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THE LATE PRINCE CHRISTIAN VICTOR.
THE LATE PRINCE CHRISTIAN VICTOR.
receives diseased meat sent up from all parts of the country. In Manchester meat inspection in the abattoir and meatmarket is conducted much in the same manner as in the City of London : there is no complete inspection of all meat and the meat which is inspected is not stamped. Dr. O’Neill embodies in his report a number of useful suggestions for an I improved method of inspection. In a separate report ’, presented to the Public Health Committee of the borough of Belfast he mentions the method of milkinspection followed in Manchester and discusses the question of the municipal supply of sterilised milk as practised at St. Helens in Lancashire for rather more than a year past. These reports will be found useful by anyone in search of information on the subjects of which they treat.
county
THE LATE PRINCE CHRISTIAN VICTOR. THE death of Prince Christian Victor from that most insidious of diseases, enteric fever, at the age of 33 years, was announced in a telegram from Lord Roberts at a time when London was rejoicing at the return of the City Imperial Volunteers, but, in accordance with the wish of the Queen and of other members of the Royal family, the public announcement of the sad fact was delayed in order that a gloom might not be cast over those rejoicings. Although the Prince was known to be seriously ill the announcement of his decease came as a shock to the country, and his death is sincerely mourned not only by the army but by every subject of our beloved sovereign whose grandson he was. By strict attention to duty he earned the praise of all who came in contact with him, and during the operations in Natal under General Hildyard he was twice mentioned in despatches. In accordance with his wishes the deceased Prince has been laid to rest among his comrades at Pretoria.
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stitched to the soft parts. The writer recommends that irrigation should be used in all cases to remove masses of fibrin which may lie at the bottom of the cavity. The fluid must be warm and have a free exit, under which conditions no harm has been done in the reported cases-half of the total cases. The wound should be irrigated daily, and if the patient’s strength permits it he should be turned on to his abdomen to facilitate drainage. 51 cases of incision of the pericardium have been reported. The pericarditis was purulent in 46 cases, rheumatic sero-fibrinous in two, hsemorrhagic from trauma in one case, and serous in two cases. The etiology was as follows: pneumonia with and without empyema (14 cases), broncho-pneumonia-in a child-(one case), osteomyelitis (five cases), wounds (four), blow on the chest (one), periostitis (one), necrosis of nasal bones (one), septic arthritis of knee (one), septic throat (one), abscess of buttock (one), empyema without pneumonia (five), pleurisy of doubtful origin (two), typhoid pleurisy (one), influenza (one), tuberculosis (two), rheumatic fever and endocarditis (three). In the 51 cases there were 31 deaths-a mortality of 60 per cent. Recovery took place in the two cases of serous pericarditis. In the 14 cases of pneumonia there were four recoveries. Dr. Porter’s conclusions are as follows : 1. Pericardotomy is indicated in all cases of suppurative pericarditis. 2. Because of the varying relations of the pleura and the anterior position of the heart when the pericardium is distended aspiration is a more dangerous operation than open incision. 3. Peribe done and can resection of the cardotomy quickly safely by fifth cartilage, in many cases under local anaesthesia. 4. In many cases of serous effusion open incision offers less risk and a spsedaer cure than aspiration.
THE REGISTRATION OF NURSE-CHILDREN. TREATMENT OF SUPPURATIVE PERICARDITIS: "IDEAL PERICARDOTOMY." THE Boston Medical and Surgical Journal of Oct. 18th contains an important paper on this subject by Dr. C. B. Porter. The line of reflexion of the pleura and pericardium is very variable. Even at the level of the fifth space the pleura will often be found behind the sternal border. Hence some of the methods which have been used for opening the pericardium-trephining the sternum approach through an intercostal space and epigastric incision-should be discarded as there is danger of wounding the pleura or diaphragm. After experiments on the cadaver Dr. Porter devised the following "ideal operation"to meet the following indications : (1) to avoid opening the pleural cavity ; (2) to open. the pericardium opposite the point where drainage will remain good after the sac has contracted ; and (3) to secure free permanent drainage. An incision is made from the middle of the sternum outwards over the fifth costal cartilage to its junction with the rib. The soft parts are reflected from the cartilage with a periosteal elevator, care being taken not to wound the pleura on the under surface. The cartilage is divided with a bone forceps near the rib and sternum. The internal mammary vessels thus exposed are ligatured in two places and divided. The triangularis sterni is separated from the sternum and pushed to the left. If fat is encountered a little careful dissection with a director exposes the pericardium, which is much thicker than the pleura. An aspirating needle is introduced (if this has not previously been done) to corroborate the diagnosis. If this is confirmed the knife should follow the needle. The pericardial incision is best made downward and outward, beginning close to the sternum. An operation essentially identical with this has been performed in five cases by Brentanc.1 The edges of the incision should be 1
Deutsche Medicinische Wochenschrift, 1898, Band xxxii., S. 506.
