« ForrigeFortsæt »
W. 4.-No. The 40th clause is too loosely construeted to be of much MR. BOCKMASTER, Churchwarden of Wandsworth, has had to appear in a
use even for a grosser misuse of titles than that complained of; but, Police Court for endeavouring to prevent the enclosure of part of Wands
though it would be difficult to prove it to be illegal, such a use of a wrong worth Common by a builder. The magistrate dismissed the case, because,
title is dishonourable, and not binding upon others, as he said, a question of right had been raised which he thought very COMMUNICATIONS, LETTERS, &c., have been received from – Prof. Lister, important. Of the wrong of permitting builders to rob the public of the Edinburgh; Prof. Halford, Melbourne ; Mr. Hamilton ; Mr. Proudhon ; smallest part of an open space so valuable in a sanitary point of view, Dr. Parsons, Liverpool ; Mr. Watkins; Mr. Henry, Hastings; Dr. Macrae, there is no question whatever in our minds.
Whitby ; Mr. Home, Leeds; Dr. Thornton, Dewsbury; Dr. Jeune, Ostend; The papers of Dr. Eustace Smith and Dr. Edwin Payne are in type, and shall Dr. Wheatley ; Mr. Walpole; Mr. Curry ; Dr. Milner, Selby; Dr. Moore, appear next week.
Wolverhampton; Dr. Jeaffreson, Framlingham ; Dr. Pritchard ; Mr. Vane, Mr. Edward Hotchin, (New Rotherham.)--Let our correspondent consult a Harrow; Mr. Barrett ; Dr. Blanc; Mr. Phillips; Dr. Hughes, Amwch ;
respectable practitioner, and avoid quacks. There is no end of the latter Mr. Bradley, Pensnett; Dr. Thorne ; Dr. Harmer; Dr. Thomas, Cardigan ; who would, no doubt, willingly undertake to cure "the noise in his head"; Dr. Norris, South Petherton; Mr. Prosser; Mr. Hall; Mr. Allison, Bridbut he would find the noise in his head remain, whilst the cash in his lington; Mr. Pence, Brynmawr; Mr. Buckell; Dr. Wilme ; Mr. Hands, pockets had vanished.
Hornsey ; Mr. Lumley; Dr. Sutcliffe ; Mr. Dempsey ; Mr. H. Butterfield, One who is Interested.-The practice of receiving commissions from under- Southampton; Mr. Jones; Dr. Arthur; Mr. Gammage ; Mr. Henderson; takers and that of accepting significant presents from proprietors of
Mr. Harrison; Mr. Cameron ; Dr. Colborne ; Dr. Foss; Dr. Drinkwater, lunatic asylums are alike, and decidedly to be condemned. It is scarcely Liverpool; Mr. Walker; Mr. Le Neve Foster ; Mr. Kidd; Dr. Hopgood, conceivable that a medical man should do two things so unseemly and Royal Surrey County Hospital; Dr. Donovan ; Mr. J. Hales; Dr. Adams, undignified.
Bangay; Mr. Hoskin; Dr. Forbes; Dr. Lowther, Hawes; Mr. Bamford, L.K.Q.C.P.-We believe not. See an annotation on the subject of Titles in Horton; Dr. Coombs, Bedford ; Dr. Curran, Downpatrick ; Mr. Anderson.; our last number.
Mr. Webb; Mr. Geffrae, King William Town ; Dr. Monckton, Wadebridge; BONE-SETTERS.
Dr. E. Smith; Mr. Wade; Mr. Price; Mr. Riley, Edgbaston ; Mr. Brown; To the Editor of THE LANCET.
