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While we agree with Dr. Brinton, that in many cases we may and must suspect gastric ulcer, and should keep this probability steadily in view in our treatment, we must express our opinion decidedly that the occurrence of hæmorrhage, though succeeding such symptoms as pain and vomiting, is no sure evidence that there is any “breach of continuity” in the gastric mucous membrane, not at least such as we describe under the term ulcer. Our rule, until lately, used to be that if in a case of sudden profuse gastric hæmorrhage one could exclude cirrhosis of the liver, vicarious menstruation, purpura, and heart disease, one might feel pretty confident of its being the result of ulceration. But latterly we have met with so many instances in which the hæmorrhage concurred with symptoms of lowered nerve-power and aguish disorder, apart from any special gastric affection, that we have been much less ready to diagnose ulcer of the stomach than formerly. We would suggest to Dr. Brinton, that many of the cases he meets with among his out-patients may be of this kind, the gastric mucous surface being flushed with blood by reason of paralysis of the arterial nerves, and hæmorrhage then occurring by capillary rupture much as in a case of epistaxis. The prevalence of aguish disorders has been so considerable for some time, that we cannot think this cause should be overlooked. In fact, the author notices “ ague" as a cause of gastric ulcer—in our view it is only of gastric hæmorrhage. The existence of hepatic cirrhosis, or other portal obstruction, ought also in all cases to be canvassed as a possibility. The former may occur, we know, in perfectly temperate persons, and in the young, and may declare itself by hæmorrhage without any dropsy.
The chapter On Treatment contains nothing particularly novel, except the recommendation (which we think very judicious) to give opium as a means of promoting the cure of the ulceration. The author looks to it not only to relieve pain and check irritation, but also “to support the strength, to buoy up the nervous system, and to check the waste or expenditure of the tissues generally.” The subject of diet is most properly insisted on, the principle being to administer bland nutriment in very small quantities frequently repeated, so as to avoid distension of the organ. Some allusion should have been made to Dr. Budd's previously published observations upon this head. So also while a course of tonics is advised in the latter part of the treatment, it would have been well to have referred to Dr. Handfield Jones' remarks on that subject. * These, however, are mere accidental omissions, and do not detract from the value of the work.
The latter part of the volume is occupied with a series of reports, originally published in the Association Journal.' Of these we need only say that they are very complete, and will well repay perusal.
• Pathological and Clinical Observations respecting Morbid Conditions of the Stomach (pp. 219); and Lancet, March, 1856.
ART. IV.- Report on the Formation and General Management of
Renkioi Hospital, on the Dardaneles, Turkey. Addressed to the
PARKES, M.D., late Superintendent of the Hospital. It is grievous to think that one of the greatest achievements that have resulted from the combination of engineering skill and medical science in behalf of our sick and wounded soldiers in the Russian war, should only have served to prove what we can do, and then have been doomed to destruction. The Renkioi Hospital, in which appear to have been united all the requirements of sanatory and sanitary science, was a thing of a day, and the necessities which called it into existence having ceased, it was—we would almost say ruthlessly-scattered to the winds. On admirable soil, on a tongue of land allowing of shelter to ships, in whatever weather they might arrive, shelving downwards to the sea in such a manner that drainage was much facilitated, while terracing and excavation for the wooden houses composing the hospital were unnecessary; supplied with pure water adequate for the purposes of economy; open to the invigorating breezes of the sea,
-all the conditions were united which could be desired to render the ancient Ophrynium a monument of modern civilization and philanthropy. It was only after much labour that this advantageous site was discovered. Its selection shows the spirit and the judgment which animated Dr. Parkes and his coadjutor, the engineer, Mr. Brunton.
The hospital, which had been constructed by Mr. Brunel, was sent out in parts from England, ready to be put together on their arrival at Renkioi. It occupied the tongue of land in such a way as to stretch down from the higher to the lower level-a space in all about half a mile in length. The main hospital consisted of thirty-four houses, capable of holding 1500 sick, arranged along the two sides of a long central corridor. Two accessory hospitals, on a similar plan, intended to hold 750 patients each, were nearly completed when the conclusion of peace put a stop to the works.
