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THE TRAVELLING ARRANGEMENTS AT THE BUDAPEST CONGRESS.
1060 As is very general in cholera, but not univibro was found after the disease was developed in the patient ; but it is not stated to which of the thirteen species of comma vibrios that Professor Cunningham of Calcutta has shown to exist it belonged. It would appear, moreover, from the account that Dr. Oergel had previously experimented on himself with comma vibrios without effect. The case is of value also as evidence of the specific nature of Asiatic cholera. Though only one case occurred in a non-infected town it was at once recognised as different from ordinary cases of cholera nostras. It would seem as if Hamburg was destined to be the CO’J’p1lS ’Cile from ’, which we are to obtain our experimental knowledge of cholera. ’It will be remembered that, relying on Dr. Koch’s methods of diagnosis in 1892, the authorities declined to recognise the disease as Asiatic cholera for very nearly a week, till the town had become a scandal to Europe, and now we have this additional evidence from it. But Hamburg has no Western rival in its familiarity witb cholera, for it has already had sixteen epidemics, and unless it listens to the advice given by the Commissioner of THE LANCET it is likely even yet to add considerably to its experience. I am. Sirs. faithfullv vours. A. J. WALL, M.D. London, W., Oct. 22nd, 1894.
demonstration.
versal,
a
comma
COMMISSION."
anybody else to prove that this proposition has by experiment. To save time, as replies are received from me by THE LANCET after so much delay that the subject is in danger of being forgotten, I enclose a diagram of what happens in uncomplicated death from chloroform poisoning. This diagram shows :Mr. Ward
or
mot been confirmed
results which will either confirm ours or clash with them. In the latter event Mr. Ward will have grounds for questioning my statement. I challenge him to put it to the proof. I am. Sirs. vours obedientlv. EDWARD LAWRIE Hyderabad, Deccan, Oct. 10th, 1894.
THE TRAVELLING ARRANGEMENTS AT THE BUDAPEST CONGRESS. To the Editors of THE LANCET. SIRS,-Now that the 1894 International Congress of
" THE HYDERABAD CHLOROFORM To the Editors of THE LANCET. SiRs,-I am much obliged to Mr. Arthur H. Ward for his courteous reply to my letter. It is somewhat inconsistent, however, of him to profess that he could not quote correctly a sentence of mine, three lines and a half long, in a paper ’extending over a column, seeing that he has now done so in a letter which occupies less than twenty lines of THE LANCET. Moreover, he is entirely wrong in asserting that SurgeonLieutenant-Colonel Lawrie challenges me (Mr. Ward) to prove that a distinctly different proposition has not been ’confirmed by experiment." The only distinctly different proposition is Mr. Arthur H. Ward’s compression of my statement into the meaningless proposition that ’’chloroform is perfectly safe when the respiration alone is watched." The sentence since correctly quoted by Mr. Ward, from THE LANCET report of the meeting of the Royal Medical and Chirur3rd, in your issue of Sept. 22nd gical Society of July 11 irnns as follows : I think I have shown that, while it is possible to give chloroform with uniform safety by proper attention to the respiration, no man can do so who dreads heart failure and takes the pulse as a guide," and I challenge
danger of taking the pulse as a guide. The pulse is clearly not a guide to anaesthesia beyond which chloroform ought never to be pushed ; and, on the other hand, the information derived from the pulse when the heart begins to fail and death is most likely inevitable (at the point marked arrow IV.) constitutes nothing more than a second-hand warning that the respiration had stopped previously (at the point marked by arrow III.). It is obvious from the diagram that, while heart failure may be prevented by proper attention to the respiration, it is impossible to prevent it by feeling the pulse. 3. Provided the inhalation of chloroform is not pushed beyond the point where anaesthesia is complete (arrow II.) and is maintained at the level of the dotted tracing, the region of danger is never entered, and cardiac failure from the action of chloroform is impossible. The experiment from which my diagram is taken-of simple uncomplicated chloroform poisoning-can be repeated in every laboratory and medical school in Great Britain, with
committee has been appointed to deal the 1897 meeting, might I through your columns draw their attention to the necessity ofmaking better travelling arrangements ? At the Budapest gathering the reduction accorded to members of the Congress on railway tickets amounted to about 10s. For those who travelled by France, although they were given a reduction of 50 per cent., obtaining this reduction was hedged in by so many formalities It seems many were not able to avail themselves of it. to me that a far better way would be for the committee to negotiate direct with the railway company, for I think that all who went there will admit that the intervention of agents and the arrangements made by them were far from satisI am, Sirs, yours faithfully, factory. COXGRESSIST. Camberwell, Oct. 26th, 1894.
