- Email: [email protected]
OPERATIONS FOR STRICTURE.
of service. Of Bengal I know years ago so many annuities were given off that they went begging. Seniors entitled to them could not pay up their minimum; and some were obtained by men who had just served their seventeen years, and had a little money. Such a thing is little likely to happen again. Twentythree years would probably be about the average time of service when an annuity might be expected. Sir George speaks of the snows of Canada, which, with the Mediterranean stations, the Cape, Australia, &c., we consider to make the Queen’s service so desirable, in the same category with the swamps of Sierra Leone and the heats of the Indies. The swamps of Sierra Leone might be fairly matched by those of Arracan and other places in India as regards health; and, as for the heats of the Indies, it is because our whole period of .service is passed in India that the Company’s officers retire on full pay. And yet, after twenty-fiveyears’ service, our pension is only 15s. a day, being, however, not half pay nor full pay, but both together-the actual pay of a surgeon of twentyfive years’ service being, in India, 10s., on furlough, 10s. while, in Her Majesty’s service, it is 22s.-more than double. You indulge in some ingenious speculations as to the cause of the failure of the new system of competition. For myself, preferring fact to theory, 1 think no accidental circumstances so well explain the failure as the following table of pay :-
increasing according to length little; but that
some
6d.;
In India there are no staff-surgeons. In Bombay, of 192 medical officers, 137 are assistant-surgeons, and only 8 belong to a grade superior to that of surgeon. In Bengal, out of 373, only 15 have rank superior to that of surgeon. When we consider the disasters and mismanagement in the Crimea (often attributed to want of organization in the medical as well as in other departments), it is frightful to contemplate the mess that we should make of it were we to have a fighting campaign in India, or near India. A battle or two is all very well; we can manage that, as before, by denuding the country for hundreds of miles of everything in the shape of a doctor. Of the twenty-five years entitling to the pension of 15s. a day, twenty-two must have been passed in India in the actual performance of duty. Should a surgeon who has had his three years’ leave, go to some deadly climate like Arracan on duty, and again have sick leave, after twenty-five years’ service he could not retire on a pension of 15s. a day; thus being, as regards pension, worse off than his brother medico in Her Majesty’s service. But I am trespassing on your valuable space, and subscribe
myself,
obstruction, as nearly as possible in the situation and in the described, with an ordinary tenotomy knife, also with good result, and should be disposed to perform the operation manner
again on such a case presenting itself, dilatation having really completely failed. But I think any attempt of the kind posterior to the scrotum would be productive of greater danger than the operation as now performed by Mr. Syme on several grounds, while it could scarcely be considered less serious as It is certainly true that some strican operative procedure. tures presenting in the anterior part of the urethra are more obstinate and unyielding than those found in any other por. tion, and for such the practice referred to appears to be well adapted. I am Sir, your’s obediently, Wimpole-street, Sept.,
1855.
HENRY THOMPSON.
CRANIOTOMY AND THE FŒTAL HEAD. To the Editor of THE LANCET. SIR, -Having published several paperson the Practice of Midwifery in the Jourreal of the Provincial Association, particularly on craniotomy and the condition of the foetal head at the full period of gestation, and its effects on parturition, my attention was naturally led to Dr. Strange’s case in TIlE LANCET for August 25th, entitled, " On the Delivery by the Forceps of a the Head had been Opened in Three Living Child, after " previous Labours. Women with very contracted and distorted pelves will sometimes give birth to living and well-formed children without much difficulty. I have had in my practice two patients with very contracted and deformed pelves, and for one of them I had to perform the operation of craniotomy four times; nevertheless, on the 25th of January, 1852, she gave birth to a living and a tolerably firm child, without any unusual assistance from me; but on the 12th of July last, I was again called in, and had to open the head of a fine boy before the mother could be delivered. In the other instance, I had to reduce the head on three occasions, yet, with her fourth child, the woman had a very natural labour, and gave birth to a living child without the slightest assistance, and I was not in the bed-room five minutes before the child was born. The successful application of the forceps, and the happy result of Dr. Strange’s case, must be attributed to the state of the fœtal head. A highly ossified and unyielding skull would not have entered into the cavity of the pelvis, and could not have been encompassed within the grasp of the forceps. It isis the condition of the child’s head that renders the murderous operation of craniotomy necessary. I believe I am the first practitioner that directed the attention of the obstetric practitioner to the condition of the fcetal head at the full period of gestation, (see Journal of the Association, volume for 1853, p. 965.) I am, Sir, yours &c., GEO. KING. Bath, September, 1855. -
A GREY-HEADED ASSISTANT-SURGEON. ASSISTAN’r-SURGEON.
