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ANTERIOR OR POSTERIOR GASTROJEJUNOSTOMY.
1498
give the date of his communication Medical Society, but only the date when the British Medical Journal. Unless I am mistaken Mr. Moynihan’s communication at Mirfield was several weeks after Mr. Littlewood’s at Leeds. With regard to the clamps, it was hardly more necessary to tell me that Mr. Littlewood was not the first to use Doyen’s pattern in intestinal surgery than it would have been to tell me that he did not invent them. What I claim is that he first combined this special application of them with excision of the mucosa and that this is essentially the operation to which Dr. W. J. Mayo gives the name of the Moynihan operation. Mr. Moynihan is a facile and prolific author, but although I do not claim to have read all his writings I had, as a matter of fact, read his eight points, and in spite, or possibly in consequence, of this I was led to ask the question set forth in my former letter. I think it would be a regrettable circumstance if by tacitly allowing his name to be affixed to the operation Mr. Moynihan should seem to be associated with any act which would tend to obscure or to belittle the work of others in the same field. Let it not be supposed for a moment that I have any intention or desire to belittle Mr. Moynihan’s own brilliant and well-known work. That would be unfriendly, futile, and absurd. No one could be associated with him as I have been since the day when he first began the practical study of surgery without fully recognising his qualities. But I fear that in surgery, as no doubt in other human affairs, when a man’s sound has gone out into all lands insidiously there grows in him a tendency to regard himself as the chief, if not the sole, authority upon the particular question at issue. I am, Sirs, yours faithfully, I EDWARD WARD. Leeds, May 21st, 1906.
on himself I I am compelled to think that the misunderMoynihan does standing has been entirely due to a misuse of the King’s to the Mirfield it appeared in Yours faithfully, English, on his part.
THOMAS D. LUKE. LUKE. Edinburgh, May 22nd, 1906. Dr. Luke’s of Dr. letter seems interpretation *** Simpson’s to us a very natural one.-ED. L. THE HAMPSTEAD GENERAL HOSPITAL.
To the Editors of THE LANCET. SIRS,—Since the conference of the local profession of May 5th on this subject (recorded in THE LANCET of May 12th, p. 1340) I have received from the honorary secretary of the King’s Hospital Fund a letter explaining "that without attaching any condition (as to the staff of the Hampstead General Hospital) to the grant of 5000 which they have recommended in order to enable the hospital to take advantage of the offer made through Sir Henry Harben of 20,000, they remain of opinion
not
that it is desirable that all general hospitals in London should be staffed by consultants in the usual way." It is necessary to point out that this letter (dated May 8th), though written after the conference of the local profession had been held, was written in ignorance of the opinion expressed at that conference. The King’s Fund committee was, however, aware on April 9th of the executive views of the local division of the British Medical Association and was also aware that a conference of medical men was to be held at which those who do not belong to the association would express their views and it seems unfortunate that they should have come to any opinion of this kind without first ascertaining the views of the local medical profession. These views include the unanimous opinion that a large general hospital staffed by consultants is not fitted to the needs of the locality but rather a home hospital staffed by REFORM OF THE ROYAL COLLEGE OF the practitioners of the neighbourhood. Doubtless the SURGEONS OF ENGLAND. authorities of the hospital will fall in with the views of the To the Editors of THE LANCET. local profession ; it will then be a simple matter for the executive of the King’s Fund to withdraw the recommendaI SIRS,-May draw attention to the reply of the Prime tion associated with their grant of .E5000. Minister to Sir William Collins’s question on this matter, I am, Sirs, yours faithfully, reported in THE LANCET of May 19th, p. 1443 ?7 This reply REGINALD A. YELD, states that " any change in the constitution of the Royal YELD, M.D. M.D. Cantab., Cantab., Honorary Secretary of the Hampstead Division of the College of Surgeons of England can only be carried out British Medical Association. May 15th, 1906. by legislation unless such change has the support of the governing body of the College." I should like, Sirs, to ask what foundation there is for this statement, which is ANTERIOR OR POSTERIOR GASTROequivalent to saying that all proposals for reform must JEJUNOSTOMY. emanate from the body to be reformed, and which, as our old friend Euclid says, is absurd, Was this dictum put To the Editors of THE LANCET. into the mouth of the Prime Minister by the Clerk to the letter in THE LANCET of May 19th, SIRS,—Mr. Moynihan’s Privy Council, Mr. Almeric FitzBoy ?7 I observe that this p. 1430, occasions me surprise and disappointment, for it gentleman was a guest at the College dinner held last week. seems to make it clear