THE SITE OF THE NEW MELBOURNE HOSPITAL - Australian Medical Journal: (April, 1886)

The first positive step has been taken in the direction

^of

obtaining a site on which the Melbourne Hospital may be r e- built. The Committee of the Hospital have decided to g° direct to the Government, and ask for ten acres of the ground now included within the University area. It appears

176

Australian Medical Journal. APRIL 15, 1886

that a piece of that extent has been temporarily vested ⁱⁿ the University for educational purposes. While, therefore , it is clear that the portion of land referred to is not strictly the property of the University, it is also apparent that the intention was that it should be applied for the furtherance of its educational ends. It is quite commonly understood that the intention was to have a hospital built on it at some time. It was neither wise nor courteous, however, for the Hospital committee to disregard the University authorities altogether, and so run the risk of exciting opposition.

Already there have been indications of unpleasantness being excited, and of resistance being offered to the claim about to be made. It is not probable that there would be absolute opposition to the proposal to place a hospital at the corner of Madeline and Grattan Streets, but it is vain to suppose that the University will quietly give up all right and title without receiving some consideration. If the land referred to was deliberately reserved for educational purposes, it can be handed over to the committee of a hospital, _only on a guarantee being given that the teaching of students in a proper manner shall be as much one of its objects as the curing of patients.

It is impossible to avoid the suspicion that, in thus over - looking the prescriptive right of the University, the Hospital Committee show a desire to be left unfettered as regards their obligation to medical students. This le eminently unreasonable, because wherever the Hospital is ultimately placed, something must be done to remedy the present unsatisfactory relations between the Medical School at the University and the Hospital where students must get the chief portion of their practical training. It is something more than unfortunate, if there is really a wish on the part of the Hospital authorities to shirk the fulfil- ment of this important part of their duty. The present absurd and anomalous state of things cannot be allowed to continue much longer, and the sooner this is recognised the better for all parties concerned.

There may be difference of opinion as to this selection

of a site being the best possible, but it seems to be the

411M 15 , 1886 Australian Medical Journal. 177

only one, reasonably suitable, which there is good prospect of obtaining without delay and without large cost. The block of land on which the horse and pig markets are built height be better ; but it is known that the City Corporation will offer strenuous resistance to its alienation for any Purpose. It is wise to strive for the attainable, and to seek for it in the easiest and most direct way ; and if the

U niversity and the Hospital were in full agreement, there would be more likelihood of the Government listening to

the prayer that the part of the University block, which is still open for selection, should be permanently applied for hospital purposes.

gebittus.

RALFE ON DISEASES OF THE KIDNEYS.*

This work, which is one of Lewis's Practical Series of Medical Manuals, is distinctly the best that has so far been issued. There was room for a new book on its subject, and Dr. Ralfe's previous studies had placed him in the position of being able to present to his readers a summary, within moderate compass, of what had been done of late years on the subject of renal pathology. Perhaps the book

savours

a little too much of the laborious compilation, though there are not by any means wanting proofs of independent observation and

r

esearch. As might perhaps have been expected from the author's Previous publications, the best chapters are those taken up with Physiological topics, and with the chemistry of the urine, in its normal and morbid conditions. The first chapter gives a very good sketch of the general symptomatology of kidney disease, in 'which such matters as the nature of the urmmic condition, and the exact relation of the cardio-vascular changes to the degeneration of the kidney, are carefully and fairly discussed; though Dr. Ralfe's Own opinions are not always so clearly brought out as might have

been

expected. The chapter on the clinical examination of the urine is fully and well done, further details of quantitative analysis

being

provided in an appendix. The illustrations are sufficient,

the

various forms of casts and all the commoner deposits being

* A Practical Treatise on Diseases of the Kidneys and Urinary Derange- Ments. By CHARLES H. RALPH, M.A., M.D. London : H. K. Lewis, 1886.

