- Email: [email protected]
THE THERAPEUTIC VALUE OF LIQUID AIR AND SOLID CARBON DIOXIDE.
1937
Correspondence. I I Audi alteram
partem."
Sodæ bicarbonas by the mouth was administered almost immediately, but was as immediately returned. Two hours later the stupor was more marked, the pupils still dilated and sluggish, and a new symptom had appeared-abdominal pain. To locate this I gently percussed the bladder region to obviate any retention
THE THERAPEUTIC VALUE OF LIQUID AIR AND SOLID CARBON DIOXIDE.
trouble, but there, and in the left
In the was to be found. region, nothing right iliac region, however, even the lightest touch produced cries of pain. For this I advised hot applications until my To the Editor of THE LANCET. I next visit. At 1 o’clock I was called again on account of SIR,-I notice in your issue of Dec. llth the letter from the pain having become agonising. Being professionally Dr. Stupford Taylor and Dr. MacKenna concerning the value engaged elsewhere I was unable to see her at the moment, of liquid air and solid CO2. Both in hospital and private and advised the family to call in the nearest medical man, work I have now had considerable experience of the value of Mr. Dalton Tacey, who kindly saw her and administered a both these remedies, and consider they have a marked thera- hypodermic injection of morphia and atropine, and when I peutic value and that there is no difficulty in regulating the saw her later in conjunction with that gentleman she was in pressure in either case. The liquid air we use after the deepest coma, moribund, dying at 8 P.M. method as given by Dr. Stopford Taylor, the snow with the The features of the case which struck me were: (1) The aid of various-sized cupping-glasses, and tubes containing a fall of the specific gravity with commencing coma ; (2) the sort of jack in the box spring of wool, tow, &c. intensely rapid onset of pain in the Tight iliac region with no With either remedy the greatest care is necessary with explanation of its cause on digital examination, unrelieved exdelicate skins in order to prevent a serious burn, but even cept by morphia ; and (3) the long amenorrhoea. and the rapid when this has occurred the scar tissue has been supple and change from the ever so much better and stronger"conof a fairly natural colour. We also prefer the liquid air to dition to the fatal termination. I much regret that in my the snow, but find the former very much more costly than hasty first visit I omitted to put my ophthalmoscope in the latter. For lupus erythematosus I prefer to use zinc my pocket and therefore was unable to view the fundi. I venture these somewhat sketchy notes for your readers ions, but for capillary nævi and moderately shallow venocapillary nasvi use nothing now but either the snow or air, in the hope that each clinical observer of this diabetic phase applied once or twice to five or six times, and for from five may add his mite, thereby increasing the sum of truth and to ten and up to 40 seconds exposures. We have found it difficult to get adult patients with large port-wine stains to stand enough of the treatment to get really good results. It is the after-soreness that they object to rather than the temporary pain during the applications. This is lessened by excluding air from the affected area by means of collodion or dusting powders, but is not prevented. Latterly we have only treated a small area at a time, but this of course enormously increases the period of treatment. The cleanest results that I have had in the treatment of noevi are with radium, but the expense of the salt is a drawback, and particularly so in hospital work, and, furthermore, with babies constant attention is necessary to prevent the slipping away of the applicators or buttons from the affected area. I am, Sir, yours faithfully, W. T. FREEMAN. 1909. Dec. 16th, Reading,
ABDOMINAL CRISES IN DIABETES. _
To the Editor of THE LANCET. SIR,-Dr. Nestor Tirard’sinteresting communication in your issue of to-day and the preceding annotation upon the same subject impel me to add a few brief observations of my own. Miss A- B-,aged 27, a fever hospital nurse, on August 18th last entered my consulting-room in a state of great debility, having been compelled to resign her hospital appointment from sheer bodily weakness. Her a rapid general aspect and the odour of her breath diagnosis (which the urine examination amply corroborated -specific gravity 1032 ; sugar in quantity) of diabetes. There had been amenorrhoea for seven months. From the above date, at intervals of a week or so, she was under my observation ; the urine, despite rigid diet and medicine (principally sodas salicyl.), remained at the same high specific gravity both morning and evening, although her weight improved from 7 stone to 7 stone 7 pounds. Among the marked features of her case were the following : Eczema of the eyebrows ; vivid ’’ hectic "flush of the cheeks ; a red, dry, papillated, very sore tongue, and a typical breath-odour which pervaded my room at each visit with an unusually sickening persistence. At the beginning of November she was able to have a change of air, at Brighton. Her means limiting her visit she returned home, much benefited by the change, about Nov. 17th, and called upon me to report herself as feeling ever so much better and stronger." One week later, at 8 A.M., I was urgently summoned to see her. I found her in a condition of marked drowsiness, with dilated and sluggish pupils, rapid shallow breathing, and a disability to heed those around her, in fact, in a condition She answered my questions with of commencing coma. semi-intelligence and was able voluntarily to yield me a specimen of urine for examination. This, tested, showed much less sugar; specific gravity, 1015.
