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RADICAL CURE OF HERNIA
344
degree of deformity can be produced. There would be prescriptions regarding the precautions to be taken against be a volume of immense size. The difficulty in producing the appearance of a supposititious evil the result wouldblind adherence to vulgar error, would people who, through deliver over a great city like Alexandria to the tender negative to produce a print of an apparent fracture, but that mercies of a pestilence are brute beasts and not human so could be unfair deformities, strictly called, produced by beings. The fleet, the hospitals, and the arsenal by a due means we take leave to doubt, especially if the use of an observance of sanitary .rules have succeeded, thanks to the accurate localiser is insisted upon. Nevertheless, Dr. Hall’s Almighty, in protecting themselves from the reigning evil. Is not this a sufficient proof of the efficacy of sanitation ? paper contains a useful warning against belief in skiagrams taken by non-experts, for these certainly may be deceptive. Under Mohammed Ali and Clot Bey the public health of Egypt was well supervised, but unfortunately their successors were not equally enlightened and soon nothing but the dry RADICAL CURE OF HERNIA bones of the sanitary organisation remained. Corruption HOWEVER satisfactory some of the results may be which and inefficiency became paramount, and it was not until 1884, are obtained by the methods of radical cure for -hernia when an English sub-director was added to the Services
any no
bullet or needle in thebody,oreven by manipulationof the
I
"
.
which
in
it cannot be denied that these methods In this number of THE LANCET we two new methods-one for the radical treatment of femoral hernia and the other for inguinal hernia. The former is contained in a clinical lecture by Mr. W. H. Battle and the method consists in bringing down a portion of the aponeurosis of the external oblique muscle and placing it as a shutter over the upper end of the crural canal, suturing it to the fascia over the pectineus and to Gimbernat’s ligament. Additional sutures are used to hold the displaced aponeurosis in its new posiThis method has proved valuable in several cases tion. under Mr. Battle’s care and is well worthy of more extended The operation for inguinal hernia is one which trial. has been practised for some time by Mr. H. P. Symonds of Oxford. By means of an incision above the external abdominal ring the peritoneal cavity is opened, and from within, with the help of a pair of volsellum forceps, the hernial sac is inverted and is then twisted and stitched to the cut edge of the peritoneum ; then the wound is closed, the pillars of the external ring being also drawn together with sutures. The procedure is decidedly ingenious, but its true value can only be determined by further trial.
are
are now
use
by no. means perfect. print descriptions of
Sanitaires, that any improvement took place.
Since then there has been a systematic attempt to deal with outbreaks of infectious disease, and considering the insufficiency of the funds at the disposal of the sanitary authorities the results may be said to have been satisfactory. According to a somewhat elaborate return which has lately been published the Egyptian infectious disease record for the 10 years 1886-95 may be briefly shown in tabular form as
follows :Docennial Period 1886-1895:Total N1lmbe’r of Deaths.
