279 THE LANCET. LONDON: SATURDAY, MARCH 7, 1846. OPHTHALMIC HOSPITAL.-SYPHILIS IN BELGIUM. AT the hour of going to press, no "official" announcement had been made by the Council of the College of Surgeons respecting the vote of censure which has been passed by them on the conduct of Mr. LAWRENCE. Consequently, the terms of the "resolution" in which the condemnation expressed by the Council was declared are unknown to the members of the College. The silence thus doggedly maintained regarding the insults offered to the members by Mr. LAWRENCE, makes it appear to the world that the offensive conduct of that person has been adopted by the aggregate body of the Council. Probably it is considered, in Lincoln’s-inn-fields, that twelve thousand members of the College are not worthy of receiving an " official" communication from the governing body of their own institution. It is understood that Mr. LAWRENCE has not yet tendered his resignation. THE character of the monopoly which has been created and fostered in London by the Council of the College of Surgeons, acting, for many years, in their capacity as Surgeons of the London Hospitals, is tolerably well illustrated in the follow- ing paragraph, extracted from an advertisement, issued by the LONDON OPHTHALMIC HOSPITAL, which appeared in the daily papers of Wednesday last. Mr. SCOTT, one of the sur- geons of that hospital, having resigned, the profession are here made acquainted with the kind of persons whom the by- laws of the hospital describe as alone qualified to fill the va- cated situation. " ROYAL LONDON OPHTHALMIC HOSPITAL, MoORFIELDS. " By rule twenty-three, a candidate for the office of surgeon must be a surgeon of a metropolitan hospital, or have served an apprenticeship, or be, or have been, a demonstrator of anatomy at a metropolitan hospitad.-Dated this 2nd day of MlJ.rch, 1846." The members of the College being thus shut out from im- portant offices in our public institutions, are then taunted with "not being capable of acting as surgeons." They are first injured by the Council, and then grossly insulted because they have been injured. WITHOUT attributing to the disease, called SYPHILIS,-that direful plague of the human race,-the mysterious importance with which the more than quackish, or half-cracked followers of HAHNEMANN invest it,-following, in this respect, the erratic footsteps of their visionary master,-we cannot deny that the propagation of syphilis is one of the most potent causes of the deterioration of mankind, and one of the greatest evils, physical as well as moral, to which the human race is liable. Were the disease merely to affiict those persons who have exposed themselves to contagion in the haunts of vice, it might be considered merely a just punishment for moral depravity. But such is not the fact. The innocent victims of syphilis are infinitely more numerous than the guilty; for it is a disease which follows vice and crime down to " the third and fourth" generations; syphilis in the parents being, it is generally considered, one of the chief causes of scrofula, pulmonary consumption, and other fatal and distressing dis- eases in their children. ’ Under such circumstances, it will at least be admitted, that it is a question worthy of consideration, whether it may not be wise for a government to adopt measures to prevent the propagation of this malignant and destructive malady, with the humane object of protecting future generations from early decay and death. We are thus guarded in putting the question, because we are well aware that it is the general opinion in this country, that any interference with vicious pursuits, for sanatory purposes, is an indirect sanction of such practices, and is, therefore, to be condemned. Acting on such views in this country, syphilis has been left to itself ; it has exercised its ravages on multitudes of the population, unrestricted, uncontrolled. The result is, that in no part of the world, we believe, in accordance with the generally-received opinion of the profession, is there more sy- philis, as compared with the population, than in Great Britain; and in scarcely any is the disease seen in a more virulent form. In no country, also, as a necessary corollary, are we likely to find its influence as a cause of consumption and scrofula, and of cachectic diseases in general, more fully de- veloped ; these dire affections, according to the philosophical idea of M. LUGOL, being destined to purify the human race from contaminated stock, and thus to prevent its continuous and final deterioration. The difficulty, however, which we should experience in establishing any kind of medical super- intendence over the abandoned classes of society, and the moral objection which may be raised, with a certain appear- ance of correctness, to the marshalling of the vicious, even for general sanatory purposes, is perhaps a sufficient reason why no