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THE MEDICAL EXAMINATIONS OF THE EAST INDIA COMPANY.
196
death, which was the result of perforation, great thickening and induration were found around the ulcer, showing that it must have existed for several years. Mr. Sedgwick observed that when perforation took place, he had always found the " Audi alteram partem." symptoms sufficiently indicative. These were, sudden and with not a in intense pain the epigastric region, unfrequently feeling on the part of the patient that something had given CHLOROFORM IN SURGICAL OPERATIONS. way in his inside, followed by collapse, and in some cases even To the Editor of THE LANCET. syncope; tenderness over the abdomen, with occasionally shall be SIR,—I obliged by your permitting me to supply a tympanitis; a disposition to vomit, generally without the in my letter on chloroform, which appeared in THE deficiency and the of do urine. to thirst, so; urgent suppression ability Some writers on the subject were of opinion that vomiting LANCET of last week, relating to the alleged saving of life by it occurred in most cases of perforation; but in his experience of in severe operations. As a letter from Professor Simpson was the disease the recurrence of vomiting was unusual, and he had printed in The Times of the 5th inst., strongly insisting on of chloroform, it is more necessary that the only noticed it in one case, which was in other respects also an this advantage should be remedied. exceptional one. The suppression of urine, which did not defect In this letter, communicated by Colonel Napier, who kindly appear to have attracted much notice, was as marked a symptom in these cases as in cholera, and the patient, notwith- acts as accoucheur on the occasion, he presents the great public standing the quantity of fluid so often improperly allowed to with a table, showing that there is a saving of life to the exbe swallowed, either did not pass any urine after the accident, traordinary amount of 11 per cent., by the use of anaesthetics in amputation of the thigh. What can be said against chloroor only a few ounces, which were turbid and high-coloured, and after death no urine was found in the bladder, which, as form after this triumphant argument-this statistical, mathein cholera, appeared to be always firmly contracted. Whilst matical proof? he considered that, with a due regard to these symptoms, so Unhappily, there are other tables in existence proving the gravean accident as perforation of the stomach was not likely very contrary, drawn up by parties having no personal interest to take place without being recognised during life, he would in the matter, and under other circumstances better calculated win our confidence than those under which Dr. Simpson’s beg to call the attention of the Society to the possibility of the to To these I only alluded in my letter; I now were prepared. more cases or less mistake from simulating opposite occurring are contained in the American Journal of the send them. after the stomach They and of the death, stomach, where, perforation had been found free from disease. During the last year he Medical Sciences for April, 1852, and are accompanied with had been present, by invitation, at two post-mortem examina- the necessary explanations, and with criticisms on Dr. Simpson’s tions where this was the case. As they both presented many tables. The records of the hospitals of New York, Boston, and data on which these tables are consymptoms in common, and the sudden death was due to the Philadelphia, furnish the structed ; and, surely, if a prejudice is to exist anywhere in same cause in each, he would only describe the first-a woman, aged forty-three, and suffering from cancer of the favour of etherization, we should expect to find it in the land womb. There had been, as was so often observed in these of its birth:cases, great irritability of the stomach, with much nausea and occasional vomiting after taking food. For four or five days before death she had suffered much from pain in the pit of the stomach, and complained of tenderness on pressure there, for which turpentine fomentations had been used. The pain and tenderness increased, and after passing a night of great suffering, she was suddenly seized, at nine A. M., with agonizing pain .in the epigastrium, and complained that the pressure of the These tables tell a very different tale from Dr. Simpson’s; bed-clothes over the abdomen distressed her. She quickly they show that, instead of saving, chloroform kills 11 per cent., passed into a state of collapse, and died soon after eleven A.M. and annexed to this is the express " conviction of Dr. Porter, the same morning.,. The sudden death was found to be due to of the American army, that in the cases in which he saw anæsdisease of the heart, which was in a very advanced stage of thetics employed during the late war with Mexico, they exerfatty degeneration ; there was no evidence