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MODERN VIEWS ON RESPIRATION
374 that though enough oxygen was usually in nitrous oxide anaesthesia to provide the needs of the body, the tension of oxygen in the blood was definitely lowered when cyanosis was present and this had an adverse effect on all tissues. I also referred to the work of Ward and myself on the electrocardiographic changes in nitrous oxide anaesthesia in which we showed that the development of anoxaemia was frequently accompanied by changes in the electrical record suggestive of considerable functional disturbance. I am, Sir, yours faithfully, SAMSON WRIGHT.
clinical state improves and rectal pyrexia vanishes." If the treatment which I advocate had in reality damaged the rectal mucous membrane, as Dr. Hurst suggests, how could the clinical state possibly become completely healthy, pyrexia disappear, and the result of lavage clean and normalI Two pints of barium may, at times, reach the caecum when given for diagnostic X ray. But this does not alter the fact that four or five pints of solution may be necessary effectually to clear the csecum ; less than this may fail to effect cure. As regards the administration, at present the question seems to be treated as a matter of nursing, whereas it is in reality a procedure requiring specialised knowledge both on the part of the medical man and his assistants. I am, Sir, yours faithfully, HENRY W. HALES.
out
was
present
Department of Physiology, Middlesex Hospital Medical School, Feb, 12th, 1934.
LOCAL ANÆSTHESIA FOR ABDOMINAL OPERATIONS
Portland-place, W., Feb. 12th, 1934.
To the Editor A
QUESTION OF NEGLIGENCE To the Editor
SIR,-On returning a few days ago from the country a friend of mine in the West End found her cook-housekeeper looking ill and complaining of a pain in her back. She sent her to bed and asked her panel doctor to call. He did so, was very offhand and said her temperature was normal, but he would call next day. When he did so he again took her temperature, said it was normal, prescribed, and told
profession. Is this
an
argument against
the
adoption
of
a
National Medical Service Ithink it,is. I am, Sir, yours faithfully, LEONARD MOLLOY.
Monte Carlo, Feb. 7th, 1934.
no
such tribunal for the
MODERN VIEWS
ON RESPIRATION
non-
panel doctor.-ED. L. To the Editor
months I have used the method in suitable cases, for partial gastrectomy and for certain intestinal obstructions. The anaesthesia and the relaxation are very satisfactory. It does not appear to be necessary to remove the fluid at the end of the operation for I have not experienced any harmful effect by leaving it. I am, Sir, yours faithfully, T. G. I. JAMES. London, N.W., Feb. 13th, 1934.
notably
.
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED FEB. 3RD, 1934
Not2fccations.-The following cases of infectious disease were notified during the week : Small-pox, 8 (last week 9) ; scarlet fever, 3348 ; diphtheria, 1415; enteric fever, 15; acute pneumonia (primary or
puerperal fever, 48 ; puerperal cerebro-spinal fever, 32 ; acute acute polio-encephalitis, 2 ; encepha11 ; dysentery, 23 ; ophthalmia No case of cholera, plague, or typhus fever was notified during the week.
influenzal), 1335 pyrexia, 128 ; poliomyelitis, 6 ; litis lethargica, neonatorum, 80.
;
The number of cases in the Infectious Hospitals of the London County Council on Feb. 6th-7th was as follows : Small-pox, 36 (last week 24) ; scarlet fever, 2068 ; diphtheria, 2058 ; enteric fever, 7 ; measles, 1473 ; whooping-cough, 319 ; puerperalfever, 29 mothers (plus 11 babies) ; encephalitis lethargica, 260 ; poliomyelitis, 4 ; " other diseases," 173. At St. Margaret’s Hospital there were 19 babies (plus 7 mothers) with ophthalmia neonatorum.
