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783 URETHROTOMY OR LITHOTOMY IN AGED OR DEBILITATED PERSONS. To the Editor of THE LANCET. SIR,-Having read in THE LANCET of November 1st, 1873, a paper by Mr. W. L. Crowther, headed as above, it has been thought desirable by myself and other medical men here that the following facts in connexion with the so-called "urethrotomy and dilatation of the prostate" should receive as much publicity as Mr. Crowther’s statements, in order that the profession may fully understand the merits of the operation advocated. The following table embraces the whole of the cases operated on by Mr. Crowther at the Hobart Town General Hospital during a period of about nine years :- R. N.-This patient is recorded as having been dis- charged on the 10th of November, 1862, but there was at that time a fistulous opening in the perineum through which the whole of the urine passed; my diagnosis of the case being that in the attempt to dilate the prostate the mem- branous urethra had been torn through. The boy was re- admitted for the purpose of having this cured. He remained in hospital for upwards of five years, and was then dis- charged without anything further having been done. C. H.-I made a preparation of this man’s bladder. The prostate was so extensively lacerated that the little finger could be laid in the rent. So far as is known by medical men here, Mr. Crowther’s experience in lithotomy extends to fifteen or sixteen cases- I may safely say under twenty,-these embracing both pri- vate and hospital practice. The whole of the hospital cases are recorded above ; and, of the private cases, one death at least is known to have occurred; in another case, at which I was present, the calculi, three in number, were of such a size (the largest being little greater than a small bean) that one crush from a lithotrite would have readily reduced any of them to powder.-I am. Sir. vours obedientlv. GEORGE TURNLEY, Surgeon-Superintendent. General Hospital, Hobart Town, March 23rd, 1874. THE MECHANICAL TREATMENT OF FACIAL PARALYSIS. To the Editor of THE LANCET. SIR,-The discomfort and helplessness experienced by patients labouring under facial paralysis has led me to try some simple mode of mechanical assistance. The greatest difficulty is overcome by the employment of limp flesh-coloured silk plaster, which adheres without irri- tating, and does not interfere with the movement of the skin. In a case of ptosis of some years’ standing, a narrow strip of the plaster is applied from the edge of the eyelid over the eyebrow, so that it corresponds with the open lid of the other eye. I find, then, that in the use of the orbioularis the frontal muscle relaxes, and permits the eye to close, the lid being connected with and opened by that muscle. In this instance perfect relief is afforded, the patient making the applications herself. In cases of facial paralysis I have found that the distortion can be greatly remedied by the ap- plication of a strip of the plaster from the corner of the mouth to the temple. This overcomes the tension of the other side, and gives the facial muscles fixed points to make use of, and so develop the slightest contraction to aid re- covery. It also gives the tongue more freedom, and pre- vents the cheek from falling between the teeth. Where no improvement is possible, great comfort is afrorded by the plan, which is, of course, supplementary to constitutional treatment I am qir- yours friilv- FREDERICK H. SMITH, M.D. Lewisham-hill, S.E., May 12th, 1874. THE NAVAL MEDICAL SERVICE. To the Editor of THE LANCET. SIR,-The thanks of the Naval Medical Service are due to THE LANCET for the able advocacy of their cause which has lately appeared in its columns. No doubt it has been dis- tasteful to some that such matters should form the theme of comment, as is evident from the paragraph which ap- peared last Saturday in a naval contemporary so singularly ill-informed in matters purely professional as to propagate an opinion, so glaringly inconsistent with facts, that the Naval Medical Service is a popular one-done apparently in total ignorance of Mr. Ward Hunt’s admissions in Parlia- ment, and his regrets that resignations of young surgeons were daily coming before him. Setting that aside, how- ever, as unworthy of serious comment except to show how the official wind blows, I would trespass on your space to bring publicly to notice at the present juncture a circum- stance that has done more injury to the department than the authorities are probably aware of. I allude to the appoint- ment of a civilian to Greenwich Hospital for the perform- ance of medical duties. At the time the destruction of that ancient institution was effected the medical staff, which was looked upon as the "blue ribbon" of the service, was abolished. The school alone remained to be provided for, and a staff-surgeon of high reputation was appointed to it, who, after a few months’ service, found himself superseded by a young civilian totally unconnected with the navy. And this injustice was committed without the slightest considera- tion for the staff-surgeon. The whole business was felt to be an injury to a deserving officer, an insult to the class, and is now a standing opprobrium to the service. When the question was mooted in Parliament last session hopes were held out that the arrangement was tentative only, and open to alteration; but I trust the time has now arrived when such a standing insult to the whole Naval Medical Service will be removed. - remain, Sir, yours &c., 17th May, 1874. MEDICUS. AFRICAN FEVERS. To the Editor of THE LANCET. SIR,-I notice in your number of Nov. lst, 1873, in an annotation on African Fevers, the following sentence :- H Dr. Comrie, the surgeon of the Dido, states that the re- missions are apparent only, the clinical thermometer showing no change of temperature, &c." Without for a moment doubting the correctness of his observations, the more so that I remember a physician of considerable experience in West Africa saying to me that he had never seen a case in which there was remission or intermission, I send you notes of two cases which happened at Cape Coast this year, and say that in my own person and according to the descriptions of patients, the feelings of ease and apyrexia, and their converse, constantly correspond with the changes shown by the thermometer.

URETHROTOMY OR LITHOTOMY IN AGED OR DEBILITATED PERSONS

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Page 1: URETHROTOMY OR LITHOTOMY IN AGED OR DEBILITATED PERSONS

783

URETHROTOMY OR LITHOTOMY IN AGED ORDEBILITATED PERSONS.

