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A REMARKABLE CASE OF PNEUMO-THORAX.
1286
.
Harveian Lectures that it was in some way due to bactericidal effusion of serum into the’ peritoneum: after the abdominal incision and Mr. Owen inquires whether it be due to "letting air in or letting tluid out." That it need not be due to letting air in is argued by successful cases in which the peritoneal effusion is withdrawn by aspiration or other mode of paracentesis. This fact likewise casts doubt upon the essential necessity of laparotomy in some cases. But it may be questioned, also, whether even paracentesis be always necessary to a successful issue. It is a common experience that minor degrees of tuberculous ascites, especially in children, disappear with mere recumbency and flannel bandaging ; and in THE LANCET of Oct. llth, 1902, p. 989, Dr. Robert Knox of Higbgate publishes a case which I saw with him, presumably of pleural and peritoneal tuberculosis, which made a satisfactory recovery under general management and abdominal strapping. The influence, as he points out, of a restriction of abdominal movement, coupled with mechanical support of the abdominal muscles, is to exaggerate thoracic respiration and aspiration and to increase lymphatic absorption. These effects exercised upon the circulation cannot be ignored in considering the results of procedures for the cure of the disease in the peritoneal cavity. And, again, the exaggerated respiration and aeration of the lungs thus induced cannot be denied their share, both in improving the state of these organs when simultaneously affected and in promoting a more vigorous pulmonary circulation. The conclusion to be drawn from these considerations is that the influence of Harvey’s work is felt even in the determination of this question at present so interesting to the surgeon. What success attends the open-air treatment of pulmonary tuberculosis, indeed, is probably due in part to the indirect influence of the measures adopted upon the circulation of the blood. The open window is doubtless something in such cases, but not everything, and the poitrinaire in his wind-swept hut might possibly at times be even more sheltered than he is at present with increased comfort to himself and no less advantage. The secret held and not yet revealed by the successful treatment of peritoneal tuberculosis may prove the key to the cure of consumption." When revealed it may check the precipitancy with which " open-air treatment institutions are now being erected. I am, Sirs, yours faithfully, ALEXANDER MORISON, M.D. Edin. Upper Berkeley-street, W., Oct. 27th, 1902.
been given to the metric terms, modern text-books would have been framed on the same lines, and the student would have learned to write his prescriptions in the language in which he had been trained to think. A new edition of the Pharmacopoeia is probably many years distant; but with it, I venture to think, the, best hope of the adoption of the metric system in medicine rests. Once secure the expression of the official doses in terms of that system and all else follows-text-books, teachers, examiners, students, physicians, prescriptions, and pharmacists. Ease in translation will no doubt help an individual here and there to use a new language, but it will hardly make that language a common I am, Sirs, yours faithfully, tongue. C. O. 0. HAWTHORNE. Weymouth-atreet, W., Nov. lst, 1902. To the Editors of THE LANCET. on the use of the metric system in pharmacy must be largely academic until that system is taught, and exclusively taught, in our medical schools. As long as the prescriber thinks in grains and ounces, so long will his prescriptions be couched in those terms. Doubtless there are many medical men whose scientific investigations make it obligatory for them to possess a practical knowledge of the metric system ; but the majority even of these, I venture to think, would only by a mental effort and by a process of translation write a prescription in the terms of that system. As regards the relative advantage of weighing and of measuring liquids for medicines given internally, it must be remembered that the patient takes his dose by measure and not by weight. If, then, absolute accuracy of any active ingredient is desired a dose of that active ingiedient must be represented by a definite fluid quantity of the medicine. It appears, therefore, that in such a case the weighing of liquids other than water is undesirable unless special regard is paid to their very varying specific gravities. Registered chemists generally are prepared for the change, whenever it may come, many of them having frequent occasion to prepare foreign prescriptions involving the use of the metric system. Moreover, it is hardly necessary to add that " a practical knowledge of the metric system of weights and measures" is required of all candidates for the minor" " or qualifying examination of the Pharmaceutical Society. I am, Sirs, yours faithfully, WALTER HILLS. Oxford-street, W., Nov. lst, 1902.
