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THE HAMPSTEAD GENERAL HOSPITAL 863 "vacca" process, an account of which I remember to have small privileged staff is unfair to the patients of other read in your valuable journal. The great drawback to milk practitioners, as, indeed, it is to the practitioners themselves treated by the Budde process is that it only remains sweet for (though the staff, by all reports, do their work in a very a period of from eight to 14 days, whilst your report, coupled satisfactory manner) ; and that the appointment of a staff with that of Dr. Klein, of the " vacca " milk in your issue of of consultants, which is rumoured as a possibility, in place March 8th, 1902, which I have before me, states that the of the existing general practitioner staff is opposed both to latter will keep indefinitely in bottle-in fact, some of the the original objects of the founder and to the needs of the samples on which you report you state to be quite a month locality. I am, Sirs, yours faithfully, old. The " vacca " milk is, in fact, absolutely sterile and yet F. R. HUMPHREYS, neither heat in the way nor preservatives are em- Chairman, Hampstead Division, British ordinary Medical Association. The Budde on the to Association. ployed. process, contrary, according Fellows-road, N.W., March 20th, 1906. Professor Hewlett, does not kill spores. From Professor Hewlett’s account of the Budde process I cannot help thinking that the results must prove to be THE ADMINISTRATION OF ADRENALIN rather uncertain. The effect of this method must be largely IN CASES OF FAILURE OF THE dependent upon the quantity of "catalase" which is present in the fresh milk. This quantity varies in fresh CIRCULATION. milk and decreases as the milk gets older, from the time it To the Editors of THE LANCET. has been drawn from the cow. This must necessarily cause J. P. Lockhart comments on the case an element of uncertainty in the process. In any case it SIRS,-Mr. Mummery’s I in THE LANCET of March 3rd did me the service must be admitted that in the Budde process a preservative is published added to the milk in the shape of peroxide of hydrogen, of calling my attention to his extremely valuable articles in the issues of March 18th and 1905. I see which may or may not be harmless. In Germany, at any April lst, quite that the ideal method of the rate, the addition of peroxide of hydrogen to fluids or food theoretically administering drug is states that even " in cases is prohibited. By treating milk by the Budde process there intravenously. He, however, is not always the certainty that the peroxide of hydrogen of failing circulation...... adrenalin if injected under the skin will have a chance of the has decomposed because the same quantity of catalase is very poor reaching peripheral not always present and it is impossible to find this out each circulation." In my case, however, the pulse at the wrist was not to be felt and the of the time in a practical methodical way. I am pleased to note yet recovery patient proves that it did reach the circulation. it be said that Professor Hewlett admits this himself where he says Of course, may that the needle a fair Mze but that it may prove necessary to add yeast enzymes artificially hypodermic pierced vein, to the milk. the same almost immediate effect (about 20 seconds elapsing before a was occurred after each Having made the preservation of milk the object of many change noticed) injection. The I wish to is that in suitable cases an years’ study I was naturally interested in this article and I point emphasise of adrenalin be of the utmost trust you will allow me to point out what I consider to be injection hypodermically may its scientific imperfections. However ingenious the idea service. As a general practitioner I have constantly come across cases in which I now see that its use have been may appear it is not on a level, in my with the vacca might opinion, of the value. In of circumstances would process which you have previously described, which, while greatest many these, not have intravenous infusion. It completely preserving the milk, adds nothing to it or disturbs permitted consequently seems to me that if some manufacturer would on the its nourishing qualities, as is the case by the ordinary place methods of milk. market sealed capsules containing suitable doses capable of sterilising carried in the he would be I am, Sirs, yours faithfully, being hypodermic pocket-case a want. Mr. also finds the action of Amsterdam, March 14th, 1906. Dr. F. BASENAU. fulfilling Mummery adrenalin very transitory. In my case, however, weakening of the pulse began quite 15 minutes after the first injection THE