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A Course of Clinical Lectures ON CHRONIC DISEASES OF BONES AND JOINTS, CHIEFLY IN RELATION TO THE TREATMENT OF DEFORMITIES.
APRIL 13, 1861. ST. BARTHOLOMEW’S HOSPITAL.
affection at first glance. The pelvis is more oblique than natural; the spine bent forwards; the hips wide; the patient rolls from side to side, and waddles in progression. The head of the bone may be readily felt when it exists. Now in
these cases you may draw the head of the bone down to its proper level without much trouble, but you cannot keep it there. I know of no well-authenticated instance in which the ON dislocation has been reduced so as permanently to removethe deformity. I do not say that you should not make the effort, provided you are careful and gentle in vour manipulation; but do not be yourselves disappointed, and guard against the same CHIEFLY IN RELATION TO THE occurrence in your patient by explaining that hitherto all such attempts have been failures. The same remark applies to cases in which the dislocation has proceeded from effusion into the joint and elongation of the BY HOLMES COOTE, F.R.C.S., capsule. The preparation which I hereshow illustrates the ASSISTANT-SURGEON TO ST. RARTHOLOMEW’S AND TO THE ROYAL ORTHOfact. (Ser. III., No. 24.) The capsule is entire, and measures, PÆEIC HOSPITAL. now that it is laid open, between four and five inches in length. (Delivered in the Winter Session, 1861.) The cavity of the acetabulum has almost disappeared, being both reduced in size and filled by fibrous tissue. The liga1 mentum teres is absent, and a portion of the head of the femur has been absorbed. The capsule around the neck of the femur LECTURE IX. -( Concluded from page 334.)) presents a fringe of slender growths. This specimen is figured ON THE TREATMENT OF CONTRACTIONS AT THE HIP-JOINT. in the " Medico-Chirurgical Transactions," vol. xxiv., plate iv., FAULTY positions of the hip may proceed from dislocations. fig. 1, in illustration of a paper by Mr. Stanley, on ’’ DislocaI do not here speak of those which are the result of accident, tions accompanied by Elongation of Ligaments."" In this preand come at once under the surgeon’s care; but of congenital paration, (Ser. II., No. 54,) the ligamentum teres is entire, but and separated into three cords. dislocations, and of those which are produced insidiously, while elongated, Erichsen observes, " that it is a question whether an Mr. the patient is confined to bed, or by some acute disease, such as attempt at reduction should be made in these cases of consecufever or rheumatism. tive dislocation, as it is very rarely that it would prove permanently successful, the acetabulum being either filled up with fibrous matter, or the head of the bone being so diseased and lessened in size that it would not remain in its cavity when put back. Occasionally, however, he adds, the reduction may be successfully effected. In a woman under his care at the hospital, with spontaneous dislocation of the hip of a month’s duration, reduction was effected by means of the pulleys, and the head of the bone replaced in the cotyloid cavity, where it remained for some weeks, becoming, however, displaced again in consequence of its being necessary to remove a bandage."* We have had several such cases at different times at St. Bartholomew’s Hospital, all yielding the same result. In June, 1847, a healthy boy, aged five years, was admitted under the care of Mr. Lawrence. The right leg was shorter than the opposite by three-quarters of an inch, and was inverted, the toes touching the opposite tarsus, and the hip more prominent than natural ; the great trochanter and the head of the femur could be readily felt, and there was considerable mobility, the surrounding parts being soft and healthy. It was said to have proceeded from a fall. On June 27th an attempt was made to reduce the limb. The head of the bone was readily brought down to the acetabulum, but it would not remain there, and after a few weeks the child was sent home in the same state. Are there any cases in which, after disease, the joint becomes contracted in consequence of thickening of parts external to the synovial cavity, the interior of the articulation being healthy? This is an important question, because those who answer it in the affirmative found thereon the practice of making repeated and forcible movements of the limb, the patient being rendered insensible by chloroform. It is averred that such forcible move. ments restore motion to the limb. Mr. Brodhurst asserts that Congenital dislocations, as far as I have been