834 descended ? Was the growth of the mixed form that is recognised as congenital ? " Assuming that there was no local injury to the testicle, the growth could not, by any stretch of imagination, be ascribed to the injury. A single direct injury on normal testicles has not, so far as I know, It has been ever been proved to cause a new growth. claimed, although I very much doubt it, that repeated injuries to an imperfectly descended testicle are the cause of new growth. If the testicle was imperfectly descended there is no need to attribute the growth to a single injury, for the frequency with which growth develops in such a testicle, apart from injury, is recognised. If the histology is that of a mixed growth, the congenital origin, apart from injury, is clear. In any case there is nothing to connect the appendicitis with the injury or with the orchidectomy." Another surgeon writes : " In regard to the testicle, it is well known that in the majority of testicular tumours there is a history of injury some time before the appearance of the tumour, and the injury is
In this case, however, we can safely assume that the tumour was a very slowly growing one because 18 months were allowed to elapse between its recognition and its removal; and as the injury occurred only four weeks before the first recognition of the swelling in the testicle, one is safe in maintaining . that it must have been present before the accident. Arguing on these lines I feel confident that a claim for compensation cannot be maintained. In respect of the attack of acute appendicitis I should give a strong expression of opinion against the accident having had anything to do with it at all. Trauma as an atiological factor in appendicitis is a very debatable point and the balance of opinion is against it. Anyway, in this case it seems out of the question to blame an accident 19 months previously for a subsequent attack of appendicitis. "-ED. L.
20 gr. of bromide of ammonia t,o be taken night and morning, and one teaspoonful of citrate of soda to be taken with each dose of bromide. Subsequently I added to each dose of the bromide mixture 10 gr. of urotropine. The result is that the patient’s tits have ceased and that up to the date of writing there has been no recurrence.
No unpleasant by-effects have appeared in any of the cases treated with urotropine and citrate. I have also tried benzoate of ammonia, but as this seemed in some instances to depress the patient’s spirits and to derange his digestion I have nearly ceased to prescribe it. Further investigation will show to what extent the daily dose of bromide could, in course of time, be reduced.-I am, Sir, yours faithfully, E. J. McC. MORRIS, F.R.C.S. Edin. Poynders-road, S.W.. April 10th, 1926.
IN THE TROPICS. of THE LANCET. SiR,—In my letter on the above subject which appeared in your issue of March 13th, on referring to the " 1 lb. ration " instituted by the Government of India against the strenuous advice of Cornish, I stated from Jan. 31st, 1876, to May 22nd, 1877, this diet In both instances the year quoted was in force." should have been 1877. As the context shows famine was not officially recognised till October, 1876, the discrepancy is apparent; but seeing that the results of error in nutrition both in individuals and populations must be estimated not only as to its nature but in the light of duration of its incidence, I venture to ask your permission to correct the slip of diction for which I am responsible, lest the casual reader be misled. Had the " 1 lb. ration " been in force for the longer period, a diminution not of 3,000,000 of the population of the affected districts, but a great multiple of that number would have been inevitable. I am, Sir, yours faithfully, W. G. KING, Hendon, N.W., April 5th, 1926. Colonel, I.M.S. (retd.) FAMINE
To the Editor
UROTROPINE, CITRATE OF SODA, AND BROMIDE OF AMMONIA IN THE TREATMENT OF EPILEPSY. To the Editor of THE LAN C ET.
To the Editor of THE LANCET. Mr. SIR,—In Twistington Higgins’s most interesting article on empyema in children which appeared in THE LANCET of March 20th, there is one piece of advice with which I would join issue. It reads as follows :-
SiR,-Recently I have investigated the treatment of epilepsy in the light of my belief that an important factor in the causation of this disease is the colon bacillus ; and the one outstanding result of my investigations is the discovery that the power possessed by Once the tube is out the child should be encouraged to ammonium bromide of preventing epileptic fits is lie on the good side and deep-breathing exercises should be decidedly raised by administering with this remedy continued." urotropine and citrate of soda. In almost every case Presumably this indicates that it is the opposite of fits under my care I now give two separate pre- side—i.e., the side where the resection of the rib scriptions, as follows :— was made-which will be given thereby a chance of functioning better than the sound side on which the patient is advised to lie. In an article of mine which appeared in THE LANCET of April 26th, 1919, p. 697, on Gunshot Wounds and Other Affections of the Chest I wrote :"
Under the action of the medicines shown in these prescriptions the fits in all my cases have so far disappeared. In one remarkable case of hysteroepilepsy, where attacks were occurring at the rate of three to eight a day, and where 20 gr. of bromide, thrice daily, failed to control them, the use of these prescriptions in a short time caused them to cease. The following is a record of a case which has been under observation for a considerable time. A. B. C., a male aged 44 years, has been suffering from fits for 20 years. From 1907 to 1917 he took, without much benefit, about 20 gr. of bromide twice daily. In February, 1917, he came under my care, and although I gave him large doses of the mixed bromides night and morning, he continued to have fits at varying intervals to September, 1924. The following is an accurate account of his seizures : 1917, six ; 1918, nine; 1919, ten ; 1920, four ; 1921, seven ; 1922, six ; 1923, six; 1924, four. On Sept. 16th, 1924, 1 prescribed two
" Great assistance in making a collapsed lung function properly is rendered by bending the body away from the injured side, as the patient lies on his back. This position causes a partial collapse of the sound lung by mechanical Also, when possible, the patient pressure of the ribs. should lie on the injured side when preparing for sleep." I have often been questioned about this advice, doubt being cast on the idea that it is the lung on the side on which the patient is lying that is getting more air than the opposite lung. From careful observation I believe that this is really so. The side on which the patient lies sinks into the bed in a convex position and apparently the lung functions freely, the opposite or upper side is mechanically
compressed by the position assumed, and expansion is restricted. I therefore always advise patients with an empyema to lie on the back, as described, or on the side where the rib has been resected, both from a drainage point of view and for expansion of the lung.