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THE MEDICAL MEETING AT CHELSEA.
59 the only means of connexion.) The condithat existed prior to the rheumatic attack was again established in about a fortnight. These cases well illustrate the lesser degree of vitality existing in newly formed than in the original textures of the body. In the latter case a degree of febrile excitement of the circulation, which produced only such an amount of inflammation as was compatible with the integrity of the structures in which it was seated, was attended with sufficient vascular disturbance in the uniting medium of the bone, to occasion its partial absorption. In the former case a similar result also was produced, owing to the powers of the circulation having been simply reduced to so low an ebb as to be incapable of maintaining the consistence of the structure that had been deposited between the separated portions of the bone.
apparently forming tion, however,
DISLOCATION OF THE
FEMUR
ON TO THE ISCHIATIC NOTCH.
William C-, plasterer, aged thirty-five, of rather spare build, admitted under Mr. Scott, June 3rd. He was in a state of boister ous intoxication, and had fallen, while in this condition, a considerable height from some scaffolding. The injury sustained was confined to the left hip, the femur, on careful examination, being found dislocated on to the ischiatic notch. The extremity was about half an inch shorter than the right, and admitted of but very slight movement. The toe was directed to the ball of the great toe of the opposite side. The knee was directed forwards and inwards, inclining to the inner edge of the opposite patella. In the region of the sciatic notch was observed marked rotundity, or rather fulness of the soft parts, arising from the presence of the head of the bone, which was distinctly felt on rotating the thigh inwards. Reduction was effected in the usual manner in about seven or eight minutes; no audible snap accompanied the head of the bone regaining its normal position. The patient was immediately placed in bed; the lower extremities were bound closely together, and fomentations were applied to the glutseal region. On the following day, the man, who had recovered from his drunkenness, was not at all conscious either of having dislocated his thigh or of having been subject to the operation necessary for its reduction. From this period to June 26 nothing untoward occurred, no swelling of the soft parts around the joint having resulted, no pain either existing or other symptom indicative of inflammation. He was kept quiet in bed for about three weeks, at the end of which time he walked about the ward with crutches, and complained only of occasional stiffness of the joint.
and face; he was then submitted to another course of mercury, combined with sarsaparilla; the mercury has been continued up to the present time, (three months.) Appearance on admission.—His whole face is covered with sores, having large and elevated incrustations, more particularly upon the forehead and lips; upon the thighs also they are of the size of crown pieces, and surrounded by a much inflamed areola. There is great constitutional debility, loss of sleep, and of appetite, constant pain over the eyebrows, and a weak, tremulous pulse, which beats 140 in the minute. The second and longcontinued course of mercury has produced no effect upon the mouth. Ordered, compound decoction of sarsaparilla, one pint, and diluted nitric acid, one drachm, to be taken daily. Acetate of morphia, half a grain, to be taken each night at bed-time. Bread-poultices to be applied to the sores. The diet to consist of beef-tea and light pudding, with porter. Sept. 20th.-Under this treatment improvement has been most rapid. The crusts have separated, leaving healthy sores, healing, both in the centre and at the circumference ; many have separated, leaving a sound surface beneath; appetite very good; sleeps well, and gains strength rapidly. To have meat diet, and continue the remedies as before, and to apply very diluted nitric acid lotion to the sores. 25th.-Has been attacked with diarrhoea, and the sores have lost their healthy appearance. Ordered to omit the sarsaparilla. To have a rhubarb draught, and, if diarrhoea continues, to take occasionally a draught containing chalk mixture and a few drops of laudanum. 28th.—Diarrhœa has quite subsided. Ordered to take again the sarsaparilla, substituting fifteen grains of iodide of potassium for the one drachm of diluted nitric acid, and to use a lotion of sulphate of zinc (two grains to the ounce of water) to the sores. Oct. 23rd.-He was discharged, cured, the above treatment having been persisted in throughout. In the above case no other secondary symptom except the rupia (if that be one) presented itself; no sore throat or pains in the bones, or nodes, which might have been expected from the severe mercurial treatment.
thighs,
THE MEDICAL MEETING AT CHELSEA. To the Editor
SIR,—I feel
of THE
assured you will allow
LANCET. me an
opportunity, in your
to correct a mis-statement in your report of the above meeting, relative to one of the resolutions laudatory of the
next
number,
Society of Apothecaries, in which Mr. Morrah and myself are represented as having declared ourselves against the upholding of
BACKWARD DISLOCATION OF THE CARPUS.
