ber of cataract
56
operations performed,
were
successful, or a percentage of 6*6, and these principally amongst patients who interfered with not
their dressings and were not amenable to orders. Of the total number of stone cases operated on, 126 come under the heading of litholapaxyy. with a mortality of under 4 per cent. Amongst the remainder of the operations performed, it may be noted that 13 operations were performed for the radical cure of hernia and strangulated hernia, with only one death, and one operation for the removal of ovarian tumour, which was successful. Of the four cases of intestinal obstruction for which laparotomy was undertaken, none were successful, and this result is due to the fact that these cases are almost invariably sent into hospital for surgical treatment when the stage has been reached which precludes successful operation. It is remarkable that only 16 cases of glaucoma should have presented themselves in which it was deemed advisable to perform the operation of iridectomy, and this is due to the fact that although the disease is of common occurrence, patients very rarely present themselves in this country during the stage when the performance of iridectomy holds out any prospect of conferring benefit.
very
INDIAN MEDICAL CONGRESS.: List
JUMiciI Items.
q. u
T
ri .
Further
of
"
f Carlsbad
and its Thermal Waters for Auglo-Indians.
_
ayiei
CONTRIBUTORS TO THE INDIAN MEDICAL GAZETTE DURING THE YEAR 1893. 33 Medical Service 11 Madras Medical Service 7 Service Medical Bombay 2 Arm}r Medical Staff 7 Assistant Surgeons 54 Others
Bengal
?
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
Total
...
114
ASh;hUl?n-
T
Herbert
...
E.
Surgn.-Major Dobson
...
J.
Boccaro.
?
Owing to the difficulties experienced in the supply of Chemical Examiners for the various local Governments at/short notice, for leave vacancies, the question of the formation of a Chemical Department for the whole of India is now under final consideration, and will be submitted to the Secretary of State for orders during the current season.
SURGICAL OPERATIONS PERFORMED IN THE MAYO HOSPITAL/LAHORE, DURING THE YEAR 1893. ! Surgn.-Major Perry reports that the major operations performed during the past year numbered 1,575, or 31G in excess of the number credited to'the preceding year. Of these, 841 or more than 50 per cent, were for cataract and 151 for stone in the bladder. Of the total num'i
of Cholera in India. The Prevalence of Anchylostomiasis.
J Meteorology [ (
\
E.j^^'2^ Specimens Fungi.
...j
A CHEMICAL DEPARTMENT FOR INDIA.
1
^j-RWoplasty. H.
Surgn.-Capt.
Assfc.-Surgn.
Papers Promised."
of
( On some difficult cases of
A. Neve
...?
Sunstroke.
Gupta
...
J
H. E. \ Qn t]ie Surgical treatment > Drake-Brockof Ectopia yesicoe.
Surgn.-Capt. man.
from the early records of the Bengal Medical Department. ( Unhealthy Tracts in Bengal. Dr. W. H. Gregg.- s Vaccination in Bengal. Farming in Bengal. J. L. \ Typhus Fever at Hati MaSurgn.-Capt. Pisani j dam and in Baluchistan. Surgn.-Cap, J. J. in
Dr. T. H. Hendley
CGleanings
1
^Sewage
...
strychnia J Indigenous Drugs
Snake-bite.
(
T,
J
.
_
of India.
Antipyretics.
Dr. K. P. Banerjee-N ]?everg 0f India. (_ Spleen Diseases.
Surgn.-Major Dim mock
H. P. ?
??
\ Symphysiotomy.
J
Dr, Brojonath Saha On Capillary Bruit. Dr. C. Banks Sanitary Progress in Pun. Dr. Haj Jagonna- \ paranoia. dhan J ...
...
of AnchylosSurgn.-Capt. Wil-\Prevalance tomiasis in Madras.
liams
...
J
THE POONA VOLUNTEERS' AMBULANCE CLASS. From the Daily Telegraph and Beccan Herald learn that His Excellency Lieutenant-General
we
of the BomAmbulance Class of the the bay Army, inspected Poona Volunteers, on August 30th, at the Volunteer Head-Quarters. His Excellency having inof honor who were paraded spected the
Nairne,
Commander-in-Chief
C.B.,
guard
outside the head-quarters, proceeded to inspect the Ambulance Class which was drawn up on the parade ground under Surgeon-Major C. J. Addison. The Ambulance Class were then put drill of giving first aid to the
through'their
385
wounded, carrying out the various movements with clock-work precision and in a highly cred-
The class was made up of 32 officer and two non-commissioned officers in attendance) divided into eight squads of four men each. Eight stretchers were provided, " one for each squad, and eight wounded men were told off for the purpose of the drill. The squads advanced in proper order to where the folded up stretchers lay, opened the stretchers, lifted them, marched on to where the wounded men lay on the ground, and deposited the stretchers alongside the wounded men, each of whom had tickets showing the nature of their wounds. There were fractures of the left and right forearm, of the right fibula, of the right and left thigh, of the humerus (right), and of the tibia (left), haemorrhage of the right radial artery and of the right brachial artery, broken bone of the right forearm, wound of the forehead, and sword wound of the head and chest. First aid to the wounded having been given, i.e., the wounds having been temporarily dressed, the wounded men were carefully lifted into the stretchers and carried back to the first field hospital where the medical officer inspected the wounded men and saw that the broken legs and arms were properly bandaged and the injured arteries ligatured, and then the wounded were sent back to carts, which were in waiting, for the purpose of being taken to the next hospital to have their wounds further attended to. The Ambulance Class went through the operation of lifting the wounded into the transport carts and taking them out again, and having deposited the wounded on the ground ao-ain they formed up in close order. His Excellency the Commander-in-Chief expressed his hearty appreciation of the manner in which the men had gone through the drill, and said that from the perfect way in which they did everything it showed that they had been most carefully trained and that they had given most careful attention to the instruction given them by Surgeon-Major Addison. The class was then dismissed. The wounded men, however, still remained lying down on the ground, and Dr. Addison showed the ladies of the Poona Ambulance Class, now undergoing instruction, who were present, the nature of the bandages used for the various wounds and explained those wounds. Dr. Addison also explained to the ladies of his class the contents of his field hospital chests, &c. The spectators were greatly interested in the ambulance drill. Surgeon-Major Addison deserves very great praise for the trouble with taken he has the class; he has spared no pains in imparting to them invaluable instruction, and the men are to be complimented on the attention they bestowed on the work and the admirable manner in which they acquitted themselves, which was, as His Excellency remarked beyond all praise. itable men
manner.