that he ignores Mr. Littlewood’s the Council knows how to keep on the right side of the Truly, work and almost suggests that he desires and designs to that be. It is probable that College reform would be I had powers annex gastro-enterostomy, lock, stock, and barrel. hastened if Members generally, when requiring a consultanot thought of going into the question of exact dates. To were to avoid calling in any of the 24 gentlemen who those who remember Mr. Littlewood’s original communi- tion, so persistently deny them their corporate rights. cation to the Leeds and West Riding Medico-Chirurgical I I am, Sirs, yours faithfully, Society and the discussion upon it, in which Mr. Moynihan May 21st, 1906. W. G. DICKINSON. took part, there can remain only one impression, and to those who will take the trouble to look up the illustration which appeared in THE LANCET the prototype of the A HOME FOR INVALIDS. beautiful drawings in Mr. Moynihan’s book seems disclosed. I To the Editors of THE LANCET. as to " I have But Mr. Moynihan appeals asoertainable fact obtained the precise date of Mr. Littlewood’s first operation SIRS,-The daughter of a medical man, who many with excision of the mucosa and it was performed, according ago bequeathed a large sum to the British Medical years to the infirmary records, on May 24th, 1900, eight days before Benevolent Fund, is anxious, through an unforeseen Mr. Moynihan’s. Thisjuxtaposition of dates carries an un- diminution of income, to let her well-furnished house or to avoidable suggestion and I hope it is possible for me with- receive as paying guest, those who may require rest or out offence to make the suggestion that for once Mr. The house is at one of the favourite south Devon change. Moynihan’s memory has failed him, and that he has seaside places, situated on high ground, sheltered from the forgotten that he may have known, along with others about north and east winds and with fine views of the surrounding the hospital, of Mr. Littlewood’s operation and that he has which is noted for its beauty. The accommodation in that way come in the course of five years to regard it as country is ample and there are good gardens, a paddock, con" original in his own mind." &c. But Mr. Littlewood first made the suggestion at a meeting servatory, If any of your readers would like further particulars, of the Leeds and West Riding Medico-Chirurgical Society on either for themselves or their patients, I shall be glad to May 4th, 1900, when discussing a paper by Mr. W. H. Brown commuricate the address. Thanking you on behalf of my on a case of closure of the opening after gastro-enterostomy. committee for so kindly finding space for this communicaMr. Moynihan was present. Mr. Littlewood, after having I am, Sirs, yours faithfully, tion, practised the operation upon the cadaver, actually performed W. E. SARGANT, it upon the living subject, as I have stated, on May 24th. Honorary Secretary British Medical Benevolent Fund. the of in As to St. Bartholomew’s Hospital, E.C., May 16th, 1906. question priority publication Mr.
give the date of his communication Medical Society, but only the date when the British Medical Journal. Unless I am mistaken Mr. Moynihan’s communication at Mirfield was several weeks after Mr. Littlewood’s at Leeds. With regard to the clamps, it was hardly more necessary to tell me that Mr. Littlewood was not the first to use Doyen’s pattern in intestinal surgery than it would have been to tell me that he did not invent them. What I claim is that he first combined this special application of them with excision of the mucosa and that this is essentially the operation to which Dr. W. J. Mayo gives the name of the Moynihan operation. Mr. Moynihan is a facile and prolific author, but although I do not claim to have read all his writings I had, as a matter of fact, read his eight points, and in spite, or possibly in consequence, of this I was led to ask the question set forth in my former letter. I think it would be a regrettable circumstance if by tacitly allowing his name to be affixed to the operation Mr. Moynihan should seem to be associated with any act which would tend to obscure or to belittle the work of others in the same field. Let it not be supposed for a moment that I have any intention or desire to belittle Mr. Moynihan’s own brilliant and well-known work. That would be unfriendly, futile, and absurd. No one could be associated with him as I have been since the day when he first began the practical study of surgery without fully recognising his qualities. But I fear that in surgery, as no doubt in other human affairs, when a man’s sound has gone out into all lands insidiously there grows in him a tendency to regard himself as the chief, if not the sole, authority upon the particular question at issue. I am, Sirs, yours faithfully, I EDWARD WARD. Leeds, May 21st, 1906.
on himself I I am compelled to think that the misunderMoynihan does standing has been entirely due to a misuse of the King’s to the Mirfield it appeared in Yours faithfully, English, on his part.
THOMAS D. LUKE. LUKE. Edinburgh, May 22nd, 1906. Dr. Luke’s of Dr. letter seems interpretation *** Simpson’s to us a very natural one.-ED. L. THE HAMPSTEAD GENERAL HOSPITAL.
