Letters, Notes, and Answers to Correspondents

1891 BMJ (Clinical Research Edition)  
THE BRITISH MEDICAL JOURNAL. LETTERS, NOTES, AND ANSWERS TO CORRESPONDENTS. C('OMMNTNCATIoNS'l%'rTt TI!r. CUTRIENT W'EEK'S JOURNAL SHOULD REACH THEs OFFICPI NOT TATER THAN MiIDDAY l'OST ON WEDNESDAY. TELE-GRAMS CAN ni, RrcEFIVFD oNs THuRSDAY HORNINmGt. COMMUNICATIONS reCSPectilng editorial niatters sliould be addm'essed to time Editor, 429, Strand, W.C., Londoti; thiose concerning bhusimmess imatters, nion-delivery of the JOURNAL, etc., shiould be addr-essed to tlioe Mamiager, at the Office,
more » ... , at the Office, 429, Strand, W.C., London. IN order to avoid delay, it is partic ularhy requested that all letter's on the editorial business of time JOURNAL he addressed to time Editor at the OffCe Of the JOURNAL, iuiad not to his private limouse. AuTHORs desiring reprinits of their articles published In tlime BR?ITIsH MEDICAL JOItiNAL are, i'equested to comnmuiuleato beforelhand with time Manager, 429., Strand, W.C,________ QVUERIEN* F. T. A. asks for any imaform-atioma as to time reguilations of time Italian Government to wvlichmi Britisht miedical mmmcmi must contform imm ordem' to admit of tlleir practisinig hin Italy aniomng time Eniglisht imesideiits amid visitors. 1MR. RAiNNSFOISD (Kilbur-n Lane, WN.) asks: For information of anly book puiblislied coiutainimig -an analys;is of the priuucipIui propr'ietar'y uumediclimies, or if ammy systematic attempt has becum mmmmde. tim investigate their pi-oper-ties. 2. A few Imimits with regard to the tr-eatmient of ommtstammding prom-ineint ears, as a young lady patient, aged Iit, is very anuxioums to bce (iu'ed of this dishigurememiit. Mawi, Soii, mmmid (mo. mini-c set of spr'ings, anti pads fec time pur-pose, Ibst lie does not kimowv whlether tucy asue of mumy uise. ANSWERS. P'mAoCAmPIat IN DEAFNESS. DaR. T. COKE SQUANCE (Ph'iysic.ianm and l'athologist to time Snmnidem-land fimimary, Coimsmitiimg Plmysi'iamm to the Mommkwearnuiomuth. aumd Soumthwvick Hlospital) wm-ites: reply to "1M.D.'s" imuquiry in time BmuTmsHrMDI-m JOURNAL as totime admaimii-istrntion of Jahoranidi by time mnoutht in lahyin-imuthiine deafness whiere a, patteiut objects to time misc (if time imeedle, I mmay sa-y that I hiave hreated two cases tim this way witht decided menetit, but I gave a miiglitly dose of liiixxx, contimiueod for twvo ummumimlims. '. (Damil'ford) wu-mites ;Time BRITISH MEDICAL. JOURINAL of Det-embiier' llthm cotarmmins a pirammgrmiphm wit ii time abouc heading, in whichi r'eferenmie is mammde to at pimamphilet 1wN-Dir. Bitter, of Breshmun, the emiiploviiiemit oif this prmepimrutmtiim in uuuidumifem-y practuice. It is-theme stated thitit omf 2,iswu cases sto t-e1itted. 4 developedt s3-mliptoumms of poisonlimag. Fi-omim time excellent r-esults I luavc invmruiably mmmet withi, I (cmuimmot hee that the po(isommoims'syniptomis ima time cases, referred tc were muttributable to creotinim. The symmptonims miiematioimedI puohit to time absuorpitionm of carbmolie acid, amid I womud, thuerefore, suggest I'llm-t tIme prcpmum'Iutiomm emmaployed muimust hmmvs beeti i im pure foriii of cer ioliui lar'gehy mdu uiterated wvitlm c muboli avmmiii. I hiave eniployed cieohimit exteuusively immy pr'ait ice for-stmrgival dr'essings, vagiiial inijectionms, immhaml mtionms, mmmd ium t it' tremitm ment Of oxa-Vimm, tonisillitis, otorihimemia, etc. simugle inmstainme himve Poisonumts svmmuptommms ever t)eeni (deueloped, I also invuariai~bly use it mucswms a genemmal (disimifectant, and. vei'y lmargely so imm imifectiouis cases ; amid I mines-er hieat' tlme comphaimmts ouf hemadachle, drynmess mif time mumomitim mand thmromit, etc., whmichs were -onustamntly mmade-wu cicrheio'uuuuil' ieltd mu-ms em iployed. IitithieBlImTISi.NMEDICAL JOURiNAL of JmuIlmntIirylltlm,l59. .a muse is reportedI of a maim wlhso swvallowed imemu-ly mibmel oummuces of crucolimi, aind us-ho pci-fec'thy recovered wvithuimu tliree weeks. Stich a r-esuilt wvould ibo imipossmible with ecirbolie acidl. Only, a day or twvo ago a geiitleman well knowvn to mimie, casually remairked thiat witihin thue pirevious teum days lie liad taken tour dozen capstulcs of creoliii (mepreseniting 4 dm'achmmns of time fluid) fiou fiatulenee. Not only were theme mao ill-effeets, but thio flatuleiiee hiad been considerably relieved, Of the