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OPERATIVE TREATMENT OF HYDROCELE.
THE STREPTOCOCCAL THEORY OF ACUTE RHEUMATISM.
770
anatomical basis for the different human capacities and individual talents." Considering these conflicting views, the information contained in my book should prove of value to every investigator, and should be read by every physician interested in the problem of the relation of mental activities to brain functions. And on this point, I am pleased to see, your reviewer seems to agree. I am, Sir, yours faithfully, BERNARD HOLLANDER. an
OPERATIVE TREATMENT OF HYDROCELE.
To the Editor
of THE
LANCET.
last issue (p. 680), Mr. Mooro calls attention to the value of the cautery in carrying out a radical operation for hydrocele of the tunica vaginalis. From my experience I agree with him that the procedure is well worth adopting. Most surgeons must have had experience of troublesome hsematomas forming after this operation has been carried out with the knife. However careful one is to use all ordinary methods of haemostasis they are liable to occur, especially in old-standing cases in which the sac is thickened. For the past four years when operating for hydrocele I have removed the parietal sac as a routine with the diathermy needle. I have also used the actual cautery in a few cases. If it is available, the diathermy cautery is extraordinarily convenient and easy to control, and involves no risk of damaging the body of the testis. With due care similar results are no doubt obtained with the actual cautery. I have several times observed considerable temporary swelling in the testicle following this operation, but not greater than is observed when the older method I am. Sir. vours faithfullv. is used. C. MAX PAGE.
giving a glimmer of hope that some new discovery as to its meaning may lead us a step nearer in our search for the truth, for a test, and even for a remedy. There may, perchance, be a cause of acute rheumatism unthought of and hidden from us, but I dare to write that streptococcal infection will always prove of interest in the history of this disease, and to think that it will prove to be the exciting cause. It would be grimly humorous to me if I believed that the streptococcal theory had ever lost interest in England; but too much practical work toward prevention of the disease has been done over these 30 years by those who have leaned to the streptococcal theory to make me either cynical or sad. I am, Sir, yours faithfully, F. JOHN POYNTON.
SIR,-In your
THE STREPTOCOCCAL THEORY OF ACUTE RHEUMATISM.
To the Editor
of THE
LANCET.
HEALTH OF MERCHANT SEAMEN.
To the Editor
of
THE LANCET.
SiR,-It was a grief to see mention in your last issue of the deaths of Sir William Simpson and Dr. W. F. Dearden, who were both anxious to improve the health of merchant seamen. Sir William Simpson had many other medical interests, through which he will be longer remembered, but he had the welfare of seamen at heart, and at various meetings said weighty words on their behalf. Dr. Dearden did a great deal at Manchester to direct attention to and to improve the conditions of their work. Younger men, interested in the hygiene of the mercantile marine, are coming on, but the cause of the seamen has for the moment lost valued support by the deaths of these experienced advocates. I am, Sir, yours faithfully, W. E. HOME. Tunbridge Wells, Sept. 29th, 1931.
