Rogers, Joseph

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522perhaps, found too many advocates amongst us, the publica-tion of his results will doubtless interest all practicalsurgeons.The case in question is that of a man aged forty-five whosustained a severe injury to his right foot by the wheel of ia locomotive. The soft parts were extensively lacerated,and the phalanges and the metatarsal and tarsal boneswere comminuted ; even the calcaneus itself was fracturedtransversely near the cuboid articulation. By the violenttraction of the wheel-flange the tissues divided at the operation were found more or less contused and strained, andthe plantaris tendon and a portion of the deep fascia on theinner aspect of the leg were so much damaged as to beultimately cast off by sloughing. I therefore brought thecase forward to show that, notwithstanding these injuries,the patient had recovered with a useful ’,limb, capable ofbearing the weight of the body, with less than half an inchof shortening, and complete bony union at the end of ithree months.Now, Sir, in a given case, assuming the tissues in theline of amputation to be sound, or, if injured, within thepale of recovery, I believe that Pirogoff’s operation forobvious reasons is as far preferable to Syme’s as the latteris to amputation through the leg ; and upon the sameprinciple we must also admit that Chopart’s operation issuperior to Pirogoff’s. But in practice we sometimes find,particularly if the healing process has been tardy, thatthe extensors of the foot primarily, and the abductorssecondarily (for the new attachments of the latter havetime to contract and consolidate), take advantage of thesevered flexors and adductors, and so elongate and tend toweaken the medium of their new insertion, constituting aform of false talipes equina valgus (partial or complete),which necessitates further surgical attention. Thus for atime locomotion is rendered imperfect when compared withthe more speedy results of Pirogoff’s operation ; and here,without binding myself to any special operation, I thinkMr. Craddock’s preference deserves consideration.In regard to Pirogoff’s operation, two points are essentialto the best results. 1. The accurate adjustment of thebone surfaces. 2. Their retention in situ. And I would justremark that the gastrocnemius muscle is of signal serviceas a retaining power behind, whilst in front we substitutean extensor more powerful than its antagonist. But sup-posing we fail to obtain osseous union, and the ligamentousmedium permits the calcaneus to occupy its original posi-tion, I doubt whether Syme’s operation offers so serviceablea limb; certainly one of the best results after Pirogoff’soperation was in a case of this kind, which I had the op-portunity of examining eight years after amputation.We must not, however, forget that there are severallesions of the calcaneus and its covering which contra-indicate Pirogoffs operation, and here Syme’s amputationcomes to our aid as the best surgical procedure.The importance of the subject under discussion must bemy apology for the length of this letter.I am. Sir. vour obedient servant.Guildford-street, April 4th, 1871. JOHN D. HILL, F.R.C.S.POOR RELIEF IN THE METROPOLIS.JOSEPH ROGERS.To the Editor of THE LANCET.SIR,&mdash;Will you permit me through your columns to informthe profession that Mr. W. H. Smith’s notice of motion torefer the consideration of poor relief in the metropolis to aRoyal Commission, adjourned by the transfer of Mr.Goschen to the Admiralty, will come on for discussion onFriday, May 5th ; and as it is most desirable, in the interestsof the Poor-law medical service, that this motion should beacceded to, I do hope that Poor-law medical officers willnot fail to press on such M.P.s as they may know, thedesirability of supporting this gentleman’s proposition. Iwould further point out to provincial medical men that,whilst the terms of Mr. Smith’s motion limit the inquiryto the metropolis, Mr. Fawcett has given notice of hisintention to move an amendment to the effect that thecontemplated inquiry should be extended to the whole ofthe country.That this motion &c. will be opposed, and that, too,determinedly, by all those who can be influenced by thesophstries of the officials at Gwydyr House may safely becalculated on; it therefore behoves all those members ofthe profession who are interested in a. humane and economictreatment of the sick and other poor, to use that wide-spread political influence which they undoubtedly possessin support of both these propositions.I am. Sir. vour obedient servant.Dean-street, Soho, April 12Lh, 1871.Obituary.DR. FELIX VON NIEMEYER.IT is with much regret that we learn the death of Dr.Felix von Niemeyer, the author of the well-known 11 Text-book of Practical Medicine " and of a series of ClinicalLectures on Pulmonary Consumption that have been trans-lated by the New Sydenham Society. Dr. Felix von Niemeyerwas Director of the Medical Clinique and Professor ofClinical Medicine in the University of T&uuml;bingen. On theoutbreak of the recent Franco-Prussian war, he undertookthe direction of a field ambulance, and contractedtyphoid fever, of which, unhappily for the profession andmedical science, he died recently at Nancy while in thedischarge of his duties with the ambulance. He was a manof considerable learning, and of no little professional emi-nence as a clinical teacher. Although von Niemeyer’s bookwas, perhaps, regarded in Germany as a good and well-arranged compilation rather than as a very thoughtful andcritical exposition of practical medicine, its author wasevidently not deficient in originality and intellectual grasp,as the readers of THE LANCET will know from the influencewhich his views in regard to the relation between hmmo-ptysis and phthisis have exerted in this country and else-where. His death will be regarded as a great loss not tothe Tubingen School alone. Like so many of his country-men during the late horrid war, he fell a victim to his senseof duty while at his work.JAMES HENDERSON, M.D.,INSPECTOR-GENERAL OF HOSPITALS TO THE BRITISH ARMY.THIS officer, who, since his retirement from the service in1859, has chiefly resided at Jersey, where he died on the23rd ultimo, had a long and distinguished service as anarmy surgeon. Born in Glasgow in 1789, he received hisearly education at the grammar school, and afterwardsstudied at the University both in arts and medicine. In1809 he obtained the diploma of the Faculty of Physiciansand Surgeons, when, as part of his examination, he wrotea thesis on Injuries of the Head, and some years afterwardshe graduated in medicine at the University. On August4th, 1809, he entered the army as assistant-surgeon. Hewas at the capture of Guadaloupe, in 1810, for which hereceived a medal and clasp. He afterwards served in thecampaign of 1813-1815 in Lower Canada as acting-surgeonof the 13th Regiment, and was present at the two attackson Plattsburg. He was in medical charge of the 13th and14th Regiments through the whole of the first Burmesewar, under Sir Archibald Campbell, and was at the storm-ing and capture of Cheduba, the attack and captureof Donabu, Melloon, and Poghmmew, for which hereceived a medal and clasp. In 1834 he was present at thecapture of Coorg, as surgeon to the 48th Regiment, andwas senior medical officer of the successful column underGeneral Fowlis, for which he got another medal. In 1842he served in Affghanistan as surgeon of the 3rd LightDragoons, and was present at the forcing of the KhyberPass, the storming of the heights of Juddulluck, the actionsof Tezeen, and Kuftkotul, and the occupation of Cabool=medal and clasp. In 1848-9 he served in the Punjab withthe 3rd Light Dragoons, was present in the affair of Ram-nugger, the battles of Sadoulapore, Chillianwallah, andGoozerat-medal and two clasps. He afterwards served asstaff-surgeon of the first class at Corfu and other places.In 1859 he was reluctantly forced to retire, having attainedthe age at which retirement is imperative in the medicaldepartment of the army. He was promoted to the rank of

Poor Relief in the Metropolis.

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Poor Relief in the Metropolis.

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