THE MEDICAL AUTHORSHIP OF THE THIRD GOSPEL.

1101 It is reasonable to sup.h not yet been given. nothing visible, red and white blood corpuscles being has that if the definite change in the blood which conspicuous by their absence. The final examination was pose p conducted on August 5th when, apart from any marked occurs in all cases of advanced cancer can be o A systematic and thorough alteration in the character of the physical signs, the urine r,rectified a cure may result. was found to be normal, in colour pale amber tint, reaction i] of the condition of the blood cells, especially investigation acid with litmus as indicator, specific gravity 1022, no of 0 the white, carried out during any form of experin treatment at any of the institutions specially albumin, no deposit, but just a trace of mucus in suspension, mental as is commonly observed in the case of healthy individuals. d devoted to the treatment of cancer would probably give most The points of interest are these :-1. The comparative valuable v information. By our treatment the red cells quickly i: to normal or over, but it is much more difficult to length of time that elapsed before symptoms manifested increase r themselves (12 hours). This may be accounted for in part reduce the number of the white corpuscles to the average of We are, Sir, yours faithfully, by the character of the preparation used, the proportion of 1:health. the active ingredient in the plaster being 1 in 3 approxi. SKENE KEITH, GEO. E. KEITH. mately and in the liquor 1 in 2. The personal factor has likewise to be taken into consideration, patients varying, no Upper Berkeley-street, Portman-square, W., Oct. 5th, 1908. doubt, in their susceptibility to the influence of the drug. In this direction it is of interest to recall certain observations AN OPERATION FOR PARAPHIMOSIS. made by Christison in dealing with the subject of poisoning To the Editor of THE LANCET. by cantharides.. He remarks that "it is probable that this is one of the poisons whose operation is liable to be materially shall be grateful if you will allow me to bring SIR,--I The medical dose is frombefore affected by idiosyncrasy. your readers the following procedure in cases of gr. to 2 grs. of the powder, and from 10 drops to 2 drs.2 -paraphimosis. 1. An annular incision is made through the But Dr. Beck has quoted an instancemucous membrane of the foreskin a of the tincture. quarter of an inch from where 6 ozs. of the tincture were taken without injury. its reflection from the this incision reaches down glans penis; On the other hand, Werlhoff has mentioned the case of a to the submucous plane. 2. A second annular incision is made lad who used to be attacked with erection and involunthe skin of the penis half an inch from the mucothrough tary emission on merely smelling the powder." This state- cutaneous junction ; this incision reaches down to the subcu. ment, adds Christison, though extraordinary, is not without taneous plane. 3. A sagittal incision is made along the dorsum support from the parallel effects of other substances. connecting the two annular incisions and as before reaching 2. Absence of symptoms due to the manner in which the drug down to the submucous-subcutaneous planes. 4. The collar is excreted by the gastro-intestinal mucous membrane ; there of tissue thus marked out is off in the above plane. peeled was neither vomiting nor diarrhoea ; indeed, it was necessary 5. All bleeding vessels are secured and tied with catgut. to administer purgatives before the bowels could be induced 6. The cut edges of the skin and mucous membrane are to act. 3. Absence of symptoms referable to the genital approximated by a series of discontinuous catgut sutures. organs; no heat, no pain, tenderness, or swelling of the The following points illustrate the advantages of this parts having been observed, and no spermatozoa having method: 1. Reduction in old-standing cases can at the best been detected in the urinary sediment, though looked for be performed (a) by the exercise of much force and Christison remarks that whilst "a only on several occasions. with considerable pain to the patient ; or (b) " the narrow great number of cases are on record, but few have been constricting band caused by the orifice of the prepuce must minutely related. Sometimes cantharides have been swallowed be divided on the dorsal aspect. This will free the parts for the purpose of self-destruction, sometimes for procuring which can be subsequently drawn forwards, and after the miscarriage ; but most frequently on account of a prevalent cedema has been reduced by applying lotio plumbi for a few notion that it possesses aphrodisiac properties, it has been days circumcision may be advantageously undertaken " (Rose both voluntarily swallowed and secretly administered to and Carless). 2. Circumcision at a later date is generally excite the venereal appetite. That it has this effect in many thus necessitating delay and a second anesthetic. advisable, instances cannot be doubted. But the old stories which 3. The can be safely undertaken, even in these cases. operation have been the cause of its being so frequently used for the where local destruction of tissue has resulted from pressure. pmpusti am ilially ui uimin muuiuus auu all exaggerautu. I am, Sir, yours faithfully, no Often venereal appetite is excited, sometimes even no G. H. DIVE, M.R.C.S. Eng. affection of the urinary or genital organs at all, and the St. Bartholomew’s Hospital, Sept. 30th, 1908. kidneys and bladder may be powerfully affected without the genital organs participating. It is established, too, by THE MEDICAL AUTHORSHIP OF THE frequent observation that the excitement of the genital organs can never be induced without other violent conTHIRD GOSPEL. stitutional symptoms being also brought on to the great

was

1

hazard of life." The patient is convalescent at the present time, a natural cure having been effected by resorption of the pleural exudate. The urine is quite normal. In conclusion, I beg to state my indebtedness to Dr. Currie for permission to publish brief notes on the case. I am, Sir, yous faithfully, J. STANLEY AVERY, M.B., B.S. Lond., House Physician, Johannesburg Hospital.