(with
an
"
Reported Reported by.
Date.
in Indian Medical
Gazette, January
Kind of Snake.
Age.
Sex.
42
M.
Believed to be rinata.
11
M.
Believed to be
386
CASES OF SNAKE-BITE TREATED BY HYPODERMIC INJECTION OF STRYCHNIA. 1890 to October lb94.
Interval before Treatment.
Seat of Bite.
Remarks.
Result.
1891.
Banerjee
Ditto
December
an
an
Echis Ca-
Echidce
Dorsum of
Below
right foot
Cured.
right inner malleolus
...
^
hour
i
hour
Do.
Strychnia.
Pot. permang. and
monia.
liq.
am-
1892.
289 October
Surgn.-Major H. Cadge Surgn.-Capt.
W. and J.
12
M.
Genuine Cobra
24
M.
Believed to be a Krait
Ulnar
13?
F.
Believed to be
Dorsum of index hand.
M.
Stated to be a Cobra
F.
Russell's
...
...
Great toe of left foot
Do.
65 ms.
Do.
60 ms. of a 1 p. c. sol. in 3 lirs. and 45 ms. = gr. J.
(B.
P.
sol.)
in 13 doses.
J. Pratt.
1893.
267 August
Surgn.-Capt. J. Yaugban.
305
Dr. Reddie
September.
373 November.
Surgn.-Capt. H.
'
C.
E.
a
Cobra
Left
Drake-Brock-
edge
1 hr. 15 ms.
of hand
finger,
left
foot, below ankle
...
1?
hour
Do.
60 ms.
1?
hour
Do.
Gr.
1?
hour
Do.
10 ms. B. P. sol.
3
hours
Death
12 ms. B. P. sol.
1 hour
Cured
Gr. iV.
Death
Over gr.
=
gr. i3ff.
J.
man.
GAZETTE. MEDICAL INDIAN
Dr. R. P.
275 September
1894.
Surgn,-Lt.-Col.
O.
178 May-
Surgn. Capt.
H.
220
Dr.
June
.
35
sellii).
Baker.
Viper (Yipera
Rus-
Right
M.
Unknown
Toe
ankle
Smith.
Wea-
45
M.
Krait
Finger
J. J. Pratt and Asst.Surgn. H. D. Pant.
25
F.
Unknown
Inner side of left arm, close to posterior axillary fold.
li
hour
S. E.
30
M.
Genuine Cobra
Right thumb finger.
1?
hour
A.
J.
therly. 299 August
Surgn.-Capt.
379 October
Surgn.-Capt. Prall.
...
and
left
index
J.
60 ms. B. P. sol. in 4 doses.
[Oct.
February
1894.
59
Oct.
MEDICAL NEWS.
1894.]
387
of 1,250 ; the deaths IN THE DISPENSARIES AND giving a total for the year of or a 3*1, which compares 39, were THE PUNJAB. percentage HOSPITALS OF
OPERATIONS
with a percentage of 5*5 in 1891 and the fol- favorably of 4 in 1892. lowing interesting details of the surgical work As the operation of litholapaxy is one of the done in 1893 in the Punjab :? advances made in modern surgery, and greatest There were 5,373 operations performed for as it has an important bearing on the dispensary cataract, of which 5,309 were by extraction of and surgical practice of this Province, I have the lens, the others by solution and depression. thought it advisable to submit the names of all J-he number of cases of extraction remaining officers who have performed ten and more operunder treatment from 1892 amounted to 135, ations, showing the number of cases operated on giving a total of 5,444 cases, and of these 4,636 by each with the results. The remaining 127 were cured, or a percentage of So l. In 1892 were performed by 39 different officers. the total number was 4,440 with S2'4 per cent. List of the operators who performed Litholapaxy operations in ?f cures. The operation has been performed in the dispensaries of the Punjab during the year 1893. every district of the Province except Kohat and ^3 -Dera Ghazi Khan. O ? S3 "Tt o 2 The following officers performed 100 and No. Namo of Operator. St-o a c3 upwards:? til ^
Surgn.-Col. Cleghorn's report gives
fc-
"
cc
715
Surgn.-Major Mulroney ??
,,
Perry
Asst.-Surgn. Surgn.-Major >,
693 430 300 291 179 163 155 153 143 133 131 125 115 114 105
...
Mehr Chand
O'Dwyer
(II)
...
Bamber
,,
Mr. Marchant Asst.-Surgn. Duni Chand Rai Kadha Kishen ? ? i, Bhagwan Das (I) ? >, Brij Lai... ? ? Bhagwan Das (II) ? Ram Abnashi ,, ?
...
?
,,
?
?
?
,,
?
,,
and 119 ants.
Mehta Duni Chand Hira Lall Tliakur Das, Rai Bahadu Balkishen Kaul ...
were
performed by
18
Hospital
Assist-
In nearly all the cases of extraction performed at Amritsar the lens is removed with the capsule
The results, in the and without iridectomy. hands of such experienced operators as SurgeonMajor Mulroney and Assistant-Surgeon Mehr Chand II, are reported to be eminently satis-
factory.
The total number of operations performed for removal of stone in the bladder was 1,828, and the different operations resorted to were
as
follows:?
Lithotomy? Supra-pubic
???
???
Perineal
On females by incision Do. by dilatation
???
???
???
???
...
...
...
...
...
...
???
*"
Crushing? Lithotrity Litholapaxy
Jj
562 9 4 8
??
???
...
1,239 1,828
The percentage of cutting operations to the total of both cutting smd crushing was 31'6, and that of crushing to the same total was 68*4. In 1892 the percentages were 37'3 and 62*7, and in 1891, 43-7 and 56'3. Of the cutting operations 26 remained under treatment from 1892, which, combined with those operated on during the year, give a total of 594 cases. There were 52
deaths,
which
the crushing
represents
cases
3
a
of 8*8. In under treatment,
mortality
remained
i 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39
Surgn.-Major S. Little Asst.-Surgn. SodhiFateh Singh Surgn.-Major C. J. Bamber F. F. Perry T. R. Mulroney Kali Nath Rai Asst.-Surgn. ...
