778

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

ST. GEORGE’S HOSPITAL.RECENT OPERATIONS PERFORMED UNDER THE

INFLUENCE OF ETHER.

(By Mr. POLLOCK.)

Nullaautem est aliapro certo noscendivia, nisi quamplurimasetmorborumet dissectionum historias, turn aliorum, turn proprias collectas habere, etinter se cornparare.-MOBGAGNI De Sed. et Caua.3orb., lib. iv. Procemium.

A DELICATE GIRL, sixteen years of age, who was the sub-

ject of necrosis of the popliteal surface of the femur, under-went the removal of several portions of dead bone throughan incision in the outer side; a suppurating cyst in thethigh was laid open and dressed with blue lint; ligatureswere applied to some piles; and an operation for the cureof hare-lip was performed in a child of ten months.

(By Mr. HENRY LEE.)In the case of a boy whose left tibia was the subject of I

great thickening consequent on a blow received two yearspreviously, Mr. Lee trephined the bone and opened a cavityfrom which some broken-down cancellous tissue was re-moved ; no pus was observed, but the free hsemorrba.gewhich occurred rendered it difficult to ascertain the exactcontents of the cavity. Some dead bone was removed withunusual ease from the popliteal surface of the femur of achild through an opening in the outer side. And, for a vari-cose condition of both internal saphena veins in a man

fifty-six years of age, Mr. Lee performed his usual operation:the vein was lifted with the thumb and forefinger, and twoneedles were passed beneath it at a distance of about twoinches from each other, a figure-of-8 ligature was passedround the needles, and the portion of vein thus isolatedwas then divided subcutaneously.

Excepting that for hare-lip, all these operations wereperformed during anaesthesia produced by ether apparentlywith as much ease and rapidity as is usual with chloroform.In two cases, those of adults, in which the time was noted,insensibility was produced in five and four minutes and ahalf respectively. The inhaler employed by Mr. Hawardconsisted of a, cone of felt, into which a small sponge wasintroduced, and which was so constructed that the etheicould not drain down on to the patient’s face. One childvomited some undigested food, but sickness did not occurin any of the other cases.The only outward difference between the administratioi

of ether and that of chloroform appeared to be the morEfrequent replenishment of the inhaler, and the very appreciable extent to which the theatre became pervaded witlthe vapour of the anaesthetic.

ST. THOMAS’S HOSPITAL.[OPHTHALMIC OUT-PATIENT DEPARTMENT.]

THE department for ophthalmic out-patients consists of asuite of rooms which is approached from the main hospitalthrough a wicket-gate which shuts it completely off from theremainder of the building, and, from without, by an entrancedistinct from that used by the general out-patients. It com-prises a spacious room, in which the patients are seen by thesurgeon ; a dark room in which every particle of colour hasbeen rigidly suppressed, and in which ophthalmoscopic ob-servations can be carried on in six patients simultaneously;male and female waiting-rooms; a dresser’s room; a patho-logical and chemical laboratory; and an operating theatre.To avoid confusion, the medicines are dispensed to opthal-mic patients from the casualty dispensary through a win-dow which can be approached only from the ophthalmicdepartment. Considering that these rooms were erectedwithout any reference to their present special use, and havehad to undergo considerable alteration in order to become

at all suitable, the arrangements may be said to be verygood, though not altogether free from defect.The ophthalmic ward is not yet ready for the reception

of in-patients, and the comparatively small attendance ofout-patients may, perhaps, in some measure, be attributedto this circumstance. As it was, we had not, on the occa-sion of our visit, much opportunity of observing the prac-tice pursued by Mr. Liebreich. It was, however, evidentthat he relies almost exclusively on nitrate of silver as astimulant application in the treatment of chronic inflam-matory affections of the lids and the superficial structuresof the globe. The patients mostly attend daily and receivethe application in the form of a solution, of the strength often grains to the ounce, from his own hand. All the casesof corneitis were treated either with this solution or withatropine.

PROVINCIAL HOSPITAL REPORTS.

RADCLIFFE INFIRMARY, OXFORD.CASES OF CHOREA TREATED ON THE EXPECTANT PLAN.

(Under the care of Dr. GRAY and Dr. TUCKWELL.)THE following series of cases of chorea, in none of which

any special treatment calculated to influence the nervoussystem was adopted from the first onset to the completedisappearance of the symptoms, will form an interestingsequel to another series occurring in the practice of theHospital for Sick Children, which is recorded in the numbersof THE LANCET for the 21st and 28th ult., in which sul-phate of zinc was administered in considerable doses.Having come to the conclusion that, in spite of arsenic,

sulphate of zinc in gradually increasing doses, iron, andstrychnine, chorea will go very much its own way, Dr. Grayand Dr. Tuckwell decided, some time since, to desist fromthe use of all the approved remedies for chorea. Twice intheir experience a fatal issue has occurred in spite of activeand varied treatment; in others of their cases a relapsehas occurred during a course of increasing doses of thepopular drug; while others became steadily aggravated inspite of every remedy, and then, without apparent reason,showed a gradual abatement of symptoms, which ended ina so-called cure. They have been also moved by a desire toascertain what is the average natural duration of choreawhen uninfluenced by drugs, the course of the disease beingmoderated only by the removal of the patient from the de-

’ pressing effects of insufficient food and warmth, and small,l damp, and crowded dwellings, to the better hygienic con-I ditions of the infirmary.

In each of these cases, which have not been selected butL

are given in the order of their admission, the parents orfriends were closely questioned as to the earliest appear-ance of twitching; and the duration of the disease has been

1 calculated from that time until the disappearance of allirregular movements.

(Under the care of Dr. GRAY.)1. Girl, aged six. First attack. Chorea general, mode-

rately severe. No assigned or discoverable cause, but herfather had chorea when twelve years old. No cardiacmurmur throughout. Treated with house-diet and pepper-mint-water. Duration before admission, five weeks; move-ments ceased five weeks after admission; total duration,ten weeks.

2. Girl, aged thirteen. Second attack. Chorea general,slight. No assigned or discoverable cause. Mitral murmur,which disappeared before she left the hospital. Treatedwith house-diet and peppermint-water. Duration beforeadmission, two weeks ; movements ceased six weeks afteradmission ; total duration, eight weeks.

3. Boy, aged fourteen. First attack. Chorea general,slight, dating from a severe blow under one eye (no scar orthickening left). Mitral murmur (which disappeared beforehe left the hospital) audible in recumbent, not in erect,

. posture. Treated with house-diet and pepermint-water.

. Duration before admission, twelve weeks; movements: ceased eight weeks after admission; total duration, twentyL weeks.

4. Girl, aged seventeen. First attack. Chorea affecting) right limbs and both sides of face. No assigned or dis-