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FRACTURE OF THE EXTERNAL MALLEOLUS.
714 in this notable effort to enlighten the lay public
regarding
then be truly transverse and unobstructed, and the shadow of the rings on the plate will prove the fact. I am, Sir, yours faithfully, W. HAMPSON. West Chapel-street, W., Feb. 24th, 1914.
scriptions !
A
the treatment and prevention of disease." An additional allurement is held forth in the fact that the work, which is published fortnightly and may be had for 7d., contains more than 2000 pre-
COMPARISON
OF
THE
ACTIONS
OF
suggest that the more or less distinCHLOROFORM AND ETHER ON guished contributors to this philanthropic (!) publiTHE BLOOD PRESSURE. cation are directly responsible for this blatant advertisement of the departments of medicine in To the Editor of THE LANCET. which they practise, but I venture to think that it note in your issue of Feb. 28th a paper by will be the opinion of most of the profession that Dr.SIR,-I H. P. Fairlie with this title in which he quotes my the spirit, if not the letter, of the prohibition conclusions published in THE LANCET in 1908. He against such advertisement- is infringed by their mentions that I pointed out that no form of£ names appearing, however little on their own stimulant should be given previous to or during the initiative, in this broadcast trade circular. He also quotes me as course of an operation. From time to time we find some struggling that ether should be given as an anaesthetic. stating doctor accused of conduct infamous in a proHe then states that to his mind these statements fessional sense because he has " placed his goods in are quite contradictory, for while disapproving of the windowin some much more obscure manner, ether as a stimulant I recommend it as an anaesand I fail to see that the conduct is any less " thetic on account of the fact that it is a stimulant." infamous professionally because the goods of these " Now, in mypaper, I laid careful stress upon the fact more or less eminent specialists" are placed in that ether should not be given because it is a the window for them by someone else. Personally, but in spite of it as it is less toxic than stimulant, I think the attention of the Censors of the Colleges chloroform. My actual words were : " The absence should be called to this particular advertisement, of shock is not in these cases due to any stimulating and hope, Sir, that your inserting this letter in effect of the drug [ether], for, as has been pointed THE LANCET may have that effect. I enclose my out, when shock is present the centres fail to react Yours faithfully, card, and am, Sir, to any form of stimulant. In fact, stimulants only F.R.C.P. Feb. 26th, 1914. further exhaust the centres and aggravate the ,* A meeting of the medical men concerned has been condition." I am, Sir, yours faithfully, summoned, we are informed, when their course will be ALBERT J. WALTON. I do not
decided
upon.-ED.
L.
EXTERNAL MALLEOLUS. To the Editor of THE LANCET.
FRACTURE OF THE
SIR,-Dr. B. Whitchurch Howell asks in THE LANCET of Feb. 28th three questions in regard to the removal of the external malleolus when broken. They are easily answered :1. At present I only remove the malleolar fragment when it is displaced. 2. There is no sign of varus or valgus in the patients who have had the malleolus excised. 3. There is no evidence of displacement of the peronei tendons. The tendon sheaths keep them in I am, Sir, yours faithfully, position. JOHN BLAND-SUTTON. Brook-street, Grosvenor-square, W., Feb. 28th, 1914.
RADIOGRAPHY OF THE SELLA TURCICA. To the Editor of THE LANCET.
SIR,-At the last meeting of the ElectroTherapeutical Section of the Royal Society of Medicine consideration for the crowded state of the agenda list made me refrain from offering the following suggestion for centring the sella in the directly transverse rays from the tube. It will, I think, be more certain, as well as easier, than Mr. S. Gilbert Scott’s shot, or Dr. Finzi’s sixpences, while satisfying Dr. Parkes Weber’s requirements as to giving visible evidence on the plate itself that the centring has been properly done. Take two metal curtain rings of about 1½ inches in diameter, and to each attach two small strips Fix them by these strips in of adhesive plaster. the proper position with reference to each auditory meatus, and then arrange head and tube so that the screen shows the rings concentrically placed one apparently within the other. The central rays will A
Weymouth-street, W.,
Feb. 28th, 1914.
METHODS OF INCREASING THE ACCURACY AND DELICACY OF THE WASSERMANN REACTION. To the Editor of THE LANCET. Thiele and Dr. Embleton in a paper in SIR,-Dr. THE LANCET of Feb. 21st state their conclusion in antigens for that " the use of cholesterin the Wassermann reaction is not only unnecessary, but introduces a very serious source of error." These authors have allowed themselves to be led into a very rash and totally erroneous generalisation. The introduction of cholesterin into syphilitic antigens was originally advocated in a paper by myself along with Dr. Cruickshank and Dr. McKenzie.1 The statement of Dr. Thiele and Dr. Embleton as applied to our antigen, employed in the fashion which we recommended, is absolutely wrong. We showed that the introduction of cholesterin into an alcoholic solution of ox liver " lecithin greatly enhanced the antigenic power of the latter-i.e., the property of deviating complement in the presence of syphilitic serum, but had practically no effect on the inhibitory action of the antigen either by itself or in the presence of normal serum. In addition to providing a means of increasing the antigenic power of certain lipoid solutions by means of cholesterin, we were also enabled in this way to establish a new criterion for the detection of sera, which has proved valuable in conweak positive reactions. The original estimate of our method has been substantiated by nearly a dozen workers in the examination of over 3000 cases here and by other observers elsewhere. The value of the addition of cholesterin ......