To the Editor of THE LANCET.

SIR,-Having read in THE LANCET of November 1st,1873, a paper by Mr. W. L. Crowther, headed as above,it has been thought desirable by myself and other medical

men here that the following facts in connexion with theso-called "urethrotomy and dilatation of the prostate" shouldreceive as much publicity as Mr. Crowther’s statements, inorder that the profession may fully understand the meritsof the operation advocated.The following table embraces the whole of the cases

operated on by Mr. Crowther at the Hobart Town GeneralHospital during a period of about nine years :-

R. N.-This patient is recorded as having been dis-charged on the 10th of November, 1862, but there was atthat time a fistulous opening in the perineum through whichthe whole of the urine passed; my diagnosis of the casebeing that in the attempt to dilate the prostate the mem-branous urethra had been torn through. The boy was re-admitted for the purpose of having this cured. He remainedin hospital for upwards of five years, and was then dis-charged without anything further having been done.

C. H.-I made a preparation of this man’s bladder. Theprostate was so extensively lacerated that the little fingercould be laid in the rent.

So far as is known by medical men here, Mr. Crowther’sexperience in lithotomy extends to fifteen or sixteen cases-I may safely say under twenty,-these embracing both pri-vate and hospital practice. The whole of the hospital casesare recorded above ; and, of the private cases, one death atleast is known to have occurred; in another case, at which Iwas present, the calculi, three in number, were of such asize (the largest being little greater than a small bean) thatone crush from a lithotrite would have readily reduced anyof them to powder.-I am. Sir. vours obedientlv.

GEORGE TURNLEY,Surgeon-Superintendent.

General Hospital, Hobart Town, March 23rd, 1874.

THE MECHANICAL TREATMENT OF FACIALPARALYSIS.

To the Editor of THE LANCET.SIR,-The discomfort and helplessness experienced by

patients labouring under facial paralysis has led me to trysome simple mode of mechanical assistance.The greatest difficulty is overcome by the employment of

limp flesh-coloured silk plaster, which adheres without irri-tating, and does not interfere with the movement of theskin.In a case of ptosis of some years’ standing, a narrow strip

of the plaster is applied from the edge of the eyelid overthe eyebrow, so that it corresponds with the open lid of theother eye. I find, then, that in the use of the orbioularisthe frontal muscle relaxes, and permits the eye to close, thelid being connected with and opened by that muscle. Inthis instance perfect relief is afforded, the patient makingthe applications herself. In cases of facial paralysis I havefound that the distortion can be greatly remedied by the ap-plication of a strip of the plaster from the corner of themouth to the temple. This overcomes the tension of theother side, and gives the facial muscles fixed points to makeuse of, and so develop the slightest contraction to aid re-covery. It also gives the tongue more freedom, and pre-vents the cheek from falling between the teeth. Where noimprovement is possible, great comfort is afrorded by theplan, which is, of course, supplementary to constitutionaltreatment I am qir- yours friilv-

FREDERICK H. SMITH, M.D.Lewisham-hill, S.E., May 12th, 1874.

THE NAVAL MEDICAL SERVICE.To the Editor of THE LANCET.

SIR,-The thanks of the Naval Medical Service are due toTHE LANCET for the able advocacy of their cause which haslately appeared in its columns. No doubt it has been dis-tasteful to some that such matters should form the themeof comment, as is evident from the paragraph which ap-peared last Saturday in a naval contemporary so singularlyill-informed in matters purely professional as to propagatean opinion, so glaringly inconsistent with facts, that theNaval Medical Service is a popular one-done apparentlyin total ignorance of Mr. Ward Hunt’s admissions in Parlia-ment, and his regrets that resignations of young surgeonswere daily coming before him. Setting that aside, how-ever, as unworthy of serious comment except to show howthe official wind blows, I would trespass on your space tobring publicly to notice at the present juncture a circum-stance that has done more injury to the department than theauthorities are probably aware of. I allude to the appoint-ment of a civilian to Greenwich Hospital for the perform-ance of medical duties. At the time the destruction of thatancient institution was effected the medical staff, which waslooked upon as the "blue ribbon" of the service, wasabolished. The school alone remained to be provided for,and a staff-surgeon of high reputation was appointed to it,who, after a few months’ service, found himself supersededby a young civilian totally unconnected with the navy. Andthis injustice was committed without the slightest considera-tion for the staff-surgeon. The whole business was felt tobe an injury to a deserving officer, an insult to the class, andis now a standing opprobrium to the service. When thequestion was mooted in Parliament last session hopes wereheld out that the arrangement was tentative only, and opento alteration; but I trust the time has now arrived whensuch a standing insult to the whole Naval Medical Servicewill be removed. - remain, Sir, yours &c.,17th May, 1874. MEDICUS.

AFRICAN FEVERS.To the Editor of THE LANCET.

SIR,-I notice in your number of Nov. lst, 1873, in anannotation on African Fevers, the following sentence :-H Dr. Comrie, the surgeon of the Dido, states that the re-missions are apparent only, the clinical thermometer showingno change of temperature, &c."Without for a moment doubting the correctness of his

observations, the more so that I remember a physician ofconsiderable experience in West Africa saying to me thathe had never seen a case in which there was remission orintermission, I send you notes of two cases which happenedat Cape Coast this year, and say that in my own person andaccording to the descriptions of patients, the feelings ofease and apyrexia, and their converse, constantly correspondwith the changes shown by the thermometer.