Pharmacology and Therapeutics.

Pharmacology and Therapeutics.

PHARMACOLOGY AND THERAPEUTICS. 941 AN influential committee has been formed to presentibhe muscular fibres and thus to favour their contraction. fn ...

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AN influential committee has been formed to presentibhe muscular fibres and thus to favour their contraction. fn one case where a polypus was the cause of the hemorrhage, Mr. George Knottesford Fortescue, the late superintendentifter a fortnight’s treatment the tumour was extruded into of the reading-room of the British Museum, with bhe vagina, which had never occurred with other drugs preilluminated address expressive of the readers’ heartyviously tried. Twenty of the cases where erodium succeeded appreciation of the ability and courtesy which he everafter the failure of ergot and hydrastis were due to manifested in the performance of the duties of his office.metritis; but others were dependent on myoma and abortion. The committee would be very glad if any of the readers who The preparation used was an infusion made with 12 parts of water to 1 of the plants, to which a few drops of peppermint are disposed to contribute a small sum towards this purpose, were added to improve the taste. Of this a tablespoonful not exceeding 2s. 6d., would kindly send such contribution was prescribed every two hours. In no case were any unto the treasurer, Dr. Samuel Rawson Gardiner, or to the pleasant by-effects produced, though sometimes the medicine honorary secretary, the Rev. Dr. Samuel Kinns, at his private was continued for some weeks. The active principles of the are stated to be " an ethereal oil, a bitter principle address, 182, Haverstock-hill, Hampstead. There must be plant called geramin, and tannic acid. It has been used as an of our readers who will be to learn of the many glad astringent diuretic in dropsy."1 opportunity that is thus offered to them.



