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marriages of consanguinity are referred to’as the cause of the long and anxiously preoccupied by the thought of inflammation idiocy, the tuberculosis of the progenitors is a potent, but often and gastritis, and I acted accordingly. But the deplorable re- disregarded, element. The Mongolian type, which 1 have sults which I witnessed after bloodlettings and the starving elsewhere described, occurs, according to my observation, in system (diéte sévère) upset my ideas. Above all, I was im- greater degree when the tubercular element is strongly im- pressed by a document published by the Administration of the pressed, still more where it exists in both branches of the Hospitals of Paris, setting forth the mortality amongst the family, and greatest if consanguinity is added thereto. wounded of different nations received in our hospitals in 1814. It appears to me that tuberculosis must be accepted as one French, Prussians, Austrians, and Russians were included in important cause of idiocy; that it impresses special characters the table. The wounded of the first three categories were sub. thereon, characters which impart a strong family likeness to jected to strict dietetic regimen; while the Russians were libe- the subjects of this class. rally treated with bread, vegetables, meat, wine, and even It is no less clear to me that idiocy of a non-tubercular origin brandy." The last word having deeply moved the learned leads to tuberculosis. Whether this arises through the influ- assembly, M. Malgaiglle continued: "That astonishes you, ence of the pneumogastric nerve, mal-assimilation of food, or gentlemen. Well, the table of mortality will astonish you defective innervation, it cannot but be regarded that the con- still more. Here it is:- nexion between these two maladies is no means , Of the French soldiers...... 1 in 7 - by accidental,

,nd a ...... in 9 that due appreciation of this relation is necessary to ’, " Russian 1

...... 1. in 12 those who would treat effectively congenital mental lesions. i " Austrian RfH-Iswood, Redhi1:, 1867. " Russian ...... 1 in 27ï Is this enormous difference sufficiently eloquent? So far as T am personally concerned, it has caused me to change my prac- THE tice entirely in the matter of regimen, and I am satisfied with the result." Professor concurred, with some PRESENT STATE OF SURGERY IN PARIS. Velpeau though reservation. "He never absolutely deprived of nourishment BY SAMPSON GAMGEE, ESQ., the wounded on whom he had operated. If fever was absent, SURGEON TO THE QUEEN’S HOSPITAL, BIRMINGHAM; FOREIGN CORRESPOND- the tongue clean, and the patient hungry, he gave soups, and ING MEMBER OF THE SOCIETY OF SURGERY OF PARIS ; even bread, the first days; and, as a rule, in the course of the LATE STAFF SURGEON OF THE FIRST CLASS. second week, some meat and wine." This timid assent to the (Continued from p. 297.) innovation which constitutes M. Malgaigne’s best title as a practical surgeon, has long since given way to a bolder and more successful and I found the of Paris Ox the question of Diet and Regimen after operations a wide practice; surgeons generally holding the same opinions as M. (Gosselin expressed, difference existed, to a recent date, between the comparatively at La Pitié, when I asked him what measures he adopted for surgeons of France and England. None of us could formerly the prevention of pyasmia. "Free ventilation," he replied. visit the Paris hospitals without being struck by the languid " Moreover, I avoid giving pain as much as possible after expression and the feeble running pulse of a large number of the operation; I allow good nourishment, and apply cold- water on the which I never to those who had recently undergone capital operations. To say compresses wound, attempt for the moment the last ex- nothing for the present of the dressings, the wounds accurately bring together." Reserving pression, I think English surgeons who have not yet grown reflected the constitutional state : pale when not dirty, smooth old, when recalling their early visit to Paris hospitals, must when not sloughing, the surfaces of stumps poured forth an congratulate M. Gosselin and his colleagues on a healthy ill-conditioned liquor, and the termination, in a remarkably change-I do not say, on the adoption of English practice. ventilation the first and it is so in In large per-centage of cases, was fatal. Whenever the question Fancy thought! earnest. most of the wards I found at least one-half of the win- was raised, as I did more than once with MM. high Velpeau, dows wide and the sisters of vied with the sur- and the less in open ; charity Amussat, Jobert, others, frequent mortality geons, when I recalled the days of stifling air and cligte