282 HOSPITAL REPORTS.-STRANGULATED HERNIA.

a diploma from any College of Surgeons, or College of Phy-sicians and Surgeons, or by a joint Board appointed by thoseColleges; whether registered practitioners should be entitledat law to recover charges for attendance and professional ser-vices, and for medicines supplied by them to their patients,and whether the dispensing of medicines to their patientsshould disentitle them to any professional privileges, and, ifso, to specify them;--whether the public should be allowed toselect candidates to fill public medical offices, indiscriminately,from the Register; or whether they should be compelled tochoose from specific classes of practitioners; an accurate de-scription of the diplomas, licences, and other testimonialswhich should entitle persons now practising in any of thedepartments of medicine, to be placed on the Register in

the first instance; what should be the nature, the mode, andthe amount of punishment inflicted on uzaregistered medical ipractitioners;-whether the sale of quack or secret medicines ’,should be interdicted, and, if so, by what means; and whetherthe sale of secret medicines, by legally-qualified practitioners,should subject the sellers to the erasure of their names fromthe Register,-whether persons carrying on the business ofchemists and druggists should be registered, and, if so, bywhom;-whether unregistered chemists and druggists shouldbe subjected to any penalty, and, if so, by whom, and whatshould be its nature and amount;-whether any restrictionshould be imposed to prevent the present dangerous indis-criminate sale of poisons, and, if so, of what descriptionit should be ;-whether, the five-years’ apprenticeship clauseof the Apothecaries Act being repealed, it would be advisablethat pupils should be articled for any term, such as one ortwo years, to qualified medical practitioners, and, if so, atwhat age such an articled pupilage should commence;-whether there should be any preliminary examination of such

pupils, what should be its nature, and by whom conducted;how many examinations should take place before the diplomais granted, and at what period they should be enforced; andwhether there should be sessional examinations at the schools

and certificates granted for them.All these subjects have repeatedly been discussed in the

Medical Associations of London, and recently they have en-

gaged the attention of the Councils of our Colleges. The

opinions of the profession in this country, with regard to themost important of them, are tolerably well known. Can

suggestions of this description, embodying almost all the

points of interest in medical education, government, anc

practice, be submitted to the notice of the profession in Ireland and Scotland, with a knowledge of the fact, that a Billrelating to the entire subject, is to be introduced into Parliament during the present session, without exciting in thosfcountries the gravest attention? î

HOSPITAL REPORTS.

LONDON HOSPITAL.A boy, aged about 14 years, riding on a gate, was capsized, andfalling on his hands, produced a dislocation of the radius for-wards.

WHEN brought to the hospital, the following were the symp-toms:-The forearm was semiflexed and semiprone, attendedwith inability either to extend or flex it completely, or to ren-der the hand more or less prone; a twisting and flattening ofits upper part; and the head of the radius could be perceivedin front of the elbow-joint, and opposite the upper part of thecoronoid fossa of the humerus, and a depression in its normal

locality. On attempting forcibly to flex the forearm, a pecu-liar and very characteristic interruption was produced, by thehead of the radius striking against the humerus, between itscondyles. The tumefaction and pain were comparativelylittle.

Reduction.—Counter-extension being made from the lowerpart of the arm, the forearm was gradually extended from thehand, held as in shaking hands, supination being at the sametime attempted, and assisted by pressure with the operator’sthumb against the upper part of the radius: in a few secondsthe dislocation was reduced. Flexion and extension couldthen be made by the patient himself, who was anxious to ex-hibit his recovery of power, and not the slightest reappearanceof dislocation was perceived on his so doing.The joint was then confined on an angular splint, and spirit

lotion applied. Very little inflammation ensued, and in amonth from the time of the accident he was discharged, the- forearm at the time being strong, and perfectly symmetrical.

Remarks.—This case presents a remarkable contrast withthe generality of those on record-first, as regards the reduc-tion, which was so easily effected; and secondly, in the ab-sence of that great tendency to re-dislocation, said so com-monly to exist in these cases.

DREADNOUGHT HOSPITAL SHIP.STRANGULATED HERNIA.—OPERATION.