permitted
abnormal
iliac
the benefit of future records. I am, Sir, yours faithfully, HUGHES R. DAVIES. Woodford Green, Essex, Dec. llth, 1909.
THE JOHN HERBERT WELLS FUND. THE following is the seventh list of subscriptions to the John Herbert Wells Fund. Further contributions will be gratefully received by the Earl of Dalhousie and Mr. Julian G. Lousada, honorary secretaries and treasurers of the fund, at 16, Old Broad-street, E.C., or by ourselves at this office :B
s.
d.
Æsculapius Lodge...... 10 10 0 Professor A. H. White... Dr. William Hill 5 5 0 Dr. Hughlings Jackson, Lord Willoughby de LL.D., F.R.S..........
2 s. d. 0 2 2
......
M.F....... Eresby, Honourable
Right
Marquis of Zetland ... Lord Leconfield Mr. Evelyn Heseltine... Mrs. Broucke Mr. James Mackee...... Mrs. Mosenthal ......
.........
......
5 5 0 Mr. and Mrs. J. W.
Gill
Mrs.A.Drury.........
Goodenough
5 00 Miss F. A. 5 0 0Messrs. Price and King 2 2 0 Mrs. Forsyth 2 2 0 Dr. S. G. Scott......... 2 20 Mr. W. C. Biss ......... 2 2 0 Mr. Gerald H. Hardy ...
.........
2 20 1 10 0 1 10 1 1 0 0 1 1 1 10 1 1 0 1 0 0 1 00
THE SERVICES. ROYAL NAVY MEDICAL SERVICE. THE following appointments are notified :-Fleet-Surgeons : H. W. Macnamara, C. Bradley, A. G. W. Bowen, and J. C. Durston to the President, additional, for three months’ hospital course ; J. K. Robinson to the Cæsarand J. Moore to the Shannon. Staff-Surgeons: E. T. P. Eames, W. R. Trythall, F. F. Lobb, J. Boyan, E. 0. B. Carbery, and A. R. H. Skey to the President, additional, for three months’hospital course; C. H. Rock to the Indus; E. Arkwright to the Blenheim; J. E. H. Phillips to the Endynaion; K. H. Jones to the 1)ido; J. Lindop to the Exeellent; and W. J. Codrington to the Cornwall, on recommissioning. Surgeons: E. R. L. Thomas, W. C. B. Smith, T. E. Blunt, G. E. Hamilton, and H. S. Turner, to the President, additional, for three months’ hospital course ; J. Barrett to the Defiance, lent temporarily ; W. N. Blatchford to the Vernon, additional, for the Niger;B. S. Robson to the Haicyon;J. Hadwen to the Dominion; J. C. Orwin to the New Zealand; and H. C. Devas to the Cornwall, on recommissioning. ROYAL ARMY MEDICAL CORPS. Captain Dudley S. Skelton, from the Seconded List, is restored to the establishment (dated Dec. 11th, 1909). Captain A. E. F. Hastings has been detailed as medical officer of the first and second camps of artillery training at
Bargarh.
