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DRY AND INFREQUENT WOUND DRESSING.
202 than it i-. at present." Inanswer to this, Ican only point out treatment of the sick through all the various epidemics the freedom of Scorland from small-pox, and I should wh’chhave invaded us during all those years. I need not hardly think you would wish better proof of the sucuess tellou, then, that I claim some consideration for my of our system. opinion on the various subjects connected with sanitary I shall be glad if this letter will in any way assist in maTters, though they may be antagonistic to the opinions of altering the views of the profes-inn in England so that others, as to the reckless systems of sewerage, S.-,c., advocated they may adopt the six mouth3’ limit instead uf three, which by many at the present day. I am sure would material1y assist in the continual In conclusion, I hope, Sir, you will give this letter the prosecutions in England, and in rapidly increasing the same publicity you have thought fit to give t the article in As a public officer I know that my popularity of the Toperation. your annotations. remain. Sir yours truly actions are open to criticism, and I have no wish to shirk JOHN R. HAMILTON, M.D. but I have a right to expect that that the criticism will’be truthful.
stopping
responsibility ;
DRY AND INFREQUENT WOUND DRESSING. To the Editor of THE LANCET. Edward SIR,-Dr. Thompson’s communication on Puffball and Dr. Lockhart Gibson’s on Salicylic Slk for Wound Dressing, in your current number, suggest a few observations on the principles underlying the treatment. Those materials have the common character of being dry and absorbent, and, in the case of the salicylic silk, it is especially noticed that the dressing was renewed infrequently, sometimes not until the twelfth or fifteenth day. The discussion on wound treatment has brought more more into prominence the value of infrequent dressing, on which the majority of surgeons are now agreed. Dry dressing is also gaining largely in favour. The value of rest is universally conceded, and of position rarely questioned. Pressure is also, though more slowly, winning the place it merits in surgical therapeutics; and I venture to think the time is not far distant, when general assent will be given to the proposition which I have repeatedly had the privilege of sustaining in these columns : "The majority of wounds heal rapidly and painlessly under dry and infrequent dressing, uniform gentle pressure, and absolute rest." I am. Sir. vours faithfullv. SAMPSON GAMGEE.
* * In addition to have received a local paper in which there is a letter from Dr. Pearson on Mr. Spear’s report in May last, and we have also received the subjoined -letter from Mr. Mathias. Taken together they are, in our opinion, confirmatory of the main points in Mr. Spear’s official report, on which we eommented. Mr. Mathias’s letter speaks for itself, and Dr. Pearson’s letter of May, in so far as it deals with matters referred to in our annotation, admits that the hospital is " insufficient" and "out of order," that "it is impossible to ascertain" the number of cases of fever, that it would be well if the Sanitary Authority could " rebuild the town," that it would be well if the cellar dwellings "could be closed as such," that " no one can deny that there is room for improvement in the scavenging," and that as regards sewerage he "would have none of it" until what amounts to perfection from an engineering point of view can be attained. The portions of our annotation in inverted commas, and to which Dr. Pearson objects, were quoted from the official report of the Local Government Board.ED. L.
"SANITARY STATE OF MARYPORT." To the Editor of THE LANCET.
