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CONGENITAL ATRESIA OF THE ŒSOPHAGUS.
214 The condition of.the oesophagus was almost exactly as shown in the illustration given by Dr. Poison. In my case there was not so much hypertrophy and dilatation of the upper portion as he shows, and the lower portion opened into the trachea at the level of the bifurcation. In addition the child presented the following congenital abnormalities : (1) imperforate anus with complete absence of the rectum, the pelvic colon ending blindly; (2) hydronephrosis of the right kidney with no connexion between pelvis and ureter ; (3) patent foramen ovale ; (4) absence of the right thumb ; and (5) abduction of the right hand at the wrist. The lungs showed a marked degree of interstitial emphysema arising apparently from the difficulty with respiration. I am, Sir, yours faithfully, C. P. DONNISON, M.B., B.S. Lond.
the greatest amount of paraesthesia was still in these fingers. In addition there was a patch of herpes over the seventh cervical vertebra. On July 6th pain developed in the right heel accompanied by numbness, still present on the lth when she saw me. I found herpes over the seventh cervical vertebra as stated and also in front over the right sterno-clavicular joint, with a few vesicles extending across the mid-line. The face was normal. There was marked weakness in the right grasp and in the triceps. There was anaesthesia to light touch, to vibration, to temperature, and to pinprick from the tips of the fingers to the upper arm at shoulder level. In addition there was definite wobbling in the fingernose test on that side. The right leg showed similar sensory changes as high as the knee. I could detect no ataxia in the leg ; the heel was painful to stand on. The reflexes were all normal ; the abdominals could not be elicited. The left side was normal. There had been a certain amount of headache since the illness began but not at all severe. There had been no eye trouble, and she was feeling much better than she had been.
I saw the patient again to-day, when I found that The anoesmarked improvement had taken place. thesia was confined to the right thumb and index ; the grasp was still weak but greatly better than a week ago. An examination of the C.’S.F. was not done; it did not seem worth while in an illness already over three weeks old when I first saw the I am, Sir, yours faithfully, W. FRASER ANNAND. Coventry, July 18th, 1930.
patient.
EFFECT OF RADIUM ON CARCINOMA.
To the Editor
of
THE LANCET.
SiR,-The question whether it is possible to stimulate cells by means of irradiation, and if so, whether that stimulation is direct or indirect, is still in dispute, but every surgeon, I think, will agree that if a malignant growth is cut into with a knife, needle, or any other’ instrument, cells may be disseminated, and, moreover, their actual growth may be stimulated by the tissue juices created as a
malignant
South Benflcet, Essex, July 21st, 1930.
THE OUT-PATIENT
To the Editor
of
QUEUE.
THE LANCET.
of the overcrowded out-patient department to which you referred last week is largely in the hands of the management of the hospital. It is the indiscriminate welcome accorded to all and sundry who apply for treatment that is at the root of the trouble. I would suggest that, except for emergencies, no patient be seen in an out-patient department unless he brings a letter from a doctor or proves that he is not insured under the National Health Insurance Act, and is too poor to afford even the most modest doctor’s fee. I, I am, Sir, yours faithfully, i
SIR,-The
cure
Westbourne Park-road, W., July 19th.
J. COHEN.
THE PROPER STRAPPING OF THE CHEST.
To the Editor of THE LANCET. result of the trauma. Mr. Romanis, in his interesting note, has not SiR,—-Dr. C. W. Chapman, in his letter on Left these possibilities, and I would suggest therefore If Inframammary Pain which appears in your issue that the only thing he can deduce is that the radium of June 28th (p. 1434), properly calls attention did not kill the cells that were in the track of the needle. to the value of strapping of the chest in those cases If radium plaques had been used and the growth had where the pain is manifestly made worse by the been increased near those plaques, there would have movements of respiration. But in his description been more justification for assuming that irradiation ’, of how strapping should be done he leaves out the could in some cases stimulate malignant growth. ’, important point that the strips should be drawn tight and pressed firmly into position while the patient’s I am, Sir, yours faithfully, chest is in the position of full expiration. Unless MALCOLM DONALDSON. Harley-street W., July 19th. this detail is attended to, the movements of the side are little affected by the presence of strapping on the CONGENITAL ATRESIA OF THE ŒSOPHAGUS. surface. Another point not mentioned, but no doubt assumed, is that the straps should run horizontally To the Editor of THE LANCET. round the side of the chest, thus crossing the lines SIR,-A few days before Dr. Polson’s paper on of two or more ribs, and so increasing the fixation atresia of the oesophagus was published in your last aimed at. issue I attended at the deliverv of a child that I feel like apologising, Sir, for thus mentioning presented this as well as several other congenital such apparently small points, but it is the attention abnormalities. He was born on July 12th, at full to details in many therapeutic measures that makes time after a pregnancy and labour that presented all the difference between success and failure. The mother was a primino abnormality of note. I am, Sir, yours, faithfully, 22. The R. D. RUDOLF. baby appeared to be fairly para, aged Toronto, July 8th, 1930. healthy at birth and weighed 6t lb. A few hours after birth it seemed to have considerable difficulty OPENINGS OF BETHLEM ROYAL HOSPITAL.-The with respiration and quantities of rather viscid new hospital at Monk’s Orchard, Beckenham, of which froth were brought up with difficulty. At intervals the foundation-stone was laid in July, 1928, by Prince it became cyanosed. The quantity of froth prevented Arthur of Connaught, was opened by the Queen recently. The hospital, which has cost jE450,000, stands in its own any attempt at feeding. On account of an imper- park of 200 acres, a few minutes’ walk from Eden Park forate anus the child was removed to Rochford station (S.R.) and on the ten mile circle drawn round Hospital, where Dr. Newey attempted to find the Charing Cross. Patients will for the most part have separate rectum by the perineal route but without success. bedrooms, with a few four- and five-bed wards for special The move from Lambeth will soon follow. The The child died on July 15th. The following day purposes. cost of laboratories for routine and research work has been I was present at an autopsy carried out by Dr. Newey; met by a gift from Lord Wakefield.
