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ROYAL COLLEGE OF SURGEONS AND ITS MEMBERS.
504 furnish a lever by which the fragments of the lower end of the humerus may be manipulated and adjusted. Moreover, in the extended position the anterior portion of the capsule of the joint is held "on the stretch," and the bones of the forearm are, as far as possible, prevented from becoming entangled in the proliferating and overlapping callus. Three illustrative cases are given in which, although fairly good mobility of the elbow and usefulness of the limb existed, there was a greater or less degree of cubitus varus. The patients, adults, were a sailor, and a student, and had suffered from fracture of the elbow at the ages oz’ five, eleven, and seven years respectively, and had been treated in the rectangular position. Dr. Lauenstein insists that surgeons ought not to rest satisfied with conserving the mobility of the joint simply, since the deformity of cubitus valgus or varus may be of ulterior prejudice to the patient. Dr. Illingworth of Accrington read a paper on Fractures into and in the vicinity of the Elbow-joint in the Section of Surgery at the Dublin meeting ofthe British Medical Association in 1887, and illustrated the deformity caused by rectangular splints by casts, and he has devised a splint2 for the putting up of these fractures in the extended position. I regret that I was not earlier aware of the existence of this paper, but by some means or other it escaped publication until Feb. 9th of this year. I remain, Sirs, your obedient servant, T. W. NUNN. March, 1889.
the nature of cow-pox. If the current view of the origin of cow-pox from the hands of the variolous milkers be the true explanation, how is it that it has never been confirmed by observation ? If it be inaccurate, by all means let us "nail it to the counter," or sweep it into the " pathological dustbin." I am, Sirs, your obedient servant, EDGAR CROOKSHANK. Manchester-square, 1’et). 23rd, 188S. -,
a lady,
THE TREATMENT OF FRACTURES OF THE
ELBOW-JOINT. To the Editors
of THE
LANCET. SIRS,—At the meeting of the Clinical Society on the first evening of this session, I took the opportunity of suggesting that fractures through the elbow-joint should be treated by placing the forearm in an extended position ; and I made this suggestion in consequence of having seen several instances in which the ordinary treatment by the rectangular splint had not been followed by results entirely satisfactory. As is shown by your report of the meeting in THE LANCET of Oct. 20th, 1888, in this suggestion Mr. Bryant and Mr. Heath did not concur, and Mr. Heath again, in his clinical lecture on Fractures of the Upper Extremity, published in THE LANCET of Jan. 19th, 1889, recommends that, "in all cases of fracture of the lower end of the humerus the arm should be well bent." A short time after the meeting of the Clinical Society, Sir James Paget most kindly pointed out to me a communication on this subject to the German Surgical Society, published in the Transactions of that Society, by Dr. Carl Lauenstein of Hamburg. Treatment of these fractures by placing the elbow in the extended position is strongly advocated by Dr. Lauenstein. The following is a preczs of his paper. Reference is made to the fact that in most manuals of surgery it is recommended that fractures of the lower end of the humerus should be put up with the elbow flexed. This position is also in the teaching of Professor Baum approved, whether the fracture be transverse immediately above the trochlea, T-shaped, or oblique through the condyles. Dr. Lauenstein alleges, on the other hand, that serious and irreparable damage to the joint may accrue from this treatment, and asserts that mischief may be avoided by placing the forearm in the extended position at the commencement of treatment. A description is given of the dissection of an elbow twelve months after it had been fractured and put up in the rectangular position, the patient, who had been under the care of Dr. Dencker, having died of tabes. The elbow-joint, which was supposed to have been flexed when the splints were applied, was really extended, the flexion having been actually through the line of transverse fracture, just above the trochlea. The fracture had united, so that the trochlear fragment was fixed at right angles to the shaft ofthc humerus, and, therefore, the patient had lost the power of extension movement, the joint being already fully extended, although seemingly flexed. This dissection led to the conclusion that the extended position at the commencement of treatment should replace the old position of flexion. Since he had adopted this position for these fractures Dr. Lauenstein had obtained improved results, a more free ultimate use of the extremity had been secured and the deformity either of cubitus valgus or cubitus varus had been obviated. Great weight is attached to the circumstance that even considerable displacement of the lower end of the humerus (processus cubitalis) cannot be adequately recognised in the rectangular position of the joint, more especially when effusion of blood and swelling of the soft parte exist. This is corroborated by the fact that where an oblique fracture through the inner condyle has united witl an upward displacement of the condyle no effect on th< shape of the arm by this displacement is seen until th( forearm is extended, when a considerable degree of cubitui varus becomes at once evident. A parallel is drawn ir respect of this point between cubitus varus and gent valgum; the flexed position of the knee can conceal a higl degree of genu valgum, which extension betrays. One advan tage of the extended position is that it enables the surgeon by his eye, to detect any deviation from the normal axis o the limb as easily as in fracture of the shaft of a long bone and the bones of the forearm in the extended positiOl 1 Verhandlungen der Deutschen Gesellschaft
