778

registered on the roll of midwives. In these conditions

naturally a number of untrained and ignorant women arepractising in various parts of the country as certificated

midwives. As time goes on the number of these women

will gradually diminish and their places will be taken

by properly trained women who have passed the exa-

minations of the Central Midwives Board. It is difficult

to see how any other solution of the problem couldhave been arrived at without a grave injustice beingdone to certain competent midwives and without deprivingthe public of a form of necessary assistance. The Board

has, of course, the power necessary to take off the rollthe name of anyone who is found to be unfitted or who isconvicted of negligence, and no doubt will do so in thecase of the midwife in this instance if it finds the viewsof the coroner and his jury just.

THE BATHS AT HARROGATE.

AN important addition to the bathing facilities at Harrogate has recently been completed by the installationof the necessary appliances for the carrying out of the treatment which has hitherto been almost entirely asso-

ciated with the French spa, Plombieres-les-Bains. InTHE LANCET of April 30th, 1904, p: 1186, we published a paper by Dr. de Langenhagen on the Treatment of

Muco-membranous Colitis in which the methods adoptedat Plombieres are set forth in detail. Rectal irriga- tions when properly carried out are without doubt veryvaluable in the condition described by Dr. de Langen-hagen and also in other diseases of the intestinal

tract, such as catarrhal enteritis and intestinal lithiasis.The treatment has also been recommended for appen-dicitis and in cases of doubtful diagnosis a " hydro-mineral cure " may often be tried with advantage. Dr. de

Langenhagen is of opinion that the "intestinal bathing "should be considered as a real internal dressing" of themucous membrane, and he therefore claims that rectal

irrigation is suitable not only in cases of colitis with

constipation but also in those cases in which there arealternations of constipation and of diarrhoea or in cases ofchronic diarrhoea. Many patients who cannot from financialor private circumstances proceed to a continental spa canand will go to one in England. This latest addition, then,to the baths of Harrogate is likely to prove a most usefulone and the corporation of Harrogate may be congratulatedon the enterprise which has just been completed.

CONGRESS OF THE INTERNATIONAL SOCIETYOF SURGERY.

AT the first Congress of the International Society of Surgery, which will be held in Brussels from Sept. 18th to <

23rd, one of the subjects for discussion will be the Surgical ]Treatment of Non-Cancerous Affections of the Stomach. The discussion will be opened by Dr. A. Monprofit, professor sof clinical surgery in the Medical School of Angers in France ; Mr. A. W. Mayo Robson, Vice-President of the (

Royal College of Surgeons of England ; Dr. J. Rotgans of Amsterdam ; and Dr. A. Mattoli of Rome. From abstracts

of the forthcoming addresses, published by the secretary of the Congress, it appears that Dr. Monprofit will include in 1

his remarks the operations of puncture of the stomach ,

through the abdominal wall, paragastric exploratory laparotomy, extragastric and intragastric dilatation of 1

the pylorus, pyloroplasty, exploratory gastrotomy, gastror- rhaphy, curetting and cauterisation of gastric ulcers, gastro- 1

stomy, partial gastrectomy in various situations, gastro- J

plasty, gastropexy, gastro-anastomosis, anagastrostomosis, total gastrectomy, and gastro-enterostomy. This last is the operation which he considers to be the most ]

applicable in the majority of these diseases of the

stomach. Mr. Mayo Robson will deal with the subjects’of simple ulcer, haemorrhage, adhesions of the stomachto adjoining organs or to the abdominal parietes, per-

foration, hour-glass contraction, tetany of gastric origin,dilatation, gastroptosis, acute phlegmonous gastritis,stenosis of the pylorus, injury of the stomach, hyper-chlorhydria, and persistent gastralgia. Dr. Rotgans willconfine himself entirely to gastric ulcer and its com-

plications. He recommends operative treatment when themovements of the stomach are interfered with by conditionssuch as excessive peristalsis, vomiting, hypertrophy of thewall of the stomach, and retention of its contents. In such

cases the cause is usually mechanical-namely, stricture ofsome part of the stomach or the existence of adhesions.The cause may also consist in troubles dynamo-moteurs,conditions in which the above-mentioned mechanical defectsdo not exist and gastroptosis is the only anatomical cora-plication. He would also operate in cases of severe pain,tumours, h&aelig;morrhage, perforation, and emaciation. Dr.Mattoli will discuss the surgical treatment of gastroptosis,pyloric stenosis, circular perforating ulcer, and several othergastric abnormalities. The official languages of the Congressare English, French, German, and Italian. During theproceedings a general meeting will be held to appoint theInternational Committee, to fix the next place of meeting,and to elect a president. We understand that the Belgiancommittee will send invitations to fetes in honour of foreignmembers of the society on hearing from them. Intimationsshould be sent direct without delay to the general secretary,Dr. Depage, 75, Avenue Louise, Brussels.

THE SURGEON’S RESPONSIBILITY FOR THEDETAILS OF AN OPERATION.

A MODERN surgical operation in many instances demandson the part of the surgeon not only a high degree of

manipulative dexterity but also in a considerable measurethe power of organisation. The details of the preparationof the patient, of the dressings, instruments, ligatures, andso on, take up a good deal of time and require special know-ledge, and it may be impossible for the really busy surgeonto attend personally to all these matters. It is true that ofrecent years with the gradual replacement of antisepsis byasepsis these details have been a good deal simplified, butthe danger to the patient where asepsis is practised is allthe greater if by chance any of the procedure is not carriedout with scrupulous accuracy. Whether the surgeon looksafter these things himself or is compelled from the pressureof work to intrust them to others there can be no questionbut that he must be held responsible in the case of anyaccident occurring. If he has any doubt as to the capabilityof his nurses then it is his duty to see that their work isproperly supervised and checked. If he does not give clearand definite instructions&mdash;and whenever it is possible theseshould be written-then he is alone to blame if his orders arenot executed in their entirety. In hospital practice it isobvious that much must be left to resident officers and

nurses, but even here it is the duty of the surgeon to inquirefrom time to time into the manner in which these dutiesare performed. There is always a tendency on the part ofthe most conscientious man or woman, although inspiredwith the best intentions, to become a little careless in theperformance of duties which are of the nature of a routineto be carried on quite without superv i,ion. It would seem

hardly necessary to call attention to such an obvious truth,but from time to time instances occur in which a surgeon,forgetting human fallibility, has trusted too much to othersand has neglected to overlook properly their subordinate

work, with disastrous results to the patient. A great responsibility rests upon every surgeon with regard to all,even the minutest, details of an operative procedure, no