CASE 1.—PHILIP F , aged fifty-four, was admitted 24thDecember, 1845. Strangulation commenced on the morning ofthe 22nd. There has been hernia in the same situation forabouttwenty-five years,never entirely reducible.and on several occa-sions he has suffered temporary incarceration. No stool sincethe 21st; symptoms very urgent; severe pain across the navel;frequent vomiting; tenderness and pain in the tumour; pulsefrequent; great anxiety and restlessness; loud complaining ofthe feeling of tension and fulness of abdomen. On the 20th hewas attacked with pain and sickness; pain continued to in-crease so as to be very severe on the 22nd, when the vomitingbecame more frequent and the distress more urgent. Tumourlarge, rising above Poupart’s ligament, which is indistinct,from a quantity of loose subcutaneous tissue. The swellingappears to consist of two equal portions. At the internal andinferior part the integument is reddened and tender to touch.A feeling of fluctuation is conveyed to the finger, as if this werea small glandular abscess situated on the hernial protrusion.The whole swelling is remarkably tense-no impulse is con-veyed by coughing. After a very short trial of the taxis theoperation was proceeded with. A long incision was madeobliquely across the front of the tumour. The thick adiposetissue was carefully divided down to the sac, which was foundto be separated into two equal portions, by a band of fibroustissue, very distinct, when the sac was partly uncovered,much resembling a large bubo, consisting of two glands in astate of suppuration. The surface of the sac was smooth,tense, very thick, and firm; it could, however, be nipped updistinctly from the contained parts, except quite at the infe-rior and internal angle opposite to the external reddening.It was opened where it could be nipped, and the incision wascarried across the whole length. The sac was found to be

remarkably thick: the contents, on opening it, appeared to beomentum only, adhering slightly to the interior of the sac.On separating these attachments, and raising the omentum,there was discovered a knuckle of intestine, two inches inlength. The colour of the intestine was a deep mottledpurple, with the surface covered by a fibrinous exudation; noappearance of gangrene. The stricture was divided upwardsand inwards, and the intestine was drawn down a little; asthe portion immediately above the stricture was found unin-jured, the knuckle was returned. The large, long portion ofomentum, which was firmly adherent to the upper and outerpart of the neck of the sac, was cast off. The divided surfacedid not yield a single drop of blood. In a former case, de-tailed in TUE LANCET, 26th August, 1843, the omentum wasleft adherent, and perhaps occasioned vomiting, by bringingdown the stomach. The two edges of the wound were broughttogether by suture, wet lint applied, and then a large sponge,retained by a bandage. Forty minims of Battley’s solution.Catheter used; fomentation to the leg.25th.-Passed an excellent night; bowels freely opened;

quite comfortable; pulse 90, soft; skin natural.29th.-Has gone on without any bad symptom. Towards

evening he has had usually a good deal of flatus with accele-ration of pulse. This disturbance was always relieved by twograins of opium, which he has taken nightly. He does not

283

now require it. The abdomen is free from pain or tenderness;natural to the feel. Copious suppuration at the wound; nopain; to eat rice-pudding.30th.-Going on well. Passed scybala after enema. No

pain either in the abdomen or wound. The inflammation hasgreatly subsided. Copious discharge.February 4th.-Discharged. Cure uninterrupted.

ERYSIPELAS OF LEG AFTER PISTOL SHOT.

CASE 2.-James G-, aged twenty-two,was brought in drunk,on Jan. 10th, 1846, having shot himself in the foot, while prac-tising in a shooting-gallery at Greenwich. Not having fullcommand over his finger, he had pulled the trigger in liftingthe pistol. The ball entered the right foot, shattering theedge of the cuneiform bone, and lodged in the sole, imme-diately beneath the cuticle, whence it was easily extracted. It

appeared to have divided the dorsalis pedis, as there wasconsiderable hæmorrhage, readily, however, restrained by apiece of lint in the wound.

11th.—No pain, no inflammation; water dressing; a dose ofhouse medicine.12th.-No complaint; a loose fragment of bone removed by

the lower wound.13th.-Some inflammatory appearance in the foot; very

little pain; no sign of suppuration; no disturbance.14th.—A severe rigor last night, followed by sickness, and

painful swelling of the femoral glands; red lines extending upthe inner side of the leg and thigh; the foot rather moreswelled, not tender nor painful; wounds were freely dilated;twenty-four leeches to the course of the lymphatics; constanthot fomentations to the foot, spirit lotion to the thigh; feelsfeverish; pulse 108.

15th.—Pain and swelling in the thigh diminished; less swell-ing of foot; slight purulent discharge from the wounds; fancieshimself better, but looks ill; eighteen leeches.16th.-Delirium; pale and sallow; swelling and pain dimi-

nished ; one or two faint red streaks in front of the thigh; nohardness in the course of the absorbents; a diffuse red patchin the lower part of the leg, not continuous with the foot,which is very little swelled, with but little suppuration.Another fragment of bone removed from the upper wound.The bones injured appeared to be the two internal cuneiform.Pulse 130, small; fomentation. There was a free incisionmade down to the bone, but no pus. To have a draught everynight, containing a grain of muriate of morphia, spirits ofnitre, and camphor mixture.

