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THE TREATMENT OF OBLIQUE FRACTURES OF TIBIA AND FIBULA.
SCARLET FEVER AND EPIDEMIC ROSEOLA.
1035
of the lymphatics in scarlet fever and in rötheln ; but I did observe that children suffering from rötheln early in the case frequently complained of pain in the neck, and drew my attention to the hard pea-like glands ; whereas in scarlet fever I do not remember to have heard a child complain, early in a case, of suffering pain or inconvenience from these enlarged lymphatics. Here possibly may be a hint of some diagnostic value.-I am, Sirs, yours truly, HENRY E. BRIDGMAN. Burton-on-Trent, April 9th, 1894.
enlargement
Correspondence. .. Audl alteram
partem."
SCARLET FEVER AND EPIDEMIC ROSEOLA. To the Editors of THE LANCET.
SiBS,—It was with considerable interest and
some
curiosit]
thatI read Dr. Clement Dukes’ valuable paper "Ontbf Features which Distinguish Epidemic Roseola (Rose crrom Measles and from Scarlet Feverin your
Rash’ iSSUE formingf
.cf March 31st. The occasional difficulties of oorrect diagnosis as between rötheln and measles or scarle1 fever are, I suppose, admitted by everyone with expe. cience, probably the greater the experience the more read3 Dr. Clement Dukes, in his paper, sets ,the admission. ,forth points of difference between these diseases with such admirable clearness that there should in the future be nc trouble whatever in determining the nature of a group oj - cases, which is always comparatively easy, or even in
THE TREATMENT OF OBLIQUE FRACTURES OF TIBIA AND FIBULA. To t7te Editors of THE LANCET.
SIRS,-Mr. Lane’s paper, read at the last meeting of the Clinical Society, raises the very important question of the ultimate result of the usual treatment of oblique fractures of the tibia and fibula. The after-histories of such cases are seldom inquired into, but several results that I have lately seen have not been satisfactory. In one case, that of a young woman aged twenty-four, six months after the accident, and after treatment for six weeks in a Croft’s splint, there were very marked lameness, complete fixation of the ankle-joint, and much pain in the ankle and foot whenever walking was attempted. Examination showed that though the result was good in so far as there was good union with little or no deformity, nevertheless the position of the limb was faulty on account of the distal fragments having been allowed to unite at a wrong angle, so that the inner surface of the tibia below the fracture looked directly inwards, and as a consequence the foot was inverted, the patient walking mainly on the outer side of the foot. As a result of the displacement of the line of pressure along which the weight of the body is transmitted, a serious condition of traumatic arthritis of the ankle-joint had resulted, causing fixation of that joint ; in fact, under chloroform rough and irregular movement of the cartilage surfaces could be detected. In this particular case osteotomy of both bones was necessary to restore the limb to a more useful condition ; whereas, a better understanding of the mechanism by which the weight of the body is supported, and the changes in bones and joints consequent on alterations in the lines along which that weight acts, would have saved the patient much pain and trouble. The practice of putting up fractured limbs with the feet inverted is very common, but disastrous in its results, for anyone who tries to stand for a few minutes only with the feet inverted will readily experience for himself a small portion of the pain which patients often suffer permanently as the result of a fractured limb so called cured. If, as Mr. Lane’s cases show, the majority of cases of, oblique fractures of the tibia and fibula result in insecure limbs, from the difficulty of reducing the bones into their proper position, our methods at present in use are obviously insufficient ; and assuredly the risk of immediate restitution and fixation of the bones is infinitely preferable to that of subsequent osteotomy or to a life of chronic disability. Hull, April 16th,
1894.
I am, Sirs, yours truly, ALFRED PARKIN.
To the Editors
of
THE LANCET.
