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" ABDOMINAL SECTION IN CERTAIN CASES OF PELVIC PERITONITIS."
1356 THE SOLDIERS’ MESSINC. We are very glad to hear that means have been taken for spreading a practical knowledge of the new method of military cooking among the regiments and depots qnartered at various stations by sending the superintendent of the Army School of Cooking at Aldershot to inspect their cook-houses and appliances and to afford practical instruction in the Aldershot system, which is said to have given such general satisfaction at that camp. SICKNESS AMONG THE TROOPS IN NORTHERN INDIA. We have already alluded to the prevalence of sickness among the troops at Peshawar and to the removal of one regiment, the Royal Welsh Fusiliers, to Nowshera, about twenty-eight miles distant. Cherat, the nearest hill station to Peshawar, is also occupied by half a regiment from that garrison. At this season and during the autumn months Peshawar is frequently--we may say usually-unhealthy from the prevalence of a bad form of malarious fever. Removal from the Peshawar valley is often the only reliable remedy ; quinine and other drugs are of little or no avail as long as the affected men remain in the district. The Northumberland Fusiliers relieves the Royal Welsh Fusiliers at Peshawar, and the Royal Scots Fusiliers will be railed from that station to join the camp of exercise at Rawal Pindi.
ROYAL VICTORIA HOSPITAL, NETLEY. Sandhurst, Under Secretary of State for War, accompanied by his private secretary, visited the Royal Victoria Hospital last week, and went over the buildings and grounds with the principal medical officer of the district.
Lord
Cockspnr-strcet, on "How to Pack, How to to Keep Well on a Winter Tour in India." Its author is the lion. Mrs. Neville Lyttleton, and it sets forth various details in these directions which are likely to prove useful to ladies embarking for India. Its price is one shilling, and if the information contains nothing particularly new, it is of a rertdy practical kind and supplies hints and suggestions in regard to various points that might otherwise fail to be Mr. Stanford of
Dress, and How
..
remembered.
Correspondence. "Audi alteram
partem"
" ABDOMINAL SECTION IN CERTAIN CASES OF PELVIC PERITONITIS." To the Editors
of THE LANCET. SIRS,—Although present at the adjourned discussion at the Obstetrical Society on Dr. Cullingworth’s paper I was not prepared then to express an opinion on the many issues raised, but trust that the importance of the matters in dispute may be a sufficient excuse for trespassing on your valuable space in the form of a letter. Personally I think the title of the paper was unfortunate, grouping as it did several classes of pelvic disease, which, whether diagnosed before or after operation, ought to have been classified under their distinctive headings. Had Dr. Cullingworth in. stead confined his paper to the frequent connexion which
THE WOUNDS CAUSED BY SMALL-BORE BULLETS. Our service contemporary, the llruay and Navy Gazette of last week, published a communication from Veterinary’Captain Smith, the late professor of the Army Veterinary exists between inflammatory disease of the uterine ’’School, detailing the results of further experiments with the Lee-Metford bullet on the bones of the horse at ranges appendages and pelvic peritonitis, giving at the same fixed at every hundred yards-from 100 to 1000 yards. These time his views as to the value of abdominal section in those results are apparently mainly determined by differences in cases alone, a less discursive but much more valuable discusthe strength and resistant powers of the substance and sion would have been the result. At the present moment the structural arrangement of the bone at the part struck. From treatment of the above class of diseases may with fairness be ’.50 to 200 yards the effect is pulverising and destructive ; but called the burning question of the day in gynaecological from 300 to 1000 yards the effect is different, according circles ; and the reduction to plain well-defined lines of their ,to the part of the bone hit-that is to say, whether therapeusis would be conferring a real benefit upon the proit be the dense resistant substance of the shaft or fession at large. Some of the speakers seemed to look upon the cancellous spongy structure of the ends of the bone. ’, appendageal disease as a comparatively trifling malady, and In the former case, the shaft of the bone is shattered one which usually occasional rest, assisted by nature, would ’and fissured in all directions with much loss of sub- cure. No doubt a large number of these cases do get well under stance, and it