Imágenes de páginas
PDF
EPUB

returned into the country. The correctness of the diagnosis cannot therefore be determined.- Lancet.

GANGLION OF TIIE WRIST.

By Robert BURNETT, F.R.C.S.I., L.K.Q.C.P.I., of Tullow, Respecting the treatment of Ganglion of the Wrist," described in the article on this disease in The Medical Press of last week, where the extreme measure of excision of the diseased structure is recommended, I beg to offer the plan I pursue in such cases as much less painful, without danger, and equally as certain of cure in the results-namely, that after rendering the parts tense by bending the hand at the wrist, you make a subcutaneous incision at the side of the tumour with a narrow-bladed sharp-pointed bistoury, next carried horizontally through the same, dividing it into equal portions. Retain some of its contents in the wound, and apply a compress containing in its folds a thin piece of lead or a small copper coin, and applied firmly over the incision supported by a bandage to be kept moist by the employment of cold water should any pain or heat be felt.

The removal of these dressings after a few days will exhibit the parts perfectly amalgamated, and after the lapse of some years I can produce parties thus treated without the least appearance of the disease.

ACTION FOR DAMAGES: ACUPRESSURE. At Kilmarnock, last week, Dr. John Caldwell sued one Hamilton, residing near Dreghorn, for L12 damages for defamation of his professional character. Defender's son was wounded in the leg by a scythe ; and pursuer, on being called, found that the posterior tibial artery had been cut. He thought it a good case for the method of acupressure introduced by Dr. Simpson two or three years ago. He accordingly applied needles and bandaged the leg, which he said effectually stopped bleeding. On the ninth day after, secondary hæmorrhage ensued and the same treatment was repeated; and again a third time. On the fourth occasion (September 13th), he cut up the limb in order to get at the artery, but finding it rotten up to the knee-joint, he sent for a tourniquet and screwed it on, to give time for a consultation. He then went for a few minutes into a neighbouring house, during which time the boy died. After he left, pursuer stated that the boy's parents had allowed him to unserew the tourniquet, contrary to express instructions. It was complained that defender had subsequently said to different persons that pursuer had - murdered" or " killed” his son. The defence was that the expres

44

[ocr errors]

sions libelled on were not used; but it was attempted to be shown that acupressure was not a fit mode of treatment in the circumstances, and should not have been persisted in. Dr. McLeod approved of his treatment in every respect. Dr. Campbell thought it was unjustifiable to use needles at the depth of the posterior tibial artery, and said that the proper mode would have been to tie up the artery with ligatures. He also thought it was wrong of pursuer to enter on the last operation without professional assistance, as the parties who held the artery by thumb pressure could not do it properly unless they had a knowledge of anatomy. From the evidence, as to the expression complained of being used, the Sheriff held that it had been substantially proved. He also held that it had not been proved that Dr. Caldwell had erred in any one particular. and his lordship therefore decerned £5 damages. --Glasgow Herald.

Midwifery and Diseases of Women and Children.

DELIVERY DURING SLEEP.

By ADOLPICS SAMELSON, M.D., Manchester.-In the evening of February 22nd, 1814, I was sent for to Zabelsdorf, a village near Zehdenick, in the Uckermark, where I then resided (some thirty miles from Berlin), to attend a case of labour. Hannah Rohde, the wife of a farm-labourer, about forty years old, of middle size, spare habit, and sallow complexion, having had eight children, of whom three were living, had passed easily through all her confinements; but, immediately after several of the births, especially after the eighth, she had for a short time been unconscious.

At about one a.m., on the above day, some blood was first observed to come from the vagina; however, it stopped again, when about nodn a more copious flow set in, which now continued through the afternoon, and soon associated itself with unconsciousness. At 7.30 p.m.—the time of my arrival—I found the os uteri pretty well dilated, and the membranes fairly distended, but the head placed quite to the right, and still so high that the particulars of the presentation could not be verified. Towards the right, partly in front, and partly to the side of membranes, the placenta could be felt. The flooding had ceased. The woman did not recognize any one, and answered incoherently. The pulse, but little accelerated, and at first weak, became somewhat fuller soon after my arrival. The skin perspired moderately. During the afternoon, ode single pain had been felt. From time to time the membranes grew a little more tense, but the woman made no complaint; she only appeared

to feel rather hot. She was placed on her left side—that opposed to the uterine tumour. She kept pretty quiet in this posture, appeared to sleep tranquilly, and after a time awoke a trifle more conscious. Soon, however, she relapsed into her doze. A few slight twitchings of the arms had been observed meanwhile. At ten o'clock the messenger returned, who had been sent for some crgot to the town, about six miles distant. At five minutes past ten, I gave half one of the ten-grain powders ordered. Almost immediately a labour came on; but, even before it was observed, the woman exclaimed, “ The water !" The membranes were ruptured; the head had at once descended lower : it soon placed itself right in the middle of the pelvis, and came further down. Fifteen minutes after the first, the woman got another dose of ergot, of two and a half grains only (the midwife in attendance having mistakenly once more divided the half powder left); fresh labour-pains ensued, which. thirty-five minutes after ten, caused the face of the child to appear at the outlet. The entire body followed rapidly, and was immediately succeeded by a great gush of blood, welling out in two or three large

Within a few minutes more, the placenta, perfectly normal, came away; the funis was rather short.

