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Analyses OF COMMUNICATIONS IN MS. RECEIVED FOR PUBLICATION IN THE LANCET.
402
who
similar. advances in their attainments. We believe that two a pretensions of any may be unprincipled and courageous certain extent this is really the case, though we are firmly enough to prey upon public credulity. This is a state of things which few will attempt to defend, convinced, that under a wiser system of professional legislation these advances would have been very much more exten- and which, if the medical profession be a fit subject of legisla. sive. It is certain, however, that, taking the profession gene- tion at all, ought surely to be altogether superseded by a more rally, its members constitute a more intelligent and scientific harmonious arrangement, by collecting together the genuine body than. formerly. There alwayshave been, and always but disjoined parts, and rooting out the anomalous excres. will be, men who stand pre-eminent for natural talent, zeal cences, which tend alike to disfigure the order and beauty of in the pursuit of knowledge, and success. in its acquisition- the whole, and to curtail the extent of its usefulness. men who stride over the entire field of professional science, (To be continued.) and are continually enlarging its boundary. Such men cannot be taken for a general standard-the many of the present age must be compared with the many of former ages, and it. cannot be denied, we believe, that they will gain. by the comOF parison. Not only have anatomy and operative surgery been. a cultivated with success considerable very generally by COMMUNICATIONS IN MS. RECEIVED FOR majority of practitioners, but their knowledge of the general PUBLICATION IN THE LANCET. principles of treating disease has become more accurate, and their practice proportionally successful. Their prescriptions, 11 L’auteur se tue a allonger ce que le lecteur se tue à aby6ger.1’ for the most part, evince correct discrimination of the symp-
Analyses
disease, a clear perception of the true indications to be held in view in treatment, and an efficient application of Air-Baths for. the Treatment of Cholera. remedies. We do not mean to affirm that in all these AMONGST other communications the following have reached respects are any members of the profession perfect, much less the general mass of practitioners, but simply that a de- us relative to the construction of these appliances:cided advance in the degree of knowledge and practical skill "A circular tin-case or-box, about six-inches in diameter, is generally observable. The same remarks apply to the con- and the same in depth, forms a receptacle for a spirit lamp. dition of surgery throughout the country. It is well known, It is perforated around the bottom with small openings for the that some years ago few surgeons in the country, except admission of air, and furnished at the side with a small door those attached to county hospitals, considered themselves for the insertion of the lamp. At the top it is dome-shaped qualified to undertake the performance of operations, espe- or conical, and terminates in a funnel or chimney about three cially the greater ones, in surgery; whereas, in every town, if inches in diameter, which, at the height of about two feet, not in almost every village, may now be found snrgeohs of gives off, at an obtuse angle, an arm, the extremity of-which, sufficient knowledge and enterprise to perform, successfully, is passed under the bed-clothes at the foot of-the bed. A the most important; and though example and emulation may cradle is placed over the patient to support the bed-clothes, sometimes have excited a few to overrate their own attain- and allow a space for the collection of the heated air, which . ments and operative skill, we cannot but conclude that this is thus brought in contact with every part of the body, and the bed-clothes are tucked closely in at the sides, and under : confidence in themselves is generally dependent on a substantial advancement in knowledge. the chin, to prevent its escape. To set the apparatus in action, Whatever imperfections may be hereafter pointed out in nothing more is necessary than to place it, and light- the 1-imp. the existing institutions, it would be unfair not to admit that Spirits of wine may be burnt, either with a very large cotton they (at any rate, the College of Surgeons, and Society of or an Argand burner. The tin case may be riveted to an iron have been eminently useful in promoting this- plate, to give it increased steadiness, and the funnel, instead of Apothecaries) increased degree of acquirement in the great mass of the pro- being in one piece, may be made of two, one sliding into the fession. But in awarding to them their due praise, let us not other, so as to adapt it to the height of the bed. attribute to them too much. It cannot be doubted, that the In diseases attended with internal congestion, it quickly progress of general intelligence in the community at large has produces a powerful reaction toward the surface. I have often necessarily carried along with it those engaged in medical as used it, and with great success. The advantages of this appawell as other pursuits, and that the public would not be con- ratus are,-that its action is immediate; it can be used with.tent to concede their confidence to persons who stood still in out moving the patient at all, and consequently exposes him their particular vocation, while all the rest of the world were z, to no fatigue; it is also very compact and convenient. I do advancing. Nor must we forget the powerful and permanent not know any exclusive maker of it; but there can be no diffiimpulse given to surgical science during the late protracted culty in manufacturing a thing so simple, and the expense is war, which called forth the energies of so many men of emi- but trifling.