ROYAL
MEDICAL
BENEVOLENT
FUND. - Th
number of new applicants helped by this Fund during the last three months of each year has usually averaged about 33, this being in addition to the grants which have been renewed to old beneficiaries. This year only seven new applications can be considered between now and the end of December unless further support is given. At the last meeting of the committee, 34 grants were voted, amounting to JB577 10s. The following are particulars of two cases
SIR,-In an annotation on p. 694 of your last issue I read the sentence: " Recent research on streptococcal throat infections and acute rheumatic fever has revived interest in the streptococcal theory of helped :rheumatism." May I suggest that the valuable work Widow, aged 35, of M.R.C.S. The husband qualified in 1930, of Dr. B. Schlesinger, Dr. W. Sheldon, and Dr. and a fortnight before he was to sail to take up an appointment a Medical Service abroad he was accidentally killed at the W. R. F. Collis, to say nothing of the researches of the in age of 28. The young widow is left with two infant children, American and German schools of thought, have not a girl of 2 years and a boy of 7 months. She has 55 a year. Fund voted k26 in four instalments. Personal service and revived interest, but have added new interest by possible further help will be given. striving to open up the path which may lead to the Widow, aged 38, of M.B. Husband died in November, 1930, solution of the exact part taken by streptococcal at the age of 47. The widow is left with two boys, ages 9 and 6, to educate. She is suffering from encephalitis lethargica, infection in rheumatism ? Can the work of Triboulet, ! and is quite incapable of earning a living or even attending A medical man in supporting the her household affairs. Menzer, and Gustav Singer at the beginning of this to writes " that the case is deserving of the utmost, century be already forgotten7 Can the fact-not the application is left with 30s. a week. Fund widow possible help." The in four instalments. Other societies are being theory-that a streptococcus isolated from an acute voted 926 to cooperate in this case. rheumatic sore-throat could produce in uninjured approached cardiac valves carditis, and also arthritis, &c., in BRIGHTON SEWER OUTFALL. - On Sept. 23rd, animals, and be recovered from the lesions in pure the reconstructed sewer outfall and pumping plant at some miles eastward of the centre of Brighton, culture, ever lose interest in this country where acute Portobello, was formally opened. The outfall has now been carried rheumatism is so rife ’1 We early investigators feared considerably further out to sea, and the pumping plant to dwell too much upon the experiments showing that enables the sewer to discharge at all states of the tide. the discharge has been restricted by the fact that streptococcal angina faucium was a cause of carditis Hitherto, when tide rose to the level of the sewer it entered it. the the hecatombs of An and arthritis, because we foresaw electrically operated sluice-gate now excludes the sea, tonsillar operations which would follow and have pumps raise the sewage over the gate, and then by gravitafollowed, and knew full well that the problem of acute tion the sewage delivers itself into the sea. The total cost of the work was .678,000. It was the scheme of Mr. David rheumatism was only partially discerned. Edwards, surveyor and engineer to the Sewers Board and The silent period before the rheumatism develops Borough Surveyor of Brighton, and it displaced an earlier after the tonsillitis is now the centre of attention- scheme for which the figure was 110,900.
770
anatomical basis for the different human capacities and individual talents." Considering these conflicting views, the information contained in my book should prove of value to every investigator, and should be read by every physician interested in the problem of the relation of mental activities to brain functions. And on this point, I am pleased to see, your reviewer seems to agree. I am, Sir, yours faithfully, BERNARD HOLLANDER. an
OPERATIVE TREATMENT OF HYDROCELE.
To the Editor
of THE
LANCET.
last issue (p. 680), Mr. Mooro calls attention to the value of the cautery in carrying out a radical operation for hydrocele of the tunica vaginalis. From my experience I agree with him that the procedure is well worth adopting. Most surgeons must have had experience of troublesome hsematomas forming after this operation has been carried out with the knife. However careful one is to use all ordinary methods of haemostasis they are liable to occur, especially in old-standing cases in which the sac is thickened. For the past four years when operating for hydrocele I have removed the parietal sac as a routine with the diathermy needle. I have also used the actual cautery in a few cases. If it is available, the diathermy cautery is extraordinarily convenient and easy to control, and involves no risk of damaging the body of the testis. With due care similar results are no doubt obtained with the actual cautery. I have several times observed considerable temporary swelling in the testicle following this operation, but not greater than is observed when the older method I am. Sir. vours faithfullv. is used. C. MAX PAGE.
giving a glimmer of hope that some new discovery as to its meaning may lead us a step nearer in our search for the truth, for a test, and even for a remedy. There may, perchance, be a cause of acute rheumatism unthought of and hidden from us, but I dare to write that streptococcal infection will always prove of interest in the history of this disease, and to think that it will prove to be the exciting cause. It would be grimly humorous to me if I believed that the streptococcal theory had ever lost interest in England; but too much practical work toward prevention of the disease has been done over these 30 years by those who have leaned to the streptococcal theory to make me either cynical or sad. I am, Sir, yours faithfully, F. JOHN POYNTON.
