- Email: [email protected]
BOYCOTTING IRISH QUALIFICATIONS BY LONDON HOSPITALS.
1306 form of spray, the latter being, however, somewhat choking. Some time ago the probability occurred to us (as it must have to many others) that similar good effects might follow its use in tuberculous ulceration of the skin. Accordingly, without consulting any literature on the subject, we employed ib in the following cases, in each of which the concentrated acid was rubbed in vigorously by means of cotton-wool wrapped firmly round a pair of dressing forceps :-CASE 1.-A patient aged sixty-five was admitted, suffering from tuberculous ulceration of the skin of the right forearm of two years’ standing. After scraping, the acid was applied as above, and, in spite of considerable pain, repeated daily for a fortnight. During this period it was noted that a portion of infected tissue had been left behind on which the lactic acid seemed to have no specific effect, and it had ultimately to be removed. It was over two months before cure was effected, and we are not satisfied that the result was any better than that obtainable by ordinary methods. CASE 2.-A schoolgirl aged twelve was admitted, affected with lupus of the nose, extending also to the mucous membrane. In this case only the cutaneous portion was scraped and the patient made an excellent recovery. It is to be noted that on the mucous membrane the acid apparently exercised its specific effect, a fact which may be contrasted with its failure in the previous case. CASE 3.-A servant aged seventeen was suffering from tuberculous ulceration covering the greater part of one forearm, of ten years’ standing, which had been subjected during this period to various forms of non-operative treatment. After scraping, the concentrated acid was applied and continued for five weeks, when creasote ointment was substituted. This case was encouraging, its progress and the ultimate result being all that could be desired. CASE 4.-A fireman aged thirty-two was admitted with a patch of tuberculous ulceration the size of the palm of the This was scraped and silver nitrate was applied. hand. Later lactic acid was used, and. although producing marked pain, it was continued, the patient being discharged cured at the end of three weeks. We have heard tliat there has been recurrence.
CASE 5. -A schoolbov aged ten had extensive tuberculous ulceration of the dorsum of one foot with outlying nodules. This, after scraping, was treated throughout with lactic acid, the application of which was, as in the other cases, accompanied by pain. The patient was in hospital over four months, during which further scraping became necessary, and once more, although a cure was finally obtained, we were unable to detect any special advantage in the use of lactic acid. The result has been on the whole disappointing, for while it leaves untouched the old dictum that there is but one satisfactory treatment in such cases-a thorough scraping—lactic acid evidences no superiority over caustic potash or chloride of zinc as an after application. We are, Sirs, yours truly, W. NEWLANDS CLEMMEY, M.R.C. S. JOHN BIERNACKI, M.B. Glas. Bootle,iNov. 21set, 1892.
was to uphold the higher qualifications, and that if 1 wished t,o aspire in the future to one of their appointments, I must obtain the F.R.C.S. Eng., which I suppose is the higher college referred to, but whose new cognomen puzzled me for the nonce. Notwithstanding his provocative spcech 1 suppressed my ire and humbly pointed out that his valuation of my fellowship was not in accordance with that of the Select Committee of the House of Lords, which seemed to surprise him-so much so that he offered to go into my application instanter, which I declined with thanks. Twenty years hence this fossilised condition of affairs will be interred with its guardians ; but in the meantime those of us who are capable of, and have an ambition for, hospital work in London cannot hope for any relaxation from these gentlemen,judging from the above experience, which speaks for itself. The only alternative open is, with the help of philanthropic Irishmen, to establish a St. Patrick’s Hospital in London, manned by Irish surgeons and physicians, on such a large and generous basis as that we may hope to have for consultants such distinguished Irishmen as Sir Richard Quain and Sir William Mac Cormac, and in the administration and work done in this hospital prove practically—"which is all that a generous English public requires "-that we Irish graduates are as worthy of their confidence as English ones, only askingafair field " and no favour. I am, Sirs, your obedient servant, ROBERT O’CALLAGHAN, F.R.C.S.I.
tendency
Carlow,
Nov.
24th,
1M2.
TALIPES EQUINO-VARUS AT THE ROYAL MEDICAL AND CHIRURGICAL SOCIETY. To the Editors
of THE LANCET.