of peritonitis, and cised a decidedly unfavourable influence upon the state of the the stomach, beyond some patches of well-marked mammilla- wounds and upon the result of operations." I do not, however, conceive that this question can as yet be tion, appeared free from disease. After discussing at some length the seat of the disease, and referring to one of the pre- settled by statistics, if, indeed, it be one admitting of such eviparations on the table as an exceptional instance of a perforating dence ; but if tables on one side are published, common fairness ulcer, occurring, not only in the cardiac division, but also on its requires that those on the other should not be concealed. A posterior surface, he (Mr. Sedgwick) concluded with some priori, we could not expect advantage, under the circumremarks on the terminations of the disease by perforation. He stances, from an agent possessing the properties of chloroform. observed that all the preparations on the table illustrated this All analogy is against such a supposition. I shall take this opportunity of stating that communications tendency in ulcer of the stomach to go on to a fatal termination, either by communicating with the cavity of the abdomen, have been made to me respecting a difficulty that has been exand so causing death by peritonitis, or by opening into an perienced in getting frigorific mixtures to act properly during arterial branch, and so leading to death by haemorrhage. Four the present cold weather. I ought to have stated in my lately of the cases related proved fatal by peritonitis from perforation, published " minute instructions," that ice of a lower temperaand, as usual, in each of them one ulcer only existed in the ture than 32° does not dissolve with sufficient rapidity. Constomach. One of these cases was remarkable from the fact of sequently, whoever uses it for anaesthesia, must, when it is haemorrhage, to an almost fatal extent, having occurred five brought to him of that temperature, do, as the lady, peevishly years previous to death, and on no subsequent occasion. In complaining of the coldness of the ice-cream which he had prethe last case, that of a labourer, aged sixty-six, the immediate scribed, was recommended to do by Sir Henry Halford-he cause of death was doubtful. In this case, two ulcers were must warm it. The courtly physician may have been better found in the stomach, in both of which the perforating process acquainted with the chemistry of confections than those who had evidently been going on up to the time of death in the have laughed at his polite recommendation. I am, Sir, yours most obediently, posterior ulcer leading to haemorrhage, which commenced three JAMES ARNOTT. days before death, and was alone sufficiently profuse to account February, 1855. for it; whilst in the anterior ulcer there was a small opening with the cavity of the abdomen, and which had THE MEDICAL EXAMINATIONS OF THE given rise to peritonitis, which was, however, unusually slight. After commenting upon all the particulars of this interesting EAST INDIA COMPANY. case, he (Mr. Sedgwick) was inclined to believe that the perthe Editor of THE LANCET. To foration in the anterior ulcer was the result of the over-distension of the stomach with blood, and that the haemorrhage think SIR,—I most-yea, all-practical men (and women, should be considered to have accelerated, rather than have too) who have been in India, will agree in the soundness of caused, the death of the patient. your remarks on the impropriety of so large a number as The paper gave rise to a protracted discussion, in which a out of sixty-nine questions, having been devoted considerable number of the members took part. Mr. Sedgwick to botany and zoology in the late examinations of the twenty-
Correspondence.
l
communicating
thirty-two,
-
replied,
and the
Society adjourned.
eight
candidates for the medical service
ofthe East
India
197 If any medical as noticed by’you on the 20th ult. the world is, or ought to be, a good general practi-
’Company, man in
APPLICATION OF BANDAGES AFTER
DELIVERY. and practical knowledge of the varied branches of our profession, it is the Indian military surgeon. To t7te Editoi- of THE LANCET. Within a very short space of time, I (and every surgeon in SIR,—The late Dr. Hugh Ley recommended that " no India is subject to the same liabilities) have been called on to attend a variety of medical cases, such as remittent fevers and bandage should be applied after delivery." I beg to bear my to the value of this suggestion. dysentery, requiring the greatest promptitude-to amputate a testimony now notes of upwards of a thousand midwifery cases, limb, reduce a dislocation, attend a case of uterine heemor- in Having none of which has the an a reduce attend case of bandage been applied for several rhage, inguinal hernia, puerperal after delivery, and in very many of them not at all, I mania, removeadiseased tooth, and report upon a case of