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SIR JAMES Y. SIMPSON AND ANÆSTHESIA.
1067 have been described as of the Landry type, have gone so far as to deny any clinical or pathological entity to Landry’s paralysis. But the present state of our knowledge does notjustify this generalisation, while it must not be forgotten that Farquhar Buzzard and others have recorded acute ascending motor paralysis cases of this in which the infective agent was not the virus of poliomyelitis. There are, besides, certain minor points in the type of motor palsy which are met with in Landry’s paralysis and not in cases
Correspondence. "Audi alteram
partem."
SIMPSON AND ANÆSTHESIA.
SIR JAMES Y.
To the Editor of THE LANCET.
and
some
SIR,-In his delightful Harveian Oration Sir poliomyelitis. As to the morbid agent in Dr. Butler’s cases, it is R. Douglas Powell attributes the discovery of anuesto hazard any suggestion. Whether it unwise thesia, to Sir James Y. Simpson. By a curious was toxic or infective must remain obscure, coincidence, on the very day on which I heard the
examination of the cerebro-spinal fluid address I received from Sir Alexander Simpson the although In have of considerable value. might proof sheets of a letter written in April, 1870, any case theproved one of condition was probably of in which Sir James to Dr. Bigelow, Boston, infection of the streams through ascending lymph Simpson repudiates anything so " wild or extrava- the cord and lower brain stem, involving spinal he used chloroform as that as an anaesgant" ether. Thirteen thetic before months had almost exclusively the ventral cornua of grey matter. of this specific action .elapsed; and later in the letter, discussing the is still The explanation unknown ; but in certain cases the rival claims of Jackson, Wells, and Morton, he decides in favour of Morton, saying that he was syphilitic virus has been found to invade the "the gentleman to whom I believe the profession ventral horns exclusively in a similar fashionand mankind are really and truly indebted for first so-called syphilitic poliomyelitis. A case of this sort, in which the pathological findings corroreducing into practice the production of insensi- borated the clinical view taken of the case, was bility by ether inhalation, with the object of published by Professor Leri, of Paris, and myself annihilating pain in surgical operations." The in the Nouvelle Iconographie de la Salpetrie°e .splendid work which Sir James Simpson did in (1904). those early days can never be forgotten, but it is Dr. Norman Butler is to be congratulated on the unjust to his memory to attribute to him, as is so often done in this country, a discovery which had precision with which he has worked out these two become"the blessed possession of the whole world" interesting cases, which are of undoubted docu{to use a phrase of Professor Welch) before the mentary value.-I am, Sir, yours faithfully, S. A. KINNIER WILSON. ,introduction of chloroform. I am,
Sir,
yours
faithfully, WILLIAM OSLER.
WANTED,
A
DIAGNOSIS.
SHELL WOUNDS IN MODERN NAVAL WARFARE. To the Editor of THE LANCET.
To the Editor of THE LANCET.
SIR,-Dr. Norman Butler’s two cases,, observed
reported in THE LANCET of Oct. 24th, .are so lucidly described as to make their diagnosis for the neurologist a matter of comparative simplicity. They belong to a group of acute toxiinfective diseases of the nervous system in which are distinguished four main subdivisions-acute ascending meningomyelitis, acute toxic polyneuritis, acute poliomyelitis or polioencephalomyelitis, and with
care
and
Landry’s paralysis. The first of these is excluded mainly by the absence of any sensory changes and the absence of any sphincter impairment of any duration. The second is excluded partly for a similar reason-viz., the absence of sensory symptoms or signs such as are constant in multiple neuritis, though it is true Dr. Butler’s second case had transient pains. The third class, acute poliomyelitis, is more difficult to exclude, for there is an ascending type the symptoms of which are not unlike those of Dr. Butler’s cases. Even in the ascending cases, however, the affection is not, as a rule, as symmetrical as it appears to have been in his, and, further, the excellence of the recovery in them is far from common
in universal poliomyelitis. Dr. Butler’s cases come most
readily under the category of Landry’s paralysis, acute ascending motor paralysis of central origin. It is true that in various recent epidemics of poliomyelitis ascending
SIR,-In the article with the above title which I jointly contributed to your issue of last week a mistake has crept in which I should be grateful if you would correct. The vaccine was not made by Messrs. Parke, Davis, and Co., but was prepared in the inoculation department of St. Mary’s Hospital and under the supervision of Sir Almroth Wright, who has generously sent a stock for Admiralty use through the Medical Director-General. I am, Sir, yours faithfully, BRYAN PICK, Staff-Surgeon, R.N.
THE
NATIONAL MEDICAL UNION AND THE £90,000 WINDFALL TO PANEL DOCTORS. To the Editor of THE LANCET.