fur
ROYAL COLLEGE OF SURGEONS AND ITS MEMBERS. To the Editors of THE LANCET. SIRS,— The Council of the Medical Defence Union has decided to support Mr. Lawson Tait in his action against the Council of the Royal College of Surgeons, and the con. siderations which led to this decision may be of interest to your readers. The Medical Defence Union is not concerned with the merits of the dispute between the College and its Members; but since Mr. Tait, as a Member and Fellow of the College, hp.s been threatened by the Council with deprivation of his Fellowship and Membership because in the course of the controversy lie has followed what he conscientiously thinks to be a right and proper policy, the Council of the Medical Defence Union considers that it is a fit and proper case to be defended. The position is simply incredible that Mr. Tait or any other Member of the College should be threatened with deprivation of the privileges of Member. ship because he affixed his name to a document calling a meeting of the Members at the College. We are, Sira, yours obediently,
LESLIE
A. J.
,
Chirurgie, April,
1888, and also printed in Von Langenbeck’s Archiv, Bd. xxxvii.
PHILLIPS, M.D.,Hon. Secs. Med, BATEMAN, M.B., Defence Union.
To the Editors of THE LANCET. SIRS,-Doubtless by this time most of the Members of the Royal College of Surgeons are acquainted with the recent action of this Association at the meeting which was convened and held at the College, but adjourned to the Venetian Chamber of the Holborn Restaurant, on Thursday, the 28th ult. This meeting, after an ineffectual application from us to the Council for permission to hold the same in the hall of the College, was summoned, on the requisition of thirty Fellows and Members, for the purpose of presenting to the whole corporation the draft of a Bill which is about to be presented to Parliament for amending the constitution of the College, and for establishing the rights of the Members which have for so many years been denied them. Those who convened this meeting of the Fellows and Members have been threatened with the penalties contained in Bye-law 17, which enables the Council to degrade and ruin any who may have taken part in summoning a meeting of one’s fellow members for the purposeof discussing matters seriously affecting their interests. The Association of the Members has now taken definite action in the matter, and injunctions have been served updn the various members of the Council restraining them from closing their doors against the Fellows and Members, and prohibiting them from enforcing the penalties of Byelaw 17, which, it is alleged, on behalf of the Members, is invalid, and also from their using the College funds in 2 Made
by Aitken
and Co. of York
505
defending this action. To sustain the legal action which capital outlay of about JE1,140,000, and an annual outlay the Members have now taken, counsel has been instructed for materials, barging, sludge, working expenses, &c., of and large expenses incurred. We look to the general body ;B1l5,000. To carry the sewage to Hole Haven will cost of the Members to support the Association and those who about 3,400,000, with an annual outlay for pumping of have shown their willingness to risk so much on behalf of about t40,000. As the sewage will in any case have to be their professional brethren, and we ask for both moral and submitted to a precipitation process, the interest on assistance, as the necessary expenses incurred by ;E3,400,000 and the JE40,000 a year will be charges in addition pecuniary and the legal Parliamentary proceedings which have been to the above. It is really time that loose statements regardtaken can only be met by very substantial donations, which ing the enormous cost of the Board’s scheme should cease. should be sent to the Treasurer, Deputy Surgeon- The scheme may, in course of time, have to be supplemented; but there cannot be a shadow of a doubt that it is by far General C. M. Jessop, 98, Sutherland-avenue, W. the cheapest scheme as yet proposed, and that it will, if We are, Sirs, your obedient servants, WARWICK C. STEELE,Hon. Sees. Assoc. Memb. properly carried out, be effective for a good many years to come. I am, Sirs, yours &c., Roy. Coll. Surg. &c., March 6th, 1889. WM. ASHTON ELLIS, A. DUPRÉ. Westmin. Med. School, Laboratory, Hosp. that notices to mean our We B* presume correspondents Feb. 23rd, 1889. of application for injunctions have been served.-ED. L.