17th.—Rather better, more collected; a drachm of laudanuminstead of the morphia.

18th.—Much the same; no delirium; copious suppurationfrom foot.

20th.-Erysipelas of the whole limb; not much swelling.The fascia was divided, but there was no pus.

23rd.—Much worse; died.25th.—The body was examined. The viscera were healthy;

some slight adhesion of one lung, and a small collection of pusat the junction of the clavicle and sternum, not penetratingthe pleura; the bone in one place was denuded of cartilage;there was pus in the interstices of the bones of the foot sur-

rounding the wound. The ball had passed between the bonestowards the front of the cuneiform, and on its inner side.There was no displacement; the edges only torn. All thebones in contact with the ball were slightly injured.

DISLOCATION OF THE FEMUR INTO THE FORAMEN OVALE.

REDUCTION.

CASE 3.—Robert H—, aged thirty-seven, was admitted Nov.20th,18I5; brought at night with his right leg dislocated. Itwas done an hour previously, by being struck by a crane, whilestanding with his legs apart. The symptoms very distinct.Abduction of thigh and aversion of knee; depression in thesituation of the trochanter, with great pain on motion; astrong muscular man. He was placed in a hot bath, and bledto faintness; then laid on a mattress on the floor; a bandagewas passed round the left side of the pelvis, and fixed at somedistance opposite, and at right angles; a padded belt waspassed round the dislocated limb, as high up as possible, andfixed to pulleys on the other side on a line with it. On tight-ening the pulleys, the knee was kept well down; the leg usedas a lever, and reduction effected in about a minute.

Dec. 8th.—Discharged.CASE OF IN’JURY INFLICTED ON THE CIRCUMFERENCE OF THE

NERVOUS SYSTEM, WITH SOME SHOCK AT THE CENTRE.CASE 4.—W. T. G. -, aged fifty-one, admitted Aug. 26&,

1845, was employed, the day before, bearing a cask in over thehatchway, and using great force: this was expended in preci-

pitating him into the hold, for the cask turned round. Helighted upon his head, which he struck against a barrel ; andthen his body was struck on the right side against some ironbars. One or two ribs were broken, and the shoulder severelyhurt. He felt the pain of the blow, which bent the head for-ward and shook the vertebrae. He was picked up, and madeto sit. He then went to Guy’s Hospital, but was not takenin. Next day-it being the taking in-he went to St. Thomas’sHospital, where he was cupped on the side, and then sent tothe Dreadnought Ship.* He was put to bed, and fomenta-tions were employed. About a week after, the fracture wasdiscovered, and a flannel roller employed. Kept his bed forthree weeks. The roller confined the arm to the body sothat the loss of power and sensation was not discovered.Afterwards, all the fingers were found to be numbed, and thearm could not be raised. The shoulder was leeclied, and two

belladonna plasters applied; a plaster of galbanum to theback, and afterwards blisters-one to the neck, and another,

. afterwards, to the loins.Feb. 5.-For the last three weeks he has been subjected to

the galvanic battery. In a few days he recovered sensationin his fingers, and then the use, partially. The little fingerand inner side of the next were differently affected. Indeed,the affection of the nerves distributed on the right upper sideof the body is partial. The man cannot lift the humerus, andcomplains of an occasional burning liain about the outline ofthe deltoid. There is no displacement of the vertebrae, andno pain felt on touch through the whole line. The nailsstopped growing, but have now commenced again. Here theinjury was inflicted on the termination of the nerves, pro-ducing loss of motion and sensation. There is no symptom ofparaplegia, beyond a frequent desire to make water.The galvanic apparatus is one of Weiss’s, very portable and

compact. The shock is very powerful, so as not to be bornefor a minute by a healthy person.COMPOUND FRACTURE OF THE THIGH, ATTENDED WITH ERYSIPELAS,AND FORMATION OF PUS; BENEFIT OF WINE IN LARGE QUANTITY.

