- Email: [email protected]
TRACHEOTOMY IN LARYNGEAL PARALYSIS,
1008 clerk at bankers, and men and maidThe residue of his real and personal estate is to be held upon trust for his wife for life, and then for his said
dispenser, executors, servants.
daughter.
-
The following legacies have recently been left to hospitals and other medical charities :-Mr. William Robinson of Milk-street, Cheapside, and of Darley Dale, Upper Norwood, £500 each to the London Fever Hospital, the City of London Hospital for Diseases of the Chest, the Royal Free Hospital, the Lock Hospital, the London Hospital, the Cancer Hospital, and the Middlesex Hospital, Charles-street; £300 to the National Hospital for - the Paralysed and Epileptic; and JE200 each to the Hospital for Women and the North London Consumption Hospital. Mrs. Emily Williams of Oxford Lodge, Worthing, £1000 to the Worthing Infirmary, and £500 each to the Sussex County Hospital and the Hospital for Incurables, Putney.—Mr. Henry Pim has left £50 to each of the following : Sir Patrick Dun’s, Hospital for Incurables, and Convalescent Home, Stillorgan.-Mr. John Fitzpatrick has bequeathed the following sums to Cork charities: Mercy Hospital, £1000; St. Patrick’s Hospital for Incurables, £500; Fever Hospital, £500; Blind Asylum, £500; and North Charitable Infirmary, £500. -
Correspondence.
North London, the possibilities feared by Mr. Pope and others have been anticipated and effectually guarded against, as the following quotation from a published circular will show :" A North London area will be defined. The streets in this area will be classified in the following order : "1. Absolutely poor streets, from which out-patients will be received wirhout question. Doubtfully poor, out-patients from which may be
"2.3. Streets
inquired about. ’‘
not poor, all out-patients from which must be inquired about. " Every out-patient must give name and address, which shall be entered in an out-patients’ book. The house-surgeon, or receiving clerk, shall temporarily adjudicate on all applications by out-patients, according to the principles of the street classification.
To the Editor
of THE LANCET. SIR,—Mr. Charles Pope raises several interesting questions in his letter on this subject. Perhaps the one to which he and many other practitioners attach most weight is the relation of the pay-system to the interests of the family physician-a most important aspect of the case. It may be well to premise that the merits of the pay-system cannot be settled by this comideration alone. The real test of the value of the system is that of public utility. If experience shall prove that this method of hospital administration does more good and le3s harm than any other, then it must take precedence of any other in the minds of all good citizens. It is a commonplace of national morality that private interests cannot be aUowed to stand in the way of the public good. Still, no one would expect to gain the approval of medical men who should encourage a scheme for the diminution of their already too scanty supply of breadand-butter - least of all a brother medical man and a "companion in tribulation." But would a well-regulated pay-system have the effect of attracting people to hospitals at the expense of family doctors ? In thejudgment of many competent and experienced persons the very opposite result would ensue. Many people, especially young men with certain diseases, rush to the out-patient departments of hospitals solely because they will be treated there for nothing. If they were met by a demand for payment according to their means, they would think twice before they exposed themselves to the inconveniences and publicity of such a course. One of the most prominent grounds on which a pay-system is advocated, at any rate by medical men, is that it will diminish the injurious competition between hospitals and private practitioners. As matters stand at present, the private practitioner is heavily weighted in the contest, the advantages being all on the side of the hospital. Whilst its treatment is equal, if not superior, to that of the family doctor, it practically opens wide its doors to all comers, and asks neither fee nor reward ; and by so doing it goes without saying that it must lessen the private practitioner’s gains. If there were two shops in one street, one of which supplied the public with goods for nothing, whilst the other charged the full value for every article, the one would be fall and the other empty. What should we say of the man with the empty shop if he complained that he was neighbour, who had pregoing to be ruined hisbecause his viously given away goods for nothing, was proposing to charge a fair price for them ? In the scheme for the establishment of a mixed hospital in
cases
must be referred to
a
be entitled to call the attention of the house committee to abuses of the department by persons who, in their judgment, are not objects of charity." I am, Sir, yours faithfully, GEO. W. W. POTTER. POTTER. Grosvenor.road, June 12th, 1882.
TRACHEOTOMY IN LARYNGEAL PARALYSIS,
"Audi alteram partem."
" ARE HOSPITALS FOR THE POOR TO BECOME HOTELS?"