-I am, Sir, your obedient servant, nent talents, (some of whom still flourish in many of the "ED. HART VInEIV, M.R.C.S. countries of Europe,) and afforded a field for practical sur" Chepstow Villa, Notting.hill, 1848." gery unknown in the previous history of the profession. ANOTHER correspondent statesFrom these and other causes, the state of medical science, both " in the number and the extent of its constituent departments, I did not know where such an article could be procured, and in the degree of its general diffusion, must be considered and having occasion for its use, I lately designed one which I as exhibiting a gratifying subject of contemplation; but the find answers very well, and can be made very readily, and at satisfaction thus excited must be greatly lessened by the im- very little expense. I obtained a planed deal board, two feet perfect state of its organization, in consequence of the impo- long, one foot wide, one inch thick; this I had cut into a semilitic and inefficient constitution of the legalized institutions circle, and perforated in the centre by a hole, one inch in which are placed at its head. diameter, to receive a curved tin tube, two feet long; this The effect of these institutions has been, to render the pro- formed the base or end; to the curve of this board I had fession a heterogeneous mass of practitioners of various grades stout wicker rods, three feet six inches long, at intervals of and qualifications, without order, without definite privileges, two inches, made secure by being inserted into the wood, and and with pretensions and interests continually placed in oppo- worked across, at one foot distance, with wicker or basket sition to each other. They hold out to their members and work, and at their ends to form a semicircle the same size:as licentiates the hope of protection from unqualified competitors, the board. The tin tube is circular, curved in the shape of a which is in the highest degree fallacious; and while we should horn; the small end one inch in diameter, and made to fit airseem to possess a greater number of bulwarks against tight in the hole of the board; the large end three inches in A small spirit lamp completes the apparatus. quackery and imposture than any other country in the world, diameter. " there is none where they are so openly and successfully pracEvery surgeon I presume to be familiar with the way in tised. For besides the several classes of physicians sanctioned which it is applied. I would add, that I find it more efficient by the Royal College, the graduates of the English and if temporarily covered with any kind of Macintosh’d material. Scottish universities, the members of the College of Surgeons, —Iam, Sir, yours &c., FRANCIS WARD, M.R.C.S.E. &c. and the licentiates of the Society of Apothecaries, there are " Balham-hill, Surrey, September, 1848." innumerable prescribing chemists, notorious empirics, boneA THIRD correspondent recommends an arrangement very etters, and vendors of all descriptions of nostrums and specifics. Our newspapers abound with advertisements of cures similar to the foregoing. " effected by patent medicines, the sale of which is expressly It consists of a slight frame, similar to a fracture cradle, authorized by permission of government, and there seems to about six feet in length, two feet and a half broad, and one be neither obstacle nor limit to the fraudulent and perniciousIfoot high. This frame, for the convenience of carriage, is toms of
403 divided into two parts, which slide into each other in telescope fashion. The foot of the frame is solid, with an aperture in the centre, to admit the nozzle of a tin case, which holds a small tin spirit-lamp, with two wicks. "The mode of applying it is to place the frame directly over the body-linen of the patient; several blankets are then put over the frame, and well tucked in, covering every part of the body except the head. The lamp is then adjusted, and the hot air rushes into the cavity. In ten or fifteen minutes reaction is usually established, The lamp is then removed, and the frame withdrawn, leaving the patient enveloped in the blankets in a profuse sweat. The vomiting and cramps generally subside at the same time. During the whole process the patient should drink plentifully of hot mint tea. " I beg to say I have not the merit of inventing this bath. The first was sent me by a lady from Brighton. I then set my own carpenter and whitesmith to work, and had several made, at a cost, I think, of about sixteen shillings; and I kept one at every village to which I was likely to be called. I dare.say the same tradesmen would be glad to make the bath for any gentleman desirous of having one.-I am, Sir, CHARLES MATTHEW THOMPSON. your obedient servant, 11 Westerham, Sept. 25th, 184s,"
rheumatic gout.
MR. H.
letter from a medical correspondent, we learn that Mr. Coxeter, the surgical instrument maker, " has constructed a very simple, portable, inexpensive apparatus for administering a
hot-air bath. The spirit lamp, the funnel-shaped orifice, and an extensible metallic tube, are all contained in a space five inches by six inches." a
of I
a
Another apparatus suggested is, "a spirit lamp encased in a double cylinder of wire gauze, and enclosed in a light wooden framework. I had it (says our correspondent) almost in daily
during a period
of five years that I
was
’
THE communication of Mr. BATEMAN, a manufacturer, in Harleyford-road, Kennington-oval, is an advertisement.-In
very small cost. "1. It consists of an iron cup for spirits of wine, two inches and a half wide. "2. A furnace made of sheet-iron, with chimney. "3. Rings to support the chimney in the centre of guard, which must be fastened by rivets to the guard. " 4. Guard for chimney, to keep the bedclothes from being burnt, two feet long by eighteen inches in diameter. " This apparatus is to be placed on a stool at the foot of the bed,and the guard introduced under the bedclothes, which are to be propped up by pieces of stick, so as to admit the hot air equally over the whole surface of the patient."
use
communication which I had from Dr.
" Harley,street, Cavendish-sq., Sept. 1848. P.S.--I may add that the cost is about 24s"
HULME, of Liverpool, sends us a drawing of an appaat
a
"
Dr. WOOD, of Peckham, remarks" I have been in the habit of recommending a cheap and easy mode of applying the vapour bath, for many years, by placing a hot brick in a tub of water, the patient being enveloped in a flannel gown or blankets round it, of course the head external. I have found this convenient, expeditious, and of great comfort to both rich and poor. At the same time I beg to observe, that I think medical men lose sight, in many cases of debilitated patients, of the great advantage of the vapour bath over the hot bath, the latter sometimes losing its beneficial effects by the patient being exposed to its influence too long. "If not trespassing too much on your valuable pages, may I call attention to a letter signed a ’Quondam Parish Doctor.’ I am sure some such plan as there stated, from what I hear in my daily perambulations, would meet with satisfaction both as regards the pauper and medical attendant, looking to No. 2 as well as No. 1.—Your obedient servant, "Peckham, 1848." T. C. WOOD, M.D., M.R.C.S.E., & L.S.A.
ratus, which, he says, " can be made by any tinman,
In
Golding Bird on the subject some time ago, that intelligent physician informed me that he remembered to have seen something similar exhibited many years back at the Medical Society of London. In the hope that this communication may have the effect of rescuing from comparative oblivion a really useful invention, I remain, your obedient servant, R. CHAIlIBERS M.D.
