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THE GRESHAM UNIVERSITY.
442 examined here. The results may be stated as follows, with strict regard to the morbid conditions specified above? 1. The arteries at the base are described as "healthy," " normal," and 11 atheromatous " ; there is no mention of congestion. It is quite improbable that congestion in & remarkable degree should have escaped notice and record. 2. In two cases the "internal membranes" are described as were
Correspondence. "
Audi alteram
partem."
THE GRESHAM UNIVERSITY. To the Editors of THE LANCET. SIRS,-In your leading article of last week you referred to a quotation, or supposed quotation, from a speech oj
mine, with the perfectly justifiable remark that any words
of mine were merely the expression of a personal opinion, and therefore, of course, unimportant in the discussion vi a question of medical education. But I am not disposed to sit down under the false imputation of having said a foolish thing, and of having injured a good cause by my
folly.
by an anonymous committee Temple, with Mr. C. S. Roundell of Merton College, Oxford, for chairman, and Mr. J. S. Hill, of the Chelsea Branch of the London University Extension Association, for Secretary, after stating that "there is every reason to fear... the standard of degrees in the Gresham University will be unduly lowered," this committee without members, whose chairman and secretary are alike unknown to Univeisity education and to medical education in London, proceed as follows : " These apprehensions are confirmed by the official utterances of prominent promoters of the scheme, who have not hesitated to purchase the cooperation of the medical schools by the ominous suggestion that the mere qualification granted by the General Medical Council shall also qualify candidates (per saltum) for the Albert M.D. degree." The use of the cant phrase per saltum shows that reference is made to my speech at the Westminster Hospital Medical School, which was (very imperfectly) reported in The Times, and still more imperfectly quoted-I might say garbled-in the Quarterly Review. To all I said I adhere. In the case of students now studying in the medical schools who have satisfactorily performed a part of their course, I should rejoice to see, and I believe there will be no legal difficulty in providing, that they should have access to degrees in the Gresham University without being compelled to begin their students’ course over again. This, however, must be subject to their giving satisfactory evidence of scientific and general attainment. Further, seeing that aU students will be compelled to obtain a qualification outside the University ab or about the time when they would, if the degrees conferred a qualification, be going in for an M.B. degree, I think it would be well for the medical authorities to consider whether they may not with advantage dispense with the M. B. degree altogether, and allow licentiates to proceed to the M.D. degree, as has In
a
sitting
document put out
at the Outer
sometimes been the case in other universities, per saltum. That the standard of the M.D. should in this way be lowered I have not proposed, and am sure it would be scouted by the authorities I was addressing, as such a proposal would deserve. That I said the mere qualification should also qualify for the M.D. degree is an entire mistake. I am, Sirs, yours truly, GEORGE YOUNG.
POST-MORTEM APPEARANCES OF THE BRAIN OF INFLUENZA PATIENTS. To
the
Editors of
THE LANCET. I will briefly state the results of post-mortem examinations of the brain made at the West Riding Asylum in cases of influenza, in order that they may be compared with those quoted by Dr. Althaus from a Danish medical periodical. The morbid conditions described by the Danish observer and dwelt upon by Dr. Althaus in his letter may be summarised as follows :(1) Hypereemia at the base of the brain, arteries at base filled to bursting ; (2) a most intense hyperæmia of the pia mater and brain ; (3) increased consistence of brain and spinal cord ; (4) fresh paeby- and lep to-meningitis. In addition, Dr. Althaus infers from the description that intense congestion of the medulla existed. During the spring and early summer of last year the brains of thirteen cases dead of influenza and its pulmonary complications
SIRS,-With
your
permission
"congested,"in one as "perhaps congested."Intwootbersitf pia contained but little blood. In the remaining cases the lepto meninges were either normal or showed the changes of chronic brain disease (thickening, opacity), As regards hypersemia of the brain itself, one case showed "much injection of grey and white matter throughout," and "the internal capsules were notably injected." In another the grey matter was "slightly congested." Ina third the white matter was "congested in the posterior part is stated that the
of the brain." In two other cases the brain is described as " pale." In the remaining cases the colour was the average. 3. There is no note of increase in consistence in any of the cases ; in nine the brain is said to have been of "reduced consistence." 4. No pacby- or leptn-meningitis in any of the cases. Lastly, if we take (as Dr. Althaus does) the state of the arteries at the base of the brain as a criterion of the vascular condition of the medulla oblongata, it may be inferred that no congestion existed in this organ in these cases, an inference which may be drawn with the greater confidence in view of the fact that the bulb is invariably examined in every necropsy held here. It is therefore extremely improbable that noteworthy congestion would have escaped detection. Apart from the testimony of the records, I am informed by my colleagues, who made the examina. tions, that they have no recollection of remarkable hyperaemia in any of these cases, whether at the base of the brain or I am, Sirs, yours faithfully, elsewhere. EDWIN GOODALL, M D Lond., B.S., M.R.C.P,, Pathologist, West Riding Asylum, Wakefield. _
-
-
DEATH UNDER ETHER. To the Editors
of
to forward the
THE LANCET.
