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WANDSWORTH COMMON.

MR. BUCKMASTER, Churchwarden of Wandsworth, has had to appear in a Police Court for endeavouring to prevent the enclosure of part of Wandsworth Common by a builder. The magistrate dismissed the case, because, as he said, a question of right had been raised which he thought very important. Of the wrong of permitting builders to rob the public of the smallest part of an open space so valuable in a sanitary point of view, there is no question whatever in our minds.

THE papers of Dr. Eustace Smith and Dr. Edwin Payne are in type, and shall appear next week.

Mr. Edward Hotchin, (New Rotherham.)-Let our correspondent consult a respectable practitioner, and avoid quacks. There is no end of the latter who would, no doubt, willingly undertake to cure "the noise in his head"; but he would find the noise in his head remain, whilst the cash in his pockets had vanished.

One who is Interested.-The practice of receiving commissions from undertakers and that of accepting significant presents from proprietors of lunatic asylums are alike, and decidedly to be condemned. It is scarcely conceivable that a medical man should do two things so unseemly and undignified.

L.K.Q.C.P.-We believe not. See an annotation on the subject of Titles in our last number.

BONE-SETTERS.

To the Editor of THE LANCET.

SIR, In reference to Dr. Foster's complaint, I can assure him that the annoyance he writes of is a very common one with medical men for a circuit of many miles around Watford. I had to suffer it on two or three occasions 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 confined to the humbler and uneducated class; and when decent and respectably educated people go to bone-setters for advice, as they frequently do, we can only wonder at the credulity which is so rife among all grades of 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 want of "common sense." This supposed universal faculty appears to be the rarest of all the senses.

Regarding the suggestion of a remedy, a medical friend, who was lately 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 would effectually deter any future patient of his from applying to these individuals. He would, he said, be sure to make his patient feel that he was doing something for his relief by working the joint or limb in all conceivable positions-a 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 decision and that of your readers the question of the propriety of practically carrying it into execution. All that I can take upon myself to recommend 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 to use every available means for the alleviation and cure of our patients. Regrets and annoyances will then have no existence for us, either as affecting our professional ability or as touching our pockets. I am, Sir, yours, &c.,

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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," 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. Two cases have come to my knowledge within the last three months, where one of these "bone-setters" had been applied to; in both the most eminent men (surgeons) of our profession had previously been consulted. The tale was much 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; mosed for more than a fortnight after the bone-setter's supposed cure. 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, May 17th, 1869. A SURGEON.

