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"HOSPITAL ABUSE AT BRIGHTON."
"HOSPITAL ABUSE AT BRIGHTON." I a point important clinically. suppose the prevailing view is that, whilst a murmur need not be felt as a thrill, a thrill will always be heard as a murmur. Is this prevailing view incorrect ? So far as my own experience goes I should say that wherever I have felt a thrill I have heard a corresponding murmur; but my impression is that on more than one occasion I have felt some difficulty in assuring myself that the thrill felt and the murmur heard coincided accurately in point of time. Physically regarded, it is, I suppose, quite possible to conceive that the vibrations or ripples should be so coarse and infrequent as to be palpable and not audible ; but in practical medicine is this the case ? If it be the case the hand should, I think, take cognisance of the thrill as special in character-special by reason of its extreme coarse or undulatory character. I am. Sirs. yours trulv. HARRINGTON SAINSBURY. Welbeck-street, W., Sept. 23rd, 1896.
The observation raises
809
3 35’8 per cent. of its in-patients and 21 per cent. of its outfrom the county, as opposed to Brighton and p patients I Hove. Hence the patients are drawn from a population of considerably over 150,000. 1 2. In the annual’ r for the year ending 1894 the following parareport occurs: "A searching scrutiny was made this g graph y year by a subcommittee, which showed that 96 per of the cases (out-patients) were entirely fit and c cent. rproper subjects for gratuitous treatment, and though in t the remaining 4 per cent. sufficient information could not be it was thought that even in these cases, were closer c obtained, s scrutiny possible, it might be shown that several could be r without any abuse of the charity." May I suggest received t that the primary cause of hospital abuse is the carelessness which subscribers give their tickets. I am, Sirs, yours faithfully, ADOLPHUS J. RICHARDSON, Assistant Physician to the Sussex County Hospital St. John’s-terrace, West Brighton, Sept. 24th, 1895.
with
To the Editors of THE LANCET. SiRs,-Dr. Phear, in his paper upon the occurrence of a presystolic murmur without mitral stenosis, mentions the
"THE PHYSIOLOGY OF DEATH BY
presence of thickened and shortened chordæ tendineæ in his ELECTRIC SHOCK." cases, and suggests that, although the mitral orifice was To the Editors of THE LANCET. of normal size, a virtual stenosis may havebeen produced during diastole by the reaction of these shortened SIRs,-The note which you inserted immediately after my cords upon the edges of the mitral flaps. Although mitral 1( letter1 calls attention to a fact with which I have long been stenosis may generally be said to be as much a disease acquainted a and of which I venture to think a complete of the chordæ tendineas as of the flaps of the mitral eexplanation can be given. I must, however, premise my
r. may undoubtedly occur in which some remarks by calling attention to the fact that it is an error to and shortening of the chordæ tendinefe exist s that I regarded death from electric shock as. suppose without any associated narrowing of the mitral orifice. Only " simply a violent disturbance of the normal magnetic lines o flow through the body," although such disturbance mustto-day I made a post-mortem examination upon such a case. of o What I said was "that it is impossible to separate While, however, I believe in the possibility of such a lesion occur. I do not think that this shortening of the chordae tendineae the t physics of the cause of death from electric shock from can easily produce the virtual narrowing of the mitral orifice t the physics which are continuously operating to mainthat Dr. Phear supposes may be present during diastole. tain t the phenomena of life." I then proceeded to show When the edges of the mitral flaps remain quite flexible it that t the passage of the arterial blood over the nerves seems reasonable to conclude that the orifice will maintain other conductors of impressions, in proportion to the a and its full circumference while blood is flowing from the auricle coxyhæmoglobin present, which is a highly magnetic subto the ventricle, since during the time the flow continues the stance, a gives rise to currents of energy through the pressure upon the auricular surface of the flaps must nerves which from their effects appear to be of the be greater than upon the ventricular. Dr. Phear states thatsame character as the currents of energy obtained by passingartificial traction upon the musculi papillares will demon-an a electric current through a nerve or muscle. This strate how the flaps can be drawn down and the orifice (conclusion is in accordance with the generally received opinion narrowed. It is doubtless true that the mitral orifice can be that t electricity and magnetism are manifestations of one and narrowed by such traction, but the