THE MILITARY MEDICAL STAFF IN CANADA.—

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577 overlapped it ; the upper and lateral surfaces of the astragalus articulating with the tibia and fibula were not displaced, nor were any of the ligaments attaching those bones ruptured. No bleeding occurred. The house-surgeon failing to reduce the dislocation, a con- sultation was called, when the attempt having been again made with no different result, it was determined to remove the astragalus and endeavour to save the foot, the boy having a good constitution. An assistant slightly extending the foot with his left hand, and guarding the tendons with a spatula, Mr. Turner divided the ligaments attaching the bone to the tibia, fibula, and cal- caneum, and with very little difficulty removed the bone with- out injuring either tendon or bloodvessel. The leg was flexed, and laid upon a pillow and the wound covered with lint dipped in compound tincture of benzoin. To take a quarter of a grain of morphia at bed-time. December 14th-Extremely feverish, skin hot and dry, tongue loaded, and pulse quick; bowels confined. Efferves- eing draughts with small quantities of sulphate of magnesia were prescribed. To continue the morphia pills and to have low diet. 17th.-Much better, the feverish symptoms have nearly subsided, and the wound has begun to discharge. To continue the effervescing draughts without the sulphate of magnesia ; to have meat diet and a little wine; water dressing to be applied to the leg. 19th.-The skin on the opposite side of the foot has ulcera- ted, and is discharging freely. 20th.-A piece of gutta percha was now modelled to the limb, supporting the calf of the leg and passing under the heel and entire sole of the foot, a piece being cut out of each side to allow of the wounds being dressed with water dres- sing as before. All medicines to be discontinued. January 2nd, 1854.-A small sore appearing on the heel, the limb was ordered to be suspended to relieve it from the pres- sure of the bed. 6th.-The cavity nearly filled up. To continue water dres- sing and apply resin ointment to the heel. 1Oth.-The granulations being now very prominent on both sides, they were ordered to be dressed with the oxide of zinc ointment. 20th. -The wound on the outer side of the foot healed. 25th.-Heel quite well. February 14th.-The original wound perfectly healed. 16th.-A small sore noticed on the outside of the foot; to apply a poultice. 20th.-Healed up. 24th.-The same place has broken out again ; to be touched with nitrate of silver. 28th.-Quite well. March 1st.-A gutta percha model was now fitted to the entire limb below the knee, and the boy allowed to sit up. About a week afterwards he was allowed to walk about upon crutches, the leg being slung, and he continued im- proving till the 6th of April, when he was discharged cured. The boy called at the hospital yesterday ; he can bear his whole weight upon the leg, but is ordered to continue the use of his crutches for some time longer. The leg is not half an inch shorter than the sound one, the foot is slightly in- verted ; the distance from the ball of the great toe to the inner side of the heel being a little shorter than before the accident. He has the power of flexing and extending the foot, though of course to a much more limited extent than formerly. The preceding cases, which would formerly have been destined to amputation, appear to me of especial interest, now that conservative surgery is being so much and so justly advanced by the profession. The latter case is particularly interesting as well as exceedingly rare, and shows the sur- prising reparative powers of nature when carefully aided and directed. The fact of a useful foot being left with the power of motion, which will, no doubt, be considerably in- creased by using it, after so serious an operation, is a very great encouragement for us to make every endeavour to save a limb which may have sustained such an alarming injury. At the same time, it should not tempt us to dally too long with doubt- ful cases, especially when they occur in bad constitutions. THE MILITARY MEDICAL STAFF IN CANADA.— THE MILITARY MEDICAL STAFF IN CANADA.-Accord ing to the army estimates for 1854, the sum of £ 378f 17s. 6d. is required to pay the medical staff stationed ii Canada. Reviews and Notices of Books. ’The Cure and P?-ez,e?ztion of C?-etini-32)?, and their latest A dmnces. Communications to the Swiss Natural History Society. By 1. GUGGE-NBi:’HL, M.D., Founder and Director of the first Institution for the Cure of Cretinism on the "Abendberg," &c. &e. Berne and St. Gallen. 1853. 4to, pp. 121. IN the pages before us we have a concise exposition of all the more interesting and practical points connected with cretinism, as well as of the most recent opinions arrived at by one of the most assiduous inquirers into this infliction of humanity. Few works can be taken up which, in their union of scientific and moral interest, render an account so highly to the credit of their writers as those of Dr. Guggenbuhl. The present production is no less redolent of honourable testimony to its well-known and respected author, whose enthusiastic hopes are scarcely less than are his exertions for their further- ance, as the following quotation will testify :- " The third period includes the carrying out of prophylactic measures on the great scale, by means of a Society, after the model of the English’ Anti-Slavery’ one. Facts of consider- able importance give room for hope that cretinism will be universally diminished-yea, in the course of a century, will be altogether exterminated. Nevertheless, the increase of the evil observed again in later times, in several places, without sufficient reasons for such increase becoming afterwards appa- rent, shows us that we must not at once surrender ourselves up to hopes of too sanguine a character. "-p. 6. The most interesting portion of this treatise is that em- bracing an account of the Institution of the Abendberg, and we cannot do better, in parting from Dr. Guggenbuhl, after this short notice of his late additional exertions, than quote the following passage from Verga’s Report ’of the Royal Commission to Inquire into the Cretinism of Sardinia, in rela- tion to the Abendberg and its Director: " Tutti i mezzi igienici e farmaceutici, fisici e psicologici che possiede la scienza si trovano radunati in quel alpestre stabili- mento ed il dottore passa il tempo a metterli metodicamente in opera a pro dei suoi figli e lo fa con un amore edificante. Se egliperseveranelletriste, e faticosa carriera, bisognerabendire che non sia punto esaggerato 1’entusiasmo religioso che egli spira dalle sue lettere ne immeritata la gloria che già la circonda." Manual of Diseases of the Skin, from the French of 111. Cazenave; with Notes and Additions. By THOMAS H. BURGESS, M.D. Second Edition, considerably Enlarged and Improved. London: Renshaw. 8vo, pp. 432. THE merits of M. Cazenave’s Manual of Diseases of the Skin are so well known to the profession in this country and abroad, that it is unnecessary for us to dwell on them now. The chief cause of the great popularity of this work is its essentially practical character. Avoiding all historical or descriptive details, or speculative theories, the author describes in simple and concise terms each disease, the manner of distinguishing it from other cutaneous affections, and the method of treatment which an extensive experience has proved to be the most effectual. This, the second English edition of the Manual, contains copious additions by Dr. Burgess, embracing all the recent im- provements in the treatment of skin complaints, which con- siderably enhances its value. Several diseases are introduced by Dr. Burgess into the present, which were not described in the former editions, as, for example, " button scurvy," which, we believe, has not been mentioned in any other work on cutaneous affections; diseases of the hair; diseases of the nails; and also several new remedies, as oxalic acid, strychnia, aconite, and juniper. A volume which the editor tells us " has been rendered into the language of every country in which medicine is cultivated as a science," needs no further eulogium, and we shall merely state, in conclusion, that the practitioner will find it a safe and unerring guide in the treat- ment of these troublesome complaints.