physician to the
Essex and Colchester Hospital, and I feel myself justified in
stating, that for efficiency, portability, and facility of application, it has no equal. Indeed, I deem it to be an indispensable appendage to the armamentarium of every hospital and surgery. " About one ounce and a half of rectified spirit will keep it in action for an hour. When desirable, the vapour of camphor may be conjoined with it, by placing about two drachms of camphor upon the top of the gauze cylinder, the heat of which volatilizes it. "For application it only requires to be trimmed as an ordinary spirit lamp, and when ignited, to be placed between the
patient’s lower extremities, an extra blanket being placed upon the ordinary bed-clothes. From fifteen to thirty minutes will
A New Truss for Oblique
Inguinal Hernia. first at Fort Pitt,Chatham, class, MR.DARTNELL,sta’9’-surgeon has forwarded to us a truss, accompanied by a letter containing" the following remarks:It has long been a desideratum to obtain for the soldier a simpler and more efficient truss than the one commonly in use, which, from its weight and clumsy form, the large size of the rupture pad, the perinaeal strap, and the great pressure produced by the instrument on the pubis and spermatic veshas been found both irksome and inefficient. sels, " With this view it was (and being myself a sufferer) that I turned my attention to the subject; and the truss I now submit for your inspection has met with the highest approval of the director-general, and several other military medical officers, as you will see by the accompanying testimonials. It is now the only truss issued to the army abroad as well as at home, and will be found, I am convinced, equally well suited to the civilian as to the soldier. By a slight modification of the anterior curve of the spring, and the shape of the pad, this truss can be rendered available for crural as well as hernia. inguinal " I shall not further encroach on your time, but beg to G. R. DARTNELL, remain, Sir, your obedient servant, Staff-surgeon, First Class." Testimonials in favour of this invention from Dr. Ely, of Rochester, Mr. Alexander Smith, Cavalry Depot, Maidstone, and various military medical officers, have been submitted to us, with one of the patent trusses. The following is a description of the instrument, which is called the " solid pad truss," and may be seen at the estatablishments of Messrs. Philp and Whicker, Weiss and Co., Evans and Co., Palmer, (Rochester,) &c. " It consists of a short and pliant steel spring, which is terminated at either end by a pad. The anterior or rupture pad is of small size, formed of hard wood, polished, and of arounded oval and somewhat conical shape. The back pad is flat, formed of strong leather, padded on the inner face, and furnished with two bridles on the outer one for connexion with the spring. The spring itself is cased with leather, and has a downward curve at its anterior extremity, which brings the wooden pad attached to it directly on the inguinal canal and internal ring. The instrument, when applied, is retained in its place by a light strap, continuous with the sheath of the spring, which, being passed round the opposite hip, loops on a button screw on the front pad. "The polished wooden pad requires no renewal, does not absorb the perspiration, or heat and excoriate the skin; it may, if preferred, be covered with a cap of chamois leather,* and as it imbeds itself in the soft parts above the pubic bone, and completely closes the walls of the inguinal canal, it causes no inconvenience to the wearer, effectually prevents protrusion of the bowels, and cannot in any way injure the spermatic cord. "The leather pad (which can readily be adjusted to the centre by sliding it either way on the spring) lies flat and close to the back, and obviates the necessity for a continuation of the steel spring round the opposite side of the bodya desideratum in all cases, more especially in that of the ruptured soldier, whose truss is so apt to be broken in the centre by the striking of the ammunition pouch. " Lay the patient on his back, and place the truss on the affected side; return the bowel, and feel for the internal ring,
be sufficient for a single application, and so powerful is it, that I have known the perspiration to drop through the bed. " I regret to say that I do not know to whom the merit of the invention is due. It is manufactured by Mr. Wallis, an ironmonger at Colchester, who received the pattern many * Flannel I now find preferable; it years ago from an old gentleman, who used it for chronic cracks, as the leather does.-G. R. D.
washes
clean, and
never
hardens
or
404 or upper opening through which the intestine protrudes; (you will find that the point of the finger pressed firmly on this spot will effectually prevent any protrusion;) on this point lay the wooden pad, taking care that it does not press on the pubic bone. Place the leather pad on the lower part of the hollow of the back, pass the strap round the opposite hip, and loop it on the button screw in front. No under strap is re-
He
had
seen
the worst effects of mercury in
children, when
employed as alteratives.
Dr. WILLS HIRE admitted that the specifics of mercury were exerted most beneficially. In cases of syphilis in young children, one grain of the mercury with chalk, and two grains of soda, night and morning, generally, in ten or fourteen days, succeeded in effecting a cure, but without producing salivation. He threw out a hint that mercury in inflammation might not be so effective as some had imagined, and appealed to the opinions expressed by Dr. Alison, and by a reviewer in Forbes’s Journal, on this point. Mr. RoBARTs believed that the effects of mercury were influenced and modified much by the period of year, state of weather, &c., at which it was administered. He had tried the plan of treating chronic catarrh with small doses of blue-pill, as recommended by Dr. F. Thompson, and published in THE LANCET, with much success. Mr. HANCOCK had found, in cases where it was thought almost impossible to produce salivation, that a few grains of iodide of potassium, administered in the intervals, was most effective. Mr. Bisnop had observed the same circumstance.
quired.
" Care must be taken to select an instrument that is of the proper size and shape, that fits everywhere closely and accurately, and that is not stronger in the spring than is absolutely
required."