excess of tension is upon the i same force. Thus, in the case of death from electric the ventricular edges of the flaps in such a case, and beforeshock and in the process of life under normal conditions the this state of tension could be reached in the ventricle duringactive cause of the phenomena is found to be the same, the c diastole it seems to me that the flow of blood from different result in each case being due to the different degree the auricle would cease. Allowing, however, that suchiin which the force was present. My remarks about the a condition could be present, it could only occurmagnetic lines of force through the body due to the magnetism when the ventricle had become filled or nearlv filled of the earth do not materially affect this argument. They with blood-in other words, the virtual stenosis would occur were intended to elucidate one of the causes of the magnetic towards the end of diastole and the murmur it occasioned beenergy possessed by the corpuscles of the arterial blood. presystolic in time. But in one of Dr. Phear’s cases the Before passing on I may mention that I did not wish to murmur was sometimes early diastolic in time. This murmur imply that an electric charge might not enter the body at any could hardly have been produced by a virtual stenosis of fpoint and in doing so by its disruptive effects be productive of the character he suggests. In closing I may say that since such lesions as would necessarily prove fatal. My observareading Dr. Phear’s paper I have examined the mitral orifice tions were directed more especially to showing the cause of of the heart from the case of presystolic murmur occurring the phenomena recorded by Dr. A. M. Bleile. with disease of the aortic orifice recorded by me in THE I now come to the explanation of the facts brought forward LANCET. There can be no suspicion of shortened chords in your note. You say that if death from electric shock tendineag being the cause of the murmur in that case. Not were simply a violent disturbance of the normal magneticonly do I not believe that the veine fluide theory will explain lines of flow through the body, we should at least expect anomalous presystolic murmurs, but the true presystolic marked effects in animals placed in strong murmur is often of such peculiar character and so different magnetic fields of large electro-magnets, for under these from other murmurs that it seems possible that its true conditions the lines of magnetic flow through the body are explanation has yet to be discovered. completely altered. No such effects, however, are manifest, I am, Sirs, yours truly, the man or animal placed under such conditions being comPembroke-road, Clifton, Sept. 24th, 1895. THEODORE FISHER. pletely unconscious that anything abnormal is going on." I must in the first place direct attention to some well-known facts of magnetism and electricity. 1. Every form of matter has what may be called its own specific capacity for "HOSPITAL ABUSE AT BRIGHTON." magnetic energy. In other words, every form of matter, To the Editors of THE LANCET. when suspended in a magnetic field, assumes a definite axial SIRS,—In your issue of Sept. 21st you quote from a letterinclination with reference to the poles of the magnet, which of Dr. Waring with respect to hospital abuse at Brighton. is peculiar to itself ; and in accordance with its axial Whilst fully endorsing your view as to the kindly spirit in inclination any particular substance is termed magnetic or which the letter is written, yet as regards the most irn- diamagnetic. 2. This magnetic capacity is most apparent portant charity mentioned there are additional facts which in soft iron. In iron, therefore, we shall find the clearest may modify the judgment of many. 1. The Sussex County 1 THE LANCET, Sept. 14th, 1895. Hospital received during the first six months of this year
valve,
cases
thickening
"
physiological
The observation raises
809
3 35’8 per cent. of its in-patients and 21 per cent. of its outfrom the county, as opposed to Brighton and p patients I Hove. Hence the patients are drawn from a population of considerably over 150,000. 1 2. In the annual’ r for the year ending 1894 the following parareport occurs: "A searching scrutiny was made this g graph y year by a subcommittee, which showed that 96 per of the cases (out-patients) were entirely fit and c cent. rproper subjects for gratuitous treatment, and though in t the remaining 4 per cent. sufficient information could not be it was thought that even in these cases, were closer c obtained, s scrutiny possible, it might be shown that several could be r without any abuse of the charity." May I suggest received t that the primary cause of hospital abuse is the carelessness which subscribers give their tickets. I am, Sirs, yours faithfully, ADOLPHUS J. RICHARDSON, Assistant Physician to the Sussex County Hospital St. John’s-terrace, West Brighton, Sept. 24th, 1895.
