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CLINICAL INSTRUCTION IN THE METROPOLITAN SCHOOLS.
from
With a view of correcting the predisposition to haemorrhage, frankly recording his experience whenever it seems requito defend the doctrines of his profession or answer improving muscular tone, and thus increasing the chances of
site, either
the calls of humanity. For my own part, I have yet to learn how far the promotion and prospects of Army medical officers have been injured by an honest and straightforward discharge of their duties, either as regards exposing the errors of their Seniors, or recommending measures for the good of the service. I was not personally acquainted with the late Director-General, but have a great respect for his memory; and I opine that there are few who watched his meritorious and honourable career who will not accord to Thomas Alexander what Samuel Rogers said of a far more exalted but not more honest and conscientious public servant, that "glorious was his course, and long the track of light he left behind him." I am, Sir, yours respectfully, A VOICE TFROX THE MEDITERRANEAN. August, 1860. P.S.-I enclose my name.
CONGENITAL HYDROCEPHALUS. To the Editor of THE LANCET.
SiR,—Ifyou
consider that the following case will interest are welcome to it for your valuable journal, my mistake in the presentation may assist others similarly
your readers, you as
situated :Mrs. G-, aged forty, in labour with her second child. The liquor amnii was suddenly discharged on the 20th of March, 1859; and I attended her at four A.M. on the 21st, and found the os uteri high up, but well dilated, with the placenta apparently presenting. I at once passed up my left hand and secured the left foot, which was retained by tape. I then succeeded in bringing down the right foot, and, after some difficulty, brought the head into the world, with a large hydrocyst growing at its posterior portion, and containcephalic ing about three pints of fluid. This cyst having occupied the os uteri, while the head was resting on the pubis, misled me as to the nature of the presentation. The child was dead, but the mother did well, and has just been confined again with a fine I am. Sir. yours. &c.. healthv child. J. S. BOSTOCK, M.R.C.S.
CLINICAL INSTRUCTION IN THE METROPOLITAN SCHOOLS. To the Editor of THE LANCET.
efficient contraction of the uterus after delivery, I would pro. pose that small doses of strychnine or extract of nux vomica be administeredtwice or thrice daily some short time prior to parturition. To arrest bleeding and promote contraction of the womb, the injection of a cold infusion of ergot of rye, and in alarming cases, where other and more convenient means have failed, I would recommend the following mode of applying electricity:-Let the negative pole of an induction apparatus be attached to the arm or elbow of the accoucheur, while the positive pole armed with a wet sponge is applied either over the fundus uteri or directed to the spine. The hand of the operator should now be introduced into the uterus, and the machine set in motion. The current enters at the fundus uteri, and passing through the hand and forearm of the operator completes the circuit at the negative pole. The action should be kept up some time, and gradually increased, the accoucheur directing with his fingers a stream of electricity to the various portions of the internal surface of the womb until contraction ensues, and the hand be expelled. When we reflect that electricity possesses the power of causing violent muscular contraction some hours after death, it is difficult to imagine a case where the stimulus of the "galvanic hand" would fail in producing such. salutary effect in the living subject, if properly and carefully applied. -
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CHARLES TAYLOR, M.D. To the Editor of THE LANCET. I be allowed to offer my experience on the preSIR,-May vention of post-partum haemorrhage in support of that of Mr. Lammiman’s, in your journal of Saturday last. My plan in every obstetric case is, whether I anticipate post-partum haemorrhage or not, to apply a shawl, folded cornerwise to about three or four inches wide, round the abdomen prior to the expulsion of the child, that it may be in readiness. As soon as the child is expelled, the shawl is tightened as far as the patient can bear, by straining the ends in opposite directions, and suddenly twisting them exactly over the uterus, and tucking the twist under, so that it might form a kind of tour. niquet pad pressing on the womb. I prefer this way of fasten’ ing the shawl to Mr. Lammiman’s plan of tying anything round the patient-first, because a greater amount of pressure can be more easily attained-; secondly, when properly twisted, the shawl never slackens; thirdly, a most effectual pad is at once at