SIRS,—The somewhat abrupt conclusion, owing to the late. ness of the hour, of the debate on Mr. Edmund Owen’s paper
Royal Medical and Chirurgical Society, when only three Fellows had spoken, must be my excuse for addressing these observations to you. It is not to be denied that in a certain proportion of cases of congenital club-foot relapse does occur after what Mr. Owen calls the orthodox treatment, either from neglect or from faulty growth. Even such cases can, in my experience, all be brought into a good position by sub. cutaneous tenotomy and myotomy and the use of instruments, but it is not always easy to maintain the improvement. In two such cases at the National Orthopaedic Hospital I have performed what is known as Phelps’ operation with encouraging results. My father, Dr. W. J. Little, long ago stated as his opinion that congenital club-foot couldnot be too early operated on. I am glad to hear that Mr. Owen adopts this view. If seen early enough and the after treatment be carefully carried out, even the most severe case may be rectified without even using a Scarpa’s shoe or other elaborate appliance. Whether Phelps’ operation or tenotomy only be done, the foot must be held in a good position until it has grown into it. Mr. Owen spoke of the pain caused by the " orthodox treatment."No splint or shoe need be applied so as to cause pain or the subsequent formation of sores. A visit to the wards of the National Orthopaedic Hospital would convince anyone that the treatment can be carried out without pain. Subcutaneous surgery is one means (as Mr. Hulke pointed out) of maintaining asepsis, and is surely a simpler and more certain way of doing at the
BOYCOTTING IRISH QUALIFICATIONS BY LONDON HOSPITALS. Is it, then, an so than the most rigid antiseptic precautions. anachronism ?’! Where the one method is inapplicable we To the Editors of THE LANCET. need not, thanks to Listerism, hesitate as in former days to SIRS,—From your report of the last meeting of the Irish make an open wound ; but it can never be good surgery to Graduates’ Association 1 see that they have set themselves divide any structure needlessly. The foot that ha, been a Titanic task, inasmuch as they hope to get Irish qualifica- cured by tenotomy and gradual methods has its functions less tions their legitimate recognition by the governors of London impaired than that which has undergone a radical operation hospitals. The following facts will prove this, being the involving opening of joints and probable division without experience of one who had the audacity to appear before hope of repair of the internal plantar nerve ; but the latter one of these august corporations : In June last your columns is obviously a better foot than one in the condition of equinocontained an advertisement for an assistant surgeon to a varus. There are other points of interest raised by Mr. Owen large London hospital ; for this appointment I was one of which considerations of space forbid me to touch upon. several candidates, and in due course appeared before a ’, I am, Sirs, yours faithfully, court of governors of that hospital. To my utter astonishSeymour-street, W., Nov. 23rd, 1892. E. MUIRHEAD LITTLE. ment I was asked by the chairman why I applied for such an appointment, not having obtained the F.R.C.S. Eng. In "’CAISSON’ WORKING IN BLADDER reply, I stated that there were no such conditions in their advertisement, which led me to believe that monopoly SURGERY." had been done away with by them, as it had been at To t7te Editors of THE LANCET. Hastings and Bristol. This simple statement seemed to stimulate this gentleman to add insult to injury by stating I was unfortunately unable to be present at the SIRS,—As that there was no chance of any surgeon with an "inferior Medical Society on Monday, Nov. 14th, when Mr. Fenwick qualification being admitted to their hospital; that their read a short paper with the above-mentioned title, perhaps, "
CASE 5. -A schoolbov aged ten had extensive tuberculous ulceration of the dorsum of one foot with outlying nodules. This, after scraping, was treated throughout with lactic acid, the application of which was, as in the other cases, accompanied by pain. The patient was in hospital over four months, during which further scraping became necessary, and once more, although a cure was finally obtained, we were unable to detect any special advantage in the use of lactic acid. The result has been on the whole disappointing, for while it leaves untouched the old dictum that there is but one satisfactory treatment in such cases-a thorough scraping—lactic acid evidences no superiority over caustic potash or chloride of zinc as an after application. We are, Sirs, yours truly, W. NEWLANDS CLEMMEY, M.R.C. S. JOHN BIERNACKI, M.B. Glas. Bootle,iNov. 21set, 1892.