THERE is a defect in the statute-book to, which we, and not we alone, have repeatedly directed attention. It is the absence of any provision for regulating the boarding-out of
single nurse-children. For some reason, probably more imaginary than real, it has been assumed that the interference of law is required only where two or more children are concerned. The case is one in which logic has been too little regarded. For the interest of one child is in no wise different from that of several, and though it may appear at first sight that the danger of neglect or other form of malpraxis is less in the former than the latter case experience has often shown, and still continues to show, that it may be equally great in both. Infant children are not very often sent out to board in this country. When it happens that they are so boarded the motive is to be found only too commonly in the apathy or the ill-will of parents to whom It is now generally their mere existence is a disgrace. child is as a the rule, recognised that, illegitimate which If these two be becomes the prey of the baby-farmer. no infant is second needed to insure the brought together inevitable result. In a case recently unearthed by the National Society for the Prevention of Cruelty to Children a child, aged six months, was found in the possession of a drunken " nurse" the mother of three children, all of whom, as well as the nurse-child, were shamefully neglected. The woman was very properly condemned to six months’ hard labour, but it is noteworthy that her conviction was only indirectly due to her farming the nearly starved infant. This most important part of the delinquency would probably never have been known but for the inquiries of a School Board officer after her own children. Such a fact-and it is means an isolated example of its kind-should go far to convince any doubter that the registration of single nurse-children is both necessary and just. What objection can be brought against this needful provision it is difficult to see. We feel certain that if enacted it would meet with
by no
receives diseased meat sent up from all parts of the country. In Manchester meat inspection in the abattoir and meatmarket is conducted much in the same manner as in the City of London : there is no complete inspection of all meat and the meat which is inspected is not stamped. Dr. O’Neill embodies in his report a number of useful suggestions for an I improved method of inspection. In a separate report ’, presented to the Public Health Committee of the borough of Belfast he mentions the method of milkinspection followed in Manchester and discusses the question of the municipal supply of sterilised milk as practised at St. Helens in Lancashire for rather more than a year past. These reports will be found useful by anyone in search of information on the subjects of which they treat.
county
THE LATE PRINCE CHRISTIAN VICTOR. THE death of Prince Christian Victor from that most insidious of diseases, enteric fever, at the age of 33 years, was announced in a telegram from Lord Roberts at a time when London was rejoicing at the return of the City Imperial Volunteers, but, in accordance with the wish of the Queen and of other members of the Royal family, the public announcement of the sad fact was delayed in order that a gloom might not be cast over those rejoicings. Although the Prince was known to be seriously ill the announcement of his decease came as a shock to the country, and his death is sincerely mourned not only by the army but by every subject of our beloved sovereign whose grandson he was. By strict attention to duty he earned the praise of all who came in contact with him, and during the operations in Natal under General Hildyard he was twice mentioned in despatches. In accordance with his wishes the deceased Prince has been laid to rest among his comrades at Pretoria.