Mr. Hotchips; Mr. Brooks; Mr. Griffith ; Dr. Kay; Mr. Settle; Dr. Sealy, SIR.-In reference to Dr. Foster's complaint, I can assure him that the
Barbadoes ; Mr. Maclean ; Dr. Gaye; Mr. Kent; Dr. Purdon; Mr. Draper; annoyance he writes of is a very common one with medical men for a circuit Dr. C.S. Fitzgerald ; Dr. Tiley; Mr. Platt, Pont Blyddyn ; Mr. Bickersteth, of many miles around Watford. I had to suffer it on two or three occasions Liverpool; Dr. Crosbie, Kingston, Jamaica; Dr. Macleod; Mr. Halkin, myself, but not to the extent some of my medical friends in this district have. The patients who consult this celebrated bone-setter are by no means
Braintree ; Dr. Adams, The Punjaub; Dr. Hitchman, Liverpool ; Dr. Skae, confined to the humbler and uneducated class; and when decent and re
Edinburgh; Dr. Wardell, Tunbridge Wells; Mr. Daniel; Mr. Herring, spectably educated people go to bone-setters for advice, as they frequently Sandbach ; Dr. Crane; Mr. Coates; Mr. Hyde; Dr. Fryer, Manchester ; do, we can only wonder at the credulity which is so rife among all grades of Dr. Rendle ; Dr. Kitchener, Jersey ; Dr. H. Lawson; Messrs. Argles & Co.; society. Education, at least, so far as the ordinary education of youth extends in this country, has, I think, very little to do with it, but rather a
Mr. Davies; Dr. Prowse, Amersham; Mr. Crampton; Mr. Cotton, Washwant of “common sense." This supposed universal faculty appears to be
brook ; Mr. Callow, Douglas; Dr. Williams, Sudbury ; Dr. Hornbieyer, the rarest of all the senses.
New Orleans ; Mr. S. Wood; A Surgeon; L.R.C.P. Edin.; Boscobel; W.; Regarding the suggestion of a remedy, a medical friend, who was lately
A Doctor's Wife; Honorary Secretary of the French Hospital; J.X. X. X.; much annoyed by a case similar to that related by Dr. Foster, told me he had resolved upon a course of action which he thought wonld effectually
Microscope; The Vicar of Seaford; A Benighted Brother; South Devon; deter any future patient of his from applying to these individuals. He
Arts Student, Edinbargh; Physician and Surgeon; Velocipede, Preston; would, he said, be sure to make his patient feel that he was doing something One of Mr. Syme's Thousand Old Pupils ; L.K.Q.C.P.; X. Y. Z.; Medicus; for his relief by working the joint or limb in all conceivable positions-a A Constant Subscriber to THE LANCET; Quarter Century, Madras; L.M.; rather sharp practice, and one not always likely to be successful. Whether the above resolution has been acted upon I cannot say. I leave to your de
T. Q. R.; One who is Interested; Anti-Quackery ; &c. &c. cision and that of your readers the question of the propriety of practically Retford Times, Clerkenwell News, Yarmouth Independent, Brighton Herald, carrying it into execution. All that I can take upon myself to recommend Yorkshire Post, Cork Daily Herald, Times of India, Brighton Gazette, is this, that in every accident affecting the bones or joints, we should take especial and even extraordinary care to be minute in our examination, and
Alloa Journal, Western Morning News, Brighton Guardian, New York to use every available means for the alleviation and cure of our patients.
Medical Gazette, Scarborough Gazette, New York Medical Record, LinRegrets and annoyances will then have no existence for us, either as atfect- colnshire Chronicle, Surrey Comet, Licerpool Albion, Brighton Times, ing our professional ability or as touching our pockets.
Gateshead Observer, Japan Times, Australian Medical Journal, California I am, Sir, yours, &c., Amersham, May 17th, 1869.
Medical Gazette, Le Noureau Monde, Le Monde Illustré, and Vanity Fair
have been received. To the Editor of THE LANCET. SIR,--Having read Dr. Foster's letter in your last number and your footnote--"we can see no other cure for the evil but the spread of education,”— TERMS FOR ADVERTISING IN THE LANCET. I cannot refrain from remarking that I am afraid it is not only the poor who are treated by these men, but the rich and educated also. Iwo cases have For 7 lines and under .... £0 4 6 For half a page
£2 12 0 come to my knowledge within the last three months, where one of these For every additional line...... 0 0 6 For a page
5 0 0 “bone-setters" had been applied to; in both the most eminent men (sur
The average number of words in each line is eleven. geons) of our profession had previously been consulted. The tale was much
Advertisements (to ensure insertion the same week) should be delivered at the same as that told to Dr. Foster's patient. In one case the whole hand (palm as well as back), together with the fingers and thumb, were ecchy; panied by a remittance.
the Office not later than Wednesday; those from the country must be accommosed for more than a fortnight after the bone-setter's supposed eure. I can see no way of stopping such things as long as persons of standing and education are foolish enough to believe that these men can do more than the leading surgeons of this metropolis.-Yours obediently,
TERMS OF SUBSCRIPTION TO THE LANCET. May 17th, 1869.
