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WOMEN AND A STATE MEDICAL SERVICE.
577 in any random
sample of the adult population a number of really deaf ears will be sufficient furnish the proportion of larger defects. present to It would be interesting to know whether one ear, say the right, was uniformly tested before the other, and whether the tests were made singly or A further as the mean of several determinations. conclusion arrived at is the ground for doubting in that the the general belief gun-deafness is past obstructive not at all an deafness, but of a purely
labyrinthine type.
would be the gainer, and there would be a raising On these of the standard of the work done. grounds Dr. Chisholm advises her colleagues in general practice to welcome the setting up of State-subsidised treatment centres with laboratories attached, to be at the service of all practitioners, thus affording opportunities to the insured for specialised treatment. Women practitioners with special qualifications could then choose between private practice, or paid posts at the centres, or a combination of the two. Dr. Chisholm’s suggestions will command the careful consideration of the many keen women students entering the medical
profession.
Annotations. " Ne qmid nimis."
WOMEN AND A STATE
THE
MEDICAL SERVICE.
subject of a Ministry of Health claimed the attention of the Medical Women’s Federation at their recent conference in Manchester, and no dissent was expressed with Dr. Jane Walker’s view that such a Ministry was really coming and was to be welcomed in so far as it simplified the present cumbersome methods of various Government departments dealing with health matters. But a distinction was clearly drawn between such action and the merging of the personality of the general practitioner in a State Medical Service. Dr. Catherine Chisholm dealt with the whole question as it affects medical women and their individual work. To the women of the country the woman practitioner has become a necessity in their lives, someone, that is, who knows the family intimately, its health, its position, and its difficulties, and who is a friend in need at times of trouble. Women are relying more on doctors of their own sex for themselves and their children, and Dr. Chisholm foresees an ever-increasing demand for medical women practitioners in all grades But the development of public of social life. health practice acts on the profession of medicine by women in many ways, for while such practice rivals general practice in interest, it provides posts with fixed salaries and regular hours, which may draw away numbers of women who would otherThe wise do general service among the people. right solution for this perplexing situation Dr. Chisholm sees in a better cooperation between the various phases of medical activity. While women should be encouraged to develop their medical work along the lines which most appeal to them, specialisation ought to follow on general experience and not commence at too early a stage in the career. The practical clinical work under the various departments of the Ministry of Health, such as maternity, child welfare, and venereal treatment, should, in her opinion, be carried out by medical practitioners who have given evidence of special experience in these subjects rather than by wholetime officers. At present these posts are often held by women with little, if any, general experience either of medicine or of life, with results which, Dr. Chisholm finds, are disadvantageous to preventive medicine, while promoting jealousy between it and clinical practice. Parttime posts, at all events in large centres, are not open to the same objection, and if the practical encouragement of specialisation led to women of ability settling in sufficient numbers in areas where they are needed, the general public
--
FUNCTIONAL CARDIAC AND PULMONARY TROUBLES ATTRIBUTABLE TO A LESION OF THE CARDIAC PLEXUS AND THE NERVES IN THE MEDIASTINUM. AT a meeting of the Académie de Medecine of Paris M. Emile Sergent called attention to a lesion He has which the war has brought to light. observed a group of cases in which wounds of the chest are followed some time after recovery by
respiratory difficulty, palpitation, and pains, and yet examination of the chest shows complete integrity of the heart, pericardium, lungs, pleurae, and mediastinum, except perhaps for the presence on the screen of the shadow of a bullet in the region of the great vessels, in the zone of the cardiac plexus. Excluding nervous and hypochondriac patients, there remains a certain number of wounded, the reality of whose troubles cannot be doubted. M. Sergent’s attention was first called to this group by the following case.
beginning of the war, in August, 1914, a by a rifle-bullet which entered the chest the left mpple, passed from before backwards, and lodged in the muscles of the back on the left side. After initial symptoms, such as loss of At
man
the
was wounded 4 cm. above
consciousness and hemoptysis, he was considered cured and sent away convalescent. However, he continued to complain of constant oppression, increased by the slightest effort, palpitation, and pains in the chest. M. Sergent saw him in November and found typical left phrenic neuralgia with immobility of the left half of the diaphragm, instability of the pulse, which increased on the slightest movement, inequality of pupils (the left being in mydriasis), and preservation of the accommodation reflexes. Radioscopy showed
complete integrity of
the
lungs, pleural cul-de-sacs,
mediastinum, and movements of the heart, and confirmed the immobility of the left half of the diaphragm. There gradually developed hypertrophy of the thyroid gland with permanent tachycardia, tremor, and proptosis. Under high-frequency currents and hemato-6thyroidinethe symptoms of Graves’s disease diminished at the same time as the other symptoms. "
M. Sergent attributes these symptoms to lesions of the cardiac plexus and the phrenic nerve produced in the passage of the bullet. He regarded the supervention of symptoms of Graves’s disease as supporting the theory which ascribes them to His view was irritation of the sympathetic. supported by 9 other cases of the same kind in which there was instability of the pulse and respiratory rhythm with constant dyspnoea, To these increased by the slightest effort. cardinal symptoms there was added in 3 cases phrenic neuralgia, inequality of pupils in 4, and symptoms of Graves’s disease in 5. In all the region of the cardiac plexus was injured by a projectile, which was shown either by its presence being revealed by radioscopy or by the position of its track. When the projectile is present the question of its removal arises. The surgeon must consider whether the risks of operation in such a region are not greater than those of
sample of the adult population a number of really deaf ears will be sufficient furnish the proportion of larger defects. present to It would be interesting to know whether one ear, say the right, was uniformly tested before the other, and whether the tests were made singly or A further as the mean of several determinations. conclusion arrived at is the ground for doubting in that the the general belief gun-deafness is past obstructive not at all an deafness, but of a purely
labyrinthine type.