I

W. A.-No. The 40th clause is too loosely constructed to be of much
use even for a grosser misuse of titles than that complained of; but,
though it would be difficult to prove it to be illegal, such a use of a wrong
title is dishonourable, and not binding upon others.
COMMUNICATIONS, LETTERS, &c., have been received from Prof. Lister,
Edinburgh; Prof. Halford, Melbourne; Mr. Hamilton; Mr. Proudhon;
Dr. Parsons, Liverpool; Mr. Watkins; Mr. Henry, Hastings; Dr. Macrae,
Whitby; Mr. Home, Leeds; Dr. Thornton, Dewsbury; Dr. Jeune, Ostend;
Dr. Wheatley; Mr. Walpole; Mr. Curry; Dr. Milner, Selby; Dr. Moore,
Wolverhampton; Dr. Jeaffreson, Framlingham; Dr. Pritchard; Mr. Vane,
Harrow; Mr. Barrett; Dr. Blanc; Mr. Phillips; Dr. Hughes, Amwch;
Mr. Bradley, Pensnett; Dr. Thorne; Dr. Harmer; Dr. Thomas, Cardigan;
Dr. Norris, South Petherton; Mr. Prosser; Mr. Hall; Mr. Allison, Brid-
lington; Mr. Pence, Brynmawr; Mr. Buckell; Dr. Wilme; Mr. Hands,
Hornsey; Mr. Lumley; Dr. Sutcliffe; Mr. Dempsey; Mr. H. Butterfield,
Southampton; Mr. Jones; Dr. Arthur; Mr. Gammage; Mr. Henderson;
Mr. Harrison; Mr. Cameron; Dr. Colborne; Dr. Foss; Dr. Drinkwater,
Liverpool; Mr. Walker; Mr. Le Neve Foster; Mr. Kidd; Dr. Hopgood,
Royal Surrey County Hospital; Dr. Donovan; Mr. J. Hales; Dr. Adams,
Bungay; Mr. Hoskin; Dr. Forbes; Dr. Lowther, Hawes; Mr. Bamford,
Horton; Dr. Coombs, Bedford; Dr. Curran, Downpatrick; Mr. Anderson;
Mr. Webb; Mr. Geffrae, King William Town; Dr. Monckton, Wadebridge;
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Liverpool; Dr. Crosbie, Kingston, Jamaica; Dr. Macleod; Mr. Halkin,
Braintree; Dr. Adams, The Punjaub; Dr. Hitchman, Liverpool; Dr. Skae,
Edinburgh; Dr. Wardell, Tunbridge Wells; Mr. Daniel; Mr. Herring,
Sandbach; Dr. Crane; Mr. Coates; Mr. Hyde; Dr. Fryer, Manchester;
Dr. Rendle; Dr. Kitchener, Jersey; Dr. H. Lawson; Messrs. Argles & Co.;
Mr. Davies; Dr. Prowse, Amersham; Mr. Crampton; Mr. Cotton, Wash-
brook; Mr. Callow, Douglas; Dr. Williams, Sudbury; Dr. Hornbieyer,
New Orleans; Mr. S. Wood; A Surgeon; L.R.C.P. Edin.; Boscobel; W.;
A Doctor's Wife; Honorary Secretary of the French Hospital; J. X. X. X. ;
Microscope; The Vicar of Seaford; A Benighted Brother; South Devon;
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A Constant Subscriber to THE LANCET; Quarter Century, Madras; L.M.;
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colnshire Chronicle, Surrey Comet, Liverpool Albion, Brighton Times,
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Medical Gazette, Le Nouveau Monde, Le Monde Illustré, and Vanity Fair
have been received.

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LAVISH EXPENDITURE FOR SANITARY PURPOSES. THE municipal authorities of Arundel appear to entertain very primitive, if not absolutely funny, ideas about drainage. Some time since the Town Council appointed a committee to consider the drainage of the town, with power to spend £5. With this large capital at command the committee went to work, and effected certain improvements, the cost of which has 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.

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An Edition of "THE LANCET," printed on thin paper,

THE LANCET can be obtained from all the principal Booksellers and Newsmen throughout the world, or from the following special agents:EDINBURGH: MACLACHLAN & CO. DUBLIN: FANNIN & CO.

PARIS: G. GERMER BAILLIERE, Rue de l'Ecole de Médecine, 17. UNITED STATES OF AMERICA: KELLY, PIET, & Co., Baltimore. Terms of Subscription by mail to any part of the United States (Territories excepted), 12 dollars currency per annum, per Messrs. KELLY PIET, and Co., Baltimore.

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DENMAN'S

GREEK

WINES,

20, PICCADILLY.

Pamphlet Priced List "Pure Wine and how to know it," free on Application.-Sample Cases of Six Red and Six White Wines, £1 11s. 4d.

FRENCH WINES.-The great increase in the consumption of Clarets has led to the introduction here of Wines, many of which, sold under high-sounding names, are sound and pure, whilst others are vastly inferior. As Wines can only be judged by actual comparison, E. GALLAIS & CO. (WINE GROWERS) recommend a trial of their "VIN DE MEDOC," at 12s. per dozen (bottles included), which they are daily supplying to the Medical Profession and the London Clubs, Regimental and Naval Messes, &c. A single Sample Bottle may be had.

