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GASTROSCOPY.
342 examination of the patient. The passage of the instrument is made with the patient in the position of left lateral decubitus, local anaesthesia is employed, and a guiding thread is first swallowed by the patient. " Ne quid nimis." After detailing the technique necessary to obtain an view of the greater part of the stomach, adequate PRACTITIONERS AND DANGEROUS DRUGS. the author points out the value of the method for EFFECT has now been given to the recommenda- studying recent peptic ulcers and for identifying early malignant growths. As regards the latter, he tion, made by the Departmental Committee on notes the disappointment that must result from the Morphine and Heroin Addiction, that a medical fact that patients experience symptoms so late that tribunal should be set up to consider the case of most accurate means of diagnosis early even the by medical practitioners addicted to drugs or supplying In the study of them for purposes of addiction. As already fore- cancer will rarely be discovered. true gastritis the instrument holds out hope of this tribunal is to consist of three medical shadowed,l in our knowledge, for it is only when direct - practitioners, assisted by a legal assessor, and as progress from July 29th last the Home Secretary is no longer vision is added to our armamentarium that we can for any real advance concerning this disease. " obliged to chase an offending doctor into the police- hope Dr. Rachet concludes, " appears to Gastroscopy," court in order to obtain the withdrawal of his authority to supply and possess habit-forming drugs. It was be a method promising rich results ; but it requires the feeling of the Departmental Committee that a great prudence and much further research to establish tribunal with a strong medical element would serve its’final value. It should in no case supplant other the double purpose of protecting from himself a means of investigation, and it is by the accumulation doctor who had unfortunately become a drug addict of clinical facts that it will acquire its right to be .and protecting his patients by preventing him from quoted as a first-class means of examining cases prescribing dangerous drugs in excess. The new of digestivedisturbance." Regulations will achieve this purpose and at the same time avoid unseemly publicity in a distressing MEDIÆVAL MEDICINE. but happily very small class of cases. The other AN excellent epitome has been made from the four Regulations which came into force on the same date of Mr. R. T. Gunther’s make it an offence for a person to go to a second volumes already published doctor for a supply or prescription of habit-forming larger work, " Early Science in Oxford," in order that a large number of students for whom the cost of drugs unless he first discloses that he has been receiv- the original book was prohibitive may have an treatment from another ing practitioner. Doctors, of studying some of the subjects therein opportunity dentists, and veterinary surgeons are now required mentioned. The present workl is in seven chapters - to keep records of all supplies of dangerous drugs with Early Medicine, Medicine dealing respectively or obtained whether or not by them, purchased they
Annotations.
dispense or otherwise supply the drugs. Copies of these Regulations, amending the Dangerous Drug -Regulations of 1921, are obtainable from H.M. Stationery Office..
Century and After, Anatomy, Physiology, Zoology, Botany, and Geology. The book is of a size handy to read, admirably printed, has many illustrations, and is altogether delightful. Mr. Gunther has a wonderful flair for extracting
in the Seventeenth
gems from the various ancient mines in which he has been working, and many of them show how true is the aphorism that there is nothing new under the For instance, the following excerpt, taken sun. from the diaries of one Simon Forman (1552-1611), of Magdalen College, puts modern professors of rejuvenation in the shade : " and myselfe did boill 2 snakes in my strong water when I distilled it and after I drank of that water and yt made me to be fresh and take away all my gray hairs when I was 56 yers old and many toke me not to be above 40 or 42." Another would, if he reads it, make Sir Arthur Conan Doyle extremely envious. It concerns a Fellow of Trinity, by name Th. Allen (1542-1632), noted for his skill in mathematics and astrology. The vulgar looked upon him as a magician and his servitor would tell them " that he met the spirits coming up the stairs like bees." Few outside the medical profession, or we might even say within it, know that the architect of St. Paul’s was the same Dr. Christopher Wren, Fellow of All Souls, to whom are due the beautiful anatomical drawings in illustration of Willis’s work on the brain, and that he was also gastric examination ;-, it occupies a position in the the originator of intravenous injections. The dismeans at our disposal after radiographic examination covery of a method of injecting bodies with a solidibut before laparotomy. Gastroscopy demands the fying fluid is due to Boyle, as also the method of .exercise of the greatest prudence, the greatest keeping moist anatomical preparations in spirit. - patience, and the greatest gentleness. The method Richard Lower, a pupil of Willis, studied the anatomy cannot be looked upon as an everyday means of of the heart (1669) and left some accurate drawings investigation and should remain in the hands of showing the spiral arrangement of the muscular fibres, experts trained in its use. The safety of its employ- a fact almost forgotten until its revival by Pettigrew. ment must not be sacrificed even for the benefit of Robert Hooke, of Christ Church (1635-1702), who It is impossible with a gastroscope to was not only a skilled microscopist but an archiprogress. explore the whole of the stomach and consequently tect of no mean talents (he built the new buildings a negative finding does not permit of the exclusion of Bethlehem Hospital in 1675), was the first to record of organic disease. A straight, rigid gastroscope for that the blue colour in a peacock’s tail has no real a texture visible under the indirect vision is advocated by Dr. Rachet, and he existence, but is due to insists on the importance of scrupulous preliminary microscope "-i.e., is due to interference, though,
GASTROSCOPY. THERE is significance in the fact that endoscopic ’.examination of the stomach was being attempted in London before the war, whereas to-day the practice is so rare as to be almost unknown. The difficulties and dangers of the procedure have caused it to fall into ’abeyance. Nevertheless, it is still employed quite frequently both in Germany and in Austria, "and it seems clear that -if it could be brought to ,a more perfect state of technique it would be of the utmost importance both in diagnosis and for watching the effects- of treatment. When we realise the ,immense issues determined by the examination of an X ray shadow the potential value of a direct view of the gastric mucosa is apparent. Stimulated by such views Dr. Jean Rachet,2 working with Dr. Bensaude at the Hopital Saint-Antoine in Paris, has recently published a study of his clinical and experimental observations with this instrument. The modesty and-logic of his conclusions are such that we feel them worthy of reproduction here. Gastroscopy must remain an exceptional method of -
"