attempt of the kind has been made amongst us. In various continental countries, on the contrary, the public authorities have considered it their bounden duty to endea- vour, by every means in their power, to arrest the progress of a pestilence, the effects of which on society at large are so deplorable. In their philanthropic ardour, they have not allowed themselves to be arrested by the difficulties and ob- jections to which we have alluded, but have boldly interfered with vicious habits for the humane purpose of protecting the morals and the health of the general population. Nor have their efforts, startling as it may appear, been unattended with suc- cess. In the large towns of France, where a vigilant scrutiny has been for some time exercised on women of abandoned cha- racter, syphilis is very much less common than it was previous to the adoption of these measures, and the intensity of its manifestation is also diminished. This is no doubt owing to a large proportion of the cases falling under the eye of medical men at the onset. But it is in BELGIUM that the authorities have been most active, that the principle of interference has been carried to the greatest extent, and that the most marked results have been obtained. It is more especially within the last three or four years that the attention of the Belgian government and municipal authorities has been directed to the prevention of the propagation of this disease. The mea- sures adopted have been most ingenious, and have been so successful, that the malady has been nearly exterminated in the army,-in all other countries, a great focus of the syphilitic affections. The sanatory measures which have been adopted in Belgium within the last few years, in order to diminish the ravages of syphilis, may be ascribed to the Belgian Royal Academy of Medicine. Previous to 1842, little or no attention was paid
AT the hour of going to press, no "official" announcementhad been made by the Council of the College of Surgeonsrespecting the vote of censure which has been passed by themon the conduct of Mr. LAWRENCE. Consequently, the terms ofthe "resolution" in which the condemnation expressed by theCouncil was declared are unknown to the members of the
College. The silence thus doggedly maintained regardingthe insults offered to the members by Mr. LAWRENCE, makes it
appear to the world that the offensive conduct of that personhas been adopted by the aggregate body of the Council.
Probably it is considered, in Lincoln’s-inn-fields, that twelvethousand members of the College are not worthy of receivingan
" official" communication from the governing body of theirown institution.
It is understood that Mr. LAWRENCE has not yet tenderedhis resignation.
THE character of the monopoly which has been created andfostered in London by the Council of the College of Surgeons,acting, for many years, in their capacity as Surgeons of theLondon Hospitals, is tolerably well illustrated in the follow-ing paragraph, extracted from an advertisement, issued bythe LONDON OPHTHALMIC HOSPITAL, which appeared in the
daily papers of Wednesday last. Mr. SCOTT, one of the sur-geons of that hospital, having resigned, the profession arehere made acquainted with the kind of persons whom the by-laws of the hospital describe as alone qualified to fill the va-cated situation.
" ROYAL LONDON OPHTHALMIC HOSPITAL, MoORFIELDS." By rule twenty-three, a candidate for the office of surgeon
must be a surgeon of a metropolitan hospital, or have served anapprenticeship, or be, or have been, a demonstrator of anatomyat a metropolitan hospitad.-Dated this 2nd day of MlJ.rch, 1846."The members of the College being thus shut out from im-
portant offices in our public institutions, are then taunted with"not being capable of acting as surgeons." They are first
injured by the Council, and then grossly insulted because theyhave been injured.
WITHOUT attributing to the disease, called SYPHILIS,-thatdireful plague of the human race,-the mysterious importancewith which the more than quackish, or half-cracked followersof HAHNEMANN invest it,-following, in this respect, theerratic footsteps of their visionary master,-we cannot denythat the propagation of syphilis is one of the most potentcauses of the deterioration of mankind, and one of the greatestevils, physical as well as moral, to which the human race is
liable. Were the disease merely to affiict those persons whohave exposed themselves to contagion in the haunts of vice,it might be considered merely a just punishment for moraldepravity. But such is not the fact. The innocent victimsof syphilis are infinitely more numerous than the guilty; forit is a disease which follows vice and crime down to " thethird and fourth" generations; syphilis in the parents being, itis generally considered, one of the chief causes of scrofula,pulmonary consumption, and other fatal and distressing dis-eases in their children.
