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NOTE ON THE INFLUENCE OF DEFLECTION OF THE NASAL SEPTUM ON THE SINGING VOICE.
705 we read Dr. Kirk’s letter my son and I were " quite ignorant of the existence"of his "buried" paper. I also repeat my original statement, that I was induced to use picric acid as a test for albuThe suggestion was first men by my son’s suggestion. made several years ago, and from time to time it was repeated ; but it was not until about two years ago that I began to act upon it, and I have now to express my regret that I did not sooner recognise the value of the test. It was not until I had ascertained by numerous trials that a saturated aqueous solution is a most delicate and therefore valuable test for minute traces of albumen, and that the powder may advantageously be substituted for nitric acid in a pocket test case, that I felt called upon to publish my experience of its use. If Dr. Kirk will refer again to what he is pleaqed to call "some jubilant remarks" in the British Medical Journal of March 17th, he will find that the short article in question relates mainly to my account of sugar testing and analysis by picric acid and potash. Perhaps, however, he considers that his paper published two years ago entitles him to the credit of all that has been done with picric acid as a clinical test both before and since the publication in question. I am, Sir, yours faithfully, GEORGE JOHNSON. Savilerow, April 16th, 1883.
to say that until
INTRA-PERITONEAL INJECTIONS IN CASES OF POISONING.
To the Editor of THE LANCET. SIR,—It would, I think, be difficult to over-estimate the value of Dr. Ringer’s suggestion, that the injection of saline solutions should be resorted to in cases of poisoning. It is generally supposed that the introduction of fluids into the peritoneal cavity is an operation attended with considerable risk, but the experimental observations of Ponfick and of Bizzozero and Golgi have shown that defibrinated blood can be injected into the abdomen with little or no danger. Ponfick relates that in one case 250 grammes of blood were transfused, in another 350, and in a third 220 grammes. The results were most satisfactory, the only unfavourable symptoms being a little tenderness of the abdomen and a slight and transitory elevation of temperature. Recently, I have had occasion to resort to intra-peritoneal injection six times, and in four instances I have used Ringer’s solution with much benefit. The only apparatus employed was the cannula of the aspirator, attached to a pce of indiarubber tubing, the fluid, warmed to the temperature of the body, being allowed to run in by syphon action. The cannula was pushed through the abdominal "A NEW OPERATION FOR CATARACT." wall on one side, no special antiseptic precautions being To the Editor of THE LANCET. The first injection measured 500cc., or about taken. ounces, the second half that quantity, and the third SIR,-I have read with much pleasure Dr. Bell Taylor’s fifteen 600cc. In a case of peritonitis in a child, serous fluid to the letter in your issue ofthe7th inst., which bears out the fact amount of 320cc. was drawn off by the aspirator, and the I had already pointed out, that was then washed out with 400 cc. of the salt peritoneum " the so-called new operation" solution. The temperature on the following day rose to for cataract had been frequently 102°, but with this exception there were no unfavourable performed in this country. My symptoms. In cases of emergency it may not be practicable to prepare present object, however, inwriting solution in exact accordance with his directions; Ringer’s is to show that the difficulties but the formula, which is almost identical with following experienced by Dr. Bell Taylor that recommended by him, can be quickly dispensed :— have also been shared by myself, Common salt, one drachm ; bicarbonate of soda, four grains ; and led me some five years ago to chloride of calcium, three grains; chloride of potassium, have constructed by Messrs. Weiss one grain; water, twenty ounces, at a temperature of 100° F. This may be used either for intra-venous or intraand Co. a knife, to which Dr. Taylor’s, as figured in THE LANCET peritonealI injection. am, Sir, your obedient servant, of April 7th, bears many points of WILLIAM MURRELL, M.D. resemblance. In my instrument, Weymouth-street, W., April, 1883. of a little screw at means the by end of the handle, the blade can be set at any angle to the handle, NOTE ON THE INFLUENCE OF DEFLECTION and thus the right hand can be OF THE NASAL SEPTUM ON THE used for operating upon the left SINGING VOICE. One knife, eye from behind. for is To the Editor of THE LANCET. therefore, only necessary A structural diffieither eye. of the American Laryngological SIR,—At the last culty, however, sometimes renders Society (Archives ofmeeting Jan. 1883), in the course Laryngology, the use of the knife impossible " of a on The discussion for the left eye, and that is want lengthy Singing Voice, its Physioof space between the inner margin logy, Pathology, and Treatment," the question of the inof the cornea and the bridge of tiuence of deflection of the nasal septum on the tone and the nose, and this difficulty of quality of the voice was raised, and some difference of opinion course becomes greater in proporof the tion to the length knife’s was expressed whether any alteration was produced by the blade. I find on measurement deflection, and whether any improvement was the result of that the length of the blade in the reposition of the septum and the consequent restoration Dr. Taylor’s knife is a little over of free nasal respiration. In all the cases that have come one inch and a quarter, and as under my care the voice has been impaired, and considerable the average distance between the improvement has been the result of treatment ; but I would inner margin of the cornea and more particularly refer to the case of a gentleman whose the bridge of the nose is scarcely septum I straightened about a year ago. He had suffered more than one inch, it would be from obstructed respiration in the affected nostril as long as impossible in many cases to intro- he could remember, and for the last few years had been quite duce the point of the knife into unable to sing. The septum, which was strongly bent to the cornea without considerable the right side, was forcibly straightened, the septal cartilage outward rotation of the globe. being at the same time divided in a stellar manner by means To obviate this difficulty, the of a tenotome to overcome its resiliency, and maintained in blade of my knife is made a position by retentive apparatus. The improvement in this little under one inch in length. case was most marked. The nasal intonation was lost, and Still I meet with many cases in he tells me that he is now able to sing with pleasure, and which it is difficult to use it, and I think it might be further that his friends consider that he has a very good voice. shortened with I am, Sir, your obedient servant, I am, Sir, yours &c., W. J. WALSHAM, F.R.C.S. C. S. JEAFFRESON. Newcastle-on-Tyne, April 10th, 1883. Weymouth-atreet, W., April, 1883. -
advantage.
