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MIDWIFERY FORCEPS
449 resut among the more difficult and more suitable cases belonging to the poor, and it can only be done by the ,sacriice of the really deserving objects amongst the poor. If the rich really wish to get into hospitals when suffering from disease, surely they can get up such institutions on the linited liability principle, where they might, as they ought to do, pay for the benefits they receive, even though those )enefits might be medical and surgical advice and .skill, pst as barristers, lawyers, and others would be if their advice were required. It is a question of daily hnad with the medical profession, and it is in no way comected with benevolence or philanthropy, and I am glad to find that the Master of the Ilolls has given a seasonalle and just definition of the word charitable" " in the eye of Bhe law. The paraphrase of the word "charitable," he says, "is the purpose of assisting people to something which the dmor intends shall be given to people which, in the opinion cf the donor, cannot, from poverty, be obtained without his assistance." I am,I am, Sirs, Sirs, yours yours truly, truly, E. CHESSHIRE, F.R.C.S., Consulting Surgeon to the Birmingham and Midland Eye Hospital. Birmingham, Fe.., 1889
paid
rn
r
P.S.—By a
,
recent number of the
Monning Post
1
see
that
has been held on a retired jeweller, who died, whilst under treatment for kidney disuse, in the University College Hospital. Such perversion of the uses for which hospitals ana other similar charitable medical institutions were founded must have the effect of bringing them into discredit, and I am assured, when tickets of admission are required, that thet poor now find great difficulty in obtaining them, while well-to-do people get them easily enough.
.an
inquest
MIDWIFERY
FORCEPS
To the Editors of THE LANCET. doubt if Mr. Blenkarne’s letters will convince .any of your readers of the " extreme utility " of his "invention," at least as an obstetrical instrument. What does his "invention" consist of ? Is it midwifery forceps, which date from the sixteenth century, or the design of shortening the upper blade by means ofa hinge in the handle, so as to facilitate its insertion without drawing the patient to the ’edge of the bed? This modification is, I believe, my original idea; the mechanism of the hinge itself was constructed by Mr. Coxeter under my direction (vide THE LANCET, March 5th, 187); I beg to substantiate all that I said in my letter of Feb. 2nd, but I took it for granted that the patient would be supposed to be lying in the usual obstetric position of this country .(one cannot go into details where space is so valuable). It must, however, be patent to all in this type of instrument that the handle-rigid to forward pressure, but flexing’’ backwards" in order to shorten the blade, without any obstacle to its action-must be practically superior to one which flexes ’ forwards," which will yield to forward pressure at a critical time, and which must come against the thighs of the patient at the moment of introduction. It is altogether a matter of choice or use as to which blade should be introduced first, but, as it is generally admitted that the right is the more difficult, I suggest that it is a good plan to overcome the main difficulty early in any operation, so that the succeeding steps may be rendered easy. As regards the photoof my instrument, which Mr. Blenkarne had so carefully taken, 1 still feel that it does not convey an accurate representation, and also that his " invention" is but a perversion of my design. I had no idea of the use to which Mr. Blenkarne intended to put my forceps when they were borrowed, but I wish him and his instrument all success. I am, Sirs, yours faithfully, WM. D. HASLAM. Mecklenburgh.square, Feb. 15th, 1889. * We cannot insert more letters on this subject.-ED. L
SIRS,—I
graph
THE BIRMINGHAM WORKHOUSE INFIRMARY. To the Editors of THE LANCET. SIRS,—All devotees of the Birmingham Workhouse Infirmary must feel an accumulating debt of gratitude to your journal for the masterly manner in which its plans and
arrangements have been dealt with and its defects and deficiencies explained. It is to be regretted that, as the outcome of nor even
this, amendments have
openly suggested
neither been initiated by the controllers
and discussed
of that vast institution. Now, as an outsider interested in this branch of work, I ask, Why?—and leave it to your readers to decide the source of obstruction, whether Local Government Board, guardians, ratepayeis (whom the latter represent), or the medical officers themselves. Delay is dangerous, and the guardians--when they state that, if after a trial the arrangements for medical attendance are found to be in any way wanting, they are prepared to increase it as may be necessary—appearto be complacently awaiting some serious fatality under the present system before taking the responsibility of adopting the course laid down in your leading article-viz., the increase of the medical staff. Though no very effectual remedial measure has been so far mooted, it would be ungenerous to ignore the efforts of Dr. Suckling to extenuate, and Mr. Tait to redress, the present mode of management. Dr. Suckling boldly defended and eulogised the organisation in its in a letter in your issue of Dec. 29th, but since the correspondence of Jan. 5th, which drew attention to the statements it contained, he has not, beyond referring to the "Christmasing" of the opening ceremony, proffered further information. Mr. Tait has made a proposal, which has been rejected, to introduce an honorary consulting staff (THE LANCET, Jan. 26th, p. 182). Now I believe the inaction of the guardians is in view of economy, and therefore suggest what seems to me an easy and practical solution of the difficulty, as these appointments are valued as fields of clinical experience more than for the emoluments attached to them. I venture to think that a staff of four visiting officers (with an honorarium of £100 a year)-i.e., an addition of two otlicers to the present staff-would work much more advantageously both for the institution and themselves, as by this means the total expense to the ratepayers be increased from i350 to £400 a year, or i50 a year would in all; and the patients would receive double the attention I am, Sirs, yours truly, they now have. A VISITING MEDICAL OFFICER. Feb. 20th, 1889. In above the letter, wedesire to state that %* publishing the willingness of medical men to take appointments of the nature indicated is no sufficient reason for the guardians to obtain medical services at less than their proper value. There is no ground for the exercise of charity in regard to the medical care of the sick in the Birmingham Infirmary, and the remuneration should be such as would properly compensate the holder of the omce for the demands made upon his time.-ED. L.
