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THE ADMINISTRATION OF SALINE SOLUTIONS.
REVIEWS AND NOTICES OF BOOKS.-NEW INVENTIONS.
794
methods, their indications, and the results to be expected so far as our present experience goes. , Dr. Fox has himself written the section on hydrological methods and most of the remainder of the book, but he has been assisted by such authorities as Professor Tait McKenzie on mechanical methods and exercises, Dr. J. B. Mennell on massage, and Dr. F. Hernaman-Johnson on electrical treatment. Naturally in such subjects, which are comparatively new to the profession at large, there will arise criticism of detail. For example, the mechanical exercisers, usually named after Zander, which Dr. Fox describes, have found but few advocates in this country. But it is only right that the knowledge of these methods should be widely diffused, so that everyone may try them and form their own conclusions, and Dr., Fox makes no miraculous claims for any method but only asks for their trial. 2. Massage has few text-books in this country, and perhaps not one that is really first-class. Dr. Mennell’s book should fill a long-felt want. It treats of massage as it should be treated, as a means to an end. Massage in the treatment of injuries is only a step towards the attainment first of passive then of active movements, leading on finally to treatment with active exercises with or without apparatus. Dr. Mennell deals with it in this spirit, he devotes a considerable space to treatment by exercises, and he describes his apparatus, which is certainly a model of compactness and at the same time of simplicity. In this work again there is room for criticism, and it is to be hoped this will come. It is time that the whole profession studied massage; it can be studied in theory in Dr. Mennell’s book, a practical observation of patients under treatment and of results will then lead on to the formation of individual opinions, not upon the value of "massage"as a therapeutic method, but upon the value of the different methods included under this
generic
term.
By DENNIS E. JACKSON, Professor of Pharmacology, Washington University Medical School, St. Louis, U.S.A. London: Henry Kimpton. Pp. 536. Price 20s.
Empe’l’imental Pltarmcceoloyy. Associate
The Method OJ Enz!lrne Aot6ot. By JAMES BEATTY, M.A., M.D. Dub., D.P.H. London : J.and A. Ohurchill. 1917. Pp. 143. Price 5s. net. THE hypothesis put forward by the author in these pages as to the mode of action of enzymes has at least the merit of simplicity. Without dealing completely with his summary given in the last section of the book, we may say that his general conclusions is that the whole of the chemical action of enzymes may be reduced to the action of hydrogen and hydroxyl, and this, he adds, is to be expected, as the two substances everywhere present when life first developed The use of enzymes, he continues, is to were water and air. control the rate and the sphere of naturally occurring reactions. The former is secured by increasing the number of the active H and OH radicles ; the latter by limiting them to definite points to which the substrate of the reaction is also attracted. It is suggested that in the light of his hypothesis it ought to be possible to manufacture enzymes by adapting the constitution of any given enzyme to a congenial substrate or environment. Dr. Beatty’s work should attract the attention of all workers in this field. It is a most interesting contribution on the subject that invites many directions of research, whether it does or does not some day culminate, to" use the author’s last words, in " the synthesis of life itself." ______________
New Inventions. THE ADMINISTRATION OF SALINE SOLUTIONS. Lieutenant-Colonel P. Fiaschi, A.A.M.C., has called onr attention to a method for the rapid intravenous administration of prepared sterile saline solution, or of sterile gelatin saline solution (Hogan’s solution), in the field. "The difficulties of preparing a surgically perfect saline solution,says LieutenantColonel Fiaschi, ’’ and of being able to rapidly give this intravenously to a number of cases demanding such a procedure, either during the rush of an engagement, or even to a few
of comparative quiescence in the fighting reserved schools of the United States was confined to the departments only for those of us of anatomy and pathology, except in one or two of the most who have attempted advanced centres. How far medical education has pro- this rational and from the didactic lecture which then formed the gressed physiologic method staple of instruction is shown by this elaborate description of treatment on the of the technique of pharmacological experimentation. The Egyptian Desert, at author gives no less than 158 experiments, more than one or at the Galllpoli, half of them on mammals, which may be used to elucidate Somme."" By his the action of drugs; not all of these are intended to be the solugiven in any one course, the instructor is given a wide tion is supplied in choice of illustration. The directions are simple, accurate, bottles with autoand detailed, so that the student can readily follow them; matic stoppers, some of them may appear a little startling in present condieach holding tions, as where the student is advised to give a dog half a pint 500 c.c., together of