+ All Categories
Home > Documents > KING'S COLLEGE HOSPITAL

KING'S COLLEGE HOSPITAL

Date post: 01-Jan-2017
Category:
Upload: vuongque
View: 214 times
Download: 0 times
Share this document with a friend
2
27 ’behalf of their constituents, in support of the same." Carried unanimously. E. J. NEWCOMBE, Esq., moved-’’ That the thanks of this meeting are especially due to the Editors of the Times,’ THE LANCET, and the Medical Gazette,’ for their powerful support of the best interests of the profession." T. W. BENFIELD, Esq., seconded the motion. Carried unanimously. THOMAS TAYLOR, Esq., proposed, and JAMES COLE, Esq., seconded, the seventh resolution-" That the report of this meet- ing be sent to the Editors of THE LANCET, the Times,’ the Ten Towns’ Messenger,’ the ’ Provincial Medical and Surgical Journal,’ and the Medical Gazette,’ and that they be requested to publish the same." Carried unanimously. Dr. RODEN then moved the following resolution:—" That the thanks of this meeting are due, and are hereby tendered, to the Editor of the Ten Towns’ Messenger,’ for the very able article, in defence of the medical profession, which lately appeared in its columns; and also to the Reporter, for his attendance on the present occasion." This resolution having been seconded by C. J. PHiLBRicK, Esq., was unanimously adopted. On the motion of THOMAS THURSFIELD, Esq., a committee was appointed, consisting of the Chairman and the members of the profession present, for the purpose of carrying the above resolu- tions into effect, and watching the progress of Sir James Graham’s bill, Dr. Roden being requested to accept the office of secretary. Thanks were then voted to the chairman for his courtesy in presiding, and efficient conduct in the chair; which having been suitably acknowledged by that gentleman, the meeting separated. NORWICH. MEETING OF THE MEDICAL PROFESSION, J. G. CROSSE, ESQ. IN THE CHAIR. AT a meeting of the members of the medical profession residing in Norwich and in the county of Norfolk, held on the 19th inst., the following resolutions were carried :- 1. That, being deeply impressed with the necessity of fresh legislation to reconcile the discrepancies of the medical profession and to create reciprocity of privileges and uniformity of education for each grade respectively throughout the United Kingdom, this meeting is thankful for the ample opportunity offered by the Right Hon. Sir James Graham, Bart., for discussing the bill introduced at the close of the late session of parliament. 2. That the registration clause of the said bill deserves the support of the profession; but, in order to be efficient, the regis- tering should not be voluntary, but be made requisite and essential for every one who is permitted to practise as a medical man, whilst the list of the duly registered should be annually pub- lished. 3. That it appears a further defect in the proposed bill, that it may leave undisturbed in their present practice and appointments some persons not now legally qualified. 4. That the Apothecaries’ Act of 1815 has been very instru- mental in advancing and regulating the most numerous portion of the medical profession in the parts of the kingdom to which its operations were limited, and more especially in the provinces; that its provisions have been ably carried out by the Court of Examiners of that society, who are entitled to the thanks of the community; and in so far as the said act has failed, such failure is attributable to its being a partial measure, and too feeble in its clauses for repressing the unlicensed and unqualified. 5. That to repeal the said Act, without substituting any general penal clause, in lieu of the one therein contained, against unqualified practitioners, is to be highly deprecated as eventually injurious to the public and unjust to the profession. 6. That some penal check upon the practice of the unqualified, by a summary process easy of application, is essential to the efficiency of every legislative measure, and its restriction to those unlawfully practising in public offices is wholly inadequate to protect the public; whilst, on the other hand, it seems an anomal- ous novelty in legislation to enact, that the unregistered shall not recover churges for practising in a way not forbidden by the law. 7. That the foregoing resolutions be published in the local papers, and a copy of them sent to each member of parliament for this city, the county of Norfolk and its boroughs ; and that a petition, based upon these resolutions, be prepared by the follow- ing committee-viz., Dr. Evans, Dr. Lynn, Dr. Wayte, J. G. Crosse, J. G. Johnson, C. Costerton, W. S. Ferrier, A. Dal- rymple, D. Dalrymple, B. H. Norgate, W. P. Nichols, P. Eade. And after receiving the signatures of those members of the profession who are willing to support its prayer, be presented to