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NINTH INTERNATIONAL MEDICAL CONGRESS
833 A MODIFIED FORM OF URETHROTOME. A LARGE majority of surgeons are agreed that internal division is the best treatment of many strictures of the urethra. Of the innumerable instruments for the performance of this operation which I have seen or have been able to find described, all of them, while possessing many good and ingenious qualities, have had also some one or more faulty features. My aim has been to combine in one instrument all the good and eliminate all the bad points. I do not claim for my instrument many original features, only that it possesses the merits and avoids the faults of its
predecessors.
That this instrument possesses the other qualities of a perfect urethrotome as given above will be seen from the following description. It. consists essentially of a jointed knife (A, fig. 1), which can be projected from a sheath (B) to regulated distances. This is effected by pressure on the button (c, figs. 1 and 2), which is continuous with the steel rod (E, fig. 2) tightly fitting the tube (F), the end of this rod being the knife (a), and the rod being reduced and tempered for a short distance from the knife. The other blade (b) also runs into a fine-tempered end-piece, which rests against the solid probe point, either straight (R) or curved (H"), which screws on at o.
The blades are withdrawn on removal of the
spring (x, Fig. 2). The extent of projection of the knives is regulated by the graduated wheel (L), turning
pressure by the
the screw (d), and held in place after setting to the required number (French gauge) by the spring wedge (c). The whole tube (F) carrying the knives is only slotted for a short distance, and the steel rod is squared and fitted to a square box at the point f, Fig. 2. To clean the instrument screw easily off H. Turn the milled head (c) until the two parts of the smallest calibre possible when the blades are sheathed; of the rod which are united by a screw at k, FIg. 2, (6) to be adapted to carry a guide bougie; and (7) to be are separated. The anterior part of the rod with the easily cleaned. The value of the first of these may not blades can then be drawn out at the end (o). The be apparent; but with one hand you have a much more spring box unscrews at m, Fig. 1. Fig. 3 is the condelicate sense of touch, which is all you have to rely upon ducting bougie, which can be screwed on at n, Fig. 1, in in this operation. Who would hold a probe or a catheter place of the probe point. The tube carrying the knife-rod with both hands? It is also advantageous to be able to is only slotted for two inches and a quarter, and is grasp and steady the urethra with the free hand. To attain thus rigid. The square socket at f, Fig. 2, prevents this the projection of the knives must be produced by flexion twisting of the knives. of the fingers, because this is more powerful than extension, The instrument has been most satisfactorily made for me and much more completely under our control-I presume in by Messrs. Hilliard and Son, Renf1eld-street. consequence of our habituation to use all instruments by the WM. JAS. FLEMING, M.D., There
seem
to
me
to be
required in
a
perfect
urethrotome
on
at least seven qualities—viz.: (1) to be used with one hand ; (2) to cut either from before back or from behind forward ; (3) to incise any part of the circumference of the urethra (4) to be regulated, so as to cut to any depth, even when the blades are out of sight in the urethra; (5) to be
aid of the flexor muscles.
NINTH INTERNATIONAL MEDICAL CONGRESS IN the section on Medical Climatology and Demography of the Congress to be held at Washington in September next, the following scheme of subjects for papers and discusions has been prepared :1. Importance of the study of climatology and demography in connexion with the science of medicine. 2. What constitute determinate climatic characteristics. 3. The effects of climate on the human race as manifested in local demographic conditions; and of the several elements of climate as shown by coincident meteorological, morbility, and mortality statistics. 4. The question of acclimation. 5. Relative advantages of mountain and seaside resorts for recuperative purposes and as palliative or curative in certain diseased states of the system-segregation versus aggregation of invalids at health stations. 6. The therapeutic value of natural mineral waters. 7. Accurate records of prevailing sickness in any community a necessary factor in
Surgeon to the Glasgow Royal Infirmary.
comprehensive system of vital statistics. The responsibility of Governments to amply supply their people with the climatic and vital statistics of their respective countries. 8. Collective investigation, apart from aiding the study of the natural history of disease, as contributive of numerical data having a demographic bearing—(1) as to the kinds and proportions of prevailing diseases; (2) as to the absolute amount of daily sickness and consequent loss of 9. Medical nomenclature considered time, occupation, &c. in its practical relations to vital statistics. 10. The melioration of demographic conditions effected by preventive medicine. Influence of the physical well-being of a population upon its economy. Offences against moral and any
civil law in their medical relations to stances.
demographic circum-
Albert L. Gibon, M.D., P. 0. Box 291, Vallejo, California, is president of this section; and Charles Denison, M.D., of Denver, Colorado; Isambard Owen, M.D., of Hertford-street, Mayfair, London; Dr. E. Bertherand, of Algeria; and Dr. A. Wernich, of Cöslin, Germany, are the secretaries.