"On the sides of the hills in rear were numerous small springs of excellent water, which were collected together and conveyed in earthenware pipes to a large reservoir placed by Mr. Brunton 70 feet above the highest house, which was itself about 60 feet above the sea. From this reservoir the water was carried in iron pipes down the centre of the long corridor, and at every ward (which was placed at intervals at either side of the corridor) a leaden servicepipe came off, and led an abundant and never-ceasing supply into the ward cisterns, which supplied the baths, lavatories, and closets. By this arrangement, all necessity for pumping water was avoided, and the sewers were able to be
flushed very perfectly. The lavatories and closets were placed at the ends of - the wards most remote from the corridor, and immediately outside them ran the two main sewers, which at their sea terminations were carried some distance into the Dardanelles. The plan of the hospital may be at once understood by imagining a covered way, open at the sides, and 22 feet wide, running nearly east and west, and reaching for a length of more than a third of a mile, on either side of which stood, at intervals of 27 feet on the south side, and in most cases 94 feet on the north, the 34 houses, each of which, as already said, was 100 feet long, 40 feet wide, 12 feet high at the eaves, and 25 in the centre, and was capable of containing 50 patients, with an allowance of nearly 1300 40-xx.
cubic feet for each man. Some portion of this space was occupied by the closets, and some small rooms used as orderlies' and bath rooms. Thirty of these houses were used as wards; four were used as dispensaries and purveyor's stores. To the south of each division of ten houses was placed an iron kitchen, which afforded the necessary accommodation for preparing 500 diets. At the inland extremity of the corridor were placed two iron laundries, the water from which (some 4000 gallons daily) was passed into the sewers. Beyond the laundries were placed on either side the wooden houses of the medical and other officers, who were thus able to see down either side of this long line, and to preserve, to a certain extent, surveillance over the patients." (pp. 14, 15.)
The great recommendation of the system adopted was its simplicity, as it was a repetition of similar parts throughout; while the separation of the different buildings facilitated ventilation to an extent which rendered an accumulation of septic poisons and a communication of disease from ward to ward impossible. The facility with which extensive accommodation can, under such circumstances, be rapidly provided for an army in the field, is shown by the fact that the erection of the houses having been commenced on the 21st of May, 1855, Dr. Parkes reported the hospital ready for 300 sick on the 12th of July; on the 11th of August it was ready for 500; on the 4th of December for 1000 sick ; and by January, 1856, or seven months from its commencement, the hospital could receive 1500 patients.
The principle of the construction of this hospital was one that we held up to admiration, some time since, in speaking of the Hospital of Bordeanx. It is one that we hope to see adopted before long in an English hospital, though necessarily modified in such a way as to meet the necessities of the climate. The subject of hospital architecture is one which merits our further attention. In the mean time, we briefly draw attention to Dr. Parkes' Report chiefly on account of the instruction afforded by the plans and descriptions of his magnificent hospital -magnificent in point of perfect adaptation to the proposed objects and urge, also, upon all persons interested in these questions, the lesson to be learned from the success attending the harmonious co-operation of the arts and sciences.
ART. V.—The Baths of Germany, France, and Switzerland. By
EDWIN LEE, M.D., Corresponding and Honorary Member of the Medical Academies and Societies of Paris, Berlin, Madrid, Turin, Florence, &c. Third Edition. Two Volumes in One - London,
1857. pp. 208. The third edition of Dr. Lee's balneological work, though not including every watering place in the three countries mentioned in the title, comprises faithful accounts of all the more important places of the kind resorted to by invalids of this country. In most instances the author speaks from personal knowledge, and always quotes from the best-informed sources.
The work is one that may be safely consulted by medical men, as it contains reliable information on the therapeutic action of the various waters, as well as upon the localities in which they are found. The work recommends itself by the style in which it is written, as well as by the very suitable selection of the material placed before the reader.
