THE SHOEBURYNESS EXPLOSION
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526 the reader feeling, to any great extent, the want of associa- tion. The fact, however, that it has taken eleven years to complete the work serves to strengthen the assertion we have previously advanced, that with the present rapidly advancing state of medical knowledge the age for the production of large treatises is past; for before an author has time fairly to master the literature of his subject, in itself a gigantic task, and arrange the details of his work, new discoveries necessitate a revision of much that he has already completed. Dr. Dickinson has undoubtedly solved a part of this difficulty by dividing his work into a series of mono- graphs, but even here the obvious objection arises that whilst the last volume represents our latest knowledge on the subjects of which it treats, the first and second un- doubtedly require considerable revision to bring them up to the same level. In the present volume the essay on Renal Calculus deserves the first place for consideration. It is undoubtedly the most complete description extant of this formidable and painful affection. The etiology, structure, classification, symptoms, and treatment, are all fully detailed. The author is evidently no great believer in the solvent treatment of renal calculi, as advocated by Dr. Roberts; and this negative atti- tude is justified by the experience of the past, for in the days when solvents were largely used physicians pointed out that while good results were often obtained with vesical, the administration of solvents in the case of renal, calculi was nearly always futile. The reason of this lies in the fact that in the bladder it is possible to keep the stone always surrounded with alkaline urine, whilst in the kidney the action of the solvent is only partial and temporary. Dr. Dickinson does not allude to the possibility of causing encystment of the calculus by keeping the patient at rest, in one position, as much as possible. In cases where the calculus is tolerably large and an operation not advisable, this plan may be adopted with advantage. In one case which came under our observation it proved a complete success; and the fact that calculi are found thus encysted post mortem, in persons who have suffered but little during life, ought to encourage us to give the plan a fair trial. Speaking of pyelitis, the author criticises the statement of Roberts, that the very irregular, spindle-shaped epithelium shed affords " certain evidence of its origin," and maintains that epithelium of like character is derived from other parts of the urinary tract besides the pelvis. In this we quite agree with Dr. Dickinson, for we are sure that no positive con- clusion as to its place of origin in the urinary tract can be drawn from the appearance of this epithelium, and the part of the urinary tract it is derived from can only be deter- mined by other clinical indications. In the section devoted to the consideration of Malignant Tumours the writer incidentally brings forward a very im- portant question-viz., Which kidney is the more frequently attacked ? Thus Roberts found in sixty unilateral cases each kidney affected an equal number of times. Ebstein, on the other hand, states that the right is attacked oftener than the left, in the ratio of thirty-one to twenty-three, whilst Dr. Dickinson found eleven belonging to the left side and only one belonging to the right. Our own experience is in accord with that of Dr. Dickinson; indeed, so frequently have we found the left kidney affected-as regards not only malig- nant, but other unilateral affections of that organ,-that we have considered whether the selection is altogether acci- dental, or if there may not be some as yet undetermined cause for the preference. It would be impossible for us, with the space at our command, to notice all the good features of the work before us; but after the chapters on Renal Calculus, those on Hæmoglobinuria and Chyltiria deserve special study and attention. We should, however, fail in our duty if after such commendation we omitted to point out those parts of. the work which in our opinion fall short of existing knowledge on the subject. In the lirst place, we regret to find in the section on "surgical kidney" no reference is made to Mr. Beck’s invaluable clinical and pathological researches nor can there be any excuse for the omission, since it is now six years since they were published in "Reynolds s System of Medicine," and have been generally accepted, as is shown by their having formed the basis for further investigations, and also by their having been adopted by most writers on pathology. The author no doubt differs from Mr. Beck, but, in omitting to reply to or notice views contrary to his own, Dr. Dickinson tacitly admits, we think, that they are unanswerable. Nor has he done full justice to the subject of phosphaturia. Although he speaks of the condition as " phosphuria," implying thereby that unoxidised phosphorus, as lecithin, glycerine, phosphoric acid, &c., may pass into the urine, he makes no allusion to that now well-ascertained fact, nor the conditions of the nervous system in which it has been noticed. Nor, even when speaking of the elimination of phosphates, does he refer to the numerous facts recently determined, chiefly by German observers, with regard to the relative elimi- nation of nitrogen and phosphoric acid under different conditions of metabolism. Again, the important clinical fact, that certain pathological states are characterised