each house of parliament, and that the committee be requested to continue their services for the purpose of watching the interests of the profession in regard to this bill. THE MEDICAL PROFESSION IN SURREY. ON Thursday, the 22nd ult., the medical practitioners of the county of Surrey assembled at the Coffee-house at Epsom, for the purpose of taking into consideration Sir James Graham’s bill for the regulation of medical practice. After one or two other more formal resolutions, unanimously passed, one was proposed by Mr. W. Chaldecott, of Dorking, and seconded by Mr. J. Allen, of Epsom, acknowledging the obligations of the medical profes- sion to the Society of Apothecaries, and recommending immediate co-operation with this body, to aid, by all legal means, in arrest- ing the reneal of the act of 1815. HOSPITAL REPORTS. KING’S COLLEGE HOSPITAL. CASES OF HYDROCELE TREATED WITH IODINE INJECTION. ENCYSTED HYDROCELE OF THE SPERMATIC CORD. CASE 1.-James H-, aged fourteen, admitted under Mr. Fergusson, January 22nd, 1844. Always enjoyed good health, with the exception of having had for the last eight years a hydro- cele of the right tunica vaginalis. Twelve months ago the swell- ing had attained the size of a man’s fist, and the radical treatment for hydrocele was resorted to with apparent success. Some time after, however, a small swelling appeared in the upper part of the scrotum, which has gradually increased to its present size-that’ of a pullet’s egg. The tumour now lies in front of the pubes, in the site of the external abdominal ring, passing some way into the inguinal canal, and also down towards the testicle, which can be distinctly felt at the lower part of the scrotum. The swelling can be pressed slightly downwards or upwards; there is no indi- cation of hernia; no remarkable impulse on coughing; no altera- tion in size or position as the patient alters his attitude, but there is distinct fluctuation, and, when a candle is used, the tumour is seen to be transparent. Has been refused admission into her Majesty’s naval service in consequence of this affection, and is anxious for a cure. Jan. 23rd.-To-day, with a small trochar and canula, about two ounces of clear-coloured fluid was drawn off, and thereafter about a drachm of iodine fluid (one drachm of the tincture of iodine to three drachms of water) was thrown into the cavity, and allowed to remain. The canula was removed, and it was desired that the scrotum should be fomented with hot water in the event of great pain coming on. 24th.-Patient has not suffered much, although there is now considerable swelling in the whole scrotum. 27th.-Since last report the swelling has diminished almost entirely. In the site of the original disease there is a hard, firm mass, about the size of a filbert. Patient dismissed. CASE 2.-John B-, aged twenty-four, admitted under Mr. Fergusson, 13th March, 1844, a ship-carpenter and tee- totaller. Twelve years ago an inguinal hernia appeared on the right side, which, after the application of leeches, while the patient was in the horizontal position, returned spon- taneously. Subsequently it used often to come down, but was speedily reduced by a change of position. Four months ago, on one of these occasions, it could not be returned, although leeches, cold lotions, and ice, were had recourse to, and a swelling has remained in the canal and upper part of the scrotum ever since. At the bottom of the scrotum there is another swelling, about half the size of the first, soft, elastic, and transparent, which is seemingly quite distinct from the one above, and pre- sents all the usual characteristics of hydrocele. The upper swelling has a soft, doughy feel, and all attempts at pushing the protruded parts into the abdomen are abortive. Patient is about to proceed on a long voyage, and is anxious for something being done before he leaves, as he feels inconvenience from the size of the scrotum, produced by these two swellings. The lower part of the scrotum was punctured, and about three or four ounces of clear-coloured fluid was drawn off. No change was perceptible on the upper part of the swelling. About a drachm of the diluted tincture of iodine was passed into the cavity, and allowed to remain. Immediately after the operation, he experienced smart pain in the testicle, and some uneasiness in the abdomen. Both, however, subsided after the lapse of a couple of hours. March 16th.—Has not had any return of pain. The swelling is nearly the same size as before the operation, but is free from pain or tenderness. To remain in bed, and continue to support the part in a sling. 19th.-Swelling almost entirely gone. Testicle can be felt dis- tinctly of its natural size, and in a healthy condition. Patient dismissed, cured.
Transcript

27

’behalf of their constituents, in support of the same." Carriedunanimously.