Correspondence. I I Audi alteram
partem."
Sodæ bicarbonas by the mouth was administered almost immediately, but was as immediately returned. Two hours later the stupor was more marked, the pupils still dilated and sluggish, and a new symptom had appeared-abdominal pain. To locate this I gently percussed the bladder region to obviate any retention
THE THERAPEUTIC VALUE OF LIQUID AIR AND SOLID CARBON DIOXIDE.
trouble, but there, and in the left
In the was to be found. region, nothing right iliac region, however, even the lightest touch produced cries of pain. For this I advised hot applications until my To the Editor of THE LANCET. I next visit. At 1 o’clock I was called again on account of SIR,-I notice in your issue of Dec. llth the letter from the pain having become agonising. Being professionally Dr. Stupford Taylor and Dr. MacKenna concerning the value engaged elsewhere I was unable to see her at the moment, of liquid air and solid CO2. Both in hospital and private and advised the family to call in the nearest medical man, work I have now had considerable experience of the value of Mr. Dalton Tacey, who kindly saw her and administered a both these remedies, and consider they have a marked thera- hypodermic injection of morphia and atropine, and when I peutic value and that there is no difficulty in regulating the saw her later in conjunction with that gentleman she was in pressure in either case. The liquid air we use after the deepest coma, moribund, dying at 8 P.M. method as given by Dr. Stopford Taylor, the snow with the The features of the case which struck me were: (1) The aid of various-sized cupping-glasses, and tubes containing a fall of the specific gravity with commencing coma ; (2) the sort of jack in the box spring of wool, tow, &c. intensely rapid onset of pain in the Tight iliac region with no With either remedy the greatest care is necessary with explanation of its cause on digital examination, unrelieved exdelicate skins in order to prevent a serious burn, but even cept by morphia ; and (3) the long amenorrhoea. and the rapid when this has occurred the scar tissue has been supple and change from the ever so much better and stronger"conof a fairly natural colour. We also prefer the liquid air to dition to the fatal termination. I much regret that in my the snow, but find the former very much more costly than hasty first visit I omitted to put my ophthalmoscope in the latter. For lupus erythematosus I prefer to use zinc my pocket and therefore was unable to view the fundi. I venture these somewhat sketchy notes for your readers ions, but for capillary nævi and moderately shallow venocapillary nasvi use nothing now but either the snow or air, in the hope that each clinical observer of this diabetic phase applied once or twice to five or six times, and for from five may add his mite, thereby increasing the sum of truth and to ten and up to 40 seconds exposures. We have found it difficult to get adult patients with large port-wine stains to stand enough of the treatment to get really good results. It is the after-soreness that they object to rather than the temporary pain during the applications. This is lessened by excluding air from the affected area by means of collodion or dusting powders, but is not prevented. Latterly we have only treated a small area at a time, but this of course enormously increases the period of treatment. The cleanest results that I have had in the treatment of noevi are with radium, but the expense of the salt is a drawback, and particularly so in hospital work, and, furthermore, with babies constant attention is necessary to prevent the slipping away of the applicators or buttons from the affected area. I am, Sir, yours faithfully, W. T. FREEMAN. 1909. Dec. 16th, Reading,
ABDOMINAL CRISES IN DIABETES. _
To the Editor of THE LANCET. SIR,-Dr. Nestor Tirard’sinteresting communication in your issue of to-day and the preceding annotation upon the same subject impel me to add a few brief observations of my own. Miss A- B-,aged 27, a fever hospital nurse, on August 18th last entered my consulting-room in a state of great debility, having been compelled to resign her hospital appointment from sheer bodily weakness. Her a rapid general aspect and the odour of her breath diagnosis (which the urine examination amply corroborated -specific gravity 1032 ; sugar in quantity) of diabetes. There had been amenorrhoea for seven months. From the above date, at intervals of a week or so, she was under my observation ; the urine, despite rigid diet and medicine (principally sodas salicyl.), remained at the same high specific gravity both morning and evening, although her weight improved from 7 stone to 7 stone 7 pounds. Among the marked features of her case were the following : Eczema of the eyebrows ; vivid ’’ hectic "flush of the cheeks ; a red, dry, papillated, very sore tongue, and a typical breath-odour which pervaded my room at each visit with an unusually sickening persistence. At the beginning of November she was able to have a change of air, at Brighton. Her means limiting her visit she returned home, much benefited by the change, about Nov. 17th, and called upon me to report herself as feeling ever so much better and stronger." One week later, at 8 A.M., I was urgently summoned to see her. I found her in a condition of marked drowsiness, with dilated and sluggish pupils, rapid shallow breathing, and a disability to heed those around her, in fact, in a condition She answered my questions with of commencing coma. semi-intelligence and was able voluntarily to yield me a specimen of urine for examination. This, tested, showed much less sugar; specific gravity, 1015.