SIRS,-The discussion
THE METRIC SYSTEM IN PHARMACY. THE MEDICAL DEFENCE UNION. To the Editors of THE LANCET. To the Editors of THE LANCET. SIRS,—In the recent correspondence on this subject SIRS,-Before imposing an entrance fee the council of the various ingenious suggestions have been made with a view Medical Defence Union should have ascertained the wishes to facilitate the translation of the terms denoting the of its members. To do anything which may tend to restrict weights and measures at present used in dispensing into the growth of the union is a doubtful policy ; nor should it those of the metric system. These suggestions may have be necessary to impose a heavier tax on the smaller incomes distinct value, but none of them it is to be feared will be of the more recently qualified practitioners from whose ranks effectual to secure anything like general adoption of the the bulk of new members should naturally come. The reason metric notation. Indeed, no scheme which involves an act for this important change is the success of the union. of translation can be expected to secure this result. What is given This hardly constitutes an urgent matter and if the council wanted is to train physicians and pharmacists to think in will hold its hand for a few months the question can be far metric terms. And this on a large and general scale can more satisfactorily decided at the next annual meeting. only be effected in the stage of studentship. So far, thereI am, Sirs, yours faithfully, in THE LANCET of Mr. Kenneth Scott’s fore, suggestion PERCY ROSE. Oct. 1902. E., 29th, Barking-road, Oct. 25th, p. 1152, is one having a large measure of promise. But it is, I suggest, necessary to carry the process of Writers of text-books reconstruction still further back. A REMARKABLE CASE OF PNEUMOon materia medica and pharmacy are necessarily influthe or even and method dominated, by enced, example THORAX. of the Pharmacopoeia, and so long as that volume expresses the To Editors oj THE LANCET. the doses of the various official medicines in terms of the current notation, so long will this notation be the one allow me to make a remark or SIRS,- Will you kindly adopted in the text-books, demanded by the examiner, and two on the interesting case with the above heading, so well acquired by the student. If, on the other hand, the official described by Dr. H. C. Morris in THE LANCET of Oct. 25th, doses were expressed in metric weights and measures both p. 1124 ? It is, I think, an unusual thing for traumatic teachers and examiners would be almost compelled to follow pneumothorax and emphysema to occur without being the same course, and the student, trained in this fashion, caused by the spicula of a fractured rib or some other would naturally think and write in metric terms. In my mechanical injury to the lung. The affections in this case judgment a great opportunity was lost when in the last were doubtless caused by the excessive inflation of the lungs edition of the Pharmacopoeia the doses were printed solely owing to the deep inspiration which the patient instincin the terms of the present system. Such a decision was all tively gave in his endeavours to avoid falling ; thus, the the more astonishing seeing that the quantities of the sub- rupture of an air vessel or two. One would have thought, stances to be used in making the official preparations were falling from an altitude of 20 feet, that he would have susoffered in both systems. Had the same plan been adopted in tained a fractured limb, but he fell on grass that may have the statement of doses,
more
especially if priority of place had
been
long
and the soil may have been
soft,
both of which
1287 would help to mollify the hardly have been avoided
violence of the impact ; this could if he had fallen on a slab or stone
pavement.
