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handsome frontispiece, and the text is liberally illustrated by wood-cuts. It is one of those treatises on especial subjects which practitioners would do well to study with care. They cannot afford to plead the excuse of want of time. The liver has long enough been blamed for most of the ills to which we are heirs, a target for map diagnoses and hap-hazard treatment. With such instruction as these volumes give, patients have at least the right to claim from their doctors a knowledge of the views of the staudard writers of the day. The very cheap rate at which these volumes are disposed of to the subscribers is a significant fact, and we trust the experiment now being made will convince publishers that cheap medical literature of the right sort will “ pay” as well as forms, we fear, perhaps more familiar to the trade.
THE SANITARY ASSOCIATION OF LYNN. The excellent results from the voluntary sanitary societies in Edinburgh and Tottenham have suggested the value of similar organizations elsewhere, and already Newport and Lynn in this country have followed their example. The Lynn association has just published a small pamphlet containing their rules, etc., in which one may readily recognize the work of a skillful and practiced sanitarian ; and it might well serve as a model for similar societies which we hope will spring up throughout the country.
The objects of the association are (1) to promote a general interest in sani. tary science, and to diffuse among the people a knowledge of the means of preventing disease ; (2) to secure the adoption by the city authorities of the most effectual methods of improving the sanitary condition of the city ; (3) to provide its members at moderate cost with such skilled inspection as shall secure the proper sanitary condition of their premises and those of other people in whom they may be interested. Any citizen of Lynn may become a member by paying an annual assessment of five dollars. He is entitled to vote at all meetings; to an annual inspection and report upon his premises by a competent person ; to occasional supplementary inspection and advice, in case of an epidemic or undue prevalence of disease ; to inspection of other buildings than his dwelling upon terms agreed upon by the executive council. There are working committees on diffusion of sanitary knowledge, on the sanitary condition of the city, and on inspection of buildings. Public meetings, lectures, articles for the press, tracts for distribution, investigations, coöperation with the municipal authorities, etc., are provided for. From the names of their officers, and from the quiet, straightforward statement of their plans, we predict for the Lynn Sanitary Association a future of great usefulness. Every city and town in the State should follow their example.
MEDICAL NOTES. We print this week another letter from Dr. Bigelow on the subject of litholapaxy, in which he criticises some remarks of Sir Henry Thompson on that operation, which appeared in the New York Medical Record.
- One of our principal surgeons, Dr. John Thomson Darby, has just died in the prime of life, although after a long and painful illness. He was born at Pond Bluff Plantation, St. Matthew's Parish, South Carolina, in December, 1836, and was consequently in his forty-third year. He pursued his medical studies at the medical department of the University of Pennsylvania, where he passed an unusually brilliant examination, and received his degree in 1858. He then became assistant to Dr. Joseph Leidy, the distinguished professor of anatomy in his alma mater, and remained in Philadelphia till the outbreak of the late war, when he returned to South Carolina, and entered the Confederate service as a surgeon. He was at one time on Gen. Robert E. Lee's staff, and also held, during a considerable period, the position of chief medical and surgical director in the commands of the armies of Virginia and Tennessee. After the close of the war he went abroad to study in England and on the Continent, and during the German war of 1866 served as a volunteer surgeon in the Prussian army.
On returning to America he was appointed professor of surgery in the Charleston Medical School, and retained the position until 1873, when he received an election to the chair of surgery in the medical department of the University of the City of New York, made vacant by the resignation of Prof. Alfred C. Post, and removed to this city. In time he was also appointed surgeon to Bellevue and the Mount Sinai hospitals. Ever since the civil war it is stated that he has suffered more or less from the results of a poisoned wound, and during the last two courses of winter lectures his health was such as to interfere seriously with the performance of his duties at the university. Consequently this spring he resigned his chair, and was elected professor emeritus.
Dr. Darby's wife was a niece of Gen. Wade Hampton, who was present at his funeral, and he leaves four children. He was esteemed no less as an accomplished gentleman than as a skillful surgeon, and he had won hosts of warm friends in his adopted city by his genial manners and high-toned character. In addition to various contributions to periodical medical literature, he was the author of Campaign Notes on the German War of 1866. He suffered from malarial trouble, with marked enlargement of the liver, besides his other complaint, and had been confined to the house since the early part of February last. The funeral services, prior to the removal of the remains to Columbia, S. C., for interment, were held at St. Ignatius Church on the 10th of June, and were attended by a large number of prominent medical men (besides other friends), including almost the entire faculty of the medical department of the university.
