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SLEEPING SICKNESS: A DISCLAIMER.
1257 stretch"may be doubtless true in the case of spasmodic asthma or in hypertrophous emphysema, where the pulmonary suction is abolished or nearly so, but in normal
breathing,
matters
are
precisely
the
reverse,
as
herein,
members of our Liverpool school ever made such a statement. We have not sent any expeditions from Liverpool to the sleeping-sickness area with the exception of the expedition very recently ent to the Congo. I would be much obliged if you could give publicity to this statement. I am, Sirs, yours faithfully, RUBERT BOYCE. University of Liverpool, Oct. 23rd, 1903.
instead of the inspiratory muscles acting to tone up the pulmonary fibres, their action is directed towards overcoming this tonus. It is only when a lelaxation of lung occurs to such an extent as to pass the indifferent point that the inspiratory muscles are necessarily THE UNIVERSITIES’ MISSION TO called into play in the direction of"toning up"the CENTRAL AFRICA. lung fibres. It was certainly the original view, as propounded by Hutchinson, that the inspiratory muscles To the Editors of THE LANCET. acted in the normal respiration not only in overcoming SIRS,—I have been asked on behalf of the Bishop of the elastic resistance of the lungs but also a resistance on the part of the chest walls. But some time afterwards Zanzibar (the Right Rev. J. E. Hine, M.D.) to make known Salter2 made the important observation above referred to the great need that exibts in his diocese for the services of a fully qualified medical practitioner. In a letter received on the elastic recoil of the chest wall following post-mortem within the last few weeks the Bixhop writes :of the and this was puncture pleura, accurately resiliency After completing a visit of some duration in the Magila archdeaconry estimated subsequently in a number of very careful experiI ,see more clearly than before what an opening there is here for a ments by Sir R. Douglas Powell.3 Dr. When, therefore, doctor and what a useful work he could do in this part of the country. Campbell makes the general assertion thatany enlargement Wherever I go, whether to Msalabani, or Kologwe, or into the interior, of the chest ...... is chiefly brought about by the inspiratory I have people coming to me seeking medical or surgical treatment, cases often of conbiderable scientific interest. muscles," he fails to appreciate that enlargement (up to a genuine At Kologwe in this last week I had to do quite a succession of operacertain point) which is brought about by the reserve recoil of tions and there were other cases needing longer and careful attention which I could not, owing to lack of time, undertake with any hope of the chest walls. As regards the lung reflex, once it be proved that bronchial benefit to them. A resident surgeon (resident in the district I mean) would have now a larger area to travel over than was the (and therefore pulmonary) dilatation can be induced by case some years agoconsiderably when Dr. Ley was alive. The people all prefer to stimuli applied to the chest wall or otherwise, it is a matter come for treatment to the mission or to the mission dispensaries of secondary consequence how far the in’piratory muscles rather than to go to the German Government Hospital at Tanga, though it no doubt is. With our present staff of nurses thereafter contribute to the thoracic enlargement, but Dr. excellent there ought to be no difficulty in a competent man undertaking cases so far as to that the entire assert phenomena of the gravest nature. In the Likoma diocese I had the valuable Campbell goes of the lung reflex may in fact be due to reflex excitement of help of Dr. R. Howard and his work, I hear, is always increasing as people on the lake shores get to understand and to value the the inspiratory muscles themselves. Now, in regard to the the We want another skilled treatment receive at his hands. chest generally, it is doubtless true that such a procedure as .ur. Howard here atthey Magila ; ne would nnd plenty to do and possibly a investigate of scientific interest, as well as very practically vigorous rubbing tends to induce, if not dyspncea, at least a good dealtheto work of the mission. Such a doctor must, of course, be deeper character of the breathing. In neurotic persons helping one in thorough sympathy with the church work that is carried on in this is sometimes very marked, but that this is chiefly the the and should have to some degree the missionary vocation he country result of a reflex pulmonary relaxation is