David B-, aged eighteen, admitted under Mr. Scott, Sept. 4th, He had fallen from the mainmast of a brig, and besides having driven in the lower part of the outer wall of the frontal bone, in the situation of the sinus, and dislocated the middle finger of the right hand, had also displaced the left carpus backwards, the dislocation being evidenced by the following symptoms:-Lower ends of the radius and ulna prominent, both styloid processes being entire, a marked depression beneath, or rather in front Hand partially adducted and thrown backwards; a of them. prominent tumour, formed by the carpus, extending from the level of the radius and ulna backwards, i. e., towards the elbow, for about an iuch and a half; a marked depression above the tumour, i. e., towards the elbow; movements of the hand almost lost, there remaining only slight power of extension, none of flexion. No inconvenient symptom resulted subsequent to reduction, which was effected by making extension from the hand, the elbow being fixed by the knee. The fore-arm and hand were placed in splints for about three weeks, and he soon after this regained perfect movement of the joint.
the present
of the Apothecaries’ Society, as well as in some remarks by no means laudatory of the Court of Examiners. I beg to state, and I have the authority of Mr. Morrah (the worthy chairman) to do so, that neither of us expressed any disapprobation either of the Society or Court of Examiners, and that the resolution itself was carried by a majority of 18 to 2. If you will do me the justice to insert this explanation, you will greatly oblige your well-wisher and constant reader, WILLIAM DICKINSON, Surgeon to the Chelsea, Brompton, and
organization
concurring
Sloane-street, Sept. 30,
1844.
Belgrave Dispensary.
THE APOTHECARIES’ COMPANY, AND SIR JAMES GRAHAM’S BILL. To the Editor of THE LANCET. MR. EDITOR,-According to the bill for Medical Reform, lately introduced by Sir James Graham, three classes of medical men are to be recognised-medical practitioners, surgeons, and physicians. The old and respectable class hitherto known under the name of apothecary is to be for ever abolished; and it is to LOCK HOSPITAL. be presumed that the important duty of compounding medicines, SYPHILITICAL RUPIA. for the future, is to be entrusted to the persons calling themselves William A-, aged twenty, admitted Sept. 7th, 1843, under Mr. chemists and druggists. Lane. From the patient’s history it appears that in February Now, with all due respect to’the home secretary, this alteration last he contracted a sore upon the prepuce; that he was at once of things is neither wise nor judicious. It is well known throughout subjected to mercurial treatment, this being continued for one the country and in this metropolis, that the great majority of month, at the expiration of which time the sore healed, though modern apothecaries are intelligent men, and well educated in with considerable induration remaining, his mouth at the same ’, their profession, and that they only receive their qualification time being severely affected. Seven weeks after the healing of ’, after a long course of study, and when their abilities have been the sore the rupial spots began to make their appearance, com- tested by a careful and impartial scrutiny. Hence the charge mencing upon the arm, and extending successively over the legs, Sir James Graham has made against the Board of Examiners at
apparently forming tion, however,
DISLOCATION OF THE
FEMUR
ON TO THE ISCHIATIC NOTCH.
William C-, plasterer, aged thirty-five, of rather spare build, admitted under Mr. Scott, June 3rd. He was in a state of boister ous intoxication, and had fallen, while in this condition, a considerable height from some scaffolding. The injury sustained was confined to the left hip, the femur, on careful examination, being found dislocated on to the ischiatic notch. The extremity was about half an inch shorter than the right, and admitted of but very slight movement. The toe was directed to the ball of the great toe of the opposite side. The knee was directed forwards and inwards, inclining to the inner edge of the opposite patella. In the region of the sciatic notch was observed marked rotundity, or rather fulness of the soft parts, arising from the presence of the head of the bone, which was distinctly felt on rotating the thigh inwards. Reduction was effected in the usual manner in about seven or eight minutes; no audible snap accompanied the head of the bone regaining its normal position. The patient was immediately placed in bed; the lower extremities were bound closely together, and fomentations were applied to the glutseal region. On the following day, the man, who had recovered from his drunkenness, was not at all conscious either of having dislocated his thigh or of having been subject to the operation necessary for its reduction. From this period to June 26 nothing untoward occurred, no swelling of the soft parts around the joint having resulted, no pain either existing or other symptom indicative of inflammation. He was kept quiet in bed for about three weeks, at the end of which time he walked about the ward with crutches, and complained only of occasional stiffness of the joint.