Hon.
II
SEWAGE DISPOSAL. To the Editors of THE LANCET.
SIRS,—As
I have
only just had
an
opportunity of reading
Dr. Corneld’s address " On the History of Sewage-disposal Inquiries," to which your leader has given additional
importance,
you
late, to make
a
will,I trust, allow few remarks
on
though somewhat that address in THE
me,
PARALYTIC DEFORMITY OF THE FOOT. To the Editors of THE LANCET. SiRS,—Mr. Edward Freer, in your issue of this date, states that in my paper on the above subject no mention is made of a condition of slight calcaneus which coexists with talipes arcuatus. I admit the fact with all readiness, for these twc conditions of paralytic deformity cannot by any possibility be developed in the same foot; in calcaneus the contractile power of the extensors is less than that of the flexor of the foot, while arcuatus results from the tlexors being weaker than the extensors. The condition to which Mr. Freer refers is ordinary paralytic calcaneus in the early stage, and if he will turn to your issue of Feb. 2nd he will find that I have there described the distortion of the foot, with shortening of the plantar fascia, which is one of the characteristics of that deformity. Talipes arcuatus is the term I have applied to distinguish a condition of increased arching of the foot, unaccompanied by any other and its complication. The existence of this deformity, classification, were first given in an article on " Orthopaedic Surgery," written by me some five or six years ago, and published in the International Encyclopaedia of Surer,l vol. vi. I am, Sirs, yours faithfully, F. R. FISHER. Harley-street, W., March 2nd, 1889.
LANCET. I pass at once to Dr. Corfield’s remarks re the late Royal Commission on Metropolitan Sewage Discharge. Regarding the previous portions, I can only express a hope that they are more accurate as to their facts than these are. In the concluding paragraph of his address, Dr. Corfield states that the scheme proposed to be carried out by the Metropolitan Board of Works, " while being enormously costly, will not only not settle the question, but will, rather, increase the difficulties of settling it effectually." i feel tempted to ask, does Dr. Corfield know the scheme proposed, and has he even read his own address ? On pages 31 and 32 &c. of the separate copy of the address, Dr. Corfield gives some of the recommendations made by the Royal Commission, which are as follows. Recommen4ation 3: Some process of deposition or precipitation should be adopted. Recommendation 4: Such process could be convenientlv applied at the two present outfalls. CONSTIPATION. Recommendation 10 : The clarified sewage would require To the Editors of THE LANCET. further purification. Recommendation 11 : To effect this it should be applied to land in the neighbourhood of the Sins,—In your issue of Feb. 9th, Mr. Jeaffreson recomoutfalls; or (Recommendation 13), if suitable land in mends a certain form of exercise for constipation dependsufficient quantity cannot be secured at the present out- ing on weakness of the abdominal muscles, and considers falls, the clarified sewage should be carried down as low as the bulk of cases due to this cause. Without criticism, Hole Haven, or, as an alternative, the raw sewage should may I ask will this alone suflice without medicinal treatbe carried to Hole Haven, there clarified, and then dis- ment ? Where abdominal weakness is present there is ’, mostly a general want of tone coexisting, and although the eharged into the river. Now what is the scheme in process of being carried abdominal muscles play an important part in the act of the Metropolitan Board of Works? The sewage is to be defecation, constipation is as often referable to torpidity of clarified by precipitation at the present outfalls, and the the muscular coat of the intestine ; hence, will this exercise ’effluent is to be further purified by the addition of per- overcome the difficulty without such important drugs as nervoNMganate before its discharge into the river. What, then, muscular