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Petition on Poor-Law Medical ReliefSource: Provincial Medical and Surgical Journal (1840-1842), Vol. 3, No. 19 (Feb. 5, 1842), pp.381-382Published by: BMJStable URL: http://www.jstor.org/stable/25490927 .

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OPERATION BY MR. FERGUSSON.-POOR-LAW MEDICAL RELIEF. 381

has a healthy smootil appearance, without seam or puckering of any kind; and, as he was able to move the joinit freely, and walk about the garden with tolerable case, he was discharged from the hospital, and made an out-patient.

He called a short tiine after-wards and told me that hie walked with perfect freedom, and had had no re turn of ulceration of the cicatrix, as is sometimes found to be the case after injuries of this kind.

In recording the treatment adopted in the foregoing case, I do not wish to take any credit to myself for employing a remedy with the virtues of which, in suich cases, suirgeons have been long acquainted. Mr. Greenhow, of Newcastle, first introduced it into practice, iisinig it as a defensative, for the purpose of preventing the access of air to the denuded parts. He did not, I believe, continue to use it throuighout the whole progress of the case, but substituited for it other applications which the circumstances of the case might afterwards seem to require. In the com

mencement of thte precedin, case I used it, mixed witlh flour, for the saame purposo of excluding air, but, tindinig it occasioned pain, and that I could Inot properly see what was going on underneath, althougl it had seemed to promote the growth of granulation, I de termined to uise equal parts of treacle and water, on rags, constantly applied as a lotion to the injured sur face. 'l'he application of treacle in this manner has convinced me by the result of this, and other cases similarly treated, tlhat it has some specific effect in expediting the cicatrisation of burns and scalds, how ever extensive they may be, and that it prevents, in a great degree, the unsightly puckering and contraction which too often interfere with the proper actions of joints involved in these accidents. I have, since that time, had several opportunities of testing its valuie as a remedy in these cases; and have, from what I have seen of its effects, adopted it in every case of the kind which lhas comne under my care, both in hospital and private practice ; and in each case it has seemed to have been instrumnental in preventing, or at least diminislhing, the chanices of consecuitive contraction.

KING'S COLLEGE HOSPITAL. EXCISION OF THE SUPERIOR MfAXILLARY BONE.

On Wednesday last Mr. Fergusson excised the superior maxillary bone, before a numerous collection of students, and members of the profession, from different parts of the metropolis. We had the ad vantage of being present duiring the performance of this difficult operation, and cannot avoid expressing our admiration of the coolness and dexterity which

Mr. Fergusson displayed on this occasion. The patient was a child about 12 years old, affected with a tumour of the superior maxillary bone; the tumour had grown very slowly, and presented several characters, which induced Mr. Fergusson to believe that it was not of a

malignant nature. The result of the operation proved the correctness of Mr. Fergusson's diagnosis. The

morbid growth was composed of bone, and fibro cartilage: the whlole of the diseased parts were re

moved, and we sincerely trust that the ultimate result of the operation, which cannot fail to increase

Mr. Fergusson's reputatioli in a remarkable degree, will be favourable.

POOR-LAW MEDICAL RELIEF. We have beenl favouired by the President of the

Royal College of Surgeons with the following com

munication on the subject of poor-law medical relief

Although we cannot agree with Mr. Guthrie in expect.

ing any considerable ameliorations from the poor-lwn

commissioners, we cannlot blut return our thanks, or

the part of the medical profession, to Mr. Guithrie, foi

the praiseworthy exertions, which we have reason tc

know he lias recently made on the behalf of union

surgeons: "4, Berkeley-street,

Feb. 1, 1842. My dear Sir,-I am glad to have it in my power to

inforn you, that I hate again conferred with the poor law commissioners, on the subject of the variouis grievances of which the surgeons employed under the poor-laws complain; and they have been pleased to

make such alterations in their regulations about to be iss'ued as -will redress nearly all of them; and I have a confidert hope that, in the course of a reasonable time, thie whole will be removed.