cream as a preliminary to the study of the lymph circulation. with a siphon and Many of the more difficult operations are obviously intended intravenous cannula to be demonstrated by the teacher rather than performed apparatus. These by the student himself; for example, few students can be are shown in the expected to insert cannulse into the thoracic or the pancreatic illustration. The -duct without much previous experience in operations of this bottle is warmed to blood heat in a basin of water, tne kind. In this country this manual can hardly be used by stopper removed, and the cannula apparatus fitted to the students under the regulations on experiments on animals. mouth of the bottle. The solution is allowed to flow through But it may be highly recommended to teachers of pharmaco- the cannula by inverting the bottle. The method of use is logy, for it offers a wealth of experiments which may be quite simple, and it is easy to double the quantity of fluid used to illustrate lectures, and the care with which these are administered by using two bottles in place of one. described renders it ’easy to perform those which may be The sterile saline solutions (09 per cent. sodium chloride selected. It deserves attention also from investigators in in glass-distilled water) and sterile gelatin saline solution the fields of physiology, pharmacology, and pathology for 2-5 per cent., sodium chloride 0-9 per cent., sodium (gelatin its review of reliable methods and for many useful hints carbonate 0’2 per cent.) in bottles with automatic stoppers, drawn from the author’s experience. It contains nearly autoclaved lb. pressure for one hour), are prepared by (15 400 illustrations (24 full-page colour plates), some of which Messrs. Burroughs, Wellcome, and Co., who supply one are superfluous, but others presenting the anatomical relaand intravenous cannula apparatus to each six hnttlps. siphon tions and the successive steps of the operations are extraordinarily useful. As examples the series of drawings of DEVON AND EXETER HOSPITAL.-At the last the exposure of the salivary ducts and nerves may be cited. When these are compared with the single woodcut which is meeting of the governors of the Devon and Exeter Hospital it was reported that the deficit balance against the generally supplied of the operation, the advance may be harity now amounted to JE2100; the President (Sir E. this bo()k promises to lighten the Ohaning Wills) gave £ 500 towards reducing this deficiency. appreciated. Altogether labours of many teachers, and will prove almost indispensable Two years ago Sir E. Chaning Wills gave £ 1000 for the in laboratories of experimental research. funds of the institution.
. TWENTY years ago laboratory instruction in the medical
}ases
in
;ector,
method
periods
are
THE VALUE OF SANATORIUM TREATMENT.
795
apparently equal prospect of maintaining their health. In the one case the patients returned to their former occupation in and about a large city, and of these 30 per cent. were well and at work two years later. Of the second group, who changed their environment in accordance with the advice LONDON: SATURDAY, NOVEMBER 24, 1917. given to them, 80 per cent. were continuously well and at work after the same period. Sanatorium The Value of Sanatorium treatment cannot fairly be judged apart from what Treatment. precedes and what succeeds it. It has been described as one link in a chain of remedial measures, or, in a SANATORIUM treatment has now been on trial in this country for about a generation, and there hass the language of metaphor, as a stanza in the lullaby been time to form a considered opinion upon itss which tuberculosis sings from the cradle to the All that can fairly be expected from merits. Although the debate at the Medical Society’I grave. of London on the Value and Limitations of Sana- sanatorium treatment is that it shall teach to torium Treatment, begun on Nov. 12th, was again1 those who are experiencing it the hygiene of the adjourned on the 19bh, it was evidently the3 healthy life, and shall raise for a brief period the conviction of a large proportion of those takingf resistance to the disease which has been lost under part in it that sanatorium treatment, what- unfavourable circumstances. Nothing can prevent a return to the environment which produced the ever its limitations, is the best treatment that disease from leading to a renewed breakdown. we yet have for early pulmonary tuberculosis. Sanatorium treatment is therefore bound up so : The immediate results under favourable conditions : with after-treatment that the two cannot closely are obviously very good, as seen in the summary in sense be considered apart, and where useful any given by Dr. DAVID LAWSOlt last week of a is lacking no result can be after-care efficient thousand cases on the point of leaving his care in London are especially Conditions expected. at Banchory. Of these, 53 per cent. had appreand the two distinguished laymen disappointing, ciated during sanatorium treatment to the extenti the contributed to who adjourned discussion of I of probable arrest of disease, and a further 27 this at the Medical subject Society last Monday Dr. W. 0. MEEK, cent. had definitely improved. the were not value obtained in impressed by whose paper we publish in full this week, finds from on sanatorium benefit. expenditure