Reviews. Pharmacopccia ad
Usum Nosocomii Phthisicm-U1n &-c. accommoLandini: Bradbury & Evans. 1848. pp. 36. THis neat little work is the pharmacopoeia in use at the Hospital for Consumption and Diseases of the Chest at Brompton ; it contains one hundred and three such formulas as are usually prescribed by the medical officers of that institution. These comprise many combinations, an acquaintance with which will be found suggestive and useful to the practitioners engaged in the treatment of pulmonary diseases in
data.
foreign Department.
Quinine prophylactic of Puerperal Fever. THE idea that quinine is preservative against puerperal fever We observe amongst the mixtures, two in which the nauwas started by M. Alphonse Leroy, of Rouen, in 1793. M. seous character of cod-liver oil is overcome, in one case, by its union with mucilage, and in the other, by being combined with LEUDET put it to the test in an epidemic which occurred in 1843, and lasted for three months, administering it before the liquor potassse. period of the first appearance of the malady. For We take this opportunity of remarking that the Hospital this purpose he employed the quinine in 15 grain (one gramme) for Consumption is deservedly attracting much public notice. doses, and in the few cases it was then tried in, no fever followed. He repeated his experiments in two other epidemics, occurring in the years 1815 and 1846, when he found that those submitted to this medicine did not contract the fever. To give the statistics:-Of 83 women who entered the Hotel Dieu de Rouen, between September, 1843, and January, 1844, MEDICAL SOCIETY OF LONDON. 74 took no medicine, and 21 of them were seized with puerperal fever, whilst the remaining nine were dosed with the MONDAY, OCTOBER 2, 1848.—MR. HANCOCK, PRESIDENT. quinine, and escaped contagion. Again; between July 8th and MERCURY AND ITS EFFECTS. August 9th, 1845, 26 deliveries occurred: 11 women were submitted to no medication, and eight of them were attacked with MR. HANCOCK inquired if any members had tried the plan I the epidemic fever; of the 15 others, treated with sulphate of recommended by some French surgeons, of giving calomel in one only caught the disease. Lastly, between the quinine, very small doses, in inflammatory cases1 The dose recom- 9th of March and the 21st of April, 1846, 36 women were mended was a twentieth part of a grain every hour, day and delivered: of the 19 who took no 11 were attacked; night, until the specific effect of the medicine was produced. of the 16 submitted to its action, quinine, one was seized with only He had tried this plan with two patients in Charing-cross z, fever. Hospital, both of whom had been admitted with inflammation The following is the manner in which M. Leudet employs of the testicle, consequent upon gonorrhoea. In one case, he the quinine:--As soon as the newlv delivered woman has a gave a twentieth of a grain of calomel every hour; in the I little recovered the shock of child-birth-viz., in about four other, a twentieth of a grain every three hours. In the hours after delivery, 15 grains of the medicine are given in case, the patient was salivated in thirty-six hours; in the the course of the 24 hours, in three portions. The same second case, in forty-eight hours. The advantages of this mode is prescribed the next day, but on the third day it is of producing ptyalism was, that the effect was milder and more quantity diminished to ten grains, and the same dose is persevered in controllable than where larger doses were administered; the until the usual period of the accession of the fever has passed bowels were also unaffected. The mode of its administration i to about the sixth day. The occurrence of milk fever by, up was as follows:-Calomel, one grain; confection of opium, a ’, is not always an indication to stay the quinine, for in very scruple; divide in twenty pills-one every hour. In the cases many cases that febrile disturbance is very slight. related, the effects of this medicine were most decided. , The plan of using quinine as a prophylactic has been subseMr. MIDDLETON had been occasionally surprised to see in Paris by M. Cazeaux, who could, from his small doses of the mercury and chalk produce ptyalism in quently adopted make no report of its efficacy. Neverhowever, experience, children of all ages, when given merely as an alterative. theless, any remedy holding out such a promise, in so fearful doses of calomel failed He to such effect. Large produce any a disease, should not be thrown aside until after a ca,’eful and had seen salivation produced in a child by a single dose of the repeated trial. On the other hand, hygienic measures must mercury with chalk. be looked upon as by far the best safeguards, both against Dr. WILLSr3IRE had never seen ptyalism in a very young the development and the propagation of puerperal fever. child, though he had observed its effects on the mouth from the administration of this medicine. Nitrate of Silver in Mercurial Ptyalism. Mr. HOOPER had never seen a child salivated by calomel. Numerous have been the remedies proposed in severe saliWith respect to small doses of calomel to produce the specific effects of mercury on the constitution, he had long been in vation, but none of them is so effectual as we could wish. The the habit of employing them. One grain every three or four nitrate of silver is now advocated as a powerful curative agent in the mercurial ptyalism, by M. BOUCHACOURT, in the Journal hours he found more effective than larger doses. Mr. HiRD said, that if all the beneficial effects of mercury de Médecine de Lyon. He narrates a case in which almost all could be obtained from the small doses mentioned by Mr. the known agents had been vainly resorted to, but upon the Hancock, then, indeed, would the new plan be very useful. use of a solution of the nitrate of silver, rapid recovery took His opinion, however, founded, it was true, on his experience place. The solution was made of the strength of one part of of the small doses, was, that in acute inflammatory diseases of the salt to sixty of water, and was applied to the mouth and serous membranes they would be found less effective in tongue by means of a staff covered with lint. Its application lowering the heart’s action, and producing the other specific caused at first some pain, particularly where there were effects of mercury than the more commonly employed doses. aphthous patches, but in a few minutes great relief was expe-
general.
accustomed
Medical Societies.