Then the way a person falls is an important element in accidents of this kind. Some hunting men will tell you that they have learned to fall in a way that prevents broken bones. They curl themselves up and endeavour to meet I once saw the ground first with their arched backs. this neatly done by a young Horse Artillery officer who, having mounted his horse, struck a match to light a cigar before he had placed his feet in the stirrups. The horse, startled at the noise made by the match, jumped, kicked, and threw its rider a lofty somersault, but the rider, who fell on his rounded back on a flagged side path, was up in a moment unhurt and sprang on his horse again in quick time. Dr. Morris’s patient would have been up and about in a few days were it not for the secondary symptoms that set in, but if he had fallen on his head instead of his feet most probably he would have been killed. This event was the result in the first accident of the kind we have recorded in history. We read in the Fourth Chapter of the First Book of Samuel that when Eli had heard of the catastrophe which had befallen the armies of Israel, of the death of his two sons, and that the Ark of God had been taken by the enemyhe fell from off the seat backward by the side of the gate, and his neck brake, and he died : for he was an old man, and heavy." I saw a man fall from a height of 12 or 14 feet without receiving the slightest injury. He and a few friends were drinking in an inn in a room where a window had been temporarily removed. The man got up from the table, walked to the window (mistaking it for an open door), and stepped out, and, fortunately for him, he fell into a cabbage-garden. Several people ran to his assistance and when he had scrambled on his feet he looked up at the window from which he had emerged and at the long strip of blank wall between it and the ground and then he apostrophised the landlord with the malediction, " Bad luck to you, Terry McGrath, for it’s yourself that has the high step to your hall dooer." I am, Sirs, yours faithfully, Lincoln, Oct. 28th, 1902. O’NEILL, M.D. Aberd.
WILLIAM
THE USE OF INSUFFLATIONS FOR SUPPURATION OF THE ANTRUM OF HIGHMORE. To the Editors of THE LANCET. be SIRS,-That a very bad case of antral empyema cured by the extraction of a tooth followed by the active use of antiseptic washings through the socket is within the experience of many practical surgeons, but that the persistent discharge of a chronic suppuration in the antrum of Highmore cannot be arrested quite so easily is only too evident after reading the experience of experts in these A great deal of excellent work has lately been pubcases. lished on diseases of the accessory sinuses and anyone who follows these writings, as well as the discussion on the subject at the Manchester meeting of the British Medical Association, must be impressed with the difficulties of dealing satisfactorily with chronic cases of antral empyema. Without claiming anything like the experience desirable to form conclusions about relieving such intractable cases I feel that a most valued adjunct to the usual method of dealing with chronic maxillary sinusitis will be found in the insufflation of dry powders. It is generally admitted that the constantly moist condition which necessarily follows the repeated irrigation of mucous cavities like the middle ear is highly unfavourable to recovery from any purulent process, and that a bland powder in a state of fine division like boric acid is likely to give the most useful results. In the antrum of Highmore into which an opening has been made from the mouth we have just those conditions which Mr. Edmund W. Roughton has made us familiar with in his admirable lecturesdelivered before the Medical Graduates’
can
College
and
incubator.
Polyclinic-viz.,
a
perfect bacteriological
Now, keeping these conditions in view,
one is justified in for the best results in any uncomplicated case of chronic discharge from the maxillary antrum by having resource to some such method as the following. Having
hoping
1 THE
1902.
LANCET, Sept. 27th (p. 847), Oct. 18th (p. 1029),
and 25th
(1108),
made
good-sized perforation through the alveolus and the cavity with antiseptic solutions as suggested by Dr. Herbert Tilley in a recent paper2 we may with advantage follow this up by repeated insufflations of dry boric powder to which has been added a little menthol or carbolic acid. Any ordinary insufflator fixed to the and the will meet all requirements antral tube method of doing it will suggest itself naturally. In my own practice I use pulvis acidi borici impregnated with a concentrated tincture of calendula officinalis mixed with five grains of menthol to the half ounce, and I blow this powder to every corner of the cavity by means of a Kabievskie’s insufHator fixed to the end of a large-sized Svmonds’s antral pipe. To test the efficacy of the treatment the antrum is washed out periodically with a clear antiseptic solution (carbolic acid 1 in 40 or even weaker) by means of a modified Higginson’s syringe and the washings are received into a vulcanite dish, the object of the clear solution and black vessel being obviously to detect any purulent matter. Having satisfied oneself that the solution runs clear the bucco-antral opening is allowed to close, and that all the more readily because the chances of reinfection from the mouth are rendered improbable by the presence of an antiseptic powder in the maxillary antrum. I am. Sirs. vours faithfullv. WALTER WILLIAMS, M.B. Glasg. Portmadoc, North Wales, Oct. 26th, 1902. a
irrigated
RIGHT-HANDEDNESS AND LEFTBRAINEDNESS.
