- Email: [email protected]
PERMANGANATE OF POTASSIUM IN SNAKE-BITE.
133 as tuberculosis affecting the commonwealth I a great amount of interest, but I should like to draw attensupposed to be : whether the disease ought to i tion to a statement he makes which I cannot allow to pass as be completely eradicated at once by the knife or trifled correctly representing my views as to the origin of the diswith by the application of feeble caustics and narcotics. ease. On page 1748 he says : "Dr. Bannatyne ascribes the Experience of the latter old wives’ method of treatment disease to a toxæmia affecting the anterior cornua of the has taught surgeons to be wary of it. With respect to the cord." Now this is not my idea of the origin of the disease. argument that the hygienic laws proposed will tend to To put it shortly, I look on rheumatoid arthritis as due to .curtail the liberties of Englishmen, it is quite possible that specific bacteria having their nidus in the affected joints these changes will be opposed by a sentimental anti-progress themselves and that the joint symptoms are the primary and league which will ultimately, however, be brought to its essential symptoms of the disease. I look on the vaso-motor and other nerve symptoms as purely secondary, possibly senses when there is a danger of the nation being left behind in the struggle for supremacy by communities more caused by absorption of the bacterial products elaborated by the micro-organisms in the joints. My principal point is that in sympathy with scientific progress and discovery. I look on the joint troubles as caused by the local action of I am, Sirs, yours faithfully, the bacteria and not as the result of trophic changes due to a E. CLUNEGLAS DAVIES. Lampeter, Dec. 26th, 1902. toxsemio poisoning.-I am, Sirs, yours faithfully,
such
cancer
may be
GILBERT A.
Bath,
REFLEXES: THEIR RELATION TO DIAGNOSIS IN RHEUMATOID
partakes in excitability though not necessarily to the same extent. In one cae I am thinking of Dr. Carter pointed out to me the markedly spastic gait of the man. Here Babinski’s fign was absent. The most marked condition of myotatic irritability"I have seen was in a middle-aged woman who was greatly distressed one morning by an attack of clonic muscular spasms of all the extremities. especially the left side. Her muscular convulsions !-hook the bed and on firmly holding the arm or leg muscles rapid twitchings were to be felt. Her pulse was 160, the respirations were 40, and the temOn her admission we nGticed perature was 99.6° F. Stellwag’s symptom occurring rhythmically in both eyes, slight proptosis, and von Graefe’s sign. There was no thyroid enlargement and her morning pulse was 80. Belladonna, bromide, and digitalis seemed to cut the attack short. Some might quotehysteria as the cause, but her general behaviour was against it and I believe that the arthritis was closely - connected with the attack-probably of the same origin. I am, Sirs, yours faithfully, J. W. MALIM, B. A., M.B., B C. Cantab., ..
Resident Medical Officer. Royal Mineral Water Hospital, Bath.
Bath, Jan. 3rd, 1903. To the Editors of THE LANCET. SIRS,--I have read Dr. R. Llewelyn Jones’s paper under the above title in THE LANCET of Dec. 27th, p. 1746, with
28th, 1902.
BANNATYNE, M.D. Glasg.
PERMANGANATE OF POTASSIUM SNAKE-BITE.
ARTHRITIS. To the Editors of THE LANCET. SIRS,--In Dr. R. Llewelyn Jones’s interesting paper on the Reflexes in Rheumatoid Arthritis in THE LANCET of I notice a reference to "jaw Dec. 27th, p. 1746, On his as resident medical officer resignation jerks." of the Royal Mineral Water Hospital, Bath, Dr. Jones kindly showed me this clinical phenomenon which I have carefully tested. The mandibular joint being so fre,quently affected one found plenty of material to work with and it may be of interest to note my conclusions. Invariably where the jaw has been recently affected one obtains a smart response to percussion, and irritability is so marked that clonus is not a rare occurrence though a single acknowledgment to the tap is more often elicited. In cases where the jaw has apparently been free from trouble for many months the jerk is still easily obtained, though in most of thee apparently recovered joints grating or slight morning stiffness can be made out. Frequently, however, one meets with cases giving histories of former jaw attacks and where no evidence of any active arthritic mischief is present I have received a response, showing how persistent the irritability is. An interesting case recently in hospital gave no history beyond that of aching teeth and on examination though no dental caries was made out yet the jaw responded. The aching teeth, I take it, was a referred joint affection. In most cases, however, where jaw trouble has been complained of the molars and bicuspids were degenerate or absent, though the incisors seemed to be peculiarly resistant. A passing reference to knee-jerks is not out of place. We notice here in rheumatoid affections of the lower extremities where no joint contract ures have occurred a more than slight increase in deep reflexes. In fact, digital percussion to the patellar ligament not infrequently throws the affected leg into an almost epileptiform condition of clonus, and this seemingly often out of proportion to the joint changes. As a rule, where such a state of affairs exists the other limb
Dec.