Under such circumstances, it will at least be admitted,that it is a question worthy of consideration, whether it maynot be wise for a government to adopt measures to preventthe propagation of this malignant and destructive malady,with the humane object of protecting future generations fromearly decay and death. We are thus guarded in putting thequestion, because we are well aware that it is the generalopinion in this country, that any interference with viciouspursuits, for sanatory purposes, is an indirect sanction of suchpractices, and is, therefore, to be condemned.Acting on such views in this country, syphilis has been left
to itself ; it has exercised its ravages on multitudes of thepopulation, unrestricted, uncontrolled. The result is, that inno part of the world, we believe, in accordance with thegenerally-received opinion of the profession, is there more sy-philis, as compared with the population, than in Great Britain;and in scarcely any is the disease seen in a more virulentform. In no country, also, as a necessary corollary, are welikely to find its influence as a cause of consumption andscrofula, and of cachectic diseases in general, more fully de-veloped ; these dire affections, according to the philosophicalidea of M. LUGOL, being destined to purify the human racefrom contaminated stock, and thus to prevent its continuousand final deterioration. The difficulty, however, which weshould experience in establishing any kind of medical super-intendence over the abandoned classes of society, and themoral objection which may be raised, with a certain appear-ance of correctness, to the marshalling of the vicious, even forgeneral sanatory purposes, is perhaps a sufficient reason whyno attempt of the kind has been made amongst us.
In various continental countries, on the contrary, the publicauthorities have considered it their bounden duty to endea-vour, by every means in their power, to arrest the progress ofa pestilence, the effects of which on society at large are sodeplorable. In their philanthropic ardour, they have notallowed themselves to be arrested by the difficulties and ob-
jections to which we have alluded, but have boldly interferedwith vicious habits for the humane purpose of protecting themorals and the health of the general population. Nor have their
efforts, startling as it may appear, been unattended with suc-cess. In the large towns of France, where a vigilant scrutinyhas been for some time exercised on women of abandoned cha-
racter, syphilis is very much less common than it was previousto the adoption of these measures, and the intensity of itsmanifestation is also diminished. This is no doubt owing toa large proportion of the cases falling under the eye of medicalmen at the onset. But it is in BELGIUM that the authorities
have been most active, that the principle of interference hasbeen carried to the greatest extent, and that the most markedresults have been obtained. It is more especially within thelast three or four years that the attention of the Belgiangovernment and municipal authorities has been directed tothe prevention of the propagation of this disease. The mea-
sures adopted have been most ingenious, and have been sosuccessful, that the malady has been nearly exterminated inthe army,-in all other countries, a great focus of the syphiliticaffections.
The sanatory measures which have been adopted in Belgiumwithin the last few years, in order to diminish the ravages of
syphilis, may be ascribed to the Belgian Royal Academy ofMedicine. Previous to 1842, little or no attention was paid
280 SYPHILIS IN BELGIUlL-MEI3ICAL LEGISLATION.
to the subject, either by the municipal authorities or by with the most beneficial results. Whenever a soldier is at-
government. At the latter end of that year, M. SEUTiN, one tacked with syphilis, he is taken by a corporal or sergeantof the most influential members of the Academy, proposed before the commissary of police, and obliged-and that beforethat the learned body to which he belonged should formally he can be received into the hospital or treated-to state byrequest of the Minister of the Interior, to propose to the whom he was infected, or whom he suspects. This system islegislature the adoption of regulations c(Ûc:ulated to arrest the rigidly and successfully enforced, so that the source of con-progress of the syphilitic disease. A committee of the Academy, tagion is generally discovered when the diseased person is a-composed of five members, was named to investigate the soldier. In order to induce the latter to reveal the name and
subject, and after four months’ labour, made a very able address of the female through whom he suffers, variousreport through the medium of M. VLEMINCKX. In this report, punishments which were formerly inflicted on them when sothe absolute necessity of enforcing the five following resolu- affected, such as the stoppage of pay, distinctive marks, &c.,tions was strongly insisted upon :- have been withdrawn, in favour of those who conform im-
lst.-That all women publicly living by prostitution plicitly with the regulation. On the other hand, those whoshould be subjected to proper police regulations. refuse are punished, as also others who delay reporting to their2ndly.-That no prostitute should be allowed to walk or superior officers the fact of their suffering under the venereal
stand in the streets. disease.