STAMPED. (Free by post.).
£1 14 8 Tir municipal authorities of Arundel appear to entertain very primitive, if
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0 8 8 not absolutely funny, ideas about drainage. Some time since the Town Council appointed a committee to consider the drainage of the town, with
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THE LANCET Office, 423, Strand, London, and made payable to him at the power to spend £5. With this large capital at command the committee
Post-office, Charing-cross. went to work, and effected certain improvements, the cost of which has
An Edition of “THE LANCET," printed on thin paper, actually amounted to twenty-five shillings! It is clear that the Rev. C. Kingsley has no need to go to Arundel to teach the good folks there the for Foreign and Colonial circulation, is now published weekly.
meaning of thrift. A Benighted Brother.-We will request our correspondent in future not to
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more remarkable, considering the greater rotation which Lectures
has taken place in this portion of the spine--rotation equal to one-fourth of a circle. Thus it is that a spiral twist of the spinal column may exist to a very great extent, through
rotation of the bodies of the vertebræ, without the apices of ORTHOPÆDIC SURGERY. the spinous processes describing a corresponding curve.
It is important to remember this circumstance; for many beDelivered at St. George's Hospital, 1868.
come hopelessly deformed, because the mode in which spinal BY BERNARD E. BRODHURST, F.R.C.S.,
curves are formed is not rightly understood.
LBOTURER ON ORTHOPEDIC SURGERY AT THE HOSPITAL.
LECTURE VIII.—(Concluded. ON DISTORTIONS OF THE TRUNK AND NECK. Lateral curvature of the spine (continued).— The pathological conditions which result from lateral curvature of the spine may be divided into those effects which are produced immediately upon the spine and trunk, and those which are consequent upon these changes.
Confirmed lateral curvature is not purely a lateral deviation; for so soon as the curves become more or less permanent, the vertebræ which are involved in then become rotated on their axes in such a manner that the anterior surfaces of the bodies of the vertebræ occupy the convexities of the curves, and consequently present more or less laterally. In a severe case, such as that from which Fig. 24 was taken, the anterior surfaces of the bodies of the
While a lateral deviation of the spine is incipient only, the intervertebral cartilages become compressed laterally, and they recover their form when the superincumbent pressure is removed ; just as is well known to occur in health, when a man of ordinary stature, who has been in an upright position during the whole day, loses from half an inch to three-fourths of an inch, through the compression which takes place of the intervertebral substances, and which he regains only after some hours spent in a recumbent posture.
When, however, these intervertebral substances become unequally compressed, and this effect is continued from day to day, they lose in a measure their elasticity, and do not recover their full form during the period of repose, but
remain somewhat compressed and wedge-shaped. Curvature vertebræ have undergone such an amount of rotation that is then permanent, and rotation of the bodies of the verthey have acquired a lateral instead of their normal direc- tebræ commences. The bodies of the vertebræ are not all tion, and occupy the greatest convexities of the curves. in the same measure rotated; but those are most rotated But although the bodies of the vertebræ may have become which are nearest to the centre of the curve, and that verthus rotated, the spinous processes may perhaps undergo tebra which is central is most rotated and most wedgeonly slight change, so as scarcely to indicate a lateral curve. shaped. This is shown in Fig. 27, where the vertebra in These points are well shown in Figs. 25 and 26, especially the centre of the lumbar curve is represented as rotated to in the dorsal curve, which, if traced by a novice, would the extent of one-fourth of a circle and wedge-shaped, while scarcely be recognised as a spinal curve, although the those above and below are both less rotated and less wedgebodies of the vertebræ are rotated to the extent of nearly a shaped. And in the same manner the intervertebral subquarter of a circle. Perhaps, however, the course of the stances which enter into the curve are reduced in thickspinous processes in the lumbar portion of the spine is even
The thoracic space, on the convex side of the curve, is FIG. 27.
diminished by the flattening of the ribs, and by the rotation of the bodies of the vertebræ; and the heart is in consequence somewhat displaced towards the concave side of the curve. Respiration is considerably affected; and in consequence of the imperfect expansion of the chest and lungs, the right side of the heart becomes dilated, and the blood is insufficiently aërated.