We are informed that although there are at present no female students in the medical department of Syracuse University, this failure of an attempt at coeducation of the sexes, the faculty believe, is not to be attrbiuted to any evil moral results, as a passage in our editorial of June 5th might possibly have led a hasty reader to infer.
- Small-pox continues to spread to a slight extent among the Bohemians, among whom the recent cases of it occurred, and who, as a rule, are not properly vaccinated. The objection made by them to vaccination is mainly in
consequence of superstition, and the health authorities have applied to the minister of the Bohemian chapel in Fourth Street to give a little commonsense advice on the subject to his congregation, with the hope of overcoming this prejudice. Last week six cases of small-pox were reported to the board of health, but since the beginning of the present week as many as five cases have been reported on a single day.
Scarlet fever still continues quite prevalent for this season of the year, one hundred and one cases having been reported during the week ending June 7th.
On the first Saturday in June the first of the Poor Children's Summer Excursions took place, the party consisting of three hundred children from the German quarter of the city, who were taken to the summer home of the Children's Aid Society, at Bath, Long Island. On the following Monday one hundred and thirty children from the industrial schools of the society were sent down to remain for a week, and enjoy the benefit of the fresh air, the sea bathing, and good country fare that is there provided for them. Seventy quarts of milk a day are supplied by cows kept on the premises.
- A warning to many of the fair sex ought to be found in the announcement that a certificate of death from peritonitis in the case of a young woman who swallowed a pin eight months ago was recently received at the coroner's office.
ST. LOUIS. Entertainments in the way of a fair, an amateur opera, and an opera bouffe have recently been given here for the benefit of three hospitals, - the Mullanphy (Catholic), St. Luke's (Episcopalian), and the Woman's (non-sectarian) hospitals, — by which between twenty-eight and thirty thousand dollars were raised. Over twenty-six thousand of this went to the Mullanphy Hospital.
- A few days ago, at the City Hospital, upon post mortem, an aneurism was found in the kidney. The sac of the aneurism had ruptured, and the escaped blood had distended the capsule of the kidney till it was some eight inches long and between two and three inches wide. The aneurism itself was about the size of a pigeon egg.
At the same institution there is a case of hypospadias, the urethra opening just as it emerges from the scrotum. One testicle is very much atrophied; the other was injured, and removed some four years ago. The patient is forty-eight, and has never known sexual desire.
CORRESPONDENCE. LITHOLAPAXY.— DR. BIGELOW TO THE EDITOR OF THE NEW YORK MEDICAL
RECORD. TO THE EDITOR OF THE NEW YORK MEDICAL RECORD, — An editorial paragraph in the Record of May 31st mentions that the letter from Sir Henry Thompson to Professor Van Buren, which appeared in the previous issue, was written for publication.
Sir Henry's reiterated criticisms of lithotrites should not be allowed to ob
scure the main facts, be their value more or less, of rapid lithotrity, which means long sittings for the immediate and complete evacuation of the fragments by large tubes, and depends upon the newly-discovered tolerance of the bladder to the smooth surfaces of instruments, while the old lithotrity meant repeated short sittings and sharp fragments left in the bladder.
The size of a lithotrite has little to do with litholapaxy. Stones are so frequently soft and small that a small lithotrite of any kind may be often large enough. Of course the operator will be careful not to break such a lithotrite upon a large or hard stone. Like other lithotrites, mine is made in various sizes. It is not a large lithotrite that I have desired to bring to the attention of surgeons, but a new lock, with protective and non-impacting blades, designed to promote safe and rapid work at a moment when the hand or the attention of the operator is fatigued by a long operation. I prefer a large lithotrite, if it possesses these qualities, even in dealing with common calculi. Sir Henry prefers a smaller one, whether it clogs or not, and frequently withdraws it to clean it. His prejudice against a large instrument is connected with a life-long and erroneous theory that the dangers of lithotrity result mainly from the instruments used in the operation. This was the general mistake of the day. It was not known that the irritation was really occasioned by the fragments which it was the custom to leave in the bladder. When these fragments were drawn out by my apparatus, and that source of danger to the bladder was removed, it was found that the instruments themselves did but little harm. Sir Henry, perhaps, might long ago have discovered this fact of the tolerance of the bladder to instrumentation, if he had possessed any means of evacuating it thoroughly. But he had only Clover's instrument, the tube of which was so small (21 French) that it drew out only sand, and left the fragments. Hence his error and failure to discover the new facts of what is now known as rapid lithotrity.