by a decided diminution of phosphorus in the urine, is not men- tioned ; as, for instance, Gee’s observation as to the almost complete disappearance of the phosphates from the urine in ague, and the similar observation that has been made as regards scurvy, and after the administration of cer- tain medicines, such as bromide of potassium, &c. All these points ought to have received attention, since it is alone by the study of them that we can hope to get an insight into the nature of the tissue changes occurring under pathological conditions. Apart from these objections, we must congratulate Dr. Dickinson on the high quality of his work throughout; it is that of a scholar, a scientific physician, and a clinical teacher, and will for long hold its place as a classic treatise on the subject of which it treats. Nor, whilst awarding this high degree of praise to the text, must we forget to mention the very admirable engravings that illustrate it. ______________ THE SHOEBURYNESS EXPLOSION. THE following is a description of the fatal injtiries incurred by the officers who lost their lives by the recent sad accident at Shoeburyness:— Colonel Fox Strangways: Laceration of right foot, part of great toe blown away, compound comminuted fracture of both legs. Amputation of both legs was performed by Sir W. Mac Cormac after midnight. Death from shock before 8 A.M. the next morning. Colonel Lyon: Both legs completely smashed, great shock. Amputation of both legs immediately performed by Mr. Deeping and Mr. Jones. Death from shock about 8 A.M. next morning. Sergeant-Major Daykin: Compound comminuted fracture of left leg, involving the knee-joint. Amputation at the middle of thigh by Mr. Jones. There was also severe chest injury. Death from shock next morning. Gunner Underwood: Compound comminuted fracture of right thigh. Amputation by Mr. Morris. Death from shock next morning. Gunner Allen : Right leg blown away from below knee, lacerated wounds under chin and on side of throat. Killed on the spot from profound shock. Mr. Rance : Large lacerated wound in the middle of both thighs, wound under left knee crushing the tibia, the fragments of shell passing backwards and downwards and coming out through the lower part of the calf. Shock and depression so great that no operative interference was resorted to. Died from exhaustion on the ninth day. Colonel Betty and the ollicers of the garrison, Shoebury- ness, have sent a letter of thanks to the medical men who rendered aid to the sufferers by the explosion, Messrs. Deeping, Phillilus, Morris, and Jones, and have requested them to consider themselves perpetual honorary members of the Royal Artillery Mess, Shouburyness.
Transcript of THE SHOEBURYNESS EXPLOSION
526
the reader feeling, to any great extent, the want of associa-tion. The fact, however, that it has taken eleven yearsto complete the work serves to strengthen the assertion wehave previously advanced, that with the present rapidlyadvancing state of medical knowledge the age for the
production of large treatises is past; for before an authorhas time fairly to master the literature of his subject, in itselfa gigantic task, and arrange the details of his work, newdiscoveries necessitate a revision of much that he has alreadycompleted. Dr. Dickinson has undoubtedly solved a part ofthis difficulty by dividing his work into a series of mono-graphs, but even here the obvious objection arises thatwhilst the last volume represents our latest knowledge onthe subjects of which it treats, the first and second un-doubtedly require considerable revision to bring them up tothe same level.
In the present volume the essay on Renal Calculus deservesthe first place for consideration. It is undoubtedly the mostcomplete description extant of this formidable and painfulaffection. The etiology, structure, classification, symptoms,and treatment, are all fully detailed. The author is
evidently no great believer in the solvent treatment of renalcalculi, as advocated by Dr. Roberts; and this negative atti-tude is justified by the experience of the past, for in the dayswhen solvents were largely used physicians pointed outthat while good results were often obtained with vesical,the administration of solvents in the case of renal, calculiwas nearly always futile. The reason of this lies in thefact that in the bladder it is possible to keep the stonealways surrounded with alkaline urine, whilst in the kidneythe action of the solvent is only partial and temporary.Dr. Dickinson does not allude to the possibility of causingencystment of the calculus by keeping the patient at rest,in one position, as much as possible. In cases where thecalculus is tolerably large and an operation not advisable,this plan may be adopted with advantage. In one casewhich came under our observation it proved a completesuccess; and the fact that calculi are found thus encysted postmortem, in persons who have suffered but little during life,ought to encourage us to give the plan a fair trial. Speakingof pyelitis, the author criticises the statement of Roberts,that the very irregular, spindle-shaped epithelium shedaffords " certain evidence of its origin," and maintains thatepithelium of like character is derived from other parts ofthe urinary tract besides the pelvis. In this we quite agreewith Dr. Dickinson, for we are sure that no positive con-clusion as to its place of origin in the urinary tract can bedrawn from the appearance of this epithelium, and the partof the urinary tract it is derived from can only be deter-mined by other clinical indications.
