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COEXISTENCE OF DISEASES.
TREATMENT OF IRITIS, INTERSTITIAL KERATITIS, Erc., BY
ACETOZONE.I
679
believe that an alteration in the regulations will be for the had been under treatment off and on for 12 months in the department of a large metropolitan hospital. At good of the institution which they administer and of the ophthalmic the first visit to the Croydon General Hospital on patient’s public which it serves) it is right that the change should be Dec. 16th vision was on Dec. 20th it was Three weeks conclusion as to the made. We cannot express any legality later vision was normal and the eye appeared to have made a of the action of the governors. As to its advisability, our perfect recovery. The patient was seen about ten days ago general view is that any modification of hospital rules which and the eye remains free from all traces of deposit. (b) A tends to break down artificial barriers, purporting to divide second case of sympathetic iritis. This patient came to the the medical profession into classes and sections, is for the Western Ophthalmic Hospital on Nov. 17th with vision reduced to fingers (Dr. F. Hewkley). On Nov. 24th good of the profession and of the public. Very large vision was counting on Dec. 1st it was , and slight keratitis ; questions are opened by this aspect of the matter.-ED. L. punctata; on Jan. 19th there was no trace of deposits even under high magnification. This patient was seen three weeks ago and the eye seemed to be free from all THE TREATMENT OF IRITIS, INTER- trace of disease with the exception of a little uveal pigment STITIAL KERATITIS, &c., BY on the lens. In all nine cases of interstitial keratitis, several of ACETOZONE. extreme severity, were treated by acetozone. In one case To the Editors of THE LANCET. not only was the cornea absolutely opaque and salmonbut bulged in a most alarming way. In the courseSIRS,-During the last 16 months I have treated all my coloured of six weeks the corneas had cleared sufficiently for the cases of intra-ocular inflammation on the assumption that to get about and the vision is now .lo - --/6’ In a they were the result of bacterial action and with gratifying patient results. The post hoc ergo propter hoc fallacy of basing the second case one eye was entirely lost before the child came constitutional treatment on such history as is obtainable under my care and the sight in the other was reduced to from the patient has been so far the rule of practice and the seeing hand movements at a few inches. This, however, relieved in less than a week, although all previous possibility that there may be no connexion between the was constitutional disease and the intra-ocular inflammation remedies used in an ophthalmic hospital had proved unavail and the mother’s gratitude was profound. The child is habitually lost sight of. Are we to ignore the possibility of ing still under treatment but as the disease had lasted for many that have no with venereal connexion disease organisms and the corneas were leucomatous before the child causing iritis in persons who are the victims of syphilis ?7 months Iritis would not be diagnosed as gonorrhceal iritis in a came under my care it is improbable that there will be any considerable improvement in vision. A third case that has syphilitic subject were it not for the urethral discharge. In been under treatment for over six months gave excellent this form of iritis it is practically certain the ocular conresults as regards vision (f), although the patient was unable dition is due to circulating toxins, and if we may assume as to carry out his instructions properly on account of his work. much in syphilis, rheumatism, &c., results very important One case with salmon patches recovered in three monthsfollow, for bacteriology furnishes us with proof of the im- with vision and another in eight weeks with vision 6. The in of for treatment, as, instance, early diphtheria, portance in which disease the antitoxin is almost useless after the remainder are still under treatment. The acetozone treatment has also been used in a case of fourth day. A most unsatisfactory feature of constitutional neuro-retinitis that progressed rapidly in spite of syphilitic and the slowness treatment in syphilis rheumatism is of its The disease was promptly action. If in these diseases early treatment is imperative pil. hyd. c. creta, II. t.d. became and visioneasily in six the discs normal, arrested, and we must infer the toxins have done their worst specific remedies will have little effect. Toxins being almost cer- weeks. The results in all forms of iritis were admirable and so in interstitial keratitis when seen within a week tainly albumoses, it follows that the blood should be hurried equally or so of the commencement of the disease. Indeed, in the as frequently as possible through the liver to convert these latter two or three days at times suffice to remove the and in to the skin order that bodies into urea and kidneys the urea may be excreted, and this metabolism will be corneal opacity and nothing remains but a little keratitis facilitated by systematic exercise and copious potations of punctata. In future cases there is no reason why the treatment should not be combined with inunction but in nearly water. I have made it a routine practice for several years to all the