178 Australian Medical Journal. APRIL 15, 1 886

well depicted. Under the headings " Diffuse Inflammation," , " Suppurative Inflammation," " Degenerations and Infiltrations,

" New Growths," " Parasites," and " Abnormalities (i.e. of fora and position) of the Kidney," most of the topics in renal pathology proper are discussed. Diabetes finds a place in a chapter on variations in the amount of urine, and has its nature and treat- ment carefully considered; a help to the dietetic management being supplied in an appendix, which presents lists of articles of food which may be allowed and which must be avoided, and besides, gives hints on the subject of variations of diet.

Altogether this book is a very useful one, written well up to the times, and presenting a large mass of reliable information carefully arranged ; helps to further study being given by references to the newest and best literature on the various points referred to. -A serious defect, and one which spoils the reader's pleasure, i s the evident carelessness with which some parts have been written, many sentences, both as regards grammar and general construction, being absurd almost to unintelligibility. The almost habitual use of the vulgarism " lays " instead of " lies," as, " The reason, I think, . . . lays in the fact " (p. 180), or, " so that laying flat, its lowest side is on a straight line, &c." (p. 74), should not have been fallen into by a gentleman calling himself M.A., M.P.

Cantab. Such sentences as this : " Thus in one interesting case where about a pint and a half of anasarcous fluid, together with the twenty-four hours' urine passed by the patient, I found the percentage composition nearly equal," &c., or this : "These consider - ations certainly seem to warrant us in regarding the acute forms of diabetic coma as due to a toxic agent ; and that this agent to be of an acid nature," &c., are common. We have no doubt that a new edition of this book, so valuable in spite of its defects, will soon be called for, and if so, we hope that in the interests of his readers, the author will take care that the English will not be overlooked in the revision and correction.

PICK ON FRACTURES AND DISLOCATIONS.*

This volume of " Cassell's Clinical Manuals " gives abundant evidence of having been written by a man of large experience ⁱⁿ

* Fractures and Dislocations, by T. Pickering Pick, F.R.C.S. London Cassell and Company, 1885.

APRIL 15, 1886 Australian Medical Journal.

179 t he subject he is treating of. In it the student will find concisely Put almost all that he needs to know about fractures and di slocations, as almost every variety of these lesions is described a nd discussed from a practical point of view. The causes and s ymptoms of the different injuries are fully gone into, the points

°f diagnosis are generally made clear, and the best methods of tr eatment indicated. The remarks on " immovable

and

"m ovable-immovable" apparatus are especially

good, and well

worth re membering.

There can be no doubt of the propriety of

keeping all patients with

oblique fractures of the lower extremity

at rest iu bed, with the

fracture exposed to view until there is

at least some solid union of

the fragments. Collis's and Potts's

fractures, with their appropriate treatment,

are fully discussed.

Still, the

1)00

k is not without

its defects : In some cases

the treatment is d escribed much

too fully, e.g.,

two

pages are devoted

to fractures of the nasal bones, and

eight

pages

to fractures of

the lower jaw ; t

°0

many

methods of treatment are indicated

without the Preference being

given to

any, and

without

the particular cir cumstances,

under which any particular method

should be adopted, being

mentioned ; whilst, on the other

hand,

some c ases the treatment

is not described

nearly

fully

enough,

the

most n oticeable instance

of this being furnished by the

treatment of f ractures of

_the

shaft of the

humerus, which is

disposed of in about half a page.

The various

dislocations, with the different

methods of reducing th em, are fully and

clearly described. This is especially the

case with the most

important class, viz., dislocations of

the shoulder.

1( ocher's method

of reducing these dislocations, which

is

recent ( Me, and has

not yet found its way into the surgical

text

books,

is Very simple

and very efficient, almost always

succeeding

rapidly,

and without

ae

sthesia. Much space is occupied by diagrams and

the description of

the various methods of reduction

by

pulleys,

Whilst such

treatment, since the, introduction of

an

sthetics,

and

t he recent

perfecting of the various methods of reduction by

m anipulation,

is scarcely ever adopted, and should be adopted still

less often.

The illustrations, mostly taken from previous publications,

are very

plain and show clearly the points that they are meant to

explain ; but

there has been evinced quite a fondness for using

e xceptional

instances as illustrations, this being done in at least

t hree

different cases.