3rdly.-That in all populous districts there should be one or These measures have been so successful, it appears, as
more medical men, and a commissary, specially intrusted with regards the ARMY, that it does not exhibit now more thanthe superintendence of prostitutes. one hundred and thirty venereal cases, on a total of thirty thou-
4thly.-That the communal (parish) authorities should have sand men. Moreover, the number would be even smaller, itadditional power to act against prostitutes in general, appears, were it not that in two towns, Gard and Namur, the
5thly.-That all persons attacked with syphilitical disease "sanatory police" has still to be satisfactorily established.should be admitted, without restriction or difficulty, into the At the same time that the frequency of syphilis has thus evi-
public hospitals. dently diminished in the army, it is also considered to have
These resolutions were adopted by the Academy, after a- become less frequent in private life, the number of cases ap-lengthened discussion. The deliberations, however, had plying for admission into the hospitals having much decreased.
reference, not to the views contained in the report, which The evident success which has attended the efforts thus
were unanimously approved, but to the propriety of the Aca- made, during the last three years, has, it would seem, stimu-
demy taking the initiative in recommending government to lated the Belgian authorities to make further exertions ininterfere with the functions of the municipal authorities, those the same direction, and it is confidently expected that thebodies not having been consulted on the subject. But the ob- disease will, in the course of time, be reduced to the mere
jection was, at last, over-ruled. The intervention of govern- shadow of the previous terrible malady.ment, however, became unnecessary, the civil authorities at It is likewise apparent that France is on the point of follow-once applying to the Academy for advice and assistance, on ing the example of Belgium, by endeavouring to render more
hearing of the discussion that had taken place. The Com- perfect its police regulations.mittee was re-appointed, and entrusted with the drawing up We shall resume this important and interesting subject.a series of rules, embodying the foregoing propositions. The
regulations framed by the Committee were at once carried SiNCE it was announced by the Government that the Medicalinto effect by the civil authorities. They are too voluminous Bills were abandoned, a conviction appears to have becometo admit of being printed at length in this place. But their prevalent amongst the profession that no well-founded hopemain features may be disclosed by stating that they carry into of a successful legislation in medical affairs can be entertained,effect all the views contained in the previous report. Not unless there be some general agreement as to the leading prin-only is an examination of all prostitutes, twice a week, by ciples on which the proceedings of Parliament should becompetent and well-remunerated medical functionaries, ren- based.
dered imperative, and every possible precaution taken to This view of the question has been entertained in THEensure its being efficiently enforced, but, in addition, active LANCET throughout the discussion. Often have we empha-measures are taken to ferret out every case of syphilis with tically declared that no good Medical Bill would ever pass the9, view to stop the propagation of the disease. legislature if it did not receive the hearty support of a large
It is in this latter respect, more especially, that the measures majority of the professional body.adopted by the Belgian authorities differ from those pursued Strenuous efforts ought to be made, at the present importantin France, and in other continental countries. Thus, the crisis, to obtain from all the constituted medical authoritiesmedical officers of the venereal hospitals, and of all other statements of their wants in medical legislation. In London,hospitals and dispensaries, are requested to ask of their vene- the respectable and influential COMMITTEE OF ASSOCIATED
real patients the names and addresses of the persons by whom SLRGEOVS are prosecuting their labours, with a view to accom-they were infected. These are handed to the police, and when plish that object in the College of Surgeons of England. The
it is possible, that is, when the culprits are prostitutes, they PHYSICIANS ought to take similar steps with respect to theirare at once examined, and if found infected, taken to the College, and the medical Faculties of the Universities andhospital to be treated. These arbitrary measures, as may be their graduates would show a prudent forethought by noteasily supposed, are not susceptible of being carried to any being idle or inactive at such a juncture. If any of the
great extent with ordinary patients in civil life, but in the Institutions have schemes to propose, their intentions cannot
army they have been enforced with the utmost rigour, and be too promptly published. On the contrary, if they have no
281AS RELATING TO IRELAND AND SCOTLAND.suggestions to offer, that fact cannot be too speedily known. same time, to students of medicine, the best rules and regu-Whatever may be their intentions or objects, a sense of lations for their guidance and government in the progress ofhonour and justice ought to induce the governing bodies no their studies.