To the Editors of THE LANCET. SIRS,—Since the conference of the local profession of May 5th on this subject (recorded in THE LANCET of May 12th, p. 1340) I have received from the honorary secretary of the King’s Hospital Fund a letter explaining "that without attaching any condition (as to the staff of the Hampstead General Hospital) to the grant of 5000 which they have recommended in order to enable the hospital to take advantage of the offer made through Sir Henry Harben of 20,000, they remain of opinion
not
that it is desirable that all general hospitals in London should be staffed by consultants in the usual way." It is necessary to point out that this letter (dated May 8th), though written after the conference of the local profession had been held, was written in ignorance of the opinion expressed at that conference. The King’s Fund committee was, however, aware on April 9th of the executive views of the local division of the British Medical Association and was also aware that a conference of medical men was to be held at which those who do not belong to the association would express their views and it seems unfortunate that they should have come to any opinion of this kind without first ascertaining the views of the local medical profession. These views include the unanimous opinion that a large general hospital staffed by consultants is not fitted to the needs of the locality but rather a home hospital staffed by REFORM OF THE ROYAL COLLEGE OF the practitioners of the neighbourhood. Doubtless the SURGEONS OF ENGLAND. authorities of the hospital will fall in with the views of the To the Editors of THE LANCET. local profession ; it will then be a simple matter for the executive of the King’s Fund to withdraw the recommendaI SIRS,-May draw attention to the reply of the Prime tion associated with their grant of .E5000. Minister to Sir William Collins’s question on this matter, I am, Sirs, yours faithfully, reported in THE LANCET of May 19th, p. 1443 ?7 This reply REGINALD A. YELD, states that " any change in the constitution of the Royal YELD, M.D. M.D. Cantab., Cantab., Honorary Secretary of the Hampstead Division of the College of Surgeons of England can only be carried out British Medical Association. May 15th, 1906. by legislation unless such change has the support of the governing body of the College." I should like, Sirs, to ask what foundation there is for this statement, which is ANTERIOR OR POSTERIOR GASTROequivalent to saying that all proposals for reform must JEJUNOSTOMY. emanate from the body to be reformed, and which, as our old friend Euclid says, is absurd, Was this dictum put To the Editors of THE LANCET. into the mouth of the Prime Minister by the Clerk to the letter in THE LANCET of May 19th, SIRS,—Mr. Moynihan’s Privy Council, Mr. Almeric FitzBoy ?7 I observe that this p. 1430, occasions me surprise and disappointment, for it gentleman was a guest at the College dinner held last week. seems to make it clear that he ignores Mr. Littlewood’s the Council knows how to keep on the right side of the Truly, work and almost suggests that he desires and designs to that be. It is probable that College reform would be I had powers annex gastro-enterostomy, lock, stock, and barrel. hastened if Members generally, when requiring a consultanot thought of going into the question of exact dates. To were to avoid calling in any of the 24 gentlemen who those who remember Mr. Littlewood’s original communi- tion, so persistently deny them their corporate rights. cation to the Leeds and West Riding Medico-Chirurgical I I am, Sirs, yours faithfully, Society and the discussion upon it, in which Mr. Moynihan May 21st, 1906. W. G. DICKINSON. took part, there can remain only one impression, and to those who will take the trouble to look up the illustration which appeared in THE LANCET the prototype of the A HOME FOR INVALIDS. beautiful drawings in Mr. Moynihan’s book seems disclosed. I To the Editors of THE LANCET. as to " I have But Mr. Moynihan appeals asoertainable fact obtained the precise date of Mr. Littlewood’s first operation SIRS,-The daughter of a medical man, who many with excision of the mucosa and it was performed, according ago bequeathed a large sum to the British Medical years to the infirmary records, on May 24th, 1900, eight days before Benevolent Fund, is anxious, through an unforeseen Mr. Moynihan’s. Thisjuxtaposition of dates carries an un- diminution of income, to let her well-furnished house or to avoidable suggestion and I hope it is possible for me with- receive as paying guest, those who may require rest or out offence to make the suggestion that for once Mr. The house is at one of the favourite south Devon change. Moynihan’s memory has failed him, and that he has seaside places, situated on high ground, sheltered from the forgotten that he may have known, along with others about north and east winds and with fine views of the surrounding the hospital, of Mr. Littlewood’s operation and that he has which is noted for its beauty. The accommodation in that way come in the course of five years to regard it as country is ample and there are good gardens, a paddock, con" original in his own mind." &c. But Mr. Littlewood first made the suggestion at a meeting servatory, If any of your readers would like further particulars, of the Leeds and West Riding Medico-Chirurgical Society on either for themselves or their patients, I shall be glad to May 4th, 1900, when discussing a paper by Mr. W. H. Brown commuricate the address. Thanking you on behalf of my on a case of closure of the opening after gastro-enterostomy. committee for so kindly finding space for this communicaMr. Moynihan was present. Mr. Littlewood, after having I am, Sirs, yours faithfully, tion, practised the operation upon the cadaver, actually performed W. E. SARGANT, it upon the living subject, as I have stated, on May 24th. Honorary Secretary British Medical Benevolent Fund. the of in As to St. Bartholomew’s Hospital, E.C., May 16th, 1906. question priority publication Mr.