able to ascer. such a condition of the morbid parts is common after gonoreven in children not who have yet rhceal rheumatism affecting a joint, and that his success by tain, are always combined, learnt to walk, with some malformation. The head and neck such treatment has been considerable. I have not yet met of the femur are not developed, the former being absent or with cases of a character to warrant such a proceeding, those flatter and smaller than natural; the acetabulum also, in some cases of external rigidity which I have been called upon to to friction and gentle movements, aided by the treat cases, is shallow and partly filled by fatty matters. But the use of yielding heated air. But you must see and judge for yourselves. ligamentum teres is rarely absent, though elongated and un- I would only urge caution in manipulations, because violence, folded. The particulars of such cases have been recorded by even in the most skilful hands, may set up inflammatory disPalletta, * Parise,t Cruveilhier,t Vrolik, and Gurlt;1I and all turbance, which will be difficult to control. In justice, howauthors combine in saying that the want of relation between ever, to Mr. Brodhurst, I must say that the result of his expethe parts increases considerably after the patient has attained rience is widely different. He has applied his principles of treatment to twenty-seven cases of contractions at the hip, and an age when he makes efforts to stand upright and to use the " of all these cases, including others involving other limb in walking. I have seen many such cases, presenting joints, inflammation was in one many set up as the result of only dislocations of one or of both hips. The peculiarity of the gait treatment, and in this instance it was of a very mild character, is such that you may almost pronounce upon the nature of the and easily subdued. "t I cannot conclude, gentlemen, without expressing my most * Exercitationes Patholog. (s. s. 171), p. 90. earnest hope that you may never be tempted, either for the t In Archiv. G6n. de Méd., 3e ser., t.14. 1842. sake of arresting disease or removing deformity, to ’’ cut out t Anat. Patholog., avec planohes, liv. 2, pl. 2. * Science and Art of § Tabu]ae ad Illustrand. Embryog. (s. s. 106), tab. 84, 1. Surgery, p. 637."" 11 Beitrage zur Pathol. Anat. d. Gelenkk., s. 457. t On Anchylosis, p. 114. No. 1963.
A Course of Clinical Lectures
CHRONIC DISEASES OF BONES AND JOINTS, TREATMENT OF DEFORMITIES.
-
-
358 the head of the femur" in young subjects. You may doubtless succeed in removing the portion of bone, and it by no means follows that your patient will die; but I firmly believe, first, that the ends which you desire may be attained by rest and other simple measures; and, secondly, that even by this dangerous operation you do not improve the patient’s condition. I am not speaking of cases of necrosis of the bone of the hip, where the dead bone keeps up irritation, nor of those rare cases in which the head of the femur has quittel the acetabulum, and produced inflammation and ulceration of the thinned integuments covering it. Operations performed on such cases are no surgical novelties; but I speak of the excision and removal of the diseased head of the femur from the cavity of the acetabulum. Imagine such a proceeding in an infant of nine or ten years ! The words of a modern author so exactly harmonize with my own ideas, as well as with the timehonoured practice of this hospital, that I will here quote
following observations, beginning with a brief statement of recently-recorded events. Her Majesty’s steam-ship Highflye2· arrived from England at
the
some
Port Royal on the 20th of October, 1852. She left on the 2Sth for Havanna, where she remained for two or three weeks, and then proceeded to St. Thomas’s, which she reached on the 30th of November, and where yellow fever was then raging. After fifty-five hours’ stay for the purpose of coaling, she left for Trinidad, where she remained from the 6th to the 17th December, when she returned to Port Royal, which she reached on the 23rd. From the arrival of the ship in the West Indies to her departure from St. Thomas’s on the 2nd of December, no case of fever of any kind had been entered on her sick-list. On the 4th, or two days afterwards, a stoker was attacked with fever;
