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THE DUCTLESS GLANDS.
421
theand
The early stage of mental disorder is by far hospital administrators, but I do submit most important period in the disease ; skilled treat- that it is a task well worth accomplishing, and I ment may often arrest, while unskilled treatment, trust that now you, Sir, have raised the question it however well intentioned, may lead to lasting or will not be allowed to drop. I am. Sir. vours faithfullv. Certification even permanent mental wreckage. M. GREENWOOD, jun. is so much dreaded (whether reasonably or not) Lister Institute of Preventive Medicine, Statistical that all kinds of procedures are now adopted Laboratory, Feb. 2nd, 1914. To save the rest of the family to avoid it. from the slur of having an insane relative great risks are run in the treatment of the THE DUCTLESS GLANDS. patient, and great expenses incurred. If these To the Editor ot THE LANCET. patients could be legally treated for a time without certification the relatives would naturally SiR,-Owing to some oversight I was unaware of desire to send them to the hospitals, licensed allusions in the Annus Medicus 1913 to my your homes, &c., in which they could have the best and Arris and Gale Lectures and the discussion at the most experienced treatment, and in this way much Society of Medicine on the Relations of the of the prejudice against asylums would be over- Royal Internal Secretions to the Female Characteristics and The prejudice, indeed, is not so much come. Functions. The remarks in summary appear the against asylum (although this is considerable)1to me to be a fair, if cautious, your statement of the posias against the certification which asylum care 1 tion. But I think that Professor Swale Vincent’s necessitates in all but the voluntary boarder i in your issue of Jan. 31st over-emphasises letter The success of the voluntary boarder cases. C remarks in your article, and calls for some certain system is an evidence of this so far as the patients reply from me. are concerned, and the patient’s friends would I fear I cannot agree either with yourselves or often be very thankful to use the asylum if the Professor Vincent that the facts indicating-I might certification could be avoided. say proving-that definite correlations exist between If, therefore, the law in regard to certification isthe 1 organs of internal secretion are few; or, in the relaxed this should be accompanied by redoubled words of Professor Vincent, that " the facts at our stringency and vigilance against the treatment disposal have so far not been sufficient to warrant C which is now so largely carried on by unskilled us in drawing any very definite conclusions as to persons in unsuitable surroundings. the interrelations between the various organs I am, Sir, vours faithfully, furnishing an internal secretion." This statement HENRY RAYNER. M.D. Aberd. is much stronger than that expressed in your article. Queen Anne-street, W., Feb. 4th, 1914. In any case both are entirely misleading, if not absolutely wrong. In my lectures and introductory paper at the discussion at the Royal Society of Medicine I stated HOSPITAL STATISTICS. nothing that I did not prove by actual colour To the Editor of THE LANCET. photomicrographs illustrating the changes which SIR,-Your leading article on Hospital Statistics are regularly produced in the other endocrinous in THE LANCET of Jan. 31st has earned the organs by removal of one of their number. Owing gratitude of all who are interested in the to the cost of reproduction these coloured pictures subject. There are, indeed, many reasons why have not yet been published. In the special experithis matter should receive more attention than ments of thymus excision and partial removal of has up to now been devoted to it. In the first the pituitary I quoted the findings of Noel Paton place, those who, like myself, have analysed clinical and Harvey Cushing; but I could not, as I said, or anthropometric data derived from hospital vouch for their -results. Indeed, in some respects records have been unable to determine the precise their conclusions have not been fully demonstrated significance attaching to their results, because, so far as I know. Professor Vincent alludes to my writings and while conscious of the unrepresentative character of a " general hospital population," they have never those of " other clinicians " as though my work was had sufficient data to render its peculiarities in some way different from his. This may be so, distinct, and no corresponding materials with regard for I am not aware that he has done much experito the non-hospital population have been available. mental work on this aspect of the subject; but it From statements which have appeared in the press does not necessarily follow that my results are with reference to the Government scheme of wrong. His objections to my conclusions are medical research under the Insurance Act, it would founded on fancy, my arguments are based on appear probable that adequate medico-statistical ascertained facts. I think the final decision may data respecting the non-hospital working and lower safely be left to the future. In his first paramiddle-class population will be made available. graph Professor Vincent practically denies that The time is therefore opportune for a corresponding there is any evidence in support of my statestudy of the " general hospital population." In the ments, and asserts that my complaint of Biedl second place, cursory inspection of the Registrar- for not so correlating the functions of the inGeneral’s last annual report is sufficient to convince ternal secretions in his recent work is unjustifiable. anyone not already convinced that the morbidityex- Yet in the second paragraph Professor Vincent perience of the hospitals covers in the case of more announces that in a future edition of his book he than one disease a considerable portion of the total is going to do exactly what I have done! This morbidity experience of the metropolis, This in- seems to be an unusually unscientific and unformation ought surely to be made available in the reasonable mental attitude. What is right for interest of the public health service. I am under Professor Vincent in 1915 cannot be far wrong no illusions as to the difficulties of standardising and for me in 1913! Biedl himself all through his centralising our hospital data. It is a task which will book gives a vast amount of evidence of the demand the cooperation of clinicians, statisticians, correlations that exist; and my complaint against -,
1
.