THE TREATMENT OF INOPERABLE CANCER. lo the Editor

of THE LANCET.

SiR,—In his most interesting paper on this subject in THE LANCET of Oct. 3rd, p. 997, Mr. Henry Morris does not refer to the advisability of the systematic examination of the blood. It is a matter of common knowledge that the white corpuscles are increased in number and altered in relative proportion to each other. At the same time the red cells are as a rule diminished. It would appear that in these facts there is to be found a starting point capable of being used in the investigation of possible remedies and one to which sufficient attention 2

The

dose of the tincture of cantharides is from 5 to from 2 to 5 minims if used repeatedly.—ED. L.

present official

15 minims,

or

- Zo the Editor

of THE LANCET.

SIR,-In an annotation in THE LANCET of Sept. 26th you’ adduce strong evidence to prove that both the Third Gospel and the Acts of the Apostles were written by St. Luke. Incidentally I think this fact affords a proof that the Second Gospel was written by St. Mark. In Paul’s first journey with Barnabas they were accompanied by Mark, who left them on the way, and as Paul himself said "went not with them to the work." When they proposed a second’ journey Paul objected so strongly to Mark accompanyingthem that he and Barnabas parted and Mark accompanied Barnabas whilst Paul selected Silas as a companion. Forsome unassigned reason Silas appears to have ceased to be Paul’s companion and his place was taken by Luke who accompanied Paul on his last journeys. It would be only natural that Mark should retain some of the ill feeling which arose during the strife between Barnabas and Paul about him and should include also Paul’s companion Luke. It is curious to note that while St. Luke simply mentions the case of a woman having an issue of blood 12 years, which had spent all her living upon physicians and neither could be healed by any," Mark says,"She suffered many things from many physicians but was nothing better but rather grew worse." In this expression there appears a certain amount of bitterness against the profession to which St. Luke belonged, and which, if hardly to be expected an evangelist, was nevertheless entirely human, and I

from

1102 think tends to show that Mark was actually the author of the Gospel which bears his name. I am, Sir, yours faithfully, Oct. 6th, 1908. A PHYSICIAN.