The aorta follows the inflections of the vertebræ in spinal curvature. It is bound down to the spine by its branches,
and, therefore, always follows the curves of the spine. Its course, under these circumstances, is well shown in a preparation numbered 3416 in the museum of the Royal College of Sur. geons. In a practical point of view, this course of the aorta may appear to be a matter of only small importance. It deserves to be remembered however; for in a thin person, with the convexity of the lumbar curve towards the right side, the aorta may be felt immediately under the finger, lying out of its normal course, and to the right of the um. bilicus. I have known the pulsation of the artery to sug. gest ideas of aneurism,
Together with severe lumbar curvature, there is always found obliquity of the pelvis. This obliquity of the pelvis is not a simple tilting to one side (one side being raised while the other is depressed), but there is at the same time a slight movement of rotation of the pelvis itself,—which, indeed, is necessitated by the circumstance of the lumbar curve and the rotation of the lumbar vertebræ; so that the anterior superior spinous process of the ilium is not only raised above that of the opposite side, but it is also in advance of it. In the female this obliquity is of less importance than in the male; but in the male the triangular ligament of the urethra, together with the rest of the pelvis, being twisted, the direct course of the urethra behind the ligament no longer corresponds with that in front of it. This twisted condition of the urethra may cause an impediment to the introduction of a catheter into the bladder; and it should always be borne in mind when stricture of
the urethra exists in such a case. Whenever in cases of These changes in form of the vertebræ during the de- severe lumbar curvature it is required that an elastic velopment of a lateral spinal curve are very remarkable ; catheter shall be used, this is always withdrawn moulded but the most striking change which takes place in relation into a double curve, similar to the urethral curve. to spinal curvature is that which is effected in the shape of The treatment of lateral curvature can only be undertaken the thorax. The ribs necessarily follow the altered posi- with advantage when the cause of the curvature is undertions of the vertebræ to which they are attached, and un. stood, and, further, when the order in which the various dergo a movement of rotation backwards on the convex side curves have been formed is understood. of the curve, so that their angles are rendered more promi. It must be obvious to all who reflect on the subject that it nent, and they become more horizontal in their direction, is useless to endeavour to remove a spinal curve whilst the while the intercostal spaces become wider than in their cause of curvature yet remains; for, even should the curve normal state; but on the concave side of the curve the ribs be removed, it will recur so soon as the means which were sink and become flattened, the intercostal spaces also be adopted to remove it are discontinued, and the same cause come more or less effaced through overlapping of the ribs, will immediately again distort the spinal column in the and the ribs are carried forward, and become prominent on same manner as before. Thus, let us, for instance, suppose the anterior and lower part of the chest. On both sides of that some affection of the lower limbs has occasioned obthe chest the ribs are flattened; but on the convex side of liquity of the pelvis, a primary lumbar curve and a comthe curve, in consequence of the rotation of the vertebræ pensating dorsal curve. The treatment which was formerly into the convexity and of the fattening of the ribs, the adopted was, without reference to the cause of curvature, lung is much compressed. Through these changes in the to make pressure on the convexity of the dorsal curve. This form of the thorax and others which are coincident with mode of treatment was not only useless, but positively inthem, the capacity of the chest is diminished. Also, the jurious: it increased the lumbar curve, and flattened still appearance of distortion is much increased by the promi- more the flattened ribs. nence of the scapula. On the convex side of the curve this The course of treatment which should be adopted is, in bone is thrust up, and is placed obliquely, through the in- the first instance, to remove the cause of the obliquity of creased angularity of the ribs, and it is still further raised the pelvis. Whatever this may be—whether it be some by muscular action.