I London equally favourable results in the different class of One described it as so much money thrown away, patient for which Frimley Sanatorium provides. and both their hearers the necessity of urged upon Given a reasonable selection of cases for treatment, drastic reform in the environment of the workinghe finds the response and the immediate resultto classes. An increased hygienic standard-for town uniformly good. life is essential to maintain the immunity acquired But, except in the case of the well-to-do, the sanatorium treatment, and will, as Dr. T. D. immediate effect of sanatorium treatment gives no during LISTER pointed out trenchantly in opening the trustworthy indication of the ultimate result. avoid the necessity of sanatorium Professor SIMS WoonrEAn and Mr. VaRRIER-JONES, debate, largely treatment at all if it is applied in advance. Do in a communication to our columns this week, with dirty surroundings and bad habits of express the fact in exact terms when they state Sir DOUGLAS POwELL put it, and the infection life, that the well-to-do person has three times more of tuberculosis would almost cease to be operative. chance of keeping sound after treatment than has the working-man. Recognition of this fact has, indeed, resulted in certain quarters in Medicine. branding the sanatorium treatment of the workingclasses as a complete failure. But figures based GEORGIAN medicine, especially the theory and on sound clinical observation and analysed on practice of our science and art the half methods must GEORGE III. was formed when the logical replace general impressions. century king, Dr. NOEL BARDSWELL has compared the pro- interesting subject chosen by Dr. ARNOLD CHAPLIN spect of life of sanatorium patients, as they for the FitzPatrick lectures delivered last week leave Midhurst Sanatorium, with the actuarial before the Royal College of Physicians of London. i expectation of life for a healthy person at theIn giving the chief reasons which had determined same age. He finds that in first-stage leavers the this selection Dr. CHAPLIN stated that the reign of I prospect of life was about one-sixth, and in second- GEORGE III. witnessed the last struggle of Feudalism stage leavers about one-twentieth of the normal to control the acts of mankind, and the dawn of expectation. The calculation is a novel and useful those conceptions of civil, intellectual, and religious one, but Dr. BARDSwELL pointed out himself that freedom under which we at present live. - This, of the comparison should in fairness be made with the course, is substantially true, though a good many prospect of life for the tuberculous patient not vested abuses remained to be dealt with in undergoing sanatorium treatment, but the figures Victorian days, nor is the victory over them yet for such an analysis, however, are not available.complete. Between the general conditions of Although Dr. MEEK did not put the Frimley figuresintellectual advancement and the special progress into similar form, he gave a most instructive com-taking 1 place in medicine at the close of the I parison between two series of leavers and beginning of the nineteenth eighteenth
THE
LANCET.
-
"
,
per
be almost
away
Georgian
during
I’ ’
"
with
794
methods, their indications, and the results to be expected so far as our present experience goes. , Dr. Fox has himself written the section on hydrological methods and most of the remainder of the book, but he has been assisted by such authorities as Professor Tait McKenzie on mechanical methods and exercises, Dr. J. B. Mennell on massage, and Dr. F. Hernaman-Johnson on electrical treatment. Naturally in such subjects, which are comparatively new to the profession at large, there will arise criticism of detail. For example, the mechanical exercisers, usually named after Zander, which Dr. Fox describes, have found but few advocates in this country. But it is only right that the knowledge of these methods should be widely diffused, so that everyone may try them and form their own conclusions, and Dr., Fox makes no miraculous claims for any method but only asks for their trial. 2. Massage has few text-books in this country, and perhaps not one that is really first-class. Dr. Mennell’s book should fill a long-felt want. It treats of massage as it should be treated, as a means to an end. Massage in the treatment of injuries is only a step towards the attainment first of passive then of active movements, leading on finally to treatment with active exercises with or without apparatus. Dr. Mennell deals with it in this spirit, he devotes a considerable space to treatment by exercises, and he describes his apparatus, which is certainly a model of compactness and at the same time of simplicity. In this work again there is room for criticism, and it is to be hoped this will come. It is time that the whole profession studied massage; it can be studied in theory in Dr. Mennell’s book, a practical observation of patients under treatment and of results will then lead on to the formation of individual opinions, not upon the value of "massage"as a therapeutic method, but upon the value of the different methods included under this
generic
term.
By DENNIS E. JACKSON, Professor of Pharmacology, Washington University Medical School, St. Louis, U.S.A. London: Henry Kimpton. Pp. 536. Price 20s.