and on the 6th, six of the crew were seized, one of whom died with black vomit. From that time to her arrival at Port i Royal the disease continued, until the number attacked, them :’’ Experience teaches us, that by absolute rest of the diseased amongst men and officers, was forty-three. The sick were joint, with tonics and sedatives, it is wonderful what nature immediately landed, and sent to the Naval Hospital, upon the will do in very severe cases, and it requires only perseverance advice of Deputy-Inspector Mr. Watson, the principal medical to obtain a satisfactory termination. The cases which fail are officer of the hospital, who had long resided there, and had had very few, if fairly treated. Much time and patience may be great experience of yellow fever. Eight fresh cases of the disconsumed by both surgeon and patient, but neither must be ease occurred on board between the 23rd and the 27th; these too closely calculated to obtain success."** were also sent to the hospital. After the 29th the disease enI once removed the diseased head of the femur in a boy, and tirely ceased, and the ship again became quite healthy. In all, I am happy to add that he recovered-not that, to use the fifty-one persons-viz., thirty-eight men and boys, and thircommon parlance of the day, "he made an excellent recovery;" teen officers-had been attacked, and seven had died. The I mean merely that he did not die, the limb being, when the death-rate amongst the latter was much higher than amongst wound was closed, in as useless a state as before the operation. the former. Several of the officers had joined the Higliflyer But at that time I had no experience in orthopedic appliances, from the admiral’s ship, the Cumberland, at Trinidad after the nor did I attach sufficient value to the imposition of perfect disease had begun on board. The total mortality, as well as rest. You will not see me operate in a similar way again, for the numbers attacked, were much smaller than they have I am convinced that by the steady use of. the apparatus here usually been in similar vessels in which yellow fever, in an epi. before you I could have extended the limb, and have enabled demic form, has broken out in the West India station. It will the boy to use it freely, without any operation at all. be observed that the season was far advanced at the time. In the case of the adult the question is rarely raised, and it In his official report to the Admiralty, Mr. Watson states : assumes an importance only to be discussed in treating of par"recommended that there should be no impediment to the ticular cases. So, likewise, in its application to gun-shot Hig7yer’s men communicating with the shore, but intimated injuries, the consideration of which would lead me beyond the that it would be dangerous for strangers to be exposed to the limits of my present subject. atmosphere of the ship, as long as the disease continued in her. .-Notwithstanding this freedom of communication with the sick (the yellow fever cases were not segregated from the other in the spacious airy naval hospital) from the HYg’7://e)’ OUTBREAKS OF YELLOW FEVER IN SHIPS patients and of her officers and stewards with the townspeople, not a single case occurred of the extension of the disease in the OF WAR. hospital or town of Port Royal." Mr. Watson adds: "I feel BY GAVIN MILROY, M.D., F.R.C.P. Lond. perfectly satisfied that any contagious powers the disease may possess in crowded ships is speedily rendered inoperative by THE important paper, read by Dr. Bryson at a late meeting moderately good ventilation, and that the best mode of checkof the Epidemiological Society, respecting the disastrous preva- ing the progress of such diseases is to remove the sick to roomy epidemic lence of this fever on board H.M.S. Icarus, and the extension quarters on shore as speedily as possible. If the no doubt should continue unchecked in the ship, there can be of the disease to other vessels of our West India squadron, has that, if possible, she should immediately sail out of the tropics."’ so forcibly excited the attention of the profession, that it is Her Majesty’s ship Dauntless appears to have caught the earnestly to be hoped the subject will not be allowed to drop fever at St. Thomas’s about the same time as the Highflyer, as< until it has been thoroughly examined in its manifold bearings. she arrived from that island at Bridgetown, Barbadoes, on the having already There are many and various questions of deep moment to the 16th of November, in a very sickly state, and lost many of her crew during the voyage. " Immediately on welfare of our shipping, both of the royal navy and of the mer- her arrival," says Governor Sir W. Colebrooke, in a dispatch of cantile marine, involved in its consideration. We have only to the 6th of January, 1853, to the Secretary of State for the bear in mind that, every now and then, ships of