SIRS, -Having had the pleasure of hearing Mr. W. Arbuthnot Lane’s very excellent paper on "Cases Illustrating a more Effectual and Scientific Treatment of Fracture of the Tibia and Fibula," which he read before the Clinical Society of London on Friday evening last (April 13th), and thinking that I might be able to confirm or shake the opinion arrived at by his statistics, I made’inquiries for all the fractured legs in this institution, and among them found fifteen cases of fracture of the tibia and fibula; twelve of this number were treated in the wards of our large medical schools, so the results should be as good as possible ; but two of the three cases treated privately were of the number that regained complete use of their limbs. There was only one case in which there was no evidence of the seat of the fracture. In two cases the position of fracture was evident, but there was In the remaining twelve no displacement of the fragments. displacement was well marked, and in many excessively so. In six cases, or 40 per cent., the limbs were quite as useful after as before the accident, the time at which utility was restored varied from four to eighteen months. Three of these were cases in which there was no displacement three had displacement, but in only one was it excessive. The ages at which the fractures took place were as follows : four under twenty-six years, one at forty-one and one at fifty-
1036
LIVERPOOL.-NORTHERN COUNTIES NOTES.
In nine cases, or 60 per cent., the utility of the limb was mittee last week the representative of the workmen, medical much depreciated, they were unable to earn the same at their staff, and other governors of the infirmary waited upon the work as before, or had to change their occupation. All com- committee with respect to a site for a new infirmary. The plained of pain at the seat of fracture and several of pain in ground selected is that extending from St. James’s-street the ankle-joint, which tended to get worse. The average age across the Leazes, a portion of the Town Moor, and consists at which fracture took place in these cases was fifty-five in all of about eight acres. The matter was considered, and it was ultimately decided that the Town Moor Management years. From the above the following deductions may be made : Committee and the Stewards’ Committee should each have (1) that a very large percentage of the working classes have the opportunity to further consider the application, after their earning powers very much depreciated by fractures of which the chairman should call a special meeting of the joint the tibia and fibula ; (2) that those who regained complete committees to finally consider the appiication. A Local Government Board inspector has held an inquiry in theuse of their limbs were the young and those with the least after mid-life that in Council Cbamber, Newcastle, into the application of the city cases the displacement ; (3) occurring the displacement was more marked, the pain was a marked corporation for a grant of £ 113 500 for improvements in the feature and not always limited to the place of fracture ; and public buildings in the municipality. It was proposed to (4) that the treatment as employed in the above cases leaves spend the loan as follows : 100,000 for the extension of much to be desired. I am. Sirs. vours faithfully. the Lunatic Asylum, .610,000 for new baths and washhouses In reply to the town clerk, Mr. Dyson said that the asylum J. W. SMITH, M.R.C.S., L.R.C.P. LOND., &c. Assistant Medical Officer, Lambeth Infirmary. buildings it was proposed to erect would last four or five hundred years. Eventually the inspector intimated that he would lay the whole matter before the Local Government Board. LIVERPOOL. OUR One Hundred Fatal Cases of Cholera at Sea. OWN (FROM CORRESPONDENT.) The inspector’s report of the Tyne port sanitary authority The Medical Institution.showed that sixty-three emigrants had passed through the THE last meeting of the Medical Institution for the session port during the month. The captain of the steamer Samoa I 1893-94 was held on the 12th inst., and was marked soon 1had reported 100 fatal cases of cholera while on her last after its commencement by an incident very gratifying to al ,voyage from the East. The vessel, however, had been disinfected prior to her arrival. Three cases of t present. Mr. Shears, the honorary secretary to the ordinary thoroughly meetings, read a communication from Mr. Mitchell Banks.small-pox had also been reported by a second vessel ; it had 1 disinfection since its arrival. containing the announcement that the President of the insti- undergone tution, Mr. Chauncy Puzey, had that day been elected an Lunatics in Durham County :Another Asylum to be built. honorary Fellow of the Royal College of Surgeons of England. The large increase in the number of lunatics in the county This wholly unexpected piece of news was received by ( all present with much pleasure. Mr. Puzey has done