422 him was, not that he did not support the doctrine, but that nowhere did he attempt to sort out all the wealth of detail collected, and classify it according to the specialised functions. My attempt to do so in regard to the female genital functions is the
first, but I
am sure
it will not be the last,
PERFORATION. To the Editor of THE LANCET.
SIR,-The tamponade method of Mr. E. M. Corner
attempt is
of the sort. In conclusion, I would like myself to state how cordially I agree with much that has been said and written about many wild generalisations that have been made in papers which give no evidence of first-hand knowledge; and also to point out that the pure physiologist will not go far in the solution of the problems connected with the internal secretions until he takes more heed of the clinical and pathological aspects of the subject. I am, Sir, yours faithfully, W. BLAIR BELL. Liverpool, Feb. 2nd, 1914.
DOSAGE AND THE METRIC SYSTEM. To the Editor
TREATMENT OF GASTRIC AND DUODENAL
of THE LANCET.
one that most surgeons have been obliged to content themselves with occasionally in desperate cases and when the perforation is found to be inaccessible to ready suture. That it can be a means of saving life as a substitute for laborious suturing there can be no doubt, and Mr. Corner is to be congratulated on his effort to bring the method prominently before surgeons. In the discussion on this subject I did not notice any mention of a valuable auxiliary to any method of dealing with abdominal catastrophes of this class-that is, cases of acute peritoneal sepsis. I refer to the injection of camphor and olive oil I have been using this for into the cavity. about 18 months, and have formed the opinion that it is of real value ; in fact, as regards treatment alone I am inclined to place it alongside of the Murphy proctoclysis and the Fowler
The procedure is simple and rapid; for an adult 100 grammes of a 1 per cent. solution of camphor in olive oil is poured into the peritoneal cavity as soon as the perforation is found and secured by whatever method is deemed suitable, the cavity having been previously cleansed by mopping out, not flushing. The method is equally effective and equally useful in cases of fulminating appendicitis and such-like causes of diffuse septic peritonitis. A point of practical im. portance is that if silkworm gut sutures are used for the abdominal and suprapubic drainage wounds, they may either be placed before the oil is used or a pair of cotton gloves should be put over the rubber ones as the oiled silkworm gut is slippery to I a,m. Sir. yours faitbfully handle. The theoretical proposition is that the camphor C. O. HAWTHORNE. Harley-street, W., Feb. 2nd, 1914. acts quickly as a cardiac stimulant, and that the oil is taken up rapidly by the lymphatics and temblocks them, thus diminishing the absorpporarily GOATS’ MILK. tion of toxins. If oil has any value in preventing To the Editor of THE LANCET. the formation of adhesions, then this is an addiSIR,-The correspondence about milk ought not tional incentive to use the method. As there appears to be some difficulty in procuring the to close without a word about goat’s milk. mixture ready sterilised, I may say that Messrs. Goats practically never have tubercle, therefore and Wellcome have prepared for me Burroughs their milk can be given without pasteurising; flasks in two sizes, 50 grammes for children and it can I be obtained and clean. once fresh further, 100 for adults. For those who desire a caught in a test-tube milk from the teat of a goat full grammes of this treatment I would refer account being milked by a boy ; the test-tube was placed in them to an excellent article in Lyon Chirurgical, an incubator and remained sterile. With respect to M. Vignard and cost you will find an estimate in the British December, 1910-January, 1911, by M Arnaud T am Sir yours faihfully Goat Society’s Monthly Circular; it figures out W. J. GREER. Newport, Mon., Jan. 28th, 1914. for the keep only of the goats at 1’4d. per quart of milk, but goat’s milk is not an article of commerce, and it is necessary for the child’s ASEPTIC URETERAL CATHETERISATION. father to take some trouble in the matter, which, To the Editor of THE LANCET. if the object is explained to him and he lives in THE LANCET of Jan. 24th Mr. R. J. SIR,—In Goats are the country, he will be willing to do. Will an describes his ingenious appliance for persmall and cleanly animals, and can be kept in The ureteral catheterisation. forming aseptic health even in the centre of a large town ; their same ideal can be obtained by means of a far milk is said to be better for infants than cow’s milk simpler appliance which I adopted some time ago. because the curd is finer. It consists of a tube made of fine linen or calico. I am, Sir, yours faithfully, open at both ends, about half an inch in diameter Deconshire place, W., Jan. 31st, 1914. WALTER EDMUNDS. and than the ureteric catheter. The