entirety
PARALYTIC DEFORMITY OF THE FOOT. To the Editors of THE LANCET. SIRS,—Mr. F. R. Fisher, in his article on the above subject in your issue of January 19th, speaking of Talipes Arcuatus, omits to mention a condition of slight calcaneus
that often coexists. It is somewhat doubtful whether this is secondary, the contraction of the plantar fascia eventually drawing down the heel; or primary, the dropping of the heel necessitating an increased arching of the foot to bring the front part upon the same level. From examination of a number of these cases, I am inclined to think that the latter is frequently the cause of the contraction, for I have noticed that the calf muscles of the affected legs are often less developed, and in such cases I have experienced the best results (after division of the plantar fascia) from the use of an instrument attached to the boot with a spring lock to prevent undue flexion of the foot for a considerable time, together with exercises and massage to the gastrocnemii, at the same time insisting on the ankle-joint being fixed by one hand supporting the heel during the necessary daily manipulations at the transverse I am, Sirs, yours faithfully, EDWARD L. FREER, Feb.l4th.l889. Hon. Surg. Roy. Orthopædic Hosp., Birmingham.
tarsal joint.
BRITISH MEDICAL TEMPERANCE
ASSOCIATION.-
The quarterly meeting was held on Tuesday, Feb. 26th, in the Medical Society’s rooms, Chandos-street. The president, Dr. 13. W. Richardson, showed Allen’s pump and injector. Dr. Walter Pearce then read a paper on Toxic Hysterical Paralysis, in which lie narrated three cases, one probably due to alcohol and one to bisulphide of carbon, characterised by hemiplegia or local paralysis with hemiansesthesia, and restriction of the field of vision. A discussion ensued.
paid
rn
r
P.S.—By a
,
recent number of the
Monning Post
1
see
that
has been held on a retired jeweller, who died, whilst under treatment for kidney disuse, in the University College Hospital. Such perversion of the uses for which hospitals ana other similar charitable medical institutions were founded must have the effect of bringing them into discredit, and I am assured, when tickets of admission are required, that thet poor now find great difficulty in obtaining them, while well-to-do people get them easily enough.