CASE 5.-Peter C-, aged thirty, was brought to the ship onthe 28th of October,1845,with the left thigh broken at the lowerthird, with a communicating wound, about half an inch long,on the inner and anterior aspect of the thigh, done two daysago. He had fallen into the engine-room of his vessel, and

got entangled in the machinery.The wound was dressed with lint, dipped in compound tinc-

ture of benzoin; bandage, and long splint; no pain, swelling,or inflammation occurring. The dressings were undisturbed,and the splint unremoved, till November 14th, when lie com-plained of nausea and general uneasiness. On removing thebandages suppuration was found to have taken place to verylittle extent, the wound being filled with granulations, andthe surrounding integument reddened; redness, diffuse anderysipelatous. Liston’s splint, with the many-tailed bandage,was applied, so that the limb could be dressed without movingit. No retraction; very little union.November 16th.—General erysipelas extending up and

down the thigh; feels better in his general health; tonguewith a dry streak; an ounce of wine every two hours.

18th.-Feels better; tongue dry, furred, and brown; erysi-pelas stationary at the anterior superior spinous process ofilium; inguinal glands slightly enlarged.

20th.—Erysipelas now increasing downwards over the knee.Much reduced himself; pulse 96, soft, undulating; tongue dryand brown ; teeth covered with sordes; four stools. He hastaken during the last twenty-four hours an ounce of wineevery hour.

, 21st.—Discharge from wound continues healthy. No moreerysipelas. Was attacked last night with vomiting after

, taking food. This has continued at intervals with purging;tongue not so much furred, moister at the edges; pulse soft,94; sleeps a good deal.

, 22nd.—Wound going on well; some fresh erysipelas aroundit; the pulse and tongue indicate improvement; vomitingceased; the ten-grain solution of silver caustic applied to theerysipelas, which, on the 23rd, had subsided. Wound anddischarge healthv.

24th.—Wine, two ounces every two hours.25th.—Four stools; complains of being liglxt-headed; wine,

two ounces every hour; opium, one and a half grains everynight.29th.-A large collection of matter was discovered in the

calf of the leg, situated beneath the fascia, dividing the gas-’ * It may be observed, that patients are kept a long time in the Dread-’

nought if there be any prospect of a return to health; though, generally.i they are discharged as soon as cured.

284

trocnemins from soleus; matter very thin, fetid, and disco-loured ; two incisions made down to it; water-dressing changedtwice a day.December 1st.—Wound in the thigh nearly well; abscess

in the calf discharges freely; pus healthy; a more stimulatingdressing, and a small abscess in the groin, below Poupart’sligament.March 6th.-He left the ship.

A MEDICAL BILL.

JOHN GROVE.

T’O the Editor of THE LANCET.SIR,—In all the plans hitherto adopted for procuring a com-

bination of professional men in the cause of medical reform,there have been so many difficulties to contend with, that Iam not surprised at their failure. It is not, however, neces-sary for me now to enter into an explanation of my opinions.I have only to repeat a suggestion made to you some monthsback,-a suggestion to which you then kindly lent your aid.I’again solicit your assistance, and should you approve of theaccompanying address, which I, an humble member of theprofession, offer to my brethren, you would oblige me by givingit a place in your journal.. cannot but feel that if you present a Bill to the House

having the objects you have described to us, and at the timecarry your’journal in your hand, containing the names of thebulk of the profession, a stronger or more forcible petitioncould not be presented to Parliament.

I am, Sir, your obedient servant,Wandsworth, March, 1846. JOHN GROvE.

AN ADDRESS TO THE MEDICAL PRACTITIONERS OFGREAT BRITAIN AND IRELAND.

By JOHN GROVE, M.R.C.S. Eng., L.S.A., Surgeon to theWandsworth and Clapham Union.

GENTLEMEN,—Early, during this session, Mr. Wakley hastold you he intends bringing in a bill for the better regula-tion of the practice of physic and surgery.His scheme, of which you have been in possession for somemonths, offers you everything which an enlightened mindcould suggest or desire. If this scheme should be enactedinto law, you would be emancipated from the professionalbondage under which you have so long laboured, you wouldshake off the trammels and ignominy of hybrids or professionaltraders, your legitimate position would be obtained, and youwould stand before the world, as you ought, a body of upright,intelligent men, having a title worthy your calling, a characterworthy your title.He has told you his intentions some months since, and I

doubt not he is ready to take upon himself the arduous taskof framing, and bringing in, a bill for an object which hashitherto bailed all who have encountered it.