stimulants ? Habitual purgation and the use of is the difference between this scheme and the first one pro- enemata are undoubtedly pernicious, but in the treatment of posed by the. Royal Commission? Simply the substitution constipation, whatever be the cause, unless the natural means of purification of the effluent by permanganate-a process of acting on the bowels-viz., proper diet--be attended to, not thought of at the time of the Royal Commission-in service can scarcely be ensured. Where the abpermanent place of filtration through land. In connexion with this, it dominal muscles are so deficient as to call for treatment, it readers that the only chemist would probably be in corpulent persons with pendulous may be well to remind by profession on the Royal Commission is one of the four abdomens; hence the difficulty of the prescribed treatment. chemists recommending the adoption of the Metropolitan Would not the wearing of a firm, broad, flannel bandage Board of Works scheme. be equally benelicial ?-I am, Sirs, yours truly, Now, assuming even that the scheme proposed will ulti- Feb. 13th, 1889. R. P. mately be found insufficient-which I have no hesitation In saying will not be the case during this century, if only the new County Council have the wisdom to leave the LIVERPOOL. Management of it in the able hands of their chemist, Mr. (FROM OUR OWN CORRESPONDENT.) Dibdin,-and supposing it fails, what then? Not a single will have been and two of the alternative wasted, penny schemes proposed by the Royal Commission can be carried Election of Mr. Rushton Parker. out with the present plant-viz., that given under A SPECIAL MEETING of the trustees of the Royal Infirmary 11 and the first one under Kecommendation 13. Where, then, have the Metropolitan Board of was held on the 1st inst., to elect an honorary surgeon in Works run counter to the recommendation of the Royal the place of Mr. E. It. Bickersteth, the senior surgeon, whose retirement was noticed in THE LANCET a few weeks Commission ? The next point I should like to discuss is the alleged back. Mr. Rushton Parker, F.RC.S.Eng., Professor of enormous cost of this scheme, branded as abortive. Does Surgery in the Liverpool University College, and for the Dr. Corfield know what the cost will be ?9 If not, let me last eleven years honorary assistant surgeon to the ininform him and your readers that the scheme involves a 1 Macmillan & Co., 1886.
muscles
out
your
________________
all
Recommendation
the nature of cow-pox. If the current view of the origin of cow-pox from the hands of the variolous milkers be the true explanation, how is it that it has never been confirmed by observation ? If it be inaccurate, by all means let us "nail it to the counter," or sweep it into the " pathological dustbin." I am, Sirs, your obedient servant, EDGAR CROOKSHANK. Manchester-square, 1’et). 23rd, 188S. -,
a lady,
THE TREATMENT OF FRACTURES OF THE
ELBOW-JOINT. To the Editors
of THE
LANCET. SIRS,—At the meeting of the Clinical Society on the first evening of this session, I took the opportunity of suggesting that fractures through the elbow-joint should be treated by placing the forearm in an extended position ; and I made this suggestion in consequence of having seen several instances in which the ordinary treatment by the rectangular splint had not been followed by results entirely satisfactory. As is shown by your report of the meeting in THE LANCET of Oct. 20th, 1888, in this suggestion Mr. Bryant and Mr. Heath did not concur, and Mr. Heath again, in his clinical lecture on Fractures of the Upper Extremity, published in THE LANCET of Jan. 19th, 1889, recommends that, "in all cases of fracture of the lower end of the humerus the arm should be well bent." A short time after the meeting of the Clinical Society, Sir James Paget most kindly pointed out to me a communication on this subject to the German Surgical Society, published in the Transactions of that Society, by Dr. Carl Lauenstein of Hamburg. Treatment of these fractures by placing the