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ST. THOMAS’S HOSPITAL.

WHETHER or no St. Thomas’s Hospital is to be blotted outof the list of metropolitan charities, is a question still in sus-

pense. A special general Court of Governors was held onTuesday last. About forty governors only were present.Some, it is said, failed to attend through a misconception as tothe place of meeting. A resolution was proposed by Mr. TITE,and seconded by Mr. J. 0. JoHNSON, the object of which was to refer the absolute power of choosing a site to the Grand liCommittee. An amendment was moved by Mr. DeputyELLIOTT, seconded by Mr. ADAMS, and ably supported byAlderman PHILLIPS, Mr. R. A. GRAY, and Mr. BEDFORDPHILLIPS. The amendment recommended that no action forthe acquisition of a new site should be taken until the eligi-bility of that of the temporary hospital had been further tested.A course more fair or more expedient could not be suggested.To set it aside is simply to confess that the question is pre-judged, and that the prejudice in favour of rearing a magnifi-cent building in the midst of thirty or forty acres of ground,seven or eight miles away from where an hospital is

wanted, is to be gratified, in spite of reason, experience,and the wants and rights of the labouring poor. It was set

aside, nevertheless, by a majority of 21 to 16. That is, theGrand Committee reserve to themselves the power of choosinga site before they decide, or, at least, before they are permittedto carry out the gross injustice of depriving the poor of South-wark and of the City, of their inheritance. It is right thatthose who have a more enlightened appreciation of the meritsof the case should bestir themselves. If necessary, an injunc-tion might be applied for in Chancery on behalf of the inha-bitants of South wark, to restrain further action until the

meeting of Parliament. And, in the meantime, the vestriesand other local authorities, the inhabitants generally, and theirParliamentary represf ntatives, should actively exert themselves.Experience bears the most satisfactory evidence in favour of thepresent site. The number of out-patients is actually largerthan it was at London Bridge, although four days only, insteadof six, are open for their admission.

PORTRAIT OF SIR BENJAMIN BRODIE.

WE have much pleasure in presenting our readers with s

portrait of Sir BENJAMIN BRODIE, which has been carefully executed from the latest photograph taken of him.The biography published in our last number would be felt t(

be incomplete without this representation of the thoughtfulineaments of the great surgeon.

THE

GREAT INTERNATIONAL EXHIBITION.

XVII.

REPORT ON SURGICAL INSTRUMENTS.

THE collection of artificial legs, arms, hands, eyes, and othersubstitutes for deficient parts, removed by surgical, accidental,or natural processes, is well worthy of the attentive study ofsurgeons, and shows a very marked advancement both in

novelty of design and constructive merit since the last Exhi-bition. There are not less than fifty artificial limbs exhibitedin the British and foreign surgical sections; and although some,of the latter especially, are extremely crude in their principlesof construction and clumsy in their execution, yet they areinteresting as affording standards of comparison, and showing

the relative merit and ingenuity of the various nations in thisbranch of surgical mechanism.

In the British department the two old-established houses ofBigg and Grossmith, which have been highly reputed for up-wards of a century, show collections of useful and well-devisedlimbs. Mr. Masters has a display of uncommon originality andmerit, whether novelty and excellence of design or perfectionof workmanship be considered. Many other exhibitors haveexamples of artificial limbs more or less noteworthy; but assome of these exhibit limbs not of their own manufacture, andothers do not challenge our admiration, we do not proposespecially to notice them here. ln the French section, MM.Charricre, Bechard, and Mathieu are the principal exhibitors,and also introduce some novelties.

Mr. Bigg exhibitsseveral well-executedmodels of limbs, withenameled exteriors,and of good form; andhe has recently intro.daced a new methodof making the ankle-

joints, givinga. lateralrotative motion bymeans of a ball andsocket, invented andpatented by Dr. Bly,of Rochester, U.S.We are inclined to

doubt whether a la-teral motion is desi-rable, since it must,we think, tend moreor less to make thefoot unsteady to thebearing. Mr. Biggthinks differently,and contends that

greater security is ob-tained by the foot

being made to adjustits level to the surfaceof the ground whilethe wearer gives hisbody either a forwardor lateral movement. (Fig. 57.)

