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PERIARTERIAL SYMPATHECTOMY
1475 the four units, and the way will be open for extensive A clause of the Bill measures of coordination. describes one of the objects of the new " Liverpool United Hospital" in the following terms : "As soon as may be feasible the carrying on of all such work (i.e., the work of the existing hospitals) in new buildings on one site." The Bill thus contains a direct reference to the desirability of rebuilding on a single site. The commission suggested that a body should be formed to coordinate the policy of all the voluntary hospitals in Liverpool, and the Associated Voluntary Hospitals Board, which was the result of that suggestion, has been responsible for the promotion of the scheme for amalgamation, and is now considering the problems of rebuilding with the assistance of Mr. Herbert J. Rowse, F.R.I.B.A. PERIARTERIAL SYMPATHECTOMY
THE repeated advocacy, by so distinguished a surgeon as Prof. Archibald Young, of the periarterial operation as an alternative to ganglionectomy in the treatment of various vascular diseases leads us to reconsider the evidence for its usefulness. An opening contributionto a discussion at the Cairo Surgical Congress last January afforded him the opportunity for a restatement of his claims for the operation, and this he has now reprinted and circulated. After reviewing the history of periarterial sympathectomy, the physiological basis for the operation is discussed .and the author concludes that the intramural nerve plexus of an artery is to be regarded as "a homogeneous structure, maintained at a certain degree of molecular tension which varies according to the receipt of nerve impulses from the central nervous consequently disruption of the plexus system ; is followed by the radiation of molecular shock to the distal branches of the vascular tree, with alteration of the physico-chemical reactions governing the most mobile part of the vascular tube." While this .explanation may appeal to the physiologist, the surgeon may have his doubts whether the effects of the operation are explicable on physiological ,grounds, and will base his opinion upon clinical results. Prof. Young suggests that many surgeons .are dissatisfied with the operation either because they have chosen cases which were unsuitable, or because, being unduly timid, they have failed to perform it in a sufficiently radical manner. The records of his own cases-notes of examination and -after-history-are given in sufficient detail for others to judge how far the operation may be held responsible for the results achieved. The cases-which include chronic ulceration, delayed union of fractures, traumatic oedema, incipient gangrene, causalgia, thrombo-angiitis obliterans, and Raynaud’s diseaseare essentially similar to those described by other .surgeons, and lead to the conclusion that periarterial neurectomy is of undoubted value in the treatment of indolent ulcers, in some cases of causalgia, and in alleviating the pain and limiting the extent of senile gangrene. Its limitations are seen in Prof. Young’s cases of Raynaud’s disease and thrombo-angiitis obliterans, in many of which ganglionectomy was subsequently required. Study of his clinical material case by case reveals the disappointing features which have led other surgeons to restrict the use of periarterial sympathectomy in the limbs to the relief of certain types of pain. That even this effect of the operation may be transitory is Prof. Young’s personal experience. He has shown his own faith in periarterial neurectomy by having his left brachial ...
1
See THE LANCET, 1936, i., 119, 209.
as one step in the treatment of chronic X ray dermatitis with ulceration. The operation relieved his pain, and grafts survived on ulcers when previous attempts at grafting had failed. A year later further grafting was undertaken after excision of a diseased area of skin ; on this occasion the graft failed to take, and severe pain persisted throughout the long period which the ulcer took to heal.
artery stripped
CHRISTIE OF MUKDEN
THE death occurred on Dec. 2nd at his house in Edinburgh, after a short illness, of Dr. Dugald Christie, the well-known medical missionary, in his 81st year. As a boy he entered business in Glasgow; then, to use the old-fashioned phrase, he experienced "a call" and entered the medical profession with the intention of becoming a missionary. He qualified as L.R.C.P. Edin. and immediately took up a post with the Mukden Medical Mission. Here he remained for forty years, gaining the sobriquet " Christie of Mukden," and the fine work which he performed gained for him an unusual reputation among the Chinese official classes, as well as among his poor patients. None the less, his experiences were, at different times, dramatic and dangerous, as passages in an early autobiography show. In this he speaks of hostility and persecutions, " our houses and all our worldly goods burned, wars and deadly plague, tragic death among our ranks, partings with children sent away to the homeland-they have not been smooth years, but it has been worth our while." But he records the arrival of better things, writing: " We look back on almost incredible changes, and all who have shared in them feel that it has been a great thing to take part in the awakening of a nation, the regeneration of a great people. Hostility to foreigners is at an end. In all public emergencies, plague, war, famine, it is the missionaries, and of necessity specially the medical missionaries, that are looked to for advice and help." Assuredly Christie was a brave and optimistic man so to write, for during his sojourn at Mukden on three occasions it was found necessary to evacuate all foreign women and children in face of threatened risings. But he saw the foundation of a Chinese Medical College in Manchuria and two years ago the University of Edinburgh resolved to recognise the degrees of the Mukden Medical College. Christie who was created C.M.G. in 1911 was naturally the recipient of many Chinese honours, and in 1925 his Chinese friends erected a monument to him outside the Mukden College. He was a saint and a hero. BENZEDRINE
BENZEDRINE is the name given to a synthetic substance (3-phenyl-isopropylamine) chemically akin to adrenaline and ephedrine and comparable with them in its pharmacological effects. Itt became known about three years ago, and has been widely recommended both by medical writers and by manufacturing chemists as a nasal application for its vasoconstrictor and shrinking effect on swollen nasal mucosa. That, however, is one of the least of its actions. It was found to wake animals from the narcotic sleep induced by barbitone, and Prinzmetal and Bloombergintroduced it into the treatment of narcolepsy. Its blood-pressure-raising effect has been investigated in man by Myerson, Loman, and Dameshek,2 who find that doses of the order of 20-50 mg. cause a rise of 8 to 68 mm. Hg in the systolic 1 Jour. Amer. Med. Assoc., 1935, cv., 2051. 2 Amer. Jour. Med. Sci., October, 1936, p. 560.