SIR,—Your readers interested in the application of the metric system to medicine and pharmacy will note with much satisfaction Mr. G. E. M. Johnson’s announcement in your last issue (p. 357) that the Decimal Association has been assured by the General Medical Council of the adoption of the metric system in the dosage of the forthcoming edition of the British Pharmacopoeia. Possibly this announcement gives to my proposal in your issue of Jan. 24th (p. 231) a somewhat belated appearance. Yet, as qualifying this criticism, I may plead that the proposal was originally advanced in 1903/ and that, in so far as I knew, it had attracted no attention. In these circumstances a ten years’ interval may perhaps excuse its repetition.
position.
slightly longer
We have been
compelled by
pressure on our corre** spondence columns to hold further letters on the subject of milk sterilisation over until next week.-ED. L. 1
Polyclinic Journal, April, 1903, p. 138.
tube is sterilised by boiling, and the end of the previously sterilised catheter is inserted by means ot sterile forceps in the end of the tube. The catheter is then worked along the tube exactly as a housewife works a bodkin along a seam. As soon as
theand
The early stage of mental disorder is by far hospital administrators, but I do submit most important period in the disease ; skilled treat- that it is a task well worth accomplishing, and I ment may often arrest, while unskilled treatment, trust that now you, Sir, have raised the question it however well intentioned, may lead to lasting or will not be allowed to drop. I am. Sir. vours faithfullv. Certification even permanent mental wreckage. M. GREENWOOD, jun. is so much dreaded (whether reasonably or not) Lister Institute of Preventive Medicine, Statistical that all kinds of procedures are now adopted Laboratory, Feb. 2nd, 1914. To save the rest of the family to avoid it. from the slur of having an insane relative great risks are run in the treatment of the THE DUCTLESS GLANDS. patient, and great expenses incurred. If these To the Editor ot THE LANCET. patients could be legally treated for a time without certification the relatives would naturally SiR,-Owing to some oversight I was unaware of desire to send them to the hospitals, licensed allusions in the Annus Medicus 1913 to my your homes, &c., in which they could have the best and Arris and Gale Lectures and the discussion at the most experienced treatment, and in this way much Society of Medicine on the Relations of the of the prejudice against asylums would be over- Royal Internal Secretions to the Female Characteristics and The prejudice, indeed, is not so much come. Functions. The remarks in summary appear the against asylum (although this is considerable)1to me to be a fair, if cautious, your statement of the posias against the certification which asylum care 1 tion. But I think that Professor Swale Vincent’s necessitates in all but the voluntary boarder i in your issue of Jan. 31st over-emphasises letter The success of the voluntary boarder cases. C remarks in your article, and calls for some certain system is an evidence of this so far as the patients reply from me. are concerned, and the patient’s friends would I fear I cannot agree either with yourselves or often be very thankful to use the asylum if the Professor Vincent that the facts indicating-I might certification could be avoided. say proving-that definite correlations exist between If, therefore, the law in regard to certification isthe 1 organs of internal secretion are few; or, in the relaxed this should be accompanied by redoubled words of Professor Vincent, that " the facts at our stringency and vigilance against the treatment disposal have so far not been sufficient to warrant C which is now so largely carried on by unskilled us in drawing any very definite conclusions as to persons in unsuitable surroundings. the interrelations between the various organs I am, Sir, vours faithfully, furnishing an internal secretion." This statement HENRY RAYNER. M.D. Aberd. is much stronger than that expressed in your article. Queen Anne-street, W., Feb. 