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MORTALITY IN PARIS AFTER AMPUTATION.
671 cylinders, on a small scale, correspond with boxes, large and the other small; a couple of candles are placed in the latter, (which is made air-tight by closing the glass sides,) and when the flames for want of oxygen are becoming weak, and ready to fail altogether, the cylinders are made to revolve, oxygen is driven into the smaller chamber, and the flames revive. The same experiment may be made upon a guinea-pig, or by driving smoke from the large to the smaller chamber. One great advantage of this ingenious and serviceable apparatus is, that by reversing the revolution of the cylinders, the impure air may be withdrawn from a room. We trust that the subject will be worked out, and that our charitable institutions may benefit by Lord Mountedgecombe’s system of ventilation. ing manner. two
The
one
Contemporary Medical Literature. SUBCUTANEOUS DIVISION OF THE COCCYGEAL ATTACHMENTS OF THE EXTERNAL SPHINCTER AND THE LEVATORES ANI FOR LACERATION OF SPHINCTER IN ONE CASE, AND PROLAPSUS ANI IN ANOTHER.
WE find this operation described in the " Guy’s Hospital for 1853, and cannot help thinking, from the results of the same, and the anatomical reasons given by the operator, that it might in similar cases be beneficially imitated. In the first case, the sphincter ani was, after delivery by the forceps, lacerated anteriorly, the rent extending through the perineum; and in the second, there was prolapsus of the uterus and rectum. Both cases did well; we subjoin Mr. Hilton’s letter to Dr. Lever, (the latter having had the obstetrical care of the
sharp-pointed knife was introduced through the skin on one side of the point or free extremity of the coccyx, about half or three-quarters of an inch from its end; it was then passed into the pelvis, between the concave surface of the coccyx and the rectum, special care being taken not to puncture the intestine; the cutting edge of the knife was now made to sweep over the
sides and end of the coccyx, so as to separate from it the coccygeal attachments of both the sphincter and levatores ani; the knife was then withdrawn through the same small opening by which it had been introduced ; scarcely any blood escaped at the wound, but a compress of lint supported by adhesive plaster was applied over it, to keep the parts quiet, and to the flow of blood. intercept " That the operation had accomplished its intention of detaching the muscles from the coccyx, was obvious enough, by examining with the finger upon the skin, the median line between the end of the coccyx and the posterior margin of the anus, the resistance which the muscles naturally give to pressure in that position had disappeared, and the anal aperture became retracted or drawn up into the pelvis. " During the time I had the opportunity of seeing the patients after the operations, I have no hesitation in saying they were much benefited by what had been done for them, so much so, that no further treatment was deemed necessary. How far the operation may have succeeded ultimately and persistently, " I do not know. Yours faithfully, ’’ ’JOHN JOHN HILTON. " 10, New Broad-street; October, 1853."
Reports"
patients. ) " MY DEAR LEVER,-I certainly think the cases of lacerated perineum are worth publishing, and I have great pleasure in sending to you a statement of the reasons which induced me to adopt the operation performed in each of the cases. As far as I know, such an operation had not been done before that period, 1848, with the purpose of relieving the distress and annoyance to which these patients were exposed, but in this opinion regarding the originality of the operation I may be wrong, if so, your better information will set me right. 0
"When you requested my assistance to determine what had best be done in a surgical direction, remembering that the levatores ani have one firm and fixed attachment to bone near the arch of the pubes, and another at the coccyx, and that the external sphincter ani might be regarded anatomically nearly in the same light in relation to its effects upon the injury to the perineum, and bearing in mind that all muscles contract towards their.more fixed point, no matter how that fixity of position may have been acquired, it occurred to me, if I could, by a simple and uncomplicated operation, disengage the coccygeal attachments of the levatores ani, I might allow them to retract the anal aperture and adjacent structures in a direction towards the pubes, as it were, to bury the perineal injury deeply in the pelvis, thus enabling the lower fibres of those muscles (which blend with the muscular parietes of the vagina, rectum, and perineum) to assume the office of a sphincter to the lacerated opening, by approximating the edges of it, and drawing it upwards toward the pubic arch. In reference to the external sphincter ani, I concluded that, by taking away or separating the coccygeal fixed point of that muscle, I should necessarily change the direction of its contractile power from the coccyx towards the vagina, and thence to the pubes; this I hoped would help to occlude the lacerated opening between the vagina and rectum. Whether I had reasoned rightly or not, the results were as satisfactory, and indeed more so, than I had anticipated. It seemed to myself, that two ulterior purposes might be held in view by such an operation; the first was to ascertain how much of complete relief could be afforded by an operation which promised to be altogether free from both the danger and the severity of the ordinary operation for such cases, and secondly, should no important immediate benefit be derived, it would certainly tend to the advantage of the patient, by putting the parts into a better state (by relaxing them, and so taking off tension) for the easy and perfect accomplishment of the usual but more formidable operation of paring the edges of the lacerated wound, and maintaining them in contact for a time by sutures. "The method of proceeding was as follows :-A narrow
CALOMEL AND QUININE IN TROPICAL FEVER.