-
INFECTIOUS DISEASE IN EGYPT. The generic term typ7tic includes the following diseases : IN Mohamedan countries infectious diseases are seldom enteric fever, exanthematic typhus, relapsing fever, and interfered with, being allowed to run their courses freely bilious fever. At first the ambulances dealt with only a without any attempt to check or to control their ravages. In small proportion of the cases, but towards the end their a case here or there some little effort may be made. to operation was extended. The above figures do not include ameliorate the condition of individual sufferers, but measures the returns from the Frontier Province which is under calculated to prevent or eve&bgr;c to limit the dissemination of the military control. infection are never adopted. As an excuse for such grossly culpable negligence it is averred by adherents of Islamism A SCHEME FOR RESEARCH WORK IN MENTAL that resistance against the Divine will would be an impious PATHOLOGY IN THE UNITED STATES. procedure. They contend that since disease is an instruA COMMITTEE of the New York Neurological Society, with ment of punishment in the hand of the Almighty Dr. Frederick Peterson as President, was recently appointed their duty lies in a blind submission to the chastenby the President of the New York Commission in Lunacy ing, but that their -contention is the outcome of sheer ’’ to offer suggestions as to a scheme ofscientific study of ignorance is plainly shown by the following extract mental diseases in connexion with the State’s hospitals for from a decree issued by Mohammed Ali the Great, the insane," and its report has now appeared. The signathe first independent ruler of Egypt. Writing to Zeki tories include well-known names in neurological and psychoEffendi, his Wakil at Alexandria, on the 12th Ohawal, 1250 medicine such as Dr. Frederick Peterson, Dr. B. logical (Feb. llth, 1835), the founder of the present dynasty Sachs, Professor Charles Dana, Professor Graeme says :Dr. Joseph Collis, Professor Allen Starr, and others, and ’’ The aversion of theinhabitants of Alexandria to their recommendations are appended as follows :arises their measures from The sanitary ignorance....... "1. It is to the interests of the State that original research plague-may God preserve us from it 1-being the scourge in order to take refuge work should be carried on in relation to insanity in order of the deity, to flee the divine wrath in his mercy is in no wise contrary to the holy law. Inas- that the science should be advanced and better methods of much as the condition of things now prevalent is a danger to prevention, treatment, and cure discovered. 2. There should be one central laboratory in the State, mankind, in trying to escape therefrom one does not disobey the orders set forth in the divine book. Did not God, by the wherein the energies of the best scientific men in the mouth of his prophet, say,Flee from my wrath as you various departments of medicine relating to insanity should would flee from the presence of a lion’ 1 Is not this be devoted wholly to the prosecution of original research. 3. Such a laboratory, combining the labours of wellinjunction applicable in the case of infection?1 If it should be wished I can call upon the doctors of canonical qualified workers in general pathology, neuro-pathology, law to issue precepts (fetrva) to that effect. In a word, if it psychologp, chemistry, and anthropology, should be able to should be necessary to collect the whole of the prophet’si produce from year to year results invaluable in advancing -
Hammond,
degree of deformity can be produced. There would be prescriptions regarding the precautions to be taken against be a volume of immense size. The difficulty in producing the appearance of a supposititious evil the result wouldblind adherence to vulgar error, would people who, through deliver over a great city like Alexandria to the tender negative to produce a print of an apparent fracture, but that mercies of a pestilence are brute beasts and not human so could be unfair deformities, strictly called, produced by beings. The fleet, the hospitals, and the arsenal by a due means we take leave to doubt, especially if the use of an observance of sanitary .rules have succeeded, thanks to the accurate localiser is insisted upon. Nevertheless, Dr. Hall’s Almighty, in protecting themselves from the reigning evil. Is not this a sufficient proof of the efficacy of sanitation ? paper contains a useful warning against belief in skiagrams taken by non-experts, for these certainly may be deceptive. Under Mohammed Ali and Clot Bey the public health of Egypt was well supervised, but unfortunately their successors were not equally enlightened and soon nothing but the dry RADICAL CURE OF HERNIA bones of the sanitary organisation remained. Corruption HOWEVER satisfactory some of the results may be which and inefficiency became paramount, and it was not until 1884, are obtained by the methods of radical cure for -hernia when an English sub-director was added to the Services
any no
bullet or needle in thebody,oreven by manipulationof the
I
"
.
which
in
it cannot be denied that these methods In this number of THE LANCET we two new methods-one for the radical treatment of femoral hernia and the other for inguinal hernia. The former is contained in a clinical lecture by Mr. W. H. Battle and the method consists in bringing down a portion of the aponeurosis of the external oblique muscle and placing it as a shutter over the upper end of the crural canal, suturing it to the fascia over the pectineus and to Gimbernat’s ligament. Additional sutures are used to hold the displaced aponeurosis in its new posiThis method has proved valuable in several cases tion. under Mr. Battle’s care and is well worthy of more extended The operation for inguinal hernia is one which trial. has been practised for some time by Mr. H. P. Symonds of Oxford. By means of an incision above the external abdominal ring the peritoneal cavity is opened, and from within, with the help of a pair of volsellum forceps, the hernial sac is inverted and is then twisted and stitched to the cut edge of the peritoneum ; then the wound is closed, the pillars of the external ring being also drawn together with sutures. The procedure is decidedly ingenious, but its true value can only be determined by further trial.
are
are now
use
by no. means perfect. print descriptions of
Sanitaires, that any improvement took place.