E. J. NEWCOMBE, Esq., moved-’’ That the thanks of thismeeting are especially due to the Editors of the Times,’ THELANCET, and the Medical Gazette,’ for their powerful supportof the best interests of the profession." T. W. BENFIELD, Esq.,seconded the motion. Carried unanimously.THOMAS TAYLOR, Esq., proposed, and JAMES COLE, Esq.,

seconded, the seventh resolution-" That the report of this meet-ing be sent to the Editors of THE LANCET, the Times,’ the Ten Towns’ Messenger,’ the ’ Provincial Medical and SurgicalJournal,’ and the Medical Gazette,’ and that they be requestedto publish the same." Carried unanimously.

Dr. RODEN then moved the following resolution:—" That thethanks of this meeting are due, and are hereby tendered, to theEditor of the Ten Towns’ Messenger,’ for the very able article,in defence of the medical profession, which lately appeared in itscolumns; and also to the Reporter, for his attendance on thepresent occasion." This resolution having been seconded byC. J. PHiLBRicK, Esq., was unanimously adopted.On the motion of THOMAS THURSFIELD, Esq., a committee was

appointed, consisting of the Chairman and the members of theprofession present, for the purpose of carrying the above resolu-tions into effect, and watching the progress of Sir James Graham’sbill, Dr. Roden being requested to accept the office of secretary.

Thanks were then voted to the chairman for his courtesy inpresiding, and efficient conduct in the chair; which having beensuitably acknowledged by that gentleman, the meeting separated.

NORWICH.MEETING OF THE MEDICAL PROFESSION,

J. G. CROSSE, ESQ. IN THE CHAIR.

AT a meeting of the members of the medical profession residingin Norwich and in the county of Norfolk, held on the 19th inst.,the following resolutions were carried :-

1. That, being deeply impressed with the necessity of freshlegislation to reconcile the discrepancies of the medical professionand to create reciprocity of privileges and uniformity of educationfor each grade respectively throughout the United Kingdom,this meeting is thankful for the ample opportunity offered by theRight Hon. Sir James Graham, Bart., for discussing the billintroduced at the close of the late session of parliament.

2. That the registration clause of the said bill deserves thesupport of the profession; but, in order to be efficient, the regis-tering should not be voluntary, but be made requisite and essentialfor every one who is permitted to practise as a medical man,whilst the list of the duly registered should be annually pub-lished.

3. That it appears a further defect in the proposed bill, that itmay leave undisturbed in their present practice and appointmentssome persons not now legally qualified.

4. That the Apothecaries’ Act of 1815 has been very instru-mental in advancing and regulating the most numerous portionof the medical profession in the parts of the kingdom to whichits operations were limited, and more especially in the provinces;that its provisions have been ably carried out by the Court ofExaminers of that society, who are entitled to the thanks of thecommunity; and in so far as the said act has failed, such failureis attributable to its being a partial measure, and too feeble in itsclauses for repressing the unlicensed and unqualified.

5. That to repeal the said Act, without substituting anygeneral penal clause, in lieu of the one therein contained, againstunqualified practitioners, is to be highly deprecated as eventuallyinjurious to the public and unjust to the profession.

6. That some penal check upon the practice of the unqualified,by a summary process easy of application, is essential to theefficiency of every legislative measure, and its restriction to thoseunlawfully practising in public offices is wholly inadequate toprotect the public; whilst, on the other hand, it seems an anomal-ous novelty in legislation to enact, that the unregistered shallnot recover churges for practising in a way not forbidden by the law.

7. That the foregoing resolutions be published in the local

papers, and a copy of them sent to each member of parliamentfor this city, the county of Norfolk and its boroughs ; and that apetition, based upon these resolutions, be prepared by the follow-ing committee-viz., Dr. Evans, Dr. Lynn, Dr. Wayte, J. G.Crosse, J. G. Johnson, C. Costerton, W. S. Ferrier, A. Dal-rymple, D. Dalrymple, B. H. Norgate, W. P. Nichols, P. Eade.And after receiving the signatures of those members of the

profession who are willing to support its prayer, be presented toeach house of parliament, and that the committee be requestedto continue their services for the purpose of watching the interestsof the profession in regard to this bill.