cases treated by acetozone mercury has been tried for six weeks and in some cases for several months. The inquire into the condition of the bowels in all cases of eye at least to acetozone is the price and this is a cononly objection in that are inflammations and find, especially children, they sideration if the drug has to be used for several weeks. that so it the association frequent foul, being mostly very In the treatment of such Doubtless in iritis this would be inconsiderable and the can scarcely be a fortuitous one. Three-grain doses have excellent cases I used to begin by the internal administration of money wisely spent. resorcin or salol, but the former sometimes produced quasi- results but it is not unlikely larger doses could be given The use of the drug by means of carboluria and the latter was apt to make the patient ill. with advantage. have its drawbacks, but this method has capsules may in could be that as found acetozone, Having typhoid fever, used with advantage as an intestinal and general antiseptic advantages, and in eye diseases there is not the objection in eye diseases I gave it first in three-grain doses dissolved in to the exhibition of the remedy in solid form which might be four ounces of water. Subsequently I increased the amount offered in the case of enteric disease. However administered of water largely and my present method is as follows. The there is no doubt it should be given in eye cases with a much quantity of water than in typhoid fever. The limitapatient drinks a tumbler of water and takes a three-grain larger tions as to space prevent my taking up the bacteriology of the of acetozone walks after which he capsule immediately, to deal with this on another occasion. briskly for ten minutes and then takes a second glass of subject but I Ipropose am, Sirs, yours faithfully, water and again walks for ten or 15 minutes. Four doses CHARLES WRAY, F.R.C.S. Eng., are taken daily-before breakfast, in the middle of the Surgeon, Western Ophthalmic Hospital; Ophthalmic morning, in the middle of the afternoon, and in the evening. Surgeon, Croydon General Hospital and The results have been satisfactory ; so much so that one will Croydon Infirmary. never revert to the old methods, and especially as it is probable that still better results will be obtainable by the COEXISTENCE OF DISEASES. supplementary use of recognised drugs, such as the inunction of mercury, &c. To the Editors of THE LANCET. Altogether I have used the acetozone-hydrotherapeutic treatment in 45 cases of iritis, interstitial keratitis, &c., SiRS,-I read with much interest your annotation on the and also in one case of syphilitic optic neuritis and two Coexistence of Diseases in THE LANCET of August 25th, cases of sympathetic ophthalmia. If the cases of iritis p. 515. In it the following sentence occurs : "The result of an infectious disease occurring in a tuberculous subject does are seen early, say, before the fourth day, the patient not infrequently experiences relief from pain in a very few hours not essentially differ from that found when a healthy subject and we frequently find all redness gone by the sixth or is attacked except that in the former the powers of resistseventh day. We should, of course, as a routine procedure ance are less and not infrequently an intercurrent affection is so badly borne as to threaten seriously the patient’s life." dilate the pupil as much as possible at the first visit. The following cases treated by acetozone are of interest. That recalled to my memory a case that came under my (a) A case of sympathetic iritis with keratitis punctata that notice some three years ago in which scarlet fever,
THE GERMAN LANGUAGE AND MEDICAL MEN.
680
an intercurrent affection in a patient suffering from tuberculous disease of the hip-joint, appeared to have a beneficial and curative influence on the tuberculous condition. A boy, aged seven years, was under treatment for tuberculous hip disease with a sinus discharging on the posteroexternal aspect of the thigh when he had an attack of scarlet fever. He was removed to the isolation hospital. A large abscess had now formed on the anterior aspect of the thigh in the region of the hip and it was necessary to operate. Under an anmsthetic the abscess was incised and a gauze drain was put in. For the next two or three days the boy lay in a very precarious condition and it was doubtful if he would recover. However, the fever abated and he began to improve. As convalescence progressed the tuberculous condition got very much better and by the time con. valescence was established the tuberculous sinuses had healed. The change in his general condition was also very marked. At first he was thin and pale, but during convalescence he put on weight and when discharged was quite fat and rosy. He was also able to run about and had no discharging sinuses, a state of affairs which had not been his for over two years. The question is whether the cure of the tuberculous condition was influenced by the scarlet fever. I have not had an opportunity of watching another case similar to the above. Of course, there is always the chance of the cure occurring at that time being a mere coincidence, but I must say I have never yet seen a tuberculous condition take such a rapid turn for the better.-I am. Sirs. vours faithfully. JOHN ALLAN, M.B. August 25th, 1906.