Sévère, the surgical wards of English hospitals was, if conceded at in protesting, " Nos operes respirent fair pur, mangent la all, only so for the sake of argument. The favourite explana- bonne viande, et boivent du vin." After all, the Russian tion has generally been, the physical superiority and the alleged wounded who entered Paris in 1814 did some good. Surviving French and lived to deal the lower nervous organisation of our race. Beef-steaks and alco- bullets, cutlets, cognac, they death-blow, under Malgaigne’s leadership, to Broussais’s pre- holic drinks might do for Englishmen, but they would kill scription of bloodletting and starvation, which had proved Frenchmen, who after capital operations required frequent fatal to greater numbers than ever fell before the legions of bleedings and diète 8él:ère to counteract their great tendency to the first Napoleon. inflammatory affections,-this last being a fatal inheritance of Delighted as I was with most of M. Gosselin’s precepts the fallacious teaching of Broussais. With the indisposition, for the prevention of pyasmia, the dressing of wounds qiies- if not inaptitude, which, in science as in politics, prevents the tion must still stand over. It was not until I went round French acquiring much from the experience of others, who so with M. Maisonneuve that I heard and saw something industriously learn from them, the practice of surgeons in the unquestionably original, and, amidst much that was ex- two countries in the matter of regimen continued as widely cellent, something which, in spite of myself, recalled the different as ever; until the deplorable events of June, 1849, exclamation of the veteran Bosquet, as he quietly gazed on the filled the H6tel Dieu and Val de Grace, Beaujon, la Charité, charge of the six hundred: 11 C’est magnifique, mais ce n’est and other great hospitals of the capital, with the wounded from pas de la guerre." We were walking across the hall hung with the barricades. Baudens, then surgeon-in-chief of the military the portraits of Dupuytren and other worthies, who recalled hospital of Val de Grace, thought the opportunity a favourable the glories of the place, when I suggested that it was almost a one for reconsidering some disputed questions in surgical thera- pity the Hôtel Dieu was to be rebuilt, on a magnificent scale, a attainment of the peutics and making step towards the truth, on a site immediately adjacent to the unhealthy one on which even if it were impossible to pronounce a definitive judgment. the old hospital stood. "Not at all," rejoined M. Maison- a letter his in the He accordingly addressed to colleagues Aca- neuve. " I do not recognise the existence of unhealthy hos- which rise to a of which a demy of Medicine, gave discussion, pitals, though I admit that there are unhealthy methods of full record has been It abounds in. matter happily preserved.* treatment. In determining the site of amputations, I no longer of interest on the great subject of gunshot wounds. My object allow myself to be influenced by considerations of relative is to call attention to some observations in referring to it here danger. I believe that I am able to assure the recovery of all of who to himself for recom- Professor Malgaigne, sought justify persons who have undergone amputation; consequently I look mending a practice which was positively novel in Paris in 1849. all such mutilations as so far as concerns " upon equal, danger Moreover, gentlemen, "to translate the words of Pare’s learned to life." When I asked him if he did not think there was " I allow to eat. As soon as are commentator, my patients they greater danger in an amputation of the thigh than in one of the I feed them. I bleed them when the indications hungry only leg or forearm, M. Maisonneuve continued : "Thanks to the are are not those which I urgent. """ My present opinions new process, I do not find any amputations serious. entertained. A of Val de Grace and of Brous- Formerly, formerly pupil of one hundred amputations of the thigh, only one-third re- saia-of whom I had the honour to be de was chef clinique,-I covered. Since I have employed the new method we have * Deq 1’laies d’ Armes a Feu: Communications faites 1’Acarmie National had five amputations of the thigh, three of the leg, and one of tilÌ! Médecine par MM, Balldel1!!, Ronx, Malgaigne, Ac. Paris- Baillière. the forearm, with as many recoveries. We must wait to see 1M!