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ORDER AND DISORDER IN THE LARGE INTESTINE
611 Becauseof the high interest of the matter, may I make a plea, through your columns, that Lieut.-Colonel Turner and any other workers who may come across similar cases publish them with the greatest possible detail and include reproduction of the skiagrams ?P It would also be of the highest interest to have a followup of these cases. I havevividly in mind the case of a who was diagnosed as having atypical a chest physician at a London teaching hospital : four months later she developed a pleural effusion from which tubercle bacilli were grown, and a cavity was found in the region where the pulmonary lesion had been found four morths before. E. MONTUSCHI. Sidcup.
girl, aged 16,
pneumonia by
FATAL AIR-EMBOLISM DURING BLOOD TRANSFUSION SiR,-The case of fatal air-embolism during a bloodtransfusion reported in your issue of April 28 (p. 531) would not have occurred had the drip-feed here illustrated, which was described by Macintosh and Pask four.years ago (Lancet, 1941, ii, 10), been used.
ORDER AND DISORDER
IN THE LARGE INTESTINE SiB,—In his first Crconian lecture, reported in your issue of April 28, Dr. Hardy refers to the uncertainty of the vagus distribution to the colon. In a patient I saw some years ago, a tumour of the left carotid body had set up obstinate constipation as well as syncopal attacks. Presumably these effects were in part mediated by the efferent vagal fibres, activated from the carotid receptors, although there is some difficulty in excluding the concept of direct vagal stimulation. A barium meal showed rapid transit as far as the midpoint of the transverse colon. The meal was held up here for several days. At operation, performed by a competent surgeon, the vagus was incidentally divided. The left vocal cord was later found to have been paralysed. The two symptoms-syncope and intractable * were relieved. In this particular case, the X-ray findings suggested that the vagus had a colonic " sphere of influence " which extended as far as the midpoint of the transverse -
constifation’
ff<1rm
Wimpole Street, Wl.
H. A. DUNLOP.
STRESS FRACTURES SIR,-Dr. Morris in his letter of April 28 gives interesting figures regarding the incidence rate of complete fracture among metatarsal " fatigue fractures." ’ They indicate that in 92 5% of these lesions the fracture is incomplete : thus bearing out in striking manner the accuracy of my observation that " fatigue fractures are essentially
(" in
an
important degree":
incomplete."
Nuttall’s
Dictionary)
J. BLAIR HARTLEY.
Manchester.
HERPETIC
ULCER OF CORNEA annotation of April 14 you say that " herpetic ulcers of the cornea may arise after high pyrexia from whatever cause, but especially after pneumonia, malaria, and influenza...." I have worked in Malaya, and, during the war, in Egypt and India, for a total period of 19 years. During this time I have had many thousands of cases of malaria through my hands, but I have only seen-one case of herpetic ulcer occurring during an attack of malaria. I did, however, meet an ophthalmic surgeon in India, with previous experience in East Africa, who stated that he regarded it as a common complication. It would be interesting to learn in what parts of the world this is indeed a common complication of malaria ; for, surely, it is not a condition to which the patient would not
Sin.—In
an
draw one’s attention. London, SW1.
As long as fluid enters the drip-feed chamber the glass float remains on the surface of the liquid (fig. 1). If air instead of liquid enters the chamber, the float falls on to its seating and prevents the passage of air (fig. 2). Nuffield Dept. of Anæsthetics, WILLIAM W. MUSHIN. Radcliffe Infirmary, Oxford. HORMONE CARTEL SiR,-Your leading article of April 21 is timely in its warning of the possibility of German interests attempting renewed infiltration after the war. It may interest your readers to know that in the case of Schering products steps were taken to safeguard against this possibility as early as 1941, when a British company-British Schering Ltd.-formed with the approval and assistance of the Board of Trade, took over all the formerly Germanowned Schering interests in this country. These interests include complete ownership of trade-marks and all rights to operate German-held British patents covering processes of manufacture. Today, with a few minor exceptions, all former German Schering products are manufactured in England. British Schering Ltd. is financed, controlled, and managed solely by British subjects and will never be allowed to revert in any way to German influence. E. P. CARTER, 185-190, High Holborn, L!IDdon,WC1. Chairman, British Schering Ltd. THE
BERNARD DAY.
ASSOCIATION OF SURGEONS OF GREAT AND IRELAND
BRITAIN
meeting on May 2 and 3 the annual Connaught Rooms. Sir Alfred WebbJohnson, PROS, proposing the health of the association, said it could do more than any other body to establish the criteria entitling a man to claim the status of surgical specialist ; it could stimulate the colleges of surgeons to adopt a uniform standard. Paying tribute to the president (Surgeon RearAdmiral G. Gordon-Taylor), Sir Alfred described him as one of the greatest and boldest of British surgeons today-a man who had risen high because his foundations were deep. In his reply Admiral Gordon-Taylor passed in review some of the giants of former days-Lister ; Hunter ; WatsonCheyne ; StClair Thomson ; Moynihan ; Rutherford Morison ; Larrey; Pirogov ; Travers ; Dupuytren ; Woodall, -_ DURI-NG the annual dinner was held at the
Lind, Trotter, and Gilbert Blane ; and those other naval Huxley, Darwin, and Hooker; Syme, Liston, Astley-Cooper ; Charles Bell ; George Makins ; Bowlby; Percy Sargent ; Bland-Sutton ; David Wilkie ; and many surgeons
more--each pictured in a few evocative words. The men of progress, he said, are those with a respect for the past. As for the future, he quoted the poem quoted by the Prime Minister-" But westward, look, the land is
bright."
girl, aged 16,
pneumonia by
FATAL AIR-EMBOLISM DURING BLOOD TRANSFUSION SiR,-The case of fatal air-embolism during a bloodtransfusion reported in your issue of April 28 (p. 531) would not have occurred had the drip-feed here illustrated, which was described by Macintosh and Pask four.years ago (Lancet, 1941, ii, 10), been used.