The child, a middle-sized male, was some little time before he made himself heard. Only by degrees the woman's consciousness returned; she felt weary, and was much inclined to sleep. Soon after eleven o'clock she had recovered her senses, and was not a little surprised at what had happened. The uterus kept contracting satisfactorily; nothing unusual further occurred. The number of pains had been seven or eight in all. As a stimulant, about three tablespoonfuls of poor Sauterne wine had been consumed during the process.- Brit. Meil. Journal.

Taves.

RUPTURE OF THE ABDOMINAL PARIETES AND ISSUE OF A LIVING

CHILD. Dr. Geisseler relates the following extraordinary case:- A woman was found in a stable trodden under foot by a bull, and at the point of deathThe horn of the animal had passed under the edge of the ribs in the right hypochondrium, and had torn the parietes in nearly a transverse direction as far as the left side. The intestines were torn and extruded, and the upper part of the uterus was carried clean away, with the exception of a portion on the right side, to which the placenta was still attached. The os uteri was closed. A full-timed, strong male child was in this way liberated uninjured from the womb, and screamed loudly. The funis was twisted several times round the neck, a piece of torn placenta remaining attached to it. — Medical Times and Gazette.

[ocr errors]

Canada Medical

Medical Journal.

H

MONTREAL, DECEMBER, 1865.

PROFESSIONAL REMUNERATION,

a

The honorurium, which medical men should receive for the exercise of their skill and professional knowledge, has, within the past few months. been greatly discussed by the Medical Journals of the mother country. Strange to say, there is no recognised tariff in Great Britain—the fees differing in England, Ireland, and Scotland, and even varying in differ ent sections of these countries. As might be expected from this condi tion of things, when an account becomes disputed, there is no lack of medical men to attest its reasonableness, while an equal number can be obtained to swear quite the contrary. Unseemly as this may appear, it has been a circumstance of somewhat frequent occurrence of late—thi last instance being the case of a Mr. Irving, Surgeon of Liverpool, wb sued the executors of a wealthy estate for a long and disagreeable attend ance upon its proprietor, and a brief attendance upon a niece's child-th. amount sued for being £250. The patient first came under Mr. Irving care for gleet and stricture, the prostate gland being greatly enlarged he subsequently, on the 1st of January, 1864, applied for the cure of a virulent attack of gonorrhoea and chancre—the stricture being From this time till his death, which took place on the 4th of March, 1865 Mr. Irving was constantly in attendance. During the attendance orebitis supervened, for which the scrotum was incised, retention of urine frequently took place, for which the catheter had to be employed-typhu» fever showed itself on the 26th July, 1864, convulsions having occurred on the morning of the 24th, and on that day and night the patient was visited ten times by Mr. Irving. Finally softening of the brain occurred which eventually carried the patient off. Mr. Irving in his bill made the following his scale of charges : office consultations, 2s.6d; giving an injection, 2s. 6d.; visit, 5s. ; passing the catheter, 10s. 6d. Some of the most eminent medical men of Liverpool and vicinity came forward voluatarily, and attested under oath their belief in the reasonableness and moderation of the charges, which were less than they would expect under

WOS

similar circumstances, and the necessity which might often exist for a practitioner to visit a patient during a day and night as often as ten times. One who had been an assistant to Mr Spence of Edinburgh, now Professor of Surgery in the Edinburgh University, asserted that for passing a catheter, Mr. Spence never received less than two guineas, and very often as much as five guineas. On the other hand two medical men were produced on behalf of the defence, who reduced the bill to £80 9s. 6d., asserting that the fees were exorbitant, and that 2s. 6d. was an ample fee for passing a catheter, no matter how difficult. Judgment was however given for £190 9s. 6d. This decision has, as we before stated, caused a good deal of discussion, the leading journals of our profession having taken the matter up. The bad results of not having a settled scale of fees is ably argued by the London Medical Times and Gazette, which suggest that the Britis! Medical Association, as the organ of British medicine, should act on this matter. The Times and Gazette says: * We think by such a work, well done, the Association would earn the gratitude of the whole profession. Of course the task would be neither casy nor light, and it would not be possible to draw up a table which could invariably and under all circumstances be applicable, but still a scale might be framed which would be of great value as a standard and guide of some weight and authority.The Dublin Medical Press, alluding to the same case, says,

“ We fear we must assume that according to the dictum of the two medical men who appeared for the defence, we are nothing better than rogues and extortionists; for we think that few Irish medical men, who can boast of any practice at all, would undertake an eight months' attendance on a man of property and the encountering daily every species of filth and offensiveness for a less sum than £250. The question resolves itself into what fee Dr. Irving's professional status entitled him to, and we think his status must be very low, indeed, if it be overstated in the remuneration which he demanded.” Of course in Canada, such large fees are not often to be had, simply because men of ample means are not numerous, but for all that, we think that as a rule the profession in this country value their services at altoget!er too low a rate, and that much trouble and annoyance is frequently caused by the want of a uniform rate of charging. For instance, in city practice, at all events in Montreal, it is believed to be usual to charge $1 per visit ; and should the attendance be a prolonged one, to make a slight deduction from the gross amount; but yet we know of many instences where first class families have not been charged anything like the above named rate, and even families where, as a rule, the yearly bill seldom corresponds to the amount of work done,-a year of great sickness being followed by a

[ocr errors]
« AnteriorContinuar »