}. if the success continues-Reste d voir ca continuera." The. 393 method here referred to is designated Pneumatic aspiration, carbolic acid to 100 of water, has been regularly employed in or occlusion. It is practised thus :-Assuming an amputation dressing wounds in M. Maisonneuve’s clinique. Dr. Markham’s of the thigh to have been just performed and the vessels observation,’ that in 1840 the Hôtel Dieu presented the worst secured, the edges of the wound are brought together and held picture of Parisian hospitals, has seemed deserving confirmation in apposition with adhesive plaster, but without sutures. A at more than one of my subsequent visits ; but, during the hood of vulcanised india-rubber is then passed over the stump last one, I am bound to say that the wounds in M. Maison- several inches-a foot if space allow-from the extremity. It neuve’s wards looked as healthy as, if not better than, any is essential that the aperture of the india-rubber cap fit the in the more favourably situated and constructed hospitals, not limb accurately; but the crown, or lower part, may hang some excepting Beaujon. Built on high ground near the Bois de distance from the wound. To the centre of the crown of the Boulogne, with beautiful gardens between the different pa. india-rubber cap is attached a tube, of similar material, about vilions, the Hopital Beaujon might be a model one for the two or three feet long, fi tted by its opposite extremity, through surgical practice of Paris, if less crowded : at least one-third a metallic canula, in a rubber plug which fits into a gallon glass of the patients should be removed ; the ward for puerperal jar. A second metallic tube pierces the india-rubber plug, and is women, containing about thirty beds, should be suppressed; connected with another vulcanised tube, of convenient length, all the bed-curtains removed, and one or two wide fire-places attached to a brass exhausting pump. A few strokes of the built in each ward. In an hospital such as Beaujon might be piston morning and evening suffice to draw the discharges from with the suggested improvements, it would be possible to set the stump into the jar, where, in the absence of air, they ac- at rest, once and for ever, the fundamental question, which has cumulate without danger of decomposition; while the healing so long divided the surgeons of the two countries, on the desira- of the wound is facilitated by the accurate and immovable bility and practicability of obtaining union by the first inten- adaptation of its surfaces, and the exclusion of air. At the tion after great operations. Twenty years after the practice same time, and by the same means, the danger of possible of English surgeons had been settled with the publication of contamination from the wound is averted.* Mr. John Bell’s classical " Discourse on the Nature and Cure While at the Hôtel Dieu (Aug. 31st) I saw two patients who of Wounds," M. Roux read a papery to the Institute of had undergone amputation, and been treated with the pneu- France to prove the safety and advantage of sometimes attempt- matic apparatus. One, a lad aged fifteen, had had his thigh ing to obtain immediate union after amputations. While amputated three weeks previously. The stump was healed, recently discussing this matter with M. Verneuil at Lari- and a thoroughly good one. The patient said he had felt no boisiere, and learning from him that, in consequence of the pain and no discomfort from the apparatus, which was removed difficulty of obtaining union, excision of the elbow is rarely on the tenth day after the operation, when the wound was performed in Paris, I cited the last case in which I had per- nearly as perfectly healed as it was at my visit. The other formed the operation. The wound had healed perfectly, case was one of amputation in the lower part of the leg in an under the care of Dr. Jolly, within a month. "Ne me parlez adult. The operation had been performed on the 19th of July. pas de reunion immediate dans les résections," was M. Ver- The pneumatic apparatus was on for fifteen days, and its use neuil’s summing up; and to prove that this feeling is by no was quite free from heat or pain. The wound was nearly means singular, I may quote the opinion of so sound a surgeon healed on its removal. The manner in which these patients as M. Richard, in whose clinique I made this note, amongst answered all my questions left no doubt that the apparatus many others, from the bedside discussions in which he so cour- had been as conducive to their comfort as to the healing of their teously engaged with me: " Il y a une abime entre nous et les wounds. Anglais quant à la réunion immédiate." I saw the breadth I may incidentally mention that the site of the last amputa- and depth of the abîme in another clinique, in the case of a poor tion led me to inquire in what estimate the Paris surgeons held fellow whose arm had been amputated at the shoulder-joint Professor Syme’s amputation at the ankle-joint? The majority two days previously. The whole wound was gaping to the of them never appear to have understood it well, and I could