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HOSPITAL OUT-PATIENT PRACTICE.
331
A
their seat of division by what is called the fourth method, two pins being used, and the bleeding stopped; there was a vessel in the scrotum also looped by the fourth method. This man lost more blood than usual, but Mr. Forster attributes this to his not being quite aware of the exact amount of compression required to stop the vessels of the cord. The same evening and the next day, all the patient knew of his operation was that he felt only as much pain as if he had cut his finger slightly. In forty-eight hours all the pins were removed, and
Mirror
OF THE PRACTICE OF
MEDICINE AND SURGERY IN THE
HOSPITALS OF LONDON. Nulla autem est alia pro certo noscendi via, nisi quamplurlinas et morborum et dissectionum historias, tum aliorum, tum proprias collectas habere, et inter se comparare.-MORGAGNI De Sed. et Caus. Morb., lib. iv. Proœemium.
GUY’S HOSPITAL.
COOPER
was no
’,
haemorrhage.
The second case was a woman about fifty years of age, with carcinoma of the right breast. The operation of removal was performed by Mr. Hilton. The parts were very vascular, and Mr. Cooper Forster applied two pins by the first method and These pins were all removed in five by the fourth method. twenty-four hours, without any bleeding. The woman had very sick from chloroform during the whole of that time, and consequently there had been considerable strain upon the tissues. The wires in this instance were not all removed at same time as the pins; they were, however, taken away the next day. I The third case was a child aged three years, at the Infirmary for Children, Waterloo-road, where Mr. Forster divided a cicatrix for a contraction of the elbow-joint after a burn ; one middle-sized artery, a branch of the radial, bled freely, and was looped by the fifth method, or Aberdeen twist-a proceeding which is evidently applicable to the extremities in prefer. to any other part.
been
CASES ILLUSTRATING THE ARREST OF HÆMORRHAGE BY ACUPRESSURE.
(Under the care of Mr.
there
FORSTER.)
the
THE recent publication of the excellent work of Drs. Keith and Pirrie on Acupressure will of necessity draw increased attention to the interesting subject, and we shall doubtless find the plan being largely practised in our hospitals. The book has the advantage of conveying a more correct and perfect manner of carrying out the proceeding than any that has yet appeared, backed as the work is by the details of a number of cases in which the process was used by the authors. We corwith Sir he James that has not dially sympathise Simpson been enabled himself to put in practice his original idea, but we think he may safely leave the matter in surgical hands, and rest assured that, as the originator of the plan, due honour will be awarded him. The practical working of the process has been thoroughly tested by Drs. Pirrie and Keith, to whom we consider no small thanks are owing for the patient trial they have made during the last year, and for the boldness they have shown in carrying to a satisfactory issue what was at first I but an experiment. We have more than once recorded cases in which Sir Wm. ’, Fergusson, at King’s College, and Mr. Berkeley Hill, at University College, have successfully applied Sir James Simpson’s process. It is certain, however, that the practice has not generally received the attention which was its due no less from its apparent utility than on account of the merit of its distin-
ence
guished originator.
We trust that many of the surgeons of
least, who have
London-those, at
given acupressure a trial, will now do so, with a view of testing whether the prospective advantages of the plan-viz., adhesive union of -wounds, so common a result not
in Scotland-must not be attributed rather to the plastic powers of the patient than to the absence of a foreign body such as a ligature from the wound. Of the capability of acupressure to arrest hæmorrhage there can be no doubt. Mr. Cooper Forster, we believe, has lately seen the practice of acupressure fairly carried out by Drs. Keith and Pirrie. He speaks most warmly of it as a rapid means of arresting haemorrhage; as neat, and easily adopted; as requiring, of course, some little manipulative skill, but easily acquired; as most useful where the surgeon is short-handed-in country practice, for instance; and as a means of getting rid of those offensive setons which hang out of all wounds for several days after an operation. Indeed, so satisfied is Mr. Forster with the process, that he states it is not his intention to use ligatures for the arrest of hemorrhage when the objectof obtaining primary union in a wound is desired. Through the kindness of Messrs. Cock and Hilton, Mr. Forster has been enabled to test the practice of acupressure at Guy’s Hospital; and we give the following cases of the proceeding in the more difficult forms, as Mr. Forster looks upon the practice in amputations as comparatively easy, owing to the vessels to be compressed all running from one direction. The first case was a man aged fifty-four, who was suffering from medullary cancer of the right testicle, which Mr. Cock was about to remove. Previous to the removal, Mr. Forster passed a long pin under the cord, and secured both by a wire outsidethe skin. The operation was then proceeded with by illr. Cock, and the cord divided, when bleeding occurred from the spermatic artery, the pin not having been tightly enough secured, The divided artery or arteries were then looped at
