- Email: [email protected]
TREATMENT OF LIVER ABSCESS BY ASPIRATION.
1026 middle of the second century A.D., that I thought it might be of historical interest to quote the words of The following sentences are that great physician. " from the translation by Francis Adams of the Extant Printed for the Works of Aretæus" (London: Sydenham Society, 1856). Writing of liver abscess he says :-
THE ABUSE
OF VENEREAL CLINICS. To the Editor’ of THE LANCET.
SIR,—May I ask if THE following facts concerning
LANCET is aware of the the venereal clinics and whether it proposes to use its influence to rectify these matters ? 1. That these clinics are abused by a great many persons who can well afford to pay. 2. That the free treatment of diseases contracted by promiscuous sexual intercourse is a direct encouragement to vice and immorality. 3. That this is an injustice to the ratepayers and a waste of public money. 1. That many practices hitherto more or less dependent on the treatment of these diseases have depreciated in value, and in some cases ceased to exist, owing to the abuse of the venereal clinics. I am, Sir, yours faithfully, C. F. MARSHALL, M.D., F.R.C.S. Welbeck-street, W., May 9th, 1923. **The report of the Trevethin Committee is expected to deal with the sound points raised by our correspondent. The feeling is undoubtedly widespread that patients who can afford it should pay for their treatment at the clinics, but no satisfactory method of compulsion has yet been devised. In some places instruction and warning are given as well as treatment, and where this is done as it should be there can be no question of encouragement to vice. Until practitioners generally are equipped to deal efficiently with venereal disease, we have repeatedly advocated a panel of practitioners through whom treatment could be provided.-ED. L.
If the
" process incline inwardly, nature is far superior to the physician .... but if it incline outwards, it is bad not to make an incision, for otherwise the liver is corroded by the pus, and death is not long deferred. But, if you intend to make an incision, there is a danger of haemorrhage, from which the patient may die suddenly ; for haemorrhage in the liver cannot be checked. But if you are reduced to the necessity of making an incision, heat a cautery in the fire to a bright heat and push it down to the pus, for it at the same time cuts and burns ; and if the patient survive, there will run out a white, concocted, smooth, not fetid, very thick pus, by which the fever and other bad symptoms are diminished, and altogether the health is restored."
Dr. Manson-Bahr also stresses the diagnostic importance of right shoulder pain, which we now
believeto be due to involvement of the under surface
the diaphragm and reference via the phrenic to the I of With this symptom of fourth cervical
hepatic
area.
abscess
Aretaeus was quite familiar, interpretation of it was different. In inflammations of the liver, he states :-
though his referring to
‘’ If it be converted into pus, a sharp pain possesses the as far as the clavicle and the tops of the shoulders, for the diaphragm from which the liver is suspended is dragged down by the weight, and the diaphragm drags the membrane lining the ribs to which it is attached, and this membrane (the pleura) is stretched up to the clavicle and the top of the shoulders, which also are dragged down."
parts
He further recognises that the painful, difficult respiration which may be present is due to impairment of " " for," he says, the diaphragmatic movement does not with the cooperate lungs, by diaphragm assisting them in contraction and dilatation." I am. Sir. yours faithfully, J. A. RYLE. ....
SUBCUTANEOUS CALCAREOUS DEPOSITS. To the Editor of THE LANCET. SIR,—In THE LANCET for May 5th (p. 900) Dr. J. R. Logan is reported as having shown a case of subcutaneous calcareous deposits in the hands in an elderly female, suffering from a mild degree of Haynaud’s disease. Most similar cases, as far as I am aware, have shown sclerodactylia of the hands, and sclerodactylia is often accompanied by angiospastic symptoms resembling mild Raynaud’s disease. I would suggest that the case is of the same class as the one of sclerodactylia with subcutaneous calcareous concretions in a woman that I described, jointly with Dr. R. F. Scholefield, in 1911.1 The are mostly females. In Haldin Davis’s case there " were Raynaud-like " symptoms, but no definite sclerodactylia. when brought before the Dermatological Section of the Royal Society of Medicine in March. 1912. The publications on cases of subcutaneous calcareous concretions and " Kalk" steingicht have become very numerous. In France and Italy cases have sometimes been described under the heading ’’ Profichet’s disease " owing to (’T. C. Profichet’s thesis " Sur une variete de concrétions phosphatiques sous-cutanees (pierres de la peau),’’ Paris, 1900. Considerably earlier was the writing by a Swiss doctor, H. Weber, on the subject. A recent " is that of Iialksteingiclt naper of interest on E. Holländer.2—I am, Sir. yours faithfully. F. PARKES WEBER. London, May 8th, 1923.