SIRS,—I beg particulars of a case of death under the influence of ether, which occurred on Jar. 29th at the Royal United Hospital, Bath. On Jan. 27th I ad. mitted into the hospital, under the care of Mr. Freeman, S. D-, aged thirty-seven, a dustman, who was suffering from a small strangulated right inguinal hernia. He had attended as an out-patient at the hospital on the previous day (and was seen by one of the honorary assistant medical officers), complaining of symptoms which appeared to be due to his diinking habits, he making no mention of the rupture. The patient, although very weak, walked to the hospital on the day of admission. He was placed in bed and the usual measures for taxis were employed; but, these proving unavailing, and his general condition becoming rapidly worse, he was given an enema of brandy, and taken to the operating theatre for the purpose of performing herniotomy. On examination no sign of organic lesion was discovered in the chest, and ether was slowly administered by myself. There was some struggling at the commencement, but anaesthesia was induced in from six to eight minutes, and the operation was begun by Mr. Freeman. Two minutes later breathing ceased (the temporal pulse persisting), after three or four shallow respirations. There was no stertor or mydriasis. The tongue was immediately drawn forward, the head thrown back, and artificial respiration performed, enemata of brandy and injections of strychnia being given and the faradaic current employed to the phrenic nerves. A few ounces of dirty bilious fluid escaping from the mouth soon after, tracheotomy was performed to obviate the risk of any foreign matter being sucked into the lungs. Although artificial respiration was continued for an hour and a half, all efforts to resuscitate the patient were ineffectual, no signs of vitality being noted after the cessation of breathing. A post-mortem examination was made by myself thirty-six hours later. Rigor mortis was marked. On opening the hernial sac a small knuckle of ileum was alone seen. This was very deeply congested, but the congestion did not extend to the mesenteric border, in. volving only about two-thirds of the circumference of the gub. The bowel was adherent to the sac round the neck, and there were a few flakes of recent lymph on the abdominal side of the ring. Beyond a few atheromatous patches on the aorta above the sigmoid valves and slight
Correspondence. "
Audi alteram
partem."
THE GRESHAM UNIVERSITY. To the Editors of THE LANCET. SIRS,-In your leading article of last week you referred to a quotation, or supposed quotation, from a speech oj
mine, with the perfectly justifiable remark that any words
of mine were merely the expression of a personal opinion, and therefore, of course, unimportant in the discussion vi a question of medical education. But I am not disposed to sit down under the false imputation of having said a foolish thing, and of having injured a good cause by my
folly.
by an anonymous committee Temple, with Mr. C. S. Roundell of Merton College, Oxford, for chairman, and Mr. J. S. Hill, of the Chelsea Branch of the London University Extension Association, for Secretary, after stating that "there is every reason to fear... the standard of degrees in the Gresham University will be unduly lowered," this committee without members, whose chairman and secretary are alike unknown to Univeisity education and to medical education in London, proceed as follows : " These apprehensions are confirmed by the official utterances of prominent promoters of the scheme, who have not hesitated to purchase the cooperation of the medical schools by the ominous suggestion that the mere qualification granted by the General Medical Council shall also qualify candidates (per saltum) for the Albert M.D. degree." The use of the cant phrase per saltum shows that reference is made to my speech at the Westminster Hospital Medical School, which was (very imperfectly) reported in The Times, and still more imperfectly quoted-I might say garbled-in the Quarterly Review. To all I said I adhere. In the case of students now studying in the medical schools who have satisfactorily performed a part of their course, I should rejoice to see, and I believe there will be no legal difficulty in providing, that they should have access to degrees in the Gresham University without being compelled to begin their students’ course over again. This, however, must be subject to their giving satisfactory evidence of scientific and general attainment. Further, seeing that aU students will be compelled to obtain a qualification outside the University ab or about the time when they would, if the degrees conferred a qualification, be going in for an M.B. degree, I think it would be well for the medical authorities to consider whether they may not with advantage dispense with the M. B. degree altogether, and allow licentiates to proceed to the M.D. degree, as has In
a
sitting
document put out
at the Outer
sometimes been the case in other universities, per saltum. That the standard of the M.D. should in this way be lowered I have not proposed, and am sure it would be scouted by the authorities I was addressing, as such a proposal would deserve. That I said the mere qualification should also qualify for the M.D. degree is an entire mistake. I am, Sirs, yours truly, GEORGE YOUNG.
