beri-beri in a whaling expedition

377

Correspondence."Audi alteram partem."

RADIUM OR EXCISION FOR EPITHELIOMAOF THE TONGUE.

To the Editor of THE LANCET.

SiR,-Mr. Ogilvie’s letter contains a fallacy whichappears likely to provide difficulties whenever anyattempt is made to compare statistically the resultsof surgical treatment with those of treatment byradium, in that he does not take into account theoperability rate. To compare Regaud’s figures,which are based on cases of which only some 20 percent. were operable when submitted to treatment,with those of surgical excision which were necessarilyall operable, is to reduce statistical comparison to theabsurd. A further point which appears to me to beof far greater importance than statistics can ever

convey is the fact that the patient treated by surgeryis necessarily a mutilated patient, the one treated byradium is not. Actually the time has not yet comewhen statistical comparison between surgery andradium can fruitfully be made, but if we consider thepatient as a human being rather than as a unit in dgroup of figures, then, in the case of cancer of thetongue at any rate, there can be little doubt as towhich method has the most to offer him.

I am, Sir, yours faithfully,E. G. SLESINGER.

Wimpole-street, W., Feb. 9th, 1930.

THE SALE OF WEED-KILLER.To the Editor of THE LANCET.

SIR,-I wish to direct your attention to a matterof grave importance-it is this : although no layperson can obtain poisons from a chemist withoutgiving his or her name and address, anyone can

go to an oil shop and purchase enough weed-killerto end the days of 50 persons without being askedany questions. In the inquest on the Stanley familyit was stated that a teaspoonful of weed-killer wasa fatal dose, and that mixed with ordinary foodit was quite tasteless. What a terrible state ofaffairs this is, and how unsatisfactory for the medicalprofession ; a doctor cannot know that the patienthas taken weed-killer until he has had the vomitanalysed, but by that time the patient is dead,so that nothing can be done for him. I trust youwill use your influence to have this state of affairsaltered as soon as possible.

I am, Sir, yours faithfully,ERIC CLINE, M.R.C.S. Eng., L.R.C.P. Lond.

Weybridge, Feb. 8th, 1930.

* * Our correspondent rightly draws attention to theperilous ease with which weed-killer can be purchased.The law is not now so vigorous as in the time of IHenry VIII. when, after a deplorable incident inthe Bishop of Rochester’s household, Parliamentimposed on persons found guilty of wilful poisoningthe penalty of being boiled to death. Nowadays, infipite of restrictions on the sale and possession ofpoisons and " dangerous drugs," a would-be murderercan easily equip himself with a tin of the right stuffat an oil store. The Arsenic Act of 1851 is stillupon the statute-book, but Section 2 of the Poisonsand Pharmacy Act of 1908 seems more anxiousto encourage the sale of sheep-dip and weed-killerthan to protect His Majesty’s lieges from beingpoisoned. The Section provides that sale is to beunder licence of the local authority and subjectto regulations. It is commonly said that localauthorities take these responsibilities lightly andthat the few formalities required by the regulations.are neither widely known nor invariably observed.Facilities for buying sheep-dip and weed-killer are

commercially desirable, but are there no prospectsof non-poisonous preparations being produced whichwill satisfy the requirements of farmer or gardener ?Quite apart from statute, there is a common-lawduty of persons who possess poisons to take goodcare that they are so securely kept as not to bea source of injury to others. If it be true that weed-killer is sometimes sold to minors or others withoutadequate inquiry, it would seem that this common-lawduty is not discharged.-ED. L.

BERI-BERI IN A WHALING EXPEDITION.

To the Ed’itor of THE LANCET.SIR,-I was much interested in your annotation

(p. 250) on Dr. Nissen’s experience of beri-beri in anantarctic whaling expedition. During the 1927-28season I was in the antarctic as medical officer on awhaling ship and was called on several occasions toother ships to see cases of beri-beri. I had with me avery limited quantity of marmite which I gave insmall quamtities to these cases. The improvementshown in the few days prior to the men being sent tothe base was so striking that I put in a strong recom-mendation to the company that in future all their shipsshould have an adequate supply of marmite on board,to be used for the prophylaxis of beri-beri. This has,I believe, been done with excellent results.

I am, Sir, yours faithfully,Edinburgh, Feb. 5th, 1930. JOHN B. ROLT, M.B.

SPINAL ANÆSTHESIA.

To the Editor of THE LANCET.

SiB,—Dr. Howard Jones says the explanation ofthe escape of the phrenic motor roots when numbnessin the neck follows a novocain injection is simple ;and he suggests that it is as follows :-

" (1) The upper remnant of a heavy solution tends toaffect the posterior roots more than the anterior."

Quite so, but I am using a lighter solution. Cloudsof witnesses will testify to this. They have seen thecerebro-spinal fluid as it comes into the syringe dropby drop fall to the bottom leaving the spinocain orMay and Baker’s solution at the top. The tendencytherefore would be for it to affect the anterior roots.

" (2) The concentration in the cervical region is too diluteto affect motor fibres."

A few months ago I saw a patient unconscious,analgesic from head to foot, and pulseless, whom thesurgeon declared to be dead-not only dead, butthat he smelt dead (this was partially true, for he hadfour feet of completely gangrenous gut inside theabdomen)-whom I declared to be alive, simply onthe grounds that he was breathing regularly, albeitquietly. This ground proved to be solid rock, andhe recovered. Here, then, apparently Dr. Jones andI are agreed, that the concentration in the cervicalregion is too dilute to affect the motor fibres. Butthe concentration used was amply sufficient for alloperative procedures. In other words, in the con-centration commonly used and necessary, novocainparalyses receptors, leaving the phrenic motor roots,nerves, and diaphragm active.One case is not enough, so let me quote Jonesco,

who, using mostly stovaine, but also novocain, records1387 cases which he injected " au dessous de laproeminente," with successful analgesia withoutfatality. Here again the concentration in the cervicalregion was too dilute to affect the motor fibres-forall these patients must have breathed. The paperof Koster and Kasman, to which you referred in yourissue of Jan. 18th (p. 145), shows that novocain willnot paralyse the phrenics; it does not offer anyexplanation of the paralysis of the abdominal muscles.I think it is a fair inference from their paper to supposethat in the strength used novocain paralysesabdominal muscles merely by cutting off afferent