?
?
?
,,
...
...
Mehta Duni Ohand ? ,, Hira Lai ,, ? Mehr Chand II, Rai Bahad ,, ,, Surgn.-Major G. W. P. Dennys H. G. Melville Lieut. ,, Asst.-Surgn. Gobind Ram Hem Chandar Ghose ? Jf Ramji Lai... ,, ,, Surgn.-Capt. R. H. Charles Das Rai Bahadur Thakur Asst.-Surgn. Beli Ram, Rai Bahadur ? Girdhari Lai ? ? Daljang Singh, Khanka ? ? Chand Krishn ? ? Abnashi Ram ? ? Fazl-ud-din ,, ,, ..? Fatteh Chand ,, ? Jaswant Rai, Rai Bahadur ? tt Barber H. R. C. Surgn.-Capt. Mr. W. Marchant Asst.-Surgn. Ilahi Bakhsh Surgn.-Major B. Doyle M. O'Dwyer ? ,, Asst.-Surgn. Alia Ditta Surgn.-Capt. C. Duer ...
...
_
...
Asst.-Surgn. Durga Das, Saigal
...
Asst. Nonith Ram Asst.-Surgn. Sahib Ditta Ralia Singh ? ? Surgn.-Capt. A. J. Macnab Asst.-Surgn. Sodhi Karam Singh Bhagwan Das II ,, M Maya Das ? ?
Hospital
...
103 100 60 59 48 48 48 47 35 33 28 29 26 26 25 25
25 25 25 24 21 20 18 18 17 16 15 14 14 14 13 13 14 12 12 11 11 10 10
There are litholapaxy instruments, more or less complete, in every district except Umballa and Montgomery. The former will soon be set, and I trust that provided with a complete other Civil Surgeons will use every endeavour to improve existing ones where these are defective. The enormous increase in the number of patients operated on which has occurred since 1884, when only 4 cases appear in the returns, ought to stimulate every Medical Officer to become thoroughly acquainted with the use of the instruments, the mortality, as appears from the above statement, being greatly dependent on trained manipulation. A brilliant example of
888
INDIAN MEDICAL GAZETTE.
success
cases, and
out
and
is shown in the 216 series of cases withdeath from the Mooltan district; the principal operators being Surgeon-Major Little, 103 cases; and the late Assistant-Surgeon Sodhi Fatteh Singh, 100 cases. A large number of the litholapaxy cases were in children, and, from reports received from Civil Surgeons, I have arranged the following table showing all cases of the age of 10 years and under, with the number operated on at each age, and the results :? a
Result.
3 2
ac
a -3 03
Ages. 0) O
S
3
O
"
?-G
?
W
o
4J m
c3
*
o
&2
o
.
?
tc ?
.??!
G
rt o
8
.c8
Grains.
Years, under 2.
At
tw
u o C
120
2
120
'Asst.-Surgn.
Beli Ram, R. B. Ditto.
1
remainunder treatment.
ing
..
3
280
Hospital Asst. Pir Bakhsh.
,,
4
720
?
5
480
Asst.-Surgn.
.Asst.-Surgn. Kali Rai.
Nath
Sodhi
Ka-
?
6
900
Singh. Asst.-Surgn. Beli Ram,
,,
7
720
Asst.-Surgn.
480
Rai, R. B. Asst.-Surgn.
ram
R. B.
Jaswant
420
Kali Nath Rai. and Ditto S u r g n Capt. A. J. Macnab. .
10
?
10
542
Surgn.-Major G.
W.
P.
Dennys. Total
375
36G
The total number of deaths on the 375 operations was 8, giving a mortality of 21 per cent. Numerous stones were crushed in patients over 70 years of age, and one weighing 30 grains was removed at Gujrat from a man stated to be 100 years old. Dr. Bamber at Rawalpindi crushed two stones, one weighing 5,740 grains, and the other 4,260 grains; and both patients made a good recovery. The same officer removed a stone by the supra-pubic operation weighing 25? ounces ; the patient was a very old man, and died of exhaustion a few days after the operation. Among the more formidable operations performed were five ovariotomies, all of them successful. The Operators were Dr. E. Bielby, tw
[Oct.
1894.
Surgeon-Majors Perry, Cunningham each. Two nephrolithotomies were performed at the Mayo Hospital, both unfortunately unsuccessful. Seven laparotomies were also performed at the same institution by Dr. Perry, 4 of whom died. Surgeon-Major Young, Murree, also performed one, which terminated fatally. Among the slighter operations classified as major, which occupy rather a prominent position in the statement as regards numbers, are those of trichiasis and pterygium. The former increasMulroney, one
ed from 971 in 1892 to 1,907 in 1893, and it appears to be particularly common in the districts of Amritsar, Gujrat and Jhang, where a total of 856 operations were performed for the radical cure of this affection. Operations for pterygium increased from 275 to 746, and 259 of these, or 35 per cent., were performed in the Jhang district. In the returns from that district 1,177 operations are classified as major, 40 per cent, consisting of trichiasis and pterygium. There are also in the statement some curious peculiarities in the distribution of dislocation of joints. The inhabitants of the districts of Gurgaon, Gujranwala, Amritsar, Gurdaspur and Hoshiarpur appear to be peculiarly liable to dislocations of the lower jaw, as the dispensaries in these districts return a total of 218 reductions, 78 from Gurgaon alone, which is equal to a percentage of 43 on the number for the whole ProvIn the districts contiguous to Gurgaon ince. the accident appears to be much less common, as Delhi only returns 26, Karnal 10, and Rohtak 10. Dislocations of the elbow joint are generally supposed to be a comparatively rare accident, but the statement shows that 243 of them were reduced during the year, as compared with 191 in 1892, and that 70 of them, or 29 per cent., occurred in the three districts of Gurdaspur 26, Gurgaon 24, and Rawalpindi 20. In fact, the people of Gurgaon seem to be particularly liable to dislocations, as 102 were treated during the year, equal to 40 per cent, of the total number of major operations performed in that district. Anomalies such as these, which are not confined to any one year, combined with other facts which have come to my notice, have led me to conclude that the present list of major operations requires modification in the way of eliminating many of the trivial ones which require no particular skill on the part of the Operator, and which afford but little relief to the patient. Mere numbers are not necessarily an indication of the skilful and successful Surgeon; and in considering 'the merits of individual officers, it will be necessary to examine the details of their work. The Government of India, Home Department,
13(fis^
in letter No. ? dated 30th September 1893, directed that the names of all officers who performed any major surgical operations should,
LONDON LETTER.
