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UNILATERAL PHRENIC NERVE PARALYSIS.
519 Here there was no fever, and care, and wants training and practice. But it is for that period, and when work which only requires a couple of hours twice a tenderness did appear it was to the left of the middle week regularly and it is of the greatest possible interest. line. Dysuria and rectal tenderness aroused me Those of us who have worked at it for years do believe {Cope’s test was negative), and an incision through the in it-it is only those who do not wait for results who right rectus later disclosed a pelvic abscess. One reject it as no good. In my opinion there are a large number of untouched case, ill for two days before I saw her, passed about 5 oz. of blood per rectum. At operation this was cases of early tuberculosis who might be entirely saved found to be due to a deeply engorged caecum which from disaster by six months’ treatment at very little had a rotten gangrenous appendix behind it. A expense and without the patient losing a day’s work. drainage-tube was inserted and recovery took place Late cases are often improved materially, and in any case the expectoration is minimised and so they become without faecal fistula, which one rather expected. converted into comparatively harmless cases. I am, Sir, yours faithfully, My in writing is to say I will give all help I can to object AMBROSE W. OWEN. Feb. 1925. 23rd, Aberdare, any doctor who is anxious to see and learn at 37, Jeffreys-road, Clapham-road, S.W. 4, every Tuesday and Friday from 9-10 A.M. " "
only one of the series. tenderness, or rigidity
POST-ANÆSTHETIC
VOMITING.
I
am-
Sir.
vonrs
faithfully.
ANNIE MCCALL, To the Eclit01’ of THE LANCET. Feb. 28th, 1925. Director, Clapham Maternity. SiR,-In view of Dr. Mortimer’s article on postanaesthetic vomiting in THE LANCET of Feb. 14th, perhaps a note of my experience may be of use to UNILATERAL PHRENIC NERVE PARALYSIS. others. To the jE’(70?’ of THE LANCET. Vomiting occurs most frequently with ether anwsthesia, and frequently, though not vomiting, the SiR,—The letter of Mr. Morriston Davies in your patient complains that he can taste the anaesthetic issue of Feb. 28th indicated that he has not found for days, or at least until he has had an aperient. symptoms arising after evulsion of the phrenic nerve Aly point is that it is the ether vapour which is such as I described in your issue of the 21st, as swallowed rather than that which is inhaled which accompanying pressure paralysis. causes vomiting and retching. This is due to irritaMr. Morriston Davies is probably dealing with tion of the gastric mucosa, and consequent secretion tubercle, and as such, his patients are likely to differ of thick mucus in which the ether dissolves, and which from the majority of mine in the following respects : remains there until vomited or passed on to the small (a)they are younger, or (b) they have had attacks of intestine. While house surgeon at various hospitals pleurisy. I frequently noticed that many patients, especially As I stated in my paper, the symptoms are mouth-breathers, complained of a dry mouth while least marked in these two classes of individualsbeing anaesthetised, sometimes due perhaps to the namely, in the young, where thoracic movement is injection of atropine they might have had. These free, and in those in whom the diaphragm on the patients were apt to moisten their lips and swallow affected side is anchored by adhesions. This would to explain the differences in our experiences. frequently during administration of the anaesthetic, and I perceived gradually that as a rule those who swallowed most were those who vomited later on. CHARLTON BRISCOE. I then made a practice of telling the patient to Harley-street, W’., March 3rd, 1925. breathe through the nose if possible, and even though the mouth felt dry, on no account to swallow, as he would swallow anaesthetic vapour and increase the TINCTURE OF IODINE (PH. FR.). risk of being sick. I am pleased to be able to say that To the Editor of THE LANCET. in those cases in which the patient refrained from SIR,-In your issue of Feb. 28th the editor of the allowing air (and vapour) the vomiting was negligible. In some cases in which the patienthad had Prescriber points out the difficulty of the absence of previous operations with much post-anaesthetic a suitable preparation of tr. iodi without potassium vomiting he remembered that the mouth had been iodide. I would like to state that I have for some dry and that in consequence he had swallowed considerable period used a preparation of iodine with frequently ; when this was pointed out to him and alcohol and glycerine for the intensive iodine treathe refrained from swallowing, there was no vomiting ment on a large number of patients and have had no at any subsequent operation. untoward symptoms, such as iodism, &c., the I am, Sir, yours amount of iodine tolerated being very surprising and A. J. K. DREW. the immense benefit derived in arthritic cases has Ramsgate, Feb. 28th, 1925. been very assuring. I may add that the formula is to be found in the Extra Pharmacopoeia (Martindale), vol. i., p. 1004, under the head of guttse iodi (Farrer). TUBERCULIN DISPENSARIES. ’
seem
I
-.
T
am.
Sir- vmirs fa.it,hfnllv_
To the Editor of THE LANCET. SIR,-I am one of those doctors who watched and1I Harley-street, W., March 2nd, 1925. learnt Dr. Camac yVilkinson’s method of treating tuberculosis with bi-weekly injections of tuberculin from 19’10 onwards, and have myself followed out his METHYLATED SPIRIT AND ITS SUBSTITUTES. teaching carefully with very many good results. To the Editor oj THE LANCET. From London dispensary work and in sanatoria at and we Rudgwick, Fritton, SiR,—With reference to the annotation with this Ockley, got uniformly good results. And now in 1925 I have been told evidence heading published on p. 398 of the issue of THE exists of 50 per cent. of the tuberculin-treated patients LANCET for Feb. 21st, we should be glad if you would being alive ten years after cessation of treatment, give publicity to the fact that the Petrohol brand of while as control, only 5 per cent. of the patients who isopropyl alcohol is imported solely by ourselves. were not so treated were alive, all being cases with T.B. To any of your readers who are interested, we shall As recently as Feb. 27th a small but important be pleased to forward copies of the publications meeting was held in Central London to suggest referred to in your article, and for your own informaopening again tuberculin dispensaries. At least eight tions weenclose copies of same. doctors were present, possibly more. At that meeting We are, Sir, yours faithfully, it was emphasised that any medical staff should be ANGLO-AMERICAN OIL COMPANY, LIMITED. paid, as it is highly technical work requiring skill . Albert-street, Camden Town, N.W. 1, Feb. 23rd, 1925.