IN
To the Editors of THE LANCET.
SIRS,—In regard to the annotation respecting the efficacy of the subcutaneous injection of solution of permanganate of potassium referred to in THE LAXCET of D c. 20th, p. 1711, it was strikingly illustrated by experiments conducted by M. Louis Perinquey and myself with the poison of the puff-adder and described in the Medical Prevsand Circular for June, 1886. Since then, with great caution, Ihave employed the same remedy, likewise subcutaneously injected, in a very extreme case of blood poisoning occurring in a man who in order to remove an obstruction in a drain-pipe had pushed his arm into it, thereby receiving a scratch, after which the whole arm gradually swelled up to an enormous size. In this condition, attended with severe constitutional symptoms threatening imminent death, he came to me. All hope seemed gone but he made a complete recovery. A few notes of this case, which occurred in 1894, I recorded in the British Medical Journal. In the snake-bitten dog, although I used a strong solution and injected it freely into the tissues and also into the muscles, there was only a small local reaction. The animal made an astonishing recovery and it was well bitten several times over by the very same snake which had caused the death of another dog within about six hours. There were scarcely any noticeable dangerous symptoms except a little listlessness and sleepiness. The remedy probably destroyed the virus. The injection of the solution did no harm and the dog scarcely suffered at all. The treatment should only be used in dangerous cases in human beings and always with much care and, as a rule, only in snake-poisoning should intra- muscular injections be made. I am, Sirs, yours faithfully, GEORGE GRESSWELL. Grimsby, Dec. 24th, 1902.
THE STAFFING OF RECEPTION HOUSES. To the Editors of THE LANCET. SIRS,-The London County Council with its habitual in lunacy matters having decided to houses for incipient mental disorders, it is very essential that these should be staffed from the outset in the most efficient manner. The treatment of incipient mental disorder has occupied my attention for many years past and I trust therefoie I may not be considered as presuming in venturing to express my views in this particular to which I have also given very considerable attention. Many members of our own profession are in the habit of asserting that no specal skill or exterience is needed in the treatment of mental disorder. This view, I consider, is the strongest and most conclusive evidence that could be advanced that they know absolutely nothing of the
progressive spirit establish reception
subject. !
physician of the present day must not only full and long experience of mental disease but he must be a specialist in neurology, gynaecology, ophthalmology, and, in fact, in every pecialism, to the extent of knowing when he needs the aid of one of these specialties. The asylum physician, it must be remembered, has unequalled opportunities in the large institutions for the insane for observing not only mental disease, but every other An alienist
have
a
such
cancer
may be
GILBERT A.
Bath,
REFLEXES: THEIR RELATION TO DIAGNOSIS IN RHEUMATOID
partakes in excitability though not necessarily to the same extent. In one cae I am thinking of Dr. Carter pointed out to me the markedly spastic gait of the man. Here Babinski’s fign was absent. The most marked condition of myotatic irritability"I have seen was in a middle-aged woman who was greatly distressed one morning by an attack of clonic muscular spasms of all the extremities. especially the left side. Her muscular convulsions !-hook the bed and on firmly holding the arm or leg muscles rapid twitchings were to be felt. Her pulse was 160, the respirations were 40, and the temOn her admission we nGticed perature was 99.6° F. Stellwag’s symptom occurring rhythmically in both eyes, slight proptosis, and von Graefe’s sign. There was no thyroid enlargement and her morning pulse was 80. Belladonna, bromide, and digitalis seemed to cut the attack short. Some might quotehysteria as the cause, but her general behaviour was against it and I believe that the arthritis was closely - connected with the attack-probably of the same origin. I am, Sirs, yours faithfully, J. W. MALIM, B. A., M.B., B C. Cantab., ..
Resident Medical Officer. Royal Mineral Water Hospital, Bath.
Bath, Jan. 3rd, 1903. To the Editors of THE LANCET. SIRS,--I have read Dr. R. Llewelyn Jones’s paper under the above title in THE LANCET of Dec. 27th, p. 1746, with
28th, 1902.