patients
I
"
TREATMENT OF LIVER ABSCESS BY ASPIRATION. To ihe Editor of THE LANCET. SIR,—In their interesting paper on this subject in THE LANCET of May 12th Dr. P. Manson-Bahr and his collaborators refer to the method of evacuating a pointing abscess by means of a trocar, which was practised as long ago as 1828. So close and ingenious an approximation to this method was recommended by Aretæus, the Cappadocian, who flourished about the 1 Brit. Jour. Dermat., 1911, xxiii., 276. 2 Deut. med. Wochenschr., 1917, xliii., 431.
The Warden’s House, Guy’s Hospital, S.E., May 14th, 1923.
THE
DOSE
OF
7o the Editor
of
BAYER "205." THE LANCET.
SIR,—In view of the dearth of experience at present available as to the dosage of Bayer" 205," it may be worth while recording that as much as 5 g. have been given intravenously in 50 hours to a native of this country. There were no untoward symptoms, but although no readily recognisable albuminuria resulted the presence of a few casts in the urine could be detected for a month afterwards. During the last few months, however, no casts have been seen and the patient is back at work. The dosage suggested by Dr. G-. C. Low and Dr. P. Manson-Bahr for the treatment of Europeans may require modification when the African native for whom the drug was prepared comes to be treated. His greater tolerance may enable him to receive a single curative dose of 3 to 5 g I am indebted to the courtesy of Dr. C. H. or more. Hennings for placing a small quantity of the drug at my
disposal. I am,
Sir,
yours
Kaduna, Nigeria, April 19th.
faithfully, N. A. DYCE SHARP,
West African Medical Service.
OTITIC MENINGITIS. To the Editor of THE LANCET. SIR.—In the report last week of my paper on Otitic Meningitis, read before the Section of Otology of the Royal Society of Medicine, there is an error which reads : " Otitic meningitis of the middle fossa and cortex of the brain was much more frequent than that of the posterior fossa." It should be infrequent. The large majority of cases of otitic meningitis commence in the posterior fossa, and involve the base of the brain. I am, Sir. yours faithfully, EDWARD D. D. DAVIS. Harley-street, W’., May 14th.
THE ABUSE
OF VENEREAL CLINICS. To the Editor’ of THE LANCET.
SIR,—May I ask if THE following facts concerning
LANCET is aware of the the venereal clinics and whether it proposes to use its influence to rectify these matters ? 1. That these clinics are abused by a great many persons who can well afford to pay. 2. That the free treatment of diseases contracted by promiscuous sexual intercourse is a direct encouragement to vice and immorality. 3. That this is an injustice to the ratepayers and a waste of public money. 1. That many practices hitherto more or less dependent on the treatment of these diseases have depreciated in value, and in some cases ceased to exist, owing to the abuse of the venereal clinics. I am, Sir, yours faithfully, C. F. MARSHALL, M.D., F.R.C.S. Welbeck-street, W., May 9th, 1923. **The report of the Trevethin Committee is expected to deal with the sound points raised by our correspondent. The feeling is undoubtedly widespread that patients who can afford it should pay for their treatment at the clinics, but no satisfactory method of compulsion has yet been devised. In some places instruction and warning are given as well as treatment, and where this is done as it should be there can be no question of encouragement to vice. Until practitioners generally are equipped to deal efficiently with venereal disease, we have repeatedly advocated a panel of practitioners through whom treatment could be provided.-ED. L.
If the
" process incline inwardly, nature is far superior to the physician .... but if it incline outwards, it is bad not to make an incision, for otherwise the liver is corroded by the pus, and death is not long deferred. But, if you intend to make an incision, there is a danger of haemorrhage, from which the patient may die suddenly ; for haemorrhage in the liver cannot be checked. But if you are reduced to the necessity of making an incision, heat a cautery in the fire to a bright heat and push it down to the pus, for it at the same time cuts and burns ; and if the patient survive, there will run out a white, concocted, smooth, not fetid, very thick pus, by which the fever and other bad symptoms are diminished, and altogether the health is restored."