Oct. 1894.]
389
with the Channel Islands, where many of limited income settle in order to the yearly report. This list is published as personsthe best an obtain advantages procurable for themas a one is and Appendix, highly satisfactory selves and their children for a modest expenditure. of number officers who the showing perlarge formed these operations. Those with the largest There were rumours before we left England of cholera being prevalent in Brittany, but so far number are? I can we have heard or seen no indications of it. 1,027 Surgn.-Major Mulroney a like St. Malo that conceive would 1,010 Perry place quite 533 Bamber offer enticements for cholera;?a walled city 399 O'Dwyer with narrow, tortuous streets, foul gutters, doubt1,139 Asst.-Surgn. Mehr Chand II 595 Mehta Duni Chand ful water, and defective sanitary arrangements. 575 Bliagwan Das (I) It is a marvel to me how the provincial French, 572 Thakur Das 483 Bhagwan Das (II) who are so devoted to the amenities of life in 445 Krishn Chand other respects, do not devise better arrangements 335 Abnashi Ram 334 Brij Lai for domestic sanitation. The water-closets in 331 Gobind Ram most houses are most objectionable and the Hira Lai 327 Hem Chandar Ghose 322 supply of water for washing and flushing very 304 Girdhari Lai meagre; old-fashioned contrivances prevail everywhere. Fortunately, they seem to consume very LONDON LETTER. little water for drinking purposes. Cider seems It is very cheap and to be the universal drink. (By our Special Correspondent.) " no means unpalatable, and the light beer of This can hardly be called a London letter," as by the country and a pleasant beverage. Fruits and I write from Dinard, a charming watering-place vegetables are abundant and excellent and enter on the North Coast of Brittany, whither I have into the dietary. The people look robust largely a short holiday. A betaken myself to spend and well blooded, and the pallid Parisian children for such a is more it purpose delightful place soon acquire roses in their cheeks on the sands and impossible to conceive. The scenery is beautiful. rocks. The heat is sometimes unpleasant here. The rocky coast is indented with lovely sandy was so last year; but this year there has been It bays most enticing to bathers, and those who unusual amount of rain, and the air, though indulge in that pastime have every facility an not so bracing, perhaps, as that of Scotland, is for their placed at their disposal accomplishing fresh and invigorating. I shall certainly retain purpose with comfort and enjoyment. For myself I prefer a tub in my room; but I find a most pleasant recollection of my sojourn at the promenade and Dinard, and can recommend it thoroughly as a amusement in joining and healthy resort for a summer holiday. watching the men and women disporting them- lively the 30th of July I had the pleasure of atOn the small in rollers and selves a la Franpciis breakers of the beach. The place is very easy tending the distribution of prizes at Netley. Dr. Weir Mitchell, the well-known American physi?f reach,?12 hours from Southampton. The no and cian, means presided on the occasion and delivered a very hotels are comfortable by expensive. There is an excellent casino and some good interesting address. The hospital, reading-room, mess-rooms are very much as they cafes where the evening can be pleasantly spent. museum and At this time of year, the}7- have races, regattas, were in 1865, when I attended the summer course. trees have grown very much since then and concerts, plays, processions, illuminations, fire- The the and grounds are more shady and pretty. A entertaining, works, &c., &c., all very lively There is an excellent golf link at St. Brise, number of portraits and pieces of plate have been about four miles off, on a most picturesque pro- added tc the Mess; the teaching staff has undera change since my day; but it is a montory. Tennis and cricket are available for gone complete those who prefer these games. Country drives pleasure to recognize excellent pictures of Parkes, and Maclean on the walls. by omnibus, drag or cab can be had at moderate Aitken, Longmore was present at the Maclean Dr. steamer or coach prize-giving and cost, an excursion by rail, made a lively, interesting aud characteristic taken to Dinan Mont St. Michel, and other places. The air is fresh and pure and the view speech. The old gentleman, though now well into the eighties, preserves his physique,?I on ?f coast and country charming. A more delightalmost written juvenility,?and intellectual had ful place for the jaded Londoner or Indian to for another power in the most marvellous manner. Work recruit his health and prepare seems to go on at Netley in a quiet and businessThe cannot I imagine. place pampaign of work The young officers who had completed like is full of English, Americans and Parisians, and theirway. course, appeared to be thoroughly happy and the demands made on one's small stock of seemed to be a good set of fellows. The idea of French are by no means severe. Many English abolishing Netley as an Army Medical School settle here, as the expense of living is moderI certainly for seems to have been abandoned. ate and facilities for education good. In this one never shared the feeling that at one time life favourof compare prethe conditions
with the number in
?
,,
99
,,
99
?
99
9,
9,
,,
9,
,,
?
,,
?
performed by each, be
...
...
?
...
?
?
?
?
?
respect
...
recorded
ably
INDIAN MEDICAL GAZETTE.
390
vailed that the Netley course was useless. The Civil School do not, and, in the nature of things, cannot supply the sort of instruction and training which men obtain at Netley. The very important experience of being licked into army shape and being taught the manners and customs of the service is much more advantageously and appropriately acquired at Netley than in a regiment, and there are specialities of adaptation of medicine, surgery and hygiene to the circumstances and requirements of military life in peace and war and under so many diversities of place and climate that can onl}7" be systematically presented in a place like Netley. I trust therefore that the idea of depriving medical officers of this preliminary training will never be revived. The meeting of the British Medical Association at Bristol seems to have been a complete I can't say that I have studied the prosuccess. ceedings and addresses very carefully. I reserve that for my return to London, when the emptiness of the place and absence of acquaintances will render a perusal of the back numbers of the Lancet and British Medical Journals, pleasant recourse.
I am afraid I have written rather a rambling O letter; but when one's thoughts and purposes are on pleasure bent, the task of inditing an ?
epistle
for
a
scientific
journal
is not
an
easy
one.
[Oct.
