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APPROACH TO THE GASSERIAN GANGLION.
498
occluding the artery. From that moment all danger of haemorrhage from this vessel had passed. The process of slowly raising the dura was continued until the Gasserian ganglion was reached and eventually divided. I am convinced that the time occupied in raising the dura mater in this way is economically spent Feb. 23rd, 1931. since haemorrhage from the middle meningeal artery can assume alarming proportions, sufficient to cause the surgeon to abandon the operation-sometimes ACUTE TOXIC HEPATITIS AFTER In the case described by with a fatal result. ACRIFLAVINE. Mr. Wakeley, attention is drawn to the amount of To the Editor of THE LANCET. fibrosis around the ganglion which he suggests may due to previous alcoholic injections. The patient SIR,—My attention has been drawn by Prof. C. H. be on whom I operated had received four alcoholic Browning to an error which occurred in my letter injections. The first from the lateral approach was on this subject published in THE LANCET of Jan. 24th. It was there stated that in the experiments of Meleney unsuccessful, but the remainder from the anterior and Zan a single intravenous injection of 0-00025 g. approach produced relief from pain for nine months, seven months, and three months respectively, the per kilo body-weight killed a rabbit within six days. patient insisting upon operation, from which 100 times greater and the he madefinally Actually the fatal dose was a successful recovery with a satisfactory I for 0-025 this should read error, apologise g. figure end-result.
inoculation and a spread of infectious disease. I believe the abolition of the waste plug and the use of the elevated tap in wash-hand basins would lower the incidence of infectious diseases all over the country. I am, Sir, yours faithfully, LACHLAN GRANT. Bacteriological Laboratory, Ballachulish, Argyleshire,
but it in no way affects my main contention which that acriflavine given by mouth may sometimes be followed by serious consequences in the human I am, Sir, yours faithfully, being. EDWARD R. CULLINAN.
Despite
was
Harley-street, W., Feb. 17th, 1HH1.
BARBITURATES AS BASAL HYPNOTICS.
LANCET. SIR,—In a series of cases after the intravenous injection of nembutal I have encountered instances of restlessness, prolonged drowsiness, and slight vomiting. In no case has anxiety been aroused. As a preoperative sedative in nervous patients I have found nembutal valuable and easier to employ than avertin per rectum. In obstetrical practice it is preferable to sodium amytal given by the mouth, I venture to inform you for, in my experience. numbers are small as compared with although my those of Dr. Magill and Dr. Rowbotham, I have observed the cases from a different angle, that of the surgeon. I am, Sir, yours faithfully, JAMES RIDDELL, To the Editor
the
injections little
evidence of fibrosis
met with except in the immediate neighbourhood of the ganglion, where a little difficulty was was
I
encountered before division could be completed. I am. Sir. vours faithfullv. J. EWART SCHOFIELD, F.R.C.S. Eng., Assistant Surgeon, Great Western Hospital, Swindon.
Feb. 23rd, 1931.
of THE
Consulting Gynæcologist, Plymouth City Hospital. Plymouth, Feb. 20th, 1931. APPROACH TO THE GASSERIAN GANGLION.
PROPAGANDA AND MEDICINE.
To the Editor
of THE LANCET.
SIR,—Sydenham is said to have declared that " the arrival of a good clown in a village is infinitely more valuable for the health of its inhabitants than the arrival of 20 donkeys laden with drugs."1 Probably he would have said the same thing of 20 donkeys laden with leaflets. The modern villager, however, need not choose between his clown and his health instructor, for the offices of both are combined in his newspaper. And my justification for writing is that I play the unpopular part of "our medical correspondent." The present
enthusiasm for information about health and disease-so much deplored by Dr. Hutchison-is largely due to the press, but the appetite of news editors is getting jaded and they ask for little save sauces and strong meat. Speaking on publicity in public health at the Central Council for Health Education last November Lord Riddell is reported as saying that " a better method of securing editorial notice was to make some startling expression of opinion on a subject which would be taken up by reporters with avidity " (THE LANCET, 1930, ii., 1160). The truth is that a conscientious medical correspondent would spoil almost any story by his pleas for caution and confirmation, and it is very difficult for him to keep his job. Readers may say (like Dr. Johnson) that they wish it were actually impossible, but there are two sides to that. Hygienic advances make tiresome reading unless they are written round a picturesque personage, and only the best newspapers like to publish judicial reviews of medical subjects. For the rest news editors are chiefly interested in novel methods of treatment-preferably Ruritanian and unorthodox. No one nowadays wants a medical correspondent
To the Editor of THE LANCET. SIR,—I was interested to read in your issue of Feb. 14th (p. 348) the account by Mr. C. P. G. Wakeley and Dr. W. 0. Reid of the difficulty experienced in raising the dura mater from the middle fossa and of the trouble which arose from haemorrhage in approaching the Gasserian ganglion. A few months " ago I operated on a case of trigeminal neuralgia at " the Hackney Hospital. In dealing with the dura mater and the middle meningeal artery I used a method which I understand is employed by Mr. Norman Dott. By pushing gently with pledgets of cotton-wool soaked in saline and held in a long pair of toothless dissecting forceps the dura was slowly but surely raised from the middle fossa. The amount of dura elevated by each stroke was almost negligible, but in 15 minutes the artery was exposed as far as its exit from the foramen spinosum. Having anticipated the direction of the foramen, a piece of sterilised match stalk half an inch long, brought to a 1 Quoted by Dr. Erwin point at one end, was pressed into the foramen, thus London, John Murray, 1930.
