- Email: [email protected]
PROGNOSIS IN UNOPERATED CASES OF EXOPHTHALMIC GOITRE, INCLUDING TOXIC ADENOMA.
104 anethods of treating haemorrhoids by injection and by other " ambulatory " methods shows that at last the
the collections of pus from these pocks behind the tonsil a resection of the tonsil was necessary. Adhesions of the capsule to the peritonsillar tissue behind were, in the circumstances, inevitable, but could not be attributed to the effect of the cautery unless the burner had perforated the capsule, which one is careful to avoid doing when using the galvano-cautery. These cases of diffuse staphylococcal infection last for months and are very troublesome. I have seen which ran on for two years, but eventually yielded to an autogenous vaccine. One would think, however, that in Dr. Way’s case a considerable auto-immunisation had taken effect by the time the tonsils were. removed. I am unable to follow his reasoning when he suggests an analogy between a septic tooth and a septic tonsil. A tooth is a purely mechanical structure, designed for biting and mastication ; the tonsil is a lymph gland with a highly specialised function ; at present we know only of its protective action, but it may eventually be proved to be one of the endocrine organs. In the many hundreds of cases which I have treated with the galvano-cautery I have never seen any closure of crypts, nor any recurrence of sepsis ; and the red vascular appearance of the mucous membrane quickly subsides under the continued use of the
:profession has realised that operations on btmorare disliked by patients and that the latter, too, are becoming aware that operation is not the only - or the most satisfactory way of dealing with this rhoids
and troublesome ailment. I am, Sir, yours faithfully, ARTHUR S. MORLEY. Upper Wimpole-street, W., Jan. 5th, 1929.
.-common
one
LONDON COUNTY COUNCIL (GENERAL
POWERS) ACT, ’0 the -Laitor
Oj’-UHE
1920. LANCET.
Sm,-This Act, passed some years ago, has recently been put into action. One clause of the Act required .that any medical practitioner, carrying on work of the nature covered by the Act, might send in an exemption certificate " annually and so avoid staking out the licence which is necessary for all other ,persons. The underlying idea of the Act in question ’was undoubtedly good, in that it was a real attempt to protect the public from unqualified persons, who were ,getting bolder in irregular practice, and had even gone chloramine spray.-I am, Sir, yours faithfully, ’.the length of installing X ray apparatus for the W. S. WHITCOMBE, M.D. Harley-street, W., Dec. 30th, 1928. depilation of facial hair, " when nature in vagary mistakes for Thomas, Mistress Mary,"-a most dangerous and gross form of treatment. Quite apart from the efficacy of such a procedure, many of the people A TUDOR ACT OF INDEMNITY FOR treated may, sooner or later, in place of a few hairs UNQUALIFIED PRACTICE. have telangiectases, if nothing more serious. It was To the Editor of THE LANCET. ;felt therefore, much as the idea of yet another body being allowed to regulate the practice of a duly Sir,- notice among the correspondence recently - registered medical practitioner was resented, that appearing in your paper relative to the above Act that -the Act had been passed and it was our duty to obey its authenticity is questioned. Further, that informait. The London County Council have been most tion is desired as to whether the document at New :helpful and sympathetic so far as the medical members Romney is a copy of the Statute or a proclamation. .of the British Institute of Radiology are concerned, The document in question is undoubtedly authentic, -and they have agreed (in lieu of the personal certificate having been found among a bundle of proclamations, signed by two medical practitioners) to accept a single dating from Henry VIL’s reign to the eighteenth .certificate signed by officials of the Institute, together century. In itself it is one of the many regular with a schedule of names, as complying with the printed proclamations of the time, presumably sent requirements of the Act. In acknowledging the down to the town from London, in the ordinary schedule the official of the L.C.C. made the following custom of those times. observations :That these valuable proclamations have been " With regard to the question of inspection, I would point preserved is due to the care which successive town out that, provided the required certificate has been furnished clerks of New Romney have given to the documents in respect of an establishment carried on by a registered in their charge.
