BREAST DISEASE AND THE DEMODEX FOLLICULORUM.
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morphia and 12 to will usually enable
21 hours later a simple enema BREAST DISEASE AND THE DEMODEX the patient to pass flatus and FOLLICULORUM. fsecal material; the enema should be repeated in 12 hours’ time. 7’o the Nailor of THE LANCET. There are few things more striking in surgical SIR,—The article by Dr. Helen Chambers and Miss work than the rapid improvement in the patient’s Somerset in THE LANCET of Jan. 24th under condition, appearance, and subjective sensations which follows this treatment. As I have pointed the above title, opens up a new idea for the out elsewhere, post-operative ileus can be prevented workers in comparative medicine, and it may interest to a great extent by taking certain precautions at your readers to see by the accompanying photograph the operation for appendicitis and by care in the immediate after-treatment. Purgation before operation for acute appendicitis has long been recognised as a grave mistake, and I believe it to be so after operation, at least in the severe cases with diffuse peritonitis.-I am, Sir, yours faithfully, H. H. RAYNER. Alanchester, Feb. 8th, 1925.
Mil icent
AIR-EMBOLISM FOLLOWING To the Editor ’
URETHROSCOPY.
of THE LANCET.
SIR,-Prof. Andrew Fullerton’s letter
is important it draws attention to the fact that accidents during aero-urethroscopy are more frequent than have been recorded. Most will agree that simply on account of this urethroscopic examination should not be abandoned, but the question arises, Is aero-distension I have elsewhere stated essential in every case ? (Practitioner, July, 1924) that it is advisable for diagnostic purposes first to examine the urethra without distension, for many pathological conditions are thus better observed. Hyperapmia, slight infiltration, excessive secretion, granular and patulous i states of the mucous naembrane vanish when the urethra is distended with air, so I personally reserve aero-dilations for obscure cases and for operativee purposes. If this practice is followed no operator I, need fear air embolism. I iiii, Sir, yours faithfully, I M. W. BROWDY. Harley-street, W., Feb. 3rd, 1925. as
Bull puppy severely affected with follicular mange.
(for which I am indebted to the late Prof. Mettam, of the Royal Veterinary College of Ireland) the widespread THE ACIDIC VALUE OF THE URINE IN SKIN form which the demodex parasite often takes in the skin of the dog. The authors of the paper might have AND OTHER MANIFESTATIONS. added the horse to their list of domesticated animals To the Editor 0/ THE LANCET. :which can be infected, but it is in the dog that the article on to Dr. Doble’s veterinarian most commonly meets with this form reference SIR,—With the above in your issue of Feb. 7th, I should like to of mange. It is by no means an uncommon affection state that it has been my routine practice for many and is well recognised by the canine practitioner, years past to examine the urine of my private patients and, indeed, too, by many owners and breeders. In by a long series of tests including the reaction to animals I have never read or heard of it as associated with cancer. litmus. In by far the greater proportion of cases of acne It is met with in all breeds and is more common in " dermatitis the reaction the young dog than the old one, the incidence of age and so-called " seborrhoeic has been found to be either very mildly acid to in cancer being the reverse. Although I am not aware litmus or amphoteric, though on rare occasions that especial attention has, up to the present, been either a high acidity or a high alkalinity has been paid to the point as to whether the demodex parasite met. I have inquired of my biochemical friends as can be microscopically demonstrated as common in to the validity of the simple litmus test and have been (or around) the nipples, I know from experience that informed that it is satisfactory, any error in the the mammæ of animals are not a usual spot for litmus test lying rather on the side of its indicating visible evidence of its lodgment. It may come on any a higher degree of acidity than is actually present. other part of the body, and it is especially troublesome When Drs. Barber and Semon published their to treat around the lips and eyelids, particularly in researches on the acidity of the urine associated breeds (such as the bull-dog, bloodhound, or spaniel) with " seborrhoeic " dermatitis during the war Iwhose skin in those regions is loose and pendulous. endeavoured to control their work in this country, To assert decisively that it is incurable, even in the but was unable to obtain confirmatory results, as is dog, quite correct; although in most I believe was the case with others who attempted instancesscarcely the trouble and length of time which it control work. I therefore came to the conclusion takes influences the owner to decide upon the painless that what they had described was a state of things destruction of the Some four or five months patient. due to the special conditions in the field and was not a minimum is usually asked for, and a variety of to be found in ordinary civilian life. In Dr. Doble’s external preparations are used, one of the most effectual case I am on firmer ground, as he is presumably a weak solution of chloride of zinc, applied daily dealing with a sample of the population similar toafter squeezing out the contents of every pustule that which I have investigated, and here I am in i which may be visible. a position to state definitely that the urine of mosti I am, Sir, yours faithfully, cases of acne and " seborrhoeic " dermatitis as seen FREDERICK HOBDAY, F.R.C.V.S. me in numbers is not in by large notably high ’ Section of Comparative Medicine, Royal Society of or alkalinity.---I am, Sir, yours faithfully, Medicine, Wimpole-street, W., ARTHUR WHITFIELD. Feb. 4th, 1925. Harley-street, W., Feb. 9th.
I as
Ibeing
acidity
OBITUARY.
