THE PROGNOSIS OF COMPOUND FRACTURES.

1168 Bill makes

pretension to do, and unless it is amended in its this Act as it at present stands is, however, not passage through Parliament it is probable that London will adapted to London circumstances, and a more comremain for a number of years deprived of much of the useful plete and satisfactory adjustment is needed to meet service which its central health department could render. the special conditions of the metropolis. We should be When the Local Government Act of 1888 was passed it glad to see some such course adopted, for we are satisfied that the more intimately the County Council is assowas perhaps a wise course to leave the county health officer without duties which were very clearly defined. That there ciated with the district health administration of London From the point of the more effective it will be. was ample work for such an officer no one familiar with no

health administration has

doubted, but it has remained for view of the district medical officer of health there

the officers first appointed to show how their services may be is nothing to object to in this suggestion, for it would best employed. In London the position shaped itself very add to the dignity of his office and, we hope, to his quickly ; the medical officer of health of the county had influence with the district authority. Whether the immediately important duties under the Housing of the subject will come in any precise form before Parliament we Working Classes Act and these duties were in 1891 largely do not know, but in our view unless the Bill be amended in added to by the powers conferred upon the London County the sense we have indicated a fine opportunity for improving Council under the Public Health (London) Act. That the the health administration of the metropolis will be lost. County Council has thus been able to render great services to London there is

no possible doubt. which needs consideration now is :-what question should be the position of the County Council in the future in relation to the health administration of London ? This, we think, should have been determined by the present Bill, but it gives no such indication of the intentions of

The

Annotations. "Ne

quid nimis."

THE PROGNOSIS OF COMPOUND FRACTURES. the Government. Beyond providing the Council with an unBEFORE the days of antiseptic surgery cases of compound satisfactory method of exercising, when a sanitary authority of the limbs usually ended in a sacrifice of the fracture is in default, certain powers, which it has itself hitherto either primarily so as to prevent the risk of the patient exercised to the public advantage irrespectively of failure limb, being subjected to pyaemia, erysipelas, or prolonged supon the part of the sanitary authority, its position is practipuration or by a subsequent amputation. Since the use of cally the same as before. It is, however, possible to obtain antiseptics a limb is rarely removed by primary amputasome insight into the views of the Council on this matter tion unless the bones are so comminuted, the main vessels and also into the views of its chief health officer ; with torn, or the tendons and muscular structures so damaged regard to the former through amendments to the Bill of that repair is beyond consideration. This situation appears to us to offer certain unfortunate opportunities. If after a which notice has been given ; with regard to the latter by a surgeon hasdone his best to save the limb an unfavourable paper which has been prepared by the medical officer of union is the result he now runs the risk of being blamed for health of London and which the County Council has printed. infirmities has which he done his best causing the very We may summarise the latter document by stating that it according to modern teaching and experience to avoid. shows reason for linking together the several administra- It is to be regretted that medical men can be tions of London in such a way as to create a really effective found to support such actions; if it were not for Any surgeon of Mr. SHIRLEY this these actions could not arise. machine for the prevention of disease. even limited knows how difficult it is to experience MURPHY has an easy task in showing the great disadvanform an accurate prognosis in cases of compound fractage from which London suffers owing to the severance ture. In some cases the fragment can be readily got of the administrations for notification of infectious into favourable apposition and the outside wound can be disease and for hospital provision from the admin- easily cleaned while the destruction of the soft parts istration of the central metropolitan health authority. turns out to be not so great as at first appeared. For this we believe that there is only one remedy and Then, and perhaps aided by the patient’s vitality and robust health, progress is favourable and very little that, as we have before stated, is that these two adminisdeformity is left. On the other hand, the fracture may trations should be combined. It is, indeed, difficult to be comminuted and the bone split in a longitudinal direcexplain why the Government have not recognised the tion, or the fracture may be oblique and the two ends necessity of this change and have not provided for it in their impossible to get into apposition, while the patient’s general health may be such that complications ensue even under present Bill. As we have said, the A further proposal is, we find, that the medical officers of the most intelligent treatment. in cases of compound fracture is uncertain. A prognosis health of London districts should be county officers and thus union may occur or much deformity may result from linked with the central as well as the district authorities. faulty a superabundance of callus despite all precautions ; then This question was much discussed in 1888 when the although the limb has been saved it may be nearly Local Government Bill of that year was before Parliament useless for a very long period or even permanently-a result and the proposal received the approval of the Council which is all the more disappointing to the patient in that he of the Society of Medical Officers of Health and of the has hoped so much from the conservative treatment. At British Medical Association who, indeed, took active steps the recent Manchester Assizes an action for damages was tried before Mr. Justice Bigham and a special jury. Mr. to secure its adoption. In this they were partially successRichard Gunn, a surgeon of Droylsden, was sued by a man ful, for the Local Government Act does give opportunity for named Kite who had acted for him as groom. The groom County Councils to appoint the medical officers of health of was driving home when the horse stumbled and he was districts in other counties than London. The provision in thrown out receiving a compound fracture of the right arm.

