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ANESTHETICS.
222
pleasure in adding for his information that palate on the same side as the lesion was
ANÆSTHETICS.—LIVERPOOL.
the half of the unaffected by mechanical stimulation. The velum was not attenuated and with respect to size capable of being approximated to the posterior pharyngeal wall. No physical impedimenta in the nature of membrane on its posterior wall, new growths in its substance or neoplasms in the naso-pharyngeal cavity were present. From these and the data already given in my paper, together with the fact that fluid returned through the nose, I could not possibly arrive at any other conclusion than that of unilateral paralysis of the soft palate. These conditions, pointing to this fact, were readily recognised by my clinical assistants and the students attending my clinique at the Evelina Hospital. The object of a scientific paper being not to teach the symptoms of any well-recognised disease, but to detail clinical facts, I did not think it necessary to give all the information that Dr. Kidd misses. Of adenoid vegetations occurring in my practice I have notes of over two hundred cases, yet I have not met with in these the symptoms of passage of fluid viu the nares, but I should not be so rash as to deny its occasional occurrence for such has been noted by competent observers. Had adenoid vegetations been present in this case I should certainly have mentioned that fact. Dr. Kidd’s supposition that the tonsils were removed for chronic hypertrophy is correct. On the patient’s return from the fever hospital the left tonsil, as stated, was found enlarged, but no subacute inflammatory condition was present. The case quoted by Dr. Kidd is interesting, but by no means unfamiliar to the medical profession. It is an example in which the passage of fluid through the nares might have been due to mechanical causes, but seeing that it was a case of diphtheria it would be difficult to deny that there was no palatine paralysis, and the fact that there were no other palsies, or that the patellar reflexes were present would not militate against this. Certainly the absence of facial paralysis, upon which stress has been laid by Dr. Kidd, would not negative this diagnosis, for this complication must be infinitely rare as a sequel to that disease. Interesting as his case is it is hardly on all fours with the one I quote, where facial paralysis was complicated by paresis of the corresponding half of the soft palate. Moreover, Dr. Kidd seems to have ignored the fact that the palatine paresis in my case was present after ablation of both tonsils and before admission to the Fever Hospital, whereas the secondary enlargement of the left tonsil was found only after her return from that institution ; therefore the condition of the left tonsil has no bearing It was merely mentioned as a fact worthy of on the case. note. Much as I respect the opinions of Drs. Gowers and Hughlings Jackson and much as I appreciate the work of Dr. Beevor and Mr. Horsley, I do not feel justified in ignoring ocular evidence before me, or passing over clinical observations which I have by your courtesy placed on record, because such did not completely coincide with the clinical experience and anatomical views of a section ofthe profession. Whether the palate be supplied by the spinal accessory nerve or from the facial through the petrosal nerve of the Vidian, the facts I have recorded remain. I am, Sirs, yours faithfully, GEORGE CARPENTER. Queen Anna-street, W., Jan. 2&tb, 1893.
Glass and shot were both passed over as being too This is an engineer’s idea. I am, Sirs, yours truly, TOM BIRD, Brook-street, W., Jan. 20th, 1893.
noise. 1
lheavy.
LIVERPOOL. (FROM
OUR OWN
CORRESPONDENT.)
The Port Sanitary Authority. THE inquiry which has been opened before Mr. JennerFust and Dr. Barry, of the Local Government Board, has been adjourned until the end of this month. This inquiry possesses far more than local interest, as anyone may judge by taking a glance at Liverpool’s geographical position. There is no port at the mouth of the river Mersey analogous to Gravesend at the mouth of the Thames, and the number of vessels which annually arrive in the Mersey is 22,000. Although this includes many arrivals and departures of the same vessels, some of which call at Queenstown and other intermediate ports, a very large proportion comprises vessels which arrive here after a voyage long or short, Liverpool being the first port visited since leaving the point of departure. Under any circumstances it is of paramount importance that steps should be taken to prevent any patient with infectious disease from being allowed to land on either the Lancashire or Cheshire side and to spread disease to an extent which could be neither calculated nor prevented. But more important than ever is it now when cholera has appeared in our midst and when there is every probability of its appearing again. At present the medical officer of health for the city is also the port sanitary medical officer. It must, however, be manifest that the duties of medical officer of health for such a city as Liverpool must be more than sufficient for any one man’s whole energies, and that there are reasons why Liverpool should have its own port sanitary medical officer acting with, but subordinate to, the medical officer of health for the city. It must also be remembered that Liverpool is liable to the importation of cholera, small-pox and other diseases from the east coast and overland a circumstance which in itself requires the most careful vigilance on the part of the medical officer of health and his staff. With reference to disease brought by vessels arriving in the river there is no difficulty in having full notification of any and every such case sent to the medical officer of health or port sanitary medical officer ; but it is of only secondary importance to this that the vessel notified should be boarded as soon as possible by the medical officer, since a favourable wind may bring up vessels in scores, and even hundreds, into the river within a few days. In short, the necessity for a special port sanitary medical officer does not