affection of the foot, knee, or hip,-it should be treated and The pelvis is not materially affected in an ordinary in- removed, if not before, at least at the same time as the stance of lateral curvature of the spine. It becomes oblique, lumbar curve is being treated. Again, when the dorsal is as has been already observed ; and when the superincumbent the primary curve, it may be treated by means of a portable weight is unequally transmitted to the ground, it becomes instrument, while the lumbar curve is supported by another slightly flattened. "When, however, the pelvis is affected portion of the same instrument. In this form of curvature, with rickets, it becomes flattened from above downwards, muscular exercises are useful to develop the muscles on both by the superincumbent weight and by the resistance the concave side of the curve. of the lower limbs; so that the space between the promon.
The treatment of spinal curvature should be undertaken tory of the sacrum and the symphysis of the pubes is dimi- so soon as the slightest distortion is perceived. It is difficult nished. A case of this description is on record, where it to remove a spinal curve at any time; especially it becomes was necessary to perform the Cæsarean section, in which difficult when the disposition to curvature is inherited, and the pelvis was so much deformed that a ball of one
inch in it can only be removed when mechanical means are rightly diameter would not pass through the brim.
directed to this end. It was with good reason that Sir I will, in the second place, proceed to consider, cursorily, Benjamin Brodie said: "The treatment of the disease canthe changes which result to the parts contained within the not be begun too soon after the first signs of spinal curvacompressed thorax, and to those which are attached to the ture are perceptible.” * trunk itself.
* Lectures on Distortion of the Spine not connected with Caries.
SURGEOX TO TIE LIVERPOOL ROYAL INFIRMARY.
A slight curvature of the spine is by some considered to be a matter of such trivial importance as to be unworthy of
REMARKS attention. It is a very serious error to offer such advice, however, and in later years it must occasion great distress. However trivial spinal curvature may appear in the com
ANTISEPTIC TREATMENT OF WOUNDS. mencement, its course is necessarily to produce increasing By E. R. BICKERSTETH, F.R.C.S. EDIN., deformity, with more or less pain, and impairment of the general health. So little are the laws of equilibrium understood, that it is imagined by some that a wry-neck, or a “growing out” shoulder, or an oblique pelvis is an affair of
LIGATURE OF THE CAROTID, ETC. small importance, and that distortion will probably not in- The editorial remarks regarding the antiseptic treatment crease beyond that which is at the time observed. Some of wounds contained in a recent number of THE LANCET, in even are bold enough to imagine that a child will “grow which comment is made on the discrepancy of the results out” of these distortions. These are delusions which observation quickly dispels. When curvature of the spine, from obtained by Mr. Lister and by other surgeons, induce me whatever cause, has commenced, it must go on increasing to notice briefly the result of my personal experience in this until, by the formation of compensating curves, the equili. matter. And I do this with the more pleasure as it affords brium of the body is restored. Having explained how pathological spinal curves
me the opportunity of recording the first cases in which the formed, and how they are compensated, so that the equili antiseptic catgut ligature has been successfully used on the brium of the body may be restored, I will proceed to con
human subject. sider the application of mechanical means to the removal of
Before detailing these cases, I would remark that for spinal curves.
several years I have used carbolic acid in various forms in So long as a spinal curve is incipient, it may not be ne- the treatment of severe wounds, and have the utmost concessary to have recourse to mechanical support to the spine fidence in its power in preventing putrefaction and the initself; but it may be sufficient to remove the exciting cause flammatory processes dependent on disorganisation. One of distortion, and to develop the muscular system by means
case, vividly impressed on my mind, and which I can never of well-directed exercises. When, however, these measures forget, occurred in the summer of 1867. A man was adare found insufficient, support should be given to the spine mitted into my wards, with his right hand terribly crushed itself without more delay.