shown by examin- himself, though he would not be required to do anything else except calling. ing the state of the lungs and comparing the same with to pursue his own particular health of the European staff to be considered. That, the effect produced by simply getting the patient to draw 1 There is alsoa the too, requires resident doctor, so that in severe cases it may not again a number of deep breaths. In the former case there is a be 1 necessary to cable to Zanzibar for assistance or to send down to distension of lung which persists for some time after theTanga on the possible chance of being able to call in the German who is sometimes to be found there. If those who are in touch breathing has become quiet, whereas in the latter case thedoctor with hospitals or with young surgeons recently qualified could bring distension subsides with the breathing ; in other words, the this 1 want before them it is not unlikely that someone might be found mean size of the chest is more persistently enlarged when who would be willing to offer himself for the work. the lung reflex is induced, and if the cutaneous stimulus be I should be most glad to give further and more detailed maintained for some time this expansion is correspondingly information to who may desire it. any maintained. The conclusive evidence, however, as to the OSWALD A. BROWNE, M.D. Lond., existence of the lung reflex of dilatation is that afforded by Member of the Medical Board of the Universities’ the application of stimuli over small areas of lung which Mission to Central Africa. 9, Dartmouth-street, Westminster, S.W., Oct. 26th, 1903. have been invaded by collapse. If such a small area be irritated, as by spraying with ether, it will be found that the percussion note, formerly dull, will acquire some resonance, and I SMALL-POX IN TASMANIA. have observed that the same effect is frequently produced by To the Editors of THE LANCET. prolonged percussion over the area. Now such an effect over a limited area, say at the base of the lung, is only observe in THE LANCET of Oct. 17th, p. 1132, a SIRS,-I " susceptible of one explanation-viz., a reflex dilatation of the paragraph headed " Small-pox in Tasmania I may mention If dilatation were a the air cells. the that outbreak to refer was confined which collapsed produced by you entirely to dyspneea involving the action of the inspiratory muscles the the city of Launceston. It has now been altogether stamped remaining portions of the lungs would likewise be dilated, out I have been advised by cable that the last case of whereas no dyspnoea is apparently produced nor are the lungs small-pox occurred on Sept. 3rd and that the quarantine otherwise altered in volume. restrictions which had existed for a short time in Australasia As regards the reflex of dilatation which is induced by the against Tasmania have now been removed. As this subject inhalation of certain irritating vapours and which Dr. may interest some of your readers I shall esteem it a favour ’Campbell believes to be merely an effect of inspiration, it if you will kindly insert the above information in your next I am, Sirs, yours faithfully, may be sufficient to point out that the reflex of dilatation issue. can also be brought about by the oral administration or the ALFRED DOBSON, subcutaneous injection of such drugs as atropine and Agent-General. Victoria-street, Westminster, S.W., Oct. 22nd, 1903. hyoscine wherein inspiratory effort is wanting. I am, Sirs, yours faithfully, A. G. AULD. Henrietta-street, W., Oct. 24th, 1903. PROPOSED MEMORIAL TO THE NURSES
I
WHO DIED ON ACTIVE SERVICE IN THE SOUTH AFRICAN WAR.
SLEEPING SICKNESS: A DISCLAIMER. To the
Editors of THE LANCET. To the Editors of THE LANCET. have just learnt that I have been credited with the statement, made in certain newspapers this week, that SIRS,-Nearly two years have elapsed since the conclusion a Liverpool student discovered the cause of sleeping sick- I of the war in South Africa and a duty still remains to be I did not make any such statement, nor have any of the fulfilled which we venture to commend to the generous ness. sympathy of the whole nation. While all honour has been 1 Transactions of the Royal Medical and Chirurgical Society, accorded to the nurses who have returned from active service vol. xxix., p. 137. and acknowledgment has been made of the value of their 2 THE LANCET, August 5th, 1865, p. 141. work by the award of orders and decorations, nothing has 3 Transactions of the Royal Medical and Chirurgical Society, vol. lix., been done to express the nation’s appreciation of the devotion p. 165.