4th, 1914. In any case both are entirely misleading, if not absolutely wrong. In my lectures and introductory paper at the discussion at the Royal Society of Medicine I stated HOSPITAL STATISTICS. nothing that I did not prove by actual colour To the Editor of THE LANCET. photomicrographs illustrating the changes which SIR,-Your leading article on Hospital Statistics are regularly produced in the other endocrinous in THE LANCET of Jan. 31st has earned the organs by removal of one of their number. Owing gratitude of all who are interested in the to the cost of reproduction these coloured pictures subject. There are, indeed, many reasons why have not yet been published. In the special experithis matter should receive more attention than ments of thymus excision and partial removal of has up to now been devoted to it. In the first the pituitary I quoted the findings of Noel Paton place, those who, like myself, have analysed clinical and Harvey Cushing; but I could not, as I said, or anthropometric data derived from hospital vouch for their -results. Indeed, in some respects records have been unable to determine the precise their conclusions have not been fully demonstrated significance attaching to their results, because, so far as I know. Professor Vincent alludes to my writings and while conscious of the unrepresentative character of a " general hospital population," they have never those of " other clinicians " as though my work was had sufficient data to render its peculiarities in some way different from his. This may be so, distinct, and no corresponding materials with regard for I am not aware that he has done much experito the non-hospital population have been available. mental work on this aspect of the subject; but it From statements which have appeared in the press does not necessarily follow that my results are with reference to the Government scheme of wrong. His objections to my conclusions are medical research under the Insurance Act, it would founded on fancy, my arguments are based on appear probable that adequate medico-statistical ascertained facts. I think the final decision may data respecting the non-hospital working and lower safely be left to the future. In his first paramiddle-class population will be made available. graph Professor Vincent practically denies that The time is therefore opportune for a corresponding there is any evidence in support of my statestudy of the " general hospital population." In the ments, and asserts that my complaint of Biedl second place, cursory inspection of the Registrar- for not so correlating the functions of the inGeneral’s last annual report is sufficient to convince ternal secretions in his recent work is unjustifiable. anyone not already convinced that the morbidityex- Yet in the second paragraph Professor Vincent perience of the hospitals covers in the case of more announces that in a future edition of his book he than one disease a considerable portion of the total is going to do exactly what I have done! This morbidity experience of the metropolis, This in- seems to be an unusually unscientific and unformation ought surely to be made available in the reasonable mental attitude. What is right for interest of the public health service. I am under Professor Vincent in 1915 cannot be far wrong no illusions as to the difficulties of standardising and for me in 1913! Biedl himself all through his centralising our hospital data. It is a task which will book gives a vast amount of evidence of the demand the cooperation of clinicians, statisticians, correlations that exist; and my complaint against -,
1
.
422 him was, not that he did not support the doctrine, but that nowhere did he attempt to sort out all the wealth of detail collected, and classify it according to the specialised functions. My attempt to do so in regard to the female genital functions is the
first, but I
am sure
it will not be the last,
PERFORATION. To the Editor of THE LANCET.
SIR,-The tamponade method of Mr. E. M. Corner
attempt is
of the sort. In conclusion, I would like myself to state how cordially I agree with much that has been said and written about many wild generalisations that have been made in papers which give no evidence of first-hand knowledge; and also to point out that the pure physiologist will not go far in the solution of the problems connected with the internal secretions until he takes more heed of the clinical and pathological aspects of the subject. I am, Sir, yours faithfully, W. BLAIR BELL. Liverpool, Feb. 2nd, 1914.