Hygiene is
over, and
with matters
a
concerning
that
’
MANCHESTER. CORRESPONDENT.) (FROM OUR OWN
The Amalgamation of St. Mary’s and the Southern Hospitals. THE annual meetings of these institutions were held about a fortnight ago, and at each of them the scheme for amalgamation was alluded to. At the St. Mary’s Hospital meeting it was stated that the negotiations with the Southern Hospital were progressing, but were not sufficiently advanced to enable the ooard to report definitely as to the final plans decided on in order to bring the amalgamation into actual operation. The David Lewis Trust proposed at first to give £ 50, 000 for the building of a hospital at the corner of Gloucester-street and Oxford-road and another in Stanley-grove, Oxford-road, on condition that this amalgamation should take place. It was subsequently intimated that the grant would be increased to .670.000 if the land and building of St. Mary’s Hospital in Quay-street were handed over to the Trust for appropriation to the public use. The Gloucester-street Hospital will be for midwifery cases and out-patients ; that in Stanley-grove will be reserved for the treatment of diseases of women and children. Some awkward compounding of names will take place. St. Mary’s Hospital, the older instituexisted over a century-retains its name ; the tion-having Gloucester-street building being called St. Mary’s HospitalsMaternity Hospital; and that in Stanley-grove the St. Mary’s Hospitals-the David Lewis Southern Hospital. These cumbrous titles are unfortunate, but time will no doubt bring into use some briefer appellations. The committees of the two institutions have agreed on the details of the amalgama.
1. The sequence of events in death from chloroform is lowerthe blood pressure with, first, anaesthesia, then stoppage of the respiration, then failure of the heart, and, finally, death. The only modification which may take place in the ?nodu8 >percadi of the anxsthetic is that in patients or animals who are very susceptible to the effects of chloroform and in those with weak or diseased hearts the intervals between certain tion, but are waiting for the sanction of the Charity Comof the events depicted in the diagram may be shortened and missioners. Lack of subscriptions was bewailed at both meetin extreme cases almost inappreciable. 2. The futility and ings, and one of the speakeru at the meeting of the Southern Hospital said : "If the great scheme of amalgamation with 1 THE St. Mary’s were accomplished it would entail an immense LANCET, Sept. 22nd, 1894.
ing of
demonstration.
versal,
a
comma
COMMISSION."
anybody else to prove that this proposition has by experiment. To save time, as replies are received from me by THE LANCET after so much delay that the subject is in danger of being forgotten, I enclose a diagram of what happens in uncomplicated death from chloroform poisoning. This diagram shows :Mr. Ward
or
mot been confirmed
results which will either confirm ours or clash with them. In the latter event Mr. Ward will have grounds for questioning my statement. I challenge him to put it to the proof. I am. Sirs. vours obedientlv. EDWARD LAWRIE Hyderabad, Deccan, Oct. 10th, 1894.