elbow in the extended position is strongly advocated by Dr. Lauenstein. The following is a preczs of his paper. Reference is made to the fact that in most manuals of surgery it is recommended that fractures of the lower end of the humerus should be put up with the elbow flexed. This position is also in the teaching of Professor Baum approved, whether the fracture be transverse immediately above the trochlea, T-shaped, or oblique through the condyles. Dr. Lauenstein alleges, on the other hand, that serious and irreparable damage to the joint may accrue from this treatment, and asserts that mischief may be avoided by placing the forearm in the extended position at the commencement of treatment. A description is given of the dissection of an elbow twelve months after it had been fractured and put up in the rectangular position, the patient, who had been under the care of Dr. Dencker, having died of tabes. The elbow-joint, which was supposed to have been flexed when the splints were applied, was really extended, the flexion having been actually through the line of transverse fracture, just above the trochlea. The fracture had united, so that the trochlear fragment was fixed at right angles to the shaft ofthc humerus, and, therefore, the patient had lost the power of extension movement, the joint being already fully extended, although seemingly flexed. This dissection led to the conclusion that the extended position at the commencement of treatment should replace the old position of flexion. Since he had adopted this position for these fractures Dr. Lauenstein had obtained improved results, a more free ultimate use of the extremity had been secured and the deformity either of cubitus valgus or cubitus varus had been obviated. Great weight is attached to the circumstance that even considerable displacement of the lower end of the humerus (processus cubitalis) cannot be adequately recognised in the rectangular position of the joint, more especially when effusion of blood and swelling of the soft parte exist. This is corroborated by the fact that where an oblique fracture through the inner condyle has united witl an upward displacement of the condyle no effect on th< shape of the arm by this displacement is seen until th( forearm is extended, when a considerable degree of cubitui varus becomes at once evident. A parallel is drawn ir respect of this point between cubitus varus and gent valgum; the flexed position of the knee can conceal a higl degree of genu valgum, which extension betrays. One advan tage of the extended position is that it enables the surgeon by his eye, to detect any deviation from the normal axis o the limb as easily as in fracture of the shaft of a long bone and the bones of the forearm in the extended positiOl 1 Verhandlungen der Deutschen Gesellschaft
fur
ROYAL COLLEGE OF SURGEONS AND ITS MEMBERS. To the Editors of THE LANCET. SIRS,— The Council of the Medical Defence Union has decided to support Mr. Lawson Tait in his action against the Council of the Royal College of Surgeons, and the con. siderations which led to this decision may be of interest to your readers. The Medical Defence Union is not concerned with the merits of the dispute between the College and its Members; but since Mr. Tait, as a Member and Fellow of the College, hp.s been threatened by the Council with deprivation of his Fellowship and Membership because in the course of the controversy lie has followed what he conscientiously thinks to be a right and proper policy, the Council of the Medical Defence Union considers that it is a fit and proper case to be defended. The position is simply incredible that Mr. Tait or any other Member of the College should be threatened with deprivation of the privileges of Member. ship because he affixed his name to a document calling a meeting of the Members at the College. We are, Sira, yours obediently,
LESLIE
A. J.
,
Chirurgie, April,
1888, and also printed in Von Langenbeck’s Archiv, Bd. xxxvii.
PHILLIPS, M.D.,Hon. Secs. Med, BATEMAN, M.B., Defence Union.