aof Durham has been a source of inconvenience during the past few years to the municipal and rural authorities who, very large amount of good surgical work in the operatingmaintain ] the county asylum, and latterly many patients have in and in the medical theatre, private practice, to be sent to institutions in other parts of tbe country. had quietly and unobtrusively, never seeking his own advantageRecently it was proposed to enlarge the Sedgetield Asylum, in any way whatever. It is felt by all who know him best but the proposal has not been received with favour by the that this jealously guarded honour could not have been more Lunacy Commissioners. One of the visiting commissioners. worthily bestowed, while the members and associates of the for the borough has received notice that the Lunacy CommisMedical Institution feel that it is a compliment through their sioners will not permit the enlargement of the county asylum, president to them. and that the Gateshead and South Shields authorities will be The late r. John Stephen Clarke. ;compelled to provide a separate asylum for their own The deceased had been for twenty-four years surgeon to patients. Five years’ notice has been given by the Commisthe police ; at first as surgeon to the members of the forcesioners of their intention, and this period will allow of a. who were on the sick list, being promoted later on to the separate asylum being built. The Gateshead and South higher office of surgeon to those hurt on duty, and to examine Shields authorities will probably agree to build an institution recruits and those applying for superannuation. Mr. Clarke for their lunatics in one or other of the boroughs. This will was always extremely popular with his patients, having a mean an expense of probably from £ 80,000 to £ 100,000. genial, pleasant manner and being very attentive. It was North-Eastern Counties Ambulance Revierv. his misfortune to suffer for a considerable time before his death from a serious internal disease which caused him much This review will probably be held about July 21st next, andf suffering, in spite of which he continued to practise till no am told that the proceeds are likely to be devoted to charitablelonger able to do so. He received every care and attention purposes, and on the occasion of the review a number of from his friends Dr. G. S. Taylor and Mr. Larkin till death the head officials of the St. John Ambulance Association will, put an end to his sufferings on the 8th inst. His funeral was it is expected, be present, including Sir Edmund Lechmere, attended by many professional and other friends, and wit- M P., Colonel Thackeray, and Surgeon-Major Hutton. A13 nessed by large crowds of the poorer classes, with whom the: ambulance classes in Northumberland and Durham not repredeceased was very popular. He leaves a widow and a son toI sented on the committee are requested to send members. mourn their loss. A Record of Northern Longevity. Presentation to Dr. John Stopford Taylor. Mrs. Betty Webster, known a,s the Wensleydale centenarian Dr. Taylor, on his retirement from the office of medical officer of health, has been made the recipient of a magnifi- and residing at Aysgarth, hasjust celebrated her 104th birthcent vase and the following address from the chiefs of day. On the occasion of her hundredth birthday four years the various corporate departments: "As the heads of the: ago there were considerable rejoicings in the dale. Mrs. various departments of the municipal service of this city, we: Webster has a daughter living aged seventy-four, and numerous great-grand-children.-The death took place on beg your acceptance of the vase that accompanies this communication as a token of the esteem and regard entertained Saturday of Mr. John Thompson, farmer, Lambrigg Park, The deceased would have attained his for you by the officials of every class during the many years5 near Kendal. hundredth on May 4th. His wife died about a anniversary you occupied the important position of medical officer of health. We bid you farewell in the earnest hope that many month ago, having attained the age of ninety-seven years.Mr. James Dods, retired shepherd, who recorded his vote in the years of health and happiness lie before you. " To this were recent contest in Berwickshire, and celebrated his hundredth added ten signatures, the subscribers to the testimonial also on April 5th, still retains to a marked degree his birthday comprising many others. faculties, mental and physical, so that the aggregate ages of April 16th. these four persons would a few weeks ago have amounted to about 400 years. NORTHERN COUNTIES NOTES. Workmen and Medical Charities. (FROM OUR OWN CORRESPONDENT.) The workmen of Sir W. G. Armstrong, Mitchell and Co. have contributed over ;E200 to our city medical charities Sanitary Improvements in Newcastle. during the last quarter. AT a special meeting of the Newcastle Town Moor Com.Newcastle.on-Tyne, April 18th. one.
