302 POOR-LAW SURGEONS.-INDIAN MEDICAL OFFICERS.-THE " MIRROR."

huge system of imposture. Of one result we are well assured

- namely, that very few among the globulists will be foundwho are fools enough to trust to the veritably infinitesimaldoses which it is pretended is the foundation of this odious

system of quackery. By scrutiny and publicity this brazenmask will be pulled down, and it will be proved that theterms homoeopathy and infinitesimal doses are now nothingbut mere "topics of discourse and sectarian insignia."

WE regret to perceive the desponding tone of the late

Report of the Convention of Poor-law Medical Officers. It

would appear from the Report that great want of union andcordial co-operation have been evinced by those who shouldhave thrown themselves into this important movement. The

Convention appear to be themselves almost sick of the

subject for which they were appointed, and they declare theiropinion of the difficulty with which the medical colleges, themembers of the Government, the profession generally, andeven union surgeons themselves, can be brought to attend tothis seemingly distasteful subject. This should not, and mustnot be. For the sake of the poor, and for the sake of the

two thousand medical men engaged in ministering to theirwants, a better system of remuneration for poor-law medicalservices must be perseveringly contended for. At the presentjuncture, the guardians are everywhere making attacks on thescanty scale according to which medical men are paid by theunions. Medical officers cannot rest where they are. Theymust either assert their claims to a just remuneration, or be

despoiled of the pittance they have already gained. We do nothesitate to declare that the present rate of remuneration is

grossly cruel to the poor, unjust to the medical man, scan-dalous to society, and a stigma upon our whole profession.There is not a man amongst us who does not suffer from thecontumelies heaped upon poor-law surgeons. Here is the weak

spot of our profession, and every effort should be directed toits removal. If a system had been especially devised to

prevent the poor from having proper medical attendance, andto disgrace the medical profession, a better than that

which obtains could not exist. The Convention and poor-lawsurgeons must take heart of grace, and renew their efforts; thesame success which has attended other exertions will ulti-

mately crown theirs, properly directed and sustained.

WE desire to draw the attention of our readers to an im-

portant and interesting letter by Mr. VAUGHAN, an assistant-surgeon in the Bombay army, and another communicationfrom Mr. DAUBENY, of Bombay, on the Kousso, which has oflate proved of such signal effect in the expulsion of thattenacious parasite, the tape-worm. The great expense of the

drug has hitherto been the chief obstacle to its ample employ-ment, but if there be a regular demand for it in the bazaarsof Aden, our own " Gibraltar of the East," no reasonable doubtcan exist that it may be forwarded to this country by theoverland route, so as to keep up a supply at a price which willrender it quite available in general practice.The letter of Mr. VAUGHAN is another indication also (if

any were wanting) of the high acquirements, both in medicaland in general literature, of the branch of the public serviceto which he belongs, and the promptitude with which its

members devote themselves to minister to the well-being of

the human race in all the countries to which they are called,or with which they have any connexion. The scientific jour-nals published at all the presidencies are full of valuablecommunications from the medical officers of the East Indian

service, and in conjunction with their brethren in the Britisharmy and navy, we can only wonder that their high meritsand claims to proper distinction should have remained so longunrecognised and unrewarded by the distributors of publichonours.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

ST. BARTHOLOMEW’S HOSPITAL.Psoas Abscess.

(Under the care of Mr. LAWRENCE.)THE management of large chronic abscesses has attractedthe attention of some of our most eminent surgeons, among,whom Abernethy takes a prominent rank: the precautionswhich he took to prevent the ingress of air into the sac, havein general been imitated, though fears in this respect are nolonger so anxious as they formerly were. As to the proprietyof completely emptying the sac, or evacuating its contents bysmall portions, it would appear that the practice is, in ourdays, more influenced by the peculiarities of the special casethan by fixed and unvarying rules. It will be seen by thefollowing case, lately under the care of Mr. Lawrence, what alarge quantity of purulent matter may be discharged by onepuncture, and how favourably such a case may neverthelessterminate.W. B-, aged twenty-four, of light complexion, lymphatic

temperament, a tendency to obesity, of temperate habits, anda baker in the country, was admitted May 25th, 1850, underthe care of Mr. Lawrence. The patient has always enjoyedtolerable health until about fourteen months ago, when he