(2) (3)
HÆMATOGENOUS ALBUMINURIA. To the Editors
.
of THE LANCET.
’
SiRS,-I was interested to read Dr. R. Hingston Fox’s article on this subject in THE LANCET of August 25th, p. 497. Since the publication of Sir A. E. Wright’s observation on the influence of calcium lactate in so-called "functional" albuminuria I have tested the point repeatedly. In four cases which I suspected to be of this type the albuminuria was readily controlled by the drug, but in cases with other evidence of kidney disease calcium lactate had I therefore agree with Dr. Fox that it no obvious effect. is a useful diagnostic test and that the primary cause of But I am the albuminuria is the state of the blood. inclined to think that he rather belittles the disturbance of the cardio-vascular mechanism in these cases. The great tendency to fainting, especially on standing for some time, and the appearance of albuminuria only after getting up, strongly suggest a lax condition of the vaso-motor system which, failing to compensate for the effect of gravity, allots both cerebral anasmia and back pressure on the kidney to occur. These considerations have led me to use digitalis as well as calcium lactate and, so far as I can judge, the effect has been good.-I am, Sirs, yours faithfully, W. LANGDON BROWN. Finsbury-square, E.C., Sept. 3rd, 1906.
as follows: (1) that the main drainage was sound; that the public health was in no way endangered; and that the chief main drainage was then carried right out into the river Inn, whence it issued with torrential force. The wish was no doubt father to the thought. It seems, however, on inquiry, (1) that the experts referred to in the letter had (as the authorities frankly admit) recommended that all drainage into the lake should be stopped and another system adopted, thereby showing that in their opinion the existing main system was faulty ; (2) that complaints of suppurative tonsillitis and like ailments were extraordinarily numerous during the winter in question, and when septic illness occurs in an antiseptic air and the drains are subse. quently ordered to be remodeled it is more likely that the public health was endangered than not, though actual typhoid fever, diphtheria, &c., were absent ; and (3) that (as the authorities likewise admit) the new main system instead of being complete on Sept. 16th, 1905, as stated in the letter, was not complete in March, 1906, or expected to be so till later. The fact is that St. Moritz had rapidly outgrown its sani. tary system, and though the authorities assure us that they are doing their best to put things right the publication of a certificate by first-class independent professional experts that the entire system, both main and subsidiary, is now perfected and up-to-date would be more conclusive than any other assurance. At present the only promise obtainable (in March last) is that the work when complete will be certified by an authority, but by whom and whether or where the certificate will be published is not stated nor whether it will include the subsidiary system. I trust I have said enough to show that there is nothing unreasonable in now asking for the publication of this certificate in THE LANCET, especially as it is over a year since the London Sanitary Protection Association reported confidentially on the matter and suggested the necessary alterations. Such a step would at once remove the uneasiness to which Dr. Parkinson referred, and would be in the best interests of the place to which many of us owe much. I am, Sirs, yours faithfully, H. CAMPBELL JENKINS. United University Club, London, Sept. 3rd, 1906.