width of nearly three inches at the lower part. Not a single obtain no satisfactory account of experience in Paris of what suture had been attempted. The whole surface of the wound. is, to use the words of Professor Vanzetti, of Padua, one of the was black, through the application of perchloride of iron to very greatest, certainly one of the most useful, modern im- prevent pyasmia; and, with the same object, a drainage-tube provements in operative surgery. pierced the inner flap. Again old Marshal Bosquet’s dictum M. Maisonneuve’s treatment of amputations by the pneu- at Balaklava was uppermost ; but the almanac seemed at fault. matic exhauster is founded on facts and reasons which he Was it surgery in 1867 ? If so, where was the magnifique? lately made the subject of an elaborate address to the Academy The whole question of the management of wounds merits fur- of Sciences on Surgical Poisonings (" Des Intoxications Chi- ther development, which the length of the present article com- rurgicales.") From the unpublished manuscript (which, through pels me to postpone ; but I cannot do so without observing the courtesy of the learned author, is now before me) I glean that, though the teaching of Hunter and Bell on the healing his ruling ideas to be that, in ninety-five per cent. of cases of wounds never produced its legitimate influence on the prac- after surgical operations, death is due to poisoning of the sys- tice of Parisian surgeons, it found a worthy disciple in Del- tern through the wound, and that the fatal result may be pre- pech ; and the healthy tradition never appears to have forsaken vented either by arresting the formation of the poison or by Montpellier, if I am to judge from an article in Professor preventing its decomposition and its entrance into the circula- Bouisson’s§ "Tribut à la Chirurgie," of which I venture to tion. After quoting Prof. Nelaton’s statement:!: concerning the recommend the perusal to my learned friends in Paris, as an great mortality of operations in Paris from causes supposed to able exposition, in good French, by one of their own country. lie beyond control, M. Maisonneuve does not hesitate to avow men, of what Englishmen believe to be good surgery. a conviction that "a simple modification in the manual pro- (To be eontinzted.) cedure succeed in the most may transforming deadly operations * Remarks on the Surgical Practice of Paris. (Edinburgh Prize Thesis, into most innocent ones, and that without in any way changing by W 0. Markham, M.D. London. 1840. pp. 83.) the conditions to which have so t Edinburgh. 1795. many hygienic surgeons long " attributed their failures." The aimed at in $Quoted in Sketches of the Medical School of Paris," by John Cross. operative objects London. 1815. the referred to to check the formation pp. 78. modification are-1stly, § Nouveaux Moyens de Contribuer au Succès de la Réunion Imm4d!ate. of matter ; 2ndly, to prevent its decomposition when formed ; Bonisson: Tribut à la Chirti r gie. Paris and Montpellier, 1858, vol. i., p. 439 and 3rdly, to prevent its poisonous action on the system by et seq. entrance into the circulation. In amputations these ends are w _ M. Maisonneuve’s the simultaneously gained, in estimation, by EPHELIS AND INSANITY.--Dr. Lombroso expresses pneumatic apparatus, which maintains accurate coaptation of ! the in the number of the Jo2crrznal Venereal the cut from belief, July for surfaces, and regularly draws the discharges away and Skin Diseases, at Milan, that (1) the into an as published parts air-tight vessel. Whenever practicable, I Affectionsis observed the insane, which for removal of are ephelis frequently among pig- the female breast or of tumours, caustics mental sometimes when the to the infected phenomenon disappears patients preferred knife, the blood being very rarely Ephelis also is observed after attacks of through the wounds produced by those agents ; and for the recover. meningitis, where the mental disease becomes worse. Dr. Lombroso last six an of or years antiputrescent lotion, containing part has also noted that the herpetic dyscrasia is pretty frequently * M. Maisonneuve’s apparatus is manufactured by Charrière, from whom with insanity. I purchased it. connected t No precept is eiven for the sawing off the lower end of the tibia, or even AT the instance of Sir Roderick Murchison the of the either in the text-book of Vidal "Traité de Patho- malleoli, (de Casis), Government have, we understand the Pall Mall logie Externe," 3me Ed., vol. v., pp. 776, Paris, 1851; or of Chassaignae, I (says Gazette), to aencl a "Traité des Operations Chirurgicales," vol. i., pp, 575, Parie, 1861, resolved out geographer, a geologist, and a naturalist Gazette dos Hôpitaux, 1862, No. 17, with the Abyssinian expedition