antiseptic pr-operties of cecohhin thucie cammumtot be tie slightest douibt, aniid, in mmy opimiciomi it is fmar superitor to c'mri'linili acid, TisE RECENT D)mSCUtSSION O.NAN.SST11ETWCS A,r rilEMDhOCih('i(IA SociETy oF (iLASiiOWu. Dnt. ROBERT KIRK (I'artick, Glasgow) us-ites4 If oumly himl time miammue of tommimoni fairiiess, I imiay suirely cainin time riglut tio mamke. a few rmenarks oni -the m-eport of time above diseussiomi, wshim-h appemaied in youri issue of November'22nad,1890. Iwas askedby tlhe secietariiy, Di'. Wahke.'Domwnic, to take par't in the discussion, chui*l,~I helteve, fmmm' flue reason thiat I haduc just publishied a pamphilet giving a mmcei-explanatitou of thiat foi-ni of syncope whaich may occur in t al ear'ly.stages of inarvosis, amid which. hias been gener'ally m'efem-red to as time ' , primariy synvmope." In thlie paper' read before the S9ociety, wh-ichi, as youm' m-epom-ter trimly says', was came-c fully prepared, I presented a restatement of my v-iewus-oni tlaii impor~tant suibject, whichl perhaps set thmemima imn made the imatter plainer than I had pn-eviotishv done. My complaint is that your reporter' has stunlio sl avoidedi any reference to the distinctive character of my theory, and I desire to supply the omission. My view is simp)ly that syncope maiay he caim;ed byt mie reaction which ensues in the circulation w~hen an anaesthetic vsap omir is aillowed to escape from the lungs in superficial aimmesthe:sia, iv lii le its occurrence is rendered Impossible in deeper narcosis by the presence of a sufficient amount of the agenit in the blood. Accordingr to this view, therefore, the primary syncope is reactionary, and it is imipossiblO to confound this withi the "reflex" theory of bIr. Coats. Not that I deny that the action of the vapour in the respiraitory tr-act leads to reflex inhibition of the hecart: oni the contr-ary, I maintain that theo reactioni whichi cau be proved to occur wheni the~vapour escapes is ai better pr-oof of this r-eflex clettet thlani any that hias yet been aff'orded. and also furniishies a niew explaniat ion of the modus operamid of the reflex, mnechanismn. the pr-iimary synicope is reactionary in its cauisation it is earsily avoidable; while if it be duie to reflex inhihiitioni, it is not so, for this danger miust increas-,e as thle administration proceeds, and thie. direct Inhibition exercised by the clhloroforii in the blood comies to be added to that piroduced thriouigh r-eflex agency. The practical outcome of tliereactioniarythieory is mlomlentouis : ithe we)llfounded.inot asiingle breath of freshi air is to'be allowed unitil satisfactory anws%thesia is inlduced, aiid this r-ule stanids in dlirect cointradictioni to time recoinmendations of the H{ydlerabad Comminissioni. 'Neither this Commission nior thei Glasgowv Commiiittee hias ventured to face thte facts oii which the new thteor-y is based, nior the explaniationi whiceh It affords of time fall of blood pr-essure to zero whichl may occur after the chiloroformn liac heelm withdrawl i, anid wivicltlihas been iiiatter of dipu)tte bet ween thlese authlorities. lIn these circumnstanices the routlimie dsilence of ouir most Influential mnedical journaitls onl the 'ubject is a quiiestioni forlime editorsi and thec proressloim to comsider. "MEDICos UNDER TilE, MImCROSCePs." UNDER this title theo e,ditor of tito Gentleicmmin annouinces, a series of special articles, inteiided to ser-ve, in. his owni words, "1as a guiide wvliili wvill steer time neophiyte clear of incoumpetent or seiiii-iiicornipetent men iiito the safe harbourage of tIme consulting r-oonli of the dloctor whio combines the essential qualities of ability, exper-iemice, anid highi cliaracter'." " It miust," 1ie addis. "1be absoluitely unider-stoodl that thle geimtlemen whose pen-portraits wvill he given hiave in ico wvay assisted at, or even conseilted to. thecir owni delineationm." Thi.s is a v-ery sorry enterprise, anid oiie which it would well to abaiidoin. writer hiayiii g tle necessairy qualificaticns, to undertakze safely this iiiost super-l1inons andt inividioustask, would (crtaiiily dleiairrd by thle sense of propriety aimd lils deference to profe'ssional1 r-eticencee f Iomit undi(ertaking it. No onie whlo is acqutainted withi time diniity anid wvorthi of professional traditions would willingly miixed uip withi