1 THE LANCET, June 19th, p. 1218. 2 La Gastroscopie. By Dr. Jean Rachet. Paris : 1926. Pp. 117. Fr.20.
Doin.
Octave
1 Early Medical and Biological Science ; extracted from Early Science in Oxford, by R. T. Gunther, M.A., LL.D. Oxford University Press, Humphrey Milford. 1926. Pp. 246. 7s. 6d.
Annotations.
dispense or otherwise supply the drugs. Copies of these Regulations, amending the Dangerous Drug -Regulations of 1921, are obtainable from H.M. Stationery Office..
Century and After, Anatomy, Physiology, Zoology, Botany, and Geology. The book is of a size handy to read, admirably printed, has many illustrations, and is altogether delightful. Mr. Gunther has a wonderful flair for extracting
in the Seventeenth
gems from the various ancient mines in which he has been working, and many of them show how true is the aphorism that there is nothing new under the For instance, the following excerpt, taken sun. from the diaries of one Simon Forman (1552-1611), of Magdalen College, puts modern professors of rejuvenation in the shade : " and myselfe did boill 2 snakes in my strong water when I distilled it and after I drank of that water and yt made me to be fresh and take away all my gray hairs when I was 56 yers old and many toke me not to be above 40 or 42." Another would, if he reads it, make Sir Arthur Conan Doyle extremely envious. It concerns a Fellow of Trinity, by name Th. Allen (1542-1632), noted for his skill in mathematics and astrology. The vulgar looked upon him as a magician and his servitor would tell them " that he met the spirits coming up the stairs like bees." Few outside the medical profession, or we might even say within it, know that the architect of St. Paul’s was the same Dr. Christopher Wren, Fellow of All Souls, to whom are due the beautiful anatomical drawings in illustration of Willis’s work on the brain, and that he was also gastric examination ;-, it occupies a position in the the originator of intravenous injections. The dismeans at our disposal after radiographic examination covery of a method of injecting bodies with a solidibut before laparotomy. Gastroscopy demands the fying fluid is due to Boyle, as also the method of .exercise of the greatest prudence, the greatest keeping moist anatomical preparations in spirit. - patience, and the greatest gentleness. The method Richard Lower, a pupil of Willis, studied the anatomy cannot be looked upon as an everyday means of of the heart (1669) and left some accurate drawings investigation and should remain in the hands of showing the spiral arrangement of the muscular fibres, experts trained in its use. The safety of its employ- a fact almost forgotten until its revival by Pettigrew. ment must not be sacrificed even for the benefit of Robert Hooke, of Christ Church (1635-1702), who It is impossible with a gastroscope to was not only a skilled microscopist but an archiprogress. explore the whole of the stomach and consequently tect of no mean talents (he built the new buildings a negative finding does not permit of the exclusion of Bethlehem Hospital in 1675), was the first to record of organic disease. A straight, rigid gastroscope for that the blue colour in a peacock’s tail has no real a texture visible under the indirect vision is advocated by Dr. Rachet, and he existence, but is due to insists on the importance of scrupulous preliminary microscope "-i.e., is due to interference, though,
GASTROSCOPY. THERE is significance in the fact that endoscopic ’.examination of the stomach was being attempted in London before the war, whereas to-day the practice is so rare as to be almost unknown. The difficulties and dangers of the procedure have caused it to fall into ’abeyance. Nevertheless, it is still employed quite frequently both in Germany and in Austria, "and it seems clear that -if it could be brought to ,a more perfect state of technique it would be of the utmost importance both in diagnosis and for watching the effects- of treatment. When we realise the ,immense issues determined by the examination of an X ray shadow the potential value of a direct view of the gastric mucosa is apparent. Stimulated by such views Dr. Jean Rachet,2 working with Dr. Bensaude at the Hopital Saint-Antoine in Paris, has recently published a study of his clinical and experimental observations with this instrument. The modesty and-logic of his conclusions are such that we feel them worthy of reproduction here. Gastroscopy must remain an exceptional method of -
"
1 THE LANCET, June 19th, p. 1218. 2 La Gastroscopie. By Dr. Jean Rachet. Paris : 1926. Pp. 117. Fr.20.
Doin.
Octave
1 Early Medical and Biological Science ; extracted from Early Science in Oxford, by R. T. Gunther, M.A., LL.D. Oxford University Press, Humphrey Milford. 1926. Pp. 246. 7s. 6d.