Jevzykowski reports in the Noviny Lekarski ten cases MR. RICHARD BRAYN, L.R.C.P. Lond., M.R.C.S. Eng., of which he treated with the dried thyreoidin corpulence has been appointed Superintendent of the State Criminal manufactured by Merk with excellent results. This preparaLunatic Asylum, Broadmoor, in succession to Dr. Nicolson, tion was given in doses of from 5 to 8 grains per diem, of a thyroid gland from appointed a Lord Chancellor’s Visitor in Lunacy. Mr. Brayn 10 grains of it being the equivalent a medium-sized calf. It did not give rise to any unpleasant was a distinguished student and scholar at King’s College. such as have been noticed by some observers. In He has done much good work in Her Majesty’s prison service, by-effects one case, however, that of a patient with fatty degeneration having been medical officer to Parkhurst and Pentonville of the heart suffering from occasional attacks of an anginal prisons, assistant surgeon to Portsmouth and Millbank character, after some 300 5-grain doses had been taken, which prisons, and governor and medical officer to Her Majesty’s had reduced the weight about 251b., a considerable amount of dilatation of the left auricle was diagnosed and the Female Convict Prisons, Woking and Aylesbury. heart’s action was weakened; this state of things lasted for about a fortnight, but afterwards the patient completely THE Metropolitan Asylums Board has just issued its recovered and lost all tendency to anginal attacks. Speaking found that a very considerable expected report on the results from the use of anti- generally,ofDr. Jevzykowski was produced by the treatment, at all events toxin in diphtheria cases under treatment in the hospitals decrease weight the patients were willing to give up their previous habits under their control. The report, which is full of elaborate where of over-eating and over-drinking. In one case more than tables, reflects great credit upon the medical superintendents 401bs. were lost in two months, and in another 30 Ib. in three of the six hospitals by whom it is signed, for the statistics months. Dr. Jevzykowski also tried the dried thyreoidin in a and the conclusions arrived at are case of inveterate ichthyosis, the skin regaining its ordinary are well arranged character after five weeks’ treatment. When the judiciously moderate in tone and are free from any attempt was left off, however, the disease began to reappear thyreoidin ; another to overstate the case in favour of antitoxin. course of the remedy in increased doses again improved it, and when the patient was last seen there were no signs of any recurrence. MR. S. OSBORN, F.R.C.S., has put on the agenda SALICYLATB OF 1!IETIiYL ADMINISTERED BY CUTANEOUS paper for the next meeting of the Metropolitan Asylums ABSORPTION. Board, to be held on April llth, the following The facility with which the skin can absorb guaiacol has motion: " That a vote of thanks be given to the medical been shown to be very considerable, so that after painting superintendents of the metropolitan fever hospitals of the the surface with this substance no less than forty-five grains Board for their excellent report upon the use of Antitoxic of it have been recovered from the urine, a much larger dose Serum in the treatment of Diphtheria, which adds so materi- than could have been introduced into the system by means of the stomach. This fact led MM. Linossier and Lannois ally to the history of treatment in this disease as to be of Lyons to try the effect of administering an anti-rheumatic beneficial to the whole medical profession." drug-salicylate of methyl, the substance which forms ninetenths of the ordinary Wintergeen oil-in a similar manner. It becomes transformed into salicylate of soda in the AT a sessional meeting of the Sanitary Institute, to be blood and is eliminated by the urine in the form’ of held at the Parkes Museum on Wednesday, April 15th, a salicylic acid. It can also be detected in considerdiscussion will be opened by Dr. J. F. J. Sykes, medical able quantity in the fasces. The daily elimination takes officer of health for St. Pancras, on the Factory and Work- place in a regular manner during the course of treatment and no effect is on the skin by the applications. When shops Acts and the Powers and Duties of Sanitary Authorities sixty grainsproduced were painted on the surface of the thigh as much with regard to Workshops. as twenty grains of salicylic acid were recovered from the urine within twenty-four hours. Like guaiacol, salicylate of THE President of the Local Government Board has methyl is absorbed by the cutaneous surface in a state of as can be readily shown by surrounding the limb appointed Dr. Frederick St. George Mivart to the temporary vapour, with The method of application is a cylinder of wire gauze. medical inspectorship in his department which became the liquid is spread on the limb by means very simple : vacant by the promotion of Dr. Wheaton to permanent of a brush with or without the aid of a medicine dropper ; office. the part is then covered with a layer of oiled silk is or other impermeable tissue, over which cotton wool fastened, and the whole left undisturbed for four-and-twenty hours. Sixty grains can be rearlily applied in this way, but if a larger dose is desired some lint is rolled round the limb, which becomes saturated with it. The absorption appears to be retarded by mixing lard or vaseline with the salicylate BRODIUM CICUTARIUM IN 1-1-;E’NTORRHAGE. of methyl. The great advantage of administering medicines DR. KomoRovic-H, writing in the Yrach of Feb. 29th, by the skin is that there is less risk of disordering the states that he has made considerable use of "Hemlock stomach than is the case when they are introduced into that stork’s bill," erodium cicutarium, in uterine haemorrhage organ, but it is only possible to employ this method in the with excellent results, often after better known drugs, such case of drugs that are of a decidedly volatile nature. as ergot and hydrastis canadensis, had failed. He believes that the effect of the erodium is to increase the elasticity of 1 Sydenham Society’s Lexicon. Dr.


Pharmacology and Therapeutics.













CHAPTER XIV. Their Pe’l’sonal Ol’1lsades. -


Impersonal ’,

of HOIpital Reports. - k5peeli7iens of this Department in Early Numbers of THE LANCET.-

C/’ !SSeope -Dep
The these As has been indicated, Wakley now found himself with two avowed objects of attack-the administration of the metropolitan hospitals and the constitution of the Royal College of Surgeons of England-and against each he waged a relentless war. In the columns of THE LANCET he poured scorn upon the educational system by which the students were compelled to pay large fees to support hospital surgeons unable to teach them ; and upon the public meetings he held up to ridicule platforms a learned corporation which withheld from its members all the benefits it had been created to bestow. The personal or impersonal character of his attacks must be recognised because it was identical in either crusade. It would seem, on the one hand, that the College, being a corporation, was open to censure that was not personal, and that no grave want of taste could be discovered in the designation of its constitution and behaviour as corrupt, inept, and impertinent. The officers of the College had a charter whereby they were guided in the administration of its affairs, and while they conformed to their charter the hardest things that were said about the institution reflected in no way upon them personally. It would seem, on the other hand, that attacks upon hospital administration were compelled to be of a highly personal nature, inasmuch as they were bound to resolve themselves into reflections upon the surgical skill or intellectual grasp and verbal felicity of the gentlemen who operated or lectured as members of the various staffs. Wakley desired to treat both sets of abuses in the same way, clearly perceiving that they had a common origin in the want of unity and general apathy of the body of the medical profession. This body he desired to arouse to the two facts that their teachers failed in duty towards them, and that the College of which the majority of them were members mulcted them in fees but withheld from them all their rightful privileges. No one glancing over the columns of THE LANCET during its first decade will have a moment’s hesitation in deciding that Wakley, having to frame a method of indictment suitable to both sets of abuses, deliberately, even wantonly, chose the personal one always. Such an opinion would be wrong. His writings teemed with personalities, his speeches derived much of their point from the same element, but he tried in every way to preserve a middle course in his indictments of the Royal College of Surgeons and of hospital officials. Into his criticism of the corporation he certainly introduced much that almost amounted to personal abuse of individuals, while it would have been possible for him to deal with the legitimate complaints of the members of the College in a more abstract manner. But his reflections upon the administration in the hospitals were whenever feasible directed against systems, and although names were constantly introduced, and although personal remarks formed the basis of much of his fault-finding, yet it was the administration rather than the administrators that he designed to attack. Wakley, in fact, compromised, who