In the section devoted to the consideration of MalignantTumours the writer incidentally brings forward a very im-portant question-viz., Which kidney is the more frequentlyattacked ? Thus Roberts found in sixty unilateral cases eachkidney affected an equal number of times. Ebstein, on theother hand, states that the right is attacked oftener thanthe left, in the ratio of thirty-one to twenty-three, whilstDr. Dickinson found eleven belonging to the left side and onlyone belonging to the right. Our own experience is in accordwith that of Dr. Dickinson; indeed, so frequently have wefound the left kidney affected-as regards not only malig-nant, but other unilateral affections of that organ,-that wehave considered whether the selection is altogether acci-dental, or if there may not be some as yet undeterminedcause for the preference.
It would be impossible for us, with the space at our
command, to notice all the good features of the workbefore us; but after the chapters on Renal Calculus, thoseon Hæmoglobinuria and Chyltiria deserve special studyand attention. We should, however, fail in our dutyif after such commendation we omitted to point out thoseparts of. the work which in our opinion fall short of existingknowledge on the subject. In the lirst place, we regret to
find in the section on "surgical kidney" no reference ismade to Mr. Beck’s invaluable clinical and pathologicalresearches nor can there be any excuse for the omission,since it is now six years since they were published in
"Reynolds s System of Medicine," and have been generallyaccepted, as is shown by their having formed the basis forfurther investigations, and also by their having beenadopted by most writers on pathology. The author nodoubt differs from Mr. Beck, but, in omitting to reply to ornotice views contrary to his own, Dr. Dickinson tacitlyadmits, we think, that they are unanswerable. Nor has hedone full justice to the subject of phosphaturia. Althoughhe speaks of the condition as " phosphuria," implying therebythat unoxidised phosphorus, as lecithin, glycerine, phosphoricacid, &c., may pass into the urine, he makes no allusion tothat now well-ascertained fact, nor the conditions of thenervous system in which it has been noticed. Nor, evenwhen speaking of the elimination of phosphates, does herefer to the numerous facts recently determined, chiefly byGerman observers, with regard to the relative elimi-nation of nitrogen and phosphoric acid under differentconditions of metabolism. Again, the important clinicalfact, that certain pathological states are characterised by adecided diminution of phosphorus in the urine, is not men-tioned ; as, for instance, Gee’s observation as to the almostcomplete disappearance of the phosphates from the urine inague, and the similar observation that has been made as
regards scurvy, and after the administration of cer-
tain medicines, such as bromide of potassium, &c. Allthese points ought to have received attention, since it isalone by the study of them that we can hope to get aninsight into the nature of the tissue changes occurringunder pathological conditions. Apart from these objections,we must congratulate Dr. Dickinson on the high quality ofhis work throughout; it is that of a scholar, a scientific
physician, and a clinical teacher, and will for long hold itsplace as a classic treatise on the subject of which it treats.Nor, whilst awarding this high degree of praise to the text,must we forget to mention the very admirable engravingsthat illustrate it.
______________
THE SHOEBURYNESS EXPLOSION.
THE following is a description of the fatal injtiriesincurred by the officers who lost their lives by the recentsad accident at Shoeburyness:—
Colonel Fox Strangways: Laceration of right foot, partof great toe blown away, compound comminuted fracture ofboth legs. Amputation of both legs was performed by SirW. Mac Cormac after midnight. Death from shock before8 A.M. the next morning.
Colonel Lyon: Both legs completely smashed, great shock.Amputation of both legs immediately performed by Mr.Deeping and Mr. Jones. Death from shock about 8 A.M.next morning.Sergeant-Major Daykin: Compound comminuted fracture
of left leg, involving the knee-joint. Amputation at themiddle of thigh by Mr. Jones. There was also severe chest
injury. Death from shock next morning.Gunner Underwood: Compound comminuted fracture of
right thigh. Amputation by Mr. Morris. Death from shocknext morning.Gunner Allen : Right leg blown away from below knee,
lacerated wounds under chin and on side of throat. Killedon the spot from profound shock.Mr. Rance : Large lacerated wound in the middle of both
thighs, wound under left knee crushing the tibia, thefragments of shell passing backwards and downwards andcoming out through the lower part of the calf. Shock anddepression so great that no operative interference was
resorted to. Died from exhaustion on the ninth day.Colonel Betty and the ollicers of the garrison, Shoebury-
ness, have sent a letter of thanks to the medical men whorendered aid to the sufferers by the explosion, Messrs.Deeping, Phillilus, Morris, and Jones, and have requestedthem to consider themselves perpetual honorary members ofthe Royal Artillery Mess, Shouburyness.