Doubtful
weekly meeting of the house committee. "The out-patients’ book shall always be open to the in. spection of Jneclical men resident in the defined area, and to all subscribers to the hospital ; and both these classes shall
To the Editor
of THE LANCET.
fault I have only just read annotation in THE LANCET of May 20th, on the above subject. I need scarcely say that I entirely agree with you as to the caution which should be exercised in performing tracheotomy when an aneurism is known to exist. When, however, the aneurism causes paralysis of the abductors of the vocal cords (as in my own case, to which you allude) by its pressure on the trunk of the left pneumogasttic and on the recurrent nerve, it is extremely difficult to establish the fact that the trachea is at the same time compressed by the sac with any degree of certainty. The stridor which accompanies inspiration when the abductors of the cords are paralysed, masks the symptoms of compressionof the trachea. The laryngeal stenosis is sufficient to account for the dyspnoea, and although in the case brought before the Pathological Society the possibility of a further complication naturally occurred to me, it seemed right under the existing circumstances to give the patient the chance of relief by operation. Were a case with precisely similar laryngoscopic appearances to occur again, I cannot but think that, in the absence of any more definite evidence of compression of the trachea, tracheotomy would be justifiable. I am, Sir, yours faithfully, THOS. WHIPHAM. Grosvenor-street, W., June llth, 1882.
SIR,-Partly through my own
an
PROFESSOR JAMES R. WOOD, OF NEW YORK. To the Editor of THE LANCET. SIR,—Allow me in the name of the medical graduates of New York resident in this country to thank you for the flattering obituary notice you have rendered to our distinguished surgeon, the late Professor James R. Wood. His noble qualities and his skill as an operator are still in my memory, though years have passed away; and your lucid description of his dress vividly portrays his tout ensemble. This gracious record, though in a few words, will not be lost upon our American cousins, or, I venture to hope, upon those of his relatives who have to mourn an irreparable loss to his country. A grateful tribute to the memory of a lost friend may serve to mitigate some of the grievances amongst the poorer classes of Irish, many of whom have to thank the late Prof. J. R. Wood for relief from suffering in the Bellevue and Charity Hospitals of New York. All should admire the noble self -sacrificing qualities he possessed; his face beaming with delight, and his eyes almost moved to tears, when honoured by the presence of such a vast number of students in the operating theatre. I am, Sir, yours faithfully, G. DE COURCY MORRIS, G. MORRIS, M.D. New York. Clapham-road, S.W., June 12th, 1882.
dispenser, executors, servants.
daughter.
-
The following legacies have recently been left to hospitals and other medical charities :-Mr. William Robinson of Milk-street, Cheapside, and of Darley Dale, Upper Norwood, £500 each to the London Fever Hospital, the City of London Hospital for Diseases of the Chest, the Royal Free Hospital, the Lock Hospital, the London Hospital, the Cancer Hospital, and the Middlesex Hospital, Charles-street; £300 to the National Hospital for - the Paralysed and Epileptic; and JE200 each to the Hospital for Women and the North London Consumption Hospital. Mrs. Emily Williams of Oxford Lodge, Worthing, £1000 to the Worthing Infirmary, and £500 each to the Sussex County Hospital and the Hospital for Incurables, Putney.—Mr. Henry Pim has left £50 to each of the following : Sir Patrick Dun’s, Hospital for Incurables, and Convalescent Home, Stillorgan.-Mr. John Fitzpatrick has bequeathed the following sums to Cork charities: Mercy Hospital, £1000; St. Patrick’s Hospital for Incurables, £500; Fever Hospital, £500; Blind Asylum, £500; and North Charitable Infirmary, £500. -
Correspondence.
North London, the possibilities feared by Mr. Pope and others have been anticipated and effectually guarded against, as the following quotation from a published circular will show :" A North London area will be defined. The streets in this area will be classified in the following order : "1. Absolutely poor streets, from which out-patients will be received wirhout question. Doubtfully poor, out-patients from which may be
"2.3. Streets
inquired about. ’‘
not poor, all out-patients from which must be inquired about. " Every out-patient must give name and address, which shall be entered in an out-patients’ book. The house-surgeon, or receiving clerk, shall temporarily adjudicate on all applications by out-patients, according to the principles of the street classification.
