NEW TRANSFUSION APPARATUS.

417

New Inventions. GAITER SUPPORT FOR FLATFOOT AND TALIPES VALGUS. THIS support is one which I have used occasionally for some years in cases of flatfoot and talipes valgus. It consists of a gaiter of black kid reaching from the tubercle of the tibia to the malleoli, and lacing in front. Running the entire length of the inner side of the gaiter, and sewn into it, is a steel bar, from one-half to three-quarters of an inch in width. To the upper part of this bar a buckle is attached ; a piece of webbing passes round the ankle to the outer side, where one end is buttoned to the main band, and is continued under the hollow of the sole to the inner side, where a piece ,of stout black elastic is attached to it, and to the other end of the elastic a black kid strap, which is then buckled at the top of the gaiter. By this strap the elastic and webbing can be drawn up to the required pitch and altered at will. The advantages of this support are-(l) it can be fitted to any leg, and will keep its place however thin the leg may be; (2) the boots can be changed or slippers worn withFIG. 1.

FIG. 2.

out interfering with it ; (3) it is neat, and on casual observation looks like a high French boot ; and (4) in suitable cases it is very comfortable to the patient, the ’elastic acting as an artificial calcaneo-scaphoid ligament. The cases in which it will, I think, be found specially useful are those of flatfoot combined with a valgous condition, such as we find in delicate or rachitic children. It is also useful in some older patients, but in many the surgical sole Cases of valgus depending on answers all requirements. spasm of the peronei I find do better with the inner part of the sole and heel of the boot raised, the above appliance and also the surgical sole appearing in some cases to increase the spasm. The support has been made for me by Messrs. Ferris and Co. of Bristol. W. J. PENNY, F.R.C.S. Eng. C),iton

NEW TRANSFUSION APPARATUS. THE

apology

for

introducing this new transfusion profession is that if ever transfusion is to become a widely used means of saving life (threatened by haemorrhage) and alleviating the superreniBg distressing symptoms of certain toxic conditions of the b’o?d—e.g., diabetes, urasmia, and certain poisonsthe apparatus for its performance must be simple, compact,

apparatus

to the

and ready at hand. The many transfusion apparatus at present known to the profession, such as Professor Annandale’s and Dr. Herbert Spencer’s, are in themselves most excellent, but they are rarely ready at hand in an emergency, both on account of their size and complicated mechanism. A practitioner cannot be expected always to go about with a Spencer’s transfusion apparatus, and should the necessity for transfusion be indicated the patient is possibly dead before the apparatus can be obtained. The advantages claimed for this apparatus by Dr. L. J. G. Carré, who suggested it, are: 1, Its absolute simplicity. Transfusisn can be quite readily performed absolutely single-handed. He informs us that he has done so in a case of excessive collapse after severe post-partum haemorrhage. 2. Its compactness. Everything that can possibly be required for the safe and successful performance of the operation is immediately at hand. 3. The small size of the complete case, so that it is possible that it may serve as one of the invariab!e contents of the practitioner’s midwifery bag or the surgeon’s operating bag. A transfusion apparatus is always required on an emergency, and generally when the practoti"^e° y« ’ "1-.,5 prepared.. Im this apparatus he may always feel :’:’.1:; ,,13 ha3 with him often the last resource which will enable him to save life. Spencer’s transfusion bottle is essentially a hospital apparatus this is an apparatus rather adapted for the usa of the private practitioner. The case, which measures 2-2L in. by 32 in. by 7 in., is lined with a special leather, which will wash, so that the whole apparatus can be kept aseptic. Comprised in the case are all the instruments necessary for the performance of saline infusion-a metal-handled scalpel, a combined director and

aneurysm

forceps,

needle, a pair of scissors, a pair of Spencer Wells pair of dressing forceps, and silk. The case also six small glass tubes, each holding a drachm of

a

contains pure chloride of sodium.

In addition, there is a small celluloid funnel, attached to which is a piece of flexible rubber tube, which does not kink or collapse, this, again, ending in a glass cannula bent at an angle of 30°, bulbous at one end, over which the rubber tube fits tightly, tapering at the other, so that a vein is easily entered. The cannulas are supplied in three sizes. The apparatus is a very neat one, and should find a place amongst the instruments kept ready for emergencies in hospitals and in the midwifery bag of many practitioners. An advantage is undoubtedly possessed by having all the instruments together ; the majority, however, are contained in every surgeon’s dressing case, and greater call would probably be made for a small bag containing the celluloid funnel and its tubes and the chloride of sodium. tubes. The apparatus is made by Messrs. C. Wright and Co., 108, New Bond-street, W.

418

FEVER AND SMALL-POX HOSPITALS.