longer to parley or dally with a subject so vitally interesting By whom can such labours as these be so appropriately un-to humanity and science as the question of medical legislation. dertaken as by the governing bodies in Dublin and Edinburgh,Quackery is absolutely rampant, and the respectability, the and by the many eminent and able practitioners residing inutility, and almost the existence of the profession, (as a pro- those cities, and in the countries in which they are situated ?fession) are threatened. Thoroughly acquainted with the state of things around them-The wise rejection, by the Minister, of the project for estab- with all the local conditions and interests-with the effects
lishing a second Apothecaries’ Hall, has cleared the ground resulting from the operation of the existing laws-no otherwhich had previously been occupied by large numbers of faith- persons can be half so capable of executing such a task asful and able reformers, of an obstacle which was suddenly and themselves. Will they undertake it?-or will they decline tounwittingly interposed between the intentions of the govern- make a single combined effort for their own protection andment and the views of the mass of the profession. future welfare? As they all admit that legislation is neces-This difficulty having been removed by the determination of sary, how can they, consistently with honour and justice,
Sir JAMES GRAHAM no longer to regard such a project as ex- refuse to make a trifling effort to render it as perfect as pos-hibiting the opinions of any number of the scientific and sible ?
influential members of the medical fraternity, there is every Again, then, do we appeal to the authorities in Dublin andreason to believe that immediate measures will be adopted in Ireland, and in Edinburgh and Scotland, to awaken fromthis metropolis, for ascertaining what are really the views of their lethargy, and to take immediate steps towards obtain-the corporations and the. profession generally, relative to the ing for such scheme, as they may deem best for their
chief provisions of a Medical Bill. respective countries, the introduction into Parliament of aWhile such a work is proceeding in London and England, Bill which it is hoped will obtain the sanction of Her
ought the profession to remain idle and inactive in Edin- Majesty’s government. Unsupported by the general approvalburgh and Scotland, and Dublin and Ireland ? 1 of the profession, no Medical Bill is likely to be enacted intoOn this subject, we admonished the whole body of a law; but the rejection even of a very good Bill is certain,
the profession last year, and now we repeat the admo- although approved by the profession generally, if the con-nition. Will they be content to see the medical profession stituted medical authorities employ all their corporate and
entirely controlled and regulated in London ? Will they public and private influence in opposition to its enactment.be content to see only one "Council of Health," and that Instructive and painful is the lesson which a lengthened ex-Council always sitting in London ? That the registration perience has taught us on this subject. But on these accounts.
ought to be conducted in three divisions, is, to our minds, it is not the less valuable.
a self-evident proposition, which admits of no refutation, and The leading matters which the governing bodies of thethe force of it cannot be weakened, either by sophistry or medical corporations in Ireland and Scotland should be calledargument. The cause of medical science and the protection upon to consider and determine, would be, the mode of electingof medical interests in Ireland and Scotland ought to be ob- their govern ing medical Councils, and the mode of selecting from themjects of as high interest with the legislature as are similar a member, or Memoes, to act in a Sup’reme Council of Medicine.