VICHY WATER COMPANY, 27, MARGARET ST., REGENT ST., & 61, QUADRANT, REGENT ST., W.

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OLD MARSALA WINE

Guaranteed the finest imported; free from acidity or heat, and much superior to low-priced Sherry. One Guinea per dozen. Bronte Madeira, a full, soft, golden Wine, 30s. per dozen. Mazzara, a stout, brown Wine, with Sherry character, 288. per dozen. 3 dozen and upwards carriage free by rail to all England and Wales. For highly favourable opinion of W. D. WATSON'S Old Marsala Wine, see British Medical Journal, Dec. 26th, 1868; Medical Times and Gazette, No. 770, April 1st, 1865, p. 345; or Dr. Druitt's "Report on cheap Wines," p. 174.

W. D. WATSON, Wine Merchant, 72 and 73, Great Russell-street, corner of Bloomsbury-square, London, W.C. Established 1841. Terms cash.

de

Champagne,

as drunk in Reims and Epernay.

A very dry and pleasant sparkling Wine, free from alcohol and sugar, particularly suitable for invalids and delicate persons.

Price per dozen Quarts

per 2 doz. Pints

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per 4 doz. Half-pints...

Less 5 per cent. discount for cash.
Carriage paid to any part of Great Britain.

428.

468.

518.

Sold only by CHAPERON & DEMELLE, Wine and Spirit Merchants,
22, Conduit-street, Bond-street, London, W.,
where the Wine may be tasted.

N.B.-A sample sent, free of charge, to any medical gentleman

on application.

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DUBLIN EXHIBITION, 1865.

This celebrated old IRISH WHISKY gained the Dublin Prize Medal. It is pure, mild, mellow, delicious, and very wholesome. Sold in bottles, 38. 8d., at the retail houses in London; by the agents in the principal towns in

Old-fashioned Dry Port and Rare Old England; or wholesale, at 6, Great

CONNOISSEURS.-Messrs. HEDGES and BUTLER in

vite attention to their extensive STOCK of choice old PORT, selected and bottled with the utmost care, and now in the highest state of perfection, embracing the famed vintages of 1820, 1834, 1840, 1847, 1858, 1861, and 1863, ranging in prices from 428. to 144s. per dozen. White Port (very rare), 728.; pale and brown Sherry, upwards of fifty years old, 120s.; choice old East India Sherry, 848.; remarkably fine East India Madeira, very old in bottle, 968.; Chateau Lafitte, 84s., 968.; Chateau Margaux, 60s., 728.; Steinberger Cabinet, 1834 vintage, 120s.; Imperial Tokay, fine old Sack, Malmsey, Frontignac, Constantia, Vermuth, &c.

WINES FOR ORDINARY USE.

Sherry, 24s., 30s., 368., 428. per dozen; Port, 24s., 30s., 36s., 42s.; Claret, 188., 20s., 24s., 30s., 368., 42s.; Champagne, 36s., 42s., 48s., 60s.; Hock and Moselle, 24s., 30s., 36s., 488.; fine old pale Cognac Brandy, 48s., 60s., 72s., 848. Full lists of prices on application.

On receipt of a Post-office order, or reference, any quantity will be forwarded immediately by

HEDGES AND BUTLER,

155, Regent-street, London, and 30, King's-road, Brighton.

(Originally Established A.D. 1667.)

Windmill-street, London, W. Observe the

pink label, and cork branded “Kinahan's LL Whisky."

Allsopp's Pale or Bitter

Ale.-Messrs.

S. ALLSOPP and SONS beg to inform the Medical Profession that their Ale, so strongly recommended by the Faculty, may be procured, in casks of 18 gallons and upwards, at 61, King William-street, London, and at the Brewery, Burton-on-Trent; and in bottles or casks from any respectable Wine and Beer Merchant Allsopp's Pale Ale being specially asked for.

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Lectures

ON

ORTHOPEDIC

more remarkable, considering the greater rotation which 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 vertebra, without the apices of SURGERY. the spinous processes describing a corresponding curve. It

Delivered at St. George's Hospital, 1868.