To the Editors of THE LANCET. SIRS,-Though quite agreeing with Professor D. J. Cunningham as to the existence of a preferential right-handedness, it is a question whether this is due to some structural foundation transmitted from parent to offspring or a functional activity or pre-eminence acquired during the lifetime of the individual. Facts would seem to point to the latter as being the true explanation. It is true that growth, and therefore the circulation, in plants tends from right to left and it may be so in brain circulation, for active function Be means and demands an active flow of nourishing biood. that as it may, I think that clinical evidence points to acquired rather than to transmitted or hereditary function. The skilled pianist or violinist goes through as intricate muscular movements with the left as with the right hand, and even where the muscular movements are more directly due to skilled automatism, say of one hand, it is evidently due to acquired educational movements, purely functional and not necessarily dependent on any structural foundation. A lady, a friend of mine, after undergoing an operation on the right arm conducted her somewhat voluminous correspondence with her left hand, and there was no difficulty in reading and recognising her characteristic penmanship. Another illustration is the case of another friend, an engineer and architect, who after having his right arm torn out from the shoulder-joint kept his appointment and did all his necessary drawings and designs with his left hand; thus, though we have a preferential right-handedness, we may when this is lost have a compensatory one in the left, the result of education and necessity. Therefore it seems to me that it is going too far to maintain that the left hand holds a subservient position in reference to the right-the one is simply on duty, the other is not. I am, Sirs, yours faithfully, JAMES MORE, M.D. Edin. Rothwell, Northamptonshire, Nov. 3rd, 1902.
GUY’S
,
HOSPITAL SOUTH MEMORIAL.
AFRICAN
To the Editors of THE LANCET. SIRS,-A shortly be erected within the precincts of Guy’s Hospital to the memory of those Guy’s men whose lives were lost in the service of their country during the South African war. The memorial will take the form of a drinking fountain to be placed in the colonnade, and a suitable design by Mr. Frederick Wheeler, F.R.I.B.A., has been selected. The committee is very anxious that the names of all Guy’s students, past and present, who lost their memorial will
2
Brit. Med.
Jour., April 19th, 1902.
.
Harveian Lectures that it was in some way due to bactericidal effusion of serum into the’ peritoneum: after the abdominal incision and Mr. Owen inquires whether it be due to "letting air in or letting tluid out." That it need not be due to letting air in is argued by successful cases in which the peritoneal effusion is withdrawn by aspiration or other mode of paracentesis. This fact likewise casts doubt upon the essential necessity of laparotomy in some cases. But it may be questioned, also, whether even paracentesis be always necessary to a successful issue. It is a common experience that minor degrees of tuberculous ascites, especially in children, disappear with mere recumbency and flannel bandaging ; and in THE LANCET of Oct. llth, 1902, p. 989, Dr. Robert Knox of Higbgate publishes a case which I saw with him, presumably of pleural and peritoneal tuberculosis, which made a satisfactory recovery under general management and abdominal strapping. The influence, as he points out, of a restriction of abdominal movement, coupled with mechanical support of the abdominal muscles, is to exaggerate thoracic respiration and aspiration and to increase lymphatic absorption. These effects exercised upon the circulation cannot be ignored in considering the results of procedures for the cure of the disease in the peritoneal cavity. And, again, the exaggerated respiration and aeration of the lungs thus induced cannot be denied their share, both in improving the state of these organs when simultaneously affected and in promoting a more vigorous pulmonary circulation. The conclusion to be drawn from these considerations is that the influence of Harvey’s work is felt even in the determination of this question at present so interesting to the surgeon. What success attends the open-air treatment of pulmonary tuberculosis, indeed, is probably due in part to the indirect influence of the measures adopted upon the circulation of the blood. The open window is doubtless something in such cases, but not everything, and the poitrinaire in his wind-swept hut might possibly at times be even more sheltered than he is at present with increased comfort to himself and no less advantage. The secret held and not yet revealed by the successful treatment of peritoneal tuberculosis may prove the key to the cure of consumption." When revealed it may check the precipitancy with which " open-air treatment institutions are now being erected. I am, Sirs, yours faithfully, ALEXANDER MORISON, M.D. Edin. Upper Berkeley-street, W., Oct. 27th, 1902.