I
first
I
who
similar. advances in their attainments. We believe that two a pretensions of any may be unprincipled and courageous certain extent this is really the case, though we are firmly enough to prey upon public credulity. This is a state of things which few will attempt to defend, convinced, that under a wiser system of professional legislation these advances would have been very much more exten- and which, if the medical profession be a fit subject of legisla. sive. It is certain, however, that, taking the profession gene- tion at all, ought surely to be altogether superseded by a more rally, its members constitute a more intelligent and scientific harmonious arrangement, by collecting together the genuine body than. formerly. There alwayshave been, and always but disjoined parts, and rooting out the anomalous excres. will be, men who stand pre-eminent for natural talent, zeal cences, which tend alike to disfigure the order and beauty of in the pursuit of knowledge, and success. in its acquisition- the whole, and to curtail the extent of its usefulness. men who stride over the entire field of professional science, (To be continued.) and are continually enlarging its boundary. Such men cannot be taken for a general standard-the many of the present age must be compared with the many of former ages, and it. cannot be denied, we believe, that they will gain. by the comOF parison. Not only have anatomy and operative surgery been. a cultivated with success considerable very generally by COMMUNICATIONS IN MS. RECEIVED FOR majority of practitioners, but their knowledge of the general PUBLICATION IN THE LANCET. principles of treating disease has become more accurate, and their practice proportionally successful. Their prescriptions, 11 L’auteur se tue a allonger ce que le lecteur se tue à aby6ger.1’ for the most part, evince correct discrimination of the symp-
Analyses
disease, a clear perception of the true indications to be held in view in treatment, and an efficient application of Air-Baths for. the Treatment of Cholera. remedies. We do not mean to affirm that in all these AMONGST other communications the following have reached respects are any members of the profession perfect, much less the general mass of practitioners, but simply that a de- us relative to the construction of these appliances:cided advance in the degree of knowledge and practical skill "A circular tin-case or-box, about six-inches in diameter, is generally observable. The same remarks apply to the con- and the same in depth, forms a receptacle for a spirit lamp. dition of surgery throughout the country. It is well known, It is perforated around the bottom with small openings for the that some years ago few surgeons in the country, except admission of air, and furnished at the side with a small door those attached to county hospitals, considered themselves for the insertion of the lamp. At the top it is dome-shaped qualified to undertake the performance of operations, espe- or conical, and terminates in a funnel or chimney about three cially the greater ones, in surgery; whereas, in every town, if inches in diameter, which, at the height of about two feet, not in almost every village, may now be found snrgeohs of gives off, at an obtuse angle, an arm, the extremity of-which, sufficient knowledge and enterprise to perform, successfully, is passed under the bed-clothes at the foot of-the bed. A the most important; and though example and emulation may cradle is placed over the patient to support the bed-clothes, sometimes have excited a few to overrate their own attain- and allow a space for the collection of the heated air, which . ments and operative skill, we cannot but conclude that this is thus brought in contact with every part of the body, and the bed-clothes are tucked closely in at the sides, and under : confidence in themselves is generally dependent on a substantial advancement in knowledge. the chin, to prevent its escape. To set the apparatus in action, Whatever imperfections may be hereafter pointed out in nothing more is necessary than to place it, and light- the 1-imp. the existing institutions, it would be unfair not to admit that Spirits of wine may be burnt, either with a very large cotton they (at any rate, the College of Surgeons, and Society of or an Argand burner. The tin case may be riveted to an iron have been eminently useful in promoting this- plate, to give it increased steadiness, and the funnel, instead of Apothecaries) increased degree of acquirement in the great mass of the pro- being in one piece, may be made of two, one sliding into the fession. But in awarding to them their due praise, let us not other, so as to adapt it to the height of the bed. attribute to them too much. It cannot be doubted, that the In diseases attended with internal congestion, it quickly progress of general intelligence in the community at large has produces a powerful reaction toward the surface. I have often necessarily carried along with it those engaged in medical as used it, and with great success. The advantages of this appawell as other pursuits, and that the public would not be con- ratus are,-that its action is immediate; it can be used with.tent to concede their confidence to persons who stood still in out moving the patient at all, and consequently exposes him their particular vocation, while all the rest of the world were z, to no fatigue; it is also very compact and convenient. I do advancing. Nor must we forget the powerful and permanent not know any exclusive maker of it; but there can be no diffiimpulse given to surgical science during the late protracted culty in manufacturing a thing so simple, and the expense is war, which called forth the energies of so many men of emi- but trifling.