Transcript of THE MILITARY MEDICAL STAFF IN CANADA.—

Page 1: THE MILITARY MEDICAL STAFF IN CANADA.—

577

overlapped it ; the upper and lateral surfaces of the astragalusarticulating with the tibia and fibula were not displaced, norwere any of the ligaments attaching those bones ruptured.No bleeding occurred.The house-surgeon failing to reduce the dislocation, a con-

sultation was called, when the attempt having been againmade with no different result, it was determined to removethe astragalus and endeavour to save the foot, the boy havinga good constitution.An assistant slightly extending the foot with his left hand,

and guarding the tendons with a spatula, Mr. Turner dividedthe ligaments attaching the bone to the tibia, fibula, and cal-caneum, and with very little difficulty removed the bone with-out injuring either tendon or bloodvessel. The leg was flexed,and laid upon a pillow and the wound covered with lint dippedin compound tincture of benzoin. To take a quarter of agrain of morphia at bed-time.December 14th-Extremely feverish, skin hot and dry,

tongue loaded, and pulse quick; bowels confined. Efferves-eing draughts with small quantities of sulphate of magnesiawere prescribed. To continue the morphia pills and to havelow diet.17th.-Much better, the feverish symptoms have nearly

subsided, and the wound has begun to discharge. To continuethe effervescing draughts without the sulphate of magnesia ; tohave meat diet and a little wine; water dressing to be appliedto the leg.19th.-The skin on the opposite side of the foot has ulcera-

ted, and is discharging freely.20th.-A piece of gutta percha was now modelled to the

limb, supporting the calf of the leg and passing under the heeland entire sole of the foot, a piece being cut out of eachside to allow of the wounds being dressed with water dres-sing as before. All medicines to be discontinued.January 2nd, 1854.-A small sore appearing on the heel, the

limb was ordered to be suspended to relieve it from the pres-sure of the bed.6th.-The cavity nearly filled up. To continue water dres-

sing and apply resin ointment to the heel.1Oth.-The granulations being now very prominent on both

sides, they were ordered to be dressed with the oxide of zincointment.20th. -The wound on the outer side of the foot healed.25th.-Heel quite well.February 14th.-The original wound perfectly healed.16th.-A small sore noticed on the outside of the foot; to

apply a poultice.20th.-Healed up.24th.-The same place has broken out again ; to be touched

with nitrate of silver.28th.-Quite well.March 1st.-A gutta percha model was now fitted to

the entire limb below the knee, and the boy allowed tosit up.About a week afterwards he was allowed to walk about