hours in no one case has there been serious flooding or poisoning. Now, is it possible for a man who is liable to be can state that called on to see all these serious and varied cases (and often he syncope. There can be no question that bandaging relieves, to is isolated and separated from his professional brethren) con- a certain extent, that sensation of weariness and exhaustion succeeds delivery; but the almcL rerum parens provides scientiously to discharge his duty if he devotes his time and which talents to pure botany or zoology? Out of the large number of this state of prostration, in order to prevent haemorrhage; and the most casual observer cannot fail to notice how beautifully a hundred and thirty surgeons, and two hundred and thirty uterus contracts when this wise provision of Nature is not assistant-surgeons in the Bengal presidency, there are about the two or three who ex officio devote their time to botany-viz., interfered with. Is, then, the bandage ever to be applied, and if so, under the superintendent of the honourable company’s botanical what circumstances? As a general rule, never in a healthy and the at Calcutta, Saharampore, superintendent gardens, in the north-western provinces; and both the gentlemen who primipara, nor where the uterus has not properly contracted, fulfil these appointments are exempted from all professional lest much valuable time be lost in removing the bandage, to enable you to use more efficient means. It is equally unnecesresponsibilities. To fill up these appointments when vacant, by far the sary even after the abdomen has been much distended by twins better plan would be to send out well-known botanists from or other causes. A bandage may he applied an hour or two home. No doubt India offers to the botanist, the zoologist, after delivery, if the patient be harassed by cough. There are occasionally cases in which (under any manageand the geologist a vast field, and, as yet, partially unexdoes not recover its natural formin such ment) plored ; but why allow this to interfere with the practical cases the abdomen will be more serviceable after the fourth or physician, surgeon, and accoucheur? The addition of three fifth bandaging day, this being the period when the congestion of the months at a lunatic asylum, and three months ophthalmic suruterus and its appendages has nearly disappeared. gery to the former acquirements, is most judicious; to these I believe that a more general adoption of Dr. Hugh Ley’s might well be added, three months dental surgery. How few advice would prevent many serious cases of flooding. a know how to extract much less to military surgeons tooth, T am Sir yours obediently take out a stump decently ; yet, in India, we are frequently HARRY DOVE, M.R.C.S.L., &c. Norwich, February, 1855. called on by officers, civil and military, to afford relief to themselves and families, as well as to soldiers, their wives and children, in painful affections of the teeth and gums. FRACTURES TREATED BY STARCHED I would strongly recommend every assistant-surgeon, previous to sailing to India, if not acquainted with the use of the BANDAGES, BAGS OF SAND, &c. various kinds of forceps, and Bell’s and Clendon’s elevators, to - To the Editor of THE LANCET. become cognizant of their several applications and uses before SIR,—In your " Mirror" of the 3rd inst., I find reported a case he proceeds to India. There are not any dentists in India, of fracture, under the care of Mr. Erichsen. Permit me to offer except at the Presidencies; and I have known of persons a few remarkson it. of and from want of a days suffering nights agony qualified Probably your readers are aware that the treatment by a remove a doctor small, deep-seated stump, though person to The Company do not supply the largE the immovable apparatus" is not a " new method," havwas close at hand. employed, under various forms, from times of antiforceps, or the modern elevators. The Company’s cases o: ing beenFor an historical account of it, I would refer to the tooth instruments consist of keys, and the old-fashionec quity. double-toothed punch, which is next to useless. It would bi chapter, in Mr. Gamgees book, on this subject. The apparaas applied at the present time in this hospital, was also in well, therefore, to get a few pair of the valuable forceps nov tus, use for simple fractures of the leg (and for others after the lapse or of Bell’s and Clendon’s elevators. made, and two three of a week or so) in the time of the lamented Mr. Morton. The I remain. Sir, vour obedient servant. new feature brought forward by Mr. Gamgee in this country, CHARLES MADDEN, A.B., is the application of it to fractures of a serious kind, such as of Late Feb. 1855. Sth, Surgeon Bengal Army. Clifton, Bristol, the thigh, immediately after their occurrence, and, always provided it is applied secundem artem, such treatment, in my experience, is uniformly successful. Now, to the case in CHARING-CROSS HOSPITAL.