-I am, Sir, your obedient servant, nent talents, (some of whom still flourish in many of the "ED. HART VInEIV, M.R.C.S. countries of Europe,) and afforded a field for practical sur" Chepstow Villa, Notting.hill, 1848." gery unknown in the previous history of the profession. ANOTHER correspondent statesFrom these and other causes, the state of medical science, both " in the number and the extent of its constituent departments, I did not know where such an article could be procured, and in the degree of its general diffusion, must be considered and having occasion for its use, I lately designed one which I as exhibiting a gratifying subject of contemplation; but the find answers very well, and can be made very readily, and at satisfaction thus excited must be greatly lessened by the im- very little expense. I obtained a planed deal board, two feet perfect state of its organization, in consequence of the impo- long, one foot wide, one inch thick; this I had cut into a semilitic and inefficient constitution of the legalized institutions circle, and perforated in the centre by a hole, one inch in which are placed at its head. diameter, to receive a curved tin tube, two feet long; this The effect of these institutions has been, to render the pro- formed the base or end; to the curve of this board I had fession a heterogeneous mass of practitioners of various grades stout wicker rods, three feet six inches long, at intervals of and qualifications, without order, without definite privileges, two inches, made secure by being inserted into the wood, and and with pretensions and interests continually placed in oppo- worked across, at one foot distance, with wicker or basket sition to each other. They hold out to their members and work, and at their ends to form a semicircle the same size:as licentiates the hope of protection from unqualified competitors, the board. The tin tube is circular, curved in the shape of a which is in the highest degree fallacious; and while we should horn; the small end one inch in diameter, and made to fit airseem to possess a greater number of bulwarks against tight in the hole of the board; the large end three inches in A small spirit lamp completes the apparatus. quackery and imposture than any other country in the world, diameter. " there is none where they are so openly and successfully pracEvery surgeon I presume to be familiar with the way in tised. For besides the several classes of physicians sanctioned which it is applied. I would add, that I find it more efficient by the Royal College, the graduates of the English and if temporarily covered with any kind of Macintosh’d material. Scottish universities, the members of the College of Surgeons, —Iam, Sir, yours &c., FRANCIS WARD, M.R.C.S.E. &c. and the licentiates of the Society of Apothecaries, there are " Balham-hill, Surrey, September, 1848." innumerable prescribing chemists, notorious empirics, boneA THIRD correspondent recommends an arrangement very etters, and vendors of all descriptions of nostrums and specifics. Our newspapers abound with advertisements of cures similar to the foregoing. " effected by patent medicines, the sale of which is expressly It consists of a slight frame, similar to a fracture cradle, authorized by permission of government, and there seems to about six feet in length, two feet and a half broad, and one be neither obstacle nor limit to the fraudulent and perniciousIfoot high. This frame, for the convenience of carriage, is toms of
403 divided into two parts, which slide into each other in telescope fashion. The foot of the frame is solid, with an aperture in the centre, to admit the nozzle of a tin case, which holds a small tin spirit-lamp, with two wicks. "The mode of applying it is to place the frame directly over the body-linen of the patient; several blankets are then put over the frame, and well tucked in, covering every part of the body except the head. The lamp is then adjusted, and the hot air rushes into the cavity. In ten or fifteen minutes reaction is usually established, The lamp is then removed, and the frame withdrawn, leaving the patient enveloped in the blankets in a profuse sweat. The vomiting and cramps generally subside at the same time. During the whole process the patient should drink plentifully of hot mint tea. " I beg to say I have not the merit of inventing this bath. The first was sent me by a lady from Brighton. I then set my own carpenter and whitesmith to work, and had several made, at a cost, I think, of about sixteen shillings; and I kept one at every village to which I was likely to be called. I dare.say the same tradesmen would be glad to make the bath for any gentleman desirous of having one.-I am, Sir, CHARLES MATTHEW THOMPSON. your obedient servant, 11 Westerham, Sept. 25th, 184s,"
rheumatic gout.
MR. H.
letter from a medical correspondent, we learn that Mr. Coxeter, the surgical instrument maker, " has constructed a very simple, portable, inexpensive apparatus for administering a
hot-air bath. The spirit lamp, the funnel-shaped orifice, and an extensible metallic tube, are all contained in a space five inches by six inches." a
of I
a
Another apparatus suggested is, "a spirit lamp encased in a double cylinder of wire gauze, and enclosed in a light wooden framework. I had it (says our correspondent) almost in daily
during a period
of five years that I
was
’
THE communication of Mr. BATEMAN, a manufacturer, in Harleyford-road, Kennington-oval, is an advertisement.-In
very small cost. "1. It consists of an iron cup for spirits of wine, two inches and a half wide. "2. A furnace made of sheet-iron, with chimney. "3. Rings to support the chimney in the centre of guard, which must be fastened by rivets to the guard. " 4. Guard for chimney, to keep the bedclothes from being burnt, two feet long by eighteen inches in diameter. " This apparatus is to be placed on a stool at the foot of the bed,and the guard introduced under the bedclothes, which are to be propped up by pieces of stick, so as to admit the hot air equally over the whole surface of the patient."
use
communication which I had from Dr.
" Harley,street, Cavendish-sq., Sept. 1848. P.S.--I may add that the cost is about 24s"
HULME, of Liverpool, sends us a drawing of an appaat
a
"
Dr. WOOD, of Peckham, remarks" I have been in the habit of recommending a cheap and easy mode of applying the vapour bath, for many years, by placing a hot brick in a tub of water, the patient being enveloped in a flannel gown or blankets round it, of course the head external. I have found this convenient, expeditious, and of great comfort to both rich and poor. At the same time I beg to observe, that I think medical men lose sight, in many cases of debilitated patients, of the great advantage of the vapour bath over the hot bath, the latter sometimes losing its beneficial effects by the patient being exposed to its influence too long. "If not trespassing too much on your valuable pages, may I call attention to a letter signed a ’Quondam Parish Doctor.’ I am sure some such plan as there stated, from what I hear in my daily perambulations, would meet with satisfaction both as regards the pauper and medical attendant, looking to No. 2 as well as No. 1.—Your obedient servant, "Peckham, 1848." T. C. WOOD, M.D., M.R.C.S.E., & L.S.A.
ratus, which, he says, " can be made by any tinman,
In
Golding Bird on the subject some time ago, that intelligent physician informed me that he remembered to have seen something similar exhibited many years back at the Medical Society of London. In the hope that this communication may have the effect of rescuing from comparative oblivion a really useful invention, I remain, your obedient servant, R. CHAIlIBERS M.D.