"
Ifirming syphilitic 1
Journal of
Pathology
and
Bacteriology,
vol. xiv., 1910, p. 484.
regarding
then be truly transverse and unobstructed, and the shadow of the rings on the plate will prove the fact. I am, Sir, yours faithfully, W. HAMPSON. West Chapel-street, W., Feb. 24th, 1914.
scriptions !
A
the treatment and prevention of disease." An additional allurement is held forth in the fact that the work, which is published fortnightly and may be had for 7d., contains more than 2000 pre-
COMPARISON
OF
THE
ACTIONS
OF
suggest that the more or less distinCHLOROFORM AND ETHER ON guished contributors to this philanthropic (!) publiTHE BLOOD PRESSURE. cation are directly responsible for this blatant advertisement of the departments of medicine in To the Editor of THE LANCET. which they practise, but I venture to think that it note in your issue of Feb. 28th a paper by will be the opinion of most of the profession that Dr.SIR,-I H. P. Fairlie with this title in which he quotes my the spirit, if not the letter, of the prohibition conclusions published in THE LANCET in 1908. He against such advertisement- is infringed by their mentions that I pointed out that no form of£ names appearing, however little on their own stimulant should be given previous to or during the initiative, in this broadcast trade circular. He also quotes me as course of an operation. From time to time we find some struggling that ether should be given as an anaesthetic. stating doctor accused of conduct infamous in a proHe then states that to his mind these statements fessional sense because he has " placed his goods in are quite contradictory, for while disapproving of the windowin some much more obscure manner, ether as a stimulant I recommend it as an anaesand I fail to see that the conduct is any less " thetic on account of the fact that it is a stimulant." infamous professionally because the goods of these " Now, in mypaper, I laid careful stress upon the fact more or less eminent specialists" are placed in that ether should not be given because it is a the window for them by someone else. Personally, but in spite of it as it is less toxic than stimulant, I think the attention of the Censors of the Colleges chloroform. My actual words were : " The absence should be called to this particular advertisement, of shock is not in these cases due to any stimulating and hope, Sir, that your inserting this letter in effect of the drug [ether], for, as has been pointed THE LANCET may have that effect. I enclose my out, when shock is present the centres fail to react Yours faithfully, card, and am, Sir, to any form of stimulant. In fact, stimulants only F.R.C.P. Feb. 26th, 1914. further exhaust the centres and aggravate the ,* A meeting of the medical men concerned has been condition." I am, Sir, yours faithfully, summoned, we are informed, when their course will be ALBERT J. WALTON. I do not
decided
upon.-ED.
L.
EXTERNAL MALLEOLUS. To the Editor of THE LANCET.
FRACTURE OF THE
SIR,-Dr. B. Whitchurch Howell asks in THE LANCET of Feb. 28th three questions in regard to the removal of the external malleolus when broken. They are easily answered :1. At present I only remove the malleolar fragment when it is displaced. 2. There is no sign of varus or valgus in the patients who have had the malleolus excised. 3. There is no evidence of displacement of the peronei tendons. The tendon sheaths keep them in I am, Sir, yours faithfully, position. JOHN BLAND-SUTTON. Brook-street, Grosvenor-square, W., Feb. 28th, 1914.
RADIOGRAPHY OF THE SELLA TURCICA. To the Editor of THE LANCET.
SIR,-At the last meeting of the ElectroTherapeutical Section of the Royal Society of Medicine consideration for the crowded state of the agenda list made me refrain from offering the following suggestion for centring the sella in the directly transverse rays from the tube. It will, I think, be more certain, as well as easier, than Mr. S. Gilbert Scott’s shot, or Dr. Finzi’s sixpences, while satisfying Dr. Parkes Weber’s requirements as to giving visible evidence on the plate itself that the centring has been properly done. Take two metal curtain rings of about 1½ inches in diameter, and to each attach two small strips Fix them by these strips in of adhesive plaster. the proper position with reference to each auditory meatus, and then arrange head and tube so that the screen shows the rings concentrically placed one apparently within the other. The central rays will A
Weymouth-street, W.,
Feb. 28th, 1914.
METHODS OF INCREASING THE ACCURACY AND DELICACY OF THE WASSERMANN REACTION. To the Editor of THE LANCET. Thiele and Dr. Embleton in a paper in SIR,-Dr. THE LANCET of Feb. 21st state their conclusion in antigens for that " the use of cholesterin the Wassermann reaction is not only unnecessary, but introduces a very serious source of error." These authors have allowed themselves to be led into a very rash and totally erroneous generalisation. The introduction of cholesterin into syphilitic antigens was originally advocated in a paper by myself along with Dr. Cruickshank and Dr. McKenzie.1 The statement of Dr. Thiele and Dr. Embleton as applied to our antigen, employed in the fashion which we recommended, is absolutely wrong. We showed that the introduction of cholesterin into an alcoholic solution of ox liver " lecithin greatly enhanced the antigenic power of the latter-i.e., the property of deviating complement in the presence of syphilitic serum, but had practically no effect on the inhibitory action of the antigen either by itself or in the presence of normal serum. In addition to providing a means of increasing the antigenic power of certain lipoid solutions by means of cholesterin, we were also enabled in this way to establish a new criterion for the detection of sera, which has proved valuable in conweak positive reactions. The original estimate of our method has been substantiated by nearly a dozen workers in the examination of over 3000 cases here and by other observers elsewhere. The value of the addition of cholesterin ......
"
Ifirming syphilitic 1
Journal of
Pathology
and
Bacteriology,
vol. xiv., 1910, p. 484.