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A GREEN BACKGROUND FOR THE OPERATION AREA.
781 And
again:
Dullness may be elicited in practically any chest by using a plexor and pleximeter.2
region
It seems certainly rather curious that Dr. Riviere should allege that Abrams’s areas bear no relationship to his in position, size, shape, &c., even in regard to those small areas described by Abrams which are known to Dr. Riviere. With regard to the posterior band of dullness described by Dr. Riviere, as a matter of fact, Abrams’s posterior circles are placed just over the angles of the scapulas, and it would be rather a difficult feat to locate them much nearer to certain of Dr. Riviere’s shadings, while as regards that portion of the band described by the latter from about the fifth to the seventh dorsal spines, Abrams has the following statement :It must be recalled, however, that the region correspond-
A GREEN BACKGROUND FOR THE OPERATION AREA. To the Editor of THE LANCET.
SIR,-Sir Berkeley Moynihan’s letter to THE LANCET of Sept. 18th, in which he advocates the use of green towels, interests me very much since I have used for the past five or six years pale-blue towels for operations in private. My object was not to rest the eyesight, although I agree with Sir Berkeley Moynihan that white towels certainly make the operation wound relatively darker. To realise this, one has only to recall a cystoscopy in a sunlit bedroom with a bad blind-a very feeble affair. My aim, however, was a very practical one-to distinguish at a glance between my own sterilised towels and those of other people, of which there is always a profusion in private houses before operaand none of which one ever uses. I found tions, ing to the fifth dorsal vertebra is normally dull, the dullness further that the blue colour had on strange for a short distance on either side.3 extending nurses a distinctly inhibitory effect and kept This, together with the circular areas just alluded unsterilised people away from the operation area. to, pretty well fulfil Dr. Riviere’s conditions. One’s instructions to unsterilised assistants (whose Dr. Riviere seems anxious to separate the reflex in their proper capacity is often more of contraction from the atelectatic zones. But it help valuable than that of sterilised ones in private) are is impossible to do so. The dull areas described so simple-to "avoid anything blue." The only by Dr. Riviere are in fact " atelectatic " zones, and forcible criticism one can make of blue or green this particular form of atelectasis appears, under towels is that nurses who have had to wash them all circumstances, to be due to the action of the at night say they look darker, and it is a little reflex in question. To support this suggestion difficult to be certain of having got rid of all the would take up too much space. It may be sufficient blood stains. Light Cambridge blue, however, to indicate that the atelectatic areas resulting from solves this difficulty. defective ventilation found in normal lungs may ’ I am, Sir, yours faithfully, be due to the reflex being induced by metabolic FRANK JEANS. Sept. 23rd, 1915. products resulting from the defective gaseous Liverpool, exchanges. This is in accord with Dr. Riviere’s own theory of the reflex being induced by the TINCTURE OF IODINE AND CALOMEL IN presence of pulmonary tubercle. TYPHOID FEVER. I am, Sir, yours faithfully, To the Editor of THE LANCET. A. G. AULD. Harley-street, W., Sept. 24th. 1915. SIR,-The question as to the best treatment of typhoid fever is not settled yet. Hard-and-fast TREATMENT OF SCORPION STINGS. rules for its treatment have not been laid down, and therefore I hope the few remarks which I am To the Editor of THE LANCET. to make on the treatment of enteric fever going SIR,—I have read Sir Lauder Brunton’s letter in will not be superfluous. THE LANCET of July 24th on the subject of scorpion I would first of all draw attention to the letter of stings, and note that he suggests treatment by Dr. D. Walsh in THE LANCET of May 10th, 1913, permanganate of potash. From personal experience concerning the treatment of typhoid fever by tincI can endorse the statement that the pain caused ture of iodine. the late South African War by a scorpion sting is severe. The idea one I tried tincture During of iodine in about a dozen cases gets is that a red-hot knitting needle has been with undoubtedly good results. Again trying it driven into the affected part, and in addition the same war in other cases I noticed that there is the feeling that electricity is being dis- during of this remedy was not so favourable by the effect charged from the needle into the tissues. If far as in the former I was wondering why cases. feasible, proximal ligature and immediate scarifica- such a have should occurred, and it discrepancy tion round the sting, followed by the rubbing in of struck me that while for the first cases I had used permanganate of potash, gives the greatest relief. a tincture which had been put away in my surgery If permanganate is applied quickly swelling does for more than a year, to the latter patients I had not occur, the pain quickly subsides, and the patient feels nothing more than a slight degree of stiffness given a freshly made tincture. An old tincture of in the affected part for a few hours. If untreated, iodine, regularly taken by an enteric fever patient, manifests its beneficial influence on the disease in scorpion stings often cause great swelling and so much that the patient’s general state improves œdema, sometimes followed by sloughing, as well and he and at the same time the gets brighter, as considerable constitutional disturbance. The mucosa of his mouth and tongue loses its dryness same procedure is successful in the case of stings from hornets, and if one habitually carries a snake and gets wet and clean, whereas the freshly made lancet the permanganate treatment can be carried preparation of the tincture of iodine does not seem to possess such healing properties. This difference out without any delay. in the working of an old and a freshly made tincture I am, Sir, yours faithfully, of iodine could only be explained in such a way A. J. MACKENZIE. Hartley, Rhodesia, August 31st, 1915. that an old tincture, put away for a considerable 2 time, is no more a simple solution of iodine, or of Spondylotherapy. pp. 299-300. 3 Ibid., iodine and potassium iodide in alcohol;as on p. 80.
again:
Dullness may be elicited in practically any chest by using a plexor and pleximeter.2
region
It seems certainly rather curious that Dr. Riviere should allege that Abrams’s areas bear no relationship to his in position, size, shape, &c., even in regard to those small areas described by Abrams which are known to Dr. Riviere. With regard to the posterior band of dullness described by Dr. Riviere, as a matter of fact, Abrams’s posterior circles are placed just over the angles of the scapulas, and it would be rather a difficult feat to locate them much nearer to certain of Dr. Riviere’s shadings, while as regards that portion of the band described by the latter from about the fifth to the seventh dorsal spines, Abrams has the following statement :It must be recalled, however, that the region correspond-
A GREEN BACKGROUND FOR THE OPERATION AREA. To the Editor of THE LANCET.