BY BERNARD E. BRODHURST, F.R.C.S.,

LECTURER ON ORTHOPEDIC SURGERY AT THE HOSPITAL.

is important to remember this circumstance; for many become hopelessly deformed, because the mode in which spinal curves are formed is not rightly understood.

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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 them 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 FIG. 24.

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vertebræ have undergone such an amount of rotation that they have acquired a lateral instead of their normal direction, and occupy the greatest convexities of the curves. But although the bodies of the vertebræ may have become thus rotated, the spinous processes may perhaps undergo only slight change, so as scarcely to indicate a lateral curve. These points are well shown in Figs. 25 and 26, especially in the dorsal curve, which, if traced by a novice, would scarcely be recognised as a spinal curve, although the bodies of the vertebræ are rotated to the extent of nearly a quarter of a circle. Perhaps, however, the course of the spinous processes in the lumbar portion of the spine is even No. 2387.

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 is then permanent, and rotation of the bodies of the vertebræ commences. The bodies of the vertebræ are not all in the same measure rotated; but those are most rotated which are nearest to the centre of the curve, and that vertebra which is central is most rotated and most wedgeshaped. This is shown in Fig. 27, where the vertebra in the centre of the lumbar curve is represented as rotated to the extent of one-fourth of a circle and wedge-shaped, while those above and below are both less rotated and less wedgeshaped. And in the same manner the intervertebral substances which enter into the curve are reduced in thick

ness.

FIG. 27.

These changes in form of the vertebræ during the development of a lateral spinal curve are very remarkable; but the most striking change which takes place in relation to spinal curvature is that which is effected in the shape of the thorax. The ribs necessarily follow the altered positions of the vertebræ to which they are attached, and undergo a movement of rotation backwards on the convex side of the curve, so that their angles are rendered more prominent, and they become more horizontal in their direction, while the intercostal spaces become wider than in their normal state; but on the concave side of the curve the ribs sink and become flattened, the intercostal spaces also become more or less effaced through overlapping of the ribs, and the ribs are carried forward, and become prominent on the anterior and lower part of the chest. On both sides of the chest the ribs are flattened; but on the convex side of the curve, in consequence of the rotation of the vertebræ into the convexity and of the flattening of the ribs, the lung is much compressed. Through these changes in the form of the thorax and others which are coincident with them, the capacity of the chest is diminished. Also, the appearance of distortion is much increased by the prominence of the scapula. On the convex side of the curve this bone is thrust up, and is placed obliquely, through the increased angularity of the ribs, and it is still further raised by muscular action.

The pelvis is not materially affected in an ordinary instance of lateral curvature of the spine. It becomes oblique, as has been already observed; and when the superincumbent weight is unequally transmitted to the ground, it becomes slightly flattened. When, however, the pelvis is affected with rickets, it becomes flattened from above downwards, both by the superincumbent weight and by the resistance of the lower limbs; so that the space between the promontory of the sacrum and the symphysis of the pubes is diminished. A case of this description is on record, where it was necessary to perform the Cæsarean section, in which the pelvis was so much deformed that a ball of one inch in diameter would not pass through the brim.

I will, in the second place, proceed to consider, cursorily, the changes which result to the parts contained within the compressed thorax, and to those which are attached to the trunk itself.

The thoracic space, on the convex side of the curve, is 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 Surgeons. 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 suggest 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 vertebra; 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 severe lumbar curvature it is required that an elastic catheter shall be used, this is always withdrawn moulded into a double curve, similar to the urethral curve.

The treatment of lateral curvature can only be undertaken with advantage when the cause of the curvature is understood, and, further, when the order in which the various curves have been formed is understood.