From the various communications I have lhad at differenit times with the poor-law commissioners, anid

particularly with Mr. G. C. Lewis, I am convinced that the members of the medical profession have firm friends in them, and I rely as mucil oni their kiindly feelings as on the justice of the claims which may be placed before them.

A carefuil inquiry has satisfied me that the total sum p)aid by the different boards of guardians, to all the practitioners in England and Wales in clharge of the' poor, is not half what it ought to be, accordinig to any of the computations or calculations wlhiclh have been made, either by doctors or assistant poor-law commissioners, on the suibject; and if the guardians of the poor will not consenit to give a reasonable remuneration to a medical man for his attendance on the poor, the public must not expect them to be fairly or honestly taken care of.

I beg you will have the goodness to communicate the contents of this note to the gentlemei wlho favoured thle vice-presidents, and myself, with their comnpany at tlle college; and that you will believe Ine to be, most truly yours,

G. J. GUTHRIE, President, R.C.S. T. Howell, Esq., Clapton."

P'ETITION ON POOR-LAW MEDICAL

RELIEF. The following for-m of petition oni the suibject- of

poor-law medica! relief has been adopted by the

Worcester Council of the Provincial Association. As

the season for active exertion in this important matter

is rapidly approaching, we would earnestly entreat

the local councils of the Association to prepare

petitions of a similar nature for presentation to

Parliament. A well sustained effort at the present moment

cannot fail to produce beneficial resuilts:

That the bill, which your petitioners expect will speedily come under the consideratioii of Parliament, for the further amenidment of the laws relating to the relief of the poor, will afford an opportuniity for in provinig the present imperfect and iunsatisfactory pro vision of medical relief.

That in the year 1838, a committee of your Honour able House examined several medical practitioniers,

who were unanimous in suggesting certain amend ments of the present system, several of which were approved of and recommended by that committee, and have since been agreed to, although not adopted by the poor-law commissioners.

Your petitioners therefore humbly pray that pro visions to secure the general adoption of these inea sures may be introduced into the said bill; and, in particular:

First,--That a medical director may be appointed to superintend all matters relating to the

medical relief of the poor, to which depart. ment his wvhole time and attention may be devoted.

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.382 PROPAGATION OF GLANDERS 13Y INFECtION.-SCRIVENERS' SPASM.

Secondly,-That the disgraceful and injurious system of appointing union medical officers, by tender, may be abolished; and that a rate of remuncration, calculated to secure an adequate supply of medicines and medical attendance to the sick poor, may be ensured to those officers by the enactment of maxi

mutm and minimum limits to such remunera tioIn, thus protecting on the one lhand the rate payers, and on the other the medical profession; thus also allowing the board of guardians of each union to determine the precise amount of payment within the pre scribed limits, according to the custom and peculiar circumstances of the respective localities, and stubject to the final decision of the medical director, in case of dispute.

Thirdly,-That certain limits, to the extent and population of medical districts, may be de fined; and that an increase of remuneration, in proportion to the distance of each parish from its medical officers, may be determined, so that the guardianis may be induced to place the poor inl charge of the nearest duly qualified practitioner.

And Fourthly,-That no future practitioner may be eligible to the appointment of medical officer, unless he shall have proved his com petency to practise by passing examinations in medicine, surgery, and midwifery, and unless he slhall have been in actual practice, as principal or assistant, for two years.

By the enactment of the above provisions, your Honourable House would humanely confer a most essential benefit on more than a million poor, annually suiffering from sickness combined with destitution,

would afford importanit protection to the public in gene ral, and wouild granit encouragement to the members of a useful profession in the performance of the most labo rious and arduous department of their duties.

And your petitioners will ever pray.

PROPAGATION OF GLANDERS BY INFECTION.

A writer in a late number of the " Sporting Maga zine" relates the followinig anecdote, whichi tends to

prove that glanders may sometimes be propagated by infection. This idea has not, we believe, been enter tained by M. Rayer, or other writers on glanders, although the possibility of snlch infection is alluded to by Professor Williams, of Uniiversity College, in some observations which lie recently published on a case of glanders.

