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so many, and the room was crowded to excess—nor were we disappointed.
His paper was a most able and exhaustive, and at the same time, concise exposition of his views on most of the many very important questions which so often arise in connection with this serious trouble-it will well repay perusal. As regards diag. nosis, he especially remarked upon the fimportance of bearing in mind the great similarity between an acute obstruction and a paralysis of the bowel caused by acute peritonitis, generally from perforation. Several instances of the mistake were alluded to. Of course, the practical importance of this point cannot be overrated. Then, with reference to operation in cases of impermeable obstruction where all other means have failed, Mr. Hutchinson, with characteristic caution, tells us that as in even apparently desperate cases he has seen spontaneous recovery take place, he would uever consent to operate, except where the diagnosis could really be satisfactorily made out and where a constricting band was believed to be the cause, In cases of intus-susception he prefers trusting to nature. He strongly condemned the practice now followed by many of puncturing the abdomen to relieve from flatus, as he has seen severe peritonitis from the focal gaseous exudations from the little holes. In this he was opposed by Dr. Clifford Allbutt and others, as they claim that sometimes it really may help to cure, and that puncture is not dangerous except after the abdomen has been opened in gastrotomy. One member, whose practice lies in a lead-working district, stated that he had quite frequently met with forms of lead colic strongly resembling obstruction, and advocated the importance of excluding this possible origin of the symptoms. Dr. Broadbent urged the value of forming a diagnosis as early as possible of the exact seat of the obstruction, as then, from the patient's age and the other circumstances of the attack, a very certain opinion might often be formed of the real nature of the trouble. He also would examine every such case by the rectum, observing that, although no tumor may be felt, yet sometimes other information may be got, as, for instance, that the rectum is held open by a tumor and not allowed naturally to collapse. Several other papers on the same subject and illustrating various points, were read by Drs. Kerr, J. Kerrit, and others, and the discussion was sustained and animated.
The Surgical section was presided over by Mr. Callender, of St. Bartholomew's, who, in his introductory remarks, dwelt chiefly upon the necessity of relief to pain in encouraging the healing of wounds. All that this eminent surgeon says on that point and every other with the same end in view is worth bearing in mind, because it is notorious that his results are said to be every way equal to those of Lister, and still he is the great unbeliever in antiseptics. The jealousy of the London sur geons towards Lister crops out every now and then. Callender was showing a splint with some modifications—“ We, of London.” he said, “ have seen fit to import a surgeon from Edinburgh, whilst they of Edinburgh have actually imported this splint. We thought they considered that no good thing could come out of London.” This was followed by the reading of papers on subjects connected with stone in the bladder-but not having attended, I am not able to give you any further particulars, but I did not learn that anything very novel concerning the operations for stone had been developed.
The following day, however, Surgery came to the front. The address had been entrusted to Mr. Wheelhouse, of Leeds, and he certainly did not fail to do full justice to the subject he had in hand. It was a lively and interesting review of the progress of Surgery during the 50 years of the writer's own experience. It was admirably delivered, and at times the reader's enthusiasm even carried him into eloquence. Its interest was greatly enhanced by the numerous examples introduced, in which he had himself been led by reasoning upon the now established principles of Surgery, to some of the most remarkable and satisfactory results. I may not take up much more of your space, but would refer your readers to the address itself. One or two instances, however, may be mentioned of the unusual procedures to which Mr. Wheelhouse has occasionally had resort. For example, he has recently had under his care a man
who, through a fall upon a scythe, had received a great gash in the back of the thigh, injuring also the sciatic nerve.
The subsequent cicatrisation had completed the destruction of the nerve’s function by pressure, and complete paralysis was the result. This paralysis had lasted several months, and the man came to the hospital for the purpose of having the limb amputated, so cumbersome had it become. This surgeon, however, determined to try the effect of exposing the ends of the divided nerve and joining them together. This was done, and the result was a perfectly good limb, with (after some months) free motion and sensation.
Antiseptic Surgery, of course came in for a full share of attention, Without entering into any theoretical discussion, Mr. Wheelhouse contented himself simply with stating his belief that by this means results could be attained which he had always failed to procure before its introduction, and which, indeed, he believed to be still impossible without it. Reference was also made to the great advantages which surgery has reaped from Dieulafoy's method of aspiration. After enumerating many of the maladies to which this improved means of removing fluid is applicable the writer made some further suggestions with reference to the extension of its use —especially to the emptying of large and putrid cavities in lungs and washing them out with some disinfectant fluid. (I have since been informed that this has already been done by some German surgeons.)—G. R.
