A HOSPITAL AND AMBULANCE MUSEUM.
1
611 Annotations. A HOSPITAL AND AMBULANCE MUSEUM. "Ne quid nimis." IN a recent letter to the Times Sir John Furley proposed the establishment of a museum for the display of ambulance and hospital material, with a view to the study and comparison of the various patterns of apparatus and equipment that are brought forward from time to time, and the attain- ment of a standard as the result of such comparison and of the criticism that would arise. This propo- sition was first made several years ago, when Sir John Furley submitted to the late Lord Wantage a scheme for standardising the various patterns of stretchers and other means of sick transport. From his long and varied experience in the methods of dealing with the removal and disposal of wounded men in many campaigns, Sir John Furley has been much impressed by the suffering that results from the transfer of the man from one stretcher to another, such transfer being rendered necessary because of the variation in dimensions of the numerous patterns in use. On account of this the ambulance carriages available with any parti- cular force might not be able to accommodate the various stretchers of the different units from which the wounded men would be derived. The main proposition is that a museum should be opened in London or the suburbs, under the control of a small committee of experts, and that any object or appliance accepted should be exhibited for a year; and at the end of this period it should be removed if, in the opinion of the expert authorities, it was found to have been improved upon, or superseded by a subsequent invention. In this case, the latter should then be substituted for the original appliance under similar conditions. Everyone interested and experienced in the subject would then have an opportunity for comparing the inventions, criticising, and possibly further im- proving them in some points. The result would be that inventions which had been put forward long ago, and condemned by competent authorities as useless, would not continue to be re-introduced as supposed valuable improvements by well- meaning persons unacquainted with the prac- tical history of ambulance development. Sir John Furley’s original proposition fell through, partly because no eligible site was available. It may be remembered that Mr. Henry S. Wellcome has offered .f:2000 to be awarded in prizes for im- provements in motor ambulance construction for Red Cross field-work, and that in 1914 a Commission was formed to deal with the matter. At the Royal Army Medical College in Grosvenor- road we understand that there is a considerable amount of material illustrating progress in ambu- lance construction, and no doubt the military authorities would be approached in the first instance by the supporters of Sir John Furley s proposal. As to the practical value and interest of such a collection, suitably arranged and con- veniently accessible, we imagine there can be no two opinions-indeed it is surprising that there should be no such comprehensive exhibition already in existence. THE THORACOSCOPE IN ENDOPLEURAL OPERATIONS. AT the International Congress of Medicine held in London three years ago Dr. H. C. Jacobaeus, of Stockholm, gave an account of laparothoracoscopy, or the art of inspecting the peritoneal or pleural cavities through an instrument resembling a cystoscope pushed into them. This inspection can also be used, in the case of the pleural cavity, for the purpose of controlling operative procedures such as the division of pleural adhesions by the electric cautery. In a recent paper 1 Dr. Jacobaeus recounts his further experiences with the thoraco- scope and galvano-cautery, employed on five patients with pulmonary tuberculosis who had been treated by the establishment of artificial pneumo- thorax. In each case X ray examination showed the presence of pleural adhesions preventing com- plete collapse of the affected lung. Under local anaesthesia the thoracoscope is pushed into the pleural cavity through a convenient intercostal space, usually the fourth, fifth, or sixth, between the nipple-line and the mid-axillary or scapular line. The trocar for the galvano-cautery is then pushed through the intercostal space next above or below the thoracoscope, as maybe most convenient, and the two instruments are manipulated in such a way as to give the operator a good view both of the adhe- sions it is desired to sever by cautery and of the orogress of the severance. Dr. Jacobaeus remarks that the X ray examination does not as a rule give :ull or satisfactory information as to the nature of adhesions present in the pleural cavity, or the ease with which they will be reached by the galvano- cautery ; the operative manoeuvres are often mexpectedly difficult. In one case, after the adhesion had been burnt through, the cautery vas brought too close to the pleura, and the Jatient felt a slight sudden pain. In another here was a slight capillary oozing of blood rom the pleural end of the severed adhesion; the oozing could not be checked by the cautery, and must have stopped spontaneously, for no ill consequences ensued. In a third patient the local anaesthesia was unsatisfactory and the operation was painful in consequence; three bands of adhesions were burnt through, but a fourth could not be reached by the cautery. Ten weeks later the X ray examination showed that a pulmonary cavity previously measuring 3 by 3 cm. had collapsed considerably, measuring only 1 by 11/2 cm. ; five weeks later it had almost entirely collapsed. In another patient whose lung had collapsed upwards, as a result of the artificial pneumothorax treat- ment, but was prevented from fully collapsing by the presence of a broad adhesion passing forwards, outwards, and downwards, there was great difficulty in effecting the severance. As soon as the cautery had been got to work on the adhesion the latter slipped away, probably as a result of the respiratory movements. In consequence the two instruments had to be manoeuvred into position again 10 or 12 times before the adhesion was fully divided, the opera- tion taking 30 to 40 minutes. The results, however, were satisfactory. In a fifth patient there was a large and thick pleural adhesion running from the lung upwards, backwards, and outwards to the second or third rib in the scapular region. The thoracoscope was inserted in the seventh intercostal space in the scapular line ; the galvano-cautery was entered in the fifth space just internal to the 1 Nordiskt Medicinskt Arkiv, 1914, Kirurgi, Afd. I., h. 4, Stockholm, 1915.
Transcript of A HOSPITAL AND AMBULANCE MUSEUM.
611
Annotations.
A HOSPITAL AND AMBULANCE MUSEUM.