- 6.
medical practitioner, the Council’s officers have inspect such establishment."
no
power to
As one of the most objectionable features of the Act the domiciliary visit of inspection to the consultingroom of a registered medical practitioner, I think you will do a great service by making the above comment widely known. There is much in the Act that appears .capable of more than one interpretation, and it seems likely that this may have to be solved by a friendly ,action in the law courts, but such a question is hardly .of immediate concern. I am, Sir, yours faithfully, STANLEY MELVILLE. London, W., Jan. 3rd, 1929.
was
T
am
qir-
V01W’"
fa.it,hfnllv
M. TEICHMAN-DERVILLE
(Major).
Littlestone, New Romney, Kent, Jan. 3rd, 1929.
PROGNOSIS IN UNOPERATED CASES OF EXOPHTHALMIC GOITRE, INCLUDING TOXIC ADENOMA.
To the Editor of THE LANCET. SiR,-May I ask for information from those surgeons and physicians who have treated many cases of Graves’s disease on the question of prognosis in cases where the patient declines operation ? To avoid confusion these cases may be divided into the following TONSILLECTOMY OR GALVANO-PUNCTURE two classes : (a) primary Graves’ (diffusely enlarged vascular thyroid with hyperplasia) ; and (b) secondary To the Editor of THE LANCET. Graves’ (including toxic adenoma and cases following SIR,-I have read with interest Dr. Berkeley Way’s simple goitre). The patient (usually female) is not .lucid account of his attack of general staphylococcal interested in percentages of deaths and recoveries. infection (THE LANCET, Dec. 29th, 1928, p. 1367). What she wants to know is the prognosis, without Cases of the kind are not uncommon, but an invasion operation, in her individual case. of the tonsil by Staphylococcus p. is surely very The points, on which I should be grateful for rare. I have never seen such a condition, and information, distinguishing between (a) primary and I cannot believe that in Dr. Way’s case the primary (b) secondary Graves’s disease are : (1) Is it possible nidus of the infection was in the tonsil. There was to a correct prognosis as to what will happen in give diffuse furunculosis, and what Dr. Way rather vaguely the individual case which is not operated upon ? calls carbuncles, which I presume were very large 2. If this is what are the signs and symptoms possible, furuncles. There were abscesses in the axilla, on which the prognosis should be based ? obviously not of tonsillar origin, and there were I am. Sir. vours faithfullv. .quinsies, which I presume were peritonsillar abscesses, C. HAMILTON WHITEFORD. .and therefore behind the capsule. To entirely liberate Plymouth, Dec. 28th, 1928.
?
the collections of pus from these pocks behind the tonsil a resection of the tonsil was necessary. Adhesions of the capsule to the peritonsillar tissue behind were, in the circumstances, inevitable, but could not be attributed to the effect of the cautery unless the burner had perforated the capsule, which one is careful to avoid doing when using the galvano-cautery. These cases of diffuse staphylococcal infection last for months and are very troublesome. I have seen which ran on for two years, but eventually yielded to an autogenous vaccine. One would think, however, that in Dr. Way’s case a considerable auto-immunisation had taken effect by the time the tonsils were. removed. I am unable to follow his reasoning when he suggests an analogy between a septic tooth and a septic tonsil. A tooth is a purely mechanical structure, designed for biting and mastication ; the tonsil is a lymph gland with a highly specialised function ; at present we know only of its protective action, but it may eventually be proved to be one of the endocrine organs. In the many hundreds of cases which I have treated with the galvano-cautery I have never seen any closure of crypts, nor any recurrence of sepsis ; and the red vascular appearance of the mucous membrane quickly subsides under the continued use of the
:profession has realised that operations on btmorare disliked by patients and that the latter, too, are becoming aware that operation is not the only - or the most satisfactory way of dealing with this rhoids
and troublesome ailment. I am, Sir, yours faithfully, ARTHUR S. MORLEY. Upper Wimpole-street, W., Jan. 5th, 1929.
