviously against impartial representation of the already too feebly represented general practitioner. Referring to the refusal of the College of Surgeons to givea Licentiate a copy of the College by-laws, may I now placeon record my sense of the untenable position the College is now placed in should it have reason to criticise the professional deportment of a Licentiate to whom it so openly refused their by-laws by "the advice of their solicitor? Royal College

of

circumstance, indeed, may be taken as

’s

Indeed, its criticism of any Licentiate’s conduct now could hardly have other than ludicrous effect, considering the unfortunate manner in which they themselves are shown to have neglected their own charter responsibilities. The Royal College of Surgeons in Ireland has now been given ample opportunities of refuting any false statements I have made. Its irregular higher examinations I have shown up in the In silence it has accepted the face of great opposition. only verdict that can now occur to your readers. In concluding, therefore, this correspondence I take the opportunity of returning you my heartiest thanks for so kindly placing your columns at my disposal and I recognise in such editorial courtesy a continuity of that same public spirit which actuated the great Wakley, where abuses were to be. corrected or grievances were to be redressed. I am, Sirs, yours faithfully, S. WESLEY WILSON. May 30th, 1903.-

ACUTE AMAUROSIS FOLLOWING INFANTILE CONVULSIONS. To M6 Editors

of

THE

LAN C E

T.

THE LANCET of

SIRS,—In May 23rd, p. 1476, Dr. GeorgeCarpenter was good enough to comment upon some 1 of the points raised by us in our paper under the above title. Will

you allow us to make one or two remarks in answer to his criticisms ? In our paper we brought forward facts to show that a temporary amaurosis sometimes follows severe attacks of infantile convulsions and we sought to distinguish this group from the better known group of cases of amaurosis which follows an attack of posterior basal meningitis. In Physician, Herefordshire General Hospital. the former or post-eclamptic group we suggested that theMay 23rd, 1903. blindness was due to a discharge from the visual centres THE ROYAL COLLEGE OF SURGEONS IN followed by a condition of anaesthesia. We need hardly say that we are conscious of the difficultiesIRELAND. attending the diagnosis of the cause of the attacks of To the Editors of THE LANCET. infantile convulsions in many instances and also that SIRS,—In my letter which you published in THE LANCET meningitis or a local encephalitis may be easily overlooked But of May 9th, p. 1328, I inadvertently stated that I paid during infancy, especially in its initial stages. doubtful cases on one side and taking the typical putting for the of £10 10s. primary certificate Fellowship which to which we called attention and which came under purported to grant exemption from the subjects of the cases our own observation we cannot agree with Dr. Carpenterthis should have been Primary Fellowship Examination ; £15 15s. Also, the number of successful Fellowship can- if he thinks that these were in reality cases of meningitis. didates should have been 51 out of 52 persons who presented I Infants commencing with meningitis may or may not have themselves at four successive examinations. In answer to convulsions, but no one can pretend that meningitis is a Dr. G. Fleming of Ombersley, whose comments on my letter common cause of convulsions ; indeed, the whole history of eclampsia and epilepsy disproves this. Surely because a appeared in THE LANCET of May 23rd, p. 1477, I have to neurotic infant has a feverish attack and severe convulsions state that the Executive Committee of the General Medical in ending recovery we are not justified on such symptomsCouncil did me the courtesy of considering and placing my alone in diagnosing meningitis, even though the attack may their of the examination on minutes printed report illegal and transmitted a copy of the same to the President, Vice- havebeen followed by a fleeting amaurosis. Certainly, as a President, and Council of the College for their informa- rule, if meningitis commences with convulsions the moretion." In a letter dated May 26th, 1903, the Registrar of the characteristic symptoms of cerebral disease follow ; they General Medical Council informs me ’’ that the Council had do not begin and end with fever, convulsions, coma, and recovery. reason to believe that a minute on the subject was sent by The pathology of the temporary blindness, hemiopia, the Royal College of Surgeons in Ireland to the Privy Council." It is evident, therefore, that the Privy Council for aphasia, or paresis which sometimes follows convulsions or epileptic attacks is far from certain ; there may be punctiIreland, to whom I also reported the matter, has not been form haemorrhages, toxin poisoning, or, as we suggested as negligent. a cause for the amaurosis, a condition of exhaustion followAlthough Section XXVI. of the Medical Act, 1858, gives the General Medical Council the power of erasing higher ing discharge. That the more lasting hemiplegias or other are associated at times with convulsions or qualifications from the Medical Register, further action on paralyses which either one or both, are due to a meningeal whooping-cough, the part of the Council it would be unreasonable to expect, for it must be recollected that although the Irish College haemorrhage resulting from the stress and strain consequent of Surgeons has only one accredited representative on the on the convulsions and respiratory spasm is, we think, very General Medical Council, Sir Charles Ball, it has in reality probable and it is quite possible that the temporary loss of three members of the body corporate to espouse its interests, function which takes place may be due to a similar cause. for the representative of the University of Dublin and the With regard to another point raised as to the condition of the Direct Representative for Ireland are also members of the pupils and their reaction to light, our own experience is that 1

THE

LANCET, March 28th, 1903, p. 869.

1

THE

LANCET, May 9th,

p. 1294.