been given to the metric terms, modern text-books would have been framed on the same lines, and the student would have learned to write his prescriptions in the language in which he had been trained to think. A new edition of the Pharmacopoeia is probably many years distant; but with it, I venture to think, the, best hope of the adoption of the metric system in medicine rests. Once secure the expression of the official doses in terms of that system and all else follows-text-books, teachers, examiners, students, physicians, prescriptions, and pharmacists. Ease in translation will no doubt help an individual here and there to use a new language, but it will hardly make that language a common I am, Sirs, yours faithfully, tongue. C. O. 0. HAWTHORNE. Weymouth-atreet, W., Nov. lst, 1902. To the Editors of THE LANCET. on the use of the metric system in pharmacy must be largely academic until that system is taught, and exclusively taught, in our medical schools. As long as the prescriber thinks in grains and ounces, so long will his prescriptions be couched in those terms. Doubtless there are many medical men whose scientific investigations make it obligatory for them to possess a practical knowledge of the metric system ; but the majority even of these, I venture to think, would only by a mental effort and by a process of translation write a prescription in the terms of that system. As regards the relative advantage of weighing and of measuring liquids for medicines given internally, it must be remembered that the patient takes his dose by measure and not by weight. If, then, absolute accuracy of any active ingredient is desired a dose of that active ingiedient must be represented by a definite fluid quantity of the medicine. It appears, therefore, that in such a case the weighing of liquids other than water is undesirable unless special regard is paid to their very varying specific gravities. Registered chemists generally are prepared for the change, whenever it may come, many of them having frequent occasion to prepare foreign prescriptions involving the use of the metric system. Moreover, it is hardly necessary to add that " a practical knowledge of the metric system of weights and measures" is required of all candidates for the minor" " or qualifying examination of the Pharmaceutical Society. I am, Sirs, yours faithfully, WALTER HILLS. Oxford-street, W., Nov. lst, 1902.
SIRS,-The discussion
THE METRIC SYSTEM IN PHARMACY. THE MEDICAL DEFENCE UNION. To the Editors of THE LANCET. To the Editors of THE LANCET. SIRS,—In the recent correspondence on this subject SIRS,-Before imposing an entrance fee the council of the various ingenious suggestions have been made with a view Medical Defence Union should have ascertained the wishes to facilitate the translation of the terms denoting the of its members. To do anything which may tend to restrict weights and measures at present used in dispensing into the growth of the union is a doubtful policy ; nor should it those of the metric system. These suggestions may have be necessary to impose a heavier tax on the smaller incomes distinct value, but none of them it is to be feared will be of the more recently qualified practitioners from whose ranks effectual to secure anything like general adoption of the the bulk of new members should naturally come. The reason metric notation. Indeed, no scheme which involves an act for this important change is the success of the union. of translation can be expected to secure this result. What is given This hardly constitutes an urgent matter and if the council wanted is to train physicians and pharmacists to think in will hold its hand for a few months the question can be far metric terms. And this on a large and general scale can more satisfactorily decided at the next annual meeting. only be effected in the stage of studentship. So far, thereI am, Sirs, yours faithfully, in THE LANCET of Mr. Kenneth Scott’s fore, suggestion PERCY ROSE. Oct. 1902. E., 29th, Barking-road, Oct. 25th, p. 1152, is one having a large measure of promise. But it is, I suggest, necessary to carry the process of Writers of text-books reconstruction still further back. A REMARKABLE CASE OF PNEUMOon materia medica and pharmacy are necessarily influthe or even and method dominated, by enced, example THORAX. of the Pharmacopoeia, and so long as that volume expresses the To Editors oj THE LANCET. the doses of the various official medicines in terms of the current notation, so long will this notation be the one allow me to make a remark or SIRS,- Will you kindly adopted in the text-books, demanded by the examiner, and two on the interesting case with the above heading, so well acquired by the student. If, on the other hand, the official described by Dr. H. C. Morris in THE LANCET of Oct. 25th, doses were expressed in metric weights and measures both p. 1124 ? It is, I think, an unusual thing for traumatic teachers and examiners would be almost compelled to follow pneumothorax and emphysema to occur without being the same course, and the student, trained in this fashion, caused by the spicula of a fractured rib or some other would naturally think and write in metric terms. In my mechanical injury to the lung. The affections in this case judgment a great opportunity was lost when in the last were doubtless caused by the excessive inflation of the lungs edition of the Pharmacopoeia the doses were printed solely owing to the deep inspiration which the patient instincin the terms of the present system. Such a decision was all tively gave in his endeavours to avoid falling ; thus, the the more astonishing seeing that the quantities of the sub- rupture of an air vessel or two. One would have thought, stances to be used in making the official preparations were falling from an altitude of 20 feet, that he would have susoffered in both systems. Had the same plan been adopted in tained a fractured limb, but he fell on grass that may have the statement of doses,
more
especially if priority of place had
been
long
and the soil may have been
soft,
both of which
1287 would help to mollify the hardly have been avoided
violence of the impact ; this could if he had fallen on a slab or stone
pavement.