Mr. Grossmith introduces a

novel principle of spring actionto the limbs for thigh amputa-tions. (See Fig. 58.) A rod pass-ing through the calf of the leg,fitted on each side with spiralsprings, connects the action ofthe knee and ankle joints. The

bending of the knee exerts a pres-sure on the ankle tenon, throwingthe foot forward, and loweringthe toe to the proper level for

taking the step. A slot and boltat the lower part of the bar pre-vents the toe from being throwntoo much downwards, and thewithdrawal of the pressure as

the leg straightens raises it suffi-

ciently to clear the ground. Thetendon bands are only used tothrow back the action at a cer-tain point. The flexion of the

leg in the sitting position (orwhen kneeling) brings the action-bar immediately under the axisof the knee-joint, and the limb

remains motionless until the:

wearer rises, when it imme-L diately resumes its power of

action. (Fig. 09.)Mr. Grossmith has with con-

siderable ingenuity applied this

principle to the limbs intended’ for amputations below the knee’ in cases where the joint has be-; come contracted and stiffened,

490

and the patient is obliged to kneel on the limb. It gives fullpower of flexion to the knee in walking, as in the natural limb;and renders it unnecessary to use the stop bolt hitherto em-ployed to fasten the joint. (Fig. 60.)

Other recent improvements by Mr. Grossmith in the manu-facturing depaitments have the object of obtaining waterproof

which is worthy of notice. The flexible toe dispenses with thewooden joint and steel bolt, which makes the foot much lighter,and also causes the boot to wrinkle, so as to correspond with theother, which the wooden toe-piece will not do. The weight ofthis is only 2 lb. 7 oz. Notwithstanding its lightness, it is

capable of bearing the weight of an adult man, and has beenput to the severest test before the jury.

No. 2 represents a leg for amputation below the knee,with Masters’ patent perfurated concave binge. The advantageof this hinge will be found by everyone wearing an artificialleg for amputation below the knee. Firstly, it is, we believe,lighter and stronger than any other hinge hitherto made ;secondly, its concavity gives room for the condyles of the knee,and consequently it lies much closer to the leg ; thirdly, by aningenious arrangement of the bolt, there are not less than nineinches by one-sixteenth of an inch surface for the hinge to workupon, thus rendering it next to an impossibility for the hinge towear out by friction, which is constantly the case in all othershitherto made. Every surgeon having a patient wearing a legfor amputation below the knee should see this hinge.An artificial foot for amputation at the ankle, with the bear-

ing taken on the thigh, is represented by No. 3. The objectattained in this case by carrying the bearing on to the thigh,is that the tendon can be inserted (as in No. 2), thereby ob.taining the vertical action in the foot, without which no onecan walk well on it for any distance ; and when the weight,which is only three pounds, is taken into consideration, the ad-

. and noiseless action for the joints of the limbs, and also moreaccurate methods of fitting the stump and of attaching thelimb to the body. He states that the ititeiior mechanism is ofsuch simple corstruction that the limbs can be taken to piecesby the patient and adjusted at pleasure. These are all objectsof great solicitude to the wearers of artificial limbs, and thecollection of Mr. Grossmith is in every way worGhy of com-mendation.

Mr. Masters’ case deserves the most careful study of the sur-geon. It is the only one in which we find a complete series ofartificial limbs, and the pieces exhibited are not only remai-k-able for The most exquisite finish, but are replete with evidencesof great ingenuity and original thought. It is in every respectthe most remarkable collection of artificial limbs in the Exhibi-tion.

LNo. 1 (Fig. 61) represents a leg for amputation above the knee,constructed on the old "tendon" principle of Pott, vtithtwoimprovements by Mr. Masters—viz., the knee spring and theflexible toe. The knee spring is so constructed as to allow thelower leg to recoil (when force is given) to the natural angle,and no more. Another advantage in this spring is, that insitting down it loses a11 power on the knee-joint, thus avoidingthe possibility of the leg spninging out and doing mischief toany one that might be netr. Some makers have contended thata spring in the knee is not necessary ; others have maintainedthat a strong spring is necessary. Now, a leg which has nospring in the knee will recoil too much when power is applied,and there being no spring to assist its reaction, it will be ob-vious to everyone that the wearer’s progress must be very slow.On the other hand, if the spring is too strong, great power is re-quired to flex the knee at all, such as wonld speedily exhaustthe wearer ; and without the knee be flexed, he could notraise the foot clear from the ground ; hence the necessity ofhaving a spring in the knee, and of the proper strength.

.

The second improvement by Mr. Masters is the flexible toe,

vantage of carrying the bearing on the thigh in preference tothe condyles of the knee, seems considerable.