1361
stitched to the soft parts. The writer recommends that irrigation should be used in all cases to remove masses of fibrin which may lie at the bottom of the cavity. The fluid must be warm and have a free exit, under which conditions no harm has been done in the reported cases-half of the total cases. The wound should be irrigated daily, and if the patient’s strength permits it he should be turned on to his abdomen to facilitate drainage. 51 cases of incision of the pericardium have been reported. The pericarditis was purulent in 46 cases, rheumatic sero-fibrinous in two, hsemorrhagic from trauma in one case, and serous in two cases. The etiology was as follows: pneumonia with and without empyema (14 cases), broncho-pneumonia-in a child-(one case), osteomyelitis (five cases), wounds (four), blow on the chest (one), periostitis (one), necrosis of nasal bones (one), septic arthritis of knee (one), septic throat (one), abscess of buttock (one), empyema without pneumonia (five), pleurisy of doubtful origin (two), typhoid pleurisy (one), influenza (one), tuberculosis (two), rheumatic fever and endocarditis (three). In the 51 cases there were 31 deaths-a mortality of 60 per cent. Recovery took place in the two cases of serous pericarditis. In the 14 cases of pneumonia there were four recoveries. Dr. Porter’s conclusions are as follows : 1. Pericardotomy is indicated in all cases of suppurative pericarditis. 2. Because of the varying relations of the pleura and the anterior position of the heart when the pericardium is distended aspiration is a more dangerous operation than open incision. 3. Peribe done and can resection of the cardotomy quickly safely by fifth cartilage, in many cases under local anaesthesia. 4. In many cases of serous effusion open incision offers less risk and a spsedaer cure than aspiration.
THE REGISTRATION OF NURSE-CHILDREN. TREATMENT OF SUPPURATIVE PERICARDITIS: "IDEAL PERICARDOTOMY." THE Boston Medical and Surgical Journal of Oct. 18th contains an important paper on this subject by Dr. C. B. Porter. The line of reflexion of the pleura and pericardium is very variable. Even at the level of the fifth space the pleura will often be found behind the sternal border. Hence some of the methods which have been used for opening the pericardium-trephining the sternum approach through an intercostal space and epigastric incision-should be discarded as there is danger of wounding the pleura or diaphragm. After experiments on the cadaver Dr. Porter devised the following "ideal operation"to meet the following indications : (1) to avoid opening the pleural cavity ; (2) to open. the pericardium opposite the point where drainage will remain good after the sac has contracted ; and (3) to secure free permanent drainage. An incision is made from the middle of the sternum outwards over the fifth costal cartilage to its junction with the rib. The soft parts are reflected from the cartilage with a periosteal elevator, care being taken not to wound the pleura on the under surface. The cartilage is divided with a bone forceps near the rib and sternum. The internal mammary vessels thus exposed are ligatured in two places and divided. The triangularis sterni is separated from the sternum and pushed to the left. If fat is encountered a little careful dissection with a director exposes the pericardium, which is much thicker than the pleura. An aspirating needle is introduced (if this has not previously been done) to corroborate the diagnosis. If this is confirmed the knife should follow the needle. The pericardial incision is best made downward and outward, beginning close to the sternum. An operation essentially identical with this has been performed in five cases by Brentanc.1 The edges of the incision should be 1
Deutsche Medicinische Wochenschrift, 1898, Band xxxii., S. 506.
THERE is a defect in the statute-book to, which we, and not we alone, have repeatedly directed attention. It is the absence of any provision for regulating the boarding-out of
single nurse-children. For some reason, probably more imaginary than real, it has been assumed that the interference of law is required only where two or more children are concerned. The case is one in which logic has been too little regarded. For the interest of one child is in no wise different from that of several, and though it may appear at first sight that the danger of neglect or other form of malpraxis is less in the former than the latter case experience has often shown, and still continues to show, that it may be equally great in both. Infant children are not very often sent out to board in this country. When it happens that they are so boarded the motive is to be found only too commonly in the apathy or the ill-will of parents to whom It is now generally their mere existence is a disgrace. child is as a the rule, recognised that, illegitimate which If these two be becomes the prey of the baby-farmer. no infant is second needed to insure the brought together inevitable result. In a case recently unearthed by the National Society for the Prevention of Cruelty to Children a child, aged six months, was found in the possession of a drunken " nurse" the mother of three children, all of whom, as well as the nurse-child, were shamefully neglected. The woman was very properly condemned to six months’ hard labour, but it is noteworthy that her conviction was only indirectly due to her farming the nearly starved infant. This most important part of the delinquency would probably never have been known but for the inquiries of a School Board officer after her own children. Such a fact-and it is means an isolated example of its kind-should go far to convince any doubter that the registration of single nurse-children is both necessary and just. What objection can be brought against this needful provision it is difficult to see. We feel certain that if enacted it would meet with
by no