Then the way a person falls is an important element in accidents of this kind. Some hunting men will tell you that they have learned to fall in a way that prevents broken bones. They curl themselves up and endeavour to meet I once saw the ground first with their arched backs. this neatly done by a young Horse Artillery officer who, having mounted his horse, struck a match to light a cigar before he had placed his feet in the stirrups. The horse, startled at the noise made by the match, jumped, kicked, and threw its rider a lofty somersault, but the rider, who fell on his rounded back on a flagged side path, was up in a moment unhurt and sprang on his horse again in quick time. Dr. Morris’s patient would have been up and about in a few days were it not for the secondary symptoms that set in, but if he had fallen on his head instead of his feet most probably he would have been killed. This event was the result in the first accident of the kind we have recorded in history. We read in the Fourth Chapter of the First Book of Samuel that when Eli had heard of the catastrophe which had befallen the armies of Israel, of the death of his two sons, and that the Ark of God had been taken by the enemyhe fell from off the seat backward by the side of the gate, and his neck brake, and he died : for he was an old man, and heavy." I saw a man fall from a height of 12 or 14 feet without receiving the slightest injury. He and a few friends were drinking in an inn in a room where a window had been temporarily removed. The man got up from the table, walked to the window (mistaking it for an open door), and stepped out, and, fortunately for him, he fell into a cabbage-garden. Several people ran to his assistance and when he had scrambled on his feet he looked up at the window from which he had emerged and at the long strip of blank wall between it and the ground and then he apostrophised the landlord with the malediction, " Bad luck to you, Terry McGrath, for it’s yourself that has the high step to your hall dooer." I am, Sirs, yours faithfully, Lincoln, Oct. 28th, 1902. O’NEILL, M.D. Aberd.
WILLIAM
THE USE OF INSUFFLATIONS FOR SUPPURATION OF THE ANTRUM OF HIGHMORE. To the Editors of THE LANCET. be SIRS,-That a very bad case of antral empyema cured by the extraction of a tooth followed by the active use of antiseptic washings through the socket is within the experience of many practical surgeons, but that the persistent discharge of a chronic suppuration in the antrum of Highmore cannot be arrested quite so easily is only too evident after reading the experience of experts in these A great deal of excellent work has lately been pubcases. lished on diseases of the accessory sinuses and anyone who follows these writings, as well as the discussion on the subject at the Manchester meeting of the British Medical Association, must be impressed with the difficulties of dealing satisfactorily with chronic cases of antral empyema. Without claiming anything like the experience desirable to form conclusions about relieving such intractable cases I feel that a most valued adjunct to the usual method of dealing with chronic maxillary sinusitis will be found in the insufflation of dry powders. It is generally admitted that the constantly moist condition which necessarily follows the repeated irrigation of mucous cavities like the middle ear is highly unfavourable to recovery from any purulent process, and that a bland powder in a state of fine division like boric acid is likely to give the most useful results. In the antrum of Highmore into which an opening has been made from the mouth we have just those conditions which Mr. Edmund W. Roughton has made us familiar with in his admirable lecturesdelivered before the Medical Graduates’
can
College
and
incubator.
