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THE TREATMENT OF TUBERCULOUS ABSCESSES OF JOINTS.
1558
syphon is so easily unsealed that it is almost useless. Whilst interesting and suggestive, and the more so when we u "5’ing that their total abolition is to be desired, he points remember that a combined method exists in the practice out that the danger of syphonage can be easily overcome if of aspiration followed by injection of iodoform in glycerine. every closet has a ventilating pp3 attached to the distal end It should not be forgotten that this method has been of the syphon. Unfortunately the traps used have no pro- attended by curative results not less effectual, and probably vision made for any connexion of this kind. The arguments much more speedy, than those attributed to the expectant ia favour of these closets, economy in first cost, economy in course which he recommends. t9 use of water, and the non-lial)ittty to freez in winter, are BEATTY v. CULLINGWORTH. discussed, and it is pointed out that the more modern slop closet is nearly as cheap, is much bstter, probably more THE plaintiff in this case having presented a petition for in economical the use of water, and is even less likely to be leave to prosecute an appeal before the House of Lords affected by frost. Where water is obtainable, however, a in formu pauperis, the matter was referred, according to the suitable flashing cistern is to be preferred. The procedure .usual course, to the Appeal Committee, and was duly connecessary to get rid of these abominations is referred to, but sidered at a sitting of the committee held on May 27th. the authorities are recommended first to decide that these The petition was dismissed, on the ground, we believe, conveniences are a source of danger to the pablic health that there was no prinra-facie case for further appeal, ani then to consult with their officers as to the best mode of and that it was unlikely that the House would reverse the dealing with them. The serious danger to health resulting decisions of the Court of Queen’s Bench and the Court of from the use of waterless water closets cannot be denied, and Appeal. The result of this decision is that if the plaintiff it is believed by many of the local health officers that the persists in her intention of bringing her case before the emanations therefrom have from time to time given rise to House of Lords she will have to conform to the ordinary outbreaks of diphtheria and typhoid fever. It is to be hoped rules, one of which involves the payment of a substantial that the various authorities implicated will seriously con- deposit as a preliminary proceeding. sider this report, and act upon the suggestions contained
ROYAL
therein.
COLLEGE
OF SURGEONS OF ENGLAND.
___
ON Thursday, July lst, two important meetings of the THE TREATMENT OF TUBERCULOUS ABSCESSES Fellows of the College will be held. At 1.30 P.M. an OF JOINTS. election of members of the Conncil will take place. There THE treatment of a "cold"abscess is a question about are five vacancies, Mr. Howes, Mr. Ward Cousins, and Mr. which any two surgeons could probably express at least Heath retiring by rotation, and the other two being caused As regards that important variety by the deaths of Mr. Oliver Pemberbon and Mr. Walter more than two opinions. which is connected with tuberculous disease of joints, Dr. Rivington. Mr. Howes and Mr. Ward Cousins will, we Russell A. Hibbshas stated his own view, which is that understand, offer themselves for re-election, but Mr. Heath it should be considerately and watchfully let alone. In will not. Sir William Dalby, Mr. Rickman J. Godlee, Mr. support of this proposition he quotes the observations of Edmund Owen, and Mr. Bennett May will also be candidates. Cheyne, Warren, and Ogston that such abscesses are The names of candidates with their proposers must be sent to generally sterile of pyogenic organisms. He also refers the Secretary not later than Friday, June llth. At 5 o’clock to Volkmann’sdescriptions of the tuberculous membrane, the half-yearly meeting of the Fellows will be held, and any studded with miliary tubercles, which lines the abscess Fellow who wishes to introduce a resolution must forward cavity, and is itself encapsuled in a dense, fibrous case, it, signed by the mover, to the Secretary not later than devoid of tuberculous deposits, and apparently almost im- Thursday, June 10th. penetrable by the tubercle bacillus. His own observations, ’CROSS-COUNTER THERAPEUTICS. extending over four years of hospital and dispensary practice, OuR Rome Correspondent writes:-To the casualtieslead him to think that this form of abscess tends to spontaneous, if slow, absorption or to gradual evacuation by already in Italy and elsewhere a formidable listthe small aperture contrived by nature, which is in a measure occasioned by this most dangerous practice Castellammare protective against the admission of foreign bacilli. He on the Neapolitan Riviera contributes another of unusually prefers, therefore, a policy of non-interference, and regards tragic interest. Signor Edoardo Varrelli having consulted free incision, scraping, and more heroic measures