would be the gainer, and there would be a raising On these of the standard of the work done. grounds Dr. Chisholm advises her colleagues in general practice to welcome the setting up of State-subsidised treatment centres with laboratories attached, to be at the service of all practitioners, thus affording opportunities to the insured for specialised treatment. Women practitioners with special qualifications could then choose between private practice, or paid posts at the centres, or a combination of the two. Dr. Chisholm’s suggestions will command the careful consideration of the many keen women students entering the medical
profession.
Annotations. " Ne qmid nimis."
WOMEN AND A STATE
THE
MEDICAL SERVICE.
subject of a Ministry of Health claimed the attention of the Medical Women’s Federation at their recent conference in Manchester, and no dissent was expressed with Dr. Jane Walker’s view that such a Ministry was really coming and was to be welcomed in so far as it simplified the present cumbersome methods of various Government departments dealing with health matters. But a distinction was clearly drawn between such action and the merging of the personality of the general practitioner in a State Medical Service. Dr. Catherine Chisholm dealt with the whole question as it affects medical women and their individual work. To the women of the country the woman practitioner has become a necessity in their lives, someone, that is, who knows the family intimately, its health, its position, and its difficulties, and who is a friend in need at times of trouble. Women are relying more on doctors of their own sex for themselves and their children, and Dr. Chisholm foresees an ever-increasing demand for medical women practitioners in all grades But the development of public of social life. health practice acts on the profession of medicine by women in many ways, for while such practice rivals general practice in interest, it provides posts with fixed salaries and regular hours, which may draw away numbers of women who would otherThe wise do general service among the people. right solution for this perplexing situation Dr. Chisholm sees in a better cooperation between the various phases of medical activity. While women should be encouraged to develop their medical work along the lines which most appeal to them, specialisation ought to follow on general experience and not commence at too early a stage in the career. The practical clinical work under the various departments of the Ministry of Health, such as maternity, child welfare, and venereal treatment, should, in her opinion, be carried out by medical practitioners who have given evidence of special experience in these subjects rather than by wholetime officers. At present these posts are often held by women with little, if any, general experience either of medicine or of life, with results which, Dr. Chisholm finds, are disadvantageous to preventive medicine, while promoting jealousy between it and clinical practice. Parttime posts, at all events in large centres, are not open to the same objection, and if the practical encouragement of specialisation led to women of ability settling in sufficient numbers in areas where they are needed, the general public
--
FUNCTIONAL CARDIAC AND PULMONARY TROUBLES ATTRIBUTABLE TO A LESION OF THE CARDIAC PLEXUS AND THE NERVES IN THE MEDIASTINUM. AT a meeting of the Académie de Medecine of Paris M. Emile Sergent called attention to a lesion He has which the war has brought to light. observed a group of cases in which wounds of the chest are followed some time after recovery by
respiratory difficulty, palpitation, and pains, and yet examination of the chest shows complete integrity of the heart, pericardium, lungs, pleurae, and mediastinum, except perhaps for the presence on the screen of the shadow of a bullet in the region of the great vessels, in the zone of the cardiac plexus. Excluding nervous and hypochondriac patients, there remains a certain number of wounded, the reality of whose troubles cannot be doubted. M. Sergent’s attention was first called to this group by the following case.
beginning of the war, in August, 1914, a by a rifle-bullet which entered the chest the left mpple, passed from before backwards, and lodged in the muscles of the back on the left side. After initial symptoms, such as loss of At
man
the
was wounded 4 cm. above
consciousness and hemoptysis, he was considered cured and sent away convalescent. However, he continued to complain of constant oppression, increased by the slightest effort, palpitation, and pains in the chest. M. Sergent saw him in November and found typical left phrenic neuralgia with immobility of the left half of the diaphragm, instability of the pulse, which increased on the slightest movement, inequality of pupils (the left being in mydriasis), and preservation of the accommodation reflexes. Radioscopy showed
complete integrity of
the
lungs, pleural cul-de-sacs,
mediastinum, and movements of the heart, and confirmed the immobility of the left half of the diaphragm. There gradually developed hypertrophy of the thyroid gland with permanent tachycardia, tremor, and proptosis. Under high-frequency currents and hemato-6thyroidinethe symptoms of Graves’s disease diminished at the same time as the other symptoms. "
M. Sergent attributes these symptoms to lesions of the cardiac plexus and the phrenic nerve produced in the passage of the bullet. He regarded the supervention of symptoms of Graves’s disease as supporting the theory which ascribes them to His view was irritation of the sympathetic. supported by 9 other cases of the same kind in which there was instability of the pulse and respiratory rhythm with constant dyspnoea, To these increased by the slightest effort. cardinal symptoms there was added in 3 cases phrenic neuralgia, inequality of pupils in 4, and symptoms of Graves’s disease in 5. In all the region of the cardiac plexus was injured by a projectile, which was shown either by its presence being revealed by radioscopy or by the position of its track. When the projectile is present the question of its removal arises. The surgeon must consider whether the risks of operation in such a region are not greater than those of