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SURGERY OF ELONGATED PELVIC COLON.
358
only hope that the labours of the Committee Pathological Society will result in something more tangible and a better definition as to what exactly is to be understood under the term status lymphaticus.-I am, Sir, yours faithfully, We
can
of the
JAMES MILLER. Queen’s University, Kingston, Canada, July 29th, 1926.
SURGERY OF ELONGATED To the Editor
PELVIC
COLON.
THE LANCET.
of SIR,—Mr. E. G. Slesinger’s
paper on this subject in your last issue will create widespread interest. The elongated pelvic colon is a serious cause of stasis. In its extreme form the elongation is enormous and is an insuperable obstacle to successful treatment. Its surgical removal offers great attraction, and Mr. Slesinger’s cases prove that success may follow resection of redundant bowel with end-to-end union. But success is not invariable. I have records of a good many X ray observations after resection (for Union is perfect, but cancer, diverticulitis, &c.).
function remains imperfect and does not improve with time. There is a break in peristaltic continuity, due to division of Auerbach’s plexus. The peristaltic waves do not bridge the gap. Fæces accumulate at the union until enough has been thrust through to start an independent wave in the distal section. Mr. Slesinger gets over this difficulty by giving paraffin and by enemata if paraffin fails. My own conviction is that a case severe enough to warrant surgery is best treated by complete colectomy, for then the distal section receives no solid matter and cannot become obstructed. I am well aware that colectomy is a serious responsibility. If Mr. Slesinger’s less drastic operation can be made to succeed, it will be a boon indeed.-I am, Sir, yours faithfully. ALFRED C. JORDAN.
and states the kind and number of drinks he has had. He breaks the convention in a way he would not do when sober ; he wears his hat indoors, sits when he should stand, smokes without permission, and is familiar and facetious. He is talkative and argumentative, and may wander off to irrelevant subjects. He loses control of his emotions and becomes maudlin or too genial. When these mental symptoms are combined with muscular incoordination there is no doubt about the diagnosis. When, however, the mental symptoms are present without motor derangement the suspected person is often said to be under the influence of drink but not drunk. This phrase is misleading and is better avoided. It led to the acquittal of Dr. Spriggs’s " drunken " motorist and has been equally serviceable to many another drunken man. It is probable that half the adult population is under the influence of alcohol at some time in the day, but not every person so influenced is drunk. If, however, the mental effects of alcohol can be readily detected, not only is the subject under the influence of drink, but according to my definition he is drunk. He may be steady on his legs and correct in his speech, but his sense of responsibility, his judgment, his estimation of distances, and his caution are all gravely impaired and replaced by a reckless sense of well-being and disregard of danger which make him a greater menace to society than any person who is drunk and incapable. I am, Sir, yours faithfully, G. A. WILKES.
DEFENCE
OF ASSISTANTS TENENTS.
LOCUM
AND
To the Editor
SIR,—I
am
of THE LANCET. instructed by the Council of the
Medical and Dental Defence Union of Scotland Limited to bring before the notice of your readers the fact that this Union, which enrols medical and dental practitioners in any part of Great Britain and THE DEFINITION OF DRUNKENNESS. Northern Ireland, has always accepted responsibility To the Editor of THE LANCET. for the acts of their member’s assistant or locum tenent. therefore, a claim is made, or an action raised SIR,—As a police surgeon it is my unpleasant duty If, a member of this Union in respect of a against to examine persons accused of drunkenness, and like (or alleged negligent) act of his assistant or Dr. N. I. Spriggs I have been unable to find a satis- negligent locum the Union will defend the case. The tenent, factory definition of the condition. Union’s insurance scheme, under which indemnity The committee appointed by the British Medical members are in the event of an action protected for to consider the tests drunkenness Association them defended, also against being unsuccessfully will doubtless formulate a concise and comprehensive covers the member, not only against his own Meanwhile I define drunkenness as an definition. but that of his assistant or locum tenent. obvious impairment of the functions of the nervous negligence, I am. Sir. vours faithfullv. system due to alcohol. Alcohol disturbs first the W. FINDLAY, higher intellectual faculties, then the motor centres. Secretary and Treasurer to the Union. If a suspected person sways or staggers in his gait, .
