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THE TREATMENT OF MALIGNANT STRICTURE OF THE ŒSOPHAGUS, WITH ESPECIAL REFERENCE TO INTUBATION AND TO RADIUM.
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T: which the examiner can explore the larynx or trachea in chloroform from the irritation of vapour. For intra-laryngeal cases I use the Bellamy Gardner tube, though I think there is room for some improvement here, and should like to see a laryngoscope made with an arrangement for the delivery of the anaesthetic vapour near its lower end. When the œsophagoscope or gastroscope is being used the respiration is not infrequently embarrassed, the patients are often old and feeble, and I find a slow stream of oxygen passed through the Junker bottle of great I am, Sir, yours faithfully, service. G. A. A, H. BARTON. Talbot-road, W., March 9th, 1911.
strain of its investing irritated muscles is gradually compressed and at length gives way. Deformity once commenced proceeds more rapidly as the mechanical advantage under which the anterior spinal muscles act becomes more pronounced, while the opposition offered by the posterior muscles simultaneously decreases." (e) "As soon, however, as the body bends forward, as it must at the seat of the disease, the posterior muscles, because obliged to pull round the angle of the knuckle, work at a distinct disadvantage....... The anterior muscles improperly antagonised draw the body forward.’ (Quoted from Goldthwait, Painter, and Osgood.) The muscles once contracted, if left to themselves, do not relax, but remain permanently shortened. Even if the disease does become arrested they still anchor down the bent and by this time the commonly ankylosed spine....... In dorsal caries the baneful effects of this are particularly apparent." Now, Sir, where are these anterior spinal muscles ? You will admit that they exist only in the imagination of Mr. Gauvain. If Mr. Gauvain were to examine a cadaver he would find that the longus colli ceases at the third dorsal vertebra, and that the psoas magnus commences at the twelfth. Between these vertebræ there are no anterior muscles at all, yet he speaks of their ’’baneful effects " as particularly apparent here. Moreover, in the very regions, the cervical and lumbar, where there are muscles which could conceivably act as he describes, the angular deformity is least marked. (I need not enter into the reasons for that
expired
comfort, free
AUTUNITE (HYDRATED URANIUMCALCIUM PHOSPHATE). To
Editor of THE LANCET. SIR,-Your readers may be interested by a brief account of the radio-active mineral referred to by Dr. Churchward in his article in your issue of March llth. Hydrated uranium-calcium phosphate, or autunite,is a natural uranyl phosphate known for some time as existing in France (notably at Autun-whence the name) and in Cornwall, and recently proved to occur in great quantities in certain districts in Portugal. It is now worked for radium. The precise origin of the ore is debated, but it occurs largely as a crystalline deposit in tracts of decomposed granitic rock. The average mineral, as worked, contains between 1 and 2 per cent. of the uranium ; but here and there are found " couches"containing clusters of uranite crystals, often of some size and of great purity. This, I take it, is the mineral used by Dr. Churchward. The pure hydrated crystal con. tains approximately the equivalent of 50 per cent. uranoso. uranic oxide ; its theoretical"activity"is therefore patent to any student of radio-activity. A most interesting point arises here. Certain French chemists, now engaged on the separation of radium from this ore, maintain that the available radium therein is in excess of the theoretical "radium-uranium constant" hitherto recognised. I think I am correct in stating that this has not yet been formally substantiated; but it would be interesting in this connexion to see Dr. Churchward’s experiments repeated with an equal amount of, say, pitchblende containing the same percentage of uranium as the phosphate. On the "constant"" theory the activity should
here.)
If Mr. Gauvain’s theory-or is it Dr. Goldthwait’s ?-of muscular spasm as a cause of deformity in spinal caries be correct, it must surely hold good for the dorsal region, which the disease most frequently attacks, and where that deformity is most marked. But it does not hold good, for there are no muscles. Is it possible that Mr. Gauvain has been unconsciously led away by the plausible and voluminous output of Dr. Goldthwait, M.D. ? I am, Sir, yours faithfully, PAUL B. ROTH, F.R.C.S. F. R. C. S. London, March 7th, 1911.