Sir Henry devotes the last half of his letter to the expression of creditable sentiments in relation to his attitude towards surgical progress. A little explanation may be here desirable.
A year after the publication of my paper, he published a lecture in the Lancet (February 1, 1879), in which he says, “ My own system has for a long time past been gradually inclining to the practice of crushing more calculus at a sitting, and removing more débris by the aspirator, than I formerly did," — which might very well be true, his former sittings having been limited to two minutes or less; but the hindrance to his “ removing more débris ” was the small size of Clover's tube. The editor of the Lancet replied (February 15th), “ We cannot close our eyes to the fact that the views advanced in his lecture of the 1st inst. do involve an abandonment of his old position. Lithotrity as hitherto practiced by him, and lithotrity as recommended and performed by Professor Bigelow, are different operations, and based on opposite and contradictory principles.” This “editorial observation " in the Lancet Sir Henry, curiously enough, chooses to regard, in his letter published in the Record, as “adverse criticism of himself personally, not of bis mode of operating.”
In this connection Sir Henry expresses the opinion that the terms “abandonment of position,” and the like, "adapted as they are to military men,” do
not accord with the aims of men who "live and learn,' .... It is an er. ror,” he says, “ to look for a life-long consistency in matters of opinion from men who think for themselves.” The world will not question the right of Sir Henry to "live and learn,” nor to “ think for himself,” but only the propriety of his claiming to have originated by “thinking for himself” ideas he has learned from others.
A friend has to-day sent me the fifth edition, just published, of Sir Henry's Diseases of the Urinary Organs. I find that in this edition Sir Henry both honors rapid lithotrity with his indorsement, and appropriates as his own its essential details.
He adopts large tubes, increasing the ineffectual catheter of Clover from 21 to 29, which latter calibre I often employ, my smallest tube being 27, my usual size 30, and the largest 31. “ You are first to introduce,” he says (page 173),
an evacuating silver catheter fitted with a flexible stylet, — in size, say, from No. 14 to No. 16, English scale,” calibres equivalent to 24 and 29 French." Here being the essential feature of the operation, Sir Henry at this point definitively abandons “ consistency” and the 21 tube of his previous editions in favor of “ large evacuating catheters and a good aspirator” (page 177). Neither of these he used before I described them. This gives him the whole key to rapid lithotrity, and he is able to accomplish thorough evacuation at once by prolonging the sitting till evacuation is complete, demonstrating at the same time that the bladder tolerates instrumentation if the fragments are removed, — which is the new principle that underlies litholapaxy. The large tube once appropriated, the rest is easy. The aspiration of his new edition means effectual aspiration with large tubes, and his lithotrity becomes rapid lithotrity.
A comparison of this, Sir Henry's present practice, with his recent opposite teaching of frequently repeated crushings -- each confined to a few minutes, lest the polished instrument injure the bladder, but leaving the bladder nevertheless to struggle, in the intervals, with sharp, broken pieces of stone, which he had no means of extracting, — will show the significance of the criticism by the editor of the Lancet. 2
In conclusion, I may venture to hope that the valuable example set by Sir Henry in accepting large tubes will aid in doing away with whatever apprehension still exists of danger from their use.
HENRY J. BIGELOW. 1 Handerson's comparative scale, from which these equivalent numbers are taken, is made by Reynders & Co., New York. It is accurate, and very convenient in having, in: stead of holes, a long triangular slit like a wire guage. “In England,” says Sir Henry Thompson, “we cannot be said to have a uniform scale; all our measurements are rery arbitrary. One maker has one scale, and another another.” (Diseases of the Urinary or gans, 1879, page 47.) On page 48, however, he gives a scale, of which the largest size, 14, is the equivalent of 24, and this corresponds to Handerson's scale. (New York Medical Record, 1877, page 638.) The French numbers increase more rapidly than the English. Larger calibres have hitherto been but little known either in France or England. The main point is the necessity of enlarging Clover's tube.
The Lancet of May 17th contains a letter on this subject.