To the Editors of THE LANCET. SIRS,-Doubtless by this time most of the Members of the Royal College of Surgeons are acquainted with the recent action of this Association at the meeting which was convened and held at the College, but adjourned to the Venetian Chamber of the Holborn Restaurant, on Thursday, the 28th ult. This meeting, after an ineffectual application from us to the Council for permission to hold the same in the hall of the College, was summoned, on the requisition of thirty Fellows and Members, for the purpose of presenting to the whole corporation the draft of a Bill which is about to be presented to Parliament for amending the constitution of the College, and for establishing the rights of the Members which have for so many years been denied them. Those who convened this meeting of the Fellows and Members have been threatened with the penalties contained in Bye-law 17, which enables the Council to degrade and ruin any who may have taken part in summoning a meeting of one’s fellow members for the purposeof discussing matters seriously affecting their interests. The Association of the Members has now taken definite action in the matter, and injunctions have been served updn the various members of the Council restraining them from closing their doors against the Fellows and Members, and prohibiting them from enforcing the penalties of Byelaw 17, which, it is alleged, on behalf of the Members, is invalid, and also from their using the College funds in 2 Made
by Aitken
and Co. of York
505
defending this action. To sustain the legal action which capital outlay of about JE1,140,000, and an annual outlay the Members have now taken, counsel has been instructed for materials, barging, sludge, working expenses, &c., of and large expenses incurred. We look to the general body ;B1l5,000. To carry the sewage to Hole Haven will cost of the Members to support the Association and those who about 3,400,000, with an annual outlay for pumping of have shown their willingness to risk so much on behalf of about t40,000. As the sewage will in any case have to be their professional brethren, and we ask for both moral and submitted to a precipitation process, the interest on assistance, as the necessary expenses incurred by ;E3,400,000 and the JE40,000 a year will be charges in addition pecuniary and the legal Parliamentary proceedings which have been to the above. It is really time that loose statements regardtaken can only be met by very substantial donations, which ing the enormous cost of the Board’s scheme should cease. should be sent to the Treasurer, Deputy Surgeon- The scheme may, in course of time, have to be supplemented; but there cannot be a shadow of a doubt that it is by far General C. M. Jessop, 98, Sutherland-avenue, W. the cheapest scheme as yet proposed, and that it will, if We are, Sirs, your obedient servants, WARWICK C. STEELE,Hon. Sees. Assoc. Memb. properly carried out, be effective for a good many years to come. I am, Sirs, yours &c., Roy. Coll. Surg. &c., March 6th, 1889. WM. ASHTON ELLIS, A. DUPRÉ. Westmin. Med. School, Laboratory, Hosp. that notices to mean our We B* presume correspondents Feb. 23rd, 1889. of application for injunctions have been served.-ED. L.
Hon.
II
SEWAGE DISPOSAL. To the Editors of THE LANCET.
SIRS,—As
I have
only just had
an
opportunity of reading
Dr. Corneld’s address " On the History of Sewage-disposal Inquiries," to which your leader has given additional
importance,
you
late, to make
a
will,I trust, allow few remarks
on
though somewhat that address in THE
me,
PARALYTIC DEFORMITY OF THE FOOT. To the Editors of THE LANCET. SiRS,—Mr. Edward Freer, in your issue of this date, states that in my paper on the above subject no mention is made of a condition of slight calcaneus which coexists with talipes arcuatus. I admit the fact with all readiness, for these twc conditions of paralytic deformity cannot by any possibility be developed in the same foot; in calcaneus the contractile power of the extensors is less than that of the flexor of the foot, while arcuatus results from the tlexors being weaker than the extensors. The condition to which Mr. Freer refers is ordinary paralytic calcaneus in the early stage, and if he will turn to your issue of Feb. 2nd he will find that I have there described the distortion of the foot, with shortening of the plantar fascia, which is one of the characteristics of that deformity. Talipes arcuatus is the term I have applied to distinguish a condition of increased arching of the foot, unaccompanied by any other and its complication. The existence of this deformity, classification, were first given in an article on " Orthopaedic Surgery," written by me some five or six years ago, and published in the International Encyclopaedia of Surer,l vol. vi. I am, Sirs, yours faithfully, F. R. FISHER. Harley-street, W., March 2nd, 1889.