India, July, 1SS5.
OPERATIONS FOR STRICTURE. To the ECI2t09
DR. A. SMITH AND THE FACULTY OF PHYSICIANS AND SURGEONS OF GLASGOW.
of THE LANCET.
you give me space for a line or two in remark upon Mr. J. Z. Laurence’s suggestion respecting subcutaneous division of the stricture on Mr. Syme’s staff, in the " treatment of aggravated cases of impermeable stricture of the urethra."" I believe it is not very generally known that Mr. Syme formerly adopted this method in some cases of stricture which, although permeable, dilatation had proved inadequate to cure, and that he was soon led to substitute for it, on the grounds of danger from extravasation, his present well known method of down from the perineal surface upon and through the obstruction, excepting only in those cases where the stricture is situated in that part of the urethra which is anterior to the scrotum. In these he still, to the best of my belief, cuts through the stricture completely by subcutaneous incision, in order to avoid the formation of fistulous opening, which is so very prone to follow a, considerable wound of the urethra in that part of its course. The late Mr. Avery also, to my knowledge, performed that operation in two cases in which the stricture was situated within an inch and a half from the meatus, and had reason to be satisfied with the result. Some references to these cases have appeared in print, but I cannot at the present moment point out where they are to be found. Nearly two years ago I divided a very narrow and obstinate
SIR,-Will
cutting
234
[The following answer has been returned by Dr. Andrew Smith to the address of the Faculty of Physicians and Surgeons published in THE LANCET of July, page 134:-] Army and Ordnance
Medical Department,
August 13the,1855.
SIR,-I have-the honour to acknowledge the receipt of your communication of the 6th ultimo, setting forth the views and opinions of the Faculty of Physicians and Surgeons of Glasgow, in reference to the accusations which have been made against myself and the Medical Department of the Army since the commencement of the present war, and further acquainting mp that I had been elected an honorary fellow of the faculty by acclamation. The incessant efforts I made after I was informed that a war was imminent, m’y certain, gave me fair reason to expect that the Medical Department at least of the Army about to take the field, would be found fully provided, therefore, when The Times newspaper began to proclaim it as not only defective, but even the most defective of all the Departments, the disappointment was crushing; and had I not felt convinced that there could be no just grounds for the accusations which were made, assuming the measures I had recommended had been adopted, I should not. have been able to have borne up against the -obloquy which was cast on- me. The full convic-
increasing according to length little; but that
some
6d.;
In India there are no staff-surgeons. In Bombay, of 192 medical officers, 137 are assistant-surgeons, and only 8 belong to a grade superior to that of surgeon. In Bengal, out of 373, only 15 have rank superior to that of surgeon. When we consider the disasters and mismanagement in the Crimea (often attributed to want of organization in the medical as well as in other departments), it is frightful to contemplate the mess that we should make of it were we to have a fighting campaign in India, or near India. A battle or two is all very well; we can manage that, as before, by denuding the country for hundreds of miles of everything in the shape of a doctor. Of the twenty-five years entitling to the pension of 15s. a day, twenty-two must have been passed in India in the actual performance of duty. Should a surgeon who has had his three years’ leave, go to some deadly climate like Arracan on duty, and again have sick leave, after twenty-five years’ service he could not retire on a pension of 15s. a day; thus being, as regards pension, worse off than his brother medico in Her Majesty’s service. But I am trespassing on your valuable space, and subscribe
myself,
obstruction, as nearly as possible in the situation and in the described, with an ordinary tenotomy knife, also with good result, and should be disposed to perform the operation manner
again on such a case presenting itself, dilatation having really completely failed. But I think any attempt of the kind posterior to the scrotum would be productive of greater danger than the operation as now performed by Mr. Syme on several grounds, while it could scarcely be considered less serious as It is certainly true that some strican operative procedure. tures presenting in the anterior part of the urethra are more obstinate and unyielding than those found in any other por. tion, and for such the practice referred to appears to be well adapted. I am Sir, your’s obediently, Wimpole-street, Sept.,
1855.