No. 4 represents an artificial foot for a short leg, and is’certainly a very ingenious and completely arranged instrument.The advantage of this artificial foot over others hitherto madeis, that the artificial ankle-joint being made to correspondwith the other, a resting-place is made to receive the naturalfoot ; and the ankle joint being anchylosed, all leverage is re-moved from the leg, thus enabling the patient to walk withease, and without limping.An arm for amputation above the elbow is represented by

No. 5, and contains three improvements by Mr. Masters :

firstly, by means of the jointed-spring wrist-plate, the springot which is always flush with the outline of the arm, thehand can be detached, and any instrument inserted v.ith thegreatest ease; secondly, the elbow-joint is lighter, and givesto the arm a much more symmetrical shape than the old ball-and-socket joint ; and, thirdly, there is attached to the elbow-joint an extremely ingenious stop-work, by which the wearercan look the elbow-joint at any angle at will, which is of greatadvantage in using instruments. The stop-work can also bethrown off with ease, even with the coat on. The weight ofthis arm is a pound and an ounce.

No. G represents an arm for amputation below the elbow,with a sempstress’s instrument attached, invented by Mr.Masters. This instrument is a very ingenious piece of me-

chanism, and will be exceedingly useful for females who have

491

unfortunately lost a hand, as by it a large amount of needle-work can be done. The instrument represents three fingers,as will be seen by the illustration ; the uppermost one is keptdown by a spring sufficiently strong to hold the fabric be-tween the two lower fingers, and at the end of the uppermostfinger is a lever, to which is attached a band passing round theupper arm, and by slightly extending the elbow-joint the springis depressed, and the fabric readily shifted as though the handwere not lost.The artificial legs exhibited in the French department are

very differently constructed to those in the British section. TheParisians usually form the whole framework of the limb insteel, and mould the sockets for the stump and the exteriorshaping in leather. Some advantage is gained by the use of aleather socket, as it can be made to lace, and so expanded ordiminished to suit the variations which often take place in thesize and form of the stump. It is not, however, nearly sodurable or so light in weight as the beautiful close-grainedwillow wood used by the London makers, either for the socketsor the shaping, and we certainly give a decided preference tothe English materials. In M. Charrière’s case there is a. goodstop-jomt leg for contracted knee stump, the bolt falling and Ifastening the joint straight on the patient rising from his seat. Surgeons having patients whose stumps have b - come contractedby the long use of the common kneeling pin-leg or from othercauses, will do well to examine this limb, comparing it withthe one with knee-action in Mr. Grossmith’s case to which wehave before alluded.For calf amputations MM. Charriere, Becha,rd, Mathieu, and

Lebellequie, all exhibit limbs similarly constructed in steel andleather, and of excellent workmanship, the only portion formedin wood being the foot, the joints of which are covered with ashaped silver plate, to form the instep. We have not observedany new modifications in these, except in the throwing backthe centres of the steel knee-joints to a considerable distancebehind the line of bearing in the thigh socket (particularly inthe one shown by M. Mathieu), for the purpose, we presume, ofobtaining a firmer support to the thigh.Of the artificial arms and hands exhibited in the French de-

partment, the apparatus made for M. Roger, the popular tenorof the Opera Comique, appears to be the only novelty, MM.Charrire, Mathieu, and Bechard each showing a specimen, andall asserting their proprietary rights in the matters of originalityand construction. M. Mathieu shows a letter written by thegreat tenor himself, but he does not say whether written bythe artificial hand. We think the merits of the apparatus arescarcely worth the contention. A joint in the centre of theforearm, fitted with complicated springs and mechanism, enablesthe wearer to turn the hand and point the finger, the actionbeing obtained by means of gut strings passing across the bodyto the opposite shoulder. There is no practical benefit gainedby its use ; it is worthy of inspection only from its ingenuityand the interest M. Roger’s name gives to it.From Italy, Christiana, and the Netherlands some collections

of artificial limbs have been sent to the Exhibition of mostpristine conception and execution. We trust that, for thecomfort of the maimed inhabitants of those countries, the exhi -bitors of these specimens have visited the Exhibition and ob-tained a few ideas for their future guidance in construction andmanufacture. We should think that one of the artificial lesexhibited in the case of Messrs. Schweink Brothers, of Arnheim,in the Netherlands, would weigh more than half a dozen ofthose we have described of English make. We regret, how-ever, that M. Nyrop, of Copenhagen, has not exhibited a betterdisplay of these appliances; for, judging by the admirablelithographic designs in a work which he has forwarded to us,he is capable of making some really good and ingenious limbs,which we should like to have seen-not in the flesh, but in thewood.