journals,
.
f
e
_______________
1035
of the lymphatics in scarlet fever and in rötheln ; but I did observe that children suffering from rötheln early in the case frequently complained of pain in the neck, and drew my attention to the hard pea-like glands ; whereas in scarlet fever I do not remember to have heard a child complain, early in a case, of suffering pain or inconvenience from these enlarged lymphatics. Here possibly may be a hint of some diagnostic value.-I am, Sirs, yours truly, HENRY E. BRIDGMAN. Burton-on-Trent, April 9th, 1894.
enlargement
Correspondence. .. Audl alteram
partem."
SCARLET FEVER AND EPIDEMIC ROSEOLA. To the Editors of THE LANCET.
SiBS,—It was with considerable interest and
some
curiosit]
thatI read Dr. Clement Dukes’ valuable paper "Ontbf Features which Distinguish Epidemic Roseola (Rose crrom Measles and from Scarlet Feverin your
Rash’ iSSUE formingf
.cf March 31st. The occasional difficulties of oorrect diagnosis as between rötheln and measles or scarle1 fever are, I suppose, admitted by everyone with expe. cience, probably the greater the experience the more read3 Dr. Clement Dukes, in his paper, sets ,the admission. ,forth points of difference between these diseases with such admirable clearness that there should in the future be nc trouble whatever in determining the nature of a group oj - cases, which is always comparatively easy, or even in
THE TREATMENT OF OBLIQUE FRACTURES OF TIBIA AND FIBULA. To t7te Editors of THE LANCET.
SIRS,-Mr. Lane’s paper, read at the last meeting of the Clinical Society, raises the very important question of the ultimate result of the usual treatment of oblique fractures of the tibia and fibula. The after-histories of such cases are seldom inquired into, but several results that I have lately seen have not been satisfactory. In one case, that of a young woman aged twenty-four, six months after the accident, and after treatment for six weeks in a Croft’s splint, there were very marked lameness, complete fixation of the ankle-joint, and much pain in the ankle and foot whenever walking was attempted. Examination showed that though the result was good in so far as there was good union with little or no deformity, nevertheless the position of the limb was faulty on account of the distal fragments having been allowed to unite at a wrong angle, so that the inner surface of the tibia below the fracture looked directly inwards, and as a consequence the foot was inverted, the patient walking mainly on the outer side of the foot. As a result of the displacement of the line of pressure along which the weight of the body is transmitted, a serious condition of traumatic arthritis of the ankle-joint had resulted, causing fixation of that joint ; in fact, under chloroform rough and irregular movement of the cartilage surfaces could be detected. In this particular case osteotomy of both bones was necessary to restore the limb to a more useful condition ; whereas, a better understanding of the mechanism by which the weight of the body is supported, and the changes in bones and joints consequent on alterations in the lines along which that weight acts, would have saved the patient much pain and trouble. The practice of putting up fractured limbs with the feet inverted is very common, but disastrous in its results, for anyone who tries to stand for a few minutes only with the feet inverted will readily experience for himself a small portion of the pain which patients often suffer permanently as the result of a fractured limb so called cured. If, as Mr. Lane’s cases show, the majority of cases of, oblique fractures of the tibia and fibula result in insecure limbs, from the difficulty of reducing the bones into their proper position, our methods at present in use are obviously insufficient ; and assuredly the risk of immediate restitution and fixation of the bones is infinitely preferable to that of subsequent osteotomy or to a life of chronic disability. Hull, April 16th,
1894.
I am, Sirs, yours truly, ALFRED PARKIN.
To the Editors
of
THE LANCET.