excludedI I
the greatest amount of paraesthesia was still in these fingers. In addition there was a patch of herpes over the seventh cervical vertebra. On July 6th pain developed in the right heel accompanied by numbness, still present on the lth when she saw me. I found herpes over the seventh cervical vertebra as stated and also in front over the right sterno-clavicular joint, with a few vesicles extending across the mid-line. The face was normal. There was marked weakness in the right grasp and in the triceps. There was anaesthesia to light touch, to vibration, to temperature, and to pinprick from the tips of the fingers to the upper arm at shoulder level. In addition there was definite wobbling in the fingernose test on that side. The right leg showed similar sensory changes as high as the knee. I could detect no ataxia in the leg ; the heel was painful to stand on. The reflexes were all normal ; the abdominals could not be elicited. The left side was normal. There had been a certain amount of headache since the illness began but not at all severe. There had been no eye trouble, and she was feeling much better than she had been.
I saw the patient again to-day, when I found that The anoesmarked improvement had taken place. thesia was confined to the right thumb and index ; the grasp was still weak but greatly better than a week ago. An examination of the C.’S.F. was not done; it did not seem worth while in an illness already over three weeks old when I first saw the I am, Sir, yours faithfully, W. FRASER ANNAND. Coventry, July 18th, 1930.
patient.
EFFECT OF RADIUM ON CARCINOMA.
To the Editor
of
THE LANCET.
SiR,-The question whether it is possible to stimulate cells by means of irradiation, and if so, whether that stimulation is direct or indirect, is still in dispute, but every surgeon, I think, will agree that if a malignant growth is cut into with a knife, needle, or any other’ instrument, cells may be disseminated, and, moreover, their actual growth may be stimulated by the tissue juices created as a
malignant
South Benflcet, Essex, July 21st, 1930.
THE OUT-PATIENT
To the Editor
of
QUEUE.
THE LANCET.
of the overcrowded out-patient department to which you referred last week is largely in the hands of the management of the hospital. It is the indiscriminate welcome accorded to all and sundry who apply for treatment that is at the root of the trouble. I would suggest that, except for emergencies, no patient be seen in an out-patient department unless he brings a letter from a doctor or proves that he is not insured under the National Health Insurance Act, and is too poor to afford even the most modest doctor’s fee. I, I am, Sir, yours faithfully, i
SIR,-The
cure
Westbourne Park-road, W., July 19th.
J. COHEN.
THE PROPER STRAPPING OF THE CHEST.
To the Editor of THE LANCET. result of the trauma. Mr. Romanis, in his interesting note, has not SiR,—-Dr. C. W. Chapman, in his letter on Left these possibilities, and I would suggest therefore If Inframammary Pain which appears in your issue that the only thing he can deduce is that the radium of June 28th (p. 1434), properly calls attention did not kill the cells that were in the track of the needle. to the value of strapping of the chest in those cases If radium plaques had been used and the growth had where the pain is manifestly made worse by the been increased near those plaques, there would have movements of respiration. But in his description been more justification for assuming that irradiation ’, of how strapping should be done he leaves out the could in some cases stimulate malignant growth. ’, important point that the strips should be drawn tight and pressed firmly into position while the patient’s I am, Sir, yours faithfully, chest is in the position of full expiration. Unless MALCOLM DONALDSON. Harley-street W., July 19th. this detail is attended to, the movements of the side are little affected by the presence of strapping on the CONGENITAL ATRESIA OF THE ŒSOPHAGUS. surface. Another point not mentioned, but no doubt assumed, is that the straps should run horizontally To the Editor of THE LANCET. round the side of the chest, thus crossing the lines SIR,-A few days before Dr. Polson’s paper on of two or more ribs, and so increasing the fixation atresia of the oesophagus was published in your last aimed at. issue I attended at the deliverv of a child that I feel like apologising, Sir, for thus mentioning presented this as well as several other congenital such apparently small points, but it is the attention abnormalities. He was born on July 12th, at full to details in many therapeutic measures that makes time after a pregnancy and labour that presented all the difference between success and failure. The mother was a primino abnormality of note. I am, Sir, yours, faithfully, 22. The R. D. RUDOLF. baby appeared to be fairly para, aged Toronto, July 8th, 1930. healthy at birth and weighed 6t lb. A few hours after birth it seemed to have considerable difficulty OPENINGS OF BETHLEM ROYAL HOSPITAL.-The with respiration and quantities of rather viscid new hospital at Monk’s Orchard, Beckenham, of which froth were brought up with difficulty. At intervals the foundation-stone was laid in July, 1928, by Prince it became cyanosed. The quantity of froth prevented Arthur of Connaught, was opened by the Queen recently. The hospital, which has cost jE450,000, stands in its own any attempt at feeding. On account of an imper- park of 200 acres, a few minutes’ walk from Eden Park forate anus the child was removed to Rochford station (S.R.) and on the ten mile circle drawn round Hospital, where Dr. Newey attempted to find the Charing Cross. Patients will for the most part have separate rectum by the perineal route but without success. bedrooms, with a few four- and five-bed wards for special The move from Lambeth will soon follow. The The child died on July 15th. The following day purposes. cost of laboratories for routine and research work has been I was present at an autopsy carried out by Dr. Newey; met by a gift from Lord Wakefield.
excludedI I