1894.
56
operations performed,
were
successful, or a percentage of 6*6, and these principally amongst patients who interfered with not
their dressings and were not amenable to orders. Of the total number of stone cases operated on, 126 come under the heading of litholapaxyy. with a mortality of under 4 per cent. Amongst the remainder of the operations performed, it may be noted that 13 operations were performed for the radical cure of hernia and strangulated hernia, with only one death, and one operation for the removal of ovarian tumour, which was successful. Of the four cases of intestinal obstruction for which laparotomy was undertaken, none were successful, and this result is due to the fact that these cases are almost invariably sent into hospital for surgical treatment when the stage has been reached which precludes successful operation. It is remarkable that only 16 cases of glaucoma should have presented themselves in which it was deemed advisable to perform the operation of iridectomy, and this is due to the fact that although the disease is of common occurrence, patients very rarely present themselves in this country during the stage when the performance of iridectomy holds out any prospect of conferring benefit.
very
INDIAN MEDICAL CONGRESS.: List
JUMiciI Items.
q. u
T
ri .
Further
of
"
f Carlsbad
and its Thermal Waters for Auglo-Indians.
_
ayiei
CONTRIBUTORS TO THE INDIAN MEDICAL GAZETTE DURING THE YEAR 1893. 33 Medical Service 11 Madras Medical Service 7 Service Medical Bombay 2 Arm}r Medical Staff 7 Assistant Surgeons 54 Others
Bengal
?
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
Total
...
114
ASh;hUl?n-
T
Herbert
...
E.
Surgn.-Major Dobson
...
J.
Boccaro.
?
Owing to the difficulties experienced in the supply of Chemical Examiners for the various local Governments at/short notice, for leave vacancies, the question of the formation of a Chemical Department for the whole of India is now under final consideration, and will be submitted to the Secretary of State for orders during the current season.
SURGICAL OPERATIONS PERFORMED IN THE MAYO HOSPITAL/LAHORE, DURING THE YEAR 1893. ! Surgn.-Major Perry reports that the major operations performed during the past year numbered 1,575, or 31G in excess of the number credited to'the preceding year. Of these, 841 or more than 50 per cent, were for cataract and 151 for stone in the bladder. Of the total num'i
of Cholera in India. The Prevalence of Anchylostomiasis.
J Meteorology [ (
\
E.j^^'2^ Specimens Fungi.
...j
A CHEMICAL DEPARTMENT FOR INDIA.
1
^j-RWoplasty. H.
Surgn.-Capt.
Assfc.-Surgn.
Papers Promised."
of
( On some difficult cases of
A. Neve
...?
Sunstroke.
Gupta
...
J
H. E. \ Qn t]ie Surgical treatment > Drake-Brockof Ectopia yesicoe.
Surgn.-Capt. man.
from the early records of the Bengal Medical Department. ( Unhealthy Tracts in Bengal. Dr. W. H. Gregg.- s Vaccination in Bengal. Farming in Bengal. J. L. \ Typhus Fever at Hati MaSurgn.-Capt. Pisani j dam and in Baluchistan. Surgn.-Cap, J. J. in
Dr. T. H. Hendley
CGleanings
1
^Sewage
...
strychnia J Indigenous Drugs
Snake-bite.
(
T,
J
.
_
of India.
Antipyretics.
Dr. K. P. Banerjee-N ]?everg 0f India. (_ Spleen Diseases.
Surgn.-Major Dim mock
H. P. ?
??
\ Symphysiotomy.
J
Dr, Brojonath Saha On Capillary Bruit. Dr. C. Banks Sanitary Progress in Pun. Dr. Haj Jagonna- \ paranoia. dhan J ...
...
of AnchylosSurgn.-Capt. Wil-\Prevalance tomiasis in Madras.
liams
...
J
THE POONA VOLUNTEERS' AMBULANCE CLASS. From the Daily Telegraph and Beccan Herald learn that His Excellency Lieutenant-General
we
of the BomAmbulance Class of the the bay Army, inspected Poona Volunteers, on August 30th, at the Volunteer Head-Quarters. His Excellency having inof honor who were paraded spected the
Nairne,
Commander-in-Chief
C.B.,
guard
outside the head-quarters, proceeded to inspect the Ambulance Class which was drawn up on the parade ground under Surgeon-Major C. J. Addison. The Ambulance Class were then put drill of giving first aid to the
through'their
385
wounded, carrying out the various movements with clock-work precision and in a highly cred-
The class was made up of 32 officer and two non-commissioned officers in attendance) divided into eight squads of four men each. Eight stretchers were provided, " one for each squad, and eight wounded men were told off for the purpose of the drill. The squads advanced in proper order to where the folded up stretchers lay, opened the stretchers, lifted them, marched on to where the wounded men lay on the ground, and deposited the stretchers alongside the wounded men, each of whom had tickets showing the nature of their wounds. There were fractures of the left and right forearm, of the right fibula, of the right and left thigh, of the humerus (right), and of the tibia (left), haemorrhage of the right radial artery and of the right brachial artery, broken bone of the right forearm, wound of the forehead, and sword wound of the head and chest. First aid to the wounded having been given, i.e., the wounds having been temporarily dressed, the wounded men were carefully lifted into the stretchers and carried back to the first field hospital where the medical officer inspected the wounded men and saw that the broken legs and arms were properly bandaged and the injured arteries ligatured, and then the wounded were sent back to carts, which were in waiting, for the purpose of being taken to the next hospital to have their wounds further attended to. The Ambulance Class went through the operation of lifting the wounded into the transport carts and taking them out again, and having deposited the wounded on the ground ao-ain they formed up in close order. His Excellency the Commander-in-Chief expressed his hearty appreciation of the manner in which the men had gone through the drill, and said that from the perfect way in which they did everything it showed that they had been most carefully trained and that they had given most careful attention to the instruction given them by Surgeon-Major Addison. The class was then dismissed. The wounded men, however, still remained lying down on the ground, and Dr. Addison showed the ladies of the Poona Ambulance Class, now undergoing instruction, who were present, the nature of the bandages used for the various wounds and explained those wounds. Dr. Addison also explained to the ladies of his class the contents of his field hospital chests, &c. The spectators were greatly interested in the ambulance drill. Surgeon-Major Addison deserves very great praise for the trouble with taken he has the class; he has spared no pains in imparting to them invaluable instruction, and the men are to be complimented on the attention they bestowed on the work and the admirable manner in which they acquitted themselves, which was, as His Excellency remarked beyond all praise. itable men
manner.