There cannot be a doubt that if not calomel, yet certainly salivation, is an antidote to malarious fever. The instant a patient’s mouth is sore, the fever leaves him. The mercury produces not the slightest effect till then; but from that moment the disease vanishes as if charmed. The change is from death to life-from extremity of suffering to calm and comfort. Numerous instances, too, of the safety which salivation gives from the effects of the malarious poison, may be found in Dr. Johnson’s book, such as patients salivated for syphilis sleeping with impunity in places which were fatal to every one of their companions; and also many cases are on record of officers in India passing in a state of salivation by Dak, unharmed, through the most deadly jungles.......But since the discovery of the invaluable quinine, we have wanted a bold return to the practice of our forefathers; for in quinine we have all the qualities required. It is not a bulky medicine, and does not cause vomiting. It is a perfect antidote, and will cure all cases of malarious fever not otherwise hopeless, and it has no bad effect, like mercury, on the constitution. The gradual introduction of quinine in place of calomel has left our mortality by fever much the same as in former days; but by the expectant treatment for malarious dysentery, where quinine has not been substituted for salivation, the statistics of the General Hospital for twenty-five years, show that the mortality is actually double now what it was under the salivating treatment.Surgeon HARE ill EcLiztbury3a },[edicul and Surgical Journal. MORTALITY IN PARIS AFTER AMPUTATION.
Of the thousands who enter the numerous hospitals of Paris every year, statistics show that one-tenth never come out alive. I am not familiar with the statistics of the hospitals of the United States or Great Britain, but I have no idea that they tell so badly as this. I heard Professor Nelaton say, the other morning, that it had become a moral question with him, whether he ought to perform the operation of amputation of the leg or thigh at all, for of all of the amputations performed at this hospital, (la Clinique,) there have been but two czt2-es;all the rest havedied, and generally of purulent absorption. And he would not have it understood that this hospital was peculiar in this respect-all the other surgical clinics of Paris gave the same results. This frightful mortality demanded a complete reform in the management of hospitals.—-FrcA Correspondent of .New Jusey 1Iedícal Reloitcr.
DURHAM UNIVERSITY.—The DCRH.nr UNIVERSITY.—
University
of
Durham,
at
which has been lately held, have set the University seal to a petition to the House of Commons, praying that graduates in Medicine of the University of Durham may be included in any bill which may be introduced to entitle graduates of any University in the United Kingdom to the same privileges as those enjoyed by graduates in medicine of the Universities of Oxford and a
convocation,
Cambridge
’
The
one
Contemporary Medical Literature. SUBCUTANEOUS DIVISION OF THE COCCYGEAL ATTACHMENTS OF THE EXTERNAL SPHINCTER AND THE LEVATORES ANI FOR LACERATION OF SPHINCTER IN ONE CASE, AND PROLAPSUS ANI IN ANOTHER.
WE find this operation described in the " Guy’s Hospital for 1853, and cannot help thinking, from the results of the same, and the anatomical reasons given by the operator, that it might in similar cases be beneficially imitated. In the first case, the sphincter ani was, after delivery by the forceps, lacerated anteriorly, the rent extending through the perineum; and in the second, there was prolapsus of the uterus and rectum. Both cases did well; we subjoin Mr. Hilton’s letter to Dr. Lever, (the latter having had the obstetrical care of the
sharp-pointed knife was introduced through the skin on one side of the point or free extremity of the coccyx, about half or three-quarters of an inch from its end; it was then passed into the pelvis, between the concave surface of the coccyx and the rectum, special care being taken not to puncture the intestine; the cutting edge of the knife was now made to sweep over the
sides and end of the coccyx, so as to separate from it the coccygeal attachments of both the sphincter and levatores ani; the knife was then withdrawn through the same small opening by which it had been introduced ; scarcely any blood escaped at the wound, but a compress of lint supported by adhesive plaster was applied over it, to keep the parts quiet, and to the flow of blood. intercept " That the operation had accomplished its intention of detaching the muscles from the coccyx, was obvious enough, by examining with the finger upon the skin, the median line between the end of the coccyx and the posterior margin of the anus, the resistance which the muscles naturally give to pressure in that position had disappeared, and the anal aperture became retracted or drawn up into the pelvis. " During the time I had the opportunity of seeing the patients after the operations, I have no hesitation in saying they were much benefited by what had been done for them, so much so, that no further treatment was deemed necessary. How far the operation may have succeeded ultimately and persistently, " I do not know. Yours faithfully, ’’ ’JOHN JOHN HILTON. " 10, New Broad-street; October, 1853."