admit of argument, though there must be some discussion and difference of opinion as to the area of his duties and as to the question of upon whom the expenses of his office are to fall. The Societyfor the Prevention of Cruelty to Children. At the annual meeting of the Society for the Prevention of’ Cruelty to Children, held last week, there was a large attendThe report showed that the number of cases dealt ance. with this year had been 1803 as compared with 1403 last year, the number of children affected being 2481 as compared with 2039, these numbers being larger than those dealt with ANESTHETICS. by the Society in any previous year. The police had taken to the shelter 1015 children (as compared with 502 last year) To the Editors of THE LANCET. found begging and selling in the streets after 10 P.M., SIRS,-With regard to your review of Dr. Dudley Buxton’s the children being under ten years of age. In 614 cases the book on Anaesthetics, you notice " but two points omitted," parents had been cautioned and dismissed, in 247 cases fined, in Junker’s inhaler " and " the the "great improvements and in 19 cases sent to prison. A letter was read from the practice of admitting air during the administration of nitrous stipendiary magistrate suggesting that the time had come oxide. " Dr. Junker did not originate the principle of his when the Council might make it unlawful for these inhaler, which was applied to methylene administration. The children toCity trade later than 9 P.M., or even 8 P.M. —a suggesprinciple was in use at Guy’s Hospital in 1864. A chloroform tion which received the approval of the meeting. bottle on the same principle, that does not allow chloroform The Northern Hospital. to pass over unless turned upside down, has been in use since I have been on the staff. The administration of air The annual meeting of the Northern Hospital of this city with nitrous oxide was in use by myself twenty years ago, was also held last week, and the proceedings derived addiand was tried before that. It is just ten years ago, come tional interest from the circumstance that the erection of a May, that an ovariotomy was done under my own administra- new hospital has been all but resolved upon. The only question of gas and air successfully. I may add that the bulb, tion is that of which of two sites should be selected, one to prevent too sudden rush of gas blocking the outlet from being that of the present hospital, with possibly some adclithe gas cylinder, has been in existence over fifteen years, and tional space : the other being a piece of ground to the westmine has the original piece of string inserted to prevent ward itltl nearer the river. Each lias of course its merits and
cogent
pleasure in adding for his information that palate on the same side as the lesion was
ANÆSTHETICS.—LIVERPOOL.
the half of the unaffected by mechanical stimulation. The velum was not attenuated and with respect to size capable of being approximated to the posterior pharyngeal wall. No physical impedimenta in the nature of membrane on its posterior wall, new growths in its substance or neoplasms in the naso-pharyngeal cavity were present. From these and the data already given in my paper, together with the fact that fluid returned through the nose, I could not possibly arrive at any other conclusion than that of unilateral paralysis of the soft palate. These conditions, pointing to this fact, were readily recognised by my clinical assistants and the students attending my clinique at the Evelina Hospital. The object of a scientific paper being not to teach the symptoms of any well-recognised disease, but to detail clinical facts, I did not think it necessary to give all the information that Dr. Kidd misses. Of adenoid vegetations occurring in my practice I have notes of over two hundred cases, yet I have not met with in these the symptoms of passage of fluid viu the nares, but I should not be so rash as to deny its occasional occurrence for such has been noted by competent observers. Had adenoid vegetations been present in this case I should certainly have mentioned that fact. Dr. Kidd’s supposition that the tonsils were removed for chronic hypertrophy is correct. On the patient’s return from the fever hospital the left tonsil, as stated, was found enlarged, but no subacute inflammatory condition was present. The case quoted by Dr. Kidd is interesting, but by no means unfamiliar to the medical profession. It is an example in which the passage of fluid through the nares might have been due to mechanical causes, but seeing that it was a case of diphtheria it would be difficult to deny that there was no palatine paralysis, and the fact that there were no other palsies, or that the patellar reflexes were present would not militate against this. Certainly the absence of facial paralysis, upon which stress has been laid by Dr. Kidd, would not negative this diagnosis, for this complication must be infinitely rare as a sequel to that disease. Interesting as his case is it is hardly on all fours with the one I quote, where facial paralysis was complicated by paresis of the corresponding half of the soft palate. Moreover, Dr. Kidd seems to have ignored the fact that the palatine paresis in my case was present after ablation of both tonsils and before admission to the Fever Hospital, whereas the secondary enlargement of the left tonsil was found only after her return from that institution ; therefore the condition of the left tonsil has no bearing It was merely mentioned as a fact worthy of on the case. note. Much as I respect the opinions of Drs. Gowers and Hughlings Jackson and much as I appreciate the work of Dr. Beevor and Mr. Horsley, I do not feel justified in ignoring ocular evidence before me, or passing over clinical observations which I have by your courtesy placed on record, because such did not completely coincide with the clinical experience and anatomical views of a section ofthe profession. Whether the palate be supplied by the spinal accessory nerve or from the facial through the petrosal nerve of the Vidian, the facts I have recorded remain. I am, Sirs, yours faithfully, GEORGE CARPENTER. Queen Anna-street, W., Jan. 2&tb, 1893.
