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DOUBLE DISLOCATION OF THE SHOULDERS.
94 bed. In the surgical wards, too, a gangrenous form has been rather suddenly assumed by indolent ulcers and traumatic lesions, due, it is believed, to the influenza microbe. The disease is also reported from Cesena and other towns on the Adriatic seaboard, while, notably at Spezia, it has appeared in a very characteristic, if not actually dangerous, form on the Mediterranean littoral. In all these places it seems to obey the law it has observed in the European cities where it has been most severe-to wit, a tendency to choose its victims among masses of the population living together under the same roof and the same sanitary conditions, such as garrisons, collegiate schools, and religious
confraternities. ___
ASPHALTE OR WOOD? A DISCUSSION has been going on in The Tinzes on the relative merits of the different systems of street paving, as estimated from sanitary, humanitarian, and economical points of view. Asphalte, wood, and macadam have each found warm supporters, and each has been denounced by the others. As a result of observation for a long series of years we have come to the conclusion that the wood paving, when carefully laid on a sufficient concrete foundation, is the most desirable. The asphalte is the cause of a much greater number of accidents to horses, and these attended with serious results; and as regards sanitary objections, it does not appear to be more free from them than wood paving. The latter affords a firmer footing for horses, although by no means so firm as macadam, and if properly watered and swept appears to be as free from objection on sanitary grounds as the others. Macadam has a considerable advantage in the way of foothcld, but in wet weather is very objectionable from the amount of mud ; in dry weather it is more dusty than the other two, and if this is obviated by watering it is apt to degenerate into a muddy condition. Blocks of granite are perhaps less liable to objection in some respects, but they are also very slippery when dry, and the noise caused by traffic on them is very distressing. From a careful consideration of the advantages and drawbacks we are disposed to think that wood paving is the most suitable for the London streets as regards health, comfort, and humanity. The question of expense we do not touch, as we have no data on which to found an opinion. -
SELF-MALTREATMENT. THOSE persons who believe in self-treatment would do well to note the finding of a coroner’.3 jury at an inquest lately held at St. Giles’s Court. Their investigation related to the death of a gentleman of middle age, once a naval surgeon, who, relying upon his professional knowledge, insisted on diagnosing and prescribing for himself, and would have no other adviser. Believing himself to be suffering from bronchitis, he accordingly applied such remedies as he thought suitable to his condition, and felt much better. Next morning he was found in bed lifeless. A post-mortem examination revealed the presence of fatty degeneration of the heart and acute pneumonia. Death was attributed to syncope consequent Comment on such a case is almost on these conditions. Here was an educated medical man, who, superfluous. could afford to dispense with the services he supposing of a brother practitioner, acted on this supposition, who when, judging by subjective symptoms, he believed himself to be better, was really very ill, and whose sudden death, it is probable, was largely if not entirely due to an error, scarcely avoidable, in the primary matter of diagnosis. If members of the medical profession cannot better carry out a system of self-treatment, the chances of success in this work possessed by the general public must
be ruinously small. The sad incident should impress on all who read it the patent fact that the first and chief essential in the work of healing is not a knowledge of drugs, but of disease. This no one can truly depend upon learning from self-examination, however careful. DOUBLE DISLOCATION OF THE SHOULDERS.
ON the 30tih ult., a man aged forty-five was admitted into the Royal Free Hospital under the care of Mr. Gant, suffering from double dislocation of the subcoracoid variety at both shoulder-joints. He had fallen, with others, from the top of an omnibus, when that vehicle was overturned, a short time before. It was the patient’s impression that he, in his fall, dislocated one shoulder-joint, and that a friend fell on the other shoulder, dislocating that also. Thedislocations were easily reduced. The number of these double displacements recorded is small, and nearly all are subcoracoid. They are generally produced by falling forwards from some height with the arms stretched out in front, the full force being received on the hands. Hamilton gives an example of this in the case of a coachman aged thirtyeight, who fell from a carriage. A case in which double
displacement was produced by a man, aged forty-three, falling into a cellar with the arms stretched out before him is recorded by Holmes, where the displacements were produced by the sudden and violent throwing upwards of the arms in the effort to save himself. More recently attention has been drawn to this rare occurrence by the cases recorded in the last issue of THE LANCET, and in which Sir Joseph Lister operated-the one, a man aged forty-seven, whose injuries were caused by a fall from a tree; and the other, a man aged twenty-three whose humeri were displaced during an epileptic fit. -
INFLUENZA AMONGST HORSES. Jan. 4th a brief account is the symptoms and treatment of given by Mr. Dollar of influenza which has been prevailing amongst horses in London during the last four months. A few well-marked cases occurred in August, but the disease did not prevail on a large scale till the middle of October. He found the treatment by sulphate of soda or magnesia, combined with nitrate of potash and some carminative, the most efficacious. He tried the stimulant treatment on a few horses, but with results so unfavourable that he found it necessary to discontinue it. As soon as the febrile stage has passed the administration of quinine is attended with marked benefit. Mr. Dollar points out the want of accurate information as regards " the causation, histology, or postmortem appearances"of this disease, and suggests the collection by the Royal Veterinary College of a sufficient number of carefully recorded observations to form a solid foundation of facts on which to base a successful system of treatment, and if possible of prevention. IK the
Veterinary Yecord of