SIRS, -Having had the pleasure of hearing Mr. W. Arbuthnot Lane’s very excellent paper on "Cases Illustrating a more Effectual and Scientific Treatment of Fracture of the Tibia and Fibula," which he read before the Clinical Society of London on Friday evening last (April 13th), and thinking that I might be able to confirm or shake the opinion arrived at by his statistics, I made’inquiries for all the fractured legs in this institution, and among them found fifteen cases of fracture of the tibia and fibula; twelve of this number were treated in the wards of our large medical schools, so the results should be as good as possible ; but two of the three cases treated privately were of the number that regained complete use of their limbs. There was only one case in which there was no evidence of the seat of the fracture. In two cases the position of fracture was evident, but there was In the remaining twelve no displacement of the fragments. displacement was well marked, and in many excessively so. In six cases, or 40 per cent., the limbs were quite as useful after as before the accident, the time at which utility was restored varied from four to eighteen months. Three of these were cases in which there was no displacement three had displacement, but in only one was it excessive. The ages at which the fractures took place were as follows : four under twenty-six years, one at forty-one and one at fifty-
1036
LIVERPOOL.-NORTHERN COUNTIES NOTES.
In nine cases, or 60 per cent., the utility of the limb was mittee last week the representative of the workmen, medical much depreciated, they were unable to earn the same at their staff, and other governors of the infirmary waited upon the work as before, or had to change their occupation. All com- committee with respect to a site for a new infirmary. The plained of pain at the seat of fracture and several of pain in ground selected is that extending from St. James’s-street the ankle-joint, which tended to get worse. The average age across the Leazes, a portion of the Town Moor, and consists at which fracture took place in these cases was fifty-five in all of about eight acres. The matter was considered, and it was ultimately decided that the Town Moor Management years. From the above the following deductions may be made : Committee and the Stewards’ Committee should each have (1) that a very large percentage of the working classes have the opportunity to further consider the application, after their earning powers very much depreciated by fractures of which the chairman should call a special meeting of the joint the tibia and fibula ; (2) that those who regained complete committees to finally consider the appiication. A Local Government Board inspector has held an inquiry in theuse of their limbs were the young and those with the least after mid-life that in Council Cbamber, Newcastle, into the application of the city cases the displacement ; (3) occurring the displacement was more marked, the pain was a marked corporation for a grant of £ 113 500 for improvements in the feature and not always limited to the place of fracture ; and public buildings in the municipality. It was proposed to (4) that the treatment as employed in the above cases leaves spend the loan as follows : 100,000 for the extension of much to be desired. I am. Sirs. vours faithfully. the Lunatic Asylum, .610,000 for new baths and washhouses In reply to the town clerk, Mr. Dyson said that the asylum J. W. SMITH, M.R.C.S., L.R.C.P. LOND., &c. Assistant Medical Officer, Lambeth Infirmary. buildings it was proposed to erect would last four or five hundred years. Eventually the inspector intimated that he would lay the whole matter before the Local Government Board. LIVERPOOL. OUR One Hundred Fatal Cases of Cholera at Sea. OWN (FROM CORRESPONDENT.) The inspector’s report of the Tyne port sanitary authority The Medical Institution.showed that sixty-three emigrants had passed through the THE last meeting of the Medical Institution for the session port during the month. The captain of the steamer Samoa I 1893-94 was held on the 12th inst., and was marked soon 1had reported 100 fatal cases of cholera while on her last after its commencement by an incident very gratifying to al ,voyage from the East. The vessel, however, had been disinfected prior to her arrival. Three cases of t present. Mr. Shears, the honorary secretary to the ordinary thoroughly meetings, read a communication from Mr. Mitchell Banks.small-pox had also been reported by a second vessel ; it had 1 disinfection since its arrival. containing the announcement that the President of the insti- undergone tution, Mr. Chauncy Puzey, had that day been elected an Lunatics in Durham County :Another Asylum to be built. honorary Fellow of the Royal College of Surgeons of England. The large increase in the number of lunatics in the county This wholly unexpected piece of news was received by ( all present with much pleasure. Mr. Puzey has done aof Durham has