Empe’l’imental Pltarmcceoloyy. Associate
The Method OJ Enz!lrne Aot6ot. By JAMES BEATTY, M.A., M.D. Dub., D.P.H. London : J.and A. Ohurchill. 1917. Pp. 143. Price 5s. net. THE hypothesis put forward by the author in these pages as to the mode of action of enzymes has at least the merit of simplicity. Without dealing completely with his summary given in the last section of the book, we may say that his general conclusions is that the whole of the chemical action of enzymes may be reduced to the action of hydrogen and hydroxyl, and this, he adds, is to be expected, as the two substances everywhere present when life first developed The use of enzymes, he continues, is to were water and air. control the rate and the sphere of naturally occurring reactions. The former is secured by increasing the number of the active H and OH radicles ; the latter by limiting them to definite points to which the substrate of the reaction is also attracted. It is suggested that in the light of his hypothesis it ought to be possible to manufacture enzymes by adapting the constitution of any given enzyme to a congenial substrate or environment. Dr. Beatty’s work should attract the attention of all workers in this field. It is a most interesting contribution on the subject that invites many directions of research, whether it does or does not some day culminate, to" use the author’s last words, in " the synthesis of life itself." ______________
New Inventions. THE ADMINISTRATION OF SALINE SOLUTIONS. Lieutenant-Colonel P. Fiaschi, A.A.M.C., has called onr attention to a method for the rapid intravenous administration of prepared sterile saline solution, or of sterile gelatin saline solution (Hogan’s solution), in the field. "The difficulties of preparing a surgically perfect saline solution,says LieutenantColonel Fiaschi, ’’ and of being able to rapidly give this intravenously to a number of cases demanding such a procedure, either during the rush of an engagement, or even to a few
of comparative quiescence in the fighting reserved schools of the United States was confined to the departments only for those of us of anatomy and pathology, except in one or two of the most who have attempted advanced centres. How far medical education has pro- this rational and from the didactic lecture which then formed the gressed physiologic method staple of instruction is shown by this elaborate description of treatment on the of the technique of pharmacological experimentation. The Egyptian Desert, at author gives no less than 158 experiments, more than one or at the Galllpoli, half of them on mammals, which may be used to elucidate Somme."" By his the action of drugs; not all of these are intended to be the solugiven in any one course, the instructor is given a wide tion is supplied in choice of illustration. The directions are simple, accurate, bottles with autoand detailed, so that the student can readily follow them; matic stoppers, some of them may appear a little startling in present condieach holding tions, as where the student is advised to give a dog half a pint 500 c.c., together of cream as a preliminary to the study of the lymph circulation. with a siphon and Many of the more difficult operations are obviously intended intravenous cannula to be demonstrated by the teacher rather than performed apparatus. These by the student himself; for example, few students can be are shown in the expected to insert cannulse into the thoracic or the pancreatic illustration. The -duct without much previous experience in operations of this bottle is warmed to blood heat in a basin of water, tne kind. In this country this manual can hardly be used by stopper removed, and the cannula apparatus fitted to the students under the regulations on experiments on animals. mouth of the bottle. The solution is allowed to flow through But it may be highly recommended to teachers of pharmaco- the cannula by inverting the bottle. The method of use is logy, for it offers a wealth of experiments which may be quite simple, and it is easy to double the quantity of fluid used to illustrate lectures, and the care with which these are administered by using two bottles in place of one. described renders it ’easy to perform those which may be The sterile saline solutions (09 per cent. sodium chloride selected. It deserves attention also from investigators in in glass-distilled water) and sterile gelatin saline solution the fields of physiology, pharmacology, and pathology for 2-5 per cent., sodium chloride 0-9 per cent., sodium (gelatin its review of reliable methods and for many useful hints carbonate 0’2 per cent.) in bottles with automatic stoppers, drawn from the author’s experience. It contains nearly autoclaved lb. pressure for one hour), are prepared by (15 400 illustrations (24 full-page colour plates), some of which Messrs. Burroughs, Wellcome, and Co., who supply one are superfluous, but others presenting the anatomical relaand intravenous cannula apparatus to each six hnttlps. siphon tions and the successive steps of the operations are extraordinarily useful. As examples the series of drawings of DEVON AND EXETER HOSPITAL.-At the last the exposure of the salivary ducts and nerves may be cited. When these are compared with the single woodcut which is meeting of the governors of the Devon and Exeter Hospital it was reported that the deficit balance against the generally supplied of the operation, the advance may be harity now amounted to JE2100; the President (Sir E. this bo()k promises to lighten the Ohaning Wills) gave £ 500 towards reducing this deficiency. appreciated. Altogether labours of many teachers, and will prove almost indispensable Two years ago Sir E. Chaning Wills gave £ 1000 for the in laboratories of experimental research. funds of the institution.
. TWENTY years ago laboratory instruction in the medical
}ases
in
;ector,
method
periods
are
THE VALUE OF SANATORIUM TREATMENT.