.-common
one
LONDON COUNTY COUNCIL (GENERAL
POWERS) ACT, ’0 the -Laitor
Oj’-UHE
1920. LANCET.
Sm,-This Act, passed some years ago, has recently been put into action. One clause of the Act required .that any medical practitioner, carrying on work of the nature covered by the Act, might send in an exemption certificate " annually and so avoid staking out the licence which is necessary for all other ,persons. The underlying idea of the Act in question ’was undoubtedly good, in that it was a real attempt to protect the public from unqualified persons, who were ,getting bolder in irregular practice, and had even gone chloramine spray.-I am, Sir, yours faithfully, ’.the length of installing X ray apparatus for the W. S. WHITCOMBE, M.D. Harley-street, W., Dec. 30th, 1928. depilation of facial hair, " when nature in vagary mistakes for Thomas, Mistress Mary,"-a most dangerous and gross form of treatment. Quite apart from the efficacy of such a procedure, many of the people A TUDOR ACT OF INDEMNITY FOR treated may, sooner or later, in place of a few hairs UNQUALIFIED PRACTICE. have telangiectases, if nothing more serious. It was To the Editor of THE LANCET. ;felt therefore, much as the idea of yet another body being allowed to regulate the practice of a duly Sir,- notice among the correspondence recently - registered medical practitioner was resented, that appearing in your paper relative to the above Act that -the Act had been passed and it was our duty to obey its authenticity is questioned. Further, that informait. The London County Council have been most tion is desired as to whether the document at New :helpful and sympathetic so far as the medical members Romney is a copy of the Statute or a proclamation. .of the British Institute of Radiology are concerned, The document in question is undoubtedly authentic, -and they have agreed (in lieu of the personal certificate having been found among a bundle of proclamations, signed by two medical practitioners) to accept a single dating from Henry VIL’s reign to the eighteenth .certificate signed by officials of the Institute, together century. In itself it is one of the many regular with a schedule of names, as complying with the printed proclamations of the time, presumably sent requirements of the Act. In acknowledging the down to the town from London, in the ordinary schedule the official of the L.C.C. made the following custom of those times. observations :That these valuable proclamations have been " With regard to the question of inspection, I would point preserved is due to the care which successive town out that, provided the required certificate has been furnished clerks of New Romney have given to the documents in respect of an establishment carried on by a registered in their charge.
- 6.
medical practitioner, the Council’s officers have inspect such establishment."
no
power to
As one of the most objectionable features of the Act the domiciliary visit of inspection to the consultingroom of a registered medical practitioner, I think you will do a great service by making the above comment widely known. There is much in the Act that appears .capable of more than one interpretation, and it seems likely that this may have to be solved by a friendly ,action in the law courts, but such a question is hardly .of immediate concern. I am, Sir, yours faithfully, STANLEY MELVILLE. London, W., Jan. 3rd, 1929.
was
T
am
qir-
V01W’"
fa.it,hfnllv
M. TEICHMAN-DERVILLE
(Major).
Littlestone, New Romney, Kent, Jan. 3rd, 1929.
PROGNOSIS IN UNOPERATED CASES OF EXOPHTHALMIC GOITRE, INCLUDING TOXIC ADENOMA.
To the Editor of THE LANCET. SiR,-May I ask for information from those surgeons and physicians who have treated many cases of Graves’s disease on the question of prognosis in cases where the patient declines operation ? To avoid confusion these cases may be divided into the following TONSILLECTOMY OR GALVANO-PUNCTURE two classes : (a) primary Graves’ (diffusely enlarged vascular thyroid with hyperplasia) ; and (b) secondary To the Editor of THE LANCET. Graves’ (including toxic adenoma and cases following SIR,-I have read with interest Dr. Berkeley Way’s simple goitre). The patient (usually female) is not .lucid account of his attack of general staphylococcal interested in percentages of deaths and recoveries. infection (THE LANCET, Dec. 29th, 1928, p. 1367). What she wants to know is the prognosis, without Cases of the kind are not uncommon, but an invasion operation, in her individual case. of the tonsil by Staphylococcus p. is surely very The points, on which I should be grateful for rare. I have never seen such a condition, and information, distinguishing between (a) primary and I cannot believe that in Dr. Way’s case the primary (b) secondary Graves’s disease are : (1) Is it possible nidus of the infection was in the tonsil. There was to a correct prognosis as to what will happen in give diffuse furunculosis, and what Dr. Way rather vaguely the individual case which is not operated upon ? calls carbuncles, which I presume were very large 2. If this is what are the signs and symptoms possible, furuncles. There were abscesses in the axilla, on which the prognosis should be based ? obviously not of tonsillar origin, and there were I am. Sir. vours faithfullv. .quinsies, which I presume were peritonsillar abscesses, C. HAMILTON WHITEFORD. .and therefore behind the capsule. To entirely liberate Plymouth, Dec. 28th, 1928.
?