HAMPSTEAD GENERAL HOSPITAL.and was not marked enough to call for a second injection To tkc Editors of THE LANCET. till 30 minutes after it. It is true that I gave 10 minims but Mr. this can have had no effect. SIRS,-The of the General Hos- orally, Mummery says management Hampstead The were at about two-hour has been the subject of much criticism the local remaining injections given pital by intervals as the that is to medical for some time and the matter has according pulse required it; say profession past the effect to last about that of time. One been coming to a head gradually in the course of the past appeared length small point more: do the words vaso-motor stimulant" year or two. The hospital was originally founded by a local imply a nervous action ? It that I knew the general practitioner as a home hospital, where individual happened action of adrenalin was direct, and unless these words local could themselves continue, in more imply practitioners action a which it does not seem to me circumstances, the treatment commenced in the through nerve, they do, satisfactory it is not to that "adrenalin can in no sense homes. The was in considerable diffi- surely right say patients’ hospital be called a vaso-motor stimulant." culties for some years ; finally it was only by the united I am, Sirs, yours faithfully, efforts of the local that it was kept open. profession Chiswick, W., March 19th, 1906. H. O.0. BUTLER. From a home hospital this institution has advanced, or degenerated, into a "general hospital," with a large out- patient department, a limited staff of general practitioners, THE DANGERS OF THE FLUTE-KEY a few (pay) beds for the patients of practitioners not on the FLASK FOR ADMINISTRATION OF staff, and a management on which the outside profession is unrepresented. This divorce between the management and ETHYL CHLORIDE. the local profession is greatly to be deprecated on every To the Editors of THE LANCET. ground. The hospital has recently become possessed of a to thank for letter in very large donation and it is rumoured that it is about to SIRS,—I beg you inserting my THE LANCET of March 17th on the of the receive another. It has been transferred to a new specially dangers flute-key erected building quite recently (and objections might be flask. I regret that I have made an error. Instead of made to the choice of The lines which "(3) Messrs. Sumner’s measure," it should be "Messrs. easily site). upon " the hospital authorities have been recent,ly developing that Reynolds and Branson’s Antivolat.’" I should be glad if institution indicate further alterations in the near future you would correct this.-I am, Sirs, yours faithfully, THOMAS and, indeed, there are rumours, apparently well founded, Y. SIMPSON. which foreshadow further drastic changes. Royal Albert Hospital, Devonport, March 19th, 190r). This letter is not for the purpose of opening a discussion in your columns, Sirs, but in order to request the general THE BATTERSEA BOROUGH COUNCIL practitioners of Hampstead and its neighbourhood to keep an open mind upon the subject in view of the proposal to AND ITS MEDICAL OFFICER OF call a meeting of the local profession in the course of the HEALTH. next few weeks to consider the whole matter. I there- will, To the Editors of THE LANCET. fore, merely ooserve that there appears to be a consensus of medical opinion that an out-patient department in this SIRS,—I observe in the list of duties proposed by the neighbourhood is neither necessary nor desirable ; that if Battersea borough council for the medical officer of health any hospital be required in Hampstead it should be one of to be appointed by them that this officer must " issue all the nature of a home hospital ; that the appointment of a instructions and communications to sanitary inspectors 864 THE FIFTEENTH INTERNATIONAL CONGRESS OF MEDICINE. (male and female) through the chief sanitary inspector." As the extra cost of the Sud express will take the ordinary a medical officer of health who has direct supervision of the express. In that cae they can leave London on April 16th work of both male and female inspectors may I draw (Monday morning) by any one of the three routes-Calais, attention to the serious difficulties which will almost Boulogne, or Dieppe. The trains arrive at Paris in time to, certainly arise if this duty as to instructions and com- allow for dinner with all ease and comfort. Coffee and munications be literally carried out and particularly in the cigars may follow, for the express does not leave the Quai case of the female inspectors ?‘! Their work will consist, one d’Orsay before 10.23 P.M.

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