SIR,-Sir Berkeley Moynihan’s letter to THE LANCET of Sept. 18th, in which he advocates the use of green towels, interests me very much since I have used for the past five or six years pale-blue towels for operations in private. My object was not to rest the eyesight, although I agree with Sir Berkeley Moynihan that white towels certainly make the operation wound relatively darker. To realise this, one has only to recall a cystoscopy in a sunlit bedroom with a bad blind-a very feeble affair. My aim, however, was a very practical one-to distinguish at a glance between my own sterilised towels and those of other people, of which there is always a profusion in private houses before operaand none of which one ever uses. I found tions, ing to the fifth dorsal vertebra is normally dull, the dullness further that the blue colour had on strange for a short distance on either side.3 extending nurses a distinctly inhibitory effect and kept This, together with the circular areas just alluded unsterilised people away from the operation area. to, pretty well fulfil Dr. Riviere’s conditions. One’s instructions to unsterilised assistants (whose Dr. Riviere seems anxious to separate the reflex in their proper capacity is often more of contraction from the atelectatic zones. But it help valuable than that of sterilised ones in private) are is impossible to do so. The dull areas described so simple-to "avoid anything blue." The only by Dr. Riviere are in fact " atelectatic " zones, and forcible criticism one can make of blue or green this particular form of atelectasis appears, under towels is that nurses who have had to wash them all circumstances, to be due to the action of the at night say they look darker, and it is a little reflex in question. To support this suggestion difficult to be certain of having got rid of all the would take up too much space. It may be sufficient blood stains. Light Cambridge blue, however, to indicate that the atelectatic areas resulting from solves this difficulty. defective ventilation found in normal lungs may ’ I am, Sir, yours faithfully, be due to the reflex being induced by metabolic FRANK JEANS. Sept. 23rd, 1915. products resulting from the defective gaseous Liverpool, exchanges. This is in accord with Dr. Riviere’s own theory of the reflex being induced by the TINCTURE OF IODINE AND CALOMEL IN presence of pulmonary tubercle. TYPHOID FEVER. I am, Sir, yours faithfully, To the Editor of THE LANCET. A. G. AULD. Harley-street, W., Sept. 24th. 1915. SIR,-The question as to the best treatment of typhoid fever is not settled yet. Hard-and-fast TREATMENT OF SCORPION STINGS. rules for its treatment have not been laid down, and therefore I hope the few remarks which I am To the Editor of THE LANCET. to make on the treatment of enteric fever going SIR,—I have read Sir Lauder Brunton’s letter in will not be superfluous. THE LANCET of July 24th on the subject of scorpion I would first of all draw attention to the letter of stings, and note that he suggests treatment by Dr. D. Walsh in THE LANCET of May 10th, 1913, permanganate of potash. From personal experience concerning the treatment of typhoid fever by tincI can endorse the statement that the pain caused ture of iodine. the late South African War by a scorpion sting is severe. The idea one I tried tincture During of iodine in about a dozen cases gets is that a red-hot knitting needle has been with undoubtedly good results. Again trying it driven into the affected part, and in addition the same war in other cases I noticed that there is the feeling that electricity is being dis- during of this remedy was not so favourable by the effect charged from the needle into the tissues. If far as in the former I was wondering why cases. feasible, proximal ligature and immediate scarifica- such a have should occurred, and it discrepancy tion round the sting, followed by the rubbing in of struck me that while for the first cases I had used permanganate of potash, gives the greatest relief. a tincture which had been put away in my surgery If permanganate is applied quickly swelling does for more than a year, to the latter patients I had not occur, the pain quickly subsides, and the patient feels nothing more than a slight degree of stiffness given a freshly made tincture. An old tincture of in the affected part for a few hours. If untreated, iodine, regularly taken by an enteric fever patient, manifests its beneficial influence on the disease in scorpion stings often cause great swelling and so much that the patient’s general state improves œdema, sometimes followed by sloughing, as well and he and at the same time the gets brighter, as considerable constitutional disturbance. The mucosa of his mouth and tongue loses its dryness same procedure is successful in the case of stings from hornets, and if one habitually carries a snake and gets wet and clean, whereas the freshly made lancet the permanganate treatment can be carried preparation of the tincture of iodine does not seem to possess such healing properties. This difference out without any delay. in the working of an old and a freshly made tincture I am, Sir, yours faithfully, of iodine could only be explained in such a way A. J. MACKENZIE. Hartley, Rhodesia, August 31st, 1915. that an old tincture, put away for a considerable 2 time, is no more a simple solution of iodine, or of Spondylotherapy. pp. 299-300. 3 Ibid., iodine and potassium iodide in alcohol;as on p. 80.