hand. of the metropolitan hospitals are now I have attended more than 1000 obstetric cases during my urging- by advertisements in the daily papers each its claim for practice of twenty-two years, and never had the misfortune to preference as a school of medicine, will you allow me through lose a single case from post-partum haemorrhage, which I your journal to tender a word of advice to those who are un- mainly attribute to not overlooking this simple plan of predecided as yet in the choice of a medical school. vention. My father, too, adopted this plan during his thirtyF would advise the intending student, before attaching him- two years’ practice with equal success. self to any particular school, to examine for himself the mode I am, Sir, your obedient servant, of clinical instruction pursued in each. Self-dependence is- no H. B. CURTIS, M.R.C.S. doubt a very estimable quality, and it is true that a student should have recourse to his teacher more by way of supplementing the knowledge he has striven to obtain of any partiRAMBLING WORDS ON ARMY MEDICAL cular case; but, at the same time, it is rather discouraging to OFFICERS. the student to find his inquiries answered in such a- slurring To the Editor of THE LANCET. and impatient manner as I have frequently witnessed at the achool of medicine to which 1 belong. It is only fair to say SIR,-No men of fortune or, probably, of comparative indethat there are a few exceptions (one glorious one in particular), or men capable of influencing the destinies of the pendence, but the average character of the instruction is such as would nation, do, or ever will, enter the British Army in the capacity deter me from rendering myself again a victim to it, with my of medical officers. is the me "Noli interrogare prevailing present experience. Medical men in the Army are a.class by themselves, genemotto, and little is there of that earnest spirit which, admirable rally men who before have seen little of the world; they are in all, should, in my humble opinion, especially mark out the civilians clothed in the garb and living in the society of men of clinical teacher. war, but their thoughts and ideas are, or ought to be, about Hoping that these lines may catch the eye of some of those healing, not killing, although doubtless they do the latter now for whom they are intended, and that the hint may be of ser- and again. Sometimes, however, he of the lancet thinks himI am, Sir, your obedient servant, vice to them, not allowed, nearly as much entitled to draw self, although CANTAB. August, 1860. the sword, and wear the sash, as the combatant officer; forgetting that academical honours are his, rather than those of POST-PARTUM HÆMORRHAGE. chivalry. Many may think this a hard pill to swallow; howlet them answer themselves whether it is true or not. ever, To the Editor of THE LANCET. Strange indeed are medicos in their ideas. Almost all suffer SIR,-Will you allow me to suggest to those who may be from a species of ill-defined jealousy with regard to the officers interested in the discussion on "post-partum hsemorrhage," with whom they come in contact. Some attempt to bluster; which has recently occupied a place in your columns, one or it may make one smile, but still it is so. Others are painfully two methods of treating such accidents, that so far as I am sensitive and retiring. Some remain uncouth, either goodaware have not been hitherto employed, and which I conceive hearted, or puffed up with no small opinion of their conseworthy of attentionquence ; others remain gentlemen, generally somewhat sub-
Sm,--As several
222
With a view of correcting the predisposition to haemorrhage, frankly recording his experience whenever it seems requito defend the doctrines of his profession or answer improving muscular tone, and thus increasing the chances of
site, either
the calls of humanity. For my own part, I have yet to learn how far the promotion and prospects of Army medical officers have been injured by an honest and straightforward discharge of their duties, either as regards exposing the errors of their Seniors, or recommending measures for the good of the service. I was not personally acquainted with the late Director-General, but have a great respect for his memory; and I opine that there are few who watched his meritorious and honourable career who will not accord to Thomas Alexander what Samuel Rogers said of a far more exalted but not more honest and conscientious public servant, that "glorious was his course, and long the track of light he left behind him." I am, Sir, yours respectfully, A VOICE TFROX THE MEDITERRANEAN. August, 1860. P.S.-I enclose my name.
CONGENITAL HYDROCEPHALUS. To the Editor of THE LANCET.
SiR,—Ifyou
consider that the following case will interest are welcome to it for your valuable journal, my mistake in the presentation may assist others similarly
your readers, you as
situated :Mrs. G-, aged forty, in labour with her second child. The liquor amnii was suddenly discharged on the 20th of March, 1859; and I attended her at four A.M. on the 21st, and found the os uteri high up, but well dilated, with the placenta apparently presenting. I at once passed up my left hand and secured the left foot, which was retained by tape. I then succeeded in bringing down the right foot, and, after some difficulty, brought the head into the world, with a large hydrocyst growing at its posterior portion, and containcephalic ing about three pints of fluid. This cyst having occupied the os uteri, while the head was resting on the pubis, misled me as to the nature of the presentation. The child was dead, but the mother did well, and has just been confined again with a fine I am. Sir. yours. &c.. healthv child. J. S. BOSTOCK, M.R.C.S.