Glass and shot were both passed over as being too This is an engineer’s idea. I am, Sirs, yours truly, TOM BIRD, Brook-street, W., Jan. 20th, 1893.
noise. 1
lheavy.
LIVERPOOL. (FROM
OUR OWN
CORRESPONDENT.)
The Port Sanitary Authority. THE inquiry which has been opened before Mr. JennerFust and Dr. Barry, of the Local Government Board, has been adjourned until the end of this month. This inquiry possesses far more than local interest, as anyone may judge by taking a glance at Liverpool’s geographical position. There is no port at the mouth of the river Mersey analogous to Gravesend at the mouth of the Thames, and the number of vessels which annually arrive in the Mersey is 22,000. Although this includes many arrivals and departures of the same vessels, some of which call at Queenstown and other intermediate ports, a very large proportion comprises vessels which arrive here after a voyage long or short, Liverpool being the first port visited since leaving the point of departure. Under any circumstances it is of paramount importance that steps should be taken to prevent any patient with infectious disease from being allowed to land on either the Lancashire or Cheshire side and to spread disease to an extent which could be neither calculated nor prevented. But more important than ever is it now when cholera has appeared in our midst and when there is every probability of its appearing again. At present the medical officer of health for the city is also the port sanitary medical officer. It must, however, be manifest that the duties of medical officer of health for such a city as Liverpool must be more than sufficient for any one man’s whole energies, and that there are reasons why Liverpool should have its own port sanitary medical officer acting with, but subordinate to, the medical officer of health for the city. It must also be remembered that Liverpool is liable to the importation of cholera, small-pox and other diseases from the east coast and overland a circumstance which in itself requires the most careful vigilance on the part of the medical officer of health and his staff. With reference to disease brought by vessels arriving in the river there is no difficulty in having full notification of any and every such case sent to the medical officer of health or port sanitary medical officer ; but it is of only secondary importance to this that the vessel notified should be boarded as soon as possible by the medical officer, since a favourable wind may bring up vessels in scores, and even hundreds, into the river within a few days. In short, the necessity for a special port sanitary medical officer does not admit of argument, though there must be some discussion and difference of opinion as to the area of his duties and as to the question of upon whom the expenses of his office are to fall. The Societyfor the Prevention of Cruelty to Children. At the annual meeting of the Society for the Prevention of’ Cruelty to Children, held last week, there was a large attendThe report showed that the number of cases dealt ance. with this year had been 1803 as compared with 1403 last year, the number of children affected being 2481 as compared with 2039, these numbers being larger than those dealt with ANESTHETICS. by the Society in any previous year. The police had taken to the shelter 1015 children (as compared with 502 last year) To the Editors of THE LANCET. found begging and selling in the streets after 10 P.M., SIRS,-With regard to your review of Dr. Dudley Buxton’s the children being under ten years of age. In 614 cases the book on Anaesthetics, you notice " but two points omitted," parents had been cautioned and dismissed, in 247 cases fined, in Junker’s inhaler " and " the the "great improvements and in 19 cases sent to prison. A letter was read from the practice of admitting air during the administration of nitrous stipendiary magistrate suggesting that the time had come oxide. " Dr. Junker did not originate the principle of his when the Council might make it unlawful for these inhaler, which was applied to methylene administration. The children toCity trade later than 9 P.M., or even 8 P.M. —a suggesprinciple was in use at Guy’s Hospital in 1864. A chloroform tion which received the approval of the meeting. bottle on the same principle, that does not allow chloroform The Northern Hospital. to pass over unless turned upside down, has been in use since I have been on the staff. The administration of air The annual meeting of the Northern Hospital of this city with nitrous oxide was in use by myself twenty years ago, was also held last week, and the proceedings derived addiand was tried before that. It is just ten years ago, come tional interest from the circumstance that the erection of a May, that an ovariotomy was done under my own administra- new hospital has been all but resolved upon. The only question of gas and air successfully. I may add that the bulb, tion is that of which of two sites should be selected, one to prevent too sudden rush of gas blocking the outlet from being that of the present hospital, with possibly some adclithe gas cylinder, has been in existence over fifteen years, and tional space : the other being a piece of ground to the westmine has the original piece of string inserted to prevent ward itltl nearer the river. Each lias of course its merits and
cogent