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Annotations.

A HOSPITAL AND AMBULANCE MUSEUM.

"Ne quid nimis."

IN a recent letter to the Times Sir John Furleyproposed the establishment of a museum for thedisplay of ambulance and hospital material, with aview to the study and comparison of the variouspatterns of apparatus and equipment that are

brought forward from time to time, and the attain-ment of a standard as the result of such comparisonand of the criticism that would arise. This propo-sition was first made several years ago, when SirJohn Furley submitted to the late Lord Wantage ascheme for standardising the various patterns ofstretchers and other means of sick transport. Fromhis long and varied experience in the methods ofdealing with the removal and disposal of woundedmen in many campaigns, Sir John Furley has beenmuch impressed by the suffering that resultsfrom the transfer of the man from one stretcherto another, such transfer being rendered necessarybecause of the variation in dimensions of thenumerous patterns in use. On account of thisthe ambulance carriages available with any parti-cular force might not be able to accommodatethe various stretchers of the different units fromwhich the wounded men would be derived. Themain proposition is that a museum should be

opened in London or the suburbs, under the controlof a small committee of experts, and that anyobject or appliance accepted should be exhibitedfor a year; and at the end of this period it shouldbe removed if, in the opinion of the expertauthorities, it was found to have been improvedupon, or superseded by a subsequent invention.In this case, the latter should then be substitutedfor the original appliance under similar conditions.Everyone interested and experienced in the subjectwould then have an opportunity for comparing theinventions, criticising, and possibly further im-

proving them in some points. The result wouldbe that inventions which had been put forwardlong ago, and condemned by competent authoritiesas useless, would not continue to be re-introducedas supposed valuable improvements by well-meaning persons unacquainted with the prac-tical history of ambulance development. Sir JohnFurley’s original proposition fell through, partlybecause no eligible site was available. It maybe remembered that Mr. Henry S. Wellcome hasoffered .f:2000 to be awarded in prizes for im-

provements in motor ambulance constructionfor Red Cross field-work, and that in 1914 a

Commission was formed to deal with the matter.At the Royal Army Medical College in Grosvenor-road we understand that there is a considerableamount of material illustrating progress in ambu-lance construction, and no doubt the militaryauthorities would be approached in the firstinstance by the supporters of Sir John Furley sproposal. As to the practical value and interestof such a collection, suitably arranged and con-veniently accessible, we imagine there can be notwo opinions-indeed it is surprising that thereshould be no such comprehensive exhibitionalready in existence.

THE THORACOSCOPE IN ENDOPLEURALOPERATIONS.

AT the International Congress of Medicine heldin London three years ago Dr. H. C. Jacobaeus, ofStockholm, gave an account of laparothoracoscopy,or the art of inspecting the peritoneal or pleuralcavities through an instrument resembling a

cystoscope pushed into them. This inspection canalso be used, in the case of the pleural cavity, forthe purpose of controlling operative proceduressuch as the division of pleural adhesions by theelectric cautery. In a recent paper 1 Dr. Jacobaeusrecounts his further experiences with the thoraco-scope and galvano-cautery, employed on fivepatients with pulmonary tuberculosis who had beentreated by the establishment of artificial pneumo-thorax. In each case X ray examination showedthe presence of pleural adhesions preventing com-plete collapse of the affected lung. Under localanaesthesia the thoracoscope is pushed into the

pleural cavity through a convenient intercostal

space, usually the fourth, fifth, or sixth, between thenipple-line and the mid-axillary or scapular line.The trocar for the galvano-cautery is then pushedthrough the intercostal space next above or belowthe thoracoscope, as maybe most convenient, and thetwo instruments are manipulated in such a way asto give the operator a good view both of the adhe-sions it is desired to sever by cautery and of theorogress of the severance. Dr. Jacobaeus remarksthat the X ray examination does not as a rule give:ull or satisfactory information as to the nature ofadhesions present in the pleural cavity, or the easewith which they will be reached by the galvano-cautery ; the operative manoeuvres are oftenmexpectedly difficult. In one case, after theadhesion had been burnt through, the cauteryvas brought too close to the pleura, and theJatient felt a slight sudden pain. In anotherhere was a slight capillary oozing of bloodrom the pleural end of the severed adhesion;the oozing could not be checked by the cautery,and must have stopped spontaneously, for no ill

consequences ensued. In a third patient the localanaesthesia was unsatisfactory and the operationwas painful in consequence; three bands ofadhesions were burnt through, but a fourth couldnot be reached by the cautery. Ten weeks laterthe X ray examination showed that a pulmonarycavity previously measuring 3 by 3 cm. had collapsedconsiderably, measuring only 1 by 11/2 cm. ; fiveweeks later it had almost entirely collapsed. Inanother patient whose lung had collapsed upwards,as a result of the artificial pneumothorax treat-ment, but was prevented from fully collapsing bythe presence of a broad adhesion passing forwards,outwards, and downwards, there was great difficultyin effecting the severance. As soon as the cauteryhad been got to work on the adhesion the latterslipped away, probably as a result of the respiratorymovements. In consequence the two instrumentshad to be manoeuvred into position again 10 or 12times before the adhesion was fully divided, the opera-tion taking 30 to 40 minutes. The results, however,were satisfactory. In a fifth patient there was alarge and thick pleural adhesion running from thelung upwards, backwards, and outwards to thesecond or third rib in the scapular region. The

thoracoscope was inserted in the seventh intercostalspace in the scapular line ; the galvano-cautery wasentered in the fifth space just internal to the

1 Nordiskt Medicinskt Arkiv, 1914, Kirurgi, Afd. I., h. 4, Stockholm, 1915.