as tending Signor Francesco Rega, a leading pharmacist in the on the whole to complicate the disease by admitting a pyotown, received from him a pill containing (we are genetic element, and thus to prejudice recovery by lowering told) "pochi centigrammi"" (a few centigrammes) of the vitality of the tissues. The science and wisdom of aconitum napellus. Shortly afterwards it was found that expectancy he understands to consist in supporting by every a terrible mistake had been committed and poor Varrelli died means the general vital tone, in affording the diseased joint with all the symptoms-the burning sensation in the mouth, all needful mechanical protection, and in sparing surgical the feeling of searedness," the numbness, the cardiac methods except it be now and then to aid an imperfect depression, and the dyspnoea—characteristic of aconite natural effort at relief by a counter opening or to use an anti- poisoning. In what pharmaoopceial form the alkaloid was .septic douche. Quoting Shaffer. he states that this plan, exhibited we are left to conjecture. It may have been (as, pursued at the New York Orthopaedic Hospital during four indeed, has happened too often before) the potent English jears, was successful in obtaining absorption and apparent aconitine instead of the impure and inert exotic or German recovery in 93 per cent. of the cases treated, while the anti- alkaloid or mixture of alkaloids passing under that name. septic operative procedure employed by Lister and Cheyne All we yet know is that Signor Rega, profoundly im(" Tuberculosis of Bones and Joints ") achieved success pressed by the accident" and apparently in doubt in 73-5 per cent. Dr. Hibbs does not attempt any comparison as to the dose or pharmacopaeial form being to between these two series in respect of the pathological or blame, experimented on himself with an exact replica other condition of the joint after the close of the period of of the pill prescribed to his "patient." And he, too, treatment, nor does he furnish any details of the after- with scarcely less appalling celerity than Signor Varrelli, history of the naturally absorbed abscesses. His contribution succumbed, in his own pharmacy, to the preparation. The to our knowledge of these cases is, nevertheless, both incident conveys a loud warning to that all too numerous -
1 New York Medical Journal, May 15th, 1897. 2 Ibid., Jan. 29th, 1896.
public which,
rather than call in a duly qualified practia chemist and druggist, and takes the
tioner, consults
syphon is so easily unsealed that it is almost useless. Whilst interesting and suggestive, and the more so when we u "5’ing that their total abolition is to be desired, he points remember that a combined method exists in the practice out that the danger of syphonage can be easily overcome if of aspiration followed by injection of iodoform in glycerine. every closet has a ventilating pp3 attached to the distal end It should not be forgotten that this method has been of the syphon. Unfortunately the traps used have no pro- attended by curative results not less effectual, and probably vision made for any connexion of this kind. The arguments much more speedy, than those attributed to the expectant ia favour of these closets, economy in first cost, economy in course which he recommends. t9 use of water, and the non-lial)ittty to freez in winter, are BEATTY v. CULLINGWORTH. discussed, and it is pointed out that the more modern slop closet is nearly as cheap, is much bstter, probably more THE plaintiff in this case having presented a petition for in economical the use of water, and is even less likely to be leave to prosecute an appeal before the House of Lords affected by frost. Where water is obtainable, however, a in formu pauperis, the matter was referred, according to the suitable flashing cistern is to be preferred. The procedure .usual course, to the Appeal Committee, and was duly connecessary to get rid of these abominations is referred to, but sidered at a sitting of the committee held on May 27th. the authorities are recommended first to decide that these The petition was dismissed, on the ground, we believe, conveniences are a source of danger to the pablic health that there was no prinra-facie case for further appeal, ani then to consult with their officers as to the best mode of and that it was unlikely that the House would reverse the dealing with them. The serious danger to health resulting decisions of the Court of Queen’s Bench and the Court of from the use of waterless water closets cannot be denied, and Appeal. The result of this decision is that if the plaintiff it is believed by many of the local health officers that the persists in her intention of bringing her case before the emanations therefrom have from time to time given rise to House of Lords she will have to conform to the ordinary outbreaks of diphtheria and typhoid fever. It is to be hoped rules, one of which involves the payment of a substantial that the various authorities implicated will seriously con- deposit as a preliminary proceeding. sider this report, and act upon the suggestions contained
ROYAL
therein.
COLLEGE
OF SURGEONS OF ENGLAND.