.an
inquest
MIDWIFERY
FORCEPS
To the Editors of THE LANCET. doubt if Mr. Blenkarne’s letters will convince .any of your readers of the " extreme utility " of his "invention," at least as an obstetrical instrument. What does his "invention" consist of ? Is it midwifery forceps, which date from the sixteenth century, or the design of shortening the upper blade by means ofa hinge in the handle, so as to facilitate its insertion without drawing the patient to the ’edge of the bed? This modification is, I believe, my original idea; the mechanism of the hinge itself was constructed by Mr. Coxeter under my direction (vide THE LANCET, March 5th, 187); I beg to substantiate all that I said in my letter of Feb. 2nd, but I took it for granted that the patient would be supposed to be lying in the usual obstetric position of this country .(one cannot go into details where space is so valuable). It must, however, be patent to all in this type of instrument that the handle-rigid to forward pressure, but flexing’’ backwards" in order to shorten the blade, without any obstacle to its action-must be practically superior to one which flexes ’ forwards," which will yield to forward pressure at a critical time, and which must come against the thighs of the patient at the moment of introduction. It is altogether a matter of choice or use as to which blade should be introduced first, but, as it is generally admitted that the right is the more difficult, I suggest that it is a good plan to overcome the main difficulty early in any operation, so that the succeeding steps may be rendered easy. As regards the photoof my instrument, which Mr. Blenkarne had so carefully taken, 1 still feel that it does not convey an accurate representation, and also that his " invention" is but a perversion of my design. I had no idea of the use to which Mr. Blenkarne intended to put my forceps when they were borrowed, but I wish him and his instrument all success. I am, Sirs, yours faithfully, WM. D. HASLAM. Mecklenburgh.square, Feb. 15th, 1889. * We cannot insert more letters on this subject.-ED. L
SIRS,—I
graph
THE BIRMINGHAM WORKHOUSE INFIRMARY. To the Editors of THE LANCET. SIRS,—All devotees of the Birmingham Workhouse Infirmary must feel an accumulating debt of gratitude to your journal for the masterly manner in which its plans and
arrangements have been dealt with and its defects and deficiencies explained. It is to be regretted that, as the outcome of nor even
this, amendments have
openly suggested
neither been initiated by the controllers
and discussed
of that vast institution. Now, as an outsider interested in this branch of work, I ask, Why?—and leave it to your readers to decide the source of obstruction, whether Local Government Board, guardians, ratepayeis (whom the latter represent), or the medical officers themselves. Delay is dangerous, and the guardians--when they state that, if after a trial the arrangements for medical attendance are found to be in any way wanting, they are prepared to increase it as may be necessary—appearto be complacently awaiting some serious fatality under the present system before taking the responsibility of adopting the course laid down in your leading article-viz., the increase of the medical staff. Though no very effectual remedial measure has been so far mooted, it would be ungenerous to ignore the efforts of Dr. Suckling to extenuate, and Mr. Tait to redress, the present mode of management. Dr. Suckling boldly defended and eulogised the organisation in its in a letter in your issue of Dec. 29th, but since the correspondence of Jan. 5th, which drew attention to the statements it contained, he has not, beyond referring to the "Christmasing" of the opening ceremony, proffered further information. Mr. Tait has made a proposal, which has been rejected, to introduce an honorary consulting staff (THE LANCET, Jan. 26th, p. 182). Now I believe the inaction of the guardians is in view of economy, and therefore suggest what seems to me an easy and practical solution of the difficulty, as these appointments are valued as fields of clinical experience more than for the emoluments attached to them. I venture to think that a staff of four visiting officers (with an honorarium of £100 a year)-i.e., an addition of two otlicers to the present staff-would work much more advantageously both for the institution and themselves, as by this means the total expense to the ratepayers be increased from i350 to £400 a year, or i50 a year would in all; and the patients would receive double the attention I am, Sirs, yours truly, they now have. A VISITING MEDICAL OFFICER. Feb. 20th, 1889. In above the letter, wedesire to state that %* publishing the willingness of medical men to take appointments of the nature indicated is no sufficient reason for the guardians to obtain medical services at less than their proper value. There is no ground for the exercise of charity in regard to the medical care of the sick in the Birmingham Infirmary, and the remuneration should be such as would properly compensate the holder of the omce for the demands made upon his time.-ED. L.
entirety
PARALYTIC DEFORMITY OF THE FOOT. To the Editors of THE LANCET. SIRS,—Mr. F. R. Fisher, in his article on the above subject in your issue of January 19th, speaking of Talipes Arcuatus, omits to mention a condition of slight calcaneus
that often coexists. It is somewhat doubtful whether this is secondary, the contraction of the plantar fascia eventually drawing down the heel; or primary, the dropping of the heel necessitating an increased arching of the foot to bring the front part upon the same level. From examination of a number of these cases, I am inclined to think that the latter is frequently the cause of the contraction, for I have noticed that the calf muscles of the affected legs are often less developed, and in such cases I have experienced the best results (after division of the plantar fascia) from the use of an instrument attached to the boot with a spring lock to prevent undue flexion of the foot for a considerable time, together with exercises and massage to the gastrocnemii, at the same time insisting on the ankle-joint being fixed by one hand supporting the heel during the necessary daily manipulations at the transverse I am, Sirs, yours faithfully, EDWARD L. FREER, Feb.l4th.l889. Hon. Surg. Roy. Orthopædic Hosp., Birmingham.
tarsal joint.
BRITISH MEDICAL TEMPERANCE
ASSOCIATION.-
The quarterly meeting was held on Tuesday, Feb. 26th, in the Medical Society’s rooms, Chandos-street. The president, Dr. 13. W. Richardson, showed Allen’s pump and injector. Dr. Walter Pearce then read a paper on Toxic Hysterical Paralysis, in which lie narrated three cases, one probably due to alcohol and one to bisulphide of carbon, characterised by hemiplegia or local paralysis with hemiansesthesia, and restriction of the field of vision. A discussion ensued.