Liek:
The
Doctor’s
Mission.
occluding the artery. From that moment all danger of haemorrhage from this vessel had passed. The process of slowly raising the dura was continued until the Gasserian ganglion was reached and eventually divided. I am convinced that the time occupied in raising the dura mater in this way is economically spent Feb. 23rd, 1931. since haemorrhage from the middle meningeal artery can assume alarming proportions, sufficient to cause the surgeon to abandon the operation-sometimes ACUTE TOXIC HEPATITIS AFTER In the case described by with a fatal result. ACRIFLAVINE. Mr. Wakeley, attention is drawn to the amount of To the Editor of THE LANCET. fibrosis around the ganglion which he suggests may due to previous alcoholic injections. The patient SIR,—My attention has been drawn by Prof. C. H. be on whom I operated had received four alcoholic Browning to an error which occurred in my letter injections. The first from the lateral approach was on this subject published in THE LANCET of Jan. 24th. It was there stated that in the experiments of Meleney unsuccessful, but the remainder from the anterior and Zan a single intravenous injection of 0-00025 g. approach produced relief from pain for nine months, seven months, and three months respectively, the per kilo body-weight killed a rabbit within six days. patient insisting upon operation, from which 100 times greater and the he madefinally Actually the fatal dose was a successful recovery with a satisfactory I for 0-025 this should read error, apologise g. figure end-result.
inoculation and a spread of infectious disease. I believe the abolition of the waste plug and the use of the elevated tap in wash-hand basins would lower the incidence of infectious diseases all over the country. I am, Sir, yours faithfully, LACHLAN GRANT. Bacteriological Laboratory, Ballachulish, Argyleshire,
but it in no way affects my main contention which that acriflavine given by mouth may sometimes be followed by serious consequences in the human I am, Sir, yours faithfully, being. EDWARD R. CULLINAN.
Despite
was
Harley-street, W., Feb. 17th, 1HH1.
BARBITURATES AS BASAL HYPNOTICS.
LANCET. SIR,—In a series of cases after the intravenous injection of nembutal I have encountered instances of restlessness, prolonged drowsiness, and slight vomiting. In no case has anxiety been aroused. As a preoperative sedative in nervous patients I have found nembutal valuable and easier to employ than avertin per rectum. In obstetrical practice it is preferable to sodium amytal given by the mouth, I venture to inform you for, in my experience. numbers are small as compared with although my those of Dr. Magill and Dr. Rowbotham, I have observed the cases from a different angle, that of the surgeon. I am, Sir, yours faithfully, JAMES RIDDELL, To the Editor
the
injections little
evidence of fibrosis
met with except in the immediate neighbourhood of the ganglion, where a little difficulty was was
I
encountered before division could be completed. I am. Sir. vours faithfullv. J. EWART SCHOFIELD, F.R.C.S. Eng., Assistant Surgeon, Great Western Hospital, Swindon.
Feb. 23rd, 1931.
of THE
Consulting Gynæcologist, Plymouth City Hospital. Plymouth, Feb. 20th, 1931. APPROACH TO THE GASSERIAN GANGLION.
PROPAGANDA AND MEDICINE.
To the Editor
of THE LANCET.
SIR,—Sydenham is said to have declared that " the arrival of a good clown in a village is infinitely more valuable for the health of its inhabitants than the arrival of 20 donkeys laden with drugs."1 Probably he would have said the same thing of 20 donkeys laden with leaflets. The modern villager, however, need not choose between his clown and his health instructor, for the offices of both are combined in his newspaper. And my justification for writing is that I play the unpopular part of "our medical correspondent." The present
enthusiasm for information about health and disease-so much deplored by Dr. Hutchison-is largely due to the press, but the appetite of news editors is getting jaded and they ask for little save sauces and strong meat. Speaking on publicity in public health at the Central Council for Health Education last November Lord Riddell is reported as saying that " a better method of securing editorial notice was to make some startling expression of opinion on a subject which would be taken up by reporters with avidity " (THE LANCET, 1930, ii., 1160). The truth is that a conscientious medical correspondent would spoil almost any story by his pleas for caution and confirmation, and it is very difficult for him to keep his job. Readers may say (like Dr. Johnson) that they wish it were actually impossible, but there are two sides to that. Hygienic advances make tiresome reading unless they are written round a picturesque personage, and only the best newspapers like to publish judicial reviews of medical subjects. For the rest news editors are chiefly interested in novel methods of treatment-preferably Ruritanian and unorthodox. No one nowadays wants a medical correspondent
To the Editor of THE LANCET. SIR,—I was interested to read in your issue of Feb. 14th (p. 348) the account by Mr. C. P. G. Wakeley and Dr. W. 0. Reid of the difficulty experienced in raising the dura mater from the middle fossa and of the trouble which arose from haemorrhage in approaching the Gasserian ganglion. A few months " ago I operated on a case of trigeminal neuralgia at " the Hackney Hospital. In dealing with the dura mater and the middle meningeal artery I used a method which I understand is employed by Mr. Norman Dott. By pushing gently with pledgets of cotton-wool soaked in saline and held in a long pair of toothless dissecting forceps the dura was slowly but surely raised from the middle fossa. The amount of dura elevated by each stroke was almost negligible, but in 15 minutes the artery was exposed as far as its exit from the foramen spinosum. Having anticipated the direction of the foramen, a piece of sterilised match stalk half an inch long, brought to a 1 Quoted by Dr. Erwin point at one end, was pressed into the foramen, thus London, John Murray, 1930.
Liek:
The
Doctor’s
Mission.