purposes in England. It is not just to either Ireland or Scot- The numbers of which the Council for Ireland and Scotland
land to refuse to the profession in those countries a governing should be composed-the qualifications of the members of suchelective Council, and the system of registration for qualified Councils-whether they should be paid for their services, and
practitioners, as perfectly and as effectively in all respects as how paid-the powers which should be confided to them-
any that can be adopted and enforced in England. Out of the whether the system of ecluecctioza should be defined in the Bill,Councils in the three countries, assuredly a supreme medical or whether it should be left to be controlled by the GeneralCouncil might be chosen ; the departmental bodies being or by the National Councils-what plan of registration it wouldentrusted with the discharge of certain duties pertaining to be best to adopt-whether all legally qualified practitionerstheir own institutions; but measures affecting the profession should be registered as such, alphabetically, with a descriptionmore extensively being subject to the control or rule of a of their qualifications appended to their names, or whether
chief or supreme Council. The registration in Scotland and they should be registered, in classes, as PHYSICIANS, SURGEONS,Ireland could not, with justice to those countries, be conducted AccoucHEURS, APOTHECARIES;—whether practitioners, on re-in London. This must be admitted. ceiving their diplomas in one country, should be immediatelyWe would, then, most earnestly impress on the medical entitled to practise in another camztrg, without undergoing any
corporations of Dublin and Edinburgh, and the members of other examination, or being required to pay any additional fees,the profession connected with them, the necessity of at once and if not so entitled immediately, what time ought to elapsetaking this subject into their most serious consideration. For before the right should be acquired;—whether practitionersthe medical institutions and profession in each country they receiving their diplomas in utediciue should be allowed toought to devise such a system of government as would enable practice surgery, and rice versa;whether examinations shouldit most successfully to cultivate the science of medicine-to be conducted at different institutions, or carried on by oneshield the community against the practices of the fraudulent Board, chosen by the different Colleges, and how the governingand infamous quacks-to protect the legally-qualified medical bodies of the College,3 should themselves be chosen;—whetherpractitioners in the exercise of their legal professional rights, graduates in medicine only, or surgery only, should be entitledand all just and honourable privileges-offering, at the to register, and, consequently, to practise, without receiving
282 HOSPITAL REPORTS.-STRANGULATED HERNIA.
a diploma from any College of Surgeons, or College of Phy-sicians and Surgeons, or by a joint Board appointed by thoseColleges; whether registered practitioners should be entitledat law to recover charges for attendance and professional ser-vices, and for medicines supplied by them to their patients,and whether the dispensing of medicines to their patientsshould disentitle them to any professional privileges, and, ifso, to specify them;--whether the public should be allowed toselect candidates to fill public medical offices, indiscriminately,from the Register; or whether they should be compelled tochoose from specific classes of practitioners; an accurate de-scription of the diplomas, licences, and other testimonialswhich should entitle persons now practising in any of thedepartments of medicine, to be placed on the Register in
the first instance; what should be the nature, the mode, andthe amount of punishment inflicted on uzaregistered medical ipractitioners;-whether the sale of quack or secret medicines ’,should be interdicted, and, if so, by what means; and whetherthe sale of secret medicines, by legally-qualified practitioners,should subject the sellers to the erasure of their names fromthe Register,-whether persons carrying on the business ofchemists and druggists should be registered, and, if so, bywhom;-whether unregistered chemists and druggists shouldbe subjected to any penalty, and, if so, by whom, and whatshould be its nature and amount;-whether any restrictionshould be imposed to prevent the present dangerous indis-criminate sale of poisons, and, if so, of what descriptionit should be ;-whether, the five-years’ apprenticeship clauseof the Apothecaries Act being repealed, it would be advisablethat pupils should be articled for any term, such as one ortwo years, to qualified medical practitioners, and, if so, atwhat age such an articled pupilage should commence;-whether there should be any preliminary examination of such
pupils, what should be its nature, and by whom conducted;how many examinations should take place before the diplomais granted, and at what period they should be enforced; andwhether there should be sessional examinations at the schools
and certificates granted for them.All these subjects have repeatedly been discussed in the
Medical Associations of London, and recently they have en-
gaged the attention of the Councils of our Colleges. The
opinions of the profession in this country, with regard to themost important of them, are tolerably well known. Can
suggestions of this description, embodying almost all the
points of interest in medical education, government, anc
practice, be submitted to the notice of the profession in Ireland and Scotland, with a knowledge of the fact, that a Billrelating to the entire subject, is to be introduced into Parliament during the present session, without exciting in thosfcountries the gravest attention? î
LONDON HOSPITAL.A boy, aged about 14 years, riding on a gate, was capsized, andfalling on his hands, produced a dislocation of the radius for-wards.