tioner, and have a sound
,
question:To the Editor of THE LANCET. James M’N——, aged forty-five, bricklayer’s labourer, was SiR,-As you have so often evinced a desire to befriend the admitted, October 10th, 1854, under the care of Mr. Erichsen, student, and as we have real cause of grievance at our hospital, having fallen forty-fivefeet from a scaffold, and fractured the I beg that you will aid us in obtaining redress, and call upon thigh and arm of the left side. The femur was broken in two the governors of Charing-cross Hospital to state why the places, an inch or two below the trochanters, and in the middle of the shaft. The starched bandage was applied to the limb new wards, with room for forty beds, should remain in the same state as when I entered, in October, 1853- immediately, before any swelling had come on. The humerus unused and unoccupied? What are the governors doing was fractured in its middle third, and I put it up on a splint, that they allow these wards to be empty, to the detri- introduced by Mr. Turle (late house-surgeon to this hospital). ment of the student, when we are constantly sending away This, however, was found awkward to the patient as he lay in patients that cannot be admitted through want of space ? Is bed; accordingly, on the seventh day, the starched apparatus it owing to the mismanagement of the present director ? or is was used to this, but not in the manner described by your it owing to the want of funds of the hospital ? If so, why not reporter. There were only two splints used, an inner and an place these wards at the disposal of Government, as other outer one, with a bend at right angles in each for the elbow, hospitals are doing at the present time ? Then those students extending from the fingers to the axilla. As to the width of who intend entering the army may have an opportunity ofthe splints, your reporter is better informed on the subject than studying military surgery; but perhaps this latter suggestion I am, for I never took the trouble of being so accurate in my could not be acted upon through the absence of one of our measurement in setting any fracture. On the sixth week, the principal surgeons. Are we to be as long without assistance! arm was sufficiently consolidated to allow of the patient’s using in the surgical as we were in the medical department ? I trust3aa crutch, so he got up, and finally left the hospital, after being not, but I am afraid these grievances will be long unredressedLunder treatment for ten weeks and three days, on December unless it is brought prominently before the governors throughi 22nd, in this condition :-No shortening of the inferior extrethe medium of your widely-circulated columns. mity ; no thickening or deformity in the shaft of the bone; some small amount about the seat of upper fracture; in the I am, Sir, your obedient servant, no shortening; loss of mobility for the time being, and A SECOND-YEAR’S STUDENT. Feb. 1855. .
.
’
arm,
death, which was the result of perforation, great thickening and induration were found around the ulcer, showing that it must have existed for several years. Mr. Sedgwick observed that when perforation took place, he had always found the " Audi alteram partem." symptoms sufficiently indicative. These were, sudden and with not a in intense pain the epigastric region, unfrequently feeling on the part of the patient that something had given CHLOROFORM IN SURGICAL OPERATIONS. way in his inside, followed by collapse, and in some cases even To the Editor of THE LANCET. syncope; tenderness over the abdomen, with occasionally shall be SIR,—I obliged by your permitting me to supply a tympanitis; a disposition to vomit, generally without the in my letter on chloroform, which appeared in THE deficiency and the of do urine. to thirst, so; urgent suppression ability Some writers on the subject were of opinion that vomiting LANCET of last week, relating to the alleged saving of life by it occurred in most cases of perforation; but in his experience of in severe operations. As a letter from Professor Simpson was the disease the recurrence of vomiting was unusual, and he had printed in The Times of the 5th inst., strongly insisting on of chloroform, it is more necessary that the only noticed it in one case, which was in other respects also an this advantage should be remedied. exceptional one. The suppression of urine, which did not defect In this letter, communicated by Colonel Napier, who kindly appear to have attracted much notice, was as marked a symptom in these cases as in cholera, and the patient, notwith- acts as accoucheur on the occasion, he presents the great public standing the quantity of fluid so often improperly allowed to with a table, showing that there is a saving of life to the exbe swallowed, either did not pass any urine after the accident, traordinary amount of 11 per cent., by the use of anaesthetics in amputation of the thigh. What can be said against chloroor only a few ounces, which were turbid and high-coloured, and after death no urine was found in the bladder, which, as form after this triumphant argument-this statistical, mathein cholera, appeared to be always firmly contracted. Whilst matical proof? he considered that, with a due regard to these symptoms, so Unhappily, there are other tables in existence proving the gravean accident as perforation of the stomach was not likely very contrary, drawn up by parties having no personal interest to take place without being recognised during life, he would in the matter, and under other circumstances better calculated win our confidence than those under which Dr. Simpson’s beg to call the attention of the Society to the possibility of the to To these I only alluded in my letter; I now were prepared. more cases or less mistake from simulating