Dr. Manson-Bahr also stresses the diagnostic importance of right shoulder pain, which we now
believeto be due to involvement of the under surface
the diaphragm and reference via the phrenic to the I of With this symptom of fourth cervical
hepatic
area.
abscess
Aretaeus was quite familiar, interpretation of it was different. In inflammations of the liver, he states :-
though his referring to
‘’ If it be converted into pus, a sharp pain possesses the as far as the clavicle and the tops of the shoulders, for the diaphragm from which the liver is suspended is dragged down by the weight, and the diaphragm drags the membrane lining the ribs to which it is attached, and this membrane (the pleura) is stretched up to the clavicle and the top of the shoulders, which also are dragged down."
parts
He further recognises that the painful, difficult respiration which may be present is due to impairment of " " for," he says, the diaphragmatic movement does not with the cooperate lungs, by diaphragm assisting them in contraction and dilatation." I am. Sir. yours faithfully, J. A. RYLE. ....
SUBCUTANEOUS CALCAREOUS DEPOSITS. To the Editor of THE LANCET. SIR,—In THE LANCET for May 5th (p. 900) Dr. J. R. Logan is reported as having shown a case of subcutaneous calcareous deposits in the hands in an elderly female, suffering from a mild degree of Haynaud’s disease. Most similar cases, as far as I am aware, have shown sclerodactylia of the hands, and sclerodactylia is often accompanied by angiospastic symptoms resembling mild Raynaud’s disease. I would suggest that the case is of the same class as the one of sclerodactylia with subcutaneous calcareous concretions in a woman that I described, jointly with Dr. R. F. Scholefield, in 1911.1 The are mostly females. In Haldin Davis’s case there " were Raynaud-like " symptoms, but no definite sclerodactylia. when brought before the Dermatological Section of the Royal Society of Medicine in March. 1912. The publications on cases of subcutaneous calcareous concretions and " Kalk" steingicht have become very numerous. In France and Italy cases have sometimes been described under the heading ’’ Profichet’s disease " owing to (’T. C. Profichet’s thesis " Sur une variete de concrétions phosphatiques sous-cutanees (pierres de la peau),’’ Paris, 1900. Considerably earlier was the writing by a Swiss doctor, H. Weber, on the subject. A recent " is that of Iialksteingiclt naper of interest on E. Holländer.2—I am, Sir. yours faithfully. F. PARKES WEBER. London, May 8th, 1923.
patients
I
"
TREATMENT OF LIVER ABSCESS BY ASPIRATION. To ihe Editor of THE LANCET. SIR,—In their interesting paper on this subject in THE LANCET of May 12th Dr. P. Manson-Bahr and his collaborators refer to the method of evacuating a pointing abscess by means of a trocar, which was practised as long ago as 1828. So close and ingenious an approximation to this method was recommended by Aretæus, the Cappadocian, who flourished about the 1 Brit. Jour. Dermat., 1911, xxiii., 276. 2 Deut. med. Wochenschr., 1917, xliii., 431.
The Warden’s House, Guy’s Hospital, S.E., May 14th, 1923.
THE
DOSE
OF
7o the Editor
of
BAYER "205." THE LANCET.
SIR,—In view of the dearth of experience at present available as to the dosage of Bayer" 205," it may be worth while recording that as much as 5 g. have been given intravenously in 50 hours to a native of this country. There were no untoward symptoms, but although no readily recognisable albuminuria resulted the presence of a few casts in the urine could be detected for a month afterwards. During the last few months, however, no casts have been seen and the patient is back at work. The dosage suggested by Dr. G-. C. Low and Dr. P. Manson-Bahr for the treatment of Europeans may require modification when the African native for whom the drug was prepared comes to be treated. His greater tolerance may enable him to receive a single curative dose of 3 to 5 g I am indebted to the courtesy of Dr. C. H. or more. Hennings for placing a small quantity of the drug at my
disposal. I am,
Sir,
yours
Kaduna, Nigeria, April 19th.
faithfully, N. A. DYCE SHARP,
West African Medical Service.
OTITIC MENINGITIS. To the Editor of THE LANCET. SIR.—In the report last week of my paper on Otitic Meningitis, read before the Section of Otology of the Royal Society of Medicine, there is an error which reads : " Otitic meningitis of the middle fossa and cortex of the brain was much more frequent than that of the posterior fossa." It should be infrequent. The large majority of cases of otitic meningitis commence in the posterior fossa, and involve the base of the brain. I am, Sir. yours faithfully, EDWARD D. D. DAVIS. Harley-street, W’., May 14th.