- Email: [email protected]
AN UNUSUAL ACCIDENT.
237
Laryngoskopie,"1 has given his reminiscences of practice from 1858 to 1913. These reminiscences, therefore, date from and are contemporary with the application of lsryngoscopy to practical medicine by Czermak and Turck. They are an important addition to the history of the subject, and their value is enhanced by the author’s personal knowledge of those clinical investigators. The history and development of the allied science of rhinology has been minutely dealt with in a compactly printed volume of nearly 500 pages by Dr. Karl KasseJ.2 The volume represents a painstaking literary research and covers the history of the subject from the earliest times. Although written in chronological order, its usefulness as a work of
Sir StClair Thomson doubts if any department of medicine has made anything like the rapid progress which rhino-laryngology had accomplished in the first years of the twentieth century. It no longer limits its domain, as it used to do, to the upper air passages. It had extended its field of operation up to and through the air sinuses at the base of the skull, down to smaller bronchi, and through the whole length of the oesophagus. He thus suiumarises the present situation : " The days are happily passed when laryngology, in common with other specialties, was apt to be sneered at by the high priests of medicine and surgery, and we were charged with invading territories where we were not wanted and where we did no good. Rhinolaryngology has explored and tilled the lands which general medicine and surgery had either neglected or failed to bring into cultivation, and now that this pioneer work has produced a plenteous harvest I think the present occasion is an opportunity to make known what are the fruits of our reaping and to indicate the portions of these new provinces which can now be handed over to
century.
reference would have been increased by an index to a table of contents. The book even without these has added to the prominence of the nose that nature always intended it should enjoy. Sir StClair Thomson, in an address recently delivered before the Harveian Society of London, took as his subject " Modern Methods in Rhinolaryngology." He opened his address with the remark that it was a little diffiult to define exactly the general republic of medicine." " what is modern" in a specialty which is only 60 years old. After reading Dr. Kassel’s interesting AN UNUSUAL ACCIDENT. account of rhinology as practised by the ancient Egyptians and their forebears, the difficulty, instead AN unusual accident due to an explosion is of being lessened, is further increased. The period reported by Mr. Leonard A. Wright in the Medical of 60 years, as Sir StClair Thomson remarked, Journal of Australia. A contractor, aged 40 years, could be conveniently divided into three stages. walked into St. Vincent’s Hospital, Melbourne, The first might be dated from the publication impaled upon a broomstick which transfixed his in 1855 of Garcia’s paper on the laryngoscope right hand to his right shoulder. While using It was chiefly devoted the stick for tamping an experimental charge up to the year 1881. to the study by inspection of diseases of of a new explosive for blasting an explosion the nose and throat and their treatment by occurred. On admission he was suffering from a, topical or internal medication. Another mile- moderate degree of shock. The stick was driven stone it is essential to notice is the publication through the palm between the first and second at about this latter date of Sir Morell Mackenzie’s metacarpal bones, causing a compound fracture work on diseases of the throat, which for many years dislocation of the base of the first. The stick was the standard work on the subject, and initiated then passed through his shirt and entered the many into the specialty both in this and other axilla just below the anterior fold and traversed countries. The discovery of cocaine in 1881, which it a little above its floor upwards and outopened the second stage, at once facilitated laryngo- wards to emerge through its posterior wall. scopy and rendered possible quite a large number There was very little bleeding from the wound of operations. The rapid surgical development of of entrance or of exit. There was no oedema. rhino-laryngology of the following 20 years was of the arm, and the radial pulse was equal further helped by the discovery of the haemostatic in volume to that on the opposite side. The action of the extract of the suprarenal gland. The skin of the face, both forearms, and the chest inception of the third stage was marked by the and abdomen was tattooed with fine grit. Both perfecting of those endoscopic methods foreseen corneæ were powdered with grit, and the upper and originated by Sir Morell Mackenzie. This and outer part of the left cornea had been penethird stage dates from the beginning of the trated by a small gritty particle which was lying in present century; it has shared in the great the anterior chamber. Consent to amputation of advance of modern medicine and surgery, and the limb, if necessary, having been obtained, the it was chiefly the progress of those 15 years patient was anaesthetised, his