Correspondence.

THE NEW BRITISH PHARMACOPŒIA.

" Audi alteram partem."

To the Eclitor of ThE LANCET.

SIR,-I find that preparations are now beit:g made accordingto the formu]ae of the new British Pharmacopoeia, and supplied,by some who have the means of acquiring the necessary infor-mation. I have had one preparation ordered of the " Pharm.

Britt. ;" the name of the establishment where it could be ob-tained being stated, I sent and obtained it on payment of amonopolist charge.

I can scarcely imagine that in an undertaking of suchnational importance as the compilation of a new Pharmacopoeia,the personal interest of one or a few can have any prior claimto what concerns the whole body of chemists, even though theyhave been permitted to have a voice in the matter. Surelysuch proceedings are not sanctioned by the College of Physicians.Can you kindly inform me who is the proper person to apply

to for any of the formulas, if they are permitted to be usedbefore the publication of the work, and in case they shouldcontinue to be prescribed ?

I am, Sir, your obedient servant,EdgwMe-road. Oct. 27th, 1862. CHARLES M. BLADES.

THERAPEUTICS OF CONSUMPTION.

B. MALLAM.

, To the Editor of THE LANCET.

I . SIR.,-In Dr. Cottun’s paper on the above subject, reportedin THE LANCET of last week, he states that of all the remediestried in patients suffering from phthisis pulmonalis, he foundthe tincture of sesquichioride of iron the most efficacious. Forthe last eight yeats I have beeti in the habit of prescribing formy patients suffering from phthisis pulmonalis a combinationof the tincture of sesquichloride of iron, chlorate of potash, andtincture of opium-a dose three times a day; and cod-liver oiltwice a day, in a little rum. This treatment has been un-usually successful, more especially as I have had in some in-stances to contend with close rooms and inferior diet for thepatients. I believe that the sesquichloride of iron gives a toneand braces up the relaxed tissues. It also greatly diminishesthe nightly perspirations. The chlorate of potash seems togive oxygen to the blood, relieving the diseased lungs fromincreased exertion ; and the tincture of opium allays the irri-

tability of the mucous membranes. The cod-liver oil with the

foregoing medicine is able to be taken for a longer time, andseems to me to be productive of much benefit.

I think the observation of Dr. Cotton, " that phthisis, likeall other diseases, varies much in its several characters, andrequires modifications of treatment to suit each particular case,"will be confinred by all medical practitioners who have hadmuch practical experience in the treatment of this sad disease.L hope, however, that the time is not far distant when thelabours of practical men, like Dr. Cotton, will be rewarded byfinding out plan of treatment which, if followed, will curephthisis, and ease many an aching heart.

1 am, Sir, yours obediently,Loraine-place, Upper Holloway, Oct. 1862. B. MALLAM.

INFANTICIDE.

THOMAS WALL, Sec.

To the Editor of THE LANCET.

SIR,-I have, by order of the committee, to transmit to youa copy of a petition to Parliament, in relation to the crime ofinfanticide, and to solicit your kind attention thereto.Any further information required I shall be happy to

afford.I am, Sir, your obedient servant,

THOMAS WALL, Sec.Association for the Preservation of Infant Life,

THOMAS WALL, Sec.

office, 188, Strand, Oct. 29th, 1862.

To the Honourable the Commons of Great Britain and Irelandin Parliament assembled.

The petition of the undersigned most respectfullysheweth.-

That your petitioners view with much anxiety the pre-valence and vast increase of the destruction of infant life.That your petitioners believe the present state of the law

regarding bastardy is most unsatisfactory, and requires amend.ment.That the provisions of the statute 7 and 8 Viet. chap. 101,

which throw the whole burden upon the mother, and pro-hibit inquiry by parochial authorities, are the means of inflict-ing great hardship upon the female, and have led to the in-crease of infanticide.Your petitioners therefore pray your Honourable House to

take steps for the repeal of the said Act and 8 Viet. chap. 101,and for a full inquiry into the laws as regards illegitimacy, soas to place them on a more equitahle basis as regards bothparents ; and your petitioners further pray for a strict inves-