opposite occurring are contained in the American Journal of the send them. after the stomach They and of the death, stomach, where, perforation had been found free from disease. During the last year he Medical Sciences for April, 1852, and are accompanied with had been present, by invitation, at two post-mortem examina- the necessary explanations, and with criticisms on Dr. Simpson’s tions where this was the case. As they both presented many tables. The records of the hospitals of New York, Boston, and data on which these tables are consymptoms in common, and the sudden death was due to the Philadelphia, furnish the structed ; and, surely, if a prejudice is to exist anywhere in same cause in each, he would only describe the first-a woman, aged forty-three, and suffering from cancer of the favour of etherization, we should expect to find it in the land womb. There had been, as was so often observed in these of its birth:cases, great irritability of the stomach, with much nausea and occasional vomiting after taking food. For four or five days before death she had suffered much from pain in the pit of the stomach, and complained of tenderness on pressure there, for which turpentine fomentations had been used. The pain and tenderness increased, and after passing a night of great suffering, she was suddenly seized, at nine A. M., with agonizing pain .in the epigastrium, and complained that the pressure of the These tables tell a very different tale from Dr. Simpson’s; bed-clothes over the abdomen distressed her. She quickly they show that, instead of saving, chloroform kills 11 per cent., passed into a state of collapse, and died soon after eleven A.M. and annexed to this is the express " conviction of Dr. Porter, the same morning.,. The sudden death was found to be due to of the American army, that in the cases in which he saw anæsdisease of the heart, which was in a very advanced stage of thetics employed during the late war with Mexico, they exerfatty degeneration ; there was no evidence of peritonitis, and cised a decidedly unfavourable influence upon the state of the the stomach, beyond some patches of well-marked mammilla- wounds and upon the result of operations." I do not, however, conceive that this question can as yet be tion, appeared free from disease. After discussing at some length the seat of the disease, and referring to one of the pre- settled by statistics, if, indeed, it be one admitting of such eviparations on the table as an exceptional instance of a perforating dence ; but if tables on one side are published, common fairness ulcer, occurring, not only in the cardiac division, but also on its requires that those on the other should not be concealed. A posterior surface, he (Mr. Sedgwick) concluded with some priori, we could not expect advantage, under the circumremarks on the terminations of the disease by perforation. He stances, from an agent possessing the properties of chloroform. observed that all the preparations on the table illustrated this All analogy is against such a supposition. I shall take this opportunity of stating that communications tendency in ulcer of the stomach to go on to a fatal termination, either by communicating with the cavity of the abdomen, have been made to me respecting a difficulty that has been exand so causing death by peritonitis, or by opening into an perienced in getting frigorific mixtures to act properly during arterial branch, and so leading to death by haemorrhage. Four the present cold weather. I ought to have stated in my lately of the cases related proved fatal by peritonitis from perforation, published " minute instructions," that ice of a lower temperaand, as usual, in each of them one ulcer only existed in the ture than 32° does not dissolve with sufficient rapidity. Constomach. One of these cases was remarkable from the fact of sequently, whoever uses it for anaesthesia, must, when it is haemorrhage, to an almost fatal extent, having occurred five brought to him of that temperature, do, as the lady, peevishly years previous to death, and on no subsequent occasion. In complaining of the coldness of the ice-cream which he had prethe last case, that of a labourer, aged sixty-six, the immediate scribed, was recommended to do by Sir Henry Halford-he cause of death was doubtful. In this case, two ulcers were must warm it. The courtly physician may have been better found in the stomach, in both of which the perforating process acquainted with the chemistry of confections than those who had evidently been going on up to the time of death in the have laughed at his polite recommendation. I am, Sir, yours most obediently, posterior ulcer leading to haemorrhage, which commenced three JAMES ARNOTT. days before death, and was alone sufficiently profuse to account February, 1855. for it; whilst in the anterior ulcer there was a small opening with the cavity of the abdomen, and which had THE MEDICAL EXAMINATIONS OF THE given rise to peritonitis, which was, however, unusually slight. After commenting upon all the particulars of this interesting EAST INDIA COMPANY. case, he (Mr. Sedgwick) was inclined to believe that the perthe Editor of THE LANCET. To foration in the anterior ulcer was the result of the over-distension of the stomach with blood, and that the haemorrhage think SIR,—I most-yea, all-practical men (and women, should be considered to have accelerated, rather than have too) who have been in India, will agree in the soundness of caused, the death of the patient. your remarks on the impropriety of so large a number as The paper gave rise to a protracted discussion, in which a out of sixty-nine questions, having been devoted considerable number of the members took part. Mr. Sedgwick to botany and zoology in the late examinations of the twenty-
Correspondence.
