TREATMENT OF HÆMORRHOIDS BY THE ACTUAL CAUTERY.

262 in cases of delirium tremens-a treatment which, to the best of my knowledge, has never been tried in England, and which I first met with in my practice when in charge of the Royal Naval Hospital, Port Hoyal, Jamaica. I refer to the use ot powdered capsicum (cayenne pepper), in doses varying from a scruple to a drachm, given in a glass of spirits-and-water-gin being generally used-every four hours until sleep supervenes. I have found that three doses is the average required, but have occasionally given seven at intervals of four hours. I have noticed that the patient generally sleeps five hours, and wakes composed and refreshed, without any nervous symptoms. In many cases one dose has been sufficient. This hospital occasionally affords many opportunities for testing the value of treatment in this disease, being the infirmary for the Chatham Division of Marines, among whom the greater number of cases occur; few happen among the limited number of seamen here and at Sheerness. During the last half-year of 1861, eighty cases of this disease The average number of days in hoswere under treatment. pital of cases of uncomplicated delirium tremens has been a little over five. In only three cases has gastric irritation been In all of these obstinate constipation has been observed. noticed, and laxative medicine removed all unfavourable symptoms. As a result of my experience, I think the capsicum powder, given in half-drachm doses in a small quantity of gin, and repeated every four hours until the patient sleeps, will be generally found successful. From three to five doses will usually be sufficient, even in the worst cases. Care must be taken that the bowels are freely open. I beg to invite the attention of the profession to these facts, and shall be glad to hear of any cases confirming my experience.

Chatham,

T remain f4ir.

vnnr

nharliani: servant

C. R. KINNEAR, M.D., Dep. Inspect.-Gen. of Hospitals and Fleets. Melville Hospital, Chatham,

ON THE CONSTRUCTION OF HOSPITALS.

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notice while at Lisbon last autumn - namely, the wooden model of an improved window-pane invented by Dr. Wood for Bethlem Hospital when resident medical officer, and which the Portuguese Government or Board of Health had obtained purposely from London as a guide to their architect before making some sanitary alterations in the chief militury hospital of Lisbon. An interchange of civilities like the above is highly creditable to both contributors and recipients. Further, by so acting practical knowledge becomes- more diffused, which invariably benefits mankind by its greater extension; therefore such reciprocal movements ought always to receive encouragement between different peoples and their respective governors. T remain- Sir vour obedient servant. JOHN WEBSTER, M.D. Brook-street, March, 1S63.

THE MEDICAL ACT AND ILLEGAL PRACTICE. To tlte Edito-r of THE LANCET. the present session of Parliament-to quote from a leading article in one of the daily journals-" bids fair to be one of tranquil and steady work in the wide field of social amendment," the medical profession may fairly expect that the Medical Council will endeavour to introduce a " Medical Amendment Act" to remedy the defects which render the Medical Act quite useless to restrain illegal practice. I shall be most happy to renew my subscription to the National Medical Registration Association as soon as the Medical Act gives the profession the power to prosecute unqualified practitioners. In the neighbourhood in which I live there is an unqnalitied man, who practises with considerable success; and also a chemist, who, not satisfied with counter practice, visits patients at home. At present we can do nothing, for although we have paid two guineas each for registration under the Medical Act, we are in some respects in a worse position than we were ten years since; for then the Apothecaries’ Company did occasionally institute a prosecution, but now they decline to interfere. The men who compose the medical parliament are not taken from the class of practitioners who see the evils and injustice of illegal practice, and therefore are not alive to the necessity of more stringent enactments. The Medical Council represents, not the large body of general practitioners, but almost exclusively the medical colleges and schools of the United Kingdom. I hope, Sir, you will take up the subject, and, through the pages of your journal, bring it under the notice of that select assembly which holds its meetings with closed doors, lest a breath of public opinion should enter with too much force. I observe in the last number of THE LANCET a very practical suggestion by " W. R.,"which if carried out would probably check illegal practice. I remain, Sir, yours respectfully, Y. Z. March, 1862.