THE repeated advocacy, by so distinguished a surgeon as Prof. Archibald Young, of the periarterial operation as an alternative to ganglionectomy in the treatment of various vascular diseases leads us to reconsider the evidence for its usefulness. An opening contributionto a discussion at the Cairo Surgical Congress last January afforded him the opportunity for a restatement of his claims for the operation, and this he has now reprinted and circulated. After reviewing the history of periarterial sympathectomy, the physiological basis for the operation is discussed .and the author concludes that the intramural nerve plexus of an artery is to be regarded as "a homogeneous structure, maintained at a certain degree of molecular tension which varies according to the receipt of nerve impulses from the central nervous consequently disruption of the plexus system ; is followed by the radiation of molecular shock to the distal branches of the vascular tree, with alteration of the physico-chemical reactions governing the most mobile part of the vascular tube." While this .explanation may appeal to the physiologist, the surgeon may have his doubts whether the effects of the operation are explicable on physiological ,grounds, and will base his opinion upon clinical results. Prof. Young suggests that many surgeons .are dissatisfied with the operation either because they have chosen cases which were unsuitable, or because, being unduly timid, they have failed to perform it in a sufficiently radical manner. The records of his own cases-notes of examination and -after-history-are given in sufficient detail for others to judge how far the operation may be held responsible for the results achieved. The cases-which include chronic ulceration, delayed union of fractures, traumatic oedema, incipient gangrene, causalgia, thrombo-angiitis obliterans, and Raynaud’s diseaseare essentially similar to those described by other .surgeons, and lead to the conclusion that periarterial neurectomy is of undoubted value in the treatment of indolent ulcers, in some cases of causalgia, and in alleviating the pain and limiting the extent of senile gangrene. Its limitations are seen in Prof. Young’s cases of Raynaud’s disease and thrombo-angiitis obliterans, in many of which ganglionectomy was subsequently required. Study of his clinical material case by case reveals the disappointing features which have led other surgeons to restrict the use of periarterial sympathectomy in the limbs to the relief of certain types of pain. That even this effect of the operation may be transitory is Prof. Young’s personal experience. He has shown his own faith in periarterial neurectomy by having his left brachial ...
1
See THE LANCET, 1936, i., 119, 209.
as one step in the treatment of chronic X ray dermatitis with ulceration. The operation relieved his pain, and grafts survived on ulcers when previous attempts at grafting had failed. A year later further grafting was undertaken after excision of a diseased area of skin ; on this occasion the graft failed to take, and severe pain persisted throughout the long period which the ulcer took to heal.
artery stripped
CHRISTIE OF MUKDEN
THE death occurred on Dec. 2nd at his house in Edinburgh, after a short illness, of Dr. Dugald Christie, the well-known medical missionary, in his 81st year. As a boy he entered business in Glasgow; then, to use the old-fashioned phrase, he experienced "a call" and entered the medical profession with the intention of becoming a missionary. He qualified as L.R.C.P. Edin. and immediately took up a post with the Mukden Medical Mission. Here he remained for forty years, gaining the sobriquet " Christie of Mukden," and the fine work which he performed gained for him an unusual reputation among the Chinese official classes, as well as among his poor patients. None the less, his experiences were, at different times, dramatic and dangerous, as passages in an early autobiography show. In this he speaks of hostility and persecutions, " our houses and all our worldly goods burned, wars and deadly plague, tragic death among our ranks, partings with children sent away to the homeland-they have not been smooth years, but it has been worth our while." But he records the arrival of better things, writing: " We look back on almost incredible changes, and all who have shared in them feel that it has been a great thing to take part in the awakening of a nation, the regeneration of a great people. Hostility to foreigners is at an end. In all public emergencies, plague, war, famine, it is the missionaries, and of necessity specially the medical missionaries, that are looked to for advice and help." Assuredly Christie was a brave and optimistic man so to write, for during his sojourn at Mukden on three occasions it was found necessary to evacuate all foreign women and children in face of threatened risings. But he saw the foundation of a Chinese Medical College in Manchuria and two years ago the University of Edinburgh resolved to recognise the degrees of the Mukden Medical College. Christie who was created C.M.G. in 1911 was naturally the recipient of many Chinese honours, and in 1925 his Chinese friends erected a monument to him outside the Mukden College. He was a saint and a hero. BENZEDRINE
BENZEDRINE is the name given to a synthetic substance (3-phenyl-isopropylamine) chemically akin to adrenaline and ephedrine and comparable with them in its pharmacological effects. Itt became known about three years ago, and has been widely recommended both by medical writers and by manufacturing chemists as a nasal application for its vasoconstrictor and shrinking effect on swollen nasal mucosa. That, however, is one of the least of its actions. It was found to wake animals from the narcotic sleep induced by barbitone, and Prinzmetal and Bloombergintroduced it into the treatment of narcolepsy. Its blood-pressure-raising effect has been investigated in man by Myerson, Loman, and Dameshek,2 who find that doses of the order of 20-50 mg. cause a rise of 8 to 68 mm. Hg in the systolic 1 Jour. Amer. Med. Assoc., 1935, cv., 2051. 2 Amer. Jour. Med. Sci., October, 1936, p. 560.