(with
an
"
Reported Reported by.
Date.
in Indian Medical
Gazette, January
Kind of Snake.
Age.
Sex.
42
M.
Believed to be rinata.
11
M.
Believed to be
386
CASES OF SNAKE-BITE TREATED BY HYPODERMIC INJECTION OF STRYCHNIA. 1890 to October lb94.
Interval before Treatment.
Seat of Bite.
Remarks.
Result.
1891.
Banerjee
Ditto
December
an
an
Echis Ca-
Echidce
Dorsum of
Below
right foot
Cured.
right inner malleolus
...
^
hour
i
hour
Do.
Strychnia.
Pot. permang. and
monia.
liq.
am-
1892.
289 October
Surgn.-Major H. Cadge Surgn.-Capt.
W. and J.
12
M.
Genuine Cobra
24
M.
Believed to be a Krait
Ulnar
13?
F.
Believed to be
Dorsum of index hand.
M.
Stated to be a Cobra
F.
Russell's
...
...
Great toe of left foot
Do.
65 ms.
Do.
60 ms. of a 1 p. c. sol. in 3 lirs. and 45 ms. = gr. J.
(B.
P.
sol.)
in 13 doses.
J. Pratt.
1893.
267 August
Surgn.-Capt. J. Yaugban.
305
Dr. Reddie
September.
373 November.
Surgn.-Capt. H.
'
C.
E.
a
Cobra
Left
Drake-Brock-
edge
1 hr. 15 ms.
of hand
finger,
left
foot, below ankle
...
1?
hour
Do.
60 ms.
1?
hour
Do.
Gr.
1?
hour
Do.
10 ms. B. P. sol.
3
hours
Death
12 ms. B. P. sol.
1 hour
Cured
Gr. iV.
Death
Over gr.
=
gr. i3ff.
J.
man.
GAZETTE. MEDICAL INDIAN
Dr. R. P.
275 September
1894.
Surgn,-Lt.-Col.
O.
178 May-
Surgn. Capt.
H.
220
Dr.
June
.
35
sellii).
Baker.
Viper (Yipera
Rus-
Right
M.
Unknown
Toe
ankle
Smith.
Wea-
45
M.
Krait
Finger
J. J. Pratt and Asst.Surgn. H. D. Pant.
25
F.
Unknown
Inner side of left arm, close to posterior axillary fold.
li
hour
S. E.
30
M.
Genuine Cobra
Right thumb finger.
1?
hour
A.
J.
therly. 299 August
Surgn.-Capt.
379 October
Surgn.-Capt. Prall.
...
and
left
index
J.
60 ms. B. P. sol. in 4 doses.
[Oct.
February
1894.
59
Oct.
MEDICAL NEWS.
1894.]
387
of 1,250 ; the deaths IN THE DISPENSARIES AND giving a total for the year of or a 3*1, which compares 39, were THE PUNJAB. percentage HOSPITALS OF
OPERATIONS
with a percentage of 5*5 in 1891 and the fol- favorably of 4 in 1892. lowing interesting details of the surgical work As the operation of litholapaxy is one of the done in 1893 in the Punjab :? advances made in modern surgery, and greatest There were 5,373 operations performed for as it has an important bearing on the dispensary cataract, of which 5,309 were by extraction of and surgical practice of this Province, I have the lens, the others by solution and depression. thought it advisable to submit the names of all J-he number of cases of extraction remaining officers who have performed ten and more operunder treatment from 1892 amounted to 135, ations, showing the number of cases operated on giving a total of 5,444 cases, and of these 4,636 by each with the results. The remaining 127 were cured, or a percentage of So l. In 1892 were performed by 39 different officers. the total number was 4,440 with S2'4 per cent. List of the operators who performed Litholapaxy operations in ?f cures. The operation has been performed in the dispensaries of the Punjab during the year 1893. every district of the Province except Kohat and ^3 -Dera Ghazi Khan. O ? S3 "Tt o 2 The following officers performed 100 and No. Namo of Operator. St-o a c3 upwards:? til ^
Surgn.-Col. Cleghorn's report gives
fc-
"
cc
715
Surgn.-Major Mulroney ??
,,
Perry
Asst.-Surgn. Surgn.-Major >,
693 430 300 291 179 163 155 153 143 133 131 125 115 114 105
...
Mehr Chand
O'Dwyer
(II)
...
Bamber
,,
Mr. Marchant Asst.-Surgn. Duni Chand Rai Kadha Kishen ? ? i, Bhagwan Das (I) ? >, Brij Lai... ? ? Bhagwan Das (II) ? Ram Abnashi ,, ?
...
?
,,
?
?
?
,,
?
,,
and 119 ants.
Mehta Duni Chand Hira Lall Tliakur Das, Rai Bahadu Balkishen Kaul ...
were
performed by
18
Hospital
Assist-
In nearly all the cases of extraction performed at Amritsar the lens is removed with the capsule
The results, in the and without iridectomy. hands of such experienced operators as SurgeonMajor Mulroney and Assistant-Surgeon Mehr Chand II, are reported to be eminently satis-
factory.
The total number of operations performed for removal of stone in the bladder was 1,828, and the different operations resorted to were
as
follows:?
Lithotomy? Supra-pubic
???
???
Perineal
On females by incision Do. by dilatation
???
???
???
???
...
...
...
...
...
...
???
*"
Crushing? Lithotrity Litholapaxy
Jj
562 9 4 8
??
???
...
1,239 1,828
The percentage of cutting operations to the total of both cutting smd crushing was 31'6, and that of crushing to the same total was 68*4. In 1892 the percentages were 37'3 and 62*7, and in 1891, 43-7 and 56'3. Of the cutting operations 26 remained under treatment from 1892, which, combined with those operated on during the year, give a total of 594 cases. There were 52
deaths,
which
the crushing
represents
cases
3
a
of 8*8. In under treatment,
mortality
remained
i 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39
Surgn.-Major S. Little Asst.-Surgn. SodhiFateh Singh Surgn.-Major C. J. Bamber F. F. Perry T. R. Mulroney Kali Nath Rai Asst.-Surgn. ...