Since then there has been a systematic attempt to deal with outbreaks of infectious disease, and considering the insufficiency of the funds at the disposal of the sanitary authorities the results may be said to have been satisfactory. According to a somewhat elaborate return which has lately been published the Egyptian infectious disease record for the 10 years 1886-95 may be briefly shown in tabular form as
follows :Docennial Period 1886-1895:Total N1lmbe’r of Deaths.
-
INFECTIOUS DISEASE IN EGYPT. The generic term typ7tic includes the following diseases : IN Mohamedan countries infectious diseases are seldom enteric fever, exanthematic typhus, relapsing fever, and interfered with, being allowed to run their courses freely bilious fever. At first the ambulances dealt with only a without any attempt to check or to control their ravages. In small proportion of the cases, but towards the end their a case here or there some little effort may be made. to operation was extended. The above figures do not include ameliorate the condition of individual sufferers, but measures the returns from the Frontier Province which is under calculated to prevent or eve&bgr;c to limit the dissemination of the military control. infection are never adopted. As an excuse for such grossly culpable negligence it is averred by adherents of Islamism A SCHEME FOR RESEARCH WORK IN MENTAL that resistance against the Divine will would be an impious PATHOLOGY IN THE UNITED STATES. procedure. They contend that since disease is an instruA COMMITTEE of the New York Neurological Society, with ment of punishment in the hand of the Almighty Dr. Frederick Peterson as President, was recently appointed their duty lies in a blind submission to the chastenby the President of the New York Commission in Lunacy ing, but that their -contention is the outcome of sheer ’’ to offer suggestions as to a scheme ofscientific study of ignorance is plainly shown by the following extract mental diseases in connexion with the State’s hospitals for from a decree issued by Mohammed Ali the Great, the insane," and its report has now appeared. The signathe first independent ruler of Egypt. Writing to Zeki tories include well-known names in neurological and psychoEffendi, his Wakil at Alexandria, on the 12th Ohawal, 1250 medicine such as Dr. Frederick Peterson, Dr. B. logical (Feb. llth, 1835), the founder of the present dynasty Sachs, Professor Charles Dana, Professor Graeme says :Dr. Joseph Collis, Professor Allen Starr, and others, and ’’ The aversion of theinhabitants of Alexandria to their recommendations are appended as follows :arises their measures from The sanitary ignorance....... "1. It is to the interests of the State that original research plague-may God preserve us from it 1-being the scourge in order to take refuge work should be carried on in relation to insanity in order of the deity, to flee the divine wrath in his mercy is in no wise contrary to the holy law. Inas- that the science should be advanced and better methods of much as the condition of things now prevalent is a danger to prevention, treatment, and cure discovered. 2. There should be one central laboratory in the State, mankind, in trying to escape therefrom one does not disobey the orders set forth in the divine book. Did not God, by the wherein the energies of the best scientific men in the mouth of his prophet, say,Flee from my wrath as you various departments of medicine relating to insanity should would flee from the presence of a lion’ 1 Is not this be devoted wholly to the prosecution of original research. 3. Such a laboratory, combining the labours of wellinjunction applicable in the case of infection?1 If it should be wished I can call upon the doctors of canonical qualified workers in general pathology, neuro-pathology, law to issue precepts (fetrva) to that effect. In a word, if it psychologp, chemistry, and anthropology, should be able to should be necessary to collect the whole of the prophet’si produce from year to year results invaluable in advancing -
Hammond,