permitted
abnormal
iliac
the benefit of future records. I am, Sir, yours faithfully, HUGHES R. DAVIES. Woodford Green, Essex, Dec. llth, 1909.
THE JOHN HERBERT WELLS FUND. THE following is the seventh list of subscriptions to the John Herbert Wells Fund. Further contributions will be gratefully received by the Earl of Dalhousie and Mr. Julian G. Lousada, honorary secretaries and treasurers of the fund, at 16, Old Broad-street, E.C., or by ourselves at this office :B
s.
d.
Æsculapius Lodge...... 10 10 0 Professor A. H. White... Dr. William Hill 5 5 0 Dr. Hughlings Jackson, Lord Willoughby de LL.D., F.R.S..........
2 s. d. 0 2 2
......
M.F....... Eresby, Honourable
Right
Marquis of Zetland ... Lord Leconfield Mr. Evelyn Heseltine... Mrs. Broucke Mr. James Mackee...... Mrs. Mosenthal ......
.........
......
5 5 0 Mr. and Mrs. J. W.
Gill
Mrs.A.Drury.........
Goodenough
5 00 Miss F. A. 5 0 0Messrs. Price and King 2 2 0 Mrs. Forsyth 2 2 0 Dr. S. G. Scott......... 2 20 Mr. W. C. Biss ......... 2 2 0 Mr. Gerald H. Hardy ...
.........
2 20 1 10 0 1 10 1 1 0 0 1 1 1 10 1 1 0 1 0 0 1 00
THE SERVICES. ROYAL NAVY MEDICAL SERVICE. THE following appointments are notified :-Fleet-Surgeons : H. W. Macnamara, C. Bradley, A. G. W. Bowen, and J. C. Durston to the President, additional, for three months’ hospital course ; J. K. Robinson to the Cæsarand J. Moore to the Shannon. Staff-Surgeons: E. T. P. Eames, W. R. Trythall, F. F. Lobb, J. Boyan, E. 0. B. Carbery, and A. R. H. Skey to the President, additional, for three months’hospital course; C. H. Rock to the Indus; E. Arkwright to the Blenheim; J. E. H. Phillips to the Endynaion; K. H. Jones to the 1)ido; J. Lindop to the Exeellent; and W. J. Codrington to the Cornwall, on recommissioning. Surgeons: E. R. L. Thomas, W. C. B. Smith, T. E. Blunt, G. E. Hamilton, and H. S. Turner, to the President, additional, for three months’ hospital course ; J. Barrett to the Defiance, lent temporarily ; W. N. Blatchford to the Vernon, additional, for the Niger;B. S. Robson to the Haicyon;J. Hadwen to the Dominion; J. C. Orwin to the New Zealand; and H. C. Devas to the Cornwall, on recommissioning. ROYAL ARMY MEDICAL CORPS. Captain Dudley S. Skelton, from the Seconded List, is restored to the establishment (dated Dec. 11th, 1909). Captain A. E. F. Hastings has been detailed as medical officer of the first and second camps of artillery training at
Bargarh.