THE PRACTICAL ELEMENT IN MEDICAL EDUCATION.
834
generate into something but little removed from drudgery, and very few parents outside our profession can be expected of medical
LONDON: SATURDAY, APRIL 23, 1887. -
Besides details practice, pupil may reasonably expect to be taught chemistry and physics, a little botany, and the rudiments of materia medica in his first year; and this should be secured, either by the practitioner being really able as well as willing to undertake these obligations, or by his seeing that an efficient teacher can be found within ready distance. Dispensing medicines and visiting ordinary cases are very important, but they should not occupy the whole time of a pupil between his leaving school and his entering at a hospital, if the pupilage is to extend over more than two or three months. Again, the more select in the status of the patients the practice may be, the less can the pupil learn, so that it is only in mining, factory, Poor-law, and similar large practices that he can gain the essentially practical knowledge of infantile and common diseases that is urged on him as a necessity. Dispensing and
to discriminate between the two extremes.
THE LANCET. (
a
THE deficiencies in the knowledge of the routine work of professional practice shown by our young practitioners fresh from the schools and from examinations, which have been so frequently referred to in our columns by ourselves and by numerous correspondents, were officially brought before the General Medical Council at its last session by Dr. GLOVBB, and a committee to consider the question was agreed to. He has reprinted as a small pamphlet the statement in which he introduced his resolution. Hospital practice is very unlike general practice, and it is evident that the success and value of a practitioner depends much more on his familiarity with everyday diseases and their treatment than on his making book-keeping are not now so formidable as in former days. exceptional diagnoses of phenomenal cases. How this Dispensing has been quite changed within late years. Alixroutine knowledge can be best obtained without materially tures, concentrated infusions, and pills are now largely used interfering with the general plan of his medical cur- according to set formulas, and have materially lightened the riculum is the question which is before the committee work which made great inroads on the time of the older for consideration, and everyone will agree on its importance. practitioners ; and anyone quickly learns to keep his books "A limited pupilage with a registered practitioner, and on his own plan and system. The proper writing of insistence on more clinical, therapeutical, and pathological prescriptions is another and a different matter, but we if this can be judiciously taught until late in a teaching and work at medical schools," are the remedies career, and it may be and should be made a suggested by Dr. GLOVER for this defect, and we hope the committee will be able to make some useful recomfeature in the instruction obtained from outmendations for the guidance of parents and teachers. The patient class-rooms. We would like to ask the comdifficulties, however, in framing any useful report are mittee to seriously weigh these arguments for and against early pupilage even for a limited time, and to take the greater than appears at first sight. In England, owingi to the non-enforcement at of of practitioners in the provinces and in the metrothe time an mainly present which was the and also of some of our younger teachers brought apprenticeship, Apothe-polis, formerly required by caries’ Society, medical education more and more tends under the new regime, as to whether six months de-
I
i question
thatstudent’s prominent
an opinions
up voted
to general practice spent between the second and medical school or recognised final examinations would not be a’ better alternative. hospital, and in Scotland this practice is almost universal, for in the quinquennium 1871-75 only seven students There are, however, objections to this course also, for it out of 1717 began their study elsewhere than at the would interfere with the regulations for resident appointUniversities. Any enforced pupilage would therefore ments in many medical schools, which are so valuable to entirely change Scotch medical education, and are there the student from every point of view; and if required to sufficient grounds for doing this ? Is the Scotch graduate assist in working a general practice at this period of his so far inferior to his compeers in England and Ireland in the curriculum a student would probably ask to be paid for practical details of his work that his methods of early study his services, instead of having to pay a premium as under must be radically changed? The average interval between the old apprenticeship system. To Dr. GLOVEB’s other the registered date of studentship and the date of a first suggestions for utilising country hospitals and workhouse qualification has been shown to be nearly five years, infirmaries as centres of medical education no objection although forty-five months only is the period insisted on whatever can be taken, and the difficulties surrounding by the Conjoint Examining Board in England; and no their practical application could be easily removed. We regulation can be adopted which will in any way lengthen hope that the committee will draw up a reasonable and this period of study without materially affecting the number workable scheme, so that the great advantages held out by of those who are desirous of entering the medical pro- the proposition may be realised to the medical student. fession. Pecuniary reasons alone will be sufficient to deter IN an article last week we commented on certain Bills many, otherwise well qualified, from studying for the prowhich have this session been introduced into Parliament, if fession an increased length of probationary study be required. Moreover, another factor besides the student mustand which have as their object the improvement of house be dealt with. The committee will have to judge whetherdrainage, but which take no heed of the many conditions every general practitioner is fitted for the duties involved in1connected with the dwelling which are also concerned in taking pupils. Pupilage with a scientific practitioner is thei prejudicing the health of the inmates. Professor CORFIELD greatest possible boon ; pupilage in other cases may de--has now brought before the profession other circumstances
to
a
commencement at
a
the
predecessors.