___
ON Thursday, July lst, two important meetings of the THE TREATMENT OF TUBERCULOUS ABSCESSES Fellows of the College will be held. At 1.30 P.M. an OF JOINTS. election of members of the Conncil will take place. There THE treatment of a "cold"abscess is a question about are five vacancies, Mr. Howes, Mr. Ward Cousins, and Mr. which any two surgeons could probably express at least Heath retiring by rotation, and the other two being caused As regards that important variety by the deaths of Mr. Oliver Pemberbon and Mr. Walter more than two opinions. which is connected with tuberculous disease of joints, Dr. Rivington. Mr. Howes and Mr. Ward Cousins will, we Russell A. Hibbshas stated his own view, which is that understand, offer themselves for re-election, but Mr. Heath it should be considerately and watchfully let alone. In will not. Sir William Dalby, Mr. Rickman J. Godlee, Mr. support of this proposition he quotes the observations of Edmund Owen, and Mr. Bennett May will also be candidates. Cheyne, Warren, and Ogston that such abscesses are The names of candidates with their proposers must be sent to generally sterile of pyogenic organisms. He also refers the Secretary not later than Friday, June llth. At 5 o’clock to Volkmann’sdescriptions of the tuberculous membrane, the half-yearly meeting of the Fellows will be held, and any studded with miliary tubercles, which lines the abscess Fellow who wishes to introduce a resolution must forward cavity, and is itself encapsuled in a dense, fibrous case, it, signed by the mover, to the Secretary not later than devoid of tuberculous deposits, and apparently almost im- Thursday, June 10th. penetrable by the tubercle bacillus. His own observations, ’CROSS-COUNTER THERAPEUTICS. extending over four years of hospital and dispensary practice, OuR Rome Correspondent writes:-To the casualtieslead him to think that this form of abscess tends to spontaneous, if slow, absorption or to gradual evacuation by already in Italy and elsewhere a formidable listthe small aperture contrived by nature, which is in a measure occasioned by this most dangerous practice Castellammare protective against the admission of foreign bacilli. He on the Neapolitan Riviera contributes another of unusually prefers, therefore, a policy of non-interference, and regards tragic interest. Signor Edoardo Varrelli having consulted free incision, scraping, and more heroic measures as tending Signor Francesco Rega, a leading pharmacist in the on the whole to complicate the disease by admitting a pyotown, received from him a pill containing (we are genetic element, and thus to prejudice recovery by lowering told) "pochi centigrammi"" (a few centigrammes) of the vitality of the tissues. The science and wisdom of aconitum napellus. Shortly afterwards it was found that expectancy he understands to consist in supporting by every a terrible mistake had been committed and poor Varrelli died means the general vital tone, in affording the diseased joint with all the symptoms-the burning sensation in the mouth, all needful mechanical protection, and in sparing surgical the feeling of searedness," the numbness, the cardiac methods except it be now and then to aid an imperfect depression, and the dyspnoea—characteristic of aconite natural effort at relief by a counter opening or to use an anti- poisoning. In what pharmaoopceial form the alkaloid was .septic douche. Quoting Shaffer. he states that this plan, exhibited we are left to conjecture. It may have been (as, pursued at the New York Orthopaedic Hospital during four indeed, has happened too often before) the potent English jears, was successful in obtaining absorption and apparent aconitine instead of the impure and inert exotic or German recovery in 93 per cent. of the cases treated, while the anti- alkaloid or mixture of alkaloids passing under that name. septic operative procedure employed by Lister and Cheyne All we yet know is that Signor Rega, profoundly im(" Tuberculosis of Bones and Joints ") achieved success pressed by the accident" and apparently in doubt in 73-5 per cent. Dr. Hibbs does not attempt any comparison as to the dose or pharmacopaeial form being to between these two series in respect of the pathological or blame, experimented on himself with an exact replica other condition of the joint after the close of the period of of the pill prescribed to his "patient." And he, too, treatment, nor does he furnish any details of the after- with scarcely less appalling celerity than Signor Varrelli, history of the naturally absorbed abscesses. His contribution succumbed, in his own pharmacy, to the preparation. The to our knowledge of these cases is, nevertheless, both incident conveys a loud warning to that all too numerous -
1 New York Medical Journal, May 15th, 1897. 2 Ibid., Jan. 29th, 1896.
public which,
rather than call in a duly qualified practia chemist and druggist, and takes the
tioner, consults