"Ne quid nimis."
IN a recent letter to the Times Sir John Furleyproposed the establishment of a museum for thedisplay of ambulance and hospital material, with aview to the study and comparison of the variouspatterns of apparatus and equipment that are
brought forward from time to time, and the attain-ment of a standard as the result of such comparisonand of the criticism that would arise. This propo-sition was first made several years ago, when SirJohn Furley submitted to the late Lord Wantage ascheme for standardising the various patterns ofstretchers and other means of sick transport. Fromhis long and varied experience in the methods ofdealing with the removal and disposal of woundedmen in many campaigns, Sir John Furley has beenmuch impressed by the suffering that resultsfrom the transfer of the man from one stretcherto another, such transfer being rendered necessarybecause of the variation in dimensions of thenumerous patterns in use. On account of thisthe ambulance carriages available with any parti-cular force might not be able to accommodatethe various stretchers of the different units fromwhich the wounded men would be derived. Themain proposition is that a museum should be
opened in London or the suburbs, under the controlof a small committee of experts, and that anyobject or appliance accepted should be exhibitedfor a year; and at the end of this period it shouldbe removed if, in the opinion of the expertauthorities, it was found to have been improvedupon, or superseded by a subsequent invention.In this case, the latter should then be substitutedfor the original appliance under similar conditions.Everyone interested and experienced in the subjectwould then have an opportunity for comparing theinventions, criticising, and possibly further im-
proving them in some points. The result wouldbe that inventions which had been put forwardlong ago, and condemned by competent authoritiesas useless, would not continue to be re-introducedas supposed valuable improvements by well-meaning persons unacquainted with the prac-tical history of ambulance development. Sir JohnFurley’s original proposition fell through, partlybecause no eligible site was available. It maybe remembered that Mr. Henry S. Wellcome hasoffered .f:2000 to be awarded in prizes for im-
provements in motor ambulance constructionfor Red Cross field-work, and that in 1914 a
Commission was formed to deal with the matter.At the Royal Army Medical College in Grosvenor-road we understand that there is a considerableamount of material illustrating progress in ambu-lance construction, and no doubt the militaryauthorities would be approached in the firstinstance by the supporters of Sir John Furley sproposal. As to the practical value and interestof such a collection, suitably arranged and con-veniently accessible, we imagine there can be notwo opinions-indeed it is surprising that thereshould be no such comprehensive exhibitionalready in existence.
THE THORACOSCOPE IN ENDOPLEURALOPERATIONS.
AT the International Congress of Medicine heldin London three years ago Dr. H. C. Jacobaeus, ofStockholm, gave an account of laparothoracoscopy,or the art of inspecting the peritoneal or pleuralcavities through an instrument resembling a
cystoscope pushed into them. This inspection canalso be used, in the case of the pleural cavity, forthe purpose of controlling operative proceduressuch as the division of pleural adhesions by theelectric cautery. In a recent paper 1 Dr. Jacobaeusrecounts his further experiences with the thoraco-scope and galvano-cautery, employed on fivepatients with pulmonary tuberculosis who had beentreated by the establishment of artificial pneumo-thorax. In each case X ray examination showedthe presence of pleural adhesions preventing com-plete collapse of the affected lung. Under localanaesthesia the thoracoscope is pushed into the
pleural cavity through a convenient intercostal
space, usually the fourth, fifth, or sixth, between thenipple-line and the mid-axillary or scapular line.The trocar for the galvano-cautery is then pushedthrough the intercostal space next above or belowthe thoracoscope, as maybe most convenient, and thetwo instruments are manipulated in such a way asto give the operator a good view both of the adhe-sions it is desired to sever by cautery and of theorogress of the severance. Dr. Jacobaeus remarksthat the X ray examination does not as a rule give:ull or satisfactory information as to the nature ofadhesions present in the pleural cavity, or the easewith which they will be reached by the galvano-cautery ; the operative manoeuvres are oftenmexpectedly difficult. In one case, after theadhesion had been burnt through, the cauteryvas brought too close to the pleura, and theJatient felt a slight sudden pain. In anotherhere was a slight capillary oozing of bloodrom the pleural end of the severed adhesion;the oozing could not be checked by the cautery,and must have stopped spontaneously, for no ill
consequences ensued. In a third patient the localanaesthesia was unsatisfactory and the operationwas painful in consequence; three bands ofadhesions were burnt through, but a fourth couldnot be reached by the cautery. Ten weeks laterthe X ray examination showed that a pulmonarycavity previously measuring 3 by 3 cm. had collapsedconsiderably, measuring only 1 by 11/2 cm. ; fiveweeks later it had almost entirely collapsed. Inanother patient whose lung had collapsed upwards,as a result of the artificial pneumothorax treat-ment, but was prevented from fully collapsing bythe presence of a broad adhesion passing forwards,outwards, and downwards, there was great difficultyin effecting the severance. As soon as the cauteryhad been got to work on the adhesion the latterslipped away, probably as a result of the respiratorymovements. In consequence the two instrumentshad to be manoeuvred into position again 10 or 12times before the adhesion was fully divided, the opera-tion taking 30 to 40 minutes. The results, however,were satisfactory. In a fifth patient there was alarge and thick pleural adhesion running from thelung upwards, backwards, and outwards to thesecond or third rib in the scapular region. The
thoracoscope was inserted in the seventh intercostalspace in the scapular line ; the galvano-cautery wasentered in the fifth space just internal to the
1 Nordiskt Medicinskt Arkiv, 1914, Kirurgi, Afd. I., h. 4, Stockholm, 1915.