?
?
?
,,
...
...
Mehta Duni Ohand ? ,, Hira Lai ,, ? Mehr Chand II, Rai Bahad ,, ,, Surgn.-Major G. W. P. Dennys H. G. Melville Lieut. ,, Asst.-Surgn. Gobind Ram Hem Chandar Ghose ? Jf Ramji Lai... ,, ,, Surgn.-Capt. R. H. Charles Das Rai Bahadur Thakur Asst.-Surgn. Beli Ram, Rai Bahadur ? Girdhari Lai ? ? Daljang Singh, Khanka ? ? Chand Krishn ? ? Abnashi Ram ? ? Fazl-ud-din ,, ,, ..? Fatteh Chand ,, ? Jaswant Rai, Rai Bahadur ? tt Barber H. R. C. Surgn.-Capt. Mr. W. Marchant Asst.-Surgn. Ilahi Bakhsh Surgn.-Major B. Doyle M. O'Dwyer ? ,, Asst.-Surgn. Alia Ditta Surgn.-Capt. C. Duer ...
...
_
...
Asst.-Surgn. Durga Das, Saigal
...
Asst. Nonith Ram Asst.-Surgn. Sahib Ditta Ralia Singh ? ? Surgn.-Capt. A. J. Macnab Asst.-Surgn. Sodhi Karam Singh Bhagwan Das II ,, M Maya Das ? ?
Hospital
...
103 100 60 59 48 48 48 47 35 33 28 29 26 26 25 25
25 25 25 24 21 20 18 18 17 16 15 14 14 14 13 13 14 12 12 11 11 10 10
There are litholapaxy instruments, more or less complete, in every district except Umballa and Montgomery. The former will soon be set, and I trust that provided with a complete other Civil Surgeons will use every endeavour to improve existing ones where these are defective. The enormous increase in the number of patients operated on which has occurred since 1884, when only 4 cases appear in the returns, ought to stimulate every Medical Officer to become thoroughly acquainted with the use of the instruments, the mortality, as appears from the above statement, being greatly dependent on trained manipulation. A brilliant example of
888
INDIAN MEDICAL GAZETTE.
success
cases, and
out
and
is shown in the 216 series of cases withdeath from the Mooltan district; the principal operators being Surgeon-Major Little, 103 cases; and the late Assistant-Surgeon Sodhi Fatteh Singh, 100 cases. A large number of the litholapaxy cases were in children, and, from reports received from Civil Surgeons, I have arranged the following table showing all cases of the age of 10 years and under, with the number operated on at each age, and the results :? a
Result.
3 2
ac
a -3 03
Ages. 0) O
S
3
O
"
?-G
?
W
o
4J m
c3
*
o
&2
o
.
?
tc ?
.??!
G
rt o
8
.c8
Grains.
Years, under 2.
At
tw
u o C
120
2
120
'Asst.-Surgn.
Beli Ram, R. B. Ditto.
1
remainunder treatment.
ing
..
3
280
Hospital Asst. Pir Bakhsh.
,,
4
720
?
5
480
Asst.-Surgn.
.Asst.-Surgn. Kali Rai.
Nath
Sodhi
Ka-
?
6
900
Singh. Asst.-Surgn. Beli Ram,
,,
7
720
Asst.-Surgn.
480
Rai, R. B. Asst.-Surgn.
ram
R. B.
Jaswant
420
Kali Nath Rai. and Ditto S u r g n Capt. A. J. Macnab. .
10
?
10
542
Surgn.-Major G.
W.
P.
Dennys. Total
375
36G
The total number of deaths on the 375 operations was 8, giving a mortality of 21 per cent. Numerous stones were crushed in patients over 70 years of age, and one weighing 30 grains was removed at Gujrat from a man stated to be 100 years old. Dr. Bamber at Rawalpindi crushed two stones, one weighing 5,740 grains, and the other 4,260 grains; and both patients made a good recovery. The same officer removed a stone by the supra-pubic operation weighing 25? ounces ; the patient was a very old man, and died of exhaustion a few days after the operation. Among the more formidable operations performed were five ovariotomies, all of them successful. The Operators were Dr. E. Bielby, tw
[Oct.
1894.
Surgeon-Majors Perry, Cunningham each. Two nephrolithotomies were performed at the Mayo Hospital, both unfortunately unsuccessful. Seven laparotomies were also performed at the same institution by Dr. Perry, 4 of whom died. Surgeon-Major Young, Murree, also performed one, which terminated fatally. Among the slighter operations classified as major, which occupy rather a prominent position in the statement as regards numbers, are those of trichiasis and pterygium. The former increasMulroney, one
ed from 971 in 1892 to 1,907 in 1893, and it appears to be particularly common in the districts of Amritsar, Gujrat and Jhang, where a total of 856 operations were performed for the radical cure of this affection. Operations for pterygium increased from 275 to 746, and 259 of these, or 35 per cent., were performed in the Jhang district. In the returns from that district 1,177 operations are classified as major, 40 per cent, consisting of trichiasis and pterygium. There are also in the statement some curious peculiarities in the distribution of dislocation of joints. The inhabitants of the districts of Gurgaon, Gujranwala, Amritsar, Gurdaspur and Hoshiarpur appear to be peculiarly liable to dislocations of the lower jaw, as the dispensaries in these districts return a total of 218 reductions, 78 from Gurgaon alone, which is equal to a percentage of 43 on the number for the whole ProvIn the districts contiguous to Gurgaon ince. the accident appears to be much less common, as Delhi only returns 26, Karnal 10, and Rohtak 10. Dislocations of the elbow joint are generally supposed to be a comparatively rare accident, but the statement shows that 243 of them were reduced during the year, as compared with 191 in 1892, and that 70 of them, or 29 per cent., occurred in the three districts of Gurdaspur 26, Gurgaon 24, and Rawalpindi 20. In fact, the people of Gurgaon seem to be particularly liable to dislocations, as 102 were treated during the year, equal to 40 per cent, of the total number of major operations performed in that district. Anomalies such as these, which are not confined to any one year, combined with other facts which have come to my notice, have led me to conclude that the present list of major operations requires modification in the way of eliminating many of the trivial ones which require no particular skill on the part of the Operator, and which afford but little relief to the patient. Mere numbers are not necessarily an indication of the skilful and successful Surgeon; and in considering 'the merits of individual officers, it will be necessary to examine the details of their work. The Government of India, Home Department,
13(fis^
in letter No. ? dated 30th September 1893, directed that the names of all officers who performed any major surgical operations should,
LONDON LETTER.