and lacerated by being caught between the cog-wheels of If it be a fact that one curve is first formed, and that machinery. Several of the metacarpal bones and the phaothers are formed as compensatory of this primary curve- langes of all the fingers were more or less extensively fracand no one can doubt it who has watched these cases atten- tured, and the soft parts were generally so much ontused tively,—then it should follow that treatment must in the and detached that amputation appeared inevitable. The first instance be directed especially to the removal of this thumb, however, and its metacarpal bones were uninjured, primary curve; for to remove a secondary curve without and I should have proposed to preserve this much had it not giving efficient support to the primary curve is the most been that the soft parts around were so lacerated that it certain mode that could be devised of increasing the original seemed doubtful whether sufficient living structure could curve. Having determined, then, which is the primary be obtained to form an efficient covering. In order to gain curve, force should be applied (not on the greatest con
time for determining this point I resolved to wait, expectvexity of the dorsal curve, to flatten still more the ribs and ing that a line of demarcation would presently form, and Tender the sternum prominent) in that direction which shall indicate how much texture was irrecoverably destroyed. tend to restore the positions of the ribs, and also to restore The hand was placed on a pillow covered with macintosh, the vertebræ, which have undergone some rotation. This and irrigation with carbolic-acid lotion (one part to forty) is most effectively done by applying the force to be used to
was constantly maintained by means of bottles, with strips the lower arc of the curve, both of the primary and of the of lint hanging from their necks, suspended from the cradle secondary curve, when the curves are formed from below placed over the limb. Day after day I carefully looked at upwards; and when they are formed from above downwards the parts, but failed to find any indication of intammatory the lower arc of the dorsal curve should be supported, and action, either in the hand or in the arm above. There was the upper arc of the lumbar curve. When the combined not the slightest redness or swelling, or even constitutional forces of a well-adapted instrument are made to act in the irritation. Everything looked exactly as it did when first directions now indicated-namely, obliquely towards the put on the pillow, and I even began to hope that, after centre, they tend to unbend the primary curve. The move all, the whole of the band might be saved. At length, on ment which is thus commenced in the primary curve is the twelfth day, wishing to examine the progress and conoften greatly assisted by muscular action on the compen- dition of the parts more minutely, I ventured to raise the sating curve. In this manner the several curves are at the limb, and then, to my disgust and astonishment, it was obsame time acted on and unfolded.
vious enough that the whole hand was absolutely devoid of The time which is necessary for the completion of this life. That such a state could have been maintained for unfolding process depends on the degree of fixity of the twelve days without any visible signs of change in the incurve, and on the ability to bear the treatment. Some never jured part or in the limb above, and without any constitushrink from a well-fitting instrument, while others cannot tional symptoms, was indeed wonderful; and that the abbear effective pressure. Among the latter are those who sence of putrefaction and consequent inflammation was due suffer from rickets. Again, some cases are necessarily in- to carbolic irrigation was abundantly shown by these phecurable, and they must be recognised from the beginning; nomena rapidly supervening after irrigation was disconsuch as those which are produced by inflammation and tinued, and the parts wrapped in a poultice preparatory to its results within the thorax, from congenital malforma- amputation. tion, and also where anchylosis has taken place, whether Aneurism of the carotid; Hunterian operation, with antiseptic in angular or in lateral curvature; for in the former a catgut ligature, both ends being cut off; complete primary union slight lateral curve not unfrequently forms above and be within a week; cure.-William R- -, aged thirty-two, was low an irregular union, and in the latter, bands or bosses admitted into my wards on the 3rd April, suffering severely of bony matter are thrown out, uniting two or more ver- from aneurism of the right carotid. It had originated near tebræ.
the bifurcation twelve months before, but had not enlarged It is not necessary in this place to say that it is of the materially, or caused any serious inconvenience, till three utmost importance to attend to the general health in the weeks before admission, when a sudden increase took place, class of cases now under consideration, for constitutional due probably to rupture of the sac. When admitted, the treatment is especially needed where there is debility, tumour was the size of a large orange; it overlapped the and debility and rickets are the principal predisposing angle and base of the jaw, and extended downwards to causes of spinal curvature. At the same time, therefore, within an inch and a half of the top of the sternum. Its that mechanical treatment is undertaken in order to re- lateral dimensions were equally extensive; and internally move deformity, constitutional treatment should, so far the tumour encroached on the pharynx so much that the as is possible, be made conducive to the restoration of unfortunate patient was almost unable to swallow or to health.
speak. He was continually expectorating his saliva, and