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to say that until
INTRA-PERITONEAL INJECTIONS IN CASES OF POISONING.
To the Editor of THE LANCET. SIR,—It would, I think, be difficult to over-estimate the value of Dr. Ringer’s suggestion, that the injection of saline solutions should be resorted to in cases of poisoning. It is generally supposed that the introduction of fluids into the peritoneal cavity is an operation attended with considerable risk, but the experimental observations of Ponfick and of Bizzozero and Golgi have shown that defibrinated blood can be injected into the abdomen with little or no danger. Ponfick relates that in one case 250 grammes of blood were transfused, in another 350, and in a third 220 grammes. The results were most satisfactory, the only unfavourable symptoms being a little tenderness of the abdomen and a slight and transitory elevation of temperature. Recently, I have had occasion to resort to intra-peritoneal injection six times, and in four instances I have used Ringer’s solution with much benefit. The only apparatus employed was the cannula of the aspirator, attached to a pce of indiarubber tubing, the fluid, warmed to the temperature of the body, being allowed to run in by syphon action. The cannula was pushed through the abdominal "A NEW OPERATION FOR CATARACT." wall on one side, no special antiseptic precautions being To the Editor of THE LANCET. The first injection measured 500cc., or about taken. ounces, the second half that quantity, and the third SIR,-I have read with much pleasure Dr. Bell Taylor’s fifteen 600cc. In a case of peritonitis in a child, serous fluid to the letter in your issue ofthe7th inst., which bears out the fact amount of 320cc. was drawn off by the aspirator, and the I had already pointed out, that was then washed out with 400 cc. of the salt peritoneum " the so-called new operation" solution. The temperature on the following day rose to for cataract had been frequently 102°, but with this exception there were no unfavourable performed in this country. My symptoms. In cases of emergency it may not be practicable to prepare present object, however, inwriting solution in exact accordance with his directions; Ringer’s is to show that the difficulties but the formula, which is almost identical with following experienced by Dr. Bell Taylor that recommended by him, can be quickly dispensed :— have also been shared by myself, Common salt, one drachm ; bicarbonate of soda, four grains ; and led me some five years ago to chloride of calcium, three grains; chloride of potassium, have constructed by Messrs. Weiss one grain; water, twenty ounces, at a temperature of 100° F. This may be used either for intra-venous or intraand Co. a knife, to which Dr. Taylor’s, as figured in THE LANCET peritonealI injection. am, Sir, your obedient servant, of April 7th, bears many points of WILLIAM MURRELL, M.D. resemblance. In my instrument, Weymouth-street, W., April, 1883. of a little screw at means the by end of the handle, the blade can be set at any angle to the handle, NOTE ON THE INFLUENCE OF DEFLECTION and thus the right hand can be OF THE NASAL SEPTUM ON THE used for operating upon the left SINGING VOICE. One knife, eye from behind. for is To the Editor of THE LANCET. therefore, only necessary A structural diffieither eye. of the American Laryngological SIR,—At the last culty, however, sometimes renders Society (Archives ofmeeting Jan. 1883), in the course Laryngology, the use of the knife impossible " of a on The discussion for the left eye, and that is want lengthy Singing Voice, its Physioof space between the inner margin logy, Pathology, and Treatment," the question of the inof the cornea and the bridge of tiuence of deflection of the nasal septum on the tone and the nose, and this difficulty of quality of the voice was raised, and some difference of opinion course becomes greater in proporof the tion to the length knife’s was expressed whether any alteration was produced by the blade. I find on measurement deflection, and whether any improvement was the result of that the length of the blade in the reposition of the septum and the consequent restoration Dr. Taylor’s knife is a little over of free nasal respiration. In all the cases that have come one inch and a quarter, and as under my care the voice has been impaired, and considerable the average distance between the improvement has been the result of treatment ; but I would inner margin of the cornea and more particularly refer to the case of a gentleman whose the bridge of the nose is scarcely septum I straightened about a year ago. He had suffered more than one inch, it would be from obstructed respiration in the affected nostril as long as impossible in many cases to intro- he could remember, and for the last few years had been quite duce the point of the knife into unable to sing. The septum, which was strongly bent to the cornea without considerable the right side, was forcibly straightened, the septal cartilage outward rotation of the globe. being at the same time divided in a stellar manner by means To obviate this difficulty, the of a tenotome to overcome its resiliency, and maintained in blade of my knife is made a position by retentive apparatus. The improvement in this little under one inch in length. case was most marked. The nasal intonation was lost, and Still I meet with many cases in he tells me that he is now able to sing with pleasure, and which it is difficult to use it, and I think it might be further that his friends consider that he has a very good voice. shortened with I am, Sir, your obedient servant, I am, Sir, yours &c., W. J. WALSHAM, F.R.C.S. C. S. JEAFFRESON. Newcastle-on-Tyne, April 10th, 1883. Weymouth-atreet, W., April, 1883. -
advantage.
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