417

New Inventions.GAITER SUPPORT FOR FLATFOOT AND TALIPES

VALGUS.

THIS support is one which I have used occasionally forsome years in cases of flatfoot and talipes valgus. It consistsof a gaiter of black kid reaching from the tubercle of thetibia to the malleoli, and lacing in front. Running the entirelength of the inner side of the gaiter, and sewn into it, is asteel bar, from one-half to three-quarters of an inch inwidth. To the upper part of this bar a buckle is attached ;a piece of webbing passes round the ankle to the outer side,where one end is buttoned to the main band, and is continuedunder the hollow of the sole to the inner side, where a piece,of stout black elastic is attached to it, and to the other endof the elastic a black kid strap, which is then buckled at thetop of the gaiter. By this strap the elastic and webbing canbe drawn up to the required pitch and altered at will. The

advantages of this support are-(l) it can be fitted to anyleg, and will keep its place however thin the leg maybe; (2) the boots can be changed or slippers worn with-

FIG. 1. FIG. 2.

out interfering with it ; (3) it is neat, and on casualobservation looks like a high French boot ; and (4) insuitable cases it is very comfortable to the patient, the’elastic acting as an artificial calcaneo-scaphoid ligament.The cases in which it will, I think, be found specially usefulare those of flatfoot combined with a valgous condition,such as we find in delicate or rachitic children. It is alsouseful in some older patients, but in many the surgical soleanswers all requirements. Cases of valgus depending onspasm of the peronei I find do better with the inner part ofthe sole and heel of the boot raised, the above appliance andalso the surgical sole appearing in some cases to increase thespasm. The support has been made for me by Messrs. Ferrisand Co. of Bristol. W. J. PENNY, F.R.C.S. Eng.

C),itonW. J. PENNY, F.R.C.S. Eng.

NEW TRANSFUSION APPARATUS.THE apology for introducing this new transfusion

apparatus to the profession is that if ever transfusionis to become a widely used means of saving life(threatened by haemorrhage) and alleviating the super-reniBg distressing symptoms of certain toxic conditionsof the b’o?d—e.g., diabetes, urasmia, and certain poisons-the apparatus for its performance must be simple, compact,

and ready at hand. The many transfusion apparatus at presentknown to the profession, such as Professor Annandale’s andDr. Herbert Spencer’s, are in themselves most excellent, butthey are rarely ready at hand in an emergency, both onaccount of their size and complicated mechanism. A prac-titioner cannot be expected always to go about with a

Spencer’s transfusion apparatus, and should the necessityfor transfusion be indicated the patient is possibly deadbefore the apparatus can be obtained. The advantagesclaimed for this apparatus by Dr. L. J. G. Carré, who sug-gested it, are: 1, Its absolute simplicity. Transfusisn canbe quite readily performed absolutely single-handed. Heinforms us that he has done so in a case of excessive

collapse after severe post-partum haemorrhage. 2. Its

compactness. Everything that can possibly be required forthe safe and successful performance of the operation is

immediately at hand. 3. The small size of the complete case,so that it is possible that it may serve as one of the invariab!econtents of the practitioner’s midwifery bag or the surgeon’soperating bag. A transfusion apparatus is always requiredon an emergency, and generally when the practoti"^e° y« ’ "1-., 5prepared.. Im this apparatus he may always feel :’:’.1:; ,,13 ha3with him often the last resource which will enable him to savelife. Spencer’s transfusion bottle is essentially a hospitalapparatus this is an apparatus rather adapted for the usaof the private practitioner.The case, which measures 2-2L in. by 32 in. by 7 in., is lined

with a special leather, which will wash, so that the wholeapparatus can be kept aseptic. Comprised in the case are allthe instruments necessary for the performance of salineinfusion-a metal-handled scalpel, a combined director and

aneurysm needle, a pair of scissors, a pair of Spencer Wellsforceps, a pair of dressing forceps, and silk. The case alsocontains six small glass tubes, each holding a drachm ofpure chloride of sodium. In addition, there is a smallcelluloid funnel, attached to which is a piece of flexiblerubber tube, which does not kink or collapse, this, again,ending in a glass cannula bent at an angle of 30°, bulbousat one end, over which the rubber tube fits tightly,tapering at the other, so that a vein is easily entered.The cannulas are supplied in three sizes. The apparatus is avery neat one, and should find a place amongst the instrumentskept ready for emergencies in hospitals and in the midwiferybag of many practitioners. An advantage is undoubtedlypossessed by having all the instruments together ; themajority, however, are contained in every surgeon’s dressingcase, and greater call would probably be made for a smallbag containing the celluloid funnel and its tubes and thechloride of sodium. tubes. The apparatus is made by Messrs.C. Wright and Co., 108, New Bond-street, W.

418 FEVER AND SMALL-POX HOSPITALS.

THE LANCET.

LONDON: SATURDAY, FEBRUARY 16, 1895.