THE MEDICAL PROFESSION IN SURREY.

ON Thursday, the 22nd ult., the medical practitioners of thecounty of Surrey assembled at the Coffee-house at Epsom, for thepurpose of taking into consideration Sir James Graham’s bill forthe regulation of medical practice. After one or two othermore formal resolutions, unanimously passed, one was proposedby Mr. W. Chaldecott, of Dorking, and seconded by Mr. J. Allen,of Epsom, acknowledging the obligations of the medical profes-sion to the Society of Apothecaries, and recommending immediateco-operation with this body, to aid, by all legal means, in arrest-ing the reneal of the act of 1815.

HOSPITAL REPORTS.

KING’S COLLEGE HOSPITAL.CASES OF HYDROCELE TREATED WITH IODINE INJECTION.

ENCYSTED HYDROCELE OF THE SPERMATIC CORD.

CASE 1.-James H-, aged fourteen, admitted under Mr.Fergusson, January 22nd, 1844. Always enjoyed good health,with the exception of having had for the last eight years a hydro-cele of the right tunica vaginalis. Twelve months ago the swell-ing had attained the size of a man’s fist, and the radical treatmentfor hydrocele was resorted to with apparent success. Some timeafter, however, a small swelling appeared in the upper part of thescrotum, which has gradually increased to its present size-that’of a pullet’s egg. The tumour now lies in front of the pubes, inthe site of the external abdominal ring, passing some way intothe inguinal canal, and also down towards the testicle, which canbe distinctly felt at the lower part of the scrotum. The swellingcan be pressed slightly downwards or upwards; there is no indi-cation of hernia; no remarkable impulse on coughing; no altera-tion in size or position as the patient alters his attitude, but there isdistinct fluctuation, and, when a candle is used, the tumour is seento be transparent. Has been refused admission into her Majesty’snaval service in consequence of this affection, and is anxious fora cure.

Jan. 23rd.-To-day, with a small trochar and canula, about twoounces of clear-coloured fluid was drawn off, and thereafterabout a drachm of iodine fluid (one drachm of the tincture ofiodine to three drachms of water) was thrown into the cavity, andallowed to remain. The canula was removed, and it was desiredthat the scrotum should be fomented with hot water in the eventof great pain coming on.

24th.-Patient has not suffered much, although there is nowconsiderable swelling in the whole scrotum.27th.-Since last report the swelling has diminished almost

entirely. In the site of the original disease there is a hard, firmmass, about the size of a filbert. Patient dismissed.CASE 2.-John B-, aged twenty-four, admitted under

Mr. Fergusson, 13th March, 1844, a ship-carpenter and tee-totaller. Twelve years ago an inguinal hernia appeared on

the right side, which, after the application of leeches, whilethe patient was in the horizontal position, returned spon-taneously. Subsequently it used often to come down, but wasspeedily reduced by a change of position. Four months ago,on one of these occasions, it could not be returned, althoughleeches, cold lotions, and ice, were had recourse to, and a swellinghas remained in the canal and upper part of the scrotum eversince. At the bottom of the scrotum there is another swelling,about half the size of the first, soft, elastic, and transparent,which is seemingly quite distinct from the one above, and pre-sents all the usual characteristics of hydrocele. The upperswelling has a soft, doughy feel, and all attempts at pushing theprotruded parts into the abdomen are abortive. Patient is aboutto proceed on a long voyage, and is anxious for something beingdone before he leaves, as he feels inconvenience from the size ofthe scrotum, produced by these two swellings. The lower partof the scrotum was punctured, and about three or four ounces ofclear-coloured fluid was drawn off. No change was perceptibleon the upper part of the swelling. About a drachm of thediluted tincture of iodine was passed into the cavity, and allowedto remain. Immediately after the operation, he experiencedsmart pain in the testicle, and some uneasiness in the abdomen.Both, however, subsided after the lapse of a couple of hours.March 16th.—Has not had any return of pain. The swelling is

nearly the same size as before the operation, but is free from painor tenderness. To remain in bed, and continue to support thepart in a sling.