again
HOSPITAL OUT-PATIENT PRACTICE. THERE
are a
number of disorders which
are
often classed
amongst minor ailments, and for that reason perhaps escape the amount of attention which they deserve. For it is certain that the ordinary run of practice amongst private patients is represented (where there is anything the matter at all) by illness of this description. And a wonderful amount of annoyance and anxiety is often entailed upon a practitioner by the failure in a particular case of those measures of relief which he usually finds successful. It becomes then a matter of no small consequence to him that he should be acquainted with other methods of treatment which have been found useful in competent hands. The out-patient department of our hospitals presents a very large field for experience in the use of various remedies. It is a field, indeed, which is sometimes only too large, the number of patients to be seen preventing that accuracy of notation which is always desirable. But even where this is the case a prescriber cannot go on for a very long time treating an every-day ailment without receiving strong impressions as regards the superiority of one method of treatment over another. It is upon impressions of this kind that we are constantly called upon to act in private practice, and, as every one’s experience will tell him, frequently with no small satisfaction to our patients. It is for this reason that we present our readers this week with a comparative view of the mode of treating a very common malady in several of our most important metropolitan hospitals. We have to thank the eminent surgeons, whose names are quoted, for permitting us the opportunity of supplying information which will doubtless be of general utility. We propose, by the courtesy of the hospital staffs, to deal on future occasions with other ailments, equally small and often equally embarrassing to the medical man.
GONORRHŒA IN THE MALE. GUY’S HOSPITAL. Mr. Bryant tells us that he finds no treatment so successful as the alkaline. He gives the tartrate of potash in scruple or half-drachm doses three or four times a day; and in cases that have passed through the acute stage, in which want of power exists, he combines the alkali with the potassio-tartrate of iron. In many cases of chronic gonorrhoea the tincture of the muriate of iron as a medicine acts very beneficially. The treatment of clap by injections Mr. Bryant has found very unsatisfactory. He finds that it is uncertain in its action, and at times prejudicial, the carelessness of hospital patients
than anything else rendering the practice inefficacious. Some years since he gave an extensive trial to frequent injections of some slight astringents, such as alum, in the proportions of
more
A
their seat of division by what is called the fourth method, two pins being used, and the bleeding stopped; there was a vessel in the scrotum also looped by the fourth method. This man lost more blood than usual, but Mr. Forster attributes this to his not being quite aware of the exact amount of compression required to stop the vessels of the cord. The same evening and the next day, all the patient knew of his operation was that he felt only as much pain as if he had cut his finger slightly. In forty-eight hours all the pins were removed, and
Mirror
OF THE PRACTICE OF
MEDICINE AND SURGERY IN THE
HOSPITALS OF LONDON. Nulla autem est alia pro certo noscendi via, nisi quamplurlinas et morborum et dissectionum historias, tum aliorum, tum proprias collectas habere, et inter se comparare.-MORGAGNI De Sed. et Caus. Morb., lib. iv. Proœemium.
GUY’S HOSPITAL.
COOPER
was no
’,
haemorrhage.
The second case was a woman about fifty years of age, with carcinoma of the right breast. The operation of removal was performed by Mr. Hilton. The parts were very vascular, and Mr. Cooper Forster applied two pins by the first method and These pins were all removed in five by the fourth method. twenty-four hours, without any bleeding. The woman had very sick from chloroform during the whole of that time, and consequently there had been considerable strain upon the tissues. The wires in this instance were not all removed at same time as the pins; they were, however, taken away the next day. I The third case was a child aged three years, at the Infirmary for Children, Waterloo-road, where Mr. Forster divided a cicatrix for a contraction of the elbow-joint after a burn ; one middle-sized artery, a branch of the radial, bled freely, and was looped by the fifth method, or Aberdeen twist-a proceeding which is evidently applicable to the extremities in prefer. to any other part.
been
CASES ILLUSTRATING THE ARREST OF HÆMORRHAGE BY ACUPRESSURE.