1904-05
occurring as
THE MEDICO-LEGAL EXPERIENCES OF A GENERAL PRACTITIONER. To the Editors of THE LANCET. SIRS,-Though he gets it up for examination purposes the
but few important opporof work of exercising his if a great or important incident does come in his way the introduction of an " expert" deprives him of much of any credit or glory obtainable. To most of us our medico-legal experiences consist of an occasional inquest which, in the majority of cases, presents no difficulty, medical or legal, and does not require the employment of the coroner’s pet pathologist; an occasional lunacy certifying, which does often present some difficulty; and more rarely a police-court case-viz., assault, &c. NeverTHE GERMAN LANGUAGE AND theless, though great occasions are exceptional, minor inMEN. cidents are not so infrequent in which interesting medicoTo the Editors of THE LANCET. legal points are involved. At some time or another nearly every one of us must have SIRS,-I have received several letters from your readers which indicate that there is some difficulty in obtaining been called upon to decide as to the sobriety or otherwise of With your a given individual, and much may depend on our verdict. Messrs. Fiedler acd Sandbach’s little book. of decision is often very great and the will order I the for specification through a The difficulty give permission between "dead drunk""and "bad been drinking gradations for "A First German Course Science Students," by printer : H. G. Fiedler and F. E. Sandbach. Alex. Moring, Limited, but was not drunk " are many and subtle. Even the interval the De la More Press, 32, George-street, Hanover-square. between the apprehension of the accused and the appearance of the doctor may have been sufficient to allow I am, Sirs, yours faithfully, 1906. 2s. 6d. net. of the disappearance or modification of the signs of ARTHUR LOXTON. intoxication. The accused may lighten one’s task by Sept. 3rd, 1906. admitting to a glass or two, or to having "mixed." The most should be made of such admissions before imposing SANITATION AT ST. MORITZ. all those tests of sobriety familiar to the police, for it is To the Editurs of THE LANCET. possible for the man who has exceeded to pull himself SiRS,—In answer to an inquiry by Dr. T. W. Parkinson on together and neutralise the evidences of alcoholic excess this subject1 there appeared in THE LANCET on Sept. 16th, and evade the pitfalls contained in polysyllabic alliterative 1905, p. 854, a letter signed by Dr. J. F. Holland and Dr. lingual trials. In all cases the medical examiner should P. Gredig which stated with regard to the winter season conduct his examination before witnesses, and fortify and support his opinion by the testimony of others whose sobriety 1 THE should be undoubted. An inquiry into the history of the LANCET, August 14th, 1905, p. 553.
MEDICAL
______________
general practitioner has during even a long life medico-legal knowledge. Even
average tunities
ACETOZONE.I
679
believe that an alteration in the regulations will be for the had been under treatment off and on for 12 months in the department of a large metropolitan hospital. At good of the institution which they administer and of the ophthalmic the first visit to the Croydon General Hospital on patient’s public which it serves) it is right that the change should be Dec. 16th vision was on Dec. 20th it was Three weeks conclusion as to the made. We cannot express any legality later vision was normal and the eye appeared to have made a of the action of the governors. As to its advisability, our perfect recovery. The patient was seen about ten days ago general view is that any modification of hospital rules which and the eye remains free from all traces of deposit. (b) A tends to break down artificial barriers, purporting to divide second case of sympathetic iritis. This patient came to the the medical profession into classes and sections, is for the Western Ophthalmic Hospital on Nov. 17th with vision reduced to fingers (Dr. F. Hewkley). On Nov. 24th good of the profession and of the public. Very large vision was counting on Dec. 1st it was , and slight keratitis ; questions are opened by this aspect of the matter.-ED. L. punctata; on Jan. 19th there was no trace of deposits even under high magnification. This patient was seen three weeks ago and the eye seemed to be free from all THE TREATMENT OF IRITIS, INTER- trace of disease with the exception of a little uveal pigment STITIAL KERATITIS, &c., BY on the lens. In all nine cases of interstitial keratitis, several of ACETOZONE. extreme severity, were treated by acetozone. In one case To the Editors of THE LANCET. not only was the cornea absolutely opaque and salmonbut bulged in a most alarming way. In the courseSIRS,-During the last 16 months I have treated all my coloured of six weeks the corneas had cleared sufficiently for the cases of intra-ocular inflammation on the assumption that to get about and the vision is now .lo - --/6’ In a they were the result of bacterial action and with gratifying patient results. The post hoc ergo propter hoc fallacy of basing the second case one eye was entirely lost before the child came constitutional treatment on such history as is obtainable under my care and the sight in the other was reduced to from the patient has been so far the rule of practice and the seeing hand movements at a few inches. This, however, relieved in less than a week, although all previous possibility that there may be no connexion between the was constitutional disease and the intra-ocular inflammation remedies used in an ophthalmic hospital had proved unavail and the mother’s gratitude was profound. The child is habitually lost sight of. Are we to ignore the possibility of ing still under treatment but as the disease had lasted for many that have no with venereal connexion disease organisms and the corneas were leucomatous before the child causing iritis in persons who are the victims