THE LANCET. LONDON: SATURDAY, FEBRUARY 16, 1895. THE reissue of a memorandum1 on isolation hospitals by the medical officer of the Local Government Board acquires some importance by reason of a greater amplification than heretofore of the conditions under which sanitary authorities may contemplate the erection of hospitals for the reception of patients suffering from small-pox. Apart from this the memorandum has undergone but little change. Its wording has been made to meet the provisions of the legislation of last session, the document being addressed to the new district councils, and the extremely useful plans by which it is

hospitals. Taking the total results over a series of eight years beginning in 1877, and including some half dozen different periods of small-pox prevalence in London, it was found that the percentage of houses round the Falham Small-pox Hospital in which small-pox had appeared was as follows : 30-1 within a quarter of a mile, 14-5 between a quarter and a half mile, 9 5 between a half mile and threequarters, and 4 6 between three-quarters of a mile and one mile. It was on the repetition of such results in the later portion of the period referred to that the Asylums Board evidently found it necessary by a series of stages to discontinue the attempt to treat small-pox in London, and the establishments down the Thames and near Dartford were the ultimate results of the decisions arrived at. And this change of procedure revealed in its results another piece of

experience bearing upon the influence of small-pox hospitals, only as diffusing infection, but of ensuring an increased illustrated have been slightly modified, but otherwise it is frequency of small-pox epidemics by reason of the frequency essentially the same document as heretofore. The small-pox of their operations in collecting together at one or more centres the occasional cases of that disease. In this way there question, however, deserves attention. On the issue some thirteen years ago of Mr. PowER’s came about a recurring concentration of the infection under well-known report on the diffusion of small-pox amongst circumstances that must now be regarded as often tending to the population resident around one of the small-pox the production of a poison having a special potency for hospitals of the Metropolitan Asylums Board the question spread. In fact, whereas during the sixteen years’ existence of this diff asion was regarded as of such importance that in London of the Asylums Board’s small-pox hospitals the a Royal Commission was appointed to inquire into the death-rate for small-pox was extremely high and outbursts whole subject. Amongst the conclusions at which that were frequent, it so happens that since those centres of Commission arrived we would recall the following : "That small- pox aggregation in the metropolis have been abandoned by some means or other the Asylums’ hospitals, in their the death-rate has been trivial in comparison with the present shape, cause an increase of small-pox in their previous one. The experience of the last three years has tended strongly neighbourhoods appears to us clearly established..." and "It is evidently of paramount importance that the areas to confirm the opinion that, whatever authorities may be of small-pox wards, as well as their administration, should able to do, there are conditions under which small-pox be rigorously separated from those of fever hospitals, and hospitals become a distinct danger to surrounding comfurther that their construction should be such as to reduce munities. Those who concur in this view not only within the smallest limits the chance of spreading infection." increase constantly in number, but they include the main It is, however, impossible to read that report without being ’, bulk of investigators of repute and acknowledged standing. convinced that the Commission were, as a body, disinclined ’ Some, indeed, whilst apparently accepting the conclusion, to believe that the mischief done by small-pox hospitals was have sought to show that the distance at which diffusion produced otherwise than by means of personal communica- of small-pox takes place is much more limited than many tions between the hospitals and the outside world, and their have supposed. Thus Dr. MATTHEWS of the Gore Farm attitude in this direction endorsed the contention of a Hospital, reporting on a single year’s experience of a number of the witnesses who had appeared before them, fever hospital, together with an asylum and schools, all notably the representatives of the Metropolitan Asylums of which lie about 1000 feet from a small-pox hospital, Board. The latter body, acting on the conclusion they had states that because no one to his knowledge conmaintained in this matter, soon set themselves to work in the tracted small-pox in any of the institutions in question determination to put an end to the spread of small-pox from there seems ...... sufficient evidence from this experienee their institutions by remodelling their administration and by for assuming that the diffusion of small-pox through laying down and enforcing regulations with a stringency the air does not extend to a distance of 1000 feet." and at a cost that could hardly have been effected by a body Not a word is said as to the condition of the school inmates less powerful and less wealthy in the financial and other as regards vaccination or as to the proportion of convaresources on which they could rely to carry out their lescents to total small-pox cases. The experience, even decisions. But, unfortunately, small-pox still went on if vaccination and convalescence be ignored, is a solitary spreading around their hospitals as it had done before; one, limited to a comparatively brief period ; and it is and not only so, but the rate of incidence of the disease negative. As such it will carry conviction to very few on the surrounding communities was regulated as formerly minds. It is also quite clear that any such view does by the differing proximity of the inhabitants to the small-pox not weigh with the authorities at Whitehall; for after a long period, in which evidence had been accumu1 On the Provision of Isolation Hospital Accommodation by Local Authorities, with plans. 1895. Eyre and Spottiswoode, East Harding- lating on the subject, they now lay down the following street, E.C.; John Menzies and Co., Edinburgh and Glasgow; Hodges, Figgis, and Co., Dublin. Price 1d. rules, which, though put in the form of advice, wi1 not

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