at certain


which means much, for he was the firm fee of compromise. He directed his reflections upon the College in many instances against the authorities by name, whilst more naturally he should have called the charter to account. He saw that to animadvert against the constitution of the College would not appeal to the minds of his audience sufficiently. Abuse of men was readily understood, but the drift of reproachful criticisms of a legal instrument was not so easy to follow. If his uncomplimentary speeches had only been aimed at the charter of the College no widespread agitation against the existent state of affairs would ever have sprung from them. But so personal a turn was not necessarily given to his reflections upon the administration of the metropolitan hospitals, for his readers could thoroughly appreciate what constituted good hospital management, and no point and piquancy were given to his strictures by the unnecessary introduction of names. It will be understood that Wakley’s two separate campaigns were conducted simultaneously in THE LANCET. For the purposes of this narrative his unrelenting criticism of the metropolitan hospitals is considered first, while his actions towards reform in the College of Surgeons will be described later, but it should be remembered that he was engaged in a double war all the time, for the feeling that he had foes on either side accounted for the fierceness of some of his onslaughts, and his perpetual air of watchfulness. The Hospital Reports which it was announced in the preface of the second volume of THE LANCET would give a true and unbiased record from week to week of the practice within the walls of the various metropolitan institutions were watched with apprehension by all concerned in the administration of the institutions. Repeatedly denying that there could be any other reason for desiring to preclude him from reporting the cases that came under treatment in the hospitals save fear-fear lest malpraxis should be exposed or mismanagement and nepotism be revealed-he persevered steadily in his announced intention. Week after week there appeared in THE LANCET elaborate accounts of operations, abstracts of clinical lectures and outspoken reflec. tions upon administrative details, every hospital in the metropolis receiving these unsolicited attentions, each being treated in exactly the same spirit-unceremoniously. Hos. pitals, said Wakley, are public places, supported by the piety and wealth of members of the public for the cure of their And as public places they shall have poorer brethren.

publicity. Wakley

had some difficulty at first in obtaining these He was himself a regular attendant at the Borough reports. and the author of many of the early reports of Hospitals operative procedures at their theatres, but he was most careful to make his survey of London practice from week to week a comprehensive one, so that he had to employ reporters to work for him. His difficulty in doing this was twofold. It was necessary that the man who reported for him should be thoroughly competent and privileged to go in and out of the wards at will. It was necessary also that he should be able to keep his identity unrevealed in view of the great opposition that had been manifested by many of the hospital surgeons to the publicity threatened for their work. Mr. Travers, for instance, had frankly told the students of the Borough Hospitals that he would urge the expulsion from the united classes of any student detected in supplying THE LANCET with reports of lectures or of operative proceedings, while Mr. Abernethy had expressed the senti. ments of himself and his colleagues at St. Bartholomew’s Hospital by terming the paid reporter of THE L.’ISCET "a hireling," and bidding him stand forth to receive back his fees, which the medical school declined to keep having 1 Chapters I., II., III., IV., V., VI., VII., VIII., IX., X, XI., XII., regard to their tainted source. But as against these facts the and XIII. were published in THE LANCET, Jan. 4th, 11th, 18th, and students recognised in THE LANCET a strong friend to their 25th, Feb. 1st, 8th, 15th, 22nd, and 29th, March 7th, 14th, 21st, and 28th respectively. cause, so that Wakley obtained many ofters of assistance