24 2

180 ustralian Medical Journal. APRIL 15, 1886 The student will find this little Manual very useful in studying the numerous fractures that are admitted into the Hospital wardsr and the dislocations that are treated in the casualty room.

W. M.

extracts frant tjje Altbical 1zxtrndds.

Ether Narcosis.—Dr. Thallon finds fault with the custom of leaving the giving of the anaesthetic to the youngest and least competent member of the house staff in hospitals. It is commonly said that there is no danger with ether, only give enough ;

no

one ever dies of ether. He says, people do die of ether administration and nothing else ; while in many other cases the mal-administration of ether forms at least one factor in causing the death usually vaguely ascribed to " shock " or exhaustion. The chief point in giving ether is to give it gradually, _begin with pure air, gradually add ether, little by little, till you are giving the full current of ether vapour, and then the patient will be not in the first, but in what is ordinarliy called the second _stage of anaesthesia. Dr•

Thallon does not believe in the stage of excitement at all, his opinion being that if no irritant is applied to the spinal cord, such as the circulation of large quantities of carbonic acid in the blood there will be no excitement, and this is prevented first by not suffocating the patient by crowding the ether into the inhaler; and secondly, by not compelling him to breath the expired air over again. He never allows anyone to hold the patient, merely having a friend or nurse to sit beside the patient to give confidence.

The headache and mental depression which are observed as an after-effect of ether administration, will be reduced to a minimum, the more evenly the ether has been administered, the less stage of excitement there has been, the less ether the patient has inhaled, and the less admixture there has been of carbonic acid and other ingredients, organic or inorganic, of used-up air. Nausea and vomiting are obviated by the same means, together with the proper withholding of food before and after the anaesthetic is given. After-vomiting is best treated by sips of hot water, or

by

small pieces of cracked ice. Bronchitis and surgical pneumonia, following ether administration, are due to the refrigerating effect of the ether on the mucous membrane of the respiratory tract, this effect being in proportion to the amount of ether given, and

1886

Australian Medical Journal. 181 41'11.4., 15

to its density, and its density will be less the larger the receiver, Provided that the same amount of ether be used. Also, the higher the temp

effect

of the ether vapour, the less will be its refrigera-

ting

ct on the respiratory organs, and the temperature is raised by the friction of the ether passing along a tube. Hence, Dr.

Tha

livn administers ether by means of an apparatus, consisting of a l

arge

receiver which is connected with a mouth-piece, by means 151

a tube

53 inches long. The mouth-piece is provided with two valves, automatic in their action, the one admitting ether into the Oath-piece, and preventing the passage of the expiratory current lilt° the tube ; the other allowing the expiratory current to pass into the surrounding air, but preventing an ingress of air through that

_ Opening.

And lastly, between these two valves is an opening bY Which any desired percentage of fresh air can be added to the inspiratory current, so that you can pass from pure air through all the stages up to pure ether vapour, while the rate of flow can be

hastened

or retarded by raising or lowering the receiver.—New

Medical Journal, January 2, 1886.

Local Ancesthetization by Cocaine.—Dr. J. Leonard Corning Points out that when the local circulation is suspended in a part into which a solution of cocaine has been injected, the local lesOnsibility induced by the drug may be indefinitely prolonged ) and for this purpose a very weak solution suffices, because the sensory filaments of the nerves are thus kept for a long time in contact with the solution. Thus a solution of per cent. strengtll maintained anaesthesia during an operation which lasted an hour and a half, and at the end of that time only of a grain of the hYdrochlorate of cocaine had been used. Solutions of from half to one per cent. are those most generally useful. Cocaine has been thus used in the reductions of fractures and dislocations, in the extirpation of tumours, in the removal of in-growing toe-nails, for plastic operations, excision of hip-joint, radical operations for large abscesses, &c. Before making the injections it is well to map out the veins in order to avoid making the injection into any of them. For this purpose the circulation in the superficial veins is interrupted by an elastic band passed round the limb above the Part to be anaesthetized, and then the veins are traced by means of an ordinary blue pencil. Then an Esmarch's bandage is applied, stopping just at the distal boundary of the part to be a

nwsthetized.

