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MISTAKES IN THE DIAGNOSIS OF INFECTIOUS DISEASES.
554 also at the same time greatly improve the general nervous condition of the patient. I have never had experience of any unpleasant or injurious effects resulting from the careful application of the high-frequency currents. It may be advisable here to remark that the treatment by high frequency currents should be intrusted to qualified medical practitioners only and that it is unwise and irregular for members of our profession in practice to send their patients for any form of electrical treatment to the various unrecognised electrical institutes which are advertised in the I am. Sirs. yours faithfullv. lav Dress. August 14th, 1905. W. F. SOMERVILLE, M.D. Glasg.
Glasgow,
SECONDARY FACTORS IN THE MORTALITY AND TRANSMISSIBILITY OF PULMONARY TUBERCULOSIS. To the Editors of THE LANCET. SIRS,—With regard to my preliminary note on Secondary Factors in the Mortality of Pulmonary Tuberculosis, of which you have kindly published a summary in your issue of July 8th, p 98, I beg to point out that in my last letter I must have left out the words
"
" after " pure culture and "healthy " before "pulmonary tissues"" in the wording of the aphorism which you have quoted and which should read : " That the tubercle bacillus in pure culture, per se, is incapable of developing in the healthy pulmonary tissues either the anatomical lesions or the clinical symptoms of confirmed pulmonary tuberculosis." I am. Sirs. vours faithfully. CARLOS J. FINLAY. Havana, July 21st, 1905.
"per
se
MISTAKES IN THE DIAGNOSIS OF INFECTIOUS DISEASES. To the Editors of THE LANCET. SIRS,-A few years before the lat small-pox epidemic I was called to see a man in South Hornsey, North London, suffering from ordinary febrile symptoma, plus a rash, just beginning to appear. The man had been working in St. John’s Wood. I diagnosed variola as probable and without waiting for any further development I had the man removed and isolated. The case turned out to be virulent small-pox and owing to my promptness the disease never spread to even a member of the family and was stamped out there and then. I risked the I’ mi,,take"and saved the ratepayers a large sum of money. For many years where children are swarming in any house and one is down with some supposed infectious disease, to save lives and to save the ratepayers, it has been my custom to have the patient removed within afeiv kO’1W8 after examination. I risk the" mistake," and if I am wrong in my opinion once in 15 times-about the average for each of us medical men-the saving to the community after deducting the cost of " mistakes ’’ must be enormous. Yesterday I was called to see a child, aged five years. Apparently typical scarlet fever. House full of children. Mother informs me, when I tell her I shall have her child removed in a few hours, that the boy has only just come home four days from the fever hospital convalescent from scarlet fever! I nevertheless act with my usual promptness and I risk the " erroragain to save both lives and the pockets of the already over-burdened ratepayers. In a few hours the child was once again back in his old hospital. If medical men, through these grossly unjust remarks about their mistakes, will stand, in future, on their rights and wait till the disease is fully developed and infection has spread, instead of a los to the ratepayers of ,c12,OOO the reckoning will be nearer £120,000. I calculate that after deducting the cost of my mistakes " the various parishes that I have to do with have been saved at least £10,000 by
must take ezoeption to his statement that effervescent baths can be equally well applied at home. The natural waters containing bicarbonate of iron, calcium and sodium chlorides, &.c., are capable of -holding a much larger proportion of carbonic acid gas than those artificial waters where the 002’has been dissolved by pressure, as in the natural waters the gas has been under pressure for some considerable time. This can :be proved by the fact that a bottle of soda water when opened soon loses its CO2 under normal atmospheric pressure alone and if heat be subsequently applied very little more gas can be driven off. On the contrary, if a natural gaseous water be exposed to the air the greater proportion of CO, can only be driven off by the, . aid of heat. I have lately returned from a visit ’to Spa, Belgium, where there exists an ideal supply of effervescent ferruginous water which is brought to the bath house by a conduit and supplied directly to the various baths and when heated by means of steam the quantity of CO, driven off is Whilst at Spa I was shown over the establishenormous. ment and purposely picked out indiscriminately four different baths and found the effects identical in all. Dr. Williams mentions Nauheim as the pioneer with its long 24 hours’ journey, truly an undertaking not lightly to be considered by a cardiopath, Royat, Contrexéville, and many others equally far distant, but he has altogether omitted any mention of the town of Spa itself in Belgium, only 11 hours from London and reached by a very comfortable route where the treatment is receiving the greatest attention in a most luxurious establishment fitted with all the latest appliances. The climate, unlike Nauheim, is perfection, with bracing air, and the town, facing south, is particularly well sheltered by surrounding hills where delightful scenery abounds; and lastly, the mental comfort of the patient is catered for by excellent arrangements of concerts, race meetings, and a hundred other amusements.
arguments I
T am Sirs
I
Stony Stratford, August
8th, 1905.
vours J ---
fn.ithfn1Iv P. LAKE HOPE.