the

lesion might be difficult to discover even The treatment of cancer of the stomach, as was well known, had proved very satisfactory, and Professor Czerny advocated a better selection of cases rather than more extensive operation. Cancer of the pancreas, he was extremely difficult to recognise during life, and thought, DEGREES FOR LONDON MEDICAL the organ might be removed in part he considered although STUDENTS. palliative measures to be the more satisfactory. Mr. D’ARCY POWER (London) brought forward a case of To the Editor of THE LANCET. Malignant Disease of the Spleen. He showed the SIR,-I have been much struck by the one-sided view you Primary The patient was a which weighed 66 ounces. specimen, take of the question of an M.D. degree for London students. 47 years, who died six months after the opera. woman, aged I think that graduates of the University of London should tion. He stated that the case was the twelfth of which a have something to say on this subject. I may be writing record existed. All the cases were sarcomatous. Splenectomy from a purely selfish point of view, but I am certain that was performed ; five cases recovered and seven were cured. I am giving the opinion of many fellow graduates. The Abscess of the Liver. M.D. London was looked upon both by the profession and the laity as the hall-mark of medicine. Why strive to Reports on Abscess of the Liver were presented by Dr. lower it ? If everyone can obtain it what value will it have LEGRAND (Alexandria) and by Dr. VORONOFF (Cairo). and what recompense can be given to the unfortunate men They considered that alcoholism was a factor in producing a who worked so hard in the old days to obtain it ? As tendency to amoebic or pyogenic infection and agreed that it is, the standard has already been lowered quite enough. an operation ought to be performed as soon as pus was reco. If everyone obtains the M.D. London will there be left gnised. Plugging was the only way of arresting hemorrhage any higher honour for students to strive after ? Surely during operation and no reliance should be placed upon the ambition is of some value, and it does not appear likely thermocautery or forcipressure when dealing with bleeding that everyone will be content to remain on a dead level. from the liver. Professor PAYR (Greifswald) pointed out that much was Surgeons would not be pleased if the F.R.C.S. was made accessible to everyone. And after all, is the M. R. C. S., L. R. C. P. still required to complete the diagnosis of tumours of the a qualification to be ashamed of ? Surely it is of more value liver. He thought that the severe pain which often accom. than many a Scotch or Irish degree. To illustrate the panied simple tumours of the liver and the tendency towards grievances which alterations of this kind cause, I may men- their association with malignant disease justified early tion a point which does not appear to have been touched surgical interference in all cases where they could be upon previously-namely, that formerly one had to pass a recognised. Anrzsthesirc. separate examination for the B.S. London, whereas now the that is so on ansesthesia were although formerly M.B., degree styled M.B., B.S., Reports presented by Professor VALLAS B.S. stood for two separate examinations, the B.S. being for (Lyons), Dr. LOTHEISSEN (Vienna), Professor REVERDIN and a higher examination in surgery, now the letters only signify Dr. BERGALOXNE (Geneva), Dr. ROUFFART and Dr. Therefore the time and WALRAVENS (Brussels), Professor REHN (Frankfort), Dr. the ordinary pass examination. trouble spent over the old B.S. degree now counts for ZAHRADNICKY (Bohemia), Dr. MOTY (Paris), Dr. MACARTHUR, and Dr. ALEXIUS VON HiNTZ (Maresvasarhely). nothing. In conclusion, Sir, if everyone wishes to be styled b’urGery of the Spinal Cord. "Doctor"there is no objection, but do not lower the DE QUERVAIN (La Chaux-de-Fonds) introduced Professor F. standard of the University of London examinations to allow a discussion on Injuries of the Spine and Spinal Cord. In them to obtain this title. his paper he pointed out that there were no definite signs of I am, Sir, yours faithfully, spinal concussion, that was a functional disturbance without M.B., B.S. LONDON. any anatomical’ lesion. When a case of spinal injury could be examined at once it was generally possible to distinguish between a partial and a total lesion of the cord, but THE SECOND CONGRESS OF THE INTER- later it might not be possible. When the tendon NATIONAL SOCIETY OF SURGERY reflexes were present it was practically certain that a total lesion of the cord was not present, but the conAT BRUSSELS. The nervous verse of this proposition was not always true. (FROM OUR SPECIAL CORRESPONDENTS.) did not to be made enable a diagnosis symptoms present between compression and contusion of the spinal cord. From (ConUmted from p. 1037.) experiments on dogs and rabbits there was no probability of Neither extradural nor success in suturing the spinal cord. Acute Angiocholitis. intradural haemorrhage of the spinal cord was an indication for ON the second day of this Congress Professor QUENU and operation, except perhaps when a hasmatoma of the cervical Dr. DuvAL (Paris) made a communication upon Acute cord was causing interference with respiration, but the diaAngiocholitis, which they said was always due to microbic gnosis would be very difficult. When a diagnosis of hsematoinfection, the microbes reaching the liver either by the bile myelia was made an operation should be performed. An ducts or by the hepatic artery and portal vein. Infection operation was also indicated when the diagnosis suggested along the vascular system was, however, more common that the symptoms present were due to fracture of the lamina in the primary forms due to pneumococci, influenza, and of a vertebra or when a skiagram showed that a bullet was in cholera, whilst secondary angiocholitis was associated with the neural canal. An operation was advisable, though the gall-stones, the penetration of foreign bodies into the chances of success were small, when an irreducible fracturebile ducts, and pregnancy. Angiocholitis also occurred dislocation was present, or when a splinter of bone was in the course of piles and of appendicitis. Treatment con- compressing the cord. At present an operation in a total sisted in operation, during the quiet stage if possible, transverse section was looked upon as useless, but if the redrainage of the bile ducts and gall-bladder following upon ported successful case was confirmed by the work of others then an operation would be clearly indicated in nearly all cholecystotomy. Cancer. such cases. Dr. de Quervain had collected 218 cases of The meeting then resumed the discussion on Cancer, operation for injury of the spine and cord, with the result Professor CzERNY, the President, presented his report upon that recovery followed in 13’8 per cent., and of these Cancer of the (Esophagus and Stomach, Liver, Biliary Ducts, in 10’55 per cent. the improvement was certainly influenced Pancreas, and Peritoneum. He thought that cancer of the aeso- by the operation ; 22 per cent. were improved; in 37’2per phagus should be operated upon whilst it was still localised cent. no obvious change was present, in l’8per cent. the and he preferred operation to the use of bougies. Carcinoma operation appeared to do harm, and in 25’2per cent. the of the gall-bladder was so often secondary to gall-stones patient died. that especial care should be taken to recognise and to Professor BERARD (Leipsic) reported on Tumours of the treat them early. Cancerous peritonitis was nearly always Spinal Cord and urged that in doubtful cases there should secondary to cancer of a neighbouring organ, though always be a consultation between the physician and the

andI

primary

at the necropsy.