CLINICAL INSTRUCTION IN THE METROPOLITAN SCHOOLS. To the Editor of THE LANCET.
efficient contraction of the uterus after delivery, I would pro. pose that small doses of strychnine or extract of nux vomica be administeredtwice or thrice daily some short time prior to parturition. To arrest bleeding and promote contraction of the womb, the injection of a cold infusion of ergot of rye, and in alarming cases, where other and more convenient means have failed, I would recommend the following mode of applying electricity:-Let the negative pole of an induction apparatus be attached to the arm or elbow of the accoucheur, while the positive pole armed with a wet sponge is applied either over the fundus uteri or directed to the spine. The hand of the operator should now be introduced into the uterus, and the machine set in motion. The current enters at the fundus uteri, and passing through the hand and forearm of the operator completes the circuit at the negative pole. The action should be kept up some time, and gradually increased, the accoucheur directing with his fingers a stream of electricity to the various portions of the internal surface of the womb until contraction ensues, and the hand be expelled. When we reflect that electricity possesses the power of causing violent muscular contraction some hours after death, it is difficult to imagine a case where the stimulus of the "galvanic hand" would fail in producing such. salutary effect in the living subject, if properly and carefully applied. -
T
a.m
Stir
vnnr
obedient Kf.rva.Ttf.
CHARLES TAYLOR, M.D. To the Editor of THE LANCET. I be allowed to offer my experience on the preSIR,-May vention of post-partum haemorrhage in support of that of Mr. Lammiman’s, in your journal of Saturday last. My plan in every obstetric case is, whether I anticipate post-partum haemorrhage or not, to apply a shawl, folded cornerwise to about three or four inches wide, round the abdomen prior to the expulsion of the child, that it may be in readiness. As soon as the child is expelled, the shawl is tightened as far as the patient can bear, by straining the ends in opposite directions, and suddenly twisting them exactly over the uterus, and tucking the twist under, so that it might form a kind of tour. niquet pad pressing on the womb. I prefer this way of fasten’ ing the shawl to Mr. Lammiman’s plan of tying anything round the patient-first, because a greater amount of pressure can be more easily attained-; secondly, when properly twisted, the shawl never slackens; thirdly, a most effectual pad is at once at
hand. of the metropolitan hospitals are now I have attended more than 1000 obstetric cases during my urging- by advertisements in the daily papers each its claim for practice of twenty-two years, and never had the misfortune to preference as a school of medicine, will you allow me through lose a single case from post-partum haemorrhage, which I your journal to tender a word of advice to those who are un- mainly attribute to not overlooking this simple plan of predecided as yet in the choice of a medical school. vention. My father, too, adopted this plan during his thirtyF would advise the intending student, before attaching him- two years’ practice with equal success. self to any particular school, to examine for himself the mode I am, Sir, your obedient servant, of clinical instruction pursued in each. Self-dependence is- no H. B. CURTIS, M.R.C.S. doubt a very estimable quality, and it is true that a student should have recourse to his teacher more by way of supplementing the knowledge he has striven to obtain of any partiRAMBLING WORDS ON ARMY MEDICAL cular case; but, at the same time, it is rather discouraging to OFFICERS. the student to find his inquiries answered in such a- slurring To the Editor of THE LANCET. and impatient manner as I have frequently witnessed at the achool of medicine to which 1 belong. It is only fair to say SIR,-No men of fortune or, probably, of comparative indethat there are a few exceptions (one glorious one in particular), or men capable of influencing the destinies of the pendence, but the average character of the instruction is such as would nation, do, or ever will, enter the British Army in the capacity deter me from rendering myself again a victim to it, with my of medical officers. is the me "Noli interrogare prevailing present experience. Medical men in the Army are a.class by themselves, genemotto, and little is there of that earnest spirit which, admirable rally men who before have seen little of the world; they are in all, should, in my humble opinion, especially mark out the civilians clothed in the garb and living in the society of men of clinical teacher. war, but their thoughts and ideas are, or ought to be, about Hoping that these lines may catch the eye of some of those healing, not killing, although doubtless they do the latter now for whom they are intended, and that the hint may be of ser- and again. Sometimes, however, he of the lancet thinks himI am, Sir, your obedient servant, vice to them, not allowed, nearly as much entitled to draw self, although CANTAB. August, 1860. the sword, and wear the sash, as the combatant officer; forgetting that academical honours are his, rather than those of POST-PARTUM HÆMORRHAGE. chivalry. Many may think this a hard pill to swallow; howlet them answer themselves whether it is true or not. ever, To the Editor of THE LANCET. Strange indeed are medicos in their ideas. Almost all suffer SIR,-Will you allow me to suggest to those who may be from a species of ill-defined jealousy with regard to the officers interested in the discussion on "post-partum hsemorrhage," with whom they come in contact. Some attempt to bluster; which has recently occupied a place in your columns, one or it may make one smile, but still it is so. Others are painfully two methods of treating such accidents, that so far as I am sensitive and retiring. Some remain uncouth, either goodaware have not been hitherto employed, and which I conceive hearted, or puffed up with no small opinion of their conseworthy of attentionquence ; others remain gentlemen, generally somewhat sub-
Sm,--As several
222