which this splint material presents on its lined aspect is a matter of some consequence, as, owing to this, the splint may be applied, without any padding, directly to the skin, without causing either discomfort or injury. It also allows of its being readily cleaned, for, from its non-absorptive quality, a little water syringed over it, or a rub over with a wet cloth, removes any dirt or adhering matter, and leaves the surface perfectly clean. But it is not only as a splint material it should be useful. The ease and safety with which large supplies of it could be carried about, and its imperviousness to water, are qualities which should render it of great value in army work. How often in field service the wounded have to be laid on the bare ground, or with only a little straw between them and the damp earth, and it is well known that the deleterious influences to which they are thus exposed tend materially to increase the death-rate. Several pieces of this splint material laid on the bare ground will form a perfectly waterproof platform on which sick or wounded could be laid temporarily. A more comfortable bed would be formed by laying straw palliasses on the top of the splint material. And even where the temporary field bedstead (formed of stakes driven into the ground as figured in Mr. Longmore's "Gunshot Injuries,") is used the addition of a layer of this splint material between the bedding and the frame, would do much for the health and comfort of its occupant. Indeed, the floor of huts or tents could be laid with this material in the absence of, or in preference to, waterproof sheeting. And all that could be done without in any way interfering with its use for splints afterwards. Again, during a campaign it not unfrequently becomes desirable, even necessary, to lodge the sick and wounded in huts. These huts are constructed in all sorts of ways, and with any material which happens to be handy, but generally they are sunk several feet in the ground, and the walls and roof constructed of turf, or turf and stones with brushwood. Without a good fire-place, in which a large fire is kept constantly burning, such huts become but breeding places for typhus, &c. It is only in exceptional circumstances that fuel sufficient for such a purpose is obtainable. When, however, they are constructed of boarding or shingles, especially if double, and, instead of being sunk in the ground, have their floor somewhat raised above the natural surface, well drained and previously dried by the burning of brush, they form one of the healthiest and most convenient kinds of field hospital. But shingles are expensive, and frequently cannot be got at any price; this form of hut, therefore, is not often used. To meet this want, corrugated iron was tried during the Crimean War, but, from its conducting powers of heat, it was found a bad material for walls or roofs. In summer it became overheated, and in winter too cold, thus exposing the sick to injurious vicissitudes of temperature. The splint material would be particularly useful in such circumstances, because, as splinting, it would form part of the regular medical stores, to which it would only be necessary to add it in unusual quantity, and this, from its economy of transport, could readily be done. Immense supplies of it could be easily carried, and it is not liable to injury from climatic or weather influences. By making the framework of huts with posts fixed in the ground (material for which can almost always be readily got) this waterproof splint material would make a good, even a preferable, substitute for ordinary shingles for forming the sides and roofs. A hut made in this way, especially if the sides were double, would prove a most desirable residence for sick and wounded, being warm, airy, and perfectly water-tight. The splint material, even after use in this way, would still be quite fit for splints. Since writing the above, my attention has been drawn to a letter from the seat of war in Zululand, published in the Lancet of 16th August, from which the following extract may be quoted as apropos to the subject:-"Our wounded have been treated here for the most part in huts and marquees. The huts were constructed of reeds fastened into a wooden framework, and plastered with tempered clay inside and out. They were constructed to accommodate about fourteen patients; the floors were just plain earth, much improved by a large coarse waterproof sheet being stretched over them, which prevented exhalations rising from the ground, and foul matters from possibly soaking in. Ventilation was amply provided for, though this matter requires constant attention, as the patients, like most of their class, have, as a rule, the greatest horror of fresh air, and would stop up our ventilators on all opportunities. The huts, however, seem to have answered their purpose perfectly, as, though often terribly and unavoidably overcrowded, we have had no single case of pyæmia, erysipelas, gangrene, or phlebitis, though they have been occupied since January.' This improved splint material should therefore not only prove quite sufficient for the necessities of wounded requiring splints, but from its waterproof and climateproof qualities, admitting as they do of its varied application outside its primary and original intention, it should form a useful and valuable aid to the hard wrought and oftentimes much puzzled surgeon on duty with an army in the field. This splint material, though originally designed to meet the exigences of army work, will be found not less suitable for civil practice. The same qualities which would recommend it to the military surgeon should be nearly equally advantageous to the civil practitioner. It is firm enough for all practical purposes as a splint, though its weight has been reduced to a minimum, being at least as light again as ordinary Gooch. Though tough and not easily torn, it is yet readily cut into shape by a pocket knife. It is waterproof, and is unaffected by either extreme heat or cold. To the country surgeon summoned suddenly, perhaps in the night time, to ride or drive a dozen miles to see a case of fracture, a splint material which he can easily carry with him, and at the same time feel certain that no matter what kind of fracture the case may turn out, he will be able, by means of his pocket knife and this splint material, to fit it with the exact sort of splint required, would be a great boon. In nine-tenths of the cases of fracture it could be used instead of ordinary splints of wood, wire, &c., with great comfort to the patient and considerably less work and trouble to the doctor. Instead of the large stock of miscellaneous splints, to be seen in almost any country surgery, a few pieces of this splint material would be equally serviceable with much less trouble and expense. Messrs. Hilliard & Sons manufacture a special screw and nut for jointing together pieces of splinting for the purpose of forming rectangular splints, &c. This screw and nut is particularly handy and useful, being small and light, and