DOSAGE AND THE METRIC SYSTEM. To the Editor
TREATMENT OF GASTRIC AND DUODENAL
of THE LANCET.
one that most surgeons have been obliged to content themselves with occasionally in desperate cases and when the perforation is found to be inaccessible to ready suture. That it can be a means of saving life as a substitute for laborious suturing there can be no doubt, and Mr. Corner is to be congratulated on his effort to bring the method prominently before surgeons. In the discussion on this subject I did not notice any mention of a valuable auxiliary to any method of dealing with abdominal catastrophes of this class-that is, cases of acute peritoneal sepsis. I refer to the injection of camphor and olive oil I have been using this for into the cavity. about 18 months, and have formed the opinion that it is of real value ; in fact, as regards treatment alone I am inclined to place it alongside of the Murphy proctoclysis and the Fowler
The procedure is simple and rapid; for an adult 100 grammes of a 1 per cent. solution of camphor in olive oil is poured into the peritoneal cavity as soon as the perforation is found and secured by whatever method is deemed suitable, the cavity having been previously cleansed by mopping out, not flushing. The method is equally effective and equally useful in cases of fulminating appendicitis and such-like causes of diffuse septic peritonitis. A point of practical im. portance is that if silkworm gut sutures are used for the abdominal and suprapubic drainage wounds, they may either be placed before the oil is used or a pair of cotton gloves should be put over the rubber ones as the oiled silkworm gut is slippery to I a,m. Sir. yours faitbfully handle. The theoretical proposition is that the camphor C. O. HAWTHORNE. Harley-street, W., Feb. 2nd, 1914. acts quickly as a cardiac stimulant, and that the oil is taken up rapidly by the lymphatics and temblocks them, thus diminishing the absorpporarily GOATS’ MILK. tion of toxins. If oil has any value in preventing To the Editor of THE LANCET. the formation of adhesions, then this is an addiSIR,-The correspondence about milk ought not tional incentive to use the method. As there appears to be some difficulty in procuring the to close without a word about goat’s milk. mixture ready sterilised, I may say that Messrs. Goats practically never have tubercle, therefore and Wellcome have prepared for me Burroughs their milk can be given without pasteurising; flasks in two sizes, 50 grammes for children and it can I be obtained and clean. once fresh further, 100 for adults. For those who desire a caught in a test-tube milk from the teat of a goat full grammes of this treatment I would refer account being milked by a boy ; the test-tube was placed in them to an excellent article in Lyon Chirurgical, an incubator and remained sterile. With respect to M. Vignard and cost you will find an estimate in the British December, 1910-January, 1911, by M Arnaud T am Sir yours faihfully Goat Society’s Monthly Circular; it figures out W. J. GREER. Newport, Mon., Jan. 28th, 1914. for the keep only of the goats at 1’4d. per quart of milk, but goat’s milk is not an article of commerce, and it is necessary for the child’s ASEPTIC URETERAL CATHETERISATION. father to take some trouble in the matter, which, To the Editor of THE LANCET. if the object is explained to him and he lives in THE LANCET of Jan. 24th Mr. R. J. SIR,—In Goats are the country, he will be willing to do. Will an describes his ingenious appliance for persmall and cleanly animals, and can be kept in The ureteral catheterisation. forming aseptic health even in the centre of a large town ; their same ideal can be obtained by means of a far milk is said to be better for infants than cow’s milk simpler appliance which I adopted some time ago. because the curd is finer. It consists of a tube made of fine linen or calico. I am, Sir, yours faithfully, open at both ends, about half an inch in diameter Deconshire place, W., Jan. 31st, 1914. WALTER EDMUNDS. and than the ureteric catheter. The
SIR,—Your readers interested in the application of the metric system to medicine and pharmacy will note with much satisfaction Mr. G. E. M. Johnson’s announcement in your last issue (p. 357) that the Decimal Association has been assured by the General Medical Council of the adoption of the metric system in the dosage of the forthcoming edition of the British Pharmacopoeia. Possibly this announcement gives to my proposal in your issue of Jan. 24th (p. 231) a somewhat belated appearance. Yet, as qualifying this criticism, I may plead that the proposal was originally advanced in 1903/ and that, in so far as I knew, it had attracted no attention. In these circumstances a ten years’ interval may perhaps excuse its repetition.
position.
slightly longer
We have been
compelled by
pressure on our corre** spondence columns to hold further letters on the subject of milk sterilisation over until next week.-ED. L. 1
Polyclinic Journal, April, 1903, p. 138.
tube is sterilised by boiling, and the end of the previously sterilised catheter is inserted by means ot sterile forceps in the end of the tube. The catheter is then worked along the tube exactly as a housewife works a bodkin along a seam. As soon as