of syphilis ?7 months Iritis would not be diagnosed as gonorrhceal iritis in a came under my care it is improbable that there will be any considerable improvement in vision. A third case that has syphilitic subject were it not for the urethral discharge. In been under treatment for over six months gave excellent this form of iritis it is practically certain the ocular conresults as regards vision (f), although the patient was unable dition is due to circulating toxins, and if we may assume as to carry out his instructions properly on account of his work. much in syphilis, rheumatism, &c., results very important One case with salmon patches recovered in three monthsfollow, for bacteriology furnishes us with proof of the im- with vision and another in eight weeks with vision 6. The in of for treatment, as, instance, early diphtheria, portance in which disease the antitoxin is almost useless after the remainder are still under treatment. The acetozone treatment has also been used in a case of fourth day. A most unsatisfactory feature of constitutional neuro-retinitis that progressed rapidly in spite of syphilitic and the slowness treatment in syphilis rheumatism is of its The disease was promptly action. If in these diseases early treatment is imperative pil. hyd. c. creta, II. t.d. became and visioneasily in six the discs normal, arrested, and we must infer the toxins have done their worst specific remedies will have little effect. Toxins being almost cer- weeks. The results in all forms of iritis were admirable and so in interstitial keratitis when seen within a week tainly albumoses, it follows that the blood should be hurried equally or so of the commencement of the disease. Indeed, in the as frequently as possible through the liver to convert these latter two or three days at times suffice to remove the and in to the skin order that bodies into urea and kidneys the urea may be excreted, and this metabolism will be corneal opacity and nothing remains but a little keratitis facilitated by systematic exercise and copious potations of punctata. In future cases there is no reason why the treatment should not be combined with inunction but in nearly water. I have made it a routine practice for several years to all the cases treated by acetozone mercury has been tried for six weeks and in some cases for several months. The inquire into the condition of the bowels in all cases of eye at least to acetozone is the price and this is a cononly objection in that are inflammations and find, especially children, they sideration if the drug has to be used for several weeks. that so it the association frequent foul, being mostly very In the treatment of such Doubtless in iritis this would be inconsiderable and the can scarcely be a fortuitous one. Three-grain doses have excellent cases I used to begin by the internal administration of money wisely spent. resorcin or salol, but the former sometimes produced quasi- results but it is not unlikely larger doses could be given The use of the drug by means of carboluria and the latter was apt to make the patient ill. with advantage. have its drawbacks, but this method has capsules may in could be that as found acetozone, Having typhoid fever, used with advantage as an intestinal and general antiseptic advantages, and in eye diseases there is not the objection in eye diseases I gave it first in three-grain doses dissolved in to the exhibition of the remedy in solid form which might be four ounces of water. Subsequently I increased the amount offered in the case of enteric disease. However administered of water largely and my present method is as follows. The there is no doubt it should be given in eye cases with a much quantity of water than in typhoid fever. The limitapatient drinks a tumbler of water and takes a three-grain larger tions as to space prevent my taking up the bacteriology of the of acetozone walks after which he capsule immediately, to deal with this on another occasion. briskly for ten minutes and then takes a second glass of subject but I Ipropose am, Sirs, yours faithfully, water and again walks for ten or 15 minutes. Four doses CHARLES WRAY, F.R.C.S. Eng., are taken daily-before breakfast, in the middle of the Surgeon, Western Ophthalmic Hospital; Ophthalmic morning, in the middle of the afternoon, and in the evening. Surgeon, Croydon General Hospital and The results have been satisfactory ; so much so that one will Croydon Infirmary. never revert to the old methods, and especially as it is probable that still better results will be obtainable by the COEXISTENCE OF DISEASES. supplementary use of recognised drugs, such as the inunction of mercury, &c. To the Editors of THE LANCET. Altogether I have used the acetozone-hydrotherapeutic treatment in 45 cases of iritis, interstitial keratitis, &c., SiRS,-I read with much interest your annotation on the and also in one case of syphilitic optic neuritis and two Coexistence of Diseases in THE LANCET of August 25th, cases of sympathetic ophthalmia. If the cases of iritis p. 515. In it the following sentence occurs : "The result of an infectious disease occurring in a tuberculous subject does are seen early, say, before the fourth day, the patient not infrequently experiences relief from pain in a very few hours not essentially differ from that found when a healthy subject and we frequently find all redness gone by the sixth or is attacked except that in the former the powers of resistseventh day. We should, of course, as a routine procedure ance are less and not infrequently an intercurrent affection is so badly borne as to threaten seriously the patient’s life." dilate the pupil as much as possible at the first visit. The following cases treated by acetozone are of interest. That recalled to my memory a case that came under my (a) A case of sympathetic iritis with keratitis punctata that notice some three years ago in which scarlet fever,
THE GERMAN LANGUAGE AND MEDICAL MEN.