WHEN brought to the hospital, the following were the symp-toms:-The forearm was semiflexed and semiprone, attendedwith inability either to extend or flex it completely, or to ren-der the hand more or less prone; a twisting and flattening ofits upper part; and the head of the radius could be perceivedin front of the elbow-joint, and opposite the upper part of thecoronoid fossa of the humerus, and a depression in its normal
locality. On attempting forcibly to flex the forearm, a pecu-liar and very characteristic interruption was produced, by thehead of the radius striking against the humerus, between itscondyles. The tumefaction and pain were comparativelylittle.
Reduction.—Counter-extension being made from the lowerpart of the arm, the forearm was gradually extended from thehand, held as in shaking hands, supination being at the sametime attempted, and assisted by pressure with the operator’sthumb against the upper part of the radius: in a few secondsthe dislocation was reduced. Flexion and extension couldthen be made by the patient himself, who was anxious to ex-hibit his recovery of power, and not the slightest reappearanceof dislocation was perceived on his so doing.The joint was then confined on an angular splint, and spirit
lotion applied. Very little inflammation ensued, and in amonth from the time of the accident he was discharged, the- forearm at the time being strong, and perfectly symmetrical.
Remarks.—This case presents a remarkable contrast withthe generality of those on record-first, as regards the reduc-tion, which was so easily effected; and secondly, in the ab-sence of that great tendency to re-dislocation, said so com-monly to exist in these cases.
CASE 1.—PHILIP F , aged fifty-four, was admitted 24thDecember, 1845. Strangulation commenced on the morning ofthe 22nd. There has been hernia in the same situation forabouttwenty-five years,never entirely reducible.and on several occa-sions he has suffered temporary incarceration. No stool sincethe 21st; symptoms very urgent; severe pain across the navel;frequent vomiting; tenderness and pain in the tumour; pulsefrequent; great anxiety and restlessness; loud complaining ofthe feeling of tension and fulness of abdomen. On the 20th hewas attacked with pain and sickness; pain continued to in-crease so as to be very severe on the 22nd, when the vomitingbecame more frequent and the distress more urgent. Tumourlarge, rising above Poupart’s ligament, which is indistinct,from a quantity of loose subcutaneous tissue. The swellingappears to consist of two equal portions. At the internal andinferior part the integument is reddened and tender to touch.A feeling of fluctuation is conveyed to the finger, as if this werea small glandular abscess situated on the hernial protrusion.The whole swelling is remarkably tense-no impulse is con-veyed by coughing. After a very short trial of the taxis theoperation was proceeded with. A long incision was madeobliquely across the front of the tumour. The thick adiposetissue was carefully divided down to the sac, which was foundto be separated into two equal portions, by a band of fibroustissue, very distinct, when the sac was partly uncovered,much resembling a large bubo, consisting of two glands in astate of suppuration. The surface of the sac was smooth,tense, very thick, and firm; it could, however, be nipped updistinctly from the contained parts, except quite at the infe-rior and internal angle opposite to the external reddening.It was opened where it could be nipped, and the incision wascarried across the whole length. The sac was found to be
remarkably thick: the contents, on opening it, appeared to beomentum only, adhering slightly to the interior of the sac.On separating these attachments, and raising the omentum,there was discovered a knuckle of intestine, two inches inlength. The colour of the intestine was a deep mottledpurple, with the surface covered by a fibrinous exudation; noappearance of gangrene. The stricture was divided upwardsand inwards, and the intestine was drawn down a little; asthe portion immediately above the stricture was found unin-jured, the knuckle was returned. The large, long portion ofomentum, which was firmly adherent to the upper and outerpart of the neck of the sac, was cast off. The divided surfacedid not yield a single drop of blood. In a former case, de-tailed in TUE LANCET, 26th August, 1843, the omentum wasleft adherent, and perhaps occasioned vomiting, by bringingdown the stomach. The two edges of the wound were broughttogether by suture, wet lint applied, and then a large sponge,retained by a bandage. Forty minims of Battley’s solution.Catheter used; fomentation to the leg.25th.-Passed an excellent night; bowels freely opened;
quite comfortable; pulse 90, soft; skin natural.29th.-Has gone on without any bad symptom. Towards
evening he has had usually a good deal of flatus with accele-ration of pulse. This disturbance was always relieved by twograins of opium, which he has taken nightly. He does not