with
To the Editors of THE LANCET. SiRs,-Dr. Phear, in his paper upon the occurrence of a presystolic murmur without mitral stenosis, mentions the
"THE PHYSIOLOGY OF DEATH BY
presence of thickened and shortened chordæ tendineæ in his ELECTRIC SHOCK." cases, and suggests that, although the mitral orifice was To the Editors of THE LANCET. of normal size, a virtual stenosis may havebeen produced during diastole by the reaction of these shortened SIRs,-The note which you inserted immediately after my cords upon the edges of the mitral flaps. Although mitral 1( letter1 calls attention to a fact with which I have long been stenosis may generally be said to be as much a disease acquainted a and of which I venture to think a complete of the chordæ tendineas as of the flaps of the mitral eexplanation can be given. I must, however, premise my
r. may undoubtedly occur in which some remarks by calling attention to the fact that it is an error to and shortening of the chordæ tendinefe exist s that I regarded death from electric shock as. suppose without any associated narrowing of the mitral orifice. Only " simply a violent disturbance of the normal magnetic lines o flow through the body," although such disturbance mustto-day I made a post-mortem examination upon such a case. of o What I said was "that it is impossible to separate While, however, I believe in the possibility of such a lesion occur. I do not think that this shortening of the chordae tendineae the t physics of the cause of death from electric shock from can easily produce the virtual narrowing of the mitral orifice t the physics which are continuously operating to mainthat Dr. Phear supposes may be present during diastole. tain t the phenomena of life." I then proceeded to show When the edges of the mitral flaps remain quite flexible it that t the passage of the arterial blood over the nerves seems reasonable to conclude that the orifice will maintain other conductors of impressions, in proportion to the a and its full circumference while blood is flowing from the auricle coxyhæmoglobin present, which is a highly magnetic subto the ventricle, since during the time the flow continues the stance, a gives rise to currents of energy through the pressure upon the auricular surface of the flaps must nerves which from their effects appear to be of the be greater than upon the ventricular. Dr. Phear states thatsame character as the currents of energy obtained by passingartificial traction upon the musculi papillares will demon-an a electric current through a nerve or muscle. This strate how the flaps can be drawn down and the orifice (conclusion is in accordance with the generally received opinion narrowed. It is doubtless true that the mitral orifice can be that t electricity and magnetism are manifestations of one and narrowed by such traction, but the excess of tension is upon the i same force. Thus, in the case of death from electric the ventricular edges of the flaps in such a case, and beforeshock and in the process of life under normal conditions the this state of tension could be reached in the ventricle duringactive cause of the phenomena is found to be the same, the c diastole it seems to me that the flow of blood from different result in each case being due to the different degree the auricle would cease. Allowing, however, that suchiin which the force was present. My remarks about the a condition could be present, it could only occurmagnetic lines of force through the body due to the magnetism when the ventricle had become filled or nearlv filled of the earth do not materially affect this argument. They with blood-in other words, the virtual stenosis would occur were intended to elucidate one of the causes of the magnetic towards the end of diastole and the murmur it occasioned beenergy possessed by the corpuscles of the arterial blood. presystolic in time. But in one of Dr. Phear’s cases the Before passing on I may mention that I did not wish to murmur was sometimes early diastolic in time. This murmur imply that an electric charge might not enter the body at any could hardly have been produced by a virtual stenosis of fpoint and in doing so by its disruptive effects be productive of the character he suggests. In closing I may say that since such lesions as would necessarily prove fatal. My observareading Dr. Phear’s paper I have examined the mitral orifice tions were directed more especially to showing the cause of of the heart from the case of presystolic murmur occurring the phenomena recorded by Dr. A. M. Bleile. with disease of the aortic orifice recorded by me in THE I now come to the explanation of the facts brought forward LANCET. There can be no suspicion of shortened chords in your note. You say that if death from electric shock tendineag being the cause of the murmur in that case. Not were simply a violent disturbance of the normal magneticonly do I not believe that the veine fluide theory will explain lines of flow through the body, we should at least expect anomalous presystolic murmurs, but the true presystolic marked effects in animals placed in strong murmur is often of such peculiar character and so different magnetic fields of large electro-magnets, for under these from other murmurs that it seems possible that its true conditions the lines of magnetic flow through the body are explanation has yet to be discovered. completely altered. No such effects, however, are manifest, I am, Sirs, yours truly, the man or animal placed under such conditions being comPembroke-road, Clifton, Sept. 24th, 1895. THEODORE FISHER. pletely unconscious that anything abnormal is going on." I must in the first place direct attention to some well-known facts of magnetism and electricity. 1. Every form of matter has what may be called its own specific capacity for "HOSPITAL ABUSE AT BRIGHTON." magnetic energy. In other words, every form of matter, To the Editors of THE LANCET. when suspended in a magnetic field, assumes a definite axial SIRS,—In your issue of Sept. 21st you quote from a letterinclination with reference to the poles of the magnet, which of Dr. Waring with respect to hospital abuse at Brighton. is peculiar to itself ; and in accordance with its axial Whilst fully endorsing your view as to the kindly spirit in inclination any particular substance is termed magnetic or which the letter is written, yet as regards the most irn- diamagnetic. 2. This magnetic capacity is most apparent portant charity mentioned there are additional facts which in soft iron. In iron, therefore, we shall find the clearest may modify the judgment of many. 1. The Sussex County 1 THE LANCET, Sept. 14th, 1895. Hospital received during the first six months of this year
valve,
cases
thickening
"
physiological