ART. VI.-Studier i Brackläran. Af Dr. CARL BENEDICT MESTERTON,
Chir. Docens vid Universitet i Upsala. 1. Om Radicaloperation
för Ljumskbrack.Stockholm, J. och A. Rüs, 1857. Studies of Hernia By Dr. CHARLES BENEDICT MESTERTON, Lecturer
on Surgery in the University of Upsala. 1. On Radical Operation
for Inguinal Hernia. With a Plate. 4to, pp. 100. In our fifteenth volume* we briefly alluded to the operation for the radical cure of reducible inguinal hernia recommended by Professor Wutzer of Bonn, and fully described by Mr. Spencer Wells in the thirty-seventh volume of the · Medico-Chirurgical Transactions. The operation in question, which consists in simple invagination of a portion of the scrotum into the inguinal canal, appears to have been successfully performed in a very considerable number of cases, and to have been attended, moreover, with the very important advantage of comparative freedom from danger. Thus, Mr. Holmes Coote states that it is doubtful if any fatal accident can be reported as directly a consequence of this operation, performed now between one and two hundred times.”+
The essay before us is a very complete and masterly history of the subject of operation for the radical cure of hernia, from the earliest period to the present time. During the first quarter of the nineteenth century, the question of the radical treatment of reducible inguinal or femoral hernia was readily answered. The experience of nearly two thousand years had passed a decisive sentence upon it, and assigned to such operative interference the most subordinate place. The ancient methods had long since been condemned and forgotten, and the more recent attempts deduced from them, or at least based upon the same principles, could not obtain the confidence of modern surgeons, who, with enlarged views of the nature of hernia, had learned from the experience of their ancestors to estimate the little efficacy and great danger of such operation.
The introduction of improvements has since, however, brought about a new era in the history of radical operation, and a minority of surgeons, in full conviction of the possibility and already established efficacy of operative radical treatment, now believe that they can offer to sufferers from hernia a certain and by no means dangerous mode of getting rid of their distressing ailment. The plan, which has been tried on the largest scale, and has afforded the most favourable results, is Wutzer's modification of the method by invagination, to which we have already alluded.
" An examination of the method by invagination will show that it is founded on three principles-viz., "1. Filling the entire hernial sac with an organic plug;
Pp. 283 and 402. In the heading of the latter notice the word “ Femoral" has by mistake been substituted for " Inguinal.”
† Midland Quarterly Journal of the Medical Sciences, vol. i. part 1, p. 19. May, 1857,
“2. Closing the neck of the hernial sac throughout its whole length; and
“3. Effecting these changes without injury of the hernial sac, and consequently without risk of peritonitis.” (p. 66.)
The author reviews several of the various circumstances under which the operation may be undertaken, and concludes that it is perfectly admissible “in most cases of hernia, and that it ought to offer great advantages, especially for patients of the poorer labouring classes.” (p. 94.)
As general contra-indications he would consider:
“1. Tender age, partly because at such a time the bloodless treatment by compression is most frequently fully sufficient, partly because the necessary rest' and other precautionary measures cannot be enforced with very young children.
“2. A very advanced age, because in old persons the wound and long confinement are in themselves always attended with a degree of danger which is not counterbalanced by the diminished necessity for, and scanty prospect of, a radical cure which exist in the case of such patients.
*3. Enormous distension and relaxation of the abdomen, with numerous hernial protrusions of the walls, which are sometimes almost as thin as parcbment. This rare and entirely incurable form of hernia, which may also occur in younger individuals, is especially met with in very old persons who, after having previously been very corpulent, have in advanced years become extremely emaciated; and most particularly in women who, in addition, have in earlier life had many children; this contra-indication hence most frequently coincides with that immediately preceding.
“4. Actual eventration, where the abdominal cavity becomes so contracted around its diminished contents, that the prolapsed viscera have lost their jus domicilii, and no longer find space in the abdomen.
"5 (and lastly). Established specific dyscrasiæ, or profound general cachexy, constitute a decided contra-indication to this as to all other operations." (p. 94.) · Dr. Mesterton appends an extensive bibliography of his subject, and his volume is illustrated with a plate representing the instrument employed by Gerdy, Zeis, Wutzer, Rothmund, Langenbeck, and Valette. The present essay appears to be intended as the first of a series on the subject of hernia, and is published in a style worthy of what will form, if the succeeding parts shall be equal to that which has already appeared, a classical work on Swedish Medical Literature.
ART. VII.-How to Work with the Microscope. A Course of Lectures
on Microscopical Manipulation and the Practical Application of the Microscope to different Branches of Investigation. Delivered during the Winter Session, 1856–7. By LIONEL S. BEALE, M.B., F.R.S., Licentiate of the Royal College of Physicians, Physician to King's
College Hospital, &c.—London, 1857. pp. 124. The present generation of microscopic observers enjoys numerous advantages over its predecessors, not only in possessing more perfect tools to work with and more definite aims to accomplish, but also in being able easily to obtain that instruction in manipulation which has caused so much loss of time to those who had to acquire the knowledge for themselves empirically. The lectures of Dr. Beale are