began to feel a constant pain across the loins, though he didnot labour very heavily; and soon afterwards he experiencedsome uneasiness in the inner and anterior portion of the upperthird of the thigh. This pain did not, however, prevent himfrom walking about, and attending to his usual avocations; heeven managed to work until the swelling of his thigh becamevery large. The patient cannot recollect having suffered anyhurt or blow on the back or thigh; he never resorted to anytopical applications: and when he consulted a surgeon in thecountry, he was told that it would be advisable for him to go,to town; he therefore came and placed himself under thecare of Mr. Lawrence.On admission, the left thigh presented, in its upper third,

towards the internal portion of the limb, an enormous swelling,measuring thirty-two inches in circumference; the tumour wasfluctuating, soft, and yielding to the finger, but pressure gaveno pain. Mr. Lawrence ordered a blister to be applied to theback, to relieve the pain, and when the patient had sufficientlyrested, and his bowels had been regulated, a small puncturewas made with a double-edged scalpel, on the innerside of the tumour, where it was pointing, and eighty-fourounces of pus escaped. The fluid discharged was at first sero-purulent, containing shreds of various sizes, and towards thelatter portions the flocculi were very numerous. The patient

felt somewhat weakened after this evacuation, but he soonrallied; the wound was plugged with a piece of lint spreadwith cerate, and moderate compression used.The fluid, for the next few days, continued to accumulate,and it was occasionally freed by the probe clearing the openingrecently made. Feverish symptoms began to appear, inflam-mation of the sac took place, and it was found necessary tolay the abscess freely open. This was done by enlarging theoriginal wound, which gave exit to a moderate quantity ofpus. The pulse was now rather quick and feeble, the counte-nance somewhat blanched and anxious, the respiration hur-ried ; and obstinate vomiting set in. The latter symptom

303

was, however, subdued by the careful administration of prussicacid. The patient was, in the meanwhile, allowed good diet;he began to rally under it; the thigh was firmly bandaged,and it gradually diminished in size, so as to come very nearits fellow in point of bulk. It is very probable that the pressureapplied to the sac contributed to its not refilling; the parietesof the latter became gradually thickened by infiltration oflymph between the sac and the cellular tissue surrounding it;the patient regained a little strength, and on the 15th of July,about two months after admission, he was discharged in avery favourable condition.

This case illustrates the advantages of copious evacuationsOf the purulent fluid, and subsequent pressure on the walls ofthe sac. Much has been said of late regarding astringent in-jections into the cavity of abscesses, followed by continuedpressure; some benefit may, perhaps, in certain instances, beobtained from this method; but it would nevertheless appearthat a little risk is connected with this line of practice, andthat its application will require some amount of discrimi-nation.

Peculiar Mammary, Scirrhous, Encysted, and IncipientMelanotic Tumours.

ON August the 10th, 1850, tumours of various descriptionswere operated upon; Mr. Stanley first removed a peculiar onefrom the breast of young unmarried woman of twenty,which was about the size of an orange, and lay immediatelyunder the skin. It was of the kind called by Sir A. Cooperchronic mammary tumours, and presented interest in so faras relates to the existence of certain ramifications in the sub-stance of the tumour, the nature of which seems to haveonly recently been made out. Mr. Birkett states thatsuch branchings are nothing but lactiferous tubes developedin a newly formed mammary tissue. Thus the chronic mam- mary tumour would be merely a sort of abnormal appendageto the gland. If we recollect well, Sir A. Cooper did not lookupon these ramifications as belonging to the lactiferous svs-tem. Removal, however, seems to be the most judiciouspractice, whether the one or the other pathological view bemaintained. The patient has gone on well.Mr. Paget operated on the same day upon a woman about

forty years of age, whose breast was the seat of a scirrhousgrowth ; the latter was of small size, and presented theusual characteristics of such tumours. The peculiarity whichbelongs to this case, as pointed out by Mr. Paget, is, that byits gradual development the tumour had so encroached uponneighbouring parts that it had drawn a portion of the pectoralmuscle into its own texture, the cancerous matter lyingbetween the muscular fibres, and having completely consoli-dated them. The whole of the mammary gland was absorbed;no traces of it were left; the nipple had quite disappeared;and in the place of the former organ nothing but a smallscirrhous mass was found, which had incorporated into itselfthe superficial portion of the pectoral muscle. The progressof this patient has likewise been favourable. _ _ _ _ _