SIR,-In the interest of the general public and the medical profession the council of the National Medical Union has deemed it expedient to lodge with the Insurance Commissioners a protest against the allotment of their ;S90,000 medical benefit surplus. This surplus has accrued because nearly a quarter of a million insured persons would not elect a panel doctor to attend them during illness, and because the authorities entrusted with the
Correspondence. "Audi alteram
partem."
SIMPSON AND ANÆSTHESIA.
SIR JAMES Y.
To the Editor of THE LANCET.
and
some
SIR,-In his delightful Harveian Oration Sir poliomyelitis. As to the morbid agent in Dr. Butler’s cases, it is R. Douglas Powell attributes the discovery of anuesto hazard any suggestion. Whether it unwise thesia, to Sir James Y. Simpson. By a curious was toxic or infective must remain obscure, coincidence, on the very day on which I heard the
examination of the cerebro-spinal fluid address I received from Sir Alexander Simpson the although In have of considerable value. might proof sheets of a letter written in April, 1870, any case theproved one of condition was probably of in which Sir James to Dr. Bigelow, Boston, infection of the streams through ascending lymph Simpson repudiates anything so " wild or extrava- the cord and lower brain stem, involving spinal he used chloroform as that as an anaesgant" ether. Thirteen thetic before months had almost exclusively the ventral cornua of grey matter. of this specific action .elapsed; and later in the letter, discussing the is still The explanation unknown ; but in certain cases the rival claims of Jackson, Wells, and Morton, he decides in favour of Morton, saying that he was syphilitic virus has been found to invade the "the gentleman to whom I believe the profession ventral horns exclusively in a similar fashionand mankind are really and truly indebted for first so-called syphilitic poliomyelitis. A case of this sort, in which the pathological findings corroreducing into practice the production of insensi- borated the clinical view taken of the case, was bility by ether inhalation, with the object of published by Professor Leri, of Paris, and myself annihilating pain in surgical operations." The in the Nouvelle Iconographie de la Salpetrie°e .splendid work which Sir James Simpson did in (1904). those early days can never be forgotten, but it is Dr. Norman Butler is to be congratulated on the unjust to his memory to attribute to him, as is so often done in this country, a discovery which had precision with which he has worked out these two become"the blessed possession of the whole world" interesting cases, which are of undoubted docu{to use a phrase of Professor Welch) before the mentary value.-I am, Sir, yours faithfully, S. A. KINNIER WILSON. ,introduction of chloroform. I am,
Sir,
yours
faithfully, WILLIAM OSLER.
WANTED,
A
DIAGNOSIS.
SHELL WOUNDS IN MODERN NAVAL WARFARE. To the Editor of THE LANCET.
To the Editor of THE LANCET.
SIR,-Dr. Norman Butler’s two cases,, observed
reported in THE LANCET of Oct. 24th, .are so lucidly described as to make their diagnosis for the neurologist a matter of comparative simplicity. They belong to a group of acute toxiinfective diseases of the nervous system in which are distinguished four main subdivisions-acute ascending meningomyelitis, acute toxic polyneuritis, acute poliomyelitis or polioencephalomyelitis, and with
care
and
Landry’s paralysis. The first of these is excluded mainly by the absence of any sensory changes and the absence of any sphincter impairment of any duration. The second is excluded partly for a similar reason-viz., the absence of sensory symptoms or signs such as are constant in multiple neuritis, though it is true Dr. Butler’s second case had transient pains. The third class, acute poliomyelitis, is more difficult to exclude, for there is an ascending type the symptoms of which are not unlike those of Dr. Butler’s cases. Even in the ascending cases, however, the affection is not, as a rule, as symmetrical as it appears to have been in his, and, further, the excellence of the recovery in them is far from common
in universal poliomyelitis. Dr. Butler’s cases come most
readily under the category of Landry’s paralysis, acute ascending motor paralysis of central origin. It is true that in various recent epidemics of poliomyelitis ascending
SIR,-In the article with the above title which I jointly contributed to your issue of last week a mistake has crept in which I should be grateful if you would correct. The vaccine was not made by Messrs. Parke, Davis, and Co., but was prepared in the inoculation department of St. Mary’s Hospital and under the supervision of Sir Almroth Wright, who has generously sent a stock for Admiralty use through the Medical Director-General. I am, Sir, yours faithfully, BRYAN PICK, Staff-Surgeon, R.N.
THE
NATIONAL MEDICAL UNION AND THE £90,000 WINDFALL TO PANEL DOCTORS. To the Editor of THE LANCET.
SIR,-In the interest of the general public and the medical profession the council of the National Medical Union has deemed it expedient to lodge with the Insurance Commissioners a protest against the allotment of their ;S90,000 medical benefit surplus. This surplus has accrued because nearly a quarter of a million insured persons would not elect a panel doctor to attend them during illness, and because the authorities entrusted with the