war are being Colonies, "Captain Halsted called on me to represent the state of his ship, and applied for permission to land the sick; more than doubly decimated of their entire crew-and this, too, in the course of a few weeks-to recognise its more than ordi- and as the Commander of the Forces granted his sanction for their reception in the General Hospital at St. Anne’s, on the nary importance, and its pressing claims to a careful and comof the health officer, this measure was carried into effect. report prehensive study. What would be said in the present day if As the remainder of the crew were subsequently landed in it became known that a regiment had lost by disease a quarter divisions, and encamped, arrangements were made for clearing of its men within a month or two, and that more than another out and fumigating the ship, as far as it could be done in CarAs it was impossible, however, to provide for the quarter were on the sick list ? The Minister of War would be lisle Bay.of all the men at one time, those retained on board assailed night after night in the House with loud demands for landing have continued to be exposed to the infection, and new cases inquiry, and there would be no end to vehement appeals in have, in consequence, been of almost daily occurrence." every organ of the press until this was granted, and the whole Forty-one cases of the fever, and eleven deaths, had occurred affair searched to the bottom. It is best to anticipate; and, since leaving St. Thomas’s to her arrival at Barbadoes, and of the cases then on board were expected to prove fatal. therefore, in order to avoid such hasty and often angry animad- some " The sanitary measure I advise," says Dr. Brown, the healthwhich the from seldom it versions, profession escape scot-free, officer, "is an immediate removal of the sick to the shore, will be wise to take up the subject beforehand, and examine it taking proper precautions for an efficient segregation of them." Between the 17th of November and the 5th of January, calmly and impartially, so that we may be able to urge our opinions on those in power, and on the public generally, with twenty-two officers and 135 seamen and marines were admitted confidence and authority. With this view I have put together into the Military Hospital, and no fewer than sixty-five deaths occurred, thirteen amongst the former, and fifty-two amongst the latter. * Bryant on Diseases and Injuries of Joints, p. 145.
II
affection at first glance. The pelvis is more oblique than natural; the spine bent forwards; the hips wide; the patient rolls from side to side, and waddles in progression. The head of the bone may be readily felt when it exists. Now in
these cases you may draw the head of the bone down to its proper level without much trouble, but you cannot keep it there. I know of no well-authenticated instance in which the ON dislocation has been reduced so as permanently to removethe deformity. I do not say that you should not make the effort, provided you are careful and gentle in vour manipulation; but do not be yourselves disappointed, and guard against the same CHIEFLY IN RELATION TO THE occurrence in your patient by explaining that hitherto all such attempts have been failures. The same remark applies to cases in which the dislocation has proceeded from effusion into the joint and elongation of the BY HOLMES COOTE, F.R.C.S., capsule. The preparation which I hereshow illustrates the ASSISTANT-SURGEON TO ST. RARTHOLOMEW’S AND TO THE ROYAL ORTHOfact. (Ser. III., No. 24.) The capsule is entire, and measures, PÆEIC HOSPITAL. now that it is laid open, between four and five inches in length. (Delivered in the Winter Session, 1861.) The cavity of the acetabulum has almost disappeared, being both reduced in size and filled by fibrous tissue. The liga1 mentum teres is absent, and a portion of the head of the femur has been absorbed. The capsule around the neck of the femur LECTURE IX. -( Concluded from page 334.)) presents a fringe of slender growths. This specimen is figured ON THE TREATMENT OF CONTRACTIONS AT THE HIP-JOINT. in the " Medico-Chirurgical Transactions," vol. xxiv., plate iv., FAULTY positions of the hip may proceed from dislocations. fig. 1, in illustration of a paper by Mr. Stanley, on ’’ DislocaI do not here speak of those which are the result of accident, tions accompanied by Elongation of Ligaments."" In this preand come at once under the surgeon’s care; but of congenital paration, (Ser. II., No. 54,) the ligamentum teres is entire, but and separated into three cords. dislocations, and of those which are produced