" In reference to a conversation which I lhad with him when last in Ireland on the qieestio vexata of the propagation of glanders by infection, lie observes: ' Mr. Cooper, of the county of Sligo, a gentleman of large fortune, is the person who had his horses infected

with glanders. Every particle of wood-work in the stables, including stalls, rack, manger, &c., was taken down or replaced with new materials. The plastering on the walls was completely removed, and the pave

menit ripped up, and all was replaced with entirely new work; but the first horses that were again put into those stables became infected, and the stables were ultimately razed to the grouniid ! Indeed so pievalenlt is the idea of the infectious nature of glanders in this part of Ireland, that I never knew of any gentleman wlho was so unfortunate as to have his horses glandered that did not either destroy his stables, or convert them into some other purpose, and get new ones built. The opinion here entertained respecting this disease and its ally, farcy, is, that after they are once developed in a slhed or stable the infection re

mains for years.' The writer of the foregoing is a private gentleman;

and, in a practical point of view, his views on glanders

are, in my opinion, well worthy attention. I have frequently seenI his houise besieged with the sick horses of the neighbouring gentry and peasantry, with their grooms or owners, eagerly seeking his opinion and advice as to the nature and best method of treating the disease, whatever it might be. If great experience, combined with natural sagacity and quickness of per ception, in the hygiene of horses entitle their possessor to attention, then the opinions above written merit our best considertion."

SCRIVENERS' SPASM, CURED BY DIVISION OF MUSCLES.

By PROFESSOR STROMEYER.

The disease which may be familiarly called Scri veners' spasm, and consists in pernmanent contraction of the long flexor of the thumb, is not very rare. Several cases have been published in Germany by Albers, Heyfelder, and Kopp; and in France by Cazenave and David. The chief characteristic of this affection is an absolute incapability of using the pen, for wvriting, although the strength and motions of the hand remain u-nimpaired for all other purposes. Some authors regard it as a species of spasm; others, as depending on paralysis; it is generally permanent, but occasionially appears at intervals, and then is com monly brought on by long continiued use of the pen. This affection, tlhouigh apparently slight, is most obsti nate, and resists every method of treatment that hias hitlierto been employed against it. The following cases, which we abridge considerably, had baffled the skill of Professor Stromeyer, until lie had recourse to division of the flexor muscle, which was attended

with complete success.

CASE I.-J. M., a public writer at Hanover, Ia boured under this disease during two years. A cele.. brated physician had tried every kind of remedy with out avail. Whenever lie began to write, the muscles of the ball of the tlluimb were seized with spasm, which compelled him to desist, but the spasms did not appear at any other time. M. Stromeyer also tried a va riety of means ineffectually, and then divided the small flexor muscles of the thumb. This likewise faiied, and the sensibility of the palmar surface of the thumb was destroyed. It was now clear that the action of writing depended on the long flexor, but the patienit refused to permit any more operations to be performed on him.

CASE II.-The subject of this case had suffered under the disease for fifteen years, when first seen by Al. Stromeyer. The rigidity of the muscles of the ball of the thumb was not, however, present, but the last phalanx of the thumb became suddenly flexed, when ever thepatient attempted to write orplay on the piano.

The long flexor was not permanently contracted, nor did it impede any otlher motions of the land. From the deep situationi of the muscle it was not easy to divide it separately. M. Stromeyer bent the first

plhalanx strongly to a right angle, and at the same time turned the thumb as niuch out as possible ; he then passed a very small, curved tenotome underneath the tenidon, and divide(d it. The sensibility of the tlhumlb was very considerably diminiished after the

operation, but was restored, on the dorsal aspect the next day, and on the palmar aspect within a fortnight. The natuiral power of moving the thumb, also, re turned at the latter period, and the patient was able to write or play on the piano without the slightest re turn of the spasm.-Arch. Gen. de. Med. Jan., 1842.

Printed by SAMURL TAYLOR, of ti, Chandos-street, in the P'arislh of 8t. P'aul's, Covent-garden, at his Office, No. 6, Chan(los-street, aforesaid; and published by JOHN CHURCHILL, at his residence, No. 16, Princes-street, in the Plarish of St. Anie, pWestmitnster.-Friday, February 5, 1UV2.

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