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CONGENITAL MALFORMATIONS.
963 administration of morphine and atropine.
series
Scopolamine
Annotations.
abdominal rigidity. In this there was only one death in which the anaesthetic could be said to play a part. It was a man with a ruptured colon who died during the operation. He from the injury before the was very collapsed administration of the anaesthetic. What are the dangers and cornplications of splanchnic anaesthesia ? They are these: Reflex collapse when the needle reaches the plexus, only seen when the patient is injected sitting up ; toxic symptoms which come on immediately if the needle point should be in the cavity of the vena cava or aorta, or supervene in a few minutes if the patient be unusually susceptible to novocaine; and finally, acute dilatation of the stomach and perhaps atony of the intestine a few days after operation. The collapse from novocaine poisoning can be avoided by care in technique and avoidance of too large a dose. The dilatation of the stomach is a serious complication. It arises apparently from the upset of the coeliac plexus caused by the injection. The bad effects of it can be lessened by early recognition and the passage of a stomach tube. Manv considerations come to the fore when the of adopting the method has to be decided by English surgeons. The Teuton is a more phlegmatic individual and will submit readily to the number of needle punctures (14 or more) necessary to block both the splanchnics and the nerves of the abdominal wall. This in itself would be an ordeal for many patients in this country. The distress of being operated upon whilst conscious would be very great in some individuals. Yet it must be confessed that the comfort of the patients the day after operation under local anaesthesia is very striking. They escape the vomiting which even the most skilled general anaesthetist is unable always to prevent, and with it the exhaustion caused by the pain of uncontrolled retching, a memory always the last to fade from the mind of a laparotomised patient. Then again, it must be admitted that the toxaemia of novocaine is less than that due to a general anaesthetic. It is claimed that the mortality rate in peritonitis is less when the patients are operated upon under local aneesthesia than under ether. Probably with increasing experience it will be established that, like the spinal method, splanchnic anaesthesia has its indications as well as its limitations, and that it will come to take a recognised place in
appeared
to
cause
"
Ne quid nimis."
CONGENITAL MALFORMATIONS. CONGENITAL abnormalities have always been a source of interest and speculation to mankind. In olden days they were as often as not referred to diabolical paternity, and frequently the unfortunate mother of such offspring had reason to regret her assumed familiarity with the infernal powers. Since Geoffroy St. Hilaire and v. Vrolik classified monsters on more scientific lines embryology has been invoked in explanation of them all. Yet it sometimes happens that they themselves are really the only foundation for the embryological statements made to account for them. As a matter of fact, normal embryology is an introduction to normal anatomy, and not by any means necessarily an explanation of abnormalities. Mr. C. P. G. Wakeley gives an interesting description, in the Journal of Anatomy for April, of a case on which he had operated, in which were several congenital malformations of the intestinal canal ; he refrains from offering any general explanation of their concurcence save what might be conceded to some In this restraint Mr. Wakeley failure in nutrition. shows a philosophic wisdom such as is not always to be found. Whether nutritional faults are to be classed among the causes or not, it is certain that no other is to be decidedly given in the present state of our knowledge. It is permissible to doubt whether abnormalities such as those he describes can be cousidered even as persistences of normal stages, whether, in fact, there has been any arrest at a definite developmental point, or whether the resemblance to such a stage is not merely general and superficial, the endresult of a growth that has been faulty from the beginning. In this last case there could hardly have been a " normal " stage. It is well to understand that our present knowledge of organogeny, detailed as it is, would never account for the great majority of abnormalities. Even though such a simple thing, for example, as a cleft palate may be certainly referred to failure in the growth-forces of the maxillary process, this is no explanation of it. but is merely a re-statement of the condition in other words. Such a form of re-statement is frequently given ingenuously as an explanation, but in most of the complicated forms of abnormalities even this is not possible in terms of normal embryology. The truth is that we are practically ignorant of the forces and inter-relations behind the phenomena of growth, and are only surgical technique. acquainted with their end-products. The accumuof forces phylogenetic development are hidden among these, only recognisable here and THE annual oration of the Medical Society of but undoubtedly pervading the activities London will be given at 11, Chandos-street, London, W. 1, there, ext Monday, May 14th, by Dr. J. Walter Carr, who has throughout. This thought rises in the mind in association with taken as his subject Life and Problems in a Medical the condition of anal canal in the penis, which is menUtopia. tioned by Mr. Wakeley in his discussion of the cloacal ROYAL SOCIETY OF MEDICINE.