HENRY THOMPSON.
CRANIOTOMY AND THE FŒTAL HEAD. To the Editor of THE LANCET. SIR, -Having published several paperson the Practice of Midwifery in the Jourreal of the Provincial Association, particularly on craniotomy and the condition of the foetal head at the full period of gestation, and its effects on parturition, my attention was naturally led to Dr. Strange’s case in TIlE LANCET for August 25th, entitled, " On the Delivery by the Forceps of a the Head had been Opened in Three Living Child, after " previous Labours. Women with very contracted and distorted pelves will sometimes give birth to living and well-formed children without much difficulty. I have had in my practice two patients with very contracted and deformed pelves, and for one of them I had to perform the operation of craniotomy four times; nevertheless, on the 25th of January, 1852, she gave birth to a living and a tolerably firm child, without any unusual assistance from me; but on the 12th of July last, I was again called in, and had to open the head of a fine boy before the mother could be delivered. In the other instance, I had to reduce the head on three occasions, yet, with her fourth child, the woman had a very natural labour, and gave birth to a living child without the slightest assistance, and I was not in the bed-room five minutes before the child was born. The successful application of the forceps, and the happy result of Dr. Strange’s case, must be attributed to the state of the fœtal head. A highly ossified and unyielding skull would not have entered into the cavity of the pelvis, and could not have been encompassed within the grasp of the forceps. It isis the condition of the child’s head that renders the murderous operation of craniotomy necessary. I believe I am the first practitioner that directed the attention of the obstetric practitioner to the condition of the fcetal head at the full period of gestation, (see Journal of the Association, volume for 1853, p. 965.) I am, Sir, yours &c., GEO. KING. Bath, September, 1855. -
A GREY-HEADED ASSISTANT-SURGEON. ASSISTAN’r-SURGEON.
India, July, 1SS5.
OPERATIONS FOR STRICTURE. To the ECI2t09
DR. A. SMITH AND THE FACULTY OF PHYSICIANS AND SURGEONS OF GLASGOW.
of THE LANCET.
you give me space for a line or two in remark upon Mr. J. Z. Laurence’s suggestion respecting subcutaneous division of the stricture on Mr. Syme’s staff, in the " treatment of aggravated cases of impermeable stricture of the urethra."" I believe it is not very generally known that Mr. Syme formerly adopted this method in some cases of stricture which, although permeable, dilatation had proved inadequate to cure, and that he was soon led to substitute for it, on the grounds of danger from extravasation, his present well known method of down from the perineal surface upon and through the obstruction, excepting only in those cases where the stricture is situated in that part of the urethra which is anterior to the scrotum. In these he still, to the best of my belief, cuts through the stricture completely by subcutaneous incision, in order to avoid the formation of fistulous opening, which is so very prone to follow a, considerable wound of the urethra in that part of its course. The late Mr. Avery also, to my knowledge, performed that operation in two cases in which the stricture was situated within an inch and a half from the meatus, and had reason to be satisfied with the result. Some references to these cases have appeared in print, but I cannot at the present moment point out where they are to be found. Nearly two years ago I divided a very narrow and obstinate
SIR,-Will
cutting
234
[The following answer has been returned by Dr. Andrew Smith to the address of the Faculty of Physicians and Surgeons published in THE LANCET of July, page 134:-] Army and Ordnance
Medical Department,
August 13the,1855.
SIR,-I have-the honour to acknowledge the receipt of your communication of the 6th ultimo, setting forth the views and opinions of the Faculty of Physicians and Surgeons of Glasgow, in reference to the accusations which have been made against myself and the Medical Department of the Army since the commencement of the present war, and further acquainting mp that I had been elected an honorary fellow of the faculty by acclamation. The incessant efforts I made after I was informed that a war was imminent, m’y certain, gave me fair reason to expect that the Medical Department at least of the Army about to take the field, would be found fully provided, therefore, when The Times newspaper began to proclaim it as not only defective, but even the most defective of all the Departments, the disappointment was crushing; and had I not felt convinced that there could be no just grounds for the accusations which were made, assuming the measures I had recommended had been adopted, I should not. have been able to have borne up against the -obloquy which was cast on- me. The full convic-