680
an intercurrent affection in a patient suffering from tuberculous disease of the hip-joint, appeared to have a beneficial and curative influence on the tuberculous condition. A boy, aged seven years, was under treatment for tuberculous hip disease with a sinus discharging on the posteroexternal aspect of the thigh when he had an attack of scarlet fever. He was removed to the isolation hospital. A large abscess had now formed on the anterior aspect of the thigh in the region of the hip and it was necessary to operate. Under an anmsthetic the abscess was incised and a gauze drain was put in. For the next two or three days the boy lay in a very precarious condition and it was doubtful if he would recover. However, the fever abated and he began to improve. As convalescence progressed the tuberculous condition got very much better and by the time con. valescence was established the tuberculous sinuses had healed. The change in his general condition was also very marked. At first he was thin and pale, but during convalescence he put on weight and when discharged was quite fat and rosy. He was also able to run about and had no discharging sinuses, a state of affairs which had not been his for over two years. The question is whether the cure of the tuberculous condition was influenced by the scarlet fever. I have not had an opportunity of watching another case similar to the above. Of course, there is always the chance of the cure occurring at that time being a mere coincidence, but I must say I have never yet seen a tuberculous condition take such a rapid turn for the better.-I am. Sirs. vours faithfully. JOHN ALLAN, M.B. August 25th, 1906.
(2) (3)
HÆMATOGENOUS ALBUMINURIA. To the Editors
.
of THE LANCET.
’
SiRS,-I was interested to read Dr. R. Hingston Fox’s article on this subject in THE LANCET of August 25th, p. 497. Since the publication of Sir A. E. Wright’s observation on the influence of calcium lactate in so-called "functional" albuminuria I have tested the point repeatedly. In four cases which I suspected to be of this type the albuminuria was readily controlled by the drug, but in cases with other evidence of kidney disease calcium lactate had I therefore agree with Dr. Fox that it no obvious effect. is a useful diagnostic test and that the primary cause of But I am the albuminuria is the state of the blood. inclined to think that he rather belittles the disturbance of the cardio-vascular mechanism in these cases. The great tendency to fainting, especially on standing for some time, and the appearance of albuminuria only after getting up, strongly suggest a lax condition of the vaso-motor system which, failing to compensate for the effect of gravity, allots both cerebral anasmia and back pressure on the kidney to occur. These considerations have led me to use digitalis as well as calcium lactate and, so far as I can judge, the effect has been good.-I am, Sirs, yours faithfully, W. LANGDON BROWN. Finsbury-square, E.C., Sept. 3rd, 1906.