slurs his speech, or makes clumsy and ill-adjusted movements when he sits down, handles his cigarette case or other familiar things, I assume that there is a disturbance in equilibrium in the coordination of the muscles. This loss of control of the motor mechanism, when due to alcohol, indicates a more pronounced impairment of the higher functions of the brain and is definite evidence of drunkenness. And as arrests for drunkenness are rarely made unless the suspected person smells of alcohol, and has the muscular incoordination and disorderly behaviour peculiar to alcohol, very few sober people are taken into custody. When there are no motor symptoms, and one has to rely on mental changes only, drunkenness is not always easy to detect, for the medical man does not know the normal condition of the drinker, and has The mental derangement no standard of comparison. which attends the slighter forms of intoxication is usually revealed by the self-satisfied behaviour of the affected person. The drunken man is pleased with himself and his conduct ; he has a diminished sense of his responsibility, and if a motorist makes light of any accident that may haveoccasioned his arrest. Although accused of drunkenness he loses his caution,
CERTIFICATION OF INJURY UNDER THE WORKMEN’S COMPENSATION ACT. To the Editor
of THE LANCET. SIR,—I see from your report of the Representative Meeting (THE LANCET, July 31st, p. 229) that the British Medical Association is considering a form of certificate to be issued to injured employees at the request of the employer, who acts on the instructions
This question has of the insurance company. interested me for some years, and I made inquiries about it from two solicitors, one barrister, and one representative of an insurance company who was calling on me in reference to insurance work. The first three said the employer had no right to ask for a certificate from the employee ; the insurance man said, as nearly as I can recall his words, I am giving the show away, but we have no power to ask for a certificate." The employer has the right to have the employee examined at his own expense. I believe there is nothing in the Acts requiring the employee to go to a medical man. If my contention is correct, "
only hope that the labours of the Committee Pathological Society will result in something more tangible and a better definition as to what exactly is to be understood under the term status lymphaticus.-I am, Sir, yours faithfully, We
can
of the
JAMES MILLER. Queen’s University, Kingston, Canada, July 29th, 1926.
SURGERY OF ELONGATED To the Editor
PELVIC
COLON.
THE LANCET.
of SIR,—Mr. E. G. Slesinger’s
paper on this subject in your last issue will create widespread interest. The elongated pelvic colon is a serious cause of stasis. In its extreme form the elongation is enormous and is an insuperable obstacle to successful treatment. Its surgical removal offers great attraction, and Mr. Slesinger’s cases prove that success may follow resection of redundant bowel with end-to-end union. But success is not invariable. I have records of a good many X ray observations after resection (for Union is perfect, but cancer, diverticulitis, &c.).
function remains imperfect and does not improve with time. There is a break in peristaltic continuity, due to division of Auerbach’s plexus. The peristaltic waves do not bridge the gap. Fæces accumulate at the union until enough has been thrust through to start an independent wave in the distal section. Mr. Slesinger gets over this difficulty by giving paraffin and by enemata if paraffin fails. My own conviction is that a case severe enough to warrant surgery is best treated by complete colectomy, for then the distal section receives no solid matter and cannot become obstructed. I am well aware that colectomy is a serious responsibility. If Mr. Slesinger’s less drastic operation can be made to succeed, it will be a boon indeed.-I am, Sir, yours faithfully. ALFRED C. JORDAN.