19th.-Swelling almost entirely gone. Testicle can be felt dis-tinctly of its natural size, and in a healthy condition. Patientdismissed, cured.

28

CASE 3.-Edward H-, aged seventy-two, admitted under Mr.Fergusson, April 9th, 1844, a lawyer’s clerk, of temperate habits,and has always had good health. About three months ago, aftera trifling strain in lifting books, he first perceived an unusual en-largement of the scrotum, which was observable during the day,but disappeared in the course of the night. In about a fortnightit became stationary, and has remained so ever since, exceptingthat it is gradually increasing in bulk. The scrotum is now aboutthe size of the fist, and the skin is very tense. The swelling,which is on the right side, extends as high as the abdominal ring,and has all the ordinary indications of hydrocele.

April 11th.—The tumour was tapped, the fluid, amounting toeight ounces, was withdrawn, and two drachms of the iodinesolution, of the usual strength, were injected, and allowed toremain.

13th.—There is considerable effusion into the sac since yester-day. The skin is red and tender.

16th.—The latter symptoms ameliorated, but the effusion is asgreat as at last report.

18th.-Swelling much less, and now appears to depend asmuch upon enlargement of the testis as an effusion into the tunicavaginalis.20th.-Bulk of the scrotum much diminished. Ordered to be

strapped.22nd.-The straps have had a most favourable effect, and the

parts have almost assumed their natural condition. Patient to bedischarged.

Remarks.—In alluding to these cases, Mr. Fergusson statedthat they might be deemed fair examples of the efficacy of theradical method of treatment with iodine. The pupils had manyopportunities of witnessing the effects of this remedy, and he wasnow so satisfied of its utility, that he seldom followed any otherplan for radical cure of hydrocele than that which he had resortedto in these instances. In all of them the effects of the operationappeared to be remarkably mild, and the return of the parts to anatural condition seemed more speedy than after the use of port-wine injection. It might be a question whether, in these exam-ples, the cure was in reality complete, as the parties had beenseen so short a time after operation, but he had himself no doubton the subject, as, out of many instances, where he had pursued asimilar practice, he had never seen a patient return with the dis-ease again upon him.The cases were chiefly worthy of notice with reference to the

mode of treatment which had been adopted, but to the student,in particular, they presented features of interest otherwise. Thelast of them, (case 3) it would be observed, occurred in a personseventy-two years of age, a period of life at which it was seldomadvisable to perform any operation which could occasion a shock Ito the system. As a general practice, he should doubt the pro-priety of performing the radical cure on one so advanced in life, ’,and should advise the patient to be content with occasional tap-pings, but here was an instance where he had acted otherwise,having been induced to do so chiefly on account of the hale andcomparatively robust condition of the parts affected.

Case 1 was somewhat peculiar. He had termed it encystedhydrocele of the cord, under the impression that it was so. Ifsuch were the fact, it was, it would be observed, an instance ofthis form of disease-comparatively a rare one-occurring afterthe successful performance of the radical operation for effusioninto the tunica vaginalis. It had been suggested that possibly thecollection of fluid had taken place in the upper part of that cavitywhere adhesions had not been produced; but experience wentagainst this view; for if adhesions had been caused throughoutalmost the entire extent of the serous surfaces, the actions in anynon-adherent part were so altered, that the disease rarely, if ever,recurred. Besides, if this had been the state of matters here, inall probability the recent adhesions would have yielded in such amanner that the swelling would have increased in a downwarddirection, and occupied far less of the inguinal direction than itdid in reality.

Case 2 presented a variety, inasmuch as there was an irre-ducible hernia present as well as a hydrocele. The hernial sacwas, in his opinion, filled with omentum, which had become soaltered in shape and consistence, and possibly also adherent, as tobe irreducible. This was an instance when, under ordinary cir-cumstances, he should not have advised more than simple tapping,for the radical operation could not be decerned so free from dangeras in an ordinary case. The inflammation might extend from oneserous membrane to the other-both being so contiguous-andthe effects might be alarming. The patient, however, was aboutto proceed to parts of the world where, possibly, he might nothave the advantage of surgical advice, and even in the event ofhis being seen by some other surgeon, with the hydrocele per-haps much increased, there might be greater difficulties and