insidiously, while elongated, Erichsen observes, " that it is a question whether an Mr. the patient is confined to bed, or by some acute disease, such as attempt at reduction should be made in these cases of consecufever or rheumatism. tive dislocation, as it is very rarely that it would prove permanently successful, the acetabulum being either filled up with fibrous matter, or the head of the bone being so diseased and lessened in size that it would not remain in its cavity when put back. Occasionally, however, he adds, the reduction may be successfully effected. In a woman under his care at the hospital, with spontaneous dislocation of the hip of a month’s duration, reduction was effected by means of the pulleys, and the head of the bone replaced in the cotyloid cavity, where it remained for some weeks, becoming, however, displaced again in consequence of its being necessary to remove a bandage."* We have had several such cases at different times at St. Bartholomew’s Hospital, all yielding the same result. In June, 1847, a healthy boy, aged five years, was admitted under the care of Mr. Lawrence. The right leg was shorter than the opposite by three-quarters of an inch, and was inverted, the toes touching the opposite tarsus, and the hip more prominent than natural ; the great trochanter and the head of the femur could be readily felt, and there was considerable mobility, the surrounding parts being soft and healthy. It was said to have proceeded from a fall. On June 27th an attempt was made to reduce the limb. The head of the bone was readily brought down to the acetabulum, but it would not remain there, and after a few weeks the child was sent home in the same state. Are there any cases in which, after disease, the joint becomes contracted in consequence of thickening of parts external to the synovial cavity, the interior of the articulation being healthy? This is an important question, because those who answer it in the affirmative found thereon the practice of making repeated and forcible movements of the limb, the patient being rendered insensible by chloroform. It is averred that such forcible move. ments restore motion to the limb. Mr. Brodhurst asserts that Congenital dislocations, as far as I have been able to ascer. such a condition of the morbid parts is common after gonoreven in children not who have yet rhceal rheumatism affecting a joint, and that his success by tain, are always combined, learnt to walk, with some malformation. The head and neck such treatment has been considerable. I have not yet met of the femur are not developed, the former being absent or with cases of a character to warrant such a proceeding, those flatter and smaller than natural; the acetabulum also, in some cases of external rigidity which I have been called upon to to friction and gentle movements, aided by the treat cases, is shallow and partly filled by fatty matters. But the use of yielding heated air. But you must see and judge for yourselves. ligamentum teres is rarely absent, though elongated and un- I would only urge caution in manipulations, because violence, folded. The particulars of such cases have been recorded by even in the most skilful hands, may set up inflammatory disPalletta, * Parise,t Cruveilhier,t Vrolik, and Gurlt;1I and all turbance, which will be difficult to control. In justice, howauthors combine in saying that the want of relation between ever, to Mr. Brodhurst, I must say that the result of his expethe parts increases considerably after the patient has attained rience is widely different. He has applied his principles of treatment to twenty-seven cases of contractions at the hip, and an age when he makes efforts to stand upright and to use the " of all these cases, including others involving other limb in walking. I have seen many such cases, presenting joints, inflammation was in one many set up as the result of only dislocations of one or of both hips. The peculiarity of the gait treatment, and in this instance it was of a very mild character, is such that you may almost pronounce upon the nature of the and easily subdued. "t I cannot conclude, gentlemen, without expressing my most * Exercitationes Patholog. (s. s. 171), p. 90. earnest hope that you may never be tempted, either for the t In Archiv. G6n. de Méd., 3e ser., t.14. 1842. sake of arresting disease or removing deformity, to ’’ cut out t Anat. Patholog., avec planohes, liv. 2, pl. 2. * Science and Art of § Tabu]ae ad Illustrand. Embryog. (s. s. 106), tab. 84, 1. Surgery, p. 637."" 11 Beitrage zur Pathol. Anat. d. Gelenkk., s. 457. t On Anchylosis, p. 114. No. 1963.