Oct. 1894.]
389
with the Channel Islands, where many of limited income settle in order to the yearly report. This list is published as personsthe best an obtain advantages procurable for themas a one is and Appendix, highly satisfactory selves and their children for a modest expenditure. of number officers who the showing perlarge formed these operations. Those with the largest There were rumours before we left England of cholera being prevalent in Brittany, but so far number are? I can we have heard or seen no indications of it. 1,027 Surgn.-Major Mulroney a like St. Malo that conceive would 1,010 Perry place quite 533 Bamber offer enticements for cholera;?a walled city 399 O'Dwyer with narrow, tortuous streets, foul gutters, doubt1,139 Asst.-Surgn. Mehr Chand II 595 Mehta Duni Chand ful water, and defective sanitary arrangements. 575 Bliagwan Das (I) It is a marvel to me how the provincial French, 572 Thakur Das 483 Bhagwan Das (II) who are so devoted to the amenities of life in 445 Krishn Chand other respects, do not devise better arrangements 335 Abnashi Ram 334 Brij Lai for domestic sanitation. The water-closets in 331 Gobind Ram most houses are most objectionable and the Hira Lai 327 Hem Chandar Ghose 322 supply of water for washing and flushing very 304 Girdhari Lai meagre; old-fashioned contrivances prevail everywhere. Fortunately, they seem to consume very LONDON LETTER. little water for drinking purposes. Cider seems It is very cheap and to be the universal drink. (By our Special Correspondent.) " no means unpalatable, and the light beer of This can hardly be called a London letter," as by the country and a pleasant beverage. Fruits and I write from Dinard, a charming watering-place vegetables are abundant and excellent and enter on the North Coast of Brittany, whither I have into the dietary. The people look robust largely a short holiday. A betaken myself to spend and well blooded, and the pallid Parisian children for such a is more it purpose delightful place soon acquire roses in their cheeks on the sands and impossible to conceive. The scenery is beautiful. rocks. The heat is sometimes unpleasant here. The rocky coast is indented with lovely sandy was so last year; but this year there has been It bays most enticing to bathers, and those who unusual amount of rain, and the air, though indulge in that pastime have every facility an not so bracing, perhaps, as that of Scotland, is for their placed at their disposal accomplishing fresh and invigorating. I shall certainly retain purpose with comfort and enjoyment. For myself I prefer a tub in my room; but I find a most pleasant recollection of my sojourn at the promenade and Dinard, and can recommend it thoroughly as a amusement in joining and healthy resort for a summer holiday. watching the men and women disporting them- lively the 30th of July I had the pleasure of atOn the small in rollers and selves a la Franpciis breakers of the beach. The place is very easy tending the distribution of prizes at Netley. Dr. Weir Mitchell, the well-known American physi?f reach,?12 hours from Southampton. The no and cian, means presided on the occasion and delivered a very hotels are comfortable by expensive. There is an excellent casino and some good interesting address. The hospital, reading-room, mess-rooms are very much as they cafes where the evening can be pleasantly spent. museum and At this time of year, the}7- have races, regattas, were in 1865, when I attended the summer course. trees have grown very much since then and concerts, plays, processions, illuminations, fire- The the and grounds are more shady and pretty. A entertaining, works, &c., &c., all very lively There is an excellent golf link at St. Brise, number of portraits and pieces of plate have been about four miles off, on a most picturesque pro- added tc the Mess; the teaching staff has undera change since my day; but it is a montory. Tennis and cricket are available for gone complete those who prefer these games. Country drives pleasure to recognize excellent pictures of Parkes, and Maclean on the walls. by omnibus, drag or cab can be had at moderate Aitken, Longmore was present at the Maclean Dr. steamer or coach prize-giving and cost, an excursion by rail, made a lively, interesting aud characteristic taken to Dinan Mont St. Michel, and other places. The air is fresh and pure and the view speech. The old gentleman, though now well into the eighties, preserves his physique,?I on ?f coast and country charming. A more delightalmost written juvenility,?and intellectual had ful place for the jaded Londoner or Indian to for another power in the most marvellous manner. Work recruit his health and prepare seems to go on at Netley in a quiet and businessThe cannot I imagine. place pampaign of work The young officers who had completed like is full of English, Americans and Parisians, and theirway. course, appeared to be thoroughly happy and the demands made on one's small stock of seemed to be a good set of fellows. The idea of French are by no means severe. Many English abolishing Netley as an Army Medical School settle here, as the expense of living is moderI certainly for seems to have been abandoned. ate and facilities for education good. In this one never shared the feeling that at one time life favourof compare prethe conditions
with the number in
?
,,
99
,,
99
?
99
9,
9,
,,
9,
,,
?
,,
?
performed by each, be
...
...
?
...
?
?
?
?
?
respect
...
recorded
ably
INDIAN MEDICAL GAZETTE.
390
vailed that the Netley course was useless. The Civil School do not, and, in the nature of things, cannot supply the sort of instruction and training which men obtain at Netley. The very important experience of being licked into army shape and being taught the manners and customs of the service is much more advantageously and appropriately acquired at Netley than in a regiment, and there are specialities of adaptation of medicine, surgery and hygiene to the circumstances and requirements of military life in peace and war and under so many diversities of place and climate that can onl}7" be systematically presented in a place like Netley. I trust therefore that the idea of depriving medical officers of this preliminary training will never be revived. The meeting of the British Medical Association at Bristol seems to have been a complete I can't say that I have studied the prosuccess. ceedings and addresses very carefully. I reserve that for my return to London, when the emptiness of the place and absence of acquaintances will render a perusal of the back numbers of the Lancet and British Medical Journals, pleasant recourse.
I am afraid I have written rather a rambling O letter; but when one's thoughts and purposes are on pleasure bent, the task of inditing an ?
epistle
for
a
scientific
journal
is not
an
easy
one.
[Oct.
1894.