dangers under such circumstances than were apparent at present,He had accordingly used the injection, but not- without havingmade sure that there was no direct communication betweeen thetwo sacs. Fortunately there had been no extension of inflamma-tion, and the case might now be considered as simplified in cha-racter, there being only one disease instead of two, the remainingone being probably in that condition that it would never alter. Inthis instance, the patient had complained of considerable pain ill"the abdomen immediately after the operation, which, under thepeculiar circumstances, had caused him more anxiety than urcommon examples. Sometimes, however, persons did feel greatpain in the course of the spermatic cord, after injection, whichextended to the loins, and even to the whole abdomen; and doubt-less this was the case here, and not from any continuous action onthe peritoneal surface.The after-treatment consisted chiefly in keeping the patient in

bed for the first few days, on moderate diet; in fomenting thescrotum as the inflammation run to its height; and in keepingthe part suspended so that the scrotum and testicle should besomewhat above the level of the pubes. In one instance thescrotum had been strapped after the violence of the inflammation-had abated-a practice which Mr. Fergusson deemed of great ser-vice, and one which he should recommend in most examples ofthis mode of treatment.

NEWS OF THE WEEK.

The Court of Assistants of the Society of Apothecaries haveappointed Tuesday next, October 1st, at half-past two o’clock, toconfer with a deputation from " The Medical and Surgical Associa-tion of the borough of Marylebone." The following gentlemenform the deputation:-Messrs. Propert, Clayton, Dodd, Squibb,Ancell, Bird, Craddock, Vickers, Browne, and O’Connor.THE LATE Sin ASTLEY COOPER.—A statue has but now been

placed in St. Paul’s Cathedral to the memory of Sir AstleyCooper, the eminent surgeon. It was raised by a public sub-scription, confined to the profession of which he was so valued amember. The greater portion of the donors were pupils of the lateSir Astley Cooper, headed by Mr. Callaway and Mr. Travers.The statue, exclusive of the pedestal, is eight feet high, and thelikeness is considered good. It is by Mr. Baily, the royal acade-mician.REMOVAL OF KING’S-COLLEGE HOSPITAL. - Some months

since, the committee of management of this hospital, no doubtfinding that its present site was anything but an eligible one,made application to the Duchy of Lancaster for a site for a newhospital. The spot selected was the vacant space on the eastside of Wellington-street, close to Waterloo-bridge. This site theChancellor of the Duchy was willing to grant, but in consequenceof a memorial presented by the inhabitants of Lancaster-place, tothe effect that the houses in that place would be lessened verymuch in value if the hospital were built opposite, the Chancellorof the Duchy then peremptorily refused to grant the site. The

present position of the hospital is unfortunate, as it is surroundedby grave-yards and slaughter-houses.

The ensuing session at Guy’s Hospital (as will be observed inan advertisement for that school) is to commence on the 1st ofOctober. Last year it did not open until the 16th, the holidayshaving been taken before the work, so that no hiatus should occurat Christmas. This plan, sapiently suggested by the College ofSurgeons for adoption at all the schools, obviously did not workwell. Guy’s was the only school at which the proposal wasentertained; but it appears that one year’s trial was sufficient toprove both its injudiciousness and its inefficiency in promotingthe object it was intended to carry out.

Mr. Cartwright, jun. M.R.C.S.E., has been elected surgeon-dentist to the Royal Infirmary for Children.MEETING AT HERTFORD.-" A meeting of the members of the

medical profession practising in Hertford, was, on Wednesdayevening, held at the house of R. Shillitoe, Esq. in this town,for the purpose of petitioning parliament against the medicalreform bill, introduced by Sir James Graham. Nearly all the

’ medical men in the town attended, and they were unanimous inopposing the bill."-Hertford Reformer, Sept. 21, 1844.Our medical brethren in the towns of Ware and Hoddesdon

have signed the petition.

APOTHECARIES’ HALL, LONDON.NAMES of gentlemen who have obtained certificates of qualification to

practise as apothecaries, on Thursday, September 19, 1844:—Thomas ShawAshby-de-la-Zoueh; Benjamin Micklethwait, Sheffield ; James Reid;John Ross Diamond; James Adams Poole, Martock, Somerset; Hayes Kyd,Haresfield, Middlesex.


Recommended