- Email: [email protected]
ADMINISTRATION OF CHLOROFORM WITH OXYGEN.
735 At the present moment, we believe that the best hope of next door, and would be able to enlarge their special elucidating the main questions at issue is to combine the departments in the near future. experimental and statistical methods, by developing an Experience gained in maternity and child welfare experimental biometry of epidemic disease, in which the work and the reduction of deaths from infantile bacteriological and immunological factors shall not be so diarrhoea clearly show that most benefit accrues complex, and so little susceptible to control, as to defy where facilities for knowledge and treatment are analysis, while the numerical data shall not be so slight easily available, and although it may not be possible as to preclude the application of statistical methods of to increase the number of venereal disease clinics at inquiry." the present time, it is surely a retrograde policy to Dr. M. Greenwood’s share in the work is, of course, "
close any of them. The scheme of six large all-dav obvious from the context of the lectures, clinics will, I fear, prove both more expensive and the it matter were and I would not trouble you in efficient. less not that I have a very lively faith in the promises T between a the two out closer held by cooperation STELLA CHURCHILL. methods of research. Team-work is not a magician’s Chiswick, W., March 23rd, 1926. to resolve all our troubles and wand, potent perplexities ; indeed, it can quite easily be overpraised and overdone. But from time to time occasions arise ADMINISTRATION OF CHLOROFORM WITH in which it becomes clear that successful attack on OXYGEN. a particular problem requires the application of two To the Editor of THE LANCET. technical methods, neither of which can be acquired easily or quickly, and which are not, in fact, at the SIR,—It appears to be a usual practice, as described disposal of a single individual ; while two or more in books of recent date, to attach the tube from the persons, possessing in their joint capacity a combina- cylinder of oxygen to the afferent metal tube of a tion of technical experience which neither can command Junker or similar apparatus in place of the hand- or alone, may have a sufficient common stock of know- foot-bellows, and turn on a stream of oxygen at low ledge and ideas to see the same problem in much the pressure to bubble through the chloroform. I have same light. Under such circumstances team-work always thought this proceeding open to the objection, becomes natural, and therefore easy and profitable. which may (with others) be made against all those There is, I think, little doubt that the study of which a continuous stream is conducted to the by epidemic disease offers one such occasion to the patient’s airway, that the intake of the patient in bacteriologist and the biometrician. I shrewdly ordinary circumstances is not continuous, and theresuspect that many of the problems of infection and fore much of the anaesthetic is not only wasted, but immunity, not usually included in the domain of blown by his expirations into the faces of those epidemiology, would yield to attack along similar near by. Lately there have been, to my knowledge, I am, Sir, yours faithfully, lines. two accidents due to some obstruction in the mouthW. W. C. TOPLEY. Manchester, March 29th, 1926. tube, or kinking of the rubber tube joining this to thebottle. When using a hand- or foot-bellows the anæsthetist is at once aware of such blocking, but with the V.D. CLINICS AND THE L.C.C. method under consideration this may not be the case,. and the pressure increases until a tube is blown off To the Editor of THE LANCET. or the stopper forced out, and chloroform is spurted call the attention SIR,—I feel it might be useful to about. In one instance some drops went down the of teaching hospitals to the policy of the London neck, and in the other into the operator’s. operator’s venereal Council in to disease County making grants and anaesthetist’s eyes. clinics as it was laid down at a meeting of the Council I am. Sir. vours faithfullv. It is proposed to concentrate the this afternoon. J. D. MORTIMER. March 26th, 1926. London, N,W., work of these clinics in six large hospitals, which shall have all-day clinics, and one of these-viz., St. Paul’s, Endell-street, is not a hospital connected GENERAL PRACTITIONERS AND MEDICAL with any medical school, so far as I know. As a RESEARCH. step in this direction, the Council agreed to-day to the discontinuance (from March, 1927) of the grants To the Editor of THE LANCET. to the Elizabeth Garrett Anderson and Charing Cross SIR,—You were good enough to publish a letter Hospitals, two of the 26 general and special hospitals at present included in the scheme. No one knows from me recently on the question of the endowment which will be the next on the list, nor does the Council of research at the London Hospital. We have since received many letters suggesting subjects for research, or the Ministry of Health give notice to hospitals until it has been decided to discontinue the grant, and these suggestions will be carefully considered. so that appeal is practically impossible. One, from an old friend and colleague, Dr. N. M. During the debate which took place in the Council Goodman, of Lymington, deserves wider publicity. I pointed out that this policy of six large clinics would He considers that there is a great opportunity for entail much travelling by patients, owing to the general practitioners to cooperate with the research immense distances to be traversed in London, and departments of their old hospitals, because : (1) They that great overcrowding must be expected at clinics see the beginnings of disease much earlier and more which draw patients from a population of over five constantly than workers in hospitals. (2) Their million persons. In the case of the Elizabeth Garrett observations have the advantage of a continuity Anderson Hospital it seems very inadvisable to which may last from birth to old age. (3) They see discontinue the grant to a hospital which deals many minor, and so-called unimportant diseases especially with venereal disease in married women, " which never come near a hospital." And yet, he more particularly at a time when the Council proposes points out, little or no research is carried on in private to spend £317,900 in the coming year on special practice because there is no inducement. He states : schools for blind. deaf, defective, and epileptic children, (1) That a general practitioner does not see enough the mothers of whom may have suffered from venereal of any one disease to make his observations worth disease in some form. This hospital is also recognised recording, although the combined experience of a for the teaching of gynaecology ; in the past year it group of practitioners would produce valuable results. has had 236 new cases of venereal disease, whereas (2) That the practitioner lacks direction in his research other hospitals which are not being attacked had work-his little bit may be of no value and so he is numbers considerably below this figure. In the case disheartened from beginning ; yet, if he felt that his of Charing Cross Hospital it is unfortunate that the clinical observations could be linked up with others, clinic belonging to an important teaching school and with the pathological and clinical work of his old should be attacked, especially in view of the fact that hospital, he would willingly do it. (3) That any the authorities have recently acquired the premises research work done by a general practitioner is a
perfectly
I
.