makes but little difference as regards the ’destructive effect whether the bullet be fired at 50 or 1000 non-operative treatment, but not such as those described in yards. In the latter case, the bullet may only give rise to a Dr. Cullingworth’s paper, where the evidences of disease were ’hole in the spongy cancellous structure of the extremities of unmistakable and the lives of the patients imperilled by the the bone struck, which is sometimes perfectly clean, but fre- recurrent attacks of pelvic peritonitis. It is the so-styled ,quently fissured, the fissures extending or not into the joint. conservativefortreatment of such casesandwhich is directly If the extremity of the bone, as in the case of some of the responsible incomplete operations great mortality. bones of the extremities of a horse, consists more of compact Anyone who has had much experience of this kind of opera- than spongy structure, then the pulverising effect is produced tive work must have been compelled at times to stay his hand by reason of the extent and intimacy of visceral adhe’.and no clean hole is made. sions ; and yet, in the face of this, which is common experiTHE REMOVAL OF ST. GEORGE’S BARRACKS. ence, we are asked to believe that abdominal section is According to a contemporary St. George’s Barracks, indicated rarely only as a dernier ressort. That these Trafalgar-square, are to disappear, and the Guards from neglected cases kill is indisputable, although frequently the these barracks are to have new quarters built for them death certificate is differently worded. They are fertile pro’ We presume that the building now appro- ducers of intestinal obstruction, of septicaemia and general .at Millbank. for recruiting purposes at St. George’s Barracks and peritonitis, and, short of these, are responsible for more priated approached from the back of the square, will also disappear, invalidism in women than probably any other form of disease. .and it is quite time that it did so, for the very in- Much in the course of the debate was made of Dr. Cullingferior accommodation afforded for recruiting is not by any worth’s mortality, and Dr. Williams went so far as to say It seems to us that smart, that the death-rate of the series-viz , 18 per cent.-was not means of a creditable character. - airy and clean-looking rooms or offices, of a more attractive higher than that throughout the country in this class of kind than the old buildings, are required for this purpose, case, with a few exceptions. If so, it would be deterrent, and they should be in prominent positions and not hidden but it is far from the truth, as was abundantly proved by Dr. Cullingworth himself when speaking of his latest cases ,a,way in a sort of cul-de-sac or at the end of a back street. and others. Out of my last fifty cases I have lost two ROYAL MILITARY COLLEGE EXAMINATION. examination for The candidates for the competitive Sand- patients ; although in no case has an operation been hurst have been exceptionally numerous on this occasion and done without a clear history of recurrent inflammation, of appendageal disease and, unless in cases gave full occupation to the medical officers responsible for objective signs ’their preliminary physical examination. The candidates are urgently demanding operative relief, treatment for a suffistated to have numbered about 800 altogether, and as the cient period by rest This seems to me the truly conservative and that which is in accordance with the teachings cadetships to be competed for only amount to about 120, the treatment of modern surgery, and Dr. Cullingworth is to be congratulated will be severe. ,competition in having the courage to express so unequivocally his opinions. PRACTICAL HINTS FOR LADY TRAVELLERS TO INDIA. I am, Sirs, yours yoursfaithfully, faithfully, GEORGE ELDER, M.D. Glas. We have received copy of a small pamphlet published by Nottingham, Nov. 6TH, 1892, ,
Sirs,
.
ROYAL VICTORIA HOSPITAL, NETLEY. Sandhurst, Under Secretary of State for War, accompanied by his private secretary, visited the Royal Victoria Hospital last week, and went over the buildings and grounds with the principal medical officer of the district.
Lord
Cockspnr-strcet, on "How to Pack, How to to Keep Well on a Winter Tour in India." Its author is the lion. Mrs. Neville Lyttleton, and it sets forth various details in these directions which are likely to prove useful to ladies embarking for India. Its price is one shilling, and if the information contains nothing particularly new, it is of a rertdy practical kind and supplies hints and suggestions in regard to various points that might otherwise fail to be Mr. Stanford of
Dress, and How
..
remembered.