SIRS,-I
I
I I
breathing,
matters
are
precisely
the
reverse,
as
herein,
members of our Liverpool school ever made such a statement. We have not sent any expeditions from Liverpool to the sleeping-sickness area with the exception of the expedition very recently ent to the Congo. I would be much obliged if you could give publicity to this statement. I am, Sirs, yours faithfully, RUBERT BOYCE. University of Liverpool, Oct. 23rd, 1903.
instead of the inspiratory muscles acting to tone up the pulmonary fibres, their action is directed towards overcoming this tonus. It is only when a lelaxation of lung occurs to such an extent as to pass the indifferent point that the inspiratory muscles are necessarily THE UNIVERSITIES’ MISSION TO called into play in the direction of"toning up"the CENTRAL AFRICA. lung fibres. It was certainly the original view, as propounded by Hutchinson, that the inspiratory muscles To the Editors of THE LANCET. acted in the normal respiration not only in overcoming SIRS,—I have been asked on behalf of the Bishop of the elastic resistance of the lungs but also a resistance on the part of the chest walls. But some time afterwards Zanzibar (the Right Rev. J. E. Hine, M.D.) to make known Salter2 made the important observation above referred to the great need that exibts in his diocese for the services of a fully qualified medical practitioner. In a letter received on the elastic recoil of the chest wall following post-mortem within the last few weeks the Bixhop writes :of the and this was puncture pleura, accurately resiliency After completing a visit of some duration in the Magila archdeaconry estimated subsequently in a number of very careful experiI ,see more clearly than before what an opening there is here for a ments by Sir R. Douglas Powell.3 Dr. When, therefore, doctor and what a useful work he could do in this part of the country. Campbell makes the general assertion thatany enlargement Wherever I go, whether to Msalabani, or Kologwe, or into the interior, of the chest ...... is chiefly brought about by the inspiratory I have people coming to me seeking medical or surgical treatment, cases often of conbiderable scientific interest. muscles," he fails to appreciate that enlargement (up to a genuine At Kologwe in this last week I had to do quite a succession of operacertain point) which is brought about by the reserve recoil of tions and there were other cases needing longer and careful attention which I could not, owing to lack of time, undertake with any hope of the chest walls. As regards the lung reflex, once it be proved that bronchial benefit to them. A resident surgeon (resident in the district I mean) would have now a larger area to travel over than was the (and therefore pulmonary) dilatation can be induced by case some years agoconsiderably when Dr. Ley was alive. The people all prefer to stimuli applied to the chest wall or otherwise, it is a matter come for treatment to the mission or to the mission dispensaries of secondary consequence how far the in’piratory muscles rather than to go to the German Government Hospital at Tanga, though it no doubt is. With our present staff of nurses thereafter contribute to the thoracic enlargement, but Dr. excellent there ought to be no difficulty in a competent man undertaking cases so far as to that the entire assert phenomena of the gravest nature. In the Likoma diocese I had the valuable Campbell goes of the lung reflex may in fact be due to reflex excitement of help of Dr. R. Howard and his work, I hear, is always increasing as people on the lake shores get to understand and to value the the inspiratory muscles themselves. Now, in regard to the the We want another skilled treatment receive at his hands. chest generally, it is doubtless true that such a procedure as .ur. Howard here atthey Magila ; ne would nnd plenty to do and possibly a investigate of scientific interest, as well as very practically vigorous rubbing tends to induce, if not dyspncea, at least a good dealtheto work of the mission. Such a doctor must, of course, be deeper character of the breathing. In neurotic persons helping one in thorough sympathy with the church work that is carried on in this is sometimes very marked, but that this is chiefly the the and should have to some degree the missionary vocation he country result of a reflex pulmonary relaxation is shown by examin- himself, though he would not be required to do anything else except calling. ing the state of the lungs and