362
Practice" was published in a French journal, A nnales d’Oculistique, in 1877. It was his work at St. Mary’s Hospital that finally established his reputation and incidentally built up one of the biggest eye SIR,—You are no doubt aware that this appeal cliniques at any of the general hospitals in London, came on for hearing to-day at the High Court, when a,nd he was the first to recognise how much he was the same was allowed and the conviction quashed. aided in his work at St. Mary’s by the late Henry Judgment however was reserved, but will be given Juler and how loyally they worked together when a in due course. Dr. Bateman was of course discharged. few years later Juler was co-opted as his colleague. Our client wishes us to thank you for the great His career from now onwards is a simple record of financial and moral support which you have given increasing honours accorded to him. He was appointed him, and which has enabled him to bring this appeal surgeon-oculist in ordinary to the late King Edward to such a successful conclusion. It is extremely in 1901, in which year he was knighted, being advanced doubtful whether we could have brought sufficient to a baronetcy in 1908. weight to support the appeal, without the interest The public positions held by Sir Anderson Critchett which you have taken throughout the proceedings, were very numerous. He was at different times and in support of the medical profession generally. President of the Ophthalmological Society, President We ourselves desire to join in our client’s gratitude. of the Council of British Ophthalmologists, President Weare, Sir, yours faithfully, of the Ophthalmological Section of the International AMERY-PARKES & CO. Congress of Medicine, and President of the Inter66 and 68, Whitcomb-street, Coventry-street, national Ophthalmological Congress, in this way London, W.C. 2, FeD. 10th, 1925. repeating an honour which had been bestowed upon his father a generation before. He had been President. of the Section of Ophthalmology in the Royal Society of Medicine, and his conduct in the presidential chair on so many occasions never failed to win respect. His polished speaking was especially happy on ceremonial occasions, while his contributions when he intervened in debate were founded on vast clinical
BATEMAN. To the Editor of THE LANCET. REX
v.
Obituary.
CRITCHETT, BART., experience. Critchett was also a member of the Société Française K.C.V.O., and certain of his papers were d’Ophtalmologie, SURGEON-OCULIST TO THE KING ; CONSULTING OPHTHALMIC in the Transactions of that society and published TO SURGEON ST. MARY’S HOSPITAL. simultaneously in THE LANCFT. He contributed, as WF regret to announce the death of Sir George has been said, to the Annales d’Oculistique and, of Anderson Critchett, which occurred at a nursing home course, to the Transactions of the Ophthalmological on Monday last in the eightieth year of his age, after Society. From beginning to end his writings were of a He was a hereditary ophthalmologist, practical character. The first paper published in our an operation. for not only could he look back on a career of over columns was instigated by the arrival of cocaine. 50 years as an ophthalmic surgeon himself, but. as Before the introduction of cocaine, in England at any successor to a distinguished father, he was a link with rate. the majority of ophthalmic surgeons administered William an anaesthetic during the operation for extraction of the founders of modern ophthalmology. Bowman, Tonathan Hutchinson, George Lawson, and cataract, but Anderson Critchett pointed out that George Critchett were the great names in the ophthal- vhe absence of pain secured by the new agent, though mic world in the ’sixties a,nd’seventiesof last century, of the greatest possible value, had certain drawbacks, and George Anderson Critchett, the son of the last, was and described his own technique for iridectomy, born in the atmosphere of ophthalmology and was using the ring-finger to elevate the upper lid, as approaching manhood at the time when the discovery " Nature’s speculum." Thirty years later, in his of the ophthalmoscope produced a renaissance in the address to the Seventeenth International Congress study of diseases of the eye. " La reputation d’un of Medicine as President of the Section of Ophthalmopere est un lourd fardeau pour Ie fils." But in the case logy, he described the value of the X rays as an aid of Anderson Critchett, great though his father had to the location of foreign bodies in the eye and its made the name, he undoubtedly added to its repute, adnexa, and amongst similar new adjuncts to diagnosis and it is safe to say that few British ophthalmic mentioned the delicate manometers assisting the SiR GEORGE ANDERSON
surgeons were better known in the world. Born in London in 1845, Anderson Critchett was educated at Harrow, where he gained the prize for
surgeon to estimate the tension of the eye. Of other contributions to the technical side of his specialty we may mention his method of employing the cautery in the operation for conical cornea and his advocacy of treating certain cases of lamellar cataract by making an artificial pupil, but he generally preferred to practise well-tried methods rather than to devise new ones He was never a prolific writer, and to the regret of many of his pupils, much of his teaching, which would have been of great value, is lost for want of recording. For he was a great clinician and unrivalled
English literature, and Caius College, Cambridge, where he captained the College cricket eleven and made many friends, but did not proceed to a medical degree. On leaving Cambridge as a Bachelor of Arts in 1867, he entered the Middlesex Hospital and’ qualified M.R.C.S. in 1872, later proceeding to the F.R.C.S. Edin. There was a period in his career, however, when it seemed doubtful whether medicine or music would- claim him. He possessed a fine baritone voice, as an operator. To seeCritchett removing a cataract a love for the drama, and social qualities which acted in the heyday of his skill was to see the perfection of together to draw him away from the profession of operative technique. Never a hurried or purposeless medicine, but affection for his father and a desire to movement was made, and if any untoward complicabe of help to him prevailed. He decided to follow tion had to be met, it was faced with the same steady in his father’s footsteps and accordingly filled junior placidity as if it had been foreseen from the first. ophthalmic appointments until he secured election He had to a very high degree the most valuable first to the Royal Free Hospital as ophthalmic capacity of rousing in his patients an implicit feeling surgeon and then to St. Mary’s Hospital as lecturer of confidence and the equally valuable capacity of There followed upon this creating a feeling of friendship in his colleagues. on ophthalmic surgery. good start a life of steady professional success. He During the war lie served as ophthalmological was appointed ophthalmic surgeon to St. Mary’s surgeon to King Edward VII. Hospital and to King Hospital in 1881 and rapidly became known both as George’s Hospital, and in 1919 received the K.C.V.O. operator and learned man, and from the beginning His last professional honour reached him as recently his reputation was as high on the continent as in as 1924, when he was chosen Master of the Oxford England. It is of interest to note that his first Ophthalmological Congress. Apart from the distinc. published paper on " Inoculation in Ophthalmic tions which he received from two kings, Critchett