—The President, Sir malformation in his case, and is, no doubt, as he William Hale-White, with the hon. secretaries, Dr. A. M. H. to be referred to the ectodermal cloaca. The remarks, John Y. W. and Mr. and the Sir Gray Girling Ball, secretary, is produced MacAlister, attended at St. James’s Palace on May 4th, theory that the rectum, or its lower part, and formally presented the Honorary Fellowship of the by a secondary downgrowth from the cloaca is not in keeping with the facts of ontogenetic development. Society to the Prince of Wales. The house and library of the Royal Society of Medicine But one would hesitate to say that it might not be a will be closed from Saturday, May 19th, to Monday, phylogenetic memory, which may find its expression May 21st, both days inclusive. under unusual circumstances. It may be that future ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH.- work will show something of this sort to be at the At a meeting held on May 1st, Sir Robert Philip, President, bottom of certain monstrosities, or it may open up being in the chair, Dr. George Henry Masson was elected to vistas in most unexpected directions. Not until the Fellowship of the College, and Dr. James Davie Gilruth some idea is gained of the forces at work-not of and Dr. William Arnott Dickson were admitted to the their nature but of their methods-can we really Membership of the College. The College re-elected Dr. hope for much help from embryology, and in most William Russell as their representative on the General Council cases we can get none at all. Yet those ,who, like of Medical Education and Registration for a further period of - five years. The Freeland Barbour Fellowship for Original Mr. Wakeley, carefully report and consider such cases, Research was awarded to Br. James Walker Dawson. Lord are doing good spadework, preparing the soil in which, us hope, some future explanatory system will Polwarth presented to the College an autograph- letter by Edward Jenner dated Sept. 14th, 1799. surely grow.
advisability
Ilated
-
let
series
Scopolamine
Annotations.
abdominal rigidity. In this there was only one death in which the anaesthetic could be said to play a part. It was a man with a ruptured colon who died during the operation. He from the injury before the was very collapsed administration of the anaesthetic. What are the dangers and cornplications of splanchnic anaesthesia ? They are these: Reflex collapse when the needle reaches the plexus, only seen when the patient is injected sitting up ; toxic symptoms which come on immediately if the needle point should be in the cavity of the vena cava or aorta, or supervene in a few minutes if the patient be unusually susceptible to novocaine; and finally, acute dilatation of the stomach and perhaps atony of the intestine a few days after operation. The collapse from novocaine poisoning can be avoided by care in technique and avoidance of too large a dose. The dilatation of the stomach is a serious complication. It arises apparently from the upset of the coeliac plexus caused by the injection. The bad effects of it can be lessened by early recognition and the passage of a stomach tube. Manv considerations come to the fore when the of adopting the method has to be decided by English surgeons. The Teuton is a more phlegmatic individual and will submit readily to the number of needle punctures (14 or more) necessary to block both the splanchnics and the nerves of the abdominal wall. This in itself would be an ordeal for many patients in this country. The distress of being operated upon whilst conscious would be very great in some individuals. Yet it must be confessed that the comfort of the patients the day after operation under local anaesthesia is very striking. They escape the vomiting which even the most skilled general anaesthetist is unable always to prevent, and with it the exhaustion caused by the pain of uncontrolled retching, a memory always the last to fade from the mind of a laparotomised patient. Then again, it must be admitted that the toxaemia of novocaine is less than that due to a general anaesthetic. It is claimed that the mortality rate in peritonitis is less when the patients are operated upon under local aneesthesia than under ether. Probably with increasing experience it will be established that, like the spinal method, splanchnic anaesthesia has its indications as well as its limitations, and that it will come to take a recognised place in
appeared
to
cause
"
Ne quid nimis."