That this instrument possesses the other qualities of a perfect urethrotome as given above will be seen from the following description. It. consists essentially of a jointed knife (A, fig. 1), which can be projected from a sheath (B) to regulated distances. This is effected by pressure on the button (c, figs. 1 and 2), which is continuous with the steel rod (E, fig. 2) tightly fitting the tube (F), the end of this rod being the knife (a), and the rod being reduced and tempered for a short distance from the knife. The other blade (b) also runs into a fine-tempered end-piece, which rests against the solid probe point, either straight (R) or curved (H"), which screws on at o.
The blades are withdrawn on removal of the
spring (x, Fig. 2). The extent of projection of the knives is regulated by the graduated wheel (L), turning
pressure by the
the screw (d), and held in place after setting to the required number (French gauge) by the spring wedge (c). The whole tube (F) carrying the knives is only slotted for a short distance, and the steel rod is squared and fitted to a square box at the point f, Fig. 2. To clean the instrument screw easily off H. Turn the milled head (c) until the two parts of the smallest calibre possible when the blades are sheathed; of the rod which are united by a screw at k, FIg. 2, (6) to be adapted to carry a guide bougie; and (7) to be are separated. The anterior part of the rod with the easily cleaned. The value of the first of these may not blades can then be drawn out at the end (o). The be apparent; but with one hand you have a much more spring box unscrews at m, Fig. 1. Fig. 3 is the condelicate sense of touch, which is all you have to rely upon ducting bougie, which can be screwed on at n, Fig. 1, in in this operation. Who would hold a probe or a catheter place of the probe point. The tube carrying the knife-rod with both hands? It is also advantageous to be able to is only slotted for two inches and a quarter, and is grasp and steady the urethra with the free hand. To attain thus rigid. The square socket at f, Fig. 2, prevents this the projection of the knives must be produced by flexion twisting of the knives. of the fingers, because this is more powerful than extension, The instrument has been most satisfactorily made for me and much more completely under our control-I presume in by Messrs. Hilliard and Son, Renf1eld-street. consequence of our habituation to use all instruments by the WM. JAS. FLEMING, M.D., There
seem
to
me
to be
required in
a
perfect
urethrotome
on
at least seven qualities—viz.: (1) to be used with one hand ; (2) to cut either from before back or from behind forward ; (3) to incise any part of the circumference of the urethra (4) to be regulated, so as to cut to any depth, even when the blades are out of sight in the urethra; (5) to be
aid of the flexor muscles.
NINTH INTERNATIONAL MEDICAL CONGRESS IN the section on Medical Climatology and Demography of the Congress to be held at Washington in September next, the following scheme of subjects for papers and discusions has been prepared :1. Importance of the study of climatology and demography in connexion with the science of medicine. 2. What constitute determinate climatic characteristics. 3. The effects of climate on the human race as manifested in local demographic conditions; and of the several elements of climate as shown by coincident meteorological, morbility, and mortality statistics. 4. The question of acclimation. 5. Relative advantages of mountain and seaside resorts for recuperative purposes and as palliative or curative in certain diseased states of the system-segregation versus aggregation of invalids at health stations. 6. The therapeutic value of natural mineral waters. 7. Accurate records of prevailing sickness in any community a necessary factor in
Surgeon to the Glasgow Royal Infirmary.
comprehensive system of vital statistics. The responsibility of Governments to amply supply their people with the climatic and vital statistics of their respective countries. 8. Collective investigation, apart from aiding the study of the natural history of disease, as contributive of numerical data having a demographic bearing—(1) as to the kinds and proportions of prevailing diseases; (2) as to the absolute amount of daily sickness and consequent loss of 9. Medical nomenclature considered time, occupation, &c. in its practical relations to vital statistics. 10. The melioration of demographic conditions effected by preventive medicine. Influence of the physical well-being of a population upon its economy. Offences against moral and any
civil law in their medical relations to stances.
demographic circum-
Albert L. Gibon, M.D., P. 0. Box 291, Vallejo, California, is president of this section; and Charles Denison, M.D., of Denver, Colorado; Isambard Owen, M.D., of Hertford-street, Mayfair, London; Dr. E. Bertherand, of Algeria; and Dr. A. Wernich, of Cöslin, Germany, are the secretaries.
THE PRACTICAL ELEMENT IN MEDICAL EDUCATION.