Reviews and Notices of Books.
Transactions of the Medical Association of Georgia. Twenty
ninth Annual Session, held at Atlanta, April 17th, 18th and 19th, 1878. 8vo, pp. 279. Atlanta, Georgia :
JAMES P. HARRISON & Co., 1878. This is simply what its title indicates, and contains much matter of interest. The order of arrangement is in the usual style ; the body of the book, which consists of exactly thirtytwo pages, being taken up with table of contents, index to authors, list of officers, special committees and sections, after which a daily record of the minutes of the meetings appears. The papers which have been selected for publication are next given in the appendix. As an introduction we have the President's address—this is followed by an oration in which the author, Dr. Burgess, touches upon the subject of unwise medical literature, of which there certainly appears to be a superabundance. Dr. Dostor next reports a case of amputation of the leg for necrosis of the tibia ; the patient recovers, and, as the Dr. naively observes, he was made “ apparently a happy man," after thirty-four years of suffering. This is succeeded by a report of cases from Dr. Walker, and also a paper on tubercular meningitis, by Dr. Grimes.
The next paper is on Yellow Fever, its history, causes, nature, pathology and treatment, by Dr. J. C. Le Hardy, of Savannah. This is a very important paper, and one that will attract much interest at the present time, as yellow fever is said to be epidemic in the South just now. The paper is based on the experience gained by the author during the epidemic of 1876, through which the city of Savannah passed during the latter part of the summer of that year. In the history of the epidemic, the author gives a description of the sanitary condition of many parts of the city, and points to the condition of over-crowding of buildings and defective drainage to which he attributes the aggravation of the disease when once developed. He says :—“ The sections of the city principally inhabited by the working classes, (white and black) and extending on the eastern and western slopes of our bluff, were in their usual wretched sanitary condition. The streets narrow, running east and west ; the houses wooden, small, decaying, built in tenements, with miserable ventilation; the yards small, with high plank fences, and filled up with offal of all sorts ; their privy vaults badly closed; stables, pigeon and poultry houses, &c., all huddled together–Here was a picture to meet the eye on every side,-such a combination was quite sufficient to produce filth diseases; but it had existed for years, and although it was not in my judgment, an efficient cause for yellow fever, yet during an epidemic it could aggrvate its ravages.” It has been
said that cleanliness is next to Godliness, for in verity it consists in our duty towards our neighbour and ourselves. We fear that Savannah is not the only city on this continent afflicted with squalor and neglect of sanitary precautions in the construction of buildings and their appurtenances. We have often in our own city viewed with anxiety and regret the system of over-crowding of buildings, and we may observe that during the two past epidemics of cholera that afflicted our city, although the disease was very generally distributed, yet it proved most fatal in localities where sanitary precautions had been neglected. Such, we imagine, is the experience of all observers not only in reference to yellow fever, but also of every plague with which the human family has been afflicted since the time of Moses. Dr. Woodhull, U. S. Army, who wrote an official account of the causes of the epidemic of yellow fever at1Savannah in 1876, and which is published in the number for July, 1877, American Journal of the Medical Sciences, remarks :-“ From the data which I have been able to collect, I think it is clear: First, that there is no evidence of importation of the yellow fever poison in this epidemic; Second, that if it was imported, no system of quarantine could have guarded against it ; Third, that the spread and virulence of the epidemic were closely connected with air and soil pollution, whether this pollution be considered as a sufficient explanation of the origin of the disease or not.
Le Hardy, in his paper, is inclined to the belief that so far as Savannah is concerned, the yellow fever germ can originate without importation. Although this question is still debatable, as professional opinion is by no means pronounced on the subject, we observe that the author, while admitting that a lack of sanitary precautions will aggravate the disease, and tend to its spread, he does not regard it as a factor of the disease. On this point, he remarks : “Had filth, and its resulting gases and pollution been capable of producing yellow fever once-its presence being ever acting and increasing, its effects should be
• Am. Journal of Med, Sciences, vol. 74, p. 53.