Exophthalmic goître.

Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Exophthalmic goître. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of shoulder-straps for stooping habits that I have little to add to John Shaw’s scientific common sense. I have observed in numerous instances where shoulder- braces have been worn for several months or longer, and where, from misplaced perseverance and severity, they have been worn extra tightly, that the unfortunate wearer has tried to obtain relief from the excessive pressure of the straps over the coracoid process and adjacent clavicle on each side by throwing the whole upper trunk backward by undue arching of the loins, with the result of producing severe lumbar lordosis in addition to the dorsal kyphosis for which the apparatus was being worn. I am quite aware that dorsal kyphosis is generally accompanied by compensa- tory lumbar lordosis, but in these cases to which I refer the lumbar hollow is much severer than usual and causes an ex- aggerated thrusting forward and prominence of the abdo- men. Of course I am referring to the kyphosis of muscular debility and not to that due to spinal caries. In spite of these facts, ninety-nine out of a hundred medical men of the present day are in the habit not only of allowing, but even of advising patients to w’ear these instruments of tor- ture. I understand that large fortunes are being made by the sale of those popular American and other shoulder- braces which are so largely advertised at the present time. The only way in which shoulder-straps might be worn with benefit—not that I ever recommend them—is well illus- trated by the following anecdote, which is also culled from good old John Shaw : An eminent surgeon was consulted by a gentleman who became one of our first tragedians as to the best mode of correcting a stoop which he had ac- quired. The surgeon told him that neither stays nor straps would do him any essential good, and that the only method of succeeding was to recollect to keep his shoulders braced back by a voluntary effort. But the tragedian replied that this he could not do, as his mind was otherwise occupied. The surgeon then told him that he could give him no further assistance. Shortly after this conversation the actor ordered his tailor to make a coat of the finest kerseymere, so as to fit him very tightly when his shoulders were thrown back. Whenever his shoulders fell forward, he was re- minded by a pinch under the arms that his coat cost him six guineas and that it was made of very fragile materials; being thus forced, for the sake of his fine coat, to keep his shoulders back, he soon cured himself of the stoop. He then showed himself again to the surgeon, who ever after- ward, when consulted whether young ladies should wear shoulder-straps, permitted them, on condition that they were made of fine muslin or valuable silk, for tearing which there should be a forfeit! I have not referred to the therapeutics of round shoul- ders, etc., because my articles “ Lateral Curvature,” “ An- tero-posterior Curvature,” etc., in Heath’s “ Dictionary of Practical Surgery,” will enable any surgeon who follows the lines of treatment there indicated to cure every case of stoop that presents itself in a few weeks, provided he meets with the willing co-operation of the patient. My pleasure in acceding to Dr. Gibney’s request to con- tribute a paper to this meeting of the National Orthopaedic Association of the United States of America will be in- creased if I am able to convince some of the members pres- ent that shoulder-straps and braces are not only useless but also injurious when prescribed for weak backs. April 9, 1888. Corrcs|3onbfnce. LETTER FROM LONDON. Sir Morell Mackenzie's Reply.—The Insurance of the Lives of Infomts.—The Medical Schools.— Post-graduate Instruction in London.—Incision of a Gangrenous Lung. London, October SO, 1888. The long-expected reply of Sir Morell Mackenzie has not made nearly so much stir, either in the professional world or among the general public, as was anticipated when its publica- tion was first announced. This is partly due, no doubt, to the length of time that has elapsed since the events referred to oc- curred, but partly also to the tone of the book itself. It would have been much wiser and certainly far more dignified if Mac- kenzie had refrained from violent attacks on the German doc- tors, even if they were entirely in the w’rong, and his threat of an action for libel against any one who should dare to publish a translation of the German report is exceedingly undignified, and has done much to prevent any strong feeling in his favor. On the other hand, the suppression of his book in Germany is a very petty and contemptible action for the Government of a great empire to have taken, and altogether the sooner the whole episode is forgotten the better. The daily papers have opened their columns recently to a correspondence anent the infant insurance clubs, with which it is certainly very easy to find fault. The insurance of infant lives is a custom that prevails to a very large extent in our chief cities; active canvassing agents go about from house to house, and very easily induce parents to insure their children’s lives. It is a hard thing to say and a much harder thing to prove, but I Lave no doubt that many insured children die every year who would not die if they had not been insured, although in any given case of marasmus it is no doubt exceedingly difficult to say that the child would not have died if more care had been taken of it. The “ British Medical Journal,” in a recent article on this subject, suggested that statistics should be drawn up of the mortality among insured and uninsured infants. If this could be done in regard to infants of the same station in life and subject to the same hygienic and other surroundings, we should certainly be in a position to decide off-hand whether in- fant insurance was, as has been asserted, a most fertile cause of infant mortality. The remedy that is proposed, and that seems to meet with a good deal of favor, is that no child should be insured under three years of age. I must confess I hope no such enactment will ever be passed. Granting that some children are put to death or allowed to die (which is the same thing) for the sake of the insurance money, still the very large majority of infant deaths own no such cause, and the numbers would not be very much diminished. All the infants would in future have to be buried at the parish expense, which would not only entail an increase in the rates, but encourage parents in not making some endeavor to provide for contingencies in the future. I think that a law forbidding the insurance companies to do more than pay the actual expenses of the funeral, and this not to the parents but directly to the undertaker, would meet all the diffi- culties and would not be open to any serious objection. The medical schools are all in full swing now, but it is too