SIR,-In your
THE STREPTOCOCCAL THEORY OF ACUTE RHEUMATISM.
To the Editor
of THE
LANCET.
HEALTH OF MERCHANT SEAMEN.
To the Editor
of
THE LANCET.
SiR,-It was a grief to see mention in your last issue of the deaths of Sir William Simpson and Dr. W. F. Dearden, who were both anxious to improve the health of merchant seamen. Sir William Simpson had many other medical interests, through which he will be longer remembered, but he had the welfare of seamen at heart, and at various meetings said weighty words on their behalf. Dr. Dearden did a great deal at Manchester to direct attention to and to improve the conditions of their work. Younger men, interested in the hygiene of the mercantile marine, are coming on, but the cause of the seamen has for the moment lost valued support by the deaths of these experienced advocates. I am, Sir, yours faithfully, W. E. HOME. Tunbridge Wells, Sept. 29th, 1931.
ROYAL
MEDICAL
BENEVOLENT
FUND. - Th
number of new applicants helped by this Fund during the last three months of each year has usually averaged about 33, this being in addition to the grants which have been renewed to old beneficiaries. This year only seven new applications can be considered between now and the end of December unless further support is given. At the last meeting of the committee, 34 grants were voted, amounting to JB577 10s. The following are particulars of two cases
SIR,-In an annotation on p. 694 of your last issue I read the sentence: " Recent research on streptococcal throat infections and acute rheumatic fever has revived interest in the streptococcal theory of helped :rheumatism." May I suggest that the valuable work Widow, aged 35, of M.R.C.S. The husband qualified in 1930, of Dr. B. Schlesinger, Dr. W. Sheldon, and Dr. and a fortnight before he was to sail to take up an appointment a Medical Service abroad he was accidentally killed at the W. R. F. Collis, to say nothing of the researches of the in age of 28. The young widow is left with two infant children, American and German schools of thought, have not a girl of 2 years and a boy of 7 months. She has 55 a year. Fund voted k26 in four instalments. Personal service and revived interest, but have added new interest by possible further help will be given. striving to open up the path which may lead to the Widow, aged 38, of M.B. Husband died in November, 1930, solution of the exact part taken by streptococcal at the age of 47. The widow is left with two boys, ages 9 and 6, to educate. She is suffering from encephalitis lethargica, infection in rheumatism ? Can the work of Triboulet, ! and is quite incapable of earning a living or even attending A medical man in supporting the her household affairs. Menzer, and Gustav Singer at the beginning of this to writes " that the case is deserving of the utmost, century be already forgotten7 Can the fact-not the application is left with 30s. a week. Fund widow possible help." The in four instalments. Other societies are being theory-that a streptococcus isolated from an acute voted 926 to cooperate in this case. rheumatic sore-throat could produce in uninjured approached cardiac valves carditis, and also arthritis, &c., in BRIGHTON SEWER OUTFALL. - On Sept. 23rd, animals, and be recovered from the lesions in pure the reconstructed sewer outfall and pumping plant at some miles eastward of the centre of Brighton, culture, ever lose interest in this country where acute Portobello, was formally opened. The outfall has now been carried rheumatism is so rife ’1 We early investigators feared considerably further out to sea, and the pumping plant to dwell too much upon the experiments showing that enables the sewer to discharge at all states of the tide. the discharge has been restricted by the fact that streptococcal angina faucium was a cause of carditis Hitherto, when tide rose to the level of the sewer it entered it. the the hecatombs of An and arthritis, because we foresaw electrically operated sluice-gate now excludes the sea, tonsillar operations which would follow and have pumps raise the sewage over the gate, and then by gravitafollowed, and knew full well that the problem of acute tion the sewage delivers itself into the sea. The total cost of the work was .678,000. It was the scheme of Mr. David rheumatism was only partially discerned. Edwards, surveyor and engineer to the Sewers Board and The silent period before the rheumatism develops Borough Surveyor of Brighton, and it displaced an earlier after the tonsillitis is now the centre of attention- scheme for which the figure was 110,900.