LANCET. I pass at once to Dr. Corfield’s remarks re the late Royal Commission on Metropolitan Sewage Discharge. Regarding the previous portions, I can only express a hope that they are more accurate as to their facts than these are. In the concluding paragraph of his address, Dr. Corfield states that the scheme proposed to be carried out by the Metropolitan Board of Works, " while being enormously costly, will not only not settle the question, but will, rather, increase the difficulties of settling it effectually." i feel tempted to ask, does Dr. Corfield know the scheme proposed, and has he even read his own address ? On pages 31 and 32 &c. of the separate copy of the address, Dr. Corfield gives some of the recommendations made by the Royal Commission, which are as follows. Recommen4ation 3: Some process of deposition or precipitation should be adopted. Recommendation 4: Such process could be convenientlv applied at the two present outfalls. CONSTIPATION. Recommendation 10 : The clarified sewage would require To the Editors of THE LANCET. further purification. Recommendation 11 : To effect this it should be applied to land in the neighbourhood of the Sins,—In your issue of Feb. 9th, Mr. Jeaffreson recomoutfalls; or (Recommendation 13), if suitable land in mends a certain form of exercise for constipation dependsufficient quantity cannot be secured at the present out- ing on weakness of the abdominal muscles, and considers falls, the clarified sewage should be carried down as low as the bulk of cases due to this cause. Without criticism, Hole Haven, or, as an alternative, the raw sewage should may I ask will this alone suflice without medicinal treatbe carried to Hole Haven, there clarified, and then dis- ment ? Where abdominal weakness is present there is ’, mostly a general want of tone coexisting, and although the eharged into the river. Now what is the scheme in process of being carried abdominal muscles play an important part in the act of the Metropolitan Board of Works? The sewage is to be defecation, constipation is as often referable to torpidity of clarified by precipitation at the present outfalls, and the the muscular coat of the intestine ; hence, will this exercise ’effluent is to be further purified by the addition of per- overcome the difficulty without such important drugs as nervoNMganate before its discharge into the river. What, then, muscular stimulants ? Habitual purgation and the use of is the difference between this scheme and the first one pro- enemata are undoubtedly pernicious, but in the treatment of posed by the. Royal Commission? Simply the substitution constipation, whatever be the cause, unless the natural means of purification of the effluent by permanganate-a process of acting on the bowels-viz., proper diet--be attended to, not thought of at the time of the Royal Commission-in service can scarcely be ensured. Where the abpermanent place of filtration through land. In connexion with this, it dominal muscles are so deficient as to call for treatment, it readers that the only chemist would probably be in corpulent persons with pendulous may be well to remind by profession on the Royal Commission is one of the four abdomens; hence the difficulty of the prescribed treatment. chemists recommending the adoption of the Metropolitan Would not the wearing of a firm, broad, flannel bandage Board of Works scheme. be equally benelicial ?-I am, Sirs, yours truly, Now, assuming even that the scheme proposed will ulti- Feb. 13th, 1889. R. P. mately be found insufficient-which I have no hesitation In saying will not be the case during this century, if only the new County Council have the wisdom to leave the LIVERPOOL. Management of it in the able hands of their chemist, Mr. (FROM OUR OWN CORRESPONDENT.) Dibdin,-and supposing it fails, what then? Not a single will have been and two of the alternative wasted, penny schemes proposed by the Royal Commission can be carried Election of Mr. Rushton Parker. out with the present plant-viz., that given under A SPECIAL MEETING of the trustees of the Royal Infirmary 11 and the first one under Kecommendation 13. Where, then, have the Metropolitan Board of was held on the 1st inst., to elect an honorary surgeon in Works run counter to the recommendation of the Royal the place of Mr. E. It. Bickersteth, the senior surgeon, whose retirement was noticed in THE LANCET a few weeks Commission ? The next point I should like to discuss is the alleged back. Mr. Rushton Parker, F.RC.S.Eng., Professor of enormous cost of this scheme, branded as abortive. Does Surgery in the Liverpool University College, and for the Dr. Corfield know what the cost will be ?9 If not, let me last eleven years honorary assistant surgeon to the ininform him and your readers that the scheme involves a 1 Macmillan & Co., 1886.
muscles
out
your
________________
all
Recommendation