Reports"
patients. ) " MY DEAR LEVER,-I certainly think the cases of lacerated perineum are worth publishing, and I have great pleasure in sending to you a statement of the reasons which induced me to adopt the operation performed in each of the cases. As far as I know, such an operation had not been done before that period, 1848, with the purpose of relieving the distress and annoyance to which these patients were exposed, but in this opinion regarding the originality of the operation I may be wrong, if so, your better information will set me right. 0
"When you requested my assistance to determine what had best be done in a surgical direction, remembering that the levatores ani have one firm and fixed attachment to bone near the arch of the pubes, and another at the coccyx, and that the external sphincter ani might be regarded anatomically nearly in the same light in relation to its effects upon the injury to the perineum, and bearing in mind that all muscles contract towards their.more fixed point, no matter how that fixity of position may have been acquired, it occurred to me, if I could, by a simple and uncomplicated operation, disengage the coccygeal attachments of the levatores ani, I might allow them to retract the anal aperture and adjacent structures in a direction towards the pubes, as it were, to bury the perineal injury deeply in the pelvis, thus enabling the lower fibres of those muscles (which blend with the muscular parietes of the vagina, rectum, and perineum) to assume the office of a sphincter to the lacerated opening, by approximating the edges of it, and drawing it upwards toward the pubic arch. In reference to the external sphincter ani, I concluded that, by taking away or separating the coccygeal fixed point of that muscle, I should necessarily change the direction of its contractile power from the coccyx towards the vagina, and thence to the pubes; this I hoped would help to occlude the lacerated opening between the vagina and rectum. Whether I had reasoned rightly or not, the results were as satisfactory, and indeed more so, than I had anticipated. It seemed to myself, that two ulterior purposes might be held in view by such an operation; the first was to ascertain how much of complete relief could be afforded by an operation which promised to be altogether free from both the danger and the severity of the ordinary operation for such cases, and secondly, should no important immediate benefit be derived, it would certainly tend to the advantage of the patient, by putting the parts into a better state (by relaxing them, and so taking off tension) for the easy and perfect accomplishment of the usual but more formidable operation of paring the edges of the lacerated wound, and maintaining them in contact for a time by sutures. "The method of proceeding was as follows :-A narrow
CALOMEL AND QUININE IN TROPICAL FEVER.
There cannot be a doubt that if not calomel, yet certainly salivation, is an antidote to malarious fever. The instant a patient’s mouth is sore, the fever leaves him. The mercury produces not the slightest effect till then; but from that moment the disease vanishes as if charmed. The change is from death to life-from extremity of suffering to calm and comfort. Numerous instances, too, of the safety which salivation gives from the effects of the malarious poison, may be found in Dr. Johnson’s book, such as patients salivated for syphilis sleeping with impunity in places which were fatal to every one of their companions; and also many cases are on record of officers in India passing in a state of salivation by Dak, unharmed, through the most deadly jungles.......But since the discovery of the invaluable quinine, we have wanted a bold return to the practice of our forefathers; for in quinine we have all the qualities required. It is not a bulky medicine, and does not cause vomiting. It is a perfect antidote, and will cure all cases of malarious fever not otherwise hopeless, and it has no bad effect, like mercury, on the constitution. The gradual introduction of quinine in place of calomel has left our mortality by fever much the same as in former days; but by the expectant treatment for malarious dysentery, where quinine has not been substituted for salivation, the statistics of the General Hospital for twenty-five years, show that the mortality is actually double now what it was under the salivating treatment.Surgeon HARE ill EcLiztbury3a },[edicul and Surgical Journal. MORTALITY IN PARIS AFTER AMPUTATION.
Of the thousands who enter the numerous hospitals of Paris every year, statistics show that one-tenth never come out alive. I am not familiar with the statistics of the hospitals of the United States or Great Britain, but I have no idea that they tell so badly as this. I heard Professor Nelaton say, the other morning, that it had become a moral question with him, whether he ought to perform the operation of amputation of the leg or thigh at all, for of all of the amputations performed at this hospital, (la Clinique,) there have been but two czt2-es;all the rest havedied, and generally of purulent absorption. And he would not have it understood that this hospital was peculiar in this respect-all the other surgical clinics of Paris gave the same results. This frightful mortality demanded a complete reform in the management of hospitals.—-FrcA Correspondent of .New Jusey 1Iedícal Reloitcr.
DURHAM UNIVERSITY.—The DCRH.nr UNIVERSITY.—
University
of
Durham,
at
which has been lately held, have set the University seal to a petition to the House of Commons, praying that graduates in Medicine of the University of Durham may be included in any bill which may be introduced to entitle graduates of any University in the United Kingdom to the same privileges as those enjoyed by graduates in medicine of the Universities of Oxford and a
convocation,
Cambridge
’