THE TREATMENT OF MALIGNANT STRICTURE OF THE ŒSOPHAGUS, WITH ESPECIAL REFERENCE TO INTUBATION AND TO RADIUM.
be
To the Editor of THE LANCET. in your issue of March 4th a letter from notice SIR,-I Dr. William Hill in which he is kind enough to mention my name in connexion with anaesthesia during endoscopic
procedures. Having had
the privilege of being associated with Dr. Hill as anæsthetist in a great number of his cases it was with great regret that I found myself unable to be present at his demonstration before the Medical Society, and I should like to take this opportunity of corroborating and slightly amplifying his remarks as to the methods I have so far found useful in meeting the requirements of the operator during the passage not only of the gastroscope but the oesophagoscope and laryngoscope as well. Whatever method of induction may be used it is obvious that anæsthesia can only conveniently be maintained by means of the Junker bottle and tube and, as Dr. Hill says, either chloroform, C.E., or pure ether may be administered by this method according to the circumstances of the case. I early learnt from Dr. Hill that there were three important desiderata in these cases-absence of mucus, a perfectly quiet ansesthesia free from cough and retching (and this in spite of alterations in the position of the head and occasional intermissions in the administration), and, lastly, in laryngoscopic examinations a tender consideration for the examiner’s eye on which chloroform vapour acts as an irritant. The secretion of mucus may best be avoided by a preliminary injection of atropine and by abstaining from the use of ethyl chloride or closed methods of ether administration during the induction; C.E. slowly administered on a mask is my usual procedure. To obtain the necessary type of anaesthesia I find a preliminary injection of scopolamine and morphine of the: greatest possible service ; this also generally allows of fairly long intervals in the administration of the anaesthetic, during: ,
the
approximately equivalent.
If Dr. Churchward would state the amounts required I would gladly lend any medical man interested the requisite autunite from my collection should he care to go into the matter practically. I might add that the medical use of crude radio-active mineral is not entirely new. It has been employed in France, and also, I believe, by Professor His, of the Charity Clinic in Berlin, though on different lines from those indicated by Dr. Churchward. As a layman I naturally write of these matters with diffidence, but the subject is one in which I am much interested, as I have been connected with the scientific side of this industry since it first attracted attention in this country some few years back. I am, Sir, yours faithfully, B. HUGH ROLFE, M.A. Oxon., C.E. Parliament-street, S.W., March llth, 1911.
THE DISEASES OF MALNUTRITION. To the Editor of THE LANCET. SIR,-The agitation in favour of what is described as standard bread" is one of those public movements which,
rightly supported, are likely, both directly and indirectly, to be productive of good. Anything which has a tendency to improve the quality of the food upon which the poorer classes mainly rely for their sustenance must react beneficially upon the well-being of the community generally. The extent to which malnutrition is concerned as a primary cause of disease has probably never been fully considered nor accorded the measure of attention which its importance demands. The danger which environs everyone who has drifted into an advanced condition of "diminished resistance " cannot be disputed. The tissues are prone in such cases to become the prey of every pathogenic organism to the infection of which they may be exposed. One of the causes
T: which the examiner can explore the larynx or trachea in chloroform from the irritation of vapour. For intra-laryngeal cases I use the Bellamy Gardner tube, though I think there is room for some improvement here, and should like to see a laryngoscope made with an arrangement for the delivery of the anaesthetic vapour near its lower end. When the œsophagoscope or gastroscope is being used the respiration is not infrequently embarrassed, the patients are often old and feeble, and I find a slow stream of oxygen passed through the Junker bottle of great I am, Sir, yours faithfully, service. G. A. A, H. BARTON. Talbot-road, W., March 9th, 1911.
strain of its investing irritated muscles is gradually compressed and at length gives way. Deformity once commenced proceeds more rapidly as the mechanical advantage under which the anterior spinal muscles act becomes more pronounced, while the opposition offered by the posterior muscles simultaneously decreases." (e) "As soon, however, as the body bends forward, as it must at the seat of the disease, the posterior muscles, because obliged to pull round the angle of the knuckle, work at a distinct disadvantage....... The anterior muscles improperly antagonised draw the body forward.’ (Quoted from Goldthwait, Painter, and Osgood.) The muscles once contracted, if left to themselves, do not relax, but remain permanently shortened. Even if the disease does become arrested they still anchor down the bent and by this time the commonly ankylosed spine....... In dorsal caries the baneful effects of this are particularly apparent." Now, Sir, where are these anterior spinal muscles ? You will admit that they exist only in the imagination of Mr. Gauvain. If Mr. Gauvain were to examine a cadaver he would find that the longus colli ceases at the third dorsal vertebra, and that the psoas magnus commences at the twelfth. Between these vertebræ there are no anterior muscles at all, yet he speaks of their ’’baneful effects " as particularly apparent here. Moreover, in the very regions, the cervical and lumbar, where there are muscles which could conceivably act as he describes, the angular deformity is least marked. (I need not enter into the reasons for that
expired
comfort, free
AUTUNITE (HYDRATED URANIUMCALCIUM PHOSPHATE). To
Editor of THE LANCET. SIR,-Your readers may be interested by a brief account of the radio-active mineral referred to by Dr. Churchward in his article in your issue of March llth. Hydrated uranium-calcium phosphate, or autunite,is a natural uranyl phosphate known for some time as existing in France (notably at Autun-whence the name) and in Cornwall, and recently proved to occur in great quantities in certain districts in Portugal. It is now worked for radium. The precise origin of the ore is debated, but it occurs largely as a crystalline deposit in tracts of decomposed granitic rock. The average mineral, as worked, contains between 1 and 2 per cent. of the uranium ; but here and there are found " couches"containing clusters of uranite crystals, often of some size and of great purity. This, I take it, is the mineral used by Dr. Churchward. The pure hydrated crystal con. tains approximately the equivalent of 50 per cent. uranoso. uranic oxide ; its theoretical"activity"is therefore patent to any student of radio-activity. A most interesting point arises here. Certain French chemists, now engaged on the separation of radium from this ore, maintain that the available radium therein is in excess of the theoretical "radium-uranium constant" hitherto recognised. I think I am correct in stating that this has not yet been formally substantiated; but it would be interesting in this connexion to see Dr. Churchward’s experiments repeated with an equal amount of, say, pitchblende containing the same percentage of uranium as the phosphate. On the "constant"" theory the activity should
here.)