CLAUDE ST.AUBYN-FARRER.
1
only one of the series. tenderness, or rigidity
POST-ANÆSTHETIC
VOMITING.
I
am-
Sir.
vonrs
faithfully.
ANNIE MCCALL, To the Eclit01’ of THE LANCET. Feb. 28th, 1925. Director, Clapham Maternity. SiR,-In view of Dr. Mortimer’s article on postanaesthetic vomiting in THE LANCET of Feb. 14th, perhaps a note of my experience may be of use to UNILATERAL PHRENIC NERVE PARALYSIS. others. To the jE’(70?’ of THE LANCET. Vomiting occurs most frequently with ether anwsthesia, and frequently, though not vomiting, the SiR,—The letter of Mr. Morriston Davies in your patient complains that he can taste the anaesthetic issue of Feb. 28th indicated that he has not found for days, or at least until he has had an aperient. symptoms arising after evulsion of the phrenic nerve Aly point is that it is the ether vapour which is such as I described in your issue of the 21st, as swallowed rather than that which is inhaled which accompanying pressure paralysis. causes vomiting and retching. This is due to irritaMr. Morriston Davies is probably dealing with tion of the gastric mucosa, and consequent secretion tubercle, and as such, his patients are likely to differ of thick mucus in which the ether dissolves, and which from the majority of mine in the following respects : remains there until vomited or passed on to the small (a)they are younger, or (b) they have had attacks of intestine. While house surgeon at various hospitals pleurisy. I frequently noticed that many patients, especially As I stated in my paper, the symptoms are mouth-breathers, complained of a dry mouth while least marked in these two classes of individualsbeing anaesthetised, sometimes due perhaps to the namely, in the young, where thoracic movement is injection of atropine they might have had. These free, and in those in whom the diaphragm on the patients were apt to moisten their lips and swallow affected side is anchored by adhesions. This would to explain the differences in our experiences. frequently during administration of the anaesthetic, and I perceived gradually that as a rule those who swallowed most were those who vomited later on. CHARLTON BRISCOE. I then made a practice of telling the patient to Harley-street, W’., March 3rd, 1925. breathe through the nose if possible, and even though the mouth felt dry, on no account to swallow, as he would swallow anaesthetic vapour and increase the TINCTURE OF IODINE (PH. FR.). risk of being sick. I am pleased to be able to say that To the Editor of THE LANCET. in those cases in which the patient refrained from SIR,-In your issue of Feb. 28th the editor of the allowing air (and vapour) the vomiting was negligible. In some cases in which the patienthad had Prescriber points out the difficulty of the absence of previous operations with much post-anaesthetic a suitable preparation of tr. iodi without potassium vomiting he remembered that the mouth had been iodide. I would like to state that I have for some dry and that in consequence he had swallowed considerable period used a preparation of iodine with frequently ; when this was pointed out to him and alcohol and glycerine for the intensive iodine treathe refrained from swallowing, there was no vomiting ment on a large number of patients and have had no at any subsequent operation. untoward symptoms, such as iodism, &c., the I am, Sir, yours amount of iodine tolerated being very surprising and A. J. K. DREW. the immense benefit derived in arthritic cases has Ramsgate, Feb. 28th, 1925. been very assuring. I may add that the formula is to be found in the Extra Pharmacopoeia (Martindale), vol. i., p. 1004, under the head of guttse iodi (Farrer). TUBERCULIN DISPENSARIES. ’
seem
I
-.
T
am.
Sir- vmirs fa.it,hfnllv_
To the Editor of THE LANCET. SIR,-I am one of those doctors who watched and1I Harley-street, W., March 2nd, 1925. learnt Dr. Camac yVilkinson’s method of treating tuberculosis with bi-weekly injections of tuberculin from 19’10 onwards, and have myself followed out his METHYLATED SPIRIT AND ITS SUBSTITUTES. teaching carefully with very many good results. To the Editor oj THE LANCET. From London dispensary work and in sanatoria at and we Rudgwick, Fritton, SiR,—With reference to the annotation with this Ockley, got uniformly good results. And now in 1925 I have been told evidence heading published on p. 398 of the issue of THE exists of 50 per cent. of the tuberculin-treated patients LANCET for Feb. 21st, we should be glad if you would being alive ten years after cessation of treatment, give publicity to the fact that the Petrohol brand of while as control, only 5 per cent. of the patients who isopropyl alcohol is imported solely by ourselves. were not so treated were alive, all being cases with T.B. To any of your readers who are interested, we shall As recently as Feb. 27th a small but important be pleased to forward copies of the publications meeting was held in Central London to suggest referred to in your article, and for your own informaopening again tuberculin dispensaries. At least eight tions weenclose copies of same. doctors were present, possibly more. At that meeting We are, Sir, yours faithfully, it was emphasised that any medical staff should be ANGLO-AMERICAN OIL COMPANY, LIMITED. paid, as it is highly technical work requiring skill . Albert-street, Camden Town, N.W. 1, Feb. 23rd, 1925.
CLAUDE ST.AUBYN-FARRER.
1