It must be obvious to all who reflect on the subject that it is useless to endeavour to remove a spinal curve whilst the cause of curvature yet remains; for, even should the curve be removed, it will recur so soon as the means which were adopted to remove it are discontinued, and the same cause will immediately again distort the spinal column in the same manner as before. Thus, let us, for instance, suppose that some affection of the lower limbs has occasioned obliquity of the pelvis, a primary lumbar curve and a compensating dorsal curve. The treatment which was formerly adopted was, without reference to the cause of curvature, to make pressure on the convexity of the dorsal curve. This mode of treatment was not only useless, but positively injurious: it increased the lumbar curve, and flattened still more the flattened ribs.

The course of treatment which should be adopted is, in the first instance, to remove the cause of the obliquity of the pelvis. Whatever this may be-whether it be some affection of the foot, knee, or hip,-it should be treated and removed, if not before, at least at the same time as the lumbar curve is being treated. Again, when the dorsal is the primary curve, it may be treated by means of a portable instrument, while the lumbar curve is supported by another portion of the same instrument. In this form of curvature, muscular exercises are useful to develop the muscles on the concave side of the curve.

The treatment of spinal curvature should be undertaken so soon as the slightest distortion is perceived. It is difficult to remove a spinal curve at any time; especially it becomes difficult when the disposition to curvature is inherited, and it can only be removed when mechanical means are rightly directed to this end. It was with good reason that Sir Benjamin Brodie said: "The treatment of the disease cannot be begun too soon after the first signs of spinal curva ture are perceptible." *

* Lectures on Distortion of the Spine not connected with Caries.

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A slight curvature of the spine is by some considered to be a matter of such trivial importance as to be unworthy of 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 commencement, its course is necessarily to produce increasing 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 small importance, and that distortion will probably not increase beyond that which is at the time observed. Some even are bold enough to imagine that a child will "grow out" of these distortions. These are delusions which observation quickly dispels. When curvature of the spine, from whatever cause, has commenced, it must go on increasing until, by the formation of compensating curves, the equilibrium of the body is restored.

are

Having explained how pathological spinal curves formed, and how they are compensated, so that the equilibrium of the body may be restored, I will proceed to consider the application of mechanical means to the removal of spinal curves.

So long as a spinal curve is incipient, it may not be necessary to have recourse to mechanical support to the spine itself; but it may be sufficient to remove the exciting cause of distortion, and to develop the muscular system by means of well-directed exercises. When, however, these measures are found insufficient, support should be given to the spine itself without more delay.

If it be a fact that one curve is first formed, and that others are formed as compensatory of this primary curveand no one can doubt it who has watched these cases attentively, then it should follow that treatment must in the first instance be directed especially to the removal of this primary curve; for to remove a secondary curve without giving efficient support to the primary curve is the most certain mode that could be devised of increasing the original curve. Having determined, then, which is the primary curve, force should be applied (not on the greatest convexity of the dorsal curve, to flatten still more the ribs and render the sternum prominent) in that direction which shall tend to restore the positions of the ribs, and also to restore the vertebræ, which have undergone some rotation. This is most effectively done by applying the force to be used to the lower arc of the curve, both of the primary and of the secondary curve, when the curves are formed from below upwards; and when they are formed from above downwards the lower arc of the dorsal curve should be supported, and the upper arc of the lumbar curve. When the combined forces of a well-adapted instrument are made to act in the directions now indicated-namely, obliquely towards the centre, they tend to unbend the primary curve. The movement which is thus commenced in the primary curve is often greatly assisted by muscular action on the compensating curve. In this manner the several curves are at the same time acted on and unfolded.

The time which is necessary for the completion of this unfolding process depends on the degree of fixity of the curve, and on the ability to bear the treatment. Some never shrink from a well-fitting instrument, while others cannot bear effective pressure. Among the latter are those who suffer from rickets. Again, some cases are necessarily incurable, and they must be recognised from the beginning; such as those which are produced by inflammation and its results within the thorax, from congenital malformation, and also where anchylosis has taken place, whether in angular or in lateral curvature; for in the former a slight lateral curve not unfrequently forms above and below an irregular union, and in the latter, bands or bosses of bony matter are thrown out, uniting two or more vertebræ.