1169 The question is one about which was attended to by the house surgeon at Stockport under certain restrictions. Infirmary and he returned home the same night and was we have maintained again and again that some definite treated by Mr. Gunn. The limb would appear to have been pronouncement from the Government was needed, so that This

regular intervals but union apparently has place. A want of bony union surely cannot be the

welcome the statement that the President of the Local Government Board has decided to appoint at once an fault of the surgeon but rather of the constitution of the expert committee to inquire into the whole question of prepatient. The plaintiff’s case received medical support. For servatives, their use, and how far such use is injurious the defendant Mr. W. G. S. Nickerson, formerly assistant to health. It is impossible to deal adequately and serriatim house surgeon at the Stockport Infirmary, now a lieutenant with the issues raised in the proceedings of the Committee. in the Royal Army Medical Corps at Portsmouth, stated We must postpone therefore a general criticism of the that he put up Kite’s fracture and that it was a badly suggested amendments until they are embodied in the splintered fracture. He stated that he got the bones final report of the Committee which, as we have already straight, but that owing to the splinters the position said, may be expected to sit during a somewhat protracted He then formed time considering the contentious nature and the great of the shaft was unsatisfactory. the opinion that the fracture, which was the worst fracture number of the points with which they have to deal. of the forearm he had ever seen," would have a bad result, either from the faulty union or excessive callus. Mr. W. THE SERVICES OF THE GENERAL PRACTITIONER Thorburn of Manchester said that with a fracture of this AND JURIES. description, taking patients of average health, there was MR. EDWARD BALL, L.R.C.P.& S. Edin., L.F.P.S. Glasg., a considerable risk of incomplete union. He said that when he was a medical student the standard has had to vindicate in the Southport County-court his teaching was to amputate at once in such cases and charges for attendance on the late Mr. Thomas Platt. he saw no evidence of negligence in what Mr. Gunn had The bill amounted to E53 9s. 6d. for medical and The attendance indone. He would not like to say that he could have done surgical attendance, medicine, &c. volved often in the visits, frequent night and at other better. Mr. Walter Whitehead of Manchester gave similar it would inconvenient seem, catheterism. hours, also, testimony and said that the state of things which was shown the For the latter usual operation in Kite’s case was very likely to come about even with the charge was 10s. 6d. Mr. Ball or 3s. 6d. 5s. for visits. But charged best of treatment. The jury gave a verdict for the defendant Ordinarily from as was the case to September 7th, 3rd August without hearing his counsel, but his success in legally when, the had and case become critical required prolonged visits at vindicating his professional character and ability is but a and he all hours of the day night charged 7s. 6d. in the day poor reparation for the anxiety and expense which he must and between and one guinea for visits in 8 11, time, 10s. 6d. have undergone. for medicines. He insisted the night. He charged also that the rent of the house- £ 28-had nothing to do with THE SALE OF FOOD AND DRUGS BILL. the matter, the patient being a man of means and without As will be seen from our Parliamentary intelligence in family. But the executors objected and compelled Mr. Ball this issue the Standing Committee on Trade of the House to seek redress in the County-court. Dr. William Alexander of Commons began their work in earnest last week in regard of Liverpool and Dr. Percy Ashworth of Southport both to the consideration of the Sale of Food and Drugs Bill thought the charges moderate. The jury granted the full which was introduced by Mr. Long into the House amount claimed. And very rightly so. They appreciated In view of the great the facts and gave a right verdict. of Commons six weeks ago. number of amendments which several prominent Members have announced their intention of moving the labours LAMP EXPLOSIONS IN MANCHESTER AND of this Committee are not likely to be finished at a SALFORD. Already, however, certain important very early date. AT a recent meeting of the committee of the Manchester points have been considered and certain amendments have stand as of the Bill. The ordered to and Salford Sanitary Association held on April 12th, Dr. been part accordingly artificial colouring of margarine so as to imitate butter is Leech presiding, Mr. William Thomson, F.C.S., presented The suggestion that the words a complete report on the lamps which have exploded in not to be prohibited. be inserted in Clause 1 Manchester and Salford and the oils used. He began about branded should 11 indelible before the words " margarine cheese" was with- the end of 1895 to study the burners of the lamps in which drawn. Adulterated or impoverished cream is, however, explosions were said to have occurred. He was aided in this proposed to be placed under the provisions of this by the police who were allowed to take the burners to him. clause although many other articles of food were Towards the close of 1897 the Sanitary Association requested apparently ignored, a point which was raised by Sir that samples of the oil used should be obtained, which was Charles Cameron, and Mr. Kearley. Our opinion, there- accomplished also with the aid of the police. Up to the is Bill that the introduced by Mr. present time 40 burners and 15 samples of the oil used with fore, confirmed-namely, seems to be down the Long question to agri- them have been examined. Of the burners 31 bore a narrowing cultural products without reference to the representations particular trade-mark and "all the serious explosions he had on the wider subject of food adulteration in general which investigated had been produced in lamps having glass were urged more than a year ago by the Select Comreservoirs. The oil in such lamps would not reach mittee. An important amendment, which we are glad to such a high temperature as those in metal reservoirs, see was carried, was moved by Sir Charles Cameron to and the danger of thus obtaining the mixture of oil-vapour the effect that the Local Government Board should have and air (41 volumes to 50) to cause the maximum of explosive power to act in the administration of certain matters violence would probably be greater than in metal lamps within the province of the Sale of Food and Drugs Bill when the proportion of oil-vapour to air would probably be which decidedly have a bearing upon public health. But much greater." Mr. Thomson’s conclusion is that under the most important announcement which Mr. Walter Long any condition the danger of explosions with metal reservoirs made in Committee was that relating to the use of boric was I I infinitely small"as compared with that from the use acid and preservatives in food. He stated that scientific of glass or other fragile reservoirs. Of the 15 oils four opinion was not opposed to the use of certain preservatives were of the American low flash type and 11 were of the examined at not taken

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