A Course of Clinical Lectures
CHRONIC DISEASES OF BONES AND JOINTS, TREATMENT OF DEFORMITIES.
-
-
358 the head of the femur" in young subjects. You may doubtless succeed in removing the portion of bone, and it by no means follows that your patient will die; but I firmly believe, first, that the ends which you desire may be attained by rest and other simple measures; and, secondly, that even by this dangerous operation you do not improve the patient’s condition. I am not speaking of cases of necrosis of the bone of the hip, where the dead bone keeps up irritation, nor of those rare cases in which the head of the femur has quittel the acetabulum, and produced inflammation and ulceration of the thinned integuments covering it. Operations performed on such cases are no surgical novelties; but I speak of the excision and removal of the diseased head of the femur from the cavity of the acetabulum. Imagine such a proceeding in an infant of nine or ten years ! The words of a modern author so exactly harmonize with my own ideas, as well as with the timehonoured practice of this hospital, that I will here quote
following observations, beginning with a brief statement of recently-recorded events. Her Majesty’s steam-ship Highflye2· arrived from England at
the
some
Port Royal on the 20th of October, 1852. She left on the 2Sth for Havanna, where she remained for two or three weeks, and then proceeded to St. Thomas’s, which she reached on the 30th of November, and where yellow fever was then raging. After fifty-five hours’ stay for the purpose of coaling, she left for Trinidad, where she remained from the 6th to the 17th December, when she returned to Port Royal, which she reached on the 23rd. From the arrival of the ship in the West Indies to her departure from St. Thomas’s on the 2nd of December, no case of fever of any kind had been entered on her sick-list. On the 4th, or two days afterwards, a stoker was attacked with fever;
and on the 6th, six of the crew were seized, one of whom died with black vomit. From that time to her arrival at Port i Royal the disease continued, until the number attacked, them :’’ Experience teaches us, that by absolute rest of the diseased amongst men and officers, was forty-three. The sick were joint, with tonics and sedatives, it is wonderful what nature immediately landed, and sent to the Naval Hospital, upon the will do in very severe cases, and it requires only perseverance advice of Deputy-Inspector Mr. Watson, the principal medical to obtain a satisfactory termination. The cases which fail are officer of the hospital, who had long resided there, and had had very few, if fairly treated. Much time and patience may be great experience of yellow fever. Eight fresh cases of the disconsumed by both surgeon and patient, but neither must be ease occurred on board between the 23rd and the 27th; these too closely calculated to obtain success."** were also sent to the hospital. After the 29th the disease enI once removed the diseased head of the femur in a boy, and tirely ceased, and the ship again became quite healthy. In all, I am happy to add that he recovered-not that, to use the fifty-one persons-viz., thirty-eight men and boys, and thircommon parlance of the day, "he made an excellent recovery;" teen officers-had been attacked, and seven had died. The I mean merely that he did not die, the limb being, when the death-rate amongst the latter was much higher than amongst wound was closed, in as useless a state as before the operation. the former. Several of the officers had joined the Higliflyer But at that time I had no experience in orthopedic appliances, from the admiral’s ship, the Cumberland, at Trinidad after the nor did I attach sufficient value to the imposition of perfect disease had begun on board. The total mortality, as well as rest. You will not see me operate in a similar way again, for the numbers attacked, were much smaller than they have I am convinced that by the steady use of. the apparatus here usually been in similar vessels in which yellow fever, in an epi. before you I could have extended the limb, and have enabled demic form, has broken out in the West India station. It will the boy to use it freely, without any operation at all. be observed that the season was far advanced at the time. In the case of the adult the question is rarely raised, and it In his official report to the Admiralty, Mr. Watson states : assumes an importance only to be discussed in treating of par"recommended that there should be no impediment to the ticular cases. So, likewise, in its application to gun-shot Hig7yer’s men communicating with the shore, but intimated injuries, the consideration of which would lead me beyond the that it would be dangerous for strangers to be exposed to the limits of my present subject. atmosphere of the ship, as long as the disease continued in her. .