was to uphold the higher qualifications, and that if 1 wished t,o aspire in the future to one of their appointments, I must obtain the F.R.C.S. Eng., which I suppose is the higher college referred to, but whose new cognomen puzzled me for the nonce. Notwithstanding his provocative spcech 1 suppressed my ire and humbly pointed out that his valuation of my fellowship was not in accordance with that of the Select Committee of the House of Lords, which seemed to surprise him-so much so that he offered to go into my application instanter, which I declined with thanks. Twenty years hence this fossilised condition of affairs will be interred with its guardians ; but in the meantime those of us who are capable of, and have an ambition for, hospital work in London cannot hope for any relaxation from these gentlemen,judging from the above experience, which speaks for itself. The only alternative open is, with the help of philanthropic Irishmen, to establish a St. Patrick’s Hospital in London, manned by Irish surgeons and physicians, on such a large and generous basis as that we may hope to have for consultants such distinguished Irishmen as Sir Richard Quain and Sir William Mac Cormac, and in the administration and work done in this hospital prove practically—"which is all that a generous English public requires "-that we Irish graduates are as worthy of their confidence as English ones, only askingafair field " and no favour. I am, Sirs, your obedient servant, ROBERT O’CALLAGHAN, F.R.C.S.I.
tendency
Carlow,
Nov.
24th,
1M2.
TALIPES EQUINO-VARUS AT THE ROYAL MEDICAL AND CHIRURGICAL SOCIETY. To the Editors
of THE LANCET.
SIRS,—The somewhat abrupt conclusion, owing to the late. ness of the hour, of the debate on Mr. Edmund Owen’s paper
Royal Medical and Chirurgical Society, when only three Fellows had spoken, must be my excuse for addressing these observations to you. It is not to be denied that in a certain proportion of cases of congenital club-foot relapse does occur after what Mr. Owen calls the orthodox treatment, either from neglect or from faulty growth. Even such cases can, in my experience, all be brought into a good position by sub. cutaneous tenotomy and myotomy and the use of instruments, but it is not always easy to maintain the improvement. In two such cases at the National Orthopaedic Hospital I have performed what is known as Phelps’ operation with encouraging results. My father, Dr. W. J. Little, long ago stated as his opinion that congenital club-foot couldnot be too early operated on. I am glad to hear that Mr. Owen adopts this view. If seen early enough and the after treatment be carefully carried out, even the most severe case may be rectified without even using a Scarpa’s shoe or other elaborate appliance. Whether Phelps’ operation or tenotomy only be done, the foot must be held in a good position until it has grown into it. Mr. Owen spoke of the pain caused by the " orthodox treatment."No splint or shoe need be applied so as to cause pain or the subsequent formation of sores. A visit to the wards of the National Orthopaedic Hospital would convince anyone that the treatment can be carried out without pain. Subcutaneous surgery is one means (as Mr. Hulke pointed out) of maintaining asepsis, and is surely a simpler and more certain way of doing at the
BOYCOTTING IRISH QUALIFICATIONS BY LONDON HOSPITALS. Is it, then, an so than the most rigid antiseptic precautions. anachronism ?’! Where the one method is inapplicable we To the Editors of THE LANCET. need not, thanks to Listerism, hesitate as in former days to SIRS,—From your report of the last meeting of the Irish make an open wound ; but it can never be good surgery to Graduates’ Association 1 see that they have set themselves divide any structure needlessly. The foot that ha, been a Titanic task, inasmuch as they hope to get Irish qualifica- cured by tenotomy and gradual methods has its functions less tions their legitimate recognition by the governors of London impaired than that which has undergone a radical operation hospitals. The following facts will prove this, being the involving opening of joints and probable division without experience of one who had the audacity to appear before hope of repair of the internal plantar nerve ; but the latter one of these august corporations : In June last your columns is obviously a better foot than one in the condition of equinocontained an advertisement for an assistant surgeon to a varus. There are other points of interest raised by Mr. Owen large London hospital ; for this appointment I was one of which considerations of space forbid me to touch upon. several candidates, and in due course appeared before a ’, I am, Sirs, yours faithfully, court of governors of that hospital. To my utter astonishSeymour-street, W., Nov. 23rd, 1892. E. MUIRHEAD LITTLE. ment I was asked by the chairman why I applied for such an appointment, not having obtained the F.R.C.S. Eng. In "’CAISSON’ WORKING IN BLADDER reply, I stated that there were no such conditions in their advertisement, which led me to believe that monopoly SURGERY." had been done away with by them, as it had been at To t7te Editors of THE LANCET. Hastings and Bristol. This simple statement seemed to stimulate this gentleman to add insult to injury by stating I was unfortunately unable to be present at the SIRS,—As that there was no chance of any surgeon with an "inferior Medical Society on Monday, Nov. 14th, when Mr. Fenwick qualification being admitted to their hospital; that their read a short paper with the above-mentioned title, perhaps, "