thoroughly suitable for the end in view. A supply can readily and conveniently be carried about in the waistcoat pocket, and by their means pieces of the splint material can, when necessary, be jointed and set at any angle. For hospitals, where large quantities of splinting are made use of, this splint material, simply from its general utility, combined with a moderate price, should be particularly suitable. For antiseptic surgery it ought to be valuable as giving a perfectly non-absorbing surface. It has been tried by Dr. Macewen in the Royal Infirmary, and he speaks favourably of it. In cases which have a discharging wound, and require splinting, he finds that a rapid dip into liquid paraffin renders the wood quite non-absorptive (the lined side which goes next the wound is so already), so that the same piece of splinting may be used, quite consistently with the strictest antiseptic precautions, all through the treatment of such a case. A wash with a carbolic acid solution, or even a rub over, makes it clean and free from obnoxious matters. It is completely aseptic in itself, and treated to a rapid dip into liquid paraffin it is rendered quite incapable of absorbing septic matter. In regard to cost, the making of it is in the hands of Messrs. Hilliard & Sons of this city, who supply it for about 2s. per piece (3 ft. x 1 ft.) In very large quantity it could be supplied for 1s. 6d., or less, per piece. CURRENT TOPICS. DIAGNOSIS OF FEVERS. The UNDER this heading, Dr. J. B. Russell has a somewhat important letter in the Lancet, of 26th July. The chief subjects of remark are the anomalies in the classification of fevers in the national records of the Registrar-General. It is pointed out, to begin with, that "in 1865 the Scotch RegistrarGeneral began to classify his fevers: typhus, enteric fever, simple continued fever, and infantile remittent fever." infantile remittent is admittedly enteric fever in children, and the few cases classified as relapsing fever, in the absence of any epidemic of that disease, are doubtless also cases of enteric fever. So that virtually these fevers are reduced to three-typhus, enteric, and simple continued fever. "Since 1869, the English Registrar-General has adopted these three cardinal distinctions, but he has never abandoned entirely the system of throwing all three together as 'fever.' So deeply is this defect rooted in the English national returns, that to this day it is impossible from them to make out in what numbers the three classes prevail in the large towns, excepting in the case of London, which happens to constitute of itself a registration district." Dr. Russell then calls attention to the very remarkable difference which exists in England and Scotland, in the proportionate number of deaths that is ascribed to "simple continued fever." Taking the returns for 8 years, which are available for England, and 10 years in Scotland, we find that in England 26 per cent of the whole deaths from fever are registered as "simple continued fever," while in Scotland only 6 per cent are so registered. No. 9. Vol. XII. This high proportion is found alike in the towns and rural districts of England. Taking the ten large towns whose statistics of "fever" were given by Dr. Thursfield, and collecting the figures from the registration districts representing these towns, I find that of this "fever" in the seven years 1870-76, 53 per cent was enteric fever, 20 per cent typhus, and 27 per cent "simple continued fever." Taking the ten rural counties, 63 per cent was enteric fever, 10 per cent typhus, and 27 per cent "simple continued fever." The differences between the individual towns are extreme; but your space will not permit me to give the details. What is this simple continued fever which is so slightly fatal in Scotland, while it is said to cause no less than 27 per cent of all the fatality from "fever" both in the town and in the rural districts of England? In the Nosology of the Royal College of Physicians it is defined thus: "Continued fever having no specific character;" but in the last edition of the lamented Murchison's great work we read, p. 682: "Simple continued fever, when uncomplicated, is rarely, if ever, fatal in this country. The numerous deaths from simple fever recorded weekly by the Registrar-General are due for the most part to enteric fever with latent abdominal symptoms." My own experience is that among between twenty and thirty thousand cases of fever which have passed more or less under my observation in the hospitals of the local authority of Glasgow, I scarcely ever, if ever, saw one even approaching death which did not classify itself as having "a specific character," and no death in our wards has ever been registered as from "simple continued fever." But it may be said the business of the Registrar-General is to arrange, as correctly as possible, according to a scientific nosology, the materials placed at his disposal by the practitioners of the country. If they choose to certify 27 per cent of the total deaths from fever as attributable to simple continued fever, what can the Registrar-General do but return them accordingly? The truth is, however, that a very small proportion of the deaths so classified are actually certified by practitioners to be from simple continued fever. The paragraph in the Liverpool report, upon which you so justly animadvert, is a stereotyped one which has appeared there for many years. It gives us a good idea of the kind of material which the Registrar-General has to arrange. "The registrars of deaths attribute 12 cases to gastric fever, 122 to typhoid fever, 33 to enteric fever, 1 to continued fever, 1 to brain fever, and 155 to typhus; under the term of fever there were registered 27 deaths, under that of febris 4 deaths, and under that of febricula 4 deaths; the deaths registered under the term of infantile remittent amounted to 16." As the Registrar-General himself tells us, 66 cases of infantile fever are classed with those of enteric or typhoid fever; relapsing and other continued fevers under simple continued fever." One word as to the "relapsing fever." In the sense of the Royal College nosology, this is anything but a continued fever having no specific character." It is one of the most distinctly marked of all specific fevers. It is not endemic. It visits this country at long intervals, is at once recognised, and prevails in alarming, if not very fatal, epidemics. The insignificant number of deaths ascribed to this cause from year to year is certainly not made up of true "relapsing fever," but most probably of enteric fever, the protracted, recrudescent features of which have suggested the mistake. In 1869 and the two following years the true relapsing fever" invaded and spread over this country; yet the only trace of this fact to be discovered in your annual reports is a puzzling increase in the number of deaths from simple continued fever in some of your large towns! On the one hand, we find the Registrar-General lecturing the practitioners of England in these 66 66 |