-Notwithstanding this freedom of communication with the sick (the yellow fever cases were not segregated from the other in the spacious airy naval hospital) from the HYg’7://e)’ OUTBREAKS OF YELLOW FEVER IN SHIPS patients and of her officers and stewards with the townspeople, not a single case occurred of the extension of the disease in the OF WAR. hospital or town of Port Royal." Mr. Watson adds: "I feel BY GAVIN MILROY, M.D., F.R.C.P. Lond. perfectly satisfied that any contagious powers the disease may possess in crowded ships is speedily rendered inoperative by THE important paper, read by Dr. Bryson at a late meeting moderately good ventilation, and that the best mode of checkof the Epidemiological Society, respecting the disastrous preva- ing the progress of such diseases is to remove the sick to roomy epidemic lence of this fever on board H.M.S. Icarus, and the extension quarters on shore as speedily as possible. If the no doubt should continue unchecked in the ship, there can be of the disease to other vessels of our West India squadron, has that, if possible, she should immediately sail out of the tropics."’ so forcibly excited the attention of the profession, that it is Her Majesty’s ship Dauntless appears to have caught the earnestly to be hoped the subject will not be allowed to drop fever at St. Thomas’s about the same time as the Highflyer, as< until it has been thoroughly examined in its manifold bearings. she arrived from that island at Bridgetown, Barbadoes, on the having already There are many and various questions of deep moment to the 16th of November, in a very sickly state, and lost many of her crew during the voyage. " Immediately on welfare of our shipping, both of the royal navy and of the mer- her arrival," says Governor Sir W. Colebrooke, in a dispatch of cantile marine, involved in its consideration. We have only to the 6th of January, 1853, to the Secretary of State for the bear in mind that, every now and then, ships of war are being Colonies, "Captain Halsted called on me to represent the state of his ship, and applied for permission to land the sick; more than doubly decimated of their entire crew-and this, too, in the course of a few weeks-to recognise its more than ordi- and as the Commander of the Forces granted his sanction for their reception in the General Hospital at St. Anne’s, on the nary importance, and its pressing claims to a careful and comof the health officer, this measure was carried into effect. report prehensive study. What would be said in the present day if As the remainder of the crew were subsequently landed in it became known that a regiment had lost by disease a quarter divisions, and encamped, arrangements were made for clearing of its men within a month or two, and that more than another out and fumigating the ship, as far as it could be done in CarAs it was impossible, however, to provide for the quarter were on the sick list ? The Minister of War would be lisle Bay.of all the men at one time, those retained on board assailed night after night in the House with loud demands for landing have continued to be exposed to the infection, and new cases inquiry, and there would be no end to vehement appeals in have, in consequence, been of almost daily occurrence." every organ of the press until this was granted, and the whole Forty-one cases of the fever, and eleven deaths, had occurred affair searched to the bottom. It is best to anticipate; and, since leaving St. Thomas’s to her arrival at Barbadoes, and of the cases then on board were expected to prove fatal. therefore, in order to avoid such hasty and often angry animad- some " The sanitary measure I advise," says Dr. Brown, the healthwhich the from seldom it versions, profession escape scot-free, officer, "is an immediate removal of the sick to the shore, will be wise to take up the subject beforehand, and examine it taking proper precautions for an efficient segregation of them." Between the 17th of November and the 5th of January, calmly and impartially, so that we may be able to urge our opinions on those in power, and on the public generally, with twenty-two officers and 135 seamen and marines were admitted confidence and authority. With this view I have put together into the Military Hospital, and no fewer than sixty-five deaths occurred, thirteen amongst the former, and fifty-two amongst the latter. * Bryant on Diseases and Injuries of Joints, p. 145.
II