as follows: (1) that the main drainage was sound; that the public health was in no way endangered; and that the chief main drainage was then carried right out into the river Inn, whence it issued with torrential force. The wish was no doubt father to the thought. It seems, however, on inquiry, (1) that the experts referred to in the letter had (as the authorities frankly admit) recommended that all drainage into the lake should be stopped and another system adopted, thereby showing that in their opinion the existing main system was faulty ; (2) that complaints of suppurative tonsillitis and like ailments were extraordinarily numerous during the winter in question, and when septic illness occurs in an antiseptic air and the drains are subse. quently ordered to be remodeled it is more likely that the public health was endangered than not, though actual typhoid fever, diphtheria, &c., were absent ; and (3) that (as the authorities likewise admit) the new main system instead of being complete on Sept. 16th, 1905, as stated in the letter, was not complete in March, 1906, or expected to be so till later. The fact is that St. Moritz had rapidly outgrown its sani. tary system, and though the authorities assure us that they are doing their best to put things right the publication of a certificate by first-class independent professional experts that the entire system, both main and subsidiary, is now perfected and up-to-date would be more conclusive than any other assurance. At present the only promise obtainable (in March last) is that the work when complete will be certified by an authority, but by whom and whether or where the certificate will be published is not stated nor whether it will include the subsidiary system. I trust I have said enough to show that there is nothing unreasonable in now asking for the publication of this certificate in THE LANCET, especially as it is over a year since the London Sanitary Protection Association reported confidentially on the matter and suggested the necessary alterations. Such a step would at once remove the uneasiness to which Dr. Parkinson referred, and would be in the best interests of the place to which many of us owe much. I am, Sirs, yours faithfully, H. CAMPBELL JENKINS. United University Club, London, Sept. 3rd, 1906.
1904-05
occurring as
THE MEDICO-LEGAL EXPERIENCES OF A GENERAL PRACTITIONER. To the Editors of THE LANCET. SIRS,-Though he gets it up for examination purposes the
but few important opporof work of exercising his if a great or important incident does come in his way the introduction of an " expert" deprives him of much of any credit or glory obtainable. To most of us our medico-legal experiences consist of an occasional inquest which, in the majority of cases, presents no difficulty, medical or legal, and does not require the employment of the coroner’s pet pathologist; an occasional lunacy certifying, which does often present some difficulty; and more rarely a police-court case-viz., assault, &c. NeverTHE GERMAN LANGUAGE AND theless, though great occasions are exceptional, minor inMEN. cidents are not so infrequent in which interesting medicoTo the Editors of THE LANCET. legal points are involved. At some time or another nearly every one of us must have SIRS,-I have received several letters from your readers which indicate that there is some difficulty in obtaining been called upon to decide as to the sobriety or otherwise of With your a given individual, and much may depend on our verdict. Messrs. Fiedler acd Sandbach’s little book. of decision is often very great and the will order I the for specification through a The difficulty give permission between "dead drunk""and "bad been drinking gradations for "A First German Course Science Students," by printer : H. G. Fiedler and F. E. Sandbach. Alex. Moring, Limited, but was not drunk " are many and subtle. Even the interval the De la More Press, 32, George-street, Hanover-square. between the apprehension of the accused and the appearance of the doctor may have been sufficient to allow I am, Sirs, yours faithfully, 1906. 2s. 6d. net. of the disappearance or modification of the signs of ARTHUR LOXTON. intoxication. The accused may lighten one’s task by Sept. 3rd, 1906. admitting to a glass or two, or to having "mixed." The most should be made of such admissions before imposing SANITATION AT ST. MORITZ. all those tests of sobriety familiar to the police, for it is To the Editurs of THE LANCET. possible for the man who has exceeded to pull himself SiRS,—In answer to an inquiry by Dr. T. W. Parkinson on together and neutralise the evidences of alcoholic excess this subject1 there appeared in THE LANCET on Sept. 16th, and evade the pitfalls contained in polysyllabic alliterative 1905, p. 854, a letter signed by Dr. J. F. Holland and Dr. lingual trials. In all cases the medical examiner should P. Gredig which stated with regard to the winter season conduct his examination before witnesses, and fortify and support his opinion by the testimony of others whose sobriety 1 THE should be undoubted. An inquiry into the history of the LANCET, August 14th, 1905, p. 553.
MEDICAL
______________
general practitioner has during even a long life medico-legal knowledge. Even
average tunities