dirty clothes were cut that the lecturer summarised. The cosmetic sur- away and the chest and arm were freely dabbed gery of the external nose; the discovery of the with tincture of iodine. An assistant stood by ready nasal route to the pituitary body; intranasal dacryo- to control the right subclavian artery. The stick Gystostomy; lateral rhinotomy or Moure’s opera- was sawn across as close as possible to the dorsum tion ; the relationships of the nose and accessory of the hand and drawn out towards the palmar sinuses to the eye and the orbit; the surgery of the aspect. The stick was again sawn at its point of accessory nasal sinuses; the endo-nasal operation exit from the posterior axilla and extracted by on the frontal sinus, to mention only some of the drawing it out forwards. No hæmorrhage followed advances m:1de in this department of practice, the removal of either portion. Apparently the would justify the conclusion expressed that the had traversed the axilla without injuring modern methods of rhino-laryngology were amongst stick A drainage-tube was any important structure. the greatest triumphs of surgery in the twentieth drawn through each tract and the wounds were dressed. The skin of the forearm was painted 1 Entstehung und Entwickelung der Laryngoskopie. Von Prof. Dr. The Emerich von Navratil, Budapest. Berlin: August Hirschwald. 1914. with iodine and a dry dressing applied. Pp. 53. Price M.1.60. with out boric sacs were washed conjunotival 2 Geschichte der Nasenheilkunde von ihren Anfängen bis zum bodies were 18. Jabrhundert. Von Dr. med. Karl Kassel. Würzburg: Verlag von lotion, and many of the foreign Curt Kabitzch. 1914. Pp. 476. Price M. 12. removed from the corneas. In the left eye an
the subject matter and
238 upper and outer iridectomy was performed and many valuable suggestions. The credit, however, the penetrating foreign body was removed. A sub- for the elaborate and successful attempts to cutaneous injection of 10 c.c. of antitetanic serum exterminate G. palpalis is due to the commission was given as a prophylactic, and the dose was appointed in 1912. Principe is covered with a repeated on the following day. Recovery was luxuriant growth of vegetation which extends on all uninterrupted. Good movement was regained in sides of the island down to high water-mark. In the the shoulder and arm, and the movements of the northern and less mountainous half of the island hand were only slightly impaired. Good vision was are many unwholesome pools and swamps. The recovered in the right eye, but the left had to be forests and jungles were populated by large numbers of semi-wild pigs, the descendants of domesticated excised six weeks after the accident. swine escaped from farms and estates throughout These swine frequented the most the island. SLEEPING SICKNESS ON PRINCIPE. swampy and most densely overgrown neighbourTHERE are few more arresting chapters in the hoods, and were there greedily fastened on by glossina which found in such neigh. history of medical progress and achievement swarms of the physical conditions best suited to than those relating to the successful struggles in bourhoods various parts of the world against malaria and persistence and multiplication. The plan of earn. yellow fever. The fight against the terrible scourge paign against the glossina drawn up by the comof sleeping sickness is one of greater difficulty, and mission was a comprehensive one, and full powers and means were given to the commission by the up to the present has not been crowned with so Government to carry it out. The following were a measure of success. claims credit large Portugal essential features : 1. The forests were systeits for conducting one of the first successful campaigns against the glossina-the insect disseminator of matically thinned and the dense undergrowth freely sleeping sickness. The Portuguese triumph has cleared away so as to admit air and sunlight. 3. All wild pigs been won on the island of Principe, one of 2. All swamps were drained. the cocoa-growing islands off the west coast of were massacred, and the keeping of swine in the All stray dogs Africa, about which a good deal was heard a year island was strictly forbidden. 4. killed. of men on their were Gangs wearing or two back in connexion with the system of indentured labour prevailing there. An interesting backs cloths smeared with a sticky compound to the glossina accompanied the account of the procedure in Principe is given in attractive Large numbers of glossina at the final report of the Medical Commission (1912- clearing parties. first fastened on the cloths, but the numbers 1914) appointed by the Portuguese Government as the campaign proceeded, became fewer steadily :to investigate the subject of sleeping sickness in the island and to devise, if possible, means and the last glossina was captured in May, 1914. for the suppression of the disease. The report The effect of the campaign on the prevalence of - constitutes Vol. V. of the Arquivos de Higiene e sleeping sickness is shown in the reduction of the mortality from 251 in 1911 to 166 in 1912 and 133 Patologia Exóticas, published by the Lisbon School in 1913, the percentage mortality from sleeping of Tropical Medicine. It