The injections next are made, and in three or four

182 Australian Medical Journal. APRIL 15, 188&

minutes the application of the bandage may, if desirable, be continued a short distance above the margin of the anwsthetic zone, especial care being taken to avoid applying the bandage over the points of injection. It is not often desirable to carry the bandage above the points of injection. The infections should be made a short distance above the margin of the Esmarch's bandage, immediately after its application. First, the superficial injections are made into the skin, just below the epidermis, 2-5 minims of a one or two per cent. solution being used. The deeper parts are anaesthetized by the aid of long fine needles, attached to a syringe of a capacity of 100 minims. As the needle descends•

into the tissues a i-2 per cent. solution is injected before the point of the needle, a drop or two at a time. Directly this is done a tourniquet is applied around the limb above the zone to be anaesthetized. Then try the sensation in the anresthetized zone, and if satisfactory, the Esmarch should be removed, the tourniquet, however, being retained during the operation. Should sensation return, a supplementary injection or two must be made, the bandage being re-applied and the tourniquet being loosened for a few minutes to favour local diffusion of the anaesthetic. To.

incarcerate the anaesthetic within certain regions of the body or face, rings of thick wire covered with india-rubber are employed.

These are pressed on to the integument by handles or strong elastic bands, and so the cutaneous veins are prevented from carrying away the anaesthetic. Similarly clamps may be used in operations about the eyelids, lips, or cheeks.—New York Medical Journal, January 2, 1886.

Studensky on Laparotomy in Suppurative Peritonitis.—Professor N. Studensky reports the case of a girl, wt. 12, who, when first seen on the nineteenth day of enteric fever, presented all the usual symptoms of purulent effusion into the peritoneal cavity.

Aspiration removed six fluid pounds of pus, but no improvement followed. Four days later the author made an incision about 2 inches long. into the abdominal cavity, below the navel, and evacuated more than six fluid pounds of benign, odourless pus.

The peritoneal cavity was washed out with a 4 per cent. solution of boroglyceride, a drainage tube being inserted. The abdominal wound was closed by sutures and covered with an antiseptic dressing. There was no discharge from the abdomen, and the temperature continued high. The girl complained of pain in the

APRIL 15 1886 Australian Medical Journal. ¹⁸³ spleeic region, where there was dulness on percussion, but no pus could be obtained on exploratory puncture. A month later, a quantity of offensive pus suddenly appeared under the dressing.

, he patient's temperature immediately sank to the normal level ; bu

t days later a sharp attack of abdominal erysipelas occurred, and still further delayed her recovery. She got up only three months and a half after the operation. A t present, however (about nine months after laparotomy), she enjoys good health. Pointing to similar successful cases of Hodges, Treves, Mikulicz, Lawson Tait, Anton Schmidt, and his own, Professor Studensky expresses his belief in a brilliant future for the treatment of purulent Peritonitis by abdominal section, with free drainage. W W.M.

affelhourne

At the meeting of the Council on the 12th inst., a letter was read from Prof. Raiford, Dean of the Faculty of Medicine, containing resolutions arrived at by the Faculty with regard to the proposal made by the committee of the Melbourne Hospital, that the Government should be asked to grant the 10-acre reserve at the corner of Madeline and Grattan Streets, and now enclosed within the University fence, as a site for a new hospital. The recommendations of the Faculty were, that two acres should be added to the Medical School grounds, and that a hospital might be erected on the remaining eight acres, security being given for the training of medical students. After some discussion it was resolved—" That a letter be sent to the Government to urge that the reserve at the corner of Madeline and Grattan Streets should not be disposed of without the consent of the Council, or until the Council has had an opportunity of considering the matter." It Was decided that the Council should meet on Monday next for the consideration of the whole question.

At a meeting of the Senate, on the 23rd ult., a proposal sent down by the Council, for the creation of a Chair of Biology, was accepted.

Dr. Springthorpe brought forward a motion on the subject of the unsatisfactory relations between the University and the Melbourne Hospital, but withdrew it in favour of a resolution by Dr. Madden—" That the Council be requested to take steps to

In document Australian Medical Journal: (April, 1886) - Digitised Collections (Page 31-49)