physician to the
Essex and Colchester Hospital, and I feel myself justified in
stating, that for efficiency, portability, and facility of application, it has no equal. Indeed, I deem it to be an indispensable appendage to the armamentarium of every hospital and surgery. " About one ounce and a half of rectified spirit will keep it in action for an hour. When desirable, the vapour of camphor may be conjoined with it, by placing about two drachms of camphor upon the top of the gauze cylinder, the heat of which volatilizes it. "For application it only requires to be trimmed as an ordinary spirit lamp, and when ignited, to be placed between the
patient’s lower extremities, an extra blanket being placed upon the ordinary bed-clothes. From fifteen to thirty minutes will
A New Truss for Oblique
Inguinal Hernia. first at Fort Pitt,Chatham, class, MR.DARTNELL,sta’9’-surgeon has forwarded to us a truss, accompanied by a letter containing" the following remarks:It has long been a desideratum to obtain for the soldier a simpler and more efficient truss than the one commonly in use, which, from its weight and clumsy form, the large size of the rupture pad, the perinaeal strap, and the great pressure produced by the instrument on the pubis and spermatic veshas been found both irksome and inefficient. sels, " With this view it was (and being myself a sufferer) that I turned my attention to the subject; and the truss I now submit for your inspection has met with the highest approval of the director-general, and several other military medical officers, as you will see by the accompanying testimonials. It is now the only truss issued to the army abroad as well as at home, and will be found, I am convinced, equally well suited to the civilian as to the soldier. By a slight modification of the anterior curve of the spring, and the shape of the pad, this truss can be rendered available for crural as well as hernia. inguinal " I shall not further encroach on your time, but beg to G. R. DARTNELL, remain, Sir, your obedient servant, Staff-surgeon, First Class." Testimonials in favour of this invention from Dr. Ely, of Rochester, Mr. Alexander Smith, Cavalry Depot, Maidstone, and various military medical officers, have been submitted to us, with one of the patent trusses. The following is a description of the instrument, which is called the " solid pad truss," and may be seen at the estatablishments of Messrs. Philp and Whicker, Weiss and Co., Evans and Co., Palmer, (Rochester,) &c. " It consists of a short and pliant steel spring, which is terminated at either end by a pad. The anterior or rupture pad is of small size, formed of hard wood, polished, and of arounded oval and somewhat conical shape. The back pad is flat, formed of strong leather, padded on the inner face, and furnished with two bridles on the outer one for connexion with the spring. The spring itself is cased with leather, and has a downward curve at its anterior extremity, which brings the wooden pad attached to it directly on the inguinal canal and internal ring. The instrument, when applied, is retained in its place by a light strap, continuous with the sheath of the spring, which, being passed round the opposite hip, loops on a button screw on the front pad. "The polished wooden pad requires no renewal, does not absorb the perspiration, or heat and excoriate the skin; it may, if preferred, be covered with a cap of chamois leather,* and as it imbeds itself in the soft parts above the pubic bone, and completely closes the walls of the inguinal canal, it causes no inconvenience to the wearer, effectually prevents protrusion of the bowels, and cannot in any way injure the spermatic cord. "The leather pad (which can readily be adjusted to the centre by sliding it either way on the spring) lies flat and close to the back, and obviates the necessity for a continuation of the steel spring round the opposite side of the bodya desideratum in all cases, more especially in that of the ruptured soldier, whose truss is so apt to be broken in the centre by the striking of the ammunition pouch. " Lay the patient on his back, and place the truss on the affected side; return the bowel, and feel for the internal ring,
be sufficient for a single application, and so powerful is it, that I have known the perspiration to drop through the bed. " I regret to say that I do not know to whom the merit of the invention is due. It is manufactured by Mr. Wallis, an ironmonger at Colchester, who received the pattern many * Flannel I now find preferable; it years ago from an old gentleman, who used it for chronic cracks, as the leather does.-G. R. D.
washes
clean, and
never
hardens
or
404 or upper opening through which the intestine protrudes; (you will find that the point of the finger pressed firmly on this spot will effectually prevent any protrusion;) on this point lay the wooden pad, taking care that it does not press on the pubic bone. Place the leather pad on the lower part of the hollow of the back, pass the strap round the opposite hip, and loop it on the button screw in front. No under strap is re-
He
had
seen
the worst effects of mercury in
children, when
employed as alteratives.
Dr. WILLS HIRE admitted that the specifics of mercury were exerted most beneficially. In cases of syphilis in young children, one grain of the mercury with chalk, and two grains of soda, night and morning, generally, in ten or fourteen days, succeeded in effecting a cure, but without producing salivation. He threw out a hint that mercury in inflammation might not be so effective as some had imagined, and appealed to the opinions expressed by Dr. Alison, and by a reviewer in Forbes’s Journal, on this point. Mr. RoBARTs believed that the effects of mercury were influenced and modified much by the period of year, state of weather, &c., at which it was administered. He had tried the plan of treating chronic catarrh with small doses of blue-pill, as recommended by Dr. F. Thompson, and published in THE LANCET, with much success. Mr. HANCOCK had found, in cases where it was thought almost impossible to produce salivation, that a few grains of iodide of potassium, administered in the intervals, was most effective. Mr. Bisnop had observed the same circumstance.
quired.
" Care must be taken to select an instrument that is of the proper size and shape, that fits everywhere closely and accurately, and that is not stronger in the spring than is absolutely
required."