is profusely and beautifully in relation to the general mortality falling sickness the reader to the illustrations illustrated, enabling ,realise the marvellous luxuriance of vegetation on during the same period from 53’17 in 1911 to 43’0 the island and to follow clearly the account given in 1912 and to 38’34 in 1913. The commission has in the report of the works of sanitation devised by devised and carried out a fine piece of work with the commission and carried out under its orders a thoroughness and efficiency which reflects and expert supervision. There are but three known immense credit on the medical men of whom it is foci of glossina outside the African continent, composed, and has given in its report an admirably G. tachinoides infesting partof the coast of Arabia clear account of the whole matter. and G. palpalis having established itself on Principe and the neighbouring island of Fernando Po, both THE METROPOLITAN WATER-SUPPLY. in the Gulf of Guinea. According to the tradition THE report on the condition of the metropolitan prevalent in the island G. palpalis was introduced into Principe near the beginning of last century. water-supply during the month of April was issued The island of Sao Thome, curiously enough, has so last week. It will be recalled that April was a fine far remained uninfested by glossina, though it and dry month, the mean rainfall for all parts of ;presents conditions for the life and development of the Thames basin being 1’17 inches, which is 0’54 of the insect precisely similar to those of Principe; an inch below the average for that month during the -and there is, further, constant communication previous 32 years. Chemical tests showed a general between the two islands, including a busy traffic in improvement in all three raw river supplies (Thames, live cattle. Principe has, as one would expect from Lee, and New River), and the filtered waters also the prevalence there of the "nay," suffered severely showed improved quality. Bacteriologically the from sleeping sickness. The total mortality from the raw waters contained fewer bacteria than their disease from 1902 to 1913 was 2525. This corre- respective averages for the year 1914. The filtered sponds to 2100 deaths per decennium. As the waters also were satisfactory, but a difference, average population of the island during the same which is being investigated, is being shown between period was 3800, we see that these appalling the general filter well and pressure main results at figures mean that in 20 years the island was losing the Lambeth works. We have also received a copy from sleeping sickness a number of individuals con- of the eleventh report on research work by Dr. A. C. siderably greater than her average total population. Houston, the director of water examinations. This The Portuguese Government has been fully alive to deals with the excess lime method of purification, the importance of finding a remedy for so disastrous and the results are interesting and important, for Dr. Houston does not hesitate to express the a state of things, and in 1901 and 1908 commissions the island to opinion that river water, no matter how impure, were appointed and sent out to investigate the whole subject and suggest remedies. may be brought into a condition of absolute These commissions did excellent work and made safety bacteriologically, and of great relative
Laryngoskopie,"1 has given his reminiscences of practice from 1858 to 1913. These reminiscences, therefore, date from and are contemporary with the application of lsryngoscopy to practical medicine by Czermak and Turck. They are an important addition to the history of the subject, and their value is enhanced by the author’s personal knowledge of those clinical investigators. The history and development of the allied science of rhinology has been minutely dealt with in a compactly printed volume of nearly 500 pages by Dr. Karl KasseJ.2 The volume represents a painstaking literary research and covers the history of the subject from the earliest times. Although written in chronological order, its usefulness as a work of
Sir StClair Thomson doubts if any department of medicine has made anything like the rapid progress which rhino-laryngology had accomplished in the first years of the twentieth century. It no longer limits its domain, as it used to do, to the upper air passages. It had extended its field of operation up to and through the air sinuses at the base of the skull, down to smaller bronchi, and through the whole length of the oesophagus. He thus suiumarises the present situation : " The days are happily passed when laryngology, in common with other specialties, was apt to be sneered at by the high priests of medicine and surgery, and we were charged with invading territories where we were not wanted and where we did no good. Rhinolaryngology has explored and tilled the lands which general medicine and surgery had either neglected or failed to bring into cultivation, and now that this pioneer work has produced a plenteous harvest I think the present occasion is an opportunity to make known what are the fruits of our reaping and to indicate the portions of these new provinces which can now be handed over to
century.