l
communicating
thirty-two,
-
replied,
and the
Society adjourned.
eight
candidates for the medical service
ofthe East
India
197 If any medical as noticed by’you on the 20th ult. the world is, or ought to be, a good general practi-
’Company, man in
APPLICATION OF BANDAGES AFTER
DELIVERY. and practical knowledge of the varied branches of our profession, it is the Indian military surgeon. To t7te Editoi- of THE LANCET. Within a very short space of time, I (and every surgeon in SIR,—The late Dr. Hugh Ley recommended that " no India is subject to the same liabilities) have been called on to attend a variety of medical cases, such as remittent fevers and bandage should be applied after delivery." I beg to bear my to the value of this suggestion. dysentery, requiring the greatest promptitude-to amputate a testimony now notes of upwards of a thousand midwifery cases, limb, reduce a dislocation, attend a case of uterine heemor- in Having none of which has the an a reduce attend case of bandage been applied for several rhage, inguinal hernia, puerperal after delivery, and in very many of them not at all, I mania, removeadiseased tooth, and report upon a case of hours in no one case has there been serious flooding or poisoning. Now, is it possible for a man who is liable to be can state that called on to see all these serious and varied cases (and often he syncope. There can be no question that bandaging relieves, to is isolated and separated from his professional brethren) con- a certain extent, that sensation of weariness and exhaustion succeeds delivery; but the almcL rerum parens provides scientiously to discharge his duty if he devotes his time and which talents to pure botany or zoology? Out of the large number of this state of prostration, in order to prevent haemorrhage; and the most casual observer cannot fail to notice how beautifully a hundred and thirty surgeons, and two hundred and thirty uterus contracts when this wise provision of Nature is not assistant-surgeons in the Bengal presidency, there are about the two or three who ex officio devote their time to botany-viz., interfered with. Is, then, the bandage ever to be applied, and if so, under the superintendent of the honourable company’s botanical what circumstances? As a general rule, never in a healthy and the at Calcutta, Saharampore, superintendent gardens, in the north-western provinces; and both the gentlemen who primipara, nor where the uterus has not properly contracted, fulfil these appointments are exempted from all professional lest much valuable time be lost in removing the bandage, to enable you to use more efficient means. It is equally unnecesresponsibilities. To fill up these appointments when vacant, by far the sary even after the abdomen has been much distended by twins better plan would be to send out well-known botanists from or other causes. A bandage may he applied an hour or two home. No doubt India offers to the botanist, the zoologist, after delivery, if the patient be harassed by cough. There are occasionally cases in which (under any manageand the geologist a vast field, and, as yet, partially unexdoes not recover its natural formin such ment) plored ; but why allow this to interfere with the practical cases the abdomen will be more serviceable after the fourth or physician, surgeon, and accoucheur? The addition of three fifth bandaging day, this being the period when the congestion of the months at a lunatic asylum, and three months ophthalmic suruterus and its appendages has nearly disappeared. gery to the former acquirements, is most judicious; to these I believe that a more general adoption of Dr. Hugh Ley’s might well be added, three months dental surgery. How few advice would prevent many serious cases of flooding. a know how to extract much less to military surgeons tooth, T am Sir yours obediently take out a stump decently ; yet, in India, we are frequently HARRY DOVE, M.R.C.S.L., &c. Norwich, February, 1855. called on by officers, civil and military, to afford relief to themselves and families, as well as to soldiers, their wives and children, in painful affections of the teeth and gums. FRACTURES TREATED BY STARCHED I would strongly recommend every assistant-surgeon, previous to sailing to India, if not acquainted with the use of the BANDAGES, BAGS OF SAND, &c. various kinds of forceps, and Bell’s and Clendon’s elevators, to - To the Editor of THE LANCET. become cognizant of their several applications and uses before SIR,—In your " Mirror" of the 3rd inst., I find reported a case he proceeds to India. There