ORDER AND DISORDER
IN THE LARGE INTESTINE SiB,—In his first Crconian lecture, reported in your issue of April 28, Dr. Hardy refers to the uncertainty of the vagus distribution to the colon. In a patient I saw some years ago, a tumour of the left carotid body had set up obstinate constipation as well as syncopal attacks. Presumably these effects were in part mediated by the efferent vagal fibres, activated from the carotid receptors, although there is some difficulty in excluding the concept of direct vagal stimulation. A barium meal showed rapid transit as far as the midpoint of the transverse colon. The meal was held up here for several days. At operation, performed by a competent surgeon, the vagus was incidentally divided. The left vocal cord was later found to have been paralysed. The two symptoms-syncope and intractable * were relieved. In this particular case, the X-ray findings suggested that the vagus had a colonic " sphere of influence " which extended as far as the midpoint of the transverse -
constifation’
ff<1rm
Wimpole Street, Wl.
H. A. DUNLOP.
STRESS FRACTURES SIR,-Dr. Morris in his letter of April 28 gives interesting figures regarding the incidence rate of complete fracture among metatarsal " fatigue fractures." ’ They indicate that in 92 5% of these lesions the fracture is incomplete : thus bearing out in striking manner the accuracy of my observation that " fatigue fractures are essentially
(" in
an
important degree":
incomplete."
Nuttall’s
Dictionary)
J. BLAIR HARTLEY.
Manchester.
HERPETIC
ULCER OF CORNEA annotation of April 14 you say that " herpetic ulcers of the cornea may arise after high pyrexia from whatever cause, but especially after pneumonia, malaria, and influenza...." I have worked in Malaya, and, during the war, in Egypt and India, for a total period of 19 years. During this time I have had many thousands of cases of malaria through my hands, but I have only seen-one case of herpetic ulcer occurring during an attack of malaria. I did, however, meet an ophthalmic surgeon in India, with previous experience in East Africa, who stated that he regarded it as a common complication. It would be interesting to learn in what parts of the world this is indeed a common complication of malaria ; for, surely, it is not a condition to which the patient would not
Sin.—In
an
draw one’s attention. London, SW1.
As long as fluid enters the drip-feed chamber the glass float remains on the surface of the liquid (fig. 1). If air instead of liquid enters the chamber, the float falls on to its seating and prevents the passage of air (fig. 2). Nuffield Dept. of Anæsthetics, WILLIAM W. MUSHIN. Radcliffe Infirmary, Oxford. HORMONE CARTEL SiR,-Your leading article of April 21 is timely in its warning of the possibility of German interests attempting renewed infiltration after the war. It may interest your readers to know that in the case of Schering products steps were taken to safeguard against this possibility as early as 1941, when a British company-British Schering Ltd.-formed with the approval and assistance of the Board of Trade, took over all the formerly Germanowned Schering interests in this country. These interests include complete ownership of trade-marks and all rights to operate German-held British patents covering processes of manufacture. Today, with a few minor exceptions, all former German Schering products are manufactured in England. British Schering Ltd. is financed, controlled, and managed solely by British subjects and will never be allowed to revert in any way to German influence. E. P. CARTER, 185-190, High Holborn, L!IDdon,WC1. Chairman, British Schering Ltd. THE
BERNARD DAY.
ASSOCIATION OF SURGEONS OF GREAT AND IRELAND
BRITAIN
meeting on May 2 and 3 the annual Connaught Rooms. Sir Alfred WebbJohnson, PROS, proposing the health of the association, said it could do more than any other body to establish the criteria entitling a man to claim the status of surgical specialist ; it could stimulate the colleges of surgeons to adopt a uniform standard. Paying tribute to the president (Surgeon RearAdmiral G. Gordon-Taylor), Sir Alfred described him as one of the greatest and boldest of British surgeons today-a man who had risen high because his foundations were deep. In his reply Admiral Gordon-Taylor passed in review some of the giants of former days-Lister ; Hunter ; WatsonCheyne ; StClair Thomson ; Moynihan ; Rutherford Morison ; Larrey; Pirogov ; Travers ; Dupuytren ; Woodall, -_ DURI-NG the annual dinner was held at the
Lind, Trotter, and Gilbert Blane ; and those other naval Huxley, Darwin, and Hooker; Syme, Liston, Astley-Cooper ; Charles Bell ; George Makins ; Bowlby; Percy Sargent ; Bland-Sutton ; David Wilkie ; and many surgeons
more--each pictured in a few evocative words. The men of progress, he said, are those with a respect for the past. As for the future, he quoted the poem quoted by the Prime Minister-" But westward, look, the land is
bright."