On an improved Gum Lancet, by B. DE SANCTIS, M.D., of the University of Rome, Licentiate of the Royal College of Surgeons, London, &c. TO THE EDITOR OF THE QUARTERLY JOURNAL. Jan. 25, 1822. SIR,-Having lately had occasion several times to make use of the common gum-lancet, for performing the operation in children when their teeth are troublesome in cutting, it seemed to me very unmanageable and even dangerous in lively and obstinate children. I therefore ordered a new one, which, I think, in every respect will answer the purpose much better, and of which I take the liberty of sending you the description, accompanied by a Plate for insertion in your next Number. I have the honour to be, Sir, Yours, &c. Description of the Plate. B. DE SANCTIS, M.D. Figure I. and II. represent the form of the gum-lancets commonly used; and it is not difficult to account for the different dispositions at their upper edge, A. the blunt blade, can turn only on the side B, for being kept at different angles with the handle, and closed after using between the two plates of bone. Figure III. and IV. represent a side and a front view of the new gum-lancet, as made to order by Messrs. Simpson and Smith, 55, Strand.-The least pressure on the part A, propels by means of a spring B, the blade, contained in the sheath A, so as to cut the gums in whatever manner and direction it may be required. It is scarcely possible that any other occasional pressure could produce the same effect. The instrument is all of steel, very light and manageable; and it may be enclosed in a case. To exercise the hand nothing is better than a thimble covered with a piece of sheep-skin, where you may cut in a similar way as in operating on the gums, over or round the teeth. The price of the new instrument without the case is three shillings and sixpence. Case of Deformity of the Mouth and Neck produced by the cicatrices rssulting from a Burn. By M. BOYER, Principal Surgeon to La Charité. The subject of this CASE, aged 56, had fallen on her face into a pan of burning coals. The consequence was a deep burn of this part and of the front of the neck. In the course of the cure, which lasted four months, the precautions necessary in rach cases were not employed. The consequence was the formation of adhesions and bands, with such inconvenient cicatrices, that the patient resolved to submit to any thing that should relieve her from this situation. When she applied to M. Boyer, the left half of the opening of the mouth had disappeared by the union of the lips. The right commissure was also much nearer to the centre of this opening than natural. So small was the passage that this woman could only take liquid food, and pronunciation was so difficult, that what she said could scarcely be understood. A red and firm band of a triangular shape, stretched between the sternum and the chin, kept the head in a state of constant flexion. The lower eyelids were entirely destroyed. In their place was seen a red surface moistened with tears, which the obliterated puncta were no longer able to absorb. In addition to this picture it is to be mentioned that the face was in every part covered with a rough unequal cicatrix. N VOL. IV. NO. XIII. The deformity alone would have been of little consequence to a woman of this age; but as it impeded important functions, M. Boyer sought to restore the extent of the mouth and the mobility of the head. For this purpose he had two silver hooks made, in order to draw the commissures of the lips outwards when their adhesions were divided. The hooks were fixed to straps which buckled together on the acciput. To support the head a corset was constructed, to the front of which a steel plate was attached, which could be elevated and depressed at pleasure, and fixed by a screw. This plate was connected with another piece of steel, the upper extremity of which terminated in a crescent, padded with leather, and accurately adepted to the chin. 1 Provided with these auxiliary instruments, M. Boyer, on the 22d June, made four transverse incisions in the band between the chin and the sternum, penetrating through the whole thickness of the cicatrix, and about half an inch asunder. The separation of the edges of these incisions was at first but inconsiderable, as the bistoury divided the cicatrix, which was as firm as cartilege, with difficulty, and with a grating noise. The adhesions which united the lips, were equally firm and thick. M. Boyer made the mouth rather more extensive than he wished it to be after the cure, well convinced that it would not fail to contract. He then proceeded to the application of the hooks and the corset, having first filled the newly made incisions with dry lint. 1 On the third day the wounds of the neck were in a state of suppuration. The head was kept in its place by the apparatus. The wound nearest to the chin was extraordinarily enlarged; it was now of the size of a crown piece. The commis. sures of the lips were covered with a slight slough. The patient, whose courage is admirable, complains but little. She takes liquid food only, and through a spout. By August the patient spoke with facility, could introduce solid food into her mouth, and chew it; could raise the head to the vertical position, and turn it to every side without difficulty. Mr. H. Earle's case of restored Urethra.