THE TRAVELLING ARRANGEMENTS AT THE BUDAPEST CONGRESS. To the Editors of THE LANCET. SIRS,-Now that the 1894 International Congress of
" THE HYDERABAD CHLOROFORM To the Editors of THE LANCET. SiRs,-I am much obliged to Mr. Arthur H. Ward for his courteous reply to my letter. It is somewhat inconsistent, however, of him to profess that he could not quote correctly a sentence of mine, three lines and a half long, in a paper ’extending over a column, seeing that he has now done so in a letter which occupies less than twenty lines of THE LANCET. Moreover, he is entirely wrong in asserting that SurgeonLieutenant-Colonel Lawrie challenges me (Mr. Ward) to prove that a distinctly different proposition has not been ’confirmed by experiment." The only distinctly different proposition is Mr. Arthur H. Ward’s compression of my statement into the meaningless proposition that ’’chloroform is perfectly safe when the respiration alone is watched." The sentence since correctly quoted by Mr. Ward, from THE LANCET report of the meeting of the Royal Medical and Chirur3rd, in your issue of Sept. 22nd gical Society of July 11 irnns as follows : I think I have shown that, while it is possible to give chloroform with uniform safety by proper attention to the respiration, no man can do so who dreads heart failure and takes the pulse as a guide," and I challenge
danger of taking the pulse as a guide. The pulse is clearly not a guide to anaesthesia beyond which chloroform ought never to be pushed ; and, on the other hand, the information derived from the pulse when the heart begins to fail and death is most likely inevitable (at the point marked arrow IV.) constitutes nothing more than a second-hand warning that the respiration had stopped previously (at the point marked by arrow III.). It is obvious from the diagram that, while heart failure may be prevented by proper attention to the respiration, it is impossible to prevent it by feeling the pulse. 3. Provided the inhalation of chloroform is not pushed beyond the point where anaesthesia is complete (arrow II.) and is maintained at the level of the dotted tracing, the region of danger is never entered, and cardiac failure from the action of chloroform is impossible. The experiment from which my diagram is taken-of simple uncomplicated chloroform poisoning-can be repeated in every laboratory and medical school in Great Britain, with
committee has been appointed to deal the 1897 meeting, might I through your columns draw their attention to the necessity ofmaking better travelling arrangements ? At the Budapest gathering the reduction accorded to members of the Congress on railway tickets amounted to about 10s. For those who travelled by France, although they were given a reduction of 50 per cent., obtaining this reduction was hedged in by so many formalities It seems many were not able to avail themselves of it. to me that a far better way would be for the committee to negotiate direct with the railway company, for I think that all who went there will admit that the intervention of agents and the arrangements made by them were far from satisI am, Sirs, yours faithfully, factory. COXGRESSIST. Camberwell, Oct. 26th, 1894.
Hygiene is
over, and
with matters
a
concerning
that
’
MANCHESTER. CORRESPONDENT.) (FROM OUR OWN
The Amalgamation of St. Mary’s and the Southern Hospitals. THE annual meetings of these institutions were held about a fortnight ago, and at each of them the scheme for amalgamation was alluded to. At the St. Mary’s Hospital meeting it was stated that the negotiations with the Southern Hospital were progressing, but were not sufficiently advanced to enable the ooard to report definitely as to the final plans decided on in order to bring the amalgamation into actual operation. The David Lewis Trust proposed at first to give £ 50, 000 for the building of a hospital at the corner of Gloucester-street and Oxford-road and another in Stanley-grove, Oxford-road, on condition that this amalgamation should take place. It was subsequently intimated that the grant would be increased to .670.000 if the land and building of St. Mary’s Hospital in Quay-street were handed over to the Trust for appropriation to the public use. The Gloucester-street Hospital will be for midwifery cases and out-patients ; that in Stanley-grove will be reserved for the treatment of diseases of women and children. Some awkward compounding of names will take place. St. Mary’s Hospital, the older instituexisted over a century-retains its name ; the tion-having Gloucester-street building being called St. Mary’s HospitalsMaternity Hospital; and that in Stanley-grove the St. Mary’s Hospitals-the David Lewis Southern Hospital. These cumbrous titles are unfortunate, but time will no doubt bring into use some briefer appellations. The committees of the two institutions have agreed on the details of the amalgama.
1. The sequence of events in death from chloroform is lowerthe blood pressure with, first, anaesthesia, then stoppage of the respiration, then failure of the heart, and, finally, death. The only modification which may take place in the ?nodu8 >percadi of the anxsthetic is that in patients or animals who are very susceptible to the effects of chloroform and in those with weak or diseased hearts the intervals between certain tion, but are waiting for the sanction of the Charity Comof the events depicted in the diagram may be shortened and missioners. Lack of subscriptions was bewailed at both meetin extreme cases almost inappreciable. 2. The futility and ings, and one of the speakeru at the meeting of the Southern Hospital said : "If the great scheme of amalgamation with 1 THE St. Mary’s were accomplished it would entail an immense LANCET, Sept. 22nd, 1894.
ing of