To the Editor of THE LANCET. SIR,-In your annotation on the above subject in THE LANCET of July 22nd, after animadverting upon the wretched
and
SIR,-Amongst your annotations in THE LANCET of July 22nd, I find one on "The Sanitary State of Maryport," casting certain reflections upon me as the sanitary medical officer, to which, in justice to myself, I feel called upon to make some observations ; for I must tell you that the article is one series of misrepresentation from the beginning to the end. First, there was no typhus in April, 1881. In the next place, I never talked such nonsense as you have put between inverted commas. Neither was there one or two hundred cases of typhus ; for though suffering from the effects of an accident, and unable to attend myself, I am satisfied that nearly all the typhus cases were attended by Dr. Little, and therefore known to me. Again, the sanitary authority has a right to send fever patients to the infirmary, which is not above a rag-store, but is above an old unused malting-room, the floor of which is made of concrete, therefore it is impossible for the effluvia from any store
’
JOSEPH
PEARSON, M.D. the above letter from Dr. Pearson, we
___
condition of many of the dwellings in the town, and especially as to overcrowding, you express the hope that the case quoted by Mr. Spear, the Local Government Board Inspector, in connexion with that subject "may be an ex. whose sanitary condition ceptional one even in Maryport, " But I assure you, Sir, it is not seems almost incredible. the exception, but I might almost say the rule; there are scores of wretched tenements in Maryport entirely devoid of every requirement considered absolute necessities by any civilised community, where overcrowding exists to a shameful extent, and where common decency in regard to the separation of the sexes, in many cases, is not even observed. A correspondent in the Maryport Advertiser very recently, in calling attention to the general insanitary condition of the town, thus describes a case in point :-" In a former com. munication I alluded to the dangers of overcrowding now that such a large number of extra labourers employed at the new dock are residents in the town. I was forcibly struck a few days ago with the necessity that exists for the constant supervision and attention of the inspectors in that respect. In a house in Furnace-road, consisting of a kitchen and a bedroom, where the latter was not more than 10 ft. or 12 ft. square, a man and his wife and seven children, and a lodger, a labourer at the quarries, were sleeping ! The poor woman herself and one of her children were lying ill in one of the wretched beds, suffering, I have no doubt, judging from the symptoms, from typhoid fever, one of the other children having died a few days previously from the same complaint. Is not this a very sad and terrible condition of affairs, and can nothing be done to remedy or prevent its recurrence ? One would think that a man and his wife and seven children were enough, in all conscience, to sleep in a room of such dimensions, without taking lodgers ! And yet I have no doubt that there are nuiiiberles5 other cases equally sad and shocking if they were only made
to enter the wards; neither can the sewage from the infirmary percolate into any stores. Such are the misstatements of which I think you will agree with me that I have a right to complain. I am not here about to enter upon the sanitary question of the town ; for I have neither the time nor inclination at the present to do so; but I can say that it will compare in that respect with any town in Camberlaiad. That there is still a great deal to be done I know well ; but in my opinion such sensational writing as is contained in your article has a very great tendency to do a very great deal more harm than good, and would not, theretore, have been noticed by me if it had not appeared in the pages of THE LANCET. To show you that I am no tyro in the profession I must tell you that for about thirty-six years I have been the medical officer of the Maryport District of the Cockermouth Union, with a population of some 16,000. During all that time I have advised not only the guardians, but the trustees also, as to the carrying out of the various Orders in Council long before there was sanitary authority. Con- known." The same correspondent, in sequently, I have had to take a leading part in the care and
any
a
subsequent communication,
stopping
responsibility ;
DRY AND INFREQUENT WOUND DRESSING. To the Editor of THE LANCET. Edward SIR,-Dr. Thompson’s communication on Puffball and Dr. Lockhart Gibson’s on Salicylic Slk for Wound Dressing, in your current number, suggest a few observations on the principles underlying the treatment. Those materials have the common character of being dry and absorbent, and, in the case of the salicylic silk, it is especially noticed that the dressing was renewed infrequently, sometimes not until the twelfth or fifteenth day. The discussion on wound treatment has brought more more into prominence the value of infrequent dressing, on which the majority of surgeons are now agreed. Dry dressing is also gaining largely in favour. The value of rest is universally conceded, and of position rarely questioned. Pressure is also, though more slowly, winning the place it merits in surgical therapeutics; and I venture to think the time is not far distant, when general assent will be given to the proposition which I have repeatedly had the privilege of sustaining in these columns : "The majority of wounds heal rapidly and painlessly under dry and infrequent dressing, uniform gentle pressure, and absolute rest." I am. Sir. vours faithfullv. SAMPSON GAMGEE.