795
apparently equal prospect of maintaining their health. In the one case the patients returned to their former occupation in and about a large city, and of these 30 per cent. were well and at work two years later. Of the second group, who changed their environment in accordance with the advice LONDON: SATURDAY, NOVEMBER 24, 1917. given to them, 80 per cent. were continuously well and at work after the same period. Sanatorium The Value of Sanatorium treatment cannot fairly be judged apart from what Treatment. precedes and what succeeds it. It has been described as one link in a chain of remedial measures, or, in a SANATORIUM treatment has now been on trial in this country for about a generation, and there hass the language of metaphor, as a stanza in the lullaby been time to form a considered opinion upon itss which tuberculosis sings from the cradle to the All that can fairly be expected from merits. Although the debate at the Medical Society’I grave. of London on the Value and Limitations of Sana- sanatorium treatment is that it shall teach to torium Treatment, begun on Nov. 12th, was again1 those who are experiencing it the hygiene of the adjourned on the 19bh, it was evidently the3 healthy life, and shall raise for a brief period the conviction of a large proportion of those takingf resistance to the disease which has been lost under part in it that sanatorium treatment, what- unfavourable circumstances. Nothing can prevent a return to the environment which produced the ever its limitations, is the best treatment that disease from leading to a renewed breakdown. we yet have for early pulmonary tuberculosis. Sanatorium treatment is therefore bound up so : The immediate results under favourable conditions : with after-treatment that the two cannot closely are obviously very good, as seen in the summary in sense be considered apart, and where useful any given by Dr. DAVID LAWSOlt last week of a is lacking no result can be after-care efficient thousand cases on the point of leaving his care in London are especially Conditions expected. at Banchory. Of these, 53 per cent. had appreand the two distinguished laymen disappointing, ciated during sanatorium treatment to the extenti the contributed to who adjourned discussion of I of probable arrest of disease, and a further 27 this at the Medical subject Society last Monday Dr. W. 0. MEEK, cent. had definitely improved. the were not value obtained in impressed by whose paper we publish in full this week, finds from on sanatorium benefit. expenditure I London equally favourable results in the different class of One described it as so much money thrown away, patient for which Frimley Sanatorium provides. and both their hearers the necessity of urged upon Given a reasonable selection of cases for treatment, drastic reform in the environment of the workinghe finds the response and the immediate resultto classes. An increased hygienic standard-for town uniformly good. life is essential to maintain the immunity acquired But, except in the case of the well-to-do, the sanatorium treatment, and will, as Dr. T. D. immediate effect of sanatorium treatment gives no during LISTER pointed out trenchantly in opening the trustworthy indication of the ultimate result. avoid the necessity of sanatorium Professor SIMS WoonrEAn and Mr. VaRRIER-JONES, debate, largely treatment at all if it is applied in advance. Do in a communication to our columns this week, with dirty surroundings and bad habits of express the fact in exact terms when they state Sir DOUGLAS POwELL put it, and the infection life, that the well-to-do person has three times more of tuberculosis would almost cease to be operative. chance of keeping sound after treatment than has the working-man. Recognition of this fact has, indeed, resulted in certain quarters in Medicine. branding the sanatorium treatment of the workingclasses as a complete failure. But figures based GEORGIAN medicine, especially the theory and on sound clinical observation and analysed on practice of our science and art the half methods must GEORGE III. was formed when the logical replace general impressions. century king, Dr. NOEL BARDSWELL has compared the pro- interesting subject chosen by Dr. ARNOLD CHAPLIN spect of life of sanatorium patients, as they for the FitzPatrick lectures delivered last week leave Midhurst Sanatorium, with the actuarial before the Royal College of Physicians of London. i expectation of life for a healthy person at theIn giving the chief reasons which had determined same age. He finds that in first-stage leavers the this selection Dr. CHAPLIN stated that the reign of I prospect of life was about one-sixth, and in second- GEORGE III. witnessed the last struggle of Feudalism stage leavers about one-twentieth of the normal to control the acts of mankind, and the dawn of expectation. The calculation is a novel and useful those conceptions of civil, intellectual, and religious one, but Dr. BARDSwELL pointed out himself that freedom under which we at present live. - This, of the comparison should in fairness be made with the course, is substantially true, though a good many prospect of life for the tuberculous patient not vested abuses remained to be dealt with in undergoing sanatorium treatment, but the figures Victorian days, nor is the victory over them yet for such an analysis, however, are not available.complete. Between the general conditions of Although Dr. MEEK did not put the Frimley figuresintellectual advancement and the special progress into similar form, he gave a most instructive com-taking 1 place in medicine at the close of the I parison between two series of leavers and beginning of the nineteenth eighteenth
THE
LANCET.
-
"
,
per
be almost
away
Georgian
during
I’ ’
"
with