Polyclinic-viz.,
a
perfect bacteriological
Now, keeping these conditions in view,
one is justified in for the best results in any uncomplicated case of chronic discharge from the maxillary antrum by having resource to some such method as the following. Having
hoping
1 THE
1902.
LANCET, Sept. 27th (p. 847), Oct. 18th (p. 1029),
and 25th
(1108),
made
good-sized perforation through the alveolus and the cavity with antiseptic solutions as suggested by Dr. Herbert Tilley in a recent paper2 we may with advantage follow this up by repeated insufflations of dry boric powder to which has been added a little menthol or carbolic acid. Any ordinary insufflator fixed to the and the will meet all requirements antral tube method of doing it will suggest itself naturally. In my own practice I use pulvis acidi borici impregnated with a concentrated tincture of calendula officinalis mixed with five grains of menthol to the half ounce, and I blow this powder to every corner of the cavity by means of a Kabievskie’s insufHator fixed to the end of a large-sized Svmonds’s antral pipe. To test the efficacy of the treatment the antrum is washed out periodically with a clear antiseptic solution (carbolic acid 1 in 40 or even weaker) by means of a modified Higginson’s syringe and the washings are received into a vulcanite dish, the object of the clear solution and black vessel being obviously to detect any purulent matter. Having satisfied oneself that the solution runs clear the bucco-antral opening is allowed to close, and that all the more readily because the chances of reinfection from the mouth are rendered improbable by the presence of an antiseptic powder in the maxillary antrum. I am. Sirs. vours faithfullv. WALTER WILLIAMS, M.B. Glasg. Portmadoc, North Wales, Oct. 26th, 1902. a
irrigated
RIGHT-HANDEDNESS AND LEFTBRAINEDNESS.
To the Editors of THE LANCET. SIRS,-Though quite agreeing with Professor D. J. Cunningham as to the existence of a preferential right-handedness, it is a question whether this is due to some structural foundation transmitted from parent to offspring or a functional activity or pre-eminence acquired during the lifetime of the individual. Facts would seem to point to the latter as being the true explanation. It is true that growth, and therefore the circulation, in plants tends from right to left and it may be so in brain circulation, for active function Be means and demands an active flow of nourishing biood. that as it may, I think that clinical evidence points to acquired rather than to transmitted or hereditary function. The skilled pianist or violinist goes through as intricate muscular movements with the left as with the right hand, and even where the muscular movements are more directly due to skilled automatism, say of one hand, it is evidently due to acquired educational movements, purely functional and not necessarily dependent on any structural foundation. A lady, a friend of mine, after undergoing an operation on the right arm conducted her somewhat voluminous correspondence with her left hand, and there was no difficulty in reading and recognising her characteristic penmanship. Another illustration is the case of another friend, an engineer and architect, who after having his right arm torn out from the shoulder-joint kept his appointment and did all his necessary drawings and designs with his left hand; thus, though we have a preferential right-handedness, we may when this is lost have a compensatory one in the left, the result of education and necessity. Therefore it seems to me that it is going too far to maintain that the left hand holds a subservient position in reference to the right-the one is simply on duty, the other is not. I am, Sirs, yours faithfully, JAMES MORE, M.D. Edin. Rothwell, Northamptonshire, Nov. 3rd, 1902.
GUY’S
,
HOSPITAL SOUTH MEMORIAL.
AFRICAN
To the Editors of THE LANCET. SIRS,-A shortly be erected within the precincts of Guy’s Hospital to the memory of those Guy’s men whose lives were lost in the service of their country during the South African war. The memorial will take the form of a drinking fountain to be placed in the colonnade, and a suitable design by Mr. Frederick Wheeler, F.R.I.B.A., has been selected. The committee is very anxious that the names of all Guy’s students, past and present, who lost their memorial will
2
Brit. Med.
Jour., April 19th, 1902.