A POSSIBLE CAUSE OF CHLOROFORM FATALITIES. To the Editors of THE LANCET.
SIRS,—Some time since, when seeking for tests whereby organo-therapeutic substances might be recognised, I found that some of them had an extraordinary power of decomposing chloroform when in solution, chlorine gas becoming rapidly evolved. In the recently published report of Merck Trillat ascribes a similar property to many organic substances, and it is suggested that as the dangerous body phosgene is formed by the contact of chloroform with the
human skin it may also arise from contact with the mucous membranes in certain conditions. It seems probable then that in such circumstances the mucous membrane of the respiratory tract may have the power of decomposing chloroform, and where chlorine gas is liberated a fatal result is not to be wondered at. I am, Sirs, yours faithfully.
J. C. MCWALTER, August 12th, 1905.
F.F.P.&S. Glasg., M.D. Brux.
MIDGES.
To the Editors of THE LANCET. this SIRS,—At holiday season I should be grateful if you ’ would allow me some space in your columns to elicit the opinions of your readers about midges and their bites. These small pests seem to be particularly active this year and their " bites certainly give rise to an immense amount of oedema and irritation. I have seen people, both men and women, Your humble servant with swellings on their ankles, wrists, and neck just above the collar, varying in size from a hazel-nut to a walnut. CONSTABLE. Endymion-road, N., August Has the nature of the poison injected by these insects ever been worked out? Is there anything which will keep them THE SPA TREATMENT OF CIRCULATORY away short of a thick coating of grease, which is impossible in this land ? And can anything be done to lessen the DISORDERS. irritation, which in my own case lasts for about a week? I 10 the Editors of THE LANCET. might add that I myself am not particularly susceptible to SIRS,—I have read with great pleasure the long and able insect bites. Although I have travelled a good deal in the article by Dr. Leonard Williams on the Spa Treatment of East, mosquitoes, bugs, and lice never gave me any trouble. I am, Sirs, yours faithfully, Circulatory Disorders in THE LANCET of August 5th, p. 347, and whilst agreeing with him in the main points of his M.D. August 15th, 1905.
15th, 1905. SAML.
Glasgow,
SECONDARY FACTORS IN THE MORTALITY AND TRANSMISSIBILITY OF PULMONARY TUBERCULOSIS. To the Editors of THE LANCET. SIRS,—With regard to my preliminary note on Secondary Factors in the Mortality of Pulmonary Tuberculosis, of which you have kindly published a summary in your issue of July 8th, p 98, I beg to point out that in my last letter I must have left out the words
"
" after " pure culture and "healthy " before "pulmonary tissues"" in the wording of the aphorism which you have quoted and which should read : " That the tubercle bacillus in pure culture, per se, is incapable of developing in the healthy pulmonary tissues either the anatomical lesions or the clinical symptoms of confirmed pulmonary tuberculosis." I am. Sirs. vours faithfully. CARLOS J. FINLAY. Havana, July 21st, 1905.