been a source of inconvenience during the past few years to the municipal and rural authorities who, very large amount of good surgical work in the operatingmaintain ] the county asylum, and latterly many patients have in and in the medical theatre, private practice, to be sent to institutions in other parts of tbe country. had quietly and unobtrusively, never seeking his own advantageRecently it was proposed to enlarge the Sedgetield Asylum, in any way whatever. It is felt by all who know him best but the proposal has not been received with favour by the that this jealously guarded honour could not have been more Lunacy Commissioners. One of the visiting commissioners. worthily bestowed, while the members and associates of the for the borough has received notice that the Lunacy CommisMedical Institution feel that it is a compliment through their sioners will not permit the enlargement of the county asylum, president to them. and that the Gateshead and South Shields authorities will be The late r. John Stephen Clarke. ;compelled to provide a separate asylum for their own The deceased had been for twenty-four years surgeon to patients. Five years’ notice has been given by the Commisthe police ; at first as surgeon to the members of the forcesioners of their intention, and this period will allow of a. who were on the sick list, being promoted later on to the separate asylum being built. The Gateshead and South higher office of surgeon to those hurt on duty, and to examine Shields authorities will probably agree to build an institution recruits and those applying for superannuation. Mr. Clarke for their lunatics in one or other of the boroughs. This will was always extremely popular with his patients, having a mean an expense of probably from £ 80,000 to £ 100,000. genial, pleasant manner and being very attentive. It was North-Eastern Counties Ambulance Revierv. his misfortune to suffer for a considerable time before his death from a serious internal disease which caused him much This review will probably be held about July 21st next, andf suffering, in spite of which he continued to practise till no am told that the proceeds are likely to be devoted to charitablelonger able to do so. He received every care and attention purposes, and on the occasion of the review a number of from his friends Dr. G. S. Taylor and Mr. Larkin till death the head officials of the St. John Ambulance Association will, put an end to his sufferings on the 8th inst. His funeral was it is expected, be present, including Sir Edmund Lechmere, attended by many professional and other friends, and wit- M P., Colonel Thackeray, and Surgeon-Major Hutton. A13 nessed by large crowds of the poorer classes, with whom the: ambulance classes in Northumberland and Durham not repredeceased was very popular. He leaves a widow and a son toI sented on the committee are requested to send members. mourn their loss. A Record of Northern Longevity. Presentation to Dr. John Stopford Taylor. Mrs. Betty Webster, known a,s the Wensleydale centenarian Dr. Taylor, on his retirement from the office of medical officer of health, has been made the recipient of a magnifi- and residing at Aysgarth, hasjust celebrated her 104th birthcent vase and the following address from the chiefs of day. On the occasion of her hundredth birthday four years the various corporate departments: "As the heads of the: ago there were considerable rejoicings in the dale. Mrs. various departments of the municipal service of this city, we: Webster has a daughter living aged seventy-four, and numerous great-grand-children.-The death took place on beg your acceptance of the vase that accompanies this communication as a token of the esteem and regard entertained Saturday of Mr. John Thompson, farmer, Lambrigg Park, The deceased would have attained his for you by the officials of every class during the many years5 near Kendal. hundredth on May 4th. His wife died about a anniversary you occupied the important position of medical officer of health. We bid you farewell in the earnest hope that many month ago, having attained the age of ninety-seven years.Mr. James Dods, retired shepherd, who recorded his vote in the years of health and happiness lie before you. " To this were recent contest in Berwickshire, and celebrated his hundredth added ten signatures, the subscribers to the testimonial also on April 5th, still retains to a marked degree his birthday comprising many others. faculties, mental and physical, so that the aggregate ages of April 16th. these four persons would a few weeks ago have amounted to about 400 years. NORTHERN COUNTIES NOTES. Workmen and Medical Charities. (FROM OUR OWN CORRESPONDENT.) The workmen of Sir W. G. Armstrong, Mitchell and Co. have contributed over ;E200 to our city medical charities Sanitary Improvements in Newcastle. during the last quarter. AT a special meeting of the Newcastle Town Moor Com.Newcastle.on-Tyne, April 18th. one.
journals,
.
f
e
_______________