To the Editor
of THE LANCET. SIR,—Mr. Charles Pope raises several interesting questions in his letter on this subject. Perhaps the one to which he and many other practitioners attach most weight is the relation of the pay-system to the interests of the family physician-a most important aspect of the case. It may be well to premise that the merits of the pay-system cannot be settled by this comideration alone. The real test of the value of the system is that of public utility. If experience shall prove that this method of hospital administration does more good and le3s harm than any other, then it must take precedence of any other in the minds of all good citizens. It is a commonplace of national morality that private interests cannot be aUowed to stand in the way of the public good. Still, no one would expect to gain the approval of medical men who should encourage a scheme for the diminution of their already too scanty supply of breadand-butter - least of all a brother medical man and a "companion in tribulation." But would a well-regulated pay-system have the effect of attracting people to hospitals at the expense of family doctors ? In thejudgment of many competent and experienced persons the very opposite result would ensue. Many people, especially young men with certain diseases, rush to the out-patient departments of hospitals solely because they will be treated there for nothing. If they were met by a demand for payment according to their means, they would think twice before they exposed themselves to the inconveniences and publicity of such a course. One of the most prominent grounds on which a pay-system is advocated, at any rate by medical men, is that it will diminish the injurious competition between hospitals and private practitioners. As matters stand at present, the private practitioner is heavily weighted in the contest, the advantages being all on the side of the hospital. Whilst its treatment is equal, if not superior, to that of the family doctor, it practically opens wide its doors to all comers, and asks neither fee nor reward ; and by so doing it goes without saying that it must lessen the private practitioner’s gains. If there were two shops in one street, one of which supplied the public with goods for nothing, whilst the other charged the full value for every article, the one would be fall and the other empty. What should we say of the man with the empty shop if he complained that he was neighbour, who had pregoing to be ruined hisbecause his viously given away goods for nothing, was proposing to charge a fair price for them ? In the scheme for the establishment of a mixed hospital in
cases
must be referred to
a
be entitled to call the attention of the house committee to abuses of the department by persons who, in their judgment, are not objects of charity." I am, Sir, yours faithfully, GEO. W. W. POTTER. POTTER. Grosvenor.road, June 12th, 1882.
TRACHEOTOMY IN LARYNGEAL PARALYSIS,
"Audi alteram partem."
" ARE HOSPITALS FOR THE POOR TO BECOME HOTELS?"
Doubtful
weekly meeting of the house committee. "The out-patients’ book shall always be open to the in. spection of Jneclical men resident in the defined area, and to all subscribers to the hospital ; and both these classes shall
To the Editor
of THE LANCET.
fault I have only just read annotation in THE LANCET of May 20th, on the above subject. I need scarcely say that I entirely agree with you as to the caution which should be exercised in performing tracheotomy when an aneurism is known to exist. When, however, the aneurism causes paralysis of the abductors of the vocal cords (as in my own case, to which you allude) by its pressure on the trunk of the left pneumogasttic and on the recurrent nerve, it is extremely difficult to establish the fact that the trachea is at the same time compressed by the sac with any degree of certainty. The stridor which accompanies inspiration when the abductors of the cords are paralysed, masks the symptoms of compressionof the trachea. The laryngeal stenosis is sufficient to account for the dyspnoea, and although in the case brought before the Pathological Society the possibility of a further complication naturally occurred to me, it seemed right under the existing circumstances to give the patient the chance of relief by operation. Were a case with precisely similar laryngoscopic appearances to occur again, I cannot but think that, in the absence of any more definite evidence of compression of the trachea, tracheotomy would be justifiable. I am, Sir, yours faithfully, THOS. WHIPHAM. Grosvenor-street, W., June llth, 1882.
SIR,-Partly through my own
an
PROFESSOR JAMES R. WOOD, OF NEW YORK. To the Editor of THE LANCET. SIR,—Allow me in the name of the medical graduates of New York resident in this country to thank you for the flattering obituary notice you have rendered to our distinguished surgeon, the late Professor James R. Wood. His noble qualities and his skill as an operator are still in my memory, though years have passed away; and your lucid description of his dress vividly portrays his tout ensemble. This gracious record, though in a few words, will not be lost upon our American cousins, or, I venture to hope, upon those of his relatives who have to mourn an irreparable loss to his country. A grateful tribute to the memory of a lost friend may serve to mitigate some of the grievances amongst the poorer classes of Irish, many of whom have to thank the late Prof. J. R. Wood for relief from suffering in the Bellevue and Charity Hospitals of New York. All should admire the noble self -sacrificing qualities he possessed; his face beaming with delight, and his eyes almost moved to tears, when honoured by the presence of such a vast number of students in the operating theatre. I am, Sir, yours faithfully, G. DE COURCY MORRIS, G. MORRIS, M.D. New York. Clapham-road, S.W., June 12th, 1882.