"per
se
MISTAKES IN THE DIAGNOSIS OF INFECTIOUS DISEASES. To the Editors of THE LANCET. SIRS,-A few years before the lat small-pox epidemic I was called to see a man in South Hornsey, North London, suffering from ordinary febrile symptoma, plus a rash, just beginning to appear. The man had been working in St. John’s Wood. I diagnosed variola as probable and without waiting for any further development I had the man removed and isolated. The case turned out to be virulent small-pox and owing to my promptness the disease never spread to even a member of the family and was stamped out there and then. I risked the I’ mi,,take"and saved the ratepayers a large sum of money. For many years where children are swarming in any house and one is down with some supposed infectious disease, to save lives and to save the ratepayers, it has been my custom to have the patient removed within afeiv kO’1W8 after examination. I risk the" mistake," and if I am wrong in my opinion once in 15 times-about the average for each of us medical men-the saving to the community after deducting the cost of " mistakes ’’ must be enormous. Yesterday I was called to see a child, aged five years. Apparently typical scarlet fever. House full of children. Mother informs me, when I tell her I shall have her child removed in a few hours, that the boy has only just come home four days from the fever hospital convalescent from scarlet fever! I nevertheless act with my usual promptness and I risk the " erroragain to save both lives and the pockets of the already over-burdened ratepayers. In a few hours the child was once again back in his old hospital. If medical men, through these grossly unjust remarks about their mistakes, will stand, in future, on their rights and wait till the disease is fully developed and infection has spread, instead of a los to the ratepayers of ,c12,OOO the reckoning will be nearer £120,000. I calculate that after deducting the cost of my mistakes " the various parishes that I have to do with have been saved at least £10,000 by
must take ezoeption to his statement that effervescent baths can be equally well applied at home. The natural waters containing bicarbonate of iron, calcium and sodium chlorides, &.c., are capable of -holding a much larger proportion of carbonic acid gas than those artificial waters where the 002’has been dissolved by pressure, as in the natural waters the gas has been under pressure for some considerable time. This can :be proved by the fact that a bottle of soda water when opened soon loses its CO2 under normal atmospheric pressure alone and if heat be subsequently applied very little more gas can be driven off. On the contrary, if a natural gaseous water be exposed to the air the greater proportion of CO, can only be driven off by the, . aid of heat. I have lately returned from a visit ’to Spa, Belgium, where there exists an ideal supply of effervescent ferruginous water which is brought to the bath house by a conduit and supplied directly to the various baths and when heated by means of steam the quantity of CO, driven off is Whilst at Spa I was shown over the establishenormous. ment and purposely picked out indiscriminately four different baths and found the effects identical in all. Dr. Williams mentions Nauheim as the pioneer with its long 24 hours’ journey, truly an undertaking not lightly to be considered by a cardiopath, Royat, Contrexéville, and many others equally far distant, but he has altogether omitted any mention of the town of Spa itself in Belgium, only 11 hours from London and reached by a very comfortable route where the treatment is receiving the greatest attention in a most luxurious establishment fitted with all the latest appliances. The climate, unlike Nauheim, is perfection, with bracing air, and the town, facing south, is particularly well sheltered by surrounding hills where delightful scenery abounds; and lastly, the mental comfort of the patient is catered for by excellent arrangements of concerts, race meetings, and a hundred other amusements.
arguments I
T am Sirs
I
Stony Stratford, August
8th, 1905.
vours J ---
fn.ithfn1Iv P. LAKE HOPE.
A POSSIBLE CAUSE OF CHLOROFORM FATALITIES. To the Editors of THE LANCET.
SIRS,—Some time since, when seeking for tests whereby organo-therapeutic substances might be recognised, I found that some of them had an extraordinary power of decomposing chloroform when in solution, chlorine gas becoming rapidly evolved. In the recently published report of Merck Trillat ascribes a similar property to many organic substances, and it is suggested that as the dangerous body phosgene is formed by the contact of chloroform with the
human skin it may also arise from contact with the mucous membranes in certain conditions. It seems probable then that in such circumstances the mucous membrane of the respiratory tract may have the power of decomposing chloroform, and where chlorine gas is liberated a fatal result is not to be wondered at. I am, Sirs, yours faithfully.
J. C. MCWALTER, August 12th, 1905.
F.F.P.&S. Glasg., M.D. Brux.
MIDGES.
To the Editors of THE LANCET. this SIRS,—At holiday season I should be grateful if you ’ would allow me some space in your columns to elicit the opinions of your readers about midges and their bites. These small pests seem to be particularly active this year and their " bites certainly give rise to an immense amount of oedema and irritation. I have seen people, both men and women, Your humble servant with swellings on their ankles, wrists, and neck just above the collar, varying in size from a hazel-nut to a walnut. CONSTABLE. Endymion-road, N., August Has the nature of the poison injected by these insects ever been worked out? Is there anything which will keep them THE SPA TREATMENT OF CIRCULATORY away short of a thick coating of grease, which is impossible in this land ? And can anything be done to lessen the DISORDERS. irritation, which in my own case lasts for about a week? I 10 the Editors of THE LANCET. might add that I myself am not particularly susceptible to SIRS,—I have read with great pleasure the long and able insect bites. Although I have travelled a good deal in the article by Dr. Leonard Williams on the Spa Treatment of East, mosquitoes, bugs, and lice never gave me any trouble. I am, Sirs, yours faithfully, Circulatory Disorders in THE LANCET of August 5th, p. 347, and whilst agreeing with him in the main points of his M.D. August 15th, 1905.
15th, 1905. SAML.