and face; he was then submitted to another course of mercury, combined with sarsaparilla; the mercury has been continued up to the present time, (three months.) Appearance on admission.—His whole face is covered with sores, having large and elevated incrustations, more particularly upon the forehead and lips; upon the thighs also they are of the size of crown pieces, and surrounded by a much inflamed areola. There is great constitutional debility, loss of sleep, and of appetite, constant pain over the eyebrows, and a weak, tremulous pulse, which beats 140 in the minute. The second and longcontinued course of mercury has produced no effect upon the mouth. Ordered, compound decoction of sarsaparilla, one pint, and diluted nitric acid, one drachm, to be taken daily. Acetate of morphia, half a grain, to be taken each night at bed-time. Bread-poultices to be applied to the sores. The diet to consist of beef-tea and light pudding, with porter. Sept. 20th.-Under this treatment improvement has been most rapid. The crusts have separated, leaving healthy sores, healing, both in the centre and at the circumference ; many have separated, leaving a sound surface beneath; appetite very good; sleeps well, and gains strength rapidly. To have meat diet, and continue the remedies as before, and to apply very diluted nitric acid lotion to the sores. 25th.-Has been attacked with diarrhoea, and the sores have lost their healthy appearance. Ordered to omit the sarsaparilla. To have a rhubarb draught, and, if diarrhoea continues, to take occasionally a draught containing chalk mixture and a few drops of laudanum. 28th.—Diarrhœa has quite subsided. Ordered to take again the sarsaparilla, substituting fifteen grains of iodide of potassium for the one drachm of diluted nitric acid, and to use a lotion of sulphate of zinc (two grains to the ounce of water) to the sores. Oct. 23rd.-He was discharged, cured, the above treatment having been persisted in throughout. In the above case no other secondary symptom except the rupia (if that be one) presented itself; no sore throat or pains in the bones, or nodes, which might have been expected from the severe mercurial treatment.
thighs,
THE MEDICAL MEETING AT CHELSEA. To the Editor
SIR,—I feel
of THE
assured you will allow
LANCET. me an
opportunity, in your
to correct a mis-statement in your report of the above meeting, relative to one of the resolutions laudatory of the
next
number,
Society of Apothecaries, in which Mr. Morrah and myself are represented as having declared ourselves against the upholding of
BACKWARD DISLOCATION OF THE CARPUS.
David B-, aged eighteen, admitted under Mr. Scott, Sept. 4th, He had fallen from the mainmast of a brig, and besides having driven in the lower part of the outer wall of the frontal bone, in the situation of the sinus, and dislocated the middle finger of the right hand, had also displaced the left carpus backwards, the dislocation being evidenced by the following symptoms:-Lower ends of the radius and ulna prominent, both styloid processes being entire, a marked depression beneath, or rather in front Hand partially adducted and thrown backwards; a of them. prominent tumour, formed by the carpus, extending from the level of the radius and ulna backwards, i. e., towards the elbow, for about an iuch and a half; a marked depression above the tumour, i. e., towards the elbow; movements of the hand almost lost, there remaining only slight power of extension, none of flexion. No inconvenient symptom resulted subsequent to reduction, which was effected by making extension from the hand, the elbow being fixed by the knee. The fore-arm and hand were placed in splints for about three weeks, and he soon after this regained perfect movement of the joint.
the present
of the Apothecaries’ Society, as well as in some remarks by no means laudatory of the Court of Examiners. I beg to state, and I have the authority of Mr. Morrah (the worthy chairman) to do so, that neither of us expressed any disapprobation either of the Society or Court of Examiners, and that the resolution itself was carried by a majority of 18 to 2. If you will do me the justice to insert this explanation, you will greatly oblige your well-wisher and constant reader, WILLIAM DICKINSON, Surgeon to the Chelsea, Brompton, and
organization
concurring
Sloane-street, Sept. 30,
1844.
Belgrave Dispensary.
THE APOTHECARIES’ COMPANY, AND SIR JAMES GRAHAM’S BILL. To the Editor of THE LANCET. MR. EDITOR,-According to the bill for Medical Reform, lately introduced by Sir James Graham, three classes of medical men are to be recognised-medical practitioners, surgeons, and physicians. The old and respectable class hitherto known under the name of apothecary is to be for ever abolished; and it is to LOCK HOSPITAL. be presumed that the important duty of compounding medicines, SYPHILITICAL RUPIA. for the future, is to be entrusted to the persons calling themselves William A-, aged twenty, admitted Sept. 7th, 1843, under Mr. chemists and druggists. Lane. From the patient’s history it appears that in February Now, with all due respect to’the home secretary, this alteration last he contracted a sore upon the prepuce; that he was at once of things is neither wise nor judicious. It is well known throughout subjected to mercurial treatment, this being continued for one the country and in this metropolis, that the great majority of month, at the expiration of which time the sore healed, though modern apothecaries are intelligent men, and well educated in with considerable induration remaining, his mouth at the same ’, their profession, and that they only receive their qualification time being severely affected. Seven weeks after the healing of ’, after a long course of study, and when their abilities have been the sore the rupial spots began to make their appearance, com- tested by a careful and impartial scrutiny. Hence the charge mencing upon the arm, and extending successively over the legs, Sir James Graham has made against the Board of Examiners at