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Hospital of Val De Grace, Thought the Opportunity a Favourable

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Hospital of Val De Grace, Thought the Opportunity a Favourable 392 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.
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