If Mr. Gauvain’s theory-or is it Dr. Goldthwait’s ?-of muscular spasm as a cause of deformity in spinal caries be correct, it must surely hold good for the dorsal region, which the disease most frequently attacks, and where that deformity is most marked. But it does not hold good, for there are no muscles. Is it possible that Mr. Gauvain has been unconsciously led away by the plausible and voluminous output of Dr. Goldthwait, M.D. ? I am, Sir, yours faithfully, PAUL B. ROTH, F.R.C.S. F. R. C. S. London, March 7th, 1911.
THE TREATMENT OF MALIGNANT STRICTURE OF THE ŒSOPHAGUS, WITH ESPECIAL REFERENCE TO INTUBATION AND TO RADIUM.
be
To the Editor of THE LANCET. in your issue of March 4th a letter from notice SIR,-I Dr. William Hill in which he is kind enough to mention my name in connexion with anaesthesia during endoscopic
procedures. Having had
the privilege of being associated with Dr. Hill as anæsthetist in a great number of his cases it was with great regret that I found myself unable to be present at his demonstration before the Medical Society, and I should like to take this opportunity of corroborating and slightly amplifying his remarks as to the methods I have so far found useful in meeting the requirements of the operator during the passage not only of the gastroscope but the oesophagoscope and laryngoscope as well. Whatever method of induction may be used it is obvious that anæsthesia can only conveniently be maintained by means of the Junker bottle and tube and, as Dr. Hill says, either chloroform, C.E., or pure ether may be administered by this method according to the circumstances of the case. I early learnt from Dr. Hill that there were three important desiderata in these cases-absence of mucus, a perfectly quiet ansesthesia free from cough and retching (and this in spite of alterations in the position of the head and occasional intermissions in the administration), and, lastly, in laryngoscopic examinations a tender consideration for the examiner’s eye on which chloroform vapour acts as an irritant. The secretion of mucus may best be avoided by a preliminary injection of atropine and by abstaining from the use of ethyl chloride or closed methods of ether administration during the induction; C.E. slowly administered on a mask is my usual procedure. To obtain the necessary type of anaesthesia I find a preliminary injection of scopolamine and morphine of the: greatest possible service ; this also generally allows of fairly long intervals in the administration of the anaesthetic, during: ,
the
approximately equivalent.
If Dr. Churchward would state the amounts required I would gladly lend any medical man interested the requisite autunite from my collection should he care to go into the matter practically. I might add that the medical use of crude radio-active mineral is not entirely new. It has been employed in France, and also, I believe, by Professor His, of the Charity Clinic in Berlin, though on different lines from those indicated by Dr. Churchward. As a layman I naturally write of these matters with diffidence, but the subject is one in which I am much interested, as I have been connected with the scientific side of this industry since it first attracted attention in this country some few years back. I am, Sir, yours faithfully, B. HUGH ROLFE, M.A. Oxon., C.E. Parliament-street, S.W., March llth, 1911.
THE DISEASES OF MALNUTRITION. To the Editor of THE LANCET. SIR,-The agitation in favour of what is described as standard bread" is one of those public movements which,
rightly supported, are likely, both directly and indirectly, to be productive of good. Anything which has a tendency to improve the quality of the food upon which the poorer classes mainly rely for their sustenance must react beneficially upon the well-being of the community generally. The extent to which malnutrition is concerned as a primary cause of disease has probably never been fully considered nor accorded the measure of attention which its importance demands. The danger which environs everyone who has drifted into an advanced condition of "diminished resistance " cannot be disputed. The tissues are prone in such cases to become the prey of every pathogenic organism to the infection of which they may be exposed. One of the causes