comparing the same with to pursue his own particular health of the European staff to be considered. That, the effect produced by simply getting the patient to draw 1 There is alsoa the too, requires resident doctor, so that in severe cases it may not again a number of deep breaths. In the former case there is a be 1 necessary to cable to Zanzibar for assistance or to send down to distension of lung which persists for some time after theTanga on the possible chance of being able to call in the German who is sometimes to be found there. If those who are in touch breathing has become quiet, whereas in the latter case thedoctor with hospitals or with young surgeons recently qualified could bring distension subsides with the breathing ; in other words, the this 1 want before them it is not unlikely that someone might be found mean size of the chest is more persistently enlarged when who would be willing to offer himself for the work. the lung reflex is induced, and if the cutaneous stimulus be I should be most glad to give further and more detailed maintained for some time this expansion is correspondingly information to who may desire it. any maintained. The conclusive evidence, however, as to the OSWALD A. BROWNE, M.D. Lond., existence of the lung reflex of dilatation is that afforded by Member of the Medical Board of the Universities’ the application of stimuli over small areas of lung which Mission to Central Africa. 9, Dartmouth-street, Westminster, S.W., Oct. 26th, 1903. have been invaded by collapse. If such a small area be irritated, as by spraying with ether, it will be found that the percussion note, formerly dull, will acquire some resonance, and I SMALL-POX IN TASMANIA. have observed that the same effect is frequently produced by To the Editors of THE LANCET. prolonged percussion over the area. Now such an effect over a limited area, say at the base of the lung, is only observe in THE LANCET of Oct. 17th, p. 1132, a SIRS,-I " susceptible of one explanation-viz., a reflex dilatation of the paragraph headed " Small-pox in Tasmania I may mention If dilatation were a the air cells. the that outbreak to refer was confined which collapsed produced by you entirely to dyspneea involving the action of the inspiratory muscles the the city of Launceston. It has now been altogether stamped remaining portions of the lungs would likewise be dilated, out I have been advised by cable that the last case of whereas no dyspnoea is apparently produced nor are the lungs small-pox occurred on Sept. 3rd and that the quarantine otherwise altered in volume. restrictions which had existed for a short time in Australasia As regards the reflex of dilatation which is induced by the against Tasmania have now been removed. As this subject inhalation of certain irritating vapours and which Dr. may interest some of your readers I shall esteem it a favour ’Campbell believes to be merely an effect of inspiration, it if you will kindly insert the above information in your next I am, Sirs, yours faithfully, may be sufficient to point out that the reflex of dilatation issue. can also be brought about by the oral administration or the ALFRED DOBSON, subcutaneous injection of such drugs as atropine and Agent-General. Victoria-street, Westminster, S.W., Oct. 22nd, 1903. hyoscine wherein inspiratory effort is wanting. I am, Sirs, yours faithfully, A. G. AULD. Henrietta-street, W., Oct. 24th, 1903. PROPOSED MEMORIAL TO THE NURSES
I
WHO DIED ON ACTIVE SERVICE IN THE SOUTH AFRICAN WAR.
SLEEPING SICKNESS: A DISCLAIMER. To the
Editors of THE LANCET. To the Editors of THE LANCET. have just learnt that I have been credited with the statement, made in certain newspapers this week, that SIRS,-Nearly two years have elapsed since the conclusion a Liverpool student discovered the cause of sleeping sick- I of the war in South Africa and a duty still remains to be I did not make any such statement, nor have any of the fulfilled which we venture to commend to the generous ness. sympathy of the whole nation. While all honour has been 1 Transactions of the Royal Medical and Chirurgical Society, accorded to the nurses who have returned from active service vol. xxix., p. 137. and acknowledgment has been made of the value of their 2 THE LANCET, August 5th, 1865, p. 141. work by the award of orders and decorations, nothing has 3 Transactions of the Royal Medical and Chirurgical Society, vol. lix., been done to express the nation’s appreciation of the devotion p. 165.
SIRS,-I
I
I I