* * In addition to have received a local paper in which there is a letter from Dr. Pearson on Mr. Spear’s report in May last, and we have also received the subjoined -letter from Mr. Mathias. Taken together they are, in our opinion, confirmatory of the main points in Mr. Spear’s official report, on which we eommented. Mr. Mathias’s letter speaks for itself, and Dr. Pearson’s letter of May, in so far as it deals with matters referred to in our annotation, admits that the hospital is " insufficient" and "out of order," that "it is impossible to ascertain" the number of cases of fever, that it would be well if the Sanitary Authority could " rebuild the town," that it would be well if the cellar dwellings "could be closed as such," that " no one can deny that there is room for improvement in the scavenging," and that as regards sewerage he "would have none of it" until what amounts to perfection from an engineering point of view can be attained. The portions of our annotation in inverted commas, and to which Dr. Pearson objects, were quoted from the official report of the Local Government Board.ED. L.
"SANITARY STATE OF MARYPORT." To the Editor of THE LANCET.
To the Editor of THE LANCET. SIR,-In your annotation on the above subject in THE LANCET of July 22nd, after animadverting upon the wretched
and
SIR,-Amongst your annotations in THE LANCET of July 22nd, I find one on "The Sanitary State of Maryport," casting certain reflections upon me as the sanitary medical officer, to which, in justice to myself, I feel called upon to make some observations ; for I must tell you that the article is one series of misrepresentation from the beginning to the end. First, there was no typhus in April, 1881. In the next place, I never talked such nonsense as you have put between inverted commas. Neither was there one or two hundred cases of typhus ; for though suffering from the effects of an accident, and unable to attend myself, I am satisfied that nearly all the typhus cases were attended by Dr. Little, and therefore known to me. Again, the sanitary authority has a right to send fever patients to the infirmary, which is not above a rag-store, but is above an old unused malting-room, the floor of which is made of concrete, therefore it is impossible for the effluvia from any store
’
JOSEPH
PEARSON, M.D. the above letter from Dr. Pearson, we
___
condition of many of the dwellings in the town, and especially as to overcrowding, you express the hope that the case quoted by Mr. Spear, the Local Government Board Inspector, in connexion with that subject "may be an ex. whose sanitary condition ceptional one even in Maryport, " But I assure you, Sir, it is not seems almost incredible. the exception, but I might almost say the rule; there are scores of wretched tenements in Maryport entirely devoid of every requirement considered absolute necessities by any civilised community, where overcrowding exists to a shameful extent, and where common decency in regard to the separation of the sexes, in many cases, is not even observed. A correspondent in the Maryport Advertiser very recently, in calling attention to the general insanitary condition of the town, thus describes a case in point :-" In a former com. munication I alluded to the dangers of overcrowding now that such a large number of extra labourers employed at the new dock are residents in the town. I was forcibly struck a few days ago with the necessity that exists for the constant supervision and attention of the inspectors in that respect. In a house in Furnace-road, consisting of a kitchen and a bedroom, where the latter was not more than 10 ft. or 12 ft. square, a man and his wife and seven children, and a lodger, a labourer at the quarries, were sleeping ! The poor woman herself and one of her children were lying ill in one of the wretched beds, suffering, I have no doubt, judging from the symptoms, from typhoid fever, one of the other children having died a few days previously from the same complaint. Is not this a very sad and terrible condition of affairs, and can nothing be done to remedy or prevent its recurrence ? One would think that a man and his wife and seven children were enough, in all conscience, to sleep in a room of such dimensions, without taking lodgers ! And yet I have no doubt that there are nuiiiberles5 other cases equally sad and shocking if they were only made
to enter the wards; neither can the sewage from the infirmary percolate into any stores. Such are the misstatements of which I think you will agree with me that I have a right to complain. I am not here about to enter upon the sanitary question of the town ; for I have neither the time nor inclination at the present to do so; but I can say that it will compare in that respect with any town in Camberlaiad. That there is still a great deal to be done I know well ; but in my opinion such sensational writing as is contained in your article has a very great tendency to do a very great deal more harm than good, and would not, theretore, have been noticed by me if it had not appeared in the pages of THE LANCET. To show you that I am no tyro in the profession I must tell you that for about thirty-six years I have been the medical officer of the Maryport District of the Cockermouth Union, with a population of some 16,000. During all that time I have advised not only the guardians, but the trustees also, as to the carrying out of the various Orders in Council long before there was sanitary authority. Con- known." The same correspondent, in sequently, I have had to take a leading part in the care and
any
a
subsequent communication,