* John Whitaker, by falling with one leg on cach side of a boat, greatly injured his urethra. Six years after he was attacked with sudden retention of urine, and extensive effusion into the cellular substance, followed by gangrene and sloughing, which destroyed about an inch of the integuments of the perineum, and of the urethra. This his surgeon attempted, unsuccessfully, to restore, by uniting the integuments over a cathetra, When he came under Mr. Earle's care, there was a smooth cicatrix where the sloughing had occurred, and through the opening both the urine and semen was discharged; the meatus above this, particularly behind the scrotum, having become contracted, and approaching probably to obliteration. Mr. Earle, in order to alleviate the great inconvenience which the man suffered from the discharge,-undertook the bold operation of restoring the canal from the parts of the cicatrix and of the neighbouring integuments; and he details, at great length, all the minute steps of the operations (for there were two), and all the difficulties which he had to combat and surmount. He was at last successful in restoring the passage so completely, that the patient could perform all his natural functions nearly as well as before the accident. The case differs from similar ones by Sir A. Cooper, in the new canal having been formed from the callus of a cicatrix and not from sound integument. * Re-establishment of a canal in the place of a portion of the urethra which ad been destroyed. By HENRY EARLE, Esq. Surgeon to the Foundling, and Assistant Surgeon to St. Bartholomew's Hospital. Phil. Trans. 1821, Part II, Medical Schools of CORK and BELFAST. We understand that of late regular courses of Lectures have been delivered at Cork by Dr. Woodroffe, on Anatomy, Surgery, Midwifery, and the Theory and Practice of Medicine; and that there are other facilities of instruction for the Cork Students, of Medicine, in the Lectures on Chemistry, Natural History, Natural Philosophy, and Agriculture, delivered at the Institution, by Mr. Edmund Davy, Dr. Taylor, Dr. Willis, and Mr. Tisdal. We should take it kind were any of our Cork correspondents to favour us with a more particular account of this infant and promising establishment in the metropolis of the south of Ireland. Dr. Woodroffe, who seems to be a clever, enterprising man, and, as we are informed, an excellent lecturer, also gives popular courses on Physiology, and the Anatomy of Painting. We wonder why Dr. W. has the whole monopoly of lecturing— We are also informed (but we have no details) that there is a similar rising estalishment at Belfast, the metropolis of the north of Ireland. Mr. Barlow's Case of Cæsarean Operation.* Mrs. Ridgdale, aged 42, who had had several children, fell in labour at the full period of gestation. For several years she had suffered much from general debility. and a softened state of the bones of the pelvis had been induced. Mr. Dugdale, who attended her, found it impossible, from the state of the parts, to deliver the child, though the head presented favourable, and he attempted to use the perforator, but on trial the head of the child receded out of reach. Mr. Barlow and Dr. Chew were accordingly called to a consultation, and it was determined by them, and agreed to by the woman, that the child should be extracted by the Casarean section. Mr. Barlow operated, and began a longitudinal incision, (which was seven inches long), three inches above the umbilicus, and two inches, on the left side, carefully cutting through the muscles of the abdomen in a line parallel to the linea alba, by which the uterus came into view and appeared in close contact with the abdominal parietes through the whole extent of the wound, from which a small quantity of serous fluid escaped. A corresponding incision was then made into the uterus, and also through the placenta, for if this had been detached, they were afraid of hæmorrhage. The child was now brought into view, and extracted alive. The placenta and membrane were then brought away, and during the contraction of the uterus the bowels protruded through the wound, but were soon returned and preserved in their situation by the integuments being closed by the interrupted suture,—adhesive plaster,—and a roller like the T bandage. She never complained during the operation, nor seemed disposed to syncope. She lost only about twelve ounces of blood. Alarming sickness and vomiting, however, soon made their appearance, and she died 62 hours after the operation. Professional Degradation. It seems that the surgeons of convict ships, before they can receive their pay, are obliged to produce a certificate from the principal surgeon of the colony, stating, "that no unnecessary