reference would have been increased by an index to a table of contents. The book even without these has added to the prominence of the nose that nature always intended it should enjoy. Sir StClair Thomson, in an address recently delivered before the Harveian Society of London, took as his subject " Modern Methods in Rhinolaryngology." He opened his address with the remark that it was a little diffiult to define exactly the general republic of medicine." " what is modern" in a specialty which is only 60 years old. After reading Dr. Kassel’s interesting AN UNUSUAL ACCIDENT. account of rhinology as practised by the ancient Egyptians and their forebears, the difficulty, instead AN unusual accident due to an explosion is of being lessened, is further increased. The period reported by Mr. Leonard A. Wright in the Medical of 60 years, as Sir StClair Thomson remarked, Journal of Australia. A contractor, aged 40 years, could be conveniently divided into three stages. walked into St. Vincent’s Hospital, Melbourne, The first might be dated from the publication impaled upon a broomstick which transfixed his in 1855 of Garcia’s paper on the laryngoscope right hand to his right shoulder. While using It was chiefly devoted the stick for tamping an experimental charge up to the year 1881. to the study by inspection of diseases of of a new explosive for blasting an explosion the nose and throat and their treatment by occurred. On admission he was suffering from a, topical or internal medication. Another mile- moderate degree of shock. The stick was driven stone it is essential to notice is the publication through the palm between the first and second at about this latter date of Sir Morell Mackenzie’s metacarpal bones, causing a compound fracture work on diseases of the throat, which for many years dislocation of the base of the first. The stick was the standard work on the subject, and initiated then passed through his shirt and entered the many into the specialty both in this and other axilla just below the anterior fold and traversed countries. The discovery of cocaine in 1881, which it a little above its floor upwards and outopened the second stage, at once facilitated laryngo- wards to emerge through its posterior wall. scopy and rendered possible quite a large number There was very little bleeding from the wound of operations. The rapid surgical development of of entrance or of exit. There was no oedema. rhino-laryngology of the following 20 years was of the arm, and the radial pulse was equal further helped by the discovery of the haemostatic in volume to that on the opposite side. The action of the extract of the suprarenal gland. The skin of the face, both forearms, and the chest inception of the third stage was marked by the and abdomen was tattooed with fine grit. Both perfecting of those endoscopic methods foreseen corneæ were powdered with grit, and the upper and originated by Sir Morell Mackenzie. This and outer part of the left cornea had been penethird stage dates from the beginning of the trated by a small gritty particle which was lying in present century; it has shared in the great the anterior chamber. Consent to amputation of advance of modern medicine and surgery, and the limb, if necessary, having been obtained, the it was chiefly the progress of those 15 years patient was anaesthetised, his dirty clothes were cut that the lecturer summarised. The cosmetic sur- away and the chest and arm were freely dabbed gery of the external nose; the discovery of the with tincture of iodine. An assistant stood by ready nasal route to the pituitary body; intranasal dacryo- to control the right subclavian artery. The stick Gystostomy; lateral rhinotomy or Moure’s opera- was sawn across as close as possible to the dorsum tion ; the relationships of the nose and accessory of the hand and drawn out towards the palmar sinuses to the eye and the orbit; the surgery of the aspect. The stick was again sawn at its point of accessory nasal sinuses; the endo-nasal operation exit from the posterior axilla and extracted by on the frontal sinus, to mention only some of the drawing it out forwards. No hæmorrhage followed advances m:1de in this department of practice, the removal of either portion. Apparently the would justify the conclusion expressed that the had traversed the axilla without injuring modern methods of rhino-laryngology were amongst stick A drainage-tube was any important structure. the greatest triumphs of surgery in the twentieth drawn through each tract and the wounds were dressed. The skin of the forearm was painted 1 Entstehung und Entwickelung der Laryngoskopie. Von Prof. Dr. The Emerich von Navratil, Budapest. Berlin: August Hirschwald. 1914. with iodine and a dry dressing applied. Pp. 53. Price M.1.60. with out boric sacs were washed conjunotival 2 Geschichte der Nasenheilkunde von ihren Anfängen bis zum bodies were 18. Jabrhundert. Von Dr. med. Karl Kassel. Würzburg: Verlag von lotion, and many of the foreign Curt Kabitzch. 1914. Pp. 476. Price M. 12. removed from the corneas. In the left eye an
the subject matter and