SIR,-As

To the Editor of THE LANCET. SIR,-Considerable attention being at present directed towards the proper construction of receptacles for sick persons, both through recent discussions at the French Academy of Medicine, as also in this metropolis with reference to a new site for St. Thomas’s Hospital, perhaps you will permit me to state, through your influential columns, that those who take an interest in such inquiries might derive useful hints from inspecting several public institutions lately erected or materially improved in various capitals on the continent. Having personally visited numerous asylums, hospitals, and prisons in nearly every kingdom of Europe, during holiday autumnal excursions, I would first allude to the Lariboisiere Hospital at Paris, and next to that of St. John at Brussels, where many important ameliorations have been introduced. Indeed, it is TREATMENT OF HÆMORRHOIDS BY THE generally admitted that these buildings, on the whole, are the two best constructed throughout Europe, and may well serve ACTUAL CAUTERY. as models for imitation by other nations. But viewed in reTo the Editor of THE LANCET. ference to special points, particularly as to the good accommodation and physical advantages which inmates enjoy, noSIR,-Will you allow me, in consequence of the following where have I ever seen any apartment of that kind equal to passage in your review of the works of Messrs. Prichard and one added only a few years ago to the lunatic asylum at Spence in THE LANCET of the 1st inst., to do a simple act of Zaragoza, in Spain, excepting a new ward which the Portuguese justice to a late member of our profession-one no less reGovernment has very recently opened in the Marine Hospital spected for his great professional acquirements than for his perat Lisbon, and visited by myself last September. With the sonal and private worth-Mr. Cusack, of Dublin. Noticing ample space allowed to each of the patients, (the number of Mr. Prichard’s work, it is stated, " Following the plan of whom is usually under twenty-four,) its extreme cleanliness, Dr. Houston, of Dublin, practised by him in 1843, and recently rediscovered’ by a London surgeon, Mr. Prichard has for a admirable ventilation, and other essential arrangements, such as a constant supply of hot and cold water, and so forth, nothing long "time treated haemorrhoids by nitric acid very successcomparable exists in any other city. I told the superintendent fully." that it was better adapted for promoting the recovery of persons Now, " the plan" here referred to as Dr. Houston’s, was labouring under disease than any similar institution previously really not his, but " the plan" of the late Mr. Cusack, and visited; and I may now remark that these features then struck practised by him in Steevens’ Hospital as early as January, me so forcibly that I would strongly advise authorities pro1833, as will be seen by reference to the Dublin Quarterly posing either to build an hospital or to construct extensive J oll1’nal of Medical Science for 1846, vol. ii., p. 563; and, adjuncts at existing institutions to send a competent person, besides, Dr. Houston, in his first" Essay on the Use of Nitric who should examine the two excellent wards just named, and Acid," &c., published in the Dublin Journal of Medical Science report accordingly. This proceeding would only be following for 1843, vol. xxiii., p. 94, states: " The name of my distinthe example of Spain and Portugal, whose governments have guished friend, Mr. Cusack, I am in particular desirous of dispatched medical commissioners to various European coun- mentioning in connexion with this subject, because the em. tries in order to profit by the infoimation thus gained, when ployment of nitric acid in such cases has not only the high intending to erect any new benevolent establishment in the sanction of his approval, but to him, in an especial manner, is Peninsula. Among other examples of that description, one due the first suggestion of its use as a 2-e?)?,edy." Mr. Cusack, however, abandoned "the plan" fo one which may here be mentioned which came under my immediate

respectfully, X.

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263 could be more generally resorted to for the cure of haemorrhoids-the actual cautery, which was used by him in the following manner:-" With a pair of large clamp like forceps, meeting by their flat edges for about two inches of their blades, which are here covered over with strong buff leather, which likewise forms an apron of about six inches in diameter, the hsemorrhoidal excrescences are grasped tightly at their base. The leather and forceps are previously wet with cold water, and when the piles are fixed in the manner we have described between the jaws of the forceps, their necks or pedicles are partially strangled by means of the pressure thus applied, while the surrounding leather protects the neighbouring parts from the action of the ca.utery thus applied. A burning iron, somewhat in the shape of a hay-knife, but with a stem twelve inches in length, fastened into a wooden handle, and altogether somewhat resembling 11 r. Peil’s lithotome, is brought to a white heat, and while the hæmorrhoids are fixed as already described, it is quickly applied with a slight sawing motion upon each side of them, and they are thus instantaneously, without haemorrhage, and with comparatively little pain, re-

work of our countryman, Dr. A. Mitchell ; it is quite exhaustive, and ranks so high that it has been translated into French by my talented and courteous confrère, Dr. A. Bertherand, the Medical Director-General of the Army of Algiers. I could endorse all that has been written of the beauty and salubrity of our climate, but for obvious reasons I

to the admirable

refrain. I may, perhaps, à propos of " New Remedies," say that I have a gentleman under my cure who speaks in the highest terms of the Datura tatula. He is sixty years of age, and is subject to spasmodic asthma, which compels him yearly to winter abroad. He has tried doctors and drugs ad nauseam, and alone obtains relief from the plant in question. He smokes it, mixed with camphor, either in a pipe or in the form of a cigar; and tells me, moreover, that the Datura stramonium gives him no relief.

Apologizing for Rue

moved." (Dublin Quarterly Journal of Medical S’cience, 1846, vol. ii., p. 563.) Many years after the above was published in the Dublir. Quarterly Journal, Mr. Henry Lee read a paper, at the Medical Society of London, recommending the use of a clamp forceps in the cure of haemorrhoids. I am, Sir, your obedient servant, ERINENSIS REDIVIVUS. March, 1862.

so

Napoleon, Algiers,

desultory a letter, I

am.

Sir.

Feb. 21st, 1862.

CONSERVATIVE

&c.. THOS. CALLAWAY.

vours.

SURGERY.