BANNATYNE, M.D. Glasg.
PERMANGANATE OF POTASSIUM SNAKE-BITE.
ARTHRITIS. To the Editors of THE LANCET. SIRS,--In Dr. R. Llewelyn Jones’s interesting paper on the Reflexes in Rheumatoid Arthritis in THE LANCET of I notice a reference to "jaw Dec. 27th, p. 1746, On his as resident medical officer resignation jerks." of the Royal Mineral Water Hospital, Bath, Dr. Jones kindly showed me this clinical phenomenon which I have carefully tested. The mandibular joint being so fre,quently affected one found plenty of material to work with and it may be of interest to note my conclusions. Invariably where the jaw has been recently affected one obtains a smart response to percussion, and irritability is so marked that clonus is not a rare occurrence though a single acknowledgment to the tap is more often elicited. In cases where the jaw has apparently been free from trouble for many months the jerk is still easily obtained, though in most of thee apparently recovered joints grating or slight morning stiffness can be made out. Frequently, however, one meets with cases giving histories of former jaw attacks and where no evidence of any active arthritic mischief is present I have received a response, showing how persistent the irritability is. An interesting case recently in hospital gave no history beyond that of aching teeth and on examination though no dental caries was made out yet the jaw responded. The aching teeth, I take it, was a referred joint affection. In most cases, however, where jaw trouble has been complained of the molars and bicuspids were degenerate or absent, though the incisors seemed to be peculiarly resistant. A passing reference to knee-jerks is not out of place. We notice here in rheumatoid affections of the lower extremities where no joint contract ures have occurred a more than slight increase in deep reflexes. In fact, digital percussion to the patellar ligament not infrequently throws the affected leg into an almost epileptiform condition of clonus, and this seemingly often out of proportion to the joint changes. As a rule, where such a state of affairs exists the other limb
Dec.
IN
To the Editors of THE LANCET.
SIRS,—In regard to the annotation respecting the efficacy of the subcutaneous injection of solution of permanganate of potassium referred to in THE LAXCET of D c. 20th, p. 1711, it was strikingly illustrated by experiments conducted by M. Louis Perinquey and myself with the poison of the puff-adder and described in the Medical Prevsand Circular for June, 1886. Since then, with great caution, Ihave employed the same remedy, likewise subcutaneously injected, in a very extreme case of blood poisoning occurring in a man who in order to remove an obstruction in a drain-pipe had pushed his arm into it, thereby receiving a scratch, after which the whole arm gradually swelled up to an enormous size. In this condition, attended with severe constitutional symptoms threatening imminent death, he came to me. All hope seemed gone but he made a complete recovery. A few notes of this case, which occurred in 1894, I recorded in the British Medical Journal. In the snake-bitten dog, although I used a strong solution and injected it freely into the tissues and also into the muscles, there was only a small local reaction. The animal made an astonishing recovery and it was well bitten several times over by the very same snake which had caused the death of another dog within about six hours. There were scarcely any noticeable dangerous symptoms except a little listlessness and sleepiness. The remedy probably destroyed the virus. The injection of the solution did no harm and the dog scarcely suffered at all. The treatment should only be used in dangerous cases in human beings and always with much care and, as a rule, only in snake-poisoning should intra- muscular injections be made. I am, Sirs, yours faithfully, GEORGE GRESSWELL. Grimsby, Dec. 24th, 1902.
THE STAFFING OF RECEPTION HOUSES. To the Editors of THE LANCET. SIRS,-The London County Council with its habitual in lunacy matters having decided to houses for incipient mental disorders, it is very essential that these should be staffed from the outset in the most efficient manner. The treatment of incipient mental disorder has occupied my attention for many years past and I trust therefoie I may not be considered as presuming in venturing to express my views in this particular to which I have also given very considerable attention. Many members of our own profession are in the habit of asserting that no specal skill or exterience is needed in the treatment of mental disorder. This view, I consider, is the strongest and most conclusive evidence that could be advanced that they know absolutely nothing of the
progressive spirit establish reception
subject. !
physician of the present day must not only full and long experience of mental disease but he must be a specialist in neurology, gynaecology, ophthalmology, and, in fact, in every pecialism, to the extent of knowing when he needs the aid of one of these specialties. The asylum physician, it must be remembered, has unequalled opportunities in the large institutions for the insane for observing not only mental disease, but every other An alienist
have
a