and states the kind and number of drinks he has had. He breaks the convention in a way he would not do when sober ; he wears his hat indoors, sits when he should stand, smokes without permission, and is familiar and facetious. He is talkative and argumentative, and may wander off to irrelevant subjects. He loses control of his emotions and becomes maudlin or too genial. When these mental symptoms are combined with muscular incoordination there is no doubt about the diagnosis. When, however, the mental symptoms are present without motor derangement the suspected person is often said to be under the influence of drink but not drunk. This phrase is misleading and is better avoided. It led to the acquittal of Dr. Spriggs’s " drunken " motorist and has been equally serviceable to many another drunken man. It is probable that half the adult population is under the influence of alcohol at some time in the day, but not every person so influenced is drunk. If, however, the mental effects of alcohol can be readily detected, not only is the subject under the influence of drink, but according to my definition he is drunk. He may be steady on his legs and correct in his speech, but his sense of responsibility, his judgment, his estimation of distances, and his caution are all gravely impaired and replaced by a reckless sense of well-being and disregard of danger which make him a greater menace to society than any person who is drunk and incapable. I am, Sir, yours faithfully, G. A. WILKES.
DEFENCE
OF ASSISTANTS TENENTS.
LOCUM
AND
To the Editor
SIR,—I
am
of THE LANCET. instructed by the Council of the
Medical and Dental Defence Union of Scotland Limited to bring before the notice of your readers the fact that this Union, which enrols medical and dental practitioners in any part of Great Britain and THE DEFINITION OF DRUNKENNESS. Northern Ireland, has always accepted responsibility To the Editor of THE LANCET. for the acts of their member’s assistant or locum tenent. therefore, a claim is made, or an action raised SIR,—As a police surgeon it is my unpleasant duty If, a member of this Union in respect of a against to examine persons accused of drunkenness, and like (or alleged negligent) act of his assistant or Dr. N. I. Spriggs I have been unable to find a satis- negligent locum the Union will defend the case. The tenent, factory definition of the condition. Union’s insurance scheme, under which indemnity The committee appointed by the British Medical members are in the event of an action protected for to consider the tests drunkenness Association them defended, also against being unsuccessfully will doubtless formulate a concise and comprehensive covers the member, not only against his own Meanwhile I define drunkenness as an definition. but that of his assistant or locum tenent. obvious impairment of the functions of the nervous negligence, I am. Sir. vours faithfullv. system due to alcohol. Alcohol disturbs first the W. FINDLAY, higher intellectual faculties, then the motor centres. Secretary and Treasurer to the Union. If a suspected person sways or staggers in his gait, .
slurs his speech, or makes clumsy and ill-adjusted movements when he sits down, handles his cigarette case or other familiar things, I assume that there is a disturbance in equilibrium in the coordination of the muscles. This loss of control of the motor mechanism, when due to alcohol, indicates a more pronounced impairment of the higher functions of the brain and is definite evidence of drunkenness. And as arrests for drunkenness are rarely made unless the suspected person smells of alcohol, and has the muscular incoordination and disorderly behaviour peculiar to alcohol, very few sober people are taken into custody. When there are no motor symptoms, and one has to rely on mental changes only, drunkenness is not always easy to detect, for the medical man does not know the normal condition of the drinker, and has The mental derangement no standard of comparison. which attends the slighter forms of intoxication is usually revealed by the self-satisfied behaviour of the affected person. The drunken man is pleased with himself and his conduct ; he has a diminished sense of his responsibility, and if a motorist makes light of any accident that may haveoccasioned his arrest. Although accused of drunkenness he loses his caution,
CERTIFICATION OF INJURY UNDER THE WORKMEN’S COMPENSATION ACT. To the Editor
of THE LANCET. SIR,—I see from your report of the Representative Meeting (THE LANCET, July 31st, p. 229) that the British Medical Association is considering a form of certificate to be issued to injured employees at the request of the employer, who acts on the instructions
This question has of the insurance company. interested me for some years, and I made inquiries about it from two solicitors, one barrister, and one representative of an insurance company who was calling on me in reference to insurance work. The first three said the employer had no right to ask for a certificate from the employee ; the insurance man said, as nearly as I can recall his words, I am giving the show away, but we have no power to ask for a certificate." The employer has the right to have the employee examined at his own expense. I believe there is nothing in the Acts requiring the employee to go to a medical man. If my contention is correct, "