Reviews. Pharmacopccia ad
Usum Nosocomii Phthisicm-U1n &-c. accommoLandini: Bradbury & Evans. 1848. pp. 36. THis neat little work is the pharmacopoeia in use at the Hospital for Consumption and Diseases of the Chest at Brompton ; it contains one hundred and three such formulas as are usually prescribed by the medical officers of that institution. These comprise many combinations, an acquaintance with which will be found suggestive and useful to the practitioners engaged in the treatment of pulmonary diseases in
data.
foreign Department.
Quinine prophylactic of Puerperal Fever. THE idea that quinine is preservative against puerperal fever We observe amongst the mixtures, two in which the nauwas started by M. Alphonse Leroy, of Rouen, in 1793. M. seous character of cod-liver oil is overcome, in one case, by its union with mucilage, and in the other, by being combined with LEUDET put it to the test in an epidemic which occurred in 1843, and lasted for three months, administering it before the liquor potassse. period of the first appearance of the malady. For We take this opportunity of remarking that the Hospital this purpose he employed the quinine in 15 grain (one gramme) for Consumption is deservedly attracting much public notice. doses, and in the few cases it was then tried in, no fever followed. He repeated his experiments in two other epidemics, occurring in the years 1815 and 1846, when he found that those submitted to this medicine did not contract the fever. To give the statistics:-Of 83 women who entered the Hotel Dieu de Rouen, between September, 1843, and January, 1844, MEDICAL SOCIETY OF LONDON. 74 took no medicine, and 21 of them were seized with puerperal fever, whilst the remaining nine were dosed with the MONDAY, OCTOBER 2, 1848.—MR. HANCOCK, PRESIDENT. quinine, and escaped contagion. Again; between July 8th and MERCURY AND ITS EFFECTS. August 9th, 1845, 26 deliveries occurred: 11 women were submitted to no medication, and eight of them were attacked with MR. HANCOCK inquired if any members had tried the plan I the epidemic fever; of the 15 others, treated with sulphate of recommended by some French surgeons, of giving calomel in one only caught the disease. Lastly, between the quinine, very small doses, in inflammatory cases1 The dose recom- 9th of March and the 21st of April, 1846, 36 women were mended was a twentieth part of a grain every hour, day and delivered: of the 19 who took no 11 were attacked; night, until the specific effect of the medicine was produced. of the 16 submitted to its action, quinine, one was seized with only He had tried this plan with two patients in Charing-cross z, fever. Hospital, both of whom had been admitted with inflammation The following is the manner in which M. Leudet employs of the testicle, consequent upon gonorrhoea. In one case, he the quinine:--As soon as the newlv delivered woman has a gave a twentieth of a grain of calomel every hour; in the I little recovered the shock of child-birth-viz., in about four other, a twentieth of a grain every three hours. In the hours after delivery, 15 grains of the medicine are given in case, the patient was salivated in thirty-six hours; in the the course of the 24 hours, in three portions. The same second case, in forty-eight hours. The advantages of this mode is prescribed the next day, but on the third day it is of producing ptyalism was, that the effect was milder and more quantity diminished to ten grains, and the same dose is persevered in controllable than where larger doses were administered; the until the usual period of the accession of the fever has passed bowels were also unaffected. The mode of its administration i to about the sixth day. The occurrence of milk fever by, up was as follows:-Calomel, one grain; confection of opium, a ’, is not always an indication to stay the quinine, for in very scruple; divide in twenty pills-one every hour. In the cases many cases that febrile disturbance is very slight. related, the effects of this medicine were most decided. , The plan of using quinine as a prophylactic has been subseMr. MIDDLETON had been occasionally surprised to see in Paris by M. Cazeaux, who could, from his small doses of the mercury and chalk produce ptyalism in quently adopted make no report of its efficacy. Neverhowever, experience, children of all ages, when given merely as an alterative. theless, any remedy holding out such a promise, in so fearful doses of calomel failed He to such effect. Large produce any a disease, should not be thrown aside until after a ca,’eful and had seen salivation produced in a child by a single dose of the repeated trial. On the other hand, hygienic measures must mercury with chalk. be looked upon as by far the best safeguards, both against Dr. WILLSr3IRE had never seen ptyalism in a very young the development and the propagation of puerperal fever. child, though he had observed its effects on the mouth from the administration of this medicine. Nitrate of Silver in Mercurial Ptyalism. Mr. HOOPER had never seen a child salivated by calomel. Numerous have been the remedies proposed in severe saliWith respect to small doses of calomel to produce the specific effects of mercury on the constitution, he had long been in vation, but none of them is so effectual as we could wish. The the habit of employing them. One grain every three or four nitrate of silver is now advocated as a powerful curative agent in the mercurial ptyalism, by M. BOUCHACOURT, in the Journal hours he found more effective than larger doses. Mr. HiRD said, that if all the beneficial effects of mercury de Médecine de Lyon. He narrates a case in which almost all could be obtained from the small doses mentioned by Mr. the known agents had been vainly resorted to, but upon the Hancock, then, indeed, would the new plan be very useful. use of a solution of the nitrate of silver, rapid recovery took His opinion, however, founded, it was true, on his experience place. The solution was made of the strength of one part of of the small doses, was, that in acute inflammatory diseases of the salt to sixty of water, and was applied to the mouth and serous membranes they would be found less effective in tongue by means of a staff covered with lint. Its application lowering the heart’s action, and producing the other specific caused at first some pain, particularly where there were effects of mercury than the more commonly employed doses. aphthous patches, but in a few minutes great relief was expe-
general.
accustomed
Medical Societies.
I
first
I