THE ETIOLOGY OF DIPHTHERIA. DR. CHARLES WARxrn-oTOV EARLE. of Chicago, has been for some time past seeking evidence as to the influence of sewage and water pollution on the prevalence and severity of diphtheria, a subject which he brought before the Ninth International Medical Congress of Washington. The conclusions at which he has arrived are as follows : Diphtheria occurs in the mountains and prairies of the great new North-west with the same malignancy as in cities ; it takes place with equal virulence in vicinities remote from sewers : diphtheria once present, the inhabitants living on damp soil houses, or over cellars containing decomposing vegetables, or in proximity to manure heaps or poorly constructed sewers, seem to be subject to surroundings which increase
confraternities. ___
ASPHALTE OR WOOD? A DISCUSSION has been going on in The Tinzes on the relative merits of the different systems of street paving, as estimated from sanitary, humanitarian, and economical points of view. Asphalte, wood, and macadam have each found warm supporters, and each has been denounced by the others. As a result of observation for a long series of years we have come to the conclusion that the wood paving, when carefully laid on a sufficient concrete foundation, is the most desirable. The asphalte is the cause of a much greater number of accidents to horses, and these attended with serious results; and as regards sanitary objections, it does not appear to be more free from them than wood paving. The latter affords a firmer footing for horses, although by no means so firm as macadam, and if properly watered and swept appears to be as free from objection on sanitary grounds as the others. Macadam has a considerable advantage in the way of foothcld, but in wet weather is very objectionable from the amount of mud ; in dry weather it is more dusty than the other two, and if this is obviated by watering it is apt to degenerate into a muddy condition. Blocks of granite are perhaps less liable to objection in some respects, but they are also very slippery when dry, and the noise caused by traffic on them is very distressing. From a careful consideration of the advantages and drawbacks we are disposed to think that wood paving is the most suitable for the London streets as regards health, comfort, and humanity. The question of expense we do not touch, as we have no data on which to found an opinion. -
SELF-MALTREATMENT. THOSE persons who believe in self-treatment would do well to note the finding of a coroner’.3 jury at an inquest lately held at St. Giles’s Court. Their investigation related to the death of a gentleman of middle age, once a naval surgeon, who, relying upon his professional knowledge, insisted on diagnosing and prescribing for himself, and would have no other adviser. Believing himself to be suffering from bronchitis, he accordingly applied such remedies as he thought suitable to his condition, and felt much better. Next morning he was found in bed lifeless. A post-mortem examination revealed the presence of fatty degeneration of the heart and acute pneumonia. Death was attributed to syncope consequent Comment on such a case is almost on these conditions. Here was an educated medical man, who, superfluous. could afford to dispense with the services he supposing of a brother practitioner, acted on this supposition, who when, judging by subjective symptoms, he believed himself to be better, was really very ill, and whose sudden death, it is probable, was largely if not entirely due to an error, scarcely avoidable, in the primary matter of diagnosis. If members of the medical profession cannot better carry out a system of self-treatment, the chances of success in this work possessed by the general public must
be ruinously small. The sad incident should impress on all who read it the patent fact that the first and chief essential in the work of healing is not a knowledge of drugs, but of disease. This no one can truly depend upon learning from self-examination, however careful. DOUBLE DISLOCATION OF THE SHOULDERS.
ON the 30tih ult., a man aged forty-five was admitted into the Royal Free Hospital under the care of Mr. Gant, suffering from double dislocation of the subcoracoid variety at both shoulder-joints. He had fallen, with others, from the top of an omnibus, when that vehicle was overturned, a short time before. It was the patient’s impression that he, in his fall, dislocated one shoulder-joint, and that a friend fell on the other shoulder, dislocating that also. Thedislocations were easily reduced. The number of these double displacements recorded is small, and nearly all are subcoracoid. They are generally produced by falling forwards from some height with the arms stretched out in front, the full force being received on the hands. Hamilton gives an example of this in the case of a coachman aged thirtyeight, who fell from a carriage. A case in which double
displacement was produced by a man, aged forty-three, falling into a cellar with the arms stretched out before him is recorded by Holmes, where the displacements were produced by the sudden and violent throwing upwards of the arms in the effort to save himself. More recently attention has been drawn to this rare occurrence by the cases recorded in the last issue of THE LANCET, and in which Sir Joseph Lister operated-the one, a man aged forty-seven, whose injuries were caused by a fall from a tree; and the other, a man aged twenty-three whose humeri were displaced during an epileptic fit. -
INFLUENZA AMONGST HORSES. Jan. 4th a brief account is the symptoms and treatment of given by Mr. Dollar of influenza which has been prevailing amongst horses in London during the last four months. A few well-marked cases occurred in August, but the disease did not prevail on a large scale till the middle of October. He found the treatment by sulphate of soda or magnesia, combined with nitrate of potash and some carminative, the most efficacious. He tried the stimulant treatment on a few horses, but with results so unfavourable that he found it necessary to discontinue it. As soon as the febrile stage has passed the administration of quinine is attended with marked benefit. Mr. Dollar points out the want of accurate information as regards " the causation, histology, or postmortem appearances"of this disease, and suggests the collection by the Royal Veterinary College of a sufficient number of carefully recorded observations to form a solid foundation of facts on which to base a successful system of treatment, and if possible of prevention. IK the
Veterinary Yecord of
THE ETIOLOGY OF DIPHTHERIA. DR. CHARLES WARxrn-oTOV EARLE. of Chicago, has been for some time past seeking evidence as to the influence of sewage and water pollution on the prevalence and severity of diphtheria, a subject which he brought before the Ninth International Medical Congress of Washington. The conclusions at which he has arrived are as follows : Diphtheria occurs in the mountains and prairies of the great new North-west with the same malignancy as in cities ; it takes place with equal virulence in vicinities remote from sewers : diphtheria once present, the inhabitants living on damp soil houses, or over cellars containing decomposing vegetables, or in proximity to manure heaps or poorly constructed sewers, seem to be subject to surroundings which increase