238 upper and outer iridectomy was performed and many valuable suggestions. The credit, however, the penetrating foreign body was removed. A sub- for the elaborate and successful attempts to cutaneous injection of 10 c.c. of antitetanic serum exterminate G. palpalis is due to the commission was given as a prophylactic, and the dose was appointed in 1912. Principe is covered with a repeated on the following day. Recovery was luxuriant growth of vegetation which extends on all uninterrupted. Good movement was regained in sides of the island down to high water-mark. In the the shoulder and arm, and the movements of the northern and less mountainous half of the island hand were only slightly impaired. Good vision was are many unwholesome pools and swamps. The recovered in the right eye, but the left had to be forests and jungles were populated by large numbers of semi-wild pigs, the descendants of domesticated excised six weeks after the accident. swine escaped from farms and estates throughout These swine frequented the most the island. SLEEPING SICKNESS ON PRINCIPE. swampy and most densely overgrown neighbourTHERE are few more arresting chapters in the hoods, and were there greedily fastened on by glossina which found in such neigh. history of medical progress and achievement swarms of the physical conditions best suited to than those relating to the successful struggles in bourhoods various parts of the world against malaria and persistence and multiplication. The plan of earn. yellow fever. The fight against the terrible scourge paign against the glossina drawn up by the comof sleeping sickness is one of greater difficulty, and mission was a comprehensive one, and full powers and means were given to the commission by the up to the present has not been crowned with so Government to carry it out. The following were a measure of success. claims credit large Portugal essential features : 1. The forests were systeits for conducting one of the first successful campaigns against the glossina-the insect disseminator of matically thinned and the dense undergrowth freely sleeping sickness. The Portuguese triumph has cleared away so as to admit air and sunlight. 3. All wild pigs been won on the island of Principe, one of 2. All swamps were drained. the cocoa-growing islands off the west coast of were massacred, and the keeping of swine in the All stray dogs Africa, about which a good deal was heard a year island was strictly forbidden. 4. killed. of men on their were Gangs wearing or two back in connexion with the system of indentured labour prevailing there. An interesting backs cloths smeared with a sticky compound to the glossina accompanied the account of the procedure in Principe is given in attractive Large numbers of glossina at the final report of the Medical Commission (1912- clearing parties. first fastened on the cloths, but the numbers 1914) appointed by the Portuguese Government as the campaign proceeded, became fewer steadily :to investigate the subject of sleeping sickness in the island and to devise, if possible, means and the last glossina was captured in May, 1914. for the suppression of the disease. The report The effect of the campaign on the prevalence of - constitutes Vol. V. of the Arquivos de Higiene e sleeping sickness is shown in the reduction of the mortality from 251 in 1911 to 166 in 1912 and 133 Patologia Exóticas, published by the Lisbon School in 1913, the percentage mortality from sleeping of Tropical Medicine. It is profusely and beautifully in relation to the general mortality falling sickness the reader to the illustrations illustrated, enabling ,realise the marvellous luxuriance of vegetation on during the same period from 53’17 in 1911 to 43’0 the island and to follow clearly the account given in 1912 and to 38’34 in 1913. The commission has in the report of the works of sanitation devised by devised and carried out a fine piece of work with the commission and carried out under its orders a thoroughness and efficiency which reflects and expert supervision. There are but three known immense credit on the medical men of whom it is foci of glossina outside the African continent, composed, and has given in its report an admirably G. tachinoides infesting partof the coast of Arabia clear account of the whole matter. and G. palpalis having established itself on Principe and the neighbouring island of Fernando Po, both THE METROPOLITAN WATER-SUPPLY. in the Gulf of Guinea. According to the tradition THE report on the condition of the metropolitan prevalent in the island G. palpalis was introduced into Principe near the beginning of last century. water-supply during the month of April was issued The island of Sao Thome, curiously enough, has so last week. It will be recalled that April was a fine far remained uninfested by glossina, though it and dry month, the mean rainfall for all parts of ;presents conditions for the life and development of the Thames basin being 1’17 inches, which is 0’54 of the insect precisely similar to those of Principe; an inch below the average for that month during the -and there is, further, constant communication previous 32 years. Chemical tests showed a general between the two islands, including a busy traffic in improvement in all three raw river supplies (Thames, live cattle. Principe has, as one would expect from Lee, and New River), and the filtered waters also the prevalence there of the "nay," suffered severely showed improved quality. Bacteriologically the from sleeping sickness. The total mortality from the raw waters contained fewer bacteria than their disease from 1902 to 1913 was 2525. This corre- respective averages for the year 1914. The filtered sponds to 2100 deaths per decennium. As the waters also were satisfactory, but a difference, average population of the island during the same which is being investigated, is being shown between period was 3800, we see that these appalling the general filter well and pressure main results at figures mean that in 20 years the island was losing the Lambeth works. We have also received a copy from sleeping sickness a number of individuals con- of the eleventh report on research work by Dr. A. C. siderably greater than her average total population. Houston, the director of water examinations. This The Portuguese Government has been fully alive to deals with the excess lime method of purification, the importance of finding a remedy for so disastrous and the results are interesting and important, for Dr. Houston does not hesitate to express the a state of things, and in 1901 and 1908 commissions the island to opinion that river water, no matter how impure, were appointed and sent out to investigate the whole subject and suggest remedies. may be brought into a condition of absolute These commissions did excellent work and made safety bacteriologically, and of great relative