t
*** Under the National Insurance Acts there is .a, provision whereby aggrieved patients-or even interested people like employers with the consent of such patients-can have their grievances investigated by an impartial tribunal without cost to themselves. There is
THE LANCET
SiR,-The method of local anaesthesia for abdominal operations described by Mr. Bankoff in your issue of Feb. 10th (p. 287) is one of great practical value in circumstances where general or spinal ansesthesia is contra-indicated. During the past twelve
of THE LANCET
her she would soon be all right. After he had left my friend immediately took her temperature and found it to be over 101° F. She then sent for her own doctor, who also found the temperature over 101°, and said the woman was suffering from an acute attack of rheumatism. Next day the woman was admitted to St. Thomas’s Hospital where the diagnosis was confirmed, and where she is to remain for some weeks as her temperature continues high. Can anything be done to punish men who deal with their panel patients in this way ?z? To my mind such a man should be struck off the panel altogether and never be allowed on again, for having heard accounts as to how some of them perform their panel duties makes me fear that such instances are not uncommon. One is apt to think that the National Insurance Act has not been such a blessing to the patients as some people try to make out, and certainly it has had a deplorable effect on the prestige of our
of
of
THE LANCET
SIR,-In your report of my remarks at the section of anaesthetics of the Royal Society of Medicine last week (p. 298), I am erroneously quoted as having said that " prolonged oxygen lack in the administration of nitrous oxide did not do much harm as the oxygen need was small." What I actually pointed
Deaths.-In 118 great towns, including London, there was no death from small-pox, 2 (1) from enteric fever, 59 (13) from measles, 12 (2) from scarlet fever, 38 (9) from whooping-cough, 65 (17) from diphtheria, 34 (13) from diarrhoea and enteritis under two years, and 76 (15) from influenza. The figures in parentheses are those for London itself. The deaths from influenza during the past few weeks (working backwards) have been as follows : 76, 67, 87, 100, 109, 83, 97, 95, 70, 59. The 439 deaths during the first five weeks of the year compare with the 7136 deaths for the corresponding weeks of 1933. Eight deaths were this week attributed to influenza at Birmingham (4 at Glasgow), 3 each at Southgate, Leeds, and Warrington ; no more than 2 in any other great town. Eleven fatal cases of measles occurred at Leeds, 8 at Liverpool, 5 at Preston, and 3 at Southport. Whooping-cough was credited with 5 deaths at Liverpool, 4 at Manchester. Of the fatal cases of diphtheria 5 occurred at Manchester, 4 each at Hull and
Liverpool. The number of stillbirths notified during the week was 251 (corresponding to a rate of 40 per 1000 total births), including 30 in London.
clinical state improves and rectal pyrexia vanishes." If the treatment which I advocate had in reality damaged the rectal mucous membrane, as Dr. Hurst suggests, how could the clinical state possibly become completely healthy, pyrexia disappear, and the result of lavage clean and normalI Two pints of barium may, at times, reach the caecum when given for diagnostic X ray. But this does not alter the fact that four or five pints of solution may be necessary effectually to clear the csecum ; less than this may fail to effect cure. As regards the administration, at present the question seems to be treated as a matter of nursing, whereas it is in reality a procedure requiring specialised knowledge both on the part of the medical man and his assistants. I am, Sir, yours faithfully, HENRY W. HALES.
out
was
present
Department of Physiology, Middlesex Hospital Medical School, Feb, 12th, 1934.
LOCAL ANÆSTHESIA FOR ABDOMINAL OPERATIONS
Portland-place, W., Feb. 12th, 1934.
To the Editor A
QUESTION OF NEGLIGENCE To the Editor
SIR,-On returning a few days ago from the country a friend of mine in the West End found her cook-housekeeper looking ill and complaining of a pain in her back. She sent her to bed and asked her panel doctor to call. He did so, was very offhand and said her temperature was normal, but he would call next day. When he did so he again took her temperature, said it was normal, prescribed, and told
profession. Is this
an
argument against
the
adoption
of
a
National Medical Service Ithink it,is. I am, Sir, yours faithfully, LEONARD MOLLOY.
Monte Carlo, Feb. 7th, 1934.
no
such tribunal for the
MODERN VIEWS
ON RESPIRATION
non-
panel doctor.-ED. L. To the Editor
months I have used the method in suitable cases, for partial gastrectomy and for certain intestinal obstructions. The anaesthesia and the relaxation are very satisfactory. It does not appear to be necessary to remove the fluid at the end of the operation for I have not experienced any harmful effect by leaving it. I am, Sir, yours faithfully, T. G. I. JAMES. London, N.W., Feb. 13th, 1934.
notably
.