(Under the care of Mr.
there
FORSTER.)
the
THE recent publication of the excellent work of Drs. Keith and Pirrie on Acupressure will of necessity draw increased attention to the interesting subject, and we shall doubtless find the plan being largely practised in our hospitals. The book has the advantage of conveying a more correct and perfect manner of carrying out the proceeding than any that has yet appeared, backed as the work is by the details of a number of cases in which the process was used by the authors. We corwith Sir he James that has not dially sympathise Simpson been enabled himself to put in practice his original idea, but we think he may safely leave the matter in surgical hands, and rest assured that, as the originator of the plan, due honour will be awarded him. The practical working of the process has been thoroughly tested by Drs. Pirrie and Keith, to whom we consider no small thanks are owing for the patient trial they have made during the last year, and for the boldness they have shown in carrying to a satisfactory issue what was at first I but an experiment. We have more than once recorded cases in which Sir Wm. ’, Fergusson, at King’s College, and Mr. Berkeley Hill, at University College, have successfully applied Sir James Simpson’s process. It is certain, however, that the practice has not generally received the attention which was its due no less from its apparent utility than on account of the merit of its distin-
ence
guished originator.
We trust that many of the surgeons of
least, who have
London-those, at
given acupressure a trial, will now do so, with a view of testing whether the prospective advantages of the plan-viz., adhesive union of -wounds, so common a result not
in Scotland-must not be attributed rather to the plastic powers of the patient than to the absence of a foreign body such as a ligature from the wound. Of the capability of acupressure to arrest hæmorrhage there can be no doubt. Mr. Cooper Forster, we believe, has lately seen the practice of acupressure fairly carried out by Drs. Keith and Pirrie. He speaks most warmly of it as a rapid means of arresting haemorrhage; as neat, and easily adopted; as requiring, of course, some little manipulative skill, but easily acquired; as most useful where the surgeon is short-handed-in country practice, for instance; and as a means of getting rid of those offensive setons which hang out of all wounds for several days after an operation. Indeed, so satisfied is Mr. Forster with the process, that he states it is not his intention to use ligatures for the arrest of hemorrhage when the objectof obtaining primary union in a wound is desired. Through the kindness of Messrs. Cock and Hilton, Mr. Forster has been enabled to test the practice of acupressure at Guy’s Hospital; and we give the following cases of the proceeding in the more difficult forms, as Mr. Forster looks upon the practice in amputations as comparatively easy, owing to the vessels to be compressed all running from one direction. The first case was a man aged fifty-four, who was suffering from medullary cancer of the right testicle, which Mr. Cock was about to remove. Previous to the removal, Mr. Forster passed a long pin under the cord, and secured both by a wire outsidethe skin. The operation was then proceeded with by illr. Cock, and the cord divided, when bleeding occurred from the spermatic artery, the pin not having been tightly enough secured, The divided artery or arteries were then looped at
again
HOSPITAL OUT-PATIENT PRACTICE. THERE
are a
number of disorders which
are
often classed
amongst minor ailments, and for that reason perhaps escape the amount of attention which they deserve. For it is certain that the ordinary run of practice amongst private patients is represented (where there is anything the matter at all) by illness of this description. And a wonderful amount of annoyance and anxiety is often entailed upon a practitioner by the failure in a particular case of those measures of relief which he usually finds successful. It becomes then a matter of no small consequence to him that he should be acquainted with other methods of treatment which have been found useful in competent hands. The out-patient department of our hospitals presents a very large field for experience in the use of various remedies. It is a field, indeed, which is sometimes only too large, the number of patients to be seen preventing that accuracy of notation which is always desirable. But even where this is the case a prescriber cannot go on for a very long time treating an every-day ailment without receiving strong impressions as regards the superiority of one method of treatment over another. It is upon impressions of this kind that we are constantly called upon to act in private practice, and, as every one’s experience will tell him, frequently with no small satisfaction to our patients. It is for this reason that we present our readers this week with a comparative view of the mode of treating a very common malady in several of our most important metropolitan hospitals. We have to thank the eminent surgeons, whose names are quoted, for permitting us the opportunity of supplying information which will doubtless be of general utility. We propose, by the courtesy of the hospital staffs, to deal on future occasions with other ailments, equally small and often equally embarrassing to the medical man.
GONORRHŒA IN THE MALE. GUY’S HOSPITAL. Mr. Bryant tells us that he finds no treatment so successful as the alkaline. He gives the tartrate of potash in scruple or half-drachm doses three or four times a day; and in cases that have passed through the acute stage, in which want of power exists, he combines the alkali with the potassio-tartrate of iron. In many cases of chronic gonorrhoea the tincture of the muriate of iron as a medicine acts very beneficially. The treatment of clap by injections Mr. Bryant has found very unsatisfactory. He finds that it is uncertain in its action, and at times prejudicial, the carelessness of hospital patients
than anything else rendering the practice inefficacious. Some years since he gave an extensive trial to frequent injections of some slight astringents, such as alum, in the proportions of
more