Correspondence. "Audi alteram
partem"
" ABDOMINAL SECTION IN CERTAIN CASES OF PELVIC PERITONITIS." To the Editors
of THE LANCET. SIRS,—Although present at the adjourned discussion at the Obstetrical Society on Dr. Cullingworth’s paper I was not prepared then to express an opinion on the many issues raised, but trust that the importance of the matters in dispute may be a sufficient excuse for trespassing on your valuable space in the form of a letter. Personally I think the title of the paper was unfortunate, grouping as it did several classes of pelvic disease, which, whether diagnosed before or after operation, ought to have been classified under their distinctive headings. Had Dr. Cullingworth in. stead confined his paper to the frequent connexion which
THE WOUNDS CAUSED BY SMALL-BORE BULLETS. Our service contemporary, the llruay and Navy Gazette of last week, published a communication from Veterinary’Captain Smith, the late professor of the Army Veterinary exists between inflammatory disease of the uterine ’’School, detailing the results of further experiments with the Lee-Metford bullet on the bones of the horse at ranges appendages and pelvic peritonitis, giving at the same fixed at every hundred yards-from 100 to 1000 yards. These time his views as to the value of abdominal section in those results are apparently mainly determined by differences in cases alone, a less discursive but much more valuable discusthe strength and resistant powers of the substance and sion would have been the result. At the present moment the structural arrangement of the bone at the part struck. From treatment of the above class of diseases may with fairness be ’.50 to 200 yards the effect is pulverising and destructive ; but called the burning question of the day in gynaecological from 300 to 1000 yards the effect is different, according circles ; and the reduction to plain well-defined lines of their ,to the part of the bone hit-that is to say, whether therapeusis would be conferring a real benefit upon the proit be the dense resistant substance of the shaft or fession at large. Some of the speakers seemed to look upon the cancellous spongy structure of the ends of the bone. ’, appendageal disease as a comparatively trifling malady, and In the former case, the shaft of the bone is shattered one which usually occasional rest, assisted by nature, would ’and fissured in all directions with much loss of sub- cure. No doubt a large number of these cases do get well under stance, and it makes but little difference as regards the ’destructive effect whether the bullet be fired at 50 or 1000 non-operative treatment, but not such as those described in yards. In the latter case, the bullet may only give rise to a Dr. Cullingworth’s paper, where the evidences of disease were ’hole in the spongy cancellous structure of the extremities of unmistakable and the lives of the patients imperilled by the the bone struck, which is sometimes perfectly clean, but fre- recurrent attacks of pelvic peritonitis. It is the so-styled ,quently fissured, the fissures extending or not into the joint. conservativefortreatment of such casesandwhich is directly If the extremity of the bone, as in the case of some of the responsible incomplete operations great mortality. bones of the extremities of a horse, consists more of compact Anyone who has had much experience of this kind of opera- than spongy structure, then the pulverising effect is produced tive work must have been compelled at times to stay his hand by reason of the extent and intimacy of visceral adhe’.and no clean hole is made. sions ; and yet, in the face of this, which is common experiTHE REMOVAL OF ST. GEORGE’S BARRACKS. ence, we are asked to believe that abdominal section is According to a contemporary St. George’s Barracks, indicated rarely only as a dernier ressort. That these Trafalgar-square, are to disappear, and the Guards from neglected cases kill is indisputable, although frequently the these barracks are to have new quarters built for them death certificate is differently worded. They are fertile pro’ We presume that the building now appro- ducers of intestinal obstruction, of septicaemia and general .at Millbank. for recruiting purposes at St. George’s Barracks and peritonitis, and, short of these, are responsible for more priated approached from the back of the square, will also disappear, invalidism in women than probably any other form of disease. .and it is quite time that it did so, for the very in- Much in the course of the debate was made of Dr. Cullingferior accommodation afforded for recruiting is not by any worth’s mortality, and Dr. Williams went so far as to say It seems to us that smart, that the death-rate of the series-viz , 18 per cent.-was not means of a creditable character. - airy and clean-looking rooms or offices, of a more attractive higher than that throughout the country in this class of kind than the old buildings, are required for this purpose, case, with a few exceptions. If so, it would be deterrent, and they should be in prominent positions and not hidden but it is far from the truth, as was abundantly proved by Dr. Cullingworth himself when speaking of his latest cases ,a,way in a sort of cul-de-sac or at the end of a back street. and others. Out of my last fifty cases I have lost two ROYAL MILITARY COLLEGE EXAMINATION. examination for The candidates for the competitive Sand- patients ; although in no case has an operation been hurst have been exceptionally numerous on this occasion and done without a clear history of recurrent inflammation, of appendageal disease and, unless in cases gave full occupation to the medical officers responsible for objective signs ’their preliminary physical examination. The candidates are urgently demanding operative relief, treatment for a suffistated to have numbered about 800 altogether, and as the cient period by rest This seems to me the truly conservative and that which is in accordance with the teachings cadetships to be competed for only amount to about 120, the treatment of modern surgery, and Dr. Cullingworth is to be congratulated will be severe. ,competition in having the courage to express so unequivocally his opinions. PRACTICAL HINTS FOR LADY TRAVELLERS TO INDIA. I am, Sirs, yours yoursfaithfully, faithfully, GEORGE ELDER, M.D. Glas. We have received copy of a small pamphlet published by Nottingham, Nov. 6TH, 1892, ,
Sirs,
.