are not any dentists in India, of fracture, under the care of Mr. Erichsen. Permit me to offer except at the Presidencies; and I have known of persons a few remarkson it. of and from want of a days suffering nights agony qualified Probably your readers are aware that the treatment by a remove a doctor small, deep-seated stump, though person to The Company do not supply the largE the immovable apparatus" is not a " new method," havwas close at hand. employed, under various forms, from times of antiforceps, or the modern elevators. The Company’s cases o: ing beenFor an historical account of it, I would refer to the tooth instruments consist of keys, and the old-fashionec quity. double-toothed punch, which is next to useless. It would bi chapter, in Mr. Gamgees book, on this subject. The apparaas applied at the present time in this hospital, was also in well, therefore, to get a few pair of the valuable forceps nov tus, use for simple fractures of the leg (and for others after the lapse or of Bell’s and Clendon’s elevators. made, and two three of a week or so) in the time of the lamented Mr. Morton. The I remain. Sir, vour obedient servant. new feature brought forward by Mr. Gamgee in this country, CHARLES MADDEN, A.B., is the application of it to fractures of a serious kind, such as of Late Feb. 1855. Sth, Surgeon Bengal Army. Clifton, Bristol, the thigh, immediately after their occurrence, and, always provided it is applied secundem artem, such treatment, in my experience, is uniformly successful. Now, to the case in CHARING-CROSS HOSPITAL.
tioner, and have a sound
,
question:To the Editor of THE LANCET. James M’N——, aged forty-five, bricklayer’s labourer, was SiR,-As you have so often evinced a desire to befriend the admitted, October 10th, 1854, under the care of Mr. Erichsen, student, and as we have real cause of grievance at our hospital, having fallen forty-fivefeet from a scaffold, and fractured the I beg that you will aid us in obtaining redress, and call upon thigh and arm of the left side. The femur was broken in two the governors of Charing-cross Hospital to state why the places, an inch or two below the trochanters, and in the middle of the shaft. The starched bandage was applied to the limb new wards, with room for forty beds, should remain in the same state as when I entered, in October, 1853- immediately, before any swelling had come on. The humerus unused and unoccupied? What are the governors doing was fractured in its middle third, and I put it up on a splint, that they allow these wards to be empty, to the detri- introduced by Mr. Turle (late house-surgeon to this hospital). ment of the student, when we are constantly sending away This, however, was found awkward to the patient as he lay in patients that cannot be admitted through want of space ? Is bed; accordingly, on the seventh day, the starched apparatus it owing to the mismanagement of the present director ? or is was used to this, but not in the manner described by your it owing to the want of funds of the hospital ? If so, why not reporter. There were only two splints used, an inner and an place these wards at the disposal of Government, as other outer one, with a bend at right angles in each for the elbow, hospitals are doing at the present time ? Then those students extending from the fingers to the axilla. As to the width of who intend entering the army may have an opportunity ofthe splints, your reporter is better informed on the subject than studying military surgery; but perhaps this latter suggestion I am, for I never took the trouble of being so accurate in my could not be acted upon through the absence of one of our measurement in setting any fracture. On the sixth week, the principal surgeons. Are we to be as long without assistance! arm was sufficiently consolidated to allow of the patient’s using in the surgical as we were in the medical department ? I trust3aa crutch, so he got up, and finally left the hospital, after being not, but I am afraid these grievances will be long unredressedLunder treatment for ten weeks and three days, on December unless it is brought prominently before the governors throughi 22nd, in this condition :-No shortening of the inferior extrethe medium of your widely-circulated columns. mity ; no thickening or deformity in the shaft of the bone; some small amount about the seat of upper fracture; in the I am, Sir, your obedient servant, no shortening; loss of mobility for the time being, and A SECOND-YEAR’S STUDENT. Feb. 1855. .
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arm,