POST-MORTEM APPEARANCES OF THE BRAIN OF INFLUENZA PATIENTS. To
the
Editors of
THE LANCET. I will briefly state the results of post-mortem examinations of the brain made at the West Riding Asylum in cases of influenza, in order that they may be compared with those quoted by Dr. Althaus from a Danish medical periodical. The morbid conditions described by the Danish observer and dwelt upon by Dr. Althaus in his letter may be summarised as follows :(1) Hypereemia at the base of the brain, arteries at base filled to bursting ; (2) a most intense hyperæmia of the pia mater and brain ; (3) increased consistence of brain and spinal cord ; (4) fresh paeby- and lep to-meningitis. In addition, Dr. Althaus infers from the description that intense congestion of the medulla existed. During the spring and early summer of last year the brains of thirteen cases dead of influenza and its pulmonary complications
SIRS,-With
your
permission
"congested,"in one as "perhaps congested."Intwootbersitf pia contained but little blood. In the remaining cases the lepto meninges were either normal or showed the changes of chronic brain disease (thickening, opacity), As regards hypersemia of the brain itself, one case showed "much injection of grey and white matter throughout," and "the internal capsules were notably injected." In another the grey matter was "slightly congested." Ina third the white matter was "congested in the posterior part is stated that the
of the brain." In two other cases the brain is described as " pale." In the remaining cases the colour was the average. 3. There is no note of increase in consistence in any of the cases ; in nine the brain is said to have been of "reduced consistence." 4. No pacby- or leptn-meningitis in any of the cases. Lastly, if we take (as Dr. Althaus does) the state of the arteries at the base of the brain as a criterion of the vascular condition of the medulla oblongata, it may be inferred that no congestion existed in this organ in these cases, an inference which may be drawn with the greater confidence in view of the fact that the bulb is invariably examined in every necropsy held here. It is therefore extremely improbable that noteworthy congestion would have escaped detection. Apart from the testimony of the records, I am informed by my colleagues, who made the examina. tions, that they have no recollection of remarkable hyperaemia in any of these cases, whether at the base of the brain or I am, Sirs, yours faithfully, elsewhere. EDWIN GOODALL, M D Lond., B.S., M.R.C.P,, Pathologist, West Riding Asylum, Wakefield. _
-
-
DEATH UNDER ETHER. To the Editors
of
to forward the
THE LANCET.
SIRS,—I beg particulars of a case of death under the influence of ether, which occurred on Jar. 29th at the Royal United Hospital, Bath. On Jan. 27th I ad. mitted into the hospital, under the care of Mr. Freeman, S. D-, aged thirty-seven, a dustman, who was suffering from a small strangulated right inguinal hernia. He had attended as an out-patient at the hospital on the previous day (and was seen by one of the honorary assistant medical officers), complaining of symptoms which appeared to be due to his diinking habits, he making no mention of the rupture. The patient, although very weak, walked to the hospital on the day of admission. He was placed in bed and the usual measures for taxis were employed; but, these proving unavailing, and his general condition becoming rapidly worse, he was given an enema of brandy, and taken to the operating theatre for the purpose of performing herniotomy. On examination no sign of organic lesion was discovered in the chest, and ether was slowly administered by myself. There was some struggling at the commencement, but anaesthesia was induced in from six to eight minutes, and the operation was begun by Mr. Freeman. Two minutes later breathing ceased (the temporal pulse persisting), after three or four shallow respirations. There was no stertor or mydriasis. The tongue was immediately drawn forward, the head thrown back, and artificial respiration performed, enemata of brandy and injections of strychnia being given and the faradaic current employed to the phrenic nerves. A few ounces of dirty bilious fluid escaping from the mouth soon after, tracheotomy was performed to obviate the risk of any foreign matter being sucked into the lungs. Although artificial respiration was continued for an hour and a half, all efforts to resuscitate the patient were ineffectual, no signs of vitality being noted after the cessation of breathing. A post-mortem examination was made by myself thirty-six hours later. Rigor mortis was marked. On opening the hernial sac a small knuckle of ileum was alone seen. This was very deeply congested, but the congestion did not extend to the mesenteric border, in. volving only about two-thirds of the circumference of the gub. The bowel was adherent to the sac round the neck, and there were a few flakes of recent lymph on the abdominal side of the ring. Beyond a few atheromatous patches on the aorta above the sigmoid valves and slight