834
generate into something but little removed from drudgery, and very few parents outside our profession can be expected of medical
LONDON: SATURDAY, APRIL 23, 1887. -
Besides details practice, pupil may reasonably expect to be taught chemistry and physics, a little botany, and the rudiments of materia medica in his first year; and this should be secured, either by the practitioner being really able as well as willing to undertake these obligations, or by his seeing that an efficient teacher can be found within ready distance. Dispensing medicines and visiting ordinary cases are very important, but they should not occupy the whole time of a pupil between his leaving school and his entering at a hospital, if the pupilage is to extend over more than two or three months. Again, the more select in the status of the patients the practice may be, the less can the pupil learn, so that it is only in mining, factory, Poor-law, and similar large practices that he can gain the essentially practical knowledge of infantile and common diseases that is urged on him as a necessity. Dispensing and
to discriminate between the two extremes.
THE LANCET. (
a
THE deficiencies in the knowledge of the routine work of professional practice shown by our young practitioners fresh from the schools and from examinations, which have been so frequently referred to in our columns by ourselves and by numerous correspondents, were officially brought before the General Medical Council at its last session by Dr. GLOVBB, and a committee to consider the question was agreed to. He has reprinted as a small pamphlet the statement in which he introduced his resolution. Hospital practice is very unlike general practice, and it is evident that the success and value of a practitioner depends much more on his familiarity with everyday diseases and their treatment than on his making book-keeping are not now so formidable as in former days. exceptional diagnoses of phenomenal cases. How this Dispensing has been quite changed within late years. Alixroutine knowledge can be best obtained without materially tures, concentrated infusions, and pills are now largely used interfering with the general plan of his medical cur- according to set formulas, and have materially lightened the riculum is the question which is before the committee work which made great inroads on the time of the older for consideration, and everyone will agree on its importance. practitioners ; and anyone quickly learns to keep his books "A limited pupilage with a registered practitioner, and on his own plan and system. The proper writing of insistence on more clinical, therapeutical, and pathological prescriptions is another and a different matter, but we if this can be judiciously taught until late in a teaching and work at medical schools," are the remedies career, and it may be and should be made a suggested by Dr. GLOVER for this defect, and we hope the committee will be able to make some useful recomfeature in the instruction obtained from outmendations for the guidance of parents and teachers. The patient class-rooms. We would like to ask the comdifficulties, however, in framing any useful report are mittee to seriously weigh these arguments for and against early pupilage even for a limited time, and to take the greater than appears at first sight. In England, owingi to the non-enforcement at of of practitioners in the provinces and in the metrothe time an mainly present which was the and also of some of our younger teachers brought apprenticeship, Apothe-polis, formerly required by caries’ Society, medical education more and more tends under the new regime, as to whether six months de-
I
i question
thatstudent’s prominent
an opinions
up voted
to general practice spent between the second and medical school or recognised final examinations would not be a’ better alternative. hospital, and in Scotland this practice is almost universal, for in the quinquennium 1871-75 only seven students There are, however, objections to this course also, for it out of 1717 began their study elsewhere than at the would interfere with the regulations for resident appointUniversities. Any enforced pupilage would therefore ments in many medical schools, which are so valuable to entirely change Scotch medical education, and are there the student from every point of view; and if required to sufficient grounds for doing this ? Is the Scotch graduate assist in working a general practice at this period of his so far inferior to his compeers in England and Ireland in the curriculum a student would probably ask to be paid for practical details of his work that his methods of early study his services, instead of having to pay a premium as under must be radically changed? The average interval between the old apprenticeship system. To Dr. GLOVEB’s other the registered date of studentship and the date of a first suggestions for utilising country hospitals and workhouse qualification has been shown to be nearly five years, infirmaries as centres of medical education no objection although forty-five months only is the period insisted on whatever can be taken, and the difficulties surrounding by the Conjoint Examining Board in England; and no their practical application could be easily removed. We regulation can be adopted which will in any way lengthen hope that the committee will draw up a reasonable and this period of study without materially affecting the number workable scheme, so that the great advantages held out by of those who are desirous of entering the medical pro- the proposition may be realised to the medical student. fession. Pecuniary reasons alone will be sufficient to deter IN an article last week we commented on certain Bills many, otherwise well qualified, from studying for the prowhich have this session been introduced into Parliament, if fession an increased length of probationary study be required. Moreover, another factor besides the student mustand which have as their object the improvement of house be dealt with. The committee will have to judge whetherdrainage, but which take no heed of the many conditions every general practitioner is fitted for the duties involved in1connected with the dwelling which are also concerned in taking pupils. Pupilage with a scientific practitioner is thei prejudicing the health of the inmates. Professor CORFIELD greatest possible boon ; pupilage in other cases may de--has now brought before the profession other circumstances
to
a
commencement at
a
the