close any of them. The scheme of six large all-dav obvious from the context of the lectures, clinics will, I fear, prove both more expensive and the it matter were and I would not trouble you in efficient. less not that I have a very lively faith in the promises T between a the two out closer held by cooperation STELLA CHURCHILL. methods of research. Team-work is not a magician’s Chiswick, W., March 23rd, 1926. to resolve all our troubles and wand, potent perplexities ; indeed, it can quite easily be overpraised and overdone. But from time to time occasions arise ADMINISTRATION OF CHLOROFORM WITH in which it becomes clear that successful attack on OXYGEN. a particular problem requires the application of two To the Editor of THE LANCET. technical methods, neither of which can be acquired easily or quickly, and which are not, in fact, at the SIR,—It appears to be a usual practice, as described disposal of a single individual ; while two or more in books of recent date, to attach the tube from the persons, possessing in their joint capacity a combina- cylinder of oxygen to the afferent metal tube of a tion of technical experience which neither can command Junker or similar apparatus in place of the hand- or alone, may have a sufficient common stock of know- foot-bellows, and turn on a stream of oxygen at low ledge and ideas to see the same problem in much the pressure to bubble through the chloroform. I have same light. Under such circumstances team-work always thought this proceeding open to the objection, becomes natural, and therefore easy and profitable. which may (with others) be made against all those There is, I think, little doubt that the study of which a continuous stream is conducted to the by epidemic disease offers one such occasion to the patient’s airway, that the intake of the patient in bacteriologist and the biometrician. I shrewdly ordinary circumstances is not continuous, and theresuspect that many of the problems of infection and fore much of the anaesthetic is not only wasted, but immunity, not usually included in the domain of blown by his expirations into the faces of those epidemiology, would yield to attack along similar near by. Lately there have been, to my knowledge, I am, Sir, yours faithfully, lines. two accidents due to some obstruction in the mouthW. W. C. TOPLEY. Manchester, March 29th, 1926. tube, or kinking of the rubber tube joining this to thebottle. When using a hand- or foot-bellows the anæsthetist is at once aware of such blocking, but with the V.D. CLINICS AND THE L.C.C. method under consideration this may not be the case,. and the pressure increases until a tube is blown off To the Editor of THE LANCET. or the stopper forced out, and chloroform is spurted call the attention SIR,—I feel it might be useful to about. In one instance some drops went down the of teaching hospitals to the policy of the London neck, and in the other into the operator’s. operator’s venereal Council in to disease County making grants and anaesthetist’s eyes. clinics as it was laid down at a meeting of the Council I am. Sir. vours faithfullv. It is proposed to concentrate the this afternoon. J. D. MORTIMER. March 26th, 1926. London, N,W., work of these clinics in six large hospitals, which shall have all-day clinics, and one of these-viz., St. Paul’s, Endell-street, is not a hospital connected GENERAL PRACTITIONERS AND MEDICAL with any medical school, so far as I know. As a RESEARCH. step in this direction, the Council agreed to-day to the discontinuance (from March, 1927) of the grants To the Editor of THE LANCET. to the Elizabeth Garrett Anderson and Charing Cross SIR,—You were good enough to publish a letter Hospitals, two of the 26 general and special hospitals at present included in the scheme. No one knows from me recently on the question of the endowment which will be the next on the list, nor does the Council of research at the London Hospital. We have since received many letters suggesting subjects for research, or the Ministry of Health give notice to hospitals until it has been decided to discontinue the grant, and these suggestions will be carefully considered. so that appeal is practically impossible. One, from an old friend and colleague, Dr. N. M. During the debate which took place in the Council Goodman, of Lymington, deserves wider publicity. I pointed out that this policy of six large clinics would He considers that there is a great opportunity for entail much travelling by patients, owing to the general practitioners to cooperate with the research immense distances to be traversed in London, and departments of their old hospitals, because : (1) They that great overcrowding must be expected at clinics see the beginnings of disease much earlier and more which draw patients from a population of over five constantly than workers in hospitals. (2) Their million persons. In the case of the Elizabeth Garrett observations have the advantage of a continuity Anderson Hospital it seems very inadvisable to which may last from birth to old age. (3) They see discontinue the grant to a hospital which deals many minor, and so-called unimportant diseases especially with venereal disease in married women, " which never come near a hospital." And yet, he more particularly at a time when the Council proposes points out, little or no research is carried on in private to spend £317,900 in the coming year on special practice because there is no inducement. He states : schools for blind. deaf, defective, and epileptic children, (1) That a general practitioner does not see enough the mothers of whom may have suffered from venereal of any one disease to make his observations worth disease in some form. This hospital is also recognised recording, although the combined experience of a for the teaching of gynaecology ; in the past year it group of practitioners would produce valuable results. has had 236 new cases of venereal disease, whereas (2) That the practitioner lacks direction in his research other hospitals which are not being attacked had work-his little bit may be of no value and so he is numbers considerably below this figure. In the case disheartened from beginning ; yet, if he felt that his of Charing Cross Hospital it is unfortunate that the clinical observations could be linked up with others, clinic belonging to an important teaching school and with the pathological and clinical work of his old should be attacked, especially in view of the fact that hospital, he would willingly do it. (3) That any the authorities have recently acquired the premises research work done by a general practitioner is a
perfectly
I
.