CONGENITAL MALFORMATIONS. CONGENITAL abnormalities have always been a source of interest and speculation to mankind. In olden days they were as often as not referred to diabolical paternity, and frequently the unfortunate mother of such offspring had reason to regret her assumed familiarity with the infernal powers. Since Geoffroy St. Hilaire and v. Vrolik classified monsters on more scientific lines embryology has been invoked in explanation of them all. Yet it sometimes happens that they themselves are really the only foundation for the embryological statements made to account for them. As a matter of fact, normal embryology is an introduction to normal anatomy, and not by any means necessarily an explanation of abnormalities. Mr. C. P. G. Wakeley gives an interesting description, in the Journal of Anatomy for April, of a case on which he had operated, in which were several congenital malformations of the intestinal canal ; he refrains from offering any general explanation of their concurcence save what might be conceded to some In this restraint Mr. Wakeley failure in nutrition. shows a philosophic wisdom such as is not always to be found. Whether nutritional faults are to be classed among the causes or not, it is certain that no other is to be decidedly given in the present state of our knowledge. It is permissible to doubt whether abnormalities such as those he describes can be cousidered even as persistences of normal stages, whether, in fact, there has been any arrest at a definite developmental point, or whether the resemblance to such a stage is not merely general and superficial, the endresult of a growth that has been faulty from the beginning. In this last case there could hardly have been a " normal " stage. It is well to understand that our present knowledge of organogeny, detailed as it is, would never account for the great majority of abnormalities. Even though such a simple thing, for example, as a cleft palate may be certainly referred to failure in the growth-forces of the maxillary process, this is no explanation of it. but is merely a re-statement of the condition in other words. Such a form of re-statement is frequently given ingenuously as an explanation, but in most of the complicated forms of abnormalities even this is not possible in terms of normal embryology. The truth is that we are practically ignorant of the forces and inter-relations behind the phenomena of growth, and are only surgical technique. acquainted with their end-products. The accumuof forces phylogenetic development are hidden among these, only recognisable here and THE annual oration of the Medical Society of but undoubtedly pervading the activities London will be given at 11, Chandos-street, London, W. 1, there, ext Monday, May 14th, by Dr. J. Walter Carr, who has throughout. This thought rises in the mind in association with taken as his subject Life and Problems in a Medical the condition of anal canal in the penis, which is menUtopia. tioned by Mr. Wakeley in his discussion of the cloacal ROYAL SOCIETY OF MEDICINE.—The President, Sir malformation in his case, and is, no doubt, as he William Hale-White, with the hon. secretaries, Dr. A. M. H. to be referred to the ectodermal cloaca. The remarks, John Y. W. and Mr. and the Sir Gray Girling Ball, secretary, is produced MacAlister, attended at St. James’s Palace on May 4th, theory that the rectum, or its lower part, and formally presented the Honorary Fellowship of the by a secondary downgrowth from the cloaca is not in keeping with the facts of ontogenetic development. Society to the Prince of Wales. The house and library of the Royal Society of Medicine But one would hesitate to say that it might not be a will be closed from Saturday, May 19th, to Monday, phylogenetic memory, which may find its expression May 21st, both days inclusive. under unusual circumstances. It may be that future ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH.- work will show something of this sort to be at the At a meeting held on May 1st, Sir Robert Philip, President, bottom of certain monstrosities, or it may open up being in the chair, Dr. George Henry Masson was elected to vistas in most unexpected directions. Not until the Fellowship of the College, and Dr. James Davie Gilruth some idea is gained of the forces at work-not of and Dr. William Arnott Dickson were admitted to the their nature but of their methods-can we really Membership of the College. The College re-elected Dr. hope for much help from embryology, and in most William Russell as their representative on the General Council cases we can get none at all. Yet those ,who, like of Medical Education and Registration for a further period of - five years. The Freeland Barbour Fellowship for Original Mr. Wakeley, carefully report and consider such cases, Research was awarded to Br. James Walker Dawson. Lord are doing good spadework, preparing the soil in which, us hope, some future explanatory system will Polwarth presented to the College an autograph- letter by Edward Jenner dated Sept. 14th, 1799. surely grow.
advisability
Ilated
-
let