PEPTIC ULCER

PEPTIC ULCER

1315 desirable to suggest for individual subscriptions any limit such as might have been fitting for a tribute of a purely personal character. It i...

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1315 desirable to suggest for individual subscriptions any limit such as might have been fitting for a tribute of a

purely personal

character.

It is

strongly hoped,

however, that this will in no way deter those who may wish to have a share in the personal memorial but

are

of

All

sums.

necessity restricted to giving quite small subscriptions should be sent to the

Secretary, Fletcher Memorial Fund, 38, Old Queenstreet, Westminster, S.W.l. We are, Sir, yours STANLEY BALDWIN F. G. HOPKINS D’ABERNON

faithfully, C. J. MARTIN T. R. ELLIOTT ROBERT MUIR HARRIETTE CHICK G. M. M. TREVELYAN M. R. JAMES A. E. BOYCOTT H. H. DALE E. MELLANBY.

MILDMAY OF FLETE C. S. SHERRINGTON ALAN GREGG DAWSON OF PENN J. WARING H. J. H. London, June 7th. FURUNCLE OF THE AUDITORY MEATUS To the Editor of THE LANCET SiB.—Every nose, throat, and ear specialist has amongst his patients a number of sufferers from furunculosis of the external auditory meatus. Whilst not dangerous either to life or to hearing, the trouble assumes importance from the fact that the pain is excruciating and calls for immediate relief. My experience has led me to formulate a few " dont’s " : 1. Don’t use hydrogen peroxide. 2. Don’t use strong glycerin of carbolic drops. 3. If there is nothing to syringe out in the

ear

do not

syringe. 4. Avoid solutions of mercurochrome.

does not relieve pain and its the for other furuncles to develop. paves way Glycerin of carbolic damages healthy skin around the furuncle and renders it more liable to infection. Syringing pushes infective material further into the meatus and gives rise to a deeper and ten times more painful boil. If there is a big mass of cerumen, with or without otomycosis (a trouble very common in the tropics), then it is wise to syringe out the mass after preliminary instillation of warm phenol in paraffin (1 in 400). Mercurochrome colours everything deep red and makes the day-to-day watching of the condition difficult. I have found the following treatment successful in about 500 cases and can thoroughly recommend it. It consists of the application of an ointment locally, followed by the putting in of drops, preceded by radiant heat.

Hydrogen peroxide

use

1

1. Zinc oxid. grs. 90.

Adip. benz.5i.

Iy,

2.

Hydrarg. perchlor. gr. i. Cocain. hydrochlor. grs. 5. Atrop. sulph. gr. 4. Tinct. aconit. lllv. Glycerin5i.

small mustard spoon and half fill it with the to boiling-point over a flame, and allow it to cool. With a suitable wooden applicator and sterile cotton-wool dab the still liquid ointment on the furuncle and the parts around until well covered by a thick layer of the ointment. If there is much swelling at the meatal entrance the liquid ointment may be poured in. After three hours apply radiant heat from a lamp at a distance of 30 in. for thirty minutes. Early in the application fill up the ear completely with the drops, leaving them in for at least three minutes. Repeat the radiant heat and drops every six hours. Give internally aspirin grs. 5-10 every four hours and an adalin tablet at bedtime repeated after five hours. After 24 hours swab out the ointment gently with phenol paraffin and re-apply; Within four days almost all the pain and much of the swelling will have disappeared. Now change the drops to hydrarg. perchor. gr.in glycerin 3i night Take

a

ointment, heat it

morning for a fortnight. If there is adenitis, antiphlogistine poultices will quickly bring down the inflammation.-I am, Sir, yours faithfully, and

W. H. VAKEEL. Bombay, May 17tb. PEPTIC ULCER To the Editor of THE LANCET SiE,—I should like to make three corrections to the report of my opening speech at the Fellowship of Medicine debate on the treatment of peptic ulcer which appeared in your last issue. 1. Lord Moynihan did not contend ten years ago that an ulcer large enough to be demonstrable by the X rays could not be cured except by operation, but he told me that he had not yet seen radiological evidence that such an ulcer could be cured. 2. All symptoms and radiological signs of an enormous gastric ulcer had disappeared at the end of three months in the test case with which I convinced Lord Moynihan ; there has been no recurrence in the ten years which have since elapsed. 3. I did not say that I had never seen perforation after proper medical treatment for a sufficiently long time, but that I had never seen perforation occur in a patient whilst under strict medical treatment. I am, Sir, yours faithfully, ARTHUR F. HURST. June New Lodge Clinic, Windsor Forest, June llth. 11th.

THE HEALTH OF NURSES IN TRAINING To the Editor of THE LANCET

SiR,—You recently published figures regarding the incidence of illness among nurses at St. Bartholomew’s Hospital (THE LANCET, Jan. 13th, 1934, p. 91). It may be of interest to record the experiences of the last three years at the Royal Free Hospital. With a daily average of 125 nurses for the whole period, the average daily deficiency on account of illness was :1931 1932 1933

......

......

......

4-78 per cent.

2-21 " 1-90 ,,

" "

making 2-9 per cent. average daily deficiency for three years. The incidence of sickness among first year nurses was high in each year and formed 50 per cent. of the total in the three year period, second year nurses accounting for 26 per cent. and third year nurses 24 per cent. At the Royal Free, as at St. Bart.’s, a high proportion of the illnesses were due to throat infections and their complications ; also there was more illness in the winter than in the summer.-I am, Sir, yours faithfully, DOROTHY C. HARE, Physician to the Royal Free Hospital. Weymouth-street, W., June 10th.

A

GRAVE

PROTEST

Proprietors of THE LANCET, LD. DEAR SiRS,—On page 1254 of THE LANCET dated 9/6/34 there is a paragraph about me. It is correct so far as culled from the " Medical Directory " and The

" Kelly’s Directory." A sine qua non of such a notioe is the death of the subject, and I submit to you " I am not dead, never have been, and that I am in no earthly hurry." In regard to this paragraph I will be glad to hear from you what you mean to do. I am yours faithfully, JAMES TAYLOR. Ugie House, Keith, Banffshire, June 10th.

***We offer sincere apologies for the sad error which was due to a series of misunderstandings. We are aware of the pain as well as inconveniences which might follow upon such a mistake and hope that no such results in this case have occurred.-ED. L.