The third tumour was of the encysted kind, and had formedin the right labium pudendi of a woman about fifty years ofage, of a somewhat coarse and heavy appearance. Thistumour had, according to the patient’s statement, beengrowing for the last five years, and no particular excitingcause, such as a blow or difficult parturition, &c., could betraced. The swelling was about the size of an orange, soft,and fluctuating. Mr. Stanley laid it freely open, and a fluidof the thickness and colour of chocolate at once gushed out.The walls of the cyst immediately collapsed, and the partsresumed their normal size and appearance. Whether thiswas a sort of hydatid cyst, the clear secretion of which badbeen mixed with blood, must of course remain in doubt; butanother suggestion as to the nature of this tumour was broughtforward-viz., that it should be looked upon as a degenerationof Cowper’s glands in the female, (Lawrence.)On the 31st of August Mr. Paget had occasion to remove a

tumour, very probably of a malignant nature, from the sacrumof a woman about forty. It was of the size of a large walnut,dense, somewhat moveable, and the skin covering it of a verydark colour. Mr. Paget did not dissect it out, but excised thewhole growth with the skin covering it, by two elliptical in-cisions. He was induced to proceed in this manner, as hethought that the tumours developed in moles, as had happenedin this case, are for the most part malignant. This tumourhad been growing for about a twelvemonth, and its structure,though not quite definite, resembled medullary cancer. Abrown spot was noticed on its lower portion, which Mr. Pagetconsidered as a melanotic change, a very common transforma-tion in such growths.

ST. THOMAS’S HOSPITAL.

Talipes Varus; New Form of Apparatus for Extensionafter Operation.

(Under the care of Mr. LE GROS CLARK.)FoR several months past, we noticed among Mr. Le GrosClark’s patients a little girl, wearing a peculiar apparatus forextension, upon whom Mr. Clark had divided the tendo-Achillis, to remedy congenital talipes varus. He was kindenough to direct our attention to the case, and we have muchpleasure in offering to our readers the following details, witha representation of the new apparatus used on the occasion.The patient, Mary R-, aged fifteen, was admitted into-

St. Thomas’s Hospital, under the care of Mr. Le Gros Clark,in November, 1849. The case presented an illustration ofthat extreme form of talipes varus in which there was notonly entire inversion of the foot, but where it was also turnedover, so that the plantar region was directed upwards, whilstthe dorsal surfr.ce of the tarsus rested on the ground, (talipesdorsalis of some authors.) A large bursal pad was developedin the latter position, and progression performed with greatawkwardness and difficulty. The whole limb was shrunk,especially below the knee, and the foot shortened and curvedupon itself, the toes overlapping each other. The deformitywas congenital.

Shortly after the patient’s admission, Mr. Clark divided thetendo-Achillis in the usual position and manner, and the footwas put up loosely in Stromr yer’s apparatus. The inconvenienceand imperfection of the latter became very conspicuous inthis case at a very early period, for it occasioned considerable,pain up the leg, and vesications on the toes, dorsal surface ofthe tarsus, and heel. This induced Mr. Clark, who had feltdissatisfied with all the mechanical forms of treatment whichhad come under his observation, to consult with the instru-

. ment-maker to the hospital,* in order that an apparatus mightbe constructed, in itself more simple, efficacious, and easy of

- management, and, at the same time, less irksome to thepatient. The following description of the instrument, whichwas immediately manufactured for, and first used, in this case,was supplied by Mr. Milliken, Mr. Bigg’s intelligent foremanin St. Thomas’s-street, who superintended its construction.

"The instrument is intended for talipes equinns, valgusand varus, and consists ot’ a leg-piece, with circular strap, topass round the leg under the knee, an ankle-joint, forked ex-tremity, and foot-piece. The joint at the ankle allows of the

Mr. Bigg, of Leicester-square and St. Thomas’s-street.