upon crutches, the leg being slung, and he continued im-proving till the 6th of April, when he was dischargedcured. The boy called at the hospital yesterday ; he can bearhis whole weight upon the leg, but is ordered to continue theuse of his crutches for some time longer. The leg is not halfan inch shorter than the sound one, the foot is slightly in-verted ; the distance from the ball of the great toe to theinner side of the heel being a little shorter than before theaccident. He has the power of flexing and extending the foot,though of course to a much more limited extent than formerly.The preceding cases, which would formerly have been

destined to amputation, appear to me of especial interest,now that conservative surgery is being so much and so justlyadvanced by the profession. The latter case is particularlyinteresting as well as exceedingly rare, and shows the sur-

prising reparative powers of nature when carefully aidedand directed. The fact of a useful foot being left with thepower of motion, which will, no doubt, be considerably in-creased by using it, after so serious an operation, is a very greatencouragement for us to make every endeavour to save a limbwhich may have sustained such an alarming injury. At thesame time, it should not tempt us to dally too long with doubt-ful cases, especially when they occur in bad constitutions.

THE MILITARY MEDICAL STAFF IN CANADA.—THE MILITARY MEDICAL STAFF IN CANADA.-According to the army estimates for 1854, the sum of £ 378f17s. 6d. is required to pay the medical staff stationed iiCanada.

Reviews and Notices of Books.

’The Cure and P?-ez,e?ztion of C?-etini-32)?, and their latestA dmnces. Communications to the Swiss Natural HistorySociety. By 1. GUGGE-NBi:’HL, M.D., Founder and Directorof the first Institution for the Cure of Cretinism on the"Abendberg," &c. &e. Berne and St. Gallen. 1853.4to, pp. 121.

IN the pages before us we have a concise exposition of allthe more interesting and practical points connected withcretinism, as well as of the most recent opinions arrived at byone of the most assiduous inquirers into this infliction of

humanity. Few works can be taken up which, in their unionof scientific and moral interest, render an account so highlyto the credit of their writers as those of Dr. Guggenbuhl. The

present production is no less redolent of honourable testimonyto its well-known and respected author, whose enthusiastichopes are scarcely less than are his exertions for their further-ance, as the following quotation will testify :-

" The third period includes the carrying out of prophylacticmeasures on the great scale, by means of a Society, after themodel of the English’ Anti-Slavery’ one. Facts of consider-able importance give room for hope that cretinism will beuniversally diminished-yea, in the course of a century, willbe altogether exterminated. Nevertheless, the increase of theevil observed again in later times, in several places, withoutsufficient reasons for such increase becoming afterwards appa-rent, shows us that we must not at once surrender ourselvesup to hopes of too sanguine a character. "-p. 6.The most interesting portion of this treatise is that em-

bracing an account of the Institution of the Abendberg, andwe cannot do better, in parting from Dr. Guggenbuhl, afterthis short notice of his late additional exertions, than quotethe following passage from Verga’s Report ’of the RoyalCommission to Inquire into the Cretinism of Sardinia, in rela-tion to the Abendberg and its Director:

" Tutti i mezzi igienici e farmaceutici, fisici e psicologici chepossiede la scienza si trovano radunati in quel alpestre stabili-mento ed il dottore passa il tempo a metterli metodicamentein opera a pro dei suoi figli e lo fa con un amore edificante.Se egliperseveranelletriste, e faticosa carriera, bisognerabendireche non sia punto esaggerato 1’entusiasmo religioso che egli spiradalle sue lettere ne immeritata la gloria che già la circonda."

Manual of Diseases of the Skin, from the French of 111. Cazenave;with Notes and Additions. By THOMAS H. BURGESS, M.D.Second Edition, considerably Enlarged and Improved.London: Renshaw. 8vo, pp. 432.THE merits of M. Cazenave’s Manual of Diseases of the Skin

are so well known to the profession in this country and abroad,that it is unnecessary for us to dwell on them now. The chiefcause of the great popularity of this work is its essentiallypractical character. Avoiding all historical or descriptivedetails, or speculative theories, the author describes in simpleand concise terms each disease, the manner of distinguishing itfrom other cutaneous affections, and the method of treatmentwhich an extensive experience has proved to be the mosteffectual.

This, the second English edition of the Manual, containscopious additions by Dr. Burgess, embracing all the recent im-provements in the treatment of skin complaints, which con-siderably enhances its value. Several diseases are introduced

by Dr. Burgess into the present, which were not described inthe former editions, as, for example, " button scurvy," which,we believe, has not been mentioned in any other work oncutaneous affections; diseases of the hair; diseases of the nails;and also several new remedies, as oxalic acid, strychnia,aconite, and juniper. A volume which the editor tells us" has been rendered into the language of every country inwhich medicine is cultivated as a science," needs no furthereulogium, and we shall merely state, in conclusion, that thepractitioner will find it a safe and unerring guide in the treat-ment of these troublesome complaints.