To the Editor of THE LANCET. SIR,-I beg to send you the following case, which perhaps you may think worthy of insertion :J. C-, aged eight years, came to me on the 27th December last, with a. wound extending into the metacarpo-phalangeal articulation of the left thumb, which he had received that morning from a hatchet with which another boy was chopping wood. The ligaments and the whole of the muscles of the NEW REMEDIES. thumb, with the exception of the flexor muscles, were severed, To the Editor of THE LANCET. but the cartilages covering the ends of the bones were uninjured. Wishing, if possible, to save the thumb, I replaced it medium of to the SIR,-Allow me, through your journal, make a few remarks on a hitherto untried remedy in dysentery, in its proper position, stitched up the wound, and strapped it with strips of plaster, placing a bandage over all; and. phthisis, and strumous diseases generally-the result of some firmly the boy to remain in bed and keep his hand at perfect directed both home and but at abroad, years’ practical observation, more particularly in this country. The remedy I allude to is i rest. On removing the dressings three days afterwards, I Lichen lcelandicus communus, in the form of a syrup (concen- found the wound healing by the first intention, and looking as be wished. At the time I am now writing trated), as a substitute for, and infinitely more valuable than, well as could the nauseous drug, cod oil-at one time, and even now, so (Feb. 25th) the wound has completely healed. There is permuch in vogue. The method of preparing the syrup is as fect motion in the joint, and the boy is able to flex his thumb follows:-Take a pound and a half of the moss; soak in hot and grasp firmly any object in his hand, though, from the muscles being severed, he is not able to extendit water, not boiling, for one night only, so as to get rid of grit extensor and sand, and then drain carefully; afterwards boil for two himself. I am, Sir, your obedient servant, hours, so as to make an infusion, with one quart of water and GRAHAM CARTER, M.D. Chudleigh, Devonshire, Feb. 8862. a pound and a half of sugar added; then strain, add another of boil for ’half a and an with hour, water, quart thickening slight further addition of sugar; and when nearly cold, add four ounces of brandy or any other spirit. It is then ready for PARISIAN MEDICAL INTELLIGENCE. use, and the doses given are similar to those of the cod-liver (FROM OUR SPECIAL CORRESPONDENT.) oil, but with much more promising results. I am, Sir, yours respectfully, JOHN MITCHELL, L.R.C.S.E. THE yearly meeting of the Society of Acclimatization was Lancaster Infirmary, March 4th, 1862. held last week at the H6tel de Ville. The attendance was very numerous, and the presence of Prince Napoleon, as well as of several members of the Corps Diplomatique, combined to ON THE CONDITION OF THE MOUTH IN give an official gravity to the proceedings. Amongst the most IDIOCY. interesting of the speeches was an eloquent eulogium on the To the Editor of THE LANCET. late Geoffroy de St. Hilaire, delivered by M. Drouyn de 1’Huys, SIR,-In some recent numbers of your journal there is a for some time representative of the Imperial Government in of that " the so correspondence concerning arching palate" London. The Society of Acclimatization owes a great measure me to say that when commonly noticed amongst idiots. Allow the Asylum for Idiots was in its infancy I pointed out the of its success and prosperity to the late director, who for the peculiarity in question to Drs. Conolly and Little, and that the space of eight years had most zealously devoted his time and resident medical officer, Dr. llaxwell, always examined and to its advancement. A tribute was therefore due to his measured the palate of every patient in the Asylum. Dis- energy the ex-plenipotentiary edified his audience by the regarding any question as to the originality of the observation, memory,ofand a whole bouquet of flowers, culled most certainly would it not be better to consider the cause of the malforma- display tion ? I think it clearly depends upon the imperfect functionL from no protocollic parterre. Here is the last sprig from the of the sphenoid bone, the growth of which being arrested, the bunch:—" It was undoubtedly the love of his fellows which led vomer does not receive that impulse. which should compel it, Geoffroy St. Hilaire into the path in which we have followed in its turn, to push downwards and forwards the palatine pro- him ; we owe it to his memory to continue his work. May the cesses of the superior maxillary bones. Does this arrest off master minds of science march at our head, and pursue through development of the sphenoid depend upon a want of local1 his initiative that work of agea which brings the intelligence of nutrition, or is it the result of that deficiency in the great man into contact with the Eternal Truth ! Science is that mysnervous centre with which these unfortunates are affiicted?? terious ladder on which Jacob saw, while dreaming, angels Would it not be interesting to know whether the palates off ascending and descending to convey heavenwards the aspirathe deaf-dumb present any analogous deformity? Here, where3 tions of earth, and to convey back to earth the benedictions of I am somewhat bookless, I have few authorities to consult,, Heaven." This sounds very like an attempt to acclimatiza a bit and can only offer a suggestion. of the Koran, or else a new reading of the Pentateuch, which Your review of Dr. Pietra-Santa’s work upon the Climate off might fitly figure in an appendix to the next edition of Essays Algiers would hardly seem to be complete without a referencee and Reviews." It is anyhow fortunate for the orator that the

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