It is not necessary in this place to say that it is of the utmost importance to attend to the general health in the class of cases now under consideration, for constitutional treatment is especially needed where there is debility, and debility and rickets are the principal predisposing causes of spinal curvature. At the same time, therefore, that mechanical treatment is undertaken in order to remove deformity, constitutional treatment should, so far as is possible, be made conducive to the restoration of health.

REMARKS

ON THE

ANTISEPTIC TREATMENT OF WOUNDS.

BY E. R. BICKERSTETH, F.R.C.S. EDIN.,

SURGEON TO THE LIVERPOOL ROYAL INFIRMARY.

LIGATURE OF THE CAROTID, ETC.

THE editorial remarks regarding the antiseptic treatment of wounds contained in a recent number of THE LANCET, in which comment is made on the discrepancy of the results obtained by Mr. Lister and by other surgeons, induce me to notice briefly the result of my personal experience in this matter. And I do this with the more pleasure as it affords me the opportunity of recording the first cases in which the

antiseptic catgut ligature has been successfully used on the human subject.

Before detailing these cases, I would remark that for several years I have used carbolic acid in various forms in the treatment of severe wounds, and have the utmost confidence in its power in preventing putrefaction and the inflammatory processes dependent on disorganisation. One case, vividly impressed on my mind, and which I can never forget, occurred in the summer of 1867. A man was admitted into my wards, with his right hand terribly crushed and lacerated by being caught between the cog-wheels of machinery. Several of the metacarpal bones and the phalanges of all the fingers were more or less extensively fractured, and the soft parts were generally so much contused and detached that amputation appeared inevitable. The thumb, however, and its metacarpal bones were uninjured, and I should have proposed to preserve this much had it not been that the soft parts around were so lacerated that it seemed doubtful whether sufficient living structure could be obtained to form an efficient covering. In order to gain time for determining this point I resolved to wait, expecting that a line of demarcation would presently form, and indicate how much texture was irrecoverably destroyed. The hand was placed on a pillow covered with macintosh, and irrigation with carbolic-acid lotion (one part to forty) was constantly maintained by means of bottles, with strips of lint hanging from their necks, suspended from the cradle placed over the limb. Day after day I carefully looked at the parts, but failed to find any indication of inflammatory action, either in the hand or in the arm above. There was not the slightest redness or swelling, or even constitutional irritation. Everything looked exactly as it did when first put on the pillow, and I even began to hope that, after all, the whole of the hand might be saved. At length, on the twelfth day, wishing to examine the progress and condition of the parts more minutely, I ventured to raise the limb, and then, to my disgust and astonishment, it was obvious enough that the whole hand was absolutely devoid of life. That such a state could have been maintained for twelve days without any visible signs of change in the injured part or in the limb above, and without any constitutional symptoms, was indeed wonderful; and that the absence of putrefaction and consequent inflammation was due to carbolic irrigation was abundantly shown by these phenomena rapidly supervening after irrigation was discontinued, and the parts wrapped in a poultice preparatory to amputation.

Aneurism of the carotid; Hunterian operation, with antiseptic catgut ligature, both ends being cut off; complete primary union within a week; cure.- -William R- - aged thirty-two, was admitted into my wards on the 3rd April, suffering severely from aneurism of the right carotid. It had originated near the bifurcation twelve months before, but had not enlarged materially, or caused any serious inconvenience, till three weeks before admission, when a sudden increase took place, due probably to rupture of the sac. When admitted, the tumour was the size of a large orange; it overlapped the angle and base of the jaw, and extended downwards to within an inch and a half of the top of the sternum. Its lateral dimensions were equally extensive; and internally the tumour encroached on the pharynx so much that the unfortunate patient was almost unable to swallow or to speak. He was continually expectorating his saliva, and

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