expenditure was made of the necessaries supplied by the voyage." There is something very degrading in this requisition; for every surgeon, before hc obtains his pay is obliged to make affidavit "that the medicines and necessaries have been faithfully expended. Now why is this second affidavit required, unless the previous oath of the surgeon is distrusted? Why subject a professional gentleman to such unnecessary degradation? Reid's Two Voyages to New South Wales, p. 292-3. From Essays on Surgery and Midwifery, with Practical Observations. By James Barlow, Surgeon, 8vo, London, 1822. Professional Eclat. "Dr. Granville has arrived at his house in Saville-row, from Wilton, the seat of the Earl of Pembroke." "We are happy to learn that the Countess of Pembroke is declared out of danger. Dr. Granville, who had been sent for express to Wilton-house on Thursday night, arrived in town yesterday morning, having left her Ladyship in a fair way of recovery.”---Mirror of Fashion, Morning Chronicle, Friday, Feb. 15, 1822. CRITICAL CHARACTERISTICS OF NEW BOOKS. I.-A Manual for the Student of Anatomy; containing Rules for displaying the Structure of the Body, so as to exhibit the Elementary Views of Anatomy, and their Application to Pathology and Surgery. By JOHN SHAW. 12mo. London, 1821. p.p. 342. 10s. 6d. Mr. SHAW has, in this excellent little work, given the substance of the Demonstrations which he delivers to the students in the School of Great Windmill-street. We call the work excellent from its almost unique plan of directing the attention chiefly to those parts of Anatomy which are useful; and passing over in a cursory manner the more unimportant subjects. The whole is illustrated, as Anatomy always should be, with numerous references to Physiology, Surgery, and Morbid Anatomy. We wonder, indeed, how these ever came to be omitted; and we marvel more that there are persons so bigotted in pursuing the square and rule systems as to object to the plan altogether —(See pages 75 and 76 above.)—Such persons are like the cabinet naturalist who only knows the labelled specimens in his drawers; but when taken to the fields he discovers that nature and he are totally anacquainted. We recommend the book to every student. II.-Essays on Female Economy. By JOHN POWER, M.D. 8vo. London, 1821. 4s. 6d. Dr. POWER, unfortunately for himself, labours under the mistake, that the starting and maintaining of "New principles" and singular theories is the high road to celebrity. It never was so in practical medicine, and least of all in the department of midwifery, which is so mechanical a business, and has so long been reduced to fixed principles; and it is much less so, at present, when all theories, in every branch of science, are looked upon with suspicion, if not with ridicule. We observe that Dr. P., in the Prospectus of his Lectures on Midwifery, carefully mentions that he will illustrate his peculiar views. Is this judicious? is it professionally politic? We advise him for his own advantage to renounce these singu Jarities and keep to the beaten path, and we have no doubt his steadiness and ingenuity will do him credit. But so long as he hints that be thinks Menstruation a disease which has been induced by the habits of civil life, and so long as he recommends the abdomen to be stroked down in parturition, we are sorry we cannot praise him; though we shall cheerfully do so, whenever he renounces what we conceive to be more allied to fancy than to sound practice. [Having already exceeded our limits, we are reluctantly compelled to delay several interesting and important cases, &c. which we intended to have given, till our next number.] WINKLER, BEER, LANGENBECK, AND STEVENSON ON THE SYMPTOMS AND TREATMENT OF AMAUROSIS.* A CELEBRATED foreign oculist asserted, that it is as hopeless and visionary to seek for a CURE in amaurosis as to hunt after the philosopher's stone. The recent researches, indeed, of several distinguished practitioners have done much to elucidate the causes of this afflicting disease; yet we are compelled to acknowledge, that these causes are in most instances beyond the reach of medicine, and that Maitre-Jean's assertion is still but partly refuted, by the able works under review. It is always useful, however, to know what has, as well as what has not been done, that the attention may be the more strongly directed to points which have hitherto been unconquered, and apparently unconquerable. We are convinced, indeed, that were the causes of many diseases which are deemed incurable more accurately traced, much of the uncertainty in treating them would vanish, and more effectual and immediate methods of cure would be dis • De Amaurosi. Auctore, B. A. Winkler, 12mo. Berolinum. Neue Bibliothek für die Chirurgie und Ophthalmologie herausgegeben von C. J. M, Langenbeck. Hannover. V. Y. On the nature, symptoms, and treatment of the different species of Amaurosis, or Gutta Serena; illustrated by Cases. By John Stevenson, Esq. 8vo. pp. 277. London, 1821. VOL. IV. NO. XIV. |