proceeding, uwhich wvill certainly be resenited by time subjects; of it. no less-thani by tihe profession at large. A moore unwiise aiidI objectionmable uinder-takiiig it uvould lie diffli-(lilt to coniceive, athd it imay lioped that time better Semi-se anld wiser seomid thioughits of the edlitor will r-estraini hiii from pur-Iiing it. Ttir CLINMATE, or NEW ZE'ALAND. DRn. It. C'urLJmOax (London) invvites: As re-ards the suitability of tIme climate of New Zealand for the p)litlhisical anid weak-chiested flucre Is imuclh diflereuce of opinioni. Youir torresponident, Dr. (atrlaud, in the finiITISH MEDICAL JOURNAL, of Novembecr 22iid, isism~, speaks hiiglhly of Qucenistown and othert villages oii the plateau; of time PrIovlincle Otago in tlime Southi Island, anid says it is dryandinvigorating-and well adlapted for piliiioimar-y comnsumptioin. NN'itlm this vieWv I cammuo1t eot imlyv agree: I L avc r-ead ever-ything ont le subject pr-eparat ury to Ilhe pulib imition of mny recent work, TiBe Book of Clonmatev ima ll Lanmds,amid linivc mlso hiad some practical experience of the effect of le clisimaIte ilm ili'.ease, and, as at reiult, I hmaic conmic to the conclusion flat 'New Zealanld caiimiot ih' speciallv recomimenidedl to people iii this coimiitimy stimff~ieing from0 piiliuioiiary ('onisimpuht ive diseatse. Takinig t le cimintryN as a whlo'le tImt climiate is iimoist and varialile, with a large nXimlmer if wet (Ilav-.i rimi deal of diffeence betwieen tuie day amid iiigli t tenmim-erature, amod iluc10 ind. At D uniedimi, theO cap11itall, SituaitedI cii tIe d r-ier S (if tile So uith is~lanid, thLe whiiterclimaizte is harsh and( variable. Thie annuial ieaim is-50oO (time saiiie mis Londomi), t le wet days mire Is2, tIme raijfall inchies, and tlhere is 76i pier ont. Of Iiiuiimiiditv. Cioparing tlids-, say, with the south-west coa't oif England, thte iiiter-iorplaini, at an elevatioii of I.uswm1 foel, iii iglut tie likilened to) lie highlainds of DJevon, andt t mis is liairdlya chiiateh of elect ion for pulb-inuire Eniglishmiien. There are thre-e classes of bivalids uhiii iiaiy be lik-ely to go so fara(way for the sake of their hiealthi. Fir-st, moumig mieni withi inceipiemit ('oiisuniption or wvithi zmii hereditaryv iint, wilio, while (nicer tim get rid of thieirtrmiiille, moe anxious tim strike oiut career. These requiire, a wrarimn, suiiiiy, driy cliimate. suchl as Sonith Africa, So (Calliformnia, S mmithi A nv.4 ia lii, o c oiltaiim pa,rts; of tIme Indian peniiiisula, aiid caminot. cinisviuilit imtihy be semit to New Zealand. Set'oidl,V, cases of advanced om dos e-loped. comisimliii't ioul 11iiiu nIell-totin peoplie. These are praicticailly l)istjints; amiil wotiild findL IP) 'imitable accomimiodationi liii New Zea:oiad, aiid, (iii. uh' j)luiis if iitam,o goodi houses are necessary, as the nights ar gee morally icill. St ill. t il ('lass, if aible to lake time long voyagem, w%oulld prohia bly findi uQ iou-I inl this part of time counitry, duiring t le wsammo imicimi lms, friom Nti%is iitir toim Marcht o Apri h. ben e fi v i al. ie s o i f mioit a le Ito (to a full day's wom'k, wvill hiave mmo ('hanile. mis c'oinipet it ium is great. Foi' mind Nelson, on time norths of time Southtl Islammd, mire, tliimik, the immmstl csnitable places.. 'Neisoim is well sheltered frion the cold southeimly winds, muIld lisagood dleal of simishineanmmd time aim' is critp amid( lyaitioat nut eveim Imeime flit' mieani of wrintei' is 400, of sunimiei'ii 600,. the nimighlty mlinimuimin to0, and thecre are. 47m inchies of rain. Tlmc winters amrc. hiowever, shiorter-tluai in this coimntr-y, and time summers long mmnd cool. Imn time Noithi Island, kn('khand is hiot, and relaxing, and has a immean of i9o, In concision, I should like to say a word in eommdemnation of the ineonsiderate. laimdation of smisiuitable phlices as winter health resorts for consuimption and allied complaints. Thuts I have knowvn Harrogate hiighly commended. Scar-borouigh praisedi beyond measiire. Edinburgh ,considered utseful, Falmouth. with a moist. mild, rainy atmosphere, set uip in Competition with the, dry, suinny, warm, tone giving RivieraI. and I should not be surprised if in a. little time the death dealing winter climate of Berlin had plenty of advocate.;, Jan. 3, 1891.] 49
doi:10.1136/bmj.1.1566.49 fatcat:yghk3vjxijbzdimu62cn4ckwou