THE reissue of a memorandum 1 on isolation hospitals bythe medical officer of the Local Government Board acquiressome importance by reason of a greater amplification thanheretofore of the conditions under which sanitary authorities

may contemplate the erection of hospitals for the receptionof patients suffering from small-pox. Apart from this thememorandum has undergone but little change. Its wordinghas been made to meet the provisions of the legislation oflast session, the document being addressed to the new districtcouncils, and the extremely useful plans by which it is

illustrated have been slightly modified, but otherwise it is

essentially the same document as heretofore. The small-poxquestion, however, deserves attention.On the issue some thirteen years ago of Mr. PowER’s

well-known report on the diffusion of small-pox amongstthe population resident around one of the small-poxhospitals of the Metropolitan Asylums Board the questionof this diff asion was regarded as of such importance thata Royal Commission was appointed to inquire into the

whole subject. Amongst the conclusions at which that

Commission arrived we would recall the following : "That

by some means or other the Asylums’ hospitals, in their

present shape, cause an increase of small-pox in their

neighbourhoods appears to us clearly established..." and"It is evidently of paramount importance that the areasof small-pox wards, as well as their administration, shouldbe rigorously separated from those of fever hospitals, andfurther that their construction should be such as to reduce

within the smallest limits the chance of spreading infection."It is, however, impossible to read that report without being ’,

convinced that the Commission were, as a body, disinclined ’

to believe that the mischief done by small-pox hospitals wasproduced otherwise than by means of personal communica-tions between the hospitals and the outside world, and theirattitude in this direction endorsed the contention of a

number of the witnesses who had appeared before them,notably the representatives of the Metropolitan AsylumsBoard. The latter body, acting on the conclusion they hadmaintained in this matter, soon set themselves to work in the

determination to put an end to the spread of small-pox fromtheir institutions by remodelling their administration and bylaying down and enforcing regulations with a stringencyand at a cost that could hardly have been effected by a bodyless powerful and less wealthy in the financial and otherresources on which they could rely to carry out their

decisions. But, unfortunately, small-pox still went on

spreading around their hospitals as it had done before;and not only so, but the rate of incidence of the disease

on the surrounding communities was regulated as formerlyby the differing proximity of the inhabitants to the small-pox

1 On the Provision of Isolation Hospital Accommodation by Local Authorities, with plans. 1895. Eyre and Spottiswoode, East Harding-street, E.C.; John Menzies and Co., Edinburgh and Glasgow; Hodges,Figgis, and Co., Dublin. Price 1d.

hospitals. Taking the total results over a series of eightyears beginning in 1877, and including some half dozendifferent periods of small-pox prevalence in London, it wasfound that the percentage of houses round the Falham

Small-pox Hospital in which small-pox had appeared wasas follows : 30-1 within a quarter of a mile, 14-5 between a

quarter and a half mile, 9 5 between a half mile and three-

quarters, and 4 6 between three-quarters of a mile and onemile.

It was on the repetition of such results in the later por-tion of the period referred to that the Asylums Board

evidently found it necessary by a series of stages to dis-

continue the attempt to treat small-pox in London, and theestablishments down the Thames and near Dartford were

the ultimate results of the decisions arrived at. And this

change of procedure revealed in its results another piece of

experience bearing upon the influence of small-pox hospitals,not only as diffusing infection, but of ensuring an increasedfrequency of small-pox epidemics by reason of the frequencyof their operations in collecting together at one or morecentres the occasional cases of that disease. In this way there

came about a recurring concentration of the infection undercircumstances that must now be regarded as often tending tothe production of a poison having a special potency forspread. In fact, whereas during the sixteen years’ existencein London of the Asylums Board’s small-pox hospitals thedeath-rate for small-pox was extremely high and outburstswere frequent, it so happens that since those centres of

small- pox aggregation in the metropolis have been abandonedthe death-rate has been trivial in comparison with the

previous one.The experience of the last three years has tended strongly

to confirm the opinion that, whatever authorities may be

able to do, there are conditions under which small-poxhospitals become a distinct danger to surrounding com-

munities. Those who concur in this view not onlyincrease constantly in number, but they include the mainbulk of investigators of repute and acknowledged standing.Some, indeed, whilst apparently accepting the conclusion,have sought to show that the distance at which diffusion

of small-pox takes place is much more limited than manyhave supposed. Thus Dr. MATTHEWS of the Gore Farm

Hospital, reporting on a single year’s experience of a

fever hospital, together with an asylum and schools, all

of which lie about 1000 feet from a small-pox hospital,states that because no one to his knowledge con-

tracted small-pox in any of the institutions in questionI there seems ...... sufficient evidence from this experieneefor assuming that the diffusion of small-pox throughthe air does not extend to a distance of 1000 feet."

Not a word is said as to the condition of the school inmates

as regards vaccination or as to the proportion of conva-lescents to total small-pox cases. The experience, even

if vaccination and convalescence be ignored, is a solitaryone, limited to a comparatively brief period ; and it is

negative. As such it will carry conviction to very few

minds. It is also quite clear that any such view does

not weigh with the authorities at Whitehall; for after

a long period, in which evidence had been accumu-

lating on the subject, they now lay down the followingrules, which, though put in the form of advice, wi1