Let us, then, for once, be unanimous; let us give Mr. Wakleyand his measure all the support and encouragement in ourpower. ’

To the elder members of the profession who have attainedany eminence, I say, that very few of you have not, at sometime or other, received your due meed of praise in the pagesof THE LANCET. To the Editor of that journal, in many in-stances, much of your success is to be attributed: he has ex-tolled you when you deserved praise; the public have by himbeen taught to seek your professional assistance, by havingtheir attention directed to your particular attainments; andfor this, I say, he deserves your gratitude and esteem.To those who are rising into eminence, I say, he will award

you your deserts, and assist you in your honourable and praise-worthy exertions; perhaps even he has already breathed oilyou the vitalizing influence of editorial encouragement.

. To the junior members of the profession, I say, in Mr.Wakley you have a veteran for your champion, who knowsthe difficulties of his position and the obstacles he has to over-come. Place implicit confidence in his generalship and inte-grity, and be contented to serve in his ranks; he will not leadyou to a defeat, but bring you off victorious, if you will butfight with him faithfully.To all of you, collectively, I say,-when you have had

professional differences, when you have been threatened withnew oppressions, when you have wanted an advocate, Mr.Wakley has ever been your impartial friend, the steady up-holder of your privileges, and your eloquent pleader.

I tell you, through him, your only representative in theHouse of Commons, you must make your 20,000 voices heard;through him alone will they reach the government in harmony.

If you speak thus, you will find listening ears, attentive minds,and willing- hearts, for your cause. To this end let the Editorof THE LANCET, when he brings in his Bill, carry with him apetition, containing our legion of names, with the cause we ad-vocate ; no other matter should be inserted.What petition, I ask, could possibly carry such weight as

this? It would be a permanent record, moreover, of theunanimity, perseverance, and determination of medical menin-1846. -

I have a firm conviction, if this were done, that our greatmedical reformer would soon be enabled to say that his labourhad not been in vain.

ASSOCIATED SURGEONS, FREEMASONS’ TAVERN.WEDNESDAY, MARCH 4.

AT a meeting of the committee; G. BOTTOMLEY, Esq., ofCroydon, in the chair,-the minutes of the former meetinghaving been read, the honorary secretary stated, that in com-pliance with the resolution passed at the last meeting, he hadwritten to the gentlemen named as delegates to the council.That a request was then made, through the president, for aninterview with the council, which was readily acceded to, andon the 30th of January the meeting took place, of which areport was given in THE LANCET of February 7th; that as yetno information had been given by the council as to the proba-bility of their agreeing to the suggestions contained in thatmemorial, but that there was reason to think the subject wasstill under discussion.The Secretary stated, that since the presentation of that

memorial, one numerously signed* had been forwarded to thecouncil from the surgeons of Bath, and that the surgeons ofGloucester had petitioned her Majesty to the same effect.The Treasurer reported that he had received the following

additional subscriptions to the funds of the Association, besidesseveral smaller sumps :

Resolved, That the best thanks of the Committee be pre-sented to the above gentlemen for their liberal subscriptions.The Secretary reported, that on applying to Mr. Churchill.

for the account due for advertisements inserted by the Associa-tion in THE LANCET, he had received a note, stating that theEditor had directed that no charge would be made for them.Moved by Mr. ABRAHAM, seconded by Mr. LEWIS, and re-

solved; That the best thanks of the Committee be presentedto Mr. WAKLEY for his liberality in giving insertion to the

several advertisements referred to free of expense.A discussion then ensued as to the propriety of passing aresolution condemnatory of the late exhibition at the College,in the course of which both the Orator and his Oration werefreely canvassed, and the Committee were unanimously ofopinion, that as a vote of censure had already been passed bythe Council on that indecent attack on the members of theCollege, and that as it is with the Council as a body that thisAssociation has alone anything to do, it would not be desirablethat any formal notice should be taken of the subject by thisCommittee.The question was then mooted, whether it would be desirable

that the Committee should take part in the endeavour toestablish a Faculty of Medicine, as proposed by some other ofthe Medical Associations; but it was generally felt that asthis Association had been instituted expressly for the purposeof endeavouring to obtain for the Members of the College ofSurgeons enfranchisement in that institution, the Committeewould not be justified in taking part in any attempt whichmight interfere with that object.The Committee separated at a late hour.

THE BRISTOL MEDICAL SCHOOL.To the Editor of THE LANCET.

SiR,-The points at issue between the Bristol MedicalSchool and myself are few, but they each require a straight-forward reply. The Committee " express surprise, &c. ;" Icontend, not only that I have a right, but that it is my duty, toprefer a charge upon the authority of my pupil. My pro-fessional brethren in this city look with very great interest to

* We will print this document in the next LANCET.—ED.