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED FEB. 3RD, 1934
Not2fccations.-The following cases of infectious disease were notified during the week : Small-pox, 8 (last week 9) ; scarlet fever, 3348 ; diphtheria, 1415; enteric fever, 15; acute pneumonia (primary or
puerperal fever, 48 ; puerperal cerebro-spinal fever, 32 ; acute acute polio-encephalitis, 2 ; encepha11 ; dysentery, 23 ; ophthalmia No case of cholera, plague, or typhus fever was notified during the week.
influenzal), 1335 pyrexia, 128 ; poliomyelitis, 6 ; litis lethargica, neonatorum, 80.
;
The number of cases in the Infectious Hospitals of the London County Council on Feb. 6th-7th was as follows : Small-pox, 36 (last week 24) ; scarlet fever, 2068 ; diphtheria, 2058 ; enteric fever, 7 ; measles, 1473 ; whooping-cough, 319 ; puerperalfever, 29 mothers (plus 11 babies) ; encephalitis lethargica, 260 ; poliomyelitis, 4 ; " other diseases," 173. At St. Margaret’s Hospital there were 19 babies (plus 7 mothers) with ophthalmia neonatorum.
t
*** Under the National Insurance Acts there is .a, provision whereby aggrieved patients-or even interested people like employers with the consent of such patients-can have their grievances investigated by an impartial tribunal without cost to themselves. There is
THE LANCET
SiR,-The method of local anaesthesia for abdominal operations described by Mr. Bankoff in your issue of Feb. 10th (p. 287) is one of great practical value in circumstances where general or spinal ansesthesia is contra-indicated. During the past twelve
of THE LANCET
her she would soon be all right. After he had left my friend immediately took her temperature and found it to be over 101° F. She then sent for her own doctor, who also found the temperature over 101°, and said the woman was suffering from an acute attack of rheumatism. Next day the woman was admitted to St. Thomas’s Hospital where the diagnosis was confirmed, and where she is to remain for some weeks as her temperature continues high. Can anything be done to punish men who deal with their panel patients in this way ?z? To my mind such a man should be struck off the panel altogether and never be allowed on again, for having heard accounts as to how some of them perform their panel duties makes me fear that such instances are not uncommon. One is apt to think that the National Insurance Act has not been such a blessing to the patients as some people try to make out, and certainly it has had a deplorable effect on the prestige of our
of
of
THE LANCET
SIR,-In your report of my remarks at the section of anaesthetics of the Royal Society of Medicine last week (p. 298), I am erroneously quoted as having said that " prolonged oxygen lack in the administration of nitrous oxide did not do much harm as the oxygen need was small." What I actually pointed
Deaths.-In 118 great towns, including London, there was no death from small-pox, 2 (1) from enteric fever, 59 (13) from measles, 12 (2) from scarlet fever, 38 (9) from whooping-cough, 65 (17) from diphtheria, 34 (13) from diarrhoea and enteritis under two years, and 76 (15) from influenza. The figures in parentheses are those for London itself. The deaths from influenza during the past few weeks (working backwards) have been as follows : 76, 67, 87, 100, 109, 83, 97, 95, 70, 59. The 439 deaths during the first five weeks of the year compare with the 7136 deaths for the corresponding weeks of 1933. Eight deaths were this week attributed to influenza at Birmingham (4 at Glasgow), 3 each at Southgate, Leeds, and Warrington ; no more than 2 in any other great town. Eleven fatal cases of measles occurred at Leeds, 8 at Liverpool, 5 at Preston, and 3 at Southport. Whooping-cough was credited with 5 deaths at Liverpool, 4 at Manchester. Of the fatal cases of diphtheria 5 occurred at Manchester, 4 each at Hull and
Liverpool. The number of stillbirths notified during the week was 251 (corresponding to a rate of 40 per 1000 total births), including 30 in London.